Sub-differentiating equivocal PI-RADS-3 lesions in multiparametric magnetic resonance imaging of the prostate to improve cancer detection

PurposeTo evaluate sub-differentiation of PI-RADS-3 prostate lesions using pre-defined T2- and diffusion-weighted (DWI) MRI criteria, to aid the biopsy decision process.Methods143 patients with PIRADS-3 index lesions on MRI underwent targeted transperineal-MR/US fusion biopsy. Radiologists with 2 and 7-years experience performed blinded retrospective second-reads using set criteria and assigned biopsy recommendations. Inter-reader agreement, Gleason score (GS), positive (PPV) predictive values (±95% confidence intervals) were calculated and compared by Fisher’s exact test with Bonferroni-Hom correction.Results43% (61/143) patients had GS 6–10 and 21% (30/143) GS ≥ 3 + 4 cancer. For peripheral zone lesions, significant differences in any cancer detection were found for shape (0.26 ± 0.13 geographical vs. 0.69 ± 0.23 rounded; p = 0.0055) and ADC (mild 0.21 ± 0.12 vs marked 0.81 ± 0.19; p = 0.0001). For transition zone, significantly increased cancer detection was shown for location (anterior 0.63 ± 0.15 vs. mid/posterior 0.31 ± 0.14; p = 0.0048), border (pseudo-capsule 0.32 ± 0.14 vs. ill-defined 0.61 ± 0.15; p = 0.0092), and ADC (mild 0.35 ± 0.12 vs marked restriction 0.68 ± 0.17; p = 0.0057). Biopsy recommendations had 62% inter-reader agreement (89/143). Experienced reader PPVs were significantly higher for any cancer with “biopsy-recommended” 0.61 ± 0.11 vs. “no biopsy” 0.21 ± 0.10 (p = 0.0001), and for GS 7–10 cancers: 0.32 ± 0.10 vs. 0.08 ± 0.07, respectively (p = 0.0003).ConclusionIdentification of certain objective imaging criteria as well as a subjective biopsy recommendation from an experienced radiologist can help to increase the predictive value of equivocal prostate lesions and inform the decision making process of whether or not to biopsy.     

Diagnostic value of dynamic contrast-enhanced CT with perfusion imaging in the quantitative assessment of tumor response to sorafenib in patients with advanced hepatocellular carcinoma: A feasibility study

PurposeTo investigate the feasibility of perfusion-CT (p-CT) measurements in quantitative assessment of hemodynamic changes related to sorafenib in patients with advanced hepatocellular carcinoma (HCC).Materials and methodsTwenty-two patients with advanced HCC underwent p-CT study (256-MDCT scanner) before and 2 months after sorafenib administration. Dedicated perfusion software generated a quantitative map of arterial and portal perfusion and calculated the following perfusion parameters in target liver lesion: hepatic perfusion (HP), time-to-peak (TTP), blood volume (BV), arterial perfusion (AP), and hepatic perfusion index (HPI). After the follow-up scan, patients were categorized as responders and non-responders, according to mRECIST. Perfusion values were analyzed and compared in HCC lesions and in the cirrhotic parenchyma (n = 22), such as between baseline and follow-up in progressors and non-progressors.ResultsBefore treatment, all mean perfusion values were significantly higher in HCC lesions than in the cirrhotic parenchyma (HP 47.8 ± 17.2 vs 13.3 ± 6.3 mL/s per 100 g; AP 47.9 ± 18.1 vs 12.9 ± 10.7 mL/s; p < 0.001). The group that responded to sorafenib (n = 17) showed a significant reduction of values in HCC target lesions after therapy (HP 29.2 ± 23.3 vs 48.1 ± 15.1; AP 29.4 ± 24.6 vs 49.2 ± 17.4; p < 0.01), in comparison with the non-responder group (n = 5) that demonstrated no significant variation before and after treatment of HP (46.9 ± 25.1 vs 46.7 ± 24.1) and AP (43.4 ± 21.7 vs 43.5 ± 24.6). Among the responder group, HP percentage variation (Δ) in target lesions, during treatment, showed a significantly different (p = 0.04) ΔHP in the group with complete response (79%) compared to the group with partial response or stable disease (16%).Conclusionsp-CT technique can be used for HCC quantitative assessment of changes related to anti-angiogenic therapy. Identification of response predictors might help clinicians in selection of patients who may benefit from targeted-therapy allowing for optimization of individualized treatment.     

