Ιατρικά Άρθρα: 12/19/18

Τετάρτη 19 Δεκεμβρίου 2018

Fwd: contrast media-induced nonrenal adverse drug reactions

Contrast media-induced nonrenal adverse drug reactions
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contrast media-induced nonrenal adverse drug reactions over the last three decades: A systematic review p. 131
Maurizio Sessa, Claudia Rossi, Annamaria Mascolo, Antonella Scafuro, Rosanna Ruggiero, Gabriella di Mauro, Salvatore Cappabianca, Roberto Grassi, Liberata Sportiello, Concetta Rafaniello
DOI:10.4103/jpp.JPP_92_18
The aim of this study was to investigate the scientific contribution of Italian clinical research for contrast media-induced nonrenal adverse drug reactions over the last three decades. Ovid Embase, Ovid MEDLINE, Web of Science, and Cochrane Methodology Register were used as data sources to identify Italian descriptive studies, observational studies, meta-analyses, and clinical trials assessing contrast media-induced nonrenal adverse drug reactions as a safety outcome. The population of interest was men and women exposed to a contrast medium. Between 1990 and 2017, 24 original articles investigating contrast-induced nonrenal adverse drug reactions were identified. The cohort study was the most representative study design (10/24; 41.7%). The 24 studies were conducted mainly as monocenter studies (14/24; 58.3%) and without receiving funding (17/24; 70.8%). Seventeen out of 24 studies provided a level of evidence ranging from III-2 (11/24; 45.8%) to IV (6/24; 25.0%) on a Merlin scale. In total, 14 of 24 (58.3%) studies were published in a scientific journal ranked in the first quartile of their subject area. The 24 original articles mainly focused on adverse drug reactions already observed during clinical trials (i.e., idiosyncratic systemic reactions). In conclusion, during the last three decades and a burst was not observed in the Italian clinical research investigating contrast-induced nonrenal adverse drug reactions. High-quality clinical research is needed especially for procedures to prevent the onset of the aforementioned events, to identify risk factors, to minimize the risk of their occurrence, and to optimize their related prognosis.
http://www.jpharmacol.com/currentissue.asp?sabs=y

Fwd: Gujarati hypertensives

Gujarati hypertensives
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: A cross-sectional study p. 153
Jayesh Dalpatbhai Solanki, Hemant B Mehta, Sunil J Panjwani, Hirava B Munshi, Chinmay J Shah
DOI:10.4103/jpp.JPP_59_18
Objective: To study the effect of different classes and combinations of antihypertensive agents on arterial stiffness and central hemodynamic parameters. Materials and Methods: A cross-sectional study was conducted in 446 treated apparently healthy hypertensives. Oscillometric PWA was performed by Mobil-o-Graph (IEM, Germany) to derive cardiovascular parameters that were further analyzed in groups stratified by antihypertensive used. Study parameters were brachial hemodynamics (blood pressure (BP), heart rate, and rate pressure product); arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification); and central hemodynamics (central BP, cardiac output, and stroke work). Statistical significance was kept at P < 0.05. Results: All groups were selected by matching of age, gender, and body mass index. They were comparable with major confounding factors. There was no difference between study parameters in hypertensives taking exclusive angiotensin-converting enzyme inhibitor (ACEI), calcium channel blocker (CCB), or angiotensin II receptor blocker. Multitherapy showed better hemodynamics and monotherapy showed better stiffness parameters. Addition of CCB to ACEI did not make a difference except with diastolic BP. For most comparisons, most of the results lacked statistical significance. Conclusion: Discrete PWA parameters showed no class difference in hypertensives, treated by conventional monotherapy or combination, ACEI appears to be the best drug. This also indicates that early diagnosis and blood pressure control are more important than antihypertensive used.
http://www.jpharmacol.com/currentissue.asp?sabs=y

Fwd: Precontrast T1 signal measurements of normal pituitary and microadenoma

The dynamic contrast enhanced magnetic resonance imaging (DCE MRI),Precontrast T1 signal measurements of normal pituitary and microadenoma
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A retrospective analysis through DCE MRI signal time curves p. 380
Ishan Kumar, Tanya Yadav, Ashish Verma, Ram C Shukla, Surya K Singh
DOI:10.4103/ijri.IJRI_104_18
Background: The dynamic contrast enhanced magnetic resonance imaging (DCE MRI) has currently become the most utilized technique for the detection of pituitary microadenoma. However, owing to differential enhancement of normal pituitary, high rate of false positivity remains a concern in its interpretation. Purpose: Our aim was to assess the utility of precontrast T1 signal intensity ratio (SIR) of the lesions suspected on DCE MRI, in prediction of presence of microadenoma. Materials and Methods: We retrospectively reviewed MRI of 23 patients referred for DCE MRI of pituitary (group 1, 15 patients with diagnosis of pituitary microadenoma; and group 2, patients not clinically labeled as microadenoma). STC were plotted and T1-SIR at t = 0 s was obtained at the suspicious zone of differential enhancement (SIR T) and normal pituitary (SIR P). SIR difference (SIR P − SIR T) and relative SIR difference (SIR P − SIR T/SIR P) were calculated for each patient and was compared between the two groups. Results: Mean T1 SIR is lower in patients with microadenoma than those without (P = 0.065). SIR difference and relative SIR difference was higher in patients with microadenoma (P = 0.003 and 0.005, respectively). Receiver-operated characteristic curve analysis demonstrated that a cut-off of 26 and 0.107 for SIR difference and relative SIR difference, respectively, could diagnose microadenoma with 100% specificity and reasonable sensitivities. Conclusion: The baseline precontrast T1 SIR evaluation of the lesion suspected to be microadenoma on DCE MRI, derived through STC curve, can increase diagnostic confidence in diagnosis of microadenoma.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: 3D SPACE sequence and susceptibility weighted imaging in the evaluation of hydrocephalus and treatment-oriented refined classification of hydrocephalus

The evaluation of hydrocephalus : 3D SPACE sequence and susceptibility weighted imaging in the evaluation of hydrocephalus and treatment-oriented refined classification of hydrocephalus

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Role of 3D SPACE sequence and susceptibility weighted imaging in the evaluation of hydrocephalus and treatment-oriented refined classification of hydrocephalus p. 385
Amarnath Chellathurai, Komalavalli Subbiah, Barakath Nisha Abdul Ajis, Suhasini Balasubramaniam, Sathyan Gnanasigamani
DOI:10.4103/ijri.IJRI_161_18

Objective: The aim of our study was to evaluate the diagnostic utility of three-dimensional sampling perfection with application optimized contrast using different flip angle evolution (3D SPACE) sequence and Susceptibility Weighted Imaging (SWI) in hydrocephalus and to propose a refined definition and classification of hydrocephalus with relevance to the selection of treatment option. Materials and Methods: A prospective study of 109 patients with hydrocephalus was performed with magnetic resonance imaging (MRI) brain using standardized institutional sequences along with additional sequences 3D SPACE and SWI. The images were independently read by two senior neuroradiologists and the etiopathogenesis of hydrocephalus was arrived by consensus. Results: With conventional sequences, 46 out of 109 patients of hydrocephalus were diagnosed as obstructive of which 21 patients showed direct signs of obstruction and 25 showed indirect signs. In the remaining 63 patients of communicating hydrocephalus, cause could not be found out in 41 patients. Whereas with 3D SPACE sequence, 88 patients were diagnosed as obstructive hydrocephalus in which all of them showed direct signs of obstruction and 21 patients were diagnosed as communicating hydrocephalus. By including SWI, we found out hemorrhage causing intraventricular obstruction in three patients and hemorrhage at various sites in 24 other patients. With these findings, we have classified the hydrocephalus into communicating and noncommunicating, with latter divided into intraventricular and extraventricular obstruction, which is very well pertaining to the selection of surgical option. Conclusion: We strongly suggest to include 3D SPACE and SWI sequences in the set of routine MRI sequences, as they are powerful diagnostic tools and offer complementary information regarding the precise evaluation of the etiopathogenesis of hydrocephalus and have an effective impact in selecting the mode of management.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Olfactory fossa depth: CT analysis

Olfactory fossa depth: CT analysis

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Olfactory fossa depth: CT analysis of 1200 patients p. 395
Ashok Chirathalattu Babu, Mattavana Ramakrishna Pillai Balachandran Nair, Aneesh Mangalasseril Kuriakose
DOI:10.4103/ijri.IJRI_119_18

Background: Olfactory fossa (OF) is a depression in anterior cranial cavity whose floor is formed by cribriform plate of ethmoid. Lateral lamella, which forms its lateral boundary, is a thin plate of bone and is at risk of injury during functional endoscopic sinus surgery, especially when fossa is deep/asymmetric. Aims: To measure the variations in the depth of OF and categorize Kerala population as per Keros classification using computed tomography (CT). Settings and Design: This study was conducted in our institution from January 2016 to August 2017. Patients >16 years of age undergoing CT scan of paranasal sinuses (PNS) were included. Materials and Methods: Coronal PNS CT scan studies of 1200 patients were reviewed. The depth of OF was measured from vertical height of lateral lamella. Statistical Methods: Results were analyzed according to gender and laterality using independent sample t-test and Chi-square test. Results: The mean depth of OF was 5.26 ± 1.69 mm. Statistically significant difference was seen in the mean depth of OF between males and females but not between right and left sides. Keros type I was found on 420 sides (17.5%), type II in 1790 (74.6%), and type III on 190 sides (7.9%). Type III Keros was more on the right (9%) than left (6.8%) side, more in males (9.5%) than females (5.9%), and more among males on the right side (11.4%). Asymmetry in OF depth between two sides was seen in 75% of subjects. Conclusion: Prevalence of the dangerous type III OF, even though low, is significant especially among males and on the right side. Therefore, preoperative assessment of OF depth must be done to reduce iatrogenic complications.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: High-altitude cerebral edema

