Application of synchrotron radiation and other techniques in analysis of radioactive microparticles emitted from the Fukushima Daiichi Nuclear Power Plant accident-A review

Publication date: January 2019

Source: Journal of Environmental Radioactivity, Volume 196

Author(s): Fei Chen, Jun Hu, Yoshio Takahashi, Masatoshi Yamada, M. Safiur Rahman, Guosheng Yang

Abstract

During the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, large amounts of radioactive materials were released into the environment. Among them, a large proportion of the radionuclides, such as Cs, entered into the environment as radioactive microparticles (RMs). In recent years, the characterization of RMs based on synchrotron radiation (SR) techniques has been reported, since their physical and chemical properties played an important role in evaluating the chemical reactions and physical changes that occurred when the nuclear material meltdowns took place. In this review, we summarize separation and measurement technologies used in studies of RMs, and we emphasize the application of SR-based techniques in the characterization of RMs. We report research progress, including information for elemental composition, isotopic distribution, radioactivity, and formation processes. Also, we compare the RMs from the FDNPP and the Chernobyl Nuclear Power Plant accidents. The SR-based technologies offer great improvement in the resolution and precision compared to conventional technologies, such as X-ray fluorescence and X-ray diffraction.

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The transfer of fallout plutonium from paddy soil to rice: A field study in Japan

Publication date: January 2019

Source: Journal of Environmental Radioactivity, Volume 196

Author(s): Youyi Ni, Zhongtang Wang, Jian Zheng, Keiko Tagami, Qiuju Guo, Shigeo Uchida, Hirofumi Tsukada

Abstract

Reported transfer factor (TF) values of Pu from paddy soil to rice are rather scarce, despite the radiotoxicity of Pu and the irreplaceable role of rice in Asian peoples' diets. Here, we conducted a field study to investigate the transfer of global fallout Pu from paddy soil to rice grain (hulled rice) in Japan. The ²⁴⁰Pu/²³⁹Pu atomic ratios in two rice grain samples out of 16 samples were determined and the ratios corresponded well with the global fallout value. The soil-to-rice TF_Pu in 12 Japanese prefectures ranged from 4.5 × 10⁻⁶ to 1.2 × 10⁻⁴ with a geometric mean of 3.3 × 10⁻⁵. The TFs of rice obtained in this study were compatible to the TFs for the broad heading "cereals" compiled in the IAEA Technical Report Series No. 472. Weak correlations were found between the TF and the investigated soil characteristics such as soil pH and loss on ignition. Regarding the TFs for cerium (Ce) and thorium (Th) which are commonly considered as Pu analogues, we observed no significant correlations between the log(TF_Pu) and log(TF_Ce) or log(TF_Pu) and log(TF_Th). On the other hand, interestingly, a significantly positive correlation (r = 0.795, p < 0.001) was observed between log(TF_Pu) and log(TF_U). In view of the observed similarity of TF values for U and Pu from soil to rice, we thought that using the easy-to-measure TF_U to estimate TF_Pu from soil to rice might be suggested although the mechanism was unclear.

Graphical abstract

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Meteoric 10Be in aerosol filters in the city of Seville

Publication date: January 2019

Source: Journal of Environmental Radioactivity, Volume 196

Author(s): S. Padilla, J.M. López-Gutiérrez, G. Manjón, R. García-Tenorio, J.A. Galván, M. García-León

Abstract

Cosmogenic radionuclides in the one-million-year half-life range, like ¹⁰Be, find application fields in several Sciences. They are powerful tools in Geology and Geochronology, as they are very important tracers on the Earth, being utilized as chronometer. Meteoric ¹⁰Be (T_1/2 = 1.39 × 10⁶ y) associated to aerosols can be used as a tracer of atmospheric processes and specifically as indicators of the cosmogenic interactions in lower Stratosphere, upper Troposphere, the air exchange between both and deposition processes on the Earth surface. The applications of ¹⁰Be are even more relevant when combined with other radionuclides such as ²⁶Al. In order to provide new data about concentration ¹⁰Be in this type of samples, the first atmospheric air filters in Spain have been analysed. Values around 10⁴ at/m³ (atoms per cubic meter of air) for ¹⁰Be have been obtained. Due to the location and the features of the sampling site (urban area, at sea level and mid latitude), a new radiochemical procedure was designed and developed in our laboratory for the Accelerator Mass Spectrometry (AMS) measurement of ¹⁰Be in this kind of samples. The samples were measured in SARA, the 1 MV AMS system at Centro Nacional de Aceleradores (CNA).

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Application of synchrotron radiation and other techniques in analysis of radioactive microparticles emitted from the Fukushima Daiichi Nuclear Power Plant accident-A review

Publication date: January 2019

Source: Journal of Environmental Radioactivity, Volume 196

Author(s): Fei Chen, Jun Hu, Yoshio Takahashi, Masatoshi Yamada, M. Safiur Rahman, Guosheng Yang

Abstract

During the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, large amounts of radioactive materials were released into the environment. Among them, a large proportion of the radionuclides, such as Cs, entered into the environment as radioactive microparticles (RMs). In recent years, the characterization of RMs based on synchrotron radiation (SR) techniques has been reported, since their physical and chemical properties played an important role in evaluating the chemical reactions and physical changes that occurred when the nuclear material meltdowns took place. In this review, we summarize separation and measurement technologies used in studies of RMs, and we emphasize the application of SR-based techniques in the characterization of RMs. We report research progress, including information for elemental composition, isotopic distribution, radioactivity, and formation processes. Also, we compare the RMs from the FDNPP and the Chernobyl Nuclear Power Plant accidents. The SR-based technologies offer great improvement in the resolution and precision compared to conventional technologies, such as X-ray fluorescence and X-ray diffraction.

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Early assessment of acute kidney injury using targeted field of view diffusion-weighted imaging: An in vivo study

Publication date: Available online 25 October 2018

Source: Magnetic Resonance Imaging

Author(s): Hanjing Kong, Chengyan Wang, Fei Gao, Xiaodong Zhang, Min Yang, Li Yang, Xiaoying Wang, Jue Zhang

Abstract

Acute kidney injury (AKI) is a common complication in various clinical settings. In recent years, AKI diagnostics have been investigated intensively showing the emerging need for early characterization of this disease. To verify whether targeted field-of-view diffusion-weighted imaging (tFOV-DWI) is feasible to significantly improve the performance of traditional full field-of-view diffusion-weighted imaging (fFOV-DWI) in the early assessment of AKI. 14 rabbits with unilateral AKI were induced by injection of microspheres under the guidance of digital subtraction angiography (DSA). All rabbits underwent tFOV-DWI and fFOV-DWI immediately after the surgery. Artifacts, distortion and lesion identification were graded by two experienced radiologists, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured. Apparent diffusion coefficient (ADC) maps were then derived. Blood samples were collected pre- and post-surgery and serum creatinine weres measured. Renal specimen and biopsy were performed as the reference standard. Student t-test was used to ascertain statistical significance between the above parameters for tFOV-DWI and fFOV-DWI. The interobserver agreement and ADC measurements agreement were assessed. A higher percentage of renal lesions (17 out of 19) were detected in tFOV-DWI compared with fFOV-DWI (14 out of 19). Significant differences were observed in ADC value for both techniques between the lesion regions and normal tissues (p < 0.001). Histological findings were inversely correlated with ADC values of tFOV-DWI (r = −0.97, P < 0.001 for cortex; r = −0.98, P < 0.001 for medulla) and fFOV-DWI sequences (r = −0.95, P < 0.001 for cortex; r = −0.98, P < 0.001 for medulla). Those tFOV-DW images rated by the radiologists exhibit superior performance in terms of all assessed measures (P < 0.05), and interobserver agreement was excellent (ICC, 0.78 to 0.92). Besides, the ADC values derived from tFOV-DWI had a satisfactory agreement with those estimated by fFOV-DWI. The animal study demonstrates that the tFOV-DWI strategy provided visually better image quality and lesion depiction than conventional fFOV-DWI for early assessment of AKI.

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A Fully Automated Method for Accurate Measurement of Geometrical Distortion in Magnetic Resonance Imaging of a 3D-Lattice Phantom

Publication date: Available online 25 October 2018

Source: Magnetic Resonance Imaging

Author(s): S. Mangione, R. Acquaviva, G. Garbo

Abstract

This paper describes an automated method for extracting the apparent positions of fiducial points from 2D or 3D images of a phantom. We consider a 3D-lattice phantom for two main reasons: first, ease of manufacture and isotropy of its structure with respect to coordinate projections; second, a connected structure allowing to uniquely assess the adjacency relationship between fiducial points even if geometric distortions arising from main magnet inhomogeneity and gradient fields non-linearity is severe as observed in open-bore systems.

In order to validate our proposed method and compare different choices for the parameters of our phantom (i.e. number and distance between grids and thickness of its branches) we developed in-house a software for simulating 2D or 3D volume images of the phantom, using customizable MRI sequence parameters and Spherical Harmonic Coefficients for the fields.

We deem worthy of note that using simulated images is the only way to evaluate the estimated position error, since it allows to compare the estimates to their theoretical counterparts. Furthermore, the use of simulated images allows to evaluate the robustness of the method with respect to image quality in terms of Signal-to-Noise Ratios and geometric distortion, and allows to evaluate different phantom geometries without having to manufacture them. The proposed method can be easily extended to phantoms having an arbitrary overall shape, as long as it is a fully connected structure. Specifically, it is easy to design a phantom with fiducial points laying outside of the homogeneity sphere, so that indirect measurement of the fields becomes possible, for example by using the recent method proposed by Acquaviva et al.

