Characterization of the Ang/Tie2 Signaling Pathway in the Diaphragm Muscle of DMD Mice

In Duchenne muscular dystrophy (DMD), angiogenesis appears to be attenuated. Local administration of angiopoietin 1 (Ang1) has been shown to reduce inflammation, ischemia, and fibrosis in DMD mice. Ang1 is a vital vascular stabilizing factor that activates the endothelial cell receptor Tie2, leading to downstream pro-survival PI3K/Akt pathway activation and eNOS phosphorylation. In this study, we aimed to characterize the Ang/Tie2 signaling pathway within the diaphragm muscle of mouse models of DMD. Utilizing ELISA, immunoblots, and RT-qPCR, we demonstrated that Ang1 was downregulated, while the antagonist angiopoietin 2 (Ang2) was upregulated, leading to a decreased Ang1/Ang2 ratio. This correlated with a reduction in the phosphorylated Tie2/total Tie2 ratio. Interestingly, no significant differences in Akt or eNOS phosphorylation were observed, although DMD murine models did have elevated total Akt protein concentrations. These observations suggest that Ang1/Tie2 signaling may be dysregulated in the diaphragm muscle of DMD and further investigations may lead to new therapeutic interventions for DMD.

The community engagement course and action network: strengthening community and academic research partnerships to advance health equity

Background

Historically Black Colleges and Universities and Minority Serving Institutions are uniquely positioned to implement community-campus research partnerships based on a history of service, the pursuit of community trustworthiness and student demographics often similar to surrounding marginalized communities. The Morehouse School of Medicine Prevention Research Center collaborates with members of Historically Black Colleges and Universities, Minority Serving Institutes, and community organizations on the Community Engaged Course and Action Network. This network is the first of its kind and aims to strengthen members' ability to implement Community-Based Participatory Research (CBPR) principles and partnerships. Projects address public health priorities including mental health among communities of color, zoonotic disease prevention, and urban food deserts.

Materials and methods

To assess the effectiveness of the network, a Participatory Evaluation framework was implemented to conduct process evaluation which included review of partnership structures, operations, project implementation processes, and preliminary outcomes of the research collaborations. A focus group of Community Engagement Course and Action Network members (community and academic) was also conducted to identify benefits and challenges of the network with emphasis on key areas for improvement to further enhance the relationships between partners and to facilitate their subsequent community-campus research.

Results

Network improvements were tied to themes strengthening community-academic partnerships including sharing and fellowship, coalition building and collaboration, and greater connections and awareness of community needs through their current community-academic partnerships. The need to conduct ongoing evaluation during and after implementation, for determining the early adoption of CBPR approaches was also identified.

Conclusion

Evaluation of the network's processes, infrastructure, and operation provides early lessons learned to strengthen the network. Ongoing assessment is also essential for ensuring continuous quality improvement across partnerships such as determining CBPR fidelity, assessing partnership synergy, and dynamics, and for quality improvement of research protocol. The implications and potential for advancing implementation science through this and similar networks are great towards advancing leadership in modeling how foundations in community service can advance to CBPR partnership formation and ultimately, health equity approaches, that are local defined and assessed.

Discrimination of lamb (Ovis aries), emu (Dromaius novaehollandiae), camel (Camelus dromedarius) and beef (Bos taurus) binary mixtures using a portable near infrared instrument combined with chemometrics

Consumers demand safe and nutritious foods at accessible prices; where issues associated with adulteration, fraud, and provenance have become important aspects to be considered by the modern food industry. There are many analytical techniques and methods available to determine food composition and quality, including food security. Among them, vibrational spectroscopy techniques are at the first line of defence (near and mid infrared spectroscopy, and Raman spectroscopy). In this study, a portable near infrared (NIR) instrument was evaluated to identify different levels of adulteration between binary mixtures of exotic and traditional meat species. Fresh meat cuts of lamb (Ovis aries), emu (Dromaius novaehollandiae), camel (Camelus dromedarius) and beef (Bos taurus) sourced from a commercial abattoir were used to make different binary mixtures (95 % %w/w, 90 % %w/w, 50 % %w/w, 10 % %w/w and 5 % %w/w) and analysed using a portable NIR instrument. The NIR spectra of the meat mixtures was analysed using principal component analysis (PCA), and partial least squares discriminant analysis (PLS-DA). Two isosbestic points corresponding to absorbances at 1028 nm and 1224 nm were found to be consistent across all the binary mixtures analysed. The coefficient of determination in cross validation (R²) obtained for the determination of the per cent of species in a binary mixture was above 90 % with a standard error in cross validation (SECV) ranging between 12.6 and 15 %w/w. Overall, the results of this study indicate that NIR spectroscopy can determine the level or ratio of adulteration in the binary mixtures of minced meat.

Efficacy and Feasibility of Remote Cognitive Remediation Therapy in Parkinson's Disease: A Randomized Controlled Trial

Background

Non-motor symptoms of Parkinson's disease (PD) such as cognitive impairment are common and decrease patient quality of life and daily functioning. While no pharmacological treatments have effectively alleviated these symptoms to date, non-pharmacological approaches such as cognitive remediation therapy (CRT) and physical exercise have both been shown to improve cognitive function and quality of life in people with PD.