High-altitude cerebral edema
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Neuroimaging features of fatal high-altitude cerebral edema p. 401
Gorky Medhi, Tsella Lachungpa, Jitender Saini
DOI:10.4103/ijri.IJRI_296_18
Acute high-altitude cerebral edema can occur in an unacclimatised individual on exposure to high altitudes and sometimes it can be fatal. Here we have described the neuroimaging features of a patient who suffered from fatal high altitude cerebral edema. Available literature is reviewed. Probable pathogenesis is discussed. The risk of acute mountain sickness is reported up to 25% in individuals who ascend to an altitude of 3500 meter and in more than 50% subjects at an altitude of 6000 meter. The lack of availability of advanced imaging facilities at such a higher altitude makes imaging of such condition a less described entity.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Isolated spontaneous cerebrospinal fluid rhinorrhoea as a rare presentation of idiopathic intracranial hypertension

Isolated spontaneous cerebrospinal fluid rhinorrhoea as a rare presentation of idiopathic intracranial hypertension
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: Case reports with comprehensive review of literature p. 406
Priti Soin, Umer M Afzaal, Pranav Sharma, Puneet S Kochar
DOI:10.4103/ijri.IJRI_228_18
Isolated cerebrospinal fluid (CSF) rhinorrhoea as a sole presenting symptom of idiopathic intracranial hypertension (IIH) is extremely rare. IIH typically presents with headache, pulsatile tinnitus, dizziness, nausea, vomiting, and visual disturbance. We report two cases which presented with acute onset spontaneous CSF rhinorrhoea without any other symptom. In addition, we discuss in detail imaging features of IIH with review of its literature.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Ultrasound elastography findings in piriformis muscle syndrome

Piriformis muscle syndrome (PMS),Ultrasound elastography findings
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p. 412
Adnan Demirel, Murat Baykara, Tuba Tülay Koca, Ejder Berk
DOI:10.4103/ijri.IJRI_133_18
Background: Piriformis muscle syndrome (PMS) is relatively less known and underestimated because it is confused with other clinical pathological conditions. Delays in its diagnosis may lead to chronic somatic dysfunction and muscle weakness. Objective: Here, we aimed to evaluate the diagnostic performance of the ultrasound elastography (UE) as an easy, less-invasive, and cost-effective method for early diagnosis of PMS. Materials and Methods: Twenty-eight cases clinically diagnosed as PMS at the outpatient clinic were evaluated by UE. The elastographic strain ratio was calculated by dividing the strain value of the subcutaneous fat tissue by the mean stress value of the muscle beneath. The diagnostic performances of the strain rate measures were compared using the receiver operating characteristic curve analysis. Results: Twenty-one (N = 21) cases were female, and seven (N = 7) of the cases were male. The mean age was 45 years (ranged 24–62 years). The strain rates of piriformis muscle (PM) and gluteus maximus (GM) muscles were significantly higher on the PMS-diagnosed side (P < 0.001). The cutoff value of UE strain ratio for the PM and GM were 0.878 [95% confidence interval (CI) 0.774–0.981] and 0.768 (95% CI 0.622–0.913), respectively, and the sensitivity and specificity values were, respectively, 80.95% and 85.71% for the PM, and they were, respectively, 85.71% and 66.67% for the GM. Conclusion: We showed that the muscle elasticity and tissue hardening increased on the problematic side both on PM and GM. UE may provide early diagnosis of PMS, thereby increasing the possibility of treatment with less invasive methods.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Magnetic resonance imaging of ankle ligaments

Magnetic resonance imaging of ankle ligaments
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: A pictorial essay p. 419
Yogini Nilkantha Sawant, Darshana Sanghvi
DOI:10.4103/ijri.IJRI_77_16
Ankle trauma is commonly encountered and is most often a sprain injury affecting the ligaments. Accurate diagnosis and appropriate treatment rest on knowledge of complex ligamentous anatomy of ankle and the entire spectrum of pathologies. Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnosing ligament pathologies because of its multiplanar capability and high soft tissue contrast. With MRI, it is possible to triage and attribute the cause of post traumatic ankle pain to bone, ligament, or tendon pathologies, which otherwise overlap clinically. In this pictorial essay, emphasis is given to the intricate and unique anatomy and orientation of ankle ligaments. Pathologies of ankle ligaments have been elaborated.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: An accurate tool to detect cardiac amyloidosis

An accurate tool to detect cardiac amyloidosis

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Myocardial nulling pattern in cardiac amyloidosis on time of inversion scout magnetic resonance imaging sequence – A new observation of temporal variability p. 427
Harshavardhan Mahalingam, Binita Riya Chacko, Aparna Irodi, Elizabeth Joseph, Leena R Vimala, Viji Samuel Thomson
DOI:10.4103/ijri.IJRI_84_18
Context: The pattern of myocardial nulling in the inversion scout sequence [time of inversion scout (TIS)] of cardiac magnetic resonance imaging (MRI) is an accurate tool to detect cardiac amyloidosis. The pattern of nulling of myocardium and blood at varying times post gadolinium injection and its relationship with left ventricular mass (LVM) in amyloidosis have not been described previously. Aims: The aim is to study the nulling pattern of myocardium and blood at varying times in TIS and assess its relationship with LVM and late gadolinium enhancement (LGE) in amyloidosis. Materials and Methods: This was a retrospective study of 109 patients with clinical suspicion of cardiac amyloidosis who underwent MRI. Of these, 30 had MRI features of amyloidosis. The nulling pattern was assessed at 5 (TIS5min) and 10 (TIS10min) minutes (min) post contrast injection. Nulling pattern was also assessed at 3min (TIS3min) in four patients and 7min (TIS7min) in five patients. Myocardial mass index was calculated. Mann-Whitney U test was done to assess statistical difference in the myocardial mass index between patients with and without reversed nulling pattern (RNP) at TIS5min. Results: RNP was observed in 58% at TIS5minand 89.6% at TIS10min. Myocardial mass index was significantly higher in patients with RNP at TIS5min[mean = 94.87 g/m2; standard deviation (SD) =17.63) when compared with patients with normal pattern (mean = 77.61 g/m2; SD = 17.21) (U = 18; P = 0.0351). Conclusion: In cardiac amyloidosis, TIS sequence shows temporal variability in nulling pattern. Earlier onset of reverse nulling pattern shows a trend toward more LVM and possibly more severe amyloid load.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Pulmonary atresia and ventricular septal defect,Coronary artery as the primary source of pulmonary blood flow

Pulmonary atresia and ventricular septal defect,Coronary artery as the primary source of pulmonary blood flow

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Collateral or fistula? Coronary artery as the primary source of pulmonary blood flow in a patient with pulmonary atresia and ventricular septal defect p. 433
Anurag Yadav, Salil Bhargava, T B S Buxi, Krishna Sirvi
DOI:10.4103/ijri.IJRI_489_17
In patients with pulmonary atresia and ventricular septal defect (PA/VSD), a coronary artery being the primary source of pulmonary blood flow is a rare entity. We describe two cases of PA/VSD with coronary-to-pulmonary artery fistula with emphasis on the role of Computed Tomographic Angiography (CTA) in depicting all the sources of pulmonary blood supply, to predict surgical management and need for unifocalization of Major Aortopulmonary Collateral Arteries (MAPCA's).
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Evaluation of lung transplant perfusion using iodine maps from novel spectral detector computed tomography

Evaluation of lung transplant perfusion using iodine maps from novel spectral detector computed tomography
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p. 436
Nils Große Hokamp, Amit Gupta
DOI:10.4103/ijri.IJRI_35_18
We report the case of a 51-year-old patient who underwent bilateral lung transplantation and presented with an unstable condition and sepsis 6 days after transplantation. The performed contrast enhanced spectral detector computed tomography (CT) using a dual-layer detector showed absence of perfusion in the left lung on iodine maps, although branches of the pulmonary artery were patent. This prompted retrospective evaluation of CT images and total venous occlusion of the left pulmonary veins was found. Here, iodine maps helped in raising conspicuity of loss of lung perfusion.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Atypical alveolar proteinosis

Atypical alveolar proteinosis
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p. 439
Lova Hasina Rajaonarison Ny Ony Narindra, Emmylou Gabrielle Andrianah, Volahasina Francine Ranaivomanana, Christian Tomboravo, Hasina Dina Ranoharison, Jean Noel Bruneton, Ahmad Ahmad
DOI:10.4103/ijri.IJRI_170_18
Alveolar proteinosis is a rare pulmonary disease characterized by intra-alveolar accumulation of surfactant composed of lipoproteinaceous material, related to a lack of surfactant resorption by alveolar macrophages. Crazy paving pattern is characteristic, but not specific. The multinodular forms of this affection remain exceptional.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: The normal pancreatic dimensions in pediatric age groups

