Thorax

A small positron-generating branch in 90-Yttrium decay enables post-therapy dose assessment in liver cancer radioembolization treatment. The aim of this study was to validate clinical positron emission tomography (PET) quantification, focusing on scanner linearity as well as acquisition and reconstruction parameter impact on scanner calibration. Data from three dedicated phantom studies (activity range: 55.2 MBq-2.1 GBq) carried out on a Philips Gemini TF 16 PET/CT scanner were analyzed after reconstruction with up to 361 parameter configurations. For activities above 200 MBq, scanner linearity could be confirmed with relative error margins 4%. An acquisition-time-normalized calibration factor of 1.04 was determined for the employed scanner. Stable activity convergence was found in hot phantom regions with relative differences in summed image intensities between 3.6% and 2.4%. Absolute differences in background noise artifacts between 79.9% and 350% were observed. Quantitative accuracy was dominated by subset size selection in the reconstruction. Using adequate segmentation and optimized acquisition parameters, the average activity recovery error induced by the axial scanner sensitivity profile was reduced to (mean standard deviation). We conclude that post-therapy dose assessment in PET can be improved using adapted parameter setups.

Background Many factors have been related to the development of childhood asthma but there is inconsistency between studies. Objective To understand how early life factors are linked to the development of the various asthma phenotypes at age 6 years in the Southampton Women's Survey (SWS) children's cohort. Methods Data was collected from 940 children and their parents, primarily through questionnaires during pregnancy and at 6m, 1, 3 and 6 years. Prevalent asthma was defined by a doctor's diagnosis and a wheezing episode in the last year. Data was analysed using STATA v9. A relative risk analysis using a univariate approach was undertaken, followed by a multivariate analysis. Results Both maternal (RR=1.61, p=0.041) and paternal (RR=2.05, p=0.002) atopic disease increased the risk of asthma at age 6 years. The risk increased with atopy, defined as a positive skin prick test, at 3 years (RR=3.05, p<0.001) and with wheeze in the first 3 years (RR=8.79, p<0.001). Episodes of bronchiolitis and chest infections were associated, in a dose-dependent manner, with the risk of asthma (RR=1.50, p=0.022). Predictors in the multivariate model were wheeze in the first 3 years (RR=10.74, p<0.001), atopy (RR=2.87, p<0.001) and maternal atopy (RR=2.22, p=0.011).When asthma at age 6 years was split into atopic and non-atopic asthma, the predictors were very different. Atopic asthma was associated with paternal atopy (RR=4.13, p=0.002), male sex (RR=2.56, p=0.030), atopy at 3 years (RR=10.31, p<0.001) and wheeze in the first 3 years (RR=5.91, p=0.004). In the multivariate analysis, the following were predictive: wheeze in the first 3 years (RR=13.55, p=0.012), atopy at 3 years (RR=10.13,<0.001), paternal atopy (RR=2.97, p=0.017) and a 12 month infant dietary pattern that follows current guidelines (RR=1.79, p=0.016). For non-atopic asthma, bronchiolitis or chest infections (RR=1.76, p=0.047), wheeze in the first 3 years (RR=20.69, p=0.003) and tobacco smoke exposure at 6 years (RR=2.16, p=0.035) increased the risk. Only wheeze in the first 3 years remained in the multivariate model. Conclusions Different hereditary and early life factors modify the risk of atopic and non-atopic asthma at 6 years of age. This suggests that these two asthma phenotypes have different pathophysiologies.

Résumé Le monitorage de la PETCO 2 lors de la chirurgie de réduction de volume pulmonaire peut être mis en défaut en raison de fuites aériques importantes par les drains thoraciques. La qualité des échanges gazeux peut néanmoins être en partie explorée grâce à la mesure du gradient entre la PaCO 2 et la valeur de la PECO 2 dans l'air prélevé par aspiration au niveau des drains thoraciques.

