Advanced Robotic Angiography Systems for Image Guidance During Conventional Transarterial Chemoembolization: Impact on Radiation Dose and Image Quality

Objectives The aim of this study was to compare 2 advanced robotic angiography systems for real-time image guidance in terms of radiation dose and image quality (IQ) during conventional transarterial chemoembolization (C-TACE) of hepatic malignant tumors. Materials and Methods One hundred six patients (57 women/49 men; mean age, 60 ± 11 years) who had undergone C-TACE using 2 generations of robotic angiography platforms for image guidance were included in this retrospective study. Patients were divided into 2 groups (n = 53, respectively): group 1 (first generation) and group 2 (second generation). Radiation dose for fluoroscopy and digital subtraction angiography (DSA) was compared between first-generation and second-generation angiography equipment, respectively. Among several features of the second-generation compared with the first-generation system, improvements included a refined crystalline detector system for enhanced noise reduction and advanced CARE filter software for lowering radiation dose. Radiation dose was measured using an ionization chamber. Image quality was assessed by 3 radiologists using 5-point Likert scales. Results Both groups were comparable in terms of number and location of lesions, as well as body weight, body mass index, and anatomical variants of feeding hepatic arteries (all P > 0.05). Dose-area product (DAP) for fluoroscopy was significantly lower in group 2 (1.4 ± 1.1 Gy·cm2) compared with group 1 (2.8 ± 3.4 Gy·cm2; P = 0.001). For DSA, DAP was significantly lower (P = 0.003) in group 2 (2.2 ± 1.2 Gy·cm2) versus group 1 (4.7 ± 2.3 Gy·cm2). Scores for DSA IQ indicated significant improvements for group 2 by 30% compared with group 1 (P = 0.004). Regarding fluoroscopy, scores for IQ were 76% higher in group 2 compared with group 1 (P = 0.001). Good to excellent interrater agreement with Fleiss kappa coefficients of κ = 0.75 for group 1 and κ = 0.74 for group 2 were achieved. Conclusions Most recent generation robotic angiography equipment allows for considerable radiation dose reductions while improving IQ in fluoroscopy and DSA image guidance during C-TACE treatment. Received for publication July 16, 2018; and accepted for publication, after revision, September 4, 2018. Thomas J. Vogl and Leona S. Alizadeh contributed equally to the manuscript and therefore share the first authorship. Moritz H. Albrecht received speaker fees from Siemens and Bracco. Conflicts of interest and sources of funding: none declared. Correspondence to: Thomas J. Vogl, MD, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. E-mail: t.vogl@em.uni-frankfurt.de. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Tomoelastography for the Evaluation of Pediatric Nonalcoholic Fatty Liver Disease

Objectives Today, nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children and adults alike. Yet, the noninvasive evaluation of disease severity remains a diagnostic challenge. In this study, we apply multifrequency magnetic resonance elastography (mMRE) for the quantification of liver steatosis and fibrosis in adolescents with NAFLD. Methods Fifty adolescents (age range, 10–17 years; mean BMI, 33.9 kg/m2; range, 21.4–42.1 kg/m2) with biopsy-proven NAFLD were included in this prospective study. Multifrequency magnetic resonance elastography was performed using external multifrequency vibrations of 30 to 60 Hz and tomoelastography postprocessing, resulting in penetration rate (a) and shear wave speed (c). Hepatic fat fraction was determined using Dixon method. The diagnostic accuracy of mMRE in grading liver steatosis and staging liver fibrosis was assessed by receiver operating characteristic curve analysis. Results Multifrequency magnetic resonance elastography parameters c and a were independently sensitive to fibrosis and steatosis, respectively, providing area under the receiver operating characteristic values of 0.79 (95% confidence interval [CI], 0.66–0.92), 0.91 (95% CI, 0.83–0.99), and 0.90 (95% CI, 0.80–0.99) for the detection of any (≥F1), moderate (≥F2), and advanced (≥F3) fibrosis, and 0.87 (95% CI, 0.76–0.97) and 0.87 (95% CI, 0.77–0.96) for the detection of moderate (≥S2) and severe (S3) steatosis. Conclusions One mMRE measurement provides 2 independent parameters with very good diagnostic accuracy in detecting moderate and advanced fibrosis as well as moderate and severe steatosis in pediatric NAFLD. Received for publication August 14, 2018; and accepted for publication, after revision, September 21, 2018. Conflicts of interest and sources of funding: Financial support is acknowledged from the German Federal Ministry of Education and Research (grant number: LiSyM 031L0057). The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2kq7jVD). Correspondence to: Jing Guo, PhD, Department of Radiology, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. E-mail: jing.guo@charite.de. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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T1- and T2*-Mapping for Assessment of Tendon Tissue Biophysical Properties: A Phantom MRI Study

Objectives The aim of this study was to quantitatively assess changes in collagen structure using MR T1- and T2*-mapping in a novel controlled ex vivo tendon model setup. Materials and Methods Twenty-four cadaveric bovine flexor tendons underwent MRI at 3 T before and after chemical modifications, representing mechanical degeneration and augmentation. Collagen degradation (COL), augmenting collagen fiber cross-linking (CXL), and a control (phosphate-buffered saline [PBS]) were examined in experimental groups, using histopathology as standard of reference. Variable echo-time and variable-flip angle gradient-echo sequences were used for T2*- and T1-mapping, respectively. Standard T1- and T2-weighted spin-echo sequences were acquired for visual assessment of tendon texture. Tendons were assessed subsequently for their biomechanical properties and compared with quantitative MRI analysis. Results T1- and T2*-mapping was feasible and repeatable for untreated (mean, 545 milliseconds, 2.0 milliseconds) and treated tendons. Mean T1 and T2* values of COL, CXL, and PBS tendons were 1459, 934, and 1017 milliseconds, and 5.5, 3.6, and 2.5 milliseconds, respectively. T2* values were significantly different between enzymatically degraded tendons, cross-linked tendons, and controls, and were significantly correlated with mechanical tendon properties (r = −0.74, P

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Sensitivity to Morphosyntactic Information in Preschool Children With and Without Developmental Language Disorder: A Follow-Up Study

Purpose

This study tested children's sensitivity to tense/agreement information in fronted auxiliaries during online comprehension of questions (e.g., Are the nice little dogs running?). Data from children with developmental language disorder (DLD) were compared to previously published data from typically developing (TD) children matched according to sentence comprehension test scores.

Method

Fifteen 5-year-old children with DLD and fifteen 3-year-old TD children participated in a looking-while-listening task. Children viewed pairs of pictures, 1 with a single agent and 1 with multiple agents, accompanied by a sentence with a fronted auxiliary (is + single agent or are + two agents) or a control sentence. Proportion looking to the target was measured.

Results

Children with DLD did not show anticipatory looking based on the number information contained in the auxiliary (is or are) as the younger TD children had. Both groups showed significant increases in looking to the target upon hearing the subject noun (e.g., dogs).

Conclusions

Despite the groups' similar sentence comprehension abilities and ability to accurately respond to the information provided by the subject noun, children with DLD did not show sensitivity to number information on the fronted auxiliary. This insensitivity is considered in light of these children's weaker command of tense/agreement forms in their speech. Specifically, we consider the possibility that failure to grasp the relation between the subject–verb sequence (e.g., dogs running) and preceding information (e.g., are) in questions in the input contributes to the protracted inconsistency in producing auxiliary forms in obligatory contexts by children with DLD.

