Sleep quality and its associations with disease activity and quality of life in older patients with rheumatoid arthritis.

PURPOSE: Sleep disturbance is among the most important geriatric syndromes, and its evaluation is part of the routine comprehensive geriatric assessment (CGA). Previous studies have demonstrated that older patients with rheumatoid arthritis (RA) have poorer sleep quality than younger control patients. However, there needs to be more data on the sleep quality of older patients with RA with age-matched controls. METHODS: Totally 100 participants, 50 older RA patients classified according to the ACR criteria, and 50 age- and gender-matched control patients without RA were included in the study. All patients underwent CGA, including assessing their functionality, depressive, cognitive, and nutritional status. In addition, sleep quality was assessed by the Pittsburg Sleep Quality Index (PSQI), and RA disease activity by a rheumatologist using the Disease Activity Score 28 (DAS28-CRP), and quality of life with the RA QoL questionnaire (RAQoL). RESULTS: The median age was 70 years (min-max: 65-86), and 62.5% were female. Co-morbidities and comprehensive geriatric assessment parameters were similar between the two groups. Median PSQI global score was higher in patients with RA than controls [9 (min-max: 1-20) vs. 5 (min-max: 1-13), p = 0.029). When the patients were categorized with respect to being 'poor sleepers' (PSQI score > 5), 62% of patients with RA and 38% of controls were poor sleepers (p = 0.016). The patients classified as poor sleepers were more likely to have a diagnosis of RA, higher DAS28-CRP and RAQoL scores, lower grip strength, and be a woman. PSQI global scores were significantly positively correlated with DAS28-CRP scores (r = 0.514, p < 0.001), RAQoL scores (r = 0.689, p < 0.001), number of medications used (r = 0.292, p = 0.003), and YDS scores (r = 0.407, p < 0.001), and significantly negatively correlated with handgrip strength (r = - 0.351, p = 0.001). CONCLUSION: The results suggest that older patients with RA might have poorer sleep quality compared to age- and gender-matched controls. Moreover, sleep quality correlated with RA disease activity and QoL in old age.

MicroHikari3D: an automated DIY digital microscopy platform with deep learning capabilities.

A microscope is an essential tool in biosciences and production quality laboratories for unveiling the secrets of microworlds. This paper describes the development of MicroHikari3D, an affordable DIY optical microscopy platform with automated sample positioning, autofocus and several illumination modalities to provide a high-quality flexible microscopy tool for labs with a short budget. This proposed optical microscope design aims to achieve high customization capabilities to allow whole 2D slide imaging and observation of 3D live specimens. The MicroHikari3D motion control system is based on the entry level 3D printer kit Tronxy X1 controlled from a server running in a Raspberry Pi 4. The server provides services to a client mobile app for video/image acquisition, processing, and a high level classification task by applying deep learning models.

A stereological study of the effects of antidepressants on postmenopausal rat kidney.

Many factors can cause depression including genes (DNA), brain chemistry or stress. Antidepressant drugs affect the brain, heart, liver and kidney. We investigated the effects of the antidepressant drugs, amitriptyline (AMI) and paroxetine (PARO) on kidney. We used 24 adult female rats that were ovariectomized bilaterally 7 days before the experiment. The ovariectomized (OVX) animals and healthy control rats were divided into four equal groups for 4 weeks: control group, OVX control group (sham), AMI group and PARO group. Following the experimental period, the Cavalieri method was applied to sections of the kidney. PARO produced adverse effects on distal and proximal tubule volume, but AMI had no effect on the volume of distal and proximal tubules. Both PARO and AMI decreased the volume of Bowman spaces. PARO also damaged the kidney tubules and cells.

Electronic characterization of silicon intercalated chevron graphene nanoribbons on Au(111).

Electronic and thermal properties of chevron-type graphene nanoribbons can be widely tuned, making them interesting candidates for electronic and thermoelectric applications. Here, we use post-growth silicon intercalation to unambiguously access nanoribbons' energy position of their electronic frontier states. These are otherwise obscured by substrate effects when investigated directly on the growth substrate. In agreement with first-principles calculations we find a band gap of 2.4 eV.

Effects of radiological extent on neutrophil/lymphocyte ratio in pulmonary sarcoidosis.

