Activated macrophages are the main inflammatory cell in COVID-19 interstitial pneumonia infiltrates. Is it possible to show their metabolic activity and thus the grade of inflammatory burden with 18F-Fluorocholine PET/CT?

The recent outbreak of Covid-19 has represented a major challenge for the countries affected by the disease, not only in terms of loss of human life, economic downturn, and constraint on individual freedom, but also for the great pressure on the national health systems and hospitals. The 380 kDa virus has been a perfect storm, especially for those national health systems used to working with limited resources and high intensity rhythms, such as Italy. For the first time in the new century, a virtually unknown fast-spreading disease has caused a public health emergency thus forcing most countries to deal with an insurmountable logistic gap. Hence, every branch of Medicine, even though not directly involved in the treatment, has been called upon to provide its contribution to resolve the crisis. It is now becoming more apparent that Covid-19 is not solely a lung disease, but a complex systemic disease involving several organs and systems. This is due to an abnormal inflammatory response which eventually leads to multisystemic coagulopathy which mainly, but not uniquely, targets the lungs. Although the pathophysiology of this syndrome is still not fully understood, macrophages and their immune complex system seem to play a key role. It is not yet clear why some patients develop the violent immune response which results in pneumonitis while others do not. There are clues indicating that the systemic hyper-inflammation defined as macrophage activation syndrome (MAS), or cytokine storm, requires an increase in choline consumption to synthesize phosphatidylcholine and stimulate phagocytosis, organelle biogenesis, secretory functions, and endocytosis. 18F-Fluorocholine is a synthetic analog of the naturally occurring choline normally used for PET/CT imaging of prostate cancer patients. 18F-Fluorocholine could image and quantify the macrophage activity in pulmonary interstitial infiltrates of Covid-19 pneumonia. If the hypothesis is confirmed experimentally, 18F-Fluorocholine PET/CT could be used to in vivo image and quantify the degree of lung inflammation and potentially stratify the gravity of this disease.

Accuracy of 6 Desktop 3D Printers in Dentistry: A Comparative In Vitro Study.

PURPOSE: To compare the accuracy of 6 desktop 3D printers in dentistry. METHODS: A parallelepiped (PP) with known geometry and holes of different diameters was designed and printed with 6 desktop 3D printers (Sheraprint 40®; Solflex 350®; Form 2®; MoonRay D75®; Vida HD®; XFAB 2000®). For each printer, 9 PPs were printed with proprietary materials; these PPs were not cured and underwent dimensional analysis by optical microscopy and precision probing. A file representative of a dentate model (DM) was also printed with the aforementioned printers. For each printer, 3 DMs were printed with the proprietary materials. These DMs were cured and after 1 month, scanned with a desktop scanner and superimposed on the virtual reference model, to investigate trueness. RESULTS: Dimensional analysis by optical microscopy and precision probing highlighted the reliability of the 3D printed models; errors were compatible with clinical use. However, both linear and diameter measurements revealed statistically significant differences between the machines. The trueness of the DMs 1 month after printing was low, suggesting that they underwent dimensional contraction over time, albeit with differences between the printers. CONCLUSIONS: The 3D printed models showed acceptable accuracy, although statistically significant differences were found among them.

Detección de grasa parda en la PET/TC con 18F-FDG: diferencias entre la población adulta y pediátrica en una experiencia de 12 años / 18F-FDG PET/CT brown fat detection: differences between adult and pediatric population in a 12 year experience

