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Τρίτη, 31 Οκτωβρίου 2017

Gastrointestinal Stromal Tumor of the Jejunum with Active Bleeding Demonstrated on Dual Energy MDCT Angiography: A Case Report

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Publication date: Available online 31 October 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Abdul Razik, Kumble Madhusudhan, Abhishek Aggarwal, Rajesh Panwar, Deep N Srivastava
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract and may occasionally present with acute gastrointestinal bleed (GIB). Multidetector computed tomography (MDCT) angiography is extremely useful in demonstrating the tumor as well as the presence of active hemorrhage, thereby guiding subsequent interventional or surgical management. We report a case of a 38-year-old male who presented with acute onset melena and compensated shock, whose source of bleed remained elusive on endoscopy. MDCT angiography performed on a dual energy scanner showed a jejunal tumor with active intraluminal contrast extravasation. The tumor was subsequently resected and the patient did well on follow up. This was one of the few instances when MDCT angiography demonstrated active bleeding in a GIST and the first such case demonstrated on a dual energy scanner.



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Towards Consensus: Training in Procedural Skills for Diagnostic Radiology Residents--Current Opinions of Residents and Faculty at a Large Academic Center

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Publication date: Available online 31 October 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Adam Prater, Bradley S. Rostad, Emily L. Ebert, Mark E. Mullins, Christopher P. Ho
Rationale and ObjectivesThe Diagnostic Radiology Milestones Project provides a framework for measuring resident competence in radiologic procedures, but there is limited data available to assist in developing these guidelines [1]. We performed a survey of current radiology residents and faculty at our institution as a first step towards obtaining data for this purpose. The survey addressed attitudes toward procedural standardization and procedures that trainees should be competent in by the end of residency.Materials and MethodsCurrent residents and faculty members were surveyed about: whether or not there should be standardization of procedural training; in which procedures residents should achieve competency; and the number of times a procedure needs to be performed to achieve competency.ResultsSurvey data were received from 60 study participants with an overall response rate of 32%. Sixty-five percent of respondents thought that procedural training should be standardized. Standardization of procedural training would include both the list of procedures that trainees should be competent in at the end of residency and the standard minimum number of procedures to achieve competency. Procedures that both residents and faculty agreed are important in which to achieve competency in included: central line/port procedures; CT guided abdominal, thoracic, and musculoskeletal procedures; minor fluoroscopic guided procedures; general fluoroscopy; peripheral line placements; and US guided abdominal procedures. For most of these categories, the majority of respondents believed that these procedures needed to be performed 6–20 times to achieve competency.ConclusionBoth resident and faculty respondents agreed that procedural training should be standardized during residency and competence in specific procedures should be achieved at the completion of residency. While this study is limited to a single institution, our data may provide assistance in developing future guidelines for standardizing image guided procedure training. Future studies could be expanded to create a national consensus regarding the implementation of the Diagnostic Radiology Milestones Project [1].



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Developing a Multidisciplinary Vascular Anomalies Clinic and Reviewing the Radiologist′s Clinic Role

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Publication date: Available online 31 October 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Mark D. Mamlouk, Pristine W. Lee




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Portable CT pulmonary angiogram in an infant on veno-arterial extracorporeal membrane oxygenation in the pediatric intensive care unit

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Publication date: Available online 31 October 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Simon Ho, Meral Patel, Renee Mansour, Atul Vats, Nikhil Chanani, Bradley S. Rostad
Computed tomography (CT) has been shown to change management in children on extracorporeal membrane oxygenation (ECMO). Although techniques have been described to transport these critically ill patients to the CT suite in the radiology department, transport out of the intensive care setting is not without risk, and using portable CT is a practical alternative. However, obtaining a CT pulmonary angiogram (CTPA) in a patient on veno-arterial (VA) ECMO presents unique challenges due to bypass of the cardiopulmonary system, which may lead to suboptimal opacification of the pulmonary arteries. Here we describe a method to obtain a diagnostic CTPA study in an infant on VA ECMO in the intensive care unit using portable CT. This case demonstrates that in select instances CTPA in infants on VA ECMO can be achieved using a portable CT system.



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Development and Assessment of a Multidisciplinary Radiology Contrast Reaction Training Course: Our Experience and Future Directions

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Publication date: Available online 31 October 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Alisa Sumkin, Michael J. Magnetta, Ryan Anderson, Deborah Farkas, Margarita Zuley, Philip Orons, Marion Hughes




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Trainee Knowledge of Imaging Appropriateness and Safety: Results of a Series of Surveys from a Large Academic Medical Center

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Publication date: Available online 31 October 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Thaddeus D. Hollingsworth, Richard Duszak, Arvind Vijayasarathi, Rondi B. Gelbard, Mark E. Mullins




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Comparison of different methodologies for the 90Sr determination in environmental samples

Publication date: January 2018
Source:Journal of Environmental Radioactivity, Volume 181
Author(s): Željko Grahek, Silvia Dulanská, Gorana Karanović, Ivana Coha, Ivana Tucaković, Marijana Nodilo, Ľubomír Mátel
The paper describes different isolation/separation and detection procedures for 90Sr determination in the environmental samples which are routinely used in Laboratories A and B. In this context, four different methods for strontium isolation and two methods for detection were tested and compared by 90Sr determination in proficiency test samples (water, soil, vegetation) and animal bone samples. The chromatographic isolation of Sr on Sr resin, AnaLig®Sr01 resin gel, strong base anion exchange resins in nitrate form and combination of strong base anion exchange and Sr resin were used for the examination of the impact of sample matrix constituents on efficiency of strontium isolation (chemical yield), while Cherenkov counting of 90Y and counting of 90Sr(90Y) on proportional counter were used for the quantitative 90Sr determination. The chemical yields obtained with different isolation methods were compared with the emphasis on its influence on reliability of the 90Sr determination in different kinds of samples. The results show that the efficiency of strontium isolation depends on type of sample and separation methodology. The strontium yield on Sr resin column decreases with the increase of Sr, Ca and Na concentration. In the presence of 1 g of Ca and 1 g of Na, the yield of 85% was obtained for 5 mg of Sr carrier and dropped below 50% with further increase of Sr and other elements. However, the yield can be increased to 75% if Na and part of Ca are separated from Sr on the anion exchange column with alcoholic solution of nitric acid and by final separation of Ca from Sr on the Sr resin column. In the presence of large amounts of Ca, Na and other elements, isolation efficiency on the Sr resin column significantly decreases in comparison with other methods. The average yield for isolation from vegetation samples on the Sr resin column is only 21%. For the soil samples the highest average yield (78%) is obtained for the isolation in the combination of anion exchange and Sr resin columns. For the isolation from bone samples the average yields over 80% are on AnaLig®Sr01 and anion exchange resins columns, while Sr resin was not used for separation due to high content of Ca in samples. The results of the 90Sr determination in proficiency testing (PT) samples show that the accuracy of the determination does not depend on high chemical yield but depends on accuracy of yield determination. The analysis of z-values shows that 96% of obtained z-values range from 0 to ±2 while 77% of z-values range between 0 and ± 1. Ninety percent of obtained results of 90Sr determination deviate less than 20% from assigned values in PT provider reports. The results of 90Sr determination in animal bone samples using different methods are in good agreement. The results obtained by Cherenkov counting in both laboratories vary from −3.1–14.5% while results obtained by determination via 90Y and counting on i-Matic vary between −10.0 and −2.9%. These deviations are in accordance with deviations obtained with PT samples. Activity concentrations of 90Sr in wild boar bone samples range from 4 to 30 Bq kg−1 while in deer bone samples from 2 to 8 Bq kg−1.



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Glucose starvation impairs DNA repair in tumour cells selectively by blocking histone acetylation

Tumour cells are characterized by aerobic glycolysis and thus have high glucose consumption. Because repairing radiation-induced DNA damage is an energy-demanding process, we hypothesized that glucose starvation combined with radiotherapy could be an effective strategy to selectively target tumour cells.

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Robustness of patient positioning for interfractional error in carbon ion radiotherapy for stage I lung cancer: Bone matching versus tumor matching

Patient positioning was compared by tumor matching (TM) and conventional bony structure matching (BM) in carbon ion radiotherapy for stage I non-small cell lung cancer to evaluate the robustness of TM and BM in determining interfractional error.

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Prognostic impact of HPV-associated p16-expression and smoking status on outcomes following radiotherapy for oropharyngeal cancer: The MARCH-HPV project

Evaluate the prognostic and predictive impact of HPV-associated p16-expression and assess the combined prognostic impact of p16 and smoking on altered fractionated radiotherapy (AFRT) for oropharyngeal cancer (OPC) within the frames of the update of the Meta-Analysis of Radiotherapy in Carcinomas of Head and neck (MARCH).

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Automated, reference-free local error assessment of multimodal deformable image registration for radiotherapy in the head and neck

Head and neck MR-CT deformable image registration (DIR) for radiotherapy planning is hindered by the lack of both ground-truth and per-patient accuracy assessment methods. This study assesses novel post-registration reference-free error assessment algorithms, based on local rigid re-registration of native and pseudomodality images.

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A virtual dosimetry audit – Towards transferability of gamma index analysis between clinical trial QA groups

Quality assurance (QA) for clinical trials is important. Lack of compliance can affect trial outcome. Clinical trial QA groups have different methods of dose distribution verification and analysis, all with the ultimate aim of ensuring trial compliance. The aim of this study was to gain a better understanding of different processes to inform future dosimetry audit reciprocity.

