Pancreas fat quantification with quantitative CT: an MRI correlation analysis.

AIM: To assess the fat content of the pancreas using quantitative computed tomography (QCT) and to correlate the results with chemical-shift-encoded magnetic resonance imaging (CSE-MRI) measurements of proton density fat fraction (PDFF). MATERIAL AND METHODS: Institutional review board approval for this research was obtained and 52 participants (25 men, 27 women; mean age 35.1 years; age range 22-50 years), who were enrolled in the Prospective Urban Rural Epidemiology (PURE) Study, underwent QCT and CSE-MRI for quantification of fat content in the pancreas. Two observers placed regions of interest (area of 100-130 mm2) in the head, body, and tail of the pancreas as closely matched as possible on the two scans. Pearson correlation and Bland-Altman analysis were performed to evaluate the correlation between the QCT and CSE-MRI measurements and the systematic difference between the two techniques. RESULTS: The QCT and CSE-MRI measurements of pancreatic fat content were well correlated (r=0.805, p<0.0001), although Bland-Altman analysis showed that the QCT measurements were systematically lower by 6.3% compared to CSE-MRI PDFF. CONCLUSION: In conclusion, the results of this study suggest good correlation between QCT and CSE-MRI measurements of pancreatic fat content. Further studies are required to improve the numerical agreement of QCT measurements with PDFF.

Abdominal Aortic Calcification as a Marker of Relationship Between Atherosclerosis and Skeletal Fragility.

There is a pathophysiological and clinical link between atherosclerosis and skeletal fragility. Abdominal aortic calcifications (AACs) can be considered as a marker of coexistent atherosclerotic disease and osteoporosis. Indeed, AACs have been associated with alterations in bone strength and severe AACs predicted vertebral fractures in post-menopausal women and older men, independent of densitometric diagnosis of osteoporosis. Although quantitative computed tomography is the gold standard for evaluation of AACs, dual-energy x-ray absorptiometry can be considered as a cost-effective tool to identify and quantify AACs in clinical practice. This article provides an update on diagnostic aspects and clinical relevance of AACs as predictor of fractures in patients at high cardiovascular risk.

Pro-inflammatory dietary pattern is associated with fractures in women: an eight-year longitudinal cohort study.

In this study, during 8 years of follow-up, we reported that higher dietary inflammatory index values were associated with a higher risk of incident fractures in women, but not in men, after adjusting for potential confounders. INTRODUCTION: Inflammation is a key risk factor for many adverse outcomes in older people. While diet is a potential source of inflammation, little is known about the impact of inflammatory diet on fractures. Thus, we investigated whether higher Dietary Inflammatory Index (DII)™ ® scores are associated with fractures in a cohort of North American people. METHODS: This longitudinal study with a follow-up of 8 years included 3648 participants (1577 males and 2071 females; mean age = 60.6 years) with/at risk of knee osteoarthritis participating with in the Osteoarthritis Initiative. DII scores were calculated using the validated Block Brief 2000 Food Frequency Questionnaire, categorized into sex-specific quintiles. Information on fractures was obtained through self-reported history of fractures at hip, spine, and forearm. The relationship between baseline DII score and incident fracture was assessed through a Cox's regression analysis, adjusted for potential baseline confounders, and reported as hazard ratios (HRs). RESULTS: During 8 years of follow-up, 560 individuals developed fractures (15.4%). Adjusting for 10 potential confounders, women in the highest DII score quintile (i.e., most pro-inflammatory diet) had a significantly higher risk for fractures (HR = 1.46; 95% CI = 1.02-2.11) compared to women in the lowest quintile. An increase in one standard deviation of DII scores significantly predicted fracture onset in women (adjusted HR = 1.14; 95% CI = 1.02-1.27). The association between DII score and fractures was not significant among men or in the sample as whole. CONCLUSION: Pro-inflammatory diet is associated with a higher incidence of fractures in women but not men.

