Predictors of Shunt Dysfunction and Overall Survival in Patients with Variceal Bleeding Treated with Transjugular Portosystemic Shunt Creation Using the Fluency Stent Graft

Publication date: Available online 17 January 2018
Source:Academic Radiology
Author(s): Yue-Meng Wan, Yu-Hua Li, Ying Xu, Hua-Mei Wu, Ying-Chun Li, Xi-Nan Wu, Jin-Hui Yang
Rationale and ObjectivesTransjugular intrahepatic portosystemic shunt (TIPS) is an established method for portal hypertension. This study was to investigate the long-term safety, technical success, and patency of TIPS, and to determine the risk factors and clinical impacts of shunt dysfunction.Materials and MethodsA total of 154 consecutive patients undergoing embolotherapy of gastric coronary vein and/or short gastric vein and TIPS creation were prospectively studied. Follow-up data included technical success, patency and revision of TIPS, and overall survival of patients.ResultsDuring the study, the primary and secondary technical success rates were 98.7% and 100%, respectively. Sixty-three patients developed shunt dysfunction, 30 with shunt stenosis and 33 with shunt occlusion. The cumulative 60-month primary, primary assisted, and secondary patency rates were 19.6%, 43.0%, and 93.4%, respectively. The cumulative 60-month overall survival rates were similar between the TIPS dysfunction group and the TIPS non-dysfunction group (68.6% vs. 58.6%, P = .096). Baseline portal vein thrombosis (P < .001), use of bare stents (P = .018), and portal pressure gradient (PPG) (P = .020) were independent predictors for shunt dysfunction, hepatocellular carcinoma (P < .001), and ascites (P = .003) for overall survival. The accuracy of PPG for shunt dysfunction was statistically significant (P < .001), and a cutoff value of 8.5 had 77.8% sensitivity and 64.8% specificity.ConclusionsThe long-term safety, technical success, and patency of TIPS were good; baseline portal vein thrombosis, use of bare stents, and PPG were significantly associated with shunt dysfunction; shunt dysfunction has little impact on patients' long-term survival because of high secondary patency rates.



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Can You Do Health Disparities Research with Publicly Available Datasets?

Publication date: Available online 17 January 2018
Source:Academic Radiology
Author(s): Danny R. Hughes
Rationale and ObjectivesGiven the growing importance of identifying and reducing health disparities, it is important for radiologist researchers to engage in this space to promote evidence-based imaging disparities policy. However, researchers are often hindered by access to appropriate data to perform quality research.Materials and MethodsThis paper reviews existing publicly available data sets that may be useful for performing imaging disparities research.ResultsMultiple data sources are publicly available and have been used by previous researchers to examine imaging disparities.ConclusionsThis paper provides an overview of publicly available data sources that radiologists can use for imaging disparities research. Appropriate use of these data sources will require researchers to carefully consider the overall research question and level of analysis.



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Effect of Matrix Size on the Image Quality of Ultra-high-resolution CT of the Lung

Publication date: Available online 17 January 2018
Source:Academic Radiology
Author(s): Akinori Hata, Masahiro Yanagawa, Osamu Honda, Noriko Kikuchi, Tomo Miyata, Shinsuke Tsukagoshi, Ayumi Uranishi, Noriyuki Tomiyama
Rationale and ObjectivesThis study aimed to assess the effect of matrix size on the spatial resolution and image quality of ultra-high-resolution computed tomography (U-HRCT).Materials and MethodsSlit phantoms and 11 cadaveric lungs were scanned on U-HRCT. Slit phantom scans were reconstructed using a 20-mm field of view (FOV) with 1024 matrix size and a 320-mm FOV with 512, 1024, and 2048 matrix sizes. Cadaveric lung scans were reconstructed using 512, 1024, and 2048 matrix sizes. Three observers subjectively scored the images on a three-point scale (1 = worst, 3 = best), in terms of overall image quality, noise, streak artifact, vessel, bronchi, and image findings. The median score of the three observers was evaluated by Wilcoxon signed-rank test with Bonferroni correction. Noise was measured quantitatively and evaluated with the Tukey test. A P value of <.05 was considered significant.ResultsThe maximum spatial resolution was 0.14 mm; among the 320-mm FOV images, the 2048 matrix had the highest resolution and was significantly better than the 1024 matrix in terms of overall quality, solid nodule, ground-glass opacity, emphysema, intralobular reticulation, honeycombing, and clarity of vessels (P < .05). Both the 2048 and 1024 matrices performed significantly better than the 512 matrix (P < .001), except for noise and streak artifact. The visual and quantitative noise decreased significantly in the order of 512, 1024, and 2048 (P < .001).ConclusionIn U-HRCT scans, a large matrix size maintained the spatial resolution and improved the image quality and assessment of lung diseases, despite an increase in image noise, when compared to a 512 matrix size.



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Abnormal distance of the extralaryngeal bifurcation point of the recurrent laryngeal nerve from the cricothyroid joint

Abstract

The extralaryngeal bifurcation point of the recurrent laryngeal nerve (RLN) is typically located in a mean distance of 0–2 cm from the cricothyroid joint (CTJ). In the presented case though, the left RLN was unexpectedly identified bifurcating in a mean distance of 7 cm from the left CTJ in a young woman with multinodular goiter during total thyroidectomy. The RLN was carefully exposed throughout its course for the avoidance of iatrogenic injury of the nerval structure. The operation was uneventful. The present manuscript aims to highlight a scarce anatomic variation and its implications for thyroidectomy. Rare anatomic variations of the RLN such as the presented one encumber thyroid surgery and represent a severe risk factor of RLN injury. Meticulous operative technique combined with surgeons' perpetual awareness concerning this peculiar anatomical aberration leads to an injury-free thyroid surgery.

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Intrabilary obstruction by colorectal metastases

Abstract

Intrabiliary colorectal metastases are rare. We present a case of an 84-year-old man who developed obstructive jaundice secondary to intrabiliary growth of colorectal metastases. The patient presented with three weeks of jaundice and significant weight loss in the preceding months. The patient's background included metastatic colorectal carcinoma, with a previous right hemicolectomy and left hepatectomy for liver metastases. A MRCP showed an obstruction of the biliary tract transitioning at the ampulla. Histology confirmed a malignant adenocarcinoma. When compared to the patient's previous resected colorectal liver metastases, morphology and immunohistochemistry was consistent with colorectal metastases. This case highlights the importance of differentiating a new intraductal papillary neoplasm from a colorectal metastasis. Correctly identifying these lesions requires the use of MRCP and ERCP, as well as immunohistochemistry. This is a priority for clinicians to ensure appropriate therapy.

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Metastatic squamous cell cancer of the lung presenting as a perforated cecal cancer

Abstract

Lung cancer is the leading cause of cancer deaths worldwide, with non-small cell lung cancer (NSCLC) accounting for 85% of diagnoses. Metastasis occurs in ~50% of cases but clinically evident isolated gastrointestinal (GI) metastasis is rare. We present a 78-year-old female who underwent an urgent right hemi-colectomy after cross-sectional imaging revealed a perforated cecal mass. Final pathology demonstrated squamous cell cancer of lung origin. We review the literature on NSCLC with clinically evident metastases to the GI tract, as well as important diagnostic considerations.

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Cardiovascular Diseases and Periodontal Disease

Abstract

Purpose of Review

Periodontitis and cardiovascular diseases are both inflammatory conditions. Recent epidemiological studies have associated the effects of periodontitis on cardiovascular disease (CVD) progression. This review aims to summarize the relationship between those two conditions.

Recent Findings

Although there is no evidence of a causal relationship, an association between the two conditions is apparent. The potential factors include bacterial pathway, inflammation, and genetics. Periodontal bacteria affect endothelial cells through interactions that aggravate the atherogenic process. Ulcerated periodontium produces cytokines which increase the production of acute-phase proteins that have been associated with cardiovascular events. Genetic studies have demonstrated the presence of risk alleles in the genes ANRIL and CAMTA1/VAMP3 that are shared between these two diseases.

Summary

This review discusses the current understanding of CVD pathogenesis, underlying mechanisms of periodontitis in CVD, and effects of periodontal therapy on CVD, and provides guidelines for treating patients with CVD risks in respect to periodontal disease.

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A Generalized Blaschko Linear Congenital Eruption

Abstract

Blaschko's lines are trace of the migration of primordial cells to the ectoderm during embryogenesis. We report an intriguing, complex and very rare case of a patient with congenital rash on Blaschko's lines. A 30-year-old female patient presented at birth with erythroderma and generalized desquamation that progressively acquired a linear distribution, under Blaschko's lines, associated with pruritus and fissures in the hands.

This article is protected by copyright. All rights reserved.

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Medically Unexplained Dermatologic Symptoms (MUDS): Hiding in plain sight?

Abstract

Illness is not the same as disease. Illness refers to "the innately human experience of symptoms and suffering." ¹ Disease "is what the practitioner creates in recasting illness in terms of theories of disorder." ¹ A person's subjective experience of how she feels may not assume an underlying pathology. Illness can be organic, psychological or spiritual. A person can feel ill, but not have a disease.

This article is protected by copyright. All rights reserved.

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CHILD Syndrome Mimicking Verrucous Nevus in a Chinese Patient Responded Well to The Topical Therapy of Compound of Simvastatin and Cholesterol

Abstract

Background

Congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD) syndrome is a rare X-linked dominant disorder characterized by peculiar cutaneous presentations and ipsilateral skeletal abnormalities. CHILD syndrome is caused by mutations in NSDHL gene, which involves in cholesterol synthesis.

Objectives

To verify the diagnosis of CHILD syndrome and seek effective pathogenesis-based therapy with little side effects.

Method

We comprehensively evaluated the patient's conditions. Pathological biopsy was performed in the lesion location. Genetic tests and real-time quantitative PCR were conducted to further confirm the diagnosis. The topical application of a mixed lotion containing 2% simvastatin and 2% cholesterol to lesion areas based on the pathogenesis as well as the literature review.

Results

We diagnosed a rare and typical case of CHILD syndrome cooccurring with multiple VX -like lesions. The gene mutation is a large deletion of exon 3 and 4 of the NSDHL gene, which was discovered and reported for the first time in CHILD syndrome. The skin lesions, including the verruciform plaques and VX-like lesions, improved obviously after treatment.

Conclusions

Multiple exons deletions or microdeletion were not rare in CHILD syndrome. Classical Sanger sequencing may not be useful enough to find all kinds of mutations. Next Generation Sequencing may be more effective. It is important to conduct genetic counseling to prevent more serious defects in descendants. The excellent therapeutic effect on CHILD syndrome resulted from the topical treatment with simvastatin /cholesterol provides a proof-of-concept for other topical pathogenesis-based therapies for skin disease.

This article is protected by copyright. All rights reserved.

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Evaluation of trabecular pattern of mandible using fractal dimension, bone area fraction, and gray scale value: comparison of cone-beam computed tomography and panoramic radiography

Abstract

Objective

This study was performed to compare the fractal dimension (FD), bone area fraction (BAF), and gray scale value (GSV) on digital panoramic radiography (DPR) and cross-sectional cone-beam computed tomography (CBCT) using image analysis and to determine whether a relationship exists among parameters associated with bone quality.

