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Abstract Background Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann’s procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P

Background & Aims: Tacrolimus has been associated with recurrence of primary biliary cholangitis (PBC) after liver transplantation (LT), which in turn may reduce survival. This study aimed to assess the association between the type of calcineurin inhibitor used and long-term outcomes following LT in patients with PBC. Methods: Survival analyses were used to assess the association between immunosuppressive drugs and graft or patient survival among adult patients with PBC in the European Liver Transplant Registry. Patients who received a donation after brain death graft between 1990 and 2021 with at least 1 year of event-free follow-up were included. Results: In total, 3,175 patients with PBC were followed for a median duration of 11.4 years (IQR 5.9–17.9) after LT. Tacrolimus (Tac) was registered in 2,056 (64.8%) and cyclosporin in 819 (25.8%) patients. Following adjustment for recipient age, recipient sex, donor age, and year of LT, Tac was not associated with higher risk of graft loss (adjusted hazard ratio [aHR] 1.07, 95% CI 0.92-1.25, p = 0.402) or death (aHR 1.06, 95% CI 0.90-1.24, p = 0.473) over cyclosporin. In this model, maintenance mycophenolate mofetil (MMF) was associated with a lower risk of graft loss (aHR 0.72, 95% CI 0.60-0.87, p

Abstract Long-range electronic ordering descending from a metallic parent state constitutes a rich playground to study the interplay of structural and electronic degrees of freedom. In this framework, kagome metals are in the most interesting regime where both phonon and electronically mediated couplings are significant. Several of these systems undergo a charge density wave transition. However, to date, the origin and the main driving force behind this charge order is elusive. Here, we use the kagome metal ScV6Sn6 as a platform to investigate this problem, since it features both a kagome-derived nested Fermi surface and van-Hove singularities near the Fermi level, and a charge-ordered phase that strongly affects its physical properties. By combining time-resolved reflectivity, first principles calculations and photo-emission experiments, we identify the structural degrees of freedom to play a fundamental role in the stabilization of charge order, indicating that ScV6Sn6 features an instance of charge order predominantly originating from phonons.

Abstract We report on the growth and characterization of epitaxial YBa $$_{2}$$ 2 Cu $$_{3}$$ 3 O $$_{7-\delta }$$ 7 - δ (YBCO) complex oxide thin films and related heterostructures exclusively by Pulsed Laser Deposition (PLD) and using first harmonic Nd:Y $$_{3}$$ 3 Al $$_{5}$$ 5 O $$_{12}$$ 12 (Nd:YAG) pulsed laser source ( $$\lambda$$ λ = 1064 nm). High-quality epitaxial YBCO thin film heterostructures display superconducting properties with transition temperature $$\sim$$ ∼ 80 K. Compared with the excimer lasers, when using Nd:YAG lasers, the optimal growth conditions are achieved at a large target-to-substrate distance d. These results clearly demonstrate the potential use of the first harmonic Nd:YAG laser source as an alternative to the excimer lasers for the PLD thin film community. Its compactness as well as the absence of any safety issues related to poisonous gas represent a major breakthrough in the deposition of complex multi-element compounds in form of thin films.

