Measurement of Jupiter's asymmetric gravity field.

The gravity harmonics of a fluid, rotating planet can be decomposed into static components arising from solid-body rotation and dynamic components arising from flows. In the absence of internal dynamics, the gravity field is axially and hemispherically symmetric and is dominated by even zonal gravity harmonics J2n that are approximately proportional to qn, where q is the ratio between centrifugal acceleration and gravity at the planet's equator. Any asymmetry in the gravity field is attributed to differential rotation and deep atmospheric flows. The odd harmonics, J3, J5, J7, J9 and higher, are a measure of the depth of the winds in the different zones of the atmosphere. Here we report measurements of Jupiter's gravity harmonics (both even and odd) through precise Doppler tracking of the Juno spacecraft in its polar orbit around Jupiter. We find a north-south asymmetry, which is a signature of atmospheric and interior flows. Analysis of the harmonics, described in two accompanying papers, provides the vertical profile of the winds and precise constraints for the depth of Jupiter's dynamical atmosphere.

Pessary or surgery for a symptomatic pelvic organ prolapse: the PEOPLE study, a multicentre prospective cohort study.

OBJECTIVE: To compare the 24-month efficacy of pessary or surgery as the primary treatment for symptomatic pelvic organ prolapse (POP). DESIGN: Multicentre prospective comparative cohort study. SETTING: Twenty-two Dutch hospitals. POPULATION: Women referred with symptomatic POP of stage ≥2 and moderate-to-severe POP symptoms. METHODS: The primary outcome was subjective improvement at the 24-month follow-up according to the Patient Global Impression of Improvement (PGI-I) scale. Secondary outcomes included improvement in prolapse-related symptoms measured with the Pelvic Floor Distress Inventory (PFDI-20), improvement in subjective severeness of symptoms according to the Patient Global Impression of Severity (PGI-S) scale and crossover between therapies. The primary safety outcome was the occurrence of adverse events. MAIN OUTCOME MEASURE: PGI-I at 24 months. RESULTS: We included 539 women, with 335 women (62.2%) in the pessary arm and 204 women (37.8%) in the surgery arm. After 24 months, subjective improvement was reported by 134 women (83.8%) in the surgery group compared with 180 women (74.4%) in the pessary group (risk difference 9.4%, 95% CI 1.4-17.3%, P < 0.01). Seventy-nine women (23.6%) switched from pessary to surgery and 22 women (10.8%) in the surgery group underwent additional treatment. Both groups showed a significant reduction in bothersome POP symptoms (P ≤ 0.01) and a reduction in the perceived severity of symptoms (P ≤ 0.001) compared with the baseline. CONCLUSIONS: Significantly more women in the surgery group reported a subjective improvement after 24 months. Both therapies, however, showed a clinically significant improvement of prolapse symptoms. TWEETABLE ABSTRACT: Pessary treatment and vaginal surgery are both efficacious in reducing the presence and severity of prolapse symptoms, although the chance of significant improvement is higher following surgery.

Vibrational properties of graphdiynes as 2D carbon materials beyond graphene.

Two-dimensional (2D) hybrid sp-sp2 carbon systems are an appealing subject for science and technology. For these materials, topology and structure significantly affect electronic and vibrational properties. We investigate here by periodic density-functional theory (DFT) calculations the Raman and IR spectra of 2D carbon crystals belonging to the family of graphdiynes (GDYs) and having different structures and topologies. By joining DFT calculations with symmetry analysis, we assign the IR and Raman modes in the spectra of all the investigated systems. On this basis, we discuss how the modulation of the Raman and IR active bands depends on the different interactions between sp and sp2 domains. The symmetry-based classification allows identifying the marker bands sensitive to the different peculiar topologies. These results show the effectiveness of vibrational spectroscopy for the characterization of new nanostructures, deepening the knowledge of the subtle interactions that take place in these 2D materials.

Pulse Flour Characteristics from a Wheat Flour Miller's Perspective: A Comprehensive Review.

