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Purpose: This study aims to identify a combination of clinical, demographic, and patient competence determinants of patients' communication with doctors and nurses in an international sample of cancer patients., Methods: For our cross-sectional study, cancer patients assessed their communication with their doctors or nurses at the start of their treatment. Patients completed EORTC communication questionnaire QLQ-COMU26 to assess ten areas of communication with their doctor or nurses plus another item to assess how competent they felt when communicating with professionals. Bivariable analyses and multivariable linear regression models were performed separately for each QLQ-COMU26 area., Results: Included in the study were 988 patients from 15 centres in 13 countries (five cultural areas). Higher age was related to higher level of communication in eight QLQ-COMU26 areas. Males reported higher level of communication in three areas. Lower levels of studies and higher level of perceived competence when communicating with professionals were related to higher level of communication in the ten QLQ-COMU26 areas. Communication was of a higher level with nurses than with doctors in four areas. Having received previous treatment with the same doctor or group of nurses was related to higher communication levels in seven areas. Lack of comorbidity was related to higher communication levels in two areas. Various differences in determinants were found among tumour sites., Conclusion: Our regression model has shown several relationships between communication and the demographic and clinical variables that may help identify patients at risk of poor communication. Future studies could focus on communication at diagnosis and in follow-up, and on areas such as assessing the particularities of communication between patient and professionals in relation to cancer type., Competing Interests: Declarations. Ethics approval and consent to participate: This study was performed according to the rules of the Helsinki declaration. The protocol was approved by national or local ethical committees (for Spain, the Clinical Research Ethics Committee of Navarra under project 2015/72). Eligible patients were introduced to the study, provided written information, and invited to participate. Written informed consent was obtained from each patient prior to inclusion. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The EORTC Quality of Life Group has developed a questionnaire to evaluate cancer patients' perception of their communication with healthcare professionals (HCPs): the EORTC QLQ-COMU26. In this study we test the validity and reliability of this novel measure in an international and culturally diverse sample of cancer patients., Methods: Cancer patients completed the following EORTC questionnaires at two time points (before and during treatment): the QLQ-COMU26 (including a debriefing questionnaire), the QLQ-C30, and specific IN-PATSAT32 scales. These data were used to assess: the cross-cultural applicability, acceptability, scale structure, reliability, convergent/divergent validity, known-groups validity, and responsiveness to change of the QLQ-COMU26., Results: Data were collected from 498 patients with various cancer diagnoses in 10 European countries, Japan, Jordan and India (overall 5 cultural regions). At most, only 3% of patients identified an item as confusing and 0.6% as upsetting, which indicates that the questionnaire was clear and did not trigger negative emotional responses. Confirmatory factor analysis and multi-trait scaling confirmed the hypothesised QLQ-COMU26 scale structure comprising six multi-item scales and four single items (RMSEA = 0.025). Reliability was good for all scales (internal consistency > 0.70; test-retest reliability > 0.85). Convergent validity was supported by correlations of ≥ 0.50 with related scales of the IN-PATSAT32 and correlations < 0.30 with unrelated QLQ-C30 scales. Known-groups validity was shown according to sex, education, levels of anxiety and depression, satisfaction with communication, disease stage and treatment intention, professional evaluated, and having a companion during the visit. The QLQ-COMU26 captured changes over time in groups that were defined based on changes in the item of satisfaction with communication., Conclusion: The EORTC QLQ-COMU26 is a reliable and valid measure of patients' perceptions of their communication with HCPs. The EORTC QLQ-COMU26 can be used in daily clinical practice and research and in various cancer patient groups from different cultures. This questionnaire can help to improve communication between patients and healthcare professionals., (© 2024. The Author(s).)

