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Background. Patients with prior colorectal cancer (CRC) are at slightly increased risk of metachronous colorectal neoplasms, therefore endoscopic surveillance is indicated. Current recommendations of repeating examinations at 1, 3 and 5 years after surgery, are not tailored according to risk stratification. Our aim was to find predictive factors of colorectal neoplasms to build a predictive model, to spare colonoscopies for lowrisk patients. Methods. Multicenter retrospective study including patients with colon carcinoma surgically resected from 2001 to 2008 (training cohort) and from 2009 to 2013 (validation cohort). A predictive model for neoplasms occurrence at second surveillance colonoscopy was developed and externally validated. Results. 396 and 131 patients were included in training and validation cohort respectively. Patients with >=1 adenoma at the 2nd surveillance colonoscopy were 113/396 (28.5%) and 21/131 (16.5%) in the two groups. In the validation cohort, 3 cancers were found. Four variables were associated with higher risk of metachronous colorectal adenomas at 2nd surveillance colonoscopy on multivariate analysis: age >65 years old, left colectomy, >=1 advanced adenoma at basal colonoscopy and >=1 adenoma at first surveillance colonoscopy (table 1). The predictive model showed fair discrimination, with an area under the ROC curve of 0.69 and 0.64, in training and validation cohort respectively. In validation group, If patients with a low-risk profile (i.e. none of the risk factors) skip the 2nd surveillance colonoscopy, 25/131 (19.1%) exams would be saved while missing 2/ 21 (9.5%) patients with 1 adenoma; no cancer would be missed. Conclusions We provided a risk-stratification tool for adenoma occurrence after colon surgery, which could prove cost-effective to select patients who could skip the second surveillance colonoscopy.

Second Harmonic Generation (SHG) is a label-free imaging method used to monitor collagen organization in tissues. Due to its sensitivity to the incident polarization, it provides microstructural information otherwise unreachable by other intensity based imaging methods. We develop and test a Microscopic Multiparametric Analysis by Phasor projection of Polarization-dependent SHG (μMAPPS) that maps the features of the collagen architecture in tissues at the micrometer scale. μMAPPS retrieves pixel-by-pixel the collagen fibrils anisotropy and orientation by operating directly on two coupled phasor spaces, avoiding direct fitting of the polarization dependent SHG signal. We apply μMAPPS to fixed tissue sections and to the study of the collagen microscopic organization in tumors ex-vivo and in-vivo. We develop a clustering algorithm to automatically group pixels with similar microstructural features. μMAPPS can perform fast analyses of tissues and opens to future applications for in-situ diagnosis of pathologies and diseases that could assist histo-pathological evaluation.

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Second Harmonic Generation (SHG) is a label-free imaging method used to monitor collagen organization in tissues. Due to its sensitivity to the incident polarization, it provides microstructural information otherwise unreachable by other intensity based imaging methods. We develop and test a Microscopic Multiparametric Analysis by Phasor projection of Polarization-dependent SHG (μMAPPS) that maps the features of the collagen architecture in tissues at the micrometer scale. μMAPPS retrieves pixel-by-pixel the collagen fibrils anisotropy and orientation by operating directly on two coupled phasor spaces, avoiding direct fitting of the polarization dependent SHG signal. We apply μMAPPS to fixed tissue sections and to the study of the collagen microscopic organization in tumors ex-vivo and in-vivo. We develop a clustering algorithm to automatically group pixels with similar microstructural features. μMAPPS can perform fast analyses of tissues and opens to future applications for in-situ diagnosis of pathologies and diseases that could assist histo-pathological evaluation.

Optical Microscopy has been applied to life science from its birth and reached widespread application due to its major advantages: limited perturbation of the biological tissue and the easy accessibility of the light sources. However, as the spatial and time resolution requirements and the time stability of the microscopes increase, researchers are struggling against some of its limitations: limited transparency and the refractivity of the living tissue to light and the field perturbations induced by the path in the tissue. We have developed a compact stand-alone, completely scan-less, optical setup that allows to acquire non-linear excitation images and to measure the sample dynamics simultaneously on an ensemble of arbitrary chosen regions of interests. The image is obtained by shining a square array of spots on the sample obtained by a spatial light modulator and by shifting it (10 ms refresh time) on the sample. The final image is computed from the superposition of (100-1000) images. Filtering procedures can be applied to the raw images of the excitation array before building the image. We discuss results that show how this setup can be used for the correction of wave front aberrations induced by turbid samples (such as living tissues) and for the computation of space-time cross-correlations in complex networks.

