The dilatation of main pulmonary artery and right ventricle observed by enhanced chest computed tomography predict poor outcome in inoperable chronic thromboembolic pulmonary hypertension

BackgroundDilatation of the pulmonary artery and right ventricle on chest computed tomography images is often observed in patients with pulmonary hypertension. The clinical significance of these image findings has not been defined in chronic thromboembolic pulmonary hypertension. We investigated whether the pulmonary arterial and right ventricle dilatation was associated with poor outcome in chronic thromboembolic pulmonary hypertension.MethodsThis was a retrospective cohort investigation in 60 subjects with inoperable chronic thromboembolic pulmonary hypertension diagnosed consecutively between 1997 and 2010 at Chiba University Hospital. Digital scout multi-detector chest computed tomography images were obtained. The main pulmonary arterial to ascending aortic diameter ratio and the right ventricular to left ventricular diameter ratio were calculated.ResultsMain pulmonary arterial to ascending aortic diameter ratio ranged from 0.85 to 1.84, and right ventricular to left ventricular diameter ratio ranged from 0.71 to 2.88. During the observation period of 1284.5 days (range, 21–4550 days), 13 patients required hospitalization due to worsening; 6 of them died. Kaplan–Meier analysis showed significant differences in hospitalization between the patients with main pulmonary arterial to ascending aortic diameter ratio of ≥1.1 and <1.1 (log-rank test, p = 0.014) and between the patients with right ventricular to left ventricular diameter ratio of ≥1.2 and <1.2 (log-rank test, p = 0.013). There was a significant difference in the prognosis between the patients with RV/LV ratio ≥ 1.2 and those with RV/LV ratio < 1.2 (log-rank test, p = 0.033).ConclusionsMain pulmonary arterial to ascending aortic diameter ratio measured using enhanced CT images was associated with the risk for first clinical exacerbation, and right ventricular to left ventricular diameter ratio was associated with the risk for poor prognosis in inoperable chronic thromboembolic pulmonary hypertension.     

Energy efficiency and pulmonary artery flow after balloon pulmonary angioplasty for inoperable,chronic thromboembolic pulmonary hypertension: Analysis by phase-contrast MRI

PurposeThe aims of this study were to propose a new quantitative method for pulmonary artery (PA) flow energetics using phase-contrast magnetic resonance imaging (PC-MRI), and to investigate how balloon pulmonary angioplasty (BPA) impacts energetics in chronic thromboembolic pulmonary hypertension (CTEPH).Materials and methodsPC-MRI at 3-Teslar and with a flow sensitive gradient echo was used to examine energetics prior to and following BPA for 24 CTEPH patients. Stroke volume (m; ml) and mean velocity (V; mm/s) for the main pulmonary artery (PA), right PA, and left PA were calculated from a time-flow curve derived from PC-MRI. Based on the Bernoulli principle, PA energy was identified as 1/2 mV² (μj/kg), and energy loss was defined as the following equation “energy loss = main PA energy − (rt. PA energy + lt. PA energy)”.ResultsRight PA energy was significantly greater post-BPA than pre-BPA (61 ± 55 vs. 32 ± 40 μj/kg). There was no difference in main PA and left PA energies. Energy loss was significantly decreased post-BPA (18 ± 97 μj/kg) than pre-BPA (79 ± 125 μj/kg). An optimal cutoff of left PA energy of 45 μj/kg pre-BPA can be used to predict patients with mPAP ≥ 30 mmHg after BPA, with an area under the curve of 0.91, 78% sensitivity, and 92% specificity.ConclusionAnalysis of PA energetics using phase-contrast MRI demonstrates that BPA improves energy loss in CTEPH. In addition, BPA responses can be predicted by PA energy status pre-treatment.     

Prognostic value of computed tomography pulmonary angiography indices in patients with cancer-related pulmonary embolism: Data from a multicenter cohort study