Recent evidence shows that heteroclinic bifurcations in magnetic islands may be caused by the amplitude variation of resonant magnetic perturbations in tokamaks. To investigate the onset of these bifurcations, we consider a large aspect ratio tokamak with an ergodic limiter composed of two pairs of rings that create external primary perturbations with two sets of wave numbers. An individual pair produces hyperbolic and elliptic periodic points, and its associated islands, that are consistent with the Poincaré-Birkhoff fixed-point theorem. However, for two pairs producing external perturbations resonant on the same rational surface, we show that different configurations of isochronous island chains may appear on phase space according to the amplitude of the electric currents in each pair of the ergodic limiter. When one of the electric currents increases, isochronous bifurcations take place and new islands are created with the same winding number as the preceding islands. We present examples of bifurcation sequences displaying (a) direct transitions from the island chain configuration generated by one of the pairs to the configuration produced by the other pair, and (b) transitions with intermediate configurations produced by the limiter pairs coupling. Furthermore, we identify shearless bifurcations inside some isochronous islands, originating nonmonotonic local winding number profiles with associated shearless invariant curves.

Background: PRRT can be an option for all-grade GEP-NETs, but selecting patients is challenging. In this scenario, clinical-pathological and radiological characteristics, such as pre-treatment Ga-68 DOTA PET/CT, might have the potential to help., Methods: A retrospective chart review was conducted on advanced GEP-NETs treated with at least one PRRT dose. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method. Krenning Score (KS), and the maximum standardized uptake value (SUVmax) were derived from the pre-treatment scans. A maximally selected rank statistics test was used for SUVmax simple cut point estimate., Results: Among 36 patients, 19 had primary pancreatic tumors. The numbers of G1, G2, and G3 tumors were 10, 18, and 7, respectively. During a median follow-up of 90.5 months, 4 patients died. Median OS was not reached for G1 and G2 tumors, and it was 30 months for G3 ( p = 0.001). Median PFS was 23 months, with G3 showing lower PFS compared to G1 [7 versus 30 months; HR 8.41 (95%CI 2.2-31.0; p = 0.001)]., Conclusions: PRRT provides long-term PFS in patients with G1/G2 GEP-NETs independent of clinical characteristics and primary site. G3 has worse survival, but selected patients may experience long OS after PRRT treatment.

Peptic ulcers are lesions in the gastric and duodenal mucosa generated by an imbalance between protective factors (gastroduodenal mucus secretion, bicarbonate production, adequate blood flow) and harmful factors (excess pepsin or hydrochloric acid). Some drugs used in peptic ulcer therapy are associated with adverse effects. The aim of this study was to evaluate the antiulcerogenic and healing activity of hecogenin acetate (HA) in acute and chronic models of gastric lesions in rodents. The antiulcerogenic activity of HA was evaluated in models of gastric lesions induced by absolute ethanol and in acidified ethanol with HA (5, 10, and 20 mg/kg). For the model of gastric lesions induced by ischemia and reperfusion, rats were pre-treated with HA (5, 10, 20 mg/kg). After that, they were submitted to 30 min of ischemia, followed by 1 h of reperfusion. To evaluate the healing activity was induced gastric ulcer using acetic acid (80%) in rats. After 24 h, they were treated for 7 consecutive days with HA (10 and 20 mg/kg). They were evaluated the possible signs of toxicity, measurement of the lesions, collagen deposition, and histological analysis. HA significantly reduced the area of the lesion in models of gastric lesions induced by absolute and acidified ethanol, ischemia-induced gastric lesions and reperfusion, and regarding healing. In the collagen deposition, the presence and increase of collagen demonstrate the healing effect. The AH has antiulcerogenic and healing potential demonstrated by the decrease in gastric injury and presence of collagen fibers, respectively., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

We analyze nonlinear aspects of the self-consistent wave-particle interaction using Hamiltonian dynamics in the single wave model, where the wave is modified due to the particle dynamics. This interaction plays an important role in the emergence of plasma instabilities and turbulence. The simplest case, where one particle (N=1) is coupled with one wave (M=1), is completely integrable, and the nonlinear effects reduce to the wave potential pulsating while the particle either remains trapped or circulates forever. On increasing the number of particles ( N=2, M=1), integrability is lost and chaos develops. Our analyses identify the two standard ways for chaos to appear and grow (the homoclinic tangle born from a separatrix, and the resonance overlap near an elliptic fixed point). Moreover, a strong form of chaos occurs when the energy is high enough for the wave amplitude to vanish occasionally.

