Automated Segmentation of Cerebral Vasculature with Aneurysms in 3DRA and TOF-MRA using Geodesic Active Regions: an Evaluation Study

Purpose: To evaluate the suitability of an improved version of an automatic segmentation method based on geodesic active regions (GAR) for segmenting cerebral vasculature with aneurysms from 3D X-ray reconstruc-tion angiography (3DRA) and time of °ight magnetic resonance angiography (TOF-MRA) images available in the clinical routine.Methods: Three aspects of the GAR method have been improved: execution time, robustness to variability in imaging protocols and robustness to variability in image spatial resolutions. The improved GAR was retrospectively evaluated on images from patients containing intracranial aneurysms in the area of the Circle of Willis and imaged with two modalities: 3DRA and TOF-MRA. Images were obtained from two clinical centers, each using di®erent imaging equipment. Evaluation included qualitative and quantitative analyses ofthe segmentation results on 20 images from 10 patients. The gold standard was built from 660 cross-sections (33 per image) of vessels and aneurysms, manually measured by interventional neuroradiologists. GAR has also been compared to an interactive segmentation method: iso-intensity surface extraction (ISE). In addition, since patients had been imaged with the two modalities, we performed an inter-modality agreement analysis with respect to both the manual measurements and each of the two segmentation methods. Results: Both GAR and ISE di®ered from the gold standard within acceptable limits compared to the imaging resolution. GAR (ISE, respectively) had an average accuracy of 0.20 (0.24) mm for 3DRA and 0.27 (0.30) mm for TOF-MRA, and had a repeatability of 0.05 (0.20) mm. Compared to ISE, GAR had a lower qualitative error in the vessel region and a lower quantitative error in the aneurysm region. The repeatabilityof GAR was superior to manual measurements and ISE. The inter-modality agreement was similar between GAR and the manual measurements. Conclusions: The improved GAR method outperformed ISE qualitatively as well as quantitatively and is suitable for segmenting 3DRA and TOF-MRA images from clinical routine.

A Genetic Validation Study Reveals a Role of Vitamin D Metabolism in the Response to Interferon-Alfa-Based Therapy of Chronic Hepatitis C.

BACKGROUND: To perform a comprehensive study on the relationship between vitamin D metabolism and the response to interferon-α-based therapy of chronic hepatitis C. METHODOLOGY/PRINCIPAL FINDINGS: Associations between a functionally relevant polymorphism in the gene encoding the vitamin D 1α-hydroxylase (CYP27B1-1260 rs10877012) and the response to treatment with pegylated interferon-α (PEG-IFN-α) and ribavirin were determined in 701 patients with chronic hepatitis C. In addition, associations between serum concentrations of 25-hydroxyvitamin D(3) (25[OH]D(3)) and treatment outcome were analysed. CYP27B1-1260 rs10877012 was found to be an independent predictor of sustained virologic response (SVR) in patients with poor-response IL28B genotypes (15% difference in SVR for rs10877012 genotype AA vs. CC, p = 0.02, OR = 1.52, 95% CI = 1.061-2.188), but not in patients with favourable IL28B genotype. Patients with chronic hepatitis C showed a high prevalence of vitamin D insufficiency (25[OH]D(3)<20 ng/mL) during all seasons, but 25(OH)D(3) serum levels were not associated with treatment outcome. CONCLUSIONS/SIGNIFICANCE: Our study suggests a role of bioactive vitamin D (1,25[OH](2)D(3), calcitriol) in the response to treatment of chronic hepatitis C. However, serum concentration of the calcitriol precursor 25(OH)D(3) is not a suitable predictor of treatment outcome.

Cartilage thickness at the posterior medial femoral condyle is increased in femorotibial knee osteoarthritis: a cross-sectional CT arthrography study (Part 2).