Predicting petrophysical properties by means of digital core analysis strongly relies on the operator expertise and becomes very challenging when dealing with clay microporosity, due to resolution limits and a general lack of recommendations. In the standard workflow, 3D images of rock samples are acquired via X-ray computed tomography and processed, to reconstruct pore geometries that are used to set up numerical experiments for the calculation of physical properties, such as permeability. In the present paper, the limits of the standard workflow are investigated and specific strategies are proposed to make the entire process less operator dependent and more reliable when dealing with tight samples. A global thresholding technique is applied for the identification of the pore space. The quality of its performance has been found to be strongly related to contrast, noise and presence of rock microporosity. Threshold selection is more robust if contrast enhancement and denoising algorithms, like bilateral filter and non-local means, are applied. Furthermore, microporosity shall not be excluded from the reconstructed pore space, since it is fundamental in providing connectivity of the flow paths. The selected value for thresholding is used inside an image-based meshing strategy, to create a computational grid directly on the 3D stack of images. Methods to compute porosity, specific surface and average pore diameter are described. Absolute permeability is computed by performing Computational Fluid Dynamics (CFD) simulations of single-phase incompressible flows in the reconstructed pore space. A model to include the presence of an increased resistance to the fluid flow in the microporous region is proposed and validated by comparison with experimental measurements.

Aim The study compared the efficacy, safety and tolerability of a low-volume picosulphate/magnesium citrate preparation with that of polyethylene glycol plus ascorbic acid (PEG + ASC) in a randomized clinical trial (RCT). Method A multicentre randomized, single-blinded study was designed. Adult outpatients undergoing colonoscopy received either picosulphate/magnesium citrate (Group 1) or PEG + ASC (Group 2). Bowel cleansing was assessed using the Boston Bowel Preparation Scale (BBPS) and rated as adequate if ≥ 2 in each segment. Patient acceptance, satisfaction and related symptoms were recorded. Results Two-hundred and eighty-five patients were included. Preparation was adequate in 75.7% of patients in Group 1 and in 76.5% of patients in Group 2. The mean BBPS scores for the entire colon and for the right colon were comparable between groups. In addition, 97.1% patients in Group 1 and 84.8% in Group 2 reported no or mild discomfort (P

BACKGROUND: Febrile nonhemolytic transfusion reactions occur in 0.12% of transfusions, usually during transfusion or within 4 to 6 hours after transfusion and are not medically dangerous. CASE REPORT: A patient with thalassemia from Togo with asymptomatic malaria in which the infection became clinically manifest only after blood transfusion, mimicking a febrile nonhemolytic transfusion reaction, is presented. Thirty-two hours after transfusion of 2 O D− red blood cell (RBC) units, the patient (phenotype A2 D+) developed fever and multiorgan failure and was admitted to the intensive care unit. Direct and indirect antiglobulin tests were negative on posttransfusion samples. Blood cultures and infectious diseases testing were negative. No malaria parasites were found at thick blood smear microscopic examination on Days 1 and 2 and the malaria rapid diagnostic test gave inconsistent results. Plasmodium total antibodies were detected in the serum at high levels. On Day 5, routine microscopic examination of blood smear revealed the presence of parasites in a very small number of RBCs. This finding was almost simultaneous to the availability of polymerase chain reaction testing results that were positive for P. falciparum. The sequential agglutination with anti-A antiserum allowed patient's and donors' RBCs to be separated and revealed that the parasitized cells were almost exclusively those of donors (14.4% vs. 0.029%). Malaria infection in implicated donors was excluded. CONCLUSION: In this patient with thalassemia with asymptomatic malaria, the infusion of two normal RBC units provided a favorable environment for a rapid parasite replication leading to a dramatic acute malaria attack.

Multi-phase flow in fractured rocks plays an important role in any hydrocarbon recovery process, be it for environmental remediation or natural oil and gas extraction. Fractures may form the primary production conduits, and the mass transport at the fracture interfaces with the matrix determines the effectiveness of extraction processes. This paper presents specific evidence for a relationship between fracture apertures and the porosity of the adjoining perpendicular layers in Berea sandstone samples. Measurements of fracture apertures were done with high-resolution Micro-Computed Tomography (MCT) with a voxel resolution of about 0.05 mm in three dimensions. Multi-phase fluid flow experiments were done using a medical CT scanner with a voxel resolution of about 1.00 × 0.25 × 0.25 mm. MCT evidence shows a correlation between aperture and the porosity of the intersected layers. The comparison was made by generating two-dimensional maps of matrix porosity and CT values adjacent to the fracture and of the corresponding fracture apertures. High-porosity layers are lined up with large fracture apertures. Multi-phase fluid experiments provided hydraulic evidence that the high-porosity layers have high permeability. Oil injection into a water-saturated sample was tracked by a sequence of transverse scans near the downstream tip of a fracture. The hydraulic evidence from the two-phase flow experiments also confirms high permeability in fracture strips adjacent to high-porosity and high-permeability layers. The reasons for the relationship between fracture aperture and the properties of the adjacent layers are not fully understood. Some explanation for the physical and hydraulic observations rests in the method of fracturing, fracture propagation, and the lithological characteristics of the rock.

