A tertiary hospital audit of the use of medical imaging in the 24 h preceding death.

This study aims to investigate the number, modality and indication for imaging studies performed on acute hospital inpatients in the 24 h prior to death. Data were obtained from retrospective analysis of deceased patients from a university affiliated tertiary hospital over a 2-year period and it was found that around one in five inpatients received medical imaging in the last 24 h of their life (364 of 1855, 19.6%).

No survival benefit associated with routine surveillance imaging for Hodgkin lymphoma in first remission: a Danish-Swedish population-based observational study.

The use of routine imaging for patients with classical Hodgkin lymphoma (HL) in complete remission (CR) is controversial. In a population-based study, we examined the post-remission survival of Danish and Swedish HL patients for whom follow-up practices were different. Follow-up in Denmark included routine imaging, usually for a minimum of 2 years, whereas clinical follow-up without routine imaging was standard in Sweden. A total of 317 Danish and 454 Swedish comparable HL patients aged 18-65 years, diagnosed in the period 2007-2012 and having achieved CR following ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)/BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) therapy, were included in the study. The cumulative progression rates in the first 2 years were 4% (95% confidence interval [CI] 1-7) for patients with stage I-II disease vs. 12% (95% CI 6-18) for patients with stage III-IV disease. An imaging-based follow-up practice was not associated with a better post-remission survival in general (P = 0·2) or in stage-specific subgroups (P = 0·5 for I-II and P = 0·4 for III-IV). Age ≥45 years was the only independent adverse prognostic factor for survival. In conclusion, relapse of HL patients with CR is infrequent and systematic use of routine imaging in these patients does not improve post-remission survival. The present study supports clinical follow-up without routine imaging, as encouraged by the recent Lugano classification.

Nanomateriais magnéticos para aplicações em terapia e imagem / Magnetic nanomaterials for application in therapy and imaging

Em virtude da grande atenção que os nanomateriais magnéticos recebem atualmente, cientistas de diversas áreas (química, física, engenharia e medicina) vêm estudando as propriedades e as aplicações de nanopartículas magnéticas, gerando uma grande demanda por materiais de alta qualidade. As propriedades dos nanomateriais magnéticos são fortemente dependentes de suas propriedades intrínsecas (p. ex., composição, cristalinidade, tamanho e forma) e das interações entre as partículas, portanto sofrendo grande influencia do método de síntese aplicado. Várias técnicas para produção de nanomateriais magnéticos são conhecidas, porém muitas delas geram materiais com baixa qualidade no que diz respeito a tamanho médio e faixa de distribuição de tamanhos nas amostras. O presente trabalho teve por objetivo estudar a síntese de nanopartículas de magnetita (Fe3O4) por decomposição térmica do acetilacetonato de ferro (III), um método já conhecido e que se destaca pela alta qualidade de amostras (elevado controle no tamanho, estreita distribuição de tamanhos e forma bem definida), porém de alto custo. Estudamos a influência dos aditivos normalmente empregados no meio reacional no controle da morfologia, tamanho e polidispesão das amostras preparadas e sugerimos outros reagentes (monoóis, dióis e polióis) em busca de novas condições de síntese de nanopartículas magnéticas com morfologia e tamanho controlados. Do ponto de vista prático, reduzimos o custo de produção de nanomateriais magnéticos de alta qualidade pela utilização de aditivos mais baratos e de fácil obtenção no mercado. Os diferentes aditivos propostos modificaram as propriedades magnéticas ligadas às interações dipolares entre as partículas magnéticas. A influência dos aditivos foi testada em crescimentos sucessivos usando partículas de magnetita já formadas como sementes. O perfil de crescimento se mostrou diferente em função dos reagentes empregados e as amostras tiveram suas interações hiperfinas medidas para avaliar a relação entre o tamanho e aumento da cristalinidade das partículas formadas. O revestimento das partículas de magnetita com ouro foi estudado buscando aumentar a biocompatibilidade e proteger os núcleos magnéticos, porém as estruturas core-shell obtidas não apresentaram comportamento superparamagnético. Os estudos das interações hiperfinas mostraram perda da cristalinidade após o revestimento com ouro. As partículas de magnetita foram aplicadas para produzir calor através de hipertermia magnética, sendo que a interação entre as partículas se mostrou fundamental para o aumento do calor gerado. Outra aplicação biomédica testada foi o uso das partículas de magnetita como contraste para imagem por ressonância magnética nuclear. Nossas amostras mostraram desempenho semelhante às partículas disponíveis no mercado a alto custo

