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Masonry arch railway bridges represent a historically built heritage to be preserved. The multidisciplinary approach requires the construction of a common language, namely the creation of a formal conceptualisation of bridge domain that could serve as basis for both adding new layers of knowledge in H-BIM modeling and aiding the automatic segmentation of masonry bridge point clouds, thus supporting the semi-automatic creation of information models. The presented research aims at showing the results of an in-depth analysis conducted on masonry arched bridges computational ontologies; following this, the authors propose a semantic conceptualization in the masonry bridge domain, structured with three group of key concepts needed in the process of knowledge: bridge elements, materials, and defects. As a case study the masonry bridges of the Sicilian Circumetnea railway are chosen.

Greinacher et al.1 and Schultz et al.2 were the first to independently report the main clinical and laboratory features of 11 and five respective patients from Germany, Austria and Norway who developed life-threatening thrombohemorrhagic complications 5 to 16 days after the administration of the first dose of the chimpanzee adenoviral vector vaccine ChAdOx1nCoV-19 against SARS-CoV-2 and COVID-19. Subsequently Scully et al.3 reported similar findings in 23 patients treated with the same vaccine in the United Kingdom. More recently, See et al.4 reported a case series of 12 patients from the USA with cerebral venous sinus thrombosis following the vaccination with Ad26.CoV2.S employing a human adenoviral vector. The main post-vaccination features common to the case series were the occurrence of venous thromboembolism mainly in unusual sites (cerebral and abdominal veins) and the concomitant presence of bleeding symptoms associated with severe thrombocytopenia, often accompanied by laboratory signs of consumption coagulopathy with low plasma fibrinogen and hugely increased levels of D-dimer. The majority of reported patients reacted positively for serum immunoglobulin G (IgG) antibodies to the platelet factor 4 PF4/heparin complex. 1-4 Another common feature was the high mortality rate. The mechanism of this very rare thrombohemorrhagic syndrome was postulated to be a vaccine-triggered autoimmune reaction, with the development of antibodies against a still ill-defined PF4/polyanion complex that causes platelet activation as in heparin-induced thrombocytopenia (HIT),1-4 notwithstanding the fact that no cases were exposed to heparin before the onset of thrombosis and thrombocytopenia. We report herewith the detailed post-mortem macroscopic and microscopic findings in two similar cases that occurred in the Italian region of Sicily.

Cholangiopathies are chronic diseases that affect the bile ducts, comprising a heterogeneous group of progressive and potentially fatal entities. The diagnosis of these diseases is a great challenge for radiologists because of the overlapping of their clinical, biochemical, and imaging findings. Nevertheless, identifying the precise etiology is crucial, given that the therapeutic options are distinct and influence the prognosis of the patient. The purpose of this review article is to discuss some of the non-neoplastic causes of cholangiopathies and to provide a useful diagnostic algorithm. Resumo As colangiopatias são doenças crônicas que afetam as vias biliares, constituindo um grupo heterogêneo de doenças progressivas e potencialmente fatais. O seu diagnóstico configura um grande desafio para os radiologistas, uma vez que seus aspectos clínicos, laboratoriais e de imagem se sobrepõem. Apesar disso, a busca etiológica é crucial, tendo em vista que as opções terapêuticas são distintas e influenciam o prognóstico do paciente. O objetivo deste artigo de revisão é discutir algumas das causas não neoplásicas de colangiopatias e fornecer um algoritmo útil na abordagem diagnóstica.

In this paper, the authors developed a capacitive-based sensor technology for high-range proximity detection, composed of multiple active units. The single sensor unit consists of a multi-layer compliant structure with a coplanar plate capacitor configuration. A prototype, composed of two single active units, was designed using, for each one, conductive electrodes printed on a polyimide layer and positioned in the middle of soft polymeric insulating substrates, either acting as shock-absorber and for sensor electrical and mechanical protection. For an in-depth theoretical analysis of the physical capacitive principle, a conditioning electronic circuit (i.e. data collection, conversion, amplification and filtering modules) was built in order to collect a digital voltage output proportional to the variable sensed capacitance. Experiments were performed to characterize the single capacitive sensor and the multi-unit sensor technology (i.e. curve of response, dynamic response, accuracy and precision). The results confirmed the outcomes originally achieved through FEM simulations and the effectiveness of the technology in high-range detection. Using a combination of two active sensor units, an operating range was achieved of up to 15 times the performance of a single commercial capacitive sensor with comparable dimensions.

The evaluation of inflammatory bowel activity in patients with Crohn’s disease has traditionally been a challenge, mainly because of the difficulty in gaining endoscopic access to the small bowel. Historically, barium-based contrast studies were the only option for the evaluation of inflammatory activity in Crohn’s disease. They were gradually replaced by cross-sectional imaging techniques, computed tomography enterography (CTE) and magnetic resonance enterography (MRE) now being the modalities of choice for such evaluations. Those two imaging methods have provided important information regarding intestinal wall involvement and extra-intestinal manifestations of Crohn’s disease, not only assessing lesion characteristics and complications but also quantifying inflammatory bowel activity. The objective of this article is to review the main technical aspects of CTE and MRE, together with their indications, contraindications, and limitations, as well as the CTE and MRE imaging characteristics of inflammatory activity in Crohn’s disease. Resumo A avaliação da atividade inflamatória intestinal em pacientes com doença de Crohn tem sido tradicionalmente um desafio, principalmente pela dificuldade do acesso endoscópico ao intestino delgado. Por muito tempo os estudos baritados foram a única opção disponível, tendo sido progressivamente substituídos por novas técnicas de imagens seccionais, sendo hoje a enterografia por tomografia computadorizada (entero-TC) e por ressonância magnética (entero-RM) as modalidades de escolha para essa avaliação. Esses dois métodos de imagem acrescentam informações importantes quanto ao acometimento da parede intestinal e às manifestações extraintestinais relacionadas à doença de Crohn, avaliando não somente as características das lesões e as complicações, mas também quantificando a atividade inflamatória intestinal. O objetivo deste artigo é revisar os principais aspectos técnicos dos exames, as suas indicações, contraindicações, limitações e características de imagem da entero-TC e entero-RM na avaliação da atividade inflamatória da doença de Crohn.

