Theory of Mind and social functioning among neuropsychiatric disorders: A transdiagnostic study.

Social dysfunction is commonly present in neuropsychiatric disorders of schizophrenia (SZ) and Alzheimer's disease (AD). Theory of Mind (ToM) deficits have been linked to social dysfunction in disease-specific studies. Nevertheless, it remains unclear how ToM is related to social functioning across these disorders, and which factors contribute to this relationship. We investigated transdiagnostic associations between ToM and social functioning among SZ/AD patients and healthy controls, and explored to what extent these associations relate to information processing speed or facial emotion recognition capacity. A total of 163 participants were included (SZ: n=56, AD: n=50 and age-matched controls: n=57). Social functioning was assessed with the Social Functioning Scale (SFS) and the De Jong-Gierveld Loneliness Scale (LON). ToM was measured with the Hinting Task. Information processing speed was measured by the Digit Symbol Substitution Test (DSST) and facial emotion recognition capacity by the facial emotion recognition task (FERT). Case-control deficits in Hinting Task performance were larger in AD (rrb = -0.57) compared to SZ (rrb = -0.35). Poorer Hinting Task performance was transdiagnostically associated with the SFS (ßHinting-Task = 1.20, p<0.01) and LON (ßHinting-Task = -0.27, p<0.05). DSST, but not FERT, reduced the association between the SFS and Hinting Task performance, however the association remained significant (ßHinting-Task = 0.95, p<0.05). DSST and FERT performances did not change the association between LON and Hinting Task performance. Taken together, ToM deficits are transdiagnostically associated with social dysfunction and this is partly related to reduced information processing speed.

Verbal and General IQ Associate with Supragranular Layer Thickness and Cell Properties of the Left Temporal Cortex.

The left temporal lobe is an integral part of the language system and its cortical structure and function associate with general intelligence. However, whether cortical laminar architecture and cellular properties of this brain area relate to verbal intelligence is unknown. Here, we addressed this using histological analysis and cellular recordings of neurosurgically resected temporal cortex in combination with presurgical IQ scores. We find that subjects with higher general and verbal IQ scores have thicker left (but not right) temporal cortex (Brodmann area 21, BA21). The increased thickness is due to the selective increase in layers 2 and 3 thickness, accompanied by lower neuron densities, and larger dendrites and cell body size of pyramidal neurons in these layers. Furthermore, these neurons sustain faster action potential kinetics, which improves information processing. Our results indicate that verbal mental ability associates with selective adaptations of supragranular layers and their cellular micro-architecture and function in left, but not right temporal cortex.

Matrix 3D ultrasound-assisted thyroid nodule volume estimation and radiofrequency ablation: a phantom study.

BACKGROUND: Two-dimensional (2D) ultrasound is well established for thyroid nodule assessment and treatment guidance. However, it is hampered by a limited field of view and observer variability that may lead to inaccurate nodule classification and treatment. To cope with these limitations, we investigated the use of real-time three-dimensional (3D) ultrasound to improve the accuracy of volume estimation and needle placement during radiofrequency ablation. We assess a new 3D matrix transducer for nodule volume estimation and image-guided radiofrequency ablation. METHODS: Thirty thyroid nodule phantoms with thermochromic dye underwent volume estimation and ablation guided by a 2D linear and 3D mechanically-swept array and a 3D matrix transducer. RESULTS: The 3D matrix nodule volume estimations had a lower median difference with the ground truth (0.4 mL) compared to the standard 2D approach (2.2 mL, p < 0.001) and mechanically swept 3D transducer (2.0 mL, p = 0.016). The 3D matrix-guided ablation resulted in a similar nodule ablation coverage when compared to 2D-guidance (76.7% versus 80.8%, p = 0.542). The 3D mechanically swept transducer performed worse (60.1%, p = 0.015). However, 3D matrix and 2D guidance ablations lead to a larger ablated volume outside the nodule than 3D mechanically swept (5.1 mL, 4.2 mL (p = 0.274), 0.5 mL (p < 0.001), respectively). The 3D matrix and mechanically swept approaches were faster with 80 and 72.5 s/mL ablated than 2D with 105.5 s/mL ablated. CONCLUSIONS: The 3D matrix transducer estimates volumes more accurately and can facilitate accurate needle placement while reducing procedure time.

Operator Radiation Exposure in Cone-Beam Computed Tomography Guidance.