Aluminium salt-based antiperspirant coated prosthesis liners do not suppress local sweating during moderate intensity exercise in hot and temperate conditions

ObjectiveTo determine whether coating prosthesis liners with a 5% aluminium zirconium tetrachlorohydrate antiperspirant solution (AZCH) reduces local sweating on the thigh.DesignDouble-blinded counter-balanced crossover designMethodsFourteen able-bodied participants (age: 28 ± 5 y; body mass: 73.9 ± 7.9 kg, height: 1.73 ± 0.09 m; peak oxygen consumption [VO_2peak]: 50.7 ± 9.1 mlO₂⋅ kg⁻¹⋅ min⁻¹) simultaneously wore a prosthesis liner on each leg, one treated with AZCH and one untreated, for four days prior to running at 50% of VO_2peak for 60 min in a temperate (23.7 ± 0.7 °C and 42.2 ± 2.6% relative humidity) or hot (34.0 ± 1.6 °C and 40.8 ± 6.1% relative humidity) environment. Rectal temperature (T_re) and whole-body sweat rates (WBSR) were measured to characterize thermal strain. Local sweat rate (LSR) was measured bilaterally underneath the liners, continuously, and heat-activated-sweat gland density (HASGD) was measured bilaterally every 15 min.ResultsIn temperate condition, the mean change in T_re was 1.2±0.4 °C and WBSR was 723 ± 129 g⋅ h⁻¹, whereas in the hot condition, change in T_re was 1.2±0.5 °C and WBSR was 911 ± 231 g⋅ h⁻¹. In the temperate condition, AZCH treatment did not alter LSR (treated: 0.50±0.17 mg·cm^–2 min^–1, untreated: 0.50±0.17 mg·cm^–2 min^–1; P = 0.87) or HASGD (treated: 54±14 glands·cm^–2, untreated 55±14 glands·cm^–2; P = 0.38). In the hot condition, AZCH treatment paradoxically increased LSR (treated: 0.88 ± 0.38 mg·cm^–2 min^–1, untreated: 0.74 ± 0.28 mg·cm^–2 min^–1; P = 0.04) but not HASGD (treated: 52 ± 17 glands·cm^–2, untreated: 48 ± 19 glands·cm^–2; P = 0.77).ConclusionThese results indicate coating prosthesis liners with 5% AZCH is ineffective at reducing local sweating.     

A clinical evaluation of the efficacy of photodynamic therapy in the treatment of erosive oral lichen planus: A case series

BackgroundErosive oral lichen planus (EOLP) poses a substantial risk of malignant transformation into squamous cell cancer. The absence of established treatment gives way to alternative therapeutic strategies, including photodynamic therapy. The aim of the study was to evaluate the efficacy of PDT in the treatment of EOLP.MethodsTwelve female patients aged 63–80 with 22 OLP lesions (16 on the buccal mucosa, 6 on gingiva and tongue), underwent authors’ own PDT scheme with the use of 5% solution of 5-aminolevulinic acid (ALA) as photosensitizer. An ALA-saturated occlusive dressing was applied directly onto a lesion and surrounding mucosa 2 h prior to illumination with a custom-made diode lamp (light of 630 nm, dose of 300 mW). After a series of 10 weekly illumination sessions the patients were monitored for 12 months.ResultsThe mean size of lesions before treatment was 1.46 cm² ± 1.44. The lesions on the buccal mucosa were smaller (1.06 cm² ± 0.98) than those on the gingiva and tongue (2.63 cm² ± 1.93). Post-treatment improvement encompassed 16 lesions, 5 of which were in remission. The mean reduction in size after 10-session therapy was 8,05%. The healing continued and further reduction in size (by 69.13%) took place during the 12-month observation: 39.62% of lesions within the buccal mucosa and full remission of all lesions on the gingiva and tongue.ConclusionsThe results suggest that PDT offers non-invasive treatment of lesions in oral mucosa and may become an alternative and complementary method to those currently in use. Further studies involving larger groups of patients should be undertaken before it becomes routine practice.     

Dietary supplementation with New Zealand blackcurrant extract enhances fat oxidation during submaximal exercise in the heat

