Τετάρτη, 8 Νοεμβρίου 2017

Impact of improved attenuation correction featuring a bone atlas and truncation correction on PET quantification in whole-body PET/MR

Abstract

Purpose

Recent studies have shown an excellent correlation between PET/MR and PET/CT hybrid imaging in detecting lesions. However, a systematic underestimation of PET quantification in PET/MR has been observed. This is attributable to two methodological challenges of MR-based attenuation correction (AC): (1) lack of bone information, and (2) truncation of the MR-based AC maps (μmaps) along the patient arms. The aim of this study was to evaluate the impact of improved AC featuring a bone atlas and truncation correction on PET quantification in whole-body PET/MR.

Methods

The MR-based Dixon method provides four-compartment μmaps (background air, lungs, fat, soft tissue) which served as a reference for PET/MR AC in this study. A model-based bone atlas provided bone tissue as a fifth compartment, while the HUGE method provided truncation correction. The study population comprised 51 patients with oncological diseases, all of whom underwent a whole-body PET/MR examination. Each whole-body PET dataset was reconstructed four times using standard four-compartment μmaps, five-compartment μmaps, four-compartment μmaps + HUGE, and five-compartment μmaps + HUGE. The SUVmax for each lesion was measured to assess the impact of each μmap on PET quantification.

Results

All four μmaps in each patient provided robust results for reconstruction of the AC PET data. Overall, SUVmax was quantified in 99 tumours and lesions. Compared to the reference four-compartment μmap, the mean SUVmax of all 99 lesions increased by 1.4 ± 2.5% when bone was added, by 2.1 ± 3.5% when HUGE was added, and by 4.4 ± 5.7% when bone + HUGE was added. Larger quantification bias of up to 35% was found for single lesions when bone and truncation correction were added to the μmaps, depending on their individual location in the body.

Conclusion

The novel AC method, featuring a bone model and truncation correction, improved PET quantification in whole-body PET/MR imaging. Short reconstruction times, straightforward reconstruction workflow, and robust AC quality justify further routine clinical application of this method.



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Dual energy computed tomography for the head

Abstract

Dual energy CT (DECT) is a promising technology that provides better diagnostic accuracy in several brain diseases. DECT can generate various types of CT images from a single acquisition data set at high kV and low kV based on material decomposition algorithms. The two-material decomposition algorithm can separate bone/calcification from iodine accurately. The three-material decomposition algorithm can generate a virtual non-contrast image, which helps to identify conditions such as brain hemorrhage. A virtual monochromatic image has the potential to eliminate metal artifacts by reducing beam-hardening effects. DECT also enables exploration of advanced imaging to make diagnosis easier. One such novel application of DECT is the X-Map, which helps to visualize ischemic stroke in the brain without using iodine contrast medium.



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Heterogeneity of longitudinal and circumferential contraction in relation to late gadolinium enhancement in hypertrophic cardiomyopathy patients with preserved left ventricular ejection fraction

Abstract

Purpose

To evaluate heterogeneity of myocardial contraction in relation to extensive late gadolinium enhancement (LGE) in hypertrophic cardiomyopathy (HCM) patients with preserved left ventricular ejection fraction, using fast strain-encoded magnetic resonance imaging.

Materials and methods

Twenty-two HCM patients and 24 age-matched control subjects were included in this retrospective study. The regional and global peak values of longitudinal and circumferential strain (LSregional, LSglobal, CSregional, CSglobal), and their regional heterogeneities were evaluated using coefficients of variation (LSCoV, CSCoV) in relation to LGE. Receiver operating characteristic curve analysis was performed to identify patients with a total left ventricular myocardial LGE ≥ 15%.

Results

LSglobal in HCM patients was significantly decreased compared to that in controls (− 14.4 ± 2.4% vs − 17.2 ± 2.0%; p = 0.0004), while CSglobal was not (p = 1.0). Negative LGE segments demonstrated decreased LSregional in HCM patients compared to in controls (p < 0.0001), while CSregional was not decreased. CSCoV demonstrated the largest area under the curve (AUC) (0.91), with high sensitivity (83%) and specificity (94%) for detection of HCM patients with extensive LGE, while the AUC of LSCoV was low (0.49).

Conclusion

The heterogeneity in CSregional has a high diagnostic value for detection of HCM patients with extensive LGE.



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Marine radioecology after the Fukushima Dai-ichi nuclear accident: Are we better positioned to understand the impact of radionuclides in marine ecosystems?

Publication date: 15 March 2018
Source:Science of The Total Environment, Volume 618
Author(s): J. Vives i Batlle, M. Aoyama, C. Bradshaw, J. Brown, K.O. Buesseler, N. Casacuberta, M. Christl, C. Duffa, N.R.E.N. Impens, M. Iosjpe, P. Masqué, J. Nishikawa
This paper focuses on how a community of researchers under the COMET (CO-ordination and iMplementation of a pan European projecT for radioecology) project has improved the capacity of marine radioecology to understand at the process level the behaviour of radionuclides in the marine environment, uptake by organisms and the resulting doses after the Fukushima Dai-ichi nuclear accident occurred in 2011. We present new radioecological understanding of the processes involved, such as the interaction of waterborne radionuclides with suspended particles and sediments or the biological uptake and turnover of radionuclides, which have been better quantified and mathematically described.We demonstrate that biokinetic models can better represent radionuclide transfer to biota in non-equilibrium situations, bringing more realism to predictions, especially when combining physical, chemical and biological interactions that occur in such an open and dynamic environment as the ocean. As a result, we are readier now than we were before the FDNPP accident in terms of having models that can be applied to dynamic situations.The paper concludes with our vision for marine radioecology as a fundamental research discipline and we present a strategy for our discipline at the European and international levels. The lessons learned are presented along with their possible applicability to assess/reduce the environmental consequences of future accidents to the marine environment and guidance for future research, as well as to assure the sustainability of marine radioecology. This guidance necessarily reflects on why and where further research funding is needed, signalling the way for future investigations.

Graphical abstract

image


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Radionuclide concentration processes in marine organisms: A comprehensive review

Publication date: Available online 8 November 2017
Source:Journal of Environmental Radioactivity
Author(s): Fernando P. Carvalho
The first measurements made of artificial radionuclides released into the marine environment did reveal that radionuclides are concentrated by marine biological species. The need to report radionuclide accumulation in biota in different conditions and geographical areas prompted the use of concentration factors as a convenient way to describe the accumulation of radionuclides in biota relative to radionuclide concentrations in seawater. Later, concentration factors became a tool in modelling radionuclide distribution and transfer in aquatic environments and to predicting radioactivity in organisms. Many environmental parameters can modify the biokinetics of accumulation and elimination of radionuclides in marine biota, but concentration factors remained a convenient way to describe concentration processes of radioactive and stable isotopes in aquatic organisms. Revision of CF values is periodically undertaken by international organizations, such as the International Atomic Energy Agency (IAEA), to make updated information available to the international community. A brief commented review of radionuclide concentration processes and concentration factors in marine organisms is presented for key groups of radionuclides such as fission products, activation products, transuranium elements, and naturally-occurring radionuclides.



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Analysis of Contaminated Nuclear Plant Steel by Laser-Induced Breakdown Spectroscopy

Publication date: Available online 7 November 2017
Source:Journal of Hazardous Materials
Author(s): Adam Lang, Dirk Engelberg, Nicholas T. Smith, Divyesh Trivedi, Owen Horsfall, Anthony Banford, Philip A. Martin, Paul Coffey, William R. Bower, Clemens Walther, Martin Weiß, Hauke Bosco, Alex Jenkins, Gareth T.W. Law
Laser Induced Breakdown Spectroscopy (LIBS) has the potential to allow direct, standoff measurement of contaminants on nuclear plant. Here, LIBS is evaluated as an analytical tool for measurement of Sr and Cs contamination on type 304 stainless steel surfaces. Samples were reacted in model acidic (PUREX reprocessing) and alkaline (spent fuel ponds) Sr and Cs bearing liquors, with LIBS multi-pulse ablation also explored to measure contaminant penetration. The Sr II (407.77nm) and Cs I (894.35nm) emission lines could be separated from the bulk emission spectra, though only Sr could be reliably detected at surface loadings > 0.5mg cm−2. Depth profiling showed decay of the Sr signal with time, but importantly, elemental analysis indicated that material expelled from LIBS craters is redistributed and may interfere in later laser shot analyses.



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A prospective evaluation of hippocampal radiation dose volume effects and memory deficits following cranial irradiation

To prospectively evaluate hippocampal radiation dose volume effects and memory decline following cranial irradiation.

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CT brain artefact due to air bubbles in the oil cooling system: characteristic band-like configuration on sagittal reformatted image

Abstract

Purpose

To retrospectively review the imaging characteristics of CT artefacts due to air bubbles within the oil cooling system of the X-ray tube housing.

Materials and methods

Air bubbles were introduced into the oil cooling system of the X-ray tube housing during tube replacement in one of the CT scanners in the authors' institution. All 126 CT brain studies performed in this period were retrospectively reviewed. One hundred and four studies were negative for artefacts. Artefacts were confirmed in 5 and considered probable in 17 studies, respectively. The imaging characteristics of artefacts in these 22 cases were analysed.

Results

All artefacts manifested as ill-defined hypoattenuations in the periventricular/subcortical white matter of bilateral cerebral hemispheres with/without involvement of the internal capsule and basal ganglia. The posterior fossa was also involved in two (40%) confirmed and four (24%) probable studies. A band-like configuration of hypoattenuations on sagittal images was observed in five (100%) confirmed and eight (47%) probable studies.

Conclusion

Air bubble artefacts manifested as hypoattenuations in the periventricular/subcortical white matter of the supratentorial brain. A characteristic band-like configuration was observed in the sagittal reformatted image, which is useful for differentiating it from periventricular small vessel disease.



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Image Quality and Geometric Distortion of Modern Diffusion-Weighted Imaging Sequences in Magnetic Resonance Imaging of the Prostate.

