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Orgasm is a phase of the human sexual response, and the possible discrepancies between male and female ways to experience it are still not clear in the literature. There is a lack of tools to adequately assess orgasm perception. This study aims to develop an instrument and verify possible differences between males and females. We constructed the Orgasmic Perception Questionnaire (OPQ) through different stages: first, 316 items selection was conducted on a sample of 96 people, where items came mainly from written descriptions of orgasm perception; second, an exploratory factor analysis was conducted on 674 Italian adults with a 63-item OPQ; finally, a confirmatory factor analysis was conducted on 1100 Italian adults with a 47-item OPQ. In the first study, 63 items fitted an equidistributional pattern and were to form the 63-item OPQ used for EFA. The EFA showed that five factors out of 47 explained 44.01% of the total variance and were named: Ecstasy, Contractions, Relaxation, Power, and Sensations. The confirmatory factor analyses run on the 47-item OPQ confirmed that the five-factor structure fits. Moreover, females scored higher than males with an adequate effect size in two factors: Contractions and Sensations. In conclusion, the OPQ could be a useful tool in both clinical settings and research studies to investigate the perception of orgasmic experience in its totality.
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Orgasmo , Percepção , Adulto , Humanos , Masculino , Feminino , Orgasmo/fisiologia , Psicometria , Inquéritos e Questionários , ItáliaRESUMO
Covid-19 has been affecting people's lives on a social, economic, emotional, and sexual level. This study aims to investigate any change in how couples formed during the pandemic got to know the partner and experienced sexuality, including factors that could have influenced those changes in comparison with a pre-pandemic period. Particularly, focus groups (N = 26 women) were conducted and an online questionnaire (N = 120; 41 men and 79 women) was administered. Given the exploratory qualitative nature of the present research, no specific hypothesis was tested. Most of the sample reported an increase in sexual desire, sexual frequency, and quality of intercourse, perceiving an early development of intimacy. The results highlight the lack of stress and fear of contagion. The intense state of euphoria, typical of the initial phase of the relationship, has perhaps allowed the couples to overcome the obstacles due to the restrictions. This study underlines the role of being in love in the survival of the species, as it allows for the creation of steady relationships even in moments of danger.
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COVID-19 , Pandemias , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Sexualidade/psicologiaRESUMO
Single reports of Guillain-Barré syndrome (GBS) have been reported worldwide during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. While case reports are likely to be biased toward uncommon clinical presentations, systematic assessment of prospective series can highlight the true clinical features and spectrum. In this prospective, observational study, we included all consecutive patients who developed GBS. In patients with SARS-CoV-2 infection as antecedent, the time-gap between the infection and GBS onset had to be ≤30 days. The referral was a neurological University Research Hospital, in the Italian Region more severely involved by the pandemic, and hospitalizing both COVID+ and non-COVID neurological diseases. Clinical, laboratory, cerebrospinal fluid, and electromyographic features of GBS diagnosed between March 2020 and March 2021 were compared to a retrospective series of GBS diagnosed between February 2019 and February 2020 (control population). Nasopharyngeal swab was still positive at GBS onset in 50% of patients. Mild-to-moderate COVID-related pneumonia, as assessed by X-ray (6 patients) or X-ray plus computerized tomography (2 patients) co-occurred in 6 of 10 patients. GBS diagnosed during the pandemic period, including 10 COVID-GBS and 10 non-COVID-GBS, had higher disability on admission (P = .032) compared to the GBS diagnosed between February 2019 and 2020, possibly related to later hospital referral in the pandemic context. Compared to non-COVID-GBS (n = 10) prospectively diagnosed in the same period (March 2020-2021), post-COVID-GBS (n = 10) had a higher disability score on admission (P = .028), lower sum Medical Research Council score (P = .022) and lymphopenia (P = .025), while there were no differences in GBS subtype/variant, severity of peripheral involvement, prognosis and response to treatment. Cerebrospinal fluid search for SARS-CoV-2 RNA and antiganglioside antibodies were negative in all COVID+ patients. Temporal clustering of cases, coinciding with the waves of the pandemic, and concomitant reduction of the incidence of COVID-negative GBSs may indicate a role for SARS-CoV-2 infection in the development of GBS, although the association may simply be related to a bystander effect of systemic inflammation; lack of prevalence of specific GBS subtypes in post-COVID-GBS also support this view. GBS features and prognosis are not substantially different compared to non-COVID-GBS.
