Does past/current pain change pain experience? Comparing self-reports and pupillary responses.

Introduction: For decades, a substantial body of research has confirmed the subjective nature of pain. Subjectivity seems to be integrated into the concept of pain but is often confined to self-reported pain. Although it seems likely that past and current pain experiences would interact and influence subjective pain reports, the influence of these factors has not been investigated in the context of physiological pain. The current study focused on exploring the influence of past/current pain on self-reporting and pupillary responses to pain. Methods: Overall, 47 participants were divided into two groups, a 4°C-10°C group (experiencing major pain first) and a 10°C-4°C group (experiencing minor pain first), and performed cold pressor tasks (CPT) twice for 30 s each. During the two rounds of CPT, participants reported their pain intensity, and their pupillary responses were measured. Subsequently, they reappraised their pain ratings in the first CPT session. Results: Self-reported pain showed a significant difference (4°C-10°C: p = 0.045; 10°C-4°C: p < 0.001) in the rating of cold pain stimuli in both groups, and this gap was higher in the 10°C-4°C group than in the 4°C-10°C group. In terms of pupillary response, the 4°C-10°C group exhibited a significant difference in pupil diameter, whereas this was marginally significant in the 10°C-4°C group (4°C-10°C: p < 0.001; 10°C-4°C: p = 0.062). There were no significant changes in self-reported pain after reappraisal in either group. Discussion: The findings of the current study confirmed that subjective and physiological responses to pain can be altered by previous experiences of pain.

The physical properties and anticariogenic effect of experimental resin cement containing ursolic acid.

The aim was to evaluate the physical properties and anti-bacterial activity of resin cement containing ursolic acid (UA) and determine the optimal concentration of UA. Five types of experimental resin cement were prepared according to UA concentration (0, 0.1, 0.5, 1.0, and 2.0 wt%). Flexural strength, film thickness and in vitro cytotoxicity were measured to confirm whether the resin was appropriate under International Organization for Standardization (ISO) criteria. Fifty extracted human molars were prepared, and indirect resin inlays were cemented with experimental resins. Acid-resistant nail varnish was applied, except for the 2-mm area around the restoration. Artificial caries were induced for 6 days through Streptococcus (S.) mutans (ATCC25175). Quantitative light-induced fluorescence (QLF) was used to evaluate the caries progression. One-way analysis of variance (ANOVA) followed by the Dunnett correction were used to statistically analyze the data. In all groups, the physical property of flexural strength, film thickness, and cytotoxicity were satisfied for ISO criteria (p > 0.05). On ∆F (-%) and ∆Q (-%⋅Px) values as QLF parameters, there was a tendency of being lower in groups of resin cement containing higher concentration of UA. Resin cement containing UA of greater than or equal to 0.5% significantly inhibited caries in the area around restoration (p < 0.05). There was no difference between the groups containing UA of greater than or equal to 0.5%. Resin cement containing 0.5% or more UA showed anti-carious effect in the limited range of 2% and satisfied the ISO criteria for flexural strength, film thickness and cytotoxicity.

Recurrent bilateral breast abscess due to nontuberculous mycobacterial infection.

Since recurrent bilateral breast infection due to nontuberculous mycobacterium (NTM) is rare, its diagnosis is easily overlooked; in addition, complete recovery is often difficult to achieve. We report a case of recurrent bilateral infection in a 35-year-old woman who had completed treatment for NTM. Although various infectious diseases show similar clinical conditions and imaging findings, recurrences should raise suspicion of NTM infection, and this possibility should be considered in differential diagnoses.

Repeat Fine-Needle Aspiration Biopsy within a Short Interval Does Not Increase the Atypical Cytologic Results for Thyroid Nodules with Previously Nondiagnostic Results.

OBJECTIVE: The purpose of this study was to determine whether the recommended waiting period of 3 months is necessary for repeat fine-needle aspiration biopsy (FNAB). STUDY DESIGN: A retrospective review of 128 nodules from 126 patients with initial nondiagnostic (ND) results was performed for the period between January 2009 and December 2012. Demographic and clinical factors were recorded including age, sex, time interval between FNABs, and ultrasound (US) factors, i.e. nodule size, location, consistency, suspicious malignant findings and thyroiditis. The time interval was subdivided into

Diagnostic performance of apparent diffusion coefficient and quantitative kinetic parameters for predicting additional malignancy in patients with newly diagnosed breast cancer.

PURPOSE: To evaluate the diagnostic performance of an apparent diffusion coefficient (ADC) and quantitative kinetic parameters in patients with newly diagnosed breast cancer. MATERIALS AND METHODS: We enrolled 169 lesions in 89 patients with breast cancer who underwent dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI). Comparisons between benign and malignant lesions were performed for lesion type (mass or nonmass-like enhancement), size (≥1cm or<1cm), ADC, kinetic parameters and the presence of a US correlate. RESULTS: There were 63 benign and 106 malignant lesions. The mean size and initial peak enhancement of the benign lesions were significantly lower than those of malignant lesions (P<0.001 for both). The ADC of the benign lesions was significantly higher than that of malignant lesions (1.42×10(-3)mm(2)/sec vs. 1.04×10(-3)mm(2)/sec; P<0.001). The area under the receiver operating characteristic curve (AUC) for predicting malignancy was 0.87 for the combined parameters of size, ADC, and initial peak enhancement, which was higher than those of each parameter. CONCLUSIONS: Combination of quantitative kinetic parameters and ADC showed higher diagnostic performance for predicting malignancy than each parameter alone for the evaluation of patients with breast cancer.

Local recurrence of breast cancer in reconstructed breasts using TRAM flap after skin-sparing mastectomy: clinical and imaging features.

