Citations

Purpose Radiology descriptions of intracranial metastases following radiotherapy are often imprecise. This study sought to improve such reports by creating and disseminating a structured template that encourages discrete categorization of intracranial lesions. Methods Following initiation of the structured template, a retrospective review assessed patients with intracranial metastases that underwent radiotherapy, comparing ‘pre-template’ with ‘post-template’ reports. A total of 139 patients were included; 94 patients (67.6%) were imaged pre-template, 45 (32.4%) post-template. Reports were assessed for discrete versus non-specific descriptions of lesions: ‘(presumed) new metastases’, ‘treated metastases’, and ‘indeterminate lesions’. Non-specific language was subdivided based on the type of lesion(s) described: e.g. ‘stable enhancing foci’ was deemed a non-specific description of ‘treated metastases’. Results Non-specific descriptions of lesions were used in 25/94 reports (26.6%) pre-template, and eight reports (17.8%) post-template. No significant difference was found in the frequency of inappropriate/ambiguous descriptions of intracranial lesions following template initiation ( P = 0.52). However, only 27/45 (60.0%) of the reports in the post-template time period used the structured report; the other reports were written as free prose. Of the reports that did use the structured template, the authors used significantly less ambiguous language structured template ( P = 0.02). Conclusion When utilized, a structured report template resulted in decreased non-specific descriptions and improved discrete characterization of intracranial metastases in patients treated with radiation. However, the frequency of non-specific language usage before and after template initiation was unchanged, probably due to poor compliance with template utilization.

Many lung diseases including interstitial lung disease (ILD) are associated with changes in the lung’s biomechanical properties. ILD comprises a number of serious diseases in which fibrosis stiffens and damages lung tissue. Most ILDs are typically distributed in the lung’s peripheral and subpleural regions. Pulmonary function test (PFT) and high-resolution computed tomography (HRCT) are used to assess ILD. Ultrasonography is not widely used for lung assessment because ultrasound cannot image deep lung tissue. We have developed lung ultrasound surface wave elastography (LUSWE) for measuring superficial lung wave speed. In LUSWE, a 0.1-s harmonic vibration is generated on the chest wall of a subject using a handheld vibrator. An ultrasound probe is aligned with the vibration excitation in the same intercostal space to measure the generated surface wave propagation on the lung. A human subject is examined in a sitting position. The lung is tested at the total lung volume and through six intercostal spaces. Significant differences of surface wave speed between patients and controls were found in 6 lung regions and for 3 excitation frequencies. A positive correlation between LUSWE and clinical tests including HRCT and PTF was found. LUSWE may complement the clinical standard HRCT for assessing ILD.

Lung ultrasound (LUS) detects the presence of extravascular lung water (EVLW) through the visualization of B-Line artifacts. However, the qualitative nature of LUS limits its effectiveness in serial or longitudinal studies such as evaluating changes in EVLW at different time points in patients undergoing diuretic therapy for congestive heart failure. Lung ultrasound surface wave elastography (LUSWE) is a novel technique using a small handheld device that can measure superficial lung tissue elastic properties. We aimed to evaluate the use of LUSWE to measure quantitative changes in lung elasticity caused by acute changes in EVLW. We performed LUSWE on consecutive days in 14 patients hospitalized for acute congestive heart failure with evidence of pulmonary edema (clinical EVLW). From day#1 to day#2, the patients had an average diuresis of net negative 2.1 l associated with an average decrease in 13 B-Lines by lung ultrasound, signifying a reduction in EVLW. LUSWE analysis demonstrated a significant reduction (p < 0.05) in surface wave velocity in all interrogated intercostal spaces from day#1 to day#2. In summary, LUSWE performed at the bedside was able to demonstrate improvement in lung compliance (decreased elasticity) correlating with a reduction in EVLW in hospitalized patients being treated for congestive heart failure.

Biomechanical properties of the eye are important in understanding glaucoma. However, specific tissues that may be affected are unclear. In this study, we compared glaucomatous and normal eyes for differences in corneal tissue elasticity (as indicated by wave speed) and global ocular rigidity. Both eyes of 10 glaucoma patients and 10 normal controls, matched for age and intraocular pressure (IOP), were included. The ocular rigidity coefficient was calculated from supine IOP measured with and without a 10 g weight added to the tonometer. The wave speed in the cornea was measured by ultrasound surface wave elastography. With this technique, a spherical-tipped probe (4 mm diameter) was placed on the closed eyelid and vibrated at 100 Hz for 0.1 s. The wave speed was calculated using the phase gradient method. Measurements for normal and glaucoma eyes were compared using generalized estimating equation models. The corneal wave speed was similar between normal and glaucomatous eyes (P = 0.4). However, ocular rigidity was significantly lower in glaucomatous eyes (P < 0.001) compared with normal eyes. There was no difference in age or IOP (P > 0.3). Lower ocular rigidity in glaucomatous eyes suggests that a more compliant ocular shell may predispose to glaucoma. However, the lack of difference in the corneal wave speed suggests that corneal tissue is not significantly affected, and changes likely involve the sclera.

