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The concept of significant polyps and early colorectal cancer encompasses complex polyps not amenable to routine snare polypectomy or where malignancy cannot be excluded. The assessment and management of these lesions is contentious and increasingly important due to the significant risk of over- or undertreatment.Following the recommendations of the Significant Polyps and Early Colorectal Cancer National Program, we implemented a dedicated multidisciplinary team meeting and analyzed the influence on patient outcomes.This was a retrospective study using a prospectively collected database of patients discussed at the dedicated multidisciplinary team meeting.This study was conducted in a single tertiary-care center.Consecutive patients with significant polyps and early colorectal cancer were identified either through the Bowel Cancer Screening Program or colonoscopy for symptomatic patients.Proportions of patients who had organ preservation, and secondary treatment and recurrence rate served as outcome measures.Overall, 135 patients discussed at the dedicated multidisciplinary team meeting were included, with a median age of 71 years. Median size of the lesions was 25 mm, and 39% were in the rectum. Patients were discussed either after the lesion was removed during the initial colonoscopy (n = 38), of whom 16 (42%) had unexpected cancer, or had no initial treatment with subsequent case review (n = 97). Of these 97 patients, 46 underwent endoscopic excision (26% cancer), 20 trans-anal excision (10% cancer), 23 primary surgical resection (35% cancer), and 8 had no treatment. In 104 (82%) patients, organ preservation was achieved. Secondary surgery was required in 7 of 104 (6.7%) patients after local excision due to radical treatment of high-risk T1 lesions, local recurrence, or patients' decisions. The cumulative hazard estimates for recurrence after a median follow-up of 18.5 months was less than 10% for both benign and malignant lesions.This study was limited by its relatively small sample size and single-center setting.A dedicated multidisciplinary team meeting improved the management of significant polyps and early colorectal cancer, safely refining organ preservation for patients, with low recurrence rates. See Video Abstract at http://links.lww.com/DCR/B826.ANTECEDENTES:El concepto de pólipos complejos y cáncer colorrectal temprano abarca engloba pólipos avanzados que no es posible la reseccion endoscopica rutinaria, o aquellos en los que no se puede excluir malignidad. La evaluación y el manejo de estas lesiones es controversial y cada vez más importante debido al riesgo significativo de ser tratadas o no.OBJETIVO:Siguiendo las recomendaciones del Programa Nacional de Pólipos Complejos y Cáncer Colorrectal Temprano, implementamos reuniónes del equipo multidisciplinario especializado y analizamos el impacto en los resultados de los pacientes.DISEÑO:Estudio retrospectivo sobre una base de datos recopilada prospectivamente de los pacientes discutidos en la reunión del equipo multidisciplinario especializado.AJUSTE:Este estudio se realizó en un centro de atención terciaria.PACIENTES:Pacientes consecutivos con pólipos complejos y cáncer colorrectal temprano identificado a través del Programa de detección de cáncer intestinal o colonoscopia para pacientes sintomáticos.PRINCIPALES MEDIDAS DE RESULTADO:Proporción de pacientes que tuvieron preservación de órganos, tratamiento secundario y tasa de recurrencia.RESULTADOS:En total, se incluyeron 135 pacientes discutidos en la reunión del equipo multidisciplinario especializado dedicada, con una media de edad de 71 años. El tamaño medio de las lesiones fue de 25 mm y el 39% estaban en el recto. Se discutio de los pacientes después de que se resecara la lesión durante la colonoscopia inicial [n = 38, de los cuales 16 (42%) tenían un cáncer imprevisto] o no recibieron tratamiento de inicio, con revisión posterior del caso (n = 97). De estos, 46/97 fueron sometidos a resección endoscópica (26% cáncer), 20/97 resección transanal (10% cáncer), 23/97 resección quirúrgica primaria (35% cáncer) y 8/97 no recibieron tratamiento. En 104 (82%) pacientes, se logró la preservación de órgano. Cirugía secundaria fue requeria en 7/104 (6,7%) pacientes después de la resección local debido a tratamiento radical de lesiones T1 de alto riesgo, recidiva local o decisión del paciente. Las estimaciones de riesgo acumulativo de recurrencia después de una media de seguimiento de 18,5 meses fue inferior al 10% tanto para las lesiones benignas como para las malignas.LIMITACIONES:Tamaño de muestra relativamente pequeño y entorno de un solo centro.CONCLUSIONES:La Reunion del equipo multidisciplinario especializado mejoró el manejo de los pólipos complejos y cáncer colorrectal temprano, refinando de manera segura la preservación de órganos para los pacientes, con bajas tasas de recurrencia. Consulte Video Resumen en http://links.lww.com/DCR/B826. (Traducción- Dr. Francisco M. Abarca-Rendon).

Background: In the treatment of idiopathic pulmonary fibrosis (IPF), nintedanib and pirfenidone, with their different mechanisms of action, lead to a reduction in the rate of progression of the fibrosis process measured by the reduction of functional decline, and, in particular, the decrease in forced vital capacity (FVC) and of the diffusion capacity of the lungs for carbon monoxide (DLCO). The objective of this study was to analyze real-life adherence, persistence and efficacy in the use of pirfenidone and nintedanib in the treatment of IPF. Methods: A non-interventional multicenter retrospective observational pharmacological study in real-life treat-ment at 1 and 2 years was conducted. Furthermore, we analyzed the levels of FVC and DLCO at 6 and 12 months, respectively, from the start of treatment. Results: We identified 144 patients in the period between January 2013 and April 2019. From the point of view of adherence, there is no difference between the two drugs, even though patients who used pirfenidone had increasingly higher values: 0.90 vs 0.89, in the first year, and 0.91 vs 0.84, in the second year. In the first year of treatment, the percentage of persistent patients was 67% and 76%, while in the second year, it dropped to 47% and 53% for pirfenidone and nintedanib, respectively. Conclusion: The stratification of the adherence values as a function of the response to treatment in terms of FVC at 12 months for both study drugs showed that patients with optimal response scored adherence of more than 90%.

This paper explores how students connect meaningfully with theory through the aesthetic experiences of problem solving together in the context of a workshop. It can be challenging for students studying design in university programs to understand how theory is relevant, when applied in practical design studio activities. In the colour workshop presented, students participate in brainstorming exercises to create proposals. Theory is made meaningful through learning activities, including a creative brainstorming session animated by both teachers and industry guests. The experience described was enthusiastically received, with the academia-industry collaboration providing a valuable platform for knowledge exchange both among students and teachers.

