Severe steatohepatitis in a patient with a rare neutral lipid storage disorder due to ABDH5 mutation

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Role of Multimodal Imaging in Patients With Suspected Infections After the Bentall Procedure

Purpose: This study aimed to assess the diagnostic performances of multimodal imaging [i.e., white blood cell single-photon emission computed tomography/CT ((99m)Tc-HMPAO-WBC SPECT/CT) and 18-fluoride-fluorodeoxyglucose positron emission tomography/CT ([(18)F]FDG PET/CT)] in patients with suspected infection after the Bentall procedure, proposing new specific diagnostic criteria for the diagnosis. Methods: Between January 2009 and December 2019, we selected within a cardiovascular infections registry, 76 surgically treated patients (27 women and 49 men, median 66 years, and range 29–83 years). All the patients underwent molecular imaging for a suspected infection after the replacement of the aortic valve and ascending aorta according to the Bentall procedure. We analyzed 98 scans including 49 (99m)Tc-WBC and 49 [(18)F]FDG PET/CT. A total of 22 patients with very early/early suspected infection (<3 months after surgery) were imaged with both the techniques. Positive imaging was classified according to the anatomical site of increased uptake: to the aortic valve (AV), to both the AV and AV tube graft (AVTG) or to the TG, to surrounding tissue, and/or to extracardiac sites (embolic events or other sites of concomitant infection). Standard clinical workup included in all the patients having echocardiography/CT, blood culture, and the Duke criteria. Pretest probability and positive/negative likelihood ratio were calculated. Sensitivity and specificity of (99m)Tc labeled hexamethylpropylene amine oxime-WBC SPECT/CT ((99m)Tc-HMPAO-WBC SPECT/CT) and [(18)F]FDG PET/CT imaging were calculated by using microbiology (n = 35) or clinical follow-up (n = 41) as final diagnosis. (99m)Tc-HMPAO-WBC scintigraphy and [(18)F]FDG PET/CT findings were compared with 95% CIs by using the McNemar test to those of echocardiography/CT, blood culture, and the Duke criteria. Results: Sensitivity, specificity, and accuracy of (99m)Tc-HMPAO-WBC were 86, 92, and 88%, respectively, with a slightly higher sensitivity for tube graft infection (TGI) as compared to isolated AV and combined AVTG. Overall, sensitivity, specificity, and accuracy of [(18)F]FDG PET/CT were 97, 73, and 90%, respectively. In 22 patients with suspected very early and early postsurgical infections, the two imaging modalities were concordant in 17 cases [10 true positive (TP) and 7 true negative (TN)]. [(18)F]FDG PET/CT presented a higher sensitivity than (99m)Tc-HMPAO-WBC scan. (99m)Tc-HMPAO-WBC scan correctly classified as negative three false-positive (FP) PET/CT findings. Conclusion: Our findings supported the use of (99m)Tc-HMPAO-WBC SPECT/CT and [(18)F]FDG PET/CT in patients with suspicion infection after the Bentall procedure early in the course of the disease onset to confirm the diagnosis and provide a comprehensive assessment of disease burden through the proposed criteria

Robotic Versus Laparoscopic Adrenalectomy: Pluriannual Experience in a High-Volume Center Evaluating Indications and Results

