Changes in management and outcome of patients with rectal cancer in northern ireland:1996-2006

Aim This study aimed to document developments in rectal cancer services in a UK population and evaluate changes in outcome over a 10-year period.

Method Patients diagnosed with primary rectal carcinoma in 1996, 2001 and 2006 were identified by the Northern Ireland Cancer Registry. Data were retrospectively collected on presentation, investigation, treatment and staging. Differences over the period were analysed using the chi-squared test; Kaplan–Meier and Cox regression tests were used for survival analysis.

Results After exclusions there were 636 patients, including 187 presenting in 1996, 203 in 2001 and 246 in 2006. The use of preoperative MRI of the rectum, endorectal ultrasound and abdominal CT increased during the study period. For patients treated by surgery, total mesorectal excision (TME) increased from 19% in 1996 to 64% in 2006 (P < 0.001). The use of radiotherapy (27% in 1996, 47% in 2006) and chemotherapy (21% in 1996, 32% in 2006) increased. The overall 5-year survival improved significantly between 1996 and 2006 from 34% in 1996 to 45% in 2006 (P = 0.02). Among patients having surgery, 5-year survival increased from 43% in 1996 to 63% in 2006 (P < 0.001). Multivariate analysis showed that the improvement in survival was associated with TME and chemotherapy, while radiotherapy was not.

Conclusion Survival of patients with rectal cancer in Northern Ireland has improved significantly over the last decade, probably due to the increased use of TME and chemotherapy.

Keywords Surgery, rectum, oncology

What does this paper add to the literature?
This population-based study demonstrates a significant improvement in survival over recent years of rectal cancer patients in Northern Ireland. It concludes that surgical resection with TME and chemotherapy have had a significant impact on survival and that the improvement was not due to a stage-migration effect.

The use of theranostic gadolinium-based nanoprobes to improve radiotherapy efficacy

A new efficient type of gadolinium-based theranostic agent (AGuIX®) has recently been developed for MRI-guided radiotherapy (RT). These new particles consist of a polysiloxane network surrounded by a number of gadolinium chelates, usually 10. Owing to their small size (<5 nm), AGuIX typically exhibit biodistributions that are almost ideal for diagnostic and therapeutic purposes. For example, although a significant proportion of these particles accumulate in tumours, the remainder is rapidly eliminated by the renal route. In addition, in the absence of irradiation, the nanoparticles are well tolerated even at very high dose (10 times more than the dose used for mouse treatment). AGuIX particles have been proven to act as efficient radiosensitizers in a large variety of experimental in vitro scenarios, including different radioresistant cell lines, irradiation energies and radiation sources (sensitizing enhancement ratio ranging from 1.1 to 2.5). Pre-clinical studies have also demonstrated the impact of these particles on different heterotopic and orthotopic tumours, with both intratumoural or intravenous injection routes. A significant therapeutical effect has been observed in all contexts. Furthermore, MRI monitoring was proven to efficiently aid in determining a RT protocol and assessing tumour evolution following treatment. The usual theoretical models, based on energy attenuation and macroscopic dose enhancement, cannot account for all the results that have been obtained. Only theoretical models, which take into account the Auger electron cascades that occur between the different atoms constituting the particle and the related high radical concentrations in the vicinity of the particle, provide an explanation for the complex cell damage and death observed.

Cross-participant modelling based on joint or disjoint feature selection: an fMRI conceptual decoding study

Multivariate classification techniques have proven to be powerful tools for distinguishing experimental conditions in single sessions of functional magnetic resonance imaging (fMRI) data. But they are vulnerable to a considerable penalty in classification accuracy when applied across sessions or participants, calling into question the degree to which fine-grained encodings are shared across subjects. Here, we introduce joint learning techniques, where feature selection is carried out using a held-out subset of a target dataset, before training a linear classifier on a source dataset. Single trials of functional MRI data from a covert property generation task are classified with regularized regression techniques to predict the semantic class of stimuli. With our selection techniques (joint ranking feature selection (JRFS) and disjoint feature selection (DJFS)), classification performance during cross-session prediction improved greatly, relative to feature selection on the source session data only. Compared with JRFS, DJFS showed significant improvements for cross-participant classification. And when using a groupwise training, DJFS approached the accuracies seen for prediction across different sessions from the same participant. Comparing several feature selection strategies, we found that a simple univariate ANOVA selection technique or a minimal searchlight (one voxel in size) is appropriate, compared with larger searchlights.

