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Σάββατο, 4 Νοεμβρίου 2017

Utility of Shoulder Imaging in the Outpatient Setting: A Pilot Study

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Publication date: Available online 4 November 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Elisabeth R. Garwood, Gregory S Mittl, Michael J. Alaia, James Babb, Soterios Gyftopoulos




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Risk Factors for Late Screening Mammography

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Publication date: Available online 3 November 2017
Source:Current Problems in Diagnostic Radiology
Author(s): John Davis, Juliana Liang, Matthew B. Petterson, Albert T. Roh, Navya Chundu, Paul Kang, Samantha L. Matz, Mary J. Connell, Daniel G. Gridley
BackgroundBreast cancer has the highest incidence of cancers in women in the United States. Previous research has shown that screening mammography contributes to reduced breast cancer mortality. This study aimed to clarify why late screening might occur in an at-risk population.Materials and MethodsThis study was a prospective cross-sectional study including 758 patients presenting to our radiology department for routine screening mammography who completed a 30-question survey regarding personal characteristics and mammography history. Univariate and multivariate logistic regression were performed to determine whether survey responses correlated with late screening.ResultsOf the 758 patients, 184 (24%) were noncompliant with screening mammography guidelines. Risk factors for late screening included younger age (p = 0.001), white race/ethnicity (p = 0.03), self-reported lack of financial means or health insurance (p = 0.005), lack of satisfaction with a previous mammogram experience (p = 0.001), inadequate mammography education by a physician (p = 0.001), and lack of awareness/comprehension of screening mammography guidelines (p = 0.002).ConclusionMany factors contribute to late screening mammography. Although some are outside physician control, others can be influenced: patient education regarding screening mammography guidelines, and patient satisfaction with the mammography experience. This study highlights the importance of communication with and education of patients.



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Sensitivity of a prompt-gamma slit-camera to detect range shifts for proton treatment verification

A prompt-gamma imaging (PGI) slit-camera was recently applied successfully in clinical proton treatments using pencil beam scanning (PBS) and double scattering (DS). However, its full capability under clinical conditions has still to be systematically evaluated. Here, the performance of the slit-camera is systematically assessed in well-defined error scenarios using realistic treatment deliveries to an anthropomorphic head phantom.

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Distribution and migration of 239+240Pu in abiotic components of the Black Sea ecosystems during the post-Chernobyl period

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Publication date: Available online 3 November 2017
Source:Journal of Environmental Radioactivity
Author(s): N.N. Tereshchenko, S.B. Gulin, V. Yu Proskurnin
Distribution of 239,240Pu in abiotic components (water and bottom sediment) of the Black Sea ecosystems was studied during the post-Chernobyl period at different offshore and near-shore locations. The trends of these radionuclides accumulation by sediments were analyzed. The spatial-temporal changes in the 239,240Pu distribution as well as effective half-life for these radionuclides in the Black Sea surface water in deep-sea area are presented. The estimations of the average annual removal fluxes of the 239,240Pu into the bottom sediments were obtained. The Black Sea sediments were characterized by a higher 239,240Pu concentration factor (Cf ≈ n·104–n·106) and radiocapacity factor (F(239,240Pu) was about 99.9% on the shelf, 94.5–99.1% on deep-sea basin for silty and 94.6–98.9% on the shelf for sandy bottom sediments) as compared with Cf and F for 137Cs and 90Sr. Silty bottom sediments play the role of 239,240Pu main depot in the Black Sea ecosystem. The studied radioecological characteristics of Pu allowed us to define the type of plutonium biogeochemical behavior in the Black Sea as a pedotropic one. The results of this complex radioecological monitoring of 239+240Pu contamination in the Black Sea and their analysis makes it possible to understand the plutonium redistribution pathways which will enable to carry out the tracing of its migration within the ecosystems.



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Increased signal intensity within glioblastoma resection cavities on fluid-attenuated inversion recovery imaging to detect early progressive disease in patients receiving radiotherapy with concomitant temozolomide therapy

Abstract

Purpose

Our study tested the diagnostic accuracy of increased signal intensity (SI) within FLAIR MR images of resection cavities in differentiating early progressive disease (ePD) from pseudoprogression (PsP) in patients with glioblastoma treated with radiotherapy with concomitant temozolomide therapy.

Methods

In this retrospective study approved by our Institutional Review Board, we evaluated the records of 122 consecutive patients with partially or totally resected glioblastoma. Region of interest (ROI) analysis assessed 33 MR examinations from 11 subjects with histologically confirmed ePD and 37 MR examinations from 14 subjects with PsP (5 histologically confirmed, 9 clinically diagnosed). After applying an N4 bias correction algorithm to remove B0 field distortion and to standardize image intensities and then normalizing the intensities based on an ROI of uninvolved white matter from the contralateral hemisphere, the mean intensities of the ROI from within the resection cavities were calculated. Measures of diagnostic performance were calculated from the receiver operating characteristic (ROC) curve using the threshold intensity that maximized differentiation. Subgroup analysis explored differences between the patients with biopsy-confirmed disease.

Results

At an optimal threshold intensity of 2.9, the area under the ROC curve (AUROC) for FLAIR to differentiate ePD from PsP was 0.79 (95% confidence interval 0.686–0.873) with a sensitivity of 0.818 and specificity of 0.694. The AUROC increased to 0.86 when only the patients with biopsy-confirmed PsP were considered.

Conclusions

Increased SI within the resection cavity of FLAIR images is not a highly specific sign of ePD in glioblastoma patients treated with the Stupp protocol.



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Increased signal intensity within glioblastoma resection cavities on fluid-attenuated inversion recovery imaging to detect early progressive disease in patients receiving radiotherapy with concomitant temozolomide therapy

Abstract

Purpose

Our study tested the diagnostic accuracy of increased signal intensity (SI) within FLAIR MR images of resection cavities in differentiating early progressive disease (ePD) from pseudoprogression (PsP) in patients with glioblastoma treated with radiotherapy with concomitant temozolomide therapy.

Methods

In this retrospective study approved by our Institutional Review Board, we evaluated the records of 122 consecutive patients with partially or totally resected glioblastoma. Region of interest (ROI) analysis assessed 33 MR examinations from 11 subjects with histologically confirmed ePD and 37 MR examinations from 14 subjects with PsP (5 histologically confirmed, 9 clinically diagnosed). After applying an N4 bias correction algorithm to remove B0 field distortion and to standardize image intensities and then normalizing the intensities based on an ROI of uninvolved white matter from the contralateral hemisphere, the mean intensities of the ROI from within the resection cavities were calculated. Measures of diagnostic performance were calculated from the receiver operating characteristic (ROC) curve using the threshold intensity that maximized differentiation. Subgroup analysis explored differences between the patients with biopsy-confirmed disease.

Results

At an optimal threshold intensity of 2.9, the area under the ROC curve (AUROC) for FLAIR to differentiate ePD from PsP was 0.79 (95% confidence interval 0.686–0.873) with a sensitivity of 0.818 and specificity of 0.694. The AUROC increased to 0.86 when only the patients with biopsy-confirmed PsP were considered.

Conclusions

Increased SI within the resection cavity of FLAIR images is not a highly specific sign of ePD in glioblastoma patients treated with the Stupp protocol.



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Imatinib response of gastrointestinal stromal tumor patients with germline mutation on KIT exon 13: A family report.

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Imatinib response of gastrointestinal stromal tumor patients with germline mutation on KIT exon 13: A family report.

World J Radiol. 2017 Sep 28;9(9):365-370

Authors: Engin G, Eraslan S, Kayserili H, Kapran Y, Akman H, Akyuz A, Aykan NF

Abstract
Familial gastrointestinal stromal tumor (GIST) is a rare autosomal dominant disorder associated with mutations in the KIT gene in the majority of cases. Although, exon 11 appears to be the hot spot region for approximately 95% of germline mutations, pathogenic variations have also been identified in exon 8, 13 and 17. Exon 13 germline mutations are extremely rare amongst familial GISTs and seven families with a germline mutation have been reported to date. Moreover, the role of imatinib mesylate in this rare familiar settings is not completely known so far. We describe here clinical, imaging, pathological and genetic findings of a family with four affected members; grandmother, his son and two grand-sons having a germline gain-of-function mutation of KIT in exon 13 and discuss the imatinib mesylate treatment surveillance outcomes towards disease management.

PMID: 29098070 [PubMed]



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Reliability of the pronator quadratus fat pad sign to predict the severity of distal radius fractures.

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Reliability of the pronator quadratus fat pad sign to predict the severity of distal radius fractures.

World J Radiol. 2017 Sep 28;9(9):359-364

Authors: Loesaus J, Wobbe I, Stahlberg E, Barkhausen J, Goltz JP

Abstract
AIM: To evaluate the reliability of pronator quadratus fat pad sign to detect distal radius fracture and to predict its severity.
METHODS: Retrospectively we identified 89 consecutive patients (41 female, mean age 49 ± 18 years) who had X-ray (CR) and computed tomography (CT) within 24 h following distal forearm trauma. Thickness of pronator quadratus fat pad complex (PQC) was measured using lateral views (CR) and sagittal reconstructions (CT). Pearson's test was used to determine the correlation of the PQC thickness in CR and CT. A positive pronator quadratus sign (PQS) was defined as a PQC > 8.0 mm (female) or > 9.0 mm (male). Frykman classification was utilized to assess the severity of fractures.
RESULTS: Forty-four/89 patients (49%) had a distal radius fracture (Frykman I n = 3, II n = 0, III n = 10, IV n = 5, V n = 2, VI n = 2, VII n = 9, VIII n = 13). Mean thickness of the PQC thickness can reliably be measured on X-ray views and was 7.5 ± 2.8 mm in lateral views (CR), respectively 9.4 ± 3.0 mm in sagittal reconstructions (CT), resulting in a significant correlation coefficient of 0.795. A positive PQS at CR was present in 21/44 patients (48%) with distal radius fracture and in 2/45 patients (4%) without distal radius fracture, resulting in a specificity of 96% and a sensitivity of 48% for the detection of distal radius fractures. There was no correlation between thickness of the PQC and severity of distal radius fractures.
CONCLUSION: A positive PQS shows high specificity but low sensitivity for detection of distal radius fractures. The PQC thickness cannot predict the severity of distal radius fractures.

PMID: 29098069 [PubMed]



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Clinical significance of prostate (18)F-labelled fluorodeoxyglucose uptake on positron emission tomography/computed tomography: A five-year review.

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Clinical significance of prostate (18)F-labelled fluorodeoxyglucose uptake on positron emission tomography/computed tomography: A five-year review.