Bone management in hematologic stem cell transplant recipients.

Autologous and allogeneic hematopoietic stem cell transplantation (HSCT) is the treatment of choice for patients with some malignant and non-malignant hematological diseases. Advances in transplantation techniques and supportive care measures have substantially increased the number of long-term HSCT survivors. This has led to an increasing patient population suffering from the late effects of HSCT, of which, bone loss and its consequent fragility fractures lead to substantial morbidity. Altered bone health, with consequent fragility fractures, and chronic graft-versus-host disease (GVHD) are factors affecting long-term quality of life after HSCT. Hypogonadism, HSCT preparative regimens, nutritional factors, and glucocorticoids all contribute to accelerated bone loss and increased fracture risk. Management strategies should include bone mineral density examination, evaluation of clinical risk factors, and general dietary and physical activity measures. Evidence has accumulated permitting recommendations for more attentiveness to evaluation and monitoring of bone health, with appropriate application of osteoporosis pharmacotherapies to patients at increased risk of bone loss and fracture.

Age-related changes of bone mineral density in mandible by quantitative computed tomography.

Quantitative Computed Tomography (QCT) was used to investigate age-related changes in trabecular bones of the mandible. The volumetric Bone Mineral Density (vBMD) of mandibles was found to be increasing with aging in the 20-29, 30-39, 40-49 age groups, while resulted decreasing in the 50~ years age group in a Chinese population. The aim of this study was to validate QCT as a reliable method to measure the vBMD of the mandible and to assess vBMD of the mandible in a Chinese population. A total of seven hundred and eighteen volunteers (299 males, 419 females), ranging from 20 to 63 years of age, previously enrolled in another study, were included for vBMD measurements by QCT. A total of 50 subjects were enrolled for the validation of QCT measurement. Basic information (age, height and weight), and vBMD of the mandible (middle, body and angle) were recorded. Comparisons among age and sex groups were analyzed using the Mann-Whitney test. Linear correlation analysis between vBMD and age was performed. The mandibular vBMD was twice measured with QCT by one operator and resulted highly repeatable (ICC 0. 97, P 0. 05). The vBMD in the middle of the mandible was the highest, followed by that in the body and at the angle of mandible. In each age group, the mean vBMD increased with aging except for the 50~ years age group (P less than 0.05) in which it decreased. The mean mandibular vBMD was higher in females than males in each age group (P less than 0.05). Correlation between vBMD and age was statistically significant (r=0.15, P less than 0.01). QCT shows high precision for the measurement of BMD in the mandible. The present study provides normative data of the mandible in an age- and sex-stratified manner, which can be helpful in clinical practice.

Cyanobacterial ultrastructure in light of genomic sequence data.

Cyanobacteria are physiologically and morphologically diverse photosynthetic microbes that play major roles in the carbon and nitrogen cycles of the biosphere. Recently, they have gained attention as potential platforms for the production of biofuels and other renewable chemicals. Many cyanobacteria were characterized morphologically prior to the advent of genome sequencing. Here, we catalog cyanobacterial ultrastructure within the context of genomic sequence information, including high-magnification transmission electron micrographs that represent the diversity in cyanobacterial morphology. We place the image data in the context of tabulated protein domains-which are the structural, functional, and evolutionary units of proteins-from the 126 cyanobacterial genomes comprising the CyanoGEBA dataset. In particular, we identify the correspondence between ultrastructure and the occurrence of genes encoding protein domains related to the formation of cyanobacterial inclusions. This compilation of images and genome-level domain occurrence will prove useful for a variety of analyses of cyanobacterial sequence data and provides a guidebook to morphological features.

Improving adherence to and persistence with oral therapy of osteoporosis.