ObjectiveAge is considered a negative prognostic factor for High Grade Gliomas (HGGs) and many neurosurgeons remain skeptical about the benefits of aggressive treatment. New surgical and technological improvements may allow extended safe resection, with lower level of post-operative complications. This opportunity opens the unsolved question about the most appropriate HGG treatment in elderly patients. The aim of this study is to analyze if HGG maximal safe resection guided by an intraoperative multimodal imaging protocol coupled with neuromonitoring is associated with differences in outcome in elderly patients versus younger ones.MethodsWe reviewed 100 patients, 53 (53%) males and 47 (47%) females, with median (IQR) age of 64 (57; 72) years. Eight patients were diagnosed with Anaplastic Astrocytoma (AA), 92 with Glioblastoma (GBM). Surgery was aimed to achieve safe maximal resection. An intraoperative multimodal imaging protocol, including neuronavigation, neurophysiological monitoring, 5-ALA fluorescence, 11C MET-PET, navigated i-US system and i-CT, was used, and its impact on EOTR and clinical outcome in elderly patients was analyzed. We divided patients in two groups according to their age: 65 years, and surgical and clinical results (EOTR, post-operative KPS, OS and PFS) were compared. Yet, to better understand age-related differences, the same patient cohort was also divided into 70 years and all the above data reanalyzed.ResultsIn the first cohort division, we did not found KPS difference over time and survival analysis did not show significant difference between the two groups (p = 0.36 for OS and p = 0.49 for PFS). Same results were obtained increasing the age cut-off for age up to 70 years (p = 0.52 for OS and p = 0.92 for PFS).ConclusionsOur data demonstrate that there is not statistically significant difference in post-operative EOTR, KPS, OS, and PFS between younger and elderly patients treated with extensive tumor resection aided by a intraoperative multimodal protocol.

Background and objectives Renin-angiotensin system (RAS) inhibitors reduce cardiovascular morbidity and mortality in patients with CKD. We evaluated the cardioprotective effects of the angiotensin-converting enzyme inhibitor ramipril in patients on maintenance hemodialysis. Design, setting, participants, & measurements In this phase 3, prospective, randomized, open-label, blinded end point, parallel, multicenter trial, we recruited patients on maintenance hemodialysis with hypertension and/or left ventricular hypertrophy from 28 Italian centers. Between July 2009 and February 2014, 140 participants were randomized to ramipril (1.25–10 mg/d) and 129 participants were allocated to non-RAS inhibition therapy, both titrated up to the maximally tolerated dose to achieve predefined target BP values. The primary efficacy end point was a composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included the single components of the primary end point, new-onset or recurrence of atrial fibrillation, hospitalizations for symptomatic fluid overload, thrombosis or stenosis of the arteriovenous fistula, and changes in cardiac mass index. All outcomes were evaluated up to 42 months after randomization. Results At comparable BP control, 23 participants on ramipril (16%) and 24 on non-RAS inhibitor therapy (19%) reached the primary composite end point (hazard ratio, 0.93; 95% confidence interval, 0.52 to 1.64; P=0.80). Ramipril reduced cardiac mass index at 1 year of follow-up (between-group difference in change from baseline: −16.3 g/m2; 95% confidence interval, −29.4 to −3.1), but did not significantly affect the other secondary outcomes. Hypotensive episodes were more frequent in participants allocated to ramipril than controls (41% versus 12%). Twenty participants on ramipril and nine controls developed cancer, including six gastrointestinal malignancies on ramipril (four were fatal), compared with none in controls. Conclusions Ramipril did not reduce the risk of major cardiovascular events in patients on maintenance hemodialysis. Clinical Trial registry name and registration number: ARCADIA, NCT00985322 and European Union Drug Regulating Authorities Clinical Trials Database number 2008–003529–17.

Although most cysts of the male pelvis are benign and do not need treatment, some cysts may cause complications or have potential for malignancy, and using a workflow can help determine the most ap...

The proposal of reclassifying the mesentery as an organ prompts clinicians and radiologists to reappraise their approach to it and to mesenteric diseases (mesenteropathies). Recent updates in mesenteric anatomy and the better comprehension of its structure constitute a basis to push forward the process of disease management and allow the development of less radical (including endoscopic, radiological, and pharmacotherapeutic) treatments. Radiological evaluation currently plays a pivotal role in the noninvasive characterization of abdominal diseases. Mesenteric-based radiological assessments form an essential component in planning radiological interventions and postoperative surveillance programs. The purpose of this article, therefore, is to provide an update on the new anatomical concepts related to the mesentery, also performing an imaging-based review of mesenteric diseases by categorizing them as primary and secondary.

Synaptic Ras GTPase-activating protein 1 (SYNGAP1) is abundantly expressed in the postsynaptic space in brain tissue and has a crucial role in the regulation of the excitatory/inhibitory balance and in brain development. It is estimated that SYNGAP1 loss of function variants have an incidence of 1 to 4/10,000 individuals, mostly occurring de novo, even if few cases of vertical transmission of mosaic mutations have been reported. Loss-of-function mutations within this gene have been related with an epileptic encephalopathy characterized by eyelid myoclonia with absences (EMA) and myoclonic-atonic seizures (MAE) with early onset, commonly resistant to antiepileptic drugs (AED). Epilepsy is often associated with other clinical features, including truncal and/or facial hypotonia and/or ataxia with a wide-based and unsteady gate. Other clinical signs are intellectual disability, developmental delay, and behavioral and speech impairment, in a context of a normal neuroimaging study. In selected cases, dysmorphic features, skeletal abnormalities, and eye involvement are also described. The diagnosis of the disorder is usually established by multigene panel and, in unsolved cases, by exome sequencing. Management of the affected individuals involves different specialists and is mainly symptomatic. No clinical trials about the efficacy of AED in SYNGAP1 encephalopathy have been performed yet and Lamotrigine and valproate are commonly prescribed. In more than half of cases, however, epilepsy is refractory to AED.

Membranous nephropathy represents the most frequent cause of nephrotic syndrome in the adult, leading to end-stage renal disease in one third of all the patients. In the last years, the discovery of circulating autoantibodies against phospholipase A2 receptor 1 (PLA2R) and thrombospondin type-1 containing 7A domain (THSD7A), shed light on the pathogenesis of idiopathic forms, being responsible for 70% and 3% of all the cases, respectively. These identifications allowed the development of serological and histologic tests to detect autoantibodies and relative targets for diagnostic and prognostic purposes. Rising evidences suggest that serum titer correlates with disease activity and response to therapy. For these reasons, for patients with nephrotic syndrome, a serum-based approach has been proposed, reserving renal biopsy only in cases with doubtful/negative serology. However, the recent introduction of useful criteria for the interpretation of PLA2R/THSD7A immunohistochemistry could lead to high values of sensitivity and specificity for the in situ detection of target antigens. The present multicentric study on a series of membranous nephropathy cases with available serum/histologic correlation will show the importance of the crosstalk among the different techniques, recovering the possible role of electron microscopy in challenging situations.

The Middle East is known for its complex history and rich environment and culture. The region is home to a wide variety of traditions, cultures and religions, which have made the area vulnerable to political conflicts. Despite these difficulties, science and medicine have always thrived in the region, with many medical practices and principles established by physicians and scholars living in the Middle East. The first academic neurosurgical activity in the region started in the 1950s. The first women neurosurgeons in the Middle East started training in the 1970s, and were from Iran, Palestine, followed by Saudi Arabia in the 1970s. These pioneers have encountered serious challenges, yet have become role models for the next generation. These women have paved the way and facilitated neurosurgical training and practice for more women surgeons. The gradual increase in the number of women neurosurgical residents in the region leads to the expectation that women will play a more prominent role in the future as leaders in neurosurgery in the Middle East. This collaborative study, which identifies the known women neurosurgeons in the Middle East for the first time, may serve to provide background and context for further contributions of women neurosurgeons for our profession and our patients.