ObjectiveTo analyze the prognostic value of pulmonary artery obstruction versus right-ventricle (RV) dysfunction radiologic indices in cancer-related pulmonary embolism (PE).MethodsWe enrolled 303 consecutive patients with paraneoplastic PE, evaluated by computed tomography pulmonary angiography (CTPA) between 2013 and 2014. The primary outcome measure was serious complications at 15 days. Multivariate analyses were conducted by using binary logistic and robust regressions. Radiological features such as the Qanadli index (QI) and RV dysfunction signs were analyzed with Spearman’s partial rank correlations.ResultsRV diameter was the only radiological variable associated with an adverse outcome. Subjects with enlarged RV (diameter > 45 mm) had more 15-day complications (58% versus 40%, p = 0.001). The QI correlated with the RV diameter (r = 0.28, p < 0.001), left ventricle diameter (r = −0.19, p < 0.001), right ventricular-to-left ventricular diameter ratio (r = 0.39, p < 0.001), pulmonary artery diameter (r = 0.22, p < 0.001), and pulmonary artery/ascending aorta ratio (r = 0.27, p < 0.001). A QI ≥ 50% was only associated with 15-day complications in subjects with enlarged RV, inverted intraventricular septum, or chronic cardiopulmonary diseases. The central or peripheral PE location did not affect the correlations among radiological variables and was not associated with clinical outcomes.ConclusionsRight ventricular dysfunction signs in CTPA are more useful than QI in predicting cancer-related PE outcome.     

Xenon-enhanced CT using subtraction CT: Basic and preliminary clinical studies for comparison of its efficacy with that of dual-energy CT and ventilation SPECT/CT to assess regional ventilation and pulmonary functional loss in smokers

PurposeTo prospectively and directly compare the capability for assessments of regional ventilation and pulmonary functional loss in smokers of xenon-ventilation CT obtained with the dual-energy CT (DE-CT) and subtraction CT (Sub-CT)Materials and methodsTwenty-three consecutive smokers (15 men and 8 women, mean age: 69.7 ± 8.7 years) underwent prospective unenhanced and xenon-enhanced CTs, the latter by Sub-CT and DE-CT methods, ventilation SPECT and pulmonary function tests. Sub-CT was generated from unenhanced and xenon-enhanced CT, and all co-registered SPECT/CT data were produced from SPECT and unenhanced CT data. For each method, regional ventilation was assessed by using a 11-point scoring system on a per-lobe basis. To determine the functional lung volume by each method, it was also calculated for individual sublets with a previously reported method. To determine inter-observer agreement for each method, ventilation defect assessment was evaluated by using the χ2 test with weighted kappa statistics. For evaluation of the efficacy of each method for pulmonary functional loss assessment, functional lung volume was correlated with%FEV₁.ResultsEach inter-observer agreement was rated as substantial (Sub-CT: κ = 0.69, p < 0.0001; DE-CT: κ = 0.64, p < 0.0001; SPECT/CT: κ = 0.64, p < 0.0001). Functional lung volume for each method showed significant to good correlation with%FEV₁ (Sub-CT: r = 0.72, p = 0.0001; DE-CT: r = 0.74, p < 0.0001; SPECT/CT: r = 0.66, p = 0.0006).ConclusionXenon-enhanced CT obtained by Sub-CT can be considered at least as efficacious as that obtained by DE-CT and SPECT/CT for assessment of ventilation abnormality and pulmonary functional loss in smokers.     

Analysis of decrease in lung perfusion blood volume with occlusive and non-occlusive pulmonary embolisms

PurposeThe aim of this study was to determine if lung perfusion blood volume (lung PBV) with non-occlusive pulmonary embolism (PE) differs quantitatively and visually from that with occlusive PE and to investigate if lung PBV with non-occlusive PE remains the same as that without PE.Materials and methodsTotally, 108 patients suspected of having acute PE underwent pulmonary dual-energy computed tomography angiography (DECTA) between April 2011 and January 2012. Presence of PE on DECTA was evaluated by one radiologist. Two radiologists visually evaluated the PE distribution (segmental or subsegmental) and its nature (occlusive or non-occlusive) on DECTA and classified perfusion in lung PBV as “decreased,” “slightly decreased,” and “preserved”. Two radiologists used a lung PBV application to set a region of interest (ROI) in the center of the lesion and measured HU values of an iodine map. In the same slice as the ROI of the lesion and close to the lesion, another ROI was set in the normal perfusion area without PE, and HUs were measured. The proportion of lesions was compared between the occlusive and non-occlusive groups. HUs were compared among the occlusive, non-occlusive, and corresponding normal groups.ResultsTwenty-five patients had 80 segmental or subsegmental lesions. There were 37 and 43 lesions in the occlusive and non-occlusive groups, respectively. The proportion of decreased lesions was 73.0% (27/37) in the occlusive group, while that of preserved lesions in the non-occlusive group was 76.7% (33/43). There was a significant difference in the proportion of lesions (P < 0.001) between the two groups. HUs of the iodine map were significantly higher in the non-occlusive group than in the occlusive group (33.8 ± 8.2 HU vs. 11.9 ± 6.1 HU, P < 0.001). There was no significant difference in HUs for the entire lesion between the non-occlusive (33.8 ± 8.2 HU) and corresponding normal group (34.5 ± 6.8 HU; P = 0.294).ConclusionIodine perfusion tended to be visually and quantitatively preserved in lungs with nonocclusive PE. Lung PBV is required to evaluate pulmonary blood flow.     

