Publications by authors named "Aldo Carnevale"

38 Publications

Diffuse panbronchiolitis as parathymic syndrome in a Caucasian man previously treated for thymoma.

Radiol Case Rep 2021 Oct 9;16(10):3029-3033. Epub 2021 Aug 9.

Research Centre on Asthma and COPD, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.

Diffuse panbronchiolitis (DPB) is a rare disease characterized by bronchiolitis and chronic sinusitis. Being largely restricted to East Asia, its actual incidence in Caucasian patients is probably underestimated. DPB has been described in association with thymic neoplasms, mainly arising as a consequence of immune dysregulation. We present a rare case of DPB diagnosed in a 69-year-old Caucasian man who had undergone surgery for stage 2A thymoma a year before. The patient came to our hospital complaining of exertional dyspnea and productive cough, with a persistent lung consolidation described at chest X-rays. High resolution computed tomography (CT) showed diffuse centrilobular micronodules and solid nodules, tree-in-bud opacities, peripheral consolidations and cylindrical bronchiectasis. Sinus disease was also demonstrated by CT. Analysis of bronchoalveolar lavage showed marked granulocyte inflammation and allowed the isolation of Haemophilus Influenzae. Consequently, the diagnosis of DPB was reached by integrating clinical, and radiological data. Long-term therapy with azithromycin was prescribed, and was found to be effective in controlling symptoms and reducing radiological abnormalities at 6-month clinical and CT follow-up. Confidence with the radiological presentation and clinical significance of DPB is necessary, since the condition is responsive and reversible to long-term macrolide treatment, the effect of which is mainly attributed to an anti-inflammatory, and immunoregulatory action.
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http://dx.doi.org/10.1016/j.radcr.2021.07.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8361232PMC
October 2021

Combined approach for embolization of otherwise unmanageable gastric varices.

Ann Gastroenterol 2021 Jul-Aug;34(4):510-515. Epub 2021 Mar 23.

Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan (Anna Maria Ierardi, Gianpaolo Carrafiello).

Background: This study aimed to determine the feasibility, safety and effectiveness of combined percutaneous transhepatic obliteration (PTO) and balloon-occluded retrograde transvenous obliteration (BRTO) therapy for the treatment of patients with high-risk bleeding gastric varices.

Methods: Ten patients were retrospectively reviewed. All the patients presented gastric varices, according to the Sarin classification, at high risk of bleeding, and not otherwise manageable. Patients with portal vein thrombosis were excluded. All patients were treated with a combination of PTO and BRTO. In all cases the gastric varices were embolized with glue, combined with coils or not, with an occlusion balloon inflated into the shunt. In 7 cases, embolization was immediate; in the remaining 3 the balloon remained inflated for 4 h and in 2 of them embolization of the shunt was required. Technical success was defined as complete obliteration of the gastric varices observed during a contrast-enhanced computed tomography study and endoscopy within 1 month following treatment. Clinical success was defined as absence of bleeding of gastric varices during the follow-up period. Major and minor complications during the follow up were recorded.

Results: Twelve sessions of combined PTO and BRTO procedures were performed in 10 patients; in 2 patients a new combined treatment was required during the follow up. Technical and clinical success was 100%. Neither major nor minor procedure-related complications were observed.

Conclusion: Combined PTO and BRTO therapy is safe and effective for the treatment of gastric varices that cannot be managed otherwise.
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http://dx.doi.org/10.20524/aog.2021.0616DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276367PMC
March 2021

Gastrointestinal Hemorrhages in Patients With COVID-19 Managed With Transarterial Embolization.

Am J Gastroenterol 2021 04;116(4):838-840

1UOC Radiologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Itlay; 2Vascular and Oncological Interventional Radiology, Hopital Georges Pompidou, Paris, France; 3UO Radiologia, ASST Settelaghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; 4Radiology Department, University Radiology Unit, Sant'Anna University Hospital, Ferrara, Italy; 5Department of Experimental, Diagnostic and Speciality Medicine, UO Radiologia, Sant'Orsola Hospital, University of Bologna, Bologna, Italy; 6Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, CHU Henri Mondor, Créteil, France; 7Instituto de Investigaciones Sanitarias RyC, Research coordinator at Vascular and Interventional Service, Ramón y Cajal University Hospital, Madrid, Spain; 8CHU Djon, Dijon, France; 9Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.

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http://dx.doi.org/10.14309/ajg.0000000000000978DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553031PMC
April 2021

Diagnostic contribution of contrast-enhanced CT as compared to unenhanced low-dose CT in PET/CT staging and treatment response assessment of 18FDG-avid lymphomas: a prospective study.

J Nucl Med 2021 Mar 12. Epub 2021 Mar 12.

Section of Diagnostic Imaging, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy.

