Improved Filtering of Pulse Oximeter Monitoring Alarms in the Neonatal ICU: Bedside Significance

BACKGROUND:The OxiMax N-600x containing SatSeconds alarm management software was designed to assist clinicians in discriminating nuisance alarms from those that are clinically relevant. Instead of sounding an alarm the moment the oxygen saturation reading violates the upper or lower limit settings, a magnitude and duration of tolerance can be set. The primary objective was to study the proportion of nuisance alarms relative to the proportion of clinically relevant alarms being filtered under 4 different SatSeconds alarm settings (ie, 10, 25, 50, and 100) in the neonatal intensive care environment.METHODS:This is an observational prospective study of 50 infants cared for in 3 large neonatal ICUs. Infants were monitored for 4 continuous h each by a study observer with the study monitor, in addition to standard multiparameter monitors. The performance of the SatSeconds alarm was compared with nursing intervention.RESULTS:The area under the receiver operating characteristic curve (95% CI) for SatSeconds alarm settings when compared with nursing intervention were as follows: 0.61 (0.57–0.66) when the SatSeconds alarm setting was off, 0.63 (0.59–0.68) for the 10 SatSeconds alarm setting, 0.64 (0.59–0.69) for the 25 SatSeconds alarm setting, 0.64 (0.59–0.69) for the 50 SatSeconds alarm setting, and 0.63 (0.58–0.68) for the 100 SatSeconds alarm setting, respectively.CONCLUSIONS:The SatSeconds feature of the OxiMax N-600x pulse oximeter reduced some nuisance alarms; however, its specificity to nurse-identified desaturation events does not significantly improve with lengthening SatSeconds alarm settings.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1QtWCtH
via IFTTT

Patient-Ventilator Interaction During Noninvasive Ventilation in Simulated COPD

BACKGROUND:During noninvasive ventilation (NIV) of COPD patients, delayed off-cycling of pressure support can cause patient ventilator mismatch and NIV failure. This systematic experimental study analyzes the effects of varying cycling criteria on patient-ventilator interaction.METHODS:A lung simulator with COPD settings was connected to an ICU ventilator via helmet or face mask. Cycling was varied between 10 and 70% of peak inspiratory flow at different breathing frequencies (15 and 30 breaths/min) and pressure support levels (5 and 15 cm H2O) using the ventilator's invasive and NIV mode with and without an applied leakage.RESULTS:Low cycling criteria led to severe expiratory cycle latency. Augmenting off-cycling reduced expiratory cycle latency (P < .001), decreased intrinsic PEEP, and avoided non-supported breaths. Setting cycling to 50% of peak inspiratory flow achieved best synchronization. Overall, using the helmet interface increased expiratory cycle latency in almost all settings (P < .001). Augmenting cycling from 10 to 40% progressively decreased expiratory pressure load (P < .001). NIV mode decreased expiratory cycle latency compared with the invasive mode (P < .001).CONCLUSION:Augmenting the cycling criterion above the default setting (20–30% peak inspiratory flow) improved patient ventilator synchrony in a simulated COPD model. This suggests that an individual approach to cycling should be considered, since interface, level of pressure support, breathing frequency, and leakage influence patient-ventilator interaction and thus need to be considered.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1QtWCtE
via IFTTT

Get Fit for Lung Transplant With Ambulatory Extracorporeal Membrane Oxygenation!

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ZfwF2a
via IFTTT

Perception of Asthma Symptoms as Assessed on the Visual Analog Scale in Subjects With Asthma: A Real-Life Study

BACKGROUND:The perception of symptoms is a cornerstone in asthma management, but studies concerning this aspect provide conflicting evidence. The visual analog scale has been proposed as a useful tool for assessing perception of respiratory symptoms. The present study investigated whether visual analog scale assessment of perception of asthma symptoms was correlated to lung function or clinical features.METHODS:This cross-sectional study enrolled 388 subjects with asthma (159 males; mean age 39.7 y). Perception of asthma symptoms was assessed by the visual analog scale; lung function was measured by spirometry. Asthma control was evaluated by the asthma control test. Anxiety and depression were evaluated on the Hospital Anxiety and Depression Scale questionnaire.RESULTS:Asthma was well controlled in 46.6% of subjects. Asthma symptoms in the prior month were reported by 59% of subjects; asthma signs were detected in 7.2%. The visual analog scale score was moderately correlated to FEV1 (r = 0.43). Subjects with bronchial obstruction had lower visual analog scale values than those without (P < .001). A visual analog scale score of 6 was a reliable cutoff point to discriminate subjects with bronchial obstruction (area under the curve = 0.71 at receiver operating characteristic curve; odds ratio [OR] = 7.58). Reported asthma symptoms (OR = 4.83), asthma signs (OR = 8.36), and anxiety (OR = 1.14) were predictive of a visual analog scale score of <6.CONCLUSIONS:This real-life study found that assessment of asthma symptoms by the visual analog scale might be a reliable tool in managing patients with asthma.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1QtWACb
via IFTTT

Editor's Commentary

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ZfwG6p
via IFTTT

Liberal Manipulation of Ventilator Settings and Its Impact on Tracheostomy Rate and Ventilator-Free Days

BACKGROUND:The utilization of checklists, bundles, and protocols attempts to provide standardization in the delivery of patient care. Despite important progress obtained in the prevention of hospital-acquired infections, the daily management of mechanical ventilation is still prone to heterogeneity, depending on the number of providers manipulating the ventilator. Whether the number of changes made on ventilator parameters impacts clinical outcomes remains unknown.METHODS:A quality improvement project was designed to assess whether liberal manipulations of ventilator settings affect the rate of tracheostomy and 28 ventilator-free days. Over the course of 7 d, respiratory therapists recorded all ventilator changes in newly ventilated subjects. Ventilator changes were considered as major changes if manipulations included changes in the mode of ventilation. Minor changes included manipulations of settings within the same mode of ventilation. We evaluated whether the number of total and major changes affected clinical outcomes. Logistic regression was used for multivariate analysis.RESULTS:One-hundred seventeen ventilator manipulations were recorded among 54 subjects. Of those 117 ventilator changes, 35% were major manipulations. For every major ventilator manipulation, the odds of requiring tracheostomy increased 4.95 times. Furthermore, for every major ventilator change, there was an 18.6% decrease in 28 ventilator-free days. These associations were found after adjustments by APACHE (Acute Physiology and Chronic Health Evaluation) II score, body mass index, and type of ICU. The total number of changes was not associated with either primary outcome measure.CONCLUSIONS:The number of major ventilator manipulations is associated with rate of tracheostomy and stay on the ventilator.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1QtWCd1
via IFTTT