The importance of subpleural fibrosis in the prognosis of patients with idiopathic interstitial pneumonias

PurposeTo compare computer-aided diagnostic results with histological findings obtained by surgical biopsy and evaluate whether subpleural lesion volumes can aid identification of idiopathic pulmonary fibrosis (IPF).Materials andMethodsWe retrospectively analyzed computed tomography (CT) images of 79 patients (43 with fibrosing nonspecific interstitial pneumonia (fNSIP) and 36 with IPF) using the Gaussian Histogram Normalized Correlation (GHNC) system. We determined the H-pattern based on honeycomb and/or fibrosis with traction bronchiectasis on CT, and measured the H-pattern volume ratio at the biopsy sites and in the subpleural area. The biopsy site CT data were compared with biopsy specimens using Spearman’s correlation. H-pattern volumes in the subpleural area within 2 mm under the pleura (H₂) were analyzed to predict IPF diagnosis and patients prognosis.ResultsThe H-pattern volume ratio at the biopsy sites showed significant correlation with histological honeycomb (r = 0.355, p < 0.001), subpleural collapse (r = 0.410, p < 0.001), and heterogeneity (r = 0.484, p < 0.001). Multivariate regression analysis, adjusting for age, sex, and CT results, revealed that the H2 was a significant independent predictor of IPF diagnosis (odds ratio: 1.073; p = 0.048). H2 correlated with patients’ survival after adjusting for age (p = 0.003).ConclusionThe computer-aided H-pattern volume ratio of the subpleural area indicates subpleural abnormalities quantitatively and may help diagnose IPF.     

Pulmonary MRI at 3T: Non-enhanced pulmonary magnetic resonance Imaging Characterization Quotients for differentiation of infectious and malignant lesions

ObjectiveTo investigate 3T pulmonary magnetic resonance imaging (MRI) for characterization of solid pulmonary lesions in immunocompromised patients and to differentiate infectious from malignant lesions.Materials and methodsThirty-eight pulmonary lesions in 29 patients were evaluated. Seventeen patients were immunocompromised (11 infections and 6 lymphomas) and 12 served as controls (4 bacterial pneumonias, 8 solid tumors). Ten of the 15 infections were acute. Signal intensities (SI) were measured in the lesion, chest wall muscle, and subcutaneous fat. Scaled SIs as Non-enhanced Imaging Characterization Quotients ((SI_Lesion − SI_Muscle)/(SI_Fat − SI_Muscle)*100) were calculated from the T2-weighted images using the mean SI (T2-NICQ_mean) or the 90th percentile of SI (T2-NICQ_90th) of the lesion. Simple quotients were calculated by dividing the SI of the lesion by the SI of chest wall muscle (e.g. T1-Q_mean: SI_Lesion/SI_Muscle).ResultsInfectious pulmonary lesions showed a higher T2-NICQ_mean (40.1 [14.6–56.0] vs. 20.9 [2.4–30.1], p < 0.05) and T2-NICQ_90th (74.3 [43.8–91.6] vs. 38.5 [15.8–48.1], p < 0.01) than malignant lesions. T1-Q_mean was higher in malignant lesions (0.85 [0.68–0.94] vs. 0.93 [0.87–1.09], p < 0.05). Considering infections only, T2-NICQ_90th was lower when anti-infectious treatment was administered >24 h prior to MRI (81.8 [71.8–97.6] vs. 41.4 [26.6–51.1], p < 0.01). Using Youden’s index (YI), the optimal cutoff to differentiate infectious from malignant lesions was 43.1 for T2-NICQ_mean (YI = 0.42, 0.47 sensitivity, 0.95 specificity) and 55.5 for T2-NICQ_90th (YI = 0.61, 0.71 sensitivity, 0.91 specificity). Combining T2-NICQ_90th and T1-Q_mean increased diagnostic performance (YI = 0.72, 0.77 sensitivity, 0.95 specificity).ConclusionConsidering each quotient alone, T2-NICQ_90th showed the best diagnostic performance and could allow differentiation of acute infectious from malignant pulmonary lesions with high specificity. Combining T2-NICQ_90th with T1-Q_mean increased overall performance, especially regarding sensitivity.     

