Potential Diagnostic Role of Hepcidin in Anemic Patients Affected by Inflammatory Bowel Disease: A Systematic Review.

BACKGROUND: Anemia is the main extraintestinal comorbidity of Inflammatory Bowel Disease (IBD). Differentiating the type of anemia in these disorders is still a challenge. Hepcidin could be a promising biomarker to identify iron deficiency anemia (IDA), anemia of chronic disease (ACD) and the concomitant presence of both IDA and ACD. METHODS: To evaluate the potential role of hepcidin dosage in the management of anemia in IBD patients, we performed a systematic review by a comprehensive literature analysis of original papers reporting the dosage of hepcidin in IBD patients. In all the articles reviewed, the dosage of ferritin was reported, and the correlation between hepcidin and ferritin has been used to compare these two biomarkers. RESULTS: A total of 12 articles concerning the dosage of hepcidin in IBD were included, comprising in total of 976 patients. The results of the hepcidin values in IBD patients when compared with controls were conflicting. In fact, four articles described an increase in this biomarker, three showed a decrease and five did not find significant differences. The correlation with ferritin was positive and significant. In three studies, some differences between hepcidin dosages and ferritin levels indicate a possible role when IDA and ACD could be present at the same time. CONCLUSIONS: Considering the contradictory data of the studies, the diagnostic role of hepcidin as a biomarker remains elusive in IBD patients. These differences could be due to the clinical characteristics of the patients enrolled that should be better defined in the future. A suitable clinical trial should be designed to outline the possible role of hepcidin in differentiating IDA, ACD and concomitant IDA and ACD in IBD patients. At the moment, ferritin still remains the best marker to diagnose these conditions, in addition to hemoglobin, transferrin saturation and CRP as recommended by the ECCO guidelines.

Frequency Evaluation of the Interleukin-6 -174G>C Polymorphism and Homeostatic Iron Regulator (HFE) Mutations as Disease Modifiers in Patients Affected by Systemic Lupus Erythematosus and Rheumatoid Arthritis.

Autoimmune diseases are generally characterized by a multifactorial etiology and are often associated with a genetic predisposition. Both iron metabolism and the inflammatory cytokine system have been shown to play a pivotal role in the dysregulation of the immune response in many different autoimmune conditions, rheumatologic diseases included. The purpose of this work was to analyze the frequency of mutations altering the expression of IL-6 or influencing iron metabolism in patients affected by autoimmune diseases such as Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE). In this study, 144 patients were enrolled: 77 and 67 patients were affected by RA and SLE, respectively. In these cohorts, the frequency of the IL-6 polymorphism -174G>C located in the IL-6 gene promoter was tested. Moreover, the frequencies of the three HFE gene variations associated with iron overload were analyzed: p.His63Asp, p.Ser65Cys and p.Cys282Tyr. The two mutations p.His63Asp and p.Ser65Cys in the HFE gene did not reach statistical significance in any of the comparisons, regardless of the statistical model, cohorts of patients and control populations analyzed. The frequencies of the p.Cys282Tyr mutation and the IL-6 polymorphism -174G>C were found to be overall significantly decreased in RA and SLE patients when the Dominant model and Allele contrast were adopted with both the Odds Ratio and Chi-square. Although further investigation is needed, the examination of the frequencies of the -174G>C IL-6 promoter polymorphism and HFE mutations may add some valuable information on the interplay linking iron metabolism, inflammation and immunity in autoimmune diseases such as SLE and RA.

Admittance to Wildlife Rehabilitation Centres Points to Adverse Effects of Climate Change on Insectivorous Bats.

Climate change is exerting a broad range of (mostly adverse) effects on biodiversity, and more are expected under future scenarios. Impacts on species that deliver key ecosystem services, such as bats, are especially concerning, so their better understanding is key to preventing or mitigating them. Due to their physiological requirements, bats are especially sensitive to environmental temperatures and water availability, and heatwave-related mortality has been reported for flying foxes and, more anecdotally, other bat species. For temperate regions, to date, no study has highlighted an association between temperature extremes and bat mortality, mostly due to the difficulty of relying on data series covering long timespans. Heatwaves may affect bats, causing thermal shock and acute dehydration so bats can fall from the roost and, in some cases, are rescued by the public and brought to wildlife rehabilitation centres (WRCs). In our work, we considered a dataset spanning over 20 years of bat admittance to Italian WRCs, covering 5842 bats, and hypothesised that in summer, the number of admitted bats will increase in hotter weeks and young bats will be more exposed to heat stress than adults. We confirmed our first hypothesis for both the overall sample and three out of five synurbic species for which data were available, whereas hot weeks affected both young and adults, pointing to an especially concerning effect on bat survival and reproduction. Although our study is correlative, the existence of a causative relationship between high temperatures and grounded bats is still the best explanation for the recorded patterns. We urge such a relationship to be explored via extensive monitoring of urban bat roosts to inform appropriate management of bat communities in such environments and preserve the precious ecosystem services such mammals provide, especially insectivory services.

