Automatic prostate segmentation in cone-beam computed tomography images using rigid registration.

We propose to evaluate automatic three-dimensional gray-value rigid registration (RR) methods for prostate localization on cone-beam computed tomography (CBCT) scans. In total, 103 CBCT scans of 9 prostate patients have been analyzed. Each one was registered to the planning CT scan using different methods: (a) global RR, (b) pelvis bone structure RR, (c) bone RR refined by local soft-tissue RR using the CT clinical target volume (CTV) expanded with a 1, 3, 5, 8, 10, 12, 15 or 20-mm margin. To evaluate results, a radiation oncologist was asked to manually delineate the CTV on the CBCT scans. The Dice coefficients between each automatic CBCT segmentation - derived from the transformation of the manual CT segmentation - and the manual CBCT segmentation were calculated. Global or bone CT/CBCT RR has been shown to yield insufficient results in average. Local RR with an 8-mm margin around the CTV after bone RR was found to be the best candidate for systematically significantly improving prostate localization.

Pasteurella multocida zoonotic ascending infection: an unusual cause of tubo-ovarian abscess.

We report a tubo-ovarian abscess due to Pasteurella multocida. This zoonotic infection was likely of ascending origin, as Pasteurella was also isolated from vaginal swabs.

A realistic Computed Tomography simulator for small motion analysis of cerebral aneurysms.

This paper describes a realistic simulator for the Computed Tomography (CT) scan process for motion analysis. In fact, we are currently developing a new framework to find small motion from the CT scan. In order to prove the fidelity of this framework, or potentially any other algorithm, we present in this paper a simulator to simulate the whole CT acquisition process with a priori known parameters. In other words, it is a digital phantom for the motion analysis that can be used to compare the results of any related algorithm with the ground-truth realistic analytical model. Such a simulator can be used by the community to test different algorithms in the biomedical imaging domain. The most important features of this simulator are its different considerations to simulate the best the real acquisition process and its generality.

Needs, expectations, and concerns of medical students regarding end-of-life issues before the introduction of a mandatory undergraduate palliative care curriculum.

BACKGROUND: In the past, implementation of effective palliative care curricula has emerged as a priority in medical education. In order to gain insight into medical students' needs and expectations, we conducted a survey before mandatory palliative care education was introduced in our faculty. METHODS: Seven hundred nine students answered a questionnaire mainly consisting of numeric rating scales (0-10). RESULTS: Participants attributed a high importance to palliative care for their future professional life (mean, 7.51 ± 2.2). For most students, symptom control was crucial (7.72 ± 2.2). However, even higher importance was assigned to ethical and legal issues (8.16 ± 1.9). "Self-reflection regarding their own role as a physician caring for the terminally ill along with psychological support" was also regarded as highly important (7.25 ± 2.4). Most students were moderately concerned at the prospect of being confronted with suffering and death (5.13 ± 2.4). This emotional distress was rated significantly higher by female students (5.4 ± 2.4 versus 4.6 ± 2.4; p < 0.001). Seventeen percent of all students rated their distress as being 7 of 10 or higher, which indicates a considerable psychological strain in terms of dealing with end-of-life issues in the future. Professional or personal experience with terminally ill persons lowered these anxieties significantly (4.99 ± 2.34 versus 5.47 ± 2.5, p < 0.05). CONCLUSIONS: Medical students stated a remarkably high interest in learning palliative care competencies. Responding to their specific concerns and needs-especially with regard to the acquisition of emotional coping skills-may be key for the development of successful palliative care curricula.

Nonmolecular methods for the diagnosis of respiratory fungal infections.

Diagnosis of invasive fungal pneumonias by conventional culture methods is difficult to assess and often delayed. Nonmolecular fungal markers have emerged as an important adjunctive tool to support their diagnosis in combination with other clinical, radiologic, and microbiological criteria of invasive fungal diseases. Concerns about the sensitivity and specificity of some tests in different patient populations should lead to warnings about their widespread use. None can identify the emerging and particularly deadly fungal pathogens responsible for mucormycosis. The role of nonmolecular fungal markers should be better defined in combination with other microbiological and radiologic tools in preemptive antifungal strategies.

