Neurophysiological and behavioural correlates of ocrelizumab therapy on manual dexterity in patients with primary progressive multiple sclerosis

Background

Hand dexterity impairment is a key feature of disability in people with primary progressive multiple sclerosis (PPMS). So far, ocrelizumab, a recombinant humanized monoclonal antibody that selectively depletes CD20-expressing B cells, is the only therapy approved for PPMS and recent analysis reported its ability to reduce the risk of upper limb disability progression. However, the neural mechanisms underlying hand impairment in PPMS and the brain networks behind the effect of ocrelizumab on manual dexterity are not fully understood.

Objective

Main aims of our study were: (i) to investigate neurophysiological and behavioural correlates of hand function impairment in subjects with PPMS, and (ii) to use neurophysiologic and behavioural measures to track the effects of ocrelizumab therapy on manual dexterity.

Methods

Seventeen PPMS patients and 17 healthy-controls underwent routine neurophysiological protocols assessing the integrity of cortico-spinal and somatosensory pathways and advanced transcranial magnetic stimulation (TMS) protocols evaluating inhibitory (short and long interval intracortical inhibition, short-latency afferent inhibition) and facilitatory (motor thresholds, intracortical facilitation, short-interval intracortical facilitation) circuits in the primary motor cortex. All subjects also underwent behavioural analysis of hand dexterity by means of nine-hole peg test and finger movement analysis, and hand strength with handgrip and three-point pinch test. Neurophysiological and clinical assessments of hand functionality were also performed after 1 year of ocrelizumab therapy.

Results

At baseline PPMS patients displayed a significant impairment of hand dexterity and strength compared to healthy controls (all p < 0.03). Neurophysiological study disclosed prolonged latencies of standard somatosensory and motor evoked potentials (all p < 0.025) and an overall reduction of intracortical excitability at TMS protocols, involving both excitatory and inhibitory circuits. Importantly, hand dexterity impairment, indexed by delayed 9HPT, correlated with TMS protocols investigating cortical sensorimotor integration (short-latency afferent inhibition, SAI), p = 0.009. Both parameters, 9HPT (p = 0.01) and SAI (p = 0.01), displayed a significant improvement after 1 year of therapy with ocrelizumab.

Conclusion

Intracortical sensorimotor networks are involved in hand dexterity dysfunction of PPMS. Ocrelizumab therapy displays a beneficial effect on hand dexterity impairment most likely through intracortical networks implicated in fast sensorimotor integration.

The biomechanics of the umbilical cord Wharton Jelly: Roles in hemodynamic proficiency and resistance to compression

The umbilical cord is a complex structure containing three vessels, one straight vein and two coiled arteries, encased by the Wharton Jelly (WJ) a spongy structure made of collagen and hydrated macromolecules. Fetal blood reaches the placenta through the arteries and flows back to the fetus through the vein. The role of the WJ in maintaining cord circulation proficiency and the ultimate reason for arterial coiling still lack of reasonable mechanistic interpretations. We performed biaxial tension tests and evidenced significant differences in the mechanical properties of the core and peripheral WJ. The core region, located between the arteries and the vein, resulted rather stiffer close to the fetus. Finite element modelling and optimization based inverse method were used to create 2D and 3D models of the cord and to simulate stress distribution in different hemodynamic conditions, compressive loads and arterial coiling. We recorded a facilitated stress transmission from the arteries to the vein through the soft core of periplacental WJ. This condition generates a pressure gradient that boosts the venous backflow circulation towards the fetus. Peripheral WJ allows arteries to act as pressure buffering chambers during the cardiac diastole and helps to dissipate compressive forces away from vessels. Altered WJ biomechanics may represent the structural basis of cord vulnerability in many high-risk clinical conditions.

Tunable Two-Photon Quantum Interference of Structured Light

Structured photons are nowadays an important resource in classical and quantum optics due to the richness of properties they show under propagation, focusing, and in their interaction with matter. Vectorial modes of light in particular, a class of modes where the polarization varies across the beam profile, have already been used in several areas ranging from microscopy to quantum information. One of the key ingredients needed to exploit the full potential of complex light in the quantum domain is the control of quantum interference, a crucial resource in fields like quantum communication, sensing, and metrology. Here we report a tunable Hong-Ou-Mandel interference between vectorial modes of light. We demonstrate how a properly designed spin-orbit device can be used to control quantum interference between vectorial modes of light by simply adjusting the device parameters and no need of interferometric setups. We believe our result can find applications in fundamental research and quantum technologies based on structured light by providing a new tool to control quantum interference in a compact, efficient, and robust way.