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COVID-19 , Síndrome de Guillain-Barré , COVID-19/complicações , COVID-19/epidemiologia , Seguimentos , Síndrome de Guillain-Barré/diagnóstico , Humanos , RNA Viral , Estudos Retrospectivos , SARS-CoV-2RESUMO
In women at high/intermediate lifetime risk of breast cancer (BC-LTR), contrast-enhanced magnetic resonance imaging (MRI) added to mammography ± ultrasound (MX ± US) increases sensitivity but decreases specificity. Screening with MRI alone is an alternative and potentially more cost-effective strategy. Here, we describe the study protocol and the characteristics of enrolled patients for MRIB feasibility, multicenter, randomized, controlled trial, which aims to compare MRI alone versus MX+US in women at intermediate breast cancer risk (aged 40-59, with a 15-30% BC-LTR and/or extremely dense breasts). Two screening rounds per woman were planned in ten centers experienced in MRI screening, the primary endpoint being the rate of cancers detected in the 2 arms after 5 years of follow-up. From July 2013 to November 2015, 1254 women (mean age 47 years) were enrolled: 624 were assigned to MX+US and 630 to MRI. Most of them were aged below 50 (72%) and premenopausal (45%), and 52% used oral contraceptives. Among postmenopausal women, 15% had used hormone replacement therapy. Breast and/or ovarian cancer in mothers and/or sisters were reported by 37% of enrolled women, 79% had extremely dense breasts, and 41% had a 15-30% BC-LTR. The distribution of the major determinants of breast cancer risk profiles (breast density and family history of breast and ovarian cancer) of enrolled women varied across centers.
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The Sexual Inhibition Scales and Sexual Excitation Scales (Janssen et al., 2002a), based on the dual control model by Bancroft and Janssen (2000), are part of a 45-item self-report questionnaire evaluating individual tendencies to sexual inhibition or excitation according to three factors: two inhibition factors, SIS1, threat of performance failure, and SIS2, threat of performance consequences, and one excitation factor, SES. In this paper, we aimed to validate and explore psychometric properties of the SIS/SES in a sample of 2260 Italian men and women aged 18 to 75 years. Confirmatory factor analyses showed that the three-factor structure proposed in the original version of the scales fit with our sample. Moreover, our data confirmed the results of the original validation sample: Women scored higher on the SIS and lower on the SES than men did, but no significant differences appeared in the factor scores by age group, except for a gender × age interaction, where younger women had higher SIS2 scores. The SIS/SES appeared to be an effective, appropriate cross-cultural measurement of human sexuality in Italian samples, also shedding light on sexual arousal differences in women and men in our country. We also discuss clinical and therapeutic aspects.
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Comportamento Sexual , Disfunções Sexuais Psicogênicas , Feminino , Humanos , Inibição Psicológica , Itália , Masculino , Psicometria , Inquéritos e QuestionáriosRESUMO
ABSTRACT: Pneumatization variants of the temporal bone have a crucial importance in several surgical interventions. However, very few data are known about possible correlation with other pneumatization variants.Pneumatization of glenoid fossa, petrous apex, and infralabyrinthine portion of temporal bone was assessed in 200 computed tomography scans, equally divided between males and females (18-92âyears). Pneumatization variants of the ethmoid (concha bullosa, agger nasi, pneumatized crista galli) and the sphenoid sinuses (pneumatized pterygoid processes, anterior clinoid processes, dorsum sellae, volume) were recorded as well.Differences in prevalence of each pneumatization type according to sex and side, among different portions of the temporal bone, and between temporal bone and the pneumatized variants of the ethmoid bone and sphenoid sinuses, were assessed through chi-square test (Pâ<â0.05). Differences in sphenoid volume among different pneumatization degrees of the temporal bone were assessed through 1-way analysis of covariance test (Pâ<â0.05).Pneumatization of the petrous apex and the infralabyrinthine portion was significantly more frequent in males than in females, whereas pneumatization of the glenoid fossa was more often observed on the right side (Pâ<â0.05). Variants of the temporal bone are all related one with each other in males, whereas in females only the relationship between pneumatized petrous apex and infralabyrinthine portion was found. Moreover, in females the pneumatized petrous apex was related with pneumatized anterior clinoid process, and the pneumatized infralabyrinthine portion was related with the sphenoid sinus volume.Results may be useful for predicting these important variants in planning surgical interventions of the cranial base.
