Diagnostic accuracy of different imaging modalities following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer

BACKGROUND: Periampullary cancer includes cancer of the head and neck of the pancreas, cancer of the distal end of the bile duct, cancer of the ampulla of Vater, and cancer of the second part of the duodenum. Surgical resection is the only established potentially curative treatment for pancreatic and periampullary cancer. A considerable proportion of patients undergo unnecessary laparotomy because of underestimation of the extent of the cancer on computed tomography (CT) scanning. Other imaging methods such as magnetic resonance imaging (MRI), positron emission tomography (PET), PET-CT, and endoscopic ultrasound (EUS) have been used to detect local invasion or distant metastases not visualised on CT scanning which could prevent unnecessary laparotomy. No systematic review or meta-analysis has examined the role of different imaging modalities in assessing the resectability with curative intent in patients with pancreatic and periampullary cancer. OBJECTIVES: To determine the diagnostic accuracy of MRI, PET scan, and EUS performed as an add-on test or PET-CT as a replacement test to CT scanning in detecting curative resectability in pancreatic and periampullary cancer. SEARCH METHODS: We searched MEDLINE, Embase, Science Citation Index Expanded, and Health Technology Assessment (HTA) databases up to 5 November 2015. Two review authors independently screened the references and selected the studies for inclusion. We also searched for articles related to the included studies by performing the "related search" function in MEDLINE (OvidSP) and Embase (OvidSP) and a "citing reference" search (by searching the articles that cite the included articles). SELECTION CRITERIA: We included diagnostic accuracy studies of MRI, PET scan, PET-CT, and EUS in patients with potentially resectable pancreatic and periampullary cancer on CT scan. We accepted any criteria of resectability used in the studies. We included studies irrespective of language, publication status, or study design (prospective or retrospective). We excluded case-control studies. DATA COLLECTION AND ANALYSIS: Two review authors independently performed data extraction and quality assessment using the QUADAS-2 (quality assessment of diagnostic accuracy studies - 2) tool. Although we planned to use bivariate methods for analysis of sensitivities and specificities, we were able to fit only the univariate fixed-effect models for both sensitivity and specificity because of the paucity of data. We calculated the probability of unresectability in patients who had a positive index test (post-test probability of unresectability in people with a positive test result) and in those with negative index test (post-test probability of unresectability in people with a positive test result) using the mean probability of unresectability (pre-test probability) from the included studies and the positive and negative likelihood ratios derived from the model. The difference between the pre-test and post-test probabilities gave the overall added value of the index test compared to the standard practice of CT scan staging alone. MAIN RESULTS: Only two studies (34 participants) met the inclusion criteria of this systematic review. Both studies evaluated the diagnostic test accuracy of EUS in assessing the resectability with curative intent in pancreatic cancers. There was low concerns about applicability for most domains in both studies. The overall risk of bias was low in one study and unclear or high in the second study. The mean probability of unresectable disease after CT scan across studies was 60.5% (that is 61 out of 100 patients who had resectable cancer after CT scan had unresectable disease on laparotomy). The summary estimate of sensitivity of EUS for unresectability was 0.87 (95% confidence interval (CI) 0.54 to 0.97) and the summary estimate of specificity for unresectability was 0.80 (95% CI 0.40 to 0.96). The positive likelihood ratio and negative likelihood ratio were 4.3 (95% CI 1.0 to 18.6) and 0.2 (95% CI 0.0 to 0.8) respectively. At the mean pre-test probability of 60.5%, the post-test probability of unresectable disease for people with a positive EUS (EUS indicating unresectability) was 86.9% (95% CI 60.9% to 96.6%) and the post-test probability of unresectable disease for people with a negative EUS (EUS indicating resectability) was 20.0% (5.1% to 53.7%). This means that 13% of people (95% CI 3% to 39%) with positive EUS have potentially resectable cancer and 20% (5% to 53%) of people with negative EUS have unresectable cancer. AUTHORS' CONCLUSIONS: Based on two small studies, there is significant uncertainty in the utility of EUS in people with pancreatic cancer found to have resectable disease on CT scan. No studies have assessed the utility of EUS in people with periampullary cancer.There is no evidence to suggest that it should be performed routinely in people with pancreatic cancer or periampullary cancer found to have resectable disease on CT scan

