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Our objective was to evaluate the cortical metabolic changes and clinical outcome in patients affected by idiopathic normal pressure hydrocephalus (iNPH) after a placement of ventriculoperitoneal (VP) shunt.10 patients affected by suspected iNPH underwent a CSF hydrodynamics evaluation based on a lumbar infusion test (LIT). The main selection criterion for surgery was based on intracranial elasticity (IE)0.30. All subjects with an IE0.30 underwent a PET scan with 18 fluorodeoxiglucose (An overall number of 20 18F-FDG PET scans were performed in all the enrolled patients. As compared to PET1, PET2 showed an increase in glucose consumption in the left frontal and left parietal lobe in PET2 as compared to PET1 (P.001). All the enrolled patients presented a significant increase in neuropsychological scores (i.e Frontal Assessment Battery and Montreal Cognitive Assessment) and have clinically improved at gait analysis. A significant correlation was found between the increase of cortical glucose consumption in the left parietal area and the cognitive improvement as detectable by neuropsychological assessment.Improvement in 18F FDG PET glucose metabolism could be considered a useful imaging marker for the assessment of iNPH response to VP shunting.

Vitamin D deficiency is associated with increased risks of mortality in people with chronic kidney disease. The benefits and harm of vitamin D supplementation on cardiovascular outcomes and mortality are unknown. We aimed to assess the effectiveness of calcifediol in reducing mortality in patients with vitamin D insufficiency on hemodialysis compared to no additional therapy. A phase III, multicenter, randomized, open-label trial was conducted including 284 adults with vitamin D insufficiency undergoing hemodialysis who were randomly assigned to receive oral calcifediol or standard care for 24 months. Two hundred eighty-four participants were enrolled (143 assigned to the calcifediol group and 141 to the no additional therapy group). The primary outcome (mortality) occurred in 34 and 31 participants in the calcifediol and control group, respectively [hazard ratio (HR) 1.03; 95% confidence interval (CI) 0.63–1.67]. Calcifediol had no detectable effects on cardiovascular death (HR 1.06; 95% CI 0.41–2.74), non-cardiovascular death (HR 1.13; 95% CI 0.62–2.04), nonfatal myocardial infarction (HR 0.20; 95% CI 0.02–1.67) or nonfatal stroke (HR could not be estimated). The incidence of hypercalcemia and hyperphosphatemia was similar between groups. None of the participants underwent parathyroidectomy. In adults treated with hemodialysis and who had vitamin D insufficiency, calcifediol supplementation for 24 months had inconclusive effects on mortality and cardiovascular outcomes. NCT01457001

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Alzheimer’s disease (AD) is the most common cause of dementia in the elderly, with tremendous impact on the affected individuals and the society. Definitive diagnosis can be achieved only by post mortem examination. Clinical diagnosis criteria currently applied in clinical practice for AD often fail to accurately discriminate between AD and non-AD dementia with up to 40% of misdiagnosed patients. Several published papers demonstrated that the pre-clinical phase of AD is characterized by an early rise in beta-amyloid accumulation into inter-neuronal space, followed by a severe synaptic dysfunction. Thus, beta-amyloid protein, detected in the cerebrospinal fluid, has been considered a specific AD biomarker. Molecular imaging of beta-amyloid deposits, with positron emission tomography (PET) and 18F-labeled radiopharmaceuticals such as 18F-florbetapir, 18F-florbetaben, and 18F-flutemetamol, has emerged as potential powerful tool for aiding AD diagnosis. The aim of the present paper is to review the existing literature on the clinical use of these new amyloid tracers in order to delineate their diagnostic value and limitations.

In the last years, radioembolization (RE) has emerged as a novel technique for the treatment of malignant hepatic lesions using (90)Y embedded in spheres, which are infused directly into the hepatic arterial circulation. (90)Y-spheres, once implanted in liver, can release a significant radiation burden to neoplastic cells with a relative low dose to normal parenchyma. (90)Y RE results as a combination of embolization and radiation therapy, thus the standard radiologic follow up modalities may be not sufficiently accurate to assess tumor response to treatment. (18)Fluoro-deoxyglucose Positron Emission Tomography ((18)F-FDG PET) detects glucose uptake and metabolic activity in tumor cells. (18)F-FDG PET has become a well established diagnostic tool in many oncological scenarios. Furthermore, PET response criteria (PERCIST) have been recently introduced to categorize the metabolic response to therapy of cancer patients. Several semiquantitative parameters, such as SUVmax and its changes, the Functional Tumor Volume and the Total Lesion Glycolysis can be useful to accurately assess tumor changes after therapy. The purpose of this article is to present the literature on the role of (18)F-FDG PET in the evaluation of patients with primary and secondary liver tumors treated with (90)Y RE.

