Oral burning with dysphagia and weight loss

Fibromyalgia is a disorder characterized by an abnormal pain regulation. Widespread pain, fatigue, and sleep disturbance are the prevalent symptoms. When unusual symptoms are overbearingly predominant at clinical presentation, the diagnosis becomes challenging. We report on the case of a patient with fibromyalgia, who presented with dysphagia, odynophagia, and glossodynia as prevalent symptoms. Difficulty in swallowing gradually developed over a month prior hospitalization, and worsened progressively so that nourishment and fluid intake were impeded. Because anemia with mild iron deficiency was found, esophagogastroduodenoscopy was performed, but no lesions were seen in the upper digestive tract. Levels of zinc and vitamin B12 were normal. Intense pain at pelvis and the inferior limbs, which was at a first glance referred to as osteoarthrosis, associated with oral symptoms and feeling of being in the clouds allowed us to diagnose fibromyalgia. Amitriptyline was used, with relief of symptoms. Although oropharyngeal symptoms were occasionally reported in fibromyalgia, they are often overlooked. The present case, therefore, testifies the need to consider the diagnosis of fibromyalgia when the patient presents with such symptoms that cannot be readily explained on other grounds

Probability distributions of landslide volumes

Abstract. We examine 19 datasets with measurements of landslide volume, VL, for sub-aerial, submarine, and extraterrestrial mass movements. Individual datasets include from 17 to 1019 landslides of different types, including rock fall, rock slide, rock avalanche, soil slide, slide, and debris flow, with individual landslide volumes ranging over 10−4 m3≤VL≤1013 m3. We determine the probability density of landslide volumes, p(VL), using kernel density estimation. Each landslide dataset exhibits heavy tailed (self-similar) behaviour for their frequency-size distributions, p(VL) as a function of VL, for failures exceeding different threshold volumes, VL*, for each dataset. These non-cumulative heavy-tailed distributions for each dataset are negative power-laws, with exponents 1.0≤β≤1.9, and averaging β≈1.3. The scaling behaviour of VL for the ensemble of the 19 datasets is over 17 orders of magnitude, and is independent of lithological characteristics, morphological settings, triggering mechanisms, length of period and extent of the area covered by the datasets, presence or lack of water in the failed materials, and magnitude of gravitational fields. We argue that the statistics of landslide volume is conditioned primarily on the geometrical properties of the slope or rock mass where failures occur. Differences in the values of the scaling exponents reflect the primary landslide types, with rock falls exhibiting a smaller scaling exponent (1.1≤β≤1.4) than slides and soil slides (1.5≤β≤1.9). We argue that the difference is a consequence of the disparity in the mechanics of rock falls and slides

Towards Model-Driven Dashboard Generation for Systems-of-Systems

Configuring and evolving dashboards in complex and large-scale Systems-of-Systems (SoS) can be an expensive and cumbersome task due to the many Key Performance Indicators (KPIs) that are usually collected and have to be arranged in a number of visualizations. Unfortunately, setting up dashboards is still a largely manual and error-prone task requiring extensive human intervention. This short paper describes emerging results about the definition of a model-driven technology-agnostic approach that can automatically transform a simple list of KPIs into a dashboard model, and then translate the model into an actual dashboard for a target dashboard technology. Dashboard customization can be efficiently obtained by solely modifying the abstract model representation, freeing operators from expensive interactions with actual dashboards

Altered Gene Expression, Mitochondrial Damage and Oxidative Stress: Converging Routes in Motor Neuron Degeneration

Motor neuron diseases (MNDs) are a rather heterogeneous group of diseases, with either sporadic or genetic origin or both, all characterized by the progressive degeneration of motor neurons. At the cellular level, MNDs share features such as protein misfolding and aggregation, mitochondrial damage and energy deficit, and excitotoxicity and calcium mishandling. This is particularly well demonstrated in ALS, where both sporadic and familial forms share the same symptoms and pathological phenotype, with a prominent role for mitochondrial damage and resulting oxidative stress. Based on recent data, however, altered control of gene expression seems to be a most relevant, and previously overlooked, player in MNDs. Here we discuss which may be the links that make pathways apparently as different as altered gene expression, mitochondrial damage, and oxidative stress converge to generate a similar motoneuron-toxic phenotype

