Anna Sorrentino

Tc-99m tetrofosmin tomography after nitrate administration in patients with ischemic left ventricular dysfunction: Relation to metabolic imaging by PET

Background. In patients with ischemic left ventricular (LV) dysfunction, myocardial perfusion imaging after nitrate administration may improve the identification of dysfunctional but viable myocardium. This study was designed to assess the relationship between tetrofosmin uptake after nitrate administration and metabolic activity as assessed by positron emission tomography (PET) in patients with ischemic LV dysfunction.Methods and Results. Thirty-six patients with chronic myocardial infarction and LV dysfunction (ejection fraction, 35% ± 6%) underwent resting technetium 99m tetrofosmin single photon emission computed tomography (SPECT) imaging under control conditions (baseline) and after sublingual administration of 10 mg isosorbide dinitrate. Within 1 week, all patients underwent metabolic PET imaging with fluorine 18-fluorodeoxyglucose. Tetrofosmin uptake and metabolic activity were measured in 13 segments/patient. Regional LV function was assessed in corresponding segments by echocardiography. On baseline tetrofosmin imaging, 53 (40%) of the 131 akinetic or dyskinetic segments had reduced (<55% of peak activity) tracer uptake. Of these segments, 14 (26%) showed enhanced tetrofosmin uptake after nitrate administration (≥10% vs baseline) and the remaining 38 (74%) did not change. The sensitivity and specificity of baseline tetrofosmin SPECT for detecting preserved metabolic activity were 69% and 86%, respectively. After nitrate administration, the sensitivity was higher (81%, P < .05 vs baseline) whereas the specificity was not different (86%, P = not significant). Concordance between tetrofosmin SPECT and PET in differentiating viable and necrotic myocardium was observed in 94 (72%) of the 131 akinetic or dyskinetic segments at baseline (k = 0.35) and in 108 segments (82%) after nitrate administration (k = 0.53).Conclusions. After nitrate administration, tetrofosmin uptake in dysfunctional segments correlated with metabolic activity as assessed by fluorodeoxyglucose PET imaging better than baseline. Thus tetrofosmin SPECT after nitrate administration may improve the identification of ischemic but still viable myocardium in patients with chronic ischemic LV dysfunction. (J Nucl Cardiol 2003;10:599-606.)

Assessment of coronary flow reserve by sestamibi imaging in patients with typical chest pain and normal coronary arteries

PurposeWe assessed coronary flow reserve (CFR) by sestamibi imaging in patients with typical chest pain, positive exercise stress test and normal coronary vessels.MethodsThirty-five patients with typical chest pain and normal angiogram and 12 control subjects with atypical chest pain underwent dipyridamole/rest 99mTc-sestamibi imaging. Myocardial blood flow (MBF) was estimated by measuring first transit counts in the pulmonary artery and myocardial counts from SPECT images. Estimated CFR was expressed as the ratio of stress to rest MBF. Rest MBF and CFR were corrected for rate–pressure product (RPP) and expressed as normalised MBF (MBFn) and normalised CFR (CFRn). Coronary vascular resistances (CVR) were calculated as the ratio between mean arterial pressure and estimated MBF.ResultsAt rest, estimated MBF and MBFn were lower in controls than in patients (0.98 ± 0.4 vs 1.30 ± 0.3 counts/pixel/s and 1.14 ± 0.5 vs 1.64 ± 0.6 counts/pixel/s, respectively, both p < 0.02). Stress MBF was not different between controls and patients (2.34 ± 0.8 vs 2.01 ± 0.7 counts/pixel/s, p=NS). Estimated CFR was 2.40 ± 0.3 in controls and 1.54 ± 0.3 in patients (p < 0.0001). After correction for the RPP, CFRn was still higher in controls than in patients (2.1 ± 0.5 vs 1.29 ± 0.5, p < 0.0001). At baseline, CVR values were lower (p < 0.01) in patients than in controls. Dipyridamole-induced changes in CVR were greater (p < 0.0001) in controls (−63%) than in patients (−35%). In the overall study population, a significant correlation between dipyridamole-induced changes in CVR and CFR was observed (r = −0.88, p < 0.0001).ConclusionSPECT might represent a useful non-invasive method for assessing coronary vascular function in patients with angina and a normal coronary angiogram.

School Bullying and Cyberbullying Among Boys and Girls: Roles and Overlap

ABSTRACT The purpose of this study was to investigate gender differences in the overlap between school and cyberbullying according to the different types of involvement in such behaviors. The current study involved 2,785 Italian students, ages 11–17 recruited from 7 secondary schools, who anonymously self-reported about school and cyberbullying as victims and/or perpetrators. Based on their responses, students were classified as ‘only-bullies,’ ‘only-victims,’ ‘bully/victims,’ or ‘not involved’ in school and/or online. To explain the relationship between school and online bullying, 2 theoretical frames were tested: role continuity and role inversion. Results showed that, for girls, ‘school only-bullies’ were not overlapping with ‘cyber only-bullies,’ and ‘school only-victims’ were not overlapping with ‘cyber only-victims,’ but these categories were related for boys. ‘School bully/victims’ were significantly overlapping with ‘cyber bully/victims’ for both boys and girls. It was concluded that the role continuity approach is most appropriate to explain these 2 disturbing problems in adolescents especially for boys. Intervention efforts should especially target the bully/victims group.

