Immunotherapy for Fungal Infections

Opportunistic fungal infections are a major health problem being appointed by some studies as the fourth main cause of hospital-acquired infection in susceptible populations. The constantly growing incidences of these diseases are associated with the growing number of susceptible individuals, such as immunocompromised individuals (leukemia, AIDS, etc) and treatment-induced immunodeficiency (hematopoietic stem cell, solid organ transplant, anticancer therapy). Furthermore, other advances in medical care, patient’s long-term hospitalization and antimicrobial therapies have created several vulnerable populations to fungal infections. Currently, antifungal drug therapies are several times inefficient, and the poor outcomes are linked to difficulties in the early diagnosis of fungal infections and drug resistance among fungal pathogens. In this context, novel therapeutic approaches are welcome to stimulate efficiently the host immune response to eliminate the fungal pathogen. This chapter is intended to review advances in immunotherapy strategies for fungal infections

Large-Scale Experimental Static Testing on 50-Year-Old Prestressed Concrete Bridge Girders

The heritage of existing road infrastructures and in particular of bridges consists of structures that are approaching or exceeding their designed service life. Detrimental causes such as aging, fatigue and deterioration processes other than variation in loading conditions introduce uncertainties that make structural assessment a challenging task. Experimental data on their performances are crucial for a proper calibration of numerical models able to predict their behavior and life-cycle structural performance. In this scenario, an experimental research program was established with the aim of investigating a set of 50-year-old prestressed concrete bridge girders that were recovered from a decommissioned bridge. The activities included initial non-destructive tests, and then full-scale load tests followed by a destructive test on the material samples. This paper reports the experimental results of the full-scale tests conducted on the first group of four I-beams assumed to be in good condition from visual inspection at the time of testing. Loading tests were performed using a specifically designed steel reaction frame and a test setup equipment, as detailed in the present work. Due to the structural response of this first group of girders, a uniform behavior was found at both service and ultimate conditions. The failure mechanism was characterized by the crushing of the cast-in-situ top slab corresponding to a limited deflection, highlighting a non-ductile behavior. The outcomes of the experimental research are expected to provide new data for the life-cycle safety assessment of existing bridges through an extended database of validated experimental tests and models

A degrading Bouc\u2013Wen model for the hysteresis of reinforced concrete structural elements

This paper presents a smooth hysteresis model for reinforced concrete (RC) structural elements based on the differential equation of the Bouc?Wen model. Stiffness degradation and strength degradation are defined by introducing a damage index that includes both dissipated energy and maximum displacement. The pinching effect acts directly on the stiffness of the system and is controlled by an activation energy. The degrading functions are connected to the actual processes with which the damage occurs, thereby giving each parameter a physical meaning. The simple formulation of the model allows a straightforward identification of the best-fitting parameters and an easy interpretation of the results. Applications to the cyclic behaviour of RC structural elements demonstrate that the model is well capable of describing complex hysteretic behaviours involving degradation and pinching effects

A case report of IgG4-related disease: an insidious path to the diagnosis through kidney, heart and brain

BACKGROUND: IgG4-related disease, described around the years 2000 as a form of autoimmune pancreatitis, is now increasingly accepted as a systemic syndrome. The diagnosis is based on both comprehensive and organ-specific criteria. For the kidney, Mayo clinic classification and the guidelines of the Japanese Nephrology Society are used. Ultimately, together with parameters that characterize every organ or apparatus involved, the key element is the confirmation of growing levels of IgG4 in blood or in tissues. CASE PRESENTATION: We describe a male patient with chronic renal failure associated to hypertension without proteinuria. IgG4-related disease was diagnosed through renal biopsy. After an initial positive response to steroids, he presented tinnitus, and histological assessment showed cerebral and subsequently cardiac damage, both IgG4-related. This case appears unique for the type of histologically documented cardiac and neurological parenchymal involvement, and at the same time, exemplifies the subtle and pernicious course of the disease. Frequently, blurred and non-specific signs prevail. Here, kidney damage was associated with minimal urinary findings, slowly progressive renal dysfunction and other factors that can be equivocated in the differential diagnosis. Neurological involvement was represented by tinnitus alone, while cardiac alterations were completely asymptomatic. CONCLUSIONS: This report is representative of the neurological and cardiac changes described in the literature for IgG4-related disease, which may be correlated or not with the renal form and highlights the need, in some cases, of targeted therapeutic approaches. In addition to glucocorticoids, as in this case, rituximab may be necessary

Vitamin D effects on bone homeostasis and cardiovascular system in patients with chronic kidney disease and renal transplant recipients

Poor vitamin D status is common in patients with impaired renal function and represents one main component of the complex scenario of chronic kidney disease–mineral and bone disorder (CKD–MBD). Therapeutic and dietary efforts to limit the consequences of uremia-associated vitamin D deficiency are a current hot topic for researchers and clinicians in the nephrology area. Evidence indicates that the low levels of vitamin D in patients with CKD stage above 4 (GFR < 15 mL/min) have a multifactorial origin, mainly related to uremic malnutrition, namely impaired gastrointestinal absorption, dietary restrictions (low-protein and low-phosphate diets), and proteinuria. This condi-tion is further worsened by the compromised response of CKD patients to high-dose cholecalciferol supplementation due to the defective activation of renal hydroxylation of vitamin D. Currently, the literature lacks large and interventional studies on the so-called non-calcemic activities of vitamin D and, above all, the modulation of renal and cardiovascular functions and immune response. Here, we review the current state of the art of the benefits of supplementation with native vitamin D in various clinical settings of nephrological interest: CKD, dialysis, and renal transplant, with a special focus on the effects on bone homeostasis and cardiovascular outcomes

