Mental Health Impact among Survivors from COVID 19 Pneumonia, Almoosa Hospital Experience

Introduction

COVID-19 is associated with mental manifestations, Anxiety and depression appear to be common amongst people hospitalized for COVID-19.

Objectives

evaluate the emotional stress resulting from infection and assess its impact on the mental health of patients who recovered from COVID-19 pneumonia.

Methods

It is a cross-sectional study, The mental health assessment tool DASS2 (Arabic version) was applied in collecting the data for the study. Demographic characteristics, chronic disease status, COVID 19 pneumonia, oxygen saturation level were recorded at the follow-up visit, soon after the psychiatric evaluation. Psychological distress was assessed An Arabic version of the Depression, Anxiety, and Stress Scale-21 (DASS-21) was used to assess the mental health status. Statistical analysis by (SPSS, version 25).

Results

466 patients were consented prior to enrollment in the study, out of the total respondents; (53.2%) were females, anxiety rate was found in (18%), stress in (17%), and depression in (14%) of the patients, significantly elevated blood levels of the inflammatory marker in patients with depression and anxiety, increase in the rates of depression with male gender, increasing age and longer duration of ICU stay respectively, with non-significant p-values. There was also a small increase in the period stayed in ICU among those who developed depression and anxiety. Reduced oxygen saturation in COVID-19 patients with depression was 4 times those with no depression.

Conclusions

prolonged ICU stays and reduced oxygen saturation was associated with a high rate of depression in patients with COVID-19, as well as elevated levels of the inflammatory marker D-dimer with depression and anxiety.

Disclosure

No significant relationships.

A Protocol for the Prospective Evaluation of Novel Suction-Based Airway Clearance Devices in the Treatment of Foreign Body Airway Obstructions

Background

Foreign body airway obstructions (FBAOs, choking) are a significant cause of preventable mortality. Abdominal thrusts, back blows, and chest compressions are traditional interventions. However, suction-based airway clearance devices (ACDs) have recently been marketed as an alternative. Of note, there is limited published evidence regarding their efficacy and safety. Our research has two aims: (1) to investigate what situational and patient factors are frequently identified, and which are associated with relief of the FBAO and survival in individuals with FBAOs treated with an ACD; and (2) to describe the experience of individuals who have used ACDs in response to a FBAO and identify facilitators and barriers to the use of ACDs compared to traditional interventions.

Methods and analysis

A prospective database will be developed using an online reporting system to capture ACD uses, independent of manufacturers, from July 1st, 2021 to December 31st, 2023. Descriptive statistics will be used to summarize cases, outcomes, and adverse events. Clinically important subgroups will be stratified for analysis, including the severity of obstruction, patient demographics, and training of ACD users. Semi-structured interviews will also be conducted with a subset of ACD users to describe in detail their experience using the device. Themes from these interviews will be assessed using the theoretical domains framework.

Discussion

This study will improve the evidence surrounding ACDs and compare it to current data for traditional techniques, with the aim of optimizing FBAO treatment. Data on ACDs are urgently needed as these devices are already being used by parents, caregivers, lay rescuers, and healthcare professionals to respond to choking emergencies. This evaluation will provide important information about their effectiveness and any safety concerns which can inform the public, resuscitation guidelines, and future research studies.

511 Organising A Surgical Conference During The COVID-19 Pandemic – Is It ‘Virtually’ The Same?

Introduction

Surgical conferences are invaluable events for healthcare professionals; they provide opportunities to engage with upcoming scientific discoveries, network professionally with peers as well as expand learning through lectures and workshops. For medical students, conferences provide an opportunity to expand understanding beyond the undergraduate curriculum in an interactive manner. COVID-19 has caused disruption to the organisation and attendance of in-person conferences (IPCs). Virtual conferences (VCs) offer a viable solution, allowing delegates to attend from the comfort of their own homes.

Method

The aim of our study was to evaluate an organised VC and explore the perceived benefits and limitations of VCs compared to IPCs. A virtual one-day trauma & orthopaedics (T&O) conference was organised involving lectures, workshops, poster, and oral presentations. Anonymous questionnaire forms were distributed to delegates following the conference to assess the aims of our paper.

