Iperenzimemia Pancreatica in Pazienti Asintomatici: Alterazioni Morfo-Funzionali del Pancreas e Studio di Patologie Associate.Follow-up.

Premesse: L\u2019 iperenzimemia pancreatica cronica asintomatica (CAPH) \ue8 stata descritta dal 1996 come una condizione benigna. Recenti studi descrivono reperti patologici alla Risonanza Magnetica Colangiopancreatografia con stimolo secretinico (s-MRCP) in pi\uf9 della met\ue0 dei soggetti portatori di CAPH. Nessuno studio di follow-up \ue8 stato condotto finora in tali soggetti. Obiettivo: indagare la frequenza e la rilevanza clinica dei reperti alla s-MRCP in pazienti con CAPH; rivalutare i soggetti dopo anni per valutare eventuali modificazioni radiologiche nel tempo e/o comparsa di sintomi. Metodi: I soggetti, arruolati dal Gennaio 2005 al Dicembre 2010, sono stati sottoposti a s-MRCP ed esami bioumorali, e successivamente una parte di essi rivalutati in follow-up. Risultati: Sono stati analizzati i dati relativi a 160 soggetti (94 maschi, 66 femmine, et\ue0 49,6 \ub1 13,6 anni). Cinquantuno (32%) soggetti avevano iperamilasemia, 9 (6%) iperlipasemia, 100 (62%), un aumento in entrambi i livelli degli enzimi. Una iperenzimemia pancreatica familiare \ue8 stata osservata in 26 dei 133 soggetti (19,5%). Anomalie anatomiche del sistema duttale pancreatico alla s-MRCP sono state riscontrate in 24 dei 160 soggetti (15%). Risultati patologici erano presenti in 44 soggetti (27,5%) prima e in 80 (50%) dopo somministrazione di secretina (p <0,0001). Cinque soggetti (3,1%) sono stati sottoposti a intervento chirurgico, 3 per il tumore del pancreas endocrino, 1 per l'adenocarcinoma del pancreas e 1 per neoplasia mucinosa papillare intraduttale (IPMN) del dotto pancreatico principale e in 18 pazienti (11,3%) \ue8 stato indicato un follow-up (17 per IPMN e 1 per tumore endocrino). Nello studio di follow-up abbiamo ottenuto dati clinici di 107 soggetti e una rivalutazione radiologica mediante MRCP in 66 soggetti. Un solo soggetto ha presentato una pancreatite acuta dopo 5 anni dal primo riscontro di iperenzimemia. Un solo soggetto su 11 con IPMN aveva una progressione delle dimensioni della cisti, 1 su 10 con SOD presentava peggioramento della dilatazione del dotto di Wirsung, mentre si assisteva a progressione della pancreatite cronica nel 11% dei soggetti dopo follow-up medio di 3 \ub1 2 anni. Conclusioni: alterazioni del sistema dotto pancreatico alla s-MRCP in soggetti con CAPH possono essere osservate nel 50% dei soggetti e sono clinicamente rilevanti nel 14,4% dei casi. Le alterazioni funzionali riscontrate (SOD, sospetta pancreatite cronica) solo in modesta parte evolvono verso la cronicizzazione di malattia.Background: Chronic asymptomatic pancreatic hyperenzymemia (CAPH) has been described since 1996 as a benign disease. Recent studies described pathological findings at Magnetic Resonance Cholangio-Pancreatography with secretin stimulation in more than a half of the CAPH subjects. No study of follow-up was conducted so far in these subjects. Aim: to investigate the frequency and clinical relevance of s-MRCP findings in patients with CAPH; reevaluate the subjects after years to assess any radiological changes in time and / or appearance of symptoms. Methods: Subjects prospectively enrolled from January 2005 to December 2010 underwent s-MRCP and biochemical tests routinely performed, and then a part of them re-evaluated in follow-up. Results: Data relative to 160 subjects (94 males, 66 females, age 49.6 \ub1 13.6 years) were analyzed. Fifty-one (32%) subjects had hyperamylasemia, 9 (6%) hyperlipasemia, 100 (62%) an increase in both enzyme levels. Familial pancreatic hyperenzymemia was observed in 26 out of 133 subjects (19.5%). Anatomic abnormalities of the pancreatic duct system at s-MRCP were found in 24 out of 160 subjects (15%). Pathological MRCP findings were present in 44 subjects (27.5%) before and in 80 (50%) after secretin administration (p<0.0001). Five subjects (3.1%) underwent surgery, 3 for pancreatic endocrine tumor, 1 for pancreatic adenocarcinoma and 1 for intraductal papillary-mucinous neoplasia (IPMN) involving the main pancreatic duct and 18 patients (11.3%) needed a follow-up (17 for IPMN and 1 for endocrine tumor). In the follow-up study we obtained clinical data of 107 subjects and a radiological evaluation by MRCP in 66 subjects. One subject experienced acute pancreatitis after 5 years from the first detection of hyperenzymemia. Only one subject out of 11 with IPMN had progression of the size of the cyst, 1 out of 10 with SOD showed worsening of Wirsung duct dilation, while we observed a progression of chronic pancreatitis in 11% of subjects after mean follow-up of 3 \ub1 2 years. Conclusions: Alterations of the pancreatic duct system at s-MRCP in subjects with CAPH can be observed in 50% of the subjects and are clinically relevant in 14.4% of cases. Only a small part of the \u201cfunctional\u201d alterations observed at S-MRCP (SOD, suspected chronic pancreatitis) evolves into a chronic form of the disease