Purpose: The aim of this study was to compare qualitative and quantitative image quality and geometric distortion of 4 magnetic resonance diffusion-weighted imaging (DWI) sequences of the prostate using comparable imaging parameters and similar acquisition times. Methods and Materials: Axial T2-weighted turbo spin echo images and axial DWI echo-planar imaging (EPI) sequences, including single-shot spin-echo (ss-EPI), readout-segmented multishot (rs-EPI), selective excitation-reduced field of view (sTX-EPI), and prototype single-shot technique applying slice-specific shimming (iShim-EPI) sequences, were acquired at 3 T in 10 healthy volunteers (mean age, 26.1 +/- 3.8 years; body mass index, 23.2 +/- 3.0 kg/m2). Two radiologists, blinded to the type of DWI, independently rated DWIs on a 5-point Likert scale regarding subjective image quality features (resolution, demarcation of prostate capsule, zonal anatomy). Interreader agreement was assessed using the intraclass correlation coefficient. Signal-to-noise ratio (SNR) and apparent diffusion coefficient (ADC) values were assessed separately in the peripheral and transitional zone. For the analysis of geometric distortion, the diameter of the prostate from left to right and from anterior to posterior was measured at the level of the verumontanum on b-1000 DWIs and on T2-weighted turbo spin echo images. Differences were compared using the Wilcoxon rank sum test for qualitative parameters, analysis of variance, and Friedman test for quantitative parameters. A P value of less than 0.05 was considered significant, with correction for multiple comparisons. Results: Interreader agreement was good to excellent (intraclass correlation coefficient, 0.71-0.79) for all qualitative features. Subjective image quality regarding "resolution" was significantly better for ss-EPI than rs-EPI (mean Likert score, 4.25 vs 3.8; P = 0.031) and sTX-EPI (4.25 vs 3.3; P = 0.046) and for iShim-EPI as compared with rs-EPI (4.4 vs 3.8; P = 0.031) and sTX-EPI (4.4 vs 3.3; P = 0.047). There was no significant difference regarding capsule demarcation and zonal anatomy. Signal-to-noise ratio was significantly higher in iShim-EPI than sTX-EPI (SNR +/- standard deviation [SD], 28.13 +/- 8.21 vs 14.96 +/- 2.4; P = 0.015). The ADC values were lower for the peripheral zone in the sTX-EPI than in the ss-EPI (ADC +/- SD, 1002.94 +/- 83.51 vs 1165.05 +/- 115.64; P = 0.013) and the rs-EPI (1002.94 +/- 83.51 vs 1244.40 +/- 89.95; P = 0.0012) and in the transitional zone in the sTX-EPI compared with the rs-EPI (874.50 +/- 200.72 vs 1261.47 +/- 179.23; P = 0.0021). There were no statistically significant differences in geometric distortion between all DWI sequences. Conclusions: Single-shot spin-echo EPI and iShim-EPI showed a tendency toward superior image quality and SNR compared with rs-EPI and sTX-EPI with no significant differences in geometric distortion. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Image Quality and Geometric Distortion of Modern Diffusion-Weighted Imaging Sequences in Magnetic Resonance Imaging of the Prostate.

Purpose: The aim of this study was to compare qualitative and quantitative image quality and geometric distortion of 4 magnetic resonance diffusion-weighted imaging (DWI) sequences of the prostate using comparable imaging parameters and similar acquisition times. Methods and Materials: Axial T2-weighted turbo spin echo images and axial DWI echo-planar imaging (EPI) sequences, including single-shot spin-echo (ss-EPI), readout-segmented multishot (rs-EPI), selective excitation-reduced field of view (sTX-EPI), and prototype single-shot technique applying slice-specific shimming (iShim-EPI) sequences, were acquired at 3 T in 10 healthy volunteers (mean age, 26.1 +/- 3.8 years; body mass index, 23.2 +/- 3.0 kg/m2). Two radiologists, blinded to the type of DWI, independently rated DWIs on a 5-point Likert scale regarding subjective image quality features (resolution, demarcation of prostate capsule, zonal anatomy). Interreader agreement was assessed using the intraclass correlation coefficient. Signal-to-noise ratio (SNR) and apparent diffusion coefficient (ADC) values were assessed separately in the peripheral and transitional zone. For the analysis of geometric distortion, the diameter of the prostate from left to right and from anterior to posterior was measured at the level of the verumontanum on b-1000 DWIs and on T2-weighted turbo spin echo images. Differences were compared using the Wilcoxon rank sum test for qualitative parameters, analysis of variance, and Friedman test for quantitative parameters. A P value of less than 0.05 was considered significant, with correction for multiple comparisons. Results: Interreader agreement was good to excellent (intraclass correlation coefficient, 0.71-0.79) for all qualitative features. Subjective image quality regarding "resolution" was significantly better for ss-EPI than rs-EPI (mean Likert score, 4.25 vs 3.8; P = 0.031) and sTX-EPI (4.25 vs 3.3; P = 0.046) and for iShim-EPI as compared with rs-EPI (4.4 vs 3.8; P = 0.031) and sTX-EPI (4.4 vs 3.3; P = 0.047). There was no significant difference regarding capsule demarcation and zonal anatomy. Signal-to-noise ratio was significantly higher in iShim-EPI than sTX-EPI (SNR +/- standard deviation [SD], 28.13 +/- 8.21 vs 14.96 +/- 2.4; P = 0.015). The ADC values were lower for the peripheral zone in the sTX-EPI than in the ss-EPI (ADC +/- SD, 1002.94 +/- 83.51 vs 1165.05 +/- 115.64; P = 0.013) and the rs-EPI (1002.94 +/- 83.51 vs 1244.40 +/- 89.95; P = 0.0012) and in the transitional zone in the sTX-EPI compared with the rs-EPI (874.50 +/- 200.72 vs 1261.47 +/- 179.23; P = 0.0021). There were no statistically significant differences in geometric distortion between all DWI sequences. Conclusions: Single-shot spin-echo EPI and iShim-EPI showed a tendency toward superior image quality and SNR compared with rs-EPI and sTX-EPI with no significant differences in geometric distortion. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The Predictive Values of Lesion Size, F-18 FDG Avidity and I-131 Avidity for the Clinical Outcome of I-131 Treatment in Patients with Metastatic Differentiated Thyroid Carcinoma Only in the Lung

Abstract

Purpose

We aimed to evaluate the prognostic values of radiography, F-18 FDG PET, and I-131 whole body scans in patients with lung-only metastasis from differentiated thyroid carcinoma (DTC).

Methods

Between 1998 and 2013, we included 31 patients (F: 26, M: 5) with lung-only metastasis from DTC who had been treated with I-131 and underwent PET. Lung metastasis was categorized according to the size (macronodular ≥1.0 cm vs. micronodular <1.0 cm), FDG avidity (avid vs. non-avid), and I-131 avidity (avid vs. non-avid). Progression-free survival (PFS) was evaluated for each patient.

Results

Among 31 patients, seven (23%) had macronodular lung metastasis, 26 (84%) had FDG avid lung metastasis, and 16 (52%) had I-131 avid lung metastasis. During the median follow-up period of 9.4 y, median PFS was 6.1 y. Based on Kaplan-Meier analysis, macronodular lung metastasis (p = 0.017) and I-131 non-avid lung metastasis (p = 0.059) were significantly associated with worse outcomes, but FDG avid lung metastasis was not (p = 0.135). Patients with FDG non-avid lung metastasis did not experience disease progression during follow-up, while 11 of 26 patients (42%) experienced disease progression. Based on univariate analysis, the hazard ratio for a poor prognosis was 3.78 (p = 0.029) for macronodular lung metastasis and 3.29 (p = 0.079) for I-131 non-avid lung metastasis.

Conclusions

Macronodular and I-131 non-avid lung metastasis were associated with a poor prognosis in lung-only metastasis from DTC. Although FDG avid lung metastasis may be associated with a poor prognosis, a larger-scale study is needed.



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Imaging the multiple facets of immuno-oncology



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18F-DOPA PET/CT and 68Ga-DOTANOC PET/CT scans as diagnostic tools in focal congenital hyperinsulinism: a blinded evaluation

Abstract

Purpose

Focal congenital hyperinsulinism (CHI) is curable by surgery, which is why identification of the focal lesion is crucial. We aimed to determine the use of 18F–fluoro-dihydroxyphenylalanine (18F-DOPA) PET/CT vs. 68Ga-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic-acid-1-Nal3-octreotide (68Ga-DOTANOC) PET/CT as diagnostic tools in focal CHI.

Methods

PET/CT scans of children with CHI admitted to Odense University Hospital between August 2005 and June 2016 were retrospectively evaluated visually and by their maximal standardized uptake values (SUVmax) by two independent examiners, blinded for clinical, surgical and pathological data. Pancreatic histology was used as the gold standard. For patients without surgery, the genetic profile served as the gold standard.

Results

Fifty-five CHI patients were examined by PET/CT (18F-DOPA n = 53, 68Ga-DOTANOC n = 18). Surgery was performed in 34 patients, no surgery in 21 patients. Fifty-one patients had a classifiable outcome, either by histology (n = 33, 22 focal lesions, 11 non-focal) or by genetics (n = 18, all non-focal). The predictive performance of 18F-DOPA PET/CT to identify focal CHI was identical by visual- and cut-off-based evaluation: sensitivity (95% CI) of 1 (0.85–1); specificity of 0.96 (0.82–0.99). The optimal 18F-DOPA PET SUVmax ratio cut-off was 1.44 and the optimal 68Ga-DOTANOC PET SUVmax cut-off was 6.77 g/ml. The area under the receiver operating curve was 0.98 (0.93–1) for 18F-DOPA PET vs. 0.71 (0.43–0.95) for 68Ga-DOTANOC PET (p < 0.03). In patients subjected to surgery, localization of the focal lesion was correct in 91%, and 100%, by 18F-DOPA PET/CT and 68Ga-DOTANOC PET/CT, respectively.

Conclusion

18F-DOPA PET/CT was excellent in predicting focal CHI and superior compared to 68Ga-DOTANOC PET/CT. Further use of 68GA-DOTANOC PET/CT in predicting focal CHI is discouraged.



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Mitteilungen des Berufsverbandes der Deutschen Radiologen



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Posttherapeutische Veränderungen am muskuloskelettalen System



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Radionuclide concentration processes in marine organisms: A comprehensive review

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Publication date: Available online 8 November 2017
Source:Journal of Environmental Radioactivity
Author(s): Fernando P. Carvalho
The first measurements made of artificial radionuclides released into the marine environment did reveal that radionuclides are concentrated by marine biological species. The need to report radionuclide accumulation in biota in different conditions and geographical areas prompted the use of concentration factors as a convenient way to describe the accumulation of radionuclides in biota relative to radionuclide concentrations in seawater. Later, concentration factors became a tool in modelling radionuclide distribution and transfer in aquatic environments and to predicting radioactivity in organisms. Many environmental parameters can modify the biokinetics of accumulation and elimination of radionuclides in marine biota, but concentration factors remained a convenient way to describe concentration processes of radioactive and stable isotopes in aquatic organisms. Revision of CF values is periodically undertaken by international organizations, such as the International Atomic Energy Agency (IAEA), to make updated information available to the international community. A brief commented review of radionuclide concentration processes and concentration factors in marine organisms is presented for key groups of radionuclides such as fission products, activation products, transuranium elements, and naturally-occurring radionuclides.



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Haralick’s texture features for the prediction of response to therapy in colorectal cancer: a preliminary study

Abstract

Purpose

Haralick features Texture analysis is a recent oncologic imaging biomarker used to assess quantitatively the heterogeneity within a tumor. The aim of this study is to evaluate which Haralick's features are the most feasible in predicting tumor response to neoadjuvant chemoradiotherapy (CRT) in colorectal cancer.

