Quantitative and qualitative assessment of a coding system for reporting CT colonography.

AIM: To validate a coding system implemented to summarise computed tomography colonography (CTC) findings for the detection of suspected colorectal cancer (CRC) by assessing interobserver variability and also to evaluate any weaknesses through qualitative analysis. MATERIALS AND METHODS: All CTC investigations over a 6-month period (01/07/2016 to 31/12/2016) were analysed retrospectively. Each study was read initially by an advanced practitioner radiographer with a final report issued by a consultant gastrointestinal radiologist. Rates of interobserver agreement, using the kappa statistic, provided a quantitative assessment of levels of agreement. Areas of poor interobserver agreement were identified for further qualitative assessment. RESULTS: The present study included 1,321 CTC procedures and the mean age of patients was 68.4 years (range 28-96 years). Percentage agreement for colonic coding was 90% and for extra-colonic coding 47%. This corresponds to kappa scores of 0.69 (substantial agreement) and 0.22 (fair agreement), respectively. Reasons and examples of disagreement in the colonic coding are highlighted. CONCLUSIONS: High interobserver agreement was observed for C coding, suggesting it is a reproducible method of classifying intra-colonic CTC findings. Some of the difference in classifying extra-colonic findings is the perceived importance of incidental findings between readers, as well as differences in skill set; however, some themes recurred in areas of disagreement and recommendations for refining and improving the coding system are provided.

T-cell bispecific antibodies in node-positive breast cancer: novel therapeutic avenue for MHC class I loss variants.

BACKGROUND: Tumor-infiltrating lymphocytes (TILs) represent a prognostic factor for survival in primary breast cancer (BC). Nonetheless, neoepitope load and TILs cytolytic activity are modest in BC, compromising the efficacy of immune-activating antibodies, which do not yet compete against immunogenic chemotherapy. PATIENTS AND METHODS: We analyzed by functional flow cytometry the immune dynamics of primary and metastatic axillary nodes [metastatic lymph nodes (mLN)] in early BC (EBC) after exposure to T-cell bispecific antibodies (TCB) bridging CD3ε and human epidermal growth factor receptor 2 (HER2) or Carcinoembryonic Antigen-Related Cell Adhesion Molecule 5 (CEACAM5), before and after chemotherapy. Human leukocyte antigen (HLA) class I loss was assessed by whole exome sequencing and immunohistochemistry. One hundred primary BC, 64 surrounding 'healthy tissue' and 24 mLN-related parameters were analyzed. RESULTS: HLA loss of heterozygosity was observed in EBC, at a clonal and subclonal level and was associated with regulatory T cells and T-cell immunoglobulin and mucin-domain-3 expression restraining the immuno-stimulatory effects of neoadjuvant chemotherapy. TCB bridging CD3ε and HER2 or CEACAM5 could bypass major histocompatibility complex (MHC) class I loss, partially rescuing T-cell functions in mLN. CONCLUSION: TCB should be developed in BC to circumvent low MHC/peptide complexes.

The prevalence and correlates of depression, anxiety, and stress in a sample of college students.

BACKGROUND: Over the past four years, the Franciscan University Counseling Center has reported a 231% increase in yearly visits, as well as a 173% increase in total yearly clients. This trend has been observed at many universities as mental health issues pose significant problems for many college students. The objective of this study was to investigate potential correlates of depression, anxiety, and stress in a sample of college students. METHODS: The final analyzed sample consisted of 374 undergraduate students between the ages of 18 and 24 attending Franciscan University, Steubenville, Ohio. Subjects completed a survey consisting of demographic questions, a section instructing participants to rate the level of concern associated with challenges pertinent to daily life (e.g. academics, family, sleep), and the 21 question version of the Depression Anxiety Stress Scale (DASS21). RESULTS: The results indicated that the top three concerns were academic performance, pressure to succeed, and post-graduation plans. Demographically, the most stressed, anxious, and depressed students were transfers, upperclassmen, and those living off-campus. CONCLUSIONS: With the propensity for mental health issues to hinder the success of college students, it is vital that colleges continually evaluate the mental health of their students and tailor treatment programs to specifically target their needs.