Performance of a simple robust empiric timing protocol for CT pulmonary angiography

ObjectiveWe instituted a new, simple CT pulmonary angiography (CTPA) contrast material timing protocol using a standard empiric delay to replace our previous timing bolus method. This study tests the hypothesis that the empiric protocol more consistently produces diagnostic quality images of both the pulmonary arteries and the aorta with lower radiation exposure.Materials and methodsWe performed a retrospective review of consecutive CTPAs for 2 months both before and after the protocol change. Pulmonary artery and aortic enhancement, patient characteristics, radiation exposure and results of CTPA were analyzed.ResultsThere were 182 patients in the timing bolus group and 164 in the empiric timing group. Both groups had a female majority (59%) and a similar mean age (58 and 57 years, respectively). Enhancement was significantly higher both for the pulmonary artery (median 400 HU versus 359 HU, P < 0.001) and aorta (median 381 HU versus 218 HU, P < 0.01) in the empiric timing group versus the timing bolus group, respectively. Radiation exposure was lower (5.3 mSv versus 6.0 mSv, P = 0.05) in the empiric timing group, despite a higher body-mass-index (31 versus 29 kg/m², P < 0.01). Pulmonary embolism positivity rate was non-significantly higher in the timing bolus vs the empiric timing group (19% and 13%, P = 0.1).ConclusionA simple empiric timing protocol for CTPA has robust performance compared to a timing bolus protocol. Empiric timing preserves the required high diagnostic quality for evaluation of the pulmonary arteries with the added benefits of aortic enhancement and lower radiation exposure.     

Reallocating time spent in physical activity intensities: Longitudinal associations with physical fitness (DADOS study)

ObjectivesFirstly, to investigate the longitudinal associations between accelerometer-derived physical activity (PA) intensities and physical fitness (PF) at 24-month follow-up in adolescents. Secondly, to examine how substituting time spent in low or moderate PA intensities with vigorous PA at baseline was related to PF at 24-month follow-up.DesignLongitudinal observational studyMethodThe DADOS (Deporte, ADOlescencia y Salud) study is a 3-year longitudinal research project carried out between years 2015–2017. The analyses included 189 adolescents (91 girls) aged 13.9 ± 0.3 years at baseline. PA was assessed by a wrist-worn GENEActiv triaxial accelerometer and expressed as minutes/day of light, moderate and vigorous PA. Cardiorespiratory, musculoskeletal and motor fitness were assessed by field tests and a global fitness z-score was calculated as the mean of the z-scores values of each fitness test. Association between PA intensities and PF were determined using linear regression. Isotemporal analyses estimating the association of reallocating PA intensities with PF were performed.ResultsBaseline vigorous PA was positively associated with cardiorespiratory fitness and global fitness score at follow-up in boys (β = 0.234;p = 0.002, β = 0.340;p < 0.001) and girls (β = 0.184;p = 0.043, β = 0.213;p = 0.004). In boys, baseline vigorous PA was also positively associated with musculoskeletal and motor fitness (β = 0.139;p = 0.035, β = 0.195;p = 0.021). The substitution of 10 min/day of light PA or moderate PA with 10 min/day of vigorous PA at baseline was positively associated with all PF components and global fitness score in boys (p < 0.001), and with global fitness score girls (p < 0.05).ConclusionThese findings highlight the need of promoting vigorous PA due to its specific influence on adolescent's PF.     

Remodelado cardíaco inverso en pacientes con hipertensión pulmonar tras trasplante bipulmonar. Estudio con tomografía computarizada multidetector

ObjectiveTo use multidetector computed tomography (MDCT) to evaluate the structural changes in the right heart and pulmonary arteries that occur in patients with severe pulmonary hypertension treated by double lung transplantation.Material and methodsThis was a retrospective study of 21 consecutive patients diagnosed with severe pulmonary hypertension who underwent double lung transplantation at our center between 2010 and 2014. We analyzed the last MDCT study done before lung transplantation and the first MDCT study done after lung transplantation. We recorded the following variables: diameter of the pulmonary artery trunk, ratio of the diameter of the pulmonary artery trunk to the diameter of the ascending aorta, diameter of the right ventricle, ratio of the diameter of the left ventricle to the diameter of the right ventricle, and eccentricity index. Statistical analysis consisted of the comparison of the means of the variables recorded.ResultsIn all cases analyzed, the MDCT study done a mean of 24 ± 14 days after double lung transplantation showed a significant reduction in the size of the right heart chambers, with improved indices of ventricular interdependency index, and reduction in the size of the pulmonary artery trunk (p < 0.001 for all the variables analyzed).ConclusionPatients with pulmonary hypertension treated by double lung transplantation present early reverse remodeling of the changes in the structures of the right heart and pulmonary arterial tree. MDCT is useful for detecting these changes.     

