Τετάρτη, 21 Φεβρουαρίου 2018

Graduation Day at TNMC & Nair Hospital by Dr Sumer Sethi

Graduation day celebrations at TNMC & Nair Hospital Mumbai with brief motivational message by Dr Sumer Sethi to the fresh graduates.

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Editorial Board

Publication date: June 2018
Source:Journal of Environmental Radioactivity, Volume 186





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Journal of Environmental Radioactivity special issue: II International Conference on Radioecological Concentration Processes. (50 years later)

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Publication date: June 2018
Source:Journal of Environmental Radioactivity, Volume 186
Author(s): Rafael Garcia-Tenorio, Elis Holm
An international conference on Radioecological Concentration Processes was held in Seville, Spain, 6–9 November 2016 at the Centro Nacional de Aceleradores. It was attended by 160 participants from 35 different countries. This was the 2nd conference on this item since 1966, 50 years ago. The conference covered aspects of radiological important radionuclides on terrestrial, marine and freshwater environments and has allowed obtaining a clear picture of the status of the Radioecology as a consolidated discipline in the 21st century.



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Comparison of radiocesium concentration changes in leguminous and non-leguminous herbaceous plants observed after the Fukushima Dai-ichi Nuclear Power Plant accident

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Publication date: June 2018
Source:Journal of Environmental Radioactivity, Volume 186
Author(s): Shigeo Uchida, Keiko Tagami
Transfer of radiocesium from soil to crops is an important pathway for human intake. In the period from one to two years after the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, food monitoring results showed that radiocesium concentrations in soybean (a legume) were higher than those in other annual agricultural crops; in these crops, root uptake is the major pathway of radiocesium from soil to plant. However, it was not clear whether or not leguminous and non-leguminous herbaceous plants have different Cs uptake abilities from the same soil because crop sample collection fields were different. In this study, therefore, we compared the concentrations of 137Cs in seven herbaceous plant species including two leguminous plants (Trifolium pratense L. and Vicia sativa L.) collected in 2012–2016 from the same sampling field in Chiba, Japan that had been affected by the FDNPP accident fallout. Among these species, Petasites japonicus (Siebold & Zucc.) Maxim. showed the highest 137Cs concentration in 2012–2016. The correlation factor between all concentration data for 137Cs and those for 40K in these seven plants was R = 0.54 (p < 0.001) by t-test, thus potassium uptake ability by species would affect radiocesium uptake; however, for each species, no correlation between 137Cs and 40K was found. Interestingly, 40K concentrations in T. pratense, V. sativa and Poaceae family plants did not differ significantly, but 137Cs data in the Poaceae family plants were significantly lower than those in T. pratense (p < 0.001) and V. sativa (p = 0.017). The results indicated that leguminous species would have higher 137Cs uptake ability than Poaceae family plants.



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Transfer parameters for ICRP's Reference Animals and Plants in a terrestrial Mediterranean ecosystem

Publication date: June 2018
Source:Journal of Environmental Radioactivity, Volume 186
Author(s): J. Guillén, N.A. Beresford, A. Baeza, M. Izquierdo, M.D. Wood, A. Salas, A. Muñoz-Serrano, J.M. Corrales-Vázquez, J.G. Muñoz-Muñoz
A system for the radiological protection of the environment (or wildlife) based on Reference Animals and Plants (RAPs) has been suggested by the International Commission on Radiological Protection (ICRP). To assess whole-body activity concentrations for RAPs and the resultant internal dose rates, transfer parameters are required. However, transfer values specifically for the taxonomic families defined for the RAPs are often sparse and furthermore can be extremely site dependent. There is also a considerable geographical bias within available transfer data, with few data for Mediterranean ecosystems. In the present work, stable element concentrations (I, Li, Be, B, Na, Mg, Al, P, S, K. Ca, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Se, Rb, Sr, Mo, Ag, Cd, Cs, Ba, Tl, Pb and U) in terrestrial RAPs, and the corresponding whole-body concentration ratios, CRwo, were determined in two different Mediterranean ecosystems: a Pinewood and a Dehesa (grassland with disperse tree cover). The RAPs considered in the Pinewood ecosystem were Pine Tree and Wild Grass; whereas in the Dehesa ecosystem those considered were Deer, Rat, Earthworm, Bee, Frog, Duck and Wild Grass. The CRwo values estimated from these data are compared to those reported in international compilations and databases.



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Natural attenuation of Fukushima-derived radiocesium in soils due to its vertical and lateral migration

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Publication date: June 2018
Source:Journal of Environmental Radioactivity, Volume 186
Author(s): A. Konoplev, V. Golosov, Y. Wakiyama, T. Takase, V. Yoschenko, T. Yoshihara, O. Parenyuk, A. Cresswell, M. Ivanov, M. Carradine, K. Nanba, Y. Onda
Processes of vertical and lateral migration lead to gradual reduction in contamination of catchment soil, particularly its top layer. The reduction can be considered as natural attenuation. This, in turn, results in a gradual decrease of radiocesium activity concentrations in the surface runoff and river water, in both dissolved and particulate forms. The purpose of this research is to study the dynamics of Fukushima-derived radiocesium in undisturbed soils and floodplain deposits exposed to erosion and sedimentation during floods. Combined observations of radiocesium vertical distribution in soil and sediment deposition on artificial lawn-grass mats on the Niida River floodplain allowed us to estimate both annual mean sediment accumulation rates and maximum sedimentation rates corresponding to an extreme flood event during Tropical Storm Etau, 6-11 September 2015. Dose rates were reduced considerably for floodplain sections with high sedimentation because the top soil layer with high radionuclide contamination was eroded and/or buried under cleaner fresh sediments produced mostly due to bank erosion and sediments movements. Rate constants of natural attenuation on the sites of the Takase River and floodplain of Niida River was found to be in range 0.2–0.4 year−1. For the site in the lower reach of the Niida River, collimated shield dose readings from soil surfaces slightly increased during the period of observation from February to July 2016. Generally, due to more precipitation, steeper slopes, higher temperatures and increased biological activities in soils, self-purification of radioactive contamination in Fukushima associated with vertical and lateral radionuclide migration is faster than in Chernobyl. In many cases, monitored natural attenuation along with appropriate restrictions seems to be optimal option for water remediation in Fukushima contaminated areas.



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Radioecological modelling of Polonium-210 and Caesium-137 in lichen-reindeer-man and top predators

Publication date: June 2018
Source:Journal of Environmental Radioactivity, Volume 186
Author(s): Bertil R.R. Persson, Runhild Gjelsvik, Elis Holm
This work deals with analysis and modelling of the radionuclides 210Pb and210Po in the food-chain lichen-reindeer-man in addition to 210Po and 137Cs in top predators. By using the methods of Partial Least Square Regression (PLSR) the atmospheric deposition of 210Pb and 210Po is predicted at the sample locations. Dynamic modelling of the activity concentration with differential equations is fitted to the sample data. Reindeer lichen consumption, gastrointestinal absorption, organ distribution and elimination is derived from information in the literature. Dynamic modelling of transfer of 210Pb and 210Po to reindeer meat, liver and bone from lichen consumption, fitted well with data from Sweden and Finland from 1966 to 1971. The activity concentration of 210Pb in the skeleton in man is modelled by using the results of studying the kinetics of lead in skeleton and blood in lead-workers after end of occupational exposure. The result of modelling 210Pb and 210Po activity in skeleton matched well with concentrations of 210Pb and 210Po in teeth from reindeer-breeders and autopsy bone samples in Finland.The results of 210Po and 137Cs in different tissues of wolf, wolverine and lynx previously published, are analysed with multivariate data processing methods such as Principal Component Analysis PCA, and modelled with the method of Projection to Latent Structures, PLS, or Partial Least Square Regression PLSR.

Graphical abstract

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Estimation of air-to-grass mass interception factors for iodine

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Publication date: June 2018
Source:Journal of Environmental Radioactivity, Volume 186
Author(s): N. Karunakara, P. Ujwal, I. Yashodhara, K. Sudeep Kumara, M.P. Mohan, K. Bhaskar Shenoy, P.V. Geetha, B.N. Dileep, Joshi P. James, P.M. Ravi
Air-to-grass mass interception factors for radionuclide are important basic input parameter for the estimation of radiation dose to the public around a nuclear power plant. In this paper, we present the determination of air-to- grass mass interception factors for iodine using a 2 m × 2 m × 2 m (l × b × h) size environmental chamber. The temperature, humidity, and rainfall inside the environmental chamber was controlled to required values to simulate different environmental conditions. Grass (Pennisetum purpureum, Schum), grown in pots, was kept inside the environmental chamber and stable iodine in elemental form was sublimed quickly inside the chamber to simulate an accidental release of iodine to the environment. The concentration of iodine in the air was measured periodically by drawing air through a bubbling setup, containing 1% sodium carbonate solution. The mass interception factor for dry deposition varied in the range of 0.25–7.7 m2 kg−1 with mean value of 2.2 m2 kg−1 with respect to fresh weight of grass, and that due to wet deposition varied in the range of 0.6–4.8 m2 kg−1 with mean value of 2.3 m2 kg−1. The mass interception factor was inversely correlated with the total iodine deposited through dry deposition as well as with the rainfall.



