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Influencing behavioral patterns through primary prevention, possibly addressing more risk factors at a time, is the most effective means to tackle cardiovascular diseases. Many interdisciplinary prevention activities have been coordinated by community nurses outside of specialist centers, resulting in a more effective control of risk factors. Our study aims at describing the impact of an 18-month prevention and promotion, interdisciplinary intervention on lifestyle habits and cardiovascular risk. From December 2018 to May 2020, patients were recruited by 4 General Practitioners (GPs) in the Roman neighborhood of Torresina and received nutritional, physical and psychological counselling to learn healthy lifestyles. Until May 2020 patients had to self-manage their new healthy habits, but during this phase the SARS-CoV-2 pandemic broke out. Patients were assessed at baseline, 6, 12 and 18 months by a nutritionist, a physiotherapist, a psychologist, the 4 GPs and community nurses, and the cardiovascular risk score (CRS) was estimated at every examination. 76 patients were included, with a mean age of 54,6 years. Mean CRS showed a significant reduction between baseline and 12 months (from 4.9 to 3.8, p < 0.001), but this trend was not maintained at 18 months. As for variables included in the calculation of the cardiovascular risk score, both total cholesterol and systolic blood pressure significantly decreased at 6 months of follow up (respectively, from 211.1 to 192 (p < 0.001) and from 133.1 to 123.1(p < 0.001)). Nontheless, the reduction was maintained in the remaining points in time only for systolic blood pressure. Our interdisciplinary educational intervention in a primary care setting resulted in a CRS improvement at 12 months, but this changes where not maintained at 18 months. Community nurses were facilitators in improving health outcomes and patient's satisfaction in the described primary care setting. Key messages

Background and aim Despite adequate preoperative staging, 25% of patients with oesophageal cancer treated with primary surgery have microscopically positive resection margins (R1), and the 5-year survival rate rarely exceeds 40%. The CROSS trial demonstrated that neoadjuvant chemoradiotherapy (nCRT) double the median overall survival, with 29% of patients achieving a pathological complete response. Many authors suggest that this subgroup of patients do not benefit from additional surgery also having regard to the fact that oesophageal resections are associated with substantial morbidity and postoperative mortality rates of 3–5%. On the other hand 18% of patients who underwent nCRT were found to be non-responders, only suffering from nCRT side effects. Thus, rationale exists for identifying novel biomarkers allowing early, non-invasive prediction of pathological tumour response. Methods Starting from January 2020, all consecutive patients with biopsy proven potentially resectable oesophageal cancer scheduled to receive nCRT (CROSS regimen) were prospectively enrolled. In addition to standard of care imaging, a fully integrated hybrid PET/MR was performed at three time points (prior to, during and six weeks after treatment completion). For each patient, an early regression index (ERI) was computed according to the formula: ERI = ln [1—(tumour volume mid/tumour volume pre) tumour volume pre]. Tumour volumes were contoured on axial high resolution T2 weighted images by an experienced radiologist. Finally, after surgery, these data were systematically correlated with the pathological outcome in terms of Tumour Regression Grade(TRG). TRG = 1 refers to pathological complete response status. Results At present, of ten patients enrolled, seven underwent surgery after completion of nCRT; of these, three patients had TRG = 1. Interestingly, patients with a pathological complete response demonstrated significantly lower ERI values when compared with those patients with TRG ≥ 2 (4.09 vs. 27.94, P Conclusion Preliminary results point out the existence of a novel imaging, MR based biomarker (ERI), able to early predict pathological tumour response during nCRT, thus providing an actual aid for patients’ management. The research leading to these results has received funding from AIRC (Italian Association for Cancer Research) under Investigator Grant—IG 2019—ID. 23015 project; NCT04359732.