Supplemental Material

https://doi.org/10.23641/asha.7283459

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A polycaprolactone-β-tricalcium phosphate-heparan sulfate device for cranioplasty

Large bone defects in the skull following trauma or brain surgery, such as trepanation, must be treated promptly to restore the protective and cosmetic function of the skull. Such cranioplasty procedures date back thousands of years yet they still remain a challenge for clinicians, despite extensive research and advances in our understanding of the human body and bone biology (Donati et al. 2007, Feroze et al. 2015). The current reported complication rate ranges from 16% to 40% and general reoperation rate is about 25% (Feroze et al.

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Three-dimensional evaluation of facial asymmetry in patients with hemifacial microsomia using stereophotogrammetry

To quantify the surface facial asymmetry in a group of young patients with hemifacial microsomia (HFM) and to investigate differences with a homogeneous sample of healthy subjects, using a novel stereophotogrammetric method.

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Skull base reconstruction with pedicled nasoseptal flap: technique, indications, and limitations

Endoscopic skull base surgery allows extensive tumor resection but results in large defects requiring robust dural repair. The vascularized nasal septal flap pedicled on the posterior nasal septal artery is known to have an excellent success rate for dural defect coverage. Detailed step-by-step descriptions of the harvest and placement of this flap are scarce. Using a sketch, images, and a video, we describe a detailed method for endoscopically harvesting and placing a nasoseptal flap (NSF). We also describe the indications and the decision process leading to the use of NSF.

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Ex-vivo and In Vitro validation of an innovative mandibular condyle implant concept

The purpose of this study is to pre-validate a novel implant concept, and to compare the behavior of the mandibular condyle against a commercial Biomet implant in an ex vivo model and present results of the first cadaveric studies.

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Experience with 5% Ethanolamine oleate for sclerotherapy of oral vascular anomalies: a cohort of 15 consecutive patients

To describe the effectiveness and safety of a sclerotherapy protocol with 5% ethanolamine oleate (EO) at 0.1 mL/3 mm for oral vascular anomalies (OVAs). Our hypothesis is that EO applied at a concentration of 5% may decrease the number of sessions necessary for clinical healing.

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Investigating the cause of late deformity following fronto-orbital remodelling for metopic synostosis using 3D CT imaging

Late deformity/indentation is well-recognised following fronto-orbital remodelling (FOR) for metopic synostosis. We hypothesise that if damage to temporalis muscle were a contributor, the thickness of soft tissue and bone in the affected area would be reduced.

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Citation for Michael J Fardy for Downs Surgical Prize 2017

Mike is the eldest son of an RAF navigator and ward sister.

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Influence Disease Activity on Voice and Laryngeal Findings of Rheumatoid Arthritis Patients

To reveal and to compare the voice pathologies and the detectable laryngeal findings in different phases of rheumatoid arthritis (RA).

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Dysphonia and Dysarthria in People With Parkinson's Disease After Subthalamic Nucleus Deep Brain Stimulation: Effect of Frequency Modulation

Subthalamic nucleus deep brain stimulation (STN-DBS) parameters, for example the frequency of stimulation, seem to affect speech and voice aspects. However, this influence is not well understood. This study aimed to investigate the impact of low- and high-frequency STN-DBS on voice and speech for people with Parkinson's disease.

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The Intensive Cognitive-Communication Rehabilitation Program for Young Adults With Acquired Brain Injury

Purpose

This study investigated the effects of an intensive cognitive-communication rehabilitation (ICCR) program for young individuals with chronic acquired brain injury.

Method

ICCR included classroom lectures; metacognitive instruction, modeling, and application; technology skills training; and individual cognitive–linguistic therapy. Four individuals participated in the intensive program (6 hr with 1-hr lunch break × 4 days × 12 weeks of treatment): 3 participants completed 3 consecutive semesters, and 1 participant completed 1 semester. Two controls did not receive treatment and completed assessments before and after the 12-week treatment interval only.

Results

All 4 experimental participants demonstrated significant improvements on at least 1 standardized cognitive–linguistic measure, whereas controls did not. Furthermore, time point significantly predicted participants' scores on 2 of the 4 standardized outcome measures, indicating that as duration in ICCR increased, scores also increased. Participants who completed multiple semesters of ICCR also improved in their therapy and personal goals, classroom behavior, life participation, and quality of life.

Conclusion

After ICCR, participants showed gains in their cognitive–linguistic functioning, classroom participation, and individual therapy. They also demonstrated improvements outside the classroom and in their overall well-being. There is a gap between the large population of young adults with acquired brain injury who wish to return to higher education and a lack of rehabilitation programs supporting reentry into academic environments; ICCR is a first step in reducing that gap.

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Enriching Communicative Environments: Leveraging Advances in Neuroplasticity for Improving Outcomes in Neurogenic Communication Disorders

Purpose

Research manipulating the complexity of housing environments for healthy and brain-damaged animals has offered strong, well-replicated evidence for the positive impacts in animal models of enriched environments on neuroplasticity and behavioral outcomes across the lifespan. This article reviews foundational work on environmental enrichment from the animal literature and considers how it relates to a line of research examining rich communicative environments among adults with aphasia, amnesia, and related cognitive-communication disorders.

Method

Drawing on the authors' own research and the broader literature, this article first presents a critical review of environmental complexity from the animal literature. Building on that animal research, the second section begins by defining rich communicative environments for humans (highlighting the combined effects of complexity, voluntariness, and experiential quality). It then introduces key frameworks for analyzing and designing rich communicative environments: distributed communication and functional systems along with sociocultural theories of learning and development in humans that support them. The final section provides an overview of Hengst's and Duff's basic and translational research, which has been designed to exploit the insights of sociocultural theories and research on environmental complexity. In particular, this research has aimed to enrich communicative interactions in clinical settings, to trace specific communicative resources that characterize such interactions, and to marshal rich communicative environments for therapeutic goals for individuals with aphasia and amnesia.

Conclusions

This article concludes by arguing that enriching and optimizing environments and experiences offers a very promising approach to rehabilitation efforts designed to enhance the reorganization of cognitive-communicative abilities after brain injury. Such interventions would require clinicians to use the principles outlined here to enrich communicative environments and to target distributed communication in functional systems (not the isolated language of individuals).

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Short-Term Intensive Therapy and Outcomes for Athletes With Paradoxical Vocal Fold Motion Disorder

Purpose

The aim of the study was to develop a treatment for athletes with paradoxical vocal fold motion disorder (PVFMD) based on exercise physiology and learning theory principles and administer it over a preestablished time frame.

Method

A prospective, repeated-measures, within-subject group design was used. Eleven adolescent/teen athletes diagnosed with PVFMD via laryngoscopy received short-term intensive (STI) therapy. Eight of the athletes returned for extended follow-up. Changes in postexercise inspiratory (R _i) and expiratory (R _e) resistances and Modified Borg Dyspnea Scale (MBDS) ratings collected at baseline were compared immediately posttreatment and at extended follow-up. Dyspnea Index scores were collected at baseline and at extended follow-up. Two no-treatment control athletes with PVFMD participated in two exercise challenges—baseline and 6 weeks later.