Results

From 106 responses, 96.2% rated the conference as ‘Excellent’ or ‘Good’ with 92.5% stating that it increased their passion for T&O surgery. Based on a five-point Likert scale (5= strongly agree, 1= strongly disagree), mean score of agreement for preferring VCs to IPCs was 3.30(± 1.24). Key advantages of the VC were a lower cost (70.8%) and not having to travel (77.4%), whereas the main limitation was the inability to participate in hands-on workshops (84.9%).

Conclusions

Despite the success of our VC, delegate feedback indicates a mixed response comparing VCs to IPCs. We share our findings to encourage similar events to be organised and for other specialties.

The effect of the COVID-19 pandemic on time to angiography and outcomes in patients presenting with non-ST elevation myocardial infarction

Funding Acknowledgements

Type of funding sources: None.

Background

Covid-19 pandemic has had a profound impact on healthcare service delivery. Acute cardiovascular care however remains a priority despite the pandemic. Patients presenting with non-ST elevation MI (NSTEMI) have been poorly characterised during the pandemic.

Methods

We conducted a retrospective study of patients diagnosed with NSTEMI during the peak of the pandemic between April-May 2020 at our tertiary centre in the UK. Data was collected from electronic patient clinical records including time from admission to angiography, length of stay, mortality, prescription of secondary prevention pharmacotherapy and referral to cardiac rehabilitation. We compared this data to the same time period in 2019.

Results

As can be seen from Table 1, in 2020, the mean age, median time to angiography and length of stay were all significantly lower than the control period of 2019. Prescription of secondary prevention medication (Aspirin, P2Y12 inhibitor, Beta-blocker, Statin and ACEi/ARB) and referral to cardiac rehabilitation also improved in 2020, however neither was statistically significant.

During the 2020 period, 1 patient died due to late presentation NSTEMI and multi-organ failure. There were 3 deaths in 2019: complications following coronary bypass surgery, upper GI bleed and a subarachnoid haemorrhage.

Conclusion

Our results show that the mean age of the patients presenting with NSTEMI during the peak of Covid-19 pandemic was younger suggesting that elderly patients failed to present. Compared to 2019, there was significant improvement in patient treatment times with a significantly shorter stay in hospital, probably as a result of the reduction in elective activity allowing un-restrained access to the catheter labs.  We also saw improvement in prescription for secondary prevention and referral to cardiac rehabilitation services during this time suggesting that there may have been improved focus on these aspects of care again.

A234 EVALUATING THE EFFECT OF STOOL SUPERNATANTS FROM IBS PATIENTS AND HEALTHY CONTROLS ON THE EXCITABILITY OF DRG NEURONS

Background

Abdominal pain is commonly described in chronic disorders such as irritable bowel syndrome (IBS), but the underlying mechanisms are currently unclear. The stool metabolomic and microbiota profiles of IBS and healthy patients have shown distinct differences. Additionally, IBS stool supernatants have previously been demonstrated to induce hypersensitivity of nociceptive nerves in the ex vivo mouse colon, suggesting that mediators in the stool can sensitize nociceptors. However, the effects of healthy control (HC) or IBS patient stool supernatants on the excitability of DRG neurons have not been clarified.

Aims

To evaluate the effect of HC and IBS supernatant on DRG neurons.

Methods

HC (n=8 patients) or IBS (n=10 patients) stool was collected, dissolved and homogenized with bicarbonate-buffered Krebs solution at 37°C in a 1/10 dilution. DRG neurons from C57BL/6 mice were dissociated and incubated overnight with HC or IBS supernatant in a Krebs dissolution. Changes in DRG neuronal excitability were recorded using perforated patch-clamp techniques to measure the rheobase (amount of current needed to elicit an action potential). The effect of the IBS and HC stool supernatants on the resting membrane potential (RMP) was also recorded.