Zinc Supplementation for One Year Among Children with Cystic Fibrosis Does Not Decrease Pulmonary Infection

BACKGROUND:Children with cystic fibrosis may have a deficiency of micronutrients, including zinc, which may affect their susceptibility to infections. There is a paucity of data on zinc supplementation among children with cystic fibrosis. We hypothesized that a pharmacologic dose of zinc administered daily for 12 months would reduce the need for antibiotics by 50%.METHODS:This double-blind randomized placebo-controlled trial was conducted among children with cystic fibrosis to assess the effect of zinc supplementation on the need for antibiotics and pulmonary function tests. The children, age 5–15 y, of either sex, received either 30-mg zinc tablets or similar looking placebo tablets daily in addition to standard care. They were followed up every month for a period of 12 months and whenever they had pulmonary exacerbations. Their serum zinc was estimated at baseline and at 12 months of enrollment. During each visit, the children underwent a pulmonary function test and sputum culture.RESULTS:Of a total of 43 children screened, 40 were enrolled, and of them, 37 completed the study. The median (interquartile range) number of days of the administration of antibiotics over 12 months of follow-up among the children receiving zinc was 42 (14–97) d. In the placebo group, it was 38 (15–70) d (P = .79). There were no significant differences in the percent-of-predicted FEV1 or change in FEV1 values at 12 months (P = .44). The number of children in whose respiratory specimens Pseudomonas was isolated was similar for the 2 groups at different time intervals. The adverse events reported were similar in the 2 groups.CONCLUSION:We did not find any significant difference in the need for antibiotics, pulmonary function tests, hospitalization, colonization with Pseudomonas, or the need for antibiotics for children with cystic fibrosis receiving zinc supplementation of 30 mg/d.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1QtWAly
via IFTTT

Use and Outcomes of Noninvasive Ventilation for Acute Respiratory Failure in Different Age Groups

BACKGROUND:The prevalence of chronic disease and do-not-intubate status increases with age. Thus, we aimed to determine characteristics and outcomes associated with noninvasive ventilation (NIV) use for acute respiratory failure (ARF) in different age groups.METHODS:A database comprising prospective data collected on site on all adult patients with ARF requiring ventilatory support from 8 acute care hospitals in Massachusetts was used.RESULTS:From a total of 1,225 ventilator starts, overall NIV utilization, success, and in-hospital mortality rates were 22, 54, and 18% in younger (18–44 y); 34, 65, and 13% in middle-aged (45–64 y); 49, 68, and 17% in elderly (65–79 y); and 47, 76, and 24% in aged (≥80 y) groups, respectively (P < .001, P = .08, and P = .11, respectively). NIV use for cardiogenic pulmonary edema and subjects with a do-not-intubate order increased significantly with advancing age (25, 57, 57, and 74% and 7, 12, 18, and 31%, respectively, in the 4 age groups [P < .001 and P = .046, respectively]). For subjects receiving NIV with a do-not-intubate order, success and in-hospital mortality rates were similar in different age groups (P = .27 and P = .98, respectively).CONCLUSIONS:NIV use and a do-not-intubate status are more frequent in subjects with ARF ≥65 y than in those <65 y, especially for subjects with cardiogenic pulmonary edema. However, NIV success and mortality rates were similar between age groups. (ClinicalTrials.gov registration NCT00458926.)

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ZfwG6h
via IFTTT

Neonatal Transcutaneous Carbon Dioxide Monitoring—Effect on Clinical Management and Outcomes

BACKGROUND:This work aimed to compare frequency of blood gas measurements per day of mechanical ventilation, occurrence of extreme blood gas CO2 values, and clinical outcomes among ventilated neonates managed with and without transcutaneous carbon dioxide (PtcCO2) monitors. This work also measures agreement between simultaneous PtcCO2 and blood gas CO2 measurements and ascertains factors that affect agreement.METHODS:This is a cohort study with retrospective analysis comparing 5,726 blood gas measurements and clinical outcomes for 123 neonates intubated for >48 h before and after the introduction of transcutaneous carbon-di-oxide monitoring devices in a single tertiary care unit.RESULTS:Median (interquartile range) blood gas frequency per mechanical ventilation day was 3.9 (2.6–5.3) and 2.9 (2.1–4.0) before and after PtcCO2 monitoring (P = .002) without differences in clinical outcomes at discharge. After adjusting for confounders using Poisson regression, this difference remained significant. The mean ± 2 SD blood gas-PtcCO2 difference was −5.2 ± 17.3 mm Hg. 64% of simultaneous blood gas-PtcCO2 measurements per subject were within ±7 mm Hg. Greater bias was noted with arterial sample and during the use of high-frequency ventilation.CONCLUSION:Despite only moderate agreement between simultaneous PtcCO2 and blood gas measurements, PtcCO2 monitoring statistically decreased blood gas frequency among ventilated neonates without affecting the duration of mechanical ventilation or clinical outcomes at discharge. The clinical impact of this technology appears to be minimal.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1QtWBWt
via IFTTT

The Role of Mean Platelet Volume in Chronic Obstructive Pulmonary Disease Exacerbation

BACKGROUND:Studies have supported the correlation between mean platelet volume and COPD. However, there are limited data on the relationship between COPD exacerbation and mean platelet volume. We aimed to evaluate the mean platelet volume trend in patients with COPD exacerbation.METHODS:A total of 81 subjects, 62 men and 19 women, who were admitted to the hospital because of exacerbation of COPD during 9 months, were enrolled in this prospective observational study. The levels of mean platelet volume, C-reactive protein, complete blood count, and percent-of-predicted FEV1 were measured in subjects at admission (exacerbation period) and after 3 months (stable period). Thirty-seven age- and sex-matched healthy individuals constituted the control group.RESULTS:Subjects in the exacerbation period had significantly higher levels of C-reactive protein (P = .001), white blood cell count (P = .01), and percentage of neutrophils (P = .01) and lower percent-of-predicted FEV1 than in the stable period (P = .02). Mean platelet volume levels were significantly decreased in the exacerbation period (P = .001). Considering a cut-off point of mean platelet volume levels <8.2 fL for indicating COPD exacerbation showed a sensitivity of 80% and a specificity of 76%. Also, mean platelet volume levels correlated significantly with increase of C-reactive protein level, white blood cell count, and neutrophil percentage in the exacerbation period (P = .01, P = .01, and P = .02, respectively).CONCLUSIONS:Mean platelet volume may be an inflammatory marker in exacerbation of COPD, and the measurement of mean platelet volume values may be useful for identifying patients who are at increased risk for exacerbations of illness.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ZfwG69
via IFTTT

