Search

Purpose In the genomic era, more women with low-risk breast cancer will forego chemotherapy and rely on adjuvant endocrine therapy (AET) to prevent metastatic recurrence. However, some of these patients will unfortunately relapse. We sought to understand this outcome. Preliminary work suggested that early discontinuation of AET, also known as non-persistence, may play an important role. A retrospective analysis exploring factors related to our breast cancer patients’ non-persistence with AET was performed. Methods Women who underwent Oncotype-DX® testing between 2011 and 2014 with minimum 5 years follow-up were included. ‘Low risk’ was defined as Oncotype score Results We identified six cases of distant recurrence among low-risk patients with a median follow-up of 7.7 years. Among them, five of six patients (83%) were non-persistent with AET. The non-persistence rate in our cohort regardless of recurrence was 57/228 (25%). Non-persistent patients reported more severe side effects compared with persistent patients (p = 0.002) and were more likely to be offered a switch in endocrine therapy, rather than symptom-relief (p = 0.006). In contrast, persistent patients were 10.3 times more likely to have been offered symptom-alleviating medications compared with non-persistent patients (p p = 0.028). Conclusion Metastatic recurrence in low-risk breast cancer patients may be primarily due to non-persistence with endocrine therapy. Further work is needed to optimize care for patients who struggle with side effects. To our knowledge, these are the first published data suggesting that Oncotype-DX® score may influence persistence with AET.

Cognitive impairment is common among individuals with Parkinson's disease (PD). Intraindividual variability (IIV) is a measure of variability across multiple tasks of cognitive functioning. Due to the limited amount of research, particularly among individuals with PD, IIV has been an underutilized metric of cognitive functioning both in research and clinical practice. Previous research demonstrated that individuals with PD have greater variability in cognitive performance relative to controls, and that IIV is predictive of future cognitive impairments. The aim of this study is to investigate the association between baseline IIV and change in cortical and subcortical volumes among individuals with PD.The present study used data from 80 newly diagnosed PD patients who were part of a longitudinal cohort study (Parkinson progression marker initiative [PPMI]). Participants completed neuropsychological measures and underwent T1 structural magnetic resonance imaging (MRI) at baseline and the first annual follow-up. Neuropsychological tests assessed attention, processing speed, visuospatial functioning, verbal fluency learning, and memory. T1 scans were processed using standard Freesurfer protocols for extraction of regional volumes.Greater IIV at baseline was predictive of change in cortical volume in posterior temporal/parietal regions over the 1-year period. Baseline IIV predicted cortical volume changes above and beyond the main effect of motor severity and the baseline statistical mean/global cognition score.Our results provide initial evidence that IIV is a marker of longitudinal cortical volume loss. Evidence is building that IIV is a sensitive marker of cognitive impairment and the underlying neurodegeneration among individuals with PD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

In the genomic era, more women with low-risk breast cancer will forego chemotherapy and rely on adjuvant endocrine therapy (AET) to prevent metastatic recurrence. However, some of these patients will unfortunately relapse. We sought to understand this outcome. Preliminary work suggested that early discontinuation of AET, also known as non-persistence, may play an important role. A retrospective analysis exploring factors related to our breast cancer patients' non-persistence with AET was performed.Women who underwent Oncotype-DX® testing between 2011 and 2014 with minimum 5 years follow-up were included. 'Low risk' was defined as Oncotype score 26. Outcomes of recurrence and persistence were determined by chart review. Patient, tumor and treatment factors were collected, and persistent versus non-persistent groups compared using multivariable ANOVA and Fisher Chi square exact test.We identified six cases of distant recurrence among low-risk patients with a median follow-up of 7.7 years. Among them, five of six patients (83%) were non-persistent with AET. The non-persistence rate in our cohort regardless of recurrence was 57/228 (25%). Non-persistent patients reported more severe side effects compared with persistent patients (p = 0.002) and were more likely to be offered a switch in endocrine therapy, rather than symptom-relief (p = 0.006). In contrast, persistent patients were 10.3 times more likely to have been offered symptom-alleviating medications compared with non-persistent patients (p 0.001). A subset analysis revealed that patients who persisted with therapy had a higher Oncotype-DX® score than patients who discontinued early (p = 0.028).Metastatic recurrence in low-risk breast cancer patients may be primarily due to non-persistence with endocrine therapy. Further work is needed to optimize care for patients who struggle with side effects. To our knowledge, these are the first published data suggesting that Oncotype-DX® score may influence persistence with AET.

Resume Objectifs Des etudes internationales ont montre que la prise en charge perinatale active aux âges gestationnels les plus faibles s’accompagnait d’une amelioration de la survie sans augmentation des handicaps graves par rapport a une prise en charge moins active. Un travail mene par les societes savantes (SFMP, SFN et CNGOF) a permis d’elaborer de nouvelles propositions pour une prise en charge plus optimaledes enfants extremement prematures en France. Methode Ce groupe a ete constitue en 2015 a l’initiative des societes savantes et en lien avec les associations de parents et d’usagers. Le travail s’est appuye sur la revue de la litterature sur le pronostic des enfants extremement prematures, ainsi que sur les recommandations emises par des societes savantes europeennes. Sur la base de ces informations, un texte a ete produit, soumis a l’ensemble des membres du groupe de travail et definitivement accepte par les societes savantes en avril 2019. Resultats Ce texte propose une aide a la decision dans la prise en charge de ces naissances. Il pose comme principes : l’administration de la corticotherapie independamment de la prise en charge (reanimation ou soins de confort) ; une evaluation pronostique et une decision collegiale, hors contexte de l’urgence ; un consensus sur l’information a delivrer aux parents avant de les informer et de recueillir leur avis. Cette demarche suppose une coherence de la prise en charge avant, pendant et apres la naissance et elle s’appuie sur une etroite collaboration obstetrico-pediatrique. Conclusion Ces propositions doivent permettre de faire evoluer la prise en charge perinatale de l’extreme prematurite en France.

