Acute Dacryocystitis with Empyema of the Lacrimal Sac: Is Immediate Endoscopic Dacryocystorhinostomy Justified?

Objectives. To evaluate the efficacy of endoscopic dacryocystorhinostomy (Endo-DCR) in the treatment of acute dacryocystitis with lacrimal sac empyema (ADLSE). Design. Case series with chart review. Setting. Academic tertiary center. Patients. The study included 26 consecutive patients who underwent Endo-DCR for ADLSE between August 2005 and December 2013. Main Outcome Measures. The success of the procedure was defined as complete complaint relief and DCR patency. Data on the time from referral to surgery, postoperative complications, and revision surgery are also reported. Results. The present patient series included 4 males (15.4%) and 22 females (84.6%) (mean age, 66 years). The mean time between referral and surgery was 0.88 days and the mean follow-up time was 29 months. All patients showed immediate relief from symptoms, with no ADLSE recurrences. Complete success was achieved in 25 (96.2%) cases; the only failure was in a patient who had previously undergone radioiodine treatment. In this case, revision Endo-DCR was not successful. The only perioperative complication (3.8%) was epistaxis in a patient who required revision surgery under general anesthesia. The definitive success rate was 96.2% after primary and revision surgery. Conclusions. Endo-DCR enables rapid resolution of ADLSE with a very high success rate. Immediate surgery may reduce the risk of skin fistulization and/or orbital complications. DCR shrinkage and lacrimal obstruction are unlikely with Endo-DCR since the procedure is performed on an enlarged sac. The main advantage of Endo-DCR, compared with external DCR, is the absence of a skin incision in an inflamed and infected field

Ethical issues associated with in-hospital emergency from the medical emergency team's perspective: a national survey

Medical Emergency Teams (METs) are frequently involved in ethical issues associated to in-hospital emergencies, like decisions about end-of-life care and intensive care unit (ICU) admission. MET involvement offers both advantages and disadvantages, especially when an immediate decision must be made. We performed a survey among Italian intensivists/anesthesiologists evaluating MET's perspective on the most relevant ethical aspects faced in daily practice

Fit for the frontline? A focus group exploration of auditory tasks carried out by infantry and combat support personnel

In order to preserve their operational effectiveness and ultimately their survival, military personnel must be able to detect important acoustic signals and maintain situational awareness. The possession of sufficient hearing ability to perform job-specific auditory tasks is defined as auditory fitness for duty (AFFD). Pure tone audiometry (PTA) is used to assess AFFD in the UK military; however, it is unclear whether PTA is able to accurately predict performance on job-specific auditory tasks. The aim of the current study was to gather information about auditory tasks carried out by infantry personnel on the frontline and the environment these tasks are performed in. The study consisted of 16 focus group interviews with an average of five participants per group. Eighty British army personnel were recruited from five infantry regiments. The focus group guideline included seven open-ended questions designed to elicit information about the auditory tasks performed on operational duty. Content analysis of the data resulted in two main themes: (1)the auditory tasks personnel are expected to perform and (2) situations where personnel felt their hearing ability was reduced. Auditory tasks were divided into subthemes of sound detection, speech communication and sound localization. Reasons for reduced performance included background noise, hearing protection and attention difficulties. The current study provided an important and novel insight to the complex auditory environment experienced by British infantry personnel and identified 17 auditory tasks carried out by personnel on operational duties. These auditory tasks will be used to inform the development of a functional AFFD test for infantry personnel

