Comparison between magnetic resonance imaging and computed tomography of the lung in patients with cystic fibrosis with regard to clinical, laboratory, and pulmonary functional parameters

OBJECTIVE To evaluate whether magnetic resonance imaging (MRI) is effective as computed tomography (CT) in determining morphologic and functional pulmonary changes in patients with cystic fibrosis (CF) in association with multiple clinical parameters. MATERIALS AND METHODS Institutional review board approval and patient written informed consent were obtained. In this prospective study, 30 patients with CF (17 men and 13 women; mean (SD) age, 30.2 (9.2) years; range, 19-52 years) were included. Chest CT was acquired by unenhanced low-dose technique for clinical purposes. Lung MRI (1.5 T) comprised T2- and T1-weighted sequences before and after the application of 0.1-mmol·kg gadobutrol, also considering lung perfusion imaging. All CT and MR images were visually evaluated by using 2 different scoring systems: the modified Helbich and the Eichinger scores. Signal intensity of the peribronchial walls and detected mucus on T2-weighted images as well as signal enhancement of the peribronchial walls on contrast-enhanced T1-weighted sequences were additionally assessed on MRI. For the clinical evaluation, the pulmonary exacerbation rate, laboratory, and pulmonary functional parameters were determined. RESULTS The overall modified Helbich CT score had a mean (SD) of 15.3 (4.8) (range, 3-21) and median of 16.0 (interquartile range [IQR], 6.3). The overall modified Helbich MR score showed slightly, not significantly, lower values (Wilcoxon rank sum test and Student t test; P > 0.05): mean (SD) of 14.3 (4.7) (range, 3-20) and median of 15.0 (IQR, 7.3). Without assessment of perfusion, the overall Eichinger score resulted in the following values for CT vs MR examinations: mean (SD), 20.3 (7.2) (range, 4-31); and median, 21.0 (IQR, 9.5) vs mean (SD), 19.5 (7.1) (range, 4-33); and median, 20.0 (IQR, 9.0). All differences between CT and MR examinations were not significant (Wilcoxon rank sum tests and Student t tests; P > 0.05). In general, the correlations of the CT scores (overall and different imaging parameters) to the clinical parameters were slightly higher compared to the MRI scores. However, if all additional MRI parameters were integrated into the scoring systems, the correlations reached the values of the CT scores. The overall image quality was significantly higher for the CT examinations compared to the MRI sequences. CONCLUSIONS One major diagnostic benefit of lung MRI in CF is the possible acquisition of several different morphologic and functional imaging features without the use of any radiation exposure. Lung MRI shows reliable associations with CT and clinical parameters, which suggests its implementation in CF for routine diagnosis, which would be particularly important in follow-up imaging over the long term.

Reference values for digital X-ray radiogrammetry parameters in children and adolescents in comparison to estimates in patients with distal radius fractures.

The first objective of this study was to determine normative digital X-ray radiogrammetry (DXR) values, based on original digital images, in a pediatric population (aged 6-18 years). The second aim was to compare these reference data with patients suffering from distal radius fractures, whereas both cohorts originated from the same geographical region and were evaluated using the same technical parameters as well as inclusion and exclusion criteria. DXR-BMD and DXR-MCI of the metacarpal bones II-IV were assessed on standardized digital hand radiographs, without printing or scanning procedures. DXR parameters were estimated separately by gender and among six age groups; values in the fracture group were compared to age- and gender-matched normative data using Student's t tests and Z scores. In the reference cohort (150 boys, 138 girls), gender differences were found in bone mineral density (DXR-BMD), with higher values for girls from 11 to 14 years and for boys from 15 to 18 years (p < 0.05). Girls had higher normative metacarpal index (DXR-MCI) values than boys, with significant differences at 11-14 years (p < 0.05). In the case-control investigation, the fracture group (95 boys, 69 girls) presented lower DXR-BMD at 15-18 years in boys and 13-16 years in girls vs. the reference cohort (p < 0.05); DXR-MCI was lower at 11-18 years in boys and 11-16 years in girls (p < 0.05). Mean Z scores in the fracture group for DXR-BMD were -0.42 (boys) and -0.46 (girls), and for DXR-MCI were -0.51 (boys) and -0.53 (girls). These findings indicate that the fully digital DXR technique can be accurately applied in pediatric populations ≥ 6 years of age. The lower DXR-BMD and DXR-MCI values in the fracture group suggest promising early identification of individuals with increased fracture risk, without the need for additional radiation exposure, enabling the initiation of prevention strategies to possibly reduce the incidence of osteoporosis later in life.

PICADAR: a diagnostic predictive tool for primary ciliary dyskinesia.

