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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com, https://plus.google.com/communities/115462130054650919641?sqinv=VFJWaER0c2NCRl9ERzRjZWhxQmhzY09kVV84cjRn , ,https://plus.google.com/u/0/+AlexandrosGSfakianakis , https://www.youtube.com/channel/UCQH21WX8Qn5YSTKrlJ3OrmQ , https://www.youtube.com/channel/UCTREJHxB6yt4Gaqs4-mLzDA , https://twitter.com/g_orl?lang=el, https://www.instagram.com/alexandrossfakianakis/,

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Παρασκευή, 23 Φεβρουαρίου 2018

Determination of cesium transfer factors by instrumental neutron activation analysis

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Publication date: July 2018
Source:Journal of Environmental Radioactivity, Volume 187
Author(s): G. Bátor, A. Bednár, T.J. Glover, T. Kovács, S. Landsberger
Food-chain models are used to predict radionuclide ingestion after fallout deposition. These models include those transfer processes (soil-to-plant transfer factor(s) [TF], plant-to-animal transfer coefficient(s) [TC] and concentration ratio [CR]) that are likely to be important for radiological assessment. The range of variability for transfer factors for the same plant groups is great, about 4–5 orders of magnitude, which limits their applicability. A better way to determine the best estimate the factors for radiocaesium and other important radionuclides is if the site-specific data are available. Soil, plant and animal samples were collected from a pasture area in Hungary during the vegetation period in 2016. Stable 133Cs concentration was analysed by comparative method with neutron activation analysis (NAA). The comparator and the samples were irradiated in thermal neutron flux 2.55 × 1012 ncm−2s−1 for 2 h (soil) and 6 h (vegetation, animal samples) in the TRIGA Mark II research reactor at the Nuclear Engineering Teaching Laboratory. After an appropriate decay time (12 days) the samples were measured by gamma-spectrometry and analysed. The observed stable caesium TCpm (0.48–0.53) and CRpm (0.41–0.45) were very close to 137Cs factors in the IAEA 2009 Report of 0.49 and 0.54, respectively. This methodology is particularly suitable for the simultaneous study of natural caesium in ecosystem compartments. Consequently, the transfer of stable caesium in a pasture field may be regarded as a useful analogy in predicting the long-term changes of 137Cs affected by site-specific environmental factors.



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The arrival of axilla conserving therapy (ACT). Is this the second revolution in locoregional management of breast cancer care?

The locoregional management of breast cancer saw a revolution years ago with the advent of Breast Conserving Therapy (BCT) [1]. This technique, which established the equivalence of mastectomy and breast conservation, typically employed adjuvant radiotherapy after breast conserving surgery (BCS).

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Prevalence and Severity of Off-centering During Diagnostic CT: Observations from 57,621 CT scans of the Chest, Abdomen, and/or Pelvis

Publication date: Available online 23 February 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Oladunni O. Akin-Akintayo, Lauren F. Alexander, Rebecca Neill, Elizabeth A. Krupinksi, Xiangyang Tang, Pardeep K. Mittal, William C. Small, Courtney C. Moreno
Off-centering in the computed tomography (CT) gantry impacts radiation dose due to 1) magnification effects in the topogram with use of topogram-based tube current and tube voltage modulation software and 2) malalignment with the x-ray beam shape with use of a bow-tie filter. We retrospectively determined the distances between patient centroid and gantry isocenter during CT imaging of the chest, abdomen, and/or pelvis, and examined differences based on patient gender, scan region, patient position, and gantry aperture. A water phantom and an anthropomorphic phantom were imaged in the centered position in the CT gantry and at several off-centered positions. Additionally, data from 57,621 adult chest, abdomen, and/or pelvic CT acquisitions were evaluated. Data were analyzed with an analysis of variance using the centroid-to-isocenter data as the dependent variable and the other parameters as independent variables. The majority of patient acquisitions (83.7% (48271/57621)) were performed with the patient′s centroid positioned below isocenter (mean 1.7cm below isocenter (SD 1.8cm); range 12.1cm below to 7.8cm above isocenter). Off-centering in the x-axis was less severe (mean 0.01cm left of isocenter (SD 1.6cm)). Distance between centroid and isocenter in the y-axis did not differ as a function of gender but did differ based on scan region, patient position, and gantry aperture.



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Structural arrangement of the intrinsic muscles of the tongue and their relationships with the extrinsic muscles.

Structural arrangement of the intrinsic muscles of the tongue and their relationships with the extrinsic muscles.

Surg Radiol Anat. 2018 Feb 22;:

Authors: Sakamoto Y

Abstract
The tongue is a dense muscular organ, in which the muscles are arranged in a confusing pattern. The intrinsic muscles were gross anatomically investigated in 25 cadavers to clarify their configuration. The superior longitudinal muscle (SLm) ran beneath the dorsal mucosa and was divided into bundles by the other muscles passing through it to the dorsum. The external bundle of the styloglossus, with the palatoglossus, coursed externally to the hyoglossus. Their fibers spread beneath the SLm or attached to the apex and the inferior longitudinal muscle (ILm) ascended from the root and joined them. The genioglossus and the anterior part of the hyoglossus extended internally and externally to the ILm, respectively, to the dorsum, and the vertical muscle was sandwiched between them. The transverse muscle passed laterally from the lingual septum. The fibers of the posterior part of the hyoglossus converged to the root and spread beneath the SLm. The intersections between these vertical and transverse fibers divided one another into bundles or lamellae. The middle bundle of the styloglossus, passing between the two parts of the hyoglossus, was divided into slips by the intersection with the genioglossus. The internal bundle of the styloglossus, with the glossopharyngeus, descended internally to the posterior part to the root. The findings indicate that the intrinsic and extrinsic muscles of the tongue are not independent groups, and their fibers form a three-dimensional latticework. Each muscle contains numerous bundles or lamellae as functional units that can act separately or cooperate across the muscles.

PMID: 29470649 [PubMed - as supplied by publisher]



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A congenital accessory skin appendage of the nasal columella and nostril sill: a rare anatomical variation.

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A congenital accessory skin appendage of the nasal columella and nostril sill: a rare anatomical variation.

Surg Radiol Anat. 2018 Feb 22;:

Authors: Lee YK, Chung YH, Burm JS

Abstract
PURPOSE: An accessory skin appendage of the nasal columella and nostril sill is an extremely rare congenital anatomical malformation; only a single case has been reported in the literature. However, no pathophysiology has been proposed. The purpose of this study is to present a review of the anatomical distribution of accessory skin appendages and provide a comprehensive review of their pathophysiology based on embryological development.
METHODS: We present four cases of a protruding skin appendage of the nasal columella or nostril sill. All lesions were present from birth with no family history of skin appendages. Three patients underwent surgical excision under local anesthesia.
RESULTS: The lesions were located at the upper and lower lateral borders of the nasal columella and the medial and lateral borders of the nostril sill. There has been no sign of recurrence over a mean follow-up of 11 months.
CONCLUSIONS: Any obstacle or injury during the migration process of embryonic development may result in maldevelopment. If an obstacle or injury occurs during the medial migration of the medial nasal process, congenital polypoid remnant tissue may remain along the migration route, resulting in an accessory skin appendage of the nasal columella. The location of the accessory columellas ranged from the nostril sill to the soft triangle along the anterior border of the medial crus of the alar cartilage. These anatomical distributions correspond exactly to the migration route of the medial nasal process during embryonic development. We believe that it supports our suggested pathophysiology.