Objective

This study aims to determine the feasibility and impact of remote CRT on cognitive function and quality of life in patients with PD participating in an organized group exercise program.

Methods

Twenty-four subjects with PD recruited from Rock Steady Boxing (RSB), a non-contact group exercise program, were evaluated using standard neuropsychological and quality of life measures and randomized to the control or intervention group. The intervention group attended online CRT sessions for one hour, twice a week for 10 weeks, engaging in multi-domain cognitive exercises and group discussion.

Results

Twenty-one subjects completed the study and were reevaluated. Comparing groups over time, the control group (n = 10) saw a decline in overall cognitive performance that trended towards significance (p = 0.05) and a statistically significant decrease in delayed memory (p = 0.010) and self-reported cognition (p = 0.011). Neither of these findings were seen in the intervention group (n = 11), which overwhelmingly enjoyed the CRT sessions and attested to subjective improvements in their daily lives.

Conclusions

This randomized controlled pilot study suggests that remote CRT for PD patients is feasible, enjoyable, and may help slow the progression of cognitive decline. Further trials are warranted to determine the longitudinal effects of such a program.

Parallel development of Parkinson's-specific competencies for exercise professionals and criteria for exercise education programs

INTRODUCTION

The Parkinson's Foundation sought to develop Parkinson's specific competencies for exercise professionals who work with people with Parkinson's (PwP). These competencies built upon exercise guidelines and professional competencies for healthy populations. The purpose of this article is to describe the development of the professional competencies, continuing education criteria, and a pilot accreditation process.

METHODS

Competency development included: (1) an expert panel conducting an environmental scan, within the USA, related to exercise professional education in Parkinson's and synthesizing Parkinson's-specific exercise guidelines, (2) surveying people with Parkinson's in the USA, and (3) developing the competencies and curriculum criteria with psychometricians. A pilot accreditation process for Parkinson's exercise educational programs and continuing education courses includes an application, baseline, 6- and 12-month assessments. Activities reported here did not require ethical review. The survey was approved by NORC at the University of Chicago's Institutional Review Board (IRB).

RESULTS

The environmental scan, exercise guidelines, and survey (n = 627) informed competency development. The five key condition-specific domains were: (1) foundational information on the disease and role of exercise, (2) exercise screening, (3) group and individual exercise design, (4) behavior and counseling for exercise, and (5) interprofessional communication and program development. Seven applicants were accredited as certification programs (n = 3) or continuing education courses (n = 4).

DISCUSSION

The competencies, curriculum criteria, and accreditation processes support exercise professionals working with PwP. Reducing variation in the knowledge and skills of exercise professionals can improve the safe implementation and effectiveness of exercise programs, which are a critical part of integrated plan for people with Parkinson's disease (PD).

A Protocol for Simultaneous In Vivo Imaging of Cardiac and Neuroinflammation in Dystrophin-Deficient MDX Mice Using [18F]FEPPA PET

Duchenne muscular dystrophy (DMD) is a neuromuscular disorder caused by dystrophin loss-notably within muscles and the central neurons system. DMD presents as cognitive weakness, progressive skeletal and cardiac muscle degeneration until pre-mature death from cardiac or respiratory failure. Innovative therapies have improved life expectancy; however, this is accompanied by increased late-onset heart failure and emergent cognitive degeneration. Thus, better assessment of dystrophic heart and brain pathophysiology is needed. Chronic inflammation is strongly associated with skeletal and cardiac muscle degeneration; however, neuroinflammation's role is largely unknown in DMD despite being prevalent in other neurodegenerative diseases. Here, we present an inflammatory marker translocator protein (TSPO) positron emission tomography (PET) protocol for in vivo concomitant assessment of immune cell response in hearts and brains of a dystrophin-deficient mouse model [mdx:utrn(+/-)]. Preliminary analysis of whole-body PET imaging using the TSPO radiotracer, [¹⁸F]FEPPA in four mdx:utrn(+/-) and six wildtype mice are presented with ex vivo TSPO-immunofluorescence tissue staining. The mdx:utrn(+/-) mice showed significant elevations in heart and brain [¹⁸F]FEPPA activity, which correlated with increased ex vivo fluorescence intensity, highlighting the potential of TSPO-PET to simultaneously assess presence of cardiac and neuroinflammation in dystrophic heart and brain, as well as in several organs within a DMD model.

Glucose Infusion Induced Change in Intracellular pH and Its Relationship with Tumor Glycolysis in a C6 Rat Model of Glioblastoma

INTRODUCTION

The reliance on glycolytic metabolism is a hallmark of tumor metabolism. Excess acid and protons are produced, leading to an acidic tumor environment. Therefore, we explored the relationship between the tumor glycolytic metabolism and tissue pH by comparing ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) and hyperpolarized [1-¹³C]pyruvate MR spectroscopy imaging (MRSI) to chemical exchange saturation transfer (CEST) MRI measurements of tumor pH.

