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Introduction: Few studies have pointed to the possible role of infectious diseases in triggering Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP). Given the association of Hepatitis E Virus (HEV) with Guillain Barrè syndrome, we conducted a case-control study to determine the possible association of HEV infection with CIDP, analyzing possible risk factors for acquiring HEV infection in both CIDP patients and controls., Materials and Methods: 82 CIDP and 260 from the general population have provided some personal information (demographics, anamnestic data and recognized risk factors for HEV infection) and underwent venipuncture blood sampling for virological assays testing for anti-HEV IgG and IgM with ELISA and RNA-HEV performing RT-PCR., Results: Anti-HEV IgG seropositivity resulted in 32 CIDP patients (39.0%) and in 45 controls (17.3%), indicating a significant association between anti-HEV IgG positivity and CIDP (OR 3.04; 95% CI 1.70-5.43, p-value <0.001), but in multivariate logistic regression the only significant associations with anti-HEV positivity were eating pork liver sausages (OR 10.443, 95% CI 2.268-60.12, p-value 0.004) and IVIg/SCIg administration (OR 31.32, 95% CI 7.914-171.7, p-value <0.001)., Discussion: The higher prevalence of anti-HEV IgG in CIDP patients than in controls could be justified by chronically administering IVIg/SCIg with a passive acquisition of anti-HEV antibodies. Furthermore, all the 20 CIDP patients who underwent IVIg/SCIg administration reported HEV risk factors, so that they could have acquired the infection., Conclusions: Further studies in a larger CIDP patient sample in treatment with therapy other than IVIg/SCIg are necessary to rule out the possible confounding effect of IVIg/SCIg., Competing Interests: Declaration of competing interest ENO reports personal fees for Advisory or Scientific Board from ArgenX – Belgium, Danthus - USA, Takeda - Italy and USA, CSL-Behring - Italy and USA, Janssen – USA, Kedrion – Italy, LFB – France, Roche – Switzerland, Sanofi - USA. GA reports conference honoraria, advisory board and travel grants from Kedrion, Alnylam, Alexion, Takeda, Argenx. The other authors report no potential conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Penile tumors are rare in dogs and only single case reports or small case series have been reported., Case Description: An 11-year-old, cross-breed dog was presented for a two-week history of stranguria. At physical examination, a subcutaneous swelling of the penis was detected. Abdominal radiographs, ultrasonography, and CT showed a subcutaneous penile mass involving the penile urethra and bulbus glandis associated with marked lysis of the os penis . Histological features along with the neoplastic cell positivity to CD31 and FVIII immunohistochemical markers warranted a final diagnosis of penile hemangiosarcoma., Findings/treatment and Outcome: The dog was treated with amputation of the penis, scrotal urethrostomy, and five adjuvant doses of doxorubicin along with thalidomide. Cutaneous and omental metastases were found 235 days after surgery. The dog was euthanized at 296 days due to bone and pulmonary metastasis., Conclusion: Penile hemangiosarcoma seems to share the same aggressive behavior with other hemangiosarcomas seen in other anatomical locations. Therefore, surgery and chemotherapy may improve survival time in dogs with penile hemangiosarcoma as well., Competing Interests: No conflicts of interest are declared.