La pandemie « Corona Virus Disease 2019 » (COVID-19) liee au « SARS-CoV-2 » a ete declaree « crise sanitaire mondiale » par l’Organisation mondiale de la sante fin janvier 2020. Des mesures exceptionnelles de confinement ont ete prises pour contenir cette infection tres contagieuse et parfois grave, que les equipes soignantes combattent en premiere ligne. Les nouveau-nes hospitalises representent par principe de precaution un groupe de patients vulnerables juge potentiellement a risque, mais qui s’avere finalement peu infecte et pauci-symptomatique comme l’indiquent les faibles incidences et severites des cas pediatriques publies [1]. L’acces des parents a leur nouveau-ne hospitalise fait partie integrante des soins en neonatologie et en particulier des soins centres sur l’enfant et sa famille. La presence de ses parents a ses cotes est un droit fondamental pour l’enfant hospitalise [2] et repond a un besoin premier des parents d’etre aupres de leur bebe [3]. Les benefices de strategies environnementales et de soins portees par les parents sont etablis avec un haut niveau de preuve [4]. La prematurite est source de stress parental, de troubles de l’attachement et de troubles anxiodepressifs renforces par la separation de la dyade parent–enfant, qui entrave le contact physique normal et la proximite emotionnelle entre la mere (le pere) et son enfant [5], [6]. Cette separation precoce peut affecter la sante mentale des parents mais aussi avoir des effets durables sur la programmation emotionnelle et le neurodeveloppement des nouveau-nes. La pandemie COVID-19 expose toutes les personnes a un stress et une angoisse qui peuvent majorer les troubles psychologiques preexistants ou exacerber le vecu des situations emotionnellement difficiles [7]. Ceci est vrai pour les soignants mais aussi pour les parents de nouveau-nes hospitalises dans un contexte de distanciation sociale qui limite le soutien de leurs proches. Bien que cela ne soit pas encore documente, il est aussi possible que les meres COVID-19 positives soient exposees a un plus grand sentiment de culpabilite, deja tres present en cas de naissance prematuree ; et se rajoutant a une crainte pour leur propre etat de sante. Pourtant, la situation pandemique actuelle et le decret de confinement national ont pour effet collateral de restreindre l’accueil des parents en neonatologie aussi bien quand la mere est suspecte ou infectee par le COVID-19 au moment de l’accouchement, qu’en dehors de cette situation. Ces restrictions d’acces variables suivant les centres, resultent de regles institutionnelles editees avec les equipes d’hygiene hospitaliere de chaque hopital, de decisions prises au niveau des poles de pediatrie et/ou des hopitaux mere-enfant. Ces mesures qui visent initialement a proteger les nouveau-nes hospitalises et l’ensemble des adultes presents dans les services de neonatologie peuvent alterer la qualite des soins delivres a ces patients vulnerables et a leur famille. Notre reflexion vise a mettre en balance les mesures necessaires pour contenir la pandemie avec les besoins premiers des enfants hospitalises en neonatalogie et de leurs parents. Nous envisageons les avis emis sur la prise en charge d’un nouveau-ne d’une mere avec COVID-19 suspecte ou confirme, par des organisations internationales, des institutions et societes savantes. Pour finir, nous proposons des actions pour aider les professionnels de sante a soutenir la qualite des soins delivres, l’attachement et la participation des parents aux soins de leur nouveau-ne hospitalise, sans majorer le risque de propagation du virus.

Interventions for chronic discogenic spine pain are currently insufficient in lowering individual patient suffering and global disease burden. A 2016 study of platelet rich plasma (PRP) for chronic discogenic pain previously demonstrated clinically significant response among active group patients compared with controls.To replicate the previous research to move this intervention forward as a viable option for patient care.A double-blind, randomized, placebo-controlled study.Multicenter private practices.Twenty-six (12 men, 14 women) human patients, ages 25 to 71 with a diagnosis of chronic lumbar discogenic pain, were randomly assigned to active (PRP) or control (saline) groups in a ratio of 2 active to 1 control. Baseline and follow-up Oswestry Disability Index and Numeric Pain Rating Scale questionnaires were obtained to track patient outcomes at 8 weeks postoperatively.Within group assessment showed clinically significant improvement in 17% of PRP patients and clinically significant decline in 5% (1 patient) of the active group. Clinically significant improvement was seen in 13% of placebo group patients and no placebo patients had clinically significant decline secondary to the procedure.Possible explanations may include a range of factors including differences in patient demographics, outcome-measure sensitivity, or misalignment of statistical analyses.These findings are markedly different than the highly promising results of the 2016 PRP study. This study posits necessary caution for researchers who wish to administer PRP for therapeutic benefit and may ultimately point to necessary redirection of interventional research for discogenic pain populations.

Context The emergence and rapid spread of coronavirus disease 2019 (COVID-19) have shaken the planet, both in terms of health and economical aspects, constituting a real challenge for the scientific community. Problem At the time of the arrival of the epidemic in France, there were limited data regarding how COVID-19 could affect children. A lesser severity compared with adults was described, but knowledge concerning clinical forms and screening strategies was missing. Methodology In this retrospective and non-interventional epidemiological study, we aimed to describe the epidemiology and the clinical features of COVID-19 pediatric disease in the first university hospital affected by the epidemic in France. We included all underage patients who tested positive for SARS-CoV-2 by polymerase chain reaction (PCR) assays on nasopharyngeal smears performed between February 25, 2020 and April 30, 2020. Results The presence of fever and respiratory signs was frequent (> 50%), as was the presence of general or digestive signs, but patients were also frequently asymptomatic, making the discovery of a positive smear fortuitous. There were no deaths in our cohort. Conclusion No patient with a serious form of COVID-19 was treated in the pediatrics departments of Strasbourg University Hospital during the first 2 months of the epidemic. Diagnostic strategies have evolved over the course of the epidemic, ranging from exploring relevant symptoms to systematic screening.

All-sky imager based systems can be used to measure a number of cloud properties. Configurations consisting of two all-sky imagers can be used to derive cloud heights for weather stations, aviation and nowcasting of solar irradiance. One key question for such systems is the optimal distance between the all-sky imagers. This problem has not been studied conclusively in the literature. To the best of our knowledge, no previous in-field study of the optimal camera distance was performed. Also, comprehensive modeling is lacking. Here, we address this question with an in-field study on 93 days using 7 camera distances between 494 m and 2562 m and one specific cloud height estimation approach. We model the findings and draw conclusions for various configurations with different algorithmic methods and camera hardware. The camera distance is found to have a major impact on the accuracy of cloud height determinations. For the used 3 megapixel cameras, cloud heights up to 12,000 m and the used algorithmic approaches, an optimal camera distance of approximately 1500 m is determined. Optimal camera distances can be reduced to less than 1000 m if higher camera resolutions (e.g. 6 megapixel) are deployed. A step-by-step guide to determine the optimal camera distance is provided.

