Search

For several decades, research in tumor biology has focused on the involvement of genes encoding a protein. Only recently has it been discovered that a whole class of molecules called non-coding RNAs (ncRNAs) play a key regulatory role in health and disease. Long noncoding RNAs (lncRNAs) are a group of noncoding RNAs longer than 200 nucleotides. It has been found that lncRNAs play a fundamental role in the biology of many types of tumors, including tumors of the genitourinary system. As a result, hundreds of clinical trials dedicated to oncourology have begun, using lncRNA as new biomarkers or treatments. Identifying new specific biomarkers, in the form of lncRNAs, will increase the ability to differentiate the tumor and other processes, determine the localization and extent of the tumor, and the ability to predict the course of the disease, and plan treatment. Therapy of tumors, especially malignant ones, is also a difficult task. When surgery and chemotherapy fail, radiation therapy becomes the treatment choice. Therefore, the possibility that lncRNAs could represent innovative therapeutic agents or targets is an exciting idea. However, the possibility of their use in modern clinical practice is limited, and this is associated with several problems at the pre-, analytical and post-analytical stages. Another problem in the study of lncRNAs is the large number and variety of their functions in tumors. Therefore, solving technological problems in lncRNAs study in oncourology may open up new possibilities for lncRNAs use in modern clinical practice.

Root resorption is a common iatrogenic consequence of orthodontic treatment, although it can also be seen in the absence of orthodontic treatment. It may occur at any time during orthodontic treatment and compromise prognosis of the tooth involved and also the stability of treatment results. Orthodontics is the only branch which actually uses the inflammatory process as a tool for solving esthetic and functional problems. Therefore, every orthodontist should know the risk factors of root resorption involved in the process and plan treatment with an aim to reduce its possibility. The severity and degree of root resorption related with orthodontic treatment are multifactorial, involving environmental factors and host factors. A proper medical history, an assessment of predisposing factors, radiographic evaluation of alterations in root morphology and careful planning and execution of orthodontic mechanics may reduce the incidence of root resorption. The current review is aimed at providing clinicians and academics with an insight into the mechanical and biological aspects in the process of root resorption, the methods of identification during its early stages and intervention at the right time to reduce its severity.

Background Indocyanine green (ICG) lymphangiography is being increasingly employed to assess the severity of lymphedema, locate the areas of patent linear lymphatics and dermal backflow and plan treatment. This study suggests a novel method of reporting ICG findings in extremities to enable easy understanding among surgeons and physiotherapists and avoid repeat testing when a patient visits a disparate lymphedema center or clinician. Methods A reporting protocol was developed in the lymphedema clinic of the plastic surgery department, and patients were asked to bring along the report in every subsequent review. The ICG findings were recorded on the fluorescence imaging system as well. The report was prepared by one and analyzed by two different clinicians without repeating the test on 10 consecutive patients. Results The interrater reliability of findings in the report was found to be 98.7% among the three clinicians. Conclusion The reporting system was found to be illustratable and reproducible

Background Low‐grade gliomas (LGGs) are primary diffuse slow‐growing brain tumors derived from glial cells. The management of these tumors is dependent on their location, which often harbors eloquent areas. We retrospectively recorded the location of diffuse gliomas to identify whether specific differences exist between the histological types. Methods We analyzed 102 patients with previous histological diagnosis of WHO‐II astrocytomas (62) and WHO‐II oligodendrogliomas (40) according to WHO‐2016 classification. MRI sequences (T2‐FLAIR) were used for tumor volume segmentation and to create a frequency map of their locations within the Montreal Neurological Institute (MNI) space. The Brain‐Grid (BG) system (standardized radiological tool of intersected lines according to anatomical landmarks) was created and merged with a tractography atlas for infiltration analysis. Results Astrocytomas frequently infiltrated association and projection white matter pathways within fronto‐temporo‐insular regions on the left side. Oligodendrogliomas infiltrated larger white matter networks (association‐commissural‐projection) of the frontal lobe bilaterally. A critical number of infiltrated BG voxels (7 for astrocytomas, 10 for oligodendrogliomas) significantly predicted shorter overall survival (OS) in both groups. Bilateral tumor extension in astrocytomas and preoperative tumor volume in oligodendrogliomas were independent prognostic factors for shorter OS. Conclusions Astrocytomas and oligodendrogliomas differ in preferential location, and this has an impact on the type and the extent of white matter involvement. The number of BG voxels infiltrated reflected different tumor invasiveness and its impact on OS in both groups. All this new information may be valuable in neurosurgical oncology to classify and plan treatment for patients with diffuse gliomas., Astrocytomas preferentially infiltrate white matter of the fronto‐temporo‐insular region. Oligodendrogliomas tend to invade fibers in fronto‐mesial regions bilaterally. Tumor invasiveness as expressed by the number of invaded BG has an impact on OS.

Objectives: The imaging features of Mucoepidermoid carcinoma (MEC) of the breast are unfamiliar to the breast radiologists due to its rarity. In this paper, we aimed to review the literature, do an analysis and find a common pattern of those lesions that could potentially give a better understanding of this entity. Methods: A review is performed with searching keywords “mucoepidermoid carcinoma breast”, without limitations in the dates or the article types, in the PubMed database. Information about the number of cases, the age of the patients, the presenting symptom, the time-interval between the onset of the symptoms and the time of diagnosis, the diagnostic approach, the imaging, the treatment and the outcome have been reviewed and tabulated. Results: We identified 40 cases. The mean age of the patients was 57. The commonest symptom was a palpable mass, few months to up to 37 years, prior to the diagnosis, with the size ranging 5-82 mm. On US, the lesions appeared as irregular masses or had cystic benign features. The majority underwent a radical/modified radical mastectomy with a form of axillary lymph node procedure. 15 cases were Highgrade, 3 Intermediate-grade, and 19 Low-grade MEC. No chemotherapy was administered in most cases and in a mean follow-up time of 30 months, 5 died because of metastasis. Conclusion: Due to its rarity, the diagnostic and therapeutic approach of MEC in the breast is not welldocumented, causing challenges in daily practice, even at experienced Breast Centers. Review of the published cases is essential for multidisciplinary team meetings to plan treatment strategies.

