Search

Introduction: Cholangiocarcinoma during pregnancy is an extremely rare entity with poor prognosis. Limited data are available regarding the diagnosis, progression, and pregnancy-related outcomes. Case Presentation: We present a case of mid-to-distal cholangiocarcinoma diagnosed by endosonographically guided biopsy during pregnancy at 15 weeks of gestation. Pregnancy termination was considered but based on multidisciplinary team and shared decision-making, surgery was performed during pregnancy. The patient underwent pancreatoduodenectomy with radical resection at 17 weeks of gestation. The postoperative period was complicated by a grade B postoperative pancreatic fistula treated by antibiotics only. At 39 weeks of gestation, a cesarean section was performed and a healthy boy was delivered. Conclusion: Decision-making on whether to perform a pancreatoduodenectomy in pregnant patients is challenging. This case report is the first to report on successful pancreatoduodenectomy during pregnancy for extrahepatic cholangiocarcinoma. Moreover, this case highlights the second trimester as favorable period for surgical intervention and the importance of close follow-up and diagnostic assessment of pregnant patients with unexplained and persistent abnormal liver function tests.

Not available.

Abstract The sacred ayahuasca brew, utilized by indigenous communities in the Amazon and syncretic religious groups in Brazil, primarily consists of a decoction of two plants: (i) the Amazonian liana known as Mariri or Jagube (Banisteriopsis caapi), and (ii) the shrub referred as Chacrona or Rainha (Psychotria viridis). While Chacrona leaves are rich in N,N-Dimethyltryptamine (DMT), a potent psychedelic, the macerated vine of Mariri provides beta-carboline alkaloids acting as monoamine oxidase inhibitors, preventing DMT’s degradation. This study sequenced, assembled, and analyzed the complete genome of B. caapi’s mitochondrion, yielding a circular structure spanning 503,502 bp. Although the mtDNA encompasses most plant mitochondrial genes, it lacks some ribosomal genes, presents some atypical genes, and contains plastid pseudogenes, suggesting gene transfer between organelles. The presence of a 7-Kb repetitive segment containing copies of the rrnL and trnfM genes suggests mitogenome isomerization, supporting the hypothesis of dynamic mitogenome maintenance in plants. Phylogenetics and phylogenomics across 24 Malpighiales confirms the sample’s placement in the “Tucunacá” ethnovariety, aligning with morphological identification. This study spearheads efforts to decode the genome of this esteemed Malpighiaceae.

Within the past ten years, spark plasma sintering (SPS) has become an increasingly popular process for Mg manufacturing. In the SPS process, interparticle diffusion of compressed particles is rapidly achieved due to the concept of Joule heating. Compared to traditional and additive manufacturing (AM) techniques, SPS gives unique control of the structural and microstructural features of Mg components. By doing so, their mechanical, tribological, and corrosion properties can be tailored. Although great advancements in this field have been made, these pieces of knowledge are scattered and have not been contextualized into a single work. The motivation of this work is to address this scientific gap and to provide a groundwork for understanding the basics of SPS manufacturing for Mg. To do so, the existing body of SPS Mg literature was first surveyed, with a focus on their structural formation and degradation mechanisms. It was found that successful Mg SPS fabrication highly depended on the processing temperature, particle size, and particle crystallinity. The addition of metal and ceramic composites also affected their microstructural features due to the Zener pinning effect. In degradative environments, their performance depends on their structural features and whether they have secondary phased composites. In industrial applications, SPS'd Mg was found to have great potential in biomedical, hydrogen storage, battery, automotive, and recycling sectors. The prospects to advance the field include using Mg as a doping agent for crystallite size refinement and using bulk metallic Mg-based glass powders for amorphous SPS components. Despite these findings, the interactions of multi-composites on the processing-structure-property relationships of SPS Mg is not well understood. In total, this work will provide a useful direction in the SPS field and serve as a milestone for future Mg-based SPS manufacturing.

Among the existing series of softer metals, magnesium (Mg) has attracted much attention due to its impressive strength-to-weight ratio. However, due to its ease of deformability, Mg tends to suffer from rapid degradation in a wide variety of abrasive and electrochemical environments. One method of improving its surface properties is through surface modification techniques. Among the existing techniques, laser shock peening (LSP) has been one of the most widely utilized processes due to its surface-hardening-like effects. Despite this understanding, a comprehensive review has yet to exist that encapsulates the strengthening mechanism of LSP for Mg and its influence in degradation environments. This review aims to encapsulate the existing research around the LSP field for Mg. Specifically, an understanding of the surface-strengthening effects in relation to its mechanical, tribological, corrosion, and tribo-corrosion characteristics is elucidated. Additionally, the feasibility of LSP for Mg materials in critical industries is also discussed. Through this work, a novel understanding of LSP for Mg can be understood, which can provide a future direction for research in this field.