Methods

Thirty edentulous human hemimandibles were scanned by DPR and CBCT. Ninety regions of interest (ROIs) were evaluated on DPR and CBCT images to calculate the FD and BAF. The GSV of the ROI on CBCT was also calculated.

Results

Statistically significant differences were observed in the FD values of the ROIs between DPR and CBCT (p = 0.002) and in the BAF values of ROIs between DPR and CBCT (p = 0.017). The Spearman's correlation test revealed a statistically significant high correlation between the FD and BAF values of the ROIs on DPR and between the FD and BAF values of the ROIs on CBCT (p < 0.01). No significant correlations were observed between the GSVs of ROIs on CBCT and the FD values of ROIs on DPR, the BAF values of ROIs on DPR, the FD values of ROIs on CBCT, and the BAF values of ROIs on CBCT (p > 0.05).

Conclusions

The GSV did not support the FD and BAF. Additionally, DPR and CBCT did not have similar image quality for assessing the FD, BAF, and GSV. In evaluating the trabecular structure, the use of panoramic radiographs should be continued because the image resolution of CBCT is lower and its generalized dose is higher than that of panoramic radiography. These results may serve as a reference for clinical practitioners using dental CBCT to analyze the trabecular structures of alveolar bones.

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Genetic and functional analysis of the RYR1 mutation p.Thr84Met revealed a susceptibility to malignant hyperthermia

Abstract

Purpose

The aim of this study was to analyze the genetic and functional role of a novel RYR1 variant c.251 C > T (p.Thr84Met) identified in a patient with muscle weakness demonstrating MH susceptibility.

Methods

DNA testing of family members was conducted for assessment of pathogenicity of the genetic variant. For functional analysis, Ca²⁺ measurement using patient-derived myotubes and p.Thr84Met RYR1-transfected human embryonic kidney (HEK)-293 cells was performed to evaluate reactivity to RYR1 activators. The half-maximal effective concentration (EC₅₀) values of two RYR1 activators, caffeine and 4-chloro-m-cresol (4CmC), were calculated from the acquired dose–response curves. The EC₅₀ was compared between two groups: for myotubes, the control group and the patient, and for HEK-293 cells, WT and p.Thr84Met.

Results

Dose–response curves for caffeine and 4CmC were shifted to the left in both myotubes and HEK-293 cells compared to controls. The 50% effective concentration values for caffeine and 4CmC were significantly lower in both myotubes and HEK-293 cells compared to controls (P < 0.001 for all comparisons).

Conclusions

Our results of functional testing indicated RYR1 hypersensitivity to caffeine and 4CmC. We conclude that the genetic variant was associated with MH susceptibility.

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Onset of action for loratadine tablets for the symptomatic control of seasonal allergic rhinitis in adults challenged with ragweed pollen in the Environmental Exposure Unit: a post hoc analysis of total symptom score

Loratadine is a second-generation, non-sedating antihistamine used for the relief of allergic rhinitis symptoms. Previous studies reported that when loratadine was encapsulated, the onset of action for symptom...

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Core Differences in Synaptic Signaling Between Primary Visual and Dorsolateral Prefrontal Cortex

Abstract

Neurons in primary visual cortex (V1) are more resilient than those in dorsolateral prefrontal cortex (dlPFC) in aging, schizophrenia and Alzheimer's disease. The current study compared glutamate and neuromodulatory actions in macaque V1 to those in dlPFC, and found striking regional differences. V1 neuronal firing to visual stimuli depended on AMPA receptors, with subtle NMDA receptor contributions, while dlPFC depends primarily on NMDA receptors. Neuromodulatory actions also differed between regions. In V1, cAMP signaling increased neuronal firing, and the phosphodiesterase PDE4A was positioned to regulate cAMP effects on glutamate release from axons. HCN channels in V1 were classically located on distal dendrites, and enhanced cell firing. These data contrast with dlPFC, where PDE4A and HCN channels are concentrated in thin spines, and cAMP-HCN signaling gates inputs and weakens firing. These regional differences may explain why V1 neurons are more resilient than dlPFC neurons to the challenges of age and disease.

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Lack of Methyl-CpG Binding Protein 2 (MeCP2) Affects Cell Fate Refinement During Embryonic Cortical Development

Abstract

During differentiation, neurons progressively restrict their fate repressing the expression of specific genes. Here we describe the involvement in such developmental steps of the methyl-CpG binding protein 2 (MeCP2), an epigenetic factor that participates to chromatin folding and transcriptional regulation. We previously reported that, due to transcriptional impairments, the maturation of Mecp2 null neurons is delayed. To evaluate whether this could stem from altered progenitors proliferation and differentiation, we investigated whether lack of Mecp2 affects these features both in vitro and in vivo. We show that in Mecp2 null embryonic cortexes the expression of genes defining the identity of proliferating neuroprogenitors is enriched and that their permanence in the G1 phase is prolonged. Moreover, the number of cells transitioning from a stage of maturation to a more mature one is increased in Mecp2 null embryonic cortices, in line with the central role of G1 for cell identity refinement. We thus suggest that, possibly due to the lack of proper transcriptional control normally exerted by Mecp2, fate refinement is impaired in developing null cells. We propose that the maturation delay affecting the developing Mecp2 null cortex originates, at least in part, from deranged mechanisms of cell fate refinement.

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The Roles of Left Versus Right Anterior Temporal Lobes in Semantic Memory: A Neuropsychological Comparison of Postsurgical Temporal Lobe Epilepsy Patients

Abstract

The presence and degree of specialization between the anterior temporal lobes (ATLs) is a key issue in debates about the neural architecture of semantic memory. Here, we comprehensively assessed multiple aspects of semantic cognition in a large group of postsurgical temporal lobe epilepsy (TLE) patients with left versus right anterior temporal lobectomy (n = 40). Both subgroups showed deficits in expressive and receptive verbal semantic tasks, word and object recognition, naming and recognition of famous faces and perception of faces and emotions. Graded differences in performance between the left and right groups were secondary to the overall mild semantic impairment; primarily, left resected TLE patients showed weaker performance on tasks that required naming or accessing semantic information from a written word. Right resected TLE patients were relatively more impaired at recognizing famous faces as familiar, although this effect was observed less consistently. These findings unify previous partial, inconsistent results and also align directly with fMRI and transcranial magnetic stimulation results in neurologically intact participants. Taken together, these data support a model in which the 2 ATLs act as a coupled bilateral system for the representation of semantic knowledge, and in which graded hemispheric specializations emerge as a consequence of differential connectivity to lateralized speech production and face perception regions.

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Exophytic sinonasal papillomas and nasal florid papillomatosis: A retrospective study

Abstract

Background

Sinonasal exophytic papillomas are rare. The multifocal form, florid papillomatosis, has not been yet described in literature. We report on the clinical features and the management of the different forms of exophytic papilloma.

Methods

A retrospective study was conducted that included all patients with exophytic papilloma treated in our center over the past 12 years. We recorded clinical presentation, treatments, recurrences, pathology (p16 expression and human papillomavirus [HPV] status).

Results

We included 13 patients with a mean follow-up of 5 years. The main location of exophytic papilloma was the anterior part of the septum. Lesions were multifocal in 3 patients corresponding to florid papillomatosis. The main treatment was surgery. Cases of HPV-11 or HPV-6 were present in all forms of exophytic papilloma (dysplasia in 4 cases). Late recurrences occurred in 3 patients (2 patients with florid papillomatosis) over a period of 3 years.

Conclusion

Exophytic papilloma has 2 clinical presentations: localized and diffuse. Patients with florid papillomatosis should be monitored closely as recurrence seems to be frequent.

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Endoscopic endonasal approach for sinonasal and anterior skull base malignancies in the elderly

Abstract

Background

The purpose of this study was to report the outcomes of endoscopic transnasal resection for sinonasal and anterior skull-base cancers in elderly patients.

Methods

A retrospective review was performed. The patients were divided into 2 groups, <70 years old and ≥70 years old and compared by univariate analysis. Prognostic factors were evaluated with a multivariate analysis. Survival rates were also calculated.

Results

Two hundred three elderly patients and 397 younger patients were enrolled in this study. The elderly patients reported lower survival rates than the younger patients. When melanoma and esthesioneuroblastoma were censored, the disease-specific survival (DSS) and recurrence-free survival (RFS) were similar. Complication rates were 17.5% without any statistical significance between the groups. Multivariate analysis revealed that histology, stage, surgical margins, and surgical approaches were independent predictors of survival in elderly patients.

Conclusion

The endoscopic transnasal approach reported low mortality and morbidity rates also in geriatric patients, and age itself is not to be considered as a contraindication.

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Fungal kerion of the vulva

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Fungal kerion of the vulva

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Establishing Correlates of Protection for Vaccine Development: Considerations for the Respiratory Syncytial Virus Vaccine Field

Viral Immunology , Vol. 0, No. 0.


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Association between circulating 25-hydroxyvitamin D levels and psoriasis, and correlation with disease severity: a meta-analysis

Summary

Background

Psoriasis is a chronic, autoimmune, inflammatory skin disorder. 25-hydroxy vitamin D [25(OH)D] deficiency may contribute to the pathogenesis of psoriasis through reduction in antiproliferative, anti-inflammatory and antiangiogenic activities.

Aim

To evaluate the relationship between circulating 25(OH)D levels and psoriasis, and to determine the correlation between serum/plasma 25(OH)D levels and psoriasis severity.

Methods

We performed a meta-analysis to compare serum/plasma 25(OH)D levels between patients with psoriasis and healthy controls (HCs), and to determine the correlation coefficients between circulating 25(OH)D levels and psoriasis severity as assessed by Psoriasis Area and Severity Index (PASI).

Results

Ten articles with a total of 571 patients with psoriasis and 496 HCs were included. The 25(OH)D level was significantly lower in the psoriasis group than in the HC group. Subgroup analysis by sample size revealed a significantly lower level of 25(OH)D in the psoriasis group for large (N > 80) but not for small (N < 80) sample sizes. Stratification by adjustment for age and/or sex or sample type revealed a significantly lower 25(OH)D level in the psoriasis group after adjustment for serum but not after nonadjustment for plasma. Meta-analysis of the correlation coefficients revealed a small but statistically significant positive correlation between circulating 25(OH)D levels and PASI.

Conclusions

This meta-analysis demonstrated that circulating 25(OH)D levels are lower in patients with psoriasis, and that a small but statistically significant negative correlation exists between 25(OH)D levels and psoriasis severity.

http://ift.tt/2mFElhR

Association between circulating 25-hydroxyvitamin D levels and psoriasis, and correlation with disease severity: a meta-analysis

Summary

Background

Psoriasis is a chronic, autoimmune, inflammatory skin disorder. 25-hydroxy vitamin D [25(OH)D] deficiency may contribute to the pathogenesis of psoriasis through reduction in antiproliferative, anti-inflammatory and antiangiogenic activities.