The influence of two autochthonous lactobacilli strains with probiotic potential (Lactobacillus mucosae CNPC007 and Lactobacillus plantarum CNPC020) in comparison to a commercially available probiotic strain (Lactobacillus rhamnosus LR32) in non-fermented dairy desserts added with ingredients (syrup and hydroethanolic extract) derived from jabuticaba (Myrciaria cauliflora) peels was investigated. L. mucosae showed the best survivability and stability of the studied lactobacilli after processing and during storage, respectively, and also remarkably influenced the texture and sensory features of desserts in comparison to the other strains; L. plantarum achieved viability comparable with the commercial probiotic, above 6 log cfu/g up to the 21st day of the products refrigerated storage. The hydroethanolic extract and syrup from the jabuticaba peel contributed to the phenolic content of the dairy desserts (around 30 mg GAE/100 g) that showed to be able to scavenge DPPH radicals (around 300 g dessert/g DPPH). The different lactobacilli strains did not significantly influence the antioxidant capacity parameters of the desserts (p > 0.05), although the desserts' color was not stable during storage and tended to reduce the acceptability scores of the three trials. Non-fermented dairy desserts with jabuticaba peel ingredients showed to be good sources of phenolic compounds with an antioxidant capacity, offering suitable conditions for the viability maintenance of the autochthonous lactobacilli cultures.

We studied the surface and microstructure of cellulose acetate (CA) films to tailor their barrier and mechanical properties for application in electrochromic devices (ECDs). Cross-linking of CA was carried out with pyromellitic dianhydride to enhance the properties relative to unmodified CA: solvent resistance (by 43% in acetone and 37% in DMSO), strength (by 91% for tensile at break), and barrier (by 65% to oxygen and 92% to water vapor). Surface modification via tetraethyl orthosilicate and octyltrichlorosilane endowed the films with hydrophobicity, stiffness, and further enhanced solvent resistance. A detailed comparison of structural, chemical, surface, and thermal properties was performed by using X-ray diffraction, dynamic mechanical analyses, Fourier-transform infrared spectroscopy, and atomic force microscopy. Coplanar ECDs were synthesized by incorporating a hydrogel electrolyte comprising TEMPO-oxidized cellulose nanofibrils and an ionic liquid. When applied as the top layer in the ECDs, cross-linked and hydrophobized CA films extended the functionality of the assembled displays. The results indicate excellent prospects for CA films in achieving environmental-friendly ECDs that can replace poly(ethylene terephthalate)-based counterparts., Competing Interests: The authors declare no competing financial interest., (© 2021 The Authors. Published by American Chemical Society.)

Neural stem cells (NSCs) have the potential to generate the cells of the nervous system and, when cultured on nanofiber scaffolds, constitute a promising approach for neural tissue engineering. In this work, the impact of combining nanofiber alignment with functionalization of the electrospun poly-ε-caprolactone (PCL) nanofibers with biological adhesion motifs on the culture of an NSC line (CGR8-NS) is evaluated. A five-rank scale for fiber density was introduced, and a 4.5 level, corresponding to 70-80% fiber density, was selected for NSC in vitro culture. Aligned nanofibers directed NSC distribution and, especially in the presence of laminin (PCL-LN) and the RGD-containing peptide GRGDSP (PCL-RGD), promoted higher cell elongation, quantified by the eccentricity and axis ratio. In situ differentiation resulted in relatively higher percentage of cells expressing Tuj1 in PCL-LN, as well as significantly longer neurite development (41.1 ± 1.0 μm) than PCL-RGD (32.0 ± 1.0 μm), pristine PCL (25.1 ± 1.2 μm), or PCL-RGD randomly oriented fibers (26.5 ± 1.4 μm), suggesting that the presence of LN enhances neuronal differentiation. This study demonstrates that aligned nanofibers, functionalized with RGD, perform as well as PCL-LN fibers in terms of cell adhesion and proliferation. The presence of the full LN protein improves neuronal differentiation outcomes, which may be important for the use of this system in tissue engineering applications., (Copyright © 2020 Amores de Sousa, Rodrigues, Ferreira, Diogo, Linhardt, Cabral and Ferreira.)

