Τετάρτη, 7 Φεβρουαρίου 2018

The influence of tissue composition uncertainty on dose distributions in brachytherapy

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Publication date: Available online 7 February 2018
Source:Radiotherapy and Oncology
Author(s): Dylan Mann-Krzisnik, Frank Verhaegen, Shirin A. Enger
Background and purposeModel-based dose calculation algorithms (MBDCAs) have evolved from serving as a research tool into clinical practice in brachytherapy. This study investigates primary sources of tissue elemental compositions used as input to MBDCAs and the impact of their variability on MBDCA-based dosimetry.Materials and methodsRelevant studies were retrieved through PubMed. Minimum dose delivered to 90% of the target (D90), minimum dose delivered to the hottest specified volume for organs at risk (OAR) and mass energy-absorption coefficients (μen/ρ) generated by using EGSnrc "g" user-code were compared to assess the impact of compositional variability.ResultsElemental composition for hydrogen, carbon, oxygen and nitrogen are derived from the gross contents of fats, proteins and carbohydrates for any given tissue, the compositions of which are taken from literature dating back to 1940–1950. Heavier elements are derived from studies performed in the 1950–1960. Variability in elemental composition impacts greatly D90 for target tissues and doses to OAR for brachytherapy with low energy sources and less for 192Ir-based brachytherapy. Discrepancies in μen/ρ are also indicative of dose differences.ConclusionsUpdated elemental compositions are needed to optimize MBDCA-based dosimetry. Until then, tissue compositions based on gross simplifications in early studies will dominate the uncertainties in tissue heterogeneity.



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The first clinical implementation of real-time image-guided adaptive radiotherapy using a standard linear accelerator

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Publication date: Available online 7 February 2018
Source:Radiotherapy and Oncology
Author(s): Paul J. Keall, Doan Trang Nguyen, Ricky O'Brien, Vincent Caillet, Emily Hewson, Per Rugaard Poulsen, Regina Bromley, Linda Bell, Thomas Eade, Andrew Kneebone, Jarad Martin, Jeremy T. Booth
PurposeUntil now, real-time image guided adaptive radiation therapy (IGART) has been the domain of dedicated cancer radiotherapy systems. The purpose of this study was to clinically implement and investigate real-time IGART using a standard linear accelerator.Materials/methodsWe developed and implemented two real-time technologies for standard linear accelerators: (1) Kilovoltage Intrafraction Monitoring (KIM) that finds the target and (2) multileaf collimator (MLC) tracking that aligns the radiation beam to the target. Eight prostate SABR patients were treated with this real-time IGART technology. The feasibility, geometric accuracy and the dosimetric fidelity were measured.ResultsThirty-nine out of forty fractions with real-time IGART were successful (95% confidence interval 87–100%). The geometric accuracy of the KIM system was −0.1 ± 0.4, 0.2 ± 0.2 and −0.1 ± 0.6 mm in the LR, SI and AP directions, respectively. The dose reconstruction showed that real-time IGART more closely reproduced the planned dose than that without IGART. For the largest motion fraction, with real-time IGART 100% of the CTV received the prescribed dose; without real-time IGART only 95% of the CTV would have received the prescribed dose.ConclusionThe clinical implementation of real-time image-guided adaptive radiotherapy on a standard linear accelerator using KIM and MLC tracking is feasible. This achievement paves the way for real-time IGART to be a mainstream treatment option.



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The influence of tissue composition uncertainty on dose distributions in brachytherapy

Model-based dose calculation algorithms (MBDCAs) have evolved from serving as a research tool into clinical practice in brachytherapy. This study investigates primary sources of tissue elemental compositions used as input to MBDCAs and the impact of their variability on MBDCA-based dosimetry.

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The first clinical implementation of real-time image-guided adaptive radiotherapy using a standard linear accelerator

Until now, real-time image guided adaptive radiation therapy (IGART) has been the domain of dedicated cancer radiotherapy systems. The purpose of this study was to clinically implement and investigate real-time IGART using a standard linear accelerator.

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Ablation of colorectal liver metastasis: Interaction of ablation margins and RAS mutation profiling on local tumour progression-free survival

Abstract

Objectives

To investigate effects of ablation margins on local tumour progression-free survival (LTPFS) according to RAS status in patients with colorectal liver metastases (CLM).

Methods

This two-institution retrospective study from 2005–2016 included 136 patients (91 male, median age 60 years) with 218 ablated CLM. LTPFS was performed using the Kaplan–Meier method and evaluated with the log-rank test. Uni/multivariate analyses were performed using Cox-regression models.

Results

Three-year LTPFS rates for CLM with minimal ablation margin ≤10 mm were significantly worse than those with >10 mm in both mutant-RAS (29% vs. 48%, p=0.038) and wild-type RAS (70% vs. 94%, p=0.039) subgroups. Three-year LTPFS rates of mutant-RAS were significantly worse than wild-type RAS in both CLM subgroups with minimal ablation margin ≤10 mm (29% vs. 70%, p<0.001) and >10 mm (48% vs. 94%, p=0.006). Predictors of worse LTPFS were ablation margins ≤10 mm (HR: 2.17, 95% CI 1.2–4.1, p=0.007), CLM size ≥2 cm (1.80, 1.1–2.8, p=0.017) and mutant-RAS (2.85, 1.7–4.6, p<0.001).

Conclusions

Minimal ablation margin and RAS status interact as independent predictors of LTPFS following CLM ablation. While minimal ablation margins >10 mm should be always the procedural goal, this becomes especially critical for mutant-RAS CLM.

Key Points

RAS and ablation margins are predictors of local tumour progression-free survival.

Ablation margin >10 mm, always desirable, is crucial for mutant RAS metastases.

Interventional radiologists should be aware of RAS status to optimize LTPFS.



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Diagnosing Neoplastic Hematoma: Role of MR Perfusion

Abstract

Background

The imaging appearance of neoplastic hematoma can be complicated by the presence of a large hematoma, even on magnetic resonance imaging (MRI). We describe the role of MR perfusion (MRP) in detecting neoplastic hematomas in patients with intraparenchymal hematoma (IPH).

Material and Methods

A retrospective review was performed for consecutive patients with IPH, where MRP was performed. Routine, post-gadolinium MRI and MRP were analyzed. All patients were either operated on for evacuation of IPH or followed up on imaging. The MRP parameters of cerebral blood volume (CBV) and cerebral blood flow (CBF) and pattern of enhancement (peripheral linear vs. nodular) were recorded. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated for these parameters for diagnosing neoplastic hematoma.

Results

Of 116 patients with MRP, 16 patients (male 8; mean age—65.5 years) had IPH on their initial MRI. For diagnosing neoplastic hematoma, the sensitivity, specificity, PPV and NPV for increased CBF and CBV were 100%, 88.9%, 87.5%, and 100%; for peripheral linear enhancement were 100%, 28.6%, 50%, 100% and for nodular enhancement were 85.7%, 77.8%, 75% and 12.5%, respectively. The combination of peripheral linear enhancement and increased CBF and CBV showed 100% sensitivity, specificity, PPV and NPV.

Conclusion

In our small series, the combination of peripheral linear enhancement and increased CBF and CBV showed 100% sensitivity, specificity, PPV and NPV for diagnosing a neoplastic hematoma. These findings need to be validated in a larger study.



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Intravoxel Incoherent Motion Analysis of Abdominal Organs: Application of Simultaneous Multislice Acquisition

imagePurpose The aim of this study was to systematically evaluate the accuracy of quantitative intravoxel incoherent motion (IVIM) analysis of the upper abdomen applying simultaneous multislice (SMS) diffusion-weighted imaging (DWI) to reduce acquisition time. Materials and Methods Diffusion-weighted imaging of parenchymal abdominal organs was performed in 8 healthy volunteers at 3 T using a standard DWI sequence (acceleration factor 1 [AF1]) and an SMS-accelerated echo planar imaging sequence with acceleration factors 2 and 3 (AF2/AF3). Intravoxel incoherent motion analysis was performed with a multistep algorithm for true diffusion coefficient (Dt), pseudodiffusion coefficient (D*), and fraction of perfusion (Fp) measured for the liver, kidney cortex and medulla, pancreas, spleen, and erector spinae muscle. Qualitative and quantitative parameters were compared using a repeated measurement 1-way analysis of variance test and the Bonferroni post hoc method. Results Simultaneous multislice DWI provided diagnostic image quality in all volunteers with a reduction of scan time of 50% for AF2 (67% for AF3) compared with the standard sequence. Decent IVIM analysis for Dt, D*, and Fp can be calculated on the images of both the SMS sequences AF2 and AF3 with typical organ characteristics of IVIM; however, systematical deviations from AF1 were observed: Dt values increased and Fp decreased significantly with higher acceleration factor for liver, kidney, pancreas, and muscle (P

