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This study aimed at investigating the mechanisms underlying the oxygenation response to proning and recruitment maneuvers in coronavirus disease 2019 (COVID-19) pneumonia. Twenty-five patients with COVID-19 pneumonia, at variable times since admission (from 1 to 3 weeks), underwent computed tomography (CT) lung scans, gas-exchange and lung-mechanics measurement in supine and prone positions at 5 cmH2O and during recruiting maneuver (supine, 35 cmH2O). Within the non-aerated tissue, we differentiated the atelectatic and consolidated tissue (recruitable and non-recruitable at 35 cmH2O of airway pressure). Positive/negative response to proning/recruitment was defined as increase/decrease of PaO2/FiO2. Apparent perfusion ratio was computed as venous admixture/non aerated tissue fraction. The average values of venous admixture and PaO2/FiO2 ratio were similar in supine-5 and prone-5. However, the PaO2/FiO2 changes (increasing in 65% of the patients and decreasing in 35%, from supine to prone) correlated with the balance between resolution of dorsal atelectasis and formation of ventral atelectasis (p = 0.002). Dorsal consolidated tissue determined this balance, being inversely related with dorsal recruitment (p = 0.012). From supine-5 to supine-35, the apparent perfusion ratio increased from 1.38 ± 0.71 to 2.15 ± 1.15 (p = 0.004) while PaO2/FiO2 ratio increased in 52% and decreased in 48% of patients. Non-responders had consolidated tissue fraction of 0.27 ± 0.1 vs. 0.18 ± 0.1 in the responding cohort (p = 0.04). Consolidated tissue, PaCO2 and respiratory system elastance were higher in patients assessed late (all p

In our study we examined 75 patients treated for rectal cancer in the period between 01/01/2011 and 31/12/2014. Out of these 75 patients, we considered those 36 staged through MRI. We then compared the TNM stage obtained through MRI with the one emerged from histological examination. The correlation between the two TNM stages was assessed considering all patients staged through MRI and dividing the cases according to the submission or not to a neoadjuvant treatment. Finally, we analyzed serum levels of tumor markers CEA, CA 19.9 and AFP, relating them with the final disease stage. Data analysis showed a statistically significant correlation in the T stages, especially in the population not subjected to neoadjuvant treatment. Instead, for N, we found no statistically significant correlation. Similarly, none of the tumor markers presented a statistically significant correlation with disease stage. However, according to the positivity of tumor markers, we associated the following score: 0, (no positive marker)1 (only one marker positive) 2 (two markers positive) 3 (three markers positive). In presence of three markers positive, meaning the highest score, we found a statistically significant correlation with N + staging of the disease, obtained by postoperative pathologic examination. The conclusion is that MRI is certainly effective in T stage evaluation. Probably, for limph node involvement evaluation, more reliable parameters for establishing possible lymph node malignancy need to be found. The role of the tumor markers CEA, CA 19.9, AFP during preoperative evaluation of rectal tumors remains undefined. KEY WORDS: MRI, Rectal cancer, Tumor markes, Tumor regression, T stage.Nel nostro studio abbiamo esaminato 75 pazienti trattati per carcinoma del retto nel periodo dal 1 gennaio 2011 al 31 dicembre 2014. Di questi 75 casi abbiamo considerato 36 casi stadiati con RMN , Abbiamo confrontato la stadiazione ottenuta con lo studi oRMN con quella evidenziatasi dallo studio istologico. La correlazione tra le due stadiazioni TNM stata ulteriormente analizzata in base all’esecuzione o meno di trattamento neoadiuvante. Abbiamo, infine, analizzato i valori sierici di marcatori tumorali di CEA, Ca 19.9, AFP correlandoli alla stadiazione. I dati hanno dimostrato una correlazione statistiacmente significativa per il T specialmente nella popolazione che non aveva eseguito terapia neoadiuvante. Per il parametro N non abbiamo evidenziato correlazioni statisticamente significative; nessuno dei marcatori tumorali presentava un correlazione con lo stadio di malattia. Analizzano ulteriormente nei pazienti i marcatori tumorali positivi abbiamo associato il seguente score: 0 ( assenza di marcatori positivi),1 (solo un marcatore positivo), 2(due marcatori positivi),3 /tre marcatori positivi). In presenza di tre marcatpori positivi abbiamo trovato una correlazione statisticamente significativa con N+ in base all’esame istologico. La conclusione che la RMN efficace nella valutazione del T. Per stabilire il coinvolgimento linfonodale necessitiamo di ulteriori parametri. Il ruolo dei marcatori tumorali CEA, CA 19.9, AFP durante la valutazione preoperatoria dei tumori del retto rimane non ben definito.