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Comparison of different methodologies for the 90Sr determination in environmental samples

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Publication date: January 2018
Source:Journal of Environmental Radioactivity, Volume 181
Author(s): Željko Grahek, Silvia Dulanská, Gorana Karanović, Ivana Coha, Ivana Tucaković, Marijana Nodilo, Ľubomír Mátel
The paper describes different isolation/separation and detection procedures for 90Sr determination in the environmental samples which are routinely used in Laboratories A and B. In this context, four different methods for strontium isolation and two methods for detection were tested and compared by 90Sr determination in proficiency test samples (water, soil, vegetation) and animal bone samples. The chromatographic isolation of Sr on Sr resin, AnaLig®Sr01 resin gel, strong base anion exchange resins in nitrate form and combination of strong base anion exchange and Sr resin were used for the examination of the impact of sample matrix constituents on efficiency of strontium isolation (chemical yield), while Cherenkov counting of 90Y and counting of 90Sr(90Y) on proportional counter were used for the quantitative 90Sr determination. The chemical yields obtained with different isolation methods were compared with the emphasis on its influence on reliability of the 90Sr determination in different kinds of samples. The results show that the efficiency of strontium isolation depends on type of sample and separation methodology. The strontium yield on Sr resin column decreases with the increase of Sr, Ca and Na concentration. In the presence of 1 g of Ca and 1 g of Na, the yield of 85% was obtained for 5 mg of Sr carrier and dropped below 50% with further increase of Sr and other elements. However, the yield can be increased to 75% if Na and part of Ca are separated from Sr on the anion exchange column with alcoholic solution of nitric acid and by final separation of Ca from Sr on the Sr resin column. In the presence of large amounts of Ca, Na and other elements, isolation efficiency on the Sr resin column significantly decreases in comparison with other methods. The average yield for isolation from vegetation samples on the Sr resin column is only 21%. For the soil samples the highest average yield (78%) is obtained for the isolation in the combination of anion exchange and Sr resin columns. For the isolation from bone samples the average yields over 80% are on AnaLig®Sr01 and anion exchange resins columns, while Sr resin was not used for separation due to high content of Ca in samples. The results of the 90Sr determination in proficiency testing (PT) samples show that the accuracy of the determination does not depend on high chemical yield but depends on accuracy of yield determination. The analysis of z-values shows that 96% of obtained z-values range from 0 to ±2 while 77% of z-values range between 0 and ± 1. Ninety percent of obtained results of 90Sr determination deviate less than 20% from assigned values in PT provider reports. The results of 90Sr determination in animal bone samples using different methods are in good agreement. The results obtained by Cherenkov counting in both laboratories vary from −3.1–14.5% while results obtained by determination via 90Y and counting on i-Matic vary between −10.0 and −2.9%. These deviations are in accordance with deviations obtained with PT samples. Activity concentrations of 90Sr in wild boar bone samples range from 4 to 30 Bq kg−1 while in deer bone samples from 2 to 8 Bq kg−1.



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Fallout isotope chronology of the near-surface sediment record of Lake Bolătău

Publication date: January 2018
Source:Journal of Environmental Radioactivity, Volume 181
Author(s): Árpád Bihari, Máté Karlik, Marcel Mîndrescu, Zoltán Szalai, Ionela Grădinaru, Zoltán Kern
Fallout isotope (210Pbex,137Cs and 241Am) based dating has been carried out on the near-surface sediment core collected from Lake Bolătău-Feredeu (Bukovina, Romania). The motivation was to improve the chronology of this recent section in connection with significant fluctuations observed in sediment accumulation rates, particle size distribution and primordial radioisotope (i.e. 40K and 232Th) composition. Previously only an extrapolation of a broad-range OxCal age-depth model, which was based on 8 AMS radiocarbon dates from the deeper part of a parallel sediment sequence and tentatively validated for the upper part using the double peaks of the 137Cs activity concentration distribution, was available for the studied section (1–24 cm). Parallel to the previous 137Cs measurement, 210Pb and 226Ra (for a more detailed, 210Pbex-based chronology), 241Am (for an additional time-marker), as well as 40K and 232Th concentrations have also been determined by gamma-spectrometry. In case of the 210Pbex-based chronology, due to a large deviation from a pure exponential distribution, the Constant Flux (CF) model has been used for the calculation of sediment ages and accumulation rates. Although the broad-range OxCal and the CF model were broadly similar down to 22 cm, the 210Pbex-based ages are clearly superior in terms of uncertainty in the uppermost 12 cm, while the broad-range model has smaller uncertainty below 20 cm (>150 years). The CF model gave an average mass accumulation rate of (0.08 ± 0.03) g cm−2 yr−1 for sections 0–11 cm, and (0.03 ± 0.01) g cm−2 yr−1 for sections 12–22 cm, respectively. Significant changes have been observed in the depth distribution of both the particle size distribution and the elemental/isotopic composition of the sediment record, most likely related to the variation observable in the intensity and volume of precipitation in the catchment. The obtained high-resolution records of Lake Bolătău, including multiple radioisotopes, can serve as a regional benchmark for similar studies.

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Inside Front Cover - Editorial Board Page

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Publication date: December 2017
Source:Journal of Environmental Radioactivity, Volume 180





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Detailed effects of particle size and surface area on 222Rn emanation of a phosphate rock

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Publication date: December 2017
Source:Journal of Environmental Radioactivity, Volume 180
Author(s): Gustavo Haquin, Zohar Yungrais, Danielle Ilzycer, Hovav Zafrir, Noam Weisbrod
The dependency of radon emanation on soil texture was investigated using the closed chamber method. Ground phosphate rock with a large specific surface area was analyzed, and the presence of inner pores, as well as a high degree of roughness and heterogeneity in the phosphate particles, was found. The average radon emanation of the dry phosphate was 0.145 ± 0.016. The emanation coefficient was highest (0.169 ± 0.019) for the smallest particles (<25 μm), decreasing to a constant value (0.091 ± 0.014) for the larger particles (>210 μm). The reduction rate followed an inverse power law. As expected, a linear dependence between the emanation coefficient and the specific surface area was found, being lower than predicted for the large specific surface area. This was most likely due to an increase in the embedding effect of radon atoms in adjacent grains separated by micropores. Results indicate that knowledge of grain radium distribution is crucial to making accurate emanation predictions.



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Application of topographical source model for air dose rates conversions in aerial radiation monitoring

Publication date: December 2017
Source:Journal of Environmental Radioactivity, Volume 180
Author(s): Azusa Ishizaki, Yukihisa Sanada, Mutsushi Ishida, Masahiro Munakata
After the Fukushima Daiichi Nuclear Power Station (FDNPS) accident in 2011, aerial radiation monitoring (ARM) using a manned helicopter was conducted to rapidly measure air dose rates and the deposition of radioactive nuclides over a large area. Typically, the air dose rate is obtained by conversion from the count rate using conventional flat source model (FSM). The converted dose rate obtained via aerial monitoring poorly matches the results of ground measurement in the mountain and forest areas because FSM does not consider topographical effects. To improve the conversion accuracy, we developed new methods to analyze aerial monitoring data using topographical source model (TSM) based on the analytical calculation of the gamma-ray flux. The ARM results converted using both FSM as well as TSM were compared with ground measurement data obtained after the FDNPS accident. By using TSM, the conversion accuracy was improved. In addition, to determine a parameter sensitive to topographical effects, we examined five parameters and it was clear that the difference between the elevation just below the helicopter and the mean elevation within the measurement area was the most influential.

Graphical abstract

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Emergency preparedness for the accidental release of radionuclides from the Uljin Nuclear Power Plant in Korea

Publication date: December 2017
Source:Journal of Environmental Radioactivity, Volume 180
Author(s): Soon-Ung Park, In-Hye Lee, Seung Jin Joo, Jae-Won Ju
Site specific radionuclide dispersion databases were archived for the emergency response to the hypothetical releases of 137Cs from the Uljin nuclear power plant in Korea. These databases were obtained with the horizontal resolution of 1.5 km in the local domain centered the power plant site by simulations of the Lagrangian Particle Dispersion Model (LPDM) with the Unified Model (UM)–Local Data Assimilation Prediction System (LDAPS). The Eulerian Dispersion Model–East Asia (EDM–EA) with the UM–Global Data Assimilation Prediction System (UM-GDAPS) meteorological models was used to get dispersion databases in the regional domain. The LPDM model was performed for a year with a 5-day interval yielding 72 synoptic time-scale cases in a year. For each case hourly mean near surface concentrations, hourly mean column integrated concentrations, hourly total depositions for 5 consecutive days were archived by the LPDM model in the local domain and by the EDM-EA model in the regional domain of Asia. Among 72 synoptic cases in a year the worst synoptic case that showed the highest mean surface concentration averaged for 5 days in the LPDM model domain was chosen to illustrate the emergency preparedness to the hypothetical accident at the site. The simulated results by the LPDM model with the 137Cs emission rate of the Fukushima nuclear power plant accident for the first 5-day period were found to be able to provide prerequisite information for the emergency response to the early phase of the accident whereas those of the EDM-EA model could provide information required for the environmental impact assessment of the accident in the regional domain. The archived site-specific database of 72 synoptic cases in a year could have a great potential to be used as a prognostic information on the emergency preparedness for the early phase of accident.

Graphical abstract

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Fukushima-derived radiocesium fallout in Hawaiian soils

Publication date: December 2017
Source:Journal of Environmental Radioactivity, Volume 180
Author(s): Trista McKenzie, Henrietta Dulai
Several reactors at the Fukushima Dai-ichi Nuclear Power Plant suffered damage on March 11, 2011, resulting in the release of radiocesium (134Cs and 137Cs), as well as other radionuclides, into the atmosphere. A week later, these isotopes were detected in aerosols over the state of Hawai'i and in milk samples analyzed on the island of Hawai'i. This study estimated the magnitude of cesium deposition in soil, collected in 2015–2016, resulting from atmospheric fallout. It also examined the patterns of cesium wet deposition with precipitation observed on O'ahu and the island of Hawai'i following the disaster. Fukushima-derived fallout was differentiated from historic nuclear weapons testing fallout by the presence of 134Cs and the assumption that the 134Cs to 137Cs ratio was 1:1. Detectable, Fukushima-derived 134Cs inventories ranged from 30 to 630 Bq m−2 and 137Cs inventories ranged from 20 to 2200 Bq m−2. Fukushima-derived cesium inventories in soils were related to precipitation gradients, particularly in areas where rainfall exceeded 200 mm between March 19 and April 4, 2011. This research confirmed and quantified the presence of Fukushima-derived fallout in the state of Hawai'i in amounts higher than predicted by models and observed in the United States mainland, however the activities detected were an order of magnitude lower than fallout associated with historic sources such as the nuclear weapons testing in the Pacific. In addition, this study showed that areas of highest cesium deposition do not overlap with densely populated or agriculturally used areas.

