A feasibility study of using a high-definition intra-operative exoscope in teaching septorhinoplasty

OBJECTIVE

This pilot study aimed to assess the feasibility of using a high-definition intra-operative exoscope in teaching septorhinoplasty.

METHODS

The exoscope was used in septorhinoplasty cases with different trainers and trainees. A high-definition screen displayed real-time, magnified images. Post-procedure, a questionnaire was completed by trainer and trainees, assessing the feasibility, safety and content validity of the exoscope as a septorhinoplasty training tool.

RESULTS

Trainees and trainers assigned favourable ratings to all aspects of the exoscope as a training tool, particularly with regard to teaching anatomy and improving visualisation.

CONCLUSION

The exoscope is a potentially effective training tool in septorhinoplasty, and is especially useful in improving visualisation, without restricting the operator. Annotatable intra-operative photographs and videos allow trainees to study cases outside of the operating theatre environment. The use of an exoscope for septorhinoplasty in the UK may facilitate increased hands-on involvement earlier in training than is currently typical.

Real world outcomes of minimally invasive epicardial surgical left atrial appendage exclusion in atrial fibrillation patients with high risk of stroke and bleeding

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): AtriCure, Inc

Introduction

The left atrial appendage (LAA) is the site of thrombus formation in patients with atrial fibrillation (AF) and first line therapy for reducing the risk of stroke is oral anticoagulation (OACs). A subset of patients with AF carry a very high risk of stroke and bleeding and are ineligible for OAC and percutaneous LAA occlusion; these patients may be suitable for minimally invasive thoracoscopic epicardial surgical LAA exclusion (LAAE) which can be used with a wide variety of LAA morphologies with a ~98% rate of complete exclusion. While use of LAAE is well studied as a concomitant procedure, there are relatively few data on its use as a stand-alone procedure.

Purpose

To compare real-world outcomes of LAAE versus no-LAAE in AF patients at high risk of stroke and bleeding who are not on OACs.

Methods

We performed an analysis of Medicare beneficiaries with AF who were not on OACs and received LAAE (ICD10-PCS code 02L74CK, Oct 2015 – Dec 31, 2017) in the absence of a concomitant surgical or catheter AF ablation procedure. Patients were propensity-matched (1:4) to otherwise similar patients who did not receive LAAE (control), using age, gender, race, region, AF type, CHA2DS2-VASc, HAS-BLED, and co-morbidities. The primary endpoint was hospital readmission for a thromboembolic event (ischemic stroke, systemic embolism, or transient ischemic attack). Kaplan Meier event rates were calculated and 95% CI were generated via bootstrapping.

Results

A total of 243 patients who underwent LAAE and 1.7M control patients met study criteria. In the matched cohort, the mean age was 75 years, 61% were men, 77% had non-paroxysmal AF, and the mean CHADS2-VASC and HAS-BLED scores were 5.5 and 4.2, respectively. The 1-year rate of thromboembolism in the LAAE and control arms were 7.3% (95% CI 4.3% -10.9%) and 13.6 (95% CI 11.0% -16.4%) (Figure), respectively, with an absolute and relative risk reduction of 6.2% (95% CI 2.0-10.3, p-value=0.001, NNT 17) and 0.54 (95% CI 0.29-0.68, p=0.001).

Conclusion

Among high-risk AF patients who were not on OAC, LAAE was associated with a clinically meaningful and significantly lower risk of TE. Additional studies are needed to confirm these finding.

Image segmentation for neuroscience: lymphatics

A recent discovery in neuroscience prompts the need for innovation in image analysis. Neuroscientists have discovered the existence of meningeal lymphatic vessels in the brain and have shown their importance in preventing cognitive decline in mouse models of Alzheimer’s disease. With age, lymphatic vessels narrow and poorly drain cerebrospinal fluid, leading to plaque accumulation, a marker for Alzheimer’s disease. The detection of vessel boundaries and width are performed by hand in current practice and thereby suffer from high error rates and potential observer bias. The existing vessel segmentation methods are dependent on user-defined initialization, which is time-consuming and difficult to achieve in practice due to high amounts of background clutter and noise. This work proposes a level set segmentation method featuring hierarchical matting, LyMPhi, to predetermine foreground and background regions. The level set force field is modulated by the foreground information computed by matting, while also constraining the segmentation contour to be smooth. Segmentation output from this method has a higher overall Dice coefficient and boundary F1-score compared to that of competing algorithms. The algorithms are tested on real and synthetic data generated by our novel shape deformation based approach. LyMPhi is also shown to be more stable under different initial conditions as compared to existing level set segmentation methods. Finally, statistical analysis on manual segmentation is performed to prove the variation and disagreement between three annotators.