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The Issue of Gadolinium Retained in Tissues: Insights on the Role of Metal Complex Stability by Comparing Metal Uptake in Murine Tissues Upon the Concomitant Administration of Lanthanum- and Gadolinium-Diethylentriamminopentaacetate

imageObjectives The aim of the study was to explore the role of the stability of metal complexes in the processes that lead to the metal retention in the brain and other tissues of mice administered with lanthanides-based contrast agents. This issue was tackled by the simultaneous injection of gadolinium (Gd)-diethylentriamminopentaacetate (DTPA) and lanthanum-DTPA, which have the same charge and structure but differ in their thermodynamic stability by 3 orders of magnitude. Materials and Methods A total of 20 healthy BALB/c mice were administered by a single intravenous injection with a dose consisting of 0.6 mmol La-DTPA/kg and 0.6 mmol Gd-DTPA/kg. Then the animals were killed at different time points: 4, 24, 48, and 96 hours (5 mice each group). In an additional protocol, 5 mice were administered with 9 doses of 0.3 mmol La-DTPA/kg and 0.3 mmol of Gd-DTPA/kg every 2 days over a period of 3 weeks. The sacrifice time was set to 3 weeks after the last administration. After sacrifice, the Gd and La content in liver, spleen, kidney, muscle, cerebrum, cerebellum, bone, eye, skin, blood, and urine was determined by inductively coupled plasma-mass spectrometry. Results A general decrease in the content of both the lanthanides was observed upon delaying the sacrifice time. At relatively short times after the injection (up to 96 hours), in the spleen, kidney, muscle, skin, and eye, almost the same content of La and Gd was detected, whereas in the cerebrum, cerebellum, bones, and liver, the amount of retained La decreased much slower than that of Gd, yielding a progressive increase in La/Gd ratio. The amount of retained La in the various tissues 21 days after the last of 9 administrations of La-DTPA and Gd-DTPA was always significantly higher than that of Gd. The concentration of both La and Gd decreased rapidly both in blood and in urine samples. Discussion The departure from the 1:1 ratio in the amounts of La and Gd determined in the investigated tissues has been used to gain information on the role of the complex stability and "wash-out" kinetics. The behavior of the less s` La-DTPA highlights processes occurring for Gd-DTPA at a slower rate. The herein obtained results support the view that most of the La/Gd retained in the brain arises from the intact chelate that has extravasated immediately after the intravenous administration. Long-term deposition of metal ions from internal reservoirs seems particularly relevant for liver and spleen.

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Photon-Counting CT: High-Resolution Imaging of Coronary Stents

imagePurpose The aim of this study was to investigate computed tomography (CT) imaging characteristics of coronary stents using a novel photon-counting detector (PCD) in comparison with a conventional energy-integrating detector (EID). Materials and Methods In this in vitro study, 18 different coronary stents were expanded in plastic tubes of 3 mm diameter, were filled with contrast agent (diluted to an attenuation of 250 Hounsfield units [HU] at 120 kVp), and were sealed. Stents were placed in an oil-filled custom phantom calibrated to an attenuation of −100 HU at 120 kVp for resembling pericardial fat. The phantom was positioned in the gantry at 2 different angles at 0 degree and 90 degrees relative to the z axis, and was imaged in a research dual-source PCD-CT scanner. Detector subsystem "A" used a standard 64-row EID, while detector subsystem "B" used a PCD, allowing high-resolution scanning (detector pixel-size 0.250 × 0.250 mm in the isocenter). Images were obtained from both detector systems at identical tube voltage (100 kVp) and tube current-time product (100 mA), and were both reconstructed using a typical convolution kernel for stent imaging (B46f) and using the same reconstruction parameters. Two independent, blinded readers evaluated in-stent visibility and measured noise, intraluminal stent diameter, and in-stent attenuation for each detector subsystem. Differences in noise, intraluminal stent diameter, and in-stent attenuation where tested using a paired t test; differences in subjective in-stent visibility were evaluated using a Wilcoxon signed-rank test. Results Best results for in-stent visibility, noise, intraluminal stent diameter, and in-stent attenuation in EID and PCD were observed at 0-degree phantom position along the z axis, suggesting higher in-plane compared with through-plane resolution. Subjective in-stent visibility was superior in coronary stent images obtained from PCD compared with EID (P

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Photon-Counting Computed Tomography for Vascular Imaging of the Head and Neck: First In Vivo Human Results

imagePurpose The purpose of this study was to evaluate image quality of a spectral photon-counting detector (PCD) computed tomography (CT) system for evaluation of major arteries of the head and neck compared with conventional single-energy CT scans using energy-integrating detectors (EIDs). Methods In this institutional review board–approved study, 16 asymptomatic subjects (7 men) provided informed consent and received both PCD and EID contrast-enhanced CT scans of the head and neck (mean age, 58 years; range, 46–75 years). Tube settings were (EID: 120 kVp/160 mA vs PCD: 140 kVp/108 mA) for all volunteers. Quantitative analysis included measurements of mean attenuation, image noise, and contrast-to-noise ratio (CNR). Spectral PCD data were used to reconstruct virtual monoenergetic images and iodine maps. A head phantom was used to validate iodine concentration measurements in PCD images only. Two radiologists blinded to detector type independently scored the image quality of different segments of the arteries, as well as diagnostic acceptability, image noise, and severity of artifacts of the PCD and EID images. Reproducibility was assessed with intraclass correlation coefficient. Linear mixed models that account for within-subject correlation of analyzed arterial segments were used. Linear regression and Bland-Altman analysis with 95% limits of agreement were used to calculate the accuracy of material decomposition. Results Photon-counting detector image quality scores were significantly higher compared with EID image quality scores with lower image noise (P

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Compressed-Sensing Accelerated 3-Dimensional Magnetic Resonance Cholangiopancreatography: Application in Suspected Pancreatic Diseases

imageObjectives The aims of this study were to prospectively evaluate image quality, duct visibility, and diagnostic performance in duct-related pathologies of compressed-sensing (CS) accelerated 3-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP) prototype protocols and compare these with those of conventional 3D MRCP protocol in patients with suspected pancreatic diseases. Material and Methods The institutional review board approved this prospective study and all patients provided written informed consent. A total of 80 patients (47 men and 33 women; median age, 57 years; age range, 24–87 years) underwent 3D MRCP at 3.0 T. Three protocols were performed in each patient in random order: CS breath-hold (BH) protocol, CS navigator-triggered (NT) protocol, and conventional NT protocol. The acquisition time of each protocol was recorded. Image quality and duct visibility were independently rated in random order on a 5-point scale by 2 radiologists, who were blinded to the protocols. Receiver operating characteristic curves were generated, and area under the curve (Az value) was used to compare the diagnostic performance of each protocol in duct-related pathologies. Results Acquisition time was 17 seconds for the CS-BH and 134.1 ± 33.5 seconds for the CS-NT protocol, both being significantly shorter than the conventional NT protocol (364.7 ± 78.4 seconds; both P

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Iodine and Fat Quantification for Differentiation of Adrenal Gland Adenomas From Metastases Using Third-Generation Dual-Source Dual-Energy Computed Tomography

imageObjectives The aim of this study was to investigate the value of third-generation dual-source dual-energy computed tomography (DECT) iodine and fat quantification in differentiating adrenal gland adenomas from metastases. Materials and Methods Sixty-two patients (38 men and 24 women; mean age, 69.1 years) underwent clinically indicated DECT of the abdomen on a third-generation dual-source scanner. Examinations were retrospectively included due to detected adrenal masses. For each adrenal lesion, unenhanced and contrast-enhanced attenuation values, as well as dual-energy iodine density and fat fraction, were recorded. Additional magnetic resonance imaging data, positron emission tomography/computed tomography scans, interval imaging follow-up, and histopathological analysis were used as the reference standard for all adrenal lesions. Mean values of unenhanced and contrast-enhanced attenuation, as well as material densities, were compared between adenomas, metastases, and normal adrenal glands. Furthermore, the diagnostic accuracy of unenhanced, contrast-enhanced, and material density analysis was assessed between adrenal adenomas and metastases. Results Adrenal adenomas showed significant differences regarding iodine density and fat fraction values (1.3 ± 0.4 mg/mL and 34.2% ± 12.6%) in comparison with adrenal metastases (3.2 ± 1.4 mg/mL and 10.7% ± 7.8%) and normal adrenal glands (1.7 ± 0.6 mg/mL and 18.7% ± 12.0%) (all P ≤ 0.004). Analysis of unenhanced attenuation values revealed no significant differences between healthy adrenal parenchyma (19.1 ± 15.6 HU) and adrenal metastases (26.9 ± 16.2 HU) (P = 0.135). Iodine density and fat fraction analysis showed significantly higher diagnostic accuracy for the diagnosis of adenomas (sensitivity, 97% and 89%; specificity, 96% and 89%, respectively) compared with unenhanced and contrast-enhanced evaluation (sensitivity, 65% and 58%; specificity, 73% and 85%, respectively) (P ≤ 0.023). The combined diagnostic value of iodine density and fat fraction analysis revealed a sensitivity of 97% and a specificity of 100%. Conclusions Third-generation dual-source DECT iodine and fat quantification allow for differentiation between adrenal adenomas and metastases with high diagnostic accuracy.

