18 F-FDG PET/CT diagnostic performance in solitary and multiple pulmonary nodules detected in patients with previous cancer history: reports of 182 nodules

Abstract

Purpose

In oncological patients, ¹⁸F-FDG PET/CT performance for pulmonary nodules' characterization is not well-established. Thus, the purpose of this study was to evaluate the ¹⁸F-FDG PET/CT diagnostic performance in pulmonary nodules detected during follow-up in oncological patients and the relationship between malignancy and nodules' characteristics.

Methods

We retrospectively evaluated 182 pulmonary nodules (121 solitary, 61 multiple; mean size = 16.5 ± 8.1 mm, mean SUVmax = 5.2 ± 5.1) in 148 oncological patients (89 males; mean age = 69.5 ± 8.4 years). Final diagnosis was established by histology or radiological follow-up. Diagnostic performance of ¹⁸F-FDG visual analysis (malignancy-criterion: uptake ≥ mediastinal activity), ROC curve analysis for SUVmax and nodules' characteristics were assessed.

Results

In 182 nodules, the prevalence of malignancy was 75.8%; PET/CT provided sensitivity = 79%, specificity = 81.8%, accuracy = 79.7%, PPV = 93.1%, NPV = 55.4%; ROC analysis (SUVmax cut-off = 1.7) provided sensitivity = 85.5%, specificity = 72.7%. In 121 solitary nodules, the prevalence of malignancy was 87.6%; PET/CT provided sensitivity = 82.1%, specificity = 73.3%, accuracy = 81%, PPV = 95.6%, NPV = 36.7%; ROC analysis (SUVmax cut-off = 2) provided sensitivity = 84%, specificity = 80%. In 61 multiple nodules, the prevalence of malignancy was 52.5%; PET/CT (nodule and patient-based analysis, respectively) provided sensitivity = 68.7% and 88.9%, specificity = 86.2% and 55.6%, accuracy = 77% and 77.8%, PPV = 84.4% and 80%, NPV = 71.8% and 71.5%; ROC analysis (nodule-based, SUVmax cut-off = 1.8) provided sensitivity = 71.9%, specificity = 82.8%. Malignant nodules were prevalent in males, in solitary pattern and in upper lobes, and had significantly greater size and metabolic activity (SUVmax and TLG) than benign ones, with no differences in interval-time between previous cancer diagnosis and nodule detection, patients' age or other nodules' features (lung side, central/peripheral). When comparing solitary and multiple patterns, malignant nodules had significantly greater size and metabolic activity than benign ones in both groups.

Conclusions

In oncological patients, ¹⁸F-FDG PET/CT provides good diagnostic performance for ruling in the malignancy in pulmonary nodules detected during follow-up, even at small size and especially when solitary. In multiple patterns, PET seems useful in the perspective of a personalized management, for identifying the "reference" nodule deserving histological assessment.

http://bit.ly/2QLZYKB

A new frontier for amyloid PET imaging: multiple sclerosis

http://bit.ly/2VSo3mG

Bertoldo, F., Boccardo, F., Bombardieri, E., Evangelista, L., Valdagni, R. (Eds.) Bone Metastases from Prostate Cancer: Biology, Diagnosis and Management

http://bit.ly/2QSzp6m

Longitudinal association between astrocyte function and glucose metabolism in autosomal dominant Alzheimer’s disease

Abstract

Purpose

The spatial resolution of ¹⁸F-fluorodeoxyglucose PET does not allow the specific cellular origin of its signal to be determined, but it is commonly accepted that transport and trapping of ¹⁸F-fluorodeoxyglucose reflects neuronal glucose metabolism. The main frameworks for the diagnosis of Alzheimer's disease suggest that hypometabolism measured with ¹⁸F-fluorodeoxyglucose PET is a biomarker of neuronal injury and neurodegeneration. There is preclinical evidence to suggest that astrocytes contribute, at least partially, to the in vivo ¹⁸F-fluorodeoxyglucose PET signal. However, due to a paucity of PET tracers for imaging astrocytic processes, the relationship between astrocyte function and glucose metabolism in human brain is not fully understood. The aim of this study was to investigate the longitudinal association between astrocyte function and glucose metabolism in Alzheimer's disease.

Methods

The current investigation combined longitudinal PET data from patients with autosomal dominant Alzheimer's disease, including data on astrocyte function (¹¹C-deuterium-l-deprenyl binding) and glucose metabolism (¹⁸F-fluorodeoxyglucose uptake). Research participants included 7 presymptomatic and 4 symptomatic mutation carriers (age 44.9 ± 9.8 years and 58.0 ± 3.7 years, respectively) and 16 noncarriers (age 51.1 ± 14.2 years). Eight carriers and eight noncarriers underwent longitudinal follow-up PET imaging at an average of 2.8 ± 0.2 and 3.0 ± 0.5 years from baseline, respectively.

Results

Longitudinal decline in astrocyte function as measured using ¹¹C-deuterium-l-deprenyl PET was significantly associated with progressive hypometabolism (¹⁸F-fluorodeoxyglucose uptake) in mutation carriers; no significant association was observed in noncarriers.

Conclusion

The emerging data shift the accepted wisdom that decreases in cerebral metabolism measured with ¹⁸F-fluorodeoxyglucose solely reflect neuronal injury, and places astrocytes more centrally in the development of Alzheimer's disease.

http://bit.ly/2VXL9Z1

Correction to: Why harmonization is needed when using FDG PET/CT as a prognosticator: demonstration with EARL-compliant SUV as an independent prognostic factor in lung cancer

An error occurred in the labelling of Fig. 3, where math symbols for SUV thresholds were inverted in panel b when the EARL threshold was applied to the PSF dataset and vice versa. This figure should read as follows: Fig. 3: Prognostic value of tumour SUVmax

http://bit.ly/2QQRy4r

Performance of 18 F-FDG PET/MRI and 18 F-FDG PET/CT for T and N staging in patients with non-small-cell lung cancer

http://bit.ly/2VXLzyz

Severe posterior hypometabolism but normal perfusion in a patient with chronic fatigue syndrome/myalgic encephalomyelitis revealed by PET/MRI

http://bit.ly/2QRo8DA

Amyloid burden identifies neuropsychological phenotypes at increased risk of progression to Alzheimer’s disease in mild cognitive impairment patients

Abstract

Purpose

The extent of amyloid burden associated with cognitive impairment in amnestic mild cognitive impairment is unknown. The primary aim of the study was to determine the extent to which amyloid burden is associated to the cognitive impairment. The secondary objective was to test the relationship between amyloid accumulation and memory or cognitive impairment.

Materials and methods

In this prospective study 66 participants with amnestic mild cognitive impairment underwent clinical, neuropsychological and PET amyloid imaging tests. Composite scores assessing memory and non-memory domains were used to identify two clinical classes of neuropsychological phenotypes expressing different degree of cognitive impairment. Detection of amyloid status and definition of optimal amyloid ± cutoff for discrimination relied on unsupervised k-means clustering method.

Results

Threshold for identifying low and high amyloid retention groups was of SUVr = 1.3. Aß + participants showed poorer global cognitive and episodic memory performance than subjects with low amyloid deposition. Aß positivity significantly identified individuals with episodic memory impairment with a sensitivity and specificity of 80 and 79%, (χ2 = 21.48; P < 0.00001). Positive and negative predictive values were 82 and 76%, respectively. Amyloid deposition increased linearly as function of memory impairment with a rate of 0.13/ point of composite memory score (R = −44, P = 0.0003).

Conclusion

The amyloid burden of SUVr = 1.3 allows early identification of subjects with episodic memory impairment which might predict progression from MCI to Alzheimer's disease.

Trial registration

EudraCT 2015-001184-39.

http://bit.ly/2VXIEpU

Improved beta-amyloid PET reproducibility using two-phase acquisition and grey matter delineation

Abstract

Purpose

We investigated whether the reproducibility of standard visual reporting (STD method) in flutemetamol (FMM) PET can be improved using a newly introduced method that uses grey matter edges derived from the perfusion phase (GM-EDGE method).

Methods

Two-phase FMM PET was performed in 121 patients with mild cognitive impairment. Five nuclear medicine physicians blindly and independently evaluated all late-phase scans, initially employing the STD method and later the GM-EDGE method. A five-point scale was used to express the degree of amyloid positivity, and a binary classification (positive/negative) was used in combination with subjective confidence (five-point scale). Multirater Fleiss' kappa, intraclass correlation coefficient (ICC) and inter-rater reliability (Cohen's kappa) were determined for the STD and GM-EDGE methods.

