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Similarities in neural activation patterns in obese and substance-dependent subjects led to the food addiction concept, but studies exploiting this issue for obesity stratification are missing. We assessed brain activation in response to food cues using 18 F-2-fluoro-2-deoxy-glucose-PET in 36 overweight women, stratified by low or high food addiction groups according to the Yale Food Addiction Scale (YFAS). Assessments were repeated after a 3-month diet. We found greater activation in thalamus, hypothalamus, midbrain, putamen, and occipital cortex (reward), but not in prefrontal and orbitofrontal cortices (control/reward receipt) in the high-YFAS versus low-YFAS group. In high-YFAS subjects, orbitofrontal responsiveness was inversely related to YFAS severity and hunger rating, and positive associations were observed between regional brain activation and lipid intake. A 3-month diet abolished group differences in brain activation. Our data suggest that food addiction distinguishes an overweight phenotype that can be reversed by diet, opening to personalized strategies in obesity treatment., (© 2018 John Wiley & Sons, Ltd and Eating Disorders Association.)

In this work, we propose and test a new approach for non-linear kinetic parameters' estimation from dynamic PET data. A technique is discussed, to derive an analytical closed-form expression of the compartmental model used for kinetic parameters' evaluation, using an auxiliary parameter set, with the aim of reducing the computational burden and speeding up the fitting of these complex mathematical expressions to noisy TACs. Two alternative algorithms based on numeric calculations are considered and compared to the new proposal. We perform a simulation study aimed at (i) assessing agreement between the proposed method and other conventional ways of implementing compartmental model fitting, and (ii) quantifying the reduction in computational time required for convergence. It results in a speed-up factor of ∼120 when compared to a fully numeric version, or ∼38, with respect to a more conventional implementation, while converging to very similar values for the estimated model parameters. The proposed method is also tested on dynamic 3D PET clinical data of four control subjects. The results obtained supported those of the simulation study, and provided input and promising perspectives for the application of the proposed technique in clinical practice., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

We propose and test a novel approach for direct parametric image reconstruction of dynamic PET data. We present a theoretical description of the problem of PET direct parametric maps estimation as an inference problem, from a probabilistic point of view, and we derive a simple iterative algorithm, based on the Iterated Conditional Mode (ICM) framework, which exploits the simplicity of a two-step optimization and the efficiency of an analytic method for estimating kinetic parameters from a nonlinear compartmental model. The resulting method is general enough to be flexible to an arbitrary choice of the kinetic model, and unlike many other solutions, it is capable to deal with nonlinear compartmental models without the need for linearization. We tested its performance on a two-tissue compartment model, including an analytical solution to the kinetic parameters evaluation, based on an auxiliary parameter set, with the aim of reducing computation errors and approximations. The new method is tested on simulated and clinical data. Simulation analysis led to the conclusion that the proposed algorithm gives a good estimation of the kinetic parameters in any noise condition. Furthermore, the application of the proposed method to clinical data gave promising results for further studies.

Objectives: To assess the prevalence of specific headache disorders in a population older than 65 years seeking consultation due to memory problems or cognitive impairment., Methods: We verified the occurrence of headache symptoms and the impact of headaches on daily life. Headaches were classified as per the International Classification of Headache Disorders, 2nd edition (ICHD-2). All patients were screened with the Mini-Mental State Examination (MMSE), followed by the Selective Reminding Test and neuroimaging. Participants with severe cognitive impairment or dementia were excluded., Results: A total of 1,237 patients (51.6% women), with mean age of 75.6 years (SD = 6.9) were screened from January 2006 to December 2014. Of them, 302 (24.4%) patients suffered from headaches. Most common individual diagnoses were probable migraine (13.8%), episodic tension-type headache (3.4%), and episodic migraine (3.0%). Chronic migraine or probable chronic migraine happened in 3.5%, while chronic tension-type headache affected 0.6%. Most patients with headaches routinely used symptomatic medications (55.6%). Mean MMSE scores were similar in patients with or without headaches, or with different headache diagnoses., Conclusions: Headache disorders overall, frequent headaches, and headaches requiring treatment are commonly seen in the elderly seeking care for cognitive decline and should be properly assessed and managed., (© 2016 American Headache Society.)