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Application of bomb- and Chernobyl-derived radiocaesium for reconstructing changes in erosion rates and sediment fluxes from croplands in areas of European Russia with different levels of Chernobyl fallout

Publication date: June 2018
Source:Journal of Environmental Radioactivity, Volume 186
Author(s): V.N. Golosov, D.E. Walling, A.V. Konoplev, M.M. Ivanov, A.G. Sharifullin




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Challenges associated with the behaviour of radioactive particles in the environment

Publication date: June 2018
Source:Journal of Environmental Radioactivity, Volume 186
Author(s): Brit Salbu, Valery Kashparov, Ole Christian Lind, Rafael Garcia-Tenorio, Mathew P. Johansen, David P. Child, Per Roos, Carlos Sancho
A series of different nuclear sources associated with the nuclear weapon and fuel cycles have contributed to the release of radioactive particles to the environment. Following nuclear weapon tests, safety tests, conventional destruction of weapons, reactor explosions and fires, a major fraction of released refractory radionuclides such as uranium (U) and plutonium (Pu) were present as entities ranging from sub microns to fragments. Furthermore, radioactive particles and colloids have been released from reprocessing facilities and civil reactors, from radioactive waste dumped at sea, and from NORM sites. Thus, whenever refractory radionuclides are released to the environment following nuclear events, radioactive particles should be expected.Results from many years of research have shown that particle characteristics such as elemental composition depend on the source, while characteristics such as particle size distribution, structure, and oxidation state influencing ecosystem transfer depend also on the release scenarios. When radioactive particles are deposited in the environment, weathering processes occur and associated radionuclides are subsequently mobilized, changing the apparent Kd. Thus, particles retained in soils or sediments are unevenly distributed, and dissolution of radionuclides from particles may be partial. For areas affected by particle contamination, the inventories can therefore be underestimated, and impact and risk assessments may suffer from unacceptable large uncertainties if radioactive particles are ignored. To integrate radioactive particles into environmental impact assessments, key challenges include the linking of particle characteristics to specific sources, to ecosystem transfer, and to uptake and retention in biological systems. To elucidate these issues, the EC-funded COMET and RATE projects and the IAEA Coordinated Research Program on particles have revisited selected contaminated sites and archive samples. This COMET position paper summarizes new knowledge on key sources that have contributed to particle releases, including particle characteristics based on advanced techniques, with emphasis on particle weathering processes as well as on heterogeneities in biological samples to evaluate potential uptake and retention of radioactive particles.



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Accelerator Mass Spectrometry (AMS) in Radioecology

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Publication date: June 2018
Source:Journal of Environmental Radioactivity, Volume 186
Author(s): M. García-León
Accelerator Mass Spectrometry (AMS) provides with an excellent sensitivity for the determination of radionuclides in the environment. In fact, conventional radiometric techniques can hardly compete with AMS in the solution of many problems involving the measurement of very low levels of radioactivity in Nature. For that reason, during the last years AMS has become a powerful tool for Radioecology studies.In this paper a review is done on the evolution of AMS applications to the measurement of environmental radioactivity and, therefore, its contribution to the understanding of radionuclide behavior in Nature. For that, the advantages of using AMS to determine key nuclides as 129I, 14C, Pu-isotopes and others in different natural compartments will be discussed. The content of the paper is illustrated with the contributions to these studies of the Spanish National Center for Accelerators (CNA) AMS systems.



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Pacific Proving Grounds radioisotope imprint in the Philippine Sea sediments

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Publication date: June 2018
Source:Journal of Environmental Radioactivity, Volume 186
Author(s): Daniela Pittauer, Per Roos, Jixin Qiao, Walter Geibert, Marcus Elvert, Helmut W. Fischer
Radionuclide concentrations were studied in sediment cores taken at the continental slope of the Philippine Sea off Mindanao Island in the equatorial Western Pacific. High resolution deposition records of anthropogenic radionuclides were collected at this site. Excess 210Pb together with excess 228Th and anthropogenic radionuclides provided information about accumulation rates. Concentrations of Am and Pu isotopes were detected by gamma spectrometry, alpha spectrometry and ICP-MS. The Pu ratios indicate a high portion (minimum of 60%) of Pu from the Pacific Proving Grounds (PPG). This implies that the transport of PPG derived plutonium with the Mindanao Current southward is similarly effective as the previously known transport towards the north with the Kuroshio Current. The record is compared to other studies from northwest Pacific marginal seas and Lombok basin in the Indonesian Archipelago. The sediment core top was found to contain a 6 cm thick layer dominated by terrestrial organic matter, which was interpreted as a result of the 2012 Typhoon Pablo-related fast deposition.



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Location-allocation model for external beam radiotherapy as an example of an evidence-based management tool implemented in healthcare sector in Poland

Publication date: Available online 21 February 2018
Source:Radiotherapy and Oncology
Author(s): Adam Michał Czerwiński, Barbara Więckowska
Background and purposeExternal beam radiotherapy (EBRT) is one of three key treatment modalities of cancer patients. Its utilisation and outcomes depend on a plethora of variables, one of which is the distance a patient must travel to undergo the treatment. The relation between distance and utilisation is clearly visible in Poland. At the same time no strategic investment plan is observed. This work proposes a method of resolving these two issues.Materials and methodsWe propose a mixed-integer linear programming model that aims to optimise the distribution of linear accelerators among selected locations in such a way that a patient's journey to the nearest EBRT is as short as possible. The optimisation is done with observance of international guidelines concerning EBRT capacity. With the use of proposed theoretical framework, we develop a national, strategic plan for linear accelerator investments.ResultsAccording to model assumptions decentralisation of EBRT, together with new equipment purchases, is required to ensure optimal access to EBRT.ConclusionsThe results were incorporated into Healthcare Needs Maps for Poland. The plan based on the results of this study, implemented by 2025, should deal with the most pressing concerns of Polish EBRT.



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Location-allocation model for external beam radiotherapy as an example of an evidence-based management tool implemented in healthcare sector in Poland

External beam radiotherapy (EBRT) is one of three key treatment modalities of cancer patients. Its utilisation and outcomes depend on a plethora of variables, one of which is the distance a patient must travel to undergo the treatment. The relation between distance and utilisation is clearly visible in Poland. At the same time no strategic investment plan is observed. This work proposes a method of resolving these two issues.

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In Vivo Molecular Profiling of Human Glioma

Abstract

Purpose

To assess the diagnostic performance of dynamic susceptibility contrast perfusion magnetic resonance perfusion imaging (DSC-MRI) for in vivo human glioma molecular profiling.

Methods

In this study 100 patients with histopathologically confirmed glioma who provided written informed consent were retrospectively assessed between January 2016 and February 2017 in two prospective trials that were approved by the local institutional review board. Cerebral blood volume (CBV) measurements from DSC-MRI were assessed, and histogram parameters of relative CBV (rCBV) results were compared among World Health Organization (WHO) 2016 based histological findings and molecular characteristics. A classification and regression tree (CART) algorithm with 10-fold cross-validation was used to calculate the diagnostic accuracy.

Results

The 90th percentile (C90) of rCBV was significantly lower in patients with the isocitrate dehydrogenase 1/2 (IDH1/2) mutation (2.86 ± 1.21; p < 0.001) and loss of alpha-thalassemia mental retardation syndrome X‑linked (ATRX) expression (2.23 ± 0.91; p < 0.001) than in those with the IDH1/2 wild type (4.78 ± 2.34) and maintained ATRX expression (4.30 ± 2.02). The standard deviation (SD) of rCBV was significantly higher in glioblastoma (GBM) with methylated O6-methylguanine DNA methyltransferase (MGMT; 1.99 ± 0.73; p = 0.001) than in those with unmethylated MGMT (1.20 ± 0.45). In CART analysis, rCBV predicted the molecular subgroup in 76.3% of astroglial tumors; however, the diagnostic performance was reduced to 48.1% by including oligodendrogliomas with chromosome 1p/19q co-deletion in the analysis due to substantial overlap of rCBV values between OD1p/19q-LOH and IDHwt GBM.

