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Δευτέρα 11 Ιουνίου 2018

Carotid body tumor masquerading as metastatic cervical lymph node on fluorodeoxyglucose positron-emission tomography-computed tomography

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Amit Nautiyal, Anirban Mukherjee, Deepanjan Mitra, Piyali Chatterjee, Anindya Roy

Indian Journal of Nuclear Medicine 2018 33(3):259-260

Carotid body tumors, although representing about 65% of head and neck paragangliomas, are rare neoplasms. Doppler ultrasonography, contrast-enhanced computed tomography (CECT), and MRI have been routinely used in the diagnosis of carotid body tumor. We hereby represent a case of 56-year-old male suspected to have lymph node metastasis from carcinoma pyriform sinus detected as carotid body tumor in fluorodeoxyglucose positron-emission tomography-CECT imaging and subsequently confirmed by histopathology.

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Dacryoscintigraphy: A pictorial essay

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Shefali Madhur Gokhale

Indian Journal of Nuclear Medicine 2018 33(3):214-217

Dacryoscintigraphy is a noninvasive, simple, easy to perform imaging modality used in the evaluation of epiphora. However, it is an infrequently done study in nuclear medicine departments. A standardized protocol and a systematic interpretation of the scans help in answering the queries of the clinicians in cases of epiphora. We have attempted to build a pictorial essay of the various findings detected on dacryoscintigraphy.

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Reply by the author

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Subramanian Kannan

Indian Journal of Nuclear Medicine 2018 33(3):266-267



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Thyroglobulin “nonsecretor” metastatic poorly differentiated thyroid carcinoma with noniodine concentrating disease and aggressive clinical course: A clinical case series

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Ashwini Kalshetty, Sandip Basu

Indian Journal of Nuclear Medicine 2018 33(3):218-223

Poorly differentiated thyroid carcinomas (PDTC) are a subgroup of thyroid cancers with aggressive behavior and worse prognosis compared to the well DTC. Limited diagnostic tools and therapeutic options exist for such cases, and the appropriate management algorithm continues to evolve in this subgroup. They pose difficulty in clinical management due to their behavioral heterogeneity and increased occurrence of aggressive clinical behavior underlining the need for management individualization. In the present communication, a case series of three clinically challenging cases of PDTC (with low serum thyroglobulin (Tg) and iodine nonavidity) are presented with a discourse on their management intrigues, unresolved issues and the requirement of a distinctive management protocol. A small fraction of PDTCs may show low serum Tg values, with the questionable significance of its role for the assessment and monitoring of disease burden in this group of patients. Given uncommon occurrence, limited and variable literature data, management guidelines for "nonsecretor" PDTC needs to be more clearly defined based on scientific evidence. The present clinical case series of PDTC with low serum thyroglobulin in the context of noniodine concentrating metastatic disease and aggressive clinical course ("nonsecretor" status) was noteworthy from this viewpoint.

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Multifarious Ga-68 labeled PET radiopharmaceuticals in imaging various malignancies

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Rakhee Vatsa, Abhiram Gopalajois Ashwathanarayana, Jaya Shukla, Shashank Singh, Priya Bhusari, Rajender Kumar, Harmandeep Singh, Bhagwant Rai Mittal

Indian Journal of Nuclear Medicine 2018 33(3):242-244

The gamut of gallium labeled radiopharmaceuticals contributes to augmented variety in molecular imaging approach for in vivo identification of tumor characteristics. The spectrum ranges from somatostatin receptor based target-specific imaging agents, to those used for tumor imaging based on specific receptor types extending into ones used for therapeutic monitoring. The versatility of gallium chemistry provides the needed advantage for imaging which is further exploited in clinical practice influences the specificity of tumor imaging. Ga-68 has revealed applicability in labeling compounds from nanoparticles to micro as well as macromolecules. We in this image, present variety of frequently and infrequently used gallium labeled radiopharmaceuticals, for imaging diverse malignancies other than conventional established tracers.

