Comparison of double inversion recovery magnetic resonance imaging (DIR-MRI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in detection of prostate cancer: A pilot study

INTRODUCTION

DCE-MRI is established for detecting prostate cancer (PCa). However, it requires a gadolinium contrast agent, with potential risks for patients. The application of DIR-MRI is simple and may allow cancer detection without the use of an intravenous contrast agent by differentially nullifying signal from normal and abnormal prostate tissue, creating contrast between the cancer and background normal prostate. In this pilot study we gathered data from DIR-MRI and DCE-MRI of the prostate for an equivalence trial. We also looked at how the DIR-MRI appearance varies with the aggressiveness of PCa.

METHOD

DIR-MRI and DCE-MRI were acquired. The images were assessed by an experienced Consultant Radiologist and a novice reporter (Radiographer). The potential PCa lesions were quantified using a lesion to normal ratio (LNR). Radiological pathological correlation was made to identify the MRI lesions that represented significant PCa. A Wilcoxon sign rank was used to compare DCE-LNR and DIR-LNR for PCa containing lesions. Pearson's correlation was used to look at the relationship between DIR-LNR and PCa grade group (aggressiveness).

RESULTS

DCE-LNR and DIR-LNR were found to be significantly different (Z = -5.910, p < 0.001). However, a significant correlation was found between PCa grade group and DIR-LNR.

CONCLUSION

DIR and DCE sequences are not equivalent and significant cancer is more conspicuous on the DCE sequence. However, DIR-LNR does correlate with PCa aggressiveness.

IMPLICATIONS FOR PRACTICE

With the correlation of PCa grade group with DIR-LNR this may be a useful sequence in evaluation of the prostate; stratifying the risk of there being clinically significant PCa before biopsy is performed. Furthermore, given that DIR-LNR appears to predict PCa aggressiveness DIR might be used as part of a multiparametric MRI protocol designed to avoid biopsy.

Antidepressant treatment among social workers, human service professionals, and non-human service professionals: A multi-cohort study in Finland, Sweden and Denmark

BACKGROUND

Social workers have an elevated risk for mental disorders, but little is known about their antidepressant treatment.

AIMS

To examine any and long-term antidepressant treatment among social workers in Finland, Sweden and Denmark.

METHODS

We linked records from drug prescription registers to three prospective cohorts: the Finnish Public Sector study, years 2006-2011, and nation-wide cohorts in Sweden and Denmark, years 2006-2014, including a total of 1.5 million employees in (1) social work, (2) other social and health care professions, (3) education and (4) office work. We used Cox proportional hazards models to estimate hazard ratios for any and long-term (>6 months) antidepressant treatment among social workers compared to the three reference occupational groups and carried out meta-analyses.

RESULTS

During follow-up, 25% of social workers had any prescriptions for antidepressants (19-24% reference occupations) and 20% for long-term treatment (14-19% reference occupations). The pooled effects for any and long-term treatment showed that probabilities were 10% higher in social workers compared to other health and social care professionals and 30% higher compared to education and non-human service professionals. Probabilities for any treatment in the three countries were relatively similar, but for long-term treatment social workers in Finland had a greater risk compared with other human service professions.

LIMITATIONS

There were differences between the cohorts in the availability of data. Specific diagnoses for the antidepressant treatment were not known neither adherence to treatment.

CONCLUSION

Social workers have a higher risk for any and long-term antidepressant treatment than other human and non-human service professionals.

No support for Heincke's law in hagfish (Myxinidae): lack of an association between body size and the depth of species occurrence

This study tests for interspecific evidence of Heincke's law among hagfishes and advances the field of research on body size and depth of occurrence in fishes by including a phylogenetic correction and by examining depth in four ways: maximum depth, minimum depth, mean depth of recorded specimens and the average of maximum and minimum depths of occurrence. Results yield no evidence for Heincke's law in hagfishes, no phylogenetic signal for the depth at which species occur, but moderate to weak phylogenetic signal for body size, suggesting that phylogeny may play a role in determining body size in this group.

