Measuring Prefrontal Hemodynamic Responses Using Functional Near-Infrared Spectroscopy During Mobility for a Child With Motor Impairment

Date Presented 3/31/2017

This study used functional near-infrared spectroscopy (fNIRS) to identify changes in cognitive workload in a child with motor impairment during experiences with robot-assisted mobility. The study provides preliminary support for using fNIRS to measure cognitive workload in novel motor tasks.

Primary Author and Speaker: Kelly Cusick

Additional Authors and Speakers: Alexandra DiStasi, Stephanie Holowinski, Olivia Fitzpatrick

Contributing Authors: Megan Davis, Melody H. Wallace, Sharon A. Stansfield, Carole Dennis, Hélène M. Larin, Nancy Rader, Judith Pena-Shaff

Outcomes in dogs with uncomplicated, presumptive bacterial pneumonia treated with short or long course antibiotics

This is a prospective, observational investigation without a placebo arm to evaluate the resolution rate of pneumonia when using 14 days or less of antibiotic therapy compared to longer therapy in dogs. There was no significant difference in radiographic resolution or relapse rates between the 2 treatment groups.

A suspected case of intermediate syndrome in a dog with carbamate toxicosis

CASE REPORT

A 7-year-old female spayed Labrador Retriever was managed for suspected carbamate toxicosis after confirmed ingestion of a large amount of methiocarb. Therapy included decontamination, supportive care and management for aspiration pneumonia. On the third day of hospitalisation, after an initial clinical improvement, the dog developed respiratory muscle weakness, inspiratory dyspnoea and pronounced cervical muscle weakness. These delayed clinical signs were consistent with the 'intermediate syndrome' described in some cases of organophosphate and carbamate toxicoses in humans and also described in one case of organophosphate toxicosis in the dog. Intermediate syndrome has not been reported in carbamate toxicosis in the dog.

CONCLUSION

This case report highlights the necessity for veterinarians to monitor for additional complications not commonly considered in acute carbamate toxicoses.

Trace elements have beneficial, as well as detrimental effects on bone homeostasis

The protective role of nutrition factors such as calcium, vitamin D and vitamin K for the integrity of the skeleton is well understood. In addition, integrity of the skeleton is positively influenced by certain trace elements (e.g. zinc, copper, manganese, magnesium, iron, selenium, boron and fluoride) and negatively by others (lead, cadmium, cobalt). Deficiency or excess of these elements influence bone mass and bone quality in adulthood as well as in childhood and adolescence. However, some protective elements may become toxic under certain conditions, depending on dosage (serum concentration), duration of treatment and interactions among individual elements. We review the beneficial and toxic effects of key elements on bone homeostasis.

Abstract P1-10-20: A multi-center trial of intra-operative electronic brachytherapy during breast conservation surgery for early stage breast cancer: Early results of unplanned boost participants

Objective

To assess the safety and efficacy of single-fraction, intra-operative radiation therapy (IORT) delivered as a boost using the Xoft® Axxent® Electronic Brachytherapy System® (eBx®) immediately following surgical resection for treatment of early stage breast cancer.

Methods

This phase 4, open-label, single-arm, prospective, non-randomized trial is still enrolling participants and is currently being conducted at 26 hospitals in the USA (25) and Portugal (1). 878 participants with biopsy-proven ductal carcinoma in situ (DCIS) or invasive ductal carcinoma who met the inclusion criteria underwent lumpectomy followed by single-fraction IORT to the lumpectomy cavity. Briefly, a small, presterilized lead shield piece was placed on the chest wall to reduce the dose to the ribs, and then a balloon applicator, suitable to the surgical bed, was placed in the lumpectomy cavity and inflated with saline (30-75 cc); skin was temporarily closed over the balloon and ultrasound was used to confirm a balloon surface-to-skin distance ≥ 1.0 cm. The Xoft System was used to deliver the 20 Gy dose at the balloon applicator surface. The balloon was deflated, lead shield and balloon removed and the surgical site sutured. Upon the presence of additional risk factors, 37 participants subsequently received whole breast radiation therapy (WBRT); thus, these participants received an unplanned IORT boost and were removed from the primary analysis but will continue to be followed for the duration of the 10-year study. Cosmesis (Harvard Scale) was assessed in this subset of participants. The primary outcome for the main trial is recurrence of ipsilateral breast tumor at 5 years. Trial Registry: ClinicalTrials.gov; Identifier: NCT01644669.