Characterization and identification of hidden rare variants in the human genome

BackgroundBy examining the genotype calls generated by the 1000 Genomes Project we discovered that the human reference genome GRCh37 contains almost 20,000 loci in which the reference allele has never been observed in healthy individuals and around 70,000 loci in which it has been observed only in the heterozygous state.ResultsWe show that a large fraction of this rare reference allele (RRA) loci belongs to coding, functional and regulatory elements of the genome and could be linked to rare Mendelian disorders as well as cancer. We also demonstrate that classical germline and somatic variant calling tools are not capable to recognize the rare allele when present in these loci. To overcome such limitations, we developed a novel tool, named RAREVATOR, that is able to identify and call the rare allele in these genomic positions. By using a small cancer dataset we compared our tool with two state-of-the-art callers and we found that RAREVATOR identified more than 1,500 germline and 22 somatic RRA variants missed by the two methods and which belong to significantly mutated pathways.ConclusionsThese results show that, to date, the investigation of around 100,000 loci of the human genome has been missed by re-sequencing experiments based on the GRCh37 assembly and that our tool can fill the gap left by other methods. Moreover, the investigation of the latest version of the human reference genome, GRCh38, showed that although the GRC corrected almost all insertions and a small part of SNVs and deletions, a large number of functionally relevant RRAs still remain unchanged. For this reason, also future resequencing experiments, based on GRCh38, will benefit from RAREVATOR analysis results. RAREVATOR is freely available at http://sourceforge.net/projects/rarevator

Potentiation of thrombus instability: a contributory mechanism to the effectiveness of antithrombotic medications

© The Author(s) 2018The stability of an arterial thrombus, determined by its structure and ability to resist endogenous fibrinolysis, is a major determinant of the extent of infarction that results from coronary or cerebrovascular thrombosis. There is ample evidence from both laboratory and clinical studies to suggest that in addition to inhibiting platelet aggregation, antithrombotic medications have shear-dependent effects, potentiating thrombus fragility and/or enhancing endogenous fibrinolysis. Such shear-dependent effects, potentiating the fragility of the growing thrombus and/or enhancing endogenous thrombolytic activity, likely contribute to the clinical effectiveness of such medications. It is not clear how much these effects relate to the measured inhibition of platelet aggregation in response to specific agonists. These effects are observable only with techniques that subject the growing thrombus to arterial flow and shear conditions. The effects of antithrombotic medications on thrombus stability and ways of assessing this are reviewed herein, and it is proposed that thrombus stability could become a new target for pharmacological intervention.Peer reviewedFinal Published versio

Patterns of K-ras mutation in colorectal carcinomas from Iran and Italy (a Gruppo Oncologico dell'Italia Meridionale study): influence of microsatellite instability status and country of origin.

Background: K-ras mutations are a key step in colorectal cancer progression. Such mutations have been widely studied in case series from Western countries but there are few data on the rate and spectrum of mutations in tumors from countries where the epidemiological features of the disease are different. Patients and methods: Tumor samples from 182 Iranian colorectal cancer patients (170 sporadic cases and 12 HNPCC cases) were screened for K-ras mutations at codons 12, 13 and 61 by sequencing analysis. The cases were also characterized for microsatellite instability at mononucleotide repeats by PCR and fragment analysis, and classified according to microsatellite instability status. The frequency and the spectrum of K-ras mutations were compared with those observed in a series of colorectal cancer patients from Italy. Results: K-ras mutations were observed in 68/182 (37.4%) cases. Mutation frequencies were similar in HNPCC-associated, sporadic MSI-H and sporadic microsatellite-stable (MSS) tumors. However, the G13D substitution was more frequent in HNPCC (3/ 4, 75%) and sporadic MSI- H (7/11, 63.6%) tumors compared to sporadic MSS tumors (11/ 53, 20.4%) (P < 0.01). Comparison of mutations in the two series from Iran and Italy showed a significantly higher frequency of G13D among Italian patients. Conclusions: While the frequency of K-ras mutations could be similar, the mutational spectrum could be differentially influenced by genetic and environmental factors

