Multimodality imaging of ectopic focus in Graves’ Disease.

Herein, we report imaging findings related to an ectopic focus of thyroid tissue in a young female with Graves’ disease. The occurrence of ectopic thyroid tissue affects approximately 7% of adult population and represents commonly an occasional finding. Only rarely ectopic tissue can present with metastasis or develop a primary thyroid carcinoma. Multimodality imaging may be of help in this case to detect thyroid ectopia, although recent studies question its capability to differentiate benign from malignant tissue

Observed and simulated trophic index (TRIX) values for the Adriatic Sea basin

Abstract. The main scope of the Marine Strategy Framework Directive is to achieve good environmental status (GES) of the EU's marine waters by 2020, in order to protect the marine environment more effectively. The trophic index (TRIX) was developed by Vollenweider in 1998 for the coastal area of Emilia-Romagna (northern Adriatic Sea) and was used by the Italian legislation to characterize the trophic state of coastal waters. We compared the TRIX index calculated from in situ data ("in situ TRIX") with the corresponding index simulated with a coupled physics and biogeochemical numerical model ("model TRIX") implemented in the overall Adriatic Sea. The comparison between in situ and simulated data was carried out for a data time series on the Emilia-Romagna coastal strip. This study shows the compatibility of the model with the in situ TRIX and the importance of the length of the time series in order to get robust index estimates. The model TRIX is finally calculated for the whole Adriatic Sea, showing trophic index differences across the Adriatic coastal areas

Outcome of Patients With Differentiated Thyroid Cancer Treated With 131-Iodine on the Basis of a Detectable Serum Thyroglobulin Level After Initial Treatment

Background: In patients with differentiated thyroid cancer (DTC) and raising serum thyroglobulin (Tg) after total or near-total thyroidectomy and 131I remnant ablation an empiric 131I therapy may be considered. However, outcome data after empiric therapy in did not show a clear evidence of improved survival. We assessed the efficacy of such empiric 131I therapy in patients with DTC and evaluated the long-term outcome. Methods: A total of 100 patients with DTC showing raised Tg level during follow-up after thyroidectomy and 131I ablation were treated with a further 131I therapy (6.1 ± 1.7 GBq). Whole-body scan (WBS) was performed 5–7 days after therapy. Tg value at 12 months after 131I therapy was considered as an indicator of treatment response: 1.5 ng/ml complete remission (CR), >50% decrease partial remission (PR), higher than pre-therapy progression disease (PD), all other cases stable disease (SD). Patients were followed-up for 96 ± 75 months. Results: After 12months, 62%of patients were in CR, 16%in PR, 8%in SD, and 14%in PD. WBS was positive in 41% of patients and negative in 59% (P = NS). Among patients with local recurrences at WBS 89% showed either CR or PR, while 71% of patients with distant metastases were in SD or PD (P < 0.001). Distant metastases at WBS (P < 0.05), CR (P < 0.0001), and CR + PR (P < 0.0001) were predictors of both progression free survival and overall survival. Conclusion: There is a beneficial effect of 131I therapy on outcome of patients with DTC treated on the basis of elevated Tg value. In these patients, survival is affected by achievement of CR or PR at 12 months evaluation after 131I therapy and by the presence of distant metastases at WBS

Time-dependent effect of GLP-1 receptor agonists on cardiovascular benefits: a real-world study

Abstract Background Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown cardiovascular benefits in cardiovascular outcome trials in type 2 diabetes mellitus. However, the most convincing evidence was obtained in subjects with established cardiovascular (CV) disease. We analyzed the determinants of GLP-1 RA-mediated CV protection in a real-world population of persons with type 2 diabetes with and without a history of CV events with long-term follow-up. Methods Retrospective cohort study of 550 individuals with type 2 diabetes (395 in primary CV prevention, 155 in secondary CV prevention), followed at a single center after the first prescription of a GLP-1 RA between 2009 and 2019. CV and metabolic outcomes were assessed. Results Median duration of follow-up was 5.0 years (0.25–10.8) in primary prevention and 3.6 years (0–10.3) in secondary prevention, with a median duration of treatment of 3.2 years (0–10.8) and 2.5 years (0–10.3) respectively. In the multivariable Cox regression model considering GLP-1 RA treatment as a time-dependent covariate, in the primary prevention group, changes in BMI and glycated hemoglobin did not have an impact on MACE risk, while age at the time of GLP-1 initiation (HR 1.08, 95% CI 1.03–1.14, p = 0.001) and GLP-1 RA cessation by time (HR 3.40, 95% CI 1.82–6.32, p < 0.001) increased the risk of MACE. Regarding the secondary prevention group, only GLP-1 RA cessation by time (HR 2.71, 95% CI 1.46–5.01, p = 0.002) increased the risk of MACE. With respect to those who withdrew treatment, subjects who continued the GLP-1 RA had significantly greater weight loss and lower glycated hemoglobin levels during follow-up. Conclusions In this real-world type 2 diabetes population, discontinuation of GLP-1 RA treatment was associated to a higher risk of major cardiovascular events, in both subjects with and without a history of CV events

