Staging and Restaging Pediatric Abdominal and Pelvic Tumors: A Practical Guide.

The most common abdominal malignancies diagnosed in the pediatric population include neuroblastoma, Wilms tumor, hepatoblastoma, lymphoma, germ cell tumor, and rhabdomyosarcoma. There are distinctive imaging findings and patterns of spread for each of these tumors that radiologists must know for diagnosis and staging and for monitoring the patient's response to treatment. The multidisciplinary treatment group that includes oncologists, surgeons, and radiation oncologists relies heavily on imaging evaluation to identify the best treatment course and prognostication of imaging findings, such as the image-defined risk factors for neuroblastomas, the PRETreatment EXtent of Disease staging system for hepatoblastoma, and the Ann Arbor staging system for lymphomas. It is imperative for radiologists to be able to correctly indicate the best imaging methods for diagnosis, staging, and restaging of each of these most prevalent tumors to avoid inconclusive or unnecessary examinations. The authors review in a practical manner the most updated key points in diagnosing and staging disease and assessing response to treatment of the most common pediatric abdominal tumors. ©RSNA, 2024 Supplemental material is available for this article.

Investigation of nerve fibers in the skin by biopsy: technical aspects, indications, and contribution to diagnosis of small-fiber neuropathy.

Skin biopsy with investigation of small-diameter nerve fibers in human epidermis and dermis has been proven to be a useful method for confirming small-fiber neuropathy. In medical practice, small-fiber neuropathy is increasingly recognized as a leading cause of neuropathic pain. It is a prevalent complaint in medical offices, brought by patients often as a "painful burning sensation". The prevalence of neuropathic pain is high in small-fiber neuropathies of different etiologies, especially in the elderly; 7% of population in this age group present peripheral neuropathy. Pain and paresthesia are symptoms which might cause disability and impair quality of life of patients. The early detection of small-fiber neuropathy can contribute to reducing unhealthy lifestyles, associated to higher incidence of the disease.

Investigation of nerve fibers in the skin by biopsy: technical aspects, indications, and contribution to diagnosis of small-fiber neuropathy

ABSTRACT Skin biopsy with investigation of small-diameter nerve fibers in human epidermis and dermis has been proven to be a useful method for confirming small-fiber neuropathy. In medical practice, small-fiber neuropathy is increasingly recognized as a leading cause of neuropathic pain. It is a prevalent complaint in medical offices, brought by patients often as a "painful burning sensation". The prevalence of neuropathic pain is high in small-fiber neuropathies of different etiologies, especially in the elderly; 7% of population in this age group present peripheral neuropathy. Pain and paresthesia are symptoms which might cause disability and impair quality of life of patients. The early detection of small-fiber neuropathy can contribute to reducing unhealthy lifestyles, associated to higher incidence of the disease.

Pseudoprogression with Neoadjuvant Immunotherapy for Cutaneous Melanoma.

Immune checkpoint inhibitors (ICI) have drastically changed the landscape of metastatic melanoma management, thus significantly improving survival. Clinically, assessing treatment response may be challenging in a portion of cases due to a massive influx of immune cells into the tumor microenvironment, causing a transient increase in the target lesion size. This phenomenon, coined pseudoprogression, can occur in 5-10% of metastatic patients, and it is commonly followed by a tumor regression. Its incidence, however, may be underestimated, given its ephemeral nature and often being documented in visceral metastatic lesions, which are only assessed by imaging scans every 2-3 months. More recently, ICI has been studied in the neoadjuvant setting, yielding durable pathological responses in patients with cutaneous melanoma. Here, we report a case of a large retroauricular melanoma mass with regional lymph node involvement treated with ipilimumab and nivolumab combination therapy that developed pseudoprogression. Initially documented as an increase in size along with inflammatory features, followed by a dramatic clinical improvement. A complete regression was pathologically documented after 3 months and the patient remains disease-free for 14 months after treatment initiation. In conclusion, we document a pseudoprogression case during neoadjuvant ICI treatment and raise the question of whether the incidence of this phenomenon is higher when observed in superficial lesions, which can be assessed by routine physical exam.

