State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation

Aim The diagnosis, severity and extent of a sterile inflammation or a septic infection could be challenging since there is not one single test able to achieve an accurate diagnosis. The clinical use of 18F-fluorodeoxyglucose ([F-18]FDG) positron emission tomography/computed tomography (PET/CT) imaging in the assessment of inflammation and infection is increasing worldwide. The purpose of this paper is to achieve an Italian consensus document on [F-18]FDG PET/CT or PET/MRI in inflammatory and infectious diseases, such as osteomyelitis (OM), prosthetic joint infections (PJI), infective endocarditis (IE), prosthetic valve endocarditis (PVE), cardiac implantable electronic device infections (CIEDI), systemic and cardiac sarcoidosis (SS/CS), diabetic foot (DF), fungal infections (FI), tuberculosis (TBC), fever and inflammation of unknown origin (FUO/IUO), pediatric infections (PI), inflammatory bowel diseases (IBD), spine infections (SI), vascular graft infections (VGI), large vessel vasculitis (LVV), retroperitoneal fibrosis (RF) and COVID-19 infections. Methods In September 2020, the inflammatory and infectious diseases focus group (IIFG) of the Italian Association of Nuclear Medicine (AIMN) proposed to realize a procedural paper about the clinical applications of [F-18]FDG PET/CT or PET/MRI in inflammatory and infectious diseases. The project was carried out thanks to the collaboration of 13 Italian nuclear medicine centers, with a consolidate experience in this field. With the endorsement of AIMN, IIFG contacted each center, and the pediatric diseases focus group (PDFC). IIFG provided for each team involved, a draft with essential information regarding the execution of [F-18]FDG PET/CT or PET/MRI scan (i.e., indications, patient preparation, standard or specific acquisition modalities, interpretation criteria, reporting methods, pitfalls and artifacts), by limiting the literature research to the last 20 years. Moreover, some clinical cases were required from each center, to underline the teaching points. Time for the collection of each report was from October to December 2020. Results Overall, we summarized 291 scientific papers and guidelines published between 1998 and 2021. Papers were divided in several sub-topics and summarized in the following paragraphs: clinical indications, image interpretation criteria, future perspectivess and new trends (for each single disease), while patient preparation, image acquisition, possible pitfalls and reporting modalities were described afterwards. Moreover, a specific section was dedicated to pediatric and PET/MRI indications. A collection of images was described for each indication. Conclusions Currently, [F-18]FDG PET/CT in oncology is globally accepted and standardized in main diagnostic algorithms for neoplasms. In recent years, the ever-closer collaboration among different European associations has tried to overcome the absence of a standardization also in the field of inflammation and infections. The collaboration of several nuclear medicine centers with a long experience in this field, as well as among different AIMN focus groups represents a further attempt in this direction. We hope that this document will be the basis for a "common nuclear physicians' language" throughout all the country

Fatores maternos e neonatais associados à prematuridade

A prematuridade representa a causa mais freqüente de morbidade neonatal. O objetivo desse estudo foi realizar um levantamento dos nascimentos de recém-nascidos vivos com menos de 37 semanas completas de gestação e relacionar com as alterações patológicas encontradas. Foram coletados dados referentes à história clínica materna e do neonato. A média da idade gestacional dos 104 RNs estudados foi de 31 semanas ± 4 dias. A média de peso dos prematuros foi de 2350 gramas. Os grupos de doenças de base maternas encontradas foram: hipertensão materna 51 casos (49%), alterações útero-placentárias 21 casos (20,1%), doenças infecciosas 12 casos (11,5%), cardiopatias 9 casos (5,7 %), diabetes 2 casos (1,9%), Síndrome da Imunodeficiência Adquirida 1 caso (0,9%) ainda 8 casos (7,6%) em que não havia registro de doença de base. Entre os grupos de doenças de base fetais o mais freqüente foi o grupo de doenças do aparelho respiratório, com 81 casos (78%). Em nosso estudo, houve diferença estatisticamente significante entre idade gestacional e doença de base materna (p=0,038). A prematuridade continua sendo a principal causa de morbidade e mortalidade neonatal, representando um dos maiores desafios para o fornecimento de uma assistência profissional de qualidade

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

AGU hydrology days 2010

2010 annual AGU hydrology days was held at Colorado State University on March 22 - March 24, 2010.Includes bibliographical references.Estimation of quantiles of hydrological variables, i.e. values corresponding to fixed non-exceedence probabilities or return periods, is traditionally carried out by fitting a probability distribution function to an observed sample under the assumption of stationarity. Recent concerns about potential changes in present and future climate, however have led to challenge the hypothesis of stationary series. Despite several methods have been developed and applied to model non stationary series, very few studies have addressed the problem of how non stationarity affects the error of estimation of quantiles. In the paper, preliminary analyses regarding how the presence of trend in precipitation series affects the sampling properties of estimated quantiles are illustrated. To this end, sampling properties of precipitation quantiles, namely bias and Mean Squared Error (MSE) are investigated with respect to the size of the estimation sample, assuming a trend in the parameters of the underlying distribution. In particular, analytical results are derived for the cases of exponential distribution, while more complex cases (e.g. Gumbel distribution) are investigated numerically by simulation. Also the effect of preliminary trend removal is investigated and compared to the case when trend is neglected