Background: Robotic adrenalectomy offers several clinical benefits if compared with laparoscopic adrenalectomy; however, its superiority is still under debate. The aim of this study was the investigation of differences between the two techniques, and a comparison when approaching right or left side adrenal lesions was further conducted. Materials and Methods: All patients undergoing laparoscopic and robotic unilateral adrenalectomy at our institution from January 2006 to December 2019 were collected and retrospectively analyzed. Statistical analysis was conducted; differences between the two cohorts were reported. Results: A total of 160 cases were included (84 patients in laparoscopic adrenalectomy-group [LA-g] 76 cases in robotic adrenalectomy-group [RA-g]). The groups were homogeneous for demographic data. No intraoperative complications were reported; mean amount of intraoperative blood loss was comparable. No cases of conversion to open surgery were required. RA-g presented a longer operative time than LA-g for right adrenalectomy (P = .05), no differences were noted for left side (P = .187). Overall morbidity was 21% for LA-g and 10.5% for RA-g (P = .087), with an inferior rate of surgical complications for RA-g (P = .024), and for robotic left adrenalectomy than robotic right procedure (P = .03). Length of hospital stay was shorter for RA-g (P = .005). Conclusions: Robotic adrenalectomy presents similar outcomes as laparoscopic approach with some benefits for selected cases. Left adrenal lesions seem to receive greater advantages from robotic technique. Large randomized controlled trials are required to determine the role of robotic adrenal surgery and if the indication can be standardized based on the laterality of adrenal procedure

A multi-state physics modeling for estimating the size- and location-dependent loss of coolant accident initiating event probability

Multi-State Physics Modeling (MSPM) integrates multi-state modeling to describe a component degradation process by transitions among discrete states (e.g., no damage, micro-crack, flaw, rupture, etc.), with physics modeling by (physic) equations to describe the continuous degradation process within the states. In this work, we propose MSPM to describe the degradation dynamics of a piping system, accounting for the dependence on the size and location of the Loss of Coolant Accident (LOCA) initiating event of the Reactor Coolant System (RCS) of a Pressurized Water Reactor (PWR). Estimated frequencies of LOCA as a function of break size are used in a variety of regulatory applications and for the Probabilistic Risk Assessment (PRA) of Nuclear Power Plants (NPPs). Traditionally, two approaches have been used to assess LOCA frequencies as a function of pipe break size: estimates based on statistical analysis of field data collected from piping systems service experience and Probabilistic Fracture Mechanics (PFM) analysis of specific, postulated, physical damage mechanisms. However, due to the high reliability of NPP piping systems, it is difficult to construct a comprehensive service database based on which perform statistical analysis. On the other hand, it is difficult to utilize PFM models for calculating LOCA frequencies because many of the input variables and model assumptions are over-simplified and may not adequately represent the true plant conditions. We overcome these challenges and propose a size- and location-dependent LOCA initiating event frequencies estimation by resorting to the novel MSPM modeling scheme. Benchmarking is done with respect to the results obtained with the Generic Safety Issue (GSI) 191 framework that makes use of field data for LOCA initiating event probability calculation

Cardiac kinematic parameters computed from video of in situ beating heart

Mechanical function of the heart during open-chest cardiac surgery is exclusively monitored by echocardiographic techniques. However, little is known about local kinematics, particularly for the reperfused regions after ischemic events. We report a novel imaging modality, which extracts local and global kinematic parameters from videos of in situ beating hearts, displaying live video cardiograms of the contraction events. A custom algorithm tracked the movement of a video marker positioned ad hoc onto a selected area and analyzed, during the entire recording, the contraction trajectory, displacement, velocity, acceleration, kinetic energy and force. Moreover, global epicardial velocity and vorticity were analyzed by means of Particle Image Velocimetry tool. We validated our new technique by i) computational modeling of cardiac ischemia, ii) video recordings of ischemic/reperfused rat hearts, iii) videos of beating human hearts before and after coronary artery bypass graft, and iv) local Frank-Starling effect. In rats, we observed a decrement of kinematic parameters during acute ischemia and a significant increment in the same region after reperfusion. We detected similar behavior in operated patients. This modality adds important functional values on cardiac outcomes and supports the intervention in a contact-free and non-invasive mode. Moreover, it does not require particular operator-dependent skills

Diagnosi e valutazione della personalit alleanza terapeutica e scambio clinico nella ricerca in psicoterapia

