Use of amyloid PET/CT with 18F-Florbetaben in the management of patients with Alzheimer's disease.

INTRODUCTION AND AIM: Amyloid PET/CT is an "in vivo" imaging that may radically change management of Alzheimer's disease (AD) thanks to its ability to identify AD at the earliest stage. A diagnosis of dementia is currently made in terms of probability and is based on clinical evaluation (neuropsycological tests) as well as on the results of morphological imaging investigations (MRI) that can be supported by biohumoral (CSF analysis), and functional imaging only in the case of uncertain diagnosis of disease. The present study aimed to evaluate the role of amyloid PET/CT in the management of patients with suspicion of AD, through comparison with instrumental and clinical evaluation. METHODS: 38 consecutive patients with suspicion of AD (23 female, 15 male; median age 63 years old, range 46-72), who performed 18F-florbetaben PET/CT, were retrospectively reviewed. All of them performed a previous instrumental evaluation. A subgroup of patients (24/38) were evaluated with Mini Mental State Examination (MMSE). Cohen's K test was used as a measure of agreement between previous instrumental examinations/clinical evaluation and beta-amyloid PET results. RESULTS: Twenty-five/38 (65.8%) amyloid PET/CT scans resulted positive for amyloid deposition. Among the four target regions, precuneus was the most frequently involved. Previous instrumental evaluation was: MRI in 26/38 patients (24/26 positive for atrophy), CT in 9/38 (8/9 positive for atrophy), perfusion SPECT in 12/38 (8/12 areas of hypo-perfusion), 18F-FDG PET/CT in 2/38 (1/2 hypometabolism in frontal cortex). The agreement between previous instrumental examinations and beta-amyloid PET results was low (K= 0.084). In the subgroup of 24/38 patients, MMSE was scored positive (MMSE<24) in 14/24 (58.4%) and negative (MMSE>24) in 10/24 (41.6%). The agreement between clinical evaluation (MMSE) and beta-amyloid PET results was fair (K= 0.217). CONCLUSION: The low agreement between amyloid PET/CT and previous clinical and instrumental assessments that we found in our study suggests that the amyloid PET/CT provides additional and early information. To perform an early and differential diagnosis of AD could have a great impact on the patient's management and cost of care in order to perform the correct therapeutic interventions and to allow family members to manage adequately the patient's demanding care.

Impact of pre-treatment variables on the completion of 223radium-dichloride therapy in mCRPC patients with bone metastases.

INTRODUCTION: Radium-223 dichloride (223Ra) is an alpha-particle-emitter radiopharmaceutical, approved for metastatic castration-resistant prostate cancer (mCRPC) patients with symptomatic bone metastases and no visceral involvement. Its administration is based on a schedule of intravenous injection (55kBq/kg) every four weeks for up to six cycles. Because the biological effectiveness of 223Ra-therapy is dose-dependent, the main goal is to complete the entire treatment to achieve a better patient outcome. This study aims to identify potential pre-treatment variables that could impact on 223Ra-treatment completion and then be used to improve the clinical and supportive management of mCRPC patients. MATERIALS AND METHODS: 30 consecutive mCRPC patients (mean age 77 years old), who were admitted for Ra223-therapy at our Department from February 2016 to October 2018, were enrolled for the analysis. The population was grouped as patients who completed 223Ra-therapy (group Ra223-C) and patients who do not (group 223Ra-U). For each group, we analyzed the effects of potential pre-treatment variables (age, Gleason Score, tumor burden, "Time From Diagnosis To 223Ra therapy", type and number of previous treatments, hemoglobin level, Alkaline Phosphatase, Prostate Specific Antigen and pain) on the Ra223-therapy completion. Statistical analysis was performed to evaluate the association between the completion of 223Ra therapy and the variables examined. RESULTS: 16/30 (53%) patients were 223Ra-C, conversely 14/30 (47%) patients were 223Ra-U because of an early interrupted treatment. A statistically significant association was found only with tumor burden: 68.7% of patients who completed 223-therapy had less than 20 bone metastases (χ2=4.821, p=0.028). CONCLUSION: Our preliminary analysis demonstrates that the high tumor burden represents the most important pre-treatment factor that could affect treatment completion and that needs to be considered before starting 223Ra-therapy to achieve a better outcome in mCRPC patients.

Biofilms on tuff stones at historical sites: identification and removal by nonthermal effects of radiofrequencies.