Summary Answering general questions such as "Where is the oil?," "How much oil is there?," and "Can we extract it?" is a challenging task for a large fractured field in southern Italy. Various studies were conducted to gain more insight into the way oil is distributed in the rock and the producibility of the different structures observable on the cores (matrix, vugs, and fissures). These included the cryogenic scanning electron microscope (CryoSEM) and gas chromatography (GC)-pyrolysis, pore-size-distribution measurements, SEM analysis on thin sections, and a number of nonconventional techniques that were designed specifically for that type of rock. Nuclear magnetic resonance (NMR) imaging was conducted on several whole core samples and the different porosity contributions (microporosity, vugs, and fissures) defined on a 3D basis. An analytical approach based on the percolation theory was used to separate the permeability contributions and define the conditions under which vugs and fissures may form a conducting system. The inputs were distributions of pore throats, throat length, coordination number, fissure orientation, and porosities. Wettability is a key parameter for production estimates, and we used a technique for measuring it in both microporosity and fissures, which makes use of dielectric constant measurements. All the data contributed to our current understanding of the reservoir.

Aim of the study was to report the experience of a single center in the surgical treatment of anastomotic leak after colorectal resection for cancer, focusing on its incidence, diagnosis and management, with particular attention to surgical options.Demograhic and clinical data from 1284 consecutive patients operated on for colorectal cancer during a period of 11 years, were prospectively collected and inserted into an electronic database. For the purpose of the study, only patients in whom an anastomosis was performed were considered. Therefore, 128 patients (9.9%) were excluded and 1156 represent the study population. All complications occurring after surgery were systematically recorded. The incidence of colorectal anastomotic leak (CAL), its management and outcome was analyzed.An ileo-colic anastomosis was performed in 426 cases (36.8%), ileo-rectal in 29 (2.5%), colo-colic in 409 (35.4), colo-rectal with partial mesorectal excision in 211 (18.3%) and lower colorectal or coloanal anastomosis with total mesorectal excision and temporary loop ileostomy in 81 (7%). Colorectal anastomotic leak occurred in 78/1156 patients (6.7%), accounting for 19% of overall complications. Thirty-six out of 78 patients (46.2%) were successfully treated conservatively, whereas 42 (53.8%) underwent re-operation. Nine out of 78 patients (11.5%) with CAL died owing to an uncontrolled sepsis. All had undergone previous re-intervention, with a post-operative mortality rate of 21.4% (9 out of 42).Mortality rate in patients undergoing re-operation for colorectal anastomotic leakeage is still high, and accounts for up to 40% of the deaths after colorectal resection for cancer. In the light of these data, strategic clinical decisions are mandatory to optimize the selection of patients who need an early and fast surgical approach. What does this paper add to the literature? Systematic and prospective data recording is an essential tool to assess the quality of healthcare and to plan quality improvement programs. Every effort should be done to reach an early diagnosis of CAL, possibly in a pre-clinical phase in which non clinical methods could be used to predict it.

Telomere shortening, a well-known marker of aging and cellular stress, occurs under several conditions in the hematopoietic compartment, including aplastic anemia and following iatrogenic noxae. We decided to verify whether pathological telomere erosion also arises in restored Philadelphia-negative (Ph-negative) hematopoiesis following successful treatment of chronic myeloid leukemia (CML). Eighty-one CML patients in complete cytogenetic remission were compared to 76 age-matched healthy subjects. Myeloid cells of CML patients had shorter telomeres than controls (6521 bp vs 7233 bp, p

