Growth hormone nadir during oral glucose load depends on waist circumference, gender and age: normative data in 231 healthy subjects.

Objective  (i) To analyse the predictors of GH suppression after standard glucose load (oGTT) in the healthy population and (ii) to establish the 97th percentile of GH nadir post-oGTT according to these variables. Design  Analytical, retrospective. Measurements  GH nadir after oGTT. Subjects  Two hundred and thirty-one healthy subjects (113 women, 118 men 15-80 years) were studied. Results  The GH nadir after glucose load ranged from 0·01 (<assay detection limit) to 0·65 μg/l was higher in women and was inversely correlated with age, BMI, waist circumference, waist/hip, total cholesterol, triglycerides, basal and maximal glucose and basal insulin levels and directly correlated with basal GH levels, IGF-I SDS and HDL-cholesterol (P values ranging 0·004-<0·0001). On multistep regression analysis, the best predictors of nadir GH levels were waist circumference (t = -9·64, P < 0·0001), gender (t = -3·86, P = 0·0001) and age (t = -3·63, P = 0·0003). The results of comparative analysis among subjects grouped according to these variable showed different results in GH nadir in premenopausal women with waist circumference ≤88 cm (97th percentile 0·65 μg/l), in premenopausal women with waist circumference ≤88 cm and in men of any age with waist circumference ≤102 cm (97th percentile 0·33 μg/l) and in subjects of either gender and any age with waist circumference >88 cm in women and 102 cm in men (97th percentile 0·16 μg/l). Conclusions  The results of this study show that GH nadir after oGTT should be analysed according to gender, menopausal status and waist circumference. The GH cut-off should be limited to the assay used

Multilocus approach reveals an incipient differentiation process in the Stone-curlew, Burhinus oedicnemus around the Mediterranean basin

The Stone-curlew Burhinus oedicnemus, a steppe bird species, is mainly distributed in the Mediterranean and Macaronesian regions, which are considered hotspots of biodiversity with priority for animal and plant species richness conservation. In this study, we investigated the genetic diversity of the Stone-curlew in the Mediterranean basin and in the Canary Islands by applying a multilocus approach. We analysed mitochondrial and nuclear markers in order to evaluate the genetic structure and the congruence between morphological subspecies and geographic samples. We found a significant level of genetic differentiation between Mediterranean and Canary Island populations with all markers. Both in the Mediterranean basin and in the Canary Islands, we found a significant level of genetic diversity with nuclear markers only. We identified seven population groups, including insular populations. The four subspecies described for the Western Palaearctic were confirmed with some changes in distribution range. In spite of habitat fragmentation and negative population trend, the Stone-curlew showed a significant level of genetic diversity and gene flow among continental populations. However, islands constitute important reservoirs of genetic diversity and a potential for the evolution of the species

Body composition assessment: comparison of quantitative values between magnetic resonance imaging and computed tomography.

Background The primary objective of this study was to compare measurements of skeletal muscle index (SMI), visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) at the level of L3, on subjects who underwent computed tomography (CT) and magnetic resonance imaging (MRI) examinations within a three-month period. The secondary objective was to compare the automatic and semi-automatic quantifications of the same values for CT images. Methods Among subjects who underwent CT and MRI at our Institution between 2011 and 2020, exclusion criteria were: presence of extensive artifacts; images not including the whole waist circumference; CT acquired with low-dose technique and lack of non-contrast images. A set of three axial images (CT, MRI T1-weighted and T2-weighted) were used to extract the following measurements with semi-automatic segmentations: SMI [calculated normalizing skeletal muscle area (SMA) by the square height], SAT, VAT. For the CT images only, the same values were also calculated by using automatic segmentation. Statistical analysis was performed comparing quantitative MRI and CT measurements by Pearson correlation analysis and by Bland-Altman agreement analysis. Results A total of 123 patients were included. By performing linear regression analysis, CT and MRI measurements of SMI showed a high correlation (r2=0.81 for T1, r2=0.89 for T2), with a mean logarithmic difference between CT and MRI quantitative values of 0.041 for T1-weighted and 0.072 for T2-weighted images. CT and MRI measurements of SAT showed high correlation (r2=0.81 for T1; r2=0.81 for T2), with a mean logarithmic difference between CT and MRI values of 0.0174 for T1-weighted and 0.201 for T2-weighted images. CT and MRI measurements of VAT showed high correlation (r2=0.94 for T1; r2=0.93 for T2), with a mean logarithmic difference of 0.040 for T1-weighted and -0.084 for T2-weighted images. The comparison of values extracted by semi-automatic and automatic segmentations were highly correlated. Conclusions Quantification of body composition values at MRI from T1-weighted and T2-weighted images was highly correlated to same values at CT, therefore quantitative values of body composition among patients who underwent either one of the examinations may be compared. CT body composition values extracted by semi-automatic and automatic segmentations showed high correlation

Accuracy of magnetic resonance imaging to identify pseudocapsule invasion in renal tumors

