Purpose Insulinomas are predominantly benign neuroendocrine tumors originating from beta cells within the islets of Langerhans of the endocrine pancreas. Because surgical resection represents the only curative therapy option, exact tumor localization and discrimination of insulinomas from focal or diffuse manifestations of congenital hyperinsulinism are crucial for optimal treatment strategies. We investigated the diagnostic value of glucagon-like peptide 1 receptor PET/CT using 68Ga-DOTA-exendin...
Wed May 20, 2020 03:00
18F-NaF PET/CT in hyperparathyroidism and osteitis fibrosa cystica is rarely reported. We report the case of a 16-year-old boy who underwent NaF PET/CT for the evaluation of bilateral bone destruction, which was incidentally noted on an abdominal x-ray. The PET/CT images identified multiple bony abnormalities in the skull, pelvis, and limbs. In addition, a hypodense nodule was found posterior to the inferior pole of the right lobe of thyroid gland. Subsequent 99mTc-sestamibi imaging showed abnormal...
Wed May 20, 2020 03:00
Liposarcoma is a common soft tissue sarcoma in retroperitoneum, but adrenal liposarcoma is rare. We here described a 61-year-old man with left-upper-quadrant pain, hypertension, and weight loss. Abdominal CT showed a large, heterogeneously enhanced mass on the left adrenal area, which compressed the surrounding pancreas, spleen, and left kidney. Subsequent FDG PET/CT demonstrated heterogeneous uptake by the lesion. Postoperative pathological findings confirmed the diagnosis of adrenal liposarcoma....
Wed May 20, 2020 03:00
Purpose The aims of this study were to demonstrate the feasibility of zero echo time (ZTE) MRI for jawbone identification, and to evaluate the quantitative performance of 18F-FDG PET/MRI with ZTE-based attenuation correction (ZTE-AC) compared with PET/CT and PET/MRI with Dixon MR–based AC (Dixon-AC) in patients with oral cavity cancer (OCC). Materials and Methods Thirteen OCC patients underwent whole-body 18F-FDG PET/CT and subsequent regional PET/MRI with Dixon-AC and ZTE-AC in 1 day....
Wed May 20, 2020 03:00
FTLD (Frontotemporal lobar degeneration) is a clinically and pathologically heterogeneous group of degenerative disorders, characterized by predominantly asymmetric degeneration of frontal and temporal lobes with selective neuronal loss and gliosis. The disease presents with variable degrees of impairment in behavior, language, executive control, and motor symptoms with progressive loss of cognition. On the basis of presenting clinical symptoms, FTLD is further divided into behavioral variant, nonfluent/agrammatic...
Wed May 20, 2020 03:00
Brown adipose tissue (BAT), which produces energy and is known to play a role as a hibernating gland, is sometimes visualized on 18F-FDG PET in children or in slender young adults in a cold environment. Because BAT is activated by catecholamines, FDG uptake in BAT is also observed in patients with pheochromocytoma or paraganglioma. We present the case of an elderly woman with remarkable FDG uptake in BAT. Activation of BAT by a β3-adrenergic receptor agonist (mirabegron) prescribed for overactive...
Wed May 20, 2020 03:00
99mTc-MIBI has long been used to localize hyperfunctioning parathyroid tissue in patients with hyperparathyroidism. This tracer can also concentrate in various neoplastic tissues including prostate adenocarcinoma. We herein report a case with parathyroid hormone-secreting metastatic prostate cancer mimicking an ectopic parathyroid adenoma on the 99mTc-MIBI scan. We conclude that metastatic prostate cancer should be included as one of the differential diagnoses when interpreting 99mTc-MIBI scan. ...
Wed May 20, 2020 03:00
Peer review can be utilized to increase the quality of care for patients by upgrading the performance of all the providers by identifying learning opportunities. Peer review can identify providers whose care is below the standard of care and recommend actions to correct the situation. Peer review is also important to satisfy requirements of the government and The Joint Commission. Ongoing professional practice evaluation and focused professional practice evaluation have been required since 2008 to...
Wed May 20, 2020 03:00
Key points Individuals with Hereditary Sensory & Autonomic Neuropathy type III (HSAN III), also known as Riley‐Day syndrome or Familial Dysautonomia, do not have functional muscle spindle afferents but do have essentially normal cutaneous mechanoreceptors Lack of muscle spindle feedback from the legs may account for the poor proprioception at the knee and the ataxic gait typical of HSAN III Given that functional muscle spindle afferents are also absent in the upper limb, we assessed whether...
Tue May 26, 2020 12:09
Key points The primary motor cortex (M1) is fundamentally important for the acquisition of skilled motor behaviours. We tested the excitability changes of distinct M1 circuits at movement onset with TMS H‐reflex conditioning. Human subjects trained a discrete spatiotemporal motor skill. Practice was associated with reduced kinematic variability and improved motor performance. Performance improvements were paralleled by task‐specific excitability increases of the fastest corticospinal connections...
