Biliary Atresia in an Infant Presenting With Kabuki Syndrome: An Autopsy Report and Review of the Literature

Biliary atresia (BA) is an inflammatory obliterative cholangiopathy which is very common during neonatal and infancy period. We present an autopsy report of a BA in an infant suffering from a genetic syndrome.

A case of fatal embolization during laser lithotripsy

PURPOSE

To report in literature the first case of fatal multi-organ embolization of ureteral stones fragments during laser lithotripsy.

CASE PRESENTATION

A tetraplegic 43-year-old woman was admitted to the hospital to undergo laser lithotripsy because of bilateral ureteral stones and right ureteral infected stent. During the removal of the right ureteral stent, the patient developed a sudden severe bradycardia followed by a reduction in the arterial oxygen saturation. In spite of a rapid and intensive medical intervention, the clinical picture did not improve; the woman was therefore transferred to the nearest Emergency Room where she was rescued but a cardiocirculatory arrest occurred. A claim of alleged medical malpractice was brought against the urologists. A complete autopsy was performed 8 days after death.

AUTOPSY FINDINGS

The diagnosis was determined by the microscopic findings: they have unequivocally shown a massive embolization of calculus fragments in the lungs and in the heart. In the light of all these findings, the cause of death was attributable to a disseminated intravascular coagulation due to this unforeseeable embolization of calcified amorphous material.

CONCLUSION

Embolization of calculus fragments represents an important challenge because it is extremely unpredictable. Indeed, a prompt diagnosis of non-thrombotic pulmonary embolism, during the urologic procedure, is extremely difficult because the condition presents with no specific clinical signs: this life-threatening pathology is often underestimated. For this reason, the autopsy and the subsequent histopathological examination are indispensable in order to prove lethal embolization: microscopic findings play a key role in the final diagnosis of death.

Successful management plan of COVID-19 in a pediatric hemato-oncology department: a single-centre experience

COVID-19 pandemic raised concern about management of patients with paediatric cancer. We present the operating system that the Hemato-Oncology Department of the Santobono-Pausilipon Hospital applied. We divided our department in three zones: surveillance and screening; quarantine and COVID free, in order to screen admitted patients and to reduce the risk of cross infection. From 3 April until 29 May 2020 (56 days), 662 patients and caregivers underwent rapid serological tests for a total of 1397 assays. No patient or parent with SARS-CoV2 infection was found, demonstrating the effectiveness of COVID-19 screening process.

Rewetting in Mediterranean reclaimed peaty soils and its potential for phyto-treatment use

A pilot experimental field combining rewetting of reclaimed peaty soils and water phyto-treatment was set up in the Massaciuccoli Lake basin (Tuscany, Italy) to reduce the water eutrophication and peat degradation caused by almost a century of drainage-based agricultural use. In this paper, we investigated the restoration process occurring consequently to the conversion of a drained area in a natural wetland system (NWS) (the partial top soil removal, the realization of a perimeter levee to contain the waters, the rewetting with the drainage waters coming from the of surrounding cultivated areas) and the capability of the spontaneous vegetation to catch nutrients acting as a vegetation filter. To follow the restoration process over time (2012-2016), we used a mixed approach merging phytosociological surveys with ortophotos taken by an Unmanned Aerial Vehicle (UAV). During the last year of observation (2016), we performed destructive sampling on the most widespread plant communities in the area (Phragmites australis and Myriophyllum aquaticum community) to quantify the biomass production and the uptake of nitrogen and phosphorus. Stands of Phragmites australis (Cav.) Trin. ex Steud. yielded more than Myriophyllum aquaticum (Vell.) Verdc. (4.94 kg m-2 vs 1.08 kg m-2). M. aquaticum showed higher nutrient contents (2.04% of N and 0.35% of P), however P. australis was able to take up more nutrients within the NWS because of its larger cover and productivity. In the perspective of maximizing the plant development and consequently the amount of nutrients extracted from treated waters, the authors suggest 4-5 year-long-harvesting turns, better occurring in spring-summer.