ObjectivesThis study investigated the effect of 7 days’ supplementation with New Zealand blackcurrant extract on thermoregulation and substrate metabolism during running in the heat.DesignRandomized, double-blind, cross-over study.MethodsTwelve men and six women (mean ± SD: Age 27 ± 6 years, height 1.76 ± 0.10 m, mass 74 ± 12 kg, V̇O_2max 53.4 ± 7.0 mL kg⁻¹ min⁻¹) completed one assessment of maximal aerobic capacity and one familiarisation trial (18 °C, 40% relative humidity, RH), before ingesting 2 × 300 mg day⁻¹ capsules of CurraNZ™ (each containing 105 mg anthocyanin) or a visually matched placebo (2 × 300 mg microcrystalline cellulose M102) for 7 days (washout 14 days). On day 7 of each supplementation period, participants completed 60 min of fasted running at 65% V̇O_2max in hot ambient conditions (34 °C and 40% relative humidity).ResultsCarbohydrate oxidation was decreased in the NZBC trial [by 0.24 g min⁻¹ (95% CI: 0.21–0.27 g min^-1)] compared to placebo (p =  0.014, d = 0.46), and fat oxidation was increased in the NZBC trial [by 0.12 g min⁻¹ (95% CI: 0.10 to 0.15 g min⁻¹)], compared to placebo (p = 0.008, d = 0.57). NZBC did not influence heart rate (p = 0.963), rectal temperature (p = 0.380), skin temperature (p = 0.955), body temperature (p = 0.214) or physiological strain index (p = 0.705) during exercise.ConclusionsSeven-days intake of 600 mg NZBC extract increased fat oxidation without influencing cardiorespiratory or thermoregulatory variables during prolonged moderate intensity running in hot conditions.     

Changes in performance markers and wellbeing in elite senior professional rugby union players during a pre-season period: Analysis of the differences across training phases

ObjectivesTo assess the magnitude of change and association with variation in training load of two performance markers and wellbeing, over three pre-season training blocks, in elite rugby union athletes.DesignObservational.MethodsTwenty-two professional players (age 25 ± 5 years; training age 6 ± 5 years; body mass, 99 ± 13 kg; stature 186 ± 6 cm) participated in this study, with changes in lower (CMJ height) and upper body (bench press mean speed) neuromuscular function and self-reported wellbeing (WB) assessed during an 11-week period.ResultsThere was a small increase in CMJ height (0.27, ±0.17 – likely substantial; standardised effect size, ±95% confidence limits – magnitude-based inference) (p = 0.003), bench press speed (0.26, ±0.15 – likely substantial) (p = 0.001) and WB (0.26, ±0.12 – possibly substantial) (p < 0.0001) across the pre-season period. There was a substantial interaction in the effect of training load on these three variables across the three training phases. A two-standard deviation (2SD) change in training load was associated with: a small decrease in CMJ height during the power phase (−0.32, ±0.19 – likely substantial) (p = 0.001); a small reduction in bench press speed during the hypertrophy phase (−0.40, ±0.32 – likely substantial) (p = 0.02); and a small reduction in WB during the strength phase (−0.40, ±0.24 – very likely substantial) (p < 0.0001). The effects of changes in training load across other phases were either likely trivial, only possibly substantial, or unclear.ConclusionsThe effect of training load on performance can vary both according to the type of training stimulus being administered and based on whether upper- or lower-body outcomes are being measured.     

Persistent vestibular-ocular impairment following concussion in adolescents

ObjectivesThe current study investigated the role of persistent vestibular-ocular symptoms and impairment following sport-related concussion on recovery time and clinical outcomes among adolescents.DesignProspective cohort.Methods50 (F-22/M-28) adolescents aged 12–20 years completed a vestibular-ocular motor screening, neurocognitive assessment, and the Post-Concussion Symptom Scale (PCSS) at clinical assessments conducted at 0–10 and 11–21 days after concussion. Participants were assigned to: 1) persistent vestibular-ocular (PERSIST), 2) vestibular-ocular improvement (IMPROVE), or 3) no vestibular-ocular impairment (NONE) groups based on vestibular-ocular motor screening conducted during each assessment. A 3 (GROUP) X 2 (TIME) ANOVA was performed on neurocognitive and symptom scores, and a between-subjects ANOVA was performed for recovery time.Results49 subjects were identified among the PERSIST (n = 17), IMPROVE (n = 12) and NONE (n = 20) groups. There were no neurocognitive performance differences between groups at 0–10 days post-concussion, but groups differed on PCSS at 11–21 days (p = .001), with the PERSIST (29.0 ± 24.9) group reporting higher symptoms than the NONE (5.45 ± 10.0; p = .005) group. The PERSIST group took significantly longer to recover (34.9±11.6 days) than the NONE (22.9 ± 14.9 days) group (p = .03). All groups improved on verbal (p < .001) and visual memory (p = .028), visual motor speed (p = .005), and reaction time (p = .004) from 0–10 to 11–20 days following SRC and no significant group by time interactions for cognitive scores identified.ConclusionsPersistent post-concussion vestibular-ocular symptoms and impairment may influence neurocognitive performance and clinical recovery following sport-related concussion.     