Broadband tuning of polarization modulation instability in microstructured optical fibers.

The wideband tuning of strong bands generated through polarization modulation instability (PMI) in microstructured optical fibers (MOFs) is reported. Tunability is achieved by exploiting the dependence of the phase-matching condition on the fiber's chromatic dispersion and birefringence, which is particularly sensitive when the fiber is pumped near the zero-dispersion wavelength. MOFs designed to accomplish PMI phase-matching when they are infiltrated with ethanol and pumped at 1064 nm were designed and fabricated. Taking advantage of the large thermo-optic coefficient of ethanol, both chromatic dispersion and birefringence were varied through temperature. Wavelength shifts from 937 nm to 863 nm (anti-Stokes) and from 1231 nm to 1387 nm (Stokes) are demonstrated. Such a tuning range corresponds to a frequency shift between the pump and a PMI sideband ranging from 1274cm-1 to 2189cm-1.

Multicenter Multireader Evaluation of an Artificial Intelligence-Based Attention Mapping System for the Detection of Prostate Cancer With Multiparametric MRI.

OBJECTIVE. The purpose of this study was to evaluate in a multicenter dataset the performance of an artificial intelligence (AI) detection system with attention mapping compared with multiparametric MRI (mpMRI) interpretation in the detection of prostate cancer. MATERIALS AND METHODS. MRI examinations from five institutions were included in this study and were evaluated by nine readers. In the first round, readers evaluated mpMRI studies using the Prostate Imaging Reporting and Data System version 2. After 4 weeks, images were again presented to readers along with the AI-based detection system output. Readers accepted or rejected lesions within four AI-generated attention map boxes. Additional lesions outside of boxes were excluded from detection and categorization. The performances of readers using the mpMRI-only and AI-assisted approaches were compared. RESULTS. The study population included 152 case patients and 84 control patients with 274 pathologically proven cancer lesions. The lesion-based AUC was 74.9% for MRI and 77.5% for AI with no significant difference (p = 0.095). The sensitivity for overall detection of cancer lesions was higher for AI than for mpMRI but did not reach statistical significance (57.4% vs 53.6%, p = 0.073). However, for transition zone lesions, sensitivity was higher for AI than for MRI (61.8% vs 50.8%, p = 0.001). Reading time was longer for AI than for MRI (4.66 vs 4.03 minutes, p < 0.001). There was moderate interreader agreement for AI and MRI with no significant difference (58.7% vs 58.5%, p = 0.966). CONCLUSION. Overall sensitivity was only minimally improved by use of the AI system. Significant improvement was achieved, however, in the detection of transition zone lesions with use of the AI system at the cost of a mean of 40 seconds of additional reading time.

Incidence of asthma in young adults from Castellon, Spain: A prospective cohort study

Background: The objective was to estimate the incidence of asthma in young adults from 13-15 years old to 23-25 years old, and associated factors. Methods: In 2012, a population-based prospective cohort study was carried out in Castellon from the cohort who had participated in the International Study of Asthma and Allergy in Childhood in 1994 and 2002. A telephone survey was undertaken using the same questionnaires. A new case of asthma was defined as a participant free of the disease in 2002 who suffered asthma, was diagnosed with asthma, or took medications against asthma based on self-report from 2002 to 2012. Results: The mean age of participants was 24.9 ± 0.6 with a follow-up of 79.1%. Asthma cumulative incidence was 3.4%: 44 new cases occurred among 1280 participants. The incidence was higher in females than males with relative risk (RR) =2.02 (95% confidence interval [CI] 1.1-3.8). A significant decrease of asthma incidence density was observed (8.2 cases to 3.5 cases per 1000 person/year). Factors associated with the incidence of asthma were allergic rhinitis (RR = 4.05; 95% CI 1.7-9.6), bronchitis (RR = 2.13; 95% CI 1.0-4.5), mother's age at time of birth (RR=0.87; 95% CI 0.8-0.9) and a pet other than a dog or cat (RR = 0.42; 95% CI 0.2-0.9). For gender, some variations in the risk factors were observed. Conclusions: A significant decrease in the incidence of asthma was observed. Several risk and protective factors were found (AU)

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Incidence of asthma in young adults from Castellon, Spain: A prospective cohort study.