Tue May 26, 2020 12:09
Key points In this study, we focused on MSNA burst size and occurrence separately as subcomponents of the sympathetic baroreflex in older adults, and we found that the distribution (variation) of burst size against burst occurrence was greater in women than men. Older women had greater carotid artery stiffness compared with older men, while blood pressure (BP) distribution (variation) was comparable between sexes. Sympathetic baroreflex sensitivity assessed with bust incidence was less sensitive...
Mon May 25, 2020 13:35
Key points Extracellular matrix is highly remodelled in obesity and associates with the development of metabolic disorders, such as insulin resistance. Previously, we have shown that the lack of specific collagen XVIII isoforms impairs adipocyte differentiation in mice. Here, we show that mice lacking the medium and long isoforms of collagen XVIII develop insulin resistance and glucose intolerance and show elevated serum triglycerides and fat accumulation in the liver. We report that collagen...
Mon May 25, 2020 13:35
Key points Dietary nitrate is a prominent therapeutic strategy to mitigate some metabolic deleterious effects related to obesity. Mitochondrial dysfunction is causally linked to adipose tissue inflammation and insulin resistance. Whole‐body glucose tolerance is prevented by nitrate independent of body weight and energy expenditure. Dietary nitrate reduces epididymal adipose tissue inflammation and mitochondrial reactive oxygen species emission while preserving insulin signalling. Metabolic...
Mon May 25, 2020 13:35
Pathogenic enterotoxigenic Escherichia coli (ETEC) has been considered a major cause of diarrhea which is a serious public health problem in humans and animals. This study was aimed at examining the effect of γ-aminobutyric acid (GABA) supplementation on intestinal secretory immunoglobulin A (SIgA) secretion and gut microbiota profile in healthy and ETEC-infected weaning piglets. A total of thirty-seven weaning piglets were randomly distributed into two groups fed with the basal diet or supplemented...
Tue May 26, 2020 08:20
The radical resection of hilar cholangiocarcinoma combined with partial resection of the pancreatic head in some selected patients can actually replace hepatopancreaticoduodenectomy as a surgical treatment for hilar cholangiocarcinoma with distal bile duct involvement. Abstract Background To outline our experience with the radical resection of hilar cholangiocarcinoma (HCCA) combined with the partial resection of the pancreatic head (RRHCCAPRPH) as a treatment for HCCA with distal bile duct...
Mon May 25, 2020 19:00
Polycythemia vera is one of the myeloproliferative neoplasms that is distinguished by the uncontrolled production of blood cells and an increased red cell mass due to acquired JAK2 mutation. It has many complications and it might increase the risk of other tumors. However, it does not cause hypercalcemia and is rarely associated with parathyroid adenoma. Here, we report on a 64-year-old female with polycythemia vera found to have hypercalcemia due to parathyroid adenoma. Case Rep Oncol 2020;13:578–582
Tue May 26, 2020 10:19
Clinical alarms, including those for mechanical ventilation, have been one of the leading causes of health technology hazards. It has been reported that < 15% of alarms studied rose to the level of being clinically relevant or actionable. Most alarms in health care, whether by default or intention, are set to a hypothetical average patient, which is essentially a one size fits most approach. A method of tuning to individual patient characteristics is possible, similar to the treatment philosophy...
Tue May 26, 2020 11:24
Critical illness can threaten the adequacy of O2 delivery or CO2 excretion. Monitoring seeks to identify the adequacy of oxygenation and ventilation and to detect deterioration early. Advances in oximetry, capnography, and transcutaneous CO2 monitoring offer new opportunities for more accurate estimation of gas exchange, noninvasive monitoring of parameters previously not amenable (eg, total hemoglobin measurement), detection of disease, and prediction of fluid responsiveness.
Tue May 26, 2020 11:24
Transport of critically ill patients within and between hospitals is a common undertaking in an effort to improve patient outcomes. Intrahospital transports are frequently conducted to aid in diagnosis through advanced imaging techniques or to allow image-guided procedures. Interhospital transport is most frequently conducted to bring patients to specialized care, including centers of excellence for cardiac, trauma, transplant, and respiratory failure. Transport outside the hospital can be accomplished...
Tue May 26, 2020 11:24
Ventilator graphic monitoring is common in ICUs. The graphic information provides clinicians with immediate clues regarding patient–ventilator interaction and ventilator function. These display tools are aimed at reducing complications associated with mechanical ventilation, such as patient–ventilator asynchrony. It is also useful to assess respiratory mechanics in mechanically ventilated patients using both scalar and plot displays on the ventilator. Additional information can be gained by observing...
Tue May 26, 2020 11:24
Mechanical ventilation in critically ill patients must effectively unload inspiratory muscles and provide safe ventilation (ie, enhancing gas exchange, protect the lungs and the diaphragm). To do that, the ventilator should be in synchrony with patient’s respiratory rhythm. The complexity of such interplay leads to several concerning issues that clinicians should be able to recognize. Asynchrony between the patient and the ventilator may induce several deleterious effects that require a proper physiological...