Conclusion

The DSC-MRI procedure may provide insight into the IDH1/2 mutation and ATRX expression status and MGMT methylation profile of diffuse glioma; however, taking integrated oligodendroglioma into account limits the diagnostic performance of rCBV in non-invasively predicting the molecular subtype.



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Superficial Siderosis and Dural Ectasia in a Patient with Marfan Syndrome



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Exophytic swelling of the buccal mucosa in a young female patient

Publication date: Available online 21 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Rene Martinez, Constanza Marin, Sven Niklander, Maureen Marshall, Wilfredo Alejandro Gonzalez-Arriagada




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Vitamin D deficiency and periodontal clinical attachment loss in HIV seropositive women: a secondary analysis conducted in the women's interagency HIV study (WIHS)

Publication date: Available online 19 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Panagiotis Dragonas, Linda M. Kaste, Martha Nunn, Praveen K. Gajendrareddy, Kathleen M. Weber, Mardge Cohen, Oluwatoyin M. Adeyemi, Audrey L. French, Herve Y. Sroussi
AimTo test a hypothesized positive association between low Vitamin D (VitD) serum levels and the severity of periodontal disease in HIV-infected women.Materials and MethodsThis is a cross sectional secondary analysis of data from an oral substudy conducted within the Chicago site of the Women's Interagency HIV Study. Serum VitD levels and clinical attachment loss measurements were available for 74 HIV-infected women. VitD levels were treated as both continuous and categorical variables in bivariate and multivariate analyses. Mean clinical attachment loss (mCAL) was determined for each subject by averaging measurements taken at 4 sites in each measured tooth.ResultsAverage age of study participants (n=74) was 39.6 years (SD 7.2) and the majority were African-American (70.3%) and VitD deficient (58.1%). VitD deficiency was positively associated with higher mCAL (p=.012). With adjustment for race, age, smoking, HIV viral load, an association was found between VitD deficiency and mCAL (Beta 0.438, p=0.036).ConclusionsWe identified a previously unreported association between VitD deficiency and mCAL in HIV-infected women. Larger and more inclusive multisite longitudinal studies are warranted to investigate whether these findings generalize to all HIV infected individuals in the current treatment era and to determine causality.



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Imaging Pediatric Appendicitis: Time to Put the Discussion to Bed?

Imaging Pediatric Appendicitis: Time to Put the Discussion to Bed?

Radiology. 2018 Mar;286(3):1030-1032

Authors: van Rijn RR

PMID: 29461956 [PubMed - in process]



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Deep Learning of Radiology Reports for Pulmonary Embolus: Is a Computer Reading My Report?

Deep Learning of Radiology Reports for Pulmonary Embolus: Is a Computer Reading My Report?

Radiology. 2018 Mar;286(3):853-855

Authors: Krupinski EA

PMID: 29461955 [PubMed - in process]



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Is CT Colonography Better Tolerated than Flexible Sigmoidoscopy for Colorectal Cancer Screening?

Is CT Colonography Better Tolerated than Flexible Sigmoidoscopy for Colorectal Cancer Screening?

Radiology. 2018 Mar;286(3):884-886

Authors: Taylor SA, von Wagner C

PMID: 29461954 [PubMed - in process]



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Can Machine Learning Be Used to Generate a Model to Improve Management of High-Risk Breast Lesions?

Can Machine Learning Be Used to Generate a Model to Improve Management of High-Risk Breast Lesions?

Radiology. 2018 Mar;286(3):819-821

Authors: Shaffer K

PMID: 29461953 [PubMed - in process]



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The Power of Publishing.

The Power of Publishing.

Radiology. 2018 Mar;286(3):735-736

Authors: Bluemke DA

PMID: 29461952 [PubMed - in process]



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Football and the Brain: Does Career Duration Provide Protective Effects?

Football and the Brain: Does Career Duration Provide Protective Effects?

Radiology. 2018 Mar;286(3):978-980

Authors: Maldjian JA

PMID: 29461951 [PubMed - in process]



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Immediate Allergic Reactions to Gadolinium-based Contrast Agents.

Immediate Allergic Reactions to Gadolinium-based Contrast Agents.

Radiology. 2018 Mar;286(3):1094-1095

Authors: Raynaud JS, Darmon-Kern E, Lancelot E, Desché P

PMID: 29461950 [PubMed - in process]



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Quantitative Elastography Methods in Liver Disease: Current Evidence and Future Directions.

Quantitative Elastography Methods in Liver Disease: Current Evidence and Future Directions.

Radiology. 2018 Mar;286(3):738-763

Authors: Kennedy P, Wagner M, Castéra L, Hong CW, Johnson CL, Sirlin CB, Taouli B

Abstract
Chronic liver diseases often result in the development of liver fibrosis and ultimately, cirrhosis. Treatment strategies and prognosis differ greatly depending on the severity of liver fibrosis, thus liver fibrosis staging is clinically relevant. Traditionally, liver biopsy has been the method of choice for fibrosis evaluation. Because of liver biopsy limitations, noninvasive methods have become a key research interest in the field. Elastography enables the noninvasive measurement of tissue mechanical properties through observation of shear-wave propagation in the tissue of interest. Increasing fibrosis stage is associated with increased liver stiffness, providing a discriminatory feature that can be exploited by elastographic methods. Ultrasonographic (US) and magnetic resonance (MR) imaging elastographic methods are commercially available, each with their respective strengths and limitations. Here, the authors review the technical basis, acquisition techniques, and results and limitations of US- and MR-based elastography techniques. Diagnostic performance in the most common etiologies of chronic liver disease will be presented. Reliability, reproducibility, failure rate, and emerging advances will be discussed. © RSNA, 2018 Online supplemental material is available for this article.

PMID: 29461949 [PubMed - in process]



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Case 251: Nontraumatic Drug-associated Rhabdomyolysis of Head and Neck Muscles.

Case 251: Nontraumatic Drug-associated Rhabdomyolysis of Head and Neck Muscles.

Radiology. 2018 Mar;286(3):1088-1092

Authors: Debelmas A, Benchetrit D, Galanaud D, Khonsari RH

Abstract
History A 21-year-old man with a history of abuse of multiple drugs and mild cognitive impairment who initially underwent treatment for excited delirium developed respiratory arrest shortly after admission and was successfully resuscitated. Unenhanced computed tomography (CT) of the head and neck and contrast material-enhanced CT of the chest, abdomen, pelvis, and complete spine were performed shortly after the initial treatment. Head and neck magnetic resonance (MR) imaging was performed 24 hours after admission. No other abnormalities were noted. There were no fractures, and there was no vascular injury in the head and neck region. The patient had no external neck injuries, congestion, or petechiae suggesting neck compression. He had no history of chronic or recurrent pain or skin rash. Urine testing was positive for cocaine, cannabis, and methamphetamine. Serum creatine kinase level was initially high (31 117 U/L [520 μkat/L]; normal, 1000 U/L [16.7 μkat/L]). Corrected calcium level was 2.22 mmol/L, and ionized calcium level was 1.09 mmol/L (lower end of the normal range). There was no acute renal failure at the initial phase, but serum creatinine levels reached 180 µmol/L 24 hours after admission, and creatine kinase peaked at 61 000 U/L [1019 μkat/L]. Urine was initially red, but the patient was not tested for myoglobinuria.

PMID: 29461948 [PubMed - in process]



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Detection of Clinically Significant Prostate Cancer by Using Abbreviated Biparametric Prostate MR Imaging.

Detection of Clinically Significant Prostate Cancer by Using Abbreviated Biparametric Prostate MR Imaging.

Radiology. 2018 Mar;286(3):1093-1094

Authors: Ueno Y, Tamada T, Takahashi S

PMID: 29461947 [PubMed - in process]



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2018 RSNA Leadership.

2018 RSNA Leadership.

Radiology. 2018 Mar;286(3):733-734

Authors:

PMID: 29461946 [PubMed - in process]



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Case 255.

Case 255.

Radiology. 2018 Mar;286(3):1084-1087

Authors: Yong AM, Tambyah PA

PMID: 29461945 [PubMed - in process]



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Cervical Internal Carotid Artery Occlusion versus Pseudo-Occlusion: Can CT Angiography Help Distinguish These in the Acute Stroke Setting?

Cervical Internal Carotid Artery Occlusion versus Pseudo-Occlusion: Can CT Angiography Help Distinguish These in the Acute Stroke Setting?