To the best of our knowledge, the proposed method outperforms other state-of-the-art methods, with an average positioning offset of 0.052 mm (with a 0.99 quantile of 0.12 mm) when working on images featuring a differential Signal-to-Noise Ratio within Region-of-Interest (ROI) equal to 105 (20.2 dB) and a ROI-to-background SNR of 20 dB. Estimating the positions of 6859 fiducial points in a volume, our highest density case, was carried out in less than 30 minutes on a desktop personal computer.

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Early assessment of acute kidney injury using targeted field of view diffusion-weighted imaging: An in vivo study

Publication date: Available online 25 October 2018

Source: Magnetic Resonance Imaging

Author(s): Hanjing Kong, Chengyan Wang, Fei Gao, Xiaodong Zhang, Min Yang, Li Yang, Xiaoying Wang, Jue Zhang

Abstract

Acute kidney injury (AKI) is a common complication in various clinical settings. In recent years, AKI diagnostics have been investigated intensively showing the emerging need for early characterization of this disease. To verify whether targeted field-of-view diffusion-weighted imaging (tFOV-DWI) is feasible to significantly improve the performance of traditional full field-of-view diffusion-weighted imaging (fFOV-DWI) in the early assessment of AKI. 14 rabbits with unilateral AKI were induced by injection of microspheres under the guidance of digital subtraction angiography (DSA). All rabbits underwent tFOV-DWI and fFOV-DWI immediately after the surgery. Artifacts, distortion and lesion identification were graded by two experienced radiologists, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured. Apparent diffusion coefficient (ADC) maps were then derived. Blood samples were collected pre- and post-surgery and serum creatinine weres measured. Renal specimen and biopsy were performed as the reference standard. Student t-test was used to ascertain statistical significance between the above parameters for tFOV-DWI and fFOV-DWI. The interobserver agreement and ADC measurements agreement were assessed. A higher percentage of renal lesions (17 out of 19) were detected in tFOV-DWI compared with fFOV-DWI (14 out of 19). Significant differences were observed in ADC value for both techniques between the lesion regions and normal tissues (p < 0.001). Histological findings were inversely correlated with ADC values of tFOV-DWI (r = −0.97, P < 0.001 for cortex; r = −0.98, P < 0.001 for medulla) and fFOV-DWI sequences (r = −0.95, P < 0.001 for cortex; r = −0.98, P < 0.001 for medulla). Those tFOV-DW images rated by the radiologists exhibit superior performance in terms of all assessed measures (P < 0.05), and interobserver agreement was excellent (ICC, 0.78 to 0.92). Besides, the ADC values derived from tFOV-DWI had a satisfactory agreement with those estimated by fFOV-DWI. The animal study demonstrates that the tFOV-DWI strategy provided visually better image quality and lesion depiction than conventional fFOV-DWI for early assessment of AKI.

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A Fully Automated Method for Accurate Measurement of Geometrical Distortion in Magnetic Resonance Imaging of a 3D-Lattice Phantom

Publication date: Available online 25 October 2018

Source: Magnetic Resonance Imaging

Author(s): S. Mangione, R. Acquaviva, G. Garbo

Abstract

This paper describes an automated method for extracting the apparent positions of fiducial points from 2D or 3D images of a phantom. We consider a 3D-lattice phantom for two main reasons: first, ease of manufacture and isotropy of its structure with respect to coordinate projections; second, a connected structure allowing to uniquely assess the adjacency relationship between fiducial points even if geometric distortions arising from main magnet inhomogeneity and gradient fields non-linearity is severe as observed in open-bore systems.

In order to validate our proposed method and compare different choices for the parameters of our phantom (i.e. number and distance between grids and thickness of its branches) we developed in-house a software for simulating 2D or 3D volume images of the phantom, using customizable MRI sequence parameters and Spherical Harmonic Coefficients for the fields.

We deem worthy of note that using simulated images is the only way to evaluate the estimated position error, since it allows to compare the estimates to their theoretical counterparts. Furthermore, the use of simulated images allows to evaluate the robustness of the method with respect to image quality in terms of Signal-to-Noise Ratios and geometric distortion, and allows to evaluate different phantom geometries without having to manufacture them. The proposed method can be easily extended to phantoms having an arbitrary overall shape, as long as it is a fully connected structure. Specifically, it is easy to design a phantom with fiducial points laying outside of the homogeneity sphere, so that indirect measurement of the fields becomes possible, for example by using the recent method proposed by Acquaviva et al.

To the best of our knowledge, the proposed method outperforms other state-of-the-art methods, with an average positioning offset of 0.052 mm (with a 0.99 quantile of 0.12 mm) when working on images featuring a differential Signal-to-Noise Ratio within Region-of-Interest (ROI) equal to 105 (20.2 dB) and a ROI-to-background SNR of 20 dB. Estimating the positions of 6859 fiducial points in a volume, our highest density case, was carried out in less than 30 minutes on a desktop personal computer.

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High temperature/pressure MAS-NMR for the study of dynamic processes in mixed phase systems

Publication date: Available online 25 October 2018

Source: Magnetic Resonance Imaging

Author(s): Ali Chamas, Long Qi, Hardeep S. Mehta, Jesse A. Sears, Susannah L. Scott, Eric D. Walter, David W. Hoyt

Abstract

A new MAS-NMR rotor (the WHiMS rotor) has been developed which can reach pressures of 400 bar at 20 °C or 225 bar at 250 °C. These rotors are ideal for mixed phase systems such as a reaction using a solid catalyst with a liquid/supercritical solvent topped with high pressure gas in the head space. After solid and liquid portions of the sample are loaded, the rotor is capped with an o-ring equipped polymer bushing that snaps into a mating groove in the rotor. The bushings incorporate a check valve into the sealing mechanism which allows for pressurization without mechanical manipulation – they will allow gas to flow in but not out. This WHiMS rotor design has enabled experiments on a wide variety of biotic and abiotic mixed-phase systems. Geochemical systems have also been studied, for example, adsorption and confinement studies of supercritical methane/CO₂ in clays and other minerals which display pressure dependent ¹³C chemical shifts. Example data from other mixed-phase chemical and microbial systems are reported. These include monitoring metabolite conversion of extremophilic bacteria found in subsurface systems at elevated pressures and real-time operando reactions in catalysis systems - with liquid-quality resolution for ¹H and ¹³C NMR spectra.

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Human papillomavirus types causing recurrent respiratory papillomatosis in Zimbabwe

Publication date: Available online 26 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Naboth Matinhira, Nyarai D. Soko, Tsitsi Bandason, Ramon G. Jenson, Titus Dzongodza, Christian von Buchwald, Clemence Chidziva

Abstract

Objective

Recurrent respiratory papillomatosis (RRP) caused by human papillomavirus (HPV) is preventable through vaccination. This study was motivated by the recent thrust of the Zimbabwean government to reduce incidence of HPV related cervical cancer in Zimbabwe through vaccination against HPV. We therefore set out to type HPV genotypes causing RRP in Zimbabwe. We also describe for the first time, the demographics of Zimbabwean RRP patients, the characteristics of patients with different HPV types and possible risk factors of HPV infection in our setting.

Methods

We conducted a prospective, hospital based study were patients were recruited from two national otorhinolaryngology hospitals in Zimbabwe. All patients diagnosed with RRP during a twenty four month period were included in the study. A questionnaire was administered per patient to collect both demographic and clinical variables. HPV DNA was extracted from formalin fixed paraffin embedded laryngeal tissue. The extracted HPV DNA was amplified using polymerase chain reaction and next generation sequencing was used to genotype the HPV types.

Results

A total of 52 patients all aged 14 years and under were recruited into the study. Only Juvenile onset RRP cases were observed over the two year period and 64% of the patients were HPV positive. HPV types 6 and 11 were the dominant types observed constituting 85% of all HPV types. The remaining 15% constituted of HPV 16 and HPV 18. 27% of the patients had coinfection with at least two different HPV types. There were no statistically significant differences between the characteristics of HPV positive and HPV negative patients. No statistically significant risk factors were observed.

Conclusion

HPV types 6 and 11 were the predominant genotypes causing RRP in Zimbabwe. Thus the use of quadrivalent or even nonavalent HPV vaccines may play an important role in the prevention and management of RRP in Zimbabwe.

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The ebb and flow of attention: Between-subject variation in intrinsic connectivity and cognition associated with the dynamics of ongoing experience

Publication date: 15 January 2019

Source: NeuroImage, Volume 185

Author(s): Adam Turnbull, Hao-Ting Wang, Jonathan W. Schooler, Elizabeth Jefferies, Daniel S. Margulies, Jonathan Smallwood

Abstract

Cognition is dynamic, allowing us the flexibility to shift focus from different aspects of the environment, or between internally- and externally-oriented trains of thought. Although we understand how individuals switch attention across different tasks, the neurocognitive processes that underpin the dynamics of less constrained elements of cognition are less well understood. To explore this issue, we developed a paradigm in which participants intermittently responded to external events across two conditions that systematically vary in their need for updating working memory based on information in the external environment. This paradigm distinguishes the influences on cognition that emerge because of demands placed by the task (sustained) from changes that result from the time elapsed since the last task response (transient). We used experience sampling to identify dynamic changes in ongoing cognition in this paradigm, and related between subject variation in these measures to variations in the intrinsic organisation of large-scale brain networks. We found systems important for attention were involved in the regulation of off-task thought. Coupling between the ventral attention network and regions of primary motor cortex was stronger for individuals who were able to regulate off-task thought in line with the demands of the task. This pattern of coupling was linked to greater task-related thought when environmental demands were high and elevated off-task thought when demands were low. In contrast, the coupling of the dorsal attention network with a region of lateral visual cortex was stronger for individuals for whom off-task thoughts transiently increased with the time since responding to the external world . This pattern is consistent with a role for this system in the time-limited top-down biasing of visual processing to increase behavioural efficiency. Unlike the attention networks, coupling between regions of the default mode network and dorsal occipital cortex was weaker for individuals for whom the level of detail decreased with the passage of time when the external task did not require continuous monitoring of external information. These data provide novel evidence for how neural systems vary across subjects and may underpin individual variation in the dynamics of thought, linking attention systems to the maintenance of task-relevant information, and the default mode network to supporting experiences with vivid detail.