We investigated SARS-CoV-2 variants circulating, from November 2020 to March 2022, among military and civilian personnel at an Air Force airport in Italy in order to classify viral isolates in a potential hotspot for virus spread. Positive samples were subjected to Next-Generation Sequencing (NGS) of the whole viral genome and Sanger sequencing of the spike coding region. Phylogenetic analysis classified viral isolates and traced their evolutionary relationships. Clusters were identified using 70% cut-off. Sequencing methods yielded comparable results in terms of variant classification. In 2020 and 2021, we identified several variants, including B.1.258 (4/67), B.1.177 (9/67), Alpha (B.1.1.7, 9/67), Gamma (P.1.1, 4/67), and Delta (4/67). In 2022, only Omicron and its sub-lineage variants were observed (37/67). SARS-CoV-2 isolates were screened to detect naturally occurring resistance in genomic regions, the target of new therapies, comparing them to the Wuhan Hu-1 reference strain. Interestingly, 2/30 non-Omicron isolates carried the G15S 3CLpro substitution responsible for reduced susceptibility to protease inhibitors. On the other hand, Omicron isolates carried unusual substitutions A1803V, D1809N, and A949T on PLpro, and the D216N on 3CLpro. Finally, the P323L substitution on RdRp coding regions was not associated with the mutational pattern related to polymerase inhibitor resistance. This study highlights the importance of continuous genomic surveillance to monitor SARS-CoV-2 evolution in the general population, as well as in restricted communities.

Objective: Several studies have investigated the efficacy of VEMP (vestibular evoked myogenic potential) in patients with vestibular disorders and BPPV (benign paroxysmal positional vertigo). However, previous data were inconclusive. The aim of this study was to investigate the difference in latency, amplitude P1-N1, asymmetry ratio (AR), and cervical/ocular-VEMP values between BPPV patients and healthy controls., Methods: 125 healthy subjects and 42 BPPV patients were prospectively enrolled in the study. In both groups, c/oVEMP tests with 500 Hz tone-burst stimuli were performed. Latencies P1, N1 peaks, and corrected amplitudes (CA) were measured, and AR was calculated., Results: in the BPPV group, 14.29% of patients lacked oVEMPs that recovered after therapy. N1 latencies were significantly elongated, and 50% of patients had pathological AR; this value normalized at follow-up sessions. In addition, there was a reduction in CA in the pathologic ear compared to healthy ears ( p = 0.04) and compared to healthy controls ( p = 0.01). For cVEMP, a significant reduction in latency-P1 was observed in BPPV patients compared to controls; no significant differences were observed for P1, N1, and CA values between the two ears. The cVEMPs were absent in 14.29% of BPPV patients (AR > 35) that recovered after therapy., Conclusion: We identified several abnormal c/oVemp values in BPPV patients compared with healthy controls, with most changes in values occurring in oVEMPs, suggesting that utricular dysfunction may be more common than saccular. In addition, patients with oVEMP alteration showed later clinical recovery, suggesting a possible prognostic role of the test.

Objectives: The present study aimed to document the use of the wound infusion catheter (WIC) following a variety of surgical procedures in cats, investigating complications and risk factors associated with catheter placement or local anaesthetic (LA) administration., Methods: A retrospective, multicentric study was performed. Medical databases of eight veterinary referral hospitals from 2010 to 2021 were searched to identify records of cats where WICs were used. Information regarding signalment, type of surgery, size and type of WIC placed, and LA protocol used, as well as postoperative complications, were retrieved., Results: One hundred and sixty-six cases fulfilled the inclusion criteria. Feline injection site sarcoma resection was the most common surgery. Overall complications were identified in 22/166 cats (13.2%). Thirteen cats (7.8%) experienced wound-related complications, whereas nine cats (5.4%) experienced drug-delivery complications. The only factor associated with an increased risk of complications was the amount of a single dose of LA delivered through the catheter ( P  <0.001). An amount higher than 2.5 ml of LA delivered at each administration was associated with an increased risk of complications. All complications were minor and self-limiting., Conclusions and Relevance: WICs were used for a large variety of surgical procedures with different protocols of LA administration as part of a multimodal analgesic plan in cats. The risk of complications was relatively low and self-limiting, suggesting its safe use in cats. Further prospective studies are required to evaluate efficacy of postoperative analgesia and to determine the suitable protocol for WIC handling and maintenance.

