Imaging features and differential diagnoses of non-neoplastic diffuse mediastinal diseases.

Acute or chronic non-neoplastic diffuse mediastinal diseases have multiple causes, degrees of severity, and a wide range of management. Some situations require emergency care while others do not need specific treatment. Although the diagnosis may be suspected on chest X-ray, it is mainly based on CT. A delayed recognition is not uncommonly observed. Some findings may prompt the radiologist to look for specific associated injuries or lesions.This pictorial review will successively describe the various non-neoplastic causes of diffuse mediastinal diseases with their typical findings and major differentials.First, pneumomediastinum that can be provoked by extra- or intra-thoracic triggers requires the knowledge of patient's history or recent occurrences. Absence of any usual etiological factor should raise suspicion of cocaine inhalation in young individuals.Next, acute mediastinitis may be related to post-operative complications, esophageal perforation, or contiguous spread of odontogenic or retropharyngeal infections. The former diagnosis is not an easy task in the early stage, owing to the similarities of imaging findings with those of normal post-operative appearance during the first 2-3 weeks.Finally, fibrosing mediastinitis that is linked to an excessive fibrotic reaction in the mediastinum with variable compromise of mediastinal structures, in particular vascular and airway ones. Differential diagnosis includes tumoral and inflammatory infiltrations of the mediastinum

Strengths, Challenges, and Opportunities for Physical Activity Promotion in the Century-old National Cooperative Extension System

The need for physical activity promotion is ubiquitous, and offering physical activity interventions in community settings may reach people where they live, work, and play. Reaching people and providing evidence-based programming is exactly what the Cooperative Extension System has accomplished over the last century. In 2014, federal policy brought physical activity promotion into the mission of Extension. Although this policy marks the beginning of concerted efforts for physical activity promotion, several states have had strong success in this area. Borrowing from these efforts, this paper reports strengths, challenges, and opportunities for physical activity promotion in Extension

EFSUMB Statement on Medical Student Education in Ultrasound [long version]

Publisher Copyright: © 2016 Georg Thieme Verlag. All rights reserved.The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we report EFSUMB policy statements on medical student education in ultrasound that in a short version is already published in Ultraschall in der Medizin 1.publishersversionPeer reviewe

A study of Tycho's SNR at TeV energies with the HEGRA CT-System

Tycho's supernova remnant (SNR) was observed during 1997 and 1998 with the HEGRA Cherenkov Telescope System in a search for gamma-ray emission at energies above ~1 TeV. An analysis of these data, ~65 hours in total, resulted in no evidence for TeV gamma-ray emission. The 3sigma upper limit to the gamma-ray flux (>1 TeV) from Tycho is estimated at 5.78x10^{-13} photons cm^{-2} s^{-1}, or 33 milli-Crab. We interpret our upper limit within the framework of the following scenarios: (1) that the observed hard X-ray tail is due to synchrotron emission. A lower limit on the magnetic field within Tycho may be estimated B>=22 microG, assuming that the RXTE-detected X-rays were due to synchrotron emission. However, using results from a detailed model of the ASCA emission, a more conservative lower limit B>=6 microG is derived. (2) the hadronic model of Drury, Aharonian & Voelk, and (3) the more recent time-dependent kinetic theory of Berezhko & Voelk. Our upper limit lies within the range of predicted values of both hadronic models, according to uncertainties in physical parameters of Tycho, and shock acceleration details. In the latter case, the model was scaled to suit the parameters of Tycho and re-normalised to account for a simplification of the original model. We find that we cannot rule out Tycho as a potential contributor at an average level to the Galactic cosmic-ray flux.Comment: 9 pages, 6 figures. Accepted for publication in Astronomy and Astrophysic

A survey by the European Society of Breast Imaging on the utilisation of breast MRI in clinical practice