The extent and importance of functional heterogeneity and crosstalk between tumor cells is poorly understood. Here, we describe the generation of clonal populations from a patient-derived ovarian clear cell carcinoma model which forms malignant ascites and solid peritoneal tumors upon intraperitoneal transplantation in mice. The clonal populations are engineered with secreted Gaussia luciferase to monitor tumor growth dynamics and tagged with a unique DNA barcode to track their fate in multiclonal mixtures during tumor progression. Only one clone, CL31, grows robustly, generating exclusively malignant ascites. However, multiclonal mixtures form large solid peritoneal metastases, populated almost entirely by CL31, suggesting that transient cooperative interclonal interactions are sufficient to promote metastasis of CL31. CL31 uniquely harbors ERBB2 amplification, and its acquired metastatic activity in clonal mixtures is dependent on transient exposure to amphiregulin, which is exclusively secreted by non-tumorigenic clones. Amphiregulin enhances CL31 mesothelial clearance, a prerequisite for metastasis. These findings demonstrate that transient, ostensibly innocuous tumor subpopulations can promote metastases via “hit-and-run” commensal interactions., Cooperative interactions among tumor cells may have important implications for metastasis. Here, the authors examined the spatio-temporal nature of interactions among clonal populations of ovarian carcinoma cells and found that transient interactions cells can promote metastases via commensal interactions.

A practical instrumentation configuration for measuring focal length of cell-phone camera lenses is presented that uses a custom autocollimator, a grating, an autostigmatic microscope, and a precision stage. Uncertainty in LED wavelength is reduced by using a white LED and a set of narrow-band filters. The autocollimator is designed to allow for rapid focus adjustment at each test wavelength. Examples of the measurement technique and an error analysis are provided.

Objectives To describe patterns of care for very preterm (VP) babies across neonatal intensive care units (NICUs) and associations with outcomes.Design Prospective cohort study, EPIPAGE-2.Setting France, 2011.Participants 53 (NICUs); 2135 VP neonates born at 27 to 31 weeks.Outcome measures Clusters of units, defined by the association of practices in five neonatal care domains – respiratory, cardiovascular, nutrition, pain management and neurodevelopmental care. Mortality at 2 years corrected age (CA) or severe/moderate neuro-motor or sensory disabilities and proportion of children with scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ).Methods Hierarchical cluster analysis to identify clusters of units. Comparison of outcomes between clusters, after adjustment for potential cofounders.Results Three clusters were identified: Cluster 1 with higher proportions of neonates free of mechanical ventilation at 24 hours of life, receiving early enteral feeding, and neurodevelopmental care practices (26 units; n=1118 babies); Cluster 2 with higher levels of patent ductus arteriosus and pain screening (11 units; n=398 babies); Cluster 3 with higher use of respiratory, cardiovascular and pain treatments (16 units; n=619 babies). No difference was observed between clusters for the baseline maternal and babies’ characteristics. No differences in outcomes were observed between Clusters 1 and 3. Compared with Cluster 1, mortality at 2 years CA or severe/moderate neuro-motor or sensory disabilities was lower in Cluster 2 (adjusted OR 0.46, 95% CI 0.25 to 0.84) but with higher proportion of children with an ASQ below threshold (adjusted OR 1.49, 95% CI 1.07 to 2.08).Conclusion In French NICUs, care practices for VP babies were non-randomly associated. Differences between clusters were poorly explained by unit or population differences, but were associated with mortality and development at 2 years. Better understanding these variations may help to improve outcomes for VPT babies, as it is likely that some of these discrepancies are unwarranted.

To interrogate functional heterogeneity and crosstalk between tumor cells, we generated clonal populations from a patient-derived ovarian clear cell carcinoma model which forms malignant ascites and solid peritoneal tumors upon intraperitoneal transplantation in mice. The clonal populations were engineered with secreted Gaussia luciferase to monitor tumor growth dynamics and tagged with a unique DNA barcode to track their fate in multiclonal mixtures during tumor progression. Only one clone, CL31, grew robustly, generating exclusively malignant ascites. However, multiclonal mixtures formed large solid peritoneal metastases, populated almost entirely by CL31, suggesting that transient cooperative interclonal interactions were sufficient to promote metastasis of CL31. CL31 uniquely harbored ERBB2 amplification, and its acquired metastatic trait was dependent on transient exposure to amphiregulin, which was exclusively secreted by non-tumorigenic clones. Amphiregulin enhanced CL31 mesothelial clearance, a prerequisite for metastasis. These findings demonstrate that transient, ostensibly innocuous tumor subpopulations can promote metastases via “hit- and-run” commensal interactions.

Poster presented for 'The Bakken Play of North Dakota'

Resume L’hospitalisation d’un enfant en neonatalogie peut etre pour les parents une experience traumatisante. Une reflexion sur les besoins des parents dans les unites de neonatalogie est une etape essentielle de la modification des pratiques. Jusqu’a l’âge de 3 mois, l’enfant presente des comportements d’attachement qui ne sont pas diriges vers une figure particuliere mais vers tous les adultes s’occupant de lui. L’attachement specifique se developpe entre 3 et 6 mois aboutissant a une « base de securite » favorisant l’exploration. Du cote de la mere, le bonding est une emotion vecue juste apres la naissance sous l’influence de differents facteurs neurobiologiques, et en particulier favorise par la secretion d’ocytocine, qui la pousse a s’occuper de son bebe. Ces processus d’attachement et de bonding necessitent une proximite physique et une reconnaissance des signaux comportementaux. Une separation mere/enfant en periode neonatale risque donc d’interferer avec ce processus d’attachement et de bonding et d’etre a l’origine d’attachement desorganise. Les besoins des parents en neonatalogie decoulent de cette theorie du developpement : avoir un acces non limite a leur enfant, participer aux soins, etre valorises, vivre dans un environnement securisant, beneficier d’un accompagnement et d’un soutien. La formation des professionnels est essentielle.

