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AIM: To evaluate the acute effect of treatment with the molecular adsorbent recirculating system (MARS) on splanchnic, renal and systemic haemodynamics in patients with end-stage cirrhosis. METHODS: Twelve patients with end-stage cirrhosis, undergoing MARS treatment, were enrolled. The following haemodynamic parameters were measured by means of Doppler ultrasonography and thoracic electrical bioimpedance, before and after each session: portal velocity, renal and splenic resistance indices, cardiac output, cardiac stroke volume, heart rate, mean arterial pressure, systemic vascular resistance. RESULTS: Median portal velocity increased significantly after treatment (23.7 vs. 20.3 cm/s, P < 0.05) while renal resistance index (0.72 vs. 0.75, P < 0.05) and splenic resistance index (0.60 vs. 0.65, P < 0.05) decreased significantly. Mean arterial pressure (83 vs. 81 mmHg, P < 0.05) and vascular resistance (899 vs. 749 dyne. s/cm5, P < 0.05) increased significantly, while cardiac output and stroke volume showed no significant changes. CONCLUSIONS: Data emerging from this investigation suggest that MARS treatment improves significantly various haemodynamic alterations in cirrhotic patients in the short term. The observed decrease in renal vascular resistance and improvement in splenic resistance index, a parameter related to portal resistance, which leads us to hypothesize that these haemodynamic effects are probably mediated by clearance of vasoactive substances during MARS treatment.

Lung cancer is the leading cause of cancer-related death worldwide, with approximately 1.2 million deaths annually. The standard-of-care in patients with advanced disease is platinum-based doublet chemotherapy. Recent advances in the understanding of biological mechanisms of tumor growth have allowed for identification of some molecular targets for cancer treatment, such as vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR). VEGF is a pro-angiogenetic factor, which binds membrane receptors, and whose intra-cytoplasmatic domain presents tyrosine kinase activity. Pathological angiogenesis promotes tumor growth and metastasis. Targeted action against angiogenesis can lead to regression or normalization of neovascular structures and to inhibition of new blood vessel growth. The most commonly used mechanism is mediated by bevacizumab, a monoclonal antibody that selectively binds to VEGF and prevents interaction with its receptor. Currently bevacizumab is the only anti-angiogenic agent approved for the first-line treatment of non-small cell lung cancer (NSCLC) in selected patients. In the present review, we discuss the most important trials that demonstrate the efficacy and safety of bevacizumab. We also present an overview of the types of patients eligible for this treatment and a cost-effectiveness analysis. In conclusion, the possibility of administering a treatment with bevacizumab must be carefully analyzed case by case. It is important to identify those patients who can really benefit from the use of this drug, through the identification of specific response markers.

Nowadays, in order to be competitive on the market, it is fundamental to design optimized devices. This is especially true in the Offshore sector where the product’s weight has a material influence on all operations. Reducing this parameter implies a significant decrease in the project’s cost. This paper proposes the study of the kinematic rotation of a prototype machine required to lay down an umbilical system, needed to provide the vital supply (electricity and fiber optic) from platforms or topside vessel to subsea oil and gas furniture. In this paper, it will be proposed a solution for the delivery of a 600 mm external diameter umbilical product. In the studied case, the Client asked to have a cable that partially floats once it reaches the sea water showing incredible benefits such as the possibility to be replaced and small umbilical deflections due to a catenary effect reduction. Due to this singular request, the proposed prototype machine – characterized by the rotation of an articulated parallelogram, activated by two main pistons – ensures safety operation and integrity of the laid umbilical. Starting from an accurate structural analysis, a reliable model has been created and a first solution of the forces distribution along the chute elements has been found, highlighting some significant points (static configurations during a dynamic evolution). During the piston design phase, some limitations of current DNV standards (when dealing with offshore technologies) have been highlighted. To investigate this peculiar phenomenon several results obtained by different numerical approaches are proposed. The present machine could be even applied in the renewable energy field, for connecting wind turbines in the wind farm’s hub and then to carry the produced energy on shore. This analysis results in a 15% machine weight reduction with respect to the initial design. Such simulation provided a practical design tool for the Offshore market.

