High Prevalence of Signs of Renal Damage Despite Normal Renal Function in a Cohort of HIV-Infected Patients: Evaluation of Associated Factors

Renal disorders are an emerging problem in HIV-infected patients. We performed a cross-sectional study of the first 1000 HIV-infected patients attended at our HIV unit who agreed to participate. We determined the frequency of renal alterations and its related risk factors. Summary statistics and logistic regression were applied. The study sample comprised 970 patients with complete data. Most were white (94%) and men (76%). Median (IQR) age was 48 (42–53) years. Hypertension was diagnosed in 19%, dyslipidemia in 27%, and diabetes mellitus in 3%. According to the Chronic Kidney Disease Epidemiology Collaboration (CKD EPI) equation, 29 patients (3%) had an eGFR < 60 ml/min/1.73m2; 18 of them (62%) presented altered albumin/creatinine and protein/creatinine (UPC or UAC) ratios. Of the patients with eGFR> 60mL/min, it was present in 293 (30%), 38 of whom (7.1%) had UPC> 300mg/g. Increased risk of renal abnormalities was correlated with hypertension (OR, 1.821 [95%CI, 1.292;2.564]; p = 0.001), age (OR, 1.015 [95%CI, 1.001;1.030], per one year; p = 0.040), and use of tenofovir disoproxil fumarate (TDF) plus protease inhibitor (PI), (OR, 1.401 [95%CI, 1.078;1.821]; p = 0.012). Current CD4 cell count was a protective factor (OR, 0.9995 [95%CI, 0.9991;0.9999], per one cell; p = 0.035). A considerable proportion of patients presented altered UPC or UAC ratios, despite having an eGFR > 60mL/min. CD4 cell count was a protective factor; age, hypertension, and use of TDF plus PIs were risk factors for renal abnormalities. Based on our results, screen of renal abnormalities should be considered in all HIV-infected patients to detect these alterations early.

Pathological video game use among young Swiss men: the use of monothetic and polythetic formats to distinguish between pathological, excessive and normal gaming

There is no agreement about the distinction between pathological, excessive and normal gaming. The present study compared two classifications for defining pathological gaming: the polythetic format (gamers who met at least half of the criteria) and monothetic format (gamers who met all criteria). Associations with mental, health and social issues were examined to assess differences between subgroups of gamers. A representative sample of 5,663 young Swiss men filled in a questionnaire as part of the ongoing Cohort Study on Substance Use Risk Factors (C-SURF). Game use was assessed with the Game Addiction Scale. Mental, social and physical factors (depression, anxiety, aggressiveness, physical and mental health, social and health consequences), gambling and substance use (illicit drug use, alcohol dependence and problematic cannabis use) were also assessed. The results indicated that monothetic gamers shared problems with polythetic gamers, but were even more inclined to mental health issues (depression, anxiety, and aggressiveness) and were more vulnerable to other dependencies like substance use, alcohol dependence or gambling. A second analysis using Latent Class Analysis confirmed the distinction between monothetic and polythetic gamers. These findings support the use of a monothetic format to diagnose pathological gaming and to differentiate it from excessive gaming.

Estudo dos ventrículos cerebrais por ultrassonografia, na criança normal, nascida a termo, de 1 a 6 meses

OBJETIVO: Estudo dos ventrículos cerebrais por ultrassonografia, com o objetivo de estabelecer de forma simplificada parâmetros para diagnóstico das dilatações ventriculares leves. MATERIAIS E MÉTODOS: Foram estudadas, prospectivamente, 105 crianças, normais, nascidas a termo, com um total de 181 exames realizados, mensalmente até os 6 meses, através da observação de dados morfológicos e medidas. As medidas efetuadas foram: índice ventrículo/hemisfério, diâmetro anteroposterior do corno anterior e do quarto ventrículo. RESULTADOS: Obtiveram-se média, desviopadrão e percentis de normalidade das medidas estabelecidas, em cada faixa etária. A pesquisa de halo anecoico nos dois terços posteriores do plexo coroide em plano coronal VI, para avaliação dos cornos temporal/posterior, foi ausente, e o terceiro ventrículo mostrou-se como uma fenda anecoica, menor que 1 mm, em plano coronal V em todas as crianças do estudo. CONCLUSÃO: Os achados morfológicos relacionados aos cornos temporal/posterior e ao terceiro ventrículo, associados ao percentil 95 das medidas como limite superior da normalidade, podem ser utilizados para diagnóstico simplificado de dilatações ventriculares leves.

Multidetector computed tomography angiography of the celiac trunk and hepatic arterial system: normal anatomy and main variants

Abstract Although digital angiography remains as the gold standard for imaging the celiac arterial trunk and hepatic arteries, multidetector computed tomography in association with digital images processing by software resources represents a useful tool particularly attractive for its non invasiveness. Knowledge of normal anatomy as well as of its variations is helpful in images interpretation and to address surgical planning on a case-by-case basis. The present essay illustrates several types of anatomical variations of celiac trunk, hepatic artery and its main branches, by means of digitally reconstructed computed tomography images, correlating their prevalence in the population with surgical implications.

