Structured reporting of chest CT in COVID-19 pneumonia: a consensus proposal.

OBJECTIVES: The need of a standardized reporting scheme and language, in imaging of COVID-19 pneumonia, has been welcomed by major scientific societies. The aim of the study was to build the reporting scheme of chest CT in COVID-19 pneumonia. METHODS: A team of experts, of the Italian Society of Medical and Interventional Radiology (SIRM), has been recruited to compose a consensus panel. They used a modified Delphi process to build a reporting scheme and expressed a level of agreement for each section of the report. To measure the internal consistency of the panelist ratings for each section of the report, a quality analysis based on the average inter-item correlation was performed with Cronbach's alpha (Cα) correlation coefficient. RESULTS: The overall mean score of the experts and the sum of score were 3.1 (std.dev. ± 0.11) and 122 in the second round, and improved to 3.75 (std.dev. ± 0.40) and 154 in the third round. The Cronbach's alpha (Cα) correlation coefficient was 0.741 (acceptable) in the second round and improved to 0.789 in the third round. The final report was built in the management of radiology report template (MRRT) and includes n = 4 items in the procedure information, n = 5 items in the clinical information, n = 16 in the findings, and n = 3 in the impression, with overall 28 items. CONCLUSIONS: The proposed structured report could be of help both for expert radiologists and for the less experienced who are faced with the management of these patients. The structured report is conceived as a guideline, to recommend the key items/findings of chest CT in COVID-19 pneumonia.

Colo-rectal endoscopic full-thickness resection (EFTR) with the over-the-scope device (FTRD®): A multicenter Italian experience.

BACKGROUND AND AIM: Endoscopic full-thickness resection(EFTR) with FTRD® in colo-rectum may be useful for several indications.The aim was to assess its efficacy and safety. MATERIAL AND METHODS: In this retrospective multicenter study 114 patients were screened; 110 (61M/49F, mean age 68 ±â€¯11 years, range 20-90) underwent EFTR using FTRD®. Indications were:residual/recurrent adenoma (39), incomplete resection at histology (R1 resection) (26), non-lifting lesion (12), adenoma involving the appendix (2) or diverticulum (2), subepithelial lesions(10), suspected T1 carcinoma (16), diagnostic resection (3). Technical success (TS: lesion reached and resected), R0 resection (negative lateral and deep margins),EFTR rate(all layers documented in the specimen) and safety have been evaluated. RESULTS: TS was achieved in 94.4% of cases. EFTR was achieved in 91% with lateral and deep R0 resection in 90% and 92%. Mean size of specimens was 20 mm (range 6-42). In residual/recurrent adenomas, final analysis revealed: low-risk T1 (11), adenoma with low-grade dysplasia (LGD) (24) and high-grade dysplasia (HGD) (3), scar tissue (1). Histology reports of R1 resections were: adenoma with LGD (6), with HGD (1), low-risk (6) and high-risk (1) T1, scar tissue (12). Non-lifting lesions were diagnosed as: adenoma with HGD (3), low-risk (7) and high risk (2) T1. Adverse clinical events occurred in 12 patients (11%),while adverse technical events in11%. Three-months follow-up was available in 100 cases and residual disease was evident in only seven patients. CONCLUSIONS: EFTR using FTRD® seems to be a feasible, effective and safe technique for treating selected colo-rectal lesions. Comparative prospective studies are needed to confirm these promising results.

Cartilage ossiculoplasty in cholesteatoma surgery: hearing results and prognostic factors.

