Studio delle applicazioni metodologiche di analisi d'immagini in tc perfusionali

La Tomografia Computerizzata perfusionale (TCp) è una tecnica che permette di effettuare studi funzionali di natura emodinamica dei tessuti ispezionati, misurandone la perfusione attraverso l’analisi temporale della diffusione del mezzo di contrasto. Ricerche recenti indicano come alcuni parametri (ad esempio, il blood flow) della perfusione ematica dell’organo interessato rappresentino un valido strumento per la valutazione dell’efficacia delle terapie anti-angiogenetiche. Valutazione che, potendo avvenire già in fase precoce, senza attendere i più tardivi cambiamenti dimensionali, consente un eventuale adeguamento, altrettanto precoce, della terapia in caso di risultati parziali o di insuccesso. Tuttavia diversi problemi, tra cui la difficoltà ad ottenere misure riproducibili, dovuta alla estrema variabilità delle cause di errore, costituiscono un ostacolo alla standardizzazione e, conseguentemente, alla trasposizione in clinica della TCp. Il lavoro di tesi ha avuto come obiettivo quello di identificare le principali sorgenti di errore in tutto il processo di preparazione dell’esame, generazione e archiviazione dei dati TCp al fine di fornire a IRST-IRCCS un protocollo perfusionale che consente di tenere sotto controllo, innanzitutto, tutti i parametri relativi alla somministrazione del mezzo di contrasto e alla fase di acquisizione delle immagini. Successivamente, è stato creato un catalogo di esami perfusionali, facilmente consultabile sia dal personale medico sia da quello ingegneristico. Infine, è stato fornito il supporto, sia ai medici sia agli ingegneri, per la messa a punto di un metodo di validazione visiva dei risultati ottenuti. Contestualmente, uno dei principali risultati del lavoro di Tesi è stato quello di creare, all’interno di IRST-IRCCS, una figura che funga da “collettore” fra i radiologi e gli ingegneri dell’Università di Bologna. Proprio in questo modo è stato possibile standardizzare le procedure di esecuzione degli esami perfusionali e implementare, attraverso l’interfacciamento tra il personale medico ed i ricercatori dell’Università, i protocolli per la gestione ed il trattamento dei dati acquisiti.

Analysis of morphological and functional heterogeneity in ct perfusion images of lung tumours

Questa tesi si propone di innovare lo stato dell’arte dei metodi di analisi dell’eterogeneità in lesioni polmonari attualmente utilizzati, affiancando l’analisi funzionale (emodinamica) a quella morfologica, grazie allo sviluppo di nuove feature specifiche. Grazie alla collaborazione tra il Computer Vision Group (CVG) dell’Università di Bologna e l’Unità Operativa di Radiologia dell’IRCCS-IRST di Meldola (Istituto di Ricovero e Cura a Carattere Scientifico – Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori), è stato possibile analizzare un adeguato numero di casi reali di pazienti affetti da lesioni polmonari primitive, effettuando un’analisi dell’eterogeneità sia su sequenze di immagini TC baseline sia contrast-enhanced, consentendo quindi un confronto tra eterogeneità morfologica e funzionale. I risultati ottenuti sono infine discussi sulla base del confronto con le considerazioni di natura clinica effettuate in cieco da due esperti radiologi dell’IRCCS-IRST.