PMID: 29468267 [PubMed - as supplied by publisher]



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Bilateral patterns and motor function of the extralaryngeal branching of the recurrent laryngeal nerve.

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Bilateral patterns and motor function of the extralaryngeal branching of the recurrent laryngeal nerve.

Surg Radiol Anat. 2018 Feb 21;:

Authors: Sormaz IC, Tunca F, Şenyürek YG

Abstract
PURPOSE: To evaluate the bilateral patterns and motor function of the extralaryngeal branches (ELB) of the recurrent laryngeal nerve(RLN).
METHODS: This study included 500 consecutive patients who underwent total thyroidectomy. Intraoperative nerve monitoring (IONM) was used in 230 patients. Demographic data, indications for surgery, the bilateral patterns of ELB of the RLN, electromyographic activity of the ELB, distance between the branching point to the entrance into the larynx, and the rate of postoperative morbidity were analyzed.
RESULTS: The overall rate of ELB was 27.6% (276/1000). A single trunk of the RLN on both sides was found in 269 (54%) patients, whereas ELB on both sides was observed in 45 (9%) patients. The rates of ELB on the left and right sides were 26.6 and 28.6%, respectively. Of the 89 branched nerves which were dissected using IONM, an evoked motor response was present in 100% of the anterior branches and 5.6% of the posterior branches. The mean branching distance of the RLN was significantly greater in female patients than in male patients on the left side (p = 0.031). The patterns of ELB showed no significant difference in male and female patients. The rates of postoperative transient and permanent hypoparathyroidism and unilateral RLN palsy were 21.6 and 2.8%, and 3.2 and 0.8%, respectively. The rate of RLN palsy was higher in branched nerves compared to those with a single trunk (0.75 vs 0.3%; p = 0.2).
CONCLUSION: Unilateral ELB of the RLN might be observed in approximately 1/4 of the patients, while bilateral branching is rare. A few number of posterior branches of the RLN can have motor function. The RLN's with ELB might have a higher risk of injury compared to those with a single trunk.

PMID: 29468266 [PubMed - as supplied by publisher]



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The American Academy of Oral Medicine Clinical Practice Statement: Oromandibular dystonia

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Publication date: Available online 23 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Katherine France, Eric T. Stoopler




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Reverting iodine avidity of radioactive-iodine refractory thyroid cancer with a new tyrosine kinase inhibitor (K905-0266) excavated by high-throughput NIS (sodium iodide symporter) enhancer screening platform using dual reporter gene system.

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Reverting iodine avidity of radioactive-iodine refractory thyroid cancer with a new tyrosine kinase inhibitor (K905-0266) excavated by high-throughput NIS (sodium iodide symporter) enhancer screening platform using dual reporter gene system.

Oncotarget. 2018 Jan 23;9(6):7075-7087

Authors: Oh JM, Kalimuthu S, Gangadaran P, Baek SH, Zhu L, Lee HW, Rajendran RL, Hong CM, Jeong SY, Lee SW, Lee J, Ahn BC

Abstract
Radioactive-iodine (RAI) therapy is typically unprevailing as anaplastic thyroid cancer (ATC) management, owing to the decrease in the endogenous sodium iodide symporter (NIS) expression. Therefore, new strategies for NIS re-induction are required to improve the efficacy of RAI therapy in ATC. In this study, we developed a novel high-throughput NIS enhancer screening platform using a dual reporter gene system to identify a potent tyrosine kinase inhibitor (TKI) and selected a new hit compound, K905-0266 TKI. The effects of K905-0266 TKI treatment was validated as RAI accumulation, changes in signalling pathway related to thyroid pathogenesis, and cytotoxicity of RAI depending on re-induction of endogenous NIS expression in ATC. Furthermore, we evaluated enhancement of NIS promoter and therapeutic efficacy of RAI in ATC tumour xenograft mice. After K905-0266 TKI treatment, the expression of endogenous NIS was significantly increased, while phosphorylated-ERK was decreased. In addition, the thyroid-metabolising protein expressions were upregulated and increased of RAI accumulation and its therapeutic effects in ATC. Moreover, K905-0266 TKI increased therapeutic efficacy of RAI in ATC tumour in vivo. In conclusion, we successfully established a novel high-throughput NIS enhancer screening platform to excavate a NIS enhancer and identified K905-0266 TKI among TKI candidates and it's proven to increase the endogenous NIS expression and therapeutic efficacy of RAI in ATC. These findings suggest that a novel high-throughput NIS enhancer screening platform is useful for selecting of NIS promoter enhancers. In addition, K905-0266 TKI can be used to re-induce endogenous NIS expression and recover RAI therapy in ATC.

PMID: 29467951 [PubMed]



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Effects of iodine-131 radiotherapy on Th17/Tc17 and Treg/Th17 cells of patients with differentiated thyroid carcinoma.

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Effects of iodine-131 radiotherapy on Th17/Tc17 and Treg/Th17 cells of patients with differentiated thyroid carcinoma.

Exp Ther Med. 2018 Mar;15(3):2661-2666

Authors: Zhang L, Chen J, Xu C, Qi L, Ren Y

Abstract
T helper 17 (Th17), T cytotoxic 17 (Tc17) and regulatory T (Treg) cells serve important roles in a number of inflammatory and autoimmune diseases. The aim of the present study was to examine the distribution of Th17, Tc17 and Treg cells in patients with differentiated thyroid cancer (DTC) prior to as well as 7, 30 and 90 days following radioactive iodine-131 (131I) therapy, and to elucidate the probable effects of 131I therapy on Th17/Tc17 and Treg/Th17 cells in patients with DTC. A total of 40 patients with DTC (26 female; 14 male) between the ages of 24 and 72 years, as well as 13 age- and sex-matched healthy subjects were included in this study. The number of Th17, Tc17 and Treg cells in the peripheral blood of patients with DTC and of healthy Controls were assessed by flow cytometry. Th17 and Tc17 cells were counted as percentages of the number of CD3+ T cells; Treg cells were counted as a percentage of the number of CD4+T cells. In addition, the serum levels of interleukin (IL)-17, IL-23, IL-10 and transforming growth factor (TGF)-β1 were examined by ELISA. The frequencies of Th17, Tc17 and Treg cells, as well as the serum levels of IL-17, IL-23, IL-10 and TGF-β1 were significantly elevated in patients with DTC compared with healthy Controls, whereas 131I therapy significantly decreased them. In addition, elevated Th17/Tc17 ratio and reduced Treg/Th17 ratio were observed in patients with DTC at day 0, however, these ratios returned to normal levels following 131I therapy for 90 days as compared with healthy Controls. Notably, Th17/Tc17 and Treg/Th17 ratios varied following 131I therapy for 7 and 30 days. In addition, a strong positive correlation between Th17 and Tc17 cells was observed in the healthy Controls and patients with DTC that received 131I treatment for 90 days, whereas a weak positive correlation between Th17 and Treg cell levels was identified in the healthy Controls and no obvious correlation between Th17 and Treg cells was observed in all patients with DTC pre- and post-131I therapy during the entire treatment period. These data suggested a significant involvement of Th17, Tc17 and Treg cells in the pathology of DTC. Restoring the balance of these cells may contribute to the recovery of patients with DTC following 131I therapy.