The eastern margin of North America has been shaped by a series of tectonic events including the Paleozoic Appalachian Orogeny and the breakup of Pangea during the Mesozoic. For the past similar to 200 Ma, eastern North America has been a passive continental margin; however, there is evidence in the Central Appalachian Mountains for post-rifting modification of lithospheric structure. This evidence includes two co-located pulses of magmatism that post-date the rifting event (at 152 and 47 Ma) along with low seismic velocities, high seismic attenuation, and high electrical conductivity in the upper mantle. Here, we synthesize and evaluate constraints on the lithospheric evolution of the Central Appalachian Mountains. These include tomographic imaging of seismic velocities, seismic and electrical conductivity imaging along the Mid-Atlantic Geophysical Integrative Collaboration array, gravity and heat flow measurements, geochemical and petrological examination of Jurassic and Eocene magmatic rocks, and estimates of erosion rates from geomorphological data. We discuss and evaluate a set of possible mechanisms for lithospheric loss and intraplate volcanism beneath the region. Taken together, recent observations provide compelling evidence for lithospheric loss beneath the Central Appalachians; while they cannot uniquely identify the processes associated with this loss, they narrow the range of plausible models, with important implications for our understanding of intraplate volcanism and the evolution of continental lithosphere. Our preferred models invoke a combination of (perhaps episodic) lithospheric loss via Rayleigh-Taylor instabilities and subsequent small-scale mantle flow in combination with shear-driven upwelling that maintains the region of thin lithosphere and causes partial melting in the asthenosphere. U.S. National Science Foundation EarthScope programNational Science Foundation (NSF)NSF - Directorate for Geosciences (GEO) [EAR-1460257, EAR-1249412, EAR-1249438, EAR-1250988, EAR-1251538, EAR-1251515]; United States National Science FoundationNational Science Foundation (NSF) [EAR-1261681]; U.S. National Science Foundation GeoPRISMS program [EAR-1460257, EAR-1249412, EAR-1249438, EAR-1250988, EAR-1251538, EAR-1251515] Published version This work benefited from discussions at the EarthScope Synthesis Workshop on the Evolution of the Southern Appalachian Lithosphere, held at Brown University in March 2017. The authors acknowledge support from the U.S. National Science Foundation EarthScope and GeoPRISMS programs via grants EAR-1460257 (R. L. Evans), EAR-1249412 (E. Gazel), EAR-1249438 (E. A. Johnson), EAR-1250988 (S. D. King), EAR-1251538 (E. Kirby), and EAR-1251515 (M. D. Long). The authors thank Randy Keller for making the PACES gravity data available. The collection and dissemination of most of the geophysical data and models discussed in this study were facilitated by the Incorporated Research Institutions for Seismology (IRIS). The facilities of the IRIS Consortium are supported by the United States National Science Foundation under Cooperative Agreement EAR-1261681. The authors thank two anonymous reviewers whose valuable comments have helped us to improve the quality of the article. For the past 200 million years, the east coast of North America has been situated in the middle of a tectonic plate. Contrary to the expectations for this setting, a region of the Central Appalachian Mountains centered near the boundary between the U.S. states of Virginia and West Virginia exhibits atypical properties. The unusual observations include volcanic activity in the geologic past far away from a plate boundary, elevated rates of erosion associated with high topography in the Central Appalachians, and anomalous structure in the upper mantle that has been detected using geophysical methods. This article describes, synthesizes, and compares a suite of observations that show that this part of the Central Appalachians is unusual compared to other so-called passive continental margins. We discuss a range of different models that might describe how the lithosphere, or the rigid part of the crust and upper mantle that defines the tectonic plate, has evolved through time beneath our study region. We show that the lithosphere today is thin, and that past episodes of lithospheric loss involving a portion of dense lithosphere "dripping" into the mantle under the force of gravity may provide a good explanation for the observations.

Background Coping styles are the ways in which people deal with different stressor situations. Coping strategies can be categorized into three types: task-oriented, emotion-oriented, and avoidance-oriented. Several studies showed a strong relationship between coping styles and cardiovascular diseases. The aim of the study was to evaluate how much the SARS-CoV-2 national lockdown has impacted the coping strategies on behaviors for cardiovascular prevention. Methods 62 participants from Rome were recruited to assess the impact of prevention and promotion of health on Individual Cardiovascular Risk. The Coping Inventory to Stressful Situations (CISS, Endler & Parker, 1990) is a self-report questionnaire that measures the three strategies of coping. Behaviors dealing with cardiovascular prevention were evaluated at the beginning of the observation period, and after 6, 12, and 18 months. During 12 (February 2020) and 18 months (July 2020) the SARS-CoV-2 national lockdown enabled us to inquire into coping strategies in stressful situations and cardiovascular risk factors. Results The Pearson correlation analysis was used to assess the existence of a correlation between coping strategies and the variation of cardiovascular risk factors and alcohol consumption at 12 and 18 months. Interestingly, results showed relations between Emotional-oriented (r = 0.26 p < 0.05) and Task-oriented (r = -0.33 p < 0.01) coping styles and Differential Cardiovascular Risk Reduction (DCRR). Furthermore, a positive relation between Task-oriented (r = 0.34 p < 0.01) coping style and Differential Alcohol Consumption (DAC) was observed. Conclusions We found that the DCRR relates to the Emotional- and Task-oriented coping styles, while DAC is associated with the Task-oriented coping style. The strength of our study consists in the territorial and multidisciplinary dimension of the project, the main critical issue is represented by the small size of the patient sample. Key messages A relationship can be described between Differential Cardiovascular Risk Reduction and Emotional- and Task-oriented coping styles. There is a relationship between Differential Alcohol Consumption and the Task-oriented coping style.

Los linfomas malignos del delgado son tumores menos infrecuentes de lo que suele creerse. Aun cuando su frecuencia total no sea muy alta, merece señalarse que sí lo son en relación con otros tumores del delgado como lo atestiguan todas las estadísticas...

