Πέμπτη, 11 Ιανουαρίου 2018

Transient bacteremia induced by dental cleaning is not associated with infection of central venous catheters in patients with cancer

To determine incidence of bacteremia from a dental cleaning, and subsequent established blood stream infection (BSI) caused by oral microorganisms, in cancer patients with central venous catheters (CVC).

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Standard whole prostate gland radiotherapy with and without lesion boost in prostate cancer: Toxicity in the FLAME randomized controlled trial

To compare toxicity rates in patients with localized prostate cancer treated with standard fractionated external beam radiotherapy (EBRT) with or without an additional integrated boost to the macroscopically visible tumour.

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Clinical guidelines for dental cone-beam computed tomography

Abstract

Dental cone-beam computed tomography (CBCT) received regulatory approval in Japan in 2000 and has been widely used since being approved for coverage by the National Health Insurance system in 2012. This imaging technique allows dental practitioners to observe and diagnose lesions in the dental hard tissue in three dimensions (3D). When performing routine radiography, the examination must be justified, and optimal protection should be provided according to the ALARA (as low as reasonably achievable) principles laid down by the International Commission on Radiological Protection. Dental CBCT should be performed in such a way that the radiation exposure is minimized and the benefits to the patient are maximized. There is a growing demand for widespread access to cutting-edge health care through Japan's universal health insurance system. However, at the same time, people want our limited human, material, and financial resources to be used efficiently while providing safe health care at the least possible cost to society. Japan's aging population is expected to reach a peak in 2025, when most of the baby boomer generation will be aged 75 years or older. Comprehensive health care networks are needed to overcome these challenges. Against this background, we hope that this text will contribute to the nation's oral health by encouraging efficient use of dental CBCT.



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Evaluation of hemodynamic imaging findings of hypervascular hepatocellular carcinoma: comparison between dynamic contrast-enhanced magnetic resonance imaging using radial volumetric imaging breath-hold examination with k-space-weighted image contrast reconstruction and dynamic computed tomography during hepatic arteriography

Abstract

Purpose

To compare the visualization of hemodynamic imaging findings of hypervascular hepatocellular carcinoma (HCC) on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) using radial volumetric imaging breath-hold examination with k-space-weighted image contrast reconstruction (r-VIBE-KWIC) versus dynamic computed tomography during hepatic arteriography (dyn-CTHA).

Materials and methods

We retrospectively reviewed the databases of preoperative DCE-MRI using r-VIBE-KWIC, dyn-CTHA, and postoperative pathology of resected specimens. Fourteen patients with 14 hypervascular HCCs underwent both DCE-MRI and dyn-CTHA. The imaging findings of the tumor and adjacent liver parenchyma were assessed on both modalities by two readers. The tumor enhancement time was also compared between the two modalities.

Results

On DCE-MRI/dyn-CTHA, early staining, peritumoral low-intensity or low-density bands, corona enhancement, and washout of HCC were observed in 14/14 (100%), 10/12 (83%), 11/14 (78%), and 4/14 (29%) patients, respectively. Pathologically, four HCCs with low-density bands on dyn-CTHA had no fibrous capsules. The median tumor enhancement time on DCE-MRI and dyn-CTHA was 24 (9–24) and 23 (8–35) s, respectively. The correlation coefficient between the two groups was 0.762 (P < 0.002).

Conclusions

DCE-MRI using r-VIBE-KWIC has diagnostic potential comparable with that of dyn-CTHA in the hemodynamic evaluation of hypervascular HCC except for the washout phenomenon.



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Expression Changes in Lactate and Glucose Metabolism and Associated Transporters in Basal Ganglia following Hypoxic-Ischemic Reperfusion Injury in Piglets [PEDIATRICS]

BACKGROUND AND PURPOSE:

The neonatal brain has active energy metabolism, and glucose oxidation is the major energy source of brain tissue. Lactate is produced by astrocytes and released to neurons. In the central nervous system, lactate is transported between neurons and astrocytes via the astrocyte-neuron lactate shuttle. The aim of this study was to investigate the regulatory mechanisms of energy metabolism in neurons and astrocytes in the basal ganglia of a neonatal hypoxic-ischemic brain injury piglet model.

MATERIALS AND METHODS:

A total of 35 healthy piglets (3–5 days of age; 1.0–1.5 kg) were assigned to a control group (n = 5) or a hypoxic-ischemic model group (n = 30). The hypoxic-ischemic model group was further divided into 6 groups according to the 1H-MR spectroscopy and PET/CT scan times after hypoxia-ischemia (0–2, 2–6, 6–12, 12–24, 24–48, and 48–72 hours; n = 5/group). 1H-MR spectroscopy data were processed with LCModel software. Maximum standard uptake values refer to the maximum standard uptake values for glucose (or FDG). The maximum standard uptake values of the basal ganglia–to-occipital cortex ratio were analyzed. The expression levels of glucose transporters and monocarboxylate transporters were detected by immunohistochemical analysis.

RESULTS:

Lactate levels decreased after an initial increase, with the maximal level occurring around 2–6 hours following hypoxia-ischemia. After hypoxia-ischemia, the maximum standard uptake values of the basal ganglia and basal ganglia/occipital cortex initially increased then decreased, with the maximum occurring at approximately 6–12 hours. The lactate and glucose uptake (basal ganglia/occipital cortex maximum standard uptake values) levels were positively correlated. The expression levels of glucose transporter-1 and glucose transporter-3 were positively correlated with the basal ganglia/occipital cortex. The expression levels of monocarboxylic acid transporter-2 and monocarboxylic acid transporter-4 were positively correlated with lactate content.

CONCLUSIONS:

The results indicate that lactate and glucose transporters have a synergistic effect on the energy metabolism of neurons and astrocytes following hypoxic-ischemic reperfusion brain injury.



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Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology [WHITE PAPER]

SUMMARY:

Identification of carotid artery atherosclerosis is conventionally based on measurements of luminal stenosis and surface irregularities using in vivo imaging techniques including sonography, CT and MR angiography, and digital subtraction angiography. However, histopathologic studies demonstrate considerable differences between plaques with identical degrees of stenosis and indicate that certain plaque features are associated with increased risk for ischemic events. The ability to look beyond the lumen using highly developed vessel wall imaging methods to identify plaque vulnerable to disruption has prompted an active debate as to whether a paradigm shift is needed to move away from relying on measurements of luminal stenosis for gauging the risk of ischemic injury. Further evaluation in randomized clinical trials will help to better define the exact role of plaque imaging in clinical decision-making. However, current carotid vessel wall imaging techniques can be informative. The goal of this article is to present the perspective of the ASNR Vessel Wall Imaging Study Group as it relates to the current status of arterial wall imaging in carotid artery disease.



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Using Correlative Properties of Neighboring Pixels to Improve Gray-White Differentiation in Pediatric Head CT Images [PEDIATRICS]

BACKGROUND AND PURPOSE:

A lower radiation dose can have a detrimental effect on the quality of head CT images. The aim of this study performed in a pediatric population was to test whether an image-processing algorithm (Correlative Image Enhancement) based on the correlation among intensities of neighboring pixels can improve gray-white differentiation in head CTs.

MATERIALS AND METHODS:

Sixty baseline head CT images with normal findings obtained from scans of 30 children were processed using Correlative Image Enhancement to produce corresponding enhanced images. Gray-white differentiation in baseline and enhanced images was assessed quantitatively by calculating the contrast-to-noise ratio and conspicuity in equivalent ROIs in gray and white matter. Two masked readers rated the images for visibility of gray-white differentiation on a 5-point Likert scale. Differences in both quantitative and qualitative measures of gray-white differentiation between baseline and enhanced images were tested for statistical significance. P values < .05 were considered significant.

RESULTS:

Image processing resulted in improvement in the contrast-to-noise ratio (from 1.86 ± 0.94 to 2.26 ± 1.00, P = .02) as well as conspicuity (from 37.28 ± 11.56 to 46.4 ± 11.5, P < .001). This was accompanied by improved subjective visibility of gray-white differentiation as reported by both readers (P < .01).

CONCLUSIONS:

Image processing using Correlative Image Enhancement had a beneficial effect on quantitative measures of gray-white differentiation. This translated into improved perception of gray-white differentiation by readers. Further studies are needed to assess the effect of such image processing on the detection of disease processes using head CTs.



