Is porto sinusoidal vascular disease to be actively searched in patients with portal vein thrombosis?

Porto sinusoidal vascular liver disease (PSVD) and portal vein thrombosis (PVT) are distinct vascular liver diseases characterized, respectively, by an intrahepatic and a prehepatic obstacle to the flow in the liver portal system. PVT may also occur as a complication of the natural history of PSVD, especially if a prothrombotic condition coexists. In other cases, it is associated to local and systemic pro-thrombotic conditions, even if its cause remains unknown in up to 25% despite an active search. In our opinion, the presence of PSVD should be suspected in patients with PVT especially in those with PVT "sine causa" and the active search of this condition should be included in their diagnostic work-out. However, sometimes the diagnosis of pre-existing PSVD is very hard. Biopsy cannot be fully discriminant as similar histological data have been described in both conditions. Liver stiffness may help as it has been shown to be higher in PSVD than in "pure" PVT, due to the presence of sclerosis in the portal venous radicles observable in PSVD patients. Nevertheless, comparing liver stiffness between PVT and PSVD has until now been restricted to very limited series of patients. In conclusion, even if it is still totally hypothetical, our point of view may have clinical consequences, especially when deciding to perform a liver biopsy in patients with a higher liver stiffness and suspending the anticoagulation in patients with PVT and no detectable prothrombotic factors

Performance assessment of GPS/GLONASS single point positioning in an urban environment

In signal-degraded environments such as urban canyons and mountainous area, many GNSS signals are either blocked or strongly degraded by natural and artificial obstacles. In such scenarios standalone GPS is often unable to guarantee a continuous and accurate positioning due to lack (or the poor quality) of signals. The combination of different GNSSs could be a suitable approach to fill this gap, because the multi-constellation system guarantees an improved satellite availability compared to standalone GPS, thus providing enhanced accuracy, continuity and integrity of the positioning. The present GNSSs are GPS, GLONASS, Galileo and Beidou, but the latter two are still in the development phase. In this work GPS/GLONASS systems are combined for single point positioning and their performance are assessed for different configurations. Using GPS/GLONASS multi-constellation implies the addition of an additional unknown, i.e. the intersystem time scale offset, which requires a sacrifice of one measurement. Since the intersystem offset is quasi-constant over a short period, a pseudo-measurement can be introduced to compensate the sacrifice. The benefit after adding a pseudo-measurement has been demonstrated in a vehicular test

Clinical significance of epithelial-to-mesenchymal transition in laryngeal carcinoma: Its role in the different subsites

Background: During epithelial-to-mesenchymal transition, cancer cells lose adhesion capacity gaining migratory properties. The role of the process on prognosis has been evaluated in 50 cases of laryngeal carcinoma. Methods: E-cadherin, N-cadherin, β-catenin, α-catenin, γ-catenin, caveolin-1, and vimentin immunohistochemical expression were evaluated using a double score based on staining intensity and cellular localization. Results: Cytoplasmic E-cadherin and α/γ catenin staining were associated with a decrease in survival, cytoplasmic β-catenin was associated with advanced stage, and N-cadherin and vimentin expression were associated with poor differentiation and tumor relapse. On the basis of cancer cells, epithelial or mesenchymal morphological and immunophenotypic similarity we identified 4 main subgroups correlated with a transition to a more undifferentiated phenotype, which have a different pattern of relapse and survival. Conclusion: The negative prognostic role of epithelial-to-mesenchymal transition has been confirmed and a predictive role in glottic tumors has been suggested, leading us to propose epithelial-to-mesenchymal transition as an additional adverse feature in laryngeal carcinoma

Radiological Intervention for Shunt Related Encephalopathy

Hepatic Encephalopathy (HE) is a neuropsychiatric syndrome that occurs in up to 30% of patients with cirrhosis. HE may be a consequence of pure liver failure, as in patients with fulminant hepatitis, or of the combination of liver failure and portal-systemic shunting, as in patients with liver cirrhosis. Several clinical and pathophysiologic observations suggest the importance of portal-systemic shunts in the development of HE. Episodes of HE are usually related to precipitating events, such as infections or gastrointestinal bleeding; a minority of cirrhotic patients experienced a chronic HE, refractory to standard medical treatment. This latter type of HE should be related to spontaneous or radiological (such as Transjugular Intrahepatic Portosystemic Shunt (TIPS)) portal systemic shunts, that could be restricted or occluded in patients with chronic HE. Both TIPS reduction and shunt occlusion are radiological procedures, safe and effective to ameliorate neurological symptoms in patients with refractory HE

The contribution of faint AGN to the hard X-ray background

Hard X-ray selection is the most efficient way to discriminate between accretion-powered sources, such as AGN, from sources dominated by starlight. Hard X-rays are also less affected than other bands by obscuration. We have then carried out the BeppoSAX High Energy Large Area Survey (HELLAS) in the largely unexplored 5-10 keV band, finding 180 sources in ~50 deg^2 of sky with flux >5E-14 erg cm-2 s-1. After correction for the non uniform sky coverage this corresponds to resolving about 30 % of the hard Cosmic X-ray Background (XRB). Here we report on a first optical spectroscopic identification campaign, finding 12 AGN out of 14 X-ray error-boxes studied. Seven AGN show evidence for obscuration in X-ray and optical bands, a fraction higher than in previous ROSAT or ASCA-ROSAT surveys (at a 95-99 % and 90 % confidence level respectively), thus supporting the scenario in which a significant fraction of the XRB is made by obscured AGN.Comment: MNRAS, revised version after minor referee comment

Involvement of pro-inflammatory cytokines and growth factors in the pathogenesis of Dupuytren's contracture: a novel target for a possible future therapeutic strategy?

