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

BACKGROUND AND PURPOSE:

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

MATERIALS AND METHODS:

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

RESULTS:

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

CONCLUSIONS:

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

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Role of MR Neurography for the Diagnosis of Peripheral Trigeminal Nerve Injuries in Patients with Prior Molar Tooth Extraction [PERIPHERAL NERVOUS SYSTEM]

BACKGROUND AND PURPOSE:

Clinical neurosensory testing is an imperfect reference standard to evaluate molar tooth extraction related peripheral trigeminal neuropathy. The purpose was to evaluate the diagnostic accuracy of MR neurography in this domain and correlation with neurosensory testing and surgery.

MATERIALS AND METHODS:

In this retrospective study, nerve caliber, T2 signal intensity ratio, and contrast-to-noise ratios were recorded by 2 observers using MR neurography for bilateral branches of the peripheral trigeminal nerve, the inferior alveolar and lingual nerves. Patient demographics and correlation of the MR neurography findings with the Sunderland classification of nerve injury and intraoperative findings of surgical patients were obtained.

RESULTS:

Among 42 patients, the mean ± SD age for case and control patients were 35.8 ± 10.2 years and 43.2 ± 11.5 years, respectively, with male-to-female ratios of 1:1.4 and 1:5, respectively. Case subjects (peripheral trigeminal neuropathy or injury) had significantly larger differences in nerve thickness, T2 signal intensity ratio, and contrast-to-noise ratios than control patients for the inferior alveolar nerve and lingual nerve (P = .01 and .0001, .012 and .005, and .01 and .01, respectively). Receiver operating characteristic analysis showed a significant association among differences in nerve thickness, T2 signal intensity ratio, and contrast-to-noise ratios and nerve injury (area under the curve, 0.83–0.84 for the inferior alveolar nerve and 0.77–0.78 for the lingual nerve). Interobserver agreement was good for the inferior alveolar nerve (intraclass correlation coefficient, 0.70–0.79) and good to excellent for the lingual nerve (intraclass correlation coefficient, 0.75–0.85). MR neurography correlations with respect to clinical neurosensory testing and surgical classifications were moderate to good. Pearson correlation coefficients of 0.68 and 0.81 and of 0.60 and 0.77 were observed for differences in nerve thickness.

CONCLUSIONS:

MR neurography can be reliably used for the diagnosis of injuries to the peripheral trigeminal nerve related to molar tooth extractions, with good to excellent correlation of imaging with clinical findings and surgical results.

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Dynamic Contrast-Enhanced MRI-Derived Intracellular Water Lifetime ({tau}i): A Prognostic Marker for Patients with Head and Neck Squamous Cell Carcinomas [HEAD & NECK]

BACKGROUND AND PURPOSE:

Shutter-speed model analysis of dynamic contrast-enhanced MR imaging allows estimation of mean intracellular water molecule lifetime (a measure of cellular energy metabolism) and volume transfer constant (a measure of hemodynamics). The purpose of this study was to investigate the prognostic utility of pretreatment mean intracellular water molecule lifetime and volume transfer constant in predicting overall survival in patients with squamous cell carcinomas of the head and neck and to stratify p16-positive patients based upon survival outcome.

MATERIALS AND METHODS:

A cohort of 60 patients underwent dynamic contrast-enhanced MR imaging before treatment. Median, mean intracellular water molecule lifetime and volume transfer constant values from metastatic nodes were computed from each patient. Kaplan-Meier analyses were performed to associate mean intracellular water molecule lifetime and volume transfer constant and their combination with overall survival for the first 2 years, 5 years, and beyond (median duration, >7 years).

