Stratificazione del rischio coronarico in una popolazione di pazienti asintomatici: impatto della Cardio-TC

Scopo: valutare l’impatto della Coronaro-TC nella stratificazione del rischio coronarico in una popolazione di pazienti asintomatici con due o più fattori di rischio per malattia coronarica e comparare i risultati ottenuti con quelli calcolati con il sistema SCORE (Systematic Coronary Risk Evaluation). Materiali e Metodi: 123 pazienti (97 maschi e 26 femmine), con un punteggio SCORE a 10 anni inferiore al 5%, sono stati sottoposti ad un esame di Cardio-TC. È stato valutato inoltre il calcium score. I pazienti sono stati suddivisi in 3 gruppi: pazienti senza malattia coronarica, pazienti con stenosi non significative delle coronarie, e pazienti con stenosi significative delle coronarie. È stato sviluppato un modello di simulazione per la valutazione dei possibili differenti effetti terapeutici sulla base dei risultati della Cardio-TC e dello SCORE system. Sono stati comparati i risultati ed inoltre è stata valutata la percentuale di morte da tumore indotto da radiazioni. Abbiamo effettuato una valutazione globale del rischio coronarico con la Cardio-TC, incluso il rischio derivante l’uso di radiazioni, e comparato tale rischio con l’ipotesi di non effettuare alcuna terapia. Risultati: il rischio pretest di sviluppare malattia cardiovascolare nella popolazione asintomatica studiata è del 1,06%. Il valore medio del calcium score è 56,48 ± 176,61 (rischio moderato). 17 pazienti con stenosi significativa delle coronarie sono stati sottoposti a interventi di rivascolarizzazione. Il rischio medio di sviluppare eventi cardiovascolari utilizzando la Cardio-TC è del 0.42 ± 0.66. Utilizzando la Cardio TC per la stratificazione del rischio, abbiamo trovato un valore significativamente (p<0.05) inferiore. Conclusioni: La stratificazione del rischio coronarico risulta più accurata di quella ottenuta con lo SCORE system. Il rischio correlato all’uso di radiazioni risulta inferiore rispetto al rischio derivante dal non effettuare alcuna terapia

Stratificazione del rischio coronarico in una popolazione di pazienti asintomatici: impatto della Cardio-TC

Scopo: valutare l’impatto della Coronaro-TC nella stratificazione del rischio coronarico in una popolazione di pazienti asintomatici con due o più fattori di rischio per malattia coronarica e comparare i risultati ottenuti con quelli calcolati con il sistema SCORE (Systematic Coronary Risk Evaluation). Materiali e Metodi: 123 pazienti (97 maschi e 26 femmine), con un punteggio SCORE a 10 anni inferiore al 5%, sono stati sottoposti ad un esame di Cardio-TC. È stato valutato inoltre il calcium score. I pazienti sono stati suddivisi in 3 gruppi: pazienti senza malattia coronarica, pazienti con stenosi non significative delle coronarie, e pazienti con stenosi significative delle coronarie. È stato sviluppato un modello di simulazione per la valutazione dei possibili differenti effetti terapeutici sulla base dei risultati della Cardio-TC e dello SCORE system. Sono stati comparati i risultati ed inoltre è stata valutata la percentuale di morte da tumore indotto da radiazioni. Abbiamo effettuato una valutazione globale del rischio coronarico con la Cardio-TC, incluso il rischio derivante l’uso di radiazioni, e comparato tale rischio con l’ipotesi di non effettuare alcuna terapia. Risultati: il rischio pretest di sviluppare malattia cardiovascolare nella popolazione asintomatica studiata è del 1,06%. Il valore medio del calcium score è 56,48 ± 176,61 (rischio moderato). 17 pazienti con stenosi significativa delle coronarie sono stati sottoposti a interventi di rivascolarizzazione. Il rischio medio di sviluppare eventi cardiovascolari utilizzando la Cardio-TC è del 0.42 ± 0.66. Utilizzando la Cardio TC per la stratificazione del rischio, abbiamo trovato un valore significativamente (p<0.05) inferiore. Conclusioni: La stratificazione del rischio coronarico risulta più accurata di quella ottenuta con lo SCORE system. Il rischio correlato all’uso di radiazioni risulta inferiore rispetto al rischio derivante dal non effettuare alcuna terapia

Lean body weight-tailored Iodinated contrast Injection in obese patient. boer versus James Formula