Pulses (grain legumes) are increasingly of interest to the food industry as product formulators and consumers seek to exploit their fiber-rich and protein-rich reputation in the development of nutritionally attractive new products, particularly in the bakery, gluten-free, snack, pasta, and noodle categories. The processing of pulses into consistent high-quality ingredients starts with a well-defined and controlled milling process. However, in contrast to the extensive body of knowledge on wheat flour milling, the peer-reviewed literature on pulse flour milling is not as well defined, except for the dehulling process. This review synthesizes information on milling of leguminous commodities such as chickpea (kabuli and desi), lentil (green and red), pea, and bean (adzuki, black, cowpea, kidney, navy, pinto, and mung) from the perspective of a wheat miller to explore the extent to which pulse milling studies have addressed the objectives of wheat flour milling. These objectives are to reduce particle size (so as to facilitate ingredient miscibility), to separate components (so as to improve value and/or functionality), and to effect mechanochemical transformations (for example, to cause starch damage). Current international standards on pulse quality are examined from the perspective of their relationship to the millability of pulses (that is, grain legume properties at mill receival). The effect of pulse flour on the quality of the products they are incorporated in is examined solely from the perspective of flour quality not quantity. Finally, we identify research gaps where critical questions should be answered if pulse milling science and technology are to be established on par with their wheat flour milling counterparts.

Suitable reference genes for accurate gene expression analysis in Papaver rhoeas under 2,4-D herbicide stress.

Resistance to 2,4-D (2,4-diclorophenoxyacetic acid) herbicide is increasing in various dicotyledonous weed species, including Papaver rhoeas, a weed infesting Southern European wheat crops. Non-target-site resistance to this herbicide is governed by a range of genes involved in herbicide stress response. To enable reliable measurement of gene expression levels in herbicide-resistant and susceptible plants it is necessary to normalize qPCR data using internal control genes with stable expression. In an attempt to find the best reference genes, the stability of seven candidate reference genes was assessed in plants resistant and susceptible to 2,4-D, subjected or not to herbicide stress. Using three statistical algorithms (geNorm, BestKeeper and NormFinder), the overall results revealed that glyceraldehyde-3-phosphate dehydrogenase, actin and ubiquitin were the most stable reference genes. The normalization expression levels of GH3 (indole-3-acetic acid amido synthetase) and GST3 (glutathione S-transferase) which are two genes up-regulated following 2,4-D treatment, were determined to verify the stability of these selected reference genes. A sudden increase in GH3 and GST3 expression was already detected 5h after herbicide application, confirming their involvement in plant response to 2,4-D. The validation results confirmed the applicability and accuracy of these reference genes. This study identified and validated reference genes in the non-model weed species P. rhoeas and these will facilitate gene expression analysis studies aimed at identifying functional genes associated with non-target-site resistance.

Delivery of HIV-1 Nef linked to heat shock protein 27 using a cationic polymer is more effective than cationic lipid in mammalian cells.

BACKGROUND: Different adjuvants and delivery systems have been used to enhance the potency of DNA vaccines against viral diseases. Among them, heat shock proteins (HSPs) are stress proteins that have multiple roles such as chaperon activity and anti-apoptotic and adjuvant properties. The goal of this study was to compare the expression of HIV-1 Nef, Hsp27 and Hsp27-Nef genes transfected in HEK-293T mammalian cells by TurboFect and Lipofectamine as a cationic polymer and lipid, respectively. METHODS: At first, the pEGFP eukaryotic vectors encoding HIV-1 Nef, Hsp27 and Hsp27-Nef genes were generated and transfected in HEK-293T using TurboFect and Lipofectamine delivery systems. Then, the expression of proteins was evaluated and compared using fluorescent microscopy, flow cytometry and western blotting 48 hr after transfection. RESULTS: The accuracy of the DNA constructs was confirmed on agarose gel electrophoresis to be ~ 720 bp, ~ 648 bp, and ~ 1368 bp bands for Hsp27, Nef, and Hsp-Nef, respectively. The expression analysis in the transfected cells showed that the delivery of genes using TurboFect was significantly higher than that using Lipofectamine. Furthermore, transfection of Hsp27 gene was more effective than that of Nef gene using both delivery systems. Hsp27 linked to Nef could also increase its delivery and expression in HEK-293T cells. CONCLUSION: Generally, Hsp27 can be used as a suitable carrier in DNA vaccine design against HIV-1 infections (Fig. 5, Ref. 28).