The aim of this study was to assess the added diagnostic value of contrast-enhanced CT (CECT) as compared to unenhanced CT (UECT) in PET/CT staging and treatment response assessment of FDG-avid lymphomas. 170 PET/UECT followed by CECT scans were prospectively performed for staging ( = 85) and for treatment response assessment ( = 85) of FDG-avid lymphomas, during a single session using an integrated 64-slice PET/CT scanner. CECT and UECT images were evaluated separately by two radiologists, whereas PET images by two nuclear physicians. Nodal and extranodal UECT and CECT findings were classified according to the Lugano criteria, and successively compared with PET/CT results, considered the gold standard. In the analysed groups, the agreement rate with the disease status determined via PET was calculated separately for UECT and CECT using Mc Nemar's test on paired data. The added value of the contrast medium was shown by the agreement between the PET and CECT results and the lack of agreement between UECT and PET. CECT enabled the identification of additional extranodal lesions (hepatic, muscular and gastric) in only 3 staging group cases (3.5%), indicating different stages as compared to UECT, whereas there was absolute agreement between CECT and UECT in terms of treatment response assessment. The added diagnostic value of CECT was lower than the established threshold for clinical relevance (15%). Mc Nemar's test indicated no statistical significance in either group. The incidental findings detected by CECT but not UECT were important for clinical management, but not sufficient to alter lymphoma treatment strategy. According to our results, it might be possible to exclude CECT examination of FDG-avid lymphoma from staging and treatment response assessment, with the consequent advantages of reducing radiation exposure and potential contrast-related risks.
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http://dx.doi.org/10.2967/jnumed.120.259242DOI Listing
March 2021

NEP-Score Thresholds Predict Survival of Patients With Bronchial Carcinoids.

Front Endocrinol (Lausanne) 2020 8;11:621557. Epub 2021 Feb 8.

Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.

Survival prognostic markers are extremely needed to better define therapeutic strategies in patients with bronchial carcinoids (BC). We aim to verify the applicability of the NEP-Score in a homogeneous BC cohort and identify a derivative prognostic marker, the NEP-Score at diagnosis (NEP-D) that does not consider new metastases during follow-up. Sixty-four patients (38 females, and 26 males, mean age at diagnosis 58.9 ± 1.7 years) with BC were retrospectively evaluated. NEP-Score was calculated at the end of follow-up (NEP-T). A derivative score, the NEP-Score at diagnosis (NEP-D) that does not consider new metastases during follow-up, was then assessed. Patients were subdivided according to their living status at the end of follow-up. A NEP-Score threshold was investigated to predict survival. Mean NEP-T and mean NEP-D were significantly lower in live patients at end of follow-up. A NEP-T cut-off >138 significantly predicts survival. Atypical BC relapsed more frequently than Typical BC. Male gender and previous malignancy were negative prognostic factors for survival. We confirmed NEP-Score applicability in BC and NEP-D utility, being the latter a simple, quick, and cheap prognostic score that can help clinicians in decision making. The identified NEP-D threshold can predict NEN aggressiveness and may be used to define the best personalized therapeutic strategy. In this context, a validation study is needed.
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http://dx.doi.org/10.3389/fendo.2020.621557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897663PMC
May 2021

The potential role of MR based radiomic biomarkers in the characterization of focal testicular lesions.

Sci Rep 2021 Feb 10;11(1):3456. Epub 2021 Feb 10.

Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Via L. Ariosto 34, 44121, Ferrara, Italy.

How to differentiate with MRI-based techniques testicular germ (TGCTs) and testicular non-germ cell tumors (TNGCTs) is still under debate and Radiomics may be the turning key. Our purpose is to investigate the performance of MRI-based Radiomics signatures for the preoperative prediction of testicular neoplasm histology. The aim is twofold: (i), differentiating TGCTs and TNGCTs status and (ii) differentiating seminomas (SGCTs) from non-seminomatous (NSGCTs). Forty-two patients with pathology-proven testicular neoplasms and referred for pre-treatment MRI, were retrospectively enrolled. Thirty-two out of 44 lesions were TGCTs. Twelve out of 44 were TNGCTs or other histologies. Two radiologists segmented the volume of interest on T2-weighted images. Approximately 500 imaging features were extracted. Least Absolute Shrinkage and Selection Operator (LASSO) was applied as method for variable selection. A linear model and a linear support vector machine (SVM) were trained with selected features to assess discrimination scores for the two endpoints. LASSO identified 3 features that were employed to build fivefold validated linear discriminant and linear SVM classifiers for the TGCT-TNGCT endpoint giving an overall accuracy of 89%. Four features were employed to build another SVM for the SGCT-SNGCT endpoint with an overall accuracy of 86%. The data obtained proved that T2-weighted-based Radiomics is a promising tool in the diagnostic workup of testicular neoplasms by discriminating germ cell from non-gem cell tumors, and seminomas from non-seminomas.
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http://dx.doi.org/10.1038/s41598-021-83023-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875983PMC
February 2021

Uterine Myomas: Extravascular Treatment.

Semin Ultrasound CT MR 2021 Feb 29;42(1):56-74. Epub 2020 Aug 29.

Radiology Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.

Uterine fibroids are common benign tumors that affect the female reproductive tract. They are responsible for considerable morbidity and deterioration of life quality. The main advantages offered by mini invasive techniques are low grade of invasiveness and short times of hospitalization. The most diffuse technique is uterine artery embolization (UAE). Common concerns with UAE include postprocedural pain, postembolization syndrome, and risk of infection. Image-guided thermal ablation techniques like radiofrequency ablation, percutaneous microwave ablation, and imaging-guided high-intensity focused ultrasound were introduced to overcome the side effects related to UAE and surgery. The aim of this review is to briefly analyze the ablative procedures and their role in the management of symptomatic fibroids, and to describe the safety profile and outcomes of these modalities.
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http://dx.doi.org/10.1053/j.sult.2020.08.004DOI Listing
February 2021

Functional Magnetic Resonance Imaging in the Olfactory Perception of the Same Stimuli.

Life (Basel) 2020 Dec 25;11(1). Epub 2020 Dec 25.

