Kawasaki disease recurrence in the COVID-19 era: a systematic review of the literature

Kawasaki disease (KD) is a vasculitis of unknown origin of small and medium caliber blood vessels, especially involving coronary arteries and is the leading cause of acquired heart disease in childhood in developed countries. Although rarely, it can recur: most recurrences occur within 2 years of the initial episode. No data are available on incidence of recurrent KD in Europe and multiple recurrences are rarely seen. We reviewed the medical literature on Kawasaki disease recurrence and reported a new case of Kawasaki disease recurrence in a child with SARS-CoV-2 infection. We believe that in our case SARS Cov2 acted as a trigger capable to determine, in a genetically susceptible individual, a second recurrence of the disease. In the Covid-19 era we affirm the importance for Kawasaki disease to be tested for SARS Cov2 infection

Determinants of influenza vaccination among solid organ transplant recipients attending Sicilian reference center

Among solid organ transplant recipients, influenza infection is commonly associated with higher morbidity and mortality than immunocompetent hosts. Therefore, in these subjects influenza vaccination is of paramount importance. The main objective of the study was to assess compliance to vaccination and analyze factors associated with influenza vaccination of solid organ transplant recipients admitted to the Sicilian solid organ transplant Reference Center IRCCS-ISMETT in Palermo during 2014\u20132015 influenza season. Thirty one (37.8%) out of 82 solid organ transplant recipients were vaccinated against influenza. The main reason for vaccination refusal was fear of adverse reaction (n = 16, 31.4%), impaired health status (n = 14, 27.4%) and low vaccine efficacy (n = 10, 19.6%). Vaccinated solid organ transplant recipients compare with unvaccinated had smaller hospital admissions for infectious respiratory diseases (9.7% Vs 23.5%) during surveillance period. On multivariate analysis the factors positively associated with influenza vaccination were the advice of Reference Center physicians (OR 53.4, p < 0.001) and to perform vaccine against pneumococcus (OR 7.0, p = 0.016). This study showed that Reference Center physicians play a key role on vaccine communication and recommendation for patients at risk and it underlines the effectiveness of influenza vaccination in solid organ transplant recipients. However, it remains that, although physician advice resulted a strong determinant for vaccination, influenza vaccination coverage in this subset of population remains still unsatisfactory

Exploratory Thermo-Mechanical Assessment of the Bottom Cap Region of the EU DEMO Water-Cooled Lead Lithium Central Outboard Blanket Segment

The Water-Cooled Lead Lithium (WCLL) Breeding Blanket (BB) is one of the two BB concept candidates to be selected as the driver blanket for the EU DEMO fusion reactor. In this regard, the development of a sound architecture of the WCLL Central Outboard Blanket (COB) Segment, ensuring the fulfilment of the thermal and structural design requirements, is one of the main goals of the EUROfusion consortium. To this purpose, an exploratory research campaign has been launched to preliminarily investigate the thermo-mechanical performances of the Bottom Cap (BC) region of the WCLL COB segment because of its peculiarities making its design different from the other regions. The assessment has been carried out considering the nominal BB operating conditions, the Normal Operation (NO) scenario, as well as a steady-state scenario derived from the in-box LOCA accident, the Over-Pressurization (OP) scenario. Starting from the reference geometric layout of the WCLL COB BC region, a first set of analyses has been launched in order to evaluate its structural performances under a previously calculated thermal field and to select potential geometric improvements. Then, the analysis of a complete BC region was conducted from both the thermal and structural standpoints, evaluating its structural behaviour in compliance with the RCC-MRx code. Finally, after some iterations and geometric updates, a promising geometric layout of the BC region has been obtained even though some criticalities still persist in the internal Stiffening Plates and First Wall. However, the obtained results clearly showed that the proposed layout is worthy to be further assessed to achieve a robust enough configuration. The work has been performed following a theoretical-numerical approach based on the Finite Element Method (FEM) and adopting the quoted Ansys commercial FEM code

Thermomechanical and Thermofluid-Dynamic Coupled Analysis of the Top Cap Region of the Water-Cooled Lithium Lead Breeding Blanket for the EU DEMO Fusion Reactor