A methodology aiming at identifying and removing biofilms from cultural heritage was applied to stones from tuff walls in historical sites. Identification of phototrophic encrusting microorganisms was carried out by optical and electron microscopy, as well as by molecular techniques (DNA analyses and denaturing gradient gel electrophoresis (DGGE)). In all sites, the examination of microbial components of biofilms resulted in the identification of 17 species belonging to Cyanobacteria, Rhodophyta, Bacillariophyta and Chlorophyta, with Cyanobacteria being the dominant components in all biofilms. In order to remove the biofilms, an innovative technique based on the use of nonthermal effects of radiofrequencies was adopted. The source of the electromagnetic fields was a signal generator connected to a horn antenna through an amplifier to provide the power boost required to generate the target field amplitude. Seven days after exposure to radiofrequency electromagnetic field, about 50 % reduction of biofilm was observed; after 14 days, biofilm extension was reduced by about 90 %. DGGE analyses performed after 14 days confirmed these visual inspections. Also, DGGE analyses carried out before and 14 days after treatments showed that 12 out of 17 identified species disappeared. A complete visual disappearance of biofilms was observed a month after the beginning of treatments. DGGE repeated at this time confirmed the total disappearance of biofilm-forming species. Treated stones, when transferred back to their original sites, did not show any microorganism re-growing after 6 months. No alteration in the color and structural consistency of tuff substrata was observed after radiofrequency treatments.

Cytological and molecular characterization of Vicia barbazitae Ten. & Guss.

Vicia barbazitae, a taxon belonging to section Vicia of subgenus Vicia, was recovered and analysed by cytological, karyological and molecular methods with the aim of both proposing a general characterisation of this species and studying the relationships among the species of section Vicia . Phylogenetic relationships among the species of the section Vicia and those of the sections Microcarinae, Wiggersia and Atossa were also analysed. Automated karyotype analysis has been determined after Feulgen's reaction; chromosome banding was performed by sequence-specific fluorochrome staining. Fluorescent chromosome banding showed CMA(+)/DAPI(-) NOR-associated heterochromatin in the satellite pair. Karyomorphological parameters, based on symmetry indices, the dendrogram of linkage distance constructed on 37 chromosome parameters, as well as the molecular data based on internal transcribed spacer sequences provided information about phylogenetic position of this species inside the section Vicia and among the species belonging to the sections Microcarinae, Wiggersia, Atossa and Vicia. From our karyological and molecular results, it emerges that V. barbazitae can be considered a natural member of section Vicia.

Cytology of Vicia species. X. Karyotype evolution and phylogenetic implication in Vicia species of the sections Atossa, Microcarinae, Wiggersia and Vicia.

Automated karyotype analyses and sequence of rDNA spacers have been analysed for the species belonging to sections Atossa, Microcarinae, Wiggersia and Vicia. Karyomorphological parameters, based on Rec, Syi and TF% indices, have been determined and evidenced that, in term of symmetry, the karyotype of Vicia lathyroides was the most asymmetric one. A multivariate analysis using 34 karyological parameters, in addition to the symmetry indices, has been carried out and the corresponding dendrogram of linkage distances showed six different groups. Molecular investigations on the inclusive group in study by employing ITS DNA sequences indicated a different pattern of relationships. The cladistic analysis combining the molecular data set with karyological parameters evidenced that the species of sections Vicia and Atossa join closely to each other in a paraphyletic group, which includes the monophyletic section Wiggersia. Therefore, our karyological and molecular data provide information about the phylogenetic position of the analysed species inside the subgenus Vicia and are discussed in relation to previous results obtained by morphology, isozymes and ribosomal genes analyses.

Resident education in principles and technique of bowel surgery using an ex-vivo porcine model.

Objective. improve competency of residents with lysis of adhesion (LOA) and bowel surgery using a porcine model. Study Design. Pig bowel was removed at time of an anatomy laboratory, cleansed, and used to demonstrate surgical techniques and principles of LOA, repair of enterotomy, bowel resection, and anastomosis. Participants were surveyed pre- and posttraining session using 10 point Likert scale. Results. Thirty one residents at varying levels of training participated. After the training session, there was a significant improvement noted in mean scores for comfort level with LOA (6.3 versus 7.7, P = .007), comfort level with enterotomy repair (2.8 versus 6.4, P < .0001), understanding principles of LOA (5.0 versus 7.7, P < .0001), understanding principles of enterotomy repair (3.5 versus 7.0, P < .0001), and familiarity with instruments used (5.8 versus 7.3, P = .01). Conclusion. Training sessions using ex-vivo porcine model improve resident perception of knowledge and comfort with LOA and enterotomy repair.

Development of a chemiluminescent ELISA and a colloidal gold-based LFIA for TNT detection.