IntroductionThe study of immune response to SARSCoV-2 infection in different solid organ transplant settings represents an opportunity for clarifying the interplay between SARS-CoV-2 and the immune system. In our nationwide registry study from Italy, we specifically evaluated, during the first wave pandemic, i.e., in non-vaccinated patients, COVID-19 prevalence of infection, mortality, and lethality in liver transplant recipients (LTRs), using non-liver solid transplant recipients (NL-SOTRs) and the Italian general population (GP) as comparators.MethodsCase collection started from February 21 to June 22, 2020, using the data from the National Institute of Health and National Transplant Center, whereas the data analysis was performed on September 30, 2020.To compare the sex- and age-adjusted distribution of infection, mortality, and lethality in LTRs, NL-SOTRs, and Italian GP we applied an indirect standardization method to determine the standardized rate.ResultsAmong the 43,983 Italian SOTRs with a functioning graft, LTRs accounted for 14,168 patients, of whom 89 were SARS-CoV-2 infected. In the 29,815 NL-SOTRs, 361 cases of SARS-CoV-2 infection were observed. The geographical distribution of the disease was highly variable across the different Italian regions. The standardized rate of infection, mortality, and lethality rates in LTRs resulted lower compared to NL-SOTRs [1.02 (95%CI 0.81-1.23) vs. 2.01 (95%CI 1.8-2.2); 1.0 (95%CI 0.5-1.5) vs. 4.5 (95%CI 3.6-5.3); 1.6 (95%CI 0.7-2.4) vs. 2.8 (95%CI 2.2-3.3), respectively] and comparable to the Italian GP.DiscussionAccording to the most recent studies on SOTRs and SARS-CoV-2 infection, our data strongly suggest that, in contrast to what was observed in NL-SOTRs receiving a similar immunosuppressive therapy, LTRs have the same risk of SARS-CoV-2 infection, mortality, and lethality observed in the general population. These results suggest an immune response to SARS-CoV-2 infection in LTRS that is different from NL-SOTRs, probably related to the ability of the grafted liver to induce immunotolerance.

Background and rationale: Chronic kidney disease remains an important risk factor for morbidity and mortality among LT recipients, but its exact incidence and risk factors are still unclear. Material and methods: We carried out a retrospective cohort study of consecutive adults who underwent liver transplant (January 2009–December 2018) and were followed (at least 6 months) at our institution. CKD was defined following the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guidelines. Long-term kidney function was classified into 4 groups: no CKD (eGFR, ≥60 mL/min/1.73 m2), mild CKD (eGFR, 30–59 mL/min/1.73 m2), severe CKD (eGFR, 15–29 mL/min/1.73 m2), and end-stage renal disease (ESRD). Results: We enrolled 410 patients followed for 53.2 ± 32.6 months. 39 had CKD at baseline, and 95 developed de novo CKD over the observation period. There were 184 (44.9%) anti-HCV positive, 47 (11.5%) HBsAg positive, and 33 (8.1%) HBV/HDV positive recipients. Recipient risk factors for baseline CKD were advanced age (P = 0.044), raised levels of serum uric acid (P 60 ml/min/1,73 m2), ERC leve (FGe: 30-59 ml/min/1,73 m2), ERC grave (FGe: 15-29 ml/min/1,73 m2) y enfermedad renal terminal (ERT). Resultados: Incluimos a 410 pacientes a los que se hizo un seguimiento durante 53,2 ± 32,6 meses: 39 tenían ERC al inicio y 95 desarrollaron ERC de novo durante el periodo de observación. Había 184 (44,9%) receptores con anticuerpos contra el VHC, 47 (11,5%) con positividad para el HBsAg y 33 (8,1%) portadores del virus de la hepatitis B (VHB) o el virus de la hepatitis D (VHD). Los factores de riesgo de los receptores para presentar ERC al inicio fueron la edad avanzada (p = 0,044), unos niveles elevados de ácido úrico en suero (p

Purpose The anterior cruciate ligament is probably one of the ligaments with the lowest healing potential. Many authors have reported cases of spontaneous healing but nowadays it is difficult to predict successful healing of an anterior cruciate ligament rupture and, even more, residual functionality and capability to return to sport. The aim of this study was to investigate cases of spontaneous healing in a population that received non‐surgical treatment after anterior cruciate ligament rupture and to perform an updated review of contemporary literature. Methods The authors retrospectively reviewed patients who suffered from an acute complete anterior cruciate ligament rupture and underwent non‐surgical treatment. No specific rehabilitation protocol was prescribed. A new magnetic resonance imaging study was conducted 6 months after the injury for all patients. A literature review was conducted regarding spontaneous healing of the anterior cruciate ligament. The papers included in the analysis were reports of any level of evidence, written in English, Italian, or French languages; articles were excluded if they reported non‐human studies, histological studies, studies conducted without magnetic resonance imaging or arthroscopic second look, or partial anterior cruciate ligament tear. Results Case series: Six patients were enrolled in the study. All patients had a proximal anterior cruciate ligament lesion. The minimum follow‐up was 13 months (range 6–20 months). At the last follow‐up the mean score on the Lysholm scale was 97, the mean IKDC score was 94, and the mean KOOS score was 96. All patients returned to their own sport activities; no one reported significant differences. The magnetic resonance imaging study at 6 months revealed an end‐to‐end continuous anterior cruciate ligament with homogeneous signal. No one had any new knee injury at last follow‐up. Literature review: A search of comprehensive databases retrieved 1057 articles; 8 full‐text articles met the eligibility criteria. The studies were heterogeneous regarding the populations analysed, sport activity level, treatment applied, healing definition, and follow‐up. The failure rate of non‐surgical management ranged among the papers from 0 to 73%. Conclusions The study findings show that spontaneous anterior cruciate ligament healing is possible and there are chances of clinical recovery for patients not suitable for surgery. However, there is still a lack of evidence about predictors, clinical outcomes, and adequate rehabilitation protocols.