Secondary cytoreductive surgery, hyperthermic intraperitoneal intraoperative chemotherapy, and chemotherapy alone: a retrospective comparison of alternative approaches in relapsed platinum sensitive ovarian cancer.

INTRODUCTION: The best treatment for relapsed platinum sensitive epithelial ovarian cancer (EOC) is controversial. The aim of the study was to compare progression-free survival (PFS) and overall survival (OS) in platinum-sensitive EOC patients treated with chemotherapy alone (CTA), secondary cytoreductive surgery (SCR) or SCR plus hyperthermic intraperitoneal intraoperative chemotherapy (HIPEC). MATERIALS AND METHODS: Retrospective analysis of the clinical outcome of 46 EOC patients with at least 30 months of follow-up. RESULTS: Median follow-up time was 32 months for the CTA group, 30 months for the SCR group, and 45 months for the SCR + HIPEC group. Fifteen recurrences were observed in the CTA group, seven in the SCR group, and 16 in the SCR + HIPEC group. The median time elapsed between first and second recurrence (PFI-2) was significantly higher among patients treated with SCR + HIPEC, in comparison with patients treated with CTA (p = 0.012 andp = 0.017, respectively). On the contrary, PFI-2 did not significantly differ between the SCR and SCR + HIPEC groups (p = 0.877). A statistically significant difference in OS favouring SCR + HIPEC in comparison with CTA (p = 0.04) was observed. CONCLUSIONS: SCR HIPEC compared with CTA improves PFI-2 in patients with platinum-sensitive EOC recurrence. SCR + HIPEC might also improve OS in comparison with CTA. No improvement in favor of SCR + HIPEC vs SCR was observed,. These results further support the need of a randomized trial comparing chemotherapy with SCR ± HIPEC in this setting.

Apical microleakage of AH Plus and MTA Fillapex® sealers in association with immediate and delayed post space preparation: a bacterial leakage study.

AIM: The aim of the present study was to compare the apical microleakage of root canals obturated with AH Plus and MTA Fillapex® sealers. METHODS: A total of 76 anterior teeth were randomly divided into 4 groups (N.=15) and in each group 2 positive and 2 negative control teeth. All the teeth were cleaned, shaped and obturated using lateral compaction technique with gutta-percha and AH Plus® sealer in groups 1 and 2 and MTA Fillapex® sealer in groups 3 and 4. In groups 1 and 3 post spaces were prepared immediately and groups 2 and 4 were stored for 1 week at 100% relative humidity and then post spaces were prepared. The teeth were connected to a bacterial microleakage evaluation system. Each 72 hours, E. faecalis bacteria were inoculated into the coronal thirds of the root canals. The study period was 90 days and the samples were evaluated on a daily basis, Meier-Kaplan technique was used for estimation of the mean time of microleakage to occur. Log-rank test was used for comparison of microleakage. RESULTS: Contamination occurred in positive control groups on the first day of bacterial inoculation; however, the negative control groups did not exhibit any contamination up to the end of 90-day study period. the difference was not statistically significant between two materials (P>0.05). CONCLUSION: There were no significant differences between AH Plus® and MTA Fillapex® sealers with the two immediate and delayed postspace preparation techniques.

On complexities of impact simulation of fiber reinforced polymer composites: a simplified modeling framework.