1. Laube HR, Duwe J, Rutsch W, Konertz W. Clinical experience with autologous endothelial cell-seeded polytetrafluorethylene coronary artery bypass grafts. J Thorac Cardiovasc Surg 2000;120:134 -41. 2. Tiwari A, Salacinski HJ, Hamilton G, Seifalian AM. Tissue engineering of vascular bypass grafts: role of endothelial cell extraction. Eur J Vasc Endovasc Surg 2001;21:193-201. 3. Kleisli T, Cheng W, Jacobs MJ, et al. In the current era, complete revascularization improves survival after coronary artery bypass surgery. J Thorac Cardiovasc Surg 2005;129: 1283-91. 4. Kouchoukos NT, Wareing TH, Murphy SF, Pelate C, Marshall WG Jr. Risks of bilateral internal mammary artery bypass grafting. Ann Thorac Surg 1990;49:210 -9. 5. Sajja LR, Mannam G, Pantula NR, Sompalli S. Role of radial artery graft in coronary artery bypass grafting. Ann Thorac Surg 2005;79:2180 -8. 6. Hirose H, Amano A, Takanashi S, Takahashi A. Coronary artery bypass grafting using the gastroepiploic artery: 1,000 cases. Ann Thorac Surg 2002;73:1371-9. 7. Herring M, Gardner A, Glover J. A single-staged technique for seeding vascular grafts with autogenous endothelium. Surgery 1978;84:498-504. 8. Deutsch M, Meinhart J, Fischlein T, Preiss P, Zilla P. Clinical autologous in vitro endothelialization of infrainguinal ePTFE grafts in 100 patients: a 9-year experience. Surgery 1999;126:847-55. 9. Lembcke A, Hein PA, Dohmen PM, et al. Pictorial review: electron beam computed tomography and multislice spiral computed tomography for cardiac imaging. Eur J Radiol 2006;57:356 -67.

The purpose of this paper is to present a survey of recent (published in 1993 or later) publications concerning medical image registration techniques. These publications will be classified according to a model based on nine salient criteria, the main dichotomy of which is extrinsic versus intrinsic methods. The statistics of the classification show definite trends in the evolving registration techniques, which will be discussed. At this moment, the bulk of interesting intrinsic methods is based on either segmented points or surfaces, or on techniques endeavouring to use the full information content of the images involved. .nl) a Also formerly and popularly CAT, computed axial tomography. b Also referred to as NMR, nuclear magnetic resonance, spin imaging and various other names. c Also echo(graphy).

Some of the authors of this publication are also working on these related projects: Development of MALDI-TOF methods for detection and classification of Brucella spp., Mycobacterium spp., Salmonella e Escherichia coli in bovines View project Flábio Araújo Brazilian Agricultural Research Corporation (… 129 PUBLICATIONS 1,023 CITATIONS

The blue-dye staining method of sentinel lymph node identification in lung cancer patients has been scarcely reported. The study was designed to assess the sensitivity, accuracy and negative predictive value (NPV) of intraoperative sentinel lymph node mapping in patients with non-small cell lung cancer by means of staining with colloid or water solution of blue dye. Patients and Methods: One hundred and ten patients with clinically confirmed NO non-small cell lung cancer were enrolled into prospective study of intraoperative sentinel node identification. Four quadrants of the peritumoral tissue were injected with 4 ml of blue dye.After complete lymphadenectomy, all resected lymph nodes were examined with conventional hematoxylin-eosine staining. All negative sentinel nodes were searched for metastatic deposits with both serial sections and immunohistochemistry for cytokeratines. Results: The blue-dye technique was characterized by unacceptably low sentinel node identification rate (IR) and low sensitivity (27% and 67% respectively). No significant differences were found in either the sensitivity or NPV among the colloid or water solutions of the blue dye applied. Although patent blue (colloid) was superior to water solution of methylene blue in identifying sentinel lymph node (identification rate 36% and 22% respectively) the sensitivity and NPV were lower (63% and 80% for patent blue and 75% and 92% for methylene blue respectively). Conclusion: The blue-dye staining method of sentinel node identification in non-small cell lung cancer patients is inadequate and should not be recommended for clinical use. q

