Computed Tomography in Emergency Diagnosis and Management Considerations of Small Bowel Obstruction for Surgical vs. Non-surgical Approach.

BACKGROUND: Background: Small Bowel Obstruction (SBO) accounts for 15% of abdominal pain complaints referred to emergency departments and imposes significant financial burdens on the healthcare system. The most common symptom and sign of SBO is the absence of stool or flatus passsage and abdominal distension, respectively. Patients who do not demonstrate severe clinical or imaging findings are typically treated with conservative approaches. Patients with clinical signs of sepsis or physical findings of peritonitis are often instantly transferred to the operating room without supplementary imaging assessment. However, in cases where symptoms are non-specific or physical examination is challenging, such as in cases with loss of consciousness, the diagnosis can be complicated. This paper discusses the key findings identifiable on Computed Tomography (CT) which are vital for the emergent triage, proper treatment and appropriate decision making in patients with suspected SBO. METHODS: Narrative review of the literature. RESULTS: CT plays a key role in emergent triage, proper treatment and decision making and provides high sensitivity, specificity, and accuracy in the detection of early-stage obstruction and acute intestinal vascular compromise. CT can also differentiate between various etiologies of SBO entity which is considered an important criterion in the triage of patients into surgical vs. non-surgical treatment. CONCLUSION: There Key CT findings which may suggest a need for surgical treatment include mesenteric edema, lack of the small-bowel feces, bowel wall thickening, fat stranding in the mesentery, and intraperitoneal fluid which are predictive of urgent surgical exploration.

Current comments on contrast media administration in patients with renal insufficiency.

Contrast media administration has been associated with complications such as nephropathy, cardiovascular morbidity, and neurovascular events, particularly in patients with renal insufficiency. This association has been questioned in recent studies. This review was performed to summarize the most current evidence on contrast induced nephropathy (CIN), contributing factors, and considerations in patients with renal insufficiency. The risk of CIN was over-estimated by the previous studies, due to a lack of control groups or presence of non-randomized control groups, which led to a selection bias. However, the thresholds associated with an increased risk of CIN are controversial and require risk-benefit analysis on an individual basis. Regarding the administration of contrast media (CM) in the emergency setting, the majority of studies suggested that CM exposure does not meaningfully increase the risk of acute kidney injury in critically ill patients (including trauma patients). Several strategies have been suggested to reduce the risk of CIN, including volume expansion to increase renal blood flow, sodium bicarbonate or N-acetylcysteine administration, and use of low-osmolal contrast media in end-stage renal disease.

PET/Computed Tomography Scans and PET/MR Imaging in the Diagnosis and Management of Musculoskeletal Diseases.

PET/computed tomography scans and PET/MR imaging have been applied in imaging tumors of the musculoskeletal system for their ability to provide information about metabolic activity. However, applications of these imaging modalities are now being extended to nononcologic musculoskeletal pathologies, such as osteoarthritis, rheumatoid arthritis, and osteoporosis. This article aims to explore the alternative uses of these imaging modalities in oncologic and nononcologic musculoskeletal pathologies. It also discusses the various strengths and some weaknesses that are seen in particular situations.

Discerning Localized Thermal Heating from Mechanical Strain Using an Embedded Distributed Optical Fiber Sensor Network.

Prior research has demonstrated that distributed optical fiber sensors (DOFS) based on Rayleigh scattering can be embedded in carbon fiber/epoxy composite structures to rapidly detect temperature changes approaching 1000 °C, such as would be experienced during a high energy laser strike. However, composite structures often experience mechanical strains that are also detected during DOFS interrogation. Hence, the combined temperature and strain response in the composite can interfere with rapid detection and measurement of a localized thermal impulse. In this research, initial testing has demonstrated the simultaneous response of the DOFS to both temperature and strain. An embedded DOFS network was designed and used to isolate and measure a localized thermal response of a carbon fiber/epoxy composite to a low energy laser strike under cyclic bending strain. The sensor interrogation scheme uses a simple signal processing technique to enhance the thermal response, while mitigating the strain response due to bending. While our ultimate goal is rapid detection of directed energy on the surface of the composite, the technique could be generalized to structural health monitoring of temperature sensitive components or smart structures.