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Cerebellar Hypoperfusion in Migraine Attack: Incidence and Significance [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Patients diagnosed with migraine with aura have an increased lifetime risk of ischemic stroke. It is not yet clear whether prolonged cortical hypoperfusion during an aura increases the immediate risk of cerebellar infarction because it may induce crossed cerebellar diaschisis and subsequent tissue damage. To address this question, we retrospectively analyzed potential relationships between cortical oligemia and cerebellar hypoperfusion in patients with migraine with aura and their potential relation to small infarct-like cerebellar lesions.

MATERIALS AND METHODS:

One hundred six migraineurs who underwent MR imaging, including DSC perfusion, were included in the study. In patients with apparent perfusion asymmetry, we used ROI analysis encompassing 18 infra- and supratentorial ROIs to account for differences in regional cerebral blood flow and volume. The presence of cerebellar hypoperfusion was calculated using an asymmetry index, with values of >10% being considered significant.

RESULTS:

We observed perfusion asymmetries in 23/106 patients, 22 in patients with migraine with aura (20.8%). Cerebellar hypoperfusion was observed in 12/23 patients (52.2%), and crossed cerebellar diaschisis, in 9/23 patients (39.1%) with abnormal perfusion. In none of the 106 patients were DWI restrictions observed during migraine with aura.

CONCLUSIONS:

Cerebellar hypoperfusion and crossed cerebellar diaschisis are common in patients with migraine with aura and cortical perfusion abnormalities. Crossed cerebellar diaschisis in migraine with aura may be considered a benign phenomenon because we observed no association with DWI restriction or manifest cerebellar infarctions, even in patients with prolonged symptom-related perfusion abnormalities persisting for up to 24 hours.



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[other]



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Patterns of Sonographically Detectable Echogenic Foci in Pediatric Thyroid Carcinoma with Corresponding Histopathology: An Observational Study [HEAD & NECK]

BACKGROUND AND PURPOSE:

Small echogenic foci within pediatric thyroid nodules are commonly seen by ultrasound and are one of the features used to determine the level of suspicion for malignancy. These are sometimes termed "microcalcifications," but their relation with malignancy is controversial due to the lack of standard terminology. Our aim was to evaluate sonographic patterns of echogenic foci in malignant pediatric thyroid nodules and describe the distribution of corresponding psammoma bodies and other histopathologic findings in thyroidectomy specimens.

MATERIALS AND METHODS:

Ultrasounds of 15 pathologically proved malignant thyroid nodules in children were retrospectively reviewed by 2 radiologists who separately classified echogenic foci into the 4 morphologic patterns described in the American College of Radiology Thyroid Imaging, Reporting and Data System and noted their presence and distribution. Interobserver agreement was assessed, and consensus was reached for nodules for which there was disagreement. Surgical pathology findings from thyroidectomy specimens were retrospectively reviewed for the presence and distribution of psammomatous and dystrophic/stromal calcifications and eosinophilic/sticky colloid. Ultrasound and histopathologic ratings were compared, and frequencies and percentages corresponding to observed agreement levels were calculated.

RESULTS:

Interobserver agreement between radiologists' sonographic assessments for the presence and distribution of echogenic foci ranged from 53% to 100% for all categories. Punctate echogenic foci were present in all nodules, and macrocalcifications, in 27%. Histopathology of the 15 nodules revealed that only 4 (27%) had psammomatous calcifications, while 9 (60%) had stromal calcifications and 8 (53%) had sticky colloid.

CONCLUSIONS:

Sonographically detectable echogenic foci in malignant pediatric thyroid nodules can be reliably classified on the basis of American College of Radiology Thyroid Imaging, Reporting and Data System, with punctate echogenic foci composing the most common subtype. These echogenic foci do not represent psammomatous calcifications most of the time; instead, more than half of the malignant thyroid nodules with echogenic foci contained stromal calcifications or sticky colloid.



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Posttreatment Infarct Volumes when Compared with 24-Hour and 90-Day Clinical Outcomes: Insights from the REVASCAT Randomized Controlled Trial [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Endovascular therapy has become the standard of care for patients with disabling anterior circulation ischemic stroke due to proximal intracranial thrombi. Our aim was to determine whether the beneficial effect of endovascular treatment on functional outcome could be explained by a reduction in posttreatment infarct volume in the Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours (REVASCAT) trial.

MATERIALS AND METHODS:

The REVASCAT trial was a multicenter randomized open-label trial with blinded outcome evaluation. Among 206 enrolled subjects (endovascular treatment, n = 103; control, n = 103), posttreatment infarct volume was measured in 204 subjects. Posttreatment infarct volumes were compared with treatment assignment and recanalization status. Appropriate statistical models were used to assess the relationship among baseline clinical and imaging variables, posttreatment infarct volume, the 24-hour NIHSS score, and functional status with the 90-day modified Rankin Scale score.

RESULTS:

The median posttreatment infarct volume in all subjects was 23.7 mL (interquartile range = 68.9 mL) and 16.3 mL (interquartile range = 50.2 mL) in the endovascular treatment arm and 38.6 mL (interquartile range = 74.9 mL) in the control arm (P = .02 for endovascular treatment versus control subjects). Baseline NIHSS (P < .01), site of occlusion (P < .03), baseline NCCT ASPECTS (P < .01), and recanalization status (P = .02) were independently associated with posttreatment infarct volume. Baseline NIHSS (P < .01), time from symptom onset to randomization (P = .02), treatment type (P = .04), and recanalization status (P < .01) were independently associated with the 24-hour NIHSS scores. The 24-hour NIHSS score strongly mediated the relationship between treatment type and 90-day mRS (P < .01 for indirect effect when adjusted for age), while posttreatment infarct volume did not (P = .26).

CONCLUSIONS:

Endovascular treatment saves brain and improves 90-day clinical outcomes primarily through a beneficial effect on the 24-hour stroke severity.



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Bipolar Radiofrequency Ablation of Spinal Tumors: The Effect of the Posterior Vertebral Cortex Defect on Temperature Distribution in the Spinal Canal [LETTERS]



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Can Arterial Spin-Labeling with Multiple Postlabeling Delays Predict Cerebrovascular Reserve? [ADULT BRAIN]

BACKGROUND AND PURPOSE:

The effect of delayed transit time is the main source of error in the quantitative measurement of CBF in arterial spin-labeling. In the present study, we evaluated the usefulness of the transit time–corrected CBF and arterial transit time delay from multiple postlabeling delays arterial spin-labeling compared with basal/acetazolamide stress technetium Tc99m-hexamethylpropylene amineoxime (Tc99m-HMPAO) SPECT in predicting impairment in the cerebrovascular reserve.

MATERIALS AND METHODS:

Transit time–corrected CBF maps and arterial transit time maps were acquired in 30 consecutive patients with unilateral ICA or MCA steno-occlusive disease (severe stenosis or occlusion). Internal carotid artery territory–based ROIs were applied to both perfusion maps. Additionally, impairment in the cerebrovascular reserve was evaluated according to both qualitative and quantitative analyses of the ROIs on basal/acetazolamide stress Tc99m-HMPAO SPECT using a previously described method. The area under the receiver operating characteristic curve was used to evaluate the diagnostic accuracy of arterial spin-labeling in depicting impairment of the cerebrovascular reserve. The correlation between arterial spin-labeling and cerebrovascular reserve was evaluated.

RESULTS:

The affected hemisphere had a decreased transit time–corrected CBF and increased arterial transit time compared with the corresponding values of the contralateral normal hemisphere, which were statistically significant (P < .001). The percentage change of transit time–corrected CBF and the percentage change of arterial transit time were independently differentiating variables (P < .001) for predicting cerebrovascular reserve impairment. The correlation coefficient between the arterial transit time and cerebrovascular reserve index ratio was –0.511.

CONCLUSIONS:

Our results demonstrate that the transit time–corrected CBF and arterial transit time based on arterial spin-labeling perfusion MR imaging can predict cerebrovascular reserve impairment.