Background: Diaphragmatic herniorraphy is the treatment of choice for traumatic diaphragmatic hernia (TDH). Several methods have been described for the removal of residual air and fluid during and after surgery, such as the insertion of chest drains, intercostal thoracentesis, and transdiaphragmatic thoracentesis. However, there are no indications regarding the most useful technique and the impact that choice of technique could have in the immediate postoperative period., Aim: To evaluate the development of complications and outcomes associated with the use of intraoperative transdiaphragmatic thoracentesis in cats undergoing diaphragmatic herniorrhaphy for TDH., Methods: Medical records of cats treated for acute and chronic TDH between 2010 and 2019 were reviewed. Cats were included if intraoperative pneumothorax was treated with transdiaphragmatic thoracentesis, without the use of intercostal chest drain. Outcome, intra- and post-operative complications were recorded., Results: Intraoperative and postoperative complication rates were 3.3% and 12.4%, respectively. Development of postoperative pneumothorax was associated with the presence of comorbidities ( p = 0 . 046). The overall survival rate was 93.3%. Long-term survival had a significant association with the presence of comorbidities ( p = 0 . 045), if the procedure was performed as an emergency ( p = 0 . 041) or in older cats ( p = 0 . 011)., Conclusion: Intraoperative transdiaphragmatic thoracentesis could be considered an effective method for the removal of residual air after surgery for TDH, because it ensures a good outcome for the patient, with low development of complications, especially for uncomplicated cases. The presence of comorbidities, the need to perform a surgical procedure in emergency, and the age of the patient can be considered factors influencing the development of complications. Critical patient selection, based on assessment of potential risk factors for complications is warranted to understand which patient will benefit from thoracostomy tube placement., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: General population data on hepatitis C virus (HCV) prevalence in Italy come mostly from studies conducted in small towns. The highest rates have consistently been found in southern regions, especially in Calabria. Herein, we aimed to determine HCV prevalence, awareness, and risk factors in the general population of Catanzaro, the capital city of Calabria, Italy., Methods: A stratified probability-based random sample of adult population was drawn from the Census. Anti-HCV and HCV-RNA were assayed. Data on sociodemographycs, risk factors and awareness of infection status were also collected. Crude and age and sex directly standardized rates (DSR), using Catanzaro's general population as standard, were calculated. Log binomial regressions with sampling weights was used to identify independent predictors of infection., Results: The final study population consisted of 1003 people. Of them 27 (2.69%; 95% confidence interval, [CI] 1.78-3.89) (DSR: 2.34%; 95% CI: 1.37-3.30) and 9 (0.9%; 95% CI: 0.41-1.70) (DSR: 0.79%; 95% CI: 0.21-1.37) were anti-HCV and HCV RNA positive, respectively. Most HCV-positive participants were older people. Age ≥65 and past use of illicit drugs were both positive independent predictors of anti-HCV positivity, while female sex was an independent protective predictor of infection. Only 9 (33.3%) of anti-HCV positive participants had awareness of their status., Conclusions: We detected a much lower anti-HCV prevalence than those previously found in Calabria, along with a substantial change in HCV transmission modes. Infected people were almost only elderly and mostly unaware of their infection. Improving diagnosis and linkage to care for these infected persons would be needed.

Anecdotally, during the review of CT and MRI studies of canine patients including the cranial cervical spine, authors have identified a small osseous structure between the atlas (C1) and axis (C2) with no relevant clinical signs. This structure appeared comparable to a "persistent ossiculum terminale" in humans. The aim of this retrospective, multi-center, case series study was to describe the CT and MRI features of presumed persistent ossiculum terminale in a group of dogs presented with unrelated medical conditions.  Two databases (the imaging database of the teleradiology service VetCT Specialists and the clinical database of the University of Vienna) were scrutinized by different approaches. Medical records of dogs that underwent imaging investigation (CT and/or MRI) that included the atlanto-axial junction were reviewed. Data collected included signalment, sex, breed, age, presenting symptoms, and final diagnosis. Eighteen dogs met the inclusion criteria. Mean age was 85 months (6-166) and breed variation was present. A total of 20 imaging studies were evaluated: CT was performed in 17 dogs; MRI in three dogs; two dogs had both MRI and CT performed. In all cases the presence of at least one small osseous body on the cranial aspect of the odontoid process compatible with a persistent ossiculum terminale was identified as a possible incidental finding without any overt clinical implications. Findings indicated that a small osseous body on the cranial aspect of the odontoid process (presumed persistent ossiculum terminale) in CT and MRI studies may be present in dogs with no clinical signs of neurologic disease., (© 2022 American College of Veterinary Radiology.)