UNLABELLED: Osteoporosis treatment has low adherence and persistence. This study evaluated if greater patient involvement could improve them. At 12 months, only 114 out of 344 participants were "fully adherent and persistent" (all drug doses taken throughout the study). Only frequency of drug administration had a significant influence on adherence. INTRODUCTION: Osteoporosis affects millions of individuals worldwide. There are now several effective drugs, but adherence to and persistence with treatment are low. This 12-month multicenter, prospective, randomized study evaluated the efficacy of two different methods aimed at improving adherence and persistence through greater patient involvement, compared with standard clinical practice. METHODS: Three hundred thirty-four post-menopausal women, receiving an oral prescription for osteoporosis for the first time, were recruited and randomized into three groups: group 1 (controls, managed according to standard clinical practice) and groups 2 and 3 (managed with greater patient and caregiver involvement and special reinforcements: group 2, instructed to use several different "reminders"; group 3, same "reminders" as group 2, plus regular phone calls from and meetings at the referring Center). All enrolled women had two visits (baseline and 12 months). RESULTS: Of 334 enrolled women, 247 (74%) started the prescribed therapy. Of those who started, 219 (88.7%) persisted in therapy for at least 10 months. At final evaluation, only 114 women were considered as "fully adherent and persistent" (all doses taken throughout the 12 months). There were no significant differences regarding "full adherence" among the three randomized groups. The frequency of drug administration had a significant influence: weekly administration had a >5-fold higher adherence and monthly administration an 8-fold higher adherence (p < 0.0001) than daily administration. CONCLUSIONS: The special effort of devising and providing additional reminders did not prove effective. Additional interventions during the follow-up, including costly interventions such as phone calls and educational meetings, did not provide significant advantages.

Gastric cancer: The role of diffusion weighted imaging in the preoperative staging.

PURPOSE: Evaluate the role of diffusion-weighted-imaging (DWI) in the diagnosis and staging of gastric carcinoma. MATERIALS AND METHODS: A total of 31 patients with gastric adenocarcinoma, which underwent preoperative staging with 3Tesla Magnetic Resonance Imaging (MRI), were enrolled. Two radiologists evaluated the tumor staging in DWI. Results were compared to postsurgical pathologic findings. RESULTS: The T factor accuracy of conventional MRI and DWI was 73% and 80% respectively; while the N staging accuracy of conventional MRI and DWI was 80% and 93%, respectively. CONCLUSION: DWI and apparent diffusion coefficient (ADC) values showed to be useful in preoperative staging of gastric cancer.

Relationship between quantitative ultrasound parameters at the calcaneus and health-related quality of life in postmenopausal Italian women: the FEDRO study.

Reduced bone mineral density has been reported to adversely affect health-related quality of life (HRQoL) in postmenopausal women without vertebral fracture. To date, no data exist in the literature about any possible influences of quantitative ultrasonographic (QUS) parameters on HRQoL. This study aimed to assess whether QUS parameters at the calcaneus may be associated with HRQoL. In 1,812 ambulatory postmenopausal women aged 60 years or over, we measured HRQoL by the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) and stiffness index using QUS at the calcaneus. By grouping the 1,812 women on the basis of stiffness index, a highly significant (p < 0.001) difference was found for both total QUALEFFO and five domains of the QUALEFFO, whereas for the Pain and Mental Function domains the significance was modest. Stiffness was inversely associated (p < 0.01) with total QUALEFFO and with all QUALEFFO domains. In stepwise multiple logistic regression analysis stiffness values were negatively associated with both QUALEFFO total score and all domains of the QUALEFFO-41. The presence of concomitant diseases was associated with a worsening of HRQoL in all domains of the QUALEFFO, whereas age was associated with the three domains of physical function but not with the Pain and Mental Function domains. Our study suggests that in postmenopausal women there is a close relationship between bone status measured by QUS at the calcaneus and quality of life assessed by the QUALEFFO. Therefore, QUS at the calcaneus may have a role in early strategies to prevent HRQoL impairment and osteoporosis exacerbation.

Accuracy of radiography, computed tomography and magnetic resonance imaging in diagnosing foreign bodies in the foot.