Radiology. 2018 Mar;286(3):1095-1096

Authors: Lev MH

PMID: 29461944 [PubMed - in process]



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Radiomics Based on Adapted Diffusion Kurtosis Imaging Helps to Clarify Most Mammographic Findings Suspicious for Cancer.

Radiomics Based on Adapted Diffusion Kurtosis Imaging Helps to Clarify Most Mammographic Findings Suspicious for Cancer.

Radiology. 2018 Feb 20;:170273

Authors: Bickelhaupt S, Jaeger PF, Laun FB, Lederer W, Daniel H, Kuder TA, Wuesthof L, Paech D, Bonekamp D, Radbruch A, Delorme S, Schlemmer HP, Steudle FH, Maier-Hein KH

Abstract
Purpose To evaluate a radiomics model of Breast Imaging Reporting and Data System (BI-RADS) 4 and 5 breast lesions extracted from breast-tissue-optimized kurtosis magnetic resonance (MR) imaging for lesion characterization by using a sensitivity threshold similar to that of biopsy. Materials and Methods This institutional study included 222 women at two independent study sites (site 1: training set of 95 patients; mean age ± standard deviation, 58.6 years ± 6.6; 61 malignant and 34 benign lesions; site 2: independent test set of 127 patients; mean age, 58.2 years ± 6.8; 61 malignant and 66 benign lesions). All women presented with a finding suspicious for cancer at x-ray mammography (BI-RADS 4 or 5) and an indication for biopsy. Before biopsy, diffusion-weighted MR imaging (b values, 0-1500 sec/mm2) was performed by using 1.5-T imagers from different MR imaging vendors. Lesions were segmented and voxel-based kurtosis fitting adapted to account for fat signal contamination was performed. A radiomics feature model was developed by using a random forest regressor. The fixed model was tested on an independent test set. Conventional interpretations of MR imaging were also assessed for comparison. Results The radiomics feature model reduced false-positive results from 66 to 20 (specificity 70.0% [46 of 66]) at the predefined sensitivity of greater than 98.0% [60 of 61] in the independent test set, with BI-RADS 4a and 4b lesions benefiting from the analysis (specificity 74.0%, [37 of 50]; 60.0% [nine of 15]) and BI-RADS 5 lesions showing no added benefit. The model significantly improved specificity compared with the median apparent diffusion coefficient (P < .001) and apparent kurtosis coefficient (P = .02) alone. Conventional reading of dynamic contrast material-enhanced MR imaging provided sensitivity of 91.8% (56 of 61) and a specificity of 74.2% (49 of 66). Accounting for fat signal intensity during fitting significantly improved the area under the curve of the model (P = .001). Conclusion A radiomics model based on kurtosis diffusion-weighted imaging performed by using MR imaging machines from different vendors allowed for reliable differentiation between malignant and benign breast lesions in both a training and an independent test data set. © RSNA, 2018 Online supplemental material is available for this article.

PMID: 29461172 [PubMed - as supplied by publisher]



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Effects of Common Ear Drops on Tympanic Membrane Healing in Rats.

Effects of Common Ear Drops on Tympanic Membrane Healing in Rats.

Otolaryngol Head Neck Surg. 2018 Feb 01;:194599818757972

Authors: Dirain CO, Kosko B, Antonelli PJ

Abstract
Objective Ciprofloxacin + dexamethasone ear drops have been associated with higher rates of tympanic membrane perforations than ofloxacin. This was thought to be an effect of the steroid; however, ciprofloxacin (sans steroid) has been found to be more toxic to tympanic membrane fibroblasts than ofloxacin in vitro. This study aimed to compare the effect of these agents on tympanic membrane healing in vivo. Study Design Controlled animal study. Setting Academic research laboratory. Methods Perforations were created in 54 rats with a carbon dioxide laser. Rats were randomized to 6 groups (9/group), with 1 ear receiving ofloxacin, ciprofloxacin, dexamethasone, ofloxacin + dexamethasone, ciprofloxacin + dexamethasone, or neomycin, and the contralateral ear receiving saline twice daily for 10 days. Healing was assessed over 40 days. Results Ofloxacin did not delay healing relative to saline. All other treatments delayed healing relative to ofloxacin at day 10 ( P < .0001). Dexamethasone and ofloxacin + dexamethasone delayed healing up to day 14 ( P < .0001). Neomycin and ciprofloxacin + dexamethasone further delayed healing up to day 28 ( P = .009) and day 35 ( P = .043), respectively. All eardrums healed by day 10 with ofloxacin, day 20 with ciprofloxacin, day 28 for dexamethasone, and day 35 for ofloxacin + dexamethasone. At day 40, 2 of 9 ciprofloxacin + dexamethasone-treated eardrums had not healed. All saline-treated eardrums in the ofloxacin, ciprofloxacin, dexamethasone, and ofloxacin + dexamethasone groups were healed by day 14, but this was delayed to day 20 in the ciprofloxacin + dexamethasone group ( P = .007). Conclusions Ototopical quinolones delay rat tympanic membrane healing in a drug-specific manner, with ciprofloxacin having a greater impact than ofloxacin. This effect is potentiated by steroids.

PMID: 29460666 [PubMed - as supplied by publisher]



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High resolution SEM characterization of nano-precipitates in ODS steels

Abstract

The performance of the present-day scanning electron microscopy (SEM) extends far beyond delivering electronic images of the surface topography. Oxide dispersion strengthened (ODS) steel is on of the most promising materials for the future nuclear fusion reactor because of its good radiation resistance, and higher operation temperature up to 750°C. The microstructure of ODS should not exceed tens of nm, therefore there is a strong need in a fast and reliable technique for their characterization. In this work, the results of low-kV SEM characterization of nanoprecipitates formed in the ODS matrix are presented. Application of highly sensitive photo-diode BSE detector in SEM imaging allowed for the registration of single nm-sized precipitates in the vicinity of the ODS alloys. The composition of the precipitates has been confirmed by TEM-EDS.

Thumbnail image of graphical abstract

The nm-sized precipitates in the Oxide dispersion strengthened steels alloys registered with photo-diode BSE detector scanning electron microscopy overlarge area, with no complex preparation as for TEM. Low-kV observation revealed at least two different phases of precipitates, confirmed with energy dispersive x-ray spectroscopy measurements



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Neglected or abused children still receive little help, causing problems in adulthood

Children who experience neglect, abuse, or other adverse childhood events often receive little support and have poorer mental and physical health later in life, MPs have been told.The serious long...
recent?d=yIl2AUoC8zA recent?d=dnMXMwOfBR0 recent?i=JrSQjxkBQUs:-2fSxYazFtw:V_sGLiP recent?d=qj6IDK7rITs recent?i=JrSQjxkBQUs:-2fSxYazFtw:gIN9vFw recent?d=l6gmwiTKsz0 recent?d=7Q72WNTAKBA recent?i=JrSQjxkBQUs:-2fSxYazFtw:F7zBnMy recent?i=JrSQjxkBQUs:-2fSxYazFtw:-BTjWOF


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Vaccine development might be handled more effectively in biotech companies than in academia

Two Editorials in The BMJ comment on the implications of Cohen’s investigation into the handling of animal testing data and a clinical trial for the MVA85A tuberculosis vaccine. 123 Another aspect to...
recent?d=yIl2AUoC8zA recent?d=dnMXMwOfBR0 recent?i=EUBgDB_OjUI:dqaGPQFPZuY:V_sGLiP recent?d=qj6IDK7rITs recent?i=EUBgDB_OjUI:dqaGPQFPZuY:gIN9vFw recent?d=l6gmwiTKsz0 recent?d=7Q72WNTAKBA recent?i=EUBgDB_OjUI:dqaGPQFPZuY:F7zBnMy recent?i=EUBgDB_OjUI:dqaGPQFPZuY:-BTjWOF


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Risk Factors for Recurrence After Treatment of N1b Papillary Thyroid Carcinoma.

Risk Factors for Recurrence After Treatment of N1b Papillary Thyroid Carcinoma.

