Personalizzazione del trattamento con radioiodio nel morbo di Basedow: risultati di uno studio randomizzato su un nuovo metodo per il calcolo dell'attivita ottimale di 131I basato sulla riduzione di massa della tiroide

Scopo: Al momento attuale non c’è consenso riguardo a quale sia l’approccio dosimetrico più appropriato nella terapia del Morbo di Basedow con 131I. Questo studio sperimenta l’efficacia di un metodo personalizzato basato sulla riduzione desiderata di massa (volume) della tiroide indotta dalla terapia al fine di definire l’attività ottimale di 131I da somministrare. Metodi: un modello per calcolare il volume tiroideo “ottimale” finale è già stato pubblicato dal gruppo dell’Università di Pisa. Esso è basato su misurazioni sequenziali delle variazioni del volume tiroideo, della captazione tiroidea e delle cinetiche ottenute su 40 pazienti affetti da Morbo di Basedow in seguito a terapia con 131I. In base a questo modello è stata derivata un'equazione che consente il calcolo di quella che può essere considerata come la massa finale tiroidea ottimale (mfin): m_fin=0,24m_0/U_0 in cui m0 e U0 sono rispettivamente il volume basale della tiroide e la captazione massima nella ghiandola. Partendo dal metodo MIRD e dal Modello Lineare Quadratico, è stata sviluppata un equazione che, correlando la dose assorbita dalla tiroide (e quindi l'attività di 131I somministrata) alla riduzione di volume della stessa consente, insieme all'equazione sopra citata, di calcolare l’attività terapeutica da somministrare al fine di volume ottimale della tiroide. Un totale di 172 pazienti affetti da Morbo di Basedow, trattati nel Centro Regionale di Medicina Nucleare dell’Università di Pisa, sono stati randomizzati in 5 gruppi (di cui 4 in base alla dose assordita ed 1 in base alle dose ottimale per la riduzione del volume tiroideo): Gruppo A (100 Gy, n=29), Gruppo B (200 Gy, n=25), Gruppo C, (300 Gy, n=25), Gruppo D (400 Gy, n=29), Gruppo V (n= 64) in cui l’attività di 131I è stata calcolata al fine di ottenere il valore finale di massa tiroidea desiderata. Risultati: Ad un anno di follow-up, 14/29 pazienti del gruppo A (48%), 16/25 pazienti del gruppo B (64%), 20/25 pazienti del gruppo C (80%), 28/29 pazienti del gruppo D (97%) e 60/64 pazienti del gruppo V (94%) risultavano guariti. All’interno dei gruppi D e V vi era una percentuale di pazienti guariti maggiore rispetto ai gruppi A, B e C. Confrontando i gruppi D e V, si osserva che, a parità di tasso di guarigione, la media della dose assorbita alla tiroide risultava 407±23 Gy per il gruppo D, significativamente più alta rispetto al gruppo V (277±75 Gy. P<0,01), così come significativamente più alta era l’attività di 131I somministrata (524±201 MBq vs 386±173 MBq, P<0,01). Le attività somministrate nei gruppi A, B e C sono state rispettivamente 223±201 MBq, 266±129 MBq e 467±276, mentre le dosi assorbite alla tiroide sono risultate rispettivamente 106±12 Gy, 204±9 Gy e 299±14. Conclusioni: Questi risultati sembrano confermare che il metodo di calcolo dell'attività ottimale, basato sulla riduzione di massa della tiroide consente di raggiungere un’ottima efficacia terapeutica, personalizzando ed ottimizzando la scelta dell’attività di 131I da somministrare, portando vantaggi sia in termini dosimetrici che economici

Con el poeta Martín Rodríguez-Gaona: Contemplación de los paisajes

No presenta resumen

Metabolic and densitometric correlation between atherosclerotic plaque and trabecular bone: an 18F-Natrium-Fluoride PET/CT study