Streptococcus pneumoniae isolated from patients with invasive pneumococcal disease has been subjected to laboratory-based surveillance in Latin American and Caribbean countries since 1993. Invasive pneumococcal diseases remain a major cause of death and disability worldwide, particularly in children. We therefore aimed to assess the direct effect of pneumococcal conjugate vaccines (PCVs) on the distribution of pneumococcal serotypes causing invasive pneumococcal disease in children younger than 5 years before and after PCV introduction.We did a multicentre, retrospective observational study in eight countries that had introduced PCV (ie, PCV countries) in the Latin American and Caribbean region: Argentina, Brazil, Chile, Colombia, Dominican Republic, Mexico, Paraguay, and Uruguay. Cuba and Venezuela were also included as non-PCV countries. Isolate data for Streptococcus pneumoniae were obtained between 2006 and 2017 from children younger than 5 years with an invasive pneumococcal disease from local laboratories or hospitals. Species' confirmation and capsular serotyping were done by the respective national reference laboratories. Databases from the Sistema Regional de Vacunas (SIREVA) participating countries were managed and cleaned in a unified database using Microsoft Excel 2016 and the program R (version 3.6.1). Analysis involved percentage change in vaccine serotypes between pre-PCV and post-PCV periods and the annual reporting rate of invasive pneumococcal diseases per 100 000 children younger than 5 years, which was used as a population reference to calculate percentage vaccine type reduction.Between 2006 and 2017, 12 269 isolates of invasive pneumococcal disease were collected from children younger than 5 years in the ten Latin American and Caribbean countries. The ten serotypes included in ten-valent pneumococcal conjugate vaccine (PCV10) decreased significantly (p0·0001) after any PCV introduction, except for the Dominican Republic. The percentage change for the ten vaccine serotypes in PCV10 countries was -91·6% in Brazil (530 [72·9%] of 727 before, 27 [6·1%] of 441 after); -85·0% in Chile (613 [72·6%] of 844 before, 44 [10·9%] of 404] after); -84·7% in Colombia (231 [63·1%] of 366 before, 34 [9·7%] of 352 after); and -73·8% in Paraguay (127 [77·0%] of 165 before, 22 [20·2%] of 109 after). In the 13-valent pneumococcal conjugate vaccine (PCV13) countries, the percentage change for the 13 vaccine serotypes was -59·6% in Argentina (853 [85·0%] of 1003 before, 149 [34·3%] of 434 after); -16·5% in the Dominican Republic (95 [80·5%] of 118 before, 39 [67·2%] of 58 after); -43·7% in Mexico (202 [73·2%] of 276 before, 63 [41·2%] of 153 after); and -45·9% in Uruguay (138 [80·7%] of 171 before, 38 [43·7%] of 87 after). Annual reporting rates showed a reduction from -82·5% (6·21 before vs 1·09 after per 100 000, 95% CI -61·6 to -92·0) to -94·7% (1·15 vs 0·06 per 100 000, -89·7 to -97·3) for PCV10 countries, and -58·8% (2·98 vs 1·23 per 100 000, -21·4 to -78·4) to -82·9% (7·80 vs 1·33 per 100 000, -76·9 to -87·4) for PCV13 countries. An increase in the amount of non-vaccine types was observed in the eight countries after PCV introduction together with an increase in their percentage in relation to total invasive strains in the post-PCV period.SIREVA laboratory surveillance was able to confirm the effect of PCV vaccine on serotypes causing invasive pneumococcal disease in the eight PCV countries. Improved monitoring of the effect and trends in vaccine type as well as in non-vaccine type isolates is needed, as this information will be relevant for future decisions associated with new PCVs.None.For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

An improved weather-forecast-based link-budget design technique for space-to-Earth links is described. The aim is the stochastic optimization of both transmission symbol rate and received signal-to-noise ratio. The proposed radiometeorological operations prediction (RadioMetOP) model takes into account the forecast uncertainty by a space–time ensemble method exploiting the temporal evolution of the predicted radiometeorological variables over the weather-forecast spatial grid. The unique possibility of testing and validating the RadioMetOP model is presented, thanks to the $Ka$ -band downlink measurements available from the support of the European Space Agency’s antenna tracking network to deep-space Hayabusa-2 (HB2) mission, operated by the Japan Aerospace Exploration Agency. First, the RadioMetOP model accuracy is tested by comparing the signal-to-noise ratio, measured during the transmission periods, with the simulated one, properly scaled to the symbol rate operated by HB2, finding correlation values of 0.9 that confirm the effectiveness of the proposed approach. Second, the $a$ posteriori analysis of the optimization process is accomplished, showing that depending on the considered criteria for the link-budget optimization, the use of the RadioMetOP model would have allowed a transmitted data volume more than doubled and an average signal-to-noise ratio gain between 2.1 and 3.8 dB.

Objectives (1) To investigate whether a contrast-free biparametric MRI (bp-MRI) including T2-weighted images (T2W) and diffusion-weighted images (DWI) can be considered an accurate alternative to the standard multiparametric MRI (mp-MRI), consisting of T2, DWI, and dynamic contrast-enhanced (DCE) imaging for the muscle-invasiveness assessment of bladder cancer (BC), and (2) to evaluate how the diagnostic performance of differently experienced readers is affected according to the type of MRI protocol. Methods Thirty-eight patients who underwent a clinically indicated bladder mp-MRI on a 3-T scanner were prospectively enrolled. Trans-urethral resection of bladder was the gold standard. Two sets of images, set 1 (bp-MRI) and set 2 (mp-MRI), were independently reviewed by four readers. Descriptive statistics, including sensitivity and specificity, were calculated for each reader. Receiver operating characteristic (ROC) analysis was performed, and the areas under the curve (AUCs) were calculated for the bp-MRI and the standard mp-MRI. Pairwise comparison of the ROC curves was performed. Results The AUCs for bp- and mp-MRI were respectively 0.91–0.92 (reader 1), 0.90 (reader 2), 0.95–0.90 (reader 3), and 0.90–0.87 (reader 4). Sensitivity was 100% for both protocols and specificity ranged between 79.31 and 89.66% and between 79.31 and 83.33% for bp-MRI and mp-MRI, respectively. No significant differences were shown between the two MRI protocols (p > 0.05). No significant differences were shown accordingly to the reader’s experience (p > 0.05). Conclusions A bp-MRI protocol consisting of T2W and DWI has comparable diagnostic accuracy to the standard mp-MRI protocol for the detection of muscle-invasive bladder cancer. The experience of the reader does not significantly affect the diagnostic performance using VI-RADS. Key Points • The contrast-free MRI protocol shows a comparable accuracy to the standard multiparametric MRI protocol in the bladder cancer muscle-invasiveness assessment. • VI-RADS classification helps non-expert radiologists to assess the muscle-invasiveness of bladder cancer. • DCE should be carefully interpreted by less experienced readers due to inflammatory changes representing a potential pitfall.