PURPOSE: The purpose of this study was to determine the accuracy of conventional radiography, computed tomography (CT) and magnetic resonance imaging (MRI) in detecting foreign bodies by using cadaver feet. MATERIALS AND METHODS: One hundred and sixty foreign bodies consisting of 5 × 2-mm fresh wood, dry wood, glass, porcelain and plastic fragments were randomly placed in the plantar soft tissue of the forefoot and sole. An additional 160 incisions were made without the insertion of foreign bodies. Radiographs, CT and MRI scans were assessed in a blinded fashion for the presence of a foreign body. RESULTS: Overall sensitivity and specificity for foreign body detection was 29% and 100% for radiographs, 63% and 98% for CT and 58% and 100% for MRI. The sensitivity of radiography was lower in the forefoot. CT and MRI detection rates depended on the attenuation values of the foreign bodies and on the susceptibility artefact, respectively. CT was superior to MRI in identifying water-rich fresh wood. CONCLUSIONS: Radiography, CT and MRI are highly specific in detecting foreign bodies but sensitivity is poor. The detection rate depends on the type of foreign body for all techniques and on location for radiography. To identify foreign bodies with MRI, pulse sequences should be used to enhance the susceptibility artefact. In water-rich wood, as in chronically retained wood, CT is more accurate than MRI.

Imaging of chondrocalcinosis: calcium pyrophosphate dihydrate (CPPD) crystal deposition disease -- imaging of common sites of involvement.

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is characterised by the accumulation of pyrophosphate dihydrate crystals in articular and periarticular tissues and it can be classified as sporadic, hereditary or secondary. The diagnosis frequently rests on radiographic findings. Computed tomography scanning can detect well mineralised deposits in joints and also ultrasound may be useful in detecting CPPD crystal deposits. About MRI recent studies have demonstrated the utility of high field in depiction of CPPD crystal deposits. The aim of this review is to focus on the clinical-classificative and radiological aspects of CPPD, particularly the contribution of the different imaging techniques.

Quality assurance of imaging techniques used in the clinical management of osteoporosis.

Recent advances in the densitometric and imaging techniques involved in the management of osteoporosis are associated with increasing accuracy and precision as well as with higher exposure to ionising radiation. Therefore, special attention to quality assurance (QA) procedures is needed in this field. The development of effective and efficient QA programmes is mandatory to guarantee optimal image quality while reducing radiation exposure levels to the ALARA principle (as low as reasonably achievable). In this review article, the basic QA procedures are discussed for the techniques applied to everyday clinical practice.

Imaging in congenital deformities of the spinal cord.

Vertebromedullary malformations are a heterogeneous group of anomalies of mesenchymal and neuroectodermal tissue differentiation or closure in the midline of the back. On the basis of an embryological analysis, the authors describe the more common malformations, placing them at different times of onset and describing the pathological features and radiological findings based on the use of the most appropriate imaging techniques. The most common malformations have been divided into dysraphic and nondysraphic types and malformations affecting the vertebral bodies. The most complex malformations are detected during the antenatal period by ultrasound or foetal magnetic resonance imaging (MRI). Conversely, during the postnatal period, when the patient's clinical conditions do not warrant emergency surgical treatment, the disorder can be better defined with a detailed MRI scan of the brain and spinal cord. In less complex dysraphisms, although MRI is the imaging modality of choice, it may be useful to integrate the study with plain radiography (X-ray) and multidetector computed tomography (MDCT) for a better assessment of the skeletal components. In these disorders, the use of imaging is aimed at both identifying malformative defects and postoperative follow-up of more complex forms.

Importance of 3D-CT imaging in single-bullet cranioencephalic gunshot wounds.