Intraplate magmatic provinces found away from plate boundaries provide direct sampling of the composition and heterogeneity of the Earth's mantle. The chemical heterogeneities that have been observed in the mantle are usually attributed to recycling during subduction1-3, which allows for the addition of volatiles and incompatible elements into the mantle. Although many intraplate volcanoes sample deep-mantle reservoirs-possibly at the core-mantle boundary4-not all intraplate volcanoes are deep-rooted5, and reservoirs in other, shallower boundary layers are likely to participate in magma generation. Here we present evidence that suggests Bermuda sampled a previously unknown mantle domain, characterized by silica-undersaturated melts that are substantially enriched in incompatible elements and volatiles, and a unique, extreme isotopic signature. To our knowledge, Bermuda records the most radiogenic 206Pb/204Pb isotopes that have been documented in an ocean basin (with 206Pb/204Pb ratios of 19.9-21.7) using high-precision methods. Together with low 207Pb/204Pb ratios (15.5-15.6) and relatively invariant Sr, Nd, and Hf isotopes, the data suggest that this source must be less than 650 million years old. We therefore interpret the Bermuda source as a previously unknown, transient mantle reservoir that resulted from the recycling and storage of incompatible elements and volatiles6-8 in the transition zone (between the upper and lower mantle), aided by the fractionation of lead in a mineral that is stable only in this boundary layer, such as K-hollandite9,10. We suggest that recent recycling into the transition zone, related to subduction events during the formation of Pangea, is the reason why this reservoir has only been found in the Atlantic Ocean. Our geodynamic models suggest that this boundary layer was sampled by disturbances related to mantle flow. Seismic studies and diamond inclusions6,7 have shown that recycled materials can be stored in the transition zone11. For the first time, to our knowledge, we show geochemical evidence that this storage is key to the generation of extreme isotopic domains that were previously thought to be related only to deep recycling.

Cardiovascular Diseases (CVDs) are one of the main causes of death and morbidity worldwide. To reduce the risk of occurrence it is necessary to promote a healthy lifestyle and consider health as a collective benefit. This study aims to evaluate how the implementation of preventive interventions and health promotion could reduce the impact of CVDs on the involved population. This prospective study started 1 year ago and will last 18 months (July 2020). Participants have been recruited in General Practice clinic in Torresina neighbourhood in Rome. The intervention was a full year of multidisciplinary meetings scheduled with general practitioners, community nurses, dedicated professionals (nutritionist, physiotherapist, psychologist) and outdoor events with a coach to promote group physical activity, assisted by the use of social networks. Anthropometric data, blood chemistry tests and information about lifestyle, nutritional habits and physical activity were collected at time 0 and every 2-month follow-up and, additionally, the individual cardiovascular risk score (CVRS) was calculated. After 12 and up to 18 months, instead, the self-management ability of a correct lifestyle will be evaluated on the basis of the measured outcomes. Statistical analysis was performed using a paired t test with Jamovi software. The sample size was 62 patients, 50% male with an average age of 54.6 years (±7.8). During the analyzed period there was a reduction in the percentage of smokers from 30.6% at baseline to 22.6% after 12 months. The baseline CVRS was 4.9% (±6.3). At 12 months the CVRS significantly decreased to 3.8% (±4.0) (p Multidisciplinary interventions resulted in a significant reduction of CVRS and cholesterol levels during the study period. Further studies are necessary to evaluate our approach. Key messages Cardiovascular Diseases are the main causes of deaths among the population, so primary prevention through tailored educational interventions is fundamental. A multidisciplinary approach has proven to be effective in reducing the risk of cardiovascular disease and the level of cholesterol.

In this premarket clinical study, we evaluated the efficacy and safety of a novel Hydrogel (HYADD4-G) for reducing low back pain (LBP) in patients with degenerative disc disease (DDD).Twenty-three patients with chronic LBP were enrolled. All patients presented with up to three lumbar black discs (Pfirrmann grade III or IV), LBP of at least 40 mm on the Visual Analogue Scale (VAS), and a Roland-Morris Disability Questionnaire (RMDQ) score of at least 9. Patients received a single 1.5 ml intradiscal injection of HYADD4-G (8 mg/ml), guided by X-ray. Our primary endpoint was the change in VAS score from baseline (day 0) to 4, 12, and 24 weeks. Our secondary endpoints were black disc hydration by Magnetic Resonance Imaging (MRI); the patient's therapeutic response according to the RMDQ; the quality of life, as determined by the EuroQol-5 Dimension (EQ-5D) Index; and a global assessment of patient health status, safety, and local tolerability.Compared with baseline values, VAS score showed a significant reduction at each time point, and across the overall 24-week follow-up period (p0.0001). MRI scanning observed a significant reduction in Pfirrmann grade from baseline, by at least one grade, at both week 4 (p = 0.0039) and week 24 (p = 0.0010). Furthermore, compared with baseline values, there was a significant reduction in RMDQ score at each timepoint, and across the entire study period (p0.0001). The EQ-5D index increased significantly from baseline to week 24 (p = 0.0001). Finally, mean VAS scores for Patient Global Assessment (PTGA), and Clinical Observer Global Assessment (COGA), decreased significantly at each time point (p0.0001), except for week 4.HYADD4-G proved to be an efficient reliever of low back pain due to DDD.