Resume La famille est primordiale pour les nouveau-nes hospitalises. Elle soutient son developpement, tout en tissant des liens d’attachement solides avec lui. Les soins centres sur l’enfant et sa famille affirment que la famille fait partie de l’equipe soignante de neonatologie. Elle est integree dans le processus de decision medicale et est partenaire dans les soins a son ou ses enfants. Il semble essentiel de preciser la definition de la famille. Nous allons aborder cette definition sous un aspect juridique, sociologique ou philosophique. Le Groupe de Reflexion et d’Evaluation de l’Environnement des Nouveau-nes (GREEN) de la Societe francaise de neonatologie estime qu’il est important de clarifier la definition de la famille d’un nouveau-ne hospitalise, de decrire les difficultes lies a la separation pour l’enfant, ses parents, sa fratrie et sa famille, de faire un etat des lieux sur les pratiques, puis de proposer des recommandations et des strategies d’application.

Resume Le peau a peau est defini par le portage d’un enfant vetu d’une couche et d’un bonnet entre les seins de sa mere ou contre le torse du pere, peau contre peau. Les objectifs du Groupe de Reflexion et d’Evaluation de l’Environnement des Nouveau-nes etaient d’evaluer son rationnel scientifique et d’emettre des recommandations pratiques pour sa realisation en neonatologie et en salle de naissance. Une recherche bibliographique systematique, suivant la methodologie de la Haute Autorite de sante, montre l’existence de benefices sur la stabilite physiologique, le sommeil, la douleur, le developpement neurologique, l’allaitement, l’attachement et le stress parental. Il est recommande que le peau a peau soit propose a tous les bebes prematures hospitalises, le plus precocement et le plus largement possible, des stabilite clinique, avec des procedures ecrites de transfert et surveillance, et un environnement soutenant. Cette pratique semble beneficier aux nouveau-nes extremement prematures et/ou intubes, mais necessite une expertise de l’equipe. Le peau a peau precoce en salle de naissance avec la mere est benefique pour l’allaitement, le comportement, l’adaptation du nouveau-ne a terme ou proche du terme. Le peau a peau avec le pere ameliore aussi le comportement de l’enfant. L’installation immediate en peau a peau avec la mere est fortement recommandee pour le nouveau-ne d’âge ≥ 35 semaines, si son etat clinique le permet. Il est recommande a chaque equipe d’informer et soutenir les parents, d’instaurer des procedures de securite/surveillance adaptees pour soutenir la pratique du peau a peau en securite en salle de naissance.

Resume L’extreme prematurite, definie par une naissance avant 27 semaines d’amenorrhee (SA) en Suede est prise en charge selon les donnees de la litterature les plus recentes, avec un monitorage des resultats grâce a un registre perinatal. Des recommandations nationales ont ete emises en 2013. Elles mettent en avant l’importance des soins centres sur l’enfant et sa famille, la prise en charge de la nutrition, de la douleur, de la persistance du canal arteriel et des lesions cerebrales. Il reste cependant des domaines sans consensus national, concernant par exemple la strategie de support respiratoire. La vision francaise de l’approche suedoise souligne l’attitude pro-active des neonatologistes, la coherence obstetrico-pediatrique avec une collaboration etroite, la presence et la participation active des parents aux soins de leur enfant. Le « minimal handling » implique un monitorage tres technique tout en tenant compte de la sensorialite de l’enfant extreme premature.

Quartz-crystal microbalances (QCMs) are commercially available mass sensors which mainly consist of a quartz resonator that oscillates at a characteristic frequency, which shifts when mass changes due to surface binding of molecules. In addition to mass changes, the viscosity of gases or liquids in contact with the sensor also shifts the resonance but also influences the quality factor (Q-factor). Typical biosensor applications demand operation in liquid environments leading to viscous damping strongly lowering Q-factors. For obtaining reliable measurements in liquid environments, excellent resonator control and signal processing are essential but standard resonator circuits like the Pierce and Colpitts oscillator fail to establish stable resonances. Here we present a low-cost, compact and robust oscillator circuit comprising of state-of-the-art commercially available surface-mount technology components which stimulates the QCMs oscillation, while it also establishes a control loop regulating the applied voltage. Thereby an increased energy dissipation by strong viscous damping in liquid solutions can be compensated and oscillations are stabilized. The presented circuit is suitable to be used in compact biosensor systems using custom-made miniaturized QCMs in microfluidic environments. As a proof of concept we used this circuit in combination with a customized microfabricated QCM in a microfluidic environment to measure the concentration of C-reactive protein (CRP) in buffer (PBS) down to concentrations as low as 5 µg mL−1.

To determine the prevalence of simple and complex sacral perineural Tarlov cysts (TCs) in a cohort of children and adults.Retrospective observational epidemiological study assessing 1100 consecutive sacral magnetic resonance (MR) studies, including 100 children and adolescents. All patients underwent 1.5T MR imaging with T1 and T2 weighted image acquisitions in sagittal and axial planes. All perineural cysts affecting the sacral nerve roots S1-S4 were quantitatively and qualitatively assessed.Two hundred and sixty-three sacral TCs were found in 132 adult patients (13.2%), with a female predominance (68%). None was found in children. The prevalence of TCs increased with age. The average number of cysts per patient was 2.0±1.2 with a maximum of 6 cysts in a single patient. Most of the cysts (87.5%) showed a homogenous central fluid collection and a parietal course of the nerve fibers. Complex patterns were present in 33 cysts (12.5%) within which 28 cysts showed endocystic crossing of nerve fibers and 5 cysts contained internal septations. Seventy cysts (26.6%) eroded the adjacent bone and 13 cysts (4.9%) extended to the pelvis.The prevalence of sacral TCs in our cohort corresponded to 13%, with a female predominance. Interestingly no TCs were found in children or adolescents (18 years). In relation to the non-negligible percentage of complex cysts with internal septations, or endocystic crossing of nerve fibers, pre-interventional characterization of sacral TCs might help to choose an appropriate procedure in the treatment of rare symptomatic variants.

