Performance of imaging studies in patients with suspected appendicitis after stratification with adult appendicitis score

Background: Diagnostic scoring is used to stratify patients with suspected appendicitis into three groups: high, intermediate, and low probability of appendicitis. The stratification can be used for selective imaging to avoid the harms of radiation without compromising diagnostic accuracy. The aim was to study how stratification by Adult Appendicitis Score affects diagnostic performance of imaging studies. Methods: Analysis of 822 patients who underwent diagnostic imaging for suspected appendicitis was made. Adult Appendicitis Score was used to stratify patients into groups of high, intermediate, and low probability of appendicitis. Diagnostic performance of computed tomography (CT) and ultrasound (US) was compared between these patient groups. Results: After scoring, pre-test probability of appendicitis ranged from 9-16% in low probability group to 75-79% in high probability group in patients who underwent US or CT. Post-test probability of appendicitis after positive CT was 99, 91, and 75% in high probability, intermediate probability and low probability groups, respectively, p <0.001. After positive US the respective probabilities were 95, 91 and 42%, p <0.001. Conclusion: Diagnostic imaging has limited value in patients with low probability of appendicitis according to Adult Appendicitis Score.Peer reviewe

A retrospective study of intraductal papillary neoplasia of the pancreas (IPMN) under surveillance

Background and objective: The growing number of identified intraductal papillary mucinous neoplasm (IPMN) patients places greater pressure on healthcare systems. Only a minority of patients have IPMN-related symptoms. Thus, more precise surveillance is required. Methods: In this retrospective single-center cross-sectional study, patients with an active diagnosis of branch duct IPMN (BD-IPMN) and >6 months of surveillance were classified as follows: presence/absence of worrisome features (WF) or high-risk stigmata (HRS), newly developed WF/HRS, under/over 15 mm cyst, growing/not growingPeer reviewe

Many-body aspects of positron annihilation in the electron gas

We investigate positron annihilation in electron liquid as a case study for many-body theory, in particular the optimized Fermi Hypernetted Chain (FHNC-EL) method. We examine several approximation schemes and show that one has to go up to the most sophisticated implementation of the theory available at the moment in order to get annihilation rates that agree reasonably well with experimental data. Even though there is basically just one number to look at, the electron-positron pair distribution function at zero distance, it is exactly this number that dictates how the full pair distribution behaves: In most cases, it falls off monotonously towards unity as the distance increases. Cases where the electron-positron pair distribution exhibits a dip are precursors to the formation of bound electron--positron pairs. The formation of electron-positron pairs is indicated by a divergence of the FHNC-EL equations, from this we can estimate the density regime where positrons must be localized. This occurs in our calculations in the range 9.4 <= r_s <=10, where r_s is the dimensionless density parameter of the electron liquid.Comment: To appear in Phys. Rev. B (2003

Self-consistent Overhauser model for the pair distribution function of an electron gas in dimensionalities D=3 and D=2

We present self-consistent calculations of the spin-averaged pair distribution function $g(r)$ for a homogeneous electron gas in the paramagnetic state in both three and two dimensions, based on an extension of a model that was originally proposed by A. W. Overhauser [Can. J. Phys. {\bf 73}, 683 (1995)] and further evaluated by P. Gori-Giorgi and J. P. Perdew [Phys. Rev. B {\bf 64}, 155102 (2001)]. The model involves the solution of a two-electron scattering problem via an effective Coulombic potential, that we determine within a self-consistent Hartree approximation. We find numerical results for $g(r)$ that are in excellent agreement with Quantum Monte Carlo data at low and intermediate coupling strength $r_s$, extending up to $r_s\approx 10$ in dimensionality D=3. However, the Hartree approximation does not properly account for the emergence of a first-neighbor peak at stronger coupling, such as at $r_s=5$ in D=2, and has limited accuracy in regard to the spin-resolved components $g_{\uparrow\uparrow}(r)$ and $g_{\uparrow\downarrow}(r)$. We also report calculations of the electron-electron s-wave scattering length, to test an analytical expression proposed by Overhauser in D=3 and to present new results in D=2 at moderate coupling strength. Finally, we indicate how this approach can be extended to evaluate the pair distribution functions in inhomogeneous electron systems and hence to obtain improved exchange-correlation energy functionals.Comment: 14 pages, 7 figuers, to apear in Physical Review