OVPSYCH2: A randomized controlled trial of psychological support versus standard of care following chemotherapy for ovarian cancer

BACKGROUND

Fear of disease progression (FOP) is a rational concern for women with Ovarian Cancer (OC) and depression is also common. To date there have been no randomized trials assessing the impact of psychological intervention on depression and FOP in this patient group.

PATIENTS AND METHODS

Patients with primary or recurrent OC who had recently completed chemotherapy were eligible if they scored between 5 and 19 on the PHQ-9 depression and were randomized 1:1 to Intervention (3 standardized CBT-based sessions in the 6-12 weeks post-chemotherapy) or Control (standard of care). PHQ-9, FOP-Q-SF, EORTC QLQ C30 and OV28 questionnaires were then completed every 3 months for up to 2 years. The primary endpoint was change in PHQ-9 at 3 months. Secondary endpoints were change in other scores at 3 months and all scores at later timepoints.

RESULTS

182 patients registered; 107 were randomized; 54 to Intervention and 53 to Control; mean age 59 years; 75 (70%) had completed chemotherapy for primary and 32 (30%) for relapsed OC and 67 patients completed both baseline and 3-month questionnaires. Improvement in PHQ-9 was observed for patients in both study arms at three months compared to baseline but there was no significant difference in change between Intervention and Control. A significant improvement on FOP-Q-SF scores was seen in the Intervention arm, whereas for those in the Control arm FOP-Q-SF scores deteriorated at 3 months (intervention effect = -4.4 (-7.57, -1.22), p-value = 0.008).

CONCLUSIONS

CBT-based psychological support provided after chemotherapy did not significantly alter the spontaneously improving trajectory of depression scores at three months but caused a significant improvement in FOP. Our findings call for the routine implementation of FOP support for ovarian cancer patients.

Transforming food retail for better health: The Healthy Stores 2020 trial

Background

How food is promoted in food retail settings impacts population diet. Foods high in sugar, fat and/or salt are promoted by retailers to attract impulse purchases. To combat the high burden of chronic disease and associated conditions confronting society we examined the impact of restricted retail merchandising (promotion and visibility) of discretionary food and beverages on sales and business outcomes.

Methods

We conducted a pragmatic randomised controlled trial in partnership with a retail organisation operating stores in remote communities of Australia (the Arnhem Land Progress Aboriginal Corporation). Twenty consenting stores were allocated to the 12-week intervention (7-point Healthy Stores 2020 strategy) or to usual retail practice. Four intervention stores with retail competition implemented a modified 6-point strategy. Weekly sales data were used to assess intervention impact on free sugars (g) to energy (MJ) (primary outcome) derived from all purchased food and beverages. Impact on gross profit and sales of targeted food and beverages was also assessed. Managers of intervention stores were interviewed to determine their views on customer response and impact on retail practice.

Results

Free sugars were reduced by a relative 2.8% (95% CI -4.8, -0.7). There were significant reductions in free sugars from targeted beverages (-6.4%; -11.1, -1.5) and soft drinks (-12.5%; -18.1, -6.5). Gross profit was not impacted adversely. Managers mostly viewed the strategy favourably and of benefit to the community.

Conclusions

The public health and business relevant gains demonstrated by this novel trial have resulted in ALPA converting their stores to the Healthy Stores 2020 strategy and integrating the strategy in to their nutrition policy. Retail competition impedes complete implementation of the 7-point strategy. Tackling this will require collective agreement by retailers to implement the full strategy and/or government policy power.

Key messages

Restricting merchandising of unhealthy foods can achieve both public health relevant and business relevant gains. Working in partnership with retailers is critical to testing real-world interventions to impact population diet.

Heritable epigenetic diversity for conservation and utilization of epigenetic germplasm resources of clonal East African Highland banana (EAHB) accessions

KEY MESSAGE

Genetically identical East African Highland banana (EAHB) clones are epigenetically diverse with heritable epialleles that can contribute to morphological diversity. Heritable epigenetic variation can contribute to agronomic traits in crops and should be considered in germplasm conservation. Despite the genetic uniformity arising from a genetic bottleneck of one ancestral clone, followed by subsequent vegetative propagation, East African Highland bananas (EAHBs) display significant phenotypic diversity potentially arising from somatic mutations, heritable epialleles and/or genotype-by-environment interactions. Here, we use DNA methylation profiling across EAHB accessions representing most of the primary EAHB genepool to demonstrate that the genetically uniform EAHB genepool harbours significant epigenetic diversity. By analysing 724 polymorphic DNA methylation sites by methylation-sensitive AFLP across 90 EAHB cultivars, we could differentiate the EAHB varieties according to their regions (Kenya and Uganda). In contrast, there was minimal association of DNA methylation variation with the five morphological groups that are used to classify EAHBs. We further analysed DNA methylation patterns in parent-offspring cohort, which were maintained in offspring generated by sexual (seed) and asexual (vegetative) propagation, with higher levels of altered DNA methylation observed in vegetatively generated offspring. Our results indicate that the phenotypic diversity of near-isogenic EAHBs is mirrored by considerable DNA methylation variation, which is transmitted between generations by both vegetative reproduction and seed reproduction. Genetically uniform vegetatively propagated crops such as EAHBs harbour considerable heritable epigenetic variation, where heritable epialleles could arise in offspring and contribute to functional traits. This study provides a basis for developing strategies for conservation of epigenetic resources and for integration of epimarkers into crop breeding programmes.

