Division for Endocrine and Minimally Invasive Surgery Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina

The visual identification of the nerve is still today the standard technique in thyroid surgery. Although the systematic use of the intraoperative neuromonitoring (IONM) of the NLR has not demonstrated a statistically significant reduction in NLR lesions yet, IONM has been conclusive in the case of complex anatomy (re-operation, voluminous goiter, thyroid carcinoma) and in functional integrity of the NLR. The application of the IONM allowed to reconsider the two-phase thyroidectomy procedure in order to prevent bilateral lesions to the NLR. This method makes it possible to evaluate the possibility of proceeding safely to the completion of total thyroidectomy after resection of the dominant lobe and to decide, if necessary, to delay the resection of the second lobe at a later time, as in the case of injury or dysfunction of the NLR after lobectomy. The systematic application of IONM may lead the surgeon to modify the operative strategy in the presence of LOS from the NLR ensuring an almost zero incidence of bilateral paralysis of the NLR.It is necessary to define specific application guidelines, for the management of problems related to employment as in tumor pathology

Migraine equivalents and related symptoms, psychological profile and headache features:which relationship?

BACKGROUND: Migraine equivalents are common clinical conditions in children suffering from headache. Very few studies dealt with the psychological profile of children/adolescents with migraine equivalents. Our main aim was to compare the psychological profile between migraine children with and without migraine equivalents. Moreover, as secondary aim, exclusively in children with migraine equivalents, we investigated the possible relationship between migraine attack frequency and intensity and psychological factors. METHODS: We enrolled 136 young migraineurs. They were divided in two groups (patients with and without migraine equivalents). The psychological profile was assessed by means of SAFA Anxiety and Somatization questionnaires. RESULTS: Migraine equivalents were present in 101 patients (74.3 %). Anxiety (p = 0.024) and somatization (p = 0.001) levels, but not hypochondria (p = 0.26), were higher in patients with migraine equivalents. In children with migraine equivalents, a low frequency of attacks was related to separation anxiety (p = 0.034). CONCLUSIONS: Migraine equivalents patients tend to feel more fearful and to experience more shyness. This, together with the tendency to somatization, may lead them to become vigilant in attachment relationships with their caregivers

Therapeutic Drug Monitoring of Quinidine in Pediatric Patients with KCNT1 Genetic Variants

Quinidine (QND) is an old antimalarial drug that was used in the early 20th century as an antiarrhythmic agent. Currently, QND is receiving attention for its use in epilepsy of infancy with migrating focal seizures (EIMFS) due to potassium sodium-activated channel subfamily T member 1 (KCNT1) genetic variants. Here, we report the application of Therapeutic Drug Monitoring (TDM) in pediatric patients carrying KCNT1 genetic variants and orally treated with QND for developmental and epileptic encephalopathies (DEE). We measured plasma levels of QND and its metabolite hydroquinidine (H-QND) by using a validated method based on liquid chromatography coupled with mass spectrometry (LC-MS/MS). Three pediatric patients (median age 4.125 years, IQR 2.375-4.125) received increasing doses of QND. Cardiac toxicity was monitored at every dose change. Reduction in seizure frequency ranged from 50 to 90%. Our results show that QND is a promising drug for pediatric patients with DEE due to KCNT1 genetic variants. Although QND blood levels were significantly lower than the therapeutic range as an anti-arrhythmic drug, patients showed a significant improvement in seizure burden. These data underlie the utility of TDM for QND not only to monitor its toxic effects but also to evaluate possible drug-drug interactions

Diagnosis, treatment, and follow-up of a case of Wolman disease with hemophagocytic lymphohistiocytosis

: Wolman Disease (WD) is a severe multi-system metabolic disease due to lysosomal acid lipase (LAL) deficiency. We report on a WD infant who developed an unusual hemophagocytic lymphohistiocytosis (HLH) phenotype related to WD treated with sebelipase alfa. A male baby came to our attention at six months of life for respiratory insufficiency and sepsis, abdominal distension, severe hepatosplenomegaly, diarrhea, and severe growth retardation. HLH was diagnosed and treated with intravenous immunoglobulin, steroids, cyclosporine, broad-spectrum antimicrobial therapy, and finally with the anti-IL-6 drug tocilizumab. WD was suspected for the presence of adrenal calcifications and it was confirmed by LAL enzyme activity and by molecular analysis of LIPA. Plasma oxysterols cholestan-3β,5α,6β-triol (C-triol), and 7-ketocholesterol (7-KC) were markedly increased. Sebelipase alfa was started with progressive amelioration of biochemical and clinical features. The child died from sepsis, 2 months after sebelipase discontinuation requested by parents. Our case shows the importance of an early diagnosis of WD and confirms the difficulty to reach a diagnosis in the HLH phenotype. Sebelipase alpha is an effective treatment for LAL deficiency, also in children affected by WD. Further data are necessary to confirm the utility of measuring plasma c-triol as a biochemical marker of the disease

Observation of the γγ→ττ process in Pb+Pb collisions and constraints on the τ-lepton anomalous magnetic moment with the ATLAS detector

This Letter reports the observation of τ-lepton-pair production in ultraperipheral lead-lead collisions Pb+Pb→Pb(γγ→ττ)Pb and constraints on the τ-lepton anomalous magnetic moment a_{τ}. The dataset corresponds to an integrated luminosity of 1.44 nb^{-1} of LHC Pb+Pb collisions at sqrt[s_{NN}]=5.02 TeV recorded by the ATLAS experiment in 2018. Selected events contain one muon from a τ-lepton decay, an electron or charged-particle track(s) from the other τ-lepton decay, little additional central-detector activity, and no forward neutrons. The γγ→ττ process is observed in Pb+Pb collisions with a significance exceeding 5 standard deviations and a signal strength of μ_{ττ}=1.03_{-0.05}^{+0.06} assuming the standard model value for a_{τ}. To measure a_{τ}, a template fit to the muon transverse-momentum distribution from τ-lepton candidates is performed, using a dimuon (γγ→μμ) control sample to constrain systematic uncertainties. The observed 95% confidence-level interval for a_{τ} is -0.057<0.024

