Quality of life and sexual functioning in endometrial cancer survivors.

OBJECTIVE: Recent evidence suggests equivalent efficacy in terms of local control for adjuvant vaginal brachytherapy (VBT) compared to external beam radiotherapy after surgery in patients with intermediate-high endometrial cancer. The objective of this study is to compare the quality of life (QoL) and sexual function of women with endometrial cancer that were treated with either surgery alone or surgery in combination with postoperative VBT. METHODS: Women were interviewed at least 5 years after initial treatment for endometrial cancer. QoL was evaluated by using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and the cervical cancer module, CX-24. Sexual function was evaluated by using the Female Sexual Function Index (FSFI). Eligible women had early stage disease, were currently disease-free, and had undergone surgery and adjuvant VBT, but neither external beam radiotherapy nor systemic treatment. This study group were then compared using univariate and multivariate analyses with an age-matched control group comprising of endometrial cancer patients without adjuvant VBT. RESULTS: Fifty-five patients (29 surgery plus VBT and 26 surgical controls without VBT) were included for analysis. With respect to QoL including, e.g., physical, role, emotional and social functioning and likewise in terms of sexual function univariate and multivariate analyses did not show significant differences between patients with VBT and the controls without VBT of any of the outcome measures. CONCLUSION: Adjuvant VBT after surgery does not seem to have a significant impact on quality of life and sexual function in endometrial cancer survivors.

High-sensitivity cardiac troponin T for early prediction of evolving non-ST-segment elevation myocardial infarction in patients with suspected acute coronary syndrome and negative troponin results on admission.

BACKGROUND: We sought to determine the diagnostic performance of the new high-sensitivity cardiac troponin T (hs-cTnT) assay for early detection of non-ST-segment myocardial infarction (NSTEMI) in patients with acute coronary syndrome. METHODS: We enrolled patients with retrospectively confirmed unstable angina or NSTEMI and an initially negative cTnT concentration and compared the performance of baseline concentrations and serial changes in concentration within 3 and 6 h. Percentage change criteria included >or=20% delta change and ROC-optimized value. RESULTS: Based on the standard fourth-generation cTnT result of >or=0.03 microg/L, an evolving NSTEMI was diagnosed in 26 patients, and 31 patients were classified as having unstable angina. With the use of the hs-cTnT assay at the 99th-percentile cutoff, the percentage of NSTEMI cases detected increased gradually from 61.5% on presentation to 100% within 6 h, and the overall number of MI diagnoses increased by 34.6% (35 vs 26 cases). A delta change >or=20% or >or=ROC-optimized value of >117% within 3 h or >or=243% within 6 h yielded a specificity of 100% at sensitivities between 69% and 76%. The standard cTnT at the 99th percentile was less sensitive than hs-cTnT for early diagnosis of MI on presentation, and follow-up samples obtained within the initial 3 h demonstrated very low specificity of cTnT compared with hs-cTnT. CONCLUSIONS: The high-sensitivity cTnT assay increases the number of NSTEMI diagnoses and enables earlier detection of evolving NSTEMI. A doubling of the hs-cTnT concentration within 3 h in the presence of a second concentration >or=99th percentile is associated with a positive predictive value of 100% and a negative predictive value of 88%.

Comparison of left ventricular function assessment using phonocardiogram- and electrocardiogram-triggered 2D SSFP CINE MR imaging at 1.5 T and 3.0 T.

OBJECTIVE: As high-field cardiac MRI (CMR) becomes more widespread the propensity of ECG to interference from electromagnetic fields (EMF) and to magneto-hydrodynamic (MHD) effects increases and with it the motivation for a CMR triggering alternative. This study explores the suitability of acoustic cardiac triggering (ACT) for left ventricular (LV) function assessment in healthy subjects (n = 14). METHODS: Quantitative analysis of 2D CINE steady-state free precession (SSFP) images was conducted to compare ACT's performance with vector ECG (VCG). Endocardial border sharpness (EBS) was examined paralleled by quantitative LV function assessment. RESULTS: Unlike VCG, ACT provided signal traces free of interference from EMF or MHD effects. In the case of correct R-wave recognition, VCG-triggered 2D CINE SSFP was immune to cardiac motion effects-even at 3.0 T. However, VCG-triggered 2D SSFP CINE imaging was prone to cardiac motion and EBS degradation if R-wave misregistration occurred. ACT-triggered acquisitions yielded LV parameters (end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and left ventricular mass (LVM)) comparable with those derived from VCG-triggered acquisitions (1.5 T: ESV(VCG) = (56 +/- 17) ml, EDV(VCG) = (151 +/- 32) ml, LVM(VCG) = (97 +/- 27) g, SV(VCG) = (94 +/- 19) ml, EF(VCG) = (63 +/- 5)% cf. ESV(ACT) = (56 +/- 18) ml, EDV(ACT) = (147 +/- 36) ml, LVM(ACT) = (102 +/- 29) g, SV(ACT) = (91 +/- 22) ml, EF(ACT) = (62 +/- 6)%; 3.0 T: ESV(VCG) = (55 +/- 21) ml, EDV(VCG) = (151 +/- 32) ml, LVM(VCG) = (101 +/- 27) g, SV(VCG) = (96 +/- 15) ml, EF(VCG) = (65 +/- 7)% cf. ESV(ACT) = (54 +/- 20) ml, EDV(ACT) = (146 +/- 35) ml, LVM(ACT) = (101 +/- 30) g, SV(ACT) = (92 +/- 17) ml, EF(ACT) = (64 +/- 6)%). CONCLUSIONS: ACT's intrinsic insensitivity to interference from electromagnetic fields renders it suitable for clinical CMR.