The aim of this review is to summarize characteristic imaging findings of common skull base lesions. In addition, this study aims to review the literature regarding important and interesting new advancements in imaging of the anterior and central skull base. Imaging techniques including magnetic resonance elastography, indocyanine green fluorescence, Gallium-DOTATATE PET/CT, peptide receptor radionucleotide therapy, and 3D printing are being used to advance the care of patients with skull base pathology. Characteristic CT and MRI findings can be used to narrow the differential diagnosis and plan treatment for anterior and central skull base lesions. New imaging techniques show promise in improving the care of patients with skull base lesions.

Traditional child psychiatry practices focus on children's symptoms and families' deficits. Focusing on goals and strengths can prepare patients and families for what they can do to enhance their health. The evidence-base for well-being practices supports integration into contemporary practice. Practical guidelines are described for using the initial assessment to address well-being practices, and to plan treatment with psychoeducation, motivational interviewing, and ongoing monitoring. Engaging and effective clinical strategies can further support and build patient and family well-being.

At the present stage of development and practical application of acupuncture, we are faced with an unusual phenomenon. It lies in the fact that the doctor is involved in reflexology, reveals the nature of the lesions of certain organs with the help of modern methods of diagnostics, which are very different from the Oriental. But on the other hand, the treatment of acupuncture is not very far removed from the level and approaches of the ancient doctors, and the doctors at this stage used the combination of acupuncture points which have been tested by thousand-year practice. This leads to the complexity of the treatment of acupuncture. The authors experience of developing the plan and building an acupuncture prescription based on a modular systematization of acupuncture points. This will allow the doctor to plan treatment for virtually any patient. To avoid mistakes, a template approach is necessary: to evaluate the functional condition of the meridians and acupuncture points, to understand the causes of these violations, form of acupuncture diagnosis on the basis of leading etiopathogenetic mechanism, to develop the baseline treatment. Professionals not proficient in pulse diagnosis, we propose to use prestazioni diagnostics, which allows to evaluate and analyze the effectiveness of reflexotherapy, to adjust the treatment process. In the cycle of U-sin to evaluate the functional state of meridians, to choose the correct technique irritation of acupuncture points.

Introduction The purpose of this study was to investigate differences in orthodontists' treatment plans based on digital models compared with plaster models. Additionally, we assessed whether digital or plaster models influence the reliability of orthodontists' treatment plans, as well as the amount of time required to arrive at the plan. Methods Sixteen orthodontists planned treatment for 20 patients at 2 time points using either the same or different model formats (digital or plaster). The treatment plan decisions and time spent making the plans were recorded. The permutation test and a random effects model were used to analyze the data. Results The treatment plans arrived at with digital and plaster models were similar. With respect to extractions, the mean difference between digital and plaster formats was 11.9% (95% CI, 7.5%-16.3%). For surgery, the mean difference was 9.4% (95% CI, 5.0%-13.8%). There was no significant difference in the agreement rate between those who viewed models in different formats compared with those who viewed models twice in the same format (P >0.05). The time spent to plan treatment with plaster models was not significantly different from the time spent with digital models (P = 0.87). Conclusions Based on this study, digital models can be substituted for plaster models with no significant differences in the final plans, the reliability of the plans, and the time required to create the plan.

Biosensors consist of a biocatalyst that can detect a biological element and a transducer which can convert the combination event of the biocatalyst and the biological element into a detectable parameter. The biocatalyst can be biomolecules like, enzyme, DNA, RNA, metabolites, cells, oligonucleotides etc., and the transducers can be electrochemical, optical, piezoelectric, acoustics, calorimetric etc. In disease diagnostics biosensors utilizing immobilized cells, enzymes, nucleic acids have come into the field in recent years. Nanobiosensors exploiting the ultrasmall size and unique properties have also been used for engineering disease diagnostic biosensors. The use of biosensors can rapidly assess the health status, onset of the disease and its progression and can help to plan treatment for many diseases with the aid of multidisciplinary combination of chemistry, medical science and nanotechnology. The devices are cost effective, highly sensitive, rapid, user friendly and can be produced in bulk for human use. This review focuses on the different biosensors for the diagnosis of three major diseases like diabetes, cardiovascular disease and cancer.

Although remarkable progress has been made in the histological typing and the molecular genotyping of bone tumors, their classification remains extremely complex; in some instances, the integration of histomorphological, phenotypic, and molecular features with the clinical appearance does not provide sufficient prognostic information to assess the clinical course and plan treatment.

Cranial bone thickness and frontal sinus size are important parameters to be known before cranial procedures. Deep-learning systems have become popular for making bulk analyses to diagnose diseases/disorders and plan treatment algorithms in diverse fields of medicine. Deep-learning systems would be valuable assets also for cranial procedures. Deep-learning systems need normative values and variances of the population on which they are used. In the present study, the authors aimed to find out the normative values for skull bone thickness at 4 anatomical locations, and frontal sinus size. the authors also analyzed whether gender affected these values. Consecutive adult female and male patients that had presented to our outpatient and emergency clinics between December 2019 and April 2020 were evaluated. We included 174 patients (98 female and 76 male) into the final analysis. Skull bone thickness was measured in 4 anatomical compartments, and vertical dimension of the left and right frontal sinuses were measured. The mean thickness of frontal, parietal, temporal, and occipital bones was 7.9 mm, 9.7 mm, 6 mm, and 10.1 mm for men; 8.7 mm, 10.2 mm, 6.1 mm, and 10.1 mm for women, respectively. Women had significantly thicker frontal bone when compared to men (P = 0.009). Men had significantly larger frontal sinuses compared to women (16.1 mm versus 13.7 mm for right frontal sinus, P = 0.031; 16.4 mm versus 13.9 mm for left frontal sinus, P = 0.023). Women and men had thicker frontal bone, and larger frontal sinuses, respectively.