The anatomy and neurophysiology of cough has been reviewed in the preceding section. The objective of this section is to describe how the varied anatomic components of the respiratory system work in concert to produce an effective cough. Methods: This was accomplished by reviewing (1) the factors needed to produce effective cough pressures and gas velocity in the airways, and (2) the salient features of the interaction between the airflow generated during a cough and the mucus that lines the tracheobronchial tree. The MEDLINE database was searched for this review, and the search consisted of studies published in English between 1960 and April 2004. Search terms were "cough mechanics" and "cough physiology." Results: Inhaling to high lung volumes and glottic closure prior to the expiratory phase of cough facilitate the generation of high intrathoracic pressures. These high intrathoracic pressures (1) provide the driving force for airstream flow during cough and (2) dynamically compress the central airways, which further enhances the cough airstream velocity. Conclusions: High intrathoracic pressures are needed to generate the requisite cough expiratory flows and airstream velocities. However, cough may be effective in individuals with mild-tomoderate degrees of respiratory muscle weakness, as only modest increases in intrathoracic pressure are needed to dynamically compress the large intrathoracic airways and increase cough flow velocity.

Respiratory mechanics, chest wall configuration, and lung morphometry were determined in rats before and at 30 (PTX.30) and 60 (PTX.60) min after pneumothorax induction (intrathoracic injection of 8 ml of room air; 50% collapse). Pneumothorax increased respiratory system and lung elastances and viscoelastic/inhomogeneous pressures in both groups, but respiratory system and lung resistive pressures increased only in PTX.60 group. Antero-posterior diameters at the third intercostal space and xiphoid levels, circumference at xiphoid level, and thoracic cephalo-caudal diameter increased significantly after pneumothorax induction independently of temporal evolution. In both groups lung collapse, hyperinflation, and interstitial and alveolar edema were present. Additionally, in PTX.60 group the central airways calibre diminished in relation to PTX.30. In conclusion pneumothorax yields changes in respiratory system and lung elastic and viscoelastic parameters, which are related to alveolar collapse and edema, respectively. Temporal evolution of pneumothorax also leads to changes in lung resistive pressure, probably because of airway narrowing.

of airway obstruction, infection, and ongoing lung damage that is characteristic of this dis-Background -Patients with cystic fibrosis are known to have decreased mucociliary ease. A major goal of therapy in cystic fibrosis is the effective removal of thick tenacious se-clearance. It has previously been shown that inhalation of a 7.0% solution of hyper-cretions.

ACC ϭ American College of Cardiology AHA ϭ American Heart Association CT ϭ computed tomography CTA ϭ computed tomography angiography IE ϭ infectious endocarditis MA ϭ mycotic aneurysm MRA ϭ magnetic resonance angiography MRI ϭ magnetic resonance imaging MVR ϭ mitral valve replacement PVE ϭ prosthetic valve endocarditis 2013 Ann Thorac Surg REPORT FROM STS WORKFORCE ON EVIDENCE BASED SURGERY BYRNE ET AL 2011;91:2012-9

Cardiovascular complications of cocaine abuse include myocardial ischemia and infarction, dysrhythmias, cardiomyopathies and aortic dissection. The case in point pertains to a 26-year-old, Caucasian male, substance abuser who suffered a thoracic aortic dissection following the use of crack cocaine. The autopsy and histological findings showed a connective tissue abnormality including a focal microcystic medial necrosis and a fragmentation of the elastic fibers in the arterial walls. Blood concentrations of cocaine and benzoylecgonine, taken individually, were considered to be within a potentially toxic range. Blood concentrations of methadone also indicated use of this drug at the same time. The small amounts of morphine found in the blood and urine were compatible with heroine or morphine use more than 24 h before death.

Background: Although multiple combinations of weather factors may contribute to an increased incidence of Mycoplasma pneumoniae pneumonia, few studies have investigated the association between weather factors and cases of M pneumoniae pneumonia. Methods: Data on cases of M pneumoniae pneumonia and weather factors in Fukuoka, Japan from 1999 to 2007 were obtained and time-series analysis was used to assess the effects of weather variables on M pneumoniae pneumonia cases, adjusting for confounding factors. A total of 13 056 M pneumoniae pneumonia cases were reported during the 9-year study period, of which 12 234 (93.7%) were under 15 years of age. Results: The weekly number of M pneumoniae pneumonia cases increased by 16.9% (95% CI 11.3% to 22.8%) for every 1uC increase in the average temperature and by 4.1% (95% CI 2.7% to 5.5%) for every 1% increase in relative humidity. Conclusions: From 1999 to 2007, cases of M pneumoniae pneumonia increased significantly with increased average temperature and relative humidity in Fukuoka, Japan.