Results

The weighted Cohen's kappa values for the five-point measure of amyloid positivity ranged from 0.63 to 0.73 (median 0.70) for the STD method and from 0.76 to 0.89 (median 0.80) for the GM-EDGE method (ICC 0.84, 95% CI 0.79–0.88, for the STD method; 0.91, 95% CI 0.89–0.94, for the GM-EDGE method). The nonweighted Cohen's kappa value for the binary classification ranged from 0.73 to 0.93 (median 0.82) for the STD method and 0.90 to 0.97 (median 0.93) for the GM-EDGE method (Fleiss' kappa 0.82, 95% CI 0.77–0.88, for the STD method; 0.93, 95% CI 0.87–0.99, for the GM-EDGE method). The GM-EDGE method resulted in significantly greater subjective confidence in the readings of four physicians (p < 0.010). The binary classification was concordant among all five physicians in 80.8% of the scans using the STD method and in 91.6% of the scans using the GM-EDGE method (p = 0.016).

Conclusion

The newly introduced GM-EDGE method was associated with significantly higher inter-rater agreement among physicians and higher subjective confidence in the reading. The method is easy to implement in clinical practice, especially when the perfusion phase is utilized clinically.

http://bit.ly/2QOhEoQ

Mutational profile of papillary thyroid microcarcinoma with extensive lymph node metastasis

Abstract

Purpose

Papillary thyroid microcarcinoma (PTMC) has excellent outcomes, but extensive lymph node (LN) metastasis can be associated with fatal outcomes. We evaluated the mutational profiles of primary tumors and their metastatic LNs of PTMCs with extensive lateral cervical LN metastases.

Methods

Formalin-fixed, paraffin-embedded archival samples from 16 sets of normal thyroid tissue, the primary PTMC, and the largest metastatic LN were used for targeted sequencing.

Results

A total of seven somatic variants were confirmed in the PTMCs compared to the normal tissue. The BRAF^V600E mutation was the most common and seen in 12 primary tumors (75%) and 11 metastatic LNs (69%). A nonsense mutation in AR and an in-frame deletion in ACVR2A were detected in one primary tumor and its metastatic LN (6%). Missense mutations in KMT2A, RAF1, and ROS1 were detected in one primary tumor (3%). A frameshift deletion mutation in JAK2 was detected in a metastatic LN (3%). In PTMCs without the BRAF mutation, an ALK and RET rearrangement (one PTMC and its metastatic LN, 6%) was detected. In one patient, the BRAF mutation was detected in the primary tumor, but only a RET rearrangement was detected in its metastatic LN. No mutations were detected in two patients.

Conclusion

The mutational frequency of PTMCs was really low, even in those with extensive LN metastasis. The mutational status of the primary tumor and its metastatic LNs were not significantly different, and this suggests a minor role for genetic alterations in the process of LN metastasis in PTMC.

http://bit.ly/2MbitY6

Effect of spiral undersampling patterns on FISP MRF parameter maps

Publication date: Available online 15 January 2019

Source: Magnetic Resonance Imaging

Author(s): Gregor Körzdörfer, Josef Pfeuffer, Thomas Kluge, Matthias Gebhardt, Bernhard Hensel, Craig H. Meyer, Mathias Nittka

Abstract

Purpose

Artifacts arising from undersampling are not always treatable as incoherent noise for the pattern matching process in Magnetic Resonance Fingerprinting (MRF). To estimate the effect of undersampling artifacts on MRF quantitative results, spiral sampling trajectories and their temporal variation is examined.

Methods

The effect of sampling trajectories and their variation during the MRF experiment was assessed by characterizing aliasing artifacts. Temporal rearrangements of sampling trajectories were tested and evaluated in simulations and scans of phantoms and in a volunteer brain.

Results

Results show that some temporal variations of sampling patterns can lead to spatial biases in MRF parameter maps. Observed effects are consistent with derived performance indicators for different interleaving schemes, leading to substantially improved MRF sampling patterns.

Conclusion

With the help of the presented simulation framework, MRF implementations can be investigated and improved. This was demonstrated for a spiral FISP (Fast imaging with steady-state free precession) MRF implementation, where a significantly improved interleaving scheme was identified, and confirmed by experiment.

http://bit.ly/2Hmt1oK

Susceptibility weighted MRI after uterine artery embolization for leiomyoma

Publication date: Available online 15 January 2019

Source: Magnetic Resonance Imaging

Author(s): Yasuyuki Yamahana, Tetsuya Katsumori, Hiroshi Miura, Shunsuke Asai, Sachimi Yamada, Akiko Takahata, Kei Yamada

Abstract

Purpose

To evaluate whether susceptibility-weighted MR imaging (SWI) findings are associated with tumor infarction on contrast-enhanced MRI (CE-MRI) after uterine artery embolization (UAE) for leiomyoma.

Methods

This was a single institution, retrospective study. Between February 2016 and April 2017, 27 consecutive patients underwent UAE and completed SWI and CE-MRI before and 1 week after UAE. Two blinded readers independently reviewed the MRI of 261 tumors ≥1 cm in all patients. We evaluated the relationship between the hypointense peripheral rim observed on the tumor surface on post-procedural SWI and the infarction rates (≥90%, <90%) of each tumor based on post-procedural CE-MRI. Inter-reader correlation coefficients (ICC) and the sensitivity and specificity of the rim were measured.

Results

Substantial inter-reader agreement was noted in post-procedural SWI interpretations (ICC = 0.681, 95% CI; 0.547, 0.771). The rim was observed in 66.7% (174/261) of tumors by reader 1 and 55.9% (146/261) of tumors by reader 2 on post-procedural SWI. Correlations were observed between the rim and ≥90% tumor infarction by readers 1 and 2 (Spearman's coefficient = 0.474 and 0.438, p < 0.001 and p < 0.001, respectively). The sensitivity and specificity of the rim to tumor infarction were 77.2 and 82.6% (reader 1), and 65.8 and 100% (reader 2), respectively.

Conclusions

The present study demonstrated that the hypointense peripheral rim was observed on some leiomyomas on SWI immediately after UAE. The rim correlated with tumor infarction on post-procedural CE-MRI. This SWI finding was helpful for evaluating embolic effects on leiomyomas in the acute phase after UAE.

http://bit.ly/2RN3Ak1

Space-time variant weighted regularization in compressed sensing cardiac cine MRI

Publication date: Available online 14 January 2019

Source: Magnetic Resonance Imaging

Author(s): Alejandro Godino-Moya, Javier Royuela-del-Val, Muhammad Usman, Rosa-María Menchón-Lara, Marcos Martín-Fernández, Claudia Prieto, Carlos Alberola-López

Abstract

Purpose

To analyze the impact on image quality and motion fidelity of a motion-weighted space-time variant regularization term in compressed sensing cardiac cine MRI.

Methods

k-t SPARSE-SENSE with temporal total variation (tTV) is used as the base reconstruction algorithm. Motion in the dynamic image is estimated by means of a robust registration technique for non-rigid motion. The resulting deformation fields are used to leverage the regularization term. The results are compared with standard k-t SPARSE-SENSE with tTV regularization as well as with an improved version of this algorithm that makes use of tTV and temporal Fast Fourier Transform regularization in x-f domain.

Results

The proposed method with space-time variant regularization provides higher motion fidelity and image quality than the two previously reported methods. Difference images between undersampled reconstruction and fully sampled reference images show less systematic errors with the proposed approach.

Conclusions

Usage of a space-time variant regularization offers reconstructions with better image quality than the state of the art approaches used for comparison.

http://bit.ly/2HqC6gj

Mutational profile of papillary thyroid microcarcinoma with extensive lymph node metastasis

Abstract

Purpose

Papillary thyroid microcarcinoma (PTMC) has excellent outcomes, but extensive lymph node (LN) metastasis can be associated with fatal outcomes. We evaluated the mutational profiles of primary tumors and their metastatic LNs of PTMCs with extensive lateral cervical LN metastases.

Methods

Formalin-fixed, paraffin-embedded archival samples from 16 sets of normal thyroid tissue, the primary PTMC, and the largest metastatic LN were used for targeted sequencing.

