Multiparametric MRI in differentiating solitary brain metastasis from high-grade glioma: diagnostic value of the combined use of diffusion-weighted imaging, dynamic susceptibility contrast imaging, and magnetic resonance spectroscopy parameters

Objective. The purpose of this study was to determine whether the combined use of diffusion weighted imaging (DWI), magnetic resonance spectroscopy (MRS), and dynamic susceptibility contrast imaging (DSCI) parameters could provide a more accurate diagnosis in the differentiation of high-grade glioma (HGG) from solitary brain metastasis (SBM) in the enhancing tumour and in the peritumoural region.Materials and methods. Fifty-six patients who received DWI, DSCI, and MRS before surgery were assessed. In differentiating SBM from HGG, the cutoff values of the DWI-apparent diffusion coefficient (ADCmin, ADCmax, and ADCmean), DSCI-relative cerebral blood volume (rCBV), and MRS-Cho/Cr, Cho/NAA, and NAA/Cr parameters for the peritumoural region were determined with ROC. The combined ROC curve was used for the different combinations of the peritumoural region DWI, DSCI, and MRS parameters in differentiating between the two tumours, and the best model combination was formed. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. This study was approved by the Institutional Review Board at our institutes.Results. In the enhancing tumour, all the parameters except NAA/Cr (P = 0.024) exhibited no statistical difference in differentiating between these two groups (P > 0.05). AUC values for ADCmin, ADCmax, ADCmean, rADCmin, rADCmax, rADCmean, rCBV, Cho/Cr, Cho/NAA, and NAA/Cr parameters in the peritumoural region in differentiating SBM from HGG were 0.860, 0.822, 0.848, 0.822, 0.801, 0.822, 0.906, 0.851, 0.903, and 0.784, respectively. In differentiating HGG from SBM, the best model consisted of thecombination of peritumoural ADCmin, rCBV, and Cho/NAA parameters. AUC values were 0.970.Conclusions. The combination of peritumoural region ADCmin, rCBV, and Cho/NAA parameters can help in differentiating SBM from HGG, with a diagnostic accuracy of 97%

To Compare Time-Weighted Graphs to Evaluate the Inclination of the Acetabular Component of Patients Who Had Total Hip Replacement Surgery

Time-weighted graphs are used to detect small shifts in statistical process control. The aim of this study is to evaluate the inclination of the acetabular component with CUmulative SUM (CUSUM) chart, Moving Average (MA) chart, and Exponentially Weighted Moving Average (EWMA) chart. The data were obtained directly from thirty patients who had undergone total hip replacement surgery at Ondokuz Mayis University, Faculty of Medicine. The inclination of the acetabular component of these people, after total hip replacement, was evaluated. CUSUM chart, Moving Average chart, and Exponentially Weighted Moving Average were used to evaluate the quality control process of acetabular component inclination. MINITAB Statistical Software 15.0 was used to generate these control charts. The assessment done with time-weighted charts revealed that the acetabular inclination angles were settled within control limits and the process was under control. It was determined that the change within the control limits had a random pattern. As a result of this study it has been obtained that time-weighted quality control charts which are used mostly in the field of industry can also be used in the field of medicine. It has provided us with a faster visual decision

Investigating injury severity risk factors in automobile crashes with predictive analytics and sensitivity analysis methods

Investigation of the risk factors that contribute to the injury severity in motor vehicle crashes has proved to be a thought-provoking and challenging problem. The results of such investigation can help better understand and potentially mitigate the severe injury risks involved in automobile crashes and thereby advance the well-being of people involved in these traffic accidents. Many factors were found to have an impact on the severity of injury sustained by occupants in the event of an automobile accident. In this analytics study we used a large and feature-rich crash dataset along with a number of predictive analytics algorithms to model the complex relationships between varying levels of injury severity and the crash related risk factors. Applying a systematic series of information fusion-based sensitivity analysis on the trained predictive models we identified the relative importance of the crash related risk factors. The results provided invaluable insights for the use of predictive analytics in this domain and exposed the relative importance of crash related risk factors with the changing levels of injury severity