Comparison between multi-shot gradient echo EPI and balanced SSFP in unenhanced 3T MRA of thoracic aorta in healthy volunteers

PurposeThe purpose of this study was to compare scan time and image quality between magnetic resonance angiography (MRA) of the thoracic aorta using a multi-shot gradient echo planar imaging (MSG-EPI) and MRA using balanced steady-state free precession (b-SSFP).Materials and methodsHealthy volunteers (n = 17) underwent unenhanced thoracic aorta MRA using balanced steady-state free precession (b-SSFP) and MSG-EPI sequences on a 3T MRI. The acquisition time, total scan time, signal-to-noise ratio (SNR) of the thoracic aorta, and the coefficient of variation (CV) of thoracic aorta were compared with paired t-tests. Two radiologists independently recorded the images’ contrast, noise, sharpness, artifacts, and overall quality on a 4-point scale.ResultsThe acquisition time was 36.2% shorter for MSG-EPI than b-SSFP (115.5 ± 14.4 vs 181.0 ± 14.9 s, p < 0.01). The total scan time was 40.4% shorter for MSG-EPI than b-SSFP (272 ± 78 vs 456 ± 144 s, p < 0.01). There was no significant difference in mean SNR between MSG-EPI and b-SSFP scans (17.3 ± 3.6 vs 15.2 ± 4.3, p = 0.08). The CV was significantly lower for MSG-EPI than b-SSFP (0.2 ± 0.1 vs. 0.5 ± 0.2, p < 0.01). All qualitative scores except for image noise were significantly higher in MSG-EPI than b-SSFP scans (p < 0.05).ConclusionThe MSG-EPI sequence is a promising technique for shortening scan time and yielding more homogenous image quality in MRA of thoracic aorta on 3T scanners compared with the b-SSFP.     

Malignant breast tumours: Correlation of apparent diffusion coefficient values using diffusion-weighted images and dynamic contrast-enhancement ratio with histologic grading

PurposeTo evaluate the correlation of the apparent diffusion coefficient (ADC) using diffusion weighted imaging (DWI) and early/delayed enhancement (E/D) ratio using dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) with histological grading in malignant breast lesions.Material and methodsThirty-one women with 34 histopathologically proved malignant breast lesions underwent MRI within 2 weeks prior to surgery. MRI examination included T1 and T2 W sequences, DWI and DCE-MRI. ADC values and E/D ratios are correlated with the histological grades.ResultsThe mean ADC of the malignant lesions was 0.85 ± 0.12 × 10^?3 mm²/s. The mean ADC values of grade I, II and III were 0.96 ± 0.12 × 10^?3 mm²/s, 0.87 ± 0.07 × 10^?3 mm²/s and 0.75 ± 0.12 × 10^?3 mm²/s, respectively. Tumours with higher grade showed significantly lower ADC value (p = 0.0001) compared with lower grade and there is an inverse correlation between ADC value and histological grade (r = ?0.62, p-value = 0.0001). The mean E/D ratio for grade I, II and III tumours were 0.98 ± 0.04, 1.01 ± 0.05 and 1.07 ± 0.08, respectively. Tumours with higher grade showed significantly higher E/D ratio (p = 0.005) compared with lower grade and there was a direct correlation between E/D ratio and histological grade (r = 0.44, p = 0.008).ConclusionDWI is a useful diagnostic parameter with significantly higher correlation with the histological grade of breast cancer than DCE MRI, which is an important factor for proper treatment selection.     

Do hip and groin muscle strength and symptoms change throughout a football season in professional male football players? A prospective cohort study with repeated measures

ObjectivesGroin injuries are common in professional male football and result in significant complaints, time-loss and cost. We aimed to study: 1. Normal values of hip muscle strength and self-reported hip and groin function (Hip And Groin Outcome Score (HAGOS)). 2. Changes in these values throughout the season. 3. If previous (groin) injuries, leg dominance or league were associated with these outcome measures.DesignProspective cohort study.Methods313 professional male football players (11 clubs) participated. Player characteristics and previous injuries were registered. Hip muscle strength (hand-held dynamometer) and HAGOS measurements were done at the start, middle and end of the season.ResultsData from 217 players were analysed. Adduction strength (mean ± standard deviation, Nm/Kg) was 3.40 ± 0.72 (start), 3.30 ± 0.65 (mid) and 3.39 ± 0.74 (end) (p = 0.186). Abduction strength was 3.45 ± 0.67, 3.14 ± 0.57 and 3.28 ± 0.61 (p < 0.001). Adduction/abduction ratio was 1.00 ± 0.21, 1.07 ± 0.22 and 1.05 ± 0.23 (p < 0.001). Statistically, the HAGOS-subscale ‘Pain’ (median [interquartile range]) deteriorated slightly during the season (p = 0.005), especially from mid-season (97.5 [90.6−100.0]) to end-of-season (95.0 [87.5−100.0]) (p = 0.003). Other subscale scores remained unchanged between time points; 85.7 (symptoms), 100.0 (daily living), 96.9 (sports and recreation) 100.0, (physical activities) and 90.0 (quality of life). Previous injuries were associated with lower HAGOS-scores. Dominant legs had higher abduction strength (p < 0.001) and lower adduction/abduction ratio (p < 0.001). No differences between leagues were found for hip muscle strength and HAGOS-scores.ConclusionsIn Dutch male professional football players, hip muscle strength and HAGOS-scores remained relatively stable throughout the season. Pain increased slightly, which while statistically significant, was not clinically relevant.     