Ann Surg. 2018 Feb 16;:

Authors: Lee SH, Roh JL, Gong G, Cho KJ, Choi SH, Nam SY, Kim SY

Abstract
OBJECTIVES: To examine risk factors for posttreatment recurrence in papillary thyroid carcinoma (PTC) patients with initial presentation of lateral neck metastasis (N1b).
SUMMARY OF BACKGROUND DATA: N1b PTC recurs after definitive treatment.
METHODS: Study subjects were 437 consecutive PTC patients who underwent total thyroidectomy and therapeutic neck dissection of central and lateral compartments and postoperative radioactive iodine ablation therapy. The patients' demographics and pathological factors, including factors related to tumors and lymph nodes (LNs), and postoperative thyroglobulin levels were reviewed. Univariate and multivariate Cox proportional hazards regression analyses were used to identify factors associated with recurrence-free survival (RFS).
RESULTS: During a median follow-up of 83 months (range, 32-135 months), recurrence occurred in 81 (18.1%) patients. Univariate analyses showed that male sex, tumor size, macroscopic extrathyroidal extension, perineural invasion, extranodal extension, LN involvement, LN ratio, MACIS score, and postoperative serum levels of thyroglobulin were significantly associated with RFS (P < 0.05). Multivariate analyses revealed that LN ratio (> 0.25) in the lateral compartment (adjusted hazard ratio = 2.099, 95% confidence interval = 1.278-3.448; P = 0.003), and postoperative serum levels of stimulated (>5.0 ng/mL; 3.172, 1.661-6.056, P < 0.001) and unstimulated (>0.1 ng/mL; 3.200, 1.569-6.526, P = 0.001) thyroglobulin were independent predictors of any-site RFS. Clinical and tumor factors were not independent predictors of RFS outcomes (P > 0.1).
CONCLUSIONS: Posttreatment recurrence is predicted by the LN ratio in the lateral compartment and postoperative serum levels of thyroglobulin in patients with metastatic PTC in the lateral neck.

PMID: 29462007 [PubMed - as supplied by publisher]



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High-resolution 129I bomb peak profile in an ice core from SE-Dome site, Greenland.

http:--linkinghub.elsevier.com-ihub-imag Related Articles

High-resolution 129I bomb peak profile in an ice core from SE-Dome site, Greenland.

J Environ Radioact. 2018 Apr;184-185:14-21

Authors: Bautista AT, Miyake Y, Matsuzaki H, Iizuka Y, Horiuchi K

Abstract
129I in natural archives, such as ice cores, can be used as a proxy for human nuclear activities, age marker, and environmental tracer. Currently, there is only one published record of 129I in ice core (i.e., from Fiescherhorn Glacier, Swiss Alps) and its limited time resolution (1-2 years) prevents the full use of 129I for the mentioned applications. Here we show 129I concentrations in an ice core from SE-Dome, Greenland, covering years 1956-1976 at a time resolution of ∼6 months, the most detailed record to date. Results revealed 129I bomb peaks in years 1959, 1962, and 1963, associated to tests performed by the former Soviet Union, one year prior, in its Novaya Zemlya test site. All 129I bomb peaks were observed in winter (1958.9, 1962.1, and 1963.0), while tritium bomb peaks, another prominent radionuclide associated with nuclear bomb testing, were observed in spring or summer (1959.3, and 1963.6; Iizuka et al., 2017). These results indicate that 129I bomb peaks can be used as annual and seasonal age markers for these years. Furthermore, we found that 129I recorded nuclear fuel reprocessing signals and that these can be potentially used to correct timing of estimated 129I releases during years 1964-1976. Comparisons with other published records of 129I in natural archives showed that 129I can be used as common age marker and tracer for different types of records. Most notably, the 1963 129I bomb peak can be used as common age marker for ice and coral cores, providing the means to reconcile age models and associated trends from the polar and tropical regions, respectively.

PMID: 29331558 [PubMed - indexed for MEDLINE]



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Estimation of counting efficiencies of a portable NaI detector using Monte Carlo simulation for thyroid measurement following nuclear accidents.

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Estimation of counting efficiencies of a portable NaI detector using Monte Carlo simulation for thyroid measurement following nuclear accidents.

J Radiol Prot. 2017 Sep 25;37(3):635-641

Authors: Ha WH, Kim JK, Jin YW

Abstract
Radioiodine can be released in nuclear accidents and can cause internal contamination of the thyroid gland in members of the public. For population monitoring in radiation emergencies, measurement of counting efficiency is very important to accurately determine thyroid activity. Here, we estimate the counting efficiencies of a portable NaI detector using Monte Carlo simulations. Two different types of neck phantoms and a 7.62 cm long by 7.62 cm diameter NaI detector were modeled and the counting efficiencies were calculated depending on the thyroid size and distance from the neck phantom to the detector. We found that distance is a more important parameter than thyroid size. The optimal distance of the NaI detector from the neck surface was determined to be greater than 12 cm, beyond which the counting efficiency was not affected by thyroid size.

PMID: 28474600 [PubMed - indexed for MEDLINE]



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Libman–Sacks vegetations detected by 3D echocardiography

A 35-year-old woman with a history of systemic lupus erythematosus presented with symptoms of congestive heart failure. She was treated with diuretics with resolution of her dyspnoea. Laboratory testing revealed a white-cell count of 7300/mm3, creatinine was 2.2 mg/dL, and C-reactive protein level was 10.2 mg/L (normal < 5). Repeated blood cultures were negative. Transthoracic echo demonstrated thickened mitral valve leaflets and severe mitral regurgitation. On 3D transoesophageal echocardiography, vegetations were observed on the atrial (Panel A, arrow) as well as the ventricular aspect (Panel B, arrows) of the posterior mitral leaflet, consistent with Libman–Sacks endocarditis (LSE).

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Rationale and design of the EACVI AFib Echo Europe Registry for assessing relationships of echocardiographic parameters with clinical thrombo-embolic and bleeding risk profile in non-valvular atrial fibrillation

Abstract
The European Society of Cardiology (ESC) guidelines for management of atrial fibrillation (AF) recommend the use of CHA2DS2VASc risk score for assessment of thromboembolic (TE) risk, whereas the stratification of bleeding risk should be obtained by HAS-Bleed to balance the most appropriate anticoagulation (OAC) therapy. However, men with CHA2DS2VASc score = 1 and women with CHA2DS2VASc = 2, who are at intermediate TE risk, represent a grey zone where guidelines do not provide a definite OAC indication. Accordingly, implementation of risk stratification with echocardiography could be extremely useful. Both prospective and cross-sectional studies on transthoracic echocardiography (TTE) prediction of TE events and studies utilizing transoesophageal echocardiographic parameters as surrogate markers of TE events makes sustainable the hypothesis that echocardiography could improve TE prediction in non-valvular AF. Moreover, considering the close association of AF and stroke, all echo-Doppler parameters that have shown to predict AF onset and recurrence could be useful also to predict TE events in this clinical setting. Accordingly, EACVI AFib Echo Europe Registry has been designed as an observational, cross-sectional study, with the aim of evaluating: (i) left atrial (LA) size and function together with left ventricular geometry, systolic and diastolic functions in paroxysmal, persistent, and permanent AF; (ii) relationships of structural/functional parameters with clinical TE and bleeding risk profile. By the AFib Echo Europe Registry, we expect to collect data on echocardiographic phenotype of patients with AF. The large data set accumulated will be useful to test the level of agreement of different echocardiographic measurements with the available risk scores.

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Transthyretin amyloidosis in a septuagenarian masquerading as hypertrophic cardiomyopathy: the importance of multimodality imaging

Comprehensive cardiac evaluation was performed on a 75-year-old African American woman referred to our hypertrophic cardiomyopathy (HCM) centre for refractory diastolic heart failure. The patient carried a diagnosis of non-obstructive HCM for several years and had a daughter with a diagnosis of HCM. A 12-lead electrocardiogram (Panel A) showed sinus bradycardia without left ventricular (LV) hypertrophy. Transthoracic echocardiogram (Panels B–D, see Supplementary data online, Videos S1Supplementary data online, Videos S1–S4S4) showed thickened LV (anterior septum 23 mm, posterior septum 30 mm) without any resting or provocable LV outflow obstruction and abnormal global longitudinal strain (−13%) with relative apical sparing. Additional imaging with cardiac magnetic resonance imaging (Panels E–G) demonstrated substantial, patchy, and mid-myocardial delayed enhancement (25% of the myocardium, arrows, Panel G). The myocardium was notably difficult to null. Given the available information, infiltrative cardiomyopathy was suspected (amyloid), and a subsequent 99mTc-pyrophosphate scan suggested cardiac amyloidosis [heart/contralateral [CL] counts >1.5; Panels H (1 h) and I (3 h)]. Endomyocardial biopsy and Congo red stain (Panels J and K) confirmed amyloid fibrils infiltrating the myocardium. Genetics for HCM panel subsequently demonstrated a typical mutation for amyloidosis in African Americans [heterozygous for pathogenic Val122Ile mutation in transthyretin (TTR) gene].