PMID: 29467858 [PubMed]



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A Single Radioactive Iodine Treatment has a Deleterious Effect on Ovarian Reserve in Women with Thyroid Cancer: Results of a Prospective Pilot Study.

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A Single Radioactive Iodine Treatment has a Deleterious Effect on Ovarian Reserve in Women with Thyroid Cancer: Results of a Prospective Pilot Study.

Thyroid. 2018 Feb 21;:

Authors: Yaish I, Azem F, Gutfeld O, Silman Z, Serebro M, Sharon O, Shefer G, Limor R, Stern N, Tordjman KM

Abstract
BACKGROUND: Women of reproductive age with differentiated thyroid cancer (DTC) often need to receive radioactive iodine (RAI) treatment after surgery. In contrast to the well documented effect of RAI on testicular function, the potential negative effects of this treatment on ovarian reserve have been largely dismissed. The objective of this pilot study was to examine the possibility that RAI treatment is deleterious to the ovarian reserve by prospectively measuring the concentration of anti-Müllerian hormone (AMH) after this treatment.
METHODS: Thirty premenopausal women (aged 34 years, range 20-45) with a new diagnosis of DTC scheduled to undergo RAI ablation were recruited for this study. All of them had TNM stage 1 disease (T1-3, N0 or N1, M0), and were scheduled to receive RAI doses ranging from 30-150 mCi. AMH was measured at baseline, and 3, 6, 9 and 12 months after the administration of RAI.
RESULTS: Of the 30 women, only 24 returned after the baseline assessment. RAI treatment resulted in a significant decrease in AMH concentrations at 3 months, from 3.252.75 to 1.91.74 ng/ml, P<0.0001. Only partial recovery was subsequently documented, 82% of subjects had final values below baseline levels, such that at one year serum AMH was still 32% lower than prior to treatment (2.361.88 ng/ml, P<0.005). The only two continuous variables that correlated with the extent of AMH reduction at 3 months were the woman's age (r=0.51, P=0.02), and the age at menarche (r=0.48, P=0.03). Importantly, the RAI dose was not associated with the extent of AMH reduction, neither were smoking, nor the use of birth control pills. Older (>35) subjects were significantly more likely to experience a marked AMH reduction at 3 months (63.7±18.5% vs 33.1± 29.2%, P=0.01). The only predictor of recovery after 1 year was the extent of AMH decrease at 3 months: the lower the decline, the higher the chances for recovery.
CONCLUSIONS: RAI in DTC has a rapid and profound effect on ovarian reserve with only a partial recovery potential. In an era of declining human fertility, RAI should be carefully planned in women of reproductive age. AMH measurement could be used as a tool in this decision-making process.

PMID: 29466932 [PubMed - as supplied by publisher]



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Free-Breathing Pulmonary MR Imaging to Quantify Regional Ventilation.

Free-Breathing Pulmonary MR Imaging to Quantify Regional Ventilation.

Radiology. 2018 Feb 22;:171993

Authors: Capaldi DPI, Eddy RL, Svenningsen S, Guo F, Baxter JSH, McLeod AJ, Nair P, McCormack DG, Parraga G, Canadian Respiratory Research Network

Abstract
Purpose To measure regional specific ventilation with free-breathing hydrogen 1 (1H) magnetic resonance (MR) imaging without exogenous contrast material and to investigate correlations with hyperpolarized helium 3 (3He) MR imaging and pulmonary function test measurements in healthy volunteers and patients with asthma. Materials and Methods Subjects underwent free-breathing 1H and static breath-hold hyperpolarized 3He MR imaging as well as spirometry and plethysmography; participants were consecutively recruited between January and June 2017. Free-breathing 1H MR imaging was performed with an optimized balanced steady-state free-precession sequence; images were retrospectively grouped into tidal inspiration or tidal expiration volumes with exponentially weighted phase interpolation. MR imaging volumes were coregistered by using optical flow deformable registration to generate 1H MR imaging-derived specific ventilation maps. Hyperpolarized 3He MR imaging- and 1H MR imaging-derived specific ventilation maps were coregistered to quantify regional specific ventilation within hyperpolarized 3He MR imaging ventilation masks. Differences between groups were determined with the Mann-Whitney test and relationships were determined with Spearman (ρ) correlation coefficients. Statistical analyses were performed with software. Results Thirty subjects (median age: 50 years; interquartile range [IQR]: 30 years), including 23 with asthma and seven healthy volunteers, were evaluated. Both 1H MR imaging-derived specific ventilation and hyperpolarized 3He MR imaging-derived ventilation percentage were significantly greater in healthy volunteers than in patients with asthma (specific ventilation: 0.14 [IQR: 0.05] vs 0.08 [IQR: 0.06], respectively, P < .0001; ventilation percentage: 99% [IQR: 1%] vs 94% [IQR: 5%], P < .0001). For all subjects, 1H MR imaging-derived specific ventilation correlated with plethysmography-derived specific ventilation (ρ = 0.54, P = .002) and hyperpolarized 3He MR imaging-derived ventilation percentage (ρ = 0.67, P < .0001) as well as with forced expiratory volume in 1 second (FEV1) (ρ = 0.65, P = .0001), ratio of FEV1 to forced vital capacity (ρ = 0.75, P < .0001), ratio of residual volume to total lung capacity (ρ = -0.68, P < .0001), and airway resistance (ρ = -0.51, P = .004). 1H MR imaging-derived specific ventilation was significantly greater in the gravitational-dependent versus nondependent lung in healthy subjects (P = .02) but not in patients with asthma (P = .1). In patients with asthma, coregistered 1H MR imaging specific ventilation and hyperpolarized 3He MR imaging maps showed that specific ventilation was diminished in corresponding 3He MR imaging ventilation defects (0.05 ± 0.04) compared with well-ventilated regions (0.09 ± 0.05) (P < .0001). Conclusion 1H MR imaging-derived specific ventilation correlated with plethysmography-derived specific ventilation and ventilation defects seen by using hyperpolarized 3He MR imaging. © RSNA, 2018 Online supplemental material is available for this article.

PMID: 29470939 [PubMed - as supplied by publisher]



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Diagnostic Performance of MR Elastography for Liver Fibrosis in Children and Young Adults with a Spectrum of Liver Diseases.

Diagnostic Performance of MR Elastography for Liver Fibrosis in Children and Young Adults with a Spectrum of Liver Diseases.

Radiology. 2018 Feb 22;:172099

Authors: Trout AT, Sheridan RM, Serai SD, Xanthakos SA, Su W, Zhang B, Wallihan DB

Abstract
Purpose To assess the diagnostic performance of magnetic resonance (MR) elastography-derived liver stiffness to detect liver fibrosis in a pediatric and young adult population with a spectrum of liver diseases. Materials and Methods This retrospective study included patients younger than 21 years of age who underwent MR elastography and liver biopsy within 3 months of one another between January 2012 and September 2016 for indications other than liver transplantation or Fontan palliation of congenital heart disease. MR elastography examinations were reprocessed by a single observer, blinded to pathologic findings. Pathology specimens were reviewed by a single pathologist who scored steatosis (lipid in ≥ 5% of hepatocytes) and staged fibrosis. Receiver operating characteristic (ROC) curves were used to assess diagnostic performance. Results A total of 86 patients, 49 (57%) male with a median age of 14.2 years (range, 0.3-20.6 years), were included. Fifty-one patients (59.3%) had Ludwig stage 2 or higher fibrosis; 44 patients (51.2%) had hepatic steatosis. The area under the ROC curve for Ludwig stage 0-1 versus stage 2 or higher fibrosis was 0.70 (95% confidence interval [CI]: 0.59, 0.81) for the whole population and was significantly lower for patients with steatosis versus those without (0.53 [95% CI: 0.35, 0.71] vs 0.82 [95% CI: 0.67, 0.96], P = .014). Optimal stiffness cut-offs for the entire population were 2.27 kPa with 68.6% sensitivity (95% CI: 57.2%, 80.1%) and 74.3% specificity (95% CI: 63.5%, 85.1%) or 1.67 kPa with 35.3% sensitivity (95% CI: 23.5%, 47.1%) and 91.4% specificity (95% CI: 84.5%, 98.3%). Conclusion In children and young adults, MR elastography performs significantly better for distinguishing stage 0-1 versus stage 2 or higher fibrosis in patients without steatosis than in those with steatosis. This suggests a confounding effect of steatosis or inflammation in the population with nonalcoholic fatty liver disease. © RSNA, 2018.

