Whole-body magnetic resonance imaging in children – how and why? A systematic review

Whole-body magnetic resonance imaging (MRI) is increasingly being used for a number of indications. Our aim was to review and describe indications and scan protocols for diagnostic value of whole-body MRI for multifocal disease in children and adolescents, we conducted a systematic search in Medline, Embase and Cochrane for all published papers until November 2018. Relevant subject headings and free text words were used for the following concepts: 1) whole-body, 2) magnetic resonance imaging and 3) child and/or adolescent. Included were papers in English with a relevant study design that reported on the use and/or findings from whole-body MRI examinations in children and adolescents. This review includes 54 of 1,609 papers identified from literature searches. Chronic nonbacterial osteomyelitis, lymphoma and metastasis were the most frequent indications for performing a whole-body MRI. The typical protocol included a coronal STIR (short tau inversion recovery) sequence with or without a coronal T1-weighted sequence. Numerous studies lacked sufficient data for calculating images resolution and only a few studies reported the acquired voxel volume, making it impossible for others to reproduce the protocol/images. Only a minority of the included papers assessed reliability tests and none of the studies documented whether the use of whole-body MRI affected mortality and/or morbidity. Our systematic review confirms significant variability of technique and the lack of proven validity of MRI findings. The information could potentially be used to boost attempts towards standardization of technique, reporting and guidelines development

'A bed in the middle of nowhere': parents' meanings of place of death for adults with cystic fibrosis

As populations age and chronic conditions become more prevalent, an individual's ability to choose the location of their end-of-life care and death is increasingly considered important in the provision of good healthcare, with home implied as the 'best' place of death through UK government policy and specialist and voluntary palliative care services. However, considering meanings of place of end-of-life care and death is complex for young adults with life-limiting conditions where the disease course is variable and uncertain, and aggressive and palliative treatments are administered both at home and in hospital often until death. Although 'place' is a pivotal element in healthcare practice, research and policy, there has been little attempt to understand the meaning and importance of place in understanding experiences of care at end of life. Through analysis of in-depth interviews and letters received from parents of 27 young adults in England, Scotland and Wales who died from cystic fibrosis from 1999 to 2002 aged 17-36 years, key factors that influence families' meanings of place at end of life are presented. Both home and hospital deaths are reported, with no deaths in hospices. Preferences for possible locations of death are generally limited early in the disease course by choice of aggressive treatment, particularly lung transplantation. Rate of health decline, organisation and delivery of services, and relationships with specialist and general healthcare staff strongly influence parents' experience of death at home or in hospital, although no physical location was regarded a 'better' place of death. Meanings of, and attachment to place are mediated for families through these factors, questioning the appropriateness of a 'home is best' policy for those dying from life-limiting conditions. © 2009 Elsevier Ltd. All rights reserved

Whole-body MRI in children and adolescents: Can T2-weighted Dixon fat-only images replace standard T1-weighted images in the assessment of bone marrow?

Objective: When performing whole-body MRI for bone marrow assessment in children, optimizing scan time is crucial. The aim was to compare T2 Dixon fat-only and TSE T1-weighted sequences in the assessment of bone marrow high signal areas seen on T2 Dixon water-only in healthy children and adolescents. Materials and methods: Whole-body MRIs from 196 healthy children and adolescents aged 6 to 19 years (mean 12.0) were obtained including T2 TSE Dixon and T1 TSE-weighted images. Areas with increased signal on T2 Dixon water-only images were scored using a novel, validated scoring system and classified into “minor” or “major” findings according to size and intensity, where “major” referred to changes easily being misdiagnosed as pathology in a clinical setting. Areas were assessed for low signal on T2 Dixon fat-only images and, after at least three weeks to avoid recall bias, on the T1-weighted sequence by two experienced pediatric radiologists. Results: 1250 high signal areas were evaluated on T2 Dixon water-only images. In 1159/1250 (92.7%) low signal was seen on both T2 Dixon fat-only and T1-weighted sequences while in 24 (1.9%) it was not present on either sequence, with an absolute agreement of 94.6%. Discordant findings were found in 67 areas, of which in 18 (1.5%) low signal was visible on T1-weighted images alone and in 49 (3.9%) on T2 Dixon fat-only alone. The overall kappa value between the two sequences was 0.39. The agreement was higher for major as compared to minor findings (kappa values of 0.69 and 0.29, respectively) and higher for the older age groups. Conclusion: T2 Dixon fat-only can replace T1-weighted sequence on whole-body MRI for bone marrow assessment in children over the age of nine, thus reducing scan time

Factors influencing the prevalence of resistance-associated substitutions in NS5A protein in treatment-naive patients with chronic hepatitis C

