Scintigraphy-based analysis of possible pulmonary lesions after foam sclerotherapy: a pilot study

The aims of this study were to assess extemporaneous in vivo binding between 99mTcO4- and two sclerosant detergents in foam sclerotherapy, and subsequently to control any possible damage in lungs and other organs related to sclerosant foam passage. A prospective comparative pilot study was performed on two male patients (62 and 56 years old) affected by varicose veins; each of them underwent scintigraphy investigations with free radiotracer and a scintigraphy investigation after each of the four sessions of sclerotherapy of varicose tributaries of the lower limbs with labeled sclerosant foam. One of the two patients underwent two further scintigraphic investigations, with free radiotracer and with labeled sclerosant foam, at a later stage. Four mL of 2% polidocanol (POL) foam, or four mL of 1% sodiumtetradecylsulfate (STS) foam for session were injected. The sclerosant foam was labeled with the radioactive tracer technetium pertechnetate, 99mTcO4- (120 MBq per exam). Two scintigraphy assessments for free tracer (basal) and five scintigraphy investigations of bound-tosclerosant tracer uptake/transit were obtained. No relevant variations in time/activity curves of the lungs and other organs were documented between the basal and post-sclerotherapy findings, also at the later stage. Free radiotracer mean region-of-interest data were: 336 counts (heart), 208 counts (lungs) and 371 counts (thyroid). Mean values extrapolated from each curve at each step for labeled CO2O2-based sclerosant foam were respectively: 351 counts (POL) and 328 counts (STS) for heart, 202 counts (POL) and 188 counts (STS) for lungs, 335 (POL) and 263 (STS) for thyroid. No pulmonary damage by sclerosant foam was caused. Neither immediately after treatments, nor at short-term follow-up

Multiple large osteolytic lesions in a patient with systemic mastocytosis: a challenging diagnosis

Patients with advanced variants of Systemic Mastocytosis may develop destructive bone lesions when massive mast cell (MC) infiltrates are present. Finding of large osteolyses in indolent systemic mastocytosis, typically characterized by low MC burden, should prompt investigations for an alternative explanation

Establishment of a scalable microfluidic assay for characterization of population‐based neutrophil chemotaxis

Background: Regulation of neutrophil chemotaxis and activation plays crucial roles in immunity, and dysregulated neutrophil responses can lead to pathology as seen in neutrophilic asthma. Neutrophil recruitment is key for initiating immune defense and inflammation, and its modulation is a promising therapeutic target. Microfluidic technology is an attractive tool for characterization of neutrophil migration. Compared to transwell assays, microfluidic approaches could offer several advantages, including precis e control of defined chemokine gradients in space and time, automated quantitative analysis of chemotaxis, and high throughput. Methods: We established a microfluidic device for fully automated, quantitative assessment of neutrophil chemotaxis. Freshly isolated mouse neutrophils from bone marrow or human neutrophils from peripheral blood were assessed in real time using an epifluorescence microscope for their migration toward the potent chemoattractants C-X-C-motif ligand 2 (CXCL2) and CXCL8, without or with interleukin-4 (IL-4) pre-incubation. Results: Our microfluidic device allowed the precise and reproducible determination of the optimal CXCL2 and CXCL8 concentrations for mouse and human neutrophil chemotaxis, respectively. Furthermore, our microfluidic assay was able to measure the equilibrium and real-time dynamic effects of specific modulators of neutrophil chemotaxis. We demonstrated this concept by showing that IL-4 receptor signaling in mouse and human neutrophils inhibited their migration toward CXCL2 and CXCL8, respectively, and this inhibition was time-dependent. Conclusion: Collectively, our microfluidic device shows several advantages over traditional transwell migration assays and its design is amenable to future integration into multiplexed high-throughput platforms for screening of molecules that modulate the chemotaxis of different immune cells. Keywords: basic immunology; chemokines; inflammation; innate immunity

Breast cancer and gastrointestinal metastasis. A case report and review of the literature

Introduction: Invasive lobular cancer (ILC) is the second most common type of a heterogeneous group of different histological types of invasive breast carcinoma. Breast cancer can metastatize anywhere, the most common sites are bones, liver, lungs and brain. Gastrointestinal tract (GI) metastases observed in autopsy studies account for about 6% to 18% of the overall metastases from breast cancer. Objective: We describe a 54-year old woman with recurrent ILC in the contralateral breast. She underwent right mastectomy 16 years before. After symptomatic presentation a duodenal invasion was found and subjected to diagnostic scrutiny (FDG PET/CT, diagnostic CT, MR, EGDS). In particular, we analyse if FDG PET/CT is enough accurate in the restaging of the patient. A review of our database and of the literature of similar cases were made. Results: In this patient CT and RM were suspicious for a slow developing process of the duodenum but FDG PET/CT did not show pathological uptake in the affected duodenal tract. A highly intense focus was described in a cervical lymph node, that there isn't metastatic lesion, whereas the recurrent breast lesion had only slight increased glycolytic activity. CONCLUSION: Metastatic lobular carcinoma of the breast is a rare entity with a heterogeneous range of clinical presentations. Detection of eventual gastrointestinal metastases are complicated to assess. ILC has various scale of glycolytic activity both in the primary lesion as well in the metastatic foci. When the level of suspicion is high and there is no uptake of FDG, further investigations are necessary

Scintigraphy-based analysis of possible pulmonary lesions after foam sclerotherapy: a pilot study