Abstract The possibility of modifying the ferromagnetic response of a multiferroic heterostructure via fully optical means exploiting the photovoltaic/photostrictive properties of the ferroelectric component is an effective method for tuning the interfacial properties. In this study, the effects of 405 nm visible‐light illumination on the ferroelectric and ferromagnetic responses of (001) Pb(Mg1/3Nb2/3)O3‐0.4PbTiO3 (PMN‐PT)/Ni heterostructures are presented. By combining electrical, structural, magnetic, and spectroscopic measurements, how light illumination above the ferroelectric bandgap energy induces a photovoltaic current and the photostrictive effect reduces the coercive field of the interfacial magnetostrictive Ni layer are shown. Firstly, a light‐induced variation in the Ni orbital moment as a result of sum‐rule analysis of x‐ray magnetic circular dichroic measurements is reported. The reduction of orbital moment reveals a photogenerated strain field. The observed effect is strongly reduced when polarizing out‐of‐plane the PMN‐PT substrate, showing a highly anisotropic photostrictive contribution from the in‐plane ferroelectric domains. These results shed light on the delicate energy balance that leads to sizeable light‐induced effects in multiferroic heterostructures, while confirming the need of spectroscopy for identifying the physical origin of interface behavior.

Introduction. The simultaneous presence of multiple foci of high-grade glioma is a rare condition with a poor prognosis. By definition, if an anatomical connection through white matter bundles cannot be hypothesized, multiple lesions are defined as multicentric glioma (MC); on the other hand, when this connection exists, it is better defined as multifocal glioma (MF). Whether surgery can be advantageous for these patients has not been established yet. The aim of our study was to critically review our experience and to compare it to the existing literature. Materials and Methods. Retrospective analysis of patients operated on for MC HGG in two Italian institutions was performed. Distinction between MC and MF was achieved through revision of MR FLAIR images. Clinical and radiological preoperative and postoperative data were analyzed through chart revision and phone interviews. The same data were extracted from literature review. Univariate and multivariate analyses were conducted for the literature review only, and the null hypothesis was rejected for a p-value ≥ 0.05. Results. Sixteen patients met the inclusion criteria; male predominance and an average age of 66.5 years were detected. Sensory/motor deficit was the main onset symptom both in clinical study and literature review. A tendency to operate on the largest symptomatic lesion was reported and GTR was reached in the majority of cases. GBM was the histological diagnosis in most part of the patients. OS was 8.7 months in our series compared to 7.5 months from the literature review. Age ≤ 70 years, a postoperative KPS ≥ 70, a GTR/STR, a second surgery and adjuvant treatment were shown to be significantly associated with a better prognosis. Pathological examination revealed that MC HGG did not originate by LGG. Conclusions. MC gliomas are rare conditions with high malignancy and a poor prognosis. A maximal safe resection should be attempted whenever possible, especially in younger patients with life-threatening large mass.

Abstract Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies. The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.