Impact modeling of fiber reinforced polymer composites is a complex and challenging task, in particular for practitioners with less experience in advanced coding and user-defined subroutines. Different numerical algorithms have been developed over the past decades for impact modeling of composites, yet a considerable gap often exists between predicted and experimental observations. In this paper, after a review of reported sources of complexities in impact modeling of fiber reinforced polymer composites, two simplified approaches are presented for fast simulation of out-of-plane impact response of these materials considering four main effects: (a) strain rate dependency of the mechanical properties, (b) difference between tensile and flexural bending responses, (c) delamination, and (d) the geometry of fixture (clamping conditions). In the first approach, it is shown that by applying correction factors to the quasistatic material properties, which are often readily available from material datasheets, the role of these four sources in modeling impact response of a given composite may be accounted for. As a result a rough estimation of the dynamic force response of the composite can be attained. To show the application of the approach, a twill woven polypropylene/glass reinforced thermoplastic composite laminate has been tested under 200 J impact energy and was modeled in Abaqus/Explicit via the built-in Hashin damage criteria. X-ray microtomography was used to investigate the presence of delamination inside the impacted sample. Finally, as a second and much simpler modeling approach it is shown that applying only a single correction factor over all material properties at once can still yield a reasonable prediction. Both advantages and limitations of the simplified modeling framework are addressed in the performed case study.

Radiomic Application for Head and Neck Squamocellular Tumor: Systematic Review.

Abstract: Radiomics represents the convergence of artificial intelligence and radiological data analysis, primarily applied in the diagnosis and treatment of cancer. In the head and neck region, squamous cell carcinoma is the most prevalent type of tumor. Recent radiomics research has revealed that specific bio-imaging characteristics correlate with various molecular features of Head and Neck Squamous Cell Carcinoma (HNSCC), particularly Human Papillomavirus (HPV). These tumors typically present a unique phenotype, often affecting younger patients, and show a favorable response to radiation therapy. This study provides a systematic review of the literature, summarizing the application of radiomics in the head and neck region. It offers a comprehensive analysis of radiomics-based studies on HNSCC, evaluating its potential for tumor evaluation, risk stratification, and outcome prediction in head and neck cancer treatment.

Active immunotherapy in HER2 overexpressing breast cancer: current status and future perspectives.

BACKGROUND: The use of anti-HER2 monoclonal antibodies (mAbs) has improved the clinical outcome of HER2-overexpressing breast cancers (BCs). Unfortunately, often these tumors tend to relapse and, when metastatic, the duration of clinical benefit is limited over time and almost invariably followed by tumor progression. Alternative approaches to this essentially passive immunotherapy are therefore needed in HER2-overexpressing BC patients. As HER2 is one of the most suitable targets for active immunotherapy in BC, manipulating the immune system is a highly attractive approach. MATERIAL AND METHODS: A computer-based literature search was carried out using PubMed (keywords: breast neoplasm, HER2 vaccine, immunology); data reported at international meetings were included. RESULTS: This review provides a focus on the following active vaccinal approaches under clinical investigation against HER2-overexpressing BC: (i) peptide and protein based; (ii) DNA based; (iii) whole tumor cell based; (iv) dendritic cell based. Moreover, the review discuss future challenges in the field, trying to define the best setting for the development of this innovative strategy, considering both immunological and clinical aspects of HER2 targeting. CONCLUSIONS: Development of effective vaccines for BC remains a distinct challenge but is likely to become a substantial advance for patients with HER2-overexpressing BCs.

Modified cisplatin, etoposide, and ifosfamide (PEI) salvage therapy for male germ cell tumors: long-term efficacy and safety outcomes.

BACKGROUND: Since 1985, we introduced a modified combination of etoposide, ifosfamide, and cisplatin (PEI) as second-line therapy of adult male germ cell tumors with the aim to reduce toxic effect while maintaining efficacy over the original regimen. PATIENTS AND METHODS: Patients received four cycles of ifosfamide at 2.5 g/m(2) on days 1-2, etoposide, and cisplatin at 100 and 33 mg/m(2), respectively, on days 3-5 every 21 days, followed by surgery. Results were stratified according to the International Germ Cell Consensus Classification Group-2 (IGCCCG-2). RESULTS: From February 1985 to January 2012, 189 patients were treated. 72.6% were IGCCCG-2 intermediate-to-very high risk. Thirty-five patients (18.5%) had a complete response, 67 (35.4%) a marker normalization (PRm-). Median follow-up was 122.1 months (inter-quartile range [IQR]: 71.4-232.0). Two-year progression-free and 5-year overall survival were 34.3% [95% confidence interval (CI) 28.1% to 41.9%] and 42.1% (95% CI 35.3% to 50.2%), respectively. Survival estimates compared favorably with those obtained by conventional dose chemotherapy (CDCT) regimens in each prognostic category. 70.4% of grade 3-4 neutropenia (25.5% febrile neutropenia), 48.1% thrombocytopenia, 21.2% anemia, 3.2% neurotoxic effect, and no severe renal toxic effect were recorded. CONCLUSION: Dose-modified Italian PEI should be considered as an appropriate benchmark for CDCT in the first salvage setting.

