Preliminary Report Research Articles

Sequential Y90 liver radioembolization and portal vein embolization: an additional strategy to downstage liver tumors and to enhance liver hypertrophy before major hepatectomies.

Yttrium (Y)90 liver radioembolization (TARE) induces both tumor downsizing and contralateral liver hypertrophy. In this study, we report the preliminary results of a sequential strategy combining Y90 radioembolization and portal vein embolization (PVE) before major right liver resections. We retrospectively reviewed clinical, radiological, and biological data of 5 consecutive patients undergoing Y90 TARE-PVE before major right liver resections. Comparison was made with patients undergoing PVE alone or liver venous deprivation (LVD) during the same period. Between January 2019 and September 2022, five patients underwent sequential TARE-PVE. Type of resection included the following: right hepatectomy (n = 1), right hepatectomy + 1 (n = 2), and right hepatectomy + 1 + 4 (n = 2) with no postoperative mortality. Volumetric data showed a mean hypertrophy ratio of 30.4% after TARE and an additional 37.4% after sequential PVE. Patients undergoing sequential TARE-PVE had higher hypertrophy ratio (p = 0.02; p = 0.004), hypertrophy degree (p = 0.02; p < 0.0001), shorter time to normalize bilirubin (p = 0.04), and prothrombin time (p = 0.003; p < 0.0001) compared with patients receiving LVD or PVE. Time from diagnosis to surgery was statistically significant longer in patients undergoing sequential TARE-PVE compared with LVD or PVE (293.4 ± 169.1 vs 54.18 ±18.26 vs 58.62±13.15; p = 0.0008; p = <0.0001). This preliminary report suggests that sequential PVE and TARE can represent a safe and an alternative strategy to downstage liver tumors and to enhance liver hypertrophy before major hepatectomies. When compared with PVE and LVD, sequential TARE/PVE takes longer times but achieves some advantages which warrant further evaluation in a larger setting.

Glass trade through the Adriatic Sea: preliminary report of an ongoing project

A repertoire of 1357 glass samples from Italy, Croatia, Slovenia and Serbia was used to investigate glass trade in the Adriatic Sea. The achieved overview begins in the 1st century and, after a peak of occurrences between the 4th and the 7th century, continues until the 16th with a decreasing number of pieces of evidence.Between the 1st and the 3rd century, Levantine (Roman Mn) and Egyptian (Roman Sb) products coexist in percentages that can be considered comparable at the current state of studies. The end of the 3rd and the beginning of the 4th century mark a substantial decrease in Levantine imports. Indeed, Jalame-type glass first and Apollonia-type glass later appear to supply a small slice of the market. Egyptian products, on the contrary, continue to arrive in abundance. The HIMTa and the Foy Série 2.1 glass represent the most widespread products in the Adriatic area for about three centuries. Conversely, the Foy Série 3.2 experiences flowering in northern Italy, Slovenia and Serbia, while it shows limited diffusion in southern Italy, as well as in Tyrrhenian Italy, Sicily or other areas of the Mediterranean basin such as Spain. Based on this observation, it thus seems reliable to exclude Foy Série 3.2 glass from the basket of products typically marketed in the Adriatic Sea (i.e. Levantine products and Egyptian products of types HIMTa-b and Foy 2.1). In this case, a Balkan route may appear possible because it covers the territories where the most significant diffusion of this glass has been observed and is well connected to northern Italy through the Danube and Sava rivers. In southern Italy, the need for more data on the oldest productions prevents a reliable evaluation of Roman Mn and Roman Sb glass imports and highlights a line of research to be pursued in the immediate future.