The transition from conventional to organic agriculture is not an easy task, as it involves complicated procedures for peasant families. The objective of this paper is to discuss if the peasant families are able to write down the requirements for organic certification through a case study in a lot of members of the Grupo Bem-Estar, in settlement 72, in the municipality of Ladario / MS, on the border of Brazil with Bolivia. Fieldwork was used, with a qualitative approach, in the second half of 2018. The description of the activities developed by the family was done by the ethnographic method. It was observed that, under the conditions of the peasant family studied, the annotations on the agricultural systems are important bottlenecks between the passage of conventional agriculture, through the agro-ecological transition to organic certification, even though the Social Control Organizations.

This paper explores how the global standard setter and the European Union (EU) use public interest arguments; the study discusses these in relation to the perceptions of the actors included in the ...

Beer is one of the most consumed alcoholic beverages in the world, rich in chemical compounds of natural origin with high nutritional and biological value. It is made up of water, barley malt, hops, and yeast. The main nutrients are carbohydrates, amino acids, minerals, vitamins, and other compounds such as polyphenols which are responsible for the many health benefits associated with this consumption of drinks. Hops and malt are one of the raw materials for beer and are a source of phenolic compounds. In fact, about 30% of the polyphenols in beer comes from hops and 70%-80% from malt. Natural compounds of foods or plants exert an important antioxidant activity, counteracting the formation of harmful free radicals. In the presence of an intense stressing event, cells activate specific responses to counteract cell death or senescence which is known to act as a key-task in the onset of age-related pathologies and in the loss of tissue homeostasis. Many studies have shown positive effects of natural compounds as beer polyphenols on biological systems. The main aims of our research were to determine the polyphenolic profile of three fractions, coming from stages of beer production, the mashing process (must), the filtration process (prehopping solution), and the boiling process with the addition of hops (posthopping solution), and to evaluate the effects of these fractions on Dental-derived Stem Cells (D-dSCs) and human intestinal epithelial lines (Caco-2 cells). Furthermore, we underline the bioavailability of beer fraction polyphenols by carrying out the in vitro intestinal absorption using the Caco-2 cell model. We found an antioxidant, proliferating, and antisenescent effects of the fractions deriving from the brewing process on D-dSCs and Caco-2 cells. Finally, our results demonstrated that the bioavailability of polyphenols is greater in beer than in the control standards used, supporting the future clinical application of these compounds as potential therapeutic tools in precision and translational medicine.

Background Low anterior resection syndrome is significantly associated with a deterioration in the quality of life, and its medical treatment is usually ineffective. Objective The aim of the present study was to establish the efficacy of percutaneous tibial nerve stimulation in treating this syndrome. Design This is a randomized pilot trial with 1-year follow-up. Settings The study was conducted in a specialized colorectal unit of a tertiary hospital. Patients Patients who underwent neoadjuvant chemoradiotherapy and low anterior rectal resection for cancer with low anterior resection syndrome score ≥21 and ileostomy closed at least 18 months earlier were included. Interventions Patients were randomly assigned to receive either percutaneous tibial nerve stimulation plus medical treatment (arm A, n = 6) or medical treatment (arm B, n = 6). Low anterior resection syndrome was assessed using symptom severity and disease-specific quality-of-life scores at baseline, at the end of treatment, and at 1-year follow-up. Main outcome measures The primary outcome was a clinical response, defined as a reduction of the low anterior resection syndrome score. Results Only in group A low anterior resection syndrome score, fecal incontinence severity index, and obstructed defecation syndrome score improved significantly with treatment (35.8 ± 2.5 vs 29.0 ± 3.8 (p = 0.03); 36.8 ± 4.3 vs 18.5 ± 8.0 (p = 0.02); 10.3 ± 3.9 vs 8.0 ± 4.9 (p = 0.009)) and changes were observed in all domains of quality-of-life instruments. In both groups the symptom severity and quality-of-life scores at 1-year follow-up did not differ significantly from those recorded at the end of treatment. Limitations The study had a small number of patients and it was underpowered to detect the within-group effect. Conclusions Percutaneous tibial nerve stimulation could be an effective treatment for low anterior resection syndrome. Additional studies are warranted to investigate clinical effectiveness in low anterior resection syndrome. See Video Abstract at http://links.lww.com/DCR/B371. ESTUDIO PILOTO ALEATORIO DE ESTIMULACION PERCUTANEA DEL NERVIO TIBIAL POSTERIOR VERSUS TERAPIA MEDICA PARA EL TRATAMIENTO DEL SINDROME DE RESECCION ANTERIOR BAJA: UN ANO DE SEGUIMIENTO: El sindrome de reseccion anterior baja se asocia con un deterioro significativo en la calidad de vida y su tratamiento medico generalmente es ineficaz.El objetivo del presente estudio fue establecer la eficacia de la estimulacion percutanea del nervio tibial en el tratamiento de este sindrome.Este es un estudio piloto aleatorio con 1 ano de seguimiento.El estudio se realizo en una unidad colorrectal especializada de un hospital terciario.Se incluyeron pacientes que se sometieron a quimiorradioterapia neoadyuvante y reseccion rectal anterior baja por cancer con puntaje de sindrome de reseccion anterior baja ≥ 21 e ileostomia cerrada al menos 18 meses antes.Los pacientes fueron asignados aleatoriamente para recibir estimulacion percutanea del nervio tibial + tratamiento medico (brazo A, n = 6) o tratamiento medico (brazo B, n = 6). El sindrome de reseccion anterior baja se evaluo utilizando puntajes de la gravedad de los sintomas y de calidad de vida especificos de la enfermedad al inicio, al final del tratamiento y al ano de seguimiento.El resultado primario fue una respuesta clinica, definida como una reduccion de la puntuacion del sindrome de reseccion anterior baja.Solo en el grupo A, el puntaje del sindrome de reseccion anterior baja, el indice de severidad de incontinencia fecal y el puntaje del sindrome de defecacion obstruida mejoraron significativamente con el tratamiento (35.8 ± 2.5 vs 29 ± 3.8, p = 0.03; 36.8 ± 4.3 vs 18.5 ± 8.0, p = 0.02; 10.3 ± 3.9 vs 8.0 ± 4.9, p = 0.009, respectivamente) y se observaron cambios en todos los dominios de los instrumentos de calidad de vida. En ambos grupos, los puntajes de severidad de los sintomas y de calidad de vida al ano de seguimiento no difirieron significativamente de los registrados al final del tratamiento.El estudio tuvo un pequeno numero de pacientes y no logro suficiente poder para detectar el efecto dentro de grupo.La estimulacion percutanea del nervio tibial podria ser un tratamiento efectivo para el sindrome de reseccion anterior baja. Se requieren estudios adicionales para investigar la efectividad clinica en el sindrome de reseccion anterior baja. Consulte Video Resumen http://links.lww.com/DCR/B371.