OBJECTIVES: Quantitative analysis of operator dose in cone-beam computed tomography guidance (CBCT-guidance) and the effect of protective shielding. METHODS: Using a Rando phantom, a model was set-up to measure radiation dose for the operator hand, thyroid and gonad region. The effect of sterile radiation-absorbing drapes and ceiling/couch shielding was measured. Using this model we calculated the dose, based on relevant clinical parameters. The procedures were divided in thoracic and abdominal group. Furthermore, dosimetry measurements were performed during clinical cases to correlate with our calculations. RESULTS: One hundred thirteen procedures were included between December 2007 and January 2010 (47 thoracic, 66 abdominal). The mean hand doses were 34.2 and 54.6 µSv (thoracic/abdominal respectively). The thyroid and gonad regions doses were 83.2 and 34.3 µSv in the thoracic, and 66.2 and 47.2 µSv in the abdominal group. Combined shielding reduced the dose by 98.2-98.9% (p<0.05). The radiation dose in clinical setting in the thoracic group (n=17) was 32.9 µSv (hand), 11.4 µSv (thyroid) and 16.0 µSv (gonad region). In the abdominal group (n=20) the doses were 43.4, 21.7 and 18.8 µSv respectively. CONCLUSION: The operator dose in CBCT-guidance without shielding is quite low, compared to the literature. Based on our data, between 375-830 cases can be performed staying below the yearly limit of 20 mSv effective whole-body dose.

Percutaneous cholecystostomy: single centre experience in 111 patients with an acute cholecystitis.

PURPOSE: To evaluate the safety and long-term outcome of percutaneous cholecystostomy (PC) under radiologic guidance for acute calculous cholecystitis (ACC) and acute acalculous cholecystitis (AAC) in all patients undergoing that procedure at our institution. MATERIALS AND METHODS: We performed a retrospective analysis of 111 patients who underwent PC from 2004 to 2012. Patients were divided into two groups: AAC and ACC. For all patients, comorbidity and American Society of Anesthesiologists (ASA) classification were determined. The indications, complications, recurrence rate and long-term outcome for both groups were analysed. The mean follow-up was 55 months. RESULTS: Twenty-four patients with AAC and 87 patients with ACC underwent PC. The most common sonographic findings of ACC and AAC were gallbladder wall thickening (90.9%) and hydrops (72.9%). Twelve of 24 patients with AAC (50%) were hospitalized at the Intensive Care Unit (ICU). Overall, the procedure failed in 2 (1.8%) patients. There were 4 (3.6%) abscesses and 2 (1.8%) fistulas post PC. Drain dislodgment was found without sequelae in 8 (7.2%) patients. Elective cholecystectomy was performed in 35/111 (31.5%). Fifty-one of 87 (58.6%) patients with gallstones underwent cholecystectomy; 36/87 (41.3%) did not undergo surgery due to a too short follow-up or death of nonbiliary disease. In the AAC group, there was no recurrent cholecystitis in 17/24 (70.8%) patients; 3/24 (12.5%) underwent surgery and 4/24 (16.6%) patients died in the ICU. CONCLUSION: PC is a minimally invasive treatment with low complication rate for patients with acute cholecystitis whom considered being at high-risk for urgent cholecystectomy. Good selection (ASA III and IV) and indication is needed in patients with ACC before PC because the majority will be operated later on. AAC can be managed nonoperatively and further treatment might not be needed.

Cone beam CT guidance provides superior accuracy for complex needle paths compared with CT guidance.

OBJECTIVE: To determine the accuracy of cone beam CT (CBCT) guidance and CT guidance in reaching small targets in relation to needle path complexity in a phantom. METHODS: CBCT guidance combines three-dimensional CBCT imaging with fluoroscopy overlay and needle planning software to provide real-time needle guidance. The accuracy of needle positioning, quantified as deviation from a target, was assessed for inplane, angulated and double angulated needle paths. Four interventional radiologists reached four targets along the three paths using CBCT and CT guidance. Accuracies were compared between CBCT and CT for each needle path and between the three approaches within both modalities. The effect of user experience in CBCT guidance was also assessed. RESULTS: Accuracies for CBCT were significantly better than CT for the double angulated needle path (2.2 vs 6.7 mm, p<0.001) for all radiologists. CBCT guidance showed no significant differences between the three approaches. For CT, deviations increased with increasing needle path complexity from 3.3 mm for the inplane placements to 4.4 mm (p=0.007) and 6.7 mm (p<0.001) for the angulated and double angulated CT-guided needle placements, respectively. For double angulated needle paths, experienced CBCT users showed consistently higher accuracies than trained users [1.8 mm (range 1.2-2.2) vs 3.3 mm (range 2.1-7.2) deviation from target, respectively; p=0.003]. CONCLUSION: In terms of accuracy, CBCT is the preferred modality, irrespective of the level of user experience, for more difficult guidance procedures requiring double angulated needle paths as in oncological interventions. ADVANCES IN KNOWLEDGE: Accuracy of CBCT guidance has not been discussed before. CBCT guidance allows accurate needle placement irrespective of needle path complexity. For angulated and double-angulated needle paths, CBCT is more accurate than CT guidance.