The normal pancreatic dimensions in pediatric age groups
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Percentile reference curves for normal pancreatic dimensions in Indian children p. 442
Dhanraj S Raut, Dhananjay V Raje, Vithalrao P Dandge, Dinesh Singh
DOI:10.4103/ijri.IJRI_189_18
Objectives: This study aims at determining the normal pancreatic dimensions in pediatric age groups considering demographic parameters and thus developing percentile reference curves for normal pancreatic dimensions in Indian children. Setting and Design: It is a cross-sectional study. Materials and Methods: A hospital-based cross-sectional study was planned at a children hospital during July 2016–December 2017, in which the pancreatic dimensions of 1078 normal children in the age range of 1 month to 19 years were obtained through abdominal ultrasonography (USG). The demographic details like age and gender were obtained for each child. Statistical Analysis Used: Percentile reference curves were obtained with reference to age for each gender type independently. Generalized additive models for location, scale, and shape were used to obtain percentile plots for each pancreatic part. Results: The mean age of children was 6.65 ± 4.43 years and the male-to-female ratio was 1.63:1. The head, body, and tail dimensions increased with the age. For head, up to 25th percentile, the curves were similar for both genders, while subsequent curves were higher in males as compared to females. Similar was the observation for body of pancreas. For tail, up to 75th percentile, the curves were similar for both genders. Conclusion: The normal ranges can be supportive in diagnosis of illness related to pancreas. The dimensions within 5–95th percentile along with iso-echogenicity can be regarded as normal, while the dimensions beyond these limits along with change of echogenicity can be suspected for pancreatic disorders.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Secretory carcinoma (juvenile carcinoma) is one of the very rare breast malignancy reported to be prevalent in pediatric age group

Secretory carcinoma (juvenile carcinoma) is one of the very rare breast malignancy reported to be prevalent in pediatric age group

To:

Clinicoradiologicial aspects of secretory carcinoma breast: A rare pediatric breast malignancy p. 448
Aanchal Bhayana, Ritu N Misra, Sunil K Bajaj, Himani Bankhar
DOI:10.4103/ijri.IJRI_46_18
Secretory carcinoma (juvenile carcinoma) is one of the very rare breast malignancy reported to be prevalent in pediatric age group. We report imaging and clinicopathological features of secretory carcinoma breast with distant and axillary metastasis, in an 11-year-old girl, who presented with a painful lump in right breast. Ultrasound revealed a well-defined, partially microlobulated hypoechoic mass with skin and pectoralis muscle involvement and a suspicious morphology right axillary lymph node. Color Doppler revealed increased vascularity in both the breast mass and suspicious axillary node. Magnetic resonance imaging helped in better evaluation of pectoralis muscle involvement. Computed tomography (CT) neck, chest, and abdomen revealed multiple fibronodular opacities in bilateral lung fields. 18 Flouro-Deoxy-Glucose Positron Emission Tomography (FDG PET-CT) showed a hypermetabolic retroareolar breast mass with multiple hypermetabolic bilateral lung nodules suggesting lung metastasis. The histopathology confirmed the diagnosis of secretory carcinoma. The patient was offered chemotherapy for 2 years and put on follow-up since then.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Vertebral or vascular anomalies, anal atresia, cardiac defects, tracheoesophageal – fistula/esophageal atresia, renal defects, and limbs defects

Vertebral or vascular anomalies, anal atresia, cardiac defects, tracheoesophageal – fistula/esophageal atresia, renal defects, and limbs defects

To:

VACTERL association – Ultrasound findings and autopsy correlation p. 452
Naman Kumar Gaur, Sudheer Gokhale
DOI:10.4103/ijri.IJRI_115_18
VACTERL (vertebral, anal, cardiac, tracheoesophagus, renal, and limbs) is an abbreviation for the congenital group of abnormalities, including vertebral or vascular anomalies, anal atresia, cardiac defects, tracheoesophageal – fistula/esophageal atresia, renal defects, and limbs defects. It is a rare association and not accidental event where several organs are affected by developmental defects during blastogenesis. The exact cause is unknown; however, several environmental and genetic factors are included in literature. Three components out of seven are used to label as VACTERL. The combination is necessary, but the patient may have other congenital malformations as well. We present here an antenatal scan with autopsy correlation of one of the forms of VACTERL association spectrum.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Campomelic dysplasia with 10 pairs of ribs

Campomelic dysplasia with 10 pairs of ribs

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Campomelic dysplasia with 10 pairs of ribs in a preterm neonate: A case report p. 456
Laxman Basani, Roja Aepala, Naresh Macha
DOI:10.4103/ijri.IJRI_173_18
Campomelic dysplasia (CD) is a rare form of skeletal dysplasia (incidence 1:200,000 births) which is associated with characteristic phenotypes including bowing of the limbs, a narrow thoracic cage, 11 pairs of ribs, hypoplastic scapulae, macrocephaly, flattened supraorbital ridges and nasal bridge, cleft palate, and micrognathia. In addition to the skeletal abnormalities, hydrocephalus, hydronephrosis, and congenital heart disease have been reported. We describe a preterm neonate who presented with respiratory failure and clinical features of CD. Our case had only 10 pairs of ribs, and to the best of our knowledge this is the first case report of CD with 10 pairs of ribs.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Preoperative differentiation of benign from malignant thyroid nodules,Diffusion-weighted imaging (DWI) is highly accurate for discrimination between benign and malignant thyroid nodules.

Preoperative differentiation of benign from malignant thyroid nodules,Diffusion-weighted imaging (DWI) is highly accurate for discrimination between benign and malignant thyroid nodules.

To:

Differentiation between benign and malignant thyroid nodules using diffusion-weighted imaging, a 3-T MRI study p. 460
Leila Aghaghazvini, Hashem Sharifian, Nasrin Yazdani, Melina Hosseiny, Saina Kooraki, Pirouz Pirouzi, Afsoon Ghadiri, Madjid Shakiba, Soheil Kooraki
DOI:10.4103/ijri.IJRI_488_17
Background: Preoperative differentiation of benign from malignant thyroid nodules remains a challenge. Aims: This study assessed the accuracy of diffusion-weighted imaging (DWI) for differentiation between benign and malignant thyroid nodules. Materials and Methods: Preoperative DWI was performed in patients with thyroid nodule by means of a 3-T scanner magnetic resonance imaging (MRI). Images were obtained at b value of 50, 500, and 1000 mm2/s to draw an ADC (apparent diffusion coefficient) map. Findings were compared with postoperative histopathologic results. Receiver operating characteristic curve was used to assess the accuracy of different cutoff points. Results: Forty-one thyroid nodules (26 benign and 15 malignant) were included in this study. None of static MRI parameters such as signal intensity, heterogeneity, and nodule border was useful to discriminate between benign and malignant lesions. Mean ADC value was (1.94 ± 0.54) × 10-3 mm2/s and (0.89 ± 0.29) × 10-3 mm2/s in benign and malignant nodules, respectively (P-value < 0.005). ADC value cutoff of 1 × 10-3 mm2/s yielded an accuracy, sensitivity, and specificity of 93%, 87%, and 96% to discriminate benign and malignant nodules. Conclusion: DWI is highly accurate for discrimination between benign and malignant thyroid nodules.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Normal adrenal gland thickness on computerized tomography

Normal adrenal gland thickness on computerized tomography

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in an Asian Indian adult population p. 465
Reetu John, Tharani Putta, Betty Simon, Anu Eapen, Felix Jebasingh, Nihal Thomas, Simon Rajaratnam
DOI:10.4103/ijri.IJRI_129_18

Context: The size and morphology of the adrenal glands are affected by several physiological and pathological conditions. Radiologists need to be aware of the normal thickness of adrenal gland to accurately assess patients with suspected adrenal pathology. However, there is limited data on the normal size of the adrenal glands. Moreover, this has not been studied in our population. Aims: To study the normal thickness of adrenal gland on computerized tomography (CT) in Indian adult population. Settings and Design: Retrospective study in a tertiary care hospital in Southern India. Subjects and Methods: Our study included 586 adults who underwent a CT abdominal angiogram over 15 months, and excluding patients with clinical or imaging evidence of adrenal disease. The measurements made included: the maximum thickness of the body, medial and lateral limbs, measured perpendicular to the long axis. Results: The median age was 51 (range: 18–85) years. The mean maximum thickness of the adrenal body, medial, and lateral limbs were 7.2 ± 1.8, 4.1 ± 1.1, and 4.3 ± 1.1 mm on the right side and 8.8 ± 1.9, 4.7 ± 1.1, and 4.9 ± 1.3 mm on the left. The cumulative thickness of the body and the limbs were 15.6 ± 3.7 mm and 18.4 ± 3.8 mm on the right and left sides, respectively. There was a statistically significant difference in all the measurements between the right and left adrenal glands (all P values = 0.000) and between men and women, being larger in men (P value <0.05). Among our patients 27% had at least one adrenal gland body measuring ≥10 mm in thickness. Conclusions: Our study has defined the normal range of adrenal gland thickness in an Asian Indian adult population, which may be used as a baseline reference for future research and as a reference for radiological reporting.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis

Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis

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Dealing with technical challenges in embolization of a rare aberrant left inferior bronchial artery arising from the left gastric artery in a patient with massive hemoptysis p. 476
Gaurav Gangwani, Ajit Yadav, Amit Dhamija, Arun Gupta
DOI:10.4103/ijri.IJRI_162_18
Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis in a majority of patients. The source of bleeding in a majority of cases is systemic arteries – orthotopic bronchial arteries, anomalous bronchial arteries, or nonbronchial systemic collaterals. We report a case of an aberrant left inferior bronchial artery arising from the left gastric artery (LGA) in a patient with massive hemoptysis. Such origin from infradiaphragmatic vessels and specially left gastric arteries is very rare and needs to be considered by interventional radiologists and pulmonologists in case with hemoptysis disproportionate to supply by orthotopic arteries. Technical challenges were present in the present case in the form of an aneurysm in the aberrant artery and nontarget hepatic and gastric branches arising from LGA. Appropriate selection of hardware and embolic agents was done to deal with the clinical situation.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Ganglion impar injection approaches and outcomes for coccydynia Foye PM, Sajid N, D'Onofrio GJ - Indian J Radiol Imaging

Ganglion impar injection approaches and outcomes for coccydynia Foye PM, Sajid N, D'Onofrio GJ - Indian J Radiol Imaging
To:

We praise your journal and authors Gonnade et al., on the excellent recent publication titled, "Ganglion impar block in patients with chronic coccydynia."[1] Their study of patients with chronic coccydynia (coccyx pain) showed that ganglion impar injections with local anesthetic block and corticosteroid significantly decreased pain and disability scores even at the maximum length of study follow-up, which was 6-month postinjection.