Molecular electronic spins are good candidates as qubits since they are characterized by a large tunability of their electronic and magnetic properties through a rational chemical design. Coordination compounds of light transition metals are promising systems for spin-based quantum information technologies, thanks to their long spin coherence times up to room temperature. Our work aims at presenting an in-depth study on how the spin-phonon coupling in vanadyl-acetylacetonate, [VO(acac)2], can change as a function of temperature using terahertz time-domain spectroscopy and density functional theory (DFT) calculations. Powder THz spectra were recorded between 10 and 300 K. The temperature dependence of vibrational frequencies was then accounted for in the periodic DFT calculations using unit-cell parameters measured at two different temperatures and the optimized ones, as usually reported in the literature. In this way, it was possible to calculate the observed THz anharmonic frequency shift with high accuracy. The overall differences in the spin-phonon coupling magnitudes as a function of temperature were also highlighted showing that the computed trends have to be ascribed to the anisotropic variation of cell parameters.

PURPOSE: Hepatic hydrothorax is defined as the accumulation of pleural effusion in a cirrhotic patient in the absence of pulmonary or cardiac disease. Peritoneal fluid can pass into the pleural space through diaphragmatic fenestrations. The demonstration of such passage is important to establish the diagnosis of hepatic hydrothorax and can be achieved by intraperitoneal injection of nuclear contrast agents. Our aim was to evaluate the ability of contrast enhanced ultrasound in the detection of peritoneal-pleural communications. MATERIALS AND METHODS: Seven patients with cirrhotic ascites and pleural effusion were studied in order to make a diagnosis of hepatic hydrothorax. SonoVue was injected into the peritoneal cavity (9.8 mL), and the peritoneal and pleural cavities were monitored by ultrasound. All patients were then studied using a nuclear scan. RESULTS: Passage of SonoVue from the peritoneal to the pleural cavities was seen in 5 patients. In 2 patients, no passage of contrast agent was detectable. Nuclear scan was consistent with contrast enhanced ultrasound in all patients. CONCLUSION: This study shows that the presence of peritoneal-pleural communications can be demonstrated by real time contrast enhanced ultrasound, whose results are comparable to those of nuclear scan. Contrast enhanced ultrasound is cheaper and could theoretically be performed wherever ultrasound facilities are available.

Focal nodular hyperplasia (FNH) is the second most common benign tumor of the liver, after hemangioma. It is generally found incidentally and is most common in reproductive-aged women, but it also affects males and can be diagnosed at any age. Patients are rarely symptomatic, but FNH sometimes causes epigastric or right upper quadrant pain. The main clinical task is to differentiate it from other hypervascular hepatic lesions such as hepatic adenoma, hepatocellular carcinoma, or hypervascular metastases, but invasive diagnostic procedures can generally be avoided with the appropriate use of imaging techniques. Magnetic resonance (MR) imaging is more sensitive and specific than conventional ultrasonography (US) or computed tomography (CT), but Doppler US and contrast-enhanced US (CEUS) can greatly improve the accuracy in the diagnosis of FNH. Once a correct diagnosis has been made, in most cases there is no indication for surgery, and treatment includes conservative clinical follow-up in asymptomatic patients.SommarioL'iperplasia nodosa focale (FNH) è il tumore epatico benigno più frequente dopo l'angioma. E' di solito rilevata in modo occasionale, per lo più nelle donne in età fertile, anche se si può riscontrare in entrambi i sessi e ad ogni età. I soggetti portatori raramente sono sintomatici, nonostante l'FNH possa essere causa di dolore ai quadranti addominali superiori. Nella gestione dell'FNH il problema clinico principale è rappresentato dalla difficoltà di differenziarla dalle altre lesioni epatiche ipervascolarizzate, come l'adenoma, l'epatocarcinoma o le metastasi ipervascolari, tuttavia utilizzando le opportune tecniche diagnostiche è oggi possibile evitare il ricorso ad esami invasivi. La Risonanza Magnetica (RM) ha una sensibilità e una specificità superiori rispetto a quelle dell'ecografia convenzionale e della Tomografia Assiale Computerizzata (TC) per la diagnosi di FNH. L'uso dell'angioecografia perfusionale (CEUS) e dell'eco-Doppler può tuttavia aumentare in modo significativo la confidenza diagnostica nell'identificazione e nella caratterizzazione dell'FNH con ultrasuoni. Una volta posta con certezza la diagnosi, nella maggior parte dei casi non ci sono indicazioni al trattamento chirurgico e nei soggetti asintomatici è raccomandato un follow-up clinico.