Aim

To evaluate the relationship between circulating 25(OH)D levels and psoriasis, and to determine the correlation between serum/plasma 25(OH)D levels and psoriasis severity.

Methods

We performed a meta-analysis to compare serum/plasma 25(OH)D levels between patients with psoriasis and healthy controls (HCs), and to determine the correlation coefficients between circulating 25(OH)D levels and psoriasis severity as assessed by Psoriasis Area and Severity Index (PASI).

Results

Ten articles with a total of 571 patients with psoriasis and 496 HCs were included. The 25(OH)D level was significantly lower in the psoriasis group than in the HC group. Subgroup analysis by sample size revealed a significantly lower level of 25(OH)D in the psoriasis group for large (N > 80) but not for small (N < 80) sample sizes. Stratification by adjustment for age and/or sex or sample type revealed a significantly lower 25(OH)D level in the psoriasis group after adjustment for serum but not after nonadjustment for plasma. Meta-analysis of the correlation coefficients revealed a small but statistically significant positive correlation between circulating 25(OH)D levels and PASI.

Conclusions

This meta-analysis demonstrated that circulating 25(OH)D levels are lower in patients with psoriasis, and that a small but statistically significant negative correlation exists between 25(OH)D levels and psoriasis severity.

http://ift.tt/2mFElhR

Pediatric penile porokeratosis: A case report

Abstract

We present what we believe to be the second case of pediatric penile porokeratosis and the youngest case reported. A 6-year-old boy presented with a pruritic, verrucous growth at the urethral meatus that recurred after two meatotomies. The diagnosis of porokeratosis was confirmed by biopsy. Porokeratosis should be added to the differential diagnosis of chronic hyperkeratotic penile lesions in children.

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Utility of ultrasonography in hair-thread tourniquet syndrome

Abstract

A 2-year-old girl presented with a 2-month history of an erythematous, indurated plaque with well-defined borders on the third toe of the right foot. Bedside high-resolution ultrasonography demonstrated a thickened epidermis overlying a hyperechoic focus within the dermis. Her clinical and sonographic presentation was in keeping with a foreign body causing hair-thread tourniquet syndrome. The foreign body was surgically extirpated without neurovascular sequelae. Ultrasonography expedited accurate diagnosis and is a promising adjunct to clinical evaluation for radiolucent foreign bodies.

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Recurrent terbinafine resistant Trichophyton rubrum infection in a child with congenital ichthyosis

Abstract

Dermatophytosis in children caused by Trichophyton rubrum is preferably treated with topical or systemic terbinafine. We report the first case of terbinafine resistance in a child with recurrent T. rubrum dermatophytosis and congenital ichthyosiform erythroderma.

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Case of classic Kaposi sarcoma of the penis successfully treated with radiotherapy

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Metastatic Crohn's disease in childhood: A case report

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Primary scarring alopecia: A retrospective study of 89 patients in Taiwan

Abstract

Primary scarring alopecia (PSA) is caused by irreversible damage to the hair epithelial stem cells that reside in hair follicles. There is limited published work regarding PSA amongst the Asian population. The aim of this study was to evaluate the clinical features and to characterize the subtypes of PSA in southern Taiwan. In this retrospective case series, we reviewed 89 patients with pathology-confirmed PSA. The data was collected from National Cheng Kung University Hospital between 1988 through 2016. The clinical and histological data were reviewed, and the patients were characterized into different subtypes of PSA based on the clinical features and histological findings. We noted seven different subtypes of PSA. The most common type was dissecting cellulitis (DC) (30.3%), followed by lichen planopilaris (LPP) (23.5%), central centrifugal cicatricial alopecia (CCCA) (12.4%) and acne keloidalis nuchae (AKN) (12.4%). The other subtypes include folliculitis decalvans (FD), discoid lupus erythematosus (DLE) and pseudopelade of Brocq (PPB). Interestingly, FD, DC and AKN were more common in males, while CCCA, LPP, DLE and PPB had a female predominance. The mean age of patients with DLE, DC and AKN were younger, while patients with CCCA, LPP, PPB and FD tend to be older. The pattern of hair loss was more likely to be unifocal-ragged border in CCCA and DLE, multifocal-interconnected in LPP and FD, and multifocal-separated in DC. The pathogenesis of PSA may be influenced by sex, age and genetic background. It is important to identify the hair loss pattern to differentiate the subtypes of PSA.

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Dermoscopic features of Bednar tumor: Report of a case

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Periodontology for Geriatric Patients

Abstract

Purpose of Review

Elderly population represents the fastest growing population segment and target group of many expert organizations developing strategies for successful aging. The substantial increase in man's lifespan together with implementation of preventive dental programs resulted in decreased tooth loss and increased prevalence of periodontal disease. Hence, the present review focused on positioning periodontal health within aging process, characteristic of the senescent periodontium, periodontitis-aging interplay, clinical characteristics, and implications for periodontal care in geriatric patients.

Recent Findings

The senescent periodontium undergoes degenerative changes that are unrelated to progressive destruction in lack of inflammation. The pathological interplay periodontitis-systemic aging is evidenced. Geriatric patients demonstrate comparable treatment outcomes to those of patients ≤ 60 years regarding non-surgical and surgical periodontal treatment and implant therapy as well.

Summary

Adequate oral hygiene and appropriate control of risk factors represent the key pre-conditions for successful periodontal and systemic aging.

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Tick-Borne Relapsing Fever with Severe Jarisch-Herxheimer Reaction.

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Tick-Borne Relapsing Fever with Severe Jarisch-Herxheimer Reaction.

Isr Med Assoc J. 2018 Jan;1(20):62-63

Authors: Koton Y, Bisharat N

PMID: 29333799 [PubMed - in process]

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A Case of a Retrocardiac Mass.

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A Case of a Retrocardiac Mass.

Isr Med Assoc J. 2018 Jan;1(20):60-61

Authors: Pavlov A, Barnes S

PMID: 29333798 [PubMed - in process]

http://ift.tt/2EORAEl

Upper Extremity Deep Vein Thrombosis: Symptoms, Diagnosis, and Treatment.

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Upper Extremity Deep Vein Thrombosis: Symptoms, Diagnosis, and Treatment.

Isr Med Assoc J. 2018 Jan;1(20):53-57

Authors: Mustafa J, Asher I, Sthoeger Z

Abstract
BACKGROUND: Upper extremity deep vein thrombosis (UEDVT) is defined as thrombosis of the deep venous system (subclavian, axillary, brachial, ulnar, and radial veins), which drains the upper extremities. It can be caused by thoracic outlet anatomic obstruction, such as Paget-Schroetter syndrome, (primary) or by central intravenous catheters (secondary). UEDVT may be asymptomatic or present with acute severe pain and arm swelling. Clinical suspicion should be confirmed by diagnostic imaging procedures such as duplex ultrasound, computed tomography scan, or magnetic resonance imaging. UEDVT is managed by anticoagulant treatment. In addition to that, early thrombolysis aimed at preventing post-deep vein thrombosis syndrome and thoracic outlet decompression surgery should be given to patients with primary UEDVT. Anticoagulation without thrombolysis is the treatment of choice for patients with catheter-related thrombosis. Mandatory functioning catheters can remain in place with anticoagulant treatment. All other catheters should be immediately removed. The management of patients with UEDVT requires an experience multidisciplinary team comprised of internists, radiologists, hematologists, and vascular surgeons. Understanding the risk factors for the development of UEDVT, the diagnostic procedures, and the treatment modalities will improve the outcome of those patients.

PMID: 29333796 [PubMed - in process]

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The Impact of Surgeons: Pathologists Dialog on Lymph Node Evaluation of Colorectal Cancer Patients.

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The Impact of Surgeons: Pathologists Dialog on Lymph Node Evaluation of Colorectal Cancer Patients.

Isr Med Assoc J. 2018 Jan;1(20):30-33

Authors: Afifi R, Person B, Haddad R

Abstract
BACKGROUND: Lymph node (LN) retrieval and assessment is essential for accurate staging and treatment planning in colorectal cancer (CRC). According to U.S. National Cancer Institute recommendations, the minimal number of LNs needed for accurately staging of node-negative CRC is 12. Awareness and implementation of the guidelines has been shown to improve after assigning an opinion leader who has a special interest in CRC.
OBJECTIVES: To evaluate the impact of dialogue between surgeons and pathologists in LN evaluation.
METHODS: Consecutively treated CRC patients at the Department of Surgery B at Rambam Medical Center from January 1, 2000 through July 30, 2005 were identified from hospital discharge files. Demographic, surgical, and pathological data were extracted. Patients were divided into two groups. Group I patients underwent surgery before the initiation of a structured surgical oncology service (January 1, 2000 to October 30, 2004). Group II patients underwent surgery after the initiation of the service (November 1, 2004 to July 30, 2005).
RESULTS: The study comprised 212 patients (Group I: n=170; Group II: n=42). The median number of LNs examined was 9 in Group I and 14 in Group II (P = 0.003). Only 35% of patients in Group I received adequate LN evaluation compared to 79% in Group II (P = 0.0001). Patients with left-sided or rectal cancer were less likely to receive adequate LN evaluation than patients with right-sided cancers.
CONCLUSIONS: A durable improvement in LN evaluation was realized through a multi-pronged change initiative aimed at both surgeons and pathologists.

PMID: 29333791 [PubMed - in process]

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Exercise in the Management of Chronic Diseases: An Underfilled Prescription.

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Exercise in the Management of Chronic Diseases: An Underfilled Prescription.

Isr Med Assoc J. 2018 Jan;1(20):51-52

Authors: Sharif K, Amital H

PMID: 29333795 [PubMed - in process]

http://ift.tt/2ENORLy

Ablation-Induced Change in the Course of Fascicular Tachycardia.

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Ablation-Induced Change in the Course of Fascicular Tachycardia.

Isr Med Assoc J. 2018 Jan;1(20):43-50

Authors: Laish-Farkash A, Sabbag A, Glikson M, Glick A, Khalameizer V, Katz A, Michowitz Y

Abstract
BACKGROUND: Multiform fascicular tachycardia (FT) was recently described as a ventricular tachycardia (VT) that has a reentrant mechanism using multiple fascicular branches and produces alternate fascicular VT forms. Ablating the respective fascicle may cause a change in the reentrant circuit resulting in a change in morphology. Ablation of the septal fascicle is crucial for successful treatment.
OBJECTIVES: To describe four cases of FT in which ablation induced a change in QRS morphologies and aggravated clinical course.
METHODS: Four out of 57 consecutive FT cases at three institutions were retrospectively analyzed and found to involve multiform FT. These cases underwent electrophysiological study, fascicular potential mapping, and electroanatomical mapping. All patients initially had FT with right bundle branch block (RBBB) and superior axis morphology.
RESULTS: Radiofrequency catheter ablation (RFCA) targeting the distal left posterior fascicle (LPF) resulted in a second VT with an RBBB-inferior axis morphology that sometimes became faster and/or incessant and/or verapamil-refractory in characteristics. RFCA in the upper septum abolished the second VT with no complications and uneventful long-term follow-up.
CONCLUSIONS: The change in FT morphology during ablation may be associated with a change in clinical course when shifting from one route to another and may aggravate symptoms. Targeting of the proximal conduction system (such as bifurcation, LPF, left anterior fascicle, high septal/auxiliary pathway) may serve to solve this problem.

