Repeated endoscopic ultrasound-guided fine-needle biopsy of solid pancreatic lesions after previous nondiagnostic or inconclusive sampling

OBJECTIVES

Repeated endoscopic ultrasound (EUS)-guided tissue acquisition represents the standard practice for solid pancreatic lesions after previous nondiagnostic or inconclusive results. Since data are lacking, we aimed to evaluate the diagnostic performance of repeated EUS fine-needle biopsy (rEUS-FNB) in this setting. The primary outcome was diagnostic accuracy; sample adequacy, sensitivity, specificity, and safety were secondary outcomes.

METHODS

Consecutive patients undergoing rEUS-FNB for solid pancreatic lesions at 23 Italian centers from 2019 to 2021 were retrieved. Pathology on the surgical specimen, malignant histology together with ≥6-month follow-up, and benign pathology together with ≥12-month follow-up were adopted as gold standards.

RESULTS

Among 462 patients, 56.5% were male, with a median age of 68 (59-75) years, malignancy prevalence 77.0%. Tumor size was 26 (20-35) mm. Second-generation FNB needles were used in 89.6% cases. Diagnostic accuracy, sensitivity, and specificity of rEUS-FNB were 89.2%, 91.4%, and 81.7%, respectively (19 false-negative and 12 false-positive results). On multivariate analysis, rEUS-FNB performed at high-volume centers (odds ratio [OR] 2.12; 95% confidence interval [CI] 1.10-3.17; P = 0.03) and tumor size (OR 1.03; 95% CI 1.00-1.06; P = 0.05) were independently related to diagnostic accuracy. Sample adequacy was 94.2%. Use of second-generation FNB needles (OR 5.42; 95% CI 2.30-12.77; P < 0.001) and tumor size >23 mm (OR 3.04; 95% CI 1.31-7.06; P = 0.009) were independently related to sample adequacy.

CONCLUSION

Repeated EUS-FNB allowed optimal diagnostic performance after nondiagnostic or inconclusive results. Patients' referral to high-volume centers improved diagnostic accuracy. The use of second-generation FNB needles significantly improved sample adequacy over standard EUS-FNB needles.

Adalimumab Drug Levels at Secondary Loss of Response Do Not Predict Response to Dose-intensification in Crohn's Disease: A Retrospective, International Multicenter Study

BACKGROUND

The exposure-response relationship is less established for adalimumab (ADA) compared with infliximab in inflammatory bowel disease (IBD). Evidence supporting therapeutic drug monitoring post dose-intensification of ADA is limited. We aimed to explore the association between ADA drug levels and Crohn's disease (CD) activity at loss of response, and at 6 and 12 months post dose-intensification.

METHODS

We performed a retrospective study of adult patients with CD receiving dose-intensified weekly ADA following secondary loss of response at 3 tertiary centers across 5 years. ADA trough levels were analyzed using a drug-sensitive enzyme-linked immunosorbent assay at loss of response, and 6 and 12 months after dose-intensification. Rates of clinical remission, objective remission (C-reactive protein <5 mg/L, fecal calprotectin <150 µg/g, or absence of inflammation at endoscopy or imaging), and ADA failure were investigated.

RESULTS

A total of 131 CD patients were included, with a median disease duration of 9 (interquartile range, 4-17) years. 51% were biologic exposed prior to ADA and 50% received concomitant immunomodulators. Baseline drug levels measured at secondary loss of response did not discriminate between subsequent responders and non-responders at either 6 or 12 months post dose-intensification. However, both higher drug levels at 6 and 12 months and a higher increment from baseline were associated with improved outcomes. On receiver-operating characteristic analyses, post-escalation ADA drug levels >10.7 µg/mL (area under the receiver-operating characteristic curve [AUROC], 0.66; P = .013) and >10.9 µg/mL (AUROC, 0.67; P = .032) were associated with objective remission at 6 and 12 months, respectively.

CONCLUSIONS

Drug levels following dose-intensification rather than at the time of secondary loss of response were associated with subsequent CD remission.

The role of self-efficacy beliefs in dealing with misinformation among adolescents

The present study aims to understand the processes involved in misinformation among adolescents by examining the role of self-efficacy beliefs in dealing with misleading news. Specifically, we argue that the perceived capability to analyze and reflect critically on the reliability of online information sources should be stayed with the perceived self-regulatory capability to resist online social pressures to share unverifiable news. Moreover, we posited that specific online self-efficacies beliefs can be promoted by the capabilities related to regulating emotions and reflecting on new problems. In a sample of 273, we tested a path analysis model. The results attest that self-efficacy beliefs in dealing with online misinformation refer to specific capabilities: an active one, related to checking the sources of the news in order to validate their content, and an inhibitory one, related to the capability to refrain from sharing the news that seems unreliable. Moreover, self-efficacy beliefs in self-control during online interaction spreading misleading news are supported by cognitive reflective capability and self-efficacy in regulating negative emotion. The relationship between active self-efficacy related to fact-checking and sharing misleading news is not significant. The role of regulation in sharing misinformation during activated online dynamics is discussed.