High Temperature Effects during High Energy Laser Strikes on Embedded Fiber Bragg Grating Sensors.

As the applications of fiber Bragg gratings (FBGs) continue to grow and become more advanced, it becomes necessary to understand their behavior when exposed to high temperatures in unique situations. In these experiments, uniform 1530-nm fiber Bragg gratings and Type K Cr-Al thermocouples were embedded in three-ply carbon fiber composites. A 100 W high energy laser (HEL) heated the composites to high temperatures over timespans less than one second, and FBG spectral data and thermocouple temperature data were collected during each HEL heating test. The data from three high energy laser tests that represent different levels of damage to the FBG are analyzed to explore the spectral response and thermal decay of embedded FBG sensors when exposed to high temperatures over short timespans. Results are compared to a previously proposed power-law model describing the decay of FBGs in bare fiber when held at constant temperatures over much longer timespans.

Patient predictors of response to cognitive behaviour therapy and schema therapy for depression.

OBJECTIVE: Few studies have examined differential predictors of response to psychotherapy for depression. Greater understanding about the factors associated with therapeutic response may better enable therapists to optimise response by targeting therapy for the individual. The aim of the current exploratory study was to examine patient characteristics associated with response to cognitive behaviour therapy and schema therapy for depression. METHODS: Participants were 100 outpatients in a clinical trial randomised to either cognitive behaviour therapy or schema therapy. Potential predictors of response examined included demographic, clinical, functioning, cognitive, personality and neuropsychological variables. RESULTS: Individuals with chronic depression and increased levels of pre-treatment negative automatic thoughts had a poorer response to both cognitive behaviour therapy and schema therapy. A treatment type interaction was found for verbal learning and memory. Lower levels of verbal learning and memory impairment markedly impacted on response to schema therapy. This was not the case for cognitive behaviour therapy, which was more impacted if verbal learning and memory was in the moderate range. CONCLUSION: Study findings are consistent with the Capitalisation Model suggesting that therapy that focuses on the person's strengths is more likely to contribute to a better outcome. Limitations were that participants were outpatients in a randomised controlled trial and may not be representative of other depressed samples. Examination of a variety of potential predictors was exploratory and requires replication.

Predictive Utility of Personality Disorder in Depression: Comparison of Outcomes and Taxonomic Approach.

There is debate around the best model for diagnosing personality disorder, both in terms of its relationship to the empirical data and clinical utility. Four randomized controlled trials examining various treatments for depression were analyzed at an individual patient level. Three different approaches to the diagnosis of personality disorder were analyzed in these patients. A total of 578 depressed patients were included in the analysis. Personality disorder, however measured, was of little predictive utility in the short term but added significantly to predictive modelling of mediumterm outcomes, accounting for more than twice as much of the variance in social functioning outcome as depression psychopathology. Personality disorder assessment is of predictive utility with longer timeframes and when considering social outcomes as opposed to symptom counts. This utility is sufficiently great that there appears to be value in assessing personality; however, no particular approach outperforms any other.

Three-year follow-up after psychotherapy for young people with bipolar disorder.

OBJECTIVES: (1) To examine the differences between interpersonal and social rhythm therapy (IPSRT) and specialist supportive care (SSC) in the longer term impacts of IPSRT and SSC on cumulative depression and mania symptoms over a further 78-week follow-up period post treatment. (2) To calculate the survival time before recurrence of a new mood episode over the 3-year period. METHODS: One hundred young people with bipolar disorder aged between 15 and 36 years who had been randomized to treatment with either IPSRT or SSC for 78 weeks were followed up for a subsequent 78 weeks. The Longitudinal Interval Follow-up Evaluation was completed at 26-week intervals. A Mann-Whitney U test was used to determine if there were significant differences between therapy types and a Kaplan-Meier survival analysis was used to determine time to recurrence. Cox regression was used to assess the association between time to relapse and therapy type. RESULTS: There were no significant differences between therapies at each of the data points for either depression or mania scores. The mean change in depression and mania in both groups was significantly different for all three follow-up data points. The actuarial cumulative recurrence rates were 53% for IPSRT and 49% for SSC. There was no significant difference between the groups in time to recurrence. CONCLUSIONS: While there were no significant differences between the two therapies, there was an overall reduction in symptoms in both therapies. There may be sustained benefits in providing intensive psychotherapies in conjunction with pharmacotherapy for young people with bipolar disorder.