World J Radiol. 2017 Sep 28;9(9):350-358

Authors: Chetan MR, Barrett T, Gallagher FA

Abstract
AIM: To determine the significance and need for investigation of incidental prostatic uptake in men undergoing (18)F-labelled fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) for other indications.
METHODS: Hospital databases were searched over a 5-year period for patients undergoing both PET/CT and prostate magnetic resonance imaging (MRI). For the initial analysis, the prostate was divided into six sectors and suspicious or malignant sectors were identified using MRI and histopathology reports respectively. Maximum and mean (18)F-FDG standardised uptake values were measured in each sector by an investigator blinded to the MRI and histopathology findings. Two age-matched controls were selected per case. Results were analysed using a paired t-test and one-way ANOVA. For the second analysis, PET/CT reports were searched for prostatic uptake reported incidentally and these patients were followed up.
RESULTS: Over a 5-year period, 15 patients underwent both PET/CT and MRI and had biopsy-proven prostate cancer. Malignant prostatic sectors had a trend to higher (18)F-FDG uptake than benign sectors, however this was neither clinically nor statistically significant (3.13 ± 0.58 vs 2.86 ± 0.68, P > 0.05). (18)F-FDG uptake showed no correlation with the presence or histopathological grade of tumour. (18)F-FDG uptake in cases with prostate cancer was comparable to that from age-matched controls. Forty-six (1.6%) of 2846 PET/CTs over a 5-year period reported incidental prostatic uptake. Of these, 18 (0.6%) were investigated by PSA, 9 (0.3%) were referred to urology, with 3 (0.1%) undergoing MRI and/or biopsy. No cases of prostate cancer were diagnosed in patients with incidental (18)F-FDG uptake in our institute over a 5-year period.
CONCLUSION: (18)F-FDG uptake overlaps significantly between malignant and benign prostatic conditions. Subsequent patient management was not affected by the reporting of incidental focal prostatic uptake in this cohort.

PMID: 29098068 [PubMed]



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Radiographic and magnetic resonances contrast agents: Essentials and tips for safe practices.

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Radiographic and magnetic resonances contrast agents: Essentials and tips for safe practices.

World J Radiol. 2017 Sep 28;9(9):339-349

Authors: Nouh MR, El-Shazly MA

Abstract
With extended and continued expansion of medical imaging utilization in modern medical practice over last decade, radiologists as well as other faculty staff dealing with radiographic and magnetic resonances contrast media (CM) have to be well oriented with their potential hypersensitivity reactions and recognize high-risk groups liable to develop it and enable early recognition. Radiologists and other medical staff involved in administration and dealing with CM have to be ready to implement prompt, practical and effective management plan to deal with these scenarios should they emerge. Strategies to prevent potential contrast-induced acute and delayed renal injuries have to be routinely exercised. Paying attention to the pregnant and nursing women, pediatrics, diabetics, as well as other fragile populations is of utmost importance for patient safety during contrast administrations. Radiologists should play a pivotal role in orienting patients about necessity to use CM for their imaging studies, in case it is needed, and assure them about its safety. Moreover, they have to be oriented with the medico-legal issues related to use of CM. These will pay as improved patient safety as well as safe daily working environmentat different levels of radiology practices.

PMID: 29098067 [PubMed]



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Dual-energy CT in colorectal cancers: beyond the density measurements.

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Dual-energy CT in colorectal cancers: beyond the density measurements.

Diagn Interv Radiol. 2017 Nov-Dec;23(6):479-480

Authors: Srinivasan S

PMID: 29097351 [PubMed - in process]



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T1 mapping and magnetic resonance elastography: potential new techniques for quantification of parenchymal changes in hepatic amyloidosis.

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T1 mapping and magnetic resonance elastography: potential new techniques for quantification of parenchymal changes in hepatic amyloidosis.

Diagn Interv Radiol. 2017 Nov-Dec;23(6):478

Authors: Peker E, Erden A

PMID: 29097350 [PubMed - in process]



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Spectrum of imaging findings of chronic granulomatous disease: a single center experience.

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Spectrum of imaging findings of chronic granulomatous disease: a single center experience.

Diagn Interv Radiol. 2017 Nov-Dec;23(6):472-477

Authors: Lee M, Lee MS, Lee JS, Ko SY, Jeong SY

Abstract
The purpose of this pictorial essay is to present and summarize findings of various images of chronic granulomatous disease (CGD). CGD represents a heterogeneous group of disorders caused by defective generation of respiratory bursts in human phagocytes. This defect results in abnormal phagocytic functions and defective killing of bacteria by phagocytes. CGD may involve many organs and present with recurrent infections and inflammations. Radiologists should consider the possibility of CGD when a patient presents with atypical and recurrent infection. They must also consider other concurrent infections a patient may have.

PMID: 29097349 [PubMed - in process]



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Percutaneous transhepatic techniques for retrieving fractured and intrahepatically dislodged percutaneous transhepatic biliary drainage catheters.

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Percutaneous transhepatic techniques for retrieving fractured and intrahepatically dislodged percutaneous transhepatic biliary drainage catheters.

Diagn Interv Radiol. 2017 Nov-Dec;23(6):461-464

Authors: Hsien-Tzu L, Hsiuo Shan T, Nai Chi C, Yi Yang L, Yi You C, Chien An L

Abstract
Dislodged intrabiliary drainage devices, including catheters, endoprostheses, and stents, may further impair drainage and cause various local reactions, vascular and gastrointestinal tract complications. Endoscopic approaches for management of plastic biliary endoprostheses have been extensively discussed. However, in rare cases of fracture of percutaneous transhepatic biliary drainage (PTBD) catheters, only a percutaneous transhepatic technique for retrieving should be applied to avoid further damage by its rigid fragment. We present the adjusted techniques using either a goose neck snare, over-the-wire balloon catheter, or biopsy forceps with image demonstration and reviews. We encountered two patients with PTBD tube fracture and intrahepatic dislodgment. In both patients, percutaneous approaches were used for successfully retrieving and removing the fractured catheter through transhepatic tract: one with the use of a biopsy forceps, another with an inflatable balloon catheter.

PMID: 29097348 [PubMed - in process]



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Dual-balloon infusion microcatheter for selective drug-eluting bead transarterial chemoembolization: initial feasibility study.

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Dual-balloon infusion microcatheter for selective drug-eluting bead transarterial chemoembolization: initial feasibility study.

Diagn Interv Radiol. 2017 Nov-Dec;23(6):454-460

Authors: Monsky WL, Padia SA, Hardy AH

Abstract
PURPOSE: We aimed to demonstrate feasibility of the use of a dual-balloon infusion microcatheter for segmental/subsegmental drug-eluting bead transarterial chemoembolization (DEB-TACE).
METHODS: Over a 16-month period, 15 segmental and 21 subsegmental DEB-TACE procedures were attempted using a dual-balloon anti-reflux microcatheter (IsoFlow™ microcatheter, Vascular Designs Inc.) in 21 patients (15 males; median age, 61 years; range, 49-82 years) with hepatocellular carcinoma (Barcelona clinic liver cancer stage A [n=4]; B [n=12]; C [n=5]) with one to three tumors, median size of 3.4 cm (1.2-9 cm). Follow-up enhanced computed tomography or magnetic resonance imaging was obtained at one month then subsequently every three months for one year. Technical success was evaluated. Modified RECIST criteria was used for target tumor response assessment. Safety was evaluated by assessing for arterial injury and hepatic injury at the time of the procedure and subsequent evidence of complications and liver toxicity.
RESULTS: In 26 of the procedures, the segmental/subsegmental arteries were thought not to be easily selected with standard microcatheters due to the arterial branches being severely tortuous/angulated or atretic from prior TACE or anti-angiogenic therapy or could not be catheterized. Radiologic response assessment of treated tumors demonstrated 32% complete response, 19% partial response, 34% stable disease, and 15% progressive disease. No complications occurred. The median time to progression for the targeted tumors was 7 months (range, 3-12 months).
CONCLUSION: DEB-TACE, using this dual-balloon anti-reflux infusion microcatheter is feasible and safe.

PMID: 29097347 [PubMed - in process]



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Preliminary experience with the use of ultra-low profile endografts.

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Preliminary experience with the use of ultra-low profile endografts.

Diagn Interv Radiol. 2017 Nov-Dec;23(6):448-453

Authors: Mazzaccaro D, Malacrida G, Amato B, Alessio Angileri S, Ierardi AM, Nano G

Abstract
PURPOSE: We aimed to report a preliminary single-center experience of elective endovascular aortic repair (EVAR) using ultra-low profile (ULP) endografts of 14 F outer diameter.
METHODS: Data of 67 consecutive patients who underwent EVAR using either Ovation (group A, n=30) or Incraft (group B, n=37) endografts were retrospectively analyzed.
RESULTS: Aorto-iliac anatomy was significantly different between the two groups, as patients of group A had a greater thrombotic apposition on proximal aortic neck (thrombus thickness: 7.2±1 mm vs. 3.3±1.6 mm, P = 0.042; percentage of the circumference covered by thrombus: 45.2%±10.4% vs. 18.7%±10.6%, P = 0.0003), while patients of group B had a more angulated proximal neck in the coronal axis (35.9°±6.4° vs. 16.7°±5°, P = 0.012). Procedural success was 93.3% and 97.3%, respectively, in groups A and B. One patient in group A required an immediate conversion to open surgery for persistent occlusion of both iliac limbs. Another patient required implantation of a conical endograft with a femoro-femoral right-to-left bypass for occlusion of the contralateral gate during the cannulation. In group B, one intraoperative type Ia endoleak was immediately corrected. Neither deaths nor major adverse events were recorded within 30-days. During a median follow-up of 15.2 months (range, 1-56.7 months) two type Ia endoleaks in group A required open conversion after 12.1 and 40.5 months, respectively. Three patients in group B required a reintervention after 30 days. Neither deaths nor aortic ruptures were recorded during follow-up.
CONCLUSION: Both ULP endografts showed satisfying early and mid-term results.

PMID: 29097346 [PubMed - in process]



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Tailoring protocols for chest CT applications: when and how?

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Tailoring protocols for chest CT applications: when and how?

Diagn Interv Radiol. 2017 Nov-Dec;23(6):420-427

Authors: Iezzi R, Larici AR, Franchi P, Marano R, Magarelli N, Posa A, Merlino B, Manfredi R, Colosimo C

Abstract
In the medical era of early detection of diseases and tailored therapies, an accurate characterization and staging of the disease is pivotal for treatment planning. The widespread use of computed tomography (CT)-often with the use of contrast material (CM)-probably represents the most important advance in diagnostic radiology. The result is a marked increase in radiation exposure of the population for medical purposes, with its intrinsic carcinogenic potential, and CM affecting kidney function. The radiologists should aim to minimize patient's risk by reducing radiation exposure and CM amount, while maintaining the highest image quality. To achieve this goal, it is necessary to perform "patient-centric imaging". The purpose of this review is to provide radiologists with "tips and tricks" to control radiation dose at CT, summarizing technical artifices in order to reduce image noise and increase image contrast. Also chest CT tailored protocols are supplied, with particular attention to three most common thoracic CT protocols: aortic/cardiac CT angiography (CTA), pulmonary CTA, and routine chest CT.