Istiocitoma fibroso maligno. Caso clinico

L’istiocitoma fibroso maligno è un sarcoma aggressivo dei tessuti molli, che compare più frequentemente nei muscoli degli arti e nella cavità addominale o nel retroperitoneo di giovani adulti. È di difficile diagnosi pre-operatoria e ha una prognosi sfavorevole in alcuni casi. Questo lavoro riporta il caso di un paziente di 94 anni con istiocitoma ad origine cutanea e sottolinea l’importanza della diagnosi precoce ai fini della curabilità

Prospective validation of an automated chemiluminescence-based assay of renin and aldosterone for the work-up of arterial hypertension

AbstractBackground:The availability of simple and accurate assays of plasma active renin (DRC) and aldosterone concentration (PAC) can improve the detection of secondary forms of arterial hypertension. Thus, we investigated the performance of an automated chemiluminescent assay for DRC and PAC in referred hypertensive patients.Methods:We prospectively recruited 260 consecutive hypertensive patients referred to an ESH Center for Hypertension. After exclusion of six protocol violations, 254 patients were analyzed: 67.3% had primary hypertension, 17.3% an aldosterone producing adenoma (APA), 11.4% idiopathic hyperaldosteronism (IHA), 2.4% renovascular hypertension (RVH), 0.8% familial hyperaldosteronism type 1 (FH-1), 0.4% apparent mineralocorticoid excess (AME), 0.4% a renin-producing tumor, and 3.9% were adrenalectomized APA patients. Bland-Altman plots and Deming regression were used to analyze results. The diagnostic accuracy (area under the curve, AUC of the ROC) of the DRC-based aldosterone-renin ratio (ARRCL) was compared with that of the PRA-based ARR (ARRRIA) using as reference the conclusive diagnosis of APA.Results:At Bland-Altman plot, the DRC and PAC assay showed no bias as compared to the PRA and PAC assay. A tight relation was found between the DRC and the PRA values (concordance correlation coefficient=0.92, p&lt;0.0001) and the PAC values measured with radioimmunoassay and chemiluminescence (concordance correlation coefficient=0.93, p&lt;0.001). For APA identification the AUC of the ARRCLwas higher than that of the ARRRIA[0.974 (95% CI 0.940–0.991) vs. 0.894 (95% CI 0.841–0.933), p=0.02].Conclusions:This rapid automated chemiluminescent DRC/PAC assay performed better than validated PRA/PAC radioimmunoassays for the identification of APA in referred hypertensive patients.</jats:sec

Modelling the length of hospital stay after knee replacement surgery through Machine Learning and Multiple Linear Regression at San Giovanni di Dio e Ruggi daAragonaa University Hospital

Knee arthroplasty is one of the most commonly performed procedures within a hospital. The progressive aging of the population and the spread of clinical conditions such as obesity will lead to an increasing use of this procedure. Therefore, being able to make the process related to this procedure more effective and efficient becomes strategic within hospitals, subject to increasingly stringent clinical and financial pressures. A useful parameter for this purpose is the length of stay (LOS), whose early prediction allows for better bed management and resource allocation, models patient expectations and facilitates discharge planning. In this work, the data of 124 patients who underwent knee surgery in the two-year period 2019-2020 at the San Giovanni di Dio and Ruggi d’Aragona university hospital were studied using multiple linear regression and machine learning algorithms in order to evaluate and predict how patient data affect LOS