Dupuytren's contracture (DC) is a benign fibro-proliferative disease of the hand causing fibrotic nodules and fascial cords which determine debilitating contracture and deformities of fingers and hands. The present study was designed to characterize pro-inflammatory cytokines and growth factors involved in the pathogenesis, progression and recurrence of this disease, in order to find novel targets for alternative therapies and strategies in controlling DC. The expression of pro-inflammatory cytokines and of growth factors was detected by immunohistochemistry in fibrotic nodules and normal palmar fascia resected respectively from patients affected by DC and carpal tunnel syndrome (CTS; as negative controls). Reverse transcription (RT)-PCR analysis and immunofluorescence were performed to quantify the expression of transforming growth factor (TGF)-β1, interleukin (IL)-1β and vascular endothelial growth factor (VEGF) by primary cultures of myofibroblasts and fibroblasts isolated from Dupuytren's nodules. Histological analysis showed high cellularity and high proliferation rate in Dupuytren's tissue, together with the presence of myofibroblastic isotypes; immunohistochemical staining for macrophages was completely negative. In addition, a strong expression of TGF-β1, IL-1β and VEGF was evident in the extracellular matrix and in the cytoplasm of fibroblasts and myofibroblasts in Dupuytren's nodular tissues, as compared with control tissues. These results were confirmed by RT-PCR and by immunofluorescence in pathological and normal primary cell cultures. These preliminary observations suggest that TGF-β1, IL-1β and VEGF may be considered potential therapeutic targets in the treatment of Dupuytren's disease (DD)

Flood quantiles estimation based on theoretically derived distributions: regional analysis in Southern Italy

A regional probabilistic model for the estimation of medium-high return period flood quantiles is presented. The model is based on the use of theoretically derived probability distributions of annual maximum flood peaks (DDF). The general model is called TCIF (Two-Component IF model) and encompasses two different threshold mechanisms associated with ordinary and extraordinary events, respectively. Based on at-site calibration of this model for 33 gauged sites in Southern Italy, a regional analysis is performed obtaining satisfactory results for the estimation of flood quantiles for return periods of technical interest, thus suggesting the use of the proposed methodology for the application to ungauged basins. The model is validated by using a jack-knife cross-validation technique taking all river basins into consideration

Effects of runoff thresholds on flood frequency distributions

International audienceRunoff generation during extreme floods usually occurs whenever rainfall forcing exceeds a given threshold. In many cases, different thresholds may be identified as responsible of the hydrological losses during ordinary events or extraordinary events at the basin scale. Such thresholds are shown to be related to the dynamics of soil saturation of the river basin and to account for the high skewness of their annual flood distributions. In basins where ordinary floods are mostly due to a small portion of the surface which is particularly prone to produce runoff, depending on permeability of a river basin and its antecedent soil moisture conditions, severe rainfall may exceed a basin-wide soil storage threshold and produce the so-called outlier events responsible of the high skewness of floods distributions. In this context, the derived theoretical model based on the concept of variable contributing area to peak flow proposed by Iacobellis and Fiorentino (2000) was generalized with the aim of incorporating such kind of dynamics in the description of the phenomena. The work produced a new formulation of the derived distribution where the two runoff components are explicitly considered. The present work was validated by using as test site a group of basins belonging to Southern Italy and characterized by flood distributions with high skewness. The application of the proposed model provided a good fitting to the observed distributions. Moreover, model parameters were found to be strongly related to physiographic basin characteristics giving consistency to the modelling assumptions

Analysis on flood generation processes by means of a continuous simulation model

International audienceIn the present research, we exploited a continuous hydrological simulation to investigate on key variables responsible of flood peak formation. With this purpose, a distributed hydrological model (DREAM) is used in cascade with a rainfall generator (IRP-Iterated Random Pulse) to simulate a large number of extreme events providing insight into the main controls of flood generation mechanisms. Investigated variables are those used in theoretically derived probability distribution of floods based on the concept of partial contributing area (e.g. Iacobellis and Fiorentino, 2000). The continuous simulation model is used to investigate on the hydrological losses occurring during extreme events, the variability of the source area contributing to the flood peak and its lag-time. Results suggest interesting simplification for the theoretical probability distribution of floods according to the different climatic and geomorfologic environments. The study is applied to two basins located in Southern Italy with different climatic characteristics

Regional analysis of runoff thresholds behaviour in Southern Italy based on theoretically derived distributions

The analysis of runoff thresholds and, more in general, the identification of main mechanisms of runoff generation controlling the flood frequency distribution is investigated, by means of theoretically derived flood frequency distributions, in the framework of regional analysis. Two nested theoretically-derived distributions are fitted to annual maximum flood series recorded in several basins of Southern Italy. Results are exploited in order to investigate heterogeneities and homogeneities and to obtain useful information for improving the available methods for regional analysis of flood frequency