PMID: 29333794 [PubMed - in process]

http://ift.tt/2mIQCDe

Reduced Suprathreshold Odor Identification in Patients with Pseudotumor Cerebri: A Non-Randomized Prospective Study.

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Reduced Suprathreshold Odor Identification in Patients with Pseudotumor Cerebri: A Non-Randomized Prospective Study.

Isr Med Assoc J. 2018 Jan;1(20):34-37

Authors: Dotan G, Cohen E, Klein A, Kesler A

Abstract
BACKGROUND: Recent evidence suggests that olfaction is impaired in patients with pseudotumor cerebri (PTC).
OBJECTIVES: To measure suprathreshold olfactory function by using the University of Pennsylvania Smell Identification Test (UPSIT), assessing its usefulness for routine clinical use.
METHODS: Forty PTC patients underwent USPIT olfactory testing.
RESULTS: Twenty-nine out of 40 (73%) PTC patients (36 women, 4 men; mean age 34 years) had reduced suprathreshold smell sensation according to UPSIT scores: 19 (47%) had mild microsmia, 9 (23%) had moderate microsmia, and one (3%) was classified as having severe microsmia. The mean UPSIT score of all patients was 32.4 (95% confidence interval 31.4-33.4). Multivariate regression analysis found that UPSIT scores were not related to disease activity, disease duration, initial intracranial pressure (ICP), or visual function.
CONCLUSIONS: Many PTC patients have reduced suprathreshold olfactory dysfunction that can be discovered by UPSIT, a rapidly administered smell test, which is suitable for clinical office use.

PMID: 29333792 [PubMed - in process]

http://ift.tt/2FMPV3x

Crohn's Disease Behavior and Location is Altered when Associated with Primary Sclerosing Cholangitis.

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Crohn's Disease Behavior and Location is Altered when Associated with Primary Sclerosing Cholangitis.

Isr Med Assoc J. 2018 Jan;1(20):25-29

Authors: Iny O, Yanai H, Matalon S, Santo E, Shibolet O, Dotan I, Maharshak N

Abstract
BACKGROUND: Up to 3.4% of Crohn's disease (CD) patients will be diagnosed with concomitant primary sclerosing cholangitis (PSC). Despite the worldwide increase incidence of CD, data on the clinical characteristics of PSC-CD patients are scarce.
OBJECTIVES: To clinically characterize CD in patients who have concomitant PSC.
METHODS: A retrospective case-control analysis was conducted with 18 CD patients with concomitant PSC who attended the Inflammatory Bowel Disease Center at the Tel Aviv Sourasky Medical Center between 2011-2014 (PSC-CD patients). They were matched by age, gender, and disease duration to 90 control patients (those with CD who did not have concomitant PSC). Disease phenotype (according to the Montreal classification), demographics, and clinical data were compared in the two groups.
RESULTS: PSC-CD patients were characterized by a disease that was more frequently limited to the colon (L2) (50% vs. 16%, P = 0.004) and by a non-stricturing and non-penetrating inflammatory phenotype (83% vs. 33%, P = 0.0001) compared to controls who had an increased prevalence of the penetrating phenotype (B3) (6% vs. 33% P < 0.05). Use of 5-aminosalicylic acid agents as a single therapy was significantly more prevalent among PSC-CD patients than in controls (39% vs. 7%, P < 0.005). In contrast, biologic therapy was significantly less common among PSC-CD patients compared to controls (17% vs. 52%, P = 0.0086).
CONCLUSIONS: Patients with PSC-CD are clinically distinct from patients with isolated CD, and are characterized by predominant colonic involvement and an inflammatory, non-stricturing and non-penetrating phenotype.

PMID: 29333790 [PubMed - in process]

http://ift.tt/2FLvSma

Physical Training in a Medical Fitness Room for Patients with Chronic Diseases: Functional and Metabolic Outcomes.

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Physical Training in a Medical Fitness Room for Patients with Chronic Diseases: Functional and Metabolic Outcomes.

Isr Med Assoc J. 2018 Jan;1(20):20-24

Authors: Tayer-Shifman OE, Bar-On Y, Pereg D, Hershko AY

Abstract
BACKGROUND: Physical inactivity is a pivotal factor in the development and progression of various chronic diseases. However, most fitness facilities exclude unhealthy individuals. Therefore, an exercise program that admits such patients is imperative.
OBJECTIVES: To evaluate the effectiveness of a fitness facility that admits adult subjects with multiple chronic diseases.
METHODS: We conducted a retrospective screening of patient records from the Medical Fitness Facility at Meir Medical Center, Israel. Intake of subjects was done by a multidisciplinary team. For each individual, personalized diet and exercise plans were developed and patients attended the facility twice a week. Each participant was evaluated at enrolment and after 4 months for well-being, metabolic parameters, exercise capacity, and laboratory blood tests.
RESULTS: A total of 838 individuals were enrolled, mean age 57 years. Their medical conditions included dyslipidemia (48.8%), hypertension (37.6%), and diabetes mellitus (24.9%), followed by musculoskeletal problems (arthropathy 19%, lower back pain 16.1%) and ischemic heart disease (13.4%). Less common diagnoses were vascular diseases, pulmonary diseases, and malignancy. Only 40.5% of participants adhered to the regimen with advanced age being the best predictor for adherence. At the follow-up visit, body mass index was lower (31.2 vs. 30.2 kg/m2, P <0.0001), exercise capacity increased (measured as maximal MET; 7.1 vs. 8.1, P < 0.0001), and well-being improved (measured by Short Form Survey [SF-36]; 69.3 vs. 76.0, P <0.0001).
CONCLUSIONS: We show that a fitness program for patients with multiple chronic diseases is feasible and effective in improving prognostic parameters, albeit significantly challenged by adherence limitations.

PMID: 29333789 [PubMed - in process]

http://ift.tt/2FLnMK2

Enhancement of Standard ECGs by a New Method for Multi-Cycle Superimposition and Summation.

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Enhancement of Standard ECGs by a New Method for Multi-Cycle Superimposition and Summation.

Isr Med Assoc J. 2018 Jan;1(20):14-19

Authors: Frimerman A, Meisel S, Shotan A, Blondheim DS

Abstract
BACKGROUND: Since the introduction of the electrocardiogram (ECG) in 1902, the fundamentals of ECG data acquisition, display, and interpretation in the clinical arena have not changed much.
OBJECTIVES: To present a new method to enhance and improve acquisition, analysis, and display of the standard ECG.
METHODS: We performed ECG enhancement by superimposition and summation of multiple standard ECG cycles of each lead, by temporal alignment to peak R wave and voltage alignment to an improved baseline, at the T-P segment.
RESULTS: We enhanced ECG recordings of 504 patients who underwent coronary angiograms for routine indications. Several new ECG features were noted on the enhanced recordings. Examination of a subgroup of 152 patients with a normal rest 12-lead ECG led to the discovery of a new observation, which may help to distinguish between patients with and without coronary artery disease (CAD): namely, a spontaneous cycle-to-cycle voltage spread (VS) at the S-T interval, normalized to VS at the T-P interval. The mean normalized VS was significantly greater in those with CAD (n=61, 40%) than without (n=91, 60%), 5.61 ± 3.79 vs. 4.01 ± 2.1 (P < 0.05).
CONCLUSIONS: Our novel method of multiple ECG-cycle superimposition enhances the ECG display and improves detection of subtle electrical abnormalities, thus facilitating the standard rest ECG diagnostic power. We describe, for the first time, voltage spread at the S-T interval, an observed phenomenon that can help detect CAD among individuals with normal rest 12-lead ECG.

PMID: 29333788 [PubMed - in process]

http://ift.tt/2FJR3ot

Detection of Ureaplasma Species by a Semi-Quantitative PCR Test in Urine Samples: Can It Predict Clinical Significance?

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Detection of Ureaplasma Species by a Semi-Quantitative PCR Test in Urine Samples: Can It Predict Clinical Significance?

Isr Med Assoc J. 2018 Jan;1(20):9-13

Authors: Strauss M, Colodner R, Sagas D, Adawi A, Edelstein H, Chazan B

Abstract
BACKGROUND: Ureaplasma species (Usp) are the most prevalent genital Mycoplasma isolated from the urogenital tract of both men and women. Usp may be commensals in the genital tract but may also be contributors to a number of pathological conditions of the genital tract. Because they can also just colonize the genital tract of healthy people, their pathogenic role can be difficult to prove.
OBJECTIVES: The aim of the study was to evaluate the efficacy of a quantitative polymerase chain reaction (qPCR) method for the discrimination between infection and colonization by measuring prevalence of Usp in asymptomatic versus symptomatic patients.
METHODS: Urine samples were tested for U. parvum and U. urealyticum using a semi-quantitative multiplex PCR technique for sexually transmitted diseases (Anyplex™ STI-7 Detection Kit, Seegene, South Korea). A total of 250 symptomatic and 250 asymptomatic controls were included.
RESULTS: A strong positive result for U. parvum was significantly more prevalent in symptomatic compared to asymptomatic patients. This finding was observed especially in women and in the young group (15-35 years of age). No significant differences were observed between the prevalence in symptomatic and asymptomatic patients of U. parvum with low strength of positivity and for U. urealyticum in all groups by age, gender, and strength of positivity.
CONCLUSIONS: The significant difference between the symptomatic and asymptomatic group in the highest positivity group for U. parvum using the Anyplex™ STI-7 detection kit in urine may indicate a high probability of infection rather than colonization, especially in women and young patients.

PMID: 29333787 [PubMed - in process]

http://ift.tt/2FGpxIC

The Added Value of the Lateral Chest Radiograph for Diagnosing Community Acquired Pneumonia in the Pediatric Emergency Department.

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The Added Value of the Lateral Chest Radiograph for Diagnosing Community Acquired Pneumonia in the Pediatric Emergency Department.

Isr Med Assoc J. 2018 Jan;1(20):5-8

Authors: Soudack M, Plotkin S, Ben-Shlush A, Raviv-Zilka L, Jacobson JM, Benacon M, Augarten A

Abstract
BACKGROUND: Opinions differ as to the need of a lateral radiograph for diagnosing community acquired pneumonia in children referred to the emergency department. A lateral radiograph increases the ionizing radiation burden but at the same time may improve specificity and sensitivity in this population.
OBJECTIVES: To determine the value of the frontal and lateral chest radiographs compared to frontal view stand-alone images for the management of children with suspected community acquired pneumonia seen in a pediatric emergency department.
METHODS: Chest radiographs from 451 children with clinically suspected pneumonia were retrospectively reviewed. Interpretation of frontal views was compared to interpretation of combined frontal and lateral view, the latter being the gold standard.
RESULTS: Findings consistent with bacterial pneumonia were diagnosed in 94 (20.8%) of the frontal stand-alone radiographs and in 109 (24.2%) of the combined frontal and lateral radiographs. The sensitivity, specificity, positive predictive value, and negative predictive value of the frontal radiograph alone were 86.2%, 93.9%, 81.7%, and 95.5%, respectively. False positive and false negative rates were 15% and 21%, respectively, for the frontal view alone. The number of lateral radiographs needed to diagnose one community acquired pneumonia was 29.
CONCLUSIONS: The lateral chest radiograph improves the diagnosis of pediatric community acquired pneumonia to a certain degree and may prevent overtreatment with antibiotics.

