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Background Diastasis recti is an abdominal wall defect that occurs frequently in women during pregnancy. Patients with diastasis can experience lower back pain, uro-gynecological symptoms, and discomfort at the level of the defect. Diastasis recti is diagnosed when the inter-rectus distance is > 2 cm. Several techniques, including both minimally invasive and open access surgical treatment, are available. Abdominoplasty with plication of the anterior rectus sheath is the most commonly used, with the major limitation of requiring a wide skin incision. The new technique we propose is a modification of Costa’s technique that combines Rives–Stoppa principles and minimally invasive access using a surgical stapler to plicate the posterior sheaths of the recti abdominis. Methods It is a fully laparoscopic technique. The pneumoperitoneum is induced from a sovrapubic trocar, placed using an open access technique. The posterior rectus sheath is dissected from the rectus muscle using a blunt dissector to create a virtual cavity. The posterior sheets of the recti muscles are plicated using an endo-stapler. A mesh is then placed in the retromuscular space on top of the posterior sheet without any fixation. Using a clinical questionnaire, we analyzed the outcomes in 74 patients who underwent minimally invasive repair for diastasis of the rectus abdominis sheath. Results Seventy-four patients (9 men and 65 women) were treated using this technique. Follow-up was started two months after surgery. All procedures were conducted successfully. There were no major complications or readmissions. No postoperative infections were reported. There were two recurrences after six months. There was a significant reduction in symptoms. Conclusions This new method is feasible and has achieved promising results, even though a longer follow-up is needed to objectively assess this technique.

Objective: The aim of the study was to retrospectively evaluate the prevalence of reported and unreported potentially important incidental findings (PIFs) in consecutive nonenhanced abdominal CTs performed specifically for renal colic in the urgent setting. Methods: One radiologist, blinded to the finalized report, retrospectively re-evaluated nonenhanced abdominal CTs performed from January to December 2017 on adult patients from the emergency department with the specific request of urgent evaluation for renal colic, searching for PIFs. Results: The CTs of 312 patients were included in the study. Thirty-eight findings were reported in 38 different CTs, whereas the re-evaluation added 47 unreported findings in 47 different CTs, adding to total of 85 findings (27%). The difference in the proportion of reported and unreported PIFs between the original report and re-evaluation was significant (p < 0.001). No significant difference was found between the age of patients with and without reported findings. The proportion of potentially important findings did not vary significantly among the 3 shifts in the original report and in re-evaluation. The most frequent findings, both reported and unreported, were pleural effusion, lymphadenopathies, and liver nodules. Conclusions: Potentially important additional findings are frequently present in urgent nonenhanced abdominal CTs performed for renal colic, and many are not described in the finalized reports. Radiologists should take care not to underreport PIFs even in the urgent setting because of the possible consequences on the patient’s health and in order to avoid legal issues, while at the same time satisfying the need for timely and efficient reporting.

Background: When undergoing magnetic resonance (MR) exams, patients need to lie still in a noisy and enclosed environment for a long time. This condition, together with the anxiety burden related to the possible implications of the scan results, can entail a diagnostic outcome of poor quality. Objective: The aim of the study was to evaluate the personal perception and experience of adult patients undergoing unenhanced musculoskeletal MR. Methods: Consecutive outpatients undergoing unenhanced MR of spine, knee or shoulder were asked to respond to a 10-item questionnaire at the end of the exam. Results: 263 patients (54% males, mean age 50.6 ±15.8 years, range 18-83 years) completed the questionnaire. Patients declared that the most disturbing elements of the exam were forced immobility and noise (30% in both cases). Females perceived significantly higher degree of anxiety than males (56% vs. 21%, p Conclusion: Explanations and clarifications given before the exam were considered satisfactory by the patients. Despite some negative aspects such as noise, immobility and anxiety especially in females, patients’ satisfaction with our service was high, as well as the willingness to return.

The nasal cavities are complex anatomical structures with high inter-individual variability that relates to different functions. Different anatomic variants may manifest at this site, mainly belonging to the nasal septum and turbinates. Precise knowledge of the anatomy and variants is fundamental for both radiologists and ENT surgeons. This article provides an overview of the main anatomic variants and their frequency, according to the existing literature, as well as ongoing research on nasal cavity segmentation in order to obtain personal 3D models and to predict post-surgical results.

Background: A bilateral diaphragmatic rupture is a rare event that occurs in cases of blunt thoracic-abdominal trauma.Case Presentation: We report the case of a 56-year-old female patient with pelvic fracture and second-stage bilateral rupture of the diaphragm due to a car accident. After a chest and abdominal contrast-enhanced computed tomography (CT) scan, the patient underwent emergency suturing of the left hemidiaphragm. On postoperative day (POD) 4, a CT scan performed due to the sudden onset of dyspnea revealed rupture of the right hemidiaphragm, which was not detected on the preoperative CT scan. On POD 9, the right hemidiaphragm was repaired with mesh during a right thoracotomy. The patient recovered 14 days after surgery. However, the postoperative course was complicated by an asymptomatic COVID-19 infection that significantly delayed her discharge from the hospital.Conclusions: Difficulties in preoperative diagnosis and treatment, together with the lack of data in the literature, make this type of trauma a challenge for all acute care and general surgeons.