Case Series Summary: Twenty-nine cats from different institutions with confirmed or highly suspected primary hyperaldosteronism treated by unilateral adrenalectomy were retrospectively included in this study. The most frequent clinical signs were lethargy (n = 20; 69%) and neck ventroflexion (n = 17; 59%). Hypokalaemia was present in all cats, creatinine kinase was elevated in 15 and hyperaldosteronism was documented in 24. Hypertension was frequently encountered (n = 24; 89%). Preoperative treatment included potassium supplementation (n = 19; 66%), spironolactone (n = 16; 55%) and amlodipine (n = 11; 38%). There were 13 adrenal masses on the right side, 15 on the left and, in one cat, no side was reported. The median adrenal mass size was 2 × 1.5 cm (range 1-4.6 × 0.4-3.8); vascular invasion was present in five cats, involving the caudal vena cava in four cats and the renal vein in one. Median duration of surgery was 57 mins. One major intraoperative complication (3%) was reported and consisted of haemorrhage during the removal of a neoplastic thrombus from the caudal vena cava. In 4/29 cats (14%), minor postoperative complications occurred and were treated medically. One fatal complication (3%) was observed, likely due to disseminated intravascular coagulation. The median duration of hospitalisation was 4 days; 97% of cats survived to discharge. The potassium level normalised in 24 cats within 3 months of surgery; hypertension resolved in 21/23 cats. Follow-up was available for 25 cats with a median survival of 1082 days. Death in the long-term follow-up was mainly related to worsening of comorbidities., Relevance and Novel Information: Adrenalectomy appears to be a safe and effective treatment with a high rate of survival and a low rate of major complications. Long-term medical treatment was not required.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by a multifactorial etiology. The primary aim of this study was to estimate HCV and HBV infection prevalence in a cohort of SLE and Cutaneous Lupus Erythematosus (CLE). We assessed the frequency of these infections in our cohort and the possible associations with disease clinical/laboratory features and disease activity status. The prevalence of chronic HBV infection was 2.2% in the CLE group, while no HBsAg positive patients were identified in the SLE group. Conversely, the prevalence of anti-HCV positive was 2.2% in the SLE group while no anti-HCV positive patients were identified in the CLE group. We found no significant association between anti-HBc positive status and clinical manifestations or disease activity status in either group of patients. Hemodialysis resulted significantly associated with anti-HBc positivity in SLE. In the present study, we found HBsAg positivity in CLE patients but not in the Systemic form (SLE); conversely, a similar prevalence of anti-HBc antibodies in both groups was observed. A possible protective role exerted by SLE in HBV infection may be hypothesized. A higher frequency of HCV infection in SLE compared to CLE suggests a possible involvement of HCV in some SLE-related clinical and immunological features.

