Spontaneous porto‐femoral shunting in long‐standing portal hypertension

n/

Pylephlebitis: A Systematic Review on Etiology, Diagnosis, and Treatment of Infective Portal Vein Thrombosis

Pylephlebitis, defined as infective thrombophlebitis of the portal vein, is a rare condition with an incidence of 0.37–2.7 cases per 100,000 person-years, which can virtually complicate any intra-abdominal or pelvic infections that develop within areas drained by the portal venous circulation. The current systematic review aimed to investigate the etiology behind pylephlebitis in terms of pathogens involved and causative infective processes, and to report the most common symptoms at clinical presentation. We included 220 individuals derived from published cases between 1971 and 2022. Of these, 155 (70.5%) were male with a median age of 50 years. There were 27 (12.3%) patients under 18 years of age, 6 (2.7%) individuals younger than one year, and the youngest reported case was only 20 days old. The most frequently reported symptoms on admission were fever (75.5%) and abdominal pain (66.4%), with diverticulitis (26.5%) and acute appendicitis (22%) being the two most common causes. Pylephlebitis was caused by a single pathogen in 94 (42.8%) cases and polymicrobial in 60 (27.2%) cases. However, the responsible pathogen was not identified or not reported in 30% of the included patients. The most frequently isolated bacteria were Escherichia coli (25%), Bacteroides spp. (17%), and Streptococcus spp. (15%). The treatment of pylephlebitis consists initially of broad-spectrum antibiotics that should be tailored upon bacterial identification and continued for at least four to six weeks after symptom presentation. There is no recommendation for prescribing anticoagulants to all patients with pylephlebitis. However, they should be administered in patients with thrombosis progression on repeat imaging or persistent fever despite proper antibiotic therapy to increase the rates of thrombus resolution or decrease the overall mortality, which is approximately 14%

A self-sterilizing fluorescent Nanocomposite as versatile material with broad-spectrum Antibiofilm features

Hematogenous spread of infections from colonized central intravenous catheters or central lines is a long-recognized problem with infection rates of 2 and 6.8 per 1000 days, respectively. Besides, removal of severe microbial colonization of implanted biomaterials is still a challenge and usually requires invasive operations. Hence, on demand self-sterilizing materials are required to avoid explant of colonized biomaterials and improve patient compliance. Moreover, photoluminescence is needed to make trackable biomaterials, which can be easily monitored upon implanting them in the body. Here, we propose the incorporation of near infrared (NIR) sensitive red-emitting carbon nanodot (CDs) into a polymeric matrix to give rise to innovative biomaterials with self-tracking and photothermal antimicrobial abilities. We obtain a material which can be processed to obtain medical devices using different techniques, among which, for instance, electrospinning. Herein, a proof-of-concept preparation of electrospun scaffolds is reported as it is highly desired in biomedical applications. Beside to confer imaging properties to the scaffold, that would allow an easy control over the in vivo positioning of implanted biomaterials as well as its degradation state and grade of integration with the surrounding native tissues, thanks to the capability to convert NIR light into local heat CDs can be exploited to exert broad-spectrum antimicrobial effect toward several pathogens. The rise in temperature can be easily modulated by controlling the irradiation time to achieve both an in vitro self-sterilization of the device and eventually in vivo destabilization of the microbial colonization. This innovative biomaterial could successfully inhibits biofilm formation and might be used as a powerful tool to treat antibiotic-resistant nature of biofilm-related infections in implanted medical devices

Diverticular Disease and Rifaximin: An Evidence-Based Review

There have been considerable advances in the treatment of diverticular disease in recent years. Antibiotics are frequently used to treat symptoms and prevent complications. Rifaximin, a non-absorbable antibiotic, is a common therapeutic choice for symptomatic diverticular disease in various countries, including Italy. Because of its low systemic absorption and high concentration in stools, it is an excellent medicine for targeting the gastrointestinal tract, where it has a beneficial effect in addition to its antibacterial properties. Current evidence shows that cyclical rifaximin usage in conjunction with a high-fiber diet is safe and effective for treating symptomatic uncomplicated diverticular disease, while the cost-effectiveness of long-term treatment is unknown. The use of rifaximin to prevent recurrent diverticulitis is promising, but further studies are needed to confirm its therapeutic benefit. Unfortunately, there is no available evidence on the efficacy of rifaximin treatment for acute uncomplicated diverticulitis

Giacomo Serpotta e il "pareggiamento delle arti": la decorazione degli oratori fra manipolazione vitalistica e vocazione classicista