Cartilage tympanoplasty is an established procedure for tympanic membrane and attic reconstruction. Cartilage has been used as an ossiculoplasty material for many years. The aim of this study was to evaluate hearing results of costal cartilage prostheses in ossicular chain reconstruction procedures in subjects operated on for middle ear cholesteatoma and to determine the presence of prognostic factors. Candidates for this study were patients affected by middle ear cholesteatoma whose ossicular chain was reconstructed with a chondroprosthesis. 67 cases of ossiculoplasty with total (TORP) or partial (PORP) chondroprosthesis were performed between January 2011 and December 2013. Follow-up examination included micro-otoscopy and pure tone audiometry. The guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology Head and Neck Surgery were followed and pure-tone average (PTA) was calculated as the mean of 0.5, 1, 2 and 4 kHz thresholds. Statistical analysis was performed with ANOVA tests and regression models. Average air-bone gap (ABG) significantly improved from 39.2 dB HL (SD 9.1 dB HL) to 25.4 dB HL (SD 11 dB HL) (p < 0.001). Linear regression analysis showed that the only prognostic factor was the type of operation (p = 0.02). In fact, patients submitted to ICWT presented better post-operative ABG compared to CWDT. None of the other variables influenced the results. The present study proposes costal cartilage as material of choice when autologous ossicles are not available. The maintenance of the posterior canal wall was the only prognostic factor identified.

Sexual function in patients who underwent surgery for stress urinary incontinence.

AIM: Stress urinary incontinence (SUI) has been reported to have a negative impact on sexual relations in up to 68% of women. The effect of suburethral sling on sexual functioning has been studies, but the results are still inhomogeneous. This study was undertaken to assess the effect of the transvaginal tension free vaginal tape (TVT), transvaginal tension free vaginal tape - obturate (TVT-O) and minisling procedures (SIS) on sexual function and to also evaluate the male experience respect to sexual activity before and after surgery of partners of women underwent surgery. METHODS: We enrolled 150 patients underwent a TVT/TVT-O or SIS for female stress urinary incontinence. All patients enrolled were invited to fill out the Female Sexual Function Index (FSFI) Questionnaire, before surgery and 12 months after surgery. We also evaluate the male experience, through questionnaire, respect to sexual activity before and after surgery of female partner. RESULTS: At month 12, the mean follow-up FSFI total score in SIS group improved from baseline 22.7±3.83 to 26.2±4.01 (P=0.001), in the TVT group from baseline 22.5±4.11 to 28.5±3.87 (P=0.001) and in the TVT-O group from baseline 23.5±4.48 to 27.7±3.68. The male questionnaires reported an improvement of the sexual function of 84% for TVT group, 82.9% for SIS group and 80,9% for TVT-O group. CONCLUSION: In our present study, patients underwent TVT, TVT-O or SIS showed comparable significant improvement of sexual function after sling procedure as evaluated by FSFI.

Late recovery with cyclosporine-A of an auto-immune sudden sensorineural hearing loss.

Sensorineural hearing loss of immune-mediated origin may be present as a symptom in systemic autoimmune diseases or may occur as a primary disorder without other organ involvement (auto-immune inner ear disease). The diagnosis of auto-immune inner ear disease is still predicated on clinical features and to date specific diagnostic tests are not available. We report a case of right-sided sudden hearing loss in a female patient in which the clinical manifestations, in addition to ANA positivity and hypocomplementaemia allowed us to hypothesize an auto-immune inner ear disease. The immunosuppressive treatment with cyclosporine-A was capable of a recovery of the hearing that, however, occurred progressively with normalization of the hearing function after 1 year of treatment. cyclosporine-A could be proposed as a therapeutic option in case of auto-immune inner ear disease allowing the suspension of corticosteroids that, at high dose, expose patients to potentially serious adverse events.

Involvement of corticotrophin-releasing factor and orexin-A in chronic migraine and medication-overuse headache: findings from cerebrospinal fluid.