RESULTS:

By the last date of observation, 18 patients had died, and median follow-up for surviving patients (n = 42) was 8.32 years. Patients with high mean intracellular water molecule lifetime (4 deaths) had significantly (P = .01) prolonged overall survival by 5 years compared with those with low mean intracellular water molecule lifetime (13 deaths). Similarly, patients with high mean intracellular water molecule lifetime (4 deaths) had significantly (P = .006) longer overall survival at long-term duration than those with low mean intracellular water molecule lifetime (14 deaths). However, volume transfer constant was a significant predictor for only the 5-year follow-up period. There was some evidence (P < .10) to suggest that mean intracellular water molecule lifetime and volume transfer constant were associated with overall survival for the first 2 years. Patients with high mean intracellular water molecule lifetime and high volume transfer constant were associated with significantly (P < .01) longer overall survival compared with other groups for all follow-up periods. In addition, p16-positive patients with high mean intracellular water molecule lifetime and high volume transfer constant demonstrated a trend toward the longest overall survival.

CONCLUSIONS:

A combined analysis of mean intracellular water molecule lifetime and volume transfer constant provided the best model to predict overall survival in patients with squamous cell carcinomas of the head and neck.

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

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

BACKGROUND AND PURPOSE:

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

MATERIALS AND METHODS:

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

RESULTS:

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

CONCLUSIONS:

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

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Anticoagulants are dental friendly

The Clinicians Report newsletter is an invaluable resource for cutting-edge clinical and scientific information for practicing dentists throughout the United States and the world. While we appreciate that the important issue of dental surgery in anticoagulated patients was the topic of "Anticoagulants: are they dental friendly or not?" in the September 2017 issue,1 this article overstates the bleeding risk in anticoagulated dental patients and understates the embolic risks with interruption of anticoagulation for dental procedures, and we respectfully take issue with it for the reasons below.

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Letter to the editor: Comments in relation to the CPC case entitled: “Submucosal nodule in buccal mucosa” Oral Surg Oral Med Oral Pathol Oral Radiol 2016;122:660-665.1

We read with great interest the clinicopathological conference published by Dairot et. al. entitled "Submucosal nodule in buccal mucosa". We reviewed the virtual slides. Histologically, the tumor shows a cribriform pattern with capsular invasion and extra-capsular invasion, the latter is evident in the virtual slides, but not in the published pictures. Basal Cell Adenoma (BCA) of the minor salivary glands is a rare, and we were able to find a single article2 describing capsular invasion. Wilson and Robinson (2014)3 have reported that morphologic observation of local tissue invasion is the best parameter for differentiation BCA from Basal Cell Adenocarcinoma.

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A symptomatic swelling of the upper lip

A 67-year-old woman presented to the School of Dentistry of the Federal University of Pelotas, Brazil, complaining about a slightly painful swelling of the upper lip, lasting around 5 years. The pain was not triggered or aggravated by cold or touch. Intraoral examination showed a 1.0-cm well-defined, sessile, slightly mobile, fibrous submucosal nodule on the right upper lip. The color of the lesion was similar to the adjacent normal mucosa (Figure 1). No other contributing information was collected from the anamnesis.

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Deep Learning in Nuclear Medicine and Molecular Imaging: Current Perspectives and Future Directions

Abstract

Recent advances in deep learning have impacted various scientific and industrial fields. Due to the rapid application of deep learning in biomedical data, molecular imaging has also started to adopt this technique. In this regard, it is expected that deep learning will potentially affect the roles of molecular imaging experts as well as clinical decision making. This review firstly offers a basic overview of deep learning particularly for image data analysis to give knowledge to nuclear medicine physicians and researchers. Because of the unique characteristics and distinctive aims of various types of molecular imaging, deep learning applications can be different from other fields. In this context, the review deals with current perspectives of deep learning in molecular imaging particularly in terms of development of biomarkers. Finally, future challenges of deep learning application for molecular imaging and future roles of experts in molecular imaging will be discussed.

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A fully automatic end-to-end method for content-based image retrieval of CT scans with similar liver lesion annotations

Abstract

Purpose

The goal of medical content-based image retrieval (M-CBIR) is to assist radiologists in the decision-making process by retrieving medical cases similar to a given image. One of the key interests of radiologists is lesions and their annotations, since the patient treatment depends on the lesion diagnosis. Therefore, a key feature of M-CBIR systems is the retrieval of scans with the most similar lesion annotations. To be of value, M-CBIR systems should be fully automatic to handle large case databases.

