Volumetric Capnography For The Evaluation Of Chronic Airways Diseases.

Obstructive lung diseases of different etiologies present with progressive peripheral airway involvement. The peripheral airways, known as the silent lung zone, are not adequately evaluated with conventional function tests. The principle of gas washout has been used to detect pulmonary ventilation inhomogeneity and to estimate the location of the underlying disease process. Volumetric capnography (VC) analyzes the pattern of CO2 elimination as a function of expired volume. To measure normalized phase 3 slopes with VC in patients with non-cystic fibrosis bronchiectasis (NCB) and in bronchitic patients with chronic obstructive pulmonary disease (COPD) in order to compare the slopes obtained for the groups. NCB and severe COPD were enrolled sequentially from an outpatient clinic (Hospital of the State University of Campinas). A control group was established for the NCB group, paired by sex and age. All subjects performed spirometry, VC, and the 6-Minute Walk Test (6MWT). Two comparisons were made: NCB group versus its control group, and NCB group versus COPD group. The project was approved by the ethical committee of the institution. Statistical tests used were Wilcoxon or Student's t-test; P<0.05 was considered to be a statistically significant difference. Concerning the NCB group (N=20) versus the control group (N=20), significant differences were found in body mass index and in several functional variables (spirometric, VC, 6MWT) with worse results observed in the NCB group. In the comparison between the COPD group (N=20) versus the NCB group, although patients with COPD had worse spirometric and 6MWT values, the capnographic variables mean phase 2 slope (Slp2), mean phase 3 slope normalized by the mean expiratory volume, or mean phase 3 slope normalized by the end-tidal CO2 concentration were similar. These findings may indicate that the gas elimination curves are not sensitive enough to monitor the severity of structural abnormalities. The role of normalized phase 3 slope may be worth exploring as a more sensitive index of small airway disease, even though it may not be equally sensitive in discriminating the severity of the alterations.

Probability of achieving optimal molecular response to imatinib in chronic myeloid leukemia (CML) patients: Pharmacokinetic/Pharmacodynamic (PK/PD) relationships observed under field-conditions

Objectives: Imatinib has been increasingly proposed for therapeutic drug monitoring (TDM), as trough concentrations (Cmin) correlate with response rates in CML patients. This analysis aimed to evaluate the impact of imatinib exposure on optimal molecular response rates in a large European cohort of patients followed by centralized TDM.¦Methods: Sequential PK/PD analysis was performed in NONMEM 7 on 2230 plasma (PK) samples obtained along with molecular response (PD) data from 1299 CML patients. Model-based individual Bayesian estimates of exposure, parameterized as to initial dose adjusted and log-normalized Cmin (log-Cmin) or clearance (CL), were investigated as potential predictors of optimal molecular response, while accounting for time under treatment (stratified at 3 years), gender, CML phase, age, potentially interacting comedication, and TDM frequency. PK/PD analysis used mixed-effect logistic regression (iterative two-stage method) to account for intra-patient correlation.¦Results: In univariate analyses, CL, log-Cmin, time under treatment, TDM frequency, gender (all p<0.01) and CML phase (p=0.02) were significant predictors of the outcome. In multivariate analyses, all but log-Cmin remained significant (p<0.05). Our model estimates a 54.1% probability of optimal molecular response in a female patient with a median CL of 14.4 L/h, increasing by 4.7% with a 35% decrease in CL (percentile 10 of CL distribution), and decreasing by 6% with a 45% increased CL (percentile 90), respectively. Male patients were less likely than female to be in optimal response (odds ratio: 0.62, p<0.001), with an estimated probability of 42.3%.¦Conclusions: Beyond CML phase and time on treatment, expectedly correlated to the outcome, an effect of initial imatinib exposure on the probability of achieving optimal molecular response was confirmed in field-conditions by this multivariate analysis. Interestingly, male patients had a higher risk of suboptimal response, which might not exclusively derive from their 18.5% higher CL, but also from reported lower adherence to the treatment. A prospective longitudinal study would be desirable to confirm the clinical importance of identified covariates and to exclude biases possibly affecting this observational survey.