Efficacy and safety of intravenous thiopental for sedation during magnetic resonance imaging in pediatric patients: A retrospective analysis

Introduction: Although the administration of rectal thiopental for sedation during magnetic resonance imaging (MRI) has been well described, there are limited data regarding its intravenous (IV) use in this clinical scenario. The aim of this study was to investigate the efficiency of IV thiopental for sedation during MRI in the pediatric population. Methods: A retrospective review was conducted over a 12-month period of pediatric patients who received IV thiopental for sedation during MRI. Data collected included the procedure length, the induction dose, the time to sedation, recovery time, total sedation time, and adverse events. The parents were telephoned and questioned regarding any adverse effect after discharge and their satisfaction (yes = satisfied; no = not satisfied) regarding the sedation process. Results: A total of 300 (American Society of Anesthesiology I–II status) pediatric patients received IV thiopental for sedation during MRI. The average age of the patients was 4.7 ± 3 years. Thiopental was administered as an initial IV bolus dose of 3 mg/kg, followed by additional bolus doses of thiopental (1 mg/kg) as needed to achieve a Ramsay sedation score of 4. The average procedure length was 20.7 ± 11.9 min. The average total dose of thiopental during the procedure was 5.6 ± 0.9 mg/kg. Patients recovered in an average time of 11 ± 5.6 min after a total sedation time of 31.7 ± 14.2 min. None of the patients had oxygen desaturation, adverse effects before or after discharge, and no patient required unplanned hospital admission. All parents were satisfied with the sedation process. Conclusion: IV thiopental is an effective, safe, and inexpensive medication for the sedation of children undergoing MRI

Evaluation of road traffic crashes among admittances to 112 emergency healthcare services in Samsun 2004

Objectives: More than 1.2 million people are killed each year, and 50 millions more are injured or disabled as a result of road traffic crashes. This study aimed to determine the demographic and clinical characteristics of the patients admitted to 112 emergency healthcare services (EHS) with road traffic crashes in Samsun city in 2004

Acoustic Radiation Force Impulse Quantification in the Evaluation of Renal Parenchyma Elasticity in Pediatric Patients With Chronic Kidney Disease

WOS: 000406344700003PubMed: 28390141Objectives-To evaluate renal parenchymal elasticity with acoustic radiation force impulse imaging in pediatric patients with chronic kidney disease (CKD) and compare with healthy volunteers. Methods-Thirty-eight healthy volunteers and 30 pediatric CKD patients were enrolled in this prospective study. The shear wave velocity (SW) values of both kidneys in CKD patients and healthy volunteers were evaluated. Results-The mean SW in healthy volunteers was 2.2160.34 m/s, whereas the same value was 1.81 +/- 0.49, 1.72 +/- 0.63, 1.66 +/- 0.29, 1.48 +/- 0.37, and 1.23 +/- 0.27 for stages 1, 2, 3, 4, and 5 in CKD patients, respectively. The SW was significantly lower for each stage in the CKD patients compared with healthy volunteers. Acoustic radiation force impulse could not predict the different stages of CKD, with the exception of stage 5. The cut-off value for predicting CKD was 1.81 m/s; at this threshold, sensitivity was 76.5% and specificity was 92.1% (area under the curve = 0.870 [95% confidence interval: 0.750-0.990]; P < .001). Interobserver agreement expressed as intraclass coefficient correlation was 0.65 (95% confidence interval: 0.34 to 0.83; P < .001). Conclusions-Acoustic radiation force impulse may be a potentially useful tool in detecting CKD in pediatric patients

Evaluation of the relationship between Ki67 expression level and neoadjuvant treatment response and prognosis in breast cancer based on the Neo-Bioscore staging system

