Physical and dosimetric characterisation of different Contrast-Enhanced digital mammographic systems: A multicentric study.

PURPOSE: Contrast-enhanced digital mammography (CEDM) is a relatively new imaging technique recombining low- and high-energy mammograms to emphasise iodine contrast. This work aims to perform a multicentric physical and dosimetric characterisation of four state-of-the-art CEDM systems. METHODS: We evaluated tube output, half-value-layer (HVL) for low- and high-energy and average glandular dose (AGD) in a wide range of equivalent breast thicknesses. CIRS phantom 022 was used to estimate the overall performance of a CEDM examination in the subtracted image in terms of the iodine difference signal (S). To calculate dosimetric impact of CEDM examination, we collected 4542 acquisitions on patients. RESULTS: Even if CEDM acquisition strategies differ, all the systems presented a linear behaviour between S and iodine concentration. The curve fit slopes expressed in PV/mg/cm2 were in the range [92-97] for Fujifilm, [31-32] for GE Healthcare, [35-36] for Hologic, and [114-130] for IMS. Dosimetric data from patients were matched with AGD values calculated using equivalent PMMA thicknesses. Fujifilm exhibited the lowest values, while GE Healthcare showed the highest. CONCLUSION: The subtracted image showed the ability of all the systems to give important information about the linearity of the signal with the iodine concentrations. All the patient-collected doses were under the AGD EUREF 2D Acceptable limit, except for patients with thicknesses ≤35 mm belonging to GE Healthcare and Hologic, which were slightly over. This work demonstrates the importance of testing each CEDM system to know how it performs regarding dose and the relationship between PV and iodine concentration.

Diffusion tensor imaging and tractography of the kidneys: assessment of chronic parenchymal diseases.

OBJECTIVE: To assess renal dysfunction in chronic kidney diseases using diffusion tensor imaging (DTI). METHODS: Forty-seven patients with impaired renal function (study group) and 17 patients without renal diseases (control group) were examined using DTI sequences. Cortical and medullary regions of interest (ROIs) were located to obtain the corresponding values of the apparent diffusion coefficient (ADC) and the fractional anisotropy (FA). The mean values of the ADC and FA, for each ROI site, were obtained in each group and were compared. Furthermore, the correlations between the diffusion parameters and the estimated glomerular filtration rate (eGFR) were determined. RESULTS: In both the normal and affected kidneys, we obtained the cortico-medullary difference of the ADC and the FA values. The FA value in the medulla was significantly lower (P = 0.0149) in patients with renal function impairment as compared to patients with normal renal function. A direct correlation between DTI parameters and the eGFR was not found. Tractography visualised disruption of the regular arrangement of the tracts in patient with renal function alteration. CONCLUSION: DTI could be a useful tool in the evaluation of chronic kidney disease and, in particular, the medullary FA value seems to be the main parameter for assessing renal damage. KEY POINTS: • Magnetic resonance diffusion tensor imaging (MRDTI) provides new information about renal problems. • DTI allows non-invasive repeatable evaluation of the renal parenchyma, without contrast media. • DTI could become useful in the management of chronic parenchymal disease. • DTI seems more appropriate for renal evaluation than diffusion-weighted imaging.

Real-Life Safety Profile of the 9-Valent HPV Vaccine Based on Data from the Puglia Region of Southern Italy.

Human Papillomavirus (HPV) is responsible for epithelial lesions and cancers in both males and females. The latest licensed HPV vaccine is Gardasil-9®, a 9-valent HPV vaccine which is effective not only against the high-risk HPV types, but also against the ones responsible for non-cancerous lesions. This report describes adverse events following Gardasil-9® administration reported in Puglia, southern Italy, from January 2018 to November 2021. This is a retrospective observational study. Data about the adverse events following immunization (AEFIs) with Gardasil-9® were collected from the Italian Drug Authority database. AEFIs were classified as serious or non-serious accordingly to World Health Organization guidelines, and serious ones underwent causality assessment. During the study period, 266,647 doses of 9vHPVv were administered in Puglia and 22 AEFIs were reported, with a reporting rate (RR) of 8.25 per 100,000 doses. The most reported symptoms were neurological ones (7/22). A total of 5 (22.7%) AEFIs were classified as serious, and 2 of these led to the patient's hospitalization. In one case, permanent impairment occurred. Following causality assessment, only 2 out of 5 serious AEFIs were deemed to be consistently associated with the vaccination (RR: 0.750 per 100,000 doses). The data gathered in our study are similar to the pre-licensure evidence as far as the nature of the AEFIs is concerned. The reporting rate, though, is far lower than the ones described in clinical trials, likely due to the different approach to data collection: in our study, data were gathered via passive surveillance, while pre-marketing studies generally employ active calls for this purpose. Gardasil-9®'s safety profile appears to be favorable, with a low rate of serious adverse events and a risk/benefits ratio pending for the latter.

Incidencia de bajo peso neonatal: factores de riesgo / Incidence of neonatal low weight: factors of risk

El bajo peso neonatal, representa en la actualidad uno de los principales problemas que tiene que enfrentar la perinatología. Se efectuó un estudio retrospectivo en el cual se tomaron todos los casos de recién nacidosde bajo peso ocurridos en el período comprendido entre junio de 1994 a junio de 1996. Total de nacimientos: 7191. Bajo peso al nacer: 784 (10,9 por ciento). Se evaluaron diversos factores de riesgos, edad, paridad, hábitos, antecedentes de recién nacido de bajo peso, estado nutricional, número de controles prenatales y patologías maternas asociadas. Los resultados mostraron una mayor incidencia de recién nacidos de bajo peso en madres solteras, adolescentes, con control prenatal deficiente y cuyas patologías maternas prevalentes fueron hipertensión arterial e infección urinaria. Concluímos en la necesidad de implementar un adecuado control prenatal precoz, tratando de detectar factores de riesgo relacionado con esta entidad, con el objetivo de disminuir su incidencia

Holoprosencefalia: reporte de un caso: actualización bibliográfica / Holopresencephaly: report of a case: bibliographical bring up to date

La holoprosencefalia comprende un espectro de malformaciones que se originan como consecuencia de una falla en el clivaje del cerebro anterior o prosencéfalo. Es una patologia de muy baja incidencia, estimandose cifras entre 1/5000 a 1/16000 nacidos vivos obsevándose una incidencia más alta en casos de embriones de huevo abortados. Se presenta el caso clínico de una paciente de 25 años, cuartigesta, tres cesáreas anteriores, quien comenzó a controlar su embarazo a partir de las 34 semanas. A las 35 semanas se le realiza una ecografía de control en la cual se detecta a nivel del polo cefálico una dilatación ventricular, sin visualizarse el cuerpo calloso; diagnóstico que se confirma a través de una nueva ecografía a las 39 semanas. Se decide programar cesárea dado los antecedentes obtétricos de la paciente...