Radiology Unit, Department of Traslational Medicine, University Hospital of Ferrara, Via Aldo Moro, 8, 44124 Cona FE, Italy.

Background: Data in the literature report that a number of studies have attempted to identify the exact location of the cortical olfaction representation, searching for evidence suggesting that sniffing odors can initiate a primary activation of the piriform cortex and the insula. Nowadays, due to the SARS-CoV-2 (COVID-19) outbreak, the functional study of the olfactory system could offer a better understanding of the physiopathology of olfactory perception, elucidating better the possible site(s) of damage induced by the COVID-19 infection. The aim of this paper was to evaluate brain maps generated from functional Magnetic Resonance Imaging (fMRI) data, collected from healthy individuals in response to the same olfactory stimulus.

Methods: A total of 45 healthy volunteers, without history and/or no clinical signs of sinonasal disease and without history and/or presence of olfactory dysfunction underwent fMRI assessment. Subjects were presented with the same odorous stimuli at specific intervals. fMRI generated brain maps were used in the identification of different cortical areas, involved in the stimuli perception.

Results: The fMRI brain maps showed that odorous stimuli activate primarily the left anterior insula (in 35/45 cases or 77.8%). Other activated areas include: the low temporal gyri, the middle and superior temporal gyri, the frontal and piriform cortex, the anterior cingulate gyrus, the parahippocampal gyrus, the temporopolar area, the para-insular area, the subcentral area, the supramarginal gyrus, the occipital cortex and the cerebellum.

Conclusions: fMRI resulted as a safe and reliable means to study the perception of olfaction in the cortex. The data of this study suggest that the anterior insula is the main stimulated area when olfactory stimuli are present. This area is always activated, despite the hand and nostril dominance.
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http://dx.doi.org/10.3390/life11010011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823816PMC
December 2020

Basic embolization techniques: tips and tricks.

Acta Biomed 2020 07 13;91(8-S):71-80. Epub 2020 Jul 13.

Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan and Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.

Good knowledge of the various approaches of embolization of peripheral bleedings and different embolic materials available is of paramount importance for successful and safe embolization. We review and illustrate the main endovascular and percutaneous techniques used for embolization, along with the characteristics of the different embolic materials, and the potential complications.
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http://dx.doi.org/10.23750/abm.v91i8-S.9974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944672PMC
July 2020

Longitudinal change during follow-up of systemic sclerosis: correlation between high-resolution computed tomography and pulmonary function tests.

Clin Rheumatol 2021 Jan 3;40(1):213-219. Epub 2020 Sep 3.

Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Parma, Italy.

The objective of this study was to determine the correlation between functional and radiological longitudinal change in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD), and to test the OMERACT definition of clinically meaningful progression of pulmonary function tests (PFTs) for the prediction of ILD radiological evolution. We retrospectively retrieved high-resolution computed tomography (HRCT) studies and PFTs including DLco, both available at two time-points and performed within 6 months of each other, in SSc patients. A subset of patients was selected using a 12-24-month clinically oriented interval (n = 58). The extent of ILD at HRCT was scored according to a visual semi-quantitative method (SQCT). The correlation of absolute change (Δ) in the SQCT score with change in FVC and DLco was examined using Pearson's correlation coefficient. The concordance between the OMERACT criteria (≥ 10% FVC relative decline; or 5-10% FVC and ≥ 15% DLco relative decline) and SQCT categorical change (5% and 10%) was investigated. A total of 129 patients were enrolled. During 12-24-month follow-up, ΔSQCT was negatively correlated with ΔFVC (r = - 0.487, p = 0.0001) and ΔDLco (r = - 0.298, p = 0.023). Ten patients demonstrated CT progression ΔSQCT > 5%, among whom 5 with ΔSQCT > 10%. OMERACT criteria identified 25 patients with progressive SSc-ILD, of whom only 5 presented ΔSQCT > 5 and 3 presented ΔSQCT > 10%. In conclusion, change in radiological extent of SSc-ILD was correlated to functional decline in a limited time-frame. Repeated HRCT after 12-24 months may be useful for the longitudinal characterization of ILD evolution in patients with stable pulmonary function. Conversely, functional changes are suggestive of a concurrent radiological progression only after this interval. Key Points • In SSc patients, chest HRCT performed every 12-24 months can detect minimal but significant changes in ILD extent, even in subjects with stable pulmonary function. • PFT changes in 12-24 months are related to the radiological ILD progression. • OMERACT criteria might overlook patients with radiological progression. • Repeated chest HRCT may be useful for monitoring SSc-ILD when performed within 12 to 24 months from baseline in order to promptly detect progression and possibly impact on prognosis.
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http://dx.doi.org/10.1007/s10067-020-05375-yDOI Listing
January 2021

Outcomes following minimally invasive imagine-guided percutaneous ablation of adrenal glands.

Gland Surg 2020 Jun;9(3):859-866

Unità Operativa di Radiologia, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.

Whilst surgery represents the gold standard for the treatment of adrenal primary malignant tumors, metastatic involvement of the adrenal glands is generally approached conservatively; however, surgery for local control has been controversial, and several reports have described the utility of surgical removal in terms of prolonged survival in selected patients. Different techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), laser induced thermal therapy (LITT), cryoablation (CRA), and chemical ablation, are employed in percutaneous image-guided ablation for primary and metastatic malignancies of the adrenal glands, in case of patients with multiple comorbidities or who refuse surgery. Technical success, clinical success and safety were analysed and discussed in this systematic review. Tumor size was found a significant determinant for local disease control; histology of the primary malignancy and coexistence of tumor elsewhere were correlated with prognosis. These procedures resulted to be feasible and safe, with hypertensive crisis representing the most common complication. Although there is lack of evidence in the literature concerning outcomes compared with surgery, percutaneous ablation may represent a useful therapeutic option for controlling unresectable adrenal metastases, offering patients opportunities for improved survival.
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http://dx.doi.org/10.21037/gs.2020.03.32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347819PMC
June 2020

Pitfalls in the embolisation of a thyrocervical trunk bleeding: a case report.