BACKGROUND: The objective was to estimate the incidence of asthma in young adults from 13-15 years old to 23-25 years old, and associated factors. METHODS: In 2012, a population-based prospective cohort study was carried out in Castellon from the cohort who had participated in the International Study of Asthma and Allergy in Childhood in 1994 and 2002. A telephone survey was undertaken using the same questionnaires. A new case of asthma was defined as a participant free of the disease in 2002 who suffered asthma, was diagnosed with asthma, or took medications against asthma based on self-report from 2002 to 2012. RESULTS: The mean age of participants was 24.9±0.6 with a follow-up of 79.1%. Asthma cumulative incidence was 3.4%: 44 new cases occurred among 1280 participants. The incidence was higher in females than males with relative risk (RR)=2.02 (95% confidence interval [CI] 1.1-3.8). A significant decrease of asthma incidence density was observed (8.2 cases to 3.5 cases per 1000 person/year). Factors associated with the incidence of asthma were allergic rhinitis (RR=4.05; 95% CI 1.7-9.6), bronchitis (RR=2.13; 95% CI 1.0-4.5), mother's age at time of birth (RR=0.87; 95% CI 0.8-0.9) and a pet other than a dog or cat (RR=0.42; 95% CI 0.2-0.9). For gender, some variations in the risk factors were observed. CONCLUSIONS: A significant decrease in the incidence of asthma was observed. Several risk and protective factors were found.

Task shifting in the management of hypertension in Kinshasa, Democratic Republic of Congo: a cross-sectional study.

BACKGROUND: The Democratic Republic of the Congo (DRC) is characterized by a high prevalence of hypertension (HTN) and a high proportion of uncontrolled HTN, which is indicative of poor HTN management. Effective management of HTN in the African region is challenging due to limited resources, particularly human resources for health. To address the shortage of health workers, the World Health Organization (WHO) recommends task shifting for better disease management and treatment. Although task shifting from doctors to nurses is being implemented in the DRC, there are no studies, to the best of our knowledge, that document the association between task shifting and HTN control. The aim of this study was to investigate the association between task shifting and HTN control in Kinshasa, DRC. METHODS: We conducted a cross-sectional study in Kinshasa from December 2015 to January 2016 in five general referral hospitals (GRHs) and nine health centers (HCs). A total of 260 hypertensive patients participated in the study. Sociodemographic, clinical, health care costs and perceived health care quality assessment data were collected using a structured questionnaire. To examine the association between task shifting and HTN control, we assessed differences between GRH and HC patients using bivariate and multivariate analyses. RESULTS: Almost half the patients were female (53.1%), patients' mean age was 59.5 ± 11.4 years. Over three-fourths of patients had uncontrolled HTN. There was no significant difference in the proportion of GRH and HC patients with uncontrolled HTN (76.2% vs 77.7%, p = 0.771). Uncontrolled HTN was associated with co-morbidity (OR = 10.3; 95% CI: 3.8-28.3) and the type of antihypertensive drug used (OR = 4.6; 95% CI: 1.3-16.1). The mean healthcare costs in the GRHs were significantly higher than costs in the HCs (US$ 34.2 ± US$3.34 versus US$ 7.7 ± US$ 0.6, respectively). CONCLUSION: Uncontrolled HTN was not associated with the type of health facility. This finding suggests that the management of HTN at primary healthcare level might be just as effective as at secondary level. However, the high proportion of patients with uncontrolled HTN underscores the need for HTN management guidelines at all healthcare levels.

Impact of Pathology Review for Decision Therapy in Localized Prostate Cancer.