PMID: 29470938 [PubMed - as supplied by publisher]



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Renal Lesion Characterization with Spectral CT: Determining the Optimal Energy for Virtual Monoenergetic Reconstruction.

Renal Lesion Characterization with Spectral CT: Determining the Optimal Energy for Virtual Monoenergetic Reconstruction.

Radiology. 2018 Feb 22;:171657

Authors: Schabel C, Patel B, Harring S, Duvnjak P, Ramírez-Giraldo JC, Nikolaou K, Nelson RC, Farjat AE, Marin D

Abstract
Purpose To investigate the relationship between energy level of virtual monoenergetic (VM) imaging and sensitivity in the detection of minimally enhancing renal lesions. Materials and Methods Phantoms simulating unenhanced and contrast material-enhanced renal parenchyma were equipped with inserts containing different concentrations of iodine (range, 0-1.15 mg iodine per milliliter). A total of 180 patients (117 men; mean age, 65.2 years ± 13.0 [standard deviation]) with 194 (62 solid, 132 cystic) renal lesions larger than 10 mm in diameter underwent unenhanced single-energy CT and contrast-enhanced dual-energy CT. VM imaging data sets were created for 70, 80, 90, and 100 keV. Renal lesions were measured, and enhancement was calculated. Area under the receiver operating characteristic curve (AUC) for renal lesion characterization was determined by using the DeLong method. Results The AUC was highest at 70 keV and decreased as energy increased toward 100 keV. AUC in the phantom decreased from 98% (95% confidence interval [CI]: 95, 100) at 70 keV to 88% (95% CI: 79, 96) at 100 keV (P = .004). AUC in patients decreased from 96% (95% CI: 94, 98) at 70 keV to 79% (95% CI: 71, 86) at 100 keV (P = .001). In patients with an enhancement threshold of 15 HU, sensitivity in the detection of solid renal lesions decreased between from 91% (49 of 62 [95% CI: 78, 97]) at 70 keV to 48% (33 of 62 [95% CI: 25, 71]) at 100 keV (P < .05), with no change in specificity (93% [120 of 132 {95% CI: 87, 97}] at 70 keV, 97% [125 of 132 {95% CI: 92, 99}] at 100 keV). Conclusion There is a reduction in diagnostic accuracy for renal lesion characterization with increasing VM imaging energy. The 70-keV setting may provide an optimal trade-off between sensitivity and specificity. © RSNA, 2018 Online supplemental material is available for this article.

PMID: 29470937 [PubMed - as supplied by publisher]



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Carboplatin-based concurrent chemoradiation therapy in locally advanced head and neck cancer patients who are unfit for cisplatin therapy.

Carboplatin-based concurrent chemoradiation therapy in locally advanced head and neck cancer patients who are unfit for cisplatin therapy.

Indian J Cancer. 2017 Apr-Jun;54(2):453-457

Authors: Noronha V, Sharma V, Joshi A, Patil VM, Laskar SG, Prabhash K

Abstract
BACKGROUND: Cisplatin-based chemoradiation (CTRT) is the standard of care in locally advanced head and neck cancers. Limited treatment options are available in patients unfit for cisplatin.
AIMS: This audit was carried out to study the toxicities, tolerance, and outcomes of carboplatin-based CTRT in patients who are not eligible for cisplatin.
MATERIALS AND METHODS: A total of 63 locally advanced head and neck cancer patients treated between January 2011 and October 2015 were administered carboplatin-based CTRT. The dose of carboplatin was equivalent to area under the curve equivalent to 2 administered once a week for a maximum of 7 cycles. Toxicity was coded as per the CTCAE version 4.03. SPSS software version 16 was used for statistical analysis.
STATISTICAL ANALYSIS: Descriptive statistics was performed. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier survival analysis. Cox proportional hazard model was used for identifying factors affecting PFS and OS.
RESULTS: The reasons for patients being unfit for cisplatin were low serum creatinine clearance in 41 (65.07%), sensorineural hearing loss in 18 (28.57%), uncontrolled medical comorbidities in 3 (4.76%), and old age in 1 patient (1.6%). 53 patients (84.1%) completed planned radiotherapy. The median number of chemotherapy cycles administered was 6. Grade 3-4 toxicities were seen in 32 patients (50.8%). The median OS and PFS were 28 months (95% confidence interval [CI]: 20.9-34.6 months) and 17 months (95% CI: 08.2-25.7 months), respectively. Age was the only factor significantly affecting OS and PFS.
CONCLUSION: Carboplatin-based CTRT is well tolerated in patients unfit for cisplatin and seems to have superior outcomes than those reported in radical radiotherapy studies.

PMID: 29469077 [PubMed - in process]



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Quality of life outcome measures using University of Washington questionnaire version 4 in early T1/T2 anterior tongue cancers with and without radiotherapy: A cross-sectional study.

Quality of life outcome measures using University of Washington questionnaire version 4 in early T1/T2 anterior tongue cancers with and without radiotherapy: A cross-sectional study.

Indian J Cancer. 2017 Apr-Jun;54(2):447-452

Authors: Sakthivel P, K Irugu DV, Singh CA, Verma H, Yogal R, Jat B, Chadran A, Sikka K, Thakar A, Sharma SC

Abstract
CONTEXT: To evaluate the quality of life (QOL) outcome measures in disease-free survivors of pathological T1/T2 tongue cancers and to compare QOL in patients treated with only surgery and with adjuvant treatment.
SETTINGS AND DESIGN: Cross-sectional survey.
PATIENTS AND METHODS: All pathological T1/T2 anterior tongue cancer cases with follow-up from January 2011 till December 2015, who had locoregionally controlled disease with a minimum disease-free survival period of 1 year, were included in the study.
RESULTS: A total of 36 patients, 28 are males and 8 are females with an age range of 24-66 years (median age of 43) were enrolled in the study. The patients were divided into two groups with (n = 26) and without adjuvant postoperative radiotherapy (RT) (n = 10) and the University of Washington-QOL questionnaire version 4 for physical and social domains, global questions and three important domains were analyzed. On the physical and social domain scores, the surgery-alone group outscored the combined modality group on all scales and the differences were statistically significant for specific physical domains such as saliva (0.0001), taste (P = 0.0001), chewing (P = 0.0004), swallowing (P = 0.0026), and social domains such as mood (0.0001), pain (P = 0.0001), and shoulder function (P = 0.0061). The overall global QOL scores were also better for the surgical group compared with group which received adjuvant RT but was not statistically significant. All patients chose saliva as their top priority domain in the group which received radiation, and 60% chose "swallowing ability" as the preferred top priority domain in the only surgical group.
CONCLUSIONS: Although locoregional control and disease-free survival are the major treatment-related endpoints for cancer management, QOL outcome measures have to assess to determine the impact of a treatment modality on patients well-being and for better rehabilitation of cancer-free patients.