Methods

We present a fully automatic end-to-end method for the retrieval of CT scans with similar liver lesion annotations. The input is a database of abdominal CT scans labeled with liver lesions, a query CT scan, and optionally one radiologist-specified lesion annotation of interest. The output is an ordered list of the database CT scans with the most similar liver lesion annotations. The method starts by automatically segmenting the liver in the scan. It then extracts a histogram-based features vector from the segmented region, learns the features' relative importance, and ranks the database scans according to the relative importance measure. The main advantages of our method are that it fully automates the end-to-end querying process, that it uses simple and efficient techniques that are scalable to large datasets, and that it produces quality retrieval results using an unannotated CT scan.

Results

Our experimental results on 9 CT queries on a dataset of 41 volumetric CT scans from the 2014 Image CLEF Liver Annotation Task yield an average retrieval accuracy (Normalized Discounted Cumulative Gain index) of 0.77 and 0.84 without/with annotation, respectively.

Conclusions

Fully automatic end-to-end retrieval of similar cases based on image information alone, rather that on disease diagnosis, may help radiologists to better diagnose liver lesions.

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Leukoencephalopathy with Brain Stem and Spinal Cord Involvement and not Always Lactate Elevation

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Reduction of Metallic Artifacts of the Post-treatment Intracranial Aneurysms: Effects of Single Energy Metal Artifact Reduction Algorithm

Abstract

Purpose

This study evaluated the quality of computed tomography (CT) and CT angiography images generated using the single-energy metal artifact reduction (SEMAR) algorithm during perfusion examination in patients who had undergone reconstruction with neurosurgical clipping or endovascular coiling for treatment of aneurysms.

Methods

A total of 55 patients with implanted intracranial clips or coils (24 men and 31 women; mean age 60.15 ± 15.86 years) underwent perfusion studies evaluated by CT and CT angiography with a 320-row CT scanner. Images were reconstructed with either the SEMAR algorithm combined with iterative reconstruction (SEMAR group), or by iterative reconstruction only (non-SEMAR group control). The SEMAR and control images were compared for artifacts (index and maximum diameter), image quality, cerebral perfusion parameters, noise (images with the worst artifacts), and contrast-to-noise ratio. The metallic artifacts were visually evaluated by two radiologists using a four-point scale in a double-blinded manner.

Results

The noise, artifact diameter, and artifact index of the SEMAR images were significantly lower than that of the control images, and the subjective image quality score and contrast-to-noise ratio were significantly higher (P < 0.01, all). The cerebral perfusion parameters of the SEMAR and control images were comparable (i. e. blood flow, blood volume, and mean transit time).

Conclusion

For imaging intracranial metallic implants, the SEMAR algorithm produced images with significantly fewer artifacts than the iterative reconstruction alone, with no statistical changes in perfusion parameters. Thus, SEMAR reconstruction can be instrumental in improving CT image quality and may ultimately improve the detection of postoperative complications and patient prognosis.

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Uranium mobility across annual growth rings in three deciduous tree species

Publication date: Available online 15 November 2017
Source:Journal of Environmental Radioactivity
Author(s): Kelly C. McHugh, Elisabeth Widom, Henry B. Spitz, Gregory C. Wiles, Sam E. Glover
Black walnut (Juglans nigra), slippery elm (Ulmus rubra), and white ash (Fraxinus americana) trees were evaluated as potential archives of past uranium (U) contamination. Like other metals, U mobility in annual growth rings of trees is dependent on the tree species. Uranium concentrations and isotopic compositions (masses 234, 235, 236, and 238) were analyzed by thermal ionization mass spectrometry to test the efficacy of using tree rings to retroactively monitor U pollution from the FFMPC, a U purification facility operating from 1951 to 1989. This study found non-natural U (depleted U and detectable ²³⁶U) in growth rings of all three tree species that pre-dated the start of operations at FFMPC and compositional trends that did not correspond with known contamination events. Therefore, the annual growth rings of these tree species cannot be used to reliably monitor the chronology of U contamination.