Colorectal cancer is one of the most commonly diagnosed tumors worldwide and a leading cause of cancer-related death. Although the majority of gastrointestinal cancers are generally considered poorly immunogenic, recent data from clinical trials have demonstrated that the subgroup of patients with DNA mismatch repair system is highly responsive to immune checkpoint inhibitor-based therapy. We present the case of a 74-year-old man with pulmonary autoimmune intersitiopathy and microsatellite instability metastatic colorectal cancer who responded to nivolumab despite the concomitant steroid therapy. Furthermore, his autoimmune disease did not worsen during immunotherapy.

Background Treatment with fluoropyrimidines and concomitant long-course external radiotherapy (RTE) is the standard of care in locally advanced rectal cancer (LARC) preoperative chemoradiation. A randomized phase II study (RaP/STAR-03) was conducted that aimed to evaluate the activity and safety of the monoclonal antibody anti-epidermal growth factor receptor panitumumab as a single agent in combination with radiotherapy in low-risk LARC preoperative treatment. Materials and Methods Patients had adenocarcinoma of the mid-low rectum, cT3N− or cT2–T3N+, KRAS wild-type status, and negative circumferential radial margin. Panitumumab was administered concomitant to RTE. Rectal surgery was performed 6–8 weeks after the end of preoperative treatment. The adjuvant chemotherapy regimen was FOLFOX. The primary endpoint was the pathologic complete response (pCR) rate. The sample size was calculated using Simon's two-stage design. A pCR of 16% was considered to qualify the experimental treatment for further testing. Results Ninety-eight patients were enrolled in 13 Italian centers from October 2012 to October 2015. Three panitumumab infusions were administered in 92 (93.4%) patients. The RTE compliance was median dose 50.4 Gy; ≥28 fractions in 82 (83.7%) patients. Surgical treatment was performed in 92 (93.9%) patients, and no severe intraoperative complications were observed. A pCR was observed in 10 (10.9%) patients (95% confidence interval, 4.72%–17.07%). Pathological downstaging occurred in 45 (45.9%) patients. Grade 3 toxicities were observed in 22 (22.3%) patients, and the common adverse events were skin rash in 16 (16.3%) patients. No grade 4 toxicities were reported. Conclusion The pCR rate (our primary endpoint), at only 10.9%, did not reach the specified level considered suitable for further testing. However, the analysis showed a good toxicity profile and compliance to concomitant administration of panitumumab and RTE in preoperative treatment of LARC. The pCR evaluation in all wild-type RAS is ongoing. Implications for Practice The aim of the RaP/STAR-03 study was to evaluate the activity and safety of monoclonal antibody anti-epidermal growth factor receptor (EGFR) panitumumab as a single agent without chemotherapy in low-risk, locally advanced rectal cancer (LARC) preoperative treatment. Nevertheless, the use of panitumumab in combination with radiotherapy in preoperative treatment in patients with KRAS wild type and low-risk LARC did not reach the pathologic complete response primary endpoint. This study showed a good toxicity profile and compliance to combination treatment. Further analysis of NRAS and BRAF on tissue and circulating levels of the EGFR ligands and vascular factors (soluble vascular endothelial growth factor, E-selectin) may provide insight on the potential molecular pathways involved in the anti-EGFR response.

This paper focuses on the dynamic behaviour of a low-rise masonry building representing the Italian residential heritage through experimental and numerical analyses. The authors discuss an application of combined Operational Modal Analysis and Finite Element Model updating for indirect estimation of the structural parameters. Two ambient vibration tests were carried out to estimate the structure’s dynamic behaviour in operational conditions. The first experimental setup consisted of accelerometers gathered in a row along the first floor to characterize the local dynamic of the floor. Conversely, the second setup had the accelerometers placed at the building’s corners to characterize the global dynamics. The outcomes of the first setup were used to estimate the mechanical parameters of the floor, while the ones form the second were used to characterize the mechanical parameters of the masonry piers. Therefore, two finite element models were implemented: (i) a single beam with an equivalent section of the floor to grasp the local behaviour of the investigated horizontal structure, (ii) an equivalent frame model of the entire building to characterise the global dynamic behaviour. The model updating process was developed in two phases to seize local and global dynamic responses. The updated numerical model formed the basis for a sensitivity analysis using the modelling parameters. The authors chose to delve into the influence of the floor on the dynamic behaviour of low-rise masonry buildings. With this aim, non-linear dynamic analyses were carried out under different mechanical characteristics of floors, expressing the scatter for ordinary masonry buildings. The displacements’ trends along the height of the building evidenced the notable role of the floor’s stiffness in the non-linear dynamic behaviour of the building. Lastly, the authors derived the fragility curves predicting the seismic performance in failure probability under a highly severe damage state.

Objective In the recent years the increase of methamphetamines (MTA) abusers women has become an emerging problem. Very little data has been published regarding the effects of prenatal MTA exposure. We describe a case of MTA related toxicity in a term newborn which have early onset of neonatal encephalopathy and liver failure. Case report A term infant born to a MTA abuser mother developed seizures and severe neurological symptoms shortly after birth. Methamphetamine was detected both in maternal and in neonatal urine. The laboratoristic tests revealed severe hepatic insufficiency, coagulopathy and thrombocytopenia. Due to neonatal encephalopathy the newborn underwent hypothermia. Phenobarbital, fresh frozen plasma, platelet transfusions and vitamin K were administered. Cranial ultrasonography and magnetic resonance imaging (MRI) showed diffuse white matter damage and two ischemic-hemorrhagic cerebral lesions. Gradually the clinical conditions improved, at 1 month MRI showed a stabilization of cerebral lesions with residual diffuse leukomalacia. Physiotherapy and neurological follow up is ongoing to evaluate the long term effects. Conclusions: although infrequent, MTA-related toxicity should be suspected in infants with neurologic and hepatic symptoms. Further studies are warranted to confirm our findings in order to identify newborns at high risk of acute MTA toxicity in time to provide them the appropriate support.

In recent years, the decent work agenda has called upon vocational psychologists to advance psychological research and intervention to promote work as a human right. Furthermore, the COVID-19 pandemic is having disproportionate consequences on vulnerable workers, such as unemployment and underemployment, highlighting the need to enhance access to decent work for these workers. As a response, the present perspective article advances job crafting as a promising way to shape decent work for marginalized workers. To this end, the article deals with decent work and job crafting, starting with the definition of decent work according to the psychology of working theory (PWT) and examining the evolution of the construct of job crafting. Subsequently, the literature on job crafting is discussed, focusing on variables related to the PWT model of decent work and their effect on vulnerable workers. Finally, possibilities for further research and intervention aimed at promoting decent work through job crafting are discussed.