A realistic validation study of a new nitrogen multiple-breath washout system

Background For reliable assessment of ventilation inhomogeneity, multiple-breath washout (MBW) systems should be realistically validated. We describe a new lung model for in vitro validation under physiological conditions and the assessment of a new nitrogen (N2)MBW system. Methods The N2MBW setup indirectly measures the N2 fraction (FN2) from main-stream carbon dioxide (CO2) and side-stream oxygen (O2) signals: FN2 = 1−FO2−FCO2−FArgon. For in vitro N2MBW, a double chamber plastic lung model was filled with water, heated to 37°C, and ventilated at various lung volumes, respiratory rates, and FCO2. In vivo N2MBW was undertaken in triplets on two occasions in 30 healthy adults. Primary N2MBW outcome was functional residual capacity (FRC). We assessed in vitro error (√[difference]2) between measured and model FRC (100–4174 mL), and error between tests of in vivo FRC, lung clearance index (LCI), and normalized phase III slope indices (Sacin and Scond). Results The model generated 145 FRCs under BTPS conditions and various breathing patterns. Mean (SD) error was 2.3 (1.7)%. In 500 to 4174 mL FRCs, 121 (98%) of FRCs were within 5%. In 100 to 400 mL FRCs, the error was better than 7%. In vivo FRC error between tests was 10.1 (8.2)%. LCI was the most reproducible ventilation inhomogeneity index. Conclusion The lung model generates lung volumes under the conditions encountered during clinical MBW testing and enables realistic validation of MBW systems. The new N2MBW system reliably measures lung volumes and delivers reproducible LCI values.

Binocular contrast interactions:Dichoptic masking is not a single process

To decouple interocular suppression and binocular summation we varied the relative phase of mask and target in a 2IFC contrast-masking paradigm. In Experiment I, dichoptic mask gratings had the same orientation and spatial frequency as the target. For in-phase masking, suppression was strong (a log-log slope of ∼1) and there was weak facilitation at low mask contrasts. Anti-phase masking was weaker (a log-log slope of ∼0.7) and there was no facilitation. A two-stage model of contrast gain control [Meese, T.S., Georgeson, M.A. and Baker, D.H. (2006). Binocular contrast vision at and above threshold. Journal of Vision, 6: 1224-1243] provided a good fit to the in-phase results and fixed its free parameters. It made successful predictions (with no free parameters) for the anti-phase results when (A) interocular suppression was phase-indifferent but (B) binocular summation was phase sensitive. Experiments II and III showed that interocular suppression comprised two components: (i) a tuned effect with an orientation bandwidth of ∼±33° and a spatial frequency bandwidth of >3 octaves, and (ii) an untuned effect that elevated threshold by a factor of between 2 and 4. Operationally, binocular summation was more tightly tuned, having an orientation bandwidth of ∼±8°, and a spatial frequency bandwidth of ∼0.5 octaves. Our results replicate the unusual shapes of the in-phase dichoptic tuning functions reported by Legge [Legge, G.E. (1979). Spatial frequency masking in human vision: Binocular interactions. Journal of the Optical Society of America, 69: 838-847]. These can now be seen as the envelope of the direct effects from interocular suppression and the indirect effect from binocular summation, which contaminates the signal channel with a mask that has been suppressed by the target. © 2007 Elsevier Ltd. All rights reserved.

Size matters, but not for everyone:Individual differences for contrast discrimination

It is very well known that contrast detection thresholds improve with the size of a grating-type stimulus, but it is thought that the benefit of size is abolished for contrast discriminations well above threshold (e.g., Legge, G. E., & Foley, J. M. (1980)]. Here we challenge the generality of this view. We performed contrast detection and contrast discrimination for circular patches of sine wave grating as a function of stimulus size. We confirm that sensitivity improves with approximately the fourth-root of stimulus area at detection threshold (a log-log slope of -0.25) but find individual differences (IDs) for the suprathreshold discrimination task. For several observers, performance was largely unaffected by area, but for others performance first improved (by as much as a log-log slope of -0.5) and then reached a plateau. We replicated these different results several times on the same observers. All of these results were described in the context of a recent gain control model of area summation [Meese, T. S. (2004)], extended to accommodate the multiple stimulus sizes used here. In this model, (i) excitation increased with the fourth-root of stimulus area for all observers, and (ii) IDs in the discrimination data were described by IDs in the relation between suppression and area. This means that empirical summation in the contrast discrimination task can be attributed to growth in suppression with stimulus size that does not keep pace with the growth in excitation. © 2005 ARVO.