Analysis of web visit histories, part I: Distance-based visualization of sequence rules

This paper constitutes Part I of the contribution to the analysis of web visit histories through a new methodological framework. Firstly, web usage and web structure mining are considered as an unique mining process to detect the latent structure of the web navigation across the web sections of a single portal. We extend association rules theory to web data defining new concepts of web (patterns) association and preference matrices, as well as of (indirect and direct) sequence rules. We identify the most significant rules, according to a multiple testing procedure. In the literature, web usage patterns can be visualized in no-distance-based graphs describing the navigation behavior across web pages with sequential arrows. In the following, we introduce a geometrical visualization of sequence rules at any click of the web navigation. In particular, we provide two distance-based visualization methods for the static analysis of all data tout court and the dynamic analysis to discover the most significant web paths click by click. A real world case study is considered throughout the methodological description

Post-lacustrine evolution of a tectonically-controlled intermontane basin: Drainage network analysis of the Mercure basin, southern Italy

Topographic analysis, drainage network morphometry, river profile analysis, and spatial distribution of fluvio-lacustrine terraces have been used to reconstruct the drainage network evolution in the Mercure River basin, a large intermontane tectonic basin of the axial zone of southern Apennines. Morphotectonic evolution of the study area is mainly controlled by poly-kinematics high-angle WNW-ESE and NE-SW faults, which promoted the development of a complex landscape with relict landscapes and/or low-relief erosional surfaces that occurred in a staircase arrangement at the top of the landscapes or at higher altitudes than the basin infill. The creation of the accommodation space for the deposition of the thick basin infill was related to an important tectonic phase of block-faulting along N120°-trending normal faults, which occurred in the final part of the Lower Pleistocene. Such an evolution strongly controls the longitudinal profile forms of channels draining the northern sector of the study area, which are featured by a well-developed concave-up segment in river profiles of these channels between an upward trait with lower values of channel steepness and the trace of the master fault. River profiles in north-western and south-east sectors of the Mercure River basin exhibit clear knickpoints at altitudes comparable with those of the superimposed orders of relict landscapes related to the initial formation of the tectonic basin and the subsequent evolution of the endorheic basin, with a post-lacustrine geomorphological evolution of the drainage network that is controlled by fluvial incision occurring at rates comparable than those reconstructed by independent morphotectonic markers. The erosion of the threshold of the endorheic basin occurring during the base-level fall of the MIS 12 promoted a dramatic base-level fall of about 150 m, which corresponds to a mean incision rate of about 0.35 mm/yr. Post-lacustrine evolution of the Mercure basin strongly controls the morphometric features of the drainage network, which preserves a centripetal pattern with several planimetric anomalies such as counterflow and high-angle confluences, local-scale fluvial capture phenomena and drainage divide migrations

School-age vaccination, school openings and Covid-19 diffusion

This article investigates the relationship between school openings and Covid-19 diffusion when school-age vaccination becomes available. The analysis relies on a unique geo-referenced high frequency database on age of vaccination, Covid-19 cases and hospitalization indicators from the Italian region of Sicily. The study focuses on the change of Covid-19 diffusion after school opening in a homogeneous geographical territory (i.e., with the same control measures and surveillance systems, centrally coordinated by the Regional Government). The identification of causal effects derives from a comparison of the change in cases before and after school opening in the school year 2020/21, when vaccination was not available, and in 2021/22, when the vaccination campaign targeted individuals of age 12-19 and above 19. Results indicate that, while school opening determined an increase in the growth rate of Covid-19 cases in 2020/2021, this effect has been substantially reduced by school-age vaccination in 2021/2022. In particular, we find that an increase of approximately 10% in the vaccination rate of school-age population reduces the growth rate of Covid-19 cases after school opening by approximately 1%

Two algorithms for finding optimal solutions of the Kemeny rank aggregation problem for full rankings

The analysis of ranking data has recently received increasing attention in many fields (i.e. political sciences, computer sciences, social sciences, medical sciences, etc.).Typically when dealing with preference rankings one of the main issue is to find a ranking that best represents the set of input rankings.Among several measures of agreement proposed in the literature, the Kendall's distance is probably the most known. We propose a branch-and-bound algorithm to find the solution(s) even when we take into account a relatively large number of objects to be ranked. We also propose a heuristic variant of the branch-and-bound algorithm useful when the number of objects to rank is particularly high. We show how the solution(s) achieved by the algorithm can be employed in different analysis of rank data such as Mallow's phi model, mixtures of distance-based models, cluster analysis and so on