Un sistema informatico per la gestione di patologie oncologiche croniche

L'assistenza sanitaria in Italia e nel mondo è caratterizzata da bisogni elevati in continua crescita, ad essi si contrappone l'attuale crisi delle risorse economiche determinando per il Sistema una valutazione di scelte quali la riduzione o la rimodulazione dell'offerta sanitaria pubblica. L'idea di questo lavoro, nata all'interno dell'Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, è di approcciare questo problema in ottica di miglioramento delle performance anziché riduzione dei servizi, nella convinzione che vi siano importanti margini di perfezionamento. Per questi motivi si è valutata la necessità di sviluppare un metodo e un'applicazione software per l'identificazione dei percorsi diagnostici terapeutici assistenziali (PDTA), per la raccolta di dati dalle strutture coinvolte, per l'analisi dei costi e dei risultati, mirando ad una analisi di tipo costi - efficacia e di benchmarking in ottica di presa in carico dei bisogni di salute. La tesi descrive la fase di raccolta e analisi dei requisiti comprensiva della profilazione utenti e descrizione di alcuni aspetti dinamici salienti, la fase di progettazione concettuale (schema Entity/Relationship, glossario e volumi dei dati), la fase di progettazione logica e la prototipazione dell'interfaccia utente. Riporta inoltre una valutazione dei tempi di sviluppo realizzata tramite metodologia di calcolo dei punti per caso d'uso. L'applicazione progettata è oggetto di valutazione di fattibilità presso l'IRST, che ha utilizzato alcune delle metodologie descritte nella tesi per descrivere il percorso di patologia mammaria e presentarne i primi risultati all'interno di un progetto di ricerca in collaborazione con l'Agenzia Nazionale per i Servizi Sanitari Regionali (Agenas).

Analog mitigation of out of band strong interferers in wide band acquisition for multiband HF transmissions

It is clear that in the near future much broader transmissions in the HF band will replace part of the current narrow band links. Our personal view is that a real wide band signal is infeasible in this environment because the usage is typically very intensive and may suffer interferences from all over the world. Therefore, we envision that dynamic multiband transmissions may provide better satisfactory performance. From the very beginning, we observed that real links with our broadband transceiver suffered interferences out of our multiband but within the acquisition bandwidth that degrade the expected performance. Therefore, we concluded that a mitigation structure is required that operates on severely saturated signals as the interference may be of much higher power. In this paper we address a procedure based on Higher Order Crossings (HOC) statistics that are able to extract most of the signal structure in the case where the amplitude is severely distorted and allows the estimation of the interference carrier frequency to command a variable notch filter that mitigates its effect in the analog domain.

Spatial domain mitigation of out of band strong interferers in HF wide band acquisition using analog beamforming principles

We envision that dynamic multiband transmissions taking advantage of the receiver diversity (even for collocated antennas with different polarization or radiation pattern) will create a new paradigm for these links guaranteeing high quality and reliability. However, there are many challenges to face regarding the use of broadband reception where several out of band (with respect to multiband transmission) strong interferers, but still within the acquisition band, may limit dramatically the expected performance. In this paper we address this problem introducing a specific capability of the communication system that is able to mitigate these interferences using analog beamforming principles. Indeed, Higher Order Crossing (HOCs) joint statistics of the Single Input ? Multiple Output (SIMO) system are shown to effectively determine the angle on arrival of the wavefront even operating over highly distorted signals.

Experimental results on multicarrier SIMO HF communications

Achieving reliable communication over HF channels is known to be challenging due to the particularly hostile propagation medium. To address this problem, diversity techniques were shown to be promising. In this paper, we demonstrate through experimental results the benefits of different diversity strategies when applied to multi-input-multi-output (MIMO) multicarrier systems. The performance gains of polarisation, space and frequency diversities are quantified using different measurement campaigns.

Efficiency improvement of HF communications using cognitive radio principles

Cognitive Radio principles can be applied to HF communications to make a more efficient use of the extremely scarce spectrum. In this contribution we focus on analyzing the usage of the available channels done by the legacy users, which are regarded as primary users since they are allowed to transmit without resorting any smart procedure, and consider the possibilities for our stations -over the HFDVL (HF Data+Voice Link) architecture- to participate as secondary users. Our goal is to enhance an efficient use of the HF band by detecting the presence of uncoordinated primary users and avoiding collisions with them while transmitting in different HF channels using our broad-band HF transceiver. A model of the primary user activity dynamics in the HF band is developed in this work. It is based on Hidden Markov Models (HMM) which are a powerful tool for modelling stochastic random processes, and is trained with real measurements from the 14 MHz band.

Optimization of Arq Parameters of Stanag 5066 for the HFDVL Modem

The reliability of bidirectional communication link can be guaranteed with Automatic Repeat Request Procedures (ARQ). The standard STANAG 5066 describes the ARQ procedure for HF communications that can either be applied to existing HF physical layers modems or adapted to future physical layer designs. In this contribution the physical layer parameters of an HF modem (HFDVL), developed by the authors over the last decade, are chosen to optimize the performance of the ARQ procedure described in STANAG 5066. Besides the interleaving length, constellation size and coding type, the OFDM-based HFDVL modem permits the selection of the number of receiver antennas. It will be shown that this parameter gives additional degrees of freedom and permits reliable communication over low SNR HF communication links.