Simple Summary The literature is conflicting regarding the feasibility and survival outcomes of distal pancreatectomy with celiac axis resection (DP-CAR), although this procedure, in selected cases, represents the only therapeutical option for patients with locally advanced pancreatic cancer. The available studies often include small surgical populations, and there are important variations in the inclusion criteria and pre- and post-operative treatment. The purpose of this study was to provide an overview of the literature of the last 15 years, to evaluate the efficacy and the clinical safety of this procedure. This could help physicians in the choice of a multidisciplinary targeted therapeutical plan for patients. The combination of neoadjuvant chemo/radiochemotherapy and demolitive surgeries such as DP-CAR could have a role in changing the survival outcomes of patients with locally advanced pancreatic adenocarcinoma. Abstract Background: Major vascular invasion represents one of the most frequent reasons to consider pancreatic adenocarcinomas unresectable, although in the last decades, demolitive surgeries such as distal pancreatectomy with celiac axis resection (DP-CAR) have become a therapeutical option. Methods: A meta-analysis of studies comparing DP-CAR and standard DP in patients with pancreatic adenocarcinoma was conducted. Moreover, a systematic review of studies analyzing oncological, postoperative and survival outcomes of DP-CAR was conducted. Results: Twenty-four articles were selected for the systematic review, whereas eleven were selected for the meta-analysis, for a total of 1077 patients. Survival outcomes between the two groups were similar in terms of 1 year overall survival (OS) (odds ratio (OR) 0.67, 95% confidence interval (CI) 0.34 to 1.31, p = 0.24). Patients who received DP-CAR were more likely to have T4 tumors (OR 28.45, 95% CI 10.46 to 77.37, p < 0.00001) and positive margins (R+) (OR 2.28, 95% CI 1.24 to 4.17, p = 0.008). Overall complications (OR, 1.72, 95% CI, 1.15 to 2.58, p = 0.008) were more frequent in the DP-CAR group, whereas rates of pancreatic fistula (OR 1.16, 95% CI 0.81 to 1.65, p = 0.41) were similar. Conclusions: DP-CAR was not associated with higher mortality compared to standard DP; however, overall morbidity was higher. Celiac axis involvement should no longer be considered a strict contraindication to surgery in patients with locally advanced pancreatic adenocarcinoma. Considering the different baseline tumor characteristics, DP-CAR may need to be compared with palliative therapies instead of standard DP.

Background The intrapetrous carotid artery (IPCA) is one of the most unexplored anatomic regions, and its 3-dimensional reconstruction in living subjects is still missing. This study aims to describe the IPCA on 3D models extracted from head computed tomography (CT) scans. Methods The intrapetrous carotid artery was manually segmented on head CT scans of 100 healthy patients free from vascular and neurologic pathologies (50 men and 50 women; age range, 18–91 years). Angles of the posterior and anterior genu, diameter and length of the horizontal portion, and volume of the entire canal were calculated through 3D analysis software. Statistically significant differences according to sex and side were assessed through 2-way analysis of variance (P Results On average, the angles of the posterior and anterior genu were 120.1° ± 10.4° and 118.0° ± 10.0° in men and 119.5° ± 9.2° and 117.6° ± 10.3° in women, respectively, without statistically significant differences according to sex or side (P > 0.05). The average length and diameter of the horizontal part were, respectively, 25.5 ± 2.9 and 5.8 ± 0.8 mm in men and 24.0 ± 2.3 and 5.3 ± 0.8 mm in women. The volume of the IPCA was 0.941 ± 0.215 cm3 in men and 0.752 ± 0.159 cm3 in women. The length and diameter of the horizontal portion and the volume of the IPCA showed statistically significant differences according to sex (P Conclusions This study provides data concerning not only linear and angular measurements, but also volumes of the IPCA, which are useful in planning surgical interventions of the cranial base.

A Coriolus versicolor-based vaginal gel is available for treating women with cervical uterine high-risk human papillomavirus (HPV) infection through re-epithelizing and re-balancing microbiota actions. A longitudinal retrospective observational study was performed to evaluate efficacy and safety of the gel. Women treated with Coriolus versicolor-based vaginal gel were compared with women not treated with the gel. Both groups were monitored for HPV infection by an HPV DNA test, Pap smear (cytology) and colposcopy at baseline and after 6 months. Overall, 183 high-risk HPV positive women were enrolled (97 treated and 86 controls). After 6 months, the HPV DNA test became negative in 67.0% versus 37.2% of treated and controls, respectively (p

PURPOSE: To evaluate frequency, type, and cost of diagnostic and interventional radiological exams performed on end-stage oncologic patients in the 90 days before Hospice admission. MATERIALS AND METHODS: Data of patients admitted to Hospice from January 2012 through June 2013 (18 months) were cross-checked with data from the digital archive of the Radiology Department. Frequency and type of exams performed before admission were analyzed across three 1-month periods, namely M-3, M-2, M-1, corresponding to 90-61, 60-31 and 30-1 days before admission. The Regional Range of Fees was used to determine the costs. RESULTS: A total of 389 patients were admitted to Hospice. Before admission, 335 patients (86%) underwent 1543 radiological exams: 919 X-rays, 555 CTs, 39 MRs, and 30 interventional procedures. The cost of these services was EUR 106,988 (EUR 19,918 for X-rays, EUR 73,956 for CTs, EUR 9502 for MRs, and EUR 3612 for interventional procedures). Across the pre-Hospice periods, the proportions of examined patients increased as admission approached: 36% in M-3, 43% in M-2 (P = .038), 65% in M-1 (P < .001). The mean number of exams increased significantly, too (P < .001). CONCLUSIONS: A substantial number of end-stage oncologic patients underwent radiological exams in the 90 days before Hospice admission, and these numbers grew as Hospice access approached. In the end-of-life span, diagnostic excesses should be avoided.