Results

Overnight incubations with supernatant of HC stool diluted in Krebs solution (n=28 neurons) did not significantly decrease the rheobase compared to control neurons (n=22) (62.7 ± 3.9 pA vs 64.2 ± 2.7 pA). In a parallel experiment, we evaluated the effect of IBS stool supernatants diluted in Krebs (n=52 neurons) and found that they significantly decreased the rheobase compared to the supernatant of HC diluted in Krebs and control neurons (52.3 ± 2.3; p<0.05). The data were analyzed with a one-way ANOVA and Tukey’s test. Incubations with IBS supernatant decreased the RMP compared to HC supernatant (-42.6 ± 0.6 mV vs. -46.0 ± 0.9 mV; p<0.01), which was calculated with an unpaired t-test.

Conclusions

These findings suggest that mediators in IBS stool increase the excitability of DRG neurons compared to HC stool supernatant, and thus may contribute to pain signaling in IBS patients.

Funding Agencies

CIHR

Dengue, chikungunya and Zika in GeoSentinel surveillance of international travellers: a literature review from 1995 to 2020

INTRODUCTION

GeoSentinel is a global surveillance network of travel medicine providers seeing ill-returned travellers. Much of our knowledge on health problems and infectious encountered by international travellers has evolved as a result of GeoSentinel surveillance, providing geographic and temporal trends in morbidity among travellers while contributing to improved pre-travel advice. We set out to synthesize epidemiological information, clinical manifestations and time trends for dengue, chikungunya and Zika in travellers as captured by GeoSentinel.

METHODS

We conducted a systematic literature search in PubMed on international travellers who presented with dengue, chikungunya or Zika virus infections to GeoSentinel sites around the world from 1995 until 2020.

RESULTS

Of 107 GeoSentinel publications, 42 articles were related to dengue, chikungunya and/or Zika. The final analyses and synthesis of and results presented here are based on the findings from 27 original articles covering the three arboviral diseases.

CONCLUSIONS

Dengue is the most frequent arboviral disease encountered in travellers presenting to GeoSentinel sites, with increasing trends over the past two decades. In Southeast Asia, annual proportionate morbidity increased from 50 dengue cases per 1000 ill returned travellers in non-epidemic years to an average of 159 cases per 1000 travellers during epidemic years. The highest number of travellers with chikungunya virus infections was reported during the chikungunya outbreak in the Americas and the Caribbean in the years 2013-16. Zika was first reported by GeoSentinel already in 2012, but notifications peaked in the years 2016-17 reflecting the public health emergency in the Americas at the time.

Obsessive compulsive Personality Disorder and Autism Spectrum Disorder Traits in the Obsessive-compulsive Disorder Clinic

Introduction

Obsessive Compulsive Personality Disorder (OCPD) is a common, highly co-morbid disorder. Subjected to comparatively little research, OCPD shares aspects of phenomenology and neuropsychology with obsessive-compulsive spectrum disorders and neurodevelopmental disorders such as autism spectrum disorder (ASD). A greater understanding of this interrelationship would provide new insights into its diagnostic classification and generate new research and treatment heuristics.

Aims

To investigate the distribution of OCPD traits within a cohort of OCD patients. To evaluate the clinical overlap between traits of OCPD, OCD and ASD, as well as level of insight and treatment resistance.

Method

We interviewed 73 consenting patients from a treatment seeking OCD Specialist Service. We evaluated the severity of OCPD traits (Compulsive Personality Assessment Scale; CPAS), OCD symptoms (Yale–Brown Obsessive Compulsive Scale; Y-BOCS), ASD traits (Adult Autism Spectrum Quotient; AQ) and insight (Brown Assessment of Beliefs Scale; BABS).

Results

Out of 67 patients, 24 (36%) met DSM-IV criteria for OCPD, defined using the CPAS. Using Pearson's test, CPAS scores significantly (P < 0.01) correlated with total AQ and selected AQ domains but not with BABS. Borderline significant correlation was observed with Y-BOCS (P = 0.07). OCPD was not over-represented in a highly resistant OCD subgroup.

Conclusion

Disabling OCPD traits are common in the OCD clinic. They strongly associate with ASD traits, less strongly with OCD severity and do not appear related to poor insight or highly treatment-resistant OCD. The impact of OCPD on OCD treatment outcomes requires further research.