Background: Most SARS-CoV-2 rapid antigen detection tests (RADTs) validation studies have been performed on specimens from COVID-19 patients and negative controls or from mostly symptomatic individuals. Herein we evaluated the diagnostic accuracy of AFIAS COVID-19 Ag, hereinafter denominated as AFIAS, during a COVID-19 screening program surveillance testing conducted among personnel of an Italian military airport., Methods: Nasopharyngeal swabs (NPSs) were collected from study participants and were analysed by both AFIAS and RT-PCR assay. A questionnaire collecting demographic and exposure data were administered to all participants. AFIAS accuracy parameters including Cohen's kappa (K) were determined., Results: Overall, from November 2020 to April 2021, 1294 (NPSs) were collected from 1183 participants (88.6% males, 11.4% females; mean age were 41.3, median age 42). Forty-nine NPSs (3.78%) were positive by RT-PCR, while 54 NPSs were positive by AFIAS. Overall baseline sensitivity, specificity, positive and negative predictive values were 0.633, 0.981, 0.574, 0.985, respectively and K was 0.585 (moderate). AFIAS sensitivity tended to be higher for NPSs with higher viral load. A higher sensitivity (0.944) compared to the overall baseline sensitivity (0.633) was also found for NPSs from participants with COVID-19 compatible symptoms, for which K was 0.891 (almost perfect). Instead, AFIAS sensitivity was quite poor for NPSs from asymptomatic participants. Most false negative NPSs in this group had moderate viral load., Conclusion: Overall, AFIAS showed high specificity but only moderate sensitivity, mainly because of the high proportion of asymptomatic participants. However, AFIAS showed good sensitivity for NPSs with high viral load and nearly optimal accuracy parameters for NPSs from participants with COVID-19 compatible symptoms. Thus, taking into consideration its performance features, this test can be useful for COVID-19 case identification and management as well as for infection control., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Verde et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: The aim of this retrospective observational study was to describe the clinical presentation, treatment and outcome of cats with sialocoele., Methods: Clinical records from seven referral hospitals were retrospectively searched to identify cats with sialocoele between 2007 and 2021., Results: Nineteen cats were identified. The most common clinical signs were ptyalism, dysphagia and anorexia. Localisation of the sialocoele was cervical (n = 6), sublingual (n = 6), cervical/sublingual (n = 3), facial (n = 2), cervical/pharyngeal (n = 1) and zygomatic (n = 1). The affected salivary glands were mandibular-sublingual (n = 15), mandibular-sublingual/parotid (n = 1), zygomatic/parotid (n = 1) and parotid (n = 2). The aetiology of the sialocoele was traumatic in two cases, neoplastic in one cat and unknown in 16 cats. Sialoadenectomy was performed in 11 cats. Other treatments included ranula marsupialisation (n = 3), needle drainage (n = 2), single stab incision (n = 2) and parotid duct ligation (n = 1). The median follow-up time was 399 days (range 15-1460). Postoperative seroma was the only complication observed in one cat. No recurrence was reported., Conclusions and Relevance: Feline salivary sialocoele are relatively rare and have a good prognosis. They can be managed successfully with sialoadenectomy; however, a more conservative approach can be used with appropriate case selection.

BackgroundIn high-income countries, hepatitis E virus (HEV) infection is mainly a zoonosis. However, it is also transfusion-transmissible and some countries, but not Italy, have introduced HEV screening for blood donations.AimWe assessed HEV infection prevalence and risk factors in a nationwide sample of Italian blood donors.MethodsWe selected 107 blood establishments (BE) distributed in the 20 Italian regions by a stratified two-stage design and invited them to participate in the study. Donors were tested for anti-HEV IgG and IgM and HEV RNA. Sociodemographic data and risk factors were collected through a questionnaire.ResultsOverall, 60 BE from 60 provinces in 19 Italian regions joined the study. We assessed HEV markers in 7,172 blood donors, of whom 6,235 completed the questionnaire. Overall crude and adjusted anti-HEV IgG prevalences were 8.3% and 5.5%, respectively. Overall anti-HEV IgM prevalence was 0.5%, while no blood donor was HEV RNA-positive. Anti-HEV IgG prevalence varied widely among regions (range: 1.3%-27.20%) and hyperendemic prevalences (> 40%) were detected in some provinces in two regions. Older age (AOR = 1.81; 95% CI: 1.36-2.41), foreign nationality (AOR = 2.77; 95% CI: 1.06-7.24), eating raw pork liver sausages (AOR = 2.23; 95% CI: 1.55-3.20) and raw homemade sausages (AOR = 3.63; 95% CI: 2.50-5.24) were independent infection predictors.ConclusionItalian blood donors showed a low to moderate HEV seroprevalence. High levels in some regions and/or provinces were mainly attributable to eating habits. Prevention should include avoiding consumption of raw or undercooked meat and safe production of commercial pork products.