Completion thyroidectomy via robotic transoral vestibular approach - preliminary outcome report

Completion thyroidectomy via robotic transoral vestibular approach - preliminary outcome report

P29 The use of adjunct oral methotrexate as primary prevention for keloid scarring following syndactyly release surgery

Abstract A 12-month-old Asian female underwent syndactyly release surgery with advancement flap closure of the first web space of the right hand. The procedure was complicated by enlarging keloids over the surgical site and dactylitis, a rare complication with only a few previously reported cases [Muzaffar AR, Rafols F, Masson J et al. Keloid formation after syndactyly reconstruction: associated conditions, prevalence, and preliminary report of a treatment method. J Hand Surg Am 2004; 29: 201–8. https://doi.org/10.1016/j.jhsa.2003.10.017]. Initial treatment of the keloid scarring with intralesional triamcinolone under general anaesthetic was unsuccessful. Subsequently, we elected to surgically excise the keloids closing with a full-thickness skin graft from the groin, with adjunct oral methotrexate (0.4 mg kg–1 weekly) for 9 months post-surgery. The use of oral methotrexate for this indication is rarely reported: one series included two cases of successful keloid suppression with 4 years of follow-up [Muzaffar et al.] and another series of four patients with successful keloid suppression after surgery for syndactyly with dactylitis [Tolerton SK, Tonkin MA. Keloid formation after syndactyly release in patients with associated macrodactyly: management with methotrexate therapy. J Hand Surg Eur 2011; 36: 490–7]. Low-dose methotrexate exerts anti-inflammatory effects by stimulating adenosine A2 receptors and increasing adenosine release at sites of inflammation, such as surgical sites [Muzaffar et al.]. In our patient, methotrexate was well-tolerated, keloid recurrence and dactylitis were avoided, and range of movement and functioning of the digits was maintained. Keloid formation after syndactyly release poses a complex management challenge and we propose methotrexate should be considered as an adjunct to reduce recurrence risk.

Resting energy expenditure in children and adolescents with cerebral palsy: accuracy of available prediction formulas and development of population-specific methods.

Energy requirements are difficult to estimate in children with cerebral palsy (CP). Resting energy expenditure (REE), necessary to implement personalized nutritional interventions, is most commonly estimated using prediction formulae since indirect calorimetry, the reference method, is not available in all nutrition units. The aims of the present study were: (1) to evaluate the accuracy of the most commonly used REE prediction formulae developed for healthy children, in children with CP; (2) to assess the accuracy of the REE population-specific formula for CP children proposed in our preliminary report; (3) to develop new population-specific methods. REE was measured by indirect calorimetry in 100 children and adolescents with spastic quadriplegic cerebral palsy (SQCP) and estimated on the basis of predictive formulas selected by the clinicians [World Health Organization (WHO), Harris-Benedict, Schofield weight, Schofield weight & height, Oxford, Mifflin formulae and a population-specific formula for CP children developed in our preliminary report]. 100 children with SQCP (35 girls, 35%) classified as level V according to gross motor function classification system (GMFCS-V); 64% with oral nutrition, 29% total enteral nutrition (nasogastric tube feeding, percutaneous endoscopic gastrostomy, percutaneous endoscopic transgastric jejunostomy) and 7% mixed nutrition. The median (IQR) REE was 41.96 (17.5) kcal/kg/day.Statistical analysis highlighted a proportional bias between the indirect calorimetry and all considered predictive formulae for REE determination. By studying the relationship between the bias and the mean values of REE, specific conversion equations were obtained. With a pre-specified model having as predictors the variable weight and the variable Triceps Skinfold (TSF) and, as response the variable REE measured by indirect calorimetry, a predictive nomogram was developed to estimate the REE in this population of children. We suggest using predictive formulae for healthy children with caution, and where possible carrying out indirect calorimetry to assess REE in children with CP. However, we propose a new tool which could be developed to become an additional help for assessment of REE in the clinical practice.Future objectives will be to obtain a larger sample size, in a multicenter perspective study, to build a specific predictive model for the REE of the studied population.