In the Caledonides of northern Scotland temperatures of metamorphism (Tm) and deformation (Td) progressively increase structurally up section in the Moine thrust sheet at the foreland edge of the Scandian (mid Silurian) orogenic wedge. However, the thermal history of the structurally overlying, more hinterland positioned thrust sheets is less well known. This study focuses on determining Td and Tm for both the central/upper part of the Moine thrust sheet and the lower part of the overlying Sgurr Beag thrust sheets in the middle of the Northern Highlands Terrane. Preserved microstructures and quartz c-axis fabric opening angles in the Moine and Sgurr Beag thrust sheets imply Td of 460 °C to 605 °C ± 50 °C. Thermobarometry and pseudosection-based P-T constraints, indicate Tm of ∼550–680 °C at 4.8–7.2 kbar in the Moine thrust sheet and Tm of ∼620 °C at 5.6–7.7 kbar in the Sgurr Beag thrust sheet. Together, Td and Tm in the Moine and Sgurr Beag thrust sheets indicate that deformation continued after peak metamorphic conditions in the Sgurr Beag thrust sheet. Monazite and xenotime petrochronology show that Tm, and possibly Td, record Precambrian metamorphism. Peak metamorphism is associated with the Knoydartian orogenic event (840-720 Ma), with possible reworking during Scandian thrusting (430-425 Ma).

Objectives: Rapid and reliable exclusion of invasive fungal infections (IFI) by markers able to avoid unnecessary empirical antifungal treatment is still a critical unmet clinical need. We investigated the diagnostic performance of a newly available β-d-Glucan (BDG) quantification assay, focusing on the optimisation of the BDG cut-off values for IFI exclusion. Methods: BDG results by Wako β-glucan assay (lower limit of detection [LLOD]=2.16pg/mL, positivity≥11pg/mL) on two consecutive serum samples were retrospectively analysed in 170 patients, admitted to haematological wards (N=42), intensive care units (ICUs; N=80), or other wards (N=48), exhibiting clinical signs and/or symptoms suspected for IFI. Only patients with proven IFI (EORTC/MSG criteria) were considered as true positives in the assessment of BDG sensitivity, specificity and predictive values. Results: Patients were diagnosed with no IFI (69.4%), proven IFI (25.3%) or probable IFI (5.3%). Two consecutive BDG values7.7pg/mL, could be a promising diagnostic approach to confidently rule out an IFI in both ICU and non-ICU patients. The poor specificity in the ICU setting remains a concern, due to the difficulty to interpret positive results in this fragile population.

Bermuda’s explosive past has changed how geologists think about the processes that make volcanoes. The chemical composition of the lavas analyzed in this study indicate that Bermuda ‘tapped’ a geologically young, volatile rich layer in the mantle, unlike anything previously known.

Background Many Eastern reports attempted to identify predictive variables for esophago-jejunal anastomosis leakage (EJAL) after total gastrectomy for cancer. There are no definitive answers about reliable risk factors for EJAL. This retrospective study shows the largest Western series focused on this topic. Methods This is a multicenter retrospective study analyzing patients’ datasets collected by 18 Italian referral Centres of the Italian Research Group for Gastric Cancer (GIRCG) from 2000 to 2018. The inclusion criteria were pathological diagnosis of gastric and esophageal (Siewert III) carcinoma requiring total gastrectomy. The primary end point of risk analysis was the occurrence of EJAL; secondary end points were post-operative (30-day) morbidity and mortality, length of stay (LoS), and survival. Results Data of 1 750 patients submitted to total gastrectomy were collected. EJAL developed in 116 (6.6%) patients and represented the 26.3% of all the 441 observed post-operative surgical complications. EJAL diagnosis was followed by a reoperation in 39 (33.6%) patients and by an endoscopic/radiological procedure in 30 cases (25.9%). In 47 patients (40.5%) EJAL was managed with conservative approach. Post-operative LoS and mortality were significantly higher after EJAL occurrence (27 days versus 12 days and 8.6% versus 1.6%, respectively). At risk analysis, comorbidities (particularly, if respiratory), minimally invasive surgery, extended lymphadenectomy, and anastomotic technique resulted significant predictive factors for EJAL. EJAL did not significantly affect survival. Conclusions These results were consistent with Asian experiences: the frequency of EJAL and its higher rate observed in patients with comorbidities or after minimally invasive approach were confirmed.

