Percutaneous ablation of obscure hypovascular liver tumours in challenging locations using arterial CT-portography guidance.

PURPOSE: The purpose of this study was to evaluate the feasibility, safety and efficacy of percutaneous ablation (PA) of obscure hypovascular liver tumors in challenging locations using arterial CT-portography (ACP) guidance. MATERIALS AND METHODS: A total of 26 patients with a total of 28 obscure, hypovascular malignant liver tumors were included. There were 18 men and 6 women with a mean age of 58±14 (SD) years (range: 37-75 years). The tumors had a mean diameter of 14±10 (SD) mm (range: 7-24mm) and were intrahepatic cholangiocarcinoma (4/28; 14%), liver metastases from colon cancer (18/28; 64%), corticosurrenaloma (3/28; 11%) or liver metastases from breast cancer (3/28; 11%). All tumors were in challenging locations including subcapsular (14/28; 50%), liver dome (9/28; 32%) or perihilar (5/28; 18%) locations. A total of 28 PA (12 radiofrequency ablations, 11 microwave ablations and 5 irreversible electroporations) procedures were performed under ACP guidance. RESULTS: A total of 67 needles [mean: 2.5±1.5 (SD); range: 1-5] were inserted under ACP guidance, with a 100% technical success rate for PA. Median total effective dose was 26.5 mSv (IQR: 19.1, 32.2 mSv). Two complications were encountered (pneumothorax; one abscess both with full recovery), yielding a complication rate of 7%. No significant change in mean creatinine clearance was observed (80.5mL/min at baseline and 85.3mL/min at day 7; P=0.8). Post-treatment evaluation of the ablation zone was overestimated on ACP compared with conventional CT examination in 3/28 tumors (11%). After a median follow-up of 20 months (range: 12-35 months), local tumor progression was observed in 2/28 tumours (7%). CONCLUSION: ACP guidance is feasible and allows safe and effective PA of obscure hypo-attenuating liver tumors in challenging locations without damaging the renal function and with acceptable radiation exposure. Post-treatment assessment should be performed using conventional CT or MRI to avoid size overestimation of the ablation zone.

Intra arterial treatment of hepatocellular carcinoma: Comparison of MELD score variations between radio-embolization and chemo-embolization.

PURPOSE: The purpose of this study was to assess liver function deterioration, as assessed using the model for end-stage liver disease (MELD) score variations, following transarterial chemo-embolization (TACE) versus selective internal radiation therapy (SIRT) in patients with unresectable unilobar hepatocellular carcinomas (HCC). PATIENTS AND METHODS: We retrospectively evaluated all patients who underwent a single conventional TACE or SIRT procedure in our department from May 2013 to May 2018 for unilobar unresectable HCC. A total of 86 patients (76 men, 20 women; mean age, 65.5 years) were included. There were 63 patients in the TACE group [56 men, 7 women; mean age, 65.1±9.6 (SD) years] and 23 patients in the SIRT group [20 men, 3 women; mean age, 70±9.2 (SD) years]. Delta MELD, defined as post treatment minus pre-treatment MELD score, was considered for liver function deterioration and compared between patients who underwent single lobar treatment of SIRT versus TACE. RESULTS: Patients in SIRT group had significant higher tumor burden, alpha-fetoprotein serum level, and rates of macroscopic vessel invasion. Mean pre-treatment MELD scores did not differ between TACE [mean, 8.41±1.71 (SD); range: 7.24-9.24] and SIRT groups [mean, 8.36±1.74 (SD); range: 7.07-9.21] (P=0.896) as well as Child-Pugh class and albumin-bilirubin (ALBI) grade distribution. However, following treatment, mean DeltaMELD was greater in TACE group (mean, 0.83±1.83 [SD]; range: -0.30--1.31) than in SIRT group (mean, -0.13±1.06 [SD]; range: -0.49-0.32) (P=0.021). At multivariate analysis, SIRT treatment was independently associated with a lower DeltaMELD score than TACE (R=-0.955 [-1.68; -0.406]; P=0.017;). CONCLUSION: Whereas performed in patients with higher tumor burden, SIRT resulted in lower degrees of liver function worsening as assessed using MELD score variations.

Tokamak operation with safety factor q95 < 2 via control of MHD stability.