Unmanned Aerial Vehicle to Estimate Nitrogen Status of Turfgrasses

Spectral reflectance data originating from Unmanned Aerial Vehicle (UAV) imagery is a valuable tool to monitor plant nutrition, reduce nitrogen (N) application to real needs, thus producing both economic and environmental benefits. The objectives of the trial were i) to compare the spectral reflectance of 3 turfgrasses acquired via UAV and by a ground-based instrument; ii) to test the sensitivity of the 2 data acquisition sources in detecting induced variation in N levels. N application gradients from 0 to 250 kg ha^-1 were created on 3 different turfgrass species: Cynodon dactylon x transvaalensis (Cdxt) ‘Patriot’, Zoysia matrella (Zm) ‘Zeon’ and Paspalum vaginatum (Pv) ‘Salam’. Proximity and remote-sensed reflectance measurements were acquired using a GreenSeeker handheld crop sensor and a UAV with onboard a multispectral sensor, to determine Normalized Difference Vegetation Index (NDVI). Proximity-sensed NDVI is highly correlated with data acquired from UAV with r values ranging from 0.83 (Zm) to 0.97 (Cdxt). Relating NDVI-UAV with clippings N, the highest r is for Cdxt (0.95). The most reactive species to N fertilization is Cdxt with a clippings N% ranging from 1.2% to 4.1%. UAV imagery can adequately assess the N status of turfgrasses and its spatial variability within a species, so for large areas, such as golf courses, sod farms or race courses, UAV acquired data can optimize turf management. For relatively small green areas, a hand-held crop sensor can be a less expensive and more practical option.

Unmanned Aerial Vehicle to Estimate Nitrogen Status of Turfgrasses

Spectral reflectance data originating from Unmanned Aerial Vehicle (UAV) imagery is a valuable tool to monitor plant nutrition, reduce nitrogen (N) application to real needs, thus producing both economic and environmental benefits. The objectives of the trial were i) to compare the spectral reflectance of 3 turfgrasses acquired via UAV and by a ground-based instrument; ii) to test the sensitivity of the 2 data acquisition sources in detecting induced variation in N levels. N application gradients from 0 to 250 kg ha-1 were created on 3 different turfgrass species: Cynodon dactylon x transvaalensis (Cdxt) 'Patriot', Zoysia matrella (Zm) 'Zeon' and Paspalum vaginatum (Pv) 'Salam'. Proximity and remote-sensed reflectance measurements were acquired using a GreenSeeker handheld crop sensor and a UAV with onboard a multispectral sensor, to determine Normalized Difference Vegetation Index (NDVI). Proximity-sensed NDVI is highly correlated with data acquired from UAV with r values ranging from 0.83 (Zm) to 0.97 (Cdxt). Relating NDVI-UAV with clippings N, the highest r is for Cdxt (0.95). The most reactive species to N fertilization is Cdxt with a clippings N% ranging from 1.2% to 4.1%. UAV imagery can adequately assess the N status of turfgrasses and its spatial variability within a species, so for large areas, such as golf courses, sod farms or race courses, UAV acquired data can optimize turf management. For relatively small green areas, a hand-held crop sensor can be a less expensive and more practical option.

Spatial mapping of juxtacrine axo-glial interactions identifies novel molecules in peripheral myelination

Cell–cell interactions promote juxtacrine signals in specific subcellular domains, which are difficult to capture in the complexity of the nervous system. For example, contact between axons and Schwann cells triggers signals required for radial sorting and myelination. Failure in this interaction causes dysmyelination and axonal degeneration. Despite its importance, few molecules at the axo-glial surface are known. To identify novel molecules in axo-glial interactions, we modified the ‘pseudopodia' sub-fractionation system and isolated the projections that glia extend when they receive juxtacrine signals from axons. By proteomics we identified the signalling networks present at the glial-leading edge, and novel proteins, including members of the Prohibitin family. Glial-specific deletion of Prohibitin-2 in mice impairs axo-glial interactions and myelination. We thus validate a novel method to model morphogenesis and juxtacrine signalling, provide insights into the molecular organization of the axo-glial contact, and identify a novel class of molecules in myelination.