The authors clearly described injecting the ganglion impar via the sacrococcygeal junction. We would like to point out that other needle approaches can also be done, depending on the patient's anatomy. Specifically, interventional physicians should be aware of alternative approaches via the first[2] or second[3] intracoccygeal joint (between coccygeal vertebral bodies one and two, or between coccygeal vertebral bodies three and fourth, respectively). These approaches have been referred to as being transcoccygeal, intracoccygeal, or coccygeal transdiscal. These newer approaches have some potential advantages. First, since the sacrococcygeal joint is fused in 51% of humans,[4] these newer approaches provide access through joints that are more likely to be patent. Second, human cadaver studies have shown that the ganglion impar is usually located at the upper coccyx, rather than at the sacrococcygeal joint.[5]

We noted that the authors excluded from treatment any patients who had imaging abnormalities that would explain their tailbone pain. This surprised us since our experience is that coccydynia patients often respond extremely well to these impar injections, regardless of whether they do or do not have coccygeal imaging abnormalities. We would be very interested in the authors' thoughts on their exclusion criteria.

We hope our comments and the authors' reply will provide even more insights on relieving pain via these injections.
http://www.ijri.org/article.asp?issn=0971-3026;year=2018;volume=28;issue=4;spage=482;epage=483;aulast=Foye

Fwd: Drug-induced changes in dentate nuclei of cerebellum Aswani Y, Aswani N, Sharma R - Indian J Radiol Imaging

We read with great interest the article titled "Sequential MR imaging (with diffusion-weighted imaging) changes in metronidazole-induced encephalopathy" by Singh et al. in the April–June 2017 issue of the Indian Journal of Radiology and Imaging.[1] The article is highly informative and describes signal changes in splenium and dentate nuclei following metronidazole ingestion. In this article, we describe a few drugs that cause similar signal changes in the cerebellar dentate nuclei
http://www.ijri.org/article.asp?issn=0971-3026;year=2018;volume=28;issue=4;spage=480;epage=480;aulast=Aswani

Fwd: Role of proton MR spectroscopy in spinal cord lesions: A guarded espousal Agarwal A - Indian J Radiol Imaging

I read with great interest the article titled "3T proton MR spectroscopy evaluation of spinal cord lesions" by Sathyanathan et al. published in the July–September, 2018 issue of the Indian Journal of Radiology and Imaging.[1] The manuscript is well written and informative. The authors have narrated the MR spectroscopy (MRS) protocol and patterns in various intramedullary spinal lesions in a very efficient manner. However, I would like to make the following contributions and observations pertinent to the study.

In their study cohort of 50 patients, the authors have investigated spectral pattern on intramedullary spinal cord lesions. They designated four of them as schwannoma, which is an extramedullary lesion. Literature shows very few case reports of intramedullary schwannoma, which may be found in neurofibromatosis.[2],[3] Even in the subsequent discussion, the MRS pattern of these lesions is not elaborated. So, it will be of great help if authors could clarify my doubts in this regard.

The present study[1] defines the changes in the metabolites in different spinal lesions based on the deviation in their peak values from the normal spectra. In the previous few studies,[4],[5] the results have been expressed in terms of metabolite ratios, which is an absolute quantification method. Therefore, I would like to know about the authors' experience in evaluating the metabolite ratios and their feasibility pertaining to the study.

High signal-to-noise ratio is addressed in the present study[1] by the use of high magnetic field strength (3 T). However, there are spectral reliability indices such as Cramér–Rao lower bounds of each metabolite, mean, and standard deviation of the spectral line width, the coefficient of variations of the measurements, and the group average of the spectra.[5] These quality indicators can be used in future studies for enhancing the spectral quality and dependability.
http://www.ijri.org/article.asp?issn=0971-3026;year=2018;volume=28;issue=4;spage=481;epage=481;aulast=Agarwal

Three Neighboring Shoulder Defects

No abstract available

https://ift.tt/2A1Ruth

Pili Multigemini After Hair Transplantation

No abstract available

https://ift.tt/2Se1oyY

Patient Falls in Mohs Surgery Practices: A Survey of American College of Mohs Surgery Members

No abstract available

https://ift.tt/2A78GO7

Staged Full-Thickness Excisions and Porcine Xenograft Placement for Extensive Dissecting Cellulitis of the Scalp

No abstract available

https://ift.tt/2Satqvi

Squamous Cell Carcinoma of the Lip in a Patient With Graft-Versus-Host Disease

No abstract available

https://ift.tt/2AagSwT

Prospective Evaluation of Atrophic Acne Scars on the Face With Needle-Free High-Pressure Pneumatic Injection: Quantitative Volumetric Scar Improvement

BACKGROUND Atrophic acne facial scars still pose a treatment challenge. Needle-free high-pressure pneumatic injection has recently been introduced; however, few studies exist regarding its effectiveness. OBJECTIVE To evaluate the efficacy and safety of pneumatic injection for treating atrophic acne scars using a 3-dimensional optical profiling system. METHODS AND MATERIALS A pneumatic injection device with a 0.2-mm nozzle diameter, 50% pressure power, and 85-μL injection volume was used. The degree of depression was examined and analyzed using a 3-dimensional optical profiling system and clinical photographs. The patients also evaluated any side effects. Each subject underwent a single treatment session and was followed up after 1 and 2 months. RESULTS A total of 13 atrophic acne scars from 10 Korean men and women aged 20 to 29 (mean age 25.8 ± 2.4) years were studied. The mean scar volume values were 0.964, 0.741, and 0.566 mm3, respectively, at baseline, 1 month, and 2 months after the injection. Scar volumes after 2 months were significantly different compared with baseline volumes. However, there was no significant difference between the baseline and 1-month volumes. CONCLUSION Treatment with pneumatic injection is safe and effective in reducing atrophic acne facial scars; it results in quantitative improvement in scar volumes. Address correspondence and reprint requests to: Il-Hwan Kim, MD, PhD, Department of Dermatology, Korea University Ansan Hospital, College of Medicine, Korea University, Jeokgeum-ro 123 (Gojan-dong), Danwon-gu, Ansan-si, Gyeonggi-do 15355, Korea, or e-mail: kumcihk@korea.ac.kr This work was supported (Grant No. C0421303) by Project for Cooperative R&D between Industry, Academy, and Research Institute funded by Korea Ministry of SMEs and Startups in 2016. The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2ShjP65

Underappreciated Utility of the Purse-String Suture in Head and Neck Skin Cancer Defect Reconstruction

BACKGROUND The purse-string suture (PSS) is a simple, reversible method for reconstructing skin cancer defects. Its utility may be underappreciated in head and neck reconstructive surgery. OBJECTIVE To evaluate the utility of the PSS as an adjunct to the reconstructive ladder when reconstructing head and neck skin cancer defects. MATERIALS AND METHODS This prospective nonrandomized cohort included 109 consecutive adult patients with head and neck defects resulting from skin cancer resection. The PSS was placed in every patient after resection. Patients were evaluated before and after suture placement, and final reconstructive methods were recorded. RESULTS The PSS resulted in a mean defect area reduction of 77.1% (p

https://ift.tt/2AagNt5

Trichloroacetic Acid 25% Peel to Facilitate Dermabrasion at Difficult Sites in Vitiligo Surgery

No abstract available

https://ift.tt/2SboPsF

Repair of a Multisubunit Defect of the Medial Cheek, Nasal Sidewall, Ala, and Apical Triangle

No abstract available

https://ift.tt/2AagHBJ

Mallet Finger as a Complication of Dermatologic Surgery: Diagnosis, Treatment, and Prevention

No abstract available

https://ift.tt/2Sa1M1j

Histologic Effects of Fractional Laser and Radiofrequency Devices on Hyaluronic Acid Filler