Successful minimally invasive surgery for primary hyperparathyroidism: influence of preoperative imaging and intraoperative parathyroid hormone levels.

PURPOSE: Adenoma is the main parathyroid disorder leading to primary hyperparathyroidism (PHP). Minimally invasive parathyroidectomy (MIP) is recognized as a valid procedure for adenoma-related PHP. It requires precise preoperative localization combining Tc-99m-MIBI (methoxy-isobutyl-isonitrile) scintigraphy and single-photon emission computed tomography (SPECT) with x-ray computed tomography (CT) and intraoperative confirmation of successful excision by change in intact parathormone (iPTH) levels. The study aim was to assess the surgery success in relation to these two parameters. METHODS: All patients operated on for PHP from 2005 to mid-2014 at our institution were retrospectively reviewed. MIP was performed in case of precise preoperative adenoma localization on scintigraphy, absence of past cervical surgery, and absence of concomitant thyroid resection necessity. In these patients, iPTH levels were monitored intraoperatively. Confirmation criteria for iPTH values were a return to normal level or a decrease >50 % of basal iPTH level. RESULTS: There were 197 PHP operations during the study period: 118 MIP and 79 bilateral neck explorations (BNEs). The MIP success rate was 95 % (112/118) with a preoperative MIBI scan ± CT accurate in 94 % (111/118) of the patients and with correct iPTH in 90 % (106/118) of the cases. Among the 12 iPTH levels that did not meet the confirmation criteria, 10 returned to normal range by postoperative day 2. Treatment failure appeared in three patients (one BNE, two MIPs). CONCLUSIONS: Tc-99m-MIBI dual-phase scintigraphy with SPECT/CT is the key examination for functional and morphological parathyroid adenoma localization. If preoperative scintigraphy is obvious and intraoperative assessment is clear, one could possibly safely omit iPTH, as it may lead to unnecessary BNE in primary PHP.

A new approach to the classification of mammographic masses and normal breast tissue

A new approach to mammographic mass detection is presented in this paper. Although different algorithms have been proposed for such a task, most of them are application dependent. In contrast, our approach makes use of a kindred topic in computer vision adapted to our particular problem. In this sense, we translate the eigenfaces approach for face detection/classification problems to a mass detection. Two different databases were used to show the robustness of the approach. The first one consisted on a set of 160 regions of interest (RoIs) extracted from the MIAS database, being 40 of them with confirmed masses and the rest normal tissue. The second set of RoIs was extracted from the DDSM database, and contained 196 RoIs containing masses and 392 with normal, but suspicious regions. Initial results demonstrate the feasibility of using such approach with performances comparable to other algorithms, with the advantage of being a more general, simple and cost-effective approach

The normal distribution in some constrained sample spaces

Phenomena with a constrained sample space appear frequently in practice. This is the case e.g. with strictly positive data, or with compositional data, like percentages or proportions. If the natural measure of difference is not the absolute one, simple algebraic properties show that it is more convenient to work with a geometry different from the usual Euclidean geometry in real space, and with a measure different from the usual Lebesgue measure, leading to alternative models which better fit the phenomenon under study. The general approach is presented and illustrated using the normal distribution, both on the positive real line and on the D-part simplex. The original ideas of McAlister in his introduction to the lognormal distribution in 1879, are recovered and updated

Sales and Operations Planning Implementation

The master’s thesis focused on implementing a sales and operations planning process. The main objectives were to create planning methods and tools for the implementation. The ultimate goal of the process, beyond this master’s thesis, is to balance the supply of products with customer demand, with optimized profitability. The theoretical part focused on giving a thorough view on the sales and operations planning process. The basis for a monthly planning cycle was identified. Methods, tools, and metrics for demand forecasting and operations planning were also introduced. Based on the theoretical part, a method for forecasting, a forecast spreadsheet, and a forecast accuracy metric were designed. A spreadsheet tool and methods were also designed for the monthly planning of production volumes, capacity, and inventory. The implementation progress was reviewed for two product families for three months. The sales and operations planning process was able to successfully identify a demand peak for the product families. Suggestions for the future of sales and operations planning were also made.