Report from the 20th annual Western Canadian Gastrointestinal Cancer Consensus Conference; Saskatoon, Saskatchewan; 28-29 September 2018

The 20th annual Western Canadian Gastrointestinal Cancer Consensus Conference was held in Saskatoon, Saskatchewan, 28-29 September 2018. This interactive multidisciplinary conference is attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with gastrointestinal cancers. In addition, invited speakers from other provinces participate. Surgical, medical, and radiation oncologists, and allied health care professionals participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of colorectal cancers.

Cancer league actions against sunbed use for skin cancer prevention

The incidence of non-melanoma and melanoma skin cancer has been rising in Europe. Although the World Health Organization's International Agency for Research on Cancer has since 2009 classified sunbeds as a Group 1 carcinogen, sunbed use, especially by those under the age of 18, continues to be a concern. As the only platform for cancer leagues in Europe, the Association of European Cancer Leagues decided to explore interest and actions by its member leagues at the national level against sunbed use, to share experiences and to provide background information on possible future collective actions at the EU level.

Routine germline BRCA1 and BRCA2 testing in patients with ovarian carcinoma: analysis of the Scottish real-life experience

OBJECTIVE

To determine the rates of germline BRCA1 and BRCA2 mutations in Scottish patients with ovarian cancer, before and after a change in testing policy.

DESIGN

Retrospective cohort study.

SETTING

Four cancer/genetics centres in Scotland.

POPULATION

Patients with ovarian cancer undergoing germline BRCA1 and BRCA2 (gBRCA1/2) sequencing before 2013 (under the 'old criteria', with selection based solely on family history), after 2013 (under the 'new criteria', with sequencing offered to newly presenting patients with non-mucinous ovarian cancer), and in the 'prevalent population' (who presented before 2013, but were not eligible for sequencing under the old criteria but were sequenced under the new criteria).

METHODS

Clinicopathological and sequence data were collected before and for 18 months after this change in selection criteria.

MAIN OUTCOME MEASURES

Frequency of germline BRCA1, BRCA2, RAD51C, and RAD51D mutations.

RESULTS

Of 599 patients sequenced, 205, 236, and 158 were in the 'old criteria', 'new criteria', and 'prevalent' populations, respectively. The frequency of gBRCA1/2 mutations was 30.7, 13.1, and 12.7%, respectively. The annual rate of gBRCA1/2 mutation detection was 4.2 before and 20.7 after the policy change. A total of 48% (15/31) 'new criteria' patients with gBRCA1/2 mutations had a Manchester score of <15 and would not have been offered sequencing based on family history criteria. In addition, 20 patients with gBRCA1/2 were identified in the prevalent population. The prevalence of gBRCA1/2 mutations in patients aged >70 years was 8.2%.

CONCLUSIONS

Sequencing all patients with non-mucinous ovarian cancer gives a much higher annual gBRCA1/2 mutation detection rate, with the frequency of positive tests still exceeding the 10% threshold upon which many family history-based models operate.

TWEETABLE ABSTRACT

BRCA sequencing all non-mucinous cancer patients increases mutation detection five fold.

eHealth readiness of dietitians

BACKGROUND

The present study aimed to determine the eHealth readiness and changes over time of dietitians in Australia.

METHODS

Two cross-sectional analyses of Australian dietitians were conducted in 2013 and 2016, using a survey adapted from one conducted in 2011 by the US Academy of Nutrition and Dietetics. The survey encompassed 30 questions on eHealth readiness across five dimensions: access, standards, attitude, aptitude and advocacy. Descriptive statistics, independent t-tests, chi-squared tests and Z-tests were computed to compare responses from the 2013 and 2016 surveys.

RESULTS

The survey completion rate represented 14.5% (747) of the Dietitians Association of Australia members in 2013 and 8% (417) in 2016. The survey responses in relation to access and standards suggest that dietitians are well positioned for eHealth. For attitude and aptitude, there is a moderate level of preparedness, with minor improvements over time. Although showing significant improvement (P < 0.05), advocacy highlights the area requiring the most development because the majority of dietitians (61%) reported 'no role' in eHealth solutions.