Background. Autograft dilatation and progressive neoaortic regurgitation after the Ross procedure prompted us to perform routine aortic annuloplasty. The purpose of this review is to evaluate the success of this technical modification in preventing autograft failure requiring reoperation.

Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimise disease management. As with other chronic diseases, poor adherence is common and results in increased rates of morbidity, healthcare expenditures, hospitalisations and possibly mortality, as well as unnecessary escalation of therapy and reduced quality of life. Examples include overuse, underuse, and alteration of schedule and doses of medication, continued smoking and lack of exercise.

Dose-escalation study was performed to evaluate the maximum tolerated dose, recommended dose and toxicity profile of weekly irinotecan with daily carboplatin and concurrent thoracic radiotherapy in patients with locally advanced non-small-cell lung cancer. Thirty-one previously untreated patients with unresectable stage III non-small-cell lung cancer were enrolled in this study. Patients received weekly irinotecan plus carboplatin (20 mg x m(-2) daily for 5 days a week) for 4 weeks and thoracic radiotherapy (60 Gy in 30 fractions). The irinotecan dose was escalated from 30 mg x m(-2) in increments of 10 mg x m(-2). Four irinotecan dose levels were given and 30 patients were assessable. Their median age was 62 years (range: 52-72 years), 28 had a performance status of 0-1 and two had a performance status of 2, 12 had stage IIIA disease and 18 had IIIB disease. There were 19 squamous cell carcinomas, 10 adenocarcinomas, and one large cell carcinoma. The dose-limiting toxicities were p...

Objectives: This study aimed to compare the time-dependent deterioration of chest compressions between chest compression-only cardiopulmonary resuscitation (CPR) and conventional CPR. Methods: This study involved 106 and 107 participants randomly assigned to chest compression-only CPR training and conventional CPR training, respectively. Immediately after training, participants were asked to perform CPR for 2 min and the quality of their CPR skills were evaluated. The number of chest compressions in total and those with appropriate depth were counted every 20-s CPR period from the start of CPR. The primary outcome was the CPR quality index calculated as the proportion of chest compressions with appropriate depth among total chest compressions. Results: The total number of chest compressions remained stable over time both in the chest compressiononly and the conventional CPR groups. The CPR quality index, however, decreased from 86.6 ± 25.0 to 58.2 ± 36.9 in the chest compression-only CPR group from 0-20 s through 61-80 s. The reduction was greater than in the conventional CPR group (85.9 ± 25.5 to 74.3 ± 34.0). The difference in the CPR quality index reached statistical significance (p = 0.003) at 61-80 s period. Conclusions: Chest compressions with appropriate depth decreased more rapidly during chest compression-only CPR than conventional CPR. We recommend that CPR providers change their roles every 1 min to maintain the quality of chest compressions during chest compression-only CPR. (UMIN-CTR C0000000321)

The mildew of the vineyards is prevented by the use of sprays with a solution of copper sulphate neutralized with hydrated lime. The inhalation of this solution while spraying may give rise to predominantly interstitial pulmonary lesions which may lead to respiratory insufficiency. These lesions, which were experimentally reproduced in guinea-pigs, have a well-defined histological picture characterized by three stages-intra-alveolar desquamation of macrophages, formation of predominantly histiocytic granulomas in the septa, and the healing of these lesions generally under the form of fibro-hyaline nodules very similar to those found in silicosis. These lesions contain variable amounts of copper. The pathogenesis of these lesions and the possibility of their regression when the offending agent is removed are discussed; and the value of lung biopsy and the necessity of protecting these workers are stressed.

Concerns about the safety of long-acting b2-agonist (LABA) therapy, has led to the appearance of multiple publications and recommendations. This review critically examines the available clinical evidence and safety requirements for LABA use. On the basis of nearly 20 systematic reviews and databases, the authors conclude that LABA monotherapy significantly increases the risk of asthma-related adverse effects. We also conclude that the use of LABAs concomitantly with inhaled corticosteroids (ICS) significantly reduces asthma hospitalisations and is not associated with lifethreatening events and asthma-related deaths, especially when concurrent use of LABAs and ICS can be reasonably assured (use of a single inhaler device). An appropriate clinical study would require an extremely large sample, making it impractical. Finally, some of the new US Food and Drug Administration (FDA) recommendations have caused confusion and do not appear to be fully evidence based. Although limited by low statistical power, the evidence supports the use of LABAs plus ICS in a single inhaler device (to increase adherence and reduce the potential use of LABA monotherapy) for all patients (not only children) with moderate to severe asthma.