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Time ambiguity during intertemporal decision-making is aversive, impacting choice and neural value coding

Publication date: 15 January 2019

Source: NeuroImage, Volume 185

Author(s): Iris Ikink, Jan B. Engelmann, Wouter van den Bos, Karin Roelofs, Bernd Figner

Abstract

We are often presented with choices that differ in their more immediate versus future consequences. Interestingly, in everyday-life, ambiguity about the exact timing of such consequences frequently occurs, yet it remains unknown whether and how time-ambiguity influences decisions and their underlying neural correlates. We developed a novel intertemporal fMRI choice task in which participants make choices between sooner-smaller (SS) versus later-larger (LL) monetary rewards with systematically varying levels of time-ambiguity. Across trials, delay information of the SS, the LL, or both rewards was either exact (e.g., in 5 weeks), of low ambiguity (4 week range: e.g., in 3–7 weeks), or of high ambiguity (8 week range: e.g., in 1–9 weeks). Choice behavior showed that the majority of participants preferred options with exact delays over those with ambiguous delays, indicating time-ambiguity aversion. Consistent with these results, the ventromedial prefrontal cortex showed decreased activation during ambiguous versus exact trials. In contrast, intraparietal sulcus activation increased during ambiguous versus exact trials. Furthermore, exploratory analyses suggest that more time-ambiguity averse participants show more insula and dorsolateral prefrontal cortex activation during subjective value (SV)-coding of ambiguous versus exact trials. Lastly, the best-fitting computational choice models indicate that ambiguity impacts the SV of options via time perception or via an additive ambiguity-related penalty term. Together, these results provide the first behavioral and neural signatures of time-ambiguity, pointing towards a unique profile that is distinct from impatience. Since time-ambiguity is ubiquitous in real-life, it likely contributes to shortsighted decisions above and beyond delay-discounting.

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Community variation in adolescent cannabis use in Australia and the Netherlands

Publication date: Available online 26 October 2018

Source: Addictive Behaviors

Author(s): B. Rowland, H. Jonkman, J. Williams, P. Kremer, J.W. Toumbourou

Abstract

Background

While controversial, cannabis use is common, often beginning in adolescence. In Australia and the Netherlands, cannabis use is understood and legislated within a harm-minimisation framework. In Australia it is illegal to purchase or consume cannabis. Cannabis use in the Netherlands is illegal, except in licensed coffee shops where the sale and consumption of small amounts (5 g) are permitted.

Methods

Secondary school aged children in Victoria, Australia and the Netherlands were surveyed using the same culturally adapted questionnaire, designed to measure community rates of substance use and risk factors. Youth cannabis use and predictors of use were compared between the two countries.

Results

Similar levels of cannabis use in the last month were reported in Australia and the Netherlands (4.5%), with slightly lower use amongst girls, compared to boys. Common predictors of use were found in both the Australian and Netherlands sample.

Conclusions

The findings suggest that interventions that effectively target similar risk factors to reduce or prevent cannabis use may have applications cross-nationally.

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Association between psychological distress and elevated use of electronic devices among U.S. adolescents: Results from the youth risk behavior surveillance 2009-2017

Publication date: Available online 26 October 2018

Source: Addictive Behaviors

Author(s): Claudia Wang, Kaigang Li, Minki Kim, Shieun Lee, Dong-Chul Seo

Abstract

Objective

The purpose of this study was to provide updated information about the prevalence and temporal trends of elevated use of electronic devices (EUED) in leisure time (i.e., 3 h or more on an average school day) in nationally representative samples of U.S. adolescents in recent years and to determine whether there is a significant association between EUED and psychological distress.

Methods

We used the national Youth Risk Behavior Survey (YRBS) data from 2009, 2011, 2013, 2015, and 2017 (N = 75,807). Propensity score matching was used to reduce selection bias due to potential confounding factors with EUED. Ordinal logistic regression analyses were performed for the matched samples to predict the association between EUED and psychological distress.

Results

The prevalence of EUED in U.S. youth has substantially increased from 24.9% in 2009 to 43.1% in 2017 (p < .001). Boys had higher rates of EUED than girls only in 2009 and 2011 but not in 2013, 2015, and 2017. A significant association between EUED and psychological distress was identified throughout all the five survey years. The odds of having a higher level of psychological distress increased approximately 1.5 times among youth with EUED than those without.

Conclusions

The prevalence of U.S. youth with psychological distress and EUED has increased simultaneously in the past several years. Future longitudinal studies are warranted to examine causal and/or reciprocal relationship between the two.

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The effects of a brief meaning in life intervention on the incentive salience of alcohol

Publication date: Available online 26 October 2018

Source: Addictive Behaviors

Author(s): Brian D. Ostafin, Nils Feyel

Abstract

There is an increasing body of evidence that life meaning is inversely related to alcohol consumption. Much of this research is cross-sectional and few studies have examined mechanisms for the inverse relation. The current study investigated whether a brief meaning intervention would lead to reduced incentive salience of alcohol. Seventy undergraduate students who reported regular alcohol consumption were assigned either to control or a meaning condition, which involved thinking about and committing to pursue intrinsically valued goals. The incentive salience of alcohol was operationalized as the extent to which alcohol cues interfered with the correct completion of an alcohol Stroop task. The results indicated that the meaning intervention led to reduced incentive salience as measured by alcohol Stroop errors, but not incentive salience as measured by reaction time. The findings suggest that incentive salience may be one mechanism through which individuals with greater life meaning regulate their drinking behavior.

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Implementing statistical methods for generalizing randomized trial findings to a target population

Publication date: Available online 25 October 2018

Source: Addictive Behaviors

Author(s): Benjamin Ackerman, Ian Schmid, Kara Rudolph, Marissa J. Seamans, Ryoko Susukida, Ramin Mojtabai, Elizabeth A. Stuart

Abstract

Randomized trials are considered the gold standard for assessing the causal effects of a drug or intervention in a study population, and their results are often utilized in the formulation of health policy. However, there is growing concern that results from trials do not necessarily generalize well to their respective target populations, in which policies are enacted, due to substantial demographic differences between study and target populations. In trials related to substance use disorders (SUDs), especially, strict exclusion criteria make it challenging to obtain study samples that are fully "representative" of the populations that policymakers may wish to generalize their results to. In this paper, we provide an overview of post-trial statistical methods for assessing and improving upon the generalizability of a randomized trial to a well-defined target population. We then illustrate the different methods using a randomized trial related to methamphetamine dependence and a target population of substance abuse treatment seekers, and provide software to implement the methods in R using the "generalize" package. We discuss several practical considerations for researchers who wish to utilize these tools, such as the importance of acquiring population-level data to represent the target population of interest, and the challenges of data harmonization.

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Simplifying the implementation of modern scale scoring methods with an automated R package: Automated moderated nonlinear factor analysis (aMNLFA)

Publication date: Available online 25 October 2018

Source: Addictive Behaviors

Author(s): Nisha C. Gottfredson, Veronica T. Cole, Michael L. Giordano, Daniel J. Bauer, Andrea M. Hussong, Susan T. Ennett

Abstract

When generating scores to represent latent constructs, analysts have a choice between applying psychometric approaches that are principled but that can be complicated and time-intensive versus applying simple and fast, but less precise approaches, such as sum or mean scoring. We explain the reasons for preferring modern psychometric approaches: namely, use of unequal item weights and severity parameters, the ability to account for local dependence and differential item functioning, and the use of covariate information to more efficiently estimate factor scores. We describe moderated nonlinear factor analysis (MNLFA), a relatively new, highly flexible approach that allows analysts to develop precise factor score estimates that address limitations of sum score, mean score, and traditional factor analytic approaches to scoring. We then outline the steps involved in using the MNLFA scoring approach and discuss the circumstances in which this approach is preferred. To overcome the difficulty of implementing MNLFA models in practice, we developed an R package, aMNLFA, that automates much of the rule-based scoring process. We illustrate the use of aMNLFA with an empirical example of scoring alcohol involvement in a longitudinal study of 6998 adolescents and compare performance of MNLFA scores with traditional factor analysis and sum scores based on the same set of 12 items. MNLFA scores retain more meaningful variation than other approaches. We conclude with practical guidelines for scoring.

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Community variation in adolescent cannabis use in Australia and the Netherlands

Publication date: Available online 26 October 2018

Source: Addictive Behaviors

Author(s): B. Rowland, H. Jonkman, J. Williams, P. Kremer, J.W. Toumbourou

Abstract

Background

While controversial, cannabis use is common, often beginning in adolescence. In Australia and the Netherlands, cannabis use is understood and legislated within a harm-minimisation framework. In Australia it is illegal to purchase or consume cannabis. Cannabis use in the Netherlands is illegal, except in licensed coffee shops where the sale and consumption of small amounts (5 g) are permitted.

Methods

Secondary school aged children in Victoria, Australia and the Netherlands were surveyed using the same culturally adapted questionnaire, designed to measure community rates of substance use and risk factors. Youth cannabis use and predictors of use were compared between the two countries.

Results

Similar levels of cannabis use in the last month were reported in Australia and the Netherlands (4.5%), with slightly lower use amongst girls, compared to boys. Common predictors of use were found in both the Australian and Netherlands sample.

Conclusions

The findings suggest that interventions that effectively target similar risk factors to reduce or prevent cannabis use may have applications cross-nationally.