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Health Care Economics: A Study Guide for Neuroradiology Fellows, Part 1 [review-article]

SUMMARY:

Few resources are available in the medical literature for a comprehensive review of current health care economics as it relates to radiologists, specifically framed by topics defined by the Accreditation Council for Graduate Medical Education in the evaluation of neuroradiology fellows. Therefore, we present a comprehensive review article as a study guide for fellows to learn from and gain competence in the Accreditation Council for Graduate Medical Education neuroradiology milestones on health care economics.



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CT Attenuation Analysis of Carotid Intraplaque Hemorrhage [EXTRACRANIAL VASCULAR]

BACKGROUND AND PURPOSE:

Intraplaque hemorrhage is considered a leading parameter of carotid plaque vulnerability. Our purpose was to assess the CT characteristics of intraplaque hemorrhage with histopathologic correlation to identify features that allow for confirming or ruling out the intraplaque hemorrhage.

MATERIALS AND METHODS:

This retrospective study included 91 patients (67 men; median age, 65 ± 7 years; age range, 41–83 years) who underwent CT angiography and carotid endarterectomy from March 2010 to May 2013. Histopathologic analysis was performed for the tissue characterization and identification of intraplaque hemorrhage. Two observers assessed the plaque's attenuation values by using an ROI (≥ 1 and ≤2 mm2). Receiver operating characteristic curve, Mann-Whitney, and Wilcoxon analyses were performed.

RESULTS:

A total of 169 slices were assessed (59 intraplaque hemorrhage, 63 lipid-rich necrotic core, and 47 fibrous); the average values of the intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue were 17.475 Hounsfield units (HU) and 18.407 HU, 39.476 HU and 48.048 HU, and 91.66 HU and 93.128 HU, respectively, before and after the administration of contrast medium. The Mann-Whitney test showed a statistically significant difference of HU values both in basal and after the administration of contrast material phase. Receiver operating characteristic analysis showed a statistical association between intraplaque hemorrhage and low HU values, and a threshold of 25 HU demonstrated the presence of intraplaque hemorrhage with a sensitivity and specificity of 93.22% and 92.73%, respectively. The Wilcoxon test showed that the attenuation of the plaque before and after administration of contrast material is different (intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue had P values of .006, .0001, and .018, respectively).

CONCLUSIONS:

The results of this preliminary study suggest that CT can be used to identify the presence of intraplaque hemorrhage according to the attenuation. A threshold of 25 HU in the volume acquired after the administration of contrast medium is associated with an optimal sensitivity and specificity. Special care should be given to the correct identification of the ROI.



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Heinz First to Routinely Catheterize Carotid and Vertebral Arteries in America [LETTERS]



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Spinal Cord Gray Matter Atrophy in Amyotrophic Lateral Sclerosis [SPINE]

BACKGROUND AND PURPOSE:

There is an emerging need for biomarkers to better categorize clinical phenotypes and predict progression in amyotrophic lateral sclerosis. This study aimed to quantify cervical spinal gray matter atrophy in amyotrophic lateral sclerosis and investigate its association with clinical disability at baseline and after 1 year.

MATERIALS AND METHODS:

Twenty-nine patients with amyotrophic lateral sclerosis and 22 healthy controls were scanned with 3T MR imaging. Standard functional scale was recorded at the time of MR imaging and after 1 year. MR imaging data were processed automatically to measure the spinal cord, gray matter, and white matter cross-sectional areas. A statistical analysis assessed the difference in cross-sectional areas between patients with amyotrophic lateral sclerosis and controls, correlations between spinal cord and gray matter atrophy to clinical disability at baseline and at 1 year, and prediction of clinical disability at 1 year.

RESULTS:

Gray matter atrophy was more sensitive to discriminate patients with amyotrophic lateral sclerosis from controls (P = .004) compared with spinal cord atrophy (P = .02). Gray matter and spinal cord cross-sectional areas showed good correlations with clinical scores at baseline (R = 0.56 for gray matter and R = 0.55 for spinal cord; P < .01). Prediction at 1 year with clinical scores (R2 = 0.54) was improved when including a combination of gray matter and white matter cross-sectional areas (R2 = 0.74).

CONCLUSIONS:

Although improvements over spinal cord cross-sectional areas were modest, this study suggests the potential use of gray matter cross-sectional areas as an MR imaging structural biomarker to monitor the evolution of amyotrophic lateral sclerosis.



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Does the Volume of CSF Removed Affect the Response to a Tap in Normal Pressure Hydrocephalus? [LETTERS]



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Association of Developmental Venous Anomalies with Demyelinating Lesions in Patients with Multiple Sclerosis [ADULT BRAIN]

SUMMARY:

We present 5 cases of demyelination in patients diagnosed with multiple sclerosis that are closely associated with a developmental venous anomaly. Although the presence of a central vein is a known phenomenon with multiple sclerosis plaques, demyelination occurring around developmental venous anomalies is an underreported phenomenon. Tumefactive demyelination can cause a diagnostic dilemma because of its overlapping imaging findings with central nervous system neoplasm. The relationship of a tumefactive plaque with a central vein can be diagnostically useful, and we suggest that if such a lesion is closely associated with a developmental venous anomaly, an inflammatory or demyelinating etiology should be a leading consideration.



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Reply: [LETTERS]



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

BACKGROUND AND PURPOSE:

The multiple stent placement technique has largely improved the long-term outcomes of intracranial fusiform aneurysms, but the hemodynamic mechanisms remain unclear. In this study, we analyzed the hemodynamic changes caused by different stent-placement strategies in patient-specific models using the computational fluid dynamics technique, aiming to provide evidence for clinical decision-making.

MATERIALS AND METHODS:

Ten vertebral artery fusiform aneurysms were included, and their patient-specific computational fluid dynamics models were reconstructed. A fast virtual stent placement technique was used to simulate sequential multiple stent placements (from a single stent to triple stents) in the vertebral artery fusiform aneurysm models. Hemodynamic parameters, including wall shear stress, pressure, oscillatory shear index, relative residence time, and flow pattern, were calculated and compared among groups with different numbers of stents.

RESULTS:

Virtual stents were deployed in all 10 cases successfully, consistent with the real stent configuration. Wall shear stress decreased progressively by 7.2%, 20.6%, and 25.8% as the number of stents increased. Meanwhile, relative residence time and pressure increased on average by 11.3%, 15.4%, and 45.0% and by 15.7%, 21.5%, and 28.2%. The oscillatory shear index showed no stable variation trend. Flow patterns improved by weakening the intensity of the vortices and displacing the vortex center from the aneurysmal wall.

CONCLUSIONS:

Stent placement modifies hemodynamic patterns in vertebral artery fusiform aneurysms, which might favor thrombosis formation in the aneurysmal sac. This effect is amplified with the number of stents deployed. However, a potential risk of rupture or recanalization exists and should be considered when planning to use the multiple stent placement technique in vertebral artery fusiform aneurysms.



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Erratum [ERRATA]



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Diffusion-Weighted Imaging of the Head and Neck: Influence of Fat-Suppression Technique and Multishot 2D Navigated Interleaved Acquisitions [HEAD & NECK]

BACKGROUND AND PURPOSE:

DWI of the head and neck can reveal valuable information, but the effects of fat suppression and multishot acquisition on image quality have not been thoroughly investigated. We aimed to comprehensively compare the quality of head and neck DWI at 3T using 2 fat-suppression techniques, STIR, and spectral presaturation with inversion recovery, which were used with both single- and multishot EPI.

MATERIALS AND METHODS:

Sixty-five study participants underwent 3 DWI sequences of single-shot EPI–STIR, single-shot EPI–spectral presaturation with inversion recovery, and multishot EPI–spectral presaturation with inversion recovery of the head and neck. In multiple anatomic regions, 2 independent readers assessed 5-point visual scores for fat-suppression uniformity and image distortion, and 1 reader measured the contrast-to-noise ratio and ADC.

RESULTS:

The mean visual score for fat-suppression uniformity was higher in single-shot EPI–STIR than in other sequences (all regions except for the orbital region, P < .05). The mean visual score for image distortion was higher in multishot EPI–spectral presaturation with inversion recovery than in single-shot EPI sequences (all regions, P < .001). Contrast-to-noise ratio was mostly lower in single-shot EPI–STIR than in other sequences (P < .001), and ADC was significantly higher in multishot EPI–spectral presaturation with inversion recovery than in single-shot EPI sequences (P ≤ .001).