Ultrafast spectroscopy of linear carbon chains: the case of dinaphthylpolyynes.

The dynamics of excited states in α,ω-dinaphthylpolyyne, a class of linear sp-carbon chains, has been investigated by ultrafast transient absorption spectroscopy and DFT//TDDFT calculations. We show that the role of molecular conformers, in which end-capped naphthalene rings are planar or perpendicular to the polyyne plane, is fundamental for understanding both the steady state properties, such as UV-Vis absorption spectra and vibronic transitions, and the ultrafast transient absorption features. In particular, we observed in one of the conformers the ultrafast formation of a narrow photo-induced absorption band rising within 30 ps. This band can be assigned to an inter-system crossing event leading to the formation of triplet excited states.

Surgical treatment of pelvic organ prolapse: a historical review with emphasis on the anterior compartment.

INTRODUCTION AND HYPOTHESIS: The objective of this work was to collect and summarize a detailed historical review of the surgical treatment of pelvic organ prolapse (POP) in which we specifically focused on the anterior compartment. METHODS: A literature search in English, Dutch, and German was carried out using the keywords pelvic organ prolapse, anterior colporrhaphy, cystocele, and interposition operations in several databases (e.g., PubMed and HathiTrust Digital Library). Other relevant journal and textbook articles were found by retrieving references cited in previous articles and textbooks. RESULTS: Probably the first explanation of the treatment of POP dates from 1500 B.C. The Egyptians gave a description to "falling of the womb" in the Kahun Papyrus. More than a millennium later, Euryphon, a contemporary of Hippocrates (400 B.C.) described some interesting therapeutic options, from succussion (turning a women upside down for several minutes) to irrigating the displaced uterus with wine. A wide range of techniques has been attempted to repair the prolapsing anterior vaginal wall. By 1866, Sim had already performed a series of operations very similar to a modern anterior repair. The first reviews about the abdominal approach to correcting a cystocele were in 1890. The first description of using mesh to cystoceles was the use of tantalum mesh in 1955. In 1970, the first report of collagen mesh in urogynecology was described. Nowadays, robot-assisted surgery and cell-based tissue engineering are the latest interventions. CONCLUSION: Many surgeons have tried to find the ideal surgical therapy for anterior compartment prolapse, but to date, this has not been achieved.

Comparison of two trocar-guided trans-vaginal mesh systems for repair of pelvic organ prolapse: a retrospective cohort study.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to compare failure and complication rates in patients who underwent a trocar-guided vaginal mesh repair with either a non-absorbable or a partially absorbable mesh. METHODS: Retrospective analysis of prospectively collected data from consecutive women undergoing either non-absorbable or partially absorbable mesh for symptomatic stage 2 prolapse or higher were evaluated at 12 months. Outcome measures included objective and subjective failure rates, patient's satisfaction, complications and perioperative outcomes. RESULTS: Five hundred and sixty-nine women (347 with non-absorbable mesh, 222 with partially absorbable mesh) were included. Failure rates were similar in the two groups; the re-operation rate in the untreated compartments was higher in the non-absorbable mesh group compared with the partially absorbable mesh group (5% vs 1%). Mesh exposure rate in the non-absorbable mesh group was 12% and in the partially absorbable mesh group it was 5%. Other complication and patient satisfaction rates were similar. CONCLUSIONS: Non-absorbable and partially absorbable mesh demonstrated similar outcome rates at 12 months. The risk of reoperation was lower for partially absorbable mesh. The mesh exposure rate was significantly lower for the partially absorbable mesh group compared with the non-absorbable mesh group.