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Association between psychological distress and elevated use of electronic devices among U.S. adolescents: Results from the youth risk behavior surveillance 2009-2017

Publication date: Available online 26 October 2018

Source: Addictive Behaviors

Author(s): Claudia Wang, Kaigang Li, Minki Kim, Shieun Lee, Dong-Chul Seo

Abstract

Objective

The purpose of this study was to provide updated information about the prevalence and temporal trends of elevated use of electronic devices (EUED) in leisure time (i.e., 3 h or more on an average school day) in nationally representative samples of U.S. adolescents in recent years and to determine whether there is a significant association between EUED and psychological distress.

Methods

We used the national Youth Risk Behavior Survey (YRBS) data from 2009, 2011, 2013, 2015, and 2017 (N = 75,807). Propensity score matching was used to reduce selection bias due to potential confounding factors with EUED. Ordinal logistic regression analyses were performed for the matched samples to predict the association between EUED and psychological distress.

Results

The prevalence of EUED in U.S. youth has substantially increased from 24.9% in 2009 to 43.1% in 2017 (p < .001). Boys had higher rates of EUED than girls only in 2009 and 2011 but not in 2013, 2015, and 2017. A significant association between EUED and psychological distress was identified throughout all the five survey years. The odds of having a higher level of psychological distress increased approximately 1.5 times among youth with EUED than those without.

Conclusions

The prevalence of U.S. youth with psychological distress and EUED has increased simultaneously in the past several years. Future longitudinal studies are warranted to examine causal and/or reciprocal relationship between the two.

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The effects of a brief meaning in life intervention on the incentive salience of alcohol

Publication date: Available online 26 October 2018

Source: Addictive Behaviors

Author(s): Brian D. Ostafin, Nils Feyel

Abstract

There is an increasing body of evidence that life meaning is inversely related to alcohol consumption. Much of this research is cross-sectional and few studies have examined mechanisms for the inverse relation. The current study investigated whether a brief meaning intervention would lead to reduced incentive salience of alcohol. Seventy undergraduate students who reported regular alcohol consumption were assigned either to control or a meaning condition, which involved thinking about and committing to pursue intrinsically valued goals. The incentive salience of alcohol was operationalized as the extent to which alcohol cues interfered with the correct completion of an alcohol Stroop task. The results indicated that the meaning intervention led to reduced incentive salience as measured by alcohol Stroop errors, but not incentive salience as measured by reaction time. The findings suggest that incentive salience may be one mechanism through which individuals with greater life meaning regulate their drinking behavior.

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Implementing statistical methods for generalizing randomized trial findings to a target population

Publication date: Available online 25 October 2018

Source: Addictive Behaviors

Author(s): Benjamin Ackerman, Ian Schmid, Kara Rudolph, Marissa J. Seamans, Ryoko Susukida, Ramin Mojtabai, Elizabeth A. Stuart

Abstract

Randomized trials are considered the gold standard for assessing the causal effects of a drug or intervention in a study population, and their results are often utilized in the formulation of health policy. However, there is growing concern that results from trials do not necessarily generalize well to their respective target populations, in which policies are enacted, due to substantial demographic differences between study and target populations. In trials related to substance use disorders (SUDs), especially, strict exclusion criteria make it challenging to obtain study samples that are fully "representative" of the populations that policymakers may wish to generalize their results to. In this paper, we provide an overview of post-trial statistical methods for assessing and improving upon the generalizability of a randomized trial to a well-defined target population. We then illustrate the different methods using a randomized trial related to methamphetamine dependence and a target population of substance abuse treatment seekers, and provide software to implement the methods in R using the "generalize" package. We discuss several practical considerations for researchers who wish to utilize these tools, such as the importance of acquiring population-level data to represent the target population of interest, and the challenges of data harmonization.

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Simplifying the implementation of modern scale scoring methods with an automated R package: Automated moderated nonlinear factor analysis (aMNLFA)

Publication date: Available online 25 October 2018

Source: Addictive Behaviors

Author(s): Nisha C. Gottfredson, Veronica T. Cole, Michael L. Giordano, Daniel J. Bauer, Andrea M. Hussong, Susan T. Ennett

Abstract

When generating scores to represent latent constructs, analysts have a choice between applying psychometric approaches that are principled but that can be complicated and time-intensive versus applying simple and fast, but less precise approaches, such as sum or mean scoring. We explain the reasons for preferring modern psychometric approaches: namely, use of unequal item weights and severity parameters, the ability to account for local dependence and differential item functioning, and the use of covariate information to more efficiently estimate factor scores. We describe moderated nonlinear factor analysis (MNLFA), a relatively new, highly flexible approach that allows analysts to develop precise factor score estimates that address limitations of sum score, mean score, and traditional factor analytic approaches to scoring. We then outline the steps involved in using the MNLFA scoring approach and discuss the circumstances in which this approach is preferred. To overcome the difficulty of implementing MNLFA models in practice, we developed an R package, aMNLFA, that automates much of the rule-based scoring process. We illustrate the use of aMNLFA with an empirical example of scoring alcohol involvement in a longitudinal study of 6998 adolescents and compare performance of MNLFA scores with traditional factor analysis and sum scores based on the same set of 12 items. MNLFA scores retain more meaningful variation than other approaches. We conclude with practical guidelines for scoring.

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Self-Assessment Questions

Semin Speech Lang 2018; 39: C1-C10 DOI: 10.1055/s-0038-1673667 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Speech and Language)

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EANM Springer Prizes awarded at EANM’18 in Düsseldorf

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Correction to: A rare presentation of skull-base osteomyelitis with neurovascular sheath extension following external otitis resolved by PET/MRI

The figure in the original published version of this article was omitted.

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The renaissance of functional 18 F-FDG PET brain activation imaging

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U. Fischer, F. Baum, S. Luftner-Nagel. Breast Cancer: Diagnostic Imaging and Therapeutic Guidance

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2CG8Uxu

Lale Umutlu, Ken Herrmann (Eds.). PET/MR Imaging: Current and Emerging Applications

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The influence of PSA flare in mCRPC patients treated with alpha-emitting radiopharmaceuticals

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Correction to: a risk stratification model for nodal peripheral T-cell lymphomas based on the NCCN-IPI and posttreatment Deauville score

Unfortunately, the original version of this article contained several errors made during final step of article production. In the results section (fourth sentence) of the Abstract, the incomplete sentence,", 31.4% in high-risk group and 4.7% in treatment failure group.

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Clinical translation of [ 18 F]ICMT-11 for measuring chemotherapy-induced caspase 3/7 activation in breast and lung cancer

Abstract

Background

Effective anticancer therapy is thought to involve induction of tumour cell death through apoptosis and/or necrosis. [¹⁸F]ICMT-11, an isatin sulfonamide caspase-3/7-specific radiotracer, has been developed for PET imaging and shown to have favourable dosimetry, safety, and biodistribution. We report the translation of [¹⁸F]ICMT-11 PET to measure chemotherapy-induced caspase-3/7 activation in breast and lung cancer patients receiving first-line therapy.

Results

Breast tumour SUV_max of [¹⁸F]ICMT-11 was low at baseline and unchanged following therapy. Measurement of M30/M60 cytokeratin-18 cleavage products showed that therapy was predominantly not apoptosis in nature. While increases in caspase-3 staining on breast histology were seen, post-treatment caspase-3 positivity values were only approximately 1%; this low level of caspase-3 could have limited sensitive detection by [¹⁸F]ICMT-11-PET. Fourteen out of 15 breast cancer patients responded to first–line chemotherapy (complete or partial response); one patient had stable disease. Four patients showed increases in regions of high tumour [¹⁸F]ICMT-11 intensity on voxel-wise analysis of tumour data (classed as PADS); response was not exclusive to patients with this phenotype. In patients with lung cancer, multi-parametric [¹⁸F]ICMT-11 PET and MRI (diffusion-weighted- and dynamic contrast enhanced-MRI) showed that PET changes were concordant with cell death in the absence of significant perfusion changes.

Conclusion

This study highlights the potential use of [¹⁸F]ICMT-11 PET as a promising candidate for non-invasive imaging of caspase3/7 activation, and the difficulties encountered in assessing early-treatment responses. We summarize that tumour response could occur in the absence of predominant chemotherapy-induced caspase-3/7 activation measured non-invasively across entire tumour lesions in patients with breast and lung cancer.

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Nuclear medicine RIP (radiation induced phobia); improving the image

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Radiomics analysis of pre-treatment [ 18 F]FDG PET/CT for patients with metastatic colorectal cancer undergoing palliative systemic treatment

Abstract

Background

The aim of this study was to assess radiomics features on pre-treatment [¹⁸F]FDG positron emission tomography (PET) as potential biomarkers for response and survival in patients with metastatic colorectal cancer (mCRC).

Methods

Patients with mCRC underwent [¹⁸F]FDG PET/computed tomography (CT) prior to first- or third-line palliative systemic treatment. Tumour lesions were semiautomatically delineated and standard uptake value (SUV), metabolically active tumour volume (MATV), total lesion glycolysis (TLG), entropy, area under the curve of the cumulative SUV-volume histogram (AUC-CSH), compactness and sphericity were obtained.

