Computed tomography colonography in 2014:An update on technique and indications

Twenty years after its introduction, computed tomographic colonography (CTC) has reached its maturity, and it can reasonably be considered the best radiological diagnostic test for imaging colorectal cancer (CRC) and polyps. This examination technique is less invasive than colonoscopy (CS), easy to perform, and standardized. Reduced bowel preparation and colonic distention using carbon dioxide favor patient compliance. Widespread implementation of a new image reconstruction algorithm has minimized radiation exposure, and the use of dedicated software with enhanced views has enabled easier image interpretation. Integration in the routine workflow of a computer-aided detection algorithm reduces perceptual errors, particularly for small polyps. Consolidated evidence from the literature shows that the diagnostic performances for the detection of CRC and large polyps in symptomatic and asymptomatic individuals are similar to CS and are largely superior to barium enema, the latter of which should be strongly discouraged. Favorable data regarding CTC performance open the possibility for many different indications, some of which are already supported by evidence-based data: incomplete, failed, or unfeasible CS; symptomatic, elderly, and frail patients; and investigation of diverticular disease. Other indications are still being debated and, thus, are recommended only if CS is unfeasible: the use of CTC in CRC screening and in surveillance after surgery for CRC or polypectomy. In order for CTC to be used appropriately, contraindications such as acute abdominal conditions (diverticulitis or the acute phase of inflammatory bowel diseases) and surveillance in patients with a long-standing history of ulcerative colitis or Crohn’s disease and in those with hereditary colonic syndromes should not be overlooked. This will maximize the benefits of the technique and minimize potential sources of frustration or disappointment for both referring clinicians and patients.

Giant colonic diverticulum,clinical presentation,diagnosis and treatment: Systematic review of 166 cases

AIM: To investigate the clinical presentation,diagnosis,and treatment of giant colonic diverticulum(GCD,by means of a complete and updated literature review).GCD is a rare manifestation of diverticular disease of the colon.Less than 200 studies on GCD were published in the literature,predominantly case reports or small patient series.METHODS: A systematic review of the literature was performed using the Embase and PubM ed databases toidentify all the GCD studies.The following MESH search headings were used: "giant colonic diverticulum"; "giant sigmoid diverticulum".The "related articles" function was used to broaden the search,and all of the abstracts,studies,and citations were reviewed by two authors.The following outcomes were of interest: the disease and patient characteristics,study design,indications for surgery,type of operation,and postoperative outcomes.Additionally,a subgroup analysis of cases treated in the last 5 years was performed to show the current trends in the treatment of GCD.A GCD case in an elderly patient treated in our department by a sigmoidectomy with primary anastomosis and a diverting ileostomy is presented as a typical example of the disease.RESULTS: In total,166 GCD cases in 138 studies were identified in the literature.The most common clinical presentation was abdominal pain,which occurred in 69% of the cases.Among the physical signs,an abdominal mass was detected in 48% of the cases,whereas 20% of the patients presented with fever and 14% with abdominal tenderness.Diagnosis is based predominantly on abdominal computed tomography.The most frequent treatment was colic resection with en-bloc resection of the diverticulum,performed in 57.2% of cases,whereas Hartmann's procedure was followed in 11.4% of the cases and a diverticulectomy in 10.2%.An analysis of sixteen cases reported in the last 5 years showed that the majority of patients were treated with sigmoidectomy and en-bloc resection of the diverticulum; the postoperative mortality was null,morbidity was very low(1 patient was hospitalized in the intensive care unit for postoperative hypotension),and the patients were discharged 4-14 d after surgery.CONCLUSION: Giant colonic diverticulum is a rare manifestation of diverticular diseases.Surgical treatment,consisting predominantly of colonic resection with en bloc resection of the diverticulum,is thepreferred option for GCD and guarantees excellent results.

Hydrogen breath test for the diagnosis of lactose intolerance,is the routine sugar load the best one?