// Alice Faversani 1 , Stefano Amatori 2 , Claudia Augello 1,3 , Federico Colombo 4 , Laura Porretti 4 , Mirco Fanelli 2 , Stefano Ferrero 1,5 , Alessandro Palleschi 6 , Pier Giuseppe Pelicci 7,8 , Elena Belloni 7 , Giulia Ercoli 1 , Anna Degrassi 9 , Marco Baccarin 10 , Dario C. Altieri 11 , Valentina Vaira 1,3,* and Silvano Bosari 1,3,* 1 Division of Pathology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico , Milan, Italy 2 Department of Biomolecular Sciences, University of Urbino ‘Carlo Bo’, Molecular Pathology Lab. ‘PaoLa’, Fano, Italy 3 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy 4 Flow Cytometry Service, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy 5 Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy 6 Division of Thoracic Surgery and Lung Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy 7 Department of Experimental Oncology, European Institute of Oncology, Milan, Italy 8 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy 9 Biology Department, Nerviano Medical Sciences s.r.l., Nerviano, Italy 10 Laboratory of Medical Genetics, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy 11 Prostate Cancer Discovery and Development Program, Tumor Microenvironment and Metastasis Program, The Wistar Institute, Philadelphia, Pennsylvania, United States of America * These Authors have contributed equally to the study Correspondence to: Valentina Vaira, email: // Silvano Bosari, email: // Keywords : miR-494-3p, miRNA, NSCLC, NOTCH1, stem cells Received : August 05, 2016 Accepted : December 07, 2016 Published : December 14, 2016 Abstract Lung cancer is the leading cause of tumor-related death worldwide and more efforts are needed to elucidate lung carcinogenesis. Here we investigated the expression of 641 miRNAs in lung tumorigenesis in a K-Ras (+/LSLG12Vgeo);RERTn(ert/ert) mouse model and 113 human tumors. The conserved miRNA cluster on chromosome 12qF1 was significantly and progressively upregulated during murine lung carcinogenesis. In particular, miR-494-3p expression was correlated with lung cancer progression in mice and with worse survival in lung cancer patients. Mechanistically , ectopic expression of miR-494-3p in A549 lung cancer cells boosted the tumor-initiating population , enhanced cancer cell motility, and increased the expression of stem cell-related genes. Importantly, miR-494-3p improved the ability of A549 cells to grow and metastasize in vivo , modulating NOTCH1 and PTEN/PI3K/AKT signaling. Overall, these data identify miR-494-3p as a key factor in lung cancer onset and progression and possible therapeutic target.

Background: Novel cancer biomarkers like microRNA (miRNA) are promising tools to gain a better understanding of lung cancer pathology and yield important information to guide therapy. In recent years, new less invasive methods for the diagnosis and staging of NSCLC have become key tools in thoracic oncology and the worldwide spread of endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA). However, appropriate specimen handling is mandatory to achieve adequate results and reproducibility. The aim of this single centre prospective study was to evaluate the feasibility of a complete miRNA expression profile in fresh NSCLC cell lines obtained by EBUS-TBNA. Methods: Patients with proven NSCLC underwent EBUS-TBNA for the diagnosis of suspect lymph node metastasis, and cytological specimens were collected for epithelial cell culture and miRNA expression analysis. To validate the miRNA expression profile, we compared the results from EBUS-TBNA NSCLC specimens with those obtained from formalin-fixed paraffin-embedded (FFPE) mediastinoscopy specimens. Results: Analysis of the miRNA expression profiles of three independent EBUS-TBNA-derived primary cell lines allowed the screening of 377 different human miRNAs. One hundred and fifty miRNAs were detected in all cell lines. Analysis of the miRNA expression profile in mediastinoscopy specimens showed a strong similarity in the clusters analysed. Conclusions: The miRNA expression profile is feasible and reliable in EBUS-TBNA specimens. Validation of this protocol in fresh cytological specimens represents an effective and reproducible method to correlate translational and clinical research.

Background: Few studies, and with conflicting results, have evaluated the potential effects of iodinated contrast media on children's thyroid function. Objective: To investigate the effects of iodinated contrast medium on thyroid function in neonates, infants and young children with congenital heart disease undergoing cardiac computed tomography (CT). Materials and methods: We retrospectively evaluated 10 neonates (group 1) and 23 infants and young children (group 2) without thyroid or renal disease for serum levels of thyroid-stimulating hormone, free triiodothyronine and free thyroxine before contrast-enhanced cardiac CT, 48 h after CT and at discharge from the hospital. Cardiac CT was performed with intravenous administration of 1.14±0.17 mL/kg of body weight of iopromide (containing 370 mg of iodine/mL). Results: Group 1 had a reduction of thyroid-stimulating hormone from baseline to 48 h post injection (P=0.002). Group 2 had a reduction of thyroid-stimulating hormone median levels from baseline to 48 h post injection and an increase from 48 h to discharge (P=0.0005 and P=0.0001, respectively). Conclusion: Intravenous iodinated contrast medium in children with congenital heart disease caused transient thyroid-stimulating hormone decrease 48 h after CT, with thyroid-stimulating hormone returning to normal range at discharge.