Masonry towers, located in seismic zones, are vulnerable and prone to damages up to compromise their stability. The scatter of data on the mechanical properties of masonry, geometry and boundary conditions determine a lack of building knowledge on their expected behaviour. Therefore the assessment of the seismic capacity represents a critical task. This paper contributes to the issue of seismic analysis of masonry towers, focusing a meaningful case study: the St.Silvestro belfry in L’Aquila, Italy. The tower, severely damaged by the 2009 earthquake sequence, underwent extensive restoration works, endeavoured to mitigate its vulnerability. The observed seismic damage, the performed no-destructive testing campaign and the accomplished rehabilitation measures are described in the paper. The authors appraised the actual seismic performances of the St.Silvestro belfry, reinforced by the last restoration works. At first, the Operational Modal Analysis (OMA) is carried out to enhance building knowledge. In a second step, a refined finite element model is calibrated on the results from OMA to seize the actual dynamic response. Ultimately, by using the updated finite element model, the authors estimate the fragility curves in terms of peak ground acceleration using truncated incremental dynamic analyses.

Background Autism spectrum disorders (ASDs) and schizophrenia spectrum disorders (SSDs), although conceptualized as separate entities, may share some clinical and neurobiological features. ASD symptoms may have a relevant role in determining a more severe clinical presentation of schizophrenic disorder but their relationships with cognitive aspects and functional outcomes of the disease remain to be addressed in large samples of individuals. Aims To investigate the clinical, cognitive, and functional correlates of ASD symptoms in a large sample of people diagnosed with schizophrenia. Methods The severity of ASD symptoms was measured with the PANSS Autism Severity Scale (PAUSS) in 921 individuals recruited for the Italian Network for Research on Psychoses multicenter study. Based on the PAUSS scores, three groups of subjects were compared on a wide array of cognitive and functional measures. Results Subjects with more severe ASD symptoms showed a poorer performance in the processing speed (p = 0.010), attention (p = 0.011), verbal memory (p = 0.035), and social cognition (p = 0.001) domains, and an overall lower global cognitive composite score (p = 0.010). Subjects with more severe ASD symptoms also showed poorer functional capacity (p = 0.004), real-world interpersonal relationships (p p Conclusions These findings strengthen the notion that ASD symptoms may have a relevant impact on different aspects of the disease, crucial to the life of people with schizophrenia. Prominent ASD symptoms may characterize a specific subpopulation of individuals with SSD.

Following the introduction of Regulation (EC) No 1606/2002, listed banks in Europe must prepare their annual reports under International Financial Reporting Standards (IFRS) (Quagli, 2019). In addition, in many European countries also unlisted banks apply IFRS instead of national GAAP, depending upon national requirements (Pacter, 2017). For instance, in Italy banks are required to prepare their financial statements under IFRS and this applies whether or not the company’s securities are traded on a regulated exchange (Di Pietra, 2008). Anyway, the mandatory application of IFRS for banks is quite diffused; this happens also in Belgium, Bulgaria, Croatia, Cyprus, Estonia, Finland, Greece, Latvia, Lithuania, Malta, Poland, Portugal, Romania, Slovakia and Sweden.

First generation antipsychotics (FGAs) are more likely to induce extrapyramidal side-effects (EPS) than second generation antipsychotics (SGAs), and EPS have been shown associated to cognitive deficits in schizophrenia. So far, no study has explored the relationships between EPS and social cognition (SC) in people with schizophrenia. Therefore, we assessed the prevalence of EPS in a large sample of drug-treated community-dwelling persons with schizophrenia and explored their relationships with patients' neurocognitive and SC abilities. 875 patients underwent EPS, psychopathological, neurocognitive and SC assessments by means of standardized measures. Relationships between EPS, psychopathology and neurocognitive and SC measures were investigated by correlation tests. Moreover, a partial correlation network was computed by means of a network analysis. 256 patients were treated with FGAs alone or in combination with SGA and 619 with SGAs. EPS were significantly more frequent in FGA-treated group than in the SGA-treated one. Patients with EPS disclosed a more severe psychopathology and were more impaired in neurocognitive and SC measures compared to those without EPS. Disorganization, expressive deficit, and duration of illness were significantly associated to both neurocognitive and SC measures while EPS were associated to neurocognitive measures only. The network analysis showed that parkinsonism was the sole EPS directly connected to both psychopathological and neurocognitive indices whereas no direct connection emerged between EPS and SC measures. Present findings confirm that EPS are still present in the era of SGAs and contribute, together with other clinical variables, to the neurocognitive but not to the SC impairment of patients with schizophrenia.

Access to safe, effective, quality-assured antivenom products that are tailored to endemic venomous snake species is a crucial component of recent coordinated efforts to reduce the global burden of snakebite envenoming. Multiple access barriers may affect the journey of antivenoms from manufacturers to the bedsides of patients. Our review describes the antivenom ecosystem at different levels and identifies solutions to overcome these challenges. At the global level, there is insufficient manufacturing output to meet clinical needs, notably for antivenoms intended for use in regions with a scarcity of producers. At national level, variable funding and deficient regulation of certain antivenom markets can lead to the procurement of substandard antivenom. This is particularly true when producers fail to seek registration of their products in the countries where they should be used, or where weak assessment frameworks allow registration without local clinical evaluation. Out-of-pocket expenses by snakebite victims are often the main source of financing antivenoms, which results in the underuse or under-dosing of antivenoms, and a preference for low-cost products regardless of efficacy. In resource-constrained rural areas, where the majority of victims are bitten, supply of antivenom in peripheral health facilities is often unreliable. Misconceptions about treatment of snakebite envenoming are common, further reducing demand for antivenom and exacerbating delays in reaching facilities equipped for antivenom use. Multifaceted interventions are needed to improve antivenom access in resource-limited settings. Particular attention should be paid to the comprehensive list of actions proposed within the WHO Strategy for Prevention and Control of Snakebite Envenoming., Highlights • The global antivenom market is fragmented into multiple sub-markets of region-specific products, leaving many needs unmet. • Weaknesses in national regulatory capacity and some manufacturing processes lead to procurement of substandard antivenoms. • Prompt access to antivenom in rural settings is challenging due to lack of transportation. • Scarcity of adequately resourced facilities with experienced staff to administer antivenom is another access barrier. • Fully-financed regional antivenom stockpiles have the potential to significantly improve access.