Análise estratigráfica de subsuperfície do Devoniano Inferior da Bacia do Rio do Peixe, Nordeste do Brasil

Subsurface stratigraphic analysis of Devonian strata from the Rio do Peixe Basin, newly recognized by palynological studies, has resulted in the identification of two new lithostratigraphic units assembled in the Santa Helena Group. The Pilões Formation, the lower unit, is composed mainly of dark mudstones and medium-tovery fine-grained sandstones, with minor conglomerates and breccias. The Triunfo Formation, the upper unit, comprises whitish grey, kaolinitic, coarse-grained to conglomeratic, cross stratified sandstones and conglomerates, with interbedded mudstones and fine-grained sandstones. These units were characterized using cores, sidewall and cuttings samples, conventional logs and image log, from three wells drilled by PETROBRAS, and 3D seismic data. The Pilões Formation is interpreted as prodeltaic facies, with lesser associated subaqueous talus, debrite and sandy turbidite lobe facies, distal part of fandelta and braided fluviodeltaic facies of Triunfo Formation. The Santa Helena Group corresponds to the Lower Devonian tectono-sequence deposited in a NW-SE-trending graben during a transgressiveregressive cycle. With 343 meters of thickness (isochore) in well 1-PIL-1-PB (Pilões 1), this sequence has a non-conformity at the lower boundary and its upper boundary is an unconformity with the Lower Cretaceous tectono-sequence (Rio do Peixe Group), that represents a hiatus of about 265 million years. Ignimbrites and coignimbrite breccias (Poço da Jurema volcanic breccia), related to an unknown pyroclastic volcanic event, were recognized at the northern margin of the Sousa halfgraben. Evidence from well data suggests that this event is coeval with the Devonian graben filling. The present study indicates a polyhistorical tectono-volcanosedimentary evolution of the basin. This lithostratigraphic update brings new perspectives for geological research in the Rio do Peixe Basin, as well as in other inland basins of the Northeastern of Brazil. The results of the research also contribute to the kwnoledge of the Borborema Province and western Gondwana paleogeography during the Early Devonian.

Image segmentation through combined methods: watershed transform, unsupervised distance learning and normalized cut

Research on image processing has shown that combining segmentation methods may lead to a solid approach to extract semantic information from different sort of images. Within this context, the Normalized Cut (NCut) is usually used as a final partitioning tool for graphs modeled in some chosen method. This work explores the Watershed Transform as a modeling tool, using different criteria of the hierarchical Watershed to convert an image into an adjacency graph. The Watershed is combined with an unsupervised distance learning step that redistributes the graph weights and redefines the Similarity matrix, before the final segmentation step using NCut. Adopting the Berkeley Segmentation Data Set and Benchmark as a background, our goal is to compare the results obtained for this method with previous work to validate its performance.

Geometry-Aware Multiscale Image Registration via OBBTree-Based Polyaffine Log-Demons

Non-linear image registration is an important tool in many areas of image analysis. For instance, in morphometric studies of a population of brains, free-form deformations between images are analyzed to describe the structural anatomical variability. Such a simple deformation model is justified by the absence of an easy expressible prior about the shape changes. Applying the same algorithms used in brain imaging to orthopedic images might not be optimal due to the difference in the underlying prior on the inter-subject deformations. In particular, using an un-informed deformation prior often leads to local minima far from the expected solution. To improve robustness and promote anatomically meaningful deformations, we propose a locally affine and geometry-aware registration algorithm that automatically adapts to the data. We build upon the log-domain demons algorithm and introduce a new type of OBBTree-based regularization in the registration with a natural multiscale structure. The regularization model is composed of a hierarchy of locally affine transformations via their logarithms. Experiments on mandibles show improved accuracy and robustness when used to initialize the demons, and even similar performance by direct comparison to the demons, with a significantly lower degree of freedom. This closes the gap between polyaffine and non-rigid registration and opens new ways to statistically analyze the registration results.

Resistivity image beneath an area of active methane seeps in the west Svalbard continental slope

The Arctic continental margin contains large amounts of methane in the form of methane hydrates. The west Svalbard continental slope is an area where active methane seeps have been reported near the landward limit of the hydrate stability zone. The presence of bottom simulating reflectors (BSR) on seismic reflection data in water depths greater than 600 m suggests the presence of free gas beneath gas hydrates in the area. Resistivity obtained from marine controlled source electromagnetic (CSEM) data provides a useful complement to seismic methods for detecting shallow hydrate and gas as they are more resistive than surrounding water saturated sediments. We acquired two CSEM lines in the west Svalbard continental slope, extending from the edge of the continental shelf (250 m water depth) to water depths of around 800 m. High resistivities (5-12 Ωm) observed above the BSR support the presence of gas hydrate in water depths greater than 600 m. High resistivities (3-4 Ωm) at 390-600 m water depth also suggest possible hydrate occurrence within the gas hydrate stability zone (GHSZ) of the continental slope. In addition, high resistivities (4-8 Ωm) landward of the GHSZ are coincident with high-amplitude reflectors and low velocities reported in seismic data that indicate the likely presence of free gas. Pore space saturation estimates using a connectivity equation suggest 20-50% hydrate within the lower slope sediments and less than 12% within the upper slope sediments. A free gas zone beneath the GHSZ (10-20% gas saturation) is connected to the high free gas saturated (10-45%) area at the edge of the continental shelf, where most of the seeps are observed. This evidence supports the presence of lateral free gas migration beneath the GHSZ towards the continental shelf.

