Exertional dyspnea increases when the mechanical output of the respiratory muscles becomes uncoupled from increases in neural respiratory drive. Combining measurements of inspiratory constraints and ...ventilatory inefficiency may better uncover the role of mechanical-ventilatory abnormalities on exertional dyspnea than the currently-recommended approach, i.e., a low breathing reserve.
We determined the presence of a low breathing reserve (1-(peak ventilation (V̇E)/estimated maximal voluntary ventilation) x 100 < 15%), critical inspiratory constraints (tidal volume (VT)/exercise inspiratory capacity (ICdyn) > 0.7) and ventilatory inefficiency (V̇E/CO2 output (V̇CO2) nadir>34) in 284 subjects (161 males) with “disproportionate dyspnea” (N = 148), “dyspnea with multiple potential causes” (N = 93) and “dyspnea without an apparent cause.
The agreement between breathing reserve and assessment of inspiratory constraints was only “fair” (kappa confidence interval (CI) = 0.264 0.169–0.358). Attainment of critical inspiratory constraints and an upward inflection in dyspnea ratings systematically preceded a low breathing reserve. Of note, ~55% (93/167) of subjects with normal breathing reserve showed critical inspiratory constraints despite largely preserved lung function. Regardless of the breathing reserve, subjects showing critical inspiratory constraints and/or poor ventilatory efficiency reported higher dyspnea and more impaired exercise tolerance compared to their counterparts (p < 0.05). Poor ventilatory efficiency strongly predicted a high dyspnea/work rate in subjects without critical inspiratory constraints regardless of the breathing reserve (odds ratio 95% CI = 4.21 2.01–6.42; p < 0.001).
An integrated analysis of inspiratory constraints and ventilatory inefficiency is key to uncover physiological abnormalities germane to dyspnea in clinical populations in whom the origins of this distressing symptom are uncertain.
•~55% of subjects with dyspnea of unclear origin showed inspiratory constraints.•These subjects, however, had normal breathing reserve.•Inspiratory constraints plus ventilatory inefficiency predicted dyspnea burden and exercise intolerance.•These measurements should be routinely used in the assessment of dyspnea of unclear origin.
Objectives
Early, accurate diagnosis is crucial for the prognosis of patients with soft tissue sarcomas. To this end, standardization of imaging algorithms, technical requirements, and reporting is ...therefore a prerequisite. Since the first European Society of Musculoskeletal Radiology (ESSR) consensus in 2015, technical achievements, further insights into specific entities, and the revised WHO-classification (2020) and AJCC staging system (2017) made an update necessary. The guidelines are intended to support radiologists in their decision-making and contribute to interdisciplinary tumor board discussions.
Materials and methods
A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements were scored online by level of agreement (0 to 10) during two iterative rounds. Either “group consensus,” “group agreement,” or “lack of agreement” was achieved.
Results
Eight sections were defined that finally contained 145 statements with comments. Overall, group consensus was reached in 95.9%, and group agreement in 4.1%. This communication contains the first part consisting of the imaging algorithm for suspected soft tissue tumors, methods for local imaging, and the role of tumor centers.
Conclusion
Ultrasound represents the initial triage imaging modality for accessible and small tumors. MRI is the modality of choice for the characterization and local staging of most soft tissue tumors. CT is indicated in special situations. In suspicious or likely malignant tumors, a specialist tumor center should be contacted for referral or teleradiologic second opinion. This should be done before performing a biopsy, without exception.
Clinical relevance
The updated ESSR soft tissue tumor imaging guidelines aim to provide best practice expert consensus for standardized imaging, to support radiologists in their decision-making, and to improve examination comparability both in individual patients and in future studies on individualized strategies.
Key Points
• Ultrasound remains the best initial triage imaging modality for accessible and small suspected soft tissue tumors.