Informal caregiving as a risk factor for type 2 diabetes in individuals with favourable and unfavourable psychosocial work environments: A longitudinal multi-cohort study

AIM

To examine whether informal caregiving is associated with increased risk of type 2 diabetes (T2D), and whether job strain and social support at work modify the association.

METHODS

Individual participant's data were pooled from three cohort studies-the French GAZEL study, the Swedish Longitudinal Occupational Survey of Health (SLOSH) and the British Whitehall II study-a total of 21,243 study subjects. Informal caregiving was defined as unpaid care for a closely related person. Job strain was assessed using the demand-control model, and questions on co-worker and supervisor support were combined in a measure of social support at work. Incident T2D was ascertained using registry-based, clinically assessed and self-reported data.

RESULTS

A total of 1058 participants developed T2D during the up to 10 years of follow-up. Neither informal caregiving (OR: 1.09, 95% CI: 0.92-1.30) nor high job strain (OR: 1.04, 95% CI: 0.86-1.26) were associated with T2D risk, whereas low social support at work was a risk factor for T2D (OR: 1.18, 95% CI: 1.02-1.37). Also, informal caregivers who were also exposed to low social support at work were at higher risk of T2D (OR: 1.40, 95% CI: 1.08-1.82) compared with those who were not informal caregivers and had high social support at work (multiplicative test for interaction, P=0.04; additive test for interaction, synergy index=10).

CONCLUSION

Informal caregiving was not independently associated with T2D risk. However, low social support at work was a risk factor, and informal caregivers with low social support at work had even higher risks of T2D.

Pain expectations in neuropathic pain: Is it best to be optimistic?

BACKGROUND

Pain expectancy may be an important variable that has been found to influence the effectiveness of treatments for pain. Much of the literature supports a self-fulfilment perspective where expectations for pain relief predict the actual pain experienced. However, in conditions such as neuropathic pain (NeP) where pain relief is difficult to attain, expectations for pain relief could be unrealistic. The objective of this study was to investigate the relationship between realistic/unrealistic expectations and 6-month, post-treatment outcomes.

METHODS

We performed a retrospective analysis of a large cohort of patients with NeP (n = 789) attending tertiary care centres to determine the association between unrealistic (both positive and negative) and realistic expectations with outcomes after multidisciplinary treatment. An expectation variable with three categories was calculated: realistic expectations were those whose expected reduction in pain was similar to the observed mean group reduction in pain, while optimistic and pessimistic expectations were those who over- or under-estimated the expected response to treatment, respectively. The association between baseline realistic/unrealistic expectations and 6-month pain-related disability, catastrophizing and psychological distress was assessed.

RESULTS

Univariable analyses suggested that realistic expectations were associated with lower levels of disability, catastrophizing and psychological distress, compared to unrealistic expectations. However, after adjustment for baseline symptom severity, multivariable analysis revealed that patients with optimistic expectations had lower levels of disability, than those with realistic expectations. Those with pessimistic expectations had higher levels of catastrophizing and psychological distress at follow-up.

CONCLUSIONS

These findings are largely congruent with the self-fulfilment perspective to expectations.

SIGNIFICANCE

This study defined realistic pain expectations with patient data. Examining the relationship between expectations between pain and disability in a large cohort of patients with neuropathic pain.

Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society

BACKGROUND

Neuropathic pain (NeP), redefined as pain caused by a lesion or a disease of the somatosensory system, is a disabling condition that affects approximately two million Canadians.

OBJECTIVE

To review the randomized controlled trials (RCTs) and systematic reviews related to the pharmacological management of NeP to develop a revised evidence-based consensus statement on its management.

METHODS

RCTs, systematic reviews and existing guidelines on the pharmacological management of NeP were evaluated at a consensus meeting in May 2012 and updated until September 2013. Medications were recommended in the consensus statement if their analgesic efficacy was supported by at least one methodologically sound RCT (class I or class II) showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment were based on the degree of evidence of analgesic efficacy, safety and ease of use.

