Background Endometrial carcinoma (EC) risk stratification is generally based on histological assessment. It would be beneficial to perform risk stratification noninvasively by MRI. Purpose To investigate the application of amide proton transfer‐weighted imaging (APTWI), monoexponential, biexponential, and stretched exponential intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) for the evaluation of risk stratification in early‐stage EC. Study Type Prospective. Population Eighty patients with early‐stage EC (47 classified as low risk, 20 as medium risk, and 13 as high risk by histological grade and International Federation of Gynecology and Obstetrics stage). Field Strength/Sequence T1‐weighted imaging, T2‐weighted imaging, IVIM, APTWI, and DKI MRI at 3 T. Assessment The magnetization transfer ratio asymmetry (MTRasym [3.5 ppm]), apparent diffusion coefficient (ADC), diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f), distributed diffusion coefficient (DDC), water molecular diffusion heterogeneity index (α), mean kurtosis (MK), and mean diffusivity (MD) were calculated and compared between low‐risk and non‐low‐risk groups. Statistical Tests Individual sample t test, analysis of variance, and logistic regression. A P‐value <0.05 was considered statistically significant. Results The α, ADC, D, DDC, and MD were significantly higher and the f, MK, and MTRasym (3.5 ppm) were significantly lower in the low‐risk group than in the non‐low‐risk group. The difference in D* between the two groups was not significant (P = 0.289). MTRasym (3.5 ppm), D, and MK were independent predictors of risk stratification. The combination of these three parameters was better able to identify low‐ and non‐low‐risk groups than each individual parameter. Data Conclusion The IVIM, DKI, and APTWI parameters have potential as imaging markers for risk stratification in early‐stage EC. Level of Evidence 2 Technical Efficacy Stage 3

Purpose: To assess the impact of enhanced recovery after surgery (ERAS) protocols in pancreaticoduodenectomy. Methods: Four databases were searched for studies describing ERAS program in patients undergoing pancreatic surgery published up to May 01, 2018. Primary outcomes were mortality, readmission, reoperation and postoperative complications. Secondary outcomes were the length of stay and cost. Results: A total of 19 studies met inclusion and exclusion criteria and included 3,387 patients. Meta-analysis showed a decrease in pancreatic fistula (OR = 0.79, 95% CI: 0.67 to 0.95; I 2 = 0%), infection (OR = 0.63, 95% CI: 0.50 to 0.78; I 2 = 0%), especially incision infection (OR = 0.62, 95% CI: 0.42 to 0.91; I 2 = 0%), and pulmonary infection (OR = 0.28, 95% CI: 0.12 to 0.66; I 2 = 0%). Length-of-stay (MD: −3.89 days, 95% CI: −4.98 to −2.81; I 2 = 78%) and cost were also significantly reduced. There was no significant increase in mortality, readmission, reoperation, or delayed gastric emptying. Conclusion: This analysis revealed that using ERAS protocols in pancreatic resections may help decrease the incidence of pancreatic fistula and infections. Furthermore, ERAS also reduces length of stay and cost of care. This study provides evidence for the benefit of ERAS protocols.

Parametric imaging of Ki (the net influx rate) in FDG PET has been shown to provide better quantification and improved specificity for cancer detection compared with SUV imaging. Current methods for generating parametric images usually requires a long dynamic scan time. With the recently developed uEXPLORER scanner, a dramatic increase of sensitivity has reduced the noise in dynamic imaging, making it more robust to employ a non-linear estimation method and flexible protocols. In this work, we explored 2 new possible protocols besides the standard 60-minute one for the possibility of reducing scan time for Ki imaging.

The current clinical guidelines on post-traumatic stress disorder (PTSD) recommend selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) of drugs. However, there is uncertainty about the efficacy of other drugs and selecting which treatments work best for which patients. This meta-analysis evaluated efficacy and acceptability of pharmaceutical management for adults with PTSD. Randomized-controlled trials, which reported active comparators and placebocontrolled trials of pharmaceutical management for adults with PTSD, from the Ovid Medline, EMBase, CENTRAL, PsycINFO, Ovid Health and Psychosocial Instruments, and ISIWeb of Science, were searched until June 21, 2019. In terms of efficacy, all active drugs demonstrated superior effect than placebo (SMD = −0.33; 95% CI, −0.43 to −0.23). The medications were superior to placebo in reducing the symptom of re-experiencing, avoidance, hyperarousal, depression, and anxiety. For acceptability, medicine interventions for PTSD showed no increase in all-cause discontinuation compared with placebo. Nevertheless, in terms of safety, medicine interventions indicated a higher risk of adverse effect compared with placebo (RR = 1.47, 95% CI: 1.24 to 1.75). Compared with placebo, the SSRIs and atypical antipsychotics drugs had significant efficacy whether in patients with severe or extremely severe PTSD status. However, only atypical antipsychotics (SMD = −0.29, 95% CI: −0.48 to −0.10) showed superior efficacy than placebo in veterans. Medication management could be effective in intervention of PTSD, which demonstrated a sufficient improvement in the core symptoms. This meta-analysis supports the status of SSRIs and SNRIs as recommended pharmacotherapy. However, patients with different clinical characteristics of PTSD should consider individualized drug management.