Graphical abstract

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Study of soil-fern transfer of naturally occurring alpha emitting radionuclides in the Southern Region of Cameroon

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Publication date: December 2017
Source:Journal of Environmental Radioactivity, Volume 180
Author(s): S. Mvondo, G.H. Ben-Bolie, J.M. Ema'a Ema'a, P. Owono Ateba, P. Ele abiama, J.F. Beyala Ateba
This study was carried out in the localities Melondo and Ngombas located in the Southern Region of Cameroon where there are known to be uranium-bearing and high background radiation areas. Activity concentrations of naturally occurring radionuclides 210Po, 238U, 235U, 234U, 232Th, 230Th, 228Th and 226Ra were determined in soil and fern (filicophyta) samples collected at 10 points in both localities. In soil, the average values of these activity concentrations (in Bq.kg−1 d.w.) were 210Po(130 ± 10), 238U(126 ± 11.6), 235U(5 ± 1), 234U(131 ± 10), 232Th(400 ± 22), 230Th(145 ± 11), 228Th(381 ± 21) and 226Ra(154 ± 28) at Melondo; and 210Po(228 ± 1), 238U(170 ± 11), 235U(9 ± 2), 234U(179 ± 12), 232Th(200 ± 18), 230Th(184 ± 18), 228Th(228 ± 22) and 226Ra(416 ± 7) at Ngomba. In fern the average activity concentrations were: 210Po(35 ± 3), 238U(0.68 ± 0.05), 235U(0.042 ± 0.01), 234U(0.90 ± 0.05), 232Th(1.2 ± 0.2), 230Th(0.7 ± 0.1), 228Th(39 ± 3) and 226Ra(14 ± 3) at Melondo and 210Po(24 ± 2), 238U(0.82 ± 0.06), 235U(0.046 ± 0.01), 234U(0.92 ± 0.06), 232Th(0.8 ± 0.2), 230Th(0.9 ± 0.2), 228Th(15 ± 5) and 226Ra(14 ± 3) at Ngomba. The soil-fern transfer factors (TF) (in kg.kg−1) were respectively 210Po(1.64 × 10−1), 238U (5 × 10−3), 235U(7 × 10−3), 234U(6 × 10−3), 232Th(3 × 10−3), 230Th(5 × 10−3), 228Th(7.9 × 10−2), and 226Ra(5.1 × 10−2). The highest TF for fern was for 210Po, probably because of atmospheric deposition. The TFs of uranium and thorium were comparable to those given in the IAEA handbook for grass.



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The evaluation of the 1001.03 keV gamma emission absolute intensity using fundamental parameter method

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Publication date: December 2017
Source:Journal of Environmental Radioactivity, Volume 180
Author(s): A.E.M. Khater, Y.Y. Ebaid
The accurate evaluation of the absolute intensity of the gamma-ray transition 1001.03 keV of 234mPa is crucial for accurate determination of 238U in nuclear material and environmental samples. Over the last decades, a wide range of 1001.03 keV absolute intensity values were published by different researchers and ranged from 0.59 to 1.12%. Nowadays, one of the most commonly used values is 0.847 ± 0.008% that seems not accurate and would eventually lead to an overestimation of 238U activity concentration. The absolute intensity of 1001.03 keV gamma transition was re-evaluated using different fundamental parameter method (FPM) modes, uranium ore and granite samples, samples' geometries, sample-to-detectors' geometries and gamma ray spectrometers. The mean ± standard deviation of newly optimized absolute intensity value is 1.067 ± 0.084% with an average relative bias of - 20% from the commonly used value.



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Differentiation of grade II/III and grade IV glioma by combining “T1 contrast-enhanced brain perfusion imaging” and susceptibility-weighted quantitative imaging

Abstract

Purpose

MRI is a useful method for discriminating low- and high-grade glioma using perfusion MRI and susceptibility-weighted imaging (SWI). The purpose of this study is to evaluate the usefulness of T1-perfusion MRI and SWI in discriminating among grade II, III, and IV gliomas.

Methods

T1-perfusion MRI was used to measure relative cerebral blood volume (rCBV) in 129 patients with glioma (70 grade IV, 33 grade III, and 26 grade II tumors). SWI was also used to measure the intratumoral susceptibility signal intensity (ITSS) scores for each tumor in these patients. rCBV and ITSS values were compared to seek differences between grade II vs. grade III, grade III vs. grade IV, and grade III+II vs. grade IV tumors.

Results

Significant differences in rCBV values of the three grades of the tumors were noted and pairwise comparisons showed significantly higher rCBV values in grade IV tumors as compared to grade III tumors, and similarly increased rCBV was seen in the grade III tumors as compared to grade II tumors (p < 0.001). Grade IV gliomas showed significantly higher ITSS scores on SWI as compared to grade III tumors (p < 0.001) whereas insignificant difference was seen on comparing ITSS scores of grade III with grade II tumors. Combining the rCBV and ITSS resulted in significant improvement in the discrimination of grade III from grade IV tumors.

Conclusion

The combination of rCBV values derived from T1-perfusion MRI and SWI derived ITSS scores improves the diagnostic accuracy for discrimination of grade III from grade IV gliomas.



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Differentiation of grade II/III and grade IV glioma by combining “T1 contrast-enhanced brain perfusion imaging” and susceptibility-weighted quantitative imaging

Abstract

Purpose

MRI is a useful method for discriminating low- and high-grade glioma using perfusion MRI and susceptibility-weighted imaging (SWI). The purpose of this study is to evaluate the usefulness of T1-perfusion MRI and SWI in discriminating among grade II, III, and IV gliomas.

Methods

T1-perfusion MRI was used to measure relative cerebral blood volume (rCBV) in 129 patients with glioma (70 grade IV, 33 grade III, and 26 grade II tumors). SWI was also used to measure the intratumoral susceptibility signal intensity (ITSS) scores for each tumor in these patients. rCBV and ITSS values were compared to seek differences between grade II vs. grade III, grade III vs. grade IV, and grade III+II vs. grade IV tumors.

Results

Significant differences in rCBV values of the three grades of the tumors were noted and pairwise comparisons showed significantly higher rCBV values in grade IV tumors as compared to grade III tumors, and similarly increased rCBV was seen in the grade III tumors as compared to grade II tumors (p < 0.001). Grade IV gliomas showed significantly higher ITSS scores on SWI as compared to grade III tumors (p < 0.001) whereas insignificant difference was seen on comparing ITSS scores of grade III with grade II tumors. Combining the rCBV and ITSS resulted in significant improvement in the discrimination of grade III from grade IV tumors.

Conclusion

The combination of rCBV values derived from T1-perfusion MRI and SWI derived ITSS scores improves the diagnostic accuracy for discrimination of grade III from grade IV gliomas.



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Intensity-based dual model method for generation of synthetic CT images from standard T2-weighted MR images – Generalized technique for four different MR scanners

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Publication date: Available online 30 October 2017
Source:Radiotherapy and Oncology
Author(s): Lauri Koivula, Mika Kapanen, Tiina Seppälä, Juhani Collan, Jason A. Dowling, Peter B. Greer, Christian Gustafsson, Adalsteinn Gunnlaugsson, Lars E. Olsson, Leonard Wee, Juha Korhonen
Background and purposeRecent studies have shown that it is possible to conduct entire radiotherapy treatment planning (RTP) workflow using only MR images. This study aims to develop a generalized intensity-based method to generate synthetic CT (sCT) images from standard T2-weighted (T2w) MR images of the pelvis.Materials and methodsThis study developed a generalized dual model HU conversion method to convert standard T2w MR image intensity values to synthetic HU values, separately inside and outside of atlas-segmented bone volume contour. The method was developed and evaluated with 20 and 35 prostate cancer patients, respectively. MR images with scanning sequences in clinical use were acquired with four different MR scanners of three vendors.ResultsFor the generated synthetic CT (sCT) images of the 35 prostate patients, the mean (and maximal) HU differences in soft and bony tissue volumes were 16 ± 6 HUs (34 HUs) and −46 ± 56 HUs (181 HUs), respectively, against the true CT images. The average of the PTV mean dose difference in sCTs compared to those in true CTs was −0.6 ± 0.4% (−1.3%).ConclusionsThe study provides a generalized method for sCT creation from standard T2w images of the pelvis. The method produced clinically acceptable dose calculation results for all the included scanners and MR sequences.



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Models of diffusion signal decay in magnetic resonance imaging: Capturing complexity

Abstract

Diffusion-weighted MRI is a key diagnostic component of clinical medicine. Radiologists use models of the effects of diffusion weighting to connect the decay of the signal intensity in tissues with macroscopic (diffusion tensor imaging) and microscopic (q-space imaging) structures. This multi-scale problem has stimulated the creation of many diffusion models spanning phenomenon in cells, in tissues, and in organs. Such models can be heuristic or based on simulations, stochastic processes, histological structure or physical and physiological constraints. The goal of this paper is to provide an overview of these approaches by considering several different classes of mathematical models (linear, nonlinear, integer, and fractional orders) that can, and have in some cases, been used to fit diffusion attenuation in complex biological tissues, such as brain white and gray matter. The focus here is not on solving the Bloch-Torrey equation or on fitting curves to data, but on the choices (Gaussian, anomalous, isotropic, anisotropic) one often has to make when beginning the analysis of diffusion data. It is hoped that this presentation, while oversimplified, will be of use to students and to new investigators who seek an introduction to diffusion attenuation model selection and characterization. Examples are given that illustrate the relationship between the functional form of the diffusion decay rate and, in the case of a Stejskal-Tanner gradient pulse sequence, the expected signal decay. Model limitations are noted and connections to more advanced treatments of diffusion modeling methods are provided.



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Supplemental Screening Breast US in Women with Negative Mammographic Findings: Effect of Routine Axillary Scanning.

Supplemental Screening Breast US in Women with Negative Mammographic Findings: Effect of Routine Axillary Scanning.