Background: We investigated the presence of anti-SARS-CoV-2 antibodies in Italian plasma pools and intravenous immunoglobulins sent to our Institute (Italian National Institute of Health - Istituto Superiore di Sanità) in the context of the Official Control Authority Batch Release. The plasma pools were made up from donations collected in several different Italian regions from May 2017 to October 2020, i.e. in the pre-pandemic and pandemic periods., Materials and Methods: All plasma pools were initially tested for the qualitative detection of anti-SARS-CoV-2 antibodies against the nucleocapsid protein using the Roche Elecsys ® Anti-SARS-CoV-2 test kit. Plasma pools positive for these antibodies were further tested using the Roche Elecsys ® Anti-SARS-CoV-2 S test kit for the quantitative detection of antibodies against SARS-CoV-2 spike receptor binding domain. All plasma pools showing reactivity to these antibodies were tested undiluted for the presence of SARS-CoV-2 RNA using the Grifols Procleix SARS-CoV-2 transcription-mediated amplification assay. Intravenous immunoglobulins were tested using both test kits to determine the presence of anti-SARS-CoV-2 antibodies., Results: All plasma pools made up from donations collected in the pre-pandemic period were negative for anti-SARS-CoV-2 antibodies against the nucleocapsid protein. Of the plasma pools made up from donations collected from December 2018 to March 2020, only 1 pool out of 68 (1.4%), that was made up from donations from the Lombardy region, was reactive for these antibodies. Interestingly, 105 out of 174 (60.3%) of the plasma pools made up from donations collected from November 2018 to October 2020 showed the presence of these antibodies. All plasma pools positive for these antibodies were tested for antibodies against SARS-CoV-2 spike receptor binding domain and were confirmed positive., Discussion: None of these plasma pools tested were reactive for SARS-CoV-2 RNA. In the case of intravenous immunoglobulins, 20 out of 25 (80%) batches showed the presence of both anti-SARS-CoV-2 antibodies, reflecting the concentration in the plasma pools used for their production.

Background: Laparoscopic liver resection (LLR) is becoming essential in the treatment of malignant liver tumors but only a few reports exist about LLR for intrahepatic cholangiocarcinoma (IHCC)., Methods: We present a video of a laparoscopic left hemihepatectomy with lymphadenectomy for IHCC., Case Presentation: A 67-year-old asymptomatic male underwent a routine abdominal ultrasound, revealing a 15 × 9 mm solid nodular iso-hyperechoic lesion, located in SIII, with SII/III biliary duct dilation. Magnetic resonance imaging confirmed a 32 × 22 mm lesion in SII/III, with mild hyper-intensity on T2-weighted images and strong hypo-intensity on T1-weighted images. After administration of contrast medium, the lesion showed light peripheral enhancement on the portal and delayed phases, and hypo-intensity on the hepatospecific phase. No relevant comorbidities were reported (KPS 100). Laboratory tests showed normal liver function and normal CA19-9 levels. A laparoscopic left hemihepatectomy was indicated., Results: Operative time was 330 min. Four intermittent Pringle maneuver cycles were applied and no blood transfusions were administered. Intraoperative ultrasound confirmed preoperative findings and additionally highlighted involvement of the SIV duct. A full replacing right hepatic artery arising from the superior mesenteric artery was identified and was preserved during hilar dissection. Postoperative course was uneventful and the patient was discharged on postoperative day 3. The pathology report indicated cholangiocellular carcinoma pT1bN0. Twelve lymph nodes were retrieved., Conclusions: According to recent literature reports and our experience, laparoscopic surgery for intrahepatic cholangiocellular carcinoma should be considered feasible and safe in selected patients. Hepatic artery variations allow for adequate lymphadenectomy. Oncological long-term results require multicenter randomized studies in order to be validated., (© 2022. The Author(s).)

