Can radiomic feature analysis differentiate adrenal metastases from lipid-poor adenomas on single-phase contrast-enhanced CT abdomen?

AIM: To assess if radiomic feature analysis could help to differentiate between the lipid-poor adenomas and metastases to the adrenal glands. MATERIALS AND METHODS: Eighty-six patients (women:men 42:44; mean age 66 years) with biopsy-proven adrenal metastases and 55 patients (women:men 39:16; mean age 67 years) with lipid-poor adenomas who underwent contrast-enhanced, portal-venous phase CT of the abdomen. Radiomic features were extracted using the PyRadiomics extension for 3D Slicer. Following elastic net regularisation, seven of 1,132 extracted radiomic features were selected to build a radiomic signature. This was combined with patient demographics to create a predictive nomogram. The calibration curves in both the training and validation cohorts were assessed using a Hosmer-Lemeshow test. RESULTS: The radiomic signature alone yielded an area under the curve of 91.7% in the training cohort (n=93) and 87.1% in the validation cohort (n=48). The predictive nomogram, which combined age, a previous history of malignancy, and the radiomic signature, had an AUC of 97.2% in the training cohort and 90.4% in the validation cohort. CONCLUSION: The present nomogram has the potential to differentiate between a lipid-poor adrenal adenoma and adrenal metastasis on portal-venous CT.

The role of percutaneous CT-guided biopsy of an adrenal lesion in patients with known or suspected lung cancer.

PURPOSE: To determine the sensitivity, specificity, and complication rate of percutaneous adrenal biopsy in patients with known or suspected lung cancer. METHODS: This study was approved by the Institutional Review Board at our institution as a retrospective analysis; therefore, the need for informed consent was waived. All percutaneous adrenal biopsies performed between April 1993 and May 2019 were reviewed. 357 of 582 biopsies were performed on 343 patients with known or suspected lung cancer (M:F 164:179; mean age 66 years). The biopsy results were classified into malignant, benign, or non-diagnostic. The final diagnosis was established by pathology (biopsy and/or surgical resection) or imaging follow-up on CT for at least 12 months following the biopsy. Patients with less than 12 months follow-up were excluded (n = 44). Complications were recorded. RESULTS: The final diagnosis was metastatic lung cancer in 235 cases (77.8%), metastasis from an extrapulmonary primary in 2 cases (0.7%), pheochromocytoma in 2 cases (0.7%), and benign lesions in 63 cases (20.9%). Percutaneous adrenal gland biopsy had a sensitivity of 97% and specificity of 100% for lung cancer metastases. The non-diagnostic rate was 0.6%. Larger lesions were more likely to be malignant (p = 0.0000) and to be correctly classified as a lung metastasis (p = 0.025). The incidence of minor complications was 1.1%. There were no major complications. CONCLUSION: Over 20% of adrenal lesions in patients with known or suspected lung cancer were not related to lung cancer. Percutaneous adrenal gland biopsy is a safe procedure, with high sensitivity and specificity for lung cancer metastases.

Updates to the Canadian Notifiable Disease Surveillance System and its interactive website.

The Canadian Notifiable Disease Surveillance System (CNDSS) provides data on diseases that have been identified as priorities for public health monitoring and control. Several advances that have been made on Notifiable Diseases Online, the CNDSS interactive website, are consistent with the Government of Canada's commitment to Open Data. This article provides an update on changes in case definitions that have been made since the case definitions were last published in 2009, and describes updates that have been made to the interactive website since 2013. Changes were made to the case definitions of five diseases. For hepatitis C, the new case definition now distinguishes between acute and chronic infection. For cyclosporiasis, the probable case definition requires an epidemiologic link, with the clarification that this would likely be due to exposure to a common food source. For rabies, the probable case definition now refers to detection of rabies-neutralizing antibody instead of specific antibody titres. For Lyme disease, the revised confirmed and probable case definitions now identify five options for Lyme disease risk areas instead of endemic areas. For tuberculosis the revised case definition now includes nucleic acid amplification testing in addition to culture for diagnosis. The Notifiable Diseases Online website is an interactive tool that enables users to create customized figures and tables. Since a major redesign in 2013, numerous changes have been made to the look and feel of the site. Figures and tables can now be extracted as Excel or PDF files and large datasets are exportable into Excel files for further analysis. Case definitions in the national surveillance system will be updated as needed and its interactive website will continue to be improved and updated in response to user comments.