Radiology. 2017 Oct 30;:171218

Authors: Lee SH, Yi A, Jang MJ, Chang JM, Cho N, Moon WK

Abstract
Purpose To evaluate the effect of routine axillary scanning when supplemental screening breast ultrasonography (US) is performed in women with negative mammographic findings. Materials and Methods This retrospective review included 12 844 screening breast US examinations performed in 8664 asymptomatic women aged 40 years or older with dense breasts and negative results for cancer at mammography performed between January 2012 and December 2014. Bilateral whole-breast US was performed with a handheld device by one of 10 experienced radiologists. The bilateral axillae were routinely scanned, and representative images were documented in all examinations. The abnormal interpretation rate (AIR), cancer detection rate (CDR), and positive predictive value (PPV) of screening breast US with and without axillary scanning were calculated. The 95% confidence intervals (CIs) were calculated for cancer detection after an abnormal finding at screening US. Results The frequency of positive axillary findings was 3.5 per 1000 (14 of 4009) baseline screening US examinations and 2.2 per 1000 (19 of 8835) subsequent screening US examinations. Of the 33 women with 33 positive axillary findings, 11 had positive breast findings; none were diagnosed with breast cancer. The remaining 22 women showed positive findings only in the axilla. The axillary findings revealed no malignancy at biopsy (n = 12) or during 22-54-month follow-up (n = 21) (95% CI: 0%, 10.6%). Without routine axillary scanning, the AIR of screening US decreased from 15.2% (610 of 4009 examinations) to 15.0% (602 of 4009 examinations) at baseline US and from 8.1% (714 of 8835 examinations) to 7.9% (700 of 8835 examinations) at subsequent US examinations, and the PPV for biopsy performed increased from 6.0% (five of 83 examinations) to 6.4% (five of 78 examinations) at baseline US and from 7.6% (13 of 170 examinations) to 7.9% (13 of 164 examinations) at subsequent US examinations, without a change in the CDR. Conclusion Routine axillary scanning during screening breast US had no effect on additional cancer detection, but rather increased the number of false-positive results. However, the conclusions based on these findings must be tempered by the low rate of positive findings. (©) RSNA, 2017.

PMID: 29083988 [PubMed - as supplied by publisher]



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Amide Proton Transfer MR Imaging of Endometrioid Endometrial Adenocarcinoma: Association with Histologic Grade.

Amide Proton Transfer MR Imaging of Endometrioid Endometrial Adenocarcinoma: Association with Histologic Grade.

Radiology. 2017 Oct 30;:170349

Authors: Takayama Y, Nishie A, Togao O, Asayama Y, Ishigami K, Ushijima Y, Okamoto D, Fujita N, Sonoda K, Hida T, Ohishi Y, Keupp J, Honda H

Abstract
Purpose To evaluate the utility of amide proton transfer (APT) imaging in estimating histologic grades of endometrioid endometrial adenocarcinoma (EEA). Materials and Methods The institutional review board approved this prospective study. Between June 2012 and March 2016, 32 patients with EEA underwent magnetic resonance (MR) imaging. After their surgical procedures, their EEAs were confirmed pathologically and classified into histologic grades: grade 1 (n = 11), grade 2 (n = 11), and grade 3 (n = 10). The APT signal intensities (SIs) and the mean and minimum apparent diffusion coefficients (ADCs) of the three grades were calculated and compared. Spearman rank correlation coefficient was also calculated between the APT SIs and histologic grades, and between the ADCs and histologic grades. Results The Spearman correlation coefficient with histologic grade of the APT SIs, the mean ADC, and the minimum ADC were 0.55 (P = .001), 0.03 (P = .84), and -0.30 (P = .09), respectively. The average APT SIs and the mean and minimum ADCs were 2.2% ± 0.2 (standard deviation), 0.9 × 10(-3) mm(2)/sec ± 0.2, and 0.6 × 10(-3) mm(2)/sec ± 0.1 for grade 1; 3.2% ± 0.3, 0.8 × 10(-3) mm(2)/sec ± 0.1, and 0.5 × 10(-3) mm(2)/sec ± 0.1 for grade 2; and 3.7% ± 0.3, 0.9 × 10(-3) mm(2)/sec ± 0.1, and 0.5 × 10(-3) mm(2)/sec ± 0.1 for grade 3, respectively. The APT SIs of grade 3 EEA were significantly higher than those of grade 1 EEA (P = .01), but other pairwise comparisons did not reveal any significant differences (P = .06-.51). The mean and minimum ADCs showed no significant differences among the three histologic grades (P =.13-.51). Conclusion The APT SI was positively correlated with the histologic grades of EEA. (©) RSNA, 2017 Online supplemental material is available for this article.

PMID: 29083987 [PubMed - as supplied by publisher]



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Effect of General Anesthesia versus Conscious Sedation for Stroke Thrombectomy on Angiographic Workflow in a Randomized Trial: A Post Hoc Analysis of the SIESTA Trial.

Effect of General Anesthesia versus Conscious Sedation for Stroke Thrombectomy on Angiographic Workflow in a Randomized Trial: A Post Hoc Analysis of the SIESTA Trial.

Radiology. 2017 Oct 30;:171002

Authors: Pfaff JAR, Schönenberger S, Nagel S, Ringleb PA, Hacke W, Bendszus M, Bösel J, Möhlenbruch MA

Abstract
Purpose To investigate whether the sedation mode (ie, conscious sedation [CS] vs general anesthesia [GA]) affects the angiographic workflow applied for treatment of endovascular stroke in a post hoc analysis of a recent randomized controlled trial, Sedation versus Intubation for Endovascular Stroke Treatment (SIESTA). Materials and Methods SIESTA was an institutional review board-approved, single-center, prospective, randomized, parallel-group, open-label treatment trial with a blinded end-point evaluation to compare GA with CS for treatment of endovascular stroke in 73 and 77 patients, respectively. By using descriptive data from SIESTA, the influence of the mode of sedation on angiographic workflow during treatment for endovascular stroke (eg, procedure times) and other radiologic outcome parameters (eg, radiation exposure) were analyzed. The time between angiographic key steps for patients who underwent GA and CS was evaluated with t tests. P values were corrected for false discovery rate. Results The median time from groin puncture to first intracranial flow restoration with CS was 47 minutes (interquartile range [IQR], 29-70 minutes), and for GA, it was 41 minutes (IQR, 28-60 minutes) (P = .546). The median time to the end of angiography with CS was 104 minutes (IQR, 75-150 minutes), and with GA, it was 73 minutes (IQR, 53-125 minutes) (P = .052). Fluoroscopy time with CS was 49 minutes (IQR, 25-85 minutes), and with GA, it was 35 minutes (IQR, 20-74 minutes) (P = .098). The times were comparable in both groups for these measures. The time from groin puncture to the final angiographic result with GA, at 72 minutes (IQR, 45-109 minutes) was shorter than that with CS, at 98 minutes (IQR, 64-135 minutes) (P = .048). Conclusion This post hoc analysis of the single-center SIESTA trial revealed that time from groin puncture to final angiographic result was shorter with patients under GA than that with patients under CS. (©) RSNA, 2017 Online supplemental material is available for this article.

PMID: 29083986 [PubMed - as supplied by publisher]



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Conscientious objection as a barrier for implementing voluntary termination of pregnancy in Uruguay: Gynecologists' attitudes and behavior.

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Conscientious objection as a barrier for implementing voluntary termination of pregnancy in Uruguay: Gynecologists' attitudes and behavior.

Int J Gynaecol Obstet. 2016 Aug;134(S1):S16-S19

Authors: Coppola F, Briozzo L, Nozar F, Fiol V, Greif D

Abstract
OBJECTIVE: To analyze the attitudes and behavior of gynecologists in Uruguay with respect to the right to conscientious objection that is included in the law concerning voluntary termination of pregnancy.
METHODS: The relevant laws and decrees, academic articles, legal or administrative claims, and the positions published by the institutions representing physicians or by groups of gynecologists were analyzed.
RESULTS: In general, the institutions positioned themselves in favor of correct application of conscientious objection and the immense majority of gynecologists followed this conduct. Small groups mounted a strong opposition and in one department (province) all gynecologists declared themselves to be objectors.
CONCLUSION: Most gynecologists, whether or not they are objectors, proved to have a "loyalty to duty," fulfilling their primary obligation to abide by the ethical duty to give treatment to the persons who need it. A small group used conscientious objection to impede the provision of care to the women who needed the service, some group members being genuine objectors and others pseudo-objectors.

PMID: 28748590 [PubMed - indexed for MEDLINE]



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Treatment effectiveness for aging changes in the larynx.

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Treatment effectiveness for aging changes in the larynx.

Laryngoscope. 2017 Nov;127(11):2572-2577

Authors: Sachs AM, Bielamowicz SA, Stager SV

Abstract
OBJECTIVES: To compare the effectiveness of injection augmentation and bilateral thyroplasty surgery in managing age-related changes of the larynx.
STUDY DESIGN: Retrospective chart review of patients treated with bilateral thyroplasty and/or injection augmentation.
METHODS: We evaluated 22 patients before and after treatment using: 1) normalized glottal gap area and normalized true vocal fold width from endoscopic images; 2) patient self-rating questionnaires; and 3) acoustic and aerodynamic measures.
RESULTS: Thyroplasty surgery resulted in 38% of patients demonstrating less bowing compared to 33% after injection, and 63% demonstrated less supraglottic activity compared to 43% after injection (P = 0.09). Change in mean Voice-Related Quality of Life (V-RQOL) scores was 25.5 after thyroplasty compared to -16.4 after injection (P < 0.05). Those exhibiting a greater than 20 change in V-RQOL after treatment were significantly more likely to report swallowing symptoms pretreatment.
CONCLUSION: Patients postinjection did not rate themselves on any questionnaires as significantly better compared to pretreatment, whereas patients post-thyroplasty rated themselves as significantly improved on all questionnaires. Patients post-thyroplasty rated their voices as significantly closer to their best voice than patients postinjection. Likewise, 64% of patients who had thyroplasty surgery reported a significant treatment effect compared to 33% for injection augmentation.
LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2572-2577, 2017.

PMID: 28681923 [PubMed - indexed for MEDLINE]



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Adherence to hydroxyurea, health-related quality of life domains, and patients' perceptions of sickle cell disease and hydroxyurea: a cross-sectional study in adolescents and young adults.

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Adherence to hydroxyurea, health-related quality of life domains, and patients' perceptions of sickle cell disease and hydroxyurea: a cross-sectional study in adolescents and young adults.