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Extensive myocardial calcification in septic shock and precursor B-cell acute lymphoblastic leukaemia

A 15-year-old male with Klinefelter syndrome presented with neutropenic septic shock and multiorgan failure. Bone marrow biopsy demonstrated precursor B-cell acute lymphoblastic leukaemia. AEIOP chemotherapy was initiated on Day 6 of admission (prednisone, vincristine, daunorubicin, pegylated asparaginase, methotrexate, and intrathecal cytarabine). At Day 21, during his induction phase, echocardiography demonstrated new widespread myocardial calcification. On apical four chamber views, there was dense calcification of the left and right ventricular myocardium, the mitral annulus, the interventricular septum, and the interatrial septum (Panel A). Involvement of the papillary muscle was seen on the parasternal short axis view (Panel B). The echocardiographic ejection fraction was visually estimated at 50% (see Supplementary data online, Video S1Supplementary data online, Video S1). Computed tomography revealed dense myocardial calcification concentrated around the left ventricle (Panel C). The post contrast cardiac magnetic resonance images demonstrated multifocal areas of delayed enhancement extending from the pericardium to the subendocardium with a small pericardial effusion (Panel D). The left ventricular ejection fraction was measured as 36% with minimal tricuspid and mitral regurgitation (see Supplementary data online, Video S2Supplementary data online, Video S2).

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Corrigendum to: Quantitative deformation analysis differentiates ischaemic and non-ischaemic cardiomyopathy: sub-group analysis of the VINDICATE trial

[Eur Heart J Cardiovasc Imaging 2017; doi:10.1093/ehjci/jex235]

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Applications of cardiac computed tomography in electrophysiology intervention

Abstract
Cardiac electrophysiology is an evolving specialty that has seen rapid advances in recent years. Concurrently, there has been much progress in the field of cardiac imaging. Electrophysiologists are increasingly requesting cross-sectional imaging in advance of many procedures. Pulmonary vein isolation and left atrial appendage (LAA) occlusion are now an established treatment options for atrial fibrillation. In patients undergoing pulmonary vein isolation, applications of computed tomography (CT) include evaluating the left atrial and pulmonary venous anatomy, excluding LAA thrombus and assessing for pulmonary vein stenosis. In those undergoing LAA occlusion, CT may be of value in assessing the size, position, and morphology of the LAA as well as for determining correct positioning of the device and evaluating for peri-device leak. Implantable cardiac devices are now commonly used in the management of cardiac failure and cardiac arrhythmias. Applications of CT prior to device implantation include detecting myocardial scar, evaluating for mechanical dyssynchrony as well as visualising the coronary venous anatomy.

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Three-dimensional printing: to guide management of a right coronary artery to left ventricular fistula

A 26-year-old female presented with 4 weeks of intermittent fever. Physical examination was notable for a diastolic murmur over the left sternal edge. Blood cultures were positive for Streptococcus anginosus. Transthoracic echocardiography demonstrated a mildly dilated left ventricle (LV) with normal function and a markedly dilated right coronary artery (RCA) fistula that enters the basal inferior LV (Panel A) with turbulent Doppler flow across the mitral valve (MV) leaflets. Transoesophageal echocardiography highlighted the severely dilated RCA (Panel C) and revealed a strand-like echodensity associated with the posterior MV leaflet tip, consistent with infective endocarditis (IE). Persistent turbulent flow may have cause scarring and eventual nidus for IE. The patient was treated with intravenous penicillin.

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Thoracic Park: cardiac MRI reveals massive thoracic varices as consequence of inferior vena cava ligation

A 71-year-old gentleman underwent a cardiac magnetic resonance (CMR) scan as part of a panel of investigations for unexplained breathlessness. CMR (Panels A–C) revealed remarkable collateral thoracic vasculature; with dilatation of the superior vena cava, extreme tortuosity and massive dilatation of the azygos and hemiazygos system with large intercostal varicose venous channels draining into the axillary veins. In addition, there was splenomegaly and elevation of the left hemidiaphragm. Splenic venous drainage was complex, via innumerable serpiginous veins anastomosing at the anterior abdominal wall into the systemic venous drainage.

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The need for appropriate use criteria: the proof of the pudding

This editorial refers to ‘Understanding decision-making in cardiac imaging: determinants of appropriate use’, by R. Fonseca et al., pp. 262–268.

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Understanding decision-making in cardiac imaging: determinants of appropriate use

Abstract
Aims
Appropriate Use Criteria (AUC) for echocardiography were developed in 2007 to facilitate decision-making, reduce variability in test utilization, and encourage rational use of imaging. However, there is little evidence that the AUC have favourably influenced ordering behaviour. This study explores the factors that contribute to clinicians requesting echocardiograms with a focus on appropriate use.
Methods and results
Semi-structured face-to-face interviews with cardiologists and non-cardiologists who had requested echocardiograms were conducted at an Australian tertiary hospital. The interview guide included hypothetical clinical scenarios to better understand decision-making in ordering echocardiograms and the actions they could take when receiving test reports. Interviews underwent thematic analysis. Seventeen clinicians were interviewed, ten of whom were cardiologists. All participants ordered echocardiograms to support their clinical decision-making. Awareness of the AUC was low. The categorization of tests as ‘appropriate’ or ‘inappropriate’ was considered ineffective as it failed to reflect the decision-making process. The decision to request echocardiograms was influenced by a number of personal and systemic factors as well as guidelines and protocols. Training and experience, patients’ expectations, and management of uncertainty were key personal factors. Systemic factors involved the accessibility of services and health insurance status of the patient.
Conclusion
Factors that influenced the ordering of echocardiograms by clinicians at a tertiary care hospital did not appear to be amenable to control with AUC. Alternative approaches may be more effective than the AUC in addressing the overuse of echocardiography.

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Screening of systemic arteriopathy in patients with spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome in young women. It has been suggested that SCAD could be a reflection of an underlying systemic arterial disorder, namely fibromuscular dysplasia (FMD), a non-inflammatory systemic arteriopathy.

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Echocardiographic demonstration of a thrombus straddling the patent foramen ovale and pulmonary embolism

A 74-year-old woman presented with a 3-day history of increasing dyspnoea. She had undergone left hip arthroplasty following a car accident 5 weeks previously, resulting in prolonged bed rest. The patient was tachypnoeic, and blood pressure was 140/60 mmHg. Besides sinus tachycardia, the electrocardiogram revealed an S1Q3 pattern. NT-proBNP (4849 pg/ml) and D-dimers (3964 ng/ml) were increased. Transthoracic echocardiography (Panel A; RA: right atrium; LA: left atrium, see Supplementary dataSupplementary data online, Video S1) demonstrated a thrombus (*) straddling a patent foramen ovale (PFO), confirmed by transoesophageal echocardiography (TEE) (Panels B and C, see Supplementary data online, Videos S2Supplementary data online, Videos S2 and S3S3) which, in addition, detected another thrombus (**) in the right pulmonary artery (PA) (Panel D, see Supplementary dataSupplementary data online, Video S4). Computed tomography pulmonary angiogram showed multiple bilateral pulmonary emboli (Panel E). Emergent surgical thrombectomy and pulmonary embolectomy were performed (Panel F), followed by gradual clinical improvement under unfractionated heparin. Heparin-induced thrombocytopenia complicated by left popliteal artery thrombosis was diagnosed on the tenth postoperative day. Danaparoid sodium was initiated after thrombectomy.

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Mild cognitive impairment is associated with subclinical diastolic dysfunction in patients with chronic heart disease

Abstract
Background
To examine mild cognitive impairment and its associations with subclinical cardiac dysfunction in patients with chronic heart disease yet to develop the clinical syndrome of chronic heart failure (CHF).
Methods and results
Patients from the Nurse-led Intervention for Less Chronic Heart Failure Study (n = 373 with chronic heart disease other than CHF; 64 ± 11 years, 69% men) were screened for mild cognitive impairment [Montreal cognitive assessment (MoCA) score <26] and underwent echocardiographic/clinical profiling. We investigated associations of mild cognitive impairment and MoCA cognitive domain subscores with global cardiac status (‘normal’ vs. ‘diastolic dysfunction’ vs. ‘other cardiac abnormality’) and individual echocardiographic parameters. Patients with mild cognitive impairment (n = 161; 43%) demonstrated a higher age-adjusted prevalence of diastolic dysfunction (37% vs. 24%; P < 0.05). Multivariate logistic regression (adjusted for age, sex, and other relevant clinical factors) indicated that the odds of mild cognitive impairment were two-times higher with diastolic dysfunction (P = 0.030) and 1.7-times higher with ‘other cardiac abnormalities’ (P = 0.082) vs. normal cardiac status. In turn, mild cognitive impairment was predicted by left-ventricular (LV) filling pressure (based on the ratio of early diastolic filling and annular velocities; adjusted odds ratio 1.07 per unit increase, P = 0.022), but not LV structural parameters. Specific deficits in the cognitive domains of executive functioning and visuo-constructional abilities were also independently predicted by diastolic dysfunction (P < 0.05).
Conclusion
Mild cognitive impairment is prevalent in patients with subclinical chronic heart disease at high-risk of CHF. Independent associations with LV diastolic dysfunction suggest a link between cardiac and cognitive functioning beyond shared risk factors.