Analytic theory of ground-state properties of a three-dimensional electron gas at varying spin polarization

We present an analytic theory of the spin-resolved pair distribution functions $g_{\sigma\sigma'}(r)$ and the ground-state energy of an electron gas with an arbitrary degree of spin polarization. We first use the Hohenberg-Kohn variational principle and the von Weizs\"{a}cker-Herring ideal kinetic energy functional to derive a zero-energy scattering Schr\"{o}dinger equation for $\sqrt{g_{\sigma\sigma'}(r)}$. The solution of this equation is implemented within a Fermi-hypernetted-chain approximation which embodies the Hartree-Fock limit and is shown to satisfy an important set of sum rules. We present numerical results for the ground-state energy at selected values of the spin polarization and for $g_{\sigma\sigma'}(r)$ in both a paramagnetic and a fully spin-polarized electron gas, in comparison with the available data from Quantum Monte Carlo studies over a wide range of electron density.Comment: 13 pages, 8 figures, submitted to Phys. Rev.

The 2-D electron gas at arbitrary spin polarizations and arbitrary coupling strengths: Exchange-correlation energies, distribution functions and spin-polarized phases

We use a recent approach [Phys. Rev. Letters, {\bf 84}, 959 (2000)] for including Coulomb interactions in quantum systems via a classical mapping of the pair-distribution functions (PDFs) for a study of the 2-D electron gas. As in the 3-D case, the ``quantum temperature'' T_q of a classical 2-D Coulomb fluid which has the same correlation energy as the quantum fluid is determined as a function of the density parameter r_s. Spin-dependent exchange-correlation energies are reported. Comparisons of the spin-dependent pair-distributions and other calculated properties with any available 2-D quantum Monte Carlo (QMC) results show excellent agreement, strongly favouring more recent QMC data. The interesting novel physics brought to light by this study are: (a) the independently determined quantum-temperatures for 3-D and 2-D are found to be approximately the same, (i.e, universal) function of the classical coupling constant Gamma. (b) the coupling constant Gamma increases rapidly with r_s in 2-D, making it comparatively more coupled than in 3-D; the stronger coupling in 2-D requires bridge corrections to the hyper- netted-chain method which is adequate in 3-D; (c) the Helmholtz free energy of spin-polarized and unpolarized phases have been calculated. The existence of a spin-polarized 2-D liquid near r_s = 30, is found to be a marginal possibility. These results pertain to clean uniform 2-D electron systems.Comment: This paper replaces the cond-mat/0109228 submision; the new version include s more accurate numerical evaluation of the Helmholtz energies of the para- and ferromagentic 2D fluides at finite temperatures. (Paper accepted for publication in Phys. Rev. Lett.

Treatment response of colorectal cancer liver metastases to neoadjuvant or conversion therapy : a prospective multicentre follow-up study using MRI, diffusion-weighted imaging and H-1-MR spectroscopy compared with histology (subgroup in the RAXO trial)

Background: Colorectal cancer liver metastases respond to chemotherapy and targeted agents not only by shrinking, but also by morphologic and metabolic changes. The aim of this study was to evaluate the value of advanced magnetic resonance imaging (MRI) methods in predicting treatment response and survival. Patients and methods: We investigated contrast-enhanced MRI, apparent diffusion coefficient (ADC) in diffusionweighted imaging and H-1-magnetic resonance spectroscopy (1H-MRS) in detecting early morphologic and metabolic changes in borderline or resectable liver metastases, as a response to first-line neoadjuvant or conversion therapy in a prospective substudy of the RAXO trial (NCT01531621, EudraCT2011-003158-24). MRI findings were compared with histology of resected liver metastases and KaplaneMeier estimates of overall survival (OS). Results: In 2012-2018, 52 patients at four Finnish university hospitals were recruited. Forty-seven patients received neoadjuvant or conversion chemotherapy and 40 liver resections were carried out. Low ADC values (below median) of the representative liver metastases, at baseline and after systemic therapy, were associated with partial response according to RECIST criteria, but not with morphologic MRI changes or histology. Decreasing ADC values following systemic therapy were associated with improved OS compared to unchanged or increasing ADC, both in the liver resected subgroup (5-year OS rate 100% and 34%, respectively, P = 0.022) and systemic therapy subgroup (5-year OS rate 62% and 23%, P = 0.049). H-1-MRS revealed steatohepatosis induced by systemic therapy. Conclusions: Low ADC values at baseline or during systemic therapy were associated with treatment response by RECIST but not with histology, morphologic or detectable metabolic changes. A decreasing ADC during systemic therapy is associated with improved OS both in all patients receiving systemic therapy and in the resected subgroup.Peer reviewe