Results

A total of seven somatic variants were confirmed in the PTMCs compared to the normal tissue. The BRAF^V600E mutation was the most common and seen in 12 primary tumors (75%) and 11 metastatic LNs (69%). A nonsense mutation in AR and an in-frame deletion in ACVR2A were detected in one primary tumor and its metastatic LN (6%). Missense mutations in KMT2A, RAF1, and ROS1 were detected in one primary tumor (3%). A frameshift deletion mutation in JAK2 was detected in a metastatic LN (3%). In PTMCs without the BRAF mutation, an ALK and RET rearrangement (one PTMC and its metastatic LN, 6%) was detected. In one patient, the BRAF mutation was detected in the primary tumor, but only a RET rearrangement was detected in its metastatic LN. No mutations were detected in two patients.

Conclusion

The mutational frequency of PTMCs was really low, even in those with extensive LN metastasis. The mutational status of the primary tumor and its metastatic LNs were not significantly different, and this suggests a minor role for genetic alterations in the process of LN metastasis in PTMC.

http://bit.ly/2MbitY6

Water-soluble ion components of PM 10 during the winter-spring season in a typical polluted city in Northeast China

Abstract

From January 1 to April 22, 2014, an online analyzer for monitoring aerosols and gases (MARGA) was used to measure and analyze water-soluble ions in inhalable particulate matter with a diameter less than 10 μm (PM₁₀) during winter-spring in Shenyang city, China. The results yielded three main findings. (1) During the entire observation period and in seven pollution episodes, SO₄²⁻, NO₃⁻, and NH₄⁺ (SNA) accounted for 84.4–93.1% of the total water-soluble ions (TWSIs). TWSIs accounted for 32% of PM₁₀ mass during the entire observation period, and the contribution of TWSIs in PM₁₀ ranged from 33.4–43.1% in the seven pollution episodes. The contribution of TWSIs components increased during the pollution episodes, but certain differences were observed in different pollution episodes. In terms of ionic equilibrium, the total concentration of negative ions was slightly greater than that of positive ions and the difference was 3.1% of the total ion load on average, indicating that local aerosols are mainly neutral. The water-soluble ions show clear diurnal variation with the high concentration around 09:00 for SO₄²⁻, NH₄⁺, and Cl⁻ which is consistent with the high heating grade index. (2) Pollution episodes often occur in Northeast China, especially during the winter period. Due to the low temperature in the winter, the local coal burning for heating is one of the main sources of pollution besides vehicle exhaust and industrial pollution, which is supported by the higher NO₃⁻/SO₄²⁻ ratio in April than that in January to March. Sometimes, under the prevailing wind directions of W and SSW, the long-distance transport of pollutants from the Beijing-Tianjin-Hebei region and Shandong province superimposed on local pollution leads to the most severe pollution, such as Ep3 and Ep5. (3) SO₄²⁻ concentration is closely related to ambient water vapor pressure (e*), with increase as e* increased depending on the temperature. NO₃⁻ concentration showed a linear relationship of excess NH₄⁺, which suggests homogeneous gas-phase reaction of ammonia and nitric acid is possibly an important pathways of nitrate formation in the haze pollution process in Shenyang City. In addition, our results also suggest the nighttime liquid-phase reaction may cause large increases of nitrate in the haze pollution process.

http://bit.ly/2FwimWC

Experimental assessment and multi-response optimization of diesel engine performance and emission characteristics fuelled with Aegle marmelos seed cake pyrolysis oil-diesel blends using Grey relational analysis coupled principal component analysis

Abstract

This research focuses on the detailed experimental assessment of compression ignition (CI) engine behavior fuelled with Aegle marmelos (AM) seed cake pyrolysis oil blends. The study on effects of engine performance and emission a characteristic was designed using L₂₅ orthogonal array (OA). These multi-objectives were normalized through gray relational analysis (GRA). Likewise, the principal component analysis (PCA) was performed to assess the weighting values respective to every performance and emission characteristics. The variability induced by using the input process parameters was allocated using analysis of variance (ANOVA). Hence, GRA-coupled PCA were employed to determine the optimal combination of CI engine control factors. The greater combination of engine characteristics levels were selected with F₅ and W₅. The higher brake thermal efficiency (BTE) have been obtained for F20 fuel as 22.01% at peak engine load, which is 11.43% for diesel. At peak load condition, F20 fuel emits 14.99% lower HC and 18.52% lower CO as compared to diesel fuel. The improved engine performance and emission characters can be attained by setting the optimal engine parameter combination as F20 blend at full engine load condition. The validation experiments show an improved average engine performance of 67.36% and average lower emission of 64.99% with the composite desirability of 0.8458.

http://bit.ly/2FAr9pO

Analysis of the spatial variation of indoor radon concentrations (national survey in Bulgaria)

Abstract

This paper presents the methodology and results of the national radon survey in Bulgaria and its spatial variability. The measurements were carried out in 2778 dwellings using CR-39 track detectors over two successive 9 and 3-month periods from April 2015 to March 2016. The arithmetic (AM) and geometric (GM) means of annual indoor radon concentration were 111 ± 105 Bq/m³ and 81 Bq/m³ (GSD = 2.15), respectively. The distribution of data has been accepted to be log-normal. Two hypotheses have been investigated in the paper. The first one was a spatial variation of indoor radon concentration and the second was spatiality of the factor that influences radon variation. The indoor radon concentrations in the 28 districts have been significantly different, which prove the first hypothesis. The influence of the factors, geology (geotectonic unit, type of rock, and faults distance of the measuring site), type of the region, and the presence of the basement in the building on radon spatial variation, was examined. The analyses have been shown that they significantly affect radon variations but with a relatively small contribution in comparison to the radon variation between district. Furthermore, the significance and contribution of the investigated factors were different in each district, which confirmed the second hypothesis for their spatiality.

http://bit.ly/2FrXa4b

Journal of Nursing and Midwifery Sciences, a publication of Mazandaran University of Medical Sciences, is a peer-reviewed online journal with Quarterly print on demand compilation of issues published. The journal's full text is available online at: http://www.jnmsjournal.org. The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository.