Incidental finding of intrathoracic caudate lobe of the liver associated with an arterovenous malformation

In this case report we describe an occasional finding of intrathoracic caudate lobe protruding through the diaphragm foramen in a 73-year-old woman who came to our attention for a screening for coronary artery disease, due to the presence of cardiovascular risk. The patient had no symptoms. The computed tomography showed, a circumscribed homogeneous soft tissue mass that protruding through the aortic diaphragmatic foramen that was as isodense as the liver. Moreover was revealed an abnormal artery emerging from the celiac tripod which, through the diaphragmatic foramen, ends in an inferior pulmonary vein creating an arteriovenous malformation.

Role of computed tomography in transcatheter replacement of 'other valves': a comprehensive review of preprocedural imaging

Transcatheter procedures for heart valve repair or replacement represent a valid alternative for treating patients who are inoperable or at a high risk for open-heart surgery. The transcatheter approach has become predominant over surgical intervention for aortic valve disease, but it is also increasingly utilized for diseases of the 'other valves', that is the mitral and, to a lesser extent, tricuspid and pulmonary valve. Preprocedural imaging is essential for planning the transcatheter intervention and computed tomography has become the main imaging modality by providing information that can guide the type of treatment and choice of device as well as predict outcome and prevent complications. In particular, preprocedural computed tomography is useful for providing anatomic details and simulating the effects of device implantation using 3D models. Transcatheter mitral valve replacement is indicated for the treatment of mitral regurgitation, either primary or secondary, and computed tomography is crucial for the success of the procedure. It allows evaluating the mitral valve apparatus, the surrounding structures and the left heart chambers, identifying the best access route and the landing zone and myocardial shelf, and predicting obstruction of the left ventricular outflow tract, which is the most frequent postprocedural complication. Tricuspid valve regurgitation with or without stenosis and pulmonary valve stenosis and regurgitation can also be treated using a transcatheter approach. Computer tomography provides information on the tricuspid and pulmonary valve apparatus, the structures that are spatially related to it and may be affected by the procedure, the right heart chambers and the right ventricular outflow tract.

Pseudoaneurysm of the aortic root following aortic valve endocarditis - a case with 2 rare life - threatening complications

Infective endocarditis can have peri-annular spread and involve the valvular annulus and adjacent cardiac structures, leading to tissue necrosis and peri-annular abscess. This process may cause pseudoaneurysm formation and other rare and potentially life-threatening complications, so their identification and correct diagnosis are crucial.

We describe a case of an 81-year-old woman, with a history of aortic valve replacement and worsening of symptoms, that presents at the imaging a pseudoaneurysm of the aortic root complicated at the same time by 2 life-threatening conditions: fistulization in the Right Ventricular Outflow Tract (RVOT) and the compression of Right Coronary Artery (RCA).

This case underlines the importance of imaging, especially Coronary Computed Tomography Angiography (CCTA), in the diagnosis and follow-up of infective endocarditis and its complications, especially in a patient not eligible for surgery.

Transcatheter aortic valve implantation in patients with unruptured aortic root pseudoaneurysm: an observational study

AIMS

Unruptured aortic root pseudoaneurysm (UARP) is a rare complication of aortic valve endocarditis. Infectious spread to the valvular annulus or myocardium can cause septic complications that manifest as wall thickening, and spontaneous abscess drainage leads to pseudoaneurysm formation. We report the first patient series in which transcatheter aortic valve implantation (TAVI) using a single valve-resolved aortic valvulopathy associated with UARP was performed.

METHODS

At our center, from December 2017 to October 2019, 138 patients underwent TAVI for aortic valve stenosis and/or regurgitation, 20 of whom (12 female patients, 8 male patients) had associated incidental UARP and were considered as our study population. The average age of these patients was 76.9 ± 5.2 years. All patients were assessed using preprocedural and postprocedural multimodality imaging, including transthoracic echocardiography, transesophageal echocardiography, and cardiac computed tomography angiography (CCTA).

RESULTS

In all cases, the final angiographic examination showed correct valve positioning with complete coverage of the false aneurysm. Post-TAVI CCTA showed presence of total or subtotal UARP thrombosis. The mean follow-up period was 17.5 months (12-23 months). During follow-up, imaging showed normal prosthetic valve function, no significant leakage (trace or mild), and complete UARP exclusion in all patients, without any complications.