Neuron–glia interactions are critical in the nervous system, where they result in the extension of glial pseudopodia. Poitelon et al. isolate these protrusions using an in vitro assay, and, by characterising their proteomes, identify Prohibitin-2 as a regulator of myelination.

Preliminary investigation on the potential use of two C4 turfgrass species to reduce nutrient release in a Mediterranean drained peatland

This study compared dry matter production, nutrient uptake and tissue nutrient concentration of two C4 turfgrass species (Cynodon dactylon × Cynodon transvaalensis Burtt Davy and Paspalum vaginatum Swartz) supplied with three different nutrient solutions in a sand and peat culture. The 8-week experiment was performed in mesocosms and simulated the conditions of an open-field phyto-treatment system located in a Mediterranean drained peatland (Tuscany, Italy). Peat was collected on the site, and one of the solutions mimicked drainage water flowing into it. Three hypotheses were tested: (i) the species chosen efficiently removed nutrients from both the solution and the substrate; (ii) peat contributed to the nutrient load; and (iii) the species chosen were suitable in the open-field system. Both species adapted well to the experimental conditions and demonstrated considerable ability to remove nutrients. P. vaginatum took up nitrogen more efficiently, mainly in conditions of high nutrient availability. We observed supplementary nutrient uptake by plants in the peat treatment. Performances of the two C4 turfgrasses extrapolated to the field scale seemed effective from a phyto-treatment perspective.

Phase white matter signal abnormalities in patients with clinically isolated syndrome and other neurologic disorders

BACKGROUND AND PURPOSE

Identifying MRI biomarkers that can differentiate multiple sclerosis patients from other neurological disorders is a subject of intense research. Our aim was to investigate phase WM signal abnormalities for their presence, prevalence, location, and diagnostic value among patients with clinically isolated syndrome and other neurologic disorders and age-, sex-, and group-matched healthy controls.

MATERIALS AND METHODS

Forty-eight patients with clinically isolated syndrome and 30 patients with other neurologic diseases and a healthy control group (n = 47) were included in the study. Subjects were scanned at 3T by using SWI-filtered phase and T2WI, with WM signal abnormalities ≥3 mm being classified.

RESULTS

Patients with clinically isolated syndrome had significantly more phase and T2 WM signal abnormalities than healthy controls (P < .001). Phase WM signal abnormalities were more prevalent among patients with clinically isolated syndrome compared with patients with other neurologic disorders (4:1 ratio), whereas T2 WM signal abnormalities were more ubiquitous with a 2:1 ratio. The presence of phase WM signal abnormalities was sensitive for clinically isolated syndrome (70.8%) and achieved a moderate-to-high specificity for differentiating patients with clinically isolated syndrome and healthy controls, patients with other neurologic disorders, and patients with other neurologic disorders of other autoimmune origin (specificity, 70%-76.7%). Combining the presence of ≥2 phase lesions with the McDonald 2005 and 2010 criteria for dissemination in space improved the specificity (90%), but not the accuracy, in differentiating patients with clinically isolated syndrome from those with other neurologic disorders. In subanalyses among patients with clinically isolated syndrome who converted to clinically definite multiple sclerosis versus those who did not within a 3-year follow-up period, converters had significantly more phase (P = .008) but not T2 or T1 WM signal abnormalities.

CONCLUSIONS

Phase WM signal abnormalities are prevalent among patients with clinically isolated syndrome. The presence of (multiple) phase WM signal abnormalities tended to be more predictive of conversion to clinically definite multiple sclerosis and was specific in differentiating patients with clinically isolated syndrome and other neurologic disorders, compared with T2 WM signal abnormalities; however, the accuracy remains similar to that of the current McDonald criteria.