Increasing evidence links atherosclerosis to a decreased bone thickness. This correlation could reflect a bone/plaque interaction. Hereby we analyzed Hounsfield density (HU) and mineral turnover in bone and in the arterial calcifications (AC), using a computational method applied to PET/CT data. 79 18F-NaF PET/CT from patients with AC were retrospectively analyzed. Mean AC density and background-corrected uptake (TBR) were estimated after semi-automatic isocontour segmentation. The same values were assessed in the trabecular bone, using an automatic adaptive thresholding method. Patients were then stratified into terciles, according to their mean HU plaque density ("light", "medium" or "heavy" calcifications"). 35 18F-NaF PET/CT from patients without AC served as controls. Vertebral density and TBR were lower in patients than in controls (137\ub125 vs. 160\ub114 HU, P&lt;0.001); (6.2\ub13.9 vs. 8.4\ub13.4, P&lt;0.05). Mean trabecular TBR values were 8.3\ub14, 4.5\ub12.1 and 3.5\ub11.8 in light, medium and heavy AC groups, respectively (P&lt;0.05 for light vs. medium and P&lt;0.01 for light vs. heavy). Similarly, mean trabecular HU was 143\ub119, 127\ub126 and 119\ub118 in the three groups, respectively (P&lt;0.01 for light vs. heavy). Mean AC density was inversely associated with the trabecular HU (R=-0.56, P&lt;0.01). Conversely, plaques' TBR directly correlated with the one in trabecular bone (R=0.63, P&lt;0.001). At multivariate analysis, the sole predictor of vertebral density was plaque HU (P&lt;0.05). Our data highlight a correlation between plaque and bone morpho-functional parameters and suggest that observing skeletal bone characteristics could represent a novel window on atherosclerosis pathophysiology

Pirfenidone for Idiopathic Pulmonary Fibrosis and Beyond

Pirfenidone (PFD) slows the progression of idiopathic pulmonary fibrosis (IPF) by inhibiting the exaggerated fibrotic response and possibly through additional mechanisms, such as anti-inflammatory effects. PFD has also been evaluated in other fibrosing lung diseases. Myocardial fibrosis is a common feature of several heart diseases and the progressive deposition of extracellular matrix due to a persistent injury to cardiomyocytes may trigger a vicious cycle that leads to persistent structural and functional alterations of the myocardium. No primarily antifibrotic medications are used to treat patients with heart failure. There is some evidence that PFD has antifibrotic actions in various animal models of cardiac disease and a phase II trial on patients with heart failure and preserved ejection fraction has yielded positive results. This review summarises the evidence about the possible mechanisms of IPF and modulation by PFD, the main results about IPF or non-IPF interstitial pneumonias and also data about PFD as a potential protective cardiac drug

Misinterpretation of an inflammatory FDG uptake in a patient treated for Hodgkin lymphoma: a case report

Hodgkin Lymphoma (HL) is a malignancy involving lymph nodes and lymphatic system. [18F]F-FDG PET/CT (FDG-PET) imaging is routinely used for staging, to assess early chemotherapy response (interim FDG-PET), at the end of treatment (EoT FDG-PET) and for the identification of disease recurrence.We present a case of a 39-year-old man treated for HL. FDG-PET scans performed after first line therapy (both Interim PET and at the end of therapy) demonstrated a persistent and significant mediastinal FDG uptake. The patient was treated with a second line therapy but the FDG-PET uptake did not change. After board discussion a new surgical, thoracoscopy-guided biopsy was performed. Histopathology demonstrated a dense fibrous tissue with occasional chronic inflammatory infiltrates.Persistent FDG-PET positivity may suggest refractory or relapsed disease. However, occasionally, non-malignant conditions are responsible for a persistent FDG uptake, not related to primary disease. An accurate evaluation of clinical history and previous imaging exams is mandatory for clinicians and others experts to avoid misinterpretations of FDG-PET results. Nevertheless, in some cases, only a more invasive procedure, such as a biopsy, may finally lead to a definitive diagnosis

A Score-Based Approach to 18F-FDG PET Images as a Tool to Describe Metabolic Predictors of Myocardial Doxorubicin Susceptibility

Purpose: To verify the capability of 18F-fluorodeoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT) to identify patients at higher risk of developing doxorubicin (DXR)-induced cardiotoxicity, using a score-based image approach. Methods: 36 patients underwent FDG-PET/CT. These patients had shown full remission after DXR-based chemotherapy for Hodgkin\u2019s disease (DXR dose: 40\u201350 mg/m2 per cycle), and were retrospectively enrolled. Inclusion criteria implied the presence of both pre- and post-chemotherapy clinical evaluation encompassing electrocardiogram (ECG) and echocardiography. Myocardial metabolism at pre-therapy PET was evaluated according to both standardized uptake value (SUV)- and score-based approaches. The capability of the score-based image assessment to predict the occurrence of cardiac toxicity with respect to SUV measurement was then evaluated. Results: In contrast to the SUV-based approach, the five-point scale method does not linearly stratify the risk of the subsequent development of cardiotoxicity. However, converting the five-points scale to a dichotomic evaluation (low vs. high myocardial metabolism), FDG-PET/CT showed high diagnostic accuracy in the prediction of cardiac toxicity (specificity = 100% and sensitivity = 83.3%). In patients showing high myocardial uptake at baseline, in which the score-based method is not able to definitively exclude the occurrence of cardiac toxicity, myocardial SUV mean quantification is able to further stratify the risk between low and intermediate risk classes. Conclusions: the score-based approach to FDG-PET/CT images is a feasible method for predicting DXR-induced cardiotoxicity. This method might improve the inter-reader and inter-scanner variability, thus allowing the evaluation of FDG-PET/CT images in a multicentral setting

