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Purpose Between 15 and 30% of all nosocomial bacteremias and sepsis are associated with the use of intravascular devices. Catheter-related bloodstream infections (CRBI) are infections in which the organism identified in the blood is also present on the tip of the catheter itself or in a blood sample taken through it. The aim of the study was to evaluate the role of ultrasound in the diagnosis of infections related to the use of central catheters. Methods Between January 2018 and June 2019, we carried out a prospective study on 36 patients with a central catheter, such as a central venous catheter (CVC), a central catheter with peripheral insertion (PICC), or a fully implanted central venous catheter (PORT-a-cath) and who had signs and symptoms of infection. These patients were submitted to an ultrasound of the catheter upon arrival in the ward in case of suspected infection, or at the time of the onset of signs and symptoms of infection (if these arose during hospitalization). Patients with a central catheter but without signs and symptoms of infection were not included in the study. The end point of the study was to evaluate sensitivity (SENS), specificity (SPEC), positive and negative predictive value (PPV-NPV) and overall diagnostic accuracy (ODA) of ultrasound in the diagnosis of CRBI through Receiver Operating Characteristic (ROC) curve analysis. Results US showed a SENS of 94%, a SPEC of 84%, a PPV of 84%, an NPV of 94% and an ODA of 88.8% for the diagnosis of CRBI. Conclusions Preliminary data from our study show that US of intravascular devices has a high SENS and SPEC in the diagnosis of CRBI, and can, therefore, be used as a valid tool to decide whether to remove the device early or leave it in place.

Background and aims Diabetic retinopathy (DR) is the most common microvascular complication of diabetes. Diabetic macroangiopathies, particularly cardiovascular (CV) diseases, seem closely related to diabetes microvascular complications. Aspirin represents the most prescribed compound in CV prevention. Aspirin impact on DR is still object of debate. As it is already recommended among diabetics at high CV risk, aim of this study was to assess a potential relationship between DR and aspirin therapy, in a type 2 diabetes cohort of patients screened through telemedicine. Methods and results NO Blind is a cross-sectional, multicenter, observational study, which involved nine Italian outpatient clinics. Primary endpoint was the assessment of the relationship between aspirin treatment and DR. 2068 patients were enrolled in the study, subsequently split in two subpopulations according to either the presence or absence of DR. Overall, 995 subjects were under aspirin therapy. After adjusting for most common potential confounders, age and gender, aspirin reveals significantly associated with DR (OR: 1.72, 95%CI: 1.58–2.89, p = 0.002) and proliferative DR (PDR) (OR: 1.89, 95%CI: 1.24–2.84, p = 0.003). Association comes lost further adjusting for MACEs (OR: 1.28, 95%CI: 0.85–1.42, p = 0.157) (Model 4) and eGFR (OR: 0.93; 95%CI: 0.71–1.22; p = 0.591) (Model 5). Conclusion In this multicenter cross-sectional study including a large sample of outpatients with T2DM, we showed that aspirin was not associated with DR after adjustment for several cardio-metabolic confounders. However, as partially confirmed by our findings, and related to the well-known pro-hemorrhagic effect of aspirin, its use should be individually tailored, even by telemedicine tools.

Aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus-specific reverse transcriptase-polymerase chain reaction (RT-PCR) represents the diagnostic gold standard. We explored the value of chest ultrasonography to predict positivity to SARS-CoV-2 on RT-PCR in suspected COVID-19 cases. Patients & methods: Consecutive patients with suspect COVID-19 were included if they had fever and/or history of cough and/or dyspnea. Lung ultrasound score (LUSS) was computed according to published methods. Results: A total of 76 patients were included. A 3-variable model based on aspartate transaminase (AST) > upper limit of normal, LUSS >12 and body temperature >37.5°C yielded an overall accuracy of 91%. Conclusion: A simple LUSS-based model may represent a powerful tool for initial assessment in suspected cases of COVID-19., Lay abstract The gold standard for diagnosis of COVID-19 is RT-PCR. During a pandemic emergency, it may be useful to identify suspect symptomatic patients who may safely be observed without undergoing testing for COVID-19. In this work, a simple model based on the findings of lung ultrasound, AST levels and fever showed an overall accuracy of 91% to predict the results of RT-PCR.