Sonographic Evaluation of Pediatric Thyroid Nodules.

A thyroid nodule detected clinically or incidentally at medical imaging is a common indication for ultrasonography (US) in the adult population. This scenario is less frequently the case in pediatric patients, and the approach to evaluation of thyroid nodules deserves modification in these patients because of the increased probability of malignancy in children, compared with adults. Evaluating a thyroid nodule with US in a systematic way requires familiarity with a number of features that can be assessed and the terms that the radiologist uses in each category. The probability of malignancy is influenced by certain features, and several models have emerged to integrate these details into an overall risk assessment to guide management and biopsy of thyroid nodules. Clinical features of thyroid cancer differ between pediatric and adult patients, and risk factors and certain genetic syndromes portend earlier manifestation of thyroid malignancy. This article provides a review of (a) US features of thyroid nodules with an emphasis on the predictive capacity for malignancy, focused on the pediatric age group when the data exist, (b) clinical information, including risk factors and genetic syndromes pertinent to the pediatric population, and (c) the state of the current literature and controversies in diagnosing and managing pediatric thyroid cancer. ©RSNA, 2017.

Identification and characterization of Nanobodies targeting the EphA4 receptor.

The ephrin receptor A4 (EphA4) is one of the receptors in the ephrin system that plays a pivotal role in a variety of cell-cell interactions, mostly studied during development. In addition, EphA4 has been found to play a role in cancer biology as well as in the pathogenesis of several neurological disorders such as stroke, spinal cord injury, multiple sclerosis, amyotrophic lateral sclerosis (ALS), and Alzheimer's disease. Pharmacological blocking of EphA4 has been suggested to be a therapeutic strategy for these disorders. Therefore, the aim of our study was to generate potent and selective Nanobodies against the ligand-binding domain of the human EphA4 receptor. We identified two Nanobodies, Nb 39 and Nb 53, that bind EphA4 with affinities in the nanomolar range. These Nanobodies were most selective for EphA4, with residual binding to EphA7 only. Using Alphascreen technology, we found that both Nanobodies displaced all known EphA4-binding ephrins from the receptor. Furthermore, Nb 39 and Nb 53 inhibited ephrin-induced phosphorylation of the EphA4 protein in a cell-based assay. Finally, in a cortical neuron primary culture, both Nanobodies were able to inhibit endogenous EphA4-mediated growth-cone collapse induced by ephrin-B3. Our results demonstrate the potential of Nanobodies to target the ligand-binding domain of EphA4. These Nanobodies may deserve further evaluation as potential therapeutics in disorders in which EphA4-mediated signaling plays a role.

Predictors of premature termination from psychotherapy for anorexia nervosa: Low treatment credibility, early therapy alliance, and self-transcendence.

OBJECTIVE: Failure to complete treatment for anorexia nervosa (AN) is- common, clinically concerning but difficult to predict. This study examines whether therapy-related factors (patient-rated pretreatment credibility and early therapeutic alliance) predict subsequent premature termination of treatment (PTT) alongside self-transcendence (a previously identified clinical predictor) in women with AN. METHODS: 56 women aged 17-40 years participating in a randomized outpatient psychotherapy trial for AN. Treatment completion was defined as attending 15/20 planned sessions. Measures were the Treatment Credibility, Temperament and Character Inventory, Vanderbilt Therapeutic Alliance Scale and the Vanderbilt Psychotherapy Process Scale. Statistics were univariate tests, correlations, and logistic regression. RESULTS: Treatment credibility and certain early patient and therapist alliance/process subscales predicted PTT. Lower self-transcendence and lower early process accounted for 33% of the variance in predicting PTT. DISCUSSION: Routine assessment of treatment credibility and early process (comprehensively assessed from multiple perspectives) may help clinicians reduce PTT thereby enhancing treatment outcomes.

