Management of Portal Vein Thrombosis in Cirrhotic Patients

Portal vein thrombosis (PVT) not associated with hepatocellular carcinoma is considered a frequent complication of liver cirrhosis but, unlike PVT occurring in non-cirrhotic patients, very few data are available on its natural history and management. The reduced portal blood flow velocity is the main determinant of PVT but, as in other venous thromboses, multiple factors local and systemic, inherited or acquired often can concur with. PVT has a variety of clinical presentations ranging from asymptomatic to life-threatening diseases like gastroesophageal bleeding or acute intestinal ischemia. It is usually diagnosed by Doppler ultrasound but computed tomography and magnetic resonance imaging are useful to study the extent of thrombosis and the involvement of the abdominal organs. The risk of bleeding mainly determined by the presence of gastroesophageal varices and clotting alterations causes concern for the treatment of PVT in cirrhotic patients. To date, anticoagulant therapy seems to be indicated only in patients awaiting liver transplantation. This review focuses on the definition of the subgroups of patients with cirrhosis that might benefit from treatment of PVT and examines the pros and cons of the available treatments in terms of efficacy, monitoring and safety, providing also perspectives for future studies

river morphology monitoring using multitemporal sar data preliminary results

AbstractIn this paper, we test the capability of satellite synthetic aperture radar (SAR) images to enhance the monitoring of river geomorphological processes. The proposed approach exploits the recently introduced Level-α products. These products are bi-temporal RGB composites in which the association color-object, being physical-based, is stable whatever the scene is considered. This favors the detection of temporary rivers' characteristics for classification purposes in a change-detection environment. The case study was implemented on the Orco river (northwest Italy), where a set of 39 COSMO-SkyMed SAR stripmap images acquired from October 2008 to November 2014 was used to monitor channel planform changes. This preliminary study is devoted to assess the suitability of Level-α images for geomorphologist, with particular reference to the detection of phenomena of interest in river monitoring. This is prior for semi-automatic or automatic classification activities

A relação entre a identidade narrativa de Paul Ricouer e a identidade política de Hannah Arendt

Resumo: Tanto Ricouer quanto Arendt acreditavam que qualquer postura do sujeito no mundo e diante de si é comprometimento, é ação ética, é identidade. E o outro é condição sine qua non da identidade do sujeito. O problema filosófico da identidade narrativa é analisado neste trabalho de forma a apresentar a solução às principais aporias do problema filosófico tradicional da identidade pessoal, na qual se questiona sobre o critério essencial no reconhecimento de nós próprios ao longo do tempo. A questão da identidade narrativa e da identidade política terá como ponto de partida, neste trabalho, a questão do conceito de identidade narrativa em Paul Ricouer. Segundo, a mesma problemática será abordada, de forma a ressaltar a questão da pluralidade e da eticidade no pensamento de Ricouer e Hannah Arendt. Por fim, a temática central se fechará com a questão da promessa sobre a ótica dos dois pensadores.Palavras-chave: Identidade narrativa; Identidade política; Eticidade

Hydrological modeling in ungauged basins using SAR data

In this paper we propose a methodology devoted to exploit high resolution radars for monitoring water bodies in semi-arid countries. The proposed approach is based on appropriate registration, calibration and processing of SAR data, producing information ready to use by end-users. The obtained results were used to (i) estimate a relationship between surface and volume of water stored in reservoirs and (ii) validate a hydrological model that simulates the time evolution of water availability

Modeling Watershed Response in Semiarid Regions With High-Resolution Synthetic Aperture Radars