Accessory phase geochronology records several phases of metamorphism that affected Moine metasedimentary rocks in the Northern Highlands Terrane of Scotland. Within the Sgurr Beag nappe, monazite and xenotime record initial metamorphism at c. 750 Ma, with later resetting at c. 600 Ma and c. 425 Ma. Monazite, xenotime, titanite and zircon also cryptically record c. 750 Ma and c. 600 Ma metamorphism in the Naver and Ben Hope nappes prior to the dominant 435-415 Ma Scandian orogeny. Textural, geochemical, and isotopic data indicate that c. 600 Ma and c. 425 Ma isotopic resetting in the Sgurr Beag nappe was caused by fluid-mediated dissolution and reprecipitation of monazite and xenotime. The compositions of fluid-altered monazite fall into two distinct trends, with high and low Y+HREE apparently reflecting the distinct timing and temperature conditions of dissolution and reprecipitation. Monazite-xenotime thermometry is applied to constrain the temperatures of fluid alteration. High Y+HREE, low Th/U monazite is related to high temperature (∼650°C) alteration at c. 600 Ma and low Y+HREE, high Th/U monazite is related to lower temperature (∼400°C) reactivity at c. 425 Ma. These data show that the composition of reprecipitated monazite is sensitive to metamorphic conditions during fluid alteration and is therefore useful in understanding the evolution of polyphase metamorphic terranes. These data suggest that a widespread metamorphic or metasomatic event affected northern Scotland at c. 600 Ma, likely related to higher heat flux and magmatic activity during the break-up of Rodinia. Additionally, the now adjacent Sgurr Beag and Moine nappes appear to have contrasting metamorphic records at least until Caledonian orogenesis, which suggests that final regional scale motion on the Sgurr Beag thrust must be of Caledonian age.

Understanding the evolution of passive margins requires knowledge of temporal and chemical constraints on magmatism following the transition from super-continent to rifting, to post-rifting evolution. The Eastern North American Margin (ENAM) is an ideal study location as several magmatic pulses occurred in the 200 My following rifting. In particular, the Virginia-West Virginia region of the ENAM has experienced two post-rift magmatic pulses at ∼152 Ma and 47 Ma, and thus provides a unique opportunity to study the long-term magmatic evolution of passive margins. Here we present a comprehensive set of geochemical data that includes new 40Ar/39Ar ages, major and trace-element compositions, and analysis of radiogenic isotopes to further constrain their magmatic history. The Late Jurassic volcanics are bi-modal, from basanites to phonolites, while the Eocene volcanics range from picrobasalt to rhyolite. Modeling suggests that the felsic volcanics from both the Late Jurassic and Eocene events are consistent with fractional crystallization. Sr-Nd-Pb systematics for the Late Jurassic event suggests HIMU and EMII components in the magma source that we interpret as upper mantle components rather than crustal interaction. Lithospheric delamination is the best hypothesis for magmatism in Virginia/West Virginia, due to tectonic instabilities that are remnant from the long-term evolution of this margin, resulting in a “passive-aggressive” margin that records multiple magmatic events long after rifting ended. This article is protected by copyright. All rights reserved.

The complex geodynamic evolution of Aeolian Arc in the southern Tyrrhenian Sea resulted in melts with some of the most pronounced along the arc geochemical variation in incompatible trace elements and radiogenic isotopes worldwide, likely reflecting variations in arc magma source components. Here we elucidate the effects of subducted components on magma sources along different sections of the Aeolian Arc by evaluating systematics of elements depleted in the upper mantle but enriched in the subducting slab, focusing on a new set of B, Be, As, and Li measurements. Based on our new results, we suggest that both hydrous fluids and silicate melts were involved in element transport from the subducting slab to the mantle wedge. Hydrous fluids strongly influence the chemical composition of lavas in the central arc (Salina) while a melt component from subducted sediments probably plays a key role in metasomatic reactions in the mantle wedge below the peripheral islands (Stromboli). We also noted similarities in subducting components between the Aeolian Archipelago, the Phlegrean Fields, and other volcanic arcs/arc segments around the world (e.g., Sunda, Cascades, Mexican Volcanic Belt). We suggest that the presence of melt components in all these locations resulted from an increase in the mantle wedge temperature by inflow of hot asthenospheric material from tears/windows in the slab or from around the edges of the sinking slab.