PMID: 29097345 [PubMed - in process]



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Background parenchymal enhancement: is it just an innocent effect of estrogen on the breast?

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Background parenchymal enhancement: is it just an innocent effect of estrogen on the breast?

Diagn Interv Radiol. 2017 Nov-Dec;23(6):414-419

Authors: Arslan G, Çelik L, Çubuk R, Çelik L, Atasoy MM

Abstract
PURPOSE: We aimed to retrospectively analyze whether background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) correlates with menarche, menopause, reproductive period, menstrual cycle, gravidity-parity, family history of breast cancer, and the Breast Imaging-Reporting and Data System (BI-RADS) category of the patient.
METHODS: The study included 126 pre- and 78 postmenopausal women who underwent breast MRI in our institute between 2011 and 2016. Patients had filled a questionnaire form before the MRI. Two radiologists blinded to patient history graded the BPEs and the results were compared and analyzed.
RESULTS: The BPE was correlated with patient age and the day of menstrual cycle (P < 0.01 for both). No correlation was found with menarche age, menopause age, total number of reproductive years, and family history of breast cancer. In the moderate BPE group, only 1 out of 35 patients and in the marked BPE group only 1 out of 13 patients were postmenopausal and had BI-RADS scores of 4 and 5, respectively.
CONCLUSION: Increased symmetrical BPE is mainly due to current hormonal status in the premenopausal women. High-grade BPE, whether symmetrical or not, is rarely seen in postmenopausal women; hence, these patients should be further investigated or closely followed up.

PMID: 29097344 [PubMed - in process]



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Whole-body total lesion glycolysis is an independent predictor in patients with esophageal cancer treated with definitive chemoradiotherapy

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Publication date: Available online 3 November 2017
Source:Radiotherapy and Oncology
Author(s): Noriyoshi Takahashi, Rei Umezawa, Kentaro Takanami, Takaya Yamamoto, Youjirou Ishikawa, Maiko Kozumi, Kazuya Takeda, Noriyuki Kadoya, Keiichi Jingu
Background and purposeTo determine whether pretreatment whole-body total lesion glycolysis (TLGWB) and metabolic tumor volume (MTVWB) are associated with outcomes in patients with esophageal cancer treated with definitive chemoradiotherapy (dCRT).Materials and methodsNinety patients with stage II or III thoracic esophageal cancer who underwent FDG-PET/CT within 45 days before dCRT between 2005 and 2013 were reviewed. MTV and TLG of the primary lesion (MTVpri and TLGpri) and the sum of MTV and TLG for all lesions (MTVWB and TLGWB) were calculated. Predictors were analyzed using the Cox proportional hazards model.ResultsThe median follow-up period was 27.7 months. In multivariate analysis, MTVWB > median was an unfavorable predictor for OS (p = 0.027, hazard ratio [HR]: 2.15), LC (p = 0.039, HR: 1.98) and PFS (p = 0.041, HR: 1.96). TLGWB > median was an unfavorable predictor for OS (p = 0.019, HR: 2.26), LC (p = 0.015, HR: 2.36) and PFS (p = 0.014, HR: 2.33). SUVmax was not a predictor, and the HR of TLGWB was higher than that of MTVWB for OS, LC and PFS in multivariate analysis.ConclusionTLGWB and MTVWB are independent predictors in patients with esophageal cancer.



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Impact of dose intensified salvage radiation therapy on urinary continence recovery after radical prostatectomy: Results of the randomized trial SAKK 09/10

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Publication date: Available online 3 November 2017
Source:Radiotherapy and Oncology
Author(s): Pirus Ghadjar, Stefanie Hayoz, Jürg Bernhard, Daniel R. Zwahlen, Jürgen Stein, Tobias Hölscher, Philipp Gut, Bülent Polat, Guido Hildebrandt, Arndt-Christian Müller, Paul Martin Putora, Alexandros Papachristofilou, Corinne Schär, Alan Dal Pra, Christine Biaggi Rudolf, Peter Wust, Daniel M. Aebersold, George N. Thalmann
IntroductionAdjuvant radiation therapy (aRT) after radical prostatectomy (RP) is associated with impaired urinary continence recovery as compared to surveillance. Less is known regarding the effect of salvage radiation therapy (sRT) dose intensification on continence outcomes.Materials and methodsUrinary continence recovery was investigated within a multicentre randomized trial in biochemically recurrent prostate cancer patients who received either 64 Gy (32 fractions) or 70 Gy (35 fractions) sRT. Incontinence was assessed using Common Toxicity Criteria for Adverse Events v4.0 at baseline, at the end of sRT and 3 months afterward. Quality of life (QoL) was assessed with the EORTC QoL questionnaires C30 and PR25 at baseline and 3 months after completion of sRT. A total of 344 patients were evaluable.ResultsAt baseline 233 (68%) of patients were fully continent and 14% in both arms became incontinent three months after treatment. Of the remaining 111 (32%) patients being incontinent at baseline, continence recovery was achieved 3 months after sRT by 44% vs. 41% with 64 vs. 70 Gy, respectively (p = 0.8). This analysis is limited by its short follow-up.ConclusionsDose intensification of sRT had no impact on early urinary continence recovery or prevalence of de novo incontinence.



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Does length of intubation before tracheostomy affect intensive care unit length of stay?

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Does length of intubation before tracheostomy affect intensive care unit length of stay?

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Sep 27;:

Authors: Young SR, Bouloux GF, Perez SD, Abramowicz S

Abstract
OBJECTIVE: The purpose of this study was to determine if length of intubation before tracheotomy (LIT) affects length of stay in the intensive care unit (ICU).
STUDY DESIGN: This was a retrospective case series of patients who had open tracheotomies at Grady Memorial Hospital by the Oral and Maxillofacial Surgery (OMS) service. Medical records were reviewed to document patient demographic characteristics, etiology for ventilator dependence, and complications. The primary predictor variable was LIT and primary outcome variable was length of stay in ICU after tracheotomy. Statistical analysis was performed (significance P < .05).
RESULTS: There were 115 patients (mean age 54 years) included in the study. The majority received tracheotomies because of prolonged mechanical ventilation secondary to a medical comorbidity. Intraoperative complications were cardiac arrest and difficulty accessing trachea. Postoperative complications were bleeding. Postoperatively, most patients were discharged from the ICU or weaned off mechanical ventilation within 5 days. The correlation between LIT and ICU stay was not statistically significant, but the trend was positive.
CONCLUSIONS: The results of this study indicate that patients undergoing an earlier tracheotomy were more likely to have an earlier discharge from the ICU.

PMID: 29097138 [PubMed - as supplied by publisher]



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Outcomes in Super Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy.

Outcomes in Super Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy.

J Laparoendosc Adv Surg Tech A. 2017 Nov 03;:

Authors: Singla V, Aggarwal S, Garg H, Kashyap L, Shende DR, Agarwal S

Abstract
BACKGROUND: Super obese patients remain a challenge for management because of large liver size resulting in decreased work space and associated comorbidities.
OBJECTIVES: To study outcomes in super obese patients undergoing Laparoscopic sleeve gastrectomy (LSG).
METHODS: Retrospective data of 123 patients undergoing LSG from January 2008 to March 2015 were analyzed prospectively.
RESULTS: Mean age and body mass index (BMI) of 123 patients (± 2 standard deviation [SD]) were 39.9 ± 23.3 years and 55.6 ± 10.54 kg/m(2), respectively. Mean percentage excess weight loss (%EWL) (± 2 SD) at 1, 3, 5, and 7 years was 63% ± 36.7%, 62.3% ± 29.0%, 56.5% ± 35.8%, and 58.6% ± 40.3%, respectively. The preoperative BMI correlated with %EWL at 1 year (r(2) = 0.0397, P = .044). Staple line leak, bleeding, deep venous thrombosis, and 30-day mortality occurred in 1.6%, 0%, 0.8%, and 0% of the patients, respectively. Stricture formation and new onset gastroesophageal reflux disease (GERD) occurred in 0.8% patients each. Of the diabetic patients, 72.2% had remission and the rest required decreased dosage of oral hypoglycemic medications. Hypertension, obstructive sleep apnea, and GERD improved in 68.2%, 100%, and 25% of the patients, respectively. However, 25% of patients had worsening in GERD symptoms.
CONCLUSIONS: Super obese patients undergoing LSG as the primary procedure have reasonable weight loss of 62% and 56% at 3 and 5 years, respectively, with significant resolution of comorbidities.

PMID: 29099314 [PubMed - as supplied by publisher]



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Evaluation of the occurrence and diagnose definitions for Nocturnal Polyuria in Spinal Cord Injured patients during rehabilitation.

Evaluation of the occurrence and diagnose definitions for Nocturnal Polyuria in Spinal Cord Injured patients during rehabilitation.

Eur J Phys Rehabil Med. 2017 Nov 03;:

Authors: Viaene A, Denys MA, Goessaert AS, Claeys J, Raes A, Roggeman S, Everaert K

Abstract
BACKGROUND: Little is known about the occurrence of nocturnal polyuria in spinal cord injured (SCI) patients and the definitions which are preferable in this population.
AIM: To determine the occurrence of nocturnal polyuria (NP) in spinal cord injured patients during in-patient rehabilitation in the Ghent University Hospital. To study the influence of different time periods (daytime, bed rest and sleep) on the accuracy of the existing diagnose definitions for NP specifically for this type of patients.
DESIGN: Retrospective study using patient records.
SETTING: SCI patients during hospital based rehabilitation between 2011 and 2014.
POPULATION: Seventy-four SCI patients were selected and their records of frequency-volume charts were examined, after exclusion of unreliable data, forty-seven patients were retained for the current study.
METHODS: Retrospective study using data from frequency-volume charts of either two or three days from patients with SCI. Nocturnal urine production (NUP) and nocturnal polyuria index (NPi) were calculated.
RESULTS: There was a significant increase in diuresis, calculated as urine production, between day time and bed rest (p=0.008) and between day time and sleep (p=0.001). All patients showed nocturnal polyuria during a 12-hour night time period (including both bed rest and sleep) and 39 patients showed nocturnal polyuria during the 8 hour period of sleep. There was no significant difference in mean urine production between bed rest and sleep. Prevalence of NP did not significantly differ between the complete or incomplete SCI patients or between patients with higher and lower SCI levels.
CONCLUSIONS: This study showed that the occurrence of nocturnal polyuria in patients with SCI is high and that it is important to consider which definitions of NP are used for diagnosis. Increase in diuresis is observed during bed rest and sleep and the diagnose is correctly estimated when nocturnal urine production definitions are used in both time periods. In accordance with what was expected, diagnose of NP was overestimated when nocturnal polyuria index type definitions were used.
CLINICAL REHABILITATION IMPACT: It is important to be aware of the frequent occurrence of nocturnal polyuria in spinal cord injury patients and the impact of their daily routine to the accuracy of the diagnosis of NP. More knowledge about this topic can help to avoid incontinence caused by nocturnal polyuria.