Minimally invasive fetal autopsy using ultrasound: a feasibility study

OBJECTIVES

To evaluate postmortem ultrasound (PM-US) for minimally invasive autopsy, and to demonstrate its feasibility, sensitivity and specificity, as compared with conventional autopsy, in detecting major congenital abnormalities.

METHODS

Over a 19-month study period from 1 March 2012 to 30 September 2013, we recruited from a referral hospital 88 consecutive fetuses, at 11-40 weeks' gestation, which had undergone termination, miscarriage or intrauterine fetal death. We performed PM-US using different transducers and compared the data with those from conventional autopsy. The latter was performed, according to the Societé Francaise de Foetopathologie (France) guidelines, by experienced perinatal pathologists who were blinded to the ultrasound data.

RESULTS

Complete virtual autopsy by ultrasound was possible in 95.5% of the cases. The sensitivity of PM-US for detecting brain abnormalities was 90.9% (95% CI, 58.7-99.8%) and the specificity was 87.3% (95% CI, 75.5-94.7%). In 20% of cases, a neuropathological examination was not possible due to severe maceration. The sensitivity for detection of thoracic abnormalities was 88.9% (95% CI, 65.3-98.6%) and the specificity was 92.8% (95% CI, 84.1-97.6%), and the sensitivity for detection of abdominal anomalies was 85.7% (95% CI, 57.2-98.2%) and the specificity was 94.6% (95% CI, 86.7-98.5%).

CONCLUSION

This pilot study confirms the feasibility of PM-US for virtual autopsy as early as 11 weeks' gestation. This new technique shows high sensitivity and specificity in detecting congenital structural abnormalities as compared with conventional autopsy. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Symmetry Protection of Photonic Entanglement in the Interaction with a Single Nanoaperture

In this work, we experimentally show that quantum entanglement can be symmetry protected in the interaction with a single subwavelength plasmonic nanoaperture, with a total volume of V∼0.2λ^{3}. In particular, we experimentally demonstrate that two-photon entanglement can be either completely preserved or completely lost after the interaction with the nanoaperture, solely depending on the relative phase between the quantum states. We achieve this effect by using specially engineered two-photon states to match the properties of the nanoaperture. In this way we can access a symmetry protected state, i.e., a state constrained by the geometry of the interaction to retain its entanglement. In spite of the small volume of interaction, we show that the symmetry protected entangled state retains its main properties. This connection between nanophotonics and quantum optics probes the fundamental limits of the phenomenon of quantum interference.

Experimental Study of Nonclassical Teleportation Beyond Average Fidelity

Quantum teleportation establishes a correspondence between an entangled state shared by two separate parties that can communicate classically and the presence of a quantum channel connecting the two parties. The standard benchmark for quantum teleportation, based on the average fidelity between the input and output states, indicates that some entangled states do not lead to channels which can be certified to be quantum. It was recently shown that if one considers a finer-grained witness, then all entangled states can be certified to produce a nonclassical teleportation channel. Here we experimentally demonstrate a complete characterization of a new family of such witnesses, of the type proposed in Phys. Rev. Lett. 119, 110501 (2017)PRLTAO0031-900710.1103/PhysRevLett.119.110501 under different conditions of noise. We report nonclassical teleportation using quantum states that cannot achieve average fidelity of teleportation above the classical limit. We further use the violation of these witnesses to estimate the negativity of the shared state. Our results have fundamental implications in quantum information protocols and may also lead to new applications and quality certification of quantum technologies.

Two-year real-life efficacy, tolerability and safety of dimethyl fumarate in an Italian multicentre study

BACKGROUND

Dimethyl-fumarate (DMF) demonstrated efficacy and safety in relapsing-remitting multiple sclerosis (MS) in randomized clinical trials.