Texture Image Analysis in Differentiating Malignant from Benign Adrenal Cortical Tumors in Children and Adults

Objective: To investigate the possible role of chromatin texture parameters, nuclear morphology, DNA ploidy and clinical functional status in discriminating benign from malignant adrenocortical tumors (ACT). Patients and Methods: Forty-eight cases of clinically benign (n=40) and clinically malignant (n=8) ACT with a minimum of 5-years` follow-up were evaluated for chromatin texture parameters (run length, standard deviation, configurable run length, valley, slope, peak and other 21 Markovian features that describe the distribution of the chromatin in the nucleus), nuclear morphology (nuclear area, nuclear perimeter, nuclear maximum and minumum diameter, nuclear shape), and DNA ploidy. Nuclear parameters were evaluated in Feulgen-stained 5 mu m paraffin-sections analyzed using a CAS 200 image analyzer. Results: Since ACTs present different biological features in children and adults, patients were divided into two groups: children (<= 15 years) and adults (>15 years). In the group of children DNA ploidy presented a marginal significance (p=0.05) in discriminating ACTs. None of the parameters discriminated between malignant and benign ACT in the adult group. Conclusion: ACTs are uncommon and definitive predictive criteria for malignancy remain uncertain, particularly in children. Our data point to DNA content evaluated by image analysis as a new candidate tool for this challenging task. Texture image analysis did not help to differentiate malignant from benign adrenal cortical tumors in children and adults.

Fluorescence Microscopy Imaging Denoising with Log-Euclidean Priors and Photobleaching Compensation

Fluorescent protein microscopy imaging is nowadays one of the most important tools in biomedical research. However, the resulting images present a low signal to noise ratio and a time intensity decay due to the photobleaching effect. This phenomenon is a consequence of the decreasing on the radiation emission efficiency of the tagging protein. This occurs because the fluorophore permanently loses its ability to fluoresce, due to photochemical reactions induced by the incident light. The Poisson multiplicative noise that corrupts these images, in addition with its quality degradation due to photobleaching, make long time biological observation processes very difficult. In this paper a denoising algorithm for Poisson data, where the photobleaching effect is explicitly taken into account, is described. The algorithm is designed in a Bayesian framework where the data fidelity term models the Poisson noise generation process as well as the exponential intensity decay caused by the photobleaching. The prior term is conceived with Gibbs priors and log-Euclidean potential functions, suitable to cope with the positivity constrained nature of the parameters to be estimated. Monte Carlo tests with synthetic data are presented to characterize the performance of the algorithm. One example with real data is included to illustrate its application.

Prognostic Value of a New Cardiopulmonary Exercise Testing Parameter in Chronic Heart Failure: Oxygen Uptake Efficiency at Peak Exercise - Comparison with Oxygen Uptake Efficiency Slope