Evaluation of De Epithelization Technique in Management of Pilonidal Sinus Disease

Abstract Background Pilonidal sinus disease (PSD) is a common disorder of the sacrococcygeal region. The incidence is reported in 6 per 100,000 individuals, this method is defined as a flap or graft of thinned cutaneous layer. Aesthetic surgeons usually perform this method for mammoplasty. In this method, after de-epithelization of the cutaneous tissue is performed, cutaneous flap and fatty tissue are inverted to fill the dead space (1). De-epithelialized skin grafts are used for many indications. Objective To evaluate De epithelization technique as a new approach in management of pilonidal sinus disease as regard post operative complications and recurrence rate. Patients and Methods This Cohort retrospective and prospective study will include 50 cases, admitted to Ain Shams University and Agouza Police hospital from august 2019 till February 2020 who met the inclusion criteria. A total of 50 adult patients with PSD were randomly allocated intraoperatively to undergo De epithelization technique. Results According to our scale evaluating outcome, De-epithelization technique is effective and safe with least post operative complications regarding pilonidal sinus disease. Conclusion It allows a quicker return to daily activities and reduces costs. Furthermore, we believe that the risk of recurrence may be reduced by increasing the angle of the natal cleft during this technique. Also, this method has a satisfying aesthetic outcome. This preliminary report suggests that this new surgical approach seems to be a reasonable method in the treatment of PSD, especially in patients with uncomplicated primary disease, and is worth studying further.

Evaluation of changes in thyroid volume and selected parameters on Doppler ultrasound examination in radically irradiated patients with primary cancers of the head and neck region – preliminary report

Introduction: Implementation of even the most advanced radiotherapy techniques is still associated with a risk of damaging healthy tissues and organs by ionizing radiation. Structural and functional abnormalities of the thyroid gland have been reported in patients after radiotherapy administered for head and neck cancers (HNC). Aim: Ultrasound evaluation of changes in thyroid volume, characteristics of blood flow in the right inferior thyroid artery (ITA) and vascular invasion (VI) of the thyroid gland in patients radically irradiated due to primary HNC. Material and methods: The study group consisted of 20 patients who underwent ultrasound examinations at three time points: prior to commencing radiotherapy (I), in the first week after completion of radiotherapy (II) and after another 3–6 months (III). Results: The mean radiation dose absorbed by the thyroid gland was 54.95 6.95 Gy. The mean thyroid volume measured at the first time point was 17.14 (13.74–23.43) cm3 and this result turned out to be higher as compared to measurements obtained in the second and third examinations: 15.92 (12.51–20.35) cm3 with p&lt;0.001; 15.01 (11.16–18.92) cm3 with p&lt;0.001, respectively. Thyroid volume from the second examination was also greater than in the third examination (p&lt;0.001). Evaluation conducted at time point II showed an increase in the following vascular flow parameters: peak systolic velocity (PSV), pulsatility index (PI) and resistivity index (RI) measured in the ITA, as well as an increase in thyroid VI in comparison to results from time point I. Furthermore, a decrease of the above-mentioned values was observed at time point III as compared to time point II. However, the ultrasound vascular characteristics measured in the ITA and VI of the thyroid gland were still higher on examination III when compared to the initial values. Conclusions: We have observed that radiotherapy leads to a decrease in thyroid volume, which is found to be progressing for at least 3–6 months after treatment completion. Post-radiotherapy changes in vascular parameters of the ITA and VI value measured on Doppler ultrasound partially resolve within 3–6 months after the end of radiation treatment.

Reply to the Letter to the Editor: Percutaneous Doxycycline Treatment of Aneurysmal Bone Cysts With Low Recurrence Rate: A Preliminary Report.

Reply to the Letter to the Editor: Percutaneous Doxycycline Treatment of Aneurysmal Bone Cysts With Low Recurrence Rate: A Preliminary Report.