Necrotising fasciitis of the thigh.

Necrotising fasciitis (NF) is an extremely virulent form of infectious fasciitis. It affects skin, subcutaneous fat and superficial and deep muscular fascia by rapidly progressive necrosis. Expeditious diagnosis and radical debridement is necessary to prevent the onset of sepsis, multisystem organ failure and possible death. Perforated rectal cancer resulting in NF can spread to the perineum and genitals known as Fournier gangrene. This case describes an unusual case of NF of the right thigh as first presentation highly suggestive for rectal cancer.

Pathology of the thymus on CT-imaging.

A number of masses arise in relation to the thymus.The radiologist has an important role regarding the differential diagnosis between non-tumoral thymic pathology and malignant thymic tumors. In general, a benign hyperplasia of the thymus occurs in children and young adults, while in adults the thymoma is the most common tumor. Furthermore imaging is of great importance in the preoperative staging and oncological follow-up. To evaluate the thymus CT scan is used in the majority of the cases. MRI or PET-CT can have an added value in the differential diagnosis of various thymic pathologies in some cases. We present an overview of thymic masses with typically imaging features: thymic hyperplasia, thymomas, thymic carcinoma, thymic non-hodgkin lymphoma, thymolipoma and thymic carcinoid.

Real-Time 3D fluoroscopy guidance during needle interventions: technique, accuracy, and feasibility.

OBJECTIVE: Real-time 3D fluoroscopy guidance using cone beam CT with dedicated needle path planning software is a promising new interventional technique. The objective of this study was to evaluate the procedure and to assess the accuracy and feasibility of this technique for use in needle interventions. SUBJECTS AND METHODS: All procedures were performed using a flat panel-based fluoroscopy system capable of acquiring cone beam CT images and dedicated needle path-planning software. This new technology allows the use of fluoroscopy coregistered with a 3D data set reconstructed from the acquired attenuation information. The needle trajectory is planned in the 3D data set using the needle path-planning software. The calculated trajectory is then projected on to the real-time fluoroscopy image. Fluoroscopy time, accuracy, technical success of the procedures, median procedure time, and complications were recorded in 145 interventions. RESULTS: One hundred forty-five needle interventions were performed in 139 patients using real-time 3D fluoroscopy guidance. Procedures were divided into five groups according to anatomic region: upper thoracic (n = 19; 13.1%), lower thoracic (n = 18; 12.4%), upper abdominal (n = 65; 44.8%), lower abdominal (n = 13; 9.0%), and musculoskeletal (n = 30; 20.7%). Thirty needle interventions were therapeutic, and 115 were diagnostic biopsies. All interventions were within the predefined 5-mm safety margin and achieved 100% technical success. A histopathologic diagnosis could be made in 91.4% of the diagnostic biopsies. The median interventional procedure time was 28.5 minutes, and the median fluoroscopy time was 2 minutes 58 seconds. There were minor complications in six patients (4.3%) and one major complication (0.7%). CONCLUSION: Real-time 3D fluoroscopy guidance is a new, promising, and feasible technique providing high accuracy in needle interventions.

Percutaneous embolization on hereditary hemorrhagic telangiectasia patients with severe epistaxis.

