Monitoring Response to Transarterial Chemoembolization in Hepatocellular Carcinoma Using 18F-Fluorothymidine PET.

Accurate disease monitoring is essential after transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) because of the potential for profound adverse events and large variations in survival outcome. Posttreatment changes on conventional imaging can confound determination of residual or recurrent disease, magnifying the clinical challenge. On the basis of increased expression of thymidylate synthase (TYMS), thymidine kinase 1 (TK-1), and equilibrative nucleoside transporter 1 (SLC29A1) in HCC compared with liver tissue, we conducted a proof-of-concept study evaluating the efficacy of 3'-deoxy-3'-18F-fluorothymidine (18F-FLT) PET to assess response to TACE. Because previous PET studies in HCC have been hampered by high background liver signal, we investigated whether a temporal-intensity voxel clustering (kinetic spatial filtering, or KSF) improved lesion detection. Methods: A tissue microarray was built from 36 HCC samples and from matching surrounding cirrhotic tissue and was stained for TK-1 A prospective study was conducted; 18 patients with a diagnosis of HCC by the criteria of the American Association for the Study of Liver Diseases who were eligible for treatment with TACE were enrolled. The patients underwent baseline conventional imaging and dynamic 18F-FLT PET with KSF followed by TACE. Imaging was repeated 6-8 wk after TACE. The PET parameters were compared with modified enhancement-based RECIST. Results: Cancer Genome Atlas analysis revealed increased RNA expression of TYMS, TK-1, and SLC29A1 in HCC. TK-1 protein expression was significantly higher in HCC (P < 0.05). The sensitivity of 18F-FLT PET for baseline HCC detection was 73% (SUVmax, 9.7 ± 3.0; tumor to liver ratio, 1.2 ± 0.3). Application of KSF did not improve lesion detection. Lesion response after TACE by modified RECIST was 58% (14 patients with 24 lesions). A 30% reduction in mean 18F-FLT PET uptake was observed after TACE, correlating with an observed PET response of 60% (15/25). A significant and profound reduction in the radiotracer delivery parameter K1 after TACE was observed. Conclusion:18F-FLT PET can differentiate HCC from surrounding cirrhotic tissue, with PET parameters correlating with TACE response. KSF did not improve visualization of tumor lesions. These findings warrant further investigation.

Type 2 Diabetic Retinopathy Screening in a General Practice: A Five-Year Retrospective Analysis.

Aim To assess current standards of diabetic retinopathy screening in primary care against the National Institute of Clinical Excellence (NICE) guidelines for type 2 diabetes mellitus. Moreover, to determine whether individuals with diabetes were screened for diabetic retinopathy no later than three months from referral to the local eye screening service and no later than one year from their last retinal screen. Materials and methods A single-center, retrospective audit was undertaken at a small general practice. Data was collected from the health records of individuals placed on the type 2 diabetes register from 01/01/2013 to 01/01/2018. Individuals who were diagnosed with diabetes whilst registered at a different practice, who had pre-diabetic retinal screening or were referred onto a different screening pathway were excluded. A total of 50 records were audited and data collection involved demographics, dates individuals were placed on the diabetes register and dates of attendance and non-attendance to screening. Results 16.0% of individuals with type 2 diabetes underwent retinal screening which adhered to the NICE guidelines. Of the cohort which did not adhere, 59.5% experienced an interval greater than three months between diagnosis and first retinal screening and 64.3% experienced a screening interval greater than one year. Conclusions Diabetic retinopathy screening of individuals must be improved to meet the NICE standards. Interventions should be implemented to increase the awareness within general practitioners and practice nurses to ensure all people with diabetes receive their first retinal screen within the first three months of diagnosis with regular annual screening thereafter.

Post-Exercise Appetite and Ad Libitum Energy Intake in Response to High-Intensity Interval Training versus Moderate- or Vigorous-Intensity Continuous Training among Physically Inactive Middle-Aged Adults.