PMID: 29099160 [PubMed - as supplied by publisher]



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The Association between Sleep and Theory of Mind in School Aged Children with ADHD.

The Association between Sleep and Theory of Mind in School Aged Children with ADHD.

Med Sci (Basel). 2017 Aug 21;5(3):

Authors: Tesfaye R, Gruber R

Abstract
Theory of Mind (ToM) is defined as the ability to infer a range of internal mental states of others, including beliefs, intentions, desires, and emotions. These abilities are associated with children's ability to socialize effectively with peers. ToM impairments are associated with peer rejection and psychiatric disorders such as Attention-Deficit/Hyperactivity Disorder (ADHD). Previous studies have found poor sleep negatively impacts executive functioning (EF) and emotional information processing, which are essential for the effective use of ToM. Youth with ADHD have EF deficits and sleep problems. However, the relationship between sleep, executive functioning, and ToM in children with ADHD has not been studied. In this review, we propose that the poor social and interpersonal skills characterizing individuals with ADHD could be explained by the impact of poor sleep on the emotional and cognitive mechanisms underlying ToM.

PMID: 29099034 [PubMed]



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Montelukast in acute asthma exacerbations: Interpreting too far??

Montelukast in acute asthma exacerbations: Interpreting too far??

Lung India. 2017 Nov-Dec;34(6):576

Authors: Mittal S, Madan K

PMID: 29099012 [PubMed]



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A 26-year-old man with dyspnea and chest pain.

A 26-year-old man with dyspnea and chest pain.

Lung India. 2017 Nov-Dec;34(6):562-566

Authors: Mittal S, Jain A, Arava S, Hadda V, Mohan A, Guleria R, Madan K

Abstract
A 26-year-old smoker male presented with a history of sudden onset dyspnea and right-sided chest pain. Chest radiograph revealed large right-sided pneumothorax which was managed with tube thoracostomy. High-resolution computed tomography thorax revealed multiple lung cysts, and for a definite diagnosis, a video-assisted thoracoscopic surgery-guided lung biopsy was performed followed by pleurodesis. This clinicopathologic conference discusses the clinical and radiological differential diagnoses, utility of lung biopsy, and management options for patients with such a clinical presentation.

PMID: 29099006 [PubMed]



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Tracheobronchial puncture-site nodular reaction (TPNR) following endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): Systematic review of case reports.

Tracheobronchial puncture-site nodular reaction (TPNR) following endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): Systematic review of case reports.

Lung India. 2017 Nov-Dec;34(6):532-537

Authors: Madan K, Tiwari P, Arava S, Hadda V, Mohan A, Guleria R

Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive and efficacious diagnostic modality for lung cancer staging and evaluation of undiagnosed mediastinal lymphadenopathy. Procedure-related complications are uncommon. We herein report an infrequently described phenomenon following EBUS-TBNA in which two patients developed nodular granulation tissue at the tracheobronchial puncture site. On systematic review, we found description of such phenomena by terminologies such as endobronchial inflammatory polyp, granuloma, and endobronchial mass. The endobronchial inflammatory polyp has been one of the most commonly used terminologies for these; but in most cases, the classical features of an inflammatory polyp are lacking. We propose the term, tracheobronchial puncture-site nodular reaction (TPNR) with further classification into granulomatous and nongranulomatous subtypes, for standardized reporting of such reactions following transbronchial needle aspiration procedures. Knowledge of this entity and standardized nomenclature shall help in better characterization of the outcomes and risk factors for the occurrence of these reactions.

PMID: 29098999 [PubMed]



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Guidelines for Genome-Scale Analysis of Biological Rhythms.

Guidelines for Genome-Scale Analysis of Biological Rhythms.

J Biol Rhythms. 2017 Nov 01;:748730417728663

Authors: Hughes ME, Abruzzi KC, Allada R, Anafi R, Arpat AB, Asher G, Baldi P, de Bekker C, Bell-Pedersen D, Blau J, Brown S, Ceriani MF, Chen Z, Chiu JC, Cox J, Crowell AM, DeBruyne JP, Dijk DJ, DiTacchio L, Doyle FJ, Duffield GE, Dunlap JC, Eckel-Mahan K, Esser KA, FitzGerald GA, Forger DB, Francey LJ, Fu YH, Gachon F, Gatfield D, de Goede P, Golden SS, Green C, Harer J, Harmer S, Haspel J, Hastings MH, Herzel H, Herzog ED, Hoffmann C, Hong C, Hughey JJ, Hurley JM, de la Iglesia HO, Johnson C, Kay SA, Koike N, Kornacker K, Kramer A, Lamia K, Leise T, Lewis SA, Li J, Li X, Liu AC, Loros JJ, Martino TA, Menet JS, Merrow M, Millar AJ, Mockler T, Naef F, Nagoshi E, Nitabach MN, Olmedo M, Nusinow DA, Ptáček LJ, Rand D, Reddy AB, Robles MS, Roenneberg T, Rosbash M, Ruben MD, Rund SSC, Sancar A, Sassone-Corsi P, Sehgal A, Sherrill-Mix S, Skene DJ, Storch KF, Takahashi JS, Ueda HR, Wang H, Weitz C, Westermark PO, Wijnen H, Xu Y, Wu G, Yoo SH, Young M, Zhang EE, Zielinski T, Hogenesch JB

Abstract
Genome biology approaches have made enormous contributions to our understanding of biological rhythms, particularly in identifying outputs of the clock, including RNAs, proteins, and metabolites, whose abundance oscillates throughout the day. These methods hold significant promise for future discovery, particularly when combined with computational modeling. However, genome-scale experiments are costly and laborious, yielding "big data" that are conceptually and statistically difficult to analyze. There is no obvious consensus regarding design or analysis. Here we discuss the relevant technical considerations to generate reproducible, statistically sound, and broadly useful genome-scale data. Rather than suggest a set of rigid rules, we aim to codify principles by which investigators, reviewers, and readers of the primary literature can evaluate the suitability of different experimental designs for measuring different aspects of biological rhythms. We introduce CircaInSilico, a web-based application for generating synthetic genome biology data to benchmark statistical methods for studying biological rhythms. Finally, we discuss several unmet analytical needs, including applications to clinical medicine, and suggest productive avenues to address them.

PMID: 29098954 [PubMed - as supplied by publisher]



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Sleep pattern and decision making in physicians from mobile emergency care service with 12-hour work schedules.

Sleep pattern and decision making in physicians from mobile emergency care service with 12-hour work schedules.

Int J Neurosci. 2017 Nov 03;:1-28

Authors: Castro EAS, de Almondes KM

Abstract
INTRODUCTION: Shift work schedules are biological standpoint worse because compel the body to anticipate periods of wakefulness and sleep and thus eventually cause a disruption of biological rhythms.
OBJECTIVE: To evaluate the sleep pattern and decision making in physicians working in mobile units of emergency attention undergoing Day Shift and Rotating Shift.
METHODS: The study included 26 physicians. The instruments utilized were a sociodemographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Sleep Habits Questionnaire, the Epworth Sleepiness Scale and Chronotype Identification Questionnaire of Horne-Ostberg, the Iowa Gambling Task (IGT) and hypothetical scenarios of decision-making created according to the Policy-Capturing Technique. For inclusion and exclusion criteria, the participants answered the Chalder Fatigue Scale, the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI) and the Inventory of Stress Symptoms for adults of Lipp (ISSL).
RESULTS: It was found good sleep quality for physicians on Day Shift schedule and bad sleep quality for physicians on Rotating Shift schedule. The IGT measure showed no impairment in decision-making, but the hypothetical scenarios revealed impairment decision-making during the Shift for both schedules. Good sleep quality was related to a better performance in decision-making.
CONCLUSION: Good sleep quality seems to influence a better performance in decision-making.

PMID: 29098917 [PubMed - as supplied by publisher]



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quality of care; +859 new citations

859 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

quality of care

These pubmed results were generated on 2017/11/04

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.



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Risk factors for asthma after infant bronchiolitis

Abstract

Background

Five studies carried out after bronchiolitis at less than 24 months of age, with a follow up of more than 10 years, reported that atopic dermatitis, family asthma, early-life exposure to tobacco smoke and rhinovirus aetiology were early-life risk factors for later asthma. This study evaluated the long-term outcome at 11-13 years of age of children who were hospitalised for bronchiolitis in early infancy.

Methods

We previously prospectively followed 166 children hospitalised for bronchiolitis at less than six months of age until 5-7 years of age. The current study included a structured questionnaire, parental interviews, clinical examinations and bronchodilation test of 138 of those children at 11-13 years of age.

Results

Respiratory syncytial virus caused 66% of the bronchiolitis cases and nearly half of the patients were exposed to tobacco smoke in early life. Doctor-diagnosed asthma was present in 13% of the former bronchiolitis patients at 11-13 years of age. Maternal asthma was the only independently significant risk factor in early life (adjusted OR 3.45, 95% CI 1.07-11.74), as was allergic rhinitis at 5-7 years of age (adjusted OR 4.06, 95% CI 1.35-12.25).

Conclusions

After bronchiolitis at less than six months of age, the risk of doctor-diagnosed asthma at 11-13 years was about twice that of the general Finnish population. Maternal asthma was the only independently significant early-life risk factor for current asthma at 11-13 years of age.

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Adjuvant External Beam Radiotherapy in Locally Advanced Differentiated Thyroid Cancer.

Related Articles

Adjuvant External Beam Radiotherapy in Locally Advanced Differentiated Thyroid Cancer.