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137Cs in mushrooms from Croatia sampled 15–30 years after Chernobyl

Publication date: Available online 15 November 2017
Source:Journal of Environmental Radioactivity
Author(s): Ivana Tucaković, Delko Barišić, Željko Grahek, Ante Kasap, Ivan Širić
The aim of this study was to select species with higher potential to accumulate ¹³⁷Cs among the available mushroom species, by determining the activity concentrations of ¹³⁷Cs in mushrooms collected along north and north-western part of Croatia. A total of 55 samples of 14 different species were analyzed and the potential of mycorrhizal and saprotrophic species to accumulate ¹³⁷Cs was compared. A wide range of the dry weight activity concentrations of ¹³⁷Cs was detected, ranging from 0.95 to 1210 Bq/kg (154 Bq/kg mean value; 52.3 Bq/kg geometric mean) in mycorrhizal and 1.05–36.8 Bq/kg (8.90 Bq/kg mean value; 5.49 Bq/kg geometric mean) in saprotrophic species. Statistical analyses showed that mycorrhizal species accumulate significantly higher concentrations of ¹³⁷Cs and thus could perform better as long-term bioindicators of environmental pollution by radiocaesium then saprotrophic species. The comparison of Boletus sp. and Hydnum repandum (both mycorrhizal species commonly found in Croatia) showed, in general order of magnitude, higher accumulation in Hydnum repandum. Clearly, mushrooms, especially mycorrhizal species, can be used as significant indicators even decades after the occurrence of any serious ¹³⁷Cs contamination event. However, as a wide range of values indicates that various parameters may influence the total uptake of the ¹³⁷Cs into the mushroom fruit bodies, it is necessary to emphasize that ¹³⁷Cs activity detected in a single mushroom sample is very site-specific.

Graphical abstract

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Information

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Medical physics in radiation Oncology: New challenges, needs and roles

Publication date: Available online 14 November 2017
Source:Radiotherapy and Oncology
Author(s): Dietmar Georg, David Thwaites




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Improved pharmacodynamic (PD) assessment of low dose PARP inhibitor PD activity for radiotherapy and chemotherapy combination trials

Publication date: Available online 14 November 2017
Source:Radiotherapy and Oncology
Author(s): Rosemarie de Haan, Dick Pluim, Baukelien van Triest, Michel van den Heuvel, Heike Peulen, Damien van Berlo, Jay George, Marcel Verheij, Jan H.M. Schellens, Conchita Vens
BackgroundPARP inhibitors are currently evaluated in combination with radiotherapy and/or chemotherapy. As sensitizers, PARP inhibitors are active at very low concentrations therefore requiring highly sensitive pharmacodynamic (PD) assays. Current clinical PD-assays partly fail to provide such sensitivities. The aim of our study was to enable sensitive PD evaluation of PARP inhibitors for clinical sensitizer development.Material and methodsPBMCs of healthy individuals and of olaparib and radiotherapy treated lung cancer patients were collected for ELISA-based PD-assays.ResultsPAR-signal amplification by ex vivo irradiation enabled an extended quantification range for PARP inhibitory activities after ex vivo treatment with inhibitors. This "radiation-enhanced-PAR" (REP) assay provided accurate IC50 values thereby also revealing differences among healthy individuals. Implemented in clinical radiotherapy combination Phase I trials, the REP-assay showed sensitive detection of PARP inhibition in patients treated with olaparib and establishes strong PARP inhibitory activities at low daily doses.ConclusionsCombination trials of radiotherapy and novel targeted agent(s) often require different and more sensitive PD assessments than in the monotherapy setting. This study shows the benefit and relevance of sensitive and adapted PD-assays for such combination purposes and provides proof of clinically relevant cellular PARP inhibitory activities at low daily olaparib doses.



