The patient’s pathway for breast cancer in the COVID‐19 era: An Italian single‐center experience

COVID‐19 has been declared a pandemic by the World Health Organization. As of April 1, 2020, Italy was the country with the second highest number of cases in the world. The spread of COVID‐19 has required a rapid reorganization of health service delivery in face of the pandemic. Breast cancer units have reprioritized their workload to guarantee the health of oncologic patients at the highest risk and regular screening activities. However, at the end of the pandemic emergency, many benign and reconstructive cases will return to our attention and their surgical treatment will be necessary as soon as possible.     

The potential of paper-based diagnostics to meet the ASSURED criteria

Paper-based diagnostics have already revolutionized point-of-care approaches for health and environmental applications, by providing low-cost, disposable tools that can be utilized in remote settings. These devices typically consist of microfluidic, chemical, and biological diagnostic components implemented on paper substrates, towards addressing the ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and Robust, Equipment free and Deliverable to end users) principles set out by the World Health Organization. Paper-based diagnostics primarily contribute to the affordable, equipment-free, and deliverable-to-end-user aspects. However, additional functionality must be integrated with paper-based diagnostic devices to achieve truly ASSURED solutions. Advances in printed electronics provide a fitting foundation for implementing augmented functionality, while maintaining the affordability and disposability of paper-based diagnostics. This paper reviews the printed functional building blocks that contribute towards achieving this goal, from individual printed electronic components to fully integrated solutions. Important modules for sensing, read-out of results, data processing and communication, and on-board power are explored, and solutions printed on flexible or paper-based substrates for integration with paper-based diagnostics are considered. Although many of the unit operations required to achieve the ASSURED criteria can be implemented using paper, basic system functionality is still lacking, and this requires a concerted effort in integration of the various components for truly ASSURED solutions to be realized. Beyond ASSURED, modern clinical practises and crisis readiness also require additional informational functionality, which a systems approach using paper-based solutions could ensure.

A review of printed functionalities towards integrated paper-based diagnostics that fully meet the ASSURED principles.     

The “zebra spleen”

Abdominal Radiology -     

The “spoke wheel” sign in hepatic focal nodular hyperplasia

Abdominal Radiology -     

Accuracy of a predictive model for severe hepatic fibrosis or cirrhosis in chronic hepatitis C

AIM: To assess the accuracy of a model in diagnosing severe fibrosis/cirrhosis in chronic hepatitis C virus (HCV) infection. METHODS: The model, based on the sequential combination of the Bonacini score (BS: ALT/AST ratio, platelet count and INR) and ultrasonography liver surface characteristics, was applied to 176 patients with chronic HCV infection. Assuming a pre-test probability of 35%, the model defined four levels of post-test probability of severe fibrosis/cirrhosis: <10% (low), 10-74% (not diagnostic), 75-90% (high) and >90% (almost absolute). The predicted probabilities were compared with the observed patients' distribution according to the histology (METAVIR). RESULTS: Severe fibrosis/cirrhosis was found in 67 patients (38%). The model discriminated patients in three comparable groups: 34% with a very high (>90%) or low (<10%) probability of severe fibrosis, 33% with a probability ranging from 75% to 90%, and 33% with an uncertain diagnosis (i.e., a probability ranging from 10% to 74%). The observed frequency of severe fibrosis/ cirrhosis was within the predefined ranges. CONCLUSION: The model can correctly identify 67% of patients with a high (>75%) or low (<10%) probability of cirrhosis, leaving only 33% of the patients still requiring liver biopsy.     

Transferrin receptor 1 (TfR1) and putative stimulator of Fe transport (SFT) expression in iron deficiency and overload: an overview

Transferrin Receptor 1 (TfR1) and putative Stimulator of Fe Transport (SFT) represent two different proteins involved in iron metabolism in mammalian cells. The expression of TfR1 in the duodenum of subjects with normal body iron stores has been mainly localized in the basolateral portion of the cytoplasm of crypt cells, supporting the idea that this molecule may be involved in the sensing of body iron stores. In iron deficiency anemia TfR1 expression demonstrated an inverse relationship with body iron stores as assessed by immunohistochemistry with anti-TfR1 antibodies. In iron overload, TfR1 expression in the duodenum differed according to the presence or absence of the C282Y mutation in the HFE gene, being increased in HFE-related hemochromatosis and similar to controls in non-HFE-related iron overload. SFT is characterized by its ability to increase iron transport both through the transferrin dependent and independent uptake, and could thus affect iron absorption in the intestine. Immunohistochemistry using anti-SFT antibodies which recognize a putative stimulator of Fe transport of approximately 80 KDa revealed a localization of this protein in the apical part of the cytoplasm of enterocytes localized at the tip of the villi. The expression of the protein recognized by these antibodies was increased in iron deficiency, as well as in patients carrying the C282Y HFE mutation. Thus, the increased expression of both proteins only in patients with HFE-related hemochromatosis suggests that other factors should be involved in determining non-HFE-related iron overload.