Transvaginal pelvic ultrasound is a key tool in the examination of the subfertile woman. Cyclical physiological changes in the ovary are clearly identifiable on scan, which can also be used to assess ovarian reserve to counsel patients and plan treatment cycles. Pelvic scanning can also identify a wealth of ovarian and adnexal pathological conditions that influence fertility and may require intervention. This chapter outlines ultrasound assessment of the normal ovary and key ultrasonic features of common pathologies seen in the subfertile woman.

Tumor Treating Fields (TTFields) are electric fields known to exert an anti-mitotic effect on cancerous tumors. TTFields have been approved for the treatment of glioblastoma and malignant pleural mesothelioma. Recent studies have shown a correlation between TTFields doses delivered to the tumor bed and patient survival. These findings suggest that patient outcome could be significantly improved with rigorous treatment planning, in which numerical simulations are used to plan treatment in order to optimize delivery of TTFields to the tumor bed.Performing such adaptive planning in a practical and meaningful manner requires a rigorous and scientifically proven framework defining TTFields dose and showing how dose distribution influences disease progression in different malignancies (TTFields dosimetry). At EMBC 2019, several talks discussing key components related to TTFields dosimetry and treatment planning were presented. Here we provide a short overview of this work and discuss how it sets the foundations for the emerging field of TTFields dosimetry and treatment planning.

Introduction Molar-incisor hypomineralisation (MIH) is a common occurrence in primary and secondary care settings. While severe cases may need specialist care, mild cases should be managed in primary care.Aims To assess how UK-based general dental practitioners (GDPs) plan treatment for children with MIH using two clinical vignettesDesign An electronic vignette survey was designed using clinical photographs and radiographs. Vignette one presented a child with mild MIH who was unhappy about the appearance of his teeth. Vignette two presented an anxious child with severe MIH, caries and sensitivity. Further questions relating to confidence in management of MIH and referral were included. Participants were UK-based GDPs who regularly treat children. The survey was distributed by email and across social media platforms. Data collection occurred between February and May 2019.Results Fifty-eight GDPs completed the survey. Around half of participants addressed the aesthetic concerns of the child in vignette one. The majority of participants demonstrated sound treatment planning in terms of preventive care and management of molars. More GDPs identified increased caries risk in vignette two.Conclusion These findings demonstrate most GDPs in this study were working as effective tier one and two providers when faced with management of children with MIH.

INTRODUCTION AND OBJECTIVE:To investigate the role of urodynamic evaluation preoperatively and postoperatively to characterize and plan treatment of voiding and continence problems in women undergo...

Detailed knowledge of pancreatic ductal anatomy is indispensable in order to optimize the therapeutic approach in pancreatic diseases. Magnetic resonance cholangiopancreatography is a precious tool that can help in characterizing aspects of the pancreatic disease as well as determining the anatomy of the ducts and thus to plan treatment. This chapter focuses on the structural anatomy of the pancreas and its ducts, including the most frequent anatomic variations.

Radiation therapy has been a mainstay of managing brain metastases for decades. In the past, clinicians have relied on whole brain radiotherapy (WBRT) and in some instances partial brain radiation therapy to deliver conformal radiation dose distributions using MRI and CT-guidance to plan treatment. The dose limitations of various critical structures of the brain and treatment-induced neurocognitive side effects made intracranial treatment challenging. However, the development and popularization of stereotactic radiosurgery (SRS), including Gamma Knife stereotactic radiosurgery (GKRS) and linear accelerator (LINAC)-based SRS, has had a profound impact on the field of neuro-oncology. As the name suggests, SRS typically uses a method of immobilization to maintain a particular patient position for the duration of treatment. While this method of immobilization has traditionally been an invasive, rigid frame placed onto a patient’s head, with newer technical advances, frameless treatments with masks have become feasible without sacrificing accuracy. In this chapter, we outline seven particularly interesting applications in which SRS was used to increase the likelihood of achieving local control in patients with a variety of brain metastatic lesions.

Although similar oral and dental diseases as seen in dogs, cats, ferrets, and other carnivores are expected in suricates, published data on their oral and dental diseases are rare. The objective of this report is therefore to describe oral and dental examination findings in a family of zoo suricates. In this cross-sectional clinical study, detailed oral and dental examination and full-mouth dental radiographs were performed in 6 suricates undergoing general anesthesia for their regular annual wellness check. Attrition/abrasion was commonly observed less so were dental fractures, but both conditions were found to be associated with endodontic disease. Periodontal disease of different stages was also commonly observed. As expected, dental radiography was essential to determine dental anatomy, to accurately diagnose oral and dental diseases, and to plan treatment. This report illustrates that several painful oral and dental diseases can affect suricates in captivity. Therefore, thorough oral and dental examination supported by dental radiography under general anesthesia is warranted also in these animals as a part of their annual wellness checks.

AIM Teeth maintain the functionality and esthetic of oral cavity, they are also important for psychological and social well-being. This study aims to assess awareness of patients toward replacement of missing teeth. People with unrestored or missing teeth tend to have poor self-esteem and oral health-related quality of life; hence, their knowledge toward restoring and replacing teeth is an important aspect to be measured. MATERIALS AND METHODS It was an observational study having a cross-sectional design. Face- and content-validated questionnaire was used as study tool. Nonprobability, convenient sampling technique was employed that yielded information from 183 respondents residing in various areas of Hail city. Data were collected after written informed consent. The study was approved by the University of Hail ethical committee. RESULTS Two hundred questionnaires were distributed, out of which 183 were returned. Regarding knowledge of restoring missing teeth, 145 (79.2%) respondents know that function and esthetic can be maintained by replacing missing teeth. Information about the availability of various types of prosthesis was mostly obtained by them through their dentist (70; 48.3%), while books/magazines/Internet was the second source (38; 26.2%) and 37 (25.5%) heard it from someone who has already undergone the replacement of teeth. CONCLUSION The present study indicated that a good number of respondents have the knowledge of teeth replacement, and dentists were the most common source of information to the patients in terms of education about different treatment options. CLINICAL SIGNIFICANCE Evaluate and plan treatment options based on patients' expectations and perceptions.