A simple model to assess nitrogen and phosphorus contamination in ungauged surface drainage networks: application to the Massaciuccoli Lake Catchment, Italy

Modeling is a common practice to evaluate factors affecting water quality in environmental systems impaired by point and nonpoint losses of N and P. Nevertheless, in situations with inadequate information, such as ungauged basins, a balance between model complexity and data availability is necessary. In this paper, we applied a simplified analytical model to an artificially drained floodplain in central-western Italy to evaluate the importance of different nutrient sources and in-stream retention processes and to identify critical source areas. We first considered only a set of chemical concentrations in water measured from February through May 2008 and from November 2008 through February 2009. We then broadened available data to include water discharge and hydraulic-head measurements to construct a hydrogeological model using MODFLOW-2000 and to evaluate the reliability of the simplified method. The simplified model provided acceptable estimates of discharge (ranging from 0.03-0.75 m s) and diffuse nutrient inputs from water table discharge and in-stream retention phenomena. Estimates of PO-P and total P retention (ranging from 1.0 to 0.6 μg m s and from 1.18 to 0.95 μg m s for PO-P and total P, respectively) were consistent with the range of variability in literature data. In contrast, the higher temporal variability of nitrate concentrations decreased model accuracy, suggesting the need for more intensive monitoring. The model also separated the dynamics of different reaches of the drainage network and identified zones considered critical source areas and buffer zones where pollutant transport is reduced.

Pathogenesis of hypertrophic cardiomyopathy. Impact of growth factors on left ventricular anatomy

AIM

The aim of this study was to evaluate the effect of insulin-like growth factor 1 (IGF1) and transforming growth factor beta-1 (TGFbeta-1) on collagen turnover, left ventricular (LV) hypertrophy and on passive diastolic function of the LV in hypertrophic cardiomyopathy (HCM).

METHODS

This study group comprised 34 patients with non-dilated HCM. Procollagen I amino-terminal propeptide (PINP) and collagen I carboxy-terminal telopeptide (ICTP) were measured by radioimmunoassay. Matrix metalloproteinase 9 (MMP 9), IGF1 and TGFalfa-1 were determined by enzyme-linked immunosorbent assay. The difference in duration between transmitral forward (A) and pulmonary venous retrograde (Ar) waves, was considered as an estimate of passive diastolic function; the ratio between the peak flow velocity at rapid filling at the mitral level (E) and E' measured by tissue Doppler was considered an estimate of active diastolic function. LV mass was measured and normalized to body surface area (LVMi) by cardiac magnetic resonance imaging.

RESULTS

LVMi correlates to E/E' (r=0.597, P=0.019 ) and is inversely related to A-Ar (r=0.453, P=0.015). TGFbeta-1 is directly related to active MMP 9 (r=0.439, P=0.012 ). IGF1 is directly related to PICP-ICTP (r=0.347, P=0.501), that expresses the balance between collagen I synthesis and its degradation.

CONCLUSION

The study demonstrated that in HCM, LVMi influences active and passive diastolic dysfunction and that IGF1 stimulates collagen synthesis and TGFbeta-1 is related to LV hypertrophy.

[Doctor or technician? Reflections on the medical professional today]

Medicine is an outstanding example of an empirical science in theory and practice. In every stage of his work a doctor should be ready to pick up signs of possible scientific progress. Being constantly attentive and able to see anything new occurring, however difficult it may be to discern, should remain the basis of any professional commitment that takes care not to become sterile and thereby less effective in treating disease. A doctor is an experimenter par excellence, one who constantly applies experimental methods based on his own ''historical'' knowledge, experience, and capacity to comprehend even the tiniest signals that reach him from the real world. On the other hand, although the indiscriminate acceptance of results obtained by clinical trials and the increasing recourse to technology could herald the end of clinical freedom, we believe that such recourse to technology is, in fact, desirable. The reason for this belief is that a lack of innovation leads to loss of enthusiasm and loss of interest in specific clinical problems; it also results in a cultural attitude that refutes the notion of experimental logic being inherent in any treatment because of the changeability of individual conditions on a biological, clinical, and psycho-relational level.