REMOVED: Correlation between COVID-19 and cardiac calcification

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Deciphering the Genomic Landscape and Pharmacological Profile of Uncommon Entities of Adult Rhabdomyosarcomas.

Adult rhabdomyosarcoma (RMS) represents an uncommon entity with an incidence of less than 3% of all soft tissue sarcomas (STS). Consequently, the natural history and the clinical management of this disease are infrequently reported. In order to fill this gap, we investigated the molecular biology of an adult RMS case series. The expression of epithelial mesenchymal transition-related gene and chemoresistance-related gene panels were evaluated. Moreover, taking advantage of our STS translational model combining patient-derived primary culture and 3D-scaffold, the pharmacological profile of an adult head and neck sclerosing RMS was assessed. Furthermore, NGS, microsatellite instability, and in silico analyses were carried out. RT-PCR identified the upregulation of CDH1, SLUG, MMP9, RAB22a, S100P, and LAPTM4b, representing promising biomarkers for this disease. Pharmacological profiling showed the highest sensitivity with anthracycline-based regimen in both 2D and 3D culture systems. NGS analysis detected RAB3IP-HMGA2 in frame gene rearrangement and FGFR4 mutation; microsatellite instability analysis did not detect any alteration. In silico analysis confirmed the mutation of FGFR4 as a promising marker for poor prognosis and a potential therapeutic target. We report for the first time the molecular and pharmacological characterization of rare entities of adult head and neck and posterior trunk RMS. These preliminary data could shed light on this poorly understood disease.

Sixty-Day Mortality Among 520 Italian Hospitalized COVID-19 Patients According to the Adopted Ventilatory Strategy in the Context of an Integrated Multidisciplinary Clinical Organization: A Population-Based Cohort Study.

PURPOSE: Although the decision of which ventilation strategy to adopt in COVID-19 patients is crucial, yet the most appropriate means of carrying out this undertaking is not supported by strong evidence. We therefore described the organization of a province-level healthcare system during the occurrence of the COVID-19 epidemic and the 60-day outcomes of the hospitalized COVID-19 patients according to the respiratory strategy adopted given the limited available resources. PATIENTS AND METHODS: All COVID-19 patients (26/02/2020-18/04/2020) in the Rimini Province of Italy were included in this population-based cohort study. The hospitalized patients were classified according to the maximum level of respiratory support: oxygen supplementation (Oxygen group), non-invasive ventilation (NIV-only group), invasive mechanical ventilation (IMV-only group), and IMV after an NIV trial (IMV-after-NIV group). Sixty-day mortality risk was estimated with a Cox proportional hazard analysis adjusted by age, sex, and administration of steroids, canakinumab, and tocilizumab. RESULTS: We identified a total of 1,424 symptomatic patients: 520 (36.5%) were hospitalized, while 904 (63.5%) were treated at home with no 60-day deaths. Based on the respiratory support, 408 (78.5%) were assigned to the Oxygen group, 46 (8.8%) to the NIV-only group, 25 (4.8%) to the IMV-after-NIV group, and 41 (7.9%) to the IMV-only group. There was no significant difference in the PaO2/FiO2 at IMV inception in the IMV-after-NIV and IMV-only groups (p=0.9). Overall 60-day mortality was 24.2% (Oxygen: 23.0%; NIV-only: 19.6%; IMV-after-NIV: 32.0%; IMV-only: 36.6%; p=0.165). Compared with the Oxygen group, the adjusted 60-day mortality risk significantly increased in the IMV-after-NIV (HR 2.776; p=0.024) and IMV-only groups (HR 2.966; p=0.001). CONCLUSION: This study provided a population-based estimate of the impact of the COVID-19 outbreak in a severely affected Italian province. A similar 60-day mortality risk was found for patients undergoing immediate IMV and those intubated after an NIV trial with favorable outcomes after prolonged IMV.

Pulmonary Thromboembolism in COVID-19: Venous Thromboembolism or Arterial Thrombosis?