Disclosure of interest

This work did not receive funding from external sources. Over the past few years, Dr. Fineberg has received financial support in various forms from the following: Shire, Otsuka, Lundbeck, Glaxo-SmithKline, Servier, Cephalon, Astra Zeneca, Jazz pharmaceuticals, Bristol Myers Squibb, Novartis, Medical Research Council (UK), National Institute for Health Research (UK), Wellcome Foundation, European College of Neuropsychopharmacology, UK College of Mental Health Pharmacists, British Association for Psychopharmacology, International College of Obsessive-Compulsive Spectrum Disorders, International Society for Behavioural Addiction, World Health Organization, Royal College of Psychiatrists.

A130 RETROGRADE TRACING ANALYSIS OF THE SENSORY INNERVATION OF THE MOUSE COLON

Background

Visceral pain is a primary symptom of many gastrointestinal diseases. One feature of visceral pain is its vague localization. We hypothesized that overlap in the receptive fields of spinal primary afferent neurons that innervate the gut may contribute to this vague localization. Many studies have confirmed that the proximal and distal colon are mainly innervated by spinal afferent neurons with cell bodies in thoraco-lumbar and lumbo-sacral dorsal root ganglia (DRG), respectively. However, no murine studies have examined whether individual DRG neurons simultaneously innervate both proximal and distal colon.

Aims

To determine the extent of overlap in receptive fields of colon-projecting DRG neurons.

Methods

C57BL/6 mice (n=8) were anesthetized, and two retrograde neuronal tracers with distinct fluorescence emission spectra (Fast blue and DiI) were injected separately into the smooth muscle layers of proximal and distal colon. Mice were left for 10–13 days for dye transport, before being euthanized. Thoraco, lumbar and lumbo-sacral DRGs (T8-13, L1-4, L5-S2) were dissected and fixed in 4% paraformaldehyde overnight. 12μm cryostat sections were obtained and analyzed using a fluorescent microscope equipped with filter cubes that detect Fast blue and DiI.

Results

When DiI was injected into the proximal colon, we observed labelling to be highest in T8-13 DRG with 12.6 +/- 4.5% of cell bodies labelled, followed by L1-4 was (8.2 +/- 1.4%) and in L5-S2 (6.5 +/- 0.8%). DiI injections into the distal colon resulted in labelling of similar numbers of neurons labelled in T8-13 and L1-4 ganglia, whereas half as many neurons were labelled in L5-S2 ganglia. This data shows that the majority of spinal afferent innervation of the colon originates in thoracolumbar DRG. Most importantly, 26.4% and 17.6% of thoracolumbar and lumbo-sacral DRG neurons labelled by Fast blue injection into the proximal colon were also double-labelled by DiI injected into the distal colon. Similarly, 16.6% and 13.8% of neurons in thoracolumbar and lumbosacral DRG labelled by Fast blue injection into the distal colon were double-labelled by DiI injected into the proximal colon.

Conclusions

These data reveal a surprisingly large number of DRG neurons that innervate the colon have receptive fields that cover both the proximal and distal colon, which may contribute to the poor spatial localization of pain emanating from the colon.

Funding Agencies

CCC, CIHR

Issues in halal food product labelling: a conceptual paper

The paper was aimed to uncover the issues encountered on Halal Food Product labelling to prevent the misuse of Islamic attributes in food products labelling and to ensure the appropriate trademarks, terms, and label used on the packaging and marketing strategy. The method used for this conceptual paper was from literature reviews from journal articles, thesis, proceedings and conferences, books, and online news, which are related to the keywords and research area. Trademarks and labels are among the crucial elements in marketing, which enable the consumer to differentiate the quality, the ingredients and will affect the consumers’ buying choice. Recently there is a trend of using Islamic attributes in food product labelling as trademarks to attract Muslim consumers. The issues encountered on halal food product labelling are the use of Quranic verses on the drink, the term “Sunnah food”, using Islamic terms such as “Masjid”, “Mukmin”, and others in food products’ trademark and label. The consumers were deceived into thinking that these products have extra benefits as compared to others due to Islamic attributes they have. Thus, there is a need for an in-depth study on these issues since there is no clear and specific guideline on this matter.