Results of mechanical analyses of running may be helpful in the search for the etiology of running injuries. In this study a mechanical analysis was made of the landing phase of three trained heel-toe runners, running at their preferred speed and style. The body was modeled as a system of seven linked rigid segments, and the positions of markers defining these segments were monitored using 200 Hz video analysis.

diagnostic and therapeutic procedures. Our recommen- dations were classified as class I, IIA, IIB, or III. For each recommendation we defined the level of supporting evidence as A, B, or C. Results. We identified class I indications for transmyo- cardial revascularization as sole therapy and class IIA indications for transmyocardial revascularization as an adjunct to coronary artery bypass graft surgery

Androgens are important in hair growth and patterning, whereas growth hormone substitution enhances their effect in growth hormone-deficient men. No previous study has jointly evaluated the function of sex steroids, sex hormone-binding globulin (SHBG), and insulin-like growth factor (IGF-1) in determining hair patterning in men. We assessed the relationship between circulating hormone measurements and both head and chest hair patterning in a sample of elderly men. Fifty-one apparently healthy men older than 65 years of age were studied cross-sectionally. Head and chest hair patterning was assessed by a trained interviewer. Morning blood samples from all subjects were used for measurements of testosterone, estradiol, dehydroepiandrosterone sulfate, SHBG, and IGF-1. Results were obtained from logistic regression models, adjusting simultaneously for all the measured hormones and age. Men with higher levels of testosterone were more likely to have vertex baldness (odds ratio [OR] = 2.5, 95% confidence interval [CI: 0.9 to 7.8] per 194 ng/dL increment of testosterone). In addition, for each 59 ng/mL increase in IGF-1, the odds of having vertex baldness doubled (95% CI [1.0 to 4.6]). Those who were found to have higher circulating levels of SHBG were less likely to have dense hair on their chest (OR = 0.4, 95% CI [0.1 to 0.9] per 24 nmol/L increment in SHBG]). Testosterone, SHBG, and IGF-1 may be important in determining hair patterning in men.

RESULTS: Seventeen patients were identified and divided into two groups. Group I consisted of seven patients with primary chest wall processes: four necrotizing soft-tissue infections and three with thoracic trauma resulting in significant loss of chest wall musculature. Group II ...

Pneumothorax (Ptx) is a life-threatening complication that can result from trauma, mechanical ventilation, and invasive procedures. Infrared thermography (IRT), a compact and portable technology, has become highly sensitive. We hypothesized that IRT could detect Ptx by identifying associated changes in skin temperature.Bilateral nonpenetrating chest incisions or needle punctures were performed in 21 anesthetized rats. Rats were then randomized to no, bilateral, left, or right Ptx by either open (n = 16) or closed percutaneous (n = 5) puncture through selected pleurae. Real-time thermographic images and surface temperature data were acquired with a noncooled infrared camera.In all cases, blinded observers correctly identified each Ptx with real-time grayscale image analysis. When compared to either the ipsilateral baseline or an abdominal reference, experimental Ptx produced a significantly greater decrease in surface temperature when compared to non-Ptx control.These results demonstrate that portable infrared imaging can rapidly and accurately detect changes in thoracic surface temperature associated with experimental pneumothorax.

