ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents.

OBJECTIVES: To develop a consensus and provide updated recommendations on liver MR imaging and the clinical use of liver-specific contrast agents. METHODS: The European Society of Gastrointestinal and Abdominal Radiology (ESGAR) formed a multinational European panel of experts, selected on the basis of a literature review and their leadership in the field of liver MR imaging. A modified Delphi process was adopted to draft a list of statements. Descriptive and Cronbach's statistics were used to rate levels of agreement and internal reliability of the consensus. RESULTS: Three Delphi rounds were conducted and 76 statements composed on MR technique (n = 17), clinical application of liver-specific contrast agents in benign, focal liver lesions (n = 7), malignant liver lesions in non-cirrhotic (n = 9) and in cirrhotic patients (n = 18), diffuse and vascular liver diseases (n = 12), and bile ducts (n = 13). The overall mean score of agreement was 4.84 (SD ±0.17). Full consensus was reached in 22 % of all statements in all working groups, with no full consensus reached on diffuse and vascular diseases. CONCLUSIONS: The consensus provided updated recommendations on the methodology, and clinical indications, of MRI with liver specific contrast agents in the study of liver diseases. KEY POINTS: • Liver-specific contrast agents are recommended in MRI of the liver. • The hepatobiliary phase improves the detection and characterization of hepatocellular lesions. • Liver-specific contrast agents can improve the detection of HCC.

Improved diagnostic accuracy of readout-segmented echo-planar imaging for peripheral zone clinically significant prostate cancer: a retrospective 3T MRI study.

This study compares the readout-segmented echo-planar imaging (rsEPI) from the conventional single-shot EPI (ssEPI) diffusion-weighted imaging (DWI) for the discrimination of patients with clinically significant prostate cancer (csPCa) within the peripheral zone (PZ) using apparent diffusion coefficient (ADC) maps and pathology report from magnetic resonance imaging (MRI)-targeted biopsy. We queried a retrospective monocentric database of patients with targeted biopsy. csPCa patients were defined as an International Society of Urological Pathology grade group ≥ 2. Group-level analyses and diagnostic accuracy of mean ADC values (ADCmean) within the tumor volume were assessed from Kruskal-Wallis tests and receiving operating characteristic curves, respectively. Areas under the curve (AUC) and optimal cut-off values were calculated. 159 patients (105 rsEPI, 54 ssEPI; mean age ± standard deviation: 65 ± 8 years) with 3T DWI, PZ lesions and targeted biopsy were selected. Both DWI sequences showed significantly lower ADCmean values for patients with csPCa. The rsEPI sequence better discriminates patients with csPCa (AUCrsEPI = 0.84, AUCssEPI = 0.68, p < 0.05) with an optimal cut-off value of 1232 µm2/s associated with a sensitivity-specificity of 97%-63%. Our study showed that the rsEPI DWI sequence enhances the discrimination of patients with csPCa.

Electrical Properties of Laser Patterned Schottky Diode with ALD-Grown TiO2 Interlayer.

Heterojunction formation is the key to adjusting the electronic and optoelectronic properties of various semiconductor devices. There have been various reports on the formation and importance of semiconducting heterojunction devices based on metal oxides. Titanium dioxide (TiO2) is one of the metal oxides that has many unique properties. TiO2's importance is due to its physical and chemical properties such as large band gap, large permittivity, stability, and low leakage current density. In this context, we present the electrical properties of the metal-insulator-semiconductor (MIS) type-TiO2-based Schottky barrier diode (SBD) in the study. To create a thin layer of TiO2 on p-type silicon (p-type Si) patterned partially by the laser-induced periodic surface structure (LIPSS) technique, an atomic layer deposition (ALD) technique was used in the study. For comparison, the current-voltage (I-V) characteristics of the TiO2-based laser-patterned (LP) and nonlaser-patterned (non-LP) diodes were measured at 300 K and in the dark at ±5 V. Classical thermionic emission (TE) theory and Cheung functions were used to investigate the critical diode parameters of the diodes, including ideality factor (n), series resistance (Rs), and barrier height (Φb). The n values were obtained as 4.10 and 3.68 from the TE method and Cheung functions for the LP diode, respectively. The Φb values were found as 0.68 and 0.69 eV from the TE method and Cheung functions, respectively. According to experimental results, the laser patterning resulted in an increase in the Φb values and a decrease in the n values. After laser patterning, it was observed that the device worked effectively, and the ideality factor and barrier height values were improved. This study provides insight into the fabrication and electrical properties of TiO2-based heterojunction devices.