JAMA Otolaryngol Head Neck Surg. 2017 Nov 02;:

Authors: Tam S, Amit M, Boonsripitayanon M, Cabanillas ME, Busaidy NL, Gunn GB, Lai SY, Gross ND, Sturgis EM, Zafereo ME

Abstract
Importance: As incidence of differentiated thyroid cancer rises, treatment paradigms have become increasingly defined. Despite this, locally advanced disease continues to be challenging to manage. Postoperative therapy in the form of radioactive iodine (RAI) is generally recommended, but the role of external beam radiation therapy (EBRT) is less well defined.
Objective: To investigate the role of EBRT in locally advanced differentiated thyroid cancer.
Design, Setting, and Participants: For this retrospective cohort study, patients treated surgically for T4a differentiated thyroid cancer at the University of Texas MD Anderson Cancer Center from January 2000 through December 2015 were recruited, and 88 patients were included for analysis.
Exposures: Adjuvant treatment with RAI alone or both RAI and EBRT.
Main Outcomes and Measures: Disease-free survival (DFS), defined as the time from primary surgery to locoregional or distant recurrence or death due to any cause. Kaplan-Meier survival analysis was completed. Univariate and multivariate analysis was completed with Cox proportional hazards model to determine predictors of DFS.
Results: A total of 88 patients (44 women [50%]; mean [SD] age, 58.2 [15.3] years) were included in the analysis. Median (range) follow-up was 117 (12-164) months. Forty-four patients (50%) underwent RAI alone and 44 patients (50%) underwent RAI with adjuvant EBRT. Patients undergoing RAI alone did not receive EBRT owing to invasion into the recurrent laryngeal nerve only (n = 14 [32%]) or invasion into the tracheal perichondrium and/or esophageal muscularis only (n = 18 [41%]). Five-year DFS was 43% in those undergoing RAI alone, compared with 57% in those undergoing RAI and EBRT (effect size = 14%; 95% CI, -7% to 33%). Patients undergoing RAI alone had an increased rate of locoregional failure (effect size = -32%; 95% CI, -47% to -16%), with those undergoing RAI treatment alone, for minimal tracheal perichondrium and/or esophageal muscularis invasion having worse locoregional control than those with recurrent laryngeal nerve invasion only (effect size = 49%; 95% CI, 20% to 71%). Age (adjusted hazard ratio [adjusted HR], 1.02/y; 95% CI, 1.00 to 1.05) and esophageal invasion (adjusted HR, 2.30; 95% CI, 1.16 to 4.60) were independent predictors of worse DFS.
Conclusions and Relevance: The addition of EBRT to RAI results in good disease control in locally advanced differentiated thyroid cancer, particularly in patients with tracheal or esophageal invasion treated with aggressive surgical resection. Increased age and presence of esophageal invasion were independent predictors of poor disease control.

PMID: 29098272 [PubMed - as supplied by publisher]



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Zinc oxide nanoparticles induce toxic responses in human neuroblastoma SHSY5Y cells in a size-dependent manner

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A simple reduction-sensitive micelles co-delivery of paclitaxel and dasatinib to overcome tumor multidrug resistance

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Dual UV irradiation-based metal oxide nanoparticles for enhanced antimicrobial activity in Escherichia coli and M13 bacteriophage

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Squarticles as the nanoantidotes to sequester the overdosed antidepressant for detoxification

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Hemodynamic Changes Caused by Multiple Stenting in Vertebral Artery Fusiform Aneurysms: A Patient-Specific Computational Fluid Dynamics Study.

Related Articles

Hemodynamic Changes Caused by Multiple Stenting in Vertebral Artery Fusiform Aneurysms: A Patient-Specific Computational Fluid Dynamics Study.

AJNR Am J Neuroradiol. 2017 Nov 02;:

Authors: Lv N, Cao W, Larrabide I, Karmonik C, Zhu D, Liu J, Huang Q, Fang Y

Abstract
BACKGROUND AND PURPOSE: The multiple stent placement technique has largely improved the long-term outcomes of intracranial fusiform aneurysms, but the hemodynamic mechanisms remain unclear. In this study, we analyzed the hemodynamic changes caused by different stent-placement strategies in patient-specific models using the computational fluid dynamics technique, aiming to provide evidence for clinical decision-making.
MATERIALS AND METHODS: Ten vertebral artery fusiform aneurysms were included, and their patient-specific computational fluid dynamics models were reconstructed. A fast virtual stent placement technique was used to simulate sequential multiple stent placements (from a single stent to triple stents) in the vertebral artery fusiform aneurysm models. Hemodynamic parameters, including wall shear stress, pressure, oscillatory shear index, relative residence time, and flow pattern, were calculated and compared among groups with different numbers of stents.
RESULTS: Virtual stents were deployed in all 10 cases successfully, consistent with the real stent configuration. Wall shear stress decreased progressively by 7.2%, 20.6%, and 25.8% as the number of stents increased. Meanwhile, relative residence time and pressure increased on average by 11.3%, 15.4%, and 45.0% and by 15.7%, 21.5%, and 28.2%. The oscillatory shear index showed no stable variation trend. Flow patterns improved by weakening the intensity of the vortices and displacing the vortex center from the aneurysmal wall.
CONCLUSIONS: Stent placement modifies hemodynamic patterns in vertebral artery fusiform aneurysms, which might favor thrombosis formation in the aneurysmal sac. This effect is amplified with the number of stents deployed. However, a potential risk of rupture or recanalization exists and should be considered when planning to use the multiple stent placement technique in vertebral artery fusiform aneurysms.

PMID: 29097416 [PubMed - as supplied by publisher]



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Gadolinium DTPA Enhancement Characteristics of the Rat Sciatic Nerve after Crush Injury at 4.7T.

Related Articles

Gadolinium DTPA Enhancement Characteristics of the Rat Sciatic Nerve after Crush Injury at 4.7T.

AJNR Am J Neuroradiol. 2017 Nov 02;:

Authors: Hill BJ, Padgett KR, Kalra V, Marcillo A, Bowen B, Pattany P, Dietrich D, Quencer R

Abstract
BACKGROUND AND PURPOSE: Traumatic peripheral nerve injury is common and results in loss of function and/or neuropathic pain. MR neurography is a well-established technique for evaluating peripheral nerve anatomy and pathology. However, the Gd-DTPA enhancement characteristics of acutely injured peripheral nerves have not been fully examined. This study was performed to determine whether acutely crushed rat sciatic nerves demonstrate Gd-DTPA enhancement and, if so, to evaluate whether enhancement is affected by crush severity.
MATERIALS AND METHODS: In 26 rats, the sciatic nerve was crushed with either surgical forceps (6- to 20-N compressive force) or a microvascular/microaneurysm clip (0.1-0.6 N). Animals were longitudinally imaged at 4.7T for up to 30 days after injury. T1WI, T2WI, and T1WI with Gd-DTPA were performed.
RESULTS: Forceps crush injury caused robust enhancement between days 3 and 21, while clip crush injury resulted in minimal-to-no enhancement. Enhancement after forceps injury peaked at 7 days and was seen a few millimeters proximal to, in the region of, and several centimeters distal to the site of crush injury. Enhancement after forceps injury was statistically significant compared with clip injury between days 3 and 7 (P < .04).
CONCLUSIONS: Gd-DTPA enhancement of peripheral nerves may only occur above a certain crush-severity threshold. This phenomenon may explain the intermittent observation of Gd-DTPA enhancement of peripheral nerves after traumatic injury. The observation of enhancement may be useful in judging the severity of injury after nerve trauma.

PMID: 29097415 [PubMed - as supplied by publisher]



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The Anesthesiologist, Rather Than the Anesthesia, May Influence the Outcomes following Stroke Thrombectomy.

Related Articles

The Anesthesiologist, Rather Than the Anesthesia, May Influence the Outcomes following Stroke Thrombectomy.

AJNR Am J Neuroradiol. 2017 Nov 02;:

Authors: Fandino W

PMID: 29097414 [PubMed - as supplied by publisher]



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Spatial Correlation of Pathology and Perfusion Changes within the Cortex and White Matter in Multiple Sclerosis.

Related Articles

Spatial Correlation of Pathology and Perfusion Changes within the Cortex and White Matter in Multiple Sclerosis.

AJNR Am J Neuroradiol. 2017 Nov 02;:

Authors: Mulholland AD, Vitorino R, Hojjat SP, Ma AY, Zhang L, Lee L, Carroll TJ, Cantrell CG, Figley CR, Aviv RI

Abstract
BACKGROUND AND PURPOSE: The spatial correlation between WM and cortical GM disease in multiple sclerosis is controversial and has not been previously assessed with perfusion MR imaging. We sought to determine the nature of association between lobar WM, cortical GM, volume and perfusion.
MATERIALS AND METHODS: Nineteen individuals with secondary-progressive multiple sclerosis, 19 with relapsing-remitting multiple sclerosis, and 19 age-matched healthy controls were recruited. Quantitative MR perfusion imaging was used to derive CBF, CBV, and MTT within cortical GM, WM, and T2-hyperintense lesions. A 2-step multivariate linear regression (corrected for age, disease duration, and Expanded Disability Status Scale) was used to assess correlations between perfusion and volume measures in global and lobar normal-appearing WM, cortical GM, and T2-hyperintense lesions. The Bonferroni adjustment was applied as appropriate.
RESULTS: Global cortical GM and WM volume was significantly reduced for each group comparison, except cortical GM volume of those with relapsing-remitting multiple sclerosis versus controls. Global and lobar cortical GM CBF and CBV were reduced in secondary-progressive multiple sclerosis compared with other groups but not for relapsing-remitting multiple sclerosis versus controls. Global and lobar WM CBF and CBV were not significantly different across groups. The distribution of lobar cortical GM and WM volume reduction was disparate, except for the occipital lobes in patients with secondary-progressive multiple sclerosis versus those with relapsing-remitting multiple sclerosis. Moderate associations were identified between lobar cortical GM and lobar normal-appearing WM volume in controls and in the left temporal lobe in relapsing-remitting multiple sclerosis. No significant associations occurred between cortical GM and WM perfusion or volume. Strong correlations were observed between cortical-GM perfusion, normal appearing WM and lesional perfusion, with respect to each global and lobar region within HC, and RRMS and SPMS patients (R(2) ≤ 0.96, P < .006 and R(2) ≤ 0.738, P < .006).
CONCLUSIONS: The weak correlation between lobar WM and cortical GM volume loss and perfusion reduction suggests the independent pathophysiology of WM and cortical GM disease.

PMID: 29097413 [PubMed - as supplied by publisher]



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Brain Structural Changes following HIV Infection: Meta-Analysis.

Related Articles

Brain Structural Changes following HIV Infection: Meta-Analysis.

AJNR Am J Neuroradiol. 2017 Nov 02;:

Authors: O'Connor EE, Zeffiro TA, Zeffiro TA

Abstract
BACKGROUND: Numerous studies have used structural neuroimaging to measure HIV effects on brain macroarchitecture. While many have reported changes in total brain volume, gray matter volume, white matter volume, CSF volume, and basal ganglia volume following HIV infection, quantitative inconsistencies observed across studies are large.
PURPOSE: Our aim was to evaluate the consistency and temporal stability of serostatus effects on a range of structural neuroimaging measures.
DATA SOURCES: PubMed, reference lists, and corresponding authors.
STUDY SELECTION: The meta-analysis included 19 cross-sectional studies reporting HIV effects on cortical and subcortical volume from 1993 to 2016.
DATA ANALYSIS: Random-effects meta-analysis was used to estimate individual study standardized mean differences and study heterogeneity. Meta-regression was used to examine the effects of the study publication year.
DATA SYNTHESIS: Meta-analysis revealed standardized mean differences related to the serostatus of -0.65 (P = .002) for total brain volume, -0.28 for gray matter volume (P = .008), -0.24 (P = .076) for white matter volume, and 0.56 (P = .001) for CSF volume. Basal ganglia volume differences related to serostatus were not significant. Nevertheless, estimates of between-study heterogeneity suggested that much of the observed variance was between studies. Publication year was associated with recent reductions in many neurostructural effects.
LIMITATIONS: Many studies pooled participants with varying durations of treatment, disease, and comorbidities. Image-acquisition methods changed with time.
CONCLUSIONS: While published studies of HIV effects on brain structure had substantial variations that are likely to result from changes in HIV treatment practice during the study period, quantitative neurostructural measures can reliably detect the effects of HIV infection during treatment, serving as reliable biomarkers.