Materials and Methods

After MRI and histological assessment, eight patients were enrolled and divided into two groups based on response to neoadjuvant CRT in complete responders (CR) and non-responders (NR). Oblique Axial T2-weighted MRI sequences before CRT were analyzed by two radiologists in consensus drawing a ROI around the tumor. 14 over 192 Haralick's features were extrapolated from normalized gray-level co-occurrence matrix in four different directions. A dedicated statistical analysis was performed to evaluate distribution of the extracted Haralick's features computing mean and standard deviation.

Results

Pretreatment MRI examination showed significant value (p < 0.05) of 5 over 14 computed Haralick texture. In particular, the significant features are the following: concerning energy, contrast, correlation, entropy and inverse difference moment.

Conclusions

Five Haralick's features showed significant relevance in the prediction of response to therapy in colorectal cancer and might be used as additional imaging biomarker in the oncologic management of colorectal patients.



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Radiation dose exposure in patients affected by lymphoma undergoing repeat CT examinations: how to manage the radiation dose variability

Abstract

Purpose

To assess the variability of radiation dose exposure in patients affected by lymphoma undergoing repeat CT (computed tomography) examinations and to evaluate the influence of different scan parameters on the overall radiation dose.

Materials and methods

A series of 34 patients (12 men and 22 women with a median age of 34.4 years) with lymphoma, after the initial staging CT underwent repeat follow-up CT examinations. For each patient and each repeat examination, age, sex, use of AEC system (Automated Exposure Control, i.e. current modulation), scan length, kV value, number of acquired scans (i.e. number of phases), abdominal size diameter and dose length product (DLP) were recorded. The radiation dose of just one venous phase was singled out from the DLP of the entire examination. All scan data were retrieved by our PACS (Picture Archiving and Communication System) by means of a dose monitoring software.

Results

Among the variables we considered, no significant difference of radiation dose was observed among patients of different ages nor concerning tube voltage. On the contrary the dose delivered to the patients varied depending on sex, scan length and usage of AEC. No significant difference was observed depending on the behaviour of technologists, while radiologists' choices had indirectly an impact on the radiation dose due to the different number of scans requested by each of them.

Conclusions

Our results demonstrate that patients affected by lymphoma who undergo repeat whole body CT scanning may receive unnecessary overexposure. We quantified and analyzed the most relevant variables in order to provide a useful tool to manage properly CT dose variability, estimating the amount of additional radiation dose for every single significant variable. Additional scans, incorrect scan length and incorrect usage of AEC system are the most relevant cause of patient radiation exposure.



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International Day of Radiology 2017 : Emergency Radiology

Presenting a short teaching video on IDoR2017. Wishing all Radiologists all the best on this day when the science of radiology was started in 1895 by Roentgen.
Famous Radiology Blog http://ift.tt/1MM2hKr TeleRad Providers at http://ift.tt/1NgppuI Mail us at sales@teleradproviders.com


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Is dose de-escalation possible in sarcoma patients treated with enlarged limb sparing resection?

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Publication date: Available online 7 November 2017
Source:Radiotherapy and Oncology
Author(s): Antonin Levy, Sylvie Bonvalot, Sara Bellefqih, Philippe Terrier, Axel Le Cesne, Cécile Le Péchoux
PurposeTo evaluate the impact of dose de-escalation in a large series of resected limbs soft tissue sarcomas (STS).MethodsData were retrospectively analysed from 414 consecutive patients treated for limb STS by enlarged surgery and radiotherapy at Gustave Roussy from 05/1993 to 05/2012. Radiotherapy (RT) dose level was decided by the multidisciplinary staff and depended upon the quality of surgery and margins size.ResultsRT was delivered prior (13%) or after (87%) surgery. Seven patients (2%) had pre- and a postoperative RT boost. Median delivered RT dose was 50 Gy (36–70 Gy), and 33% received ≥55 Gy. At a median follow-up of 6.8 years, the 5-year actuarial local relapse (LR) rate was 7% (95% CI: 4.4–10%). The median time to the first LR was 2.7 years (range: 0.6–11.2 years). The LR was most often located within the irradiated field (26/32; 81%), where the median total applied dose was 56 Gy (range, 40–60 Gy). The 5-year LR rates were 4%, and 15% in patients receiving <55 Gy, and in those who had ≥55 Gy (p < 0.001), respectively. In the multivariate analysis, dose ≥55 Gy (HR [hazard ratio]: 2.9; p = 0.02), certain histological subtypes (HR: 7.8; p < 0.001), and minimal surgical margins <1 mm (HR: 2.9; p = 0.02) were associated to higher LR rates. In the subgroup of patients with "positive" margins <1 mm (n = 102), these histological subtypes (HR: 4.4; p = 0.03), and inadequate initial surgery justifying re-excision (HR: 3; p = 0.048) predicted for an increased LR, whereas dose of irradiation did not (p = 0.2). Patients who had late complications (n = 64; 15%) received higher doses of irradiation as compared with other patients (median: 55 Gy vs. 50 Gy, respectively; p < 0.001).ConclusionIn this retrospective analysis of patients having enlarged surgery and RT, histological subtype is the strongest predictor of LR, whereas dose de-escalation did not lead to worse outcomes. A dose of 50 Gy may be recommended in case of planned enlarged surgery with R0 margins.



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Sleep Apnea and Kidney Function Trajectory: Results from a 20-year Longitudinal Study of Healthy Middle-Aged Adults.

Sleep Apnea and Kidney Function Trajectory: Results from a 20-year Longitudinal Study of Healthy Middle-Aged Adults.

Sleep. 2017 Nov 03;:

Authors: Canales MT, Hagen EW, Barnet JH, Peppard PE, Derose SF

Abstract
Objective: To determine whether sleep apnea, defined by polysomnography, accelerates kidney function decline in generally healthy adults not selected for sleep apnea or kidney disease.
Methods: We performed a retrospective cohort study 855 participants from the Wisconsin Sleep Cohort Study (WSCS), a large 20-year population-based study of sleep apnea, who had at least one polysomnogram and serial measurements of serum creatinine over time. Sleep apnea was defined as an apnea-hypopnea index ≥15 or positive airway pressure (PAP) use at baseline. We compared the slope of estimated glomerular filtration rate (eGFR) change and odds of rapid eGFR decline (>2.2 ml/min/1.73m 2/year) for those with and without sleep apnea.
Results: The mean follow-up was 13.9 ± 3.4 years. The cohort was 50.4 ±7.6 years, 55% male, and 97% White. The mean eGFR was 89.3 ±13.8 ml/min/1.73m2 and 11% had sleep apnea. Overall, the mean eGFR change was -0.88 ± 1.12 ml/min/1.73m2/year. Compared to those without sleep apnea, participants with sleep apnea had a 0.2 ml/min/1.73m2/year slower eGFR decline though this was not statistically significant (95%CI [-0.06 - 0.45], p=0.134). When we excluded those on PAP therapy (n=17), eGFR decline was even slower among those with sleep apnea (0.36 ml/min/1.73m2/year slower, 95%CI [0.08-063], p=0.012). Those with sleep apnea had lower odds of rapid eGFR decline but this was not statistically significant, even after excluding PAP users.
Conclusion: Among healthy middle-aged adults, the presence of sleep apnea at baseline did not accelerate kidney function decline compared to those without sleep apnea over time.

PMID: 29112764 [PubMed - as supplied by publisher]



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Insight into Reduction of Wakefulness by Suvorexant in Patients with Insomnia: Analysis of Wake Bouts.

Insight into Reduction of Wakefulness by Suvorexant in Patients with Insomnia: Analysis of Wake Bouts.

Sleep. 2017 Nov 03;:

Authors: Svetnik V, Snyder ES, Tao P, Scammell TE, Roth T, Lines C, Herring WJ

Abstract
Objectives: To examine the duration and frequency of wake bouts underlying the wakefulness-after-sleep-onset (WASO) reduction with suvorexant.
Methods: We analyzed polysomnogram recordings from clinical trials involving 1518 insomnia patients receiving suvorexant (40/30mg, 20/15mg) or placebo to determine: 1) the number of, and time spent in, long or short wake bouts, 2) the association between sleep quality and bout characteristics. We also compared wake and sleep bout characteristics of suvorexant in insomnia patients versus zolpidem in healthy subjects undergoing experimentally-induced transient insomnia.
Results: Relative to placebo, suvorexant decreased the number and time spent in long wake bouts (>2 minutes) and increased the number and time spent in short wake bouts (≤2 minutes). The time spent in long wake bouts during Night-1 decreased by 32-54 minutes, while the time spent in short wake bouts increased by 2-6 minutes. On average, a patient returned to sleep from his/her longest awakening more than twice as fast on suvorexant than placebo. The reduced time spent in long wake bouts resulted in odds ratios of self-reported good/excellent sleep quality ranging from 1.59-2.19 versus placebo. The small increase in time spent in short wake bouts had no effect on odds ratios. Findings were more pronounced for the higher (40/30mg) doses of suvorexant. The wake and sleep bout characteristics of suvorexant differed from zolpidem which equally decreased the number of wake and sleep bouts of all durations during the early part of the night.
Conclusion: Suvorexant reduces WASO by reducing long wake bouts. This reduction has a positive effect on sleep quality.

PMID: 29112763 [PubMed - as supplied by publisher]



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European guidelines on perioperative venous thromboembolism prophylaxis: Surgery in the obese patient.

European guidelines on perioperative venous thromboembolism prophylaxis: Surgery in the obese patient.

Eur J Anaesthesiol. 2017 Nov 06;:

Authors: Venclauskas L, Maleckas A, Arcelus JI, ESA VTE Guidelines Task Force

Abstract
: A systematic literature search was performed and patients were selected as obese patients undergoing bariatric surgery or obese patients undergoing nonbariatric surgical procedures. In addition, patients were stratified according to low risk of venous thromboembolism and high risk of venous thromboembolism (age >55 years, BMI >55 kg m, history of venous thromboembolism, venous disease, sleep apnoea, hypercoagulability or pulmonary hypertension). Prophylaxis of venous thromboembolism was analysed depending on the type of modality: compression devices of the lower extremities (including intermittent pneumatic compression and graduated compression stockings), pharmacological prophylaxis or inferior vena cava filters. Two prospective studies compared mechanical devices and pharmacological prophylaxis vs. a mechanical device alone without significant differences. A few randomised controlled studies and most of the prospective nonrandomised studies showed that low-dose low molecular weight heparin (3000 to 4000 anti-Xa IU 12 h subcutaneously) was acceptable for obese patients with a lower risk of venous thromboembolism, but a higher dose of low molecular weight heparin (4000 to 6000 anti-Xa IU 12 h subcutaneously) should be proposed for obese patients with a higher risk of venous thromboembolism. Extended prophylaxis for 10 to 15 days was well tolerated for obese patients with a high risk of venous thromboembolism in the postdischarge period. The safety and efficacy of inferior vena cava filters in bariatric surgical patients is highly heterogeneous. There were no randomised trials that analysed prophylaxis of venous thromboembolism in obese patients undergoing nonbariatric surgery. Higher doses of anticoagulants could be proposed for obese patients with a BMI more than 40 kg m. The lack of good quality randomised trials with a low risk of bias did not allow us to propose strong recommendations.

