Single-center experience in the treatment of visceral artery aneurysms

Background: Visceral artery aneurysms (VAAs), although rare, represent a life-threatening disease with high mortality rates. With the more frequent use of diagnostic tests, there has been an incidental detection of these lesions which are mostly asymptomatic. It follows that surgeons are increasingly called to decide on the most appropriate management of VAAs between an open surgical or endovascular approach and among the different endovascular options currently available. The aim of this retrospective study was to evaluate the results of open surgery and interventional endovascular strategies of visceral artery aneurysms with respect to technical success, therapy-associated complications, and postinterventional follow-up in the elective and emergency situation. Methods: From January 1992 to January 2017, 125 open surgical or endovascular interventions for VAA were performed at our institution. Once the VAA was diagnosed and the indication for treatment was assessed, the preoperative diagnostic work-up consisted of contrast computed tomography (CT) or magnetic resonance imaging (MRI) and, in some patients, digital subtraction angiography. Follow-up included clinical and duplex ultrasound scan (DUS) and contrast-enhanced ultrasound to assess the treated vessel patency and organ perfusion after 1, 6, and 12 months, and yearly thereafter. CT or MRI controls were also performed at 1 year of follow-up and only when DUS was not diagnostic or showed a complication thereafter. After the first 5 years of follow-up, the status of the patient was obtained by a structured telephone survey. Results: The treatment option was endovascular in 56 of 125 cases (44.8%). Technical success was 98.3%. In one case, the procedure was interrupted for the extensive dissection of the afferent vessel. Twenty-six patients were treated by coil embolization while 29 with covered stenting. The endovascular approach was in emergency in two cases (3.6%). In the endovascular group, mortality was nil. Complications occurred in 5 cases (8.9%): 1 subacute intestinal ischemia caused by superior mesenteric artery dissection, 2 aneurysm reperfusion, 1 stent thrombosis, and 1 massive splenic hematoma. In 69 (55.2%) cases, surgical treatment was preferred, with 24 VAA resections and 45 arterial reconstructions. In 20 cases (29%), open surgery was performed in emergency conditions. In the surgical group, 8 emergency patients (40%) died intraoperatively. The mortality after elective surgical interventions was nil. Complications after surgery were 4 graft late thrombosis (5.8%): asymptomatic in three cases and requiring splenectomy in one. Conclusions: There is no overall consensus regarding the indications for treatment of VAA. Currently in emergent setting, the endovascular approach should be considered as the first choice because of its reduced invasiveness, faster way to access and bleeding control; this accounts for the lower morality of the interventional therapy than open surgery. Endovascular approach is effective for elective repair of VAAs, but procedure-related complications may occur in a not negligible number of patients. Given comparable mortality rates and low procedure-related complication rate, surgical approach still has space in the elective management of VAAs, especially for aneurysms unsuitable or challenging for the endovascular option in patients with low surgical risk. The size, location, and morphology of VAAs, systemic or local comorbidities, and specific anatomical situations such as previous abdominal surgery should dictate treatment choice

MicroRNA-551b expression profile in low and high-grade cervical intraepithelial neoplasia

OBJECTIVE: To evaluate the expression of microRNA (miR)-551b in patients with low and high grade cervical intraepithelial neoplasia (CIN) and to find an association with high-risk Human Papillomavirus (HR-HPV) infection-related prognostic biomarkers. PATIENTS AND METHODS: The expression level of miR-551b was determined in 50 paraffin-embedded cervical specimens (10 normal squamous epithelium, 18 condylomas, 8 CIN1, and 14 CIN2-3) using quantitative Real-time polymerase chain reaction (qRT-PCR). χ2-test compared miR-551b expression in different diagnosis groups. An Ordered Logistic Regression and a Probit correlation were made to correlate miR-551b expression levels with the cervical tissue histological findings. The immunohistochemical distribution of p16 and Ki-67 according to histopathological findings was also assessed. RESULTS: The distribution of the miR-551b expression profile was significantly lower in CIN1-3 samples compared to other histological diagnosis groups (condyloma and negative). The expression levels were inversely correlated to the cervical pathological grade, from negative to CIN2-3. A 1% increase in miR-551b expression level produced an increase of 19% to the probability of a minor histological grade diagnosis in a range from negative to CIN2-3 and an increase of 13% to the probability of a negative histological grade diagnosis. Among the cases with miR-551b expression < 0.02 (considered as cut-off value) a significant statistical correlation was found between p16 and Ki-67 expression and the diagnosis of CIN2-3. CONCLUSIONS: O ur d ata s howed a s ignificant inverse correlation between miR-551b expression and the histological grading of the lesions, suggesting a tumor suppressive function in the different stages of cervical dysplasia

VALUTAZIONE DELLA CLEARANCE DI HCV-RNA SOTTO TRATTAMENTO ANTIVIRALE CON TRANSCRIPTION-MEDIATED AMPLIFICATION (TMA)