Results

Immediately after STI therapy, athletes attained significant improvement in R _i, R _e, and MBDS ratings. These changes were maintained at extended follow-up as well as a significant change in Dyspnea Index scores. The 2 control athletes who were reassessed 6 weeks after baseline experienced negative changes in postexercise R _i and MBDS ratings.

Conclusion

STI therapy that incorporated individuality, specificity, and variable practice effectively changed outcome measures posttreatment with further improvement observed at extended follow-up. These results provide preliminary evidence for STI therapy for PVFMD.

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Follow‐up of patients with negative drug provocation tests to betalactams

Abstract

Drug allergy work‐up in betalactam (BL) allergy is probably the most‐developed drug‐allergy evaluation at present [1]. During the last few years, the debate on whether one‐day or several‐day (prolonged) drug provocation test (DPT) should be performed in non‐immediate reactions (i.e., occurring >1h after the last administered dose) in order to increase sensitivity has been ongoing and groups working in drug allergy diagnosis have been deploying pro and con arguments and studies in favour of either option [2‐5]. The most acceptable way to validate a negative DPT is by studying its negative predictive value (NPV) in patients who are re‐challenged to the negatively tested drug, in real‐life therapeutic conditions [6,7].

This article is protected by copyright. All rights reserved.

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Th2 cell differentiation from naive CD4+ T cells is enhanced by autocrine CC chemokines in atopic diseases

Abstract

Background

Chemokines are involved not only in regulating leukocyte recruitment, but also in other activities. However, functions other than cell recruitment remain poorly understood. We have already shown that the production of CC chemokine ligand (CCL)17 and CCL22 by antigen‐stimulated naïve CD4⁺ T cells was higher in asthmatic patients than in healthy controls. However, the role of these chemokines in stimulated naïve CD4⁺ T cells remains unclear.

Objective

To clarify the biological function of CCL17 and CCL22 on naïve CD4⁺ T, we examined effects of these two chemokines on naïve CD4⁺ T cells expressing CC chemokine receptor (CCR)4 (a receptor for CCL17 and CCL22) during differentiation of Th2 cells in asthmatic patients as allergic subjects.

Methods

Naïve CD4⁺ T cells were prepared from healthy controls and patients with asthma. We analyzed effect of CCL17 and CCL22, and blocking their receptor on differentiation of Th2 cells.

Results

Production of CCL17 and CCL22 by activated naive CD4⁺ T cells under Th2 condition was much more in asthmatic patients than in healthy controls. Proliferation and survival of the Th2 differentiating cells and restimulation‐induced IL‐4 production were much greater in asthmatic patients than in healthy controls. These cell biological phenomena were inhibited by blockade of CCR4. The biological effects of exogenous CCL17 and CCL22 were apparently observed in both healthy controls and asthmatic patients. The effectiveness of these chemokines on naïve CD4⁺ T cells from healthy controls was stronger than those from asthmatic patients. We found that thymic stromal lymphopoietin (TSLP), a Th2 promoting chemokine, is involved in the activation of CD4⁺ naïve T cells via production of CCL17 and CCL22.

Conclusions & Clinical Relevance

These data suggest that CCL17 and CCL22 produced by TSLP‐primed naïve CD4⁺ T cells in asthma might contribute to an increase in Th2 cells via autocrine loops.

This article is protected by copyright. All rights reserved.

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Desarrollo de un mapa de riesgos para la tomografía por emisión de positrones

Publication date: Available online 15 November 2018

Source: Revista Española de Medicina Nuclear e Imagen Molecular

Author(s): A. Rodríguez Fernández, E.M. Triviño Ibáñez, M. Gómez Río, J.J. Pérez Lázaro, I. Fernández Ruiz, Á. Ramírez Navarro, Y. García Rivero, E. Córdoba Cañete, C. Romero Fernández, J.M. Llamas-Elvira

Resumen

La seguridad del paciente es un componente esencial de la calidad asistencial, especialmente cuando la complejidad de la asistencia ha alcanzado niveles extremos. En la actualidad, conseguir esta seguridad se considera una estrategia básica del sistema nacional de salud. Los servicios de Medicina Nuclear muestran unas particularidades que los hacen especiales en materia de seguridad del paciente, con situaciones que se salen de la práctica asistencial común de los servicios del resto del marco hospitalario. Estas particularidades vienen definidas por el hecho de utilizar en la actividad diaria radiaciones ionizantes, tanto encapsuladas como no encapsuladas. Además, y concretamente en el caso de la tomografía por emisión de positrones (PET), el hecho de realizar la exploración implica de modo indispensable la coordinación de numerosos grupos de profesionales, tanto de la propia unidad de gestión clínica como de otros servicios del hospital (incluso de empresas ajenas al propio hospital y al propio sistema sanitario público). El objetivo del presente trabajo ha sido identificar los riesgos a los que puede exponerse un paciente que va a ser explorado mediante PET en un servicio de Medicina Nuclear y elaborar el mapa de riesgos para el proceso PET. La metodología empleada se enmarca genéricamente en la propuesta por el Ministerio de Sanidad (2007) y su concreción práctica (dada la escasa literatura disponible en Medicina Nuclear) sigue en lo posible lo desarrollado en áreas asistenciales afines (radiodiagnóstico y radioterapia). Para ello, se constituyó un equipo multidisciplinar de profesionales directamente relacionados con el proceso PET, se utilizó la metodología análisis modal de fallos y efectos con la intención de identificar los posibles fallos, sus causas y los potenciales eventos adversos que provocan cada uno de los fallos. Como paso final, se creó el mapa de riesgos, ubicando en cada etapa del proceso los fallos previamente identificados. El presente trabajo expone el proceso PET, el cual ha permitido describir los riesgos que puede correr un paciente cuando es requerido para realizarse una exploración PET, así como los eventos adversos derivados de ellos. Todo ello ha quedado plasmado en un mapa de riesgos del proceso PET.

Abstract

Patient safety is an essential component of quality of care, especially when the complexity of care has reached extreme levels. Currently achieving this safety is considered a basic strategy of the National Health System. Nuclear Medicine departments have certain peculiarities that make them special in terms of patient safety, with situations that go beyond the common healthcare practice of other departments. Namely, that both encapsulated and non-encapsulated ionizing radiation is used in daily practice, and numerous groups of professionals must be coordinated to undertake positron emission tomography (PET) specifically, from the clinical management unit itself, and from other departments of the hospital (as well as companies outside the hospital itself and the Public Health System). The objective of this paper was to identify the risks to which a patient who is to be explored through PET can be exposed in a Nuclear Medicine department and draw up a risk map for the PET process. The methodology used is part of the proposal of the Ministry of Health (2007), and its practical implementation (given the limited literature available on Nuclear Medicine), follows as far as possible that of related care areas (radiodiagnosis and radiotherapy). For this purpose, a multidisciplinary team of professionals directly related to the PET process was created, using the modal analysis of faults and effects methodology to identify possible failures, their causes and the potential adverse events causing each. As a final step, a risk map was created, locating the previously identified faults at each stage of the process. This paper exposes the PET process, and describes the risks that patients might run when a PET scan is required, as well as the adverse events deriving from it. All this is shown in a risk map of the PET process.