Patient Saf Surg 2020 6;14:19. Epub 2020 May 6.

2Section of Diagnostic Imaging, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.

Introduction: An intrathoracic bleeding from the thyrocervical branch is not common in blunt trauma, but an interventional radiologist should be aware of the risks in order to prevent complications.

Case Presentation: A 30-year-old male presented with a right pneumo-haemothorax due to active bleeding revealed at contrast-enhanced CT, as a consequence of a fall occurred in the previous week. The patient was treated with endovascular embolisation in an angiographic room with coils placement, since the right thyrocervical artery was found to be supplying the pneumo-haemothorax. A radiculo-medullary branch rose from the thyrocervical trunk, impeding the proximal embolization with microparticles and needing selective isolation of the bleeding artery with the catheter to avoid spinal cord injuries. The treatment had a successful result and the following CT control showed signs of recovering, without any complication.

Conclusion: Our paper presents a rare contingency, warning the operator to bear in mind the presence of arteries feeding the spinal cord. This crucial detail precludes the use of microparticles embolisation to prevent neurologic sequelae, whereas the use of endovascular coils for embolization should be mandatory. Moreover, this case reminds that the post-traumatic bleeding deriving from a cervical trauma may also occur later.
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http://dx.doi.org/10.1186/s13037-020-00244-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201948PMC
May 2020

Rolling in the Deep: Imaging Findings and Diagnostic Pearls in Gallstone Ileus.

Surg Res Pract 2020 24;2020:1421753. Epub 2020 Apr 24.

Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy.

Gallstone ileus is a dramatic complication of gallstone disease, uncommon but not exceptional in a busy emergency department. It represents a cause of mechanical intestinal obstruction, which predominantly occurs in elderly and frail patients; this contributes to the high morbidity and mortality rates associated with this condition. The modern radiologist is frequently asked to determine the cause of bowel obstruction and should be aware of the most pictorial features of this unusual disease. Broadly speaking, abdominal radiography and ultrasonography alone are limited in detecting the cause of bowel obstruction, but the sensitivity for the preoperative diagnosis of gallstone ileus may be improved by combining the findings obtained by both techniques. Computed tomography is the modality of choice for the diagnosis of this disease: it may accurately describe the number, size, and location of migrated gallstones and the exact site of bowel obstruction, providing a detailed preoperative planning. Magnetic resonance imaging may be used in selected cases for an exquisite anatomic definition of the fistulous communication.
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http://dx.doi.org/10.1155/2020/1421753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196161PMC
April 2020

Current concepts in ablative procedures for primary benign liver lesions: a step forward to minimize the invasiveness of treatment when deemed necessary.

Med Oncol 2020 Mar 19;37(4):31. Epub 2020 Mar 19.

Department of Morphology, Surgery and Experimental Medicine, Radiology Section, University of Ferrara, Via L. Ariosto 35, Ferrara, 44121, Italy.

With increased use of medical imaging, the incidental detection of benign solid liver tumors has become more frequent. Facing with benign disease, the indications for surgery are still object of discussion in light of the stable natural course of most lesions and obvious drawbacks of any surgical intervention; therefore, in most situations, a conservative approach is recommended, and surgery is mainly reserved for those cases with persistent or worsening symptoms, or who are at risk for complications as malignant transformation. The advent of ablative techniques has widened the range of treatment options available to these patients, presenting as a valid alternative to resection in terms of safety and efficacy in selected cases, particularly in patients who are considered poor surgical candidates and with smaller lesions. This review outlines the role of percutaneous ablative methods for benign solid liver tumors that are encountered in adults, providing a per histology analysis of the existing evidence. The up-to-date strategies for management of the most common benign solid tumors are recapitulated.
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http://dx.doi.org/10.1007/s12032-020-01355-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102179PMC
March 2020

Percutaneous microwave ablation therapy of renal cancer local relapse after radical nephrectomy: a feasibility and efficacy study.

Med Oncol 2020 Mar 13;37(4):27. Epub 2020 Mar 13.

Unità Operativa Di Radiologia, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.

Renal cell carcinoma (RCC) local recurrence after radical nephrectomy is uncommon. When feasible, surgical removal remains the primary treatment strategy; nevertheless, local RCC relapse management is controversial, and less invasive procedures may represent an attractive option to achieve oncologic control. The aim of our study was to assess the feasibility, safety, and clinical outcomes of image-guided percutaneous microwave ablation (MWA) for RCC local recurrence in patients initially treated with nephrectomy with curative intent. 10 consecutive patients underwent CT-guided percutaneous MWA of a total of 10 retroperitoneal nodules. Inclusion criteria were: histologically verified retroperitoneal metastases, previous radical nephrectomy, lesion no larger than 3 cm, no other metastatic site elsewhere. All the procedures were performed under moderate sedation choosing the most favorable patient decubitus. If deemed necessary, pneumodissection was induced before ablation. After the antenna placement inside the target lesion, thermal ablation was achieved by maintenance of a power of 100 W for a total time between 2 and 4 min. All patients were observed overnight and discharged the following day if clinically stable. Technical success was obtained in 100% of patients. One patient was re-treated to complete oncologic response with repeat MWA. No major complications were observed. No patients demonstrated local recurrence at a mean follow-up of 26 months. MWA is a safe and effective treatment strategy for loco-regional relapse of RCC following radical nephrectomy. This technique may represent a valuable approach for patients who are not eligible for surgery.
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http://dx.doi.org/10.1007/s12032-020-01354-0DOI Listing
March 2020

Coronary computed tomography angiography using model-based iterative reconstruction algorithms in the detection of significant coronary stenosis: how the plaque type influences the diagnostic performance.

