Impact of ultra-low dose CT acquisition on semi-automated RECIST tool in the evaluation of malignant focal liver lesions

PurposeTo compare the evaluation of malignant focal liver lesions (FLLs) using a semi-automated RECIST tool with a standard and an ultra-low dose (ULD) computed tomography (CT) protocol.Materials and methodsThirty-four patients with malignant FLLs underwent two abdominal-pelvic CT examinations one using a standard protocol and one using an ULD protocol. There were 23 men and 11 women with a mean age 64.3 ± 14.4 (SD) years (range: 22–91 years). Dosimetric indicators were recorded, and effective dose was calculated for both examinations. Mean malignant FLL attenuation, image noise and contrast-to-noise-ratio (CNR) were compared. The largest malignant FLL per patient was evaluated using the semi-automated RECIST tool to determine longest axis length, longest orthogonal axis length, volume and World Health Organisation area.ResultsDosimetric values were significantly reduced by −56% with ULD compared to standard protocol. No differences in mean malignant FLL attenuation values were found between the two protocols. Image noise was significantly increased for all locations (P < 0.05) with ULD compared to standard protocol, and CNR was significantly reduced (P < 0.05). On the 34 malignant FLLs analyzed, six semi-automated shapes non-concordant with radiologist's visual impression were highlighted with the software, including one FLL (1/34; 3%) with standard CT acquisition only, three FLLs (3/34; 9%) with ULD CT acquisition only and two FLLs (2/34; 6%) with both CT acquisitions. After manual editing, the concordance of the values of the studied criteria between both acquisitions was good and no significant difference was reported.ConclusionSemi-automated RECIST tool demonstrates good performances using ULD CT protocol. It could be used in routine clinical practice with a ULD protocol for follow-up studies in patients with known malignant FLL.     

海博刀与三角刀在经口内镜下肌切开术中疗效的回顾性队列研究

目的 比较海博刀与三角刀在经口内镜下肌切开术(POEM)中的临床疗效。方法 采用回顾性队列研究设计，纳入2012年6月至2014年7月因贲门失弛缓症在南方医科大学南方医院接受POEM治疗的患者，术中使用海博刀者为海博刀组，使用注射针和三角刀者为三角刀组，比较两组手术相关参数、术后症状缓解及并发症发生率。结果 共纳入57例患者，其中海博刀组25例，三角刀组32例。两组患者基线特征比较差异无统计学意义（P>0.05）。海博刀组平均手术时间短于三角刀组[(55.3±17.7)min比(69.5±9.4)min，P=0.038)]；术中平均器械交换次数少于三角刀组[(4.5±1.5)次比(10.7±1.7)次，P=0.000]。所有患者无严重不良事件发生。在1年的随访中，海博刀组治疗成功率92.0%(23/25)，三角刀组96.9%(31/32)，差异无统计学意义（P=0.576)。结论 海博刀能显著缩短POEM手术时间，并且获得与三角刀相似的治疗成功率。     

Ecological study of gastric cancer in Brazil:Geographic and time trend analysis

AIM:To investigate the geographic distributions and time trends of gastric cancer(GC)incidence and mortality in Brazil.METHODS:An ecological study of the DATASUS registry was conducted by identifying hospitalizations for GC between January 2005 and December 2010.The data included information on the gender,age,and town of residence at the time of hospital admission and death.RESULTS:The GC rates,adjusted according to available hospital beds,decreased from 13.8 per 100000in 2005 to 12.7 per 100000 in 2010.The GC rates decreased more among the younger age groups,in which the male-to-female difference also decreased in comparison to the older age groups.Although the lethality rates tended to increase with age,young patients were proportionally more affected.The spatial GC distribution showed that the rates were higher in the south and southeast.However,while the rates decreased in the central-west and south,they increased in the northern regions.A geographic analysis showed higher rates of GC in more urbanized areas,with a coast-toinland gradient.Geographically,GC lethality overlapped greatly with the hospital admission rates.CONCLUSION:The results of this study support the hypothesis of a critical role for environmental factors in GC pathogenesis.The declining rates in young patients,particularly males,suggest a relatively recent decrease in the exposure to risk factors associated with GC.The spatial distribution of GC indicates an ongoing dynamic change within the Brazilian environment.     

L’Artiste en milieu hospitalier : une expérience musicale en hémodialyse pédiatrique

Culture at the hospital is part of a policy of providing everyone access to culture. This article describes a musical intervention that provides patients and healthcare professionals a central role in creation; qualitatively assesses the benefits of these interventions for children and caregivers; evaluate the lessons learned from this ongoing experience in the pediatric hemodialysis unit of Rouen University Hospital. Ninety-minute sessions take place twice a week, with eight children aged from 18 months to 19 years, during dialysis. To assess the effects of artistic interventions in the unit, a qualitative methodology was chosen (observation grid). The progression of the project is evaluated to highlight what has helped the children and caregivers reach autonomy in artistic creation while respecting the time allotted, the artistic approach, and the esthetics of each participant's creation. The results indicate that this approach allows children to be actors, that the time at the hospital is relativized, and that the relationship with the healthcare professionals is less oriented towards care. A discussion follows on the place of the artist and the untapped potential of bringing patients to the creative act; the issue of esthetics, which then becomes secondary; the complementarity between musical activities and creation, and the role each actor plays in an artistic project. The hospital can provide access to culture; however, it is possible to go further and reveal patients’ creativity.     

Clinical factors and self‐perceived oral health

Self‐perceived oral health is affected not only by awareness of the clinical status but also by comparisons with people of a similar age. This study explored the relative contributions of clinical variables assessing caries, periodontal status, and prosthetic status to self‐perceived oral health within two age groups. Data of 891 adults (35–44 yr of age) and 760 older people (65–74 yr of age) from the Fourth German Oral Health Study (DMS IV, 2005) were evaluated. Self‐perceived oral health was obtained from questionnaires. Numbers of decayed, filled, and unreplaced teeth, mean attachment loss, bleeding on probing (BOP), the presence of a fixed denture, and the presence of a removable denture were assessed. Multinomial logistic regression models were developed for both age groups, separately, using stepwise methods. For adults, unreplaced teeth, filled teeth, decayed teeth, the presence of a removable denture, and mean attachment loss were added to the final model. For older people, the presence of a removable denture, unreplaced teeth, decayed teeth, mean attachment loss, filled teeth, and BOP were included in the final model. Awareness of the relative contributions of clinical variables to self‐perceived oral health is important for obtaining a clearer understanding of patients' subjective and objective self‐perceptions of oral health.