PMID: 29097412 [PubMed - as supplied by publisher]



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Volumetric Assessment of Swallowing Muscles: A Comparison of CT and MRI Segmentation.

Volumetric Assessment of Swallowing Muscles: A Comparison of CT and MRI Segmentation.

Rofo. 2017 Nov 03;:

Authors: Sporns KB, Hanning U, Schmidt R, Muhle P, Wirth R, Zimmer S, Dziewas R, Suntrup-Krueger S, Sporns PB, Heindel W, Schwindt W

Abstract
Purpose Recent retrospective studies have proposed a high correlation between atrophy of swallowing muscles, age, severity of dysphagia and aspiration status based on computed tomography (CT). However, ionizing radiation poses an ethical barrier to research in prospective non-patient populations. Hence, there is a need to prove the efficacy of techniques that rely on noninvasive methods and produce high-resolution soft tissue images such as magnetic resonance imaging (MRI). The objective of this study was therefore to compare the segmentation results of swallowing muscles using CT and MRI. Methods Retrospective study of 21 patients (median age: 46.6; gender: 11 female) who underwent CT and MRI of the head and neck region within a time frame of less than 50 days because of suspected head and neck cancer using contrast agent. CT and MR images were segmented by two blinded readers using Medical Imaging Toolkit (MITK) and both modalities were tested (with the equivalence test) regarding the segmented muscle volumes. Adjustment for multiple testing was performed using the Bonferroni test and the potential time effect of the muscle volumes and the time interval between the modalities was assessed by a spearman correlation. The study was approved by the local ethics committee. Results The median volumes for each muscle belly of the digastric muscle derived from CT were 3051 mm(3) (left) and 2969 mm(3) (right), and from MRI they were 3218 mm(3) (left) and 3027 mm(3) (right). The median volume of the geniohyoid muscle was 6580 mm(3) on CT and 6648 mm(3) on MRI. The interrater reliability was high for all segmented muscles. The mean time interval between the CT and MRI examinations was 34 days (IQR 25; 41). The muscle differences of each muscle between the two modalities did not reveal significant correlation to the time interval between the examinations (digastric left r = 0.003 and digastric right r = -0.008; geniohyoid muscle r = 0.075). Conclusion CT-based segmentation and MRI-based segmentation of the digastric and geniohyoid muscle are equally feasible. The potential advantage of MRI for prospective studies is the absence of ionizing radiation. Key Points  · CT-based segmentation and MRI-based segmentation of the swallowing muscles are equally feasible.. · The advantage of MRI is the absence of ionizing radiation.. · MRI should therefore be deployed for future prospective studies.. Citation Format · Sporns KB, Hanning U, Schmidt R et al. Volumetric Assessment of Swallowing Muscles: A Comparison of CT and MRI Segmentation. Fortschr Röntgenstr 2017; DOI: 10.1055/s-0043-120529.

PMID: 29100254 [PubMed - as supplied by publisher]



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Update on pediatric sinus surgery: indications and outcomes.

Update on pediatric sinus surgery: indications and outcomes.

Curr Opin Otolaryngol Head Neck Surg. 2017 Dec;25(6):486-492

Authors: Gudis DA, Soler ZM

Abstract
PURPOSE OF REVIEW: To review the recent literature of pediatric endoscopic sinus surgery (ESS).
RECENT FINDINGS: Sinus balloon catheter dilation is an important addition to the surgical treatment tools for pediatric chronic rhinosinusitis (PCRS). ESS is a safe and effective therapeutic modality for uncomplicated PCRS. For PCRS complicated by comorbidities including cystic fibrosis and primary ciliary dyskinesia, ESS and adjuvant medical therapy confers significant sinus, pulmonary, and quality of life benefits to pediatric patients.
SUMMARY: ESS is a safe and effective treatment modality in the management of pediatric acute and chronic sinus disorders.

PMID: 29099731 [PubMed - in process]



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Prospective Evaluation of Patients Undergoing Translabyrinthine Excision of Vestibular Schwannoma with Concurrent Cochlear Implantation.

Prospective Evaluation of Patients Undergoing Translabyrinthine Excision of Vestibular Schwannoma with Concurrent Cochlear Implantation.

Otol Neurotol. 2017 Nov 02;:

Authors: Rooth MA, Dillon MT, Brown KD

Abstract
OBJECTIVE: Translabyrinthine (TL) vestibular schwannoma (VS) resection may be accomplished with preservation of the cochlear nerve, permitting successful, concurrent cochlear implantation. In this single institution, Food and Drug Administration-approved feasibility study, we wished to determine the success and outcomes of concurrent cochlear implantation at the time of TL resection of VS.
STUDY DESIGN: Prospective cohort.
SETTING: Tertiary referral center.
PATIENTS: Patients with small VS less than 1.5 cm in size.
INTERVENTION: Concurrent TL VS resection and cochlear implantation.
MAIN OUTCOME MEASURE: Sound localization and speech understanding.
RESULTS: All cochlear nerves were anatomically preserved. Five out of seven patients had auditory precepts at the time of activation. At 1 month following surgery, AzBio scores (0 dB SNR, with sound front, noise to normal ear) were improved by an average of 10% with implant on, persisting to 6 months out from surgery. Localization 1 month after surgery was markedly improved with root mean square 78 degrees ±13 in the "implant off" condition and 41 ± 9 degrees in the "implant on" condition. Average tinnitus severity was reduced in subjects and speech and spatial hearing was improved on speech, spatial and qualities of hearing scale (SSQ).
CONCLUSIONS: These data demonstrate preservation of electrical hearing in TL VS surgery is consistently possible, and although speech outcomes do not achieve the same levels seen with other etiologies of hearing loss, excellent improvement in sound localization, improved speech understanding, and substantial reductions in tinnitus are achieved.

PMID: 29099442 [PubMed - as supplied by publisher]



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Mastoid and Inner Ear Measurements in Patients With Menière's Disease.

Mastoid and Inner Ear Measurements in Patients With Menière's Disease.

Otol Neurotol. 2017 Nov 02;:

Authors: Sugihara EM, Marinica AL, Vandjelovic ND, Kelley BM, Sana SS, Starkey NE, Babu SC

Abstract
OBJECTIVE: To determine the relationship between radiographic temporal bone anatomy of patients with Menière's disease in medically and surgically managed populations versus controls.
STUDY DESIGN: Retrospective chart review.
SETTING: Two tertiary referral centers.
PATIENTS: Adults older than 18 years with Menière's disease treated with endolymphatic sac decompression (ESD) or medical management (non-ESD) versus controls.
INTERVENTIONS: Magnetic resonance imaging and computed tomography imaging studies of the temporal bones were reviewed by blinded radiologists.
MAIN OUTCOME MEASURES: Radiographic temporal bone dimensions were measured in Menière's disease and control patients. Age, sex, symptoms, audiogram data, academy classification of Menière's disease, and follow-up were recorded. Statistical analysis was performed to compare outcome measures across groups and demographics.
RESULTS: A total of 90 imaging studies were reviewed (ESD = 22; non-ESD = 30; control = 38). ESD and non-ESD groups had similar pure-tone averages (33.9 ± 20.6 versus 41.6 ± 22.6 dB HL; p = 0.21) and frequency of definite Menière's disease (59.1% versus 53.3%; p = 0.68). There was no significant trend between groups for any measurement. One nonsignificant trend existed in mean vestibule length, increasing from the control (5.45 ± 0.54 mm), non-ESD (5.80 ± 0.97 mm), and ESD (5.94 ± 0.81 mm) group. In a combined Menière's group, mean vestibule length was significantly greater than controls (5.86 ± 0.89 versus 5.45 ± 0.54 mm; p = 0.008) and mean vestibule width significantly less (2.99 ± 0.46 versus 3.19 ± 0.39 mm; p = 0.024).
CONCLUSION: Medical and surgical Menière's patients were similar utilizing academy classification. There was no significant trend between medical and surgical Menière's patients versus controls for any measurement. In a combined Menière's group, the longer and narrower vestibule anatomy may suggest an anatomical basis for endolymphatic hydrops.

PMID: 29099441 [PubMed - as supplied by publisher]



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PAX5 gene as a novel methylation marker that predicts both clinical outcome and cisplatin sensitivity in esophageal squamous cell carcinoma.

PAX5 gene as a novel methylation marker that predicts both clinical outcome and cisplatin sensitivity in esophageal squamous cell carcinoma.

Epigenetics. 2017 Nov 03;:0

Authors: Kurimoto K, Hayashi M, Guerrero-Preston R, Koike M, Kanda M, Hirabayashi S, Tanabe H, Takano N, Iwata N, Niwa Y, Takami H, Kobayashi D, Tanaka C, Yamada S, Nakayama G, Sugimoto H, Fujii T, Fujiwara M, Kodera Y

Abstract
Therapeutic strategies for esophageal cancer largely depend on histopathological assessment. To select appropriate treatments for individual patients, we examined the background molecular characteristics of tumor malignancy and sensitivity to multidisciplinary therapy. Seventy-eight surgically-resected esophageal squamous cell carcinoma (ESCC) cases during 2001-2013 were examined. PAX5, a novel gene methylation marker in ESCC, was evaluated in the specimens, as methylation of this gene was identified as an extremely tumor-specific event in squamous cell carcinogenesis of head and neck. PAX5 methylation status was evaluated by quantitative MSP (QMSP) assays. Mean QMSP value was 15.7 (0-136.3) in ESCCs and 0.3 (0-8.6) in adjacent normal tissues (P < 0.001). The 78 cases were divided into high QMSP value (high QMSP, n = 26) and low QMSP value (low QMSP, n = 52). High QMSP cases were significantly associated with downregulated PAX5 expression (P = 0.040), and showed significantly poor recurrence-free survival [Hazard Ratio (HR) = 2.84; P = 0.005; 95% Confidence Interval (CI): 1.39-5.81] and overall survival (HR = 3.23; P = 0.002; 95%CI: 1.52-7.01) in multivariable analyses with histopathological factors. PAX5-knockdown cells exhibited significantly increased cell proliferation and cisplatin resistance. PAX5 gene methylation can predict poor survival outcomes and cisplatin sensitivity in ESCCs and could be a useful diagnostic tool for cancer therapy selection.