PMID: 29112546 [PubMed - as supplied by publisher]



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Atomoxetine, Parent Training, and Their Effects on Sleep in Youth with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder.

Atomoxetine, Parent Training, and Their Effects on Sleep in Youth with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder.

J Child Adolesc Psychopharmacol. 2017 Nov 07;:

Authors: Hollway JA, Mendoza-Burcham M, Andridge R, Aman MG, Handen B, Arnold LE, Lecavalier L, Williams C, Silverman L, Smith T

Abstract
OBJECTIVE: Sleep disturbance is often a problem for children with either autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD). Psychostimulant medications used to treat ADHD symptoms can exacerbate this problem. For children with ASD and ADHD, atomoxetine (ATX) is a viable alternative to psychostimulants. We investigated the effects of ATX and a manualized parent training (PT) program targeting noncompliance, on the sleep quality of children with ASD and ADHD.
METHODS: Participants in a randomized clinical trial were treated with ATX + PT, ATX alone, PT alone, or placebo (PBO) alone, for 10 weeks. Fifty-four of 128 (42%) caregivers completed the Children's Sleep Habits Questionnaire (CSHQ) at baseline and endpoint. Analysis of covariance was used to investigate possible differences between treatment groups.
RESULTS: There were no significant differences between treatment groups, including PBO on the CSHQ 33-Item total score, total hours of sleep per day, and total minutes awake after sleep onset at the study endpoint.
CONCLUSION: ATX appears sleep neutral. Clinicians who treat ADHD symptoms in children and adolescents with ASD may prefer ATX over psychostimulants when sleep disturbance is an issue.

PMID: 29112459 [PubMed - as supplied by publisher]



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Connection between bone remodeling and inflammatory markers in obstructive sleep apnea in relation to disease severity: a preliminary study.

Connection between bone remodeling and inflammatory markers in obstructive sleep apnea in relation to disease severity: a preliminary study.

Pol Arch Intern Med. 2017 Nov 07;:

Authors: Bromińska B, Cyrańska-Chyrek E, Kuźnar-Kamińska B, Kostrzewska M, Winiarska H, Sawicka-Gutaj N, Zybek-Kocik A, Hernik A, Wrotkowska E, Krasiński Z, Ruchała M, Batura-Gabryel H

Abstract
INTRODUCTION    There is growing evidence that obstructive sleep apnea (OSA) influences both bone metabolism and structure. Chitinase-3-like protein 1 (YKL-40) is a novel inflammatory and remodeling marker, which was shown to increase in OSA. YKL-40 can probably alter the bone turnover.   OBJECTIVES    Assessment of a possible interplay between YKL-40 and bone turnover markers in patients with different stages of OSA. Evaluation of the relation among bone mass, OSA severity, and YKL-40 level. PATIENTS AND METHODS    The study is based on 72 male OSA patients divided into three groups according to disease severity using apnea-hypopnea index (AHI): OSA 1 n = 18 (5 ≤ AHI < 15), OSA 2 n = 25 (15 ≤ AHI < 30), OSA 3 n = 29 (AHI ≥ 30). All subjects have undergone polysomnography and densitometry. Fasting blood samples were collected for YKL-40, C-terminal telopeptide of type-1 collagen (CTX), Procollagen type 1 N-terminal propeptide (P1NP) and other markers.  RESULTS    P1NP differed between OSA 1 and OSA 2; OSA 1 and OSA 3 (P = 0.02). OSA 2 had higher CTX than OSA 1 (borderline statistical significance P = 0.05). Simple linear regression analysis showed that YKL-40 serum levels were significantly associated with CTX (P < 0.0001, β = 0.9871) and P1NP (P <0.0001, β = 0.9780) levels.  CONCLUSIONS    Our study might suggest that YKL-40 is associated with bone turnover in OSA. We may assume that it influences both bone formation and destruction; thus, OSA could be characterized by preserve BMD.

PMID: 29112186 [PubMed - as supplied by publisher]



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Role of Various Metabolic Parameters Derived From Baseline 18F-FDG PET/CT as Prognostic Markers in Non-Small Cell Lung Cancer Patients Undergoing Platinum-Based Chemotherapy.

Role of Various Metabolic Parameters Derived From Baseline 18F-FDG PET/CT as Prognostic Markers in Non-Small Cell Lung Cancer Patients Undergoing Platinum-Based Chemotherapy.

Clin Nucl Med. 2017 Nov 03;:

Authors: Sharma A, Mohan A, Bhalla AS, Sharma MC, Vishnubhatla S, Das CJ, Pandey AK, Sekhar Bal C, Patel CD, Sharma P, Agarwal KK, Kumar R

Abstract
PURPOSE: The aim of this study was to prospectively evaluate the role of various quantitative and semiquantitative metabolic parameters derived from dynamic and static baseline F-FDG PET/CT in prediction of overall survival (OS) in non-small cell lung cancer (NSCLC) patients who were planned to undergo platinum-based chemotherapy.
METHODS: Sixty patients (51 male and 9 female patients) with biopsy-proven NSCLC and mean age 59.55 ± 10.06 years who were planned to undergo platinum-based chemotherapy were enrolled in the study. Each patient underwent a baseline regional dynamic and a static whole-body F-FDG PET/CT after injecting 0.21 mCi/kg (5.18-7.77 MBq/kg) of F-FDG intravenously. Two dynamic PET/CT parameters, that is, net influx rate constant and glucose metabolic rate at 30 and 60 minutes, were evaluated. In addition, whole-body PET/CT parameters, that is, SUVmax, average SUV, tumor-to-background ratio, metabolic tumor volume (MTV), total lesion glycolysis (TLG) of the primary tumor, and MTV and TLG of whole-body tumor lesions, were evaluated. Best possible cutoffs for all parameters were calculated using receiver operating characteristic curve analysis. Survival analysis was performed using log-rank test, Kaplan-Meier curves, and Cox proportional hazards model to determine the prognostic markers for OS.
RESULTS: The median follow-up period was 4.4 months (range, 8 days to 15.9 months). In univariate analysis, the 4 static whole-body PET/CT parameters, that is, MTV, TLG, and MTV and TLG of whole-body tumor lesions, were found to be significantly associated with OS with cutoff values of 120, 800, 160, and 1350 cm and hazard ratios of 3.64 (P = 0.001), 3.35 (P = 0.002), 2.51 (P = 0.019), and 2.69 (P = 0.008), respectively. In multivariate survival analysis, MTV was found to be an independent prognostic marker for OS.
CONCLUSIONS: Baseline MTV and TLG evaluated from primary tumor as well as the whole-body tumor lesions are reliable prognostic markers of OS in NSCLC patients undergoing platinum-based chemotherapy. However, other baseline whole-body PET/CT parameters (SUVmax, average SUV, and tumor-to-background ratio) and dynamic PET/CT parameters (net influx rate constant, glucose metabolic rate) have no prognostic value in these patients.

PMID: 29112011 [PubMed - as supplied by publisher]



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Improvements in Psychological Health Following a Residential Yoga-based Program for Frontline Professionals.

Improvements in Psychological Health Following a Residential Yoga-based Program for Frontline Professionals.

J Occup Environ Med. 2017 Nov 03;:

Authors: Trent N, Miraglia M, Dusek J, Pasalis E, Khalsa SBS

Abstract
OBJECTIVE: The purpose of this pilot study was to examine the effects of a residential yoga-based program on psychological health and health behaviors in frontline professionals.
METHODS: Frontline professionals from education, health care, human services, and corrections participated in the RISE (Resilience, Integration, Self-awareness, Engagement) program and completed questionnaires at baseline, post-program, and 2 months following RISE.
RESULTS: Paired samples t tests revealed improvements in mindfulness, stress, resilience, affect, and sleep quality from baseline to post-program (all Ps < 0.001, N = 55), which were sustained at the 2-month follow-up (all Ps < 0.01, N = 40). Participants also reported increases in exercise, fruit, and vegetable consumption post-program (all Ps < 0.001), all of which persisted at the 2-month follow-up (all Ps < 0.01) except exercise.
CONCLUSION: These findings suggest that RISE improved indices of psychological health and healthy behaviors that remained 2 months following RISE.

PMID: 29111989 [PubMed - as supplied by publisher]



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Comparing the response to acute and chronic exposure to short wavelength lighting emitted from computer screens.

Comparing the response to acute and chronic exposure to short wavelength lighting emitted from computer screens.

Chronobiol Int. 2017 Nov 07;:1-11

Authors: Green A, Cohen-Zion M, Haim A, Dagan Y

Abstract
The use of electronic devices with light-emitting screens has increased exponentially in the last decade. As a result, humans are continuously exposed to unintentional artificial light. We explored the effects of acute and chronic exposure to artificial light at night (ALAN) via screen illumination on sleep, circadian rhythms, and related functional outcomes. Nineteen participants (11 female and 8 males, mean age 28.1 ± 7.2 years) underwent a six-night study with three experimental conditions using a repeated-measures design: baseline (first night, no light exposure), acute ALAN exposure (second night), and chronic ALAN exposure (third to sixth nights). Each light exposure lasted for 2 hours (21:00-23:00). Participants underwent an overnight polysomnography at the end of each condition (nights 1, 2, and 6). We collected urine samples (for melatonin metabolite analysis), while body (oral) temperatures were measured before and after exposure. Each morning, the participants filled out questionnaires and conducted a computerized attention test. Both acute and chronic illumination significantly disrupted sleep continuity and architecture and led to greater self-reported daytime sleepiness, negative emotions, and attention difficulties. Both exposure types also altered circadian rhythms, subduing the normal nocturnal decline in body temperature and dampening nocturnal melatonin secretion. In sum, ALAN exposure from electronic screens has an immediate, detrimental, yet stable effect on sleep, circadian regulation, and next-day functional outcomes. Given the widespread use of electronic devices today, our findings suggest that even one night of screen light exposure may be sufficient to cause adverse effects on health and performance.

PMID: 29111816 [PubMed - as supplied by publisher]



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Evening chronotype and sleepiness predict impairment in executive abilities and academic performance of adolescents.

Evening chronotype and sleepiness predict impairment in executive abilities and academic performance of adolescents.

Chronobiol Int. 2017 Nov 07;:1-9

Authors: Cohen-Zion M, Shiloh E

Abstract
The study aim was to better understand sleep and sleep-related factors affecting everyday executive capacities and academic performance among healthy adolescents. A cross-sectional survey on sleep, phase preference, academic performance and executive functions of high-school students was conducted. Female gender, grade status, sleepiness and evening chronotype accounted for approximately 25-30% of the variance in daily executive ability. Sleep duration was a weak predictor of executive skills. Lower school grades were associated with increased sleepiness, evening preference and poorer executive skills. These findings support the need for health education on ways to attenuate sleepiness and delayed phase in this population.