In this paper, we propose a methodology devoted to exploit the outstanding characteristics of COSMO-SkyMed for monitoring water bodies in semiarid countries at a scale never experienced before. The proposed approach, based on appropriate registration, calibration, and processing of synthetic aperture radar (SAR) data, allows outperforming the previously available methods for monitoring small reservoirs, mainly carried out with optical data, and severely limited by the presence of cloud coverage, which is a frequent condition in wet season. A tool has been developed for computing the water volumes retained in small reservoirs based on SAR-derived digital elevation model. These data have been used to derive a relationship between storage volumes and surface areas that can be used when bathymetric information is unavailable. Due to the lack of direct measures of river's discharge, the time evolution of water volumes retained at reservoirs has been used to validate a simple rainfall-runoff hydrological model that can provide useful recommendation for the management of small reservoirs. Operational scenarios concerning the improvement in the efficiency of reservoirs management and the estimation of their impact on downstream area point out the applicative outcomes of the proposed method

Diarrhea Is a Hallmark of Inflammation in Pediatric COVID-19

: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a pathogen with enteric tropism. We compared the clinical, biochemical and radiological features of children hospitalized for acute SARS-CoV-2 infection, classified in two groups based on the presence of diarrhea. Logistic regression analyses were used to investigate the variables associated with diarrhea. Overall, 407 children were included in the study (226 males, 55.5%, mean age 3.9 ± 5.0 years), of whom 77 (18.9%) presented with diarrhea, which was mild in most cases. Diarrhea prevalence was higher during the Alpha (23.6%) and Delta waves (21.9%), and in children aged 5-11 y (23.8%). Other gastrointestinal symptoms were most commonly reported in children with diarrhea (p < 0.05). Children with diarrhea showed an increased systemic inflammatory state (higher C-reactive protein, procalcitonin and ferritin levels, p < 0.005), higher local inflammation as judged by mesenteric fat hyperechogenicity (adjusted Odds Ratio 3.31, 95%CI 1.13-9.70) and a lower chance of previous immunosuppressive state (adjusted Odds Ratio 0.19, 95%CI 0.05-0.70). Diarrhea is a frequent feature of pediatric COVID-19 and is associated with increased systemic inflammation, which is related to the local mesenteric fat inflammatory response, confirming the implication of the gut not only in multisystem inflammatory syndrome but also in the acute phase of the infection

Clinical value of radiomics and machine learning in breast ultrasound: a multicenter study for differential diagnosis of benign and malignant lesions

We aimed to assess the performance of radiomics and machine learning (ML) for classification of non-cystic benign and malignant breast lesions on ultrasound images, compare ML's accuracy with that of a breast radiologist, and verify if the radiologist's performance is improved by using ML

Association between PaO2/FiO2 ratio and thrombotic events in COVID-19 patients

PaO2/FiO(2) (P/F ratio) is considered a marker of hypoxia/hypoxemia and mortality. Several prothrombotic changes are associated with the decrease of P/F ratio. The role of P/F ratio in patients with arterial and venous thrombosis remains unclear. The aim of this study was to assess in patients with coronavirus disease 2019 (COVID-19), the association between P/F ratio and arterial/venous thrombosis. One thousand and four hundred and six COVID-19 patients were recruited; 289 (21%) patients had P/F ratio &lt; 200 and 1117 (79%) &gt;= 200. Compared to the patients with P/F ratio &gt;= 200, those with P/F ratio &lt; 200 were older and with higher levels of glycemia, D-dimer and lower levels of albumin. Multiple linear regression analysis showed that albumin (standardized coefficient beta: 0.156; SE: 0.001; p = 0.0001) and D-dimer (standardized coefficient beta: -0.135; SE: 0.0001; p = 0.0001) were associated with P/F ratio. During the hospitalization 159 patients were transferred in intensive care unit (ICU), 253 patients died, 156 patients had arterial or venous thrombotic events. A bivariate logistic analysis was performed to analyze the predictors of thrombosis in COVID-19 patients; P/F ratio &lt; 200 (Odds Ratio: [OR] 1.718, 95% Confidence Interval [CI] 1.085-2.718, p = 0.021), albumin (OR 1.693, 95% CI 1.055-2.716, p = 0.029), D-dimer (OR 3.469, 95% CI 2.110-5.703, p &lt; 0.0001), coronary artery disease (CAD) (OR 1.800, 95% CI 1.086-2.984, p = 0.023) and heart failure (OR 2.410 95% CI 1.385-4.193, p = 0.002) independently predicted thrombotic events in this population. This study suggests that the P/F ratio is associated with thrombotic events by promoting a hypercoagulation state in patients hospitalized for COVID-19