Search for resonant WZ production in the fully leptonic final state in proton–proton collisions at √s=13 TeV with the ATLAS detector

A search for a WZ resonance, in the fully leptonic final state (electrons or muons), is performed using 139 fb - 1 of data collected at a centre-of-mass energy of 13 TeV by the ATLAS detector at the Large Hadron Collider. The results are interpreted in terms of a singly charged Higgs boson of the Georgi–Machacek model, produced by WZ fusion, and of a Heavy Vector Triplet, with the resonance produced by WZ fusion or the Drell–Yan process. No significant excess over the Standard Model prediction is observed and limits are set on the production cross-section times branching ratio as a function of the resonance mass for these processes

Long-term outcome of re-irradiation for recurrent or second primary head and neck cancer: A multi-institutional study of AIRO-Head and Neck working group

Background To report the long-term outcome of patients undergoing re-irradiation (re-RT) for a recurrent or second primary head and neck cancer (RSPHNCs) in seven Italian tertiary centers, while testing the Multi-Institution Reirradation (MIRI) recursive partitioning analysis (RPA) recently published. Methods We retrospectively analyzed 159 patients. Prognostic factors for overall survival (OS) selected by a random forest model were included in a multivariable Cox analysis. To externally validate MIRI RPA, we estimated the Kaplan-Meier group-stratified OS curves for the whole population. Results Five-year OS was 43.5% (median follow-up: 49.9 months). Nasopharyngeal site, no organ dysfunction, and re-RT volume <36 cm(3) were independent factors for better OS. By applying the MIRI RPA to our cohort, a Harrell C-Index of 0.526 was found indicating poor discriminative ability. Conclusion Our data reinforce the survival benefit of Re-RT for selected patients with RSPHNC. MIRI RPA was not validated in our population

Measurements of W+W- production in decay topologies inspired by searches for electroweak supersymmetry

This paper presents a measurement of fiducial and differential cross-sections for W+W- production in proton–proton collisions at s=13 TeV with the ATLAS experiment at the Large Hadron Collider using a dataset corresponding to an integrated luminosity of 139&nbsp;fb - 1 . Events with exactly one electron, one muon and no hadronic jets are studied. The fiducial region in which the measurements are performed is inspired by searches for the electroweak production of supersymmetric charginos decaying to two-lepton final states. The selected events have moderate values of missing transverse momentum and the ‘stransverse mass’ variable mT2 , which is widely used in searches for supersymmetry at the LHC. The ranges of these variables are chosen so that the acceptance is enhanced for direct W+W- production and suppressed for production via top quarks, which is treated as a background. The fiducial cross-section and particle-level differential cross-sections for six variables are measured and compared with two theoretical SM predictions from perturbative QCD calculations

Charged-hadron production in pp, p+Pb, Pb+Pb, and Xe+Xe collisions at √sNN = 5 TeV with the ATLAS detector at the LHC

This paper presents measurements of charged-hadron spectra obtained in pp, p+Pb, and Pb+Pb collisions at s or sNN = 5.02 TeV, and in Xe+Xe collisions at sNN = 5.44 TeV. The data recorded by the ATLAS detector at the LHC have total integrated luminosities of 25 pb −1, 28 nb −1, 0.50 nb −1, and 3 μb −1, respectively. The nuclear modification factors RpPb and R AA are obtained by comparing the spectra in heavy-ion and pp collisions in a wide range of charged-particle transverse momenta and pseudorapidity. The nuclear modification factor RpPb shows a moderate enhancement above unity with a maximum at p T ≈ 3 GeV; the enhancement is stronger in the Pb-going direction. The nuclear modification factors in both Pb+Pb and Xe+Xe collisions feature a significant, centrality-dependent suppression. They show a similar distinct p T-dependence with a local maximum at p T ≈ 2 GeV and a local minimum at p T ≈ 7 GeV. This dependence is more distinguishable in more central collisions. No significant |η|-dependence is found. A comprehensive comparison with several theoretical predictions is also provided. They typically describe R AA better in central collisions and in the p T range from about 10 to 100 GeV. [Figure not available: see fulltext.

Measurements of the suppression and correlations of dijets in Xe+Xe collisions at √ sNN = 5.44 TeV

Measurements of the suppression and correlations of dijets is performed using 3 μ b − 1 of Xe+Xe data at s N N = 5.44 TeV collected with the ATLAS detector at the CERN Large Hadron Collider. Dijets with jets reconstructed using the R = 0.4 anti- k t algorithm are measured differentially in jet p T over the range of 32 to 398 GeV and the centrality of the collisions. Significant dijet momentum imbalance is found in the most central Xe+Xe collisions, which decreases in more peripheral collisions. Results from the measurement of per-pair normalized and absolutely normalized dijet p T balance are compared with previous Pb + Pb measurements at s N N = 5.02 TeV. The differences between the dijet suppression in Xe+Xe and Pb + Pb are further quantified by the ratio of pair nuclear-modification factors. The results are found to be consistent with those measured in Pb + Pb data when compared in classes of the same event activity and when taking into account the difference between the center-of-mass energies of the initial parton scattering process in Xe+Xe and Pb + Pb collisions. These results should provide input for a better understanding of the role of energy density, system size, path length, and fluctuations in the parton energy loss