The aim of this study was to explore the role of lung ultrasound (LUS) in the diagnosis of SARS-CoV-2 infection and to verify its utility in the prediction of lung disease's severity and outcome. Fifty-three consecutive patients presenting to the Emergency Department of Santa Maria delle Grazie Hospital with high suspicion of SARS-CoV-2 infection underwent diagnostic test for SARS-CoV-2 on samples obtained from nasopharyngeal swab as well as complete proper diagnostic work-up that included clinical evaluation, laboratory tests, blood gas analyses, chest CT and LUS. A semiquantitative analysis of B-lines distribution was performed to calculate the LUS score. Patients were divided into two groups according to the results of both SARS-CoV-2 diagnostic test and other exams (Group A = pneumonia due to SARS-CoV2 infection vs Group B = no SARS-CoV2 infection and another definite diagnosis). LUS showed an excellent accuracy in predicting the diagnosis of SARS-CoV-2 infection (area under the ROC curve of 0.92 with a sensibility of 73% and a specificity of 89% a the cut-off of 12.5). LUS score was more impaired in SARS-CoV-2 patients (18.1 ± 6.0 vs 7.6 ± 5.9, p < 0.00001) and it is significantly negatively correlated with PF ratio values (r = - 0.719, p < 0.0001). An intrahospital mortality rate of 46% was found; patients with adverse outcome had significant higher value of LUS, PF, LDH, and APACHE II score. None of these parameters was predictive of mortality. LUS is a useful tool for the early detection of SARS-CoV-2 infection and for the evaluation of the disease severity, but does not predict mortality. Further studies with repeated evaluations of LUS score are needed to further explore the role of LUS in the assessment of severity in SARS-CoV-2 disease and in the monitoring of the response to treatments.

Inspection of ageing, reinforced concrete structures is a world-wide challenge. Existing non-destructive evaluation techniques in civil and structural engineering have limited penetration depth and don’t allow to precisely ascertain the configuration of reinforcement within large concrete objects. The big challenge for critical infrastructure (bridges, dams, dry docks, nuclear bioshields etc.) is understanding the internal condition of the concrete and steel, not just the location of the reinforcement. In most new constructions the location should be known and recorded in the as-built drawings, where these might not exist due to poor record keeping for older structures. Muon scattering tomography is a non-destructive and non-invasive technique which shows great promise for high-depth 3D concrete imaging. Previously, we have demonstrated that individual bars with a diameter of 33.7 ± 7.3 mm can be located using muon scattering tomography. Here we present an improved method that exploits the periodicity of bar structures. With this new method, reinforcement with bars down to 6 mm thickness can be detected and imaged.

