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Near-infrared (NIR) optical properties of turbid media, e.g., tissue, can be accurately quantified noninvasively using methods based on diffuse reflectance or transmittance, such as frequency domain photon migration (FDPM). Factors which govern the accuracy and sensitivity of FDPM-measured optical properties include instrument performance, the light propagation model, and fitting algorithms used to calculate optical properties from measured data. In this article, we characterize instrument, model, and fitting uncertaintics of an FDPM system designed for clinical use and investigate how each of these factors affects the quantification of NIR absorption (μa) and reduced scattering (μs′) parameters in tissue phantoms. The instrument is based on a 500 MHz, multiwavelength platform that sweeps through 201 discrete frequencies in as little as 675 ms. Phase and amplitude of intensity modulated light launched into tissue, i.e., diffuse photon density waves (PDW), are measured with an accuracy of ±0.30° and ±3.5%, while phase and amplitude precision are ±0.025° and ±0.20%, respectively. At this level of instrument uncertainty, simultaneous fitting of frequency-dependent phase and amplitude nonlinear model functions derived from a photon diffusion approximation provides an accurate and robust strategy for determining optical properties from FDPM data, especially for media with high absorption. In an optical property range that is characteristic of most human tissues in the NIR (5×10−3<μa<5×10−2 mm−1, 0.5<μs′<2 mm−1), we theoretically and experimentally demonstrate that the multifrequency, simultaneous-fit approach allows μa and μs′ to be quantified with an accuracy of ±5% and ±3%, respectively. Although exceptionally high levels of precision can be obtained using this approach (<1% of the estimated absorption and scattering values), we show that the absolute accuracy of optical property measurements is highly dependent on specific factors associated with instrument performance, model function relevance, and details of the fitting strategy used to calculate μa and μs′.

SUMMARYA multiwavelength, high bandwidth (1 GHz) frequency-domain photon migration (FDPM) instrument has been developed for quantitative, non-invasive measurements of tissue optical and physiological properties. The instrument produces 300 kHz to 1 GHz photon density waves (PDWs) in optically turbid media using a network analyser, an avalanche photodiode detector and four amplitude-modulated diode lasers (674 nm, 811 nm, 849 nm and 956 nm). The frequency-dependence of PDW phase and amplitude is measured and compared to analytically derived model functions in order to calculate absorption, µ a , and reduced scattering, µ s , parameters. The wavelength-dependence of absorption is used to determine tissue haemoglobin concentration (total, oxy-and deoxy-forms), oxygen saturation and water concentration. We present preliminary results of non-invasive FDPM measurements obtained from normal and tumour-containing human breast tissue. Our data clearly demonstrate that physiological changes caused by the presence of small (about 1 cm diameter) palpable lesions can be detected using a handheld FDPM probe.

The incidence of malignant pheochromocytoma/paraganglioma was high in children (47%), particularly those with apparently sporadic disease, paraganglioma, and tumor diameters of > 6 cm. Patients with a known genetic mutation or familial pheochromocytoma/paraganglioma were more likely to achieve resection with negative microscopic margins and had improved disease-specific mortality rates. Surgical resection remains the treatment of choice for pheochromocytoma and paraganglioma.

The prognosis for patients with GCC tumors correlates well with the American Joint Committee on Cancer stage at initial presentation. Appendectomy alone seems adequate for stage I disease. For staging purposes, right hemicolectomy is appropriate for T4 tumors or stage II to III disease provided that it can be performed with minimal risk. Surgical debulking is a consideration but is controversial. Adjuvant chemotherapy with 5-fluorouracil and leucovorin regimen is minimally effective against GCC.

The Rives-Stoppa repair of complex incisional hernias using synthetic prosthetic materials is safe with a low recurrence rate (5%) and high patient satisfaction. Postoperative wound infection is a risk factor for hernia recurrence.

Background: The aetiology of age-related macular degeneration (AMD) and cognitive impairment is poorly understood. A link between cognitive impairment and AMD has been proposed although only a weak association was found in population-based studies. Purpose: To assess cross-sectional associations between AMD and cognitive impairment in an older Australian population. Methods: The Blue Mountains Eye Study examined 3,509 persons aged 49+ years during 1997–2000. AMD lesions were assessed from retinal photographs using the Wisconsin System. Mini-mental state examination (MMSE), demographics, lifestyle factors and medical history were collected at interview. MMSE score was categorised as high-normal (28–30), low-normal (24–27) and impaired (<24). A modified MMSE excluded five vision related items and was dichotomised as normal (18–22) and impaired (0–17). Logistic regression was used to assess associations after adjusting for age, sex, visual impairment, stroke, current smoking status, hypertension, alcohol consumption and post-high-school qualification. Results: Prevalence rates for late and early AMD were 1.5% (n = 50) and 8.3% (n = 273), respectively. Cognitive impairment was present in 18.0% in persons with late AMD and 8.4% with early AMD, compared to 2.6% in persons without AMD. After multivariate adjustment, late AMD was associated with low normal MMSE (odds ratio (OR): 2.2, 95% confidence interval (CI): 1.1–5.0) and cognitive impairment (OR: 3.7, CI: 1.3–10.6). Using the modified MMSE, the multivariate association between late AMD and cognitive impairment remained (OR: 2.2, CI: 1.0–5.0). No significant association was found between cognitive impairment and early AMD. Conclusions: We found a significant, cross-sectional association between late AMD and cognitive impairment in a sample of older Australians that appeared to be independent of visual impairment. The association was weaker but remained significant after excluding vision-related items from the MMSE.

In‐person psychotherapy (IPP) has a long and storied past, but technology advances have ushered in a new era of video‐delivered psychotherapy (VDP). In this meta‐analysis, pre‐post changes within VDP were evaluated as were outcome differences between VDP versus IPP or other comparison groups. A literature search identified k = 56 within‐group studies (N = 1681 participants) and 47 between‐group studies (N = 3564). The pre‐post effect size of VDP was large and highly significant, g = +0.99 95% CI [0.67–0.31]. VDP was significantly better in outcome than wait list controls (g = 0.77) but negligible in difference from IPP. Within‐groups heterogeneity of effect sizes was reduced after subgrouping studies by treatment target, of which anxiety, depression, and posttraumatic stress disorder (PTSD) (each with k > 5) had effect sizes nearing 1.00. Disaggregating within‐groups studies by therapy type, the effect size was 1.34 for CBT and 0.66 for non‐CBT. Adjusted for possible publication bias, the overall effect size of VDP within groups was g = 0.54. In conclusion, substantial and significant improvement occurs from pre‐ to post‐phases of VDP, this in turn differing negligibly from IPP treatment outcome. The VDP improvement is most pronounced when CBT is used, and when anxiety, depression, or PTSD are targeted, and it remains strong though attenuated by publication bias. Clinically, therapy is no less efficacious when delivered via videoconferencing than in‐person, with efficacy being most pronounced in CBT for affective disorders. Live psychotherapy by video emerges not only as a popular and convenient choice but also one that is now upheld by meta‐analytic evidence.