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Role of 18F-Fluorodeoxyglucose positron emission tomography/computed tomography scan in castleman's disease

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Naveen Kumar Reddy Akepati, Zakir Ali Abubakar, Prathyusha Bikkina

Indian Journal of Nuclear Medicine 2018 33(3):224-226

Castleman's disease (CD) is a rare benign lymphoproliferative disorder. We are presenting three cases of CD of which one is unicentric CD, and the other two are an idiopathic multicentric CD. One of the two multicentric cases is associated with POEMS syndrome. The whole body 18F-Fluorodeoxyglucose positron-emission tomography–computed tomography scan plays a significant role in identifying the centricity, distribution of disease, response to therapy, and in early detection of remission.

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Spontaneous resolution of idiopathic panniculitis: role of 18F-Fluorodeoxyglucose positron emission tomography/computed tomography in diagnosis and follow-up

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Priyanka Verma, Sumeet Gujral, Ramesh V Asopa

Indian Journal of Nuclear Medicine 2018 33(3):248-249

We present the case of a-55-year-old female patient who presented with dry cough. High-resolution computed tomography chest revealed multiple nodules in both lungs. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) was done to look for the unknown primary. It showed hypermetabolic bilateral lung nodules, subcutaneous nodules involving lower limbs, an intramuscular nodule, enlarged paratracheal, and right axillary nodes. There was no primary tumor seen. The biopsy of subcutaneous nodule revealed panniculitis with the foreign body granuloma. Follow-up scans after 6 and 9 months showed spontaneous resolution of all lesions except for few right axillary nodes. There was no active treatment given, and the patient remains asymptomatic on follow-up. Here, PET/CT played a role in excluding a primary tumor, guiding the biopsy, and follow-up.

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Rare involvement of thyroid cartilage and thyroid gland by multiple myeloma on 18F-Fluorodeoxyglucose positron emission tomography/computed tomography

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Raghava Kashyap, Rakesh Reddy, Veni Prasanna

Indian Journal of Nuclear Medicine 2018 33(3):227-229

Multiple myeloma commonly involves the skeleton. Extraosseous disease is sometimes noticed involving various organs. We present a very unusual site of myeloma involvement in the thyroid gland and thyroid cartilage.

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Hematoma in urinary bladder masquerading as neoplastic mass

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Anurag Jain, Abhishek Mahato, Mattakarotu Joseph Jacob, Madan Gopal Vishnoi, Aniruddha Govind Pandit, Kartikey Purushottam Solanki, Braj Kishore, Arun Ravi John, Neeraj

Indian Journal of Nuclear Medicine 2018 33(3):253-254

The most common reason for intraluminal urinary bladder hematoma is trauma. However in gynecological and pelvic malignancies, the pelvic irradiation can affect non targeted organs resulting in urogenital complications like hematoma. Small size hematoma can be easily diagnosed in ultrasound. Large hematoma can mimic as neoplastic mass in imaging modalities.We present here an intresting image of intraluminal urinary bladder mass, where FDG PET CT was helpful to diagnose it as a non neoplastic mass.

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Silicone implant incompatibility syndrome: Mimicking metastases on fluoro-deoxy-glucose positron emission tomography–computed tomography in a treated case of carcinoma breast

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Patel Asra, Indirani Muthukrishnan Elangoven, Simon Shelley, Kurian Ann

Indian Journal of Nuclear Medicine 2018 33(3):230-232

Silicone implant incompatibility syndrome (SIIS) has been identified as a cause of systemic symptoms such as lymphadenopathy, myalgia, and dyspnea in patients with silicone implants. We present a case of 76-year-old female patient, treated for carcinoma left breast with mastectomy and silicone breast implant, chemotherapy, and radiotherapy 42 years ago. There was a history of implant rupture and removal 2 years ago. The patient presented with right axillary swelling and dyspnea. 18-fluorine fluoro-deoxy-glucose positron emission tomography/computed tomography (F-18 FDG PET-CT) showed mildly FDG-avid left anterior chest wall and right rectus abdominis deposits, multiple lymph nodes, and low-grade FDG-avid pneumonitis changes in both lungs. Biopsy from the chest wall and rectus abdominis deposit was negative for malignancy and revealed foamy histiocytes and foreign-body giant cell reaction, indicative of SIIS. SIIS is a mimic for metastases and should be considered as a differential diagnosis in FDG PET-CT interpretation in patients with silicone breast implant.