Climate change and plant distribution: local models predict high-elevation persistence

Mountain ecosystems will likely be affected by global warming during the 21st century, with substantial biodiversity loss predicted by species distribution models (SDMs). Depending on the geographic extent, elevation range and spatial resolution of data used in making these models, different rates of habitat loss have been predicted, with associated risk of species extinction. Few coordinated across-scale comparisons have been made using data of different resolution and geographic extent. Here, we assess whether climate-change induced habitat losses predicted at the European scale (10x10' grid cells) are also predicted from local scale data and modeling (25x25m grid cells) in two regions of the Swiss Alps. We show that local-scale models predict persistence of suitable habitats in up to 100% of species that were predicted by a European-scale model to lose all their suitable habitats in the area. Proportion of habitat loss depends on climate change scenario and study area. We find good agreement between the mismatch in predictions between scales and the fine-grain elevation range within 10x10' cells. The greatest prediction discrepancy for alpine species occurs in the area with the largest nival zone. Our results suggest elevation range as the main driver for the observed prediction discrepancies. Local scale projections may better reflect the possibility for species to track their climatic requirement toward higher elevations.

« Testaments de roys, princes et grands seigneurs, et homes doctes; testaments fictifs ». 1306 à 1669. Copies.

Contient : 1 « Testament de GUILLAUME LE HONGRE, chevalier de la ville de Metz... Ceste devise fust faitte devant feste S. Luc euvangeliste, quant il out a millair M.CCC.LIX ans » ; 2 « Testamentum GALESII DE BALMA, domini VALAFINI,... Actum et datum apud Montem Revellum, in castro nostro dicti loci, duodecima mensis augusti, hora meridiei, anno Domini millesimo trecentesimo sexagesimo secundo ». En latin ; 3 « Codicillus GALESII DE BALMA, domini VALAFINI ». Même date. En latin ; 4 « Testament de JEAN DE SAULZ, escuyer, seigneur DE COURTIVRON, chancelier de Bourgongne... Le mardy vint cinquiesme jour du mois de janvier, l'an de grace courant mille trois cent soixante et dix neuf » ; 5 « Testament de CATHERINE D'ESTRABONE, dame D'AUMONT ». Après 1456 ; 6 « Testament de Jean d'Arsonvalle, evesque de Chaalon. Tiré des registres du parlement de Paris ». 23 et 24 août 1416. En latin ; 7 « Testament de messire JEHAN DE CHALLON, prince D'ORENGE et seigneur D'ARLAY,... Faict et donné en mon chastel de Lyons le Saulnyer... le 21 d'octobre 1417... Extraict des registres de l'officialité de l'arcevesché de Bezançon » ; 8 Testament de « CLAUDE DE MONTAGU, chevalier, Sr DE COULCHES, DE LONGVY et D'ESPOISSE,... Le cinquiesme jour de... l'an mil IIII.C. cinquante et trois » ; 9 Extrait du testament de Pierre Berland, archevêque de Bordeaux. Samedi 5 février 1457. En latin ; 10 « Testamentum illustris comitis Troyae, Joannis Cossa, domini de Grimaldo et de Marignana, magni Provinciae senescalli ». Dimanche 15 septembre 1476. En latin ; 11 « Testament d'Olivier, seigneur de La Marche, conseiller et premier maistre d'hostel de Mr l'archiduc d'Austriche ». Bruxelles, 8 octobre 1501 ; 12 « Testament de PHILIPPE DE MONTAGU, comtesse DE JOIGNY » ; 13 « Testament de... Loys, Sr de Graville, admiral de France... Au chasteau de Marcoussys, l'an 1516, le jeudi 26 juing » ; 14 « Testamentum Claudii de Seyssel, archiepiscopi Taurinensis ». Turin, dimanche 27 mai 1520. En latin ; 15 Testament de « GUILLAUME BUDE, conseiller du roy, maistre des requestes ordinaire de son hostel, et maistre de sa librairie... 23 juin 1536 » ; 16 Testament de « Guillaume Du Bellay, seigneur de Langey et Glatigny,... lieutenant general en Italye... Turin, le 13 novembre 1542 » ; 17 « Testament de Michel Nostradamus,... docteur en medecine et astrophile de la ville de Salon... 17 juin 1566 » ; 18 « Testament de Caesar de Nostredame, gentilhomme ordinaire de la chambre du roy... Salon, 23 janvier 1630 » ; 19 Testament d'« ODINET GODRAN, baron D'ANTILLY, president au parlement de Bourgoigne ». 