CONCLUSIONS:

Overall, multishot EPI–spectral presaturation with inversion recovery provided the best image quality, with relatively homogeneous fat suppression, less image distortion than single-shot EPI sequences, and higher contrast-to-noise ratio than single-shot EPI–STIR. The measured ADC values can be higher in multishot EPI–spectral presaturation with inversion recovery, which necessitates cautious application of the previously reported ADC values to clinical settings.



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Health Care Economics: A Study Guide for Neuroradiology Fellows, Part 2 [review-article]

SUMMARY:

In this second article, we continue the review of current health care economics as it relates to radiologists, specifically framed by topics defined by the Accreditation Council for Graduate Medical Education in the evaluation of neuroradiology fellows. The discussion in this article is focused on topics pertaining to levels 4 and 5, which are the more advanced levels of competency defined by the Accreditation Council for Graduate Medical Education Neuroradiology Milestones on Health Care Economics and System Based Practice.



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MR Imaging of the Superior Cervical Ganglion and Inferior Ganglion of the Vagus Nerve: Structures That Can Mimic Pathologic Retropharyngeal Lymph Nodes [PERIPHERAL NERVOUS SYSTEM]

BACKGROUND AND PURPOSE:

The superior cervical ganglion and inferior ganglion of the vagus nerve can mimic pathologic retropharyngeal lymph nodes. We studied the cross-sectional anatomy of the superior cervical ganglion and inferior ganglion of the vagus nerve to evaluate how they can be differentiated from the retropharyngeal lymph nodes.

MATERIALS AND METHODS:

This retrospective study consists of 2 parts. Cohort 1 concerned the signal intensity of routine neck MR imaging with 2D sequences, apparent diffusion coefficient, and contrast enhancement of the superior cervical ganglion compared with lymph nodes with or without metastasis in 30 patients. Cohort 2 used 3D neurography to assess the morphology and spatial relationships of the superior cervical ganglion, inferior ganglion of the vagus nerve, and the retropharyngeal lymph nodes in 50 other patients.

RESULTS:

All superior cervical ganglions had homogeneously greater enhancement and lower signal on diffusion-weighted imaging than lymph nodes. Apparent diffusion coefficient values of the superior cervical ganglion (1.80 ± 0.28 x 10–3mm2/s) were significantly higher than normal and metastatic lymph nodes (0.86 ± 0.10 x 10–3mm2/s, P < .001, and 0.73 ± 0.10 x 10–3mm2/s, P < .001). Ten and 13 of 60 superior cervical ganglions were hypointense on T2-weighted images and had hyperintense spots on both T1- and T2-weighted images, respectively. The latter was considered fat tissue. The largest was the superior cervical ganglion, followed in order by the retropharyngeal lymph node and the inferior ganglion of the vagus nerve (P < .001 to P = .004). The highest at vertebral level was the retropharyngeal lymph nodes, followed, in order, by the inferior ganglion of the vagus nerve and the superior cervical ganglion (P < .001 to P = .001). The retropharyngeal lymph node, superior cervical ganglion, and inferior ganglion of the vagus nerve formed a line from anteromedial to posterolateral.

CONCLUSIONS:

The superior cervical ganglion and the inferior ganglion of the vagus nerve can be almost always differentiated from retropharyngeal lymph nodes on MR imaging by evaluating the signal, size, and position.



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Influences for Gender Disparity in Academic Neuroradiology [research-article]

BACKGROUND AND PURPOSE:

There has been extensive interest in promoting gender equality within radiology, a predominately male field. In this study, our aim was to quantify gender representation in neuroradiology faculty rankings and determine any related factors that may contribute to any such disparity.

MATERIALS AND METHODS:

We evaluated the academic and administrative faculty members of neuroradiology divisions for all on-line listed programs in the US and Canada. After excluding programs that did not fulfill our selection criteria, we generated a short list of 85 US and 8 Canadian programs. We found 465 faculty members who met the inclusion criteria for our study. We used Elsevier's SCOPUS for gathering the data pertaining to the publications, H-index, citations, and tenure of the productivity of each faculty member.

RESULTS:

Gender disparity was insignificant when analyzing academic ranks. There are more men working in neuroimaging relative to women (2 = 0.46; P = .79). However, gender disparity was highly significant for leadership positions in neuroradiology (2 = 6.76; P = .009). The median H-index was higher among male faculty members (17.5) versus female faculty members (9). Female faculty members have odds of 0.84 compared with male faculty members of having a higher H-index, adjusting for publications, citations, academic ranks, leadership ranks, and interaction between gender and publications and gender and citations (9).

CONCLUSIONS:

Neuroradiology faculty members follow the same male predominance seen in many other specialties of medicine. In this study, issues such as mentoring, role models, opportunities to engage in leadership/research activities, funding opportunities, and mindfulness regarding research productivity are explored.



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Imaging Appearances and Pathologic Characteristics of Spinal Epidural Meningioma [SPINE]

BACKGROUND AND PURPOSE:

Spinal epidural meningioma is an uncommon tumor. This study aimed to analyze the imaging and pathologic characteristics of this rare tumor.

MATERIALS AND METHODS:

Fourteen confirmed cases of epidural meningioma were retrospectively reviewed, and imaging characteristics and pathologic findings were analyzed to identify the typical features.

RESULTS:

The mean age of the patients (4 men, 10 women) was 44.9 years. Twelve tumors were in the cervical spinal canal, and 2, in the thoracic spinal canal. There were 9 en plaque meningiomas, 4 dumbbell-shaped meningiomas, and 1 fusiform/ovoid meningioma. The epidural meningiomas extended over 2–5 spinal segments (mean, 3.2 spinal segments). A soft epidural mass was seen in 12/14 (86%) patients. Dural calcification was seen in 8/14 (57%) tumors. Tumor caused intervertebral foramen enlargement in 10/14 (71%) patients and adhered to the nerve roots in 11/14 (79%) patients. Intradural invasion was seen in 8/14 (57%) patients. The dural tail sign was present in 13/14 (93%) tumors on contrast-enhanced T1WI. Regarding pathologic type, 10 of 14 (71%) were psammomatous, 2 of 14 (14%) were meningothelial, 1 of 14 (7%) was angiomatous, and 1 of 14 (7%) was transitional. During follow-up (mean follow-up, 73.4 months; range, 4–192 months), 7 patients had recurrence. Recurrences were between 4 and 192 months after the operation.

CONCLUSIONS:

Epidural meningioma has 3 different growth patterns. Dural thickening, calcification, invasion, and epidural mass formation are characteristic features of epidural meningioma. Regular follow-up imaging is required to detect recurrence.



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Deep Brain Nuclei T1 Shortening after Gadobenate Dimeglumine in Children: Influence of Radiation and Chemotherapy [PATIENT SAFETY]

BACKGROUND AND PURPOSE:

Intrinsic T1-hyperintense signal has recently been reported in the deep gray nuclei on brain MR imaging after multiple doses of gadolinium-based contrast agents. Most reports have included adult patients and excluded those undergoing radiation or chemotherapy. We investigated whether T1 shortening is also observed in children and tried to determine whether radiochemotherapy is a risk factor for this phenomenon.

MATERIALS AND METHODS:

In this single-center retrospective study, we reviewed clinical charts and images of all patients 18 years of age or younger with ≥4 gadobenate dimeglumine–enhanced MRIs for 6 years. Seventy-six children (mean age, 9.3 years; 60 unconfounded by treatment, 16 with radiochemotherapy) met the selection criteria (>4 MR imaging examinations; mean, 8). T1 signal intensity ratios for the dentate to pons and globus pallidus to thalamus were calculated and correlated with number of injections, time interval, and therapy.

RESULTS:

Among the 60 children without radiochemotherapy, only 2 had elevated T1 signal intensity ratios (n = 20 and 16 injections). Twelve of the 16 children with radiochemotherapy showed elevated signal intensity ratios. Statistical analysis demonstrated a significant signal intensity ratio change for the number of injections (P < .001) and amount of gadolinium (P = .008), but not for the interscan time interval (P = .35). There was a significant difference in the average signal intensity ratio change between those with and without radiochemotherapy (P < .001). Chart review revealed no new neurologic deficits in any patients, related to their underlying conditions and prior surgeries.