PMID: 29099287 [PubMed - as supplied by publisher]



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Chemodenervation of the Larynx.

Chemodenervation of the Larynx.

Toxins (Basel). 2017 Nov 02;9(11):

Authors: Kaye R, Blitzer A

Abstract
Botulinum neurotoxin (BoNT) has existed for thousands of years; however, it was not medically utilized until investigations into its therapeutic use began in sincerity during the late 1970s and 1980s. This, coupled with the reclassification of spasmodic dysphonia as a focal dystonia, led to the use of chemodenervation for this disorder, which has since become a refined technique. Indeed, due to its safety and efficacy, BoNT has been investigated in multiple neurolaryngology disorders, including spasmodic dysphonia, vocal tremor, and muscle tension dysphonia. BoNT has been shown to be a useful and safe adjunct in the treatment for these disorders and may reduce or eliminate oral pharmacotherapy and/or prevent the need for a surgical intervention. We present the historical background, development, proposed mechanisms of action, uses, and techniques for administering BoNT for laryngeal disorders, with a particular focus on spasmodic dysphonia.

PMID: 29099066 [PubMed - in process]



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SEOM clinical guideline in nasopharynx cancer (2017).

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SEOM clinical guideline in nasopharynx cancer (2017).

Clin Transl Oncol. 2017 Nov 02;:

Authors: Pastor M, Lopez Pousa A, Del Barco E, Perez Segura P, Astorga BG, Castelo B, Bonfill T, Martinez Trufero J, Grau JJ, Mesia R

Abstract
Nasopharyngeal carcinoma (NPC) is distinct from other cancers of the head and neck in biology, epidemiology, histology, natural history, and response to treatment. Radiation therapy is an essential component of curative-intent of non-disseminated disease and the association of chemotherapy improves the rates of survival. In the case of metastatic disease stages, treatment requires platinum/gemcitabine-based chemotherapy and patients may achieve a long survival time.

PMID: 29098554 [PubMed - as supplied by publisher]



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Costs from a healthcare and societal perspective among cancer patients after total laryngectomy: are they related to patient activation?

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Costs from a healthcare and societal perspective among cancer patients after total laryngectomy: are they related to patient activation?

Support Care Cancer. 2017 Nov 03;:

Authors: Jansen F, Coupé VMH, Eerenstein SEJ, Leemans CR, Verdonck-de Leeuw IM

Abstract
PURPOSE: The aim of this study is to investigate the associations between patient activation and total costs in cancer patients treated with total laryngectomy (TL).
METHODS: All members of the Dutch Patients' Association for Laryngectomees were asked to participate in this cross-sectional study. TL patients who wanted to participate were asked to complete a survey. Costs were measured using the medical consumption and productivity cost questionnaire and patient activation using the Patient Activation Measure (PAM). Sociodemographic and clinical characteristics were self-reported, and health status measured using the EQ-5D. The difference in total costs from a healthcare and societal perspective among four groups with different PAM levels were compared using (multiple) regression analyses (5000 bootstrap replications).
RESULTS: In total, 248 TL patients participated. Patients with a higher (better) PAM (levels 2, 3, and 4) had a probability of 70, 80, and 93% that total costs from a healthcare perspective were lower than in patients with the lowest PAM level (difference €-375 to €-936). From a societal perspective, this was 73, 87, and 82% (difference €-468 to €-719). After adjustment for time since TL, education, and sex, the probability that total costs were lower in patients with a higher PAM level compared to patients with the lowest PAM level changed to 62-91% (healthcare) and 63-92% (societal). After additional adjustment for health status, the probability to be less costly changed to 35-71% (healthcare) and 31-48% (societal).
CONCLUSIONS: A better patient activation is likely to be associated with lower total costs from a healthcare and societal perspective.

PMID: 29098402 [PubMed - as supplied by publisher]



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Evaluation of an Automated Swallow-Detection Algorithm Using Visual Biofeedback in Healthy Adults and Head and Neck Cancer Survivors.

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Evaluation of an Automated Swallow-Detection Algorithm Using Visual Biofeedback in Healthy Adults and Head and Neck Cancer Survivors.

Dysphagia. 2017 Nov 02;:

Authors: Constantinescu G, Kuffel K, Aalto D, Hodgetts W, Rieger J

Abstract
Mobile health (mHealth) technologies may offer an opportunity to address longstanding clinical challenges, such as access and adherence to swallowing therapy. Mobili-T(®) is an mHealth device that uses surface electromyography (sEMG) to provide biofeedback on submental muscles activity during exercise. An automated swallow-detection algorithm was developed for Mobili-T(®). This study evaluated the performance of the swallow-detection algorithm. Ten healthy participants and 10 head and neck cancer (HNC) patients were fitted with the device. Signal was acquired during regular, effortful, and Mendelsohn maneuver saliva swallows, as well as lip presses, tongue, and head movements. Signals of interest were tagged during data acquisition and used to evaluate algorithm performance. Sensitivity and positive predictive values (PPV) were calculated for each participant. Saliva swallows were compared between HNC and controls in the four sEMG-based parameters used in the algorithm: duration, peak amplitude ratio, median frequency, and 15th percentile of the power spectrum density. In healthy participants, sensitivity and PPV were 92.3 and 83.9%, respectively. In HNC patients, sensitivity was 92.7% and PPV was 72.2%. In saliva swallows, HNC patients had longer event durations (U = 1925.5, p < 0.001), lower median frequency (U = 2674.0, p < 0.001), and lower 15th percentile of the power spectrum density [t(176.9) = 2.07, p < 0.001] than healthy participants. The automated swallow-detection algorithm performed well with healthy participants and retained a high sensitivity, but had lowered PPV with HNC patients. With respect to Mobili-T(®), the algorithm will next be evaluated using the mHealth system.

PMID: 29098398 [PubMed - as supplied by publisher]



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Radiological tumor thickness as a risk factor for local recurrence in early glottic cancer treated with laser cordectomy.

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Radiological tumor thickness as a risk factor for local recurrence in early glottic cancer treated with laser cordectomy.

Eur Arch Otorhinolaryngol. 2017 Nov 02;:

Authors: Son HJ, Lee YS, Ku JY, Roh JL, Choi SH, Nam SY, Kim SY

Abstract
OBJECTIVES: Despite the excellent prognosis of early glottic cancer (T1-T2), the significance of preoperatively measured tumor thickness has not been elucidated. We evaluated the role of tumor thickness measured using computed tomography (CT) as a predictive factor for recurrence of early glottic cancer after transoral laser microsurgery (TLM).
METHODS: The medical records of 134 patients who were diagnosed with early glottic squamous cell carcinoma and underwent TLM were reviewed. Age, sex, clinical stage, preoperative biopsy, anterior commissure involvement, CT findings, recurrence, and overall survival were evaluated.
RESULTS: Seventy-three patients (54 T1a, 2 T1b, and 17 T2) were enrolled. Tumor thickness on pathology increased proportionally with increased tumor thickness on CT. The recurrence-free survival (RFS) and overall survival rates were 82.2 and 91.2%, respectively. Upon univariate analysis, RFS was affected by the type of cordectomy, tumor differentiation, margin involvement, anterior commissure involvement, impaired vocal fold mobility, and tumor thickness (> 4 mm) on CT scan (all p < 0.01). Among the relevant covariates, an involved or close resection margin [hazard ratio (HR) 19.2; 95% confidence interval (CI) 3.5-105.6; p < 0.01], impaired vocal cord mobility (HR 8.5; 95% CI 1.45-49.2; p = 0.02), and pathological tumor thickness (> 4 mm) (HR 6.0; p = 0.02) were predictive of RFS.
CONCLUSION: Tumor thickness may be another predictive factor for recurrence in early glottic cancer. Before TLM, reviewing the extent of tumor thickness will help to improve local control in cases of early glottic cancer.

PMID: 29098372 [PubMed - as supplied by publisher]



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Safety and Effectiveness of a Bioabsorbable Steroid-Releasing Implant for the Paranasal Sinus Ostia: A Randomized Clinical Trial.

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Safety and Effectiveness of a Bioabsorbable Steroid-Releasing Implant for the Paranasal Sinus Ostia: A Randomized Clinical Trial.

JAMA Otolaryngol Head Neck Surg. 2017 Nov 02;:

Authors: Luong A, Ow RA, Singh A, Weiss RL, Han JK, Gerencer R, Stolovitzky JP, Stambaugh JW, Raman A

Abstract
Importance: Suboptimal outcomes of endoscopic sinus surgery (ESS) are often associated with restenosis and inflammation of frontal sinus ostia. Steroid-releasing sinus implants have been shown to maintain sinus patency by minimizing inflammation and scar tissue formation. An hourglass-shaped, bioabsorbable, steroid-releasing implant was developed to provide mechanical support and optimize drug delivery to paranasal sinus ostia.
Objective: To assess the safety and efficacy of the hourglass-shaped, bioabsorbable, steroid-releasing sinus implant in improving postoperative outcomes when placed in the frontal sinus ostia (FSO) following ESS in patients with chronic rhinosinusitis (CRS).
Design, Setting, and Participants: In a prospective, multicenter, randomized clinical trial using an intrapatient control design (ESS followed by implant placement within 1 FSO vs ESS alone on the contralateral side) 80 adult patients, with a mean (SD) age of 49.5 (13.4) years and consisting of 53 (66%) men and 27 (34%) women, were enrolled and underwent bilateral frontal sinusotomies with 1 frontal sinus randomized to receive a steroid-releasing implant. The study was carried out in 12 US centers between July 2015 and March 2016.
Interventions: A bioabsorbable steroid-releasing implant with hourglass shape containing 370 µg of mometasone furoate. All patients received standardized postoperative care.
Main Outcomes and Measures: The need for postoperative interventions, medical and surgical, in the FSO at day 30, as determined based on review of video endoscopic findings by an independent blinded surgeon. Also, endoscopic grading by the independent reviewer and clinical investigators at day 30 and day 90 and computed tomographic scan at day 90.
Results: The mean (SD) age of patients was 49.5 (13.4) years, 53 (66%) were men. Implants were successfully placed in all 80 randomized treatment sinuses. At day 30, steroid-releasing implants significantly reduced the need for postoperative interventions to 11.5% compared with 32.8% by surgery alone (mean difference, -21.3%; 95% CI, -35.1% to -7.6%), as assessed by the independent reviewer. Real-time endoscopic assessment by clinical investigators at day 30 demonstrated significant reduction in need for postoperative intervention (mean difference, -17.3%; 95% CI, -27.9% to -6.7%), significant reduction in inflammation score (mean difference, -12.3 mm; 95% CI, -18.3 to -6.4 mm), and significant reduction in rate of frontal restenosis or occlusion (mean difference, -22.7%; 95% CI, -33.5% to -11.9%) on treated compared with control sides. The results favoring the treatment sides were sustained through day 90: reduced need for postoperative interventions (mean difference, -11.7%; 95% CI, -21.0% to -2.4%) and reduction in restenosis and/or occlusion of the frontal ostium (mean difference, -17.4%; 95% CI, -28.6% to -6.1%). No implant-related adverse events were observed.
Conclusions and Relevance: The hourglass-shaped steroid-releasing sinus implant was safe and more effective in maintaining FSO patency and improving surgical outcomes compared with surgery alone in the setting where no other immediate postoperative corticosteroids were administered.
Trial Registration: ClinicalTrials.gov identifier: NCT02266810.

