Pancreatic steatosis on computed tomography is an early imaging feature of pre-diagnostic pancreatic cancer: A preliminary study in overweight patients

BackgroundThe prevalence of pancreatic ductal adenocarcinoma (PDAC) is on the rise, driven by factors such as aging and an increasing prevalence of obesity and diabetes mellitus. To improve the poor survival rate of PDAC, early detection is vital. Recently, pancreatic steatosis has gained novel interest as a risk factor for PDAC. This study aimed to investigate if pancreatic steatosis on computed tomography (CT) is an early imaging feature in patients with pre-diagnostic PDAC.MethodsA retrospective case-control study was performed. Patients diagnosed with PDAC (2010–2016) were reviewed for abdominal non-contrast CT-imaging 1 month-3 years prior to their diagnosis. Cases were matched 1:4 with controls based on age, gender and imaging date. Unenhanced CT-images were evaluated for pancreatic steatosis (pancreas-to-spleen ratio in Hounsfield Units <0.70) by a blinded radiologist and results were compared between cases and controls.ResultsIn total, 32 cases and 117 controls were included in the study with a comparable BMI (29.6 and 29.2 respectively, p = 0.723). Pancreatic steatosis was present in 71.9% of cases compared to 45.3% of controls (Odds ratio (OR) 3.09(1.32–7.24), p = 0.009). Adjusted for BMI and diabetes mellitus, pancreatic steatosis on CT remained a significant independent risk factor for PDAC (Adjusted OR 2.70(1.14–6.58), p = 0.037).ConclusionPancreatic steatosis measured on CT is independently associated with PDAC up to three years before the clinical diagnosis in overweight patients. If these data are confirmed, this novel imaging feature may be used to identify high-risk individuals and to stratify the risk of PDAC in individuals that already undergo PDAC screening.     

Analysis of dextromethorphan and dextrorphan in decomposed skeletal tissues by microwave assisted extraction,microplate solid‐phase extraction and gas chromatography‐ mass spectrometry (MAE‐MPSPE‐GCMS)

Analysis of decomposed skeletal tissues for dextromethorphan (DXM) and dextrorphan (DXT) using microwave assisted extraction (MAE), microplate solid‐phase extraction (MPSPE) and gas chromatography‐mass spectrometry (GC‐MS) is described. Rats (n = 3) received 100 mg/kg DXM (i.p.) and were euthanized by CO₂ asphyxiation roughly 20 min post‐dose. Remains decomposed to skeleton outdoors and vertebral bones were recovered, cleaned, and pulverized. Pulverized bone underwent MAE using methanol as an extraction solvent in a closed microwave system, followed by MPSPE and GC‐MS. Analyte stability under MAE conditions was assessed and found to be stable for at least 60 min irradiation time. The majority (>90%) of each analyte was recovered after 15 min. The MPSPE‐GCMS method was fit to a quadratic response (R² > 0.99), over the concentration range 10?10 000 ng?mL^‐1, with coefficients of variation <20% in triplicate analysis. The MPSPE‐GCMS method displayed a limit of detection of 10 ng?mL^‐1 for both analytes. Following MAE for 60 min (80 °C, 1200 W), MPSPE‐GCMS analysis of vertebral bone of DXM‐exposed rats detected both analytes in all samples (DXM: 0.9‐1.5 µg?g^‐1; DXT: 0.5‐1.8 µg?g^‐1). Copyright © 2014 John Wiley & Sons, Ltd.     

Recovery of respiratory gas exchange after exercise in adults with congenital heart disease

Background

Delayed gas exchange kinetics in the early recovery period after exercise testing has been reported in children and adults with congenital heart disease (ACHD). Our objective was to compare early and late phase recovery kinetics in three groups of ACHD-patients.

Methods

Sixty-seven adults with complex ACHD (33 repaired tetralogy of Fallot, 19 Fontan operations, and 15 transposition complexes) and 10 healthy controls underwent symptom-limited cardiopulmonary exercise testing measuring gas-exchange kinetics over a 10 minute recovery period. Changes within the first minute of recovery and late changes, characterized as the time to reach 50% of peak values (T_1/2), were compared between groups.

Results

Recovery of VO₂ in early and late recoveries was significantly delayed in all ACHD-patients compared to controls without significant differences between patient groups. VO₂-recovery at 1 min compared between patients and controls was − 7.2 ± 4.0 versus − 17.0 ± 4.5 ml·kg·min^− 1 and T_1/2 VO₂ was 147 ± 62 versus 66 ± 23 s (p < 0.0001 for both comparisons). Similar changes were observed for VCO₂-recovery. Peak VO₂ (ml·kg·min^− 1) demonstrated strong correlation with VO₂-recovery at 1 min (ml·kg·min^− 1, r = 0.90) and moderate correlation with T_1/2 VO₂ (r = − 0.70).

Conclusion

Gas exchange recovery after exercise testing is prolonged in ACHD-patients, independent of the congenital heart lesion but related to peak aerobic capacity, particularly recovery kinetics within the first minute. Recovery kinetics at 1 min is a useful and easily obtained clinical measure that warrants further study as a prognostic measure.     

Attrition from Therapy Effectiveness Research Among Youth in a Clinical Service Setting

This study examined research attrition in clinical service settings by comparing psychotherapy research completers and dropouts in a private therapy practice. Seventy-seven children 7–12 years old enrolled in the Resilience Builder Program^® (RBP), a manualized group therapy created and administered in a private practice. Children had social impairments, and most were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and/or anxiety disorders. Results found that compared to completers, research dropouts had significantly greater social deficits, disruptive behavior problems, affective problems, medication use, and were more likely to be ethnic minorities. We discuss implications for research recruitment and retention in clinical service settings.     

Effects of Cognitive–Behavioral Conjoint Therapy for PTSD on Partners’ Psychological Functioning

A number of studies have documented that posttraumatic stress disorder (PTSD) symptoms in “one” partner are negatively associated with their intimate partner's psychological functioning. The present study investigated intimate partners’ mental health outcomes (i.e., depression, anxiety, and anger) in a sample of 40 partners of individuals with PTSD within a randomized waitlist controlled trial of cognitive–behavioral conjoint therapy for PTSD (Monson & Fredman, 2012 ). There were no significant differences between active treatment and waitlist in intimate partners’ psychological functioning at posttreatment. Subgroup analyses, however, of partners exhibiting clinical levels of distress at pretreatment on several measures showed reliable and clinically significant improvements in their psychological functioning at posttreatment and no evidence of worsening. Results suggest that cognitive–behavioral conjoint therapy for PTSD may have additional benefits for partners presenting with psychological distress.     

A comparison of the home‐care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home‐care service

Restorative home‐care services, or re‐ablement home‐care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home‐care services had only been investigated in terms of singular outcomes such as length of home‐care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure – the use and cost of the home‐care and healthcare services received over the 2‐year period following service commencement. Seven hundred and fifty older individuals referred for government‐funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home‐care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home‐care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow‐up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50–0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50–0.95)]. Additionally, the aggregated health and home‐care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72–0.96) over the 2‐year follow‐up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost‐effective option than providing conventional home care.