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MRI represents the most established liver iron content (LIC) evaluation approach by estimation of liver T2* value, but it is dependent on the choice of the measurement region and the software used for image analysis.To develop a deep-learning method for unsupervised classification of LIC from magnitude T2* multiecho MR images.Retrospective.A total of 1069 thalassemia major patients enrolled in the core laboratory of the Myocardial Iron Overload in Thalassemia (MIOT) network, which were included in the training (80%) and test (20%) sets. Twenty patients from different MRI vendors included in the external test set.A5 T, T2* multiecho magnitude images.Four deep-learning convolutional neural networks (HippoNet-2D, HippoNet-3D, HippoNet-LSTM, and an ensemble network HippoNet-Ensemble) were used to achieve unsupervised staging of LIC using five classes (normal, borderline, middle, moderate, severe). The training set was employed to construct the deep-learning model. The performance of the LIC staging model was evaluated in the test set and in the external test set. The model's performances were assessed by evaluating the accuracy, sensitivity, and specificity with respect to the ground truth labels obtained by T2* measurements and by comparison with operator-induced variability originating from different region of interest (ROI) placements.The network's performances were evaluated by single-class accuracy, specificity, and sensitivity and compared by one-way repeated measures analysis of variance (ANOVA) and one-way ANOVA.HippoNet-Ensemble reached an accuracy significantly higher than the other networks, and a sensitivity and specificity higher than HippoNet-LSTM. Accuracy, sensitivity, and specificity values for the LIC stages were: normal: 0.96/0.93/0.97, borderline: 0.95/0.85/0.98, mild: 0.96/0.88/0.98, moderate: 0.95/0.89/0.97, severe: 0.97/0.95/0.98. Correctly staging of cases was in the range of 85%-95%, depending on the LIC class. Multiclass accuracy was 0.90 against 0.92 for the interobserver variability.The proposed HippoNet-Ensemble network can perform unsupervised LIC staging and achieves good prognostic performance.4 TECHNICAL EFFICACY: Stage 2.

This study analysed the impact of liver steatosis (LS) on the parameters of iron overload in 110 patients with non-transfusion dependent thalassaemia (NTDT). LS was diagnosed by ultrasound. Liver iron concentration (LIC) measurements were available for 64 patients who underwent a magnetic resonance imaging (MRI) scan. LS was frequent (35·5%) and was significantly more prevalent in males than in females (49·0% vs. 24·6%, P = 0·008). Patients with LS had significant higher levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), ALT/AST ratio and ferritin than those without, but LIC values were comparable. An ALT/AST ratio0·89 predicted the presence of LS with a sensitivity of 0·872 and a specificity of 0·901 (P 0·0001). Ferritin levels correlated with LIC values (R = 0·558, P 0·0001) but the correlation was stronger in patients without LS (R = 0·656, P 0·0001) than in patients with LS (R = 0·426, P = 0·05). LS is a frequent issue in NTDT patients and should be suspected in the presence of an ALT/AST ratio0·89. Recently, serum ferritin thresholds that predict clinically relevant LIC for guiding iron chelation therapy when MRI is unavailable have been determined. Our data show that LS may cause increase in ferritin levels and may be responsible for anticipating/exceeding chelation treatment in NTDT patients in the absence of LIC evaluation.

The aim of this study was to evaluate, in a large cohort of chronically transfused patients, whether the presence of extramedullary hematopoiesis (EMH) accounts for the typical patterns of cardiac iron distribution and/or cardiac function parameters. We retrospectively selected 1,266 thalassemia major patients who had undergone regular transfusions (611 men and 655 women; mean age: 31.3 ± 8.9 years, range: 4.2-66.6 years) and were consecutively enrolled within the Myocardial Iron Overload in Thalassemia network. The presence of EMH was evaluated based on steady-state free precession sequences; cardiac and liver iron overloads were quantified using a multiecho T2* approach; cardiac function parameters and pulmonary diameter were quantified using the steady-state free precession sequences; and myocardial fibrosis was evaluated using the late gadolinium enhancement technique. EMH was detected in 167 (13.2%) patients. The EMH+ patients had significantly lower cardiac iron overload than that of the EMH- patients (P = 0.003). The patterns of cardiac iron distribution were significantly different in the EMH+ and EMH- patients (P

Summary The relationship between diabetes mellitus (DM) and cardiac complications has never been systematically studied in thalassaemia major (TM). We evaluated a large retrospective historical cohort of TM to determine whether DM is associated with a higher risk of heart complications. We compared 86 TM patients affected by DM with 709 TM patients without DM consecutively included in the Myocardial Iron Overload in Thalassaemia database where clinical/instrumental data are recorded from birth to the first cardiovascular magnetic resonance (CMR) exam. All of the cardiac events considered were developed after the DM diagnosis. In DM patients versus non-DM patients we found a significantly higher frequency of cardiac complications (46·5% vs. 16·9%, P