Early Findings

37 boost participants received WBRT (up to 50 Gy) after IORT (36 received the prescribed 20 Gy dose; one received 14 Gy). Mean follow-up time was 430 days (range 13-1119). Mean age at IORT was 62 years (range 45-78). Boost participants had either DCIS (N=5) or invasive ductal carcinoma (N=32). The DCIS nuclear grade was high (N=3), intermediate (N=1), or low (N=1). Invasive cancers were Grade 1 (N=15), 2 (N=10), 3 (N=6), or unknown (N=1). 29 participants had T1, 3 had T2, and 5 had Tis lesions. Mean tumor size was 13.04 ± 10.26 mm. For the two participants who have reached 3-year follow-up, cosmesis was excellent (N=1) and fair (N=1). For the six participants who have reached 2-year follow-up, cosmesis was excellent (N=4), good (N=1), and fair (N=1). There was one serious adverse event with a Grade 3 for skin necrosis. The most frequent side effects were seroma (10%), edema (9%), pain (9%), erythema (6%), and induration (5%). There have been no deaths, recurrences, or new primary tumors among the boost participants to date.

Conclusions

Early results from this multi-center trial suggest that IORT as a tumor-bed boost using the Xoft Axxent eBx System at the time of breast conservation surgery is safe and has low morbidity. To date, the majority of participants receiving an unplanned IORT boost have had excellent to good cosmetic results and the majority of adverse events have been low-grade.

Funding

Funded by Xoft, Inc., a subsidiary of iCAD, Inc.

Citation Format: Syed AMN, Chang H, Schwartzberg B, Bremner A, Boylan S, Lopez-Penalver C, Vito C, Davis M, Dooley W, Chakravarthy AB, Coomer C, Proulx G, Golder S, Ivanov O, Fernandez K, Farha MJ, Gonzalez V, Wengler C, Bhatnagar A, Neuner GA, Kopkash K, Rahman S, Costa P. A multi-center trial of intra-operative electronic brachytherapy during breast conservation surgery for early stage breast cancer: Early results of unplanned boost participants [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-10-20.

Influence of Day Length and Physical Activity on Sleep Patterns in Older Icelandic Men and Women

STUDY OBJECTIVES

To identify cross-sectional and seasonal patterns of sleep and physical activity (PA) in community-dwelling, older Icelandic adults using accelerometers.

METHODS

A seven-day free-living protocol of 244 (110 female) adults aged 79.7 ± 4.9 years was conducted as part of a larger population-based longitudinal observational-cohort study in the greater Reykjavik area of Iceland. A subpopulation (n = 72) repeated the 7-day measurement during seasonal periods with greater (13.4 ± 1.4 h) and lesser (7.7 ± 1.8 h) daylight.

RESULTS

Cross-sectional analyses using multiple linear regression models revealed that day length was a significant independent predictor of sleep duration, mid-sleep, and rise time (all p < 0.05). However, the actual within-individual differences in sleep patterns of the repeaters were rather subtle between periods of longer and shorter day-lengths. Compared to women, men had a shorter sleep duration (462 ± 80 vs. 487 ± 68 minutes, p = 0.008), earlier rise time, and a greater number of awakenings per night (46.5 ± 18.3 vs. 40.2 ± 15.7, p = 0.007), but sleep efficiency and onset latency were similar between the two sexes. Daily PA was also similar between men and women and between periods of longer and shorter day-lengths. BMI, age, gender, and overall PA all contributed to the variations in sleep parameters using multiple regression analysis.

CONCLUSIONS

The sleep and PA characteristics of this unique population revealed some gender differences, but there was limited variation in response to significant daylight changes which may be due to long-term adaptation.

Vertebral Tortuosity Index in Patients with Non-Connective Tissue Disorder-Related Aneurysm Disease

OBJECTIVE

The vertebral tortuosity index (VTI) predicts increased risk of acute aortic events in patients with known genetic aortopathies. This study describes the VTI in a cohort of patients with non-connective tissue disorder-related large aneurysms.

METHODS

Hospital imaging records from July 2012 to March 2016 were interrogated to identify patients with aneurysmal disease who had undergone computed tomographic angiography that included imaging of vertebral arteries. A control group of consecutive patients undergoing carotid and vertebral imaging was also assessed. VTI was calculated using the formula: [(centre-line distance) / (straight-line distance)-1] ×100 for all patients, and statistical analysis undertaken to determine whether measured VTI was statistically different in patients of younger age, with larger aneurysms, or an acute presentation. Comparison was made with patients who had no aneurysm disease.