The study set out to investigate the role of corticotrophin-releasing factor (CRF) and orexin-A in chronic migraine (CM) and medication-overuse headache (MOH). Twenty-seven patients affected by CM and 30 with MOH were enrolled. Control CSF specimens were obtained from 20 age-matched subjects who underwent lumbar puncture for diagnostic purposes, and in all of them CSF and blood tests excluded central nervous system or systemic diseases. Orexin-A and CRF were determined by radioimmunoassay methods. Significantly higher levels of orexin-A and CRF were found in the CSF of MOH and to a lesser extent in patients with CM compared with control subjects (orexin-A: P < 0.001 and P < 0.02; CRF: P < 0.002 and P < 0.0003). A significant positive correlation was also found between CSF orexin-A values and those of CRF (R = 0.71; P < 0.0008), monthly drug intake group (R = 0.39; P < 0.03) and scores of a self-completion 10-item instrument to measure dependence upon a variety of substances, the Leeds Dependence Questionnaire (LDQ) in the MOH group (R = 0.68; P < 0.0003). The significantly higher orexin-A levels found in CM and MOH can be interpreted as a compensatory response to chronic head pain or, alternatively, as an expression of hypothalamic response to stress due to chronic pain. A potential role for orexin-A in driving drug seeking in MOH patients through activation of stress pathways in the brain can also be hypothesized.

Malignant progression of a small HCC nodule: hypovascular 'early HCC' converted to hypervascular 'small HCC' within six months.

We report a case of hepatocellular carcinoma superimposed on chronic hepatitis C virus (HCV) hepatitis in which final diagnosis of hepatocellular carcinoma was delayed because there was no consensus on hypervascularity with two diagnostic methods at the time of presentation. A 3 cm lesion was initially observed as hypovascular at multidetector-row computed tomography. Conversely, two months later the lesion appeared hypervascular at contrast-ultrasonography and gadolinium-enhanced dynamic magnetic resonance, and hyperintense after superparamagnetic iron oxide-enhanced T2W studies. Only in the late follow-up it was definitively confirmed as hypervascular in the arterial phase of multidetector-row computed tomography. This case clearly highlights some pitfalls in the European Association for the study of the liver guidelines for hepatocellular carcinoma management, which were readdressed in the last American Association for the Study of Liver Diseases (AASLD) and in the forthcoming international proposals, leading to more pragmatic suggestions for clinical practice.

Anatomía de las fibras blancas del lóbulo temporal en 3D / Three dimensional anatomy of the white fibers of the temporal lobe

Objetivo: aplicar la técnica de disección de fibras blancas para la comprensión tridimensional de las diferentes estructuras localizadas en el lóbulo temporal. Material y métodos: se utilizaron cinco cerebros humanos normales los que fueron sometidos a la técnica de preparación de Klinger para disección de fibras blancas. Se utilizó microscopio de luz con aumentos de cinco y veinte X.Resultados: las fibras del lóbulo temporal pueden dividirse dependiendo de la cara que examinemos. En la cara lateral y superior se destacan el fascículo longitudinal superior, el stratum sagital, el fascículo uncinado, el fascículo occipito - frontal, fascículo amígdalo - insular, la comisura anterior y el tapetum. En la cara inferior observamos el fascículo longitudinal inferior, banda diagonal de Brocca, ansa pendularis y estrías olfatorias y en la cara mesial las estructuras del lóbulo límbico, el fascículo del cingulum, el giro dentado, el giro fasciolar, la fimbria del fornix, y la estría terminalis. Conclusiones: la técnica de disección de fibras blancas es una herramienta útil para la comprensión tridimensional de las estructuras neuronales localizadas dentro del lóbulo temporal. El entendimiento de la disposición de estas estructuras ayuda al neurocirujano a lidiar con las patologías localizadas en la cara mesial como los tumores y la esclerosis mesial temporal, entidades que requieren claros conocimientos anatómicos para su adecuada resolución. (AU)

Anatomía de las fibras blancas del lóbulo temporal en 3D / Three dimensional anatomy of the white fibers of the temporal lobe