Localized Temperature Variations in Laser-Irradiated Composites with Embedded Fiber Bragg Grating Sensors.

Fiber Bragg grating (FBG) temperature sensors are embedded in composites to detect localized temperature gradients resulting from high energy infrared laser radiation. The goal is to detect the presence of radiation on a composite structure as rapidly as possible and to identify its location, much the same way human skin senses heat. A secondary goal is to determine how a network of sensors can be optimized to detect thermal damage in laser-irradiated composite materials or structures. Initial tests are conducted on polymer matrix composites reinforced with either carbon or glass fiber with a single optical fiber embedded into each specimen. As many as three sensors in each optical fiber measure the temporal and spatial thermal response of the composite to high energy radiation incident on the surface. Additional tests use a 2 × 2 × 3 array of 12 sensors embedded in a carbon fiber/epoxy composite to simultaneously measure temperature variations at locations on the composite surface and through the thickness. Results indicate that FBGs can be used to rapidly detect temperature gradients in a composite and their location, even for a direct strike of laser radiation on a sensor, when high temperatures can cause a non-uniform thermal response and FBG decay.

Mean telomere length is not associated with current health status in a 50-year-old population sample.

OBJECTIVES: Telomeres are nucleoprotein complexes that cap the ends of linear chromosomes. Telomeric DNA decreases with age and shows considerable heterogeneity in the wider population. There is interest in the application of telomere length measures as a biomarker of general health or "biological age," and the possibility of using mean telomere length to gauge individual disease risk, and to promote lifestyle changes to improve health. This study examined the effectiveness of telomere length as a biomarker for an individual's current overall health status by assessing several measures of general health including SF-36v2 score, current smoking status and a comprehensive obesity phenotype. METHODS: Participants were from the Canterbury Health, Ageing and Lifecourse (CHALICE) cohort, a New Zealand population based multidisciplinary study of aging. Telomere length measurements were obtained on DNA from peripheral blood samples at age 49-51 (n = 351), using a quantitative polymerase chain reaction assay. RESULTS: No associations were found between telomere length measured at age 49-51 and any measures of current health status. The only significant association observed was between telomere length and gender, with females having longer telomere length than men. CONCLUSIONS: Our results suggest that telomere length measurements are unlikely to provide information of much predictive significance for an individual's health status.

Personality, mental health and demographic correlates of hoarding behaviours in a midlife sample.

We describe the Temperament and Character Inventory personality traits, demographic features, physical and mental health variables associated with hoarding behaviour in a random community sample of midlife participants in New Zealand. A sample of 404 midlife participants was recruited to a study of ageing. To assess hoarding behaviours participants completed the Savings Inventory-Revised (SI-R), personality was assessed by the Temperament and Character Inventory and self-reported health was measured by the Short Form-36v2 (SF-36v2). Other measures were used to assess socio-demographic variables and current mental disorders. Participants were split into four groups by SI-R total score (scores: 0-4, 5-30, 31-41 and >41). Those who scored >41 on the SI-R were classified as having pathological hoarding. Trend tests were calculated across the four hoarding groups for socio-demographic, personality, mental and physical health variables. SI-R scores ranged from 0 to 58. The prevalence of pathological hoarding was 2.5% and a further 4% reported sub-clinical symptoms of hoarding. Higher hoarding behaviour scores were related to higher Temperament and Character Inventory scores for Harm Avoidance and lower scores for Self-directedness. Persistence and Cooperativeness scores were lower too but to a lesser extent. Trend analysis revealed that those with higher hoarding behaviour scores were more likely to be single, female, unemployed, receive income support, have a lower socio-economic status, lower household income and have poorer self-reported mental health scores. Current depression rates were considerably higher in the pathological hoarding group. Increasing SI-R hoarding behaviour scores were associated with higher scores of negative affect (Harm Avoidance) and lower scores of autonomy (Self-directedness). Those with pathological hoarding or sub-clinical symptoms of hoarding also reported widespread mental and socio-economic problems. In this study it is clear to see the physical, mental and socio-economic problems experienced by those achieving the highest hoarding scores. The prevalence of pathological hoarding was 2.5%, similar to the prevalence reported by other studies. The personality traits associated with hoarding behaviours are discussed.