CONCLUSIONS:

Compared with published adult series, children show a similar pattern of T1 hyperintense signal changes of the dentate and globus pallidus after multiple gadobenate dimeglumine injections. The T1 signal changes in children may have a later onset but are accelerated by radiochemotherapy.



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Spatial Correlation of Pathology and Perfusion Changes within the Cortex and White Matter in Multiple Sclerosis [ADULT BRAIN]

BACKGROUND AND PURPOSE:

The spatial correlation between WM and cortical GM disease in multiple sclerosis is controversial and has not been previously assessed with perfusion MR imaging. We sought to determine the nature of association between lobar WM, cortical GM, volume and perfusion.

MATERIALS AND METHODS:

Nineteen individuals with secondary-progressive multiple sclerosis, 19 with relapsing-remitting multiple sclerosis, and 19 age-matched healthy controls were recruited. Quantitative MR perfusion imaging was used to derive CBF, CBV, and MTT within cortical GM, WM, and T2-hyperintense lesions. A 2-step multivariate linear regression (corrected for age, disease duration, and Expanded Disability Status Scale) was used to assess correlations between perfusion and volume measures in global and lobar normal-appearing WM, cortical GM, and T2-hyperintense lesions. The Bonferroni adjustment was applied as appropriate.

RESULTS:

Global cortical GM and WM volume was significantly reduced for each group comparison, except cortical GM volume of those with relapsing-remitting multiple sclerosis versus controls. Global and lobar cortical GM CBF and CBV were reduced in secondary-progressive multiple sclerosis compared with other groups but not for relapsing-remitting multiple sclerosis versus controls. Global and lobar WM CBF and CBV were not significantly different across groups. The distribution of lobar cortical GM and WM volume reduction was disparate, except for the occipital lobes in patients with secondary-progressive multiple sclerosis versus those with relapsing-remitting multiple sclerosis. Moderate associations were identified between lobar cortical GM and lobar normal-appearing WM volume in controls and in the left temporal lobe in relapsing-remitting multiple sclerosis. No significant associations occurred between cortical GM and WM perfusion or volume. Strong correlations were observed between cortical-GM perfusion, normal appearing WM and lesional perfusion, with respect to each global and lobar region within HC, and RRMS and SPMS patients (R2 ≤ 0.96, P < .006 and R2 ≤ 0.738, P < .006).

CONCLUSIONS:

The weak correlation between lobar WM and cortical GM volume loss and perfusion reduction suggests the independent pathophysiology of WM and cortical GM disease.



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Injection of Botulinum Toxin for Preventing Salivary Gland Toxicity after PSMA Radioligand Therapy: an Empirical Proof of a Promising Concept

Abstract

The dose-limiting salivary gland toxicity of 225Ac-labelled PSMA for treatment of metastatic, castration-resistant prostate cancer remains unresolved. Suppressing the metabolism of the gland by intraparenchymal injections of botulinum toxin appears to be a promising method to reduce off-target uptake. A 68Ga-PSMA PET/CT scan performed 45 days after injection of 80 units of botulinum toxin A into the right parotid gland in a 63-year-old patient showed a decrease in the SUVmean in the right parotid gland of up to 64% as compared with baseline. This approach could be a significant breakthrough for radioprotection of the salivary glands during PSMA radioligand therapy.



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Investigation of an appropriate contrast-enhanced CT protocol for young patients following the Fontan operation

Abstract

Purpose

Children with congenital heart diseases (CHDs) may need to be followed up with contrast-enhanced CT following the Fontan operation because complications such as the occlusion of conduits may occur. The purpose of the present study was to develop an adequate contrast-enhanced CT protocol for children with CHD following the Fontan operation.

Materials and methods

Between July 2012 and July 2017, 29 CT examinations for 26 patients aged 2–11 years (median 5 years) with CHD following the Fontan operation were performed using dual-source CT. A non-ionized contrast medium was injected through the dorsum manus vein. Scanning began 60 or 70 s after the start of the injection. The delayed phase was randomly selected to be 60 s in 14 cases and 70 s in 15 cases. We evaluated the enhancement of conduits following the Fontan operation at delayed phases.

Results

The CT numbers of conduits at 60 and 70 s were 185 ± 46 and 185 ± 31 HU, respectively (P = 0.97).

Conclusion

In contrast-enhanced CT for children after the Fontan operation, both of the delayed phases (60 and 70 s) appeared to be adequate for evaluating intraconduit patency.



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Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn's Disease.

Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn's Disease.

Radiology. 2018 Jan 10;:171737

Authors: Bruining DH, Zimmermann EM, Loftus EV, Sandborn WJ, Sauer CG, Strong SA, Society of Abdominal Radiology Crohn's Disease-Focused Panel

Abstract
Computed tomography and magnetic resonance enterography have become routine small bowel imaging tests to evaluate patients with established or suspected Crohn's disease, but the interpretation and use of these imaging modalities can vary widely. A shared understanding of imaging findings, nomenclature, and utilization will improve the utility of these imaging techniques to guide treatment options, as well as assess for treatment response and complications. Representatives from the Society of Abdominal Radiology Crohn's Disease-Focused Panel, the Society of Pediatric Radiology, the American Gastroenterological Association, and other experts, systematically evaluated evidence for imaging findings associated with small bowel Crohn's disease enteric inflammation and established recommendations for the evaluation, interpretation, and use of computed tomography and magnetic resonance enterography in small bowel Crohn's disease. This work makes recommendations for imaging findings that indicate small bowel Crohn's disease, how inflammatory small bowel Crohn's disease and its complications should be described, elucidates potential extra-enteric findings that may be seen at imaging, and recommends that cross-sectional enterography should be performed at diagnosis of Crohn's disease and considered for small bowel Crohn's disease monitoring paradigms. A useful morphologic construct describing how imaging findings evolve with disease progression and response is described, and standard impressions for radiologic reports that convey meaningful information to gastroenterologists and surgeons are presented. ©2018, RSNA, AGA Institute, and Society of Abdominal Radiology This article is being published jointly in Radiology and Gastroenterology.

PMID: 29319414 [PubMed - as supplied by publisher]



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IAPs cause resistance to TRAIL-dependent apoptosis in follicular thyroid cancer.

IAPs cause resistance to TRAIL-dependent apoptosis in follicular thyroid cancer.

Endocr Relat Cancer. 2018 Jan 09;:

Authors: Werner TA, Nolten I, Dizdar L, Riemer J, Schütte SC, Verde PE, Raba K, Schott M, Knoefel WT, Krieg A

Abstract
Follicular thyroid cancer's (FTC) excellent long-term prognosis is mainly dependent on complete surgical removal and postoperative radioactive iodine (RAI) treatment. However, once the tumour becomes RAI refractory the 10-year disease specific survival rate drops below 10 %. The aim of our study was to evaluate the prognostic and biological role of the TRAIL system in FTC and to elucidate the influence of small molecule mediated antagonization of inhibitor of apoptosis proteins (IAPs) on TRAIL-sensitivity in vitro. Tissue microarrays were constructed from forty-four patients with histologically confirmed FTC. Expression levels of TRAIL and its receptors were correlated with clinicopathological data, overall as well as recurrence-free survival. Non-iodine retaining FTC cell lines TT2609-C02 and FTC133 were treated with recombinant human TRAIL alone and in combination with Smac mimetics GDC-0152 or Birinapant. TRAIL-R2/DR5 as well as TRAIL-R3/DcR1 and TRAIL-R4/DcR2 were significantly higher expressed in advanced tumour stages. Both decoy receptors were negatively associated with recurrence free and overall survival. TRAIL-R4/DcR2 additionally proved to be an independent negative prognostic marker in FTC (HR = 1.446, 95 % CI: 1.144 - 1.826; p < 0.001). In vitro, the co-incubation of Birinapant or GDC-0152 with rh-TRAIL sensitised FTC cell lines for TRAIL induced apoptosis, through degradation of cIAP1/2. The TRAIL system plays an important role in FTC tumour biology. Its decoy receptors are associated with poor prognosis and earlier recurrence. The degradation of cIAP1/2 sensitises FTC cells to TRAIL induced apoptosis and might highlight a new point of attack in patients with RAI refractory disease.