Overlap of obsessive-compulsive personality disorder and autism spectrum disorder traits among OCD outpatients: an exploratory study

Background: Whereas the phenomenology of obsessive-compulsive personality disorder (OCPD) shows similarities to that of obsessive compulsive and related disorders (OCRDs) as well as with autism spectrum disorder (ASD), the relationship between these disorders is poorly understood.Aims: Within a clinical sample, we aimed to investigate the distribution of OCD, OCPD and ASD symptoms and traits and their interrelationship, as well as to evaluate insight and treatment refractoriness.Methods: Consecutive adult OCD outpatients were assessed for OCPD traits (Compulsive Personality Assessment Scale (CPAS)), OCD symptoms (Yale-Brown Obsessive Compulsive Scale (Y-BOCS)), ASD traits (Autism Spectrum Quotient (AQ)), insight (Brown Assessment of Beliefs Scale (BABS)) and treatment resistance (clinical records). Those scoring highly on the AQ underwent a diagnostic interview for ASD.Results: Sixty-seven consenting individuals completed the CPAS, BABS and AQ, and 65 completed the Y-BOCS. Twenty-four patients (35.8%) were diagnosed with OCPD. Patients with OCPD were less likely to be employed (p=.04). They demonstrated elevated AQ scores (p=.004) and rates of ASD diagnosis (54.2%) (p <.001). OCPD traits (CPAS) showed a highly significant correlation with ASD traits (AQ) (p<.001), and no association with Y-BOCS, BABS or treatment resistance.Conclusions: In an OCD cohort limited by small size, OCPD associated strongly with unemployment and ASD, with implications for diagnosis, treatment and outcome.KEY POINTSClinicians should exercise a high level of vigilance for OCPD and ASD in patients presenting with obsessive compulsive symptoms.The presence of OCPD may indicate a likelihood of disabling ASD traits, including cognitive inflexibility, poor central coherence and poor social communication.These neuropsychological factors may require separate clinical intervention strategies.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Effects of the Razor Clam Tagelus plebeius on the Fate of Petroleum Hydrocarbons: A Mesocosm Experiment

The relationship between organisms and contaminants may be a two-way interaction: contaminants affecting the biota and the biota affecting the environmental fate and distribution of the contaminants. This may be especially so for sediment-dwelling organisms, because their burrowing and feeding can drastically influence sediment characteristics. The present study looked at the influence of the suspension-feeding stout razor clam Tagelus plebeius on the distribution of crude oil and pyrene in greenhouse mesocosm experiments. Water column turbidity and sediment redox also were monitored during the 15- to 30-day exposures to provide information on the influence of hydrocarbons and the razor clams on environmental conditions. For the experiment with crude oil, sediment was taken from the mesocosms at the end of the experiment, and the hydrocarbon-degradation potential was assessed in incubations with ¹⁴C-naphthalene. The experiments used four treatments: hydrocarbons present/absent and razor clams present/absent. Hydrocarbon dosing levels were relatively low (1 mL of oil or 30 mg of pyrene per mesocosm with 22 L of natural sediment and 11 L of seawater). The presence of the razor clams resulted in hydrocarbon concentrations at the sediment surface being 25% lower than in mesocosms without clams. No consistent effects were noted for polycyclic aromatic hydrocarbon (PAH) concentrations in the water column or in subsurface sediment. The naphthalene-degradation potential was elevated for sediment from mesocosms dosed with oil, but the presence of the clams did not affect this potential. The presence of the razor clams resulted in a lowering of water column turbidity, but no effect on sediment redox. The hydrocarbon addition had no effect on turbidity, but sediment redox was lowered. While results show that the presence of the razor clams resulted in a loss of hydrocarbons from the surface sediment, the other results do not provide a clear picture of the underlying mechanisms and the fate of the PAHs lost from the sediment surface. We hypothesize that the loss of surface sediment PAHs was due to burial of surface sediment and possibly bioaccumulation by the clams. While additional research is needed for further insights into underlying mechanisms, the present work demonstrates that the presence of sediment-burrowing suspension feeders decreases hydrocarbon levels in surface sediment. This means that assessments of the impact of an oil spill should pay attention to effects on these organisms and to their influence on the fate and distribution of the spilled oil.