Symptoms of primary ciliary dyskinesia (PCD) are nonspecific and guidance on whom to refer for testing is limited. Diagnostic tests for PCD are highly specialised, requiring expensive equipment and experienced PCD scientists. This study aims to develop a practical clinical diagnostic tool to identify patients requiring testing.Patients consecutively referred for testing were studied. Information readily obtained from patient history was correlated with diagnostic outcome. Using logistic regression, the predictive performance of the best model was tested by receiver operating characteristic curve analyses. The model was simplified into a practical tool (PICADAR) and externally validated in a second diagnostic centre.Of 641 referrals with a definitive diagnostic outcome, 75 (12%) were positive. PICADAR applies to patients with persistent wet cough and has seven predictive parameters: full-term gestation, neonatal chest symptoms, neonatal intensive care admittance, chronic rhinitis, ear symptoms, situs inversus and congenital cardiac defect. Sensitivity and specificity of the tool were 0.90 and 0.75 for a cut-off score of 5 points. Area under the curve for the internally and externally validated tool was 0.91 and 0.87, respectively.PICADAR represents a simple diagnostic clinical prediction rule with good accuracy and validity, ready for testing in respiratory centres referring to PCD centres.

Integrated program debugging, verification, and optimization using abstract interpretation (and the Ciao system preprocessor)

The technique of Abstract Interpretation has allowed the development of very sophisticated global program analyses which are at the same time provably correct and practical. We present in a tutorial fashion a novel program development framework which uses abstract interpretation as a fundamental tool. The framework uses modular, incremental abstract interpretation to obtain information about the program. This information is used to validate programs, to detect bugs with respect to partial specifications written using assertions (in the program itself and/or in system libraries), to generate and simplify run-time tests, and to perform high-level program transformations such as multiple abstract specialization, parallelization, and resource usage control, all in a provably correct way. In the case of validation and debugging, the assertions can refer to a variety of program points such as procedure entry, procedure exit, points within procedures, or global computations. The system can reason with much richer information than, for example, traditional types. This includes data structure shape (including pointer sharing), bounds on data structure sizes, and other operational variable instantiation properties, as well as procedure-level properties such as determinacy, termination, nonfailure, and bounds on resource consumption (time or space cost). CiaoPP, the preprocessor of the Ciao multi-paradigm programming system, which implements the described functionality, will be used to illustrate the fundamental ideas.

Program development using abstract interpretation (and the ciao system preprocessor)

The technique of Abstract Interpretation has allowed the development of very sophisticated global program analyses which are at the same time provably correct and practical. We present in a tutorial fashion a novel program development framework which uses abstract interpretation as a fundamental tool. The framework uses modular, incremental abstract interpretation to obtain information about the program. This information is used to validate programs, to detect bugs with respect to partial specifications written using assertions (in the program itself and/or in system librarles), to genérate and simplify run-time tests, and to perform high-level program transformations such as múltiple abstract specialization, parallelization, and resource usage control, all in a provably correct way. In the case of validation and debugging, the assertions can refer to a variety of program points such as procedure entry, procedure exit, points within procedures, or global computations. The system can reason with much richer information than, for example, traditional types. This includes data structure shape (including pointer sharing), bounds on data structure sizes, and other operational variable instantiation properties, as well as procedure-level properties such as determinacy, termination, non-failure, and bounds on resource consumption (time or space cost). CiaoPP, the preprocessor of the Ciao multi-paradigm programming system, which implements the described functionality, will be used to illustrate the fundamental ideas.

A tutorial on program development and optimization using the Ciao preprocessor

We present in a tutorial fashion CiaoPP, the preprocessor of the Ciao multi-paradigm programming system, which implements a novel program development framework which uses abstract interpretation as a fundamental tool. The framework uses modular, incremental abstract interpretation to obtain information about the program. This information is used to validate programs, to detect bugs with respect to partial specifications written using assertions (in the program itself and/or in system libraries), to generate and simplify run-time tests, and to perform high-level program transformations such as multiple abstract specialization, parallelization, and resource usage control, all in a provably correct way. In the case of validation and debugging, the assertions can refer to a variety of program points such as procedure entry, procedure exit, points within procedures, or global computations. The system can reason with much richer information than, for example, traditional types. This includes data structure shape (including pointer sharing), bounds on data structure sizes, and other operational variable instantiation properties, as well as procedure-level properties such as determinacy, termination, non-failure, and bounds on resource consumption (time or space cost).

Non-Destructive Identification of Woolly Peaches combining Mechanical Impact Response and NIR Spectroscopy.