Comparison of the correlations between impact loading rates and peak accelerations measured at two different body sites: Intra- and inter-subject analysis

BackgroundHigh average (VALR) and instantaneous vertical loading rates (VILR) during impact have been associated with many running-related injuries. Peak acceleration (PA), measured with an accelerometer, has provided an alternative method to estimate impact loading during outdoor running. This study sought to compare both intra- and inter-subject correlations between vertical loading rates and PA measured at two body sites during running.MethodsGround reaction force data were collected from 10 healthy adults (age = 23.6 ± 3.8 years) during treadmill running at different speeds and inclination surfaces. Concurrently, PAs at the lateral malleoli and the distal tibia were measured using synchronized accelerometers.ResultsWe found significant positive intra-subject correlation between loading rates and PA at the lateral malleoli (r = 0.561–0.950, p < 0.001) and the distal tibia (r = 0.486–0.913, p < 0.001). PA measured at the lateral malleoli showed stronger correlation with loading rates (p = 0.004) than the measurement at the distal tibia. On the other hand, inter-subject variances were observed in the association between PA and vertical loading rates. The inter-subject variances at the distal tibia were 3.88 ± 3.09 BW/s and 5.69 ± 3.05 BW/s in VALR and VLIR respectively. Similarly, the inter-subject variances in the measurement at lateral malleoli were 5.24 ± 2.85 BW/s and 6.67 ± 2.83 BW/s in VALR and VLIR respectively.ConclusionsPA measured at lateral malleoli has stronger correlation with VALR or VILR than the measurement at distal tibia. Caution is advised when using PA to conduct inter-subject comparisons of vertical loading rates during running.     

The value of paradoxical uptake of hepatocellular carcinoma on the hepatobiliary phase of gadoxetic acid-enhanced liver magnetic resonance imaging for the prediction of lipiodol uptake after transcatheter arterial chemoembolization

PurposeTo compare the response to transcatheter arterial chemoembolization (TACE) between hepatocellular carcinoma (HCC) with paradoxical uptake on the hepatobiliary phase (HBP) (HCC_para) and HCC with defect on the HBP (HCC_def), and to identify some imaging features that can differentiate between two groups.Materials and methodsNinety-three HCCs from 54 patients who underwent gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) prior to TACE were included. HCCs were classified into two groups according to the signal intensity (SI) on the HBP: HCC_para and HCC_def. Using post-TACE computed tomography (CT) as a reference standard, initial compact lipiodol uptake was assessed and compared between groups. The arterial enhancement ratio (AER), SI ratios of the arterial phase and HBP, and presence of the capsule appearance were compared between groups. After initial response, local tumor recurrence within 6 and 18 months was evaluated based on follow-up CT or MRI.ResultsFifteen HCC_para and 78 HCC_def were included. Compared to HCC_def, HCC_para showed more frequent initial compact lipiodol uptake (p = 0.009), larger mean size (p = 0.019), lower AER (p = 0.005), higher SI ratio of the HBP (p < 0.0001), and more frequent capsule appearance (p < 0.0001). Local tumor recurrence rate within 6 months was also significantly lower in HCC_para than in HCC_def (p = 0.008).ConclusionDespite larger size and lower AER, HCC_para showed more frequent initial compact lipiodol uptake and lower early local recurrence rate after TACE than did HCC_def.     

Can anthropometry and physical fitness testing explain physical activity levels in children and adolescents with obesity?