Tue May 26, 2020 11:24
Lung volume measurement performed during invasive mechanical ventilation can be used to determine functional residual capacity, changes in end-expiratory lung volume with the application of PEEP, and lung strain. However, many bedside measurements provide useful information without the use of specialized equipment. Ventilation distribution through the lung has traditionally been assessed with computed tomography, but more recently electrical impedance tomography has brought the ability to monitor...
Tue May 26, 2020 11:24
The estimation of pleural pressure with esophageal manometry has been used for decades, and it has been a fertile area of physiology research in healthy subject as well as during mechanical ventilation in patients with lung injury. However, its scarce adoption in clinical practice takes its roots from the (false) ideas that it requires expertise with years of training, that the values obtained are not reliable due to technical challenges or discrepant methods of calculation, and that measurement...
Tue May 26, 2020 11:24
Mechanical ventilation is an indispensable form of life support for patients undergoing general anesthesia or experiencing respiratory failure in the setting of critical illness. These patients are at risk for a number of complications related to both their underlying disease states and the mechanical ventilation itself. Intensive monitoring is required to identify early signs of clinical worsening and to minimize the risk of iatrogenic harm. Pulse oximetry and capnography are used to ensure that...
Tue May 26, 2020 11:24
Monitoring respiratory values such as breathing frequency, minute ventilation, breathing effort, and dyspnea are common in acute care. There is evidence that accurate monitoring and interpretation of these values leads to early identification and treatment of impending respiratory failure. Despite this evidence, some values, such as breathing frequency, are largely undervalued in the clinical setting. The undervaluation of breathing frequency is complex and will require a multifaceted approach, including...
Tue May 26, 2020 11:24
Respiratory compromise is a common and potentially dangerous complication of patients admitted to general care units of hospitals. There are several distinct and disparate pathophysiologic trajectories of respiratory deterioration that hospitalized patients may suffer. Obstructive sleep apnea and preexisting cardiopulmonary disease increase the risk of respiratory failure after major surgery. Patients in general care units of hospitals currently receive only intermittent monitoring of vital signs....
Tue May 26, 2020 11:24
The diaphragm is vulnerable to injury during mechanical ventilation, and diaphragm dysfunction is both a marker of severity of illness and a predictor of poor patient outcome in the ICU. A combination of factors can result in diaphragm weakness. Both insufficient and excessive diaphragmatic contractile effort can cause atrophy or injury, and recent evidence suggests that targeting an appropriate amount of diaphragm activity during mechanical ventilation has the potential to mitigate diaphragm dysfunction....
Tue May 26, 2020 11:24
The electronic health record allows the assimilation of large amounts of clinical and laboratory data. Big data describes the analysis of large data sets using computational modeling to reveal patterns, trends, and associations. How can big data be used to predict ventilator discontinuation or impending compromise, and how can it be incorporated into the clinical workflow? This article will serve 2 purposes. First, a general overview is provided for the layperson and introduces key concepts, definitions,...
Tue May 26, 2020 11:24
There existed more difference of gut fungal profile than that of gut bacterial profile between healthy individuals and D‐IBS patients whose intestinal bacterial‐fungal interactions were weak and specific gut fungal genera were related to IBS symptoms. Mycosphaerella , Aspergillus , Sporidiobolus , and Pandora which were decreased in IBS compared with HC could be used to diagnose D‐IBS. Abstract Background Little is known about intestinal fungi in IBS patients whose gut bacteria have been investigated...
Mon May 25, 2020 11:35
Abstract Background Constipated patients remain dissatisfied with current treatments suggesting a need for alternative therapies. Aim Evaluate the mechanistic effects of oral vibrating capsule in chronic idiopathic constipation (CIC) by examining the temporal relationships between the onset of vibrations, complete spontaneous bowel movements (CSBM), and circadian rhythm. Methods In post hoc analyses of two double‐blind studies, CIC patients (Rome III) were randomized to receive 5...
Mon May 25, 2020 11:09
To investigate the role of intensity-modulated proton therapy (IMPT) compared to volumetric modulated arc therapy (VMAT), realised with RapidArc and RapidPlan methods (RA_RP) for neoadjuvant radiotherapy in lo...
Sun May 24, 2020 03:00
Patients with left-sided breast cancer frequently receive deep inspiration breath-hold (DIBH) radiotherapy to reduce the risk of cardiac side effects. The aim of the present study was to analyze intra-breath-h...
Sun May 24, 2020 03:00
Abstract Recently, we established a doxycycline‐inducible human TNFα‐transgenic mouse line, ihTNFtg. Non‐induced young and elderly mice showed low but constitutive expression of hTNFα due to promoter leakiness. The persistently present hTNFα stimulated endogenous pro‐inflammatory mouse mS100A8/A9 alarmins. Secreted mS100A8/A9 in turn induced the expression and release of mouse mTNFα. The continuous upregulation of pro‐inflammatory mTNFα and mS100A8/A9 proteins, due to their mutual expression dependency,...
Mon May 25, 2020 12:36
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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,