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Health-related-quality-of-life and toxicity after single fraction 19 Gy high-dose-rate prostate brachytherapy: Phase II trial

Publication date: Available online 15 November 2017
Source:Radiotherapy and Oncology
Author(s): Alfonso Gomez-Iturriaga, Francisco Casquero, Jose Ignacio Pijoan, Pablo Minguez, Jose Maria Espinosa, Ana Irasarri, Andrea Bueso, Jon Cacicedo, David Buchser, Pedro Bilbao
PurposeTo evaluate the safety, tolerance and impact on health-related-quality-of-life (HRQoL) of the high-dose-rate brachytherapy of 19 Gy (BRT-HDR-19 Gy) single fraction in prostate cancer.MethodsFrom January 2014 to July 2016, 43 patients with low/intermediate risk were treated with BRT-HDR-19 Gy. The patients were monitored prospectively for toxicity and HRQoL.ResultsThe median age, initial PSA and the International Prostate Symptom Score (IPSS) were 71 years (55–78), 7.0 ng/mL (4.2–17.8) and 5 (0–14) respectively. 44% were low-risk and 56% intermediate-risk. Median CTV-V100 (where Vn is the fractional volume of the organ that receives n% of the prescribed dose) was 96.5%, Urethral-Dmax 106% and rectum-2 cc (the dose to 2 cc of rectal wall) 53%. After a median follow-up of 20 months (4–26), acute grade-2 genitourinary (GU) toxicity occurred in 4 patients (9%) and none presented acute gastrointestinal (GI) toxicity. Similarly, four patients (9%) presented late GU grade-2 toxicity. No grade-3 toxicity occurred.In terms of HRQoL, there was a statistically significant decline in Expanded Prostate Cancer Index Composite (EPIC) urinary urgency/obstructive domain at month 3 (p = 0.047), and returned to baseline by month 6. Mean EPIC urinary incontinence, bowel, sexual and hormonal domains did not present significant post BRT-HDR-19 Gy changes.Patients rated their satisfaction at 6 months as "very-satisfied" (23%) or "extremely-satisfied" (77%).ConclusionsBRT-HDR-19 Gy demonstrates excellent results in terms of toxicity, tolerance, safety, patient satisfaction and HRQoL.



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Determination of splenomegaly by coronal oblique length on CT

Abstract

Purpose

The aims of this study were (a) to determine whether a coronal oblique length (COL) > 12 cm, which is often used to detect splenomegaly (SM) on ultrasound, can be used as a marker of SM on computed tomography (CT), (b) to compare the diagnostic accuracy of COL with other unidimensional linear measurements (ULM) in identifying SM, (c) to determine which ULM most closely correlates with splenic volume (SVol) according to the splenic index on CT, (d) to assess the relationship between SVol and patient's gender, age and body parameters (height, weight), and (e) to determine whether there is a difference between non-contrast-enhanced and contrast-enhanced CT images in identifying SM.

Materials and methods

The body parameters and ULM (width, length, thickness, COL) were obtained from patients who underwent CT for various indications from April 2016 to April 2017. SVol and body mass indexes were calculated for each patient.

Results

Of the 1078 patients [male/female = 526/552; 47.57 (mean) ± 19.21 (standard deviation) years], 392 patients had SM. The sensitivity, specificity, positive and negative predictive values of COL > 12 cm for diagnosing SM were 44.6, 95.6, 85.3 and 75.1%, respectively (p < 0.001). SVol correlated with all ULM (p < 0.001). In the non-SM group (n = 686), the mean SVol was 331.7 ± 92.2 cm³ and females had smaller spleens than males (p < 0.001). SVol showed correlation with gender, age and height (p < 0.001).

Conclusion

COL > 12 cm is not superior to other ULM for the detection of SM, but it is very successful in determining normal spleens. The unidimensional measurements and volume of the spleen should be calculated by taking gender and body parameters into account for different ethnic populations. Non-contrast-enhanced CT can also be used to detect SM.

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Corrigendum.

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Corrigendum.

Otolaryngol Head Neck Surg. 2013 Jun;148(6):1064

Authors:

Abstract
Lim HJ, Kim YT, Choi SJ, et al. Efficacy of 3 different steroid treatments for sudden sensorineural hearing loss: a prospective, randomized trial. Otolaryngol Head Neck Surg. 2013;148:121-127. (original doi: 10.1177/0194599812464475 ).

PMID: 29135379 [PubMed]

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Response to the letter to the editor from Dr Peter Belafsky.

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Response to the letter to the editor from Dr Peter Belafsky.