Visualization of the larynx is necessary to evaluate structure and function, identify pathology, and plan treatment. There are different methods of evaluating the larynx, and each has benefits and limitations. Flexible endoscopy under halogen light can be performed in the clinic on nearly all children and provides an excellent view of general structure and mobility at the cricoarytenoid joints. Rigid or flexible stroboscopy provides more in-depth evaluation of the vibratory properties of the vocal folds, closure pattern, and any vocal fold lesions. High-speed laryngeal visualization has the advantage of being able to capture vibratory properties of aperiodic or chaotic vibration.

Purpose: The intent of this work was to evaluate the ability of our 200 kV kilovoltage arc therapy (KVAT) system to treat realistic lung tumors without exceeding dose constraints to organs-at-risk (OAR). Methods and Materials: Monte Carlo (MC) methods and the McO optimization framework generated and inversely optimized KVAT treatment plans for 3 SABR lung cancer patients. The KVAT system was designed to treat deep-seated lesions with kilovoltage photons. KVAT delivers dose to roughly spherical PTVs and therefore non-spherical PTVs were divided into spherical sub-volumes. A prescription dose of 12 Gy/fx × 4 fractions was planned to 90% of the PTV volume. KVAT plans were compared to VMC++ calculated, 6 MV stereotactic ablative radiotherapy (SABR) treatment plans. Dose distributions, dose volume histograms, gradient index (GI), planned mean doses and plan treatment times were calculated. Dose constraints for organs-at-risk (OAR) were taken from RTOG 101. Results: All plans, with the exception of the rib dose calculated in one of the KVAT plans for a peripheral lesion, were within dose-constraints. In general, KVAT plans had higher planned doses to OARs. KVAT GI values were 5.7, 7.2 and 8.9 and SABR values were 4.6, 4.1, and 4.7 for patient 1, 2 and 3, respectively. KVAT plan treatment times were 49, 65 and 17 min for patients 1, 2 and 3, respectively. Conclusions: Inverse optimization and MC methods demonstrated the ability of KVAT to produce treatment plans without exceeding TG 101 dose constraints to OARs for 2 out of 3 investigated lung cancer patients.

In dentistry, the assessment of periodontal biotype is considered one of the most important parameters with which to plan treatment, and craniofacial morphology might affect it. The aim of this study was to investigate the association between facial typology and gingival biotype in patients by means of two-dimensional and three-dimensional evaluations of facial typology. This study included 121 participants searching for orthodontic treatment (43 M, 78 F, 20.4 &plusmn, 10.4). Gingival biotype was evaluated based on the transparency of the periodontal probe through the gingival margin of the mid-buccal sulcus for both upper (UGB) and lower (LGB) anterior teeth. SellionNasion^GonionGnation (SN^GoGn) and CondylionGonionMenton (CoGoMe^) angles were measured on two-dimensional cephalograms. Three-dimensional face scans were acquired by means of a three-dimensional facial scanner (3dMD system) and successively analyzed to assess the facial typology using the ratio between lower facial height (SNMe) and total facial height (NMe). A chi-squared test and regression analysis were used to evaluate the associations between gingival biotype and facial morphology (p &lt, 0.05). The chi-squared test showed that there was no statistically significant association between facial typology and gingival biotype (UGB p = 0.83, LGB p = 0.75). The logistic regression showed an association between SNMe/NMe and the UGB (p = 0.036), and SNMe/NMe and LGB (p = 0.049). The decreased ratio of SNMe/NMe might be a protective factor for a thin gingival biotype.

Fluorescein angiography is a standard investigation done for patients with nonresolving acute central serous chorioretinopathy and chronic cases to diagnose and plan treatment. More often, it is used in conjunction with other imaging modalities as part of multimodal imaging. Recognized patterns of focal leaks described as smokestack and inkblot patterns have been described for decades. Multimodal imaging, however, provides a more comprehensive diagnostic potential.

Infectious Disease Digital twins are software replicas used in engineering to monitor a device and establish, for example, efficiency. Digital twins can also be used in medicine. Computational models can be personalized according to measurements taken from a patient for uses such as optimizing treatment. The COVID-19 pandemic has highlighted the potential use of digital twins for infections to improve diagnosis, make prognoses, and plan treatment. In a Perspective, Laubenbacher et al. discuss the challenges of building accurate models of the many systems and processes that are affected by infection that could be combined to form personalized digital twins. Science , this issue p. [1105][1] [1]: /lookup/doi/10.1126/science.abf3370

Objectives: The aim of the study to create awareness of self breast examination in and around a medical college hospital, to see how it changes the scenario and to study the clinic-pathological study of breast diseases in these patients. Methodology: Cross-sectional study was carried out in a medical college & hospital. Females were counseled and taught about the importance and method of self breast examination. Then patients of breast diseases who attended the surgery outdoor clinics and gave detailed clinical history were delineated and findings were recorded in a standard proforma. Results: There was more than 300 % increase in the number of patients after the self breast awareness campaign which is great success. 66% patients were found to have a significant pathology. Among benign breast diseases, fibroadenoma was the most common lesion constituting (68.12%) cases. Benign breast diseases are commonly seen in younger age group and usually presented with either breast lumps or nodularity. Conclusion: Awareness spread via counseling and teaching classes was very useful. Self Breast Examination being a screening tool is a good measure. Further evaluation is required by other methods to finally reach to a definitive diagnosis and to further plan treatment.