The use of agro-industrial wastes in combination with indigenous lactic acid bacteria is an interesting option to confer functional potential to food products. The microbial viability, chemical composition, antioxidant capacity, texture and sensory acceptability of a fermented dairy dessert containing the indigenous culture Lactobacillus plantarum CNPC003, whey and ingredients obtained from the jabuticaba ( Myrciaria cauliflora ) peel were compared with formulations without lactobacilli (control) or containing a commercial probiotic culture ( Lactobacillus rhamnosus LR32). L. plantarum presented viability higher than 7 log CFU g -1 in the dessert, as did the commercial probiotic, for 21 days at 4 ± 1 °C. Total phenolic contents (45⁻60 mg gallic acid equivalents, GAE, 100 g -1 ) were comparable to those of other studies evaluating dairy products containing plant sources. The formulations were low in fat, presenting as acceptable for overall consumption, with attractive color and appreciable texture. Considering the total antioxidant capacity, 200⁻250 g of dessert would be necessary to capture 1 g of 1,1-diphenyl-2-picrylhydrazyl (DPPH) radicals. The dessert with Lactobacillus plantarum CNPC003 is seen as a viable alternative for the use of whey and jabuticaba peel, as well as a potential functional food due to the concentration of lactobacilli reached, besides the presence of antioxidant phenolic compounds.

Introduction: Chordomas are rare malignancies of bone origin that occur in the axial skeleton, typically the skull base and lumbar/sacral regions. Although often classified as low-grade neoplasms, its locally infiltrative behavior may result in significant morbidity and mortality. Optimal surgical resection may be curative, but up to 50% of the cases relapse within 5 years, and currently there are no systemic treatments approved in this setting. A large proportion of these tumors express stem-cell factor receptor (c-KIT) and platelet-derived growth factor receptors (PDGFRs), providing a rationale for the use of tyrosine-kinase inhibitors (TKIs)., Case Report: A 27-year-old male presented with recurrent chordoma of the lumbar spine 4 years after initial diagnosis. Salvage therapies in the interval included repeat resections and radiation therapy. He ultimately developed multifocal recurrence not amenable to complete excision or reirradiation. A comprehensive genomic profiling assay was performed and revealed nondrugable alterations. Decision was made to proceed with systemic treatment with pazopanib 800 mg/day, resulting in tumor reduction (-23.1% reduction in size) and prolonged disease control., Conclusion: For this patient with a multiple recurrent chordoma and limited treatment options, pazopanib resulted in sustained clinical benefit following initial tumor reduction.

Nowadays, the optimization in digital mammography is one of the most important challenges in diagnostic radiology. The new digital technology has introduced additional elements to be considered in this scenario. A major goal of mammography is related to the detection of structures on the order of micrometers (μm) and the need to distinguish the different types of tissues, with very close density values. The diagnosis in mammography faces the difficulty that the breast tissues and pathological findings have very close linear attenuation coefficients within the energy range used in mammography. The aim of this study was to develop a methodology for optimizing exposure parameters of digital mammography based on a new Figure of Merit: FOM ≡ (IQF inv ) 2 /AGD, considering the image quality and dose. The study was conducted using the digital mammography Senographe DS/GE, and CDMAM and TORMAM phantoms. The characterization of clinical practice, carried out in the mammography system under study, was performed considering different breast thicknesses, the technical parameters of exposure, and processing options of images used by the equipment's automatic exposure system. The results showed a difference between the values of the optimized parameters and those ones chosen by the automatic system of the mammography unit, specifically for small breast. The optimized exposure parameters showed better results than those obtained by the automatic system of the mammography, for the image quality parameters and its impact on detection of breast structures when analyzed by radiologists.

