This paper reports a case of carcinoma expleomorphic adenoma of the minor salivary glands, where the carcinomatous component was a malignant myoepithelioma (myoepithelial carcinoma). ...Immunohistochemical investigation showed that the carcinoma cells were positive for cytokeratin, S-100 protein and vimentin, and focally positive for actin and desmin. A moderate level of positivity was found fo laminin and collagen IV around the neoplastic islands. These data are the confirmation that the carcinoma cells were myoepithelial. The number of mitoses, the istotype, the minimal extent of extracapsular infiltration and the absence of vascular invasion made it possible to include this particular case among those with a better prognosis.
Patients are instructed to restrict activity for several months after lumbar surgery to safely recuperate. However, after recuperation many patients continue sedentary lifestyles because of fear of ...spine injury, persistent pain, deconditioning, and habit. Lack of activity has serious long-term adverse consequences for spine health and other physical and mental diagnoses (ie, Sedentary Death Syndrome). Because surgeons comprehensively understand the spine condition and extent of surgery, they and their surgical team are uniquely positioned to address apprehensions and advise/encourage prudent activity. Thus programs to foster physical activity that can be integrated into the busy postop spine care setting are needed.
To determine whether an intervention encompassing major psychosocial tenets of behavior change would be effective in increasing prudent physical activity, primarily walking, after 4-6 months.
Randomized controlled trial, tertiary spine center.
A total of 225 patients 3 months after complex lumbar surgery, cleared by surgeons to increase physical activity.
Paffenbarger Physical Activity and Exercise Index (PAEI).
During routine 3-month postop visits, 111 intervention patients received (1) a booklet about benefits of physical activity and national activity guidelines, (2) instruction on how to increase lifestyle walking, (3) a pedometer calibrated to stride length, (4) made a self-contract specifying walking goals, and (5) received interval telephone contract-directed encouragement from study personnel. A total of 114 controls received information about safe physical activity. At enrollment, all patients completed the valid 3-domain PAEI measuring number of blocks walked and stairs climbed daily, and sports during the past week. Kcal/week were calculated for each domain and for an overall total. The national recommended threshold overall total is ≥2000 Kcal/week. Operative records were reviewed and a Surgical Invasiveness Index (SII) value was calculated (maximum 10 points per vertebral level); higher is greater complexity. The primary outcome was change in Kcal/week in the PAEI walking domain at 4-6 months post enrollment; a secondary outcome was change in overall total Kcal/week.
At enrollment, intervention and control groups were similar in mean age (64 vs 64), women (44% vs 50%), median SII value (11 vs 10), PAEI walking Kcal/week (1447 vs 1246), PAEI overall total Kcal/week (1826 vs 1631), and percent meeting the recommended activity threshold total (37% vs 30%) (all p>.05). Mean post-enrollment follow-up was 4.2±0.6 months. The within-patient mean increase in PAEI walking was 1132 vs 582 Kcal/week (p=.03) and the mean increase in PAEI overall total was 1713 vs 1067 Kcal/week (p=.04). In multivariable analysis with change in PAEI walking as the dependent variable, intervention group (p=.02), younger age (p=.01), and female sex (p=.05) were associated, but more complex surgery was not (p=.24). Similar results were found for the PAEI overall total as the dependent variable. At the follow-up more patients in the intervention group met the ≥2000 Kcal/week threshold (63% vs 46%) (OR 2.0, CI 1.2-3.5, p=.009).
A psychosocial intervention in the spine care setting was successful in increasing physical activity after recuperation from lumbar surgery. Our study highlights the need to guide patients in regaining prudent activity that will promote subsequent spine and overall health.
This abstract does not discuss or include any applicable devices or drugs.
Major goals of lumbar surgery are pain relief and safe and timely restoration of functional status with return to desired roles and responsibilities. In addition to increasing mobility, prudent ...physical activities, such as walking more in the near-term postop period, may facilitate return to functional status in diverse domains of daily life.