Selection of CSI-based precoding techniques in the HF channel

Multi-carrier modulations are widely employed in ionospheric communications to mitigate the adverse effects of the HF channel. In this paper we show how performance achieved by these modulations can be further increased by means of CSIbased precoding techniques in the context of our research on interactive digital voice communications. Depending on communication constraints and channel parameters, we will show which of the studied modulations and precoding techniques to select so that to maximise performance.

Profesionales de la educación en la Hispania romana

La epigrafía latina nos ha legado el recuerdo de doce docentes y un grupo de maestros de escuela en Hispania. Los diferentes textos, la mayoría de carácter funerario y procedente del ámbito urbano, nos aportan información acerca de las funciones que estos profesionales desempeñaron en la sociedad hispana, así como del contexto socio-jurídico del que provenían. En este sentido, la pieza más valiosa es la inscripción dedicada a un gramático llamado L. Memmius Probus en la antigua Tritium Magallum, gracias a la cual conocemos las circunstancias concretas en las que trabajó este educador.

Surgical site infection in colorectal surgery

Surgical Site Infection is one of the most common infection associated with health care, but can also be the most preventable situation. Surgical site infection in patients undergoing colorectal surgery varies according to the literature, from 3.5 to 21.3%, being identiied as the highest rate of infection among elective procedures and emergency. Objectives: To identify and characterize the occurrence of surgical site infection in patients undergoing colorectal surgery at a hospital in northern Portugal. Methods: A prospective study in a hospital in the north of Portugal in 2015, patients admitted to the surgical service who underwent colorectal surgery. Patients were selected more than 24 hours of admission, obtaining a sample of 102 participants. The characterization of the patient and the surgery was done using a search in the irst 24 hours after surgery and the registration of the infection at the time of occurrence and 30 days after the intervention. Results: 102 participants, 67 (65.7%) were male with a mean age of 71.92 years (37-93 years) and 40.2% underwent emergency surgery. There was a prevalence of surgical site infection in 21 patients (20.6%). Among these 15 were male (71.4%) with mean age of 72.24 years. They were hospitalized on average 22 days, with an average of 19 days of hospitalization after surgery. Escherichia-coli was the microorganism most frequently isolated in culture studies with 13 (60.0%) cases of surgical site infection and organ/space was the main site identiied with infection - 38.1%. Conclusions: The prevalence of surgical site infection was 5.1% and Escherichia coli most common etiologic agent. It is suggested that other studies can analyze the associated factors with this type of infection.

Tutankamón

O presente trabalho pretende apresentar e descrever a metodologia processual e respectivas relexões que sustentam a criação de um artefato digital interativo construído de forma a que alguns dos elementos bidimensionais que o constituem sejam manipuladas de forma a que criem ao jogador a ilusão de tridimensionalidade. Em 1992 a Id Software com o jogo Wolfenstein 3D, introduziu uma referência visual à tridimensionalidade, utilizando para o efeito tecnologia 2D, a qual, através de um sistema de redimensionamento e posicionamento de imagens, consegui transmitir a noção de tridimensionalidade, utilizando na altura um tipo de jogo em primeira pessoa, ou seja, o jogador experiência uma campo visual que visa reproduzir a própria experiência do mundo táctil na relação que dispõe entre os espaços e objetos. Através do Processing, uma linguagem de programação que assenta no Java, estes objetivos conceptuais serão reproduzidos, que procuram, por um lado, transmitir esta aparente ilusão de tridimensionalidade e por outro não utilizar um tipo de artefacto digital que proporciona uma jogabilidade em primeira pessoa mas sim possibilitam ao jogador uma experiência visual que aborda todo o espaço em que é lhe permitido circular, no qual é lhe exposto as adversidades que precisa de superar para progredir. Para que isto seja possível o jogador assume o papel de um personagem e através da sua interação com o artefato, vai ediicando uma narrativa visual que visa o seu envolvimento com a temática representada. Como tema é utilizada uma representação da busca pelo Sarcófago do faraó da 18ª Dinastia Tutankamón (1332 - 1323 AC) pelo explorador britânico Howard Carter (1874 - 1939) cuja expedição no Vales do Reis em 1922 constitui ainda hoje a mais célebre descoberta arqueológica relacionada com Antigo Egipto. Ao longo desta Dissertação são abordados temas que visam resoluções tanto no campo técnico e tecnológico, através da programação e sua linguagem, como no campo visual e estético que visa uma conexão consciente com a temática a representar e a ser experienciada