Aims: To assess the correlation between diabetic retinopathy (DR) and potential risk factors, as well as the relationship between DR and the other complications of diabetes, in a real-life population of type 2 diabetes patients recruited in several centres in Italy. Methods: The NO BLIND is a cross-sectional, multicentre, observational study, which involved nine public outpatient clinics in Italy. The patients were assessed for eligibility from November 2016 till November 2017. Those enrolled underwent standard fundus oculi exam. Clinical and laboratory data were also collected. Results: 2068 T2DM underwent fundus oculi exam. 435 received diagnosis of diabetic retinopathy (21%). Diabetic retinopathy was independently associated with HDL cholesterol (O.R.: 1.042; 95% C.I.: 1.012–1.109; p = 0.004), Albumin Excretion Rate (AER) (O.R.: 1.001; 95% C.I.: 1.000–1.002; p = 0.034) and GFR (O.R.: 1.159; 95% C.I.: 1.039–1.294; p = 0.008). HDL cholesterol values were hence split in two classes according to a potential cut-off (40 mg/dL), as defined by the ROC curve. Following analysis confirmed the association between DR and high HDL values (p = 0.032). Somatic neuropathy and diabetic ulcer were independently related with DR (p < 0.001 and p = 0.012, respectively). Conclusions: A novel relationship between high HDL cholesterol and DR was observed. © 2019 Elsevier B.V. Aims: To assess the correlation between diabetic retinopathy (DR) and potential risk factors, as well as the relationship between DR and the other complications of diabetes, in a real-life population of type 2 diabetes patients recruited in several centres in Italy. Methods: The NO BLIND is a cross-sectional, multicentre, observational study, which involved nine public outpatient clinics in Italy. The patients were assessed for eligibility from November 2016 till November 2017. Those enrolled underwent standard fundus oculi exam. Clinical and laboratory data were also collected. Results: 2068 T2DM underwent fundus oculi exam. 435 received diagnosis of diabetic retinopathy (21%). Diabetic retinopathy was independently associated with HDL cholesterol (O.R.: 1.042; 95% C.I.: 1.012–1.109; p = 0.004), Albumin Excretion Rate (AER) (O.R.: 1.001; 95% C.I.: 1.000–1.002; p = 0.034) and GFR (O.R.: 1.159; 95% C.I.: 1.039–1.294; p = 0.008). HDL cholesterol values were hence split in two classes according to a potential cut-off (40 mg/dL), as defined by the ROC curve. Following analysis confirmed the association between DR and high HDL values (p = 0.032). Somatic neuropathy and diabetic ulcer were independently related with DR (p < 0.001 and p = 0.012, respectively). Conclusions: A novel relationship between high HDL cholesterol and DR was observed.

The KM3NeT Collaboration is building a network of underwater Cherenkov telescopes at two sites in the Mediterranean Sea, with the main goals of investigating astrophysical sources of high-energy neutrinos (ARCA) and of determining the neutrino mass hierarchy (ORCA). Various Machine Learning techniques, such as Random Forests, BDTs, Shallow and Deep Networks are being used for diverse tasks, such as event-type and particle identification, energy/direction estimation, source identification, signal/background discrimination and data analysis, with sound results as well as promising research paths. The main focus of this work is the application of Convolutional Neural Network models to the tasks of neutrino interaction classification, as well as the estimation of energy and direction of the propagating particles. The performances are also compared to those of the standard reconstruction algorithms used in the Collaboration.

Muography consists in observing the differential absorption of muons – elementary particles produced through cosmic-ray interactions in the Earth atmosphere – going through the volcano and can attain a spatial resolution of tens of meters. We present here the first experiment of nuclear emulsion muography at the Stromboli volcano. Muons have been recorded during a period of five months by a detector of 0.96 m2 area. The emulsion films were prepared at the Gran Sasso underground laboratory and were analyzed at Napoli, Salerno and Tokyo scanning laboratories. Our results highlight a significant low-density zone at the summit of the volcano with density contrast of 30–40% with respect to bedrock. The structural setting of this part of the volcanic edifice controls the eruptive dynamics and the stability of the “Sciara del Fuoco” slope, which is affected by recurrent tsunamigenic landslides. Periodical imaging of the summit of the Stromboli volcano such as that provided by muography can become a useful method for studying the evolution of the internal structure of the volcanic edifice.

Muography (muon radiography) is a new geophysical technique that allows investigation of inner structures of an edifice with a very detailed spatial resolution. It has been recently used for several volcanoes and different geoscientific targets. In 2011 Tanaka et al. succeeded to find hidden ancient seismic faults. In 1949 there was a volcanic activity of the Cumbre Vieja, La Palma, Canary Islands, Spain and a 1km long fault suddenly appeared during the active period. The fault might be the sign of a large scale land collapse. In order to get additional information, investigations by several geophysical exploration techniques are needed. We consider that muography can be applied to study the shallow part of the fault and it can clarify some important parameters: the bulk density, the width of the low density zone, and the depth. Previous investigations allowed detecting two ancient seismic faults that have 20m-wide mechanically fractured zone consisting of highly damaged rocks. The 1949 fault might be the result of large scale land slide and the slide length might be just a few meter. Therefore the expected width of the fault is only a few meter. In order to detect such narrow fault, the muon detector should have as high spatial resolution as possible. In addition, it is difficult to get continuous power supply near the fault. Nuclear emulsions are a kind of photographic films that have high sensitivity for high energy charged particles. They also have high spatial resolution for high energy muon paths and do not need any power supply to be operated. We placed an emulsion detector having 0.19 m 2 effective area near the 1949 fault. The exposure started on January 2014 and lasted 106 days. All the emulsion films were developed and they are under analysis. We also estimated the expected performance of this test exposure. Assuming a very simple model, we evaluated the detectable region as a function of the low density zone width and of the depth from the ground surface as well.