Hypertrophic scars and keloids are characterized by excessive fibrosis and can be functionally problematic. Indeed, hypertrophic scarring is characterized by wide, raised scars that remain within the original borders of injury and have a rapid growth phase. There is a need for quantitative scar measurement modalities to effectively evaluate and monitor treatments. We aim to assess the role of the non-invasive scar-measuring device, ultrasound surface wave elastography (USWE), in accurately evaluating scar metrics. Two sites of breast tissue were tested control and scar portions. In USWE, a small, local, and 0.1-s harmonic vibration at three excitation frequencies (100, 150, and 200 Hz) was generated on these sites, and the resulting surface wave speed was measured via an ultrasound probe with a central frequency of 6.4 MHz. There was a statistically significant difference in the wave speed at three frequencies of the scar portion between prior and after treatment, suggesting that the scar portion was softener after treatment. USWE provides an objective assessment of the reaction of the scar to injury and treatment response.

Cardiovascular disease (CVD) is the most common cause of death worldwide. Cardiac rehabilitation (CR) is increasingly recognised as an essential part of clinical care for patients with CVD. CR is a complex intervention that encompasses a multidisciplinary approach that focuses on health education, modification of cardiovascular risk factors, exercise training, physical activity and stress management. In the current American Heart Association/American College of Cardiology guidelines, cardiac rehabilitation is a class IA recommendation for secondary prevention of acute myocardial infarction, percutaneous coronary intervention and cardiac surgery and Class II recommendation for chronic stable heart failure. Despite proven effectiveness, however, participation in traditional CR remains low. Although the reasons for participation and non-participation in CR have been well described, the use of Twitter to explore public perceptions of CR has not yet been formally reported. To the best of our knowledge, the analysis of Twitter for insights on CR is a novel investigation that is relevant for addressing significant problems related to CR awareness in the digital age. We performed data mining of Twitter to assess patients’ perceptions regarding CR and the reasons for their participation and non-participation in CR between 23 July 2015 and 22 October 2017. We analysed a total of 5515 Twitter messages. Tweets associated with CR were often used to self-report on health status either before or after participating in CR or contained emotional language with positive or negative comments, advertisements or updated news. Twitter users wrote mainly positive comments about CR, suggesting the platform has the potential to disseminate both the benefits of CR and its research to the public on the worldwide scale.

OBJECTIVES: Expression of prostaglandin biosynthetic pathway enzymes in mucinous pancreatic cysts is unknown. Cyclooxygenase-2 (COX-2) inhibition is a potential cancer chemoprevention strategy for these lesions. We evaluated the expression of COX-2, cytosolic phospholipase A2 (cPLA2), and protein kinase B (AKT) in the epithelium of pancreatic cysts and correlated enzyme expression with aspirin (ASA) use and cyst fluid prostaglandin E 2 (PGE 2 ) concentration. METHODS: Pathology of 80 resected pancreatic cysts was reviewed. Expression of COX-2, cPLA2, and AKT was quantified by tissue immunohistochemistry immunoreactivity scores (IRSs). IRS values were compared between cyst types and (in 30 cases) with matched cyst fluid PGE 2 concentrations. RESULTS: The mean IRS was higher in the epithelium of mucinous vs nonmucinous cysts for COX-2 (6.1 ± 4.7 vs 3.2 ± 2.8, P = 0.01) and cPLA2 (6.9 ± 3.0 vs 2.9 ± 2.9, P < 0.001). Cyst epithelial COX-2 expression was higher in mucinous cysts with low-grade dysplasia vs those with high-grade dysplasia or invasive carcinoma (IRS 8.0 ± 3.9 vs 1.5 ± 2.9, P < 0.001), whereas the opposite was found for cPLA2 (6.2 ± 3.0 vs 8.6 ± 2.3, P = 0.005). Cyst fluid PGE 2 concentrations did not correlate with either the IRS or a history of low- to moderate-dose ASA use. CONCLUSIONS: COX-2 and cPLA2 are overexpressed in the epithelium of mucinous pancreatic cysts. COX-2 and/or cPLA2 inhibition might prevent the emergence or progression of mucinous pancreatic cysts, but higher doses of ASA or nonsteroidal anti-inflammatory drugs may be necessary to substantially inhibit cyst epithelial COX-2 activity.

Cancer tissue engineering has remained challenging due to the limitations of the conventional biofabrication techniques to model the complex tumor microenvironment. Here, the utilization of a sacrificial bioprinting strategy is reported to generate the biomimetic mammary duct‐like structure within a hydrogel matrix, which is further populated with breast cancer cells, to model the genesis of ductal carcinoma and its subsequent outward invasion. This bioprinted mammary ductal carcinoma model provides a proof‐of‐concept demonstration of the value of using the sacrificial bioprinting technique for engineering biologically relevant cancer models, which may be possibly extended to other cancer types where duct‐like structures are involved.