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Before the introduction of imatinib, interferon alpha-based regimens were the gold standard for treatment of early chronic phase chronic myeloid leukemia patients. The combination of IFN-alpha with imatinib is currently being investigated in at least two large clinical trials, the German CML Study IV and the French SPIRIT trial. We reviewed the cytogenetic and molecular responses of 76 early chronic phase chronic myeloid leukemia patients who were treated with imatinib and interferon-alpha and of 419 early chronic phase chronic myeloid leukemia patients treated with imatinib alone front-line. The complete cytogenetic response rate was higher in the IM+IFN-alpha group than in the imatinib group at six months (60% vs. 42%; P=0.003), but not at 48 months (88% vs. 88%). The durability of the complete cytogenetic response was similar in the two groups with 94% and 91% of complete cytogenetic responders in continuous complete cytogenetic response at 48 months (P=0.56). The major molecular response rate was higher in the IM+IFN-alpha group at six months (58% vs. 34%; P=0.0001) and 12 months (67% vs. 47%; P=0.001) but not later on (65% vs. 57% at 48 months; P=0.25). Overall and progression free survival were comparable in the two groups; a significant trend to a better event free survival was observed in patients treated with PegIFNalpha (91% vs. 78%; P=0.02). These data suggest that the response to the combination treatment is more rapid. It is not yet known how much a rapid reduction will influence the longer-term overall and progression free survival, and the cure rate.

A 67-year-old man with essential thrombocythemia treated with alkylating agents developed a small lymphocytic lymphoma after 102 months of therapy. Given the rareness of such an association, this case is reported because the cytoreductive treatment may have contributed to the onset of the lymphoma.

Answering general questions such as "Where is the oil? How much oil is there? Can we extract it?" is a challenging task for a large fractured reservoir in Southern Italy. Various studies were conducted to gain more insight into the way the oil is distributed in the rock and the producibility of the different structures observable at the core scale (matrix, vugs, fissures). These included CryoSEM and GC-pyrolysis, pore size distribution measurements, SEM analysis on thin sections, and a number of non-conventional techniques that were specifically designed for that type of rock. NMR imaging was conducted on several whole core samples and the different porosity contributions (microporosity, vugs, and fissures) defined on a 3-D basis. An analytical approach based on the percolation theory was used to separate the permeability contributions and define the conditions under which vugs and fissures may form a conducting system. The inputs were distributions of pore throats, throat length, coordination number, fissure orientation and porosities. Wettability is a key parameter for production estimates, and we utilised a technique for measuring it in both microporosity and fissures, which makes use of dielectric constant measurements. All the data contributed to our current understanding of the reservoir.

Splenectomy is the treatment of choice in the majority of patients affected by idiopathic thrombocytopenic purpura refractory to corticosteroid therapy, but it is not free from early and late complications. As the available literature does not seem to contain any precise indications concerning possible factors predicting the response to splenectomy, the aim of this retrospective study of 65 splenectomized patients was to attempt to identify potentially predictive clinical or laboratory parameters.For the purposes of statistical analysis, the patients were divided into two groups: the first included those with a complete (platelets100x10(9)/L) or partial response (platelets 50-100 x10(9)/L) to splenectomy; the second, the non-responders (platelets50x10(9)/L). The non-parametric tests were based on the Kruskal-Wallis method for independent samples, and the independent samples were compared using the Chi-square test according to Pearson.Univariate analysis did not reveal any significant correlation between successful splenectomy and age, sex, platelet count at diagnosis, anti-platelets antibody positivity, the site of platelet sequestration, the time between diagnosis and surgery, or the response to high intravenous immunoglobulin doses. However, the probability of success was greater in the patients with a complete or partial pre-operative response to steroid therapy (p0.05).The factor most frequently associated with the success of splenectomy is the site of autologous platelet sequestration. Our study did not identify any clinical or laboratory parameter clearly predictive of post-splenectomy cure other than a transient response to steroid treatment. This finding needs further confirmation in larger patient populations.

Natural and artificially induced fractures in a reservoir have a great impact on fluid flow patterns and on the ability to recover hydrocarbons. This paper focuses on multiphase flow in a rock sample that was artificially fractured and explores the application of x-ray computerized tomography (CT) imaging to determine the distribution of porosity and to track hydrocarbon loading of the sample. A method for establishing the relationship between porosity in the fractured zone and the fracture aperture is demonstrated. Converging and diverging flow patterns at the fracture tips are also shown. After saturating the sample with water, oil is injected and the loading process investigated. Displacement of the water out of the matrix layers is controlled by the fracture and by the individual properties of the layers. Water in the high-porosity and high-permeability layers is displaced first. The channeling of the flow by the fracture bypasses matrix fluid and increases the length of time needed to complete the hydrocarbon loading of the core with the displacing phase. Four-dimensional CT data presented in this paper form the basis for a fluid flow simulation that will be used to determine relative permeability and capillary-pressure distributions.