• MRI is the modality of choice for the characterization and local staging of soft tissue tumors in most cases; CT is indicated in special situations. Suspicious or likely malignant tumors should undergo biopsy.
• In patients with large, indeterminate or suspicious tumors, a tumor reference center should be contacted for referral or teleradiologic second opinion; this must be done before a biopsy.
Abstract Strong evidence exists for rehabilitation programmes following a cancer diagnosis, although little is known about their cost. The effects of an 8-week, physiotherapy-led, structured group ...intervention during the early survivorship phase were evaluated. Significant changes in quality of life and fatigue, and promising changes in fitness were found. The overall cost for this programme was €196 per participant, including the salaries of the clinicians, overheads and equipment costs. The modest costs associated with this programme may support more routine ‘cancer rehabilitation’, although more robust analyses are required.
Pincer-type P2SiRh complexes featuring a rhodium–silicon bond are shown to facilitate well-defined stoichiometric reductions of CO2 with Si–O bond formation by two different pathways: (a) hydride ...transfer to CO2 followed by formate migration to silicon, or (b) complete scission of the CO bond at the Rh–Si unit to afford a product with siloxide and carbonyl ligands. A combined experimental and computational study shows that the latter process occurs by anomalous insertion of CO2 into the polarized Rhδ−–Siδ+ bond, a finding that is confirmed by extending the reactivity to an unchelated system. The siloxide carbonyl product can be further elaborated by reaction with water or pinacolborane to give structurally distinct CO2 reduction products. Taken together, these results demonstrate how metal/main-group bonds can be tuned to direct migratory insertion reactivity.
Total suspended solids (TSS) concentration is an important biogeochemical parameter for water quality management and sediment-transport studies. In this study, we propose a novel semi-analytical ...method for estimating TSS in clear to extremely turbid waters from remote-sensing reflectance (Rrs). The proposed method includes three sub-algorithms used sequentially. First, the remotely sensed waters are classified into clear (Type I), moderately turbid (Type II), highly turbid (Type III), and extremely turbid (Type IV) water types by comparing the values of Rrs at 490, 560, 620, and 754 nm. Second, semi-analytical models specific to each water type are used to determine the particulate backscattering coefficients (bbp) at a corresponding single wavelength (i.e., 560 nm for Type I, 665 nm for Type II, 754 nm for Type III, and 865 nm for Type IV). Third, a specific relationship between TSS and bbp at the corresponding wavelength is used in each water type. Unlike other existing approaches, this method is strictly semi-analytical and its sub-algorithms were developed using synthetic datasets only. The performance of the proposed method was compared to that of three other state-of-the-art methods using simulated (N = 1000, TSS ranging from 0.01 to 1100 g/m3) and in situ measured (N = 3421, TSS ranging from 0.09 to 2627 g/m3) pairs of Rrs and TSS. Results showed a significant improvement with a Median Absolute Percentage Error (MAPE) of 16.0% versus 30.2–90.3% for simulated data and 39.7% versus 45.9–58.1% for in situ data, respectively. The new method was subsequently applied to 175 MEdium Resolution Imaging Spectrometer (MERIS) and 498 Ocean and Land Colour Instrument (OLCI) images acquired in the 2003–2020 timeframe to produce long-term TSS time-series for Lake Suwa and Lake Kasumigaura, Japan. Performance assessments using MERIS and OLCI matchups showed good agreements with in situ TSS measurements.
•We developed a novel semi-analytical method for estimating TSS.•The new method outperformed three existing state-of-the-art methods.•The new method is widely applicable from clear to extremely turbid waters.•The new method can produce reasonable TSS time-series from MERIS & OLCI data.
Strontium ranelate is a new anti-osteoporosis therapy therefore, its benefits and harms need to be known.
To determine the efficacy and safety of strontium ranelate for the treatment and prevention ...of postmenopausal osteoporosis.