OBJECTIVES: To evaluate clinical and imaging features of cancer recurrence in reconstructed breasts following skin-sparing mastectomy (SSM) or nipple areolar skin-sparing mastectomy (NASSM). METHODS: This study was approved by our Institutional Review Board. In this retrospective study, we included patients with pathologically confirmed recurrent cancer who had transverse rectus abdominis myocutaneous (TRAM) flap reconstruction after SSM or NASSM and whose follow-up radiological studies were available. Each patient's demographic data, imaging studies and clinical outcomes were reviewed. Two breast radiologists analysed the imaging findings of follow-up mammography, ultrasound and magnetic resonance imaging. RESULTS: Of the 964 patients, 16 (1.7%) had local cancer recurrence. The average follow-up period until the detection was 31.1 months (range, 7-84 months). Fourteen (87.5%) patients had recurrence on the skin or in subcutaneous fat. Of the 16 patients, recurrence was detected by breast self-examination in 13 (81.3%) patients. Eight (50%) lesions mimicked benign lesions. The other eight (50%) lesions manifested various degree of suspicion for the malignancy. CONCLUSIONS: Recurrent cancer after TRAM flap reconstruction following SSM and NASSM is often recognised by breast self-examination and mimics imaging findings of benign lesions. Therefore, meticulous physical examination and history-taking are important. Pathological confirmation is worthwhile even in the benign-appearing lesions. KEY POINTS: Overview of clinical and imaging features of cancer recurrence in reconstructed breasts. 50% of recurred malignant lesions mimicking imaging findings of benign lesions. Patients may benefit from thorough self-breast examination.

Diagnostic performance of automated breast ultrasound as a replacement for a hand-held second-look ultrasound for breast lesions detected initially on magnetic resonance imaging.

To evaluate the diagnostic performance of automated breast ultrasound (ABUS) after breast magnetic resonance imaging (MRI) as a replacement for hand-held second-look ultrasound (HH-SLUS), we evaluated 58 consecutive patients with breast cancer who had additional suspicious lesions on breast MRI. All patients underwent HH-SLUS and ABUS. Three breast radiologists evaluated the detectability, location, characteristics and conspicuity of lesions on ABUS. We also evaluated inter-observer variability and compared the results with HH-SLUS results. Eighty additional suspicious lesions were identified on breast MRI. Fifteen of the 80 lesions (19%) were not detected on HH-SLUS. Eight of the 15 lesions (53%) were detected on ABUS, whereas the remaining 7 were not detected on ABUS. Among the 65 lesions detected on HH-SLUS, only 3 lesions were not detected on ABUS. The intra-class correlation coefficients for lesion location and size all exceeded 0.70, indicating high reliability. Moderate to fair agreement was found for mass shape, orientation, margin and Breast Imaging Reporting and Data System (BI-RADS) final assessment. Therefore, ABUS can reliably detect additional suspicious lesions identified on breast MRI and may help in the decision on biopsy guidance method (US vs. MRI) as a replacement tool for HH-SLUS.

Sequential transcatheter arterial chemoembolization and portal vein embolization versus portal vein embolization only before major hepatectomy for patients with hepatocellular carcinoma.

PURPOSE: To evaluate the safety and efficacy of sequential transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) prior to surgery in hepatocellular carcinoma (HCC) patients and to compare the clinical outcome of the combined procedure with that of a matched group of patients undergoing PVE alone. PATIENTS AND METHODS: From 1997 to 2008, 135 patients with HCC underwent sequential TACE and PVE (n = 71) or PVE alone (n = 64) before right hepatectomy. PVE was performed mean 1.2 months after TACE. In both groups, computed tomography (CT) and liver volumetry were performed before and 2 weeks after PVE to assess degree of left lobe hypertrophy. RESULTS: Baseline patient and tumor characteristics were similar in the two groups. After PVE, the chronological changes of liver enzymes were similar in the two groups. The mean increase in percentage future liver remnant (FLR) volume was higher in the TACE + PVE group (7.3%) than in the PVE-only group (5.8%) (P = 0.035). After surgery, incidence of hepatic failure was higher in the PVE-only group (12%) than in the TACE + PVE (4%) group (P = 0.185). Overall (P = 0.028) and recurrence-free (P = 0.001) survival rates were significantly higher in the TACE + PVE group than in the PVE-only group. CONCLUSION: Sequential TACE and PVE before surgery is a safe and effective method to increase the rate of hypertrophy of the FLR and leads to longer overall and recurrence-free survival in patients with HCC.

Preoperative portal vein embolization using an amplatzer vascular plug.

The purpose was to evaluate the safety and efficacy of preoperative portal vein embolization (PVE) using an Amplatzer vascular plug (AVP). Forty-one patients who underwent PVE using gelatin sponge particles and the AVP were enrolled. The right portal branches were embolized using gelatin sponges (1-8 mm(3)) through a 5-F catheter, and the AVP was deployed at the first- or second-order right portal vein. Technical success and complications, recanalization, and changes of total estimated liver volumes (TELV), future liver remnant (FLR), and FLR/TELV were evaluated. Follow-up CT performed 6-43 days (median, 16 days) after PVE was used to evaluate volume parameters. PVE was technically successful in 40 of 41 patients. Major complications occurred in two patients, with one each having extensive portal vein thrombosis and liver abscess. Partial recanalization of the occluded portal vein was seen in one patient. The mean FLR volume (653 +/- 174 ml vs. 532 +/- 154 ml, p < 0.001) and mean FLR/TELV ratio (43 +/- 8% vs 36 +/- 7%, p < 0.001) were significantly higher after than before PVE. PVE using the AVP seems to be a relatively safe and effective technique for inducing hypertrophy of the FLR with minimal risk of recanalization.