Peripheral nerves frequently travel close to the bone surface and are, therefore, prone to elastosonographic "bone-proximity" hardening artifacts. The impact of these artifacts on quantitative measurements of median nerve stiffness performed by shear wave elastosonography has not been explored. Our aim was to assess normal median nerve stiffness values at various locations.Thirty-six healthy volunteers (24 women and 12 men) aged between 25 and 40 years were evaluated. Two operators performed the evaluation: one expert (6 years of ultrasound experience) and one inexperienced operator (6 months' experience). The nerve was sampled in cross-section at three different locations: mid-forearm, immediately before the carpal tunnel and within the tunnel. The ultrasound scanner was equipped with a 14-MHz linear probe. The Shear Wave module was activated in one-shot mode. Measurements were performed using a ROI corresponding to the diameter of the nerve.The mean values of stiffness of the medial nerve were 32.26 kPa ± 18.60 within the carpal tunnel, 22.20 kPa ± 9.84 at the carpal tunnel inlet and 7.62 kPa ± 7.38 in the forearm. Inter-observer agreement assessed using the intraclass correlation coefficient (ICC) was "moderate" within the carpal tunnel (ICC = 0.44), "moderate" at the carpal tunnel inlet (ICC = 0.41) and "fair" in the forearm (ICC = 0.38).The stiffness of the median nerve progressively increases in its distal portions, where the nerve approaches the bone surface. Inter-observer agreement was generally good (from fair to moderate).i nervi periferici frequentemente decorrono in prossimità di superfici ossee e sono perciò soggetti agli artefatti elasosonografici di “prossimità ossea”. L’impatto di questi artefatti sulle misure quantitative di stiffness del nervo mediano realizzate con elastosonografia a onde trasversali non è stata esplorata. Il nostro intento è quello di valutare la stiffness del nervo mediano in varie sedi.Sono stati valutati trentasei volontari sani (24 donne e 12 uomini) di età compresa tra 25 e 40 anni. Le valutazioni sono state eseguite da 2 operatori: un operatore esperto (6 anni di esperienza in ecografia muscoloscheletrica) e uno non esperto (6 mesi di esperienza). Il nervo è stato campionato in sezione assiale a tre livelli differenti: a livello dell’avambraccio, immediatamente prima del tunnel carpale e entro il tunnel. L’ecografo utilizzato era equipaggiato con una sonda lineare da 14 MHz. Il modulo shear-wave è stato attivato nella modalità “one-shot”. Le misurazioni sono state realizzate usando una ROI della stessa dimensione del nervo.Il valore medio di stiffness del nervo mediano è risultato essere di 32.26 kPa ± 18.60 entro il tunnel carpale, 22.20 kPa ± 9.84 all’inlet del tunnel carpale e 7.62 kPa ± 7.38 a livello dell’avambraccio. L’agreement inter osservatore è stato valutato usando l’Intraclass Correlation Coefficient (ICC) ed è risultato “moderato” entro il tunnel carpale (ICC = 0.44), “moderato” all’inlet del tunnel carpale (ICC = 0.41) e “soddisfacente” nell’avambraccio (ICC = 0.38).La stiffness del nervo mediano aumenta progressivamente nelle sue porzioni distali ove il nervo si avvicina alle superfici ossee. L’agreement inter osservatore di queste misurazioni è stato generalmente buono (da soddisfacente a moderato).

Background: Alterations of clinical interest, ("actionable") include Copy Number Alterations (CNA), but most sequencing panels and bioinformatic pipelines are opti- mised for detection of Single Nucleotide Variants, not informative for CNA-driven tumours. Furthermore, identifying CNA boundaries becomes clinically relevant when genes with opposing effects on drug sensitivity are involved on single CNAs. With hybridization-based enrichment methods, a sizeable fraction of reads align off-target. Our Excavator2 algorithm exploits off-target reads to call CNAs and outperforms standard, on-target read-based CNA-calling algorithms on Whole Exome Sequencing (NAR 2016 Nov 16;44(20):e154). We tested whether Excavator2 calls genome-wide CNAs using sequencing data from small, hybridization-based targeted enrichment panels. Methods: We compared CNA callers (EXCAVATOR2, CopywriteR and CNVkit) on simulated cancer genomes containing CNAs of varying size (100-5000 kb), on-target and off-target (both ¼ class1, on-target only ¼ class 2 in Fig. 1) with different tumour cellularity (10-90%), generated with Xome-Blender (Semeraro et al., Submitted).We then compared genome-wide CNA calls from targeted sequencing using the Agilent ClearSeq cancer panel (coding sequences of 46 genes) vs high-density SNP-array on 5 HER2-amplified breast cancer samples. Finally, we called CNAs involving 58 genes identified as actionable from literature search in a separate set of 7 lung tumours, ClearSeq-sequenced. Results: Precision/recall for Excavator2 was superior across the whole range of simula- tions (Fig. 1). Excavator2 and CopywriteR both showed comparable resolution with SNP array for on-target (True Positive Rate (TPR) ¼ 0.75 and 0.66 and False Positive Rate (FPR) ¼ 0 and 0.09 respectively) and, more interestingly, on off-target genes genome-wide (TPR ¼ 0.9 and 0.9 and FPR ¼ 0.21 and 0.1 respectively). As expected, pre- cision/recall increased with higher tumour cellularity and CNA size for both algorithms (Fig. 2, with representative sample). On lung tumours, Excavator2 identified multiple actionable alterations on both on-target and off-target genes (Fig. 3). Conclusions: Excavator2 calls actionable CNAs, otherwise unidentifiable with targeted sequencing panels, with comparable resolution to gold standard, significantly enlarging analytical capabilities and clinical usefulness of routine clinical sequencing. Additional validation with other sequencing panels is ongoing.

http://hdl.handle.net/20.500.11768/96454 Lung cancer is the first cause of cancer mortality worldwide, and its early detection is currently the main available strategy to improve disease prognosis. While early diagnosis can be successfully achieved through tomography-based population screenings in high-risk individuals, simple methodologies are needed for effective cancer prevention programs. We developed a test, based on the detection of 34 microRNAs (miRNAs) from serum, that could identify patients with early stage non-small cell lung carcinomas (NSCLCs) in a population of asymptomatic high-risk individuals with 80% accuracy. The signature could assign disease probability accurately either in asymptomatic or symptomatic patients, is able to distinguish between benign and malignant lesions, and to capture the onset of the malignant disease in individual patients over time. Thus, our test displays a number of features of clinical relevance that project its utility in programs for the early detection of NSCLC.