PMID: 29469076 [PubMed - in process]



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Paralingual and sublingual space invasion in magnetic resonance imaging of squamous cell carcinoma of anterior two-thirds of tongue: Is there a prognostic significance? A prospective evaluation.

Paralingual and sublingual space invasion in magnetic resonance imaging of squamous cell carcinoma of anterior two-thirds of tongue: Is there a prognostic significance? A prospective evaluation.

Indian J Cancer. 2017 Apr-Jun;54(2):442-446

Authors: Jayasankaran SC, Chelakkot PG, Thankappan K, Iyer S, Moorthy S

Abstract
BACKGROUND: Magnetic resonance imaging (MRI) in tumors of anterior two-thirds of tongue has a significant role in assessing different tumor parameters, and in prognosticating.
AIM: This prospective study conducted in a tertiary cancer care center, focused on patients with squamous cell carcinoma of anterior two-thirds of tongue. The significance of invasion of paralingual and sublingual spaces in relation to the pathological grade of these tumors, and its predictive value in pathological nodal involvement were analyzed.
MATERIALS AND METHODS: All consecutive patients with the required inclusion criteria were accrued. Imaging was done with 3 Tesla MRI and invasion of sublingual and paralingual spaces were accurately assessed. Data elucidated were tabulated and analysed using IBM SPSS version 20.0. Chi-square test, nonparametric correlation using Spearman's Rho correlation, and two-independent sample test using Mann-Whitney's U-test were used to arrive at correlations between the imaging and histopathological parameters.
RESULTS: Sixty-three patients were analyzed. Mean age was 52.3 ± 11.45 years. 74.6% were males. MRI showed sublingual space invasion in 47.6%. 18/28 with and 11/33 without invasion had node positivity. Paralingual space involvement was observed in 31.7% of patients. Thirteen of these and 16/43 with no involvement had positive cervical nodes. No statistically significant correlation was observed.
CONCLUSION: This prospective study did not establish any statistically sound correlation, and robust data are lacking to support newer parameters such as sublingual space and paralingual space as probable predictors of cervical nodal involvement, and for prognostication.

PMID: 29469075 [PubMed - in process]



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Health-related quality of life in hearing-impaired adolescents and children.

Health-related quality of life in hearing-impaired adolescents and children.

Acta Otolaryngol. 2018 Feb 22;:1-7

Authors: Niemensivu R, Roine RP, Sintonen H, Kentala E

Abstract
OBJECTIVE: To evaluate health-related quality of life (HRQoL) in hearing-impaired adolescents and children and to compare it with that of hearing individuals.
STUDY DESIGN AND SETTING: Hearing-impaired adolescents and children were recruited to the study during their annual control visit to the Hearing Clinic of Helsinki University Hospital. They filled in a HRQoL questionnaire, either the 16-dimensional 16D (adolescents aged 12-17 years) or the 17-dimensional 17D (children aged 7-11 years). The total HRQoL scores were compared with previously collected data, matched for age and gender, from adolescents and children without any known handicaps or illnesses.
RESULTS: In total 50 adolescents and 50 children completed the questionnaire. Of the 16/17 dimensions of the HRQoL instrument, hearing and communication were affected the most. The total HRQoL scores were somewhat lower in adolescents and children with hearing impairment than in the general populations of age-matched peers (p < .001 for adolescents and .030 for children).
CONCLUSIONS: HRQoL in hearing-impaired adolescents and children is only slightly worse than in hearing adolescents and children.
SIGNIFICANCE: This study evaluates the impact of hearing loss on HRQoL to enhance the care of these children.

PMID: 29468919 [PubMed - as supplied by publisher]



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Definitive re-irradiation using intensity-modulated radiation therapy in cancers of the head and neck, focusing on rare tumors.

Definitive re-irradiation using intensity-modulated radiation therapy in cancers of the head and neck, focusing on rare tumors.

Acta Otolaryngol. 2018 Feb 22;:1-9

Authors: Doi H, Uemoto K, Masai N, Tatsumi D, Shiomi H, Oh RJ

Abstract
PURPOSE: To analyze the outcomes following re-irradiation for local recurrence of rare head and neck tumors.
MATERIAL AND METHODS: We retrospectively analyzed 11 patients who had received intensity-modulated radiation therapy (IMRT) for recurrent tumors in the head and neck except for laryngopharynx.
RESULTS: Primary tumor sites included the maxillary sinus, nasal cavity, and external ear canal in six, three, and two patients, respectively. The median follow-up times were 13 (range, 3-54) months. The median survival time was 17 months with 1- and 2-year survival rates of 63.64 and 39.77%, respectively. Among 11 patients, five experienced local failure in the follow-up period. The 1- and 2-year local control rates were 58 and 47%, respectively. Patients who had received a radiation dose of ≥3 Gy per fraction showed significantly better local control than those receiving less (p = .0419). One patient experienced Grade 3 facial pain as acute toxicity. Late toxicities included radiographic findings of partial central nervous system necrosis in three patients and Grade 3 osteonecrosis and Grade 3 facial nerve disorder in one patient.
CONCLUSIONS: Re-irradiation of rare head and neck tumors using IMRT for loco-regional recurrence may be an acceptable treatment option.

PMID: 29468910 [PubMed - as supplied by publisher]



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Spatiotemporal homogeneity and distinctness of the T-cell receptor β-chain repertoires in Epstein-Barr virus-associated primary and metastatic nasopharyngeal carcinomas.

Related Articles

Spatiotemporal homogeneity and distinctness of the T-cell receptor β-chain repertoires in Epstein-Barr virus-associated primary and metastatic nasopharyngeal carcinomas.

Int J Cancer. 2018 Feb 22;:

Authors: Chung YL, Wu ML

Abstract
Nasopharyngeal carcinoma (NPC) is an Epstein-Barr virus (EBV)-associated lymphoepithelioma. The aim of the present study was to characterize the homogeneity and distinctness of the T-cell repertoires within and between primary and metastatic NPCs. We used ultra-deep sequencing of the hypervariably rearranged antigen-binding CDR3 regions of T-cell receptor beta (TCRbeta ) to comprehensively profile the T-cell repertoires in NPC patients receiving definitive chemoradiotherapy with long-term follow-up. We observed not only various spatially heterogeneous patient-specific TCRbeta clone compositions that changed with time but also several commonly enriched TCRbeta subclones that were constantly shared between primary NPCs in the head and neck regions, locally recurrent tumors after treatment, and later-developed distant metastatic tumors in the liver, lung and bone. Comparison of the overlap frequency of the T-cell clonality between TCRbeta repertoires enabled us to calculate the pairwise genetic distance between primary NPCs of different patients and different sites of metastatic or recurrent NPCs. The constructed NPC phylogeny clearly differentiated the low-risk patients without relapse from the high-risk patients with distant metastasis after chemoradiotherapy. In contrast to the rather low frequency of non-silent somatic mutations in NPC cells, the degrees of similarity and divergence of NPC-infiltrating lymphocyte TCRbeta repertoires among different patients showed prognostication. Moreover, the persistent presence of commonly NPC-shared in-frame TCRbeta CDR3 gene sequences spatiotemporally identified in the NPC-infiltrating lymphocytes within varied EBV-positive NPCs and their metastases suggest the existence of frequently shared epitopes of neoantigens virally or non-virally displayed on cancer cells, thereby providing opportunities for the development of precisely tumor-targeted immunotherapy for distant metastasis. This article is protected by copyright. All rights reserved.

