CT Radiation Dose Optimization and Estimation: an Update for Radiologists

In keeping with the increasing utilization of CT examinations, the greater concern about radiation hazards from examinations has been addressed. In this regard, CT radiation dose optimization has been given a great deal of attention by radiologists, referring physicians, technologists, and physicists. Dose-saving strategies are continuously evolving in terms of imaging techniques as well as dose management. Consequently, regular updates of this issue are necessary especially for radiologists who play a pivotal role in this activity. This review article will provide an update on how we can optimize CT dose in order to maximize the benefit-to-risk ratio of this clinically useful diagnostic imaging method.     

Therapy in a subtropical climate for children with cerebral palsy. Evidence of physical and psychosocial effects?

Aim: To assess a possible therapeutic effect in children and adolescents with cerebral palsy of a habilitation programme in a warm sunny climate.
Methods: Fifty-seven children and adolescents with cerebral palsy, all integrated with normal functioning children through mainstream schooling, received an individualized four-week habilitation programme at a habilitation centre in Lanzarote in the Canary Islands. They were clinically assessed before and after treatment, and again after three and six months. The clinical tests included gross motor function measure (GMFM) and the paediatric evaluation of disability inventory (PEDI). Mental health and self-esteem were assessed by using the youth self report (YSR), the child behaviour checklist (CBCL) and the Harter's self-perception profile. We also used focus-group interviews on all 57 parents by the end of the treatment period.
Results: The study revealed some improvements in the level of physical performance. The most striking finding, however, was the lasting effect on behavioural and emotional parameters and the children's self-esteem.
Conclusion: Training in a warm climate may explain some of this positive effect. However, based on the focus-group interviews and its quantitative findings a more plausible explanation may be the interaction in a social setting with others in a similar situation.     

Expression of Antimicrobial Peptides Such as LL‐37 and hBD‐2 in Nonlesional Skin of Atopic Individuals

Abstract: Recurrent skin infection is one of the major complications of atopic dermatitis and can be partly explained by decreased expression of antimicrobial peptides such as human β‐defensin‐2 and cathelicidin (LL‐37). In the human epidermis, human β‐defensin‐2 is packed in the lamellar body and LL‐37 is co‐localized with intercellular lipid lamellae of the stratum corneum; together, these antimicrobial peptides constitute the primary defense system. IL‐1α, a potent inducer of LL‐37 and human β‐defensin‐2, is also secreted from the disrupted epidermis for barrier homeostasis. In this study, we investigated whether expression of human β‐defensin‐2 and LL‐37 is constitutively decreased in the skin of atopic individuals. Nonlesional foreskins from atopic (n = 7) and nonatopic (n = 7) individuals were analyzed. The expression of LL‐37, human β‐defensin‐2 and IL‐1α was analyzed using immunohistochemical staining, Western blot, and real‐time polymerase chain reaction. Lamellar body density and secretion were evaluated by electron microscope. Quantitative analysis showed that the expression of each parameter was not significantly different between groups. Thus, basal expression of LL‐37 and human β‐defensin‐2 was not changed in atopic individuals. These results indicate that the expression of antimicrobial peptides at baseline was not different between nonlesional skin of atopic individuals and normal skin of nonatopic individuals.     

FDG Whole-Body PET/MRI in Oncology: a Systematic Review

The recent advance in hybrid imaging techniques enables offering simultaneous positron emission tomography (PET)/magnetic resonance imaging (MRI) in various clinical fields. ¹⁸F-fluorodeoxyglucose (FDG) PET has been widely used for diagnosis and evaluation of oncologic patients. The growing evidence from research and clinical experiences demonstrated that PET/MRI with FDG can provide comparable or superior diagnostic performance more than conventional radiological imaging such as computed tomography (CT), MRI or PET/CT in various cancers. Combined analysis using structural information and functional/molecular information of tumors can draw additional diagnostic information based on PET/MRI. Further studies including determination of the diagnostic efficacy, optimizing the examination protocol, and analysis of the hybrid imaging results is necessary for extending the FDG PET/MRI application in clinical oncology.     