The predictive value of computed tomography in the detection of reflux esophagitis in patients undergoing upper endoscopy

BackgroundReflux esophagitis (RE) may mimic symptoms requiring cross-sectional imaging.MethodsFrom 565 patients who had CT and esophagogastroduodenoscopy within four days apart, CT scans of 72 patients with RE confirmed by esophagogastroduodenoscopy and 108 matched patients without RE were evaluated for distal esophageal wall characteristics.ResultsIn RE patients the distal esophageal wall thickness was greater (5.2 ± 2.0 mm) compared to patients without RE (3.5 ± 1.2 mm, p < 0.0001) with AUC of 0.78 and 56% sensitivity, 88% specificity for a 5.0 mm cut-off.ConclusionsThere is a moderate association between distal esophageal wall thickness on CT and RE diagnosed by esophagogastroduodenoscopy as the reference standard.     

Multi-parametric (mp) MRI for the diagnosis of abdominal wall desmoid tumors

IntroductionDesmoid tumors are benign myofibroblastic neoplasms, originating from the muscle aponeurosis and classified as deep fibromatoses. The aim of this study was to evaluate the utility of multi-parametric (mp)-MRI for the diagnosis of abdominal wall desmoid tumor (awdt).Material and methodsThis Institutional review board approved retrospective study compared 10 patients (mean age ± SD; 38.2 ± 13 years; 9 females and 1 male) with awdt to 14 subjects (mean age ± SD; 45.6 ± 14.7 years; 9 females and 5 males) with non-desmoid abdominal wall tumors (ndawt). All included subjects underwent mp-MRI, which included conventional, diffusion weighted and dynamic contrast-enhanced (DCE) MRI. Two blinded experienced fellowship trained radiologists (MK and SR) evaluated each lesion characteristics qualitatively and quantitatively which included margin, homogeneity, T2W/T1W signal intensity (SI), T2 dark strands, and fascial tail together with measurements of apparent diffusion coefficient (ADC) and semi-quantitative DCE analysis. Inter-observer agreement was assessed using Cohen’s kappa and data were compared between groups using independent sample t-tests and Chi-square tests.ResultsNo significant differences in age or gender appeared between groups. On qualitative analysis, T2 dark strands were identified in 90% by both radiologist (K = 0.82) of awdt, while fascial tail was identified in 70% by radiologist 1 and 80% by second radiologist (k = 0.91) of awdt; however no other lesions showed these findings. Other subjective imaging findings did not significantly differ between groups with moderate-to-strong agreements (k = 0.7–1.0). On quantitative measurements, diffusion imaging awdt lesions showed higher mean ADC value compared to other lesions, although it did not reached at the level of significance. While on DCE MRI, all awdt lesions showed type 1 (progressive) DCE curve, however no significant difference was observed between groups.ConclusionsT2 dark strands and fascial tail are characteristic features of awdt, whereas other subjective/qualitative findings are not useful. Quantitative findings such as ADC measurements and DCE curve analysis may have additional value to differentiate awdt from ndawt, but will require further analysis.     

Utility of T1-weighted MRI as a predictor of liver lesion visibility on ultrasound: A clinical tool to determine feasibility of ultrasound-guided percutaneous interventions