OBJECTIVE: To evaluate the thickness of cartilage at the posterior aspect of the medial and lateral condyle in Osteoarthritis (OA) knees compared to non-OA knees using computed tomography arthrography (CTA). DESIGN: 535 consecutive knee CTAs (mean patient age = 48.7 ± 16.0; 286 males), were retrospectively analyzed. Knees were radiographically classified into OA or non-OA knees according to a modified Kellgren/Lawrence (K/L) grading scheme. Cartilage thickness at the posterior aspect of the medial and lateral femoral condyles was measured on sagittal reformations, and compared between matched OA and non-OA knees in the whole sample population and in subgroups defined by gender and age. RESULTS: The cartilage of the posterior aspect of medial condyle was statistically significantly thicker in OA knees (2.43 mm (95% confidence interval (CI) = 2.36, 2.51)) compared to non-OA knees (2.13 mm (95%CI = 2.02, 2.17)) in the entire sample population (P < 0.001), as well as for all subgroups of patients over 40 years old (all P ≤ 0.01), except for females above 60 years old (P = 0.07). Increase in cartilage thickness at the posterior aspect of the medial condyle was associated with increasing K/L grade in the entire sample population, as well as for males and females separately (regression coefficient = 0.10-0.12, all P < 0.001). For the lateral condyle, there was no statistically significant association between cartilage thickness and OA (either presence of OA or K/L grade). CONCLUSIONS: Cartilage thickness at the non-weight-bearing posterior aspect of the medial condyle, but not of the lateral condyle, was increased in OA knees compared to non-OA knees. Furthermore, cartilage thickness at the posterior aspect of the medial condyle increased with increasing K/L grade.

Espécies de cigarrinhas (Hemiptera, Cicadellidae, Cicadellinae) em pomares de citros da região de Bebedouro, SP, com descrição de uma espécie nova de Acrogonia Stål

Sharpshooter leafhoppers (Hemiptera, Cicadellidae, Cicadellinae) in citrus groves of the area of Bebedouro, SP, with description of a new species of Acrogonia Stål. Sixteen species of Cicadellidae, subfamily Cicadellinae, were collected and identified: 11 of the tribe Cicadellini and five of the tribe Proconiini. The ten most common species, together with a new species, are characterized based on external morphology and male genitalia: Acrogonia citrina Marucci & Cavichioli sp. nov.; Bucephalogonia xanthophis (Berg, 1879); Dilobopterus costalimai Young, 1977; Ferrariana trivittata (Signoret, 1854); Hortensia similis (Walker, 1851); Macugonalia cavifrons (Stål, 1862); M. leucomelas (Walker, 1851); Oncometopia facialis (Signoret, 1854); Plesiommata corniculata Young, 1977 and P. mollicella (Fowler, 1900). The leafhopper samples were collected in citrus groves and in adjacent habitats (woods, swamp, cultivable plain, spontaneous vegetation of the grove, coffee crop and sugarcane) at the counties of Bebedouro and Monte Azul Paulista and in the district of Turvínia. The collecting methods were: insect net, yellow sticky cards, portable suction trap and Malaise trap. Identification keys were elaborated for the 16 species. There is a great diversity of Cicadellinae species in the citric groves. In the three areas sampled, it was collected a larger number of species of the tribe Cicadellini than of the tribe Proconiini. In the Bebedouro area, the vector species of Xylella fastidiosa, A. citrina sp. nov., B. xanthophis, D. costalimai and O. facialis, were collected in the citrus groves and in all adjacent habitats.

Revisão do gênero Mecocephala Dallas, 1851 (Heteroptera, Pentatomidae)

Revision of the genus Mecocephala Dallas, 1851 (Heteroptera, Pentatomidae). The genus Mecocephala Dallas, 1851 is revised, and some taxonomic and geographical distribution data are evaluated. The following species are considered to belong to this genus: M. acuminata Dallas, 1851 = M. holmbergi Pirán, 1969 syn. nov., M. curculionoides Pirán, 1959, M. bonariensis sp. nov., M. magna sp. nov., M. maldonadensis sp. nov., and M. zikani sp. nov.; their distribution is restricted to southern Neotropical Region. Other species, formerly placed in Mecocephala, are considered, respectively: M. rubripes Berg, 1894 incertae sedis, M. darwini Kirkaldy, 1909 incertae sedis, M. atra Bergroth, 1914 incertae sedis, Paramecocephala uruguayensis (Pirán, 1970) comb. nov., Paramecocephala fusca (Haglund, 1868) comb. nov. A key to the species is presented.