BACKGROUND Hyaluronic acid fillers (HAFs) and energy-based devices are frequently used sequentially. However, the effect of using fractional devices directly over HAF is unclear. OBJECTIVE To evaluate histologic changes after fractional laser and radiofrequency (RF) therapies applied over preinjected HAF. MATERIALS AND METHODS Abdominoplasty skin samples were divided into 8 zones. Intradermal injections of HAF were performed to 7 zones with 1 zone as untreated control. Six of 7 HAF injected zones were then treated with the following devices: 1,540-, 1,550-, 1927-, and 10,600-nm fractional lasers, and fractional bipolar RF delivered through insulated and noninsulated microneedles. After treatment, biopsies were collected for H&E staining. RESULTS Histology revealed HAF in the mid to deep dermis. Treatment with 1,540-, 1,550-, 1927-, and 10,600-nm lasers did not result in any morphologic changes of HAF, although thermal changes from 1,540- and 1,550-nm lasers were in very close proximity to the filler. The RF devices demonstrated thermal damage of HAF along the microneedle tracks. CONCLUSION Hyaluronic acid filler is unaffected by fractional lasers in this model. Fractional RF devices, which produce deeper dermal penetrations, will cause thermal damage of HAF. Caution is advised in using microneedle RF over recently injected filler. Study limitations include use of nonfacial skin and lack of inflammatory response in an ex-vivo model. Address correspondence and reprint requests to: Sarah Hahn Hsu, MD, Maryland Dermatology, Laser, Skin and Vein Institute, 54 Scott Adam Road, Suite #301, Hunt Valley, MD 21030, or e-mail: sarhahn@gmail.com The authors have indicated no significant interest with commercial supporters © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2A99HoO

Pain Management in Patients With Hidradenitis Suppurativa Requiring Surgery

No abstract available

https://ift.tt/2Sadjh9

Use of the Nasalis Sling Flap to Resurface Full-Thickness Defects of the Soft Triangle

No abstract available

https://ift.tt/2A8jqeV

Opioid Prescribing Patterns After Micrographic Surgery: A Follow-up Retrospective Chart Review

BACKGROUND The abuse of opioids has reached epidemic proportions in the United States, and leftover medications are a primary source for nonmedical pain relievers. A past study at the University of Utah showed that micrographic surgeons were likely overprescribing opioids, with 35% of patients receiving a postoperative prescription. OBJECTIVE To examine the current opioid prescribing habits of the micrographic surgeons at the University of Utah compared with those in 2010. METHODS Retrospective chart review of the patient records of 4 micrographic surgeons between February and May 2017. RESULTS Four hundred patient visits were reviewed. An opioid prescription was provided after 12% of encounters, 23% lower than in 2010 (p = .004). Younger patient age, increased number of stages and defect size, repair of the defect, and particular surgeons predicted opioid prescription. CONCLUSION The percentage of patients who received an opioid prescription after undergoing micrographic surgery at the University of Utah decreased from 35% in 2010 to 12% in 2017. Reports of the minimal need of opioids after micrographic surgery, the authors' past study showing an institutional tendency to overprescribe, and reports of the national opioid epidemic likely all contributed to the decrease in opioid prescriptions at the authors' institution. Address correspondence and reprint requests to: Jessica M. Donigan, MD, School of Medicine, 30 North 1900 East, 4A330 Salt Lake City, UT 84132, or e-mail: jessica.donigan@gmail.com The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2Sb99FZ

The Use of Human Amnion/Chorion Membrane and Umbilical Cord Grafts for Treatment of a Scalp Wound With Exposed Bone

No abstract available

https://ift.tt/2A8XxMN

Additive Manufacturing of Transparent Glass Structures

3D Printing and Additive Manufacturing, Volume 5, Issue 4, Page 269-283, December 2018.

https://ift.tt/2ExqPrh

A rare eyelid tumour in an elderly man

https://ift.tt/2T0FvTM

Improved Menstrual Function in Obese Women with Polycystic Ovary Syndrome after Behavioral Modification Intervention ‐ a Randomized Controlled Trial

Summary

Objective

Lifestyle intervention is the recommended first line treatment for overweight women with polycystic ovary syndrome (PCOS). However, the efficacy of lifestyle change in improving reproductive function is still unclear.

Design

A randomized controlled trial with allocation to a behavioral modification program (intervention) or minimal intervention (control) for four months with a follow‐up at 12 months.

Patients

68 women, aged 18‐40 years, BMI ≥ 27 kg/m², fulfilling all Rotterdam PCOS criteria.

Measurements

The primary outcome was improved menstrual regularity. Secondary outcomes were ovulation and pregnancy rates.

Results

At four months, the weight loss was significant in the intervention group (‐2.1%, P=.002), and non‐significant in the control group (‐1.0%). A higher proportion of patients in the intervention group improved menstrual regularity compared to the control group, mean difference 35% (95% CI 16% to 60%), P=.003. There was no difference in ovulation rate between groups. Logistic regression analysis showed that intervention was the only predictor of improved menstrual function, OR 3.9 (95% CI 1.3 to 11.9). At 12 months, a total of 54% of the women improved menstrual regularity compared to baseline (P=.000) and 43% (P=.000) had confirmed ovulation. 38% of the women wishing to become pregnant succeeded within one year of study completion.

Conclusions

This is the first randomized controlled trial in overweight women with PCOS showing efficacy in improving reproductive function following behavioral modification intervention in comparison with minimal intervention. Although extensive weight loss is difficult to achieve in these women, behavioral modification intervention can help improve reproductive function.

https://ift.tt/2rKeCYN

Issue Information

https://ift.tt/2CoCS8T

No clinical utility of common polymorphisms in IGF1, IRS1, GCKR, PPARG, GCK1 and KCTD1 genes previously associated with insulin resistance in overweight children from Romania and Moldova

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print

https://ift.tt/2QEoZw2

Strategic differences in phosphorus stabilization by alum and dolomite amendments in calcareous and red soils

Abstract

Surplus phosphorus (P) above agronomic requirements can negatively affect the water status of connected surface and subsurface water bodies. The in situ stabilization of soil P through soil amendment has been recognized as an efficient way to reduce this environmental pressure. However, the mechanism of how P is stabilized during this process and how plant available P is affected are unknown. This can be achieved by sequential chemical extraction and synchrotron-based X-ray absorption near-edge structure (XANES) spectroscopy investigations. Therefore, in the present study, P-enriched calcareous and red soils were amended with alum, dolomite, and a 1:1 mixture of alum and dolomite (MAD) at a 20 g/kg soil rate, and soil properties and P fractions were measured after a 45-day period. Results showed that alum amendment significantly decreased CaCl₂-P and Olsen-P contents in calcareous and red soils when compared with dolomite. However, dolomite incorporation maintained relatively high P availability and even increased CaCl₂-P and Olsen-P contents by 1.32% and 40.5% in red soil, respectively, compared to control. Amendment with MAD was not as effectively as the alum in P stabilization. Sequential inorganic P extraction indicated that alum dominantly contributed labile P transformed to Al-P in both soils. P K-edge XANES spectroscopy measurements further explained that alum adsorbed phosphate in calcareous soil and precipitated phosphate as AlPO₄ in red soil. Results of P fractionation and Mehlich-3-extracted Ca showed that dolomite mainly adsorbed loosely bound P in calcareous soil and red soil. However, dolomite incorporation in red soil led to Al-P and Fe-P release. The P sorption isotherms showed that dolomite and alum increased soil P sorption maxima and decreased the degree of P saturation (DPS) in both soils, while dolomite declined the Langmuir bonding energy in red soil. Differences in P stabilization by alum and dolomite addition across soil types were closely related to their characteristics, and soil properties changed, especially soil pH.

https://ift.tt/2SX6Nu8

Association of somatosensory dysfunction with symptom duration in burning mouth syndrome

Abstract

Objectives

A standardized battery of quantitative sensory tests developed by the German Research Network on Neuropathic Pain (DFNS) was used to assess the association between somatosensory dysfunction and disease duration in patients with burning mouth syndrome (BMS).

Materials and methods

The 28 female participants with BMS were classified according to disease duration: ≤ 6 months (subchronic BMS, n = 15) and > 6 months (chronic BMS, n = 13); 29 age- and sex-matched healthy volunteers (control group) were recruited from staff of a dental hospital. The DFNS quantitative sensory testing protocol was applied at the ulnar surface of the right forearm and the tip of the tongue. Values for BMS patients and controls were compared and analyzed.

Results

The mechanical detection threshold (MDT) was significantly higher (i.e., loss of sensation) at the tongue tip in the chronic BMS group than in the control group (p = 0.011), whereas mechanical pain sensitivity (MPS) at the forearm was significantly higher (i.e., gain of sensation) in the chronic BMS group than in the control group (Z score = − 2.13 and 1.99, respectively). Multivariate analyses revealed that BMS patients could be discriminated from controls by using pressure pain threshold at the tongue (79.3%) (in the subchronic BMS group) and by MDT and MPS at the tongue tip and MPS at the forearm (96.6 and 89.7%, respectively) (in the chronic BMS group).

Conclusions

In BMS patients with long disease duration, MDT showed loss of sensation.