METHODS

10⁶ C6 glioma cells were implanted in the brains of male Wistar rats (N = 11) using stereotactic surgery. A 60-min PET acquisition after a bolus of FDG was performed at 11-13 days post implantation, and standardized uptake value (SUV) was calculated. CEST measurements were acquired the following day before and during constant infusion of glucose solution. Tumor intracellular pH (pHi) was evaluated using amine and amide concentration-independent detection (AACID) CEST MRI. The change of pH_i (∆pH_i) was calculated as the difference between pH_i pre- and during glucose infusion. Rats were imaged immediately with hyperpolarized [1-¹³C]pyruvate MRSI. Regional maps of the ratio of Lac:Pyr were acquired. The correlations between SUV, Lac:Pyr ratio, and ∆pH_i were evaluated using Pearson's correlation.

RESULTS

A decrease of 0.14 in pH_i was found after glucose infusion in tumor region. Significant correlations between tumor glycolysis measurements of Lac:Pyr and ∆pH_i within the tumor (ρ = 0.83, P = 0.01) and peritumoral region (ρ = 0.76, P = 0.028) were observed. No significant correlations were found between tumor SUV and ∆pH_i within the tumor (ρ =  - 0.45, P = 0.17) and peritumor regions (ρ =  - 0.6, P = 0.051).

CONCLUSION

AACID detected the changes in pH_i induced by glucose infusion. Significant correlations between tumor glycolytic measurement of Lac:Pyr and tumoral and peritumoral pH_i and ∆pH_i suggest the intrinsic relationship between tumor glycolytic metabolism and the tumor pH environment as well as the peritumor pH environment.

Psychotherapists’ Acceptance of Telepsychotherapy: A Machine Learning Approach

Introduction

Therapists’ forced transition to provide psychotherapy remotely during the COVID-19 pandemic offers a unique opportunity to examine therapists’ views and challenges with teletherapy.

Objectives

We aimed to develop predictive models of three aspects of psychotherapists’ acceptance of teletherapy during the COVID-19 pandemic; attitudes towards teletherapy, concerns about using teletherapy, and intention to use it in the future.

Methods

In an international survey, therapists (N = 795) completed a survey about their experiences during the pandemic, including quality of therapeutic relationship, professional self-doubt, vicarious trauma, and telepsychotherapy acceptance. Regression decision trees machine learning analyses were used to build prediction models for each aspects of telepsychotherapy acceptance.

Results

Attitudes toward telepsychotherapy were most positive for therapists who reported neutral or strong online working alliance, especially if they experienced little professional self-doubt and were younger than 40 years old. Therapists who were most concerned about telepsychotherapy, were those who reported higher levels of professional self-doubt, particularly if they also reported vicarious trauma experiences. Therapists who reported low working alliance were the least likely to use telepsychotherapy in the future.

Conclusions

Therapists’ professional self-doubt and the quality of their working alliance with their telepsychotherapy patients appear to be the most pertinent factors associated with therapists’ acceptance of telepsychotherapy during COVID-19, and should be addressed in future training and research.

Disclosure

No significant relationships.

Infection free midline catheter implementation at a community hospital (2 years)

BACKGROUND

To reduce excess central line use and provide an option for difficult venous access patients through the introduction of a midline catheter.

METHODS

Design included prospective monitoring of the implementation of a quality improvement project. The setting was a 576 bed, urban, community, nonprofit, Magnet recognized, level 3 trauma center serving primarily adult patients. Midline and peripherally inserted central catheters were inserted by a specialty nursing team; care and maintenance of all devices were provided by front line staff.

RESULTS

Zero midline catheter infections were observed in the 24 months after implementation of the fixed length, power injectable device. Completion of therapy was 80%, the most frequently encountered complication was device dislodgement.

CONCLUSIONS

Adoption of a vascular access nurse led midline catheter program, coupled with device selection algorithms expanded the ability to select the right device for the patient, while decreasing excess central line usage without additional increased risks to the patient.

Symptomatic Pericardial Cyst: An Atypical Case of Pleuritic Chest Pain

Pericardial cysts were first described in 1837 as diverticula extending from the pericardium. They are rare and frequently asymptomatic. Symptomatic presentations may be similar to more common causes of chest pain or dyspnea such as acute coronary syndrome or pulmonary embolism. Emergency physicians should consider mediastinal mass, and in this case pericardial cyst, in the differential diagnosis of chest pain because of the risk for tamponade, sudden cardiac death, or other life-threatening complications. Here, we describe a novel presentation of a pericardial cyst presenting as atypical chest pain.