ABSTRACT GIACOMO SERPOTTA AND THE “EQUALIZATION OF THE ARTS”: DECORATION OF THE ORATORIES BETWEEN VITALISTIC MANIPULATION AND CLASSICIST VOCATION Ettore Sessa The value of the whole of Giacomo Serpotta's artistic vision in the orchestration of the figu¬rative apparatuses of his oratories was certainly one of the principal primers of his historical-critical raising in the modernist period. In 1901 Mauceri and in 1911 Ricci and Basile heighten a profile of it, however synthetic, of angling and above all of different breath from the rediscovery realized in positivist age. Classifiable, in fact, among the eighteenth century precedents of Gesamtkunstwerk aesthetical plant (according to a rather diffused custom within the artistic historiography of modernist culturaI area or of decadentist origin, as in different formalistic demonstrations of the wealthiest society Belle Époque) the progress of Serpottas artistic way towards tangible expressions of the idea of «the whole work of art» has a unmistakable im¬print of his and, at the same time, a feasibility thanks to the plasticism of gestures and to the uni¬tary multiplicity of his modeled. In his oratories arrangements the "realist" component, not exempted from hedonistic sensual witty remarks, acts on a foundation of Hellenic taste (also in the use of profiles and architectural elements). With wise modulation and with dosing diversified for intensity, according the nature of the subjects, combines history (see the «teatrini» with perspective sceneries, among which the Lepanto battle), micro history (from feminine allegorical subjects, to attractive dames modernly adorned with ends and brocades, to "picciotti" proudly ragged and to the anecdotal of the daily life), mysticism (from the devotional subjects to the allegories of the virtues), obscurity (from numerological components to philosophical attributes) and, finally, mythology (from the allegorical correspondences between Christianity and paganism to classical simbology). Despite the actual halving of this group of oratories (was destroyed by traumatic events as earthquakes and war actions, or by villainous demolitions big part of Serpottas works, among which the SS. Sacrament oratories to Kalsa and those of Saint Maria del Ponticello), the comparison among the palermitan examples reached us entire allows the individualization of the characters of originality typical of the generaI composition, over that of those figurative unanimously accredited among the most valid of the late- Baroque European sculpture. The typical scheme of these oratories, places with a strong secular imprint (predisposed as for cultural reunions how as for the preclusive congregational assemblies, to which the only ones not admitted affiliate were the artists), has as constants: the hall with a rectangular plant; the skiff or pavilion vault with plaster decorations dissimulating the constructive geometry; the sculptural wall register above of a high plinth; windows on the greatest sides (in number of three); two doors in the counterfacade, originally with desk for the assemblies in central position, below the principal devotional allegorical composition. The first oratory to which Giacomo Serpotta imposes an unitary imprint, except the cappellone only defined between 1717 and the following year) is that of SS. Rosary in S. Cita; he has worked since 1685 to 1688 on behalf of SS. Rosary Company. Serpotta is twenty nine, but already since almost ten years, after the apprenticeship with subordinate roles, he showed himself almost beginning in mute with the decorations of Madonna of the Pity church in Monreale, where he operated like Procopio De' Ferrari's collaborator, and perhaps with his interventions in 1678 in the lateral walls of S. Mercurio oratory, to which follow the 1679 decoration works in the Charity oratory in St. Bartholomeo of the Incurable people (no more existing), perhaps S. Pietro and S. Paolo statues dating back to 1680 for the greatest altar in Gancia church, the marble model for Charles H's equestrian monument for Messina (then realized in 1684) and during the two years 1683-1684 the scenic decorations for the transept altars of Carmine Maggiore church (where he collaborates with his brother Giuseppe and realizes the couples of twisted columns gilded and commented by a theory of plaster miniature scenes disposed according to a spiral development). Immediately after S. Cita oratory he realized, between 1688 and 1691, the decorative apparatuses of the Sacrament oratory in S. Nicolò to Kalsa (destroyed because of 1823 earthquake). Only eight years after the completion of this work (about which it was hypothesized that it were an advancement in comparison to the intervention in S. Cita) Giacomo Serpotta is entrusted by S. Francesco from Assisi and S. Lorenzo Companies to realize the complex allegorical and explanatory cycle of the plasters of S. Lorenzo orato¬ry. He worked partly on Giacomo Amato's sketches (to which are probably owed the reform interventions that confer to this oratory a great architectural "squaring" in comparison to others), completing the presbytery within 1706, while already from 1701 he is busy in the definition of the walls. In 1703 he began the counter facade with the monumental wall framework and high-relief representation of St. Lorenzo Martyrdom

