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The deleterious effects of high-dose radiation on normal tissue are sometimes extrapolated to diagnostic (SPECT and PET) radiopharmaceutical extravasation (RPE). It has been hypothesized that diagnostic RPE can have gradually evolving local tissue injury and a potentially increased risk of local dermatologic or oncologic diseases over a longer period. However, data on clinical adverse events after diagnostic RPE are limited. Therefore, our primary aim was to study the occurrence of short-term and long-term clinical adverse events in patients who underwent 99m Tc-methylene diphosphonate ( 99m Tc-MDP) whole-body bone scintigraphy (WBBS) with reported RPE. Methods: The records of 99m Tc-MDP WBBS performed from June 2010 to January 2022 were retrospectively examined for RPE documented in the scan reports. The clinical records of patients with a documented RPE were extensively reviewed for any related short-term adverse events (within 2 wk of the WBBS: local symptoms and care sought for local dermatologic or musculoskeletal issues) and long-term adverse events (until the last follow-up: local deleterious effects and related consults for dermatology, plastic surgery, oncology, or orthopedics). Results: Retrospective review of the records of 31,679 99m Tc-MDP WBBS studies showed RPE documented in 118 (0.37%). Medical records were not retrievable for 22 patients, yielding a final cohort of 96 patients with reported RPE. The median follow-up was 18.9 mo (interquartile range, 7.8-45.7 mo). Short-term events were noted in 4 patients, of whom one was asymptomatic. Of the 3 symptomatic patients, 2 experienced mild discomfort at the injection site, and 1 had tender swelling. Three of the 4 events were in patients who had a prior intravenous contrast extravasation for contrast-enhanced CT performed earlier during the day and a 99m Tc-MDP injection later at the same site, likely leading to RPE. None of the long-term local events had any plausible link with the RPE event. Conclusion: Reported RPE was rare, and 3 patients (0.009%) had short-term local symptoms, all of which were likely related to the prior higher-volume intravenous contrast extravasation. The smaller-volume diagnostic radiopharmaceutical injections for WBBS are highly unlikely to cause local symptoms on their own. No patient had any long-term adverse event with a plausible link to the RPE., (© 2023 by the Society of Nuclear Medicine and Molecular Imaging.)

Our objective was to assess the diagnostic accuracy of 99m Tc-sestamibi SPECT/CT for characterizing solid renal masses. Methods: Imaging and clinical records of patients who underwent 99m Tc-sestamibi SPECT/CT for clinical work-up of their solid renal masses from September 2018 to October 2021 were retrospectively reviewed. Histopathology formed the reference standard, and the diagnoses were categorized as malignant/concerning (renal cell carcinomas [RCCs] other than chromophobe histology) and benign/nonconcerning (oncocytic tumors including chromophobe RCC, other benign diagnoses) to calculate the sensitivity and specificity of 99m Tc-sestamibi SPECT/CT and contrast-enhanced CT (ceCT). The clinical reads of the SPECT/CT images were used for visual classification of the lesions. Additionally, the SPECT images were manually segmented to obtain the maximum and mean counts of the lesion and adjacent renal cortex and maximum and mean lesion Hounsfield units. Results: 99m Tc-sestamibi SPECT/CT was performed on 42 patients with 62 renal masses. A histopathologic diagnosis was available for 27 patients (18 male, 9 female) with 36 solid renal masses. ceCT findings were available for 20 of these patients. The most commonly identified single histologic type was clear cell RCC (13/36; 36.1%). Oncocytic tumors were the most common group of nonconcerning lesions (15/36), with oncocytoma as the predominant histologic type ( n = 6). The sensitivity and specificity of SPECT/CT for diagnosing a nonconcerning lesion were 66.7% and 89.5%, respectively, compared with 10% and 75%, respectively, for ceCT. The lesion-to-kidney ratios for maximum and mean counts and maximum lesion Hounsfield units showed significant differences between the 2 groups ( P < 0.05). The lesion-to-kidney mean count ratio at a cutoff of 0.46 showed a sensitivity and specificity of 87.5% and 86.67%, respectively, for detecting nonconcerning lesions, which was significantly higher than that of ceCT. Conclusion: The current literature on the utility of 99m Tc-sestamibi SPECT/CT for characterization of solid renal masses is limited. We offer additional evidence of the incremental value of 99m Tc-sestamibi SPECT/CT over ceCT for differentiating malignant or aggressive renal tumors from benign or indolent ones, thereby potentially avoiding overtreatment and its associated complications. Quantitative assessment can further increase the diagnostic accuracy of SPECT/CT and may be used in conjunction with visual interpretation., (© 2023 by the Society of Nuclear Medicine and Molecular Imaging.)