PURPOSE: The aim of this paper is to demonstrate that computed tomography (CT) and three-dimensional (3D) CT imaging techniques can be useful tools for evaluating gunshot wounds of the skull in forensic medicine. Three purposes can be achieved: (1) identifying and recognising the bullet entrance wound - and exit wound, if present; (2) recognising the bullet's intracranial course by studying damage to bone and brain tissue; (3) suggesting hypotheses as to the dynamics of the event. MATERIALS AND METHODS: Ten cadavers of people who died of a fatal head injury caused by a single gunshot were imaged with total-body CT prior to conventional autoptic examination. Three-dimensional-CT reconstructions were obtained with the volume-rendering technique, and data were analysed by two independent observers and compared with autopsy results. RESULTS: In our experience, CT analysis and volumetric reconstruction techniques allowed the identification of the bullet entrance and exit wounds and intracranial trajectory, as well as helping to formulate a hypothesis on the extracranial trajectory to corroborate circumstantial evidence. CONCLUSIONS: CT imaging techniques are excellent tools for addressing the most important questions of forensic medicine in the case of gunshot wounds of the skull, with results as good as (or sometimes better than) traditional autoptic methods.

Vertebral morphometry by dual-energy X-ray absorptiometry (DXA) for osteoporotic vertebral fractures assessment (VFA).

PURPOSE: This study was done to evaluate the diagnostic accuracy of dual-energy X-ray absorptiometry (DXA) compared with conventional radiography for identifying vertebral fractures. MATERIALS AND METHODS: A total of 930 postmenopausal women underwent conventional radiography and DXA imaging of the spine. The images were evaluated by two expert skeletal radiologists using the semiquantitative (SQ) method for conventional radiography and the morphometric vertebral fracture assessment (VFA) for DXA. RESULTS: The SQ method for radiography (SQ-Rx) analysed 99.1% of vertebrae, identifying 442 vertebral fractures; VFA analysed 97.5% vertebrae, detecting 420 vertebral fractures. Agreement between SQ-Rx and VFA reached 98.76%, and the κ-score was 0.96 [95% confidence interval (CI), 0.95-0.98]. Assessing the grading of vertebral fractures, agreement reached 97.5% and the κ-score was 0.841 (95% CI, 0.821-0.891). Considering SQ-Rx method as "gold standard", VFA had a sensitivity of 97.85 % and a specificity of 99.81%. The negative (NPV) and positive (PPV) predictive value for VFA were 99.83 % and 98.15%, respectively. Fractures were identified in 251 (27 %) and 242 (26 %) of patients on SQ-Rx and VFA, respectively. On a per-patient basis, the agreement between the two methods was 97% and the κ-score was 0.95 (95% CI, 0.920-0.968). The diagnostic parameters for VFA were 97.23% sensitivity, 98.86% specificity, 97.60% PPV and 98.84% NPV. CONCLUSIONS: This study demonstrated that VFA with DXA may reach a high level of accuracy for diagnosing vertebral fractures, suggesting that VFA should be introduced in the screening of individuals with a risk of osteoporosis and in the follow-up of osteoporotic patients receiving treatment.

[Prevalence of thyroid disease in healthcare workers occupationally exposed to ionizing radiation at the University Hospital of Pisa]. / Prevalenza di patologie tiroidee negli operatori sanitari radioesposti dell'Azienda Ospedaliero Universitaria Pisana.

The study analyzes the prevalence of thyroid disease in 1960 healthcare workers, classified as occupationally exposed to ionizing radiation, who have worked at the University Hospital of Pisa. They underwent a medical surveillance protocol from January 2005 until Mars 2012 at the Operative Unit of Occupational Medicine. A positive history of thyroid disease was found in 221 persons, but only 110 (the 5.61% of the population) developed the disease during or after the occupational exposure. Benign thyroid diseases, found in 93 workers, were in order of frequency: Hashimoto's thyroiditis, nodular disease, Basedow's disease, multinodular goiter, subacute thyroiditis and hypothyroidism. Malignant thyroid diseases were found in 17 workers (the 0.87% of the total population), 15 workers suffered from the papillary histotype and 2 from the medullary histotype.

