Prediction Models for Cardiac Risk Classification with Nuclear Cardiology Techniques

Regression modeling strategies are increasingly used for the management of subjects with cardiovascular diseases as well as for decision-making of subjects without known disease but who are at risk of disease in the short- or long-term or during life span. Accurate individual risk assessment, taking in account clinical, laboratory, and imaging data is useful for choosing among prevention strategies and/or treatments. The value of nuclear cardiology techniques for risk stratification has been well documented. Many models have been proposed and are available for diagnostic and prognostic purposes and several statistical techniques are available for risk stratification. However, current approaches for prognostic modeling are not perfect and present limitations. This review analyzes some specific aspects related to prediction model development and validation

Cardiac innervation electrifies!

N

Modelling the length of hospital stay in medicine and surgical departments

Healthcare Associated Infections are among the world's leading public health problems and the most serious complications for hospitalized patients that can impact length of stay (LOS). In this work, medical record data of 24365 patients admitted to general surgery and clinical medicine wards were used collectively with the aim of creating models capable of predicting overall LOS, measured in days, considering clinical information. Multiple linear regression analysis was performed with IBM SPSS, the coefficient of determination (R2) was equal to 0,288. A regression analysis with ML algorithms was performed with the Knime Analysis Platform. The R2 were quite low for both multiple linear regression and ML regression analyses. The use of these techniques showed that there is a relationship between clinical variables and overall LOS. The results constitute a valid support tool for decision makers to provide the turnover index for the benefit of health policy in the management of departments

Intruding implements: a pictorial review of retained surgical foreign objects in neuroradiology

Intra-cranial and spinal foreign body reactions represent potential complications of medical procedures. Their diagnosis may be challenging as they frequently show an insidious clinical presentation and can mimic other life-threatening conditions. Their pathophysiological mechanism is represented by a local inflammatory response due to retained or migrated surgical elements. Cranial interventions may be responsible for the presence of retained foreign objects represented by surgical materials (such as sponges, bone wax, and Teflon). Spinal diagnostic and therapeutic procedures, including myelography, chordotomy, vertebroplasty, and device implantation, are another potential source of foreign bodies. These reactions can also follow material migration or embolization, for example in the case of Lipiodol, Teflon, and cement vertebroplasty. Imaging exams, especially CT and MRI, have a central role in the differential diagnosis of these conditions together with patient history. Neuroradiological findings are dependent on the type of material that has been left in or migrated from the surgical area. Knowledge of these entities is relevant for clinical practice as the correct identification of foreign bodies and related inflammatory reactions, material embolisms, or migrations can be difficult. This pictorial review reports neuroradiological semeiotics and differential diagnosis of foreign body-related imaging abnormalities in the brain and spine

Exercise-rest Tc-99m tetrofosmin SPECT in patients with chronic ischemic left ventricular dysfunction: Direct comparison with Tl-201 reinjection

Background. This study was designed to compare the results of exercise-rest technetium-99m tetrofosmin single photon emission computed tomography (SPECT) with those of thallium-201 reinjection at rest after exercise-redistribution imaging in the same patients with chronic ischemic left ventricular (LV) dysfunction. Methods. Within 1 week, 33 patients with chronic myocardial infarction and LV dysfunction underwent exercise-rest tetrofosmin SPECT and Tl-201 reinjection at rest after exercise-redistribution imaging. In each patient, regional tetrofosmin and Tl-201 activity was quantitatively measured in 22 myocardial segments. Regional LV function was assessed in corresponding segments by echocardiography. Results. Agreement in the evaluation of regional perfusion status between tetrofosmin and Tl-201 imaging was observed in 78% of the 726 total segments, with a κ value of 0.61. In segments with normal function at echocardiography (n = 436), no difference between Tl-201 and tetrofosmin uptake was observed. In hypokinetic segments (n = 138), exercise tetrofosmin uptake was lower (P < .01) as compared with exercise Tl-201 activity, whereas no difference was observed between tetrofosmin uptake at rest as compared with Tl-201 activity on redistribution and reinjection images. In segments with severe functional impairment (akinetic or dyskinetic, n = 152), tetrofosmin uptake on exercise images was reduced (P < .01) as compared with exercise Tl-201 activity; furthermore, tetrofosmin uptake at rest was lower (P < .01) as compared with Tl-201 activity on both redistribution and reinjection images. In these segments, concordance in the detection of myocardial viability between tetrofosmin and Tl-201 imaging was observed in 138 (91%) of the 152 segments, with a κ value of 0.77. Conclusions. In patients with chronic coronary artery disease and LV dysfunction quantitative exercise-rest tetrofosmin and Tl-201 reinjection SPECT provide similar information in the assessment of perfusion status and in the detection of myocardial viability