Asthma Control Assessment Tools

Both the National Asthma Education and Prevention Program Expert Panel Report 3 and the 2015 Global Initiative for Asthma guidelines identify achieving and maintaining asthma control as goals of therapy, and they emphasize periodic assessment of asthma control once treatment is established. Accurate assessment of asthma control is difficult due to the complexity of asthma control and due to the limitations in the traditional methods of assessment, such as lung function tests, physician assessment, and patients' self-assessment. Relying solely on the role of lung function tests is insufficient to reflect the status of asthma control, since patients with asthma may have normal spirometry between exacerbations. Clinicians often overestimate the level of asthma control. Similarly, it is not uncommon for patients to overestimate how well their asthma is controlled, and, therefore, they under-report asthma symptoms and fail to recognize the impact that asthma has on their daily life. As a result, several tools have been developed to quantify the level of asthma control, identify patients at risk, and evaluate the effect of asthma management. This review examines the commonly used asthma control assessment tools in terms of content, psychometric properties, methods of administration, limitations, and ability to reflect the overall status of asthma control, which can aid clinicians in selecting the most appropriate tool for their needs.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1QtWBG3
via IFTTT

Effects of Inspiratory Muscle Training and Calisthenics-and-Breathing Exercises in COPD With and Without Respiratory Muscle Weakness

BACKGROUND:Patients with COPD may experience respiratory muscle weakness. Two therapeutic approaches to the respiratory muscles are inspiratory muscle training and calisthenics-and-breathing exercises. The aims of the study are to compare the effects of inspiratory muscle training and calisthenics-and-breathing exercises associated with physical training in subjects with COPD as an additional benefit of strength and endurance of the inspiratory muscles, thoracoabdominal mobility, physical exercise capacity, and reduction in dyspnea on exertion. In addition, these gains were compared between subjects with and without respiratory muscle weakness.METHODS:25 subjects completed the study: 13 composed the inspiratory muscle training group, and 12 composed the calisthenics-and-breathing exercises group. Subjects were assessed before and after training by spirometry, measurements of respiratory muscle strength and test of inspiratory muscle endurance, thoracoabdominal excursion measurements, and the 6-min walk test. Moreover, scores for the Modified Medical Research Council dyspnea scale were reported.RESULTS:After intervention, there was a significant improvement in both groups of respiratory muscle strength and endurance, thoracoabdominal mobility, and walking distance in the 6-min walk test. Additionally, there was a decrease of dyspnea in the 6-min walk test peak. A difference was found between groups, with higher values of respiratory muscle strength and thoracoabdominal mobility and lower values of dyspnea in the 6-min walk test peak and the Modified Medical Research Council dyspnea scale in the inspiratory muscle training group. In the inspiratory muscle training group, subjects with respiratory muscle weakness had greater gains in inspiratory muscle strength and endurance.CONCLUSIONS:Both interventions increased exercise capacity and decreased dyspnea during physical effort. However, inspiratory muscle training was more effective in increasing inspiratory muscle strength and endurance, which could result in a decreased sensation of dyspnea. In addition, subjects with respiratory muscle weakness that performed inspiratory muscle training had higher gains in inspiratory muscle strength and endurance but not of dyspnea and submaximal exercise capacity. (ClinicalTrials.gov registration NCT01510041.)

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ZfwFPR
via IFTTT

Circumstances When Arterial Blood Gas Analysis Can Lead Us Astray

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1QtWA4S
via IFTTT

Cough Augmentation in Subjects With Duchenne Muscular Dystrophy: Comparison of Air Stacking via a Resuscitator Bag Versus Mechanical Ventilation

BACKGROUND:Air stacking improves cough effectiveness in people with Duchenne muscular dystrophy (DMD) and respiratory muscle weakness. However, it is not known whether air stacking is more effective via a resuscitator bag or a home ventilator.METHODS:This prospective randomized study investigated the effect of air stacking via a volume-cycled home ventilator versus via a resuscitator bag in participants with DMD. Maximum insufflation capacity and peak expiratory flow during spontaneous (cough peak flow) and air stacking-assisted cough maneuvers (air stacking-assisted cough peak flow) were measured.RESULTS:Fifty-two adult DMD subjects receiving noninvasive ventilation were included in the study: 27 participants performed air stacking via their home ventilator (home-ventilator group; age = 25.3 ± 5.1 y; forced vital capacity (FVC) = 809 ± 555 mL), and 25 participants used a resuscitator bag (resuscitator-bag group; age = 24.7 ± 5.7 y, FVC = 807 ± 495 mL). Following a single training session, air stacking could be performed successfully by 89% (home ventilator) and 88% (resuscitator bag) of participants. There were comparable maximum insufflation capacities (1,481 mL for the home-ventilator group vs 1,344 mL for the resuscitator-bag group, P = .33) and mean air stacking-assisted cough peak flow values (199 L/min for the home-ventilator group vs 186 L/min for the resuscitator-bag group, P = .33) between techniques. Air stacking-assisted cough peak flow increased significantly compared with baseline in both groups (mean increase: +51% [home ventilator] vs +49% [resuscitator bag], P < .001), with individual air stacking-assisted cough peak flow improvements ranging from −20 to 245%.CONCLUSIONS:Cough augmentation is an important component of the respiratory management of people with a neuromuscular disorder. No difference in cough effectiveness as measured by air stacking-assisted cough peak flow was found in air stacking via a ventilator compared with via a resuscitator bag. Both methods achieved mean air stacking-assisted cough peak flow values of >160 L/min. Provision of an inexpensive resuscitator bag can effectively improve cough capacity, and it is simple to use, which may improve access to respiratory care in people with DMD.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ZfwFPK
via IFTTT

Estrogen enhances esophageal barrier function by potentiating occludin expression

Digestive Diseases and Sciences

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ObrGrj
via IFTTT

10- or 14-day sequential therapy vs. 14-day triple therapy in the first line treatment of Helicobacter pylori infection

Alimentary Pharmacology and Therapeutics

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1IYbmxY
via IFTTT

Impact of rising grades of internal rectal intussusception on fecal continence and symptoms of constipation

Diseases of the Colon and Rectum

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ObrHvn
via IFTTT

Non-invasive fatty liver markers predict liver disease mortality in the United States population