High-intensity interval training (HIIT) is considered a time-efficient exercise strategy for weight management. However, data regarding the acute appetite and energy intake responses to HIIT versus continuous training remain inconclusive. This study investigated the ad libitum energy intake and appetite responses to a single session of HIIT versus moderate-intensity continuous training (MICT) and vigorous-intensity continuous training (VICT). Using a randomized crossover design, 11 middle-aged physically inactive men (45.7 ± 7.4 years, 23.5 ± 2.1 kg m-2) participated in three treadmill trials at 7-day intervals. HIIT comprised 10 1-min periods at 100% VO2max interspersed with 1-min periods of active recovery. MICT comprised a 40-min session at 65% VO2max, while VICT comprised a 20-min session at 80% VO2max. After each trial, the participants consumed an ad libitum buffet meal for which the energy intake was recorded. The participants' perceived appetite was assessed before and after exercise sessions using the Visual Analogue Scale (VAS). No significant differences in post-exercise ad libitum energy intake were observed between trials (HIIT: 645 ± 262.9 kcal; MICT: 614.7 ± 271.2 kcal; VICT: 623.1 ± 249.0 kcal, p > 0.05). Although the perceived appetite responses exhibited a significant main effect of time (p < 0.01), no group differences were observed (p > 0.05). In summary, these findings suggest that the interval or continuous nature of exercise has no significant effect on appetite responses in physically inactive middle-aged adults, at least during the short-term post-exercise period.

Age-specific affective responses and self-efficacy to acute high-intensity interval training and continuous exercise in insufficiently active young and middle-aged men.

BACKGROUND/OBJECTIVE: High-intensity interval training (HIIT) has been recognized as an emerging trend in public health promotion, but its age-specific differences in psycho-perceptual responses have yet to be investigated. This study compared the psycho-perceptual responses after a single session of HIIT versus moderate-intensity continuous exercise (MICE) and vigorous-intensity continuous exercise (VICE) in twelve young and twelve middle-aged insufficiently active males respectively. METHODS: Using a randomized cross-over design, participants undertook three main trials consisting of: HIIT (10 x 1-min run at 100% VO2max interspersed with 1-min active recovery), MICE (40-min run at 65% VO2max) and VICE (20-min run at 80% VO2max). Affective responses, self-efficacy and exercise preference were assessed for each trial. RESULTS: Both HIIT and VICE showed more positive in-task affective responses than MICE in young adults, while middle-aged adults reported more positive responses in both HIIT and MICE than in VICE. However, middle-aged adults displayed significantly lower exercise task self-efficacy scores towards HIIT (42.7 ±â€¯25.3) and VICE (49.2 ±â€¯23.9) than MICE (63.4 ±â€¯18.3, both P < 0.01). Additionally, only 17% of participants in the middle-aged group reported a preference to engage in HIIT as opposed to either MICE (50%) and VICE (33%). CONCLUSION: Our finding revealed distinct affective and self-efficacy responses to acute HIIT versus both MICE and VICE in the two age groups which assists in our understanding of how individuals in various age populations perceive HIIT. This information will assist in the design and implementation of effective exercise programs for public health, especially for insufficiently active individuals.

Effect of fine-motor-skill activities on surgical simulator performance.

PURPOSE: To determine the effect of fine motor activity and nondominant-hand training on cataract surgical simulator (Eyesi) performance. SETTING: Departments of Ophthalmology, University of Iowa, and Veterans Affairs Health Care Systems, Iowa City, Iowa, USA. DESIGN: Prospective controlled trial. METHODS: Medical students completed a questionnaire and baseline microsurgical dexterity evaluation using the following 3 surgical simulator tasks: navigation, forceps, and bimanual. Participants were randomized to control (16) or intervention (17) consisting of writing, completing a labyrinth, eating, and brushing teeth once per day with their nondominant hand. Participants returned 4 weeks after baseline evaluation for follow-up simulator testing. RESULTS: Of the 33 students, regular video game players had greater baseline scores than nonplayers on navigation (P = .021) and bimanual tasks (P = .089). All participants showed statistically significant improvements in all 3 tasks at follow-up after a single baseline evaluation on the surgical simulator (navigation: P = .004; forceps: P < .001; bimanual: P = .004). Nondominant-hand training with daily activities did not show statistically significant differences for dominant hands or nondominant hands. The intervention group (n = 17) trended toward greater improvement than the control group (n = 16) in navigation (14.78 versus 7.06; P = .445) and bimanual tasks (15.2 versus 6.0; P = .324) at follow-up. CONCLUSIONS: Regular video game play enhanced baseline microsurgical performance measured on the surgical simulator. Simulation performance improved significantly in the intervention group and control group after 1 session on the simulator. Although not statistically significant, training the nondominant hand with daily activities showed a trend toward improved navigation and bimanual performance.