CONCLUSIONS

Dietitians are progressing in relation to access, attitudinal and aptitudinal readiness for eHealth, although they rate poorly with respect to advocacy readiness. It was concluded that dietitians are not yet ready, and also that valuable opportunities to achieve the benefits that eHealth can deliver will be missed, if dietitians do not take the lead in guiding the development, selection and implementation of nutrition-related technologies. Strengthening the dimension of advocacy and ensuring collaboration across the profession, drawing on the varying expertise demonstrated across the practice areas and by the different generations, will be central to improving dietitian eHealth readiness.

More feed efficient sheep produce less methane and carbon dioxide when eating high-quality pellets

The Australian sheep industry aims to increase the efficiency of sheep production by decreasing the amount of feed eaten by sheep. Also, feed intake is related to methane production, and more efficient (low residual feed intake) animals eat less than expected. So we tested the hypothesis that more efficient sheep produce less methane by investigating the genetic correlations between feed intake, residual feed intake, methane, carbon dioxide, and oxygen. Feed intake, methane, oxygen, and carbon dioxide were measured on Merino ewes at postweaning (1,866 at 223 d old), hogget (1,010 sheep at 607 d old), and adult ages (444 sheep at 1,080 d old). Sheep were fed a high-energy grower pellet ad libitum for 35 d. Individual feed intake was measured using automated feeders. Methane was measured using portable accumulation chambers up to 3 times during this feed intake period. Heritabilities and phenotypic and genotypic correlations between traits were estimated using ASReml. Oxygen (range 0.10 to 0.20) and carbon dioxide (range 0.08 to 0.28) were generally more heritable than methane (range 0.11 to 0.14). Selecting to decrease feed intake or residual feed intake will decrease methane (genetic correlation [] range 0.76 to 0.90) and carbon dioxide ( range 0.65 to 0.96). Selecting to decrease intake ( range 0.64 to 0.78) and methane ( range 0.81 to 0.86) in sheep at postweaning age would also decrease intake and methane in hoggets and adults. Furthermore, selecting for lower residual feed intake ( = 0.75) and carbon dioxide ( = 0.90) in hoggets would also decrease these traits in adults. Similarly, selecting for higher oxygen ( = 0.69) in hoggets would also increase this trait in adults. Given these results, the hypothesis that making sheep more feed efficient will decrease their methane production can be accepted. In addition, carbon dioxide is a good indicator trait for feed intake because it has the highest heritability of the gas traits measured; is cheaper, faster, and easier to measure than feed intake and has strong phenotypic and genetic correlations with feed intake. Furthermore, selection for feed intake, feed efficiency, methane, and carbon dioxide can be done early in sheep at postweaning age or hoggets. This early selection reduces the generation interval for breeding, thereby increasing response to selection.

A Data Processing Pipeline for Prediction of Milling Machine Tool Condition from Raw Sensor Data

With recent advances in sensor and computing technology, it is now possible to use real-time machine learning techniques to monitor the state of manufacturing machines. However, making accurate predictions from raw sensor data is still a difficult challenge. In this work, a data processing pipeline is developed to predict the condition of a milling machine tool using raw sensor data. Acceleration and audio time series sensor data is aggregated into blocks that correspond to the individual cutting operations of the Computer Numerical Control (CNC) milling machine. Each block of data is preprocessed using well-known and computationally efficient signal processing techniques. A novel kernel function is proposed to approximate the covariance between preprocessed blocks of time series data. Several Gaussian process regression models are trained to predict tool condition, each with a different covariance kernel function. The model with the novel covariance function outperforms the models that use more common covariance functions. The trained models are expressed using the Predictive Model Markup Language (PMML), where possible, to demonstrate how the predictive model component of the pipeline can be represented in a standardized form. The tool condition model is shown to be accurate, especially when predicting the condition of lightly worn tools.

Nutritional monitoring of patients post-bariatric surgery: implications for smartphone applications

BACKGROUND

Optimal results from bariatric surgery are contingent on patient commitment to dietary and lifestyle changes and follow-up care. The present study aimed to investigate the attitudes and use of mobile health (mHealth) smartphone applications (apps) as a potential tool for maintaining connectivity between dietitians and patients post-bariatric surgery.

METHODS

A cross-sectional online survey was developed and distributed to a purposeful sample of bariatric dietitians and bariatric patients in Australia. The survey questions explored technology penetration (smartphone and app use), communication preferences, nutrition monitoring methods, professional relationship expectations and reasons for loss to follow-up.