Deconstruction of the Corso Grosseto viaduct and setup of a testing site for full scale load tests

BRIDGE|50 is a research project recently launched in Italy in the context of the Torino-Ceres construction works jointly with Politecnico di Milano, Politecnico di Torino, public authorities and private companies. The aim of the BRIDGE|50 research project is to investigate the residual structural performance of the Corso Grosseto 50-year-old prestressed concrete bridge through an experimental campaign. The dismantling and demolition procedures of Corso Grosseto viaduct are presented in this paper, including the setup of the field laboratory where several deck beams and pier caps will be tested up to collapse

Diagnostic Challenge of Invasive Lobular Carcinoma of the Breast: What Is the News? Breast Magnetic Resonance Imaging and Emerging Role of Contrast-Enhanced Spectral Mammography

Invasive lobular carcinoma is the second most common histologic form of breast cancer, representing 5% to 15% of all invasive breast cancers. Due to an insidious proliferative pattern, invasive lobular carcinoma remains clinically and radiologically elusive in many cases. Breast magnetic resonance imaging (MR) is considered the most accurate imaging modality in detecting and staging invasive lobular carcinoma and it is strongly recommended in pre-operative planning for all ILC. Contrast-enhanced spectral mammography (CESM) is a new diagnostic method that enables the accurate detection of malignant breast lesions similar to that of breast MR. CESM is also a promising breast imaging method for planning surgeries. In this study, we compare the ability of contrast-enhanced spectral mammography (CESM) with breast MR in the preoperative assessment of the extent of invasive lobular carcinoma. All patients with proven invasive lobular carcinoma treated in our breast cancer center underwent preoperative breast MRI and CESM. Images were reviewed by two dedicated breast radiologists and results were compared to the reference standard histopathology. CESM was similar and in some cases more accurate than breast MR in assessing the extent of disease in invasive lobular cancers. Further evaluation in larger prospective randomized trials is needed to validate our preliminary results

Towards a FOSS Automatic Classification of Defects for Bridges Structural Health Monitoring

Bridges are among the most important structures of any road network. During their service life, they are subject to deterioration which may reduce their safety and functionality. The detection of bridge damage is necessary for proper maintenance activities. To date, assessing the health status of the bridge and all its elements is carried out by identifying a series of data obtained from visual inspections, which allows the mapping of the deterioration situation of the work and its conservation status. There are, however, situations where visual inspection may be difficult or impossible, especially in critical areas of bridges, such as the ceiling and corners. In this contribution, the authors acquire images using a prototype drone with a low-cost camera mounted upward over the body of the drone. The proposed solution was tested on a bridge in the city of Turin (Italy). The captured data was processed via photogrammetric process using the open-source Micmac solution. Subsequently, a procedure was developed with FOSS tools for the segmentation of the orthophoto of the intrados of the bridge and the automatic classification of some defects found on the analyzed structure. The paper describes the adopted approach showing the effectiveness of the proposed methodology

Perfil epidemiológico e terapêutico de pacientes com criptococose atendidos em hospital escola de Santa Maria/RS

Cryptococcosis is a fungal disease caused by yeasts of the complex Cryptococcus neoformans and Cryptococcus gattii. The infection usually occurs by inhaling the basidiospores of the fungus present in the environment. Severe cases occur due to infection of the central nervous system. The disease has a worldwide distribution, mainly associated to the immunocompromised individuals with human immunodeficiency virus (HIV). This study aimed to verify the epidemiological profile and therapeutic protocols of patients diagnosed with cryptococcosis at the Hospital Universitário de Santa Maria (Santa Maria, RS), from March 2010 to March 2017. A total of 46 clinical records were evaluated, the profile of the patients was predominantly Caucasian, aged between 31 and 50 years, with HIV, presenting a CD4 + cell count <100 cells / μL and with a prevalent clinical form neurocryptococcosis. The combination of amphotericin B and fluconazole was the therapeutic protocol adopted in the majority of patients studied.Criptococose é uma doença fúngica causada por leveduras do complexo Cryptococcus neoformans e Cryptococcus gattii. A infecção geralmente ocorre através da inalação dos basidiósporos do fungo presente no ambiente. Casos graves ocorrem devido à infecção do sistema nervoso central. A enfermidade possui distribuição mundial, associada principalmente aos indivíduos imunocomprometidos, portadores do vírus da imunodeficiência humana (HIV). Este estudo objetivou verificar o perfil epidemiológico e os protocolos terapêuticos dos pacientes diagnosticados com criptococose no Hospital Universitário de Santa Maria (Santa Maria, RS), no período de março de 2010 a março de 2017. Avaliaram-se 46 prontuários clínicos, sendo que o perfil dos pacientes observados foi predominantemente do sexo masculino, etnia branca, faixa etária de 31 a 50 anos, portadores de HIV, apresentando taxa de células CD4+<100 células/µL e com forma clínica prevalente, a neurocriptococose. A associação de anfotericina B e fluconazol foi o protocolo terapêutico adotado na maioria dos pacientes estudados