ObjectivesAs time with patients and resources are increasingly limited, it is important to determine if clinical tests can provide further insight into real-world behaviors linked to clinical outcomes. The purpose of this study was to determine which aspects of anthropometry and physical fitness testing are associated with physical activity (PA) levels among youth with obesity.DesignCross-sectional study.MethodAnthropometry [height, waist circumference, bodyweight, fat percentage], physical fitness [muscular endurance (partial curl-ups), flexibility (sit-and-reach), lower-body power (long-jump), upper-body strength (grip), speed/agility (5 × 5-m shuttle), cardiorespiratory fitness (VO₂-max)], and PA [light (LPA), moderate (MPA), vigorous (VPA), MVPA] was assessed in 203 youth with obesity.ResultsThe sample was stratified by age <12 yrs (children); 12 yrs (adolescents) and sex. Stepwise regression evaluated associations between PA with anthropometry and physical fitness. Children (57% male) and adolescents (45% male) had a BMI Z-score of 3.5(SD:0.94) and 3.1(SD:0.76) respectively. Long-jump explained 19.5% [(Standardized) Beta = 0.44; p = 0.001] of variance in VPA for childhood girls and 12.6% (Beta = 0.35; p = 0.025) of variance in MPA for adolescent boys. 5 × 5-m shuttle explained 8.4% (Beta = −0.29; p = 0.042) of variance in MVPA for childhood girls. Body mass explained 6.3% (Beta = −0.25; p = 0.007) of variance in LPA in childhood boys. Fat percentage explained 9.8% (Beta = 0.31; p = 0.03) of variance in MPA in adolescent girls.ConclusionsIn conclusion, tests of lower body power, body mass and fat percentage provide limited information concerning PA levels in youth with obesity. Activity monitoring should be considered in addition to clinical assessments to more fully understand youth health.     

Quantitative CT analysis of pulmonary pure ground-glass nodule predicts histological invasiveness

ObjectiveTo assess whether quantitative computed tomography (CT) can help predict histological invasiveness of pulmonary adenocarcinoma appearing as pure ground glass nodules (pGGNs).MethodsA total of 110 pulmonary pGGNs were retrospectively evaluated, and pathologically classified as pre-invasive lesions, minimally invasive adenocarcinoma (MIA) and invasive pulmonary adenocarcinoma (IPA). Maximum nodule diameters, largest cross-sectional areas, volumes, mean CT values, weights, and CT attenuation values at the 0th,2th,5th, 25th, 50th,75th, 95th, 98th and100th percentiles on histogram, as well as 2th to 98th, 5th to 95th, 25th to 75th,and 0th to 100thslopes, respectively, were compared among the three groups.ResultsOf the 110 pGGNs, 50, 28, and 32 were pre-invasive lesions, MIA, and IPA, respectively. Maximum nodule diameters, largest cross-sectional areas, andmass weights were significantly larger in the IPA group than in pre-invasive lesions. The 95th, 98th, 100th percentiles, and 2th to 98th, 25th to 75th, and 0th to 100thslopes were significantly different between pre-invasive lesions and MIA or IPA. Logistic regression analysis showed that the maximum nodule diameter (OR = 1.21, 95%CI: 1.071–1.366, p < 0.01) and 100th percentile on histogram (OR = 1.02, 95%CI: 1.009–1.032, p < 0.001) independently predicted histological invasiveness.ConclusionsQuantitative analysis of CT imaging can predict histological invasiveness of pGGNs, especiallythe maximum nodule diameter and 100th percentile on CT number histogram; this can instruct the long-term follow-up and selective surgical management.     

Drivers of adolescent adiposity: Evidence from the Australian LOOK study

ObjectivesTo contribute to our understanding of the drivers of body composition during adolescence we sought to employ valid and reliable measures to investigate cross-sectional and longitudinal relationships between percentage body fat (%BF) and physical activity (PA), moderate and vigorous PA (MVPA), sedentary time (ST), total energy, sugar and fat intake.DesignLongitudinal cohort study.MethodsWe measured 556 (289 male) participants at age 12.4 (SD 0.4) years, and 269 (123 males) at 16.3 (SD 0.4) years, for %BF (dual energy X-ray absorptiometry); habitual PA, MVPA, ST (accelerometry); and dietary intake (‘multi-pass’ weekday and weekend 24-h recall). Accounting for likely under-reporting of energy intake (Goldberg cut-off), general linear mixed modelling was used to generate relationships with %BF.ResultsCross-sectional analyses indicated that 10 min more MVPA per day was associated with 0.6 lower %BF (95%CI 0.4–0.9, p < 0.001), and 10 min less ST/day with 0.07 lower %BF (95%CI 0.00–0.15, p < 0.001), independently of PA. In contrast, %BF was unrelated to total energy (p = 0.4), sugar intake (p = 0.2) or fat intake (p = 0.9). Longitudinal analysis showed that if PA was increased by 3% (10,000 counts/day) over the 4 years, then %BF was reduced by 0.08 (95%CI 0.05–0.12, p = 0.06).ConclusionsThe independent relationships of %BF with PA and ST, but absence of relationships with energy, sugar or fat intake, suggest that general community campaigns in a developed country directed at reducing adolescent obesity through modifications to energy intake and output would benefit from a more concerted focus on the latter.     