Hepatology

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1IYbmhD
via IFTTT

Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis

The Lancet Oncology

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ObrHeY
via IFTTT

Phase 2 study of adjuvant chemotherapy with docetaxel, capecitabine, and cisplatin in patients with curatively resected stage IIIB–IV gastric cancer

Gastric Cancer

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ObrHeP
via IFTTT

Plasma induced signatures reveal an extracellular milieu possessing an immunoregulatory bias in treatment-naïve pediatric inflammatory bowel disease

Clinical and Experimental Immunology

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1IYbm19
via IFTTT

Prevalence of Non-Alcoholic Fatty Pancreas Disease (NAFPD) and its risk factors among adult medical check-up patients in a private hospital: a large cross sectional study

BMC Gastroenterology

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ObrFUl
via IFTTT

Clinical patterns and progression of ulcerative proctitis in the Japanese population: A retrospective study of incidence and risk factors influencing progression

Colorectal Disease

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1IYbjCr
via IFTTT

Effects of administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer

Gastric Cancer

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ObrFU8
via IFTTT

Cefoxitin plasma and subcutaneous adipose tissue concentration in patients undergoing sleeve gastrectomy

Clinical Therapeutics

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1IYblKp
via IFTTT

Diet, weight loss, and liver health in NAFLD: Pathophysiology, evidence and practice

Hepatology

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1ObrE2y
via IFTTT

Perceptual subcategories within non-native English

Publication date: March 2016
Source:Journal of Phonetics, Volume 55
Author(s): Elizabeth A. McCullough, Cynthia G. Clopper
Listeners׳ ability to distinguish native from non-native speech has been robustly attested, but less is known about the nature of perceptual subcategories within non-native speech. This study examined American English-speaking listeners׳ abilities to perform auditory free classification by talker native language (L1) background on the basis of CV- and word-length excerpts of English productions by L1 American English, L1 Hindi, L1 Korean, L1 Mandarin, and L1 Spanish talkers. Results are examined in terms of classification accuracy and perceptual similarity, and the phonetic properties predicting listeners׳ classification responses are explored. Overall, L1 American English talkers were grouped together, as were L1 Hindi talkers. Talkers from L1 Korean and L1 Mandarin were perceptually similar to one another, although they did not comprise a single shared group. Deviation from native norms in VOT and in spectral and temporal properties of vowels predicted listeners׳ classification responses. These results suggest that listeners can use specific phonetic properties of the speech signal to group talkers on the basis of very little input, and that L1 Hindi talkers form a clear and consistent subcategory of non-native talkers for American English-speaking listeners.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Pav60M
via IFTTT

P-centres in natural disyllabic Czech words in a large-scale speech-metronome synchronization experiment

Publication date: March 2016
Source:Journal of Phonetics, Volume 55
Author(s): Pavel Šturm, Jan Volín
The difficulty of pinpointing a specific event within words that would correspond to the p-centre is well known. The current experiment, investigating the position of p-centres in Czech, aims to replicate the findings from English and several other languages, and substantially increase the range of phonotactic types and the number of participants. In a speech-metronome synchronization task, 24 subjects pronounced a set of 37 natural disyllabic Czech words of differing complexity at two metronome rates. The beginning of the first vowel (V1) and the moment of the fastest increase in energy within the first syllable were the most consistent synchronization points, but the p-centre occurred earlier than at the V1 initial boundary. Synchronization intervals were significantly influenced by the complexity of the syllabic onset: the p-centre was positioned earlier (further from the V1) as more consonants were included in the onset. The effects of vowel length and final coda were also present, but weaker. In addition, various aspects of human musicality were found to correlate with the ability of speakers to synchronize their articulations with an isochronous auditory sequence.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Pav60G
via IFTTT

Selection and coordination: The articulatory basis for the emergence of phonological structure

Publication date: March 2016
Source:Journal of Phonetics, Volume 55
Author(s): Sam Tilsen
Phonological theories commonly analyze speech utterances as composed of hierarchically organized units, such as features/gestures, segments, moras, and syllables, but it is not well understood why this hierarchical organization is observed. Moreover, current phonological theories and speech production models fail to explain cross-linguistic and developmental variation in the organization of units. This paper presents the selection-coordination theory of speech production, which attempts to unify our understanding of developmental and cross-linguistic variation in phonological structure. The theory holds that hierarchical organization emerges from a recurring trend in speech development whereby children acquire coordinative regimes of control over articulatory gestures that were previously competitively selected. In this framework, segments, moras, and syllables are understood as differently-sized instantiations of the same type of motor planning unit, and cross-linguistic and developmental phonological patterns are derived from distinguishing competitive and coordinative regimes of articulatory control. Evidence for the theory is drawn from research in motor control, speech development, and phonological and phonetic patterns in speech.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Pav5Ko
via IFTTT

Investigating the use of formant frequencies in listener judgments of speaker size

Publication date: March 2016
Source:Journal of Phonetics, Volume 55
Author(s): Santiago Barreda
The formant-pattern present in a given vowel sound will be determined by the vocal-tract length (VTL) of the speaker as well as by phoneme-specific information. Although human listeners tend to associate lower formant-frequencies with larger speakers, it is unclear whether they are responding to VTL information in speech sounds, or simply responding to the formant-pattern present in the sound. In this experiment listeners were presented with pairs of synthetic vowels from the set of (/i æ ʊ/), which could differ on the basis of simulated VTL and vowel category, within-pair. Listeners were divided into groups based on the number of formants contained by stimulus vowels (2, 3, 4, and 5-formant vowel groups). For each trial, listeners were asked to indicate which vowel sounded like it had been produced by a taller speaker. Results indicate that listeners do not rely solely on VTL cues when making speaker-size judgments, and that they exhibit biases towards selecting given phonemes as taller, even when contrary to the VTL differences between the voices. Furthermore, the higher formants (up to F5) are used by listeners when making speaker-size judgments, though not in a manner consistent with VTL-based speaker-size judgments.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1QwVCEV
via IFTTT

Clinical value of fat-suppressed 3D volume isotropic spin-echo (VISTA) sequence compared to 2D sequence in evaluating internal structures of the knee

Background

Although many three-dimensional (3D) magnetic resonance imaging (MRI) sequences have been used in the clinical field, there are no studies on fat-suppressed (FS) 3D sequences for the diagnosis of knee abnormalities.

Purpose

To evaluate the usefulness of FS 3D volume isotropic turbo spin echo acquisition (VISTA) imaging for diagnosis of internal structures of knee.