ORIGINAL ARTICLES
	The effect of concurrent endurance and resistance training on cardio-respiratory capacity and cardiovascular risk markers among sedentary overweight or obese post-menopausal women	p. 123
	Anahita Shabani, Ramin Shabani, Setila Dalili, Afagh Hassanzadeh Rad DOI:10.4103/JNMS.JNMS_34_18   Context: Exercise training has been inversely associated with cardiovascular risk factors. However, the clinical trials examining the effect of exercise training on reducing cardiovascular risk factors have produced conflicting results. Aims: We aimed to assess the effect of concurrent exercise training on cardiorespiratory capacity and cardio-vascular risk factors among sedentary overweight or obese post-menopausal women. Settings and Design: This randomized controlled trial was done in 2016. Materials and Methods: This study was conducted on 22 healthy post-menopausal overweight and obese females, which randomly divided into concurrent endurance and resistance (ER) exercise (n = 12) and control (n = 10) groups. The participants did not have any history of any serious medical condition or using drugs. Demographic questionnaire was completed, vital signs and biochemical tests were measured, and Rockport one-mile submaximal exercise test for assessing maximal oxygen consumption (VO2max) was performed before and after the study. Statistical Analysis Used: Mean, standard deviation, and paired and independent t-test were used for statistical analysis. Results: The data from the ER groups showed that the body mass index (BMI), heart rate (HR), systolic and diastolic blood pressure, triglyceride, high-sensitivity C-reactive protein (CRP) decreased, high-density lipoprotein, and VO2max increased significantly, during the 8 weeks (P < 0.05). Moreover, no changes were found in the cardiovascular risk factors of women who did not exercise (P > 0.05). Conclusion: Concurrent ER training can be a suitable exercise program for improving plasma lipid profile as well as reducing body composition, high-sensitivity CRP, and increasing VO2max in postmenopausal women.
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	The effect of staff training on the amount of sound pollution in the intensive care unit	p. 130
	Kobra Zamani, Hossein Ali Asgharnia, Jamshid Yazdani, Zohreh Taraghi DOI:10.4103/JNMS.JNMS_38_18   Context: Sound pollution is a common problem in intensive care units (ICUs) with unfavorable consequences.Aims: The aim of the current study was to determine the effect of staff training on the amount of sound pollution in the ICU. Setting and Design: This quasi-experimental study was conducted in the ICU of Rouhani Hospital in Babol. Materials and Methods: Level of equivalent (leq) sound was measured in three work shifts for 2 weeks, before and after training, in 2 workdays and a holiday, using a systematic network stationing method. The sample size was determined based on the days of measurement, work-shift, and measuring stations (6 × 3 × 10 = 180). Indirect training was performed. A 2-week opportunity was given to study materials. Statistical Analysis Used:Data were analyzed using paired t-test and RMANOVA. Results: Following the training, the mean leq in all stations (ten stations) decreased from 67.21 to 62.11 dB (P = 0.002). Conclusion: Although the amount of sound pollution decreased significantly after training, it was still higher than standard. To achieve the desired level of sound, continuous monitoring of sound at intervals of 6 months, along with structural engineering and equipment, is suggested.
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	The effect of relaxation exercises on emotions of primigravida women in famenin	p. 134
	Farzaneh Soltani, Samerah Ghlichkhani, Arezoo Shayan, Parisa Parsa, Ghodratollah Roshanaei DOI:10.4103/JNMS.JNMS_32_18   Context: Recognizing effective interventions for improving women's positive emotion can improve mental health and self-confidence in anxious women, at least during pregnancy. Aim: This study aimed to investigate the effect of relaxation training on positive and negative emotions of primigravida women. Setting and Design: In this randomized quasi-experimental study, 100 primigravida women with gestational age of 28–32 weeks, who were referred to the prenatal care centers in Famenin City (Hamadan, Iran), were randomly assigned into two groups of intervention and control, using randomized blocking. Methods and Material: All the pregnant women completed the positive and negative affect schedule questionnaire. In the intervention group, eight sessions were held twice a week with emphasis on relaxation techniques. The control group received routine prenatal care.Statistical Analysis Used: Descriptive statistics, independent and paired t-tests were used to compare the difference between and within two groups. Results: The mean score of positive emotion increased from 31.92 ± 6.39 to 34.12 ± 5.41 after intervention (P = 0.034). In contrast, the mean score of positive emotion in the control group reduced from 33.62 ± 6.58 to 26.92 ± 6.35 after the intervention (P < 0.001). In addition, there was a significant difference between the mean scores of positive emotion in the two groups after the intervention (P < 0.001). The mean score of negative emotion reduced from 24.12 ± 7.06 to 17.18 ± 5.95 in the intervention group (P < 0.001). On the other hand, the mean score of negative emotion in the control group increased from 22.08 ± 6.85 to 28.42 ± 7.24 after the intervention (P < 0.001). There was a significant difference between the mean scores of negative emotion in the two groups after the intervention (P < 0.001). The mean score of positive emotion of the women increased after the intervention (from 31.92 ± 6.39 to 34.12 ± 5.41) (P = 0.034). In contrast, the mean score of positive emotion of the women in the control group reduced after the intervention (from 33.62 ± 6.58 to 26.92 ± 6.35) (P < 0.001). Also, the mean score of negative emotion reduced in the intervention group (from 24.12 ± 7.06 to 17.18 ± 5.95). On the other hand, the mean score of negative emotion of the women in the control group significantly increased after the intervention (from 22.08 ± 6.85 to 28.42 ± 7.24).Conclusion: Research findings suggest that relaxation training may increase positive emotion and reduced negative emotion in pregnant women. It is recommended that relaxation techniques are used in prenatal care centers as a simple and available health intervention in pregnancy.
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	Qualitative needs assessment: Iranian parents' perspectives in sexuality education of their children	p. 140
	Jila Ganji, Mohammad Hassan Emamian, Raziyeh Maasoumi, Afsanah Keramat, Effat Merghati-Khoei DOI:10.4103/JNMS.JNMS_42_18   Context: Parental education in sexuality plays a vital role in children's lives. Aims: The purpose of this study was to explore Iranian parents' perspectives about the needs of children sexuality education. Setting and Design: This qualitative study was done in 2016. Materials and Methods: In this qualitative inquiry, seven sessions of community group interview and focus group discussions were conducted with the parents of Ghaemshahr, Iran, using purposive sampling (n = 39, 27 mothers and 12 fathers). Statistical Analysis Used:We employed thematic analysis method to extract our findings. Results: The findings were categorized into three essential needs: (1) parents' preparedness, (2) efficacious parental management, and (3) supportive environments. The sub-theme describing the theme 1 includes "the need for adequate knowledge to answer the sexual questions and the child's sexual curiosity" and "the need for awareness about the time of beginning an appropriate sexuality education for children." Moreover, the sub-theme describing theme 2 includes "the need for sufficient skills to begin proper and intimate communication," "the need for effective monitoring and care," and "the need for capability in managing the child sexual behavior." Moreover, the sub-theme describing theme 3 includes "the need to receive training from sexual health professionals," "the need for authorized sexuality education programs," "the need for national-wide policy-making and strategy planning in sexuality education," and "the need for a comprehensive and complete educational resource." Conclusion: Our findings suggest that to address the goals in sexuality education for children, parents' need to be prepared in knowledge, and gaining positive attitude and practical skills. To achieve these goals, supportive environments must be provided by policy-makers and health providers with culturally appropriate strategy planning.
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	Strategies for improving the integrated program of HIV/AIDS with sexual and reproductive health: using nominal group technique	p. 147
	Maryam Hajizadevalokolaee, Zohreh Shahhosseini, Soghra Khani, Fereshteh Yazdani, Zeinab Hamzeghardeshi DOI:10.4103/JNMS.JNMS_35_18   Context: The spread of HIV is growing, so that its way of transmission has created worries in the field of sexual and reproductive health, because the wave of transmission has changed from injection to sexual activities.Aims: To evaluate the perspectives of sexual and reproductive health experts and providers on strategies for improving the integrated program of HIV/AIDS with sexual and reproductive health using the nominal group technique (NGT). Setting and Design: Mazandaran University of Medical Sciences, Sari, Iran. NGT. Materials and Methods: It was a semiquantitative/qualitative methodology research through NGT, based on the opinions of 30 experts and sexual and reproductive health providers in the field of health in Mazandaran (2016).Statistical Analysis Used: Semiquantitative/qualitative analysis. Results: In total, 15 cases got the scores of 2–62 as strategies to improve the integrated program of HIV/AIDS with sexual and reproductive health. The highest scores were found in society-centered level and stigma management, and the lowest scores were found in individual-centered level and negotiation skill training. Conclusion: One of the strategies to improve the integrated program of HIV/AIDS was the empowerment of women and men in sexual and reproductive health and stigma management. Based on the results, the NGT is a useful tool for doing researches and prioritizing the programs. Based on the expert opinion, it can be concluded that designing strategies based on individual-, community-, and society-centered approach would be an appropriate approach for improving the integrated program of HIV/AIDS with sexual and reproductive health issues in Iranian society.
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	Evaluation of occupational hazards for nurses in intensive care units of tertiary care centers	p. 153
	Kobra Abdi Zarrini, Akram Sanagoo, Leila Jouybari, Mohammad Ali Vakili, Ali Kavosi DOI:10.4103/JNMS.JNMS_52_18   Context: Nursing is a high-risk occupation, and intensive care units (ICUs) are one of the most sensitive hospital wards. Aim: This study aimed to determine the level of occupational hazards among nurses in the ICUs. Setting and Design: This descriptive-analytical study was conducted on a total of 281 nurses in the ICUs of tertiary care centers in Golestan and Mazandaran Universities of Medical Sciences in 2017. Materials and Methods: Data were collected using a five-dimensional occupational hazard questionnaire. Statistical Analysis Used: Data analysis was performed in SPSS software (version 16) and descriptive and inferential statistics were considered statistically significant (P < 0.05). Results: In this study, 75.1% of the nurses were female and 50.9% of the participants were within the age range of 26–35 years. The total mean and standard deviation of occupational hazards was 3.20 ± 0.66. In addition, the mean values and standard deviations of chemical, ergonomic, biological, psychosocial, and organizational, as well as physical hazards were reported to be 2.43 ± 1.06, 2.6 ± 0.82, 2.63 ± 0.91, 3.38 ± 0.7, and 3.38 ± 0.86, respectively. According to the results, significant differences were observed between occupational hazards and variables of gender, marital status, educational level, and work experience (P = 0.0001). Conclusion: Occupational hazard level was moderate among nurses in the ICUs, and most of the damages were related to the physical dimension. In addition to holding educational workshops in tertiary care centers by the related officials, proper preventive plans must be designed to reduce occupational injuries.
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	Incidence and risk factors of pressure ulcers among general surgery patients	p. 159
	Ensieh Ramezanpour, Amir Emami Zeydi, Mohammad Ali Heidari Gorji, Jamshid Yazdani Charati, Mahmood Moosazadeh, Vida Shafipour DOI:10.4103/JNMS.JNMS_23_17   Context: Pressure ulcers are among the main postoperative complications which isassociated with an increased length of hospitalization. Determining risk factors of postsurgical pressureulcers is crucial for developing prevention and treatment strategies. Aims: This study aimed to investigate the incidence rate of pressure ulcer and related risk factors after general surgery. Settings and Design: This descriptive cross-sectional study was carried out in three hospitals in Mazandaran province in 2016. Materials and Methods: The sample size was 191 surgical patients undergoing general surgery by using census method. Data were collected in pre-, intra-, and post-operative period using demographic and clinical questionnaires and also, through the Braden Scale for Predicting Pressure Ulcer Risk. Statistical Analysis Used: Descriptive statistics, t-test, Chi-square, and univariateand multivariate logistic regression were used to analyze the data. Results: The incidence rate of postoperative pressure ulcers in patients was 17.8% (34 out of 191 patients). Based on the multivariate logistic regression model, significant correlations existed between the incidence of pressure ulcers and the following variables: age over 70 years old (P = 0.003), history of hypertension (P = 0.035), history of heart diseases (P = 0.029), Braden score <15 (P = 0.017), type of surgery (P = 0.003), and type of anesthesia (P = 0.015).Conclusions: Since it is critical to consider the incidence of postoperative pressure ulcers among patients, further measurements are required to identify high-risk people and use preventive protocols by nurses at pre-, intra-, and post-operative levels. Moreover, it requires extra attention in patients over 70 years, those with a history of hypertension and heart diseases, and those undergoing emergency surgery and spinal anesthesia.
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	The relationship between the quality of nursing care and the satisfaction of pregnant mothers	p. 165
	Ali Hatami, Zohreh Saeidlandi, Azam Jahanghiri Mehr, Akram Hemmatipour DOI:10.4103/JNMS.JNMS_44_18   Context: The Health System Development Plan is one of the key steps taken by the eleventh government to promote health services in the country. Aims: The aim of this study was to determine the relationship between the quality of nursing care and the satisfaction of pregnant mothers from the implementation of the health system development plan. Settings and Design: This research was an analytic cross-sectional study. The study population included 163 mothers who were hospitalized before delivery and 18 nurses from maternity sections who were selected by the census method during the 3 months of September 2017–November 2017. Material and Methods: The data collection tool was a demographic data form, quality patient care scale, and a researcher-made questionnaire on the satisfaction of hospitalized mothers in maternity sections of the implementation of the Health System Reform Plan. Statistical Analysis Used: Data were analyzed using descriptive statistics, Mann–Whitney test, and correlation coefficient in SPSS-16 software. Results: The results showed that the quality of care in nurses at the desired level (63%) and the satisfaction of mother maternity sections of the delivery system had a moderate level of implementation of the Health System Development Plan (56.3%). The results of Pearson's correlation test showed that there is a statistically significant relationship between the quality of nursing care and patient satisfaction (P = 0.001). Conclusions: The satisfaction of the mothers participating in the research was that the quality of nursing care was often modest after implementing the Health System Reform Plan.
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Molecular epidemiology of locally acquired Hansen’s disease in Central Florida