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Estrogen receptor-alpha (ESR1) polymorphism rs1999805 associates with asthma

Publication date: Available online 16 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Melissa H. Bloodworth, Mark Rusznak, Lisa Bastarache, Janey Wang, Dawn C. Newcomb

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Fatigue failure load and finite element analysis of multilayer ceramic restorations

Publication date: Available online 15 November 2018

Source: Dental Materials

Author(s): K.C. Archangelo, L.F. Guilardi, D. Campanelli, L.F. Valandro, A.L.S. Borges

Abstract

Objective

To evaluate the fatigue failure load via staircase approach and stress distribution via FEA of different ceramic configurations arranged in multilayers composed of ceramic materials with different elastic moduli and compare them to monolayer models.

Methods

CAD–CAM ceramic blocks were used to shape 0.3 mm and 1.5 mm thick discs, corresponding to: feldspathic (F), 64 GPa; lithium disilicate (L), 95 GPa; and Yttrium-partially stabilized tetragonal zirconia (Y-TZP) (Y), 209.3 GPa. The 0.3 mm discs were arranged in 4 layers cemented with resin cement (Multilink N), and the 1.5 mm discs were not treated, in such a way that the final thickness of all specimens was 1.5 mm (±0.15 mm). The following 6 groups were tested: F (F: monolithic); L (L: monolithic); LLFF (L + L + F + F); FFLL (F + F + L + L); YLFF (Y + L + F + F); YLLF (Y + L + L + F). The loads-to-fracture were obtained using the biaxial flexural strength test until failure and the data were run using one-way ANOVA and Tukey's multiple comparisons (α = 0.05) tests. The biaxial bending test was also simulated through finite element analysis (FEA) to identify the tensile stress generated at each layer of the groups. Mean fatigue failure load (100,000 cycles; 20 Hz) was determined using the staircase approach. The fracture analysis was performed by stereomicroscope and scanning electron microscopy.

Results

The load to fracture (N) were obtained as follows: L (592.9 ± 73.8)^D > FFLL (319.78 ± 43.59)^C > YLLF (246.75 ± 24.89)^B > F (167.13 ± 9.84)^A > YLFF (166.51 ± 15.24)^A > LLFF (165.46 ± 22.75)^A; and the fatigue failure load (N): L (310.92 ± 26.73)^F > FFLL (190.17 ± 8.32)^E > F (106.21 ± 2.81)^D > YLLF (96.48 ± 5.73)^C > YLFF (89.56 ± 2.38)^B > LLFF (77.23 ± 6.33)^A. The origin of all of the tested specimens was located at the tensile region of the discs, as encountered in FEA.

Significance

The material under tensile stress is determinant for the restoration's strength and the adhesive interface negatively influenced the mechanical behavior of the multilayer structures.

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IMPROVING THE QUALITY OF DATA PRESENTATION IN HEALTH SCIENCES

Publication date: Available online 16 November 2018

Source: Archives of Oral Biology

Author(s): Paula Midori Castelo

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Embolization of a congenital arteriovenous malformation arising off the internal mammary artery

Publication date: Available online 15 November 2018

Source: Clinical Imaging

Author(s): Shamaita Majumdar, Tatulya Tiwari, Olaguoke Akinwande, Raja Siva Ramaswamy

Abstract

Congenital arteriovenous malformations (AVM) of the internal mammary artery (IMA) are exceptionally rare. Patients with AVMs arising off the left IMA may present with continuous precordial murmurs and/or a pulsatile chest mass. AVMs in this location pose a risk of enlargement, rupture, infection, or high-output cardiac failure. The potential risks associated with AVMs warrant early therapeutic intervention. We describe a case of a congenital AVM originating from the left IMA, which was successfully embolized with n‑butyl cyanoacrylate (NBCA) using a transcatheter arterial approach.

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T2-blackout e on DWI as a sign of early bone infarct and sequestration in a patient with sickle cell disease

Publication date: Available online 15 November 2018

Source: Clinical Imaging

Author(s): Ibrahim S. Tuna, Bedirhan Tarhan, Mauricio Escobar, Mehmet S. Albayram

Abstract

Differentiation of bone infarct from osteomyelitis is one of the most challenging issues in the evaluation of acute bone pain in sickle cell patients. The imaging modalities that are currently being used for assessment of bone marrow in this population have several limitations. We present a case of an 18-year-old male with a history of sickle cell disease, who was transferred to our emergency department with progressively severe headache and jaw pain for one-week. Initial evaluation was concerning for osteomyelitis and epidural abscess formation. Due to the lack of response to the current antibiotic treatment, he was transferred to our institution. On further review of the images, atypical DWI findings that were identified in the early phase of presentation helped to differentiate bone infarct from osteomyelitis. Radiologists should be aware of this phenomenon, as it can help in the differentiation between these two pathologies and can affect the patient's management overall.

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Investigating the cause of late deformity following fronto-orbital remodelling for metopic synostosis using 3D CT imaging

Publication date: Available online 16 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Naiara Rodriguez-Florez, Aran Florez-Tapia, Noor U.O. Jeelani, Sylvia Schievano, David J. Dunaway, Richard D. Hayward

Summary

Purpose

Late deformity/indentation is well-recognised following fronto-orbital remodelling (FOR) for metopic synostosis. We hypothesise that if damage to temporalis muscle were a contributor, the thickness of soft tissue and bone in the affected area would be reduced.

Materials and Methods

Soft tissues and bone were separately segmented and reconstructed three-dimensionally from computed tomograms of 8 patients 1.5 to 18 years post-FOR performed at 16 ± 2 months for metopic synostosis and from 8 age-matched controls. Soft tissue (taken as proxy for temporalis muscle) and bone thickness overall and in the indented areas were computed.

Results

Post-FOR, three-dimensional soft tissue thickness maps demonstrated temporalis extending upwards but falling short of the indented area. Overall skull thickness increased with age post-FOR (logarithmic fit R²= 0.71) and for controls (R²=0.90). Although immediately post-FOR the future indented area had a thickness of 98% of control, it decreased linearly to 64% 16 years later (Pearson's r=0.84).

Conclusion

These findings suggest that late post-FOR deformity/indentation is enhanced by limited upward extension (or retraction downwards) of temporalis muscle, while bone thickness in the affected area gradually decreases. This supports the hypothesis that aberrant re-attachment of the temporalis muscle makes a material contribution to late deformity following FOR for metopic synostosis.

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Experience with 5% Ethanolamine oleate for sclerotherapy of oral vascular anomalies: a cohort of 15 consecutive patients

Publication date: Available online 16 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Camila de Nazaré Alves de Oliveira Kato, Michel Campos Ribeiro, Márcio Bruno Figueiredo do Amaral, Soraya de Mattos Camargo Grossmann, Maria Cássia Ferreira de Aguiar, Ricardo Alves Mesquita

Summary

Purpose

To describe the effectiveness and safety of a sclerotherapy protocol with 5% ethanolamine oleate (EO) at 0.1 mL/3 mm for oral vascular anomalies (OVAs). Our hypothesis is that EO applied at a concentration of 5% may decrease the number of sessions necessary for clinical healing.