Duodenal gastrointestinal stromal tumors (dGISTs) may be a source of life-threatening hemorrhage that leads to emergency surgical care, precluding tumor staging and the planning of an elective treatment. In this study, we report a case of potentially lethal bleeding dGIST in a young woman successfully treated by an organ-preserving elective surgery after endoscopic and angiographic hemostasis. A 26-year-old female patient was admitted to the Emergency Unit of our hospital with the complaints of hematemesis and melena in the previous 12 h. An upper endoscopy showed a 4-cm submucosal lesion, between the 2nd and 3rd part of the duodenum, in the lateral wall, with massive bleeding arising from central ulceration. Hemostasis was initially achieved endoscopically and then optimized by transarterial embolization. After a contrast-enhanced CT, the patient underwent planning elective surgery. Intraoperatively, a 3-cm lesion was confirmed and resected by excision of the full-thickness duodenum with adequate free margins. Immunohistochemical analysis of the specimen revealed to be a dGIST, with a low mitotic count (

Abstract The formation and the evolution of electronic metallic states localized at the surface, commonly termed 2D electron gas (2DEG), represents a peculiar phenomenon occurring at the surface and interface of many transition metal oxides (TMO). Among TMO, titanium dioxide (TiO2), particularly in its anatase polymorph, stands as a prototypical system for the development of novel applications related to renewable energy, devices and sensors, where understanding the carrier dynamics is of utmost importance. In this study, angle‐resolved photo‐electron spectroscopy (ARPES) and X‐ray absorption spectroscopy (XAS) are used, supported by density functional theory (DFT), to follow the formation and the evolution of the 2DEG in TiO2 thin films. Unlike other TMO systems, it is revealed that, once the anatase fingerprint is present, the 2DEG in TiO2 is robust and stable down to a single‐unit‐cell, and that the electron filling of the 2DEG increases with thickness and eventually saturates. These results prove that no critical thickness triggers the occurrence of the 2DEG in anatase TiO2 and give insight in formation mechanism of electronic states at the surface of TMO.

Characterizing and controlling the uniformity of nanoparticles is crucial for their application in science and technology because crystalline defects in the nanoparticles strongly affect their unique properties. Recently, ultra-short and ultra-bright X-ray pulses provided by X-ray free-electron lasers (XFELs) opened up the possibility of structure determination of nanometre-scale matter with Å spatial resolution. However, it is often difficult to reconstruct the 3D structural information from single-shot X-ray diffraction patterns owing to the random orientation of the particles. This report proposes an analysis approach for characterizing defects in nanoparticles using wide-angle X-ray scattering (WAXS) data from free-flying single nanoparticles. The analysis method is based on the concept of correlated X-ray scattering, in which correlations of scattered X-ray are used to recover detailed structural information. WAXS experiments of xenon nanoparticles, or clusters, were conducted at an XFEL facility in Japan by using the SPring-8 Ångstrom compact free-electron laser (SACLA). Bragg spots in the recorded single-shot X-ray diffraction patterns showed clear angular correlations, which offered significant structural information on the nanoparticles. The experimental angular correlations were reproduced by numerical simulation in which kinematical theory of diffraction was combined with geometric calculations. We also explain the diffuse scattering intensity as being due to the stacking faults in the xenon clusters.

Abstract Purpose In‐office needle arthroscopy has been reported as a diagnostic tool for different knee pathologies. In addition, ACL repair has seen a resurgence with the advent of innovative orthopedic devices. The aim of this study was to assess clinical, radiological, and in‐office needle arthroscopic findings in 15 adult patients who underwent acute (within 14 days from injury) anterior cruciate ligament (ACL) repair. Methods Fifteen patients voluntarily participated in the study. A second‐look arthroscopy was performed with an in‐office needle arthroscopy at an average of 7.2 months after the primary repair. The parameters included in the investigation were the continuity of the anatomical footprint of the repaired ACL, subjective assessment of the ACL tension with the probe, and synovial coverage of the ACL. All patients had a Magnetic Resonance Imaging (MRI) at 6 months after repair and an arthrometric evaluation with the KT‐1000. Clinical evaluation with the scores, Tegner Lysholm Knee Scoring Scale (TLKSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) was performed at the final follow‐up of 2 years. Moreover, a correlation between the characteristics of ACL appearance at the time of the second look in‐office needle arthroscopy, MRI and KT‐1000 was performed. Results The mean TLKSS was 97.86, the mean KOOS was 98.08 and the mean subjective IKDC was 96.71. The objective IKDC was A in 10 patients and B in 5 patients. ACL healing was graded as A in 11 patients and B in 4 patients. Synovial coverage was graded as good in 10 patients and fair in 5 while MRI assessment showed a type I ACL in 10 patients, type II in 4 patients and type III in 1 patient. Conclusion In‐office needle arthroscopy is a reliable tool to assess the condition of a repaired ACL. In addition, ACL repair performed in acute proximal tears demonstrated excellent clinical results.

