Risk Factors for Immediate and Delayed-Onset Fever After Percutaneous Transhepatic Biliary Drainage

Objectives To prospectively investigate the pre and intraprocedural risk factors for immediate (IF) and delayedonset (DOF) fever development after percutaneous transhepatic biliary drainage (PTBD). Methods Institutional review board approval and informed patient consent were obtained. Between February 2013 and February 2014, 97 afebrile patients (77 at the Sapienza University of Rome, Italy and 20 at the Sun Yatsen University of Guangzhou, China) with benign (n = 31) and malignant (n = 66) indications for a first PTBD were prospectively enrolled. Thirty pre- and intra-procedural clinical/radiological characteristics, including the amount of contrast media injected prior to PTBD placement, were collected in relation to the development of IF (within 24 h) or DOF (after 24 h). Fever was defined as C37.5 C. Binary logistic regression analysis was used to assess independent associations with IF and DOF. Results Fourteen (14.4 %) patients developed IF and 17 (17.5 %) developed DOF. At multivariable analysis, IF was associated with pre-procedural absence of intrahepatic bile duct dilatation (OR 63.359; 95 % CI 2.658–1510.055; P = 0.010) and low INR (OR 4.7 9 10-4 ; 95 % CI 0.000–0.376; P = 0.025), while DOF was associated with unsatisfactory biliary drainage at the end of PTBD (OR 4.571; 95 % CI 1.161–17.992; P = 0.030)

Stereoscopic Estimation of Volcanic Ash Cloud-Top Height from Two Geostationary Satellites

The characterization of volcanic ash clouds released into the atmosphere during explosive eruptions includes cloud height as a fundamental physical parameter. A novel application is proposed of a method based on parallax data acquired from two geostationary instruments for estimating ash cloud-top height (ACTH). An improved version of the method with a detailed discussion of height retrieval accuracy was applied to estimate ACTH from two datasets acquired by two satellites in favorable positions to fully exploit the parallax effect. A combination of MSG SEVIRI (HRV band; 1000 m nadir spatial resolution, 5 min temporal resolution) and Meteosat-7 MVIRI (VIS band, 2500 m nadir spatial resolution, 30 min temporal resolution) was implemented. Since MVIRI does not acquire data at exactly the same time as SEVIRI, a correction procedure enables compensation for wind advection in the atmosphere. The method was applied to the Mt. Etna, Sicily, Italy, eruption of 23 November 2013. The height of the volcanic cloud was tracked with a top height of ~8.5 km. The ash cloud estimate was applied to the visible channels to show the potential accuracy that will soon be achievable also in the infrared range using the next generation of multispectral imagers. The new constellation of geostationary meteorological satellites will enable full exploitation of this technique for continuous global ACTH monitoring

Critical concepts, practice recommendations, and research perspectives of pixantrone therapy in non-Hodgkin lymphoma: a SIE, SIES, and GITMO consensus paper

Objectives: In this paper, we present a review of critical concepts and research perspectives and produce recommendations on the optimal use of pixantrone in non-Hodgkin lymphoma (NHL) by group discussion from an expert panel appointed by the Italian Society of Hematology and the affiliate societies, Societa Italiana di Ematologia Sperimentale and Gruppo Italiano Trapianto di Midollo Osseo. Methods: Recommendations were produced using the Delphi process. Scientific evidence on pixantrone efficacy was analyzed using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology in the areas where at least one randomized trial was published. The following key issues were addressed for practical recommendations: pixantrone monotherapy in aggressive relapsed or refractory non-Hodgkin B-cell lymphomas and toxicity risk management in patients candidates to pixantrone. Results and conclusions: After a balanced and value-oriented discussion, the panel agreed that the benefit/risk profile was in favor of pixantrone in the treatment of adult patients with multiply relapsed or refractory aggressive NHL B-cell lymphomas. Pixantrone was deemed to be contraindicated in patients with uncontrolled cardiovascular disease. Despite a low rate of cardiotoxicity of pixantrone reported in clinical trials, the panel recommended that all patients receiving pixantrone should undergo periodical cardiac monitoring

Metabolic syndrome and cardiovascular risk after liver transplantation: a single-center experience.