CONCLUSION

In conclusion, percutaneous valve positioning can simultaneously solve pseudoaneurysm complications by excluding the sac and promoting thrombosis.

Relationship between septo-valvular angle and risk of pacemaker implantation after transcatheter aortic valve implantation: a preliminary study

AIM

Pre-transcatheter aortic valve implantation (TAVI) computed tomography (CT) has proven to be crucial in identifying pre- and post-procedural predicting factors predisposing the onset of major arrhythmias that require permanent pacemaker (PPM) implantation caused by the compressive effects of the prostheses on the conduction system at the membranous septum (MS) and the muscular crest of the interventricular septum.Our analysis aims to verify if the pre-TAVI assessment of the angle between the MS and the aortic annulus (SVA) might be a predictive factor for the onset of arrhythmias that requires PPM.

METHODS

Two cardiovascular specialist radiologists retrospectively and double-blind evaluated a randomized list of preprocedural CT of 57 patients who underwent TAVI with a self-expandable valve from April 2019 to February 2020. Two anatomical features were measured by readers: width of the SVA and MS length (MSL).

RESULTS

A PPM was implanted in 18 patients (31%) after the procedure. There was no significant difference in the anatomical measurements performed between the two observers, regarding both anatomical measurements (intraclass correlation coefficient was 0.944 for the SVA and 0.774 for the MSL]. Receiver-operating characteristic curves (ROC) performed for both measurements have documented: for the SVA sensitivity 94% and Negative predictive value (NPV) 96% (area under the curve: 0.77; 95% confidence interval 0.66-0.90). The MSL ROC was not significant. The mean SVA value stratified for patients who did not undergo PPM implantation and patients who did resulted as significant (P < 0.005).

CONCLUSION

Measurement of the SVA performed in preprocedural CT scans has proven to be related to the onset of major arrhythmias after TAVI requiring permanent pacemaker implantation with high sensitivity (94%) and NPV (96%).

Anatomic features in SCAD assessed by CCT: A propensity score matching case control study

PURPOSE

Spontaneous coronary artery dissection (SCAD) may occur in middle age population without any cardiovascular risk factor. We retrospectively evaluated anatomic features of 11 patients with SCAD using a coronary arteries computed tomography (CCT), compared to age and sex balanced patients who underwent CCT.

MATERIAL AND METHODS

CCT was performed in 11 patients (7 females and 4 males) as follow-up in patients with SCAD (left anterior descending - LAD or circumflex artery - Cx) and compared, using the propensity score matching analysis, with 11 healthy patients. Several anatomic features were evaluated: Left main (LM) length, angle between descending coronary artery (LAD) and its first branch, angle between LAD and LM, distance from the annulus to RCA (a-RCA distance) and LM (a-LM distance) ostia and their ratio; ratio between LM length and length a-LM and tortuosity score of the vessel with SCAD. A fluid dynamic analysis has been performed to evaluate the effects on shear stress of vessels wall.

RESULTS

LM length was significantly shorter in patients with SCAD versus healthy subjects (P=0.01) as well as LM length/a-LM (P=0.03) and the angle between LAD and the first adjacent branch was sharper (P<0.01). Tortuosity score showed a statistically significant difference between groups (P<0.001). Fluid dynamic analysis demonstrates that, in SCAD group, an angle<90 degree is present at the first bifurcation and it can be a cause of increased strain on vessel wall in patients with high tortuosity of coronary artery.

CONCLUSION

Tortuosity and angle between the LAD and the adjacent arterial branch combined may determine increased shear stress on the vessel wall that increases the risk of SCAD.

Schadenfreude: Malicious Joy in Social Media Interactions

The paper presents a model of Schadenfreude, pleasure at another’s misfortune, resulting in a typology of cases of this emotion. Four types are singled out: Compensation, Identification, Aversion, and Injustice Schadenfreude. The typology is first tested on a corpus of 472 comments drawn from three social media, Facebook, Twitter and Instagram. Then a specific corpus of comments is collected and analyzed concerning a specific case of Injustice Schadenfreude, the posts concerning Brexit, United Kingdom leaving the European Union. From the analysis, it emerges that spatial or factual closeness does not look necessary to feel Schadenfreude. Finally, a lexicometric automatic analysis is conducted on the general corpus of Italian comments collected using several hashtags and enriched by comments about the fire of Notre Dame, showing how even complex emotions like Schadenfreude can be automatically extracted from social media.

Chest Computed Tomography Scoring in Patients With Novel Coronavirus-infected Pneumonia: Correlation With Clinical and Laboratory Features and Disease Outcome

BACKGROUND/AIM

This study investigated the correlation of chest computed tomography (CT), findings, graded using two different scoring methods, with clinical and laboratory features and disease outcome, including a novel clinical predictive score, in patients with novel coronavirus-infected pneumonia (NCIP).

