NAVIGATOR: an Italian regional imaging biobank to promote precision medicine for oncologic patients.

NAVIGATOR is an Italian regional project boosting precision medicine in oncology with the aim of making it more predictive, preventive, and personalised by advancing translational research based on quantitative imaging and integrative omics analyses. The project's goal is to develop an open imaging biobank for the collection and preservation of a large amount of standardised imaging multimodal datasets, including computed tomography, magnetic resonance imaging, and positron emission tomography data, together with the corresponding patient-related and omics-related relevant information extracted from regional healthcare services using an adapted privacy-preserving model. The project is based on an open-source imaging biobank and an open-science oriented virtual research environment (VRE). Available integrative omics and multi-imaging data of three use cases (prostate cancer, rectal cancer, and gastric cancer) will be collected. All data confined in NAVIGATOR (i.e., standard and novel imaging biomarkers, non-imaging data, health agency data) will be used to create a digital patient model, to support the reliable prediction of the disease phenotype and risk stratification. The VRE that relies on a well-established infrastructure, called D4Science.org, will further provide a multiset infrastructure for processing the integrative omics data, extracting specific radiomic signatures, and for identification and testing of novel imaging biomarkers through big data analytics and artificial intelligence.

Clinical predictors and significance of adherent perinephric fat assessed with Mayo Adhesive Probability (MAP) score and perinephric fat surface density (PnFSD) at the time of partial nephrectomy for localized renal mass. A single high-volume referral center experience.

BACKGROUND: Adherent perinephric fat (APF) could negatively influence surgical outcomes of partial nephrectomy (PN). Novel radiological scores have been introduced to preoperatively detect APF, i.e. Mayo Adhesive Probability (MAP) score and perinephric fat surface density (PnFSD). We aimed to evaluate clinical predictors of APF and the association of MAP and PnFSD with perioperative outcomes after PN. METHODS: Clinical and radiological data of patients undergoing open or robotic PN were prospectively gathered. Perinephric fat was retrospectively measured by a single expert uro-radiologist. Patients were divided into MAP 0-3 vs. MAP 4-5 and high vs. low PnFSD. Multivariable analysis was performed to seek for clinical predictors of APF. RESULTS: Overall, 175 patients were entered. Patients with vs. without APF were significantly different regarding age, gender, ASA score, Charlson Comorbidity Index, Body Mass Index, waist circumference, HDL status and metabolic syndrome. Conversely, tumor-related characteristics were not significantly different between the groups. At multivariable analysis, metabolic syndrome was confirmed as the only independent predictor of APF (OR: 24.9; P<0.001). Notably, APF assessed by MAP score or PnFSD was not associated with perioperative outcomes after PN. CONCLUSIONS: In experienced hands, APF did not impact on intra- or perioperative outcomes after PN. Metabolic syndrome was the only significant predictor of APF in our series.

Chest X-ray in new Coronavirus Disease 2019 (COVID-19) infection: findings and correlation with clinical outcome.

AIM: The purpose of this study is to describe the main chest radiological features (CXR) of COVID-19 and correlate them with clinical outcome. MATERIALS AND METHODS: This is a retrospective study involving patients with clinical-epidemiological suspect of COVID-19 infection, who performed CXRs at the emergency department (ED) of our University Hospital from March 1 to March 31, 2020. All patients performed RT-PCR nasopharyngeal and throat swab, CXR at the ED and clinical-epidemiological data. RT-PCR results were considered the reference standard. The final outcome was expressed as discharged or hospitalized patients into a medicine department or intensive care unit (ICU). RESULTS: Patients that had a RT-PCR positive for COVID-19 infection were 234 in total: 153 males (65.4%) and 81 females (34.6%), with a mean age of 66.04 years (range 18-97 years). Thirteen CXRs were negative for radiological thoracic involvement (5.6%). The following alterations were more commonly observed: 135 patients with lung consolidations (57.7%), 147 (62.8%) with GGO, 55 (23.5%) with nodules and 156 (66.6%) with reticular-nodular opacities. Patients with consolidations and GGO coexistent in the same radiography were 35.5% of total. Peripheral (57.7%) and lower zone distribution (58.5%) were the most common predominance. Moreover, bilateral involvement (69.2%) was most frequent than unilateral one. Baseline CXR sensitivity in our experience is about 67.1%. The most affected patients were especially males in the age group 60-79 years old (45.95%, of which 71.57% males). RALE score was slightly higher in male than in female patients. ANOVA with Games-Howell post hoc showed significant differences of RALE scores for group 1 vs 3 (p < 0.001) and 2 vs 3 (p = 0.001). Inter-reader agreement in assigning RALE score was very good (ICC: 0.92-with 95% confidence interval 0.88-0.95). CONCLUSION: In COVID-19, CXR shows patchy or diffuse reticular-nodular opacities and consolidation, with basal, peripheral and bilateral predominance. In our experience, baseline CXR had a sensitivity of 68.1%. The RALE score can be used in the emergency setting as a quantitative method of the extent of SARS-CoV-2 pneumonia, correlating with an increased risk of ICU admission.