OBJECTIVES

To track and evaluate post-market DMF profile in real-world setting.

MATERIALS AND METHODS

Patients receiving DMF referred to Italian MS centres were enrolled and prospectively followed, collecting demographic clinical and radiological data.

RESULTS

Among the 735 included patients, 45.4% were naïve to disease-modifying therapies, 17.8% switched to DMF because of tolerance, 27.4% switched to DMF because of lack of efficacy, and 9.4% switched to DMF because of safety concerns. Median DMF exposure was 17 months (0-33). DMF reduced the annual relapse rate (ARR) by 63.2%. At 12 and 24 months, 85 and 76% of patients were relapse-free. NEDA-3 status after 12 months of DMF treatment was maintained by 47.5% of patients. 89 and 70% of patients at 12 and 24 months regularly continued DMF. Most frequent adverse events (AEs) were flushing (37.2%) and gastro-enteric AEs (31.1%).

CONCLUSION

Our post-market study corroborated that DMF is a safe and effective drug. Additionally, the study suggested that naïve patients strongly benefit from DMF and that DMF improved ARR also in patients who were horizontally switched from injectable therapies due to tolerability and efficacy issues.

Birth and evolution of an optical vortex

When a phase singularity is suddenly imprinted on the axis of an ordinary Gaussian beam, an optical vortex appears and starts to grow radially, by effect of diffraction. This radial growth and the subsequent evolution of the optical vortex under focusing or imaging can be well described in general within the recently introduced theory of circular beams, which generalize the hypergeometric-Gaussian beams and which obey novel kinds of ABCD rules. Here, we investigate experimentally these vortex propagation phenomena and test the validity of circular-beam theory. Moreover, we analyze the difference in radial structure between the newly generated optical vortex and the vortex obtained in the image plane, where perfect imaging would lead to complete closure of the vortex core.

Arbitrary, direct and deterministic manipulation of vector beams via electrically-tuned q-plates

Vectorial vortex light beams, also referred to as spirally polarized beams, are of particular interest since they can be exploited in several applications ranging from quantum communication to spectroscopy and microscopy. In particular, symmetric pairs of vector beams define two-dimensional spaces which are described as “hybrid Poincaré spheres” (HPS). While generation of vortex beams has been demonstrated by various techniques, their manipulation, in particular in order to obtain transformations describing curves entirely contained on a given HPS, is quite challenging, as it requires a simultaneous action on both polarization and orbital angular momentum degrees of freedom. Here, we demonstrate experimentally this kind of manipulation by exploiting electrically-tuned q-plates: an arbitrary transformation on the HPS can be obtained, by controlling two parameters of the q-plate, namely the initial optic axis orientation α₀ and the uniform birefringent phase retardation δ. Upon varying such parameters, one can determine both the rotation axis and the rotation angle on the HPS, obtaining the desired state manipulation with high fidelity.

Free-space quantum key distribution by rotation-invariant twisted photons

"Twisted photons" are photons carrying a well-defined nonzero value of orbital angular momentum (OAM). The associated optical wave exhibits a helical shape of the wavefront (hence the name) and an optical vortex at the beam axis. The OAM of light is attracting a growing interest for its potential in photonic applications ranging from particle manipulation, microscopy, and nanotechnologies to fundamental tests of quantum mechanics, classical data multiplexing, and quantum communication. Hitherto, however, all results obtained with optical OAM were limited to laboratory scale. Here, we report the experimental demonstration of a link for free-space quantum communication with OAM operating over a distance of 210 m. Our method exploits OAM in combination with optical polarization to encode the information in rotation-invariant photonic states, so as to guarantee full independence of the communication from the local reference frames of the transmitting and receiving units. In particular, we implement quantum key distribution, a protocol exploiting the features of quantum mechanics to guarantee unconditional security in cryptographic communication, demonstrating error-rate performances that are fully compatible with real-world application requirements. Our results extend previous achievements of OAM-based quantum communication by over 2 orders of magnitude in the link scale, providing an important step forward in achieving the vision of a worldwide quantum network.