PATIENTS AND METHODS

In this retrospective, observational study, CT scan of 92 NCIP patients admitted to Policlinico Tor Vergata, were analyzed using a quantitative, computed-based and a semiquantitative, radiologist-assessed scoring system. Correlations of the two radiological scores with clinical and laboratory features, the CALL score, and their association with a composite adverse outcome were assessed.

RESULTS

The two scores correlated significantly with each other (ρ=0.637, p<0.0001) and were independently associated with age, LDH, estimated glomerular filtration rate, diabetes, and with the composite outcome, which occurred in 24 patients.

CONCLUSION

In NCIP patients, two different radiological scores correlated with each other and with several clinical, laboratory features, and the CALL score. The quantitative score was a better independent predictor of the composite adverse outcome than the semiquantitative score.

Anatomical predictors of residual left-to-right shunt after percutaneous suture-mediated patent fossa ovale closure

Background

Percutaneous suture-mediated patent fossa ovale (PFO) closure has recently been introduced in clinical practice to overcome most of the limitations of metallic PFO occluders with early results showing a favourable efficacy and safety profile in most PFO cases.

Purpose

To assess PFO anatomy in a large series of patients undergoing percutaneous suture-mediated PFO closure in order to identify anatomical predictors of significant residual right-to-left shunt (RLS) and thus appropriately select patients to be submitted to this technique.

Methods

Pre-procedural transesophageal echocardiogram of 230 patients undergoing suture-mediated PFO closure at our Institution were carefully reviewed both qualitatively and quantitatively. The following parameters were systematically assessed in all reviewed cases: presence and grade of baseline atrial RLS, presence of bidirectional shunt, PFO length and width, presence of atrial septal aneurysm and its maximal bulge, presence and size of an embryonic or foetal remnant.

Results

In 37 patients a residual atrial RLS ≥2 grade was found at a mean follow-up of 248±147 days. The following variable were found to be significantly associated with significant residual atrial RLS at follow-up: grade of baseline spontaneous and Valsalva manoeuvre RLS shunt (odds ratio 2.39, 95% confidence interval 1.48–3.89, p=0.001 and odds ratio 3.07, 95% confidence interval 1.22–7.23, p=0.017), baseline bidirectional shunt across the PFO (odds ratio 3.59, 95% confidence interval 1.47–8.77, p=0.005) and PFO width (odds ratio 2.61, 95% confidence interval 1.92–3.55, p=0.001).

At multivariable analysis, only PFO width ≥5 mm (odds ratio 10.97, 95% confidence interval 4.22–28.56, p=0.001) and grade of baseline RLS shunt (odds ratio 1.84, 95% confidence interval 1.05–3.21, p=0.032) were independent predictors of a significant atrial RLS at follow-up.

Conclusions

Suture-mediated PFO closure represents a valid alternative to traditional devices with an excellent safety and efficacy profile at follow-up. As for any new technique, it is extremely important to select the right anatomical and functional features predictive of a successful closure. The results of this study indicate that the suture-mediated closure of PFO is feasible in the majority of septal anatomies however wide PFO ≥5 mm are less likely to be closed with only one stitch.

Funding Acknowledgement

Type of funding source: None

Role of computed tomography in transcatheter aortic valve implantation and valve-in-valve implantation: complete review of preprocedural and postprocedural imaging

: Since 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the treatment and prognosis of patients with aortic stenosis. A preprocedural assessment of the patient is vital for achieving optimal outcomes from the procedure. Retrospective ECG-gated cardiac computed tomography (CT) today it is the gold-standard imaging technique that provides three-dimensional images of the heart, thus allowing a rapid and complete evaluation of the morphology of the valve, ascending aorta, coronary arteries, peripheral access vessels, and prognostic factors, and also provides preprocedural coplanar fluoroscopic angle prediction to obtain complete assessment of the patient. The most relevant dimension in preprocedural planning of TAVI is the aortic annulus, which can determine the choice of prosthesis size. CT is also essential to identify patients with increased anatomical risk for coronary artery occlusion in Valve in Valve (ViV) procedures.Moreover, CT is very useful in the evaluation of late complications, such as leakage, thrombosis and displacements. At present, CT is the cornerstone imaging modality for the extensive and thorough work-up required for planning and performing each TAVI procedure, to achieve optimal outcomes. Both the CT procedure and analysis should be performed by trained and experienced personnel, with a radiological background and a deep understanding of the TAVI procedure, in close collaboration with the implantation team. An accurate pre-TAVI CT and post-processing for the evaluation of all the points recommended in this review allow a complete planning for the choice of the valve dimensions and type (balloon or self-expandable) and of the best percutaneous access.