Purpose. To prospectively compare the performance of James and Boer formula in contrast media (CM) administration, in terms of image quality and parenchymal enhancement in obese patients undergoing CT of the abdomen. Materials and Methods. Fifty-five patients with a body mass index (BMI) greater than 35 kg/m2were prospectively included in the study. All patients underwent 64-row CT examination and were randomly divided in two groups: 26 patients in Group A and 29 patients in Group B. The amount of injected CM was computed according to the patient's lean body weight (LBW), estimated using either Boer formula (Group A) or James formula (Group B). Patient's characteristics, CM volume, contrast-to-noise ratio (CNR) of liver, aorta and portal vein, and liver contrast enhancement index (CEI) were compared between the two groups. For subjective image analysis readers were asked to rate the enhancement of liver, kidneys, and pancreas based on a 5-point Likert scale. Results. Liver CNR, aortic CNR, and portal vein CNR showed no significant difference between Group A and Group B (all P ≥ 0.177). Group A provided significantly higher CEI compared to Group B (P = 0.007). Group A and Group B returned comparable overall subjective enhancement values (3.54 and vs 3.20, all P ≥ 0.199). Conclusions. Boer formula should be the method of choice for LBW estimation in obese patients, leading to an accurate CM amount calculation and an optimal liver contrast enhancement in CT

Human Periapical Cysts-Mesenchymal Stem Cells Cultured with Allogenic Human Serum are a "clinical-grade" construct alternative to bovine fetal serum and indicated in the regeneration of endo-periodontal tissues

Aim: Our research investigated the use of human serum (HS) as a safe and clinical-grade culture medium, using a new cell-model: hPCy-MSCs. This article is aimed to concretely applicate the concept of "waste-based regenerative dentistry" to translate it in future endo-periodontal applications. Methodology: HPCy-MSCs were cultured in 2 different mediums, both containing α-MEM: the 1st with 10% FBS (Control group), and the 2nd with 10% human serum (Test group).Cell proliferation and stemness assays, gene expression, immunophenotypic analysis and osteogenic differentiation were performed to verify our hypothesis. cDNA samples were amplified with qPCR.Experiments were performed in triplicate and analysed with statistical software. Results: The hPCy-MSCs cultivated in a medium with HS were morphologically similar to those cultivated with FBS, and showed a significantly higher proliferation rate. Von Kossa's staining revealed that osteoblasts from hPCy-MSCs in HS implemented with osteogenic induction factors, showed a better osteogenic activity, also confirmed by a significant upregulation of osteopotin (OPN) and matrix extracellular phosphoglycoprotein (MEPE). Conclusions: HPCy-MSCs cultivated in HS showed phenotypic stability and a clear regenerative binding, thus, suggesting these two components as a clinically-grade construct for future endo-periodontal therapies. Riassunto: Obiettivi: La nostra ricerca ha analizzato l'utilizzo del siero umano (HS) come mezzo di coltura sicuro e "clinical-grade", per uso clinico, utilizzando un nuovo modello cellulare: le hPC-MSCs. Questo articolo ha lo scopo di applicare concretamente il concetto di "odontoiatria rigenerativa basata sui rifiuti biologici", al fine di tradurlo in future applicazioni endo-periodontali. Materiali e metodi: Le HPCy-MSCs sono state coltivate in 2 mezzi di coltura diversi, entrambi contenenti α-MEM: il primo con 10% di FBS (gruppo di controllo) e il secondo con il 10% di siero umano (gruppo di test).Sono stati eseguiti saggi di proliferazione cellulare e di staminalità, espressione genica, analisi immunofenotipica e differenziamento osteogenico per verificare la nostra ipotesi di partenza. Campioni di cDNA sono stati amplificati con qPCR.Gli esperimenti sono stati eseguiti in triplicato e analizzati con software statistici. Risultati: Le hPC-MSC coltivate in un terreno con HS erano morfologicamente simili a quelle coltivate con FBS e mostravano un tasso di proliferazione significativamente più alto. La colorazione di Von Kossa ha rivelato che gli osteoblasti da hPC-MSC coltivate in HS implementato con fattori di induzione osteogenica hanno mostrato una migliore attività osteogenica, confermata anche da una significativa up-regolazione di osteopotina (OPN) e fosfoglicoproteina della matrice extracellulare (MEPE). Conclusioni: Le HPCy-MSC coltivate in HS hanno mostrato stabilità fenotipica e un chiaro atteggiamento rigenerativo, suggerendo quindi questo protocollo come un approccio clinicamente valido per le future terapie endo-periodontali. Keywords: Regenerative medicine, Stem cells, Osteogenesis, Human periapical cyst-MSCs, Translational research, Parole chiave: Medicina rigenerativa, Cellule staminali, Osteogenesi, Human periapical cyst-MSCs, Ricerca traslazional

Patient-reported outcomes and complication rates after lateral maxillary sinus floor elevation: a prospective study