Health Qual Life Outcomes. 2017 Jul 05;15(1):136

Authors: Badawy SM, Thompson AA, Lai JS, Penedo FJ, Rychlik K, Liem RI

Abstract
BACKGROUND: Sickle cell disease (SCD) patients have impaired domains of health-related quality of life (HRQOL). Hydroxyurea is safe and efficacious in SCD; however, adherence is suboptimal, and patients' perceptions are poorly understood amongst adolescents and young adults (AYA). Study objectives were to: (1) examine patients' perceptions of SCD and hydroxyurea; and (2) explore the relationship of their perceptions to clinical characteristics, HRQOL domains and hydroxyurea adherence.
METHODS: Thirty-four SCD patients on hydroxyurea (≥6 months) participated in a single-institution study. Study measures included Brief-Illness Perceptions Questionnaire, ©Modified Morisky Adherence Scale 8-items, and Patient Reported Outcomes Measurement Information System (PROMIS®). We assessed the relationship of patients' perceptions to hydroxyurea adherence using Wilcoxon rank-sum test, the number of hospitalizations using Kruskal-Wallis test, and the number of ED visits, adherence level, HRQOL domain scores using Spearman's rho correlations. We conducted a sub-analysis in HbSS patients to evaluate the relationship of patients' perceptions to laboratory markers of hydroxyurea adherence.
RESULTS: Participants were 59% male and 91% Black, and had a median age of 13.5 (range 12-18) years. Participants with ≥4 hospitalizations over 1-year prior (using electronic medical chart review) reported more negative perceptions of SCD-related symptoms and emotional response, and perceived hydroxyurea as less beneficial; all p-values ≤0.01. Most participants (74%) reported low hydroxyurea adherence. Participants with higher hydroxyurea adherence perceived more hydroxyurea benefits (r s = 0.44, p < 0.01) and had better emotional response to SCD (r s = -0.44, p = 0.01). In a sub-analysis of HbSS patients, perceived benefits of hydroxyurea positively correlated with HbF (r s = 0.37, p = 0.05) and MCV values (r s = 0.35, p = 0.05). Participants with more negative perceptions of SCD-related consequences, concerns, and emotional response, and fewer perceived hydroxyurea benefits reported worse fatigue (r s = 0.68; r s = 0.44; r s = 0.74; r s = -0.60), pain (r s = 0.56; r s = 0.54; r s = 0.63; r s = -0.39), anxiety (r s = 0.55; r s = 0.58; r s = 0.56; r s = -0.47), and depression (r s = 0.64; r s = 0.49; r s = 0.70; r s = -0.62), respectively, all p-values <0.05.
CONCLUSIONS: Dynamics influencing hydroxyurea adherence are multifactorial, and understanding patients' perceptions is critical to overcoming adherence barriers. Patients' favorable perceptions correlated with greater adherence and better HRQOL domain scores. Prospective evaluation of patients' perceptions of SCD and hydroxyurea in relation adherence, HRQOL domains and clinical outcomes is warranted.

PMID: 28679417 [PubMed - indexed for MEDLINE]



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Longitudinal regret after treatment for low- and intermediate-risk prostate cancer.

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Longitudinal regret after treatment for low- and intermediate-risk prostate cancer.

Cancer. 2017 Nov 01;123(21):4252-4258

Authors: Hurwitz LM, Cullen J, Kim DJ, Elsamanoudi S, Hudak J, Colston M, Travis J, Kuo HC, Rice KR, Porter CR, Rosner IL

Abstract
BACKGROUND: Prostate cancer patients diagnosed with low- and intermediate-risk disease have several treatment options. Decisional regret after treatment is a concern, especially when poor oncologic outcomes or declines in health-related quality of life (HRQoL) occur. This study assessed determinants of longitudinal decisional regret in prostate cancer patients attending a multidisciplinary clinic and treated with radical prostatectomy (RP), external beam radiation therapy (EBRT), brachytherapy (BT), or active surveillance (AS).
METHODS: Patients newly diagnosed with prostate cancer at the Walter Reed National Military Medical Center who attended a multidisciplinary clinic were enrolled into a prospective study from 2006 to 2014. The Decision Regret Scale was administered at 6, 12, 24, and 36 months posttreatment. HRQoL was also assessed at regular intervals using the Expanded Prostate Cancer Index Composite and 36-item RAND Medical Outcomes Study Short Form questionnaires. Adjusted probabilities of reporting regret were estimated via multivariable logistic regression fitted with generalized estimating equations.
RESULTS: A total of 652 patients met the inclusion criteria (395 RP, 141 EBRT, 41 BT, 75 AS). Decisional regret was consistently low after all of these treatments. In multivariable models, only African American race (odds ratio, 1.67; 95% confidence interval, 1.12-2.47) was associated with greater regret across time. Age and control preference were marginally associated with regret. Regret scores were similar between RP patients who did and did not experience biochemical recurrence. Declines in HRQoL were weakly correlated with greater decisional regret.
CONCLUSION: In the context of a multidisciplinary clinic, decisional regret did not differ significantly between treatment groups but was greater in African Americans and those reporting poorer HRQoL. Cancer 2017;123:4252-4258. © 2017 American Cancer Society.

PMID: 28678408 [PubMed - indexed for MEDLINE]



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Informal caregivers experience of supplemental oxygen in pulmonary fibrosis.

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Informal caregivers experience of supplemental oxygen in pulmonary fibrosis.

Health Qual Life Outcomes. 2017 Jul 01;15(1):133

Authors: Graney BA, Wamboldt FS, Baird S, Churney T, Fier K, Korn M, McCormick M, Vierzba T, Swigris JJ

Abstract
BACKGROUND: Patients prescribed supplemental oxygen (O2) therapy face challenges as they adjust to being constantly "tethered" to an oxygen delivery device. Informal caregivers (ICs) of patients with pulmonary fibrosis (PF) face their own, often overlooked hardships when O2 is brought into their home and added to their lives. Our aim was to understand the multiple effects of supplemental oxygen therapy on ICs of patients with PF.
METHODS: We conducted single, semi-structured telephone interviews with twenty ICs of patients with PF who were using O2 for at least 8 months. We performed a qualitative, content analysis based in grounded theory to examine data across subjects.
RESULTS: ICs initially reacted to O2 with trepidation and sadness as they came to recognize the changes it would cause in the lives of their patient-loved one (PLO). ICs recognized both beneficial and negative effects of O2 on their PLOs. ICs also realized that O2 created significant changes in their own lives, including introducing new roles and responsibilities for them, altering their home environments and significantly impacting their relationships with their PLOs. Although O2 was a tangible and constant reminder of disease progression, over time ICs were able to adapt and accept their new lives with O2.
CONCLUSION: ICs of patients with PF experience many life changes when their PLO is prescribed O2. Having O2 prescribers anticipate and recognize these challenges provides an opportunity to give support and guidance to ICs of PF patients who require O2 in the hopes of limiting the negative impact of O2 on their lives.
TRIAL REGISTRATION: Clinicaltrials.gov , registration number NCT01961362 . Registered 9 October 2013.

PMID: 28668090 [PubMed - indexed for MEDLINE]



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The association between physical activity and health-related quality of life among breast cancer survivors.

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The association between physical activity and health-related quality of life among breast cancer survivors.

Health Qual Life Outcomes. 2017 Jun 30;15(1):132

Authors: Shin WK, Song S, Jung SY, Lee E, Kim Z, Moon HG, Noh DY, Lee JE

Abstract
BACKGROUND: The quality of life for breast cancer survivors has become increasingly important because of their high survival rate and prolonged life expectancy. The purpose of this study was to examine the association of physical activity following diagnosis and health-related quality of life (HRQOL) in breast cancer survivors.
METHODS: We conducted a cross-sectional study of breast cancer survivors. A total of 231 women aged 21-78 years who had been diagnosed with stages I to III breast cancer and had breast cancer surgery at least 6 months prior were recruited from three hospitals between September 2012 and April 2015 and were included in this study. We asked participants about their HRQOL and engagement in physical activity using structured questionnaires. We examined the association between HRQOL levels and physical activity using a generalized linear model.
RESULTS: Breast cancer survivors in the high physical activity group (3rd tertile) were more likely to have lower scores for fatigue (p for trend = 0.001) and pain (p for trend = 0.02) and higher scores for sexual function (p for trend = 0.007) than those in the low physical activity group (1st tertile). When we stratified participants by stage, we found increasing scores for physical functioning (p for trend =0.01) and decreasing scores for fatigue (p for trend = 0.02) with increasing levels of physical activity in breast cancer survivors with stage I breast cancer. In survivors with stages II and III, we found statistically significant associations with fatigue (p for trend = 0.02) and sexual functioning (p for trend = 0.001).
CONCLUSIONS: In conclusion, engagement in physical activity was related to better health-related quality of life among breast cancer survivors. Our findings may warrant further prospective and intervention studies to support the benefit of physical activity in improving the quality of life and survival of Korean breast cancer survivors.

PMID: 28666465 [PubMed - indexed for MEDLINE]



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Effects of Exercise on the Immune Function of Pediatric Patients With Solid Tumors: Insights From the PAPEC Randomized Trial.

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Effects of Exercise on the Immune Function of Pediatric Patients With Solid Tumors: Insights From the PAPEC Randomized Trial.

Am J Phys Med Rehabil. 2017 Nov;96(11):831-837

Authors: Fiuza-Luces C, Padilla JR, Valentín J, Santana-Sosa E, Santos-Lozano A, Sanchis-Gomar F, Pareja-Galeano H, Morales JS, Fleck SJ, Pérez M, Lassaletta A, Soares-Miranda L, Pérez-Martínez A, Lucia A

Abstract
The purpose of this study was to assess the effects of an in-hospital exercise intervention during neoadjuvant chemotherapy on the inflammatory profile and immune cell subpopulation in 20 children with solid tumors (control [n = 11] and exercise group [n = 9]). Although no significant interaction (group × time) effect was found with an analysis of variance test, we found a trend toward an interaction effect for natural killer cells expressing the immunoglobulin-like receptor KIR2DS4, with their numbers remaining stable in the exercise group but increasing in controls. Our data support that exercise interventions are safe in pediatric cancer patients with solid tumors during chemotherapy treatment despite its aggressive, immunosuppressive nature.

PMID: 28644246 [PubMed - indexed for MEDLINE]



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Longitudinal Vision-Related Quality of Life for Patients with Noninfectious Uveitis Treated with Fluocinolone Acetonide Implant or Systemic Corticosteroid Therapy.

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Longitudinal Vision-Related Quality of Life for Patients with Noninfectious Uveitis Treated with Fluocinolone Acetonide Implant or Systemic Corticosteroid Therapy.