Solution of the Navier-Stokes equations for a driven cavity

The flow field in a lid driven cavity is determined by integration of the incompressible Navier-Stokes equations. The numerical integration is accomplished via an operator splitting method known as the theta-scheme. This splitting separates the problem into the solution of a quasi-stokes problem and a nonlinear convection problem. Some details of solution methods used for the two subproblems and results obtained for the driven cavity are described. The schemes developed for the quasi-Stokes problem are more advanced at this stage than those for the nonlinear problem. However, the approaches used for both parts are outlined. As a model problem, a two dimensional square cavity with sides of unit length and a lid moving with unit velocity from left to right is considered. The Navier-Stokes equations are discretized in space on a uniform staggered or MAC mesh. The time discretization is accomplished via the theta-scheme

Identification of Extracellular Segments by Mass Spectrometry Improves Topology Prediction of Transmembrane Proteins

Transmembrane proteins play crucial role in signaling, ion transport, nutrient uptake, as well as in maintaining the dynamic equilibrium between the internal and external environment of cells. Despite their important biological functions and abundance, less than 2% of all determined structures are transmembrane proteins. Given the persisting technical difficulties associated with high resolution structure determination of transmembrane proteins, additional methods, including computational and experimental techniques remain vital in promoting our understanding of their topologies, 3D structures, functions and interactions. Here we report a method for the high-throughput determination of extracellular segments of transmembrane proteins based on the identification of surface labeled and biotin captured peptide fragments by LC/MS/MS. We show that reliable identification of extracellular protein segments increases the accuracy and reliability of existing topology prediction algorithms. Using the experimental topology data as constraints, our improved prediction tool provides accurate and reliable topology models for hundreds of human transmembrane proteins

Application of vegetation index time series to value fire effect on primary production in a Southern European rare wetland

Fire disturbance is an intrinsic component of the Mediterranean biome playing an important role in ecosystem dynamics and processes. However, frequent and severe anthropogenic wildfires can be detrimental to natural ecosystems, particularly in small natural protected areas, where they may hamper the flow of ecosystem services (ES). While post-fire dynamics of individual ES are heavily context-dependent, the primary productivity of the ecosystem can be regarded as a generic driver of several provisioning and regulating ES, as it represents the amount of energy available to plants for storage, growth, and reproduction, which drives future ecosystem structure and functions. The aim of this study was to evaluate the effect of anthropogenic wildfire on the primary productivity of a rare wetland ecosystem in the Natura 2000 site \u201cTorre Guaceto\u201d in Southern Europe. Productivity was estimated by calculating a 15-year time series of vegetation indices (EVI and NDWI)from remotely sensed MODIS imagery. Our results in terms of PP trends may be relevant to assess the change in ecosystems services provided by wetlands. Interactions between wildfire, ecosystem productivity and climate were then analyzed. During the selected period, climate did not play a significant effect on primary productivity, which was mainly driven by post-fire vegetation recovery. Findings of the present study demonstrate that the wildfire affecting the Natural Protected Area of Torre Guaceto in summer 2007 had a major effect on primary productivity, inducing the regeneration of Phragmites australis and the replacement of old individuals by structurally and functionally better ones

XAI.it 2020 - Preface to the first italian workshop on explainable artificial intelligence

Artificial Intelligence systems are increasingly playing an increasingly important role in our daily lives. As their importance in our everyday lives grows, it is fundamental that the internal mechanisms that guide these algorithms are as clear as possible. It is not by chance that the recent General Data Protection Regulation (GDPR) emphasized the users’ right to explanation when people face artificial intelligence-based technologies. Unfortunately, the current research tends to go in the opposite direction, since most of the approaches try to maximize the effectiveness of the models (e.g., recommendation accuracy) at the expense of the explainability and the transparency. The main research questions which arise from this scenario is straightforward: how can we deal with such a dichotomy between the need for effective adaptive systems and the right to transparency and interpretability? Several research lines are triggered by this question: building transparent intelligent systems, analyzing the impact of opaque algorithms on final users, studying the role of explanation strategies, investigating how to provide users with more control in the behavior of intelligent systems. XAI.it, the first Italian workshop on Explainable AI, tries to address these research lines and aims to provide a forum for the Italian community to discuss problems, challenges and innovative approaches in the various sub-fields of XAI