Abstract
Background
Transition of adolescents with inflammatory bowel disease (IBD) to adult care is a challenge for patients, families, and healthcare providers. Considering that ~ 25% of IBD ...patients are diagnosed before the age of 16 years, and that these patients are at higher risk for poorer clinical disease outcomes. interest in the transition of care has been increasing considerably in the last decade.To assess the main clinical and epidemiological features of peadiatric IBD patients in a single pediatric center in Sardinia, Italy, at diagnosis and at the time of transition to the adult center
Methods
From January 2014 to June 2023 we performed a multicenter, observational, cross-sectional study that included pediatric patients with IBD enrolled in the only pediatric IBD reference center in Sardinia. Data were obtained from the patients’ medical records and from a questionnaire administered at the inclusion visit.
Results
Sixty-five IBD patients were enrolled (UC 40, CD 25, M 32, F 33). Median age at diagnosis was 13 years (IQR 2-18). After a median disease duration of 8 years (IQR: 1-25), no UC patients experienced proximal estension of proctitis or left-sided colitis, and no CD patients experienced new localizations of disease.
Fifteen patients developed extraintestinal manifestations. No significant difference was found in median diagnostic delay (DD) between UC 4 months (IQR: 1-84) and CD patients 4,5 months (IQR: 1-48).
At the transition visit, overall, twenty-nine patients (44,6%) were exposed to one biologic agent (vs 3% at baseline; p<0.02); 0 patients (0%) were exposed to two biologic agents. 4,6% of patients (3/ 65) underwent surgery
Conclusion
Our results provide important insights into the clinical and epidemiological features of pediatric IBD population, and while waiting for a nation Italian registry, present eligible data on the IBD population in Sardinia
Abstract
Papillary fibroelastoma is an uncommon cardiac tumour. It is usually attached to the chordae tendineae or to the papillary muscles, while the involvement of the valves or the LVOT is rarely ...seen. The diagnosis is often due to incidental finding because the tumor is often asymptomatic, even though structural cardiac damages or dramatic embolization may occur. We present the case of a 66 year old woman affected by arterial hypertension and dyslipidemia. During a routine cardiologic visit a transthoracic echocardiogram unexpectedly revealed the presence of a extremely mobile peduncolate mass (11x5mm) with a homogenous speckle pattern, apparently settled on the aortic side of the right cusp of the aortic valve. No further pathological elements were detected. A diagnosis of suspected fibroelastoma was made and the patient was transferred to the cardiac surgery department. On admission clinical examination and vital signs were unremarkable. No symptoms suggestive of TIA or amaurosis were reported by the patient, hence the tumor was considered as an asymptomatic incidental finding. Since the mass did not seem to be firmly attached, based on the high risk of embolization and the possibility of coronary ostia impingement with the manipulation of the catheters, the Heart Team decided to omit a pre-interventional coronary angiography. A coronary CT scan excluded significant coronary artery disease and the patient was offered a surgical resection of the mass. After anterior mini-sternotomy, during extracorporeal circulation, the ascending aorta was opened with a transversal incision and the aortic valve was exposed. A pedunculated tumour of 1.5x2 cm implanted in the edge of the right cusp was observed and completely excised with a valve-sparing resection. Macroscopically, the tumour looked whitish and filamentous, suggestive of fibroelastoma. At the end of the procedure transesophageal echocardiography guaranteed the competence of the aortic valve was preserved. The patient recovered successfully and was discharged one week after the intervention. The control transthoracic echocardiography excluded tumoral residual and the histological examination confirmed the diagnosis of fibroelastoma. The patient was discharged after an uneventful course. This report singularly shows a rare case of aortic location of an asymptomatic fibroelastoma treated with an early surgical approach in order to avoid embolic complications. Multimodality imaging provides clear and exemplary information about this rare entity. Nowadays, the optimal management of challenging cases requires a multidisciplinary team with a discrete familiarity with the common imaging techniques, which play a pivotal role in the diagnostic, pre-procedural and interventional setting.