Abstract Background Neoadjuvant chemotherapy (NAC) is widely used in the treatment of primary breast cancer. Different staging systems have been developed to evaluate the residual tumor after NAC and classify patients into different prognostic groups. Ki67, a proliferation marker, has been shown to be useful in predicting treatment response and prognosis. We aimed to investigate the prognostic importance Neo-Bioscore stage and pretreatment and posttreatment Ki67 levels in breast cancer patients who received NAC and correlations between Neo-Bioscore stage and pretreatment and posttreatment Ki67 levels. Methods A total of 176 invasive breast carcinoma patients who underwent NAC were included in the study. Ki67 levels were evaluated by immunohistochemical methods in Trucut biopsy and surgical excision specimens. Patients were classified into prognostic groups using the Neo-Bioscore staging system. Results Patients with high pretreatment Ki67 score were more likely to be in the higher Neo-Bioscore risk group (p < 0.001). Patients with a high posttreatment Ki67 score were more likely to be in the higher Neo-Bioscore prognostic risk group (p < 0.001). Overall survival (OS) and disease-free survival (DFS) were shorter in patients with high posttreatment Ki67 scores and in patients in the higher Neo-Bioscore risk group. We also determined a cutoff 37% for pathological complete response. Conclusion Neo-Bioscore staging system is found to be important in predicting survival. The posttreatment Ki67 level is more important than pretreatment Ki67 level in predicting survival

Determining a Safe Time for Oral Intake Following Pediatric Sedation

Objective: While there are suggestions for oral hydra­tion times after general anesthesia, there is no published study with regard to sedation. The aim of this prospective study was to determine a safe time for oral intake after pediatric sedation and its association with nausea and vomiting after discharge. Methods: A total of 180 children (aged 1 month to 13 years) sedated for magnetic resonance imaging were randomly assigned into three groups. All patients fasted for 6 hours and were allowed to take clear fluids until 2 hours before sedation with thiopental (3 mg/kg). After the patients were transported to the recovery room, we al­lowed the patients to drink as much clear fluids as they wanted prior to discharge in group I, 1 hour after the pa­tients met the discharge criteria for group II, and 2 hours after the patients met the discharge criteria for group III. All patients were assessed for vomiting in the recovery room until 1 hour after their first oral hydration. The par­ents were then telephoned the next day and questioned regarding nausea/vomiting and any unanticipated hospi­tal admission. Results: There were no statistically significant intergroup differences with respect to age, sex, weight, or the ASA status. There was no nausea and vomiting in either the recovery or post discharge period in any group. In the telephone questionnaire, no hospital admissions were reported. Conclusion: Oral hydration just before discharge is safe, and fasting children after discharge for a period of time is unnecessary for patients sedated with thiopental

Quantitative assessment of muscle stiffness with acoustic radiation force impulse elastography after botulinum toxin A injection in children with cerebral palsy

WOS: 000418965300019PubMed: 28271231Our objective in this study was to assess the changes in medial gastrocnemius muscle (GCM) stiffness after botulinum toxin A (BTA) injection in children with cerebral palsy (CP) by using acoustic radiation force impulse (ARFI) elastography and to research the usability of this technique in clinical practice. Twenty-four spastic lower extremities of 12 children with CP were assessed. BTA injection treatment was applied to the medial GCM. Muscle stiffness was measured with the ARFI technique before the procedure and a month after the procedure. The patients were assessed with the modified Ashworth scale (MAS) in the physiotherapy department at about the same time. Shear wave velocity (SWV) values and MAS scores before and after the treatment were compared. Mean SWV values were measured as 3.20 +/- 0.14 m/s before BTA and as 2.45 +/- 0.21 m/s after BTA, and the difference between them was found to be statistically significant (p < 0.001). Mean MAS score (2.33 +/- 0.70) after BTA decreased significantly when compared to the score before BTA (2.96 +/- 0.62) (p = 0.001). SWV values positively correlated with MAS scores (rho = 0.578, p = 0.003). The interobserver agreement expressed as interclass correlation coefficient (ICC) was 0.65 (95% CI 0.33-0.84, p < 0.001). ARFI elastography for identifying structural changes that occur in the spastic muscle after BTA injection in children with CP can yield more valuable information with combined use of MAS