MRI Appearance of Focal Lesions in Liver Iron Overload

Liver iron overload is defined as an accumulation of the chemical element Fe in the hepatic parenchyma that exceeds the normal storage. When iron accumulates, it can be toxic for the liver by producing inflammation and cell damage. This can potentially lead to cirrhosis and hepatocellular carcinoma, as well as to other liver lesions depending on the underlying condition associated to liver iron overload. The correct assessment of liver iron storage is pivotal to drive the best treatment and prevent complication. Nowadays, magnetic resonance imaging (MRI) is the best non-invasive modality to detect and quantify liver iron overload. However, due to its superparamagnetic properties, iron provides a natural source of contrast enhancement that can make challenging the differential diagnosis between different focal liver lesions (FLLs). To date, a fully comprehensive description of MRI features of liver lesions commonly found in iron-overloaded liver is lacking in the literature. Through an extensive review of the published literature, we aim to summarize the MRI signal intensity and enhancement pattern of the most common FLLs that can occur in liver iron overload

An Imaging Overview of COVID-19 ARDS in ICU Patients and Its Complications: A Pictorial Review

A significant proportion of patients with COVID-19 pneumonia could develop acute respiratory distress syndrome (ARDS), thus requiring mechanical ventilation, and resulting in a high rate of intensive care unit (ICU) admission. Several complications can arise during an ICU stay, from both COVID-19 infection and the respiratory supporting system, including barotraumas (pneumothorax and pneumomediastinum), superimposed pneumonia, coagulation disorders (pulmonary embolism, venous thromboembolism, hemorrhages and acute ischemic stroke), abdominal involvement (acute mesenteric ischemia, pancreatitis and acute kidney injury) and sarcopenia. Imaging plays a pivotal role in the detection and monitoring of ICU complications and is expanding even to prognosis prediction. The present pictorial review describes the clinicopathological and radiological findings of COVID-19 ARDS in ICU patients and discusses the imaging features of complications related to invasive ventilation support, as well as those of COVID-19 itself in this particularly fragile population. Radiologists need to be familiar with COVID-19's possible extra-pulmonary complications and, through reliable and constant monitoring, guide therapeutic decisions. Moreover, as more research is pursued and the pathophysiology of COVID-19 is increasingly understood, the role of imaging must evolve accordingly, expanding from the diagnosis and subsequent management of patients to prognosis prediction

A Case Study of African American Parental Involvement in an Urban Middle School

Studying parental involvement offers the opportunity to develop new strategies and resources to increase involvement at the middle schools serving a similar demographic population. In a large economically disadvantaged urban middle school in the southeastern United States, very little parental involvement occurs from the African American population. The purpose of this qualitative single case study was to examine African American parents\u27 perception about their involvement in their middle school students\u27 education. Guided by Epstein, Simon, and Salinas\u27 parental involvement model, which describes 6 levels of parental involvement, the research questions guiding this project study examined African American parents\u27 perceptions about middle school children\u27s educational experiences, the level of parental involvement in middle school education, and parental beliefs about student success. A purposeful participant pool of 10 African American parents of Grade 7 and 8 students was used for data collection. Ten parents completed the preliminary paper questionnaire, 10 parents participated in 1-on-1 semi-structured interviews, and 7 parents participated in a focus group discussion. Thematic analysis of data followed the open coding process and identified categories and themes. The findings suggested the need for a parent education program involving the use of new strategies and resources for increasing African American parent involvement at the middle school level. Social change will occur by empowering African American parents to be involved in their middle school students\u27 education

Years of life that could be saved from prevention of hepatocellular carcinoma

BACKGROUND: Hepatocellular carcinoma (HCC) causes premature death and loss of life expectancy worldwide. Its primary and secondary prevention can result in a significant number of years of life saved. AIM: To assess how many years of life are lost after HCC diagnosis. METHODS: Data from 5346 patients with first HCC diagnosis were used to estimate lifespan and number of years of life lost after tumour onset, using a semi-parametric extrapolation having as reference an age-, sex- and year-of-onset-matched population derived from national life tables. RESULTS: Between 1986 and 2014, HCC lead to an average of 11.5 years-of-life lost for each patient. The youngest age-quartile group (18-61 years) had the highest number of years-of-life lost, representing approximately 41% of the overall benefit obtainable from prevention. Advancements in HCC management have progressively reduced the number of years-of-life lost from 12.6 years in 1986-1999, to 10.7 in 2000-2006 and 7.4 years in 2007-2014. Currently, an HCC diagnosis when a single tumour <2 cm results in 3.7 years-of-life lost while the diagnosis when a single tumour 65 2 cm or 2/3 nodules still within the Milan criteria, results in 5.0 years-of-life lost, representing the loss of only approximately 5.5% and 7.2%, respectively, of the entire lifespan from birth. CONCLUSIONS: Hepatocellular carcinoma occurrence results in the loss of a considerable number of years-of-life, especially for younger patients. In recent years, the increased possibility of effectively treating this tumour has improved life expectancy, thus reducing years-of-life lost

Direct-acting antivirals and hepatocellular carcinoma in chronic hepatitis C: A few lights and many shadows