Comparison of ultrasound and magnetic resonance imaging in the prenatal diagnosis of Apert syndrome: report of a case

BACKGROUND

The birth prevalence of Apert syndrome is estimated at 1:64,500 and accounts for about 4.5 % of all craniosynostosis with a male/female ratio equal to 1:1. It is associated to allelic mutations in the fibroblast growth factor receptor 2 (FGFR2) gene. Majority cases are sporadic. Prenatal ultrasound diagnosis is based on the detection of abnormal cranial shape, midfacial hypoplasia and bilateral syndactyly of hands and feet, hypertelorism, and exorbitism. Other abnormalities includes central nervous system anomalies, congenital heart diseases, cleft palate, and urogenital diseases.

CASE REPORT

A 37-year-old Caucasian woman, gravida 2, para 1, was referred to our center of Prenatal Diagnosis for routine ultrasound at 21 weeks of gestation. We detected irregular head shape, dolicocephaly, prominent forehead, bilateral mild ventriculomegaly, suspicion of partial agenesis of the corpus callosum, hypertelorism, and midfacial hypoplasia, with a depressed nasal bridge and syndactyly, prompting a suspicion for Apert syndrome. Magnetic resonance excluded agenesis of corpus callosum and confirmed bilateral mild ventriculomegaly. A follow-up ultrasound, performed at 23 weeks, confirmed the anomalies showed in the previous scan. An amniocentesis was performed. The results showed a normal male karyotype, while the molecular genetic test confirmed a mutation in FGFR2 gene. Fetus macroscopic analysis showed compatible features.

CONCLUSIONS

Our case underlines the complementary role of ultrasound and magnetic resonance imaging in the early prenatal diagnosis of Apert syndrome.

Experimental entanglement activation from discord in a programmable quantum measurement

In quantum mechanics, observing is not a passive act. Consider a system of two quantum particles A and B: if a measurement apparatus M is used to make an observation on B, the overall state of the system AB will typically be altered. When this happens, no matter which local measurement is performed, the two objects A and B are revealed to possess peculiar correlations known as quantum discord. Here, we demonstrate experimentally that the very act of local observation gives rise to an activation protocol which converts discord into distillable entanglement, a stronger and more useful form of quantum correlations, between the apparatus M and the composite system AB. We adopt a flexible two-photon setup to realize a three-qubit system (A, B, M) with programmable degrees of initial correlations, measurement interaction, and characterization processes. Our experiment demonstrates the fundamental mechanism underpinning the ubiquitous act of observing the quantum world and establishes the potential of discord in entanglement generation.

Device-independent certification of high-dimensional quantum systems

An important problem in quantum information processing is the certification of the dimension of quantum systems without making assumptions about the devices used to prepare and measure them, that is, in a device-independent manner. A crucial question is whether such certification is experimentally feasible for high-dimensional quantum systems. Here we experimentally witness in a device-independent manner the generation of six-dimensional quantum systems encoded in the orbital angular momentum of single photons and show that the same method can be scaled, at least, up to dimension 13.

A case of uterine rupture in mid-trimester spontaneous abortion: a complication of gemeprost vaginal administration

The only prostaglandin analogue licensed in Italy for induction of labour in spontaneous and therapeutic abortion is gemeprost. The authors report a case of spontaneous uterine rupture of a scarred uterus, for previous caesarean sections, in a woman at 20 weeks of gestation with a diagnosis of spontaneous abortion. She received a pessary of gemeprost every three hours. After the fifth pessary, she complained of severe pain. At the ultrasound examination, uterine cavity appeared empty and the dead fetus was dislocated in the abdomen. Emergency laparotomy was performed and uterine tear was repaired. To induce labour for fetal demise or therapeutic abortion in second trimester in women with scarred uterus, the authors decided to lengthen the time between administrations of pessary from four to five hours depending on patient's symptoms. However the appropriate drug regimen has still to be found and more data are necessary.

