ARFI: from basic principles to clinical applications in diffuse chronic disease-a review

The many factors influencing the shear wave velocity (SWV) measured with Acoustic Radiation Force Impulse (ARFI) are examined in order to define the most correct examination technique. In particular, attention is given to the information achieved by experimental models, such as phantoms and animal studies. This review targets the clinical applications of ARFI in the evaluation of chronic diffuse disease, especially of liver and kidneys. The contribution of ARFI to the clinical workout of these patients and some possible perspectives are described

Ectopic thymoma presenting as a giant intrathoracic tumor: A case report

Ectopic thymoma rarely presents as an intrathoracic tumor. We report a case of ectopic thymoma presenting as a giant right intrathoracic tumor that was treated with resection. The patient was a 50-year-old Japanese woman who presented with the chief complaint of chest pain. Detailed examination revealed a solid tumor measuring 15 × 10 × 8 cm in diameter, with a clear border. The Imaging findings suggested a solitary fibrous tumor, and surgery was performed. At surgery, the tumor was found to beadherent to the diaphragm, mediastinal pleura, and lower lobe of the lung, although it could be dissected with relative ease and was removed. Pathological diagnosis indicated a type B1 tumor with no capsular invasion according to the World Health Organization classification, and a diagnosis of Masaoka stage I thymoma was made. No continuity with the normal thymus tissue was seen, and the thymoma was considered to be derived from ectopic thymic tissue in the pleura

Apulian infectious diseases network: survey on the prevalence of delta infection among chronic HBV carriers in Apulia

BackgroundThe current prevalence and clinical burden of Hepatitis Delta Virus (HDV) infection in Apulia are unknown. This study aimed to define the current epidemiological scenario of delta infection and to detect difficulties in the diagnosis and clinical management of HDV patients in Apulia.MethodsFrom May to September 2022, a fact-finding survey was conducted at eight Infectious Diseases Units of the Apulian region; each Unit was asked to complete a questionnaire on screening and diagnosis of HDV infection and demographic, virological, and clinical characteristics of HDV patients.ResultsA total of 1,461 HBsAg-positive subjects were followed up on an outpatient basis. Screening for HDV ranged from 30 to 90% of HBsAg + carriers in a single center. Overall, 952 HBsAg ± subjects (65%) were tested for HDV, and 80/952 (8.4%) were anti-HDV positive. Serum HDV RNA was detected only in 15/80 (19%) anti-HDV-positive subjects, and 12/15 patients (80%) were viremic. Sixty-five anti-HDV-positive subjects (81%) were from Italy; risk factors for HDV acquisition included the presence of HDV infection in the family (29/80 = 36%), drug addiction (12/80 = 15%), and co-infection with HCV or HIV (7/80 = 9%). Liver cirrhosis and hepatocellular carcinoma were diagnosed in 41 (51%) and 4 (5%) patients, respectively. Fifty-seven patients (71%) received nucleos(t)ide analog treatment.ConclusionsThe results of this survey show that HDV screening is variable and insufficient, thus real prevalence data on delta infection are lacking in Apulia. Moreover, the HDV RNA test is not available in most laboratories and is not provided by the national health system. These results underline the need for an organizational model to optimize the management of HDV patients throughout the Apulian region

Epidemiological profile and north-south gradient driving baseline systemic involvement of primary Sjogren's syndrome

Objective: To characterize the systemic phenotype of primary Sjögren’s syndrome at diagnosis by analysing the EULAR-SS disease activity index (ESSDAI) scores. Methods: The Sjögren Big Data Consortium is an international, multicentre registry based on worldwide data-sharing cooperative merging of pre-existing databases from leading centres in clinical research in Sjögren’s syndrome from the five continents. Results: The cohort included 10 007 patients (9352 female, mean 53 years) with recorded ESSDAI scores available. At diagnosis, the mean total ESSDAI score was 6.1; 81.8% of patients had systemic activity (ESSDAI score ≥1). Males had a higher mean ESSDAI (8.1 vs 6.0, P < 0.001) compared with females, as did patients diagnosed at <35 years (6.7 vs 5.6 in patients diagnosed at >65 years, P < 0.001). The highest global ESSDAI score was reported in Black/African Americans, followed by White, Asian and Hispanic patients (6.7, 6.5, 5.4 and 4.8, respectively; P < 0.001). The frequency of involvement of each systemic organ also differed between ethnic groups, with Black/African American patients showing the highest frequencies in the lymphadenopathy, articular, peripheral nervous system, CNS and biological domains, White patients in the glandular, cutaneous and muscular domains, Asian patients in the pulmonary, renal and haematological domains and Hispanic patients in the constitutional domain. Systemic activity measured by the ESSDAI, clinical ESSDAI (clinESSDAI) and disease activity states was higher in patients from southern countries (P < 0.001). Conclusion: The systemic phenotype of primary Sjögren’s syndrome is strongly influenced by personal determinants such as age, gender, ethnicity and place of residence, which are key geoepidemiological players in driving the expression of systemic disease at diagnosis.

