Prevalence and variables associated with solitary pulmonary nodules in a routine clinic-based population: a cross-sectional study.

OBJECTIVE: To determine the prevalence of solitary pulmonary nodules (SPNs) in chest radiology studies and patient's features associated with malignancy in a non-high-risk clinical population. METHODS: Patients ≥35 years were referred for thoracic imaging in two hospitals (2010-2011). Eight radiologists determined the presence and characteristics of SPN. Selected variables were collected from radiological register and medical records. Observer agreement in the diagnosis of SPN was assessed. RESULTS: 25,529 patients were included: 23,102 (90.5%) underwent chest radiograph and 2,497 (9.5%) a CT. The prevalence of SPN was 2.1% (95% CI 1.9 - 2.3) in radiographs and 17.0% (95% CI 15.5 - 18.5) in CT. In patients undergoing chest radiograph, detection of SPN with an irregular border was more frequent among smokers. In patients who had a CT, larger SPNs appeared to be associated with 60 years of age or over, diagnosis of a respiratory illness, or male gender. In addition, an irregular border was also more common among men. CONCLUSIONS: The prevalence of SPNs detected by both radiograph and CT was lower than that shown in screening studies. Patient characteristics such as age, sex, respiratory disease, or smoking habit were associated with nodule characteristics that are known to be related with malignancy. KEY POINTS: There is a lower SPN prevalence in the clinical population than in screening studies. SPN prevalence is associated with some patient characteristics: sex, age, imaging test. Nodule characteristics related to malignancy were associated with some patient characteristics.

Plastics in the global environment assessed through material flow analysis, degradation and environmental transportation.

Knowledge on environmental plastic emission and spatial and temporal accumulation is vital for the development of successful mitigation strategies and risk assessments of plastics. In this study, emissions of both micro and macro plastic from the plastic value chain to the environment were assessed on a global level through a mass flow analysis (MFA). All countries, 10 sectors, 8 polymers and 7 environmental compartments (terrestrial, freshwater or oceanic) are distinguished in the model. The results assess a loss of 0.8 million tonnes (mt) of microplastics and 8.7 mt of macroplastics to the global environment in 2017. This is respectively 0.2 % and 2.1 % of plastics produced in the same year. The packaging sector contributed most for macroplastic emissions, and tyre wear for microplastic emissions. With the MFA results, accumulation, degradation and environmental transportation are considered in the Accumulation and dispersion model (ADM) until 2050. This model predicts macro- and microplastic accumulation in the environment to 2.2 gigatonnes (Gt) and 3.1 Gt in 2050 respectively (scenario: yearly consumption increase of 4 %). This will be 30 % less when a yearly production reduction of 1 % until 2050 is modeled to 1.5 and 2.3 Gt macro and microplastics respectively. Almost 2.15 Gt of micro and macroplastics accumulate in the environment until 2050 with zero plastic production after 2022 due to leakage from landfills and degradation processes. Results are compared to other modeling studies quantifying plastic emissions to the environment. The current study predicts lower emissions to ocean and higher emissions to surface waters like lakes and rivers. Non aquatic, terrestrial compartments are observed to accumulate most plastics emitted to the environment. The approach used results in a flexible and adaptable model that addresses plastic emissions to the environment over time and space, with detail on country level and environmental compartments.

The FAAH inhibitor URB-597 interferes with cisplatin- and nicotine-induced vomiting in the Suncus murinus (house musk shrew).