Diagnosis and Monitoring of Prostatic Lesions: A Comparison of Three Modalities: Multiparametric MRI, Fusion MRI/Transrectal Ultrasound (TRUS), and Traditional TRUS.

PURPOSE:  Transrectal ultrasound (TRUS) has been the gold standard of imaging for diagnosing prostate cancer for decades but is plagued by user error and undersampling. We aim to explore imaging modalities that are now being used in combination or alone for screening, diagnosis, and/or active surveillance of prostate cancer. METHODS: A PubMed literature search was performed to include articles published up to April 2016. Data were extracted and analyzed. RESULTS: Several large-scale studies have found an increased cancer detection rate in MRI-targeted lesions with an improved ability to target anterior lesions as well as an increased cancer detection in high-risk cancers using fusion platforms vs TRUS alone. CONCLUSIONS: To date, there have been few head-to-head trials to directly compare the use of multiparametric MRI (mpMRI), transrectal ultrasound, and MRI-ultrasound fusion modalities for accurate and reliable detection, active surveillance, or biopsy procedure success rates. Further investigation utilizing these modalities are needed before they can be relied upon in active surveillance management, although mpMRI appears to be currently the most reliable in monitoring and diagnosing prostate lesions.

Assessing the distinctiveness of psychotherapies and examining change over treatment for anorexia nervosa with cognitive-behavior therapy, interpersonal psychotherapy, and specialist supportive clinical management.

OBJECTIVE: Therapist adherence to cognitive-behavior therapy (CBT), interpersonal psychotherapy (IPT), and specialist supportive clinical management (SSCM) for anorexia nervosa (AN), was examined across three phases of therapy in a randomized clinical trial. METHOD: Adherence in early, middle, and late phase therapy sessions from 53 of 56 participants in the trial was assessed using the CSPRS-AN by independent raters after listening to complete therapy sessions. RESULTS: The three forms of psychotherapy were distinguishable by blind raters. Subscale scores were higher for the corresponding therapy than the other therapy modalities. In CBT and SSCM, a phase-by-therapy effect was found, with the CBT subscale highest for CBT, intermediate for SSCM, lowest for IPT, and elevated in the middle phase of CBT and SSCM. The SSCM subscale was highest for SSCM, intermediate for CBT, lowest for IPT, and elevated in the middle phase of SSCM. Adherence to activities around normalizing eating, weight gain, and education about anorexia nervosa was higher in SSCM than in either CBT or IPT. DISCUSSION: Ensuring the distinctiveness of therapies in existing clinical trials with differential treatment outcome is essential. Research on adherence to therapy modalities has the potential to help understanding of the effective components of new and existing treatments for AN. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:958-962).

Psychotherapy for transdiagnostic binge eating: A randomized controlled trial of cognitive-behavioural therapy, appetite-focused cognitive-behavioural therapy, and schema therapy.

Cognitive-behavioural therapy (CBT) is the recommended treatment for binge eating, yet many individuals do not recover, and innovative new treatments have been called for. The current study compares traditional CBT with two augmented versions of CBT; schema therapy, which focuses on early life experiences as pivotal in the history of the eating disorder; and appetite-focused CBT, which emphasises the role of recognising and responding to appetite in binge eating. 112 women with transdiagnostic DSM-IV binge eating were randomized to the three therapies. Therapy consisted of weekly sessions for six months, followed by monthly sessions for six months. Primary outcome was the frequency of binge eating. Secondary and tertiary outcomes were other behavioural and psychological aspects of the eating disorder, and other areas of functioning. No differences among the three therapy groups were found on primary or other outcomes. Across groups, large effect sizes were found for improvement in binge eating, other eating disorder symptoms and overall functioning. Schema therapy and appetite-focused CBT are likely to be suitable alternative treatments to traditional CBT for binge eating.