Clinical relevance

Increased MPS suggests that a neuropathic mechanism in the peripheral and central nervous systems is involved in BMS development.

https://ift.tt/2S5ZVdP

Reduced ecotoxicity and improved biodegradability of cationic biocides based on ester-functionalized pyridinium ionic liquids

Abstract

Ester-functionalized pyridinium ionic liquids (ILs), 1-decyloxycarbonylmethylpyridinium chloride (PyrСOOC₁₀-Cl), and 1-dodecyloxycarbonylmethylpyridinium chloride (PyrСOOC₁₂-Cl) have been synthesized and studied for their environmental toxicity. Simple long-chain pyridinium ILs, 1-dodecylpyridinium chloride (PyrC₁₂-Cl), and commercial disinfectant cetylpyridinium chloride (CPC) were used as reference compounds. Both ester-functionalized ILs and CPC showed significantly reduced antibacterial activity compared to PyrC₁₂-Cl. However, ester-functionalized ILs were found to have excellent antifungal activity towards Candida albicans fungus strains, similar to PyrC₁₂-Cl and much higher than for CPC. The molecular docking of ILs in the active site of the known antifungal target N-myristoyltransferase (Nmt) C. albicans has been conducted. The obtained results indicate the possibility of ILs binding into the Nmt pocket. The high stability of the complexes, especially for PyrCOOC₁₀-Cl, is ensured by hydrogen bonding, electrostatic anion-pi interactions, as well as hydrophobic pi-alkyl and alkyl interactions that was confirmed by calculated binding energy values. The acute toxicity studies of ester-functionalized ILs on D. rerio (zebrafish) hydrobiont have shown their dramatically reduced ecotoxicity compared to PyrC₁₂-Cl and CPC. Thus, LD₅₀ values of 15.2 mg/L and 16.8 mg/L were obtained for PyrCOOC₁₀-Cl and PyrCOOC₁₂-Cl, respectively, whereas CPC had LD₅₀ value of 0.018 mg/L. The primary biodegradation test CEC L-33-A93 of ILs indicated an improved biodegradability of ester-functionalized compounds compared to simple long-chain ILs. Based on the obtained results, PyrCOOC₁₀-Cl may be considered as very promising cationic biocide due to the combination of soft antimicrobial activity and reduced ecotoxicity, as well as improved biodegradability.

https://ift.tt/2UWJYZx

Recycling Discarded Drugs: Improving Access to Oral Antineoplastic Drugs

https://ift.tt/2RcGEdS

Prevalence of Burnout and Career Satisfaction Among Oncologists in China: A National Survey

AbstractBackground.Burnout and career satisfaction has been extensively studied among U.S. and European oncologists, although little is known about the situation among Chinese oncologists. Therefore, we conducted this national survey to investigate the prevalence of burnout and career satisfaction among Chinese oncologists.Patients and Methods.Between September 2015 and December 2016, a cross‐sectional field survey was conducted through the Chinese Society of Clinical Oncology and the Chinese Committee of Rehabilitation and Palliative Care. The full‐length survey consisted of 59 questions investigating personal and professional characteristics and standardized instruments to measure burnout (Maslach Burnout Inventory‐Human Service Survey) and career satisfaction. An additional six questions, derived from the National Survey on the Practice of Medicine by Chinese Physicians related to burnout or career satisfaction, were also included.Results.In total, 3,500 oncologists received the questionnaire, and 2,700 (77.1%) responded, of whom 1,620 (46.3%) were eligible for analysis (median age, 36 years; 56.1% male). Overall, 827 oncologists (51.0%) were burned out. Five factors (lower curative rate of patients, more hours devoted to patient care, more nights on call per week, fewer minutes allocated for return outpatient visits, and more weekends rounding per year) were associated with burnout. Meanwhile, burnout was also strongly associated with a negative view of the physician‐patient relationship (p < .001; odds ratio [OR], 2.07). Notably, the career satisfaction (34.4% for career and 52.1% for specialty) of Chinese oncologists was far less than for their U.S. colleagues, which may result from low compensation (p < .001; OR, 1.660).Conclusion.The overall prevalence of burnout among oncologists in China was similar to oncologists in the U.S., whereas personal accomplishment and career satisfaction were lower. Interestingly, the reasons were different. Beside high workload, the low curative rate of patients was found to be another factor associated with Chinese physicians' burnout. The ongoing Chinese health care system reform may improve the current situation.Implications for Practice.Burnout and career satisfaction has been extensively studied among physicians and oncologists in the U.S. and Europe, but little is known about the situation among Chinese oncologists. This study is the first large‐scale national study of Chinese oncologists using standardized instruments to evaluate burnout and career satisfaction. The experience of burnout has been linked to a long list of negative implications. However, this issue has not aroused enough concern in China until now. This study may have a vital significance for the ongoing Chinese health care reform aiming to improve the Chinese health care system.

https://ift.tt/2GEwKxA

Outcomes and Toxicities of Programmed Death‐1 (PD‐1) Inhibitors in Hodgkin Lymphoma Patients in the United States: A Real‐World, Multicenter Retrospective Analysis

AbstractBackground.Although classical Hodgkin lymphoma (cHL) is highly curable, 20%–30% of patients will not be cured with conventional treatments. The programmed death‐1 (PD‐1) inhibitors (PD‐1i) nivolumab and pembrolizumab have been Food and Drug Administration‐approved for relapsed/refractory (R/R) cHL. There is limited data on the real‐world experience with PD‐1i in cHL and it is unknown whether fewer selected patients treated with PD‐1i derive benefits similar to those observed in published trials.Materials and Methods.We performed a multicenter, retrospective analysis of R/R cHL patients treated with PD‐1i in the nontrial setting. The primary objective was to describe progression‐free survival (PFS) and overall survival (OS) in this population. Secondary objectives were to characterize response rates, toxicities, discontinuation patterns, and post‐PD‐1i therapies.Results.The study included 53 patients from nine U.S. centers. Overall response rate (ORR), complete response (CR), and partial response (PR) to PD‐1i were 68%, 45%, and 23%, respectively. Twelve‐month OS and PFS were 89% and 75%, respectively; median PFS was 29 months. Ninety‐six percent of patients with CR continue to respond at a median follow‐up of 20 months. Toxicities were similar to those previously described. Seventy percent of patients treated with systemic therapy after PD‐1i demonstrated objective responses.Conclusion.To our knowledge, this analysis is the first describing real‐world experience with PD‐1i in cHL patients in the U.S. Here, we demonstrate similar response rates compared to prior studies. The toxicity profile of PD‐1i was similar to that seen in previous studies; we further describe toxicity patterns in those with prior autoimmune disease or allogeneic transplant. Post‐PD‐1i systemic therapies appear active. These results support the effectiveness and tolerability of PD‐1i therapy in R/R cHL in a real‐world setting.Implications for Practice.Two PD‐1 inhibitors have recently been approved for patients with relapsed/refractory classical Hodgkin lymphoma based on results from nonrandomized clinical trials. However, to date, there have been no studies evaluating the effectiveness and toxicity profile of these drugs in the real‐world setting in the U.S. The present study demonstrates that patients treated in a real‐world context experience similar rates of overall effectiveness compared with published clinical trials. Patients who discontinue PD‐1 inhibitors may experience clinical responses to subsequent treatment with systemic chemotherapy or targeted therapy. This study provides clinicians with further insight into the effectiveness and tolerability of PD‐1 inhibitors and suggests that when patients progress while on these drugs, conventional systemic chemotherapy may be an effective treatment option.

https://ift.tt/2R2FO3d

Indoor inhalation dose assessment for thoron-rich regions of Indian Himalayan belt

Abstract

²²²Rn, ²²⁰Rn, and their decay products are significant contributors to background radiation dose. Their concentration level, pertaining exposure, and consequent dose are prime concerns in indoor environments. The present study was performed in 101 dwellings of different villages of Almora district situated in Kumaun hills of Indian Himalayan belt. Measurement of gases and decay products were made in three different types of dwellings (i.e., mud, cemented, and stone with plaster) in three seasons (winter, summer, and rainy). Concentration values for ²²²Rn and EERC were found to be varying in the order of winter > summer > rainy while obtained least in rainy season for the case of ²²⁰Rn and EETC. Concentration values for ²²²Rn and EERC were found to be lesser for cemented houses. Relative standard deviation of concentration values was found to be higher for the rainy season. Yearly averaged concentration values for ²²²Rn, EERC, ²²⁰Rn, and EETC were noted to be higher than the global averages but comparable to some Indian studies. Annual inhalation dose due to ²²²Rn, ²²⁰Rn, and their progeny was found to be 0.55–4.71 mSv/year with an average value of 2.36 ± 0.83 mSv/year. These values were measured for the first time in the study area and provide a link for future studies in the dwellings representing higher concentration values.

https://ift.tt/2EvfFmU

Discharge of biocidal products from healthcare activities into a sewage system—a case study at a French university hospital

Abstract

This study focused on the presence of three biocidal products specific to healthcare facilities, i.e. chlorhexidine digluconate (CHD), bis(aminopropyl)laurylamine (BAPLA), and didecyldimethylammonium chloride (DDAC), in a hospital sewage system. Five sampling campaigns were conducted in 2016 and 2017 throughout the entire Poitiers University Hospital sewage system. DDAC concentrations ranging from 933 ± 119 to 3250 ± 482 μg/L were detected in 24-h composite samples, while lower concentrations (both within the same range) were detected for the two other compounds (i.e. 25 ± 5 to 97 ± 39 μg/L for CHD and 18 ± 3 to 142 ± 16 μg/L for BAPLA). Based on these findings, a mass balance was determined for these discharged compounds to compare the quantities detected in discharges to the amounts used for healthcare in the hospital. Hence, 60–90% of the quantities of DDAC used were found to be present at the hospital sewage outfall. Higher percentages of CHD (100–242%) were noted because of the high presumably quantities used for antiseptic applications, which were not considered in mass balance calculation. Finally, only 10–30% of BAPLA quantities used were detected at the site outfall. Analysis of the results for the different sampling points revealed the nature of the emission sources. For surface applications of DDAC and BAPLA, management of hospital linen is thus a major source of discharged biocidal products, probably following the washing of biocide-soaked textiles used for hospital facility maintenance. Moreover, discharge of biocidal products from a healthcare establishment depends especially on biocide handling practices in the emitting establishment. For BAPLA, compliance with hospital recommended dosages and practices whereby operators are required to prepare tailored quantities of detergents and disinfectants for each specific task could largely explain the limited release of this compound.