Comparison of 18F-FDG avidity at PET of benign and malignant pure ground-glass opacities: a paradox? Part II: artificial neural network integration of the PET/CT characteristics of ground-glass opacities to predict their likelihood of malignancy.

AIM: To assess the ability of artificial neural networks (ANNs) to predict the likelihood of malignancy of pure ground-glass opacities (GGOs), using observations from computed tomography (CT) and 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET) images and relevant clinical information. MATERIALS AND METHODS: One hundred and twenty-five cases of pure GGOs described in a previous article were used to train and evaluate the performance of an ANN to predict the likelihood of malignancy in each of the GGOs. Eighty-five cases selected randomly were used for training the network and the remaining 40 cases for testing. The ANN was constructed from the image data and basic clinical information. The predictions of the ANN were compared with blinded expert estimates of the likelihood of malignancy. RESULTS: The ANN showed excellent predictive value in estimating the likelihood of malignancy (AUC = 0.98±0.02). Employing the optimal cut-off point from the receiver operating characteristic (ROC) curve, the ANN correctly identified 11/11 malignant lesions (sensitivity 100%) and 27/29 benign lesions (specificity 93.1%). The expert readers found 23 lesions indeterminate and correctly identified 17 lesions as benign. CONCLUSION: ANNs have potential to improve diagnostic certainty in the classification of pure GGOs, based upon their CT appearance, intensity of FDG uptake, and relevant clinical information, and may therefore, be useful to help direct clinical and imaging follow-up.

Comparison of the 18F-FDG avidity at PET of benign and malignant pure ground-glass opacities: a paradox?

AIM: To determine if pure ground-glass opacities (GGOs) and the subgroup of ground-glass nodules (GGNs) typically demonstrate higher 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) uptake at positron-emission tomography (PET) when benign than when malignant. MATERIALS AND METHODS: Informed consent was waived for this institutional review board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA) compliant, retrospective study. A review of all 1,864 combined PET/computed tomography (CT) examinations performed in 2011 on a single system to identify pure GGOs with mean diameter ≥1 cm yielded 166 GGOs. Two blinded subspecialty-trained thoracic radiologists independently assessed GGO size, morphology, attenuation, and location on CT. A blinded nuclear radiologist procured the SUVmax for each GGO. Final diagnosis of malignancy (n=21) was made based on histopathology or upon increased size and attenuation; a final diagnosis of benignity (n=106) was made if GGO resolved, was new within 3 months, evolved in a manner consistent with pulmonary fibrosis, or was stable for ≥60 months; 29 were indeterminate and were excluded, along with 10 cases with unreliable SUVmax measurements, yielding 127 GGOs, of which 68 were GGNs, in 76 patients. RESULTS: The SUVmax was significantly higher in benign than malignant GGOs (p=0.0017) and in the GGN subgroup (p=0.03). A threshold SUVmax >1.5 for GGOs, including GGNs, assured benignity in this cohort. CONCLUSION: Benign GGOs and the benign GGN subgroup demonstrated significantly higher FDG uptake at PET than malignant GGOs/GGNs. Awareness of this finding may prevent misinterpretation of highly 18FDG-avid pure GGOs/GGNs as definitively malignant, which could lead to unnecessary thoracic surgery and its associated risks.

Population-based mortality data suggests remediation is modestly effective in two Montana Superfund counties.