Overproduced reactive oxygen and reactive nitrogen species (RONS) in the brain are involved in the pathogenesis of several neurological diseases, such as Alzheimer's disease, Parkinson's disease, traumatic brain injury, and stroke, as they attack neurons and glial cells, triggering cellular redox stress. Neutralizing RONS, and, thus, alleviating redox stress, can slow down or stop the progression of neurological diseases. Currently, an increasing number of studies are applying nanomaterials (NMs) with anti-redox activity and exploring the potential mechanisms involved in redox stress-related neurological diseases. In this review, we summarize the anti-redox mechanisms of NMs, including mimicking natural oxidoreductase activity and inhibiting RONS generation at the source. In addition, we propose several strategies to enhance the anti-redox ability of NMs and highlight the challenges that need to be resolved in their application. In-depth knowledge of the mechanisms and potential application of NMs in alleviating redox stress will help in the exploration of the therapeutic potential of anti-redox stress NMs in neurological diseases. Graphical Abstract

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Background: Although enhanced recovery after surgery (ERAS) has made great progress in the field of surgery, the guidelines point to the lack of high-quality evidence in upper gastrointestinal surgery. Methods: Randomized controlled trials in four electronic databases that involved ERAS protocols for upper gastrointestinal surgery were searched through December 12, 2018. The primary endpoints were lung infection, urinary tract infection, surgical site infection, postoperative anastomotic leakage and ileus. The secondary endpoints were postoperative length of stay, the time from end of surgery to first flatus and defecation, and readmission rates. Subgroup analysis was performed based on the type of surgery. Results: A total of 17 studies were included. The results of the meta-analysis indicate that there was a decrease in rates of lung infection (RR = 0.50, 95%CI: 0.33 to 0.75), postoperative length of stay (MD =-2.53, 95%CI: − 3.42 to − 1.65), time until first postoperative flatus (MD =-0.64, 95%CI: − 0.84 to − 0.45) and time until first postoperative defecation (MD =-1.10, 95%CI: − 1.74 to − 0.47) in patients who received ERAS, compared to conventional care. However, other outcomes were not significant difference. There was no significant difference between ERAS and conventional care in rates of urinary tract infection (P = 0.10), surgical site infection (P = 0.42), postoperative anastomotic leakage (P = 0.45), readmissions (P = 0.31) and ileus (P = 0.25). Conclusions: ERAS protocols can reduce the risk of postoperative lung infection and accelerating patient recovery time. Nevertheless, we should also consider further research ERAS should be performed undergoing gastrectomy and esophagectomy.

Purpose: This study aims to explore the effectiveness and safety of the enhanced recovery after surgery (ERAS) protocol vs. traditional perioperative care programs for breast reconstruction. Methods: Three electronic databases (PubMed, EMBASE, and Cochrane Library) were searched for observational studies comparing an ERAS program with a traditional perioperative care program from database inception to 5 May 2018. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and evaluated study quality using the Newcastle-Ottawa Scale. Subgroup and sensitivity analyses were performed. The outcomes included the length of hospital stay (LOS), complication rates, pain control, costs, emergency department visits, hospital readmission, and unplanned reoperation. Results: Ten studies were included in the meta-analysis. Compared with a conventional program, ERAS was associated with significantly decreased LOS, morphine administration (including postoperative patient-controlled analgesia usage rate and duration; intravenous morphine administration on postoperative day [POD] 0, 1, 2, and 4; total intravenous morphine administration on POD 0–3; oral morphine consumption on POD 0–4; and total postoperative oral morphine consumption), and pain scores (postoperative pain score on POD 0 and total pain score on POD 0–3). The other variables did not differ significantly. Conclusion: Our results suggest that ERAS protocols can decrease LOS and morphine equivalent dosing; therefore, further larger, and better-quality studies that report on bleeding amount and patient satisfaction are needed to validate our findings.