Rotavirus vaccination as a public health strategy to reduce the burden of hospitalization: The field experience of Italy (2008-2018)

Rotavirus (RV) infection is a leading cause of severe diarrhea among children younger than 5 years old and a considerable cause of RV gastroenteritis (RVGE) hospitalization. This study aimed to evaluate the impact of vaccination in Italy in the reduction of the burden of RV-related disease, estimating the relation between vaccination coverage and hospitalization rates. RVGE-related hospitalizations that occurred in Italy from 2008 to 2018 among children aged 0-35 months were assessed by consulting the Hospital Discharge Record database and including records whose ICD-9-CM diagnosis code was 008.61 in the first or in any diagnosis position. In the 2008-2018 period, a total of 17 535 791 at-risk person-years were considered and 74 211 (423.2 cases x 100 000 per year) RVGE hospitalizations were observed. Higher hospitalization rates occurred in males (456.6 vs. 387.9 x 100 000 per year) and in children aged 1 year (507.8 x 100 000 per year). Poisson regression analysis showed a decrease of -1.25% in hospitalization rates (-1.19% to -1.31%, p &lt; 0.001) per unit increase in vaccination coverage. This is the first study that correlates hospitalization rate reduction with a percentage increase in vaccination coverage. Our findings strongly support RV vaccination as an effective public health strategy for reducing RVGE-related hospitalizations

Impact of Preventive Strategies on HPV-Related Diseases: Ten-Year Data from the Italian Hospital Admission Registry

Simple Summary HPV-related diseases are mainly represented by cancers. Furthermore, real world data with respect to the effects of primary and secondary preventive strategies are lacking. Therefore, the aim of this study is to assess the effectiveness of preventive strategies in accordance with Italian HPV-related hospital admissions. From 2008 to 2018, there was a decrease (APC = -3.8%) in all HPV-related diseases. The increase in cervical cancer screening adherence was related to a decrease in invasive cervical cancer and an increase in HPV vaccine coverage, which was found to arise from a decrease in "in situ" cervical cancer. In this study, the need to improve the acceptance of preventive strategies for HPV-related diseases, as well as the homogenous information furnished by all healthcare workers involved in their promotion (e.g., gynecologists, general practitioners, pediatricians) is highlighted. Human papillomavirus (HPV)-related diseases are still a challenge for public health. Some studies have shown the effects of preventive strategies on them, but studies at the national level are few in number. Therefore, a descriptive study through hospital discharge records (HDRs) was conducted in Italy between 2008 and 2018. Overall, 670,367 hospitalizations due to HPV-related diseases occurred among Italian subjects. In addition, a significant decrease in hospitalization rates for cervical cancer (average annual percentage change (AAPC) = -3.8%, 95% CI = -4.2, -3.5); vulval and vaginal cancer (AAPC = -1.4%, 95% CI = -2.2, -0.6); oropharyngeal cancer; and genital warts (AAPC = -4.0%, 95% CI = -4.5, -3.5) was observed during the study period. Furthermore, strong inverse correlations were found between screening adherence and invasive cervical cancer (r = -0.9, p &lt; 0.001), as well as between HPV vaccination coverage and in situ cervical cancer (r = -0.8, p = 0.005). These results indicate the positive impact of HPV vaccination coverage and cervical cancer screening on hospitalizations due to cervical cancer. Indeed, HPV vaccination also resulted in a positive impact on the decrease in hospitalization rates due to other HPV-related diseases

Successful endovascular embolization of a giant splenic artery pseudoaneurysm secondary to a huge pancreatic pseudocyst with concomitant spleen invasion

Pseudoaneurysms of the pancreatic and peripancreatic arteries is a well-known complication of chronic or necrotizing pancreatitis due to proteolytic enzymatic digestion of the arterial wall. A major part of peripancreatic pseudoaneurysms involve the splenic artery, but any peripancreatic artery may be involved and bleed. They are potentially life threatening for patients, due to spontaneous intraperitoneal rupture, rupture and fistulization into the surrounding organs, or fistulization into the pancreatic duct. Small ones are usually asymptomatic and are often diagnosed incidentally, while giant (> 5 cm) aneurysms and pseudoaneurysms are symptomatic and may be detected as a pulsatile mass in the upper-left quadrant or epigastrium. Imaging plays a key role in the identification of splenic artery aneurysms and pseudoaneurysms, while angiography still represents the gold standard for the diagnosis, although nowadays it plays a prominent role in treatment. Treatment of splenic artery pseudoaneurysms is mandatory because of the high probability of rupture, with a mortality rate of up to 90%. The gold standard treatment is represented by surgery, with a mortality rate between 16% and 50%. In recent years the endovascular approach has proven to be an effective alternative treatment for splenic artery pseudoaneurysms, and it is currently the method of choice. In this article, we present the case of a ant pseudoaneurysm of the splenic artery due to huge pseudocysts in a young alcoholic patient with recurrent and chronic pancreatitis, complicated by fistulization and invasion of spleen parenchyma and arteriovenous fistula