Gastrointestinal tract duplication is a rare congenital malformation in young patients and in adults, that occur anywhere from the mouth to the anus and their macroscopic structure may be cystic or tubular.Intestinal duplication does not show specific symptoms, indeed they can present with a variety of symptoms including abdominal distension and pain, sickness, hemorrhage, chronic respiratory disorders, as well as non-painful abdominal mass. Nonetheless, intestinal duplication can remain completely asymptomatic and be diagnosed as an incidental finding. Presentation with acute complications such as intestinal invagination or mechanical occlusion is quite rare.We present a case of asymptomatic ileum duplication cyst in young female who referred to the emergency department for trauma and was screened by eco-Focus Assessment Sonography for Trauma (eco-FAST), followed by MR and CT.The patient underwent ileal resection and prophylactic appendicectomy with ileo-cecal termino-lateral anastomosis. In this case, the intestinal duplication cyst was an asymptomatic incidental finding.

Pneumomediastinum is a rare complication of facial fractures, always persuading the physicians to search for other and potentially more serious injuries such as esophageal or tracheal rupture. A 75-year old man presented to the Emergency Department (ED) reporting an accidental fall while walking on the road. He did not report loss of consciousness (LOS), was not taking anticoagulant drugs, did not report chest, abdomen or limb trauma. On physical examination he only showed swelling of nose and right orbit. The patient underwent a Computed Tomography (CT) scan of head and facial bones, showing a complex fracture involving right nasal bone, ethmoid, right orbital lateral wall, and right maxillary sinus lateral wall. No intracranial lesions were found. Due to the finding of subcutaneous emphysema in the right cheek, the scan was extended to the whole neck and chest. The exam showed a massive pneumomediastinum, extending till the diaphragmatic hiatus. The patient thus underwent bronchoscopy and esophagogastroscopy, but no further lesions could be found. Antibiotics therapy was then administered, and was discharged in good conditions after a five-days observation. In our patient, air had probably escaped into the pharyngo-maxillary space from the right maxillary sinus and tracked into both the retropharyngeal space and, for contiguity, into the pre-tracheal space. As our case report shows, if the airway is secure, the pneumomediastinum does not necessarily require treatment other than clinical observation and management of the fracture. If no other injuries are present, resolution of the pneumomediastinum may be expected without further medical interventions.

The aim of this discussion is to describe what is a defecography, how we have to perform it, what can we see and to present the main physio-pathological illnesses of pelvic floor and anorectal region that can be studied with this method and its advantages over other screening techniques. Defecography is a contrastographic radiological examination that highlights structural and functional pelvic floor diseases. Upon preliminary ileum-colic opacification giving to patient radiopaque contrast, are first acquired static images (at rest, in maximum voluntary contraction of the pelvic muscles, while straining) and secondarily dynamic sequences (during evacuation), allowing a complete evaluation of the functionality of the anorectal region and the pelvic floor. Defecography is an easy procedure to perform widely available, and economic, carried out in conditions where the patient experiences symptoms, the most realistic possible. It can be still considered reliable technology and first choice in many patients in whom the clinic alone is not sufficient and it is not possible or necessary to perform a study with MRI.

In a society where Information and Communication Technology (ICT) becomes a key component to improve the quality of our daily-life, systems' complexity dramatically increases to better accommodate to an inherent complexity of users' requirements, especially when dealing with pervasive computing. This poses demanding architectural requirements such as massive decentralization and disintermediation along with self-organizing properties. This higher level of system complexity has triggered the birth of several software engineering methodologies that adopt the agent paradigm. Design patterns are a well known approach for capturing and reusing knowledge related to known solution for recurrent architectural problems. Even though the importance of patterns is growing as systems become more and more complex, their development does not keep up with the evolving requirements, as traditional agent patterns are unable to support the majority of current complex social scenarios. This work motivates the need for new agent-based organizational structures that are more flexible than traditional agent patterns such as, Broker and Matchmaker. The newly suggested structure supports the dynamic nature of “Active Environment” where groups of agents are formed for service delivery and then dissolved with no central coordinating mechanism—i.e., gaining the disintermediation property. Serving as a case study, the PEACH and PIL projects have paved the way for experimenting with the new agent-based organizational structures that are more flexible and more suitable than traditional agent patterns for coping with ambient intelligence scenarios.

Our goal in this paper is to introduce and motivate a methodology, called Tropos,1 for building agent oriented software systems. Tropos is based on two key ideas. First, the notion of agent and all related mentalistic notions (for instance goals and plans) are used in all phases of software development, from early analysis down to the actual implementation. Second, Tropos covers also the very early phases of requirements analysis, thus allowing for a deeper understanding of the environment where the software must operate, and of the kind of interactions that should occur between software and human agents. The methodology is illustrated with the help of a case study. The Tropos language for conceptual modeling is formalized in a metamodel described with a set of UML class diagrams.