Magnetic nanomaterials have received a great deal of attention from scientists of various research fields (chemistry, physics, engineering and medicine) that have been studying the properties and applications of magnetic nanoparticles, generating a great demand for high quality materials. The magnetic properties of nanomaterials are strongly dependent on their intrinsic properties (eg., composition, crystallinity, size and shape) and the interactions between particles, therefore are influenced by the method of synthesis applied. Various techniques for the production of nanomarerials are known, but many of them produce poor quality materials, regarding to the average size, broad size distribution range and variable shape. The present work aimed to study the synthesis of magnetite nanoparticles (Fe3O4) by thermal decomposition of iron (III) acetylacetonate, a method already known for delivering high quality samples (high control on the size and narrow size distribution ), but at high cost. We studied the influence of additives normally used in the reaction medium to control the morphology, size and polydispersion and suggested other reagents (monols, diols and polyols) in the search for new conditions to synthesize magnetic nanoparticles with controlled size and morphology. From a practical viewpoint, we have reduced cost of producing high-quality magnetic nanoparticles using cheaper additives available on the market. The different additives used in the synthetic protocol modified the magnetic properties which are related to dipolar interactions between magnetic particles. The influence of additives was tested in successive growth using magnetite particles previously formed as seeds. The growth profile showed to be different depending on the additives used and the samples had their hyperfine interactions measured to estimate the relationship between the size increasing and the crystallinity of the particles formed. The coating of the magnetite particles with gold was studied in order to increase the biocompatibility and to protect the magnetic core. In this case, the core-shell structure lost the superparamagnetic behavior. Studies of hyperfine interactions showed the loss of crystallinity after coating the nanoparticles with gold. The synthesized particles were used to produce heat by magnetic hyperthermia, where the interaction between the particles proved to be crucial to increase the generated heat. Another biomedical application tested was the use of magnetite particles as contrast agent for magnetic resonance imaging. Our samples showed similar performance to the commercially available particles at high cost

PROLARA: prognosis-based lifetime attributable risk approximation for cancer from diagnostic radiation exposure.

PURPOSE: To evaluate the impact of the reduced life expectancy of patients (compared to a nonpatient group with the same age distribution) on their nominal risk of developing cancer from the diagnostic use of radiation. METHOD: We define a "prognosis-based lifetime attributable risk modifier" (PROLARM) as the ratio of the risks for nonpatients and patients, a dimensionless quantity which indicates how strongly the life-time attributable risk (LAR) is reduced due to a patient's prognosis. An approximation to this ratio can be given (named PROLARA) which depends only on the patient's age at exposure and his/her life expectancy, but is independent of the exact choice of values for the baseline risk of cancer incidence and the excess relative risk (ERR) from radiation exposure. PROLARM and PROLARA were computed for a cohort of 4,285 female patients with metastatic breast cancer, for whom all necessary input data were available. RESULTS: LAR of solid cancer was significantly decreased in these patients: PROLARM >20 for age at exposure < or = 65 years. For any reasonable choice of function for ERR, the approximation PROLARA gave a lower estimate of the reduction in risk. The risk for a patient from the above cohort, exposed at age 50 years, is decreased by a factor of 29 (PROLARM) and 27 (PROLARA). In other words, 50 mSv in a patient with metastatic breast cancer corresponds risk-wise to only 2 mSv in a nonpatient of the same age. CONCLUSION: A major proportion of the total dose from diagnostic medical exposures does not constitute an additional cancer risk due to the poorer prognosis of patients compared to nonpatients of same gender and age. Our new PROLARA concept allows an estimation of the reduction in risk for any pathology when the associated survival is known.