Publication date: Available online 15 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Christina Dai, Ahmed Ansari, Shawn Shih, Vilma Marks, Rahul Sharma, Jeffrey Greenwald

http://bit.ly/2TXkpGz

Note to dermatopathologists: when it comes to moderately atypical nevi, leave the treatment plan to clinicians

Publication date: Available online 15 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Thomas N. Helm, Catherine G. Chung, Klaus F. Helm

http://bit.ly/2DbGSd2

Microneedling with dermaroller 192 needles along with 5-fluorouracil solution in the treatment of stable vitiligo

Publication date: Available online 15 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Akshy Kumar, Rakesh Bharti, Shail Agarwal

http://bit.ly/2TKIvnA

Risk of neurodegenerative disorders in Korean patients with vitiligo: A nationwide retrospective cohort study

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Tae-Gyun Kim, Jaeyong Shin, Shinwon Hwang, Si-Hyung Lee, Hyeon Chang Kim, Sang Ho Oh

http://bit.ly/2DaX8eB

Melanoma and Melanoma In-Situ Diagnosis after Excision of Atypical Intraepidermal Melanocytic Proliferation (AIMP): A Retrospective Cross-Sectional Analysis

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Nina R. Blank, Brian P. Hibler, Ian W. Tattersall, Courtney J. Ensslin, Erica H. Lee, Stephen W. Dusza, Kishwer S. Nehal, Klaus J. Busam, Anthony M. Rossi

Abstract

Background

There is little evidence to guide surgical management of biopsies yielding the histologic descriptor "atypical intraepidermal melanocytic proliferation" (AIMP).

Objective

Determine frequency of and factors associated with melanoma and melanoma in-situ (MIS) diagnoses after excision of AIMP and evaluate margins used to completely excise AIMP.

Methods

Retrospective, cross-sectional study of 1127 biopsies reported as AIMP and subsequently excised within one academic institution.

Results

Melanoma (in-situ, stage 1A) was diagnosed after excision in 8.2% (92/1127) of AIMP samples. Characteristics associated with melanoma/MIS diagnosis included age 60-79 (OR 8.1, 95% CI 2.5-26.2), age >80 (OR 7.2, 95% CI 1.7-31.5), head/neck location (OR 4.9, 95% CI 3.1-7.7), clinical lesion partially biopsied (OR 11.0, 95% CI 6.7-18.1), and lesion extending to deep biopsy margin (OR 15.1, 95% CI 1.7-136.0). Average surgical margin used to excise AIMP lesions was 4.5mm (SD 1.8).

Limitations

Single-site, retrospective, observational study; interobserver variability across dermatopathologists.

Conclusion

Dermatologists and pathologists can endeavor to avoid ambiguous melanocytic designations whenever possible through excisional biopsy technique, interdisciplinary communication, and ancillary studies. In the event of AIMP biopsy, physicians should consider the term a histological description rather than a diagnosis, and, during surgical planning, use clinicopathologic correlation while bearing in mind factors that might predict true melanoma/MIS.

http://bit.ly/2TSBnG2

Rosacea: Relative risk vs Absolute Risk of Malignant Comorbidities

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Leonardo A. Tjahjono, Abigail Cline, William W. Huang, Alan B. Fleischer, Steven R. Feldman

http://bit.ly/2DbMGDu

Hydroa vacciniforme-like lymphoproliferative disorder: Clinicopathologic study of 41 cases

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Yanghe Liu, Cuiling Ma, Gang Wang, Lei Wang

Abstract

Background

Hydroa vacciniforme-like lymphoproliferative disorder (HVLLPD) is a rare Epstein-Barr virus (EBV)-related disease usually found in East Asians and Latin Americans.

Objective

To report the characteristics of HVLLPD in Chinese patients.

Methods

Retrospective analysis of HVLLPD patients from a single institute.

Results

Forty-one patients were enrolled. All cases presented with papulovesicular lesions, mainly distributed on sun-exposed areas. Twenty-six cases showed systemic symptoms. Follow-up data was available in 20 cases, 16 patients were alive, and 4 patients died. Among the 4 deceased patients, 3 had serum EBV DNA test and showed high viral loads. These 3 patients also received chemotherapy. Histopathology was characterized by dense proliferation of lymphocytes in the dermis. Angiotropism or angiodestruction was found in majority cases, while prominent cellular polymorphism was noticed in only 4 cases. All cases were positive for CD3, TIA-1, and EBV-encoded RNA in situ hybridization.

Limitations

This was a retrospective study.