RESULTS

Analgesic agents recommended for first-line treatments are gabapentinoids (gabapentin and pregabalin), tricyclic antidepressants and serotonin noradrenaline reuptake inhibitors. Tramadol and controlled-release opioid analgesics are recommended as second-line treatments for moderate to severe pain. Cannabinoids are now recommended as third-line treatments. Recommended fourth-line treatments include methadone, anticonvulsants with lesser evidence of efficacy (eg, lamotrigine, lacosamide), tapentadol and botulinum toxin. There is support for some analgesic combinations in selected NeP conditions.

CONCLUSIONS

These guidelines provide an updated, stepwise approach to the pharmacological management of NeP. Treatment should be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Additional studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes and treatment of pediatric, geriatric and central NeP.

Guidelines for the use of cannabinoid compounds in chronic pain

OBJECTIVE

To provide clinicians with guidelines for the use of cannabinoid compounds in the treatment of chronic pain.

METHODS

Publications indexed from 1990 to 2005 in the National Library of Medicine Index Medicus were searched through PubMed. A consensus concerning these guidelines was achieved by the authors through review and discussion.

RESULTS

There are few clinical trials, case reports or case series concerning the use of cannabinoid compounds in the treatment of chronic pain. There are no randomized clinical trials examining the use of herbal cannabis in the treatment of chronic pain.

CONCLUSIONS

A practical approach to the treatment of chronic pain with cannabinoid compounds is presented. Specific suggestions about the off-label dosing of nabilone (Cesamet, Valeant Canada limitee/Limited) and dronabinol (Marinol, Solvay Pharma Inc, Canada) in the treatment of chronic pain are provided.

Deficiency of ALADIN impairs redox homeostasis in human adrenal cells and inhibits steroidogenesis

Triple A syndrome is a rare, autosomal recessive cause of adrenal failure. Additional features include alacrima, achalasia of the esophageal cardia, and progressive neurodegenerative disease. The AAAS gene product is the nuclear pore complex protein alacrima-achalasia-adrenal insufficiency neurological disorder (ALADIN), of unknown function. Triple A syndrome patient dermal fibroblasts appear to be more sensitive to oxidative stress than wild-type fibroblasts. To provide an adrenal and neuronal-specific disease model, we established AAAS-gene knockdown in H295R human adrenocortical tumor cells and SH-SY5Y human neuroblastoma cells by lentiviral short hairpin RNA transduction. AAAS-knockdown significantly reduced cell viability in H295R cells. This effect was exacerbated by hydrogen peroxide treatment and improved by application of the antioxidant N-acetylcysteine. An imbalance in redox homeostasis after AAAS knockdown was further suggested in the H295R cells by a decrease in the ratio of reduced to oxidized glutathione. AAAS-knockdown SH-SY5Y cells were also hypersensitive to oxidative stress and responded to antioxidant treatment. A further impact on function was observed in the AAAS-knockdown H295R cells with reduced expression of key components of the steroidogenic pathway, including steroidogenic acute regulatory and P450c11β protein expression. Importantly a significant reduction in cortisol production was demonstrated with AAAS knockdown, which was partially reversed with N-acetylcysteine treatment.

CONCLUSION

Our in vitro data in AAAS-knockdown adrenal and neuronal cells not only corroborates previous studies implicating oxidative stress in this disorder but also provides further insights into the pathogenic mechanisms in triple A syndrome.

Psychosocial risk factors, pre-motor symptoms and first-time hospitalization with Parkinson's disease: a prospective cohort study

BACKGROUND AND PURPOSE

Experimental studies support a link between stress and development of parkinsonian symptoms, but prospective population studies are lacking. The aim of the current study is to determine the effects of several psychosocial factors on the risk of Parkinson's disease (PD), as well as to identify potential pre-motor symptoms for PD in a large prospective cohort study.

METHODS

In 1991-1993, a total of 9955 women and men free of PD from the Copenhagen City Heart Study were asked about major life events, economic hardship, social network, impaired sleep and vital exhaustion. The participants were followed for first-time hospitalization with PD in nationwide registers until 2011.