Material and Methods

In 137 patients with 138 knee MRI examinations who had undergone both FS 3D VISTA MRI and two-dimensional (2D) MRI of the knee at 3.0 T, arthroscopic surgery was subsequently performed. Multiplanar reformations (MPR) of FS 3D VISTA images and their MPR sequences were compared with 2D MR images of axial T1-weighted (T1W) images, axial FS T2-weighted (T2W) images, coronal FS T2W images, and sagittal T2W images. Two musculoskeletal radiologists reviewed the images independently.

Results

Arthroscopy revealed 33 anterior cruciate ligament tears, three posterior cruciate ligament tears, 42 lateral meniscus tears, and 68 medial meniscus tears. Five medial collateral ligament tears were clinically confirmed. Image acquisition time was shorter for FS 3D VISTA imaging than 2D imaging. There were no significant differences in diagnostic values between FS 3D VISTA and 2D imaging (P > 0.05). There were excellent inter-observer agreements for both FS 3D VISTA and 2D imaging ( > 0.84).

Conclusion

FS 3D VISTA imaging could replace 2D imaging because of equal diagnostic ability and shorter scan time.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RsWieC
via IFTTT

Pediatric Radiology Casebase

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RsWiet
via IFTTT

Editorial

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Jga9x1
via IFTTT

Radiological-pathological correlation of yolk sac tumor in 20 patients

Background

Yolk sac tumor (YST) is a rare tumor. Familiarity of its radiological characteristics may permit preoperative diagnosis and improve surgical management of patients. However, a detailed description of the imaging features of YST with pathological correlation in particular is scarce.

Purpose

To investigate computed tomography (CT) findings of YSTs with pathological correlation.

Material and Methods

CT images of 20 patients with pathologically proven YST were retrospectively reviewed. The location, size, margin, internal architecture, and pattern and degree enhancement of the lesion were evaluated. Radiological findings were correlated with pathological results.

Results

The locations of 20 tumors were distributed between the testis (n = 3), ovary (n = 6), sacrococcygeal area (n = 6), rectum (n = 1), and mediastinum (n = 4). The median age was 13 years. On CT images, all tumors were seen as oval (n = 14) or irregular (n = 6), well-defined (n = 16) or ill-defined (n = 4) masses with a mean size of 9.7 cm. The lesions were solid cystic (n = 10), entirely solid (n = 6), or predominantly cystic (n = 4). Intratumoral hemorrhage, calcification, and fatty tissue were seen in nine, three, and two tumors, respectively. Discontinuity of the tumor wall was seen in eight tumors. After contrast media administration, most tumors showed heterogeneous moderate to marked enhancement (n = 7) or heterogeneous marked enhancement (n = 9). Enlarged intratumoral vessels were seen in 17 tumors.

Conclusion

YST usually appears as a large solid-cystic mass with intratumoral hemorrhage, capsular tear, marked heterogeneous enhancement, and enlarged intratumoral vessels on CT images. Intratumoral calcification and fatty tissue, although rare, may indicate a mixed YST containing teratoma component.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RsWjix
via IFTTT

Modern radiology and the use of resources. Too much technology (?) - Not at all

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RsWj27
via IFTTT

CT characteristics in 24 patients with POEMS syndrome

Background

POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, M protein, and Skin changes) syndrome is a complicated and rare disease. Systematic research on computed tomography (CT) imaging characteristics in POEMS syndrome is scanty. The role of CT in diagnosis needs to be assessed.

Purpose

To retrospectively analyze the CT imaging features in 24 patients with POEMS syndrome and evaluate the role of CT in diagnosis of this disease.

Material and Methods

Twenty-four patients with confirmed POEMS syndrome were included in the study. Chest and abdominal CT images were analyzed.

Results

The three minor diagnostic criteria for POEMS syndrome (extravascular volume overload, organomegaly, and bone lesions) can be detected effectively by CT. Extravascular volume overload involved multiple serous cavities: hydrothorax, hydropericardium, and ascites, which were found in 79.2%, 41.7%, and 54.2% patients, respectively. The volume of effusion was small to moderate. Organomegaly involved multiorgans: hepatomegaly was found in 45.8% patients, splenomegaly in 54.2%, and lymphadenopathy in 75% patients. Hepatospleen exhibited moderate homogeneous enlargement without local enhanced signal after injection of contrast material. Bone lesions were classified into three groups: osteosclerotic, osteolytic, and mixed lesions. Osteosclerotic lesions, taking multiple, scattered, and variably sized high-density plaque-like appearance, were found in 20.8% patients. Osteolytic lesions, exhibiting punched-out low-density image, were found in 4.2% patients. Mixed ones, holding both common characteristics of them, were detected in 8.3% patients. These CT abnormalities disappeared after effective treatment.

Conclusion

CT plays vital role in the confirmation of the three minor diagnostic criteria for POEMS syndrome: extravascular volume overload, organomegaly, and bone lesions.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Jga9Nt
via IFTTT

On the X-ray Diagnosis of Gallstones in the Common Duct

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RsWhHr
via IFTTT

Presurgical functional magnetic resonance imaging in patients with brain tumors

Background

Clinical functional magnetic resonance imaging (fMRI) is still an upcoming diagnostic tool because it is time-consuming to perform the post-scan calculations and interpretations. A standardized and easily used method for the clinical assessment of fMRI scans could decrease the workload and make fMRI more attractive for clinical use.

Purpose

To evaluate a standardized clinical approach for distance measurement between benign brain tumors and eloquent cortex in terms of the ability to predict pre- and postoperative neurological deficits after intraoperative neuronavigation-assisted surgery.

Material and Methods

A retrospective study of 34 patients. The fMRI data were reanalyzed using a standardized distance measurement procedure combining data from both fMRI and three-dimensional T1 MRI scans. The pre- and postoperative neurological status of each patient was obtained from hospital records. Data analysis was performed using logistic regression analysis to determine whether the distance measured between the tumor margin and fMRI activity could serve as a predictor for neurological deficits.

Results

An odds ratio of 0.89 mm^–1 (P = 0.03) was found between the risk of preoperative neurological motor deficits and the tumor-fMRI distance. An odds ratio of 0.82 mm^–1 (P = 0.04) was found between the risk of additional postoperative neurological motor deficits and the tumor-fMRI distance. The tumor was radically removed in 10 cases; five patients experienced additional postoperative motor deficits (tumor-fMRI distance <18 mm) and five did not (tumor-fMRI distance >18 mm) (P = 0.008).