The TABBY Online Project: The Threat Assessment of Bullying Behaviours Online Approach

The Threat Assessment of Bullying Behaviours among Youngsters (TABBY) Internet program was developed initially in 2010 and implemented in 2011–2013 in Italy and further four EU countries (Bulgaria, Greece, Cyprus, and Hungary) and was then undertaken in three additional EU countries (Spain, France, and Poland) with new components. The program was developed on the basis of what was known in the scientific community with regard to the reduction of cyberbullying and increased awareness of cyber risks. The program has been developed and implemented thanks to the support of the European Union Daphne Security and Justice Program for the reduction of violence against women and children, and in some of the original countries (Italy, Spain, France, Hungary) it is still used as one of the existing intervention programs.

Cyberbullying and Cybervictimization

In its first stage, research on cyberbullying focused on trying to define the phenomenon and check on the possible similarities or discrepancies between offline school bullying and online bullying. The very first studies (Smith et al. 2008; Kowalski et al. 2008) adapted the Olweus definition of bullying (Olweus 1995) to the online world, simply adding the precision that bullying was performed via electronic means of communication within the cyberspace:

Cyberbullying in Italy

Cyberbullying is well researched in Italy and intervention strategies are disseminated throughout the country. At the central level, the Ministry of Education has implemented guidelines for the prevention and comparing of cyberbullying, and was also an associate partner in this Tabby project. Studies in Italy on the prevalence and nature of cyberbullying are quite extensive, and followed the ones on school bullying (Baldry et al. 2016b; Menesini et al. 2011). Prevalence rates vary depending on age of participants, methods, instruments used, period, and cut-off criteria adopted to measure students’ involvement in cyberbullying and cybervictimization.

Conclusions and Policy Recommendations

Cyberbullying is a serious and rapidly increasing problem in many countries. We hope that this book, which contains information from researchers who were part of the European Union TABBY (Threat Assessment of Bullying Behaviour in Youth) project and from world leaders in the field, will help researchers as well as practitioners to increase knowledge and understanding of such a well-known phenomenon which still needs a lot of rigorous and well-planned research.

Assessment of coronary flow reserve by sestamibi imaging in patients with typical chest pain and normal coronary arteries (European Journal of Nuclear Medicine and Molecular Imaging (2007) 34, (1156-1161) DOI: 10.1007/s00259-006- 0333-x)

PURPOSE We assessed coronary flow reserve (CFR) by sestamibi imaging in patients with typical chest pain, positive exercise stress test and normal coronary vessels. METHODS Thirty-five patients with typical chest pain and normal angiogram and 12 control subjects with atypical chest pain underwent dipyridamole/rest (99m)Tc-sestamibi imaging. Myocardial blood flow (MBF) was estimated by measuring first transit counts in the pulmonary artery and myocardial counts from SPECT images. Estimated CFR was expressed as the ratio of stress to rest MBF. Rest MBF and CFR were corrected for rate-pressure product (RPP) and expressed as normalised MBF (MBF(n)) and normalised CFR (CFR(n)). Coronary vascular resistances (CVR) were calculated as the ratio between mean arterial pressure and estimated MBF. RESULTS At rest, estimated MBF and MBF(n) were lower in controls than in patients (0.98 +/- 0.4 vs 1.30 +/- 0.3 counts/pixel/s and 1.14 +/- 0.5 vs 1.64 +/- 0.6 counts/pixel/s, respectively, both p < 0.02). Stress MBF was not different between controls and patients (2.34 +/- 0.8 vs 2.01 +/- 0.7 counts/pixel/s, p=NS). Estimated CFR was 2.40 +/- 0.3 in controls and 1.54 +/- 0.3 in patients (p < 0.0001). After correction for the RPP, CFR(n) was still higher in controls than in patients (2.1 +/- 0.5 vs 1.29 +/- 0.5, p < 0.0001). At baseline, CVR values were lower (p < 0.01) in patients than in controls. Dipyridamole-induced changes in CVR were greater (p < 0.0001) in controls (-63%) than in patients (-35%). In the overall study population, a significant correlation between dipyridamole-induced changes in CVR and CFR was observed (r = -0.88, p < 0.0001). CONCLUSION SPECT might represent a useful non-invasive method for assessing coronary vascular function in patients with angina and a normal coronary angiogram.