OBJECTIVE: Determining the severity of sarcoidosis is based on the clinical and radiological findings of the disease and the changes in pulmonary function test results. On the other hand; studies are ongoing for objective and easy markers in this respect. Neutrophil/lymphocyte ratio (NLR) is shown as a good prognostic marker for inflammation due to tissue damage in recent clinical trials. In this study, we aimed to identify the possible relationship between NLR and radiological extent of sarcoidosis. PATIENTS AND METHODS: Data of 122 patients included in the study were evaluated retrospectively in terms of age, gender, complete blood count parameters, erythrocyte sedimentation rate (ESR) and radiological findings at the time of diagnosis. RESULTS: Mean NLR and ESR were significantly different between radiological stages according to chest radiography and also total HRCT score (THS) groups according to parenchymal involvement in thorax tomography (p <0.05). Mean NLR was found to be 1.28 in stage 0, 1.65 in stage 1, 2.88 in stage 2,5.47 in stage 3 and 8.48 in stage 4; 1.63 in THS group 1, 2.01 in group 2, 3.47 in group 3 and 5.46 in group 4. There were statistically significant positive correlations between NLR and WBC, NLR and THS, NLR and ESR, THS and ESR, ESR and platelet, WBC and #neutrophil, WBC and #lymphocyte. CONCLUSIONS: Our findings suggest that NLR might be used as a prognostic marker in pulmonary sarcoidosis.

Controversies on electromagnetic field exposure and the nervous systems of children.

This paper reviewed possible health effects from exposure to low levels of electromagnetic field (EMF) in children, arising from electrical power sources and mobile phones. Overall, the information about effects on developmental processes and cognitive functions is insufficient and further research on children and adolescents is critically needed. New research approaches are required focused on the effects on the developmental processes of children exposed to electromagnetic fields, using consistent protocols. When the current data were considered in detail, it was noted that children's unique vulnerabilities make them more sensitive to EMFs emitted by electronics and wireless devices, as compared to adults. Some experimental research shows a neurological impact and exposure in humans may lead to the cognitive and behavioral impairments. Because of the proliferation of wireless devices, public awareness of these dangers now is important to safeguard children's future healthy brain development.

Effects of prenatal 900 MHz electromagnetic field exposures on the histology of rat kidney.

PURPOSE: To research the harmful effects of prenatal exposure of 900 megahertz (MHz) electromagnetic field (EMF) on kidneys of four-week-old male rats and to determine protective effects of melatonin (MEL) and omega-3 (ω-3). MATERIALS AND METHODS: Twenty-one Wistar albino rats were randomly placed into seven groups as follows: Control (Cont), Sham, MEL, ω-3, EMF, EMF+ MEL and EMF+ω-3. After mating, three groups (EMF, EMF+ MEL, EMF+ ω-3) were exposed to an EMF. In the fourth week subsequent to parturition, six rats were randomly chosen from each group. Mean volume of kidneys and renal cortices, the total number of glomeruli and basic histological structure of kidney were evaluated by stereological and light microscopical methods, respectively. RESULTS: Stereological results determined the mean volume of the kidneys and cortices were significantly increased in EMF-exposed groups compared to the Cont group. However, EMF-unexposed groups were not significantly modified compared to the Cont group. Additionally, the total number of glomeruli was significantly higher in EMF-unexposed groups compared to the Cont group. Alternatively, the number of glomeruli in EMF-exposed groups was decreased compared to the Cont group. CONCLUSIONS: Prenatal exposure of rat kidneys to 900 MHz EMF resulted in increased total kidney volume and decreased the numbers of glomeruli. Moreover, MEL and ω-3 prevented adverse effects of EMF on the kidneys.

Diffusion tensor magnetic resonance imaging in patients with multiple sclerosis and its relationship with disability.

Multiple sclerosis is a chronic inflammatory demyelinating disease of the central nervous system. Diffusion tensor magnetic resonance imaging (DTI) can yield important information on the in vivo pathological processes affecting water diffusion. The aim of this study was to quantitatively define water diffusion in normal-appearing white matter (NAWM) distant from the plaque, in the plaque, and around the plaque, and to investigate the correlation of these changes with clinical disability. Conventional MRI and DTI scans were conducted in 30 patients with MS and 15 healthy individuals. Fractional anisotropy maps and visible diffusion coefficients were created and integrated with T2-weighted images. Regions of interest (ROIs) were placed on the plaques on the same side, white matter around the plaques and NAWM on the opposite side. Only the white matter of healthy individuals in the control group, and FA and ADC values were obtained for comparison. The highest FA and lowest ADC were detected in the control group at the periventricular region, cerebellar peduncle and at all ROIs irrespective of location. There was a significant difference in comparison to the control group at all ROIs in patients with MS (p < 0.001 for all comparisons). No significant correlation between diffusion parameters and expanded disability state scale (EDSS) scores was found in patients with MS. DTI may provide more accurate information on the damage due to the illness, compared to T2A sequences, but this damage may not be correlated with the clinical disability measured by EDSS score.