Validating the proposed ICD-11 domains.

AIM: The ICD-11 Personality Disorders Committee has proposed five personality domains: Detached, Anankastic, Negative Affective, Dissocial and Disinhibited. We attempted to validate these proposed domains in a large sample of patients with major depression. METHODS: Participants from five treatment studies received a SCID assessment interview to assess DSM-5 personality disorder symptoms. Personality disorder symptoms were assigned to the five proposed domains. Confirmatory factor analysis in an exploratory framework was used to test the hypothesized domain structure. RESULTS: A total of 606 patients were included in the analysis. A series of models were tested on the data set. The best fitting model produced five domains. Three domains detached, anankastic and negative affective were similar to the ICD-11 proposed domains. The Disinhibited domain did not emerge as a distinct factor but loaded onto a single Dissocial/Disinhibited factor. The model was improved by adding a separate Antisocial domain. The remaining domain incorporating borderline, histrionic and narcissistic symptoms is tentatively labelled Borderline to retain continuity with clinical practice and research. CONCLUSIONS: The proposed ICD-11 personality disorder domains were partially validated. We have five domains currently labelled Detached, Anankastic, Negative Emotional, Antisocial and Borderline. The sample studied limits the generalizability of our findings. In particular, the broad domain we have called Borderline requires further study. Copyright © 2016 John Wiley & Sons, Ltd.

Deficiency of the zinc finger protein ZFP106 causes motor and sensory neurodegeneration.

Zinc finger motifs are distributed amongst many eukaryotic protein families, directing nucleic acid-protein and protein-protein interactions. Zinc finger protein 106 (ZFP106) has previously been associated with roles in immune response, muscle differentiation, testes development and DNA damage, although little is known about its specific function. To further investigate the function of ZFP106, we performed an in-depth characterization of Zfp106 deficient mice (Zfp106(-/-)), and we report a novel role for ZFP106 in motor and sensory neuronal maintenance and survival. Zfp106(-/-) mice develop severe motor abnormalities, major deficits in muscle strength and histopathological changes in muscle. Intriguingly, despite being highly expressed throughout the central nervous system, Zfp106(-/-) mice undergo selective motor and sensory neuronal and axonal degeneration specific to the spinal cord and peripheral nervous system. Neurodegeneration does not occur during development of Zfp106(-/-) mice, suggesting that ZFP106 is likely required for the maintenance of mature peripheral motor and sensory neurons. Analysis of embryonic Zfp106(-/-) motor neurons revealed deficits in mitochondrial function, with an inhibition of Complex I within the mitochondrial electron transport chain. Our results highlight a vital role for ZFP106 in sensory and motor neuron maintenance and reveal a novel player in mitochondrial dysfunction and neurodegeneration.

Prospective rates of suicide attempts and nonsuicidal self-injury by young people with bipolar disorder participating in a psychotherapy study.

OBJECTIVE: Bipolar disorder is a chronic relapsing disorder associated with high rates of suicide, suicide attempts and nonsuicidal self-injury. The study aimed to prospectively identify the rates of suicide attempts and nonsuicidal self-injury in young people participating in an adjunctive randomised controlled psychotherapy for bipolar disorder and to identify differences in individuals who engaged in nonsuicidal self-injury, made suicide attempts or did both. METHOD: In all, 100 participants aged 15-36 years with bipolar disorder received 78 weeks of psychotherapy and were followed up for a further 78 weeks. Data were collected using the Longitudinal Interval Follow-up Evaluation. RESULTS: Suicide attempts reduced from 11% at baseline to 1% at the end of follow-up (week 156). Similarly, self-harm reduced from 15% at baseline to 7% at the end of follow-up. Individuals who engaged in both nonsuicidal self-injury and made suicide attempts differed from those with who only made suicide attempts, engaged in nonsuicidal self-injury or did neither. They were characterised by a younger age of illness onset and higher comorbidity. CONCLUSION: Adjunctive intensive psychotherapy may be effective in reducing suicide attempts and nonsuicidal self-injury and warrants further attention. Particular attention needs to be paid to individuals with early age of onset of bipolar disorder.