Stratification of THROMBOTIC RISK in patients that are undergoing to PICC implantation. The “CoRa-MaPiCC STUDY”

Background: The PICC is a central venous system inserted in the peripherally vein. The central peripheral catheter catheter system (PICC=peripherally inserted central catheters) is a widely used procedure in clinical practice by medical and nurse team. PICC has potential complications that are rare but not entirely irrelevant. It is used for continuous and discontinuous treatment and, after a correct insertion procedure, it can be used for a period of time between 1 week to 3 months. The last-generation dispositive has an high-biocompatibility due to the high quality of the materials (silicone or polyurethane), a total length of 40-60 cm and a diameter between 16 to 25 Gauge or 2 to 5 French. Aims: The aim of our study is to evaluate the trombotic risk related to the positioning of the device in relation to the individual risk factors. Therefore we have elaborated the CoRaMaPicc protocol that allows, based on the preliminary data evaluation, to reduce the trombotic risk in patients with high cardiovascular risk profile. Methods: The study has started in July 2016. We have enrolled 30 patients (18 males and 12 females with range age of 30-99 yrs and mean age of 82+13,5 yrs). Enrolled patients have Body mass Index or (BMI) with range from 16,3-26,5 Kg/mq and mean BMI value of 23,5+2,5 Kg/mq. Enrolled patients were subjected to laboratory assessment of cardiovascular risk factors like laboratory assessment of Methyl-Tetra-Hydro-Folate-Reductase or (MTHFR) and Homocysteine, Fibrinogen, D-Dimer, International Normalized Ratio (INR), Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT), Platelets (PLT), trombotic risk evaluation (CHA2DS2-VASc Score), and bledding risk evaluation (HAS-BLED Score). Before the insertion procedure of the PICC, single or duble lumen (Groshong or Power PICC type), the patient were subjected to a preliminary ultrasound and echo-doppler vein evaluation to underline the presence of atipical anatomical state of the patients veins. After the procedure the patients were subjected to second ultrasound and echo-doppler vein evaluation and then to a radiographic examination to verify the correct position of the PICC. All patients were enrolled for follow- Up to evaluate trombotic complications. Statistical analysis was performed using the Survival Analysis test to evaluate the patients during the follow-up period in relation to thrombotic events. The data obtained from our study have been described taking also into account the data present in the international literature. Setting: The study was performed using a specific setting in a room of the Internal Medicine Department of the Alfredo Fiorini Hospital (Terracina, Italy), guarantee an aseptic procedure , the right comfort for the patients and the appropriate privacy. Discussion: More data in the literature underline the presence of non-eliminable risk factors like anatomic state of the patients vein that can play a variable role of procedural risk factor and can predispose to procedural or post-procedural complication after the implantation procedure. In specific cases it is difficult to asses an echo-doppler examination of heart for meteorism or ascites and radiographic exams for the presence of pleural effusion. The CoRaMaPiCC protocol use different technique to explore the post-insertion period and the follow-up time at 12 week. In case of meteorism or ascites the ultrasound examination of the heart cameras was replaced by the radiographyc evaluation while in case of pleural effusion, the evaluation of the device position was deduced using the only ultrasound approach (when the vein system is explorable). Procedural algorithm utilized in our implant protocol allows to improve the diagnostic capabilities of the conditions that can predispose to thrombotic complications. During the study period (1 year), the PICCs were removed for death (7 patients; 4 patients for irreversible heart disease, 1 patient for cardiogenic shock 1 patient for septic shock and 1 patient for Creutzfeld-Jacob disease), for spontaneously remotion (1 patient for low compliance of the patient) and for end of therapy (22 patients). The presence of cardiovascular risk factors alone is not sufficient for determining statistically significant changes in the thrombotic risk. As reported historically by the description of the wirkow triad, the presence of three clinical signs, and in particular the presence of endothelial damage (functio lesa) is a sine qua non condition for the occurrence of thrombotic episodes. Conclusion: The CoRaMaPicc protocol allows, based on the evaluation of the data, to minimize endothelial damage and therefore to reduce the incidence of the wirchof's triade related with an high trombotic risk. The data were elaborated considering the different thrombotic risk linked to the presence of the homozygous MTHR mutation responsible for the increase of homocysteine values and therefore of the further thrombotic risk. Further studies are needed to expand the number of enrolled patients and increase the follow-up period. Our data give comfortable results but further evaluation are needed to have conclusive results

A Segmentation Method for fluorescence images without a machine learning approach

