Modelli di costituzionalismo ambientale tra formante legislativo, giurisprudenziale e culturale

Comparative environmental constitutionalism does not have the Constitutions as its only reference. Environmental protection, even in the European area, has been regulated in constitutional texts only quite recently, starting with the Constitutions of Greece, Portugal and Spain. The role of the Courts is crucial to increase the level of constitutional protection of the environment. The Italian constitutional reform of 2022, which attempted to systematise jurisprudential contributions, is part of this trend. Outside the European panorama, Ecuador and Bolivia have incorporated ecocentric environmental protection into their Constitutions. In particular, specialised Environmental Courts are playing a key role in the development of Environmental Constitutionalism. Within this framework, the issue of access to justice is a focal point

Assessment of poststress left ventricular ejection fraction by gated SPECT: comparison with equilibrium radionuclide angiocardiography

PURPOSE: We compared left ventricular (LV) ejection fraction obtained by gated SPECT with that obtained by equilibrium radionuclide angiocardiography in a large cohort of patients. METHODS: Within 1 week, 514 subjects with suspected or known coronary artery disease underwent same-day stress-rest (99m)Tc-sestamibi gated SPECT and radionuclide angiocardiography. For both studies, data were acquired 30 min after completion of exercise and after 3 h rest. RESULTS: In the overall study population, a good correlation between ejection fraction measured by gated SPECT and by radionuclide angiocardiography was observed at rest (r=0.82, p<0.0001) and after stress (r=0.83, p<0.0001). In Bland-Altman analysis, the mean differences in ejection fraction (radionuclide angiocardiography minus gated SPECT) were -0.6% at rest and 1.7% after stress. In subjects with normal perfusion (n=362), a good correlation between ejection fraction measured by gated SPECT and by radionuclide angiocardiography was observed at rest (r=0.72, p<0.0001) and after stress (r=0.70, p<0.0001) and the mean differences in ejection fraction were -0.9% at rest and 1.4% after stress. Also in patients with abnormal perfusion (n=152), a good correlation between the two techniques was observed both at rest (r=0.89, p<0.0001) and after stress (r=0.90, p<0.0001) and the mean differences in ejection fraction were 0.1% at rest and 2.5% after stress. CONCLUSION: In a large study population, a good agreement was observed in the evaluation of LV ejection fraction between gated SPECT and radionuclide angiocardiography. However, in patients with perfusion abnormalities, a slight underestimation in poststress LV ejection fraction was observed using gated SPECT as compared to equilibrium radionuclide angiocardiography

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

L&#8217;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

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 &lt; .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 &lt; .01) as compared with exercise Tl-201 activity; furthermore, tetrofosmin uptake at rest was lower (P &lt; .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

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

Systematic review with radiomics quality score of cholangiocarcinoma: an EuSoMII Radiomics Auditing Group Initiative

Objectives To systematically review current research applications of radiomics in patients with cholangiocarcinoma and to assess the quality of CT and MRI radiomics studies. Methods A systematic search was conducted on PubMed/Medline, Web of Science, and Scopus databases to identify original studies assessing radiomics of cholangiocarcinoma on CT and/or MRI. Three readers with different experience levels independently assessed quality of the studies using the radiomics quality score (RQS). Subgroup analyses were performed according to journal type, year of publication, quartile and impact factor (from the Journal Citation Report database), type of cholangiocarcinoma, imaging modality, and number of patients. Results A total of 38 original studies including 6242 patients (median 134 patients) were selected. The median RQS was 9 (corresponding to 25.0% of the total RQS; IQR 1-13) for reader 1, 8 (22.2%, IQR 3-12) for reader 2, and 10 (27.8%; IQR 5-14) for reader 3. The inter-reader agreement was good with an ICC of 0.75 (95% CI 0.62-0.85) for the total RQS. All studies were retrospective and none of them had phantom assessment, imaging at multiple time points, nor performed cost-effectiveness analysis. The RQS was significantly higher in studies published in journals with impact factor &gt; 4 (median 11 vs. 4, p = 0.048 for reader 1) and including more than 100 patients (median 11.5 vs. 0.5, p &lt; 0.001 for reader 1). Conclusions Quality of radiomics studies on cholangiocarcinoma is insufficient based on the radiomics quality score. Future research should consider prospective studies with a standardized methodology, validation in multi-institutional external cohorts, and open science data