PURPOSE: To investigate CT pulmonary angiography findings of pulmonary thromboembolism (PTE) in coronavirus disease 2019 (COVID-19) and its association with clinical and radiologic conditions. MATERIALS AND METHODS: This retrospective study includes 109 hospitalized patients with COVID-19 who underwent CT pulmonary angiography for suspected PTE from March 20 to May 3, 2020. Data were collected from our PACS. CT pulmonary angiography findings of PTE were evaluated. On the basis of the presence or absence of PTE, patients were divided into two groups, and their clinical and radiologic conditions were compared using the Mann-Whitney U test and χ2 test. RESULTS: The study population comprised 82 men and 19 women, with a mean age of 64.1 years ± 15.0 (95% confidence interval [CI]: 60.4, 67.6) years. CT pulmonary angiography was performed 19.8 days ± 6.1 (95% CI: 18.1, 20.2) after symptom onset and 10.5 days ± 3.8 (95% CI: 10.2, 12.9) after admission. Of 101 patients, 41 had PTE (40.6%). PTE was mostly bilateral or only right (37/41 [90.2%]), mainly involved segmental (37/41 [90.2%]) or subsegmental (25/41 [61.0%]) arteries and affected mainly the branches of the lower lobe (30/41 [73.2%]). Parenchymal segments supplied by segmental arteries with PTE showed a prevalent consolidation pattern (25/37 [67.6%]). Deep vein thrombosis was present only in five of 41 (12.2%) patients. Comparing groups with and without PTE, no significant difference was observed in age, sex, symptom onset, comorbidities, tumor history, use of respiratory supports, activated partial thromboplastin time, prothrombin time, and deep vein thrombosis. Conversely, differences were evaluated in CT lesion score (15.7 ± 1.4 [95% CI: 15.3, 16.1] vs 14.1 ± 1.1 [95% CI: 13.8, 14.4]; P = .035), d-dimer level (P < .001), lactate dehydrogenase level (P < .001), and C-reactive protein level (P = .042). CONCLUSION: PTE in COVID-19 involves mainly the segmental and subsegmental arteries of segments affected by consolidations in patients with more severe lung disease. The authors hypothesize that the development of PTE in COVID-19 might be a pulmonary artery thrombosis because of severe lung inflammation and hypercoagulability rather than thromboembolism.© RSNA, 2020.

Computed tomography quantification of bone density adjacent to cemented pegged polyethylene glenoid components in shoulder arthroplasty.

BACKGROUND: Cemented polyethylene devices are the prostheses implanted more frequently, but there is no agreement on the optimal glenoid component design. In this study, bone mineral density (BMD) adjacent to cemented all-polyethylene glenoid components was assessed to gain insights into the characteristics of glenoid bone as a potential risk factor implicated in the failure of shoulder arthroplasty. PATIENTS AND METHODS: Twenty-two subjects were examined at an average follow-up of 31 months using the Constant-Murley score (CS) and multi-detector computed tomography. BMD was measured in 5 regions of interest (ROIs) at the sites where radiolucent lines are usually detected. BMD differences among the ROIs were tested. The relationship between BMD and a number of variables (CS subscores, age, gender, follow-up duration) was explored. RESULTS: There was a significant increase in CS scores (p<0.05). Significantly different BMD (p=0.0039) was found in the 5 ROIs, especially between ROIs 2 and 5 (p=0.016, Bonferroni's test) and between ROIs 3 and 5 (p=0.005, Bonferroni's test). BMD was lower in ROI 1 than ROI 3 and in ROI 2 than ROI 4, but the difference was not significant. DISCUSSION: The heterogeneous BMD distribution may be related to: (1) an interindividual variability in glenoid BMD; (2) the fixation technique; or (3) the different bone response to eccentric loading of the prosthetic head on the glenoid component. CONCLUSIONS: BMD analysis may contribute to extent our knowledge on glenoid component loosening and encourage further techniques of glenoid fixation.

Assessment of kidney volume in polycystic kidney disease using magnetic resonance imaging without contrast medium.