Circulating tumor DNA reflects tumor metabolism rather than tumor burden in chemotherapy-naive patients with advanced non-small cell lung cancer (NSCLC):an18F-FDG PET/CT study

We aimed to evaluate the relationships between circulating tumor cells (CTCs) or plasma cell-free DNA (cfDNA) on one side and a comprehensive range of18F-FDG PET/CT-derived parameters on the other side in chemotherapy-naive patients with advanced non-small cell lung cancer (NSCLC). Methods: From a group of 79 patients included in a trial evaluating the role of pretreatment circulating tumor markers as predictors of prognosis in chemotherapy-naive patients with advanced NSCLC, we recruited all those who underwent18F-FDG PET/CT for clinical reasons at our institution before inclusion in the trial (and thus just before chemotherapy). For each patient, a peripheral blood sample was collected at baseline for the evaluation of CTCs and cfDNA. CTCs were isolated by size using a filtration-based device and then morphologically identified and enumerated; cfDNA was isolated from plasma and quantified by a quantitative polymerase chain reaction using human telomerase reverse transcriptase. The following18F-FDG PET/CT-derived parameters were computed: maximum diameter of the primary lesion (T), of the largest lymph node (N), and of the largest metastatic lesion (M); SUVmax; SUVmean; size-incorporated SUVmax; metabolic tumor volume; and total lesion glycolysis. All parameters were independently measured for T, N, and M. The associations among CTCs, cfDNA, and18F-FDG PET/CT-derived parameters were evaluated by multivariate-analysis. Patients were divided into 2 groups according to the presence of either limited metastatic involvement (M1a or M1b due to extrathoracic lymph nodes only) or disseminated metastatic disease. The presence or absence of metabolically active bone lesions was also recorded for each patient, and patient subgroups were compared. Results: Thirty-seven patients recruited in the trial matched our PET-based criteria (24 men; age, 64.5 6 8.1 y). SUVmaxfor the largest metastatic lesion was the only variable independently associated with baseline cfDNA levels (P 5 0.016). Higher levels of cfDNA were detected in the subgroup of patients with metabolically active bone lesions (P 5 0.02), but no difference was highlighted when patients with more limited metastatic disease were compared with patients with disseminated metastatic disease. Conclusion: The correlation of cfDNA levels with tumor metabolism, but not with metabolic tumor volume at regional or distant levels, suggests that cfDNA may better reflect tumor biologic behavior or aggressiveness rather than tumor burden in metastatic NSCLC

Ornithodoros brasiliensis Aragão (Acari: Argasidae): description of the larva, redescription of male and female, and neotype designation

Ornithodoros brasiliensis is an endemic tick from Brazil and is very aggressive to humans, resulting in pain, fever and intense inflammatory response. After more than 50 years without report, this species was recently found in rural areas of São Francisco de Paula municipality, State of Rio Grande do Sul, southern Brazil, from where it was originally described. Herein, we describe the larva and redescribe the adults of O. brasiliensis based on scanning electron microscopy. Since the type was lost we designate the neotype specimen under the number IBSP 10409. In addition, the relationship between O. brasiliensis and other species from the Neotropical region that share the morphological characteristics of Ornithodoros with dorsal humps on tarsi, and also live under the soil and feed on hosts other than bats, are discussed. Molecular analysis inferred from a portion of the 16S rRNA mitochondrial gene is also provided and it placed O. brasiliensis in a cluster supported by a maximal bootstrap value (100%) with Ornithodoros parkeri, Ornithodoros rostratus, and Ornithodoros turicata.Fil: Barros Battesti, Darci M.. Governo do Estado de Sao Paulo. Secretaria da Saude. Instituto Butantan; BrasilFil: Onofrio, Valeria C.. Governo do Estado de Sao Paulo. Secretaria da Saude. Instituto Butantan; BrasilFil: Nieri Bastos, Fernanda A.. Universidade de São Paulo. Faculdade de Medicina Veterinária e Zootecnia. Departamento de Medicina Veterinária Preventiva e Saúde Animal; BrasilFil: Soares, João Fábio. Universidade de São Paulo. Faculdade de Medicina Veterinária e Zootecnia. Departamento de Medicina Veterinária Preventiva e Saúde Animal; BrasilFil: Marcili, Arlei. Universidade de São Paulo. Faculdade de Medicina Veterinária e Zootecnia. Departamento de Medicina Veterinária Preventiva e Saúde Animal; BrasilFil: Famadas, Kátia M.. Universidad Federal Rural de Rio de Janeiro; BrasilFil: Faccini, Joao Luiz H.. Universidad Federal Rural de Rio de Janeiro; BrasilFil: Ramirez, Diego G.. Universidade de São Paulo. Faculdade de Medicina Veterinária e Zootecnia. Departamento de Medicina Veterinária Preventiva e Saúde Animal; BrasilFil: Doyle, Rovaina L.. Instituto de Pesquisas Veterinárias Desidério Finamor; BrasilFil: Martins, João Ricardo. Instituto de Pesquisas Veterinárias Desidério Finamor; BrasilFil: Junior, José R.. Universidade Federal do Rio Grande do Sul; BrasilFil: Guglielmone, Alberto Alejandro. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Santa Fe. Estación Experimental Agropecuaria Rafaela; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; ArgentinaFil: Labruna, Marcelo B.. Universidade de São Paulo. Faculdade de Medicina Veterinária e Zootecnia. Departamento de Medicina Veterinária Preventiva e Saúde Animal; Brasi