PMID: 29317481 [PubMed - as supplied by publisher]



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Five mental foramina in the same mandible: CBCT findings of an unusual anatomical variant.

Five mental foramina in the same mandible: CBCT findings of an unusual anatomical variant.

Surg Radiol Anat. 2018 Jan 09;:

Authors: Borghesi A, Pezzotti S, Nocivelli G, Maroldi R

Abstract
The mental foramen is an important anatomic landmark located on the buccal aspect of the mandible, typically near the apex of the second premolar. Mental foramina exhibit many anatomical variations, including differences in size, shape, position, and number. The most frequent type of variation in number is the presence of double mental foramen, which has a reported incidence ranging from 1.4 to 12.5%. The incidence of triple mental foramen ranges from 0.7 to 1.2%. The frequency of accessory mental foramina varies among ethnic groups, with a low incidence in white Caucasian populations. At present, cone beam computed tomography (CBCT) is the diagnostic tool of choice for examining the maxillofacial region, and the high spatial resolution of CBCT allows accurate three-dimensional analysis of mental foramen variations. The present report describes an unusual case of five mental foramina in a 24-year-old white European male diagnosed by CBCT.

PMID: 29318364 [PubMed - as supplied by publisher]



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Double left brachiocephalic vein with a preaortic course: a rare finding.

Double left brachiocephalic vein with a preaortic course: a rare finding.

Surg Radiol Anat. 2018 Jan 09;:

Authors: Hwang GH, Lee KH, Cho SG, Jeon YS, Kim YJ, Lee HY, Kim JH

Abstract
A double left brachiocephalic vein is an uncommon anatomic variation. Among these, a accessory branch with preaortic course is extremely rare. In this case, both branches of the left brachiocephalic vein were anterior to the aortic arch. We describe the computed tomography findings with volume-rendering imaging of this rare anatomic variation.

PMID: 29318363 [PubMed - as supplied by publisher]



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Frailty in Pulmonary and Critical Care Medicine.

https:--http://ift.tt/2bsbOVj Related Articles

Frailty in Pulmonary and Critical Care Medicine.

Ann Am Thorac Soc. 2016 Aug;13(8):1394-404

Authors: Singer JP, Lederer DJ, Baldwin MR

Abstract
Conceptualized first in the field of geriatrics, frailty is a syndrome characterized by a generalized vulnerability to stressors resulting from an accumulation of physiologic deficits across multiple interrelated systems. This accumulation of deficits results in poorer functional status and disability. Frailty is a "state of risk" for subsequent disproportionate declines in health status following new exposure to a physiologic stressor. Two predominant models have emerged to operationalize the measurement of frailty. The phenotype model defines frailty as a distinct clinical syndrome that includes conceptual domains such as strength, activity, wasting, and mobility. The cumulative deficit model defines frailty by enumerating the number of age-related things wrong with a person. The biological pathways driving frailty include chronic systemic inflammation, sarcopenia, and neuroendocrine dysregulation, among others. In adults with chronic lung disease, frailty is independently associated with more frequent exacerbations of lung disease, all-cause hospitalization, declines in functional status, and all-cause mortality. In addition, frail adults who become critically ill are more likely develop chronic critical illness or severe disability and have higher in-hospital and long-term mortality rates. The evaluation of frailty appears to provide important prognostic information above and beyond routinely collected measures in adults with chronic lung disease and the critically ill. The study of frailty in these populations, however, requires multipronged efforts aimed at refining clinical assessments, understanding the mechanisms, and developing therapeutic interventions.

PMID: 27104873 [PubMed - indexed for MEDLINE]



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Reduction in Bladder-Related Autonomic Dysreflexia after OnabotulinumtoxinA Treatment in Spinal Cord Injury.

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Reduction in Bladder-Related Autonomic Dysreflexia after OnabotulinumtoxinA Treatment in Spinal Cord Injury.

J Neurotrauma. 2016 Sep 15;33(18):1651-7

Authors: Fougere RJ, Currie KD, Nigro MK, Stothers L, Rapoport D, Krassioukov AV

Abstract
Bladder-related events, including neurogenic detrusor overactivity, are the leading cause of autonomic dysreflexia in spinal cord injured individuals. Self-reported autonomic dysreflexia is reduced following onabotulinumtoxinA treatment for neurogenic detrusor overactivity; however, none of these trials have assessed autonomic dysreflexia events using the clinical cutoff of an increase in systolic blood pressure ≥20 mm Hg. This study used a prospective, open-labelled design from 2013 to 2014 to quantitatively assess the efficacy of one cycle 200 U intradetrusor-injected onabotulinumtoxinA (20 sites) on reducing the severity and frequency of bladder-related autonomic dysreflexia events and improving quality of life. Twelve men and five women with chronic, traumatic spinal cord injuries at or above the sixth thoracic level, and concomitant autonomic dysreflexia and neurogenic detrusor overactivity, underwent blood pressure monitoring during urodynamics and over a 24 h period using ambulatory blood pressure monitoring pre- and 1 month post-treatment. Post-onabotulinumtoxinA, autonomic dysreflexia severity was reduced during urodynamics (systolic blood pressure increase: 42 ± 23 mm Hg vs. 20 ± 10 mm Hg, p < 0.001) and during bladder-related events across the 24 h period (systolic blood pressure increase: 49 ± 2 mm Hg vs. 26 ± 22 mm Hg, p = 0.004). Frequency of 24 h bladder-related autonomic dysreflexia events was also decreased post-onabotulinumtoxinA (4 ± 2 events vs. 1 ± 1 events, p < 0.001). Autonomic dysreflexia and incontinence quality of life indices were also improved post-onabotulinumtoxinA (p < 0.05). Intradetrusor injections of onabotulinumtoxinA for the management of neurogenic detrusor overactivity in individuals with high level spinal cord injuries decreased the severity and frequency of bladder-related episodes of autonomic dysreflexia, and improved bladder function and quality of life.

PMID: 26980078 [PubMed - indexed for MEDLINE]



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quality of care; +807 new citations

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

quality of care

These pubmed results were generated on 2018/01/11

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



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ERRATUM.

ERRATUM.

Diagn Interv Radiol. 2018 Jan-Feb;24(1):62

Authors:

PMID: 29317378 [PubMed - in process]



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Multiparametric MRI for the detection of local recurrence of prostate cancer in the setting of biochemical recurrence after low dose rate brachytherapy.

Multiparametric MRI for the detection of local recurrence of prostate cancer in the setting of biochemical recurrence after low dose rate brachytherapy.

Diagn Interv Radiol. 2018 Jan-Feb;24(1):46-53

Authors: Valle LF, Greer MD, Shih JH, Barrett T, Law YM, Rosenkrantz AB, Shebel H, Muthigi A, Su D, Merino MJ, Wood BJ, Pinto PA, Krauze AV, Kaushal A, Choyke PL, Türkbey B, Citrin DE

Abstract
PURPOSE: Prostate multiparametric magnetic resonance imaging (mpMRI) has utility in detecting post-radiotherapy local recurrence. We conducted a multireader study to evaluate the diagnostic performance of mpMRI for local recurrence after low dose rate (LDR) brachytherapy.
METHODS: A total of 19 patients with biochemical recurrence after LDR brachytherapy underwent 3T endorectal coil mpMRI with T2-weighted imaging, dynamic contrast-enhanced imaging (DCE) and diffusion-weighted imaging (DWI) with pathologic confirmation. Prospective reads by an experienced prostate radiologist were compared with reads from 4 radiologists of varying experience. Readers identified suspicious lesions and rated each MRI detection parameter. MRI-detected lesions were considered true-positive with ipsilateral pathologic confirmation. Inferences for sensitivity, specificity, positive predictive value (PPV), kappa, and index of specific agreement were made with the use of bootstrap resampling.
RESULTS: Pathologically confirmed recurrence was found in 15 of 19 patients. True positive recurrences identified by mpMRI were frequently located in the transition zone (46.7%) and seminal vesicles (30%). On patient-based analysis, average sensitivity of mpMRI was 88% (standard error [SE], 3.5%). For highly suspicious lesions, specificity of mpMRI was 75% (SE, 16.5%). On lesion-based analysis, the average PPV was 62% (SE, 6.7%) for all lesions and 78.7% (SE, 10.3%) for highly suspicious lesions. The average PPV for lesions invading the seminal vesicles was 88.8% (n=13). The average PPV was 66.6% (SE, 5.8%) for lesions identified with T2-weighted imaging, 64.9% (SE, 7.3%) for DCE, and 70% (SE, 7.3%) for DWI.
CONCLUSION: This series provides evidence that mpMRI after LDR brachytherapy is feasible with a high patient-based cancer detection rate. Radiologists of varying experience demonstrated moderate agreement in detecting recurrence.