Extracellular (ECW) and intracellular (ICW) volumes were measured using both segmental and wrist-ankle (W-A) bioimpedance spectroscopy (5-1000 kHz) in 15 healthy subjects (7 men, 8 women). In the 1st protocol, the subject, after sitting for 30 min, laid supine for at least 30 min. In the second protocol, the subject, who had been supine for 1 hr, sat up in bed for 10 min and returned to supine position for another hour. Segmental ECW and ICW resistances of legs, arms and trunk were measured by placing four voltage electrodes on wrist, shoulder, top of thigh and ankle and using Hanai's conductivity theory. W-A resistances were found to be very close to the sum of segmental resistances. When switching from sitting to supine (protocol 1), the mean ECW leg resistance increased by 18.2%, that of arm and W-A by 12.4%. Trunk resistance also increased but not significantly by 4.8%. Corresponding increases in ICW resistance were smaller for legs (3.7%) and arm ( 0.7%) but larger for the trunk (21.4%). Total body ECW volumes from segmental measurements were in good agreement with W-A and Watson anthropomorphic correlation. The decrease in total ECW volume (when supine) calculated from segmental resistances was at 0.79 l less than the W-A one (1.12 l). Total ICW volume reductions were 3.4% (segmental) and 3.8% (W-A). Tests of protocol 2 confirmed that resistance and fluid volume values were not affected by a temporary position change.

A variety of chest physiotherapy techniques are used following abdominal and thoracic surgery to prevent or reduce post-operative complications. Breathing techniques with a positive expiratory pressure (PEP) are used to increase airway pressure and improve pulmonary function. No systematic review of the effects of PEP in surgery patients has been performed previously. The purpose of this systematic review was to determine the effect of PEP breathing after an open upper abdominal or thoracic surgery. A literature search of randomised-controlled trials (RCT) was performed in five databases. The trials included were systematically reviewed by two independent observers and critically assessed for methodological quality. We selected six RCT evaluating the PEP technique performed with a mechanical device in spontaneously breathing adult patients after abdominal or thoracic sur-gery via thoracotomy. The methodological quality score varied between 4 and 6 on the Physiotherapy Evidence Database score. The studies were published between 1979 and 1993. Only one of the included trials showed any positive effects of PEP compared to other breathing techniques. Today, there is scarce scientific evidence that PEP treatment is better than other physiotherapy breathing techniques in patients undergoing abdominal or thoracic surgery. There is a lack of studies investigating the effect of PEP over placebo or no physiotherapy treatment.

Cystic hygroma (moist tumor) was Wrst described in 1828 by Redenbacher. The cyst usually results owing to an absence or an ineYcient connection between the lymphatic and venous systems. Of this type of malformation 75% cases are localized in the nuchal region; however, only 20% are found in the axilla while 5% of these hygromas are in other locations. Prognosis depends on associated fetal co-morbidities. There are many case reports on cystic hygroma but only a few on the axillo-thoraco-abdominal variant. This is a case report of a huge late-onset fetal axillo-thoraco-abdominal cystic hygroma, which was diagnosed at term followed by a diYcult vaginal delivery in a 38-year-old woman. The baby did not have any congenital anomaly other than cystic hygroma with no evidence of intrathoracic or intra-abdominal extension of mass and a pelvic kidney reported on neonatal ultrasound and CT scan. The surgical excision of the cyst was done on the fourth day following birth and the histopathology report conWrmed the diagnosis. Management of fetal cystic hygroma with the use of a sclerosing agent is a new modality being explored. Risk of recurrence in subsequent pregnancies for aneu-ploidy is not increased. The baby has been followed up to 5 months of birth and is thriving well. Karyotype shows an XX pattern.

Reviewing the literature on the vascular anatomy of the spinal epidural space, it appeared that the knowledge of the internal vertebral venous plexus is limited. Injection studies of the entire internal vertebral venous plexus after application of modern techniques, to the best of our knowledge, have never been performed. Based on the clinical importance of these structures, it was decided to study the human vertebral venous system after Araldite CY 221 injection, in order to update the morphological characteristics of the internal vertebral venous system.

The purpose of this study was to evaluate the trunk muscles activity of hemiparetic and control subjects during selected therapeutic exercises with surface electromyography (sEMG). The sEMG evaluation included 12 subjects presenting hemiparesis after having suffered a unilateral stroke and 12 apparently healthy subjects. A 16-channel sEMG system was used; data were band pass filtered from 20 to 450 Hz. The signal was normalized through reference voluntary contraction (RVC) and presented in percentage. The exercises used in the evaluations were trunk flexion and trunk extension. Rectus abdominis presented greater activation on the paretic side of the experimental group than on the corresponding side of the control group (P = 0.035) (Cohen's d ¼ 0:94). During leg elevation, the non-paretic obliquus externus abdominis showed greater activation than in other exercises (P = 0.019) (Cohen's d ¼ 0:75). No intergroup differences were found for either erectus spinae activity or contraction onset. Experimental group subjects showed muscle activity alterations, principally in the rectus abdominis, indicating the occurrence of compensatory strategies.

