Stress-first single photon emission computed myocardial perfusion imaging

Background. Myocardial perfusion imaging (MPI) with single photon emission tomography (SPET) is widely used in coronary artery disease evaluation. Recently major dosimetric concerns have arisen. The aim of this study was to evaluate if a pre-test scoring system could predict the results of stress SPET MPI, thus avoiding two radionuclide injections. Methods. All consecutive patients (n=309) undergoing SPET MPI during the first 6 months of 2014 constituted the study group. The scoring system is based on these characteristics: age >65 years (1 point), diabetes (2 points), typical chest pain (2 points), congestive heart failure (3 points), abnormal ECG (4 points), male gender (4 points), and documented previous CAD (5 points). The patients were divided on the basis of the prediction score into 3 classes of risk for an abnormal stress-first protocol. Results. An abnormal stress SPET MPI was present in 7/31 patients (23%) with a low risk score, in 24/90 (27%) with an intermediate score risk, and in 124/188 (66%) with an high score risk. ROC curve analysis showed good prediction of abnormal stress MPI. Conclusions. Our results suggest an appropriate use of a pre-test clinical prediction formula of abnormal stress MPI in a routine clinical setting

Occurrence and traceability of Salmonella spp. in five Sardinian fermented sausage facilities

The aims of the present study were to evaluate the presence of Salmonella in five fermented sausage processing plants and their products during the production process, and to trace the possible sources of contamination. A total of 270 samples were collected: mixture of ground pork meat and fat, products at the end of acidification, sausages at the end of ripening and, during production stages, surfaces in contact with meat and surfaces not in contact with meat. For samples of ground meat, product at the end of acidification and sausages at the end of ripening, the pH and water activity (aw), were determined. All the samples were tested for the presence of Salmonella. Thirtytwo Salmonella isolates were obtained, subjected to serotyping and PFGE. The sausages at the end of ripening pH and aw mean values were 5.39±0.24 and 0.91±0.03, respectively. Salmonella was detected in three processing plants with an overall prevalence of 16.7% in food samples and 5.8% in environmental samples. Salmonella prevalence was 24% in ground meat and products at the end of acidification and was also detected in a sample of sausage at the end of ripening (2%). In environmental samples, Salmonella was detected in 6.6% of surfaces in contact with meat and 5% of surfaces not in contact with meat. Five serotypes were identified among 32 isolates: S. Derby (37.5%), S. Typhimurium and S. Rissen (both 25%), S. Give and monophasic S. Typhimurium (both 6.25%). Six different pulsotypes were obtained with PFGE. The serotypes and the PFGE pattern of the strains were specific for each facility with no overlapping between different processing plants. The same observation can be pointed out considering different sampling days for the same processing plants, thus presumably indicating the raw material (ground pork meat and fat) as the source of contamination. The detection of Salmonella in a sample of sausage at the end of ripening highlights the ability of the pathogen to survive during manufacturing process

FENOTIPIZZAZIONE ALLERGOLOGICA DEL PAZIENTE CON RINOSINUSITE CRONICA CON POLIPOSI NASALE

La Rinosinusite Cronica con Polipi Nasali (Chronic Rhinosinusitis with Nasal Polyps – CRSwNP) è una patologia eterogenea a carico della mucosa naso-sinusale, a cui possono associarsi altre patologie con interessamento respiratorio, come asma e atopia. La CRSwNP, l’ atopia e l’asma condividono comuni meccanismi patofisiologici sottostanti (endotipo) che guidano la malattia, di cui l'infiammazione di tipo 2 è la più rilevante. Tuttavia il ruolo dell’atopia nella patogenesi della CRSwNP è ancora controverso. Lo scopo dello studio è di fenotipizzare la comorbidità allergologica nella CRSwNP. Abbiamo analizzato il nostro gruppo di pazienti affetti da CRSwNP mediante raccolta di dati anamnestici, compilazione di questionari di valutazione della qualità della vita, esecuzione di citologia nasale, classificazione endoscopica del grado di poliposi. Abbiamo indagato la prevalenza di atopia attraverso l’esecuzione di skin prick test per i maggiori aeroallergeni e la ricerca di IgE specifiche ematiche utilizzando il metodo della component-resolved diagnosis. Abbiamo analizzato le differenze tra pazienti atopici e non atopici. Nel gruppo di pazienti atopici abbiamo definito il profilo di sensibilizzazione prevalente e il suo impatto sui parametrici clinici. Dall’ analisi dei dati è emerso che il fenotipo "poliposi e atopia" tipizza una classe di pazienti con un quadro clinico più impattante e di più complessa gestione. La presenza di asma è maggiore nei pazienti atopici rispetto ai non atopici. I pazienti atopici risultano sensibilizzati a allergeni nativi più che a quelli cross-reattivi. La valutazione allergologica sistematica è quindi consigliabile nel paziente con CRSwNP, anche per motivi terapeutici

Nasal Cytology: A Comparative Study of Two Different Techniques of Processing-Smeared versus Cytocentrifuged Slides

