Investigating the Role of Minimally Invasive Surgery in Patients with Chronic Pulmonary Disease.

In the recent years, the role of minimally invasive surgery (e.g., laparoscopic or robotic assisted surgery) has emerged for the treatments of several benign and malignant conditions [1–4]. Growing..

Dialysis on pregnancy: an overview

Pregnancy rates in women on dialysis have increased in the last decades, thus making it a topic of growing interest. The rarity of this event is predominantly due to fertility problems and to the high rates of pregnancy failure including stillbirth, fetal, and neonatal deaths. We conducted a narrative review of existing literature in order to analyze the major issues about pregnancy on dialysis to give the reader a fully updated perspective about this topic which, even if not common, is becoming more and more frequent. Even if recently acquired knowledge has improved diagnosis and treatment of dialysis pregnancies focusing on several aspects, pregnancy on dialysis remains a great challenge for obstetricians and should be managed by a multidisciplinary expertise team. Dialysis in pregnancy may be necessary for women previously aected by end stage renal disease (ESRD) becoming pregnant, or in case of acute renal injury presenting for the first time during gestation or, again, in case of existent renal pathology worsening during pregnancy and requiring dialysis. Although some evidence suggests that more intensive dialysis regimens are correlated with better obstetric outcomes, the optimal therapeutic protocol still remains to be established

Use of deferoxamine (DFO) in transfusion-dependent β-thalassemia during pregnancy: A retrospective study.

Objective: To report cases of use of chelation therapy during pregnancy which resulted in favorable outcomes for the babies. Materials and methods: In this retrospective cohort study, we described the evolution and outcome of 9 pregnancies in Italian thalassemic women who received deferoxamine (DFO) inadvertently during early pregnancy. Results: The use of deferoxamine during first trimester did not lead to adverse effects on the fetus or cause major complications for the gestation, although an increase in iron burden was observed after suspending chelation therapy. Conclusion: In our experience, iron-chelation therapy might be administrated in pregnancy where the benefits to the mother outweigh the potential risks to the baby. Keywords: Deferoxamine, Iron chelation therapy, Magnetic resonance T2*, Pregnancy, Thalassemi

Efficacy of n-acetylcysteine on endometriosis-related pain, size reduction of ovarian endometriomas, and fertility outcomes

Abstract: Background: Endometriosis is a chronic, estrogen-dependent, inflammatory disease, whose pivotal symptoms are dysmenorrhea, dyspareunia, and chronic pelvic pain (CPP). Besides the usual medical treatments, recent evidence suggests there are potential benefits of oral N-acetylcysteine (NAC) on endometriotic lesions and pain. The primary objective of this prospective single-cohort study was to confirm the effectiveness of NAC in reducing endometriosis-related pain and the size of ovarian endometriomas. The secondary objective was to assess if NAC may play a role in improving fertility and reducing the Ca125 serum levels. Methods: Patients aged between 18–45 years old with a clinical/histological diagnosis of endometriosis and no current hormonal treatment or pregnancy were included in the study. All patients received quarterly oral NAC 600 mg, 3 tablets/day for 3 consecutive days of the week for 3 months. At baseline and after 3 months, dysmenorrhea, dyspareunia and CPP were assessed using the Visual Analog Scale score (VAS), while the size of the endometriomas was estimated through a transvaginal ultrasound. Analgesics (NSAIDs) intake, the serum levels of Ca125 and the desire for pregnancy were also investigated. Finally, the pregnancy rate of patients with reproductive desire was evaluated. Results: One hundred and twenty patients were recruited. The intensity of dysmenorrhea, dyspareunia and CPP significantly improved (p < 0.0001). The use of NSAIDs (p = 0.001), the size of the endometriomas (p < 0.0001) and the serum levels of Ca125 (p < 0.0001) significantly decreased. Among the 52 patients with reproductive desire, 39 successfully achieved pregnancy within 6 months of starting therapy (p = 0.001). Conclusions: Oral NAC improves endometriosis-related pain and the size of endometriomas. Furthermore, it decreases Ca125 serum levels and may improve fertility in patients with endometriosis

Ganymede from 2D to 3D: A multidisciplinary approach in preparation for JUICE. Preliminary results