Neurocognitive Profiles in Adolescents With Postural Tachycardia Syndrome and Perceived Brain Fog: A Preliminary Report

BackgroundPostural tachycardia syndrome (POTS) is associated with complaints of cognitive and emotional difficulties that may contribute to severe functional disability. For high-achieving adolescents, these symptoms can result in decreased participation in school and extracurricular activities. There are very limited data comparing subjective symptom reports to neurocognitive profiles in adolescents presenting with POTS, “brain fog,” and cognitive difficulties. MethodsA review of medical records and neuropsychological data was conducted for six adolescents diagnosed with POTS at a pediatric neurology clinic. All patients had frequent symptoms of orthostatic intolerance for more than three months. There was heart rate increase of ≥40 beats per minute (bpm) within 10 minutes of active standing or head-up tilt test in five patients and 36 bpm in one patient, who was diagnosed with probable POTS. All were referred for neuropsychological evaluations due to reported debilitating cognitive problems and an inability to function in a regular academic setting. Patients underwent a six-hour neuropsychological evaluation utilizing standardized measures of cognitive and emotional functioning. Clinically reported symptoms included fatigue, poor concentration, and memory impairment as well as “brain fog.” ResultsSubjective complaints differed from patients’ performance on standardized neuropsychological measures. Patients performed in the average to superior range across measures of general intelligence, verbal and working memory, processing speed, and sustained attention. ConclusionsFurther research is needed to elucidate the basis for perceived “brain fog” and cognitive impairment in POTS, such as better understanding of patient and parental perceptions of initial medical symptoms and diagnosis as well as symptom amplification due to biopsychosocial processes.

Efficacy of Ketamine with and without Lamotrigine in Treatment-Resistant Depression: A Preliminary Report.

Intravenous (IV) ketamine and FDA-approved intranasal (IN) esketamine are increasingly used for treatment-resistant depression (TRD). Preliminary studies have suggested a synergistic effect of ketamine and lamotrigine, although the data are inconclusive. Herein, we report the response to serial ketamine/esketamine treatment among patients with TRD with or without lamotrigine therapy. In this historical cohort study, we included adult patients with TRD who received serial IV racemic ketamine (0.5 mg/kg over 40-100 min) or IN esketamine (56/84 mg) treatments. A change in depressive symptoms was assessed using the 16-item Quick Inventory of Depressive Symptomatology self-report (QIDS-SR) scale. There were no significant differences in response or remission rates among the patients on or not on lamotrigine during the ketamine/esketamine treatments. For a percent change in the QIDS-SR from baseline, no interaction was found between the lamotrigine groups and treatment number (p = 0.70), nor the overall effect of the group (p = 0.38). There was a trend towards lower dissociation (based on the CADSS score) among current lamotrigine users, especially in patients who received IV ketamine. A major limitation is the limited number of patients taking lamotrigine (n = 13). This preliminary study provides insufficient evidence that continuing lamotrigine therapy attenuates the antidepressant effect of repeated ketamine/esketamine; however, there seems to be a signal toward attenuating dissociation with lamotrigine in patients receiving serial ketamine treatments. Further observational studies or randomized controlled trials are needed to replicate these findings.

Letter to the Editor: Percutaneous Doxycycline Treatment of Aneurysmal Bone Cysts With Low Recurrence Rate: A Preliminary Report.

Letter to the Editor: Percutaneous Doxycycline Treatment of Aneurysmal Bone Cysts With Low Recurrence Rate: A Preliminary Report.

In vitro Antioxidant, Antibiotic Complementing or Supplementing Potential and Urobactericidal Activity of Leaf Extract of Marsilea quadrifolia L.: The Water Fern