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Demonstration of 68Ga-prostate-specific membrane antigen uptake in metastatic pancreatic neuroendocrine tumor

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Meghana Prabhu, Nishikant Avinash Damle, Ravikant Gupta, Saurabh Arora, Sreedharan Thankarajan Arunraj, Chandrasekhar Bal

Indian Journal of Nuclear Medicine 2018 33(3):257-258

We present the case of a 47-year-old female with metastatic pancreatic neuroendocrine tumor (NET). The patient was treated with long-acting octreotide which failed to halt disease progression. The patient was being considered for 177Lu-peptide receptor radionuclide therapy, and a 68Ga-DOTANOC positron emission tomography-computed tomography (PET-CT) was acquired initially, which showed good uptake in the primary and metastatic lesions. Metastatic pancreatic NETs have limited treatment options, and given the background that these tumors are highly vascular and prostate-specific membrane antigen (PSMA) expression is known in the endothelium of tumor neovasculature, we decided to perform a 68Ga-PSMA-HBED-CC PET-CT scan. It revealed radiotracer uptake in the metastatic liver lesions although not as high as 68Ga-DOTANOC-PET-CT. PSMA expression needs to be researched further, especially in high-grade NETs where somatostatin expression may be poor.

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Subsynaptic spatial organization as a regulator of synaptic strength and plasticity

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Publication date: August 2018
Source:Current Opinion in Neurobiology, Volume 51
Author(s): Haiwen Chen, Ai-Hui Tang, Thomas A Blanpied
Synapses differ markedly in their performance, even amongst those on a single neuron. The mechanisms that drive this functional diversification are of great interest because they enable adaptive behaviors and are targets of pathology. Considerable effort has focused on elucidating mechanisms of plasticity that involve changes to presynaptic release probability and the number of postsynaptic receptors. However, recent work is clarifying that nanoscale organization of the proteins within glutamatergic synapses impacts synapse function. Specifically, active zone scaffold proteins form nanoclusters that define sites of neurotransmitter release, and these sites align transsynaptically with clustered postsynaptic receptors. These nanostructural characteristics raise numerous possibilities for how synaptic plasticity could be expressed.



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The ulnar ratio as a sensitive and specific marker of acute inflammatory demyelinating polyneuropathy

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Publication date: Available online 11 June 2018
Source:Clinical Neurophysiology
Author(s): Rechdi Ahdab, Mohammad Hassan A. Noureldine, Kamel Mohammedi, Manal Nader, Hela G. Zouari, Tarik Nordine, Alain Créange, Jean-Pascal Lefaucheur, Samar S. Ayache
ObjectivesTo explore the value of a novel sensory criterion, the ulnar ratio – defined as the SNAP amplitude of the palmar cutaneous (pUN) over that of the dorsal branch (dUN) of the ulnar nerve – as a predictor of Acute Inflammatory Demyelinating Polyneuropathy (AIDP).MethodsWe prospectively included 22 patients with AIDP, 20 patients with diabetic peripheral neuropathy (DPN), and 18 controls. Eligible subjects underwent nerve conduction studies including, among others, the dUN, pUN, and sural nerve.ResultsA sural sparing pattern was found in 72% of AIDP cases. The ulnar ratio was significantly lower in patients with AIDP compared to those with DPN or controls. The ROC curve area to discriminate AIDP (versus controls and diabetics together) was higher with the ulnar ratio and pUN compared to dUN. An ulnar ratio ≥ 0.78 seems to be the best threshold to rule out the diagnosis of AIDP, with a specificity of 100% and a sensitivity of 87%. The ulnar ratio was equally reliable in the subgroup of patients presenting within a week of symptoms onset.ConclusionThe ulnar ratio is a highly sensitive and specific marker of AIDP and can help confirm the diagnosis when direct signs of demyelination are lacking.SignificanceIncorporating specific sensory abnormalities, such as the ulnar ratio, in the electrodiagnostic criteria of AIDP could enhance their reliability.