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Genetic counseling during COVID-19 pandemic: Tuscany experience

Background: COVID-19 outbreak prompted health centres to reorganize their clinical and surgical activity. In this paper, we show how medical genetics department's activity, in our tertiary pediatric hospital, has changed due to pandemic. Methods: We stratified all our scheduled visits, from March 9th through April 30th, and assessed case-by-case which genetic consultations should be maintained as face-to-face visit, or postponed/switched to telemedicine. Results: Out of 288 scheduled appointments, 60 were prenatal consultations and 228 were postnatal visits. We performed most of prenatal consultations as face-to-face visits, as women would have been present in the hospital to perform other procedures in addition to our consult. As for postnatal care, we suspended all outpatient first visits and opted for telemedicine for selected follow-up consultations: interestingly, 75% of our patients’ parents revealed that they would have cancelled the appointment themselves for the fear to contract an infection. Conclusions: Spread of COVID-19 in Italy forced us to change our working habits. Given the necessity to optimize healthcare resources and minimize the risk of in-hospital infections, we experienced the benefits of telegenetics. Current pandemic made us familiar with telemedicine, laying the foundations for its application to deal with the increasing number of requests in clinical genetics

Immunotherapy in Pancreatic Cancer: Why Do We Keep Failing? A Focus on Tumor Immune Microenvironment, Predictive Biomarkers and Treatment Outcomes

The advent of immunotherapy and targeted therapies has dramatically changed the outcomes of patients affected by many malignancies. Pancreatic cancer (PC) remains one the few tumors that is not treated with new generation therapies, as chemotherapy still represents the only effective therapeutic strategy in advanced-stage disease. Agents aiming to reactivate the host immune system against cancer cells, such as those targeting immune checkpoints, failed to demonstrate significant activity, despite the success of these treatments in other tumors. In many cases, the proportion of patients who derived benefits in early-phase trials was too small and unpredictable to justify larger studies. The population of PC patients with high microsatellite instability/mismatch repair deficiency is currently the only population that may benefit from immunotherapy; nevertheless, the prevalence of these alterations is too low to determine a real change in the treatment scenario of this tumor. The reasons for the unsuccess of immunotherapy may lie in the extremely peculiar tumor microenvironment, including distinctive immune composition and cross talk between different cells. These unique features may also explain why the biomarkers commonly used to predict immunotherapy efficacy in other tumors seem to be useless in PC. In the current paper, we provide a comprehensive and up-to-date review of immunotherapy in PC, from the analysis of the tumor immune microenvironment to immune biomarkers and treatment outcomes, with the aim to highlight that simply transferring the knowledge acquired on immunotherapy in other tumors might not be a successful strategy in patients affected by PC

Access and metro network convergence for flexible end-to-end network design

This paper reports on the architectural, protocol, physical layer, and integrated testbed demonstrations carried out by the DISCUS FP7 consortium in the area of access - metro network convergence. Our architecture modeling results show the vast potential for cost and power savings that node consolidation can bring. The architecture, however, also recognizes the limits of long-reach transmission for low-latency 5G services and proposes ways to address such shortcomings in future projects. The testbed results, which have been conducted end-to-end, across access - metro and core, and have targeted all the layers of the network from the application down to the physical layer, show the practical feasibility of the concepts proposed in the project

Evidence for a large-magnitude Holocene eruption of Mount Rittmann (Antarctica): A volcanological reconstruction using the marine tephra record

In Antarctica, the near-source exposures of volcanic eruption deposits are often limited as they are not well preserved in the dynamic glacial environment, thus making volcanological reconstructions of explosive eruptions extremely challenging. Fortunately, pyroclastic deposits from explosive eruptions are preserved in Southern Ocean sediments surrounding Antarctica, and the tephrostratigraphy of these sequences offers crucial volcanological information including the timing and tempo of past eruptions, their magnitude, and eruption dynamics. Here we report the results of a tephrostratigraphy and tephrochronology study focused on four sediment cores recovered from the Wood Bay area in the western Ross Sea, Antarctica. In all these sedimentary sequences, we found a well-stratified primary tephra of considerable thickness, up to 80 cm, hereafter named the Aviator Tephra (AVT). According to the characteristics of the tephra deposit and its distribution, the AVT was associated with an eruption of considerable intensity, potentially representing one of the largest Holocene eruptions recorded in Antarctica. Based on the major and trace element geochemistry and the mineral assemblage of the tephra, Mount Rittmann was identified as the source of the AVT. A Holocene age of ∼11 ka was determined by radiocarbon dating organic material within the sediments and 40Ar-39Ar dating of alkali-feldspar crystals included in the tephra. Eruption dynamics were initially dominated by hydromagmatic magma fragmentation conditions producing a sustained, relatively wet and ash-rich eruptive cloud. The eruption then evolved into a highly energetic, relatively dry magmatic Plinian eruption. The last phase was characterized by renewed efficient magma-water interaction and/or collapse of the eruptive column producing pyroclastic density currents and associated co-ignimbritic plumes. The distal tephra deposits might be linked to the widespread lag breccia layer previously identified on the rim of the Mount Rittmann caldera which share the same geochemical composition. Diatoms found in the sediments surrounding the AVT and the primary characteristics of the tephra indicate that the Wood Bay area was open sea at the time of the eruption, which is much earlier than previously thought. AVT is also an excellent tephrostratigraphic marker for the Wood Bay area, in the Ross Sea, and a useful marker for future synchronization of continental ice and marine archives in the region