Pol J Radiol 2019 9;84:e522-e529. Epub 2019 Dec 9.

University of Ferrara, Italy.

Purpose: To evaluate the ability of coronary computed tomography angiography (CCTA) with model-based iterative reconstruction (MBIR) algorithm in detecting significant coronary artery stenosis compared with invasive coronary angiography (ICA).

Material And Methods: We retrospectively identified 55 patients who underwent CCTA using the MBIR algorithm with evidence of at least one significant stenosis (≥ 50%) and an ICA within three months. Patients were stratified based on calcium score; stenoses were classified by type and by coronary segment involved. Dose-length-product was compared with the literature data obtained with previous reconstruction algorithms. Coronary artery stenosis was estimated on ICAs based on a qualitative method.

Results: CCTA data were confirmed by ICA in 89% of subjects, and in 73% and 94% of patients with CS < 400 and ≥ 400, respectively. ICA confirmed 81% of calcific stenoses, 91% of mixed, and 67% of soft plaques. Both the dose exposure of patients with prospective acquisition (34) and the exposure of the whole population were significantly lower than the standard of reference ( < 0.001 and = 0.007).

Conclusions: CCTA with MBIR is valuable in detecting significant coronary artery stenosis with a solid reduction of radiation dose. Diagnostic performance was influenced by plaque composition, being lower compared with ICA for patients with lower CAC score and soft plaques; the visualisation of an intraluminal hypodensity could cause false positives, particularly in D1 and MO segments.
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http://dx.doi.org/10.5114/pjr.2019.91259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7016499PMC
December 2019

Factors influencing outcomes of rheolytic thrombectomy on thrombosed dialysis access grafts: Door to angiographic bed time and what else?

J Vasc Access 2020 Sep 21;21(5):738-745. Epub 2020 Feb 21.

Unità Operativa di Radiologia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.

Background: The aim of this study was to investigate the effect of the time interval from clinical presentation of arteriovenous graft thrombosis and the thrombectomy procedure by the AngioJet system in terms of technical and clinical success and to identify factors influencing success.

Methods: A total of 60 consecutive patients (35 men and 25 women; mean age = 52 ± 7.89 years) who had undergone percutaneous thrombectomy by the AngioJet device from 2016 to 2019 were retrospectively enrolled. Demographics and fistula data, previous treatments, time from clinical onset of thrombosis to intervention, procedural details and complications were recorded. Technical and clinical success and primary and secondary patency rates were calculated. One-way analysis of variance was performed to test any correlation between patient-related and fistula/procedure-related variables and technical/clinical success. Odds ratio and relative risk were also calculated when necessary.

Results: Technical success and clinical success were 95% and 91.7%, respectively. Post-interventional primary and secondary patency rates at 1 year were 72.5% and 84.3%, respectively. Complication rate was 6.7%. One-way analysis of variance showed that clinical success was higher in patients with no previous treatment (p = 0.015). Furthermore, clinical success was significantly associated with door to angiographic bed time (p = 0.002): p-value for the 24-h and the 72-h cut-off was 0.012 and 0.006, respectively.

Conclusion: Percutaneous rheolytic thrombectomy is safe and effective for thrombosed arteriovenous grafts, with acceptable primary and secondary patency rates. Higher clinical success was found in patients never treated before and when the procedure was carried out within 24 h from the clinical onset of thrombosis.
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http://dx.doi.org/10.1177/1129729820904911DOI Listing
September 2020

Percutaneous cervical discectomy: retrospective comparison of two different techniques.

Radiol Med 2020 Jun 10;125(6):569-577. Epub 2020 Feb 10.

Unità Operativa di Radiologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.

Aim: To compare clinical success and patient satisfaction of percutaneous cervical nucleoplasty (PCN) and percutaneous cervical discectomy (PCD) in contained cervical disc herniation treatment.

Materials And Methods: We retrospectively identified 50 consecutive patients in our institution: 24 underwent the PCD treatment and 26 patients were treated by the PCN procedure. All patients complained of radicular pain with or without neck pain; diagnosis of contained cervical disc herniation was obtained by MRI; all patients had received conservative therapy which did not result in symptom improvement. Exclusion from our series consisted of patients who had undergone previous surgery at the indicated level, or those with myelopathy, or those in whom more than a sole herniation was treated in the same session. Overall procedure time, fluoroscopy time, radiation dose and complications were recorded. The MacNab scale score was used to assess clinical success in terms of pain relief at 2- and 6-month follow-up. After 4-6 months, a cervical MRI was obtained in 24 patients.