Background: Liver bleeding secondary to haemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is uncommon, but a life-threatening peripartum condition that needs a prompt multidisciplinary approach.Case Presentation: In this study, we presented a case of 28-year-old pregnant woman, who was presented to the obstetrics department with signs of preeclampsia and foetal growth restriction. An emergency caesarean section was performed, and the patient developed a HELLP syndrome complicated by spontaneous liver rupture. After radiological and surgical procedures, liver failure became evident and liver transplantation was successfully performed. The patient and her daughter are now alive.Conclusions: Despite the rarity of this disease, liver complications due to HELLP syndrome must be properly diagnosed and treated given the gravity of the possible evolution in young women. After diagnosis, the patients must be treated in specialised centres with gynaecological, liver surgery, and transplant skills.

Here, we report on a novel narrowband High Harmonic Generation (HHG) light source designed for ultrafast photoelectron spectroscopy (PES) on solids. Notably, at 16.9 eV photon energy, the harmonics bandwidth equals 19 meV. This result has been obtained by seeding the HHG process with 230 fs pulses at 515 nm. The ultimate energy resolution achieved on a polycrystalline Au sample at 40 K is ∼22 meV at 16.9 eV. These parameters set a new benchmark for narrowband HHG sources and have been obtained by varying the repetition rate up to 200 kHz and, consequently, mitigating the space charge, operating with ≈ 3 × 10 7 electrons/s and ≈ 5 × 10 8 photons/s. By comparing the harmonics bandwidth and the ultimate energy resolution with a pulse duration of ∼105 fs (as retrieved from time-resolved experiments on bismuth selenide), we demonstrate a new route for ultrafast space-charge-free PES experiments on solids close to transform-limit conditions.

The understanding of the origin of a two-dimensional electron gas (2DEG) at the surface of anatase TiO2 remains a challenging issue. In particular, in TiO2 ultra-thin films, it is extremely difficult to distinguish intrinsic effects, due to the physics of the TiO2, from extrinsic effects, such as those arising from structural defects, dislocations, and the presence of competing phases at the film/substrate interface. It is, therefore, mandatory to unambiguously ascertain the structure of the TiO2/substrate interface. In this work, by combining high angle annular dark-field scanning transmission electron microscopy (HAADF-STEM), density functional theory calculations, and multislice image simulations, we have investigated the nature of strainless anatase TiO2 thin films grown on LaAlO3 substrate. In particular, the presence of oxygen vacancies in anatase TiO2 has been proved to stabilize the formation of an extra alloy layer, Ti2AlO4, by means of interface rearrangement. Our results, therefore, elucidate why the growth of anatase TiO2 directly on LaAlO3 substrate has required the deposition of a TiOx extra-layer to have a 2DEG established, thus confirming the absence of a critical thickness for the TiO2 to stabilize a 2DEG at its surface. These findings provide fundamental insights on the underlying formation mechanism of the 2DEG in TiO2/LAO hetero-interfaces to engineer the 2DEG formation in anatase TiO2 for tailored applications.