The effect of longitudinal rails on an air cavity stepped planing hull

The use of ventilated hulls is rapidly expanding. However, experimental and numerical analyses are still very limited, particularly for high-speed vessels and for stepped planing hulls. In this work, the authors present a comparison between towing tank tests and CFD analyses carried out on a single-stepped planing hull provided with forced ventilation on the bottom. The boat has identical geometries to those presented by the authors in other works, but with the addition of longitudinal rails. In particular, the study addresses the effect of the rails on the bottom of the hull, in terms of drag, and the wetted surface assessment. The computational methodology is based on URANS equation with multiphase models for high-resolution interface capture between air and water. The tests have been performed varying seven velocities and six airflow rates and the no-air injection condition. Compared to flat-bottomed hulls, a higher incidence of numerical ventilation and air–water mixing effects was observed. At the same time, no major differences were noted in terms of the ability to drag the flow aft at low speeds. Results in terms of drag reduction, wetted surface, and its shape are discussed

Glassy amorphous metal injection molded induced morphological defects

Melt rheology in injection molded metastable supercooled liquid metal of Zr44-Ti11-Cu10-Ni10-Be25 alloy may induce selective crystallizations. High mobility Be, Cu and Ni atoms have been observed to differently crystallize in bulk metal glassy supercooled liquids. Here, we analyze the result of morphological microscopic observation conduct on Bulk Metallic Glass (BMG) with composition of a commercial liquid metal alloy (LM001B). The injection molded plate has been supplied by “Liquid Metals Technologies Inc, Ca USA” and manufactured using an Engel injection molding machine operating at 1050-1100°C; the observed sample then has been cut by water jet. FEI Scios Dual-Beam has carried out the microscopic observation. Particularly, through a cross section, we observe the presence of crystalline phases on the short-range order. We investigate the presence of short-range order clusters, their distribution and the effect that they could cause on the alloys’ behaviors and properties

Integrated stratigraphy for the Late Quaternary in the eastern Tyrrhenian Sea

A high-resolution integrated stratigraphy is presented for the Late Quaternary in the southern-eastern Tyrrhenian Sea. It is based on calcareous plankton taxa (planktonic foraminifera and nannoplankton) distribution, d18OGlobigerinoides ruber record, tephrostratigraphy and radiometric dating methods (210Pb and 137Cs, AMS 14C) for a composite sediment core (from the top to the bottom, C90-1m, C90 and C836) from the continental shelf of the Salerno Gulf. High sedimentation rates from ca 1 cm/100 y for the early Holocene, to 3.45 cm/100 y for the middle Holocene to 8.78 cm/100 y from late Holocene and to 20 cm/100 y for the last 600 AD, make this area an ideal marine archive of secular paleoclimate changes. Quantitative distributional trend in planktonic foraminifera identify seven known (1Fe7F) eco-biozones, and several auxiliary bioevents of high potential for Mediterranean biostratigraphic correlation. Recognised were: the acme distribution of Neogloboquadrina pachyderma r.c. between 10.800 0.400 ka BP and 5.500 0.347 ka BP, a strong increase in abundance of Globorotalia truncatulinoides r.c. and l.c. at 5.500 0.347 ka BP and at 4.571 0.96 ka BP, respectively, an acme interval of Globigerinoides quadrilobatus (between 3.702 0.048 ka BP and 2.70 0.048 ka BP) and the acme/paracme intervals of T. quinqueloba (acme between 3.350 0.054 ka BP and 1.492 0.016 ka BP; paracme between 1.492 0.016 ka BP and 0.657 0.025 ka BP; acme beginning 0.657 0.025 ka BP). These results, integrated with trends of selected calcareous nannofossil species (Florisphaera profunda, Brarudosphaera bigelowii, Gephyrocapsa oceanica and Emiliania huxleyi) and d18OG. ruber signature, are consistent with the most important pre-Holocene and early Holocene paleoclimatic and paleoceanographic phases i.e., the BöllingeAllerod, the Younger Dryas and the time interval of Sapropel S1 deposition in the eastern Mediterranean Sea. These features revealed the high potential of this shallow water environment for high-resolution stratigraphy and correlation for the western Mediterranean. In addition, the chemical characterization of seven tephra layers supplied further data about the age and the dispersal area of some well-known Campi Flegrei explosive events, inferring the possible occurrence of explosive activity at Vesuvius around the middle of the 6th century, and contributing to refine the tephrostratigraphic framework for the last 15 ka in the south-eastern Tyrrhenian Sea.Published71-852.2. Laboratorio di paleomagnetismoJCR Journalrestricte