To identify the explosive used in a terrorist attack, or to obtain an early sign of environmental pollution it is important to use simple and rapid assays able to detect analytes at low levels, possibly on-site. This is particularly true for TNT (2,4,6-trinitrotoluene), one of the most employed explosives in the 20th century and at the same time, because of its toxicity, a well known pollutant. In this work we describe the development of an indirect competitive ELISA with chemiluminescent detection (CL-ELISA) and of a lateral-flow immunoassay (LFIA) based on colloidal gold nanoparticle labels. A commercially available monoclonal antibody was used and 13 specially synthesized conjugates were tested. We optimized the assay by determining the optimal concentration of monoclonal antibody and conjugates and the influence of various non-specific factors such as: tolerance to organic solvents at different concentrations, the washing and competitive step time, and the cross-reactivity with related compounds. The sensitivity and reproducibility of the CL-ELISA were good (LOD and IC(50) values in the ng mL(-1) range, and CV value about 7%). It has been applied to real samples of various materials involved in a controlled explosion of an "improvised explosive device". Three extraction procedures were tested on these samples, all employing methanol as the solvent. The lateral flow immunoassay (LFIA), developed by using the same immunoreagents, reached a detection limit of 1 microg mL(-1) when tested on the same samples analysed by CL-ELISA.

Cytological and molecular characterization of Vicia esdraelonensis Warb. & Eig: a rare taxon.

Vicia esdraelonensis, a rare taxon belonging to section Hypechusa of subgenus Vicia, was recovered and analyzed by cytological, karyological, and molecular methods, with the aim of both characterizing this species and furthering our knowledge of the phylogeny of subgenus Vicia. Automated karyotype analysis, nuclear DNA content, and chromatin organization were determined by the Feulgen reaction, as well as chromosome banding after double staining with 4',6-diamidino-2-phenylindole (DAPI) and chromomycin A3. The chromosome number and the nuclear DNA content were in agreement with the values of the species of section Hypechusa. The GC- and AT-rich preferential sites were determined by chromomycin A3 and DAPI staining. Karyomorphological parameters indicated that V. esdraelonensis is in an intermediate position in the spatial representation of the species of section Hypechusa on the basis of symmetry indices, as well as in the dendrogram of linkage distance constructed on 37 chromosome parameters. Molecular data based on internal transcribed spacer sequences show that V. esdraelonensis can doubtlessly be included in section Hypechusa and document its closeness to V. noeana. A cladistic analysis combining the molecular data set with karyological characters is also reported. Karyological, cytological, and molecular data allow characterization of the V. esdraelonensis genome and provide information about the phylogenetic position of this species within the Hyrcanicae series of section Hypechusa.

[A surgical emergency: iatrogenic lesion of the spleen. Case report and review of the literature]. / Un'emergenza chirurgica: la lesione iatrogena della milza. Caso clinico e review della letteratura.

The spleen is an organ often injured during surgical procedures. Iatrogenic lesions belong frequently to a low grade and can be treated with a conservative therapy. The surgeon may avoid the splenectomy by using new haemostatic agents as the patch of fibrinogen and thrombin in fixed combination.

Nuclear DNA contents, rDNAs, and karyotype evolution in subgenus Vicia: III. The heterogeneous section Hypechusa.

Nuclear DNA contents, automated karyotype analyses, and sequences of internal transcribed spacers from ribosomal genes have been determined in the species belonging to section Hypechusa of the subgenus Vicia. Karyomorphological results and phylogenetic data generated from the comparison of rDNA (genes coding for rRNA) sequences showed that sect. Hypechusa is not monophyletic; however, some monophyletic units are apparent (one including Vicia galeata, V. hyrcanica, V. noeana, and V. tigridis, another including V. assyriaca, V. hybrida, V. melanops, V. mollis, and V. sericocarpa), which partly correspond to morphology-based infrasectional groups. The relationships among these species and the species in sections Faba, Narbonensis, Bithynicae, and Peregrinae have been also investigated.

Nuclear DNA contents, rDNAs, and karyotype evolution in Vicia subgenus Vicia: II. Section Peregrinae.

Nuclear DNA contents, automated karyotype analyses, and sequences of rDNA spacers have been determined for the species of Vicia belonging to sect. Peregrinae, as well as for V. mollis. The phylogenetic data generated from the comparison of rDNA sequences and karyomorphological results would both indicate that Vicia mollis is a sister group to sect. Peregrinae. The relationships among the species belonging to the Peregrinae section and species enclosed in sections Faba, Narbonensis, and Bithynicae have been also investigated: a clade including V. mollis and sect. Peregrinae is a sister group to a clade including V. bithynica and sect. Narbonensis. With our choice of outgroup, Vicia faba (including subsp. paucijuga) is external to the above mentioned inclusive group.