Femoral exostosis causing vastus medialis pain in an active young lady: a case report.

BACKGROUND:
Musculoskeletal conditions are a common reason for consultation to General Practitioners (GPs)/family physicians in primary care. Osteochondromas are the most common benign bone tumours and usually occur in the metaphyseal region of long bones. Despite the distal femur being the commonest location to find these benign bone tumours, this is the first case report in the literature specifically describing vastus medialis muscle pain as the presenting symptom due to underlying bursa formation secondary to local pressure effects.

CASE PRESENTATION:
Twenty nine year old female of white British ethnic origin, presenting to a primary care clinic with a three year history of intermittent left distal medial thigh pain.

CONCLUSION:
The benign bone tumour, femoral exostosis/osteochondroma, was diagnosed via Magnaetic Resonance Imaging (MRI) and treated conservatively, with surgical excision an option if not resolving. GPs/family physicians need to be aware of this diagnosis and that femoral exostosis/osteochondroma can present to primary care physicians, particularly within the second decade of life.

Multifocal remitting-relapsing cerebral demyelination twenty years following allogeneic bone marrow transplantation

We report a case study of a female who received an allogeneic bone marrow transplantation (BMT) from a sex-mismatched related donor and who, after a twenty-year interval, developed an acute fulminant biopsy-proven demyelinating disorder of cerebral white matter which followed a remitting-relapsing chronic course. In situ hybridization studies using Y-chromosome-specific markers revealed Y-chromosome-positive mononuclear cells in biopsy samples of white matter. Magnetic resonance imaging (MRI) studies of the asymptomatic healthy male donor showed multiple white matter lesions. These observations suggest that donor lymphocytes were sensitized to central nervous system (CNS) antigens prior to or at the time of transplantation but remained dormant for 20 years before becoming activated to cause widespread demyelination.

Multigenerational Undernutrition Increases Susceptibility to Obesity and Diabetes that Is Not Reversed after Dietary Recuperation

People in developing countries have faced multigenerational undernutrition and are currently undergoing major lifestyle changes, contributing to an epidemic of metabolic diseases, though the underlying mechanisms remain unclear. Using a Wistar rat model of undernutrition over 50 generations, we show that Undernourished rats exhibit low birth-weight, high visceral adiposity (DXA/MRI), and insulin resistance (hyperinsulinemic-euglycemic clamps), compared to age-/gender-matched control rats. Undernourished rats also have higher circulating insulin, homocysteine, endotoxin and leptin levels, lower adiponectin, vitamin B12 and folate levels, and an 8-fold increased susceptibility to Streptozotocin-induced diabetes compared to control rats. Importantly, these metabolic abnormalities are not reversed after two generations of unrestricted access to commercial chow (nutrient recuperation). Altered epigenetic signatures in insulin-2 gene promoter region of Undernourished rats are not reversed by nutrient recuperation, and may contribute to the persistent detrimental metabolic profiles in similar multigenerational undernourished human populations.

Using Graph Components Derived from an Associative Concept Dictionary to Predict fMRI Neural Activation Patterns that Represent the Meaning of Nouns

In this study, we introduce an original distance definition for graphs, called the Markov-inverse-F measure (MiF). This measure enables the integration of classical graph theory indices with new knowledge pertaining to structural feature extraction from semantic networks. MiF improves the conventional Jaccard and/or Simpson indices, and reconciles both the geodesic information (random walk) and co-occurrence adjustment (degree balance and distribution). We measure the effectiveness of graph-based coefficients through the application of linguistic graph information for a neural activity recorded during conceptual processing in the human brain. Specifically, the MiF distance is computed between each of the nouns used in a previous neural experiment and each of the in-between words in a subgraph derived from the Edinburgh Word Association Thesaurus of English. From the MiF-based information matrix, a machine learning model can accurately obtain a scalar parameter that specifies the degree to which each voxel in (the MRI image of) the brain is activated by each word or each principal component of the intermediate semantic features. Furthermore, correlating the voxel information with the MiF-based principal components, a new computational neurolinguistics model with a network connectivity paradigm is created. This allows two dimensions of context space to be incorporated with both semantic and neural distributional representations.