To obtain a child’s perspective during a mental health assessment, he or she is usually interviewed. Although researchers and clinicians generally agree that it is beneficial to hear a child’s account of his or her presenting issues, there is debate about whether children provide reliable or valid clinical information during these interviews. Here, we examined whether children provide clinically and diagnostically relevant information in a clinical setting. In all, 31 children aged 5–12-years undergoing mental health assessments were asked open-ended questions about their presenting problems during a semi-structured interview. We coded the information that children reported to determine whether it was clinically relevant and could be used to diagnose their problems and to formulate and plan treatment. We also coded children’s information to determine whether it was congruent with the children’s presenting problems and their eventual clinical diagnoses. Most of the information that children reported was clinically relevant and included information about behaviour, affect, temporal details, thoughts, people, the environment, and the child’s physical experiences. The information that children reported was also clinically valid; it was congruent with the problems that were discussed (84%) and also with the eventual diagnosis that the child received after a complete assessment (74%). We conclude that children can contribute relevant, clinically useful, valid information during clinical psychological assessments.

Integrated treatment for people with co-occurring mental illness and substance use disorder would be enhanced by a simple, recovery-oriented instrument to plan treatment and monitor progress toward dual recovery. This paper describes the development of a clinical instrument, the WestBridge Dual Recovery Inventory, and presents a preliminary evaluation of its usability.In collaboration with participants in treatment, family members, clinicians, and program leaders, we developed an inventory on dual recovery and then examined its utility through a series of iterative steps. First, we tested the inventory for inter-rater reliability among 10 program participants (rated independently by the first and last author). Second, we examined concordance by having a separate group of 10 program participants and their care managers complete the inventory independently. Third, we observed 3 care managers and 10 participants working together to complete the inventory as part of routine care during the quarterly assessment; we evaluated shared decision making based on the process they used to resolve differences and on a brief survey completed by program participants as the end of the session. Finally, to measure the inventory's capacity to detect change over time, we analyzed the ratings from admission to one year for 43 participants with quarterly assessments available for that time period.The WestBridge Dual Recovery Inventory assesses 14 domains of recovery, each rated on 5-point scales. Inter-rater reliability was high (Kappa = .82 to 1.00); agreement between independent ratings by care managers and participants varied considerably (Kendall's tau = -.83 to +.87); and collaborative ratings demonstrated high scores on shared decision making. Participants improved significantly on 11 of 14 domains during the initial residential treatment phase (admission to six months) and sustained gains during outpatient assertive community treatment (6 to 12 months).This preliminary assessment of the WestBridge Dual Recovery Inventory suggests that it reliably assesses dual recovery, facilitates shared decision making, and captures changes over time. The inventory appears to be usable, well received by participants and care managers, specific for program goals, and sensitive to changes in the participants. Recovery measures may need to be program-specific.

Arteriovenous malformations (AVMs) are a subset of congenital vascular malformations (CVMs). They comprise abnormal connections between arterial and venous circulation; treatment approaches are dependent on the angioarchitecture of the AVM, specifically the number and arrangement of the feeder arteries and outflow veins. Various imaging modalities can be used to diagnose and plan treatment. Here we will review the use of transarterial approaches to treat AVMs.

Purpose. To examine and spot systemic findings commonly associated with a serious form of ocular Behcet’s disease. This could potentially help ophthalmologists categorize their patients based on future risk and plan treatment accordingly. Subjects and Methods. The data of 249 patients with Behcet’s disease were examined thoroughly. Correlations between systemic and ocular findings were recorded. Patients were further subgrouped by the authors as having a vision-threatening form of the disease or not. Regression analysis was done to spot predictors for a vision-threatening form of the disease. Results. The presence of systemic vasculitis and oral and genital ulcers in a patient with Behcet’s disease was found to be associated with a milder form of ocular affection or none at all and vice versa. Certain correlations between findings were also found. Conclusion. Certain findings in Behcet’s disease may act as predictors for the severity of ocular affection. Directing our attention to these factors by the internist and ophthalmologist can help plan the frequency of follow-up as well as the aggressiveness of treatment in patients with Behcet’s disease.

In focus is the debate on mental health related to universalism and relativism concerning the nature and function culture plays in diagnosis, primarily through analysis of the changes in the mental health diagnostic system: the Diagnostic and Statistical Manual of Mental Disorders (DSM). Clinicians use the DSM to diagnose and classify mental health problems, mental disorders, and to plan treatment strategies. Orientation to the diagnostic process and culture influences if, how, when, who, and what is involved in the treatment process. The chapter has three sections: (1) the debate concerning culture in mental health diagnosis; (2) developments between the DSM-IV and DSM-5; and (3) brief orientation to the diagnostic tool, Cultural Formulation Interview, and to problems with diagnosis and treatment if cultural information is excluded.

In operation, on the basis of a study of 76 cases of endometrioid ovarian cancer shows a significant role of quantitative and qualitative changes of nucleic acids in tumor cells, which are associated with increased likelihood of developing metastases. Also indicated on the role and importance of photometric and ploidometric diagnosis of uveal melanomas research in the practice of medical Oncology profile for the subsequent plan treatment of patients and the prognosis of the disease.

SummaryAutoimmune disorders in children and adolescents can have significant neuropsychiatric complications and there is growing interest in the association between autoimmune conditions and psychiatric syndromes, particularly in Down syndrome. Acute presentations with psychiatric symptoms require careful assessment in order to recognise and plan treatment of underlying autoimmune disease in collaboration with paediatric colleagues. Difficult treatment decisions arise in children with established autoimmune diagnoses and psychiatric symptoms that may be a result of neuroimmunological processes associated with their condition, psychiatric side-effects of drug treatments or psychopathology resulting from other factors in the history that may or may not have a direct relation to the autoimmune diagnosis. This article illustrates these complexities through discussion of specific autoimmune disorders and three case histories.