Recent research supports the idea that banks characterised by business models drawing more on traditional retail funding, namely customer deposits, and income diversification is likely to engage more in income smoothing than other business models (Di Fabio, Journal of Applied Accounting Research 20:311–330, 2019). Indeed, being income smoothing an accounting behaviour consistent with entities’ aim to show lower riskiness, findings of this research are overall consistent with literature suggesting that traditional funding and income diversification strategies implemented by retail banks are an integral part of a strategy characterised by risk aversion (Kohler, Journal of Financial Stability 16:195–212, 2015). Additionally, evidence provided in the fourth chapter corroborates prior literature supporting the view that supervisory strictness is associated with income smoothing behaviours (Gebhardt & Novotny-Farkas, Journal of Business Finance and Accounting, 38:289–333, 2011; Garcia-Osma et al., Journal of Banking and Finance, 102:156–176, 2019; Di Fabio et al., Journal of International Accounting, Auditing and Taxation, 43: 100385, 2020). This chapter aims to understand whether supervisory features have specifically an impact on accounting behaviour of banks characterised by certain business models.

Given banks’ crucial role of financial intermediation between depositors, one of the main goals of the revision of the supervisory system that followed the 2008 financial crisis was increasing bank transparency. From this angle, ‘high-quality’ supervision should not only increase the overall sustainability of banks’ activities and bank ability to manage risks, but also contribute to improve the quality of bank accounting data (BCBS, 2015).

The features of the supervisory system are key to explain bank accounting choices; however, research suggests that the supervisory facets produce distinct incentives for bank managers to engage in income smoothing. The previous chapter has outlined empirical evidence provided by studies on the topic, highlighting that—at least in the European context—the strictness of national supervisors seems to increase income smoothing, as this strategy is substantially in line with supervisors’ prudential approach to provisioning (Gebhardt & Novotny-Farkas, 2011; Garcia-Osma et al., 2019; Di Fabio et al., 2020). Its effect can be constrained by high independence of supervisors from the banking industry (Garcia-Osma et al., 2019) and by private investors’ monitoring (Fonseca & Gonzalez, 2008). Other two supervisory features, namely the involvement of external auditors and supervisory effectiveness, have been less investigated; however, recent research suggests that the supervisor’s reliance on the audit function is positively related to smoothing in market-oriented banks (Di Fabio, 2019) and that effectiveness seems to influence how other monitoring mechanisms reduce smoothing (Di Fabio et al., 2020).

Despite entailing more severe and uncommon side effects in 22q11.2DS compared to idiopathic schizophrenia, we strongly believe that clozapine should continue to be considered the gold standard for all treatment‐resistant schizophrenia, even in 22qDS.

Summary Background The importance of lung recruitment before surfactant administration has been shown in animal studies. Well designed trials in preterm infants are absent. We aimed to examine whether the application of a recruitment manoeuvre just before surfactant administration, followed by rapid extubation (intubate-recruit-surfactant-extubate [IN-REC-SUR-E]), decreased the need for mechanical ventilation during the first 72 h of life compared with no recruitment manoeuvre (ie, intubate-surfactant-extubate [IN-SUR-E]). Methods We did a randomised, unblinded, controlled trial in 35 tertiary neonatal intensive care units in Italy. Spontaneously breathing extremely preterm neonates (24 + 0 to 27 + 6 weeks' gestation) reaching failure criteria for continuous positive airway pressure within the first 24 h of life were randomly assigned (1:1) with a minimisation algorithm to IN-REC-SUR-E or IN-SUR-E using an interactive web-based electronic system, stratified by clinical site and gestational age. The primary outcome was the need for mechanical ventilation in the first 72 h of life. Analyses were done in intention-to-treat and per-protocol populations, with a log-binomial regression model correcting for stratification factors to estimate adjusted relative risk (RR). This study is registered with ClinicalTrials.gov , NCT02482766 . Findings Of 556 infants assessed for eligibility, 218 infants were recruited from Nov 12, 2015, to Sept 23, 2018, and included in the intention-to-treat analysis. The requirement for mechanical ventilation during the first 72 h of life was reduced in the IN-REC-SUR-E group (43 [40%] of 107) compared with the IN-SUR-E group (60 [54%] of 111; adjusted RR 0·75, 95% CI 0·57–0·98; p=0·037), with a number needed to treat of 7·2 (95% CI 3·7–135·0). The addition of the recruitment manoeuvre did not adversely affect the safety outcomes of in-hospital mortality (19 [19%] of 101 in the IN-REC-SUR-E group vs 37 [33%] of 111 in the IN-SUR-E group), pneumothorax (four [4%] of 101 vs seven [6%] of 111), or grade 3 or worse intraventricular haemorrhage (12 [12%] of 101 vs 17 [15%] of 111). Interpretation A lung recruitment manoeuvre just before surfactant administration improved the efficacy of surfactant treatment in extremely preterm neonates compared with the standard IN-SUR-E technique, without increasing the risk of adverse neonatal outcomes. The reduced need for mechanical ventilation during the first 72 h of life might facilitate implementation of a non-invasive respiratory support strategy. Funding None.

The city of L&rsquo, Aquila (Italy) includes a significant amount of masonry palaces erected from the middle of the 13th century up to the first half of the 20th century. This paper focuses on the seismic response of a masonry palace built during the first half of the 20th century and characterized by regularity in plan and elevation. The authors investigate the seismic response by varying a suite of modelling parameters that express the actual scatter of the mechanical properties typical of the masonry palaces erected in L&rsquo, Aquila. The authors discuss the seismic performance exhibited by this building during the 2009 earthquake. Then, they assess the sensitivity of the selected building&rsquo, s seismic performance via non-linear static analysis to the mechanical properties of masonry, the in-plane stiffness of the floors, and the mechanical resistance of the spandrels. The parametric analysis shows that the three variables markedly affect the shear resistance, the ultimate displacement, and the behavior factors. The fragility functions were then estimated from the results of non-linear static analysis. A significant scatter of the probability of collapse for the considered limit states reveals the limitations of typological approaches for masonry palaces.

This study adopts an institutional lens to explore enforcement as a complex and nuanced phenomenon shaped by the dynamics of its social context. It examines an IFRS regulatory incident that fails to conclude with any decision or resolving action in the context of the European Union, and as such invites serious questioning of enforcement functions. From our analysis accounting enforcement emerges as an interacting issue-based field in which auditors and the national enforcement agency adhere narrowly to their tasks, ensuring formal but not substantive IFRS compliance. Field participants are seen to respond to institutional pressures strategically by avoiding public positions and delegating choices to other actors, substantially accepting earnings manipulation. Our study shows that the national enforcer increased its interactions with other regulatory actors (i.e. agencies concerned with the setting and interpretation of standards) in the case of controversial issues and their responses can heavily influence overall enforcement effectiveness. Furthermore, its findings contribute to debates on the need for a pan-European enforcement agency and shed light on the importance of IFRS interpretation for the enforce-ability of international accounting standards.