Background: The coronavirus 2019 (COVID-19) pandemic forced health care globally to provide remote services when feasible. In March 2020, psychiatric outpatient services across the United States transitioned to telehealth. Persons with early psychosis (EP) face challenges to maintain connection with care, an important element associated with better outcome. The ongoing pandemic offers the opportunity to review the feasibility of EP services using telehealth and to evaluate implications for continued implementation., Methods: We examined delivery of coordinated specialty care (CSC) for 49 individuals aged 16-30 years enrolled in an EP (first-episode psychosis and clinical high risk) university-affiliated outpatient clinic located in Philadelphia, Pennsylvania, from March 2020 to July 2021, during which most appointments were delivered through telehealth. The services evaluated in this setting include psychotherapy, medication management, employment and educational services, peer support, and multifamily psychoeducation group. We compared completed and missed appointment rates across services and new enrollment rates with in-person versus hybrid telehealth and in-person care pre-COVID-19 and during the pandemic., Results: In 6 months pre-COVID-19 (September 2019-February 2020), the Psychosis Evaluation and Recovery Center enrolled a mean of 4 people/mo compared to during the pandemic (March 2020-July 2021), when a mean of 2.2 people/mo were enrolled. The total number of completed psychology appointments pre-COVID-19 ranged from 51 to 88 and during the pandemic ranged from 72 to 137. The rate of missed psychology appointments ranged from 1.4% to 6.4% pre-COVID-19 and from 3.4% to 11.3% during the pandemic. The total number of completed medication management appointments pre-COVID-19 ranged from 35 to 59 and during the pandemic ranged from 22 to 66. The rate of missed medication management appointments ranged from 2.1% to 8.0% pre-COVID-19 and from 1.7% to 9.1% during the pandemic. The total number of completed supported education and employment services appointments pre-COVID-19 ranged from 5 to 11 and during the pandemic ranged from 3 to 16. Finally, the mean number of family members in attendance at the family psychoeducation group was 8.3 pre-COVID-19 and 17.1 during the pandemic., Conclusions: New and continued engagement across services in EP CSC during the COVID-19 pandemic supports feasibility of telehealth and suggests that offering a hybrid model of in-person and telehealth should be considered once restrictions are lifted., (© Copyright 2022 Physicians Postgraduate Press, Inc.)

Background: In restorative proctocolectomy with ileal J-pouch, perfusion assessment is vital to prevent complications such as anastomotic leak (AL). Indocyanine green near-infrared fluorescence (ICG-NIRF) is gaining popularity, while its interpretation and relevance remain subjective. This study aimed to evaluate a standardized ICG-NIRF imaging protocol combined with a novel, software-based assessment to detect areas of impaired perfusion and a possible correlation with AL of the pouch., Methods: In this prospective study, patients undergoing ileal J-pouch for ulcerative colitis at an inflammatory bowel disease (IBD) referral center were included. Intraoperatively, strictly standardized ICG-NIRF visualization was performed and video-recorded. Postoperatively, a specific software was utilized to determine the change in fluorescence intensity per second (i/s) for systematic regions of interest, generating perfusion-time curves and a pixel-to-pixel map. These were analysed in detail and correlated with clinical outcome (primary end point: AL within 30 days; clearly defined and screened for by pouchoscopy)., Results: Four out of 18 included patients developed AL of the ileal pouch-anal anastomosis (IPAA). In the AL group, the perfusion curves on the area adjacent to the IPAA (pouch apex) displayed considerably lower ingress/inflow (median = 1.7; range = 8.5; interquartile-range = 3.8 i/s) and egress/outflow (median = -0.1; range = 0.7; interquartile-range = 0.5 i/s) values than in the non-AL group (ingress: median = 4.3; range = 10.3; interquartile-range = 4.0 i/s); egress: median = (-1.1); range = 3.9; interquartile range = 1.0 i/s). This was confirmed by further novel parameters of pouch perfusion (maximum ingress; maximum egress) and pixel-to-pixel analysis., Conclusions: This study presents the feasibility of a novel methodology to precisely assess pouch perfusion with ICG-NIRF, identifying comparable, quantifiable, and objective parameters to potentially detect perfusion-associated complications in surgery in real-time.

