A systematic review of incubator-based neonatal radiography – What does the evidence say?

ObjectivesThis systematic review aimed to explore the impact of incubator design (canopy, mattress, and mattress support) on neonatal imaging in terms of imaging technique, radiation dose and image quality.Key FindingsA systematic literature review was performed by searching multiple healthcare databases. Following study selection and extraction, 7 articles were deemed eligible and included within the study. Of these 7 studies, six were experimental phantom based with the remaining one being a retrospective analysis. Four studies reported a percentage reduction in beam attenuation for incubator components ranging from 12% to 72% with one other study reporting a reduction but with no numerical data. This wide variation in radiation beam attenuation from the incubator components was correlated with image quality within five studies, two suggesting reduced image quality when using the incubator tray under the mattress support whilst the other three found no significant difference. Although the seven studies reported that incubator components reduced X-ray beam intensity, there was limited evidence on whether this required an increase in exposure factors. Only one study suggested increasing exposure parameters to accommodate for the increase in beam attenuation when using an incubator tray.ConclusionThe literature clearly demonstrates that with existing incubator designs, there is considerable beam attenuation between placing the image receptor directly behind the neonate as oppose to the incubator tray. However, this radiation beam attenuation is not well correlated to neonatal radiation dose or image quality effects and therefore is very confusing when considering clinical implementation.Implications for practiceThis review highlights the need for standardisation and further optimisation work to ensure best practice for this vulnerable patient group.     

What about cerebral venous sinus thrombosis? A series of three autopsy cases

Cerebral venous sinus thrombosis (CVST) is an uncommon cerebrovascular disorder that gained massive media attention in 2021, when an association between COVID-19 and its vaccines was found in several reported cases, raising the suspicion of a causative relation that is still debated.Three cases of CVST unrelated to COVID-19 are reported in this article to highlight the difficulty in the early recognition and management of this condition, as it occurs in a variety of diseases with different clinical and pathological manifestations.When the diagnosis cannot be achieved in the clinical setting, the role of the pathologist becomes essential in the determination of the cause of death and in the identification of the etiology of CVST.During the autopsy, coordination between the physician and the forensic pathologist is crucial to correlate the clinical presentation with the pathological picture.     

Do brain image databanks support understanding of normal ageing brain structure? A systematic review

Objective

To document accessible magnetic resonance (MR) brain images, metadata and statistical results from normal older subjects that may be used to improve diagnoses of dementia.

Methods

We systematically reviewed published brain image databanks (print literature and Internet) concerned with normal ageing brain structure.

Results

From nine eligible databanks, there appeared to be 944 normal subjects aged ≥60?years. However, many subjects were in more than one databank and not all were fully representative of normal ageing clinical characteristics. Therefore, there were approximately 343 subjects aged ≥60?years with metadata representative of normal ageing, but only 98 subjects were openly accessible. No databank had the range of MR image sequences, e.g. T2*, fluid-attenuated inversion recovery (FLAIR), required to effectively characterise the features of brain ageing. No databank supported random subject retrieval; therefore, manual selection bias and errors may occur in studies that use these subjects as controls. Finally, no databank stored results from statistical analyses of its brain image and metadata that may be validated with analyses of further data.

Conclusion

Brain image databanks require open access, more subjects, metadata, MR image sequences, searchability and statistical results to improve understanding of normal ageing brain structure and diagnoses of dementia.

Key Points

? We reviewed databanks with structural MR brain images of normal older people. ? Among these nine databanks, 98 normal subjects ≥60 years were openly accessible. ? None had all the required sequences, random subject retrieval or statistical results. ? More access, subjects, sequences, metadata, searchability and results are needed. ? These may improve understanding of normal brain ageing and diagnoses of dementia.     

Imaging the premature brain: ultrasound or MRI?

Neuroimaging of preterm infants has become part of routine clinical care, but the question is often raised on how often cranial ultrasound should be done and whether every high risk preterm infant should at least have one MRI during the neonatal period. An increasing number of centres perform an MRI either at discharge or around term equivalent age, and a few centres have access to a magnet in or adjacent to the neonatal intensive care unit and are doing sequential MRIs. In this review, we try to discuss when best to perform these two neuroimaging techniques and the additional information each technique may provide.     