MagA expression attenuates iron export activity in undifferentiated multipotent P19 cells

Magnetic resonance imaging (MRI) is a non-invasive imaging modality used in longitudinal cell tracking. Previous studies suggest that MagA, a putative iron transport protein from magnetotactic bacteria, is a useful gene-based magnetic resonance contrast agent. Hemagglutinin-tagged MagA was stably expressed in undifferentiated embryonic mouse teratocarcinoma, multipotent P19 cells to provide a suitable model for tracking these cells during differentiation. Western blot and immunocytochemistry confirmed the expression and membrane localization of MagA in P19 cells. Surprisingly, elemental iron analysis using inductively-coupled plasma mass spectrometry revealed significant iron uptake in both parental and MagA-expressing P19 cells, cultured in the presence of iron-supplemented medium. Withdrawal of this extracellular iron supplement revealed unexpected iron export activity in P19 cells, which MagA expression attenuated. The influence of iron supplementation on parental and MagA-expressing cells was not reflected by longitudinal relaxation rates. Measurement of transverse relaxation rates (R₂* and R₂) reflected changes in total cellular iron content but did not clearly distinguish MagA-expressing cells from the parental cell type, despite significant differences in the uptake and retention of total cellular iron. Unlike other cell types, the reversible component R₂′ (R₂* ‒ R₂) provided only a moderately strong correlation to amount of cellular iron, normalized to amount of protein. This is the first report to characterize MagA expression in a previously unrecognized iron exporting cell type. The interplay between contrast gene expression and systemic iron metabolism substantiates the potential for diverting cellular iron toward the formation of a novel iron compartment, however rudimentary when using a single magnetotactic bacterial gene expression system like magA. Since relatively few mammalian cells export iron, the P19 cell line provides a tractable model of ferroportin activity, suitable for magnetic resonance analysis of key iron-handling activities and their influence on gene-based MRI contrast.

Formative Research: Using a Community-Based Participatory Research Approach to Develop an Oral Health Intervention for Migrant Mexican Families

Oral health is a leading unmet health need among migrant families. This article describes the 1-year, community-based participatory research (CBPR) approach employed to plan and develop a Líder Communitario (lay community health worker)-led educational intervention for Mexican migrant adult caregivers and their families in three underserved, remote communities in North San Diego County, California. Four partner organizations collaborated, reviewed existing oral health curricula, and sought extensive input on educational topics and research design from key informants, migrant caregivers, and Líderes Communitarios. Based on community stakeholder input, partners developed a logic model and drafted educational intervention materials. Key informants ( n = 28), including several members from two community advisory boards, ranked program priorities and intervention subgroup population via online survey. Three focus groups were conducted with Líderes Communitarios ( n = 22) and three with migrant families ( n = 30) regarding the oral health program's design and content. Twelve Líderes Communitarios reviewed draft intervention materials during two focus groups to finalize the curriculum, and their recommended changes were incorporated. Formative research results indicated that community stakeholders preferred to focus on adult caregivers and their families. A 5-week educational intervention with hands on demonstrations and colorful visuals was developed, covering the following topics: bacteria and tooth decay, oral hygiene, nutrition, gum disease, and dental services. The CBPR process engaged multiple community stakeholders in all aspects of planning and developing the educational intervention.

Quality of Life for Individuals with Schizophrenia: Validating an Assessment That Addresses Client Concerns and Occupational Issues

This article describes the initial validation study of the Quality of Life Measure for Persons With Schizophrenia (QOLM-S). This new assessment is grounded in a holistic conceptual framework, addresses occupational issues, and was developed on the basis of qualitative data collected from individuals with schizophrenia. Data were collected from 91 individuals with schizophrenia to examine aspects of reliability and validity. Results support both the internal consistency of the QOLM-S, with a Cronbach's alpha reliability coefficient of 0.97 for the overall scale, and concurrent validity. Correlations between the domain and total scores of the QOLM-S provide initial support for construct validity. This study supports the use of the QOLM-S as a descriptive tool. Future research to enhance the clinical utility and further examine the psychometric properties of the QOLM-S are suggested.

Evaluation of CT Perfusion Biomarkers of Tumor Hypoxia

BACKGROUND

Tumor hypoxia is associated with treatment resistance to cancer therapies. Hypoxia can be investigated by immunohistopathologic methods but such procedure is invasive. A non-invasive method to interrogate tumor hypoxia is an attractive option as such method can provide information before, during, and after treatment for personalized therapies. Our study evaluated the correlations between computed tomography (CT) perfusion parameters and immunohistopathologic measurement of tumor hypoxia.

METHODS

Wistar rats, 18 controls and 19 treated with stereotactic radiosurgery (SRS), implanted with the C6 glioma tumor were imaged using CT perfusion on average every five days to monitor tumor growth. A final CT perfusion scan and the brain were obtained on average 14 days (8-22 days) after tumor implantation. Tumor hypoxia was detected immunohistopathologically with pimonidazole. The tumor, necrotic, and pimonidazole-positive areas on histology samples were measured. Percent necrotic area and percent hypoxic areas were calculated. Tumor volume (TV), blood flow (BF), blood volume (BV), and permeability-surface area product (PS) were obtained from the CT perfusion studies. Correlations between CT perfusion parameters and histological parameters were assessed by Spearman's ρ correlation. A Bonferroni-corrected P value < 0.05 was considered significant.