The muon radiography is a novel imaging technique to probe the volcanoes interior, using the capability of high energy cosmic ray muons to penetrate large thicknesses of rock. In this way it is possible to derive a 2D density map along the muon trajectory of volcanic edifices and deduce information on the variations in the rock density distribution, like those expected from dense lava conduits, or low density magma supply paths. This method is applicable also to study geological objects as glaciers, faults, oil underground reservoirs, engineering constructions, where a density contrast is present. Nuclear emulsions are well suited to be employed in this context for their excellent angular resolution; they are compact and robust detectors, able to work in harsh environments without need of power supply. On the other side, a long exposure time is required for a reasonable detector surface (~10 m2) in order to collect a sufficient statistics of muons, and a quasi-real time analysis of the emulsion data is rather difficult due to the scanning time needed by the optical microscopes. Such drawback is on the way to be overcome thanks to a recent R&D program on ultra-fast scanning systems. Muon radiography technique, even if limited to the summit part of the volcano edifice, represents an important tool of investigation, at higher spatial resolution, complementary to the conventional geophysics techniques. The first successful result in this field was obtained by a Japanese group that observed in 2007 the conduit structure of Mt. Asama. Since 2010, other interesting volcanoes have been probed with the same method: Stromboli in 2011, Mt. Teide in 2012 and La Palma in 2014. Here we discuss the muon imaging technique reporting the nuclear emulsion detector design exposed at Stromboli and results of the data analysis.

Atrial fibrillation following high-dose i.v. steroids for treatment of severe immune-mediated diseases has been rarely reported in the literature. Here we report a further case of atrial fibrillation following high-dose i.v. methylprednisolone (HDIVMP) therapy of severe thrombocytopenia in a female patient with a flare-up of systemic lupus erythematosus (SLE). The available literature on this topic is reviewed as well.

Nuclear emulsions are currently being used in the field of muography, more specifically muon radiography of volcanic edifices and fault regions. The peculiar features of such detector for cosmic muons demand appropriate data processing and analysis techniques. The paper shows the current development status of readout devices and analysis techniques developed by some research groups that established a collaborative network in Italy and Japan. An overview is given of nuclear emulsion-based detectors, from the detection principles to detector operation and set-up techniques, in connection with the expectations in terms of geophysics information. Two systems for readout are presented, one developed in the first decade of the 21st century and one that is entering duty now. The evolution in terms of data quality and speed is discussed. Finally, the most relevant data processing steps that allow working out muon absorption maps from nuclear emulsion data are described.