Patient Perceptions and Knowledge of Ionizing Radiation from Medical Imaging

Importance: Although imaging has become a standard tool of modern medicine, its widespread use has been paralleled by an increasing cumulative radiation dose to patients despite technological advancements and campaigns calling for better awareness and minimization of unnecessary exposures. Objective: To assess patients' knowledge about medical radiation and related risks. Design, Setting, and Participants: A survey study of hospitals in Italy was conducted; all patients in waiting rooms for medical imaging procedures before undergoing imaging examinations at 16 teaching and nonteaching hospitals were approached to take the survey. The survey was performed from June 1, 2019, to May 31, 2020. Main Outcomes and Measures: Survey respondents' basic knowledge of ionizing radiation levels and health risks, earlier imaging tests performed, and information and communication about radiation protection issues. Results: Among 3039 patients invited to participate, the response rate was 94.3% (n = 2866). Participants included 1531 women (53.4%); mean (SD) age was 44.9 (17.3) years. Of the 2866 participants, 1529 (53.3%) were aware of the existence of natural sources of ionizing radiation. Mammography (1101 [38.4%]) and magnetic resonance imaging (1231 [43.0%]) were categorized as radiation-based imaging modalities. More than half of the 2866 patients (1579 [55.1%]; P =.03) did not know that chest computed tomography delivers a larger dose of radiation than chest radiography, and only 1499 (52.3%) knew that radiation can be emitted after nuclear medicine examinations (P =.004). A total of 667 patients (23.3%) believed that radiation risks were unrelated to age, 1273 (44.4%) deemed their knowledge about radiation risks inadequate, and 2305 (80.4%) preferred to be informed about radiation risks by medical staff. A better knowledge of radiation issues was associated with receiving information from health care professionals (odds ratio [OR], 1.71; 95% CI, 1.43-2.03; P <.001) and having a higher educational level (intermediate vs low: OR, 1.48; 95% CI, 1.17-1.88; P <.001; high vs low: OR, 2.68; 95% CI, 2.09-3.43; P <.001). Conclusions and Relevance: The results of this survey suggest that patients undergoing medical imaging procedures have overall limited knowledge about medical radiation. Intervention to achieve better patient awareness of radiation risks related to medical exposures may be beneficial

Thermal neutron detection by means of Timepix3

Thermal neutron detection plays a crucial role in numerous scientific and technical applications such as nuclear reactor physics, particle accelerators, radiotherapy,materials analysis and space exploration. There are several challenges associated with the accurate identification and quantification of thermal neutrons. The present work proposes a detailed characterization of a Timepix3 (TPX3) detector equipped with a Lithium Fluoride (6LiF) converter in order to study its response to thermal neutrons that are identified through the 6Li(n,α)3H reaction. The TPX3-based test system has been installed at the HOTNES facility in ENEA and the analysis highlighted its excellent performance showing high effectiveness in the identification of neutrons through morphological analysis of tracks produced by alpha and triton particles, after accurate discrimination from the gamma background. With the use of Monte Carlo simulations, it has been demonstrated that the main contribution is due to tritons and its signal can be used effectively in the identification of thermal neutrons obtaining an efficiency of 0.9 % for 25 meV neutrons. This allows the TPX3 to have important applications as an environmental monitor for thermal neutrons. This monitoring system can be simply realized and is easy to manage because of its compact size and its digital acquisition that allows a real-time analysis

Preliminary Study of Acute Changes in Emotion Processing in Trauma Survivors with PTSD Symptoms