New strategies and designs in pancreatic cancer research: consensus guidelines report from a European expert panel.

Although the treatment of pancreatic ductal adenocarcinoma (PDAC) remains a huge challenge, it is entering a new era with the development of new strategies and trial designs. Because there is an increasing number of novel therapeutic agents and potential combinations available to test in patients with PDAC, the identification of robust prognostic and predictive markers and of new targets and relevant pathways is a top priority as well as the design of adequate trials incorporating molecular-driven hypothesis. We presently report a consensus strategy for research in pancreatic cancer that was developed by a multidisciplinary panel of experts from different European institutions and collaborative groups involved in pancreatic cancer. The expert panel embraces the concept of exploratory early proof of concept studies, based on the prediction of response to novel agents and combinations, and randomised phase II studies permitting the selection of the best therapeutic approach to go forward into phase III, where the recommended primary end point remains overall survival. Trials should contain as many translational components as possible, relying on standardised tissue and blood processing and robust biobanking, and including dynamic imaging. Attention should not only be paid to the pancreatic cancer cells but also to microenvironmental factors and stem/stellate cells.

[Multidisciplinary management of hepatocellular carcinoma in cirrhotic patients]. / Traitement du carcinome hépato-cellulaire chez le patient cirrhotique: la nécessité d'une approche pluridisciplinaire.

The treatment of hepatocellular carcinoma (HCC) in cirrhotic patients is challenging: the incidence is increasing, the cirrhosis dramatically limits the tolerance to treatment possibilities, there are many therapeutic modalities but resources are limited, namely in the context of organ shortage for transplantation. Liver transplantation (LT) is the optimal treatment as it combines the largest tumor resection possible and the correction of the underlying liver disease. Due to organ shortage however, LT is reserved for early-stages HCC. Surgical resection and radiofrequency destruction represent potentially curative options in highly selected patients. Arterial embolizations, chemo- or radio-embolizations, allow local tumor control but are not curative. These techniques could be performed before surgical resection or LT, to downstage the tumor and/or to control tumor progression while waiting for a graft. Finally, sorafenib is the only systemic treatment which has shown a survival benefit in advanced HCC. The benefit of combination of sorafenib and surgical treatments remains undetermined. The challenge in the management of HCC in cirrhotic patients is to integrate both individual (age, comorbidities, cirrhosis stage, tumor stage, specific contraindications to LT, etc.) and collective variables (expected waiting time before LT) to determine the best therapeutic option for each patient. In this process, multidisciplinarity is a key for success.

Short- and long-term outcome in cats diagnosed with pyothorax: 47 cases (2009-2018).

OBJECTIVES: The aims of this retrospective study were to report the short- and long-term outcome in cats treated for pyothorax and to identify prognostic indicators as well as determine recurrence rate. METHODS: Medical records from April 2009 to August 2018 were retrospectively reviewed. Cases were included if a diagnosis of pyothorax was confirmed via cytology and/or culture of pleural fluid. Cats diagnosed with or suspected of having other thoracic diseases and cats with no evidence of pleural effusion were excluded from the study. RESULTS: Fifty-five cats met the inclusion criteria. Eighty five percent (n=47) cats underwent medical management with thoracostomy tubes, pleural lavage and broad-spectrum antibiotics. Fifteen percent (n=5) cases failed medical treatment and underwent thoracotomy. Twenty eight percent (n=13) did not survive to hospital discharge. Short-term survival (14 days) was achieved in 72% (n=34). Long-term follow-up was available for 31 of 34 with a long-term survival rate of 68% (n=30). The recurrence rate was 6% (n=2). CONCLUSION: For cats with pyothorax that survive to discharge the prognosis is excellent and the condition is associated with a low recurrence rate.

Optimum imaging of chronic pancreatitis.