AIM: To evaluate the prevalence of lactose intolerance (LI) following a load of 12.5 g in patients diagnosed as high-grade malabsorbers using the hydrogen breath test (HBT)-25.METHODS: Ninety patients showing high-grade malabsorption at HBT-25 were submitted to a second HBT with a lactose load of 12.5 g.Peak hydrogen production,area under the curve of hydrogen excretion and occurrence of symptoms were recorded.RESULTS: Only 16 patients (17.77%) with positive HBT-25 proved positive at HBT-12.5.Hydrogen production was lower as compared to HBT-25 (peak value 21.55 parts per million (ppm) ± 29.54 SD vs 99.43 ppm ± 40.01 SD; P < 0.001).Symptoms were present in only 13 patients.The absence of symptoms during the high-dose test has a high negative predictive value (0.84) for a negative low-dose test.The presence of symptoms during the first test was not useful for predicting a positive low-dose test (positive predictive value 0.06-0.31).CONCLUSION: Most patients with a positive HBT-25 normally absorb a lower dose of lactose and a strict lactose restriction on the basis of a "standard" HBT is,in most instances,unnecessary.Thus,the 25 g lactose tolerance test should probably be substituted by the 12.5 g test in the diagnosis of LI,and in providing dietary guidelines to patients with suspected lactose malabsorption/intolerance.

Is porto sinusoidal vascular disease to be actively searched in patients with portal vein thrombosis?

Porto sinusoidal vascular liver disease (PSVD) and portal vein thrombosis (PVT) are distinct vascular liver diseases characterized, respectively, by an intrahepatic and a prehepatic obstacle to the flow in the liver portal system. PVT may also occur as a complication of the natural history of PSVD, especially if a prothrombotic condition coexists. In other cases, it is associated to local and systemic pro-thrombotic conditions, even if its cause remains unknown in up to 25% despite an active search. In our opinion, the presence of PSVD should be suspected in patients with PVT especially in those with PVT “sine causa” and the active search of this condition should be included in their diagnostic work-out. However, sometimes the diagnosis of pre-existing PSVD is very hard. Biopsy cannot be fully discriminant as similar histological data have been described in both conditions. Liver stiffness may help as it has been shown to be higher in PSVD than in “pure” PVT, due to the presence of sclerosis in the portal venous radicles observable in PSVD patients. Nevertheless, comparing liver stiffness between PVT and PSVD has until now been restricted to very limited series of patients. In conclusion, even if it is still totally hypothetical, our point of view may have clinical consequences, especially when deciding to perform a liver biopsy in patients with a higher liver stiffness and suspending the anticoagulation in patients with PVT and no detectable prothrombotic factors.

Historic Centers Restoration and Ancient Buildings Energetic Efficiency Improvement

The historical center is a part of the city with specific environmental, architectural and historical values, which emerges from the urban fabric structural continuity. This complex reality requires a comprehensive understanding to determinate the most proper ways to carry out functional transformations and system adaptations, with respect to historical buildings values. Each building must obtain those proper improvements and functional adjustments, also in terms of technology and energetic efficiency. The achievements of a complex interdisciplinary research project on Ceglie Messapica historical center (BR, Italy) are explained. They lead to guidelines for mulation for the historical buildings’ critical conservative restoration.

Dietary Fibers and Nutraceuticals for Primary Cardiovascular Prevention in Children and Adolescents: A Critical Review

The roles of dietary fibers and nutraceuticals for primary prevention of cardiovascular disease from childhood are reviewed. Nutrition as an epigenetic modifier and the roles of endothelium, risk factors, epidemiological evidence and Mediterranean diet are critically analysed. Overfeeding in childhood can lead to the development of obesity and/or atherosclerosis in adult life. In particular, a high intake of nutrients affects the in utero programming with the adverse consequences of insulin resistance an endothelial dysfunction that lead to early atherosclerosis. Dietary fibers have important health benefits in childhood and research suggests that they may prevent obesity and lower blood cholesterol levels with a favourable impact on the risk of future cardiovascular disease incidence. However, it is for further studies to assess whether also in Southern European Countries, practicing Mediterranean diet as a normal habit, dietary fibers may contribute to modify the relatively low proportion of hyperlipemia observed in our population.