Materials and Methods

We describe a cohort of 15 consecutive patients. OVAs <20 mm were included. Clinical data of the OVAs were collected. Descriptive and bivariate statistical analyses were performed.

Results

Fifteen of the 19 OVAs were varicosities and the lower lip was the most affected site (n=7). The median size was 6 mm, and one session was required in 89.5% of cases for clinical healing within 28 days. The pain/burning score was low (<2) for most lesions (63.1%) and the degree of satisfaction was high (>8) for all OVAs. The number of applications, final volume of drug and time to resolution differed significantly according to the size of the anomaly.

Conclusion

The protocol with 5% EO was shown to be effective and safe to treat OVAs <20 mm, and with a decrease in the number of sessions, volume and time to resolution, without complications and with high patient satisfaction.

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Impact of incubation method on the release of growth factors in Non-Ca2+-activated PRP, Ca2+-activated PRP, PRF and A-PRF

Publication date: Available online 15 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Daniel Steller, Nele Herbst, Ralph Pries, David Juhl, Samer G. Hakim

Summary

The aim of this study was to investigate the influence of different incubation methods on the growth factor content of lysates of platelet-rich fibrin (PRF), advanced-platelet-rich fibrin (A-PRF) and platelet-rich plasma (PRP) products. A comparison of related studies suggests that the method of sample preparation has a significant influence on growth factor content. There are few reports on the comparison of non-Ca²⁺-activated PRP, Ca²⁺-activated PRP, A-PRF, and PRF, along with a lack of information on the release of PDGF-BB, TGF-β1, and VEGF among the different incubation methods.

The lysate preparation was made of non-Ca²⁺-activated PRP, Ca²⁺-activated PRP, PRF, and A-PRF, using a room-temperature, 37°C, or freeze–thaw–freeze incubation method. Afterwards the VEGF, PDGF-BB, and TGF-β1 content was investigated by running ELISA tests.

Growth factor levels were significantly increased in the non-Ca²⁺-activated PRP with freeze–thaw–freeze incubation, and in the PRF preparation there was a significant disadvantage to using room temperature incubation for releasing growth factors.

In conclusion, the freeze–thaw–freeze method is sufficient for releasing growth factors, and calcium activation is not necessary. Finally, the study demonstrates the possibility of preparing PRP products from platelet concentrates, so that preoperative blood sampling might not be required.

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Immediate dental implant placement in calvarial bone grafts to rehabilitate the severely resorbed edentulous maxilla: A prospective pilot study

Publication date: Available online 15 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Thomas F. Putters, Gerry M. Raghoebar, Jenneke Klein-Nulend, Arjan Vissink, Jurjen Schortinghuis

Summary

Purpose

The aim of this study was to describe the surgical technique of immediate dental implant placement in calvarial grafs for augmentation of the severely resorbed maxilla and to assess the treatment results.

Methods

In 13 patients the maxilla was augmented with calvarial bone followed by simultaneous dental implant placement (total: 68 implants). In the frontal "knife edge" region, implants were inserted in the buccal plated area. In the maxillary sinus area, implants were inserted into alveolar bone that was plated buccally or palatally through the sinus window. After 4 months, the implants were retrieved and subsequently loaded. Per-operative and post-perative variables were scored. One bone biopsy sample was taken for histological analysis.

Results

The surgical procedure and wound healing was uneventful. During abutment connection after 4 months, all implants were fully osseointegrated with no signs of graft resorption. Radiographically, the mean (±SD) peri-implant bone loss after 1 year of functional loading was 0.23±0.44 mm. No implants were lost. Histological examination revealed vital calvarial and maxillary bone with active remodeling.

Conclusion

Immediate dental implant placement in calvarial bone grafts to rehabilitate severely resorbed maxilla is technically feasible and seems to have a high success rate.

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Salvage surgery for a locally persistent or recurrent tumour in maxillary cancer patients who have undergone radiotherapy and concomitant intra-arterial cisplatin: implications for surgical margin assessment

Publication date: Available online 15 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): T. ono, K. Sakata, N. Tanaka, S. Hashiguchi, H. Migita, K. Kiyokawa, M. Morioka, T. Kurita, K. Sato, N. Takeshige, H. Umeno

Abstract

Limited information about salvage surgery is available for locally persistent and recurrent maxillary sinus cancers after the completion of chemoradiation therapy. Seventy-six maxillary sinus cancer patients who had undergone chemoradioselection using initial radiotherapy and concomitant intra-arterial cisplatin were screened retrospectively. Twenty-four of these patients who had a locally persistent or recurrent tumour were investigated. The 2-year overall survival rate of patients with maxillary sinus cancer of all types was 39.0% for those who underwent salvage surgery and 10.0% for those who did not. The 2-year overall survival rate of patients with maxillary sinus squamous cell carcinoma was 45.8% for those who underwent salvage surgery and 11.1% for those who did not. Furthermore, the 2-year local control and overall survival rates of patients with positive and negative surgical margins were 14.3% and 83.3% and 14.3% and 66.7%, respectively. There were significant differences in local control (P = 0.004) and overall survival (P = 0.005) regarding surgical margin status. Although salvage surgery for a locally persistent or recurrent maxillary sinus cancer is a feasible treatment, patients with positive surgical margins are more prone to local relapse. Therefore, surgical safety margins should be assessed thoroughly.

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Adjustment of Vocal Tract Shape via Biofeedback: Influence on Vowels

Publication date: Available online 15 November 2018

Source: Journal of Voice

Author(s): Simone Graf, Johannes Schwiebacher, Lena Richter, Maria Buchberger, Seiji Adachi, Wolfgang Mastnak, Patrick Hoyer

Summary

The study assessed 30 nonprofessional singers to evaluate the effects of vocal tract shape adjustment via increased resonance toward an externally applied sinusoidal frequency of 900 Hz without phonation. The amplification of the sound wave was used as biofeedback signal and the intensity and the formant position of the basic vowels /a/, /e/, /i/, /o/, and /u/ were compared before and after a vocal tract adjustment period. After the adjustment period, the intensities for all vowels increased and the measured changes correlated with the participants' self-perception.The diferences between the second formant position of the vowels and the applied frequency influences the changes in amplitude and in formant frequencies. The most significant changes in formant frequency occurred with vowels that did not include a formant frequency of 900 Hz, while the increase in amplitude was the strongest for vowels with a formant frequency of about 900 Hz.

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Laryngostroboscopic Exploration of Rough Vocal Effects in Singing and their Statistical Recognizability: An Anatomical and Physiological Description and Visual Recognizability Study of Distortion, Growl, Rattle, and Grunt using laryngostroboscopic Imaging and Panel Assessment

Publication date: Available online 15 November 2018

Source: Journal of Voice

Author(s): Mathias Aaen Thuesen, Julian McGlashan, Cathrine Sadolin

Abstract

Objectives

To study vocal effects in singing from the pedagogical method complete vocal technique as related to specific and discrete supraglottic structures and activities by means of laryngostroboscopic imaging and panel testing.

Study Design

This is a case-control study with a double-panel assessment.