Vortex gyroscope imaging of planar superfluids.

We propose a robust imaging technique that makes it possible to distinguish vortices from antivortices in quasi-two-dimensional Bose-Einstein condensates from a single image of the density of the atoms. Tilting the planar condensate prior to standard absorption imaging excites a generalized gyroscopic mode of the condensate, revealing the sign and location of each vortex. This technique is anticipated to enable experimental measurement of the incompressible kinetic energy spectrum of the condensate and the observation of a negative-temperature phase transition of the vortex gas, driven by two-dimensional superfluid turbulence.

Facial cutaneous sinuses of dental origin - a diagnostic challenge.

It is common for practitioners to misdiagnose the cause of facial cutaneous sinus tracts, failing to recognise that many have an odontogenic cause. Chronic infection around the apex of a dental root can drain to the mouth or less commonly to the skin via a sinus tract. Dental symptoms are not always present and this confuses the clinical picture further. Failure to identify an odontogenic cause may result in unnecessary and ineffective treatment. Elimination of dental infection via tooth extraction or root canal treatment leads to resolution of the cutaneous sinus. We present a series of cutaneous draining sinuses of dental origin that resolved rapidly following dental treatment and hope to highlight the importance of including odontogenic infection in the differential diagnosis of such a lesion in the head and neck.

Predicting the choice of anaesthesia for third molar surgery - guideline or the easy-line?

OBJECTIVE: To observe trends in choice of anaesthetic for mandibular third molar surgery in the Combined Department of Oral and Maxillofacial Surgery and Oral Medicine, based at the Edinburgh Dental Institute (EDI) and St John's Hospital (SJH) in Livingston. METHOD: Data were collected retrospectively from electronic patient records for 301 consecutive new referrals for mandibular third molar surgery from general dental practitioners to each of the oral and maxillofacial departments in the EDI and SJH from the 1 September 2009 onwards. Date of consultation, grade of assessing clinician, age, gender, postcode, required surgical procedure, choice of anaesthetic and predicted difficulty of procedure were analysed. RESULTS: One hundred and fifty patients were seen at the EDI and 151 at SJH. There was no statistically significant difference in the proportion of male and female patients or age of patients presenting at each site. Seventeen patients (11.3%) were listed for a general anaesthetic, 21 (14%) for conscious intravenous sedation and 112 (74.7%) for local anaesthetic at EDI. At SJH 57 patients (37.7%) were listed for a general anaesthetic, 30 (19.9%) for conscious intravenous sedation and 64 (42.4%) for local anaesthetic. There was only a small difference in the difficulty of cases at the two sites, though there was a significant difference in socioeconomic deprivation between the two populations. CONCLUSIONS: Significantly more general anaesthetics are being prescribed for mandibular third molar surgery at SJH than the EDI. This finding is not related to difficulty of the cases presenting at each site but may be related to the nature of a maxillofacial clinic compared to a dedicated oral surgery centre. The difference in socioeconomic deprivation may have had an impact on patient decisions.

Phytobezoar: a rare cause of late upper gastrointestinal perforation following gastric bypass surgery.

Marginal ulcers are a well described complication following Roux-en-Y gastric bypass. These may be a cause for perforation. We describe a case of upper gastrointestinal perforation 18 months following a laparoscopic Roux-en-Y gastric bypass that appeared to be caused by a food bezoar. The perforation occurred at the site of the jejunojejunal anastomosis and was repaired after an exploratory laparotomy. After extracting the food debris (phytobezoar) through the perforation, direct closure resulted in an uneventful post-operative recovery. To our knowledge, this is the first description of a food bezoar causing an intestinal perforation in such a manor after bariatric surgery. Patients should be educated carefully on what and how to eat after having undergone surgery for superobesity.

Management of febrile neutropenia in an acute oncology service.