To date the influence that specific sitting posture has on the head/neck posture and cervico-thoracic muscle activity has been insufficiently investigated. Therefore the aim of this study was to investigate whether three different thoraco-lumbar sitting postures affect head/neck posture and cervico-thoracic muscle activity.

Background and purpose: This study explores methods to reduce dose due to kV-CBCT imaging for patients undergoing radiation therapy. Material and methods: Doses resulting from kV-CBCT scans were calculated using Monte Carlo techniques and were analyzed using dose-volume histograms. Patients were modeled as were CBCT acquisitions using both 360°and 200°gantry rotations. The effects of using the half fan bow-tie and the full fan bow-tie filters were examined. Results: Doses for OBI 1.3 are 15 times (head), 5 times (thorax) and 2 times (Pelvis) larger than the current OBI 1.4. When using 200°scans, the doses to eyes and cord are 0.2 (or 0.65) cGy and 0.35 (or 0.2) cGy when rotating the X-ray source underneath (or above) the patient, respectively. The 360°Pelvis scan dose is 1-2 cGy. The rectum dose is 1.1 (or 2.8) cGy when rotating the source above (or below) the patient with the 200°Pelvis scan. The dose increases up to two times as the patient size decreases. Conclusions: The dose can be minimized by reducing the scan length, the exposure settings, by selecting the gantry rotation angles, and by using the full fan bow-tie whenever possible.

Background Many patients with lung cancer are deconditioned with poor physical fitness. Lung resection reduces physical fitness further, impairing the patient's ability to function in daily life. Methods We conducted a single-blind randomised controlled trial of high-intensity endurance and strength training (60 min, three times a week, 20 weeks), starting 5-7 weeks after surgery. The control group received standard postoperative care. The primary outcome was the change in peak oxygen uptake measured directly during walking until exhaustion. Other outcomes included changes in pulmonary function, muscular strength by one-repetition maximum (1RM), total muscle mass measured by dual energy X-ray absorptiometry, daily physical functioning and quality of life (QoL). Results The intention-to-treat analysis of the 61 randomised patients showed that the exercise group had a greater increase in peak oxygen uptake (3.4 mL/kg/min between-group difference, p=0.002), carbon monoxide transfer factor (Tlco) (5.2% predicted, p=0.007), 1RM leg press (29.5 kg, p<0.001), chair stand (2.1 times p<0.001), stair run (4.3 steps, p=0.002) and total muscle mass (1.36 kg, p=0.012) compared with the controls. The mean±SD QoL (SF-36) physical component summary score was 51.8±5.5 and 43.3±11.3 ( p=0.006), and the mental component summary score was 55.5±5.3 and 46.6±14.0 ( p=0.015) in the exercise and control groups, respectively. Conclusions In patients recently operated for lung cancer, high-intensity endurance and strength training was well tolerated and induced clinically significant improvements in peak oxygen uptake, Tlco, muscular strength, total muscle mass, functional fitness and QoL. This study may provide a basis for exercise therapy after lung cancer surgery. Trial registration number NCT01748981.

The rationale of this work is to point out the relevance of in vivo MR images of mice obtained using a dedicated low-field system. For this purpose a small 0.1 T water-cooled electro-magnet and solenoidal radio frequency (RF) transmit-receive coils were used. All MR images were acquired in threedimensional (3D) mode. An isolation cell was designed allowing easy placement of the RF coils and simple delivery of gaseous anesthesia as well as warming of the animal. Images with and without contrast agent were obtained in total acquisition times on the order of half an hour to four hours on normal mice as well as on animals bearing tumors. Typical in plane pixel dimensions range from 200 × 200 to 500 × 500 μm 2 with slice thicknesses ranging between 0.65 and 1.50 mm. This work shows that besides light installation and low See endnote 1 cost, dedicated low-field MR systems are suitable for small rodents imaging, opening this technique even to small research units.