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Diagnostic Value of Magnetic Resonance Neurography in Cervical Radiculopathy: Plexus Patterns and Peripheral Nerve Lesions

imageObjective The aim of this study was to assess the imaging appearance and diagnostic value of plexus and peripheral nerve magnetic resonance neurography (MRN) in cervical radiculopathy. Materials and Methods This prospective study was approved by our institutional ethics committee and written informed consent was obtained from all participants. A total of 24 patients were included with a diagnosis of cervical radiculopathy based on clinical examination, supporting electrophysiological examinations and spinal imaging consistent with the clinical syndrome. All patients then underwent a high-resolution MRN protocol including the brachial plexus from nerve roots to plexus cords using a 3-dimensional turbo spin echo with variable flip angle short tau inversion recovery and sagittal-oblique T2-weighted spectral adiabatic inversion recovery sequence, and ulnar, median, and radial nerves at the upper arm and elbow in T2-weighted fat saturated sequences. Two readers independently rated plexus elements regarding the presence of lesions at neuroforaminal levels, roots, trunks, and cord segments. Median, ulnar, and radial nerves were likewise rated. Findings were then compared to a referenced standard of cervical radiculopathy that was defined as the combined diagnosis of clinical syndrome including supporting electrophysiological exams and matching positive spinal imaging, and diagnostic performance parameters were calculated. Additional quantitative and qualitative analysis assessed peripheral nerve caliber and normalized T2-signal at arm level in cervical radiculopathy and compared them to 25 inflammatory neuropathy controls. Results Cervical radiculopathy resulted in distinct plexus lesion patterns for each level of neuroforaminal stenosis. Overall, brachial plexus MRN in cervical radiculopathy reached a sensitivity of 81%, a specificity of 96%, a positive predictive value of 87%, and overall diagnostic accuracy of 87%. Initial spinal magnetic resonance imaging showed multiple positive findings for clinically unaffected root levels and resulted in a specificity of 69%, a positive predictive value of 54%, and an overall diagnostic accuracy of 78%. T2-weighted peripheral nerve lesions were detected in 79% of cervical radiculopathy cases and imitated imaging appearance of inflammatory neuropathies both quantitatively and qualitatively. Conclusions Complementing spine imaging in cervical radiculopathy with brachial plexus MRN can improve diagnostic accuracy by increasing specificity and positive predictive value. T2-weighted lesions of peripheral nerves can be caused by cervical radiculopathy, which must be considered a relevant diagnostic pitfall in MRN of peripheral neuropathies.

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Implementation of a 5-Minute Magnetic Resonance Imaging Screening Protocol for Prostate Cancer in Men With Elevated Prostate-Specific Antigen Before Biopsy

imagePurpose The aims of this study were to establish a 5-minute magnetic resonance (MR) screening protocol for prostate cancer in men before biopsy and to evaluate effects on Prostate Imaging Reporting and Data System (PI-RADS) V2 scoring in comparison to a conventional, fully diagnostic multiparametric MR imaging (mpMRI) approach. Materials and Methods Fifty-two patients with elevated prostate-specific antigen levels and without prior biopsy were prospectively included in this institutional review board–approved study. In all patients, an mpMRI protocol according to the PI-RADS recommendations was acquired on a 3 T MRI system. In addition, an accelerated diffusion-weighted imaging sequence was acquired using simultaneous multislice technique (DW-EPISMS). Two readers independently evaluated the images for the presence/absence of prostate cancer according to the PI-RADS criteria and for additional findings. In a first reading session, only the screening protocol consisting of axial T2-weighted and DW-EPISMS images was made available. In a subsequent reading session, the mpMRI protocol was assessed blinded to the results of the first reading, serving as reference standard. Results Both readers successfully established a final diagnosis according to the PI-RADS criteria in the screening and mpMRI protocol. Mean lesion size was 1.2 cm in the screening and 1.4 cm in the mpMRI protocol (P = 0.4) with 35% (18/52) of PI-RADS IV/V lesions. Diagnostic performance of the screening protocol was excellent with a sensitivity and specificity of 100% for both readers with no significant differences in comparison to the mpMRI standard (P = 1.0). In 3 patients, suspicious lymph nodes were reported as additional finding, which were equally detectable in the screening and mpMRI protocol. Conclusions A 5-minute MR screening protocol for prostate cancer in men with elevated prostate-specific antigen levels before biopsy is applicable for clinical routine with similar diagnostic performance as the full diagnostic mpMRI approach.

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Pitfalls and Misinterpretations of Cardiac Findings on PET/CT Imaging: A Careful Look at the Heart in Oncology Patients

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Publication date: Available online 6 February 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Sonia L. Betancourt Cuellar, Diana P. Palacio, Marcelo F. Benveniste, Brett W. Carter, Gregory Gladish




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Comprehensive Imaging and Surgical Review of Urinary Diversions: What the Radiologist Needs to Know

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Publication date: Available online 6 February 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Arvind K. Shergill, David C. Wang, Seng Thipphavong, Alexandre R. Zlotta, Nasir Jaffer
Urinary diversions are surgical procedures that reconstruct the lower urinary tract following cystectomy. The two common surgical approaches are based on the continence status of the urinary tract. Incontinent diversions have continuous urine drainage through a cutaneous stoma whereas continent diversions offer the patient the ability to self-void either via stoma catheterization or with the patient's own urethra. Given the large number of diversion procedures available, post-surgical anatomy may be complex. Multiple imaging modalities can be used to assess the post-procedural anatomy, potential complications, and for on-going oncologic monitoring. The purpose of this review is to describe the common surgical techniques and associated complications.



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Development of advanced technology for optimal cryopreservation of human immunocyte

Publication date: February 2018
Source:Cryobiology, Volume 80
Author(s): Yanhong Xu, Qiongna Zou, Jianqiang Zhang, Suxia Xue, Daimeng Wang, Sha Liu, Xiaowen He




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Global biobanking: past, present, and future

Publication date: February 2018
Source:Cryobiology, Volume 80
Author(s): Jim Vaught




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Nonhuman primate germ cell, embryo preservation and disease models

Publication date: February 2018
Source:Cryobiology, Volume 80
Author(s): Weizhi Ji




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An Introduction to the International Society for Biological and Environmental Repositories (ISBER)

Publication date: February 2018
Source:Cryobiology, Volume 80
Author(s): Zisis Kozlakidis




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Brain Sciences, Vol. 8, Pages 31: With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas

Brain Sciences, Vol. 8, Pages 31: With a Little Help from My Friends: The Role of Intraoperative Fluorescent Dyes in the Surgical Management of High-Grade Gliomas

Brain Sciences doi: 10.3390/brainsci8020031

Authors: Rosario Maugeri Alessandro Villa Mariangela Pino Alessia Imperato Giuseppe Giammalva Gabriele Costantino Francesca Graziano Carlo Gulì Francesco Meli Natale Francaviglia Domenico Iacopino

High-grade gliomas (HGGs) are the most frequent primary malignant brain tumors in adults, which lead to death within two years of diagnosis. Maximal safe resection of malignant gliomas as the first step of multimodal therapy is an accepted goal in malignant glioma surgery. Gross total resection has an important role in improving overall survival (OS) and progression-free survival (PFS), but identification of tumor borders is particularly difficult in HGGS. For this reason, imaging adjuncts, such as 5-aminolevulinic acid (5-ALA) or fluorescein sodium (FS) have been proposed as superior strategies for better defining the limits of surgical resection for HGG. 5-aminolevulinic acid (5-ALA) is implicated as precursor in the synthetic pathway of heme group. Protoporphyrin IX (PpIX) is an intermediate compound of heme metabolism, which produces fluorescence when excited by appropriate light wavelength. Malignant glioma cells have the capacity to selectively synthesize or accumulate 5-ALA-derived porphyrins after exogenous administration of 5-ALA. Fluorescein sodium (FS), on the other hand, is a fluorescent substance that is not specific to tumor cells but actually it is a marker for compromised blood-brain barrier (BBB) areas. Its effectiveness is confirmed by multicenter phase-II trial (FLUOGLIO) but lack of randomized phase III trial data. We conducted an analytic review of the literature with the objective of identifying the usefulness of 5-ALA and FS in HGG surgery in adult patients.



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Sex-dependent reductions in high-molecular weight adiponectin during acute hyperinsulinemia are prevented with endurance training in older females

Summary

Objective

The high molecular weight (HMW) adiponectin isoform is considered the active form of adiponectin and is linked to insulin sensitivity and the reduced risk of developing cardiovascular disease. The purpose of the first study was to determine the effects of age and sex on the plasma HMW adiponectin response to acute hyperinsulinemia, and secondly determine if either endurance or resistance exercise training could affect this response.

Design and Participants

Twenty-six, healthy males (19-84 years) and twenty-six, healthy females (18-76 years) were recruited and matched for BMI to examine the effects of sex and age on the plasma adiponectin response to a 2 hour hyperinsulinemic-euglycemic clamp. To examine the effects of exercise training, a subgroup of young (<35 years) and aged (>55 years) individuals were randomized into a 12-week endurance or resistance training program and had their adiponectin response to hyperinsulinemia measured before and after training. HMW and total adiponectin were measured by ELISA.

Results

In response to hyperinsulinemia, plasma HMW adiponectin decreased in females (-9%, P<0.005), but not males. After 12 weeks of endurance training, the response of plasma HMW adiponectin to hyperinsulinemia increased in older females (36%, P<0.05) only. Resistance training had no effect on the plasma adiponectin response to hyperinsulinemia. Despite no age or sex differences at baseline, skeletal muscle AdipoR1 increased in response to endurance training (~120%, P<0.001) and resistance training (~38%, P<0.05), regardless of age or sex.