Nasal cytology is a precious tool to study nasal disorders, but in current literature, there is no consensus on the standardization of the processing procedure of the obtained samples. Therefore, we decided to test on specimens obtained by nasal scraping, a common way of nasal specimen sampling, two different processing techniques, smear and cytocentrifugation, and compare them in terms of inflammatory cell content, quality of slides, and validity on clinical assessment. We analyzed 105 patients with suspected sinonasal diseases, and in each patient, we performed nasal cytology with both techniques. Our analysis showed a good correlation between the two techniques for neutrophil and eosinophil percentages, both returned well-preserved cells, and showed higher neutrophil percentage in males and in smokers and higher eosinophil percentage in patients with polyposis, with a good concordance with clinical symptoms, as measured by a specific disease-related questionnaire (Sino-Nasal Outcome Test-22). Technically speaking, smeared slides were easier to prepare, with no need of dedicated equipment, but cell distribution was better in cytocentrifuged slides allowing shorter reading time. In conclusion, both techniques can be considered superimposable and worthy to be used

Can Magnetic Resonance Radiomics Analysis Discriminate Parotid Gland Tumors? A Pilot Study

Our purpose is to evaluate the performance of magnetic resonance (MR) radiomics analysis for differentiating between malignant and benign parotid neoplasms and, among the latter, between pleomorphic adenomas and Warthin tumors. We retrospectively evaluated 75 T2-weighted images of parotid gland lesions, of which 61 were benign tumors (32 pleomorphic adenomas, 23 Warthin tumors and 6 oncocytomas) and 14 were malignant tumors. A receiver operating characteristics (ROC) curve analysis was performed to find the threshold values for the most discriminative features and determine their sensitivity, specificity and area under the ROC curve (AUROC). The most discriminative features were used to train a support vector machine classifier. The best classification performance was obtained by comparing a pleomorphic adenoma with a Warthin tumor (yielding sensitivity, specificity and a diagnostic accuracy as high as 0.8695, 0.9062 and 0.8909, respectively) and a pleomorphic adenoma with malignant tumors (sensitivity, specificity and a diagnostic accuracy of 0.6666, 0.8709 and 0.8043, respectively). Radiomics analysis of parotid tumors on conventional T2-weighted MR images allows the discrimination of pleomorphic adenomas from Warthin tumors and malignant tumors with a high sensitivity, specificity and diagnostic accuracy

Epidemiology, presentation and long-term evolution of graves' disease in children, adolescents and young adults with turner syndrome

Abstract BACKGROUND: Epidemiological studies on the association between Turner syndrome (TS) and Graves' disease (GD) are sparse and no studies are available on the clinical course of GD in TS. OBJECTIVES: To retrospectively investigate the GD prevalence in children and young adults with TS and to compare the GD course in patients with or without TS who were followed up for 4.1 \ub1 0.6 and 4.5 \ub1 3.7 years, respectively. DESIGN: The prevalence of GD in 408 TS patients was evaluated; presentation and evolution of GD under therapy were evaluated both in 7 patients with TS (group A) and in 89 patients without TS (group B). RESULTS: (a) The prevalence of GD in TS patients was 1.7%; (b) GD in TS was not associated with a specific karyotype; (c) with respect to group B patients, those of group A exhibited at presentation more advanced age, a lower fT4 level and more frequent association with other autoimmune diseases, and (d) the clinical course under methimazole therapy was not different in the two groups. CONCLUSIONS: The prevalence of GD in children and young adults with TS is 1.7% and in TS patients, GD presents later and its clinical course is not different than in those without TS

Component-Resolved Diagnosis for Endotyping Patients with Chronic Rhinosinusitis with Nasal Polyps

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a predominantly type 2 inflammation-mediated disease of the nasal mucosa and paranasal sinuses that often coexists with asthma. The role of atopy in the development and severity of CRSwNP is still a controversial issue. Objective: The aim of our study was to propose a systematic allergy workup to identify atopic patients in the context of CRSwNP and to characterize their allergen sensitization profile (sources/molecules). Methods: Patients with a diagnosis of CRSwNP (n = 97) were studied in the otorhinolaryngologist and allergy settings. Demographic and clinical data were collected for each patient. Different allergen sensitization profiles (sources/molecules) were evaluated in atopic CRSwNP patients by using component-resolved diagnosis (CRD). Results: In our cohort of patients, the CRSwNP was frequently diagnosed during adulthood with significant impact on health-related quality of life. Asthma and atopy were the most common comorbidities with a prevalence of asthma in the atopic group. In CRSwNP patients sensitized to grass pollens and/or to house dust mites, the CRD analysis revealed a prevalence of sensitization to species-specific allergens of Phleum pratense (Phl p1, Phl p2, and Phl p5) or Dermatophagoides pteronyssinus (Der p1 and Der p2) rather than to cross-reactive ones. Conclusion: To define the allergen sensitization profile in atopic CRSwNP patients by CRD, it may be useful to better characterize type 2 inflammation, thus providing a personalized endotype-driven treatment