Objetivo: aplicar la técnica de disección de fibras blancas para la comprensión tridimensional de las diferentes estructuras localizadas en el lóbulo temporal. Material y métodos: se utilizaron cinco cerebros humanos normales los que fueron sometidos a la técnica de preparación de Klinger para disección de fibras blancas. Se utilizó microscopio de luz con aumentos de cinco y veinte X.Resultados: las fibras del lóbulo temporal pueden dividirse dependiendo de la cara que examinemos. En la cara lateral y superior se destacan el fascículo longitudinal superior, el stratum sagital, el fascículo uncinado, el fascículo occipito - frontal, fascículo amígdalo - insular, la comisura anterior y el tapetum. En la cara inferior observamos el fascículo longitudinal inferior, banda diagonal de Brocca, ansa pendularis y estrías olfatorias y en la cara mesial las estructuras del lóbulo límbico, el fascículo del cingulum, el giro dentado, el giro fasciolar, la fimbria del fornix, y la estría terminalis. Conclusiones: la técnica de disección de fibras blancas es una herramienta útil para la comprensión tridimensional de las estructuras neuronales localizadas dentro del lóbulo temporal. El entendimiento de la disposición de estas estructuras ayuda al neurocirujano a lidiar con las patologías localizadas en la cara mesial como los tumores y la esclerosis mesial temporal, entidades que requieren claros conocimientos anatómicos para su adecuada resolución. (AU)

Anatomía de las fibras blancas del lóbulo temporal en 3D / Three dimensional anatomy of the white fibers of the temporal lobe

Objetivo: aplicar la técnica de disección de fibras blancas para la comprensión tridimensional de las diferentes estructuras localizadas en el lóbulo temporal. Material y métodos: se utilizaron cinco cerebros humanos normales los que fueron sometidos a la técnica de preparación de Klinger para disección de fibras blancas. Se utilizó microscopio de luz con aumentos de cinco y veinte X.Resultados: las fibras del lóbulo temporal pueden dividirse dependiendo de la cara que examinemos. En la cara lateral y superior se destacan el fascículo longitudinal superior, el stratum sagital, el fascículo uncinado, el fascículo occipito - frontal, fascículo amígdalo - insular, la comisura anterior y el tapetum. En la cara inferior observamos el fascículo longitudinal inferior, banda diagonal de Brocca, ansa pendularis y estrías olfatorias y en la cara mesial las estructuras del lóbulo límbico, el fascículo del cingulum, el giro dentado, el giro fasciolar, la fimbria del fornix, y la estría terminalis. Conclusiones: la técnica de disección de fibras blancas es una herramienta útil para la comprensión tridimensional de las estructuras neuronales localizadas dentro del lóbulo temporal. El entendimiento de la disposición de estas estructuras ayuda al neurocirujano a lidiar con las patologías localizadas en la cara mesial como los tumores y la esclerosis mesial temporal, entidades que requieren claros conocimientos anatómicos para su adecuada resolución.

NF-kappaB activity and iNOS expression in monocytes from internal jugular blood of migraine without aura patients during attacks.

This study investigated nuclear factor-kappa B (NF-kappaB) activity by electrophoresis mobility gel shift assay and IkappaBalpha expression by Western blot analysis in monocytes obtained from serial samples of internal jugular venous blood taken from seven migraine patients without aura during attacks. Inducible nitric oxide synthase (iNOS) expression was also assessed by reverse transcription-polymerase chain reaction. An increase in NF-kappaB activity peaked 2 h after attack onset. This was accompanied by a transient reduction in IkappaBalpha expression. Up-regulation of iNOS was evident at 4 h, maintained at 6 h and reduced at the end of the attack. These findings substantiate the hypothesis of transitory delayed inflammation, as suggested by the animal model, and suggest the possibility of using therapeutic approaches to target NF-kappaB transcription in the treatment of migraine.

Weight loss in obese children carrying the proopiomelanocortin R236G variant.