RESULTS

Survey completion rate was 85% (n = 50/59) for dietitians and 80% (n = 39/49) for patients. Smartphone ownership was 98% and 95% for dietitians and patients, respectively. Common reasons given for losing patients to follow-up suggest that a traditional in-clinic practice setting could be a barrier for some. Most dietitians (n = 48; 91%) prefer to see patients face-to-face in their clinic, whereas patient preferences extended to e-mail and mobile messaging. Sixty-eight percent of bariatric patients were receptive to two-way communication with dietitians via an app between clinic visits. Both cohorts recognised the potential for emerging technologies to be used in practice, although there was no single routinely recommended mHealth app.

CONCLUSIONS

The present study provides the first insight into the use of mobile devices and apps by post-bariatric patients and the dietitians who support them. A mixture of traditional methods and smartphone technology is desirable to both dietitians and patients. The utility and effectiveness of such technologies should be confirmed in future intervention studies.

Gaussian Process Regression (GPR) Representation in Predictive Model Markup Language (PMML)

This paper describes Gaussian process regression (GPR) models presented in predictive model markup language (PMML). PMML is an extensible-markup-language (XML) -based standard language used to represent data-mining and predictive analytic models, as well as pre- and post-processed data. The previous PMML version, PMML 4.2, did not provide capabilities for representing probabilistic (stochastic) machine-learning algorithms that are widely used for constructing predictive models taking the associated uncertainties into consideration. The newly released PMML version 4.3, which includes the GPR model, provides new features: confidence bounds and distribution for the predictive estimations. Both features are needed to establish the foundation for uncertainty quantification analysis. Among various probabilistic machine-learning algorithms, GPR has been widely used for approximating a target function because of its capability of representing complex input and output relationships without predefining a set of basis functions, and predicting a target output with uncertainty quantification. GPR is being employed to various manufacturing data-analytics applications, which necessitates representing this model in a standardized form for easy and rapid employment. In this paper, we present a GPR model and its representation in PMML. Furthermore, we demonstrate a prototype using a real data set in the manufacturing domain.

The adrenergic-regulated CRTC1 and CRTC2 phosphorylation and cellular distribution is independent of endogenous SIK1 in the male rat pinealocyte

Salt inducible kinase 1 (SIK1) has been reported to repress cAMP-response element binding protein (CREB)-mediated gene transcription by causing the nuclear export of CREB-regulated transcription coactivators (CRTCs) through phosphorylation. Although the repressor role of SIK1 in suppressing the expression of arylalkylamine N-acetyltransferase, the enzyme that controls the daily rhythm in melatonin production in the rat pineal gland, has been established, whether SIK1 regulates the phosphorylation and localization of CRTC1 and CRTC2 in this tissue remains unclear. The present study found that overexpressing SIK1 in NE-stimulated rat pinealocytes could increase the phosphorylation of CRTC1 and CRTC2, reduced selectively the nuclear level of CRTC2 (but not that of CRTC1), and elevated the cytosolic levels of both CRTC1 and CRTC2. In contrast, transient knockdown of endogenous SIK1 had no effect on the phosphorylation or distribution of CRTC1 and CRTC2 in norepinephrine (NE)-stimulated pinealocytes. Our results also showed that adrenergic blockade during NE stimulation led to a rapid rephosphorylation and decline in the nucleus levels of CRTC1 and CRTC2; however SIK1 knockdown had no effect on this rapid rephosphorylation. Moreover, studies with kinase inhibitors revealed that kinase(s) sensitive to KT5823 appeared to be involved in this rapid rephosphorylation. Together, these results indicate that although overexpressing SIK1 can phosphorylate CRTC1 and CRTC2 in the NE-stimulated pinealocyte, the endogenous SIK1, in spite of its induction by NE, does not appear to be the main regulator of the phosphorylation and intracellular localization of these two coactivators.

Use of urinary renal biomarkers to evaluate the nephrotoxic effects of melamine or cyanuric acid in non-pregnant and pregnant rats

Although traditional assessments of renal damage detect loss of kidney function, urinary renal biomarkers are proposed to indicate early changes in renal integrity. The recent adulteration of infant formula and other milk-based foods with melamine revealed a link between melamine ingestion and nephropathy. Thus, the effects of melamine and related analogs (e.g., cyanuric acid) should be assessed in other potentially sensitive groups. We evaluated whether urinary Kim-1, clusterin, and osteopontin could detect the effects of high doses of melamine or cyanuric acid in pregnant and non-pregnant female rats gavaged with 1000 mg/kg bw/day for 10 days. We demonstrate that these biomarkers can differentiate the severity of effects induced by melamine or cyanuric acid. All melamine-treated animals experienced adverse effects; however, pregnant rats were most sensitive as indicated by increased SCr, BUN, and kidney weights, decreased body weight, and presence of renal crystals. These effects coincided with elevated urinary biomarker levels as early as day 2 of exposure. One cyanuric acid-treated rat displayed effects similar to melamine, including increased urinary biomarker levels. This work illustrates that these biomarkers can detect early effects of melamine or cyanuric acid crystal-induced nephropathy and further supports the use of urinary protein immunoassays as a powerful, non-invasive method to assess nephrotoxicity.