Conclusion

The inhibitory action of hyperinsulinemia on plasma HMW adiponectin occurs in females but not males, irrespective of age. Twelve weeks of endurance training protects older females against the hyperinsulinemic inhibition of plasma HMW adiponectin, which could promote healthy aging.

This article is protected by copyright. All rights reserved.



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Establishment of MRI 3D Reconstruction Technology of Orbital Soft Tissue and Its Preliminary Application in Patients with Thyroid-Associated Ophthalmopathy

Abstract

Objective

Effective management of thyroid-associated ophthalmopathy (TAO) requires precise identification of the disease activity period as it is responsive to immunosuppressive treatment. Quantitative evaluations of orbital soft tissue is useful for analysing disease stages. We aimed to establish a method for orbital soft tissue volume calculation based on MRI data using 3D reconstruction technology. Further, we validated the accuracy and precision of this method and investigated volume differences between patients with TAO and healthy individuals.

Materials and Methods

Using Mimics software for 3D reconstruction based on orbital MRI data, we quantitatively measured orbital fat volume (FV) and extraocular muscle volume (MV) using a manual phantom, and in TAO patients and healthy volunteers (n=10 each). The phantom was made using a combination of butter and chicken muscle and 2 observers measured its volume. Volume calculations were compared to a previously established standard volume. One observer measured a typical TAO case 10 times to calculate intra-observer variability while 3 observers independently measured 10 TAO patients each to calculate inter-observer variability. Orbital soft tissue volumes between 10 TAO patients and 10 healthy individuals were compared.

Results

The precision of calculations for the phantom between the two observers varied from −4.60% to −2.78% for FV and between −4.13% and 0.71% for MV. Mean differences among repetitive calculations were lower than 4%, except during measurement of MV, which was 5.84%. The intraclass correlation coefficient varied from 0.976 to 0.996. FV was 15.53±3.06 mL in TAO patients and 11.32±1.68 mL(P=0.001)in healthy individuals, while MV was 3.19±0.82 mL in TAO patients and 2.45±0.57 mL(P=0.030)in healthy individuals.

Conclusions

This method of calculating orbital soft tissue volumes based on MRI data and 3D reconstruction is both reliable and accurate as it yielded significant differences in tissue volume between TAO patients and healthy individuals.

This article is protected by copyright. All rights reserved.



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Efficacy of Chinese herbal medicine Zengru Gao to promote breastfeeding: a multicenter randomized controlled trial

Breastfeeding is recommended worldwide but not fully practiced. The first week after childbirth is regarded as a critical period for increasing breast milk production. The aim of the study was to investigate w...

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Tumors of the parapharyngeal space: the VU University Medical Center experience over a 20-year period

Abstract

Background

Tumors of the parapharyngeal space (PPS) are rare, accounting for 0.5–1.5% of all head and neck tumors. The anatomy of the PPS is responsible for a wide variety of tumors arising from the PPS. This series of 99 PPS tumors provides an overview of the clinical course and management of PPS tumors.

Materials and methods

This retrospective study included clinical data from patients treated for PPS tumors from 1991 to 2012 (warranting at least a 4-year follow-up) at the VU University Medical Center, Amsterdam, The Netherlands.

Results

Fifty percent were salivary gland tumors, 41% were neurogenic and 9% had a different origin. 18.2% of the PPS tumors were malignant. The most reported symptom at presentation was swelling of the neck and throat. In 14%, the PPS tumor was an accidental finding following imaging for other diagnostic reasons. Cytology showed an accuracy rate of 73.1% (19/26). The positive predictive value of a malignant cytology result was 86% (95% CI 42.1–99.6%). Surgery was performed in 55 patients (56%). The most frequently performed approach (56%) was the cervical–transparotid approach, followed by the cervical (25%), transmandibular (16%) and transoral (2%) approach. Nine patients died of the disease, of which seven patients had a malignant salivary gland tumor, one patient had a pleomorphic adenoma at first diagnosis which degenerated into carcinoma ex pleomorphic adenoma and one patient died of metastatic renal cell carcinoma.

Conclusion

This large single-centre report on PPS tumors shows that careful diagnostic work up and proper surgical planning are important in this specific and rare group of head and neck tumors. Surgery was the main treatment (56%) for parapharyngeal tumors. Management of parapharyngeal neurogenic neoplasms generally consists of active surveillance due to peri-operative risk for permanent cranial nerve damage. The histopathological diagnoses were consistent with previous reports.



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Validation of the second version of the LittlEARS ® Early Speech Production Questionnaire (LEESPQ) in German-speaking children with normal hearing

Abstract

Introduction

The introduction of neonatal hearing screening and the increasingly early age at which children can receive a cochlear implant has intensified the need for a validated questionnaire to assess the speech production of children aged 0‒18. Such a questionnaire has been created, the LittlEARS® Early Speech Production Questionnaire (LEESPQ). This study aimed to validate a second, revised edition of the LEESPQ.

Methods and materials

Questionnaires were returned for 362 children with normal hearing. Completed questionnaires were analysed to determine if the LEESPQ is reliable, prognostically accurate, internally consistent, and if gender or multilingualism affects total scores.

Results

Total scores correlated positively with age. The LEESPQ is reliable, accurate, and consistent, and independent of gender or lingual status. A norm curve was created.

Discussion

This second version of the LEESPQ is a valid tool to assess the speech production development of children with normal hearing, aged 0‒18, regardless of their gender. As such, the LEESPQ may be a useful tool to monitor the development of paediatric hearing device users.

Conclusion

The second version of the LEESPQ is a valid instrument for assessing early speech production of children aged 0‒18 months.



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How Google and Facebook hooked us – and how to break the habit

Big tech companies avoid taxes and have taken over our lives and created monopolies – but what can we do about it and how much change do we really want?

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We can now read the whole genome of a fetus in the womb

Knowing the ins and outs of our children's genetic secrets before they are born could help reduce the likelihood of many diseases - but could it be misused?

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Online chatter could give warning of incoming cyber attacks

An early warning system that monitors cyber-security discussions online could help prevent the next big malware outbreak

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Early Briton from 10,000 years ago had dark skin and blue eyes

A genetic analysis of Cheddar Man, one of the first people to settle in Britain after the last ice age, suggests that his skin was dark

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The US agency that guards the environment is going to be hobbled

Scott Pruitt, the head of the Environmental Protection Agency, has talked up his mission to scale back its powers. It's so shortsighted, says Ian Graber-Stiehl

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"Otolaryngol Head Neck Surg"[jour]; +109 new citations

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

"Otolaryngol Head Neck Surg"[jour]

These pubmed results were generated on 2018/02/07

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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IJERPH, Vol. 15, Pages 286: Clinical Aspects of Foot Health in Individuals with Alzheimer’s Disease

IJERPH, Vol. 15, Pages 286: Clinical Aspects of Foot Health in Individuals with Alzheimer’s Disease

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15020286

Authors: Daniel López-López Marta Grela-Fariña Marta Losa-Iglesias César Calvo-Lobo David Rodríguez-Sanz Patricia Palomo-López Ricardo Becerro-de-Bengoa-Vallejo

Alzheimer’s disease (AD) shows a marked presence of physiologic changes and the start or aggravation of underlying diseases such as physical frailty in diverse anatomical regions. It is believed to have a particularly harmful effect on the health of the foot. We examined the foot health status in older persons with AD, with a specific focus on the extent to which people with AD may be using inadequate footwear in old age. Seventy-three community-dwelling people with probable, mild to moderate AD aged 65–95 years were recruited from a center of excellence for AD. A single trained physician evaluated health status and foot conditions. Current shoe and foot length and width measurements were taken using a calibrated Brannock device. The results indicate that sixty-five participants (89.04%) suffered from feet problems. Also, only twenty-two subjects (30.14%) used the correct shoes in width and size related with the morphology of their feet. Fifty-one participants (69.86%) were using incorrect shoes in length or width. The present study revealed that peoples with AD had a high presence of foot health problems. Also, the use of inappropriate shoes revealed measurable differences of association between shoe size and the morphology of the foot.



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Correction to "Asymmetrically hypointense veins on T2*w imaging and susceptibility-weighted imaging in ischemic stroke" [World J Radiol 2013; 5(4): 156-165].

Correction to "Asymmetrically hypointense veins on T2*w imaging and susceptibility-weighted imaging in ischemic stroke" [World J Radiol 2013; 5(4): 156-165].

World J Radiol. 2018 Jan 28;10(1):7-8

Authors: Jensen-Kondering U, Böhm R

Abstract
[This corrects the article on p. 4 in vol. 5, PMID: 23671751.].

PMID: 29403580 [PubMed - in process]



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Computed tomography as primary postoperative follow-up after laparoscopic Roux-en-Y gastric bypass.

Computed tomography as primary postoperative follow-up after laparoscopic Roux-en-Y gastric bypass.

