Lymph node fine needle cytology, Epstein Barr virus infection and Hodgkin Lymphoma

Epstein-Barr virus (EBV) is a double-strand DNA virus of the herpes family; it is one of the most common human viruses and it is associated with a wide spectrum of benign and malignant conditions. EBV is related to the development of several neoplasms, globally 1% of tumours, including lymphoproliferative, epithelial and mesenchymal neoplasm. Lymphoproliferative disorders include Hodgkin lymphoma (HL) and B and T cell non-Hodgkin lymphoma. HL is one of the most common lymphoma in the developed world, affecting both young people and adults. HL pathogenesis is complex and includes various and partially unknown mechanisms. EBV has been detected in some HL neoplastic cells and expresses genes with a potential oncogenic function, therefore many studies suggest that viral infections have a causative role in neoplastic transformation. Fine Needle Cytology (FNC) is extensively used in the first diagnosis of any lymph-nodal enlargement, including reactive lymphadeno - pathies and lymphoproliferative processes; therefore cytopathologists are likely to encounter EBVassociated malignancies in cytology samples, mainly HL, which is one of the most common lymphoma. This study focuses on the cytological features and ancillary studies required to diagnose EBV-related HL

Randomized comparison of power Doppler ultrasound-directed excisional biopsy with standard excisional biopsy for the characterization of lymphadenopathies in patients with suspected lymphoma.

PURPOSE: The sensitivity of lymph node excisional biopsy requires validation. Power Doppler ultrasound (US) helps predict the malignant status of lymphadenopathies. We used power Doppler US to select for biopsy the lymph node most suspected of malignancy. PATIENTS AND METHODS: One hundred fifty-two patients having lymphadenopathies with clinical suspicion of lymphoma were divided into two well-matched groups and randomly assigned to undergo either standard or power Doppler US-directed lymph node excisional biopsy. RESULTS: Histology showed a malignancy in 64% of patients in the standard group (lymphoma, 49 patients; carcinoma, two patients) and in 87% of patients in the US-assisted group (lymphoma, 62 patients; carcinoma, one patient). There were significantly fewer biopsy-related complications in the assisted group than in the standard group. During the follow-up of the patients with lymph nodes reported as being reactive, 14 of 29 patients in the standard group were rebiopsied and were found to have lymphoma (13 patients) or carcinoma at the subsequent lymph node histology, whereas none of the patients in the assisted group (nine patients) required a second biopsy. Thus, biopsy provided false-negative results for malignancy in 21% of patients affected by lymphoma in the standard group and ever in the assisted group (P <.01). CONCLUSION: Power Doppler US is an accurate tool for screening lymphadenopathies to be removed by excisional biopsy in patients with suspected lymphoma

Long-term change in nutritional status after severe traumatic brain injury

IntroductionIn the acute phase, patients who sustained a severe Traumatic Brain injury (TBI) (Glasgow Coma Scale under 8) frequently present malnutrition during critical care. Long-term nutritional outcome after a severe TBI has been less studied. Cognitive impairments and behavioural disorders together with hormonal disorders can lead to persisting malnutrition or over-eating and obesity. The purpose of this study was to follow the weight, the body mass index (BMI), albuminemia and hormonal dosage after a severe TBI.MethodsThis study relied on a research protocol designed to follow concurrently and prospectively endocrine disorders and cognitive disorders in a cohort of patients with severe TBI (Inspire-TC protocol). In the present work, we focused specifically on the evolution in weight, height, body mass index, albuminemia and endocrine abnormalities. These parameters were collected upon admission to the rehabilitation department, at 4 months, 12 months and 18 months when feasible for the severe TBI patients included in the Inspire-TC protocol. Albuminaemia was measured late after the TBI when patients agreed.Results10 patients were included. Initially 60% of the patients had biological malnutrition, 10% were overweight, 80% presented a normal BMI and 10% had an insufficient BMI. All patients gained weight during the monitoring with an overweight at 18 months for three patients. Along the overall monitoring, 44% of the patients had hormonal disruptions. The 3 patients with long-term overweight had frontal-temporal brain lesions. All three recovered walking. Only one had hormonal disruptions. Albuminaemia was normal for all patients who accepted to make this bioessay control.ConclusionThere is a tendency to gain weight after a severe TBI. Favorable factors include fronto-temporal injuries, and the presence of executive disorders. Endocrine perturbation and immobility can also contribute to overweight but were less frequently observed in this cohort

Measurement of spleen volume by ultrasound scanning in patients with thrombocytosis: a prospective study.