Otolaryngol Head Neck Surg. 2007 Dec;137(6):984-985

Authors: Joniau SHK

PMID: 29135377 [PubMed]

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Response to "Comorbidities in head and neck cancer: Agreement between self-report and chart review" by Vinidh Paleri.

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Response to "Comorbidities in head and neck cancer: Agreement between self-report and chart review" by Vinidh Paleri.

Otolaryngol Head Neck Surg. 2007 Dec;137(6):986

Authors: Terrell JE, Duffy SA, Mukerji SS

PMID: 29135376 [PubMed]

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Corrections.

Related Articles

Corrections.

Otolaryngol Head Neck Surg. 2007 Dec;137(6):987

Authors:

PMID: 29135375 [PubMed]

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Corrections.

Related Articles

Corrections.

Otolaryngol Head Neck Surg. 2007 Dec;137(6):987

Authors:

PMID: 29135374 [PubMed]

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Highlights from the Current Issue: November 2015.

Related Articles

Highlights from the Current Issue: November 2015.

Otolaryngol Head Neck Surg. 2015 Nov;153(5):697-698

Authors: Krouse JH

PMID: 29135350 [PubMed]

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Highlights from the Current Issue: August 2015.

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Highlights from the Current Issue: August 2015.

Otolaryngol Head Neck Surg. 2015 Aug;153(2):159-160

Authors: Krouse JH

PMID: 29135349 [PubMed]

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Variant course of extensor pollicis brevis tendon in the third extensor compartment.

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Variant course of extensor pollicis brevis tendon in the third extensor compartment.

Surg Radiol Anat. 2017 Nov 14;:

Authors: Sugiura S, Matsuura Y, Suzuki T, Nishikawa S, Mori C, Kuniyoshi K

Abstract
INTRODUCTION: According to the anatomical literature, the extensor pollicis brevis (EPB) tendon passes through the first compartment and enters the base of the proximal phalanx of the thumb. There have been a few reports on the different types of supernumerary EPB tendons; however, an unusual course of the EPB tendon is extremely rare.
MATERIALS AND METHODS: During routine cadaveric dissection in the Department of Gross Anatomy, we detected an variant EPB muscle in a 96-year-old fresh female cadaver.
RESULTS: The EPB muscle originated from the posterior surface of the radius and interosseous membrane. However, the EPB tendon passed through the third compartment instead of the first compartment. It ran parallel to the extensor pollicis longus (EPL) tendon and entered the base of the thumb proximal phalanx. The EPL tendon was attached to the base of the first distal phalanx, as normally observed. Both EPB and EPL muscles were innervated by the posterior interosseous nerve.
CONCLUSIONS: We report a case of a variant course of the EPB tendon appearing in the third extensor compartment of the wrist with the EPL tendon. The knowledge of this anatomic variation will be helpful for accurate diagnosis and surgical planning.

PMID: 29138875 [PubMed - as supplied by publisher]

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'…What God and the Angels Know of US?' Character, Autonomy, and Best Interests in Minimally Conscious State.

'…What God and the Angels Know of US?' Character, Autonomy, and Best Interests in Minimally Conscious State.

Med Law Rev. 2017 Nov 13;:

Authors: Birchley G

Abstract
Determining the best interests of incapacitated patients has been observed to be an opaque area of the law, and this is no less so in decisions about the (non-)treatment of patients in the minimally conscious state. A systematic examination of the way best interests are used in judgments relating to this population suggests that narratives involving the character of the patient frequently form an important plank of judicial reasoning. Since insights into the concept of best interests may be gained by an engagement with the philosophy of well-being, I identify the court's character-based approach with perfectionist theories of well-being. These use human nature to furnish an objective list of abilities needed for human flourishing. Guided by the Mental Capacity Act (MCA), this list becomes focused primarily on autonomy. Incapacitated patients are assumed to have wishes, but to lack agency. Judges search for these wishes in narratives about the patient and supply the means to exercise these wishes. This analysis suggests three concerns about the court's approach: first, by placing so great a weight on autonomy, the law offers an impoverished account of human nature; secondly, adversarial law encourages partial determinations of character, and this raises concerns about whether the courts are equipped to explore the complexities of character narratives; and, thirdly, experimental psychology indicates character is not as predictable as an assessment under MCA requires. While character narratives may unburden decision-makers, this analysis suggests the limits of autonomy may have been exceeded in this area of the law.