Ascending aorta pseudoaneurysm simulating mediastinal lymphoma in computed tomography, a possible diagnostic error: a case report

Background

An ascending aortic pseudoaneurysm is a severe and rare complication following cardiothoracic surgery. This case report demonstrates its possible misinterpretation and the consequent importance of multidisciplinary evaluation.

Case presentation

We present a case of an 18-year-old Caucasian man with Marfan syndrome who developed an ascending aortic pseudoaneurysm about 1 year after undergoing cardiac surgery with the Bentall procedure. Computed tomographic examination of the thoracic aorta and positron emission tomography–computed tomography initially suggested a lymphomatous pathology. However, these imaging results were in contrast to the transesophageal echocardiogram and the laboratory data that showed negative results for hematological pathology. A second computed tomographic scan redirected the diagnosis toward a pseudoaneurysm.

Conclusion

This case demonstrates the utility of close communication and interdisciplinary consultation between cardiovascular radiologists and the cardiac surgery team, which are mandatory in order to maximize their diagnostic skills in identifying postoperative complications.

Association of plaque calcification pattern and attenuation with instability features and coronary stenosis and calcification grade

BACKGROUND AND AIMS

Coronary computed tomography (CT) allows calculating coronary artery calcium score (CACS). However, other CT features might be more strongly related to plaque vulnerability and risk of future coronary events. This study investigated the association of plaque calcification pattern and attenuation with plaque instability features, coronary artery disease (CAD) grade and CACS.

METHODS

One-hundred patients with coronary stenosis associated with calcified plaques were considered for this analysis. CACS, CAD grade, calcification pattern and attenuation, features of plaque instability, and epicardial adipose tissue (EAT) thickness and attenuation were assessed with non-contrast and contrast-enhanced CT angiography.

RESULTS

Of 373 calcified plaques, 131 were responsible for the highest degree of coronary stenosis (1.31 ± 0.53 per patient). Participants were stratified according to the features of the highest-grade lesion(s) into patients with large (35%), spotty (52%) or mixed (13%) calcification pattern and tertiles of plaque calcification attenuation (using the mean value for multiple lesions). Patients with large calcification pattern or higher plaque calcification attenuation had higher stenosis and CACS grade (and EAT attenuation), but lower plaque instability score, whereas those with spotty calcification pattern or lower plaque calcification attenuation had lower stenosis and CACS grade (and EAT attenuation), but higher plaque instability score. Among the instability features, low attenuation and napkin-ring sign, but not positive remodeling, were associated with a spotty pattern and a lower calcification attenuation.

CONCLUSIONS

Both the pattern and attenuation of calcification should be considered, in addition to CACS, for risk stratification of heavily calcified high-risk patients with non-critical coronary stenosis.

Association of segmental T2 ratio and late gadolinium enhancement in patients with acute myocarditis: a feasibility study

BACKGROUND

Cardiac magnetic resonance is a valuable tool in the diagnosis of acute myocarditis, but dyspnea or chest pain often reduce patient's compliance, so definition of faster magnetic resonance protocols is of paramount importance.

METHODS

Short tau inversion recovery (STIR) and phase sensitive inversion recovery images for the assessment of late gadolinium enhancement (LGE)of 22 patients with clinical suspicion of acute myocarditis were retrospectively evaluated. Signal intensity in STIR images was measured by 2 readers by placing region of interests (ROIs) within the area of maximal signal intensity in each myocardial segment derived from the ACC/AHA segmental scheme. Segmental T2 ratio was assessed with the formula: signal intensity of myocardium/signal intensity of muscle. Receiver operating characteristic (ROC) curves were used to compare diagnostic performance of T2 Signal intensity and T2 ratio in predicting the presence of LGE in each myocardial segment. Bland-Altman analysis was used to assess inter reader agreement.

RESULTS

Signal intensity in STIR images showed an area under the curve (AUC) of 0.54 (95% CI: 0.44-0.63) for reader 1 and 0.53(95% CI: 0.44-0.63) for reader 2. Segmental T2 ratio showed an AUC of 0.8 (95% CI: 0.73-0.87) for reader 1 and 0.77 (95% CI: 0.71-0.84) for reader 2. Bland-Altman analysis showed good agreement for both T2 signal intensity (mean difference =-18.5 reader1 vs. reader 2 and 2SD=247.3) and T2 ratio (mean difference=0.03 vs. reader2 and 2SD=0.9).

CONCLUSIONS

Segmental T2 ratio showed a good diagnostic accuracy in predicting the presence of LGE in patients with clinical suspicion of acute myocarditis and might be a promising approach in reducing scan times with no reduction in diagnostic accuracy.

