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A Case Series of Blastic Plasmacytoid Dendritic Cell Neoplasia. 疱疹性浆细胞树突状细胞瘤病例系列。
IF 1.5 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2020-10-31 eCollection Date: 2020-10-01
B Serio, V Giudice, M D'Addona, R Guariglia, M Gorrese, A Bertolini, F D'Alto, B Cuffa, D Pellegrino, M Langella, C Selleri

Blastic plasmacytoid dendritic cell neoplasm (BPDCN), an extremely rare and aggressive tumor, derives from plasmacytoid dendritic cell precursors and is characterized by CD4 and CD56 positivity accompanied by the expression of isolated myeloid, B- or T-cell lineage markers. Despite the recent introduction of specific targeted therapies, prognosis is still poor with a median overall survival of one year, and allogeneic bone marrow transplantation remains the only curative treatment in eligible patients. In this series, we described two cases of adult BPDCN treated with high dose cytarabine and methotrexate and autologous hematopoietic stem cell transplantation, or fludarabine, cytarabine, and idarubicin achieving the first a complete lasting remission, while the second only a transient improvement in skin lesions.

浆细胞性树突状细胞瘤(BPDCN)是一种极其罕见的侵袭性肿瘤,源于浆细胞性树突状细胞前体,其特征是 CD4 和 CD56 阳性,并伴有孤立的髓系、B 系或 T 系标志物的表达。尽管最近引入了特异性靶向疗法,但预后仍然很差,中位总生存期仅为一年,异基因骨髓移植仍然是符合条件的患者唯一的根治性治疗方法。在这组病例中,我们描述了两例成人BPDCN患者,前者接受大剂量阿糖胞苷、甲氨蝶呤和自体造血干细胞移植,或氟达拉滨、阿糖胞苷和伊达比星治疗后获得完全持久缓解,而后者仅皮肤病变得到短暂改善。
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引用次数: 0
Meningoencephalitis Associated with SARS-Coronavirus-2. 与sars -冠状病毒-2相关的脑膜脑炎。
IF 1.5 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2020-10-31 eCollection Date: 2020-10-01
G Iaconetta, P De Luca, A Scarpa, C Cassandro, E Cassandro

The aim of this work is to clarify the incidence of meningitis/encephalitis in SARS-CoV-2 patients. We conducted an initial search in PubMed using the Medical Subject Headings (MeSH) terms "meningitis," and "encephalitis,", and "COVID-19" to affirm the need for a review on the topic of the relationship between meningitis/encephalitis and SARS-CoV-2 infection. We included case series, case reports and review articles of COVID-19 patients with these neurological symptoms. Through PubMed database we identified 110 records. After removal of duplicates, we screened 70 record, and 43 were excluded because they focused on different SARS-CoV-2 neurological complications. For eligibility, we assessed 27 full-text articles which met inclusion criteria. Seven articles were excluded, and twenty studies were included in the narrative review, in which encephalitis and/or meningitis case reports/case series were reported. Neurological manifestations of COVID-19 are not rare, especially meningoencephalitis; the hypoxic/metabolic changes produced by the inflammatory response against the virus cytokine storm can lead to encephalopathy, and the presence of comorbidities and other neurological diseases, such as Alzheimer's disease, predispose to these metabolic changes. Further study are needed to investigate the biological mechanisms of neurological complications of COVID-19.