Development of de novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of a randomised controlled trial.

OBJECTIVE: To compare the de novo prolapse rate in the untreated vaginal compartments following conventional vaginal prolapse repair and tension-free vaginal mesh repair. DESIGN: Secondary analysis of a randomised controlled trial. SETTING: Thirteen centres in the Netherlands. POPULATION: Women with recurrent pelvic organ prolapse stage II or higher. METHODS: Random assignment to either conventional vaginal native tissue repair or vaginal mesh insertion. PRIMARY OUTCOME: de novo pelvic organ prolapse stage II or higher in the untreated vaginal compartments at 12 months after surgery. SECONDARY OUTCOMES: de novo pelvic organ prolapse at and beyond the hymen, de novo prolapse beyond the hymen and prolapse domain scores of the Urogenital Distress Inventory. RESULTS: At 12 months ten of 59 women (17%) in the conventional group versus 29 of 62 women (47%) in the mesh group were diagnosed with a de novo pelvic organ prolapse stage II or higher in the untreated compartment (P < 0.001, odds ratio 4.3, 95% confidence interval 1.9-10.0). Additional apical support to a mesh-augmented anterior repair significantly reduced the de novo prolapse rate. Women with a de novo prolapse in the mesh-treated group demonstrated significantly higher mean bother scores on the domain genital prolapse of the Urogenital Distress Inventory score (13.1 ± 24.2) compared with those without de novo prolapse (2.9 ± 13.9) (P = 0.03). CONCLUSION: Mesh-augmented prolapse repair in only one vaginal compartment is associated with a higher de novo prolapse rate in the untreated compartments compared with conventional vaginal native tissue repair in women with recurrent pelvic organ prolapse.

Can preoperative urodynamic investigation be omitted in women with stress urinary incontinence? A non-inferiority randomized controlled trial.

AIMS: To assess in women with stress urinary incontinence (SUI) the value of urodynamics prior to treatment. METHODS: We performed a multicenter non-inferiority randomized controlled trial. Women with SUI were randomly allocated to management based on a workup with or without urodynamics. The primary outcome was clinical reduction of complaints as measured with the Urogenital Distress Inventory urinary incontinence subscale (UDI-UI) at 12 months after the onset of treatment. A mean difference in improvement of less than 8 was considered non-inferior. The study was analyzed according to intention-to-treat. RESULTS: The trial was stopped prematurely because of slow recruitment. We randomly allocated 59 women to a strategy with (N = 31) or without (N = 28) urodynamics. The mean difference in improvement on the UDI-UI was 14 in favor of the group without urodynamics (48 SD ± 22 vs. 34 SD ± 22, 95% CI: -28 to -0.26), confirming non-inferiority. Addition of urodynamics did not result in a lower occurrence of de novo overactive bladder complaints compared to a workup without urodynamics (6/31 vs. 1/28; RR 5.4, 95% CI: 0.70-42). In the group allocated to urodynamics, initial surgical management was more often abandoned compared to the group not allocated to urodynamics (5/31 vs. 1/28; RR 4.5, 95% CI: 0.56-36). CONCLUSIONS: In this relatively small study, the omission of urodynamics was not inferior to the use of urodynamics in the preoperative workup of women with SUI. Women with SUI undergoing urodynamics had the risk of a choice for more prudent treatment, which seemed to result in a delay until effective treatment.

