Arthritic psoriasis during natalizumab treatment: a case report and review of the literature

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Exercise Oscillatory Ventilation: Inter-reviewer Agreement and a Novel Determination.

Introduction: Determination of exercise oscillatory ventilation (EOV) is subjective and the inter-reviewer agreement has not been reported. The purpose of this study was, among patients with heart failure (HF): (1) determine the inter-reviewer agreement for EOV; and (2) describe a novel, objective, and quantifiable measure of EOV. Methods: This was a secondary analysis of the HEART Camp: Promoting Adherence to Exercise in Patients with Heart Failure study. EOV was determined through a blinded review by 6 individuals based on their interpretation of the EOV literature. Inter-reviewer agreement was assessed with Fleiss kappa ([kappa]). Final determination of EOV was based on agreement by 4 of the 6 reviewers. A new measure (ventilation dispersion index; VDI) was calculated for each test and its ability to predict EOV was assessed with the receiver operator characteristics curve (ROC). Results: Among 243 patients with HF (age=60+/-12 years; 45% women) the inter-reviewer agreement for EOV was fair ([kappa]=0.303) with 10-s discrete data averages and significantly better, but only moderate ([kappa]= 0.429) with 30-s rolling data averages. Prevalence of positive and indeterminate EOVs were 18% and 30% with the 10-s discrete averages and 14% and 13% with the 30-s rolling averages, respectively. VDI was strongly associated with EOV with area under the ROC= 0.852 to 0.890. Conclusions: Inter-reviewer agreement for EOV in patients with HF is fair to moderate which can negatively affect risk stratification. VDI has strong predictive validity with EOV; as such it might be a useful measure of prognosis in patients with HF. (C) 2017 American College of Sports Medicine

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The Influence of Foot-Strike Technique on the Neuromechanical Function of the Foot.

Purpose: The aim of this study was to investigate the influence of foot-strike technique on longitudinal arch mechanics and intrinsic foot muscle function during running. Methods: 13 healthy participants ran barefoot on a force-instrumented treadmill at 2.8ms-1 with a forefoot (FFS) and rear-foot (RFS, habitual) running technique, while kinetic, kinematic and electromyographic (EMG) data from the intrinsic foot muscles were collected simultaneously. The longitudinal arch was modeled as a single "mid-foot" joint representing motion of the rear-foot (calcaneus) relative to the forefoot (metatarsals). An inverse dynamic analysis was performed to estimate joint moments generated about the mid-foot, as well as mechanical work and power. Results: The mid-foot was more plantar flexed (higher arch) at foot contact when running with a forefoot running technique (RFS 0.2 +/- 1.8o v FFS 6.9 +/- 3.0o, ES = 2.7), however there was no difference in peak mid-foot dorsiflexion in stance (RFS -11.6 +/- 3.0o v FFS -11.4 +/- 3.4o, ES = 0.63). When running with a forefoot technique, participants generated greater moments about the mid-foot (27% increase, ES = 1.1) and performed more negative work (240% increase, ES = 2.2) and positive work (42% increase, ES = 1.1) about the mid-foot. Average stance phase muscle activation was greater for Flexor Digitorum Brevis (20% increase, ES = 0.56) and Abductor Hallucis (17% increase, ES = 0.63) when running with a forefoot technique. Conclusion: Forefoot running increases loading about the longitudinal arch and also increases the mechanical work performed by the intrinsic foot muscles. These findings have substantial implications in terms of injury prevention and management for runners who transition from a rear-foot to a forefoot running technique. (C) 2017 American College of Sports Medicine

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Three nights leg thermal therapy could improve sleep quality in patients with chronic heart failure

Abstract

Sleep quality is often impaired in patients with chronic heart failure (HF), which may worsen their quality of life and even prognosis. Leg thermal therapy (LTT), topical leg warming, has been shown to improve endothelial function, oxidative stress, and cardiac function in patients with HF. However, its short-term influence to sleep quality has not been evaluated in HF patients. Eighteen of 23 patients with stable HF received LTT (15 min of warming at 45 °C and 30 min of insulation) at bedtime for 3 consecutive nights and 5 patients served as control. Subjective sleep quality was evaluated by St. Mary's Hospital Sleep Questionnaire, Oguri–Shirakawa–Azumi Sleep Inventory, and Epworth sleepiness scale, and also objectively evaluated by polysomnography. LTT significantly improved subjective sleep quality indicated by depth of sleep (p < 0.01), sleep duration (p < 0.05), number of awaking (p < 0.01), nap duration (p < 0.01), sleep quality (p < 0.05), and sleep satisfaction (p < 0.05). It was also objectively affirmed by a slight but significant decrease of sleep stage N1 (p < 0.01), and increase in sleep stage N2 (p < 0.05). No significant changes occurred in the controls. Hence, the short-term LTT could improve subjective and objective sleep quality in patients with HF. LTT can be a complimentary therapy to improve sleep quality in these patients.

