Angiorresonancia versus angiografía por sustracción digital en el seguimiento de aneurismas intracraneales embolizados. Comparación del desempeño diagnóstico

Introducción: La DSA es el método de elección para el seguimiento de pacientes con aneurismas intracraneales embolizados; esta se puede asociar a complicaciones incapacitantes o mortales. La MRA se ha propuesto como método alternativo por menor costo y menos morbi-mortalidad, aunque su desempeño diagnóstico permanece en discusión debido al desarrollo de nuevos protocolos, resonadores más potentes y nuevas aplicaciones de la DSA. Metodología: Exploramos la literatura hasta la actualidad y comparamos el desempeño diagnóstico de la MRA con la DSA para detectar flujo residual posterior a la embolización terapéutica de aneurismas intracraneales. Realizamos una revisión sistemática de la literatura y meta-análisis basados en 34 artículos detectados en la búsqueda que incluyó las bases de datos PubMed, Scopus, ScIELO y BVS. Resultados: La TOF-MRA demostró sensibilidad de 86.8% (84.3%-89.1%) y especificidad de 91.2% (89%-93.1%); la SROC para TOF-MRA demostró un AUC de 0.95. El desempeño de la CE-MRA demostró sensibilidad de 88.1% (84.6%-91.1%) y especificidad de 89.1% (85.7%-91.9%); la SROC presentó una AUC de 0.93. El análisis estratificado por potencia del resonador encontró que la TOF-MRA tiene mejor desempeño con el resonador de 3T, aunque no es estadísticamente significativo. La concordancia interobservador con TOF-MRA y CE-MRA fue moderada a muy buena. Discusión: El desempeño diagnóstico de la MRA en el seguimiento de aneurismas intracraneales embolizados demostró ser bueno, con sensibilidad mayor a 84%, siendo ligeramente mejor con TOF-MRA, sin lograr reemplazar la DSA. Sin embargo, los resultados deben ser evaluados con precaución por la heterogeneidad de los resultados de los estudios incluidos. (Abreviaturas: DSA: Angiografía por Sustracción Digital; MRA: Angiografía por Resonancia Magnética; TOF-MRA: Angiorresonancia por Tiempo de Vuelo; CE-MRA: Angiorresonancia contrastada).

Concordancia en el tratamiento de fracturas de radio distal basado en el estudio de radiografía y tomografía

Introducción: La utilidad de la tomografía computarizada como prueba de rutina en la toma de decisiones para las fracturas de radio distal no ha sido bien establecida. Metodología: Estudio de concordancia intra e interobservador en el tratamiento de fracturas de radio distal Fernández V. Se realizaron dos visitas, con intervalo de 2 semanas entre ellas a 15 ortopedistas de trauma quienes evaluaron 22 radiografías de muñeca y sus respectivas tomografías con fracturas de radio distal Fernández V, determinaron para cada caso la mejor opción de tratamiento. Se utilizó el coeficiente Kappa para evaluar la concordancia intra e interobservador para el plan de tratamiento propuesto y se analizaron los resultados según la interpretación de este coeficiente según Landis y Koch. Resultados: La concordancia entre radiografía y tomografía fue moderada kappa 0,47 – 0,51 en las dos evaluaciones respectivamente, manteniéndose el cambio de tratamiento entre 24,9% y 26,7% (p‹0,001). La concordancia observada intraobservador para radiografía y tomografía evaluadas de manera individual fue buena (72,1% y 64,2% respectivamente) evidenciándose cambio en la decisión de tratamiento hasta en el 35,8% de las evaluaciones (p‹0,001); se determinó concordancia observada muy buena en los casos a los que se propuso manejo abierto. No se identificó influencia de la edad en la decisión de tratamiento. Conclusiones: Existe buena concordancia entre radiografía simple y tomografía en fracturas de radio distal Fernández V en cuanto a la decisión de tratamiento, siendo alta la concordancia en los casos en los que se decide manejo abierto.

