Computed Tomography Colonography Angiography (CTC-A) prior to colectomy for cancer: A new tool for surgeons.

The pre-operative work-up for non-metastatic colon cancer includes colonoscopy and thoraco-abdomino-pelvic computed tomography (CT) with intravenous (IV) contrast. Colonoscopic determination of the anatomical location of the tumor may be erroneous, particularly with a long redundant colon (dolichocolon), and the search for synchronous colon neoplasms is limited when the endoscope cannot traverse the tumor-bearing segment. While computed tomography colonography angiography (CTC-A) makes it possible to assess distant tumor metastasis, it remains limited for the assessment of loco-regional extension. CTC-A requires specific colonic preparation, controlled colonic insufflation with CO2, and an injection of IV contrast. CTC-A provides a 3-D view of the overall morphology of the colon and precisely localizes the site of the colonic tumor. Merging the images of the colon with those of mesenteric and colonic vessels provides a representation of anatomical vascular variations. This information could help the surgeon to better plan the colectomy. The use of two-dimensional images of CTC-A with sections perpendicular to the major axis of the tumor-bearing colonic segment can provide precise information on the degree of parietal extension and be useful in evaluating the value of neo-adjuvant chemotherapy.

Abdominal musculature segmentation and surface prediction from CT using deep learning for sarcopenia assessment.

PURPOSE: The purpose of this study was to build and train a deep convolutional neural networks (CNN) algorithm to segment muscular body mass (MBM) to predict muscular surface from a two-dimensional axial computed tomography (CT) slice through L3 vertebra. MATERIALS AND METHODS: An ensemble of 15 deep learning models with a two-dimensional U-net architecture with a 4-level depth and 18 initial filters were trained to segment MBM. The muscular surface values were computed from the predicted masks and corrected with the algorithm's estimated bias. Resulting mask prediction and surface prediction were assessed using Dice similarity coefficient (DSC) and root mean squared error (RMSE) scores respectively using ground truth masks as standards of reference. RESULTS: A total of 1025 individual CT slices were used for training and validation and 500 additional axial CT slices were used for testing. The obtained mean DSC and RMSE on the test set were 0.97 and 3.7 cm2 respectively. CONCLUSION: Deep learning methods using convolutional neural networks algorithm enable a robust and automated extraction of CT derived MBM for sarcopenia assessment, which could be implemented in a clinical workflow.

Three artificial intelligence data challenges based on CT and MRI.

PURPOSE: The second edition of the artificial intelligence (AI) data challenge was organized by the French Society of Radiology with the aim to: (i), work on relevant public health issues; (ii), build large, multicentre, high quality databases; and (iii), include three-dimensional (3D) information and prognostic questions. MATERIALS AND METHODS: Relevant clinical questions were proposed by French subspecialty colleges of radiology. Their feasibility was assessed by experts in the field of AI. A dedicated platform was set up for inclusion centers to safely upload their anonymized examinations in compliance with general data protection regulation. The quality of the database was checked by experts weekly with annotations performed by radiologists. Multidisciplinary teams competed between September 11th and October 13th 2019. RESULTS: Three questions were selected using different imaging and evaluation modalities, including: pulmonary nodule detection and classification from 3D computed tomography (CT), prediction of expanded disability status scale in multiple sclerosis using 3D magnetic resonance imaging (MRI) and segmentation of muscular surface for sarcopenia estimation from two-dimensional CT. A total of 4347 examinations were gathered of which only 6% were excluded. Three independent databases from 24 individual centers were created. A total of 143 participants were split into 20 multidisciplinary teams. CONCLUSION: Three data challenges with over 1200 general data protection regulation compliant CT or MRI examinations each were organized. Future challenges should be made with more complex situations combining histopathological or genetic information to resemble real life situations faced by radiologists in routine practice.

End Users' Views and Preferences on Prescribing and Taking Postexposure Prophylaxis for Prevention of HIV: Methods to Support World Health Organization Guideline Development.

The 2014 World Health Organization guidelines for human immunodeficiency virus postexposure prophylaxis (PEP) are the first to combine recommendations for all populations and exposures. To inform the development of these guidelines, we gathered views of end users on key aspects of PEP provision. A mixed-methods approach was used to gather views from the populations for whom the guideline will be of relevance. Data gathered from an online survey, focus group discussions, and previously collected data from in-depth interviews with key populations were used to inform the development of recommendations, in particular where there is a paucity of evidence to assess the benefits and harms of an intervention. This was a successful method to gather end users' views and preferences; however, limitations exist in the generalizability and reliability of the evidence. Future guideline development processes should consider methods to include the views of end users to guide the decision-making process.