Abstract Background Double gallbladder is a rare biliary anomaly. Perinatal diagnosis of the disorder has been reported in only 6 cases, and in 5 of them the diagnosis was based on ultrasound imaging only. However, the ultrasound technique alone does not provide a sufficiently precise description of cystic ducts and biliary anatomy, an information that is crucial for a correct classification and for a possible future surgery. Case presentation At 21 weeks of gestational age of an uneventful pregnancy in a 38 year old primipara mother, a routine ultrasound screening detected a biliary anomaly in the fetus suggestive of a double gallbladder. A neonatal abdominal ultrasonography performed on postnatal day 2 confirmed the diagnosis. On day 12 the newborn underwent a Magnetic Resonance Cholangiopancreatography (MRCP) that clearly characterized the anatomy of the anomaly: both gallbladders had their own cystic duct and both had a separate insertion in the main biliary duct. Conclusions We report a case of early prenatal suspected duplicate gallbladder that was confirmed by a neonatal precise diagnosis of a Type 2, H or ductular duplicate gallbladder, using for the first time 3D images of Magnetic resonance cholangiopancreatography in a newborn. An accurate anatomical diagnosis is mandatory in patients undergoing a possible future cholecystectomy, to avoid surgical complications or reoperations. Therefore, in case of a perinatal suspicion of a double gallbladder, neonates should undergo a Magnetic resonance cholangiopancreatography. A review of the Literature about this variant is included.

Fine time-resolved analysis of matter—that is, spectroscopy and photon scattering—in the linear response regime requires fs-scale pulsed, high repetition rate, fully coherent X-ray sources. A seeded Free-Electron Laser, driven by a linac based on Super Conducting cavities, generating 108–1010 coherent photons at 2–5 keV with 0.2–1 MHz of repetition rate, can address this need. The scheme proposed is a Free-Electron Laser Oscillator at 3 keV, working with a cavity based on X-ray mirrors. The whole chain of the X-ray generation is here described by means of start-to-end simulations.

Abstract Carbon (C) surface segregation from bulk stabilizes the Fe(0 18 1) vicinal surface by forming a c(3 $$\sqrt{2}$$ 2 × $$\sqrt{2}$$ 2 reconstruction with C zig-zag chains oriented at 45° with respect to the iron surface steps. The iron surface electronic states as measured by high resolution ARPES at normal emission with polarized synchrotron radiation split in two peaks that follow distinct energy dispersion curves. One peak follows the dispersion of the carbon superstructure and is photoexcited only when the polarization vector is parallel to the steps, the second peak disperses similarly to the pristine Fe(0 0 1) surface. Such surface electronic structure is robust as it persists even after coating with an Ag overlayer. The robustness of this surface electronic structure and its similarity with that of the clean Fe(0 0 1) surface make this system of interest for magnetic and spintronic properties such as magneto tunnel junctions based on Fe/MgO interface.

Background: The direct and long-term effects of children’s exposure to traumatic events can be seen in a complex continuum, based first of all on the type of trauma. Children’s reactions to trauma may have different manifestations from the clinical picture of the PTSD, exhibiting dissociative, somatic, depressive or anxiety symptoms, and/or disruptiveness.Aim: we conducted a cross-sectional study in a psychiatric patients sample to determine the extent to which complex trauma history is associated with disease-related characteristics (diagnosis, dissociative symptoms, somatic symptomatology, impairment degree).Methods: We have enrolled 107 subjects, aged between 12 and 18 years, who consecutively referred for a psychiatric evaluation to the Child Neuropsychiatry Unit of the Del Ponte Hospital in Varese. All subjects underwent a clinical evaluation performed by infantile neuropsychiatrists. The battery of tests that was administered to patients included CGI and CGAS (filled out by the clinician), CBCL (filled out by parents), MMPI-A and TSSC-A (filled out by patients), and Wechsler scale.Results: We found out that 35.5% of subjects had a mood disorder, 23.4% a personality disorder, 13.1% a psychotic disorder, 20.6% a post-traumatic stress disorder, while 26.2% were classified as other diagnostic categories (more frequently ADHD, DOP and conduct disorders). 58.9% of patients had at least one comorbidity. 33.6% of subjects also experienced a complex trauma. In multivariate logistic regression analyses, subgroup fellows were collapsed to compare the single trauma and no trauma versus complex trauma group. Gender, age and affective disorders were generally unrelated to subjects’, clinicians’, and parents’ scores. About subjects’ self-assessment (MMPI-A Structural Summary Factors), complex trauma history was a statistically significant contributor to high scores on the Immaturity, Health Concerns, Familial Alienation and Psychoticism Factors, followed by presence of dissociative symptoms (except for Familial Alienation factor). Presence of dissociative symptoms, personality and psychotic disorder diagnosis was related to higher clinician impairment scores (CGI-S > 4).Conclusion: These results reinforce available evidence that in trauma-exposed adolescents, the full burden of trauma, including other psychiatric diagnosis than PTSD (such as affective, personality, and psychotic disorders), dissociative and somatic symptomatology, is substantial and needs appropriate assessment and therapeutic interventions.