Diffusion-weighted signal models in healthy and cancerous peripheral prostate tissues: comparison of outcomes obtained at different b-values.

PURPOSE: To evaluate the dependence on the b-values adopted of apparent diffusion coefficient (ADC), perfusion fraction (PF), slow and fast diffusion coefficient (Dslow, Dfast), corrected diffusion coefficient (D) and kurtosis (K), in healthy peripheral (HP) and peripheral cancerous (PCa) prostate tissues. MATERIALS AND METHODS: Patients who underwent multiparametric prostate MR examination were retrospectively evaluated for possible inclusion. ADC, PF, Dslow, Dfast, D, and K were estimated both in HP and PCa tissues, using three different ranges of b-values: 0-2300, 0-1800, 0-800 s/mm2 (group A, B and C, respectively). Analysis of variance (ANOVA) and receiver operating characteristic (ROC) analysis were performed, to establish differences among groups and to evaluate sensitivity and specificity of every parameter in distinguishing HP and PCa tissues when calculated with different b-values. RESULTS: In all, 57 patients were included. ANOVA showed significant differences of all parameters between group A-B vs. C, both in HP and PCa tissues. In ROC analysis K showed the best area under the curve (AUC) when calculated in groups A and B (0.87 and 0.86), while it was comparable with the ADC one in group C (both 0.82). CONCLUSION: A significant dependence on the adopted b-values of DWI parameters is shown. The best performance in distinguishing HP from PCa tissues was obtained by K, calculated using a high b-value sequence.

Transient Hepatic Parenchymal Enhancement detected at dynamic imaging: a short instruction manual for the clinician.

Basic knowledge in the interpretation of hepatic imaging is essential for the clinical hepatologist. In recent years, the availability of dynamic imaging studies of the liver using computed tomography or magnetic resonance has led to appreciate the importance of early changes in arterial perfusion for the interpretation of hepatic lesions. Transient Hepatic Parenchymal Enhancement (THPE) is defined as a normal area of liver parenchyma that enhances after injection of contrast agent during the arterial phase of perfusion. Appearance of this sign is mostly associated with a reduction in portal perfusion or with inflammation, and appears in different morphologic patterns. THPE should not be considered a radiological artefact, and its interpretation is essential to avoid misclassification of hepatic lesions that may have clinical significance, such as hepatocellular carcinoma or hepatic metastases. In this short review we provide essential information on the causes, pathophysiology and morphology of THPE, and discuss the relevance of these findings in a clinical perspective.

Statistical evaluation of hemodynamic effects of regular use of sildenafil on the human corpora cavernosa.

INTRODUCTION: Sildenafil citrate is currently used on demand in the treatment of erectile failure, regardless of etiology. Nevertheless, recent data suggest a significant improvement in nocturnal penile erections in potent and impotent men taking a single dose at bedtime. The present study analyzes whether continuous use of sildenafil positively correlates with improvement of penile blood flow and treatment satisfaction referred by patients with erectile dysfunction (ED) of vascular origin. PATIENTS AND METHODS: A total of 32 patients, mean age 54, with ED of vascular etiology, were evaluated at the beginning and at the end of our study using the International Index of Erectile Function (IIEF-5) and pharmaco-penile duplex ultrasonography during basic and dynamic phases. These patients were treated with sildenafil (50 mg) twice a week for 4 months. During pharmaco-penile duplex ultrasonography, we measured basal peak flow velocity, basal acceleration of peak flow in both cavernous arteries before intracavernous (i.c.) pharmaco-stimulation, maximum peak flow velocities and end-diastolic flow velocities after i.c. stimulation. The data observed were compared with those of 10 patients with ED who voluntarily decided not to take any treatment. RESULTS AND CONCLUSIONS: In this study, basal peak flow velocity, basal acceleration, maximum peak flow velocity and IIEF-5 scores were found to significantly increase after treatment. All differences were statistically significant (p < 0.05). Only few mild adverse effects were observed. Our data suggest that the regular use of sildenafil (50 mg) improves the blood flow in cavernous arteries increasing sexual performance in patients with ED of vascular origin.

Hepatocellular carcinoma bone metastasis in an 11-year-old boy.

Hepatocellular carcinoma (HCC) is the second most common primary hepatic malignant tumor in children older than 4 years. We describe a rare case of an 11-year-old boy with HCC who presented with HCC of the right liver lobe followed by multiple osseous metastases, confirmed by imaging and biopsy.

The orthopaedic treatment of fragility fractures.

The purpose of this review is the presentation of the proper orthopaedic treatment of the most frequent fragility fractures associated with low bone mineral density or established osteoporosis. In this particular group of patients, the surgical treatment is difficult for the poor quality of the broken bone that limits the reduction, the hardware fixation and the physiologic process of bone healing. Other important problems are the postoperative management of old patients with chronic diseases and more prone to develop local and general complications with big difficulties to conduct a good rehabilitation program.Some considerations will be made, lastly, about the role of the orthopaedic surgeon on the treatment of osteoporosis and on the possibility to prevent further fractures.