The aim of this study was to evaluate the detection rate of incidental second primary neoplasms in patients with prostate cancer on 18 F-fluciclovine PET/CT. Methods: Imaging reports and patient demographic data were retrospectively reviewed from 663 clinical 18 F-fluciclovine PET/CT studies, performed in 601 patients for the assessment of their prostate cancer (643 - recurrence evaluation, 20 - initial staging) from August 2016 to April 2021. Maximum SUV (SUV max ) of the suspected second neoplasms was determined. The results of 18 F-fluciclovine PET/CT were correlated with clinical and radiologic studies to determine the nature of the suspected second neoplasms. Results: Fifty-five patients (9.1%) had findings suggestive of a second neoplasm. Thirty-nine of 55 had a known second neoplasm diagnosed before the PET/CT. An incidental second primary neoplasm was first suspected on 18 F-fluciclovine PET/CT in 16 of 601 patients (2.7%). Three of the 16 patients had PET/CT suggestive of a meningioma that was corroborated on MRI. Of the remaining 13 patients, 11 had a tissue diagnosis confirming a malignancy. Second malignancies included renal cell carcinoma (RCC; 5/11; 45.5%), urothelial carcinoma ( n = 2), multiple myeloma, chondrosarcoma, cutaneous squamous cell carcinoma, and squamous cell carcinoma of the esophagus and lung ( n = 1, each; except for 1 patient with both esophageal and lung carcinomas). Among histopathologically confirmed malignancies, clear-cell RCC had the lowest uptake (SUV max 3.4), and cutaneous squamous cell carcinoma had the highest uptake (SUV max 13.6). Of the 2 patients with no histopathologic confirmation, 1 had ultrasound and MRI findings corroborating the diagnosis of RCC. The other patient had a solitary lung nodule suggestive of primary lung carcinoma and elected to undergo observation. Conclusion: Incidental findings consistent with a second primary neoplasm are not infrequently seen on 18 F-fluciclovine PET/CT performed for assessment of prostate cancer (9.1%). Of the incidentally detected primary cancers, RCC was the most common (45.5%). These findings indicate the need for a careful analysis of 18 F-fluciclovine PET/CT images, due to the broad tumor imaging capabilities of this radiotracer., (© 2022 by the Society of Nuclear Medicine and Molecular Imaging.)

Background: An anastomotic leak (AL) after a restorative proctocolectomy and an ileal J-pouch increases morbidity and the risk of pouch failure. Thus, a perfusion assessment during J-pouch formation is crucial. While indocyanine green near-infrared fluorescence (ICG-NIRF) has shown potential to reduce ALs, its suitability in a restorative proctocolectomy remains unclear. We aimed to develop a standardized approach for investigating ICG-NIRF and ALs in pouch surgery., Methods: Patients undergoing a restorative proctocolectomy with an ileal J-pouch for ulcerative colitis at an IBD-referral-center were included in a prospective study in which an AL within 30 postoperative days was the primary outcome. Intraoperatively, standardized perfusion visualization with ICG-NIRF was performed and video recorded for postoperative analysis at three time points. Quantitative clinical and technical variables (secondary outcome) were correlated with the primary outcome by descriptive analysis and logistic regression. A novel definition and grading of AL of the J-pouch was applied. A postoperative pouchoscopy was routinely performed to screen for AL., Results: Intraoperative ICG-NIRF-visualization and its postoperative visual analysis in 25 patients did not indicate an AL. The anastomotic site after pouch formation appeared completely fluorescent with a strong fluorescence signal (category 2) in all cases of ALs (4 of 25). Anastomotic site was not changed. ICG-NIRF visualization was reproducible and standardized. Logistic regression identified a two-stage approach vs. a three-stage approach (Odds ratio (OR) = 20.00, 95% confidence interval [CI] = 1.37-580.18, p = 0.029) as a risk factor for ALs., Conclusion: We present a standardized, comparable approach of ICG-NIRF visualization in pouch surgery. Our data indicate that the visual interpretation of ICG-NIRF alone may not detect ALs of the pouch in all cases-quantifiable, objective methods of interpretation may be required in the future.