Comparison of double inversion recovery and conventional magnetic resonance brain imaging in patients with multiple sclerosis and relations with disease disability.

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system, predominantly affecting the white matter, but also the grey matter. Aim of this study was to detect MS lesions with double inversion recovery (DIR), fluid-attenuated inversion recovery (FLAIR) and T2-weighted magnetic resonance (MR) techniques and determine the sensitivity of these techniques, and the correlation between the number of lesions and expanded disability state scale (EDSS) scores. Thirty-four patients with MS (20 females and 14 males) were included in this study. DIR and conventional MR (T2-A, FLAIR) sequences were obtained. Lesions were counted and classified as belonging to one of seven anatomical regions: cortical, juxtacortical, deep grey matter, deep white matter, mixed white matter-grey matter, periventricular white matter and infratentorial. The correlation between lesion number and EDSS scores was investigated. DIR images showed more intracortical and mixed white matter-grey matter lesions in comparison with both FLAIR and T2 sequences (p=0, p=0 respectively). There was a significant difference between mean lesion numbers at the juxtacortical region, obtained with DIR and T2-weighted images (p = 0.002). The total number of lesions obtained with all methods was similar. DIR brain imaging had the highest sensitivity in the detection of cortical and mixed white matter - grey matter lesions, compared with FLAIR and T2 sequences. In addition, the lesions obtained with DIR images were more easily visualized.

A parallel solution for high resolution histological image analysis.

This paper describes a general methodology for developing parallel image processing algorithms based on message passing for high resolution images (on the order of several Gigabytes). These algorithms have been applied to histological images and must be executed on massively parallel processing architectures. Advances in new technologies for complete slide digitalization in pathology have been combined with developments in biomedical informatics. However, the efficient use of these digital slide systems is still a challenge. The image processing that these slides are subject to is still limited both in terms of data processed and processing methods. The work presented here focuses on the need to design and develop parallel image processing tools capable of obtaining and analyzing the entire gamut of information included in digital slides. Tools have been developed to assist pathologists in image analysis and diagnosis, and they cover low and high-level image processing methods applied to histological images. Code portability, reusability and scalability have been tested by using the following parallel computing architectures: distributed memory with massive parallel processors and two networks, INFINIBAND and Myrinet, composed of 17 and 1024 nodes respectively. The parallel framework proposed is flexible, high performance solution and it shows that the efficient processing of digital microscopic images is possible and may offer important benefits to pathology laboratories.

Quality evaluation of microscopy and scanned histological images for diagnostic purposes.

In this work we present a study for assessing and comparing the fidelity of biopsy and cytology images captured with two different devices, that is optical microscopes and scanners, at 40× magnification in bright field. The devices use different ways to magnify images. Microscopes use a set of lenses while scanners capture light through arrays of micro-photoreceptors. The objective is to carry out a quantitative evaluation to discern which of the two devices provides better image quality in terms of contrast, colour and stain. Since there is no unanimous consensus on quality metrics, we will make use of both an objective metric based on perceptual features, together with a subjective psychophysical test as the International Telecommunications Union (ITU) recommends in ITU-R BT.500 for such type of tests. Both techniques indicate a slight preference for the scanner over the microscope in terms of better image quality, considering defocus as the main problem followed by colour distortions. However, the image quality of both devices is suitable for clinical, educational and research purposes.

A geodesic deformable model for automatic segmentation of image sequences applied to radiation therapy.

PURPOSE: Organ motion should be taken into account for image-guided fractionated radiotherapy. A deformable segmentation and registration method was developed for inter-and intra-fraction organ motion planning and evaluation. METHODS: Energy minimizing active models were synthesized for tracking a set of organs delineated by regions of interest (ROI) in radiotherapy treatment. The initial model consists of a surface deformed to match the ROI contour by geometrical properties, following a heat flow model. The deformable segmentation model was tested using a Shepp-Logan head CT simulation, and different quantitative metrics were applied such as ROC analysis, Jaccard index, Dice coefficient and Hausdorff distance. RESULTS: Experimental evaluation of automated versus manual segmentation was done for the cardiac, thoracic and pelvic regions. The method has been quantitatively validated, obtaining an average of 93.3 and 99.2% for the sensitivity and specificity, respectively, 90.79% for the Jaccard index, 95.15% for the Dice coefficient and 0.96% mm for the Hausdorff distance. CONCLUSIONS: Model-based deformable segmentation was developed and tested for image-guided radiotherapy treatment planning. The method is efficient, robust and has sufficient accuracy for 2D CT data without markers.

Automatic breast parenchymal density classification integrated into a CADe system.

