Amyloid PET imaging in cardiac amyloidosis: a pilot study using 18F-flutemetamol positron emission tomography

Annals of Nuclear Medicine - Cardiac amyloidosis is a rare disease characterized by amyloid heart deposits and is usually a part of systemic amyloidosis, in relation to systemic light chain (AL)...     

Does neoadjuvant therapy for pancreatic head adenocarcinoma increase postoperative morbidity? A systematic review of the literature with meta-analysis

Neoadjuvant treatment (NT) for pancreatic head cancer may allow some patients to undergo curative resection, but its impact on postoperative complications remains unclear. A systematic review and meta-analysis were performed to compare overall postoperative morbidity, pancreatic fistula, and mortality between patients who underwent upfront surgery and those who underwent neoadjuvant therapy first. Forty-five studies with 3359 patients were included. No significant differences in morbidity and mortality rates associated with NT for pancreatic head cancer were detected in this study.     

Atopic dermatitis in the pediatric population: A cross-sectional,international epidemiologic study

BackgroundLittle is known on the current global prevalence of atopic dermatitis (AD) in the pediatric population.ObjectiveTo estimate the real-world global prevalence of AD in the pediatric population and by disease severity.MethodsThis international, cross-sectional, web-based survey of children and adolescents (6 months to <18 years old) was conducted in the following 18 countries: North America (Canada, United States), Latin America (Argentina, Brazil, Columbia, Mexico), Europe (France, Germany, Italy, Spain, United Kingdom), Middle East and Eurasia (Israel, Saudi Arabia, Turkey, United Arab Emirates, Russia), and East Asia (Japan, Taiwan). Prevalence was determined using the following 2 definitions: (1) diagnosed as having AD according to the International Study of Asthma and Allergies in Childhood (ISAAC) criteria and self- or parent-report of ever being told by a physician that they or their child child had AD (eczema); and (2) reported AD based on the ISAAC criteria only. Severity was assessed using the Patient Global Assessment (PtGA) and Patient-Oriented Eczema Measure (POEM).ResultsAmong 65,661 responders, the 12-month diagnosed AD prevalence (ISAAC plus self-reported diagnosis) ranged from 2.7% to 20.1% across countries; reported AD (ISAAC only) was 13.5% to 41.9%. Severe AD evaluated with both PtGA and POEM was generally less than 15%; more subjects rated AD as mild on PtGA than suggested by POEM. No trends in prevalence were observed based on age or sex; prevalence was generally lower in rural residential settings than urban or suburban.ConclusionThis global survey in 18 countries revealed that AD affects a substantial proportion of the pediatric population. Although prevalence and severity varied across age groups and countries, less than 15% had severe AD.     

Transarterial Embolization of Liver Cancer in a Transgenic Pig Model

PurposeTo develop and characterize a porcine model of liver cancer that could be used to test new locoregional therapies.Materials and MethodsLiver tumors were induced in 18 Oncopigs (transgenic pigs with Cre-inducible TP53^R167H and KRAS^G12D mutations) by using an adenoviral vector encoding the Cre-recombinase gene. The resulting 60 tumors were characterized on multiphase contrast-enhanced CT, angiography, perfusion, micro-CT, and necropsy. Transarterial embolization was performed using 40–120 μm (4 pigs) or 100–300 μm (4 pigs) Embosphere microspheres. Response to embolization was evaluated on imaging. Complications were determined based on daily clinical evaluation, laboratory results, imaging, and necropsy.ResultsLiver tumors developed at 60/70 (86%) inoculated sites. Mean tumor size was 2.1 cm (range, 0.3–4 cm) at 1 week. Microscopically, all animals developed poorly differentiated to undifferentiated carcinomas accompanied by a major inflammatory component, which resembled undifferentiated carcinomas of the human pancreatobiliary tract. Cytokeratin and vimentin expression confirmed epithelioid and mesenchymal differentiation, respectively. Lymph node, lung, and peritoneal metastases were seen in some cases. On multiphase CT, all tumors had a hypovascular center, and 17/60 (28%) had a hypervascular rim. After transarterial embolization, noncontrast CT showed retained contrast medium in the tumors. Follow-up contrast-enhanced scan showed reduced size of tumors after embolization using either 40–120 μm or 100–300 μm Embosphere microspheres, while untreated tumors showed continued growth.ConclusionsLiver tumors can be induced in a transgenic pig and can be successfully treated using bland embolization.     