Results: Neither major nor minor complications were reported. Regarding patient satisfaction, overall median modified MacNab score was excellent both at 2 and 6 months after treatment. No significant statistical difference was found in mean modified MacNab score at 2 and 6 months among patients grouped by treatment choice (p = 0.319 and 0.847, respectively); radiation dose was inferior in PCN group than in PCD, with no significant statistical difference.

Conclusion: PCD and PCN were found to be safe and effective in terms of pain relief in contained cervical herniation treatment.
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http://dx.doi.org/10.1007/s11547-020-01133-xDOI Listing
June 2020

Neck paraganglioma and follicular lymphoma: a case report.

J Med Case Rep 2019 Dec 20;13(1):376. Epub 2019 Dec 20.

University Radiology Unit, Radiology Department, Sant'Anna University Hospital, Ferrara, Italy.

Background: Paragangliomas and pheochromocytomas are sympathetic or parasympathetic tumors derived from the paraganglia and the adrenal medulla, respectively. Paragangliomas and pheochromocytomas can be sporadic or familial, the latter frequently being multifocal and possibly due to succinate dehydrogenase complex genes mutations. In addition, 12% of sporadic paragangliomas are related to covered succinate dehydrogenase complex mutations. The importance of identifying succinate dehydrogenase complex mutations is related to the risk for these patients of developing multiple tumors, including non-endocrine ones, showing an aggressive clinical presentation.

Case Presentation: We report the case of a 45-year-old Caucasian man with an indolent mass in his neck. Ultrasound of his neck, magnetic resonance imaging, and 1,4,7,10-tetraazacyclododecane-N(I),N(II),N(III),N(IIII)-tetraacetic acid(D)-Phe(1)-thy(3)-octreotide (Ga-DOTATOC) positron emission tomography-computed tomography and endocrine work-up were consistent with a carotid body paraganglioma with concomitant nodal enlargement in several body regions, which turned out to be a follicular lymphoma at histology. He was found to carry a germline Succinate dehydrogenase subunit B gene (SDHB) mutation.

Conclusion: It is crucial to look for a second malignancy in the case of a paraganglioma demonstrating succinate dehydrogenase complex germline mutations.
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http://dx.doi.org/10.1186/s13256-019-2323-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6924013PMC
December 2019

The Role of the Multidisciplinary Evaluation of Interstitial Lung Diseases: Systematic Literature Review of the Current Evidence and Future Perspectives.

Front Med (Lausanne) 2019 31;6:246. Epub 2019 Oct 31.

Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna di Ferrara, Cona, Italy.

The opportunity of a multidisciplinary evaluation for the diagnosis of interstitial pneumonias highlighted a major change in the diagnostic approach to diffuse lung disease. The new American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Society guidelines for the diagnosis of idiopathic pulmonary fibrosis have reinforced this assumption and have underlined that the exclusion of connective tissue disease related lung involvement is mandatory, with obvious clinical and therapeutic impact. The multidisciplinary team discussion consists in a moment of interaction among the radiologist, pathologist and pulmonologist, also including the rheumatologist when considered necessary, to improve diagnostic agreement and optimize the definition of those cases in which pulmonary involvement may represent the first or prominent manifestation of an autoimmune systemic disease. Moreover, the proposal of classification criteria for interstitial lung disease with autoimmune features (IPAF) represents an effort to define lung involvement in clinically undefined autoimmune conditions. The complexity of autoimmune diseases, and in particular the lack of classification criteria defined for pathologies such as anti-synthetase syndrome, makes the involvement of the rheumatologist essential for the correct interpretation of the autoimmune element and for the application of classification criteria, that could replace clinical pictures initially interpreted as IPAF in defined autoimmune disease, minimizing the risk of misdiagnosis. The aim of this review was to evaluate the available evidence about the efficiency and efficacy of different multidisciplinary team approaches, in order to standardize the professional figures and the core set procedures that should be necessary for a correct approach in diagnosing patients with interstitial lung disease.
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http://dx.doi.org/10.3389/fmed.2019.00246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842981PMC
October 2019

Dual-energy X-ray absorptiometry pitfalls in Thalassemia Major.

Endocrine 2019 09 12;65(3):469-482. Epub 2019 Jul 12.

Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy.

Background: Low mineral mass and reduced bone strength with increased fracture risk are the main causes of morbidity in Thalassemia Major (TM). The pathogenesis is multifactorial and includes ineffective erythropoiesis with medullary expansion, multiple endocrine dysfunctions, direct iron bone deposition, deferoxamine-induced bone dysplasia, and reduced physical activity associated with disease complications. Dual-energy X-ray absorptiometry (DXA) is the "gold standard" for bone mineral density (BMD) assessment and for bone strength and quality evaluation. This method identifies patients at greater risk of fragility fractures, guiding treatment and monitoring response to therapy. In TM, DXA shows limitations concerning BMD calculation accuracy and fracture risk prediction. One of the main challenges in the assessment of bone health in patients with TM is the accurate interpretation of densitometric results.

Purpose: This review investigates the major pitfalls in DXA implementation and interpretation in TM.

Methods: Available literature has been assessed.

Conclusions: DXA shows limitations in assessing bone mineral "status" in TM, especially in the paediatric population, due to the peculiar characteristics of bone architecture and deformities associated with the disease. A radiological technique adjustment in this population is mandatory.
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http://dx.doi.org/10.1007/s12020-019-02003-xDOI Listing
September 2019

Correction: Uccelli, L., et al. Therapeutic Radiometals: Worldwide Scientific Literature Trend Analysis (2008⁻2018). 2019, , 640.