Background: The aim of this study was to investigate enzymatic and non-enzymatic antioxidant systems and levels of biomarker levels of oxidative damage in the saliva of patients with Down's syndrome (DS)., Methods: Saliva samples were collected from 30 patients with DS and control group (age: 14-24 years). Subsequently, the concentrations of superoxide dismutase, concentration of malondialdehyde, carbonylated proteins, uric acid, vitamin C and total protein, peroxidase activity and total antioxidant capacity were analyzed., Results: Patients with DS presented significantly higher concentrations of superoxide dismutase, higher levels of malondialdehyde and salivary total protein content than controls (p<0.05). Conversely, no difference in carbonylated proteins or antioxidants (uric acid, vitamin C, peroxidase, and total antioxidant capacity) was observed between DS patients and controls (p>0.05)., Conclusion: Patients with DS are more vulnerable to oxidative stress in saliva as indicated by the significant increase in malondialdehyde and superoxide dismutase concentrations found in this study., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

We analyze the dynamics of a relativistic particle moving in a uniform magnetic field and perturbed by a standing electrostatic wave. We show that a pulsed wave produces an infinite number of perturbative terms with the same winding number, which may generate islands in the same region of phase space. As a consequence, the number of isochronous island chains varies as a function of the wave parameters. We observe that in all the resonances, the number of chains is related to the amplitude of the various resonant terms. We determine analytically the position of the periodic points and the number of island chains as a function of the wave number and wave period. Such information is very important when one is concerned with regular particle acceleration, since it is necessary to adjust the initial conditions of the particle to obtain the maximum acceleration.

We study the dynamics of a relativistic charged particle in the presence of a uniform magnetic field and a stationary electrostatic wave that propagates at an arbitrary angle. The wave is considered as a series of periodic pulses which allows us to derive an exact map for the system. In particular, we investigate the heating process of an initially low-energy particle. It is found that abrupt changes in the maximum energy attained by the particle may occur as the angle between the wave propagation and the magnetic field varies. To determine what is the mechanism behind this phenomenon a reduced Hamiltonian that retains the important dynamical features is obtained. Using both Poincaré plots and perturbation theory, we identify that a separatrix reconnection is the key mechanism for the abrupt change in particle response.

We analyze the behavior of a relativistic particle moving under the influence of a uniform magnetic field and a stationary electrostatic wave. We work with a set of pulsed waves that allows us to obtain an exact map for the system. We also use a method of control for near-integrable Hamiltonians that consists of the addition of a small and simple control term to the system. This control term creates invariant tori in phase space that prevent chaos from spreading to large regions, making the controlled dynamics more regular. We show numerically that the control term just slightly modifies the system but is able to drastically reduce chaos with a low additional cost of energy. Moreover, we discuss how the control of chaos and the consequent recovery of regular trajectories in phase space are useful to improve regular particle acceleration.

The scope of this paper is to analyze the implementation of the Directly Observed Treatment Short-Course (DOTS) strategy in the control of tuberculosis, from the standpoint of the coordinators of the Tuberculosis Control Program (TCP) in six priority municipalities in the state of Paraíba, Brazil. Semi-structured interviews were conducted with seven TCP coordinators. Five municipalities proved to be DOTS success points achieving a 90% cure rate. Among the DOTS weak points in the political dimension, the following aspects were identified: lack of continuity of the TCP coordinator position; lack of preparedness of the local team; precarious technical-administration structure and insufficiency of the laboratory network. In the operational dimension, the search for respiratory symptoms by the Family Health Teams is still low. Changes of an epidemiological, operational and political nature have been incorporated, though the implementation and guarantee of the sustainability of DOTS in the State depends on the way the health services are organized and on the manager's political commitment to support the strategy.