L’incerta evoluzione del regionalismo sanitario in Italia

Muovendo dal riparto di competenze in materia di \u201ctutela della salute\u201d prima e dopo la riforma del Titolo V della Costituzione, il contributo esamina le principali esperienze sovranazionali (in particolare, comunitarie) di federalismo sanitario e le modalit\ue0 attraverso le quali i diversi Paesi hanno inteso coniugare il principio del decentramento con l\u2019esigenza di garantire alla popolazione assistita uniformit\ue0 di trattamento nel godimento delle prestazioni. Guardando poi all\u2019ordinamento interno, ci si domanda quanto le diverse Regioni siano riuscite a sfruttare le opportunit\ue0 di differenziazione loro concesse dalla riforma costituzionale sul piano dell\u2019offerta dei servizi sanitari, nonch\ue9 quali siano \u2013 e se siano oggi determinabili \u2013 gli effetti del federalismo fiscale sulla gestione delle risorse destinate alla sanit\ue0.Taking as its starting point the division of competences before and after the reform of Title V of the Italian Constitution, the essay surveys the main supranational experiences in health care federalism (particularly, in the European Union) and how different countries have tried to combine the principle of decentralisation and the guarantee of treatment uniformity for assisted citizens in the enjoyment of services. Turning to the Italian system, the essay investigates to which extent the Regions used the opportunities opened by the constitutional reform to adopt different models in providing health services, and which are \u2013 if they are currently determinable \u2013 the effects of fiscal federalism on the management of health care resources

Cardiac effect of thyrotoxicosis in acromegaly

Cardiac structure and function are affected both by acromegaly and hyperthyroidism. Whereas the former is mainly characterized by ventricular hypertrophy as well as diastolic and systolic impairment, the latter frequently leads to increased heart rate and enhancement of contractility and cardiac output. To further investigate this issue, we designed this two-arm study. In the first cross-sectional study, we compared echocardiography and radionuclide angiography results obtained in eight hyperthyroid acromegalic patients, eight hyperthyroid nonacromegalic patients, and eight healthy subjects. All acromegalic patients were receiving treatment for acromegaly at the onset of hyperthyroidism. In the second longitudinal study, performed in the group of acromegalic patients, we compared the cardiovascular results obtained during hyperthyroidism with the retrospective data obtained at the initial diagnosis of acromegaly and after 1-yr treatment for this disease and those prospective data obtained during the remission of hyperthyroidism. In the cross-sectional study, hyperthyroid acromegalic patients showed an increase in the left ventricular (LV) mass index (LVMi) compared to healthy and hyperthyroid controls (P < 0.05), with evidence of LVMi hypertrophy in five of them (62.5%). A significant correlation was found between LVMi and GH levels (r = 0.785; P < 0.05). The LV ejection fraction (LVEF) at rest was higher in the control hyperthyroid population than in healthy controls (P < 0.05), whereas the LVEF response to exercise was reduced in acromegalic patients (P < 0.05 vs. healthy controls). In acromegalics, the exercise-induced change in LVEF was significantly reduced compared to that in healthy controls (P < 0.001), but not to that in hyperthyroid controls (P < 0.07), being abnormal (<5% increase vs. baseline values) in six patients. Four of these six patients (66%) had elevated GH and insulin-like growth factor I levels during the treatment of acromegaly. An inverse correlation between GH and LVEF at rest (r = -0.896;P < 0.05) and at peak exercise (r = -0.950; P < 0.001) was recorded. The peak filling rate was reduced in hyperthyroid acromegalic patients compared to those in both control populations (P < 0.05). In the longitudinal study, acromegalic patients showed an increased LVMi during hyperthyroidism compared to that observed after successful treatment of acromegaly (P < 0.05); resting LVEF was increased compared to both basal (P < 0.001) and posttreatment values (P < 0.05). However, the exercise-induced change in LVEF was reduced (P < 0.05 vs. previous follow-up values). Remission of hyperthyroidism led to significant reduction of LVMi (P < 0.05) and resting LVEF (P < 0.05) and an increase in exercise-induced LVEF (P < 0.05). In light of these findings, hyperthyroidism produces a detrimental effect on the cardiovascular system of acromegalic patients, particularly in those with uncontrolled disease. Thus, control of GH and insulin-like growth factor I should be a major objective, as cardiovascular risk persists in patients with ineffective hormonal suppression, and constant endocrine and cardiovascular surveillance remain crucial steps in patient follow-up

Neuroradiological findings in Alagille syndrome

Alagille syndrome (ALGS) is a multisystemic disease caused by mutations in genes of Notch pathway, which regulates embryonic cell differentiation and angiogenesis. Clinically, ALGS is characterized by cholestasis, cardiac defects, characteristic facial features, skeletal and ophthalmologic abnormalities. The aim of this review is to illustrate neuroradiological findings in ALGS, which are less well-known and prevalent, including cerebrovascular anomalies (such as aneurysms, dolichoectasia, Moyamoya syndrome and venous peculiarities), Chiari 1 malformation, craniosynostosis, intracranial hypertension, and vertebral anomalies (namely butterfly vertebra, hemivertebra, and craniocervical junction anomalies). Rarer cerebral midline malformations and temporal bone anomalies have also been described