Considerable evidence implicates the endocannabinoid system as a neuromodulator of nausea and vomiting. The action of anandamide (AEA) can be prolonged by inhibiting its degradation, through the use of URB597 (URB), a Fatty Acid Amide Hydrolase (FAAH) enzyme inhibitor. Here we present evidence that the FAAH inhibitor, URB, interferes with cisplatin- and nicotine-induced vomiting in the Suncus murinus. In Experiment 1, shrews were injected with URB (0.9 mg/kg) or vehicle 120 min prior to the behavioral testing. They received a second injection of AEA (5 mg/kg) or vehicle 15 min prior to being injected with cisplatin (20 mg/kg) or saline and the number of vomiting episodes were counted for 60 min. In Experiment 2, shrews were injected with vehicle or URB (0.9 mg/kg) 120 min prior to receiving an injection of nicotine (5 mg/kg) or saline and the number of vomiting episodes were counted for 15 min. Experiment 3 evaluated the potential of the CB(1) antagonist, SR141716, to reverse the effect of URB on nicotine-induced vomiting. URB attenuated vomiting produced by cisplatin and nicotine and the combination of URB+AEA suppressed vomiting produced by cisplatin. The effect of URB on nicotine-induced vomiting was reversed by SR141716. These data suggest that the EC system plays a tonic role in the regulation of toxin-induced vomiting.

Evaluation of clinicians' knowledge and practices regarding medical radiological exposure: findings from a mixed-methods investigation (survey and qualitative study).

OBJECTIVES: To assess the impact of initiatives aiming to increase clinician awareness of radiation exposure; to explore the challenges they face when communicating with patients; to study what they think is the most appropriate way of communicating the long-term potential risks of medical radiological exposure to patients. DESIGN: A quantitative and qualitative evaluation through a survey and focal groups. SETTING: San Juan Hospital and Dr Peset Hospital (Southeast Spain) and clinicians from Spanish scientific societies. PARTICIPANTS: The surveys were answered (a) in person (216: all the radiologists (30), urologists (14) and surgeons (44) working at both participant hospitals; a sample of general practitioners from the catchment area of one hospital (45), and a consecutive sample of radiologists attending a scientific meeting (60)) or (b) electronically through Spanish scientific societies (299: radiologists (45), pneumologists (123), haematologists (75) and surgeons (40)). Clinicians were not randomly selected and thus the results are limited by the diligence of the individuals filling out the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: Clinicians' knowledge and practices regarding medical radiological exposure, and what they considered most appropriate for communicating information to patients. RESULTS: Nearly 80% of the clinicians surveyed had never heard of the European recommendations. Fewer than 20% of the clinicians surveyed identified correctly the radiation equivalence dose of intravenous urography or barium enema. It was reported by 31.7% that they inform patients about the long-term potential risks of ionising radiation. All participants agreed that the most appropriate way to present information is a table with a list of imaging tests and their corresponding radiation equivalence dose in terms of chest X-rays and background radiation exposure. CONCLUSIONS: Medical radiological exposure is frequently underestimated and rarely explained to patients. With a clear understanding of medical radiological exposure and proper communication tools, clinicians will be able to accurately inform patients.

The cannabinoid CB1 antagonist AM 251 produces food avoidance and behaviors associated with nausea but does not impair feeding efficiency in rats.

RATIONALE: A growing body of evidence suggests that cannabinoid CB1 receptor antagonists have potential therapeutic utility as appetite suppressants. However, the specific mechanisms underlying the reduction in food intake produced by these drugs are not well understood. OBJECTIVE: Considering the known antiemetic and motor-suppressive effects of CB1 agonists, the present studies were conducted to determine if the reductions in food intake induced by the CB1 antagonist AM 251 could result from nausea or impairments in intake-related motor control, rather than solely from appetite suppression. METHODS: Three experiments were conducted to examine the effects of AM 251 (2.0, 4.0, or 8.0 mg/kg or vehicle) on detailed parameters of food intake, on the development of conditioned taste avoidance, and on taste reactivity. RESULTS: In the first experiment, acute administration of AM 251 dose-dependently decreased food intake; nevertheless, feeding rate (grams consumed per time spent eating) and food handling were unaffected, which suggests that food intake was not reduced because of severe motor impairments. In the second experiment, AM 251 dose-dependently reduced intake of a flavor with which it had previously been associated, indicating that conditioned taste avoidance had developed. Lastly, AM 251 was found to induce conditioned rejection reactions in a dose-dependent manner. CONCLUSIONS: The CB1 antagonist AM 251 may reduce food intake in part by inducing nausea or malaise, but not because of incoordination or motor slowing related to feeding.