Este estudio retrospectivo evalúa la relación entre los factores TNM de acuerdo a la clasificación clínica propuesta por la UICC en 1987 en 122 pacientes con diagnóstico histológico de cáncer de mama vistas en el Hospital de Belén entre 1966 a 1983. La edad media fue 48.4±11.9 años (rango, 23 a 87 años). La quinta década fue la más afectada (36.1%) y 62 pacientes (50.8%) fueron premenopáusicas. El TE medio fue 12.5 meses (rango, 12 días a 10 años), los síntomas más frecuentes fueron nódulo mamario (95.1%), mastalgia (40.9%), enrojecimiento de piel (13.1%) y secreción hemática por pezón (6.5%). Los signos clínicos al diagnóstico fueron: tumor (99.1%), adenopatía axilar (46.7%), retracción del pezón (33.6%) y piel de naranja (18.8%). La neoplasia comprometió con más frecuencia la mama izquierda (55.8%) que la derecha (44.2%); y ésta se localizó en el CSE en el 54.1% de los casos, CSI en el 21.3%, CIE en el 8.2%, toda la mama en el 7.4%, la región central en el 5.7% y en el CII en el 3.3%. De las 122 pacientes, 3 (2.5%) estuvieron en EC-0, 8 (6.6%) en EC-I, 33 (27.0%) en EC II-A, 34 (27.9%) en EC II-B, 12 (9.8%) en EC III-A, 17 (13.9%) en EC III-B y 15 (12.3%) en EC IV. Quince pacientes (12.3%), presentaron MAD, siendo las localizaciones más frecuentes: pulmón (53.3%), pleura (26.6%), ganglio supraclavicular (33.3%), peritoneo (13.3) y huesos (6.6%). Hubo relación directa estadísticamente significativa entre el T y el N (p

The aim of this study was to review cases of paediatric patients with craniovertebral junction (CVJ) tuberculosis with a view to try and stratify the cases into different groups which would help plan treatment and hence develop a protocol for treatment of a fairly uncommon condition still widely seen in the developing world.Twenty-three cases of paediatric craniovertebral tuberculosis had their clinical features and radiology reviewed. The treatment plan in each case was analyzed according to their presentation. The results of treatment after 1 year were assessed in each case.The clinical presentations varied from neck pain with hypoglossal nerve palsy to frank spastic quadriparesis, and frank instability at the atlanto-axial junction was seen in five out of 23 patients. Cold abscesses were seen in 18/23 cases, and severe torticollis was the presentation in 6/23. We graded the children with this condition into three groups: 1) those with instability and gross neurodeficit who required early operative intervention (1 needed trans-oral decompression with posterior fixation and 4 required posterior fixation) 2) those who had severe torticollis and large cold abscesses who were treated with trans-oral aspiration of cold abscess followed by neck immobilization (6/23) and 3) those who did not have significant neck muscle spasm or torticollis and who were treated with immobilization alone (12/23). Only one child in group 3 required delayed intervention for instability which developed after completion of the course of anti-tubercular medication.We concluded that children with craniovertebral tuberculosis should be treated according to their clinical presentation coupled with evidence of radiological instability. Those with gross deficit and instability need early stabilization, those with minimal deficit and no instability but severe pain or torticollis need aspiration of the cold abscess with external immobilization, whereas those without deficit, instability or severe pain may be managed by external orthoses alone. Of course, medical treatment for tuberculosis is necessary in each case.

Background: The present mini review evaluates assessment and comorbidity of glaucoma and depression with the possibilities of treatment options. Subjects and methods: Web of science was searched for relevant articles using search terms "glaucoma", "depression", "glaucoma and depression", "quality of life and glaucoma". The additional relevant papers were added from the bibliography of selected papers. All type s of articles were included, no time period was defined. Results: We have reviewed 11 studies regarding the comorbidities of glaucoma and depression. The number of participants in all studies ranged from 86 to 6760. Formats of scale in one study was clinician rated, others were self-reported scales. Two studie s of the above mentioned studies explored specific types of glaucoma. In the three studies out of 11 there was no significant eviden ce of elevated depressive symptoms associated with glaucoma. In the six studies the prevalence of depression was significant among glaucoma patients. One study provided suboptimal assessments of depression in glaucoma patients. The other one showed the presence of glaucoma significantly associated with depression after adjustment for the demographic factor. Most of the studies used one scale, while two of them used two scales. The reviewed studies did not analyze the therapy options of included patients. Conclusion : The results presented in this review indicate that glaucoma is accompanied by depression in the majority of analyzed studies. The comorbidity of glaucoma and depression should be the subject of further research on both, self- reflecting and clinician-rated scales, taking into account subjective experience of patients and physicians. The therapy options should be tak en into account in future researches focusing on the multidisciplinary approach including novel possibilities of treating both diseases respectively.

Purpose Clinically, repeat renal biopsies (RRBs) have been performed in lupus nephritis to identify changes in class, plan treatment and assist in prognostication. We set out to compare the histopathological features and outcomes of disease flare and protocol biopsy patients. Methods A retrospective descriptive study was conducted on repeat biopsies performed between January 1984 and December 2015 in lupus nephritis patients. Disease flares and protocol biopsies were compared. Results Of 614 systemic lupus erythematosus (SLE) renal biopsies, 127 (20.7%) RRBs were identified. Disease flare patients accounted for 96 (75.6%) and protocol biopsies for 31 (24.4%) of RRBs. Seventy (72.9%) disease flare patients retained their original class on repeat biopsy. When categorised as proliferative and non-proliferative histology, 83 (87.4%) of the disease flare biopsy patients remained histologically unchanged. Treatment remained unchanged in 57 (60.0%) patients following RRBs for disease flares. Response to immunosuppression in disease flare patients was poorer. Non-response was associated with increased chronicity index (OR = 1.33; 95% CI 1.01-1.76; p = 0.045). Thirty-three (36.3%) disease flare patients developed end-stage kidney disease (ESKD) in one year as compared to one (3.6%) protocol biopsy patient ( p = 0.003). ESKD in disease flare patients was associated with non-response to treatment (OR = 24.6; 95% CI 2.7-219.3; p = 0.004) on multivariate analysis. One-year mortality was 30.0% in the disease flare patients and 3.5% in protocol biopsy patients ( p = 0.018). Conclusion Repeat biopsies in disease flare patients infrequently led to histological class changes, failed to lead to change of treatment in the majority of patients, and were associated with poorer outcomes.