Recently, a disorder caused by the heterozygous de novo c.1267C>T (p.R423*) substitution in SLC37A4 has been described. This causes mislocalization of the glucose-6-phosphate transporter to the Golgi leading to a congenital disorder of glycosylation type II (SLC37A4-CDG). Only one patient has been reported showing liver disease that improved with age and mild dysmorphism. Here we report the second patient with a type II CDG caused by the same heterozygous de novo c.1267C>T (p.R423*) mutation thereby confirming the pathogenicity of this variant and expanding the clinical picture with type 1 diabetes, severe scoliosis, and membranoproliferative glomerulonephritis. Additional clinical and biochemical data provide further insight into the mechanism and prognosis of SLC37A4-CDG. keywords: CDG, G6PT1, glycogen storage disease, glycosylation, hepatopathy, SLC37A4 ispartof: JIMD Reports vol:58 issue:1 pages:122-128 ispartof: location:United States status: published

Despite being classically reported as caused by mutations in solute carriers genes (SLC2A1), it has been recently shown that also mutations in ALDH7A1 can cause pyridoxine-dependent epilepsy (PDE). ALDH7A1 is a gene encoding for the antiquitin, an enzyme that catalyzes the nicotinamide adenine dinucleotide-dependent dehydrogenation of L-α-aminoadipic semialdehyde/L-Δ1-piperideine 6-carboxylate. It is a highly treatable disorder, but nevertheless it is still not certain when to consider this diagnosis and how to test for it. It is possible to identify a classical form and an atypical one of PDE associated with more than 70 mutations of ALDH7A1 gene. The typical form is characterized by the onset of seizures within the first month of life and can be treated with pyridoxine in monotherapy, as they are not responsive to traditional anticonvulsant therapy. The atypical forms are equally pyridoxine-dependent, but are characterized by a later onset of seizures, sometimes up to the age of 3 years. Several brain abnormalities have been associated with ALDH7A1 mutations. Seizure control is achieved by the administration of high-dose pyridoxine, which must be started in the patient as soon as possible. However, it has been observed that pyridoxine therapy does not prevent developmental delay in most cases; in these cases, it can be recommended and useful to supplement arginine with pyridoxine therapy associated with a dietary restriction of lysine.

We aimed to identify clinical, molecular and radiological correlates of activities of daily living (ADL) in patients with cerebellar atrophy caused by PMM2 mutations (PMM2-CDG), the most frequent congenital disorder of glycosylation. Twenty-six PMM2-CDG patients (12 males; mean age 13 ± 11.1 years) underwent a standardized assessment to measure ADL, ataxia (brief ataxia rating scale, BARS) and phenotype severity (Nijmegen CDG rating scale, NCRS). MRI biometry of the cerebellum and the brainstem were performed in 23 patients (11 males; aged 5 months–18 years) and 19 control subjects with equal gender and age distributions. The average total ADL score was 15.3 ± 8.5 (range 3–32 out of 36 indicating severe functional disability), representing variable functional outcome in PMM2-CDG patients. Total ADL scores were significantly correlated with NCRS (r2 = 0.55, p < 0.001) and BARS scores (r2 = 0.764; p < 0.001). Severe intellectual disability, peripheral neuropathy, and severe PMM2 variants were all significantly associated with worse functional outcome. Higher ADL scores were significantly associated with decreased diameters of cerebellar vermis (r2 = 0.347; p = 0.004), hemispheres (r2 = 0.436; p = 0.005), and brainstem, particularly the mid-pons (r2 = 0.64; p < 0.001) representing the major radiological predictor of functional disability score in multivariate regression analysis. We show that cerebellar syndrome severity, cognitive level, peripheral neuropathy, and genotype correlate with ADL used to quantify disease-related deficits in PMM2-CDG. Brainstem involvement should be regarded among functional outcome predictors in patients with cerebellar atrophy caused by PMM2-CDG.

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by a multisystemic involvement. In TSC, reduced function of TSC1 and TSC2 genes products (hamartin and tuberin, respectively) leads to an hyperactivation of the mechanistic target of rapamycin (mTOR) pathway and to a consequent cell growth dysregulation. In TSC patients, neurological and neuropsychiatric manifestations, especially epilepsy and neuropsychiatric comorbidities such as autism or intellectual disability, represent the most disabling features. In particular, epilepsy occurrs up to 80% of patients, is often drug resistant and is frequently associated with neurological impairment. Due to the burden of this morbidity, different treatment strategies have been proposed with the purpose to make patients epilepsy free, such as the use of different antiepileptic drugs like vigabatrin, carbamazepine, valproic acid, and levetiracetam. More recently, a mTOR inhibitor (i.e. everolimus) has showed promising results in terms of seizures reduction.

Neurofibromatosis 1 has an incidence of 1 in 2600 to 3000 individuals and represents the most frequent form of neurofibromatosis. Inherited from parents in 50% of cases and consequent to de novo mutations in the remaining half, it is an age-penetrating disorder that affects many of the body systems and in particular the nervous system; lifelong follow-up is necessary to monitor the development of clinical manifestations. Due to its numerous implications and challenging complexity, NF management should preferably be the prerogative of multidisciplinary specialist clinics. NF referral centres should also have an active role in providing education to patients and their families as well as in enforcing prevention strategies.

This study shows the results of an interdisciplinary research aimed at devising artificial intelligence methods to support data understanding in Cultural Heritage. The objective is to create automated methods for automatically classifying and successively retrieving photographic data leveraging the current breed of AI methods based on Deep Learning paradigm. In this work, the lack of images to be used for the training of the AI system is addressed by testing an approach based on Generative Adversarial Networks (GANs) for automatically synthesizing unrealistic photos, which, in turn, can be used for training image classification and retrieval systems. Specifically, we propose a method to drive the generation of realistic classical order images using GAN approaches anchored to semantic ontology domain representation. More specifically, the proposed AI leverages the advantages of knowledge-based and data-driven methods and foresees a level image generation: the first one that synthesizes isolated objects corresponding to each ontology concept and the second one that, instead, combines the generated objects according to the spatial information provided by the ontology in order to generate realistic scenes. The resulting images can then be employed to train automated classifiers and more reliable retrieval methods by minimizing the efforts usually required by human operators to manually annotate data. In addition, the proposed generative strategy allows for a deeper understanding of cultural heritage visual data enabling the possibility to enhance design capabilities in simulation contexts.