PMID: 29111789 [PubMed - as supplied by publisher]



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Short-term effects of wake- and bright light therapy on sleep in depressed youth.

Short-term effects of wake- and bright light therapy on sleep in depressed youth.

Chronobiol Int. 2017 Nov 07;:1-10

Authors: Kirschbaum I, Straub J, Gest S, Holtmann M, Legenbauer T

Abstract
Chronotherapeutics are well established for the treatment of depression and associated sleeping problems in adults. However, effects are still understudied in adolescents. Two pilot studies highlighted the crucial role of sleep when it comes to the treatment of depression, by means of chronotherapeutics, in adolescents. The aim of the present study was to investigate the role of adjunctive wake therapy (WT) in addition to bright light therapy (BLT) with respect to sleep behaviors. In the present study, 62 depressed inpatients (aged 13-18 years; diagnosed with Beck Depression Inventory Revision) were randomly assigned to two groups: BLT only (BLT-group) and a combination of BLT and WT (COMB-group). After one night of WT adolescents in the COMB-group revealed longer sleep durations, time in bed, advanced sleep onset, less wakes during night and an improved sleep efficiency. However, one night of WT plus BLT had no additional effect on sleep parameters compared with BLT-group in the long run. Therefore, future studies should assess whether more nights of WT might lead to more sustainable effects.

PMID: 29111784 [PubMed - as supplied by publisher]



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Is It Adequate to Assess Prenatal Smoking Risk to Infants Without Considering Socioeconomic Status?

Is It Adequate to Assess Prenatal Smoking Risk to Infants Without Considering Socioeconomic Status?

Am J Respir Crit Care Med. 2017 Nov 07;:

Authors: Ong T, Schechter MS

PMID: 29111767 [PubMed - as supplied by publisher]



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Influenza and Pneumocystis jirovecii pneumonia in an allogeneic hematopoietic stem cell transplantation recipient: Co-infection or superinfection?

Influenza and Pneumocystis jirovecii pneumonia in an allogeneic hematopoietic stem cell transplantation recipient: Co-infection or superinfection?

Transpl Infect Dis. 2017 Nov 07;:

Authors: Burke J, Soubani AO

Abstract
Influenza infection and Pneumocystis jirovecii pneumonia (PJP) in hematopoietic stem cell transplant (HSCT) patients are well characterized, however no dual infections have been reported in this patient population and little evidence of mechanisms of interaction between the two infections exists. We present a 53-year-old male allogeneic HSCT patient on immunosuppressive therapy for the treatment of graft-versus-host disease initially diagnosed with influenza A H3, and later PJP. Despite the development of acute respiratory distress syndrome, the patient was successfully treated with appropriate antimicrobial therapy and aggressive supportive care. This case demonstrates the necessity of maintaining a high index of suspicion for fungal (including PJP) co-infection or superinfection in the setting of worsening influenza infection. This article is protected by copyright. All rights reserved.

PMID: 29111605 [PubMed - as supplied by publisher]



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Anxiety and insomnia in young- and middle-aged adult hip pain patients with and without femoroacetabular impingement and developmental hip dysplasia.

Anxiety and insomnia in young- and middle-aged adult hip pain patients with and without femoroacetabular impingement and developmental hip dysplasia.

PM R. 2017 Oct 27;:

Authors: Prather H, Creighton A, Sorenson C, Simpson S, Reese M, Hunt D, Rho M

Abstract
BACKGROUND: Hip pain in young and middle- aged adults with and without hip deformity receive treatment focused primarily related to hip structure. Because their hip pain may be chronic, these patients develop other modifiable co-existing disorders related to pain that go undiagnosed in this young and active population including insomnia and anxiety.
OBJECTIVE: The objective is to compare assessments of insomnia and anxiety in young and middle-aged adults presenting with hip pain with no greater than minimal osteoarthritis (OA) compared to asymptomatic (healthy) controls.Comparisons between types of hip deformity and no hip deformity in hip pain patients were performed to assess if patients with specific hip deformities were likely to have insomnia or anxiety as a cofounding disorder to their hip pain.
DESIGN: Prospective case series with control comparison.
SETTING: Two tertiary university physiatry outpatient clinics.
PARTICIPANTS: Fifty hip pain patients aged 18-40 years and 50 gender and aged matched healthy controls.
METHODS: Patients were enrolled if: 2 provocative hip tests were found on physical examination and hip radiographs had no or minimal OA. Radiographic hip deformity measurements were completed by an independent examiners. Comparisons of insomnia and anxiety were completed between: 1) 50 hip pain patients and 50 controls and 2) patients with different types of hip deformity.
MAIN OUTCOME MEASURES: Insomnia severity Index (ISI) and Pain anxiety Symptom Scale (PASS) RESULTS: Fifty hip pain patients (11 male, 39 female) with mean age of 31.2+8.31 years enrolled. Hip pain patients slept significantly less (p=.001) per night than controls. Patients experienced significantly greater insomnia (p=.0001) and anxiety (p=.0001) compared to controls. No differences were found in insomnia and anxiety scores between hip pain patients with and without hip deformity or between types of hip deformity.
CONCLUSION: Hip pain patients with radiographs demonstrating minimal to no hip arthritis with and without hip deformity experience significant cofounding yet modifiable disorders of sleep and anxiety. If recognized early in presentation, treatment of insomnia and anxiety ultimately will improve outcomes for hip patients treated conservatively or surgically for their hip disorder.

PMID: 29111466 [PubMed - as supplied by publisher]



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High and low use of electronic media during nighttime before going to sleep: A comparative study between adolescents attending a morning or afternoon school shift.

High and low use of electronic media during nighttime before going to sleep: A comparative study between adolescents attending a morning or afternoon school shift.

J Adolesc. 2017 Oct 28;61:152-163

Authors: Arrona-Palacios A

Abstract
This study compared the effects of time spent on electronic media devices during nighttime before going to sleep on the sleep-wake cycle, daytime sleepiness, and chronotype in 568 Mexican students (288 girls, mean age = 14.08) attending a double school shift system (287 from morning shift and 281 from afternoon shift). Students completed anonymous self-report questionnaires. Results suggest that high exposure to an electronic media device may have an impact on their sleep-wake cycle, regardless of their school shift. Adolescents from the afternoon shift reported more time spent on devices. Those from the morning shift reported daytime sleepiness with the use of MP3 player, and from the afternoon shift with the use of computer, MP3 player, and television. Both school shifts reported an intermediate chronotype with all electronic media devices, but the afternoon shift with a tendency towards eveningness with the use of the computer, smartphone, and MP3 player.

PMID: 29111446 [PubMed - as supplied by publisher]



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Shorter sleep duration and longer sleep onset latency are related to difficulty disengaging attention from negative emotional images in individuals with elevated transdiagnostic repetitive negative thinking.

Shorter sleep duration and longer sleep onset latency are related to difficulty disengaging attention from negative emotional images in individuals with elevated transdiagnostic repetitive negative thinking.

J Behav Ther Exp Psychiatry. 2017 Oct 19;58:114-122

Authors: Nota JA, Coles ME

Abstract
BACKGROUND AND OBJECTIVES: Repetitive negative thinking (RNT) is often associated with disruptions in sleep and circadian rhythms. Disruptions in sleep and circadian rhythms may deal a "second hit" to attentional control deficits. This study evaluated whether sleep and circadian rhythm disruptions are related to the top-down control of attention to negative stimuli in individuals with heightened repetitive negative thinking.
METHODS: Fifty-two community adults with high levels of transdiagnostic RNT and varying habitual sleep durations and bedtimes participated in a hybrid free-viewing and directed attention task using pairs of emotionally-evocative and neutral images while eye-tracking data were collected. Self-report and clinician-administered interviews regarding sleep were also collected.
RESULTS: Shorter habitual sleep duration was associated with more time looking at emotionally negative compared to neutral images during a free-viewing attention task and more difficulty disengaging attention from negative compared to neutral images during a directed attention task. In addition, longer sleep onset latencies were also associated with difficulty disengaging attention from negative stimuli. The relations between sleep and attention for positive images were not statistically significant.
LIMITATIONS: A causal link between sleep and attentional control cannot be inferred from these cross-sectional data. The lack of a healthy control sample means that the relations between sleep disruption, attention, and emotional reactivity may not be unique to individuals with RNT.
CONCLUSIONS: These findings suggest that sleep disruption may be associated with a specific impact on cognitive resources that are necessary for the top-down inhibitory control of attention to emotionally negative information.

PMID: 29111422 [PubMed - as supplied by publisher]



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Diagnosis of multiple system atrophy.

Diagnosis of multiple system atrophy.

Auton Neurosci. 2017 Oct 23;:

Authors: Palma JA, Norcliffe-Kaufmann L, Kaufmann H

Abstract
Multiple system atrophy (MSA) may be difficult to distinguish clinically from other disorders, particularly in the early stages of the disease. An autonomic-only presentation can be indistinguishable from pure autonomic failure. Patients presenting with parkinsonism may be misdiagnosed as having Parkinson disease. Patients presenting with the cerebellar phenotype of MSA can mimic other adult-onset ataxias due to alcohol, chemotherapeutic agents, lead, lithium, and toluene, or vitamin E deficiency, as well as paraneoplastic, autoimmune, or genetic ataxias. A careful medical history and meticulous neurological examination remain the cornerstone for the accurate diagnosis of MSA. Ancillary investigations are helpful to support the diagnosis, rule out potential mimics, and define therapeutic strategies. This review summarizes diagnostic investigations useful in the differential diagnosis of patients with suspected MSA. Currently used techniques include structural and functional brain imaging, cardiac sympathetic imaging, cardiovascular autonomic testing, olfactory testing, sleep study, urological evaluation, and dysphagia and cognitive assessments. Despite advances in the diagnostic tools for MSA in recent years and the availability of consensus criteria for clinical diagnosis, the diagnostic accuracy of MSA remains sub-optimal. As other diagnostic tools emerge, including skin biopsy, retinal biomarkers, blood and cerebrospinal fluid biomarkers, and advanced genetic testing, a more accurate and earlier recognition of MSA should be possible, even in the prodromal stages. This has important implications as misdiagnosis can result in inappropriate treatment, patient and family distress, and erroneous eligibility for clinical trials of disease-modifying drugs.

PMID: 29111419 [PubMed - as supplied by publisher]



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Stability analysis on the radioactive iodine-labelled prostate cancer-specific recombinant oncolytic adenovirus.

Related Articles

Stability analysis on the radioactive iodine-labelled prostate cancer-specific recombinant oncolytic adenovirus.