Shorter androgen receptor polyQ alleles protect against life-threatening COVID-19 disease in European males

Background: While SARS-CoV-2 similarly infects men and women, COVID-19 outcome is less favorable in men. Variability in COVID-19 severity may be explained by differences in the host genome. Methods: We compared poly-amino acids variability from WES data in severely affected COVID-19 patients versus SARS-CoV-2 PCR-positive oligo-asymptomatic subjects. Findings: Shorter polyQ alleles (≤22) in the androgen receptor (AR) conferred protection against severe outcome in COVID-19 in the first tested cohort (both males and females) of 638 Italian subjects. The association between long polyQ alleles (≥23) and severe clinical outcome (p = 0.024) was also validated in an independent cohort of Spanish men <60 years of age (p = 0.014). Testosterone was higher in subjects with AR long-polyQ, possibly indicating receptor resistance (p = 0.042 Mann-Whitney U test). Inappropriately low serum testosterone level among carriers of the long-polyQ alleles (p = 0.0004 Mann-Whitney U test) predicted the need for intensive care in COVID-19 infected men. In agreement with the known anti-inflammatory action of testosterone, patients with long-polyQ and age ≥60 years had increased levels of CRP (p = 0.018, not accounting for multiple testing). Interpretation: We identify the first genetic polymorphism that appears to predispose some men to develop more severe disease. Failure of the endocrine feedback to overcome AR signaling defects by increasing testosterone levels during the infection leads to the polyQ tract becoming dominant to serum testosterone levels for the clinical outcome. These results may contribute to designing reliable clinical and public health measures and provide a rationale to test testosterone as adjuvant therapy in men with COVID-19 expressing long AR polyQ repeats. Funding: MIUR project "Dipartimenti di Eccellenza 2018-2020" to Department of Medical Biotechnologies University of Siena, Italy (Italian D.L. n.18 March 17, 2020) and "Bando Ricerca COVID-19 Toscana" project to Azienda Ospedaliero-Universitaria Senese. Private donors for COVID-19 research and charity funds from Intesa San Paolo

An explainable model of host genetic interactions linked to COVID-19 severity

We employed a multifaceted computational strategy to identify the genetic factors contributing to increased risk of severe COVID-19 infection from a Whole Exome Sequencing (WES) dataset of a cohort of 2000 Italian patients. We coupled a stratified k-fold screening, to rank variants more associated with severity, with the training of multiple supervised classifiers, to predict severity based on screened features. Feature importance analysis from tree-based models allowed us to identify 16 variants with the highest support which, together with age and gender covariates, were found to be most predictive of COVID-19 severity. When tested on a follow-up cohort, our ensemble of models predicted severity with high accuracy (ACC = 81.88%; AUCROC = 96%; MCC = 61.55%). Our model recapitulated a vast literature of emerging molecular mechanisms and genetic factors linked to COVID-19 response and extends previous landmark Genome-Wide Association Studies (GWAS). It revealed a network of interplaying genetic signatures converging on established immune system and inflammatory processes linked to viral infection response. It also identified additional processes cross-talking with immune pathways, such as GPCR signaling, which might offer additional opportunities for therapeutic intervention and patient stratification. Publicly available PheWAS datasets revealed that several variants were significantly associated with phenotypic traits such as "Respiratory or thoracic disease", supporting their link with COVID-19 severity outcome.A multifaceted computational strategy identifies 16 genetic variants contributing to increased risk of severe COVID-19 infection from a Whole Exome Sequencing dataset of a cohort of Italian patients