RFID-teknologian hyödyntäminen puolustusvoimien yksilöseurattavan materiaalin hallinnassa - CASE: maavoimat, Karjalan Prikaati

RFID-teknologian käyttöönotto on vakaassa kasvussa ja kiinnostus tekniikan soveltami-seen on erityisesti yksilöseurannan alueella. Diplomityössä on tutkittu RFID -teknologian mahdollisuuksia puolustusvoimien normaaliolojen kriittisen yksilöseurattavan materiaalin hallintaan. Case-joukko-osastona tutkimuksessa on toiminut Karjalan Prikaati. Tutkimus-aihetta on tarkasteltu prosessiajattelun näkökulmasta, mutta myös tiedon keräämistä on käsitelty. RFID-pohjainen tieto eroaa perinteisellä tavalla kerätystä tiedosta. RFID-teknologian hyödyntäminen tarjoaa kuitenkin entistä monipuolisemman ja virheettö-mämmän tiedon keräämisen reaaliajassa, joten se tukee hyvin prosessimaista toimintaa. Tutkimuksen painopisteenä on ollut logistiikan resurssien käytön tehostaminen RFID-teknologiaan tukeutuvan prosessimaisen toiminnan kautta. Tehokas prosessimainen toi-minta soveltuu hyvin sotilasorganisaatioihin. Prosessien määrittely ja kuvaaminen autta-vat tunnistamaan niissä ilmeneviä ongelmia ja samalla kuvaamaan mahdollisten muutos-ten vaikutukset prosesseihin sekä organisaatioihin. Perusteet prosessien uudelleen suun-nittelulle lähtevät prosessimaisen toiminnan tunnistamisesta ja kuvaamisesta. Case-joukko-osaston nykytilan kartoituksessa havaittiin, että joukko-osastotasolta on tähän asti puuttunut kokonaisvaltainen prosessimainen toimintatapa. Nykytila-analyysin pohjalta tutkimustyössä rakennettiin yksilöseurattavan materiaalin käsittelyä kuvaava toimintaprosessi, joka muodostui kuudesta eri osaprosessista. Tutki-mustyölle valitun painopisteen mukaisesti osaprosesseista viisi liittyi logistiikkaan ja kun-nossapitoon yksi. Tämän jälkeen keskityttiin tutkiman RFID-tekniikan avulla saavutetta-via keskeisiä hyötyjä. RFID-teknologian ja prosessimaisen toiminnan avulla joukko-osastotasolla on saavutettavissa useita hyötyjä verrattuna nykytilan toimintaan. Uudessa toimintatavassa keskeisiä tunnistettuja hyötyjä ovat toiminnan automatisoituminen, teho-kas tiedonkeruu, toiminnan hyvä laatu ja tehokkuus. Toiminnan tehokkuutta organisaati-on logistisissa toiminnoissa on siis mahdollista kasvattaa ja samalla lisätä näkyvyyttä toimitusketjun sisälle ja sen eri vaiheisiin. Lisäksi RFID-teknologian käyttöönotolla pys-tytään tukemaan hyvin puolustusvoimien kunnossapidon strategista kumppanuutta.

The intrinsic mechanisms of softwood fiber damage in brown stock fiber line unit operations Lappeenranta 2010

The effects of pulp processing on softwood fiber properties strongly influence the properties of wet and dry paper webs. Pulp strength delivery studies have provided observations that much of the strength potential of long fibered pulp is lost during brown stock fiber line operations where the pulp is merely washed and transferred to the subsequent processing stages. The objective of this work was to study the intrinsic mechanisms which maycause fiber damage in the different unit operations of modern softwood brown stock processing. The work was conducted by studying the effects of industrial machinery on pulp properties with some actions of unit operations simulated in laboratory scale devices under controlled conditions. An optical imaging system was created and used to study the orientation of fibers in the internal flows during pulp fluidization in mixers and the passage of fibers through the screen openings during screening. The qualitative changes in fibers were evaluated with existing and standardized techniques. The results showed that each process stage has its characteristic effects on fiber properties: Pulp washing and mat formation in displacement washers introduced fiber deformations especially if the fibers entering the stage were intact, but it did not decrease the pulp strength properties. However, storage chests and pulp transfer after displacement washers contributed to strength deterioration. Pulp screening proved to be quite gentle, having the potential of slightly evening out fiber deformations from very deformed pulps and vice versa inflicting a marginal increase in the deformation indices if the fibers were previously intact. Pulp mixing in fluidizing industrial mixers did not have detrimental effects on pulp strength and had the potential of slightly evening out the deformations, provided that the intensity of fluidization was high enough to allow fiber orientation with the flow and that the time of mixing was short. The chemical and mechanical actions of oxygen delignification had two distinct effects on pulp properties: chemical treatment clearly reduced pulp strength with and without mechanical treatment, and the mechanical actions of process machinery introduced more conformability to pulp fibers, but did not clearly contribute to a further decrease in pulp strength. The chemical composition of fibers entering the oxygen stage was also found to affect the susceptibility of fibers to damage during oxygen delignification. Fibers with the smallest content of xylan were found to be more prone to irreversibledeformations accompanied with a lower tensile strength of the pulp. Fibers poor in glucomannan exhibited a lower fiber strength while wet after oxygen delignification as compared to the reference pulp. Pulps with the smallest lignin content on the other hand exhibited improved strength properties as compared to the references.