Antiviral therapy in acute viral hepatitis B: why and when

Acute viral hepatitis B is cleared in more than 95% of patients, while the remainder ones may develop either chronic HBV infection or, rarely, fulminant hepatitis

Crack propagation calculations in aircraft engines by coupled FEM-DBEM approach

New generation jet engines are subject to severe reduced fuel consumption requirements. This usually leads to thin components in which damage issues such as thermomechanical fatigue, creep and crack propagation can be quite important. The combination of stresses due to centrifugal loads and thermal stresses usually leads to mixed-mode loading. Consequently, a suitable crack propagation tool must be able to predict mixed-mode crack propagation of arbitrarily curved cracks in three-dimensional space. To tackle this problem a procedure has been developed based on a combined FEM (Finite Element Method) - DBEM (Dual Boundary Element Method) approach. Starting from a three-dimensional FEM mesh for the uncracked structure a subdomain is identified, in which crack initiation and propagation are simulated by DBEM. Such subdomain is extracted from the FEM domain and imported, together with its boundary conditions (calculated by a previous thermal-stress FEM analysis), in a DBEM environment, where a linear elastic crack growth calculation is performed. Once the crack propagation direction is determined a new crack increment can be calculated and for the new crack front the procedure can be repeated until failure. The proposed procedure allows to also consider the spectrum effects and the creep effects: both conditions relieve residual stresses that the crack encounters during its propagation. The procedure has been tested on a gas turbine vane, getting sound results, and can be made fully automatic, thanks to in house made routines needed to facilitate the data exchange between the two adopted codes

Metacognition, Borderline Pathology and Psychotherapeutic Change: A Single-Case Study

The aim of this study is to analyze whether: (a) a specific type of metacognitive deficit is present in a patient with Borderline Personality Disorder; (b) a metacognitive improvement can be detected during the psychotherapy treatment; (c) if this improvement can be indicative of the effectiveness of psychotherapy itself. A single case study has been conducted; metacognitive deficits have been measured with the Metacognition Assessment Scale (MAS). In line with the hypothesis, the results show a global and progressive improvement of meta-cognitive functions. We conclude in agreement with the current literature, the existence of a major deficit in Differentiation and Integration subfunctions (belonging to Self-reflexivity), compared to Characterization and Relation between variables subfunctions (belonging to Metacognitive monitoring)

ERRATUM: Metacognition, borderline pathology and psychotherapeutic change: a single-case study

Not available

T-helper 17 lymphocytes in ocular cicatricial pemphigoid

T-helper 17 lymphocytes (Th17) were identified in the healthy conjunctiva and in patients with ocular cicatricial pemphigoid (OCP), a disease characterized by chronic ocular surface inflammation

Atypical Presentation of Acute Coronary Syndrome-Not ST Elevation: A Case Report

We describe the unexpected case of a 70-year-old man, with medical history of ischemic heart disease and surgery for aneurysm of abdominal aorta, who comes to the emergency department complaining of low-back pain without other symptoms or signs of organic failure. After a few hours we see a deterioration of physical conditions with pulmonary oedema, increase of blood pressure, changing in the ECG pattern, and worsening of left ventricular function with progressive increase of biomarkers for myocardial necrosis. So this pain has revealed the premature symptom of an acute coronary syndrome (ACS). After a short time a subsequent cardiac arrest complicates the clinical situation. After resuscitation, the patient undergoes successfully to coronary angiography and performed a percutaneous transluminal coronary angioplasty (PTCA)

Pancreatitis after percutaneous ethanol injection into HCC: a minireview of the literature

Deaths after percutaneous ethanol injection (PEI) into hepatocellular carcinoma (HCC) may occur within a few hours to a few days following the procedure because of hemoperitoneum and haemorrhage from oesophageal varices or hepatic insufficiency. Pancreatitis has been recently reported as a rare lethal complication of intra-arterial PEI, another modality for treating HCCs. In this minireview, we analyze the literature concerning the development of acute pancreatitis after PEI. Pathogenesis of pancreatitis from opioids and ethanol is also addressed. Treatment with opioids to reduce the patient's abdominal pain after PEI in combination with the PEI itself may lead to direct toxic effects, thus favouring the development of pancreatitis

Carriers of ADAMTS13 Rare Variants Are at High Risk of Life-Threatening COVID-19

Thrombosis of small and large vessels is reported as a key player in COVID-19 severity. However, host genetic determinants of this susceptibility are still unclear. Congenital Thrombotic Thrombocytopenic Purpura is a severe autosomal recessive disorder characterized by uncleaved ultra-large vWF and thrombotic microangiopathy, frequently triggered by infections. Carriers are reported to be asymptomatic. Exome analysis of about 3000 SARS-CoV-2 infected subjects of different severities, belonging to the GEN-COVID cohort, revealed the specific role of vWF cleaving enzyme ADAMTS13 (A disintegrin-like and metalloprotease with thrombospondin type 1 motif, 13). We report here that ultra-rare variants in a heterozygous state lead to a rare form of COVID-19 characterized by hyper-inflammation signs, which segregates in families as an autosomal dominant disorder conditioned by SARS-CoV-2 infection, sex, and age. This has clinical relevance due to the availability of drugs such as Caplacizumab, which inhibits vWF-platelet interaction, and Crizanlizumab, which, by inhibiting P-selectin binding to its ligands, prevents leukocyte recruitment and platelet aggregation at the site of vascular damage