RESULTS

Sixty-five patients were identified with adequate imaging to assess the entire aorta, including vertebral arteries. The majority of patients were male (71%, 46/65) and mean age at the time of the CT scan was 71 years (SD 11.1 years). There were 11 patients under the age of 60 years in this cohort. The mean VTI was 33.17 (SD 20.43). There was no statistically significant difference between different territories of presentation (proximal vs. distal aneurysm, p=.94), age of patient (>60 years vs. <60 years, p=.2), or size of aneurysm (>6 cm vs. <6 cm, p=.09). Acuity of presentation was not predicted by a higher VTI (p=.69). The VTI in patients with aneurysms was higher than in patients without aneurysm disease (VTI = 16.1, p<.005) CONCLUSIONS: An elevated VTI is consistently present in patients with degenerative aneurysms and has potential as a universally available predictive measurement. However, the increased VTI in the older cohort without connective tissue disease may not carry the same predictive value for acute presentations as has been demonstrated in younger patients with a known genetic basis for their aortopathy.

An investigation of Saudi Arabian MR radiographers' knowledge and confidence in relation to MR image-quality-related errors

OBJECTIVE

To investigate MR radiographers' current knowledge base and confidence level in relation to quality-related errors within MR images.

METHOD

Thirty-five MR radiographers within 16 MRI departments in the Kingdom of Saudi Arabia (KSA) independently reviewed a prepared set of 25 MR images, naming the error, specifying the error-correction strategy, scoring how confident they were in recognising this error and suggesting a correction strategy by using a scale of 1-100. The datasets were obtained from MRI departments in the KSA to represent the range of images which depicted excellent, acceptable and poor image quality.

RESULTS

The findings demonstrated a low level of radiographer knowledge in identifying the type of quality errors and when suggesting an appropriate strategy to rectify those errors. The findings show that only (n = 7) 20% of the radiographers could correctly name what the quality errors were in 70% of the dataset, and none of the radiographers correctly specified the error-correction strategy in more than 68% of the MR datasets. The confidence level of radiography participants in their ability to state the type of image quality errors was significantly different (p < 0.001) for who work in different hospital types.

CONCLUSION

The findings of this study suggest there is a need to establish a national association for MR radiographers to monitor training and the development of postgraduate MRI education in Saudi Arabia to improve the current status of the MR radiographers' knowledge and direct high quality service delivery.

Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer

BACKGROUND

Robust data on patient-reported outcome measures comparing treatments for clinically localized prostate cancer are lacking. We investigated the effects of active monitoring, radical prostatectomy, and radical radiotherapy with hormones on patient-reported outcomes.

METHODS

We compared patient-reported outcomes among 1643 men in the Prostate Testing for Cancer and Treatment (ProtecT) trial who completed questionnaires before diagnosis, at 6 and 12 months after randomization, and annually thereafter. Patients completed validated measures that assessed urinary, bowel, and sexual function and specific effects on quality of life, anxiety and depression, and general health. Cancer-related quality of life was assessed at 5 years. Complete 6-year data were analyzed according to the intention-to-treat principle.

RESULTS

The rate of questionnaire completion during follow-up was higher than 85% for most measures. Of the three treatments, prostatectomy had the greatest negative effect on sexual function and urinary continence, and although there was some recovery, these outcomes remained worse in the prostatectomy group than in the other groups throughout the trial. The negative effect of radiotherapy on sexual function was greatest at 6 months, but sexual function then recovered somewhat and was stable thereafter; radiotherapy had little effect on urinary continence. Sexual and urinary function declined gradually in the active-monitoring group. Bowel function was worse in the radiotherapy group at 6 months than in the other groups but then recovered somewhat, except for the increasing frequency of bloody stools; bowel function was unchanged in the other groups. Urinary voiding and nocturia were worse in the radiotherapy group at 6 months but then mostly recovered and were similar to the other groups after 12 months. Effects on quality of life mirrored the reported changes in function. No significant differences were observed among the groups in measures of anxiety, depression, or general health-related or cancer-related quality of life.