To determine if increased physical activity after recuperation from lumbar surgery is associated with improvement in a composite measure of overall functional status
Secondary analysis, longitudinal cohort, tertiary spine center.
Pooled sample of 220 patients enrolled during routine 3-month postop visits into a trial to increase physical activity; subsequently followed for an additional 4-6 months.
RAND-12 composite score, encompassing subscales for daily activities, work and social roles, pain, and mental health.
At enrollment patients completed the RAND-12 (composite score=50 for the general population) and the 3-domain Paffenbarger Physical Activity and Exercise Index (PAEI) measuring number of blocks walked, stairs climbed daily and sports during the past week. Kcal/week were calculated for an overall total. Patients also rated global change in pain since surgery on a 7-point scale. Patients were then assigned into groups receiving different amounts of information about safely increasing physical activity, primarily walking, and follow-ups were conducted at varying time intervals. After 4-6 months, patients again completed the RAND-12 and PAEI. Operative records were reviewed and a surgical invasiveness index value was calculated (maximum 10 points/vertebral level); higher is greater complexity. In multivariable analysis the dependent variable was change in RAND-12 scores, the main independent variable was change in overall PAEI Kcal/week, and analyses were controlled for covariates.
Group assignments did not affect RAND-12 scores, thus all patients were pooled for this analysis. The mean age was 64, 52% were men, 40% had major comorbidity. The mean time from surgery to enrollment was 2.9±0.4 months, and since surgery, 64% reported a lot of improvement in pain: 25% moderate-little, 11% same-worse. The mean time from enrollment to follow-up was 4.2±0.6 months; at the follow-up, patients reported improvement for both the RAND-12 and PAEI, with enrollment, follow-up and within-patient change mean scores for the RAND-12 of 37±10, 43±10, and 6±10 (paired ttest p<.0001), and for the PAEI of 1699±1637, 3133±2795, and 1434±2370 Kcal/week (paired ttest p<.0001). In multivariable analysis, more improvement in RAND-12 composite score was associated with greater increases in PAEI Kcal/week (p=.003), controlling for age, sex, comorbidity, pain, and surgical complexity. Change in PAEI blocks walked (880 Kcal/week, paired t-test p<.0001) gave similar multivariable results (p=.05). In multivariable analysis, the RAND-12 subscales that most improved with increased physical activity were physical function (p=.005), role physical (p<.0001), social function (p=.03), pain (p=.01) and mental health (p=.006).
Improvement in physical activity, primarily walking more, was associated with improvement in diverse subscales of functional status. Our study showed that in addition to preserving mobility, increased physical activity in the near-term postop period is a gateway behavior with beneficial downstream effects on diverse domains of physical and mental health.
This abstract does not discuss or include any applicable devices or drugs.
To determine the amount of formal instruction and evaluation about reporting given to radiology residents in the U.S.A., to document report generation methods and to quantify the performance of ...physician coding.
E-mail requests with links to a web-based, anonymous survey were sent to program directors of all accredited radiology residencies in the USA. Demographic questions included university or private affiliation, number of residents, geographic location, and number of hospitals covered. Subject-specific items covered the amount of didactic instruction, formal evaluation of reports, and use of structured reports. A didactic activity index (DAI) was calculated as the sum of answers to domain-specific questions and tested for relation to demographic variables. We also asked about dictation methods and International Classification of Diseases (ICD) or Common Procedural Terminology (CPT) coding of examinations by radiologists.
Of the 191 active radiology residencies, 151 (79%) completed the survey. Responses for hours of didactic instruction in reporting given more than a 4-year residency were distributed as follows: 0-1 = 40%, 2-4 = 46%, >4 = 14%. The percentage of resident reports formally graded was distributed as follows: 0-1 = 82%, 2-4 = 8%, >4 = 10%. The extent to which faculty-designed, structured reports were used by residents was distributed as follows: none = 16%, minimal = 25%, few = 17%, some = 33%, most = 9%. The DAI was normally distributed with a mean of 14.8 and a standard deviation of 2.4. Military programs had higher DAIs than university residencies (P = .03). There was no significant relation between any other program demographic variables and the DAI (P > .05). A substantial number of programs reported that physicians performed coding for some or most studies: ICD-9 = 30%, CPT = 26%. The dominant method for report generation was human transcription in 79% followed by speech recognition at 19%. Speech recognition penetration (departments reporting use of the technology for at least some dictation) was estimated to be 38%.