The Prevalence of Wrist Ganglia in an Asymptomatic Population: Magnetic Resonance Evaluation

Magnetic resonance imaging (MRI) was performed on the wrists of 103 asymptomatic volunteers. The images were evaluated independently by two musculoskeletal radiologists and one orthopaedic surgeon. Wrist ganglia were identified in 53 out of the 103 wrists. The average long and short axes measurements were 8 mm (range 3–22) and 3 mm (range 2–10), respectively. Seventy per cent of the ganglia originated from the palmar capsule in the region of the interval between the radioscaphocapitate ligament and the long radiolunate ligament. Fourteen per cent of the ganglia were dorsal and originated from the dorsal, distal fibres of the scapholunate ligament. Two ganglia had surrounding soft tissue oedema and one had an associated intraosseous component. Unlike previous surgical and pathological series, our study showed that palmar wrist ganglia are more common than dorsal wrist ganglia. The vast majority of these asymptomatic ganglia occur without associated ligamentous disruption, soft tissue oedema or intraosseous communication.

Computed tomography in diagnosis and staging of the retroperitoneal tumors

The main role of retroperitoneal tumor diagnosis is the imaging examination. Diagnostic imaging is essential for describing and predicting lesion integrity limits adjacent organs.

Methods. The results are based on a sample of 53 patients admitted in the Urology Clinic and investigated during the period 1 January 2005 - 31 December 2014. Results. CT scan for retroperitoneal tumor: vascular tumors are diagnosed in 100% of cases, while endocrine tumors and lymphomas values are between 50-66.67% in terms of a positive diagnosis. In 54.71% of cases studied was identified retroperitoneal tumor invasion into adjacent structures (29 patients), and for 12 cases (22.64%) CT scan was not conclusive enough. CT scan investigation to identify metastasis has statistical significance (p <0.01) according to the different types of retroperitoneal tumors, there were on average 35% for highlighting values of peritumoral lymph nodes and 13% for metastases. The relationship between retroperitoneal tumor size detected by CT (coefficient R =0.736) than those found intraoperative CT examination reveals that tends to underestimate the retroperitoneal tumor size.

Conclusions. Imaging diagnosis is mainframe of positive diagnosis for retroperitoneal tumors. CT scanning bring data not only on tumor location, but also about the nature of injuries (cystic or solid), presence or absence of necrosis, invasion of adjacent structures and abdominal metastases.

Radiation doses in chest, abdomen and pelvis CT procedures

Computed tomography (CT) scanning is recognised as a high-radiation dose modality and estimated to be 17 % of the radiological procedure and responsible for 70 % of medical radiation exposure. Although diagnostic X rays provide great benefits, their use involves some risk for developing cancer. The objectives of this study are to estimate radiation doses during chest, abdomen and pelvis CT. A total of 51 patients were examined for the evaluation of metastasis of a diagnosed primary tumour during 4 months. A calibrated CT machine from Siemens 64 slice was used. The mean age was 48.0 ± 18.6 y. The mean patient weight was 73.8 ± 16.1 kg. The mean dose-length product was 1493.8 ± 392.1 mGy cm, Volume CT dose index (CTDI vol) was 22.94 ± 5.64 mGy and the mean effective dose was 22.4 ± 5.9 mSv per procedure. The radiation dose per procedure was higher as compared with previous studies. Therefore, the optimisation of patient's radiation doses is required in order to reduce the radiation risk.