Questo contributo si propone di fornire una breve rassegna delle principali linee di ricerca seguite negli ultimi anni dal gruppo coordinato da Vittorio Lingiardi. Tra queste, ci soffermeremo in particolare su: a) valutazione e diagnosi della personalità con SWAP-200 e PDM (Psychodynamic Diagnostic Manual); b) sviluppo e validazione di strumenti clinician-report per operazionalizare l'uso del PDM; c) valutazione dei meccanismi di difesa e degli stili difensivi mediante DMRS e sua versione Q sort; d) studio del processo e della relazione terapeutica (alleanza terapeutica, rotture e riparazioni dell'alleanza controtransfert); in particolare, in quest'area di ricerca, ci siamo impegnati nello sviluppo e validazione di nuovi strumenti per la valutazione dei processi di rottura e riparazione dell'alleanza (Collaborative Interaction Scale) e della qualità dell'attaccamento tra paziente e terapeuta (Patient-Therapist Attachment Q Sort); d) sviluppo della ricerca clinica e applicativa sui temi dell'identità di genere, dell'orientamento sessuale e dell'omofobia sociale e interiorizzata

Diagnosi e valutazione della personalit alleanza terapeutica e scambio clinico nella ricerca in psicoterapia

Questo contributo si propone di fornire una breve rassegna delle principali linee di ricerca seguite negli ultimi anni dal gruppo coordinato da Vittorio Lingiardi. Tra queste, ci soffermeremo in particolare su: a) valutazione e diagnosi della personalità con SWAP-200 e PDM (Psychodynamic Diagnostic Manual); b) sviluppo e validazione di strumenti clinician-report per operazionalizare l'uso del PDM; c) valutazione dei meccanismi di difesa e degli stili difensivi mediante DMRS e sua versione Q sort; d) studio del processo e della relazione terapeutica (alleanza terapeutica, rotture e riparazioni dell'alleanza controtransfert); in particolare, in quest'area di ricerca, ci siamo impegnati nello sviluppo e validazione di nuovi strumenti per la valutazione dei processi di rottura e riparazione dell'alleanza (Collaborative Interaction Scale) e della qualità dell'attaccamento tra paziente e terapeuta (Patient-Therapist Attachment Q Sort); d) sviluppo della ricerca clinica e applicativa sui temi dell'identità di genere, dell'orientamento sessuale e dell'omofobia sociale e interiorizzata

Extracorporeal life support in mitral papillary muscle rupture: Outcome of multicenter study

Background: Post-acute myocardial infarction papillary muscle rupture (post-AMI PMR) may present variable clinical scenarios and degree of emergency due to result of cardiogenic shock. Veno-arterial extracorporeal life support (V-A ECLS) has been proposed to improve extremely poor pre- or postoperative conditions. Information in this respect is scarce.Methods: From the CAUTION (meChanical complicAtion of acUte myocardial infarcTion: an InternatiOnal multiceNter cohort study) database (16 different Centers, data from 2001 to 2018), we extracted adult patients who were surgically treated for post-AMI PMR and underwent pre- or/and postoperative V-A ECLS support. The end-points of this study were in-hospital survival and ECLS complications.Results: From a total of 214 post-AMI PMR patients submitted to surgery, V-A ECLS was instituted in 23 (11%) patients. The median age was 61.7 years (range 46-81 years). Preoperatively, ECLS was commenced in 10 patients (43.5%), whereas intra/postoperative in the remaining 13. The most common V-A ECLS indication was post-cardiotomy shock, followed by preoperative cardiogenic shock and cardiac arrest. The median duration of V-A ECLS was 4 days. V-A ECLS complications occurred in more than half of the patients. Overall, in-hospital mortality was 39.2% (9/23), compared to 22% (42/219) for the non-ECLS group.Conclusions: In post-AMI PMR patients, V-A ECLS was used in almost 10% of the patients either to promote bridge to surgery or as postoperative support. Further investigations are required to better evaluate a potential for increased use and its effects of V-A ECLS in such a context based on the still high perioperative mortality