Value of split-bolus multidetector-row CT technique in the quantitative assessment of pancreatic enhancement [Pankreatik tutulumun kantitatif değerlendirilmesinde bölünmüş-bolus multidetektör-dizi BT tekniğinin değeri]

The aim of this study is to quantitatively assess radiation comma, and pancreatic enhancement by split-bolus intravenous injection of contrast material using 64-slice CT. Single-pass split-bolus MDCT of the chest and abdomen was performed in 37 patients (female: 18, male: 9; mean age, 66.1±14.2 years; range 17-80 years) without pancreatic disease. Regions of interest in the pancreatic head, body and tail were drawn, and mean attenuation values for pancreatic parenchymal phase (PPP) of the standard MDCT protocol and split-bolus were calculated. P<0.05 was considered statistically significant. Mean effective dose by split-bolus was measured. In all MDCT examinations split-bolus protocol allowed acquisition of optimal images. Mean pancreatic enhancement was higher by split-bolus with respect to PPP of standard triphasic MDCT (131.35 HU±20.63 vs 126.1 HU±20.01). Reduction of dose using MDCT split-bolus was approximately 17%. In conclusion MDCT split-bolus protocol provides an optimal pancreatic enhancement, significantly greater than the enhancement of standard MDCT on PPP which confers an advantage for the detection and staging of pancreatic tumors

Accuracy of needle biopsy of breast lesions visible on ultrasound: audit of fine needle versus core needle biopsy in 3233 consecutive samplings with ascertained outcomes.

Abstract Introduction Core needle biopsy (CNB) has progressively replaced fine needle aspiration cytology (FNAC) in the diagnosis of breast lesions. Less information is available on how these tests perform for biopsy of ultrasound (US) visible breast lesions. This study examines the outcomes of CNB and FNAC in a large series ascertained with surgical histology or clinical-imaging follow-up. Materials and methods Retrospective five-year audit of 3233 consecutive US-guided needle samplings of solid breast lesions, from self-referred symptomatic or asymptomatic subjects, performed by six radiologists in the same time-frame (2003–2006): 1950 FNAC and 1283 CNB. The probability of undergoing CNB as a first test instead of FNAC was evaluated using logistic regression. Accuracy and inadequacy were calculated for each of CNB and FNAC performed as first test. Accuracy measures included equivocal or borderline/atypical lesions as positive results. Results The probability of CNB as a first test instead of FNAC increased significantly over time, when there was a pre-test higher level of suspicion, in younger (relative to older) women, with increasing lesion size on imaging, and for palpable (relative to impalpable) lesions. Inadequacy rate was lower for CNB (B1 = 6.9%) than for FNAC (C1 = 17.7%), p vs . C1 = 4.5%; p vs . 74.4%; p vs . 93.8%; p = 0.001), however specificity was lower for CNB than FNAC (88.3% vs . 96.4%; p vs . 71.9; p complete diagnostic accuracy (95.4% vs . 93.2; p Conclusion FNAC and CNB were generally performed in different patients, thus our study reported indirect comparisons of these tests. Although FNAC performed well (except for relatively high inadequacy), CNB had significantly better performance based on measures of sensitivity, but this was associated with lower specificity for CNB relative to FNAC. Overall, CNB is the more reliable biopsy method for sonographically-visible lesions; where FNAC is used as the first-line test, inadequate or inconclusive FNAC can be largely resolved by using repeat sampling with CNB

Vancomycin resistant enterococcus risk factors for hospital colonization in hematological patients: a matched case-control study

BackgroundVancomycin-resistant enterococcus (VRE) was the fastest growing pathogen in Europe in 2022 (+ 21%) but its clinical relevance is still unclear. We aim to identify risk factors for acquired VRE rectal colonization in hematological patients and evaluate the clinical impact of VRE colonization on subsequent infection, and 30- and 90-day overall mortality rates, compared to a matched control group.MethodsA retrospective, single center, case-control matched study (ratio 1:1) was conducted in a hematological department from January 2017 to December 2020. Case patients with nosocomial isolation of VRE from rectal swab screening (>= 48 h) were matched to controls by age, sex, ethnicity, and hematologic disease. Univariate and multivariate logistic regression compared risk factors for colonization.ResultsA total of 83 cases were matched with 83 controls. Risk factors for VRE colonization were febrile neutropenia, bone marrow transplant, central venous catheter, bedsores, reduced mobility, altered bowel habits, cachexia, previous hospitalization and antibiotic treatments before and during hospitalization. VRE bacteraemia and Clostridioides difficile infection (CDI) occurred more frequently among cases without any impact on 30 and 90-days overall mortality. Vancomycin administration and altered bowel habits were the only independent risk factors for VRE colonization at multivariate analysis (OR: 3.53 and 3.1; respectively).ConclusionsAntimicrobial stewardship strategies to reduce inappropriate Gram-positive coverage in hematological patients is urgently required, as independent risk factors for VRE nosocomial colonization identified in this study include any use of vancomycin and altered bowel habits. VRE colonization and infection did not influence 30- and 90-day mortality. There was a strong correlation between CDI and VRE, which deserves further investigation to target new therapeutic approaches