Direct-acting antivirals (DAAs) revolutionized treatment of hepatitis C virus (HCV) infection. Resistance-associated substitutions (RASs) present at the baseline impair response to DAA due to rapid selection of resistant HCV strains. NS5A is indispensable target of the current DAA treatment regimens. We evaluated prevalence of RASs in NS5A in DAA-naïve patients infected with HCV 1a (n = 19), 1b (n = 93), and 3a (n = 90) before systematic DAA application in the territory of the Russian Federation. Total proportion of strains carrying at least one RAS constituted 35.1% (71/202). In HCV 1a we detected only M28V (57.9%) attributed to a founder effect. Common RASs in HCV 1b were R30Q (7.5%), L31M (5.4%), P58S (4.4%), and Y93H (5.4%); in HCV 3a, A30S (31.0%), A30K (5.7%), S62L (8.9%), and Y93H (2.2%). Prevalence of RASs in NS5A of HCV 1b and 3a was similar to that worldwide, including countries practicing massive DAA application, i.e., it was not related to treatment. NS5A with and without RASs exhibited different co-variance networks, which could be attributed to the necessity to preserve viral fitness. Majority of RASs were localized in polymorphic regions subjected to immune pressure, with selected substitutions allowing immune escape. Altogether, this explains high prevalence of RAS in NS5A and low barrier for their appearance in DAA-inexperienced population.Fil: Kyuregyan, Karen K.. Russian Academy Of Sciences; Rusia. Russian Medical Academy Of Continuous Professional Education; Rusia. I. I. Mechnikov Research Institute For Vaccines And Sera; RusiaFil: Kichatova, Vera S.. Russian Medical Academy Of Continuous Professional Education; Rusia. Russian Academy Of Sciences; Rusia. I. I. Mechnikov Research Institute For Vaccines And Sera; RusiaFil: Karlsen, Anastasiya A.. I. I. Mechnikov Research Institute For Vaccines And Sera; Rusia. Russian Medical Academy Of Continuous Professional Education; Rusia. Russian Academy Of Sciences; RusiaFil: Isaeva, Olga V.. I. I. Mechnikov Research Institute For Vaccines And Sera; Rusia. Russian Medical Academy Of Continuous Professional Education; RusiaFil: Solonin, Sergei A.. N.V. Sklifosovsky Research Institute for Emergency Medicine; RusiaFil: Petkov, Stefan. Karolinska Huddinge Hospital. Karolinska Institutet; SueciaFil: Nielsen, Morten. Technical University of Denmark; Dinamarca. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Biotecnológicas. Universidad Nacional de San Martín. Instituto de Investigaciones Biotecnológicas; ArgentinaFil: Isaguliants, Maria G.. Russian Academy Of Sciences; Rusia. Karolinska Huddinge Hospital. Karolinska Institutet; SueciaFil: Mikhailov, Mikhail I.. Russian Medical Academy Of Continuous Professional Education; Rusia. I. I. Mechnikov Research Institute For Vaccines And Sera; Rusi

Whole body magnetic resonance imaging in healthy children and adolescents: Bone marrow appearances of the appendicular skeleton

Objective: To describe the appearances of bone marrow in the appendicular skeleton on fat-suppressed T2- weighted sequences as assessed by whole-body MRI in healthy and asymptomatic children and adolescents. Material and methods: Following ethical approval, we assessed the bone marrow of the extremities on water-only Dixon T2-weighted images as part of a whole-body MRI in 196 healthy and asymptomatic children aged 5–19 years. Based on a newly devised and validated scoring system, we graded intensity (0–2 scale) and extension (1–4 scale) of focal high signal bone marrow areas, and divided them into minor or major findings, based on intensity and extension, reflecting their potential conspicuousness in a clinical setting. Results: In the upper extremity, we registered 366 areas with increased signal whereof 79 were major findings. In the lower extremities there were 675 areas of increased signal of which 340 were major findings. Hundred-andfifteen (58.79%) individuals had at least one major finding, mainly located in the hand and proximal humerus, and the feet and knees. We found no differences according to gender, reported hours of sports activity, handedness, or age group, except for more minor findings in the upper extremities amongst 15–18-year-olds as compared to those aged 5–8 years. Conclusion: Focal areas of high signal intensity on whole-body MRI, T2-weighted fat suppressed images that, in a clinical setting could cause concern, were seen in more than half of healthy, asymptomatic children and adolescents. Awareness of this is important when interpreting whole-body MRI in this age group, particularly in the assessment of clinically silent lesions

Behavioural responses of wild, spawning Atlantic cod (Gadus morhua L.) to seismic airgun exposure