3 février 1581 ; 20 « Testament de JACQUELINE DE ROHAN, marquise DE ROTHELIN ». Décédée en 1586 ; 21 Testament de FRANÇOIS, duc D'ALENÇON, fils de Henri II, roi de France. Château-Thierry, 8 juin 1584 ; 22 Testament de « JEANNOT PATOILLET, protonotaire du S. Siege... demeurant à S. Ligier ». 22 juillet 1585 ; 23 Lettres de légitimation accordées par HENRI III, roi de France, à « Lune Patouillet, fille naturelle de Jeannot Patouillet et Jeanne Sailliot, du village d'Estrevaut, bailliage de Dijon... Donné à Dijon, au mois de febvrier, l'an 1575 » ; 24 à 26 Épitaphes d'«Odet Patoillet, d'Estrevaux », Richard Patoillet, et Jeannot Patoillet, le protonotaire. 1543, 1546, 1585. La première est en français, les deux autres sont en latin ; 27 Testament de « JAQUES DE GERMIGNY, Sr DE GERMOLLES, chevalier de l'ordre du roy, conseiller et maistre d'hostel ordinaire de sa maison, et cy devant ambassadeur pour S. M. en Levant », et de « JEHANNE BORLETTE, femme dud. Sr de Germigny,... Novembre 1585, en [la] ville de Chalon » ; 28 « Advis de conseil au proces de Mrs [Henri] de Vienne », baron de Chevreau, et François de Vienne, chevalier de Malte, « contre [Claude de La Baume], archevesque de Besançon ». Avant 1582. Commence par un extrait du testament de « dame JEHANNE DE MONBELIARD, [femme de] Loys de Chalon, prince d'Oranges et Sr d'Arlay » ; 29 Testament de « François, filz de feu Henry de Vienne, baron de Chevreaul,... Mostier, 25 octobre 1596 » ; 30 « Testamentum ROBERTI, cardinalis BELLARMINI,... Die 23 januarii, anno 1611 ». En latin ; 31 « Testament de FRANÇOIS PITHOU,... 20 novembre 1617 » ; 32 « Testament de PHILIPPE-GUILLAUME, prince D'ORANGE,... Faict à Bruxelles, le 20 de febvrier 1618 » ; 33 « Testament de messire GUILLAUME DU VAIR, evesque de Lizieux et garde des sceaux de France ». Du 10 juin au 5 juillet 1620 ; 34 « Testament de messire ANTHOINE FAVRE, baron de Peroges, de Domessin,... premier president au senat de Savoye... Faict à Chambery... ce 15 febvrier 1624 » ; 35 « Testamento di Leonor de Semeur, sigr de Tremon,... governatore per il re christianissimo di Francia della citta et paese di Macon di Bergongna... Nel... monasterio di molto reverendi padri capucini... sito sopra le fini d'Asti ». 14 juillet 1625. En italien ; 36 « Testament de Gabriel de Ste Marie, archevesque de Reims... Reims, 27 septembre 1628 » ; 37 « Exemplar testamenti cardinalis LUDOVISII ». Bologne, 10 avril 1629. En latin ; 38 « Testament de Nicolas Claude Fabri, seigneur de Peiresc, seigneur et abbé de Guistres, baron de Rians, conseiller du roy en sa cour de parlement de Provence... Aix, 22 juin 1637 » ; 39 Pièce imprimée, de 16 pages, contenant le « Testament de Mr le cardinal DE RICHELIEU ». Narbonne, 23 mai 1642 ; 40 « Testament d'ANNE DE MONTAFIE, comtesse DE SOISSONS,... Faict en mon chasteau de Creil, le 30 octobre 1642 » ; 41 « Premier testament de Gabriel de Syon,... prestre, docteur on theologie... et professeur royal... es langues orientales... Ligny le Chastel, 8 juin 1648 » ; 42 « Second Testament » du même. « Fontaine en Duesmois, 29 juin 1648 » ; 43 « Testament de CLAUDE DE SAUMAISE, chevalier de l'ordre du roy et conseiller en ses conseils d'Estat et privé... Spa, le 30 aoust 1653 » ; 44 Testament de « JEAN QUENAULT, conseiller du roy en ses conseils, et cy devant secretaire des commandemens de la feue reine Marie de Medicis,... Paris, 4 febvrier 1655 » ; 45 « Testament et codicille de Pierre Gassendi, prestre, prevost de Digne et professeur royal aux mathematiques à Paris ». 17 et 18 septembre 1655 ; 46 « Testament de Jules, cardinal Mazarin, duc de Nivernois et Donziois, pair de France ». Vincennes, 3 à 7 mars 1661 ; 47 « Testament d'Anne d'Autriche, royne de France et de Navarre... S. Germain en Laye, 13 aoust 1665 » ; 48 Pièce imprimée, de 6 pages, contenant le testament de « LOUIS DE LA RIVIERE, evesque de Langres... Petit Bourg, 22 may 1669 » ; 49 « Testamentum THEOPHILI VIAUT,... Datum in aula burgundica ». 1626. En latin ; 50 « Ejusdem epitaphium ». En latin ; 51 « Testamentum christianum cardinalis RICHELII ». En latin ; 52 « Testamentum politicum ». En latin ; 53 « Testamento della citta di Candia. Copia tratta da Pasquino, notaro publico ». En italien ; 54 « Testamento del Ruyseñor de Sa Eminencia ». En espagnol ; 55 « Epitaphio del Ruyseñor ». En espagnol