Purpose Adjuvant chemotherapy improves survival of patients with gastric cancer. Intergroup Trial of Adjuvant Chemotherapy in Adenocarcinoma of the Stomach (ITACA-S) was a phase III study comparing sequential FOLFIRI followed by docetaxel/cisplatin versus 5-fluorouracil monotherapy. The intensive regimen was not superior in terms of disease-free survival (DFS) and overall survival (OS). Methods The treatment was to be started within 8 weeks from surgery. This analysis evaluates the impact of time from surgery to chemotherapy start (TSC) on outcomes. Results Out of 1,106 randomized, 1,072 patients without major violations of eligibility criteria and receiving at least one treatment cycle were analyzed. Median TSC was 50 days. Chemotherapy was interrupted in 201 (18.8%) cases, whereas it was completed without or with modifications in 277 (25.8%) and 594 (55.4%), respectively. At a median follow-up of 56.9 months, 513 progressions and 472 deaths occurred. A longer TSC was significantly associated with longer DFS (hazard ratio [HR] 0.95; 95% confidence interval [CI] 0.89-1.00; p = 0.05) and OS (HR 0.91; 95% CI 0.86-0.97; p = 0.004), after adjustment for treatment arm, age, sex, primary tumor site, number of resected nodes, and tumor stage. Better treatment compliance was associated with improved survival. Conclusions Our findings suggest that longer TSC had at least no detrimental effect on DFS and OS, whereas treatment completion had a protective effect. Our findings need to be confirmed prospectively.

Background. In 2014, the Italian Consensus for Classification and Reporting of Thyroid Cytology (ICCRTC) reviewed the previous cytological classification proposed in 2007 including the subdivision of TIR 3 category into low risk (TIR 3A) and high risk (TIR 3B). In Italian literature, different rates of malignancy have been correlated to these subcategories. Objectives. The aim of the study is to present our experience on this subclassification for the assessment of the malignancy risk of indeterminate thyroid nodules. We correlated the subdivision into TIR 3A and TIR 3B with the histological report by highlighting the rates of malignancy detected in the two subcategories. On the one hand, we aimed to check if the groups are associated with a real and significant difference risk of malignancy. On the other hand, we evaluated the use of this subdivision in the choice of the appropriate treatment. Study Design. This is a retrospective review of all the patients with an indeterminate nodule who underwent US-FNA and had surgery at ASL Città di Torino between January 2005 and May 2018. Results. 150 patients have been analyzed for the research; 62 (41.3%) had a malignant histological report. Rates of malignancy between TIR 3A (20.8%) and TIR 3B (60.3%) were significantly different (p<0.0001). The subclassification had high sensitivity (75.8%; CI 63.3–85.8%) and NPV (79.3%; CI 68–87.8%) and low specificity (64.8%; CI 53.9–74.7%) and PPV (60.3; CI 48.5–71.2%). The measurement of the accuracy (AUC = 0.7) classified the test as “moderately accurate.” Conclusions. Obtained data show a great rate of false negative (20.8%) and limited AUC (0.7). According to our logistic regression, we argue that the 2014 subclassification into TIR 3A and TIR 3B should be considered for the choice of patient treatment, but at the same time, we believe that the association with other screening tests is necessary to increase the accuracy in the future.

Background Ceftazidime-avibactam (CAZ-AVI) has been approved in Europe for the treatment of complicated intra-abdominal and urinary tract infections, as well as hospital-acquired pneumonia, and for gram-negative infections with limited treatment options. CAZ-AVI displays in vitro activity against Klebsiella pneumoniae carbapenemase (KPC) enzyme producers, but clinical trial data on its efficacy in this setting are lacking. Methods We retrospectively reviewed 138 cases of infections caused by KPC-producing K. pneumoniae (KPC-Kp) in adults who received CAZ-AVI in compassionate-use programs in Italy. Case features and outcomes were analyzed, and survival was then specifically explored in the large subcohort whose infections were bacteremic. Results The 138 patients started CAZ-AVI salvage therapy after a first-line treatment (median, 7 days) with other antimicrobials. CAZ-AVI was administered with at least 1 other active antibiotic in 109 (78.9%) cases. Thirty days after infection onset, 47 (34.1%) of the 138 patients had died. Thirty-day mortality among the 104 patients with bacteremic KPC-Kp infections was significantly lower than that of a matched cohort whose KPC-Kp bacteremia had been treated with drugs other than CAZ-AVI (36.5% vs 55.8%, P = .005). Multivariate analysis of the 208 cases of KPC-Kp bacteremia identified septic shock, neutropenia, Charlson comorbidity index ≥3, and recent mechanical ventilation as independent predictors of mortality, whereas receipt of CAZ-AVI was the sole independent predictor of survival. Conclusions CAZ-AVI appears to be a promising drug for treatment of severe KPC-Kp infections, especially those involving bacteremia.