Matrix array transducer for the examination of fetal heart

The X6-1 xmatrix array transducer allows a completely new approach to the diagnostic ultrasound: it permits visualization of fetal heart in real time, without the need for gating, and it is unaffected by motion artefacts. It is obtained in real time, without any spatial reconstruction. The authors compared this technology with the traditional one in two case reports: a diagnostic doubt of small muscular ventricular septal defect was solved using this new technique; a diagnosis of complete atrioventricular septal defect was confirmed. Three-dimensional real-time imaging would seem very precise in the study of fetal heart: the defects were fully visualized from any angulations. This new technology is promising but from the authors' limited experience, there is no evidence to use it in routine practice. It should be very useful to commence a prospective study on fetuses at risk while testing the superiority of this technique.

Test of mutually unbiased bases for six-dimensional photonic quantum systems

In quantum information, complementarity of quantum mechanical observables plays a key role. The eigenstates of two complementary observables form a pair of mutually unbiased bases (MUBs). More generally, a set of MUBs consists of bases that are all pairwise unbiased. Except for specific dimensions of the Hilbert space, the maximal sets of MUBs are unknown in general. Even for a dimension as low as six, the identification of a maximal set of MUBs remains an open problem, although there is strong numerical evidence that no more than three simultaneous MUBs do exist. Here, by exploiting a newly developed holographic technique, we implement and test different sets of three MUBs for a single photon six-dimensional quantum state (a "qusix"), encoded exploiting polarization and orbital angular momentum of photons. A close agreement is observed between theory and experiments. Our results can find applications in state tomography, quantitative wave-particle duality, quantum key distribution.

Assessment of lung cancer mortality reduction after chest X-ray screening in smokers: a population-based cohort study in Varese, Italy

BACKGROUND

The effectiveness of screening for lung cancer (LC) in smokers on a population level, as distinct from the special circumstances that may apply in a randomized trial of selected volunteers, has not been thoroughly investigated. Here we evaluate by the standardized mortality ratio (SMR) indicator the impact of a chest X-ray (CXR) screening programme carried out at community level on LC mortality in smokers.

METHODS

All smokers of >10 pack-years, of both genders, ages 45-75 years, resident in 50 communities of the Province of Varese, Italy, screening-eligible, in 1997 were invited by their National Health Service (NHS) general practitioner physicians to a nonrandomized programme of five annual CXR screenings. The entire invitation-to-screen cohort (n=5815 subjects) received NHS usual care, with the addition of CXR exams in volunteer participants (21% of invitees), and was observed through December 2006. To overcome participants' selection bias of LC mortality assessment, for the entire invitation-to-screen cohort we estimated the LC-specific SMR, based on the local reference population receiving the NHS usual care.

RESULTS

Over the 8-year period 1999-2006, a total of 172 cumulative LC deaths were observed in the invitation-to-screen cohort; 210 were expected based on the reference population. Each year in the invited cohort the observed LC deaths were fewer than expected. The cumulative LC SMR was 0.82 (95% CI, 0.67-0.99; p=0.048), suggesting that LC mortality was reduced by 18% with CXR screening.

CONCLUSION

Implementation of a CXR screening programme at community level was associated with a significant reduction of LC mortality in smokers.

Testing sequential quantum measurements: how can maximal knowledge be extracted?

The extraction of information from a quantum system unavoidably implies a modification of the measured system itself. In this framework partial measurements can be carried out in order to extract only a portion of the information encoded in a quantum system, at the cost of inducing a limited amount of disturbance. Here we analyze experimentally the dynamics of sequential partial measurements carried out on a quantum system, focusing on the trade-off between the maximal information extractable and the disturbance. In particular we implement two sequential measurements observing that, by exploiting an adaptive strategy, is possible to find an optimal trade-off between the two quantities.

Experimental observation of impossible-to-beat quantum advantage on a hybrid photonic system

Quantum resources outperform classical ones for certain communication and computational tasks. Remarkably, in some cases, the quantum advantage cannot be improved using hypothetical postquantum resources. A class of tasks with this property can be singled out using graph theory. Here we report the experimental observation of an impossible-to-beat quantum advantage on a four-dimensional quantum system defined by the polarization and orbital angular momentum of a single photon. The results show pristine evidence of the quantum advantage and are compatible with the maximum advantage allowed using postquantum resources.