Caratterizzazione di carta antica e moderna a mezzo spettroscopia FTIR e Micro-Raman

Archive and library materials are an important part of our national cultural heritage. In order to identify appropriate methods for the  conservation and restoration of such materials, it is important to establish the current physical-chemical state of the artifact and how it can be influenced by the chemical reactions it meets with. The degree of crystallinity and orientation of the paper fibers has a significant influence on its mechanical properties. Many chemical and physical reactions can increase amorphous areas and susceptibility to biological attack, thus making the paper more brittle.Spectroscopy is one of the most powerful tools for the characterization of paper materials and for the identification of degradation products. This paper describes the application of FTIR and Micro-Raman spectroscopy for the characterization of cellulosic materials.RiassuntoI materiali di archivio e di biblioteca sono una parte importante del nostro patrimonio culturale nazionale. Al fine di individuare metodi adeguati di conservazione e restauro di tali materiali, è importante capire l'attuale stato fisico-chimico del manufatto e come questo può essere influenzato dalle reazioni chimiche che si verificano su di essi. Il grado di cristallinità e l'orientamento delle fibre di carta ha una notevole influenza sulle sue proprietà meccaniche. Molte sostanze chimiche e reazioni fisiche possono aumentare le zone amorfe e la suscettibilità agli attacchi biologici, rendendo la carta più fragile.La spettroscopia è uno dei più potenti strumenti per la caratterizzazione dei materiali costituenti la carta e per l'identificazione dei prodotti di degradazione. Questo articolo descrive l'applicazione della spettroscopia FTIR e micro-Raman per la caratterizzazione dei materiali cellulosici.RésuméLes matériels d’archives et de bibliothèque sont une partie importante de notre patrimoine culturel national. Afin de déterminer les méthodes adéquates de conservation et restauration de ces matériels, il est important de comprendre l’actuel état physico-chimique du produit manufacturé et comment celui-ci peut être influencé par les réactions chimiques qui se vérifient sur eux. Le grade de cristallinité et l'orientation des fibres de papier a une remarquable influence sur ses propriétés mécaniques. De nombreuses substances chimiques et de réactions physiques peuvent augmenter les zones amorphes et la susceptibilité aux attaques biologiques, rendant le papier plus fragile.La spectroscopie est un des plus puissants instruments pour la caractérisation des matériaux constituant le papier et pour l'identification des produits de dégradation. Cet article décrit l'application de la spectroscopie FTIR et micro-Raman pour la caractérisation des matériaux cellulosiques.   ZusammenfassungDie Archiv- und Bibliotheksmaterialien bilden einen wichtigen Bestandteil unseres nationalen Kulturerbes. Um geeignete Konservierungs- und Restaurierungsverfahren für diese Materialien zu finden, ist es wichtig, den gegenwärtigen physikalisch-chemischen Zustand des Gegenstands zu verstehen und wie dieser durch chemische Reaktionen, die an ihm eintreten, beeinflusst werden kann. Der Kristallisationsgrad und die Ausrichtung der Papierfasern haben einen beträchtlichen Einfluss auf die mechanischen Eigenschaften. Viele chemische Substanzen und physikalische Reaktionen können die amorphen Zonen vergrößern und die Anfälligkeit für biologische Angriffe erhöhen und damit das Papier brüchiger machen.Die Spektroskopie ist eines der mächtigsten Instrumente zur Charakterisierung der Materialien, aus denen das Papier besteht, und zur Identifizierung der Zersetzungsprodukte. Dieser Artikel beschreibt die Anwendung der FTIR-/Raman-Mikrospektroskopie zur Charakterisierung von Zellulosematerialien.ResumenLos materiales de archivo y de biblioteca son una parte importante de nuestro patrimonio cultural nacional. A fin de definir métodos adecuados de conservación y restauración de dichos materiales, es importante entender el actual estado físico-químico de la pieza, y como puede verse influenciado por las reacciones químicas que se producen en ellas. El grado de cristalinidad y la orientación de las fibras de papel tienen una notable influencia en sus propiedades mecánicas. Muchas sustancias químicas y reacciones físicas pueden aumentar las zonas amorfas y la susceptibilidad a los ataques biológicos, haciendo más frágil el papel.La espectroscopia es uno de los más potentes instrumentos para la caracterización de los materiales que componen el papel y para identificar los productos de degradación. Este artículo describe la aplicación de la espectroscopia FTRIR y micro-Raman para la caracterización de los materiales celulósicos.РезюмеМатериалы архива и библиотеки являются важной составляющей частью нашего национального культурного наследия. С целью определения адекватных методов для сохранения и реставрации данных материалов важно понять настоящее физико-химическое состояние артефакта и как его могут изменить химимческие реакции, влияющие на него. Степень кристалличности и ориентация волокон бумаги определяют ее механические свойства. Многие химические вещества и физические реакции могут увеличить аморфные зоны и восприимчивость к биологическим атакам, делая бумагу более хрупкой. Спектроскопия – один из наиболее мощных инструментов для определения характеристик материалов, составляющих бумагу и определения продуктов ее деградации. Данная статья описывает применение спектроскопии FTIR и микро-Раман для характеристики целлюлозного материала.

