Diagnostic accuracy of myocardial perfusion imaging with czt technology. Systemic review and meta-analysis of comparison with invasive coronary angiography

OBJECTIVES: This study sought to summarize the evidence on stress myocardial perfusion imaging (MPI) using cadmium-zinc-telluride (CZT) technology for the diagnosis of obstructive coronary artery disease (CAD). The CZT cameras are newly introduced, and comparative data with the conventional Anger technology (Anger-MPI) are lacking. BACKGROUND: The diagnostic accuracy of Anger-MPI for detection of angiographically significant CAD is well established; however, less evidence is available on the diagnostic accuracy of CZT-MPI. METHODS: Clinical studies comparing CZT-MPI and invasive coronary angiography were systematically searched and abstracted. Calculations of diagnostic accuracy, including sensitivity, specificity, likelihood ratios, and diagnostic odds ratio, were obtained with fixed and random effects, reporting point estimates and 95% confidence intervals. RESULTS: Based on our search, a total of 16 studies (N = 2,092) were included. The sensitivity of CZT-MPI was 0.84 (95% confidence interval [CI]: 0.78 to 0.89), whereas the specificity of 0.69 (95% CI: 0.62 to 0.76) was significantly reduced. The positive likelihood ratio was 2.73 (95% CI: 2.21 to 3.39), the negative likelihood ratio was 0.24 (95% CI: 0.17 to 0.31), and the diagnostic odds ratio was 11.93 (95% CI: 7.84 to 17.42). At subgroup and meta-regression analyses, the diagnostic accuracy between D-SPECT and Discovery cameras was similar (p = 0.711) and not impacted upon by smaller sample size studies (p = 0.573). CONCLUSIONS: CZT-MPI has satisfactory sensitivity for angiographically significant CAD, but its suboptimal specificity warrants further development and research

Myocardial perfusion imaging with cadmium–zinc–telluride cameras: Harry Potter and the Radiation Hallows?

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Tumori dell’intestino tenue: nostra esperienza in urgenza

I tumori dell’intestino tenue sono neoplasie relativamente rare. Sintomi di natura aspecifica ed esami diagnostici di basse sensibilità e validità sono complessivamente responsabili di una diagnosi ritardata e, in caso di malignità, di malattia spesso avanzata e per lo più incurabile con l’intervento. Uno studio retrospettivo è stato effettuato in 42 casi con presentazione clinica di acuzie, dal 1972 al 2001; l’età media dei pazienti è stata di 52 anni (range 14-79 anni); c’è stata una lieve prevalenza del sesso femminile (57.1% vs 42.9%). La presentazione acuta più comune è stata l’occlusione (57.1%), seguita da sanguinamento gastrointestinale (23.8%), perforazione (14.3%) e occlusione/perforazione (4.8%). I tumori benigni si sono presentati nel 38.1% (16 casi), l’adenoma rappresenta il tipo più comune; le forme maligne sono state il 61.9% (26 casi), l’adenocarcinoma e i linfomi rappresentano l’istotipo più comune. La chirurgia radicale è stata possibile solo nel 57% delle forme maligne (24 pazienti): la morbidità è stata del 4.8% (2 casi: 1 deiscenza anastomotica e 1 ascesso subfrenico); la mortalità è stata del 14.3%. Dal nostro studio retrospettivo possiamo affermare che la sopravvivenza per le lesioni maligne è strettamente dipendente dalla precocità della diagnosi TNM e dalla possibilità di una procedura chirurgica radicale, prima che la lesione diventi non resecabile, come è accaduto nel 42% dei nostri casi. Un indice di sospetto estremamente elevato nella valutazione di sintomi, spesso aspecifici, integrato con studi diagnostici specifici, potrebbe rappresentare l’approccio più appropriato. La prognosi per le forme benigne è invece eccellente in tutti i casi

Pursuing softer urban mobility behaviors through game-based apps

Cities are currently engaged through their urban policies in pushing people towards less environmentally impacting mobility modalities: therefore, cycling and walking are strongly promoted, especially by means of new and wider limited traffic and no-cars zones. In this paper, the effectiveness of the new smartphones and appsbased technologies in modifying the mobility behaviors of citizens towards more sustainable choices has been investigated. Specifically, the potential of a smartphone app, directly involving citizens by means of a game rewarding the most sustainable trips, has been tested on a university commuters' group. These latter, starting from their current mobility situation, were challenged by an enhanced scenario characterized by more restrictive and sustainable targets. Promising results have been obtained suggesting that game–based tools could be effectively used as urban policy interventions intended to obtain a more sustainable mobilit

Occlusione intestinale su briglia in paziente con pregressa diagnosi di sindrome di Ogilv

A case of a 72-year-old man with abdominal pain and ileus is reported. Previous surgery for Ogilvie?s syndrome had been performed. Despite conservative therapy, the occlusive symptoms worsen. Therefore the patient was submitted to surgery. At laparotomy two abdominal adhesions were found and sectioned. The differential diagnosis between mechanical ileus and pseudo-obstruction for neuro-mechanics dissociation (Ogilvie?s syndrome) is difficult, particularly in patients with neurodegenerative diseases