The loss of energy and environmental efficiency of passenger mobility in the Big La Plata, between 1993 and 2013

La forma de crecimiento de las ciudades argentinas en los últimos años ha incrementado la demanda de movilidad de pasajeros y la ineficiencia energética y ambiental de cada viaje. En este trabajo se presenta una evaluación energética y ambiental del sistema de transporte de pasajeros de la ciudad de La Plata entre 1993 y 2013, a efectos de dimensionar la pérdida de eficiencia de dicho sistema. La información de transporte se basa en encuestas de movilidad y la construcción de indicadores a partir de los valores del modelo Leap adaptados por la fundación Bariloche al caso argentino. Los resultados permiten establecer niveles de criticidad a las variables involucradas siendo la primera el incremento de las tasas de generación de viajes en automóvil, incluyendo los particulares y los autos de alquiler, y la segunda es el incremento de la distancia media de viajes por modo, especialmente por los modos individuales. Las conclusiones sugieren puntos focales para la aplicación de medidas de eficiencia energética y ambiental en el binomio integrado del desarrollo urbano y la movilidad de pasajeros.The form of growth of the Argentine cities in recent years has increased the demand for passenger mobility and energy and environmental inefficiency of each trip. In this paper an energy and environmental assessment passenger transport system of the city of La Plata between 1993 and 2013, in order to gauge the loss of efficiency of the system we are presented. Transportation information is based on surveys of mobility and construction of indicators based on the values of LEAP model adapted by the Argentine Bariloche Foundation case. The results indicate levels of criticality to the variables involved being the first increased generation rates of car trips, including individuals and rental cars, and the second is the increase in the average distance of travel by mode, especially for the individual modes. The findings suggest focal points for the implementation of measures of energy and environmental efficiency binomial integrated urban development and mobility of passengers.Instituto de Investigaciones y Políticas del Ambiente Construid

How do Vaccinators Experience the Pandemic? Lifestyle Behaviors in a Sample of Italian Public Health Workers during the COVID-19 Era

Public health workers (PHWs) have experienced substantial workload changes because of their role in managing measures to limit the spread of COVID-19. The study’s aim was to assess lifestyle changes in Italian PHWs during the pandemic. PHWs attending an annual meeting completed an anonymous questionnaire assessing their sociodemographic and behavioral characteristics and lifestyle changes during the pandemic. A total of 1000 questionnaires were completed. Most participants (63.5% women, mean age 40 ± 13.1 years) were of normal weight (61.5%), non-smokers (81.9%), had a total screen time of ≥5 h/day (83.1%), and slept at least 6 h/night (88.7%). Approximately one-third consumed sweet foods every day (30%) and did not engage in physical activity (34.6%). Current sweet food consumption, physical activity, and sleep were associated with changes in these behaviors in the last 2 years (Tau-b = 0.155; Tau-b = −0.175; Tau-b = −0.276, respectively, p &lt; 0.001). An increase in remote working was associated with worse sleep (odds ratio (OR) 2.065, 95% confidence interval (CI) 1.482–2.877) and diet (OR 1.982, 95% CI 1.385–2.838), and increased tablet/PC use (OR 3.314, 95% CI 2.358–4.656). Health promotion measures are needed to support the adoption of healthy lifestyles in this population during the current pandemic

A novel INDEL mutation in the EDA gene resulting in a distinct X- linked hypohidrotic ectodermal dysplasia phenotype in an Italian family

A novel INDEL mutation in theEDA gene resulting in a distinctX- linked hypohidroticectoder mal dysplasia phenotypein an Italian familyEditorX-Linked Hypohidrotic Ectodermal Dysplasia (XL-HED; MIM305100) is characterized by hypodontia, misshaped teeth, hypo-hidrosis, sparse hair, peculiar facial features,1,2and occurs in lessthan 1 in every 100.000 individuals.1XL-HED is caused bymutations in the Ectodysplasin-A (EDA) gene located at Xq12-q13 with more than 100 causative mutations reported todate.1,3,4The identification of disease-causing mutations con-firms the diagnosis, however, does not automatically imply agenotype\u2013phenotype correlation