Directional $\mathcal{H}^2$ Compression Algorithm: Optimisations and Application to a Discontinuous Galerkin BEM for the Helmholtz Equation

This study aimed to specialise a directional $\mathcal{H}^2 (\mathcal{D}\mathcal{H}^2)$ compression to matrices arising from the discontinuous Galerkin (DG) discretisation of the hypersingular equation in acoustics. The significant finding is an algorithm that takes a DG stiffness matrix and finds a near-optimal $\mathcal{D}\mathcal{H}^2$ approximation for low and high-frequency problems. We introduced the necessary special optimisations to make this algorithm more efficient in the case of a DG stiffness matrix. Moreover, an automatic parameter tuning strategy makes it easy to use and versatile. Numerical comparisons with a classical Boundary Element Method (BEM) show that a DG scheme combined with a $\mathcal{D}\mathcal{H}^2$ gives better computational efficiency than a classical BEM in the case of high-order finite elements and $hp$ heterogeneous meshes. The results indicate that DG is suitable for an auto-adaptive context in integral equations.     

Rudimentary empathy in macaques’ social decision-making

Primates live in highly social environments, where prosocial behaviors promote social bonds and cohesion and contribute to group members’ fitness. Despite a growing interest in the biological basis of nonhuman primates’ social interactions, their underlying motivations remain a matter of debate. We report that macaque monkeys take into account the welfare of their peers when making behavioral choices bringing about pleasant or unpleasant outcomes to a monkey partner. Two macaques took turns in making decisions that could impact their own welfare or their partner’s. Most monkeys were inclined to refrain from delivering a mildly aversive airpuff and to grant juice rewards to their partner. Choice consistency between these two types of outcome suggests that monkeys display coherent motivations in different social interactions. Furthermore, spontaneous affilitative group interactions in the home environment were mostly consistent with the measured social decisions, thus emphasizing the impact of preexisting social bonds on decision-making. Interestingly, unique behavioral markers predicted these decisions: benevolence was associated with enhanced mutual gaze and empathic eye blinking, whereas indifference or malevolence was associated with lower or suppressed such responses. Together our results suggest that prosocial decision-making is sustained by an intrinsic motivation for social affiliation and controlled through positive and negative vicarious reinforcements.Animal sociality encompasses a broad range of behaviors presumed to influence social bonds and promote group cohesion (1–5). Although higher forms of altruism, such as costly care of unknown individuals or donations to charity, may require uniquely human mentalizing abilities, evidence supports an evolutionary continuity in the motivational and affective mechanisms that regulate attachment and affiliation (6–9). In nonhuman primates, the ubiquitous social play, grooming behavior, and their hormonal correlates suggest an ability to conceive what is pleasant or unpleasant for others (10–12). Pioneering experimental studies have shown that macaques can perceive and seek to alleviate their peers’ distress (13, 14) and more recent studies have attributed even to rodents the possibility of empathy and its promotion of helping behavior (2–4). Empathy is understood to refer to vicarious experiences of the affective states of others and is believed to improve adaptive social behaviors. Different components of empathy could be described, for instance, a cognitive one is related to the capacity to abstract other''s experience, and another one depends on the emotional display of a conspecific. All of these components are known to be deeply influenced by the level of closeness existing between individuals (7). The ultimate, evolutionary basis of altruism and empathy is a topic of scientific interest that has been extensively discussed (7, 15–20). One of the recurrent issues is whether the motivations that drive prosocial behavior are selfish or purely altruistic. This question equally concerns the ubiquitous grooming behavior of nonhuman primates that has been shown to be pleasant for both participants (10, 12) or the nature of human altruism, as seen, for example, in the difficulty of discerning the inner motivations of blood donors (21). There are still appealing unanswered questions related to the underlying cognitive and affective mechanisms of nonhuman primates’ social behaviors. In particular, the implication of vicariously induced affective states in nonhuman primates’ social decision-making remains