Percutaneous renal artery embolisation has been introduced as an alternative to nephrectomy in patients with non-functioning allograft and Graft Intolerance Syndrome (GIS). The symptoms resulting from GIS include fever, local pain, hypertension and haematuria.From April to October 2003, five patients were treated using this technique. The intraparenchymal renal arteries were embolized by injection of calibrated tris-acryl gelatin microspheres of increasing size (from 100-300 to 700-900 microns) and occlusion was completed by the insertion of 5mm to 8mm steel coils into the renal artery.The procedure was well tolerated in all cases and no major complications occurred. In 3 patients GIS-related symptoms disappeared immediately. One patient required a second embolisation due to collateral circulation arising from a lumbar artery with resolution of symptoms. In the last case, the patient underwent nephrectomy because of septic fever.On the basis of our preliminary experience we believe that, in selected patients, percutaneous renal artery embolisation is an effective, repeatable and minimally invasive alternative to nephrectomy with no significant serious complications.

The realization of complex distributed applications required in areas such as e-Business, e-Government, and ambient intelligence calls for new software development paradigms, such as the service oriented computing approach, which accommodates for dynamic and adaptive interaction schemata, carried on at a peer-to-peer level. Multi agent systems promise to offer the natural architectural solutions to several requirements imposed by such an adaptive approach. Nevertheless, architectural design patterns commonly adopted to model agent interaction schemata do not totally fit the needs implied by highly adaptable service oriented computing scenarios. In this paper, the agent oriented software engineering methodology Tropos is adopted to discuss common architectural agent patterns, and propose architectural improvements to better deal with high degrees of dynamic system adaptability. The novel architectures are illustrated through a case study in the field of ambient intelligence, namely a real multi agent system application implementing a pervasive museum visitors guide.

Objective: To evaluate the percentage of cases in which emboli can be detected in unenhanced scans and to identify the cases in which they appear hyperattenuating or hypoattenuating in comparison to the circulating blood. Method: An angio-computed tomography (CT) scan was performed before and after contrast injection in 140 consecutive patients after clinical suspicion of pulmonary embolism. A radiologist analyzed the examination results thus obtained. The enhanced scan was analyzed first, and after detecting the thrombus, the unenhanced scan was evaluated. Results: Fifty-one examinations were positive for a pulmonary embolism; in 21 cases, it was possible to identify the embolus even in the unenhanced scans. In 10 cases, the clots were hyperattenuating in comparison to the circulating blood; in 5 cases, they were hypoattenuating; and in 6 cases, they were mixed hyper-hypoattenuating. Conclusion: In a relatively high percentage of cases, particularly those of central thromboembolism, it is possible to identify and characterize the clots even in unenhanced scans.

A 58-year-old man with chronic hepatitis B and HIV co-infection nderwent abdominal ultrasound for liver cancer screening. A 5 mm focal hypoechoic lesion was discovered in segment VII. Liver unction tests and tumour markers levels ( -fetoprotein, CEA, ca 9.9) were normal. On contrast abdominal computed tomography he mass was enhanced heterogeneously in the arterial phase with inimal washout in the portal and delayed phases. On superparaagnetic iron oxide-enhanced magnetic resonance imaging the esion appeared to be slightly hypointense on T1 (Fig. 1A), hyperntense on T2 fat suppression and clearly hypervascular in the rterial phase (Fig. 1B). Based on the radiological findings and the linical history a diagnosis of hepatocellular carcinoma (HCC) was

YAK (Yet Another Krapfen) is a hybrid knowledge representation environment following the tradition of KL-ONE and KRYPTON. In its terminological box (TBOX) concepts and roles are described by means of a language called KFL that, even if inspired to FL-, captures a different set of descriptions, especially allowing the formulation of structured roles, that are aimed to be more adequate for the representational goal. KFL results to have a valid and complete calculus for the notion of subsumption, and a tractable algorithm that realize it is available. In the present paper it is shown how the semantics of a sufficiently significative subset of KFL can be described in terms of standard first order logic semantics. It is so possible to develop a notion of 'relation' between KFL and a full first order logic language formulated ad hoc and usable as formalization of an assertional box (ABOX). We then use this notion to justify the use of the terminological classification algorithm of the TBOX of YAK as part of the deduction machinery of the ABOX. In this way, the whole hybrid environment can take real and consistent advantages both from the TBOX and its tractable classification algorithm, and from the ABOX, and its wider expressive capability.© (1991) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.