Methods

Twenty singers were recorded performing four of the rough vocal effects from the method Complete Vocal Technique. Two studies were performed: (1) Laryngostroboscopic examination using a videonasoendoscopic camera system and the Laryngostrobe program; (2) two blind-panel assessments with (a) voice clinicians and (b) singing teachers to investigate the recognizability of the vocal effects in supraglottic structures.

Results

The four investigated vocal effects could be related to particular and discrete vibratory pattern of supraglottic structures; Distortion as vibrations of the ventricular folds, Growl as vibrations of the arytenoid cartilages against the epiglottis, Rattle as the vibration of the arytenoid cartilages against one another, and Grunt as the vibrations of the whole supraglottic structure from level 1–4 at low frequencies with a large amplitude in the vibration of the vocal folds, with particular movement of the aryepiglottic folds. The two panels recognized the vocal effects with 91%/96% accuracy for Distortion, 91%/74% accuracy for Rattle, 90%/66% accuracy for Grunt, and 83%/99% accuracy for Growl, with an overall accuracy of 91%/84%.

Conclusion

Vocal effects can be performed, identified, and recognized as particular vibratory patterns of supraglottic structures with no visible pathology in subjects performing the effects.

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Arterial stiffness and white matter integrity in the elderly: A diffusion tensor and magnetization transfer imaging study

Publication date: Available online 16 November 2018

Source: NeuroImage

Author(s): Atef Badji, Adrián Noriega de la Colina, Agah Karakuzu, Tanguy Duval, Laurence Desjardins-Crépeau, Sven Joubert, Louis Bherer, Maxime Lamarre-cliche, Nikola Stikov, Hélène Girouard, Julien Cohen-Adad

Abstract

Background

and purpose: The stiffness of large arteries and increased pulsatility can have an impact on the brain white matter (WM) microstructure, however those mechanisms are still poorly understood. The aim of this study was to investigate the association between central artery stiffness, axonal and myelin integrity in 54 cognitively unimpaired elderly aged 65–75 years old.

Methods

The neuronal fiber integrity of brain WM was assessed using diffusion tensor metrics and magnetization transfer imaging as measures of axonal organization (Fractional anisotropy, Radial diffusivity) and state of myelination (Myelin volume fraction). Central artery stiffness was measured by carotid-femoral pulse wave velocity (cfPWV). Statistical analyses included 4 regions (the corpus callosum, the corona radiata, the internal capsule and the superior longitudinal fasciculus) which have been previously denoted as vulnerable to increased central artery stiffness.

Results

cfPWV was significantly associated with fractional anisotropy and radial diffusivity (p < 0.05, corrected for multiple comparisons) but not with myelin volume fraction. Findings from this study also show that improved executive function performance correlates with Fractional anisotropy positively (p < 0.05 corrected) as well as with myelin volume fraction and radial diffusivity negatively (p < 0.05 corrected).

Conclusions

These findings suggest that arterial stiffness is associated with axon degeneration rather than demyelination. Controlling arterial stiffness may play a role in maintaining the health of WM axons in the aging brain.

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Supervised learning for bone shape and cortical thickness estimation from CT images for finite element analysis

Publication date: Available online 16 November 2018

Source: Medical Image Analysis

Author(s): Vimal Chandran, Ghislain Maquer, Thomas Gerig, Philippe Zysset, Mauricio Reyes

Abstract

Knowledge about the thickness of the cortical bone is of high interest for fracture risk assessment. Most finite element model solutions overlook this information because of the coarse resolution of the CT images. To circumvent this limitation, a three-steps approach is proposed. 1) Two initial surface meshes approximating the outer and inner cortical surfaces are generated via a shape regression based on morphometric features and statistical shape model parameters. 2) The meshes are then corrected locally using a supervised learning model build from image features extracted from pairs of QCT (0.3-1 mm resolution) and HRpQCT images (82 μm resolution). As the resulting meshes better follow the cortical surfaces, the cortical thickness can be estimated at sub-voxel precision. 3) The meshes are finally regularized by a Gaussian process model featuring a two-kernel model, which seamlessly enables smoothness and shape-awareness priors during regularization. The resulting meshes yield high-quality mesh element properties, suitable for construction of tetrahedral meshes and finite element simulations. This pipeline was applied to 36 pairs of proximal femurs (17 males, 19 females, 76 ± 12 years) scanned under QCT and HRpQCT modalities. On a set of leave-one-out experiments, we quantified accuracy (root mean square error = 0.36 ± 0.29 mm) and robustness (Hausdorff distance = 3.90 ± 1.57 mm) of the outer surface meshes. The error in the estimated cortical thickness (0.05 ± 0.40 mm), and the tetrahedral mesh quality (aspect ratio = 1.4 ± 0.02) are also reported. The proposed pipeline produces finite element meshes with patient-specific bone shape and sub-voxel cortical thickness directly from CT scans. It also ensures that the nodes and elements numbering remains consistent and independent of the morphology, which is a distinct advantage in population studies.

Graphical abstract

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Motion Artifact Recognition and Quantification in Coronary CT Angiography using Convolutional Neural Networks

Publication date: Available online 15 November 2018

Source: Medical Image Analysis

Author(s): T. Lossau (née Elss), H. Nickisch, T. Wissel, R. Bippus, H. Schmitt, M. Morlock, M. Grass

Abstract

Excellent image quality is a primary prerequisite for diagnostic non-invasive coronary CT angiography. Artifacts due to cardiac motion may interfere with detection and diagnosis of coronary artery disease and render subsequent treatment decisions more difficult. We propose deep-learning-based measures for coronary motion artifact recognition and quantification in order to assess the diagnostic reliability and image quality of coronary CT angiography images. More specifically, the application, steering and evaluation of motion compensation algorithms can be triggered by these measures. A Coronary Motion Forward Artifact model for CT data (CoMoFACT) is developed and applied to clinical cases with excellent image quality to introduce motion artifacts using simulated motion vector fields. The data required for supervised learning is generated by the CoMoFACT from 17 prospectively ECG-triggered clinical cases with controlled motion levels on a scale of 0 to 10. Convolutional neural networks achieve an accuracy of 93.3% ± 1.8% for the classification task of separating motion-free from motion-perturbed coronary cross-sectional image patches. The target motion level is predicted by a corresponding regression network with a mean absolute error of 1.12 ± 0.07. Transferability and generalization capabilities are demonstrated by motion artifact measurements on eight additional CCTA cases with real motion artifacts.

Graphical abstract

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Enhancing Checkpoint Inhibitor Therapy with Ultrasound Stimulated Microbubbles

Publication date: Available online 15 November 2018

Source: Ultrasound in Medicine & Biology

Author(s): Sharshi Bulner, Aaron Prodeus, Jean Gariepy, Kullervo Hynynen, David E. Goertz

Abstract

Checkpoint inhibitor (CI) immunotherapy is playing an increasingly prominent role in the treatment of cancer but is effective and durable in only a subset of patients. There are concerted efforts to improve CI therapy through the use of multiple CIs or use of CIs in combination with other anti-cancer agents. Here we investigate the use of "anti-vascular" ultrasound-stimulated microbubble (USMB) treatments in combination with anti-PD-1 CI therapy. The colorectal cancer cell line CT26 was used to conduct longitudinal growth studies along with acute experiments to assess ultrasound-induced anti-tumor immune responses using flow cytometry and enzyme-linked immunospot (ELISPOT) analysis. Longitudinal experiments indicated that USMB + anti-PD-1 treatments significantly enhanced tumor growth inhibition and animal survival relative to monotherapies. Flow cytometry and ELISPOT data did not clearly support a T cell-dependent mechanism for the enhancement. Therefore, the results indicate the ability of anti-vascular USMBs to increase the anti-tumor effects of CI therapy; the specific mechanisms of enhancement remain to be established.