Purpose: Positron emission tomography (PET)/MRI combines the functional ability of PET and the high soft tissue contrast of MRI. The aim of this study was to assess contrast-enhanced (ce)PET/MRI compared to cePET/CT in patients with suspected recurrence of head and neck cancer (HNC). Methods: Eighty-seven patients underwent sequential cePET/CT and cePET/MRI using a trimodality PET/CT-MRI set-up. Diagnostic accuracy for the detection of recurrent HNC was evaluated using cePET/CT and cePET/MRI. Furthermore, image quality, presence of unclear 18F-fluorodeoxy-D-glucose (FDG) findings of uncertain significance and the diagnostic advantages of use of gadolinium contrast enhancement were analysed. Results: cePET/MRI showed no statistically significant difference in diagnostic accuracy compared to cePET/CT (91.5 vs 90.6%). Artefacts' grade was similar in both methods, but their location was different. cePET/CT artefacts were primarily located in the suprahyoid area, while on cePET/MRI, artefacts were more equally distributed among the supra and infrahyoid neck regions. cePET/MRI and cePET/CT showed 34 unclear FDG findings; of those 11 could be solved by cePET/MRI and 5 by cePET/CT. The use of gadolinium in PET/MRI did not yield higher diagnostic accuracy, but helped to better define tumour margins in 6.9% of patients. Conclusion: Our data suggest that cePET/MRI may be superior compared to cePET/CT to specify unclear FDG uptake related to possible tumour recurrence in follow-up of patients after HNC. It seems to be the modality of choice for the evaluation of the oropharynx and the oral cavity because of a higher incidence of artefacts in cePET/CT in this area mainly due to dental implants. However, overall there is no statistically significant difference.

PURPOSE Diffusion tensor imaging (DTI) adds functional information to morphological magnetic resonance neurography (MRN) in the assessment of the brachial nerve plexus. To determine the most appropriate pulse sequence in scan times suited for diagnostic imaging in clinical routine, we compared image quality between simultaneous multi-slice readout-segmented (rs-DTI) and conventional single-shot (ss-DTI) echo-planar imaging techniques. METHODS Institutional Review Board (IRB) approved study including 10 healthy volunteers. The supraclavicular brachial plexus, covering the nerve roots and trunks from C5 to C7, was imaged on both sides with rs-DTI and ss-DTI. Both sequences were acquired in scan times

Qualitatsmanagement zielt auf die Erhohung der Versorgungsqualitat durch die Uberprufung konkreter Qualitatsmasstabe ab. Im Auftrag des Arztlichen Leiters Rettungsdienst (ALRD) Tirol wurde ein interner „Kennzahlenbericht zum prahospitalen Notfallprozess 2013 (KZB)“ und in Folge der Erste Tiroler NEF-Benchmarkbericht 1. Hj 2015 (BB) erstellt. Ziel war, die Validitat zu uberprufen, Abweichungen zu erkennen, einzelne Parameter tiefgrundiger zu untersuchen sowie den BB unter den Notarztstutzpunkten zu kommunizieren. NEF-relevante einsatztaktische Intervalle und medizinische Qualitatsindikatoren (QI) zwischen KZB und BB wurden ausgewertet und verglichen. Die QI wurden gegenubergestellt und auf relevante Abweichungen uberpruft. Unter Annahme einer 10 % Dokumentationsschwache sowie weiterer Faktoren wurden Zielerreichungsgrade fur die QI vorgegeben. Zwischen KZB und BB bei dokumentiertem Symptom-Onset und bei „Blutzucker gemessen“ bei Schlaganfall (Stroke) ergab sich eine 5 % Abweichung. Wenn die Versorgungszeit am Notfallort bei ACS (akutes Koronarsyndrom) langer war, dann war das auch bei Schlaganfall so. ACS-Versorgungszeiten sind langer als bei Schlaganfall, da mehr arztliche Aufgaben anfallen. Unklar ist, warum die Reihung der Stutzpunkte nach Versorgungszeit im 50er- nicht mit der im 90er-Perzentil korreliert.

Une enquete anonyme accessible en ligne a ete diffusee des fevrier 2014 pour evaluer le ressenti des parents apres une hospitalisation en neonatologie. En octobre 2015, plus de 3 300 parents d’enfants hospitalises a la naissance avaient repondu. La premiere participation des parents aux soins donnait lieu a des emotions complexes. Les parents rapportaient souhaiter une participation active dans les soins. Le peau a peau etait decrit comme etant insuffisamment propose. Les equipes de soins peuvent s’appuyer sur ces premiers resultats pour mieux repondre aux attentes parentales.

Purpose Panoramical radiographs or cone-beam computed tomography (CT) are the standard-of-care in dental imaging to assess teeth, mandible, and mandibular canal pathologies, but do not allow assessment of the inferior alveolar nerve itself nor of its branches. We propose a new technique for “MR neurographic orthopantomograms” exploiting ultrashort echo-time (UTE) imaging of bone and teeth complemented with high-resolution morphological and functional MR neurography. Materials and Methods The Institutional Review Board approved the study in 10 healthy volunteers. Imaging of the subjects mandibles at 3.0T (Magnetom Skyra, Siemens-Healthcare) using a 64-channel head coil with isotropic spatial resolution for subsequent multiplanar reformatting, was performed. Bone images were acquired using a 3D PETRA sequence (TE, 0.07 msec). Morphological nerve imaging was performed using a dedicated 3D PSIF and 3D SPACE STIR sequence. Functional MR neurography was accomplished using a new accelerated diffusion-tensor-imaging (DTI) prototype sequence (2D SMS-accelerated RESOLVE). Qualitative and quantitative image analysis was performed and descriptive statistics are provided. Results Image acquisition and subsequent postprocessing into the MR neurographic orthopantomogram by overlay of morphological and functional images were feasible in all 10 volunteers without artifacts. All mandibular bones and mandibular nerves were assessable and considered normal. Fiber tractography with quantitative evaluation of physiological diffusion properties of mandibular nerves yielded the following mean ± SD values: fractional anisotropy, 0.43 ± 0.07; mean diffusivity (mm2/s), 0.0014 ± 0.0002; axial diffusivity, 0.0020 ± 0.0002, and radial diffusivity, 0.0011 ± 0.0001. Conclusion The proposed technique of MR neurographic orthopantomogram exploiting UTE imaging complemented with high-resolution morphological and functional MR neurography was feasible and allowed comprehensive assessment of osseous texture and neural microarchitecture in a single examination. J. Magn. Reson. Imaging 2016;44:393–400.