World J Radiol. 2018 Jan 28;10(1):1-6

Authors: Delko T, Mattiello D, Koestler T, Zingg U, Potthast S

Abstract
AIM: To evaluate upper abdominal computed tomography (CT) scan as primary follow-up after laparoscopic Roux-en-Y gastric bypass (LRYGB).
METHODS: This prospective study was approved by the Ethical Committee of the State of Zurich, and informed consent was obtained from all patients. Sixty-one patients who underwent LRYGB received upper abdominal CT on postoperative day 1, with the following scan parameters: 0.6 mm collimation, 1.2 mm pitch, CareKV with reference 120 mAs and 120 kV, and 0.5 s rotation time. Diluted water-soluble radiographic contrast-medium (50 mL) was administered to achieve gastric pouch distension without movement of the patient. 3D images were evaluated to assess postoperative complications and the radiation dose received was analysed.
RESULTS: From the 70 patients initially enrolled in the study, 9 were excluded from analysis upon the intraoperative decision to perform a sleeve gastrectomy and not a LRYGB. In all of the 61 patients who were included in the analysis, CT was feasible and there were no instances of aspiration or vomiting. In 7 patients, two upper abdominal scans were necessary as the pouch was not distended by contrast medium in the first acquisition. Radiologically, no leak and no relevant stenosis were found on the first postoperative day. These early postoperative CT findings were consistent with the findings at clinical follow-up 6 wk postoperatively, with no leaks, stenosis or obstructions being diagnosed. The average total dose length product in CT was 536.6 mGycm resulting in an average effective dose of 7.8 mSv. The most common surgical complication, superficial surgical site infections (n = 4), always occurred at the upper left trocar site, where the circular stapler had been introduced.
CONCLUSION: Early LRYGB postoperative multislice spiral CT scan is feasible, with low morbidity, and provides more accurate anatomical information than standard upper gastrointestinal contrast study.

PMID: 29403579 [PubMed]



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Brg1 promotes liver fibrosis via activation of hepatic stellate cells

Publication date: Available online 7 February 2018
Source:Experimental Cell Research
Author(s): Haijie Li, Jingqin Lan, Caishun Han, Kaixuan Guo, Guihua Wang, Junbo Hu, Jianping Gong, Xuelai Luo, Zhixin Cao
Liver fibrosis, an important health concern associated to chronic liver injury that provides a permissive environment for cancer development, is characterized by the persistent deposition of extracellular matrix components mainly derived from activated hepatic stellate cells (HSCs). Brg1, the core subunit of the SWI/SNF chromatin remodeling complex, has been proved to associated with nonalcoholic steatohepatitis which may progress to cirrhosis. Herein, we determined whether Brg1 regulates liver fibrosis and examined its mechanism by focusing on HSCs activation. In this study, we demonstrate that Brg1 is elevated in human and mouse fibrotic liver tissues and Brg1 mediate the profibrotic response in activated HSCs. Our data indicate that Brg1 regulates the activation of HSCs through TGFβ/Smad signal pathway. Moreover, Brg1 deficiency mice displayed decreased HSCs activation in vitro and liver fibrogenesis after chronic damage by CCl4 administration. In addition, Brg1 expression is positively correlated with liver fibrosis in cirrhotic patients and may be a prognostic factor in HCC. Collectively, we demonstrate that Brg1 promotes liver fibrosis by activating HSCs and may represent a potential target for anti-fibrotic therapies.



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Paracrine signaling by VEGF-C promotes non-small cell lung cancer cell metastasis via recruitment of tumor-associated macrophages

Publication date: Available online 7 February 2018
Source:Experimental Cell Research
Author(s): Yanchao Deng, Yang Yang, Bei Yao, Lei Ma, Qipeng Wu, Zhicheng Yang, Luyong Zhang, Bing Liu
High expression of tumoral vascular endothelial growth factor C (VEGF-C) is correlated with clinical non-small cell lung cancer (NSCLC) metastasis and patient survival. Nevertheless, the comprehensive mechanisms accounting for VEGF-C-mediated cancer progression remain largely unclear. The present study found that VEGF-C expression was upregulated in various NSCLC cell lines. By utilizing transwell migration assay, we found that both recombinant VEGF-C protein and overexpression of VEGF-C in NSCLC cells (A549 and H441 cell lines) could efficiently enhance RAW264.7 cell (murine macrophages) migration. However, recombinant VEGF-C treatment had no effects on both CD206 (an M2 macrophage marker) expression and M1/M2 cytokine profiles of macrophages. Furthermore, additional treatment of recombinant Flt-4/Fc, the specific VEGFR-3 inhibitor or the specific VEGFR-2 inhibitor significantly suppressed macrophage migration compared with A549-CM (conditioned medium) or H441-CM alone group, confirming that NSCLC cells-derived VEGF-C is sufficient to promote macrophage migration. Interestingly, VEGF-C could stimulate the Src/p38 signaling via VEGFR-2/3 axis in macrophages, and inhibition of Src/p38 signaling obviously reversed the enhancement effect of VEGF-C on macrophage migration. Finally, the functional importance of macrophage infiltration induced by tumoral VEGF-C in promoting metastasis was established in a mouse model. In conclusion, our results highlight a novel function of tumoral VEGF-C that paracrinely induces macrophage recruitment, and resultantly promotes NSCLC cell metastasis. Therefore, VEGF-C/VEGFR-2/3 axis may be a promising microenvironmental target against progression of NSCLC.

Graphical abstract

image


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Leucyl-tRNA synthetase is required for the myogenic differentiation of C2C12 myoblasts, but not for hypertrophy or metabolic alteration of myotubes

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Publication date: Available online 7 February 2018
Source:Experimental Cell Research
Author(s): Yoriko Sato, Yusuke Sato, Reiko Suzuki, Kodwo Obeng, Fumiaki Yoshizawa
Mammalian target of rapamycin (mTOR) signaling controls skeletal muscle cell differentiation, growth, and metabolism by sensing the intracellular energy status and nutrients. Recently, leucyl-tRNA synthetase (Lars) was identified as an intracellular sensor of leucine involved in the activation of mTOR signaling. However, there is still no evidence for the activation of mTOR signaling by Lars and its physiological roles in skeletal muscle cells. In this study, we determined the potential roles of Lars for the activation of mTOR signaling, skeletal muscle cell differentiation, hypertrophy, and metabolism using small interfering (si)-RNA knockdown. siRNA-mediated knockdown of Lars decreased phosphorylated p70 S6 kinase and inhibited the differentiation of C2C12 mouse myoblasts into myotubes, as evidenced by a decreased fusion index and decreased mRNA and protein expression levels of myogenic markers. Importantly, si-Lars decreased the level of Insulin-like growth factor 2 (Igf2) mRNA expression from the early stages of differentiation, indicating the possibility of an association between the mTOR–IGF2 axis and Lars. However, Lars knockdown did not decrease phosphorylated mTOR in differentiated myotubes, nor did it affect the hypertrophy of myotubes as evidenced by measuring their diameters and detecting the mRNA and protein expression of hypertrophy markers. Similarly, an extracellular flux analyzer showed that Lars knockdown did not affect the metabolism (glycolysis and mitochondrial respiration) of myotubes. These results demonstrate that Lars is required for skeletal muscle differentiation through the activation of mTOR signaling, but not for hypertrophy or metabolic alteration of myotubes.



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Ethnic density and cancer: A review of the evidence

Accumulating data suggest that factors in the social environment may be associated with cancer-related outcomes. Ethnic density, defined as the proportion of racial/ethnic minority individuals residing in a given geographic area, is 1 of the most frequently studied social environment factors, but studies on ethnic density and cancer have yielded inconsistent findings. Thus, the objective of the current review was to summarize the extant data on ethnic density and cancer-related outcomes (cancer risk, stage at diagnosis, and mortality) with the aim of identifying pathways by which ethnic density may contribute to outcomes across populations. In general, the findings indicated an association between ethnic density and increased risk for cancers of infectious origin (eg, liver, cervical) but lower risk for breast and colorectal cancers, particularly among Hispanic and Asian Americans. Hispanic ethnic density was associated with greater odds of late-stage cancer diagnosis, whereas black ethnic density was associated with greater mortality. In addition, this review highlights several methodological and conceptual issues surrounding the measurement of ethnic neighborhoods and their available resources. Clarifying the role of neighborhood ethnic density is critical to developing a greater understanding of the health risks and benefits accompanying these environments and how they may affect racial and ethnic disparities in cancer-related outcomes. Cancer 2018. © 2018 American Cancer Society.



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Image-guided adaptive brachytherapy in primary vaginal cancers: A monocentric experience

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Publication date: Available online 6 February 2018
Source:Brachytherapy
Author(s): Andres Huertas, Isabelle Dumas, Alexandre Escande, Eleonor Rivin del Campo, Tony Felefly, Charles-Henri Canova, Anne Tailleur, Sebastien Gouy, Enrica Bentivegna, Philippe Morice, Christine Haie-Meder, Cyrus Chargari, Renaud Mazeron
PurposePrimary vaginal cancer is a rare disease for which treatment has been modeled based on cervical cancer. We report our experience in the use of image-guided adaptive brachytherapy (IGABT) in this indication.Methods and MaterialsPatients treated for vaginal cancer with a combination of external beam radiation therapy and IGABT were identified through electronic search. The Groupe Européen de Curiethérapie–European Society for Radiotherapy and Oncology recommendations for cervical cancer have been extrapolated with the definition of two clinical target volumes (CTVs) corresponding to the residual disease after external beam radiation therapy (CTVBT), assessed from clinical and imaging findings, and the so-called CTVi, comprising the CTVBT with directional margins and at least the initial disease at diagnosis.ResultsTwenty-seven patients were identified. MRI was used for brachytherapy guidance in 82% of the cases. An interstitial component was used in 59% of the cases. The D90 CTVBT and D90 CTVi were 73.1 ± 12.8 Gy and 66.6 ± 6.7 Gy, respectively. After a median followup of 40.1 months, nine recurrences in 8 patients were observed of which four were local. Local relapses occurred within the CTVBT. Three-year local control and disease-free rates were 82% and 65%, respectively. At 2 years, the Grade 2–4 gastrointestinal or urinary morbidity accrual rate was 9%. Twelve patients experienced late sexual morbidity, including three patients with Grade 3 stenosis.ConclusionIGABT is feasible in vaginal cancer with promising outcomes. Harmonizing the definition of CTVs is required to allow comparisons between experiences and to perform multicenter studies.