Purpose: To evaluate accuracy of MRI in detecting renal tumor pseudocapsule (PC) invasion and to propose a classification based on imaging of PC status in patients with renal cell carcinoma. Methods: From January 2017 to June 2018, 58 consecutive patients with localized renal cell carcinoma were prospectively enrolled. MRI was performed preoperatively and PC was classified, according to its features, as follows: MRI-Cap 0 (absence of PC), MRI-Cap 1 (presence of a clearly identifiable PC), MRI-Cap 2 (focally interrupted PC), and MRI-Cap 3 (clearly interrupted and infiltrated PC). A 3D image reconstruction showing MRI-Cap score was provided to both surgeon and pathologist to obtain complete preoperative evaluation and to compare imaging and pathology reports. All patients underwent laparoscopic partial nephrectomy. In surgical specimens, PC was classified according to the renal tumor capsule invasion scoring system (i-Cap). Results: A concordance between MRI-Cap and i-Cap was found in 50/58 (86%) cases. ρ coefficient for each MRI-cap and iCap categories was: MRI-Cap 0: 0.89 (p &lt; 0.0001), MRI-Cap1: 0.75 (p &lt; 0.0001), MRI-Cap 2: 0.76 (p &lt; 0.0001), and MRI-Cap3: 0.87 (p &lt; 0.0001). Sensitivity, specificity, positive predictive value, negative predictive value, and AUC were: MRI-Cap 0: Se 97.87% Spec 83.3%, PPV 95.8%, NPV 90.9%, and AUC 90.9; MRI-Cap 1: Se 77% Spec 95.5%, PPV 83.3%, NPV 93.5%, and AUC 0.86; MRI-Cap 2- iCap 2: Se 88% Spec 90%, PPV 79%, NPV 95%, and AUC 0.89; MRI-Cap 3: Se 94% Spec 95%, PPV 88%, NPV 97%, and AUC 0.94. Conclusions: MRI-Cap classification is accurate in evaluating renal tumor PC features. PC features can provide an imaging-guided landmark to figure out where a minimal margin could be preferable during nephron-sparing surgery

Neuroendocrine tumor presenting like lymphoma: a case report

INTRODUCTION: Neuroendocrine tumors are a rare but diverse group of malignancies that arise in a wide range of organ systems, including the mediastinum. Differential diagnosis includes other masses arising in the middle mediastinum such as lymphoma, pericardial, bronchogenic and enteric cysts, metastatic tumors, xanthogranuloma, systemic granuloma, diaphragmatic hernia, meningocele and paravertebral abscess. CASE PRESENTATION: We present a case of 42-year-old Caucasian man with a neuroendocrine tumor of the middle-posterior mediastinum and liver metastases, which resembled a lymphoma on magnetic resonance imaging. CONCLUSION: The differential diagnosis in patients with mediastinal masses and liver lesions should include neuroendocrine tumor

THE ENVIRONMENTAL IMPACT OF POWER LINES ON BIRDS IN SICILY

Electrocution is a serious conservation problem worldwide for a large number of bird species (BEVANGER, 1994, 1998; BIRDLIFE INTERNATIONAL, 2004; PRINSEN et al., 2011). Due to its wide extension, it is necessary to seek methods that optimize the identification of the most dangerous pylons (JANSS and FERRER, 2001; MANOSA, 2001), lines and the highest risk areas (TINTÓ et al., 2010; GUIL et al., 2011). Actually, the data on bird mortality caused by electrocution and collision in Sicily are deficient, however, a preliminary study suggests that the White Stork (Ciconia ciconia L., 1758) is one of the most threatened species inside two Special Protection Areas (SPA) (ZAFARANA and BARBERA, 2016). The project C.L.E.S.A. aims at making a complete checklist of the species at risk, collecting information from published articles and personal reports. Unpublished data were collected through a request for information widely circulated among professional and dabbler ornithologists, local sections of bird conservation ONG and wildlife services. A standard monitoring method was used to collect data, monthly during the entire sampling period. First, we selected different transects randomly, and, subsequently, we counted and removed all the birds found dead. A total of 152 cases were collected from 1996 to 2017, of which 85 caused by electrocution and 67 by collision. The 55.5% of the founded species are considered as “Birds of Community Importance” (included in Annex I of the Council Directive 2009/147/EC on the conservation of wild birds). C. ciconia is the most species killed by electrocution and Phoenicopterus roseus Pallas, 1811 by collision. These preliminary results suggest that this problem, as well as having serious consequences in terms of conservation, could has serious economic repercussions for human societies, as power failures, loss of revenue, necessity of repairs infrastructures and cost of legal compliance (LEHMAN et al., 2007). The monitoring activities of the C.L.E.S.A. volunteers have the purpose of implementing direct conservation actions for endangered species. The synergy between power companies and C.L.E.S.A. will be basic to adopt the measures suggested by the Conference of the Parties in Resolution 7.4 "Electrocution of migratory birds" (BONN, 2002) and the current management plans for SPAs. This partnership will improve the effective field actions in Sicily

Different Treatments of Symptomatic Angiomyolipomas of the Kidney: Two Case Reports

Development of more sensitive imaging techniques has caused an increase in the number of diagnosed small renal tumors. Approximately 2–3% of these lesions are proved to be angiomyolipomas (AML), a rare benign tumor of the kidney sometimes causing pain and hematuria. The most required approach is observation, but in the case of recurrent symptoms or larger tumors, which may cause bleeding, a more active treatment is required. We present two cases of symptomatic AML tumors of different sizes in the kidney: one treated with transarterial embolization (TAE), and the other with percutaneous cryoablation (CRA). The lesions were diagnosed on the basis of contrast-enhanced computed tomography (CT) scan and magnetic resonance imaging (MRI). Both treatments proved to be effective and safe for treating renal AMLs. A follow-up carried out, based on contrast-enhanced CT scan, confirmed complete treatment of AML and decreased lesion size. There are myriad minimally invasive approaches for the treatment of renal AMLs, and the preservation of renal function remains a priority. The most popular treatment option is the selective renal artery embolization. Owing to its limited invasiveness, CRA could be an attractive option for the preventive treatment of AML

Combined Trans-arterial Embolization and Microwave Ablation for the Treatment of >3 cm Liver Metastases

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Our Experience in Percutaneous Ablative Treatment of Renal T1a E T1b Lesions: Results from 90 Patients Treated with Microwave Ablation, Radiofrequency Ablation and Cryoablation

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