https://ift.tt/2EDrc4o

Geochemical characterization of soil samples from gold mining areas using PIXE spectroscopy

Abstract

Particle-induced x-ray emission (PIXE) spectroscopy has been used to characterize soil samples from two relatively old gold mine sites (Iperindo and Itagunmodi) in the Ilesha schist belt of Southwestern Nigeria. This is with a view to identifying the indicator or pathfinder elements of gold for fingerprinting and toxicity potential assessment purposes. Average elemental concentrations of 19 major, minor, and trace elements were determined, and the geochemical data of Mn, Ni, Cu, Zn, Ag, As, Pb, and Au together with multivariate factor and cluster statistical analyses allowed to identify As and Ag as the pathfinder elements of gold. The high concentration of the determined pathfinder elements (As and Ag) as well as other toxic metals (Pb and Cu) implies a relatively high metal contamination risk to the miners and the ecosystem. The major hazard is represented by the abandoned mining wastes, pits, and ponds, already serving as fish ponds.

https://ift.tt/2EvfzM4

Preoperative Nerve Block for Rhinoplasty/Septoplasty

Conditions: Nasal Fracture; Deviated Nasal Septum
Intervention: Drug: Nerve block
Sponsor: University of Southern California
Not yet recruiting

https://ift.tt/2QFkOQt

This Study Tests How BI 754111 is Distributed in Patients With Advanced Non-small Cell Lung Cancer or Patients With Head and Neck Cancer Who Are Treated With BI 754091

Conditions: Carcinoma, Non-Small-Cell Lung; Head and Neck Neoplasms
Interventions: Drug: BI 754111; Drug: [89Zr]Zr-BI 754111; Drug: BI 754091
Sponsor: Boehringer Ingelheim
Not yet recruiting

https://ift.tt/2BspW00

Optimizing nitrogen management to balance rice yield and environmental risk in the Yangtze River’s middle reaches

Abstract

Currently, the urgency of balancing rice production and environmental risk from nitrogen (N) fertilization is gaining scientific and public attention. As such, a field experiment was conducted to investigate the rice yield and the fate of applied-¹⁵N for Yangliangyou 6 (a two-line hybrid cultivar) and Lvdaoq 7 (an inbred cultivar) using 10 combinations of N rates and splitting ratios in the middle reaches of the Yangtze River. The results showed that N application primarily affected fertilizer N loss to the environment, followed by plant N absorption, but had little effect on grain yield. Generally, there was no significant increase in grain yield and N accumulation in the aboveground plant when N inputs surpassed 130 or 170 kg ha⁻¹. Fertilizer N residue in soil peaked at approximately 48 kg ha⁻¹ at an N rate of 170 kg ha⁻¹ for both varieties; however, a sharp increase of fertilizer N loss occurred with further incrementally increasing N rates. Although a higher ratio of panicle-N fertilizer together with a lower ratio of tillering-N fertilizer at rates of 130, 170, and 210 kg ha⁻¹ had no grain yield benefit, it promoted aboveground N accumulation and plant N accumulation derived from fertilizer, and it reduced the amount of N residue in soil and N loss to the environment. Overall, reducing tillering-N ratios and increasing panicle-N ratios at an N rate between 130 and 170 kg ha⁻¹ using fertilizer rates of 90–0–40 kg ha⁻¹ and 90–40–40 kg ha⁻¹ N at basal-tillering-panicle initiation stages could reduce the adverse environmental risks of chemical N from rice production without sacrificing rice yield.

https://ift.tt/2LssLm9

Successful radiofrequency ablation strategies for benign thyroid nodules

Abstract

Purpose

This study aimed to evaluate the effectiveness of ultrasound (US)-guided radiofrequency ablation (RFA) treatment of benign thyroid nodules in consecutive large number series. To find out whether there is any difference according to the nature of the nodules, nodules were subdivided into two groups of predominantly solid vs. predominantly cystic lesions.

Methods

We retrospectively analyzed clinical data of thyroid nodules receiving percutaneous RFA treatment in our institution. We subdivided data into two groups according to the nodule's sonographic characteristics. We defined therapeutic success as a volume reduction rate >50% at 6 months post-RFA. The second ablation was performed in case where <50% VRR was achieved at 6 months. The primary endpoint was to identify factors prognosticating response to RFA treatment.

Results

A total of 1000 patients with 1619 thyroid nodules received US-guided RFA treatment. A volume reduction of >50% (therapeutic success) after the first ablation was 78.9% vs. 78.2% (p = 0.439) and 91.4% vs. 93.4% (p = 0.148) after the final ablation for predominantly cystic vs. predominantly solid lesions, respectively, with comparable post-interventional morbidity. RFA sessions were more frequent in the solid group than in the cystic group. Small volume of thyroid nodule (<4 mL) was the only factor significantly associated with therapeutic success in the multivariate analysis (OR 1.848; 95% CI 1.537–2.789, p = 0.030).

Conclusion

RFA was effective in reducing the volume of benign thyroid nodules volume with non-inferior result in PS group comparing to PC group and can be considered a principal treatment method for treating benign thyroid nodules, including cystic nodules.

https://ift.tt/2EE6Gkm

Excess mortality after craniopharyngioma treatment: are we making progress?

Abstract

Purpose

Craniopharyngioma is associated with an increased risk of mortality even after surgical, radiotherapeutic and hormone supplementations. Previous studies using different designs showed a possible trend of decreasing mortality in recent years. This review summarises studies reporting standardised mortality ratio (SMR) after craniopharyngioma treatment, as well as the bias and confounding in these studies to plan further researches.

Methods

PubMed and Embase was searched for manuscripts published before October 2018 using medical subject heading terms ("craniopharyngioma" or "hypopituitarism" and "mortality").

Results

Eight studies reported SMR after craniopharyngioma treatment, with a total of 2802 patients. The subgroup meta-analysis using random effects model was conducted to pool the SMR, which was 6.2 (95% CI 4.1–9.4) before 2010 and 2.9 (95% CI 2.2–3.8) after 2010 (subgroup test p < 0.01), respectively. Misclassification (one study) and selection bias (six studies) either inflated or deflated the result. The trend of increasing survival rate over the time was observed in studies without reporting SMR. Female patients, childhood-onset disease, hydrocephalus, tumour recurrence, body mass index and panhypopituitarism were identified as the important risk factors for excess mortality.

Conclusions

Though bias and confounding existed across studies, the decreasing SMR and increasing survival rate over the time was in favour of a real signal. It is necessary to launch studies to further investigate the morality and risk factors after multidisciplinary treatment of craniopharyngioma in a hospital-based manner, using the modern statistical method to adjust for bias and confounding.

https://ift.tt/2EwryZG

3D-Printed Conformal Array Patch Antenna Using a Five-Axes Motion Printing System and Flash Light Sintering

3D Printing and Additive Manufacturing, Ahead of Print.

https://ift.tt/2Bt3tjx

Correction to: Cadmium exposure alters steroid receptors and proinflammatory cytokine levels in endothelial cells in vitro: a potential mechanism of endocrine disruptor atherogenic effect

Unfortunately, the figure captions 4 and 6 were incorrectly published in the original publication. The complete correct captions are given below.

https://ift.tt/2R5G5Ct

Successful radiofrequency ablation strategies for benign thyroid nodules

Abstract

Purpose

Methods

Results

Conclusion

https://ift.tt/2EE6Gkm

Excess mortality after craniopharyngioma treatment: are we making progress?

Abstract

Purpose

Methods

PubMed and Embase was searched for manuscripts published before October 2018 using medical subject heading terms ("craniopharyngioma" or "hypopituitarism" and "mortality").

Results

Conclusions

https://ift.tt/2EwryZG

Ex Vivo Confocal Microscopy Of Basal Cell Carcinoma On A 3-Color Scale

Publication date: Available online 19 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Mercedes Sendín-Martín, Antoni Bennàssar, Konstantin L. Levitsky, Javier J. Domínguez-Cruz

https://ift.tt/2UQljFQ

Delayed cutaneous knot for closing defects located in the retroauricular fold

Publication date: Available online 19 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Javier Sabater Abad, Fernando Millán Parrilla, María Matellanes Palacios, Esther Quecedo Estébanez, Enrique Gimeno Carpio

https://ift.tt/2PNPJol

“Retraction of the cheek to enhance visualization of the nasolabial fold region”

Publication date: Available online 19 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Isadore S. Tarantino, Jacob Whitsitt, Rachel T. Pflederer, Daniel J. Aires

https://ift.tt/2POg9qn

Tumor mutational burden and response to PD-1 inhibitors in a case series of patients with metastatic desmoplastic melanoma

Publication date: Available online 18 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Lise Boussemart, Adrienne Johnson, Alexa B. Schrock, Sumanta K. Pal, Garrett M. Frampton, David Fabrizio, Zachary Chalmers, Michal Lotem, Geoffrey Gibney, Jeffery Russell, Bartosz Chmielowski, Jeffrey S. Ross, Philip J. Stephens, Vincent A. Miller, Siraj M. Ali

Abstract

Desmoplastic melanoma (DM) represents an infrequently occurring and distinct histologic pattern of melanomas, often lacking mutations in genes typically altered in conventional melanomas including BRAF, NRAS, and KIT.