Chronic pancreatitis is an inflammatory process of the pancreas characterized by progressive parenchyma destruction, resulting in pain and exocrine and endocrine insufficiency. In the advanced stages the diagnosis by imaging is usually straightforward, while in the early phases of the disease there can be a paucity of findings at imaging, thus making an early diagnosis challenging. Different imaging modalities can have a role in the initial diagnosis and in the longitudinal follow-up of patients affected by chronic pancreatitis, also enabling to assess the complications of the disease. Radiography, Ultrasonography, CT and MRI can all provide morphological information, and MRI with the administration of secretin can also provide functional information. The use of an appropriate technique is fundamental for optimizing the examination to the clinical question.

Grey areas and evidence gaps in the management of rectal cancer as revealed by comparing recommendations from clinical guidelines.

BACKGROUND: While the management of nonmetastatic and oligometastatic rectal cancer has rapidly evolved over the last few decades, many grey areas and highly debated topics remain that foster significant variation in clinical practice. We aimed to identify controversial points and evidence gaps in this disease setting by systematically comparing recommendations from national and international clinical guidelines. METHODS: Twenty-six clinical questions reflecting practical challenges in the routine management of nonmetastatic and oligometastatic rectal cancer patients were selected. Recommendations from the ESMO, NCCN, JSCCR, Australian and Ontario guidelines were extrapolated and compared using a 4-tier classification system (i.e., identical/very similar, similar, slightly different, different). Overall agreement between guidelines (i.e., substantial/complete disagreement, partial disagreement, partial agreement, substantial/complete agreement) was assessed for each clinical question and compared against the highest level of available evidence by using the χ2 statistic test. RESULTS: Guidelines were in substantial/complete agreement, partial agreement, partial disagreement, and substantial/complete disagreement for 8 (30.8%), 2 (7.7%), 7 (26.9%), and 9 (34.6%) clinical questions, respectively. High level of evidence supported clinical recommendations in 3/10 cases (30%) where guidelines were in agreement and in 10/16 cases (62.5%) where guidelines were in disagreement (χ2 = 2.6, p = 0.106). Agreement was frequently reached for questions regarding diagnosis, staging, and radiology/pathology pro-forma reporting, while disagreement characterised most of the treatment-related topics. CONCLUSIONS: Substantial variation exists across clinical guidelines in the recommendations for the management of nonmetastatic and oligometastatic rectal cancer. This variation is only partly explained by the lack of supporting, high-level evidence.

Comparative study of vertebral fractures and luxations in dogs and cats.

The purpose of this retrospective study was to compare patterns of vertebral fractures and luxations in 42 cats and 47 dogs, and to evaluate the impact of species-related differences on clinical outcome. Data regarding aetiology, neurological status, radiographic appearance and follow-up were compared between the groups. The thoracolumbar (Th3-L3) area was the most commonly affected location in both cats (49%) and dogs (58%). No lesions were observed in the cervical vertebral segments in cats, and none of the cats showed any signs of a Schiff-Sherrington syndrome. Vertebral luxations were significantly more frequent in dogs (20%) than in cats (6%), whereas combined fracture-luxations occurred significantly more often in cats (65%) than in dogs (37%). Caudal vertebral segment displacement was mostly dorsal in cats and ventral in dogs, with a significant difference in direction between cats and large dogs. The clinical outcome did not differ significantly between the two populations, and was poor in most cases (cats: 61%; dogs: 56%). The degree of dislocation and axis deviation were both significantly associated with a worse outcome in dogs, but not in cats. Although several differences in vertebral fractures and luxation patterns exist between cats and dogs, these generally do not seem to affect outcome.

Electroencephalography in the diagnosis of hydrocephalus in golden hamsters (Mesocricetus auratus).

The golden hamster (Mesocricetus auratus) is a popular laboratory animal and is used in a multitude of behavioural studies. However, it has been shown that it suffers from different forms of hereditary hydrocephalus, which may result in behavioural changes. This prospective study was designed to look into the usefulness of electroencephalography (EEG) measurements in the diagnosis of hydrocephalus in hamsters. The EEGs of the hydrocephalic hamsters were evaluated double-blind and showed a high-voltage slow wave activity, with a fast activity superimposed onto it. This pattern has already been well described in other hydrocephalic species and differed significantly from the EEGs that were obtained from the normal hamsters. It was concluded from our study that a background activity with an amplitude over 50 muV in combination with a frequency of < or =5 Hz was highly indicative of hydrocephalus in young hamsters. We believe that the EEG could be a very useful diagnostic tool in the screening for hydrocephalus in hamsters.