Abstract P640 Figure. Multimodality imaging: fibroelastoma
Abstract
Atrial mixoma represents the most common cardiac tumour. The diagnosis is usually accidental since it is benign and usually asymptomatic. Nevertheless, life-threathening complications such ...as embolization may seldom occur. In these cases emergent multispecialistic approach is deemed. We describe the case of a 46 year old man without cardiovascular risk factors and whose previous clinical history was not significant. At home, the patient abruptly presented a right hemiplegia, deviation of the buccal commissure to the left and loss of consciousness. On arrival at the emergency department GCS was 5. Routine blood tests, gas analysis and ECG were unremarkable. An urgent CT scan showed a left fronto-parietal subarachnoid hemmorhage. Soon after admission in the stroke unit the patient showed sign of acute limb ischaemia. A high-resolution 3D-angio CT revealed multiple bilateral renal and splenic infarcts and a massive thrombosis of the abdominal aorta below the renal bifurcation, with extensive involvement of the iliac arteries. Unexpectedly, a bulky mass (max diameter 8 cm) was detected in the left atrium. Transthoracic echocardiography confirmed the presence of an irregularly oval (8x3cm) mobile peduncolate mass with fringed edges, suspected for mixoma, with phasic impingement of the mitral valve and protrusion into the left ventricle. Considering the age of the patient and the very early presentation, after Heart Team discussion the patient underwent an urgent embolectomy with Fogarty catheter followed by cardiac surgery for myxoma resection. After full sternotomy, with an interatrial groove approach, a large tumor with myxoid appearance implanted in the left atrial roof was discovered (8 cm maximum diameter). A complete excision of the mass was successfully performed. The macroscopic examination revealed a tumor with a gelatinous and friable surface, very irregular edges and narrow base of implantation, suggestive of atrial myxoma. The day after a CT revealed multiple new ischemic and hemorragic lesions in the left frontal and parietal lobes, in the right occipital lobes, in the cerebellar emispheres, thalamus and hypotalamus and in the mesencephalus. Multiple thrombosis of the main branches of the Willis polygon were detected as well.
The patient remained comatous (GCS 3) with bilateral midriasis and was intubated in the intensive care unit. The anatomopathological study confirmed the diagnosis of atrial myxoma. Despite the general belief that atrial mixoma present a benign course, clinicians should carefully consider the possibility of dramatic complications, due to the risk of embolization. High resolution imaging techniques are of pivotal relevance for the diagnosis of the tumor and the complications, in which case emergent surgery may be required. Early surgery could be considered in asymptomatic patients because the evolutionary course and the prognosis can unexpectedly be ominous.
Abstract P171 Figure. Multiple embolism from atrial myxoma
Plasma membrane H+-ATPase was studied in maize (Zea mays L.) roots induced for NO3
- uptake. Membrane vesicles were isolated by means of Suc density gradient from roots exposed for 24 h either to 1.5 ...mM NO3
- or 1.5 mM SO4
-. The two populations of vesicles had similar composition as shown by diagnostic inhibitors of membrane-associated ATPases. However, both ATP-dependent intravesicular H+ accumulation and ATP hydrolysis were considerably enhanced (60-100%) in vesicles isolated from NO3
--induced roots. Km for Mg:ATP and pH dependency were not influenced by NO3
- treatment of the roots. ATP hydrolysis in plasma membrane vesicles for both control and NO3
--induced roots was not affected by 10 to 150 mM NO3
- or Cl-. On the other hand, kinetics of NO3
-- or Cl--stimulated ATP-dependent intravesicular H+ accumulation were modified in plasma membrane vesicles isolated from NO3
--induced roots. Immunoassays carried out with polyclonal antibodies against plasma membrane H+-ATPase revealed an increased steady-state level of the enzyme in plasma membrane vesicles isolated from NO3
--induced roots. Results are consistent with the idea of an involvement of plasma membrane H+-ATPase in the overall response of roots to NO3
-.