PMID: 29317377 [PubMed - in process]



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A comparison between 915 MHz and 2450 MHz microwave ablation systems for the treatment of small diameter lung metastases.

A comparison between 915 MHz and 2450 MHz microwave ablation systems for the treatment of small diameter lung metastases.

Diagn Interv Radiol. 2018 Jan-Feb;24(1):31-37

Authors: Vogl TJ, Roman A, Nour-Eldin NA, Hohenforst-Schmidt W, Bednarova I, Kaltenbach B

Abstract
PURPOSE: We aimed to retrospectively compare the local tumor control rates between low frequency (LF) and high frequency (HF) microwave ablation devices in the treatment of <3 cm lung metastases.
METHODS: A total of 36 patients (55 tumors) were treated with the LF system (915 MHz) and 30 patients (39 tumors) were treated with the HF system (2450 MHz) between January 2011 and March 2016. Computed tomography (CT) scans performed prior to and 24 hours after the ablation were used to measure the size of the ablation zone and to calculate the ablation margin. The subsequent CTs were used to detect local tumor progression. Possible predictive factors for local progression were analyzed. All patients had a minimum follow-up of 3 months with a median of 13.8 months for the LF group and 11.7 months for the HF group.
RESULTS: The ablation margin (P = 0.015), blood vessel proximity (P = 0.006), and colorectal origin (P = 0.029) were significantly associated with the local progression rate. The local progression rates were 36.3% for LF ablations and 12.8% for HF ablations. The 6, 12, and 18 months local progression-free survival rates were 79%, 65.2% and 53% for the LF group and 97.1%, 93.7%, and 58.4% for the HF group, with a significant difference between the survival curves (P = 0.048).
CONCLUSION: HF ablations resulted in larger ablation margins with fewer local progression compared with LF ablations.

PMID: 29317376 [PubMed - in process]



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Does doxorubicin survive thermal ablation? Results of an ex vivo bench top study.

Does doxorubicin survive thermal ablation? Results of an ex vivo bench top study.

Diagn Interv Radiol. 2018 Jan-Feb;24(1):28-30

Authors: Morrison JD, Schlager CK, Lee AE, van Breemen RB, Gaba RC

Abstract
PURPOSE: We aimed to test the hypothesis that doxorubicin (DOX) survives thermal ablative heating in an ex vivo model of combined transarterial chemoembolization (TACE) and thermal ablation.
METHODS: Fresh porcine psoas major muscle (3 samples, 15×10×3 cm) was submerged in aqueous DOX solution (60 µg/mL, 0.1 M) for 24 hours to passively saturate tissue. DOX-infused tissue was then dried and treated with microwave ablation (MWA) using a 2.45 GHz antenna at 65 W for 2, 5, and 10 minutes. Ablations were repeated in triplicate (9 total). Tissue was then sampled at both ablated and unablated control sites, and DOX concentration was quantified via ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS), with samples analyzed in triplicate. Tissue DOX levels in ablation and control groups were compared using one-way ANOVA.
RESULTS: Homogeneous DOX uptake into porcine tissue was evident in all three samples. Mean DOX concentration in unablated tissue was 8.0±2.2 µg/mL. MWA was technically successful in all 9 procedures (100%), with tissue heating to 95-100°C. Mean tissue DOX concentration showed progressive reduction with increasing ablation time, measuring 6.7±1.3, 4.9±0.9, and 4.8±1.3 µg/mL in MWA-treated tissue after 2, 5, and 10 minutes, respectively. Differences in tissue DOX levels between unablated tissue and MWA groups were statistically significant (P < 0.001).
CONCLUSION: Contrary to the initial hypothesis, tissue DOX concentration progressively decreased after MWA of longer ablation times. These results suggest that TACE followed by ablation may result in lower intratumoral DOX than would otherwise be anticipated for TACE alone.

PMID: 29317375 [PubMed - in process]



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Acute lower gastrointestinal bleeding: predictive factors and clinical outcome for the patients who needed first-time mesenteric conventional angiography.

Acute lower gastrointestinal bleeding: predictive factors and clinical outcome for the patients who needed first-time mesenteric conventional angiography.

Diagn Interv Radiol. 2018 Jan-Feb;24(1):23-27

Authors: Sıldıroğlu O, Muasher J, Bloom TA, Kapucu İ, Arslan B, Angle JF, Matsumoto AH, Turba ÜC

Abstract
PURPOSE: We aimed to investigate patients with lower gastrointestinal bleeding who presented to the emergency department requiring initial conventional angiography. We report risk-stratified and mesenteric conventional angiography outcomes.
METHODS: We retrospectively reviewed patients with lower gastrointestinal bleeding between 2001 and 2012. We included all consecutive patients with clinical lower gastrointestinal bleeding with a requirement of further angiography and possible embolization. Patients who had prior interventions or surgery were excluded.
RESULTS: A total of 88 patients (35 women, 53 men) with a median age of 71 years (range, 23-99 years) were included in the analysis. Conventional angiography was positive and endovascular treatment was intended in 35 patients. Once the source of bleeding was found angiographically, endovascular treatment had a technical success rate of 90.3% and clinical success rate of 71.4%. Overall early rebleeding rate (<30 days) was 14.8% and late rebleeding rate (>30 days) was 13.6%.
CONCLUSION: Identifying the source of lower gastrointestinal bleeding remains to be a clinical and angiographic challenge. Although we did not observe an association between mortality and clinical success, increased early rebleeding rates were associated with higher mortality rates.

PMID: 29317374 [PubMed - in process]



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Impact of an abbreviated protocol for breast MRI in diagnostic accuracy.

Impact of an abbreviated protocol for breast MRI in diagnostic accuracy.

Diagn Interv Radiol. 2018 Jan-Feb;24(1):12-16

Authors: Oldrini G, Derraz I, Salleron J, Marchal F, Henrot P

Abstract
PURPOSE: We aimed to compare the diagnostic accuracy and interpretation time of an abbreviated protocol relative to the complete protocol of breast magnetic resonance imaging (MRI) with the use of breast imaging reporting and data system (BI-RADS). Between-reader and between-protocol variability for BI-RADS classification and influence of reader expertise on diagnostic accuracies were also evaluated.
METHODS: We conducted a retrospective reader study in 90 women who underwent breast MRI: 30 benign examinations (graded as American College of Radiology [ACR] 1 or 2), 30 examinations graded as ACR 3 and 30 examinations requiring a histologic proof (graded as ACR 4 or 5). Two radiologists independently reviewed the protocols. The reference standard was 24 months of imaging follow-up (66.6%, n=60), percutaneous biopsy at the 12th month imaging follow-up (5.5%, n=5), and breast surgery (27.9%, n=25). Analysis was done on a per-breast basis. There were 26 cancers in 168 breasts (15.1%) RESULTS: Interpretation time was higher for the complete protocol (mean difference: 84 s, 95% CI [67;101] for senior and 83 s, 95% CI [70;95] for junior reader; P < 0.001). The reliability of BI-RADS classification between both protocols was very good with intraclass correlation coefficient of 0.89 for junior reader and 0.98 for senior reader; the inter-reader reliability was 0.94 and 0.90 for the complete and abbreviated protocols, respectively. For senior reader, the abbreviated and complete protocols yielded 95.1% and 94.4% specificity and 100% sensitivity.
CONCLUSION: Our data provide corroborating evidence that abbreviated protocols decrease interpretation time without compromising sensitivity or specificity. There was a high level of concordance between the abbreviated and complete protocols and between the two readers.

PMID: 29317373 [PubMed - in process]



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Pancreas ductal adenocarcinoma with cystic features on cross-sectional imaging: radiologic-pathologic correlation.