PMID: 29333786 [PubMed - in process]

http://ift.tt/2B5Fepc

Neuroimaging Findings in Patients with Medication Overuse Headache

Abstract

Medication overuse headache (MOH) is a secondary headache syndrome defined as the deterioration of the headache associated with the overuse of analgesics. The prevalence of MOH is 1–2% in the general population and even up to 50% in special clinics. Overuse of abortive medications is highly associated with chronic daily headaches and also a known risk factor for headache evolution. Possible mechanisms include neural plasticity changes such as sensitization and defective endogenous pain inhibition. Psychological studies have suggested dependence, even addiction, in patients with MOH. Neuroimaging studies have provided valuable information concerning MOH pathophysiology. Magnetic resonance imaging analyzed by voxel-based morphometry showed gray matter volume changes in brain areas participating the pain modulations. Changes of brain function at similar areas have been revealed by positron emission tomography and functional magnetic resonance imaging studies. Many of these changes were correlated with either headache and/or analgesics parameters such as frequency and duration. These changes are typically reversible after successful treatment. Though the cause or consequence debate remains unsettled, we are more in favor of these findings as maladaptive changes to the frequent headaches or medication overuse. Of these brain areas involved in MOH, orbitofrontal cortex is of interest in several ways. In an early positron emission tomography study, the hypometabolism persists after successful treatment which implied a causal role. The following morphological studies showed the orbitofrontal cortex volume could predict treatment responses. Functional magnetic resonance imaging studies, task positive and also resting-state ones, also reported changes within the mesocorticolimbic dopamine system, also known as reward system. Important brain areas of this system include ventral tegmental area, striatum, and orbitofrontal cortex. The system plays an important role in decision-making, dependence, and addiction, as implicated in psychological studies of MOH. Further studies on neuromodulation of this system may be considered in the treatment of MOH.

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Synthetic extracellular matrix mimic hydrogel improves efficacy of mesenchymal stromal cell therapy for ischemic cardiomyopathy

Publication date: Available online 16 January 2018
Source:Acta Biomaterialia
Author(s): Maria Chiara Ciuffreda, Giuseppe Malpasso, Cindy Chokoza, Deon Bezuidenhout, Kyle P. Goetsch, Manuela Mura, Federica Pisano, Neil H. Davies, Massimiliano Gnecchi
BackgroundMesenchymal stromal cells (MSC) repair infarcted hearts mainly through paracrine mechanisms. Low cell engraftment limits the release of soluble paracrine factors (SF) over time and, consequently, MSC efficacy. We tested whether a synthetic extracellular matrix mimic, a hydrogel containing heparin (H-HG), could ameliorate MSC engraftment and binding/release of SF, thus improving MSC therapy efficacy.Methods and ResultsIn vitro, rat bone-marrow MSC (rBM-MSC) were seeded and grown into H-HG. Under normoxia, the hydrogel did not affect cell survival (rBM-MSC survival >90% at each time point tested); vice versa, under hypoxia the biomaterial resulted to be protective for the cells (p<0.001 vs rBM-MSC alone).cells were protected from hypoxia. H-HG or control PEG hydrogels (HG) were incubated with VEGF or bFGF for binding/release quantification. Data showed significantly higher amount of VEGF and bFGF bound by H-HG compared with HG (p<0.05) and a constant release over time.In vivomyocardial infarction (MI) was induced in female Sprague Dawley rats by permanent coronary ligation. One week later, saline, rBM-MSC, H-HG or rBM-MSC/H-HG were injected in the infarct zone. The co-injection of rBM-MSC/H-HG into infarcted hearts significantly increased cardiac function. Importantly, we observed a significant gain in MSC engraftment, reduction of ventricular remodeling and stimulation of neo-vasculogenesis. We also documented higher amounts of several pro-angiogenic factors in hearts treated with rBM-MSC/H-HG.ConclusionsOur data show that H-HG increases MSC engraftment, efficiently fine tunes the paracrine MSC actions and improves cardiac function in infarcted rat hearts. Given its efficacy and safety, documented by the absence of immunoreaction, our strategy appears readily translatable to pre-clinical and clinical settings.Statement of significanceTransplantation of mesenchymal stromal cells (MSC) is a promising treatment for ischemic heart disease, but low cell engraftment limits the release of soluble paracrine factors (SF) and, consequently, MSC efficacy. Thus, in this study we developed an enzymatically degradable polyethylene glycol hydrogel containing heparin (H-HG) able to increase MSC retention and to bind and release paracrine soluble factors secreted by the cells. The result was a significant amelioration in cardiac function, neo-vasculogenesis, endogenous cardiac regeneration and a reduction in ventricular remodeling and scarring. The beneficial effects observed in our study are comparable to those obtained using a much greater number of cells, strengthening the efficacy of the biomaterial used in increasing the therapeutic effects of MSC.

Graphical abstract

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Cricothyrotomy in Helicopter Emergency Medical Service Transport.

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Cricothyrotomy in Helicopter Emergency Medical Service Transport.

Air Med J. 2018 Jan - Feb;37(1):51-53

Authors: High K, Brywczynski J, Han JH

Abstract
OBJECTIVE: Airway management is a requisite skill set for helicopter emergency medical service (HEMS) providers. Cricothyrotomy is a potentially lifesaving skill that is used when other airway maneuvers fail. The authors reviewed all transports by a helicopter program in which cricothyrotomy was performed to assess the frequency, success, and technique.
METHODS: This was a retrospective chart review of air medical patient records from an electronic medical record system over a 112-month period.
RESULTS: During the study period, 22,434 patients were transported, 13 (.057%) of whom underwent cricothyrotomy. The typical patient was a male trauma victim with a mean Glasgow Coma Score of 5 transported from an accident scene with a mean age of 34.3 years. Six (46%) of the patients were alive at 24 hours. All patients (13/100%) received attempted endotracheal intubation; the mean number of attempts per patient was 2. The success rate was 100% with all patients ventilated via cricothyrotomy.
CONCLUSION: This study shows cricothyrotomy is a rarely performed skill but that HEMS providers are able to successfully learn the skill with proper training and oversight.

PMID: 29332778 [PubMed - in process]

http://ift.tt/2mDHejl

Picky eating, pressuring feeding, and growth in toddlers

Publication date: 1 April 2018
Source:Appetite, Volume 123
Author(s): Julie C. Lumeng, Alison L. Miller, Danielle Appugliese, Katherine Rosenblum, Niko Kaciroti
Several common theoretical frameworks have posited causal pathways between picky eating, pressuring feeding, and growth in early childhood. The evidence to support these pathways is limited. This observational cohort study sought to examine the cross-lagged associations between mother-reported pressuring feeding, mother-reported child picky eating, and measured weight-for-length z-score (WLZ) across child ages 21, 27, and 33 months (n = 244). Cross-lagged analysis was used to evaluate longitudinal associations between these three constructs. The sample was 50.5% white, 52.3% male and 37.8% of mothers had a high school education or less. Mean WLZ was 0.52, 0.41, and 0.38 at each age, respectively. Pressuring feeding, picky eating, and WLZ each tracked strongly from 21 to 33 months. There were concurrent associations between pressuring feeding and picky eating. However, there were no prospective associations between pressuring feeding and future WLZ; WLZ and future pressuring feeding; pressuring feeding and future picky eating; picky eating and future pressuring feeding; or picky eating and future WLZ. Our results do not support causal relationships between picky eating, pressuring feeding, and growth in toddlerhood. Future work that examines alternative mechanisms shaping growth in early childhood is needed.



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Effects of urease and nitrification inhibitors on the soil mineral nitrogen dynamics and nitrous oxide (N 2 O) emissions on calcareous soil

Abstract

Urease inhibitors and nitrification inhibitors can reduce nitrogen (N) loss in agriculture soil. However, the effect of inhibitors on soil N₂O emissions under the drip irrigation system remains unclear. A pot and a field experiment with two inhibitors were conducted to explore how inhibitors regulate soil nitrogen transformation and N₂O emissions. In the pot experiment, three treatments included control, urea, and urea + N-(n-butyl)thiophosphoric triamide (NBPT, urease inhibitor). In the field experiment, three treatments included control, urea, and urea + NBPT + 2-chloro-6-(trichloromethyl)pyridine (nitrapyrin, nitrification inhibitor). The urease inhibition rate in the treatment of urea + NBPT was 27.5% at the 14th day of incubation (pot experiment), and NH₄⁺-N was significantly decreased by 37–64% compared with urea alone treatment. In the field experiment, the nitrification inhibition rate in the treatment of urea + NBPT + nitrapyrin was 47.7 and 63.9% on the 3rd day after fertilization at the wheat heading and filling stages, respectively. Compared to urea treatment, NO₃⁻-N concentration in the double-inhibitor-added treatment was significantly decreased by 32 and 20% on the 5th day after fertilization at the heading and filling stages, respectively; N₂O fluxes were also decreased by 30.9 and 33.3% at the two stages of wheat, respectively. In total, adding an inhibitor reduced N loss by 7.39 and 7.44% at the 14th and 35th day in the pot experiment and by 10.53 and 6.65% at the two growing stages of wheat in the field experiment, respectively. Path and correlation analysis showed that N₂O emissions were significantly correlated with soil NO₃⁻ in both pot and field experiments.

http://ift.tt/2ELOH7e

Analysis of accumulation formation of sediment contamination in reservoirs after decades of running: a case study of nitrogen accumulation in Biliuhe Reservoir

Abstract

Sediment contamination is an important influencing factor for reservoir water quality. Investigations have shown that reservoirs are facing the risk of sediment contamination after running for several decades in China. This paper proposes that the accumulation of sediment contaminant is resulted from the difference between the input and output of contaminant. Further, an accumulation model of reservoir sediment nitrogen is established based on this theory. The calculation result of Biliuhe Reservoir shows that inflow rate of total nitrogen into the reservoir is 4521.47 t/a, the outflow rate is 1033.97 t/a, nitrogen removal by denitrification is 1465.81 t/a, and the accumulation rate is 1841.68 t/a. The accumulation rate of total nitrogen is 77.84 t/a in water, 924.42 t/a in suspended solids, and 839.42 t/a in sediment. The accumulation of nitrogen resulted in the total nitrogen concentration in water increasing from 1.71 mg/L in 1995 to 3.78 mg/L in 2013, and that in sediment increasing from 779.10 mg/kg in 1993 to 2725.00 mg/kg in 2013. It is concluded that sediment contamination has the characteristics of significant accumulation trend, complex forms, and high security risks, which has been a hidden security risk for reservoirs after decades of running. Heterogeneity of the reservoir and complicated influencing factors of sediment contaminant accumulation should be concerned next.