Accumulating evidence suggests traumatic experience can rapidly alter brain activation associated with emotion processing. However, little is known about acute changes in emotion neurocircuits that underlie PTSD symptom development. To examine acute alterations in emotion circuit activation and structure that may be linked to PTSD symptoms, thirty-eight subjects performed a task of appraisal of emotional faces as their brains were functionally and structurally studied with MRI at both two weeks and three months after motor vehicle collision (MVC). As determined by symptoms reported in the PTSD Checklist at three months, sixteen survivors developed probable PTSD, whereas the remaining 22 did not meet criteria for PTSD diagnosis (non-PTSD). The probable PTSD group had greater activation than the non-PTSD group in dorsal and ventral medial prefrontal cortex (dmPFC and vmPFC) while appraising fearful faces within two weeks after MVC and in left insular cortex (IC) three months after MVC. dmPFC activation at two weeks significantly positively correlated with PTSD symptom severity at two weeks (R = 0.462, P = 0.006) and three months (R = 0.418, p = 0.012). Changes over time in dmPFC activation and in PTSD symptom severity were also significantly positively correlated in the probable PTSD group (R = 0.641, P = 0.018). A significant time by group interaction was found for volume changes in left superior frontal gyrus (SFG, F = 6.048, p = 0.019) that partially overlapped dmPFC active region. Between two weeks and three months, left SFG volume decreased in probable PTSD survivors. These findings identify alterations in frontal cortical activity and structure during the early post-trauma period that appear to be associated with development of PTSD symptoms

Minimally invasive versus open distal pancreatectomy for pancreatic neuroendocrine tumors: An analysis from the U.S. neuroendocrine tumor study group

BackgroundTo determine shortâ and longâ term oncologic outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) for the treatment of pancreatic neuroendocrine tumor (pNET).MethodsThe data of the patients who underwent curative MIDP or ODP for pNET between 2000 and 2016 were collected from a multiâ institutional database. Propensity score matching (PSM) was used to generate 1:1 matched patients with MIDP and ODP.ResultsA total of 576 patients undergoing curative DP for pNET were included. Two hundred and fourteen (37.2%) patients underwent MIDP, whereas 362 (62.8%) underwent ODP. MIDP was increasingly performed over time (2000â 2004: 9.3% vs 2013â 2016: 54.8%; Pâ <â 0.01). In the matched cohort (nâ =â 141 in each group), patients who underwent MIDP had less blood loss (median, 100 vs 200â mL, Pâ <â 0.001), lower incidence of Clavienâ Dindoâ â ¥â III complications (12.1% vs 24.8%, Pâ =â 0.026), and a shorter hospital stay versus ODP (median, 4 versus 7 days, Pâ =â 0.026). Patients who underwent MIDP had a lower incidence of recurrence (5â year cumulative recurrence, 10.1% vs 31.1%, Pâ <â 0.001), yet equivalent overall survival (OS) rate (5â year OS, 92.1% vs 90.9%, Pâ =â 0.550) compared with patients who underwent OPD.ConclusionPatients undergoing MIDP over ODP in the treatment of pNET had comparable oncologic surgical metrics, as well as similar longâ term OS.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150595/1/jso25481_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150595/2/jso25481.pd

New insights into the comorbid conditions of Turner syndrome: results from a long-term monocentric cohort study

Purpose Many questions concerning Turner syndrome (TS) remain unresolved, such as the long-term complications and, therefore, the optimal care setting for adults. The primary aim of this long-term cohort study was to estimate the incidence of comorbid conditions along the life course. Methods A total of 160 Italian patients with TS diagnosed from 1967 to 2010 were regularly and structurally monitored from the diagnosis to December 2019 at the University Hospital of Bologna using a structured multidisciplinary monitoring protocol. Results The study cohort was followed up for a median of 27 years (IQR 12-42). Autoimmune diseases were the comorbid condition with the highest incidence (61.2%), followed by osteoporosis and hypertension (23.8%), type 2 diabetes (16.2%) and tumours (15.1%). Median age of onset ranged from 22 years for autoimmune diseases to 39 years for type 2 diabetes. Malignant tumours were the most prominent type of neoplasm, with a cumulative incidence of 11.9%. Papillary thyroid carcinoma was the most common form of cancer, followed by skin cancer and cancer of the central nervous system. Only one major cardiovascular event (acute aortic dissection) was observed during follow-up. No cases of ischaemic heart disease, heart failure, stroke or death were recorded. Conclusions This cohort study confirms the need for continuous, structured and multidisciplinary lifelong monitoring of TS, thus ensuring the early diagnosis of important comorbid conditions, including cancer, and their appropriate and timely treatment. In addition, these data highlight the need for the increased surveillance of specific types of cancer in TS, including thyroid carcinoma