Epileptic encephalopathy is a condition in which seizures, electroencephalographic epileptiform abnormalities lead to a progressive deterioration of brain functions causing a significant psychomotor delay. One of the typical features of this heterogeneous and large group of severe disorders is the extremely early onset of seizures. The main causes of the epileptic encephalopathies include structural brain defects, inherited metabolic disorders; in this aspect, more than 100 genetic defects, including mutations in the solute carrier family 25 (SLC25A22) gene which encodes a mitochondrial glutamate carrier. To date, the main clinical phenotypes related to mutations of this gene are Ohtahara syndrome (or early infantile epileptic encephalopathy), early myoclonic encephalopathy and migrating partial seizures in infancy. In all the cases, prognosis is poor and no disease-modifying treatment is available in the present days.

Malignant peripheral nerve sheath tumours (MPNSTs) are aggressive neoplasms classified as soft tissue sarcomas. Extremely rare in the general population, they are frequently detected in neurofibromatosis type 1 (NF1) patients with a higher incidence, earlier onset and often worse prognosis.

Background: Nontuberculous mycobacteria (NTM) represents an important cause of infection, particularly in immunocompromised patients. Spondylodiscitis is unusual and may be associated with underlying causes such as drug abuse. Timely diagnosis and treatment are critical, as without this, patients will demonstrate progressive neurological deterioration. Here, we present a rare case of Mycobacterium mucogenicum spondylodiscitis in a 36-year-old male, along with a focused literature review. Case Description: A 36-year-old female with previous drug abuse presented with 3-years of progressive thoracolumbar pain. The MRI of the spine revealed paravertebral abscesses from Th10–L1 with vertebral lesions involving Th11–Th12 levels (e.g., vertebral body collapse/deformity and destruction of the posterior vertebral walls). After a needle CT-guided biopsy of the paravertebral tissues, real time-polymerase chain reaction (RT-PCR) amplification documented NTM; the final identification was M. mucogenicum. The patient then underwent a Th11–Th12 decompressive laminectomy, facetectomy, granulomatous tissue debridement, and posterior pedicle screw fusion from Th8–Th10, and L1–L3. Postoperatively, the patient’s pain resolved, and she was left with residual lower extremities dysesthesias; 6-months later, she could walk without assistance. Conclusion: Spondylodiscitis caused by M. mucogenicum is rare, and the medical and surgical treatment is comparable to that for other NTM groups.

OBJECTIVENo consensus exists on the best treatment for recurrent high-grade glioma (HGG), particularly in terms of surgical indications, and scant data are available on the integrated use of multiple technologies to overcome intraoperative limits and pitfalls related to artifacts secondary to previous surgery and radiotherapy. Here, the authors report on their experience with the integration of multiple intraoperative tools in recurrent HGG surgery, analyzing their pros and cons as well as their effectiveness in increasing the extent of tumor resection. In addition, they present a review of the relevant literature on this topic.METHODSThe authors reviewed all cases in which recurrent HGG had been histologically diagnosed after a first surgery and the patient had undergone a second surgery involving neuronavigation with MRI, intraoperative CT (iCT), 11C-methionine–positron emission tomography (11C-MET-PET), 5-aminolevulinic acid (5-ALA) fluorescence, intraoperative neurophysiological monitoring (IONM), and intraoperative navigated ultrasound (iUS). All cases were classified according to tumor functional grade (1, noneloquent area; 2, near an eloquent area; 3, eloquent area).RESULTSTwenty patients with recurrent HGG were operated on using a multimodal protocol. The recurrent tumor functional grade was 1 in 4 patients, 2 in 8 patients, and 3 in the remaining 8 patients. In all patients but 2, 100% EOTR was obtained. Intraoperative 5-ALA fluorescence and navigated iUS showed low specificity and sensitivity. iCT detected tumor remnants in 3 cases. Postoperatively, 6 patients (30%) had worsening neurological conditions: 4 recovered within 90 days, 1 partially recovered, and 1 experienced a permanent deficit. The median Karnofsky Performance Status remained substantially unchanged over the follow-up period. The mean progression-free survival after the second surgery was 7.7 months (range 2–11 months). The mean overall survival was 25.4 months (range 10–52 months), excluding 2 long survivors. Two patients died within 60 days after surgery, and 3 patients were still under follow-up at the end of this study.CONCLUSIONSThis is the first study reporting the integration of neuronavigation, 5-ALA fluorescence, iUS, iCT, 11C-MET-PET, and IOM during microsurgical resection of recurrent glioma. The authors believe that the proposed multimodal protocol is useful to increase the safety, effectiveness, and EOTR in patients with recurrent HGG and brain alterations secondary to radio- and chemotherapy.

Objective: To evaluate the accuracy of steady-state free precession (SSFP) unenhanced magnetic resonance angiography (MRA) at 1.5 T for the identification of multiple renal arteries, using computed tomography angiography (CTA) as the reference standard. Materials and Methods: This was a prospective study involving 39 patients (26 males; mean age, 62.6 years) who underwent CTA and unenhanced MRA to evaluate the proximal and middle segments of the renal arteries. The analysis was performed in two phases: the quality of unenhanced MRA images was classified as diagnostic or nondiagnostic for the presence of multiple renal arteries by two independent readers; two other independent readers then evaluated the images previously classified as being of diagnostic quality. The sensitivity, specificity, and overall accuracy of unenhanced MRA were calculated, CTA being used as the reference standard. The kappa statistic was used in order to calculate interobserver agreement. Results: The image quality of unenhanced MRA was considered diagnostic in 70-90% of the extrarenal arterial segments. The CTA examination revealed 19 multiple renal arteries (8 on the right and 11 on the left). The accuracy of unenhanced MRA for the identification of multiple renal arteries was greater than 90%, with a sensitivity of 72.7-100% and a specificity of 96.3-100%. Conclusion: Unenhanced MRA provides high quality imaging of the extrarenal segments of renal arteries. This method may be used as an alternative for the evaluation of the renal arteries, given that it has an accuracy comparable to that of CTA. Resumo Objetivo: Avaliar, prospectivamente, a acurácia da angiografia por ressonância magnética (angio-RM) sem contraste, com a sequência steady-state free precession (SSFP) 1,5 T, para a identificação de artérias renais múltiplas, usando para isso a angiografia por tomografia computadorizada (angio-TC) como padrão de referência. Materiais e Métodos: Trinta e nove pacientes (26 do sexo masculino; idade média de 62,6 anos) foram submetidos a angio-TC e angio-RM para avaliação dos segmentos proximais e médios das artérias renais. A análise dividiu-se em duas partes: inicialmente, a qualidade das imagens de angio-RM foi classificada como diagnóstica ou não diagnóstica por dois avaliadores independentes; posteriormente, outros dois avaliadores analisaram as imagens consideradas diagnósticas quanto à presença de múltiplas artérias renais. Sensibilidade, especificidade e acurácia da angio-RM foram calculadas utilizando-se a angio-TC como referência. Estatística kappa foi utilizada para cálculo da concordância interobservador. Resultados: A qualidade das imagens de angio-RM foi considerada diagnóstica em 70-90% dos segmentos arteriais extrarrenais. A angio-TC revelou 19 artérias renais múltiplas (8 direitas e 11 esquerdas). A acurácia da angio-RM para identificação de artérias renais múltiplas foi maior que 90%, com sensibilidade variando de 72,7% a 100% e especificidade variando de 96,3% a 100%. Conclusão: A angio-RM sem contraste proporciona imagens de alta qualidade dos segmentos extrarrenais das artérias renais. Este método pode ser alternativamente utilizado para avaliação renal, com acurácia comparável à da angio-TC.

Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors with distinct morphological and biological manifestations, the liver being the main organ affected by its metastases. However, primary hepatic involvement is quite rare. Hepatic NENs can have a variety of radiological presentation forms and can therefore mimic other lesions, making their diagnosis challenging. Nonetheless, certain imaging aspects allow NENs to be included among the main differential diagnoses of hepatic lesions and can guide the search for an extrahepatic primary site when the probable diagnosis is metastases. As neoplasias neuroendócrinas (NNEs) são um grupo heterogêneo de tumores com manifestações morfológicas e biológicas distintas, sendo o fígado o principal órgão acometido por suas metástases. Por outro lado, o acometimento primário deste órgão é muito raro. Podem-se observar as mais diversas formas de apresentação radiológica das NNEs hepáticas primária e secundária e, em razão dessa variedade e por mimetizar outras lesões, o seu diagnóstico pode se revelar um desafio. No entanto, alguns desses aspectos permitem incluir as NNEs entre os principais diagnósticos diferenciais de lesões hepáticas e, nos casos de metástases, orientar na busca de um eventual sítio primário extra-hepático.

Background and Aims According to local resources, different vascular access (VA) procedures are employed in every country. In Italy, high variability exists in VA management among different dialysis units. In 2018, the DOPPS 5 study showed a declining prevalence of lower arm arteriovenous fistulas (AVF) in Europe with an increasing tendency of making upper arm AVFs and placing central venous catheters (CVCs). Accordingly, an Italian Survey in 2013 confirmed an increasing trend in CVCs use among different Italian regions. Hence, we made an epidemiologic, multicenter study to evaluate a possible relation between this trend and the variability of local VA management policies. Method VA data from 236 patients of prevalent patients were collected from five dialysis centers in the South of Italy. The prevalence of the various types of VAs was analyzed in relation to the following different VA surgery policies adopted in the participant centers: Results Age of patients was comparable among all centers while dialysis vintage was higher in center A (P Conclusion The reduced tendency of lower arm fistulas and the increasing prevalence of CVCs showed by the DOPPS 5 study might not be applicable to all Italian regions. In our study of 5 dialysis units in the South of Italy, the stability of the nephrologist’s surgical activity probably played a crucial role in explaining the observed decreased use of CVCs with a steadily high prevalence (over 70%) of the lower arm fistulas, regardless of aging.

Introduction: The Coronavirus pandemic that started in December 2019 is mainly related to clinical pictures consistent with respiratory symptoms; nevertheless, reports about neurological complications have recently appeared in the medical literature.The case: we describe a case of a 36 years old Coronavirus-positive patient that was admitted on emergency basis; his clinical presentation included neurological symptoms such as drowsiness and mild confusion. Imaging revealed findings consistent with meningoencephalitis complicated by intracerebral hematoma and subdural hematoma. The latter was surgically evacuated after it became chronic and evidence of Coronavirus was found in the fluid. Conclusion: our experience confirms that neurological complications might be a likely event in COVID-19. Although uncommon, the possible occurrence of meningoencephalitis should be kept in mind by physicians involved in the management of COVID-19 patients. Early recognition of brain involvement may provide better prognosis, preventing evolution into intracerebral hemorrhagic events.

The current challenge worldwide is the administration of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. Even if rarely, severe vascular adverse reactions temporally related to vaccine administration have induced diffidence in the population at large. In particular, researchers worldwide are focusing on the so-called “thrombosis and thrombocytopenia after COVID-19 vaccination”. This study aims to establish a practical workflow to define the relationship between adverse events following immunization (AEFI) and COVID-19 vaccination, following the basic framework of the World Health Organization (WHO). Post-mortem investigation plays a pivotal role to support this causality relationship when death occurs. To demonstrate the usefulness and feasibility of the proposed workflow, we applied it to two exemplificative cases of suspected AEFI following COVID-19 vaccination. Based on the proposed model, we took into consideration any possible causality relationship between COVID-19 vaccine administration and AEFI. This led us to conclude that vaccination with ChAdOx1 nCov-19 may cause the rare development of immune thrombocytopenia mediated by platelet-activating antibodies against platelet factor 4 (PF4), which clinically mimics heparin-induced autoimmune thrombocytopenia. We suggest the adoption of the proposed methodology in order to confirm or rule out a causal relationship between vaccination and the occurrence of AEFI.

Speckled lentiginous nevus syndrome is a rare neurocutaneous phenotype, characterized by a specked lentiginous nevus, appearing as a light brown macule superimposed by multiple melanocytic nevi in the form of macules or papules with uneven distribution, associated with ipsilateral neurological and musculoskeletal abnormalities (i.e., dysesthesia, hyperhidrosis, and musculoskeletal abnormalities) occur. It represents a mosaic phenotype disorder resulting from postzygotic loss of heterozygosity, due to a localized defect in neural crest melanoblasts that originate certain areas of the skin and some ipsilateral neurological and musculoskeletal cells. Environmental and genetic factors may also play a role, but it has not been clarified how these factors behave in this syndrome.

Encephalocraniocutaneous lipomatosis is a sporadic, congenital neurocutaneous disorder characterized by the involvement of skin, central nervous system, and eye. A non-hereditary, autosomal mutation that may survive only in a mosaic state may be the cause of the clinical picture of the syndrome. Less than 80 patients have been so far reported and their clinical manifestations consisted of unilateral lipomatous hamartoma of the scalp or eyelid, epibulbar choristomas, and ipsilateral brain malformations. There is no clinical correlation between the severity of brain malformations and the clinical manifestations, and many patients with extremely extensive cerebral abnormalities are only minimal symptomatic. Seizures and mental retardation may also occur. The natural history is often favorable, without drug-resistant seizures and normal intelligence in most of the cases.

The upper urinary tract is the most common human system affected by congenital anomalies. Congenital anomalies of the kidneys and ureters comprise a wide spectrum of disorders ranging from simple variants with no clinical significance to complex anomalies that may lead to severe complications and end-stage renal disease. They may be classified as anomalies of renal form, which are subclassified as structural anomalies (eg, persistent fetal lobulation, hypertrophied column of Bertin, and dromedary hump) and fusion anomalies (eg, horseshoe kidney and pancake kidney); anomalies of renal position (eg, renal malrotation, simple renal ectopia, and crossed renal ectopia) and renal number (eg, renal agenesis and supernumerary kidney); and abnormalities in development of the urinary collecting system (eg, pyelocaliceal diverticulum, megacalycosis, ureteropelvic junction obstruction, duplex collecting system, megaureter, ectopic ureter, and ureterocele). US is usually the first imaging modality used because of its low cost, wide availability, and absence of ionizing radiation. Intravenous urography and voiding cystourethrography are also useful, mainly for characterization of the collecting system and vesicoureteral reflux. However, intravenous urography has been replaced by CT urography and MR urography. These imaging methods not only allow direct visualization of the collecting system but also demonstrate the function of the kidneys, the vascular anatomy, adjacent structures, and complications. Comprehension of congenital anomalies of the upper urinary tract is crucial for an accurate diagnosis and correct management. The authors discuss the spectrum of these anomalies, with emphasis on embryologic development, imaging findings, clinical manifestations, and complications.