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Programmatic comparison and dissemination of an audit of single fraction radiotherapy prescribing practices for bone metastases is associated with a meaningful and lasting change in practice on a population level

Publication date: Available online 11 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Robert Olson, Matthew Chan, Neelam Minhas, Gurkirat Kandola, Manpreet Tiwana, Shilo Lefresne, Ross Halperin, Devin Schellenberg, Elaine Wai, Nissar Ahmed, Scott Tyldesley
PurposeThere is ample evidence that single fraction radiation therapy (SFRT) is equally efficacious as more costly and morbid multi-fraction regimens. We previously demonstrated that an audit-based intervention increased the use of SFRT in all regional cancer centers the year following. However, other investigators have demonstrated interventions were only associated with a transient one-year change in prescribing practices. We sought to determine if our intervention resulted in a more lasting impact.MethodsIn 2012 we performed an audit of prescribing practices of individual physicians, which were then presented to leaders and oncologists as an intervention to increase SFRT. We then compared the use of SFRT from 2007-2011 (pre-intervention) and 2013-2016 (post-intervention) in all 31,192 patients treated in our provincial program.ResultsThe use of SFRT increased from 49.2% to 58.9% post intervention (p<0.001), with rates in 2007-2011 of 51, 51, 48, 49, and 48%, while post intervention in 2013-2016 they were 60, 62, 59, and 56%. Post intervention, half of the centers prescribed SFRT in a relatively narrow range (55-58%). However, across all centers, there was still a broad range, with the lowest and highest users at 35% and 81% respectively, though the lowest utilizing center still showed a significant increase (26% to 35%; p <0.001).ConclusionOur audit and educational based intervention resulted in a lasting and meaningful 10% change in practice. Our provincial rate is similar to a previously recommended benchmark rate of 60%, though we continue to see significant variation by center, suggesting further room for improvement in provincial standardization. With emerging evidence in support of ablative radiotherapy for select populations of patients with bone metastases, future benchmark rates of SFRT should be readdressed, though our data suggest programmatic comparison and dissemination of SFRT prescribing practices can achieve a population-based SFRT utilization rate near 60%.

Teaser

After an audit-based educational intervention in our population-based provincial radiotherapy program, we demonstrate a lasting and meaningful 10% increase in the prescription of SFRT for bone metastases. Other jurisdictions should consider using similar programmatic audit-based educational approaches in an effort to increase the use of this cost-effective treatment which has been historically used well below evidence-based benchmarks internationally. Our data suggests that the benchmark of 60% use of SFRT for bone metastases is feasible.


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Role of daily plan adaptation in MR-guided stereotactic ablative radiotherapy for adrenal metastases

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Publication date: Available online 11 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): M.A. Palacios, O. Bohoudi, A.M.E. Bruynzeel, J.R. van Sörnsen-de Koste, P. Cobussen, B.J. Slotman, F.J. Lagerwaard, S. Senan
PurposeTo study inter-fractional organ changes during MR-guided stereotactic ablative radiotherapy (SABR) for adrenal metastases and to evaluate the dosimetric advantages of online plan adaptation.Methods and MaterialsSeventeen patients underwent a total of 84 fractions of video-assisted, respiration-gated MR-guided adaptive radiotherapy to deliver either 50 Gy (5 fractions), 60 Gy (8 fractions) or 24 Gy (3 fractions). An MR scan was repeated prior to each fraction, followed by rigid co-registration to the GTV on the pre-treatment MR scan. Contour deformation, PTV (GTV+3mm) expansion and online plan re-optimization were then performed. Re-optimized plans were compared to baseline treatment plans recalculated on the anatomy-of-the-day ('predicted plans').Inter-fractional changes in OARs were quantified according to OAR volume changes within a 3 cm distance from PTV surface, centre of mass (COM) displacements and the Dice Similarity Coefficient (DSC). Plan quality evaluation was based on target coverage (GTV and PTV), and also high dose sparing of all OARs (V36Gy, V33Gy and V25Gy).ResultsSubstantial COM displacements were observed for stomach, bowel and duodenum of 17, 27 and 36 mm, respectively. Maximum volume changes for the stomach, bowel and duodenum within 3 cm of PTV were 23.8, 20.5 and 20.9 cc, respectively. DSC values for OARs ranged from 0.0 to 0.9 for all fractions.Baseline plans recalculated on anatomy-of-the-day revealed underdosage of target volumes, and variable OAR sparing, leading to a failure to meet institutional constraints in a third of fractions. Online re-optimization improved target coverage in 63% of fractions, and reduced the number of fractions not meeting the V95% objective for GTV and PTV. Re-optimized plans exhibited significantly better sparing of OAR.ConclusionsSignificant inter-fractional changes in OARs positions were observed despite breath-hold SABR delivery under MR-guidance. Online re-optimization of treatment plans led to significant improvements in target coverage and OAR sparing.