Feeling Offended: A Blow to Our Image and Our Social Relationships

The paper presents a survey study that investigates the self-conscious emotion of feeling offended and provides an account of it in terms of a socio-cognitive model of emotions. Based on the qualitative and quantitative analysis of the participants’ answers, the study provides a definition of offense and of the feeling of offense in terms of its “mental ingredients,” the beliefs and goals represented in a person who feels this emotion, and finds out what are its necessary and aggravating conditions, what are the explicit and implicit causes of offense (the other’s actions, omissions, inferred mental states), what negative evaluations are offensive and why. It also shows that the feeling of offense is not only triggered about honor or public image, but it is mainly felt in personal affective relationships. The paper finally highlights that high self-esteem may protect a person against the feeling of offense and the constellation of negative emotions triggered by it.

CCR2-dependent monocyte-derived macrophages resolve inflammation and restore gut motility in postoperative ileus

OBJECTIVE

Postoperative ileus (POI) is assumed to result from myeloid cells infiltrating the intestinal muscularis externa (ME) in patients undergoing abdominal surgery. In the current study, we investigated the role of infiltrating monocytes in a murine model of intestinal manipulation (IM)-induced POI in order to clarify whether monocytes mediate tissue damage and intestinal dysfunction or they are rather involved in the recovery of gastrointestinal (GI) motility.

DESIGN

IM was performed in mice with defective monocyte migration to tissues (C-C motif chemokine receptor 2, Ccr2^{-/ -} mice) and wild-type (WT) mice to study the role of monocytes and monocyte-derived macrophages (MΦs) during onset and resolution of ME inflammation.

RESULTS

At early time points, IM-induced GI transit delay and inflammation were equal in WT and Ccr2 ^-/- mice. However, GI transit recovery after IM was significantly delayed in Ccr2 ^-/- mice compared with WT mice, associated with increased neutrophil-mediated immunopathology and persistent impaired neuromuscular function. During recovery, monocyte-derived MΦs acquire pro-resolving features that aided in the resolution of inflammation. In line, bone marrow reconstitution and treatment with MΦ colony-stimulating factor 1 enhanced monocyte recruitment and MΦ differentiation and ameliorated GI transit in Ccr2 ^-/- mice.

CONCLUSION

Our study reveals a critical role for monocyte-derived MΦs in restoring intestinal homeostasis after surgical trauma. From a therapeutic point of view, our data indicate that inappropriate targeting of monocytes may increase neutrophil-mediated immunopathology and prolong the clinical outcome of POI, while future therapies should be aimed at enhancing MΦ physiological repair functions.

Handy Hints About Raynaud's Phenomenon in Children: A Critical Review

Raynaud's phenomenon (RP) is a vasospastic disorder characterized by recurrent self-limited episodes of skin pallor, cyanosis, and hyperemia caused by paroxysmal spasms in the small arteries of the fingers and toes and can occur in any age group. Hands, feet, nose, ears, and nipples can be affected. The diagnosis is made clinically, assessing varying degrees of ischemia in the involved areas of skin, but this transient ischemia may also herald the onset of connective tissue disease. Investigation is recommended when RP starts in childhood to exclude an underlying autoimmune condition and close follow-up for its development. Management of RP in children includes conservative and pharmacologic treatments.

Lung Involvement in Children with Hereditary Autoinflammatory Disorders

Short-lived systemic inflammatory reactions arising from disrupted rules in the innate immune system are the operating platforms of hereditary autoinflammatory disorders (HAIDs). Multiple organs may be involved and aseptic inflammation leading to disease-specific phenotypes defines most HAIDs. Lungs are infrequently involved in children with HAIDs: the most common pulmonary manifestation is pleuritis in familial Mediterranean fever (FMF) and tumor necrosis factor receptor-associated periodic syndrome (TRAPS), respectively caused by mutations in the MEFV and TNFRSF1A genes, while interstitial lung disease can be observed in STING-associated vasculopathy with onset in infancy (SAVI), caused by mutations in the TMEM173 gene. The specific pleuropulmonary diseases may range from sub-clinical abnormalities during inflammatory flares of FMF and TRAPS to a severe life-threatening disorder in children with SAVI.