Results

Lesions of 47 patients receiving third-line systemic treatment had higher SUV_max, SUV_peak, SUV_mean, MATV and TLG, and lower AUC-CSH, compactness and sphericity compared to 52 patients receiving first-line systemic treatment. Therefore, first- and third-line groups were evaluated separately. In the first-line group, anatomical changes on CT correlated negatively with TLG (ρ = 0.31) and MATV (ρ = 0.36), and positively with compactness (ρ = −0.27) and sphericity (ρ = −0.27). Patients without benefit had higher mean entropy (p = 0.021). Progression-free survival (PFS) and overall survival (OS) were worse with a decreased mean AUC [hazard ratio (HR) 0.86, HR 0.77] and increase in mean MATV (HR 1.15, HR 1.22), sum MATV (HR 1.14, HR 1.19), mean TLG (HR 1.16, HR 1.22) and sum TLG (HT1.12, HR1.18). In the third-line group, AUC-CSH correlated negatively with anatomical change (ρ = 0.21). PFS and OS were worse with an increased mean MATV (HR 1.27, HR 1.68), sum MATV (HR 1.35, HR 2.04), mean TLG (HR 1.29, HR 1.52) and sum TLG (HT 1.27, HR 1.80). SUV_max and SUV_peak negatively correlated with OS (HR 1.19, HR 1.21). Cluster analysis of the 10 radiomics features demonstrated no complementary value in identifying aggressively growing lesions or patients with impaired survival.

Conclusion

We demonstrated an association between improved clinical outcome and pre-treatment low tumour volume and heterogeneity as well as high sphericity on [¹⁸F]FDG PET. Future PET imaging research should include radiomics features that incorporate tumour volume and heterogeneity when correlating PET data with clinical outcome.

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Prostate-specific antigen flare induced by 223 RaCl 2 in patients with metastatic castration-resistant prostate cancer

Abstract

Purpose

Prostate-specific antigen (PSA) flare is a well-known phenomenon in patients with prostate cancer, but its impact during radium-223 dichloride (²²³RaCl₂) therapy is still unclear. This radioisotope has shown to improve overall survival in metastatic castration-resistant prostate cancer (mCRPC). We sought to evaluate the impact of PSA flare on survival and its relation with metabolic parameters on ¹⁸F-labeled sodium fluoride PET/CT.

Methods

We conducted a retrospective study of 168 patients with mCRPC (median age 69; median PSA 29.7) receiving ²²³RaCl₂. Overall survival (OS) and progression-free survival (PFS), estimated by the Kaplan–Meier method and compared using a log-rank test, were evaluated for patient groups corresponding to different definitions of PSA flare. Metabolic ¹⁸F-fluoride PET/CT data were analyzed as well.

Results

Immediate PSA decline was observed in 49 patients (29.2%), whereas no PSA response was observed in 59 patients (35.1%). PSA flare (defined as rise after the first cycle followed by decrease below the baseline) was observed in 20 patients (11.9%) and PSA flare followed by a decrease from peak but not below baseline was observed in 40 (23.8%). The first flare subgroup had a median PFS and OS of 20.8 and 23.9 months, respectively. These outcomes were not significantly different from patients with immediate PSA decrease, but were significantly better than in patients with persistent PSA elevation (3.1 months for PFS and 11.5 months for OS, p < 0.001). Moreover, the PSA flare group showed an alkaline phosphatase (ALP) decrease significantly greater than non-responders (p = 0.003). Metabolic ¹⁸F-fluoride PET/CT data were available in 35 patients at baseline and during ²³³RaCl₂ therapy. The tumor burden reduction, expressed by ΔTLF₁₀ and ΔFTV_10, was more evident within PSA flare group below baseline than non-responders (p = 0.005 and 0.001, respectively).

Conclusions

This report suggests that a flare does not necessarily indicate lack of response to ²²³RaCl₂ therapy.

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EANM Springer Prizes awarded at EANM’18 in Düsseldorf

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2qdtYnF

Correction to: A rare presentation of skull-base osteomyelitis with neurovascular sheath extension following external otitis resolved by PET/MRI

The figure in the original published version of this article was omitted.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2CIi1xF

U. Fischer, F. Baum, S. Luftner-Nagel. Breast Cancer: Diagnostic Imaging and Therapeutic Guidance

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Correlation of dose with toxicity and tumour response to 90 Y- and 177 Lu-PRRT provides the basis for optimization through individualized treatment planning

Abstract

Purpose

Peptide receptor radionuclide therapy (PRRT) with ⁹⁰Y-labelled and ¹⁷⁷Lu-labelled peptides is an effective strategy for the treatment of metastatic/nonresectable neuroendocrine tumours (NETs). Dosimetry provides important information useful for optimizing PRRT with individualized regimens to reduce toxicity and increase tumour responses. However, this strategy is not applied in routine clinical practice, despite the fact that several dosimetric studies have demonstrated significant dose–effect correlations for normal organ toxicity and tumour response that can better guide therapy planning. The present study reviews the key relationships and the radiobiological models available in the literature with the aim of providing evidence that optimization of PRRT is feasible through the implementation of dosimetry.

Methods

The MEDLINE database was searched combining specific keywords. Original studies published in the English language reporting dose–effect outcomes in patients treated with PRRT were chosen.

Results

Nine of 126 studies were selected from PubMed, and a further five were added manually, reporting on 590 patients. The studies were analysed and are discussed in terms of weak and strong elements of correlations.

Conclusion

Several studies provided evidence of clinical benefit from the implementation of dosimetry in PRRT, indicating the potential contribution of this approach to reducing severe toxicity and/or reducing undertreatment that commonly occurs. Prospective trials, possibly multicentre, with larger numbers of patients undergoing quantitative dosimetry and with standardized methodologies should be carried out to definitively provide robust predictive paradigms to establish effective tailored PRRT.

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Lale Umutlu, Ken Herrmann (Eds.). PET/MR Imaging: Current and Emerging Applications

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2CGBIWH

The influence of PSA flare in mCRPC patients treated with alpha-emitting radiopharmaceuticals

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2qdBM8W

Correction to: a risk stratification model for nodal peripheral T-cell lymphomas based on the NCCN-IPI and posttreatment Deauville score

Unfortunately, the original version of this article contained several errors made during final step of article production. In the results section (fourth sentence) of the Abstract, the incomplete sentence,", 31.4% in high-risk group and 4.7% in treatment failure group.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2CEOSUg

Clinical translation of [ 18 F]ICMT-11 for measuring chemotherapy-induced caspase 3/7 activation in breast and lung cancer

Abstract

Background

Effective anticancer therapy is thought to involve induction of tumour cell death through apoptosis and/or necrosis. [¹⁸F]ICMT-11, an isatin sulfonamide caspase-3/7-specific radiotracer, has been developed for PET imaging and shown to have favourable dosimetry, safety, and biodistribution. We report the translation of [¹⁸F]ICMT-11 PET to measure chemotherapy-induced caspase-3/7 activation in breast and lung cancer patients receiving first-line therapy.

Results

Breast tumour SUV_max of [¹⁸F]ICMT-11 was low at baseline and unchanged following therapy. Measurement of M30/M60 cytokeratin-18 cleavage products showed that therapy was predominantly not apoptosis in nature. While increases in caspase-3 staining on breast histology were seen, post-treatment caspase-3 positivity values were only approximately 1%; this low level of caspase-3 could have limited sensitive detection by [¹⁸F]ICMT-11-PET. Fourteen out of 15 breast cancer patients responded to first–line chemotherapy (complete or partial response); one patient had stable disease. Four patients showed increases in regions of high tumour [¹⁸F]ICMT-11 intensity on voxel-wise analysis of tumour data (classed as PADS); response was not exclusive to patients with this phenotype. In patients with lung cancer, multi-parametric [¹⁸F]ICMT-11 PET and MRI (diffusion-weighted- and dynamic contrast enhanced-MRI) showed that PET changes were concordant with cell death in the absence of significant perfusion changes.

Conclusion

This study highlights the potential use of [¹⁸F]ICMT-11 PET as a promising candidate for non-invasive imaging of caspase3/7 activation, and the difficulties encountered in assessing early-treatment responses. We summarize that tumour response could occur in the absence of predominant chemotherapy-induced caspase-3/7 activation measured non-invasively across entire tumour lesions in patients with breast and lung cancer.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2EIVun2

Nuclear medicine RIP (radiation induced phobia); improving the image

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2qdtXA7

Radiomics analysis of pre-treatment [ 18 F]FDG PET/CT for patients with metastatic colorectal cancer undergoing palliative systemic treatment

Abstract

Background

The aim of this study was to assess radiomics features on pre-treatment [¹⁸F]FDG positron emission tomography (PET) as potential biomarkers for response and survival in patients with metastatic colorectal cancer (mCRC).

Methods

Patients with mCRC underwent [¹⁸F]FDG PET/computed tomography (CT) prior to first- or third-line palliative systemic treatment. Tumour lesions were semiautomatically delineated and standard uptake value (SUV), metabolically active tumour volume (MATV), total lesion glycolysis (TLG), entropy, area under the curve of the cumulative SUV-volume histogram (AUC-CSH), compactness and sphericity were obtained.

Results

Lesions of 47 patients receiving third-line systemic treatment had higher SUV_max, SUV_peak, SUV_mean, MATV and TLG, and lower AUC-CSH, compactness and sphericity compared to 52 patients receiving first-line systemic treatment. Therefore, first- and third-line groups were evaluated separately. In the first-line group, anatomical changes on CT correlated negatively with TLG (ρ = 0.31) and MATV (ρ = 0.36), and positively with compactness (ρ = −0.27) and sphericity (ρ = −0.27). Patients without benefit had higher mean entropy (p = 0.021). Progression-free survival (PFS) and overall survival (OS) were worse with a decreased mean AUC [hazard ratio (HR) 0.86, HR 0.77] and increase in mean MATV (HR 1.15, HR 1.22), sum MATV (HR 1.14, HR 1.19), mean TLG (HR 1.16, HR 1.22) and sum TLG (HT1.12, HR1.18). In the third-line group, AUC-CSH correlated negatively with anatomical change (ρ = 0.21). PFS and OS were worse with an increased mean MATV (HR 1.27, HR 1.68), sum MATV (HR 1.35, HR 2.04), mean TLG (HR 1.29, HR 1.52) and sum TLG (HT 1.27, HR 1.80). SUV_max and SUV_peak negatively correlated with OS (HR 1.19, HR 1.21). Cluster analysis of the 10 radiomics features demonstrated no complementary value in identifying aggressively growing lesions or patients with impaired survival.