Intruding into a conversation: how behavioral manipulation could support management of Xylella fastidiosa and its insect vectors

Behavioral manipulation (BM) is a multimodal control approach based on the interference with the stimuli mediating insect perception and interaction with the surroundings. BM could represent a win–win strategy for the management of vector-borne plant pathogens as the bacterium Xylella fastidiosa, since it could reduce the number of vectors alighting on host plants and, consequently, the chances for transmission to occur. In this review, we summarized current knowledge and highlighted gaps in information on (i) how insect vectors of X. fastidiosa in general, and more specifcally the meadow spittlebug Philaenus spumarius, locate and accept the host plant; and (ii) how behavioral manipulation techniques could be applied to disrupt the vector–host plant interaction. Finally, we discussed how diverse BM strategies could be combined with other integrated pest management tools to protect olive groves from inoculation with the fastidious bacterium

State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation

Aim The diagnosis, severity and extent of a sterile inflammation or a septic infection could be challenging since there is not one single test able to achieve an accurate diagnosis. The clinical use of 18F-fluorodeoxyglucose ([F-18]FDG) positron emission tomography/computed tomography (PET/CT) imaging in the assessment of inflammation and infection is increasing worldwide. The purpose of this paper is to achieve an Italian consensus document on [F-18]FDG PET/CT or PET/MRI in inflammatory and infectious diseases, such as osteomyelitis (OM), prosthetic joint infections (PJI), infective endocarditis (IE), prosthetic valve endocarditis (PVE), cardiac implantable electronic device infections (CIEDI), systemic and cardiac sarcoidosis (SS/CS), diabetic foot (DF), fungal infections (FI), tuberculosis (TBC), fever and inflammation of unknown origin (FUO/IUO), pediatric infections (PI), inflammatory bowel diseases (IBD), spine infections (SI), vascular graft infections (VGI), large vessel vasculitis (LVV), retroperitoneal fibrosis (RF) and COVID-19 infections. Methods In September 2020, the inflammatory and infectious diseases focus group (IIFG) of the Italian Association of Nuclear Medicine (AIMN) proposed to realize a procedural paper about the clinical applications of [F-18]FDG PET/CT or PET/MRI in inflammatory and infectious diseases. The project was carried out thanks to the collaboration of 13 Italian nuclear medicine centers, with a consolidate experience in this field. With the endorsement of AIMN, IIFG contacted each center, and the pediatric diseases focus group (PDFC). IIFG provided for each team involved, a draft with essential information regarding the execution of [F-18]FDG PET/CT or PET/MRI scan (i.e., indications, patient preparation, standard or specific acquisition modalities, interpretation criteria, reporting methods, pitfalls and artifacts), by limiting the literature research to the last 20 years. Moreover, some clinical cases were required from each center, to underline the teaching points. Time for the collection of each report was from October to December 2020. Results Overall, we summarized 291 scientific papers and guidelines published between 1998 and 2021. Papers were divided in several sub-topics and summarized in the following paragraphs: clinical indications, image interpretation criteria, future perspectivess and new trends (for each single disease), while patient preparation, image acquisition, possible pitfalls and reporting modalities were described afterwards. Moreover, a specific section was dedicated to pediatric and PET/MRI indications. A collection of images was described for each indication. Conclusions Currently, [F-18]FDG PET/CT in oncology is globally accepted and standardized in main diagnostic algorithms for neoplasms. In recent years, the ever-closer collaboration among different European associations has tried to overcome the absence of a standardization also in the field of inflammation and infections. The collaboration of several nuclear medicine centers with a long experience in this field, as well as among different AIMN focus groups represents a further attempt in this direction. We hope that this document will be the basis for a "common nuclear physicians' language" throughout all the country