Differences in the distribution of versican, decorin, and biglycan in atherosclerotic human coronary arteries

The distributions of versican, biglycan, and decorin have been examined in segments of normal and atherosclerotic human coronary arteries using antibodies directed against the core proteins of these macromolecules. Versican immunostaining was prominent throughout the extracellular matrix (ECM) in regions of the vessels that contained abundant smooth-muscle cells, such as in diffuse intimal thickenings, fibrous caps, and in zones of loose, myxoid connective tissue. Versican also was present in smooth-muscle-rich thrombi and at borders of the lipid-rich cores of advanced atherosclerotic lesions. Biglycan immunostaining was observed in diffuse intimal thickenings, fibrous caps, and myxoid areas, but, unlike versican, it was abundant in the lipid-rich core of advanced plaques. However, biglycan immunostaining was absent in smooth-muscle cell-enriched thrombi. Decorin immunostaining paralleled biglycan immunostaining except that it was conspicuously absent in the myxoid areas of the plaque and markedly reduced in diffuse intimal thickenings. Both biglycan and decorin immunostaining were consistently associated with some of the microvessels in the thrombi and in advanced atherosclerotic plaques. Taken together, these results indicate that specific proteoglycans distribute to topographically defined regions of normal and atherosclerotic human coronary arteries and that these different distributions may indicate a diversity of functions in normal and pathologic processes of the arterial wall.

Dual energy computed tomography quantification of carotid plaques calcification: comparison between monochromatic and polychromatic energies with pathology correlation

PURPOSE

We compared carotid plaque calcification detection sensitivity and apparent cross-sectional area on CT as a function of CT beam energy using conventional CT techniques and virtual mono-energetic CT images generated from dual-energy acquisitions.

METHODS & MATERIALS

Five ex-vivo carotid endarterectomy (CEA) specimens were imaged with dual-energy computed tomography. Virtual monochromatic spectrum (VMS) CT images were reconstructed at energies between 40-140 keV. The same specimens were imaged using conventional polyenergetic spectrum (PS) CT with peak beam energies 80, 100, 120, and 140 kVp. The histological calcium areas on each corresponding CEA specimen were traced manually on digitized images of Toluidine-Blue/Basic-Fuchsin stained plastic sections.

RESULTS

40 keV VMS CT images provided high detection sensitivity (97 %) similar to conventional PS CT images (~96 %). The calcification size measured on CT decreased systematically with increasing CT beam energy; the rate of change was larger for the VMS images than for PS images.

CONCLUSION

From a single dual-energy CT, multiple VMS-CT images can be generated, yielding equivalent detection sensitivity and size correlations as conventional PS-CT in CEA calcification imaging. VMS-CT at 80-100 keV provided the most accurate estimates of calcification size, as compared to histology, but detection sensitivity was reduced for smaller calcifications on these images.

KEY POINTS

• Calcifications depicted at 80-100 keV were most similar to the histology standard. • Conventional polychromatic images demonstrated excellent correlation with plaque size at pathology. • Conventional polychromatic images systematically overestimate plaque size. • Plaque calcifications can be missed on high energy monochromatic images.

Impact of fatigue on outcome of selective serotonin reuptake inhibitor treatment: secondary analysis of STAR*D

OBJECTIVE

To explore relationships between baseline and changes in fatigue during treatment with outcomes in patients with major depressive disorder (MDD) receiving citalopram monotherapy.

RESEARCH DESIGN AND METHODS

Secondary analyses of data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Level 1 treatment phase (≤14 weeks citalopram monotherapy). Fatigue was assessed with item 14 on energy level from the 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16; scored 0-3: 0 = no fatigue, 3 = maximal fatigue); prospective fatigue: assessment of fatigue at Level 1 entry and exit (no fatigue, treatment-emergent fatigue, remitted fatigue, or residual fatigue).

CLINICAL TRIAL REGISTRATION

Http://clinicaltrials.gov, NCT00021528.

MAIN OUTCOME MEASURES

Remission of depressive symptoms (17-item Hamilton Rating Scale for Depression ≤7 or QIDS-SR16 ≤5); Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form; Short-Form Health Survey Mental and Physical subscales; and Work and Social Adjustment Scale (WSAS).