Intraplate magmatic provinces found away from plate boundaries provide direct sampling of the composition and heterogeneity of the Earth's mantle. The chemical heterogeneities that have been observed in the mantle are usually attributed to recycling during subduction

The aims of this study were to define in a cohort of 310 liver transplant recipients, the incidence of post-liver transplantation (LT) non-carbapenem-resistant Klebsiella pneumoniae (CRKP) and CRKP infections, pre- and post-LT CRKP colonization, CRKP-associated mortality, and risk factors for non-CRKP and CRKP infections. Every patient was screened for CRKP immediately before and after LT. The 6-month survival rate was 95%. Fifty-two patients became infected (16.5%): 8 by CRKP (2.5%) and 44 (14%) by a non-CRKP micro-organism. Median onset of CRKP infections occurred at postoperative (POD) 12 (range, 4-70). CRKP colonization occurred in 20 patients (6%): 10 before LT (3 infected and died) and 10 after (5 infected, 3 died). CRKP- versus non-CRKP-infected patients had higher rates of intensive care unit (ICU) and hospital mortality (50% vs 20% and 62.5% vs 36%; P ≤ .001), septic shock (87% vs 34%; P = .0057; confidence interval [CI], 9.8-71.5), prolonged mechanical ventilation (100% vs 64%; P = .043, CI, 3.5-51.9), and renal replacement therapy (87% vs 41%; P = .0177; CI, 2.8-65). The small number of CRKP-infected patients did not allow the definition of specific risk factors for CRKP infection. At univariate analysis, pre- and post-LT colonization (odds ratio [OR], 10.76; CI, 2.6-44; OR, 14.99; CI, 3.83-58.66, respectively), relaparotomy (OR, 9.09; CI, 4.01-20.6), retransplantation (OR, 7.45; CI, 3.45-16), bile leakage (OR, 61.28; CI, 9.23-80), and early allograft dysfunction (EAD; OR, 5.7; CI, 3-10.7) were significantly associated with infections, making CRKP colonization (any time) and post-LT surgical and medical complications critical factors for post-LT CRKP infections.

Tungsten is strongly incompatible during magmatic processes and is fluid mobile in subduction zones. Here we show that W isotope fractionation in arc lavas provide a powerful new tool for tracing slab dehydration and melting in subduction zones. Geochemically well characterized, representative arc-lavas from three subduction zones were chosen for this study to evaluate W isotope fractionation under different sub-arc conditions. Arc-lavas from SW Japan are produced by subducting a young, hot slab, and lavas from the volcanic front and rear arc of the Sangihe and Izu arcs are produced during subduction of a cold slab. The heaviest W isotope compositions ( δ 184 W ∼ 0.06 ‰ ) are observed in fluid-rich samples from the volcanic fronts of the Sangihe and Izu arcs. With increasing distance from the volcanic front, more melt-rich samples are characterized by progressively lighter W isotope compositions. Enriched alkali basalts from SW Japan, thought to be the product of mantle melting at a slab tear, and adjacent shoshonites have the lightest W isotope compositions ( δ 184 W ∼ 0 ‰ ). The correlation of W isotope fractionation with various indices of fluid release (e.g., Ce/Pb, Ba/Th) suggests that the heavy W isotope signatures record fluid recycling near the volcanic front due to dehydration of the subducted slab. Upon release of the heavy W, the residual slab preferentially retains isotopically light W, which is released during subsequent melting of drier lithologies in hot subduction zones, such as SW Japan. These data suggest that W isotopes can be used as a tracer of slab dehydration, potentially helping to determine the onset of cold subduction zone magmatism and hence, modern-style plate tectonics.

Major improvements in perioperative care and immunobiology have not abated the risk for severe pulmonary complications after solid-organ transplantation. The aim of this study is to update information on infectious and noninfectious pulmonary complications after solid-organ transplantation, addressing epidemiology, risk factors, diagnostic workup, and management.Infectious and noninfectious postoperative pulmonary complications depend on the grafted organ and the anatomical site of transplantation. Kidney transplants have the lowest incidence of pulmonary complications, the highest being reported for heart, lung, and liver recipients. Respiratory tract infections, ranking first in heart and lung transplants and second in liver recipients, are a common cause of mortality. Risk factors include end-stage organ disease, comorbidities, perioperative procedures, and graft function. Factors specific for infections are timeline, state of immunosuppression, and graft dysfunction. Nosocomial multi-drug resistant pathogens are frequently responsible for the most severe infections. Aggressive diagnostic workup, early and broad empiric antiinfective therapy, and deescalation policy are the mainstays of their management. The role of intraoperative protective ventilation is under scrutiny.Pulmonary complications after solid-organ transplantation, and particularly infections, are able to compromise the extremely good results of the transplant procedures. Solid-organ transplantation recipients challenge the ICU physician with unique aspects of their post-transplant course, adding, in an already critical patient, the immunosuppressed state and the quality of the functional recovery of the graft.