Estimation of clinical parameters of chronic kidney disease by exhaled breath full-scan mass spectrometry data and iterative PCA with intensity screening algorithm.

Breath mass spectrometry is a useful tool for identifying important compounds associated with health. However, there have been few studies that have explored human exhaled breath by full-scan mass spectrometry as a non-invasive method for medical diagnosis, which may be attributed to the difficulties resulting from multicollinearity and small sample sizes relative to a large number of product ions. In this study, breath samples from 54 chronic kidney disease patients were analyzed by selected ion flow tube mass spectrometry in the full-scan mode. With the signal intensities of product ions, we developed a novel and robust algorithm, iterative PCA with intensity screening (IPS), to build linear models for estimating important clinical parameters of chronic kidney disease. It has been shown that IPS provided good estimations in cross-validated samples, and furthermore the identified product ions could have direct medical relevance to the disease. The study demonstrated the potential of quantitative breath analysis using mass spectrometry for medical diagnosis, and the importance of applying appropriate statistical tools to unveil the rich information in this type of data.

Effectiveness of a workplace training programme in improving social, communication and emotional skills for adults with autism and intellectual disability in Hong Kong--a pilot study.

This pilot study explored the effectiveness of workplace training programme that aimed to enhance the work-related behaviours in individuals with autism and intellectual disabilities. Fourteen participants with autism and mild to moderate intellectual disability (mean age = 24.6 years) were recruited. The workplace training programme included practices in work context and group educational sessions. A pre-test-post-test design was used with the Work Personality Profile, the Scale of Independent Behaviour Revised and the Observational Emotional Inventory Revised to evaluate the targeted behaviours. Improvement in social and communication skills specific to the workplace was achieved. For emotional control, participants became less confused and had a better self-concept. However, improvement in other general emotional behaviours, such as impulse control, was limited. The results indicated that a structured workplace training programme aimed at improving social, communication and emotional behaviours can be helpful for people with autism and intellectual disability. Further study with a larger sample size and a control group is recommended. The development of specific programme to cater for the emotional control needs at workplace for people with autism is also suggested.

evPaeds: undergraduate clinical reasoning.

BACKGROUND: Clinical reasoning is one of the most important skills that medical students need to develop. Our medical students learn clinical reasoning in small group discussion sessions and during their clinical attachments. We wanted to provide additional opportunities for them to develop these important skills. CONTEXT: Our undergraduate paediatric curriculum is based on 25 clinical presentations, and is delivered on the website myPaediatrics. We used simple show-and-hide case examples in each presentation to illustrate to students how to use the knowledge and skills they acquire to solve the clinical presentations. These are popular with students but provide little opportunity for interaction. INNOVATION: Based on two commonly available formats for the virtual patient, neither of which had fully met the specific needs of our undergraduate students, we developed hybrid software: evPaeds. Close collaboration with students and teachers ensured that evPaeds met the unique learning needs of undergraduate students. evPaeds incorporates the Paediatric Decision Tree, which encourages students to make decisions on investigations and management, with immediate feedback. Explicitly referring to the basic sciences in our virtual patients resulted in them being valuable to students in both the pre-clinical and clinical years. IMPLICATIONS: evPaeds has proven popular with students to practise and develop clinical reasoning, individually or in small group sessions.