OBJETIVO: Analizar las características epidemiológicas y antropométricas de los pacientes con activación de la grasa parda detectada por tomografía por emisión de positrones con fluoruro 18-fluorodeoxiglucosa/tomografía computarizada (18F-FDG PET/TC). MATERIAL Y MÉTODOS: De 2005 a 2017, se incluyeron retrospectivamente 818 estudios PET/TC con 18F-FDG positivos para detección de grasa parda, 742 exámenes realizados en población adulta y 76 PET/TC en población pediátrica. Se realizó una prueba de Chi cuadrado para comparar la distribución de las características entre pacientes adultos y pediátricos. RESULTADOS: Los adultos mostraron una tasa más alta de detección de grasa parda en mujeres (79% vs.61%, p < 0,001) y en pacientes con hiperglucemia (> 100mg/dl) (24% vs.16%, p = 0,02), no se encontraron diferencias significativas considerando el sobrepeso (IMC>25kg/m2) (22% vs.20%, p = 0,55). Teniendo en cuenta solo a mujeres, los adultos mostraron una tasa más alta de detección de grasa parda tanto en pacientes con hiperglucemia (83% frente a 42%, p < 0,001), como en pacientes con sobrepeso (80% frente a 67%, p = 0,005). En ambas poblaciones, la activación de la grasa parda ocurrió con mayor frecuencia en las estaciones frías; no hubo diferencias significativas en la distribución considerando la temporada de nacimiento (p = 0,2). CONCLUSIONES: El sexo, la glucemia y el IMC desempeñan un papel importante en la predicción de la activación de la grasa parda, con diferencias significativas entre adultos y niños. Se confirma que la exposición al frío es un factor de predicción importante, mientras que la temporada de nacimiento no es significativa

PURPUSE: To analyze epidemiological and anthropometric features of patients with brown adipose tissue (BAT) activation detected by fluorine18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). MATERIAL AND METHODS: From 2005 to 2017, 818 18F-FDG PET/CT studies positive for BAT detection were retrospectively included, 742 examinations performed on the adult population and 76 PET/CT on the pediatric population. A Chi-squared test was performed to compare features distribution between the adult and pediatric patients. RESULTS: Adults showed a higher rate of BAT detection in females (79% vs.61%, p < 0.001) and in hyperglycaemic patients (>100mg/dL) (24% vs.16%, p = 0.02), no significant difference was found with regard to overweight patients (BMI>25kg/m2) (22% vs.20%, P=.55). Considering females only, the adults showed a higher rate of BAT detection both in hyperglycaemic (83% vs.42%, p < 0.001) and overweight patients (80% vs.67%, p = 0.005). In both populations BAT activation happened more frequently in cold seasons; there was no significant distribution difference with regard to season of birth (p = 0.2). CONCLUSIONS: Sex, glycemia and BMI play a major role in predicting BAT activation, with significant differences between adults and pediatric patients. Cold exposure is confirmed as an important predicting factor, while season of birth is not significant

Cistitis incrustada detectada por PET/TC con 18F-FDG / Encrusted cystitis detected by 18F-FDG PET/CT

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18F-FDG PET/CT brown fat detection: Differences between adult and pediatric population in a 12 year experience. / Detección de grasa parda en la PET/TC con 18F-FDG: diferencias entre la población adulta y pediátrica en una experiencia de 12 años.

PURPOSE: To analyze epidemiological and anthropometric features of patients with brown adipose tissue (BAT) activation detected by fluorine18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). MATERIAL AND METHODS: From 2005 to 2017, 818 18F-FDG PET/CT studies positive for BAT detection were retrospectively included, 742 examinations performed on the adult population and 76 PET/CT on the pediatric population. A Chi-squared test was performed to compare features distribution between the adult and pediatric patients. RESULTS: Adults showed a higher rate of BAT detection in females (79% vs. 61%, P<0.001) and in hyperglycaemic patients (>100mg/dL) (24% vs. 16%, P=0.02), no significant difference was found with regard to overweight patients (BMI>25kg/m2) (22% vs. 20%, P=.55). Considering females only, the adults showed a higher rate of BAT detection both in hyperglycaemic (83% vs. 42%, P<0.001) and overweight patients (80% vs. 67%, P=0.005). In both populations BAT activation happened more frequently in cold seasons; there was no significant distribution difference with regard to season of birth (P=0.2). CONCLUSIONS: Sex, glycemia and BMI play a major role in predicting BAT activation, with significant differences between adults and pediatric patients. Cold exposure is confirmed as an important predicting factor, while season of birth is not significant.