A systematic review of the reliability of diagnostic ultrasound imaging in measuring tendon size: Is the error clinically acceptable?

BackgroundDiagnostic ultrasound (US) is a commonly used imaging modality for visualising tendon pathology and morphology. In comparison to magnetic resonance imaging (MRI), diagnostic US is perceived to have a higher risk of error when evaluating tendon size.AimTo systematically assess the evidence regarding the Intra rater and Inter rater reliability of diagnostic US measurements of tendon size.Data sourcesEight electronic databases were searched using an agreed set of keywords. Studies which investigated the reliability of tendon size (thickness or cross sectional area) using diagnostic US were eligible.ResultsCombined Inter rater and Intra rater ICC values for tendon thickness ranged from 0.45 to 0.99. Combined Inter rater and Intra rater ICC values for tendon cross-sectional area (CSA) ranged from 0.58 to 0.92. Overall, Intra rater ICC values (0.59–0.99) were marginally higher than Inter rater values (0.45–0.99) across all tendon sites. Percentage co-efficient of variation (CV%) for tendon thickness and CSA ranged from 0 to 35% across all tendons. Percentage standard error of the mean SEM% values for tendon thickness ranged from 3.33% to 7.39%.ConclusionsThe findings of this review suggest diagnostic US measures of tendon size are reliable, both in terms of relative and absolute reliability. However, the findings must be considered in light of the presence of tendon abnormalities in a large percentage of asymptomatic populations.     

Does exercise reduce brain oxidative stress? A systematic review

The aim of the present systematic review was to investigate the influence of different exercise programs on brain oxidative stress. A search of the literature was conducted up to 1 December 2012 across five databases: PUBMED, SCOPUS, SPORTS DISCUS, Web of Science, and The Cochrane Library. The search strategy used in the electronic databases mentioned was established as: (swim* OR exercise OR training) AND (“oxidative stress” AND brain) for each database. A methodological quality assessment valuation/estimation was additionally carried out in the final sample of studies. Of 1553 potentially eligible papers, 19 were included after inclusion and exclusion criteria. The methodological quality assessment showed a total score in the Quality Index between 40% and 80%, with a mean quality of 56.8%. Overall, regular moderate aerobic exercise appears to promote antioxidant capacity on brain. In contrast, anaerobic or high‐intensity exercise, aerobic‐exhausted exercise, or the combination of both types of training could deteriorate the antioxidant response. Future investigations should be focused on establishing a standardized exercise protocol, depending on the exercise metabolism wanted to test, which could enhance the objective knowledge in this topic.     

How can we meet the support needs of LGBT cancer patients in oncology? A systematic review

ObjectivesApproximately 3.6 million people in the UK identify as lesbian, gay, bisexual and transgender (LGBT). Fear of discrimination and lack of sexual orientation and gender identity recording suggests LGBT people are invisible to health services. A systematic review was conducted to critically analyse primary research investigating psychosocial support needs for LGBT cancer patients during and after treatment.Key findingsTwenty studies were included in the review; of which ten were qualitative, seven quantitative and three mixed methods. The main themes highlighted include health care professional knowledge and education, negative impact on mental health, lack of inclusive support groups, prevalence of discrimination within healthcare services and the disclosure or non-disclosure of sexual orientation and gender identity.ConclusionThe review highlights how healthcare providers are failing LGBT cancer patients in psychosocial support resulting in unmet needs. Recommendations have been made to ensure an LGBT inclusive environment within cancer services, as well as the need to develop support services for LGBT cancer patients.Implications for practiceTraining should be provided for HCP staff in LGBT health and awareness. Sexual orientation and gender identity recording and monitoring is important to ensure LGBT people are not ‘invisible’ in oncology, radiotherapy and in future research. LGBT cancer support groups and resources should be created, as the review evidence suggests LGBT patients are actively looking for these resources.     