PURPOSE: Breast parenchymal density is an important risk factor for breast cancer. It is known that mammogram interpretation is more difficult where dense tissue is involved. Therefore, automated breast density classification may aid in breast lesion detection and analysis. METHODS: Several image pattern classification techniques for screen-film (SFM) mammography datasets were tested and classified according to BIRADS categories using known cases. A hierarchical classification procedure based on k-NN, SVM and LBN combined with principal component analysis on texture features uses the breast density features. The classification techniques have been incorporated into a CADe system to drive the detection algorithms. RESULTS: The results obtained on 322 mammograms demonstrate that up to 84% of samples were correctly classified. The results of the lesion detection algorithms were obtained from modules integrated within the CADe system developed by the authors. CONCLUSIONS: The ability to detect suspicious lesions on dense and heterogeneous tissue has been tested. The tools enhance the detectability of lesions and they are able to distinguish their local attenuation without local tissue density constraints.

Aripiprazole-induced rabbit syndrome: a case report.

Rabbit syndrome (RS) is a rare side effect of prolonged neuroleptic administration characterised by rapid, fine, rhythmic movements of the mouth along a vertical axis. Long-term exposure to the first generation neuroleptics has clearly been associated with RS, but little is known regarding the risk of RS because of the exposure to the newer atypical antipsychotics. Aripiprazole is a new dopaminergic agent and has been reported to be clinically useful as an antipsychotic drug with reduced extrapyramidal motor side effects. In addition, there are some case reports concerning extrapyramidal side effects, which include tardive dyskinesia, parkinsonism and RS associated with aripiprazole. We present the case of a patient who developed RS during treatment with aripiprazole. Potential mechanisms, including D2 receptor occupancy, low anticholinergic properties and dopamine hypersensitivity theory, are discussed. Although studies with aripiprazole have shown a low liability for extrapyramidal side effects, the present case emphasises the need for caution when treating patients with aripiprazole.

Fast Monte Carlo simulation on a voxelized human phantom deformed to a patient.

PURPOSE: A method for performing fast simulations of absorbed dose using a patient's computerized tomography (CT) scan without explicitly relying on a calibration curve is presented. METHODS: The method is based on geometrical deformations performed on a standard voxelized human phantom. This involves spatially transforming the human phantom to align it with the patient CT image. Since the chemical composition and density of each voxel are given in the phantom data, a calibration curve is not used in the proposed method. For this study, the Monte Carlo (MC) code PENELOPE has been used as the simulation of reference. The results obtained with PENELOPE simulations are compared to those obtained with PENFAST and with the collapsed cone convolution algorithm implemented in a commercial treatment planning system. RESULTS: The comparisons of the absorbed doses calculated with the different algorithms on two patient CTs and the corresponding deformed phantoms show a maximum distance to agreement of 2 mm, and in general, the obtained absorbed dose distributions are compatible within the reached statistical uncertainty. The validity of the deformation method for a broad range of patients is shown using MC simulations in random density phantoms. A PENFAST simulation of a 6 MV photon beam impinging on a patient CT reaches 2% statistical uncertainty in the absorbed dose, in a 0.1 cm3 voxel along the central axis, in 10 min running on a single core of a 2.8 GHz CPU. CONCLUSIONS: The proposed method of the absorbed dose calculation in a deformed voxelized phantom allows for dosimetric studies in the geometry of a patient CT scan. This is due to the fact that the chemical composition and material density of the phantom are known. Furthermore, simulation using the phantom geometry can provide dosimetric information for each organ. The method can be used for quality assurance procedures. In relation to PENFAST, it is shown that a purely condensed-history algorithm (class I) can be used for absorbed dose estimation in patient CTs.

Peripheral immune response in pulmonary tuberculosis.

Cellular immune response and delayed-type hypersensitivity reactions are considered to play a major role in the immunopathogenesis of pulmonary tuberculosis (PTB). But the exact mechanism is still to be clarified. Th1 cells are mainly involved in cellular immune responses in PTB and provide a normal healing process with minimal or no sequela whereas Th2 cell and CD8(+) T lymphocyte responses may lead to more severe type of disease. In this study, we investigated the peripheral blood immune responses in PTB. The study group consisted of acid fast positive young male soldiers with PTB and a negative HIV serology. The control group included healthy young volunteer male soldiers without a history of PTB. Intracytoplasmic cytokine content of CD8(+) T cells and lymphocytes, including IL-2, IL-4, IL-5, IL-10 and IFN-gamma were determined by flow cytometry, and IL-2, IL-4, IL-5, IL-10, IFN-gamma and TNF-alpha serum levels were measured by cytometric bead array (CBA). No difference was observed between the percentages of T, B, NK cells and HLA-DR expression in both groups, however, the number of CD3(+)HLA-DR(+) activated T cell percentages was higher in PTB group as compared to healthy subjects. IL-2, IL-4, IL-5, IL-10 contents of lymphocytes and IFN-gamma(+)CD8(+) T cells were found to be significantly lower in PTB patients when compared with healthy subjects, and in parallel, serum IL-2, IL-4, IL-5 and TNF-alpha levels were also significantly lower in PTB patients. In conclusion we suggest that, CD8(+) T cells producing both Th1 and Th2 type cytokines, may play important role in the peripheral immune response to mycobacteria.