Magnetic feedback control of the resistive-wall mode has enabled the DIII-D tokamak to access stable operation at safety factor q(95) = 1.9 in divertor plasmas for 150 instability growth times. Magnetohydrodynamic stability sets a hard, disruptive limit on the minimum edge safety factor achievable in a tokamak, or on the maximum plasma current at a given toroidal magnetic field. In tokamaks with a divertor, the limit occurs at q(95) = 2, as confirmed in DIII-D. Since the energy confinement time scales linearly with current, this also bounds the performance of a fusion reactor. DIII-D has overcome this limit, opening a whole new high-current regime not accessible before. This result brings significant possible benefits in terms of fusion performance, but it also extends resistive-wall mode physics and its control to conditions never explored before. In present experiments, the q(95) < 2 operation is eventually halted by voltage limits reached in the feedback power supplies, not by intrinsic physics issues. Improvements to power supplies and to control algorithms have the potential to further extend this regime.

Common key-signals in learning and neurodegeneration: focus on excito-amino acids, beta-amyloid peptides and alpha-synuclein.

In this paper a hypothesis that some special signals ("key-signals" excito-amino acids, beta-amyloid peptides and alpha-synuclein) are not only involved in information handling by the neuronal circuits, but also trigger out substantial structural and/or functional changes in the Central Nervous System (CNS) is introduced. This forces the neuronal circuits to move from one stable state towards a new state, but in doing so these signals became potentially dangerous. Several mechanisms are put in action to protect neurons and glial cells from these potentially harmful signals. However, in agreement with the Red Queen Theory of Ageing (Agnati et al. in Acta Physiol Scand 145:301-309, 1992), it is proposed that during ageing these neuroprotective processes become less effective while, in the meantime, a shortage of brain plasticity occurs together with an increased need of plasticity for repairing the wear and tear of the CNS. The paper presents findings supporting the concept that such key-signals in instances such as ageing may favour neurodegenerative processes in an attempt of maximizing neuronal plasticity.

Structural plasticity in G-protein coupled receptors as demonstrated by the allosteric actions of homocysteine and computer-assisted analysis of disordered domains.

Structural plasticity of G-protein coupled receptors (GPCRs) is of basic importance for their interactions with ligands, in particular with other proteins such as receptors or receptor-modifying proteins that can lead to different functions for the same GPCR. In the present paper, structural plasticity of GPCRs has been investigated discussing allosteric modulatory actions of Homocysteine (Hcy) on D2 receptors together with data obtained by computer-assisted analysis of the presence of disordered domains in GPCRs. Previous evidence for a modulatory action of Hcy on D2 receptors has been further extended by means of experiments on the effects of Hcy local intrastriatal injection on rotational behaviour. Altogether the present data allow considering under a new angle the well known proposal of A2A antagonists as new therapeutic agents in Parkinson's disease (PD). Furthermore, they point out to not only the importance of drugs capable of reducing Hcy brain levels, but also to the potential therapeutic impact of drugs capable of regionally blocking (for PD) or enhancing (for some schizophrenic syndromes) Hcy allosteric action on D2 receptors. As far as the investigations on GPCR plastic domains, extracellular, intracellular and transmembrane domains of 14 GPCRs have been considered and propensity of each of these domains for a structured or unstructured conformation has been evaluated by means of ad hoc computer programs. It has been shown that the N- and C-terminals as well as intracellular loop 3 have a high propensity towards an unstructured conformation, hence they are potentially very plastic domains, which can undergo easily to interactions with other ligands, particularly with other protein domains. This aspect is obviously of the greatest importance not only for the function of single GPCRs, but also for their interactions either with other receptors (receptor-receptor interactions) or, more generally, for formation of clusters of membrane associated proteins, hence of "protein mosaics", where the GPCRs could represent the input unit of the supra-molecular device.

Virtual Reality as an assessment tool for arm motor deficits after brain lesions.

The currently used assessment techniques for measuring neurological deficits are time consuming and may lack of sensibility and repeatability. Previous studies suggested that the cinematic analysis of the movement, might represent a reliable alternative instrument for documenting the degree of motor impairment. To verify this hypothesis we investigated motor/functional progress in 20 post-stroke patients, undergoing rehabilitation therapy, by means of a widely used clinical test (Fugl-Meyer scale), and by evaluating kinematics of arm motion. After rehabilitation therapy, velocity and duration of reaching movements significantly improved with respect to baseline values. Before and after rehabilitation there was a significant correlation between each cinematic parameter and the clinical scale scores. These results, suggests that the cinematic analysis of movement can be proposed as a precise and objective assessment tool to be used in clinical practice.

Epidemiological aspects of tuberculosis in the Padua Health District 1985-1996.

