The Clinical Utility of Lower Extremity Dual-Energy CT Angiography in the Detection of Bone Marrow Edema in Diabetic Patients with Peripheral Artery Disease

(1) Background: Type 2 diabetes is a major cause of incidences and the progression of peripheral artery disease (PAD). Bone marrow edema (BME) is an important finding suggestive of underlying bone inflammation in non-traumatic diabetic patients with PAD. Our aim was to evaluate the presence, severity, and clinical implications of BME detected by virtual non-calcium application (VNCa) of dual-energy CT angiography (DE-CTA). (2) Methods: A consecutive series of 76 diabetic patients (55 men; mean age 71.6 ± 11.2 yrs) submitted to lower limb DE-CTA for PAD evaluation and revascularization planning, which were retrospectively analyzed. VNCa images were independently and blindly revised for the presence, location, and severity of BME by two radiologists with 10 years of experience. BME and non-BME groups were evaluated in terms of PAD clinical severity and 6-month secondary major amputation rate. (3) Results: BME was present in 17 (22%) cases, while 59 (78%) patients were non-BME. The BME group showed a significantly higher incidence of major amputation (p < 0.001) and a significantly higher number of patients with advanced clinical stages of PAD compared to the non-BME group (p = 0.024). (4) Conclusions: Lower limb DE-CTA with VNCa application is a useful tool in the detection of BME in diabetic patients with PAD, simultaneously enabling the evaluation of the severity and location of the arterial disease for revascularization planning. BME presence could be a marker of clinically severe PAD and a possible risk factor for revascularization failure

Vertical Greening Systems and Urban Heat Island related aspects: outcomes of a research project

Vegetation in architecture can be assumed as a proper design strategy aimed at improving climate in cities and towns. Vertical Greening Systems (VGSs) and green roof are both building systems introduced extensively in recent times in architecture design. The interest about such systems is remarkable and it is often due to both their physics and environmental performances. A variety of ecological benefits can be ascribed to VGSs, i.e. heat island effect mitigation, noise abatement, heating and cooling energy demand reduction, absorption of particulate matters as well as of VOC, enhancement of biodiversity. Furthermore a noteworthy contribution is given towards those aspects related to extreme weather events affecting nowadays European cities, such as heat-waves and urban flooding. Within an industrial research project, focused on the design, manufacture and performance assessment of a VGS, a number of environmental issues were tackled in. The study was aimed, on one hand, identifying a methodology to select materials to be used in the module assembly and, on the other hand, at testing its performance during actual operating use. In this paper results are presented concerning the aspects related to UHI at the mere building envelope scale, as the assessment of the CO2 equivalent emissions due to manufacturing processes, the analysis of VGS thermal behavior and of its potential in reducing the wall external surface temperatures. These experimental results will constitute the starting point for a research activity aimed at evaluating, through the use of simulation tools, the UHI mitigation at building and urban scal

Conservative treatment of ectopic cervical pregnancy with uterine artery embolization and cervical curettage: A case report

Cervical pregnancy is a rare form of non-tubal ectopic pregnancy. Although uncommon, this condition can determine serious complications with massive hemorrhages and a high rate of fatality. The choice of the appropriate management depends on several factors, such as severity of vaginal bleeding, gestational age, serum β-hCG level, and on embryonic cardiac activity. However, no specific guidelines have been developed, and the "gold standard" treatment has yet to be defined. The authors report a case of cervical pregnancy successfully managed through a combined approach of percutaneous bilateral uterine artery embolization immediately followed by cervical curettage

Predictive factors of selective transarterial embolization failure in acute renal bleeding: a single-center experience

PurposeTransarterial embolization of renal artery branches (RTE) is a minimally invasive procedure commonly performed in life-threatening renal bleeding of different etiologies. Despite the widespread use of RTE, no consensus guidelines are currently available. Our aim was to investigate clinical and technical efficacy and to identify potential predictors for clinical failure of this procedure.MethodsAll the RTE procedures performed in our Interventional Radiology unit in last 10 years were retrospectively collected and analyzed. All selected patients underwent both pre-procedural computed tomography angiography (CTA) and post-procedural CTA within 30 days. Clinical success was considered as primary endpoint. Demographic, laboratory, and diagnostic findings predictive of clinical failure of RTE were identified.ResultsOver a total of 51 patients enrolled, 27 (53%) were females and 33 (64.7%) had a renal bleeding of iatrogenic origin. Technical and clinical success was 100% and 80.4%, respectively. Hematoma volumes > 258.5 cm(3) measured at CTA, higher pre- and post-procedural serum creatinine (Scr) levels, an increase in Scr value > 0.135 mg/dl after the procedure, a worse post-procedural estimated glomerular filtration rate (eGFR), a post-procedural reduction of eGFR 46.50 x 10(3)/mmc showed a significantly higher rate of clinical failure.ConclusionRTE is a safe and effective procedure in the management of acute renal bleeding of various origins. Hematoma volume, Scr, PLT, and eGFR values were found to be predictive factors of poor clinical outcome and should be closely monitored