In the EU, the Water-Cooled Lithium Lead (WCLL) Breeding Blanket (BB) concept is one of the candidates for the design of the DEMO reactor. From the past campaign of analysis emerged that the thermal-induced stress led to the failure in the verification of the RCC-MRx structural criteria. Hence, in this paper the classic conceptual design approach, based on a pure FEM thermal and structural analysis, is compared to a coupled thermofluid-dynamic/structural one. Even though the coupled approach requires tremendous modelling effort and computational burden, it surely allows determining the thermal field with a higher level of detail than the FEM analysis. Therefore, in this work, the focus is put on the impact of a more detailed thermal field on the DEMO WCLL BB global structural performances, focusing on the Top Cap region of its Central Outboard Blanket segment. The obtained results have allowed confirming the soundness of the design solution of the Top Cap region, except for concerns arising on the mass flow rate distribution. Moreover, results have shown that, globally, the pure FEM approach allows for obtaining more conservative results than the coupled one. This is a positive outcome in sight of the follow-up of the DEMO WCLL BB design, as it will be still possible adopting the pure FEM approach to quickly down-select design alternatives, using the most onerous coupled approach to finalise the most promising

Performance of radiomics features in the quantification of idiopathic pulmonary fibrosis from HRCT

Background: Our study assesses the diagnostic value of different features extracted from high resolution computed tomography (HRCT) images of patients with idiopathic pulmonary fibrosis. These features are investigated over a range of HRCT lung volume measurements (in Hounsfield Units) for which no prior study has yet been published. In particular, we provide a comparison of their diagnostic value at different Hounsfield Unit (HU) thresholds, including corresponding pulmonary functional tests. Methods: We consider thirty-two patients retrospectively for whom both HRCT examinations and spirometry tests were available. First, we analyse the HRCT histogram to extract quantitative lung fibrosis features. Next, we evaluate the relationship between pulmonary function and the HRCT features at selected HU thresholds, namely -200 HU, 0 HU, and +200 HU. We model the relationship using a Poisson approximation to identify the measure with the highest log-likelihood. Results: Our Poisson models reveal no difference at the -200 and 0 HU thresholds. However, inferential conclusions change at the +200 HU threshold. Among the HRCT features considered, the percentage of normally attenuated lung at -200 HU shows the most significant diagnostic utility. Conclusions: The percentage of normally attenuated lung can be used together with qualitative HRCT assessment and pulmonary function tests to enhance the idiopathic pulmonary fibrosis (IPF) diagnostic process

Responsiveness differences in outcome instruments after revision hip arthroplasty: What are the implications?

Responsiveness to change is an important psychometric property of an outcome instrument. Assessment of health-related quality of life (HRQoL) is critical to outcome assessment after total joint replacement, a surgery aimed at improving pain, function and HRQoL of the patients undergoing these procedures. In a recent study, Shi et al. examined the responsiveness to change of various subscales of two instruments, physician-administered Harris Hip Score and patient self-administered Short Form-36 (SF-36), 6 months after revision total hip arthroplasty. The responsiveness statistics for both scales were reasonable, higher for Harris Hip Score than SF-36. This is the first study to examine responsiveness of these instruments in revision THA patients in a systematic fashion

Substantial lymph-vascular space invasion (Lvsi) as predictor of distant relapse and poor prognosis in low-risk early-stage endometrial cancer

Objective: The aim of this study is to analyze the prognostic role of lymph-vascular space invasion (LVSI), evaluated in a semi-quantitative fashion on prognosis of early stage, low risk endometrial cancer (EC). Methods: We enrolled patients who underwent surgery for endometrial cancer between 2003 and 2018 in two referral cancer center. All patients had endometrioid EC, G1–G2, with myometrial invasion &lt;50%, and no lymph-node involvement. LVSI was analyzed in a semi-quantitative way, according to a 3-tiered scoring system in absent, focal and substantial. Results: Among 524 patients, any positive LVSI was found in 57 patients (10.9%) with focal LVSI (n=35, 6.7%) and substantial LVSI (n=22, 4.2%). Substantial LVSI was associated to higher rate of G2 (p&lt;0.001), myometrial infiltration (p=0.002) and greater tumor dimensions (p=0.014). Patients with substantial LVSI were more likely to receive adjuvant treatment (6.6% vs. 52.6%, p&lt;0.001). The 5-year OS was 99.5% in patients with absent LVSI and 70.6% in those with substantial LVSI (p&lt;0.001). The 5-year disease free survival (DFS) was 93.6% in patients with absent LVSI and 56.5% in those with substantial LVSI (p&lt;0.001). The rate of distant failures increased from 1.8% for absent LVSI to 22.7% for substantial LVSI (p=0.002). In univariate analysis substantial LVSI was the strongest predictor of poor overall survival (hazard ratio [HR]=11.9, p=0.001). Multivariate analysis showed that substantial LVSI was an independent predictive factor of both recurrence (HR=5.88, p=0.001) and distant failure (HR=10.6, p=0.006). Conclusions: Substantial LVSI represents the strongest independent risk factor for decreased survival and distant relapse, indicating a role for potential hematogenous dissemination