Gallbladder adenomyomatosis: imaging findings, tricks and pitfalls

Gallbladder adenomyomatosis (GA) is a benign alteration of the gallbladder wall that can be found in up to 9% of patients. GA is characterized by a gallbladder wall thickening containing small bile-filled cystic spaces (i.e., the Rokitansky-Aschoff sinuses, RAS). The bile contained in RAS may undergo a progressive concentration process leading to crystal precipitation and calcification development. A correct characterization of GA is fundamental in order to avoid unnecessary cholecystectomies. Ultrasound (US) is the imaging modality of choice for diagnosing GA; the use of high-frequency probes and a precise focal depth adjustment enable correct identification and characterization of GA in the majority of cases. Contrast-enhanced ultrasound (CEUS) can be performed if RAS cannot be clearly identified at baseline US: RAS appear avascular at CEUS, independently from their content. Magnetic resonance imaging (MRI) should be reserved for cases that are unclear on US and CEUS. At MRI, RAS can be identified with extremely high sensitivity, but their signal intensity varies widely according to their content. Positron emission tomography (PET) may be helpful for excluding malignancy in selected cases. Computed tomography (CT) and cholangiography are not routinely indicated in the suspicion of GA

Mediterranean megaturbidite triggered by the AD 365 Crete earthquake and tsunami

Historian Ammianus Marcellinus documented the devastating effects of a tsunami hitting Alexandria, Egypt, on July 21, AD 365. "The solidity of the earth was made to shake … and the sea was driven away. The waters returning when least expected killed many thousands by drowning. Huge ships… perched on the roofs of houses… hurled miles from the shore….”. Other settlements around the Mediterranean were hit at roughly the same time. This scenario is similar to that of the recent Sumatra and Tohoku tsunamis. Based on geophysical surveys and sediment cores from the Ionian Sea we show that the 20–25 m thick megaturbidite known in the literature as Homogenite/Augias was triggered not by the Santorini caldera collapse but by the 365 AD Cretan earthquake/tsunami. An older similar megaturbidite was deposited after 14.590 ± 80 yr BP, implying a large recurrence time of such extreme sedimentary events in the Mediterranean Sea

Building the adaptive capacity of institutions towards managing climate security: a social learning approach

The complex nature of climate-related security risks is widely recognized as embodying a collective action problem, thereby requiring a diverse set of actors to mitigate such risks. However, the exact makeup of actor coalitions and the mechanisms to integrate multi-sectoral approaches in programming solutions remain something to be explored under distinct governance systems. This article presents a practical methodological approach to overcome these challenges building upon social learning theory, to foster institutional innovation towards governance systems that are more responsive to climate-related security risks. Social learning is proposed as a governance mechanism to develop multi-stakeholder communities of practice that facilitate climate security-sensitive policies, strategies, and programmes. Outputs from an applied reflexive dialogue evidenced how such a coalition of actors can strengthen capacities to develop locally-owned and adaptive climate action interventions that consciously work to mitigate climate-related security risks

Decreased subunit stability as a novel mechanism for potassium current impairment by a KCNQ2 C terminus mutation causing benign familial neonatal convulsions.

KCNQ2 and KCNQ3 K+ channel subunits underlie the muscarinic-regulated K+ current (I(KM)), a widespread regulator of neuronal excitability. Mutations in KCNQ2- or KCNQ3-encoding genes cause benign familiar neonatal convulsions (BFNCs), a rare autosomal-dominant idiopathic epilepsy of the newborn. In the present study, we have investigated, by means of electrophysiological, biochemical, and immunocytochemical techniques in transiently transfected cells, the consequences prompted by a BFNC-causing 1-bp deletion (2043deltaT) in the KCNQ2 gene; this frameshift mutation caused the substitution of the last 163 amino acids of the KCNQ2 C terminus and the extension of the subunit by additional 56 residues. The 2043deltaT mutation abolished voltage-gated K+ currents produced upon homomeric expression of KCNQ2 subunits, dramatically reduced the steady-state cellular levels of KCNQ2 subunits, and prevented their delivery to the plasma membrane. Metabolic labeling experiments revealed that mutant KCNQ2 subunits underwent faster degradation; 10-h treatment with the proteasomal inhibitor MG132 (20 microm) at least partially reversed such enhanced degradation. Co-expression with KCNQ3 subunits reduced the degradation rate of mutant KCNQ2 subunits and led to their expression on the plasma membrane. Finally, co-expression of KCNQ2 2043deltaT together with KCNQ3 subunits generated functional voltage-gated K+ currents having pharmacological and biophysical properties of heteromeric channels. Collectively, the present results suggest that mutation-induced reduced stability of KCNQ2 subunits may cause epilepsy in neonates

Expansion of activated regulatory T cells inversely correlates with clinical severity in septic neonates.