To acquire more information relative to the course of obesity in conditions of food restriction in subjects carrying mutations in the melanocortin signaling pathway, 710 obese children (mean age: 9.5+/-2.1 yr; mean z-score body mass index: 3.63+/-1.6) were genotyped for the proopiomelanocortin (POMC) R236G substitution, a variant which has been associated to early onset obesity, by restriction fragment length polymorphism (RFLP) analysis. Three children were heterozygotes for the R236G variant (0.4%). One of them had the metabolic syndrome. This variant was not found in 400 controls. The 3 probands followed a hypocaloric balanced diet and, after about 12 months, normalized their weight as well as fat mass and insulin resistance. The patient with the metabolic syndrome reversed this condition. These results show that a) the R236G substitution of POMC gene, although not a major cause of obesity among Italian obese children and adolescents, is associated with early onset obesity, and that b) inherited alterations of the melanocortin signaling pathway, independently of the degree of obesity, do not preclude the possibility to lose weight in mutated individuals following a hypocaloric diet.

Follicular fluid vascular endothelial growth factor concentrations are increased during GnRH antagonist/FSH ovarian stimulation cycles.

BACKGROUND: The aim of this study was to investigate the effect of GnRH antagonists (GnRH-ant) on follicular fluid vascular endothelial growth factor (FF VEGF). METHODS: Sixty women undergoing assisted reproduction were randomised (computer-generated randomisation list) and assigned to two different GnRH analogue regimens: GnRH agonist (GnRH-a) (Group A; n = 30) and GnRH-ant (Group B; n = 30). RESULTS: Mean (+/-S.D.) FF VEGF concentrations were 1598+/-612 pg/mL and 2906+/-1558 pg/mL for Groups A and B, respectively (p < 0.001). In the women treated with GnRH-ant, we found a statistically significant reduction in serum LH levels (1.72+/-0.74 IU/L in Group A versus 0.93+/-0.43 IU/L in Group B, p < 0.001), in serum oestradiol (E2) levels (1562.1+/-410.7 pg/mL in Group A versus 1214.67+/-779.9 pg/mL in Group B, p < 0.05), in FF E2 levels (1146+/-593 ng/mL in Group A versus 621+/-435 ng/mL in Group B, p < 0.05), and in FF androstenedione levels (136+/-55 ng/mL in Group A versus 78+/-31 ng/mL in Group B, p < 0.001), as well as a reduction in the number of pregnancies, though not statistically significant (23.3% in Group A versus 16.6% in Group B). CONCLUSION: The increase in FF VEGF levels in women treated with GnRH-ant might be explained by a suppression of LH and E2 levels.

Follicular fluid levels of vascular endothelial growth factor and early corpus luteum function during assisted reproductive technology cycles.

BACKGROUND: The relation between vascular endothelial growth factor (VEGF) and early luteal function has rarely been proven in humans. The purpose of this study was to define the relation between follicular fluid concentrations of VEGF (FF VEGF) and early luteal function at the preimplantation stage during assisted reproductive technology (ART) cycles. METHODS: 71 women were divided into two groups, based on reproductive outcome: women who became pregnant after embryo transfer (ET) (n = 18, Group A) and non-pregnant women (n = 53, Group B). Serum progesterone (Se P) and inhibin A on ET day, and FF VEGF levels were measured in all women. Data were expressed as mean +/- standard deviation. Statistical analysis was performed using Excel Office 98 for Student's t-test, linear regression test and chi-square test. A p value of < 0.05 was considered statistically significant. RESULTS: The groups were comparable for age, ovarian reserve, number and quality of the oocytes retrieved and of the embryos obtained and transferred. FF VEGF levels were increased (4235 +/- 1433 vs 3432 +/- 1231 pg/ml), while Se P and inhibin A levels were significantly reduced (83.1 +/- 34.1 vs 112.0 +/- 58.8 ng/ml and 397.4 +/- 223 vs 533.5 +/- 283 pg/ml, respectively) in the non-pregnant group and were negatively correlated with FF VEGF (r = -0.482, p < 0.05; r = -0.468, p < 0.05) only in pregnant women. CONCLUSION: Much has to be learned about the regulation and role of VEGF during the early luteal phase. We advance the hypothesis that the existence of a negative correlation between FF VEGF/Se P and FF VEGF/inhibin A in pregnant women might indicate the existence of a normal VEGF-mediated paracrine response when Se P and inhibin A levels are decreased. Excess production of FF VEGF and the absence of a correlation between FF VEGF/Se P and FF VEGF/inhibin A in non-pregnant women may be a paracrine reaction to immature luteal vasculature, resulting in luteal dysfunction.