Oncol Lett. 2017 Dec;14(6):6403-6408

Authors: Zhou J, Hao L, Shi Z, Ning S, He H, Zhao Y, Dong Y, Li Z, He J, Zang G, Han C

Abstract
The aim of the present study was to construct the (125)I-replication-selective oncolytic adenovirus (RSOAds)-human telomerase reverse transcriptase (hTERT)/prostate specific antigen (PSA) nuclide-oncolytic virus marker by labelling the hTERT/PSA double-regulation replicative oncolytic adenovirus with (125)I nuclide, and investigate the influence of viral markers under various reaction conditions on labelling efficiency. N-bromosuccinimide (NBS) was used as the oxidizer for (125)I labelling, and the best conditions for labelling were identified through the reactions between oncolytic adenovirus at various concentrations and NBS. Dosage of (125)I, reaction duration, pH values and reaction volume were respectively evaluated to determine their effects on the labelling efficiency of (125)I-RSOAds-hTERT/PSA nuclide-oncolytic adenovirus markers. Purified nuclide-oncolytic adenovirus markers were isolated by gel-filtration chromatography; paper chromatography was performed to assay the radiochemical purity of (125)I-RSOAds-hTERT/PSA markers at various time points. Radiochemical purity of (125)I-RSOAds-hTERT/PSA was >95%, and could be maintained at 4°C for 7 days. The best reaction conditions were set as follows: 0.5 µl of (125)I (~0.2 m Ci, 7.4 MBq); 25 qg of NBS; 100 µl of 8×10(9) VP/ml (125)I-RSOAds-hTERT/PSA virus solution; 30 min of reaction duration; pH 7.5; 120 µl of PBS. Labelling hTERT/PSA double-regulation replicative oncolytic adenovirus with (125)I was identified to be available, and the radiochemical purity of acquired virus markers could be maintained under specific conditions.

PMID: 29109762 [PubMed]



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Antibiotics, Vol. 6, Pages 27: Bacteriophages in the Dairy Environment: From Enemies to Allies

Antibiotics, Vol. 6, Pages 27: Bacteriophages in the Dairy Environment: From Enemies to Allies

Antibiotics doi: 10.3390/antibiotics6040027

Authors: Lucía Fernández Susana Escobedo Diana Gutiérrez Silvia Portilla Beatriz Martínez Pilar García Ana Rodríguez

The history of dairy farming goes back thousands of years, evolving from a traditional small-scale production to the industrialized manufacturing of fermented dairy products. Commercialization of milk and its derived products has been very important not only as a source of nourishment but also as an economic resource. However, the dairy industry has encountered several problems that have to be overcome to ensure the quality and safety of the final products, as well as to avoid economic losses. Within this context, it is interesting to highlight the role played by bacteriophages, or phages, viruses that infect bacteria. Indeed, bacteriophages were originally regarded as a nuisance, being responsible for fermentation failure and economic losses when infecting lactic acid bacteria, but are now considered promising antimicrobials to fight milk-borne pathogens without contributing to the increase in antibiotic resistance.



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Aldehyde dehydrogenase 1 isoenzyme expression as a marker of cancer stem cells correlates to histopathological features in head and neck cancer: A meta-analysis.

Aldehyde dehydrogenase 1 isoenzyme expression as a marker of cancer stem cells correlates to histopathological features in head and neck cancer: A meta-analysis.

PLoS One. 2017;12(11):e0187615

Authors: Dong Y, Ochsenreither S, Cai C, Kaufmann AM, Albers AE, Qian X

Abstract
There is a lack of predictive biomarkers that can identify patients with head and neck squamous cell carcinoma (HNSCC) who will experience treatment failure and develop drug resistance, recurrence, and metastases. Cancer stem-like cells (CSC) were identified as a subset of cells within the tumor in a variety of solid tumors including HNSCC. CSC are considered the tumor-initiating population responsible for recurrence or metastasis and are associated with therapy resistance. This meta-analysis including fourteen studies with altogether 1258 patients updates and summarizes all relevant data on the impact of ALDH1+ CSC on the prognosis of HNSCC and its association with clinicopathological parameters. ALDH1 expression is highly correlated with tumor differentiation (G3 vs. G1+G2; odds ratio = 2.85. 95% CI: 1.72-4.73, P<0.0001) and decreased overall survival (relative risk = 1.77. 95% CI: 1.41-2.22, P<0.0001) if one out of seven studies was excluded because of heterogeneity. These findings provide insights into the understanding of more aggressive tumor phenotypes and also suggest that the prognostic value provided by HNSCC-subtyping by CSC frequency warrant further clinical investigation.

PMID: 29112953 [PubMed - in process]



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Periodontal therapy for the management of cardiovascular disease in patients with chronic periodontitis.

Periodontal therapy for the management of cardiovascular disease in patients with chronic periodontitis.

Cochrane Database Syst Rev. 2017 Nov 07;11:CD009197

Authors: Li C, Lv Z, Shi Z, Zhu Y, Wu Y, Li L, Iheozor-Ejiofor Z

Abstract
BACKGROUND: There is an association between chronic periodontitis and cardiovascular disease (CVD). However, it is not known whether periodontal therapy could prevent or manage CVD in patients with chronic periodontitis.
OBJECTIVES: The objective of this systematic review was to investigate the effects of periodontal therapy in preventing the occurrence of, and management or recurrence of, CVD in patients with chronic periodontitis.
SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 31 August 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 7), MEDLINE Ovid (1946 to 31 August 2017), Embase Ovid (1980 to 31 August 2017) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL EBSCO) (1937 to 31 August 2017) . The US National Institutes of Health Trials Registry (ClinicalTrials.gov), the World Health Organization International Clinical Trials Registry Platform and Open Grey were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.We also searched the Chinese BioMedical Literature Database (1978 to 27 August 2017), the China National Knowledge Infrastructure (1994 to 27 August 2017), the VIP database (1989 to 27 August 2017) and Sciencepaper Online (2003 to 27 August 2017).
SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs were considered eligible. Studies were selected if they included patients with a diagnosis of chronic periodontitis and previous CVD (secondary prevention studies) or no CVD (primary prevention studies); patients in the intervention group received active periodontal therapy compared to maintenance therapy, no periodontal treatment or another kind of periodontal treatment in the control group.
DATA COLLECTION AND ANALYSIS: Two review authors carried out the study identification, data extraction and risk of bias assessment independently and in duplicate. Any discrepancies between the two authors were resolved by discussion or with a third review author. A formal pilot-tested data extraction form was adopted for the data extraction, and the Cochrane tool for risk of bias assessment was used for the critical appraisal of the literature.
MAIN RESULTS: No studies were identified that assessed primary prevention of CVD in people with periodontitis. One study involving 303 participants with ≥ 50% blockage of one coronary artery or a coronary event within three years, but not the three months prior, was included. The study was at high risk of bias due to deviation from the protocol treatment allocation and lack of follow-up data. The trial compared scaling and root planing (SRP) with community care for a follow-up period of six to 25 months. No data on deaths (all-cause or CVD-related) were reported. There was insufficient evidence to determine the effect of SRP and community care in reducing the risk of CVD recurrence in patients with chronic periodontitis (risk ratio (RR) 0.72; 95% confidence interval (CI) 0.23 to 2.22; very low quality evidence). The effects of SRP compared with community care on high-sensitivity C-reactive protein (hs-CRP) (mean difference (MD) 0.62; -1.45 to 2.69), the number of patients with high hs-CRP (RR 0.77; 95% CI 0.32 to 1.85) and adverse events (RR 9.06; 95% CI 0.49 to 166.82) were also not statistically significant. The study did not assess modifiable cardiovascular risk factors, other blood test results, heart function parameters or revascularisation procedures.
AUTHORS' CONCLUSIONS: We found very low quality evidence that was insufficient to support or refute whether periodontal therapy can prevent the recurrence of CVD in the long term in patients with chronic periodontitis. No evidence on primary prevention was found.

PMID: 29112241 [PubMed - as supplied by publisher]



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Impact of the insurance type of head and neck cancer patients on their hospitalization utilization patterns.

Impact of the insurance type of head and neck cancer patients on their hospitalization utilization patterns.

Cancer. 2017 Nov 07;:

Authors: Gupta A, Sonis ST, Schneider EB, Villa A

Abstract
BACKGROUND: Head and neck cancer (HNC) patients with Medicaid, Medicare, or no insurance show poor outcomes in comparison with privately insured patients. It was hypothesized that nonprivate insurance coverage biases the selection of the treatment site to favor hospitals that are not associated with optimum treatment outcomes. This study assessed the relation between the insurance type of HNC patients and the hospital type for inpatient care.
METHODS: Adult HNC patients were identified from the Nationwide Inpatient Sample (2012 and 2013). The primary exposure was the insurance provider type. The outcome was the hospital type, which was classified by the hospital's ownership and its location and teaching status. Multivariate multinomial logistic regression models were constructed to control for the patient's age, sex, race, income, mortality risk, and geographic location. The analysis was weighted and was adjusted for multiple comparisons.
RESULTS: In all, 37,466 HNC patients representing 187,330 patients nationally were identified. After adjustments for age, sex, race, income, and mortality risk, in comparison with privately insured patients, Medicaid, Medicare, and uninsured patients demonstrated 1.14 to 2.29 increased odds of undergoing treatment at rural, urban nonteaching, private investor-owned, or government (nonfederal) hospitals (P < .05). This trend remained apparent even after adjustments for the geographic location.
CONCLUSIONS: Uninsured patients or patients insured by government programs predominantly underwent care for HNC at hospital types most often associated with inferior survival outcomes. This finding could explain some proportion of insurance-related disparities in HNC outcomes. Further studies are warranted to determine whether interventions to promote equitable access to optimal hospital settings for patients, regardless of their insurance type, might improve outcomes among nonprivate insurance holders. Cancer 2017. © 2017 American Cancer Society.

PMID: 29112234 [PubMed - as supplied by publisher]



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Individualized outcome prognostication for patients with laryngeal cancer.

Individualized outcome prognostication for patients with laryngeal cancer.

Cancer. 2017 Nov 07;:

Authors: Hoban CW, Beesley LJ, Bellile EL, Sun Y, Spector ME, Wolf GT, Taylor JMG, Shuman AG

Abstract
BACKGROUND: Accurate prognostication is essential to the optimal management of laryngeal cancer. Predictive models have been developed to calculate the risk of oncologic outcomes, but extensive external validation of accuracy and reliability is necessary before implementing them into clinical practice.
METHOD: Four published prognostic calculators that predict 5-year overall survival for patients with laryngeal cancer were evaluated using patient information from a prospective epidemiology study cohort (n = 246; median follow-up, 60 months) with previously untreated, stage I through IVb laryngeal squamous cell carcinoma.
RESULTS: Different calculators yielded substantially different predictions for individual patients. The observed 5-year overall survival was significantly higher than the averaged predicted 5-year overall survival of the 4 calculators (71.9%; 95% confidence interval [CI], 65%-78%] vs 47.7%). Statistical analyses demonstrated the calculators' limited capacity to discriminate outcomes for risk-stratified patients. The area under the receiver operating characteristic curve ranged from 0.68 to 0.72. C-index values were similar for each of the 4 models (range, 0.66-0.68). There was a lower than expected hazard of death for patients who received induction (bioselective) chemotherapy (hazard ratio, 0.46; 95% CI, 0.24-0.88; P = .024) or primary surgical intervention (hazard ratio, 0.43; 95 % CI, 0.21-0.90; P = .024) compared with those who received concurrent chemoradiation.
CONCLUSIONS: Suboptimal reliability and accuracy limit the integration of existing individualized prediction tools into routine clinical decision making. The calculators predicted significantly worse than observed survival among patients who received induction chemotherapy and primary surgery, suggesting a need for updated consideration of modern treatment modalities. Further development of individualized prognostic calculators may improve risk prediction, treatment planning, and counseling for patients with laryngeal cancer. Cancer 2017. © 2017 American Cancer Society.