Hallazgos radiológicos de la enfermedad pulmonar en pacientes Colombianos con esclerodermia

La esclerosis sistémica (ES) es una enfermedad autoinmune multisistémica que afecta principalmente la piel, los pulmones, el tracto gastrointestinal, el corazón y los riñones. La enfermedad pulmonar, presente en casi el 100% de los casos, es el factor con mayor influencia en la mortalidad. El propósito de este estudio es realizar un análisis detallado de la enfermedad pulmonar por tomografía computarizada de alta resolución(TCAR) en pacientes Colombianos con ES, para lo cual se realizó un estudio de prevalencia analítica en 44 pacientes con ES valorados en el Hospital Universitario Mayor Méderi en los últimos 7 años. Los resultados mostraron características demográficas y clínicas similares a las previamente descritas. La prevalencia de enfermedad pulmonar intersticial fue alta, y los hallazgos de fibrosis pulmonar como vidrio esmerilado y panal de abejas se asociaron con la presencia del autoanticuerpo antiSCL70. La medida del diámetro esofágico por TCAR fue mayor en los pacientes con disfagia, antiSCL 70 y linfopenia, los cuales son marcadores de mal pronóstico.

Breast cancer incidence and overdiagnosis in Catalonia (Spain)

Early detection of breast cancer (BC) with mammography may cause overdiagnosis and overtreatment, detecting tumors which would remain undiagnosed during a lifetime. The aims of this study were: first, to model invasive BC incidence trends in Catalonia (Spain) taking into account reproductive and screening data; and second, to quantify the extent of BC overdiagnosis. We modeled the incidence of invasive BC using a Poisson regression model. Explanatory variables were: age at diagnosis and cohort characteristics (completed fertility rate, percentage of women that use mammography at age 50, and year of birth). This model also was used to estimate the background incidence in the absence of screening. We used a probabilistic model to estimate the expected BC incidence if women in the population used mammography as reported in health surveys. The difference between the observed and expected cumulative incidences provided an estimate of overdiagnosis.Incidence of invasive BC increased, especially in cohorts born from 1940 to 1955. The biggest increase was observed in these cohorts between the ages of 50 to 65 years, where the final BC incidence rates more than doubled the initial ones. Dissemination of mammography was significantly associated with BC incidence and overdiagnosis. Our estimates of overdiagnosis ranged from 0.4% to 46.6%, for women born around 1935 and 1950, respectively.Our results support the existence of overdiagnosis in Catalonia attributed to mammography usage, and the limited malignant potential of some tumors may play an important role. Women should be better informed about this risk. Research should be oriented towards personalized screening and risk assessment tools

Sistemas digitais directos vs indirectos : níveis de referência de diagnóstico locais na radiografia de tórax em projeção postero-anterior em dois hospitais portugueses

Este estudo teve como objetivo avaliar e comparar as doses de radiação recolhidas numa amostra de 69 pacientes, em dois hospitais, com diferentes métodos de aquisição de imagem digital, direta e indireta, que realizaram radiografia de tórax, em projeção postero-anterior (PA). Para os dois hospitais, a dose à entrada da pele (DEP) e efectiva (E), foram medidas usando o software PCXMC para comparação entre si e com referências internacionais. No Hospital A, com aquisição digital direta, a média de DEP foi de 0,089 mGy e a média de E foi 0,013 mSv. No Hospital B, com aquisição digital de indireta, a média de DEP foi de 0.151 mGy e a média de E foi 0.030mSv. Em ambos os hospitais, as doses médias não ultrapassaram os limites recomendados por lei (0,3 mGy). Para a radiografia de tórax PA, o nível de referência diagnostico (NRD) local calculado foi 0.107 mGy, para o Hospital A e 0.164 mGy, para o Hospital B. Na radiografia de tórax PA, a utilização de um sistema de aquisição direta implicou uma redução de dose de 41 %, concordante com as referências disponíveis que apontam para a redução da dose de cerca de 50 % entre os dois sistemas.