The value of routine evaluation of gastric residuals in very low birth weight infants.

OBJECTIVE: Little information exists regarding gastric residual (GR) evaluation prior to feedings in premature infants. The purpose of this study was to compare the amount of feedings at 2 and 3 weeks of age, number of days to full feedings, growth and incidence of complications between infants who underwent RGR (routine evaluation of GR) evaluation versus those who did not. STUDY DESIGN: Sixty-one premature infants were randomized to one of two groups. Group 1 received RGR evaluation prior to feeds and Group 2 did not. RESULT: There was no difference in amount of feeding at 2 (P=0.66) or 3 (P=0.41) weeks of age, growth, days on parenteral nutrition or complications. Although not statistically significant, infants without RGR evaluation reached feeds of 150 ml kg(-1) per day 6 days earlier and had 6 fewer days with central venous access. CONCLUSION: RESULTs suggest RGR evaluation may not improve nutritional outcomes in premature infants.

Intra-visceral insular cortex 2-arachidonoylglycerol, but not N-arachidonoylethanolamide, suppresses acute nausea-induced conditioned gaping in rats.

The visceral insular cortex (VIC) has previously been shown to play a critical role during acute nausea-induced conditioned gaping in rats. Specifically, localized administration of the conventional anti-emetic, ondansetron or the synthetic cannabinoid, HU210, interferes with the establishment of conditioned gaping, likely by reducing the effects of an illness-inducing treatment. However the precise role of the VIC in endocannabinoid-suppression of nausea remains unknown; thus we investigated the potential of localized intra-VIC endocannabinoid administration to interfere with acute nausea-induced conditioned gaping behavior in male Sprague-Dawley rats. Animals received an intraoral infusion of saccharin (0.1%) followed by intra-VIC exogenous N-arachidonoylethanolamide (AEA; 0.4, 4 µg) or 2-arachidonoylglycerol (2-AG; 0.5, 1 µg), and were subsequently injected with nausea-inducing LiCl (0.15M) 15 min later. Bilateral intra-VIC infusions of 2-AG (1 µg, but not 0.5 µg) dose-dependently suppressed conditioned gaping, whereas exogenous AEA was without effect. Interestingly, 2-AG reduced conditioned gaping despite additional pretreatment with the selective cannabinoid receptor type 1 (CB1) antagonist, AM-251; however, concomitant pretreatment with the cyclooxygenase inhibitor, indomethacin (0.5 µg), blocked the suppressive effects of intra-VIC 2-AG. These findings suggest that the modulatory role of the endocannabinoid system during nausea is driven largely by the endocannabinoid, 2-AG, and that its anti-nausea effects may be partly independent of CB1-receptor signaling through metabolic products of the endocannabinoid system.

Cannabinoids suppress acute and anticipatory nausea in preclinical rat models of conditioned gaping.

The sensation of nausea is one of the most debilitating human experiences. Current antiemetic therapies are effective in reducing vomiting, but are less effective in reducing acute and delayed nausea and are completely ineffective in reducing anticipatory nausea. Recent preclinical evidence using a selective rat model of nausea (conditioned gaping reactions) has revealed that cannabinoids have great promise as treatments for nausea and that their antinausea effects may be mediated by the interoceptive insular cortex.

Rewarding drugs produce taste avoidance, but not taste aversion.