BACKGROUND/AIMS: Total renal volume (TRV) is an important index to evaluate the progression of autosomal-dominant polycystic kidney disease (ADPKD). TRV has been assessed by manually tracing renal contours from CT or MR scans, often employing contrast medium (CM). We developed a fast and nearly automated technique based on the analysis of MR images acquired without CM injection for TRV quantification. METHODS: 30 ADPKD patients underwent MRI. After the selection of one point inside each kidney for the entire volume, the automatic extraction of kidney contours was performed on each acquired slice; the segmentation procedure was based on region growing and on the application of morphological operators and curvature-based motion. The area inside each contour was calculated and TRV was derived. Volume measurements were validated by comparison with measurements obtained by stereology. RESULTS: TRV estimated in patients was 768 ± 545 ml (range 161-3,111 ml). The automatic measurements were in excellent correlation with the manual ones (r = 0.99, y = x - 0.7), with a small bias and narrow limits of agreement in both absolute (-5 ± 37 ml) and percentage (-0.6 ± 9.6%) terms. CONCLUSION: This preliminary study showed the feasibility of a fast and nearly automated method for determining TRV; importantly it does not require the use of potentially nephrotoxic CM.

Successful thoracoscopic resection of pulmonary metastasis less than 1 cm in size utilizing preoperative CT-guided wire localization.

Preoperative computer tomography (CT) guidance localization utilizing a percutaneous guidewire before thoracoscopic resection is safe and beneficial in children with pulmonary nodules less than 1 cm in size or located deep in the pleural surface. This paper describes a successful thoracoscopic resection of a little subpleural pulmonary metastasis of a Wilm's tumor in a 5-year-old child utilizing preoperative CT-guided wire localization of the lesion. The thoracoscopic procedure was performed with the use of two ports, the nodule was easily localized,and the pulmonary wedge resection was made by the use of an endo-GIA linear stapling device after guidewire removal. The operating time was 45 minutes and the chest tube was removed after 48 hours. The postoperative course was uneventful, and the child was discharged on postoperative day 5. This technique allows the surgeon to resect little pulmonary nodules, avoiding the need of more invasive procedures as standard thoracotomy without adjunctive morbidity and with good cosmetic results.

[Dissection of epiaortic vessels: clinical appearance and potentiality of imaging techniques].

PURPOSE: To analyse the major radiological and clinical features of dissections of the epiaortic vessels and evaluate the potential of imaging techniques on the basis of the findings reported in the literature over the last few years. MATERIALS AND METHODS: We evaluated 9 dissections (7 carotid lesions and 2 vertebral lesions) in 9 patients (5 women and 4 men; age range: 30-56 years) who came to our attention between September 1999 and June 2002. These were all stenoses and obstructions located in the cervical region and, in two patients, extended intracranially. The morphologic features were assessed in each case by colour-Doppler US, CT, MR or conventional angiography and correlated with clinical, therapeutic and distant progression patterns. Colour-Doppler US of the neck vessels was performed in 4 patients; CT angiography of neck and intracranial vessels was performed in 4 patients using a single-slice spiral scanner and a single contrast medium bolus injection, following unenhanced examination of the brain; MR angiography was performed in 6 patients after baseline examination using flow-dependent and/or angiographic sequences; conventional angiography was performed in 7 patients. Clinical manifestations at onset were peripheral neurological lesions in 5 cases and central ischaemic lesions in the remaining 4 cases. All patients underwent medical therapy (anticoagulants or antiaggregants). The follow-up was done by colour-Doppler US, MR and/or MR angiography; follow-up conventional angiography at 6-9 months was also performed in 6 patients. Distant progression was assessed on the basis of the degree of vascular re-canalization and the residual signs and symptoms. RESULTS: MR- and CT-angiography were diagnostic in all cases. In particular, diagnosis was obtained by MR-angiography in 4 patients and by CT-angiography in 3 patients. Conventional angiography yielded a diagnosis in 2 cases which had previously undergone non-contrast brain CT or MR without examination of neck vessels alone. Colour-Doppler US revealed non-specific wall and flow alterations in 2 cases, thus requiring further diagnostic studies. In patients with central neurological symptoms at onset the diagnosis was obtained within 48-72 hours, whereas in patients with initial peripheral neurological symptoms the time to diagnosis was significantly longer (up to 10 days) due to the poor specificity of the clinical picture and/or failed detection of the warning symptoms. Medical treatment gave rise to no major complications. Overall, distant progression was good: 6 patients recovered completely and 3 had mild to moderate residual neurological deficits. DISCUSSION AND CONCLUSIONS: Dissection of epiaortic vessels should always be considered as a probable cause of cerebral ischaemia in adults aged 20-50 years, particularly in the absence of vascular risk factors. Clinical assessment is fundamental for the diagnosis and treatment. Currently, CT and MR imaging techniques providing similar information are reliable diagnostic tools that can rapidly and non-invasively clarify suspicious clinical cases. Nevertheless, angiography continues to have an important role in the overall evaluation of disease severity in view of the possible endovascular or surgical treatment of complications.