Teaser

Stereotactic ablative radiotherapy (SABR) delivered during shallow inspiration breath-hold under MR-guidance, was implemented for adrenal gland metastases. We studied inter-fractional changes in GTV and OARs, and also the role of online plan re-optimization in ensuring both adequate target coverage and OAR sparing. Online plan adaptation led to improved target coverage in 63% of treatment fractions, and significantly reduced OAR doses. Our results indicate that online plan adaptation is beneficial in adrenal SABR.


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State health department validations of central line–associated bloodstream infection events reported via the National Healthcare Safety Network

Publication date: Available online 11 June 2018
Source:American Journal of Infection Control
Author(s): Suparna Bagchi, Jennifer Watkins, Daniel A. Pollock, Jonathan R. Edwards, Katherine Allen-Bridson
BackgroundNumerous state health departments (SHDs) have validated central line–associated bloodstream infection (CLABSI) data, and results from these studies provide important insights into the accuracy of CLABSI reporting to the National Healthcare Safety Network (NHSN) and remediable shortcomings in adherence to the CLABSI definition and criteria.MethodsState CLABSI validation results were obtained from peer-reviewed publications, reports on SHD Web sites, and via personal communications with the SHD health care–associated infections coordinator. Data accuracy measures included pooled mean sensitivity, specificity, positive predictive value, and negative predictive value. Total CLABSI error rate was computed as the proportion of mismatches among total records reviewed. When available, reasons for CLABSI misclassification reported by SHDs were reviewed.ResultsAt least 23 SHDs that have completed CLABSI validations indicated sensitivity (pooled mean, 82.9%), specificity (pooled mean, 98.5%), positive predictive value (pooled mean, 94.1%), and negative predictive value (pooled mean, 95.9%) of CLABSI reporting. The pooled error rate of CLABSI reporting was 4.4%. Reasons for CLABSI misclassification included incorrect secondary bloodstream infection attribution, misapplication of CLABSI definition, missed case finding, applying clinical over surveillance definitions, misapplication of laboratory-confirmed bloodstream infection 2 definition, and misapplication of general NHSN definitions.ConclusionsCLABSI underreporting remains a major concern; validations conducted by SHDs provide an important impetus for improved reporting. SHDs are uniquely positioned to engage facilities in collaborative validation reviews that allow transparency, education, and relationship building.



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Patient- and hospital-level predictors of vancomycin-resistant Enterococcus (VRE) bacteremia in Ontario, Canada

Publication date: Available online 11 June 2018
Source:American Journal of Infection Control
Author(s): Jennie Johnstone, Cynthia Chen, Laura Rosella, Kwaku Adomako, Michelle E. Policarpio, Freda Lam, Chatura Prematunge, Gary Garber
BackgroundData are limited on risk factors for vancomycin-resistant Enterococcus (VRE) bacteremia.MethodsAll patients with a confirmed VRE bacteremia in Ontario, Canada, between January 2009 and December 2013 were linked to provincial healthcare administrative data sources and frequency matched to 3 controls based on age, sex, and aggregated diagnosis group. Associations between predictors and VRE bacteremia were estimated by generalized estimating equations and summarized using odds ratios (ORs) and corresponding 95% confidence intervals (CIs).ResultsIn total, 217 cases and 651 controls were examined. In adjusted analyses, patient-level predictors included bone marrow transplant (OR 106.99 [95% CI 12.19–939.26]); solid organ transplant (OR 17.17 [95% CI 4.95–59.54]); any cancer (OR 8.64 [95% CI 3.88–19.21]); intensive care unit (ICU) admission (OR 6.81 [95% CI 3.53–13.13]); heart disease (OR 5.27 [95% CI 2.00–13.90]); and longer length of stay (OR 1.07 per day [95% CI 1.06–1.09]). Hospital-level predictors included hospital size (per increase in 100 beds (OR 1.26 [95% CI 1.07–1.48]) and teaching hospitals (OR 3.87 [95% CI 1.85–8.08]).ConclusionsPatients with a bone marrow transplant, solid organ transplant, cancer, or who are admitted to the ICU are at highest risk of VRE bacteremia, particularly at large hospitals and teaching hospitals.