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Osso Etmoide , Osso Esfenoide , Feminino , Humanos , Masculino , Osso Petroso/diagnóstico por imagem , Osso Esfenoide/diagnóstico por imagem , Seio Esfenoidal/diagnóstico por imagem , Osso Temporal/diagnóstico por imagemRESUMO
PURPOSE: To assess the ability of radiomic features (RF) extracted from contrast-enhanced CT images (ceCT) and non-contrast-enhanced (non-ceCT) in discriminating histopathologic characteristics of pancreatic neuroendocrine tumors (panNET). METHODS: panNET contours were delineated on pre-surgical ceCT and non-ceCT. First- second- and higher-order RF (adjusted to eliminate redundancy) were extracted and correlated with histological panNET grade (G1 vs G2/G3), metastasis, lymph node invasion, microscopic vascular infiltration. Mann-Whitney with Bonferroni corrected p values assessed differences. Discriminative power of significant RF was calculated for each of the end-points. The performance of conventional-imaged-based-parameters was also compared to RF. RESULTS: Thirty-nine patients were included (mean age 55-years-old; 24 male). Mean diameters of the lesions were 24 × 27 mm. Sixty-nine RF were considered. Sphericity could discriminate high grade tumors (AUC = 0.79, p = 0.002). Tumor volume (AUC = 0.79, p = 0.003) and several non-ceCT and ceCT RF were able to identify microscopic vascular infiltration: voxel-alignment, neighborhood intensity-difference and intensity-size-zone families (AUC ≥ 0.75, p < 0.001); voxel-alignment, intensity-size-zone and co-occurrence families (AUC ≥ 0.78, p ≤ 0.002), respectively). Non-ceCT neighborhood-intensity-difference (AUC = 0.75, p = 0.009) and ceCT intensity-size-zone (AUC = 0.73, p = 0.014) identified lymph nodal invasion; several non-ceCT and ceCT voxel-alignment family features were discriminative for metastasis (p < 0.01, AUC = 0.80-0.85). Conventional CT 'necrosis' could discriminate for microscopic vascular invasion (AUC = 0.76, p = 0.004) and 'arterial vascular invasion' for microscopic metastasis (AUC = 0.86, p = 0.001). No conventional-imaged-based-parameter was significantly associated with grade and lymph node invasion. CONCLUSIONS: Radiomic features can discriminate histopathology of panNET, suggesting a role of radiomics as a non-invasive tool for tumor characterization. TRIAL REGISTRATION NUMBER: NCT03967951, 30/05/2019.
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Linfonodos/patologia , Estadiamento de Neoplasias/métodos , Neoplasias Pancreáticas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/secundário , Curva ROC , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodosRESUMO
BACKGROUND: Invasive imaging techniques have been applied for lymphedema (LE) assessment; noncontrast MR lymphography (NCMLR) has potential as an alternative, but its performance is not known in secondary lower limb LE. PURPOSE: To assess the role of NCMRL for the classification and characterization of secondary lower limb LE. STUDY TYPE: Retrospective. POPULATION: Fifty adults with clinically diagnosed secondary LE. FIELD STRENGTH/SEQUENCE: 1.5T, 3D T2 -weighted turbo spin-echo, 3D T2 -weighted turbo spin-echo short tau inversion recovery. ASSESSMENT: Three radiologists assessed the following characteristics on NCMRL: honeycomb pattern, dermal thickening, muscular abnormalities, distal dilated lymphatics, inguinal lymph node number, appearance of iliac lymphatic trunks. An LE grading based on the MR images was assigned. The relationship between imaging findings and clinical staging was evaluated, as well as between dermal backflow at lymphoscintigraphy and MR staging, and between the limb swelling duration and peripheral lymphatics dilatation. STATISTICAL TESTS: Pearson's correlation test and Cramer's V coefficient were computed to measure the strength of association. The Mann-Whitney test was used to compare the limb swelling duration between patients with and without dilated distal vessels. Agreement among raters was assessed through Kendall's W coefficient of correlation. RESULTS: Clinical stage and the MR grading were correlated, with Cramer's V coefficient of 1 for reader 1 (P < 0.05), 0.846 for reader 2 (P < 0.05), and 0.912 (P < 0.05) for reader 3; agreement between interraters was very good (W = 0.0.75; P = 0.05). A honeycomb pattern (P < 0.05), dermal thickening (P < 0.001), muscular abnormalities (P < 0.05), iliac lymphatic trunks appearance (P < 0.05), distal dilated vessels (P < 0.05), and lymph nodes number (P < 0.05) were significantly correlated with LE clinical stage. Dermal backflow at lymphoscintigraphy was described in 10 (20%) patients and showed a significant correlation with the MR grading (P < 0.05). DATA CONCLUSION: These preliminary results suggest that NCMRL may provide information useful for the staging and management of patients affected by secondary lower limb LE. Level of Evidence 4 Technical Efficacy Stage 2 J. MAGN. RESON. IMAGING 2021;53:458-466.