Prevalence of Cryptosporidium species isolated from diarrheic children in Makkah, Saudi Arabia.

Cryptosporidiosis has been identified as a significant underlying cause of morbidity and mortality worldwide. Studies in high and low income countries have recognized the importance of Cryptosporidium as a cause of diarrhea. The objectives of the current study were to determine the prevalence rate and genotypes of Cryptosporidiumin in diarrheic children in Makkah Region. A total of 1,380 fecal samples were collected from children aged up to 14 years attending 3 major hospitals of Makkah between March 2015 and March 2016. Stool collected were subjected to direct microscopic examination and crypto antigen detection using ImmunoCard STAT, Cryptosporidium/Giardia rapid test. Part of each positive stool sample was kept frozen at -20ºC for molecular characterization. Initial screening by immunochromatographic detection kit revealed 23 positive cases. PCR was performed for positive cases by amplification of a piece of the gene encoding the small (18S) subunit of rRNA producing a 435-438 bp product. Cryptosporidium genotyping was performed by RFLP analysis of PCR products. Genotyping revealed 18 cases C. hominis genotype, 4 cases C. parvaum genotype and one sample failed to be amplified. The data revealed a higher incidence of the common human species C. hominis (81.8%). The detection of both C. hominis and C. parvaum genotypes point to the possibility of both anthroponotic and zoonotic transmission routes occurring in Makkah region. Further studies are needed to verify the subgenotypes of Cryptosporidium to elucidate the real transmission modes and hence plan for effective control strategies.

Benign biliary diseases.

Benign biliary diseases include a large spectrum of congenital and acquired disorders, which have different prognosis and require different treatment management. The diagnosis may be challenging since some benign disorders may mimic malignancy. Imaging has an important role in the diagnostic process, for treatment decision and planning and in patient follow up. Magnetic resonance (MR) with magnetic resonance cholangiopancreatography (MRCP) sequences is the imaging modality of choice for biliary diseases and has demonstrated high diagnostic accuracy. Moreover, the use of a hepato-specific MR contrast agent allows morphological and functional assessment of the liver and the biliary tree improving the diagnostic performance.

Endoscopic therapy for chronic pancreatitis.

When endoscopic therapy is used for the treatment of patients with painful chronic pancreatitis, extracorporeal shock wave lithotripsy (ESWL) can be proposed as a first-line approach when obstructive ductal stone(s) induce upstream dilation of the main pancreatic duct. Stone fragmentation by ESWL is followed by endoscopic ductal drainage using pancreatic sphincterotomy, fragmented stone(s) extraction, and pancreatic stenting in case of ductal stricture. After completion of endoscopic pancreatic ductal drainage, long-term clinical benefit can be expected for two thirds of the patients. Best clinical results are associated with absence or cessation of smoking and with early treatment in the course of chronic pancreatitis, while alcohol abuse increases the risks of diabetes, steatorrhea and mortality. The complications of chronic pancreatitis are mainly the development of pseudocyst secondary to the downstream ductal obstruction, and biliary obstruction caused by fibrotic changes in the head of the pancreas. Successful endoscopic pseudocyst drainage is currently obtained in most patients, and carries a low complication rate. Biliary stenting is a safe and effective technique for the short-term treatment of symptomatic bile duct stricture due to chronic pancreatitis, but permanent resolution is obtained in only 25% of cases. In conclusion, endoscopic management is now considered to be the preferred interventional treatment of chronic pancreatitis, for patients selected on the basis of the anatomical changes caused by the disease. This treatment is generally safe, minimally invasive, often effective for years, does not prevent further surgery, and can be repeated.

A study on the epidemiology of brucellosis in Punjab (India) using Survey Toolbox.

