Inflammation burst after 5-aminolevulinic acid-photodynamic therapy for the treatment of actinic keratosis complicating rosacea: A case report

A 72-year-old woman suffering from multiple actinic keratosis (AK) complicating steroid-induced rosacea received 5-aminolevulinic acid-photodynamic therapy (ALA-PDT) in our outpatient clinic. Both AKs and rosacea achieved remission after one session of PDT. However, an adverse effect of severe acute inflammatory response emerged with lasting hyperpigmentation. We then terminated the following PDT sessions . After skin care and close follow-up for a half year, most symptoms and lesions of AK and rosacea disappeared with mild hyperpigmentation left. ALA-PDT is commonly recommended for multiple AKs based on effectiveness and noninvasiveness, but has controversial efficacy and safety for rosacea. The unusual excessive inflammation in this patient after ALA-PDT may due to skin barrier destruction, vasomotor dysfunction and the immune response by dead Demodex after PDT. This case indicated that carefully evaluation before ALA-PDT is of great importance, especially for those patients with complicated skin situation. For AKs complicating rosacea, modified parameters of ALA-PDT such as less ALA incubation time or reduced light dose should be further studied to achieve the optimal efficacy and safety of ALA-PDT and offer the best benefit.     

Dermoscopy and ultrosound monitoring actinic keratosis with cutaneous squamous cell carcinoma: A case report and literature review

Actinic keratosis(AK) is a common premalignant skin lesion that can progress to invasive squamous cell carcinoma(iSCC). Clinically, AK presents as reddish or brownish macules, papules, or hyperkeratotic plaques. AK cannot be reliably predicted whether it will transform into invasive carcinomas, so skin biopsy is currently a gold standard for identifying suspicious malignancy. Currently, there are non-invasive methods to help diagnose and determine the difference between AKs and iSCC. For example, dermoscopy and ultrasound can be very useful in diagnosing and monitoring skin diseases non-invasively. Therefore, we report a case of multiple facial AKs with poorly differentiated skin squamous cell carcinoma, which was diagnosed early through dermoscopy and ultrasound, and confirmed by histopathology.     

A simple method to improve image nonuniformity of brain MR images at the edges of a head coil

One of the major sources of image nonuniformity in the high field MR scanners is the radiofrequency (RF) coil inhomogeneity. It degrades conspicuity of lesion(s) in the MR images of the brain and surrounding tissues and reduces accuracy of image postprocessing particularly at the edges of the coil. In this investigation, we have devised and tested a simple method to correct for nonuniformity of MR images of the brain at the edges of the RF head coil. Initially, a cylindrical oil phantom, which fit exactly in the head coil, was scanned on a 1.5 T imager. Then, a correction algorithm identified a reference pixel value in the phantom at the most homogeneous region of the RF coil. Next, every pixel inside the phantom was normalized relative to this reference value. The resulting set of coefficients or "correction matrices" was obtained for different types of MR contrast agent. Finally, brain MR images of normal subjects and multiple sclerosis patients were acquired and processed by the corresponding correction matrices obtained with different pulse sequences. Application of correction matrices to brain MR images showed a gain in pixel intensity particularly in the slices at the edge of the coil.     

Common k-space acquisition: A method to improve myocardial grid-tag contrast

A current limitation of many myocardial tag acquisitions employing SPAMM encoding is the relatively rapid loss of tag contrast over the cardiac cycle. Acquisition schemes that apply line tags produce prolonged tag contrast compared with directly excited grid tags. However, a grid-tag series can be generated by combining two orthogonal line-tag series. To be time efficient, each line-tag series can be acquired with the read gradient oriented perpendicular to the line-tag direction. There are several disadvantages associated with this approach, including the requirement to avoid signal fold-over and that fat shift artifacts appear in different directions in each line-tag series. Presented here is a method of applying separate line tags that does not require interchanging the read and phase encoding gradients and does not extend the scan time compared with a conventional grid-tag acquisition. Additionally, the means of generating grid tags results in a doubling of the tag contrast to noise ratio compared a line-tag set. Computer simulations are presented along with phantom and volunteer scans.     