The T309G Murine Double Minute 2 Gene Polymorphism Is an Independent Prognostic Factor for Patients with Renal Cell Carcinoma.

The purpose of this study was to evaluate the association of the T309G MDM2 gene polymorphism with renal cell carcinoma (RCC) risk, pathology, and cancer-specific survival (CSS). T309G MDM2 was genotyped in 449 Caucasians, including 240 with RCC and 209 cancer-free controls. The T309G MDM2 genotype was TT in 174 (38.8%), GT in 214 (47.7%), and GG in 61 (13.6%) subjects, without any significant differences between cases and controls on both univariable (p=0.58) and multivariable logistic regression (each p>0.25). Furthermore, T309G MDM2 was not linked with T stage (p=0.75), N stage (p=0.37), M stage (p=0.94), grade (p=0.21), and subtype (p=0.55). There was, however, a statistically significant association of T309G MDM2 with CSS (p=0.022): patients with TT had significantly worse survival than GG/GT (p=0.009), while those with GT and GG had similar outcomes (p=0.92). The 5-year survival rate for patients with TT, GT, and GG was 69.5%, 84.5%, and 89.7%, respectively. On the multivariable analysis, T309G was identified as an independent prognostic factor. The T309G MDM2 polymorphism is an independent prognostic factor for patients with RCC, with the TT genotype being associated with worse prognosis. In this study, there were no significant associations with RCC risk and pathology.

Specialized home palliative care for adults and children: differences and similarities.

OBJECTIVE: To compare the provision of specialized home palliative care (SHPC) by the adult and pediatric SHPC teams at the Munich University Hospital. METHODS: All patients treated by one of the SHPC teams and their primary caregivers were eligible for the prospective nonrandomized survey. We analyzed the demographics, the underlying diseases, duration and impact of SHPC on symptom control and quality of life (QOL) as well as the caregivers' burden and QOL. RESULTS: Between April 2011 and June 2012, 100 adult and 43 pediatric patients were treated consecutively; 60 adults (median age, 67.5 years; 55% male) and 40 children (median age, 6 years, 57% male) were included in the study. Oncologic diseases were dominant only in the adult cohort (87 versus 25%, p<0.001). The median period of care was higher in the pediatric sample (11.8 versus 4.3 weeks; NS). Ninety-five percent of adult and 45% of pediatric patients died by the end of the study (p<0.001), 75% and 90% of them at home, respectively. The numbers of significant others directly affected by the patient's disease was higher in children (mean 3.4 versus 1.2; p<0.001). The QOL of adult patients and children (p<0.05 for both), as well as of their primary caregivers (p<0.001 for both) improved during SHPC, while the caregivers' burden was lowered (p<0.001 for both). CONCLUSIONS: Our results show important differences in several clinically relevant parameters between adults and children receiving SHPC. This should assist in the development of age-group specific SHPC concepts that effectively address the specific needs of each patient population.