Are there adaptive changes in the human brain of patients with Parkinson’s disease treated with long-term deep brain stimulation of the subthalamic nucleus? A 4-year follow-up study with regional cerebral blood flow SPECT

Purpose The aim of this follow-up study was to assess persistent motor and regional cerebral blood flow (rCBF) changes in patients with Parkinson’s disease (PD) treated with high-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN). Methods Ten PD patients with STN-DBS underwent three rCBF SPECT studies at rest, once preoperatively in the off-drug condition (T₀), and twice postoperatively in the off-drug/off-stimulation conditions at 5 ± 2 (T₁) and 42 ± 7 months (T₂). Patients were assessed using the UPDRS, H&Y and S&E scales. SPM was used to investigate baseline rCBF changes from the preoperative condition to the postoperative conditions and the relationship between rCBF and UPDRS scores used as covariate of interest. Results Parkinsonian patients showed a clinical improvement which was significant only on follow-up at 42 months. The main effect of treatment from T₀ to T₁ was to produce baseline rCBF increases in the pre-supplementary motor area (pre-SMA), premotor cortex and somatosensory association cortex. From T₁ to T₂ a further baseline rCBF increase was detected in the pre-SMA (p < 0.0001). A correlation was detected between the slight improvement in motor scores and the rCBF increase in the pre-SMA (p < 0.0001), which is known to play a crucial role in clinical progression. Conclusion Our study suggests the presence of adaptive functional changes in the human brain of PD patients treated with long-term STN-DBS. Such adaptive processes seem to occur in the pre-SMA and to play only a slightly beneficial role in terms of functional compensation of motor impairment.     

Chronic cerebrospinal venous insufficiency: does ultrasound really distinguish multiple sclerosis subjects from healthy controls?

Objectives  

To investigate the differences between multiple sclerosis (MS) and control subjects by using extracranial venous grey-scale, colour and spectral Doppler ultrasound.     

How valid is the determination of hematocrit values to detect blood manipulations?

The aim of this paper is a critical reflection of the practice in competitive cycling to use the hematocrit value (Hct) as an indirect control measure for doping with erythropoietin. To demonstrate the individual physiological variation of Hct values, five different studies were performed: 1) Eight subjects were observed (i) during 23 h after a 1 h lasting bout of cycle exercise at 60% of maximum performance and (ii) during 24h under control conditions. 2) Seven subjects were exposed to a 20 min period of -7 head down tilt (HDT), which was followed by 15 min in sitting position. 3) From four subjects blood samples were taken in a sitting position up to 60 min after they had ingested 1 liter isotonic saline solution. 4) Ten subjects performed a vita maxima test on a cycle ergometer, starting at 100W and increasing the workload by 17W every minute. 5) Four elite cyclists participated in a 10 days competition (1,700 km). RESULTS: 1) During the 24h observation period Hct decreased during the night from 45.3+/-3.1 % to 42.9+/-1.5% and returned to the initial values in the morning. This diurnal variation was even more pronounced after submaximal exercise (-4.1 %). 2) Due to fluid shifts from the interstitial into the intravasal compartment, HDT was accompanied by a 3.1+/-0.5% lower Hct. 3) Drinking of the isotonic saline solution also reduced the hematocrit by 3.3+/-0.5% after one hour. 4) Maximum cycle exercise increased the Hct from 46.8+/-2.4 % to 51.3+/-1.9% which was due to a 15 % decrease in plasma volume. 5) Repeated bouts of cycle-exercise reduced the Hct from 46.4+/-1.5% to 41.3+/-1.6%. CONCLUSIONS: All experiments demonstrate that the Hct is not a constant value but can be considerably changed by physiological measures. Clinical studies show that brain oxygen supply decreases with increasing Hct-values, which are also associated with a higher risk of stroke accidents. We therefore recommend to use a Hct-limit solely under strongly controlled standardized conditions to protect professional cyclists from hazardous manoeuvre until more appropriate methods to detect EPO-doping are developed.     

The angioarchitectural factors of the cerebral developmental venous anomaly; can they be the causes of concurrent sporadic cavernous malformation?

Introduction  

The aim of this paper was to evaluate the angioarchitectural factors that can induce concurrent cavernous malformation (CM) in the territory of developmental venous anomaly (DVA).     

Treatment of spastic varus/ equinovarus foot with split-tendon transfers in cerebral palsy: How does it affect the hindfoot motion?