The treatment of NAFLD.

Nonalcoholic fatty liver disease (NAFLD) is becoming an increasing cause of chronic liver damage. The decision of start a medical treatment is based on the documented risk of progression to cirrhosis and liver cancer, when steatohepatitis (NASH) occurs. The therapy of this syndrome requires, as obviously, some considerations on the natural history of the condition, on the efficacy and safety of various therapeutic options, as well as on the costs. Treatment of patients with NAFLD has typically been focused on the management of associated conditions such as obesity, diabetes mellitus and hyperlipemia. Weight loss improves insulin sensitivity, and NASH may resolve with weight reduction. Insulin resistance seems to be the common denominator in many cases of NAFLD. Two classes of drugs have been shown to correct insulin resistance: biguanides (e.g., metformin) and thiazolidinediones (e.g., rosiglitazone and pioglitazone). The last two decades have witnessed a considerable progress in the understanding of the mechanisms respon-sible for the fibrogenic progression of chronic liver diseases. Several drugs believed to be hepatoprotective or antifibrotic agent as UDCA, betaine, vitamin E, lecithin, beta-carotene and selenium have been used in patients with NASH. Silybin is the main component of silymarin that is absorbed when linked whith a phytosome. This substance reduces in rats the lipid-peroxidation and the activaction of hepatic stellate cells. In humans, some non controlled data show that silybin is able to reduce insulin resistance, liver steatosis and plasma markers of liver fibrosis.

Metabolismo de los estrógenos endógenos y cáncer de mama / Metabolism of endogenous strogens and breast cancer

El cáncer de mama es el cáncer más frecuente en las mujeres de los países desarrollados occidentales. Si bien Uruguay no integra este grupo de países, el cáncer de mama presenta cifras similares a estos, con tasas de incidencia y mortalidad extremadamente altas. La tasa de mortalidad ajustada por edad , en el período de 1993 a 1997, en Uruguay es de 25,1 cada 100.000 mujeres por año, una de las más altas a nivel mundial. Esto ha llevado a que el cáncer de mama sea un grave problema de salud pública en nuestro país. La relación cáncer de mama con el uso dee hormonoterapia de reemplazo está firmemente establecida. Diversos estudios, en especial el estudio WHI (Women's Health Iniciative), han confirmado el mayor riesgo con el aporte exógeno dee estrógenos. Esto, junto a los mayores riesgos cardiovasculares de la terapia estrogénica para los trastornos climatéricos, ha llevado a la drástica reducción de sus indicaciones y su uso a nivel mundial. Sim embargo, el rol de estas hormonas en la patogénesis del cáncer de mama no se reduce a su administración exógena. Los estrógenos endógenos tienen un papel preponderante en la génesis de este cáncer, y distintas situaciones dependientes del ambiente y los hábitos de vida pueden modificar el riesgo de cáncer de mama mediado por estrógenos endógenos. El presente artículo realiza una revisión sobre el metabolismo de los estrógenos y su relación con el cáncer de mama, dado que los distintos metabolitos de los estrógenos tienen acciones biológicas diferentes y una incidencia opuesta en el riesgo de este cáncer. La ruta de metabolización hacia la 2-alfa hydroxyestrona se asocia a una reducción de 40 por ciento de desarrollar cáncer de mama. Se analizaz la influencia de los cambios dietéticos en la ruta de metabolización de los estrógenos y se plantea la hipótesis de aplicar el cambio de la dieta como una de las estrategias para abatir la incidencia del cáncer de mama.