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SUMOylation: One small modification for proteins, multiple giant problems for mankind



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IJMS, Vol. 19, Pages 499: Complex Epigenetic Regulation of Chemotherapy Resistance and Biohlogy in Esophageal Squamous Cell Carcinoma via MicroRNAs

IJMS, Vol. 19, Pages 499: Complex Epigenetic Regulation of Chemotherapy Resistance and Biohlogy in Esophageal Squamous Cell Carcinoma via MicroRNAs

International Journal of Molecular Sciences doi: 10.3390/ijms19020499

Authors: Kirsten Lindner Ann-Kathrin Eichelmann Christiane Matuszcak Damian Hussey Jörg Haier Richard Hummel

Background: Resistance towards chemotherapy is a major obstacle in the treatment of esophageal squamous cell carcinoma (ESCC). We investigated the role of specific microRNAs in chemotherapy resistance and tumor biology. Methods: We selected three microRNAs from characteristic microRNA signatures of resistant ESCC (hsa-miR-125a-5p, hsa-miR-130a-3p, hsa-miR-1226-3p), and hsa-miR-148a-3p. Effects on chemotherapy, adhesion, migration, apoptosis and cell cycle were assessed in six ESCC cell lines. Target analyses were performed using Western blotting and luciferase techniques. Results: MiR-130a-3p sensitized cells towards cisplatin in 100% of cell lines, miR-148a-3p in 83%, miR-125a-5p in 67%, miR-1226-3p in 50% (p ≤ 0.04). MiR-130a-3p sensitized 83% of cell lines towards 5-FU, miR-148a-3p/miR-125a-5p/miR-1226-3p only 33% (p ≤ 0.015). Several resistance-relevant pathways seem to be targeted on various levels. Bcl-2 was confirmed as a direct target of miR-130a-3p and miR-148a-3p, and p53 as a target of miR-125a-5p. All microRNAs decreased migration and adhesion, except miR-130a-3p, and increased apoptosis. Simultaneous manipulation of two microRNAs exhibited additive sensitizing effects towards cisplatin in 50% (miR-125a-5p/miR-148a-3p), and 75% (miR-148a-3p/miR-130a-3p) of cell lines (p ≤ 0.006). Conclusion: Our data present strong evidence that specific microRNA signatures are responsible for drug resistance and aggressiveness of ESCC. Final functional readout of these complex processes appears to be more important than single microRNA-target interactions.



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health technology; +310 new citations

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

health technology

These pubmed results were generated on 2018/02/07

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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head and neck; +104 new citations

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

head and neck

These pubmed results were generated on 2018/02/07

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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How Google and Facebook hooked us – and how to break the habit

techlashmain-800x533.jpg

Big tech companies avoid taxes and have taken over our lives and created monopolies – but what can we do about it and how much change do we really want?

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We can now read the whole genome of a fetus in the womb

d51mdy-800x533.jpg

Knowing the ins and outs of our children's genetic secrets before they are born could help reduce the likelihood of many diseases - but could it be misused?

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Online chatter could give warning of incoming cyber attacks

gettyimages-817486116-800x533.jpg

An early warning system that monitors cyber-security discussions online could help prevent the next big malware outbreak

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Early Briton from 10,000 years ago had dark skin and blue eyes

cheddar_man_for_web.jpg

A genetic analysis of Cheddar Man, one of the first people to settle in Britain after the last ice age, suggests that his skin was dark

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The US agency that guards the environment is going to be hobbled

rexfeatures_9348508b-800x533.jpg

Scott Pruitt, the head of the Environmental Protection Agency, has talked up his mission to scale back its powers. It's so shortsighted, says Ian Graber-Stiehl

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NASA Should Start Funding SETI Again

The search for extraterrestrial intelligence should be a part of the agency’s Astrobiology mission—but thanks to a 1992 law, it’s not 

-- Read more on ScientificAmerican.com
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Frequency of the acquired resistant mutation T790 M in non-small cell lung cancer patients with active exon 19Del and exon 21 L858R: a systematic review and meta-analysis

Although EGFR-TKI is the preferred treatment for NSCLC patients with sensitive mutations, subsequent drug resistance is almost inevitable. The specific mechanisms of EGFR-TKI drug resistance can be identified ...

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PD-L1 expression in malignant salivary gland tumors

Programmed death-1 ligand-1 (PD-L1) an important cancer biomarker that can suppress the immune system and its high expression is often reported to be related with increased tumor aggressiveness in some cancers...

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Impact of body mass index on surgical outcomes of gastric cancer

The association between body mass index (BMI) and clinical outcomes of gastric cancer were still under debate. The aim of the present study was to investigate the impact of BMI on intraoperative conditions, po...

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Frankfurt is Calling!



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Comparison of Endonasal DCR Surgery Using Cautery and Surgical Blade Technique in Cases of Chronic Dacryocystitis

Abstract

Dacryocystitis is defined as inflammation of lacrimal sac. This can be congenital or acquired. Congenital dacryocystitis is commonly chronic while acquired dacryocystitis is acute and chronic both. Endonasal DCR surgery is the most commonly used treatment in chronic DCR but recent use of cautery technique in endonasal DCR surgery rather than traditional surgical blade technique has emerged with promising results with good success rate and fewer complications.



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Surgeon volume and prognosis of patients with advanced papillary thyroid cancer and lateral nodal metastasis.

Surgeon volume and prognosis of patients with advanced papillary thyroid cancer and lateral nodal metastasis.

Br J Surg. 2018 Feb;105(3):270-278

Authors: Kim HI, Kim TH, Choe JH, Kim JH, Kim JS, Kim YN, Kim H, Kim SW, Chung JH

Abstract
BACKGROUND: Surgery is the most important treatment modality for papillary thyroid cancer (PTC). However, the relationship between surgeon volume and long-term oncological outcomes has not been explored.
METHODS: Patients diagnosed with N1b PTC after initial thyroid surgery between 1 July 1994 and 31 December 2011 were eligible for inclusion in the study. Surgeons were categorized into high (at least 100 operations per year) and low (fewer than 100 operations per year) volume groups. Kaplan-Meier survival analysis according to surgeon volume was performed, and Cox proportional hazard modelling was used to estimate hazard ratios (HRs) with 95 per cent confidence intervals according to patient, tumour and surgeon factors.
RESULTS: A total of 1103 patients with a median follow-up of 81 (i.q.r. 62-108) months were included in the study. During follow-up, 200 patients (18·1 per cent) developed structural recurrence. A high surgeon volume was associated with low structural recurrence (P = 0·006). After adjustment for age, sex and conventional risk factors for recurrence (histology, tumour size, gross extrathyroidal extension, margin status, more than 5 positive lymph nodes, radioactive iodine therapy), the adjusted HR for structural recurrence for low-volume surgeons was 1·46 (95 per cent c.i. 1·08 to 1·96), compared with high-volume surgeons. Distant metastasis (P = 0·242) and disease-specific mortality (P = 0·288) were not affected by surgeon volume.
CONCLUSION: Surgeon volume is associated with structural recurrence, but not distant metastasis or cancer-specific death in patients with N1b PTC. Surgeon volume is important in initial surgery for advanced PTC with extensive nodal metastasis in order to ensure curative outcome and reduce treatment-related morbidity.

PMID: 29405275 [PubMed - in process]



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Improved therapeutic outcomes of thermal ablation on rat orthotopic liver allograft sarcoma models by radioiodinated hypericin induced necrosis targeted radiotherapy.

http:--www.impactjournals.com-oncotarget https:--www.ncbi.nlm.nih.gov-corehtml-pm Related Articles

Improved therapeutic outcomes of thermal ablation on rat orthotopic liver allograft sarcoma models by radioiodinated hypericin induced necrosis targeted radiotherapy.