With the introduction of direct-acting antiviral agents (DAA), the rate of sustained virological response (SVR) in the treatment of hepatitis C virus (HCV) has radically improved to over 95%. Robust scientific evidence supports a beneficial role of SVR after interferon therapy in the progression of cirrhosis, resulting in a decreased incidence of hepatocellular carcinoma (HCC). However, a debate on the impact of DAAs on the development of HCC is ongoing. This review aimed to analyse the scientific literature regarding the risk of HCC in terms of its recurrence and occurrence after the use of DAAs to eradicate HCV infection. Among 11 studies examining HCC occurrence, the de novo incidence rate ranged from 0 to 7.4% (maximum follow-up: 18 mo). Among 18 studies regarding HCC recurrence, the rate ranged from 0 to 54.4% (maximum "not well-defined" followup: 32 mo). This review highlights the major difficulties in interpreting data and reconciling the results of the included studies. These difficulties include heterogeneous cohorts, potential misclassifications of HCC prior to DAA therapy, the absence of an adequate control group, short follow-up times and different kinds of follow-up. Moreover, no clinical feature-based scoring system accounts for the molecular characteristics and pathobiology of the tumours. Nonetheless, this review does not suggest that there is a higher rate of de novo HCC occurrence or recurrence after DAA therapy in patients with previous HCV infection. \ua9 2018 The Author(s). Published by Baishideng Publishing Group Inc. All rights reserved

Fragilità dell'utenza e del patrimonio costruito. L'architettura del cammino come occasione per una riqualificazione condivisa

The contribution investigates the relationship of fragility between users and cultural heritage. It considers the rural heritage as a cultural asset, as a matrix of local identity and cultural expression of the community, and defines strategies through the networking of the heritage for receptive purposes. The recovery should include the re-functionalization of the heritage and its link with other vernacular polarities, according to the needs of users. To be ‘for all’, the design must be based on meticulous attention to detail and must be invisible and integrated into the environment. The enhancement of inclusive aspects represents an incremental value of quality by satisfying users’ expectations. The case study described is part of the “Banca del Fare” project and provides for the recovery and re-functionalization of the “ciabòt d’Alta Langa” from the point of view of environmental, economic and social sustainability. A reinterpretation of the project from an inclusive point of view has allowed ideas, suggestions and considerations about the possible ways of implementation of accessibility, outlining solutions and good practices for widespread hospitality

Fragilità dell’utenza e del patrimonio costruito. L’architettura del cammino come occasione per una riqualificazione condivisa

The contribution investigates the relationship of fragility between users and cultural heritage. It considers the rural heritage as a cultural asset, as a matrix of-local identity and cultural expression of the community, and defines strategies through the networking of the heritage for receptive purposes. The recovery should include the re-functionalization of the heritage and its link with other vernacular polarities, according to the needs of users. To be “for all”, the design must bemed on meticulous attention to detail and must be invisible and integrated into the environment. The enhancement of-inclusive aspects represents an incremental value of-quality by satisfying users’ expectations. the case study described is part of the “Banca del Fare” project and provides for the recovery and re-functionalization of the “Ciabot d’Alta Langa” from the point of view of environmental, economic and social sustainability. A reinterpretation of the project from an inclusive point of view allowed ideas, suggestions and considerations about the possible ways of-implementation of-accessibility, outlining solutions and good practices for widespread hospitality

YTTRIUM-90 MICROSPHERE RADIOEMBOLIZATION FOR UNRESECTABLE CHOLANGIOCARCINOMA

The term radioembolization defines those procedures in which intra-arterially injected radioactive microspheres are used for internal radiation purposes. The aim of this procedure is to selectively target radiation to liver tumors and to limit the dose to the normal liver parenchyma. The yttrium-90 microspheres delivered through the hepatic artery are implanted into liver tumors in a ratio ranging from 3:1 to 20:1 as compared to a normal liver parenchyma. The principles of radioembolization are fundamentally different from the conventional embolization of liver cancer through transarterial embolization or chemoembolization. A work-up, involving computed tomography scanning, contrast-enhanced magnetic resonance imaging and hepatic angiography, is essential for assessing the appropriateness of the patient for yttrium-90 treatment. A simulation of the procedure, carried out with technetium-99m-labeled macroaggregated albumin particles which approximate the size of the microspheres, is used to identify the shunting of microparticles to the lungs or the gastrointestinal tract, thus helping in patient selection. Excellent periprocedural care, discharge planning and follow-up are essential in assessing treatment response and ensuring that the short-term side effects of radioembolization are adequately managed. In the management of hepatocellular carcinoma and metastatic tumors, the ever increasing literature regarding radioembolization shows that this is an effective treatment, improving survival with a low incidence of side effects. In bile duct tumors, radioembolization can only be used as a palliative treatment for intrahepatic cholangiocarcinoma; some recent studies have reported good safety and efficacy rates and low complication rates, with median survival ranging from 9 to 22 month

Characterization of Gold of the Murcielago Fluvial Placer (Central Honduras) and Its Possible Primary Sources

The Murcielago gold placer is located in the Lepaguare Valley, Olancho Department (Central Honduras). The placer mineralogy includes silicates (quartz, garnets, amphibole, Ca-pyroxene, micas, epidote, and tourmaline); calcite; and in the heavy fraction, zircon, ilmenite–rutile, magnetite, hematite, cassiterite, and cinnabar. Gold grains recovered from the Murcielago placer production plant are mainly flattened grains with a moderately to high elliptical shape. The composition of the gold grains varies continuously in the range Au46Ag54 to Au88Ag12. Few of them are characterized by Au-rich rims of a few microns in size (Ag 3-1 atoms percent (at%)). Gold from the Canan lode deposit, a nearby hydrothermal Au mineralization area, has a composition (from Au54Ag44 to Au81Ag19) overlapping the composition of the Murcielago grains. Inclusions in the alluvial gold particles are arsenopyrite, pyrite, acanthite, sphalerite, and hematite. On the basis of the placer mineralogy and the gold grains analyses, possible gold source(s) include the Canan lode and skarn gold deposits in the area. We obtained new data on the Murcielago gold placer that will be the basis for an exploration of the potential sources of gold in the area