Background: Gracilis muscle interposition (GMI) is an established treatment option for complex perineal fistulas and reconstruction. The outcome is limited by complications such as necrosis, impaired wound healing and fistula persistence or recurrence. Quantifiable methods of assessing muscle flap perfusion intraoperatively are lacking. This study evaluates a novel and objective software-based assessment of indocyanine green near-infrared fluorescence (ICG-NIRF) in GMI., Methods: Intraoperative ICG-NIRF visualization data of five patients with inflammatory bowel disease (IBD) undergoing GMI for perineal fistula and reconstruction were analyzed retrospectively. A new software was utilized to generate perfusion curves for the specific regions of interest (ROIs) of each GMI by depicting the fluorescence intensity over time. Additionally, a pixel-to-pixel and perfusion zone analysis were performed. The findings were correlated with the clinical outcome., Results: Four patients underwent GMI without postoperative complications within 3 months. The novel perfusion indicators identified here (shape of the perfusion curve, maximum slope value, distribution and range) indicated adequate perfusion. In one patient, GMI failed. In this case, the perfusion indicators suggested impaired perfusion., Conclusions: We present a novel, software-based approach for ICG-NIRF perfusion assessment, identifying previously unknown objective indicators of muscle flap perfusion. Ready for intraoperative real-time use, this method has considerable potential to optimize GMI surgery in the future.

Aim: Pennsylvania (PA) first-episode psychosis (FEP) program evaluation is a statewide initiative, supported by the PA Office of Mental Health and Substance Abuse Services (PA-OMHSAS) and administered by PA Early Intervention Center/Heads Up, which evaluates fidelity and outcomes of PA Coordinated Specialty Care (CSC) programs. Programs participate in standard computerized measures of CSC outcomes using centralized informatics. The aims of the current report are to describe implementation of this core battery for program evaluation in PA and to present 6- and 12-month outcomes., Methods: Participants (n = 697) from nine PA CSC programs completed the core battery at admission. The battery was re-administered at 6- and 12-month follow-up, and data were analysed for individuals (n = 230) who had completed 12-months of treatment. Domains assessed via clinician report and/or self-report included symptoms, role and social functioning, self-perceived recovery and service utilization., Results: PA FEP CSC participants showed improvement over time in several domains, including decreased symptoms, higher role and social functioning, decreased hospitalizations, and improved self-perception of recovery, quality of life, and services satisfaction. Trends towards improvements were observed for participant happiness, hopelessness, and school-enrolment. Nearly all improvements were observed at 6-month follow-up, with earlier gains maintained at 12-months., Conclusions: PA FEP CSC programs demonstrate the ability to assess and improve critical outcomes of coordinated specialty care in PA. Improved outcomes by 12 months in treatment provides evidence of an effective treatment model and supports the continuation of these programs in pursuit of our goal of reducing schizophrenia disease burden on individuals and society., (© 2020 John Wiley & Sons Australia, Ltd.)

Models for early psychosis intervention often involve shared decision-making among patients, their caregivers, and clinicians. However, this process rests on a shared understanding of constructs, experiences, and language. This study examined how various aspects of early psychosis care were conceptualized by those involved in the help-seeking process, and the extent to which their perceptions aligned with one another. We conducted a free listing study to systematically explore perceptions of the help-seeking process and management of psychosis-related symptoms among a sample of 65 patients, caregivers, and clinicians at an early psychosis intervention clinic. Results indicated varying levels of agreement between different roles on getting or giving help, taking medications, factors influencing symptom management, and thoughts regarding the future. These findings highlight important differences and emphasize a need for further exploration of how stakeholder perceptions may influence decisions surrounding the care of individuals experiencing early psychosis.

Each of the macronutrients-carbohydrate, protein, and fat-has a unique set of properties that influences health, but all are a source of energy. The optimal balance of their contribution to the diet has been a long-standing matter of debate. Over the past half century, thinking has progressed regarding the mechanisms by which each macronutrient may contribute to energy balance. At the beginning of this period, metabolic signals that initiated eating events (i.e., determined eating frequency) were emphasized. This was followed by an orientation to gut endocrine signals that purportedly modulate the size of eating events (i.e., determined portion size). Most recently, research attention has been directed to the brain, where the reward signals elicited by the macronutrients are viewed as potentially problematic (e.g., contribute to disordered eating). At this point, the predictive power of the macronutrients for energy intake remains limited.