The health effects of living in proximity to Superfund sites with ongoing remediation were evaluated for residents of two contiguous Montana counties, Deer Lodge and Silver Bow. Deer Lodge and Silver Bow are home to the Anaconda Smelter and Silver Bow Creek/Butte Area Superfund sites, respectively. Established by the Environmental Protection Agency in 1983, both sites have had ongoing remediation for decades. Employing county level death certificate data obtained from the Centers for Disease Control and Prevention WONDER site, sex and age-adjusted standardized mortality ratios (SMRs) for composite targeted causes of death were calculated using observed versus expected mortality for both counties, and compared to the expected mortality from the remaining Montana counties. Cancers, cerebro- and cardiovascular diseases (CCVD), and organ failure were elevated for the two counties during the study period, 2000-2016, with SMRs of 1.19 (95% CI 1.10, 1.29); 1.36 (95% CI 1.29, 1.43); and 1.24 (95% CI 1.10, 1.38), respectively. Neurological conditions were not elevated for the two counties (SMR = 1.01; 95% CI 0.89, 1.14). Time trend analyses performed using Cox regression models indicate that deaths from cancers (HR = 0.97; p = 0.0004), CCVDs (HR = 0.95; p ≤ 0.0001), and neurological conditions (HR = 0.97; p = 0.01) decreased over the study period. While the ecological approach applied limits the interpretation of our results, our study suggests that while mortality is elevated, it is also decreasing over time for these two Superfund sites.

Temporal records of diet diversity dynamics in individual adult female Steller sea lion (Eumetopias jubatus) vibrissae.

Detailed information on the nutrition of free-ranging mammals contributes to the understanding of life history requirements, yet is often quite limited temporally for most species. Reliable dietary inferences can be made by analyzing the stable carbon (C) and nitrogen (N) isotopic values (δ13C and δ15N) of some consumer tissues; exactly which tissue is utilized dictates the inferential scope. Steller sea lion (SSL) vibrissae are grown continuously without shedding and thus provide a continuous multi-year record of dietary consumption. We applied a novel kernel density approach to compare the δ13C and δ15N values along the length of SSL vibrissae with δ13C and δ15N distributions of potential prey species. This resulted in time-series of proportion estimates of dietary consumption for individual SSL. Substantial overlap in δ13C and δ15N distributions for prey species prevented a discrete species-scale assessment of SSL diets; however, a post hoc correlational analysis of diet proportion estimates revealed grouping by trophic level. Our findings suggest that adult female SSL diets in the western and central Aleutian Islands shift significantly according to season: diets contain a higher proportion of lower trophic level species (Pacific Ocean perch, northern rockfish, Atka mackerel and walleye pollock) in the summer, whereas in the winter SSL consume a much more diverse diet which includes a greater proportion of higher trophic level species (arrowtooth flounder, Kamchatka flounder, darkfin sculpin, Pacific cod, Pacific octopus, rock sole, snailfish, and yellow Irish lord).

Factors associated with ambulatory care sensitive emergency department visits for South Carolina Medicaid members with intellectual disability.

INTRODUCTION: Ambulatory care sensitive conditions (ACSCs) can be seen as failure of access or management in primary care settings. Identifying factors associated with ACSCs for individuals with an Intellectual Disability (ID) provide insight into potential interventions. METHOD: To assess the association between emergency department (ED) ACSC visits and a number of demographic and health characteristics of South Carolina Medicaid members with ID. A retrospective cohort of adults with ID was followed from 2001 to 2011. Using ICD-9-CM codes, four ID subgroups, totalling 14 650 members, were studied. RESULTS: There were 106 919 ED visits, with 21 214 visits (19.8%) classified as ACSC. Of those, 82.9% were treated and released from EDs with costs averaging $578 per visit. People with mild and unspecified ID averaged greater than one ED visit per member year. Those with Down syndrome and other genetic cause ID had the lowest rates of ED visits but the highest percentage of ACSC ED visits that resulted in inpatient hospitalisation (26.6% vs. an average of 16.8% for other subgroups). When compared with other residential types, those residing at home with no health support services had the highest ED visit rate and were most likely to be discharged back to the community following an ED visit (85.2%). Adults residing in a nursing home had lower rates of ED visits but were most likely to be admitted to the hospital (38.9%) following an ED visit. Epilepsy and convulsions were the leading cause (29.6%) of ACSC ED visits across all subgroups and residential settings. CONCLUSION: Prevention of ACSC ED visits may be possible by targeting adults with ID who live at home without health support services.