Conclusions

HVLLPD in Chinese patients showed indolent behavior in the majority of cases, which differed from HVLLPD characteristics in Latin Americans. Patients with high serum EBV DNA loads had an increased risk of evolving into aggressive disease. Chemotherapy should not be considered as first line treatment for most Chinese patients.

http://bit.ly/2TSBoK6

Risk of bias assessment in primary studies for the development of systematic reviews: a reflection about exposure to systemic dermatological drugs and its effects on infertility and teratogenicity in males

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Gianfranco Enriquez-Gutierrez, Fernando Sosaya-Muñoz, Claudia Rojas-Varona, Edward Mezones-Holguín

http://bit.ly/2DaX929

Efficacy and safety of antiscabietic agents: A systematic review and network meta-analysis of randomized controlled trials

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Kunlawat Thadanipon, Thunyarat Anothaisintawee, Sasivimol Rattanasiri, Ammarin Thakkinstian, John Attia

Abstract

Background

Many drugs have been used to treat scabies, but it is unclear which of them is the most efficacious.

Objective

To evaluate the comparative efficacy and safety of antiscabietic agents.

Methods

Systematic review of randomized controlled trials was conducted. Direct and network meta-analyses were applied to 13 antiscabietic agents on 3 outcomes (cure, persistent itching, and adverse events). Their probability of having highest efficacy and safety was estimated and ranked.

Results

Network meta-analysis based on 52 trials in 9917 patients indicated that permethrin (the reference treatment) had significantly higher cure rate than sulfur, malathion, lindane, crotamiton, and benzyl benzoate. Permethrin+oral ivermectin combination had non-significantly higher cure rate than permethrin. Permethrin+oral ivermectin combination, topical ivermectin, and synergized pyrethrins were the treatment ranked highest in terms of cure, persistent itching, and adverse events, respectively. Based on clusterd ranking, permethrin, oral ivermectin, and synergized pyrethrins seemed to retain balance between cure and adverse events.

Limitations

There are small numbers of trials and patients in some comparisons, and high risk of bias in some trials.

Conclusion

There is no one treatment that ranked highest in all aspects. Physicians should consider the drug's efficacy and safety profiles, along with ease of administration.

http://bit.ly/2TOAdLt

Clinicopathologic, misdiagnosis and survival differences between clinically amelanotic melanomas and pigmented melanomas

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Lauren C. Strazzulla, Xiaoxue Li, Kathleen Zhu, Jean-Phillip Okhovat, Sandra J. Lee, Caroline C. Kim

Abstract

Background

Amelanotic malignant melanoma (AMM) is challenging to diagnose. Clinical risk factors for AMM are not well defined.

Objective

To investigate clinicopathologic, misdiagnosis and survival differences between AMM versus (vs.) pigmented malignant melanoma (PMM) patients.

Methods

A cross-sectional retrospective medical record review at a tertiary academic medical center.

Results

933 melanoma patients with known presenting tumor color were identified (342 AMM vs. 591 PMM). AMM was associated with older age, history of non-melanoma skin cancer and red hair, while AMM was inversely associated with a family history of melanoma, >50 nevi and a history of dysplastic nevi. AMM was more likely on the head/neck compared to PMM, had more aggressive pathologic features (greater Breslow depth/mitoses, ulceration, nodular subtype), and was less likely associated with a precursor nevus or regression. Finally, patients with AMM were more likely to be misdiagnosed than PMM (25% vs. 12% clinically; 12% vs. 7% pathologically), and had poorer melanoma-specific survival (5-year overall survival rate: 0.77 [95% confidence interval (CI): 0.72-0.82] vs. 0.84 [CI: 0.80-0.87]).

Limitations

Retrospective study design, single institutional study.

Conclusion

Greater clinician awareness, lower biopsy thresholds, and increased patient education may be useful to enhance AMM detection in patients with certain characteristics.

http://bit.ly/2DaZl9E

Dermoscopy in lymphoproliferative disorders – experience from a cutaneous lymphoma clinic in a tertiary cancer center

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Shamir Geller, Cristián Navarrete-Dechent, Patricia L. Myskowski

http://bit.ly/2TQZip8

Prevalence of clinically significant incidental findings by whole-body FDG-PET/CT scanning in moderate-to-severe psoriasis patients participating in clinical trials

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Marilyn T. Wan, Drew A. Torigian, Abass Alavi, Judith Alvarez, Zelma C. Chiesa Fuxench, Megan H. Noe, Maryte Papadopoulos, Daniel B. Shin, Junko Takeshita, Thomas J. Werner, Nehal N. Mehta, Joel M. Gelfand

Abstract

Objective

Determine the prevalence of incidentalomas and rate of malignancy identified by FDG-PET/CT imaging in clinical trial patients with moderate-to-severe psoriasis.

Methods

Cross-sectional secondary analysis of moderate-to-severe psoriasis patients who underwent FDG-PET/CT scans at the baseline visit, prior to randomization, for three phase 4 vascular inflammation in psoriasis clinical trials. Only patients without active infection, malignancy or uncontrolled comorbidities were eligible for the clinical trials.

Results

259 healthy patients with moderate-to-severe psoriasis underwent an FDG-PET/CT scan as part of study procedures. Thirty-one patients (11.97% [95% Confidence Interval (CI):8.28-16.56]) had clinically significant incidentalomas on the baseline FDG-PET/CT scan. Univariate logistic regression demonstrated that with every increase in 10 years of age, there was an approximate 30% increased risk of discovering an incidentaloma (Odds Ratio 1.30 [95%CI:1.01-1.68]). Of the findings suspicious for malignancy (n=28), cancer was confirmed in 6 patients resulting in a 2.31% (95%CI:0.9-5.0) prevalence of malignancy. Positive predictive value of a true cancer was 31.58% (range 21%-54%).

Limitations

Generalizability and lost to follow-up.

Conclusion

Incidentalomas on FDG-PET/CT imaging are common in otherwise healthy, asymptomatic clinical trial patients with moderate-to-severe psoriasis. Our results can help inform clinical trials safety data interpretation and emphasizes the importance of compliance with cancer screening recommendations.

http://bit.ly/2DaZ3zA

Poor prognosis for thin ulcerated melanomas and implications for a more aggressive approach to treatment

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Makenzie L. Hawkins, Matthew J. Rioth, Megan M. Eguchi, Myles Cockburn

Abstract

Background

Clinical guidelines for the treatment of melanoma are based largely on the behavior of thicker tumors. As a result, little is known about survival differences among patients with thinner tumors.

Objective

To investigate the variability in survival for AJCC stage T1 thin melanoma tumors, defined as less than 1mm at diagnosis.

Methods

This population-based series included 43,008 non-Hispanic whites diagnosed with cutaneous melanoma between 2004 and 2013 from the California Cancer Registry. Survival outcomes estimated using the Kaplan-Meier Method. Cox proportional hazard models were used to estimate risk of death.

Results

Survival for patients with thin ulcerated tumors was comparable to patients with Stage II tumors, who are currently treated more aggressively. At 12 months, patients with thin ulcerated tumors had approximately 6% lower survival (92.5%, 95%CL:90.6-93.9%) compared to patients with thin non-ulcerated tumors (98.2%, 95%CL:98.0-98.3%). At 24 months, this survival difference increased (85.2% (95%CL: 82.8%-87.4%), 96.1% (95%CL:95.8-96.3%); respectively) and continued to increase over 2-fold by 60 months.

Limitations

Previous reports of cancer registry data have noted some evidence of miscoding of thin tumors.