Reestruturação do gênero Deois Fennah; descrição de um novo gênero e de novas espécies (Homoptera, Cercopidae, Tomaspidinae)

Restructure of the genus Deois Fennah; description of a new genus and new species (Homoptera, Cercopidae, Tomaspidinae). The genus Deois Fennah is reviewed and some changes in the taxonomy are introduced. The genus and its four subgenera are redefined, having now the following composition: 1) subgenus Deois (Deois) with: D. (D.) correntina (Berg, 1879), D. (D.) grandis Sakakibara, 1979, D. (D.) knoblauchii (Berg, 1879) (formerly in D. (Pandysia)), D. (D.) morialis (China & Myers, 1934), D. (D.) mourei Cavichioli & Sakakibara, 1994, D. (D.) piraporae Sakakibara, 1979, D. (D.) pseudoflavopicta (Lallemand, 1938) comb. nov. (formerly in Mahanarva) = D. (D.) similis Sakakibara, 1979 syn. nov., D. (D.) rubropicta Sakakibara, 1979, D. (D.) spinulata sp. nov., D. (D.) terrea (Germar, 1821), D. (D.) uniformis (Distant, 1909). 2) subgenus Deois (Pandysia) with: D. (P.) bergi sp. nov., D. (P.) crenulata sp. nov., D. (P.) schach (Fabricius, 1787) = Sphenorhyna transiens Walker, 1851 syn. nov.. 3) Deois (Fennahia) with: D. (F.) coerulea (Lallemand, 1924), D. (F.) flexuosa (Walker, 1851). 4) Deois (Acanthodeois) with: D. (A.) flavopicta (Stål, 1854), Deois (A.) incompleta (Walker, 1851). The genus Orodamnis Fennah, 1953 stat. nov. (formerly Deois (Orodamnis)) with: Orodamnis rhynchosporae (China & Myers, 1934) comb. nov. The genus Deoisella gen. nov. is described for: Deoisella fasciata sp. nov. (type species) and Deoisella picklesi (China & Myers, 1934) comb. nov.

Notas sinonímicas em Lepturini sul-americanos (Coleoptera, Cerambycidae, Lepturinae)

Novas sinonímias propostas: Strangalia flavocincta (Thomson, 1860) = Ophistomis tristis Melzer, 1922 syn. nov. = O. latifasciata Melzer, 1926 syn. nov.; Strangalia succincta (Redtenbacher, 1867) = O. auriflua Redtenbacher, 1867 syn. nov.; Strangalia melanura (Redtenbacher, 1867) = Euryptera dimidiata Redtenbacher, 1867 syn. nov.; Strangalia lyrata (Redtenbacher, 1867) = Ophistomis discophora Redtenbacher, 1867 syn. nov.; Strangalia fulvicornis (Bates, 1872) = Ophistomis variabilis Melzer, 1926 syn. nov. = O. flavovittata Melzer, 1926 syn. nov.; Strangalia melanophthisis (Berg, 1889) reval. = Euryptera melanura var. nigripennis Melzer, 1930 syn. nov.; Anastrangalia sanguinolenta (Linnaeus, 1761) (espécie introduzida na Argentina) = Leptura bonaeriensis Burmeister, 1865 syn. nov.

Femoroacetabular impingement: normal values of the quantitative morphometric parameters in asymptomatic hips.

OBJECTIVE: To determine the means and the reference intervals of the quantitative morphometric parameters of femoroacetabular impingement (FAI) in normal hips with high-resolution computed tomography (CT). METHODS: We prospectively included 94 adult individuals who underwent CT for thoracic, abdominal or urologic pathologies. Patients with a clinical history of hip pathology and/or with osteoarthritis on CT were excluded. We calculated means and 95 % reference intervals for imaging signs of cam-type (alpha angle at 90° and 45° and femoral head-neck offset) and pincer-type impingement (acetabular version angle, lateral centre-edge angle and acetabular index). RESULTS: The 95 % reference interval limits were all far beyond the abnormal thresholds found in the literature for cam-type and to a lesser extent for pincer-type FAI. The upper limits of the reference intervals for the alpha angles (at 90°/45°) were 68°/83° (men) and 69°/84° (women), compared to thresholds from the literature (50°, 55° or 60°). Reference intervals were similar between genders for cam-type parameters, and slightly differed for pincer-type. CONCLUSION: The 95 % reference intervals of morphometric measurements of FAI in asymptomatic hips were beyond the abnormal thresholds, which was especially true for cam-type FAI. Our results suggest the need for redefining the current morphometric parameters used in the diagnosis of FAI. KEY POINTS: ? 95 % reference intervals limits of FAI morphotype were beyond currently defined thresholds. ? Reference intervals of pincer-type morphotype measurements were close to current definitions. ? Reference intervals of cam-type morphotype measurements were far beyond the current definitions. ? Current morphometric definitions of cam-type morphotype should be used with care.