Conclusion

This study indicates that the distance measured between the tumor margin and fMRI activation could serve as a valuable predictor of neurological motor deficits.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RsWhr4
via IFTTT

Classic papers from the Acta Radiologica archives

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Jga6RR
via IFTTT

Computer tomography imaging findings of adrenal cavernous hemangiomas: a report of 10 cases

Background

Cavernous hemangiomas (CHs) of the adrenal gland are extremely rare. To date, only a few studies of adrenal CH imaging have been reported.

Purpose

To analyze the computed tomography (CT) imaging findings of adrenal CHs.

Material and Methods

Ten cases of adrenal CHs confirmed by a histopathological examination were retrospectively analyzed. All of the patients had undergone unenhanced and enhanced CT examinations, and eight had also undergone multiphase CT enhancement examinations. CT characteristics, including shape, size, margin, attenuation, and enhancement patterns, were analyzed.

Results

The study included six women and four men with a mean age of 49.2 years (age range, 25–62 years) and no signs of abnormal endocrine activity. The unenhanced CTs showed well-defined, heterogeneous (n = 8) or homogeneous (n = 2) density masses with scattered (n = 8) or spread calcifications (n = 2) in six tumors. In the contrast-enhanced CTs, seven tumors appeared to be marked with heterogeneous enhancement, whereas three cases exhibited no obvious enhancement. The evaluation of the pattern of dynamic enhancement in eight patients revealed that the tumors showed early peripheral enhancement (n = 4), early central enhancement (n = 1), and mixed enhancement (n = 1) with progressive partial filling-in, and no obvious enhancement in any phases (n = 2).

Conclusion

Adrenal CHs should be included in the differential diagnosis when an adrenal neoplasm is incidentally found and appears as a well-defined, heterogeneous mass with calcifications and various enhancement patterns, including heterogeneous enhancement with characteristic progressive partial filling-in, as well as lack of enhancement in any phase.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RsWhqU
via IFTTT

Comparison of volume perfusion computed tomography and contrast-enhanced ultrasound for assessment of therapeutic effect of transarterial chemoembolization in patients with hepatocellular carcinoma: a preliminary report

Background

Evaluation of transarterial chemoembolization (TACE) by using contrast-enhanced ultrasound (CEUS) and volume perfusion computed tomography (VPCT) as methods that display tumor vascularization.

Purpose

To assess early results of TACE in patients with hepatocellular carcinoma (HCC) using CEUS and VPCT.

Material and Methods

Twenty patients with HCC underwent CEUS and VPCT in the pre- and post-TACE setting (1 day). Hepatic perfusion index (HPI), arterial liver perfusion (ALP), blood flow (BF), and blood volume (BV) were measured with VPCT. Peak intensity (PI), time-to-peak (TTP), and regional blood flow (RBF) were measured with CEUS. Sensitivity, specificity, negative and positive predictive values, and cutoff values for these parameters were calculated. Immediate tumor response after TACE was classified as responder or non-responder. Results were compared with those at follow-up after 2 and 4 months (FU_2mo/FU_4mo) following modified RECIST.

Results

CEUS and VPCT showed comparable immediate post-TACE results in 20/20 cases. Complete response was confirmed in 10/20 patients at FU_2mo and in 9/20 at FU_4mo. For responders, reduction in HPI, ALP, BV, and BF at day 1 post TACE proved significant (P < 0.001). For non-responders, the course of all VPCT parameters proved non-significant. A cutoff of 40% reduction in HPI and a reduction in ALP of >29.6%, in BV of >41.4%, or in BF of >53.1% was indicative of response according to FU_2mo. For responders only, changes in PI (P < 0.001), TTP (P < 0.01), and BF (P < 0.01) proved significant whereas for non-responders, all CEUS parameters proved non-significant.

Conclusion

CEUS performs equally to VPCT for assessment of early response to TACE in HCC by a lesion-by-lesion assessment and showed prognostic value at mid-term.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Jga9gm
via IFTTT

How accurate is the label "allergic to iodinated contrast agents"?

Background

Iodinated contrast agents (ICAs) are crucial to the use of many imaging studies. Reported allergies to ICAs in the medical record can interfere with optimal diagnostic imaging workups.

Purpose

To investigate the accuracy with which the label "allergic to ICAs" is applied.

Material and Methods

The medical records of 500 patients labeled "allergic to ICAs" at a single tertiary care hospital were reviewed. Patients were separated into three groups based on documentation in their medical records, as follows: Group 1, documented hypersensitivity reaction to ICAs; Group 2, documented ICA exposure with non-hypersensitivity adverse event (Group 2a) or without documented reaction (Group 2b); and Group 3, no documented prior exposure to an ICA. We then further reviewed the EMR to determine whether or not patients had subsequent administration of an ICA, whether or not they were given specific premedication, and whether or not they had a subsequent ICA-related event.

Results

A total of 16.6% of patients (n = 83) listed as "allergic to ICAs" had a documented hypersensitivity reaction following ICA administration (Group 1) while 58.6% (n = 293) of patients (Group 2) had a documented exposure to ICAs with either: (i) a non-hypersensitivity adverse event (23.5%, n = 69) or (ii) no record of a reaction to ICAs (76.5%, n = 224). The remaining 24.8% (n = 124), Group 3, had no record of exposure to an ICA, yet still carried the label.

Conclusion

The majority of patients carrying the label "allergic to ICAs" had no record of a prior hypersensitivity reaction to ICAs.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RsWhar
via IFTTT

Additional US or DBT after digital mammography: which one is the best combination?

Background

Digital mammography (DM) is widespread used for the detection of breast cancer, but its sensitivity drops in dense breasts. It is well known that additional breast ultrasound (US) and digital breast tomosynthesis (DBT) increase the sensitivity of DM. However, to our knowledge, there are no articles comparing the role of both additional techniques.

Purpose

To assess the diagnostic performance of DM and the different combinations of DM + additional DBT and DM + additional US in an enriched sample of patients.

Material and Methods

Retrospective study in an enriched sample of 1042 patients. Out of them, 84 patients had histologically proven malignant lesions and 258 patients had benign lesions. Finally 700 patients with normal explorations or benign lesions without biopsy confirmation (but stable for at least 12 months) were included. All of them underwent DM, US, and DBT examinations that were retrospectively reviewed by one expert radiologist, blinded to the final diagnoses. The DBT examinations were performed using one single view with wide angle (50°). The reader categorized the cases as benign (BI-RADS 1 or 2) or malignant (BI-RADS 3–5) for DM and the different combination of techniques. The sensitivity (SE) and specificity (SP) were calculated with the PEPI software and the ROC curves of the different techniques and combinations were calculated by using the SPSS 15.0 software.