To evaluate the prevalence and the clinical evolution of patients with an initial diagnosis of indeterminate colitis.Retrospective, observational study.Fifteen gastrointestinal units in northern Italy.Patients with an initial diagnosis of indeterminate colitis seen between 1988 and 1993.Patients were traced through a common database and centres were requested to update their clinical follow-up.Frequency of patients with an initial diagnosis of indeterminate colitis among those with IBD; rate of patients who subsequently had a definite diagnosis of either Crohn's disease or ulcerative colitis.Fifty out of 1113 IBD patients (4.6%) had been diagnosed as having indeterminate colitis. During follow-up, 37 patients (72.5%) had a definite diagnosis of either Crohn's disease or ulcerative colitis. The cumulative probability of having a definite diagnosis of either ulcerative colitis or Crohn's disease was 80% 8 years after the first one (i.e. the first diagnosis). The probability of having a diagnosis of Crohn's disease was increased in patients with fever at onset, segmental endoscopic lesions or extra-intestinal complications and in current smokers. The probability of having a diagnosis of ulcerative colitis was increased in patients who had not undergone appendectomy before diagnosis.In our area, indeterminate colitis accounts for about 5% of initial diagnoses of IBD. In about 80% of patients, a diagnosis of either ulcerative colitis or Crohn's disease is made within 8 years. Several clinical and demographic features can help in identifying those patients more likely to have a subsequent diagnosis of Crohn's disease and those more likely to have a subsequent diagnosis of ulcerative colitis.

The diagnostic and prognostic value of bone marrow biopsy (BMB) has been widely investigated in patients with chronic myeloproliferative disorders (CMPD). The present study is based on a review of the results of routine BMBs taken from 93 essential thrombocythemia (ET) patients at the time of diagnosis.The common BMB histologic parameters and clinico-hematologic variables were considered for diagnostic and prognostic purposes. Clinico-pathologic correlations were looked for univariately. Moreover, the diagnostic significance of the histologic findings was tested by means of cluster analysis. Overall survival and event-free survival were considered as prognostic endpoints.There were no correlations between the clinic and pathologic findings, and none of the histologic and clinical parameters was predictive of survival or the occurrence of major clinical events. Cluster analysis of the BMB findings revealed two distinct morphologic patterns: one was clearly myeloproliferative; the other had somewhat dysplastic features. The event-free and overall survival rates in the latter group were significantly worse (p = 0.0377 and p = 0.0162 respectively), with major ischemic events accounting for most of the difference in event-free survival.These results have no clearcut counterpart in the literature, but we feel that dysplastic BMB findings could be included in the definition of ET prognostic scores in order to allow therapeutic strategies to be adapted to the level of risk.

Abstract Imaging techniques are widely used in the oil industry, but their integration is much less common. Here we present the relevance, in rock structure characterisation, of the integration of Magnetic Resonance Imaging (MRI), X-ray Computed Tomography (X-ray CT) and Scanning Electron Microscopy (SEM), based on different physical principles and investigating different rock volumes. A set of experimental studies on various fields with different lithologies (chalk, brecciated dolostone, limestone, calcarenite and conglomerate) is presented. The results of these applications demonstrate that the integration of different approaches greatly improves the characterisation of internal rock structure. P. 23

In this paper we present an integrated approach, via sophisticated experimental and numerical techniques, to the investigation of displacement phenomena in porous media. A non-destructive imaging technique, Magnetic Resonance Imaging (MRI), has been used to study fluid flow in core plugs, and a Mixed Finite Element/TVD Finite Volume simulator to reproduce the observed data. The main advantage of the MFE/FV code is its capability of accurately solving physical phenomena without introducing unrealistic numerical dispersion or oscillations. Comparison with standard Finite Differences (FD) code has been performed.

The paper reports a number of cases of uncommon metastasis confirmed by histological tests in surgical biopsies; following a brief discussion of the literature on this topic and in particular on the basis of an earlier study by one of the authors, the paper affirms that metastasis is related to general and local biological factors, that the diffusion of neoplastic cells is an early and generalised phenomenon opposed by organic defence mechanisms, and that the concept of uncommon metastasis should be revised, without resorting to fixed anatomical references, according to a general "impregnation" of tumour cells.

The Authors report about one surgical case of pulmonary carcinosarcoma recently observed. The literature is reviewed and the histogenesis of this rare affection is discussed.