Photodynamic therapy effective for the treatment of actinic keratosis and basal cell carcinoma in bullous pemphigoid patients

Treating skin cancers and extensive actinic keratosis in patients with bullous pemphigoid (BP) can be challenging. Treatment options pose unique risks in these patients as surgical wounds can have delayed wound healing and photodynamic therapy (PDT) may exacerbate their blistering disease. We report the successful use of PDT to treat actinic keratosis and skin cancers in two patients with BP, both of whom had excellent response to PDT and tolerated treatment without any bullous disease flares. Carefully selected patients with skin cancers and stable, well controlled BP can be safely considered for treatment using PDT.     

Neuromuscular training after concussion to improve motor and psychosocial outcomes: A feasibility trial

ObjectiveTo determine the feasibility of an 8-week neuromuscular training program initiated upon return-to-play clearance following concussion.DesignFeasibility trial.SettingA single sports medicine center.ParticipantsWe approached n = 54 patients; n = 32 agreed to participate (59%). N = 27 participants returned for their second visit at return-to-play clearance (84%) and were randomized to neuromuscular training (n = 13) or standard-of-care (n = 14).Main outcome measuresParticipants completed three assessments: within 14 days post-concussion, immediately after return-to-play clearance, and 8-weeks following return-to-play clearance. The intervention aimed to achieve positive neuromuscular adaptations and occurred 2x/week for 8 weeks under supervision.ResultsN = 2 participants randomized to the intervention elected not to participate, both due to schedule conflicts (e.g., time required to meet with the study team). Participants began the intervention an average of 11 days after return-to-play clearance, the majority (91%) completed >75% of training sessions, and training sessions lasted an average of 18.2 ± 4.8 min. One participant stopped the intervention after 7 training sessions due to time availability.ConclusionIt is feasible to initiate a neuromuscular training program for most athletes shortly after returning to play following concussion. Clinicians and researchers may consider this approach to mitigate the increased musculoskeletal injury risk for concussion patients returning to sports.     

A simple method for embedding anatomical specimens

A simple embedding method for brain slices using epoxy resin is described. The embedding can be done immediately after cutting the brain and can be completed in 5-6 hrs. Discoloration of the slices is insignificant.     

A simple procedure to improve FMRIb Software Library Brain Extraction Tool performance

The Oxford FMRIb Software Library (FSL) Brain Extraction Tool (BET) is a widely used algorithm for removing extracranial tissues from MR images. Although BET is effective and simple to operate, it often fails to exclude fully all non-brain tissues unless the centre of gravity of the brain is specified to the programme. In this communication we present a recursive procedure for using BET that is extremely robust for extracting brain images without any manual intervention. The approach was tested on 150 adult head volumes and produced accurate results in all cases. The approach is efficient and suitable for incorporation into automated workflows and other pipeline methods.     

PD/PDT for gynecological disease: A clinical review

The evolution of diagnostic and interventional procedures for gynecologic disease has led to organ, sexual and reproductive sparing treatments. Photodiagnosis (PD) and photodynamic therapy (PDT) may play a great role for gynecological patients as both offer the potential to achieve these goals.PD/PDT for a wide variety of diagnostic and therapeutic interventions have shown potential for excellent clinical outcomes. However, significant limitations remains, both clinically and dosimetrically, that prevent consistent results. When those limitations are resolved PD/PDT could move to the forefront of gynecological therapy.This clinical review highlights the outcomes and shortcomings of PD/PDT through the peer reviewed literature for gynecological sites.     

A simple method for fitting curves to dose-effect data for functional damage.