Objectives: Hearing loss is a condition that interferes with the development of the child at a cognitive and language level. Therefore, early diagnosis of deafness is important for (re)habilitation, namely through the use of cochlear implant (CI). The present study aimed at screening CI Portuguese individuals for the presence of mutations in the genes GJB2 and GJB6 (DFNB1 locus), and searching a possible correlation between the genotype and the oral habilitation outcome following implantation., Methods: Our sample included 117 CI individuals implanted longer than 5 years. Sequencing of GJB2 entire coding region was first performed. The presence of deletions del(GJB6-D13S1830) and del(GJB6-D13S1854) was subsequently tested by multiplex PCR. To assess the oral outcome of these individuals, a global score is calculated through a formula that integrates the results of a battery of speech and audiological tests routinely used in ORL services. This global oral performance score was used to test whether individuals with DFNB1-associated deafness perform significantly better than individuals without DFNB1-associated deafness., Results: In 35% of the cases, deafness was clearly associated to DFNB1. The most common mutated allele was c.35delG (85%). Other variants have also been found, namely p.Gly130Ala, p.Asn206Ser, p.Val37Ile, p.Glu47X, p.Arg184Trp, p.Trp24X and the two common GJB6 deletions, del(GJB6-D13S1854) and del(GJB6-D13S1830), the last one identified for the first time in our population. Regarding the oral outcome, after testing the homogeneity of the two groups it could be observed that, in mean, the individuals with DFNB1-associated deafness perform significantly better (p=0.012) than the individuals without DFNB1-associated deafness., Discussion and Conclusion: This first screening of DFNB1 genes in the Portuguese CI population provides clear evidence of the high proportion of DFNB1-associated deafness amongst the Portuguese implanted individuals. DFNB1 status is significantly associated to higher oral performance scores, with DFNB1 individuals performing, on average, 6% better than the individuals without DFNB1-associated deafness., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

We investigate the concept of a standard map for the interaction of relativistic particles and electrostatic waves of arbitrary amplitudes, under the action of external magnetic fields. The map is adequate for physical settings where waves and particles interact impulsively, and allows for a series of analytical result to be exactly obtained. Unlike the traditional form of the standard map, the present map is nonlinear in the wave amplitude and displays a series of peculiar properties. Among these properties we discuss the relation involving fixed points of the maps and accelerator regimes.

We detected an outbreak of American cutaneous leishmaniasis in the Jequitinhonha River Valley, Minas Gerais, Brazil. Clinical and epidemiological aspects were studied for a period of two years. Data include results of physical examinations, Montenegro skin test and serology. In total 72 of the 299 individuals evaluated presented active lesions. Only one case out of these 72 patients showed the mucosal form of the disease. The precarious sanitary conditions, low educational level and low income found in the population studied demonstrated that, as with the other parasitic diseases, cutaneous leishmaniasis occurs with greater frequency in needy populations. A canine serological survey detected 20.3% (30/148) of dogs reactive to the Leishmania antigen. Lutzomyia intermedia was the predominant phlebotomine species and the majority of the specimens (84.9%) were captured in the peridomicile. Four samples from human and three from canine cases were isolated and characterised by PCR and isoenzymes as being Leishmania (Viannia) braziliensis. The peridomiciliary nature of the disease is discussed.