[Report of medical surveillance of workers exposed to asbestos at the Operative Unit of Occupational Medicine in Pisa]. / Attività di sorveglianza sanitaria dei lavoratori ex esposti ad amianto presso la Unità Operativa di Medicina Preventiva del Lavoro di Pisa.

We report our experience about the medical surveillance of 739 workers previously exposed to asbestos. They were observed during the period between January 2009 and May 2012. The diagnosis of 594 patients, that were observed for the first time, were analyzed in order to assess the presence of benign or malignant pulmonary diseases that is so found: 16.33% of benign pulmonary diseases related to asbestos, 17.84% benign pulmonary diseases not related to asbestos and 1% of malignant pulmonary diseases probably related to asbestos. The diagnosis of 221 patients, that were followed over time, were analyzed in order to assess the evolution in time: a new onset of pulmonary disease was found in the 2.26%, a worsening of the pulmonary disease was found in the 6.79%.

Quarantine and Mental Health Challenges for Occupational Medicine: The Case Report of a Nurse Infected With SARS-CoV-2.

This case study draws attention to the psychosocial difficulties that emerged in the context of the coronavirus disease 2019 (COVID-19) outbreak in relation to the remote management of subjects with psychiatric vulnerabilities following exposure to prolonged quarantine. The case involves a 56-year-old hospital nurse, followed by the Occupational Health Department of a major university hospital in central Italy for mood instability in the context of a cyclothymic temperament. She was quarantined for occupationally acquired COVID-19 and remained positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via swab test for more than 2 months between March and May 2020. In this case study, we discuss the challenges presented by the risk of a prolonged quarantine in a psychologically vulnerable employee, the need for occupational medicine to provide adequate health surveillance of all health care workers during the COVID-19 pandemic, the effectiveness of telepsychiatry, and the difficulties in formulating a proper treatment strategy.

Relationship between body composition, body mass index and bone mineral density in a large population of normal, osteopenic and osteoporotic women.

PURPOSE: The knowledge of factors modulating the behaviour of bone mass is crucial for preventing and treating osteoporotic disease; among these factors, body weight (BW) has been shown to be of primary importance in postmenopausal women. Nevertheless, the relative effects of body composition indices are still being debated. Our aim was to analyze the relationship between body mass index (BMI), fat and lean mass and bone mineral density (BMD) in a large population of women. Moreover, this study represents a first important report on reference standard values for body composition in Italian women. MATERIALS AND METHODS: Between 2005 and 2008, weight and height of 6,249 Italian women (aged 30-80 years) were measured and BMI was calculated; furthermore BMD, bone mineral content, fat and lean mass were measured by dual-energy X-ray absorptiometry. Individuals were divided into five groups by decades (group 1, 30.0-39.9; group 2, 40.0-49.9; group 3, 50.0-59.9; group 4, 60.0-69.9; group 5, 70.0-79.9). Differences among decades for all variables were calculated using a one-way analysis of variance (ANOVA) and Bonferroni test by the SPSS programme. RESULTS: Mean BW was 66.8±12.1 kg, mean height 159.1±6.3 cm and mean BMI 26.4±4.7 kg/m(2). According to BW and BMI, there was an increase of obesity with age, especially in women older than 50 years (p<0.001). Lean mass increased until 50 years of age but significantly decreased after this age (p<0.001). The percentage of osteopenia and osteoporosis in the examined population was 43.0% and 16.7%, respectively. CONCLUSIONS: Our data show that obesity significantly decreased the risk for osteoporosis but did not decrease the risk for osteopenia. It is strongly recommended that a strong policy regarding prevention of osteopenia and osteoporosis be commenced. An overall examination of our results suggests that both fat and lean body mass can influence bone mass and that their relative effect on bone could be modulated by their absolute amount and ratio to total BW.