Preclinical Cushing's syndrome in adrenal incidentalomas

Adrenal tumors are usually diagnosed by clinical symptoms of hormone excess. The increasing use of ultrasound and computed tomography results in the detection of a substantial number of incidentally discovered adrenal tumors. Most of these tumors are nonfunctional adrenocortical adenomas, but a few cases of subclinical cortisol production in "incidentalomas" have been reported. We investigated prospectively the prevalence of autonomous cortisol production in 68 patients (44 females and 24 males, aged 25-90 yr) with adrenal incidentalomas at our institution. As a screening procedure all patients with incidentalomas underwent an overnight dexamethasone suppression test (1 mg). Patients who failed to suppress serum cortisol below 140 nmol/L (5 micrograms/dL) underwent more comprehensive studies (prolonged dexamethasone suppression test, determination of the diurnal rhythm of cortisol secretion in saliva, and CRH stimulation test). Eight patients (12% of all patients with incidentalomas; 5 females and 3 males, aged 25-71 yr) were finally identified as having cortisol- producing tumors, and the findings in these patients were compared with those of overt Cushing's syndrome in 8 patients (8 females, aged 26-50 yr) suffering from cortisol-producing adrenal adenomas. The tumor size of patients with cortisol-producing incidentalomas ranged from 2-5 cm. No specific signs and symptoms of hypercortisolism were present, but arterial hypertension (seven of eight subjects), diffuse obesity (four of eight subjects), and noninsulin-dependent diabetes mellitus (NIDDM; two of eight subjects) were frequently observed. Baseline cortisol levels were in the normal to upper normal range, whereas baseline ACTH levels were suppressed in five of the eight patients. In none of the patients was serum cortisol suppressible by low dose or high dose dexamethasone. The ACTH and cortisol responses to CRH were normal in two, blunted in one, and suppressed in four patients. Unilateral adrenalectomy was performed in seven patients and resulted in temporary adrenal insufficiency in four of them. After surgery, improvement of arterial hypertension, a permanent weight loss in obese subjects, and a better metabolic control of NIDDM were noted in the majority of patients. The following conclusions were reached. Incidentally diagnosed adrenal tumors with pathological cortisol secretion in otherwise clinically asymptomatic patients are more frequently observed than previously assumed. Adrenocortical insufficiency is a major risk in these patients after adrenalectomy. After surgery, hypertension, obesity, and NIDDM may improve. Patients with asymptomatic adrenal incidentalomas, therefore, should be screened for cortisol production by means of an overnight dexamethasone suppression test

Study design for concurrent development, assessment, and implementation of new diagnostic imaging technology

With current constraints on health care resources and emphasis on value for money, new diagnostic imaging technologies must be assessed and their value demonstrated. The state of the art in the field of diagnostic imaging technology assessment advocates a hierarchical step-by-step approach. Although rigorous, such a hierarchical assessment is time-consuming, and, given the current rapid advances in technology, results are often too late to influence management and policy decisions. The purpose of this article is to discuss a study design in which development, assessment, and implementation of new diagnostic imaging technology take place concurrently in one integrated process. An empirically based pragmatic study design is proposed for imaging technology assessment. To minimize bias and enable comparison with current technology, a randomized controlled design is used whenever feasible and ethical. Outcome measures should reflect the clinical decision-making process based on imaging information and acceptance of the new test. Outcome measures can include additional imaging studies requested, costs of diagnostic work-up and treatment, physicians' confidence in therapeutic decision making, recruitment rate, and patient outcome measures related to the clinical problem. The key feature of the proposed study design is analysis of trends in outcome measures over time

Women in radiology: gender diversity is not a metric-it is a tool for excellence.

Women in Focus: Be Inspired was a unique programme held at the 2019 European Congress of Radiology that was structured to address a range of topics related to gender and healthcare, including leadership, mentoring and the generational progression of women in medicine. In most countries, women constitute substantially fewer than half of radiologists in academia or private practice despite frequently accounting for at least half of medical school enrolees. Furthermore, the proportion of women decreases at higher academic ranks and levels of leadership, a phenomenon which has been referred to as a "leaky pipeline". Gender diversity in the radiologic workplace, including in academic and leadership positions, is important for the present and future success of the field. It is a tool for excellence that helps to optimize patient care and research; moreover, it is essential to overcome the current shortage of radiologists. This article reviews the current state of gender diversity in academic and leadership positions in radiology internationally and explores a wide range of potential reasons for gender disparities, including the lack of role models and mentorship, unconscious bias and generational changes in attitudes about the desirability of leadership positions. Strategies for both individuals and institutions to proactively increase the representation of women in academic and leadership positions are suggested. KEY POINTS: • Gender-diverse teams perform better. Thus, gender diversity throughout the radiologic workplace, including in leadership positions, is important for the current and future success of the field. • Though women now make up roughly half of medical students, they remain underrepresented among radiology trainees, faculty and leaders. • Factors leading to the gender gap in academia and leadership positions in Radiology include a lack of role models and mentors, unconscious biases, other societal barriers and generational changes