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Heterogeneity of myocardial 2-[18F]fluoro-2-deoxy-D-glucose uptake is a typical feature in cardiac sarcoidosis: a study of 231 patients

Abstract
Aims
The goal of the investigation was to evaluate whether a semi-quantitative method reflecting myocardial 2-[18F]fluoro-2-deoxy-D-glucose (FDG) uptake heterogeneity has added value in addition to visual analysis in the diagnosis of cardiac sarcoidosis (CS).
Methods and results
This retrospective analysis included 271 consecutive patients suspected of CS attending cardiac positron emission tomography combined with computed tomography (PET-CT) at our institution between 2007 and 2013. Visual analysis of PET-CT and semi-quantitative analysis of heterogeneity [coefficient of variation (CoV)] of myocardial FDG uptake were performed. The presence of CS and initial symptoms were verified from patient data. The criteria for CS included histological verification from the myocardium or from an extracardiac site. Thirty cancer patients without cardiac disease were included as controls. CS was diagnosed in 48/231 (20.8%) of analysed patients. Of these, 13 (27.1%) had no extracardial signs of the disease and 30 (62.5%) had FDG positive mediastinal lymph nodes. Visual analysis of PET-CT identified 48.9% of the CS patients. We found a cut-off value of 0.184 for CoV to have the best accuracy to detect CS from a patient population with suspected CS (75.0% sensitivity and 51.4% specificity). Compared to controls, CoV identified CS patients with a good accuracy (68.8% sensitivity and 93.3% specificity). CS patients with FDG positive mediastinal lymph nodes had higher CoV than CS patients without lymph node involvement (0.282 vs. 0.208, P = 0.016). CS patients with more severe initial symptoms had a higher CoV than patients with more benign symptoms (0.283 vs. 0.195, P = 0.01).
Conclusion
CoV provides a good addition to visual analysis of cardiac FDG PET-CT in diagnosis of CS. As a semi-quantitative measure, it reduces intra-observer variability. It also seems to indicate more severe disease, but to confirm this, prospective studies are needed.

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The association between alcohol consumption and left ventricular diastolic function and geometry change in general Korean population

Abstract
Aims
The adverse effect of heavy alcohol intake on cardiovascular disease is well established. However, there is only limited information about the risk of subclinical left ventricular (LV) abnormality according to alcohol consumption. Thus, this study was to investigate the association between alcohol consumption and LV functional and structural abnormality.
Methods and results
Study participants were 49 714 Korean adults received echocardiogram as an item of health check-up program. They were stratified into 6 groups according to alcohol consumption; non (life time never drinker), occasional (<1 g/day), light (1–15 g/day), moderate (15–30 g/day), heavy (30–60 g/day), and very heavy (>60 g/day) drinker. Multiple logistic regression analysis was used to assess the odd ratios (ORs) for LV hypertrophy (LVH), increased relative wall thickness (RWT) and impaired LV diastolic (LVD) function with a reference of non-drinker. Additionally, the adjusted mean values of echocardiographic parameters were evaluated to assess LV diastolic function and structure. In logistic regression analysis, very heavy alcohol drinker had the highest adjusted ORs for LVH, increased RWT and impaired LVD function in all participants and male subgroup (P < 0.05). The dose dependent relationship was found between alcohol consumption and impaired LVD function in all participants and gender subgroups. There was no specific pattern of relationship to suggest the favourable effect of light alcohol drinking on heart.
Conclusion
Increased alcohol intake had the adverse effect on LV function and structure. However, potential favourable effect of light alcohol intake was not observed. Prospective studies are required to investigate long-term effect of alcohol consumption on subclinical LV change.

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Mitral annular calcification progression and the risk of atrial fibrillation: results from MESA

Abstract
Aims
To determine if progression of mitral annular calcium (MAC) detected by cardiac computed tomography (CT) predicts incident atrial fibrillation (AF).
Methods and results
This analysis included 5683 participants (mean age 64 ± 10 years; 52% women; 40% whites; 27% blacks; 21% Hispanics; 12% Chinese–Americans) from the Multi-Ethnic Study of Atherosclerosis. MAC was measured by cardiac CT at baseline and at a follow-up CT scan over a mean time of 2.4 ± 0.84 years. AF was ascertained by review of hospital discharge records and from Medicare claims data through 31 December 2012. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between MAC progression and AF. Over a median follow-up of 8.6 years, a total of 533 (9.4%) incident AF cases were detected. In a model adjusted for age, sex, race/ethnicity, education, income, baseline MAC, systolic blood pressure, body mass index, diabetes, smoking, total cholesterol, high-density lipoprotein cholesterol, antihypertensive medications, lipid-lowering therapies, and aspirin, any MAC progression (>0/year) was associated with an increased risk for AF (HR = 1.50, 95% CI = 1.20–1.87). Multiplicative interactions were not significant between MAC progression and AF by age (<65 year vs. older), sex, or race/ethnicity (whites vs. non-whites).
Conclusion
Important prognostic information regarding AF risk is obtained with follow-up MAC measurement, as the risk for participants with any MAC progression was substantively greater than participants without progression. MAC progression may detect underlying left atrial abnormalities that predispose to AF.

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Prolonged central circulation transit time in patients with HFpEF and HFrEF by magnetic resonance imaging

Abstract
Aims
Prolonged central circulation transit time (TT) has long been associated with heart failure (HF) and left ventricular (LV) dysfunction. In this study, we assessed the central circulation TT using cardiovascular magnetic resonance imaging (CMR) in patients with HF of preserved ejection fraction (HFpEF) and of reduced EF (HFrEF) and investigated its relation to haemodynamics.
Methods and results
Fifty eight prospectively recruited volunteers underwent CMR. TT was taken as the time between the peaks of time-intensity curves from first pass perfusion images and normalized to cardiac cycle length intervals. Left ventricular ejection fraction was 55 ± 3%, 57 ± 7%, and 28 ± 10% in control (N = 10), HFpEF (N = 20), and HFrEF (N = 28), respectively (P < 0.001). Global central TT from right atrium to ascending aorta was significantly prolonged in patients with HFrEF [17 ± 5 cardiac cycles (cc)] and HFpEF (12 ± 3 cc) when compared to the normal controls (8 ± 1 cc) (P < 0.001). Regional TT was also prolonged in HF patients between right atrium and pulmonary artery (PA), PA and left atrium (LA), and LA and ascending aorta (all P-value < 0.001) with the longest delay seen between PA and LA. Among 48 HF patients, 28 underwent same day cardiac catheterization. Multivariate regression analysis suggested while reduced left and right ventricular EF were the strongest correlates for HFrEF increased pulmonary capillary wedge (PCWP) and reduced PA oxygen saturation were the strongest correlates for HFpEF.
Conclusions
Global and regional central TT can be assessed in the first pass perfusion imaging. Prolonged normalized global TT correlates with reduced EF in HFrEF and increased PCWP in HFpEF.

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Adverse prognosis associated with asymmetric myocardial thickening in aortic stenosis

Abstract
Aims
Asymmetric wall thickening has been described in patients with aortic stenosis. However, it remains poorly characterized and its prognostic implications are unclear. We hypothesized this pattern of adaptation is associated with advanced remodelling, left ventricular decompenzation, and a poor prognosis.
Methods and results
In a prospective observational cohort study, 166 patients with aortic stenosis (age 69, 69% males, mean aortic valve area 1.0 ± 0.4 cm2) and 37 age and sex-matched healthy volunteers underwent phenotypic characterization with comprehensive clinical, imaging, and biomarker evaluation. Asymmetric wall thickening on both echocardiography and cardiovascular magnetic resonance was defined as regional wall thickening ≥ 13 mm and > 1.5-fold the thickness of the opposing myocardial segment. Although no control subject had asymmetric wall thickening, it was observed in 26% (n = 43) of patients with aortic stenosis using magnetic resonance and 17% (n = 29) using echocardiography. Despite similar demographics, co-morbidities, valve narrowing, myocardial hypertrophy, and fibrosis, patients with asymmetric wall thickening had increased cardiac troponin I and brain natriuretic peptide concentrations (both P < 0.001). Over 28 [22, 33] months of follow-up, asymmetric wall thickening was an independent predictor of aortic valve replacement (AVR) or death whether detected by magnetic resonance [hazard ratio (HR) = 2.15; 95% confidence interval (CI) 1.29–3.59; P = 0.003] or echocardiography (HR = 1.79; 95% CI 1.08–3.69; P = 0.021).
Conclusion
Asymmetric wall thickening is common in aortic stenosis and is associated with increased myocardial injury, left ventricular decompenzation, and adverse events. Its presence may help identify patients likely to proceed quickly towards AVR.
Clinical Trial Registration:
https://clinicaltrials.gov/show/NCT01755936: NCT01755936.