Abstract We describe 1000 patients with essential thrombocythemia seen at the Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Florence, Italy, between 1980 and 2023: median age 59 years (18–95), females 65%, JAK2/CALR/MPL-mutated 66%/19%/4%, triple-negative (TN) 11%. Extreme thrombocytosis (ExT, platelets ≥1000 × 109/L) in 16%, leukocytosis (leukocytes >11 × 109/L) in 16%, and at least one cardiovascular risk factor in 52% of cases. JAK2-mutated patients were older (median 62 years) and CALR-mutated and TN (53 years for both) younger (p

Introduction Bronchiolitis obliterans syndrome (BOS) is the most common form of CLAD and is characterized by airflow limitation and an obstructive spirometry pattern without parenchymal opacities. The protein signature of BOS lesions concerns extracellular matrix organization and aberrant basement membrane composition. In this pilot study, we investigated the presence of COL4A5 in the serum of patients with BOS. Methods 41 patients who had undergone LTX were enrolled. Of these, 27 developed BOS and 14 (control group) were considered stable at the time of serum sampling. Of BOS patients, serum samples were analysed at the time of BOS diagnosis and before the clinical diagnosis (pre-BOS). COL4A5 levels were detected through the ELISA kit. Results Serum concentrations of COL4A5 were higher in pre-BOS than in stable patients (40.5 ± 13.9 and 24.8 ± 11.4, respectively, p = 0.048). This protein is not influenced by comorbidities, such as acute rejection or infections, or by therapies. Survival analysis also reveals that a higher level of COL4A5 was also associated with less probability of survival. Our data showed a correlation between concentrations of COL4A5 and FEV1 at the time of diagnosis of BOS. Conclusion Serum concentrations of COL4A5 can be considered a good prognostic marker due to their association with survival and correlation with functional parameters., Author(s): M. Armati [sup.1], S. Cattelan [sup.1], M. Guerrieri [sup.1], M. Messina [sup.1], B. Perea [sup.1], M. Genovese [sup.2], M. d'Alessandro [sup.1], S. Gangi [sup.1], P. Cameli, F. Perillo [sup.1], [...]

Silvia Grazzini,1,* Edoardo Conticini,1,* Paolo Falsetti,1 Miriana D’Alessandro,2 Jurgen Sota,1 Riccardo Terribili,1 Caterina Baldi,1 Claudia Fabiani,3 Elena Bargagli,2 Luca Cantarini,1 Bruno Frediani1 1Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy; 2Respiratory Diseases and Lung Transplant Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy; 3Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy*These authors contributed equally to this workCorrespondence: Edoardo Conticini, Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, AOUS Le Scotte, viale Mario Bracci 14, Siena, 53100, Italy, Email conticini.edoardo@gmail.comIntroduction: No head-to-head study has assessed the superiority of tocilizumab versus methotrexate in giant cell arteritis (GCA), and few studies have demonstrated its effectiveness in terms of ultrasonographic findings, but without a control group. The primary endpoint was to assess whether tocilizumab was superior to methotrexate in inducing normalization of US findings, whereas the secondary endpoint was to assess the effectiveness of precocious withdrawal of glucocorticoids.Methods: We prospectively enrolled all the patients with active GCA at our clinic. The inclusion criteria were clinical diagnosis of GCA; active disease; and clinical, laboratory, and US data, evaluated using the halo count (HC) and OMERACT GCA Ultrasonography Score (OGUS). Evaluations were repeated at 3, 6, and 12 months.Results: Twenty patients were treated with Tocilizumab and 9 with Methotrexate. All but three tocilizumab-treated patients achieved remission at six months, whereas at 12 months, all patients were in glucocorticoid-free remission. Up to three of the nine methotrexate patients experienced a lack of efficacy or minor relapses. Tocilizumab-treated patients showed a statistically significant difference between baseline and all follow-ups in terms of OGUS and HC, whereas the difference in the Methotrexate group was significant after 1 year. The mean glucocorticoid dosage significantly decreased in both groups. No severe adverse events or major relapses were reported.Conclusion: Our study demonstrates the superiority in terms of rapidity of a tocilizumab-based scheme over a methotrexate-based scheme in inducing clinical and US remission. Precocious withdrawal of glucocorticoids did not increase the risk of relapse.Keywords: GCA, giant cell arteritis, methotrexate, tocilizumab, ultrasonography, vasculitis