Protective effect of intravitreal injection of vasoactive intestinal peptide-loaded liposomes on experimental autoimmune uveoretinitis.

PURPOSE: The aim of this study was to investigate the effect of a single intravitreal (i.v.t.) injection of vasoactive intestinal peptide (VIP) loaded in rhodamine-conjugated liposomes (VIP-Rh-Lip) on experimental autoimmune uveoretinitis (EAU). METHODS: An i.v.t. injection of VIP-Rh-Lip, saline, VIP, or empty-(E)-Rh-Lip was performed simultaneously, either 6 or 12 days after footpad immunization with retinal S-antigen in Lewis rats. Clinical and histologic scores were determined. Immunohistochemistry and cytokine quantification by multiplex enzyme-linked immunosorbent assay were performed in ocular tissues. Systemic immune response was determined at day 20 postimmunization by measuring proliferation and cytokine secretion of cells from inguinal lymph nodes (ILNs) draining the immunization site, specific delayed-type hypersensitivity (DTH), and the serum concentration of cytokines. Ocular and systemic biodistribution of VIP-Rh-Lip was studied in normal and EAU rats by immunofluorescence. RESULTS: The i.v.t. injection of VIP-Rh-Lip performed during the afferent, but not the efferent, phase of the disease reduced clinical EAU and protected against retinal damage. No effect was observed after saline, E-Rh-Lip, or VIP injection. VIP-Rh-Lip and VIP were detected in intraocular macrophages and in lymphoid organs. In VIP-Rh-Lip-treated eyes, macrophages expressed transforming growth factor-beta2, low levels of major histocompatibility complex class II, and nitric oxide synthase-2. T-cells showed activated caspase-3 with the preservation of photoreceptors. Intraocular levels of interleukin (IL)-2, interferon-gamma (IFN-gamma), IL-17, IL-4, GRO/KC, and CCL5 were reduced with increased IL-13. At the systemic level, treatment reduced retinal soluble autoantigen lymphocyte proliferation, decreased IL-2, and increased IL-10 in ILN cells, and diminished specific DTH and serum concentration of IL-12 and IFN-gamma. CONCLUSIONS: An i.v.t. injection of VIP-Rh-Lip, performed during the afferent stage of immune response, reduced EAU pathology through the immunomodulation of intraocular macrophages and deviant stimulation of T-cells in ILN. Thus, the encapsulation of VIP within liposomes appears as an effective strategy to deliver VIP into the eye and is an efficient means of the prevention of EAU severity.

Determinants of the effect of existential behavioral therapy for bereaved partners: a qualitative study.

BACKGROUND: Informal caregivers of palliative patients took part in existential behavioral therapy (EBT), a group intervention comprising mindfulness exercises to reduce psychological distress and improve quality of life. OBJECTIVES: This study examined what the participants perceived as helpful to cope with their loss during the first year of bereavement, particularly with regard to the EBT intervention. DESIGN: Sixteen problem-centered, semi-structured interviews were evaluated with content analysis. RESULTS: Two main categories were found: social support and self-regulation. Social support includes sense of belonging as well as emotional, cognitive, and practical help experienced from others. Mindfulness and acceptance, a clear focus on the positive, and orientation toward the future were helpful strategies of self-regulation; these were also part of the EBT intervention. Mindfulness was understood as permitting emotions and acceptance of one's inner processes, even if they were not pleasant, and was found to be helpful to stop ruminative thinking. CONCLUSIONS: The categories considered as being helpful parallel core elements of EBT and recent grief theories. The intervention was found to be supportive and met the needs of the participants. The interviewees appreciated the continuity of EBT support from palliative care into bereavement.