Background: Image analysis applications in digital pathology include various methods for segmenting regions of interest. Their identification is one of the most complex steps, and therefore of great interest for the study of robust methods that do not necessarily rely on a machine learning (ML) approach. Method: A fully automatic and optimized segmentation process for different datasets is a prerequisite for classifying and diagnosing Indirect ImmunoFluorescence (IIF) raw data. This study describes a deterministic computational neuroscience approach for identifying cells and nuclei. It is far from the conventional neural network approach, but it is equivalent to their quantitative and qualitative performance, and it is also solid to adversative noise. The method is robust, based on formally correct functions, and does not suffer from tuning on specific data sets. Results: This work demonstrates the robustness of the method against the variability of parameters, such as image size, mode, and signal-to-noise ratio. We validated the method on two datasets (Neuroblastoma and NucleusSegData) using images annotated by independent medical doctors. Conclusions: The definition of deterministic and formally correct methods, from a functional to a structural point of view, guarantees the achievement of optimized and functionally correct results. The excellent performance of our deterministic method (NeuronalAlg) to segment cells and nuclei from fluorescence images was measured with quantitative indicators and compared with those achieved by three published ML approaches.Comment: 25 page

NeuronAlg: An Innovative Neuronal Computational Model for Immunofluorescence Image Segmentation

Background: Image analysis applications in digital pathology include various methods for segmenting regions of interest. Their identification is one of the most complex steps and therefore of great interest for the study of robust methods that do not necessarily rely on a machine learning (ML) approach. Method: A fully automatic and optimized segmentation process for different datasets is a prerequisite for classifying and diagnosing indirect immunofluorescence (IIF) raw data. This study describes a deterministic computational neuroscience approach for identifying cells and nuclei. It is very different from the conventional neural network approaches but has an equivalent quantitative and qualitative performance, and it is also robust against adversative noise. The method is robust, based on formally correct functions, and does not suffer from having to be tuned on specific data sets. Results: This work demonstrates the robustness of the method against variability of parameters, such as image size, mode, and signal-to-noise ratio. We validated the method on three datasets (Neuroblastoma, NucleusSegData, and ISBI 2009 Dataset) using images annotated by independent medical doctors. Conclusions: The definition of deterministic and formally correct methods, from a functional and structural point of view, guarantees the achievement of optimized and functionally correct results. The excellent performance of our deterministic method (NeuronalAlg) in segmenting cells and nuclei from fluorescence images was measured with quantitative indicators and compared with those achieved by three published ML approaches

The role of network connectivity on epileptiform activity

A number of potentially important mechanisms have been identified as key players to generate epileptiform activity, such as genetic mutations, activity-dependent alteration of synaptic functions, and functional network reorganization at the macroscopic level. Here we study how network connectivity at cellular level can affect the onset of epileptiform activity, using computational model networks with different wiring properties. The model suggests that networks connected as in real brain circuits are more resistant to generate seizure-like activity. The results suggest new experimentally testable predictions on the cellular network connectivity in epileptic individuals, and highlight the importance of using the appropriate network connectivity to investigate epileptiform activity with computational models

Le Conseil d’Etat et l’extension de la matière pénale en droit pénitenciaire

Cycle de conférences ISPECPour le pénaliste, la matière pénale visée par l’intitulé de la conférence, renvoie inexorablement à la définition que la CEDH a donnée de ce concept à l’occasion d’un contentieux disciplinaire dans l’affaire Engel c/ France. C’est dire que selon la CEDH la matière pénale va bien au-delà du droit pénal pris en son sens formel. Aussi peut-on affirmer que le juge répressif n’est pas seulement le juge judiciaire pénal. Pour autant le juge administratif a pendant longtemps répugné à intervenir dans les lieux clos, qu’il s’agisse de la caserne, de l’école ou encore de la prison. S’agissant plus particulièrement de l’univers carcéral, le juge administratif refusait sa compétence en matière d’exécution des peines de peur d’empiéter sur les prérogatives du juge judiciaire, jusqu’à ce que le Tribunal des Conflits décide dans l’arrêt Dame Fargeaud d’Epied de soumettre au contrôle de la juridiction administrative le fonctionnement du service pénitentiaire. Pour autant cette reconnaissance ne s’est pas immédiatement accompagnée de l’élargissement du contrôle opéré par le juge administratif

Isabelle Rosé, Construire une société seigneuriale. Itinéraire et ecclésiologie de l’abbé Odon de Cluny (fin du IXe-milieu du Xe siècle)

La place d’Odon dans la succession des abbés de Cluny n’est pas évidente à définir : ni fondateur comme Bernon, ni saint abbé érigé en modèle par les moines, comme Maïeul, pourtant, à nos yeux, réformateur infatigable, à Cluny et ailleurs. D’où une grande rareté des ouvrages consacrés à cet abbé tant au Moyen Âge qu’aujourd’hui. C’est cette apparence d’injustice qu’examine Isabelle Rosé, dont elle tente de trouver l’explication, et qu’elle a, si l’on peut dire, la volonté de réparer. Initial..