A random survey was conducted to study the epidemiology of brucellosis in Punjab (India), using the 'Survey Toolbox' sampling software. A two-stage sampling procedure was adopted: in the first stage, villages were selected, and in the second the selection of animals was made. In all, 52 villages were selected randomly from a sampling frame of all the villages of Punjab. The total number of animals in these villages was 18,644, out of which 973 animals (approximately 5%) belonging to various owners were randomly selected. Serum samples collected from the animals were screened for Brucella antibodies by an avidinbiotin enzyme-linked immunosorbent assay, which showed the apparent overall prevalence of brucellosis to be 12.09% (true prevalence, 11.23%). The prevalence varied from a low of 0% to a high of 24.3% in various districts. Higher variance (0.08) was noted within villages than between different villages (0.03). The prevalence rates among buffaloes and cattle were 13.4% and 9.9%, respectively. The seroprevalence of brucellosis was found to be significantly higher (chi square = 24.50, p < 0.001) in animals with a history of abortion (33.87%) than in those without such a history (11.63%).

Seroepidemiologic study of Leishmania infantum infection in Castilla-Leon, Spain.

Leishmaniasis has increased in importance in recent years because infection with human immunodeficiency virus (HIV) has emerged as a risk factor for this disease. However, the actual prevalence of leishmaniasis in the general population of Spain is unknown. We present a study of the seroprevalence of infection with Leishmania infantum in the general population of Castilla-Leon, Spain. A random sample of individuals presenting to health care clinics (4,825 sera) and of HIV-infected patients in the autonomous community of Castilla-Leon was collected in 1996. The sero-prevalence of antibodies to L. infantum was determined by an indirect enzyme immunoassay and found to be 4.9% in the general population. There was a significant increase in seroprevalence with age (P = 0.001), from 3.96% in those 14-20 years old to 7.2% in those > 70 years old. There were no significant differences between women and men (5.0% versus 4.9%; P = 0.9534). Seroprevalence was significantly higher in people from rural areas than in those from cities (6.0% versus 3.4%; P = 0.001). Patients infected with HIV had a seroprevalence for L. infantum of 64.0%. No differences were observed between women and men, and prevalence did not increase with age.

Primary high grade malignant lymphoma of bladder.

Primary malignant lymphoma of bladder is one of the rarest extranodal site for lymphomas. Less than 100 cases have been reported so far. A history of chronic cystitis has been shown to be a preceding feature in many cases (40%) of primary bladder lymphoma. Most of the cases reported in the literature have a low-grade lymphoma including the subtypes of mucosa-associated lymphoid tissue. The diffuse large cell lymphoma is the most frequent type among the subtypes of high-grade bladder lymphomas. In this report, a case with high-grade primary malignant lymphoma of bladder is reported and the clinical, pathological aspects of diseases are reviewed.

Adenomatoid tumor of the uterus in a patient with chronic renal failure.

A case of adenomatoid tumor of the uterus in a 34-year-old patient, who had received a renal transplant and was undergoing immunosuppresive therapy is presented. At surgery, there were a total of eight nodular intramural and subserous masses thought to be leiomyoma nodules, and tumor excision was unusually, hardly performed because the nodules were strictly adherent to the myometrium. All the specimens yielded the same pathological diagnosis - adenomatoid tumor. This case is unusual because of the multiple nodular pattern and its association with the immunocompromised status of the patient. Although adenomatoid tumors have not been shown to recur, we are in doubt in our case, because the uterus is still intact and the immunocompromised status of the patient might have a role in the extensive growth and also in the possibility of recurrence.

Electroretinographic responses in epileptic children treated with vigabatrin.

Vigabatrin is an antiepileptic drug that results in higher gamma-aminobutyrate levels in the brain and retina. Vigabatrin-induced visual field defects are usually asymptomatic and only detectable by perimetry. Further, perimetry requires good cooperation, and children aged under 10 years cannot do it. Electroretinogram response amplitude to full-field 30-Hz flicker shine has been offered to be more specific in predicting visual field defects. This study is scheduled to investigate the vigabatrin-associated visual complications in 67 epileptic children taking vigabatrin using full-field electroretinogram. Electroretinographic surveys showed normal range parameters despite 3 months of vigabatrin treatment, and just 3 (4.47%) children had been visually impaired at the end of 6-month treatment. Among these 3 cases, 1 patient had persistent electroretinogram abnormality despite vigabatrin discontinuation. Our study suggests that vigabatrin is secure for short-term pediatric antiepileptic treatment, with few cases of visual impairments and that are often reversible.