Efficacy of different concentrations of sodium hypochlorite and chlorhexidine in disinfection of contaminated Resilon cones.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of different concentrations of Chlorhexidine (CHX) and sodium hypochlorite (NaOCl) in disinfecting contaminated Resilon cones within one minute. STUDY DESIGN: Fifty Resilon cones were divided into seven experimental groups and three control groups of 5 cones each. The cones of experimental groups were contaminated with E. faecalis and subsequently disinfected with different concentrations of NaOCl or CHX. The cones were then transferred into glass tubes containing thioglycollate media and incubated for 7 days. The tubes were examined for turbidity every 24 hours, and if bacterial growth occurred, samples were plated, incubated, gram stained and observed under microscope to confirm E. faecalis growth. Negative, positive, and washing control groups were also used. RESULTS: All the positive and washing control showed profound E.faecalis growth. All the cones disinfected with CHX showed bacterial growth; however, no E. faecalis growth occurred in any samples disinfected with NaOCl. CONCLUSION: Sodium hypochlorite, at concentrations of 0.5 to 5.25%, is an effective agent for disinfection of contaminated Resilon cones within one minute; however, chlorhexidine is unable to disinfect Resilon cones during one-minute exposure.

CT features of toxic megacolon: A systematic review.

INTRODUCTION: Toxic megacolon is a rare but life-threatening condition. Diagnosis is made when both systemic toxicity and an enlarged colon are present. We undertook a systematic review of the literature to provide a list of toxic megacolon findings on computed tomography (CT) imaging along with the prevalence rate for each finding. METHODS: PubMed, Embase, and Cochrane library were searched. After eligibility screening and quality assessment, the reported CT findings of toxic megacolon with their respective prevalence rates were extracted from the included studies. Pooled prevalence rates were calculated for each finding using random-effects model and inverse variance method. I2 statistics were used to estimate the heterogeneity. All statistical analyses were performed using R software. P-values less than 0.05 were considered significant. RESULTS: Database search yielded a total of 122 records. Only 2 of these studies were finally selected following two-step eligibility screening. Most common CT features of toxic megacolon and their pooled prevalence rates [95% CI] were: colonic distension (reported in 100% of patients), abnormal haustration 96% [0.75-0.99], peri-colonic fat stranding 87% [0.29-0.99], nodular pseudo polyps 76% [0.52-0.91], multilayered appearance of colonic wall 58% [0.38-0.76], and ascites 57% [0.21-0.87]. Other reported CT features: colonic wall thickening, pleural effusion, accordion sign, small bowel/gastric distension, and segmental colonic wall thinning. CONCLUSION: and implication for practice: Colonic distension can be accompanied by 10 other findings in CT images of patients with toxic megacolon. Although these findings are not specific, toxic megacolon should be included in the list of differential diagnoses when these findings are present.

Value of diffusion-weighted images in diagnosis of locoregionally recurrent rectal tumors.

INTRODUCTION: To assess the value of referring to Diffusion-weighted images in evaluation of T2-weighted images of patients clinically suspicious of locoregional rectal cancer recurrence. METHODS: After ethics committee approval and informed consent were obtained, 37 consecutive patients (male/female of 22/15; mean age 56 ± 13.5 SD) clinically suspicious of recurrent rectal tumor were prospectively included in the study over a two-year period. T2-weighted images of the patients were reviewed and the results were recorded. Right after that, the corresponding DWI images were provided for the radiologist and new ratings were given to the patients after taking into account the DWI findings. Finally, the patients underwent tissue biopsy. Receiver Operating Characteristic (ROC) analysis was performed, and Area Under the Curve (AUC) of the "T2-weighted alone" and "T2-weighted + DWI" methods were calculated and compared. RESULTS: "T2-weighted alone" and "T2-weighted + DWI" methods had an AUC of 0.64 (95% CI 0.47 to 0.79) and 0.75 (95% CI 0.58 to 0.88), respectively. The Difference between the two AUCs was 0.11 (P = 0.16). In the subgroup of patients having equivocal ratings in T2-weighted images, DWI images correctly identified 81% (13/16) of patients with true tumor recurrence and 66% (8/12) of patients without recurrence. CONCLUSION: Our results suggest that referring to DWI does not significantly change the overall diagnostic performance of T2-weighted images. However, DWI is of great value in evaluation of the subgroup of patients with equivocal findings in T2-weighted images. Studies with larger sample sizes are needed to confirm these findings. IMPLICATIONS FOR PRACTICE: When T2-weighted images are equivocal, DWI images may be helpful in evaluation of patients with suspected locoregional recurrence of rectal tumor.