PMID: 29112231 [PubMed - as supplied by publisher]



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Variants in CIB2 cause DFNB48 and not USH1J.

Variants in CIB2 cause DFNB48 and not USH1J.

Clin Genet. 2017 Nov 07;:

Authors: Booth KT, Kahrizi K, Babanejad M, Daghagh H, Bademci G, Arzhangi S, Zareabdollahi D, Duman D, El-Amraoui A, Tekin M, Najmabadi H, Azaiez H, Smith RJ

Abstract
The genetic, mutational and phenotypic spectrum of deafness-causing genes shows great diversity and pleiotropy. The best examples are the group of genes, which when mutated can either cause non-syndromic hearing loss (NSHL) or the most common dual sensory impairment, Usher Syndrome (USH). Variants in the CIB2 gene have been previously reported to cause of hearing loss at the DFNB48 locus and deaf-blindness at the USH1J locus. In this study, we characterize the phenotypic spectrum in a multiethnic cohort with autosomal recessive non-syndromic hearing loss (ARNSHL) due to variants in the CIB2 gene. Of the 6 families we ascertained, 3 segregated novel loss-of-function variants, 2 families segregated missense variants (one novel) and 1 family segregated a previously reported pathogenic variant in trans with a frameshift variant. This report is the first to show that biallelic loss of function variants in CIB2 cause ARNSHL and not USH. In the era of precision medicine, providing the correct diagnosis (NSHL vs USH) is essential for patient care as it impacts potential intervention and prevention options for patients. Here we provide evidence disqualifying CIB2 as an USH-causing gene.

PMID: 29112224 [PubMed - as supplied by publisher]



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Distinguishing Neurofibroma From Desmoplastic Melanoma: The Value of p53.

Distinguishing Neurofibroma From Desmoplastic Melanoma: The Value of p53.

Am J Surg Pathol. 2017 Nov 03;:

Authors: Elsensohn A, Shiu J, Grove N, Hosking AM, Barr R, de Feraudy S

Abstract
Distinguishing desmoplastic melanomas (DMs) from neurofibromas (NFs) can be histologically challenging in some cases. To date, a reliable marker to differentiate the 2 entities has remained elusive. S100 subtyping and CD34 fingerprinting have been proposed, but controversy remains as to their reliability. Missense mutations in TP53 are often found in DMs, resulting in a dominant negative effect and paradoxical accumulation of the tumor suppressor protein p53. We hypothesized that p53 may be expressed differentially in DMs, making it a valuable tool in differentiating DMs from NFs. Using immunohistochemistry, we compared p53 protein expression in 20 DMs and 20 NFs retrieved from our tissue archives and stained with p53 antibody (Monoclonal, DO-7). Patients with DM included 18 men and 2 women (age, 36 to 95 y; mean, 70.5 y; median, 70 y). Fifteen (15/20) tumors occurred in head and neck area; 2 (2/20) on the trunk; and 3 (3/20) on the extremities. Patients with NF included 12 men and 8 women (age, 47 to 85 y; mean, 65.2 y; median, 69.5 y). Eleven (11/20) tumors occurred on the trunk, 6 (6/20) on the extremities, and 3 (3/20) on the head and neck area. A total of 19/20 (95%) DMs were positive for p53. DM Histo-scores ranged from 0 to 300 (mean, 203; median, 260). Nuclear accumulation of p53 was seen in all 19 positive DMs. None of the 20 NFs were positive for p53 (2-tailed t test P-value <0.0001). Detection of p53 by immunohistochemistry can help to distinguish DMs from NFs.

PMID: 29112020 [PubMed - as supplied by publisher]



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Staphylococcus Aureus Alpha-toxin Induces Actin Filament Remodeling in Human Airway Epithelial Model Cells.

Staphylococcus Aureus Alpha-toxin Induces Actin Filament Remodeling in Human Airway Epithelial Model Cells.

Am J Respir Cell Mol Biol. 2017 Nov 07;:

Authors: Ziesemer S, Eiffler I, Schönberg A, Müller C, Hochgräfe F, Beule AG, Hildebrandt JP

Abstract
Exposure of cultured human airway epithelial model cells (16HBE14o-, S9) to Staphylococcus aureus alpha-toxin (hemolysin A, Hla) induces changes in cell morphology and cell layer integrity which are due to the inability of the cells to maintain stable cell-cell or focal contacts and to properly organize their actin cytoskeleton. The aim of this study was to identify Hla-activated signaling pathways involved in regulating the phosphorylation level of the actin depolymerizing factor cofilin. We used recombinant wild-type Hla (rHla) as well as a variant of Hla (rHla-H35L) that is unable to form functional transmembrane pores to treat immortalized human airway epithelial cells (16HBE14o-, S9) as well as freshly isolated human nasal tissue. Our results indicate that rHla-mediated changes in cofilin phosphorylation require the formation of functional Hla-pores in the host cell membrane. Formation of functional transmembrane pores induced hypo-phosphorylation of cofilin at Ser3, which was mediated by rHla-induced attenuation of PAK- and LIMK activities. Because dephosphorylation of pSer3-cofilin results in activation of this actin depolymerizing factor, treatment of cells with rHla resulted in loss of actin stress fibers from the cells and destabilization of cell shape followed by the appearance of paracellular gaps in the cell layers. Activation of protein kinase A or activation of small GTPases (Rho, Rac, Cdc42) do not seem to be involved in this response.

PMID: 29111771 [PubMed - as supplied by publisher]



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The Middle Temporal Artery: Surgical Anatomy and Exposure for Cerebral Revascularization.

The Middle Temporal Artery: Surgical Anatomy and Exposure for Cerebral Revascularization.

World Neurosurg. 2017 Oct 27;:

Authors: Rubio RR, Lawton MT, Kola O, Tabani H, Yousef S, Meybodi AT, Burkhardt JK, El-Sayed I, Benet A

Abstract
BACKGROUND: The middle temporal artery (MTA) is the proximal medial branch of the superficial temporal artery (STA), supplying the temporalis muscle along with deep temporal arteries. Its use in vascularized flaps for reconstructive and otologic procedures has been described, yet its potential use in neurosurgery is not studied. We report a novel technique for exposing the MTA and evaluated its characteristics for extracranial-intracranial (EC-IC) cerebrovascular bypass.
METHODS: After a curvilinear frontotemporal incision in 10 cadaveric specimens, the STA was dissected from distal to proximal. The horizontal portion of MTA was found posterolateral to the posterior end of the zygomatic root (PEZR) and was followed proximally until its origin and distally until its two terminal branches. The total length, visible branches, and caliber of MTA were measured.
RESULTS: The mean total harvested length of MTA was 31.7±5.1mm, with an average proximal caliber of 1.7±0.4mm, and distal caliber of 1.3±0.5mm. There were 4-6 terminal MTA branches. The caliber of the proximal STA trunk was 2.5±0.5mm. The origin of the MTA was visible with a mean distance of 16.9±4.9mm inferior to the PEZR. The parotid gland was traversed and a communicating auriculotemporal nerve to the temporal branch of the facial nerve crossed MTA in 2 specimens.
CONCLUSION: MTA can be safely harvested using an anterolateral approach, following its horizontal portion at the level of the zygomatic root, which is constant. The length and caliber of MTA makes it a potential alternative donor vessel or interposition graft for EC-IC bypass, especially when other donors are unavailable.

PMID: 29111474 [PubMed - as supplied by publisher]



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Regenerative Effects of Basic Fibroblast Growth Factor on Restoration of Thyroarytenoid Muscle Atrophy Caused by Recurrent Laryngeal Nerve Transection.

Regenerative Effects of Basic Fibroblast Growth Factor on Restoration of Thyroarytenoid Muscle Atrophy Caused by Recurrent Laryngeal Nerve Transection.

J Voice. 2017 Oct 27;:

Authors: Kaneko M, Tsuji T, Kishimoto Y, Sugiyama Y, Nakamura T, Hirano S

Abstract
OBJECTIVES: Vocal fold atrophy following unilateral vocal fold paralysis is caused by atrophy of the thyroarytenoid (TA) muscle and remains a challenge. Medialization procedures are popular treatment options; however, hoarseness often remains due to the reduction in mass or tension of the TA muscle. Therefore, in addition to medialization procedures, TA muscle reinnervation is desirable. In vivo studies have shown the potential for basic fibroblast growth factor (bFGF) to affect muscular and nerve regeneration. The present study aimed to examine the regenerative effects of bFGF on restoration of TA muscle atrophy caused by recurrent laryngeal nerve transection.
STUDY DESIGN: Prospective animal experiments with controls.
METHODS: TA muscle atrophy was induced by unilateral transection of the recurrent laryngeal nerve. One month after transection, different doses (200 ng, 100 ng, 10 ng) of bFGF in 50 µL were repeatedly injected into the TA muscle four times with an interval of 1 week between injections. Saline only was injected in the sham group. Larynges were harvested for histologic and immunohistochemical examination 4 weeks after the final injection.
RESULTS: The cross-sectional TA muscle area was significantly larger in the bFGF-treated groups compared with the sham-treated groups. Immunohistochemistry indicated that bFGF significantly increases the number of neuromuscular junctions and satellite cells in the TA muscle.
CONCLUSIONS: These results suggest that local application of bFGF to the TA muscle may improve TA muscle atrophy caused by recurrent laryngeal nerve paralysis. Furthermore, bFGF may have regenerative effects on both nerves and muscles.

PMID: 29111336 [PubMed - as supplied by publisher]



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Density dependent re-tuning of autoreactive T cells alleviates their pathogenicity in a lymphopenic environment.

Density dependent re-tuning of autoreactive T cells alleviates their pathogenicity in a lymphopenic environment.