Prostate cancer radiotherapy: potential applications of metal nanoparticles for imaging and therapy

Prostate cancer (CaP) is the most commonly diagnosed cancer in males. There have been dramatic technical advances in radiotherapy delivery, enabling higher doses of radiotherapy to primary cancer, involved lymph nodes and oligometastases with acceptable normal tissue toxicity. Despite this, many patients relapse following primary radical therapy, and novel treatment approaches are required. Metal nanoparticles are agents that promise to improve diagnostic imaging and image-guided radiotherapy and to selectively enhance radiotherapy effectiveness in CaP. We summarize current radiotherapy treatment approaches for CaP and consider pre-clinical and clinical evidence for metal nanoparticles in this condition.

Prostate cancer (CaP) is the most commonly diagnosed cancer in males and is responsible for more than 10,000 deaths each year in the UK.1 Technical advances in radiotherapy delivery, including image-guided intensity-modulated radiotherapy (IG-IMRT), have enabled the delivery of higher radiation dose to the prostate, which has led to improved biochemical control. Further improvements in cancer imaging during radiotherapy are being developed with the advent of MRI simulators and MRI linear accelerators.2–4

Nanotechnology promises to deliver significant advancements across numerous disciplines.5 The widest scope of applications are from the biomedical field including exogenous gene/drug delivery systems, advanced biosensors, targeted contrast agents for diagnostic applications and as direct therapeutic agents used in combination with existing treatment modalities.6–11 This diversity of application is especially evident within cancer research, with a myriad of experimental anticancer strategies currently under investigation.

This review will focus specifically on the potential of metal-based nanoparticles to augment the efficacy of radiotherapy in CaP, a disease where radiotherapy constitutes a major curative treatment modality.12 Furthermore, we will also address the clinical state of the art for CaP radiotherapy and consider how these treatments could be best combined with nanotherapeutics to improve cancer outcomes.

Do grafema ao gesto : contributos linguísticos para um sistema de síntese de base articulatória

Motivados pelo propósito central de contribuir para a construção, a longo prazo, de um sistema completo de conversão de texto para fala, baseado em síntese articulatória, desenvolvemos um modelo linguístico para o português europeu (PE), com base no sistema TADA (TAsk Dynamic Application), que visou a obtenção automática da trajectória dos articuladores a partir do texto de entrada. A concretização deste objectivo ditou o desenvolvimento de um conjunto de tarefas, nomeadamente 1) a implementação e avaliação de dois sistemas de silabificação automática e de transcrição fonética, tendo em vista a transformação do texto de entrada num formato adequado ao TADA; 2) a criação de um dicionário gestual para os sons do PE, de modo a que cada fone obtido à saída do conversor grafema-fone pudesse ter correspondência com um conjunto de gestos articulatórios adaptados para o PE; 3) a análise do fenómeno da nasalidade à luz dos princípios dinâmicos da Fonologia Articulatória (FA), com base num estudo articulatório e perceptivo. Os dois algoritmos de silabificação automática implementados e testados fizeram apelo a conhecimentos de natureza fonológica sobre a estrutura da sílaba, sendo o primeiro baseado em transdutores de estados finitos e o segundo uma implementação fiel das propostas de Mateus & d'Andrade (2000). O desempenho destes algoritmos – sobretudo do segundo – mostrou-se similar ao de outros sistemas com as mesmas potencialidades. Quanto à conversão grafema-fone, seguimos uma metodologia baseada em regras de reescrita combinada com uma técnica de aprendizagem automática. Os resultados da avaliação deste sistema motivaram a exploração posterior de outros métodos automáticos, procurando também avaliar o impacto da integração de informação silábica nos sistemas. A descrição dinâmica dos sons do PE, ancorada nos princípios teóricos e metodológicos da FA, baseou-se essencialmente na análise de dados de ressonância magnética, a partir dos quais foram realizadas todas as medições, com vista à obtenção de parâmetros articulatórios quantitativos. Foi tentada uma primeira validação das várias configurações gestuais propostas, através de um pequeno teste perceptual, que permitiu identificar os principais problemas subjacentes à proposta gestual. Este trabalho propiciou, pela primeira vez para o PE, o desenvolvimento de um primeiro sistema de conversão de texto para fala, de base articulatória. A descrição dinâmica das vogais nasais contou, quer com os dados de ressonância magnética, para caracterização dos gestos orais, quer com os dados obtidos através de articulografia electromagnética (EMA), para estudo da dinâmica do velo e da sua relação com os restantes articuladores. Para além disso, foi efectuado um teste perceptivo, usando o TADA e o SAPWindows, para avaliar a sensibilidade dos ouvintes portugueses às variações na altura do velo e alterações na coordenação intergestual. Este estudo serviu de base a uma interpretação abstracta (em termos gestuais) das vogais nasais do PE e permitiu também esclarecer aspectos cruciais relacionados com a sua produção e percepção.