Clinico-Radiologic Profile of Spinal Cord Multiple Sclerosis in Adults

MRI is extremely useful for the assessment of initial disease burden and to identify the dissemination of the multiple sclerosis (MS) in time and space. Though MRI of the spinal cord is not used to establish the diagnosis of MS, spinal cord is frequently involved in this disease and there has been increasing emphasis of the spinal imaging in making clinical decision in the management of MS. We undertook a retrospective study of patients with diagnosed MS: 1) to identify radiologic pattern of spinal cord involvement in MS and 2) to correlate radiologic findings with clinical presentation. We reviewed radiologic records from 2004 to 2009 of patients with abnormal T2 signal intensity of the spinal cord with radiologic concern of demyelinating disease. Patients in this cohort who met the Revised McDonald MS Diagnostic Criteria were included in this study. 166 patients were included in the study. There was preference for cervical spinal cord particularly posterior aspect of the spinal cord. Enhancement of the lesions was rare (4.1%). Mean lesion length was 18.2 mm. The average number of lesions per patient was 2.04. Sensory symptoms were predominating and most of the patients had relapsing-remitting course. Patients with sensory symptoms, bladder and bowel involvement and motor symptoms had almost equally distributed lesions among anterior, posterior and central spinal cord. However, all of the patients presented with posterior column signs and gait abnormality had involvement of the posterior spinal cord. Radiologic manifestation of spinal cord MS is extremely variable and can involve the entire length of the spinal cord. Clinical symptoms may or may not be associated with radiologic presentation of the lesions.

Impact of FDG-PET scan on follow-up care in nonmetastatic breast cancer

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Background: Fluorine-18-FDG positron emission tomography (FDG-PET) role in the follow up care of non-metastatic breast cancer is not defined. Methods: We retrospectively analyzed 177 patients with stage I-III breast cancer between November 2004 and June 2006. IRB approval was obtained for this study. Patients were divided into two groups. Group A consisted of patients who had one or more FDG-PET scans as part of their clinical follow up (N=68), and Group B consisted of patients who did not (N=109). Clinical, radiological and pathology data were obtained from patients’ records. Results: Median follow-up is 35 months. Mean age 53 years for group A and 57 years for group B. Group A patients were more likely to have had higher stages (29% stage I, 53% stage II, and 18% stage III) compared with group B (64 % stage I, 31% stage II and 4% stage III). The two groups did not differ significantly in ER+ status (69% vs. 78% p=0.21), or Her2neu status (19% vs. 17%; p=0.6). Group A patients had more clinic visits (18 vs. 11; p=0.009), their tumor marker was checked more often (13 vs. 9 times; p=0.0001), had more radiological studies (10 studies vs. 5; p=0.0001), and had more biopsies (0.88 vs. 0.48 biopsy per patient; p=0.05). These differences were significant even after controlling for stage and chemotherapy. 9/68 patients in group A had tumor recurrence compared to 1/109 in group B (p=0.0003). PET scan indications were as follows: 29 (43%) for asymptomatic follow up evaluation [2 recurred]; 18 (26%) concerning symptoms [0 recurred]; 10 (15%) elevated tumor marker [2 recurred]; 7 (10%) other abnormal imaging studies [1 recurred]; 4 (6%) metastatic workup. Conclusions: While FDG-PET might aid in detecting recurrence in some patients with non-metastatic breast cancer, its use was associated with more clinic visits, blood tests, biopsies, and radiological tests.

No significant financial relationships to disclose.

Positron emission tomography analysis of [11C]KW-6002 binding to human and rat adenosine A2A receptors in the brain

Adenosine A(2A) receptors are found on striatal neurones projecting to the external pallidum. KW-6002 (istradefylline) is a potent and selective antagonist for the adenosine A(2A) receptors in the CNS and acts to inhibit the excessive activity of this pathway in the MPTP marmoset model of PD, thus relieving parkinsonism. The objectives of this study were to investigate the regional binding of the novel positron emission tomography tracer [(11)C]KW-6002 in the healthy human brain and the rat brain, along with receptor occupancy by cold KW-6002 at varying doses in human. The highest [(11)C]KW-6002 uptake in the rat brain was seen in striatum and lower levels in cortex and cerebellum. Brain [(11)C]KW-6002 uptake was well characterized in humans by a two-tissue compartmental model with a blood volume term, and the ED(50) of cold KW-6002 was 0.5 mg in the striatum. Over 90% receptor occupancy was achieved with daily oral doses of greater than 5 mg. In humans, blockable binding was present in all gray matter structures including the cerebellum, which has not been reported to express A(2A) receptors. MRS 1745, an A(2B) receptor selective antagonist, had no effect on the cerebellar binding of [(11)C]KW-6002 in rats, suggesting that this blockable signal is unlikely to result from an affinity for adenosine A(2B) receptors.