IntroductionThe flexible spastic varus foot in cerebral palsy is commonly corrected by split-tendon transfer of tibialis anterior or tibialis posterior. These tendon transfers are said to preserve hindfoot motion, which is until now not been proven. Therefore, the aim of the study was to show the hindfoot motion following split-tendon transfer in comparison to a midtarsal arthrodesis.Materials and methodsA retrospective study was done on patients with flexible spastic varus foot in cerebral palsy who underwent a combined split-tendon transfer of tibialis anterior and posterior. Patients with a rigid foot deformity underwent a midfoot arthrodesis. These children and normal children served as controls. An instrumented gait analysis was done in all patients before and at follow-up. A statistical analysis was done using 2-factor ANOVA with repeated measures on time.ResultsThirteen children underwent a combined split-tendon transfers of tibialis anterior and posterior muscles and 14 children midtarsal arthrodesis. The mean follow-up was 2.4 (SD=0.8) years for flexible varus foot and 1.9 (SD=0.7) years for rigid foot deformity. The preoperative hindfoot range of motion in eversion-inversion was 54% and 49% of TD controls in flexible varus foot and rigid foot deformity respectively. At follow-up, it reduced further to 45% and 42% of TD controls in the respective groups.ConclusionBoth flexible and rigid hindfoot deformity reduced the hindfoot motion. However following surgery, the hindfoot motion reduced further and was identical in both groups independent of the type of surgery. This indicates a tenodesis-effect of split-tendon transfers on the hindfoot.     

Chest ultrasound in the assessment of patients in ICU: How can it help?

Background: Different imaging techniques can be used for assessment of chest problems in ICU patients, however ultrasound is a good diagnostic tool giving more information and at the same time without exposure to radiation and without risk of critical patient transfer.Aim of the work: The aim of this work was to study the role of thoracic ultrasound in assessment of ICU patients.Materials and methods: The study was carried out on 30 patients admitted to the ICU.B and M modes chest ultrasound was done for all patients using EsaoteMyLab?Alpha with eHD Technology.Results: The study included 19 males and 11 females with mean age of 42.6 ± 21.4 years. In this study ultrasound was able to diagnose Pneumothorax: 3 cases (10%). Pleural effusion: 20 cases (66.6%). Alveolar interstitial syndrome: 7 cases (23.3%). Lung consolidation: 20 cases (66.6%). Pulmonary infarcts: 1 case (3.3%). Neoplastic disease: 1 case (3.3%). Chest wall pathology: 1 case (3.3%).Conclusion: Ultrasound examination of the chest is a non- invasive, and promising bed side tool for examination of ICU patients.     

Is magnetic resonance imaging a viable alternative to ultrasound as the primary imaging modality in the diagnosis of paediatric appendicitis? A systematic review

BackgroundAppendicitis is the most common cause of acute abdominal pain requiring surgical intervention in paediatric patients. Ultrasound is generally the diagnostic imaging modality of choice, followed by CT, where paediatric appendicitis is suspected. However, high operator dependency and diagnostic restrictions related to anatomical and clinical presentation may limit consistency of application. This paper explores whether MRI is a viable alternative to ultrasound as the primary imaging modality.MethodA systematic review of the literature was undertaken. A search of Medline, Cinahl, PubMed Central and Google Scholar was undertaken supplemented by a review of reference lists, author searching and review of NICE evidence base for existing guidelines. Included studies were assessed for bias using the QUADAS-2 quality assessment tool and data were extracted systematically using a purposefully designed electronic data extraction proforma.ResultsSeven studies were included in final review. The age range of participants extended from 0 to 19 years. Only one study with a patient age range of 0–14 used sedation. Sensitivity estimates from the included studies ranged from 92% to 100% while specificity ranged from 89% to 100%. A significant variation in the number and type of sequences was noted between the studies.ConclusionMRI offers high sensitivity and specificity comparable to contrast enhanced CT and greater than ultrasound as reported in the literature. Where accessibility is not a restriction, MRI is a viable alternative to ultrasound in the assessment and diagnosis of paediatric appendicitis. Clinical practice recommendations have been provided to facilitate the translation of evidence into practice.