Sensitivity of feature-based analysis methods of storm tracks to the form of background field removal

For the tracking of extrema associated with weather systems to be applied to a broad range of fields it is necessary to remove a background field that represents the slowly varying, large spatial scales. The sensitivity of the tracking analysis to the form of background field removed is explored for the Northern Hemisphere winter storm tracks for three contrasting fields from an integration of the U. K. Met Office's (UKMO) Hadley Centre Climate Model (HadAM3). Several methods are explored for the removal of a background field from the simple subtraction of the climatology, to the more sophisticated removal of the planetary scales. Two temporal filters are also considered in the form of a 2-6-day Lanczos filter and a 20-day high-pass Fourier filter. The analysis indicates that the simple subtraction of the climatology tends to change the nature of the systems to the extent that there is a redistribution of the systems relative to the climatological background resulting in very similar statistical distributions for both positive and negative anomalies. The optimal planetary wave filter removes total wavenumbers less than or equal to a number in the range 5-7, resulting in distributions more easily related to particular types of weather system. For the temporal filters the 2-6-day bandpass filter is found to have a detrimental impact on the individual weather systems, resulting in the storm tracks having a weak waveguide type of behavior. The 20-day high-pass temporal filter is less aggressive than the 2-6-day filter and produces results falling between those of the climatological and 2-6-day filters.

Record of natural and anthropogenic changes in reef environments (Barbados West Indies) using laser ablation ICP-MS and sclerochronology on coral cores

Coral growth rate can be affected by environmental parameters such as seawater temperature, depth, and light intensity. The natural reef environment is also disturbed by human influences such as anthropogenic pollutants, which in Barbados are released close to the reefs. Here we describe a relatively new method of assessing the history of pollution and explain how these effects have influenced the coral communities off the west coast of Barbados. We evaluate the relative impact of both anthropogenic pollutants and natural stresses. Sclerochronology documents framework and skeletal growth rate and records pollution history (recorded as reduced growth) for a suite of sampled Montastraea annularis coral cores. X-radiography shows annual growth band patterns of the corals extending back over several decades and indicates significantly lower growth rate in polluted sites. Results using laser-ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) on the whole sample (aragonite, organic matter, trapped particulate matter, etc.), have shown contrasting concentrations of the trace elements (Cu, Sn, Zn, and Pb) between corals at different locations and within a single coral. Deepwater corals 7 km apart, record different levels of Pb and Sn, suggesting that a current transported the metal pollution in the water. In addition, the 1995 hurricanes are associated with anomalous values for Sn and Cu from most sites. These are believed to result from dispersion of nearshore polluted water. We compared the concentrations of trace elements in the coral growth of particular years to those in the relevant contemporaneous seawater. Mean values for the concentration factor in the coral, relative to the water, ranged from 10 for Cu and Ni to 2.4 and 0.7 for Cd and Zn, respectively. Although the uncertainties are large (60-80%), the coral record enabled us to demonstrate the possibility of calculating a history of seawater pollution for these elements from the 1940s to 1997. Our values were much higher than those obtained from analysis of carefully cleaned coral aragonite; they demonstrate the incorporation of more contamination including that from particulate material as well as dissolved metals.

Evaluation of probabilistic occupancy map people detection for surveillance systems

In this paper, we evaluate the Probabilistic Occupancy Map (POM) pedestrian detection algorithm on the PETS 2009 benchmark dataset. POM is a multi-camera generative detection method, which estimates ground plane occupancy from multiple background subtraction views. Occupancy probabilities are iteratively estimated by fitting a synthetic model of the background subtraction to the binary foreground motion. Furthermore, we test the integration of this algorithm into a larger framework designed for understanding human activities in real environments. We demonstrate accurate detection and localization on the PETS dataset, despite suboptimal calibration and foreground motion segmentation input.

Efficient calculation of two-dimensional periodic and waveguide acoustic Green’s functions

New representations and efficient calculation methods are derived for the problem of propagation from an infinite regularly spaced array of coherent line sources above a homogeneous impedance plane, and for the Green's function for sound propagation in the canyon formed by two infinitely high, parallel rigid or sound soft walls and an impedance ground surface. The infinite sum of source contributions is replaced by a finite sum and the remainder is expressed as a Laplace-type integral. A pole subtraction technique is used to remove poles in the integrand which lie near the path of integration, obtaining a smooth integrand, more suitable for numerical integration, and a specific numerical integration method is proposed. Numerical experiments show highly accurate results across the frequency spectrum for a range of ground surface types. It is expected that the methods proposed will prove useful in boundary element modeling of noise propagation in canyon streets and in ducts, and for problems of scattering by periodic surfaces.