We searched MEDLINE (1996 to March 2005), EMBASE (1996 to week 9 2005), the Cochrane Library (1996 to Issue 1 2005), reference lists of relevant articles and conference proceedings from the last two years. Additional data was sought from authors and industry sponsors.
We included randomized controlled trials (RCTs) of at least one year duration comparing strontium ranelate versus placebo reporting fracture incidence, bone mineral density (BMD), health related quality of life and/or safety outcomes in postmenopausal women. Treatment (versus prevention) population was defined as women with prevalent vertebral fractures and/or lumbar spine BMD T score < -2.5 SD.
Two reviewers independently determined study eligibility, assessed trial quality and extracted the relevant data. Disagreements were resolved by consensus. RCTs were grouped by dose of strontium ranelate and treatment duration. Where possible, meta-analysis was conducted using the random effects model.
A total of four trials met our inclusion criteria, three of which investigated the effects of strontium ranelate compared to placebo in a treatment population (doses ranged from 0.5 to 2 g daily) and one, in a prevention population (doses 0.125, 0.5 and 1 g daily). In osteoporotic, postmenopausal women a 37% reduction in vertebral fractures (two trials, n = 5082, RR 0.63, 95% CI 0.56 to 0.71) and a 14% reduction in non-vertebral fractures (two trials, n = 6572, RR 0.86, 95% CI 0.75 to 0.98) was demonstrated over a three year period with 2 g of strontium ranelate daily. An increase in BMD at all sites was shown with the same dose: lumbar spine BMD (two trials, n = 1614, WMD adjusted for strontium content 5.44, 95% CI 3.41 to 7.46 and WMD not adjusted 11.29, 95% CI 10.22 to 12.37 over two years), femoral neck and total hip (two trials, n = 4230, WMD 8.25, 95% CI 7.84 to 8.66 and WMD 9.83, 95% CI 9.39 to 10.26 respectively over three years). One gram of strontium ranelate daily in postmenopausal women without osteoporosis increased BMD at all sites over a two year period: lumbar spine (one trial, n = 59, WMD adjusted for strontium content 2.39, 95% CI 0.15 to 4.63 and WMD not adjusted 6.68, 95% CI 5.16 to 8.20), femoral neck (one trial, n= 60, WMD 2.52, 95%CI 0.96 to 4.09) and total hip (one trial, n = 60, WMD 1.02, 95% CI 0.48 to 1.56). In both the treatment and prevention populations, lower doses of strontium ranelate were superior to placebo with the highest dose of strontium ranelate demonstrating the greatest reduction in vertebral fractures and increase in BMD. There is some evidence to suggest that 2 g of strontium ranelate daily compared to placebo may have a beneficial effect on health related quality of life in postmenopausal women after three years of treatment. Two grams of strontium ranelate daily increased the risk of diarrhea (RR 1.38%, 95% CI 1.02 to 1.87); however, adverse events did not affect the risk of discontinuing strontium ranelate nor did it increase the risk of serious side effects, gastritis or death. Additional data obtained suggests that the risk of vascular system disorders including venous thromboembolism (two trials, n = 6669, 2.2% versus 1.5%, OR 1.5, 95% CI 1.1 to 2.1) and pulmonary embolism (two trials, n = 6669, 0.8% versus 0.4%, OR 1.7, 95% CI 1.0 to 3.1) as well as nervous system disorders such as headaches (3.9% versus 2.9%), seizures (0.3% versus 0.1%), memory loss (2.4% versus 1.9%) and disturbance in consciousness (2.5% versus 2.0%) is slightly increased with taking 2 g of strontium ranelate daily over a 3 to 4 year period.
There is silver level evidence to support the efficacy of strontium ranelate for the reduction of vertebral fractures (and to a lesser extent non-vertebral fractures) in postmenopausal osteoporotic women and an increase in BMD (all sites) in postmenopausal women with and without osteoporosis. Diarrhea may occur however, adverse events leading to study withdrawal were not significantly increased in the strontium ranelate group. Potential risks to the vascular and neurological system associated with taking 2 g of strontium ranelate daily need to be further explored and quantified.