We aimed at better characterizing the genetic profile of this subgroup of melanomas to match patients with available therapies.

Pathology reports were reviewed for 1,240 consecutive melanoma cases sequenced by comprehensive genomic profiling (CGP) using a hybrid-capture based next generation sequencing during the course of clinical care. The mutational profile of the 12 DM identified was compared with the remaining 1,228 melanomas examined.

We report a median tumor mutational burden (TMB) of 77 mutations per megabase (mut/Mb) in DM, which was significantly greater than a median of 35 mut/Mb in non-DM. A UV DNA damage signature was detected in 10/12 (83%) DM. For a subset of patients with available clinical course, we report that 100% (5/5) had clinical benefit from treatment with PD-1 inhibitors as monotherapy.

TMB and UV signature show significant promise as an approach to identify patients who are likely to benefit from PD-1 targeted immunotherapy.

https://ift.tt/2UVHdYl

TNF-α Inhibitor-Induced psoriasis: A decade of experience at the Cleveland Clinic

Publication date: Available online 18 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Sean E. Mazloom, Di Yan, Jeffery Z. Hu, Jason Ya, M. Elaine Husni, Christine B. Warren, Anthony P. Fernandez

Abstract

Background

TNF-α inhibitor-induced psoriasis (TNFi-psoriasis) remains poorly understood despite being described 15 years ago. As TNF-α inhibitors (TNFis) often provide life-changing patient benefits, understanding effective treatments for TNFi-psoriasis is important.

Objective

We characterized a cohort of TNFi-psoriasis patients specifically diagnosed and (co)managed by dermatologists at a single tertiary care institution over a ten-year period.

Methods

Retrospective review of patients diagnosed with TNFi-psoriasis between 2003-2013.

Results

102 patients with TNFi-psoriasis were identified. Mean age of onset was 40 years, and there was a female predominance(73.5%). Crohn's disease(48%) and rheumatoid arthritis(24.5%) were the most common primary conditions. Infliximab(52%) was the most common inciting agent. The most common TNFi-psoriasis subtypes were plaque-type(49.5%), scalp(47.5%), and palmoplantar pustulosis(41%). Topical medications alone improved/resolved TNFi-psoriasis in 63.5% patients, and cyclosporine and methotrexate (>10mg weekly) were often effective if topicals failed. Discontinuation of the inciting TNFi with/without other interventions improved/resolved TNFi-psoriasis in 67% of refractory cases, while switching TNFis resulted in persistence/recurrence in 64%.

Limitations

Retrospective nature of study and some patients may have developed typical psoriasis unresponsive to TNFis,

Conclusion

This represents the largest single-institution cohort of TNFi-psoriasis patients diagnosed and (co)managed by dermatologists to date. Based on our findings we propose a treatment algorithm for TNFi-psoriasis.

https://ift.tt/2POTQkm

Wide area digital dermoscopy

Publication date: Available online 18 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Gerson Dellatorre, Guilherme Augusto Gadens

https://ift.tt/2USS0Tj

Editorial Board and Contents

Publication date: January 2019

Source: Trends in Endocrinology & Metabolism, Volume 30, Issue 1

Author(s):

https://ift.tt/2PORBNY

Il-23/Th17 cell pathway: A promising target to alleviate thymic inflammation maintenance in myasthenia gravis

Publication date: Available online 18 December 2018

Source: Journal of Autoimmunity

Author(s): José A. Villegas, Alexandra C. Bayer, Katia Ider, Jacky Bismuth, Frédérique Truffault, Régine Roussin, Nicola Santelmo, Rozen Le Panse, Sonia Berrih-Aknin, Nadine Dragin

Abstract

IL-23/Th17 pathway has been identified to sustain inflammatory condition in several autoimmune diseases and therefore being targeted in various therapeutic and effective approaches. Patients affected with autoimmune myasthenia gravis exhibit a disease effector tissue, the thymus, that harbors ectopic germinal centers that sustain production of auto-antibodies, targeting proteins located in the neuromuscular junction, cause of the organ-specific chronic autoimmune disease.

The present study aims to investigate the IL-23/Th17 cell pathway in the thymic inflammatory and pathogenic events.

We found that thymuses of MG patients displayed overexpression of Interleukin-17, signature cytokine of activated Th17 cells. This activation was sustained by a higher secretion of Interleukin-23 by TEC, in addition to the increased expression of cytokines involved in Th17 cell development. The overexpression of Interleukin-23 was due to a dysregulation of interferon type I pathway. Besides, Interleukin-17 secreted, and Th17 cells were localized around thymic ectopic germinal centers. These cells expressed podoplanin, a protein involved in B-cell maturation and antibody secretion. Finally, production of Interleukin-23 was also promoted by Interleukin-17 secreted itself by Th17 cells, highlighting a chronic loop of inflammation sustained by thymic cell interaction.

Activation of the IL-23/Th17 pathway in the thymus of autoimmune myasthenia gravis patients creates an unstoppable loop of inflammation that may participate in ectopic germinal center maintenance. To alleviate the physio-pathological events in myasthenia gravis patients, this pathway may be considered as a new therapeutic target.

https://ift.tt/2R8HkRh

Sustainable utilization of a recovered struvite/diatomite compound for lead immobilization in contaminated soil: potential, mechanism, efficiency, and risk assessment

Abstract

A waste–struvite/diatomite compound (MAP@Dia) recovered from nutrient-rich wastewater treated by MgO-modified diatomite (MgO@Dia) was provided to immobilize lead in aqueous solution and contaminated soil. The mechanism and effectiveness of lead immobilization was investigated, and the pH_stat leaching test and fixed-bed column experiments were carried out to assess the risk of MAP@Dia reuse for lead immobilization. The results showed that MAP@Dia were effective in immobilizing lead in aqueous solution with adsorption capacity of 832.47–946.50 mg/g. The main mechanism of Pb immobilization by MAP@Dia could be contributed by surface complexation and dissolution of struvite followed by precipitation of hydroxypyromorphite Pb₁₀(PO₄)₆(OH)₂. Lead(II) concentration reduced from 269.61 to 78.26 mg/kg, and residual lead(II) increased to 53.14% in contaminated soil when the MAP@Dia application rate was 5%. The increased neutralization capacity (ANC) and lower lead extraction yields in pH_stat leaching test in amended soil suggested 5 times of buffering capacity against potential acidic stresses and delayed triggering of "chemical time bombs." The results of column studies demonstrated that amendment with MAP@Dia could reduce the risk of lead and phosphorus (P) leaching. This study revealed that MAP@Dia could provide an effective solution for both P recycling and lead immobilization in contaminated soil.

https://ift.tt/2QHu2vM

Inference and control of the nosocomial transmission of methicillin-resistant Staphylococcus aureus.

Inference and control of the nosocomial transmission of methicillin-resistant Staphylococcus aureus.

Elife. 2018 Dec 18;7:

Authors: Pei S, Morone F, Liljeros F, Makse H, Shaman JL

Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a continued threat to human health in both community and healthcare settings. In hospitals, control efforts would benefit from accurate estimation of asymptomatic colonization and infection importation rates from the community. However, developing such estimates remains challenging due to limited observation of colonization and complicated transmission dynamics within hospitals and the community. Here, we develop an inference framework that can estimate these key quantities by combining statistical filtering techniques, an agent-based model, and real-world patient-to-patient contact networks, and use this framework to infer nosocomial transmission and infection importation over an outbreak spanning 6 years in 66 Swedish hospitals. In particular, we identify a small number of patients with disproportionately high risk of colonization. In retrospective control experiments, interventions targeted to these individuals yield a substantial improvement over heuristic strategies informed by number of contacts, length of stay and contact tracing.

PMID: 30560786 [PubMed - in process]

https://ift.tt/2BueReJ

Localization of Deep Brain Stimulation Electrode by Image Registration Is Software Dependent: A Comparative Study between Four Widely Used Software Programs

Background: The control of the anatomic position of the active contacts is essential to understand the effects and adapt the settings of the neurostimulation. The localization is commonly assessed by a registration between the preoperative MRI and the postoperative CT scan. However, its accuracy depends on the quality of the registration algorithm and many software programs are available. Objective: To compare the localization of implanted deep brain stimulation (DBS) leads in the subthalamic nucleus (STN) between four registration devices. Methods: The preoperative stereotactic MRI was co-registered and fused with the 3-month postoperative CT scan in 27 patients implanted in the STN for Parkinson's disease (53 leads). Localizations of the active contacts were calculated in the stereotactic frame space and compared between software programs. Results: The coordinates of the active contacts were different between software programs in the 3 axes (p #x3c; 0.001) with a mean vectorial error between the deepest contact locations of 1.17 mm (95% CI 1.09–1.25). Conclusion: We found a small but significant difference in the coordinates calculated on four different devices. These results have to be considered when performing studies comparing active contact locations or when following patients with an implanted DBS lead.
Stereotact Funct Neurosurg

https://ift.tt/2ECJPFM

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Τετάρτη 19 Δεκεμβρίου 2018

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