The aims of this study were to assess extemporaneous in vivo binding between 99mTcO4- and two sclerosant detergents in foam sclerotherapy, and subsequently to control any possible damage in lungs and other organs related to sclerosant foam passage. A prospective comparative pilot study was performed on two male patients (62 and 56 years old) affected by varicose veins; each of them underwent scintigraphy investigations with free radiotracer and a scintigraphy investigation after each of the four sessions of sclerotherapy of varicose tributaries of the lower limbs with labeled sclerosant foam. One of the two patients underwent two further scintigraphic investigations, with free radiotracer and with labeled sclerosant foam, at a later stage. Four mL of 2% polidocanol (POL) foam, or four mL of 1% sodiumtetradecylsulfate (STS) foam for session were injected. The sclerosant foam was labeled with the radioactive tracer technetium pertechnetate, 99mTcO4- (120 MBq per exam). Two scintigraphy assessments for free tracer (basal) and five scintigraphy investigations of bound-tosclerosant tracer uptake/transit were obtained. No relevant variations in time/activity curves of the lungs and other organs were documented between the basal and post-sclerotherapy findings, also at the later stage. Free radiotracer mean region-of-interest data were: 336 counts (heart), 208 counts (lungs) and 371 counts (thyroid). Mean values extrapolated from each curve at each step for labeled CO2O2-based sclerosant foam were respectively: 351 counts (POL) and 328 counts (STS) for heart, 202 counts (POL) and 188 counts (STS) for lungs, 335 (POL) and 263 (STS) for thyroid. No pulmonary damage by sclerosant foam was caused. Neither immediately after treatments, nor at short-term follow-up

Addition of New Androgen Receptor Pathway Inhibitors to Docetaxel and Androgen Deprivation Therapy in Metastatic Hormone-Sensitive Prostate Cancer: A Systematic Review and Metanalysis

In recent years, significant changes have occurred in metastatic hormone-sensitive prostate cancer (mHSPC) management, where docetaxel and new androgen receptor pathway inhibitors (ARPI) have been shown to improve overall survival (OS) compared to androgen deprivation therapy (ADT). Recent data could once again radically change mHSPC treatment. PEACE-1 and ARASENS trials demonstrated a survival benefit of the addition of ARPI to docetaxel and ADT combination (triplet therapy), compared to docetaxel and ADT. With multiple options to choose from, it is crucial to identify the patients who would benefit most from triplet therapy. In this meta-analysis, we evaluated the activity of the triplet therapy versus docetaxel plus ADT in mHSPC. A systematic review of PubMed/Medline, Embase, and the proceedings of major international meetings was performed. Five RCTs fulfilled the inclusion criteria. PEACE-1 and ARASENS studies reported disease-free survival (DFS) and OS. Post hoc analysis of three other trials evaluated the combination of ARPI, docetaxel and ADT. Globally, 2538 patients were included (1270 triplet therapy; 1268 docetaxel + ADT). Triplet therapy was associated with improved OS (hazard ratio (HR) 0.74; 95% confidence interval (CI), 0.66–0.83, p < 0.00001). A statistically significant benefit was shown in high-volume mHSPC patients (HR 0.76; 95% CI 0.59–0.97, p = 0.03) and in patients with de novo metastatic disease (HR 0.73; 95% CI, 0.64–0.82, p < 0.00001). The addition of ARPI to standard therapy was associated with DFS improvement (HR 0.41; 95% CI, 0.35–0.49, p < 0.00001). This metanalysis shows a significant OS benefit from concomitant administration of ARPI, docetaxel and ADT in high volume and de novo mHSPC

Outcomes of Locally Advanced Rectal Cancer Patients Treated with Total Neoadjuvant Treatment: A Meta-Anaysis of Randomized Controlled Trials

Determining outcomes using the total neoadjuvant therapy (TNT) in patients with local advanced rectal cancer is important for stratifying patients according to expected outcomes in future studies in the era of treatment combination. The present meta-analysis estimated the pathological complete response, disease-free survival, and overall survival probabilities of rectal cancer patients and identified predictors of outcomes

Stress Echocardiography in Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging

Background: The Italian Society of Echography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand the volumes of activity, modalities and stressors used during stress echocardiography (SE) in Italy. Methods: We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved through an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results: Data were obtained from 228 echocardiographic laboratories, and SE examinations were performed in 179 centers (80.6%): 87 centers (47.5%) were in the northern regions of Italy, 33 centers (18.4%) were in the central regions, and 61 (34.1%) in the southern regions. We annotated a total of 4057 SE. We divided the SE centers into three groups, according to the numbers of SE performed: <10 SE (low-volume activity, 40 centers), between 10 and 39 SE (moderate volume activity, 102 centers) and >= 40 SE (high volume activity, 37 centers). Dipyridamole was used in 139 centers (77.6%); exercise in 120 centers (67.0%); dobutamine in 153 centers (85.4%); pacing in 37 centers (21.1%); and adenosine in 7 centers (4.0%). We found a significant difference between the stressors used and volume of activity of the centers, with a progressive increase in the prevalence of number of stressors from low to high volume activity (P = 0.033). The traditional evaluation of regional wall motion of the left ventricle was performed in all centers, with combined assessment of coronary flow velocity reserve (CFVR) in 90 centers (50.3%): there was a significant difference in the centers with different volume of SE activity: the incidence of analysis of CFVR was significantly higher in high volume centers compared to low - moderate - volume (32.5%, 41.0% and 73.0%, respectively, P < 0.001). The lung ultrasound (LUS) was assessed in 67 centers (37.4%). Furthermore for LUS, we found a significant difference in the centers with different volume of SE activity: significantly higher in high volume centers compared to low - moderate - volume (25.0%, 35.3% and 56.8%, respectively, P < 0.001). Conclusions: This nationwide survey demonstrated that SE was significantly widespread and practiced throughout Italy. In addition to the traditional indication to coronary artery disease based on regional wall motion analysis, other indications are emerging with an increase in the use of LUS and CFVR, especially in high-volume centers