Linfoma de Burkitt etmoidal y extranodal en un niño con lesiones renales bilaterales de linfoma de Burkitt detectadas por 18F-FDG PET/TC / Ethmoidal and extranodal Burkitt lymphoma in a child with bilateral kidney Burkitt lymphoma lesions incidentally detected by 18F-FDG PET/CT

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Diferente captación de 123I-MIBG en los 2 lóbulos hepáticos principales: un misterio persistente sin resolver / Different uptake of 123I-MIBG in the two main liver lobes: A persistant unsolved mistery

Objetivo: Después de la inyección del radiofármaco se observa con frecuencia una concentración incrementada de 123I-MIBG en el lóbulo hepático izquierdo en comparación con el derecho, pero la razón de este hallazgo sigue siendo desconocida. Nuestro objetivo fue analizar retrospectivamente el patrón de absorción de 123I-MIBG entre los 2 lóbulos hepáticos y correlacionar nuestros resultados con algunas características epidemiológicas/clínicas. Material y métodos: Se seleccionaron 94 gammagrafías 123I-MIBG de 71 pacientes. Las regiones de interés se dibujaron en los lóbulos derecho e izquierdo utilizando secciones tomográficas transversales y se calcularon relaciones de actividad de izquierda a derecha (relación I/D) a las 6 y 24horas de la administración del radiofármaco. Resultados: Veintisiete exámenes fueron positivos para lesiones hipermetabólicas, mientras que los 67 restantes fueron negativos. En todos los casos las relaciones medias de I/D temprana y tardía fueron superiores a 1; la relación I/D temprana media fue de 1,37 y la relación I/D tardía de 1,52. La relación I/D tardía fue significativamente mayor que la precoz. No hubo diferencias en la relación I/D con respecto a la edad, sexo, enfermedad primaria y resultado de la gammagrafía. Conclusiones: La absorción de 123I-MIBG fue mayor en el lóbulo hepático izquierdo en comparación con el derecho, y esta relación no se correlacionó con ninguna característica epidemiológica o clínica. La razón de este metabolismo todavía no se ha explicado, y algunas hipótesis biomoleculares podrían ser probadas en modelos 3D dinámicos in vitro

Purpose: After radiopharmaceutical injection, a heightened 123I-MIBG concentration is frequently observed in the left hepatic lobe compared to the right one, but the reason of this finding remains unknown. Our aim was to retrospectively analyze the different 123I-MIBG uptake pattern between the two hepatic lobes and correlate our results with some epidemiological/clinical features. Material and methods: Ninety-four 123I-MIBG scintigraphies from 71 patients were selected. Regions of interest were drawn in the right and left lobes using transverse tomographic sections and left to right activity ratios (L/R ratio) were calculated at 6 and 24h after radiotracer administration. Results: Twenty-seven examinations were positive for hypermetabolic lesions while the remaining 67 were negative. In all cases mean early and delayed L/R ratios were greater than 1.00; average early L/R ratio was 1.37 and delayed L/R ratio 1.52. The delayed L/R ratio was significantly higher than the early one. There was no difference in the L/R ratios with regard to age, gender, primary disease and result of scintigraphy. Conclusions: 123I-MIBG uptake was higher in left hepatic lobe compared to right and this ratio did not correlate with any epidemiological or clinical feature. The reason of this metabolic is not yet explained and some biomolecular hypotheses could be tested in 3D dynamic in vitro models

Different uptake of 123I-MIBG in the two main liver lobes: A persistant unsolved mistery. / Diferente captación de 123I-MIBG en los 2 lóbulos hepáticos principales: un misterio persistente sin resolver.

PURPOSE: After radiopharmaceutical injection, a heightened 123I-MIBG concentration is frequently observed in the left hepatic lobe compared to the right one, but the reason of this finding remains unknown. Our aim was to retrospectively analyze the different 123I-MIBG uptake pattern between the two hepatic lobes and correlate our results with some epidemiological/clinical features. MATERIAL AND METHODS: Ninety-four 123I-MIBG scintigraphies from 71 patients were selected. Regions of interest were drawn in the right and left lobes using transverse tomographic sections and left to right activity ratios (L/R ratio) were calculated at 6 and 24h after radiotracer administration. RESULTS: Twenty-seven examinations were positive for hypermetabolic lesions while the remaining 67 were negative. In all cases mean early and delayed L/R ratios were greater than 1.00; average early L/R ratio was 1.37 and delayed L/R ratio 1.52. The delayed L/R ratio was significantly higher than the early one. There was no difference in the L/R ratios with regard to age, gender, primary disease and result of scintigraphy. CONCLUSIONS: 123I-MIBG uptake was higher in left hepatic lobe compared to right and this ratio did not correlate with any epidemiological or clinical feature. The reason of this metabolic is not yet explained and some biomolecular hypotheses could be tested in 3D dynamic in vitro models.