PMID: 29140436 [PubMed - as supplied by publisher]

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Stoic beliefs and health: development and preliminary validation of the Pathak-Wieten Stoicism Ideology Scale.

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Stoic beliefs and health: development and preliminary validation of the Pathak-Wieten Stoicism Ideology Scale.

BMJ Open. 2017 Nov 14;7(11):e015137

Authors: Pathak EB, Wieten SE, Wheldon CW

Abstract
INTRODUCTION: We developed and validated a new parsimonious scale to measure stoic beliefs. Key domains of stoicism are imperviousness to strong emotions, indifference to death, taciturnity and self-sufficiency. In the context of illness and disease, a personal ideology of stoicism may create an internal resistance to objective needs, which can lead to negative consequences. Stoicism has been linked to help-seeking delays, inadequate pain treatment, caregiver strain and suicide after economic stress.
METHODS: During 2013-2014, 390 adults aged 18+ years completed a brief anonymous paper questionnaire containing the preliminary 24-item Pathak-Wieten Stoicism Ideology Scale (PW-SIS). Confirmatory factor analysis (CFA) was used to test an a priori multidomain theoretical model. Content validity and response distributions were examined. Sociodemographic predictors of strong endorsement of stoicism were explored with logistic regression.
RESULTS: The final PW-SIS contains four conceptual domains and 12 items. CFA showed very good model fit: root mean square error of approximation (RMSEA)=0.05 (95% CI 0.04 to 0.07), goodness-of-fit index=0.96 and Tucker-Lewis Index=0.93. Cronbach's alpha was 0.78 and ranged from 0.64 to 0.71 for the subscales. Content validity analysis showed a statistically significant trend, with respondents who reported trying to be a stoic 'all of the time' having the highest PW-SIS scores. Men were over two times as likely as women to fall into the top quartile of responses (OR=2.30, 95% CI 1.44 to 3.68, P<0.001). ORs showing stronger endorsement of stoicism by Hispanics, Blacks and biracial persons were not statistically significant.
DISCUSSION: The PW-SIS is a valid and theoretically coherent scale which is brief and practical for integration into a wide range of health behaviour and outcomes research studies.

PMID: 29138193 [PubMed - in process]

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Brain Sciences, Vol. 7, Pages 152: Salivary Oxytocin Concentration Changes during a Group Drumming Intervention for Maltreated School Children

Brain Sciences, Vol. 7, Pages 152: Salivary Oxytocin Concentration Changes during a Group Drumming Intervention for Maltreated School Children

Brain Sciences doi: 10.3390/brainsci7110152

Authors: Teruko Yuhi Hiroaki Kyuta Hisa-aki Mori Chihiro Murakami Kazumi Furuhara Mari Okuno Masaki Takahashi Daikei Fuji Haruhiro Higashida

Many emotionally-disturbed children who have been maltreated and are legally separated from their parents or primary caregivers live in group homes and receive compulsory education. Such institutions provide various special intervention programs. Taiko-ensou, a Japanese style of group drumming, is one such program because playing drums in a group may improve children’s emotional well-being. However, evidence for its efficacy has not been well established at the biological level. In this study, we measured salivary levels of oxytocin (OT), a neuropeptide associated with social memory and communication, in three conditions (recital, practice, and free sessions) in four classes of school-aged children. Following the sessions, OT concentrations showed changes in various degrees and directions (no change, increases, or decreases). The mean OT concentration changes after each session increased, ranging from 112% to 165%. Plasma OT concentrations were equally sensitive to drum playing in school-aged boys and girls. However, the difference between practice and free play sessions was only significant among elementary school boys aged 8–12 years. The results suggest that younger boys are most responsive to this type of educational music intervention.

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Acute respiratory distress syndrome

What you need to knowConsider the possibility of acute respiratory distress syndrome (ARDS) in any sick patient with respiratory distress, especially in the presence of risk factors such as...