Ophthalmology. 2017 Nov;124(11):1662-1669

Authors: Sugar EA, Venugopal V, Thorne JE, Frick KD, Holland GN, Wang RC, Almanzor R, Jabs DA, Holbrook JT, Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group

Abstract
PURPOSE: To evaluate longitudinal vision-related quality of life (VRQoL) in patients with noninfectious uveitis.
DESIGN: Cohort study using randomized controlled trial data.
PARTICIPANTS: Patients with active or recently active intermediate uveitis, posterior uveitis, or panuveitis enrolled in the Multicenter Steroid Treatment Trial and Follow-up Study.
METHODS: Data from the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) for the first 3 years after randomization were evaluated semiannually. Analyses were stratified by assigned treatment (129 implants vs. 126 systemic therapies) because of substantial differences in the trajectories of VRQoL. The impact of baseline measurements of visual function (visual acuity and visual field), demographics, and disease characteristics was assessed using generalized estimating equations.
MAIN OUTCOME MEASURES: Primary outcome was the NEI-VFQ-25 composite score over 3 years after randomization.
RESULTS: Individuals in both treatment groups showed similar improvement in NEI-VFQ-25 scores after 3 years of follow-up (implant: 11.9 points; 95% confidence interval [CI], 8.6-15.2; P < 0.001; systemic: 9.0 points; 95% CI, 5.6-12.3; P < 0.001; P = 0.21 for interaction). Individuals in the implant group showed a substantial improvement during the first 6 months followed by stable scores, whereas individuals in the systemic group showed a steady improvement over the course of follow-up. Worse initial visual acuity and visual fields were associated with lower initial NEI-VFQ-25 scores for both treatment groups. In the systemic group, these differences were maintained throughout follow-up. In the implant group, individuals with initial visual acuity worse than 20/40 showed additional improvement in NEI-VFQ-25 score to come within -7 points (95% CI, -15.0 to 0.9) of those with visual acuity 20/40 or better initially, a clinically meaningful but not statistically significant difference (P = 0.081). Results based on sensitivity analyses showed similar patterns.
CONCLUSIONS: Both treatment groups demonstrated significant improvements in NEI-VFQ-25 scores; however, the improvement was immediate for the implant group as opposed to gradual for the systemic group. Poorer visual function was associated significantly with initial differences in NEI-VFQ-25 scores. However, only individuals in the implant group with poor visual acuity were able to overcome their initial deficits by the end of 3 years.

PMID: 28624167 [PubMed - indexed for MEDLINE]



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The right hemisphere's contribution to discourse processing: A study in temporal lobe epilepsy.

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The right hemisphere's contribution to discourse processing: A study in temporal lobe epilepsy.

Brain Lang. 2017 Aug;171:31-41

Authors: Lomlomdjian C, Múnera CP, Low DM, Terpiluk V, Solís P, Abusamra V, Kochen S

Abstract
OBJECTIVE: Discourse skills - in which the right hemisphere has an important role - enables verbal communication by selecting contextually relevant information and integrating it coherently to infer the correct meaning. However, language research in epilepsy has focused on single word analysis related mainly to left hemisphere processing. The purpose of this study was to investigate discourse abilities in patients with right lateralized medial temporal lobe epilepsy (RTLE) by comparing their performance to that of patients with left temporal lobe epilepsy (LTLE).
METHODS: 74 pharmacoresistant temporal lobe epilepsy (TLE) patients were evaluated: 34 with RTLE and 40 with LTLE. Subjects underwent a battery of tests that measure comprehension and production of conversational and narrative discourse. Disease related variables and general neuropsychological data were evaluated.
RESULTS: The RTLE group presented deficits in interictal conversational and narrative discourse, with a disintegrated speech, lack of categorization and misinterpretation of social meaning. LTLE group, on the other hand, showed a tendency to lower performance in logical-temporal sequencing.
SIGNIFICANCE: RTLE patients showed discourse deficits which have been described in right hemisphere damaged patients due to other etiologies. Medial and anterior temporal lobe structures appear to link semantic, world knowledge, and social cognition associated areas to construct a contextually related coherent meaning.

PMID: 28478355 [PubMed - indexed for MEDLINE]



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IJMS, Vol. 18, Pages 2289: Apoptosis Induced by the Curcumin Analogue EF-24 Is Neither Mediated by Oxidative Stress-Related Mechanisms nor Affected by Expression of Main Drug Transporters ABCB1 and ABCG2 in Human Leukemia Cells

IJMS, Vol. 18, Pages 2289: Apoptosis Induced by the Curcumin Analogue EF-24 Is Neither Mediated by Oxidative Stress-Related Mechanisms nor Affected by Expression of Main Drug Transporters ABCB1 and ABCG2 in Human Leukemia Cells

International Journal of Molecular Sciences doi: 10.3390/ijms18112289

Authors: Nikola Skoupa Petr Dolezel Eliska Ruzickova Petr Mlejnek

The synthetic curcumin analogue, 3,5-bis[(2-fluorophenyl)methylene]-4-piperidinone (EF-24), suppresses NF-κB activity and exhibits antiproliferative effects against a variety of cancer cells in vitro. Recently, it was reported that EF-24-induced apoptosis was mediated by a redox-dependent mechanism. Here, we studied the effects of N-acetylcysteine (NAC) on EF-24-induced cell death. We also addressed the question of whether the main drug transporters, ABCB1 and ABCG2, affect the cytotoxic of EF-24. We observed that EF-24 induced cell death with apoptotic hallmarks in human leukemia K562 cells. Importantly, the loss of cell viability was preceded by production of reactive oxygen species (ROS), and by a decrease of reduced glutathione (GSH). However, neither ROS production nor the decrease in GSH predominantly contributed to the EF-24-induced cell death. We found that EF-24 formed an adduct with GSH, which is likely the mechanism contributing to the decrease of GSH. Although NAC abrogated ROS production, decreased GSH and prevented cell death, its protective effect was mainly due to a rapid conversion of intra- and extra-cellular EF-24 into the EF-24-NAC adduct without cytotoxic effects. Furthermore, we found that neither overexpression of ABCB1 nor ABCG2 reduced the antiproliferative effects of EF-24. In conclusion, a redox-dependent-mediated mechanism only marginally contributes to the EF-24-induced apoptosis in K562 cells. The main mechanism of NAC protection against EF-24-induced apoptosis is conversion of cytotoxic EF-24 into the noncytotoxic EF-24-NAC adduct. Neither ABCB1 nor ABCG2 mediated resistance to EF-24.



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IJMS, Vol. 18, Pages 2290: Endothelial Mesenchymal Transition in Hypoxic Microvascular Endothelial Cells and Paracrine Induction of Cardiomyocyte Apoptosis Are Mediated via TGFβ1/SMAD Signaling

IJMS, Vol. 18, Pages 2290: Endothelial Mesenchymal Transition in Hypoxic Microvascular Endothelial Cells and Paracrine Induction of Cardiomyocyte Apoptosis Are Mediated via TGFβ1/SMAD Signaling

International Journal of Molecular Sciences doi: 10.3390/ijms18112290

Authors: Isabella Sniegon Mona Prieß Jacqueline Heger Rainer Schulz Gerhild Euler

Cardiac remodeling plays a crucial role in the development of heart failure after mycocardial infarction. Besides cardiomyocytes, endothelial cells are recognized to contribute to cardiac remodeling. We now investigated processes of endothelial mesenchymal transition (EndoMT) in microvascular endothelial cells of rat (MVEC) under hypoxia and paracrine effects on ventricular cardiomyocytes of adult rat. Exposure of MVECs to hypoxia/reoxygenation enhanced TGFβ/SMAD signaling, since phosphorylation, and thus activation, of SMAD1/5 and SMAD2 increased. This increase was blocked by inhibitors of TGFβ receptor types ALK1 or ALK5. Exposure of ventricular cardiomyocytes to conditioned medium from hypoxic/reoxygenated MVECs enhanced SMAD2 phosphorylation and provoked apoptosis in cardiomyoyctes. Both were blocked by ALK5 inhibition. To analyze autocrine effects of hypoxic TGFβ signaling we investigated EndoMT in MVECs. After 3 days of hypoxia the mesenchymal marker protein α-smooth muscle actin (α-SMA), and the number of α-SMA- and fibroblast specific protein 1 (FSP1)-positive cells increased in MVECs cultures. This was blocked by ALK5 inhibition. Similarly, TGFβ1 provoked enhanced expression of α-SMA and FSP1 in MVECs. In conclusion, hypoxia provokes EndoMT in MVECs via TGFβ1/SMAD2 signaling. Furthermore, release of TGFβ1 from MVECs acts in a paracrine loop on cardiomyocytes and provokes apoptotic death. Thus, in myocardial infarction hypoxic endothelial cells may contribute to cardiac remodeling and heart failure progression by promotion of cardiac fibrosis and cardiomyocytes death.



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A new lithostratigraphic scheme for the Schinznach Formation (upper part of the Muschelkalk Group of northern Switzerland)

The sediments of late Anisian and Ladinian age in northern Switzerland, which were formerly named Upper Muschelkalk and Lower Keuper, mostly consist of carbonates. They accumulated in a transitional area between central parts of the Central European Epicontinental Basin and its margin towards the Vindelician Swell. Oolitic intervals imply the former presence of shoals or ramps in this region. They characterise this transitional region (“Alemannische Fazies”) together with dolomites in the upper part of the sedimentary succession. The total thickness usually varies between 50 and 85 m. A general decrease in thickness towards southeast has been found. The newly named Schinznach Formation is defined as a mappable unit of the upper part of the Muschelkalk Group. It is precisely introduced for those sedimentary rocks formerly named Upper Muschelkalk and Lower Keuper in northern Switzerland between the Doubs River and the Lake Biel in the west and the Lake Constance in the east. Within this formation the informal lithostratigraphic subdivisions currently in use should be replaced by new terms in accordance with the rules of lithostratigraphic nomenclature. In the scheme presented here the Schinznach Formation comprises 5 members and 5 beds.