The present study was carried out in order to monitor the epidemiology of Mycobacterium tuberculosis disease in the Padua Health District over the period 1985-1996 with a view to the situation in some population subgroups. The average annual rate per 100,000 persons per year was 7.9 with a peak in 1994 (15.6 per 100,000 persons). The most significant variations are not per annum but between the periods 1985-1990 and 1991-1996 (average rates per 100,000 persons: 4.8 and 10.9, respectively). The trend shows an increasing frequency in all age groups and especially among the elderly. Immigration from endemic areas and human immunodeficiency virus (HIV) infection appear to contribute to the increase the number of notified cases among adults. In the last four years an increase of tuberculosis cases was also observed among subjects with professional exposure risk. Improvements of programs both at national and regional level are believed to be essential to the tuberculosis control.

Effects of fluoxetine and maprotiline on functional recovery in poststroke hemiplegic patients undergoing rehabilitation therapy.

BACKGROUND AND PURPOSE: In animals, drugs that increase brain amine concentrations influence the rate and degree of recovery from cortical lesions. It is therefore conceivable that antidepressants may influence outcome after ischemic brain injury in humans. We evaluated the effects of the norepinephrine reuptake blocker maprotiline and the serotonin reuptake blocker fluoxetine on the motor/functional capacities of poststroke patients undergoing physical therapy. METHODS: Fifty-two severely disabled hemiplegic subjects were randomly assigned to three treatment groups; during 3 months of physical therapy, patients were treated with placebo, maprotiline (150 mg/d), or fluoxetine (20 mg/d). Before and at the end of the observation period, we assessed activities of daily living by the Barthel Index, degree of neurological deficit by a neurological scale for hemiplegic subjects, and depressive symptomatology by the Hamilton Depression Rating Scale. RESULTS: The diverse treatments ameliorated walking and activities of daily living capacities to different extents. The greatest improvements were observed in the fluoxetine-treated group and the lowest in the maprotiline-treated group. Furthermore, fluoxetine yielded a significantly larger number of patients with good recovery compared with maprotiline or placebo. These effects of the drugs were not related to their efficacy in treating depressive symptoms. CONCLUSIONS: Fluoxetine may facilitate or, alternatively, maprotiline may hinder recovery in poststroke patients undergoing rehabilitation. The effects of fluoxetine as an adjunct to physical therapy warrant further investigation, since treatment with fluoxetine may result in a better functional outcome from stroke than physical therapy alone.

Poliovirus neutralizing antibody persistence after vaccination with the Sabin vaccine: a follow-up study.

In 1976, a cohort survey on the persistence of neutralizing antibodies in children regularly immunized 1 to 4 years earlier with the Sabin attenuated vaccine (OPV) was undertaken in the Venice mainland. Subsequent serological evaluations in the same cohort were carried out in 1983 and 1993. A macroneutralization test using a 1:4 initial serum dilution was utilized in the 1976 and 1983 survey years. In the 1993 survey a microneutralization test using a 1:2 initial dilution was utilized. In this survey, however, sera were tested using both the latter microneutralization test and the former test. Using the former method, the results indicate that the OPV-induced humoral immunity to poliovirus 1 and 2 remain fairly stable after the initial decrease, whereas antibodies to poliovirus 3 are further declining. Using the latter more sensitive method the seropositivity rates were found to be equal or close to 100 percent. The results of our follow-up survey thus indicate that the OPV-induced humoral immunity is long-lasting when tested with a highly sensitive and reproducible method. The clinical protection that ensues after OPV-immunization is probably lifelong similar to that which follows the natural infection.

A case of type I Arnold-Chiari malformation of anomalous onset.

A case of type I Arnold-Chiari malformation, with onset of diplopia, without associated medullar alteration, is presented. The symptomatology remained unique and had transitory presentation for many years with negative ophthalmic examinations. Attention is drawn to the great variability of the syndrome's presenting symptoms confirming the importance of MR in the diagnostic course and of evoked potentials of the brain stem to follow progress of the illness.

Immunity status to poliovirus in Veneto region (north-east Italy). A seroepidemiological survey.

The immunity state to poliovirus types 1, 2, and 3 of a population aged 2 to 75 years was determined by examining 274 sera collected in the Venice mainland (North-East Italy). Altogether, the neutralizing antibody prevalences (at a titre > or = 1:2) for poliovirus 1, 2, and 3 were 99.0 percent (geometrical mean titres [GMT]: 72.1), 99.6 percent (GMT: 95.9) and 98.2 percent (GMT: 17.3), respectively, and all the age groups also showed very good levels of humoral immunity. High antibody titres (> or = 1:256) to one or more types of poliovirus were demonstrated in older age groups also, possibly indicating exposure to natural polioviruses or contact with vaccine strains. Although probably all the older subjects had practically acquired their antibodies as a result of natural infection and those under 30 through vaccination, these results indicate that the humoral immunity against poliomyelitis in our population is satisfactory, and the maintenance of such good protection level depends on an effective immunization program.