L'idatidosi epatica: pregresse e attuali strategie terapeutiche

Gli Autori, nel riportare la loro casistica, ribadiscono come ancora oggi l’incidenza dell’idatidosi epatica e delle complicanze legate a questa patologia rimanga molto significativa. Precisano come gli obiettivi da perseguire con il trattamento siano ormai standardizzati: eliminazione del parassita, prevenzione o trattamento delle complicanze, ostacolo all’insorgenza delle recidive. Gli Autori si soffermano quindi sulle varie tecniche, sia di tipo conservativo che radicale, che hanno segnato la storia della chirurgia dell’idatidosi epatica, e concludono affermando come proprio le tecniche di eradicazione del parassita e del pericistio, soprattutto se attuate a cielo aperto, rappresentino il trattamento ideale anche in considerazione dei risultati poco incoraggianti della terapia medica

I traumi chiusi della milza. Indicazioni al trattamento chirurgico

Gli Autori fanno un cenno all’evoluzione storica che ha portato a considerare la splenectomia quale intervento ideale in pazienti con lesioni post-traumatiche della milza. Si soffermano quindi sulle attuali conoscenze della fisiopatologia di questo organo che hanno determinato un sostanziale cambiamento di indirizzo spostando l’interesse, quando possibile, verso il trattamento conservativo. Nel riportare la loro esperienza relativa all’ultimo decennio, puntualizzano come ogni scelta terapeutica debba essere conseguente ad una corretta valutazione clinica che consenta di porre l’indicazione all’esplorazione dell’addome in urgenza o, invece, di avviare un protocollo di monitorizzazione del paziente. Si soffermano in particolare sulla validità della ricerca e della quantizzazione delle lesioni d’organo e del conseguente emoperitoneo. Concludono affermando come una corretta valutazione diagnostica e la conseguente terapia debbano essere attuate in opportuni Trauma Center che assicurino il monitoraggio intensivo e, se necessario, l’intervento tempestivo su questi pazienti

Rottura spontanea di milza in presenza di infezione citomegalica. Descrizione di un caso clinico

portano un caso clinico di rottura spontanea di milza in paziente con infezione da Citomegalovirus e colgono da questo lo spunto per puntualizzare le caratteristiche principali di questa infezione ed il meccanismo che, in corso di infezione virale, induce alterazioni morfologiche e funzionali dell’organo. L’ipersplenismo da iperfunzionamento, la formazione di immunocomplessi con conseguente necrosi infartuale, specie della polpa bianca, e la coagulopatia da consumo sono responsabili, come nel caso osservato, di processi evolutivi che possono indurre la lacerazione della capsula. L’ampia diffusione dell’infezione da Citomegalovirus impone la conoscenza di tutte la manifestazioni patologiche da questa indotte allo scopo di pervenire a diagnosi e trattamento tempestivi