EMP2 is a novel therapeutic target for endometrial cancer stem cells.

Previous studies have suggested that overexpression of the oncogenic protein epithelial membrane protein-2 (EMP2) correlates with endometrial carcinoma progression and ultimately poor survival from disease. To understand the role of EMP2 in the etiology of disease, gene analysis was performed to show transcripts that are reciprocally regulated by EMP2 levels. In particular, EMP2 expression correlates with and helps regulate the expression of several cancer stem cell associated markers including aldehyde dehydrogenase 1 (ALDH1). ALDH expression significantly promotes tumor initiation and correlates with the levels of EMP2 expression in both patient samples and tumor cell lines. As therapy against cancer stem cells in endometrial cancer is lacking, the ability of anti-EMP2 IgG1 therapy to reduce primary and secondary tumor formation using xenograft HEC1A models was determined. Anti-EMP2 IgG1 reduced the expression and activity of ALDH and correspondingly reduced both primary and secondary tumor load. Our results collectively suggest that anti-EMP2 therapy may be a novel method of reducing endometrial cancer stem cells.

Imaging the Abdominal Manifestations of Cystic Fibrosis.

Cystic fibrosis (CF) is a multisystem disease with a range of abdominal manifestations including those involving the liver, pancreas, and kidneys. Recent advances in management of the respiratory complications of the disease has led to a greater life expectancy in patients with CF. Subsequently, there is increasing focus on the impact of abdominal disease on quality of life and survival. Liver cirrhosis is the most important extrapulmonary cause of death in CF, yet significant challenges remain in the diagnosis of CF related liver disease. The capacity to predict those patients at risk of developing cirrhosis remains a significant challenge. We review representative abdominal imaging findings in patients with CF selected from the records of two academic health centres, with a view to increasing familiarity with the abdominal manifestations of the disease. We review their presentation and expected imaging findings, with a focus on the challenges facing diagnosis of the hepatic manifestations of the disease. An increased familiarity with these abdominal manifestations will facilitate timely diagnosis and management, which is paramount to further improving outcomes for patients with cystic fibrosis.

Group B streptococcal PCR testing in comparison to culture for diagnosis of late onset bacteraemia and meningitis in infants aged 7-90 days: a multi-centre diagnostic accuracy study.

The aim of this study was to compare an in-house real-time PCR assay, with bacterial culture as the reference, for the diagnosis of late onset group B Streptococcal (GBS) disease. This was a retrospective review. All children aged 7-90 days presenting to four paediatric centres that had a blood or CSF sample tested by GBS PCR were included. Of 7,686 blood and 2,495 cerebrospinal fluid (CSF) samples from patients of all ages received for PCR testing, 893 and 859 samples were eligible for the study, respectively. When compared to culture, the sensitivity of blood PCR was 65% (13/20) in comparison to the CSF PCR test which was 100% (5/5). Ten of 23 PCR-positive blood samples and 17 of 22 PCR-positive CSF samples were culture negative. The median threshold Ct values for culture-positive/PCR-positive CSF samples was lower than that of culture-negative/PCR-positive CSF samples (p = 0.08). Clinical details of 17 available cases that were culture negative/PCR positive were reviewed; seven were deemed to be definite cases, eight were probable and two were possible. The results showed that detection of GBS by PCR is useful for CSF samples from infants aged 7-90 days with suspected meningitis; however, analysis of blood samples by PCR is of limited value as a routine screening test for late onset GBS sepsis and should not replace bacterial culture.