The research project: "Ganimede from 2D to 3D: A multidisciplinary approach in preparation for JUICE", was selected in 2019 in the framework of an "INAF Mainstream" call. This work aims to show the potential of a multidisciplinary data analysis approach in anticipation of the JUICE mission.We focus on three instruments carried onboard the ESA JUICE mission, where Italy's National Institute for Astrophysics (INAF) is involved: the optical camera (JANUS), sensitive to the 0.4-1.0 µm spectral region [1], the VIS-NIR imaging spectrometer (MAJIS), operating in the overall 0.5-5.54 µm spectral domain [2], and the radar sounder (RIME), operating at 9 MHz (33.3 m) [3]. This project is important to prepare combined analysis techniques and models that could be applied to a larger number of regions of interest that will be observed by JUICE in the 2030s, when data of the icy Galilean moons will be finally acquired. Here we show regions of interest on Ganymede that are most promising for a multi-sensor data analysis, first of all by combining optical images acquired by the Galileo/SSI framing camera and by the Galileo/NIMS imaging spectrometer with good spatial resolution. Unfortunately, topographic information is currently not available for most of the Ganymede's surface. However, we built a synthetic topographic dataset for the Nippur Sulcus region based on the existing high-resolution optical images, which could be representative of topographic models that will be obtained in the future by means of JUICE data. We process such a synthetic topographic dataset with a self-similar clustering method [e.g., 4] able to model how the fractures are distributed not only on the surface, but also inside the icy crust.In the near future, this synthetic topographic dataset will also be used to apply a code able to simulate radar echoes coming from the radio waves investigation of Ganymede's subsurface, which was successfully tested on Mars by means of the MARSIS radar data [5].Among other things, the study of specific regions of interest on Ganymede is key to drive the planning and prioritization of the observations to be carried out by multiple JUICE instruments, especially during the dedicated Ganymede orbit phase, which will be the final and salient phase of the entire mission. References [1] Della Corte, V., Noci, G., Turella, A., Paolinetti R., et al. (2019). Scientific objectives of JANUS Instrument onboard JUICE mission and key technical solutions for its Optical Head. Proceedings of the 2019 IEEE 5th International Workshop on Metrology for AeroSpace, Turin (Italy), 19-21 June 2019. Doi: 10.1109/MetroAeroSpace.2019.8869584. [2] Piccioni, G., Tommasi, L., Langevin, Y., Filacchione, G., et al. (2019). Scientific goals and technical challenges of the MAJIS imaging spectrometer for the JUICE mission. Proceedings of the 2019 IEEE 5th International Workshop on Metrology for AeroSpace, Turin (Italy), 19-21 June 2019. Doi: 10.1109/MetroAeroSpace.2019.8869566. [3] Bruzzone, L., Croci, R. (2019). Radar for Icy Moon Exploration (RIME). Proceedings of the 2019 IEEE 5th International Workshop on Metrology for AeroSpace, Turin (Italy), 19-21 June 2019. Doi: 10.1109/MetroAeroSpace.2019.8869624. [4] Lucchetti, A., Pozzobon, R., Mazzarini, F., Cremonese, G., Massironi, M. (2017). Brittle ice shell thickness of Enceladus from fracture distribution analysis. Icarus 297, 252-264. Doi: 10.1016/j.icarus.2017.07.009. [5] Orosei, R., Rossi, A. P., Cantini, F., Caprarelli, et al. (2017). Radar sounding of Lucus Planum, Mars, by MARSIS. Journal of Geophysical Research (Planets) 122 (7), 1405-1418. Doi: 10.1002/2016JE005232

Nippur Sulcus from 2D to 3D: A Multidisciplinary approach in preparation for JUICE