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Hypersensitivity Pneumonitis: A Fibrosing Alveolitis Produced by Inhalation of Diverse Antigens

Publication date: Available online 15 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Paul A. Greenberger

Abstract

Hypersensitivity pneumonitis (HP) is a T_H1 lymphocyte biased fibrosing alveolitis that is caused by antigens ranging from avian excreta, fungi, thermophilic bacteria, and protozoa to reactive chemicals found in the workplace. Mimicking a viral syndrome, acute exposures to inciting antigens cause abrupt onset of non-productive cough, dyspnea, chills, with arthralgias or malaise usually from 4-8 hours later so that the temporal relationship between antigen exposure and symptoms may be unsuspected. The histology of HP reveals prominent lymphocyte infiltrates that thicken the alveolar septa with poorly formed granulomas or giant cells. Broncholalveolar lavage demonstrates > 20% lymphocytes in nearly all patients. Abnormalities on high resolution computerized tomography examinations range from nodular, centrilobular opacities in acute/subacute disease to increased reticular markings and honeycombing fibrosis, which typically are predominant in the upper lobes, in advanced disease. Descriptors include "mosaic attenuation" and "ground-glass" opacities. Repeated episodes can result in nodular pulmonary infiltrates and suspected nonspecific interstitial pneumonia or idiopathic pulmonary fibrosis. Clinicians require a high level of suspicion to make an early diagnosis of HP before extensive pulmonary fibrosis or restrictive lung disease has occurred.

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Radiologic evaluation of pulmonary injury following carmustine- and cyclophosphamide-based preparative regimen for autologous peripheral blood stem cell transplantation in children

Abstract

Background

Toxicity of carmustine and cyclophosphamide can cause pulmonary injury after hematopoietic stem cell transplantation.

Objective

To evaluate the radiologic findings of pulmonary injuries following carmustine- and cyclophosphamide-based preparative regimens in children.

Materials and methods

From 2010 to 2014, 35 children received carmustine- and cyclophosphamide-based preparative regimens. Fourteen of 35 children presented with symptoms and radiologic abnormalities. Eight of 14 children had no evidence of infection, cardiogenic edema, or other explainable causes. We retrospectively analyzed their chest radiographs and CT scans for ground-glass opacity, consolidation, septal thickening and pleural effusion.

Results

Major chest radiographic findings were bilateral diffuse ground-glass opacity (n=8) and septal thickening (n=7). CT findings were multifocal patchy (n=4) or inhomogeneously diffuse (n=4) ground-glass opacity, multifocal consolidations (n=7) and septal thickening (n=7). All of these lesions at CT were bilateral, but showed lower lobe predominance in 88, 100, and 63%, respectively. There was no central/peripheral or anterior/posterior predilection. Six children had small pleural effusions, which were bilateral in five children.

Conclusion

Bilateral ground-glass opacity with or without consolidation, septal thickening and pleural effusion were common radiologic findings in pulmonary injury following carmustine- and cyclophosphamide-based preparative regimens.

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Gauging potential risk for patients in pediatric radiology by review of over 2,000 incident reports

Abstract

Background

Incident reporting can be used to inform imaging departments about adverse events and near misses.

Objective

To study incident reports submitted during a 5-year period at a large pediatric imaging system to evaluate which imaging modalities and other factors were associated with a greater rate of filed incident reports.

Materials and methods

All incident reports filed between 2013 and 2017 were reviewed and categorized by modality, patient type (inpatient, outpatient or emergency center) and use of sedation/anesthesia. The number of incident reports was compared to the number of imaging studies performed during that time period to calculate an incident report rate for each factor. Statistical analysis of whether there were differences in these rates between factors was performed.

Results

During the study period, there were 2,009 incident reports filed and 1,071,809 imaging studies performed for an incident report rate of 0.19%. The differences in rates by modality were statistically significant (P=0.0001). There was a greater rate of incident reports in interventional radiology (1.54%) (P=0.0001) and in magnetic resonance imaging (MRI) (0.62%) (P=0.001) as compared to other imaging modalities. There was a higher incident report rate for inpatients (0.34%) as compared to outpatient (0.1%) or emergency center (0.14%) (P=0.0001). There was a higher rate of incident reports for patients under sedation (1.27%) as compared to non-sedated (0.12%) (P=0.0001).

Conclusion

Using incident report rates as a proxy for potential patient harm, the areas of our pediatric radiology service that are associated with the greatest potential for issues are interventional radiology, sedated patients, and inpatients. The areas associated with the least risk are ultrasound (US) and radiography. Safety improvement efforts should be focused on the high-risk areas.

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Patchy increased echogenicity: a sonographic sign of femoral head necrosis following reduction and casting for developmental dysplasia of the hip

Abstract

A developmental dysplasia of the hip (DDH) case treated by closed reduction and casting and subsequently confirmed to have avascular necrosis (AVN) was retrospectively noted to have an abnormal pattern of echogenicity in the femoral head on sonograms obtained within 1.5 months of surgery. Patchy increased echogenicity in parts of the unossified cartilage replaced the normal pattern of central coalescence of vessels described with development of the ossification center. An additional case with similar findings confirms this should be considered a sign of evolving AVN following closed reduction.

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Hermes

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Correction to: Comparative safety and efficacy of balloon use in air enema reduction for pediatric intussusception

The original version on this paper contained an error. The names of M. John Hicks and R. Paul Guillerman, though correctly appeared in the published version, are incorrectly displayed in indexing sites.

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A retrospective segmentation analysis of placental volume by magnetic resonance imaging from first trimester to term gestation

Abstract

Background

Abnormalities of the placenta affect 5–7% of pregnancies. Because disturbances in fetal growth are often preceded by dysfunction of the placenta or attenuation of its normal expansion, placental health warrants careful surveillance. There are limited normative data available for placental volume by MRI.

Objective

To determine normative ranges of placental volume by MRI throughout gestation.

Materials and methods

In this cross-sectional retrospective analysis, we reviewed MRI examinations of pregnant females obtained between 2002 and 2017 at a single institution. We performed semi-automated segmentation of the placenta in images obtained in patients with no radiologic evidence of maternal or fetal pathology, using the Philips Intellispace Tumor Tracking Tool.

Results

Placental segmentation was performed in 112 women and had a high degree of interrater reliability (single-measure intraclass correlation coefficient =0.978 with 95% confidence interval [CI] 0.956, 0.989; P<0.001). Normative data on placental volume by MRI increased nonlinearly from 6 weeks to 39 weeks of gestation, with wider variability of placental volume at higher gestational age (GA). We fit placental volumetric data to a polynomial curve of third order described as placental volume = –0.02*GA³ + 1.6*GA² – 13.3*GA + 8.3. Placental volume showed positive correlation with estimated fetal weight (P=0.03) and birth weight (P=0.05).