http://ift.tt/2FMyXCn

Effect of brewery wastewater obtained from different phases of treatment plant on seed germination of chickpea ( Cicer arietinum) , maize ( Zea mays ), and pigeon pea ( Cajanus cajan )

Abstract

Brewing industry releases large quantities of wastewater after product generation. Brewery wastewater contains organic compounds which are biodegradable in nature. These biodegradable wastes can be recycled and reused and hence considered as suitable products for agriculture. But before using wastewater for agriculture, it is better to evaluate the phytotoxic effects of wastewater on crops. Hence, the main objective of this study is to evaluate the effects of brewery effluent on seed germination and growth parameters of selected crop species like chickpea (Cicer arietinum), maize (Zea mays), and pigeon pea (Cajanus cajan). Study comprised seven types of water treatments—tap water as control, diluted UASBR effluent (50% effluent + 50% distilled water): UASBR50, undiluted UASBR effluent: UASBR100, diluted TC effluent (50% effluent + 50% distilled water): ETP50,TC effluent without dilution: ETP100, 10% diluted reverse osmosis (RO10) reject (10% RO reject + 90% distilled water), and 25% diluted reverse osmosis(RO25) reject (25% RO reject + 75% distilled water) with three replications in completely randomized design. Germination test was performed in petri plates for 5 days. Parameters like germination percentage, germination rate index, seedling length, phytotoxicity index, seed vigor index, and biomass were calculated. All parameters decreased with increase in respective effluent concentration. Among all treatments, RO25 showed highest inhibitory effect on all three crops. Even though undiluted effluent of UASBR and ETP effluent showed positive effect on germination, seedling growth of three crops was promoted to the maximum by UASBR50 and ETP50. Hence, from the study, it was concluded that dilution of brewery effluent can be recommended before using it for irrigational purpose.

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Absence of iodine/iodide in cough/expectorant medications: A true disclaimer or not?

Ramya Sugumar, Subramanian Kannan, Adlyne Reena Asirvatham, Shriraam Mahadevan

Indian Journal of Nuclear Medicine 2018 33(1):84-85



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Reduction of radiation exposure to patients and professionals by reducing the administered activity of 18f-fluorodeoxyglucose in a positron-emission tomography/computed tomography study

Sneha Mithun, Ashish Kumar Jha, Ameya D Puranik, Priya Monteiro, Sneha Shah, Archi Agarwal, Nilendu C Purandare, Venkatesh Rangarajan

Indian Journal of Nuclear Medicine 2018 33(1):6-9

Aim: With increased clinical indications for positron-emission tomography/computed tomography (PET/CT) and repeated PET/CT scans, there is a need to reduce the radiation burden to the patient, professionals as well as public. This requires a redefining of the workflow and the 18-F-fluorodeoxyglucose (18F-FDG) administered activity. The objective of our study is to observe the impact of strike out reduction of administered activity on the radiation exposure to personnel and public, as well as the absorbed dose to the patient with no compromise on image quality by increasing the image acquisition time. Materials and Methods: Nineteen patients evaluated in this study (11 males, 8 females) were put into two groups, namely, A and B. Patients in Group A (n = 10) were administered with 18F-FDG equivalent to the recommended dose (7–8 MBq/kg body weight) whereas patients in Group B (n = 9) were administered with 18F-FDG equivalent to half the recommended dose (3–4MBq/kg body weight). The exposure rates from the patients at the body surface and 100 cm distance were measured immediately and 1 h postinjection. Results: The average surface dose rate and 100 cm dose rate of the adult patients immediately postinjection for patients of Group A were 0.94 ± 0.19 mSv/h and 0.057 ± 0.007 mSv/h, and for Group B were 0.34 ± 0.24 mSv/h and 0.031 ± 0.01 mSv/h. Conclusion: This study suggests that reduction in injected 18F-FDG activity reduces the radiation exposure rate from the patient, absorbed dose to the patient with reportable image quality.

http://ift.tt/2DiI7Jt

Incidental global hypometabolism in the brain of patient with AIDS-related dementia seen on 18f-fluorodeoxyglucose positron emission tomography/computed tomography

Priyanka Verma, Ramesh V Asopa

Indian Journal of Nuclear Medicine 2018 33(1):73-75

Human immunodeficiency virus (HIV)-related dementia is the most severe form of neurocognitive disorder in patients with AIDS. It is relatively uncommon in postantiretroviral therapy (HAART) era and is associated with a high cerebrospinal fluid CSF/plasma viral load. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has proven useful in malignancies, infections, and central nervous system lesions in HIV-infected patients and has been used to explore regional cerebral glucose metabolism patterns in HIV-positive patients with and without cognitive impairment. We present the case of a 36-year-old male with AIDS presenting as pyrexia of unknown origin, where global brain hypometabolism was noted incidentally on FDG PET/CT referred for identification of the infective focus/tumor causing the fever.

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Reply by Author

Indian Journal of Nuclear Medicine 2018 33(1):91-91



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Comparison of left ventricular phase parameters analysis between two software programs in patients with normal gated single-photon emission computed tomography-myocardial perfusion imaging

Dharmender Malik, Ashwani Sood, Madan Parmar, Bhagwant Rai Mittal

Indian Journal of Nuclear Medicine 2018 33(1):14-19

Background: Phase analysis can be easily performed by different software to assess the left ventricular dyssynchrony from gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) with high precision. However, the normal values of histogram bandwidth (HBW) and phase standard deviation (PSD) and their comparison using different programs have not been fully elucidated and actively being evaluated at present. The aim of this study was to determine the phase analysis parameters values and to compare the phase indices of two commonly used programs in a group of patients with normal gated SPECT-MPI. Methods: Phase parameters were retrospectively evaluated in 138 consecutive nondiabetic patients having a normal gated SPECT-MPI using the quantitative gated SPECT (QGS) and Emory Cardiac Toolbox (ECTb) software. HBW, PSD, and phase entropy were calculated separately using both programs. Results: The fair correlation between software programs was observed. HBW and PSD in QGS and ECTb were 26.20 ± 9.7 and 25.46 ± 8.0 (r-value. 56, SEE 6.65) and 6.64 ± 2.5 and 7.65 ± 2.5 (r = 0.54, SEE 2.14), respectively. The value of phase entropy in QGS program was 45.08 ± 6.3. A fair correlation between phase entropy and PSD in QGS was observed (r = 0.44, 95% confidence interval-0.29–0.56). Conclusion: Phase analysis parameters derived from gated SPECT-MPI in patients with normal myocardial perfusion are program dependent and may differ. The results cannot be interchangeably used in the same patients.

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Vitamins E and C prevent DNA double-strand breaks in peripheral lymphocytes exposed to radiations from iodine-131

Mehdi Safaei, Seyed Masoud Jafarpour, Mehran Mohseni, Morteza Salimian, Hossein Akbari, Fateme Karami, Akbar Aliasgharzadeh, Bagher Farhood

Indian Journal of Nuclear Medicine 2018 33(1):20-24

Purpose: Iodine-131 is used as a radiopharmaceutical to treat thyroid cancer. The current study aimed to evaluate the effects of vitamins E and C on the level of DNA double-strand breaks (DSBs) caused by Radioiodine-131 (I-131) in human lymphocytes. Materials and Methods: Whole blood samples from human volunteers were incubated with a certain concentration of vitamins. After 1-h incubation, the samples were incubated with 20 μCi I-131/2 mL (blood + NaCl) for 1 h. To evaluate the effects of antioxidants, lymphocytes were separated, and the mean DSBs/cell was measured for each sample through γ-H2AX assay. Results: After 1-h incubation with 20 μCi I-131/2 mL (blood + NaCl), iodine-131 increased the level of DSBs by 102.9%, compared with the background group. Vitamins E and C reduced the level of DSBs by 21.5% and 36.4%, respectively. Conclusion: Using vitamins E and C as antioxidants can reduce the toxicity of I-131. Furthermore, vitamin C provided the more protection for DNA, compared with vitamin E.

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Incidental detection of bilateral large urinary bladder diverticulae on tc99m ethylene dicysteine renography with single-photon emission computed tomography-computed tomography

Ashwin Singh Parihar, Shelvin Kumar Vadi, Prema Menon, Bhagwant Rai Mittal, Anish Bhattacharya

Indian Journal of Nuclear Medicine 2018 33(1):79-81

The complementary anatomical and functional information provided by hybrid imaging with single-photon emission computed tomography-CT (SPECT-CT) is a very useful imaging tool in selected cases where anatomical information is lacking as in the scenario of dynamic renal scintigraphy. The authors present a case of a 5-year-old male child with symptoms suggestive of cutis laxa with urinary tract infection. The child underwent dynamic renal scintigraphy with Tc99m ethylene dicysteine for cortical function and drainage assessment. Hybrid SPECT/CT proved valuable in the child in identification of the bilateral gross urinary bladder diverticulae.

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Cerebral hemisphere hypoperfusion with ipsilateral internal jugular vein and upper extremity deep vein thrombosis in lung carcinoma on 18f-fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography

Tarun Kumar Jain, Rajender Kumar Basher, Ashwani Sood, Abhiram Gopalajois Ashwathanarayana, Ashwin Singh Parihar, Bhagwant Rai Mittal

Indian Journal of Nuclear Medicine 2018 33(1):88-89



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Role of myocardial perfusion study in differentiating ischemic versus nonischemic cardiomyopathy using quantitative parameters

Preeti Singh, Bhairavi Bhatt, Shwetal U Pawar, Ashish Kamra, Suruchi Shetye, Mangala Ghorpade

Indian Journal of Nuclear Medicine 2018 33(1):32-38

Purpose: Ischemic cardiomyopathy (ICM) and non-ICM (NICM) causes of dilated cardiomyopathy with similar clinical presentation have different management and prognosis. This study employed myocardial perfusion imaging (MPI) to differentiate between the two using quantitative parameters in Indian population. Methods and Materials: Fifty patients prospectively underwent MPI and 18F-fluorodeoxyglucose metabolism studies. P values (0.05 as significant) were calculated for the left ventricular ejection fraction (EF), end diastolic volume (EDV) at rest and stress, end systolic volume (ESV) at rest and stress, summed rest score (SRS), summed difference score (SDS), and eccentricity. On 6-month follow-up, rate of hospital admission, change in management and death was correlated for ICM and NICM. Coronary angiography (CAG) being gold standard, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and level of agreement were calculated for MPI. Results: MPI and CAG had a moderate level of agreement (κ = 0.463) for differentiating ICM and NICM. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 79.31%, 66.67%, 76.67%, 70.0%, and 74% for ICM and 66.67%, 79.31%, 70%, 76.67%, and 74% for NICM, respectively. Significant differences were seen in EDV stress (P = 0.045), EDV rest (P = 0.031), ESV rest (P = 0.034), SRS (P = 0.004), Left ventricular EF rest (P = 0.049) and SDS in ICM and NICM, respectively. Conclusion: EDV at rest and stress, ESV at rest, SRS, SDS, and EF at rest obtained using MPI provides precise quantitative information to differentiate ICM and NICM. It is wide and easy availability, noninvasiveness, objectivity, and near absence of complications favors it as a preferable diagnostic tool with its given sensitivity, specificity, and accuracy for the purpose.