How the malaria research community responds to funding opportunities

Thesis (S.M. in Technology and Policy)--Massachusetts Institute of Technology, Engineering Systems Division, 2010.Cataloged from PDF version of thesis.Includes bibliographical references (p. 102-108).Agencies that fund research shape both the rate and direction of scientific progress through the resource allocation choices they make. However, our understanding of the degree to which scientists respond to shifts in that allocation is very limited. How does the scientific community reorganize itself and gain new entrants? How do research priorities change? What collaborative arrangements are formed with the advent of more funding? In this study malaria research is used as a setting in which to explore these critical issues. This provides a useful context not only because it is a relatively small and easily identifiable research community, but also because funding for malaria research has increased more than fourfold over the past 15 years first through a large expansion of the NIH budget and subsequently through the entry of the Bill and Melinda Gates foundation. This provides a quasi-experimental setting to explore how scientific communities react to funding incentives. In particular changes in productivity of scientists, the entry of other biologists into the field of malaria, the diversity of the scientific community and individual research lines pursued, and the collaborative agreements struck, are examined here. The research methods include a bibliometric analysis of the malaria publication space and extensive interviews and discussions with malaria researchers and global health experts. The analysis suggests that when funding is scaled up rapidly, scientific output increases at diminishing returns. Publication growth was accounted for primarily by the entry of scientists into the field of malaria in the late 1990s and onwards, while individual productivity rates remained flat in the advent of more funding. Furthermore, there was a shift in research emphasis towards more applied translational research, particularly drug and vaccine development. Finally, the network of researchers and policy makers became more collaborative, but also concentrated decision making power into the hands of a small, tight-knit global health community.by Ruth Viviane Krestin.S.M.in Technology and Polic

Benign versus malignant hepatic nodules: MR imaging findings with pathologic correlation

According to the currently used nomenclature, there are only two types of hepatocellular nodular lesions: regenerative lesions and dysplastic or neoplastic lesions. Regenerative nodules include monoacinar regenerative nodules, multiacinar regenerative nodules, cirrhotic nodules, segmental or lobar hyperplasia, and focal nodular hyperplasia. Dysplastic or neoplastic nodules include hepatocellular adenoma, dysplastic foci, dysplastic nodules, and hepatocellular carcinoma (HCC). Many of these types of hepatic nodules play a role in the de novo and stepwise carcinogenesis of HCC, which comprises the following steps: regenerative nodule, low-grade dysplastic nodule, high-grade dysplastic nodule, small HCC, and large HCC. State-of-the-art magnetic resonance (MR) imaging facilitates detection and characterization in most cases of hepatic nodules. State-of-the-art MR imaging includes single-shot fast spin-echo imaging, in-phase and opposed-phase T1-weighted gradient-echo imaging, T2-weighted fast spin-echo imaging with fat saturation, and two-dimensional or three-dimensional dynamic multiphase contrast material-enhanced imaging

Usulan Perbaikan Kualitas Menggunakan Metode Failure Mode And Effect Analysis (FMEA) Pada Unit Produksi Sheeting Line Proses Penggilingan Di PT. Supratama Aneka Industri