Objectives Oral surgery morbidity is highly variable based on patients' characteristics and kind of surgical intervention. However, poor data are available in the literature regarding patient outcomes after oral surgery. The aim of this retrospective study was to evaluate patient-reported outcome and complication rates after maxillary sinus floor elevation. Materials and methods Data from the records of patients undergoing maxillary sinus elevation have been collected from a private dental office. Patient-reported outcome has been assessed using a 100-mm visual analog scale to evaluate the post-operative pain (VAS(pain)) experienced in the first week following surgery and visual rating scales to evaluate discomfort level (VRSdiscomfort: 0 to 4) and willingness to repeat the same surgical procedure (VRSwillingness: 0 to 3). Analgesics intake, swelling onset and duration, and ecchymosis have been also recorded. Results VAS(pain) showed moderate values in the first 2 days (&lt; 50) post-surgery, with a tendency to progressively decrease over the next 2 days. Average assumption of painkillers was 3.93 +/- 3.03. Discomfort level (VRSdiscomfort) after surgery was low (median: 1; IR: 1-0), while willingness to undergo the same surgical procedure was very high (77.63% of patients). Swelling and ecchymosis were experienced by 97.36% and 51.32% of patients, respectively, with a mean duration of 4.09 +/- 1.43 and 2.21 +/- 2.31 days, respectively. Membrane perforation occurred in 4 cases. Other post-operative complications were not observed. Conclusions Maxillary sinus grafting is a safe procedure, with a low complication rate and moderate morbidity that is well tolerated by patients. Particular attention is needed in case selection, surgical planning and operator expertise. © 2021, The Author(s)

State of the art: iterative CT reconstruction techniques

Owing to recent advances in computing power, iterative reconstruction (IR) algorithms have become a clinically viable option in computed tomographic (CT) imaging. Substantial evidence is accumulating about the advantages of IR algorithms over established analytical methods, such as filtered back projection. IR improves image quality through cyclic image processing. Although all available solutions share the common mechanism of artifact reduction and/or potential for radiation dose savings, chiefly due to image noise suppression, the magnitude of these effects depends on the specific IR algorithm. In the first section of this contribution, the technical bases of IR are briefly reviewed and the currently available algorithms released by the major CT manufacturers are described. In the second part, the current status of their clinical implementation is surveyed. Regardless of the applied IR algorithm, the available evidence attests to the substantial potential of IR algorithms for overcoming traditional limitations in CT imaging

CT colonography: can we achieve an adequate bowel preparation without diet restriction?

ObjectiveTo evaluate if an adequate bowel preparation for CT colonography, can be achieved without diet restriction, using a reduced amount of cathartic agent and fecal tagging. To investigate the influence of patients' characteristics on bowel preparation and the impact on patients' compliance.MethodsIn total, 1446 outpatients scheduled for elective CT colonography were prospectively enrolled. All patients had the same bowel preparation based on a reduced amount of cathartic agent (120 g of macrogol in 1.5 l of water) the day before the exam and a fecal tagging agent (60 ml of hyperosmolar oral iodinated agent) the day of the exam. No dietary restrictions were imposed before the exam. The bowel preparation was evaluated using a qualitative and quantitative score. Patients were grouped by age, gender, and presence of diverticula in both scores. Patients' compliance has been evaluated with a questionnaire after the end of the exam and with a phone-calling interview the day after the exam.ResultsAccording to the qualitative score, adequate bowel preparation was achieved in 1349 patients (93.29%) and no statistical differences were observed among the subgroups of patients. Quantitative scores demonstrated that colon distension was significantly better in younger patients and without diverticula. A good patients' compliance was observed and most patients (96.5%) were willing to repeat it.ConclusionsThe lack of diet restriction does not affect the quality of CTC preparation and good patient's compliance could potentially increase the participation rate in CRC screening programs

Automated segmentation of colorectal tumor in 3D MRI Using 3D multiscale densely connected convolutional neural network

The main goal of this work is to automatically segment colorectal tumors in 3D T2-weighted (T2w) MRI with reasonable accuracy. For such a purpose, a novel deep learning-based algorithm suited for volumetric colorectal tumor segmentation is proposed. The proposed CNN architecture, based on densely connected neural network, contains multiscale dense interconnectivity between layers of fine and coarse scales, thus leveraging multiscale contextual information in the network to get better flow of information throughout the network. Additionally, the 3D level-set algorithm was incorporated as a postprocessing task to refine contours of the network predicted segmentation. The method was assessed on T2-weighted 3D MRI of 43 patients diagnosed with locally advanced colorectal tumor (cT3/T4). Cross validation was performed in 100 rounds by partitioning the dataset into 30 volumes for training and 13 for testing. Three performance metrics were computed to assess the similarity between predicted segmentation and the ground truth (i.e., manual segmentation by an expert radiologist/oncologist), including Dice similarity coefficient (DSC), recall rate (RR), and average surface distance (ASD). The above performance metrics were computed in terms of mean and standard deviation (mean ± standard deviation). The DSC, RR, and ASD were 0.8406 ± 0.0191, 0.8513 ± 0.0201, and 2.6407 ± 2.7975 before postprocessing, and these performance metrics became 0.8585 ± 0.0184, 0.8719 ± 0.0195, and 2.5401 ± 2.402 after postprocessing, respectively. We compared our proposed method to other existing volumetric medical image segmentation baseline methods (particularly 3D U-net and DenseVoxNet) in our segmentation tasks. The experimental results reveal that the proposed method has achieved better performance in colorectal tumor segmentation in volumetric MRI than the other baseline techniques