Supercritical Equilibrium Data of the Systems Carbon Dioxide—Linalool and Carbon Dioxide—Orange Essential Oil

In this paper experimental equilibrium data on the system supercritical CO2-orange essential oil and the system supercritical CO2-linalool are reported at 323.15 K and 343.15 K, for pressures in the ranges of 7.6-13.5 MPa. The behavior of the system supercritical CO2-orange essential oil was represented by means of thermodynamic model, based on Peng-Robinson equation of state. To this aim the orange essential oil was represented by a mixture of limonene, linalool and β-caryophyllene, selected to represent the classes of monoterpenes, oxygenated terpenes and sesquiterpenes respectively. The model uses only regression parameters calculated from binary sub-systems, CO2-limonene and CO2-β-caryophyllene (taken from literature) and CO2-linalool (calculated from the fitting of original data reported in the present work) thus being predictive with respect to the multicomponent mixture.

Changes in nutritional status after liver transplantation

Chronic liver disease has an important effect on nutritional status, and malnourishment is almost universally present in patients with end-stage liver disease who undergo liver transplantation. During recent decades,a trend has been reported that shows an increase in number of patients with end-stage liver disease and obesity in developed countries. The importance of carefully assessing the nutritional status during the workup of patients who are candidates for liver replacement is widely recognised. Cirrhotic patients with depleted lean body mass(sarcopenia) and fat deposits have an increased surgical risk; malnutrition may further impact morbidity, mortality and costs in the post-transplantation setting. After transplantation and liver function is restored, many metabolic alterations are corrected,dietary intake is progressively normalised, and lifestyle changes may improve physical activity. Few studies have examined the modifications in body composition that occur in liver recipients. During the first 12 mo, the fat mass progressively increases in those patients who had previously depleted body mass, and the muscle mass recovery is subtle and non-significant by the end of the first year. In some patients, unregulated weight gain may lead to obesity and may promote metabolicdisorders in the long term. Careful monitoring of nutritional changes will help identify the patients who are at risk for malnutrition or over-weight after liver transplantation. Physical and nutritional interventions must be investigated to evaluate their potential beneficial effect on body composition and muscle function after liver transplantation.

Impact of chronic exposure to bevacizumab on EpCAM-based detection of circulating tumor cells

Background： Circulating tumor cells （CTCs） are often undetected through the immunomagnetic epithelial cell adhesion molecule （EpCAM）-based CellSearch~ System in breast and colorectal cancer （CRC） patients treated with bevacizumab （BEV）, where low CTC numbers have been reported even in patients with evidence of progression of disease. To date, the reasons for this discrepancy have not been clarified. This study was carried out to investigate the molecular and phenotypic changes in CRC cells after chronic exposure to BEV in vitro. Methods： The human CRC cell line WiDr was exposed to a clinically relevant dose of BEV for 3 months in vitro. The expression of epithelial and mesenchymal markers and EpCAM isoforms was determined by western blotting and immunofluorescence. To evaluate the impact of EpCAM variant isoforms expression on CTC enumeration by CellSearch, untreated and treated colon cancer cells were spiked into 7.5 mL of blood from a healthy donor and enumerated by CellSearch. Results： Chronic exposure of CRC cell line to BEV induced decreased expression of EpCAM 40 kDa isoform and increased expression EpCAM 42 kDa isoform, together with a decreased expression of cytokeratins （CK）, while no evidence of epithelial to mesenchymal transition （EMT） in treated cells was observed. The recovery rate of cells through CellSearch was gradually reduced in course of treatment with BEV, being 84% , 70% and 40% at l, 2 and 3 months, respectively. Conclusions： We hypothesize that BEV may prevent CellSearch from capturing CTCs through altering EpCAM isoforms.

Therapeutic approaches enhancing peripheral nerve regeneration

Peripheral nerve injury is a common occurrence and represents a major economic burden for society. The development of novel strategies to enhance peripheral nerve regeneration is, therefore, of great relevance. Conventional treatments include surgical repair of the damaged nerves for minor injuries, whereas autologous nerve grafts are required to recover longer interruptions. However, despite great surgical advances, functional recovery is often poor. Although it is well known that the peripheral nervous system has a greater regenerative capacity than the central nervous system and, considering the scientific advancements and knowledge in regenerative medicine, clinical applications appears still limited. This review provides an overview of the methodological approaches currently under study, aimed at enhancing peripheral nerve regeneration. In particular, tissue engineering, cell therapy and pharmacological approaches will be discussed.