RESULTS

Vital exhaustion was associated with a higher risk of PD hospitalization in an exposure-dependent manner (P(trend) = 0.001), with high vs. low vital exhaustion being associated with a hazard ratio of 2.50 [95% confidence interval (CI): 1.28-4.89]. A slightly higher risk of PD hospitalization (hazard ratio = 1.49; 95% CI: 0.87-2.56) was suggested in participants with impaired sleep at baseline. No more than weak associations were observed for economic hardship, major life events or inadequate social network in the current study.

CONCLUSIONS

Overall, the hypothesis that psychosocial risk factors affect the risk of PD is not supported. The results, however, suggest that vital exhaustion may be a pre-motor marker of the neurodegenerative process eventually leading to motor symptoms and clinical PD. Vital exhaustion may be useful for screening aimed at early detection and when considering disease-modifying therapies in people at high risk of clinical PD.

Prolonged swing phase rectus femoris activity is not associated with stiff-knee gait in children with cerebral palsy: a retrospective study of 407 limbs

Prolonged swing phase rectus femoris (RF) activity has been implicated as a cause of stiff-knee gait (SKG) in children with cerebral palsy (CP) and continues to be cited as an indicator for RF intervention. The purpose of this study was to determine what, if any, association exists between abnormal RF activity during preswing, initial swing and/or midswing and SKG in children with CP. This retrospective analysis involved three examiners independently reviewing sagittal plane knee kinematic and RF surface electromyographic (EMG) data from 407 affected limbs of 234 pediatric patients with CP. Five kinematic parameters were rated by each examiner as normal or pathologic: peak knee flexion, knee range of motion during initial swing, total knee range of motion, peak knee flexion timing, and rate of knee flexion. These ratings were used to classify each limb into one of three groups: SKG, Borderline SKG, or Non-SKG. From a representative EMG tracing, RF activity was examined during: the first half of preswing, the latter 2/3 of initial swing, and midswing. Chi-squared tests were used to determine if significant associations existed between SKG and RF activation during these three subphases. There was no association between SKG and prolonged RF activity during the latter 2/3 of initial swing or during midswing. However, a significant relationship between SKG and RF activity during the first half of preswing was found (p<0.001). Neither prolonged RF activity during initial swing, nor the presence of RF activity during midswing, were associated with SKG, thus refuting these commonly held associations.

Thermodynamic consistency in variable-level coarse graining of polymeric liquids

Numerically optimized reduced descriptions of macromolecular liquids often present thermodynamic inconsistency with atomistic level descriptions even if the total correlation function, i.e. the structure, appears to be in agreement. An analytical expression for the effective potential between a pair of coarse-grained units is derived starting from the first-principles Ornstein-Zernike equation, for a polymer liquid where each chain is represented as a collection of interpenetrating blobs, with a variable number of blobs, n(b), of size N(b). The potential is characterized by a long tail, slowly decaying with characteristic scaling exponent of N(b)(1/4). This general result applies to any coarse-grained model of polymer melts with units larger than the persistence length, highlighting the importance of the long, repulsive, potential tail for the model to correctly predict both structural and thermodynamic properties of the macromolecular liquid.

Ontogenetic scaling of the morphology and biomechanics of the feeding apparatus in the Pacific hagfish Eptatretus stoutii

The form and function of the support skeleton, musculature and teeth were examined in an ontogenetic series of Pacific hagfish Eptatretus stoutii spanning about a six-fold range in total length (L(T)). Tooth area, feeding apparatus length, basal plate size, theoretical dental plate retractile force, penetration force and applied tooth stress were measured relative to body size. Morphological variables (e.g. tooth area and basal plate size) scaled with positive allometry and functional variables (e.g. retractile force and applied tooth stress) scaled isometrically with L(T). These results suggest that juveniles do not undergo ontogenetic dietary changes and consume functionally equivalent prey to adults, although adults can grasp proportionally larger portions of food. Low tooth stress in juveniles and adults imposes mechanical constraints to puncturing and tearing, which are circumvented by a preference for softer prey tissue or the inclusion of knotting behaviours for reducing tougher prey.