Excessive weight gain, hypertension, hyperlipidemia, and diabetes are frequently observed among orthotopic liver transplantation (OLT) patients. These alterations, which are probably multifactorial in origin, contribute to posttransplantation metabolic syndrome (PTMS), which increases the risk of cardiovascular events. We assessed the prevalence of PTMS (diagnosed according to modified NCEP Adult Treatment Panel III criteria) in 156 OLT patients undergoing regular follow-up after transplantation (median 68 months; range, 6 to 234 months). Several pre- and post-OLT data were collected to identify the factors associated with the presence of PTMS which was found in 28% of cases. The only independent predictive factors for PTMS were diabetes mellitus and patients who were overweight or obese before-OLT. The prevalence of PTSM was lower among patients on tacrolimus immunosuppression. In our population, 21% of patients showed a high cardiovascular risk score with a 4% incidence of cardiovascular events, which was higher among subjects with PTMS. Close follow-up is mandatory to prevent the development of PTMS mainly among overweight and diabetic patients before transplantation

ESI-mass spectrometry analysis of unsubstituted and disubstituted β-cyclodextrins: fragmentation mode and identification of the AB, AC, AD regioisomers

AbstractThe study of unsubstituted and disubstituted β-cyclodextrins (β-CDs) by ESI-mass spectrometry is reported, applying a cone-induced fragmentation in the presence of a twofold excess of sodium chloride, in order to gain information about the fragmentation of the different regioisomers. On the basis of the fragmentation pattern observed for the unsusbstituted β-CD, a statistical model shows that the fragments generated by every regioisomer of a disubstituted CD (AB, AC, and AD) are expected to differ in their relative intensity and, therefore, they can be used for correctly identifying the three different regioisomers. The model was tested on the three regioisomeric (AB, AC, and AD) diamino-β-CDs and ditosyl-β-CD and on the AC and AD regioisomers of dimesitylenesulphonyl-β-CD, allowing in every case through statistical analysis of the fragmentation pattern the correct assignment of every regioisomer on the basis of an ESI mass spectrum (single quadrupole analyzer, high cone voltage) of the pure compounds. The absolute intensities of the fragmentation peaks were voltage-dependent but their ratios was voltage-independent, indicating that no mass bias in peak ratios is introduced by the analyzer. Given the fast time of analysis and its general applicability, independently from the substituents, we propose our method as an easy way to identify the regioisomers of disubstituted β-CDs

A new simplified approach for simultaneous retrieval of SO2 and ash content of tropospheric volcanic clouds: an application to the Mt Etna volcano

A new procedure is presented for simultaneous estimation of SO2 and ash abundance in a volcanic plume, using thermal infrared (TIR) MODIS data. Plume altitude and temperature are the only two input parameters required to run the procedure, while surface emissivity, temperature, atmospheric profiles, ash optical properties, and radiative transfer models are not necessary to perform the atmospheric corrections. The procedure gives the most reliable results when the surface under the plume is uniform, for example above the ocean, but still produces fairly good estimates in more challenging and not easily modelled conditions, such as above land or meteorological cloud layers. The developed approach was tested on the Etna volcano. By linearly interpolating the radiances surrounding a detected volcanic plume, the volcanic plume removal (VPR) procedure described here computes the radiances that would have been measured by the sensor in the absence of a plume, and reconstructs a new image without plume. The new image and the original data allow computation of plume transmittance in the TIR-MODIS bands 29, 31, and 32 (8.6, 11.0 and 12.0 \u3bcm) by applying a simplified model consisting of a uniform plume at a fixed altitude and temperature. The transmittances are then refined with a polynomial relationship obtained by means of MODTRAN simulations adapted for the geographical region, ash type, and atmospheric profiles. Bands 31 and 32 are SO2 transparent and, from their transmittances, the effective ash particle radius (Re), and aerosol optical depth at 550 nm (AOD550) are computed. A simple relation between the ash transmittances of bands 31 and 29 is demonstrated and used for SO2 columnar content (cs) estimation. Comparing the results of the VPR procedure with MODTRAN simulations for more than 200 000 different cases, the frequency distribution of the differences shows the following: the Re error is less than \ub10.5 \u3bcm in more than 60% of cases; the AOD550 error is less than \ub10.125 in 80% of cases; the cs error is less than \ub10.5 gm 122 in more than 60% of considered cases. The VPR procedure was applied in two case studies of recent eruptions occurring at the Mt Etna volcano, Italy, and successfully compared with the results obtained from the established SO2 and ash assessments based on look-up tables (LUTs). Assessment of the sensitivity to the plume altitude uncertainty is also made. The VPR procedure is simple, extremely fast, and can be adapted to other ash types and different volcanoes