Winter weather controls net influx of atmospheric CO2 on the north-west European shelf.

Shelf seas play an important role in the global carbon cycle, absorbing atmospheric carbon dioxide (CO2) and exporting carbon (C) to the open ocean and sediments. The magnitude of these processes is poorly constrained, because observations are typically interpolated over multiple years. Here, we used 298500 observations of CO2 fugacity (fCO2) from a single year (2015), to estimate the net influx of atmospheric CO2 as 26.2 ± 4.7 Tg C yr-1 over the open NW European shelf. CO2 influx from the atmosphere was dominated by influx during winter as a consequence of high winds, despite a smaller, thermally-driven, air-sea fCO2 gradient compared to the larger, biologically-driven summer gradient. In order to understand this climate regulation service, we constructed a carbon-budget supplemented by data from the literature, where the NW European shelf is treated as a box with carbon entering and leaving the box. This budget showed that net C-burial was a small sink of 1.3 ± 3.1 Tg C yr-1, while CO2 efflux from estuaries to the atmosphere, removed the majority of river C-inputs. In contrast, the input from the Baltic Sea likely contributes to net export via the continental shelf pump and advection (34.4 ± 6.0 Tg C yr-1).

Bias in recent miRBase annotations potentially associated with RNA quality issues.

Although microRNAs are supposed to be stable in-vivo, degradation processes potentially blur our knowledge on the small oligonucleotides. We set to quantify the effect of degradation on microRNAs in mouse to identify causes for distorted microRNAs patterns. In liver, we found 298, 99 and 8 microRNAs whose expression significantly correlated to RNA integrity, storage time at room temperature and storage time at 4 °C, respectively. Expression levels of 226 microRNAs significantly differed between liver samples with high RNA integrity compared to liver samples with low RNA integrity by more than two-fold. Especially the 157 microRNAs with increased expression in tissue samples with low RNA integrity were most recently added to miRBase. Testing potentially confounding sources, e.g. in-vitro degraded RNA depleted of small RNAs, we detected signals for 350 microRNAs, suggesting cross-hybridization of fragmented RNAs. Therefore, we conclude that especially microRNAs added in the latest miRBase versions might be artefacts due to RNA degradation. The results facilitate differentiation between degradation-resilient microRNAs, degradation-sensitive microRNAs, and likely erroneously annotated microRNAs. The latter were largely identified by NGS but not experimentally validated and can severely bias microRNA biomarker research and impact the value of microRNAs as diagnostic, prognostic or therapeutic tools.

Comparative Local Quality Assessment of 3D Medical Image Segmentations with Focus on Statistical Shape Model-Based Algorithms.

The quality of automatic 3D medical segmentation algorithms needs to be assessed on test datasets comprising several 3D images (i.e., instances of an organ). The experts need to compare the segmentation quality across the dataset in order to detect systematic segmentation problems. However, such comparative evaluation is not supported well by current methods. We present a novel system for assessing and comparing segmentation quality in a dataset with multiple 3D images. The data is analyzed and visualized in several views. We detect and show regions with systematic segmentation quality characteristics. For this purpose, we extended a hierarchical clustering algorithm with a connectivity criterion. We combine quality values across the dataset for determining regions with characteristic segmentation quality across instances. Using our system, the experts can also identify 3D segmentations with extraordinary quality characteristics. While we focus on algorithms based on statistical shape models, our approach can also be applied to cases, where landmark correspondences among instances can be established. We applied our approach to three real datasets: liver, cochlea and facial nerve. The segmentation experts were able to identify organ regions with systematic segmentation characteristics as well as to detect outlier instances.