BACKGROUND: The conversion of hydroxybenzyl alcohols, nitro-benzyl alcohol and methoxybenzyl alcohols into the corresponding aldehydes is attempted in aqueous solution by Cu(II) (which reduces to Cu(0)), at room temperature, under acidic and deaerated conditions, using TiO2 solar simulated light photocatalysis. RESULTS: Under the experimental conditions adopted, the yields of the corresponding hydroxyaldehydes, when Cu(II) was completely reduced to Cu(0), were 21.6% for 4-hydroxybenzaldehyde, 11.5% for 3-hydroxybenzaldehyde and 20.2% for 2-hydroxybenzaldehyde. Higher conversions of 2-methoxybenzyl alcohol and 4-methoxybenzyl alcohol were recorded relative to unsubstituted benzyl alcohol. A selectivity of 5.2%, at 50% conversion of the substrate, was observed for the oxidation of 4-nitrobenzyl alcohol to 4-nitrobenzaldehyde. For high degrees of aromatic alcohols conversion, oxidation of the generated aldehydes to the corresponding benzoic acid derivatives is observed. CONCLUSION: The introduction of substituents into the aromatic alcohols structure changes the photocatalytic oxidation rate and product selectivities with respect to that previously observed for unsubstituted benzyl alcohol. In particular, the presence of both electron donating (hydroxy, methoxy groups) and electron withdrawing (nitrogroup) groups on the aromatic ring of the substrate causes a detrimental effect on the selectivity of the process with respect to the case of benzyl alcohol. © 2012 Society of Chemical Industry

Background: Patients with beta-thalassemia major (β-TM) are at increased risk for sudden cardiac death (SCD). Heterogeneity of ventricular repolarization is considered to provide an electrophysiological substrate for malignant arrhythmias. QT dispersion (QTc-D) and JT dispersion (JTc-D) are electrocardiographic parameters indicative of heterogeneity of ventricular repolarization. The aim of our study was to evaluate the heterogeneity of ventricular repolarization in patients with beta-thalassemia and to test the hypothesis that an abnormal QTc and JTc dispersion may predict SCD in this population. Materials and Methods: The study involved 51 patients with β-TM (age 33.9 ± 8.4; 33 M) and 51 healthy subjects used as controls, matched for age, gender, and body mass index (BMI). Among the β-TM group, 14 patients with β-TM (age 27 ± 6.64; 11 M) died from SCD during follow-up. For each patient, QTD and JTD intervals were calculated. Results: Compared to the healthy control group, β-TM group presented increased values of the QTc-D (65.36 ± 33.95 vs. 37, 62 ± 17.65; P

The present study investigated myocardial T2* heterogeneity in thalassaemia major (TM) patients by cardiac magnetic resonance (CMR), to determine whether is related to inhomogeneous iron overload distribution. A total of 230 TM patients consecutively referred to our laboratory were studied retrospectively. Three short-axis views (basal, medium and apical) of the left ventricle (LV) were obtained by multislice multiecho T2* CMR. T2* segmental distribution was mapped on a 16-segment LV model. The level of heterogeneity of the T2* segmental distribution, evaluated by the coefficient of variation (CoV), was compared with that of a surrogate data set, to determine whether the inhomogeneous segmental distribution of T2* could be generated by susceptibility artefacts. Susceptibility artefacts offer an explanation for the T2* heterogeneity observed in patients without iron overload. In subjects with global T2* below the lower limit of the normal, T2* heterogeneity increased abruptly which could not be explained by artefactual effects. Some segmental T2* values were below and others above the limit of normal threshold (20 ms) in 104 (45%) TM patients. Among these patients, 74% showed a normal T2* global value. In conclusion, a true heterogeneity in the iron overload distribution may be present in TM patients. Heterogeneity seemingly appears in the borderline myocardial iron and stabilizes at moderate to severe iron burden. Copyright © 2009 John Wiley & Sons, Ltd.

The ideal reconstruction after circumferential pharyngolaryngectomy is represented by the jejunum free flap, but when the resection extends to the oro- or nasopharynx, the discrepancy between the lumen of the flap and the pharyngeal defect represents a disadvantage. Two reconstructions to overcome this problem are presented: end-to-side anastomosis between the pharynx and the antimesenteric side of the jejunum; and a jejunal "reservoir." The type 1 technique is quicker to perform, but can result in dysphagia; the type 2 technique is more complex, but usually no dysphagia is observed. In our opinion, no ideal surgical technique exists to equal the jejunum loop. The choice must be tailored to the single patient, bearing in mind the degree of the defect, the stage of the tumor removed, the general conditions of the patient, and personal surgical experience. Whatever procedure is chosen, it should provide the best possible quality of life for the expected life span of the patient.