BACKGROUND: The Gleason score is an essential tool in the decision to treat localized prostate cancer. However, experienced pathologists can classify Gleason score differently than do low-volume pathologists, and this may affect the treatment decision. This study sought to assess the impact of pathology review of external biopsy specimens from 23 men with a recent diagnosis of localized prostate cancer. METHODS: All external biopsy specimens were reviewed at our pathology department. Data were retrospectively collected from scanned charts. RESULTS: The median patient age was 63 years (range: 46-74 years). All patients had a Karnofsky performance score of 90% to 100%. The median prostate-specific antigen level was 23.6 ng/dL (range: 1.04-13.6 ng/dL). Among the 23 reviews, the Gleason score changed for 8 (35%) patients: 7 upgraded and 1 downgraded. The new Gleason score affected the treatment decision in 5 of 8 cases (62.5%). CONCLUSIONS: This study demonstrates the need for pathology review in patients with localized prostate cancer before treatment because Gleason score can change in more than one-third of patients and can affect treatment decision in almost two-thirds of recategorized patients.

Incidence of allergic rhinitis in a cohort of young adults from 13-15 years old to 23-25 years old in Castellon (Spain)

BACKGROUND: The objective of this study was to estimate the incidence of Allergic Rhinitis (AR) in young adults and its risk or protective factors. METHODS: A population-based prospective cohort study was carried out in 2012. The cohort participated in the International Study of Asthma and Allergy in Childhood in Castellon in 1994 and 2002. A telephone survey was conducted using the same questionnaires. A new case of AR was defined as the participants free of the disease in 2002, who self-reported suffering from AR or taking medications for AR in the period 2002-2012. RESULTS: Of the 1805 schoolchildren in the cohort in 2002, 1435 young adults (23-25 years old) participated (follow-up 79.1%) in 2012; 743 were female and 692 male; their mean age was 24.9±0.6 years. Two hundred new cases of AR occurred in 1259 participants free of the disease with an incidence of 17.3 per 1000 person-years, and the incidence increased from 2002 (RR=1.42; 95% CI 1.15-1.75). The risk factors of AR adjusted by age and gender were sinusitis (RR=1.77; 95% CI 1.16-2.68), atopic dermatitis (RR=1.51; 95% CI 1.11-2.06) and constant exposure to truck traffic (RR=1.88; 95% CI 1.12-3.17). For male participants, the risk factors were asthma, sinusitis and atopic dermatitis, and for females bronchitis was a risk factor and presence of older siblings a protective factor. CONCLUSIONS: An increase in AR incidence was observed. Sinusitis, atopic dermatitis and constant exposure to truck traffic were the risk factors of the AR with some differences by gender

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Incidence of allergic rhinitis in a cohort of young adults from 13-15 years old to 23-25 years old in Castellon (Spain).

BACKGROUND: The objective of this study was to estimate the incidence of Allergic Rhinitis (AR) in young adults and its risk or protective factors. METHODS: A population-based prospective cohort study was carried out in 2012. The cohort participated in the International Study of Asthma and Allergy in Childhood in Castellon in 1994 and 2002. A telephone survey was conducted using the same questionnaires. A new case of AR was defined as the participants free of the disease in 2002, who self-reported suffering from AR or taking medications for AR in the period 2002-2012. RESULTS: Of the 1805 schoolchildren in the cohort in 2002, 1435 young adults (23-25 years old) participated (follow-up 79.1%) in 2012; 743 were female and 692 male; their mean age was 24.9±0.6 years. Two hundred new cases of AR occurred in 1259 participants free of the disease with an incidence of 17.3 per 1000 person-years, and the incidence increased from 2002 (RR=1.42; 95% CI 1.15-1.75). The risk factors of AR adjusted by age and gender were sinusitis (RR=1.77; 95% CI 1.16-2.68), atopic dermatitis (RR=1.51; 95% CI 1.11-2.06) and constant exposure to truck traffic (RR=1.88; 95% CI 1.12-3.17). For male participants, the risk factors were asthma, sinusitis and atopic dermatitis, and for females bronchitis was a risk factor and presence of older siblings a protective factor. CONCLUSIONS: An increase in AR incidence was observed. Sinusitis, atopic dermatitis and constant exposure to truck traffic were the risk factors of the AR with some differences by gender.

Brazilian guidelines for diagnosis, treatment and follow-up of primary cutaneous melanoma - Part II.