Photodynamic Therapy for an iris metastasis from pulmonary adenocarcinoma

Uveal metastasis is the most common intraocular malignancy. Lung cancer is one of the most common malignancies that metastasize to uvea. Iris involvement is rarely reported. Here we report a case of iris metastasis from pulmonary adenocarcinoma that was treated with photodynamic therapy (PDT).A 65-year-old Chinese man was referred to our hospital for iris white neoplasm and blurred vision for 2 weeks in his right eye. His accepted pulmonary lobectomy, radiotherapy and chemotherapy for pulmonary adenocarcinoma 1 year ago and liver metastases were found 2 months earlier. At presentation, anterior segment examination of the right eye showed a hypopigmented, vascularized papillary 3.8 *3.19 mm neoplasm located on the temporal iris expanding to 9-clock anterior chamber angle. The patient refused to accept MRI, biopsy and treatment. One week later the tumor grew up to 5.5*7.4 mm with diffuse mixed conjunctiva congestion and elevated IOP. A modified PDT was applied. Intravenous verteporfin (3 mg/m2) was infused with a 1 min bolus. PDT with 3 partly overlapped 5 mm laser spots, 689 nm (50 J/cm²) and 166 s were performed 4 minuets later without contact lens. The neo-genesis vessels were occluded with small patch bleeding on the edema tumor that was separated from the anterior chamber angle in the 3 days follow-up.PDT may be a safe, noninvasive and psychologically well-accepted treatment for iris metastasis.     

Preoperative evaluation of anomalous pulmonary venous connection using dual-source computed tomography: Comparison with echocardiography

PurposeTo evaluate the image features and diagnostic agreement for anomalous pulmonary venous connection (APVC) by dual-source computed tomography (DSCT) before surgery when compared with trans-thoracic echocardiography (TTE).Materials and methodsA total of one hundred and twenty-three patients were enrolled in this study. The associated malformation was analyzed between 39 total anomalous pulmonary venous connections (TAPVC) and 84 partial anomalous pulmonary venous connections (PAPVC). For 75 patients who received surgical treatment, the diagnostic agreement between the surgical findings of DSCT and TTE was evaluated. The dimensions of the four chambers of the heart were also measured by DSCT and TTE.ResultsAtrial septal defect is the most common anomaly associated with APVC (86/123, 69.9%), which has a higher incidence in TAPVC compared to that in PAPVC (100% vs. 56.0%, p < 0.001). Of 75 operative patients, discrepancies in diagnostic sensitivity existed between DSCT and TTE for different drainage sites, supracardiac (94.4% vs. 82.2%, p = 0.001), cardiac (98.7% vs. 91.1%, p = 0.089), and infracardiac (100% vs. 57.1%, p = 0.096), respectively, and for different venous origins, right superior pulmonary vein (98.4% vs. 87.1%, p = 0.871), right inferior pulmonary vein (100% vs. 87.3%, p = 0.006), left superior pulmonary vein (100% vs. 93.1%, p = 0.246), left inferior pulmonary vein (100% vs. 95.7%, p = 0.500), and atypical pulmonary vein (66.7% vs. 44.4%, p = 0.011), respectively. Good agreement was obtained between DSCT and TTE for measurements of left atrium, left ventricle, right atrium, and right ventricle sizes (bias 0.3 ± 5.05 mm, −0.3 ± 4.50 mm, 5.8 ± 14.15 mm, and 1.1 ± 5.95 mm, respectively).ConclusionsDSCT can provide optimal and accurate anatomy details for patients with APVC, and serves as a promising accessary imaging modality after TTE to achieve a better and comprehensive preoperative imaging evaluation.     

Physical activity,mental health and well-being of adults during initial COVID-19 containment strategies: A multi-country cross-sectional analysis