MicroRNAs as Regulators of Neo-Angiogenesis in Hepatocellular Carcinoma

MicroRNAs involved in Neoangiogenesis in Hepatocellular Carcinom

Predictors of Hepatocellular Carcinoma Early Recurrence in Patients Treated with Surgical Resection or Ablation Treatment: A Single-Center Experience

Introduction: Hepatocellular carcinoma (HCC) is the sixth most diagnosed malignancy and the fourth leading cause of cancer-related death worldwide, with poor overall survival despite available curative treatments. One of the most crucial factors influencing survival in HCC is recurrence. The current study aims to determine factors associated with early recurrence of HCC in patients with BCLC Stage 0 or Stage A treated with surgical resection or local ablation. Materials and Methods: We retrospectively enrolled 58 consecutive patients diagnosed with HCC within BCLC Stage 0 or Stage A and treated either by surgical resection or local ablation with maximum nodule diameter < 50 mm. In the first year of follow-up after treatment, imaging was performed regularly one month after treatment and then every three months. Each case was discussed collectively by the Liver Multidisciplinary Group to decide diagnosis, treatment, follow-up, and disease recurrence. Variables resulting in statistically significant difference were then studied by Cox regression analysis; univariately and then multivariately based on forward stepwise Cox regression. Results are represented in hazard ratio (H.R.) with 95% confidence interval (C.I.). Results: There was no statistically significant difference in recurrence rates (34.8 vs. 45.7%, log-rank test, p = 0.274) between patients undergoing surgical resection and local ablation, respectively. Early recurrence was associated with male gender (HR 2.5, 95% C.I. 1.9–3.1), nodule diameter > 20 mm (HR 4.5, 95% C.I. 3.9–5.1), platelet count < 125 × 103 cell/mm3 (HR 1.6, 95% C.I. 1.2–1.9), platelet-lymphocyte ratio < 95 (HR 2.1, 95% C.I. 1.7–2.6), lymphocyte-monocyte ratio < 2.5 (HR 1.9, 95% C.I. 1.4–2.5), and neutrophil-lymphocyte ratio > 2 (HR 2.7, 95% C.I. 2.2–3.3). Discussion and Conclusions: Our results are in line with the current literature. Male gender and tumor nodule dimension are the main risk factors associated with early HCC recurrence. Platelet count and other combined scores can be used as predictive tools for early HCC recurrence, although more studies are needed to define cut-offs

Harnessing the power of synthetic data in healthcare: innovation, application, and privacy

Abstract Data-driven decision-making in modern healthcare underpins innovation and predictive analytics in public health and clinical research. Synthetic data has shown promise in finance and economics to improve risk assessment, portfolio optimization, and algorithmic trading. However, higher stakes, potential liabilities, and healthcare practitioner distrust make clinical use of synthetic data difficult. This paper explores the potential benefits and limitations of synthetic data in the healthcare analytics context. We begin with real-world healthcare applications of synthetic data that informs government policy, enhance data privacy, and augment datasets for predictive analytics. We then preview future applications of synthetic data in the emergent field of digital twin technology. We explore the issues of data quality and data bias in synthetic data, which can limit applicability across different applications in the clinical context, and privacy concerns stemming from data misuse and risk of re-identification. Finally, we evaluate the role of regulatory agencies in promoting transparency and accountability and propose strategies for risk mitigation such as Differential Privacy (DP) and a dataset chain of custody to maintain data integrity, traceability, and accountability. Synthetic data can improve healthcare, but measures to protect patient well-being and maintain ethical standards are key to promote responsible use

Behind the Decrease of Liver Stiffness After Successful Hepatitis C Virus Eradication with Direct-Acting Antiviral Agents

5N/AopenopenGiuffrè, Mauro; Masutti, Flora; Crosato, Ivo Maria; Luzzati, Roberto; Crocè, Lory SaveriaGiuffrè, Mauro; Masutti, Flora; Crosato, Ivo Maria; Luzzati, Roberto; Crocè, Lory Saveri

Surrogate Measures of Safety at Roundabouts in AIMSUN and VISSIM Environment

This paper addresses issues on road safety analysis through microscopic traffic simulation models. The Surrogate Safety Assessment Model (SSAM) was applied to read vehicle trajectory files generated by two microsimulators and then calculate surrogate measures of safety. Since safety assessment of any road entity can provide different results based on the microsimulator which is used, the main objective of this research was to estimate the safety performance of three roundabout layouts and compare the conflict events simulated by AIMSUN and VISSIM. The two micro-simulators were used to build the calibrated models of the roundabouts, each fitting the corresponding empirical capacity function. The results provided insights on how to set the SSAM filters in order to have a comparable frequency of conflicts by simulation and examine conditions under which a safety analysis could be independent of the software used