Isolation of Batborne Neglected Zoonotic Agent Issyk-Kul Virus, Italy.

We isolated Issyk-Kul virus (ISKV) from a bat sampled from Italy in 2021 and conducted ISKV-specific surveillance in bats collected in Italy during 2017-2023. ISKV circulation among synanthropic and sedentary species of bat, such as Savi's pipistrelle bat (Hypsugo savii) in northern Italy, may have public health implications in this region.

Blood L-Lactate Concentration as an Indicator of Outcome in Roe Deer (Capreolus capreolus) Admitted to a Wildlife Rescue Center.

Roe deer (Capreolus capreolus) are among the most frequent patients of rescue centers in Italy. Three outcomes are possible: natural death, euthanasia, or treatment and release. The aim of the present study is to propose blood L-lactate concentration as a possible prognostic biomarker that may assist veterinarians in the decision-making process. Sixty-three roe deer, admitted to one rescue center in the period between July 2018 and July 2019, were sampled and divided into 4 groups according to their outcome: (1) spontaneous death (17 cases), (2) humanely euthanized (13 cases), (3) fully recovered and released (13 cases), and (4) euthanized being unsuitable for release (20 cases). In addition, blood samples from 14 hunted roe deer were analyzed as controls. Whole blood lactate concentrations were measured with a point of care lactate meter. Differences among groups were close to statistical significance (p = 0.51). A cut-off value of 10.2 mmol/L was identified: all the animals with higher values died or were humanely euthanized. The results suggest that roe deer with lactatemia higher than 10.2 mmol/L at admission, have a reduced prognosis for survival during the rehabilitation period, regardless of the reason for hospitalization and the injuries reported. Therefore, humane euthanasia should be considered for these animals.

Uterine fibroid therapy using interventional radiology mini-invasive treatments: current perspective.

Uterine fibroids are common benign tumors of unclear etiopathology that affect the female reproductive tract. They are responsible for considerable morbidity and deterioration of life quality, and may have a negative impact on the reproductive system as well. Besides surgery aided by uterus-saving techniques, several minimally invasive procedures are now available within the field of interventional radiology that represent a valid solution for women who desire pregnancy and relief from disease-specific symptomatology. The main advantages offered by these techniques are low grade of invasiveness and short times of hospitalization. The most diffuse techniques are uterine artery embolization (UAE) and magnetic resonance-guided high-intensity focused ultrasound (MRgFUS). UAE is an endovascular procedure whose goal is obtained by provoking ischemia of the uterine vessels. MRgFUS is a thermoablation procedure that selectively ablates the symptomatic fibroids. In this review study, both procedures will be described, including a description of technical details, indications, contraindications, complications, and outcomes.

640-Slice CT Measurement of Superior Orbital Fissure as Gateway for Light into the Brain: Statistical Evaluation of Area and Distance.

OBJECTIVE: Our aim was to provide normative data concerning superior orbital fissure area (SOFA), ocular skin and the substantia nigra (D-SS) and orbital fissure and the substantia nigra (D-SOF-S) distances by CT scan in adult Caucasian population. METHODS: The area of the superior orbital fissure (SOF), the distance between the ocular skin and the substantia nigra and the distance between the superior orbital fissure and the substantia nigra using CT and 3D-CT images. RESULTS: Normative data stratified for age and gender were obtained. The data here reported show that some degree of variability in SOFA, D-SS and D-SOF-S measurements can be observed healthy Caucasian subjects. Gender stratified prediction intervals (mean +/- 2 Standard Deviations) for SOFA and D-SOF-S were 69.2 (+/-15.8) and 38.4 (+/-7.6) for male and 56.8 (+/-11.9) and 36.5 (+/-6.1) for female, respectively. Age and gender significantly impacted on D-SS values and normative data were constructed generating data stratified for these two variables. D-SS was 89.4 (+/-10.3) and 86.4 (+/-9.7) for male and female, respectively. CONCLUSIONS: Here we provide adjunctive anatomical information on specific anatomical cerebral zones. Our data may have implications for surgeons actively committed to treat pathological conditions involving these cerebral areas. Additionally, the anatomical variability found with respect to SOF and the potential different exposure of the substanzia nigra to the bright light could play a role in Parkinson's disease as already speculated in literature.

