Evaluation of background parenchymal enhancement on breast MRI: A systematic review

Objective: To perform a systematic review of the methods used for background parenchymal enhancement (BPE) evaluation on breast MRI. Methods: Studies dealing with BPE assessment on breast MRI were retrieved from major medical libraries independently by four reviewers up to 6October 2015. The keywords used for database searching are "background parenchymal enhancement", "parenchymal enhancement", "MRI" and "breast". The studies were included if qualitative and/or quantitative methods for BPE assessment were described. Results: Of the 420 studies identified, a total of 52 articles were included in the systematic review. 28 studies performed only a qualitative assessment of BPE, 13 studies performed only a quantitative assessment and 11 studies performed both qualitative and quantitative assessments. A wide heterogeneity was found in the MRI sequences and in the quantitative methods used for BPE assessment. Conclusion: A wide variability exists in the quantitative evaluation of BPE on breast MRI. More studies focused on a reliable and comparable method for quantitative BPE assessment are needed. Advances in knowledge: More studies focused on a quantitative BPE assessment are needed

Steroid treatment of acute graft-versus-host disease grade I: A randomized trial

Patients with acute graft-versus-host disease (GvHD) grade I were randomized to an observation arm (n=85) or to a treatment arm (n=86) consisting of 6-methylprednisolone 1 mg/kg/day, after stratification for age and donor type. The primary end point was development of grade II-IV GvHD. The cumulative incidence of grade II-IV GvHD was 50% in the observation arm and 33% in the treatment arm (P=0.005). However, grade III-IV GvHD was comparable (13% vs. 10%, respectively; P=0.6), and this was true for sibling and alternative donor transplants. Moderate/severe chronic GvHD was also comparable (17% vs. 9%). In multivariate analysis, an early interval between transplant and randomization

Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis

Objective: This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS). Methods: We retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results. Results: Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18-4.74, p = 0.015) with increased risk of severe COVID-19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20-12.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses. Interpretation: This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists

COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context

Background and objectives: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. Methods: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). Results: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). Discussion: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

Supply chain management, value chain and accounting issues in the wine industry

This chapter offers an overview of the main features of the global wine industry, at the same time portraying how firms are facing pivotal challenges in an increasing global scenario. The chapter illustrates the main primay and secondary activites which compose the value chain in the wine industry. In a related manner, it is explained how to build up an effective cost accounting architecture in a small-medium size wine company, at the the same time disclosing the main accounting issues related to stock management. The chapter subsequently highlights how to achieve a supply chain integration in the wine industry, and finally depicts the contours of innovation and experimentation as pivotal elements sustaining the survival and relaunch of the wine business in the world

Quantitative evaluation of background parenchymal enhancement (BPE) on breast MRI. A feasibility study with a semi-automatic and automatic software compared to observer-based scores

To evaluate quantitative measurements of background parenchymal enhancement (BPE) on breast MRI and compare them with observer-based scores

Copolymers of isopropenyl alkyl ethers with fluorinated acrylates and fluoroacrylates: influence of fluorine on their thermal, photochemical and hydrolytic stability

The homopolymer of butyl isopropenyl ether (pBPE) and a series of homo- and copolymers of BPE and decyl isopropenyl ether (DPE) with acrylates and methacrylates fluorinated on the vinyl and/or the alkoxy group were synthesized by cationic (pBPE) or free-radical process. The three structurally analogous 1,1,1,3,3,3-hexafluoroisopropyl methacrylate (HFIMA), 1,1,1,3,3,3-hexafluoroisopropyl 2-fluoroacrylate (HFIFA), and isopropyl 2-fluoroacrylate (IFA) as well as ethyl 3,3-difluoro-2-methylpropenoate (EFMA) were used as the fluorinated comonomers. The thermal properties and aging behavior of the copolymers were correlated to their structure and particularly to the protective action of the fluorinated moieties against photooxidative and acid catalyzed hydrolytic degradation triggered by the labile side chains of the BPE units. Depending on their distance from the primary center of photooxidation, the fluorinated groups can either slow down or largely modify the degradation pathway, as shown by the dominant cross-linking in the strictly alternating HFIFA/BPE which outweighs the prevailing chain fragmentation of the other copolymers

Caratterizzazione dei parametri murari di edifici civili con tecniche georadar

E' noto che diversi atti amministrativi concernenti gli edifici residenziali o del terziario, nuovi o preesistenti, devono essere corredati dal certificato energetico dell'edificio, a seguito degli obblighi di legge introdotti nell'ultimo quinquennio a livello nazionale e, a maggior ragione, in forza di recenti delibere emanate da diverse regioni. In accordo con il "Censimento Generale delle Popolazione e delle Abitazioni" pubblicato da ISTAT nel 2001, a quella data il patrimonio edilizio nazionale a destinazione d'uso residenziale risultava essere costituito per una quota superiore al 60% da edifici con murature portanti. La quota totale degli edifici con pareti in muratura (portante o non) è quindi sicuramente ancora oggi di gran lunga preponderante nell'insieme degli edifici civili. Per gli edifici meno recenti ben difficilmente si dispone delle informazioni di progetto relative alla composizione delle murature che concorrono ad una corretta definizione della dispersione termica dell'edificio. Sono altresì noti gli inconvenienti ed i limiti di applicazione del metodo normato del termoflussimetro per la misura in sito della trasmittanza termica delle pareti opache. Recenti attività di ricerca propongono in alternativa l'utilizzo quantitativo della termografia IR ([2], [3]), che presenta il vantaggio di una stima più globale sulla parete in esame e può fornire elementi diagnostici sullo stato di conservazione o di messa in opera dei materiali, ma che non è esente da considerevoli incertezze e da onerosità di applicazione; ad oggi comunque non risulta normato alcun approccio termografico. Questi metodi sono stati discussi in [4]. RSE, con la collaborazione di Solgeo s.r.l. e del Dipartimento di Elettronica e Informazione del Politecnico di Milano, ha esplorato la possibilità di identificare la struttura interna delle murature di edifici civili mediante la tecnica georadar, che conosce numerose applicazioni nel settore della ingegneria civile. Nota la struttura di una muratura, se ne può calcolare la conduttanza termica mediante dati tabulati in apposite norme o abachi tecnici. Obiettivo primario della ricerca è stato quello di sperimentare l'impiego della tecnica georadar ai fini della ricostruzione di un’immagine tridimensionale della struttura interna delle pareti in esame, a partire da misure condotte su una fitta griglia bidimensionale. Le misure sono state condotte dapprima in laboratorio su quattro simulacri di parete, con struttura rappresentativa di tipologie molto diffuse, e successivamente estese ad alcune pareti opache in opera su edifici reali. Di seguito, dopo un richiamo dei principi di funzionamento della tecnica georadar, si sintetizzano le condizioni di prova ed i risultati ottenuti e si discutono brevemente le criticità incontrate ed i possibili sviluppi della metodologia di indagine. Maggiori dettagli sono forniti in due rapporti liberamente consultabili, disponibili in rete sul sito di RSE (www.rse-web.it)