Platelet-to-lymphocyte ratio in the setting of liver transplantation for hepatocellular cancer. A systematic review and meta-analysis

AIM: To perform a systematic review and meta-analysis on platelet-to-lymphocyte ratio (PLR) as a risk factor for post-transplant hepatocellular cancer (HCC) recurrence. METHODS: A systematic literature search was performed using PubMed. Participants of any age and sex, who underwent liver transplantation for HCC were considered following these criteria: (1) studies comparing pre-transplant low vs high PLR values; (2) studies reporting post-transplant recurrence rates; and (3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measure was set for HCC recurrence after transplantation. RESULTS: A total of 5 articles, published between 2014 and 2017, fulfilled the selection criteria. As for the quality of the reported studies, all the investigated articles presented an overall high quality. A total of 899 cases were investigated: 718 cases (80.0%) were males. Three studies coming from European countries and one from Japan presented HCV as the main cause of cirrhosis. On the opposite, one Chinese study presented a greater incidence of HBV-related cirrhotic cases. In all the studies apart one, the PLR cut-off value of 150 was reported. At meta-analysis, high PLR value was associated with a significant increase in recurrence after transplantation (OR = 3.33; 95%CI: 1.78-6.25; p < 0.001). A moderate heterogeneity was observed among the identified studies according to the Higgins I 2 statistic value. CONCLUSION: Pre-transplant high PLR values are connected with an increased risk of post-operative recurrence of hepatocellular cancer. More studies are needed for better clarify the biological mechanisms of this results

Specific issues concerning the management of patients on the waiting list and after liver transplantation

The present document is a second contribution collecting the recommendations of an expert panel of transplant hepatologists appointed by the Italian Association for the Study of the Liver (AISF) concerning the management of certain aspects of liver transplantation, including: the issue of prompt referral; the management of difficult candidates; malnutrition; living related liver transplants; hepatocellular carcinoma; and the role of direct acting antiviral agents before and after transplantation. The statements on each topic were approved by participants at the AISF Transplant Hepatology Expert Meeting organized by the Permanent Liver Transplant Commission in Mondello on 12-13 May 2017. They are graded according to the GRADE grading system

Peribiliary glands as a niche of extra-pancreatic precursors yielding insulin-producing cells in experimental and human diabetes

Peribiliary glands (PBGs) are niches in the biliary tree and containing heterogeneous endodermal stem/progenitors cells that can differentiate, in vitro and in vivo, towards pancreatic islets. The aim of this study was to evaluate, in experimental and human diabetes, proliferation of cells in PBGs and differentiation of the biliary tree stem/progenitor cells (BTSCs) towards insulin-producing cells. Diabetes was generated in mice by intraperitoneal injection of a single dose of 200 mg/kg (N=12) or 120 mg/kg (N=12) of streptozotocin. Liver, pancreas and extrahepatic biliary trees were en bloc dissected and examined. Cells in PBGs proliferated in experimental diabetes, and their proliferation was greatest in the PBGs of the hepato-pancreatic ampulla, and inversely correlated with the pancreatic islet area. In rodents, the cell proliferation in PBGs was characterized by the expansion of Sox9-positive stem/progenitor cells that gave rise to insulin-producing cells. Insulin-producing cells were located mostly in PBGs in the portion of the biliary tree closest to the duodenum, and their appearance was associated with up-regulation of MafA and Gli1 gene expression. In patients with type 2 diabetes, PBGs at the level of the hepato-pancreatic ampulla contained cells showing signs of proliferation and pancreatic fate commitment. In vitro, high glucose concentrations induced the differentiation of human BTSCs cultures towards pancreatic beta cell fates. The cells in PBGs respond to diabetes with proliferation and differentiation towards insulin-producing cells indicating that PBG niches may rescue pancreatic islet impairment in diabetes. These findings offer important implications for the patho-physiology and complications of this disease. This article is protected by copyright. All rights reserved