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Linfedema , Linfografia , Adulto , Humanos , Extremidade Inferior/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Linfedema/etiologia , Imageamento por Ressonância Magnética , Estudos RetrospectivosRESUMO
The COVID-19 pandemic is heavily influencing people's general well-being worldwide. Since its outbreak, many studies have explored the population's general psychological well-being, while only a few studies have addressed how the COVID-19 pandemic and the lockdown are affecting sexuality. Sexual health, an important aspect of general well-being, has relevant consequences on people's daily lives. Although it is well known that distress can affect sexuality, and it is possible to speculate that the outbreak's psychological outcomes are affecting the population's sexual life; recent literature does not explore couples' sexuality and their relationship quality during the lockdown. The present preliminary research aimed to understand if the Italian population's sexuality has changed, and if so, how it had changed since the spread of COVID-19, and which variables were influencing couples' relationship quality during the COVID-19 lockdown. A questionnaire reserved especially for cohabiting couples was designed and distributed online from April 11 to May 5, 2020, the 5th and 8th weeks, respectively, after the start of the lockdown. Of the 124 respondents who completed the online survey, 73% were females. Despite the pandemic's psychological consequences, when asked directly, most couples responded that they did not perceive any differences in their sexuality. However, some female participants did report a decrease in pleasure, satisfaction, desire, and arousal. The main reasons behind the changes in sexuality in women, therefore, appear to be worry, lack of privacy, and stress. Even when participants seemed to show high levels of resilience, the negative aspects of lockdown could affect their quality of sexual life. This study needs to be completed using qualitative data from online focus groups that have investigated how sexual life has changed and the main needs of couples. All the same, our results will serve to better address population needs and experiences, and provide ad hoc interventions during this unprecedented time of crisis.
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Chest X-ray (CXR) is an essential first-line tool in COVID-19 pneumonia diagnosis and management. Our study aimed at assessing 1) CXR manifestations, frequency, and distribution; 2) the feasibility and repeatability of a CXR severity score; and 3) the correlation between the CXR severity score and clinical and laboratory parameters. We reviewed baseline CXRs and clinical data of consecutive patients who presented to our emergency department and resulted positive at SARS-CoV-2 reverse transcriptase-PCR oropharyngeal swab test from March 1, 2020 to April 6, 2020. Lung abnormalities and their distribution were analyzed. A score of CXR severity was assigned by two radiologists, independently, according to the extent of lung involvement, with a maximum score of 8 for CXR. Correlations between the CXR score and the clinical data were assessed. One hundred fifty-five patients were included; 143/155 (92%) were positive at baseline CXR. Ground-glass opacity was the most common finding (141/143, 99%). Involvement was mainly bilateral (96/143, 67%), with peripheral distribution (79/143, 55%). The mean CXR severity score was 3.3 (±2); interobserver agreement was excellent, with a Cohen's K correlation coefficient of 0.901. The CXR score showed a significant positive correlation with C-reactive protein, lactate dehydrogenase, and fever duration, and a negative correlation with oxygen saturation. Chest X-ray findings are in line with those reported by computed tomography studies. The use of a visual CXR score, easy to assess and highly reproducible, can reflect the clinical severity and help the patients' management.