BACKGROUND: Neutropenic fever in patients receiving chemotherapy is a medical emergency and should be treated promptly within 1 h with antibiotics as specified within the 2009 NCAG report on chemotherapy services. AIM: To determine door-to-assessment, door-to-treatment and door-to-investigation intervals for patients with febrile neutropenia who presented to the inpatient Oncology Ward, the outpatient Oncology Day Unit and the Emergency Department in Addenbrooke's Hospital, Cambridge. DESIGN: Retrospective observational audit. METHODS: Thirty-two patients on treatment for solid cancers who were admitted with febrile neutropenia between January and December 2010 were identified, and paper and electronic medical records were analysed to determine door to: assessment, treatment and investigation intervals. RESULTS AND CONCLUSIONS: Patients in this series were assessed quicker and received the first dose of antibiotics faster when they presented to an oncology ward rather than the emergency department. However, imaging was performed faster and blood results issued quicker if performed in the emergency department due to a better infrastructure that has been tailored to comply with national targets. Nonetheless, compliance with optimum standards of care was poor, with only 9% of sampled patients getting antibiotics within 1 h of presenting to hospital, and 53% within 1 h of being assessed by a clinician.

Frostbite following use of a commercially available cryotherapy device for the removal of viral warts.

Warts are a common skin complaint in childhood. We describe 3 unusual cases in which inadvertent tissue injury was caused during the treatment of viral warts by a commercially available cryotherapy device. In each case there was a failure to follow the instructions provided correctly. If such devices are to remain available for public use we feel changes should be implemented to reduce the risk of such injuries occurring again in the future. Alternatively, cryotherapy as a treatment modality should remain in the realm of the trained health care professional.

Relief of severe retro-orbital pain and vision improvement after optic-nerve decompression in polyostotic fibrous dysplasia: case report and review of the literature.

INTRODUCTION: We describe a case of a 9-year-old girl who developed progressive severe retro-orbital pain and partial visual loss in association with left optic-nerve compression due to polyostotic fibrous dysplasia of the skull. MATERIALS AND METHODS: Intradural decompression of the optic nerve resulted in immediate and complete resolution of the pain as well as a vast visual improvement. CONCLUSION: In cases of fibrous dysplasia of the skull with evidence of optic-nerve compression, relief of retro-orbital pain should be an additional consideration when deciding to proceed with surgical management.

[Attachment and suffering mothers]. / Attachement et mères en souffrance.

Attachment between an infant and his/her parents is instinctive and vital for the psychoaffective development of the child. This process is fragile, and parents have to present with adaptive capacities. They need a good mental health to be able to welcome their child and to develop the interactions that will enable the baby to acquire an internal security. When mental disorders, especially maternal disorders, appear during this crucial perinatal period, the relationship between the parents and their baby may become unstable, and the attachment process can be disturbed.

Acute interferon-alpha administration modulates sucrose consumption in the rat.

One of the two core symptoms of depression as defined by the Diagnostic and statistical manual of mental disorders (DSM-IV) (American Psychiatric Association) is anhedonia, or a loss of interest or pleasure. Sucrose consumption has been described as a valid measure of sensitivity to reward. In the present set of studies, changes in sucrose consumption (three-bottle test using 1, 8 and 32% sucrose) were taken as a measure of the anhedonic effect of interferon-alpha (IFN-alpha). Sucrose tests were carried out following the i.p. administration (20 min pre-treatment time) of Recombinant Human Interferon-alphaA (rHIFN-alpha), 10(1), 10(2), 10(4) units(U) and Rat Interferon alpha (rRIFN-alpha), 1,10 and 100 IRU. Both types of IFN-alpha produced a decrease in sucrose consumption and drinking rate (DR) at the highest doses, with the greatest inhibition being at the lowest sucrose concentration (1%). Longer pre-treatment times with rHIFN-alpha (40 and 80 min prior to commencement of 1 h drinking test) resulted in insignificant effects. Significant hypothermia relative to vehicle-injected rats was observed following interferon administration in the 20 min pre-treatment condition, but showed no significant difference when compared to vehicle at 40 or 80 min. Overall these results confirm a depression-like behavioural syndrome (anhedonia) following administration of IFN-alpha.