AIMS: Studies have pointed to insulin resistance as a pathogenic factor in fatty liver. Although pancreatic B-cell function is believed to be involved, its role is unclear. This study was undertaken to test whether fasting C-peptide, an index of fasting B-cell function, was related to intra-hepatic fat (IHF) content in non-diabetic humans. METHODS: We assessed, retrospectively, fasting plasma C-peptide concentration in 31 patients with fatty liver and 62 individuals without fatty liver. The IHF content was measured by proton magnetic resonance spectroscopy ((1)H-MRS), while insulin sensitivity was estimated based on fasting plasma glucose and insulin with the homestasis model assessment (HOMA) 2 method. RESULTS: Age, sex and body mass index (BMI) were not different between groups. Patients with fatty liver had higher fasting insulin (P < 0.01), C-peptide (P < 0.005) and lower insulin sensitivity (HOMA2-%S). Fasting insulin alone explained 14% of the IHF content variability (P < 0.001); inclusion of fasting C-peptide in multivariate regression explained up to 32% (P < 0.001). A subgroup analysis was performed by matching 1 : 1 for HOMA2-%S. These data were analysed by conditional logistic regression which showed that, when HOMA2-%S was matched between groups, fasting C-peptide remained the only significant predictor of fatty liver. CONCLUSIONS: Non-diabetic individuals with fatty liver are characterized by increased fasting plasma C-peptide concentration, irrespective of their insulin resistant state. AIMS: Studies have pointed to insulin resistance as a pathogenic factor in fatty liver. Although pancreatic B-cell function is believed to be involved, its role is unclear. This study was undertaken to test whether fasting C-peptide, an index of fasting B-cell function, was related to intra-hepatic fat (IHF) content in non-diabetic humans. METHODS: We assessed, retrospectively, fasting plasma C-peptide concentration in 31 patients with fatty liver and 62 individuals without fatty liver. The IHF content was measured by proton magnetic resonance spectroscopy ((1)H-MRS), while insulin sensitivity was estimated based on fasting plasma glucose and insulin with the homestasis model assessment (HOMA) 2 method. RESULTS: Age, sex and body mass index (BMI) were not different between groups. Patients with fatty liver had higher fasting insulin (P < 0.01), C-peptide (P < 0.005) and lower insulin sensitivity (HOMA2-%S). Fasting insulin alone explained 14% of the IHF content variability (P < 0.001); inclusion of fasting C-peptide in multivariate regression explained up to 32% (P < 0.001). A subgroup analysis was performed by matching 1 : 1 for HOMA2-%S. These data were analysed by conditional logistic regression which showed that, when HOMA2-%S was matched between groups, fasting C-peptide remained the only significant predictor of fatty liver. CONCLUSIONS: Non-diabetic individuals with fatty liver are characterized by increased fasting plasma C-peptide concentration, irrespective of their insulin resistant state.

OBJECTIVE. Fabry's disease may be difficult to differentiate from symmetric hypertrophic cardiomyopathy. Our aim was to compare the myocardial location and distribution patterns of delayed enhancement between patients with Fabry's disease who are affected by symmetric myocardial hypertrophy and patients with symmetric hypertrophic cardiomyopathy in order to identify a specific sign to best differentiate the two diseases. CONCLUSION. Patients with Fabry's disease-related hypertrophy showed left ventricular (LV) delayed enhancement with a typical and consistently found pattern characterized by the involvement of the inferolateral basal or mid basal segments and a mesocardial distribution that spared the subendocardium. This pattern seems to be specific to Fabry's disease; in fact, patients with symmetric hypertrophic cardiomyopathy had variable locations and distributions of delayed enhancement. These observations may contribute to identifying Fabry's disease as a specific cause of symmetric hypertrophy. © American Roentgen Ray Society

OBJECTIVE. The aims of this article are to present the main features of MRI of cardiomyopathy and to show selected images of cardiomyopathies. CONCLUSION. Cardiomyopathy is a frequent reason for cardiac MRI evaluation, which is now considered the most appropriate imaging technique for the diagnosis and follow-up of this wide range of myocardial diseases. © American Roentgen Ray Society

Objective: Ageing of the human heart is characterised by morphological, functional and metabolic changes. Short-term interventions and cross-sectional studies in older individuals questioned the possibility that physical exercise may reverse these alterations. In this study we aimed to assess whether in middle-aged men involved in regular and long lasting physical activity these alterations were attenuated. Design: Left ventricular (LV) magnetic resonance imaging (MRI) and three-dimensional image selected in-vivo spectroscopy (3D-ISIS) 31 P magnetic resonance spectroscopy (MRS) were performed using a 1.5T scanner in 20 healthy, young and 25 healthy middle-aged non-obese men with a sedentary lifestyle (11 young and 14 middle-aged) or undergoing regular aerobic oxidative training (9 young and 11 middle-aged). Insulin sensitivity was estimated by the homeostatic model assessment 2 (HOMA-2) model. Results: Sedentary young and middle-aged men were not different with respect to LV morphological parameters and systolic function. The phosphocreatine/ATP (PCr/ATP) ratio (marker of high energy phosphates metabolism) and the LV E-peak filling rate/A-peak filling rate ratio (E/A ratio) were lower in sedentary middle-aged than physically active subjects. Parameters of LV systolic function and the PCr/ATP ratio were not different in the middle-aged compared with the young trained men; the E/A peak flow ratio was higher in the middle-aged trained men than in the middle-aged sedentary men. Within the entire population, the PCr/ATP ratio and the E/A peak flow ratio were associated with insulin sensitivity. Conclusions: Trained middle-aged subjects showed a better pattern of LV energy metabolism and of diastolic function than their sedentary counterparts. At this age the exercise-related cardiac benefits were detectable when physical exercise was performed regularly and for a long period of time.