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Child growth and coeliac disease . . . and other stories

Early growth in children with coeliac diseaseA cohort study in Norway measured the growth of nearly 60 000 children on six occasions during the first two years of their lives (Arch Dis Child...

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IJERPH, Vol. 14, Pages 1395: The Association between Environmental Lead Exposure and High School Educational Outcomes in Four Communities in New South Wales, Australia

IJERPH, Vol. 14, Pages 1395: The Association between Environmental Lead Exposure and High School Educational Outcomes in Four Communities in New South Wales, Australia

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14111395

Authors: Jennifer McCrindle Donna Green Marianne Sullivan

The associations between environmental lead exposure and high school educational outcomes in four communities located in New South Wales, Australia, were examined in this ecological study. A mixed model analysis was performed to account for each school’s results being more similar than results for other schools. The effect of environmental lead exposure on mean results for five educational outcomes was examined. ‘Leaded’ schools with more than five per cent of students living in the highest lead risk areas were tested against non-leaded ‘comparison’ schools that were matched by a pre-defined socio-educational advantage rating. A small disadvantage was found for leaded schools for four out of five outcomes, which was statistically significant for three outcomes: Higher School Certificate English (p &lt; 0.01), School Certificate Mathematics (p &lt; 0.05), and Australian Tertiary Admissions Rank eligibility rate (p &lt; 0.01). This study adds to the large body of evidence in Australia and elsewhere supporting the importance of primary prevention to protect health at multiple stages of development.

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A propensity-matched comparison of hard outcomes in children on chronic dialysis

Abstract

Data concerning outcomes of children on hemodialysis (HD) and peritoneal dialysis (PD) are scarce and frequently derived from single-center experiences. We sought to compare survival and transplantation rates in a large cohort of PD and HD patients. We extracted all patients initiating dialysis under 16 years of age between 2004 and 2013 from the Italian Registry of Pediatric Chronic Dialysis. Patients on PD were propensity-matched to those on HD based on gender, age, primary cause of ESRD, and the number of co-morbidities. Stratified Cox proportional hazard models were used to compare outcomes by dialysis modality. Three hundred ten patients were matched from 452 incident patients. In the unmatched cohort, PD patients were younger, more likely to be diagnosed with CAKUT, and had a higher urine output than HD patients. In the propensity-matched cohort, covariates were balanced between the two groups. At 2 years, the cumulative hazard ratio for death was similar (CHR 0.95, 95% CI 0.17–5.20) for HD relative to PD patients; and at 5 years, the CHR was lower for HD patients (0.22 95% CI 0.16–0.29). The cumulative incidence of transplantation at 3 years after dialysis initiation was 60.9% in HD patients and 59.7% in PD patients, with a CHR of 1.03 (95% CI 0.73–1.45).

Conclusions: Pediatric PD and HD patients have distinct characteristics. After controlling for treatment-selection biases, children selected to start on PD or HD exhibit a similar mortality risk during the first 2 years on treatment, after which this risk increases in PD children.

What is Known: • Few studies have compared hard outcomes in children on maintenance dialysis. • Children started on different dialysis modalities have distinct characteristics that impact on survival.

What is New: • After controlling for treatment-selection biases, children selected to start dialysis on PD or HD exhibit a similar mortality risk during the first 2 years on treatment, after which this risk appears to be increased in PD children. • An “integrative care” approach should be used in children on PD, switching them to HD when PD-related morbidity tends to increase.

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The swollen pinna

A 65 year old man presented to his general practitioner with a one month history of pain and swelling of his left ear. His only comorbidity was a renal transplant 14 years earlier for immunoglobulin...

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Climate change: health effects and response in South Asia

Extreme weather events such as cyclones, flooding, and heat spells in South Asia have drawn attention to the effect of climate change on human life and our lack of preparedness. Rapid urbanisation...

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Dangers of fatigue

Health systems in the northern hemisphere are gearing up for winter. In the UK this brings traditional prognostications of doom, which were heightened last week by an unprecedented public call for...

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