Prevalence of colonizing bacteria and their association with primary bacteremias in hemodialysis of a university hospital

to be from 2.5 to 5.5 cases per 1,000 catheter-day. the clinical impact is relevant and increases the cost of the HD Unit. Methods: The present study is the irst of 2 phases. It was conducted from January to December of 2012, and included all patients and nurses who were in the HD Unit. The prevalence of Gramnegative bacilli (GNB) and methicillin-resistant Staphylococcus aureus (MrSA) colonizing the nasal passages and the skin is described. Also, phenotypic association was sought by genus, species and sensitivities between colonizing bacterial strains and blood cultures with GNB and MRSA. Results: the study included 70 patients and 10 nurses. the prevalence of nasal colonization in patients by GNB was 9% and 6% in the pericatheter, and no nursing GNB colonization was discovered. The prevalence of MRSA nasal colonization was 19% and 6% in the pericatheter for patients and in the nurses the nasal colonization was 50% and 10% in the hands. We identiied 29 cases of primary bacteremia. The primary bacteremia rate is 1.5 per 1,000 catheter-day or 0.4 episodes per patient per year. Conclusion: We demonstrated a high prevalence of MrSA colonization in patients and nurses in the HD Unit. No relationship was found between primary bacteremia by GNB and patients and nurses’ bacteria colonization by the phenotypic comparison.

External ophthalmomyiasis by Oestrus ovis treated with tobacco: clinical case report and medical literature review

External ophthalmomyiasis is an infestation of conjunctiva with larvae or maggots of certain lies. Oestrus ovis is the most common cause of human ophthalmomyiasis. The case of a 16-yearold female is described, who presented with foreign body sensation, pain, and redness in the left eye. Slit-lamp biomicroscopy revealed 32 tiny larvae crawling around the conjunctival sac. The larvae were mechanically removed under topical anesthesia, and identiied under a light microscope as irst-stage larvae of O. ovis causing external ophthalmomyiasis. She was successfully treated with topical tobacco juice. Follow-up examination of these cases is recommended to avoid possible complications.

Ebola virus disease 2014

Ebola virus disease was irst described in 1976 originating from the Ebola River in the Democratic Republic of Congo. Since then, Ebola virus has become an important public health threat in Africa, and now it is of great concern worldwide due to the recent outbreaks (9216 cases with 4555 deaths up to October 20th, 2014), and it is so far the largest and deadliest recorded in history. Five Ebola virus species have been identiied (including Zaire, Sudan, Ivory Coast, Reston, and Bundibugyo Ebola virus), and four of them have proved to be highly pathogenic for both human and non-human primates, causing viral hemorrhagic fever with case fatality rates of up to 90%, for which no approved therapeutics or vaccines are currently available. Ebola virus infections are characterized by immune suppression and a systemic inlammatory response that causes impairment of the vascular, coagulation, and immune systems, leading to multiorgan failure and shock, and thus, in some ways, resembling septic shock. The major affected countries, Sierra Leone, Guinea, Liberia, and Nigeria, have been struggling to contain and to mitigate the outbreak. Gene sequencing of the 2014 virus (2014WA) outbreak has demonstrated 98% homology with the Zaire Ebola virus, with a 49% case fatality ratio across the affected countries. In this review the characteristics of the viruses, pathogenesis, diagnosis, treatment, and the cases reported in health care workers (HCW) are described, as well as a summary of outbreaks of the virus since its discovery, including these last two outbreaks in Africa.