Summary. We focus on a portion of the Nippur Sulcus region on Ganymede, which is currently promising for a multisensor data analysis. We first combine data acquired by the Galileo/SSI framing camera and by the Galileo/NIMS imaging spectrometer. We then apply a self-similar clustering technique able to explain how the grooves visible on the surface are distributed inside the icy crust. Finally, we apply a simple model to obtain a synthetic topographic dataset based on the existing optical dataset, which is used to simulate radar echoes coming from the RIME instrument with the goal of evaluating the magnitude of clutter noise.Geological and compositional context. We first focus on optical images obtained by the Galileo/SSI framing camera on a portion of Nippur Sulcus bordering Galileo Regio to the east and Marius Regio to the west (167.4°E-193.5°E and 16.8°N-38.2°N) (Fig. 1). This region includes different terrain units, such as dark terrains, grooved terrains, and the palimpsest crater Epigeus [1].Fig. 1. Overview of the Nippur Sulcus region of inter-est used for our case study, from Ganymede's optical basemap (1 km/px). The violet contours highlight the regions for which high-resolution optical imagery is available, while the green contour highlights the region covered by hyperspectral, near-infrared (NIMS) data (see Fig. 2).The coverage obtained by the Galileo/NIMS imaging spectrometer [2] allows for the combination of geologic and compositional information, using specific spectral indices such as an IR slope, the 2-μm band depth, and a IR ratio, which can account for the distribution of contaminants, water ice, and grain size, respectively (Fig. 2).Fig. 2. NIMS Color composite map covering the Nip-pur Sulcus region at a spatial resolution of 6.7 km/px (R: IR slope 1.10-2.25 µm, G: 2-µm band depth, B: IR ratio between 3.6 µm and 1.82 µm). In the adopted color scheme, green marks high albedo, large (100s µm) regolith grains and stronger water ice band, while magenta is associated with dark terrain where the 2-µm water ice band is shallower and the grain size is smaller (10s of µm).Grooves' length and fractal analysis. On the selected region of interest within Nippur, we establish a link between geology and geophysics, namely between what is seen on the surface at visible to infrared wavelengths, and Ganymede's shallow subsurface, which is still largely unknown today. To do so, we analyse the grooves' length and spatial distribution to estimate the potential thickness of the icy crust above the deep ocean required to develop the grooves. A fractal approach, namely a self-similar clustering method, allows us to determine the maximum depth at which grooves can penetrate the icy subsurface [3, 4]. As a result, the grooves mapped in the Nippur Sulcus region in principle could penetrate the ice crust up to 130-145 km (Fig. 3).Fig. 3. A self-similar clustering method allows us to determine the maximum depth up to which grooves can penetrate the icy subsurface. To do this, we calcu-late an integral correlation coefficient within certain length ranges. In this plot, the x axis is the logarithm of these threshold lengths, while the y axis represents the logarithm of the correlation coefficient (on the left) and what is called the local slope (on the right, which is the point-by-point measurement of the slope of the tangent to the curve). As a result, the grooves mapped in the Nippur Sulcus region in principle could pene-trate the ice crust up to 130-145 km, which is in agreement with independent estimates of the average thickness of the icy shell.Simulation of radar surface scattering at RIME frequencies. The Radar for Icy Moon Exploration (RIME) is one of the payload instruments aboard the JUICE spacecraft [5]. Operating at a central frequency of 9 MHz, and transmitting either a 3-MHz or a 1-MHz bandwidth (corresponding to a range resolution in water ice of about 30 m and 90 m respectively), RIME is tasked to explore the subsurface of Ganymede, Europa and Callisto down to a depth of several kilometres. However, clutter noise from rougher terrains is a limiting factor in the detectability of deeper, weaker reflections from the subsurface. The application of a coherent model of surface scattering to a roughness model of Nippur Sulcus demonstrates that clutter decays much slower than on Mars for a Ganymede-like topography (Fig. 4), which creates a challenge for the scientific interpretation of future RIME data.Fig. 4. Radargram of simulated surface echoes pro-duced for a subset of Nippur Sulcus, for a 3-MHz bandwith pulse. The time delay of echoes has been converted to the depth in water ice from which a radar echo would have the same time delay. The radargrams have been cropped to show only the part of the echoes that is unaffected by the finite size of the pseudo-topographic model.Conclusions. The case of Nippur Sulcus is well suited to test what could be closely observed in the future by different instruments onboard the JUICE mission, combining remote sensing data probing the surface and theoretical modeling aimed at the geophysical study of the satellite's subsurface. The merits and issues brought to light by our study should be taken into account to achieve a broader understanding of the physical processes linking Ganymede's surface and subsurface. Acknowledgements: We acknowledge support from the research project: "Ganymede from 2D to 3D: A multidisciplinary approach in preparation for JUICE", selected in 2019 in the framework of an "INAF Mainstream" call.References: [1] Collins G. C., et al., Global geologic map of Ganymede: U.S. Geological Survey Scientific Investigations Map 3237, pamphlet 4 p., 1 sheet, scale 1:15,000,000 (2013). [2] Carlson R. W, et al., Space Sci. Rev. 60, 457-502 (1992). [3] Lucchetti A., Pozzobon R., Mazzarini F., Cremonese G., Massironi M. (2017). Icarus 297, 252-264. [4] Lucchetti A., Rossi C., Mazzarini F., Pajola M., Pozzobon R., Massironi M., Cremonese G. (2021). Planet. Space Sci. 195, article id. 105140. [5] Bruzzone L., Croci R. (2019). Proceedings of the 2019 IEEE 5th International Workshop on Metrology for AeroSpace, Turin (Italy), 19-21 June 2019

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Bioethical issue of personal identity in David DeGrazia

reservedSiamo persone. Per la precisione siamo persone umane, membri della specie Homo sapiens. Ma cosa significa dire che qualcuno è una persona? E cosa significa essere un umano? Siamo essenzialmente animali umani o persone auto-narranti? Qual è il criterio che determina la nostra esistenza e che ci rende capaci di persistere nel tempo? Quale invece quello che ci permette di sviluppare una prospettiva individuale sul nostro vissuto e pianificare il futuro? Insomma, cosa o chi siamo fondamentalmente? . Rispondere a tutti questi interrogativi per David DeGrazia significa tentare di sciogliere il nodo della questione filosofica dell’identità personale o Personhood Issue che intreccia complesse argomentazioni epistemologiche e morali attorno al concetto di persona