In walking faster than 3 km/h, transverse pelvic rotation lengthens the step (''pelvic step''). It is often assumed that the thorax then starts to counter rotate to limit total body angular momentum around the vertical. But the relative timing of pelvis and thorax rotation during gait is insufficiently understood. The present study aimed at analysing how transverse pelvis and thorax rotations relate to the movements of the upper leg, and how these patterns contribute to total body angular momentum. Nine healthy male volunteers walked on a treadmill at nine different velocities, ranging from 2.0 km/h to 5.2 km/h. Full body kinematics were recorded. Femur-pelvis, pelvis-thorax, and femur-thorax relative phase were calculated, as well as transverse plane angular momentum of all body segments. The shift in pelvis-thorax coordination from in-phase to out of phase with increasing velocity was found to depend on the pelvis beginning to move in-phase with the femur, while the thorax continued to counter rotate with respect to the femur. Moreover, pelvic and thoracic contributions to total body angular momentum were low (less than 10%), while contributions of the legs and arms were much larger (approximately 90%), suggesting that pelvis-thorax coordination is relatively unimportant to the organisation of total body angular momentum. Taken together, these results may imply that our understanding of the pelvic step need to be changed. Moreover, the alterations in pelvis-thorax relative phase that were reported for different locomotor pathologies may depend on different mechanisms. #

Spontaneous pneumomediastinum is a rare medical entity occurring almost exclusively in otherwise healthy young individuals without known predisposing factors. We reported our experience with patients presenting with spontaneous pneumomediastinum related to sports.Between January 1991 and December 2002, 10 patients were admitted with spontaneous pneumomediastinum related to sporting activities. We retrospectively reviewed their medical records with regard to predisposing factors, clinical presentation, diagnostic evaluation, and outcome.The mean age of our patients was 18.9 years (range 15 to 25 years). Retrosternal chest pain was the most common symptom (90%), and subcutaneous emphysema the most common physical finding (90%). Hamman's sign was present in 9 patients. In all 10 patients, physical exertion during sports was the only implicating factor (scuba diving in 4 patients, basketball in 2, soccer in 3, and volleyball in 1). All patients were treated conservatively. Complete resorption of the pneumomediastinum occurred in 3 to 8 days. Hospital stay ranged from 2 to 6 days (mean 3.8 days). Follow-up was complete in 8 patients (80%), and ranged from 6 to 84 months (mean 35 months). Only 1 recurrence of pneumomediastinum was found that was treated similarly.Spontaneous pneumomediastinum after sporting activities is a benign disease that generally resolves without clinical sequelae. Restriction of physical and athletic activity after the first episode is unnecessary, the only exception being that of scuba diving.

Background: Physiotherapists sometimes use elective surgical procedures for children with cystic fibrosis as an opportunity to perform physiotherapy treatments during anesthesia. These treatments theoretically facilitate direct endotracheal airway clearance and compensate for any post-operative respiratory deterioration related to the anaesthetic and surgery. Materials, patients, and methods: Children were randomized either to receive physiotherapy or not following anesthesia and intubation. Respiratory mechanics (C rs and R rs ), tidal volume, and peak inspiratory pressure (PIP) were measured immediately before and after physiotherapy. FEV 1 was measured before and after surgery and post-operative physiotherapy requirements were recorded. Results: Eighteen patients, mean age 12 years (range 2.8-15 years) were recruited, with nine in each group. Both groups showed a non-significant decline in FEV 1 the day after surgery compared with pre-operative values (À5.8%: physiotherapy and À7.1%: control). Both PIP and R rs increased significantly following physiotherapy (within-and between-groups, P < 0.05). In addition, there was a significant within-group reduction in C rs after physiotherapy which approached significance between-groups (P ¼ 0.07). There were no significant within-or between-group differences in tidal volume following treatment in either group. Conclusion: The unanticipated decline in respiratory function immediately following physiotherapy was short-lived and not discernible in longer term outcomes measured by FEV 1 or physiotherapy requirements post-operatively. If respiratory physiotherapy under anesthesia is considered necessary and the benefits of removing secretions are deemed to outweigh the short-term risks, it may be necessary for the anaesthetist to consider modifying ventilatory support to counteract any short-term negative effects of the treatment.