Objectives: While magnetic resonance imaging (MRI) is considered a helpful diagnostic tool in breast imaging, discussions are ongoing about appropriate protocols and indications. The European Society of Breast Imaging (EUSOBI) launched a survey to evaluate the utilisation of breast MRI in clinical practice. Methods: An online survey reviewed by the EUSOBI board and committees was distributed amongst members. The questions encompassed: training and experience; annual breast MRI and MRI-guided-intervention workload; examination protocols; indications; reporting habits and preferences. Data were summarised and subgroups compared using \u3c72test. Results: Of 647 EUSOBI members, 177 (27.4%) answered the survey. The majority were radiologists (90.5%), half of them based in academic centres (51.9%). Common indications for MRI included cancer staging, treatment monitoring, high-risk screening and problem-solving, and differed significantly between countries (p 640.03). Structured reporting and BI-RADS were mostly used. Breast radiologists with 6410 years of experience preferred inclusion of additional techniques, such as T2/STIR (p=0.03) and DWI (p=0.08) in the scan protocol. MRI-guided interventions were performed by a minority of participants (35.4%). Conclusions: The utilisation of breast MRI in clinical practice is generally in line with international recommendations. There are substantial differences between countries. MRI-guided interventions and functional MRI parameters are not widely available. Key points: \u2022 MRI is commonly used for the detection and characterisation of breast lesions. \u2022 Clinical practice standards are generally in line with current recommendations. \u2022 Standardised criteria and diagnostic categories (mainly BI-RADS) are widely adopted. \u2022 Younger radiologists value additional techniques, such as T2/STIR and DWI. \u2022 MRI-guided breast biopsy is not widely available

Implementation of lung cancer screening in Europe: Challenges and potential solutions: Summary of a multidisciplinary roundtable discussion

Recent randomised trials on screening with low-dose CT have shown important reductions in lung cancer (LC) mortality and have triggered international efforts to implement LC screening. Detection rates of stage I LC with volume CT approaching 70% have been demonstrated. In April 2019 'ESMO Open-Cancer Horizons' convened a roundtable discussion on the challenges and potential solutions regarding the implementation of LC screening in Europe. The expert panel reviewed the current evidence for LC screening with low-dose CT and discussed the next steps, which are covered in this article. The panel concluded that national health policy groups in Europe should start to implement CT screening as adequate evidence is available. It was recognised that there are opportunities to improve the screening process through 'Implementation Research Programmes'

Molecular evidence of Ureaplasma urealyticum and Ureaplasma parvum colonization in preterm infants during respiratory distress syndrome

BACKGROUND: Ureaplasma urealyticum and U. parvum have been associated with respiratory diseases in premature newborns, but their role in the pathogenesis of the respiratory distress syndrome (RDS) is unclear. The aim of this study was to detect, using molecular techniques, the role of Mycoplasma spp. and Ureaplasma spp. in respiratory secretion and blood specimens of preterm newborns with or without RDS and to evaluate the prevalence of perinatal U. urealyticum or U. parvum infection. The influence of chemotherapy on the clinical course was also evaluated. METHODS: Tracheal aspirate or nasopharingeal fluid samples from 50 preterm babies with (24) or without RDS (26) were analysed for detection of U. urealyticum and U. parvum by culture identification assay and PCR. Sequencing analysis of amplicons allowed us to verify the specificity of methods. Clarithromycin (10 mg kg(-1 )twice a day) was administered in ureaplasma-positive patients who presented clinical signs of RDS. RESULTS: 15/24 neonates with RDS (p < 0.001) and 4/26 without RDS were found PCR-positive for U. urealyticum or U. parvum. Culture identification assay was positive in 5/50 newborns, three of which with RDS. Sequencing analyses confirmed the specificity of these methods. Association of patent ductus arteriosus with ureaplasma colonization was more statistically significant (p = 0.0004) in patients with RDS than in those without RDS. CONCLUSION: Colonization of the lower respiratory tract by Ureaplasma spp. and particularly by U. parvum in preterm newborns was related to RDS. The routine use of molecular methods could be useful to screen candidate babies for etiologic therapy

Cytomegalovirus antibodies in dried blood spots: a minimally invasive method for assessing stress, immune function, and aging

<p>Abstract</p> <p>Background</p> <p>Cytomegalovirus (CMV) is a prevalent herpesvirus with links to both stress and aging. This paper describes and validates a minimally invasive method for assessing antibodies against CMV in finger stick whole blood spot samples for use as an indirect marker of an aspect of cell-mediated immunity.</p> <p>Results</p> <p>Analysis of CMV in dried blood spot samples (DBS) was based on modifications of a commercially available protocol for quantifying CMV antibodies in serum or plasma. The method was evaluated through analysis of precision, reliability, linearity, and correlation between matched serum and DBS samples collected from 75 volunteers. Correlation between DBS and plasma values was linear and high (Pearson correlation <it>R </it>= .96), and precision, reliability, and linearity of the DBS assay were within acceptable ranges.</p> <p>Conclusions</p> <p>The validity of a DBS assay for CMV antibodies will enable its inclusion in population-based surveys and other studies collecting DBS samples in non-clinical settings, increasing scientific understanding of the interaction of social and biological stress and immune function.</p