Results

The SE and SP of DM were 69.05% and 88.20%, respectively. Additional DBT significantly increased the AUC of DM as well as additional US or the combination DM + DBT + US (P < 0.05). However there were no significant differences between the AUC of DM + US and DM + DBT (P = 0.7).

Conclusion

Additional US, DBT, or both, in combination with DM, significantly increased the AUC of DM. However, there were no significant differences between DM + DBT and DM + US.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Jga6RD
via IFTTT

Comparison of the diagnostic accuracy of 99 m-Tc-MDP bone scintigraphy and 18 F-FDG PET/CT for the detection of skeletal metastases

Background

Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is commonly performed for cancer staging, as it can detect metastatic disease in multiple organ systems. However, there has been some controversy in the scientific literature when comparing FDG PET/CT and technetium-99 m-bone scintigraphy (bone scan) for the detection of skeletal metastases.

Purpose

To compare the accuracy of FDG PET/CT with bone scan for the detection of skeletal metastases.

Material and Methods

The study group comprised 202 adult cancer patients who underwent both FDG PET/CT and bone scan within 31 days for staging. Bone scans and FDG PET/CT were evaluated by two musculoskeletal radiologists for the presence and location of skeletal metastatic disease. Confirmation of the final diagnosis was based on the CT or magnetic resonance imaging (MRI) appearance, follow-up imaging, or histology.

Results

The sensitivity, specificity, and accuracy for detecting skeletal metastatic disease of FDG PET/CT were 97%, 98%, and 98%, respectively, and of bone scan were 83%, 98%, and 93%, respectively. The lesions that bone scan most commonly missed were located in the pelvis, spine, and sacrum. FDG PET/CT missed mostly lesions that were outside of the field of view, but in all of these cases the patient had additional sites of skeletal metastatic disease. Bone scan falsely identified six metastatic lesions and FDG PET/CT falsely identified three metastatic lesions.

Conclusion

FDG PET/CT is an accurate technique for detection of skeletal metastases, and is superior to bone scan, especially in the spine and pelvis.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Jga901
via IFTTT

Comparison of image quality and application values on different field-of-view diffusion-weighted imaging of breast cancer

Background

Single-shot echo planar imaging (SS-EPI) diffusion-weighted magnetic resonance imaging (DW-MRI) is the most-widely sequence in breast MRI. MRI artifacts and magnetic susceptibility are sometimes severe when this sequence is utilized at 3T.

Purpose

To compare the imaging quality, ADC values between SS-EPI DWI sequence and two reduced field-of-view (rFOV) DWI sequences of breast cancer.

Material and Methods

Twelve cases with breast cancer were scanned using SS-EPI DWI (FOV, 360 x 360 mm), rFOV DWI1 (FOV, 360 x 180 mm), and rFOV DWI2 (FOV, 280 x 140 mm), respectively. Image quality (scores 1 to 5) and ADC values of breast imaging were compared among three groups by different DWI sequences. SNR were compared between rFOV DWI1 and rFOV DWI2.

Results

The imaging quality score of 12 cases was 5.00 in rFOV DWI1, 3.60 in SS-EPI DWI, and 3.75 in rFOV DWI2. The mean ADC value of 12 cases was 1.211 x 10^–3 mm²/s in SS-EPI DWI, 1.107 x 10^–3 mm²/s in rFOV DWI1, and 1.038 x 10^–3 mm²/s in rFOV DWI2. SNR of rFOV DWI1 images was much higher than that of rFOV DWI2.

Conclusion

rFOV DWI1 is the optimal DWI sequence in our study. Comparing with SS EPI DWI, suitable rFOV DWI has an obvious advantage, which can present higher image resolution and less distortion. It may be helpful in the diagnosis of breast cancer.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Jga6Bm
via IFTTT

Modified thoracolumbar injury classification and severity score (TLICS) and its clinical usefulness

Background

Thoracolumbar injury classification and severity score (TLICS) is not very reliable for assessment of injury to the posterior ligament complex, even when scored by experts. It is not reasonable to score every compression fracture or burst fracture the same as there is great variety in the severity of compression fractures and burst fractures.

Purpose

To propose a modified TLICS (mTLICS) and evaluate the performance of the mTLICS system by measuring the agreement between scores determined by radiologists using both systems and actual treatment procedure delivered.

Material and Methods

We retrospectively evaluated 134 patients with acute lumbar and thoracic spinal trauma after undergoing magnetic resonance imaging (MRI) using new mTLICS and conventional TLICS system. Inter-observer agreements of TLICS and mTLICS scores were analyzed using the kappa statistic. Nonparametric correlation analysis was used to determine correlation (R) among each score and the surgical intervention.

Results

The mTLICS system showed slightly higher correlation than TLICS (Rs, TLICS, 0.592 and 0.613 vs. mTLICS, 0.628 and 0.639). If we consider a total maximal score of 4 to be a negative surgical indication, mTLICS showed significantly higher sensitivities than TLICS, and if we consider a total minimal score of 4 to be a positive surgical indication, mTLICS showed significantly higher specificities than TLICS.

Conclusion

The mTLICS score corrects deficiencies in the TLICS system that lead to ambiguity in the radiological diagnostic criteria. mTLICS is a more suitable scoring system than TLICS for predicting surgical management accurately, especially for morphological injuries.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RsWgTT
via IFTTT

128-slice dual-source CT coronary angiography with prospectively electrocardiography-triggered high-pitch spiral mode: radiation dose, image quality, and diagnostic acceptability

Background

Dual-source computed tomography (CT) enables CT coronary angiography (CTCA) with a prospectively electrocardiography (ECG)-triggered high-pitch spiral (HPS) mode.

Purpose

To evaluate the radiation dose, image quality, and diagnostic acceptability of the HPS mode in CTCA and to compare HPS with the step-and-shoot (SAS) and low-pitch spiral (LPS) modes.

Material and Methods

One hundred and thirty-eight patients who underwent CTCA with a 128-slice dual-source CT scanner were retrospectively included in this study. Seventeen patients (average heart rate of ≤65 beats per minute [bpm] prior to acquisition) were evaluated in the HPS mode, 88 (average heart rate of >65 and ≤80 bpm prior to acquisition) in the SAS mode, and 33 (average heart rate of >80 bpm prior to acquisition or patients with an unstable heart rhythm) in the LPS mode. Radiation dose and image noise were recorded for each patient. Diagnostic acceptability was graded using a four-point scale (1, unacceptable; 2, suboptimal; 3, acceptable; 4, fully acceptable).