An investigation was carried out to assess the effect of nitrate supply on the root plasma membrane (PM) H+‐ATPase of etiolated maize (Zea mays L.) seedlings grown in hydroponics. The treatment ...induced higher uptake rates of the anion and the expression of a putative high‐affinity nitrate transporter gene (ZmNRT2.1), the first to be identified in maize. Root PM H+‐ATPase activity displayed a similar time‐course pattern as that of net nitrate uptake and investigations were carried out to determine which of the two isoforms reported to date in maize, MHA1 and 2, responded to the treatment. MHA1 was not expressed under the conditions analysed. Genome analysis revealed that MHA2, described as the most abundant form in all maize tissues, was not present in the maize hybrid investigated, but a similar form was found instead and named MHA3. A second gene (named MHA4) was also identified and partially sequenced. Both genes, classified as members of the PM H+‐ATPase subfamily II, responded to nitrate supply, although to different degrees: MHA4, in particular, proved more sensitive than MHA3, with a greater up‐ and down‐regulation in response to the treatment. Increased expression of subfamily II genes resulted in higher steady‐state levels of the enzyme in the root tissues and enhanced ATP‐hydrolysing activity. The results support the idea that greater proton‐pumping activity is required when nitrate inflow increases and suggest that nitrate may be the signal triggering the expression of the two members of PM H+‐ATPase subfamily II.
The zero degree calorimeters for the ALICE experiment Puddu, G.; Arnaldi, R.; Chiavassa, E. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
10/2007, Letnik:
581, Številka:
1
Journal Article
Recenzirano
The Zero Degree Calorimeters (ZDC) for the ALICE experiment will measure the energy of the spectator nucleons in heavy ion collisions at the CERN LHC, providing a direct measure of the centrality of ...the collisions. ZDC are spaghetti calorimeters, which detect the Cherenkov light produced by the shower particles in silica optical fibers embedded in a dense absorber. The main characteristics of the ZP and ZN detectors are described in this article. The calorimeters were tested at the CERN SPS using pion and electron beams with momenta ranging from 50 to
200
GeV
/
c
. Test beam results such as the calorimeter response, the energy resolution, the signal uniformity and the localizing capability are presented.
Cardiac involvement by metastatic gastric sarcoma is a rare event. We describe an unusual case of gastric sarcoma involving the heart in a 29-year-old man who presented with heart failure. The ...diagnosis was made at two-dimensional echocardiography. Heart metastases prolapsing into and obstructing the mitral valve orifice were located in the left atrium. In an attempt to excise the left atrial mass, the patient underwent heart surgery twice. The resections were non-curative. The patient died of refractory heart failure 9 months after the onset of symptoms. This case report is an example of a secondary intracavitary tumor that causes obstruction of the mitral valve orifice. Two-dimensional echocardiography has been confirmed as the examination of choice for the early diagnosis of cardiac tumors.
Plasma membrane H+-ATPase was studied in maize (Zea mays L.) roots induced for NO3- uptake. Membrane vesicles were isolated by means of Suc density gradient from roots exposed for 24 h either to 1.5 ...mM NO3- or 1.5 mM SO4-. The two populations of vesicles had similar composition as shown by diagnostic inhibitors of membrane-associated ATPases. However, both ATP-dependent intravesicular H+ accumulation and ATP hydrolysis were considerably enhanced (60-100%) in vesicles isolated from NO3- induced roots. Km for Mg:ATP and pH dependency were not influenced by NO3- treatment of the roots. ATP hydrolysis in plasma membrane vesicles for both control and NO3- induced roots was not affected by 10 to 150 mM NO3- or Cl-. On the other hand, kinetics of NO3- or Cl- stimulated ATP-dependent intravesicular H+ accumulation were modified in plasma membrane vesicles isolated from NO3- induced roots. Immunoassays carried out with polyclonal antibodies against plasma membrane H+-ATPase revealed an increased steady-state level of the enzyme in plasma membrane vesicles isolated from NO3- induced roots. Results are consistent with the idea of an involvement of plasma membrane H+-ATPase in the overall response of roots to NO3-
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