Giant proximity effect in cuprate superconductors.

Using an advanced molecular beam epitaxy system, we have reproducibly synthesized atomically smooth films of high-temperature superconductors and uniform trilayer junctions with virtually perfect interfaces. We found that supercurrent runs through very thick barriers. We can rule out pinholes and microshorts; this "giant proximity effect" (GPE) is intrinsic. It defies the conventional explanation; it might originate in resonant tunneling through pair states in an almost-superconducting barrier. GPE may also be significant for superconducting electronics, since thick barriers are easier to fabricate.

No mixing of superconductivity and antiferromagnetism in a high-temperature superconductor.

There is still no universally accepted theory of high-temperature superconductivity. Most models assume that doping creates 'holes' in the valence band of an insulating, antiferromagnetic 'parent' compound, and that antiferromagnetism and high-temperature superconductivity are intimately related. If their respective energies are nearly equal, strong antiferromagnetic fluctuations (temporally and spatially restricted antiferromagnetic domains) would be expected in the superconductive phase, and superconducting fluctuations would be expected in the antiferromagnetic phase; the two states should 'mix' over an extended length scale. Here we report that one-unit-cell-thick antiferromagnetic La2CuO4 barrier layers remain highly insulating and completely block a supercurrent; the characteristic decay length is 1 A, indicating that the two phases do not mix. We likewise found that isolated one-unit-cell-thick layers of La1.85Sr0.15CuO4 remain superconducting. The latter further implies that, on doping, new electronic states are created near the middle of the bandgap. These two findings are in conflict with most proposed models, with a few notable exceptions that include postulated spin-charge separation.

[Gynaecological pelvic mass. Emergency clinical assessment]. / Le tumefazioni ginecologiche dello scavo pelvico. Atteggiamento clinico in urgenza.

BACKGROUND: The authors report the gynaecological pathology of surgical interest occurring in an Emergency Department in the first half of 2000 and occasionally found during an operation in women who presented a pelvic mass or abdominal pain. METHODS: Six women, average age of 50 years, reached the Emergency Department: five of them were operated with an emergency procedure. RESULTS: Of the 6 cases, 1 patient was affected by uterine mass, 1 by uterine-ovarian mass and 3 by ovarian mass; in one patient, affected by ovarian tumour, another intervention was necessary for intestinal metastasis. CONCLUSIONS: The authors have considered the clinical aspect of the abdominal masses, the age of the patients, the diagnostic laboratory and instrumental implications, the surgical approach and the histological result, referring to literature. Their contribution is related to the need for an appropriate surgical approach in emergency where it may, sometimes, solve or, at least, stabilize an uncertain clinical case, thanks to the implicit basic knowledge of multidisciplinary surgical technique.

[CT pulmonary density mapping: surgical utility]. / Mappe TAC di isodensità polmonare: significato chirurgico.

BACKGROUND: The present paper considers the technique of CT scan maps of pulmonary isodensity, examining lung density differences as a function of the type of disease and considering their significance for the purposes of refined, useful diagnosis in a surgical context. METHODS. The method is used to examine 3 groups of subjects selected on a clinical/anamnestic basis and a further group already admitted for surgery. For each patient we obtained 2 thoracic density scans during the phase of maximum inspiration and expiration. On each scan we constructed 50 isodensity maps, the equivalent of more than 2500 measurements: the preliminary standard was represented by 100 wide windows to produce total "illumination" of the pulmonary fields. The isodensity windows were then codified differently. Subsequently, the density scans were analysed with the technique of scalar decomposition. RESULTS: The CT scan maps of lung isodensity proved useful for certain lung diseases in which early diagnosis, topographic extent of the pathology and the refined definition of the pathological picture provide important solutions as regards the indication and planning of surgical treatment and for the evaluation of the operative risk and prognosis. CONCLUSIONS: We consider that the technique is rapidly performed, not complex and inexpensive and is able to supply detailed information on the lung parenchyma such as to be used not only as a routine technique but also in emergencies.

[Rupture of the urinary bladder caused by trivial trauma. Case report]. / Lo scoppio della vescica repleta da trauma banale. Contributo clinico.