Molecular imaging-its current role in cancer.

Medical imaging has undergone extensive growth over the last few decades and now plays a central role in clinical oncology. The future of imaging in the management of oncology patients is molecularly targeted imaging agents. Molecular imaging differs from conventional anatomical imaging in that imaging probes are utilized to visualize target molecules-of-interest. It is envisioned that molecular imaging will have a major impact on oncology and personalized medicine by allowing earlier diagnosis, assessing early response to treatment and by predicting treatment response. It will, hopefully, also have an impact on drug development by streamlining preclinical and clinical tests for new drug candidates.

In-hospital Paging Systems: An Effective Method of Communication between Hospital Staff in 2015?

Policies in relation to paging are designed to achieve effective in-hospital communication. This study recorded data in relation to pages received by interns over a two-week period. A survey was conducted assessing perceptions on paging and existing hospital policy. Four interns collected data in relation to 20 regular-day, 4 extended-day and 4 on-call (two weekday and two weekend) shifts (n = 423 pages). Sixty-nine pages (16%) were made during pager-free periods. On average 3 minutes per hour were spent dealing with pages. Compliance with ISBAR ranged from 50.1% to 83.4%. Of the episodes where pages were made during protected times (n = 85), 67% did not meet urgent criteria. While the majority of these pages were from nurses, they were less likely to violate the policy than other staff (relative risk 0.648, p = 0.016). Efforts need to be made to ensure pager-free periods are respected in the interest of effective communication, staff morale and protected training time.

Quantifying alosine prey in the diets of marine piscivores in the Gulf of Maine.

The objectives of this work were to quantify the spatial and temporal distribution of the occurrence of anadromous fishes (alewife Alosa pseudoharengus, blueback herring Alosa aestivalis and American shad Alosa sapidissima) in the stomachs of demersal fishes in coastal waters of the north-west Atlantic Ocean. Results show that anadromous fishes were detectable and quantifiable in the diets of common marine piscivores for every season sampled. Even though anadromous fishes were not the most abundant prey, they accounted for c. 5-10% of the diet by mass for several marine piscivores. Statistical comparisons of these data with fish diet data from a broad-scale survey of the north-west Atlantic Ocean indicate that the frequency of this trophic interaction was significantly higher within spatially and temporally focused sampling areas of this study than in the broad-scale survey. Odds ratios of anadromous predation were as much as 460 times higher in the targeted sampling as compared with the broad-scale sampling. Analyses indicate that anadromous prey consumption was more concentrated in the near-coastal waters compared with consumption of a similar, but more widely distributed species, the Atlantic herring Clupea harengus. In the context of ecosystem-based fisheries management, the results suggest that even low-frequency feeding events may be locally important, and should be incorporated into ecosystem models.

Use of state administrative data sources to study adolescents and young adults with rare conditions.

BACKGROUND: Effective care of young people with rare conditions requires ongoing coordinated medical treatment as well as educational and social support services. However, information on treatment is often lacking due to limited data. South Carolina has a repository of comprehensive health and human service data with which individuals may be tracked across the data systems of multiple state agencies and organizations. OBJECTIVE: To develop a method for studying health care of young persons with rare conditions using this repository. METHODS: We identified individuals aged 15 to 24 years diagnosed during 2000-2010 with Fragile X syndrome (FXS), spina bifida (SB), or muscular dystrophy (MD) using a series of algorithms. ICD-9-CM codes were used to initially identify the cohort from medical billing data. Demographics, medical care, employment, education, and socioeconomic status data were then extracted from linked administrative sources. RESULTS: We identified 1,040 individuals with these rare conditions: 125 with FXS, 695 with SB, and 220 with MD. The vast majority of the cases (95%) were identified in the Medicaid database. Half of the cohort was male, with a higher percentage in the FXS and MD groups. Sixty-two percent of the cohort was enrolled in the last year of high school. Over half of the cohort received support services from the state's disability and special-needs agency; 16% received food assistance. Thirty-eight percent were employed at some point during the study period. Forty-nine individuals with SB and 56 with MD died during the study period. CONCLUSIONS: We used a linked statewide data system to study rare conditions. Strengths include the diversity of information, rigorous identification strategies, and access to longitudinal data. Despite limitations inherent to administrative data, we found that linked state data systems are valuable resources for investigating important public health questions on rare conditions.