We describe the clinical and whole genome sequencing (WGS) study of a non-consanguineous Italian family in which two siblings, a boy and a girl, manifesting a severe epileptic encephalopathy (EE) with skeletal abnormalities, carried novel SLC35A3 compound heterozygous mutations. Both siblings exhibited infantile spasms, associated with focal, and tonic vibratory seizures from early infancy. EEG recordings showed a suppression-burst (SB) pattern and multifocal paroxysmal activity in both. In addition both had quadriplegia, acquired microcephaly, and severe intellectual disability. General examination showed distal arthrogryposis predominant in the hands in both siblings and severe left dorso-lumbar convex scoliosis in one. WGS of the siblings-parents quartet identified novel compound heterozygous mutations in SLC35A3 in both children. SLC35A3 encodes the major Golgi uridine diphosphate N-acetylglucosamine transporter. With this study, we add SLC35A3 to the gene list of epilepsies. Neurological symptoms and skeletal abnormalities might result from impaired glycosylation of proteins involved in normal development and function of the central nervous system and skeletal apparatus.

Background Individuals with severe mental illness (SMI) may be considered violent, but in most cases they are victims. Substance abuse, a clinical history of violence and gender are among the main risk factors for aggressive behavior. To date, evidence on the mechanisms involved in violent behavior in SMI is still scarce and controversial. From a neuropsychological point of view, the deficits in executive functions, may be a key element in increasing propensity to violence. Methods Sample: 50 offender SMI patients recruited at the Residence for the Execution of Security Measures (REMS) of Castiglione d/S (case group) and 35 non-offender SMI patients recruited at the Department of Mental Health and Addictive Disorders of Brescia (control group). Match 1: 1 by gender, education and main diagnosis. An interview was given to collect the anamnestic data. All patients were assessed with clinical (CGI-S, PANSS-EC), neurocognitive (TMT, SCWT, BACS), social cognitive (FEIT), psychosocial functioning / wellness (MCH-SF, PSP), impulsiveness (BIS-11, IGT) and aggressive behaviour risk assessment (MOAS, HCR-20, PCL-R) measures. Results The two groups appeared to be significantly different as far as the total scores for both HCR-20 and PCL-R, with REMS patients have significant higher values. HCR-20 and PCL-R showed a significant predictive value independent of each other, in determining membership of the case group or control group. In particular, each additional point in the HCR-20 increased the probability of belonging to the case group of 1.8, while each additional point at the PCL-R increased this probability by 1.3. Significant differences were observed regarding the CGI-S and the PANSS-EC scores, where REMS patients had, at the same diagnosis, more severe psychopathology. PANSS-EC, BACS token test and SCWT errors showed a significant independent predictive value in HCR-20 score. In particular, for each additional point at the PANSS-EC, the HCR-20 increased 1 point, while this score is reduced by 0.16 for each additional point to the BACS token test and 0.42 for each additional point to the SCWT errors. Considering the cognitive profile, poorer performances were found in the offenders patients in the TMT-A and the BACS token exercise, indicating greater deficits in both visuomotor speed and attention. Regarding school performance (a possible proxy of cognitive reserve), the two groups appeared significantly different for the number of failures (p Discussion Results of the present study highlight that offenders patients with SMI have higher levels of clinical, cognitive and friends relationships severity, but better social cognition skills and a higher degree of perceived well-being. The greatest number of failures in REMS patients could be due to a greater impairment of cognitive function from an early stage of the disease. Even if the majority of crimes is carried out against the family members, family relationships do not present differences between the two groups. Although preliminary, these results could help clinicians to better understand offenders patients with SMI and to identify more homogeneous subgroups of patients, in order to plan more tailored care pathways.

ObjectiveTo describe the case of an African patient who was diagnosed with cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL).MethodsCase report and literature review.ResultsWe present a 39-year-old Gabonese man who developed progressive gait difficulty at the age of 32, followed by insidious tetraparesis, urinary sphincter disturbance, spastic dysarthria, cognitive dysfunction, and seizures. Brain imaging was performed many years after disease onset and revealed diffuse confluent white matter lesions and lacunar infarcts. He tested negative for acquired white matter disease, but genetic screening detected a genetic variant of HTRA1 gene (G283R), which has not been previously reported.ConclusionsCARASIL is a disease that usually affects Asian patients. This case report describes a unique case of an African patient diagnosed with CARASIL and a novel genetic mutation in HTRA1 that has not been previously described in the literature.

Hepatic lymphoma can be divided into its primary and secondary forms. To be classified as primary hepatic lymphoma, the disease should be limited to the liver and hilar lymph nodes, with no distant involvement (to the bone marrow or other sites). Primary hepatic lymphoma is quite rare, accounting for less than 1% of all cases of non-Hodgkin lymphoma, whereas secondary hepatic lymphoma affects nearly half of such cases. Familiarity with the imaging features of hepatic lymphoma is important for its early diagnosis and appropriate management. In this essay, we aim to review the roles of computed tomography and magnetic resonance imaging in identifying and monitoring hepatic lymphomas, using sample cases to describe and illustrate the wide spectrum of imaging findings in the primary and secondary forms of this disorder.O linfoma hepático pode ser dividido em primário e secundário. Para ser classificada como linfoma hepático primário, a doença deve estar limitada ao fígado e linfonodos hilares, sem acometimento de outros órgãos (incluindo a medula óssea). O linfoma hepático primário é muito raro, correspondendo a menos de 1% de todos os linfomas não Hodgkin. Já o envolvimento secundário do fígado ocorre em quase metade dos casos de linfoma não Hodgkin. O conhecimento dos aspectos de imagem do linfoma hepático é importante para o diagnóstico precoce e manejo adequado do paciente. Com base em imagens de casos, nosso objetivo é revisar o papel da imagem por tomografia computadorizada e ressonância magnética na identificação e segmento do linfoma hepático, ilustrando e descrevendo o amplo espectro de achados de imagem observados nas formas primária e secundária da doença.