Multifunctional nanoparticles for MR and fluorescence imaging

In the past few years a new generation of multifunctional nanoparticles (NPs) has been proposed for biomedical applications, whose structure is more complex than the structure of their predecessor monofunctional counterparts. The development of these novel NPs aims at enabling or improving the performance in imaging, diagnosis and therapeutic applications. The structure of such NPs comprises several components exhibiting various functionalities that enable the nanoparticles to perform multiple tasks simultaneously, such as active targeting of certain cells or compartmentalization, imaging and delivery of active drugs. This thesis presents two types of bimodal bio-imaging probes and describes their physical and chemical properties, namely their texture, structure, and 1H dynamics and relaxometry, in order to evaluate their potential as MRI contrast agents. The photoluminescence properties of these probes are studied, aiming at assessing their interest as optical contrast agents. These materials combine the properties of the trivalent lanthanide (Ln3+) complexes and nanoparticles, offering an excellent solution for bimodal imaging. The designed T1- type contrast agent are SiO2@APS/DTPA:Gd:Ln or SiO2@APS/PMN:Gd:Ln (Ln= Eu or Tb) systems, bearing the active magnetic center (Gd3+) and the optically-active ions (Eu3+ and Tb3+) on the surface of silica NPs. Concerning the relaxometry properties, moderate r1 increases and significant r2 increases are observed in the NPs presence, especially at high magnetic fields, due to susceptibility effects on r2. The Eu3+ ions reside in a single low-symmetry site, and the photoluminescence emission is not influenced by the simultaneous presence of Gd3+ and Eu3+. The presence of Tb3+, rather than Eu3+ ion, further increases r1 but decreases r2. The uptake of these NPs by living cells is fast and results in an intensity increase in the T1-weighted MRI images. The optical features of the NPs in cellular pellets are also studied and confirm the potential of these new nanoprobes as bimodal imaging agents. This thesis further reports on a T2 contrast agent consisting of core-shell NPs with a silica shell surrounding an iron oxide core. The thickness of this silica shell has a significant impact on the r2 and r2* relaxivities, and a tentative model is proposed to explain this finding. The cell viability and the mitochondrial dehydrogenase expression given by the microglial cells are also evaluated.