RESULTS

BF and BV showed significant correlations with percent hypoxic area ρ = -0.88, P < 0.001 and ρ = -0.81, P < 0.001, respectively, for control animals and ρ = -0.7, P < 0.001 and ρ = -0.6, P = 0.003, respectively, for all animals, while TV and BV were correlated (ρ = -0.64, P = 0.01 and ρ = -0.43, P = 0.043, respectively) with percent necrotic area. PS was not correlated with either percent necrotic or percent hypoxic areas.

CONCLUSIONS

Percent hypoxic area provided significant correlations with BF and BV, suggesting that CT perfusion parameters are potential non-invasive imaging biomarkers of tumor hypoxia.

Anatomic variation and orgasm: Could variations in anatomy explain differences in orgasmic success?

Though the public consciousness is typically focused on factors such as psychology, penis size, and the presence of the "G-spot," there are other anatomical and neuro-anatomic differences that could play an equal, or more important, role in the frequency and intensity of orgasms. Discovering these variations could direct further medical or procedural management to improve sexual satisfaction. The aim of this study is to review the available literature of anatomical sexual variation and to explain why this variation may predispose some patients toward a particular sexual experience. In this review, we explored the available literature on sexual anatomy and neuro-anatomy. We used PubMed and OVID Medline for search terms, including orgasm, penile size variation, clitoral variation, Grafenberg spot, and benefits of orgasm. First we review the basic anatomy and innervation of the reproductive organs. Then we describe several anatomical variations that likely play a superior role to popular known variation (penis size, presence of g-spot, etc). For males, the delicate play between the parasympathetic and sympathetic nervous systems is vital to achieve orgasm. For females, the autonomic component is more complex. The clitoris is the primary anatomical feature for female orgasm, including its migration toward the anterior vaginal wall. In conclusions, orgasms are complex phenomena involving psychological, physiological, and anatomic variation. While these variations predispose people to certain sexual function, future research should explore how to surgically or medically alter these. Clin. Anat. 29:665-672, 2016. © 2016 Wiley Periodicals, Inc.

Ethylene bisdithiocarbamate pesticides Maneb and Mancozeb cause metal overload in human colon cells

Previous studies in our laboratory have shown that ethylene bisdithiocarbamate (EBDC) fungicides Maneb and Mancozeb are equipotent gastrointestinal toxicants that produce cell loss and metal accumulation within HT-29 and Caco2 colon cells. Nabam, MnCl2, CuCl2 and ZnCl2 exposure produced no loss of viability up to 200 μM and increases in metal levels were noted but not to the same extent as Maneb and Mancozeb. EBDC exposure caused increases in copper levels (20-200 μM). Maneb and Mancozeb treatment also caused increases in manganese and zinc concentrations (20-200 μM). Nabam plus MnCl2 and Nabam and MnCl2 plus ZnCl2 caused decreases in viability and increases in metal levels comparable to Maneb and Mancozeb. Decreases in the ratio of reduced glutathione to glutathione disulfide were observed with Maneb and Mancozeb (20-200 μM). Maneb and Mancozeb treatment results in intracellular metal accumulation leading to the oxidative stress. The metal moiety and the organic portion of EBDCs contribute to toxicity.

CT perfusion imaging as an early biomarker of differential response to stereotactic radiosurgery in C6 rat gliomas

BACKGROUND

The therapeutic efficacy of stereotactic radiosurgery for glioblastoma is not well understood, and there needs to be an effective biomarker to identify patients who might benefit from this treatment. This study investigated the efficacy of computed tomography (CT) perfusion imaging as an early imaging biomarker of response to stereotactic radiosurgery in a malignant rat glioma model.

METHODS

Rats with orthotopic C6 glioma tumors received either mock irradiation (controls, N = 8) or stereotactic radiosurgery (N = 25, 12 Gy in one fraction) delivered by Helical Tomotherapy. Twelve irradiated animals were sacrificed four days after stereotactic radiosurgery to assess acute CT perfusion and histological changes, and 13 irradiated animals were used to study survival. Irradiated animals with survival >15 days were designated as responders while those with survival ≤15 days were non-responders. Longitudinal CT perfusion imaging was performed at baseline and regularly for eight weeks post-baseline.

RESULTS

Early signs of radiation-induced injury were observed on histology. There was an overall survival benefit following stereotactic radiosurgery when compared to the controls (log-rank P<0.04). Responders to stereotactic radiosurgery showed lower relative blood volume (rBV), and permeability-surface area (PS) product on day 7 post-stereotactic radiosurgery when compared to controls and non-responders (P<0.05). rBV and PS on day 7 showed correlations with overall survival (P<0.05), and were predictive of survival with 92% accuracy.

CONCLUSIONS

Response to stereotactic radiosurgery was heterogeneous, and early selection of responders and non-responders was possible using CT perfusion imaging. Validation of CT perfusion indices for response assessment is necessary before clinical implementation.

Novel operative anoscope for Ferguson hemorrhoidectomy: a feasibility study and comparative cohort analysis

BACKGROUND

Operative hemorrhoidectomy can result in pain and altered continence from excessive excision of anoderm or surrounding tissue. We assessed a novel low-profile slotted anoscope to determine if the device would promote safe dissection, lessen trauma, and reduce operative times for hemorrhoidectomy.