Purpose: The plasma membrane P-glycoprotein (Pgp) is an efflux transporter involved in multidrug resistance and in the onset of neurodegenerative disease. Its function and most mechanisms of action are still under investigation. We developed a C-11-labeled 2-arylethylphenylamine-([ 11 C]AEPH) derivative for positron emission tomography (PET), as a novel probe to better understand the activity and the function of Pgp in vivo., Procedures: The synthetic procedure and the quality control of the selected lead compound, [ 11 C]AEPH-1, were set up and optimized. The biodistribution and the dynamic extraction in target organs of [ 11 C]AEPH-1 were studied in vivo by PET in healthy rats at baseline and after pre-treatment with a Pgp inhibitor (tariquidar)., Results: In vivo dynamic imaging was consistent with the results of ex vivo extraction on explanted organs. An adequate stability for in vivo studies, as well as a high activity of [ 11 C]AEPH-1 in intestine and barrier tissues, has been demonstrated. Results of the blockade study showed a decrease of uptake after the pre-treatment, indicating a behavior attributable to a Pgp ligand., Conclusions: The suitable pharmacokinetics and the specificity tested in the pre-treated animals have indicated the potentiality of this AEPH derivative to act as Pgp ligand, providing new opportunities for further studies on expression and function of this important efflux transporter in the fields of neurology and oncology.

The rate of fragile elderly patients affected by chronic kidney disease stage 5-5D is rapidly increasing. The decision making process regarding the start and the withdrawal of dialysis is often difficult for all those involved: patients, relatives, nephrologists and renal nurses. Therefore nephrologists and renal nurses are called to rapidly improve their theoretical and practical competence about the end-of-life care. The quality of clinical intervention and management requires a sound expertise in the ethical, legal, organizational and therapeutic aspects, not trivial nor even deductible from purely private and individual opinions nor from traditional medical practice. The present paper discusses the ethical and legal implications related to the start rather than to withdrawn from dialysis, preferring a non-dialysis medical treatment and / or palliative care. Operational aspects regarding the regional network of palliative care, the path of shared decision making process and a systematic approach to optimize medical and nursing interventions through the Liverpool Care Pathway program are discussed thereafter.

Aim: The aim of this study was to evaluate the possible impact of stress-induced left ventricular (LV) diastolic dysfunction at cadmium-zinc-telluride (CZT) imaging, on the detection of significant coronary artery disease (CAD)., Methods and Results: Four hundred and twenty-five consecutive patients underwent myocardial perfusion imaging at rest and after stress with a low-dose CZT protocol and the evaluation of coronary anatomy by invasive or computed coronary angiography. The summed difference score (SDS) was calculated in every patient. Left ventricular ejection fraction and peak filling rate (PFR) at baseline and after stress were derived from gated CZT images and the '% stress-to-rest' PFR difference, as an indicator of stress-induced diastolic dysfunction, determined. In the study population, the mean SDS was 5 ± 4, while mean stress PFR and rest PFR were 2.5 ± 0.8 end-diastolic volumes (EDV)/s and 2.5 ± 0.7 EDV/s, respectively. There was a strict correlation between the presence and extent of CAD and both myocardial SDS and '% stress-to-rest' PFR (P < 0.001 for both). Interestingly, while myocardial SDS and '% stress-to-rest' PFR were significantly correlated (P < 0.001), they resulted independent predictors of the presence of significant CAD (P < 0.001 and P < 0.032, respectively). Of note, at receiving operating characteristic analysis, a '% stress-to-rest' PFR ≤3 showed 71% sensitivity in unmasking the presence of significant coronary luminal narrowings., Conclusion: The present study shows that the assessment of stress-induced diastolic dysfunction with an ultrafast scintigraphic protocol can improve the accuracy in detection of significant ischaemic heart disease., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)

We report on the conduct and results of an economic model of two different strategies of vaccination against hepatitis A in Italy. In strategy 1 (universal vaccination), all newborns are vaccinated simultaneously with MMR at 15 months and all 12 year olds are vaccinated with combined hepatitis A and B vaccine. In strategy 2 (contacts' vaccination) only subjects with a close social and spatial relationship with the sick are vaccinated. In strategy 1 costs per avoided case and net costs per avoided case values are always very high. Net costs become very low when newborns and 12 year olds are vaccinated, and become negative (indicating a potential gain) when 12 year olds are vaccinated. From an economic viewpoint, universal vaccination appears recommendable only in epidemic conditions. For strategy 2 our model shows that cost for avoidable case are very low and net costs for avoided case are always negative, showing the potential presence of an absolute benefit. We conclude that in Italy mass vaccination appears economically worthwhile only during epidemics but vaccination of contacts is an economically worthwhile routine measure.

Scientific progress in molecular biology and genetics is now providing the medical field with new OtoolsO for diagnosis of possible gene alterations which may be connected with the risk of disease later in life. The development of predictive medicine incurs novel problems in the relationship of the medical doctor and the individual at risk of disease, with particular reference to the identification of situations in which genetic testing may be relevant, the type of information which one should give the individual in order to have the informed consent for the diagnosis and the type of possible therapy taking into account the confidential aspect of using the data produced. These problems are exmined in the light of ethical citations and guidelines which are included in the National Comittee for Bioethics in Gene Therapy, 1991, the Italian privacy law, 1996, the European Convention on Bioethics, 1996, the 98/44/CE Directive on the Patentability of Biotechnological Inventions and the Deontological Medical Code, 1998.