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Cerebral Autoregulation in Non-Brain Injured Patients: A Systematic Review.

Introduction: Cerebral autoregulation (CA) plays a fundamental role in the maintenance of adequate cerebral blood flow (CBF). CA monitoring, through direct and indirect techniques, may guide an appropriate therapeutic approach aimed at improving CBF and reducing neurological complications; so far, the role of CA has been investigated mainly in brain-injured patients. The aim of this study is to investigate the role of CA in non-brain injured patients. Methods: A systematic consultation of literature was carried out. Search terms included: "CA and sepsis," "CA and surgery," and "CA and non-brain injury." Results: Our research individualized 294 studies and after screening, 22 studies were analyzed in this study. Studies were divided in three groups: CA in sepsis and septic shock, CA during surgery, and CA in the pediatric population. Studies in sepsis and intraoperative setting highlighted a relationship between the incidence of sepsis-associated delirium and impaired CA. The most investigated setting in the pediatric population is cardiac surgery, but the role and measurement of CA need to be further elucidated. Conclusion: In non-brain injured patients, impaired CA may result in cognitive dysfunction, neurological damage, worst outcome, and increased mortality. Monitoring CA might be a useful tool for the bedside optimization and individualization of the clinical management in this group of patients

Analysis of the common genetic component of large-vessel vasculitides through a meta- Immunochip strategy

Giant cell arteritis (GCA) and Takayasu's arteritis (TAK) are major forms of large-vessel vasculitis (LVV) that share clinical features. To evaluate their genetic similarities, we analysed Immunochip genotyping data from 1,434 LVV patients and 3,814 unaffected controls. Genetic pleiotropy was also estimated. The HLA region harboured the main disease-specific associations. GCA was mostly associated with class II genes (HLA-DRB1/HLA-DQA1) whereas TAK was mostly associated with class I genes (HLA-B/MICA). Both the statistical significance and effect size of the HLA signals were considerably reduced in the cross-disease meta-analysis in comparison with the analysis of GCA and TAK separately. Consequently, no significant genetic correlation between these two diseases was observed when HLA variants were tested. Outside the HLA region, only one polymorphism located nearby the IL12B gene surpassed the study-wide significance threshold in the meta-analysis of the discovery datasets (rs755374, P?=?7.54E-07; ORGCA?=?1.19, ORTAK?=?1.50). This marker was confirmed as novel GCA risk factor using four additional cohorts (PGCA?=?5.52E-04, ORGCA?=?1.16). Taken together, our results provide evidence of strong genetic differences between GCA and TAK in the HLA. Outside this region, common susceptibility factors were suggested, especially within the IL12B locus

Endogenous growth and changing sectoral composition in advanced economies

We study how changing sectoral composition in employment and output shares affects aggregate growth by modeling a two-sector economy with a technologically "progressive" industry, which produces for consumption and investment, and a technologically "stagnant" industry producing only for consumption. Hence, unbalanced improvements in total factor productivity interact with changes in the composition of final demand in shaping the growth process. Within this endogenous growth framework, we show under what conditions on preferences Baumol's asymptotic stagnancy occurs. Beside studying the limiting behavior of the economy, numerical examples are presented to analyze the structural change going on along the transition path. © 2007 Elsevier B.V. All rights reserved

TRADE AND GROWTH IN A TWO-COUNTRY MODEL WITH HOME PRODUCTION AND UNEVEN TECHNOLOGICAL SPILLOVERS

We develop a two-country growth model distinguishing between a market sector producing services that can also be home produced and a market sector producing goods without home-produced substitutes. The former is a technologically 'stagnant' sector, while the latter is subject to learning-by-doing and technological spillovers. This distinction coincides in the model with the distinction between the sector producing non-tradables and the sector producing internationally tradable goods. We study how differentials in labor tax rates across countries influence the mix of tradable and non-tradable goods that characterizes the market output of each country, thus affecting their bilateral trade balance and growth rates. Copyright � 2010 The Authors. Journal compilation � 2010 Blackwell Publishing Ltd and The University of Manchester.

Endogenous growth and changing sectoral composition in advanced economies

We study how changing sectoral composition in employment and output shares affects aggregate growth by modeling a two-sector economy with a technologically "progressive" industry, which produces for consumption and investment, and a technologically "stagnant" industry producing only for consumption. Hence, unbalanced improvements in total factor productivity interact with changes in the composition of final demand in shaping the growth process. Within this endogenous growth framework, we show under what conditions on preferences Baumol's asymptotic stagnancy occurs. Beside studying the limiting behavior of the economy, numerical examples are presented to analyze the structural change going on along the transition path.