Background The aim of this study was to assess adherence to and persistence with androgen deprivation therapy (ADT) in a large cohort of prostate cancer (PCa) patients selected from an administrative database, with special attention to elderly patients. Methods Patients treated with LHRH analogues, LHRH antagonists, the novel androgen antagonist enzalutamide, and the CYP17 inhibitor abiraterone were included spanning the years 2011-2017. Descriptive statistics were used to analyze persistence and adherence in older patients stratified by age (46-55, 56-65, 66-75, 76-85, and >85 years). The effect of persistence duration on overall survival in super-elderly patients was analyzed by the Kaplan-Meier method, together with the influence of multiple prescriptions on overall survival. Results A total of 1160 male patients were treated with ADT. Of these, 1075 were given LHRH analogues, 80 LHRH antagonists, 14 novel androgen antagonists, and 109 the CYP17 inhibitor. Median adherence values were 0.93, 0.97, 0.95, and 0.99 respectively. The highest persistence was recorded for LHRH analogues/antagonists (24 months), followed enzalutamide and abiraterone (8 months). A total of 107 patients (9.2%) were classified as super-elderly (age range 85-97 years). Median persistence and OS in this group were 13 months and 29 months, respectively. The adherence was 0.92. Overall survival was significantly associated with additional prescriptions for other conditions-indications (P=0.0047) but not with differences in adherence rates (P=0.98). Conclusions Our data showed high adherence and persistence rates in men on ADT. The overall survival in the super-elderly is not influenced by persistence and/or adherence but rather by coprescriptions.

OBJECTIVE To examine the relationship between electrographic seizures and developmental outcome at 18 and 24 months in neonates with moderate and severe hypoxic-ischemic encephalopathy [HIE] treated with therapeutic hypothermia [TH]. STUDY DESIGN 30 term infants with moderate-severe HIE treated with TH were enrolled prospectively from June 2012 to May 2018. All had continuous single channel amplitude integrated EEG (aEEG) monitoring for a minimum of 72 h and brain MR within 4 weeks. The aEEG was classified by severity of background and seizure burden. MR images were graded by the severity of injury. Outcome (defined abnormal in case of death, dyskinetic or spastic quadriplegic cerebral palsy, epilepsy, or Bayley III score < 85 in all three subscales or < 70 in any individual subscale) was assessed at 18 and 24 months. RESULTS Seizures were recorded in 24 out of 30 [80 %] neonates and an abnormal outcome was observed in 7 [23 %] of infants. Patients with poor outcome had a statistically significant correlation with: high seizure burden (p = 0.0004), need for more than one antiepileptic drugs (p = 0.006), a persistent abnormal aEEG trace at 48 h (p = 0.0001) and moderate-severe brain injury at MRI (p = 0.0001). Moreover, infants with status epilepticus or frequent seizures reported a significantly association with abnormal MR imaging and poor outcome than patients with sporadic seizures (p = 0.0009). CONCLUSION The role of seizures in the pathogenesis of brain injury remains controversial. In our cohort the presence of seizures, per se, was not associated with abnormal outcome; however a high seizure burden as well as a persistent abnormal aEEG background pattern and MR lesions resulted significantly associated with poor prognosis.

AimsOptical microscopic (OM) evaluation of peripheral blood (PB) cells is still a crucial step of the laboratory haematological workflow. The morphological cell analysis is time-consuming and expensive and it requires skilled operator. To address these challenges, automated image-processing systems, as digital morphology (DM), were developed in the last few years. The aim of this multicentre study, performed according to international guidelines, is to verify the analytical performance of DM compared with manual OM, the reference method.MethodsFour hundred and ninety PB samples were evaluated. For each sample, two May Grunwald-stained and Giemsa-stained smears were performed and the morphological evaluation of cells was analysed with both DM and OM. In addition, the assessment times of both methods were recorded.ResultsComparison of DM versus OM methods was assessed with Passing-Bablok and Deming fit regression analysis: slopes ranged between 0.17 for atypical, reactive lymphocytes and plasma cells (LY(AT)) and 1.24 for basophils, and the intercepts ranged between −0.09 for blasts and 0.40 for LY(AT). The Bland-Altman bias ranged between −6.5% for eosinophils and 21.8% for meta-myemielocytes. The diagnostic agreement between the two methods was 0.98. The mean of assessment times were 150 s and 250 s for DM and OM, respectively.ConclusionDM shows excellent performance. Approximately only 1.6% of PB smears need the OM revision, giving advantages in terms of efficiency, standardisation and assessment time of morphological analysis of the cells. The findings of this study may provide useful information regarding the use of DM to improve the haematological workflow.

The Liver Imaging Reporting and Data System (LI-RADS) is a recently developed classification aiming to improve the standardization of liver imaging assessment in patients at risk of developing hepatocellular carcinoma (HCC). The LI-RADS v2017 implemented new algorithms for ultrasound (US) screening and surveillance, contrast-enhanced US diagnosis and computed tomography/magnetic resonance imaging treatment response assessment. A minor update of LI-RADS was released in 2018 to comply with the American Association for the Study of the Liver Diseases guidance recommendations. The scope of this review is to provide a practical overview of LI-RADS v2018 focused both on the multimodality HCC diagnosis and treatment response assessment.

Schizophrenia occurs in about one in four individuals with 22q11.2 deletion syndrome (22q11.2DS). The aim of this International Brain and Behavior 22q11.2DS Consortium (IBBC) study was to identify genetic factors that contribute to schizophrenia, in addition to the ~20-fold increased risk conveyed by the 22q11.2 deletion. Using whole-genome sequencing data from 519 unrelated individuals with 22q11.2DS, we conducted genome-wide comparisons of common and rare variants between those with schizophrenia and those with no psychotic disorder at age ≥25 years. Available microarray data enabled direct comparison of polygenic risk for schizophrenia between 22q11.2DS and independent population samples with no 22q11.2 deletion, with and without schizophrenia (total n = 35,182). Polygenic risk for schizophrenia within 22q11.2DS was significantly greater for those with schizophrenia (padj = 6.73 × 10−6). Novel reciprocal case–control comparisons between the 22q11.2DS and population-based cohorts showed that polygenic risk score was significantly greater in individuals with psychotic illness, regardless of the presence of the 22q11.2 deletion. Within the 22q11.2DS cohort, results of gene-set analyses showed some support for rare variants affecting synaptic genes. No common or rare variants within the 22q11.2 deletion region were significantly associated with schizophrenia. These findings suggest that in addition to the deletion conferring a greatly increased risk to schizophrenia, the risk is higher when the 22q11.2 deletion and common polygenic risk factors that contribute to schizophrenia in the general population are both present. ispartof: Molecular Psychiatry vol:26 issue:8 pages:1-15 ispartof: location:England status: published