The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In this second part, the following clinical questions were answered: 1) which patients with primary cutaneous melanoma benefit from sentinel lymph node biopsy? 2) Follow-up with body mapping is indicated for which patients? 3) Is preventive excision of acral nevi beneficious to patients? 4) Is preventive excision of giant congenital nevi beneficious to patients? 5) How should stages 0 and I primary cutaneous melanoma patients be followed?

Brazilian guidelines for diagnosis, treatment and follow-up of primary cutaneous melanoma - Part II

Abstract The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In this second part, the following clinical questions were answered: 1) which patients with primary cutaneous melanoma benefit from sentinel lymph node biopsy? 2) Follow-up with body mapping is indicated for which patients? 3) Is preventive excision of acral nevi beneficious to patients? 4) Is preventive excision of giant congenital nevi beneficious to patients? 5) How should stages 0 and I primary cutaneous melanoma patients be followed?.

Estiramiento activo excéntrico frente a estiramiento analítico pasivo de los músculos isquiotibiales en dolor lumbar inespecífico subagudo o crónico. Un estudio piloto / Active eccentric stretch against passive analytical hamstring stretch in subacute or chronic non-specific low back pain. a pilot trial

OBJETIVOS: 1) Comparar la efectividad del estiramiento activo excéntrico según el método Pilates frente al estiramiento pasivo analítico isquiotibial en extensibilidad, discapacidad y dolor en pacientes con dolor lumbar inespecífico subagudo o crónico. MATERIAL Y MÉTODOS: Ensayo clínico piloto en centros de atención primaria María Montessori y Jaime Vera (Leganés). Se seleccionó a 24 sujetos entre 18 y 60 años con dolor lumbar inespecífico subagudo o crónico. Fueron excluidos los trastornos degenerativos, las estenosis lumbar, los antecedentes quirúrgicos raquídeos o en los miembros inferiores. Se aleatorizaron en 2 grupos. Ambos recibieron sesiones de Pilates 2 veces por semana durante 3 semanas. Tras cada sesión, el grupo 1 realizó estiramiento activo excéntrico de isquiotibiales según el método Pilates y el grupo 2 estiramiento pasivo analítico de isquiotibiales. Se registraron: extensibilidad isquiotibial mediante inclinómetro Chattanooga, percepción de dolor con escala visual analógica y discapacidad con índice Oswestry, pre-post y a los 6 meses. RESULTADOS: El grupo 1 obtuvo una mejoría clínicamente significativa frente al grupo 2 en percepción de dolor, postintervención y a los 6 meses. Además, mostró diferencias clínicas significativas en la extensibilidad de ambos isquiotibiales postintervención. El grupo 2 reveló diferencias clínicas en extensibilidad del isquiotibial izquierdo postintervención. No hubo diferencias en discapacidad. CONCLUSIÓN: El estiramiento según el método Pilates es clínicamente más efectivo que el estiramiento pasivo en el dolor postintervención y a los 6 meses. Además, esta técnica mejora clínicamente la extensibilidad isquiotibial postintervención en sujetos con dolor lumbar inespecífico subagudo o crónico

OBJECTIVES: 1) To compare the effectiveness of active eccentric hamstring stretch according to the Pilates method versus passive analytical hamstring stretch on hamstring extensibility, disability and pain perception in patients with subacute or chronic non-specific low back pain. MATERIAL AND METHODS: A pilot clinical trial in María Montessori and Jaime Vera primary care centers in Leganes (Madrid, Spain). Twenty-four subjects from 18 to 60 years with subacute or chronic non-specific low back pain were selected. Exclusion criteria were degenerative disorders, lumbar stenosis, spine or lower limb surgery. Subjects were randomized into two groups. Both groups received Pilates sessions twice a week for 3 weeks. After each session, group 1 performed active eccentric hamstring Pilates-based stretch while group 2 performed passive analytical hamstring stretch. Measurements were pre- and post-intervention and at 6 months follow-up, regarding: hamstring extensibility with Chattanooga inclinometer, pain perception using visual analogue scale and disability with Oswestry index. RESULTS: Group 1 obtained a clinically significant improvement compared to group 2 in pain perception at post-intervention and after 6 months. In addition, it demonstrated clinically significant differences in hamstring extensibility at post-intervention. Group 2 showed clinical post-intervention differences in left hamstring extensibility. There were no differences regarding disability. CONCLUSION: Active hamstring Pilates stretch is clinically more effective than passive hamstring stretch in pain perception at post-intervention and after 6 months. Furthermore, this technique clinically improves hamstring extensibility at post-intervention in subjects with subacute or chronic non-specific low back pain

Construction of a WMR for trajectory tracking control: experimental results.