Treatment response of colorectal cancer liver metastases to neoadjuvant or conversion therapy : a prospective multicentre follow-up study using MRI, diffusion-weighted imaging and H-1-MR spectroscopy compared with histology (subgroup in the RAXO trial)

Background: Colorectal cancer liver metastases respond to chemotherapy and targeted agents not only by shrinking, but also by morphologic and metabolic changes. The aim of this study was to evaluate the value of advanced magnetic resonance imaging (MRI) methods in predicting treatment response and survival. Patients and methods: We investigated contrast-enhanced MRI, apparent diffusion coefficient (ADC) in diffusionweighted imaging and H-1-magnetic resonance spectroscopy (1H-MRS) in detecting early morphologic and metabolic changes in borderline or resectable liver metastases, as a response to first-line neoadjuvant or conversion therapy in a prospective substudy of the RAXO trial (NCT01531621, EudraCT2011-003158-24). MRI findings were compared with histology of resected liver metastases and KaplaneMeier estimates of overall survival (OS). Results: In 2012-2018, 52 patients at four Finnish university hospitals were recruited. Forty-seven patients received neoadjuvant or conversion chemotherapy and 40 liver resections were carried out. Low ADC values (below median) of the representative liver metastases, at baseline and after systemic therapy, were associated with partial response according to RECIST criteria, but not with morphologic MRI changes or histology. Decreasing ADC values following systemic therapy were associated with improved OS compared to unchanged or increasing ADC, both in the liver resected subgroup (5-year OS rate 100% and 34%, respectively, P = 0.022) and systemic therapy subgroup (5-year OS rate 62% and 23%, P = 0.049). H-1-MRS revealed steatohepatosis induced by systemic therapy. Conclusions: Low ADC values at baseline or during systemic therapy were associated with treatment response by RECIST but not with histology, morphologic or detectable metabolic changes. A decreasing ADC during systemic therapy is associated with improved OS both in all patients receiving systemic therapy and in the resected subgroup.Peer reviewe

Centralized repeated resectability assessment of patients with colorectalliver metastases during first-line treatment : prospective study

Y Background: Metastasectomy is probably underused in metastatic colorectal cancer. The aim of this study was to investigate the effect of centralized repeated assessment on resectability rate of liver metastases. Methods: The prospective RAXO study was a nationwide study in Finland. Patients with treatable metastatic colorectal cancer at any site were eligible. This planned substudy included patients with baseline liver metastases between 2012 and 2018. Resectability was reassessed by the multidisciplinary team at Helsinki tertiary referral centre upfront and twice during first-line systemic therapy. Outcomes were resectability rates, management changes, and survival. Results: Of 812 patients included, 301 (37.1 per cent) had liver-only metastases. Of these, tumours were categorized as upfront resectable in 161 (53.5 per cent), and became amenable to surgery during systemic treatment in 63 (20.9 per cent). Some 207 patients (68.7 per cent) eventually underwent liver resection or ablation. At baseline, a discrepancy in resectability between central and local judgement was noted for 102 patients (33.9 per cent). Median disease-free survival (DFS) after first resection was 20 months and overall survival (OS) 79 months. Median OS after diagnosis of metastatic colorectal cancer was 80, 32, and 21 months in R0-1 resection, R2/ablation, and non-resected groups, and 5-year OS rates were 68, 37, and 9 per cent, respectively. Liver and extrahepatic metastases were present in 511 patients. Of these, tumours in 72 patients (14.1 per cent) were categorized as upfront resectable, and 53 patients (10.4 per cent) became eligible for surgery. Eventually 110 patients (21.5 per cent) underwent liver resection or ablation. At baseline, a discrepancy between local and central resectability was noted for 116 patients (22.7 per cent). Median DFS from first resection was 7 months and median OS 55 months. Median OS after diagnosis of metastatic colorectal cancer was 79, 42, and 17 months in R0-1 resection, R2/ablation, and non-resected groups, with 5-year OS rates of 65, 39, and 2 per cent, respectively. Conclusion: Repeated centralized resectability assessment in patients with colorectal liver metastases improved resection and survival rates.Peer reviewe