Right atrial metastasis of GIST detected by 18F-FDG PET/CT / Metástasis en la aurícula derecha de una GIST detectada por 18F-FDG PET/TC

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[The enforcement of the new Italian law on alcohol assumption in work activities with high accident risk in Lombardy]. / Stato di applicazione della normativa sul consumo di alcolici nelle attività ad elevato rischio di infortunio in Lombardia.

The 125/2001, the national law that forbids the alcohol consumption by workers with work tasks having high accident risks, has been activated a year ago. We carried out in Lombardy a research to evaluate the state of enforcement of the law in firms having different work activities. We found a complete application of the law only in very few firms. We think that the Occupational Health doctors should give more attention to the problem of alcohol consumption at the work places, giving the firms their specific scientific and medical support, using the peculiar knowledge of our discipline.

Preoperative diagnosis of 221 consecutive ovarian masses: scoring system and expert evaluation.

OBJECTIVE: The aim of our work was to assess the diagnostic accuracy of a scoring system versus subjective assessment of the risk of malignancy of pelvic masses achieved by gynecologist/sonologists in the preoperative triage of a busy gynecology department. METHODS: One hundred and eighty-two consecutive patients who underwent surgical removal of ovarian neoplasms were examined. In 39 patients pelvic masses were bilateral. The total number of neoplasms analyzed in this series was 221. Lesions were examined and scored according to the sonographic characteristics. Gynecologist/sonologists also recorded a subjective evaluation of the adnexal masses defining them as "probably benign", and "suspicious/probably malignant". Preoperative ultrasound risk assessment was compared to the final pathologic report and diagnostic accuracy was calculated. CA125 was obtained in all patients and its independent and combined accuracy was calculated. RESULTS: The sensitivity of the scoring system and subjective evaluation was 86% and 95% respectively, specificity was 79% and 91% with a positive predictive value of 41% and 53%. The frequency of positive diagnoses for CA125 was 44% due to the high prevalence of endometrosis in this series (48%). In premenopausal patients (75%) the specificity was 93% and 89% for scoring and subjective evaluation, respectively. The combined use of morphological scoring and CA125 achieved higher specificity and positive predictive values both for the whole series and in premenopausal patients. CONCLUSIONS: These results confirmed that the experience of gynecological surgeons with ultrasound skills, outperforms the morphological indexing assessment of ovarian masses. Nonetheless an easy sonographic descriptive scoring system is not significantly lower in accuracy than the expertise achieved by gynecologists with sonographic skills.

Preliminary results of a nutritional survey in a sample of 35,000 Italian schoolchildren.

An investigation of the nutrient intake of a large-scale sample (n = 35,072), drawn from the Italian school-age population (7-10 years) was carried out in a nationwide survey of nutritional patterns. Friuli, the Piedmont, Latium and Sicily regions were selected as representative of the nation's north-south and east-west socio-economic divisions. A food frequency questionnaire was used to assess nutritional intake. Traditional methods of 24-h dietary recall and a weighted food diary were used in subsamples to assess the validity of the food frequency questionnaire. Our data suggest that the average diet of Italian schoolchildren is rich in protein (especially animal proteins) and lipids (prevalently saturated fatty acids), but that carbohydrate and fibre intakes remain generally low. The relatively low calcium intake among girls and a widespread, more than adequate iron intake are also noteworthy. The food and nutrient intakes assessed suggest a dietary pattern with several positive points, but also reveal potential hazards for a wider population spectrum. The type of large-scale nutritional monitoring with a multi-method approach can be used in Italy and elsewhere to describe the dietary trends of a school-age population.