Marathon runners: how do they age?

Marathon running performance among men and women is generally fastest, as indicated by world record performances, when individuals are 25-35 years old. The time to complete a marathon gradually increases with age, with substantial losses in performance after the age of 70 years. A decline in cardiovascular capacity of 0.5% per decade occurs in highly trained distance runners, while a 1.0% and 1.5% decline per decade occurs in moderately trained and untrained individuals, respectively. In middle-aged veteran runners, skeletal muscle continues to have high aerobic potential, while a decline in muscle cell size and contractile performance are apparent. These changes in the skeletal muscle profile may contribute to distance running performance with age. The changes in physiological function and running performance with age are closely related to the level of distance run training. Current research supports the concept that continued running late into life attenuates a decline in physiological function with age and is beneficial for overall health.     

Imaging nodules within cirrhotic liver: how do I do it?

Cirrhosis is a chronic liver disease characterized by the presence of diffuse parenchymal necrosis, reactive fibrosis and nodular regeneration. These regenerative nodules may evolve into dysplastic nodules and finally nodules of hepatocellular carcinoma (HCC). Improved survival of cirrhotic patients with HCC depends on eligibility to liver transplantation. The purpose of this paper is to review the imaging features of liver nodules within cirrhotic liver and to propose the imaging strategies when considering the possibility of liver transplantation.     

Pharmacovigilance and radiologists: How well do they get along?

Objectives:Considering the growing use of imaging modalities and contrast agents, radiologists are prone to encounter adverse drug reactions (ADR). In the current study, we mainly aim to evaluate the knowledge of radiologists regarding pharmacovigilance (PV). Also, we intend to gather information about their previous ADR experiences. Secondarily, we hope to increase the awareness about contrast-medium-related ADRs and attract attention to the importance of properly reporting these ADRs.Methods:A survey was generated by using an online survey webpage, and the relevant link was e-mailed to radiologists and radiology residents. The survey begins with a short explanation about the study. The second section contains questions about PV knowledge level, and the final section aims to gather information about the experienced ADRs.Results:The survey was completed by 202 participants. 65.3% stated that they were aware of PV. 24.8% of the participants said that they know the national PV program. 97% told that they knew the term ADR. 66.3% of the participants encountered an ADR. 53.7% of them reported these ADRs. 70.8% of them reported these ADRs to a clinician.Conclusions:Radiologists encounter ADRs almost as frequently as the other doctors. Their awareness about PV is similar with other healthcare professionals. They have fewer information about TUFAM and PvCPs. Radiologists generally prefer to communicate with a clinician about an ADR. Overall condition of radiologists about PV is quite similar with other healthcare professionals and education can improve it, as for the others.Advances in knowledge:Radiologists encounters ADRs almost as frequently as the other doctors. Overall condition of radiologists about PV is quite similar with other healthcare professionals and education can improve it, as for the others.     

The nuclear issue: where do we go from here?

The drive for the elimination of nuclear weapons is going badly and there is currently little support from the general public. The United States Nuclear Posture Review incorporates nuclear capability into conventional war planning. The Stockpile Stewardship Program is designed to maintain nuclear weapon capability. The US is planning an essentially new earth-penetrating nuclear weapon and is prepared to test this in the national interest if thought necessary. These policies could stimulate nuclear proliferation by others, do nothing to deter terrorism, promote persisting polarization of the world, are a clear breach of the Non-Proliferation Treaty and rest world security on a continued balance of terror. A renewed mass campaign to counteract all this, on legal and moral grounds in particular, is urgently needed. IPPNW and kindred organizations must restore sanity in our policies and humanity to our actions.     

Diagnosis of acute cholecystitis: why do patients get multiple studies?

The aim of this study is to establish factors affecting total number of imaging studies performed for acute cholecystitis (AC) prior to surgery. The study included subjects with cholecystectomy and pathologic diagnosis of AC 1/1/05–1/1/14 and imaging studies (computed tomography (CT), ultrasound (US), and/or cholescintigraphy) within 7 days of surgery. The subjects were separated into groups based on modality of the first study. For each subject, report of the first study was reviewed for report’s confidence in diagnosis of AC (scored 1–5 on Likert scale: 5?=?definitely AC, 1?=?definitely no AC), recommendation of additional study, clinical history concerning for AC (history of right upper quadrant pain, cholelithiasis, and/or “rule out AC”). There were 219, 339, and 38 subjects in CT, US, and cholescintigraphy groups, respectively, with mean confidence scores of 3.7 (±1.2), 3.7 (±1.1), and 4.7 (±0.9), respectively (p?<?0.001). Prior to surgery, only one study was performed in 21.9 % (48/219) of CT group, 70.2 % (238/339) of US group, and 71.1 % (27/38) of cholescintigraphy group (p?<?0.0001). Compared to the US group, the odds of undergoing additional study were 11.8 times higher (p?<?0.001) in CT group and 1.7 times higher (p?=?0.229) in cholescintigraphy group, adjusting for age, sex, time interval between first study and the surgery, confidence score, recommendation of follow-up study, and clinical history concerning for AC. Patients with AC and CT as the first study are more likely to undergo additional imaging studies prior to surgery as compared to US or cholescintigraphy.     