From generations, most of the communities of India are dependent on locally available ethnomedicines for tackling urogenital related issues. The efficacies of these herbal supplements for prophylactic and curative purposes need immediate scientific validation. For this, the accurate antibacterial potential of methanolic extracts of leaves of Marsilea quadrifolia L. (MMq) are investigated via each possible method of estimation including the supplementary and complementary antibacterial effects on pathogenic strains. The phytochemical constituents like carbohydrates, flavonoids, glycosides, phenolics, steroids and terpenoids are tested positive in the MMq. The total phenolic content (TPC) and total flavonoid content (TFC) are calculated to be 16.48 ± 0.4 mg/g of gallic acid equivalent and 96.33±4.4 mg/g of rutin equivalent respectively from the standard calibration curves. The IC50 value of MMq is found to be 258.55μg/ml in 1, 1 diphenyl-2-picrylhydrazyl radical (DPPH) assay by taking ascorbic acid as the standard. The extract gives significant complementary or supplementary inhibitory effects when added to certain antibiotic discs specifically against Enterococcus faecalis and Escherichia coli. The efficacy of MMq is verified and confirmed through different antibacterial assays against all the test uropathogenic bacteria. A reduction of 52%, 20.9%, 39.7% and 86.6% in number of colonies is noted in cfu/ml on treating the bacterial stains of E. coli, Staphylococcus aureus, E. faecalis and Proteus vulgaris respectively with a higher dose of MMq (1200μg) as compared to a lower dose of (200μg) in spread plate method. Present study recorded a minimum inhibitory concentration (MIC) of 2.5mg/ml of MMq each against E. faecalis, E. coli, Pseudomonas aeruginosa and 1.25mg/ml against S. aureus and P. vulgaris respectively. The preliminary reports of this study on MMq affirm an in-depth analysis of the usefulness of this plant as a miracle drug against certain uropathogens and urinary tract infections.

Preliminary Report on the Efficacy of Music Therapy to Optimize the Compliance of Rett Syndrome Patients Attending Oral Hygiene Procedures

Background: Individuals with intellectual developmental disability (IDD) often face barriers in accessing dental care. The main aim of the present study was to test the feasibility and the outcome of oral hygiene (OH) procedures in Rett syndrome (RS) patients, and a secondary aim was to test the utility of music therapy during dental hygiene procedures. Methods: A case group (Group 1) of female patients with RS (stage 3 of disease, age &gt; 5 years and &lt;18 years) and a control group of age-matched healthy females (Group 0) were formed, and subgroups received the intervention of oral hygiene combined with a music therapy (Subgroup 1M and Subgroup 0M) or standard oral hygiene (subgroup 1W and subgroup 0W). The Simplified Oral Hygiene Index (OHI-S) was used to assess the effectiveness of oral hygiene measures. Results: The OHI-S at T0 was 1.41 in Group 1 and 2.58 in Group 0 (p value &lt; 0.001). The mean duration of the oral hygiene treatment was 7018″ (SD 3272″) in Group 1 and 873″ (SD 161″) in Group 0 (p value &lt; 0.001). The mean duration of OH was significantly higher in Subgroup 1M and Subgroup 0M. Discussion: Based on the results of our case-control study, OH procedures can be successfully performed in RS patients with good compliance and efficacy. In addition, our study provides preliminary evidence to suggest that music therapy may be a useful adjunct, as it appears to improve patient cooperation.

Unilateral biportal endoscopic technique combined with percutaneous transpedicular screw fixation for thoracolumbar burst fractures with neurological symptoms: technical note and preliminary report

BackgroundPrevious studies on thoracolumbar fractures with neurological symptoms have focused on how to achieve satisfactory fracture reduction, adequate nerve decompression, and stable spinal alignment. With the development of the minimally invasive spine surgery technique, achieving satisfactory treatment results and reducing iatrogenic trauma at the same time has become a new goal of spinal surgery. This research used percutaneous transpedicular screw distraction to partially reduce the fractured vertebrae, followed by completing nerve decompression and reducing residual displacement bone fragments with the assistance of the unilateral biportal endoscopic (UBE) technique to achieve full protection of bone-ligament tissue and obtain good clinical efficacy.MethodsGuide wires were safely inserted into the fractured vertebra and adjacent upper and lower vertebra under the surveillance of anteroposterior and lateral X-ray fluoroscopy. Transpedicular screws were implanted via guide wires on the side with mild neurological deficits or bone fragment compression (the opposite side of the endoscopic operation). A titanium rod was installed and moderately distracted to reduce the fractured vertebra. Then, under the guidance of the endoscopic view, the laminectomy and ligamentum flavum resection were completed according to the position of the protruding bone fragment into the spinal canal, and the compressed dural sac or nerve root was fully exposed and decompressed. An L-shaped replacer was used to reduce residual bone fragments. The ipsilateral transpedicular screws and rod were installed and adjusted to match the contralateral side. The drainage tube was indwelled, and the incision was closed. The preoperative and postoperative images of the patients were evaluated, and the recovery of neurological symptoms was observed.ResultsSurgery was successfully completed on all six patients, and no intraoperative conversion to open surgery was performed. Postoperative images showed good reduction of the protruding bone fragment and good placement of all screws. At the last follow-up, the neurological symptoms of all patients returned to normal.ConclusionThe UBE technique combined with percutaneous transpedicular screw fixation in the treatment of thoracolumbar fractures with neurological symptoms can effectively achieve the reduction of displaced bone fragments, improve damaged nerve function, stabilize spinal alignment, and protect the integrity of bone-ligament tissue.