Sintesi di potenziali inibitori duali degli enzimi monoacilglicerolo lipasi (MAGL) e ammide idrolasi degli acidi grassi (FAAH) a struttura benzilpiperidinica

Il sistema Endocannabinoide rappresenta un importante target d'azione farmacologica per il trattamento di molte patologie, come, per esempio, il dolore di tipo infiammatorio, neuropatico, termico e chimico. È possibile sfruttare farmacologicamente gli effetti di questo sistema anche per alcuni disturbi neurologici, quali Morbo di Parkinson e Morbo di Alzheimer, nonché per disturbi metabolici come l’obesità. Infine, è stato visto che una modulazione del sistema endocannabinoide può trovare impiego anche nel trattamento di diverse tipologie di cancro. Nonostante i noti effetti benefici, l’utilizzo clinico degli agonisti diretti dei recettori cannabinoidi è piuttosto limitato, in quanto questi composti provocano anche effetti collaterali indesiderati. Una possibile alternativa terapeutica è rappresentata invece dall’inibizione degli enzimi MAGL e FAAH. In base allo studio relativo alle strutture di questi due enzimi e ai loro vari inibitori selettivi presenti in letteratura, il mio lavoro di tesi è finalizzato alla sintesi di composti che possono comportarsi da inibitori duali di MAGL e di FAAH. Per quanto riguarda FAAH, è stato preso in considerazione il potente inibitore PF-3845 a struttura benzilpiperidinica. Tra i molteplici inibitori di MAGL sono stati sfruttati quelli appartenenti alla classe dei derivati benzoilpiperidinici, riconosciuti come composti altamente potenti e reversibili. L’obbiettivo del mio lavoro è stato sintetizzare, sfruttando le analogie strutturali di questi composti, due nuovi potenziali inibitori duali di MAGL e di FAAH, creando composti strutturalmente “ibridi”. Oltre a questi derivati è stato progettato, in maniera del tutto teorica, un nuovo potenziale inibitore duale di MAGL e di FAAH, con l’obbiettivo di aumentare la potenza di queste molecole, sfruttando le analogie strutturali tra l’inibitore selettivo MAGL JJKK-006 e gli inibitori selettivi FAAH PF-04457845 e JNJ-40355003

Laminin-332 γ2 Monomeric Chain Promotes Adhesion and Migration of Hepatocellular Carcinoma Cells

Extracellular matrix (ECM) has a well-recognized impact on the progression of solid tumors, including hepatocellular carcinoma (HCC). Laminin 332 (Ln332) is a ECM molecule of epithelial basal lamina, composed of three polypeptide chains (α3, β3, and γ2), that is usually poorly expressed in the normal liver but is detected at high levels in HCC. This macromolecule was shown to promote the proliferation, epithelial-to-mesenchymal transition (EMT), and drug resistance of HCC cells. The monomeric γ2 chain is up-regulated and localized preferentially at the invasive edge of metastatic intrahepatic HCC nodules, suggesting its potential involvement in the acquisition of invasive properties of HCC cells. HCC cells were tested in in vitro adhesion, scattering, and transwell migration assays in response to fibronectin and the Ln332 and Ln332 γ2 chains, and the activation status of major signaling pathways involved was evaluated. Here, we show that the Ln332 γ2 chain promotes HCC the cell adhesion, migration, and scattering of HCC cells that express the Ln332 receptor α3β1 integrin, proving to be a causal factor of the EMT program achievement. Moreover, we found that efficient HCC cell adhesion and migration on γ2 require the activation of the small cytosolic GTPase Rac1 and ERKs signaling. These data suggest that the γ2 chain, independently from the full-length Ln332, can contribute to the pro-invasive potential of aggressive HCC cell subpopulations

Flexural behaviour of glulam beams reinforced with CFRP Rods

Fibre Reinforced Polymer (FRP) composites have been largely used in combination with masonry and concrete structural elements in the last decade. Recent applications showed that new advantages may be achieved also in the field of timber structures, even if at the moment a large use of steel elements is made. This study investigated the possibility of using CFRP rods as glued-in connectors for glulam timber joints that should transfer flexural moment between two adjacent beams. Full-size head joints were prepared and tested. Flexural behaviour of joints was compared with the mechanical properties of mono-piece beams that were used as reference specimens. Three different bonded lengths were used for the construction of CFRP-timber joints. Experimental results showed that the use of CFRP rods in timber joints was successful since the capacity of the CFRP-jointed beams was almost the same as the monolithic beams for the longest bond length that was adopted. This result is important in order to find an adequate alternative to traditional joints made with steel bolts and plates that are not able to create rigid connections and increase dramatically the weight of timber structures