Objective: In relation to chronological and dialytic age, we have studied for 6 months the quality of life (QoL) of 56 stable subjects on peritoneal dialysis (PD), and also nutritional, immunological, and dialytic efficiency factors, com- pared to psychological tests. Methods: We divided the patients (pts) into 4 age groups: G1 (up to 49 years), G2 (50–59 years), G3 (60–69 years), G4 (over 70 years). Age-based dialysis in months (m) in 3 groups: 1–12 m, 13–36 m, 37– 90 m. Clinical parameters: nutritional, immunological, and dialytic efficiency values: albumin, Hb, WBC, ferritin, C3, C4, BMI, IgG, IgA, IgM, C-reactive pro- tein (CRP), CA125, Ca19-9, GFR, Kt/V, CCL, PTH. Psychometric tests: SF-36, POMS, MHLCS, MPSS, COPE. Results: In all pts during the observations is detected: significant worsening of SF-36 AF (0.04) and SF-36 AS (0.02) and MHLC internal (0.05), that shows the tendency of pts to personally manage their health condition; decrease of GFR (0.00) and CCL Tot (0.00); increase of Ca19-9 (0.01); decrease of Kt/V close to significance (0.07); increase of C3 close to significance (0.07); an increase of BMI close to significance (0.06). Chronological age (yrs): G1 (up to 49): worsening levels of depression and anxiety (POMS) almost significant (0.07). Decrease of GFR values close to significance (0.07). G2 (up to 59): worsening of SF-36 AS (0.07), increased levels of anxiety and tension at the POMS (0.03), of research support-help (COPE; 0.05), of PCR (0.04), C3 (0.00), and IgM (0.04). G3 (60–69): increase of PCR (0.02) and Alb (0.04), no significant increase in BMI. G4 (over 70): no significant changes in studied parameters. Dialytic age (m): 1–12: increase of Ca19-9 (0.05), C3 (0.01), and PTH (0.04); 13–36: worsening of SF-36-AF (0, 05); 37–90: increase of C3 (0.01) and PTH (0.04). Conclusions: Our study suggests that PD pts, especially those of G2 and dialytic age 13–36 months, implement a worse QoL compared to the physical capabilities and the impact of pain (SF-36, POMS). Proinflammatory indices (C3, Ca19-9, PCR, PTH) vary with dialytic age, prob- ably for the current poor biocompatibility of PD. With the support of family and life expectancy, pts over 70 years are the only group without significant changes, confirming that the PD treatment is more convenient at this age.

The aim of the present study was to investigate brain glucose metabolism in patients with Hodgkin disease (HD) after diagnosis and during chemotherapy treatment. Following the administration of first-line doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy, 74 HD patients underwent 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET)/computed tomography brain scans, both baseline (PET0) and interim (PET2) at the Department of Biomedicine and Prevention, University of Rome Tor Vergata (Rome, Italy). Fifty-seven patients were further evaluated 15±6 days after four additional cycles (PET6). Furthermore, a control group (CG) of 40 chemotherapy-naïve subjects was enrolled. Differences in brain 18F-FDG uptake between the CG, PET0, PET2 and PET6 scans were analyzed using statistical parametric mapping. Compared with the PET0 and CG scans, the PET2 scan demonstrated a higher metabolic activity in Brodmann area (BA) 39, and a metabolic reduction in BA 11 bilaterally and in left BA 32. All of these changes disappeared at PET6. The results of the present study indicate that ABVD chemotherapy has a limited impact on brain metabolism.

Background The observation of gait abnormalities, parkinsonism and vascular lesions in elderly patients is often reported as vascular parkinsonism (VP). However the status of striatal dopamine transporter (DAT) and the effects of brain vascular lesions on motor features and levodopa responsiveness are poorly defined. Methods We recorded clinical features, chronic response to levodopa and vascular risk factors in a cross-sectional cohort of consecutive elderly patients with possible Parkinson's disease (PD) or VP recruited in 20 centers in Italy. Results We included a total of 158 patients. Onset of motor symptoms was asymmetric in 93 (59%) and symmetric in 65 patients (41%). Symmetric motor onset was associated with greater disease severity. Chronic levodopa response was positive in 75 (47.8%) and negative in 82 patients (52.2%). A negative response to levodopa was associated with greater frequency of symmetric onset of motor symptoms, worst disease severity, absence of dyskinesia and greater number of vascular risk factors. Frontal lobe showed largest vascular load. Striatal DAT was normal in 48 (30.4%) and abnormal in 110 (69.6%) patients. Patients with normal DAT binding showed higher vascular load at MRI. Significant predictive factors of worst disease severity and negative response to levodopa were hypertension, vascular lesions in basal ganglia/periventricular regions, and normal DAT uptake. Conclusions Multiple cerebral vascular lesions modify clinical presentation and severity in patients with parkinsonism and this is underlined by specific risk factors primarily hypertension. Striatal DAT assessment is helpful in identifying patients where therapy benefit is less likely.