Conclusion

This study provides normative placental volume by MRI from early first trimester to term gestation. Deviations in placental volume from normal might prove to be an imaging biomarker of adverse fetal health and neonatal outcome, and further studies are needed to more fully understand this metric. Assessment of placental volume should be considered in all routine fetal MRI examinations.

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Iterative algorithms for metal artifact reduction in children with orthopedic prostheses: preliminary results

Abstract

Background

Increased computational power allows computed tomography (CT) software to process very advanced mathematical algorithms to generate better quality images at lower doses. One such algorithm, iterative metal artifact reduction (iMAR) has proven to decrease metal artifacts seen in CT images of adults with orthopedic implants.

Objectives

To evaluate artifact reduction capability of the algorithm in lower-dose pediatric CT compared to our routine third-generation advanced modeled iterative reconstruction (ADMIRE) algorithm.

Materials and methods

Thirteen children (11–17 years old) with metal implants underwent routine clinically indicated CT. Data sets were reconstructed with an iMAR algorithm. Hounsfield units and image noise were measured in bone, muscle and fat in the streak artifact (near the implant) and at the greatest distance from the artifact (far from the implant). A regression model compared the effects of the algorithm (standard ADMIRE vs. iMAR) near and far from the implant.

Results

Near the implant, Hounsfield units with iMAR were significantly different in our standard ADMIRE vs. iMAR for bone, muscle and fat (P<0.001). Noise was significantly different in standard ADMIRE vs. iMAR in bone (P<0.003). Far from the implant, Hounsfield units and noise were not significantly different for ADMIRE vs. iMAR, for the three tissue types.

Conclusion

These preliminary results demonstrate that iMAR algorithms improves Hounsfield units near the implant and decreases image noise in bone in low-dose pediatric CT. It does this without changing baseline tissue density or noise far from the implant.

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Active reviewers (from October 1, 2017 through September 30, 2018)

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VOT or quantity: What matters more for the voicing contrast in German regional varieties? Results from apparent-time analyses

Publication date: November 2018

Source: Journal of Phonetics, Volume 71

Author(s): Felicitas Kleber

Abstract

Standard German distinguishes voiced (short-lag) and voiceless (long-lag) stops in domain-initial and -medial position with VOT being the most important cue. This phonemic distinction has been neutralized in many dialects but the merger appears to have been reversed in the corresponding regional accents probably due to the increasing influence of the standard language. This apparent-time study investigates the emerging importance of VOT and VCratio (a combined measure of proportional vowel and closure duration) in Bavarian and Saxon, two German regional varieties prone to reverse the merger. To this end we analyzed acoustically minimal pairs with stops in medial and initial position and investigated the integrated effects of VOT and VCratio in perception. VOT is becoming more important in younger speakers and dialectal traces are more pronounced in older participants. While a trading relation between VOT and VCratio was present in the perception of all groups it has only emerged in younger Bavarians' production (possibly reinforced by a greater amount of schwa deletion in this group). The findings are discussed within a usage-based model.

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Editorial Board

Publication date: December 2018

Source: Autoimmunity Reviews, Volume 17, Issue 12

Author(s):

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Mathematical thinking in children with Developmental Language Disorder: The roles of pattern skills and verbal working memory

Publication date: Available online 15 November 2018

Source: Journal of Communication Disorders

Author(s): Emily R. Fyfe, Lauren Eisenband Matz, Kayla M. Hunt, Martha W. Alibali

Abstract

Previous research suggests that children with language disorders often have difficulties in mathematical tasks. In the current study, we investigated two relevant factors – working memory and pattern skills – that may underlie children's poor mathematics performance. Children with developmental language disorder (DLD, n = 18, ages 6 to 13) and age-matched typically-developing children (n = 18) completed three math tasks that tapped calculation skill and knowledge of concepts. Children also completed a visual pattern extension task and a verbal working memory task. There were four key findings: (1) children with DLD exhibited poorer mathematical knowledge than typically-developing children, both in calculation and on key math concepts, (2) children with DLD performed similarly to typically-developing children on the visual pattern extension task, (3) children with DLD had lower verbal working memory scores than typically-developing children, and these differences in working memory accounted in part for their poorer calculation performance, and (4) children's pattern extension scores predicted their arithmetic calculation scores, but not their concept scores.

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Synthesising visual speech using dynamic visemes and deep learning architectures

Publication date: Available online 16 November 2018

Source: Computer Speech & Language

Author(s): Ausdang Thangthai, Ben Milner, Sarah Taylor

Abstract

This paper proposes and compares a range of methods to improve the naturalness of visual speech synthesis. A feedforward deep neural network (DNN) and many-to-one and many-to-many recurrent neural networks (RNNs) using long short-term memory (LSTM) are considered. Rather than using acoustically derived units of speech, such as phonemes, viseme representations are considered and we propose using dynamic visemes together with a deep learning framework. The input feature representation to the models is also investigated and we determine that including wide phoneme and viseme contexts is crucial for predicting realistic lip motions that are sufficiently smooth but not under-articulated. A detailed objective evaluation across a range of system configurations shows that a combined dynamic viseme-phoneme speech unit combined with a many-to-many encoder-decoder architecture models visual co-articulations effectively. Subjective preference tests reveal there to be no significant difference between animations produced using this system and using ground truth facial motion taken from the original video. Furthermore, the dynamic viseme system also outperforms significantly conventional phoneme-driven speech animation systems.

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Upregulation of proteins of the NLRP3 inflammasome in patients with periodontitis and uncontrolled type 2 diabetes

Abstract

Objectives

To evaluate the expression of proteins related to activation of the NLRP3 inflammasome in patients with chronic periodontitis (CP) and type 2 diabetes mellitus (T2D), and to determine whether the exacerbated periodontal pathological process observed in diabetic patients is related to its upregulation.

Materials and Methods

We performed an observational, analytical, cross‐sectional study in three study groups: individuals systemically and orally healthy, and patients with CP with and without T2D. Gingival biopsies were taken from the three study groups. The expression of mRNAs for CASP1, NLRP3, and ASC was detected using real‐time PCR, the expression of NLRP3 and ASC proteins was determined by immunohistochemistry. The quantification of IL‐18 and IL‐1β was determined in the gingival crevicular fluid using ELISA. The results were analyzed by ANOVA followed by Tukey's test to compare differences between individual groups.

Results

Patients with CP and uncontrolled T2D presented severe periodontal disease and inflammation (PPD, p= 0.0072; CAL, p = 0.0480; bone loss, p = 0.0088), higher levels of CASP1 mRNA expression (p = 0.0026), a stronger pattern of staining for NLRP3 and ASC proteins in the epithelium and connective tissues, and significantly higher production of IL‐18 (p = 0.0063) and IL‐1β (p = 0.0018) in comparison with healthy or CP subjects.

Conclusion

The upregulation of genes and proteins involved in the activation of the NLRP3 inflammasome components in patients with periodontitis and uncontrolled T2D suggests a possible role in the more severe pathological processes leading to destruction of periodontal tissues observed in these patients.

This article is protected by copyright. All rights reserved.

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