Language in calculation: A core mechanism?

Although there is evidence that exact calculation recruits left hemisphere perisylvian language systems, recent work has shown that exact calculation can be retained despite severe damage to these networks. In this study, we sought to identify a “core” network for calculation and hence to determine the extent to which left hemisphere language areas are part of this network. We examined performance on addition and subtraction problems in two modalities: one using conventional two-digit problems that can be easily encoded into language; the other using novel shape representations. With regard to numerical problems, our results revealed increased left fronto-temporal activity in addition, and increased parietal activity in subtraction, potentially reflecting retrieval of linguistically encoded information during addition. The shape problems elicited activations of occipital, parietal and dorsal temporal regions, reflecting visual reasoning processes. A core activation common to both calculation types involved the superior parietal lobule bilaterally, right temporal sub-gyral area, and left lateralized activations in inferior parietal (BA 40), frontal (BA 6/8/32) and occipital (BA 18) regions. The large bilateral parietal activation could be attributed to visuo-spatial processing in calculation. The inferior parietal region, and particularly the left angular gyrus, was part of the core calculation network. However, given its activation in both shape and number tasks, its role is unlikely to reflect linguistic processing per se. A possibility is that it serves to integrate right hemisphere visuo-spatial and left hemisphere linguistic and executive processing in calculation.

Differentiating core and co-opted mechanisms in calculation: The neuroimaging of calculation in aphasia

The role of language in exact calculation is the subject of debate. Some behavioral and functional neuroimaging investigations of healthy participants suggest that calculation requires language resources. However, there are also reports of individuals with severe aphasic language impairment who retain calculation ability. One possibility in resolving these discordant findings is that the neural basis of calculation has undergone significant reorganization in aphasic calculators. Using fMRI, we examined brain activations associated with exact addition and subtraction in two patients with severe agrammatic aphasia and retained calculation ability. Behavior and brain activations during two-digit addition and subtraction were compared to those of a group of 11 healthy, age-matched controls. Behavioral results confirmed that both patients retained calculation ability. Imaging findings revealed individual differences in processing, but also a similar activation pattern across patients and controls in bilateral parietal cortices. Patients differed from controls in small areas of increased activation in peri-lesional regions, a shift from left fronto-temporal activation to the contralateral region, and increased activations in bilateral superior parietal regions. Our results suggest that bilateral parietal cortex represents the core of the calculation network and, while healthy controls may recruit language resources to support calculation, these mechanisms are not mandatory in adult cognition.

Towards radiocarbon calibration beyond 28ka using speleothems from the Bahamas

We present a new speleothem record of atmospheric Δ14C between 28 and 44 ka that offers considerable promise for resolving some of the uncertainty associated with existing radiocarbon calibration curves for this time period. The record is based on a comprehensive suite of AMS 14C ages, using new low-blank protocols, and U–Th ages using high precision MC-ICPMS procedures. Atmospheric Δ14C was calculated by correcting 14C ages with a constant dead carbon fraction (DCF) of 22.7 ± 5.9%, based on a comparison of stalagmite 14C ages with the IntCal04 (Reimer et al., 2004) calibration curve between 15 and 11 ka. The new Δ14C speleothem record shows similar structure and amplitude to that derived from Cariaco Basin foraminifera (Hughen et al., 2004, 2006), and the match is further improved if the latter is tied to the most recent Greenland ice core chronology (Svensson et al., 2008). These data are however in conflict with a previously published 14C data set for a stalagmite record from the Bahamas — GB-89-24-1 (Beck et al., 2001), which likely suffered from 14C analytical blank subtraction issues in the older part of the record. The new Bahamas speleothem ∆14C data do not show the extreme shifts between 44 and 40 ka reported in the previous study (Beck et al., 2001). Causes for the observed structure in derived atmospheric Δ14C variation based on the new speleothem data are investigated with a suite of simulations using an earth system model of intermediate complexity. Data-model comparison indicates that major fluctuations in atmospheric ∆14C during marine isotope stage 3 is primarily a function of changes in geomagnetic field intensity, although ocean–atmosphere system reorganisation also played a supporting role.