这项工作的目的是阐明严重急性呼吸系统综合征冠状病毒2型患者脑膜炎/脑炎的发病率。我们在PubMed中使用医学主题标题(MeSH)术语“脑膜炎”、“脑炎”和“新冠肺炎”进行了初步搜索,以确认有必要对脑膜炎/脑炎与SARS-CoV-2感染之间的关系进行审查。我们纳入了新冠肺炎有这些神经系统症状患者的病例系列、病例报告和综述文章。通过PubMed数据库,我们确定了110条记录。去除重复项后,我们筛选了70份记录,其中43份被排除在外,因为它们专注于不同的严重急性呼吸系统综合征冠状病毒2型神经并发症。关于资格,我们评估了27篇符合入选标准的全文文章。7篇文章被排除在外,20项研究被纳入叙述性综述,其中报告了脑炎和/或脑膜炎病例报告/病例系列。新冠肺炎的神经系统表现并不罕见,尤其是脑膜炎;针对病毒细胞因子风暴的炎症反应产生的缺氧/代谢变化可导致脑病,而合并症和其他神经系统疾病(如阿尔茨海默病)的存在易导致这些代谢变化。需要进一步研究新冠肺炎神经并发症的生物学机制。
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引用次数: 0
Saving Limited Resources During Covid-19 Pandemic. 在 Covid-19 大流行期间节约有限的资源。
IF 1.5 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2020-10-31 eCollection Date: 2020-10-01
O Piazza
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引用次数: 0
Histopathology of Celiac Disease. Position Statements of the Italian Group of Gastrointestinal Pathologists (GIPAD-SIAPEC). 乳糜泻的组织病理学。意大利胃肠道病理学家小组(GIPAD-SIAPEC)的立场声明。
IF 1.5 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2020-10-31 eCollection Date: 2020-10-01
V Villanacci, C Ciacci, T Salviato, G Leoncini, L Reggiani Bonetti, T Ragazzini, F Limarzi, L Saragoni

Celiac Disease (CeD) is an immune-mediated inflammatory disorder of the small intestine, affecting genetically susceptible individuals when exposed to gluten. Small intestinal biopsy interpretation has been the "gold standard" for celiac disease (CeD) for over 50 years. Despite today's availability of sensitive and specific serological tests, the histopathological features from mucosal biopsy play a key role in diagnosing when CeD is suspected. Such a diagnostic approach requires a multidisciplinary team to optimize both tissue sampling and interpretation via the interaction between the pathologist and the gastroenterologist. Pathologists of the Italian Group of Gastrointestinal Pathology (GIPAD-SIAPEC), together with a member (TR) of the Italian Society of Technicians (AITIC) and an expert gastroenterologist (CC), provide position statements as a practical tool for reading and interpreting the report. Moreover, a position statement was formulated about the recently described condition known as Non-Celiac Gluten Sensitivity (NCGS). Within such a diagnostic setting, both the architectural abnormalities of the duodenal mucosa, namely glandular hyperplasia, and villous atrophy and the number of intraepithelial T-lymphocytes should be well highlighted. Ancillary tests such as anti-CD3 stain are useful for an accurate count of the intraepithelial T lymphocytes when CeD or NCGS is suspected. Moreover, anti-CD3 and anti-CD8 stains are recommended in patients not responding to the gluten-free diet (GFD) to confirm a diagnosis of Refractory Celiac Disease (RCeD). Diagnostic clues about the differential diagnosis of both CeD and RCeD have also been rendered.

乳糜泻(Celiac Disease,CeD)是一种免疫介导的小肠炎症性疾病,暴露于麸质时会影响遗传易感人群。50 多年来,小肠活检一直是乳糜泻 (CeD) 的 "金标准"。尽管如今已经有了敏感而特异的血清学检测方法,但粘膜活检的组织病理学特征在疑似乳糜泻的诊断中仍起着关键作用。这种诊断方法需要一个多学科团队,通过病理学家和胃肠病学家之间的互动,优化组织取样和解释。意大利胃肠道病理学组(GIPAD-SIAPEC)的病理学家与意大利技师协会(AITIC)的一名成员(TR)和一名胃肠病专家(CC)一起提供了立场声明,作为阅读和解释报告的实用工具。此外,还就最近描述的非麸质过敏症(NCGS)制定了立场声明。在这种诊断环境下,十二指肠粘膜的结构异常(即腺体增生和绒毛萎缩)和上皮内 T 淋巴细胞的数量都应得到充分强调。当怀疑有 CeD 或 NCGS 时,抗 CD3 染色等辅助检查有助于准确计数上皮内 T 淋巴细胞。此外,建议对无麸质饮食(GFD)无效的患者进行抗-CD3 和抗-CD8 染色,以确诊难治性乳糜泻(RCeD)。此外,还提供了鉴别诊断乳糜泻和难治性乳糜泻的诊断线索。
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引用次数: 0
The Frailty of the Invincible. 无敌的弱点。
IF 1.5 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2020-10-31 eCollection Date: 2020-10-01
M Illario, V Zavagli, L Noronha Ferreira, M Sambati, A Teixeira, F Lanata, S Pais, J Farrell, D Tramontano

The COVID-19 pandemic has unveiled the frailty of our societies from too many points of view to look away. We need to understand why we were all caught unprepared. On the one hand, we have all short memories. As we forget too quickly, we were unable to recognize key factors influencing response and preparedness to public health threats. For many years, economic evaluation pushed governments all over the world to cut resources for public health systems, with COVID-19 pandemic the question arises: do we spend too much or too little on health care? What is the right amount to spend on health? Moreover, in many countries, the privatisation, or semi-privatisation, of healthcare may give rise to inequitable access to health care for everyone. Although COVID-19 is very "democratic", its consequences aren't. According to OECD, income inequality in OECD countries is at its highest level for the past half century. Three main causes have been recognized, technological revolution, globalization, and "financialisation". In this scenario, lockdown measures adopted to save lives are showing dramatic economic consequences. To address post COVID-19 reconstruction we need to go beyond GDP. As an economic measure this has many shortcomings in describing the real well-being of a country, and since what we measure affects what we do, new paradigms will have to guide the post COVID-19 reconstruction strategies, as the fate of countries and their citizens is at stake.