Molecules 2019 Apr 3;24(7). Epub 2019 Apr 3.

Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Ludovico Ariosto, 35-44121 Ferrara, Italy.

The authors wish to make the following corrections to their paper [...].
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http://dx.doi.org/10.3390/molecules24071308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479921PMC
April 2019

Therapeutic Radiometals: Worldwide Scientific Literature Trend Analysis (2008⁻2018).

Molecules 2019 Feb 12;24(3). Epub 2019 Feb 12.

Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Ludovico Ariosto, 35-44121 Ferrara, Italy.

Academic journals have published a large number of papers in the therapeutic nuclear medicine (NM) research field in the last 10 years. Despite this, a literature analysis has never before been made to point out the research interest in therapeutic radionuclides (RNs). For this reason, the present study aims specifically to analyze the research output on therapeutic radiometals from 2008 to 2018, with intent to quantify and identify global trends in scientific literature and emphasize the interdisciplinary nature of this research field. The data search targeted conventional (I, Y, Lu, Re, Re, Sm, Sr, Er) and emergent (Cu, Sc, Ra, Ho, Tb, Tb, Pb/Bi, Ac, Bi, At, Sn) RNs. Starting from this time frame, authors have analyzed and interpreted this scientific trend quantitatively first, and qualitatively after.
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http://dx.doi.org/10.3390/molecules24030640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385165PMC
February 2019

Anomalous Fusion of Right Pulmonary Artery to Aortic Arch: Case Report of a Rare and Fatal Congenital Malformation in a Newborn and a Literature Review.

Am J Case Rep 2018 Nov 28;19:1416-1421. Epub 2018 Nov 28.

Department of Medical, Oral and Biotechnological Sciences, University 'G. d'Annunzio' of Chieti-Pescara, Chieti, Italy.

BACKGROUND We present a report of a rare cardiac malformation case as well as a review of the literature. In addition, the diagnostic features are discussed. CASE REPORT The case of a female newborn who died on her third day of life was studied at the Institute of Legal Medicine, University of Chieti-Pescara (Italy). The investigations around her death revealed a cardiac congenital malformation, seen as a rare variant of a common arterial trunk, in which the aorta was fused with the right branch of the pulmonary artery. The ascending aorta showed hypoplasia, while the coronary arteries were free of any pathological findings. The atrial septum showed a closed foramen ovale and the ventricular septum did not show any defect. Only an isolated right ventricular hypertrophy and dilation with no other cardiac abnormalities was found. The cause of death was acute respiratory failure on the third day of extrauterine life when the ductus Botalli closed. The karyotype analysis performed in this case was normal, and the fluorescent in situ hybridization analysis did not show the 22q11.2 microdeletion suggestive of the DiGeorge syndrome. CONCLUSIONS These findings underline the value of 3-dimensional/4-dimensional ultrasound imaging when added to a fetal cardiology screening program, and the need for improvements in postnatal screening routines by using pulse oximetry in order to discover isolated vascular defects before circulatory collapse occurs, as well as to reduce the medico-legal disputes in cases of missed diagnosis. We found the relevant literature search lacked a description of this congenital malformation, which supports our deeper perinatal investigation.
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http://dx.doi.org/10.12659/AJCR.909749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280717PMC
November 2018

An unusual presentation of anomalous left coronary artery from the pulmonary artery (ALCAPA) syndrome in a 70-year-old man: a case report.

J Med Case Rep 2018 Oct 22;12(1):308. Epub 2018 Oct 22.

Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy.

Background: We present a rare case of anomalous origin of the left coronary artery from the pulmonary artery syndrome in an elderly man, and we describe coronary computed tomographic angiographic imaging findings to improve diagnostic confidence for the evaluation of this uncommon coronary artery anomaly.

Case Presentation: A 70-year-old Caucasian man came to our hospital with slight limitation of physical activity (New York Heart Association class II). He was asymptomatic for angina, syncope, and palpitations. Cardiac magnetic resonance imaging was performed after echocardiography because a hypertrophic cardiomyopathy was suspected; a plausible coronary artery anomaly was demonstrated as collateral evidence. Subsequently, coronary computed tomographic angiography showed the anomalous origin of left coronary artery from the pulmonary artery; the coronary vessels appeared markedly dilated and tortuous. Dilated intercoronary vessels along the epicardial surface of the heart and dilated bronchial arteries, corresponding to collateral pathways, were observed. Left ventricular hypertrophy, delayed subendocardial enhancement, and mitral insufficiency were better evaluated on magnetic resonance images. Invasive coronary angiography confirmed the main findings. Given the patient's age and clinical performance, surveillance with medical management was considered appropriate, and surgical repair was avoided.

Conclusions: Confidence with the anatomic pattern and clinical significance of this anomalous condition is necessary to improve cardiac imaging evaluation ability. In our patient, coronary computed tomographic angiography proved to be a reliable imaging approach, superior to invasive coronary angiography in terms of diagnostic performance and patient safety.
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http://dx.doi.org/10.1186/s13256-018-1851-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196447PMC
October 2018

An Autopsy Case of Misdiagnosed Wernicke's Syndrome after Intragastric Balloon Therapy.

Case Rep Gastrointest Med 2018 13;2018:1510850. Epub 2018 Feb 13.

Department of Medicine and Aging Sciences, Università degli Studi "G. d'Annunzio", Via Dei Vestini, 66100 Chieti, Italy.