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Radon as a tracer of atmospheric influences on traffic-related air pollution in a small inland city

One year of radon, benzene and carbon monoxide (CO) concentrations were analysed to characterise the combined influences of variations in traffic density and meteorological conditions on urban air quality in Bern, Switzerland. A recently developed radon-based stability categorisation technique was adapted to account for seasonal changes in day length and reduction in the local radon flux due to snow/ice cover and high soil moisture. Diurnal pollutant cycles were shown to result from an interplay between variations in surface emissions (traffic density), the depth of the nocturnal atmospheric mixing layer (dilution) and local horizontal advection of cleaner air from outside the central urban/industrial area of this small compact inland city. Substantial seasonal differences in the timing and duration of peak pollutant concentrations in the diurnal cycle were attributable to changes in day length and the switching to/from daylight-savings time in relation to traffic patterns. In summer, average peak benzene concentrations (0.62 ppb) occurred in the morning and remained above 0.5 ppb for 2 hours, whereas in winter average peak concentrations (0.85 ppb) occurred in the evening and remained above 0.5 ppb for 9 hours. Under stable conditions in winter, average peak benzene concentrations (1.1 ppb) were 120% higher than for well-mixed conditions (0.5 ppb). By comparison, summertime peak benzene concentrations increased by 53% from well-mixed (0.45 ppb) to stable nocturnal conditions (0.7 ppb). An idealised box model incorporating a simple advection term was used to derive a nocturnal mixing length scale based on radon, and then inverted to simulate diurnal benzene and CO emission variations at the city centre. This method effectively removes the influences of local horizontal advection and stability-related vertical dilution from the emissions signal, enabling a direct comparison with hourly traffic density. With the advection term calibrated appropriately, excellent results were obtained, with high regression coefficients in spring and summer for both benzene (r2 ~0.90–0.96) and CO (r2 ~0.88–0.98) in the two highest stability categories. Weaker regressions in winter likely indicate additional contributions from combustion sources unrelated to vehicular emissions. Average vehicular emissions during daylight hours were estimated to be around 0.503 (542) kg km−2 h−1 for benzene (CO) in the Bern city centre.

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Zoophycos in deep-sea sediments indicates high and seasonal primary productivity: Ichnology as a proxy in palaeoceanography during glacial-interglacial variations

Trace fossils provide valuable palaeoenvironmental information in hemipelagic settings. This is particularly true in the case of Zoophycos, an easily recognizable trace fossil in core. At IODP site U1385, Zoophycos was found throughout an interval representing 1.5 Ma, covering 45 glacial–interglacial cycles mediated by obliquity (41 ka) and short-term eccentricity (100 ka). Zoophycos is most common in sediments deposited during glacial times and when the sedimentation rate was intermediate and primary production was high and seasonal. Occurrences of Zoophycos elsewhere support a similar relationship with seasonal organic-matter deposition. This is particularly significant considering that seasonality of organic-matter deposition is difficult to decipher from the sediment record. Zoophycos appears to represent a useful proxy to characterize high and seasonal organic-matter deposition and primary productivity in Neogene hemipelagic deposits.

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Potential of combining morphometry and ancient DNA information to investigate grapevine domestication

The goal of this work was to explore the possibility (1) of carrying out both morphogeometric and archaeological DNA analyses on the same grape pips and (2) of comparing different molecular markers to reveal DNA variation, namely Simple Sequence Repeats (SSRs) and Single Nucleotide Polymorphisms (SNPs). We focused on waterlogged seeds originating from three Roman and one medieval archaeological sites in France. Our first results indicate that taking photographs of pips is not detrimental to the preservation of DNA, provided a specific protocol is respected. Regarding the genetic markers, obtaining reliable information in sufficient quantity proved very difficult using SSRs. SNPs have a much more interesting potential, providing greater success rates and reliability. Here in four archaeological pips we studied 842 SNPs, derived from known polymorphisms in several genes, including one gene related to sex. Phylogenies built using these genetic markers indicate that three pips from the Roman site of Gasquinoy are close to modern wild grapevines and/or the female group, while the only medieval pip from Colletière is hermaphrodite and close to the modern cultivated group. Morphogeometrical results are in agreement with these findings. We conclude that the combined use of SNP markers and morphogeometry is promising for deciphering the intricate history of grapevine domestication.

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When do psychotherapeutic placebos work? A critical review on the example of systematic desensitization

Hintergrund: Die Voraussetzungen der randomisierten, Placebo-kontrollierten Evaluation - die Ununterscheidbarkeit der Therapiebedingungen für die Patienten und die Verblindung der Therapeuten - sind in der Psychotherapieforschung nicht uneingeschränkt gegeben. Das Ziel dieser qualitativen systematischen Übersichtsarbeit ist es, am Beispiel der systematischen Desensibilisierung (SD) die Vorgehensweisen zur Bestimmung der Behandlungsspezifität zu beschreiben und deren theoretische und praktische Implikationen zu diskutieren. Methodik: Auf der Basis einer systematischen Literaturrecherche in PsycINFO und PubMed für den Zeitraum von 1976-2015 wurden Psychotherapiestudien gesucht, in denen Patienten mit Angstsymptomen einer SD- oder Placebo-Gruppe zugewiesen und verglichen wurden. Nach Extraktion der gewählten Moderator-Variablen konnten 11 Studien eingeschlossen werden. Ergebnisse: Die Ergebnisse zu den spezifischen Effekten der SD waren nicht einheitlich. Eine durchgeführte Moderator-Analyse zeigte, dass der Nachweis spezifischer Effekte von der Glaubwürdigkeit des Placebos und dem dabei erlebten Ausmaß emotionaler Erfahrungen abhängig ist. Schlussfolgerung: Ob ein bestimmtes psychotherapeutisches Verfahren als spezifisch einzustufen ist, hängt von der Operationalisierung der Placebo-Kontrolle ab. Insbesondere bei SD scheint die Einschränkung des zu bearbeitenden Themas und in der Folge die Unterbindung der emotionalen Erfahrung des Patienten innerhalb der Kontrollbedingung eine Voraussetzung dafür zu sein, spezifische Effekte der SD zu finden.

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Greenhouse gas emissions from waste stabilisation ponds in Western Australia and Quebec (Canada)

Waste stabilisation ponds (WSPs) are highly enriched environments that may emit large quantities of greenhouse gases (GHG), including CO2, CH4 and N2O. However, few studies provide detailed reports on these emissions. In the present study, we investigated GHG emissions from WSPs in Western Australia and Quebec, Canada, and compared emissions to WSPs from other climatic regions and to other types of aquatic ecosystems. Surface water GHG concentrations were related to phytoplankton biomass and nutrients. The CO2 was either emitted or absorbed by WSPs, largely as a function of phytoplankton dynamics and strong stratification in these shallow systems, whereas efflux of CH4 and N2O to the atmosphere was always observed albeit with highly variable emission rates, dependent on treatment phase and time of the day. The total global warming potential index (GWP index, calculated as CO2 equivalent) of emitted GHG from WSPs in Western Australia averaged 12.8 mmol m(-2) d(-1) (median), with CO2, CH4 and N2O respectively contributing 0%, 96.7% and 3.3% of the total emissions, while in Quebec WSPs this index was 194 mmol m(-2) d(-1), with a relative contribution of 93.8, 3.0 and 3.2% respectively. The CO2 fluxes from WSPs were of the same order of magnitude as those reported in hydroelectric reservoirs and constructed wetlands in tropical climates, whereas CH4 fluxes were considerably higher compared to other aquatic ecosystems. N2O fluxes were in the same range of values reported for WSPs in subtropical climate.

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Validierung einer deutschen Version des Ruminative Thought Style Questionnaire (RTS-D)

Theoretischer Hintergrund: Der Ruminative Thought Style Questionnaire (RTS) wurde entwickelt, um einen ruminativen Denkstil unabhängig von Inhalt, zeitlicher Orientierung und Valenz der Gedanken zu erfassen. Fragestellung: Überprüfung von Reliabilität und Validität einer deutschen Übersetzung des Fragebogens (RTS-D). Methode: Psychometrische Kennwerte und Faktorenstruktur der deutschsprachigen Version wurden an einer nicht-klinischen (N = 203) und einer klinischen Stichprobe (N = 201) überprüft. Ergebnisse: Die einfaktorielle Struktur der Originalversion konnte für die deutsche Übersetzung nicht bestätigt werden. Hingegen schnitt ein von Tanner, Voon, Hasking und Martin (2013) vorgeschlagenes vierfaktorielles Modell mit 15 Items zufriedenstellend ab. Die 15-Item-Version beinhaltet neben dem übergeordneten Faktor Ruminativer Denkstil die vier Subskalen Repetitives Denken, Kontrafaktisches/Hypothetisches Denken, Problemfokussiertes Denken und Antizipatorisches Denken. Die Befunde zu Reliabilität und Validität der gekürzten Fragebogenfassung erwiesen sich als zufriedenstellend bis gut. Schlussfolgerungen: Der RTS-D bildet Rumination als mehrdimensionales Konstrukt mit verschiedenen Facetten von grüblerischem Denken ab und kann sowohl im nicht-klinischen Setting als auch störungsübergreifend im klinischen Bereich eingesetzt werden. Weiterführende Untersuchungen insbesondere zur faktoriellen Struktur des Fragebogens werden jedoch empfohlen.

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Rezension. Psychopharmaka für Kinder: Manfred Gerlach, Claudia Mehler-Wex, Susanne Walitza, Andreas Warnke und Christoph Wewetzer (2016). Neuro-/Psychopharmaka im Kindes- und Jugendalter. Grundlagen Therapie (3. Auflage). Berlin/Heidelberg: Springer-Verlag, 635 S. ISBN 978-3-662-48623-8



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Predicting response to immunotherapy

Prof Ottensmeier speaks with ecancer at the ACP immunotherapy workshop about matching patients to treatments with predictive models of their likely response. He describes assessments of changing cellular expression and broader microbiota to establish how...