OBJECTIVE—Perturbations in cardiac energy metabolism might represent early alterations in diabetes preceding functional and pathological changes. We evaluated left ventricular (LV) structure/geometry and function in relation to energy metabolism and cardiovascular risk factors in overweight/obese men using magnetic resonance techniques. RESEARCH DESIGN AND METHODS—We studied 81 healthy men (aged 22–55 years, with BMI between 19 and 35 kg/m2) by means of cardiac magnetic resonance imaging and 31P-magnetic resonance spectroscopy in the resting and fasted conditions and stratified them in quartiles of BMI (cut offs: 23.2, 25.5 and 29.0 kg/m2). RESULTS—LV mass increased across quartiles of BMI; meanwhile, the volumes did not differ. Parameters of LV systolic and diastolic function were not different among quartiles. The phosphocreatine-to-ATP ratio was reduced across increasing quartiles of mean ± SD BMI (2.25 ± 0.52, 1.89 ± 0.26, 1.99 ± 0.38, and 1.79 ± 0.29; P < 0.006) in association with insulin sensitivity (computer homeostasis model assessment 2 model); this relation was independent of age, BMI, blood pressure, wall mass, HDL cholesterol, triglycerides, smoking habits, and metabolic syndrome. CONCLUSIONS—Abnormal LV energy metabolism was detectable in obese men in the presence of normal function, supporting the hypothesis that metabolic remodeling in insulin resistant states precedes functional and structural/geometrical remodeling of the heart regardless of the onset of overt hyperglycemia.

Churg–Strauss syndrome can be associated with Loeffler-like eosinophilic endocarditis. We report a case of a young woman in which the diagnosis of Churg–Strauss syndrome was made subsequently to the magnetic resonance demonstration of eosinophilic endocarditis associated to left ventricle apical thrombosis. In our report, this rare condition evolved in an unusual complication: the embolic migration of the left ventricle apical thrombus in the abdominal aorta as showed by multi-detector-computed-tomography angiography.

Luminal gastrointestinal (GI) metastases from breast cancer are rare, reports are fragmentary and poor. The purposes of this study are to assess the gastrointestinal involvement from breast cancer in a retrospective study at a single institution and reviewing the related literature. Between January 2007 and December 2011 a total of 980 patients with breast cancer were treated at our institution, patients’ records and report database were analysed. Institutional Review Board approval was obtained for this study. A search of the literature using PubMed, CancerLit, Embase, was performed. Selected for the present review were papers published in English before June 2012. Five of 980 patients (0.5%) showed gastrointestinal metastases from breast cancer, 3 patients had gastric involvement, 1 jejunum, and 1 rectum. Reviewing the literature, 206 patients affected by gastrointestinal metastasis from breast cancer were identified: the most frequent site of metastasis was the stomach (60%). The majority of the patients underwent chemotherapy and endocrine therapy, someone surgery and radiotherapy. GI metastases from breast cancer are rare, but possible, and a very late recurrence can also occur. Cyto-histological diagnosis is mandatory, to differentiate GI metastases from breast cancer to other diseases and to allow an adequate treatment.

This study investigated the clinical application of a magnetic-resonance (MR)-guided breast biopsy (MRBB) system consisting of a nonmagnetic coaxial needle and a ferromagnetic core biopsy needle.MRBB was performed on 70 breast lesions. The biopsy device consisted of a nonmagnetic 14- to 16-gauge coaxial needle and a ferromagnetic 16- to 18-gauge biopsy needle.Of the 70 lesions, 29 were malignant and 41 nonmalignant. All 29 malignant lesions underwent surgery and were confirmed as malignant at final histology. Of the 41 nonmalignant lesions, 35 underwent follow-up breast MR imaging (mean, 26 ± 19 months), which demonstrated no lesions changes; six lesions underwent surgery because of poor radiological-pathological correlation; of these 6 lesions, 3 were nonmalignant, one was borderline (lobular carcinoma in situ) and two were malignant (well-differentiated tubular carcinoma and infiltrating ductal carcinoma). Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were, respectively, 93.5%, 100%, 100%, 95.1% and 97.1% if the lobular carcinoma in situ was considered a nonmalignant histological result, and 90.6%, 100%, 100%, 92.7% and 95.7% if the lobular carcinoma in situ was considered malignant.MRBB with a ferromagnetic-nonmagnetic coaxial system represented an easy way to perform a biopsy procedure and was easily applicable in the routine clinical setting.

A patient undergoing chemotherapy for multiple myeloma had a sudden onset of heart failure. Cardiac magnetic resonance was performed after echocardiography to rule out myocardial late enhancement, which was not detected. In- terestingly, the inversion time of the T1-weighted inversion recovery late enhancement sequence needed to be significantly increased (from the usual 250-300 to 490 ms) to obtain diagnostic images. This report presents the clinical case of this patient, and discusses potential implications.