A population-based cohort study of chest x-ray screening in smokers: lung cancer detection findings and follow-up

BACKGROUND

Case-control studies of mass screening for lung cancer (LC) by chest x-rays (CXR) performed in the 1990s in scarcely defined Japanese target populations indicated significant mortality reductions, but these results are yet to be confirmed in western countries. To ascertain whether CXR screening decreases LC mortality at community level, we studied a clearly defined population-based cohort of smokers invited to screening. We present here the LC detection results and the 10-year survival rates.

METHODS

The cohort of all smokers of > 10 pack-years resident in 50 communities of Varese, screening-eligible (n = 5,815), in July 1997 was invited to nonrandomized CXR screening. Self-selected participants (21% of cohort) underwent screening in addition to usual care; nonparticipants received usual care. The cohort was followed-up until December 2010. Kaplan-Meier LC-specific survival was estimated in participants, in nonparticipants, in the whole cohort, and in an uninvited, unscreened population (control group).

RESULTS

Over the initial 9.5 years of study, 67 LCs were diagnosed in screening participants (51% were screen-detected) and 178 in nonparticipants. The rates of stage I LC, resectability and 5-year survival were nearly twice as high in participants (32% stage I; 48% resected; 30.5% 5-year survival) as in nonparticipants (17% stage I; 27% resected; 13.5% 5-year survival). There were no bronchioloalveolar carcinomas among screen-detected cancers, and median volume doubling time of incidence screen-detected LCs was 80 days (range, 44-318), suggesting that screening overdiagnosis was minimal. The 10-year LC-specific survival was greater in screening participants than in nonparticipants (log-rank, p = 0.005), and greater in the whole cohort invited to screening than in the control group (log-rank, p = 0.001). This favourable long-term effect was independently related to CXR screening exposure.

CONCLUSION

In the setting of CXR screening offered to a population-based cohort of smokers, screening participants who were diagnosed with LC had more frequently early-stage resectable disease and significantly enhanced long-term LC survival. These results translated into enhanced 10-year LC survival, independently related to CXR screening exposure, in the entire population-based cohort. Whether increased long-term LC-specific survival in the cohort corresponds to mortality reduction remains to be evaluated.

TRIAL REGISTRATION NUMBER

ISRCTN90639073.

Deterministic qubit transfer between orbital and spin angular momentum of single photons

In this work we experimentally implement a deterministic transfer of a generic qubit initially encoded in the orbital angular momentum of a single-photon to its polarization. Such a transfer of quantum information, which is completely reversible, has been implemented adopting an electrically tunable q-plate device and a Sagnac interferometer with a Dove prism. The adopted scheme exhibits high fidelity and low losses.

Mediastinal masses: a case of fetal teratoma and literature review

Fetal mediastinal masses are rare congenital formations that could complicate pregnancy. They are usually discovered as space occupying lesions in the fetal chest during routine ultrasound scan. The most important prognostic factors of mediastinal masses are mass location, compressing effect causing pulmonary hypoplasia and/or heart failure, and the presence or absence of hydrops. We report a case of fetal mediastinal teratoma and a review of the literature. A 32-year-old woman carrying a fetus with hydrops due to a mediastinal mass underwent cesarean section at 32 1/7 weeks' gestation. A well encapsulated tumor was excised by surgery at one day of life. The baby is now eight months old without respiratory difficulty. To our knowledge, this is the fourth case report of a mediastinal teratoma associated with nonimmune hydrops in a fetus that survived the neonatal period. Fetal mediastinal teratoma requires close surveillance and multidisciplinary management by obstetricians, neonatologists, and pediatric surgeons.

Efficacy of three different antithrombotic regimens on pregnancy outcome in pregnant women affected by recurrent pregnancy loss

INTRODUCTION

Recurrent pregnancy loss (RPL) is a common health problem affecting 1-5% of women at reproductive age.

AIM OF THE STUDY

Evaluation of three different antithrombotic treatments in women with antecedent of RPL, comparing the results in negative and positive to thrombophilic screening pregnant women.