RESULTS

At baseline, of 2868 patients included in the analyses, 5.5% had a QIDS-SR16 item 14 score of 0; 22.9%, a score of 1; 53.6%, a score of 2; and 18.0%, a score of 3. During Level 1 treatment, 3.5% of patients had no prospective fatigue, 2.1% had treatment-emergent fatigue, 33.6% had fatigue remitting during treatment, and 60.8% had residual fatigue. Female gender, unemployment, fewer years of education, and lower monthly income were significantly associated with higher rates of baseline fatigue (all P < 0.0001). Higher levels of baseline or prospective fatigue were associated with reduced likelihood of remission, decreased overall satisfaction (P < 0.0001), and reduced mental and physical function at outcome (P ≤ 0.05). Patients with higher baseline or prospective fatigue reported higher WSAS total scores (P < 0.0001), indicative of more severe functional impairment.

CONCLUSIONS

Lower baseline fatigue and remission of fatigue during antidepressant treatment in patients with MDD are associated with higher rates of remission of depressive symptoms and better function and quality of life. Study limitations include use of the STAR*D Level 1 sample (citalopram as only antidepressant), use of a proxy measure of energy/fatigue (item 14 from the QIDS-SR16), and the secondary post-hoc analysis design.

Rhinosinusitis in oral medicine and dentistry

Rhinosinusitis is a very common condition which is normally readily recognizable. Given the intimate anatomic relationship between the antrum and the posterior maxillary teeth, maxillary sinusitis can present as odontalgia. Distinguishing between odontogenic orofacial pain and pain associated with maxillary sinusitis is important to prevent unnecessary dental intervention and to direct patients to medical colleagues. Conversely, odontogenic infection can spread to involve the antrum, termed odontogenic sinusitis, or maxillary sinusitis of dental origin. Odontogenic sinusitis accounts for about 10-40% of all cases of sinusitis, and usually requires combined dental and medical treatment. Maxillary sinusitis can also be a complication of exodontia, resulting from tuberosity fractures, displaced teeth or root fragments and the creation of oroantral communications and fistulae. Dental implants and endodontic materials can also impinge on the maxillary sinus, and are rare causes of sinusitis. Often it is stated that rhinosinusitis may contribute to a halitosis complaint, and widely used diagnostic protocols for rhinosinusitis sometimes list halitosis as a minor criterion. However, gold standards in halitotosis research such as organoleptic assessment or gas chromatography have not been used to validate a correlation between objective (genuine) halitosis and sinusitis. The pathophysiology of this mechanism is unclear, and the relative importance of this alongside other causes of extraoral halitosis is debated.

Quantifying effect of intraplaque hemorrhage on critical plaque wall stress in human atherosclerotic plaques using three-dimensional fluid-structure interaction models

Recent magnetic resonance studies have indicated that intraplaque hemorrhage (IPH) may accelerate plaque progression and play an important role in plaque destabilization. However, the impact of hemorrhage on critical plaque wall stress (CPWS) and strain (CPWSn) has yet to be determined. The objective of this study was to assess the effect of the presence and size of IPH on wall mechanics. The magnetic resonance image (MRI) of one patient with histology-confirmed IPH was used to build eight 3D fluid-structure interaction (FSI) models by altering the dimensions of the existing IPH. As a secondary end point, the combined effect of IPH and fibrous cap thickness (FCT) was assessed. A volume curve fitting method (VCFM) was applied to generate a mesh that would guarantee numerical convergence. Plaque wall stress (PWS), strain (PWSn), and flow shear stress (FSS) were extracted from all nodal points on the lumen surface for analysis. Keeping other conditions unchanged, the presence of intraplaque hemorrhage caused a significant increase (27.5%) in CPWS; reduced FCT caused an increase of 22.6% of CPWS. Similar results were found for CPWSn. Furthermore, combination of IPH presence, reduced FCT, and increased IPH volume caused an 85% and 75% increase in CPWS and CPWSn, respectively. These results show that intraplaque hemorrhage has considerable impact on plaque stress and strain conditions and accurate quantification of IPH could lead to more accurate assessment of plaque vulnerability. Large-scale studies are needed to further validate our findings.

The sonopartogram: a novel method for recording progress of labor by ultrasound

OBJECTIVES

Progress of labor has hitherto been assessed by digital vaginal examination (VE). We introduce the concept of a non-intrusive ultrasound (US)-based assessment of labor progress (the 'sonopartogram') and investigate its feasibility for assessing cervical dilatation and fetal head descent and rotation.

METHODS

This was a prospective study performed in 20 women in the first stage of labor in two European maternity units. Almost simultaneous assessment of cervical dilatation and fetal head descent and rotation were made by US and digital VE.

