2.4 Magnetic resonance imaging, ultrasonography and conventional radiography in the assessment of bone erosions in juvenile idiopathic arthritis

OBJECTIVE: To compare magnetic resonance imaging (MRI), conventional radiography, and ultrasonography in identifying bone erosions in patients with juvenile idiopathic arthritis (JIA), and to determine the validity and reliability of an MRI scale in detecting and grading joint damage. METHODS: In 26 JIA patients, the clinically more affected wrist was studied with MRI, radiography, and ultrasonography, coupled with standard clinical assessment and biochemical analysis. MR images were assessed independently by 2 readers according to an apposite devised scoring system. RESULTS: Of 26 patients, 25 (96.1%) had 1 or more erosions as detected by MRI, whereas conventional radiography and ultrasonography revealed erosions in 13 (50%) of 26 and 12 (50%) of 24 patients, respectively. The ability of MRI to detect erosive changes was significantly higher with respect to conventional radiography (P = 0.002 with Bonferroni correction [P(B)]) and ultrasonography (P(B) = 0.0002) in the group of patients with <3 years' disease duration. Ultrasonography and conventional radiography were of equivalent value for the detection of destructive changes. Wrist MRI score correlated highly with radiographic erosion score (r(s) = 0.82) and with wrist limited range of motion score (r(s) = 0.69). The interreader intraclass correlation coefficient (ICC) for MRI score was excellent (0.97); intrareader ICCs were good for both investigators (0.97 and 0.79). CONCLUSION: MRI seems to be a powerful tool to detect early structural damage in JIA. The proposed MRI scale for bone erosions appears promising in terms of reliability and construct validity. The pathophysiologic meaning and the prognostic value of bone erosions revealed only by MRI remain to be established in longitudinal studies

Misure sperimentali delle prestazioni di caldaie a condensazione per il riscaldamento centralizzato

The condensing boiler technology has been known for at least two decades and its energy saving potential is nowadays acknowledged. Taking advantage from the additional heat recovered from the condensation of the water vapour contained in the exhaust flow, condensing boilers achieve, during test operations, efficiencies up to 108% on the LHV of natural gas. However, the yearly global performance of such boilers strongly depends on the type of heating system installed downstream. Due to the operating temperature ranges of the device, the radiant floor seems to be the most suitable heating system for such boilers. The present study evaluates the experimental data collected from a centralised plant, coupled to radiator and fan coil heating systems, over two years of operation. Although these medium/high temperature devices are not expected to fit at best to the condensing boiler, the yearly average performance reaches very high values

Prestazioni delle caldaie a condensazione. Misure sperimentali per il riscaldamento centralizzato

Misure sperimentali per il riscaldamento centralizzato. Il presente lavoro valuta le prestazioni di un impianto di riscaldamento centralizzato che opera con terminali a radiatore. Lo schema idraulico adottato consente un funzionamento del sistema che da un lato ottimizza la resa dei corpi scaldanti e dall\u2019altro minimizza la temperatura di ritorno in caldaia, requisito fondamentale per un buon funzionamento di quest\u2019ultima

Combined endoscopic-microscopic approach for vestibular schwannoma removal: outcomes in a cohort of 81 patients

Patients affected by vestibular schwannomas typically report a number of symptoms and minor disabilities after surgery. Therefore, surgeons dealing with this pathology should also try to achieve a good QoL for patients who have undergone tumour removal. The aim of this study was to analyse QoL in subjects undergoing surgery for vestibular schwannomas and to try to establish a relationship with both the tumour size and post-surgical alterations (e.g. facial motor dysfunctions, difficulties in balance, persistence of headache and tinnitus). A retrospective analysis was performed on a consecutive series of 81 patients affected by vestibular schwannomas and treated by a combined microscopic-endoscopic approach. Three groups of patients were identified on the basis of tumour size. Group 1 (lesions 26 mm and 41 mm) with 11 patients (14%). Data obtained with the Short Form Questionnaire showed a statistically significant difference in QoL in those undergoing intervention compared with a control group of healthy subjects. The Glasgow Benefit Inventory Questionnaire showed that 25 (31%) patients felt better, 11 (14%) felt similarly, and 45 (55%) felt poorer health conditions in comparison to the pre-surgical period. Concerning the relationship between preservation of facial nerve function and QoL, using the Glasgow Health Status Inventory, it appeared that only 34% of subjects with good facial nerve function (RGS grade I-II) complained of worsening of QoL, while 45% of those with serious facial nerve injury (RGS grade IV-V) referred poorer QoL. Moreover, the possibility of recovery of facial nerve function during the months following surgery was clearly highlighted by our analysis. Our study confirmed the close relation between tumour size and post-surgical QoL, which is worse for patients affected by larger lesions