CONCLUSIONS

In this analysis of patient-reported outcomes after treatment for localized prostate cancer, patterns of severity, recovery, and decline in urinary, bowel, and sexual function and associated quality of life differed among the three groups. (Funded by the U.K. National Institute for Health Research Health Technology Assessment Program; ProtecT Current Controlled Trials number, ISRCTN20141297 ; ClinicalTrials.gov number, NCT02044172 .).

An investigation of the emotion of disgust as an affective barrier to intention to screen for colorectal cancer

Colorectal cancer (CRC) screening participation remains unacceptably low. This study investigated the emotion of disgust as a potential deterrent to intention to screen for CRC. The study utilised a convenience sample of individuals' 40-70 years of age to complete an online survey. Participants included 30 men and 118 women recruited between December 1, 2013 and March 31, 2014. Data on socio-demographics, health status, screening intentions and emotional barriers to bowel screening were collected via an on-line survey. Logistic regression analysis was utilised to investigate predictors of screening intention. Individuals were more likely to report intention to screen if they had prior screening experience, and reported fewer emotional concerns to screening for CRC. Results implicate disgust as a predictor of screening avoidance among participants. Specifically, higher reported faecal disgust was predictive of a 3% decrease in screening intention. This study was the first to empirically position disgust alongside other negative emotional states as an affective barrier to screening for CRC. Trait disgust sensitivity was not a reliable predictor of screening intention. This research suggests that anticipated faecal disgust may contribute to avoidance of screening for CRC.

Preparedness for use of the rapid result HIV self-test by gay men and other men who have sex with men (MSM): a mixed methods exploratory study among MSM and those involved in HIV prevention and care

Objectives

The aim of the study was to explore preparedness for the HIV self‐test among men who have sex with men (MSM) and those involved in HIV prevention and care.

Methods

A mixed methods exploratory research design was employed, detailing awareness and willingness to use the self‐test and the perceived barriers and facilitators to implementation. Quantitative and qualitative data collection and analysis were completed in parallel. Descriptive and inferential analysis of cross‐sectional bar‐based survey data collected from MSM through a self‐completed questionnaire and oral fluid specimen collection (n = 999) was combined with qualitative, thematic, analysis of data collected through 12 expert focus groups (n = 55) consisting of gay men, National Health Service (NHS) staff, community organizations, entrepreneurs and activists. Findings were subsequently combined and assessed for synergies.

Results

Among MSM, self‐test awareness was moderate (55%). Greater awareness was associated with increased educational attainment [adjusted odds ratio 1.51; 95% confidence interval (CI) 1.00–2.30; P = 0.05] and previous history of sexually transmitted infection (STI) testing (adjusted odds ratio 1.63; 95% CI 1.11–2.39; P = 0.01). Willingness to use the test was high (89%) and associated with meeting sexual partners online (unadjusted odds ratio 1.96; 95% CI 1.31–2.94; P < 0.001). Experts highlighted the overall acceptability of self‐testing; it was understood as convenient, discreet, accessible, and with a low burden to services. However, some ambivalence towards self‐testing was reported; it could reduce opportunities to engage with wider services, wider health issues and the determinants of risk.

Conclusions

Self‐testing represents an opportunity to reduce barriers to HIV testing and enhance prevention and access to care. Levels of awareness are moderate but willingness to use is high. Self‐testing may amplify health inequalities.

Calcification of a Synthetic Renovascular Graft in a Child

INTRODUCTION

Vascular grafts, especially in paediatric cases, need to be durable. Common failures such as thrombosis are well documented with research efforts directed towards them. However, there are lesser known causes of graft failure, such as graft calcification, and these also require further research focus.

REPORT

A paediatric case is described in which a synthetic renovascular graft, implanted for mid-aortic syndrome, became calcified, necessitating surgical intervention to resolve graft malfunction. Significant calcification in the limb of a bifurcated polyethylene terephthalate graft was found to be the cause of resistant stenosis and refractory hypertension. Histology conducted on the explanted limb showed the presence of multinuclear giant cells, indicating a chronic foreign body response.

DISCUSSION

Calcification of vascular grafts is probably more common than previously recognised. Stenosis typically resistant to angioplasty may result in the long term and thus leading to surgical intervention. In young children, this is suboptimal as these grafts need to last throughout adulthood. Explanted prosthetic grafts should be sent to specialist registries such as that in Strasbourg to be optimally assessed so that contributory factors can be identified.