Background: The latest European Chikungunya virus (CHIKV) outbreak occurred in Italy in 2017, in the municipalities of Anzio and Rome (Lazio Region), with a secondary outbreak in the Calabrian Region. Most CHIKV infections are symptomatic but about 15% of people who acquire the infection may be asymptomatic. A retrospective study was conducted with the aim of assessing the prevalence of recent/ongoing CHIKV infections on the blood donor population in the Lazio Region, during the 2017 outbreak (including in the period before it was detected)., Methods: The study was conducted on 4595 plasma samples from donors who donated in 14 different Blood Establishments in the Lazio Region, in the period June-November 2017. A total of 389 of these samples were collected in provinces not affected by the outbreak and were used as negative controls. All samples were tested for IgM detection by the use of an ELISA test, and positive samples were tested for confirmation through the use of a PRNT. Molecular tests were performed on sera that were found to be IgM-positive or borderline., Results: A total of 41 (0.89%) blood donors tested positive for IgM. None of these positive IgM ELISA results was confirmed either by PRNT or by molecular tests., Conclusions: Our study has shown no evidence of recent/ongoing CHIKV infection in blood donors of the affected area.

Hemorrhagic Cholecystitis is a rare condition and usually represents a complication of acute cholecystitis. The clinical presentation is quite overlapping and usually involves abdominal pain that may be associated with fever, jaundice, nausea, vomiting, and finally haemobilia. It frequently involves patients with preexisting conditions such as chronic kidney disease undergoing hemodialysis or anticoagulation therapy. Due to the deadly potential of this condition attention must be high during diagnostics and treatment in order to avoid an ill-fated conclusion. To our knowledge, there is a lack of a comprehensive review on the subject as most of the literature consists of case reports or small case series. In order to give a contribution to improving the treatment strategy of this condition, we report a case successfully treated with cholecystectomy, and performed a literature review. Using the term "Hemorrhagic Cholecystitis", on PubMed database we found 67 cases reported in the English literature. The cases were analyzed by two researchers and clinical information was extrapolated and organized, aiming to create a comprehensive review on the subject, that may be clear and useful in clinical practice. KEY WORDS: Hemorrhagic cholecystitis, Surgical treatment.

Magnetite (Fe 3 O 4 ) nano-particles (MNPs) have been found in human tissues and causally linked to serious illnesses. The possible negative role of MNPs has been not still fully ascertained even though MNPs might cause health effects due to their magnetic property, redox activity and surface charge. The origin of MNPs in human tissues still remains to be unambiguously identified since biological processes, natural phenomena and anthropogenic production have been proposed. According to this latter increasingly convincing hypothesis, anthropogenic MNPs might enter mainly in the human body via inhalation, penetrate deeply into the lungs and in the alveoli and also migrate into the blood circulation and gather in the extrapulmonary organs and central nervous system. In order to identify the releasing source of the potentially inhalable MNPs, we pioneered an innovative approach to rapidly investigate elemental profile and morphology of a large number of airborne micron and sub-micron-sized Fe-bearing particles (FePs). The study was performed by collecting a large amount of micron and sub-micron sized inhalable airborne FePs in trafficked and densely frequented areas of Rome (Italy). Then, we have investigated individually the elemental profile and morphology of the collected particles by means of high-spatial resolution scanning electron microscopy, energy dispersive spectroscopy and an automated software purposely developed for the metal-bearing particles analysis. On the basis of specific elemental tracing features, the investigation reveals that almost the total amount of the airborne FePs is released by the vehicle braking systems mainly in the form of magnetite. Furthermore, we point out that our approach might be more generally used to identify the releasing sources of different inorganic airborne particles and to contribute to establish more accurately the impact of specific natural or anthropogenic particles on the environment and human health., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)