Hydrogeological Conceptual Model of Groundwater from Carbonate Aquifers Using Environmental Isotopes (¹⁸O, ²H) and Chemical Tracers: A Case Study in Southern Latium Region, Central Italy

The present work provides hydrochemical and stable isotope data and their interpretations for 54 springs and 20 wells, monitored from 2002 to 2006, in the Southern Latium region of Central Italy to identify flow paths, recharge areas and hydrochemical processes governing the evolution of groundwater in this region. The hydrogeological conceptual model of the carbonate aquifers of southern Latium was based on environmental isotopic and hydrochemical investigation techniques to characterize and model these aquifer systems with the aim of achieving proper management and protection of these important resources. Most of the spring samples, issuing from Lepini, Ausoni and Aurunci Mts., are characterized as Ca-Mg-HCO3 water type, however, some samples show a composition of Na-Cl and mixed Ca-Na-HCO3-Cl waters. Groundwater samples from Pontina Plain are mostly characterized by Na-Cl and Ca-Cl type waters. Geochemical modeling and saturation index computation of the Lepini, Ausoni Aurunci springs and Pontina Plain wells shows an interaction with carbonate rocks. Most of the spring and well water samples were saturated with respect to calcite and dolomite, however all sampled waters were undersaturated with respect to gypsum and halite. The relationship between δ18O and δ2H, for spring and well water samples, shows shifts of both the slope and the deuterium excess when compared to the world meteoric (WMWL) and central Italy meteoric (CIMWL) water lines. The deviation of data points from the meteoric lines can be attributed to evaporation both during the falling of the rain and by run-off on the ground surface before infiltration. Most springs and wells have a deuterium excess above 10 ‰ suggesting the precipitation in the groundwater comes from the Mediterranean sector. On the basis of local isotopic gradients, in combination with topographic and geologic criteria, four recharge areas were identified in the Aurunci Mountains. In Pontina Plain, the elevations of the recharging areas suggest that the Lepini carbonate aquifers are feeding them.

A Mechanism for Hadron Molecule Production in <i>pp</i>(<i>p</i>) Collisions

The problem of understanding loosely bound hadron molecules prompt production at hadron colliders is still open: how is it possible that meson molecules with binding energy compatible with zero could be formed within the bulk of the hadrons ejected in very high energy collisions? Monte Carlo simulations have been performed in the literature, leading to production cross sections, two orders of magnitude which were smaller than the experimental value. One possible mechanism to reduce this gap could be final state interactions of heavy mesons, but a precise evaluation of such effect is challenged by the presence of pions between the molecular constituents. In this paper, we present a new mechanism by using precisely such comoving pions. Heavy meson pairs can indeed slow down because of elastic scattering with surrounding pions. The number of low-relative-momentum meson pairs increases, thereby enhancing prompt production cross section. In this preliminar simulation, we show that an enhancement of 100 is indeed possible.

Giant xanthogranuloma of the pelvis with S1 origin: Complete removal with only posterior approach, technical note

Xanthogranulomas(XG) are benign proliferative disorder of histiocytes, a non-Langerhans cell histiocytosis. Whose etiology is unknown. The nature of these lesions is controversial and could be either reactive or neoplastic;the presence of monoclonal cells does, however, favor the second hypothesis. Xanthogranuloma is frequently found in young adults and children(under 20 years old), mainly in the skin. In about 5%-10% of all Juvenile XG(JXG) cases xanthogranuloma are extracutaneous. Within this group, the site most frequently involved is the eye. Other involved organs are heart, liver, adrenals, oropharynx, lung, spleen, central nervous system and subcutaneous tissue, although involvement of the spine is uncommon. Isolated lesions involving the sacral region are extremely rare. To date, this is the first reported case of a giant JXG arising from S1 with extension into the pelvic region in an adult spine.

TWENTY-EIGHT YEARS WITH “HYPERBOLIC CONSERVATION LAWS WITH RELAXATION”

This paper is a review on the results inspired by the publication “Hyperbolic conservation laws with relaxation” by Tai-Ping Liu [1], with emphasis on the topic of nonlinear waves （specifically, rarefaction and shock waves）. The aim is twofold： firstly, to report in details the impact of the article on the subsequent research in the area; secondly, to detect research trends which merit attention in the （near） future.