Lameness is one of the most important welfare and productivity concerns in the dairy industry. Our objectives were to obtain producers' estimates of its prevalence and their perceptions of lameness, and to investigate how producers monitor lameness in tiestall (TS), freestall with milking parlor (FS), and automated milking system (AMS) herds. Forty focal cows per farm in 237 Canadian dairy herds were scored for lameness by trained researchers. On the same day, the producers completed a questionnaire. Mean herd-level prevalence of lameness estimated by producers was 9.0% (±0.9%; ±SE), whereas the researchers observed a mean prevalence of 22.2% (±0.9%). Correlation between producer- and researcher-estimated lameness prevalence was low (r = 0.19) and mean researcher prevalence was 1.6, 1.8, and 4.1 times higher in AMS, FS, and TS farms, respectively. A total of 48% of producers thought lameness was a moderate or major problem in their herds (TS = 34%; AMS =53%; FS = 59%). One third of producers considered lameness the highest ranked health problem they were trying to control, whereas two-thirds of producers (TS = 43%; AMS = 63%; FS = 71%) stated that they had made management changes to deal with lameness in the past 2 yr. Almost all producers (98%) stated they routinely check cows to identify new cases of lameness; however, 40% of producers did not keep records of lameness (AMS = 24%; FS = 23%; TS = 60%). A majority (69%) of producers treated lame cows themselves immediately after detection, whereas 13% relied on hoof-trimmer or veterinarians to plan treatment. Producers are aware of lameness as an issue in dairy herds and almost all monitor lameness as part of their daily routine. However, producers underestimate lameness prevalence, which highlights that lameness detection continues to be difficult in in all housing systems, especially in TS herds. Training to improve detection, record keeping, identification of farm-specific risk factors, and treatment planning for lame cows is likely to help decrease lameness prevalence.

Magnetic resonance imaging (MRI) serves as the principal imaging modality to diagnose and plan treatment for children with cutaneous vascular anomalies. While routine MRI protocols can lead to the correct diagnosis in the majority of cases, the imaging appearances can sometimes be nonspecific or confusing, yielding more than one possible diagnosis. This review highlights specific MRI sequence recommendations and scanning tips that can optimize the imaging protocol to increase diagnostic confidence.

This was to create a new easy-to-use index for the treatment of MIH. An international MIH working group developed a new MIH index as an epidemiological screening procedure for assessing MIH treatment needs (MIH-TNI), and also for the screening and monitoring of individuals by dental practitioners. The MIH TNI assesses in particular the extent of the destruction of tooth structure in combination with any hypersensitivity occurring in MIH. The MIH-TNI is suggested as a basis for individual dental examinations covering all MIH typical problems or treatment planning. In addition, this index shall be the basis for decision-making in any MIH therapy studies already planned. After the validation of the MIH TNI it may be possible to create a standardised approach for dental treatment for MIH.

Failure of a post-retained restoration can provide a challenge to the general dental practitioner (GDP) in terms of diagnosis, treatment planning and communication with the patient. The cause of failure must be identified, and a thorough assessment of the restoration, remaining tooth and its functional and aesthetic demands carried out in order to plan treatment to provide the most reliable result. Clinical Relevance: This article discusses the assessment of failing post-retained crowns, with discussion of reasons for failure, thereby assisting the GDP in decision-making and treatment planning for such teeth.

Nonketotic hyperglycemia has been described as a metabolic cause of Hemiballism-hemichorea (HB-HC), especially in elderly patients with poorly controlled diabetes. Pathophysiology is not known yet. MRI features tend to be hyperintense in the putamen on T1-weighted images. We present conventional MRI with diffusion weighted imaging (DWI) and susceptibility weighted imaging (SWI) features of two cases with nonketotic hyperglycemia. T1 hyperintensity without diffusion restriction on DWI and minimal putaminal hypointensity without phase shift on SWI were compatible with either pathological mineralization or petechial microhemorrhage or protein denaturation. In the type 2 diabetic patients with HC-HB, conventional MRI together with SWI and DWI will guide to clinician to plan treatment approach.

The increase in the frequency of abdominal aortic aneurysms (AAA) and the widely accepted use of endovascular aneurysm repair (EVAR) as a first-line treatment or as an alternative to conventional surgery make it necessary for radiologists to have thorough knowledge of the pre- and post-treatment findings. The high image quality provided by multidetector computed tomography (MDCT) enables CT angiography to play a fundamental role in the study of AAA and in planning treatment. The objective of this article is to review the cases of AAA in which CT angiography was the main imaging technique, so that radiologists will be able to detect the signs related to this disease, to diagnose it, to plan treatment, and to detect complications in the postoperative period.