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Radiation dose to the occupational worker during the synthesis of 188Re-labeled radiopharmaceuticals in the nuclear medicine department

Parul Thakral, Jyotsna , Pankaj Tandon, Sugandha Dureja, Vineet Pant, Ishita Sen

Indian Journal of Nuclear Medicine 2018 33(1):1-5

Aim: The aim of this study is to estimate whole-body radiation dose to the radiopharmacist involved in labeling of three different 188Re-labeled compounds, namely, 188Re-Lipiodol, 188Re-tin colloid, and 188Re-hydroxyl-ethylidene-diphosphonate (HEDP) and to compare the occupational burden with the dose limits recommended by Atomic Energy Regulatory Board, India. Materials and Methods: The Department of Nuclear Medicine at Fortis Memorial Research Institute currently synthesizes three different Rhenium-188 labeled compounds, namely, 188Re-Lipiodol, 188Re-HEDP, and 188Re-tin colloid. To estimate the radiation exposure to the radiopharmacist involved in the synthesis, a survey meter was used to measure radiation level before the start of labeling procedure in the radiopharmacy by keeping it at the location where the radiopharmacist normally stands during preparation. Data were collected for 6 syntheses of each 188Re-Lipiodol, 4 for 188Re-HEDP, and 3 for 188Re-tin colloid followed by the quality control. The pocket dosimeter was used by the radiopharmacistat chest level, performing the labeling of 188Re-labeled compounds. All radiopharmaceuticals were synthesized by a single radiopharmacist. Results: 1850 MBq (50 mCi) 188W-188Re generator was eluted before the preparation of each radiopharmaceutical. The amount of 188ReO4- used for labeling with lipiodol/4-hexadecyl-1,2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol, HEDP, and Tin colloid was in the range of 3182–4440 MBq (86–120 mCi), 2812–3774 MBq (76–102 mCi), and 962–1295 MBq (26–35 mCi), respectively. Meantime required to complete the synthesis was 95, 40, and 131.5 min, respectively. Mean whole-body effective dose received was 0.052, 0.009, and 0.004 mSv, respectively, as measured by using the pocket dosimeter. Conclusion: From this small study, we observed that the whole-body radiation dose to the radiopharmacist in radiolabeling and quality control of 188Re-labeled radiopharmaceuticals is within prescribed limits at the current synthesis frequency.

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Comparison of the F+20 and F-15 diuresis technetium-99m diethylenetriaminepentacetate renography protocols for diagnosis of ureteropelvic junction obstruction in adult patients with hydronephrosis

Majhi Tapas Kumar, Singh Hanuwant

Indian Journal of Nuclear Medicine 2018 33(1):39-42

Introduction: Hydronephrosis (HDN) in adults is a common presentation and may be due to congenital ureteropelvic junction obstruction. Diuresis renography is the method of choice for differentiating a dilated unobstructed urinary system from a true obstruction. The aim of this study was to compare the F+20 protocol with F-15 protocol and see whether this new protocol can reduce inconclusive results. Materials and Methods: It was a prospective, comparative study included 51 adult patients of primary HDN. Each patient underwent both F+20 and F-15 diuretic Technetium-99m diethylenetriaminepentacetate (Tc-DTPA) renography protocol studies. The results of diuretic Tc-DTPA renography studied in terms of obstructive, nonobstructive, or equivocal. Results: A total 60 renal units (RU) with HDN were included in this study. The mean age of patients was 25.25 years. 36 RU presented with specific symptoms and 24 RU with vague symptoms or diagnosed incidentally. The equivocal results were significantly lower in F-15 protocol than F+20 protocol. The equivocal results in F+20 protocol were significantly higher with incidentally diagnosed HDN and patients presented with vague symptoms. Most of the equivocal results of F+20 protocol were converted into either obstructive or nonobstructive by the F-15 protocol. Conclusion: The F-15 diuretic renogram protocol was associated with significantly less equivocal results than F+20 protocol. Moreover, F-15 protocol allowed clarification in cases of equivocal results of F+20 protocol. Therefore, we suggest the F-15 diuresis protocol as a single test for confirmation or exclusion of obstruction especially in the adult patient of HDN presented with vague symptoms or diagnosed incidentally.

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Locked-in Syndrome and 18F-fluorodeoxyglucose-positron Emission Tomography/Computed Tomography: Observations from a Case of Basilar Artery Thrombosis

Angelina Cistaro, Giuliano Lo Bianco, Piercarlo Fania, Simone Margotti, Simone Vigneri, Cristina Geraci, Natale Quartuccio

Indian Journal of Nuclear Medicine 2018 33(1):65-67

We report the case of a 59-year-old male patient suffering from locked-in syndrome (LIS) following basilar artery thrombosis despite an attempt of thrombolysis. Neurological examination showed quadriplegia and aphonia and a state of coma requiring mechanical ventilation was diagnosed. The use of 18F-fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET) allowed to detect a normal 18F-FDG uptake in the main cerebral cortical areas and a significant reduction of 18F-FDG uptake in both cerebellar hemispheres, compatible with a functional deafferentation, helping confirming the clinical suspicion of LIS. The diagnosis of LIS, according to literature, is based on the clinical assessment and the utilization of scores as the Coma Recovery Scale-Revised. The standard neuroimaging techniques, although recognize the site of injury, are not able to differentiate the different conditions affecting a state of altered consciousness. Performing 18F-FDG-PET in patients with LIS might help addressing the correct diagnosis and prompting subsequent appropriate treatment, and therefore, ultimately improving the patient outcome. Therefore, 18F-FDG-PET should be taken into account in the early clinical assessment of doubtful cases.

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Dacroscintigraphy by pediatric dropper technique: A user-friendly instillation procedure of radiotracer

Anurag Jain, Deepak Aheer, Amit Arora, Arun Ravi John, KP Solanki, Braj Kishore, MG Vishnoi, Abhishek Mahto, Surya Prakash, AG Pandit

Indian Journal of Nuclear Medicine 2018 33(1):43-47

Context: Instillation or application of the radiotracer over the tear film is one of the important parts of dacroscintigraphy. Our study explains the value of an improvised dropper technique so that desired amount of radioactivity in desired volume can be instilled over the tear film. Aim: The aim of the study is to introduce a simple and convenient instillation method based on dropper technique for performing dacroscintigraphy. This improvised dropper technique can be used so that desired amount of radioactivity in desired volume can be instilled over the tear film. The objectives of this experiment are to measure the volume and activity of each drop from the dropper. Settings and Design: Experiment of volume and activity measurement standardization was carried out in two parts. In the first part, we calculated the volume of each drop indirectly to standardize the volume of drop. In the second part, we standardized the activity in each drop by measuring it in a dose calibrator. Subjects and Methods: In this study, we used a common pediatric dropper of approximately 1 ml capacity, radioactivity (99mTcO4 pertechnetate), sample vial (container), vial holder, a pair of nonsterile gloves, dose calibrator, etc., Experiments of volume and radioactivity standardization were carried out in two parts. The first part of experiment calculated volume of each drop indirectly, and in the second, we standardized the activity in each drop by measuring it in dose calibrator. Statistical analysis used: Analysis of variance test was used to calculate the correlation of readings by same individual as well as among the three individuals Results: After analysis of result obtained, it was understood that there was no significant difference found in volume and activity of each drop in the readings recorded by same individual as well as among the three individuals. The calculated activity and observed activity were 86.64 and 79.16 μCi, respectively. The difference was only 8.63% lying within acceptable limits.

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Testicular metastasis from recurrent gastroesophageal junction adenocarcinoma: Fluorodeoxyglucose positron emission tomography/computed tomography findings

Ishan Garg, Maria Jose Baladron Zanetti, Ayse Tuba Kendi

Indian Journal of Nuclear Medicine 2018 33(1):71-72

Testicular metastasis from gastroesophageal junction (GEJ) adenocarcinoma is a very rare condition. A 57-year-old male with a history of neoadjuvant chemotherapy and surgery for HER-2-positive GEJ adenocarcinoma underwent a follow-up 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT). It revealed multiple metastases including bilateral testicular and L4 laminar metastasis. The patient received multiple chemotherapies, but follow-up PET/CT showed interval progression of disease. Here, we present a case highlighting one of the unusual sites of metastasis from GEJ cancer, role of PET/CT as a surveillance tool in such patients, and the importance of radiologists to be aware of such uncommon sites of metastasis to avoid interpretative errors.

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18F-Fluorodeoxyglucose positron emission tomography-computed tomography in evaluation of large vessel vasculitis

Amrutha Lakshmi Rayudu, Tekchand Kalawat, VS Krishna Mohan, A Mohan, Amancharla Yadagiri Lakshmi, Ranadheer Gupta Mantri

Indian Journal of Nuclear Medicine 2018 33(1):48-51

18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) is a rapidly evolving hybrid imaging technique in evaluation of infection and inflammation. Usually, functional changes often precede anatomical changes. 18F-FDG PET-CT, a noninvasive diagnostic test and it is useful for the early detection of inflammation. Most of the large vessel vasculitis patients present with nonspecific signs and symptoms, which are difficult to diagnose clinically. Here, we discuss three cases of large vessel vasculitis with different clinical presentations, identified by 18F-FDG PET-CT scan.

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Significance of 18F-sodium fluoride positron emission tomography in characterization of POEMS osteosclerotic lesions better than 18F-fluorodeoxyglucose positron emission tomography

Fahad Abdul Rehman Marafi, Rashid Rasheed, Sharjeel Usmani, Fareeda Alkandari, Anam Iqbal

Indian Journal of Nuclear Medicine 2018 33(1):76-78

Crow-Fukase syndrome (POEMS syndrome) is a rare systemic paraneoplastic syndrome. Bone lesions are manifested by sclerotic osteoblastic lesions often associated with bone pain. Characterization of osseous lesions is always crucial for clinical correlation and better patient management. We present a case where 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) was unable to characterize a clinically symptomatic patient, and 18F-fluoride PET/CT showed excellent characterization of osteosclerotic lesions. The results were in correlation with already published data and showed that 18F-fluoride PET/CT has better uptake in osteoblastic lesions in POEMS syndrome when compared to18F-FDG PET/CT and have superior imaging quality in assessing the bone lesions.

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Primary versus secondary tracheoesophageal puncture: systematic review and meta-analysis.

Related Articles

Primary versus secondary tracheoesophageal puncture: systematic review and meta-analysis.