Is size an essential criterion to define tumefactive plaque? MR features and clinical correlation in multiple sclerosis.

Tumefactive multiple sclerosis is an inflammatory demyelinating disease of the central nervous system. It has recently been described as a rare subtype of multiple sclerosis (MS) characterised by the appearance of solitary or multiple space-occupying lesions associated with imaging characteristics mimicking neoplasm. Atypical features include plaque size >2 cm with mass effect, oedema, and/or ring enhancement on magnetic resonance (MR) images.This study is a retrospective review designed to evaluate the prevalence of tumefactive plaques in a selected population of 440 MS patients referred to our MS centre in Southern Italy between 2005 and 2014. We analysed the radiographic features of lesions ranging in size from 0.5 to 2 cm to establish whether smaller plaques with MR characteristics similar to tumefactive plaques present different symptoms, disease evolution and prognosis. We also aimed to ascertain if MR features suggestive of biological aggressiveness could be useful prognostic criteria for a correct diagnosis of the disease and subsequent treatment. Our data suggest that lesions 0.5-2 cm and >2 cm have similar MR features and clinical evolution.

Effectiveness of Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) in the uterine adenomyosis treatment: technical approach and MRI evaluation.

PURPOSE: To evaluate the treatment efficacy of uterine adenomyosis using MRgFUS as a mini-invasive therapy. MATERIALS AND METHODS: Twenty-three patients affected by symptomatic uterine adenomyosis (11 focal and 7 diffuse forms), diagnosed using MRI, were included in this study. Eighteen out of 23 were submitted to MRgFUS. All junctional zone more than 12 mm in width were considered to be adenomyosis. Study evaluates the pre-treatment target volume measured prior to the treatment on the CE T1-weighted sequence and the MRgFUS-treated volume (MRgFUS-TV), represented by the volume of the lesion ablated, measured directly by means of the MRgFUS. The treated volume on the CE T1-weighted sequence (CE MRI-TV) was measured immediately after treatment. After 1 year, the junctional zone thickness was measured in order to compare pre- and post-treatment values. The therapeutic plan consisted of a high-energy-grid sonication. Symptomatology was assessed through the UFS-QOL. RESULTS: The pre-treatment target volume mean value was of 59.7 cc; the MRgFUS-TV had a mean value of 44.9 cc, and the mean value of CE MRI-TV, measured immediately after treatment, was of 52.8 cc, with an increase of 13.7%. The 86.5% of the lesion was treated. After 1 year from the treatment, 15/18 (83%) patients showed thickness of the junctional zone <12 mm; 3/18 (17%) had a junctional zone >12 mm. CONCLUSION: MRgFUS is an encouraging mini-invasive treatment for adenomyosis that permits to maintain the integrity of the uterus in a pathology with limited therapeutic possibility.

Occult neural foraminal stenosis caused by association between disc degeneration and facet joint osteoarthritis: demonstration with dedicated upright MRI system.

PURPOSE: The aim of our study was to evaluate the presence of dynamic foraminal stenosis using a new low-field dedicated magnetic resonance (MR) unit with a balancing system that allows images to be acquired both in the recumbent and upright position. Imaging of lumbar spine with the patient in a supine, nonweight-bearing position is likely to misrepresent the degree and potential risk of spinal stenosis. MATERIALS AND METHODS: In the period between September 2008 and May 2011, we selected 630 symptomatic patients aged 40-65 years (mean age 56) who underwent conventional MR in clinostatic position. The study only included selected patients (total 160) who underwent clinostatic and orthostatic evaluation using a dedicated MR system (G-scan). The biomechanical parameters were also considered. Changes in the dimension of the neural foramina were compared using the presence of disc and facet degeneration by statistical analysis. RESULTS: Stenosis of the intervertebral foramen was never found in the presence of normal intervertebral discs either in the presence or in the absence of facet disease, in either clinostatic or orthostatic position. Sixty-one stenotic levels were detected which were visualised exclusively in scans obtained under weight-bearing conditions. We named this dynamic condition "occult stenosis". In all of these cases, disc disease was associated with facet pathology. CONCLUSION: Our data show that the association between disc pathology and facet osteoarthrosis can cause occult foraminal stenosis. Strategies to image the spine under physiological load conditions may improve the clinical diagnosis of radicular pain.