Aim: The aim was to measure doses of eyes and lenses in the presence and absence of shield during whole brain irradiation (WBI). In addition, the dose calculations accuracy of radiation therapy dose plan treatment planning system (TPS) in dose calculation of the eyes and lenses in WBI was evaluated. Materials and Methods: To measure the eyes and lenses doses during WBI, an inhomogeneous phantom of human head was used. Then, the eyes and lenses doses in the presence and absence of shield were measured by EBT3 film. Results: In single fraction with 200 cGy to reference point, average doses received by the left and right eyes in the absence of shield were 20 ± 1.5 and 22 ± 1.0 cGy, respectively, and for the left and right eyes in the presence of shield were 18 ± 2.2 and 21 ± 2 cGy, respectively. In addition, the average dose received by the left and right lenses in the absence of shield were 19.5 ± 0.5 and 18.5 ± 0.5 cGy, respectively, and for the left and right lenses in the presence of shield were 20.5 ± 1.5 and 19.5 ± 1.5 cGy, respectively. The results showed the TPS compared to the film underestimates doses for the eyes and lenses. Conclusion: The average dose received by the eyes and lenses during WBI were estimated around 9–11% of prescribed dose. According to the results, there is probability of radiation-induced cataractogenesis during WBI. By investigating the effect of shield on the lenses and eyes doses, using shield during WBI is not recommended. In addition, the results showed dose calculation accuracy of the TPS for the estimation of doses received by the eyes and lenses during WBI is not acceptable.

Root resorption is a common iatrogenic consequence of orthodontic treatment, although it can also be seen in the absence of orthodontic treatment. It may occur at any time during orthodontic treatment and compromise prognosis of the tooth involved and also the stability of treatment results. Orthodontics is the only branch which actually uses the inflammatory process as a tool for solving esthetic and functional problems. Therefore, every orthodontist should know the risk factors of root resorption involved in the process and plan treatment with an aim to reduce its possibility. The severity and degree of root resorption related with orthodontic treatment are multifactorial, involving environmental factors and host factors. A proper medical history, an assessment of predisposing factors, radiographic evaluation of alterations in root morphology and careful planning and execution of orthodontic mechanics may reduce the incidence of root resorption. The current review is aimed at providing clinicians and academics with an insight into the mechanical and biological aspects in the process of root resorption, the methods of identification during its early stages and intervention at the right time to reduce its severity.

Introduction The Siewert classification has been used to plan treatment for tumours of the gastro-oesophageal junction since its proposal in the 1980s. The purpose of this study was to assess its continued relevance by evaluating whether there were differences in the biology and clinical characteristics of adenocarcinomas by Siewert type, in a contemporary cohort of patients, in whom the majority had received neoadjuvant chemotherapy. Methods A prospective database was reviewed for all patients who underwent resection from 2005 to 2011 and analysed with regard to Siewert classification determined from the pathological specimen, treatment and clincopathological outcomes. Results Two hundred and sixteen patients underwent oesophagogastric resection: 133 for type I, 51 for type II and 33 for type III tumours. 135 Patients (62.5%) received neoadjuvant chemotherapy with no difference between groups. There were no significant differences in age, sex, pT stage, pN stage, pM stage, ASA, or inpatient complications between patients with adenocarcinoma based on their Siewert classification. There was a significant increase in maximum tumour diameter (P = 0.023), perineural invasion (P = 0.021) and vascular invasion (P = 0.020), associated with more distal tumours (Type III > Type II > Type I). Median overall survival was significantly shorter for more distal tumours (Type I: 4.96 years vs. Type II: 3.3 years vs. Type III: 2.64 years; P = 0.04). The surgical approach did not influence survival. Conclusion In the era of multi-modal treatment pathological Siewert tumour type is of prognostic value, as patients with Type III disease are likely to have larger and more aggressive tumours that lead to worse outcomes. J. Surg. Oncol. 2014;109:202–207.

Purpose of review This review intends to present some epidemiological findings regarding the epidemiology of head and neck squamous cell carcinoma not related to alcohol or tobacco (HNSCCNAT). Recent findings Twenty-five percent of squamous cell carcinomas of head and neck are not related to tobacco or alcohol consumption. The risk factors for this group of malignancies are not very well established yet. HNSCCNAT are more likely to occur in the oropharynx. The diagnosis is more frequent at young age (before 50). The prevalence of human papillomavirus (HPV-positive) infection is high. Summary Monitoring HPV status in head and neck cancer patients who are not tobacco or alcohol consumers will enable physicians to better plan treatment.

1From the Department of Abdominal Imaging, St Eloi University Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, Montpellier, 34295 France (S.N., E.D., B.G.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (Y.L., E.S.); Department of Radiology, McGill University Health Centre, Montreal, QC, Canada (C.R.); Department of Radiology, Addenbrooke’s Hospital, Cambridge, England (H.C.A.); Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan (S.F.); IRCM, Institut de Recherche en Cancerologie de Montpellier, Montpellier, France (S.N., B.G.); and INSERM, Unit 896, Montpellier, France (S.N., B.G.). Received June 15, 2015; revision requested October 6 and received November 1; accepted November 14. All authors have disclosed no relevant relationships. Address correspondence to S.N. (email: stephanienougaret@free.fr).

Repetitive behaviors are essential features in autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD). Both conditions show a wide range of repetitive behaviors and some of the same repetitive behaviors can be observed in both conditions. Although some children with ASD warrant a separate diagnosis of OCD, there are differences that have important clinical implications. Repetitive behavior in children with OCD is often driven by unwanted and bothersome thoughts that cause anxiety. Compulsive behaviors result in temporary reduction in anxiety, which reinforces the repetitive behavior. In contrast to obsessive-compulsive symptoms in children with OCD, repetitive behaviors may not cause distress for children with ASD. Indeed, distress may occur when the preferred behavior is interrupted. The preoccupations observed in children with ASD reflect areas of restricted interest and are fundamentally different from intrusive and bothersome concerns in children with OCD. Here we review the similarities and differences in repetitive behaviors in ASD and OCD. Examination of similarities and differences may help clinicians disentangle the repetitive behaviors attributable to OCD from those attributable to ASD, plan treatment, and monitor progress.

Characterization of the pancreatic cystic lesion with reliable, noninvasive methods is crucial to distinguish benign from malignant cystic tumors of the pancreas in order to plan treatment options or follow-up. Despite evaluation with sophisticated preoperative investigations, a correct pathologic diagnosis rate does not exceed 68 %, due to heterogeneous variety of lesions with different behaviors, resulting often in over- or undertreatment of these lesions.