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Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Radiografia Torácica , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , COVID-19 , Serviço Hospitalar de Emergência , Estudos de Viabilidade , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Pandemias , Reprodutibilidade dos Testes , Estudos Retrospectivos , SARS-CoV-2RESUMO
The aim of this article is to present recent applications of emotion regulation theory and methods to the field of psychotherapy. The term Emotion Regulation refers to the neurocognitive mechanisms by which we regulate the onset, strength, and the eventual expression of our emotions. Deficits in the regulation of emotions have been linked to most, if not all, psychiatric disorders, with patients presenting either dysregulated emotions, or dysfunctional regulatory strategies. We discuss the implications of regulating emotions from two different theoretical perspectives: the Cognitive Emotion Regulation (CER), and the Experiential-Dynamic Emotion Regulation (EDER) model. Each proposes different views on how emotions are generated, dysregulated and regulated. These perspectives directly influence the way clinicians treat such problems. The CER model views emotional dysregulation as due to a deficit in regulation mechanisms that prioritizes modifying or developing cognitive skills, whilst the EDER model posits emotional dysregulation as due to the presence of dysregulatory mechanisms that prioritizes restoring natural regulatory processes. Examples of relevant techniques for each model are presented including a range of cognitive-behavioral, and experiential (including both dynamic and cognitive) techniques. The aim of the paper is to provide a toolbox from which clinician may gain different techniques to enhance and maintain their patient's capacity for emotional regulation. Finally, the biological mechanisms behind the two models of emotion regulation are discussed as well as a proposal of a dual route model of emotion regulation.
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Infecções por Coronavirus , Coronavirus , Pandemias , Pneumonia Viral , Adulto , Betacoronavirus , COVID-19 , Humanos , Pessoa de Meia-Idade , Radiografia , SARS-CoV-2RESUMO
AIM: To assess imaging findings and characteristics of the lymphatic system in patients affected by lipedema and lipolymphedema of the lower extremities on Non-Contrast MR Lymphography (NCMRL). MATERIALS AND METHODS: 44 lower extremities in 11 consecutive female patients affected by lipedema, and 11 patients with lipolymphedema were examined by NCMRL. MR imaging was performed on 1.5-T system MR equipment. The examination consisted of one 3D short-tau inversion recovery (STIR) and one heavily T2-weighted 3D-Turbo Spin Echo (TSE) sequence. RESULTS: All patients showed symmetrical enlargement of the lower extremities with increased subcutaneous fat tissue. The fat tissue was homogeneous, without any signs of edema in pure lipedema patients. In all the extremities with lipolymphedema, high signal intensity areas in the epifascial region could be detected on the 3D-TSE sequence (p < .001) with evidence of mild epifascial fluid collections (p < .001). No sign of honeycomb pattern fat appearance was observed. The appearance of the iliac lymphatic trunks was normal in both lipedema and lipolymphedema patients. Dilated peripheral lymphatics were observed in 2 patients affected by lipedema, indicating a subclinical status of lymphedema, and in 10 patients with lipolymphedema (p = .001). Signs of vascular stasis were observed in both groups, without statistically significant difference (p = .665). CONCLUSION: NCMRL is a non-invasive imaging technique that is suitable for the evaluation of patients affected by lipedema and lipolymphedema, helping in the differential diagnosis.
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Lipedema/diagnóstico por imagem , Extremidade Inferior/diagnóstico por imagem , Linfografia , Imageamento por Ressonância Magnética , Tecido Adiposo/patologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: Radiofrequency and cryoablation (Cryo) are the most widely used techniques for the treatment of T1a renal tumors in non-surgical candidates, yet microwave ablation (MWA) has been gaining popularity. In this study, we tested the hypothesis that MWA has comparable safety and efficacy to Cryo in the treatment of selected T1a renal masses. MATERIALS AND METHODS: A retrospective comparative analysis of two patient cohorts was carried out on 83 nodules in 72 consecutive patients treated using image-guided percutaneous ablation with either Cryo or MWA. Patient demographics, tumor histology and characteristics, technical success, procedure time, adverse events and complications, nephrometry score (mRENAL) and renal function were evaluated. Local recurrence was evaluated at 1, 6, 12 and 18-24 months. RESULTS: Fifty-one nodules were treated with Cryo and 32 with MWA (44 and 28 patients, respectively). No statistical differences were observed following Cryo or MWA in median tumor size (p = 0.6), mRENAL (p = 0.1) or technical success (p = 0.8). Median procedure time was significantly lower using microwave ablation (p = 0.003). Median follow-up time was similar in the two groups (22 and 20 months, respectively). Occurrence of complications did not differ (Cryo 5/51, MWA 2/32; p = 0.57), and probability of complications or technical success adjusted for mRENAL did not reach statistical significance (p = 0.6). Renal function was preserved in all patients regardless of techniques. Disease recurrence was observed in 3/47 and in 1/30 treated nodules in the Cryo and MWA groups, respectively, without reaching statistical significance (p = 0.06). CONCLUSION: In the patient population studied, MWA showed comparable safety and efficacy relative to Cryo. LEVEL OF EVIDENCE: Level 3, Non-randomized cohort study.