Transreal proof of the existence of universal possible worlds

Transreal arithmetic is total, in the sense that the fundamental operations of addition, subtraction, multiplication and division can be applied to any transreal numbers with the result being a transreal number [1]. In particular division by zero is allowed. It is proved, in [3], that transreal arithmetic is consistent and contains real arithmetic. The entire set of transreal numbers is a total semantics that models all of the semantic values, that is truth values, commonly used in logics, such as the classical, dialetheaic, fuzzy and gap values [2]. By virtue of the totality of transreal arithmetic, these logics can be implemented using total, arithmetical functions, specifically operators, whose domain and counterdomain is the entire set of transreal numbers

Interactions between the powdery mildew effector BEC1054 and barley proteins identify candidate host targets

There are over 500 candidate secreted effector proteins (CSEPs) or Blumeria effector candidates (BECs) specific to the barley powdery mildew pathogen Blumeria graminis f.sp. hordei. The CSEP/BEC proteins are expressed and predicted to be secreted by biotrophic feeding structures called haustoria. Eight BECs are required for the formation of functional haustoria. These include the RNase-like effector BEC1054 (synonym CSEP0064). In order to identify host proteins targeted by BEC1054, recombinant BEC1054 was expressed in E. coli, solubilized, and used in pull-down assays from barley protein extracts. Many putative interactors were identified by LC-MS/MS after subtraction of unspecific binders in negative controls. Therefore, a directed yeast-2-hybrid assay, developed to measure the effectiveness of the interactions in yeast, was used to validate putative interactors. We conclude that BEC1054 may target several host proteins, including a glutathione-S-transferase, a malate dehydrogenase, and a pathogen-related-5 protein isoform, indicating a possible role for BEC1054 in compromising well-known key players of defense and response to pathogens. In addition, BEC1054 interacts with an elongation factor 1 gamma. This study already suggests that BEC1054 plays a central role in barley powdery mildew virulence by acting at several levels.

Cone-beam computerized tomographic, radiographic, and histologic evaluation of periapical repair in dogs` post-endodontic treatment

Objective. To evaluate the periapical repair after root canal treatment in the teeth of dogs using CT and conventional radiography and to compare these findings with the gold standard microscopic evaluation. Study design. The animals were divided into three groups according to endodontic treatment performed: Group 1, single-visit endodontic treatment in teeth without apical periodontitis; Group 2, single-visit endodontic treatment in teeth with apical periodontitis; and Group 3, endodontic treatment in teeth with apical periodontitis using calcium hydroxide as a root canal dressing. Group 4 consisted of teeth with apical periodontitis not submitted to root canal treatment and Group 5 consisted of healthy teeth without periapical disease. Radiographic, tomographic, and microscopic evaluations were performed by blind examiners. At 180 days experimental time, CT and radiographic measurements of periapical disease were compared with the gold standard microscopic measurement using intraclass correlation coefficient. Intergroup comparisons considering different methods of periapical lesions measurement or different clinical protocols of root canal treatment were performed by Kruskal Wallis test followed by Dunn. Integrity of lamina dura, presence of radiolucent areas, and presence of root resorption were analyzed by Fisher`s exact test. Results. There was discontinuity of the lamina dura and CPD in all teeth from Groups 2, 3, and 4 evaluated by tomography and radiography 45 days after CPD induction. Radiographically, 180 days after root canal treatment, there was no periapical lesion in teeth from Groups 1 and 3, different from groups 2 and 4 (p < .05). The highest reduction in the CPD size was observed on Group 3 (p < .05). According to the tomographic results, there was decrease of the size of the CPD on Group 3 but not on Groups 2 or 4. However, in all groups the periapical lesions presented larger mesio-distal extension if compared with radiography, both 45 days after CPD induction and 180 days after root canal treatment. At 180 days, CT measurements were closely related to microscopic results (ICC = 0.95) differently from radiographic evaluation (ICC = 0.86). Conclusion. CT Scan evaluation of periapical repair following root canal treatment provided similar information than that obtained by microscopic analysis, whereas radiographic evaluation underestimated the size do periapical lesion. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108:796-805)