The concept of significant polyps and early colorectal cancer (SPECC) encompasses complex polyps not amenable to routine snare polypectomy or where malignancy cannot be excluded. Surgical resection (SR) offers definitive treatment, but is overtreatment for the majority which are benign and amenable to less invasive endoscopic resection (ER). The aim of this study was to investigate variations in the management and outcomes of significant colorectal polyps.This was a retrospective observational study of significant colorectal polyps, defined as nonpedunculated lesions of ≥ 20 mm size, diagnosed across nine UK hospitals in 2014. Inclusion criteria were endoscopically or histologically benign polyps at biopsy.A total of 383 patients were treated by primary ER (87.2%) or SR (12.8%). Overall, 108/383 (28%) polyps were detected in the Bowel Cancer Screening Programme (BCSP). Primary SR was associated with a significantly longer length of stay and major complications (P 0.01). Of the ER polyps, 290/334 (86.8%) patients were treated without undergoing surgery. The commonest indication for secondary surgery was unexpected polyp cancer, and of these cases 60% had no residual cancer in the specimen. Incidence of unexpected cancer was 10.7% (n = 41) and was similar between ER and SR groups (P = 0.11). On multivariate analysis, a polyp size of 30 mm and non-BCSP status were independent risk factors for primary SR [OR 2.51 (95% CI 1.08-5.82), P = 0.03].ER is safe and feasible for treating significant colorectal polyps. Robust accreditation within the BCSP has led to improvements in management, with lower rates of SR compared with non-BCSP patients. Standardization, training in polyp assessment and treatment within a multidisciplinary team may help to select appropriate treatment strategies and improve outcomes.

The faster pace of technological change is increasing the interest in studying the mechanisms of new products diffusion. Many ICT technologies have peculiar features and adoption behaviours, compared to typical "stand alone" products. Therefore, it is important to carry out an overview of diffusion models to understand ways of extending existing models to explain the most complex technologies. This paper covers the state of the art of the literature on the diffusion of innovations. In particular, the work focuses on fundamental concepts of technological diffusion, and on the main models that have characterized this literature. The review uses numerical and graphical examples to better explain the fundamental issues of diffusion, because ICT technologies are now an integral part of the daily life of people, societies and economies.

Follicular cysts develop from the enamel epithelium of an un-erupted tooth. Two cases of extremely large and extended follicular cysts related to the upper impacted third molars in young patients and treatments are described. Case 1 Female, aged 16 with swelling of the right cheek and oral vestibule, right exophthalmos and diplopia. Spiral Computed Tomography (CT) showed a massive lesion occupying the maxillary sinus with extension into the pterygo-maxillary space, due to the destruction of the posterior antral bone wall. Above the lesion was compressing the orbital floor. Transantral surgical excision was performed approaching to the pterygo-maxillary space and orbital structure also using the operating microscope. 5-years follow-up shows good restoring of the involved structures without relapse. Case 2 - Female, aged 22, with swelling of the left cheek and oral vestibule, left nasal obstruction, orbital pain and diplopia. Spiral CT-MR integrated study allowed a very accurate analysis: the lesion occupied the entire maxillary sinus, the pterygo-maxillary space, the left nasal cavity, ethmoidal structures with posterior orbital compression. Transantral surgical excision was performed approaching to the pterygo-maxillary space; nasal-ethmoidal and orbital structures were approached by endoscopic technique. Follow-up shows good clinical, anatomical and functional conditions. Histological examination confirmed in both cases the diagnosis of follicular cyst. Giant follicular cysts require an accurate preoperative study due to the delicate structures that may be involved. In the reported cases, the operating microscope and endoscopic surgical procedures were needed in the delicate surgical steps to perform the detachment in deep areas.

Objective To define the association between mandibular fractures and alterations of the cranio-atlo-axial joint (CAAJ). Methods 315 cases of displaced mandibular fractures were retrospectively evaluated by CT scan and cervical X-ray for associated alterations of the CAAJ. Statistical analysis employed the chi-square and Cohen's kappa coefficient. Results Single fractures amounted to 69.84% and multiple fractures to 30.16% of total fractures. CT scans showed a rotation of the atlas on the same side of single fractures and subluxation of the CAAJ. Vertical derangement of the joint was observed in 79.65% of single fractures and in 20.35% of multiple fractures. Approximately16.19% of all displaced mandibular fractures showed cervical disorders at long-term follow-up. Discussion The outcomes of this study revealed an association between traumatic mandibular fractures and CAAJ, accompanied by clinical disorders. These conditions require clinical attention due to their effects on long-term craniocervical functionality and future forensic issues.

Introduction Recent automated hematology analyzers (HAs) can identify and report nucleated red blood cells (NRBC) count as a separate population out of white blood cells (WBC). The aim of this study was to investigate the analytical performances of NRBC enumeration on five top of the range HAs. Methods We evaluated the within-run and between-day precision, limit of blank (LoB), limit of detection (LoD), and limit of quantitation (LoQ) of XE-2100 and XN-module (Sysmex), ADVIA 2120i (Siemens), BC-6800 (Mindray), and UniCel DxH 800 (Beckman Coulter). Automated NRBC counts were also compared with optical microscopy (OM). Results The limits of detection for NRBC of the BC-6800, XN-module, XE-2100, UniCel DxH 800, and ADVIA 2120i are 0.035×109/L, 0.019×109/L, 0.067×109/L, 0.038×109/L, and 0.167×109/L, respectively. Our data indicated excellent performance in terms of precision. The agreement with OM was excellent for BC-6800, XN-module, and XE-2100 (Bias 0.023, 0.019, and 0.033×109/L, respectively). ADVIA 2120i displayed a significant constant error and UniCel DxH 800 both proportional and small constant error. Conclusion Regards to NRBC counting, the performances shown by BC-6800, XN-module, and XE-2100 are excellent also a low count, ADVIA 2120i and UniCel DxH 800 need to be improved.

Objectives Congenital pulmonary lymphangiectasia (CPL) is a rare but fatal disorder of the lung. Case presentation We describe the case of an extremely low birth weight (ELBW) infant who presented with severe respiratory distress and recurrent bilateral pneumothorax. He died on day 17. The post-mortem examination of the lungs showed numerous cystic spaces, ranging from 1 to 2 mm in size, in the visceral pleura, in the thickened interlobular septum and hilum. A diagnosis of primary CPL was made. Conclusions We intend to underline that CPL, albeit rare, must be one of the differential diagnoses in infants with severe neonatal respiratory distress not responding to intensive care. Chronic interstitial lung diseases are a challenging diagnostic clinical problem, which requires a multidisciplinary approach. Histological lung examination may be useful to demonstrate the presence of CPL.