Conclusion

We demonstrated an association between improved clinical outcome and pre-treatment low tumour volume and heterogeneity as well as high sphericity on [¹⁸F]FDG PET. Future PET imaging research should include radiomics features that incorporate tumour volume and heterogeneity when correlating PET data with clinical outcome.

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Prostate-specific antigen flare induced by 223 RaCl 2 in patients with metastatic castration-resistant prostate cancer

Abstract

Purpose

Prostate-specific antigen (PSA) flare is a well-known phenomenon in patients with prostate cancer, but its impact during radium-223 dichloride (²²³RaCl₂) therapy is still unclear. This radioisotope has shown to improve overall survival in metastatic castration-resistant prostate cancer (mCRPC). We sought to evaluate the impact of PSA flare on survival and its relation with metabolic parameters on ¹⁸F-labeled sodium fluoride PET/CT.

Methods

We conducted a retrospective study of 168 patients with mCRPC (median age 69; median PSA 29.7) receiving ²²³RaCl₂. Overall survival (OS) and progression-free survival (PFS), estimated by the Kaplan–Meier method and compared using a log-rank test, were evaluated for patient groups corresponding to different definitions of PSA flare. Metabolic ¹⁸F-fluoride PET/CT data were analyzed as well.

Results

Immediate PSA decline was observed in 49 patients (29.2%), whereas no PSA response was observed in 59 patients (35.1%). PSA flare (defined as rise after the first cycle followed by decrease below the baseline) was observed in 20 patients (11.9%) and PSA flare followed by a decrease from peak but not below baseline was observed in 40 (23.8%). The first flare subgroup had a median PFS and OS of 20.8 and 23.9 months, respectively. These outcomes were not significantly different from patients with immediate PSA decrease, but were significantly better than in patients with persistent PSA elevation (3.1 months for PFS and 11.5 months for OS, p < 0.001). Moreover, the PSA flare group showed an alkaline phosphatase (ALP) decrease significantly greater than non-responders (p = 0.003). Metabolic ¹⁸F-fluoride PET/CT data were available in 35 patients at baseline and during ²³³RaCl₂ therapy. The tumor burden reduction, expressed by ΔTLF₁₀ and ΔFTV_10, was more evident within PSA flare group below baseline than non-responders (p = 0.005 and 0.001, respectively).

Conclusions

This report suggests that a flare does not necessarily indicate lack of response to ²²³RaCl₂ therapy.

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Exercise-Induced Anaphylaxis: Literature Review and Recent Updates

Abstract

Purpose of Review

This paper will review the pathophysiology, diagnosis, and treatment of exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis with an emphasis on novel studies published in the past several years.

Recent Findings

Exercise-induced anaphylaxis (EIAn) is a clinical syndrome characterized by anaphylaxis during or shortly after physical exertion. The syndrome is broadly grouped into two categories: exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis (FDEIAn). Recent literature indicates that FDEIAn is a primary IgE-mediated food allergy which is augmented by several cofactors. Cofactors such as exercise, NSAIDs, and alcohol increase intestinal permeability and allow increased antigen uptake, thereby causing symptoms. The pathophysiology of EIAn is still under investigation.

Summary

EIAn and FDEIAn are rare clinical syndromes characterized by symptoms during or shortly after exercise. Despite recent advances in the understanding of EIAn and FDEIAn, the pathophysiology of both conditions is not fully understood.

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Potential new targets for drug development in severe asthma

In recent years there has been increasing recognition of varying asthma phenotypes that impact treatment response. This has led to the development of biological therapies targeting specific immune cells and cy...

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Exercise-Induced Anaphylaxis: Literature Review and Recent Updates

Abstract

Purpose of Review

This paper will review the pathophysiology, diagnosis, and treatment of exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis with an emphasis on novel studies published in the past several years.

Recent Findings

Exercise-induced anaphylaxis (EIAn) is a clinical syndrome characterized by anaphylaxis during or shortly after physical exertion. The syndrome is broadly grouped into two categories: exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis (FDEIAn). Recent literature indicates that FDEIAn is a primary IgE-mediated food allergy which is augmented by several cofactors. Cofactors such as exercise, NSAIDs, and alcohol increase intestinal permeability and allow increased antigen uptake, thereby causing symptoms. The pathophysiology of EIAn is still under investigation.

Summary

EIAn and FDEIAn are rare clinical syndromes characterized by symptoms during or shortly after exercise. Despite recent advances in the understanding of EIAn and FDEIAn, the pathophysiology of both conditions is not fully understood.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2ONge1L

Potential new targets for drug development in severe asthma

In recent years there has been increasing recognition of varying asthma phenotypes that impact treatment response. This has led to the development of biological therapies targeting specific immune cells and cy...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2AsoyuX

Radiologische Abklärung des akuten Abdomens im Kindesalter

Zusammenfassung

Klinisches/methodisches Problem

Das akute, nichttraumatische Abdomen stellt einen der häufigsten Gründe für eine ärztliche Vorstellung im Kindesalter dar. Wichtig für die richtige Differenzialdiagnose und Therapie ist die Kenntnis der unterschiedlichen Erkrankungen, welche eine deutliche Altersabhängigkeit aufweisen.

Radiologische Standardverfahren

Das radiologische Standardverfahren ist der Ultraschall. Röntgen sollte nur im akuten Notfall, u. a. zum Ausschluss einer Perforation, eingesetzt werden.

Methodische Innovationen

Die Sonographie wird ergänzt durch kontrastverstärkten Ultraschall (CEUS) und die Elastographie.

Leistungsfähigkeit

Die MRT zeigt eine zunehmende Relevanz insbesondere im Bereich der Differenzialdiagnostik bei sonographisch unklaren Befunden.

Empfehlung für die Praxis

Primäre Bildgebungsmodalität des kindlichen Abdomens ist der Ultraschall. MR-Schnittbildgebung sollte nur bei unklaren Sonographiebefunden zum Einsatz kommen.

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Exercise-Induced Anaphylaxis: Literature Review and Recent Updates

Abstract

Purpose of Review

This paper will review the pathophysiology, diagnosis, and treatment of exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis with an emphasis on novel studies published in the past several years.

Recent Findings

Exercise-induced anaphylaxis (EIAn) is a clinical syndrome characterized by anaphylaxis during or shortly after physical exertion. The syndrome is broadly grouped into two categories: exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis (FDEIAn). Recent literature indicates that FDEIAn is a primary IgE-mediated food allergy which is augmented by several cofactors. Cofactors such as exercise, NSAIDs, and alcohol increase intestinal permeability and allow increased antigen uptake, thereby causing symptoms. The pathophysiology of EIAn is still under investigation.

Summary

EIAn and FDEIAn are rare clinical syndromes characterized by symptoms during or shortly after exercise. Despite recent advances in the understanding of EIAn and FDEIAn, the pathophysiology of both conditions is not fully understood.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2ONge1L

Radiologische Abklärung des akuten Abdomens im Kindesalter

Zusammenfassung

Klinisches/methodisches Problem

Das akute, nichttraumatische Abdomen stellt einen der häufigsten Gründe für eine ärztliche Vorstellung im Kindesalter dar. Wichtig für die richtige Differenzialdiagnose und Therapie ist die Kenntnis der unterschiedlichen Erkrankungen, welche eine deutliche Altersabhängigkeit aufweisen.

Radiologische Standardverfahren

Das radiologische Standardverfahren ist der Ultraschall. Röntgen sollte nur im akuten Notfall, u. a. zum Ausschluss einer Perforation, eingesetzt werden.

Methodische Innovationen

Die Sonographie wird ergänzt durch kontrastverstärkten Ultraschall (CEUS) und die Elastographie.

Leistungsfähigkeit

Die MRT zeigt eine zunehmende Relevanz insbesondere im Bereich der Differenzialdiagnostik bei sonographisch unklaren Befunden.

Empfehlung für die Praxis

Primäre Bildgebungsmodalität des kindlichen Abdomens ist der Ultraschall. MR-Schnittbildgebung sollte nur bei unklaren Sonographiebefunden zum Einsatz kommen.

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Exercise-Induced Anaphylaxis: Literature Review and Recent Updates

Abstract

Purpose of Review

This paper will review the pathophysiology, diagnosis, and treatment of exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis with an emphasis on novel studies published in the past several years.

Recent Findings

Exercise-induced anaphylaxis (EIAn) is a clinical syndrome characterized by anaphylaxis during or shortly after physical exertion. The syndrome is broadly grouped into two categories: exercise-induced anaphylaxis and food-dependent, exercise-induced anaphylaxis (FDEIAn). Recent literature indicates that FDEIAn is a primary IgE-mediated food allergy which is augmented by several cofactors. Cofactors such as exercise, NSAIDs, and alcohol increase intestinal permeability and allow increased antigen uptake, thereby causing symptoms. The pathophysiology of EIAn is still under investigation.

Summary

EIAn and FDEIAn are rare clinical syndromes characterized by symptoms during or shortly after exercise. Despite recent advances in the understanding of EIAn and FDEIAn, the pathophysiology of both conditions is not fully understood.