Immunol Lett. 2017 Oct 27;:

Authors: Chuang E, Augustine M, Jung M, Schwartz RH, Singh NJ

Abstract
Peripheral T cell tolerance is challenging to induce in partially lymphopenic hosts and this is relevant for clinical situations involving transplant tolerance. While the shortage of regulatory cells is thought to be one reason for this, T cell-intrinsic tolerance processes such as anergy are also poorly triggered in such hosts. In order to understand the latter, we used a T cell deficient mouse model system where adoptively transferred autoreactive T cells are significantly tolerized in a cell intrinsic fashion, without differentiation to regulatory T cells. Intriguingly these T cells often retain sufficient effector functions to trigger autoimmune pathology. Here we find that the high population density of the autoreactive T cells that accumulated in such a host limits the progression of the cell-intrinsic tolerance process in T cells. Accordingly, reducing the cell density during a second transfer allowed T cells to further tune down their responsiveness to antigenic stimulation. The retuning of T cells was reflected by a loss of the T cell's abilities to proliferate, produces cytokines or help B cells. We further suggest, based on altering the levels of chronic antigen using miniosmotic pumps, that the effects of cell-density on T cell re-tuning may reflect the effective changes in the antigen dose perceived by individual T cells. This could proportionally elicit more negative feedback downstream of the TCR. Consistent with this, the retuned T cells showed signaling defects both proximal and distal to the TCR. Therefore, similar to the immunogenic activation of T cells, cell-intrinsic T cell tolerance may also involve a quantitative and progressive process of tuning down its antigen-responsiveness. The progress of such tuning seems to be stabilized at multiple intermediate stages by factors such as cell density, rather than just absolute antigen levels.

PMID: 29111199 [PubMed - as supplied by publisher]



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Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapy.

Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapy.

Radiother Oncol. 2017 Oct 27;:

Authors: Cereda E, Cappello S, Colombo S, Klersy C, Imarisio I, Turri A, Caraccia M, Borioli V, Monaco T, Benazzo M, Pedrazzoli P, Corbella F, Caccialanza R

Abstract
BACKGROUND: To evaluate the benefit of oral nutritional supplements (ONS) in addition to nutritional counseling in head and neck cancer (HNC) patients undergoing radiotherapy (RT).
METHODS: In a single-center, randomized, pragmatic, parallel-group controlled trial (ClinicalTrials.gov: NCT02055833; February 2014-August 2016), 159 newly diagnosed HNC patients suitable for to RT regardless of previous surgery and induction chemotherapy were randomly assigned to nutritional counseling in combination with ONS (N = 78) or without ONS (N = 81) from the start of RT and continuing for up to 3 months after its end. Primary endpoint was the change in body weight at the end of RT. Secondary endpoints included changes in protein-calorie intake, muscle strength, phase angle and quality of life and anti-cancer treatment tolerance.
RESULTS: In patients with the primary endpoint assessed (modified intention-to-treat population), counseling plus ONS (N = 67) resulted in smaller loss of body weight than nutritional counseling alone (N = 69; mean difference, 1.6 kg [95%CI, 0.5-2.7]; P = 0.006). Imputation of missing outcomes provided consistent findings. In the ONS-supplemented group, higher protein-calorie intake and improvement in quality of life over time were also observed (P < 0.001 for all). The use of ONS reduced the need for changes in scheduled anti-cancer treatments (i.e. for RT and/or systemic treatment dose reduction or complete suspension, HR=0.40 [95%CI, 0.18-0.91], P = 0.029).
CONCLUSION: In HNC patients undergoing RT or RT plus systemic treatment, and receiving nutritional counseling, the use of ONS resulted in better weight maintenance, increased protein-calorie intake, improved quality of life and was associated with better anti-cancer treatment tolerance.

PMID: 29111172 [PubMed - as supplied by publisher]



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Traumatic Perforation of the Tympanic Membrane: A Review of 80 Cases.

Traumatic Perforation of the Tympanic Membrane: A Review of 80 Cases.

J Emerg Med. 2017 Oct 28;:

Authors: Sagiv D, Migirov L, Glikson E, Mansour J, Yousovich R, Wolf M, Shapira Y

Abstract
BACKGROUND: Traumatic perforation of the tympanic membrane (TPTM) is often encountered in primary care or in the emergency department (ED). Several therapeutic interventions have been described, but conservative follow-up until spontaneous complete recovery is the most common choice.
OBJECTIVE: Our goal was to analyze the trauma mechanism, perforation characteristics, and outcome of patients with TPTM.
METHODS: The study included patients examined in the ED of a tertiary, university-affiliated medical center because of TPTM between 2012 and 2016. Their medical records were retrospectively reviewed for demographics, trauma mechanism, clinical characteristics, and outcome. A phone survey was performed to obtain the missing information of all the patients who did not continue their follow-up in our outpatient clinic.
RESULTS: We reviewed the histories of 80 patients with a mean age of 26.7 ± 14.6 years (20 children; 25%). TPTM was caused by blunt trauma in 45 patients (56%) and penetrating trauma in 35 patients (44%). Thirty-five patients (44%) completed their follow-up in the hospital outpatient clinic, with a mean duration of 6.2 weeks. Twenty-five patients (38%) completed their follow-up in a community-based otolaryngology clinic, 6 patients (9%) chose not to complete their follow-up, and 14 patients were lost to follow-up. Of the 60 patients who completed follow-up, 56 patients recovered spontaneously, 3 patients underwent successful tympanoplasty, and 1 patient was referred to surgery but was lost to follow-up. All children healed spontaneously.
CONCLUSION: TPTM was more common in young males with main mechanisms of blunt trauma (an assault) or cleaning the ear canal. All children demonstrated complete spontaneous recovery.

PMID: 29110975 [PubMed - as supplied by publisher]



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In response to the commentary of Dr. Lou on treatment of laryngopharyngeal reflux using a sleep positioning device: A prospective cohort study.

In response to the commentary of Dr. Lou on treatment of laryngopharyngeal reflux using a sleep positioning device: A prospective cohort study.

Am J Otolaryngol. 2017 Oct 03;:

Authors: Tierney WS, Gabbard SL, Bryson PC

PMID: 29110918 [PubMed - as supplied by publisher]



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Wireless intraoral tongue control of an assistive robotic arm for individuals with tetraplegia.

Wireless intraoral tongue control of an assistive robotic arm for individuals with tetraplegia.

J Neuroeng Rehabil. 2017 Nov 06;14(1):110

Authors: Andreasen Struijk LNS, Egsgaard LL, Lontis R, Gaihede M, Bentsen B

Abstract
BACKGROUND: For an individual with tetraplegia assistive robotic arms provide a potentially invaluable opportunity for rehabilitation. However, there is a lack of available control methods to allow these individuals to fully control the assistive arms.
METHODS: Here we show that it is possible for an individual with tetraplegia to use the tongue to fully control all 14 movements of an assistive robotic arm in a three dimensional space using a wireless intraoral control system, thus allowing for numerous activities of daily living. We developed a tongue-based robotic control method incorporating a multi-sensor inductive tongue interface. One abled-bodied individual and one individual with tetraplegia performed a proof of concept study by controlling the robot with their tongue using direct actuator control and endpoint control, respectively.
RESULTS: After 30 min of training, the able-bodied experimental participant tongue controlled the assistive robot to pick up a roll of tape in 80% of the attempts. Further, the individual with tetraplegia succeeded in fully tongue controlling the assistive robot to reach for and touch a roll of tape in 100% of the attempts and to pick up the roll in 50% of the attempts. Furthermore, she controlled the robot to grasp a bottle of water and pour its contents into a cup; her first functional action in 19 years.
CONCLUSION: To our knowledge, this is the first time that an individual with tetraplegia has been able to fully control an assistive robotic arm using a wireless intraoral tongue interface. The tongue interface used to control the robot is currently available for control of computers and of powered wheelchairs, and the robot employed in this study is also commercially available. Therefore, the presented results may translate into available solutions within reasonable time.

PMID: 29110736 [PubMed - in process]



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Lingual metastasis as an initial presentation of renal cell carcinoma: a case report.

Lingual metastasis as an initial presentation of renal cell carcinoma: a case report.

J Med Case Rep. 2017 Nov 07;11(1):314

Authors: Raiss H, Duplomb S, Tartas S, Layachi M, Errihani H

Abstract
BACKGROUND: Renal cell carcinoma is the third most common tumor that metastasizes to the head and neck, after breast and lung carcinomas. Tongue metastasis as an initial presentation of renal cell carcinoma is extremely rare, and very few cases have been reported. The prognosis is poor. We present a rare case of metastatic renal cell carcinoma that initially presented as a tongue lesion.
CASE PRESENTATION: We report the case of a 55-year-old white man who presented with a large exophytic lesion on his tongue. A biopsy was taken, and pathologic examination showed a poorly differentiated carcinoma including a sarcomatoid component. Subtotal glossectomy with neck dissection were planned, but a positron emission tomographic-computed tomography scan showed a left kidney mass. Immunohistochemical evaluation of the tongue lesion was performed, and it was compatible with metastasis from primary renal cell carcinoma. The biopsy of the renal lesion showed a high-grade unclassified renal cell carcinoma. Although our patient underwent systemic therapy, he died of hemorrhagic complications 3 months after the initiation of therapy.
CONCLUSION: Tongue lesions require a complete assessment to distinguish a metastasis from a primary cancer in order to give the appropriate treatment.

PMID: 29110685 [PubMed - in process]



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A meta-science for a global bioethics and biomedicine.

A meta-science for a global bioethics and biomedicine.

Philos Ethics Humanit Med. 2017 Nov 07;12(1):9

Authors: Basser DS

Abstract
BACKGROUND: As suggested by Shook and Giordano, understanding and therefore addressing the urgent international governance issues around globalizing bio-medical/technology research and applications is limited by the perception of the underlying science.
METHODS: A philosophical methodology is used, based on novel and classical philosophical reflection upon existent literature, clinical wisdoms and narrative theory to discover a meta-science and telos of humankind for the development of a relevant and defendable global biomedical bioethics.
RESULTS: In this article, through pondering an integrative systems approach, I propose a biomedical model that may provide Western biomedicine with leadership and interesting insight into the unity beyond the artificial boundaries of its traditional divisions and the limit between physiological and pathological situations (health and disease). A unified biomedicine, as scientific foundation, might then provide the basis for dissolution of similar reflected boundaries within bioethics. A principled and communitarian cosmopolitan bioethics may then be synonymous with a recently proposed principled and communitarian cosmopolitan neuroethics based on a novel objective meta-ethics. In an attempt to help facilitate equal and inclusive participation in inter-, multi-, and transdisciplinary intercultural discourse regarding the aforementioned international governance issues, I offer: (1) a meta-science derived through considering the general behaviour of activity, plasticity and balance in biology and; (2) a novel thought framework to encourage and enhance the ability for self-evaluation, self-criticism, and self-revision aimed at broadening perspective, as well as acknowledging and responding to the strengths and limitations of extant knowledge.
CONCLUSIONS: Through classical philosophical reflection, I evolve a theory of medicine to discover a telos of humankind which in turn provides an 'internal' moral grounding for a proposed global biomedical bioethics.

PMID: 29110730 [PubMed - in process]



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