Prebiotic oligosaccharides are defined by their selective stimulation of growth and/or activity of bacteria in the digestive system in ways claimed to be beneficial for health. However, apart from the short chain fatty acids, little is known about bacterial metabolites created by fermentation of prebiotics, and the significance of the size of the oligosaccharides remains largely unstudied. By in vitro fermentations in human fecal microbial communities (derived from six different individuals), we studied the effects of high-mass (HA, >1 kDa), low-mass (LA, <1 kDa) and mixed (BA) sugar beet arabino-oligosaccharides (AOS) as carbohydrate sources. Fructo-oligosaccharides (FOS) were included as reference. The changes in bacterial communities and the metabolites produced in response to incubation with the different carbohydrates were analyzed by quantitative PCR (qPCR) and Liquid Chromatography-Mass Spectrometry (LC-MS), respectively. All tested carbohydrate sources resulted in a significant increase of Bifidobacterium spp. between 1.79 fold (HA) and 1.64 fold (FOS) in the microbial populations after fermentation, and LC-MS analysis suggested that the bifidobacteria contributed to decomposition of the arabino-oligosaccharide structures, most pronounced in the HA fraction, resulting in release of the essential amino acid phenylalanine. Abundance of Lactobacillus spp. correlated with the presence of a compound, most likely a flavonoid, indicating that lactobacilli contribute to release of such health-promoting substances from plant structures. Additionally, the combination of qPCR and LC-MS revealed a number of other putative interactions between intestinal microbes and the oligosaccharides, which contributes to the understanding of the mechanisms behind prebiotic impact on human health., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Alterations in the human gut microbiota caused, for example, by diet, functional foods, antibiotics, or occurring as a function of age are now known to be of relevance for host health. Therefore, there is a strong need for methods to detect such alterations in a rapid and comprehensive manner. In the present study, we developed and validated a high-throughput real-time quantitative PCR-based analysis platform, termed 'GUt Low-Density Array' (GULDA). The platform was designed for simultaneous analysis of the change in the abundance of 31 different microbial 16S rRNA gene targets in fecal samples obtained from individuals at various points in time. The target genes represent important phyla, genera, species, or other taxonomic groups within the five predominant bacterial phyla of the gut, Firmicutes, Bacteroidetes, Actinobacteria, Proteobacteria, and Verrucomicrobia and also Euryarchaeota. To demonstrate the applicability of GULDA, analysis of fecal samples obtained from six healthy infants at both 9 and 18 months of age was performed and showed a significant increase over time of the relative abundance of bacteria belonging to Clostridial cluster IV (Clostridia leptum group) and Bifidobacterium bifidum and concurrent decrease in the abundance of Clostridium butyricum and a tendency for decrease in Enterobacteriaceae over the 9-month period., (© 2012 Federation of European Microbiological Societies. Published by Blackwell Publishing Ltd. All rights reserved.)

Data from a joint research project between the University of Trier and the Humboldt University Berlin of personality dimensions were compared and analyzed. Since Germany was separated for forty years, studies of the general population are necessary in order to yield possible cultural differences. In the present comparison we analyzed personality constructs like anxiety, curiosity, anger and anger expression as well as variables of objective personality tests. The sample from the former western German states contained N = 109 persons. As a basis for comparison, we selected a parallized matched sample (n = 109) from the new eastern German states out of a larger sample (N = 586). The main results were as follows: (1) reliability (consistency) and factor structure of the measures are similar for both samples. This equivalency is the formal prerequisite for a comparison. (2) There are substantial differential effects between eastern and western samples. Wellness as well as emotionality also show different results considerable with regard to age and sex.

The transverse diameter fo the foramen occipitale magnum (f. o. m.) in the semiaxial skull X-ray was measured and evaluated statistically in 174 cerebrally healthy children of different ages. These normal values are contrasted with the foramen diameters of 35 children with verified Arnold-Chiari malformation as well as children with macrocephaly and microcephaly. The values in children with Arnold-Chiari malformation are all above the norm, irrespective of whether or not there is a concomitant hydrocephalus.