Minimally invasive multiport surgery of the lateral skull base.

OBJECTIVE: Minimally invasive procedures minimize iatrogenic tissue damage and lead to a lower complication rate and high patient satisfaction. To date only experimental minimally invasive single-port approaches to the lateral skull base have been attempted. The aim of this study was to verify the feasibility of a minimally invasive multiport approach for advanced manipulation capability and visual control and develop a software tool for preoperative planning. METHODS: Anatomical 3D models were extracted from twenty regular temporal bone CT scans. Collision-free trajectories, targeting the internal auditory canal, round window, and petrous apex, were simulated with a specially designed planning software tool. A set of three collision-free trajectories was selected by skull base surgeons concerning the maximization of the distance to critical structures and the angles between the trajectories. RESULTS: A set of three collision-free trajectories could be successfully simulated to the three targets in each temporal bone model without violating critical anatomical structures. CONCLUSION: A minimally invasive multiport approach to the lateral skull base is feasible. The developed software is the first step for preoperative planning. Further studies will focus on cadaveric and clinical translation.

Quality assurance of multiport image-guided minimally invasive surgery at the lateral skull base.

For multiport image-guided minimally invasive surgery at the lateral skull base a quality management is necessary to avoid the damage of closely spaced critical neurovascular structures. So far there is no standardized method applicable independently from the surgery. Therefore, we adapt a quality management method, the quality gates (QG), which is well established in, for example, the automotive industry and apply it to multiport image-guided minimally invasive surgery. QG divide a process into different sections. Passing between sections can only be achieved if previously defined requirements are fulfilled which secures the process chain. An interdisciplinary team of otosurgeons, computer scientists, and engineers has worked together to define the quality gates and the corresponding criteria that need to be fulfilled before passing each quality gate. In order to evaluate the defined QG and their criteria, the new surgery method was applied with a first prototype at a human skull cadaver model. We show that the QG method can ensure a safe multiport minimally invasive surgical process at the lateral skull base. Therewith, we present an approach towards the standardization of quality assurance of surgical processes.

Compliance, analgesic use and side-effect protection within a German cohort of the TEAM trial.

BACKGROUND: Compliance is an essential aspect for the success of any medical intervention. Adverse events (AEs) contribute significantly to non-compliance with endocrine treatment. The Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial compared five years of adjuvant exemestane therapy with the sequence of tamoxifen followed by exemestane. PATIENTS AND METHODS: A retrospective analysis of the German cohort of TEAM was conducted to determine the effects of prior tamoxifen on the tolerability profile of exemestane in both treatment arms. RESULTS: Fracture incidence was significantly higher during the first 30 months of exemestane versus the 30 months of exemestane following tamoxifen for 2-3 years; however, the incidence of AEs was not significantly different. With regard to compliance, the use of analgesics did not influence overall or disease-free survival (DFS) nor the incidence of distant recurrence in both treatment groups. CONCLUSION: Tamoxifen has a boneprotective effect when applied before exemestane treatment. Intake of analgesics (or pain medication) does not influence compliance or treatment outcome.

3D active shape model segmentation with nonlinear shape priors.

The Active Shape Model (ASM) is a segmentation algorithm which uses a Statistical Shape Model (SSM) to constrain segmentations to 'plausible' shapes. This makes it possible to robustly segment organs with low contrast to adjacent structures. The standard SSM assumes that shapes are Gaussian distributed, which implies that unseen shapes can be expressed by linear combinations of the training shapes. Although this assumption does not always hold true, and several nonlinear SSMs have been proposed in the literature, virtually all applications in medical imaging use the linear SSM. In this work, we investigate 3D ASM segmentation with a nonlinear SSM based on Kernel PCA. We show that a recently published energy minimization approach for constraining shapes with a linear shape model extends to the nonlinear case, and overcomes shortcomings of previously published approaches. Our approach for nonlinear ASM segmentation is applied to vertebra segmentation and evaluated against the linear model.

Automatic construction of statistical shape models for vertebrae.

For segmenting complex structures like vertebrae, a priori knowledge by means of statistical shape models (SSMs) is often incorporated. One of the main challenges using SSMs is the solution of the correspondence problem. In this work we present a generic automated approach for solving the correspondence problem for vertebrae. We determine two closed loops on a reference shape and propagate them consistently to the remaining shapes of the training set. Then every shape is cut along these loops and parameterized to a rectangle. There, we optimize a novel combined energy to establish the correspondences and to reduce the unavoidable area and angle distortion. Finally, we present an adaptive resampling method to achieve a good shape representation. A qualitative and quantitative evaluation shows that using our method we can generate SSMs of higher quality than the ICP approach.