新冠肺炎大流行从太多的角度揭示了我们社会的脆弱性。我们需要理解为什么我们都措手不及。一方面,我们都有短暂的记忆。由于我们忘记得太快,我们无法认识到影响应对和准备应对公共卫生威胁的关键因素。多年来,经济评估推动世界各国政府削减公共卫生系统的资源,随着新冠肺炎大流行,问题来了:我们在医疗保健上的支出是太多还是太少?花在健康上的正确金额是多少?此外,在许多国家,医疗保健的私有化或半私有化可能会导致每个人获得医疗保健的机会不公平。尽管新冠肺炎非常“民主”,但其后果并非如此。根据经合组织的数据,经合组织国家的收入不平等处于过去半个世纪以来的最高水平。人们已经认识到三个主要原因:技术革命、全球化和“金融化”。在这种情况下,为挽救生命而采取的封锁措施正在显示出巨大的经济后果。为了应对新冠肺炎后的重建,我们需要超越GDP。作为一种经济衡量标准,这在描述一个国家的真正福祉方面有许多缺点,而且由于我们衡量的内容影响我们的工作,新的模式必须指导新冠肺炎后的重建战略,因为国家及其公民的命运岌岌可危。
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引用次数: 0
Head and Neck Surgery Residency during Covid-19 Pandemic. Lessons from Southern Italy. Covid-19 大流行期间的头颈外科住院医师培训。意大利南部的经验教训。
IF 1.5 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2020-10-31 eCollection Date: 2020-10-01
P De Luca
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引用次数: 0
Meningoencephalitis Associated with SARS-Coronavirus-2. 与sars -冠状病毒-2相关的脑膜脑炎。
IF 1.5 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2020-09-01 DOI: 10.37825/2239-9747.1007
G. Iaconetta, P. De Luca, A. Scarpa, C. Cassandro, E. Cassandro
The aim of this work is to clarify the incidence of meningitis/encephalitis in SARS-CoV-2 patients. We conducted an initial search in PubMed using the Medical Subject Headings (MeSH) terms "meningitis," and "encephalitis,", and "COVID-19" to affirm the need for a review on the topic of the relationship between meningitis/encephalitis and SARS-CoV-2 infection. We included case series, case reports and review articles of COVID-19 patients with these neurological symptoms. Through PubMed database we identified 110 records. After removal of duplicates, we screened 70 record, and 43 were excluded because they focused on different SARS-CoV-2 neurological complications. For eligibility, we assessed 27 full-text articles which met inclusion criteria. Seven articles were excluded, and twenty studies were included in the narrative review, in which encephalitis and/or meningitis case reports/case series were reported. Neurological manifestations of COVID-19 are not rare, especially meningoencephalitis; the hypoxic/metabolic changes produced by the inflammatory response against the virus cytokine storm can lead to encephalopathy, and the presence of comorbidities and other neurological diseases, such as Alzheimer's disease, predispose to these metabolic changes. Further study are needed to investigate the biological mechanisms of neurological complications of COVID-19.