Discrimination of cathinone regioisomers, sold as 'legal highs', by Raman spectroscopy.

The discrimination of a cross section of cathinone regioisomers, sold as 'legal highs', using Raman spectroscopy, is reported here. Mephedrone and flephedrone were identified in 'legal high' products sold in Irish head shops, and their 2, 3 and 4-isomers were synthesized as reference standards. The 3,4-methylenedioxy substituted cathinones, methylone, butylone and methylenedioxypyrovalerone (MDPV), were also identified in 'legal highs' and their 2,3-isomers were synthesized for comparison. In addition, alpha- and beta-naphyrone were synthesized. Raman spectra of all the isomers were obtained using far-red excitation (785 nm) and it was found possible to discriminate the isomers of each substituted cathinone. In addition, Raman spectra were also recorded for a number of head shop products and, by comparison with the reference standards, correct isomer assignment for 4-mephedrone, 3-flephedrone, 3,4-methylone, 3,4-butylone, 3,4-MDPV, alpha-naphyrone and beta-naphyrone was achieved, thus providing a non-destructive, high-throughput and minimal sample preparation technique for the discrimination of such drug isomers.

Pre-pregnancy body mass index, weight change during pregnancy, and risk of intellectual disability in children.

OBJECTIVE: This study investigated pre-pregnancy body mass index (BMI) and weight change in pregnancy as potential risk factors for intellectual disability (ID) in children. DESIGN: Retrospective cohort study. SETTING: South Carolina, USA. POPULATION: A total of 78,675 mother-child pairs, insured by the South Carolina Medicaid programme, born in the period 2004-2007. METHODS: We analysed South Carolina Medicaid data, linked to data from both the South Carolina Department of Education (DOE) and the South Carolina Department of Disabilities and Special Needs (DDSN). Maternal pre-pregnancy BMI and weight change during pregnancy were obtained from birth certificates. ID cases were identified from the three sources listed above. We used generalised estimating equation logistic regression models to model the odds of ID in children. MAIN OUTCOME MEASURES: Identified as having ID in special education, DDSN, or Medicaid billing records. RESULTS: The risk of ID was greater in children of women with pre-pregnancy obesity, and the risk was greatest in children born to women with morbid obesity (OR 1.52, 95% CI 1.30-1.77 for ID of any severity; OR 1.73, 95% CI 1.23-2.45 for severe ID). Gestational weight change (gain or loss) was not significantly associated with odds of ID. CONCLUSIONS: Pre-pregnancy obesity may be a modifiable risk factor for ID in children, although further study is needed to evaluate whether the association meets criteria for causation.

Mapping of within-species segregation distortion in Drosophila persimilis and hybrid sterility between D. persimilis and D. pseudoobscura.

In contrast to the prevailing dogma in the 1990s, recent studies have suggested that an evolutionary history of segregation distortion within species may contribute to sterility in species hybrids. However, this recent work identified segregation distortion exclusively in species hybrids that may never have had an evolutionary history of segregation distortion in either parent species. We expand on previous work using a strain of Drosophila persimilis exhibiting segregation distortion within species to generate QTL maps for segregation distortion and hybrid sterility in crosses between D. persimilis and D. pseudoobscura. The maps localize regions along the XR contributing to both phenotypes, and they indicate one region of overlap between the two maps. This overlap could provide preliminary evidence for an association between segregation distortion within species and hybrid sterility, but the localizations are currently too broad to have confidence in this conclusion. This work is a first step towards possibly supporting a genetic conflict model of speciation in this system.