Drug repurposing: a systematic approach to evaluate candidate oral neuroprotective interventions for secondary progressive multiple sclerosis.

OBJECTIVE: To develop and implement an evidence based framework to select, from drugs already licenced, candidate oral neuroprotective drugs to be tested in secondary progressive multiple sclerosis. DESIGN: Systematic review of clinical studies of oral putative neuroprotective therapies in MS and four other neurodegenerative diseases with shared pathological features, followed by systematic review and meta-analyses of the in vivo experimental data for those interventions. We presented summary data to an international multi-disciplinary committee, which assessed each drug in turn using pre-specified criteria including consideration of mechanism of action. RESULTS: We identified a short list of fifty-two candidate interventions. After review of all clinical and pre-clinical evidence we identified ibudilast, riluzole, amiloride, pirfenidone, fluoxetine, oxcarbazepine, and the polyunsaturated fatty-acid class (Linoleic Acid, Lipoic acid; Omega-3 fatty acid, Max EPA oil) as lead candidates for clinical evaluation. CONCLUSIONS: We demonstrate a standardised and systematic approach to candidate identification for drug rescue and repurposing trials that can be applied widely to neurodegenerative disorders.

[Fluoride content in well water in rural areas in Morocco]. / Teneur en fluorures des eaux de puits des régions rurales au Maroc.

The aim of our study was to determine fluorides (F-) content in the well water consumed as drinking water by some Moroccan populations in rural areas. All samples were collected between April and October 2011. Measurements were performed by an ion selective electrode. Thirty wells spread to cover most of the country and locally chosen based on the number of inhabitants who consume its water. All wells were in rural areas. The mean (+/- SD) of F- was 1.84 +/- 1.6 mg/L with a range from 0.42 to 8.95 mg/L Concentrations of F- in phosphate regions were higher than those found in other regions. More than half of the samples exceeded the current standard. Our study showed that water of some Moroccan regions is naturally rich in F-exposing people who consume it at high risk of fluorosis.

Bilateral ewing sarcoma/primitive neuroectodermal tumor of the breast: a very rare entity and review of the literature.

Peripheral primitive neuroectodermal tumors (PNET) are rare malignant tumors, affecting mostly children and adolescents and have been described in breast in eight case reports only. In this paper, we present a case of bilateral mammary ES/PNET where distinction between primary and metastatic diseases was discussed through a literature review. The aim of this work is to demonstrate that although rare, the possibility of PNET should be kept in mind while evaluating a palpable breast abnormality in a young female.

[Determination of fluoride in toothpastes marketed in Morocco using a fluoride-selective electrode]. / Détermination des teneurs en fluor dans les pâtes dentifrices commercialisées au Maroc par électrode sélective au fluor.

INTRODUCTION: Dental caries represents a problem of public health in Morocco and the reduction of this pathology is a priority of the Ministry of Health. The use of fluoride toothpastes is, at present, recognized as being an effective means for the prevention of dental caries. MATERIAL AND METHODS: [corrected] The aim of our study was to verify the correspondence of the information marked on packagings with the international standards, but also to determine using potentiometry the quantity of fluorine presents in toothpastes marketed in Morocco from three origins: pharmacies, hypermarkets and ambulant sellers. RESULTS: The study concerned 56 toothpastes, 73.2% of toothpastes respect the standards of the concerning WHO dates of manufacturing and lapsing. The type of fluoride was specified only on 67.8% of packagings and the used concentration of fluoride was indicated only in 62.5% of the tested samples. For 56 studied toothpastes, the results revealed that if we take into account standards recommended by the WHO and the European Union, only 57.1% of toothpastes could have an effect dental caries. CONCLUSION: The results of this study show that there is a real need of quality control of fluoride toothpastes sold in Morocco especially those of the itinerant market.

[Anti-inflammatory activity of aqueous and ethanolic extracts of Zygophyllum gaetulum]. / Activité anti-inflammatoire des extraits aqueux et éthanolique de Zygophyllum gaetulum.