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Parental feeding practices associated with children's eating and weight: What are parents of toddlers and preschool children doing?

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Publication date: 1 September 2018
Source:Appetite, Volume 128
Author(s): Catherine Georgina Russell, Jillian J. Haszard, Rachael W. Taylor, Anne-Louise M. Heath, Barry Taylor, Karen J. Campbell
Parental feeding practices are associated with children's eating behaviours and weight, yet current use of such practices lacks detailed description. This limits our understanding of which behaviours to target to promote healthy growth. We explored the frequency with which a range of parental feeding practices occurs in mothers of toddler and preschool children. Combined data from four Australasian trials of healthy feeding and growth were utilized, each using the Comprehensive Feeding Practices Questionnaire (CFPQ). Data were included from mothers of toddlers (1.3–2 years; n = 1344) and preschool children (4–6 years; n = 795). Means and standard deviations for each CFPQ dimension were calculated for the two age groups. Scores were categorised by frequency, and percentages in each category calculated. Linear regression analysis determined associations between socio-demographics and feeding practices. In both age groups, mothers reported extensive use of some CFPQ dimensions including modelling, encouraging balance and variety, and healthy food environment (between 84% and 100% reported using these practices 'usually' to 'often'). Greater variation existed for other practices including pressure to eat and restriction for health. Food as a reward and pressure to eat were used more with preschool children (M = 2.5, SD = 1.0 and M = 3.1 SD = 0.9) than with toddlers (M = 1.7, SD = 0.8 and M = 2.5 SD = 0.9). For both age groups, mothers' age, education, SEP and BMI category, or the child's BMI, sex, or age predicted use of some feeding practices. Feeding practices such as modelling and providing a healthy food environment are important, but interventions are unlikely to detect effects as most parents report following best practice. In contrast, given greater variability in reported use of other feeding practices like pressure to eat and restriction for health these constructs may be more likely to detect change.



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Say yes to “Sunday Dinner” and no to “Nyam and Scram”: Family mealtimes, nutrition, and emotional health among adolescents and mothers in Jamaica

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Publication date: 1 September 2018
Source:Appetite, Volume 128
Author(s): Cagla Giray, Gail M. Ferguson
We explore the quantity (frequency) and quality (priority, atmosphere, structure) of family mealtimes and associations with nutritional and emotional health in Jamaica. Urban adolescents (N = 330, M = 13.8 years, SD = 1.8, 64% girls) and their mothers (M = 41.4 years, SD = 7.8) completed questionnaires. On average, mothers reported having family meals 3–4 times/week and mealtime quality, but not quantity, was associated with health. Correlations revealed that mothers ate more unhealthily if they watched more TV during meals, and actor-partner independence modeling showed that high SES adolescents ate more unhealthily if their mothers had more difficulty finding time for family meals (and vice versa: partner interaction). Additionally, adolescents and mothers were more psychologically distressed if they themselves had more difficulty finding time for family meals, if they had less positive attitudes/behaviors around mealtime atmosphere (actor effects), or if they were high SES individuals placing lower importance on mealtimes (actor interaction). Overall, however many weekly meals Jamaican families are able to share together, what's important is to make those mealtimes count as quality time. Leisurely family meals with enjoyable conversation uninterrupted by television, such as the age-old Jamaican tradition of "Sunday Dinner", may nourish both body and soul.



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Epigenetic ConFUSION: SS18-SSX Fusion Rewires BAF Complex to Activate Bivalent Genes in Synovial Sarcoma

Publication date: 11 June 2018
Source:Cancer Cell, Volume 33, Issue 6
Author(s): Marc A. Morgan, Ali Shilatifard
In this issue of Cancer Cell, McBride and colleagues report that the synovial sarcoma SS18-SSX fusion drives BAF complex recruitment to bivalent domains repressed by PRC2 complex to orchestrate aberrant transcriptional activation. Redistribution of BAF localization is a major driver of synovial sarcoma proliferation and presents a promising therapeutic target.

Teaser

In this issue of Cancer Cell, McBride and colleagues report that the synovial sarcoma SS18-SSX fusion drives BAF complex recruitment to bivalent domains repressed by PRC2 complex to orchestrate aberrant transcriptional activation. Redistribution of BAF localization is a major driver of synovial sarcoma proliferation and presents a promising therapeutic target.


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