Performance of Coopworth ewe lambs exposed to low levels of ryegrass endophyte (Neotyphodium lolii) alkaloids and allowed access to a mycotoxin deactivator

During February–April, Coopworth ewe lambs grazing a pasture dominated by naturalised perennial ryegrass (PRG) exhibited slight signs of ill-thrift and heat stress. PRG represented 85% of the herbage; 90% of the PRG population was infected with Neotyphodium endophyte. Concentrations of ergovaline and lolitrem B in perennial ryegrass were each within the range 0.5–1.0 mg/kg DM during this period. Two groups of 30 lambs rotated weekly between two paddocks that offered 6 t DM/ha of mature, low-quality pasture. They received an allowance of crushed barley and peas (80 : 20) at 100 g/head per day. One group was treated with a mycotoxin deactivator, Mycofix® Plus, mixed into their mash during processing (5 g/100 g). No sign of ‘staggers’ was observed in the lambs at any time. Lambs with access to Mycofix Plus made great use of shade; their occupancy of shade increased steeply with ambient temperature over the range 18−38°C (P < 0.001). For the control group, occupancy of shade was low (P < 0.001) and independent of temperature (P < 0.001). Instead of using shade on hot days, the control lambs whose respiration rate was higher than treated ewes (P < 0.001) commonly stood by the wire fence, huddled in the open. Over the first 56 days of treatment, while pasture remained dry, weight change in control and treated lambs was –13 and +16 g/day, respectively (P < 0.010). The need for greater investigation of the effects of endophyte alkaloids on livestock is discussed.

Laparoscopic resection of advanced colorectal cancer

Background

Palliative resection of the primary tumour in asymptomatic patients with stage IV colorectal cancer is associated with improved survival and fewer complications. Laparoscopic surgery is widely employed in the curative treatment of colorectal cancer, but its value in advanced colorectal cancer remains unclear.

Methods

All patients who underwent laparoscopic resection of primary colorectal cancer in this unit between June 1991 and Jan 2010 were entered into a prospective computerized database. Outcomes for patients with laparoscopic resection of stage IV colorectal cancer were compared with those of patients who had laparoscopic surgery for stage I disease.

Results

Some 185 patients with stage IV colorectal cancer who underwent laparoscopic resection were compared with 310 patients who had stage I colorectal cancer. Some 94·1 and 98·4 per cent of operations respectively were completed laparoscopically. Hospital stay was slightly longer in the group with stage IV disease (mean 6·2 versus 5·3 days; P = 0·091). The 30-day mortality rate was 2·7 per cent in patients with stage IV disease and 0·6 per cent in those with stage I tumours (P = 0·061). There was no difference in complications. One-year survival rates were 77·8 and 99·0 per cent respectively (P &lt; 0·001).

Conclusion

Short-term outcomes after laparoscopic surgery for stage IV colorectal cancer in selected patients are equivalent to those for stage I cancers.

The replication fork's five degrees of freedom, their failure and genome rearrangements

Genome rearrangements are important in pathology and evolution. The thesis of this review is that the genome is in peril when replication forks stall, and stalled forks are normally rescued by error-free mechanisms. Failure of error-free mechanisms results in large-scale chromosome changes called gross chromosomal rearrangements, GCRs, by the aficionados. In this review we discuss five error-free mechanisms a replication fork may use to overcome blockage, mechanisms that are still poorly understood. We then speculate on how genome rearrangements may occur when such mechanisms fail. Replication fork recovery failure may be an important feature of the oncogenic process. (Feedback to the authors on topics discussed herein is welcome.).

Traumatic extrathoracic lung herniation

We report a case of traumatic extrathoracic lung herniation. This is a rare injury that is potentially life threatening. The imaging features, associated injuries and complications are discussed to facilitate rapid recognition for best patient outcome. Uniquely, we demonstrate the injury with a three-dimensional reconstructed minimum intensity projection.