INTRODUCTION: A growing body of evidence shows the prognostic value of oxygen uptake efficiency slope (OUES), a cardiopulmonary exercise test (CPET) parameter derived from the logarithmic relationship between O(2) consumption (VO(2)) and minute ventilation (VE) in patients with chronic heart failure (CHF). OBJECTIVE: To evaluate the prognostic value of a new CPET parameter - peak oxygen uptake efficiency (POUE) - and to compare it with OUES in patients with CHF. METHODS: We prospectively studied 206 consecutive patients with stable CHF due to dilated cardiomyopathy - 153 male, aged 53.3±13.0 years, 35.4% of ischemic etiology, left ventricular ejection fraction 27.7±8.0%, 81.1% in sinus rhythm, 97.1% receiving ACE-Is or ARBs, 78.2% beta-blockers and 60.2% spironolactone - who performed a first maximal symptom-limited treadmill CPET, using the modified Bruce protocol. In 33% of patients an cardioverter-defibrillator (ICD) or cardiac resynchronization therapy device (CRT-D) was implanted during follow-up. Peak VO(2), percentage of predicted peak VO(2), VE/VCO(2) slope, OUES and POUE were analyzed. OUES was calculated using the formula VO(2) (l/min) = OUES (log(10)VE) + b. POUE was calculated as pVO(2) (l/min) / log(10)peakVE (l/min). Correlation coefficients between the studied parameters were obtained. The prognosis of each variable adjusted for age was evaluated through Cox proportional hazard models and R2 percent (R2%) and V index (V6) were used as measures of the predictive accuracy of events of each of these variables. Receiver operating characteristic (ROC) curves from logistic regression models were used to determine the cut-offs for OUES and POUE. RESULTS: pVO(2): 20.5±5.9; percentage of predicted peak VO(2): 68.6±18.2; VE/VCO(2) slope: 30.6±8.3; OUES: 1.85±0.61; POUE: 0.88±0.27. During a mean follow-up of 33.1±14.8 months, 45 (21.8%) patients died, 10 (4.9%) underwent urgent heart transplantation and in three patients (1.5%) a left ventricular assist device was implanted. All variables proved to be independent predictors of this combined event; however, VE/VCO2 slope was most strongly associated with events (HR 11.14). In this population, POUE was associated with a higher risk of events than OUES (HR 9.61 vs. 7.01), and was also a better predictor of events (R2: 28.91 vs. 22.37). CONCLUSION: POUE was more strongly associated with death, urgent heart transplantation and implantation of a left ventricular assist device and proved to be a better predictor of events than OUES. These results suggest that this new parameter can increase the prognostic value of CPET in patients with CHF.

Image quality assessment in digital mammography: part I. Technical characterization of the systems.

In many European countries, image quality for digital x-ray systems used in screening mammography is currently specified using a threshold-detail detectability method. This is a two-part study that proposes an alternative method based on calculated detectability for a model observer: the first part of the work presents a characterization of the systems. Eleven digital mammography systems were included in the study; four computed radiography (CR) systems, and a group of seven digital radiography (DR) detectors, composed of three amorphous selenium-based detectors, three caesium iodide scintillator systems and a silicon wafer-based photon counting system. The technical parameters assessed included the system response curve, detector uniformity error, pre-sampling modulation transfer function (MTF), normalized noise power spectrum (NNPS) and detective quantum efficiency (DQE). Approximate quantum noise limited exposure range was examined using a separation of noise sources based upon standard deviation. Noise separation showed that electronic noise was the dominant noise at low detector air kerma for three systems; the remaining systems showed quantum noise limited behaviour between 12.5 and 380 µGy. Greater variation in detector MTF was found for the DR group compared to the CR systems; MTF at 5 mm(-1) varied from 0.08 to 0.23 for the CR detectors against a range of 0.16-0.64 for the DR units. The needle CR detector had a higher MTF, lower NNPS and higher DQE at 5 mm(-1) than the powder CR phosphors. DQE at 5 mm(-1) ranged from 0.02 to 0.20 for the CR systems, while DQE at 5 mm(-1) for the DR group ranged from 0.04 to 0.41, indicating higher DQE for the DR detectors and needle CR system than for the powder CR phosphor systems. The technical evaluation section of the study showed that the digital mammography systems were well set up and exhibiting typical performance for the detector technology employed in the respective systems.

The combined use of reflectance, emissivity and elevation Aster/Terra data for tropical soil studies

Reflectance, emissivity and elevation data of the sensor ASTER (Advanced Spaceborne Thermal Emission and Reflection Radiometer)/Terra were used to characterize soil composition variations according to the toposequence position. Normalized data of SWIR (shortwave infrared) reflectance and TIR (thermal infrared) emissivity, coupled to a soil-fraction image from a spectral mixture model, were evaluated to separate bare soils from nonphotosynthetic vegetation. Regression relationships of some soil properties with reflectance and emissivity data were then applied on the exposed soil pixels. The resulting estimated values were plotted on the ASTER-derived digital elevation model. Results showed that the SWIR bands 5 and 6 and the TIR bands 10 and 14 measured the clay mineral absorption band and the quartz emissivity feature, respectively. These bands improved also the discrimination between nonphotosynthetic vegetation and soils. Despite the differences in pixel size and field sampling size, some soil properties were correlated with reflectance (R² of 0.65 for Al2O3 in band 6; 0.61 for Fe2O3 in band 3) and emissivity (R² of 0.65 for total sand fraction in the 10/14 band ratio). The combined use of reflectance, emissivity and elevation data revealed variations in soil composition with topography in specific parts of the landscape. From higher to lower slope positions, a general decrease in Al2O3 and increase in total sand fraction was observed, due to the prevalence of Rhodic Acrustox at the top and its gradual transition to Typic Acrustox at the bottom.