Dose-effect curves are used extensively to assess how tissues respond to radiation. One method of obtaining these is to fit a curve to the values of some measured effect plotted against dose using non-linear least-squares regression. This paper reports the use of a generalized (four-parameter) sigmoid equation fitted to all the individual data points, rather than to the mean values for each dose group, which eliminates the need to incorporate weighting of the data. The equation allows an analytical solution for values of isoeffect doses, which can be used, for example, to determine dose enhancement ratios, or equivalent remembered doses in top-up experiments. The regression approach can also determine both standard errors and 95% confidence limits on the mean predicted effect values from the fit to the data at all doses, and these define a uniform envelope of errors about the best-fit line, from which an error in an isoeffect dose can be assessed. This approach has been used to fit dose-effect data from a variety of normal tissues and tumours with highly satisfactory results.     

A simple method for bone age assessment: the capitohamate planimetry

Objectives

To determine if the capitohamate (CH) planimetry could be a reliable indicator of bone age, and to compare it with Greulich-Pyle (GP) method.

Methods

This retrospective study included 391 children (age, 1–180 months). Two reviewers manually measured the areas of the capitate and hamate on plain radiographs. CH planimetry was defined as the measurement of the sum of areas of the capitate and hamate. Two reviewers independently applied the CH planimetry and GP methods in 109 children whose heights were at the 50th percentile of the growth chart.

Results

There was a strong positive correlation between chronological age and CH planimetry measurement (right, r = 0.9702; left, r = 0.9709). There was no significant difference in accuracy between CH planimetry (84.39–84.46 %) and the GP method (85.15–87.66 %) (p ≥ 0.0867). The interobserver reproducibility of CH planimetry (precision, 4.42 %; 95 % limits of agreement [LOA], ?10.5 to 13.4 months) was greater than that of the GP method (precision, 8.45 %; LOA, ?29.5 to 21.1 months).

Conclusions

CH planimetry may be a reliable method for bone age assessment.

Key Points

? Bone age assessment is important in the work-up of paediatric endocrine disorders. ? Radiography of the left hand is widely used to estimate bone age. ? Capitatohamate planimetry is a reliable and reproducible method for assessing bone age.

     

A threshold method to improve standardized uptake value reproducibility

Although standardized uptake values (SUV) are widely used to quantify the uptake of 18F-fluorodeoxyglucose (18F-FDG) in tumours, there are systematic differences in the way this index is applied by different investigators. The aims of this study were to compare the effects of using maximum or mean region counts in the calculation of SUV and to investigate an alternative technique based on a fixed fraction of the maximum counts. Simulated PET projections of the thorax were generated together with spherical lesions that varied in diameter from 1.6 to 4.8 cm with uptake values of 2, 4 and 8. The lesion SUVs were determined using either the maximum (SUVmax) or mean count (SUVmean) values found in regions circumscribing the lesion. In addition, average values were calculated that only included region pixels that exceeded a selected fraction of maximum value (SUV0.6max or SUV0.75max). These methods were also applied to six clinical 18F-FDG PET studies with a total of 12 lesions. The SUVs for these lesions were determined independently by four observers. Decreases with respect to SUVmax of 57%, 23% and 14% were found for SUVmean, SUV0.6max and SUV0.75max approaches respectively in the simulation study. The variation in SUVmean with region size was 35%, while the SUV0.6max and SUV0.75max was less than 3%. Similar results were obtained for the clinical data. We conclude that the proposed technique produces SUVs that are essentially independent of lesion region size and shape. It is expected that this will provide a more stable and reliable result than current approaches.     

A simple and inexpensive method for CT-guided stereotaxy

Summary A simle and inexpensive method for CT-guided stereotaxy is described. The method requires neither sophisticated computer programs nor additional stereotactic equipment, such as special head holders for the CT, and can be easily obtained without technical assistance. The method is designed to yield the vertical coordinates.     

A simple method to lock large mushroom-tip catheters.

Dislodgment is a major drawback with large-bore Malecot catheters. A locking mechanism with a suture affixed to the distal portion of the mushroom tip is described. In a 32-month period, 17 Malecot catheters with locking mechanisms were placed in 15 patients. One catheter dislodged as a result of suture failure. A variation in design prevented subsequent failure of sutures. This simple locking mechanism prevents collapse of the catheter wings and thereby maintains catheter placement.