Conclusion

The poorer survival in less than 1mm thick, ulcerated tumors implies the need for additional studies to determine potential benefits of more aggressive treatment.

http://bit.ly/2TQjvvq

Response to "Risk of bias assessment in primary studies for the development of systematic reviews: a reflection about exposure to systemic dermatological drugs and its effects on infertility and teratogenicity in males”

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): George A. Zakhem, Catherine C. Motosko, Euphemia W. Mu, Roger S. Ho

http://bit.ly/2D9N2uu

Title: Intentional inhibition but not source memory is related to hallucination-proneness and intrusive thoughts in a university sample

Publication date: Available online 14 January 2019

Source: Cortex

Author(s): Ben Alderson-Day, David Smailes, Jamie Moffatt, Kaja Mitrenga, Peter Moseley, Charles Fernyhough

Abstract

Proneness to unusual perceptual states – such as auditory or visual hallucinations – has been proposed to exist on a continuum in the general population, but whether there is a cognitive basis for such a continuum remains unclear. Intentional cognitive inhibition (the ability to wilfully control thoughts and memories) is one mechanism that has been linked to auditory hallucination susceptibility, but most evidence to date has been drawn from clinical samples only. Moreover, such a link has yet to be demonstrated over and above relations to other cognitive skills (source monitoring) and cognitive states (intrusive thoughts) that often correlate with both inhibition and hallucinations. The present study deployed two tests of intentional inhibition ability – the Inhibition of Currently Irrelevant Memories (ICIM) task and Directed Forgetting (DF) task – and one test of source monitoring (a source memory task) to examine how cognitive task performance relates to self-reported i) auditory hallucination-proneness and ii) susceptibility to intrusive thoughts in a non-clinical student sample (N = 76). Hierarchical regression analyses were used to assess the independent and combined contributions of task performance to proneness scores. ICIM performance but not DF or source memory scores were significantly related to both hallucination-proneness and intrusive thoughts. Further analysis suggested that intrusive thoughts may mediate the link between intentional inhibition skills and auditory hallucination-proneness, suggesting a potential pathway from inhibition to perception via intrusions in cognition. The implications for studying cognitive mechanisms of hallucination and their role in "continuum" views of psychosis-like experiences are discussed.

http://bit.ly/2svxWJm

Ventromedial frontal lobe damage affects interpretation, not exploration, of emotional facial expressions

Publication date: Available online 14 January 2019

Source: Cortex

Author(s): Avinash R. Vaidya, Lesley K. Fellows

Abstract

Recognizing and distinguishing the emotional states of those around us is crucial for adaptive social behavior. Previous work has shown that damage to the ventromedial frontal lobe (VMF) impairs recognition of subtle emotional facial expressions and affects fixation patterns to face stimuli. However, whether this relates to deficits in acquiring or interpreting facial expression information remains unclear. We tested 37 patients with frontal lobe damage, including 17 subjects with VMF lesions, in a series of emotion recognition tasks with different gaze manipulations. Subjects were asked to rate neutral, subtle and extreme emotional expressions while freely examining faces, while instructed to look only at the eyes, and in a gaze-contingent condition that required top-down direction of eye movements to reveal the stimulus. People with VMF damage were worse at detecting subtle disgust during free viewing and confused extreme emotional expressions more than healthy controls. However, fixation patterns did not differ systematically between groups during free or gaze-contingent viewing conditions. Moreover, instruction to fixate only the eyes did not improve the performance of VMF damaged subjects. These data argue that VMF is not necessary for normal fixations to emotional face stimuli, and that impairments in emotion recognition after VMF damage do not stem from impaired information gathering, as indexed by patterns of fixation.

http://bit.ly/2M9wKo6

Effect of prism adaptation on neglect hemianesthesia

Publication date: Available online 14 January 2019

Source: Cortex

Author(s): Alessio Facchin, Elena Sartori, Chiara Luisetti, Anna De Galeazzi, Nicoletta Beschin

Abstract

Prism adaptation (PA) has proven to be effective in alleviating many signs of unilateral spatial neglect (USN). Generally, the principal improvement after PA treatment was found to be in the high-level cognitive function. Nevertheless, some evidence has also been found for it in somatosensory function. We have aimed to test the influence of PA on neglect hemianesthesia, a condition in which the high-level neglect-related deficit mimics hemianesthesia. Twenty-one USN patients were enrolled in the study. Each patient performed two sessions of PA, one with neutral glasses and one with prism glasses using a cross-over design. Sensibility on the upper limb was tested using two methods. The first task was the sensibility subtest which was derived from the standard clinical examination. The second was the perceptual and motor electro-cutaneous threshold on the forearms using an electro-cutaneous stimulator. Four neuropsychological tests were used to diagnose USN and to check improvement: Star cancellation, Line bisection, Sentence reading and the Comb & Razor test. Comparing prism with sham conditions, our results show significant improvements in double extinction and in the electro-cutaneous perceptual threshold only for the contralesional hand. No improvement was found for the ipsilesional hand, for the motor threshold, and for neutral glasses. Significant improvement was found in personal neglect. Replication of the task in a subgroup of patients confirmed the primary results. The improvements in somatosensory perception together with the amelioration of personal neglect suggest that PA also has a specific effect on the neglect hemianesthesia.

http://bit.ly/2sqD29U

Exploring distinct default mode and semantic networks using a systematic ICA approach

Publication date: Available online 14 January 2019

Source: Cortex

Author(s): Rebecca L. Jackson, Lauren L. Cloutman, Matthew A. Lambon Ralph

Abstract

Resting-state networks (RSNs; groups of regions consistently co-activated without an explicit task) are hugely influential in modern brain research. Despite this popularity, the link between specific RSNs and their functions remains elusive, limiting the impact on cognitive neuroscience (where the goal is to link cognition to neural systems). Here we present a series of logical steps to formally test the relationship between a coherent RSN with a cognitive domain. This approach is applied to a challenging and significant test-case; extracting a recently-proposed semantic RSN, determining its relation with a well-known RSN, the default mode network (DMN), and assessing their roles in semantic cognition. Results showed the DMN and semantic network are two distinct coherent RSNs. Assessing the cognitive signature of these spatiotemporally coherent networks directly (and therefore accounting for overlapping networks) showed involvement of the proposed semantic network, but not the DMN, in task-based semantic cognition. Following the steps presented here, researchers could formally test specific hypotheses regarding the function of RSNs, including other possible functions of the DMN.

http://bit.ly/2M9wFAO

Left hemispatial neglect and overt orienting in naturalistic conditions: Role of high-level and stimulus-driven signals

Publication date: Available online 14 January 2019

Source: Cortex

Author(s): Davide Nardo, Maria De Luca, Francesca Rotondaro, Barbara Spanò, Marco Bozzali, Fabrizio Doricchi, Stefano Paolucci, Emiliano Macaluso

Abstract

Deficits of visuospatial orienting in brain-damaged patients affected by hemispatial neglect have been extensively investigated. Nonetheless, spontaneous spatial orienting in naturalistic conditions is still poorly understood. Here, we investigated the role played by top-down and stimulus-driven signals in overt spatial orienting of neglect patients during free-viewing of short videos portraying everyday life situations. In experiment 1, we assessed orienting when meaningful visual events competed on the left and right side of space, and tested whether sensory salience on the two sides biased orienting. In experiment 2, we examined whether the spatial alignment of visual and auditory signals modulates orienting. The results of experiment 1 showed that in neglect patients severe deficits in contralesional orienting were restricted to viewing conditions with bilateral visual events competing for attentional capture. In contrast, orienting towards the contralesional side was largely spared when the videos contained a single event on the left side. In neglect patients the processing of stimulus-driven salience was relatively spared and helped orienting towards the left side when multiple events were present. Experiment 2 showed that sounds spatially aligned with visual events on the left side improved orienting towards the otherwise neglected hemispace. Anatomical scans indicated that neglect patients suffered grey and white matter damages primarily in the ventral frontoparietal cortex. This suggests that the improvement of contralesional orienting associated with visual salience and audiovisual spatial alignment may be due to processing in the relatively intact dorsal frontoparietal areas. Our data show that in naturalistic environments, the presence of multiple meaningful events is a major determinant of spatial orienting deficits in neglect patients, whereas the salience of visual signals and the spatial alignment between auditory and visual signals can counteract spatial orienting deficits. These results open new perspectives to develop novel rehabilitation strategies based on the use of naturalistic stimuli.

http://bit.ly/2sscPbd

Handedness in monkeys reflects hemispheric specialization within the central sulcus. An in vivo MRI study in right- and left-handed olive baboons

Publication date: Available online 14 January 2019

Source: Cortex

Author(s): Konstantina Margiotoudi, Damien Marie, Nicolas Claidière, Olivier Coulon, Muriel Roth, Bruno Nazarian, Romain Lacoste, William D. Hopkins, Sandra Molesti, Pauline Fresnais, Jean-Luc Anton, Adrien Meguerditchian