Oncotarget. 2016 Aug 09;7(32):51450-51461

Authors: Gao L, Zhang J, Ma T, Yao N, Gao M, Shan X, Ni Y, Shao H, Xu K

Abstract
Residual tumor resulting in tumor recurrence after various anticancer therapies is an unmet challenge in current clinical oncology. This study aimed to investigate the hypothesis that radioiodinated hypericin (131I-Hyp) may inhibit residual tumor recurrence after microwave ablation (MWA) on rat orthotopic liver allograft sarcoma models.Thirty Sprague-Dawley (SD) rats with hepatic tumors were divided into three groups: Group A received laparotomy MWA and sequential intravenous injection (i.v.) of 131I labelled hypericin (131I-Hyp) in a time interval of 24 h; Group B received only laparotomy MWA; Group C was a blank control. Tumor inhibitory effects were monitored with in vivo magnetic resonance imaging (MRI) and these findings were compared to histopathology data before (baseline, day 0) and 1, 4, and 8 days after MWA. In addition, biodistribution of 131I-Hyp was assessed with in vivo single-photon emission computed tomography-computed tomography (SPECT-CT) imaging, in vitro autoradiography, fluorescent microscopy, and gamma counting.A fast clearance of 131I-Hyp and increasing deposit in necrotic tumors appeared over time, with a significantly higher radioactivity than other organs (0.9169 ± 1.1138 % ID/g, P < 0.01) on day 9. Tumor growth was significantly slowed down in group A compared to group B and C according to MRI images and corresponding tumor doubling time (12.13 ± 1.99, 4.09 ± 0.97, 3.36 ± 0.72 days respectively). The crescent tagerability of 131I-Hyp to necrosis was visualized consistently by autoradiography and fluorescence microscopy.In conclusion, 131I-Hyp induced necrosis targeted radiotherapy improved therapeutic outcomes of MWA on rat orthotopic liver allograft sarcoma models.

PMID: 27285983 [PubMed - indexed for MEDLINE]



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‘Role of sentinel lymph node biopsy as a staging procedure in patients with melanoma: A critical appraisal’ by Omgo E Nieweg, Alan Cooper and John F Thompson



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Radiological comparison of inferior turbinate hypertrophy between allergic and non-allergic rhinitis: does allergy really augment turbinate hypertrophy?

Abstract

Background

Inferior turbinate hypertrophy could be a result of allergic rhinitis (AR) that leads to nasal congestion and nasal airway obstruction, which is the most bothersome complaint in patients with AR. However, evidence regarding whether patients with AR have a more hypertrophied inferior turbinate than do patients with non-AR is lacking.

Objective

We aimed to evaluate the degree of inferior turbinate hypertrophy according to the presence of AR using radiological measurements of the inferior turbinate.

Methods

For evaluating the inferior turbinate, which contributes to nasal obstruction in patients with AR, we enrolled 90 adult patients with septal deviation and divided them into two groups (AR group: n = 49; non-AR group: n = 41). Allergic rhinitis was diagnosed according to the presence of an allergic history, positive multiple allergen simultaneous test, and serological total immunoglobulin E level (≥ 100 kU/L). We analyzed the minimal cross-sectional area on acoustic rhinometry for both groups. The bilateral total width as well as medial mucosa and nasal cavity space in the anterior and posterior portions of the inferior turbinate were measured using computed tomography.

Results

We could not find any significant differences in the anterior and posterior dimensions of the inferior turbinate, intranasal space, and choanal spaces between the AR and non-AR groups. Instead, the anterior part of the inferior turbinate in both the groups showed significant differences between the deviated and contralateral sides. The contralateral side had a larger width than did the deviated side, but no significant difference was noted in the posterior portion of the inferior turbinate.

Conclusion

The degree of inferior turbinate hypertrophy showed no difference between patients with and without AR. Therefore, we suggest that surgical treatment for reducing the size of the inferior turbinate hypertrophy should be considered when performing septoplasty in patients with symptoms of nasal obstruction, regardless of the presence of AR.



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health technology; +310 new citations

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

health technology

These pubmed results were generated on 2018/02/07

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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Antibodies, Vol. 7, Pages 10: Factors Affecting the Pharmacology of Antibody–Drug Conjugates

Antibodies, Vol. 7, Pages 10: Factors Affecting the Pharmacology of Antibody–Drug Conjugates

Antibodies doi: 10.3390/antib7010010

Authors: Andrew Lucas Lauren Price Allison Schorzman Mallory Storrie Joseph Piscitelli Juan Razo William Zamboni

Major advances in therapeutic proteins, including antibody–drug conjugates (ADCs), have created revolutionary drug delivery systems in cancer over the past decade. While these immunoconjugate agents provide several advantages compared to their small-molecule counterparts, their clinical use is still in its infancy. The considerations in their development and clinical use are complex, and consist of multiple components and variables that can affect the pharmacologic characteristics. It is critical to understand the mechanisms employed by ADCs in navigating biological barriers and how these factors affect their biodistribution, delivery to tumors, efficacy, and toxicity. Thus, future studies are warranted to better understand the complex pharmacology and interaction between ADC carriers and biological systems, such as the mononuclear phagocyte system (MPS) and tumor microenvironment. This review provides an overview of factors that affect the pharmacologic profiles of ADC therapies that are currently in clinical use and development.



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New system developed to match genetic anomalies with precision medicine

A team of computer scientists from the University of Delaware and Georgetown University has developed a new system to rapidly determine which cancer drugs are likely to work best given a patient's genetic markers. The first publicly available system of...

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New algorithm decodes spine oncology treatment

Every kind of cancer can spread to the spine, yet two physician-scientists who treat these patients describe a paucity of guidance for effectively providing care and minimizing pain. To resolve the confusion and address the continually changing landscape...

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Two step process to starve liver cancer

Scientists at the University of Delaware and the University of Illinois at Chicago have found a new way to kill liver cancer cells and inhibit tumour growth. First, they silence a key cellular enzyme, and then they add a powerful drug. They describe...

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Last Month in Oncology with Dr. Bishal Gyawali: January 2018

CONCORD shows Discordance in global cancer outcomes The CONCORD Working group has published the global surveillance of trends in cancer survival for 18 common cancers from 322 population based registries in 71 countries between 2000-2014. Although the...

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Wide skin markings pattern - melanoma descriptor or patient-related factor?: reply from authors

We read with great interest the letter by Rishpon and Colleagues on our paper titled “Uncovering the diagnostic dermoscopic features of flat melanomas located on the lower limbs” (1). In the current letter, we investigated a series of 247 lesions, including 71 thin melanomas, located on lower limbs with the aim to identify diagnostic specific dermoscopic criteria for melanoma diagnosis. Furthermore, a new dermoscopic descriptor, namely wider skin markings was introduced.

This article is protected by copyright. All rights reserved.



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"Otolaryngol Head Neck Surg"[jour]; +109 new citations

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

"Otolaryngol Head Neck Surg"[jour]

These pubmed results were generated on 2018/02/07

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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IJERPH, Vol. 15, Pages 285: WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Cognition

IJERPH, Vol. 15, Pages 285: WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Cognition

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15020285

Authors: Charlotte Clark Katarina Paunovic

This systematic review assesses the quality of the evidence across individual studies on the effect of environmental noise (road traffic, aircraft, and train and railway noise) on cognition. Quantitative non-experimental studies of the association between environmental noise exposure on child and adult cognitive performance published up to June 2015 were reviewed: no limit was placed on the start date for the search. A total of 34 papers were identified, all of which were of child populations. 82% of the papers were of cross-sectional design, with fewer studies of longitudinal or intervention design. A range of cognitive outcomes were examined. The quality of the evidence across the studies for each individual noise source and cognitive outcome was assessed using an adaptation of GRADE methodology. This review found, given the predominance of cross-sectional studies, that the quality of the evidence across studies ranged from being of moderate quality for an effect for some outcomes, e.g., aircraft noise effects on reading comprehension and on long-term memory, to no effect for other outcomes such as attention and executive function and for some noise sources such as road traffic noise and railway noise. The GRADE evaluation of low quality evidence across studies for some cognitive domains and for some noise sources does not necessarily mean that there are no effects: rather, that more robust and a greater number of studies are required.



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head and neck; +104 new citations

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

head and neck

These pubmed results were generated on 2018/02/07

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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Read our blogger Dr Bishal Gyawali's latest piece, including CONCORD's global surveillance of trends in cancer surv… https://t.co/3M3PXRglML

Read our blogger Dr Bishal Gyawali's latest piece, including CONCORD's global surveillance of trends in cancer surv… https://t.co/3M3PXRglML

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Breast cancer researchers have a significant role to play in disseminating information to the public on breast dens… https://t.co/MP5fMjxz1u

Breast cancer researchers have a significant role to play in disseminating information to the public on breast dens… https://t.co/MP5fMjxz1u

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When is a sentinel node biopsy indicated for patients with primary melanoma? Comment on the ‘Australian guidelines for the management of cutaneous melanoma’



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Dynamic contrast-enhanced ultrasonography (D-CEUS) for the early prediction of bevacizumab efficacy in patients with metastatic colorectal cancer

Abstract

Objectives

To investigate early changes in tumour perfusion parameters by dynamic contrast-enhanced ultrasonography (D-CEUS) and to identify any correlation with survival and tumour response in patients with metastatic colorectal cancer (CRC) treated with bevacizumab (B).

Methods

Thirty-seven patients randomized to either chemotherapy (C) plus B or C alone were considered for this study. D-CEUS was performed at baseline and after the first treatment cycle (day 15). Four D-CEUS perfusion parameters were considered: derived peak intensity (DPI), area under the curve (AUC), slope of wash-in (A) and time to peak intensity (TPI).

Results

In patients treated with C plus B, a ≥22.5 % reduction in DPI, ≥20 % increase in TPI and ≥10 % reduction in AUC were correlated with higher progression-free survival in the C+B arm (p = 0.048, 0.024 and 0.010, respectively) but not in the C arm. None of the evaluated parameter modifications had a correlation with tumour response or overall survival.