PMID: 29468660 [PubMed - as supplied by publisher]



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Does focal mechanical stimulation of the lower limb muscles improve postural control and sit to stand movement in elderly?

Related Articles

Does focal mechanical stimulation of the lower limb muscles improve postural control and sit to stand movement in elderly?

Aging Clin Exp Res. 2018 Feb 21;:

Authors: Attanasio G, Camerota F, Ralli M, Galeoto G, La Torre G, Galli M, De Vincentiis M, Greco A, Celletti C

Abstract
BACKGROUNDS: Imbalance in elderly is a common problem strictly related to fall.
AIMS: This study investigates the possibility that a new protocol based on the focal mechanical muscle vibration may improve balance and stability in elderly.
METHODS: Pre-post non-randomized clinical trial has been used. Patients referring postural disequilibrium with negative vestibular bed-side examinations have been treated with focal muscle vibration applied to quadriceps muscles and evaluated before and immediately after therapy and after 1 week and after 1 month with postural stabilometric examination and with an inertial measurement units during the time up and go test.
RESULTS: Stabilometric analysis showed statistically significant differences in both the area (p = 0.01) and sway (p < 0.01) of the center of pressure during the close eyes tests. Moreover, the global time of the time up and go test was reduced (p < 0.05) and the rotation velocity was increased (p < 0.01).
CONCLUSIONS: The findings confirm the beneficial role of focal muscle vibration in elderly patients improve postural stability and mobility.

PMID: 29468616 [PubMed - as supplied by publisher]



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Immunohistochemical Detection of p16 in Clinical Samples.

Related Articles

Immunohistochemical Detection of p16 in Clinical Samples.

Methods Mol Biol. 2018;1726:123-142

Authors: Karpathiou G, Peoc'h M

Abstract
P16 immunohistochemical expression, a surrogate marker of the retinoblastoma pathway, has become a major adjunct in the routine practice mostly of cervical and head/neck pathology, but with other indications too. In this chapter, a detailed immunohistochemical technique for the detection of p16 is described, followed by indications and interpretation of its expression in uterine, ovarian, vulvar, penile, head-and-neck, melanocytic, and other pathologies.

PMID: 29468549 [PubMed - in process]



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[The innate immune system in oropharyngeal squamous cell carcinoma : Immune modulation by HPV].

Related Articles

[The innate immune system in oropharyngeal squamous cell carcinoma : Immune modulation by HPV].

HNO. 2018 Feb 15;:

Authors: Wagner S, Böckmann H, Gattenlöhner S, Klussmann JP, Wittekindt C

Abstract
Based on clinical and experimental data, oropharyngeal squamous cell carcinomas (OPSCC) associated with human papillomavirus (HPV) have been recognized as a distinct entity of head and neck cancers. However, outside of clinical trials, HPV status currently has no impact on treatment. The natural replication cycle of HPV takes place in epithelial cells, and is thus spatially separated from cytotoxic immune cells in the epidermis. Dendritic cells (Langerhans cells, LC), however, are frequent in this upper dermal layer. The ability of LC to process antigens, migrate, and, ultimately activate T cells is inhibited by the activity of the viral oncoproteins (E5-E7). Downregulation of functional human leukocyte antigen I (HLA-I) epithelial cell surface expression contributes to LC inhibition. However, due to their absence in upper skin layers, corresponding activation of natural killer (NK) cells via missing-self recognition is not relevant. Genome-wide analyses have revealed specific expression signatures for HPV-associated OPSCC that are distinct from HPV-negative cancers. Interestingly, aberrations in HLA-I genes were common in HPV-associated OPSCC. Our own findings indicate more frequent infiltration of HPV-associated OPSCC by CD56-positive (CD56+) NK cells, which might be related to HLA-I downregulation during HPV-associated carcinogenesis. In patients with OPSCC, CD56 positivity correlates with improved prognosis after conventional therapy. This could be evidence for HPV-associated OPSCC being especially eligible for novel immune-based therapies and an indication that immunological data should be included in the design of clinical trials.

PMID: 29468275 [PubMed - as supplied by publisher]



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Effects of metformin on survival outcomes of pancreatic cancer patients with diabetes: A meta-analysis.

Related Articles

Effects of metformin on survival outcomes of pancreatic cancer patients with diabetes: A meta-analysis.

Mol Clin Oncol. 2018 Mar;8(3):483-488

Authors: Xin W, Fang L, Fang Q, Zheng X, Huang P

Abstract
Pancreatic cancer risk is reduced by metformin treatment in patients with diabetes. However, the effect of metformin on pancreatic cancer overall survival is unclear. The aim of the present study was to determine the association between metformin and clinical outcomes of pancreatic cancer patients with diabetes. An electronic and manual search was conducted using PubMed, Web of Science, Medline-Ovid and Cochrane Library databases between the beginning and March 31, 2017. A total of 8 studies consisting of 4,293 patients with pancreatic cancer with diabetes were included, comprising 2,033 patients who had received metformin and 2,260 patients who had not. The meta-analysis showed that metformin was associated with a relative survival benefit in pancreatic cancer patients [hazard ratio (HR), 0.81; 95% confidence interval (CI), 0.70-0.93]. These associations were also observed in subgroups of Asian countries 0.64 (95% CI, 0.52-0.80) and Western countries 0.88 (95% CI, 0.82-0.95), as well as diabetes (no indication of diabetes type). Excluding the studies considered as be prone to immortal time bias resulted in HRs (95% CIs) of 0.86 (0.69-1.07). The results of this study support the notion that the use of metformin may improve the overall survival of patients with pancreatic cancer with concurrent diabetes. However, the proposed beneficial effect of metformin on pancreatic cancer survival may be based on immortal time bias. Further carefully designed studies with high quality are warranted to confirm this efficacy.

PMID: 29468063 [PubMed]



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health technology; +352 new citations

352 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 2018/02/23

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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Putting melanoma to sleep

An international research team has succeeded in stopping the growth of malignant melanoma by reactivating a protective mechanism that prevents tumour cells from dividing. The team used chemical agents to block the enzymes responsible for erasing...

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Scientists isolate cancer stem cells using novel method

Researchers at The University of Texas at Dallas have devised a new technique to isolate aggressive cells thought to form the root of many hard-to-treat metastasised cancers - a significant step towards developing new drugs that might target these...