METHODS

Patients requiring hemorrhoidectomy (June 2008 - January 2010) underwent a prospective phase-2 trial evaluating a new operating anoscope (CAD, Ethicon Endosurgery, Cincinnati, OH). Demographics and perioperative end points including bleeding, pain, fecal incontinence, stenosis, and symptom recurrence were analyzed at 4 weeks, 3 months, 6 months, and 1 year postoperatively. We compared these to patients undergoing hemorrhoidectomy (February 2010 - November 2012) with a traditional Hill-Ferguson anoscope (THF).

RESULTS

40 patients (CAD, 20 vs THF, 20) were included. Presenting symptoms were similar, whereas mean duration of symptoms was longer for CAD (41.2 ± 8.4 vs 27 ± 9.5 months; P < .05). Estimated blood loss was lower for CAD [8.3 mL (range = 2-40 mL) vs 11.3 mL THF (range = 5-35 mL; P = .87)]. Mean operative times were lower for the CAD than the THF group (15.6 ± 3.4 vs 26.1 ± 4.1 minutes; P < .05). Visual analog pain scores were non-significantly increased in the THF group at 4 weeks (P = .23). At 3 months, 6 months, and 1 year, there was no difference in continence.

CONCLUSION

The CAD anoscope reduced operative times for modified Ferguson (closed) hemorrhoidectomy when compared with traditional retractors. There was no difference in incontinence or pain between groups.

Improving quantitative CT perfusion parameter measurements using principal component analysis

RATIONALE AND OBJECTIVES

To evaluate the improvements in measurements of blood flow (BF), blood volume (BV), and permeability-surface area product (PS) after principal component analysis (PCA) filtering of computed tomography (CT) perfusion images. To evaluate the improvement in CT perfusion image quality with poor contrast-to-noise ratio (CNR) in vivo.

MATERIALS AND METHODS

A digital phantom with CT perfusion images reflecting known values of BF, BV, and PS was created and was filtered using PCA. Intraclass correlation coefficients and Bland-Altman analysis were used to assess reliability of measurements and reduction in measurement errors, respectively. Rats with C6 gliomas were imaged using CT perfusion, and the raw CT perfusion images were filtered using PCA. Differences in CNR, BF, BV, and PS before and after PCA filtering were assessed using repeated measures analysis of variance.

RESULTS

From simulation, mean errors decreased from 12.8 (95% confidence interval [CI] = -19.5 to 45.0) to 1.4 mL/min/100 g (CI = -27.6 to 30.4), 0.2 (CI = -1.1 to 1.4) to -0.1 mL/100 g (CI = -1.1 to 0.8), and 2.9 (CI = -2.4 to 8.1) to 0.2 mL/min/100 g (CI = -3.5 to 3.9) for BF, BV, and PS, respectively. Map noise in BF, BV, and PS were decreased from 51.0 (CI = -3.5 to 105.5) to 11.6 mL/min/100 g (CI = -7.9 to 31.2), 2.0 (CI = 0.7 to 3.3) to 0.5 mL/100 g (CI = 0.1 to 1.0), and 8.3 (CI = -0.8 to 17.5) to 1.4 mL/min/100 g (CI = -0.4 to 3.1), respectively. For experiments, CNR significantly improved with PCA filtering in normal brain (P < .05) and tumor (P < .05). Tumor and brain BFs were significantly different from each other after PCA filtering with four principal components (P < .05).

CONCLUSIONS

PCA improved image CNR in vivo and reduced the measurement errors of BF, BV, and PS from simulation. A minimum of four principal components is recommended.

Improving social cognition in schizophrenia: a pilot intervention combining computerized social cognition training with cognitive remediation

BACKGROUND

Social cognition is significantly impaired in schizophrenia and contributes to poor community functioning. This study examined whether cognitive remediation (CR; COGPACK), shown to improve neurocognition, improves an integral component of social cognition, emotion perception, compared with CR combined with a computerized Emotion Perception intervention (Mind Reading: Interactive Guide to Emotions [MRIGE]).

METHODS

59 stable schizophrenia or schizoaffective predominantly inpatients were randomized to either CR (N=27) alone or CR+MRIGE (N=32) for 12 weeks. Assessments included the Facial Emotion Identification Task (FEIT), Facial Emotion Discrimination Task (FEDT), MCCB-MATRICS, Personal and Social Performance Scale, and the Positive and Negative Syndrome Scale.

RESULTS

There was a significant group-by-time effect on FEIT (F=11.509, P=.004); CR+MRIGE demonstrated significantly greater improvement than CR alone (CR+MRIGE, Z=1.89, P=.05; CR alone Z=0.57, P=.13). There was significant group-by-time effect on FEDT (F=5.663, P=.022); CR+MRIGE demonstrated significantly greater improvement than CR alone (CR+MRIGE, Z=1.90, P=.05; CR alone Z=0.67, P=.21). There was also a significant group by time effect for social cognition, measured by the Mayer-Salovey-Caruso Emotional Intelligence Test (F=5.473, P=.050): CR+MRIGE demonstrated significantly greater improvement than CR alone (CR+MRIGE, Z=1.98, P=.02; CR alone, Z=1.00, P=.05).