PMID: 29098299 [PubMed - as supplied by publisher]



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A New Method for Photocephalometry.

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A New Method for Photocephalometry.

JAMA Facial Plast Surg. 2017 Nov 02;:

Authors: Gu JT, Hu A, Oh C, Wong BJF

PMID: 29098287 [PubMed - as supplied by publisher]



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Cranioplasty Using a Mixture of Biologic and Nonbiologic Agents.

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Cranioplasty Using a Mixture of Biologic and Nonbiologic Agents.

JAMA Facial Plast Surg. 2017 Nov 02;:

Authors: Arnaoutakis D, Bahrami A, Cohn JE, Smith JE

Abstract
Importance: A surgeon faces challenges with cranioplasty techniques to achieve a successful result with relatively few complications.
Objective: To describe a unique technique for incorporating both biologic autologous bone and nonbiologic allograft materials for defect coverage in cranioplasty with favorable outcomes and low occurrence of complications.
Design, Setting, and Participants: A retrospective medical records review of all 26 patients who underwent primary cranioplasty procedure with a modified technique between January 2011 and December 2015 at a high-volume head and neck oncologic reconstructive practice was conducted; data analysis was also performed during that period. After several years of experience with traditional cranioplasty maneuvers, the modified technique has evolved to incorporate both autologous bone grafts and alloplastic materials in the formation of a shapeable on-lay material. Data were collected on demographics, need for cranioplasty, materials used, outcomes, and risk factors.
Main Outcomes and Measures: Rates of infection, hematoma, flap loss or resorption, cerebrospinal fluid leak, hardware exposure or malfunction, and repeated reconstruction.
Results: Of the 26 patients, 21 (81%) were men; mean (SD) age was 65.8 (14.3) years. Eight (31%) patients had a history of diabetes, 4 (15%) patients were receiving immunosuppressive drugs, and 5 (19%) patients were active smokers at the time of surgery. Neoplasia was the most common cause of the calvarial defect seen, responsible for 20 of 28 (71%) operative defects and necessitated procedures. All but 1 patient achieved successful mineralization following primary cranioplasty with the modified technique; this success was verified based on physical examination and follow-up imaging. Complications were rare and involved only 3 patients who developed postoperative infection; 1 (4%) of these patients lost the integrity of the cranioplasty. Thus, the rate of infection was 11% and loss rate was 4%. Preoperative and postoperative radiotherapy appeared to have no bearing on graft survival.
Conclusions and Relevance: The results using a unique technique for incorporating both biologic autologous bone and nonbiologic allograft materials for defect coverage in cranioplasty are favorable, with satisfactory aesthetic outcomes and limited postoperative complications.
Level of Evidence: 4.

PMID: 29098278 [PubMed - as supplied by publisher]



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Adjuvant External Beam Radiotherapy in Locally Advanced Differentiated Thyroid Cancer.

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Adjuvant External Beam Radiotherapy in Locally Advanced Differentiated Thyroid Cancer.

JAMA Otolaryngol Head Neck Surg. 2017 Nov 02;:

Authors: Tam S, Amit M, Boonsripitayanon M, Cabanillas ME, Busaidy NL, Gunn GB, Lai SY, Gross ND, Sturgis EM, Zafereo ME

Abstract
Importance: As incidence of differentiated thyroid cancer rises, treatment paradigms have become increasingly defined. Despite this, locally advanced disease continues to be challenging to manage. Postoperative therapy in the form of radioactive iodine (RAI) is generally recommended, but the role of external beam radiation therapy (EBRT) is less well defined.
Objective: To investigate the role of EBRT in locally advanced differentiated thyroid cancer.
Design, Setting, and Participants: For this retrospective cohort study, patients treated surgically for T4a differentiated thyroid cancer at the University of Texas MD Anderson Cancer Center from January 2000 through December 2015 were recruited, and 88 patients were included for analysis.
Exposures: Adjuvant treatment with RAI alone or both RAI and EBRT.
Main Outcomes and Measures: Disease-free survival (DFS), defined as the time from primary surgery to locoregional or distant recurrence or death due to any cause. Kaplan-Meier survival analysis was completed. Univariate and multivariate analysis was completed with Cox proportional hazards model to determine predictors of DFS.
Results: A total of 88 patients (44 women [50%]; mean [SD] age, 58.2 [15.3] years) were included in the analysis. Median (range) follow-up was 117 (12-164) months. Forty-four patients (50%) underwent RAI alone and 44 patients (50%) underwent RAI with adjuvant EBRT. Patients undergoing RAI alone did not receive EBRT owing to invasion into the recurrent laryngeal nerve only (n = 14 [32%]) or invasion into the tracheal perichondrium and/or esophageal muscularis only (n = 18 [41%]). Five-year DFS was 43% in those undergoing RAI alone, compared with 57% in those undergoing RAI and EBRT (effect size = 14%; 95% CI, -7% to 33%). Patients undergoing RAI alone had an increased rate of locoregional failure (effect size = -32%; 95% CI, -47% to -16%), with those undergoing RAI treatment alone, for minimal tracheal perichondrium and/or esophageal muscularis invasion having worse locoregional control than those with recurrent laryngeal nerve invasion only (effect size = 49%; 95% CI, 20% to 71%). Age (adjusted hazard ratio [adjusted HR], 1.02/y; 95% CI, 1.00 to 1.05) and esophageal invasion (adjusted HR, 2.30; 95% CI, 1.16 to 4.60) were independent predictors of worse DFS.
Conclusions and Relevance: The addition of EBRT to RAI results in good disease control in locally advanced differentiated thyroid cancer, particularly in patients with tracheal or esophageal invasion treated with aggressive surgical resection. Increased age and presence of esophageal invasion were independent predictors of poor disease control.

PMID: 29098272 [PubMed - as supplied by publisher]



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Life-Threatening Irinotecan-Induced Toxicity in an Adult Patient with Alveolar Rhabdomyosarcoma: The Role of a UGT1A1 Polymorphism.

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Life-Threatening Irinotecan-Induced Toxicity in an Adult Patient with Alveolar Rhabdomyosarcoma: The Role of a UGT1A1 Polymorphism.

Case Rep Oncol Med. 2017;2017:2683478

Authors: Jannin A, Hennart B, Adenis A, Chauffert B, Penel N

Abstract
Alveolar rhabdomyosarcoma (AR) in adult patients is an exceptional malignancy. Management of AR is based on (neo)adjuvant chemotherapy combining ifosfamide, vincristine, and actinomycin D and local curative-intent surgery/radiotherapy. In cases of relapsing AR, the combination of temozolomide/irinotecan is regarded as a possible option. Here we describe life-threatening long-lasting toxicity related to the 1st cycle of irinotecan-based chemotherapy in a 56-year-old woman suffering from locally advanced and metastatic head and neck AR. The patient experienced grade 4 vomiting and diarrheas resulting in acute functional renal failure, associated with grade 4 neutropenia complicated by severe septic shock. The hospital stay duration was 40 days. The analysis of the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene revealed homozygous UGT1A1 (⁎)28 polymorphism with an associated homozygous mutation c.-3275T>G; the latter is associated with a decrease of about 80% of UGT1A1 transcription explaining this irinotecan induced toxicity. Physician must be aware of the potential hematological (mainly neutropenia and infectious disease) and digestive (mainly diarrhea) toxicities caused by irinotecan and especially when the patient presents a UGT1A1 (⁎)28 homozygous allele. UGT1A genotyping performed before initiating treatment is useful to anticipate severe toxic reaction to irinotecan and improve the benefit/risk ratio of its use.

PMID: 29098099 [PubMed]



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Impact of tumoral carbonic anhydrase IX and Ki-67 expression on survival in oral squamous cell carcinoma patients.

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Impact of tumoral carbonic anhydrase IX and Ki-67 expression on survival in oral squamous cell carcinoma patients.

Oncol Lett. 2017 Nov;14(5):5434-5442

Authors: Brockton NT, Lohavanichbutr P, Enwere EK, Upton MP, Kornaga EN, Nakoneshny SC, Bose P, Chen C, Dort JC

Abstract
Oral squamous cell carcinoma (OSCC) is the most commonly diagnosed type of head and neck cancer, accounting for ~300,000 new cases worldwide annually. Carbonic anhydrase IX (CAIX) and Ki-67 have been associated with reduced disease-specific survival (DSS) in patients with OSCC. We previously proposed a combined CAIX and Ki-67 signature of 'functional hypoxia' and sought to replicate this association in a larger independent cohort of patients with OSCC at the Fred Hutchinson Cancer Research Center (FHCRC) in Seattle. The study population included patients with incident primary OSCC treated at the University of Washington Medical Center and the Harborview Medical Center in Seattle between December 2003 and February 2012. Archived tumor blocks were obtained with tissue samples from 189 patients, and triplicate 0.6 mm cores were assembled into tissue microarrays (TMAs). Fluorescence immunohistochemistry and AQUAnalysis(®) were used to quantify the expression of tumoral CAIX (tCAIX) and stromal CAIX (sCAIX) and tumoral Ki-67 for each TMA core. Hazard ratios for DSS were calculated using Cox proportional hazards analysis. High tCAIX and sCAIX expression levels were associated with reduced DSS (aHR=1.003, 95% CI:1.00-1.01 and aHR=1.010, 95% CI:1.001-1.019, per AQUA score unit, respectively). Ki-67 expression was not associated with survival (aHR=1.01, 95% CI:0.99-1.02) in the FHCRC cohort. DSS for patients with high sCAIX and low Ki-67 did not differ from that of other patient groups. Elevated tCAIX was associated with reduced DSS as a continuous and as a dichotomized (75%) variable. sCAIX was associated with DSS as a continuous variable but not when dichotomized (75%). However, the previously proposed 'functional hypoxia' signature was not replicated in the current FHCRC study. The failure to replicate our prior observation of poorer survival in patients with combined high sCAIX and low tumoral Ki-67 was likely due to the absence of an association between tumoral Ki-67 and DSS in this cohort. However, the association between DSS and tCAIX and sCAIX supports a role for CAIX in OSCC clinical outcomes.

PMID: 29098033 [PubMed]



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