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Psychiatrist who failed in care of teenager with epilepsy who died in bath is suspended for 12 months

A consultant psychiatrist who failed to carry out a risk assessment on a teenager with autism, learning difficulties, and epilepsy, and who drowned in the bath following a seizure, has been suspended...
recent?d=yIl2AUoC8zA recent?d=dnMXMwOfBR0 recent?i=Ln3esjppDSM:t3K76Mg21eQ:V_sGLiP recent?d=qj6IDK7rITs recent?i=Ln3esjppDSM:t3K76Mg21eQ:gIN9vFw recent?d=l6gmwiTKsz0 recent?d=7Q72WNTAKBA recent?i=Ln3esjppDSM:t3K76Mg21eQ:F7zBnMy recent?i=Ln3esjppDSM:t3K76Mg21eQ:-BTjWOF


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Biopsy is not necessary for the diagnosis of soft tissue hemangiomas

Abstract

Objective

To describe the clinical and ultrasonography (US) findings of soft tissue hemangiomas, and to compare with the results of histologic diagnosis after US-guided biopsy.

Method and materials

We retrospectively studied the files of 97 patients (48 female, 49 male; mean age, 34 years; range 4–84 years) with soft tissue hemangiomas diagnosed from 2004 to 2011. Mean follow-up was 9 years (range 7–13 years). Clinical presentation included intermittent mild pain associated with a soft tissue swelling/palpable mass in all patients, chronic pain and increased local heat in 29 patients, local swelling and decreased range of motion of the adjacent joint in 45 patients, and all the above symptoms in 23 patients. B-mode and color Doppler US evaluation included the site, location, size, shape, margins, presence of calcifications, echo structure and echogenicity. All patients had US-guided biopsy for histologic analysis.

Results

US-guided biopsy and histology confirmed the diagnosis of soft tissue hemangioma in 92 of the 97 lesions (94.8%). Histologic examination of the remaining five lesions showed nodular fasciitis (two lesions), endometriosis (one lesion), hemangioendothelioma (two lesions); US of these lesions showed variable size, irregular margins, and deep-seated location. Histologically documented soft tissue hemangiomas were most commonly superficial (74 lesions) and arteriovenous (45 lesions). Shape was most commonly oval (fusiform), margins were most commonly not well defined (irregular, hazing but circumscribed), phleboliths were more common in deep-seated lesions, echo structure was heterogeneous, and echogenicity was most commonly hyperechogen and involuting.

Conclusion

Clinical presentation and typical B-mode and color Doppler US findings are adequate for the diagnosis of soft tissue hemangiomas without the need for biopsy and histologic analysis. If any clinical or US doubt, an US-guided biopsy should be performed.



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Sclerotherapy of peripheral low-flow vascular malformations: technical aspects and mid-term clinical outcome

Abstract

Purpose

The therapeutical management of low-flow vascular malformations (LFVMs) is challenging because of high recurrence rate; multiple strategies have been proposed. This paper aims to report a single-center experience of direct puncture sclerotherapy of peripheral LFVMs, focusing on technical aspects and clinical outcome in mid-term follow-up.

Materials and methods

16 patients have been treated for peripheral LFVMs (mean age 36.1 years), complaining mild pain, swelling of the region of interest, and cosmetic nuisance. Preprocedural US and MR were acquired; angiography performed only in doubt vascular supply. Standard procedure consisted of direct puncture of the nidus using 20–23 gauge needles under US guidance and injection of up to 15 ml foam of sodium tetradecyl sulphate under fluoroscopic guidance. Clinical and radiological follow-up were assessed at 1, 3, and 6 months.

Results

Lesions were localized: 8 in the upper and 5 the in lower limbs, 2 in the cheeks, and 1 in the vaginal labia. All procedures have been technically accomplished (100%). At 6 month follow-up, technical and clinical success were obtained in all cases, while radiological follow-up showed 81.2% (13 patients) complete vessels thrombosis after multiple sclerotherapy sessions. No major complications have been recorded; five patients (31.2%) referred minor complications.

Conclusions

Sclerotherapy via direct puncture of LFVMs is a clinically effective procedure, well tolerated by patients, with reduced costs and mild minor complications rate; interventionalists should always clarify to the patients that multiple sessions would be performed and recurrences are expected at imaging follow-up despite clinical improvement.



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Re: Effects of serial macrocyclic-based contrast materials gadoterate meglumine and gadobutrol administrations on gadolinium-related dentate nuclei signal increases in unenhanced T1-weighted brain: a retrospective study in 158 multiple sclerosis (MS) patients



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See what the leading experts in prostate cancer had to say in San Francisco about results from the 2018 Genitourina… https://t.co/yznRT6x10P

See what the leading experts in prostate cancer had to say in San Francisco about results from the 2018 Genitourina… https://t.co/yznRT6x10P

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MRI supervised and unsupervised classification of Parkinson's disease and multiple system atrophy

Abstract

Background: Multimodal MRI approach is based on a combination of MRI parameters sensitive to different tissue characteristics (eg, volume atrophy, iron deposition, and microstructural damage). The main objective of the present study was to use a multimodal MRI approach to identify brain differences that could discriminate between matched groups of patients with multiple system atrophy, Parkinson's disease, and healthy controls. We assessed the 2 different MSA variants, namely, MSA-P, with predominant parkinsonism, and MSA-C, with more prominent cerebellar symptoms.

Methods: Twenty-six PD patients, 29 MSA patients (16 MSA-P, 13 MSA-C), and 26 controls underwent 3-T MRI comprising T2*-weighted, T1-weighted, and diffusion tensor imaging scans. Using whole-brain voxel-based MRI, we combined gray-matter density, T2* relaxation rates, and diffusion tensor imaging scalars to compare and discriminate PD, MSA-P, MSA-C, and healthy controls.

Results: Our main results showed that this approach reveals multiparametric modifications within the cerebellum and putamen in both MSA-C and MSA-P patients, compared with PD patients. Furthermore, our findings revealed that specific single multimodal MRI markers were sufficient to discriminate MSA-P and MSA-C patients from PD patients. Moreover, the unsupervised analysis based on multimodal MRI data could regroup individuals according to their clinical diagnosis, in most cases.

Conclusions: This study demonstrates that multimodal MRI is able to discriminate patients with PD from those with MSA with high accuracy. The combination of different MR biomarkers could be a great tool in early stage of disease to help diagnosis. © 2018 International Parkinson and Movement Disorder Society



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Assessing cognitive dysfunction in Parkinson's disease: An online tool to detect visuo-perceptual deficits

ABSTRACT

Background: People with Parkinson's disease (PD) who develop visuo-perceptual deficits are at higher risk of dementia, but we lack tests that detect subtle visuo-perceptual deficits and can be performed by untrained personnel. Hallucinations are associated with cognitive impairment and typically involve perception of complex objects. Changes in object perception may therefore be a sensitive marker of visuo-perceptual deficits in PD.

Objective: We developed an online platform to test visuo-perceptual function. We hypothesised that (1) visuo-perceptual deficits in PD could be detected using online tests, (2) object perception would be preferentially affected, and (3) these deficits would be caused by changes in perception rather than response bias.

Methods: We assessed 91 people with PD and 275 controls. Performance was compared using classical frequentist statistics. We then fitted a hierarchical Bayesian signal detection theory model to a subset of tasks.

Results: People with PD were worse than controls at object recognition, showing no deficits in other visuo-perceptual tests. Specifically, they were worse at identifying skewed images (P < .0001); at detecting hidden objects (P = .0039); at identifying objects in peripheral vision (P < .0001); and at detecting biological motion (P = .0065). In contrast, people with PD were not worse at mental rotation or subjective size perception. Using signal detection modelling, we found this effect was driven by change in perceptual sensitivity rather than response bias.