IGF-I influences everolimus activity in medullary thyroid carcinoma

Context: Medullary thyroid carcinoma (MTC) is a rare tumor originating from thyroid parafollicular C cells. It has been previously demonstrated that insulin-like growth factor I (IGF-I) protects MTC from the effects of antiproliferative drugs. Everolimus, an mTOR inhibitor, has shown potent antiproliferative effects in a human MTC cell line, TT, and in two human MTC primary cultures. Objective: To verify whether IGF-I may influence the effects of everolimus in a group of human MTC primary cultures. Design: We collected 18 MTCs that were dispersed in primary cultures, treated without or with 10 nM-1 mu M everolimus and/or 50 nM IGF-I. Cell viability was evaluated after 48 h, and calcitonin (CT) secretion was assessed after a 6 h incubation. IGF-I receptor downstream signaling protein expression profile was also investigated. Results: Everolimus significantly reduced cell viability in eight MTC [by similar to 20%; P < 0.01 vs. control; everolimus-responders (E-R) MTCs], while cell viability did not change in 10 MTCs [everolimus-non-responders (E-NR) MTCs]. In E-R MTCs, IGF-I blocked the antiproliferative effects of everolimus that did not affect CT secretion, but blocked the stimulatory effects of IGF-I on this parameter. IGF-I receptor downstream signaling proteins were expressed at higher levels in E-NR MTC as compared to E-R MTCs. Conclusion: IGF-I protects a subset of MTC primary cultures from the antiproliferative effects of everolimus and stimulates CT secretion by an mTOR mediated pathway that, in turn, may represent a therapeutic target in the treatment of aggressive MTCs

Treatment of atherosclerotic renovascular hypertension: review of observational studies and a meta-analysis of randomized clinical trials.

open9Atherosclerotic renal artery stenosis can cause ischaemic nephropathy and arterial hypertension. We herein review the observational and randomized clinical trials (RCTs) comparing medical and endovascular treatment for control of hypertension and renal function preservation. Using the Population Intervention Comparison Outcome (PICO) strategy, we identified the relevant studies and performed a novel meta-analysis of all RCTs to determine the efficacy and safety of endovascular treatment when compared with medical therapy. The following outcomes were examined: baseline follow-up difference in mean systolic and diastolic blood pressure (BP), serum creatinine, number of drugs at follow-up, incident events (heart failure, stroke, and worsening renal function), mortality, cumulative relative risk of heart failure, stroke, and worsening renal function. Seven studies comprising a total of 2155 patients (1741 available at follow-up) were considered, including the recently reported CORAL Study. Compared with baseline, diastolic BP fell more at follow-up in patients in the endovascular than in the medical treatment arm (standard difference in means -0.21, 95% confidence interval (CI): -0.342 to -0.078, P = 0.002) despite a greater reduction in the mean number of antihypertensive drugs (standard difference in means -0.201, 95% CI: -0.302 to -0.1, P &lt; 0.001). At variance, follow-up changes (from baseline) of systolic BP, serum creatinine, and incident cardiovascular event rates did not differ between treatment arms. Thus, patients with atherosclerotic renal artery stenosis receiving endovascular treatment required less anti-antihypertensive drugs at follow-up than those medically treated. Notwithstanding this, they evidenced a better control of diastolic BP.openopenCaielli P;Frigo AC;Pengo MF;Rossitto G;Maiolino G;Seccia TM;Calò LA;Miotto D;Rossi GPCaielli, P; Frigo, ANNA CHIARA; Pengo, Mf; Rossitto, G; Maiolino, G; Seccia, TERESA MARIA; Calò, La; Miotto, Diego; Rossi, Gianpaol

RAndomized Clinical Trial Of NAfamostat Mesylate, A Potent Transmembrane Protease Serine 2 (TMPRSS2) Inhibitor, in patients with Covid-19 pneumonia: Safety SUPPLEMENTAL DATA

The file includes: Protocol of RACONA Study; Table S1: Seven-category ordinal scale; Table S2. Inclusion and ex-clusion criteria; Table S3. Flow-chart of the study; Table S4. Laboratory tests; Table S5. Secondary Outcomes; Table S6. Secondary biomarker endpoints; Table S7. Group-sequential design; Table S8. Completed trials of nafamostat mesylate for treatment of Covid-19 patients; Table S9. Ongoing trials of nafamostat mesylate for treatment of Covid-19 patients; Figure S1. Flow chart of the RACONA Study; Annex 1: CONSORT chart