Abstract

Handedness, one of the most prominent expressions of laterality, has been historically considered unique to human. This noteworthy feature relates to contralateral inter-hemispheric asymmetries in the motor hand area following the mid-portion of the central sulcus. However, within an evolutionary approach, it remains debatable whether hand preferences in nonhuman primates are associated with similar patterns of hemispheric specialization. In the present study conducted in Old world monkeys, we investigate anatomical asymmetries of the central sulcus in a sample of 86 olive baboons (Papio anubis) from in vivo T1 anatomical magnetic resonance images (MRI). Out of this sample, 35 individuals were classified as right-handed and 28 as left-handed according to their hand use responses elicited by a bimanual coordinated tube task. Here we report that the direction and degree of hand preference (left or right) as measured by this manual task relates and correlates to contralateral hemispheric sulcus depth asymmetry, within a mid-portion of the central sulcus. This neuroanatomical manifestation of handedness in baboons located in a region, which may correspond to the motor hand area, questions the phylogenetic origins of human handedness that may date back to their common ancestor, 25-40 millions years ago.

http://bit.ly/2MfKKNq

Use of the type A botulinum toxin in patients submitted to cheiloplasty to improve results in scarring in patients with nonsyndromic cleft lip and palate

Abstract

Background

Cleft lip, and its association with cleft palate, is the most common craniofacial malformation worldwide, having a high incidence in the Hispanic population, with 9.6 cases being reported per 10,000 newborns. The standard treatment is cheiloplasty with satisfying functional result. However, the presence of the hypertrophic scar constitutes the most frequent sequel, requiring, in some cases, a new surgery. Said scar often becomes a social stigma of this pathology.

Methods

Aim: To determine if the application of type A botulinum toxin prior to the surgery, improves the aesthetical results of the surgery evaluated by the Vancouver scale.

A randomized triple-blind clinical trial was performed that included all patients from 4 to 24 months of age, with unilateral or bilateral cleft lip and palate, without any history of prior surgery, at the HRAEB in Mexico. The surgery was performed by the same senior surgeon in both groups. Patients were randomized into two groups: a study group of 11 patients who received a type A Botulinum toxin injection at least 7 days before the surgery and a control group of 11 patients who received placebo. Both groups were evaluated by a different investigator, 3 and 6 months postoperatively using the Vancouver scale.

Results

There was statistical significance in the width of the scar in millimeters, in the study group, of 2 mm (0–3) and in the control group of 4 mm with p value of < 0.001. There was also a difference in Vancouver scale, obtaining in the study group a mean of 2 points (IC 0–3) and in the control group one of 4 points (IC 0–6) with a p value of < 0–001. No side effects of the toxin were documented during the study and there were less surgical complications.

Conclusion

The use of type A botulinum toxin decreases the presence of a hypertrophic scar in patients with a cleft lip who undergo primary cheiloplasty; however, more studies with a larger number of patients are needed.

Level of evidence: level II, therapeutic study.

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An extended high‐frequency ultrasound protocol for assessing and quantifying of inflammation and fibrosis in localized scleroderma

Abstract

Background

Clinical characteristics of the lesions are used to identify activity and damage in localized scleroderma (LoS). For high‐frequency ultrasound (HF‐US), the features of active lesions were described.

Materials and Methods

Clinical signs of activity and damage in LoS lesions were assessed with the use of Localized Scleroderma Cutaneous Assessment Tool (LoSCAT) and HF‐US by two examiners independently. All US images were obtained using a 20 MHz HF‐US (DermaLab System, Cortex Technology, Hadsund, Denmark). The dermal thickness (DT) and echogenicity (intensity score, IS) of the LoS lesional dermis were measured in the area of each lesion with the highest score for erythema (ER), skin thickness (ST), and dermal atrophy (DAT). Measurements were compared to the site‐matched unaffected skin. The relative difference of DT and IS values was calculated between each lesion and its normal control for comparison among different clinical scores for ER, ST, and DAT.

Results

A total of 92 lesions in 40 adult patients were examined with HF‐US. Thirty one lesions were erythematous, 26 were in sclerosis, and 35 were in atrophy. A correlation between the clinical evaluation of the LoS lesions and US measurements was found. The sensitivity and specificity of HF‐US were 97% and 90%, respectively. The positive predictive value was 83%, negative predictive value—98%. Interrater reliability was excellent for LoSCAT and HF‐US findings.

Conclusion

High‐frequency ultrasound allows an accurate assessment of the inflammatory and fibrotic skin lesions in LoS.

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Low dose thalidomide monotherapy for the treatment of recalcitrant erosive lichen planus

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Mucocutaneous ulcers as forerunners of methotrexate toxicity

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Relative efficacy of 5‐fluorouracil compared with other treatments among patients with actinic keratosis: A network meta‐analysis

http://bit.ly/2TQx7GK

Treatment of lipedema by low‐volume micro‐cannular liposuction in tumescent anesthesia: Results in 111 patients

Abstract

Lipedema is a painful disease of subcutaneous adipose tissue leading to bilateral increase of leg and/ or arm volume, but sparing hands and feet. Although conservative treatment with complex decongestive therapy has been considered as the fundamental treatment, micro‐cannular liposuction in tumescent anesthesia has become a surgical option.

We report on 111 patients mostly with advanced lipedema treated by this technique in our center between 2007 and 2018. The median age of the patients was 44 years. Eighty percent of patients had at least one comorbidity. There was an association of longstanding and advanced disease to obesity and diseases of the metabolic syndrome‐spectrum. The median total amount of lipoaspirate was 4700 mL, with a range of 950 mL to 14 250 mL. The median reduction of limb circumference was 6 cm. The median pain level before treatment was 7.8 and 2.2 at the end of the treatment. An improvement of mobility could be achieved in all patients. Bruising was also reduced. Serious adverse events were observed in 1.2% of procedures, the infection rate was 0% and the bleeding rate was 0.3%. Liposuction is an effective treatment for painful lipedema. The procedure should be performed in specialized centers.

This article is protected by copyright. All rights reserved.

http://bit.ly/2DappBP

Post‐erysipela panniculitis ossificans of the lower leg treated with pentoxifylline

Abstract

We report the case of a female patient who developed a firm, wooden‐like, non‐pitting oedema of the left lower leg after a dermo‐hypodermitis. The clinical picture was accompanied by intense pain, strongly impacting the patient's quality of life. A soft‐tissue ultrasound demonstrated several millimetric hyperechoic linear lesions whose histopathological examination was conclusive for panniculitis ossificans.

A conservative medical management with compression stockings associated with pentoxifylline 800 mg/day was prescribed with improvement of the oedema and, in particular, a good pain control. To date, after a two‐year therapy with pentoxifylline, the leg wooden‐like oedema has substantially improved, despite the persistence of the well‐known foci of ossification, and the pain has resolved, conditioning a substantial improvement of the patient's quality of life. No side effect has been observed during the routine follow‐up.

Although there is no unanimous opinion in the Literature about the effect of pentoxifylline on bone formation and osteogenic differentiation, pentoxifylline treatment proved to be beneficial in our patient both for the heterotopic ossification process and the pain control. We collected some of the data in literature about pentoxifylline effects and advanced some hypotheses to explain our results. Finally, we suggest that an anti‐inflammatory and vasodilators drug such as pentoxifylline could be a possible alternative in heterotopic ossification disorders.

http://bit.ly/2TQx6ma

Process of fruit peel waste biorefinery: a case study of citrus waste biorefinery, its environmental impacts and recommendations

Abstract

Fruit peels are a rich source of cellulose, hemicellulose, phenolic compounds, and terpenic compounds. Thus, they have the potential to be a novel renewable, sustainable, and low-cost raw material (source) for the production of several value-added products based on framework and concepts such as waste hierarchy that includes biofertilizers, dietary fiber, animal feed, industrial enzymes, substrate for the bioactive compounds production, synthesis of nanomaterials, and clean energy (from residual biomass). With a view of evaluating the environmental burden of biorefinery, a life cycle assessment (LCA) is performed for a representative citrus waste (CW) biorefinery. The functional unit used for LCA was set as 2500 kg of CW processed. The overall GWP was observed to be 937.3 kg CO₂ equivalent per 2500 kg of CW processed. On further analysis of the environmental impact, it was found that different steps contributed significantly, as shown by the various environmental indicator values. Alternative advanced process intensification technologies like microwave and ultrasound-assisted steps replacing the conventional steps when implemented show considerable reduction in environmental indicator values. The variations in the contribution to environmental indicators should be considered during the design and process selection of biorefineries.

http://bit.ly/2FvE2Ce