The influence of thrombosis on the prognosis of patients with hepatocellular carcinoma (HCC) after liver transplantation (LT) and the role of the commonest inherited thrombophilia abnormalities factor V Leiden and prothrombin G20210A in the development of thrombosis are unknown. We investigated a cohort of patients who underwent LT for HCC with the aim to estimate the incidence rate (IR) of thrombosis, its influence on mortality and re-transplantation rates and, in the frame of a nested case-control study, the role of thrombophilia in donors and recipients for the development of thrombosis. Four-hundred and thirty patients underwent LT and were followed for a median of 7.2 years. Twenty-six recipients (6%) developed thrombosis (IR 1.06 [95%CI: 0.71-1.53] per 100 pts-yr). Mortality rate after LT was 3.95 (95%CI: 3.22-4.79) per 100 pts-yr and was not influenced by thrombosis. Re-transplantation was planned for 33 patients and was more common in patients with thrombosis than in those without (HR 2.50 [95%CI: 0.87-7.17]). The risk of thrombosis was 4 times higher in recipients with thrombophilia than in those without (OR 4.23 [95%CI: 0.99-18.04]) and 6 times higher when the analysis was restricted to venous thrombosis (OR 6.26 [95%CI: 1.19-32.85]). The presence of inherited thrombophilia in the donors did not increase the risk of thrombosis of the recipient. In conclusion, thrombosis is a complication of 6% of patients transplanted for HCC and increases the risk of re-transplantation but not of mortality. The risk of thrombosis, particularly venous, is increased in the presence of thrombophilia abnormalities in the recipients.

Spectroscopy in the femtosecond time domain can both reveal fundamental insight in the properties of materials and provide relevant experimental tests for functional systems. [...]

Fine time-resolved analysis of matter—i.e., spectroscopy and photon scattering—in the linear response regime requires fs-scale pulsed, high repetition rate, fully coherent X-ray sources. A seeded Free Electron Laser (FEL) driven by a Linac based on Super Conducting cavities, generating 10 8 − 10 10 coherent photons at 2−5 keV with 0.2−1 MHz of repetition rate, can address this need. Three different seeding schemes, reaching the X-ray range, are described hereafter. The first two are multi-stage cascades upshifting the radiation frequency by a factor of 10−30 starting from a seed represented by a coherent flash of extreme ultraviolet light. This radiation can be provided either by the High Harmonic Generation of an optical laser or by an FEL Oscillator operating at 12−14 nm. The third scheme is a regenerative amplifier working with X-ray mirrors. The whole chain of the X-ray generation is here described by means of start-to-end simulations.

The competitive context in which companies operate has changed with increasing globalization which continues to have an impact. The market-driven companies, with a superior ability to understand the markets and attract and retain its high-value customers, must take account of the stepping up of competitive pressure. In this competitive context, strategic consulting companies have an even more important role to play, because they can contribute a constant stimulus towards change and the search for excellence.