Intravenous ketamine for benzodiazepine deprescription and withdrawal management in treatment-resistant depression: a preliminary report

We present the first evidence that sub-anesthetic ketamine infusions for treatment resistant depression (TRD) may facilitate deprescription of long-term benzodiazepine/z-drugs (BZDRs). Long-term BZDR prescriptions are potentially harmful yet common, partly because of challenging withdrawal symptoms. Few pharmacological interventions have evidence for facilitating BZDR discontinuation, and none in patients actively suffering from TRD. In this ambi-directional cohort study, discontinuation of long-term (>6 month) BZDRs was attempted in 22 patients with severe unipolar or bipolar TRD receiving a course of six subanesthetic ketamine infusions over four weeks. We investigated the rates of successful BZDRs deprescription, trajectories of acute psychological withdrawal symptoms, and subsequent BZDRs abstinence during a mean follow-up of 1 year (primary outcome). Clinically significant deteriorations in depression, anxiety, sleep, and/or suicidality during the acute BZDR discontinuation phase were measured by repeated standardized scales and analyzed by latent growth curve models and percent correct classification analysis. Of the 22 eligible patients, all enrolled in this study and 91% (20/22) successfully discontinued all BZDRs by the end of the 4-week intervention, confirmed by urinary analyses. Less than 25% of discontinuers experienced any significant worsening of anxiety, depression, sleep difficulties, or suicidality during treatment. During follow-up (mean [range] duration, 12 [3–24] months), 64% (14/22) of patients remained abstinent from any BZDRs. These preliminary results suggest that ketamine infusions for TRD may facilitate the deprescription of BZDRs, even in patients with active depressive symptoms and significant comorbidity. Further investigation is warranted into this potential novel application of ketamine.

Assessment of genetic background of hypocholesterolemia and correlations with clinical characteristics in children and adolescents: A preliminary report

Assessment of genetic background of hypocholesterolemia and correlations with clinical characteristics in children and adolescents: A preliminary report

Use of a context-specific package to increase sputum smear monitoring among people with pulmonary tuberculosis in Uganda: a quality improvement study

BackgroundPeople with bacteriologically confirmed pulmonary tuberculosis (BC-PTB) require sputum smear monitoring (SSM) to ascertain response to anti-TB treatment and cure from TB disease. We aimed to increase SSM at 2,...

Safety, tolerability, and immunogenicity of a CpG/Alum adjuvanted SARS-CoV-2 recombinant protein vaccine (ZR202-CoV) in healthy adults: Preliminary report of a phase 1, randomized, double-blind, placebo-controlled, dose-escalation trial