In the future, solar energy, along with other renewable resources, could play a key role in mass production of fine chemicals. It could also potentially solve environmental problems, as demonstrated by recent developments in the use of solar energy, such as solar photocatalysis. The solar photocatalytic technology has been demonstrated to be effective for: • Treating groundwater, drinking water, industrial wastewater, and air and soil pollution, • Water disinfection, and • Industrial production of fine chemicals. This report summarizes the current status of solar photocatalysis and identifies future opportunities for research and industry in this field, including recent relevant bibliography. The main commercial solar photocatalytic applications are described, included the technologies based on sunlight for antifogging and self-cleaning of coating materials, glass, and concrete. An overview of several different solar photoreactors and the main operating process parameters are also provided. For the estimation of capital costs, it is suggested the use of appropriate “figures of merit”. The present review would be of interest for researchers, technologists, engineers, and industrialists.

Ficus benjamina plants, galled both at epi- and hypogeous parts, were observed in Italy and in The Netherlands, and these were the first records of the appearance of weeping fig crown gall in Europe. A total of 241 Agrobacterium isolates was obtained from 41 tumours and studied for their morphological, physiological and phytopathological characters. Two main groups of agrobacteria were distinguished by their colony morphology and through classical biovarietal tests that allowed allocation of 86 isolates into biovar 1 and 155 into an intermediate biovar rather different from any of the three biovars defined for agrobacteria. Most of the isolates were unable to utilize mannopine, nopaline or octopine as C and N sources; only 62 strains utilized nopaline. However, when nonopine-utilizing strains were inoculated into F. benjamina, only nopaline was detected in the developing tumours. BIOLOG ML 1™ system analysis applied to 50 representative strains allowed identification of the biovar 1 isolates as Agrobacterium tumefaciens and most of the intermediate biovar isolates as the newly proposed species Agrobacterium fici. Analysis of sensitivity to a set of 14 antibiotics confirmed the allocation of the 50 strains into two well defined main clusters matching the BIOLOG identification. Out of 141 tumorigenic isolates, 66 were sensitive in vitro to agrocine 84, but four of these strains showed scarce or no sensitivity to the antagonist A. radiobacter K84 when tested in fig plants. The two types of agrobacteria could usually be isolated from the same tumours. Tumorigenic strains were able to induce tumours in six herbaceous plant species, in eight to 10 out of 12 woody plants and in six to eight out of nine Ficus species, indicating a wide host-range Ti plasmid. Agrobacteria were able to survive and move in the vascular system of galled ficus plants and to induce tumour growth in stem-cutting propagated plants. Moreover, agrobacteria were detected in many healthy F. benjamina plants as part of the endophytic microflora. These findings suggest potential for spread of the disease through latently infected plant propagation material produced as cuttings or by tissue culture.

Objectives: The benefits of combined chelation therapy with daily deferiprone (DFP) and subcutaneous desferrioxamine (DFO) have been widely reported in literature. We retrospectively evaluated the efficacy of different schedules of combined chelation therapy and the incidence of adverse events. Methods: We evaluated 36 patients affected by thalassemia major treated with combined chelation therapy. Patients were subdivided into four treatment arms according to severity of iron overload and previous onset of adverse events to DFP therapy: Group 1 (13 pts) DFP 75 mg ⁄ kg per d plus DFO (25–35 mg ⁄ kg per d for 5 d); Group 2 (6 pts) DFP 50 mg ⁄ kg per d plus DFO (25–35 mg ⁄ kg for 5 d), Group 3 (10 pts) DFP 75 mg ⁄ kg per d plus DFO (25–35 mg ⁄ kg for 3 d), and Group 4 (7 pts) DFP 50 mg ⁄ kg per d plus DFO (25– 35 mg ⁄ kg for 3 d). Change in serum ferritin level was evaluated in all patients. Results: Overall, ferritin decreased from 2592 ± 1701 to 899 ± 833 ng ⁄ mL (P < 0.001). All treatments were able to reduce ferritin levels, but in patients of group 1 and group 2 the highest mean decrease in serum ferritin level and the greatest improvement in liver iron concentration (LIC) and in T2* values were observed. Conclusions: This study showed that the administration of DFO for 5 d a wk in combination with daily administration of DFP at 75 mg ⁄ Kg seemed to be the most efficacy and rapid method for reducing iron overload at liver and heart level. Furthermore, the use of different schedules of combined DFO and DFP administration was not associated with different incidence of adverse effects between the groups.