There is a long history of non-contact profilometry of mirrors performed using an autocollimator. An autocollimator is scanned over a mirror resulting in a set of local slope measurements that are then integrated to produce a measurement of the mirror profile. Such profilometers are often associated with the testing of x-ray optics. In this application a small beam is usually created by placing an aperture near the mirror under test. The W2-AM uses a reticle with a circular target. The noise, sensitivity and error characteristics of the W2-AM instrument is assessed relative to the needs of profilometry of x-ray optics.

The literature suggests that cesarean delivery or birth is carried out more often in pregnant women with epilepsy (WWE) than in pregnant women in the general population. Data were utilized from the Australian Pregnancy Register (APR) for Women on Antiepileptic Medication to investigate this issue in Australia. Over almost two decades, the mean CS rate in 1900 APR women was 39.2%, but was only 29.9% in women in the general population (relative risk (R.R.) = 1.31, 95% confidence interval (C.I.) 1.24, 1.39). Rates for forceps and suction-assisted delivery were similar in the two datasets. The 9.3% excess CS rate was almost entirely accounted for by operations carried out prior to the onset of labor. The rates for CS during labor were very similar. Only 11.0% of the WWE knew the indication for their prelabor CS, whereas 69.8% knew why theirs had been carried out during labor (odds ratio (O.R.) = 0.054; 99% C.I. 0.032, 0.089). Slightly older mothers and increased proportions of primipara probably made small contributions to the increased prelabor CS rate in the Australian WWE, but most of the excess could not be accounted for in the Register data. Australian obstetricians may have tended to regard prelabor CS as a preferable course of action in managing delivery in WWE, even in the absence of other indications.

Background A medicinal treatment optimisation (MTO) programme has been implemented since 2012 in a gerontological sector (GS) of our territory. Purpose Measure the degree of involvement of the Establishments for Elderly Dependent Persons (EEDP) in this programme. Material and methods A first audit evaluating each stage of the medication circuit (from prescription to drugs administration) was carried out between 2012 and 2014 in every EEDP of the GS (38 institutions). Then, individualised and specific improvement actions (IA) have been defined for each EEDP in a multidisciplinary way. Finally, since 2015, a second audit is carried out in each EEDP, with the same analysis criteria of the first audit. We presents here first comparison results (only from the EEDP that benefited from this second audit): on the one hand, we measured the rate of implementation of IA in every EEDP, and on the other we compared specific prescription indicators before and after implementation of these IA. Results These first results concern 47% of the EEDP of the GS (18/38). For these 18 EEDP, 250 IA were defined after the first audit, with an average of 13.9 IA per EEDP (min: 9, max: 22). After the second audit, we observed that 189 IA (75.6%) had been implemented partially or totally (average: 10.5IA/15 per EEDP). Concerning prescriptions’ indicators, the number of medications per prescription decreased from 7.5 on average per EHPAD after the first audit (min: 4.2, max: 14) to 5.5 after the second (min: 4, max: 8.1). A recent renal clearance (less than 1 year) was found in 63% of residents records after the first audit (min: 20%, max: 96%) and in 85% of residents records after the second (min: 63.3%, max: 100%). Conclusion The impact of our MTO programme appears to be positive, although these results have to be confirmed in other EEDP of the GS. One of the often-proposed IA for improving drug prescriptions in the elderly was the implementation of multidisciplinary proofreading sessions of prescriptions within the EEDP, with the participation of general practitioners. In the end, we observed a decrease of two drugs per prescription, and an increase of 20% in renal clearance measures.

The synthesis of 4,4,4-trifluoro-3,3-dihydroxy-2-methyl-1-(thien-2-yl)butan-1-one (3) through acylation of 1,1-dimethoxy-1-(thien-2-yl)propane (1) with trifluoroacetic anhydride and its reactions with hydroxylamine and hydrazine was investigated. X-ray structural analysis of new trifluoromethyl-substituted dielectrophile 3 revealed that this hydrate exists as a racemate with inter- and intramolecular O-H·O bonds. The crystal structure shows alignment along axis b of pair molecules with the same configuration of the O2-H·O1 bond. For 5(3)-trifluoromethyl-4-methyl-3(5)-(thien-2-yl)-1H-pyrazole (4), obtained via cyclocondensation of precursor 2 and hydrazine hydrochloride, X-ray structural analysis indicated that its rings are almost planar (torsion angle N2-C5-C6-C7–5.4°) and that S1 at the thienyl moiety is anti-periplanar to N2 (torsion angle N2-C5-C6-S1 176.01); no disorder effect was observed for the thienyl ring.

NIDCAP is theory-guided, relationship-based and system-oriented. According to Gilkerson & Als, “Changes in the larger system affect the dynamics within the smaller unit”.1 Therefore it appears important to act at a national level to support NIDCAP dissemination.

OBJECTIVES The aims of this study were to show feasibility and to quantitatively and qualitatively evaluate the use of high-permittivity dielectric pads for imaging the temporomandibular joint (TMJ) at 7.0 T. MATERIALS AND METHODS This study is an institutional review board-approved study with written informed consent. Ten asymptomatic volunteers (20 TMJs) were magnetic resonance imaged using a 32-channel head coil at 7.0 T (Achieva; Philips Healthcare, the Netherlands) with and without high-permittivity dielectric pads consisting of barium titanate in deuterated suspension. Imaging protocol consisted of an oblique sagittal proton density-weighted turbo-spin echo sequence. For quantitative evaluation, B1 maps and voxelwise signal-to-noise ratio (SNR) maps were calculated. For qualitative evaluation, 2 readers assessed the visibility of anatomical structures of the TMJ and overall image quality on a 5-point Likert scale from 1 (excellent visibility) to 5 (not visible) in consensus. Quantitative and qualitative measurements were compared between images acquired with and without pads. RESULTS Imaging the TMJ using dielectric pads was feasible in all volunteers. The quantitative analysis showed locally higher B1+ and higher SNR in the area covering the TMJ for the scans performed with dielectric pads compared with those without pads (SNR: mean [SD] pads, 12.38 [3.18]; mean [SD] no pads, 6.60 [0.72]). The qualitative analysis showed significantly better visibility and delineation of clinically relevant anatomical structures of the TMJ, including temporomandibular disc, bilaminar zone, mandibular fossa, mandibular condyle, and pterygoid muscle. In addition, observers judged overall image quality as better for images taken with pads compared with those taken without pads (mean [SD] pads, 1.40 [0.50]; mean [SD] no pads, 4.25 [0.78]). CONCLUSIONS The application of high-permittivity dielectric pads improves the local B1+ field and thus the SNR, optimizing TMJ magnetic resonance imaging at 7.0 T.