Spleen size was assessed in 73 patients with thrombocytosis and in 15 healthy subjects, comparing palpation with ultra-sonography (US) measurement of longitudinal diameter and volume. Intraobserver and interobserver variability for volume on US, checked in 12 patients, was very low. Correlation between spleen volume measured by US and that measured by computed tomography was excellent. Splenomegaly was detected by palpation in 25% of patients, by US assessment of longitudinal diameter in 33%, and by US assessment of volume in 52%. After diagnostic work-up, 54 patients had a diagnosis of essential thrombocythemia (ET), 4 of idiopathic myelofibrosis (IMF), and 15 of secondary thrombocytosis (ST). Spleen volume in patients with ST was in the normal range (138 ± 47 mL) and was significantly lower than that in patients with ET or IMF (370 ± 210 mL; P &lt; .001). Thus, US-measured volume was the most sensitive method for identifying nonpalpable splenomegaly in patients with primary myeloproliferative diseases, and it may help in distinguishing these diseases from reactive disorder

VoxLogicA : A Spatial Model Checker for Declarative Image Analysis

Spatial and spatio-temporal model checking techniques have a wide range of application domains, among which large scale distributed systems and signal and image analysis.We explore a new domain, namely (semi-)automatic contouring in Medical Imaging, introducing the tool VoxLogicA which merges the state-of-the-art library of computational imaging algorithms ITK with the unique combination of declarative specification and optimised execution provided by spatial logic model checking. The result is a rapid, logic based analysis development methodology. The analysis of an existing benchmark of medical images for segmentation of brain tumours shows that simple VoxLogicA analysis can reach state-of-the-art accuracy, competing with best-in-class algorithms, with the advantage of explainability and easy replicability. Furthermore, due to a two-orders-of-magnitude speedup compared to the existing generalpurpose spatio-temporal model checker topochecker, VoxLogicA enables interactive development of analysis of 3D medical images, which can greatly facilitate the work of professionals in this domain

How do etiological factors can explain the different clinical features of patients with differentiated thyroid cancer and their histopathological findings?

Abstract The aim was to retrospectively analyse the clinical–histopathological characteristics of patients with newly diagnosis of differentiated thyroid cancer (DTC) referred to two Italian centres, one in Northern and the other in Southern Italy, between 2000 and 2013. 1081 patients were included and subdivided into two groups: group A (474 patients from Novara) and group B (607 patients from Naples). The group A came from the industrial area of Novara, while the Group B came from the areas around Vesuvius and Campi Flegrei. The two groups were comparable for iodine levels, body mass index, diagnostic timing and clinical procedures. For all patients, demographic and clinical data were collected. No difference was found in gender, whereas the age at diagnosis was later in the group A (group A 53.1 ± 15.16 years, group B 41.9 ± 14.25 years, p < 0.001). In both groups, the most frequent histotype was papillary thyroid cancer (PTC) with prevalence of follicular variant in group A (p < 0.0001) and classical variant in group B (p < 0.0001). Aggressive histological features were mainly seen in group A (bilaterality p < 0.0001, multifocality p < 0.0001 and thyroid capsular invasion p < 0.0001). Microcarcinomas were more frequent in group A (p < 0.0001) but mostly characterized by bilaterality (p < 0.001) and multifocality (p < 0.04). In both groups, tumour-associated thyroiditis showed a significant increase over the years (group A p < 0.05, group B p < 0.04). Environmental factors could justify the differences found in our study. These preliminary data should stimulate the need for an Italian Cancer Registry of DTC in order to allow an epidemiological characterization, allowing the identification of specific etiological factors and an improvement in the management of the diseas

Quantitative evaluation of enforcement strategies

In Security, monitors and enforcement mechanisms run in parallel with programs to check, and modify their run-time behaviour, respectively, in order to guarantee the satisfaction of a security policy. For the same pol- icy, several enforcement strategies are possible. We provide a framework for quantitative monitoring and enforcement. Enforcement strategies are analysed according to user-dened parameters. This is done by extending the notion controller processes, that mimics the well-known edit automata, with weights on transitions, valued in a C-semiring. C-semirings permit one to be exible and general in the quantitative criteria. Furthermore, we provide some examples of orders on controllers that are evaluated under incomparable criteria

Rituximab plus bendamustine as front-line treatment in frail elderly (>70 years) patients with diffuse large b-cell non-hodgkin lymphoma: A phase ii multicenter study of the fondazione italiana linfomi

We conducted a phase II study to assess activity and safety profile of bendamustine and rituximab in elderly patients with untreated diffuse large B-cell lymphoma (DLBCL) who were prospectively defined as frail using a simplified version of the Comprehensive Geriatric Assessment (CGA). Patients had to be over 70 years of age, with histologically confirmed DLBCL. Frail patients were those younger than 80 years with a frail profile at CGA or older than 80 years with an unfit profile. Treatment consisted of 4-6 courses of bendamustine [90 mg/m 2 days (d)1-2] and rituximab (375 mg/m 2 d1) administered every 28 days. Other main study end points were complete remission rate and the rate of extra-hematologic adverse events. Forty-nine patients were enrolled of whom 45 were confirmed eligible. Overall, 24 patients achieved a complete remission (53%; 95%CI: 38-68%) and the overall response rate was 62% (95%CI: 47-76%). The most frequent grade 3-4 adverse event was neutropenia (37.8%). Grade 3-4 extra-hematologic adverse events were observed in 7 patients (15.6%; 95%CI: 6.5-29.5%); the most frequent was grade 3 infection in 2 patients. With a median follow up of 33 months (range 1-52), the median progression-free survival was ten months (95%CI: 7-25). The study shows promising activity and manageable toxicity profile of BR combination as first-line therapy for patients with DLBCL who are prospectively defined as frail according to a simplified CGA, as adopted in this trial (clinicaltrials.gov identifier: 01990144)