Conclusions: Online tests can detect visuo-perceptual deficits in people with PD, with object recognition particularly affected. Ultimately, visuo-perceptual tests may be developed to identify at-risk patients for clinical trials to slow PD dementia. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.



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α-synuclein (SNCA) but not dynamin 3 (DNM3) influences age at onset of leucine-rich repeat kinase 2 (LRRK2) Parkinson's disease in Spain

ABSTRACT

Objectives: A recent study showed that Arab-Berbers GG homozygous at rs2421947(C/G) in the dynamin 3 gene (DNM3) had 12.5 years earlier age at onset of leucine-rich repeat kinase 2 (LRRK2)-associated Parkinson's disease (PD) (L2PD). We explored whether this variant modulates the L2PD age at onset in Spain.

Methods: We genotyped rs2421947 in 329 participants (210 L2PD patients, 119 L2PD nonmanifesting p.G2019S carriers), and marker rs356219 (A/G) in the α-synuclein gene (SNCA).

Results: By Kaplan Meier and Cox regression analyses, we did not find an association of the DNM3 polymorphism with L2PD age at onset. However, we found an association of the SNCA marker with up to an 11 years difference in the L2PD median age at onset (58 years for GG carriers vs 69 years for AA).

Conclusion: Our results indicate that SNCA rs356219 but not dynamin 3 DNM3 rs2421947 modifies the penetrance of the mutation G2019S in the Spanish population by influencing the L2PD age at onset. These findings suggest that different genetic modifiers may influence the L2PD age at onset in different populations. © 2018 International Parkinson and Movement Disorder Society



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Facial emotion recognition in Parkinson's disease: A review and new hypotheses

Abstract

Parkinson's disease is a neurodegenerative disorder classically characterized by motor symptoms. Among them, hypomimia affects facial expressiveness and social communication and has a highly negative impact on patients' and relatives' quality of life. Patients also frequently experience nonmotor symptoms, including emotional-processing impairments, leading to difficulty in recognizing emotions from faces. Aside from its theoretical importance, understanding the disruption of facial emotion recognition in PD is crucial for improving quality of life for both patients and caregivers, as this impairment is associated with heightened interpersonal difficulties. However, studies assessing abilities in recognizing facial emotions in PD still report contradictory outcomes. The origins of this inconsistency are unclear, and several questions (regarding the role of dopamine replacement therapy or the possible consequences of hypomimia) remain unanswered. We therefore undertook a fresh review of relevant articles focusing on facial emotion recognition in PD to deepen current understanding of this nonmotor feature, exploring multiple significant potential confounding factors, both clinical and methodological, and discussing probable pathophysiological mechanisms. This led us to examine recent proposals about the role of basal ganglia-based circuits in emotion and to consider the involvement of facial mimicry in this deficit from the perspective of embodied simulation theory. We believe our findings will inform clinical practice and increase fundamental knowledge, particularly in relation to potential embodied emotion impairment in PD. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.



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Associations of postoperative mortality with the time of day, week and year

Summary

Studies that have investigated circadian, weekday and seasonal variation in postoperative mortality have been relatively small or have been for scheduled surgery. We retrospectively tested a large mixed surgical cohort from a German tertiary care university hospital for the presence of cyclical variation in all-cause in-hospital mortality after operations performed between 2006 and 2013. We analysed mortality rates after 247,475 operations, adjusted for age, sex, comorbidities, location, urgency and duration of the surgery, and intra-operative blood transfusions. The mortality odds ratio (95%CI) after operations started in the morning (08:00–11:00) were lowest, 0.73 (0.66–0.80), p < 0.001 and highest for operations started in the afternoon (13:00–17:00), 1.29 (1.18–1.40), p < 0.001. Mortality at the weekend was the same as during the week. There was no seasonal variation in mortality, p = 0.12. However, the interference of four-yearly and ten-monthly cycle amplitudes resulted in higher mortality odds ratio (95%CI) in winter 2008–2009, 1.41 (1.18–1.69), p < 0.001, and lower mortality in spring 2011 and 2012, 0.70 (0.56–0.85) and 0.67 (0.53–0.85), p < 0.001 and p = 0.001, respectively. The ability to predict cyclical phenomena would facilitate the design of interventional studies, aimed at reducing mortality following surgery in the afternoon and when cycles interfere constructively.



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Editorial Board and Contents

Publication date: March 2018
Source:Trends in Immunology, Volume 39, Issue 3





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Lipid Droplets as Immune Modulators in Myeloid Cells

Publication date: Available online 22 February 2018
Source:Trends in Immunology
Author(s): Martijn H. den Brok, Tonke K. Raaijmakers, Estel Collado-Camps, Gosse J. Adema
Lipid droplets (LDs) were initially described as fat storage organelles in adipocytes, but are increasingly recognized as dynamic players in lipid metabolism, with important roles not only in diseases such as diabetes and cancer, but also in immune regulation. Alterations in immune cell function, such as myeloid cell activation, are connected to profound changes in LD numbers and LD protein composition. Thus, these organelles appear to be essential to metabolically support immune responses, and have a vital role in antigen crosspresentation, interferon (IFN) responses, production of inflammatory mediators, and pathogen clearance. Here, we review recent studies that report on the role of LDs in the modulation of immune cell function, primarily focusing on myeloid cells, such as macrophages and dendritic cells (DCs).



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Natural Killer Cells Detect a Tumor-Produced Growth Factor: A Vestige of Antiviral Resistance?

Publication date: Available online 22 February 2018
Source:Trends in Immunology
Author(s): Giorgio Trinchieri
In addition to exogenous ligands derived from pathogens, natural killer (NK) and other innate cells can recognize endogenous ligands that often act as markers of stress or damage. A recent study reports that one of these receptors, human NKp44, recognizes PDGF-DD, providing a rare example of the recognition of a soluble growth factor as a stress signal. The recognition of PDGF-DD induces the secretion of cytokines with antitumor activity.



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Skin Commensal Antigens: Taking the Road Less Traveled

Publication date: Available online 22 February 2018
Source:Trends in Immunology
Author(s): Miqdad O. Dhariwala, Tiffany C. Scharschmidt
Although our knowledge of host–commensal interactions has increased exponentially, the mechanisms linking a specific commensal, its detection by the immune system, and its impact on tissue function are still often poorly understood. In a recent study in Cell, Linehan et al. dissect one of these interactions in the context of the skin, and demonstrate that Staphylococcus epidermidis antigens, presented through a non-classical pathway, drive the accumulation of CD8+ T cells that promote wound healing.



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Mary Catherine Ann Jorro

bmj;360/feb23_7/k779/FAF1faMary Catherine Ann Jorro was born in Bristol to a Spanish father and Bristolian mother. After qualifying and house jobs, she joined Jimmy Macrae at Ham Green Hospital,...
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Gordon Canti

bmj;360/feb23_9/k776/FAF1faGordon Canti was born in Hampstead, north London, the third son of Clara Clarissa (née Eyles) and Ronald George Canti (1884-1936).His father’s family had descended from a...
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Katherine Paule Cotter

bmj;360/feb23_8/k773/FAF1faKatherine Paule Cotter was appointed consultant haematologist at Coventry to a combined clinical and laboratory haematology department, where she treated patients with...
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Kenneth Scott

bmj;360/feb23_6/k848/FAF1faKenneth Scott was born in north London, the youngest child and only son of Rachel and Sidney Scott, a school teacher in Hackney for over 40 years. On leaving school Kenneth...
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