A robust analysis of adhesively bonded joints requires valuable input data for simulation. Mechanical properties of adhesives in tensile and shear directions at high deformation rates are necessary, particularly for crash scenarios. Butt joint specimens and lap shear specimens were, therefore, tested under impact loading using a tensile split Hopkinson bar (SHB). In this study, the adhesive deformation was measured using a high-speed camera and digital image correlation (DIC). The method was compared to a measurement of the adhesive deformations using the classical SHB analysis. It could be shown that the accuracy of the deformation measurement was significantly increased using high-speed imaging and DIC. In the butt joint specimens, the adhesive stiffness was 12.28 times higher and the energy absorbed was 1.83 times smaller using the DIC measurement than when using the classical SHB measurement of the deformations. In the lap shear specimens, the adhesive stiffness was 6.13 times higher and the energy ab...

Background and purpose Quantitative susceptibility mapping has been previously used to differentiate lesions in patients with brain tumors. The aim of this work was to characterize the response of magnetic susceptibility differences in malignant brain tumors and surrounding edema to hyperoxic and hypercapnic respiratory challenges. Methods Images of malignant brain tumor patients (2 glioblastoma multiforme, 2 anaplastic astrocytoma, 1 brain metastasis) with clinical MRI exams (contrast-enhanced T1w) were acquired at 3T. 3D multi-gradient-echo data sets were acquired while the patients inhaled medical-air (21% O2), oxygen (100% O2), and carbogen (95% O2, 5% CO2). Susceptibility maps were generated from real and imaginary data. Regions of interest were analyzed with respect to respiration-gas-induced susceptibility changes. Results Contrast-enhancing tumor regions with high baseline magnetic susceptibility exhibited a marked susceptibility reduction under hyperoxic challenges, with a stronger effect (− 0.040 to − 0.100 ppm) under hypercapnia compared to hyperoxia (− 0.010 to − 0.067 ppm). In contrast, regions attributed to necrotic tissue and to edema showed smaller changes of opposite sign, i.e. paramagnetic shift. There was a correlation between malignant tumor tissue magnetic susceptibility at baseline under normoxia and the corresponding susceptibility reduction under hypercapnia and – to a lesser degree – under hyperoxia. Conclusion In this small cohort of analysis, quantification of susceptibility changes in response to respiratory challenges allowed a complementary, functional differentiation of tumorous sub-regions. Those changes, together with the correlations observed between baseline susceptibility under normoxia and susceptibility reduction with challenges, could prove helpful for a non-invasive characterization of local tumor microenvironment.

The addition of a piezo-electric focusing stage and phase retrieval algorithms to a compact, adaptable autostigmatic microscope provides for both improved focus sensitivity during optical system alignment as well as the ability to measure low-order aberrations for system qualification. A description of the instrument and initial results are reported.

Fluctuations in blood-oxygenation level dependent (BOLD) signal and perfusion affect the quantification of changes in cerebral blood flow (CBF), coupled to neuronal activity, in arterial spin labeling (ASL). Subtraction methods for control and labeled MR images (i.e. pair-wise, surround subtraction, and subtraction of sinc-interpolated images), postulated to mitigate this interference in pseudo-continuous ASL (pCASL), were evaluated by comparison with quantitative 15O-water PET. At rest, a good agreement in the CBF values was found between PET and MRI for each of the subtraction methods. Stimulation of the visual system resulted in a regional CBF increase in the occipital lobe, which was detectable in both modalities. Bland–Altman analysis showed a systematic underestimation of the CBF values during activation in MRI. Evaluation of the relative CBF change induced by neuronal stimulation showed good inter-modality agreement for the three subtraction methods. Perfusion data obtained with each subtraction method followed the stimulation paradigm without significant differences in the correlation patterns or in the time lag between stimulation and perfusion response. Comparison to the gold standard confirmed the detectability of a neuronal stimulation pattern by pCASL. The results indicate that the combined use of background suppression and short TE reduces the BOLD-weighting in the pCASL signal.

Objective: The purpose of this study was to analyze whether diffusion-weighted imaging (DWI) adds significant information to positron emission tomography/magnetic resonance imaging (PET/MRI) on lesion detection and characterization in head and neck cancers. Methods: Seventy patients with different head and neck cancers were enrolled in this prospective study. All patients underwent sequential contrast-enhanced (ce) PET/computed tomography (CT) and cePET/MRI using a tri-modality PET/CT-MR setup either for staging or re-staging. First, the DWI alone was evaluated, followed by the PET/MRI with conventional sequences, and in a third step, the PET/MRI with DWI was evaluated. McNemar's test was used to evaluate differences in the accuracy of PET/MRI with and without DWI compared to the standard of reference. Results: One hundred eighty-eight (188) lesions were found, and of those, 118 (62.8%) were malignant and 70 (37.2%) were benign. PET/MRI without DWI had a higher accuracy in detecting malignant lesions than DWI alone (86.8% vs. 60.6%, p

Le but de ce travail est d’evaluer la prise en charge medicamenteuse du sujet âge au sein des etablissements sanitaires et medicosociaux de la filiere gerontologique, en vue de reduire la iatrogenie medicamenteuse evitable. L’audit clinique realise a permis d’evaluer d’une part la juste prescription par l’analyse de 980 ordonnances (incluant trois hopitaux et 28 EHPAD), et d’autre part les differentes etapes du circuit du medicament de 27 EHPAD de la filiere. Ainsi, des points forts et points faibles ont pu etre identifies, et des axes d’amelioration specifiques ont pu etre mis en place.