Optimized delivery radiological reports: applying Six Sigma methodology to a radiology department.

PURPOSE: To optimise the process of reporting and delivering radiological examinations with a view to achieving 100% service delivery within 72 hours to outpatients and 36 hours to inpatients. To this end, we used the Six Sigma method which adopts a systematic approach and rigorous statistical analysis to analyse and improve processes, by reducing variability and minimising errors. More specifically, our study focused on the process of radiological report creation, from the end of the examination to the time when the report is made available to the patient, to examine the bottlenecks and identify the measures to be taken to improve the process. MATERIALS AND METHODS: Six Sigma uses a five-step problem-solving process called DMAIC, an acronym for Define, Measure, Analyze, Improve and Control. The first step is to define the problem and the elements crucial to quality, in terms of Total Quality Control. Next, the situation is analysed to identify the root causes of the problem and determine which of these is most influential. The situation is then improved by implementing change. Finally, to make sure that the change is long-lasting, measures are taken to sustain the improvements and obtain long-term control. In our case we analysed all of the phases the report passes through before reaching the user, and studied the impact of voice-recognition reporting on the speed of the report creation process. RESULTS: Analysis of the information collected showed that the tools available for report creation (dictaphone, voice-recognition system) and the transport of films and reports were the two critical elements on which to focus our efforts. Of all the phases making up the process, reporting (from end of examination to end of reporting) and distribution (from the report available to administrative staff to report available to the patient) account for 90% of process variability (73% and 17%, respectively). We further found that the reports dictated into a voice-recognition reporting system are delivered in 45 hours (median), whereas those dictated using a dictaphone take 96 hours: voice-recognition reporting systems therefore improve performance by 50 hours. Unfortunately, 38% of our reports are delivered within longer timeframes than the 72h for outpatients and 36h for inpatients agreed with the service users. Reports for inpatients have much faster delivery times and lower variability, as 95% of these examinations are reported using voice-recognition reporting (as a result of the greater sensitivity of physicians to the problem of inpatient waiting times). For conventional radiology examinations, numerically greater than CT or MRI, there is a stronger tendency to use the dictaphone which allows for faster dictation as it is unburdened by administrative tasks such as entering examination codes, correcting errors, etc. Freelance status has no impact on report delivery times, service delivery being the same as in the institutional setting. The subprocess of reporting is strongly affected by the choice of reporting method (voice-recognition system or dictaphone), whereas report delivery is affected by the individual's behaviour patterns and ultimately by habits generated by the lack of a clearly charted process (lack of synchronisation among the various phases), and therefore potentially avoidable. DISCUSSION: The analytical study of the various phases of examination reporting, from writing to delivery, allowed us to identify the process bottlenecks and take corrective measures. Regardless of imaging modality and individual physician, examination reporting consistently takes longer when a dictaphone is used instead of a voice-recognition reporting system, as this makes the process more complex. To improve the two critical subprocesses whilst maintaining constant resources, a first step is to abandon the dictaphone in favour of the voice-recognition system. In addition, we are experimenting other measures to improve the collection and sorting of examinations and the delivery of reports: the technical staff take the films from the examination rooms to the reporting rooms three times a day; the radiologists collect their examinations and prepare the reports, possibly on the same day; the radiologists leave their signed reports on the table in the central reporting room; the administrative staff collect the signed reports three times a day in the morning and afternoon to be able to deliver them on the same day. CONCLUSIONS: This project has allowed us to become familiar with the principles of total quality, to better understand our internal processes and to take effective measures to optimise them. This has resulted in enhanced satisfaction of all the department staff and has laid the grounds for further measures in the future.