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Endocrine Health Problems Detected in 764 Patients Evaluated in a Late Effects Clinic

Background: Many pediatric cancer survivors have endocrine conditions. After treatment with alkylating agents, steroids, methotrexate, and radiation, several endocrine dysfunctions may appear. Surveillance for late effects is recommended by guidelines worldwide. Objective: The objective of this study was to describe the endocrine outcomes of 764 patients followed during a 20 years’ period in our out-patient clinic. Design: We retrospectively reviewed the medical records. Patients: The study included 764 patients whose oncological or hematological dangerous diseases appeared before they were 18 years old. Larger groups were constituted by leukemias, central nervous tumors, and lymphomas. Outcome Measures: The frequency and types of endocrine conditions were analyzed. Results: 1,091 endocrine conditions were observed in all groups. The most common types of endocrine conditions were problems with growth and the thyroid. We found puberty abnormalities and bone problems in third and fourth places of frequency. ACTH insufficiency was found in seventh place. Conclusion: Endocrine dysfunctions are very common in survivor populations. Endocrinologists should be aware of international guidelines and make an effort to optimize screening and treatment of endocrine effects of cancer therapy. The crucial period is the puberty with growth spurt failure and accelerated maturity both of which can bring future social and professional difficulties.
Case Rep Oncol 2017;10:954–959

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Pazopanib and Statin-Induced Rhabdomyolysis

Background: The VEGF inhibitor pazopanib is a widely used first-line therapy for the treatment of advanced renal cell carcinoma. Potential drug-drug interactions and toxicities may be underrecognized. Case Presentation: A 73-year-old woman with metastatic renal cell carcinoma on treatment with pazopanib presented with progressive inability to ambulate. The initial concern was for metastasis to the spine. However, MRI of the spine revealed diffuse muscle edema with no metastatic deposits or lytic lesions. Upon further evaluation, creatine kinase was significantly elevated and the diagnosis of rhabdomyolysis was made. With aggressive hydration and discontinuation of both pazopanib and rosuvastatin, the patient made a full recovery. Conclusion: This case of drug-induced rhabdomyolysis demonstrates an unexpected toxicity resulting from concomitant pazopanib and rosuvastatin therapy. This combination is predicted to be safe due to different, nonoverlapping effects on the cytochrome p450 enzymes. Discontinuation of statin therapy in patients with metastatic cancer should be considered when the risk of cancer-related death exceeds the risk of cardiovascular-related death.
Case Rep Oncol 2017;10:954–957

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Genes, Vol. 8, Pages 300: Functional Analysis of Two Flavanone-3-Hydroxylase Genes from Camellia sinensis: A Critical Role in Flavonoid Accumulation

Genes, Vol. 8, Pages 300: Functional Analysis of Two Flavanone-3-Hydroxylase Genes from Camellia sinensis: A Critical Role in Flavonoid Accumulation

Genes doi: 10.3390/genes8110300

Authors: Yahui Han Keyi Huang Yajun Liu Tianming Jiao Guoliang Ma Yumei Qian Peiqiang Wang Xinlong Dai Liping Gao Tao Xia

Flavonoids are major secondary metabolites in Camellia sinensis. Flavanone-3-hydroxylase (F3H) is a key enzyme in flavonoid biosynthesis in plants. However, its role in the flavonoid metabolism in C. sinensis has not been well studied. In this study, we cloned two F3Hs from C. sinensis, named CsF3Ha and CsF3Hb, where CsF3Ha containing 1107 bases encoded 368 amino acids, and CsF3Hb containing 1071 bases encoded 357 amino acids. Enzymatic activity analysis showed both recombinant CsF3H enzymes in Escherichia coli could convert naringenin and eriodictyol into dihydrokaempferol (DHK) and dihydroquercetin (DHQ), respectively. The expression profiles showed that CsF3Ha and CsF3Hb were highly expressed in the tender leaves of tea plants. Under different abiotic stresses, the two CsF3Hs were induced remarkably by ultraviolet (UV) radiation, sucrose, and abscisic acid (ABA). In the seeds of CsF3Hs transgenic Arabidopsis thaliana, the concentration of most flavonol glycosides and oligomeric proanthocyanidins increased significantly, while the content of monocatechin derivatives decreased. The present study revealed that CsF3Hs played critical roles in flavonoid biosynthesis in tea plants.



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How social and non-social information influence classification decisions: A computational modelling approach

Social information such as observing others can improve performance in decision making. In particular, social information has been shown to be useful when finding the best solution on one's own is difficult, costly, or dangerous. However, past research suggests that when making decisions people do not always consider other people's behaviour when it is at odds with their own experiences. Furthermore, the cognitive processes guiding the integration of social information with individual experiences are still under debate. Here, we conducted two experiments to test whether information about other persons' behaviour influenced people's decisions in a classification task. Furthermore, we examined how social information is integrated with individual learning experiences by testing different computational models. Our results show that social information had a small but reliable influence on people's classifications. The best computational model suggests that in categorization people first make up their own mind based on the non-social information, which is then updated by the social information.

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Social Influences in Sequential Decision Making

People often make decisions in a social environment. The present work examines social influence on people’s decisions in a sequential decision-making situation. In the first experimental study, we implemented an information cascade paradigm, illustrating that people infer information from decisions of others and use this information to make their own decisions. We followed a cognitive modeling approach to elicit the weight people give to social as compared to private individual information. The proposed social influence model shows that participants overweight their own private information relative to social information, contrary to the normative Bayesian account. In our second study, we embedded the abstract decision problem of Study 1 in a medical decision-making problem. We examined whether in a medical situation people also take others’ authority into account in addition to the information that their decisions convey. The social influence model illustrates that people weight social information differentially according to the authority of other decision makers. The influence of authority was strongest when an authority's decision contrasted with private information. Both studies illustrate how the social environment provides sources of information that people integrate differently for their decisions.

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Plnění ambiciózních cílů po kapkách: evaluace dopadů environmentálních investic na kvalitu vod

Water pollution not only affects leisure activities, but also the cost of production of drinking water quality and the overall quality of aquatic ecosystems. The Czech Republic has pledged to meet European policy on treatment of wastewater from settlements and ensure a certain quality of all water bodies in the next decade (see Water Framework Directive no. 2000/60 / EC). Therefore, the Operational Programme Environment devotes its first priority axis to improving water infrastructure, particularly the construction and reconstruction of wastewater treatment plants and sewerage systems. The research presented here focuses on whether there has been real improvement in water quality due to investments in the construction of wastewater treatment plants. The analysis is performed on data from the monitoring system of the Operational Programme Environment 2007–2013 and data on phosphorus pollution and phosphorus phosphate measured by the Vltava River, Inc. for the years 2007–2014. Statistical tests estimate the impact of environmental investments confirms that spending on construction, renovation and expansion of sewage treatment plants in the Vltava River basin have a positive effect on water quality.

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Counterfactual Impact Evaluation on EU Cohesion Policy Interventions in Training in Companies

An evaluation culture in the EU Cohesion Policy is developing. It applies a more rigorous approach than few years ago. Although the European Commission is introducing a requirement for impact evaluations, such evaluations are still rare. An employment is one of the core objectives of EU policies. Application of the counterfactual impact evaluation on the EU Cohesion Policy enables the inquiry into how one of the most important EU policies operates. The analysis comprises a sample of 373 supported and 202 rejected applicants. The appraisal experts´ approach to applications is used as an instrumental variable to estimate the impacts of the assistance from the European Social Fund in Czech companies through interventions aimed at training of employees. The results indicate positive effects of the European Social Fund’s assistance in companies even one year after the support ended. The estimates vary between 3 838 and 5 513 created or saved jobs.

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Better to know than to imagine: Including children in their health care

BACKGROUND: This article describes the overall attitudes of children, their parents, and attending physicians toward including or excluding pediatric patients in medical communication and health care decision-making processes. METHODS: Fifty-two interviews were carried out with pediatric patients (n = 17), their parents (n = 19), and attending oncologists (n = 16) in eight Swiss pediatric oncology centers. The interviews were analyzed using thematic coding. RESULTS: Parenting styles, the child's personality, and maturity are factors that have a great impact upon the inclusion of children in their health care processes. Children reported the desire to be heard and involved, but they did not want to dominate the decision-making process. Ensuring trust in the parent-child and physician-patient relationships and respecting the child as the affected person were important values determining children's involvement. These two considerations were closely connected with the concern that fantasies are often worse than reality. Seeking children's compliance with treatment was a practical but critical reason for informing them about their health care. The urge to protect them from upsetting news sometimes resulted in their (partial) exclusion. CONCLUSIONS: The ethical imperative for inclusion of children in their health care choices was not so much determined by the right for self-determination, but by the need to include them. If children are excluded, they imagine things, become more isolated, and are left alone with their fears. Nevertheless, the urge to protect children is innate, as adults often underestimate children's coping capacities.

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Cancer care in Romania: challenges and pitfalls of children’s and adolescents’ multifaceted involvement

Communication about diagnosis and medical treatment for children suffering from life-threatening illnesses is complex. It is a primary step in involving underage patients and families in care and lays the foundation for obtaining parental permission and patient assent for treatment. In practice child participation in care is often difficult to obtain due to patients' different and sometimes fluctuating preferences, but also parents' protective strategies. Physicians may be susceptible to parental wishes to limit information and feel uncomfortable discussing issues related to uncertainty of cure with patients. A qualitative study in Romanian paediatric oncology units was conducted to explore children's involvement from the perspectives of parents and oncologists. Interviews with participants discussed 18 patient cases. Data were transcribed and thematic analysis was used to interpret and mine patients' involvement during treatment. Different facets of patient participation were identified: restricting, widening and enhancing involvement. A fourth category, unintentional involvement, occurred for all patients due to children's observations during long-term hospitalisations and access to Internet. Uncertainty overarched parental attitudes regarding the extent to which children should be included. Physicians usually complied with parental wishes to limit involvement, but together with parents involved patients at least in a practical way. Adults' protective attitude may backfire, as adolescents' online searches often expose patients to worse-case scenarios. Further research should acknowledge the hazards of restricted diagnosis disclosure and develop clinician tools to support families in communicating with patients. This should be paralleled by physician efforts to elicit patients' needs regarding participation.

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Decision making in pediatric oncology: Views of parents and physicians in two European countries

Background: Decision making is a highly complex task when providing care for seriously ill children. Physicians, parents, and children face many challenges when identifying and selecting from available treatment options. Methods: This qualitative interview study explored decision-making processes for children with cancer at different stages in their treatment in Switzerland and Romania. Results: Thematic analysis of interviews conducted with parents and oncologists identified decision making as a heterogeneous process in both countries. Various decisions were made based on availability and reasonableness of care options. In most cases, at the time of diagnosis, parents were confronted with a “choiceless choice”—that is, there was only one viable option (a standard protocol), and physicians took the lead in making decisions significant for health outcomes. Parents' and sometimes children's role increased during treatment when they had to make decisions regarding research participation and aggressive therapy or palliative care. Framing these results within the previously described Decisional Priority in Pediatric Oncology Model (DPM) highlights family's more prominent position when making elective decisions regarding quality-of-life or medical procedures, which had little effect on health outcomes. The interdependency between oncologists, parents, and children is always present. Communication, sharing of information, and engaging in discussions about preferences, values, and ultimately care goals should be decision making's foundation. Conclusions: Patient participation in these processes was reported as sometimes limited, but parents and oncologists should continue to probe patients' abilities and desire to be involved in decision making. Future research should expand the DPM and explore how decisional priority and authority can be shared by oncologists with parents and even patients.

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