a matter of debate (7, 16, 22). Different theories have emphasized the role of proximate affective mechanisms in shaping behavior mainly through social reinforcement (6, 7, 23, 24). For example, it has been proposed that matching a peer’s affective state to one’s own prior or current state might be involved in social decision-making (7, 25). In addition to that, it is not known whether a common motivation drives social behavior across different contexts, such as sharing food or avoid harming a conspecific.We investigated the motivational and affective basis of prosocial behavior through social decisions, asking whether macaques take into account the welfare of others (defined here as the exposure to a pleasant or unpleasant experience) when making choices leading to positive or negative outcomes on others. Specifically, we sought to determine whether their motivation is consistent for different outcome valences and is predicted by their sensitivity to a peer’s affective state. Pairs of animals sat face to face in a primate chair and alternately made forced-choice decisions by touching one of two visual cues that were projected on a transparent touch-sensitive panel (Fig. 1A), leading to the subsequent delivery of a combination of outcomes (Fig. 1 B and C). Social decisions consisted, for one monkey (the actor), in choosing an outcome for another monkey (the partner) vs. the same outcome to nobody. The outcome was either a drop of juice or an airpuff delivered close to the eyes. From the actor’s perspective, sensory events associated with partner and nobody outcomes were similar in every respect, except for their impact on the partner monkey. Choosing one or the other option did not determine the outcome for the actor monkey, who received a constant juice reward for touching one of the cues. Nonsocial decisions were interleaved with social decisions to control for the animals’ perception of the same outcomes when delivered to self. Eye-tracking devices were used to record the monkeys’ gaze and eye blinks as proxies of, respectively, social engagement and negative affect.Open in a separate windowFig. 1.Task design. (A) Two monkeys (actor in black, partner in light brown) faced each other on either side of transparent touch panels on which visual stimuli were virtually projected. Both animals could observe the images and each other at all times. Tubes connected to solenoid devices allowed delivering the different outcomes. (B) Monkeys made social decisions regarding potential appetitive (offer J-S) and aversive (offer A-S) outcomes for the partner and nonsocial decisions regarding similar outcomes for self (offers J-nS and A-nS). For nonsocial decisions involving airpuffs and for social decisions, the actor was always rewarded with a drop of juice so as to maintain an adequate motivation level. (C) Typical trial sequence. A visual cue instructed the monkeys as to their role (actor or partner) in the current trial. The actor first touched this cue, triggering the appearance of two additional images. The monkey indicated its choice by touching one of these images. The unchosen image was then turned off and following a delay the partner’s and actor’s outcomes were delivered, preceded by unique 500-ms-long warning tones.     

Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS

Purpose

Prone position (PP) improves oxygenation and outcome of acute respiratory distress syndrome (ARDS) patients with a PaO₂/FiO₂ ratio <150 mmHg. Regional changes in lung aeration can be assessed by lung ultrasound (LUS). Our aim was to predict the magnitude of oxygenation response after PP using bedside LUS.

Methods

We conducted a prospective multicenter study that included adult patients with severe and moderate ARDS. LUS data were collected at four time points: 1 h before (baseline) and 1 h after turning the patient to PP, 1 h before and 1 h after turning the patient back to the supine position. Regional lung aeration changes and ultrasound reaeration scores were assessed at each time. Overdistension was not assessed.

Results

Fifty-one patients were included. Oxygenation response after PP was not correlated with a specific LUS pattern. The patients with focal and non-focal ARDS showed no difference in global reaeration score. With regard to the entire PP session, the patients with non-focal ARDS had an improved aeration gain in the anterior areas. Oxygenation response was not associated with aeration changes. No difference in PaCO₂ change was found according to oxygenation response or lung morphology.

Conclusions

In ARDS patients with a PaO₂/FiO₂ ratio ≤150 mmHg, bedside LUS cannot predict oxygenation response after the first PP session. At the bedside, LUS enables monitoring of aeration changes during PP.