PurposeTo determine the utility of fat-suppressed T1-weighted gradient recalled echo (FS-T1W-GRE) MRI to predict visibility of focal liver lesions (FLL) on abdominal ultrasound (US).Materials and methodsWith IRB approval, between 2010 and 2013, 109 patients (28.4% females, age 66.9 ± 10.9 years) with 177 FLL (hepatocellular carcinoma = 132, metastases = 44, other = 1) underwent MRI and prospective, radiologist-performed treatment-planning US (to determine eligibility for US-guided ablation). MRI examinations were reviewed by a blinded radiologist who assessed: a) size and location of FLL, b) presence of hepatic steatosis on dual-echo T1W-GRE, and c) quantitative signal intensity of FLL relative to liver on FS-T1W-GRE. Associations between MR imaging findings and visibility on US were assessed using independent t-tests and the chi-squares test.Results69.5% (123/177) FLL were identified with US and 30.5% (54/177) were not visible. Size of FLL on MRI was associated with visibility on US (p < 0.0001) with no association between FLL visibility on US and segmental or subcapsular location (p = 0.29 and p = 0.25, respectively). 20.2% (22/109) patients had hepatic steatosis on MRI, which was not associated with non-visibility of FLL on US (p = 0.67). 38.4% (68/177) FLL were isointense to liver on FS-T1W-GRE which was associated with non-visibility on US (p = 0.036) particularly in non-steatotic livers (p = 0.014).ConclusionFLL size and isointensity of FLL to liver parenchyma on FS-T1W-GRE MRI are associated with non-visibility on US, particularly in non-steatotic livers. These results have implications when planning US-guided percutaneous interventions of FLL detected with MRI.     

Cardiovascular responses to heat acclimatisation in athletes with spinal cord injury

ObjectivesTo determine the effect of heat acclimatisation (HA) training on blood profile and resting cardiac function in elite athletes with spinal cord injury (SCI).DesignQuasi-experimental.MethodsEleven athletes (10 m, 1f) with SCI (C5-T3) completed a five-day isothermic HA protocol whereby gastrointestinal temperature (Tc) was elevated to and maintained at ∼38.5 degrees Celsius (°C) via intermittent exercise for sixty minutes each day. Blood samples were collected pre- and post-HA to determine changes in plasma volume (PV). Doppler ultrasound of the left-ventricular outflow tract and 2-d speckle tracking echocardiography were performed in a subset of athletes (n = 5) to determine changes in indices of resting left-ventricular function and mechanics, respectively.ResultsTen athletes were successfully able to raise and maintain Tc to 38.5 °C. There was a non-significant increase in PV with HA training (ΔPV%: 3.0 ± 5.4%, p = 0.086). Following HA, resting HR decreased (63 ± 4 pre-HA vs. 58 ± 5 bpm post-HA, p = 0.020), velocity time integral (21.4 ± 2.7 vs. 23.7 ± 3.0 cm, p = 0.045) and stroke volume increased (64.8 ± 7.6 vs. 70.2 ± 10.5 mL, p = 0.055).ConclusionsOur findings suggest a short-term HA protocol in athletes with SCI is safe and may induce beneficial changes in indices of resting left-ventricular function — however results are highly individualized. Future studies on HA in athletes with SCI should focus on determining mechanisms of adaptation and performance outcomes.     

Image quality evaluation of dual-layer spectral detector CT of the chest and comparison with conventional CT imaging

ObjectivesTo evaluate image quality parameters of virtual mono-energetic (MonoE) and conventional (CR) imaging derived from a dual-layer spectral detector CT (DLCT) in oncological follow-up venous phase imaging of the chest and comparison with conventional multi-detector CT (CR_MDCT) imaging.Materials and methodsA total of 55 patients who had oncologic staging with conventional CT and DLCT of the chest in venous phase were included in this study. Established image quality parameters were derived from all datasets in defined thoracic landmarks. Attenuation, image noise, and signal-/contrast- to noise ratios (SNR, CNR) were compared between CR_DLCT and MonoE as well as CR_MDCT imaging. Two readers performed subjective image analysis.ResultsCR_MDCT showed significant lower attenuation values compared to CR_DLCT and MonoE at 40–70 keV (p ≤ 0.05). Moreover, MonoE at 40–70 keV revealed significantly higher attenuations values compared to CR_DLCT (p < 0.001). Noise was statistically lower in CR_MDCT compared with CR_DLCT and MonoE at 40 keV (11.4 ± 2.3 HU vs. 12.0 ± 3.1 HU vs. 11.7 ± 5.2 HU; p < 0.001). In contrast, all MonoE levels showed significantly lower noise levels compared to CR_DLCT (p < 0.001). SNR was not significantly different between CR_MDCT and CR_DLCT (13.5 ± 3.7 vs. 14.4 ± 5.3; p > 0.99). SNR values were significantly increased for MonoE at 40–80 keV compared to CR_MDCT and CR_DLCT (p < 0.001). CR_DLCT and MonoE (40–70 keV) from DLCT revealed significantly higher CNR values than CR_MDCT (p < 0.001). In subjective analysis, MonoE at 40 keV surpassed all other image reconstructions except for noise in MonoE at 70 keV.ConclusionIn dual-layer spectral detector CT, MonoE at low keV showed superior image quality compared to conventional images derived from the same system and may therefore be added to clinical routine imaging protocols. Whether MonoE reconstructions yield additional diagnostic information is still unknown.     