这项工作的目的是阐明严重急性呼吸系统综合征冠状病毒2型患者脑膜炎/脑炎的发病率。我们在PubMed中使用医学主题标题(MeSH)术语“脑膜炎”、“脑炎”和“新冠肺炎”进行了初步搜索,以确认有必要对脑膜炎/脑炎与SARS-CoV-2感染之间的关系进行审查。我们纳入了新冠肺炎有这些神经系统症状患者的病例系列、病例报告和综述文章。通过PubMed数据库,我们确定了110条记录。去除重复项后,我们筛选了70份记录,其中43份被排除在外,因为它们专注于不同的严重急性呼吸系统综合征冠状病毒2型神经并发症。关于资格,我们评估了27篇符合入选标准的全文文章。7篇文章被排除在外,20项研究被纳入叙述性综述,其中报告了脑炎和/或脑膜炎病例报告/病例系列。新冠肺炎的神经系统表现并不罕见,尤其是脑膜炎;针对病毒细胞因子风暴的炎症反应产生的缺氧/代谢变化可导致脑病,而合并症和其他神经系统疾病(如阿尔茨海默病)的存在易导致这些代谢变化。需要进一步研究新冠肺炎神经并发症的生物学机制。
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引用次数: 7
The Many Faces of Covid-19: Organizing Pneumonia (OP) Pattern HRCT Features Covid-19的多个方面:组织肺炎(OP)型HRCT特征
IF 1.5 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2020-09-01 DOI: 10.37825/2239-9747.1001
G. Rea, T. Valente, R. Lieto, G. Bocchini, E. Marchiori, A. Pinto, A. Maglio, A. Vatrella
Covid-19 (coronavirus disease 2019) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On 30 January 2020 the World Health Organization (WHO) declared that the outbreak of Covid-19 realizes a public health emergency of international concern. Because of the primary involvement of the respiratory system, chest CT is strongly recommended in suspected Covid-19 cases, for both initial and follow-up. We present the case of a Covid-19 patient, a 57-year-old man, with a typical HRCT course of OP reaction.
Covid-19(冠状病毒病2019)是由严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)引起的传染病。2020年1月30日,世界卫生组织(世卫组织)宣布,2019冠状病毒病疫情构成国际关注的突发公共卫生事件。由于主要累及呼吸系统,强烈建议对疑似Covid-19病例进行初始和随访的胸部CT检查。我们报告一名57岁的男性Covid-19患者,其HRCT表现为典型的OP反应。
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引用次数: 5
Head and Neck Surgery Residency During Covid-19 Pandemic. Lessons from Southern Italy. Covid-19大流行期间头颈外科住院医师。意大利南部的教训。
IF 1.5 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2020-09-01 DOI: 10.37825/2239-9747.1008
P. De Luca
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引用次数: 3
Saving Limited Resources During Covid-19 Pandemic 在Covid-19大流行期间节省有限的资源
IF 1.5 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2020-09-01 DOI: 10.37825/2239-9747.1003
Ornella Piazza
"Age (is) an important factor in making the terrible choice of who will receive scarce resources in a pandemic.", wrote Professor Arthur Caplan, Director of the section of Medical Ethics at the New York UniversityGrossman School of Medicine [1]. This opinion, if extrapolated from its context, would be immediately rejected as inhuman and unacceptable by anyone, medical or lay people, young or old. However, in Italy, the SARSCoV-2 pandemic was marked by the severe lack of personal protective equipment (PPE), mechanical ventilators, hospital beds and in particular ICU beds, and this resulted in an inevitable selection of patients. ICU physicians, often by themselves, face this situation, when ER request exceeds the availability of beds and mechanical ventilators in the area, also before the pandemic. This problem has been aggravated by COVID19, and it is now known and feared by the large audience. If maximizing the number of saved lives is the common societal objective, and when epidemiological and clinical data support the risk of failure, can age lawfully be used for the allocation of a valuable resource as a mechanic ventilator? Simplifying, if there is an equal need between two patients, age can be the decisive element in defining the priority of treatment: lifesaving procedures, such as intubating and ventilating, will be carried out only in younger patients, reserving only less invasive or palliative treatments for the elderly. Following this principle, the elderly, lesser valued citizens, would give young people the right to play their game of life, as defined by the principle of “fair innings”, or fair life expectancy. Is the age of patients the right choice when it is selected as a triage criterion? In my opinion, age must never be the main factor that determines a person's right to intensive care, since it is an unreliable and insufficient index of the patient's ability to respond to intensive care and to recover autonomy functional. A healthy 75-year-old cannot be denied access to resuscitation treatment on the basis of age alone, although elderly patients with severe respiratory insufficiency secondary to COVID-19 have a high probability of dying despite intensive care and, consequently, they may have a lower priority for admission to intensive care in conditions of irremediable and extreme shortage of beds. The Italian Society of Anesthesia (SIAARTI) has published a document entitled "clinical ethics recommendations for the breakdown of intensive care treatments, in exceptional circumstances limited to resources" in partial agreement with Professor Caplan. In this document, the principle of "saving limited resources, which can become extremely scarce, for those who have a much greater chance of survival and life expectancy, in order to maximize the benefits for the greatest number of people" is stated. COVID 19 acute respiratory disease in frail elderly patients has a long course, and outcomes are more malignant than in healthy young su
纽约大学格罗斯曼医学院医学伦理部主任亚瑟·卡普兰教授写道:“在做出流行病期间谁将获得稀缺资源的糟糕选择时,年龄是一个重要因素。”这一意见,如果从其背景推断出来,将立即被任何人,无论是医务人员还是非专业人士,无论是年轻人还是老年人,视为不人道和不可接受而予以拒绝。然而,在意大利,sars -2大流行的特点是严重缺乏个人防护装备(PPE)、机械呼吸机、医院病床,特别是ICU病床,这导致不可避免地选择患者。在大流行之前,当急诊室的需求超过该地区的床位和机械呼吸机的可用性时,ICU医生往往自己面临这种情况。这一问题因covid - 19而加剧,现在为广大观众所知和恐惧。如果最大限度地挽救生命是共同的社会目标,并且当流行病学和临床数据支持失败的风险时,是否可以合法地使用年龄来分配作为机械呼吸机的宝贵资源?简单地说,如果两个病人之间有同样的需要,年龄可以成为确定治疗优先次序的决定性因素:只有年轻病人才会进行插管和呼吸等挽救生命的程序,而对老年人只保留侵入性较小或姑息性较低的治疗。遵循这一原则,老年人,较不受重视的公民,将给予年轻人玩他们的生活游戏的权利,这是由“公平回合”原则定义的,或公平的预期寿命。患者的年龄作为分诊标准是正确的选择吗?在我看来,年龄绝不能成为决定一个人是否有权接受重症监护的主要因素,因为它是病人对重症监护作出反应和恢复自主功能的能力的一个不可靠和不充分的指标。健康的75岁老人不能仅仅因为年龄而被拒绝接受复苏治疗,尽管继发于COVID-19的严重呼吸功能不全的老年患者即使接受重症监护也有很高的死亡可能性,因此,在床位极度短缺且无法补救的情况下,他们接受重症监护的优先级可能较低。意大利麻醉学会(SIAARTI)发表了一份题为“在资源有限的特殊情况下,重症监护治疗中断的临床伦理建议”的文件,部分同意卡普兰教授的意见。在这份文件中,“为那些有更大的生存机会和预期寿命的人节省有限的资源,这些资源可能变得极其稀缺,以便为最大多数人带来最大的利益”的原则得到了阐述。老年体弱患者急性呼吸道疾病病程长,预后较健康青年患者恶性。因此,SIAARTI建议:“在这些特殊情况下,必须仔细评估每位危重患者的年龄、合并症和功能状态”。英国国家健康与护理卓越研究所(NICE)的指南更新至2020年4月29日,建议仅为65岁以上、脆弱性评分低的患者保留重症监护,同时考虑对65岁以上的体弱患者非常有选择性地在ICU住院。临床虚弱量表(CFS)得分超过5分,应劝阻尝试侵入性方法或“浪费”机械呼吸机,以帮助需要帮助的患者爬楼梯,洗涤或穿衣。在这次大流行中,公共卫生政策可以超越优先考虑个别患者福祉的道德义务,推动为最多的患者提供更大的利益。White和Lo b[2]支持优先考虑重症患者的方法,这些患者在出院时也更有可能存活下来。在我看来,定义一个严格的界限,一个精确的年龄门槛和慢性疲劳综合症评分,对年轻和缺乏经验的医生来说,更多的是“防御”工具,而不是道德因素,这些医生被疫情摧毁,留在急诊室里痛苦不堪。我再次重申,这些决定必须基于与治疗结果相关的临床因素,而不是基于对个人生命价值的歧视性判断。同样,一个简单的基于年龄或残疾的退出制度不仅是不道德的,而且是非法的,因为它将构成歧视。这些决定对那些受影响的人和被迫做出决定的人来说都是极其痛苦的。几天前去世的97岁的伟大哲学家阿尔多·马苏洛(Aldo Masullo)教授写了一篇关于“COVID-19在COVID-19大流行期间节省有限资源”的文章
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引用次数: 2
期刊
Translational Medicine at UniSa
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