OBJECTIVES: To evaluate the results of embolization in patients with hereditary hemorrhagic telangiectasia (HHT) because of severe epistaxis. METHODS: All HHT patients who underwent an embolization (between 1992 and 2006) were asked to participate in this retrospective study. Twelve patients who had in total 19 embolization procedures were interviewed. A questionnaire was used assessing the frequency, severity, duration of epistaxis and their Impact on Lifestyle (IoL). Haemoglobin values were collected from the patients' records. Embolization of the pathologically enhancing lesions was performed using PVA particles. RESULTS: The direct effect of the embolization is very good in 95% of patients. The Impact factor (daily frequency x severity) of epistaxis improved in the first month (p = 0.000) and one year after embolization (p = 0.009). Eleven embolizations (61%) were still associated with significant improvement. There was a reduction in the duration of epistaxis by 16 minutes per day one month after embolization (p = 0.005). However, this reduction was not found one year after embolization. Mean haemoglobin rose significantly after 1 year by an average of 0.8 mmol/l (p = 0.045). Impact on Lifestyle improved in 68% of the procedures and was unchanged in 32%. CONCLUSION: Embolizations remain a therapeutic option in experienced hands. The indication should be made carefully, because of possible (major) complications.

Do neurosurgeons subscribe to the guideline lumbosacral radicular syndrome?

BACKGROUND: This study presents a survey of the opinion of neurosurgeons on the multidisciplinary clinical guideline 'lumbosacral radicular syndrome'. The aim was to describe to what extent neurosurgeons in the Netherlands endorse the content of this guideline. The guideline was issued in 1996 by the Netherlands Institute of Quality Health Care and this is the first attempt to evaluate the implementation of this guideline. METHODS: All active neurosurgeons (n=92) in the Netherlands were invited to complete a questionnaire investigating to what extent they agree with the 26 recommendations in the guideline 'lumbosacral radicular syndrome'. The results are represented in frequencies (%) in order to express the magnitude of their consent or dissent with the recommendations. RESULTS: Overall, 75% of the neurosurgeons responded and, of these, 94% agreed (at least partially) with the content of the guideline. Of the 26 recommendations in the guideline, seven were not fully endorsed by the neurosurgeons. Three of these seven recommendations may need revision based on newly published data. CONCLUSION: This survey shows that almost all neurosurgeons subscribed (at least partially) to the multidisciplinary LRS guideline. Therefore, one important aspect of the implementation process has been fulfilled, i.e. acceptance of the content of the guideline.

Fluorescence assessment of Lactococcus lactis viability.

The reproduction and activity of lactic acid bacteria (LAB) are essential in their applications in the dairy industry and other fermentations. Traditionally used methods like plate counting and acidification tests require long incubation times and provide limited information. Fluorescence techniques provide possibilities for rapid assessment of cell physiology. We used traditional and fluorescence assays to assess the physiological condition of L. lactis subsp. lactis ML3 cultures that were exposed to various stress conditions. After exposure to some of the stress conditions, carboxyfluorescein (cF) labelling did not agree with plate counts. Therefore, a two-step method was developed in which cF labelling was followed by a lactose-energized efflux assay. The combined assay proved to be a good and rapid indicator for reproduction and acidification capacity of stressed L. lactis. This novel assay has potential for physiological research and dairy applications related to LAB.

Rapid fluorescence assessment of the viability of stressed Lactococcus lactis.

The aim of this study was to establish the use of the fluorescent probes carboxyfluorescein (cF) and propidium iodide (PI) for rapid assessment of viability, using Lactococcus lactis subsp. lactis ML3 exposed to different stress treatments. The cF labeling indicated the reproductive capacity of mixtures of nontreated cells and cells killed at 70 degrees C very well. However, after treatment up to 60 degrees C the fraction of cF-labeled cells remained high, whereas the survival decreased for cells treated at above 50 degrees C and was completely lost for those treated at 60 degrees C. In an extended series of experiments, cell suspensions were exposed to heating, freezing, low pH, or bile salts, after which the colony counts, acidification capacity, glycolytic activity, PI exclusion, cF labeling, and cF efflux were measured and compared. The acidification capacity corresponded with the number of CFU. The glycolytic activity, which is an indicator of vitality, was more sensitive to the stress conditions than the reproduction, acidification, and fluorescence parameters. The cF labeling depended on membrane integrity, as was confirmed by PI exclusion. The fraction of cF-labeled cells was not a general indicator of reproduction or acidification, nor was PI exclusion or cF labeling capacity (the internal cF concentration). When the cells were labeled by cF, a subsequent lactose-energized efflux assay was needed for decisive viability assessment. This novel assay proved to be a good and rapid indicator of the reproduction and acidification capacities of stressed L. lactis and has potential for physiological research and dairy applications related to lactic acid bacteria.