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Merkel cells in extraocular sebaceous carcinoma

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


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Cryptococcus‐like Changes in the Setting of Vasculitis

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


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Cryptococcus‐like Changes in the Setting of Vasculitis

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


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Angiolymphoid Hyperplasia with Eosinophilia and Kimura Disease Overlap with Evidence of Diffuse Visceral Involvement

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


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Angiolymphoid Hyperplasia with Eosinophilia and Kimura Disease Overlap with Evidence of Diffuse Visceral Involvement

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


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Erythema Elevatum Diutinum a Rare and Poorly Understood Cutaneous Vasculitis: A Single Institution Experience

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


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Erythema Elevatum Diutinum a Rare and Poorly Understood Cutaneous Vasculitis: A Single Institution Experience

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


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Reply: The Comparison of Strattice and SurgiMend in Acellular Dermal Matrix-Assisted, Implant-Based Immediate Breast Reconstruction

No abstract available

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The Timing of Chemoprophylaxis in Autologous Microsurgical Breast Reconstruction

Background: Patients undergoing autologous breast reconstruction are at high risk of perioperative venous thromboembolic events. The efficacy of chemoprophylaxis in decreasing venous thromboembolic events is well established, but the timing of chemoprophylaxis remains controversial. The authors compare the incidence of bleeding following preoperative versus postoperative initiation of chemoprophylaxis in microvascular breast reconstruction. Methods: A retrospective chart review was performed from August of 2010 to July of 2016. Initiation of chemoprophylaxis changed from postoperative to preoperative in 2013, dividing subjects into two groups. Patient demographics, comorbidities, and complications were reviewed. Results: A total of 196 patients (311 flaps) were included in the study. A total of 105 patients (166 flaps) received preoperative enoxaparin (40 mg) and 91 patients (145 flaps) received postoperative chemoprophylaxis. A total of five patients required hematoma evacuation (2.6 percent). Of these, one hematoma (1 percent) occurred in the preoperative chemoprophylaxis group. Seven patients received blood transfusions: three in the preoperative group and four in the postoperative group (2.9 percent versus 4.4 percent; p = 0.419). There was a total of one flap failure, and there were no documented venous thromboembolic events in any of the groups. Conclusions: This study demonstrates that preoperative chemoprophylaxis can be used safely in patients undergoing microvascular breast reconstruction. The higher rate of bleeding in the postoperative group may be related to the onset of action of enoxaparin of 4 to 6 hours, which allows for intraoperative hemostasis in the preoperative group and possibly potentiating postoperative oozing when administered postoperatively. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Sifting through the Ashes to Find the Meaning of Resilience

No abstract available

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Measurement of Warping Angle in Human Rib Graft: An Experimental Study

No abstract available

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Breast Implant Mycobacterial Infections: An Epidemiologic Review and Outcome Analysis

Background: Epidemiologic evidence of periprosthetic mycobacterial infections is limited. The recent boom in cosmetic surgery tourism has been associated with a rise of surgical-site infections in returning patients. This review aims to explore available data, examine trends of documented periprosthetic mycobacterial infections, and analyze outcomes of management techniques. Methods: A search in the Biosis, Embase, LILACS, MEDLINE, and Web of Science databases from inception until December of 2017 for "Breast Implants" and "Mycobacterial Infections" and equivalents was performed. Data were pooled after two screening rounds following full-text retrieval and cross-referencing. Results: Forty-one reports describing 171 female patients who had breast prosthesis–related mycobacterial infections were identified. Bibliometric case-based analysis revealed a rise of periprosthetic mycobacterial infections in developing countries since the start of the millennium. The mean patient's age was 37.9 years and the majority of patients had undergone bilateral breast augmentation. Most patients presented with breast pain or tenderness, after an average incubation period of 9 months. Mycobacterium fortuitum was isolated from 90 cases (52.6 percent). Immediate explantation with or without delayed reimplantation was the most commonly used surgical strategy, complemented by combination antimicrobial therapy for an average of 4.6 months. The mean follow-up time was 39.7 months, during which recurrence was observed in 21 of 171 patients (12.3 percent). Conclusions: The emergence of periprosthetic mycobacterial infections in relation to cosmetic medical tourism alerts clinicians to the importance of educating the public about the associated risks. In addition, this study identifies risk factors associated with recurrence of periprosthetic mycobacterial infections.

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Reply: Increasing Diversity in Plastic Surgery

No abstract available

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Ergonomics in the Operating Room: The Cervicospinal Health of Today’s Surgeons

Summary: In its many forms, operating can lead surgeons to adopt postures that have damaging long-term effects on physical health through imparting musculoskeletal fatigue. One area that is particularly susceptible is the cervical spine, as surgeons are forced into positions that require sustained cervical hyperflexion. The repercussions of resultant injuries can be steep, as they have the potential to adversely affect one's operative capacity. The purpose of this article is to assess the spinal health of today's surgeons by evaluating available research in various surgical subspecialties. By focusing on the ergonomic principles that govern the surgical arena and identifying unifying themes between plastic surgery and other surgical subspecialties, it is the goal of this article to enhance the understanding of cervical spine health as it pertains to the plastic and reconstructive surgeon.

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The Relationship between Age and Facial Asymmetry

Background: Facial symmetry is a fundamental goal of plastic surgery, yet some asymmetry is inherent in any face. Three-dimensional photogrammetry allows for rapid, reproducible, and quantitative facial measurements. With this tool, the authors investigated the relationship between age and facial symmetry. Methods: The authors imaged normal subjects using three-dimensional photogrammetry. Facial symmetry was calculated by identifying the plane of maximum symmetry and the root-mean-square deviation. Regression analysis was used to assess the relationship between age and symmetry. Subgroup analyses were performed among facial thirds. Results: The authors imaged 191 volunteers with an average age of 26.7 ± 22.2 years (range, 0.3 to 88 years). Root-mean-square deviation of facial symmetry clustered between 0.4 and 1.3 mm (mean, 0.8 ± 0.2 mm). The authors found a significant positive correlation between increasing age and asymmetry (p

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Nitroglycerin Ointment for Reducing the Rate of Mastectomy Flap Necrosis in Immediate Implant-Based Breast Reconstruction: Correction

No abstract available

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The Feasibility Determination of Risky Severe Complications of Arterial Vasculature Regarding the Filler Injection Sites at the Tear Trough

Background: The tear trough is a significant sign of periorbital aging and has usually been corrected with filler injection. However, the arterial supply surrounding the tear trough could be inadvertently injured during injection; therefore, this study aimed to evaluate the nearest arterial locations related to the tear trough and investigate the possibility of severe complications following filler injection. Methods: Thirty hemifaces of 15 Thai embalmed cadavers were used in this study. Results: The artery located closest to both the inferior margin (TT1) and mid-pupil level (TT2) of the tear trough was found to be the palpebral branch of the infraorbital artery. Furthermore, at 0.5 mm along the tear trough from the medial canthus (TT3), the angular artery was identified, which was found to be a branch of the ophthalmic artery. The artery at TT1 and TT2 was located beneath both the zygomaticus major and the orbicularis oculi muscles. The distances from TT1 to the artery were measured as follows: laterally, 2.79 ± 1.08 mm along the x axis; and inferiorly, 2.88 ± 1.57 mm along the y axis. For the TT2, the artery was located inferomedially from the landmark of 4.65 ± 1.83 mm along the x axis and 7.13 ± 3.99 mm along the y axis. However, the distance along the x axis at TT3 was located medially as 4.00 ± 2.37 mm. Conclusion: The high risk of injury to the artery at the tear trough should be considered because of the numerous arteries to this area.

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Lower Body Lift in the Massive Weight Loss Patient: A New Classification and Algorithm for Gluteal Augmentation

No abstract available

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High-Throughput Screening of Full-Face Clinically Relevant Arterial Variations Using Three-Dimensional Postmortem Computed Tomography

Background: Vascular complications resulting from intravascular filler injection and embolism are major safety concerns for facial filler injection. It is essential to systematically screen full-face arterial variations and help design evidence-based safe filler injection protocols. Methods: The carotid arteries of 22 cadaveric heads were infused with adequate lead oxide contrast. The facial and superficial temporal arteries of another 12 cadaveric heads were injected with the contrast in a sequential order. A computed tomographic scan was acquired after each contrast injection, and each three-dimensional computed tomographic scan was reconstructed using validated algorithms. Results: Three-dimensional computed tomography clearly demonstrated the course, relative depth, and anastomosis of all major arteries in 63 qualified hemifaces. The ophthalmic angiosome consistently deploys two distinctive layers of branch arteries to the forehead. The superficial temporal and superior palpebral arteries run along the preauricular and superior palpebral creases, respectively. The study found that 74.6 percent of the hemifaces had nasolabial trunks coursing along the nasolabial crease, and that 50.8 percent of the hemifaces had infraorbital trunks that ran through the infraorbital region. Fifty percent of the angular arteries were the direct anastomotic channels between the facial and ophthalmic angiosomes, and 29.2 percent of the angular arteries were members of the ophthalmic angiosomes. Conclusions: Full-face arterial variations were mapped using postmortem three-dimensional computed tomography. Facial creases were in general correlated with underlying deep arteries. Facial and angular artery variations were identified at high resolution, and reclassified into clinically relevant types to guide medical practice.