Identification of reference genes for quantitative PCR during C3H10T1/2 chondrogenic differentiation

C3H10T1/2, a mouse mesenchymal stem cell line, is a well-known in vitro model of chondrogenesis that can be easily employed to recapitulate some of the mechanisms intervening in this process. Moreover, these cells can be used to validate the effect of candidate molecules identified by high throughput screening approaches applied to the development of targeted therapy for human disorders in which chondrogenic differentiation may be involved, as in conditions characterized by heterotopic endochondral bone formation. Chondrogenic differentiation of C3H10T1/2 cells can be monitored by applying quantitative polymerase chain reaction (qPCR), one of the most sensitive methods that allows detection of small dynamic changes in gene expression between samples obtained under different experimental conditions. In this work, we have used qPCR to monitor the expression of specific markers during chondrogenic differentiation of C3H10T1/2 cells in micromass cultures. Then we have applied the geNorm approach to identify the most stable reference genes suitable to get a robust normalization of the obtained expression data. Among 12 candidate reference genes (Ap3d1, Csnk2a2, Cdc40, Fbxw2, Fbxo38, Htatsf1, Mon2, Pak1ip1, Zfp91, 18S, ActB, GAPDH) we identified Mon2 and Ap3d1 as the most stable ones during chondrogenesis. ActB, GAPDH and 18S, the most commonly used in the literature, resulted to have an expression level too high compared to the differentiation markers (Sox9, Collagen type 2a1, Collagen type 10a1 and Collagen type 1a1), therefore are actually less recommended for these experimental conditions. In conclusion, we identified nine reference genes that can be equally used to obtain a robust normalization of the gene expression variation during the C3H10T1/2 chondrogenic differentiation

’Ndrangheta ed estorsioni. Il crime script del racket nella provincia di Milano

La cronaca giudiziaria degli ultimi anni ha sottolineato il ruolo di primo piano della ’ndrangheta in Lombardia. Si è quindievidenziata una diffusione delle condotte estorsive di matrice ’ndranghetista, specie nella provincia di Milano. Nonostanteciò, ad oggi non sono stati compiuti adeguati sforzi analitici per comprendere i meccanismi che ne consentono una tale diffusionea livello sistemico. Lo scopo del presente studio è dunque quello di descrivere qualitativamente il racket delle estorsionidi matrice ’ndranghetista nella provincia di Milano al fine di produrre una conoscenza organica e scientifica della condottadelittuosa in esame. Si è quindi deciso di ricorrere al metodo del crime script per individuare tutti quegli elementi che caratterizzanoil modus operandi tipico dell’agire criminale, dal momento della sua pianificazione fino al momento successivo allasua consumazione. Per raggiungere tale obiettivo si è operata un’analisi secondaria su numerosi atti giudiziari quale fonte diinformazione primaria. Tali atti giudiziari fanno quindi riferimento a nove diverse indagini condotte dalla Direzione DistrettualeAntimafia di Milano. I risultati dell’analisi che maggiormente rilevano sono due. Il primo, è possibile distingueredue modelli di racket entro cui le diverse tipologie di condotta estorsiva ricadono: uno perimetrale, l’altro reticolare. Un modellonon esclude l’altro, semmai lo integra. Il secondo, la diffusione delle condotte estorsive si consegue attraverso: ciclicità, concatenazione,consequenzialità e integrazione. In tutti i casi, sono questi i meccanismi che consentono il consolidamento di unaprassi estorsiva a livello sistemico

Transfection of the mutant MYH9 cDNA reproduces the most typical cellular phenotype of MYH9-related disease in different cell lines

ABSTRACT: BACKGROUND: Heterozygous mutations of MYH9, encoding the Non-Muscular Myosin Heavy Chain-IIA (NMMHC-IIA), cause a complex disorder named MYH9-related disease, characterized by a combination of different phenotypic features. At birth, patients present platelet macrocytosis, thrombocytopenia and leukocyte inclusions containing NMMHC-IIA. Moreover, later in life some of them develop the additional features of sensorineural hearing loss, cataracts and/or glomerulonephritis that sometimes leads to end stage renal failure. RESULTS: To clarify the mechanism by which the mutant NMMHC-IIA could cause phenotypic anomalies at the cellular level, we examined the effect of transfection of the full-length mutated D1424H MYH9 cDNAs. We have observed, by confocal microscopy, abnormal distribution of the protein and formation of rod-like aggregates reminiscent of the leukocyte inclusions found in patients. Co-transfection of differently labeled wild-type and mutant full-length cDNAs showed the simultaneous presence of both forms of the protein in the intracellular aggregates. CONCLUSION: These findings suggest that the NMMHC-IIA mutated in position 1424 is able to interact with the WT form in living cells, despite part of the mutant protein precipitates in non-functional aggregates. Transfection of the entire WT or mutant MYH9 in cell lines represents a powerful experimental model to investigate consequences of MYH9 mutations