OBJECTIVE. Gadobutrol is an extracellular macrocyclic gadolinium chelate recently introduced in MRI, and it has already been used for cardiac late enhancement imaging; however, until now it has never been compared with gadopentetate dimeglumine. The purpose of our study was to compare 0.1 mmol/kg gadobutrol to 0.2 mmol/kg gadopentetate dimeglumine for the detection of myocardial late enhancement in the same group of patients. SUBJECTS AND METHODS. This was an exploratory single-blind parallel group study comparing gadobutrol (0.1 mmol/kg) to gadopentetate dimeglumine (0.2 mmol/kg) in 20 adult patients scheduled for cardiac late enhancement MRI with gadopentetate dimeglumine and whose MR images showed late enhancement. MR images were acquired at 10, 15, and 20 minutes after peripheral injection of gadobutrol by using a 3D turbo field echo inversion recovery T1-weighted sequence. Volume and percentage of late enhancement, number of involved segments, late enhancement localization and pattern, and late enhancement signal-tonoise ratio (SNR) and contrast-to-noise ratio (CNR) were compared between contrast agents. RESULTS. Late enhancement was not significantly different with gadobutrol and gadopentetate dimeglumine both in terms of total volume of myocardium (mean ± SD, 37.8 ± 56.1 and 35.1 ± 46.7 cm 3, respectively; p = 0.33) and percentage of myocardial wall involvement (22.5% ± 19.1% and 22.0% ± 17.2%, respectively; p = 0.67). The number of segments involved was not different (138 with gadobutrol vs 134 with gadopentetate dimeglumine). Furthermore, SNR and CNR were not different (gadopentetate dimeglumine, 123.8 ± 82.9 and gadobutrol, 117.2 ± 88.6, p = 0.58 and gadopentetate dimeglumine, 96.2 ± 68.9 and gadobutrol, 88.4 ± 72.9, p = 0.53, respectively). CONCLUSION. A single dose of gadobutrol seems to be as effective as a double dose of gadopentetate dimeglumine for the detection of late enhancement. © American Roentgen Ray Society

In 2007, an Italian cancer research group proposed a specific concerted action aimed at the “analytical and clinical validation of new biomarkers for early diagnosis: Network, resources, methodology, quality control, and data analysis.” The proposal united 37 national operative units involved in different biomarker studies and it created a strong coordinative body with the necessary expertise in methodologies, statistical analysis, quality control, and biological resources to perform ad hoc validation studies for new biomarkers of early cancer diagnosis. The action, financed by the Italian Ministry of Health within the Integrated Oncology Program (PIO) coordinated by NCI-Istituto Tumori Bari, started in 2007 and activated 7 projects, each of which focused on disease-specific biomarker studies. Overall, the 37 participating units proposed studies on 50 biomarkers, including analytical and clinical validation procedures. Clusters of units were specifically involved in research of early-detection biomarkers for cancers of the lung, digestive tract, prostate/bladder, and nervous system, as well as female cancers. Furthermore, a cluster involved in biomarkers for bioimaging and infection-related cancers was created. The first investigators' meeting, “Analytical and clinical validation of new biomarkers for early diagnosis,” was held on 9 September 2008 in Bari. During this meeting, methodological aspects, scientific programs and preliminary results were presented and discussed.

Objective: Areas of intramyocardial late enhancement (LE) at delayed enhanced magnetic resonance imaging (DE-MRI) and reduction of myocardial phosphocreatine (PCr)/ATP-ratio at phosphorus magnetic resonance spectroscopy (p31pP-MRS) are both reported in hypertrophic cardiomyopathy (HCM) and indicate areas of increased interstitial myocardial space with fibrosis and impairment of myocardial energy metabolism, respectively. We sought to ascertain whether in HCM patients the abnormal features of left ventricular (LV) interstitial space revealed by DE-MRI correlated with impaired LV energy metabolism shown at p31pP-MRS. Methods: 19 patients with HCM proved by histological analysis of multiple endomyocardial biopsies and with normal coronary arteries, underwent cardiac MRI including DE-MRI and p31pP-MRS. DE-MRI for detection and quantification of late enhancement (LE) and p31pP-MRS to assess the myocardial PCr/ATP-ratio were performed by means of a 1.5-T magnet. 19 healthy subjects, matched for gender and age were studied by p31pP-MRS as control group. Results: LE areas in the LV wall were found in 17 out of 19 patients with an extension ranging from 0.8% to 19.5% of the LV-mass (mean value 7.6% (SD 5.6%). The PCr/ATP-ratio was lower in HCM patients than in control subjects (2.18 (0.41) vs 2.41 (0.30); p

CONTEXT:Serum retinol-binding protein 4 (RBP-4), leptin, and adiponectin concentrations identify insulin resistance in varied conditions, but their relationships with insulin sensitivity and ectopic fat accumulation are unclear.OBJECTIVE:Our objective was to establish how these adipokines are related with intramyocellular lipid (IMCL) and intrahepatic lipid (IHL) content.DESIGN AND SETTING:We assessed retrospectively serum fasting RBP-4 concentrations in 1) 53 nondiabetic individuals in which insulin sensitivity and IMCL content were assessed by means of the insulin clamp and of 1H magnetic resonance spectroscopy of the calf muscles, and 2) 140 nondiabetic individuals in which insulin sensitivity and the IHL content were assessed by means of the updated homeostasis model assessment and of 1H magnetic resonance spectroscopy. In both experiments, serum leptin and adiponectin concentrations were measured.RESULTS:Fasting serum RBP-4, adiponectin, and leptin were associated with peripheral insulin sensitivity, were abnormal in the first-degree relatives of type 2 diabetic parents, and correlated with the soleus IMCL content and with the IHL content. The association of RBP-4 and adiponectin with insulin sensitivity was age, sex, and body mass index independent, but stepwise regression analysis suggested that RBP-4, but not adiponectin and leptin, was independently associated with insulin sensitivity. Adiponectin was independently associated with the IHL content, RBP-4, and leptin with the soleus IMCL content.CONCLUSION:Serum RBP-4 was a robust marker of insulin resistance. Serum RBP-4, leptin, and adiponectin concentrations reflected ectopic fat accumulation in humans CONTEXT:Serum retinol-binding protein 4 (RBP-4), leptin, and adiponectin concentrations identify insulin resistance in varied conditions, but their relationships with insulin sensitivity and ectopic fat accumulation are unclear.OBJECTIVE:Our objective was to establish how these adipokines are related with intramyocellular lipid (IMCL) and intrahepatic lipid (IHL) content.DESIGN AND SETTING:We assessed retrospectively serum fasting RBP-4 concentrations in 1) 53 nondiabetic individuals in which insulin sensitivity and IMCL content were assessed by means of the insulin clamp and of 1H magnetic resonance spectroscopy of the calf muscles, and 2) 140 nondiabetic individuals in which insulin sensitivity and the IHL content were assessed by means of the updated homeostasis model assessment and of 1H magnetic resonance spectroscopy. In both experiments, serum leptin and adiponectin concentrations were measured.RESULTS:Fasting serum RBP-4, adiponectin, and leptin were associated with peripheral insulin sensitivity, were abnormal in the first-degree relatives of type 2 diabetic parents, and correlated with the soleus IMCL content and with the IHL content. The association of RBP-4 and adiponectin with insulin sensitivity was age, sex, and body mass index independent, but stepwise regression analysis suggested that RBP-4, but not adiponectin and leptin, was independently associated with insulin sensitivity. Adiponectin was independently associated with the IHL content, RBP-4, and leptin with the soleus IMCL content.CONCLUSION:Serum RBP-4 was a robust marker of insulin resistance. Serum RBP-4, leptin, and adiponectin concentrations reflected ectopic fat accumulation in humans.