Seismic airgun surveys to map petroleum deposits in the seabed may impact behaviour of marine animals over large distances. Understanding whether fish spawning behaviour is affected by this anthropogenic noise source is important because reproductive success may be impacted. The fine-scale behavioural responses of Atlantic cod to airgun exposure over an extended period were investigated using an acoustic telemetry positioning system on a spawning ground in Norway. During 2019 to 2021, 135 spawning cod were equipped with telemetry sensor tags and were exposed to airgun shooting during the spawning periods of 2020 and 2021, with varying received sound levels comparable to a full-scale survey at distances of 5 to >40 km. Cod demonstrated only weak responses to the disturbance from repeated 3-h treatment periods over 5-d, swimming on average slightly deeper during seismic exposure compared to silent control periods. This response varied between individuals. Longer-term effects of seismic exposure on swimming depth were not detected. No changes in swimming acceleration, displacement, or area use occurred. These results suggest that relatively distant seismic surveys do not substantially alter cod behaviour during the spawning period at received sound exposure levels varying between 115 and 145 dB re 1 µPa2s over a 5-d period.publishedVersio

Coverage with timely administered vaccination against hepatitis b virus and its influence on the prevalence of HBV infection in the regions of different endemicity

Funding Information: Funding: This research was funded by grant of the Russian Science Foundation (ID-20-15-00148). Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Universal hepatitis B vaccination of newborns was implemented in Russia starting from 1998. From 1998 to 2019, the incidence of acute hepatitis B reduced from 43.8 to 0.57 cases per 100,000 population. Here, we assessed the timely coverage of newborns with the birth dose (HepB-BD), second dose (HepB-2nd), and three vaccine doses (HepB3) in two remote regions of Russia with low (Belgorod Oblast) and high (Yakutia) levels of hepatitis B virus (HBV) endemicity. Vaccination data were obtained from the medical records of 1000 children in Yakutia and 2182 children in Belgorod Oblast. Sera of healthy volunteers from Belgorod Oblast (n = 1754) and Yakutia (n = 1072) across all age groups were tested for serological markers of HBV to assess the infection prevalence and herd immunity. Average HepB-BD coverage was 99.2% in Yakutia and 89.4% in Belgorod Oblast (p < 0.0001) and in both regions varied significantly, from 66% to 100%, between medical centers. The principal reason for the absence of HepB-BD was parent refusal, which accounted for 63.5% of cases of non-vaccination (83/123). While timely HepB-2nd coverage was only 55.4%–64.7%: HepB3 coverage by the age of one year exceeded 90% in both study regions. HBV surface antigen (HBsAg) prevalence in the 1998–2019 birth cohort was 0.2% (95% CI: 0.01–1.3%) in Belgorod Oblast and 3.2% (95% CI: 1.9–5.2%) in Yakutia. The proportion of persons testing negative for both antibodies to HBsAg (anti-HBs) and antibodies to HBV core antigen (anti-HBc) in the 1998–2019 birth cohort was 26.2% (125/481) in Belgorod Oblast and 32.3% (162/501) in Yakutia. We also assessed the knowledge of and attitude towards vaccination among 782 students and teachers of both medical and non-medical specialties from Belgorod State University. Only 60% of medical students knew that hepatitis B is a vaccine-preventable disease. Both medical and nonmedical students, 37.8% and 31.3%, respectively, expressed concerns about safety and actual necessity of vaccination. These data indicate the need to introduce a vaccine delivery audit system, improve medical education with respect to vaccination strategies and policies, and reinforce public knowledge on the benefits of vaccination.Peer reviewe

Single-centre, triple-blinded, randomised, 1-year, parallel-group, superiority study to compare the effects of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes and β-cell function in subjects with morbid obesity: a protocol for the Obesity surgery in Tønsberg (Oseberg) study

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MPs’ principals and the substantive representation of disadvantaged immigrant groups

This article provides an alternative understanding of the substantive representation of immigrant-origin citizens compared to previous work in the ‘politics of presence’ tradition. Rather than assuming that the representational activities of members of parliaments (MPs) are underpinned by intrinsic motivations, it highlights extrinsic motives. Drawing on principal–agent theory, the article conceptualises MPs as delegates who are to act on behalf of their main principals, constituents and party bodies. This approach permits the rigorous analysis of the impact of electoral rules, candidate selection methods and legislative organisation on substantive representation. Based on an analysis of more than 20,000 written parliamentary questions tabled in the 17th German Bundestag (2009–2013), empirical findings suggest that electoral rules do not influence the relationship between MPs and their principals in relation to the substantive representation of disadvantaged immigrant groups; however, results indicate that candidate selection methods as well as powerful parliamentary party group leaderships do