Dental chair units (DCUs) use water to cool and irrigate DCU-supplied instruments and tooth surfaces, and provide rinsewater during dental treatment. A complex network of interconnected plastic ...dental unit waterlines (DUWLs) supply water to these instruments. DUWLs are universally prone to microbial biofilm contamination seeded predominantly from microorganisms in supply water. Consequently, DUWL output water invariably becomes contaminated by high densities of microorganisms, principally Gram-negative environmental bacteria including Pseudomonas aeruginosa and Legionella species, but sometimes contain human-derived pathogens such as Staphylococcus aureus. Patients and staff are exposed to microorganisms from DUWL output water and to contaminated aerosols generated by DCU instruments. A wide variety of approaches, many unsuccessful, have been proposed to control DUWL biofilm. More recently, advances in biofilm science, chemical DUWL biofilm treatment agents, DCU design, supply water treatment and development of automated DUWL biofilm control systems have provided effective long-term solutions to DUWL biofilm control.
The SPectrometer for Ion DEtermination in fission Research (SPIDER) has been developed for measuring mass yield distributions of fission products from spontaneous and neutron-induced fission. The ...2E–2v method of measuring the kinetic energy (E) and velocity (v) of both outgoing fission products has been utilized, with the goal of measuring the mass of the fission products with an average resolution of 1 atomic mass unit (amu). The SPIDER instrument, consisting of detector components for time-of-flight, trajectory, and energy measurements, has been assembled and tested using 229Th and 252Cf radioactive decay sources. For commissioning, the fully assembled system measured fission products from spontaneous fission of 252Cf. Individual measurement resolutions were met for time-of-flight (250ps FWHM), spacial resolution (2mm FHWM), and energy (92keV FWHM for 8.376MeV). Mass yield results measured from 252Cf spontaneous fission products are reported from an E–v measurement.
Purpose
This study aims to evaluate the feasibility and efficacy of an 8-week supervised exercise program in de-conditioned cancer survivors within 2–6 months of chemotherapy completion.
Methods
...Participants were randomly assigned to an 8-week, twice-weekly, supervised aerobic exercise training regime (
n
= 23) or a usual care group (
n
= 20). Feasibility was assessed by recruitment rate, program adherence and participant feedback. The primary outcome was aerobic fitness assessed by the Modified Bruce fitness test at baseline (0 weeks), post-intervention (8 weeks) and at 3-month follow-up. Secondary outcomes included physical activity, waist circumference, fatigue and quality of life.
Results
The recruitment rate was 81 % and adherence to the supervised exercise was 78.3 %. Meaningful differences in aerobic fitness between the exercise and usual care groups at both the 8-week mean 3.0 mL kg
−1
min
−1
(95 % CI −1.1–7.0) and 3-month follow-up 2.1 mL kg
−1
min
−1
(−2.3–6.6) were found, although these differences did not achieve statistical significance (
p
values >0.14). Self-reported physical activity increased in the exercise group (EG) compared to the usual care group at both 8-week (
p
= 0.01) and 3-month follow-up (
p
= 0.03) and significant differences in favour of the EG were found for physical well-being at both the 8-week (
p
= 0.03) and 3-month follow-up (
p
= 0.04). Improvements in fatigue (
p
= 0.01), total quality of life plus fatigue (
p
= 0.04), and a composite physical functioning score (
p
= 0.01) at the 3-month follow-up were also found.
Conclusion
The PEACH trial suggests that 8 weeks of supervised aerobic exercise training was feasible and may improve aerobic fitness, fatigue and quality of life in de-conditioned cancer survivors during the early survivorship phase.
Implications for Cancer Survivors
Exercise interventions commenced in the early survivorship phase appear safe, feasible and may lead to improvements in QOL and fatigue.
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