Background: Professional, long-term physical training is often associated with morphological and metabolic changes in the heart. This study was undertaken to assess the left ventricular (LV) and right ventricular (RV) morphology and function and the LV high-energy phosphates of athletes trained to a sustained power or aerobic exercise. Methods: Magnetic resonance imaging (MRI) of the LV and RV and phosphorous 31 magnetic resonance spectroscopy of the LV were performed by means of a 1.5-T clinical scanner in 23 elite track sprinters (sustained power or anaerobic power sprint training, 100-400 m) or marathon runners (sustained aerobic endurance training) and in 10 sedentary, young, lean men. Results: Athletes had LV hypertrophy and unaffected chamber size, systolic and diastolic functions, and high-energy phosphates metabolism. Also, the RV of the athletes was hypertrophied in comparison with that of the nonathletic controls, and the systolic and diastolic functions were unaffected; the chamber volume was higher in the sprinters (end-diastolic volume 190 ± 15 mL) in comparison with that of the marathon runners (174 ± 19 mL, P < .05) and controls (168 ± 19 mL, P < .01) even if this difference, when adjusted for body surface area, was maintained only when compared with that of controls (P < .02). Conclusions: Left ventricular and RV hypertrophy in athletes is associated with normal systolic and diastolic functions and resting cardiac energy metabolism, supporting its benign nature. A more pronounced RV dilatation was found in the anaerobic power athletes and further investigation is warranted to establish the clinical significance of this training effect. © 2007 Mosby, Inc. All rights reserved

OBJECTIVE—Fatty liver may be involved in the pathogenesis of type 2 diabetes. Physical exercise is a tool to improve insulin sensitivity, but little is known about its effect on intrahepatic fat (IHF) content. The purpose of this study was to examine the association of habitual physical activity, insulin resistance, and adiponectin with IHF content. RESEARCH DESIGN AND METHODS—Participants were 191 (77 female and 114 male) apparently healthy, nonalcoholic individuals (aged 19–62 years; BMI 17.0–35.5 kg/m2). IHF content was assessed in a quantitative fashion and noninvasively as a continuous variable by means of 1H magnetic resonance spectroscopy (MRS), and habitual physical activity was assessed by means of a questionnaire. Fatty liver was defined as IHF content of >5% wet weight, and insulin sensitivity was estimated using the computer homeostasis model assessment (HOMA)-2 indexes. RESULTS—A reduced prevalence of fatty liver in the quartile of the most physically active individuals (25, 11, 25, and 2% in quartile 1, 2, 3, and 4, respectively; χ2 = 15.63; P = 0.001) was found along with an inverse correlation between the physical activity index and the IHF content when plotted as continuous variables (Pearson’s r = −0.27; P < 0.000). This association was not attenuated when adjusted for age, sex, BMI, HOMA-2, and adiponectin (partial correlation r = −0.25; P < 0.001). CONCLUSIONS—This study demonstrated that a higher level of habitual physical activity is associated with a lower IHF content and suggested that this relationship may be due to the effect of exercise per se.

Background/purpose The Currarino syndrome (CS) is a peculiar form of caudal regression syndrome (CRS) characterized by the association of hemisacrum, anorectal malformation (ARM), and presacral mass. The authors analyzed retrospectively their series, and they propose a multidisciplinary diagnostic and therapuetic protocol that until now has not been introduced. Methods A series of 6 patients with CS is presented. Five of them were treated initially in other centers. None of them had an early diagnosis. All presented associated anomalies; in 50%, Hirschsprung’s disease (HD) and other dysganglionoses were present. One patient died of a presacral ectopic nephroblastoma. Results Depending on the expressivity, 3 types of CS can be identified, complete, mild, and minimal. Dysganglionoses and HD can be considered part of CS. A multidisciplinary diagnostic and therapeutic protocol is presented. Main points are sacrum x-Ray, molecular genetic diagnosis, radiologic evaluation of every member of CS families, magnetic resonance (MR) evaluation of patient spine and pelvis, suction rectal biopsies, and search for associated anomalies. Conclusions This protocol could give a valid contribution to the treatment of CS, allowing an early diagnosis and proposing a rational timing of multidisciplinary surgical procedures. Early diagnosis and treatment are essential to avoid morbidity and mortality from an undiagnosed presacral mass.