Safety issues should always be kept in mind when using diagnostic ultrasound, which is associated with potentially hazardous bio-effects, especially with the introduction of new technologies.To assess the level of awareness and knowledge of safety issues related to the clinical use of ultrasound among physician-members of the Italian National Society for Ultrasound.A questionnaire with 11 multiple-choice questions was sent to members of the Italian Society for Ultrasound in Medicine and Biology. The answers were forwarded from the Society's Secretariat to the investigators, who statistically analyzed the data.The mean age of the 105 respondents was 44 years. The most frequent kind of ultrasound examinations (in addition to conventional B-mode) were: Doppler (74%), contrast-enhanced US (43%), and pediatric studies (43%). Only 50-60% of the responders knew the correct definitions of the terms thermal index and mechanical index. Almost all respondents understood the bio-effects reflected by the thermal index, but only a minority knew the most likely organ target of bio-effects related to the mechanical index and what do indicate the units in which the thermal index is expressed. The majority knew that fetuses are at higher risk of damage. Few respondents were able to identify the correct safety statements included in the recommendations of the International Ultrasound Societies.In conclusion, the present findings indicate that greater efforts of National Ultrasound Societies are warranted in disseminating knowledge of the bio-effects of diagnostic ultrasound modalities among operators.Sommario INTRODUZIONE: La sicurezza nell'uso degli ultrasuoni va sempre considerata in campo ecografico, in quanto gli ultrasuoni sono in grado di indurre effetti biologici potenzialmente dannosi, soprattutto con l'introduzione di nuove tecnologie. SCOPO DELLO STUDIO: Valutare il livello di consapevolezza e di conoscenza dei medici italiani soci SIUMB sulla sicurezza nell'uso dell'ecografia nella pratica clinica. MATERIALI E METODI: Un questionario contenente 11 domande a risposta multipla è stato inviato per e-mail a soci SIUMB (Società Italiana di Ultrasonologia in Medicina e Biologia). Le risposte sono state inserite in un database elettronico ed analizzate statisticamente. RISULTATI: Sono tornati questionari da 105 soci, di età media di 44 anni i cui esami ecografici più frequentemente eseguiti, in aggiunta all'ecografia B-mode standard, erano l'ecoDoppler (74%), l'ecografia con mezzo di contrasto (43%) e l'ecografia pediatrica (43%). Solo il 50–60% conosceva la definizione corretta dell'Indice Meccanico e dell'Indice Termico. Quasi tutti i partecipanti comprendevano gli effetti biologici espressi con Indice Termico, nonostante che solo una minoranza sapesse in quale organo gli effetti biologici, in relazione all'Indice Meccanico, potevano, con più probabilità, verificarsi; analogamente solo una minoranza conosceva l'unità di grandezza per l'Indice Termico. La maggioranza era a conoscenza di come i tessuti del feto siano più suscettibili ai potenziali effetti di quelli adulti. Pochi partecipanti conoscevano le raccomandazioni delle Società Internazionali di Ultrasonologia in campo di sicurezza. CONCLUSIONI: Lo studio ha fatto emergere come sia necessaria una maggior diffusione delle conoscenze sugli effetti biologici degli ultrasuoni tra gli ecografisti italiani.

Aims: Portal venous thrombosis (PVT) is considered an absolute contraindication to liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) when neoplastic PVT cannot be excluded. Aim of the study is to assess whether imaging techniques allow evaluation of nature of PVT in HCC-patients allowing safe selection of candidates to LT. Methods: We analyzed 34 HCC-patients with PVT detected at the time of assessment for LT or developed while on the waiting list. The benign nature of the thrombus was established using the following criteria: lack of vascularization of the thrombus at contrast enhanced ultrasound with SonoVue and ceCT or ceMRI, steadiness/regression of thrombosis during follow-up, absence of mass-forming aspects of PVT on ultrasound examination, absence of features of disruption of the vessel walls, and negative biopsy of the thrombus in case of uncertainty. Patients who did not fulfill the criteria for benignity of PVT were excluded from the waiting list. Results: The outcome of 34 patients analyzed is as follows: 13 were listed and transplanted, with no sign of malignant PVT at explant pathological examination; 9 were admitted in the list and are actively waiting. Two patients died for HCC unrelated causes while actively listed. Of the remaining 10 patients, 7 were not included or excluded from the list for the suspicion or confirmation of malignant PVT, whereas 3 were included and subsequently excluded for progression of HCC without evidence of malignant PVT. Conclusions: Imaging techniques allow safe not-invasive assessment of the nature of PVT in HCC-candidates to LT.