Factors influencing hydration status during a National Collegiate Athletics Association division 1 soccer preseason

ObjectivesTo investigate the roles that training load and environmental conditions have on fluid balance during a collegiate men’s soccer preseason.DesignObservational study.MethodsTwenty-eight male collegiate soccer players (mean ± SD; age, 20 ± 1.7 y; body mass (BM), 79.9 ± 7.3 kg; height, 180.9 ± 6.8 cm; body fat, 12.7 ± 3.1%; VO_2max, 50.7 ± 4.3 ml·kg⁻¹·min⁻¹) participated in this study. Prior to (PRE) and following (POST) each team session, BM, percent BM loss (%BML) and hydration status was measured. Participants donned a heart rate and GPS enabled monitor to measure training load. For all team activities, ambient temperature (T_AMB) and relative humidity (RH) were obtained from the nearest local weather station. Participants consumed 500 mL of water as part of the team-based hydration strategy before and after training session. Stepwise linear regression was used to identify the variables that predicted %BML. Significance was set a-priori p < 0.05.ResultsTotal distance covered predicted %BML during all preseason activities (r² = 0.253, p < 0.001), with T_AMB and RH further adding to the model (r² = 0.302, p < 0.001). %BML never exceeded 2% of BM during any one session and daily variation in BM was <1% from baseline measures. Urine specific gravity was greater than 1.020 on 12/15 days and U_COL was above 4 on 13/15 days, indicating a state of hypohydration.ConclusionsTotal distance covered was the best predictor for the extent of body water losses during a collegiate preseason. While the team-based hydration strategy during preseason was successful in minimizing fluid losses during activity, participants arrived hypohydrated 80% of the time, necessitating a greater focus on daily fluid needs.     

Transitioning from daytime to nighttime operations in military training has a temporary negative impact on dynamic balance and jump performance in U.S. Army Rangers

ObjectivesExplore the impact transitioning from daytime to nighttime operations has on performance in U.S. Army Rangers.MethodsFifty-four male Rangers (age 26.1 ± 4.0 years) completed the Y-Balance Test (YBT), a vertical jump assessment, and a grip strength test at three time points. Baseline testing occurred while the Rangers were on daytime operations; post-test occurred after the first night into the nighttime operation training (after full night of sleep loss), and follow-up testing occurred six days later (end of nighttime training).ResultsOn the YBT, performance was significantly worse at post-test compared to baseline during right posteromedial reach (104.1 ± 7.2 cm vs 106.5 ± 6.7 cm, p = .014), left posteromedial reach (105.4 ± 7.5 cm vs 108.5 ± 6.6 cm, p = .003), right composite score (274.8 ± 19.3 cm vs 279.7 ± 18.1 cm, p = .043), left composite score (277.9 ± 18.1 cm vs 283.3 ± 16.7 cm, p = .016), and leg asymmetry was significantly worse in the posterolateral direction (4.8 ± 4.0 cm vs 3.7 ± 3.1 cm, p = .030) and the anterior direction (5.0 ± 4.0 cm vs 3.6 ± 2.6 cm, p = .040). The average vertical jump height was significantly lower at post-test compared to baseline (20.6 ± 3.4 in vs 21.8 ± 3.0 in, p = .004). Baseline performance on YBT and vertical jump did not differ from follow-up.ConclusionsArmy Rangers experienced an immediate, but temporary, drop in dynamic balance and vertical jump performance when transitioning from daytime to nighttime operations. When feasible, Rangers should consider adjusting their sleep cycles prior to anticipating nighttime operations in order to maintain their performance levels. Investigating strategies that may limit impairments during this transition is warranted.     

Vessel shape alterations of the vertebrobasilar arteries in Mucopolysaccharidosis type IVa (Morquio A) patients