Job satisfaction and motivation: how do we inspire employees?

Productivity is defined as the efficient and effective use of resources with minimum waste and effort to achieve outcome. We live in a world that has limited resources. The health care industry faces this limitation more than any other industry. With these challenges facing health care administrators, the concept of productivity, job satisfaction and motivation become very important. Employee satisfaction and retention have always been an important issue for physicians, medical centers and businesses in general. Conventional human resources theories, developed some 50 years ago by Maslow and Herzberg, suggest that satisfied employees tend to be more productive, creative and committed to their employers. People are essential to productivity. The success of productivity improvement strategy is dependent on employee commitment, job satisfaction, skills, and motivation. Maslow's theory consists of a 5-level pyramid: physiologic or basic survival; physical and mental safety; sense of belonging; accomplishment, creativity, and growth; and self-actualization. Herzberg's theory suggests there are 2 groups of factors: hygiene (which satisfy) and motivation. The terms "job satisfaction" and "motivation" have, in my experience, become used interchangeably. There is a difference. Job satisfaction is an individual's emotional response to his or her current job condition, while motivation is the driving force to pursue and satisfy one's needs. Maslow and Herzberg's theories can be easily applied to the workplace. Managers can help employees achieve overall job satisfaction, which, with the employee's internal motivation drive, increase performance on the job.     

Acute stroke assessment with CT: do we need multimodal evaluation?

PURPOSE: To assess detection of stroke and prediction of extent of infarction with multimodal computed tomographic (CT) evaluation (unenhanced CT, perfusion CT, and CT angiography) in patients suspected of having acute stroke. MATERIALS AND METHODS: Forty-four consecutive patients with a mean National Institutes of Health Stroke Scale score of 10.45 and suspected of having ischemic stroke of the anterior circulation were examined with multi-detector row CT within 8 hours (mean, 3.05 hours) of onset of symptoms. All evaluations were performed with the knowledge that acute stroke was suspected but without detailed clinical information. The extent of ischemia or final infarction on the baseline unenhanced CT scan and follow-up images was assessed with the Alberta Stroke Program Early CT score. Different perfusion maps and follow-up images were assessed to determine the percentage of the ischemia-affected hemisphere. Each component, as well as the multimodal CT evaluation, was compared with follow-up unenhanced CT scans or magnetic resonance images after a mean time of 2.32 days. RESULTS: Multimodal CT revealed true-positive findings in 30 of 41 patients and true-negative findings in three, resulting in a sensitivity of 78.9%. Unenhanced CT, CT angiography, and perfusion CT showed sensitivities of 55.3%, 57.9%, and 76.3%, respectively. In eight patients, small infarctions (mean size, 1.47 cm) that were proved at follow-up were missed with all modalities at initial multimodal CT. With perfusion CT, four of these small infarctions were missed within the white matter of the section levels. Maps of cerebral blood flow showed the best correlation with the final size of infarction with an r(2) value of 0.71. CONCLUSION: The presented multimodal CT evaluation improves detection rate and prediction of the final size of infarction in comparison with unenhanced CT, CT angiography, and perfusion CT alone.     

Civilian versus military trauma dogma: who do you trust?

Combat trauma differs from its peacetime counterpart by involving a different spectrum of injuries, occurring in austere environments, dealing with mass casualties, and embodying inherent treatment delays. Thus, civilian trauma practices may be inappropriate in certain combat settings. A review of historical as well as current vivilian and military data is presented for four trauma topics (military antishock trousers, wound debridement, colon wounds, fluid resuscitation) in which civilian and military principles have clashed. The following recommendations are made. (1) Military antishock trousers are still useful in a combat setting. (2) Soft-tissue wound management should be directed by the wound rather than by the weapon. (3) Cautious avoidance of colostomy may be indicated in certain wartime colon wounds. (4) The majority of combat casualties require early vigorous fluid resuscitation. When civilian trauma experience challenges military dogma, it must be carefully considered before being applied to a combat setting.     

COVID-19; beyond the obvious: how do we move forward?

European Journal of Nuclear Medicine and Molecular Imaging -