Pancreas ductal adenocarcinoma with cystic features on cross-sectional imaging: radiologic-pathologic correlation.

Diagn Interv Radiol. 2018 Jan-Feb;24(1):5-11

Authors: Youn SY, Rha SE, Jung ES, Lee IS

Abstract
Most pancreatic ductal adenocarcinomas (PDAs) show solid growth pattern, but ductal adenocarcinomas may demonstrate intratumoral cystic appearance or accompany peritumoral non-neoplastic cystic lesions, thus mimicking cystic pancreatic tumors on imaging studies. The histopathologic findings for PDA with cystic feature are divided into neoplastic and non-neoplastic cysts. Neoplastic cystic changes include large-duct type cysts (microcystic appearance), neoplastic mucin cysts (macrocystic appearance), colloid carcinomas (mucinous noncystic adenocarcinomas), and degenerative cystic change usually caused by hemorrhagic necrosis of tumor. Non-neoplastic cystic changes include retention cysts caused by ductal obstruction and pseudocysts caused by tumor-associated pancreatitis. Depending on the presence, size, number, and configuration of cystic changes, PDA should be differentiated from various types of cystic neoplasms. This pictorial essay provides histopathologic classification of PDAs with cystic features along with the corresponding cross-sectional imaging findings, and their differential diagnosis.

PMID: 29317372 [PubMed - in process]



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The Darker Side of Military Mental Healthcare Part Two: Five Harmful Strategies to Manage Its Mental Health Dilemma

Abstract

This is the second part of our analysis of the military’s mental health care dilemma. Since the First World War, military and government officials have been quite wary of mass psychiatric attrition and escalating pension costs from warzones. Specifically, the military worries about unknown repercussions should war stress injuries be de-stigmatized and treated equally as physical wounds, as required per the military’s own documented lessons learned. Leaders fear that so-called evacuation syndromes would spread, thereby depleting the fighting force for invalid reasons, eroding unit morale, and providing an acceptable escape from one’s military duties instead of the disapproval deserved, thus jeopardizing the military’s primary mission to fight and win wars, as well as risk possible financial strain in societies dealing with too many psychiatrically disabled veterans. Consequently, the military routinely admits to ignoring its war trauma lessons, resulting in a generational pattern of self-inflicted crises, including suicide epidemics. Moreover, besides neglecting such lessons, the military has adopted various approaches over time to reduce the possibility of evacuation syndromes by aggressively preventing psychiatric attrition, treatment, and disability pensions. After an extensive review of the war stress literature, we identified 10 overarching strategies the military has employed in order to resist fully learning from its lessons on the psychiatric realities of modern warfare by eliminating, minimizing, and/or concealing its mental health problem. Part two of the article series examines the following avoidance strategies intended to prevent psychiatric attrition and disability pensions: (1) Cruel and Inhumane Handling; (2) Legal Prosecution, Incarceration, and Executions; (3) Weaponizing Stigma to Humiliate, Ridicule, and Shame into Submission; (4) Denying the Realities of Mental Health; and (5) Screening and Purging Weakness. We argue that by not accepting the realities of the combat stressors, no effective methods for assessment and treatment of the stress reactions, not to mention prevention methods, have emerged that contributes to alleviating the veteran suicide and mental health crises.



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Use of inductors in the control of Colletotrichum gloeosporioides and Rhizopus stolonifer isolated from soursop fruits: in vitro tests

Abstract

Soursop (Annona muricata) is a tropical fruit that can be infected by Colletotrichum gloeosporioides and Rhizopus stolonifer. Traditional methods used for postharvest disease control include the application of fungicides, however due to their excessive use, as well as their persistence in the environment, the development of new strategies that control pathogens are required. The application of chitosan (Chi), salicylic acid (SA) and methyl jasmonate (MJ) is an environmentally-friendly alternative with antimicrobial properties and also induces defense mechanisms in plant tissues. In this study, Colletotrichum was reactivated and Rhizopus was identified using morphological features and molecular tools. In vitro, the application of 0.5 and 1.0% of Chi alone or in combination with SA and MJ decreased mycelial growth and sporulation, a complete inhibition of spore germination was obtained. Thus, the application of Chi in combination with SA and MJ could be a smart strategy to inhibit the development of pathogens that attack soursop fruit.



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Proteomic Analysis of Vibrio parahaemolyticus Under Cold Stress

Abstract

Vibrio parahaemolyticus is a kind of food-borne pathogenic bacterium, which can seriously infect food, especially seafood causing gastroenteritis and other disease. We studied the global proteome responses of V. parahaemolyticus under cold stress by nano-liquid chromatography-tandem mass spectrometry to improve the present understanding of V. parahaemolyticus proteomics events under cold stress. A total of 1151 proteins were identified and 101 proteins were differentially expressed, of which 69 were significantly up-regulated and 32 were downregulated. Functional categorization of these proteins revealed distinct differences between cold-stressed and control cells. These proteins were grouped into 21 functional categories by the clusters of orthologous groups (COG) analysis. The most of up-regulated proteins were functionally categorized as nucleotide transport and metabolism, transcription, function unknown, and defense mechanisms. These up-regulated proteins play an important role under cold stress.



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Surgery remains the most important treatment for breast cancer - read our new special issue covering the latest hot… https://t.co/SKoRCHeB2i

Surgery remains the most important treatment for breast cancer - read our new special issue covering the latest hot… https://t.co/SKoRCHeB2i

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H εikόνa toυ Mπaτák στη συλλoγιkή μνήμη тων Boυλγάрων



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Does biochar affect the availability and chemical fractionation of phosphate in soils?

Abstract

Biochar as a soil amendment has been reported to affect the content and availability of soil nutrients. In this study, we aimed to test whether the biochar addition to soils would change the availability and chemical fractionation of phosphate in soils. Two soils (Ultisol and Alfisol) were amended with five kinds of biochars at application rate of 0, 1, and 2% (w/w). After 3-month incubation, availability and chemical forms of P were measured to investigate the potential effect and role of biochar in improving P availability in soils. The biochars used here had a lager variation of P content, depending on their feedstocks. Compared to the untreated soils, application of biochars derived from deciduous tree leaves (DLB), reed (RB), and rice straw (RSB) significantly increased the pH of two soils. The total P content of biochar-amended soils was increased with the addition of biochars. However, only RSB exhibited a significant increase (p < 0.05) of total P content. Application of biochars significantly increased the NH4Cl-extractable P content of two soils, indicating that biochars were able to increase the availability of phosphate in soils, but the amount of available P was dependent on biochar types. Ultisol and Alfisol amended with RSB (2% w/w) showed an increase in the P availability (0.5 M NaHCO3-extractable P) by 46 and 39%, respectively. For strongly acidic Ultisol, addition of biochar significantly increased Al-P and Ca-P content, as well as decreased Fe-P content. The P desorption test indicated the release of P from soils increased with the addition of biochar. Results suggested that biochar would change the P sorption affinity of the soil and help to increase the availability of fixed P. The increase of P availability with biochar application was due to the pH change and direct P contribution from biochar. Our results concluded that biochar affected the availability, chemical forms, and sorption capability of phosphate in soil. The extent of biochar effects on soil P varied greatly with the type of feedstock of biochar and soil type.



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Pulmonary function and uric acid . . . and other stories

Uric acid and the lungsUric acid has antioxidant properties, and Danish investigators wondered if it might protect against impaired pulmonary function. In fact, the reverse seemed to be true since,...
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Rethinking neoadjuvant chemotherapy for breast cancer

Key messagesNeoadjuvant chemotherapy is being increasingly used for breast cancer despite higher rates of local recurrence and no evidence of survival benefit, mainly because of the immediate and...
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Chronic limb threatening ischaemia

What you need to knowChronic limb threatening ischaemia (CLTI) is a more difficult diagnosis than acute limb ischaemia for the non-specialist because the clinical features can be more subtle and...
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We need better animal research, better reported

New drug development is underpinned by animal research, but is the animal evidence base fit for purpose? A collection of articles published in The BMJ this week suggest not. They conclude that the...
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An ulcer on the nipple

A 39 year old woman presented with an asymptomatic ulcer on her left nipple. The ulcer had been present for five weeks. She also reported malaise. She denied any travel history in the past three...
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