CONCLUSIONS

Combined CR with emotion perception remediation produced greater improvements in emotion recognition, emotion discrimination, social functioning, and neurocognition compared with CR alone in chronic schizophrenia.

Molecular imaging to target transplanted muscle progenitor cells

Duchenne muscular dystrophy (DMD) is a severe genetic neuromuscular disorder that affects 1 in 3,500 boys, and is characterized by progressive muscle degeneration. In patients, the ability of resident muscle satellite cells (SCs) to regenerate damaged myofibers becomes increasingly inefficient. Therefore, transplantation of muscle progenitor cells (MPCs)/myoblasts from healthy subjects is a promising therapeutic approach to DMD. A major limitation to the use of stem cell therapy, however, is a lack of reliable imaging technologies for long-term monitoring of implanted cells, and for evaluating its effectiveness. Here, we describe a non-invasive, real-time approach to evaluate the success of myoblast transplantation. This method takes advantage of a unified fusion reporter gene composed of genes (firefly luciferase [fluc], monomeric red fluorescent protein [mrfp] and sr39 thymidine kinase [sr39tk]) whose expression can be imaged with different imaging modalities. A variety of imaging modalities, including positron emission tomography (PET), single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), optical imaging, and high frequency 3D-ultrasound are now available, each with unique advantages and limitations. Bioluminescence imaging (BLI) studies, for example, have the advantage of being relatively low cost and high-throughput. It is for this reason that, in this study, we make use of the firefly luciferase (fluc) reporter gene sequence contained within the fusion gene and bioluminescence imaging (BLI) for the short-term localization of viable C2C12 myoblasts following implantation into a mouse model of DMD (muscular dystrophy on the X chromosome [mdx] mouse). Importantly, BLI provides us with a means to examine the kinetics of labeled MPCs post-implantation, and will be useful to track cells repeatedly over time and following migration. Our reporter gene approach further allows us to merge multiple imaging modalities in a single living subject; given the tomographic nature, fine spatial resolution and ability to scale up to larger animals and humans, PET will form the basis of future work that we suggest may facilitate rapid translation of methods developed in cells to preclinical models and to clinical applications.

Kinetic model optimization for characterizing tumour physiology by dynamic contrast-enhanced near-infrared spectroscopy

Dynamic contrast-enhanced (DCE) methods are widely used with magnetic resonance imaging and computed tomography to assess the vascular characteristics of tumours since these properties can affect the response to radiotherapy and chemotherapy. In contrast, there have been far fewer studies using optical-based applications despite the advantages of low cost and safety. This study investigated an appropriate kinetic model for optical applications to characterize tumour haemodynamics (blood flow, F, blood volume, V(b), and vascular heterogeneity) and vascular leakage (permeability surface-area product, PS). DCE data were acquired with two dyes, indocyanine green (ICG) and 800 CW carboxylate (IRD(cbx)), from a human colon tumour xenograph model in rats. Due to the smaller molecular weight of IRD(cbx) (1166 Da) compared to albumin-bound ICG (67 kDa), PS of IRD(cbx) was significantly larger; however, no significant differences in F and V(b) were found between the dyes as expected. Error analysis demonstrated that all parameters could be estimated with an uncertainty less than 5% due to the high temporal resolution and signal-to-noise ratio of the optical measurements. The next step is to adapt this approach to optical imaging to generate haemodynamics and permeability maps, which should enhance the clinical interest in optics for treatment monitoring.

Relationship between metabolic syndrome and cognition in patients with schizophrenia

BACKGROUND

The metabolic syndrome (MetS) and cognitive impairments are common in schizophrenia. Both are associated with poor outcomes, which have received increasing medical and mental health attention. Whether MetS is associated with impaired cognitive functions in schizophrenia has not been thoroughly addressed. The aim of this study was to compare the association between patients with and without MetS and its contributing components with neurocognitive performance. We hypothesized that patients with MetS would be associated with more impaired cognitive performance.

METHODS

159 patients with schizophrenia or schizoaffective disorder, with available metabolic data were included in the study. Patients were classified as either having or not having MetS as defined by the NCEP Adult Panel-III criteria. All patients completed neurocognitive and metabolic tests.

RESULTS

Of the 159 patients, 43.34% had MetS. Patients without the MetS performed significantly better on tests measuring processing speed (p=0.050), attention/vigilance (p=0.040), working memory (p=0.041) and problem solving/reasoning (p=0.050) compared with those with MetS. Patients with MetS showed significantly lower cognitive domain scores. After Bonferroni correction greater waist circumference was associated with lower scores on attention/vigilance (β=-0.551; p≤.0083), HDL was positively associated with scores on attention/vigilance (β=0.900, p≤.0083) and higher triglycerides were associated with lower scores on attention/vigilance (β=-1.004, p≤.0083).