Zygophylle or Zygophyllum gaetulum Emberger and. Maire is a Moroccan medicinal plant which has been used as an anti-inflammatory, antidiabetic, antispasmodic and antidiarrheic. The present study was carried out to study and compare the anti-inflammatory effect of ethanolic extract with aqueous extract of Z. gaetulum. Organic extract of Z. gaetulum was obtained in soxhlet apparatus. Aqueous extract was obtained by infusion. The Wistar albinos rats of either sex weighing 200-300 g aged 2-3 months were used for this experiment. The rats were housed under standard environmental conditions. The anti-inflammatory activity was estimated by measuring the oedema induced by carragenin according to the method of Winter and al. Ethanolic extract of Z. gaetulum reduced the increase of the paw volume with a percentage of inhibition of 46% (p<0.01), this percentage was 47.48% (p<0.01) with aqueous extract. The inhibition decrease in time, it arrived to 39% (p<0.01) at the sixth hour while the activity of aqueous extract decrease a lot. In conclusion, Z. gaetulum is an interesting plant which the aqueous and éthanolic extracts could be used scientifically in the treatment of inflammation.

Carbon monoxide poisoning in Morocco during 1999-2007.

INTRODUCTION: Carbon monoxide (CO) intoxication is one of the most common types of poisoning in the modern world. The aim of the present study is to describe the evolution of CO poisoning during a period between January 1999 and December 2007 based on data collected from result of toxicological analysis in the laboratory of toxicology in the National Institute of Health in Morocco. MATERIALS AND METHODS: This study was based on autopsies samples sent to the laboratory of forensic toxicology covering the time period January 1999 to December 2007. Cases were analyzed according to the following criteria: age, region, month, gender, presence or not of autopsy report and post mortem blood carbon monoxide determination. RESULT: From January 1999 to December 2007, 139 out of the 4402 analysis performed were recorded as acute CO intoxications. Cases (93.5%) were classified as accident (E859). Hundred percentage of our cases were exclusively due to gaze inhalation. Circumstances of intoxications were described in autopsy report which is found in 41% (57 cases). Males predominated in accidental poisoning with 77 cases (55%) while females represented 62 cases (44%). the most represented city was Rabat with 48 cases (34%), followed by Casablanca with 20 cases (14.4%). the highest frequency of CO deaths was found in February and March with 29 cases (20.9%) and 28 cases (20.1%), respectively. The highest poisoning frequency was recorded for the age mean 34+/- years old. The average of carbon monoxide concentration was 5.76+/-4.3 ml/100ml of blood. Males predominated in accidental poisoning with 77 cases (55%) while females represented 62 cases (44%). CONCLUSION: Acute carbon monoxide intoxication is too dangerous because of its speed in addition to the particularities of carbon monoxide which is one of many ubiquitous contaminants of our environment that requires prevention and control measures inside and outside to insure adequate protection of public health.

Evaluation of air trapping at CT: comparison of continuous-versus suspended-expiration CT techniques.

PURPOSE: To compare thin-section computed tomographic (CT) scans obtained during suspended end expiration with helical CT scans obtained during continuous expiration for the assessment of air trapping. MATERIALS AND METHODS: Forty-nine patients with an airway disease were examined with suspended-end-expiration CT after a 6-8-second expiratory maneuver, which was followed with continuous-expiration CT during a 10-second expiratory maneuver. The extent of expiratory air-trapping areas was calculated by two observers by using a semiquantitative grid score. The relative decrease in attenuation in the areas of air trapping was evaluated with a visual continuous-scale score. RESULTS: Air trapping was noted in 36 and 35 patients with continuous-expiration CT and with suspended-end-inspiration CT, respectively. The extents of and relative attenuation decreases in air-trapping areas in patients with air-trapping areas on at least one expiratory CT scan increased significantly in scans obtained with continuous-expiration CT compared with those obtained with suspended-end-expiration CT, respectively, with mean extent scores of 0.24 +/- 0.20 (SD) and 0.18 +/- 0.20 (paired t test, P: =.001) respectively, and with mean relative contrast decrease scores of 0.35 +/- 0.23 and 0.27 +/- 0.23 (paired t test, P: =.007), respectively. CONCLUSION: When suspended-end-expiration CT images are ambiguous, complementary continuous-expiration CT can be used to improve the conspicuity and apparent extent of air trapping.

Contrast-enhanced helical CT for pulmonary embolism detection: inter- and intraobserver agreement among radiologists with variable experience.