Woolliness (mealiness in other fruits) is a negative attribute of peach sensory texture that is a physiological disorder associated with inadequate cold storage. It is characterised by lack of crispness and juiciness without variation in the tissue water content (Harker and Hallet, 1992). Many attempts have been made to develop destructive instrumental procedures to detect mealiness and woolliness. Non-destructive procedures attempted include using nuclear magnetic resonance (Sonego et al., 1995). However, this technique has economical limitations and is not practical at present. Non-destructive impact tests and NIR are non-destructive techniques which have been used to assess internal characteristics of fruits (Chen and Sun, 1991). The objective of this study was to develop a novel non-destructive procedure to identify woolly peaches by combining impact and NIR approaches.

The Imaging and Slitless Spectroscopy Instrument for Surveys (ISSIS): expected radiometric performance, operation modes and data handling

ISSIS is the instrument for imaging and slitless spectroscopy on-board WSO-UV. In this article, a detailed comparison between ISSIS expected radiometric performance and other ultraviolet instruments is shown. In addition, we present preliminary information on the performance verification tests and on the foreseen procedures for in-flight operation and data handling.

Design and integration of lower ports for ITER diagnostic systems

All around the ITER vacuum vessel, forty-four ports will provide access to the vacuum vessel for remotehandling operations, diagnostic systems, heating, and vacuum systems: 18 upper ports, 17 equatorialports, and 9 lower ports. Among the lower ports, three of them will be used for the remote handlinginstallation of the ITER divertor. Once the divertor is in place, these ports will host various diagnosticsystems mounted in the so-called diagnostic racks. The diagnostic racks must allow the support andcooling of the diagnostics, extraction of the required diagnostic signals, and providing access and main-tainability while minimizing the leakage of radiation toward the back of the port where the humans areallowed to enter. A fully integrated inner rack, carrying the near plasma diagnostic components, will bean stainless steel structure, 4.2 m long, with a maximum weight of 10 t. This structure brings water forcooling and baking at maximum temperature of 240?C and provides connection with gas, vacuum andelectric services. Additional racks (placed away from plasma and not requiring cooling) may be requiredfor the support of some particular diagnostic components. The diagnostics racks and its associated exvessel structures, which are in its conceptual design phase, are being designed to survive the lifetimeof ITER of 20 years. This paper presents the current state of development including interfaces, diagnos-tic integration, operation and maintenance, shielding requirements, remote handling, loads cases anddiscussion of the main challenges coming from the severe environment and engineering requirements.

Ventilated Stone Veneer: Mechanical Behaviour, Calculation Methodologies, Major Pathologies and Existing Tests

The increase of building pathologies related to the use of stone materials and the use of ventilated stone veneers, requires the reformulation of design concepts in building façades and also the reformulation of the architectural project. The aim of this paper is to identify, analyze and evaluate synthetically building pathologies in stone ventilated façades in order to obtain the main technical conditions to be considered in the architectural design, by interpreting its mechanical behavior and capabilities to prevent such pathologies and to ensure the proper features during the building lifetime. The methodology is based on both laboratory stone tests and in situ tests about construction systems, by analyzing physical and mechanical behavior of the outer layer in relation to other building requirements. The results imply the need of proper sizing, specific quality control and practical application of calculation methods, to control high concentration pressures in ventilated façades by reaching appropriate project solutions. In conclusion, the research about different pathologies of stone ventilated façades, the study of their mechanical behavior, their anchorage and their connection with their constructive aspects, will help to improve the construction quality of the stone ventilated façade in buildings and to enhance the use of natural stone in modern architecture.

Precision medicine in patients with allergic diseases: Airway diseases and atopic dermatitis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology

In this consensus document we summarize the current knowledge on major asthma, rhinitis, and atopic dermatitis endotypes under the auspices of the PRACTALL collaboration platform. PRACTALL is an initiative of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology aiming to harmonize the European and American approaches to best allergy practice and science. Precision medicine is of broad relevance for the management of asthma, rhinitis, and atopic dermatitis in the context of a better selection of treatment responders, risk prediction, and design of disease-modifying strategies. Progress has been made in profiling the type 2 immune response-driven asthma. The endotype driven approach for non-type 2 immune response asthma, rhinitis, and atopic dermatitis is lagging behind. Validation and qualification of biomarkers are needed to facilitate their translation into pathway-specific diagnostic tests. Wide consensus between academia, governmental regulators, and industry for further development and application of precision medicine in management of allergic diseases is of utmost importance. Improved knowledge of disease pathogenesis together with defining validated and qualified biomarkers are key approaches to precision medicine.

Truck, bus, and motorcycle safety status methodology: final report. Volume II: technical report.

National Highway Traffic Safety Administration, Washington, D.C.

Automobile inspection, maintenance and repair conference. Proceedings.

National Highway Traffic Safety Administration, Washington, D.C.

Clinical pathology and transfusion medicine guide /

"February 1997"--p. [4] of cover.

Fuel economy improvement through diagnostic inspection. Technical report.

Mode of access: Internet.