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Randomized comparison of sirolimus eluting, and biolimus eluting bioresorbable polymer stents: the SORT-OUT VII optical coherence tomography study

Abstract
Aims
To show non-inferiority of the 67- or 87 µm thick, sirolimus-eluting Orsiro drug eluting stent (DES) to the 122 µm thick, biolimus-eluting Nobori DES regarding size of vessel lumen outside the stent at 13-month follow-up.
Methods and results
This study was a substudy to the SORT-OUT VII trial, a prospective, 1:1-randomized, comparison of the two stents in patients with stable coronary artery disease or acute coronary syndrome. Optical coherence tomography was acquired after percutaneous coronary intervention and at 13-month follow-up. The substudy was powered to access non-inferiority (Δ = 0.60 mm2) of the Orsiro DES to the Nobori DES for the primary endpoint of mean extra stent lumen (ESL) i.e. vessel lumen outside the stent at 13-month follow-up. We randomized 124 patients to Orsiro (n = 60) or Nobori (n = 64). Due to a difference in the one-sided 95%-confidence interval of 0.26 mm2, but increased to 0.82 mm2 after appropriate log-transformation, it could not be rejected that Orsiro exceeded the non-inferiority limit. Testing for superiority, Orsiro had a significantly larger mean ESL at follow-up (Orsiro: 0.11 mm2 [0.02;0.30] mm2, Nobori: 0.03 mm2 [0.00;0.17] mm2, P = 0.04). Stent strut coverage was, Orsiro: 97.6 % [93.8;99.4]%, and Nobori: 96.3 % [90.5;98,6]% (P = 0.13).
Conclusion
Orsiro DES had a significantly larger mean ESL at follow-up and it could not be excluded that Orsiro exceeded the limit for non-inferiority. Nobori DES had a more heterogeneous distribution of neointima but stent strut coverage did not differ significantly between the two stents.

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Pre- and postoperative tricuspid regurgitation in patients with severe symptomatic aortic stenosis: importance of pre-operative tricuspid annulus diameter

Abstract
Aims
Secondary tricuspid regurgitation (STR) is commonly found in patients with aortic stenosis and is associated with increased morbidity. The study sought to evaluate the prevalence of pre-operative STR and its progression after surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Also, it sought to analyse the predictors of post-operative changes in STR.
Methods and results
We prospectively evaluated 116 patients (aged 75.1 ± 9.8 years, predominantly male) who undergo SAVR or TAVI for severe aortic stenosis (AS) from September 2013 to April 2015. Patients with associated valve disease requiring intervention, significant coronary artery disease or left ventricular ejection fraction (LVEF) <50% were excluded. Clinical and echocardiographic data, including TR grade and right ventricular (RV) size and function, were assessed at baseline and at the 1-year follow-up. At baseline, significant TR was documented in 13 patients (11.1%) and non-significant TR was documented in 103 patients (88.9%). Atrial fibrillation (AF) was more prevalent in patients with a tricuspid annulus diameter ≥40 mm (P < 0.0051). At the 1-year follow-up, the TR grade had improved in 17 patients (14.7%), was unchanged in 68 patients (58.6%) and had worsened in 31 patients (26.7%). Moderate to severe TR was found in 30 patients (25.8%). Tricuspid annulus diameter >40 mm was the only echocardiographic predictor of significant postoperative TR (relative risk (RR) = 2.12 [1.26–3.54], P = 0.004). Right heart function and size were not independent predictors.
Conclusion
Significant TR was present pre-operatively in 11.1% of patients. Post-operative progression was observed in 26.7% of patients. Only tricuspid annulus size >40 mm was an independent echocardiographic predictor of moderate to severe TR at the 1-year follow-up.

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Nitrate in drinking water increases the risk of colorectal cancer

The results have just been published in the scientific journal International Journal of Cancer. Nitrate in groundwater and drinking water, which primarily comes from fertilisers used in the agricultural production, has not only been subject to decades of...

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Highly mutated protein in skin cancer plays central role in skin cell renewal

Approximately once a month, our skin completely renews itself. If this highly coordinated process goes awry, it can lead to a variety of skin diseases, ranging from skin cancer to psoriasis. Cells lining such organs as skin and the gut, lungs, and many...

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Similarities found in cancer initiation in kidney, liver, stomach, pancreas

Recent research at Washington University School of Medicine in St. Louis demonstrated that mature cells in the stomach sometimes revert back to behaving like rapidly dividing stem cells. Now, the researchers have found that this process may be universal;...

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health technology; +287 new citations

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

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These pubmed results were generated on 2018/02/21

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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Protein kinase D1 regulates subcellular localisation and metastatic function of metastasis-associated protein 1

Protein kinase D1 regulates subcellular localisation and metastatic function of metastasis-associated protein 1

Protein kinase D1 regulates subcellular localisation and metastatic function of metastasis-associated protein 1, Published online: 20 February 2018; doi:10.1038/bjc.2017.431

Protein kinase D1 regulates subcellular localisation and metastatic function of metastasis-associated protein 1

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Protein kinase D1: gatekeeper of the epithelial phenotype and key regulator of cancer metastasis?

Protein kinase D1: gatekeeper of the epithelial phenotype and key regulator of cancer metastasis?

Protein kinase D1: gatekeeper of the epithelial phenotype and key regulator of cancer metastasis?, Published online: 20 February 2018; doi:10.1038/bjc.2018.1

Protein kinase D1: gatekeeper of the epithelial phenotype and key regulator of cancer metastasis?

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IJERPH, Vol. 15, Pages 367: Managing Risk Aversion for Low-Carbon Supply Chains with Emission Abatement Outsourcing

IJERPH, Vol. 15, Pages 367: Managing Risk Aversion for Low-Carbon Supply Chains with Emission Abatement Outsourcing

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15020367

Authors: Qinpeng Wang Longfei He

Reducing carbon emissions, including emission abatement outsourcing at the supply-chain level, is becoming a significant but challenging problem in practice. Confronting this challenge, we therefore break down the practice to focus on a low-carbon supply chain consisting of one supplier, one manufacturer and one third-party emission-reducing contractor. The contractor offers a carbon reduction service to the manufacturer. In view of the increasing proportion of Greenhouse Gases (GHG) emissions and absence of carbon reduction policies in developing countries, we adopt the prospect of consumers’ low-carbon preferences to capture the demand sensitivity on carbon emission. By exploiting the Mean-Variance (MV) model, we develop a supply chain game model considering risk aversion. Comparing the supply chain performances of the cases under risk neutrality and risk aversion, we investigate the impact of the risk aversion of the supplier and the manufacturer on the low-carbon supply chain performances, respectively. We show that the risk aversion of chain members will not influence the relationship underlain by the profit-sharing contract between the manufacturer and contractor, whereas they may extend the supplier’s concerning range. Although the manufacturer’s risk aversion has a positive impact on the wholesale price, interestingly, the supplier’s impact on the wholesale price is negative. Furthermore, we propose a contract to coordinate the risk-averse low-carbon supply chain by tuning the aversion levels of the supplier and the manufacturer, respectively. Through numerical study, we draw on managerial insights for industrial practitioners to adopt a low carbon strategy potentially by managing the risk attitudes along the supply chain channel.



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Outcomes of non-invasive diagnostic modalities for the detection of coronary artery disease: network meta-analysis of diagnostic randomised controlled trials

AbstractObjectiveTo evaluate differences in downstream testing, coronary revascularisation, and clinical outcomes following non-invasive diagnostic modalities used to detect coronary artery...
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Zulfiqar Bhutta: A better world for children

bmj;360/feb21_4/k638/FAF1faDuncan SmithBiographyZulfiqar Bhutta, 62, is an energetic and peripatetic paediatrician who has made child health and nutrition his life’s work. Born at the foot of the...
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