J Laryngol Otol. 2018 Jan;132(1):14-21

Authors: Chakravarty PD, McMurran AEL, Banigo A, Shakeel M, Ah-See KW

Abstract
BACKGROUND: Tracheoesophageal puncture represents the 'gold standard' for voice restoration following laryngectomy. Tracheoesophageal puncture can be undertaken primarily during laryngectomy or in a separate secondary procedure. There is no current consensus on which approach is superior. The current evidence comparing primary and secondary tracheoesophageal puncture was assessed.
METHODS: A systematic review and meta-analysis of articles comparing outcomes for primary and secondary tracheoesophageal puncture after laryngectomy were conducted. Outcome measures were: voice success, overall complication rate and pharyngocutaneous fistula rate.
RESULTS: Eleven case series met the inclusion criteria, two prospective and nine retrospective. Meta-analysis did not demonstrate statistically significant differences in overall complication rate or voice outcomes, though it suggested a significantly increased risk of pharyngocutaneous fistula in primary compared to secondary tracheoesophageal puncture.
CONCLUSION: Primary tracheoesophageal puncture is a safe and efficient approach for voice rehabilitation. However, secondary tracheoesophageal puncture should be preferred where there is a higher risk of pharyngocutaneous fistula.

PMID: 29173195 [PubMed - indexed for MEDLINE]

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Investigating the composition characteristics of dissolved and particulate/colloidal organic matter in effluent-dominated stream using fluorescence spectroscopy combined with multivariable analysis

Abstract

Fluorescence excitation-emission matrix (EEM) spectroscopy combined with principal component analysis (PCA) and parallel factor analysis (PARAFAC) were used to investigate the compositional characteristics of dissolved and particulate/colloidal organic matter and its correlations with nitrogen, phosphorus, and heavy metals in an effluent-dominated stream, Northern China. The results showed that dissolved organic matter (DOM) was comprised of fulvic-like, humic-like, and protein-like components in the water samples, and fulvic-like substances were the main fraction of DOM among them. Particulate/colloidal organic matter (PcOM) consisted of fulvic-like and protein-like matter. Fulvic-like substances existed in the larger molecular form in PcOM, and they comprised a large amount of nitrogen and polar functional groups. On the other hand, protein-like components in PcOM were low in benzene ring and bound to heavy metals. It could be concluded that nitrogen, phosphorus, and heavy metals in effluent had an effect on the compositional characteristics of natural DOM and PcOM, which may deepen our understanding about the environmental behaviors of organic matter in effluent.

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Acute intestinal obstruction due to extrinsic compression by previa myoma and ectopic pregnancy: a case report

Acute intestinal obstruction during pregnancy is a rare digestive surgical emergency with significant maternal and fetal mortality. Diagnosis is difficult, often delaying the management. Here, we report an exc...

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Epidermal melanocytes of segmental vitiligo show altered expression of E-cadherin, but not P-cadherin

Abstract

Vitiligo is the most common pigmentation disorder, with a worldwide prevalence of 1%. The loss of melanocytes from the skin is the main clinical feature of patients with vitiligo, resulting in depigmentation macules. Vitiligo has been classified into two major forms: non-segmental vitiligo (NSV) and segmental vitiligo (SV). NSV lesions are generally bilateral or symmetrically scattered over the entire body. Onset may occur at any age, but most patients develop vitiligo before 40 years of age, and the depigmentation evolves over time.

This article is protected by copyright. All rights reserved.

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Reflectance Confocal Microscopy for the Diagnosis of Langerhans Cell Histiocytosis

Abstract

Langerhans cell histiocytosis (LCH) is a rare proliferative disease occurring in young children. The most affected organs are the bones and the skin (1). The diagnosis of LCH relies on histopathology. Reflectance confocal microscopy (RCM) is a non-invasive imaging technique used to diagnose skin cancer (2). We report that in three children RCM examination of cutaneous lesions of LCH showed specific signs correlated to histopathology.

This article is protected by copyright. All rights reserved.

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Do Cutibacterium acnes and Staphylococcus aureus define two different types of folliculitis?

Abstract

Scalp folliculitis is a common disorder in dermatology. Its clinical spectrum includes three main forms: "simple" folliculitis with an ad integrum evolution without sequellar alopecia, Quinquaud's folliculitis decalvans, and acne keloidalis nuchae. The pathophysiology of scalp folliculitis remains poorly understood. The assumptions would be infectious and/or inflammatory causes possibly involving Staphylococcus aureus and Propionibacterium acnes (now referred to as Cutibacterium acnes according to a new taxonomic classification).

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Merkel cell carcinoma in France: A registries-based, comprehensive epidemiological survey

Abstract

Background

Merkel cell carcinoma (MCC) is a rare primary cutaneous neuroendocrine carcinoma. Owing to its low incidence, epidemiological data are scarce and have never been analysed in France to identify the main epidemiological trends.

Methods

Data from MCC patients diagnosed between 1998 and 2010 were obtained from 11 French cancer registries in the FRANCIM network. The main epidemiological characteristics of MCC were investigated between 2006 and 2010 because comprehensive data were only available for this period. The main focus was tumour incidence and mortality over time.

Results

Between 1998 and 2010, 562 cases of MCC were reported in the registries. From 2006 to 2010 (290 cases), European- and world-standardized incidence rates were 0.26 and 0.43 per 100,000 person-years in men; and 0.24 and 0.38 per 100,000 person-years in women. MCC is more frequent in females in France (56.9%) with male/female ratio1.1. Relative survival rates were 84%, 56% and 42% at one, three and five years, respectively.

Conclusions

The incidence of MCC clearly increased over time in all areas under focus. The standardized incidence in France was comparable to the incidence observed in other countries for the same period but French data are too recent to conclude on an increase in MCC incidence. Prognosis remains poor in all countries in which data are available.

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Mogamulizumab-induced phosensitivity in patients with mycosis fungoides and other T cell neoplasms

Abstract

Background

Mogamulizumab (Mog) is a defucosylated, therapeutic monoclonal antibody, targeting CCR4, and was first approved in Japan for the treatment of adult T cell leukaemia/lymphoma (ATLL), followed by cutaneous T cell lymphoma and peripheral T cell lymphoma.

Objective

To retrospectively investigate development of photosensitivity in patients with mycosis fungoides and other T cell neoplasms after treatment with Mog.

Methods

We treated 7 cutaneous lymphoma patients with Mog. Upon combination treatment with narrow-band UVB, we noticed that 4 patients developed photosensitivity dermatitis following Mog therapy, including 2 cases of mycosis fungoides, one case of adult T-cell leukemia/lymphoma, and one case of EB virus-associated T-cell lymphoproliferative disorder. Phototest was performed with UVA and UVB, and immunohistochemical staining for CD4, CD8 and Foxp3 were conducted in both photosensitivity and lymphoma lesions.

Results

Phototest revealed that the action spectrum of the photosensitivity was UVB in 3 cases and both UVB and UVA in one case. Histopathologically, the photosensitive lesions were characterized by a lichenoid tissue reaction with a CD8⁺ T cell-dominant infiltrate, sharing the feature with chronic actinic dermatitis, an autoreactive photodermatosis with a cytotoxic T-cell response. Foxp3⁺ regulatory T cells (Tregs) were decreased in the photosensitivity lesions compared with the lymphoma lesions.

Conclusion

Increased incidence of photosensitivity reaction was observed during Mog treatment. Decreased number of Tregs in the lesional skin suggests that this reaction is possibly induced by autoreactive cytotoxic T cells.

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Histiocytosis - cutaneous manifestations of hematopoietic neoplasm and non-neoplastic histiocytic proliferations

Abstract

Histiocytoses are rare disorders characterized by the accumulation of cells derived from macrophages, dendritic cells, or monocytes in various tissues. There is a broad spectrum of disease manifestations with some subtypes commonly showing skin lesions while in others the skin is rarely involved. Here we describe cutaneous manifestations of histiocytoses belonging to the Langerhans group (L group), the group of cutaneous and mucocutaneous histiocytoses (C group) and the group of Rosai-Dorfman disease and related histiocytoses (R group) according to the current classification. Charcteristic clinical presentations noted were a rust-brown color or xanthomatous aspect in many cases of histicytoses. Histological criteria for differentiation are described. Immunohistochemistry shows positivity for S100 and CD1a in Langerhans-cell histiocytoses of the L group while CD68 positivity with S100 and CD1a negativity is typical in histiocytoses of the C-group of cutaneous and mucocutaneous histiocytoses. Rosai-Dorfman disease in the R group shows positivity for S100 and CD68 while CD1a is negative. We further review the pathogenesis of Langerhans-cell histiocytoses based on insights on the central role of the MAPK kinase pathway. Common mutations in various histiocytic populations of diverse ontogeny and at different stages of differentiation may be responsible for the diverse clinical picture of this neoplastic entity. For histiocytoses of the C group and R group a reactive origin is discussed with the exception of the disseminated form of juvenile xanthogranuloma. We suggest exploring the role of an origin from skin residing histiocytes for the isolated cutaneous manifestation in some types. With regard to therapeutic options, skin directed therapies are the first choice in limited disease while systemic chemotherapy has traditionally been used in extensive disease. In Langerhans-cell histiocytoses and related entities therapy by BRAF inhibition has led to a breakthrough especially in patients with an activation of the MAPK pathway.

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Epidermal melanocytes of segmental vitiligo show altered expression of E-cadherin, but not P-cadherin

Abstract

Vitiligo is the most common pigmentation disorder, with a worldwide prevalence of 1%. The loss of melanocytes from the skin is the main clinical feature of patients with vitiligo, resulting in depigmentation macules. Vitiligo has been classified into two major forms: non-segmental vitiligo (NSV) and segmental vitiligo (SV). NSV lesions are generally bilateral or symmetrically scattered over the entire body. Onset may occur at any age, but most patients develop vitiligo before 40 years of age, and the depigmentation evolves over time.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rilu2e

Reflectance Confocal Microscopy for the Diagnosis of Langerhans Cell Histiocytosis

Abstract

Langerhans cell histiocytosis (LCH) is a rare proliferative disease occurring in young children. The most affected organs are the bones and the skin (1). The diagnosis of LCH relies on histopathology. Reflectance confocal microscopy (RCM) is a non-invasive imaging technique used to diagnose skin cancer (2). We report that in three children RCM examination of cutaneous lesions of LCH showed specific signs correlated to histopathology.

This article is protected by copyright. All rights reserved.

http://ift.tt/2mLouzm

Cicatricial Alopecia Research Foundation Meeting, May 2016: Progress Towards the Diagnosis, Treatment, and Cure of Primary Cicatricial Alopecias

Abstract

Primary Cicatricial Alopecias (PCAs) are a group of skin diseases in which there is progressive and permanent destruction of hair follicles followed by replacement with fibrous tissue. Unfortunately, by the time patients seek clinical evaluation of their hair loss, the skin is already inflamed and/or scarred, so there is little hope for a return to their normal hair growth pattern. Clinical and basic science investigations are now focusing on three forms of human PCA, lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and central centrifugal cicatricial alopecia (CCCA). Transcriptome, lipidome, and other new technologies are providing new insight into the pathogenesis of some of these diseases that are being validated and further investigated using spontaneous and genetically engineered mouse models.

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