"The Bitter Laughter". When Parody Is a Moral and Affective Priming in Political Persuasion

Research on socially aware systems requires fine-grained knowledge of the mechanisms of persuasion in order to promote civic knowledge and aware political participation. Within humor studies, political parody is generally considered a simple pleasant weapon for political evaluation, currently explained by referring to the so called “just a joke effect” (Nabi et al., 2007). Indeed the funny side of parody can induce positive emotions, but it also includes a discrediting act that sometimes produces a “bitter laughter.” The present study aims to understand the role played by negative and moral emotions aroused by parody. A parody is defined as a communicative behavior (a discourse, text, body movement, song) that imitates a communicative behavior or trait displayed by some Target by reproducing it in a distorted way, with the aim of making fun of the Target. Based on a socio-cognitive approach, a distinction is made between “surface” and “deep” parody (Poggi and D’Errico, 2013), with the former simply imitating behaviors actually displayed by the Target, and the latter implying a (humorous) re-categorization of the Target. The paper studies the effect of these two different types of parody on persuasion processes. Results show that the deep parody, as opposed to surface parody, triggers more negative emotions, and in particular indignation, that in turn lead to more negative evaluations of the Target. Moreover, the moral priming of parody is influenced by the Target politician’s gender.

Immunomodulating effects of the anti-viral agent Silibinin in liver transplant patients with HCV recurrence

Background

Silibinin has been shown to have anti-HCV activity and immune-modulating properties by regulating dendritic cell (DC) function. DCs are antigen-presenting cells that, together with regulatory T cells (Treg), play a pivotal role in controlling alloimmune, as well as anti-HCV immune responses.

Methods

Twelve liver transplant patients with HCV recurrence received iv infusion of Silibinin (iv-SIL) for 14 consecutive days. Using flow cytometry, before and at the end of treatment, we determined the frequencies of circulating myeloid (m) and plasmacytoid (p) DC and Treg and the expression of costimulatory/coregulatory molecules by the DC subsets and Treg. Statistical analysis was performed using the paired Student’s t test and Pearson correlation test.

Results

After iv-SIL treatment, we observed an elevated plasmacytoid dendritic cell (pDC)/myeloid dendritic cell (mDC) ratio, while pDC displayed lower HLA-DR and higher immunoglobulin-like transcript 4 (ILT4), CD39, and HLA-G expression compared to the pretreatment baseline. In addition, after iv-SIL, mDC showed increased inducible costimulator ligand (ICOSL) expression. No changes were detected in Treg frequency or programed death (PD)-1 expression by these cells. Moreover, several correlations between DC/Treg markers and clinical parameters were detected.

Conclusions

This descriptive study, in liver transplant patients with HCV recurrence, reveals the impact of iv-SIL on DC and Treg. The changes observed in circulating pDC and mDC that have previously been associated with tolerogenic conditions shed new light on how iv-SIL may regulate anti-viral and alloimmunity. We have also observed multiple clinical correlations that could improve the clinical management of liver transplant patients and that deserve further analysis.

Social signals: from theory to applications

The Special Issue Editorial introduces the research milieu in which Social Signal Processing originates, by merging computer scientists and social scientists and giving rise to this field in parallel with Human-Computer Interaction, Affective Computing, and Embodied Conversational Agents, all similarly characterized by high interdisciplinarity, stress on multimodality of communication, and the continuous loop from theory to simulation and application. Some frameworks of the cognitive and social processes underlying social signals are identified as reference points (Theory of Mind and Intersubjectivity, mirror neurons, and the ontogenesis and phylogenesis of communication), while three dichotomies (automatic vs. controlled, individualistic vs. intersubjective, and meaning vs. influence) are singled out as leads to navigate within the theoretical and applicative studies presented in the Special Issue.

Social signals: a framework in terms of goals and beliefs

The paper defines the notion of social signal, in terms of a cognitive model of mind and social interaction, as a communicative or informative signal or a cue that directly or indirectly provides information about "social facts": social interactions, social emotions, social attitudes, evaluations and stances, social relations, and social identities. This notion is compared with other connected notions in Semiotics, Ethology, and Psychology, several types of informative and communicative signals and cues are exemplified, and their process of production and interpretation is overviewed, while considering the role of context and previous knowledge in it. The implications of this model are outlined for the construction of systems for the analysis of social signals and their simulation in Virtual Agents.

Transient Global Amnesia as the First Symptom of Primary Antiphospholipid Syndrome: A Case Report

We describe the case of a 45-year-old woman who had drawn our attention for some recent episodes of transient global amnesia that, upon further examination, resulted from ischemic events caused by multiple arterial thrombosis (bilateral internal carotid occlusion, significant stenosis of the right external carotid, mild stenosis of the right vertebral artery, right anterior cerebral artery occlusion and severe stenosis of the anterior descending coronary artery) due to primary antiphospholipid syndrome. Revascularisation of either carotid was not attempted. A percutaneous intervention in the anterior descending coronary artery stenosis was performed successfully. Due to severe arterial thrombosis, the patient was discharged with only duplex antiplatelet treatment and subcutaneous anticoagulant therapy, since immunotherapy is not indicated in primary APS. The occurrence of transient global amnesia should raise the suspicion of APS.