ObjectivesTo assess physical activity (PA), mental health and well-being of adults in the United Kingdom (UK), Ireland, New Zealand and Australia during the initial stages of National governments’ Coronavirus disease (COVID-19) containment responses.DesignObservational, cross-sectional.MethodsAn online survey was disseminated to adults (n = 8,425; 44.5 ± 14.8y) residing in the UK, Ireland, New Zealand and Australia within the first 2-6 weeks of government-mandated COVID-19 restrictions. Main outcome measures included: Stages of Change scale for exercise behaviour change; International Physical Activity Questionnaire (short-form); World Health Organisation-5 Well-being Index; and the Depression Anxiety and Stress Scale-9.ResultsParticipants who reported a negative change in exercise behaviour from before initial COVID-19 restrictions to during the initial COVID-19 restrictions demonstrated poorer mental health and well-being compared to those demonstrating either a positive-or no change in their exercise behaviour (p < 0.001). Whilst women reported more positive changes in exercise behaviour, young people (18-29y) reported more negative changes (both p < 0.001). Individuals who had more positive exercise behaviours reported better mental health and well-being (p < 0.001). Although there were no differences in PA between countries, individuals in New Zealand reported better mental health and well-being (p < 0.001).ConclusionThe initial COVID-19 restrictions have differentially impacted upon PA habits of individuals based upon their age and sex, and therefore have important implications for international policy and guideline recommendations. Public health interventions that encourage PA should target specific groups (e.g., men, young adults) who are most vulnerable to the negative effects of physical distancing and/or self-isolation.     

‘Maths on the move’: Effectiveness of physically-active lessons for learning maths and increasing physical activity in primary school students

ObjectivesThis study evaluated the benefit of physically-active lessons for learning maths multiplication-tables. The impact of the intervention on general numeracy, physical activity (PA), aerobic fitness, body mass index (BMI) and school-day moderate to vigorous PA (MVPA) was also assessed.DesignRandomised controlled cross-over trial.MethodYear 3 students (n = 172, mean age 8.4 ± 0.3 years, 48% male) were recruited from 10 classes across two urban primary schools. Participants were randomly assigned to a seated classroom (Classroom) group or physically-active lessons in the playground (Playground) and crossed over to the alternative condition in the subsequent school term. The 6-week intervention comprised 3 × 30 min sessions/week. Multiplication-tables (teacher-designed test) and general maths (standardised test) were assessed pre- and post-intervention. Aerobic fitness was assessed via the shuttle-run. Pre- to post-intervention change scores were compared for analysis and effect sizes (ES) calculated. Total PA and MVPA were assessed with accelerometers in a subset of participants.ResultsMultiplication scores improved significantly more in Playground than Classroom groups (ES = 0.23; p = 0.045), while no significant differences were observed in general numeracy (ES = 0.05; p = 0.66). Total PA and MVPA were substantially higher during Playground than Classroom lessons (ES: total PA = 7.4, MVPA = 6.5; p < 0.001) but there were no differences in PA/MVPA between the groups throughout the rest of the school day. Aerobic fitness improved more in Playground than Classroom groups (ES = 0.3; p < 0.001) while the change in BMI was not different between groups (p = 0.39).ConclusionsPhysically-active lessons may benefit the learning of maths multiplication-tables while favourably contributing to school-day PA/MVPA.     

Application of image-derived and venous input functions in major depression using [carbonyl-11C]WAY-100635

IntroductionImage-derived input functions (IDIFs) represent a promising non-invasive alternative to arterial blood sampling for quantification in positron emission tomography (PET) studies. However, routine applications in patients and longitudinal designs are largely missing despite widespread attempts in healthy subjects. The aim of this study was to apply a previously validated approach to a clinical sample of patients with major depressive disorder (MDD) before and after electroconvulsive therapy (ECT).MethodsEleven scans from 5 patients with venous blood sampling were obtained with the radioligand [carbonyl-¹¹C]WAY-100635 at baseline, before and after 11.0 ± 1.2 ECT sessions. IDIFs were defined by two different image reconstruction algorithms 1) OSEM with subsequent partial volume correction (OSEM + PVC) and 2) reconstruction based modelling of the point spread function (TrueX). Serotonin-1A receptor (5-HT_1A) binding potentials (BP_P, BP_ND) were quantified with a two-tissue compartment (2TCM) and reference region model (MRTM2).ResultsCompared to MRTM2, good agreement in 5-HT_1A BP_ND was found when using input functions from OSEM + PVC (R² = 0.82) but not TrueX (R² = 0.57, p < 0.001), which is further reflected by lower IDIF peaks for TrueX (p < 0.001). Following ECT, decreased 5-HT_1A BP_ND and BP_P were found with the 2TCM using OSEM + PVC (23%–35%), except for one patient showing only subtle changes. In contrast, MRTM2 and IDIFs from TrueX gave unstable results for this patient, most probably due to a 2.4-fold underestimation of non-specific binding.ConclusionsUsing image-derived and venous input functions defined by OSEM with subsequent PVC we confirm previously reported decreases in 5-HT_1A binding in MDD patients after ECT. In contrast to reference region modeling, quantification with image-derived input functions showed consistent results in a clinical setting due to accurate modeling of non-specific binding with OSEM + PVC.