Total metabolic tumor volume by 18F-FDG PET/CT for the prediction of outcome in patients with non-small cell lung cancer

Objective Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are imaging parameters derived from 18F-FDG PET/CT that have been proposed for risk stratification of cancer patients. The aim of our study was to test whether these whole-body volumetric imaging parameters may predict outcome in patients with non-small cell lung cancer (NSCLC). Methods Sixty-five patients (45 men, 20 women; mean age +/- SD, 65 +/- 12 years), with histologically proven NSCLC who had undergone 18F-FDG PET/CT scan before any therapy, were included in the study. Imaging parameters including SUVmax, SUVmean, total MTV (MTVTOT) and whole-body TLG (TLG(WB)) were determined. Univariate and multivariate analyses of clinical and imaging variables were performed using Cox proportional hazards regression. Survival analysis was performed using Kaplan-Meier method and log-rank tests. Results A total of 298 lesions were analyzed including 65 primary tumors, 114 metastatic lymph nodes and 119 distant metastases. MTVTOT and TLG(WB) could be determined in 276 lesions. Mean value of MTVTOT was 81.83 ml +/- 14.63 ml (SE) whereas mean value of TLG(WB) was 459.88 g +/- 77.02 g (SE). Univariate analysis showed that, among the variables tested, primary tumor diameter (p = 0.0470), MTV of primary tumor (p = 0.0299), stage (p 54.7 g (p 9.5 ml (p < 0.0001). Similar results were obtained in a subgroup of 43 patients with advanced disease (stages III and IV). Conclusions Whole-body PET-based volumetric imaging parameters are able to predict outcome in NSCLC patients

A new relational database including clinical data and myocardial perfusion imaging findings in coronary artery Disease

Background: The aim of this study was to test a relational database including clinical data and imaging findings in a large cohort of subjects with suspected or known Coronary Artery Disease (CAD) undergoing stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging. Methods: We developed a relational database including clinical and imaging data of 7995 subjects with suspected or known CAD. The software system was implemented by PostgreSQL 9.2, an open source object-relational database, and managed from remote by pgAdmin III. Data were arranged according to a logic of aggregation and stored in a schema with twelve tables. Statistical software was connected to the database directly downloading data from server to local personal computer. Results: There was no problem or anomaly for database implementation and user connections to the database. The epidemiological analysis performed on data stored in the database demonstrated abnormal SPECT findings in 46% of male subjects and 19% of female subjects. Imaging findings suggest that the use of SPECT imaging in our laboratory is appropriate. Conclusion: The development of a relational database provides a free software tool for the storage and management of data in line with the current standard

Treatment of Acromegalic Osteopathy in Real-life Clinical Practice: The BAAC (Bone Active Drugs in Acromegaly) Study.

Background: Vertebral fractures (VFs) are a frequent complication of acromegaly, but no studies have been so far published on effectiveness of anti-osteoporotic drugs in this clinical setting. Objective: To evaluate whether in real-life clinical practice bone-active drugs may reduce the risk of VFs in patients with active or controlled acromegaly. Study design: Retrospective-longitudinal study including 9 tertiary care Endocrine Units. Patients and methods: Two-hundred-forty-eight patients with acromegaly (104 males; mean age 56.0\ub113.6 years) were evaluated for prevalent and incident VFs by quantitative morphometric approach. Bone-active agents were used in 52 patients (20.97%) and the median period of follow-up was 48 months (range 12-132). Results: During the follow-up, 65 patients (26.21%) developed incident VFs in relationship with pre-existing VFs (odds ratio (OR) 3.75; p&lt;0.001), duration of active acromegaly (OR 1.01; p=0.04), active acromegaly at the study entry (OR 2.48; p=0.007) and treated hypoadrenalism (OR 2.50; p=0.005). In the entire population, treatment with bone active drugs did not have a significant effect on incident VFs (p=0.82). However, in a sensitive analysis restricted to patients with active acromegaly at the study entry (111 cases), treatment with bone-active drugs was associated with a lower risk of incident VFs (OR 0.11; p=0.004), independently of prevalent VFs (OR 7.65; p&lt;0.001) and treated hypoadrenalism (OR 3.86; p=0.007). Conclusions: Bone-active drugs may prevent VFs in patients with active acromegaly