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Técnicas de Ablação/métodos , Criocirurgia/métodos , Neoplasias Renais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Neoplasias Renais/diagnóstico por imagem , Masculino , Micro-Ondas , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
AIM: Our aim was to assess MRI findings in the acute phase of ON and their correlation with visual acuity at presentation, visual outcome (VO) and MS development, to analyze a possible correlation between lesions number and diagnosis, and to assess correlation between orbits MRI and OCT. MATERIALS AND METHODS: We retrospectively studied 37 patients, who presented to our Emergency Department with an ON first episode from January 2015 to January 2017. Patients underwent immediately a complete neuro-ophthalmological evaluation, blood test, CSF analysis. MRI of brain, orbits, cervical spine was executed within 7 days from ON onset. Brain MRI was classified as: normal, non-specific, suspected demyelination, lesions with dissemination in space and time. Optic nerves findings were localized in three sites (intra-orbital, canalicular and chiasmal) and classified as: normal, STIR- alteration, altered contrast enhancement. Patients underwent neuro-ophthalmological follow-up and MRI at 6 months to assess VO (complete recovery, partial recovery, deficit persistence). Another follow-up at 1 year was performed to identify MS or clinically isolated syndrome (CIS). RESULTS: 64.8% patients received a diagnosis of MS; 35% of CIS. Lesions of the optic nerve were found in 65.8%. We observed statistically significant correlation between brain MRI pattern and diagnosis and between lesions number and diagnosis. We observed a statistically significant correlation between orbital MRI pattern and optical coherence tomography (OCT) results. MRI brain findings correlate with development of MS. MRI brain features and lesions number can predict the risk of MS conversion.
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Encéfalo/diagnóstico por imagem , Imageamento por Ressonância Magnética , Esclerose Múltipla/diagnóstico por imagem , Neurite Óptica/diagnóstico por imagem , Doença Aguda , Adulto , Técnicas de Diagnóstico Oftalmológico , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/etiologia , Nervo Óptico/diagnóstico por imagem , Neurite Óptica/tratamento farmacológico , Estudos Retrospectivos , Estatísticas não Paramétricas , Esteroides/uso terapêutico , Fatores de Tempo , Tomografia de Coerência Óptica , Acuidade Visual , Adulto JovemRESUMO
BACKGROUND: Spinocerebellar ataxias are rare dominantly inherited neurodegenerative diseases that lead to severe disability and premature death. OBJECTIVE: To quantify the impact of disease progression measured by the Scale for the Assessment and Rating of Ataxia on survival, and to identify different profiles of disease progression and survival. METHODS: Four hundred sixty-two spinocerebellar ataxia patients from the EUROSCA prospective cohort study, suffering from spinocerebellar ataxia type 1, spinocerebellar ataxia type 2, spinocerebellar ataxia type 3, and spinocerebellar ataxia type 6, and who had at least two measurements of Scale for the Assessment and Rating of Ataxia score, were analyzed. Outcomes were change over time in Scale for the Assessment and Rating of Ataxia score and time to death. Joint model was used to analyze disease progression and survival. RESULTS: Disease progression was the strongest predictor for death in all genotypes: An increase of 1 standard deviation in total Scale for the Assessment and Rating of Ataxia score increased the risk of death by 1.28 times (95% confidence interval: 1.18-1.38) for patients with spinocerebellar ataxia type 1; 1.19 times (1.12-1.26) for spinocerebellar ataxia type 2; 1.30 times (1.19-1.42) for spinocerebellar ataxia type 3; and 1.26 times (1.11-1.43) for spinocerebellar ataxia type 6. Three subgroups of disease progression and survival were identified for patients with spinocerebellar ataxia type 1: "severe" (n = 13; 12%), "intermediate" (n = 31; 29%), and "moderate" (n = 62; 58%). Patients in the severe group were more severely affected at baseline with higher Scale for the Assessment and Rating of Ataxia scores and frequency of nonataxia signs compared to those in the other groups. CONCLUSION: Rapid ataxia progression is associated with poor survival of the most common spinocerebellar ataxia. Theses current results have implications for the design of future interventional studies of spinocerebellar ataxia. © 2019 International Parkinson and Movement Disorder Society.