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Impact of pharmacological spasm provocation test in patients with a history of syncope

Abstract

Coronary artery spasm is involved in the pathogenesis of various cardiac disorders. We investigated patients with a history of syncope who underwent elective coronary angiography. We retrospectively analyzed 5781 consecutive patients who had diagnostic or follow-up angiography during a 26-year period. During this period, we found 95 patients with a history of syncope before elective coronary angiography. Pharmacological spasm provocation testing was performed in 64 patients with a history of syncope (<1 year). Positive pharmacological response was observed in 48 patients, while the remaining 16 patients had negative tests. Positive spasm was defined as a transient ≥90% narrowing with ischemic electrocardiographic changes. Among the 64 patients, definite coronary spastic angina (CSA) was found in 35 patients (54.7%) and suspected CSA was found in 13 patients (20.3%). Among the 35 patients with definite CSA, 22 patients (62.9%) had chest symptoms before syncope, but 13 (37.1%) had no chest symptom before syncope. No difference in clinical characteristics was observed between the two groups. Focal spasm during pharmacological spasm provocation tests was significantly higher in patients with chest symptoms than in those without chest symptoms before syncope (54.3 vs. 12.0%, p < 0.002). CSA was observed in 75.0% of patients with a history of syncope (<1 year). Thirteen patients with definite CSA had neither chest pain nor chest pressure before syncope. We should therefore investigate coronary artery spasm as a potential etiology in patients with a history of syncope.

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ADC-derived spatial features can accurately classify adnexal lesions

Background

The role of quantitative apparent diffusion coefficient (ADC) maps in differentiating adnexal masses is unresolved.

Purpose/Hypothesis

To propose an objective diagnostic method devised based on spatial features for predicting benignity/malignancy of adnexal masses in ADC maps.

Study Type

Prospective.

Population

In all, 70 women with sonographically indeterminate and histopathologically confirmed adnexal masses (38 benign, 3 borderline, and 29 malignant) were considered for this study.

Field Strength/Sequence

Conventional and diffusion-weighted magnetic resonance (MR) images (b-values = 50, 400, 1000 s/mm²) were acquired on a 3T scanner.

Assessment

For each patient, two radiologists in consensus manually delineated lesion borders in whole ADC map volumes, which were consequently analyzed using spatial models (first-order histogram [FOH], gray-level co-occurrence matrix [GLCM], run-length matrix [RLM], and Gabor filters). Two independent radiologists were asked to identify the attributed (benign/malignant) classes of adnexal masses based on morphological features on conventional MRI.

Statistical Tests

Leave-one-out cross-validated feature selection followed by cross-validated classification were applied to the feature space to choose the spatial models that best discriminate benign from malignant adnexal lesions. Two schemes of feature selection/classification were evaluated: 1) including all benign and malignant masses, and 2) scheme 1 after excluding endometrioma, hemorrhagic cysts, and teratoma (14 benign, 29 malignant masses). The constructed feature subspaces for benign/malignant lesion differentiation were tested for classification of benign/borderline/malignant and also borderline/malignant adnexal lesions.

Results

The selected feature subspace consisting of RLM features differentiated benign from malignant adnexal masses with a classification accuracy of ∼92%. The same model discriminated benign, borderline, and malignant lesions with 87% and borderline from malignant with 100% accuracy. Qualitative assessment of the radiologists based on conventional MRI features reached an accuracy of 80%.

Data Conclusion

The spatial quantification methodology proposed in this study, which works based on cellular distributions within ADC maps of adnexal masses, may provide a helpful computer-aided strategy for objective characterization of adnexal masses.

Level of Evidence: 1

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2017.

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Quantitative evaluation of breast cancer response to neoadjuvant chemotherapy by diffusion tensor imaging: Initial results

Background

Diffusion tensor imaging (DTI) yields several parameters that have not been tested in response evaluation to neoadjuvant chemotherapy (NAC).

Purpose

To evaluate and compare in reference to histopathology findings the ability of DTI and dynamic contrast-enhanced (DCE) MRI to monitor response to NAC.

Study Type

Retrospective.

Population

Twenty patients treated with neoadjuvant chemotherapy.

Field Strength/Sequence

1.5T MRI axial, bilateral T₂-weighted, DTI, and DCE-MRI.

Assessment

A standardized blinded image analysis at pixel resolution generated color-coded maps of DTI and DCE parameters

Statistical Tests

Pearson's correlation analysis and Bland–Altman plots of the DTI and DCE size changes and of the pathological final residual tumor diameter and DCE or DTI final diameter, from pre- to post-NAC. Spearman coefficient of rank correlation between the DTI and DCE size changes from pre- to post-NAC and Miller and Payne (M&P) pathological response grading. Receiver operating characteristic curve analyses to differentiate between responders to nonresponders on the basis of the DTI and DCE percent size changes and the changes in DTI parameters.

Results

DTI and DCE changes in the cancers' diameter and volume from pre- to post-NAC exhibited high and significant Pearson correlation (r = 0.82 P = 1.2 × 10⁻⁵). The DTI volume changes exhibited a significant Spearman coefficient rank correlation (0.68, P = 0.001) with the pathological M&P grading and differentiated between responders and nonresponders with area-under-the-curve (AUC) of 0.83 ± 0.10. A similar AUC for differentiating responders from nonresponders was exhibited by the changes in the highest diffusion coefficient (0.84 ± 0.11) and the mean diffusivity (0.83 ± 0.11). The DTI residual-tumor-diameter showed a high and significant Pearson correlation (r = 0.87 P = 1.2 × 10⁻⁶) to pathology tumor diameter.

Data Conclusion

DTI monitors changes in cancer size and diffusion tensor parameters in response to NAC with an accuracy equivalent to that of DCE, enabling differentiation of responders from nonresponders and assessment of residual tumor size in high congruence with pathology.

Level of Evidence: 1

Technical Efficacy: Stage 4

J. Magn. Reson. Imaging 2017.

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