MATERIALS AND METHODS

We recruited 361 women with an antecedent of two or more pregnancy losses. From this group, 167 women became pregnant and considered for the study. The evaluated pregnant women were divided as negative/positive to thrombofilic screening: (a) 80 (48%) with negative thrombophilic screening, (b) 87 (52%) positive to thrombophilic screening. Pregnant women included in the study and considered negative or positive for thrombophilic screening, were randomized into three different therapy groups: (a) group 1: Acetil salicylic acid (ASA) 100 mg daily until third month of pregnancy, (b) group 2: low molecular-weight heparin (LMWH) - enoxaparine 40 mg daily until third month of pregnancy, (c) group 3: ASA 100 mg plus LMWH 40 mg daily until third month of pregnancy.

RESULTS

In 80 negative to thrombophilic screening pregnant women, the comparison of efficacy of the three treatments, shows that all three treatment regimens were significantly effective comparing live births against fetal losses. In 87 positive to thrombophilic screening pregnant women, the comparison of efficacy for the three regimens, shows that the therapy with LMWH or LMWH plus ASA are significantly protective against fetal losses with respect to ASA, which showed a high number of fetal losses (11 live births, 18 fetal losses).

COMMENT

We suggest that thromboprophylaxis is indicated in women with RPL independently from positiveness to thrombophilic markers.

The polarizing Sagnac interferometer: a tool for light orbital angular momentum sorting and spin-orbit photon processing

In this paper we show that an optical setup based on a polarizing Sagnac interferometer combined with a Dove prism can be used as a convenient general-purpose tool for the generation, detection and sorting of spin-orbit states of light. This device can work both in the classical and in the quantum single-photon regime, provides higher sorting efficiency and extinction ratio than usual hologram-fiber combinations, and shows much higher stability and ease of alignment than Mach-Zehnder interferometer setups. To demonstrate the full potential of this setup, we also report some demonstrative experiments of several possible applications of this setup.

[Eosinophilic colitis: an unusual cause of acute abdomen. Case report and review of literature]

The Authors report a case of acute abdomen caused by a colic stenosis due to eosinophilic gastroenteritis. It is a not frequent disease, often clinically unclear: in the medical literature the Authors have found only 346 cases in publications concerning the period January 1990 - December 2005. The clinical presentation is very changeable, related to the involved site of alimentary tract and to the level of eosinophilic infiltration of the wall. There are no diagnosis criteria universally acknowledged and the most efficient procedure is thought being the intestinal biopsy which enables showing the infiltration of the digestive wall. The cure is above all medical with administration of corticosteroid: surgery surely has a less important role, reserved to the cases with acute onset.

Spontaneous splenic rupture in a patient with acute lymphoblastic leukemia of Burkitt type

We describe a case of spontaneous splenic rupture occurred in a patient with acute lymphoblastic leukemia of Burkitt type before starting cytotoxic chemotherapy. Left hypochondrial pain radiating to the homolateral shoulder was the only clinical symptom. Emergency computed tomography showed splenic laceration and hemoperitoneum. The patient underwent immediate laparatomy with splenectomy and experienced an uneventful postoperative recovery. Eight days after surgery, chemotherapy could be administered and complete remission was achieved. Although spontaneous rupture of the spleen is rare in leukemia and related disorders, this diagnosis should be taken in account also when clinical symptoms are mild. Following immediate operative management, patients may completely recover and receive cytotoxic chemotherapy with substantial possibilities of achieving complete remission.

Plasma myoglobin in the early diagnosis of acute myocardial infarction

Serum and plasma myoglobin and creatine kinase-MB catalytic activity were analysed in 157 patients admitted within 2 hours of the onset of chest pain (58 were retrospectively recognized as acute myocardial infarction). Serum and plasma values were highly correlated for both myoglobin and creatine kinase-MB. Plasma myoglobin appeared to be more sensitive than creatine kinase-MB for the early diagnosis of acute myocardial infarction; using a cut-off value of 100 micrograms/l, 90% of acute myocardial infarction cases were correctly recognized by plasma myoglobin 6 hours after the onset of chest pain, with a diagnostic specificity of 100% for non-acute myocardial infarction chest pain subjects. Plasma creatine kinase-MB showed a diagnostic sensitivity of 62% and a diagnostic specificity of 95% in the same group of patients. We suggest the inclusion of the plasma myoglobin immunonephelometric assay together with plasma creatine kinase-MB activity analysis in protocols for the early diagnosis of acute myocardial infarction.