Comparison between early-onset and late-onset alzheimer's disease patients with amnestic presentation: CSF and 18F-FDG PET study

BACKGROUND/AIMS To investigate the differences in brain glucose consumption between patients with early onset of Alzheimer's disease (EOAD, aged ≤65 years) and patients with late onset of Alzheimer's disease (LOAD, aged >65 years). METHODS Differences in brain glucose consumption between the groups have been evaluated by means of Statistical Parametric Mapping version 8, with the use of age, sex, Mini-Mental State Examination and cerebrospinal fluid values of AΒ1-42, phosphorylated Tau and total Tau as covariates in the comparison between EOAD and LOAD. RESULTS As compared to LOAD, EOAD patients showed a significant decrease in glucose consumption in a wide portion of the left parietal lobe (BA7, BA31 and BA40). No significant differences were obtained when subtracting the EOAD from the LOAD group. CONCLUSIONS The results of our study show that patients with EOAD show a different metabolic pattern as compared to those with LOAD that mainly involves the left parietal lobe

Prognostic Significance of Endothelial Dysfunction in Hypertensive Patients

Background — Forearm endothelial dysfunction, characterized by an impaired vasodilating response to acetylcholine (ACh), may be associated with several cardiovascular risk factors, including essential hypertension. Although the prognostic value of coronary endothelial dysfunction has been demonstrated, that of forearm endothelial dysfunction is still unknown. Methods and Results — Endothelium-dependent and -independent vasodilation was investigated in 225 never-treated hypertensive patients (age, 35 to 54 years) by intra-arterial infusion of increasing doses of ACh and sodium nitroprusside. Patients were divided into tertiles on the basis of their increase in ACh-stimulated forearm blood flow (FBF) from basal: group 1, from 30% to 184%; group 2, from 185% to 333%; and group 3, from 339% to 760% increase from basal. During a mean follow-up of 31.5 of months (range, 4 to 84 months), there were 29 major adverse events at the cardiac (n=19), cerebrovascular (n=9), or peripheral vascular (n=1) level. Events included myocardial infarction, angina, coronary revascularization procedures, stroke, transient cerebral ischemic attack, and aortoiliac occlusive disease. Event rate per 100 patient-years was 8.17, 4.34, and 2.02 in the first, second, and third tertiles of peak percent increase in FBF during ACh infusion. The excess risk associated with an FBF increase in the first tertile was significant (relative risk, 2.084; 95% CI, 1.25 to 3.48; P =0.0049) after controlling for individual risk markers, including 24-hour ambulatory blood pressure. Conclusions — Our data suggest that forearm endothelial dysfunction is a marker of future cardiovascular events in patients with essential hypertension

New Bioactive Peptides from the Mediterranean Seagrass Posidonia oceanica (L.) Delile and Their Impact on Antimicrobial Activity and Apoptosis of Human Cancer Cells

The demand for new molecules to counter bacterial resistance to antibiotics and tumor cell resistance is increasingly pressing. The Mediterranean seagrass Posidonia oceanica is considered a promising source of new bioactive molecules. Polypeptide-enriched fractions of rhizomes and green leaves of the seagrass were tested against Gram-positive (e.g., Staphylococcus aureus, Enterococcus faecalis) and Gram-negative bacteria (e.g., Pseudomonas aeruginosa, Escherichia coli), as well as towards the yeast Candida albicans. The aforementioned extracts showed indicative MIC values, ranging from 1.61 μg/mL to 7.5 μg/mL, against the selected pathogens. Peptide fractions were further analyzed through a high-resolution mass spectrometry and database search, which identified nine novel peptides. Some discovered peptides and their derivatives were chemically synthesized and tested in vitro. The assays identified two synthetic peptides, derived from green leaves and rhizomes of P. oceanica, which revealed interesting antibiofilm activity towards S. aureus, E. coli, and P. aeruginosa (BIC50 equal to 17.7 μg/mL and 70.7 μg/mL). In addition, the natural and derivative peptides were also tested for potential cytotoxic and apoptosis-promoting effects on HepG2 cells, derived from human hepatocellular carcinomas. One natural and two synthetic peptides were proven to be effective against the “ in vitro” liver cancer cell model. These novel peptides could be considered a good chemical platform for developing potential therapeutics

ELIMED: MEDICAL APPLICATION AT ELI-BEAMLINES. STATUS OF THE COLLABORATION AND FIRST RESULTS

ELI-Beamlines is one of the four pillars of the ELI (Extreme Light Infrastructure) pan-European project. It will be an ultrahigh-intensity, high repetition-rate, femtosecond laser facility whose main goal is to generate and apply high-brightness X-ray sources and accelerated charged particles. In particular, medical applications are treated by the ELIMED task force, which has been launched by collaboration between ELI and INFN researchers. ELIMED aims to demonstrate the clinical applicability of laser accelerated ions. In this article, the state of the ELIMED project and the first scientific results are reported. The design and realisation of a preliminary beam handling system and of an advanced spectrometer for diagnostics of high energy (multi-MeV) laser-accelerated ion beams will also be briefly presented