Intragastric balloon (IGB) therapy is a widely used technique to counter obesity, and it is known to be safe and effective. Although there can be a high rate of side effects following IGB therapy, most are self-healing and they are mainly accommodative in nature. Few cases of Wernicke's syndrome under IGB therapy have been described in the literature, and to the best of our knowledge, none have been fatal. We present here a case of a 51-year-old woman who underwent IGB therapy over 8 months. Late diagnosed Wernicke's syndrome that first appeared as lower limb neuropathy progressively immobilized the patient, until she required bed rest. Finally, a major complication of pneumonia caused her death. Wernicke's syndrome has been mainly related to bariatric surgery techniques, but it must also be linked to IGB therapy (and also to other restrictive weight-loss interventions). As the use of IGB therapy spreads, the literature must alert physicians to this complication. Wernicke's syndrome is a severe but reversible condition when diagnosed and treated early.
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http://dx.doi.org/10.1155/2018/1510850DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831924PMC
February 2018

Primary septic arthritis of the manubriosternal joint in an immunocompetent young patient: A case report.

Radiol Case Rep 2017 Dec 11;12(4):682-685. Epub 2017 Sep 11.

Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy.

The aim of this article was to illustrate a case of primary septic arthritis of the manubriosternal joint, due to infection, in an immunocompetent 28-year-old male patient. The manubriosternal joint can be rarely involved in inflammatory processes, but pyarthrosis is even more unusual in an otherwise healthy adult. Although rare, pyarthrosis could be associated with significant morbidity and mortality, first of all because of spreading to mediastinal structures. Diagnosis is generally made thanks to imaging findings after clinical suspicion in a patient with anterior chest pain and swelling, fever, and raised inflammatory markers, especially when any risk factors are known. Management is generally aggressive because intravenous antibiotics and surgical debridement are necessary.
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http://dx.doi.org/10.1016/j.radcr.2017.08.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823320PMC
December 2017

Imaging of the scrotum: beyond sonography.

Insights Imaging 2018 Apr 15;9(2):137-148. Epub 2018 Feb 15.

Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy.

The aim of this article is to describe the role of second-level imaging techniques after an initial ultrasonography evaluation in the assessment of scrotal diseases. While ultrasonography remains central as the primary imaging modality for the evaluation of pathologic conditions of the scrotum, the role of magnetic resonance imaging continues to evolve: it can actually be valuable as a problem-solving tool when sonographic findings are equivocal or inconclusive. Magnetic resonance imaging of the scrotum may provide accurate detection and characterization of scrotal diseases, well depicting the precise location of scrotal masses (intratesticular or extratesticular) and reliably characterizing benign conditions simulating neoplastic processes, thus preventing unnecessary radical surgery. Advanced magnetic resonance techniques, most of all diffusion weighted imaging and magnetic resonance spectroscopy, play in the meanwhile a more significant role in evaluating scrotal diseases.

Teaching Points: • Multiparametric ultrasonography usually represents the initial imaging modality for approaching scrotal diseases. • MRI is well established as a problem-solving tool for inconclusive sonographic findings. • Advanced MRI techniques can be successfully applied in scrotal pathology assessment. • MRI is valuable in differentiating benign conditions from neoplastic processes. • CT plays a role in trauma assessment and cancer staging alongside PET/CT.
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http://dx.doi.org/10.1007/s13244-017-0592-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5893488PMC
April 2018

A particular case of accidental asphyxiation.

Med Sci Law 2018 Jan 28;58(1):55-57. Epub 2017 Dec 28.

2 Department of Biomedicine and Prevention, 60259 Section of Forensic Medicine, Social Security and Forensic Toxicology, Tor Vergata University of Rome, Italy.

The case reported involved a 60-year-old man with psychiatric illness who was found dead at his home. He was almost naked and showed signs of death by violent asphyxiation, which led to the suspicion of homicide. Autopsy findings showed foreign material in the trachea and larynx. However, the partially digested content in his stomach, the study of the gastric content and the microscopic analysis of the airways made it possible to define this as accidental death due to inhalation of material from a diaper. Toxicological analysis detected the presence of phenytoin, valproic acid, and phenobarbital in his blood, with values within the therapeutic ranges. This is certainly a peculiar case, as particularly evident after careful review of the literature on deaths by asphyxiation in psychiatric patients. Furthermore, this study highlights the importance of a full autopsy and microscopic evaluation of any foreign bodies.
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http://dx.doi.org/10.1177/0025802417747430DOI Listing
January 2018

Sudden death due to catecholaminergic polymorphic ventricular tachycardia following negative stress-test outcome: genetics and clinical implications.

Forensic Sci Med Pathol 2017 Jun 13;13(2):217-225. Epub 2017 Apr 13.

Institute of Public Health, Legal Medicine Section, Catholic University, School of Medicine, Largo Francesco Vito 1, 00168, Rome, Italy.

This paper discusses the case of a young boy who died suddenly during a football match. The victim's personal and family medical histories were negative for cardiac events. He had undergone a cardiological investigation some months before his death, enabling him to participate in competitive sports. Only post-mortem molecular analysis allowed for a clearer determination of the most plausible cause of death, which was identified as inherited arrhythmogenic heart disease, known as catecholaminergic polymorphic ventricular tachycardia. It was possible to detect a novel, previously undescribed, variant in the RYR2 gene. This case report highlights the importance of a meaningful forensic multidisciplinary investigation in such cases, and also discusses possible medical malpractice claims.
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http://dx.doi.org/10.1007/s12024-017-9862-9DOI Listing
June 2017
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