A comparative ID migraine screener study in ophthalmology, ENT and neurology out-patient clinics.

Migraine is more likely to be misdiagnosed in patients with comorbid diseases. Not only primary care physicians, but also specialists might misdiagnose it due to the lack of diagnostic criteria awareness. The ID migraine test is a reliable screening instrument that may facilitate and accelerate migraine recognition. This study aimed to compare the prevalence and characteristics of migraine in a large sample of patients admitted to clinics of ophthalmology (OC), ear, nose and throat diseases (ENTC) and neurology (NC), as well as to validate the use of the ID migraine test in OC and ENTC settings. This was a multicentre (11 cites) study of out-patients admitting either to NC, ENTC or OC of the study sites during five consecutive working days within 1 week. From each of the clinics, 100 patients were planned to be recruited. All recruited patients were interviewed and those having a headache complaint received an ID migraine test and were examined for headache diagnosis by a neurologist, blinded to the ID migraine test result. A total of 2625 subjects were recruited. Only 1.3% of OC patients and 5.4% of ENTC patients have been admitted with a primary complaint of headache, whereas the percentage of NC patients suffering from headache was 37.6%. Whereas 138 patients (19.3%) in OC, 154 (17.3%) in ENTC and 347 (34%) in NC were found to be ID migraine test positive, 149 patients (20.8%) in OC, 142 (16%) in ENTC and 338 (33.1%) in NC were diagnosed with migraine. The sensitivity, specificity, and positive and negative predictive ratios of the ID migraine test were found to be similar in all clinics. An important fraction of the patients admitted to NC, as well as to OC and ENTC, for headache and/or other complaints were found out to have migraine by means of a simple screening test. This study validated the ID migraine test as a sensitive and specific tool in OC and ENTC, encouraging its use as a screening instrument.

Intramedullary angioma with bilateral arm hypothermia.

Spinal cavernous malformations are collections of abnormal blood vessels in the spinal cord. They are rare and frequently accompany cranial cavernous angiomas. They exhibit clinical features representing the region of the spine affected by the cavernous malformation. We present a 12-year-old boy with bilateral hypothermia predominantly in the left arm and motor weakness of the upper extremities, and lesser involvement of the lower extremities The case had normal cranial magnetic resonance imaging, but MRI of cervical region revealed an intramedullary cavernous haemangioma confirmed with histopathological examination. The lesion was totally excised and hypothermia completely improved within 2 weeks after operation. We suggested that hypothermia in the extremities may be added as a rare finding to the list of the clinical features in cervical myelopathy.

Pulmonary artery diameters measured by multidetector-row computed tomography in healthy adults.

BACKGROUND: The range of the diameters of pulmonary arteries (PA) is not fully shown in the current literature. Contrast-enhanced computed tomography (CT) of the thorax might be used for measuring diameters of the PA. PURPOSE: To determine the diameters of PAs in subjects with normal PA pressure by using thoracic CT. MATERIAL AND METHODS: 126 subjects aged between 19 and 46 years, having normal thoracic CTs (5-mm slice thickness) and normal PA pressures ((25 mmHg, determined by echocardiography), were included in the study. The diameters of the main, right, and left PAs were measured by using multidetector CT. RESULTS: The main PA diameters of all the subjects showed a normal distribution, and the mean was 24.0 ± 2.8 mm. The main PA diameters in male and female subjects also showed a normal distribution. The difference between the sexes for the main PA diameters was not significant (P=0.08). There were correlations between main PA diameter and body-mass index (BMI) (R=0.41, P=0.001) and weight (R=0.34, P=0.001). However, there was no significant correlation between main PA diameter and height (R=0.05, P=0.6). CONCLUSION: This study suggests that diameters of the main PA and its main branches show a normal distribution in subjects having normal PA pressures. Based on our findings, the upper limits of the main, right, and left PA diameters are 29.5 mm,19.8 mm, and 22.1 mm, respectively, in healthy adults.