RESULTS

The total number of paired US and digital VE assessments was 52, with a median of three per woman. Overall, 5% of sonopartogram parameters were not obtained compared with 18% of conventional digital VE parameters (P < 0.001). Assessment of cervical dilatation was possible in 86.5% of US examinations and 100% of digital VEs (P = 0.02), and dilatation was assessed as being greater by digital VE than by US (mean difference, 1.16 (95% limits of agreement, -0.76, 3.08) cm, r(2) = 0.68, P = 0.01). Fetal head descent was measured in all 52 cases by both methods (r(2) = 0.33, P < 0.001), but correlation between the two was only moderate. Head rotation was obtainable in 98% of US examinations and 46% of digital VEs (P < 0.001), with a mean difference of -3.9° (95% limits of agreement, -144.1°, 136.3°).

CONCLUSION

In this proof-of-concept study, the acquisition of data regarding progress of labor was more successful for the sonopartogram than the conventional partogram. The agreement between digital VE and US was good for cervical dilatation and head rotation but less so for head descent. US assessment of the progress of labor is feasible in most cases.

An exploratory study to evaluate whether medical nutrition therapy can improve dietary intake in hospital patients who eat poorly

BACKGROUND

The Australasian Nutrition Care Day Survey (ANCDS) reported that two-fifths of patients consume ≤50% of the offered food in Australian and New Zealand hospitals. After controlling for confounders (nutritional status, age, disease type and severity), the ANCDS also established an independent association between poor food intake and increased in-hospital mortality. The present study aimed to evaluate whether medical nutrition therapy (MNT) could improve dietary intake in hospital patients eating poorly.

METHODS

An exploratory pilot study was conducted in the respiratory, neurology and orthopaedic wards of an Australian hospital. At baseline, percentage food intake (0%, 25%, 50%, 75% and 100%) was evaluated for each main meal and snack for a 24-h period in patients hospitalised for ≥2 days and not under dietetic review. Patients consuming ≤50% of offered meals as a result of nutrition-impact symptoms were referred to ward dietitians for MNT. Food intake was re-evaluated on the seventh day after recruitment (post-MNT).

RESULTS

One hundred and eighty-four patients were observed over 4 weeks; 32 patients were referred for MNT. Although baseline and post-MNT data for 20 participants [mean (SD) age 68 (17) years, 65% females] indicated a significant increase in median energy and protein intake post-MNT (3600 kJ day(-1) ; 40 g day(-1) ) versus baseline (2250 kJ day(-1) ; 25 g day(-1) ) (P < 0.05), the increased intake met only 50% of dietary requirements. Persistent nutrition impact symptoms affected intake.

CONCLUSIONS

In the present pilot study, although dietary intake improved, it remained inadequate to meet participants' estimated requirements as a result of ongoing nutrition-impact symptoms. Appropriate medical management and early enteral feeding could be a possible solution for such patients.

Sustained adrenergic stimulation is required for the nuclear retention of TORC1 in male rat pinealocytes

The process involved in relocation of the coactivator, transducer of regulated cAMP-regulated element-binding protein (TORC) to the cytoplasm, unlike its activation, is not well understood. Using cultured pineal cells prepared from male rats, we found that although both α- and β-adrenergic stimulation could cause TORC1 dephosphorylation, only α-adrenergic stimulation was effective in the norepinephrine (NE)-mediated translocation of TORC1 into the nucleus. In contrast, blockade of either the α- or the β-adrenergic receptor after NE stimulation was effective in causing the rephosphorylation and rapid relocation of TORC1 into the cytoplasm. Studies with phosphoprotein phosphatase (PP) inhibitors indicated that although both PP2A and PP2B could dephosphorylate TORC1, only PP2B could cause translocation into the nucleus. However, after NE stimulation, treatment with either PP2A or PP2B inhibitors could cause the rephosphorylation and cytoplasmic relocation of TORC1. These results indicate a requirement of continuous activation of both α- and β-adrenergic receptors as well as PP2A and PP2B activities for the nuclear retention of TORC1 during NE stimulation. Knockdown of salt-inducible kinase 1 (SIK1) had no effect on the phosphorylation or localization of TORC1. Although overexpressing SIK1 could induce TORC1 phosphorylation in the nucleus, it did not reduce TORC1 level in the nucleus, indicating that SIK1-mediated TORC1 phosphorylation may not be sufficient for its relocation into the cytoplasm. Together, these results demonstrate that, in the rat pineal gland, different mechanisms are involved in regulating the nuclear entry and exit of TORC1 and that the SIK1-mediated phosphorylation of TORC1 may not lead to its nuclear exit.