Saat ini berbagai perusahaan industri sedang mengalami perkembangan. Salah satunya PT. Supratama Aneka Industri adalah pabrik yang bergerak di bidang industri manufaktur, yang memproduksi berbagai macam aneka jenis dari hasil penggilingan biji plastik salah satunya mangkuk plastik dengan merek (super bubur). Adapun permasalahan yang sering terjadi dan dikeluhkan yaitu mengenai tentang kecacatan produk dari mangkuk plastik yang masih sering terjadi di perusahaan. Maka dari itu sebagai upaya untuk mendukung dan mengevaluasi kebijakan dalam mengatasi kecacatan yang terjadi di perusahaan, yaitu dengan menggunakan Statistical Process Control, dengan tahapan alat bantu dari check sheet, peta kendali, dan diagram tulang ikan (fishbone diagram). Hasil penelitian menunjukan bahwa kecacatan yang terjadi pada perusahaan terbagi menjadi beberapa jenis diantaranya yaitu karena mangkuk cacat yang terlalu panas/tipis, terdapat flashing pada mangkuk, dan terdapat sink mark pada mangkuk. Berdasarkan data yang sudah diteliti pada bulan Oktober hingga November 2020 dalam pelaksanaan proses produksi mangkuk plastik, perusahaan memililiki kecacatan sebesar 1.807/pcs. Selanjutnya faktor kecacatan lain pada mangkuk yaitu karena lingkungan, mesin, human error, material, dan metode. Dari permasalahan diagram tulang ikan, ada upaya yang dilakukan sebagai usulan dalam perbaikan, maka digunakan Failure Mode and Effect Analysis (FMEA) sebagai metode untuk menganalisa dengan tujuan untuk mengidentifikasi dan mengetahui lebih lanjut masalah yang paling dominan dengan ranking yang paling tertinggi pada kecacatan mangkuk dari proses produksi

Soft tissue sarcomas at a glance: clinical, histological, and MR imaging features of malignant extremity soft tissue tumors

Soft tissue sarcomas comprise approximately 1% of malignant tumors. There are more than 50 subtypes, but pleomorphic sarcoma, liposarcoma, leiomyosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor account for 75%. Differentiation between these subtypes is difficult because they often present with a painless enlarging mass, and share many histological and MR imaging features. Nonetheless, subdifferentiation is important because the different subtypes have different prognoses and therapeutic strategies. In this manuscript we discuss the clinical, histological, and MR imaging features of soft tissue sarcomas according to the WHO classification. An overview is provided and differentiating features are discussed that can help to narrow down the differential diagnosis

Labelling of mammalian cells for visualisation by MRI

Through labelling of cells with magnetic contrast agents it is possible to follow the fate of transplanted cells in vivo with magnetic resonance imaging (MRI) as has been demonstrated in animal studies as well as in a clinical setting. A large variety of labelling strategies are available that allow for prolonged and sensitive detection of the labelled cells with MRI. The various protocols each harbour specific advantages and disadvantages. In choosing a particular labelling strategy it is also important to ascertain that the labelling procedure does not negatively influence cell functionality, for which a large variety of assays are available. In order to overcome the challenges still faced in fully exploiting the benefits of in vivo cell tracking by MRI a good understanding and standardisation of the procedures and assays used will be crucial

Genicular artery embolization as a novel treatment for mild to moderate knee osteoarthritis:protocol design of a randomized sham-controlled clinical trial

INTRODUCTION: Knee osteoarthritis is a common disease with pain as the most prevalent symptom. Previous cohort studies have shown genicular artery embolization to reduce pain symptoms in patients with mild to moderate knee osteoarthritis. Patients resistant to conservative therapy but not eligible yet for surgical treatment due to young age or comorbidities may profit from an effective and sustained pain reduction treatment. This study is a randomized sham-controlled trial to evaluate the efficacy of genicular artery embolization in patients with knee osteoarthritis. METHODS AND ANALYSIS: Fifty-eight patients with mild-to-moderate knee osteoarthritis will be recruited and randomly allocated to the treatment or control group in a 1:1 ratio. Participants in the treatment group will undergo genicular artery embolization. Patients in the control group will undergo sham treatment. Outcome measurements will be assessed at baseline and after 1, 4, 8, and 12 months with questionnaires, pressure pain threshold testing, and MR imaging. The MR imaging protocol is designed to (semi)quantitatively assess osteoarthritis in the knee joint. The primary outcome is the change from baseline of the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscale after 4 months. Secondary outcomes include change in osteoarthritis-related questionnaires, pressure pain threshold, and OA-related MRI features, particularly synovitis and bone marrow lesions. ETHICS AND DISSEMINATION: This trial will determine the efficacy of genicular artery embolization compared to a sham treatment. This is of importance to assess before proceeding to larger-scale efficiency studies and, ultimately, implementing this treatment into day to day clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov NCT03884049. Registered on 21 March 201