ASTRI-Horn is a prototypal telescope of an imaging atmospheric Cherenkov telescope developed by the Italian National Institute of Astrophysics (INAF), proposed for the Cherenkov Telescope Array (CTA) Observatory. The CTA Observatory represents the next generation of imaging atmospheric Cherenkov telescopes and will explore the very highenergy domain from a few tens of GeV up to few hundreds of TeV. It will be composed of large-, medium-, and small sized telescopes; ASTRI-Horn is an end-to-end prototype proposed for the Small Sized array. The main scientific instrument of the ASTRI-Horn telescope is an innovative and compact Camera with Silicon- Photomultiplier based detectors and a specifically designed fast read-out electronics based on a custom peak-detector mode. The thermo-mechanical assembly is designed to host both the entire electronics chain, from the sensors to the raw data transmission system and the calibration system, and the complete thermoregulation system. This contribution gives a high level description of the T/M and electrical design of the Cherenkov Camera, it describes the assembling procedure of its different subsystems and their integration into the complete camera system. A discussion about possible design improvements coming from the problems/difficulties encountered during assembly is also presented. Finally, results from engineering tests conducted in-field are also presented.

Aim: Measles is one of the most infectious communicable diseases. The objective of this study was to determine the immunity to measles of healthcare workers (HCWs) operating in three hospitals of Catania. Methods: A total of 549 HCWs underwent measles screening. A 5 ml blood sample was taken from each worker to measure IgG antibody levels. Results: Overall seroprotection was 86%. Unvaccinated HCWs agreed to undergo the vaccination offered by the hospital. Furthermore, it was found that younger workers are less seroprotected than older ones. Conclusion: Model legislation may be helpful to countries wishing to implement immunization requirements in healthcare settings in order to virtually eliminate the risk of acquiring and spreading measles in healthcare settings.

Purpose Membranous nephropathy (MN) is the most frequent cause of nephrotic syndrome in adults and the disease course is characterized by the "rule of third", with one-third of patients experiencing complete remission and the remaining experiencing relapses or progression of the disease. Additionally, the therapeutic approach is not standardized, leading to further heterogeneity in terms of response and outcome. Experimental design In this pilot study, MALDI-MSI analysis is performed on renal biopsies (n = 13) obtained from two homogeneous groups of patients, which differentially responded to the immunosuppressive treatments (Ponticelli regimen). Results A signal at m/z 1303 displays the greatest discriminatory power when comparing the two groups and is observed to be of higher intensity in the glomeruli of the non-responding patients. The corresponding tryptic peptide is identified as macrophage migration inhibitory factor (MIF). Conclusions and clinical relevance Despite much effort being made in recent years to understand the pathogenesis of MN, a biomarker able to predict the outcome of these patients following therapeutic treatment is still lacking. Here, a protein (MIF), verified by immunohistochemistry, that can differentiate between these MN patients and could be a valuable starting point for a further study focused on verifying its predictive role in therapy response is highlighted.

The Muon Portal Project was born as a joint initiative between Italian research and industrial partners, aimed at the construction of a real-size working detector prototype to inspect the content of traveling containers by means of secondary cosmic-ray muon radiation and recognize potentially dangerous hidden materials. The tomographic image is obtained by reconstructing the incoming and outgoing muon trajectories when crossing the inspected volume, employing two tracker planes located above and below the container under inspection. In this paper, the design and development of the front-end electronics of the Muon Portal detector is presented, with particular emphasis being devoted to the photo-sensor devices detecting the scintillation light and to the read-out circuitry which is in charge of processing and digitizing the analog pulse signals. In addition, the remote control system, mechanical housing, and thermal cooling system of all structural blocks of the Muon Portal tracker are also discussed, demonstrating the effectiveness and functionality of the adopted design.

Background The soluble fraction of the CD44 protein (solCD44) may constitute a valuable biological marker of Cancer Stem Cells (CSCs), useful for screening/early detection of laryngeal cancer, and for the prognosis. In previous papers, in fact, we have studied the expression of salivary solCD44 in patients with laryngeal tumors, supporting its use for early diagnosis of laryngeal carcinoma with high sensitivity and specificity, also with prognostic role, useful for clinical outcome. Objective The purpose of present study was to verify the levels of solCD44 isoform v6, sCD44var (v6), in saliva samples of patients with laryngeal carcinoma in our tumoral biobank, to evaluate possible correlations with clinical-anamnestic and prognostic data. Methods Study design was retrospective. Salivary samples of 66 patients with laryngeal cancer recruited from January 2012 to December 2013 were selected from our tumoral biobank. For each salivary sample was performed the determination of solCD44 and its isoform v6, sCD44var (v6), by ELISA. Qualitative and quantitative results of the test were correlated with clinical and medical history data. For statistical analysis we used the software MedCalc (versione 12.2.1.0). Results Concentrations of salivary sCD44var v6 were significantly higher according to the size of the primary tumor (T) (p= 0.001), the tumor site glottic or supraglottic-transglottic (p= 0.005) and according to the metastatic lymph node involvement (p= 0005). Furthermore, tumors in advanced disease (stage III-IV) showed values of salivary sCD44var v6 higher than the tumors in early stage, with a statistically significant difference (p= 0.005). Conclusions The determination of the levels of salivary solCD44 v6 may represent a promising prognostic test in laryngeal carcinomas.

The increasing presence of distributed generation (DG) in the electrical grid determines new challenges in grid operations, especially in terms of voltage and frequency regulation. Recently, several grid codes have required photovoltaic (PV) inverters to control their reactive power output in order to provide voltage regulation services, and the allocation of a certain amount of active power reserve for fast frequency response (FFR) service during under-frequency contingencies is needed. This requirement involves a significant waste of energy for PV systems, due to the necessity to constantly operate in de-loaded mode, under normal operating conditions. In addition, the variability of the irradiance can affect the correct amount of active power reserve that the system can provide in the moments after an under-frequency occurrence. The increasing number of battery energy storage systems (BESSs), coupled to PV systems, can be used to provide a worthy contribution to this frequency regulation service. The aim of this paper is to analyze the efficiency of active power reserve provided by a BESS connected to the DC bus of a non-ideal grid-connected PV inverter, taking into account the impact of reactive power control. For this purpose, the contribution of BESSs to frequency regulation is discussed and, starting from an existing model of real inverter, an analytical formulation for active power reserve evaluation is presented. Results concerning the impact of reactive power control are also given. Finally, the possibility for a low voltage (LV) grid with aggregated PV systems and BESSs to contribute to grid active power reserve is considered. Different voltage control strategies are compared, defining a helpful new parameter.