A feasibility study of [11C]choline for the molecular imaging of human breast cancer in vivo using positron emission tomography (PET)

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Background: [11C]Choline is a novel PET radiotracer. Preclinical studies suggest that it may be promising in breast cancer. [11C]Choline has been recently evaluated as a screening agent in prostate cancer, but no studies have yet investigated its potential in breast cancer. We report a pilot study evaluating the utility and reproducibility of [11C]Choline-PET in breast cancer. Methods: Dynamic imaging was performed on an ECAT962 HR+ PET scanner for 65 min after intravenous injection with 190–369 MBq [11C]choline. Patients with locally advanced and metastatic breast cancer were eligible. All histological subtypes were included (ductal, lobular, and inflammatory). Arterial blood samples were taken continuously for 10 min, with 8 discrete samples up to 60 min to measure [11C]choline and metabolites. Tissue uptake was determined by standardised uptake value at 60 min (SUV, dose and BSA corrected) and Ki (irreversible trapping) calculated using Patlak (corrected for [11C]choline metabolites in plasma) and modified Patlak analysis (corrected for plasma + tissue metabolites). Reproduciblilty scans were performed 2–17 days later in the absence of treatment. Results: Tumour [11C]choline uptake was observed in 10 out of 11 patients (12 out of 13 distinct lesions). There was a significant difference between tumour and normal tissue (breast/lung) in [11C]choline uptake for Ki (p<0.0001) and SUV (p<0.0001). Tissue uptake was of the order lung ≤ normal breast < tumour < liver ≤ spleen. [11C]choline was rapidly metabolised, at 60 min the mean ± S.E. plasma radioactivity due to [11C]choline was 16.4 ± 2.9%. [11C]Choline uptake was found to be reproducible for Ki (modified Patlak: r=0.93, p<0.0001, Patlak: r=0.85, p=0.002) and SUV (r=0.94, p<0.0001) - measured in 8 patients (median of 2 days after the 1st scan). Tumour Patlak Ki was 13.2% > Ki calculated using modified Patlak analysis. Conclusions: [11C]Choline-PET imaging of breast cancer is promising and warrants further evaluation. Tumour [11C]Choline uptake measured by Ki and SUV is reproducible. We plan to study the relationship between choline uptake measured by PET and immunoassays of tumour samples. Functional imaging could have a vital role to determine the efficacy of target-specific agents.

No significant financial relationships to disclose.

Glucose metabolism in brain tumours can be estimated using [18F]2-fluorodeoxyglucose positron emission tomography and a population-derived input function scaled using a single arterialised venous blood sample

The aim of this study was to assess simplified methods for deriving input functions for estimating glucose metabolism using 18F-FDG-PET. Nine glioma patients underwent paired 18F-FDG-PET scans as part of a phase II study and the data used to estimate the metabolic rate of glucose (MRGlu) using a population-derived input function (arterial data from 14 scans) scaled using a single arterial blood sample taken at 20 min. Paired studies were performed in four further glioma patients with stable disease at least four months following radiotherapy to determine whether scaling the population-derived input function using a 20-min arterialised venous or venous sample further simplified the method. The heated hand method was used to obtain arterialised venous blood that approximated arterial blood. In the 9 phase II glioma patients, there was a good, statistically significant correlation between the MRGlu values estimated using the individual arterial input functions and the single arterial sample scaled population-derived input functions (r(2)=0.88, p<0.001, n=36). Blood samples collected during three scans on two of the stable disease patients showed no significant difference between the arterialised venous and arterial plasma concentrations of 18F (p>0.1, n=15) when the degree of arterialisation of the blood was monitored and maintained using a thermocouple. A significant difference was found between the plasma arterial and venous levels of 18F. There was an excellent correlation between MRGlu estimated using an arterial input function and a population-derived input function scaled using a single arterialised venous blood sample (r(2)=0.98, n=12). The method was reproducible with less than 4.4% variation between repeat tumour scans. Therefore, a population-derived input function scaled using a single arterialised venous blood sample at 20 min can be used for estimating MRGlu using 18F-FDG PET in glioma patients.