Pre-operative core muscle index in combination with hypoalbuminemia is associated with poor prognosis in advanced ovarian cancer.

BACKGROUND AND OBJECTIVES: Age and frailty have been correlated with poor clinical outcomes in cancer. Core muscle index (CMI) and nutritional status are integral in assessing frailty. We explored the effect of pre-operative serum albumin and body composition on clinical outcomes in patients with epithelial ovarian cancer (EOC). METHODS: We identified stage III-IV EOC patients undergoing primary cytoreductive surgery from 2007 to 2015. Data were abstracted from medical records. Body composition measurements were obtained from pre-operative imaging. Psoas muscle cross-sectional area was normalized to height2 to determine CMI. Sarcopenia was defined as CMI below the population mean. The influence of sarcopenia on short-term morbidity was evaluated. Relationships among body composition measurements and albumin were assessed with Spearman correlations. Patient characteristics and body composition measurements between patients with and without sarcopenia were compared with parametric and non-parametric statistical methods. Kaplan-Meier survival curves were compared using log-rank. RESULTS: 102 women met inclusion criteria. Sarcopenia correlated with albumin (P = 0.0002). Sarcopenia was not associated with short-term morbidity or time to recurrence. Sarcopenia was associated with nearly a fourfold increased risk of death when hypoalbuminemia was present (P = 0.02). CONCLUSIONS: Pre-operative sarcopenia in combination with hypoalbuminemia was associated with significantly worse survival.

Role of Diffusion Weighted Imaging in Musculoskeletal Infections: Current Perspectives.

Accurate diagnosis and prompt therapy of musculoskeletal infections are important prognostic factors. In most cases, clinical history, examination and laboratory findings help one make the diagnosis, and routine magnetic resonance imaging (MRI) is useful to identify the extent of the disease process. However, in many situations, a routine MRI may not be specific enough especially if the patient cannot receive contrast intravenously, thereby delaying the appropriate treatment. Diffusion-weighted imaging (DWI) can help in many such situations by providing additional information, accurate characterization and defining the extent of the disease, so that prompt treatment can be initiated. In this article, we illustrate the imaging findings of the spectrum of musculoskeletal infections, emphasizing the role of DWI in this domain. KEY POINTS: • Abscess in background cellulitis is detected on DWI. • Infectious tenosynovitis shows diffusion restriction as compared to mechanical tenosynovitis. • Pyomyositis with abscess can be differentiated from diabetic myonecrosis on DWI. • Intraosseous abscess is bright on DWI versus devitalized tissue, sequestrum and air. • DWI can be used to differentiate spine infection from simple Modic changes.

The SF-36 and 6-Minute Walk Test are Significant Predictors of Complications After Major Surgery.

BACKGROUND: Major surgeries are associated with postoperative morbidity and mortality. Current preoperative evaluation fails to identify patients at increased risk of postoperative complications. This study is aimed to determine whether the Short Form-36 health survey (SF-36) and the 6-minute walk test (6-MWT) are useful predictors of postoperative complications after major surgery. METHODS: All patients scheduled to undergo major surgery were eligible for the study. Major surgeries include patients undergoing thoracotomy, sternotomy, or upper abdominal laparotomy. The SF-36 health survey and 6-MWT were administered prior to surgery. Spirometry and other preoperative testing, ordered by the surgeon, like echocardiography were included in the study. Patients were then followed-up for postoperative complications for 30 days. RESULTS: One-hundred and seventeen subjects undergoing major surgery were recruited to the study. The mean age was 58 years and 66 (56.4%) were male. Physical Functioning as a component of the SF-36 positively correlated with decreased length of hospital stay (LOS). The 6-MWT had a negative correlation with LOS (p < 0.0001) and with severity of postoperative complications (p < 0.0001). Spirometry and echocardiography did not correlate with LOS or grade of complications. CONCLUSIONS: SF-36 (Physical Functioning) and 6-MWT are useful indicators for predicting postoperative complications and LOS. Patients undergoing major surgery answered SF-36 and performed 6-MWT. Physical Functioning as a component of the SF-36 correlated with LOS. The 6-MWT had a negative correlation with LOS and with complication grade. SF-36 and 6-MWT are useful predictors of postoperative complications.

Diffusion tensor imaging of peripheral nerves.

Diffusion tensor imaging (DTI) is a powerful MR imaging technique that can be used to probe the microstructural environment of highly anisotropic tissues such as peripheral nerves. DTI has been used predominantly in the central nervous system, and its application in the peripheral nervous system does pose some challenges related to imaging artifacts, the small caliber of peripheral nerves, and low water proton density. However advances in MRI hardware and software have made it possible to use the technique in the peripheral nervous system and to obtain functional data relating to the effect of pathologic processes on peripheral nerves. This article reviews the imaging principles behind DTI and examines the literature regarding its application in assessing peripheral nerves.

Optimization of breathing instructions and timing of late arterial phase acquisition on gadobutrol-enhanced MRI of the liver.

PURPOSE: To compare a protocol with higher concentration macrocyclic gadolinium-based contrast agent (GBCA) [study group] to the traditional protocol with lower-concentration linear GBCAs [control group] for breath-held arterial phase magnetic resonance imaging. MATERIAL AND METHODS: A total of 136 patients were quantitatively evaluated for image quality (IQ), breathing artifacts (BA), and timing of the arterial phase (Tap). Quantitative analysis was also performed. RESULTS: No significant differences in IQ, BA and Tap (P>.05). Study group exhibited less enhancement of the aorta (P=.0091) and smaller standard deviation for the portal vein enhancement (P=.0173). CONCLUSION: Similar arterial-phase image quality can be achieved with a macrocyclic GBCA compared to traditional linear GBCA.

Activated protein C attenuates acute lung injury and apoptosis in a hyperoxic animal model.

Evidence suggests that activated protein C (APC) attenuates acute lung injury (ALI) through antithrombotic and anti-inflammatory mechanisms. The aim of this study was to determine the effects of APC on ALI in adult rats exposed to hyperoxic environment. Rats were divided into control, hyperoxia, hyperoxia + APC, and APC. Hyperoxia and hyperoxia + APC were exposed to 1, 3, and 5 days of hyperoxia. Hyperoxia + APC and APC were injected with APC (5 mg/kg, i.p.) every 12 h. Control and hyperoxia received isotonic sodium chloride solution injection. Measurement of wet to dry ratio and albumin leak demonstrated significant improvement in hyperoxia + APC when compared with hyperoxia. Apoptosis, as measured by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay, was significantly reduced in hyperoxia + APC when compared with hyperoxia. Histological evaluation of lung sections showed significant reduction in inflammation, edema, and in the number of marginating neutrophils in hyperoxia + APC as compared with hyperoxia. Transcriptional expression of lung inflammatory mediators demonstrated a time-dependent surge in the levels TNF-alpha, IL-1beta, and IL-6 in response to hyperoxia that was attenuated with APC administration in the presence of hyperoxia. In this rat model, APC attenuates lung injury and the expression of inflammatory mediators in ALI secondary to hyperoxia.