Assessment of coronary artery calcification is increasingly used for cardiovascular risk stratification. We evaluated the reliability of calcium-scoring results using a novel iterative reconstruction algorithm (ASIR) on a high-definition 64-slice CT scanner, as such data is lacking.In 50 consecutive patients Agatston scores, calcium mass and volume score were assessed. Comparisons were performed between groups using filtered back projection (FBP) and 20-100% ASIR algorithms. Calcium score was measured in the coronary arteries, signal and noise were measured in the aortic root and left ventricle. In comparison with FBP, use of 20%, 40%, 60%, 80%, and 100% ASIR resulted in reduced image noise between groups (7.7%, 18.8%, 27.9%, 39.86%, and 48.56%, respectively; p0.001) without difference in signal (p=0.60). With ASIR algorithms Agatston coronary calcium scoring significantly decreased compared with FBP algorithms (837.3 ± 130.3; 802.2 ± 124.9, 771.5 ± 120.7; 744.7 ± 116.8, 724.5 ± 114.2, and 709.2 ± 112.3 for 0%, 20%, 40%, 60%, 80%, and 100% ASIR, respectively, p0.001). Volumetric score decreased in a similar manner (p0.001) while calcium mass remained unchanged. Mean effective radiation dose was 0.81 ± 0.08 mSv.ASIR results in image noise reduction. However, ASIR image reconstruction techniques for HDCT scans decrease Agatston coronary calcium scores. Thus, one needs to be aware of significant changes of the scoring results caused by different reconstruction methods.

Objectives/Hypothesis The aim was to compare the value of 18-Fluoro-Deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) regarding contralateral lymph node (LN) metastasis in the neck. Study Design Retrospective analysis of 61 patients staged by 18F-FDG-PET/CT. Methods Cytology/histology served as a reference standard. Further, metabolic midline invasion (MI) of the primary tumor and the presence of bilateral LN metastases were assessed. Results A true positive rate in the ipsilateral neck of 80% versus 65% in the contralateral neck was found (P = 0.067). Median-standardized uptake value (SUV)-max for suspicious LN ipsilaterally was 7.6 versus 5.8 contralaterally (P = 0.038). There was no positive correlation between metabolic MI and bilateral metastasis (P = 0.82). Conclusions The rate of true positive detected LN by 18F-FDG-PET/CT is less on the contralateral neck side; therefore, all suspicious LNs should be verified by cytology. A high SUV in the contralateral neck suggests metastatic disease regardless of nodal size. Metabolic MI needs to be addressed carefully as it was not predictive for bilateral LN involvement. Level of Evidence 4.

Although clinical positron emission tomography (PET)/computed tomography (CT) applications were obvious and have completely replaced PET in oncology, clinical applications of PET/magnetic resonance (MR) are currently not clearly defined. This is due to the lack of clinical data, which is mainly because PET/MR technology is not clinically mature at this point. Open issues are technical and concern ease of obtaining PET attenuation correction maps, dealing with, for example, MR surface coil metal in the PET field-of-view and appropriate workflows leading to a cost-effective examination. All issues can be circumvented by using a shuttle-connected PET/CT-MR system, but the penalty is that simultaneous PET and MR imaging are not possible and potential motion between examinations may occur. Clinically, some systems installed worldwide start to have a reasonable bulk of clinical data. Preliminary results suggest that in oncology, PET/MR may have advantages over PET/CT in head and neck imaging. In liver imaging, more PET-positive lesions are seen on MR than on CT, but that does not mean that PET/MR is superior to PET/CT. Possibly in some settings where a contrast-enhanced PET/CT is needed to be diagnostic, PET/MR can be done without contrast media. Although PET/CT has virtually no role in brain imaging, this may be an important domain for PET/MR, particularly in dementia imaging. The role of PET/MR in the heart is as yet undefined, and much research will have to be done to elucidate this role. At this point, it is also not clear where the simultaneity afforded by a fully integrated PET/MR is really needed. Sequential data acquisition even on separate systems and consecutive software image fusion may well be appropriate. With the increasing installed base of systems, clinical data will be forthcoming and define more clearly where there is clinical value in PET/MR at an affordable price.

Extreme prematurity, defined as birth occurring before 27 weeks of gestation in Sweden, is managed according to the latest data of the most recent literature, with monitoring of the results through a continuous perinatal registry. National guidelines were issued in 2013. They highlight the importance of infant developmentally supportive and family-centered care focused on the child and the family, nutritional support, pain management, management of ductus arteriosus, and brain damage. However, there remain areas without national consensus including respiratory support management. The French vision of the Swedish approach highlights the proactive attitude of neonatologists, the coherent and narrow collaboration between neonatologists and obstetricians, and the active presence and involvement of parents in the care of their infants.

To qualitatively and quantitatively compare MRI of the temporomandibular joint (TMJ) at 7.0 T using high-permittivity dielectric pads and 3.0 T using a clinical high-resolution protocol.Institutional review board-approved study with written informed consent. 12 asymptomatic volunteers were imaged at 7.0 and 3.0 T using 32-channel head coils. High-permittivity dielectric pads consisting of barium titanate in deuterated suspension were used for imaging at 7.0 T. Imaging protocol consisted of oblique sagittal proton density weighted turbo spin echo sequences. For quantitative analysis, pixelwise signal-to-noise ratio maps of the TMJ were calculated. For qualitative analysis, images were evaluated by two independent readers using 5-point Likert scales. Quantitative and qualitative results were compared using t-tests and Wilcoxon signed-rank tests, respectively.TMJ imaging at 7.0 T using high-permittivity dielectric pads was feasible in all volunteers. Quantitative analysis showed similar signal-to-noise ratio for both field strengths (mean ± SD; 7.0 T, 13.02 ± 3.92; 3.0 T, 14.02 ± 3.41; two-sample t-tests, p = 0.188). At 7.0 T, qualitative analysis yielded better visibility of all anatomical subregions of the temporomandibular disc (anterior band, intermediate zone and posterior band) than 3.0 T (Wilcoxon signed-rank tests, p 0.05, corrected for multiple comparisons).MRI of the TMJ at 7.0 T using high-permittivity dielectric pads yields superior visibility of the temporomandibular disc compared with 3.0 T.

Purpose To compare the diagnostic accuracy of PET+MR with PET/CT in the initial staging of head and neck cancer. Materials and methods Contrast-enhanced PET/CT+MR was performed in 27 patients with newly diagnosed head and neck cancer. PET/CT and PET+MR were evaluated separately, and the TNM stage and factors influencing treatment were assessed. Results The TNM staging by PET+MR was comparable to PET/CT (T: p =0.331, N: p =0.453, M: p =0.034). The sensitivity/specificity/accuracy of treatment-influencing factors by PET/CT and PET+MR were 0.68/0.99/0.97, and 1.00/1.00/0.99, respectively. Conclusions Whole-body staging with PET+MR yields at least equal diagnostic accuracy as PET/CT in head and neck cancer.