Conclusions

D-CEUS could be useful for detecting and quantifying dynamic changes in tumour vascularity as early as 15 days after the start of B-based therapy. Although these changes may be predictive of progression-free survival, no correlation with response or overall survival was found.

Key Points

• D-CEUS showed early changes in liver metastasis perfusion in colorectal cancer.

• A decrease in tumour perfusion was associated with longer progression-free survival.

• The decrease in perfusion was not correlated with higher overall survival.



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Preparation of virus-like particles for porcine circovirus type 2 by YeastFab Assembly

Abstract

Porcine circovirus type 2 (PCV2) poses a genuine threat to pig industry. An effective vaccine production against the pandemic is desirable. The aim of this study was to construct recombination yeast strains with PCV2 Cap protein. We adopt to YeastFab Assembly method to synthesize transcriptional units in a single tube by piecing up promoter, open reading frame, and terminator in S. cerevisiae. Two yeast recombinants were successfully constructed using GPD and TEF2 promoters, respectively, to express PCV2 by secreting Cap protein in vitro. Electronic microscope observation demonstrated that the yeast-derived PCV2 Cap protein could self-assembles into 18-nm-diameter virus-like particles (VLPs). The yield of two different recombination yeasts containing GPD and TEF2 promoters were 12, 25 μg/ml, respectively. Our results showed that it is feasible to use S. cerevisiae as a safe and simple system to produce PCV2 virus-like particles. This indicated that there is possibility of obtaining PCV2 VLP vaccine by homologous recombination in yeast genome, and Cap protein was secreted into the cultural supernatant which can be used as a potential oral vaccine to protect pigs from PCV2-infection.



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Brain Sciences, Vol. 8, Pages 30: Possible Role of Inflammation and Galectin-3 in Brain Injury after Subarachnoid Hemorrhage

Brain Sciences, Vol. 8, Pages 30: Possible Role of Inflammation and Galectin-3 in Brain Injury after Subarachnoid Hemorrhage

Brain Sciences doi: 10.3390/brainsci8020030

Authors: Hirofumi Nishikawa Hidenori Suzuki

Aneurysmal subarachnoid hemorrhage (SAH) is known as one of the most devastating diseases in the central nervous system. In the past few decades, research on SAH has focused on cerebral vasospasm to prevent post-SAH delayed cerebral ischemia (DCI) and to improve outcomes. However, increasing evidence has suggested that early brain injury (EBI) is an important mechanism contributing to DCI, cerebral vasospasm as well as poor outcomes. Though the mechanism of EBI is very complex, inflammation is thought to play a pivotal role in EBI. Galectin-3 is a unique chimera type in the galectin family characterized by its β-galactoside-binding lectin, which mediates various pathologies, such as fibrosis, cell adhesion, and inflammation. Recently, two clinical studies revealed galectin-3 to be a possible prognostic biomarker in SAH patients. In addition, our recent report suggested that higher acute-stage plasma galectin-3 levels correlated with subsequent development of delayed cerebral infarction that was not associated with vasospasm in SAH patients. We review the possible role and molecular mechanisms of inflammation as well as galectin-3 in brain injuries, especially focusing on EBI after SAH, and discuss galectin-3 as a potential new therapeutic or research target in post-SAH brain injuries.



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Relationship between cancer-related traumatic stress and family milestone achievement in adolescent and young adult survivors of childhood cancer

Abstract

Late physical and emotional effects of cancer treatment pose a burden for adolescent and young adult survivors of childhood cancer, including family milestone achievement. This brief report examined links between ongoing cancer-related post-traumatic stress symptoms (CR-PTSS) and family milestone achievement. Survivors (n = 51; Mage = 24.73, SD = 8.20) completed CR-PTSS and family formation questionnaires. Descriptive statistics, univariate parameter-constraints, and correlation analyses examined relations among study variables. Ongoing intrusive thoughts and hyperarousal were negatively linked to family identity development and family achievement. Findings from the present study provide support that ongoing CR-PTSS may be a barrier to family formation.



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Nephrin as a biomarker of sickle cell glomerulopathy in Malawi

Abstract

Background

Glomerulopathy is an increasingly identified complication in young patients with sickle cell disease (SCD). Hyperfiltration and albuminuria followed by declining glomerular filtration rates and eventual end-stage renal disease (ESRD) is assumed to be the typical progression of glomerular disease. There are only a few reported biomarkers to identify early-stage renal disease in SCD.

Procedures

We detail the renal profile of 101 children with SCD in Malawi and propose a novel urinary biomarker for the identification of early renal disease.

Results

Among children with sickle cell anemia, 24.8% had a urine albumin–creatinine ratio of 30 mg/g or above. In univariate analysis, only patients with higher urinary nephrin, a urinary marker of glomerular injury, had significantly greater odds of having albuminuria. In multivariable analysis, nephrin remained significantly associated with albuminuria. A nephrin–creatinine ratio (NCR) cut-point of 622 ng/mg, the 50th percentile, was associated with a 45.8 times greater odds of having albuminuria in children with nephrinuria above this value. Further analysis revealed this urinary NCR cut-point to have 96% sensitivity, 64% specificity, 47% positive predictive value, and 98% negative predictive value for the presence of albuminuria.

Conclusions

These data suggest that a substantial number of children with SCD in Malawi have renal disease and could be at risk for worsening nephropathy and ESRD as they age. Our data suggest that urinary nephrin could be utilized as an early marker of glomerular disease in SCD.



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Corrigendum: Zekri W, Alfaar AS, Yehia D, et al. Clear cell sarcoma of the kidney: Patients' characteristics and improved outcome in developing countries. Pediatr Blood Cancer. 2014;61:2185–2190. DOI: 10.1002/pbc.25192



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Suspected thrombotic microangiopathy in a child with Epstein–Barr virus-induced hemophagocytic lymphohistiocytosis



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Corrigendum: Mueller EL, Sabbatini A, Gebremariam A, et al. Why pediatric patients with cancer visit the emergency department: United States, 2006–2010. Pediatr Blood Cancer. 2015;62:490–495. DOI: 10.1002/pbc.25288



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Burnout

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Publication date: Available online 6 February 2018
Source:Academic Radiology
Author(s): Jeffrey P. Guenette, Stacy E. Smith
ObjectiveWe aimed to identify job resources and job demands associated with measures of personal accomplishment (PA) in radiology residents in the United States.Materials and MethodsA 34-item online survey was administered between May and June 2017 to U.S. radiology residents and included the 8 Likert-type PA questions from the Maslach Burnout Inventory-Human Services Survey, 19 visual analog scale job demands-resources questions, and 7 demographic questions. Multiple linear regression was calculated to predict PA based on job demands-resources. Effects of binomial demographic factors on PA scores were compared with independent-samples t tests. Effects of categorical demographic factors on PA scores were compared with one-way between-subjects analysis of variance tests. A linear regression was calculated to evaluate the relationship of age on PA scores.Results"The skills and knowledge that I am building are important and helpful to society" (P = 2 × 10−16), "I have good social support from my co-residents" (P = 4 × 10−5), and "I regularly receive adequate constructive feedback" (P = 4 × 10−6) all positively correlated with PA. PA scores were significantly lower for individuals who were single vs those married or partnered (P = .01).ConclusionsRadiology residents score higher in the PA domain of burnout when they receive adequate constructive feedback, have good co-resident social support, and feel that the skills and knowledge they are building are important to society. Improving constructive feedback mechanisms, enabling resident-only social time, and supporting opportunities that reinforce the importance of their contributions may therefore improve radiology residents' sense of PA.



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Cardiothoracic MRI in the ICU

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Publication date: Available online 6 February 2018
Source:Academic Radiology
Author(s): Narmadan Kumarasamy, Nima Tishbi, Shey Mukundan, Ariel Shiloh, Jeffrey M. Levsky, Linda B. Haramati
Rationale and ObjectiveThe objective of this study was to identify the feasibility and pitfalls of cardiothoracic magnetic resonance imaging (MRI) in intensive care unit (ICU) patients.Materials and MethodsThis retrospective study identified adult ICU patients scheduled for cardiothoracic MRIs during a 10-year study period. ICU patients scheduled for brain MRIs served as a comparison group. A chart review was performed to identify factors impacting a patient's ability to undergo an MRI. Differences between completed and canceled examinations for both cardiothoracic and brain MRIs were evaluated. For the cardiothoracic group, clinical indications and the diagnostic value of the study performed were also identified.ResultsA total of 143 cardiothoracic MRIs and 1011 brain MRIs were requested. Cardiothoracic MRI patients were less frequently completed (52% vs 62%), more frequently men (64% vs 43%), younger (55 vs 63 years), less likely mechanically ventilated (8% vs 29%), more likely to require intravenous contrast (83% vs 23%), and had longer examination times compared to brain MRI patients (64 vs 21 minutes). Successful completion of cardiothoracic MRI was associated with lower serum creatinine, higher glomerular filtration rate, and the absence of mechanical ventilation; significant differences were not seen with regard to gender and use of vasoactive agents. Cardiothoracic MRI results were diagnostic in 69% of examinations, most frequently when performed for myocardial disease (84%) and aortic disease (33%), and less frequently for viability (33%).ConclusionsIn an ICU population, successful completion of cardiothoracic MRI is challenging but feasible in patients with intact renal function and the absence of mechanical ventilation. Examinations were most frequently diagnostic for myocardial and aortic disease indications.



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