Electrorotation: A Spectroscopic Imaging Approach to Study the Alterations of the Cytoplasmic Membrane

Electrorotation (ER) is a technique allowing the characterization of the surface properties of a variety of supra-molecular aggregates and living cultured cells as well as cellular organelles and biological materials in general. In particular, this technique allows measuring two important physical parameters of the cell membrane: specific capacitance and specific conductance. These parameters are strictly related to the structure/function relationships of the biological membrane;ER becomes thus a powerful means to investigate a number of phenomena involving the membrane integrity. These phenomena may originate from treatments with exogenous molecules and/or from pathological effects. Concerning these aspects, the study of the transfer of exogenous material (i.e. cat-anionic vesicles or liposomes) across the cell membrane assumes a high importance. This review is focused on the physical functioning principles of ER and on the quantitative analysis of the experimental measurements. This work also reports on different fields of application of ER with particular reference to data obtained in our laboratory. The investigation of the alterations of the cytoplasmic membrane function, as evidenced by this strategy, will be illustrated in detail.

The Ever Expanding Role of Ubiquitin and SUMO in Plant Biology

When it was discovered in the 1970s as a ubiquitous protein, ubiquitin, a 76-aminoacid peptide, had no assigned function. It was not until later that ubiquitin was found to be a necessary cofactor in a vital cellular process： the degradation of proteins. Work by Avram Hershko, Aaron Ciechanover, and Irwin Rose （for which they received the 2004 Nobel Prize in Chemistry） showed that the covalent attachment of ubiquitin provide pro-teins with a tag that dispatches them to the proteasome, the main cell degradation machinery （Ciechanover 2012）. Subsequent work, has revealed that ubiquitin belongs to a broader family of ubiquitin-like proteins that can modify not only protein stability, but also subcellular localization and function.

Convective Transport in Rectangular Cavities Partially Heated at the Bottom and Cooled at One Side

Laminar natural convection heat transfer inside air-filled, rectangular enclosures partially heated from below and cooled at one side is studied numerically. A computational code based on the SIMPLE-C algorithm is used for the solution of the system of the mass, momentum, and energy transfer governing equations. Simulations are performed for a complete range of heater size, for Rayleigh numbers based on the height of the cavity ranging from 10~3to 10~6, and for height-to-width aspect ratios of the cavity spanning from 0.25 to 4. It is found that the heat transfer rate increases with increasing the heater size and the Rayleigh number, while it decreases with increasing the aspect ratio of the cavity. Dimensionless heat transfer correlations are also proposed.

Effect of Heat Loss on Laminar Flamelet Species Concentration

The effects of heat loss on the structure of laminar flamelets,which are the constitutive elements of turbulent flames under the most common operating conditions,are investigated for typical aeronautical gas-turbine operating conditions at take-off.The magnitude of heat loss is quantified via the "enthalpy defect" measured with respect to an adiabatic flame.A procedure to generate laminar flamelets with an assigned enthalpy defect at the boundaries is devised and applied to nonpremixed propane/air flames,as propane reproduces the essential features of higher hydrocarbon combustion.It is found,contrary to commonly held beliefs,that the enthalpy defect has a significant effect on the concentration not only of minor species,but also of main reaction products.Such effects are found in general to be more pronounced for fuel-rich conditions.An impact is anticipated on the formation rate of nitric oxides.The effects of scalar dissipation rate are also discussed.

KLOE results on scalar and pseudoscalar mesons

The data collected by the KLOE Collaboration at the Frascati φ-factory DAФNE from 2001 to 2006 have been used for extensive studies in meson spectroscopy. The decays of the scalar mesons a0（980） and f0（980） into two pseudoscalar mesons have been exploited to measure the relevant parameters of those resonances. The radiative decays φ →ηγ and η＇γ have been used for the determination of the pseudoscalar mixing angle and to search for a possible gluonium content in the η＇. The dynamics of the η → 3π decay has been studied and the Dalitz Plot parameters have been measured. The large amount of η mesons produced allowed also to study interesting rare η decays.

Lectures on Wonderful Varieties

These notes are an introduction to wonderful varieties. We discuss some general results on their geometry, their role in the theory of spherical varieties, several aspects of the combinatorics arising from these varieties, and some examples.