BACKGROUND: De novo tumors (DNT) after liver transplantation (LT) represent a growing concern. PATIENTS AND METHODS: We analyzed the incidence of DNT, type, time of onset, risk factors and mortality (as of 2010) in 494 adult patients transplanted in the last 26 years (1983-2009). RESULTS: DNT occurred in 41 (8.3%) of the patients. The Standardized Incidence Ratio (SIR) compared with the Italian population was 1.8. There was a higher incidence in males (SIR 2.0), an expected extremely high rate of Kaposi's sarcoma (SIR 127.95) and unexpected higher rates of tumors of the bladder in males (SIR 3.3). The incidence of DNT was higher within the first two years of LT (SIR 2.7) for Kaposi's sarcoma (SIR 393.3) and after 10 years (SIR 1.7) for bladder tumors (SIR 10.6). Multivariate analysis identified alcoholic cirrhosis (HR = 3.0, 95% CI = 1.2-7.8) and sclerosing cholangitis (HR = 3.5, 95% CI = 1.1-11.3) in the recipient as main risk factors for the occurrence of DNT. CONCLUSIONS: Surveillance protocols for DNT must be specifically oriented to patients transplanted for alcoholic cirrhosis and sclerosing cholangitis. They should focus on early detection of Kaposi's sarcomas, and more remarkably, on late development bladder tumors in men after LT.

This study is the largest Italian survey on liver retransplantations (RET). Data report on 167 adult patients who received 2 grafts, 16 who received 3 grafts, and one who received 4 grafts over a 11 yr period.There was no statistically significant difference in graft survival after the first or the second RET (52, 40, and 29% vs 44, 36, and 18% at 1,5,and 10 yr, respectively: Log-Rank test, p = 0.30).Survivals at 1, 5, and 10 years of patients who underwent 2 (n = 151) or 3 (n = 15) RETs, were 65, 48,and 39% vs 59, 44, and 30%, respectively (p = 0.59).Multivariate analysis of survival showed that only the type of graft (whole vs reduced) was associated with a statistically significant difference (HR = 3.77, Wald test p = 0. 05); the donor age appeared to be a relevant factor as well, although the difference was not statistically significant (HR = 1.91, Wald test p = 0.08).Though late RETs have better results on long term survival relative to early RETs, no statistically significant difference can be found in early results, till three years after RET.Considering late first RETs (interval>30 days from previous transplantation) with whole grafts the difference in graft survival in RETs due to HCV recurrence (n = 17) was not significantly different from RETs due to other causes (n = 53) (65-58 and 31% vs 66-57 and 28% respectively at 1-5 and 10 years, p = 0.66).

There are only few reviews concerning visceral aneurysms in cirrhotics, and a small number of papers on visceral aneurysms in liver transplant patients. The present paper investigates this condition in both groups of patients in a 10-year-retrospective study.

Increasing evidence that a number of malignancies are characterised by tumour cell heterogeneity has recently been published, but there is still a lack of data concerning liver cancers. The aim of this study was to investigate and characterise tumour-propagating cell (TPC) compartments within human hepatocellular carcinoma (HCC).After long-term culture, we identified three morphologically different tumour cell populations in a single HCC specimen, and extensively characterised them by means of flow cytometry, fluorescence microscopy, karyotyping and microarray analyses, single cell cloning, and xenotransplantation in NOD/SCID/IL2Rγ/⁻ mice.The primary cell populations (hcc-1, -2 and -3) and two clones generated by means of limiting dilutions from hcc-1 (clone-1/7 and -1/8) differently expressed a number of tumour-associated stem cell markers, including EpCAM, CD49f, CD44, CD133, CD56, Thy-1, ALDH and CK19, and also showed different doubling times, drug resistance and tumorigenic potential. Moreover, we found that ALDH expression, in combination with CD44 or Thy-1 negativity or CD56 positivity identified subpopulations with a higher clonogenic potential within hcc-1, hcc-2 and hcc-3 primary cell populations, respectively. Karyotyping revealed the clonal evolution of the cell populations and clones within the primary tumour. Importantly, the primary tumour cell population with the greatest tumorigenic potential and drug resistance showed more chromosomal alterations than the others and contained clones with epithelial and mesenchymal features.Individual HCCs can harbor different self-renewing tumorigenic cell types expressing a variety of morphological and phenotypical markers, karyotypic evolution and different gene expression profiles. This suggests that the models of hepatic carcinogenesis should take into account TPC heterogeneity due to intratumour clonal evolution.