PurposeMain symptom of mucopolysaccharidosis type IVa (MPS IVa) is progressive systemic skeletal dysplasia. This is routinely monitored by cerebral and spinal MRI. The vascular system is generally not in the primary focus of interest. In our population of MPS IVa patients we observed vessel shape alterations of the vertebrobasilar arteries, which has not been described before.Material and methodsMRI-datasets of 26 patients with MPS IVa acquired between 2008 and 2015 were eligible for retrospective analysis of the vertebrobasilar arteries. The vessel length and angle of the basilar artery (BA) and both vertebral arteries (VA) were analyzed. A deflection angle between 90° and 130° in the vessel course was defined as tortuosity, less than 90° as kinking. The results were compared to a matched control group of 23 patients not suffering from MPS.ResultsThe deflection angle [°] of the VA and BA was significantly decreased in the majority (85%) of MPS IVa patients compared to the control group: BA 132 ± 24 vs. 177 ± 6, BA/VA transition 113 ± 21 vs. 152 ± 13, right VA 108 ± 23 vs. 156 ± 13, left VA 110± 22 vs. 157 ± 14 (all p < 0.005). Likewise, vessels of MPS IVa patients were significantly longer compared to the control group: BA 27 ± 4 vs. 21 ± 2, right VA 20 ± 6 vs. 10 ± 1, left VA 18 ± 5 vs. 11 ± 2 (all p < 0.005).ConclusionMPS IVa is associated with significantly increased tortuosity of vertebrobasilar arteries. Therefore the vascular system of MPS IVa patients should be monitored on routinely basis, as vessel shape alterations had been associated with dissections, leading to a higher risk of cerebrovascular events.     

Patterns of head impact exposure in men’s and women’s collegiate club water polo

ObjectivesRecent reports have demonstrated a risk of concussion and subconcussive head impacts in collegiate varsity and international elite water polo. We sought to characterize patterns of head impact exposure at the collegiate club level of water polo.DesignProspective cohort study.MethodsHead impact sensors (SIM-G, Triax Technologies) were worn by men’s (n = 16) and women’s (n = 15) collegiate club water polo players during 11 games. Peak linear acceleration (PLA) and peak rotational acceleration (PRA) of head impacts were recorded by the sensors. Two streams of competition video were used to verify and describe the nature of head impacts.ResultsMen’s players sustained 52 verified head impacts of magnitude 39.7 ± 16.3 g PLA and 5.2 ± 3.2 krad/s² PRA, and women’s players sustained 43 verified head impacts of magnitude 33.7 ± 12.6 g PLA and 4.0 ± 2.8 krad/s² PRA. Impacts sustained by men had greater PLA than those sustained by women (p = .045). Athletes were impacted most frequently at the offensive center position, to the back of the head, and by an opponent’s torso or limb.ConclusionsOur cohort of male and female athletes sustained relatively infrequent head impacts during water polo competitions played at the collegiate club level. The amount of head impact exposure in our cohort was dependent on player position, with offensive centers prone to sustaining the most impacts. Head impact sensors are subject to large amounts of false positives and should be used in conjunction with video recordings to verify the validity of impact data.     

Thermoregulatory responses to ice slurry ingestion during low and moderate intensity exercises with restrictive heat loss

ObjectivesWe investigated the thermoregulatory responses to ice slurry ingestion during low- and moderate-intensity exercises with restrictive heat loss.DesignRandomised, counterbalanced, cross-over design.MethodsFollowing a familiarisation trial, ten physically active males exercised on a motorised treadmill at low-intensity (L; 40% VO_2max) or moderate-intensity (M; 70% VO_2max) for 75-min, in four randomised, counterbalanced trials. Throughout the exercise bout, participants donned a raincoat to restrict heat loss. Participants ingested 2 g kg^?1 body mass of ambient water (L + AMB and M + AMB trials) or ice slurry (L + ICE and M + ICE trials) at 15-min intervals during exercise in environmental conditions of T_db, 25.1 ± 0.6 °C and RH, 63 ± 5%. Heart rate (HR), gastrointestinal temperature (T_gi), mean weighted skin temperature (T_sk), estimated sweat loss, ratings of perceived exertion (RPE) and thermal sensation (RTS) were recorded.ResultsCompared to L + AMB, participants completed L + ICE trials with lower ΔT_gi (0.8 ± 0.3°C vs 0.6 ± 0.2 °C; p = 0.03), mean RPE (10 ± 1 vs 9 ± 1; p = 0.03) and estimated sweat loss (0.91 ± 0.2 L vs 0.78 ± 0.27 L; p = 0.04). Contrastingly, T_gi (p = 0.22), T_sk (p = 0.37), HR (p = 0.31), RPE (p = 0.38) and sweat loss (p = 0.17) were similar between M + AMB and M + ICE trials. RTS was similar during both low-intensity (4.9 ± 0.5 vs 4.7 ± 0.3; p = 0.10) and moderate-intensity exercise (5.3 ± 0.47 vs 5.0 ± 0.4; p = 0.09).ConclusionsPer-cooling using ice slurry ingestion marginally reduced thermal strain during low-intensity but not during moderate-intensity exercise. Ice slurry may be an effective and practical heat mitigation strategy during low-intensity exercise such as in occupational and military settings, but a greater volume should be considered to ensure its efficacy.