The urinary bladder occupies the deep pelvic cavity and is well protected from the bacin: this is the reason why it can rarely be traumatized. Anyway it could suffer traumas, which can cause extraperitoneal and intraperitoneal ruptures. A classification of traumas that can injure the urinary bladder and the treatments of these lesions are presented. A clinical case personal observed regarding a 78 year-old female patient is described. An accidental fall and direct trauma in the hypogastrium caused a rupture of her urinary bladder. In this case, the patient was anuric, though the macrohematuria and microhematuria can be present in the 85% of the urinary bladder lesions. This is an interesting case since it deals with a urinary bladder wall rupture, due to a trivial trauma on the bladder.

[Combined complex surgical procedures: cardiovascular and general surgery]. / Gli interventi chirurgici complessi combinati: chirurgia cardiaca e chirurgia generale.

BACKGROUND: Aim of the paper is to evaluate the surgical indication in patients with cardiac and concomitant pathology. METHODS: In this study, are examined ten combined surgical sessions performed from 1992 at 1999, in patients affected by both cardiac and neoplastic disease with surgical indication. Eight men and two women, mean age 59.4 (range 50-68 years), eight affected by thoracic or abdominal tumour, one affected by hypersplenism and one by pulmonary cystic dysplasia with recurring pneumothorax. Anatomic resection and in two patient wedge-resection were performed except one woman who was splenectomized and one man who underwent atypical resection and pulmonary decortication. All subjects required extracorporeal circulation. RESULTS: No peri-operative deaths were observed and mean survival was 34 months (range 6-72 months). Moreover, there were no hemorrhages due to coagulation values of extracorporeal circulation. This approach proved useful both from the economic point of view and hospitalization time. CONCLUSIONS: According to personal experience this can be considered a successful therapeutic choice in selected patients. These observations suggest further considerations on combined operations surgery risk and mortality-morbidity appears to be reduced by a better myocardial revascularization.

Maternal inheritance of plastids in Encephalartos Lehm. (Zamiaceae, Cycadales).

The mode of inheritance of chloroplast DNA has been determined in Encephalartos by employing a restriction fragment length polymorphism analysis of chloroplast DNA. Artificial F1 hybrids were produced between a female specimen of E. natalensis and a male specimen of E. woodii. The hybridization patterns of all hybrids correspond, in all cases, with that of E. natalensis, and are different from that of E. woodii, thus indicating the maternal inheritance of cpDNA in cycads.

[Biliary complications during videolaparoscopic cholecystectomy. Remarks on methodology and indications in the training period]. / Le complicanze biliari in corso di colecistectomia videolaparoscopica. Riflessioni sulla metodica e sulle indicazioni nella fase di apprendimento.

In our study we have considered the activity of a surgeon working in our Surgery Department during his laparoscopic training period. We focus our attention on a date related to the same complications checked in 27 cases of cholelithiasis operated by the same surgeon. We have observed three cases of biliary cholelithiasis fistulas, all of them during the three last operations. The examination of the above mentioned cases considers the clinical post-surgery situation and the therapeutic standards we adopted to work out the complications. Now we can precisely state, according to our experience, the particular directions for the videolaparoscopic training period. In addition we can propose one simple mathematical formula to value the IRL (Laparoscopic Risk Index) concerning three variables: the experience of the surgeon; the instruments condition; the clinical situation of the patient. The relation of these three factors turned in numbers suggests the chance of success of a videolaparoscopic operation. We conclude our study mentioning the gasless videolaparoscopic technique that seems to have a large indication, according to the same Surgery School. This technique is particulary indicated on those classes of patients in which the CO2 insufflation into abdominal cavity and the increase of endocavity pressure can represent a contraindication to the videolaparoscopic approach: in this case the surgeon will follow the surgical indication to solve the clinical situation, as happens in war surgery.

[Hemorrhoids: epidemiology and correlation with chronic constipation]. / Malattia emorroidaria: inquadramento epidemiologico e correlazione con la stipsi cronica.

Following a review of international literature, AA report main results and refer their opinion about the correlation of hemorrhoidal disease with constipation, considering some variants as well as age, sex, breed, social-economic condition and geographic distribution in USA, England and Wales. Epidemiologically ten millions of people, in USA, are affected by hemorrhoidal disease; the incidence rate is 4.4% with an age distribution that shows a prevalence between 45-65 years old subject while constipation has an exponential increase with aging. Hemorrhoidal disease is significantly influenced by sex and geographic distribution that is in white breed more than in black, in social high class and in men more than women. In black breed constipation and hemorrhoidal disease present especially in lower social classes. Based on these results hemorrhoidal disease shows on epidemiological pattern that differ from constipation's one. Many questions are still present about correlations between hemorrhoidal disease and chronic constipation regarding etiopathogenesis. Only future case-control studies will solve the problem.