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Ataxias Espinocerebelares/mortalidade , Ataxias Espinocerebelares/fisiopatologia , Adulto , Idoso , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Estudos de Coortes , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Progressão da Doença , Distonia/etiologia , Distonia/fisiopatologia , Feminino , Humanos , Estudos Longitudinais , Doença de Machado-Joseph/complicações , Doença de Machado-Joseph/mortalidade , Doença de Machado-Joseph/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ataxias Espinocerebelares/complicações , Taxa de Sobrevida , Fatores de TempoRESUMO
Our experience suggests that ultrasound-assisted thrombolysis with the EkoSonic system could be a valid bail-out strategy in cases of massive pulmonary embolism unresponsive to systemic thrombolysis and provides insight into the role of prolonged administration time in non-high bleeding risk patients with elevated thrombotic burden and initial suboptimal results. In this setting, multimodality imaging could guide patient selection and monitor treatment efficacy to individualize its duration in cases of slow hemodynamic improvement.
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Cateterismo de Swan-Ganz/métodos , Artéria Pulmonar , Embolia Pulmonar , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Ultrassonografia de Intervenção/métodos , Angiografia por Tomografia Computadorizada/métodos , Ecocardiografia/métodos , Fibrinolíticos/administração & dosagem , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Terapia Trombolítica/instrumentação , Terapia Trombolítica/métodos , Resultado do TratamentoRESUMO
PURPOSE: The aim of this study was to quantify the impact of CT delineation uncertainty of pancreatic neuroendocrine neoplasms (panNEN) on Radiomic features (RF). METHODS: Thirty-one previously operated patients were considered. Three expert radiologists contoured panNEN lesions on pre-surgical high-resolution contrast-enhanced CT images and contours were transferred onto pre-contrast CT. Volume agreement was quantified by the DICE index. After images resampling and re-binning, 69 RF were extracted and the impact of inter-observer variability was assessed by Intra-Class Correlation (ICC): ICCâ¯>â¯0.80 was considered as a threshold for "very high" inter-observer agreement. RESULTS: The median volume was 1.3â¯cc (range: 0.2-110â¯cc); a satisfactory inter-observer volume agreement was found (mean DICEâ¯=â¯0.78). Only 4 RF showed ICCâ¯<â¯0.80 (0.48-0.73), including asphericity and three RFs (of five) of the neighborhood intensity difference matrix (NID). CONCLUSIONS: The impact of inter-observer variability in delineating panNEN on RF was minimum, with the exception of the NID family and asphericity, showing a moderate agreement. These results support the feasibility of studies aiming to assess CT radiomic biomarkers for panNEN.
Assuntos
Carcinoma Neuroendócrino/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Incerteza , Humanos , Padrões de Referência , Tomografia Computadorizada por Raios X/normasRESUMO
PURPOSE: The pterygopalatine fossa is an important anatomical structure for several surgical and anaesthesiologic procedures; yet, very few data are available about its size. This study aims at providing a metrical assessment of pterygopalatine fossa through an innovative 3D segmentation procedure on head CT-scans. METHODS: CT-scans from 100 patients (50 males and 50 females) aged between 18 and 85 years were chosen for the study. Right and left pterygopalatine fossae were segmented through ITK-SNAP open source software. Height and volume were calculated on the acquired 3D models. In addition, anterior-posterior nasal spine distance, upper facial height (nasion-prosthion) and biorbital breadth (ectoconchion-ectoconchion) were measured as well. Statistically significant differences of height and volume according to sex and side were assessed through two-way ANOVA test: sexually dimorphic measurements were further assessed through one-way ANCOVA test using the three cranial measurements as covariates (p < 0.05). RESULTS: On average pterygopalatine fossa height was 24.1 ± 3.5 mm in males, and 22.8 ± 3.4 mm in females, whereas volume was 0.930 ± 0.181 cm3 in males and 0.817 ± 0.157 cm3 in females, with statistically significant differences according to sex (p < 0.05), but not to side (p > 0.05); interaction was negligible for both the measurements. ANCOVA test verified that sexual dimorphism of both measurements is independent from general cranial size (p < 0.05). CONCLUSIONS: The present study highlighted the sexual dimorphism of pterygopalatine fossa: results may improve the knowledge of this anatomical structure difficult to explore, but crucial in several fields of clinics and surgery.