Ressonância magnética em estudos de produção de fala

Estudar os mecanismos subjacentes à produção de fala é uma tarefa complexa e exigente, requerendo a obtenção de dados mediante a utilização de variadas técnicas, onde se incluem algumas modalidades imagiológicas. De entre estas, a Ressonância Magnética (RM) tem ganho algum destaque, nos últimos anos, posicionando-se como uma das mais promissoras no domínio da produção de fala. Um importante contributo deste trabalho prende-se com a otimização e implementação de protocolos (RM) e proposta de estratégias de processamento de imagem ajustados aos requisitos da produção de fala, em geral, e às especificidades dos diferentes sons. Para além disso, motivados pela escassez de dados para o Português Europeu (PE), constitui-se como objetivo a obtenção de dados articulatórios que permitam complementar informação já existente e clarificar algumas questões relativas à produção dos sons do PE (nomeadamente, consoantes laterais e vogais nasais). Assim, para as consoantes laterais foram obtidas imagens RM (2D e 3D), através de produções sustidas, com recurso a uma sequência Eco de Gradiente (EG) rápida (3D VIBE), no plano sagital, englobando todo o trato vocal. O corpus, adquirido por sete falantes, contemplou diferentes posições silábicas e contextos vocálicos. Para as vogais nasais, foram adquiridas, em três falantes, imagens em tempo real com uma sequência EG - Spoiled (TurboFLASH), nos planos sagital e coronal, obtendo-se uma resolução temporal de 72 ms (14 frames/s). Foi efetuada aquisição sincronizada das imagens com o sinal acústico mediante utilização de um microfone ótico. Para o processamento e análise de imagem foram utilizados vários algoritmos semiautomáticos. O tratamento e análise dos dados permitiu efetuar uma descrição articulatória das consoantes laterais, ancorada em dados qualitativos (e.g., visualizações 3D, comparação de contornos) e quantitativos que incluem áreas, funções de área do trato vocal, extensão e área das passagens laterais, avaliação de efeitos contextuais e posicionais, etc. No que respeita à velarização da lateral alveolar /l/, os resultados apontam para um /l/ velarizado independentemente da sua posição silábica. Relativamente ao /L/, em relação ao qual a informação disponível era escassa, foi possível verificar que a sua articulação é bastante mais anteriorizada do que tradicionalmente descrito e também mais extensa do que a da lateral alveolar. A resolução temporal de 72 ms conseguida com as aquisições de RM em tempo real, revelou-se adequada para o estudo das características dinâmicas das vogais nasais, nomeadamente, aspetos como a duração do gesto velar, gesto oral, coordenação entre gestos, etc. complementando e corroborando resultados, já existentes para o PE, obtidos com recurso a outras técnicas instrumentais. Para além disso, foram obtidos novos dados de produção relevantes para melhor compreensão da nasalidade (variação área nasal/oral no tempo, proporção nasal/oral). Neste estudo, fica patente a versatilidade e potencial da RM para o estudo da produção de fala, com contributos claros e importantes para um melhor conhecimento da articulação do Português, para a evolução de modelos de síntese de voz, de base articulatória, e para aplicação futura em áreas mais clínicas (e.g., perturbações da fala).

Soft-computing techniques applied to artificial tissue temperature estimation

Tese dout., Engenharia electrónica e computação - Processamento de sinal, Universidade do Algarve, 2008

Radiographers perceptions of magnetic resonance imaging: a study of the causes that lead to the exams repetition

Purpose: To know how often occur the repetitions of MRI exams and sequences in radiology departments. Methods and Materials: A self applied-questionnaire was used as instrument and assigned to 57 radiographers who performed MRI exams to determine which were the causes that lead to the repetition. The questionnaires were interpreted and statistically analyzed through descriptive statistics and Spearman’s rho correlations. Results: At a 95% confidence interval, the major results suggest that the patient’s movement during de MRI exams is the main cause to repeat this exams (mean of 3.88 on a 5 points likert scale). However, there are causes related to the radiographer’s and the results showed that the introduction of wrong imaging parameters by the performer are a major cause too (N=26). Spearman rho correlations between radiographer’s time of experience and frequency of MRI exams repetitions were poor and not significant (r=0.141; p=0.297). The correlations between radiographer’s tiredness and frequency of MRI exams repetitions were negative, weak and not significant (r= -0.151; p=0.263). Conclusion: The patients’ movement may disrupt the examination or degrade the images with artifacts. The level of experience doesn’t influence the repetitions of MRI exams, it seems that seniors radiographers don’t have improvements in performance as it should be expected. It’s recommendable to do training courses regularly to improve the performance and systematically evaluate. Several features will need to be identified which would decrease the MRI exams repetitions.

Drug repurposing in the treatment of Melanoma Brain Metastasis

Dissertação de Mestrado, Biologia Molecular e Microbiana, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2015

Intelligent modelling of temperature propagation induced by therapeutic ultrasound

Dissertação de Mestrado, Engenharia Electrónica e Telecomunicações, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2015