CONCLUSIONS

Schizophrenia patients with MetS showed significant cognitive impairments in three key cognitive domains. Aggressive medical treatment of the constituent components of MetS may provide the potential for important beneficial effects on patients' cognitive functioning.

Ethylene bisdithiocarbamate pesticides cause cytotoxicity in transformed and normal human colon cells

The effects of the fungicides Maneb, Mancozeb, and Zineb were investigated in transformed colon cells, HT-29, Caco2 and non-transformed cells, CCD-18Co. Significant decreases in viability were observed with Maneb and Mancozeb in HT-29 and CCD-18Co (80-260μM), and Caco2 cells (40-180μM). No significant decreases in viability were observed in all cell types up to 800μM with Zineb. MnCl(2) and ZnCl(2) exposure produced no loss of viability in all cell types up to 400μM. Light microscopy confirmed viability analysis. Lipid peroxidation was observed with Maneb and Mancozeb in cell types tested (60-200μM). Caspase 3/7, 8, and 9 activities were observed with Maneb and Mancozeb in cell types tested (40-200μM). Maneb and Mancozeb treated HT-29 and Caco2 cells demonstrated increases in manganese and zinc concentrations (20-200μM). The lack of toxicity observed with Zineb, MnCl(2), and ZnCl(2) suggests that both the metal moiety and the organic portion of these fungicides together contribute to toxicity.

Psychosocial health care needs assessment of adult cancer patients: a consensus-based guideline

PURPOSE

Although recommended as an essential part of cancer care, there is limited evidence regarding the optimum approach to psychosocial health care needs assessment in this setting. To address this gap, the Cancer Journey Action Group of the Canadian Partnership Against Cancer (CPAC) and the Canadian Association of Psychosocial Oncology (CAPO) partnered to develop consensus-based recommendations regarding the routine assessment of psychosocial and supportive care needs. The purpose of this paper is to summarize the evidence that informed the guideline and disseminate the recommendations developed by the expert panel.

METHODS

Clinical practice recommendations were developed by a panel comprised of psychosocial and interdisciplinary experts. Recommendations were informed by a review of oncology clinical practice guidelines, systematic reviews, and primary research, through to May 2008. Following expert consensus on the recommendations, the clinical practice guideline was externally reviewed by a purposively selected sample of national and international interdisciplinary experts.

RESULTS

A total of nine clinical practice guidelines, three systematic reviews, and 14 primary studies were included in the review. Overall, this body of literature suggested that routine collection of psychosocial health care data has an influence on communication with oncologists and other study specific outcomes, but the evidence was limited by heterogeneity and methodological limitations. Based on the interpretation of this body of evidence by clinical experts, research methodologists, and external reviewers, 12 substantive recommendations were developed regarding the process and parameters of psychosocial needs assessment in adult cancer patients.

CONCLUSION

Given the limitations in the current body of evidence, there remains a need for rigorous empirical research regarding the optimal approach to psychosocial needs assessment, including the specific characteristics that influence effectiveness on patient outcomes. This guideline fills an important gap in psychosocial care, regarding the routine assessment of psychosocial health care needs.

Randomized clinical trial comparing the cost and effectiveness of bipolar vessel sealers versus clips and vascular staplers for laparoscopic colorectal resection

BACKGROUND

The widespread use of laparoscopy has resulted in a variety of instruments being used routinely for vascular control. This randomized controlled trial evaluated the cost-effectiveness of bipolar vessel sealer (BVS) compared with clips and vascular stapler (CVS) in straight laparoscopic colorectal resection.

METHODS

Patients scheduled for elective colorectal resection, including benign and malignant diseases, were randomized to either BVS or CVS for vascular control. Patients whose operation was converted to an open approach before pedicle ligation were excluded. The primary endpoints were duration of operation, including time taken to control vascular pedicles, and cost of disposable instruments for vascular control.

RESULTS

Of 114 patients randomized to BVS (60 patients) or CVS (54), 14 did not receive the allocated vascular control device, leaving 55 and 45 respectively for analysis. The BVS reduced the time spent for vascular control by a mean of 6·9 min (P = 0·031) and reduced the cost of disposable instruments for vascular control by US $ 80·7 per patient (P = 0·043). For total colectomy, the BVS reduced the operating time by 103·6 min (P = 0·023) and the time taken for vascular control by 16·8 min (P = 0·022). For left colectomy, it decreased the time to vascular control by 9·3 min (P = 0·021). In multivariable analysis, the cost of disposable instruments for vascular control was independently reduced by randomization to BVS, type of procedure, female sex and estimated blood loss. The mean cost reduction was $ 88·2 for left colectomy (P = 0·037), $ 377·7 (P = 0·005) for total colectomy and $ 366·9 (P = 0·012) for proctectomy. Conversely, use of the BVS increased the cost of instruments used for vascular control in right colectomy by $ 92·6 (P = 0·012).

CONCLUSION

BVS devices are expedient and cost-efficient in proctectomy, left and total colectomy procedures.