Revisão taxonômica de Kanaima Distant (Hemiptera, Cercopidae, Ischnorhininae)

Kanaima Distant, 1909 é revisado, sendo suas espécies descritas e redefinidas. Este trabalho ressalta os caracteres taxonomicamente importantes das espécies de Kanaima, como os da morfologia externa e da genitália. Quatro espécies são reconhecidas como válidas: K. katzensteinii (Berg, 1879), K. fluvialis (Lallemand, 1924), K. fusca (Lallemand, 1927) comb. nov., e K. nigra sp. nov. (Brasil, RS). Os nomes Monecphora fluvialis var. lateralis Lallemand, 1924 e Monecphora fluvialis var. bipunctata Lallemand, 1924 são sinonimizados sob Kanaima fluvialis. Quatro espécies incluídas em Kanaima são transferidas para Mahanarva: M. (Ipiranga) vittata (Walker, 1851) comb. nov., M. (Ipiranga) fortunata (Lallemand, 1924) comb. nov., M. (Mahanarva) radiata (Walker, 1851) comb. nov. e M. (Mahanarva) dubia (Stancik & Cavichioli, 2003) comb. nov. Pachypterinella Lallemand, 1927 sin. nov.

Mechanisms of Symptomatic Spinal Cord Ischemia After TEVAR: Insights From the European Registry of Endovascular Aortic Repair Complications (EuREC).

Abstract Purpose: To test the hypothesis that simultaneous closure of at least 2 independent vascular territories supplying the spinal cord and/or prolonged hypotension may be associated with symptomatic spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR). Methods: A pattern matching algorithm was used to develop a risk model for symptomatic SCI using a prospective 63-patient single-center cohort to test the positive predictive value (PPV) of prolonged intraoperative hypotension and/or simultaneous closure of at least 2 of 4 the vascular territories supplying the spinal cord (left subclavian, intercostal, lumbar, and hypogastric arteries). This risk model was then applied to data extracted from the multicenter European Registry on Endovascular Aortic Repair Complications (EuREC). Between 2002 and 2010, the 19 centers participating in EuREC reported 38 (1.7%) cases of symptomatic spinal cord ischemia among the 2235 patients in the database. Results: In the single-center cohort, direct correlations were seen between the occurrence of symptomatic SCI and both prolonged intraoperative hypotension (PPV 1.00, 95% CI 0.22 to 1.00, p = 0.04) and simultaneous closure of at least 2 independent spinal cord vascular territories (PPV 0.67, 95% CI 0.24 to 0.91, p = 0.005). Previous closure of a single vascular territory was not associated with an increased risk of symptomatic spinal cord ischemia (PPV 0.07, 95% CI 0.01 to 0.16, p = 0.56). The combination of prolonged hypotension and simultaneous closure of at least 2 territories exhibited the strongest association (PPV 0.75, 95% CI 0.38 to 0.75, p<0.0001). Applying the model to the entire EuREC cohort found an almost perfect agreement between the predicted and observed risk factors (kappa 0.77, 95% CI 0.65 to 0.90). Conclusion: Extensive coverage of intercostal arteries alone by a thoracic stent-graft is not associated with symptomatic SCI; however, simultaneous closure of at least 2 vascular territories supplying the spinal cord is highly relevant, especially in combination with prolonged intraoperative hypotension. As such, these results further emphasize the need to preserve the left subclavian artery during TEVAR.