Paradoxically, drugs that animals will self-administer also produce conditioned taste avoidance at similar dosage levels. The present review presents evidence that the taste avoidance produced by these rewarding drugs differs qualitatively from the taste avoidance produced by the nonrewarding, emetic drug, lithium chloride. An analysis of data pooled across 6 experiments compares the nature of flavor-drug associations produced by various rewarding drugs (amphetamine, cocaine, methamphetamine, methylphenidate, morphine, nicotine and phencyclidine) with that produced by lithium. The data from the groups conditioned with the rewarding drugs and with lithium were combined into the two categories of low/moderate and high doses. When assessed by the CTA test, the rewarding drugs did not differ from lithium in the strength of the CTA at low/moderate or at high doses. However, when assessed by the TR test, lithium produced more prominent aversive taste reactions than did the rewarding drugs. These findings suggest that the flavor-drug association produced by lithium and rewarding drugs differs qualitatively. With the large pooled data set we also assessed the relationship among the various TR categories, resulting in two factors of "Ingestion" and "Aversion" accounting for 55% of the total variability within the data.

The role of computed tomography in the evaluation of post-mastectomy locally recurrent breast cancer.

The rate of post mastectomy local-regional recurrence of breast cancer has remained in the range of 10-30% for decades. The traditional treatment, external beam radiation therapy, is successful in eradicating local disease in most cases, but re-recurrences are seen in about 50% of patients. Since 1982, 33 patients with such recurrences have undergone evaluation with computed tomography (CT) at our institution as part of their diagnostic work-up. In 22/33 (67%), CT revealed unsuspected disease, and in 10 of these patients the radiation treatment plan had to be altered. These results, similar to three other published series, strongly suggest that CT is a necessary part of the work-up of patients with post-mastectomy local-regional recurrences. The significance of these findings with respect to the cause of post mastectomy local-regional failures is further discussed.

Recurrent alveolar proteinosis following double lung transplantation.

We present a case of recurrent alveolar proteinosis following double lung transplantation.

Percutaneous small bore catheter drainage in the management of lung abscesses.

For patients with pyogenic lung abscesses who do not respond to medical therapy, thoracotomy with pulmonary resection is the widely-accepted treatment of choice. Six patients with lung abscess who failed to respond to conservative medical management were treated by percutaneous catheter drainage using small catheters (10 Fr or smaller). Five patients showed prompt clinical improvement and the sixth improved after a modification in antibiotic therapy. All patients recovered with radiographic resolution of the abscess and were well at followup periods from two months to two years. In such patients, percutaneous drainage with small catheters provides an excellent clinical result with minimal risk and trauma.

Taste reactivity responses elicited by reinforcing drugs: a dose-response analysis.

A series of 3 experiments with Sprague-Dawley rats measured taste reactivity (TR) responses elicited by sucrose that was paired on 5 occasions with various doses of d-amphetamine (0, 1, 2, 5, or 10 mg/kg), nicotine (0, 0.4, 0.8, 1.2, or 2.0 mg/kg), or morphine (0, 2, 8, 20, or 80 mg/kg). The TR responses elicited by flavors paired with each of these drugs were compared with those elicited by flavors paired with lithium. The only doses of d-amphetamine and nicotine that effectively conditioned aversive TR responses were high doses that have also been demonstrated to be incapable of producing a place preference. Extremely high doses of morphine were incapable of producing aversive TR responses. It is suggested that aversive TR responses are only produced by doses of agents that are not reinforcing in other paradigms.

Place conditioning in a three- or four-choice apparatus: role of stimulus novelty in drug-induced place conditioning.

A series of 4 experiments examined the suggestion (Scoles & Siegel, 1986) that drug-induced place preference conditioning may be due to interference with habituation. In each experiment, rats had the opportunity to select among a drug-paired chamber, a saline-paired chamber, and a novel (or relatively novel) chamber. The drugs included the positively reinforcing drugs amphetamine, apomorphine, morphine, and nicotine and the aversive drug lithium chloride. The rats preferred chambers that were paired with amphetamine, apomorphine, and morphine more than chambers that were novel; however, they also consistently preferred novel chambers to familiar saline-paired chambers. There was no evidence of place conditioning with nicotine. The drug-induced place preference, but not the novelty preference, occurred after a single conditioning trial in a 3-choice apparatus but not a 4-choice apparatus. Lithium chloride established a place aversion after 1-3 conditioning trials. Measures of activity revealed that the rats were least active while in their most preferred chamber and most active while in their least preferred chamber.