清麴酱激酶的溶栓活性可减轻栓塞性脑梗死后脑损伤

Cheonggukjang is a soybean paste made by fermenting whole cooked soybean with Bacillus subtilis. Cheonggukjang contains a fibrinolytic enzyme that may have clinical applications in removing blood clots. In this study, we use the term “cheonggukjang kinase” (CGK) to refer to this fibrinolytic enzyme. We used fibrin clot lysis and platelet-rich clot lysis assays to clarify the mechanisms by which CGK exerts thrombolytic effects, and, specifically, whether it acts more like a plasminogen activator or like plasmin. Additionally, we examined the thrombolytic effects of CGK in a rat model of cerebral embolic stroke produced by middle cerebral artery occlusion (MCAO) with respect to infarct volume and behavioral performance. In both the fibrin clot lysis and platelet-rich clot lysis assays, the thrombolytic activity was highest in CGK that had been cultured for 40 h. Furthermore, T50%, the time needed to decompose half the clot, did not differ in the presence or absence of plasminogen, indicating that CGK is a plasmin-like protein, not a plasminogen activator. In the rat model of cerebral embolic stroke, clots were no longer visible in rats that received an intravenous infusion of CGK (1 U plasmin-like activity/100 μg CGK/kg) 1 h after MCAO. CGK-treated groups showed a significant dose-dependent reduction in infarct volume. Treatment with CGK also improved functional recovery, as assessed by neurological deficit scores. Reduction of infarct volume and improvement in functional recovery after CGK treatment (1 U plasmin-like activity/100 μg CGK/kg) was greater than after treatment with recombinant tissue plasminogen activator (r-tPA; 10 mg/kg). These data suggest that CGK is an effective agent for reducing infarct volume and improving functional recovery following ischemic brain injury. Moreover, CGK may be a more efficacious clot-dissolving agent than r-tPA. CGK has a number of potential clinical applications in the treatment of stroke.     

Risk Factors for Long-term Outcomes after Initial Treatment in Hepatolithiasis

Hepatobiliary complications, such as stone recurrence, recurrent cholangitis, liver abscess, secondary biliary cirrhosis, and cholangiocarcinoma may occur after treatment for hepatolithiasis. However, few previous studies have addressed the risk factors and long-term outcomes after initial treatment. Eighty-five patients with newly diagnosed hepatolithiasis, actively treated for hepatolithiasis, constituted the cohort of this retrospective study. Patients were treated by hepatectomy or nonoperative percutaneous transhepatic cholangioscopic lithotomy. Long-term complications, such as recurrent cholangitis, liver abscess, secondary biliary cirrhosis, and cholangiocarcinoma, and their relationships with clinical parameters were analyzed. The mean follow-up period was 57.4 months. The overall hepatobiliary complication rate after the treatment was 17.6%. Multivariate analysis of suspected risk factors showed that complications were associated with age (HR, 1.046; CI, 1.006-1.089), bile duct stricture (HR, 4.894; CI, 1.295-18.495), and residual stones (HR, 3.482; CI, 1.214-9.981). In conclusion, several long-term hepatobiliary complications occur after hepatolithiasis treatment, and regular observation is necessary in patients with concomitant biliary stricture or residual stones.     

Unit cost of Mohs and Dermasurgery Unit

Background Appropriate pricing for medical services of not‐for‐profit hospital is necessary. The prices should be fair to the public and should be high enough to cover the operative costs of the organization. Objective The purpose of this study was to determine the cost and unit cost of medical services performed at the Mohs and Dermasurgery Unit (MDU), Department of Dermatology, The University of Texas – MD Anderson Cancer Center, Houston, TX from the healthcare provider’s perspective. Methods MDU costs were retrieved from the Financial Department for fiscal year 2006. The patients’ statistics were acquired from medical records for the same period. Unit cost calculation was based on the official method of hospital accounting. Results The overall unit cost for each patient visit was $673.99 United States dollar (USD). The detailed unit cost of nurse visit, new patient visit, follow‐up visit, consultation, Mohs and non‐Mohs procedure were, respectively, $368.27, $580.09, $477.82, $585.52, $1,086.12 and $858.23 USD. With respect to a Mohs visit, the unit cost per lesion and unit cost per stage were $867.89 and $242.30 USD respectively. Conclusions Results from this retrospective study provide information that may be used for pricing strategy and resource allocation by the administrative board of MDU.