In 86% of sampled radiology residencies, trainees receive no more than one hour of didactic instruction in radiology reporting per year. An aggregate measure of didactic activity about interpretative reporting was identical across all program demographic variables except that military residencies seemed to do slightly more than those located at universities.
A patient presented 3 1/2 years after resection of a malignant parotid tumor with a new cerebellopontine angle mass. The presence of multiple punctate calcifications and loss of T2 signal were ...helpful in correctly identifying the lesion as mucinous adenocarcinoma.
Hepatocellular carcinoma (HCC) is a complication of cirrhosis. Due to blood transfusions, patients with β-thalassemia (thal) are often infected with either hepatitis C virus (HCV) or hepatitis B ...virus (HBV). In the past, many patients did not survive long enough to develop HCC. The recent improvements in prognosis have helped in the diagnosis of HCC that has developed. The aim of this study was to evaluate HCC incidence in β-thal. We performed liver ultrasound (US) on all adults without a previous diagnosis of HCC. Risk factors (iron overload, HCV infection, HBV infection, cirrhosis) were evaluated. One hundred and eight thalassemia patients have been evaluated; of whom three were excluded (two patients as they were under the age of 18 years and one patient because he had a previous history of HCC). Seventy-two patients 31 had thalassemia major (TM), 41 had thalassemia intermedia (TI) with risk factors (iron overload in 72, HCV infection in 46, HBV infection in two, cirrhosis in 10) and 33 (four with TM and 29 with TI) without risk factors underwent liver US. Overall, two patients were found to have a newly developed HCC. Of these two patients, one was treated with surgery and the other with percutaneous radiofrequency. Further follow-up did not show any evidence of recurrence after 23 and 15 months, respectively. Ultrasound screening can allow early detection and treatment of HCC in thalassemia patients.
We report on a search for nuclear recoil signals from solar ^{8}B neutrinos elastically scattering off xenon nuclei in XENON1T data, lowering the energy threshold from 2.6 to 1.6 keV. We develop a ...variety of novel techniques to limit the resulting increase in backgrounds near the threshold. No significant ^{8}B neutrinolike excess is found in an exposure of 0.6 t×y. For the first time, we use the nondetection of solar neutrinos to constrain the light yield from 1-2 keV nuclear recoils in liquid xenon, as well as nonstandard neutrino-quark interactions. Finally, we improve upon world-leading constraints on dark matter-nucleus interactions for dark matter masses between 3 and 11 GeV c^{-2} by as much as an order of magnitude.
The detection of surface defects during periodic inspection is important because, usually, the stresses are higher at the surface, thus affecting the growth of the discontinuity. Surface defects can ...be detected using some traditional non-destructive testing methods, such as eddy current, dye penetrant, magnetic particle and ultrasonic. Some of these methods can be used only in static conditions; the others have limitations for the dynamic inspection.The recent progress in the field of non-contact ultrasonic sensors has led us to develop a simple system for the real-time inspection of moving bodies at a high speed. The paper presents the possibility of using, with the developed system, two methodologies, based on non-contact ultrasound, to detect surface defects on objects moving at 100 km/h, so that in service inspection is possible. A methodology, based on laser and air-coupled sensors, uses the advantages of laser-generated surface waves; the analysis is done on the reflected wave, created by the interaction of the surface wave with the defect. The inspected surface layer can be selected from the wavelength of the surface wave. The other methodology, based on air-coupled sensors, uses the disadvantages of the ultrasound transmission at the air/metal interface; the analysis is done on the diffraction of the wave reflected from the surface. The execution of the inspection is simple with both techniques. The experimental results indicate a good efficiency of the two methodologies proposed for the real-time detection of surface defects on objects moving at high speed.
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