Within the framework of the Cherenkov Telescope Array (CTA) observatory, the Italian National Institute for Astrophysics (INAF) is leading the “Astrofisica con Specchi a Tecnologia Replicante Italiana” (ASTRI) Project mainly devoted to the definition and development of a set of small-size class telescopes with dual-mirror optical design (SST-2M) for the CTA southern site. The prototype of such telescopes, named ASTRI SST-2M, is installed in Italy at the INAF “M.C. Fracastoro” observing station located in Serra La Nave, Mount Etna, Sicily. In addition to the dual-mirror optical design based on the Schwarzschild-Couder configuration, the ASTRI SST-2M telescope adopts a focal plane camera formed by an array of monolithic silicon photomultiplier sensors coupled with a specifically designed front-end electronics and back-end electronics that represent a further innovative solution for the detection of atmospheric Cherenkov light. The ASTRI SST-2M prototype is currently under completion of the overall commissioning phase: structure, mirrors, camera, control software, data archiving and analysis pipeline. This contribution focuses the attention on the software devoted to the control and monitoring operations of the ASTRI camera. We will provide a brief description of the electronic assemblies and of the software architecture designed, according to software engineering modularization, in terms of functional blocks and how they are deployed in the back-end electronics. Then, we will show how all these functionalities are accessible by the user through the graphical user interface developed and currently used for the engineering tests performed on site.

Silicon nanowires (Si-NWs) have been extensively studied for their numerous applications in nano-electronics. The most common method for their synthesis is the vapor&ndash, liquid&ndash, solid growth, using gold as catalyst. After the growth, the metal remains on the Si-NW tip, representing an important issue, because Au creates deep traps in the Si band gap that deteriorate the device performance. The methods proposed so far to remove Au offer low efficiency, strongly oxidize the Si-NW sidewalls, or produce structural damage. A physical and chemical characterization of the as-grown Si-NWs is presented. A thin shell covering the Au tip and acting as a barrier is found. The chemical composition of this layer is investigated through high resolution transmission electron microscopy (TEM) coupled with chemical analysis, its formation mechanism is discussed in terms of atomic interdiffusion phenomena, driven by the heating/cooling processes taking place inside the eutectic-Si-NW system. Based on the knowledge acquired, a new efficient etching procedure is developed. The characterization after the chemical etching is also performed to monitor the removal process and the Si-NWs morphological characteristics, demonstrating the efficiency of the proposed method and the absence of modifications in the nanostructure.

Eugenia Allegra,1 Vincenzo Saita,2 Alfio Azzolina,2 Massimo De Natale,2 Maria Rita Bianco,1 Domenico Michele Modica,3 Aldo Garozzo1 1Otolaryngology, Department of Health Sciences, University of Catanzaro, Catanzaro, Italy; 2Otolaryngology Unit, Cannizzaro Hospital, Catania, Italy; 3Otolaryngology Unit, University of Palermo, Palermo, Italy Background: Laryngeal early glottic tumors can benefit from different treatment modalities, including transoral laser microsurgery, open partial horizontal laryngectomy (OPHL), and radiotherapy. However, the treatment of early glottic tumors with the involvement of the anterior commissure remains controversial. The studies about the role of anterior commissure involvement in oncologic outcomes in patients with early glottic cancer treated with supracricoid laryngectomy (SCL) are very few. For this reason, we conducted a retrospective study to evaluate local recurrence-free survival and specific survival in patients with and without involvement of the anterior commissure who underwent SCL with cricohyoidoepiglottopexy.Methods: This retrospective study has been carried out on patients with T1b–T2 glottic squamous cell carcinoma submitted to SCL with cricohyoidoepiglottopexy. The patients’ demographic and clinical data were collected, and the histological findings of the surgical specimens were reviewed to identify patients who had involvement of the anterior commissure.Results: A total of 72 patients were included in the study; two of them were female and 70 were male. The mean age at diagnosis was 61.5±8.0 SD years. In 26 of the 72 (36.2%) patients, anterior commissure was not pathologically involved (group A), while in 46 (63.8%) patients, it was involved (group B). The 5-year local recurrence-free survival rate was 96.1% and 93.48% in groups A and B, respectively, P=0.09. The 5-year disease-specific survival rate was 92.31% and 95.65% in groups A and B, respectively, P=0.057.Conclusion: SCL with cricohyoidoepiglottopexy seems to be an adequate treatment modality, even for T1b–T2 glottic tumors with anterior commissure involvement. Keywords: open partial horizontal laryngectomy, laryngeal cancer, supracricoid laryngectomy, cricohyoidoepiglottopexy

To determine the relationship between multidetector computed tomography (MDCT) findings, management strategies, and ultimate clinical outcomes in patients with splenic injuries secondary to blunt trauma. This Institutional Review Board-approved study collected 351 consecutive patients admitted at the Emergency Department (ED) of a Level I Trauma Center with blunt splenic trauma between October 2002 and November 2015. Their MDCT studies were retrospectively and independently reviewed by two radiologists to grade splenic injuries according to the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) and to detect intraparenchymal (type A) or extraparenchymal (type B) active bleeding and/or contained vascular injuries (CVI). Clinical data, information on management, and outcome were retrieved from the hospital database. Statistical analysis relied on Student’s t, chi-squared, and Cohen’s kappa tests. Emergency multiphase MDCT was obtained in 263 hemodynamically stable patients. Interobserver agreement for both AAST grading of injuries and vascular lesions was excellent (k = 0.77). Operative management (OM) was performed in 160 patients (45.58% of the whole cohort), and high-grade (IV and V) OIS injuries and type B bleeding were statistically significant (p

IL-6 has a key role in the pathogenesis, clinical manifestations and activity of Systemic Onset Idiopathic Arthritis (sJIA). Tocilizumab (TCZ), the first humanized antihuman IL-6 receptor antibody, inhibits the activity of IL-6. In this review, we summarize the main studies performed, to date, about the use of TCZ in children affected by sJIA refractory to conventional treatment. Nowadays TCZ can be used, alone or in association with Metotrexate, in children older than 2 years. Its use in children younger than 2 years is being investigated. Further study about its use in sJIA and other type of idiopathic arthritis should be done.

In this paper, a 0-dimensional model for the understanding of dry etching characteristics in silicon oxide and nitride materials is reported. The model is applied to analyze the etching performances in a design of experiments where gas mixtures are varied in the fluorocarbon chemistry typical of the “protected sidewall” regime. The modeling analysis of flat sample etching allows for an accurate tuning of the selectivity's behavior, and can be generalized to deal with patterned samples. In particular, we apply a phenomenological technique to transform the equipment parameters in the microscopic quantities ruling the reagent-surface interactions. The correct prediction of the etch rate trends in flat samples and the sensibility to the different etching mechanisms for the nitride case demonstrate the reliability of the proposed approach.

The Muon Portal is a recently started Project aiming at the construction of a large area tracking detector that exploits the muon tomography technique to inspect the contents of traveling cargo containers. The detection planes will be made of plastic scintillator strips with embedded wavelength-shifting fibres. Special designed silicon photomultipliers will read the scintillation light transported by the fibres along the strips and a dedicated electronics will combine signals from different strips to reduce the overall number of channels, without loss of information. Different silicon photomultiplier prototypes, both with the p-on-n and n-on-p technologies, have been produced by STMicroelectronics during the last years. In this paper we present the main characteristics of the silicon photomultipliers designed for the Muon Portal Project and describe the setup and the procedure implemented for the characterization of these devices, giving some statistical results obtained from the test of a first batch of silicon photomultipliers.