Effect of postweaning growth and bulls selected for extremes in retail beef yield and intramuscular fat on progeny liveweight and carcass traits

The present study is a component of a multi-site experiment, using Bos taurus cattle generated at four locations across southern Australia, designed to examine postweaning growth pathways for progeny whose sires were extreme in retail beef yield and intramuscular fat. Treatment and interaction effects on beef production and meat quality were examined within and across sites. The present paper describes the effect of postweaning growth and sire carcass type on liveweight and carcass traits at the Hamilton site. Angus sires selected on estimated breeding values for extremes in retail beef yield (RBY%), intramuscular fat (IMF%) (estimated breeding values for IMF% are derived by using live-animal ultrasound scanning) or both and sire breed types considered to be more extreme in those traits (Limousin, and Belgian Blue for yield, and Wagyu for intramuscular fat) were joined to crossbred and straight-bred cows. After weaning, the resultant 645 steer and heifer progeny were grown on a fast and slow growth path to ~550 kg and slaughtered, averaging 0.68 kg/day and 22.2 months, and 0.49 kg/day and 27.8 months for growth rate and age at slaughter, respectively. Growth path, sire carcass type and sex affected carcass traits; however, there were no sire carcass type by growth treatment interactions. The fast growth-path cattle were fatter, had more intramuscular fat (measured chemically), a higher Meat Standards of Australia (MSA) USA and AUS marble score, and a higher predicted MSA eating-quality score. Progeny of Wagyu sires were lighter at weaning and slaughter and had a lower hot standard carcass weight than the other sire carcass types. The Belgian Blue and Limousin progeny had a higher dressing percentage, a higher RBY% and a lower P8 and rib-fat depth and lower IMF% than the other sire breed types. Progeny of the high RBY% Angus had a lower rib-fat depth, a lower IMF% and higher RBY% than those selected for high IMF%. There was no difference in IMF% between the Wagyu or the high IMF% Angus. Progeny from the Belgian Blue, Limousin and Wagyu had a larger eye muscle area than the other sire breeds. The results indicate that simultaneous selection for supposedly antagonistic traits of IMF% and RBY% would result in carcass having high values of both measurements. Females were lighter than steers at slaughter, had a lower hot standard carcass weight, were fatter at the P8 and rib, and had a higher marble score and IMF%, a lower yield and a lower MSA-predicted eating-quality score than did steers. There was no interaction between postweaning growth and sire carcass type. These results indicate that with the use of appropriate sire carcass types and BREEDPLAN, and post-weaning nutrition, beef producers can confidently change carcass parameters to suit market specifications.

Pharmacological management of chronic neuropathic pain - consensus statement and guidelines from the Canadian Pain Society

Neuropathic pain (NeP), generated by disorders of the peripheral and central nervous system, can be particularly severe and disabling. Prevalence estimates indicate that 2% to 3% of the population in the developed world suffer from NeP, which suggests that up to one million Canadians have this disabling condition. Evidence-based guidelines for the pharmacological management of NeP are therefore urgently needed. Randomized, controlled trials, systematic reviews and existing guidelines focusing on the pharmacological management of NeP were evaluated at a consensus meeting. Medications are recommended in the guidelines if their analgesic efficacy was supported by at least one methodologically sound, randomized, controlled trial showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment are based on degree of evidence of analgesic efficacy, safety, ease of use and cost-effectiveness. Analgesic agents recommended for first-line treatments are certain antidepressants (tricyclics) and anticonvulsants (gabapentin and pregabalin). Second-line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine. Tramadol and controlled-release opioid analgesics are recommended as third-line treatments for moderate to severe pain. Recommended fourth-line treatments include cannabinoids, methadone and anticonvulsants with lesser evidence of efficacy, such as lamotrigine, topiramate and valproic acid. Treatment must be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Further studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes, and treatment of pediatric and central NeP.