Taste reactivity responses elicited by cocaine-, phencyclidine-, and methamphetamine-paired sucrose solutions.

The nature of flavor-drug associations produced by a range of doses of the reinforcing agents cocaine (5, 10, 15, 20, or 40 mg/kg sc), phencyclidine (0.5, 2, 10, or 20 mg/kg sc), and methamphetamine (2, 5, or 10 mg/kg ip) were assessed by the taste reactivity (TR) test and the conditioned taste avoidance (CTA) test. Even at the highest doses tested, none of the agents produced aversive TR responding. At doses that produced equivalent-strength CTA, lithium did establish aversive TR responding. These results provide evidence that drugs that serve as reinforcers in other paradigms produce conditioned flavor avoidance that is not motivated by a conditioned dislike for the flavor.

LSD produces place preference and flavor avoidance but does not produce flavor aversion in rats.

The hedonic properties of lysergic acid diethylamide (LSD) were assessed using the place conditioning, taste reactivity, and taste avoidance tests. LSD produced a conditioned place preference, but only at the highest dose tested (0.2 mg/kg). A single preexposure to the conditioning chamber (latent inhibition) prevented the establishment of a place preference. When paired with sucrose, doses of 0.05 to 0.2 mg/kg of LSD produced taste avoidance, but no dose of LSD produced an aversion to the taste as assessed by the taste reactivity test. These results suggest that LSD, like other rewarding drugs, produces taste avoidance by a mechanism other than that produced by emetic drugs.

THC-induced place and taste aversions in Lewis and Sprague-Dawley rats.

The hedonic properties of delta-9-tetrahydrocannabinol (THC) were assessed in place and taste conditioning paradigms in both Lewis and Sprague-Dawley rat strains. THC produced place avoidance, taste avoidance, and aversive taste reactivity responses in both strains. The Lewis strain displayed more aversive taste reactions and a stronger taste avoidance when conditioned with lower doses of THC than did the Sprague-Dawley strain of rats. THC is an anomalous drug of abuse that appears to be aversive to rats when assessed by these measures.

Morphine- and naltrexone-induced modification of palatability: analysis by the taste reactivity test.

We used the taste reactivity (TR) test, a direct measure of the hedonic properties of a tastant, to assess in Sprague-Dawley rats the ability of morphine (an opiate agonist) and naltrexone (an opiate antagonist) to modify the palatability of a bitter quinine solution and a sweet sucrose solution. Morphine reduced the aversive hedonic properties of both novel and familiar quinine solution (0.05% and 0.1%) but did not modify the palatability of 20% sucrose solution. Naltrexone reduced the positive hedonic properties of sucrose solution (2% and 20%) but did not modify the palatability of 0.05% quinine solution. The pattern of results suggests that the modification of feeding produced by opiate agonists and antagonists may be mediated by an hedonic shift in the palatability of the tastant.

Defensive burying of flavors paired with lithium but not amphetamine.

Although rats demonstrated avoidance of both lithium- and amphetamine-paired flavored solutions, only the lithium-paired flavor elicited a defensive burying response. These data support the contention that lithium-paired flavors become hedonically unpalatable. Additionally, a simplified economical method for measuring defensive burying is described.

Rewarding and aversive properties of IP and SC cocaine: assessment by place and taste conditioning.

Three experiments were conducted to compare the effectiveness of intraperitoneally (IP) administered or subcutaneously (SC) administered cocaine to produce place and/or taste conditioning after four conditioning trials. In each experiment, IP (5-20 mg/kg) cocaine produced a place preference, but SC (0.5-20 mg/kg) cocaine at concentrations that prevented necrosis, did not produce a place preference. The failure of SC cocaine to produce a place preference was not a function of conditioning trial duration. On the other hand, SC cocaine (20 mg/kg) produced conditioned taste avoidance, but IP cocaine (20 mg/kg) did not produce conditioned taste avoidance. The results suggest that IP cocaine, but not SC cocaine, is rewarding.