This paper reports a solution for trajectory tracking control of a differential drive wheeled mobile robot (WMR) based on a hierarchical approach. The general design and construction of the WMR are described. The hierarchical controller proposed has two components: a high-level control and a low-level control. The high-level control law is based on an input-output linearization scheme for the robot kinematic model, which provides the desired angular velocity profiles that the WMR has to track in order to achieve the desired position (x∗, y∗) and orientation (φ∗). Then, a low-level control law, based on a proportional integral (PI) approach, is designed to control the velocity of the WMR wheels to ensure those tracking features. Regarding the trajectories, this paper provides the solution or the following cases: (1) time-varying parametric trajectories such as straight lines and parabolas and (2) smooth curves fitted by cubic splines which are generated by the desired data points {(x1∗, y1∗),..., (x(n)∗, y(n)∗)}. A straightforward algorithm is developed for constructing the cubic splines. Finally, this paper includes an experimental validation of the proposed technique by employing a DS1104 dSPACE electronic board along with MATLAB/Simulink software.

m-bonacci metamaterial multilayers: location of the zero-average index bandgap edges.

We examine quasiperiodic multilayers arranged in m-bonacci sequences, which combine ordinary positive-index materials and dispersive metamaterials with negative index in a certain frequency range. When the volume-averaged refractive index of the nonperiodic multilayer equals zero, the structure does not propagate light radiation and exhibits a forbidden band. We identify some analytical expressions to determine the upper and lower limits of the above zero-average refractive-index bandgap. We recognize that these limits are not explicitly dependent on the geometrical parameters of the stack of layers.

Octave-spanning ultraflat supercontinuum with soft-glass photonic crystal fibers.

We theoretically identify some photonic-crystal-fiber structures, made up of soft glass, that generate ultrawide (over an octave) and very smooth supercontinuum spectra when illuminated with femtosecond pulsed light. The design of the fiber geometry in order to reach a nearly ultraflattened normal dispersion behavior is crucial to accomplish the above goal. Our numerical simulations reveal that these supercontinuum sources show high stability and no significant changes are detected even for fairly large variations of the incident pulse.

Waveguiding properties of a photonic crystal fiber with a solid core surrounded by four large air holes.

The polarization-dependent guiding properties of a hexagonal-lattice photonic crystal fiber with a solid-core surrounded by four large air holes are investigated. The appearance of a polarization dependent cutoff frequency, together with several parameters as the birefringence, the modal effective area, the group velocity dispersion and the polarization dependent loss are analyzed. A collection of fibers with different structural parameters were fabricated and characterized. An effective anti-guide structure from at least 450 nm to 1750 nm, a polarizing fiber with a polarization dependent loss of 16 dB/m at 1550 nm, and an endlessly singlemode polarization-maintaining fiber with group birefringence of 2.1x10(-3) at 1550 nm are reported. Experimental results are compared with accurate numerical modeling of the fibers.

Two cases of tetrasomy 9p syndrome with tissue limited mosaicism.

Tetrasomy of short arm of chromosome 9 constitutes a clinically recognizable chromosomal syndrome. Isochromosome 9p shows a strong propensity to tissue-limited mosaicism. It occurs predominantly in peripheral blood cultures, often at a lower frequency or even absent in skin, amniotic fluid or chorionic villous cell cultures. Tissue-limited nature of mosaicism may render prenatal detection of this condition very difficult. Herein, we report two new cases of mosaic tetrasomy 9p. Conventional cytogenetics (CC) and FISH studies demonstrated a differential expression of the mosaicism in several tissues. We review the literature and discuss the implications of these findings in cytogenetic prenatal diagnosis.