Abstract We applied a parametric Markov five-state model, on a well-characterized international cohort of 1,545 patients with polycythemia vera (PV; median age 61 years; females 51%), in order to examine the impact of incident thrombosis on the trajectory of death or disease progression. At a median follow-up of 6.9 years, 347 (23%) deaths, 50 (3%) blast phase (BP), and 138 (9%) fibrotic (post-PV MF) transformations were recorded. Incident thrombosis occurred at a rate of 2.62% pt/yr (arterial 1.59% and venous 1.05%). The probability of death, in the first 10 years, for 280 (18%) patients who developed thrombosis during follow-up was 40%, which was two-fold higher than that seen in the absence of thrombosis or any other transition state (20%; p

Earthquake environmental effects may significantly contribute to the damage caused by seismic events; similar to ground motion, the environmental effects are globally stronger in the vicinity and decrease moving away from the epicenter or seismogenic source. To date, a single intensity prediction equation (IPE) has been proposed in the Italian Apennines for intensity scale dealings with environmental effects: the Environmental Seismic Intensity (ESI-07). Here, we evaluate the sensitivity of the IPE with respect to input data and methodological choices and we propose IPEs with global validity for crustal normal faults. We show the strong influence of input data on the obtained attenuation investigating the 1980 Irpinia–Basilicata (Southern Italy) earthquake. We exploit a dataset of 26 earthquakes to build an IPE considering the epicentral distance. We also propose an IPE considering the distance from the fault rupture, which is derived from a dataset of 10 earthquakes. The proposed equations are valid for normal faults up to 40 km from the epicenter/fault and may flank other models predicting ground motion or damage to the built environment. Our work thus contributes to the use of the ESI-07 scale for hazard purposes.

Genome sequencing is a powerful tool for identifying SARS-CoV-2 variant lineages; however, there can be limitations due to sequence dropout when used to identify specific key mutations. Recently, ThermoFisher Scientific has developed genotyping assays to help bridge the gap between testing capacity and sequencing capability to generate real-time genotyping results based on specific variants. Over a 6-week period during the months of April and May 2021, we set out to assess the ThermoFisher TaqMan mutation panel genotyping assay, initially for three mutations of concern and then for an additional two mutations of concern, against SARS-CoV-2-positive clinical samples and the corresponding COVID-19 Genomics UK Consortium (COG-UK) sequencing data. We demonstrate that genotyping is a powerful in-depth technique for identifying specific mutations, is an excellent complement to genome sequencing, and has real clinical health value potential, allowing laboratories to report and take action on variants of concern much more quickly.

PurposeZ-spectrum imaging, defined as the consecutive collection of images after saturating over a range of frequency offsets, has been recently proposed as a method to measure the fat-water fraction by the simultaneous detection of fat and water resonances. By incorporating a binomial pulse irradiated at each offset before the readout, the spectral selectivity of the sequence can be further amplified, making it possible to monitor the subtle proton resonance frequency shift that follows a change in temperature.MethodsWe tested the hypothesis in aqueous and cream phantoms and in healthy mice, all under thermal challenge. The binomial module consisted of 2 sinc-shaped pulses of opposite phase separated by a delay. Such a delay served to spread out off-resonance spins, with the resulting excitation profile being a periodic function of the delay and the chemical shift.ResultsDuring heating experiments, the water resonance shifted downfield, and by fitting the curve to a sine function it was possible to quantify the change in temperature. Results from Z-spectrum imaging correlated linearly with data from conventional MRI techniques like T1 mapping and phase differences from spoiled GRE.ConclusionBecause the measurement is performed solely on magnitude images, the technique is independent of phase artifacts and is therefore applicable in mixed tissues (e.g., fat). We showed that Z-spectrum imaging can deliver reliable temperature change measurement in both muscular and fatty tissues.

Abstract Myelofibrosis (MF) is a clonal malignancy frequently characterized by anemia and in 10%–20% of cases it can evolve into blast phase (BP). Anemia in MF is associated with reduced survival and ‐in primary MF‐ also with an increased probability of BP. Conventional treatments for anemia have limited effectiveness in MF. Within a dataset of 1752 MF subjects largely unexposed to ruxolitinib (RUX), BP incidence was 2.5% patients per year (p‐y). This rate reached respectively 4.3% and 4.5% p‐y in case of patients with common terminology criteria for adverse events (CTCAE) grade 3/4 and grade 2 anemia, respectively, that represented together 32% of the cohort. Among 273 MF cases treated with RUX, BP incidence was 2.89% p‐y and it reached 4.86% p‐y in subjects who started RUX with CTCAE grade 2 anemia (one third of total). Within patients with red blood cell transfusion‐dependency at 6 months of RUX (21% of the exposed), BP rate was 4.2% p‐y. Our study highlights a relevant incidence of BP in anemic MF patients, with a similar rate whether treated with or without RUX. These findings will help treating physicians to make decisions on the safety profile of innovative anemia treatments.