The rifted eastern North American margin (ENAM) provides important clues to the long-term evolution of continental margins. An Eocene volcanic swarm exposed in the Appalachian Valley and Ridge Province of Virginia and West Virginia (USA) contains the youngest known igneous rocks in the ENAM. These magmas provide the only window into the most recent deep processes contributing to the postrift evolution of this margin. Here we present new 40 Ar/ 39 Ar ages, geochemical data, and radiogenic isotopes that constrain the melting conditions and the timing of emplacement. Modeling of the melting conditions on primitive basalts yielded an average temperature and pressure of 1412 ± 25 °C and 2.32 ± 0.31 GPa, corresponding to a mantle potential temperature of ∼1410 °C, suggesting melting conditions slightly higher than average mantle temperatures beneath mid-ocean ridges. When compared with magmas from Atlantic hotspots, the Eocene ENAM samples share isotopic signatures with the Azores and Cape Verde. This similarity suggests the possibility of a large-scale dissemination of similar sources in the upper mantle left over from the opening of the Atlantic Ocean. Asthenosphere upwelling related to localized lithospheric delamination is a possible process that can explain the intraplate signature of these magmas that lack evidence of a thermal anomaly. This process can also explain the Cenozoic dynamic topography and evidence of rejuvenation of the central Appalachians.

The LUMIRA trial evaluated the effectiveness of radiofrequency (RFA) and microwave ablation (MWA) in lung tumours ablation and defining more precisely their fields of application. It is a controlled prospective multi-centre random trial with 1:1 randomization. Fifty-two patients in stage IV disease (15 females and 37 males, mean age 69 y.o., range 40–87) were included. We randomized the patients in two different subgroups: MWA group and RFA group. For each group, we evaluated the technical and clinical success, the overall survival and complication rate. Inter-group difference was compared using Chi-square test or Fisher’s exact test for categorical variables and one-way ANOVA test for continuous variables. For RFA group, there was a significant reduction in tumour size only between 6 and 12months (p value=0.0014). For MWA group, there was a significant reduction in tumour size between 6 and 12months (p value=0.0003) and between pre-therapy and 12months (p value=0.0215). There were not significant differences between the two groups in terms of survival time (p value=0.883), while the pain level in MWA group was significantly less than in RFA group (1.79&nbsp

Over the last two decades, a solid consensus grew in the scientific community that the so-called Citizen Science could contribute to advancing our current knowledge in many disciplines. In particular Hydro-Meteorological (HM) researchers immediately pointed out to the countless advantages of cooperating with Citizen Scientists. In this paper we present the experience made during the Distributed Research Infrastructure for Hydro- Meteorology (DRIHM) project for supporting citizen scientists involvement. The paper describes the different roles participants can assume, based on their capabilities in using and extending the DRIHM virtual collaborative platform and specifically giving a case for identifying and integrating citizen scientists. The major achievement is represented by the possibility for citizen scientists to execute actual simulations using real forecasting models and computational platforms. This can represent a first step for the dissemination of the right culture of the HM risk among the population and to enforce the involvement of citizen scientists in HM data processing and analysis tasks.

Background: The goal was to understand factors leading to prolonged wait times for neurological assessment of children with new onset seizures. A second objective was to develop an innovative approach to patient flow through and achieve a reduction in waiting times utilizing limited resources.Methods:Audit of the referrals, flow through, wait timesIdentification of bottlenecksDevelopment of triaging strategy:Suspected Febrile seizures and non-epileptic events;Suspected benign and absence epilepsies;Suspected other Focal epilepsies, generalized epilepsies, epilepsy under 2 yearsInitiation of early telephone contact and supportDevelopment of a ketogenic dietResults: Using a triaging strategy and focusing on timely access to investigations, wait times for clinic evaluations were shortened despite larger numbers of referrals (mean wait time reductions from 179 to 91 days). Limiting factors such increase in referral numbers, attrition in support staff, interfered with sustainability of reduced wait times achieved in the initial phase of the program. Conclusions: This pilot study highlights the effectiveness of an innovative triaging strategy and improvements in patient flow through in achieving the goals of reduction in wait times for clinical evaluation and timely investigations to improve care for children with new onset seizures. Insights into limitations of such strategies and factors determining sustainability are discussed.

Acute liver failure (ALF) is defined as a severe, sudden liver dysfunction that induces encephalopathy and coagulopathy (prothrombin time [PT/INR] > 1.5) within 26 weeks of the onset of symptoms (usually jaundice) in patients without previous liver disease. Quantitative and qualitative platelet dysfunction, reduced synthesis of clotting factors, increased consumption of factors (mainly II, V, VII, X), reduced clearance of both activated factors, and/or factor inhibitor complexes are among the most important proposed pathogenetic factors. A possible role might be also played by the diminished degradation of anticoagulants. Plasminogen activator inhibitor 1 (PAI-1) is increased, shifting the balance toward hypofibrinolysis, despite the elevated levels of tissue plasminogen activator (tPA). Although changes in coagulation parameters provide crucial information for the management of the patient with ALF, the optimal management of the hemostatic defects is far from being defined. Because spontaneous bleeding occurs rarely during ALF, measures to improve the bleeding diathesis (fresh frozen plasma, cryoprecipitate, platelet transfusion) are recommended only in patients with clinically significant bleeding or before placement of invasive devices. Antifibrinolytic drugs are used in some cases, but often empirically. The role of rFVIIa, even if promising, is still under debate.