This work aims at continuing the contribution of Brazilian nursing in the elaboration of ICNPâ, which is being constructed by the coordination of ICN. It has two main objectives which are: 1) the definition of the terms identified in the CIPESC project and classified in the axis focus of nursing practice of the Nursing Phenomena Classification of ICNPâ-Beta Version; 2) the validation of these definitions within a group of judges composed of professionals who were previously involved in the execution of the CIPESC project, or who were teachers or nurse assistants in the area of community health nursing. The process was carried out in two phases, considering that the definitions that had a 0.80 rate of Agreement (RA) within the group of judges were validated. Ninety-nine definitions of the terms were validated: 26 attained a RA equal to 1.00; 56 attained a RA between 0.90-0.99 and, 17 attained a RA between 0.80 an 0.89. The definition of one term was not validated.

The physical performance of the patient scintillation dosemeter Skin Dose Monitor (SDM) was evaluated for use in diagnostic radiology. The SDM response was found to be linear, with output air kerma and output air kerma rate having a reproducibility in time lower than +/- 2.4%) (one standard deviation). A calibration protocol taking into account the more significant parameters, such as radiation quality dependence and the relative sensitivity of SDM detectors of the same batch, can be applied so that the maximum overall uncertainty is +/- 18% at the 95% confidence level. The SDM detectors did not show any loss of sensitivity during the 5-month period of evaluation. SDM performance was evaluated against thermoluminescent dosemeters (TLDs) (GR200A) by monitoring chest X-rays in 18 adult patients. The difference in entrance surface dose (ESD) values between the SDM and TLDs was less than 10%, but a lack of accuracy in ESD values of less than 0.3 mGy was observed. The main benefit of the SDM device compared with TLDs is the real-time read-out of dose combined with a better flexibility and rapidity of use for approximately the same cost per measurement. The SDM device is a good candidate for regular measurement of patient doses in diagnostic imaging departments as required under implementation of the European Council Medical Exposure Directive of 30 June 1997.

Unlabelled: This study examines how scatter correction might affect lesion detection and quantitation of tumor-to-normal breast tissue activity ratio in planar scintimammography., Methods: Forty-one phantom acquisitions were performed to mimic a wide variety of scintimammographic imaging conditions in which lesions would be close to the chest wall. For each acquisition, the images corresponding to a 10% energy window (110) and two scatter correction methods [the Jaszczak (JA) method and a factor analysis (FA)-based method] were obtained in addition to the conventional 20% image (120). A total of 368 images in which detection of the "tumor" was judged borderline were selected, and 10 independent observers were asked to detect lesions in these images. Receiver operating curve analyses were performed to assess detection performance. Tumor-to-normal tissue activity ratios were calculated for quantitative analysis., Results: Detection performance significantly improved for the I10, JA and FA images compared to the 120 images, with an increase in sensitivity up to 8% for FA images. Sensitivity was especially increased for small lesions (13- and 16-mm3 spheres) and true heart-to-normal tissue activity ratios of > 12. Scatter correction also increased the certainty with which the readers gave their judgment. The tumor-to-normal tissue activity ratio was approximately 8% larger on JA or FA images and 1% larger on the I10 images compared to the 120 images. For a given image, the variability with which this ratio was estimated was reduced by approximately 4% on JA and FA images., Conclusion: Based on these phantom results, scatter correction might be used with benefit in scintimammography.

We present 3 eyes that underwent photorefractive keratectomy (PRK) for residual myopia after penetrating keratoplasty, and 1 eye that was treated for recurrent granular dystrophy and myopia following penetrating keratoplasty. The 3 refractive eyes experienced improvements in visual acuity and refractive error through 3 months postoperative, but exhibited regression of effect after 6 months postoperative. One eye also exhibited substantial corneal haze at three months postoperative that was not responsive to steroid retreatment. The eye with granular dystrophy obtained symptomatic relief as well as improvement in vision. We tentatively conclude that the corneal transplant reacts to photorefractive keratectomy in much the same way as a normal cornea. Eyes with substantial degrees of post-graft myopia exhibit regression of refractive effect, much like high myopes following primary photorefractive keratectomy. Photorefractive was unable to prevent the recurrence of granular dystrophy in the transplanted tissue. The eyes reported here achieved only modest long-term visual and refractive improvements.