ABSTRACT This was a phase 1 dose-escalation study of ZR202-CoV, a recombinant protein vaccine candidate containing a pre-fusion format of the spike (S)-protein (S-trimer) combined with the dual-adjuvant system of Alum/CpG. A total of 230 participants were screened and 72 healthy adults aged 18–59 years were enrolled and randomized to receive two doses at a 28-day interval of three different ZR202-CoV formulations or normal saline. We assessed the safety for 28 days after each vaccination and collected blood samples for immunogenicity evaluation. All formulations of ZR202-CoV were well-tolerated, with no observed solicited adverse events ≥ Grade 3 within 7 days after vaccination. No unsolicited adverse events ≥ Grade 3, or serious adverse events related to vaccination occurred as determined by the investigator. After the first dose, detectable immune responses were observed in all subjects. All subjects that received ZR202-CoV seroconverted at 14 days after the second dose by S-binding IgG antibody, pseudovirus and live-virus based neutralizing antibody assays. S-binding response (GMCs: 2708.7 ~ 4050.0 BAU/mL) and neutralizing activity by pseudovirus (GMCs: 363.1 ~ 627.0 IU/mL) and live virus SARS-CoV-2 (GMT: 101.7 ~ 175.0) peaked at 14 days after the second dose of ZR202-CoV. The magnitudes of immune responses compared favorably with COVID-19 vaccines with reported protective efficacy.

Daytime, evening, and overnight: the 24-h radiology cycle and impact on interpretative accuracy.

To assess the influence of time of day when a study is interpreted on discrepancy rates for common and advanced studies performed in the acute community setting. This retrospective study used the databank of a U.S. teleradiology company to retrieve studies between 2012 and 2016 with a preliminary report followed by a final report by the on-site client hospital. Neuroradiology, abdominal radiology, and musculoskeletal radiology studies were included. Teleradiologists were fellowship trained in one of these subspecialty areas. Daytime, evening, and overnight times were defined. Associations between major and minor discrepancies, time of day, and whether the study was common or advanced were tested with significance set at p = .05. A total of 5,883,980 studies were analyzed. There were 8444 major discrepancies (0.14%) and 17,208 minor discrepancies (0.29%). For common studies, daytime (0.13%) and evening (0.13%) had lower major discrepancy rates compared to overnight (0.14%) (daytime to overnight, RR = 0.57, 95%CI: 0.45, 0.72, p < 0.01 and evening to overnight, RR = 0.57, 95%CI: 0.49,0.67, p < 0.01). Minor discrepancy rates for common studies were decreased for evening (0.29%) compared to overnight (0.30%) (RR = 0.89, 95%CI: 0.80,0.99, p = 0.029). For advanced studies, daytime (.15%) had lower major discrepancy rates compared to evening (0.20%) and overnight (.23%) (daytime to evening, RR = 0.77, 95%CI: 0.61, 0.97, p = 0.028 and daytime to overnight, RR = 0.66, 95%CI: 0.50, 0.87, p ≤ 0.01). Significantly higher major discrepancy rates for studies interpreted overnight suggest the need for radiologists to exercise greater caution when interpreting studies overnight and may require practice management strategies to help optimize overnight work conditions. The lower major discrepancy rates on advanced studies interpreted during the daytime suggest the need for reserving advanced studies for interpretation during the day when possible.

Fasting-mimicking diet: a metabolic approach for the treatment of breast cancer.

Metabolic reprogramming is a new and potentially targetable hallmark of cancer. In recent years, fasting and fasting-mimicking diets (FMDs) have been tested as anticancer strategies both in preclinical experiments and in clinical trials. In this review, we aim at summarizing the available evidence about the antitumour activity of these approaches in preclinical breast cancer models, as well as results from clinical trials investigating fasting/FMD in breast cancer patients. Preclinical evidence demonstrated that nutrient deprivation boosts the antitumor activity of chemotherapy, immunotherapy or targeted therapies in triple-negative breast cancer (TNBC) and HR+/HER2 models through both cell-autonomous antitumour effects in cancer cells and favourable modifications in intratumor immune cells. Several clinical experiences demonstrated that fasting/FMD is feasible and well tolerated in combination with standard treatments in BC patients, and that it could reduce chemotherapy-related toxicities. Finally, despite the absence of randomized trials demonstrating the antitumor activity of fasting/FMD in breast cancer patients, preliminary clinical reports suggest that this experimental nutritional strategy may enhance chemotherapy activity. Randomized clinical trials are ongoing to validate these results at a larger scale. Fasting/FMD is a promising therapeutic approach in patients with breast cancer; ongoing and future trials will confirm their role in improving breast cancer care.