Improving the Accuracy of DaT Scan Interpretation: a retrospective study to identify variables that standardize the review of DaT scans for idiopathic Parkinson’s disease

Introduction: Until recently, the diagnosis of Parkinson’s disease (PD) has been based solely on clinical observation. The DaT scan is a tool that allows clinicians to visualize areas of neurodegeneration in PD and can help guide diagnosis. However, there is a discordance between clinical judgement and interpretation of DaT scans. In this study, we aim to improve the utility of DaT scans in the diagnosis of PD by identifying factors that can lead to a misdiagnosis and determine which image findings predict a clinical syndrome of parkinsonism. Methods: We will conduct a retrospective chart review to analyze DaT scans of 100 patients clinically diagnosed with PD. We will calculate the initial SN/SP/PPV/NPV for diagnoses based clinically compared to scan. We will then blindly review and reclassify all scans as definitely abnormal, definitely normal, or indeterminate. We will then recalculate a revised SN/SP/PPV/NPV to see if these values changed following reanalysis. From the discordant scans, we will attempt to identify factors that can further assist in interpreting DaT scans. Results: Patients have been identified and we are in the process of extracting data. We anticipate that after systematic, careful re-review, the specificity of DaT scans will be higher, due to improvement in identifying positive scans. Discussion: Imaging can be costly and cumbersome for patients and clinicians alike. Currently, DaT scans do not offer an improved accuracy in diagnosis over clinical judgement. If the interpretation of DaT scans can be optimized, they will be of greater utility to both patients and physicians

Edoardo Bassini (1844-1924): father of modern-day hernia surgery.

According to Roman scripture, it was Celsus who attempted the first inguinal hernia repair in history during the first century A.D. His attempts were unsuccessful and resulted in an early recurrence of the hernia, which eventually led to the patient’s death.1 Over the next two millennia, little understanding was gained regarding the anatomy of the inguinal canal. It was only in the last 100 years that major advancements in herniorrhaphy were established, thanks in large part to the work of Edoardo Bassini, who revolutionized the surgical treatment of the inguinal hernia with a technique which has become the basis of modern-day herniorrhaphy

Multiplicity, average transverse momentum and azimuthal anisotropy in U+U collisions at sNN\sqrt{s_{NN}} = 200 GeV using AMPT model

Using a multi-phase transport (AMPT) model that includes the implementation of deformed Uranium nuclei, we have studied the centrality dependence of the charged particle multiplicity, , eccentricity (e2), triangularity (e3), their fluctuations, elliptic flow (v2) and triangular flow (v3) for different configurations of U+U collisions at midrapidity for \sqrt(s_NN)=200 GeV. The results are compared to the corresponding observations from Au+Au collisions. We find that for the U+U collisions the dNch/d\eta at midrapidity is enhanced by about 15-40% depending on the collision and model configuration chosen, compared to Au+Au collisions. The tip-to-tip collisions leads to the largest values of Nch,transverse energy (ET) and . The and its fluctuation shows a rich centrality dependence, whereas not much variations are observed for and its fluctuations. The U+U side-on-side collision configuration provides maximum values of and minimum values of eccentricity fluctuations, whereas for peripheral collisions and mid-central collisions minimum values of and maximum value of eccentricity fluctuations are observed for body-to-body configuration and the tip-to-tip configuration has minimum value of and maximum value of eccentricity fluctuations for central collisions. The calculated v2 closely correlates with the eccentricity in the model. It is smallest for the body-to-body configuration in peripheral and mid-central collisions while it is minimum for tip-to-tip configuration in central collisions. For peripheral collisions the v2 in U+U can be about 40% larger than in Au+Au whereas for central collisions it can be a factor 2 higher depending on the collision configuration. It is also observed that the v3(pT) is higher for tip-to-tip and body-to-body configurations compared to other systems for the collision centrality studied.Comment: 10 pages and 29 figures. Accepted for publication in Physical Review

Trans-lymphatic Contrast-Enhanced Ultrasound in Combination with Blue Dye Injection is Feasible for Detection and Biopsy of Sentinel Lymph Nodes in Breast Cancer

Objective: The best method for sentinel lymph node biopsy (SLNB) in early-staged breast cancer (EBC) remains controversial. This study aimed to evaluate a novel method by combining trans-lymphatic contrast-enhanced ultrasound (TLCEUS) with blue dye injection as a guidance of SLNB. Methods: TLCEUS was performed in 88 patients with newly diagnosed EBC. Methylene blue dye was percutaneously injected into enhanced sentinel lymph nodes (SLNs) under ultrasound guidance, followed by standard SLNB and axillary lymph node dissection. Enhancement patterns and the arriving time (AT) of contrast agent within SLNs were evaluated. Histopathological examination of dissected nodes was performed to confirm metastasis. Results: A total of 95 enhanced SLNs were identified and biopsied in 86 of 88 patients with identification rate of 97.7%. The specificity was 75.0%, sensitivity was 83.3%, and false-negative rate was 16.7%. Contrast-enhanced SLNs with type I, type II, and type III patterns had a metastatic positive rate of 11.4% (5/44), 57.1% (12/21) and 80.0% (24/30), respectively. Metastatic positive SLNs showed a mean AT of 61.6 ± 58.7 s while metastatic negative SLNs showed a mean AT of 41.3 ± 19.9 s, which was statistically significantly different. Conclusion: The TLCEUS/blue dye method can be used as an alternative to the radioisotope/blue dye method for its feasibility and accuracy