Revitalization of the historic villages through new models of tourist territorial management. The horizontal structure of the Albergo diffuso

Dottorato di Ricerca in: Quality of design Ciclo IV,a.a.2007-2010Università della Calabri

Nutritional management of glycogen storage disease type III: a case report and a critical appraisal of the literature

: Glycogen storage disease Type III (GSD III) is an autosomal recessive disease due to the deficiency of the debranching enzyme, which has two main consequences: a reduced availability of glucose due to the incomplete degradation of glycogen, and the accumulation of abnormal glycogen in liver and cardiac/skeletal muscle. The role of dietary lipid manipulations in the nutritional management of GSD III is still debated. A literature overview shows that low-carbohydrate (CHO) / high-fat diets may be beneficial in reducing muscle damage. We present a 24-year GSD IIIa patient with severe myopathy and cardiomyopathy in whom a gradual shift from a high-CHO diet (61% total energy intake), low-fat (18%), high-protein (21%) to a low-CHO (32 %) high-fat (45%) / high-protein (23%) diet was performed. CHO was mainly represented by high-fiber, low glycemic index food, and fat consisted prevalently of mono and polyunsaturated fatty acids. After a 2-year follow-up, all biomarkers of muscle and heart damage markedly decreased (by 50-75%), glucose levels remained within the normal range and lipid profile was unchanged. At echocardiography, there was an improvement in geometry and left ventricular function. A low -CHO, high-fat, high-protein diet seems to be safe, sustainable and effective in reducing muscle damage without worsening cardiometabolic profile in GSDIIIa. This dietary approach could be started as early as possible in GSD III displaying skeletal/cardiac muscle disease in order to prevent/minimize organ damage

Landfill mining: A case study on characterization of excavated waste

Landfilling has represented the dominant method for municipal solid waste (MSW) disposal during the recent decades. Therefore, the recovery of materials from landfills through landfill mining is proclaimed as an innovative method to address these challenges. The excavation, processing, treatment and recycling of deposited materials is mainly referred to the economic aspects and to the reduction of the re-landfilled fraction of the waste. The main objective of this work is to describe a case study of sampling and characterization of excavated waste of a potential landfill mining site in Peccioli - Pisa (Legoli Landfill). Approximately at 10 m depth, the samples were collected from two layers of waste of different ages (2001 and 2007). Manual sieving and sorting into different waste fractions was performed. All the fractions were characterized in terms of total solids and total volatile solids and Biochemical Methane Potential test. Anaerobic tests were performed to evaluate methane production coming from landfilled waste, in particular referring to the residual biodegradable fraction contained in the municipal waste. Results show that the composition of the two excavated waste analyzed are quite different due to the waste management system used in that years. This factor affects methane production that resulted respectively 115 Nm 3 CH 4 /ton e 47 Nm 3 CH 4 /ton for 2001 and 2007

Nuclear medicine imaging of bone infections

The inflammation and infection of bone include a wide range of processes that can result in a reduction of function or in the complete inability of patients. Apart from the inflammation, infection is sustained by pyogenic microorganisms and results mostly in massive destruction of bones and joints. The treatment of osteomyelitis requires long and expensive medical therapies and, sometimes, surgical resection for debridement of necrotic bone or to consolidate or substitute the compromised bones and joints. Radiographs and bone cultures are the mainstays for the diagnosis but often are useless in the diagnosis of activity or relapse of infection in the lengthy management of these patients. Imaging with radiopharmaceuticals, computed tomography and magnetic resonance are also used to study secondary and chronic infections and their diffusion to soft or deep tissues. The diagnosis is quite easy in acute osteomyelitis of long bones when the structure of bone is still intact. But most cases of osteomyelitis are subacute or chronic at the onset or become chronic during their evolution because of the frequent resistance to antibiotics. In chronic osteomyelitis the structure of bones is altered by fractures, surgical interventions and as a result of bone reabsorption produced by the infection. Metallic implants and prostheses produce artefacts both in computed tomography and magnetic resonance images, and radionuclide studies should be essential in these cases. Vertebral osteomyelitis is a specific entity that can be correctly diagnosed by computed tomography or magnetic resonance imaging at the onset of symptoms but only with radionuclide imaging is it possible to assess the activity of the disease after surgical stabilization or medical therapy. The lack of comparative studies showing the accuracy of each radiopharmaceutical for the study of bone infection does not allow the best nuclear medicine techniques to be chosen in an evidence-based manner. To this end we performed a meta-analysis of peer reviewed articles published between 1984 and 2004 describing the use of nuclear medicine imaging for the study of the most frequent causes of bone infections, including prosthetic joint, peripheric post-traumatic bone infections, vertebral and sternal infections. Guidelines for the choice of the optimal radlopharmaceuticals to be used in each clinical condition and for different aims is provided