Results

The effective dose in the HPS mode was 1.5 ± 0.2 mSv, which was lower than that in SAS (8.9 ± 2.7 mSv) and LPS (21.5 ± 4.3 mSv) modes. There were no significant differences in the image noise levels in the descending aorta and left atrium. The average per-patient diagnostic acceptability was 3.2, 3.6, and 3.7 in HPS, SAS, and LPS modes, respectively.

Conclusion

The radiation dose is lower with HPS than with other modes, and the HPS mode-acquired images of patients with heart rates of ≤65 bpm are nearly acceptable for diagnostic image interpretation.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RsWgDx
via IFTTT

Alteration patterns of brain glucose metabolism: comparisons of healthy controls, subjective memory impairment and mild cognitive impairment

Background

Some groups have focused on the detection and management of subjective memory impairment (SMI) as the stage that precedes mild cognitive impairment (MCI). However, there have been few clinical studies that have examined biomarkers of SMI to date.

Purpose

To investigate the differences in glucose metabolism as a prodromal marker of dementia in patients with SMI, MCI, and healthy controls using brain F-18 fluoro-2-deoxyglucose positron emission tomography (FDG-PET).

Material and Methods

Sixty-eight consecutive patients with SMI, 47 patients with MCI, and 42 age-matched healthy subjects were recruited. All subjects underwent FDG-PET and detailed neuropsychological testing. FDG-PET images were analyzed using the statistical parametric mapping (SPM) program.

Results

FDG-PET analysis showed glucose hypometabolism in the periventricular regions of patients with SMI and in the parietal, precentral frontal, and periventricular regions of patients with MCI compared with healthy controls. Interestingly, hypometabolism on FDG-PET was noted in the parietal and precentral frontal regions in MCI patients compared to SMI patients.

Conclusion

The results suggest that hypometabolism in the periventricular regions as seen on FDG-PET may play a role as a predictive biomarker of pre-dementia, and the extension of reduced glucose metabolism into parietal regions likely reflects progression of cognitive deterioration.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Jga8sP
via IFTTT

Assessment of operability by means of CTPA and perfusion SPECT in patients with chronic thromboembolic pulmonary hypertension

Background

Chronic thromboembolic pulmonary hypertension (CTEPH) can potentially be cured by pulmonary thrombendarterectomy (PEA), the criteria for differentiation between operable and non-operable patients are not standardized.

Purpose

To retrospectively evaluate the value of rigidly registered computed tomography pulmonary angiography (CTPA) and single photon emission CT (SPECT) in differentiating for PEA.

Material and Methods

Forty-nine patients with CTEPH (21 men; age, 58 ± 13 years) were evaluated by an interdisciplinary expert board using all available diagnostic information and their consensus statement as gold standard. For SPECT a lobe based perfusion score was visually assessed using the score of 0 (lack of perfusion) to 1 (normal perfusion) calculating percentage of vascular obstruction (PVO). By CTPA, vascular obstruction index (OI) of central, peripheral, and global PA-bed were determined. The accuracy of the alignment between CTPA and SPECT was determined by fusion score (FS) ranging from 1 (no alignment) to 5 (exact alignment). Angiography provided PA pressure (PAP), pulmonary vascular resistance (PVR), and PA wedge pressure (PAWP). Receiver operating characteristics (ROC) analysis was performed.

Results

Twenty-nine patients were considered surgically amenable, and 20 patients were inoperable. Mean PAP, PVR, and PAWP were 48 ± 11 mmHg, 868 ± 461 dynes*sec*cm^–5, and 11 ± 5 mmHg, without differences between surgical and non-surgical patients (P > 0.5). In all patients accurate registration was reached (FS = 4.1 ± 0.7; range, 2–5). PVO and central OI separated PEA-amenable patients (P ≤ 0.001) resulting in the area under the curve of 0.828 (cutoff for PVO: 37.8% with a sensitivity of 82% and specificity of 79%) and 0.755 (cutoff for central OI: 29% with a sensitivity and specificity of 86.2% and 79%) for operability.

Conclusion

An accurate interpretation of rigidly registered CTPA and perfusion SPECT may contribute to stratification of operability in patients with CTEPH.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1RsWf2o
via IFTTT

The value of ADC, T2 signal intensity, and a combination of both parameters to assess Gleason score and primary Gleason grades in patients with known prostate cancer

Background

The ability to non-invasively analyze tumor aggressiveness is an important predictor for individual treatment stratification and patient outcome in prostate cancer (PCA).

Purpose

To evaluate: (i) whether apparent diffusion coefficient (ADC), the T2 signal intensity (SI), and a combination of both parameters allow for an improved discrimination of Gleason Score (GS) ≥7 (intermediate and high risk) and GS <7 (low risk) in PCA; and (ii) whether ADC may distinguish between 3 + 4 and 4 + 3 PCA (primary Gleason grades [pGG]).

Material and Methods

Prostatectomy specimens of 66 patients (mean age, 63 ± 5.6 years; 104 PCA foci) with a preceding multiparametric 1.5 T endorectal coil magnetic resonance imaging (MRI) were included. ADC (b values = 0, 100, 400, 800 s/mm²), standardized T2 (T2s), and the ADC/T2s ratio were tested for correlation with GS applying multivariate analysis. ADC cutoff values were calculated for prediction of GS and pGG, and logarithm of the odds (LOGIT) was used to express the probability for GS and pGG. Diagnostic accuracy was assessed by ROC analysis.

Results

We found an almost linear negative relationship of ADC for GS ≥7 (P = 0.002). The effect of ADC for GS ≥7 (adjusted odds ratio = 0.995) was almost identical for peripheral and transition zone PCA (P = 0.013 and P < 0.001, respectively). ADC showed an AUC of 78.9% for discrimination between GS <7 and GS ≥7. An ADC cutoff of <1.005 x 10^–3 mm²/s indicated a GS ≥7 (90.5% sensitivity, 62.5% specificity). Within the group of GS = 7 PCA, an ADC > 0.762 x 10^–3 mm²/s indicated a pGG of 3 (AUC = 69.6%).

Conclusion

T2s and the ADC/T2s ratio do not provide additional information regarding prediction of GS. ADC values have a good discriminatory power to distinguish tumors with GS ≥7 from GS <7 and to predict pGG in GS = 7 PCA.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/1Jga8cq
via IFTTT