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Vascular Anomalies: From a Clinicohistologic to a Genetic Framework

No abstract available

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Alar Cinching with Subcutaneous Flaps: A Procedure to Achieve Narrowing of the Nasal Base while Controlling the Alar Axis and Sidewall Curvature

Background: Insufficient narrowing of alar width, alar distortion, and noticeable scarring are commonly encountered after alar base reduction. The authors aimed to demonstrate an alar cinching with subcutaneous flaps procedure to reduce the alar width while controlling the alar axis and sidewall curvature. Methods: A retrospective chart review of 560 patients who underwent alar base reduction between 2000 and 2015 was performed. The clinical outcomes of alar cinching with subcutaneous flaps were compared to those of vestibular floor excision with cinching suture. Mean change in alar width was compared to assess narrowing efficacy between the two groups. In addition, mean changes in interalar distance for the upper, middle, and lower parts of the alae were compared to evaluate the alteration of alar axes. Results: Seventy-three patients who underwent alar base narrowing alone (alar cinching with subcutaneous flaps, n = 42; vestibular floor excision with cinching suture, n = 31) were identified. Alar cinching with subcutaneous flaps was significantly more effective than vestibular floor excision with cinching suture in reducing alar width. In patients with vertical alar axes, alar cinching with subcutaneous flaps achieved more uniform narrowing of the entire alae, resulting in prevention of alar distortion. The incidence of complications after alar cinching with subcutaneous flaps was 5.7 percent. Conclusions: Alar cinching with subcutaneous flaps achieved sufficient narrowing of the nasal base in the long-term follow-up in patients with any type of alar axis and enabled the reduction of sidewall curvature while eliminating the need for wedge resection. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Reply: The Comparison of Strattice and SurgiMend in Acellular Dermal Matrix-Assisted, Implant-Based Immediate Breast Reconstruction

No abstract available

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The Timing of Chemoprophylaxis in Autologous Microsurgical Breast Reconstruction

Background: Patients undergoing autologous breast reconstruction are at high risk of perioperative venous thromboembolic events. The efficacy of chemoprophylaxis in decreasing venous thromboembolic events is well established, but the timing of chemoprophylaxis remains controversial. The authors compare the incidence of bleeding following preoperative versus postoperative initiation of chemoprophylaxis in microvascular breast reconstruction. Methods: A retrospective chart review was performed from August of 2010 to July of 2016. Initiation of chemoprophylaxis changed from postoperative to preoperative in 2013, dividing subjects into two groups. Patient demographics, comorbidities, and complications were reviewed. Results: A total of 196 patients (311 flaps) were included in the study. A total of 105 patients (166 flaps) received preoperative enoxaparin (40 mg) and 91 patients (145 flaps) received postoperative chemoprophylaxis. A total of five patients required hematoma evacuation (2.6 percent). Of these, one hematoma (1 percent) occurred in the preoperative chemoprophylaxis group. Seven patients received blood transfusions: three in the preoperative group and four in the postoperative group (2.9 percent versus 4.4 percent; p = 0.419). There was a total of one flap failure, and there were no documented venous thromboembolic events in any of the groups. Conclusions: This study demonstrates that preoperative chemoprophylaxis can be used safely in patients undergoing microvascular breast reconstruction. The higher rate of bleeding in the postoperative group may be related to the onset of action of enoxaparin of 4 to 6 hours, which allows for intraoperative hemostasis in the preoperative group and possibly potentiating postoperative oozing when administered postoperatively. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Hybrid Prepectoral Breast Reconstruction: A Surgical Approach that Combines the Benefits of Autologous and Implant-Based Reconstruction

Background: The advantages of hybrid breast reconstruction (i.e., the combination of free tissue transfer with simultaneous implant placement) are well known. In an attempt to further minimize morbidity and simplify the procedure, the authors have modified their approach in that a prepectoral approach is now routinely chosen. Methods: A retrospective analysis of patients who underwent immediate microsurgical breast reconstruction with simultaneous prepectoral implant placement was performed. Clinical outcomes and postoperative complications were examined. Results: A total of 23 patients with a mean age of 46.6 years (range, 26 to 72 years) and mean body mass index of 25.8 kg/m2 (range, 21.4 to 32.1 kg/m2) underwent reconstruction with 46 free flaps with simultaneous prepectoral silicone gel implant placement. The most common implant volume was 210 cc (range, 150 to 255 cc). Postoperative complications included hematoma [n = 1 (4.3 percent)], mastectomy skin flap necrosis [n = 5 (21.7 percent)], fat necrosis [n = 3 (13 percent)], and delayed wound healing at the flap donor site [n = 4 (17.4 percent)]. No case of implant malposition, implant infection, flap loss, or "red breast" syndrome was encountered during a mean follow-up of 8.4 months (range, 2 to 17 months). Conclusions: Prepectoral hybrid breast reconstruction is a safe procedure that combines the benefits of autologous and implant-based reconstruction. Although the transfer of well-vascularized soft tissue allows reconstruction of natural breast ptosis, the addition of an implant provides the desired projection, but without being associated with complications such as rippling or animation deformity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Reply: Targeting Reflux-Free Veins with a Vein Visualizer to Identify the Ideal Recipient Vein Preoperatively for Optimal Lymphaticovenous Anastomosis in Treating Lymphedema

No abstract available

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Sifting through the Ashes to Find the Meaning of Resilience

No abstract available

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Perioperative Ketorolac Use and Postoperative Hematoma Formation in Reduction Mammaplasty: A Single-Surgeon Experience of 500 Consecutive Cases

Background: In light of the escalating opioid crisis, surgeons are increasingly focused on minimizing opioid use. Ketorolac has well-documented opioid-sparing effects in the postoperative period; however, its use is limited because of concerns of postoperative bleeding and hematoma formation. This study explores the relationship between hematoma formation and administration of perioperative ketorolac in adolescent female patients and young adult women undergoing reduction mammaplasty. It also aims to determine the effect of perioperative ketorolac administration on the requirement for opioid analgesia. Methods: The authors reviewed the medical records of 500 consecutive female patients who underwent reduction mammaplasty for bilateral macromastia from 2007 to 2017. The authors collected data pertaining to perioperative analgesia use and postoperative hematoma formation. Results: Five-hundred patients were included in analyses. The average age of the patients was 18.1 ± 2.2 years. Three hundred eighty-nine patients (77.8 percent) received intravenous ketorolac during the perioperative period. Seven patients (1.4 percent) developed a postoperative hematoma. Hematoma was not associated with intraoperative, postoperative, and perioperative ketorolac use (p > 0.43, all). Intraoperative ketorolac use was associated with lower total intraoperative dosing of fentanyl and morphine, and postoperative ketorolac use was associated with lower total postoperative doses of oxycodone and morphine (p

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Measurement of Warping Angle in Human Rib Graft: An Experimental Study

No abstract available

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Breast Implant Mycobacterial Infections: An Epidemiologic Review and Outcome Analysis

Background: Epidemiologic evidence of periprosthetic mycobacterial infections is limited. The recent boom in cosmetic surgery tourism has been associated with a rise of surgical-site infections in returning patients. This review aims to explore available data, examine trends of documented periprosthetic mycobacterial infections, and analyze outcomes of management techniques. Methods: A search in the Biosis, Embase, LILACS, MEDLINE, and Web of Science databases from inception until December of 2017 for "Breast Implants" and "Mycobacterial Infections" and equivalents was performed. Data were pooled after two screening rounds following full-text retrieval and cross-referencing. Results: Forty-one reports describing 171 female patients who had breast prosthesis–related mycobacterial infections were identified. Bibliometric case-based analysis revealed a rise of periprosthetic mycobacterial infections in developing countries since the start of the millennium. The mean patient's age was 37.9 years and the majority of patients had undergone bilateral breast augmentation. Most patients presented with breast pain or tenderness, after an average incubation period of 9 months. Mycobacterium fortuitum was isolated from 90 cases (52.6 percent). Immediate explantation with or without delayed reimplantation was the most commonly used surgical strategy, complemented by combination antimicrobial therapy for an average of 4.6 months. The mean follow-up time was 39.7 months, during which recurrence was observed in 21 of 171 patients (12.3 percent). Conclusions: The emergence of periprosthetic mycobacterial infections in relation to cosmetic medical tourism alerts clinicians to the importance of educating the public about the associated risks. In addition, this study identifies risk factors associated with recurrence of periprosthetic mycobacterial infections.

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Reply: Increasing Diversity in Plastic Surgery

No abstract available

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Anatomy of the Superficial Fascia System of the Breast: A Comprehensive Theory of Breast Fascial Anatomy

Background: It has been two centuries since Petrus Camper identified superficial fascia and over 175 years since Sir Astley Cooper wrote his book on the anatomy of the breast. In the 1990s, Ted Lockwood taught us the importance of the superficial fascia layers in body contouring procedures he pioneered. These descriptions, however, fail to explain the three-dimensional fascial system in the breast. The authors set out to discover and describe a theory of superficial fascia structures responsible for breast shape. Methods: The nature of the superficial fascia system that surrounds the breast and its attachments to the chest were studied in 12 cadaver breast dissections and in clinical cases of both cosmetic and reconstructive breast procedures. Results: The authors found a three-dimensional, closed system of fascia and fat surrounding the corpus mammae, which attaches to the skin by means of specialized vertical cutaneous ligaments, or Cooper ligaments, and which attaches to the chest wall by means of a three-dimensional zone of adherence at the breast's periphery. Conclusions: The breast is shaped by a three-dimensional, fibrofatty fascial system. Two layers of this system surround the corpus mammae and fuse together around it, and anchor it to the chest wall in a structure we have called the circummammary ligament.

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Ergonomics in the Operating Room: The Cervicospinal Health of Today’s Surgeons

Summary: In its many forms, operating can lead surgeons to adopt postures that have damaging long-term effects on physical health through imparting musculoskeletal fatigue. One area that is particularly susceptible is the cervical spine, as surgeons are forced into positions that require sustained cervical hyperflexion. The repercussions of resultant injuries can be steep, as they have the potential to adversely affect one's operative capacity. The purpose of this article is to assess the spinal health of today's surgeons by evaluating available research in various surgical subspecialties. By focusing on the ergonomic principles that govern the surgical arena and identifying unifying themes between plastic surgery and other surgical subspecialties, it is the goal of this article to enhance the understanding of cervical spine health as it pertains to the plastic and reconstructive surgeon.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2yCjEKw