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Novara di Sicilia, Italy

Marcassa C.,Scientific Institute of Veruno
Quarterly Journal of Nuclear Medicine and Molecular Imaging

In the last 30 years, non-invasive cardiac imaging was employed for the diagnostic and prognostic assessment of patients with suspected or known coronary artery disease. Nuclear myocardial perfusion scintigraphy or stress echocardiography provide a high sensitivity and specificity in the detection of functionally significant coronary artery disease (CAD) and demonstrated incremental diagnostic and prognostic value over exercise electrocardiography and clinical variables. Recently, cardiac computed tomography has been increasingly used a non-invasive tool for the detection and quantification of coronary artery stenoses and calcifications. The increase in this technical "offer" induces a significant increase in the "demand" for non-invasive imaging assessment, with a rise in the number of imaging studies performed in the last years, which appropriateness, however, is often questionable. A critical evaluation of the use of imaging techniques in different clinical scenarios is briefly discussed. Source

Nardone A.,University of Piemonte Orientale | Nardone A.,Scientific Institute of Veruno | Schieppati M.,University of Pavia | Schieppati M.,Scientific Institute of Pavia
European Journal of Physical and Rehabilitation Medicine

This review addresses the issue whether instrumental evaluations of balance may be helpful in orienting the clinical decision regarding balance rehabilitation. The aptitude of instrumental assessment of balance in supporting decision making in patients with balance disorders connected with ageing and with neurological diseases is considered. Among instrumental evaluations, recording of body sway during quiet stance and dynamic conditions are described, together with manoeuvres for recording postural reactions to predictable or unpredictable postural perturbations. The posturography patterns encountered in elderly subjects and patients affected by Parkinson's disease, spasticity, peripheral neuropathy, cerebellar diseases, vestibular deficit and neck disorders are presented and discussed. Findings from instrumental assessments of balance are helpful in understanding the pathophysiology of balance disorders, in screening for balance disorders, and in evaluating the natural progression of the disease or the response to therapy, be it physical or pharmacological. Conversely, as far as the prediction of the risk of falling in one individual patient is concerned, the various posturography tests do not produce consistent results. Source

Cutolo Prof. M.,University of Genoa | Iaccarino L.,University of Padua | Doria A.,University of Padua | Govoni M.,University of Ferrara | And 2 more authors.
Clinical and Experimental Rheumatology

Objective In rheumatoid arthritis (RA), low-dose glucocorticoids (GCs) demonstrate disease-modifying potential when added to DMARDs. Modified-release (MR) prednisone taken at bedtime (released 2am) is more effective than immediate-release (IR) GC taken in the morning. Methods In an open-label observational study, 950 RA outpatients (mean age 57 ± 13 years; 75% females) treated with GCs and DMARDs (83.7% methotrexate, 10.5% leflunomide; 15.8% biologics) were switched from IR-prednisone or 6-methyl (6M)-prednisolone to low-dose MR-prednisone and followed for 4 months. Morning stiffness duration (MS), pain intensity (numerical rating scale [NRS], 0-10), patient and physician global assessment (GA, 0-10 scale) and disease activity score (DAS28) were assessed at baseline, 2 and 4 months. Results 513 patients were switched to MR-prednisone from IR-prednisone (9.4±5.4 mg) and 437 from 6M-prednisolone (6.7±3.7 mg). Among 920 patients (96.8%) completing 4-months' MR-prednisone treatment, MS decreased from 58±37 min at T1 to 32±24 min at endpoint (p<0.001); NRS pain intensity reduced from 5.4±1.8 to 3.5±1.4 (p<0.001), and patient and physician GA scores improved from 5.4±1.7 to 3.5±1.4 and 5.1±1.7 to 3.3±1.4, respectively (p<0.001). DAS28 score decreased from 4.2±1.4 to 3.3±1.2 (p<0.001). Mean daily MR-prednisone dosage decreased from 8.2mg to 6.7mg between baseline and endpoint and significantly higher improvements in MS, NRS pain and GA scores were seen in patients switched from 6M-prednisolone versus IR-prednisone. MR-prednisone was well tolerated. Conclusions Switching GC-treated RA patients to low-dose MR-prednisone significantly improved outcomes over 4 months. © Copyright Clinical and Experimental Rheumatology 2013. Source

Flotats A.,Autonomous University of Barcelona | Knuuti J.,University of Turku | Gutberlet M.,Herzzentrum Leipzig GmbH | Marcassa C.,Scientific Institute of Veruno | And 3 more authors.
European Journal of Nuclear Medicine and Molecular Imaging

Improvements in software and hardware have enabled the integration of dual imaging modalities into hybrid systems, which allow combined acquisition of the different data sets. Integration of positron emission tomography (PET) and computed tomography (CT) scanners into PET/CT systems has shown improvement in the management of patients with cancer over stand-alone acquired CT and PET images. Hybrid cardiac imaging either with single photon emission computed tomography (SPECT) or PET combined with CT depicts cardiac and vascular anatomical abnormalities and their physiologic consequences in a single setting and appears to offer superior information compared with either stand-alone or side-by-side interpretation of the data sets in patients with known or suspected coronary artery disease (CAD). Hybrid systems are also advantageous for the patient because of the single short dual data acquisition. However, hybrid cardiac imaging has also generated controversy with regard to which patients should undergo such integrated examination for clinical effectiveness and minimization of costs and radiation dose, and if software-based fusion of images obtained separately would be a useful alternative. The European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC) in this paper want to present a position statement of the institutions on the current roles of SPECT/CT and PET/CT hybrid cardiac imaging in patients with known or suspected CAD. © 2010 Springer-Verlag. Source

Caligari M.,Foundation Medicine | Godi M.,Foundation Medicine | Guglielmetti S.,Foundation Medicine | Franchignoni F.,Scientific Institute of Veruno | And 2 more authors.
Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration

People with amyotrophic lateral sclerosis (PwALS) show progressive loss of voluntary muscle strength. In advanced disease, motor and phonatory impairments seriously hinder the patient's interpersonal communication. High-tech devices such as eye tracking communication devices (ETCDs) are used to aid communication in the later stages of ALS. We sought to evaluate the effect of ETCDs on patient disability, quality of life (QoL), and user satisfaction, in a group of 35 regular ETCD users in late-stage ALS with tetraplegia and anarthria. The following scales were administered: 1) the Individually Prioritized Problem Assessment (IPPA) scale, in three conditions: without device, with ETCD and, when applicable, with an Eye Transfer (ETRAN) board; 2) the Psychosocial Impact of Assistive Devices Scale (PIADS); and 3) the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0). With ETRAN, IPPA showed an increase in communicative abilities with respect to the condition without device, but ETCD produced a further significant increase. PIADS evidenced a large increase of QoL, and QUEST 2.0 showed high user satisfaction with ETCD use. In conclusion, ETCDs should be considered in late-stage ALS with tetraplegia and anarthria, since in these patients they can reduce communication disability and improve QoL. © 2013 Informa Healthcare. Source

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