[Atherosclerosis and simvastatin: new questions for the new millennium]

Coronary artery disease is still associated with high morbidity and mortality in Western countries. Lipid blood levels have a tight correlation with the risk of coronary events, and the results of many trials on lipid-lowering therapy (and particularly on simvastatin) demonstrated a significant reduction in total and cardiac mortality, and in the incidence of myocardial infarction and coronary events; even the progression of coronary stenosis has been reduced by treatment with statins. Beyond cholesterol reduction, simvastatin exerts many favorable effects on endothelial function, inflammatory activity, expression of pro-thrombotic factors and oxidative stress, yielding a rational basis for its important clinical positive effects, both in primary and secondary prevention of coronary disease. Future developments, which are the subjects of many planned or ongoing clinical trials, are related to the treatment of high-risk patients, the evaluation of the efficacy of elevated simvastatin dosages and of a deep reduction in cholesterol blood levels, the interaction between simvastatin and other drugs (antioxidant compounds, vitamins, antiplatelet drugs) or interventional procedures (percutaneous transluminal coronary angioplasty). Particularly, the Heart Protection Study, the A to Z trial, and the SEARCH and SMART studies will provide important data on a wider, earlier and greater use of simvastatin, which has been demonstrated effective both in the prevention and treatment of acute coronary syndromes.

In vivo neutron dosimetry during high-energy Bremsstrahlung radiotherapy

PURPOSE

A new technique is presented for in vivo measurements of the dose equivalent from photoneutrons produced by high-energy radiotherapy accelerators.

METHODS AND MATERIALS

The dosimeters used for this purpose are vials of superheated halocarbon droplets suspended in a tissue-equivalent gel. Neutron interactions nucleate the formation of bubbles, which can be recorded through the volume of gel they displace from the detector vials into graduated pipettes. These detectors offer inherent photon discrimination, dose-equivalent response to neutrons, passive operation, and small sensitive size. An in vivo vaginal probe was fabricated containing one of these neutron detector vials and a photon-sensitive diode. Measurements were carried out in patients undergoing high-energy x-ray radiotherapy and were also repeated in-phantom, under similar irradiation geometries.

RESULTS AND CONCLUSION

Neutron doses of 0.02 Sv were measured in correspondence to the cervix, 50 cm from the photon beam axis, following a complete treatment course of 46.5 Gy with an upper mantle field of 18-MV x-rays. This fraction of dose from neutrons is measured reliably within an intense photon background, making the technique a valid solution to challenging dosimetry problems such as the determination of fetal exposure in radiotherapy. These measurements can be easily carried out with tissue-equivalent phantoms, as our results indicate an excellent correlation between in vivo and in-phantom dosimetry.

Holes and grooves: the contribution of microscopy and taphonomy to the problem of art origins

Optical and scanning electron microscopy, comparative anatomy, data from modern and Pleistocene carnivore accumulations, and analysis of archeological materials show that some of the pieces interpreted by various scholars as engraved or perforated bones from European Lower and Middle Paleolithic sites (such as Pech de l'Azé II, Stránska Skála, Kulna, Bois Roche and Cueva Morin) are not early manifestations of non-utilitarian behavior. Putative engravings are in fact vascular grooves, while perforated pieces are partially-digested bones regurgitated by hyenas. The current debate on art origins has often been centered on the symbolic value and cognitive implications of these and similar pieces without a first-hand analysis of the objects to provide convincing demonstration of the human origins of the marks. Such demonstration is a necessary prerequisite to any discussion of their significance for the evolution of symbolic behavior.

Dose distribution of proton beams with NMR measurements of Fricke-agarose gels

Fricke-agarose gels have been irradiated with a proton beam. Then samples have been extracted at different depths with respect to the beam penetration distance, corresponding to different irradiation doses. Relaxation times T1 and T2, measured at 17 MHz, appear sensitive to this kind of radiation. In particular, T2 exhibits three components T2a, T2b and T2c, the first two being sensitive to proton irradiation. At 1% agarose concentration, the relaxation rates R1 = 1/T1, R2a = 1/T2a and R2b = 1/T2b of samples irradiated with both modulated and unmodulated beams, increase with the dose, irrespective of the beam energy. The yield G of Fe3+ ions per 100 eV of absorbed energy is always higher than that obtained for gamma irradiated samples.

[Calculosis of the biliary tract in childhood and adolescence]

A series of 55 cases of calculosis of the bile ducts observed in subjects aged 9-20 yr between 1963 and 1977 is presented. Haemolytic anaemia, familial predisposition, pregnancy, obesity, and deformity of the bile ducts are regarded as possible pathogenetic factors in accordance with the views of other workers.