OBJECTIVE: The objective of this study was to evaluate inter- and intraobserver agreement in the diagnosis of central pulmonary embolism using contrast-enhanced helical CT among observers with variable experience in the interpretation of pulmonary CT angiograms. MATERIALS AND METHODS: Helical CT angiograms of 60 patients clinically suspected of having pulmonary embolism were analyzed retrospectively and independently by two chest radiologists, one cardiovascular radiologist, and three general radiologists. The films were rated a second time by the chest radiologists to assess intraobserver variability. Findings for pulmonary embolism were categorized as positive, negative, or indeterminate at the main, lobar, and segmental pulmonary artery levels. RESULTS: The observers interpreted 19-21 CT angiograms as positive for pulmonary embolism (mean, 19.7) and one to six as indeterminate (mean, 3.2). Agreement occurred among all observers in 50 patients (83.3%), among five observers in six patients (10.0%), among four observers in three patients (5.0%), and among three observers in one patient (1.7%). Interobserver agreement was very good (kappa, .85) for the diagnosis of pulmonary embolism on a per-patient basis. Agreement on a per-artery basis for all arteries was moderate (66%; kappa, .56); for lobar arteries was good (83%; kappa, .75); and for segmental arteries was moderate (57%; kappa, .47). Mean intraobserver agreement on a per-patient basis was very good (93%; kappa, .87). CONCLUSION: Inter- and intraobserver agreement in the diagnosis of pulmonary embolism with helical CT is very good despite a wide variety of experience among radiologists.

Pulmonary tuberculosis: computed tomography and high-resolution computed tomography patterns in patients who are either HIV-negative or HIV-seropositive.

To compare findings of active pulmonary tuberculosis on computed tomography (CT) and high-resolution computed tomography (HRCT) scans in patients without the human immunodeficiency virus (HIV) and patients with HIV, and to define the spectrum of pulmonary tuberculosis in patients with HIV according to the CD4 T cell status, 76 patients (47 patients without HIV and 29 patients with HIV) with newly diagnosed pulmonary tuberculosis were studied retrospectively. The diagnosis of active pulmonary tuberculosis was based on acid-fast bacilli (AFB) in sputum culture. All patients underwent CT within 1 month of diagnosis. Patients with HIV demonstrated significantly less cavitation and bronchial wall thickening (24% vs. 49% [p < 0.05]; and 14% vs. 45% [p < 0.01], respectively) than the combined group of patients with HIV. Centrilobular nodules were significantly less common in patients without HIV (14% vs. 45%, p < 0.05). Lymphadenopathy with low attenuation centers was significantly less frequent in the patients with HIV (3% vs. 15%, p < 0.05). In patients with HIV, cavitation, lymphadenopathy, as well as the the number of nodules and the number of lobes involved correlated well with the CD4 levels. Two patients with less than 50 CD4 T cells/mm3 had normal chest CT results. Atypical chest CT patterns are frequently encountered in patients with HIV. Knowledge of these CT patterns may assist in the diagnosis and follow-up of patients with HIV with known or suspected pulmonary tuberculosis.

Mycobacterium tuberculosis versus nontuberculous mycobacterial infection of the lung in AIDS patients: CT and HRCT patterns.

PURPOSE: The aim of this study was to determine discriminating CT and HRCT features between mycobacterial pulmonary tuberculosis and nontuberculous mycobacterial (NTMB) pulmonary infections in patients with AIDS. METHOD: CT and HRCT scans of 52 AIDS patients with culture-proven mycobacterial infection [29 with Mycobacterium tuberculosis (MTB) and 23 with NTMB] without concomitant pulmonary infection were reviewed by two observers. RESULTS: Nodular opacities, mainly centrilobular in distribution, were the most common finding, seen in 21 (72%) and 15 (65%) of patients with MTB and NTMB, respectively. A lower lobe predominance of centrilobular nodules was seen more commonly in NTMB (p < 0.03). Ground-glass attenuation was seen in 5 (17%) and 11 (48%) of patients with MTB and NTMB, respectively (p = 0.03). Ground-glass opacities and bronchial wall thickening affected a larger number of lobes in NTMB (p < 0.01), while centrilobular nodules involved more lobes in MTB (p < 0.01). A higher prevalence of unilateral lung involvement was seen in MTB (12 patients, 44%) than NTMB (1 patient, 5%) (p < 0.01). Enlarged lymph nodes were more frequent in patients with MTB than in those with NTMB (22, 76% vs. 10, 43%, respectively) (p < 0.02). CONCLUSION: NTMB infection and pulmonary tuberculosis display different CT and HRCT patterns in AIDS patients, but there is considerable overlap in CT findings.