Background: Hepatocellular carcinoma (HCC) is the leading cause of death amongst cirrhotic patients. Its diagnosis and discrimination from non-HCC malignant lesions in cirrhosis includes contrast enhanced computed tomography (CECT), contrast enhanced magnetic resonance imaging (CEMRI), or, in selected cases, liver biopsy. The role of contrast-enhanced ultrasonography (CEUS) is still controversial. Aims: To evaluate whether, by selecting an appropriate ‘time to wash-out’ cut-off value, CEUS capability of discriminating between HCC and non-HCC malignancies in cirrhotic patients may be enhanced. Methods: We enrolled 282 cirrhotic patients who underwent CEUS at our institute, from January 2008 to January 2012, for focal liver lesions (FLLs) detected at ultrasound (US). We used liver biopsy and subsequent histological evaluation as the gold standard for correct classification of FLLs. We calculated the area under receiver operator characteristic curves for CEUS to distinguish patients with HCC from those with non-HCC malignancies. The best ‘time to wash-out’ cut-off values were selected. Results: Histological diagnosis of FLLs was as follows: 34 benign lesions (i.e. 25 regenerative nodules and 9 dysplastic nodules) and 248 malignant lesions (223 well-to-moderately differentiated HCCs; 7 poorly-differentiated HCCs; 5 intrahepatic colangiocellular carcinomas (ICCs); 5 primary non-Hodgkin B-cell lymphomas (NHBLs); and 8 metastatic liver tumors). A time to wash-out >55s identified patients with HCC with the highest level of accuracy (92.7%). Similarly, a time to washout � 55s correctly identified the vast majority of the non-HCC malignancies (100% sensitivity, 98.2% specificity and diagnostic accuracy of 98.3%). Conclusions: CEUS is an accurate and safe procedure for discriminating FLLs in cirrhotic patients, especially when a cut-off time to wash-out of 55s is chosen as a reference value.

Aims Diabetic retinopathy (DR) represents the main cause of blindness among adults in the industrialized Countries. Use of telemedicine could offer an easy, smart specialist fundus oculi examination, as well as putting in a screening programme many patients who otherwise would be excluded. Materials and methods The NO BLIND is a transversal, multicentre, observational study. Its pilot phase involved nine public outpatient clinics for 6 months. As endpoint of the study, we assessed the prevalence of DR by retinography in a subset of the Italian population. Patients' fundus oculi photos were performed by trained diabetologists through a digital smart ophthalmoscope. Results According to our endpoint, in the final study population (n = 1461), obtained excluding patients for whom retinography was not able to provide any diagnosis, DR prevalence was equal to 15.5%. According to the receiver operating characteristic (ROC) curve performed, we can observe how retinography appears a highly accurate method to detect DR (AUROC 0.971, 95% confidence interval, 0.954-0.989), with a specificity of the 100% and a sensitivity of the 94.3%. Conclusions Our findings, in an Italian setting, confirm main data in the literature about DR prevalence. Hence, telemedicine could represent an accurate, fast, and cheap method for screening of DR.

Obesity is considered an emerging epidemic that is often associated with non-alcoholic fatty liver disease. Among the therapeutic options for morbid obesity, bariatric surgery plays an important role when conventional therapies fail. The effects of bariatric surgery on liver function and morphology are controversial in the literature. Liver failure has been reported after jejunoileal bypass (JIB), biliopancreatic diversion and gastric bypass. Biliointestinal bypass (BIB) is considered an effective procedure among recently introduced bariatric surgery techniques. It is a clinically safe, purely malabsorptive operation in which the blind intestinal loop of the JIB is anastomosed to the gallbladder, allowing a portion of bile to transit into excluded intestinal tract. BIB is the only procedure, to our knowledge, to have no liver side effects reported in the literature. We report the case of a young obese woman who developed liver failure 8 mo after BIB. She had a rapid weight loss (70 kg) with a reduction in body mass index of 41% from January to September 2012. Because of a severe hepatic decompensation, she was referred to a transplantation centre. We strongly believe that the most important pathogenetic mechanism involved in the development of liver injury is the rapid weight loss that produced a significant fatty liver infiltration.

3D detectors for high-energy physics have always needed large computing power. Its availability has sometimes determined the statistics and performance of experiments. The increasing specific computing power of GPUs in recent years offers new opportunities for this field of application that should not be missed. The paper shows a novel algorithm that supports, as a by-product of speed, wider angular acceptance with respect to established techniques based on CPUs. While the algorithm has been developed in the environment of nuclear emulsions, it has been conceived from the very beginning as a tool for general tracking in 3D detectors. The overall logic can apply to many operational contexts in which tracking occurs in high combinatorial background. The performances of the algorithm are evaluated from different points of view, describing the details of the computing technique that are common to tracking problems and discussing measurements and data from a test-beam exposure. Computing speed has been evaluated on a broad variety of hardware, investigating an approximated scaling formula.