Comparison of Radiation Dose and Image Quality of Pediatric High-Resolution Chest CT Between Photon-Counting Detector CT and Energy-Integrated Detector CT: A Matched Study.

BACKGROUND. Photon-counting detector (PCD) CT has been shown to reduce radiation dose and improve image quality in adult chest CT examinations; its potential impact in pediatric CT is not well documented. OBJECTIVE. The purpose of our study was to compare radiation dose, objective image quality, and subjective image quality of PCD CT and energy-integrating detector (EID) CT in children undergoing high-resolution CT (HRCT) of the chest. METHODS. This retrospective study included 27 children (median age, 3.9 years; 10 girls, 17 boys) who underwent PCD CT between March 1, 2022, and August 31, 2022, and 27 children (median age, 4.0 years; 13 girls, 14 boys) who underwent EID CT between August 1, 2021, and January 31, 2022; all examinations comprised clinically indicated chest HRCT. The patients in the two groups were matched by age and water-equivalent diameter. Radiation dose parameters were recorded. One observer placed ROIs to measure objective parameters (lung attenuation, image noise, and SNR). Two radiologists independently assessed subjective measures (overall image quality and motion artifacts) using 5-point Likert scales (1 = highest quality). Groups were compared. RESULTS. PCD CT, in comparison with EID CT, showed lower median CTDIvol (0.41 vs 0.71 mGy, p < .001), DLP (10.2 vs 13.7 mGy × cm, p = .008), size-specific dose estimate (0.82 vs 1.34 mGy, p < .001), and tube current-exposure time product (48.0 vs 202.0 mAs, p < .001). PCD CT and EID CT showed no significant difference in right upper lobe (RUL) lung attenuation (mean, -793 vs -750 HU; p = .09), right lower lobe (RLL) lung attenuation (mean, -745 vs -716 HU; p = .23), RUL image noise (mean, 55 vs 51 HU; p = .27), RLL image noise (mean, 59 vs 57 HU; p = .48), RUL SNR (mean, -14.9 vs -15.8; p = .89), or RLL SNR (mean, -13.1 vs -13.6; p = .79). PCD CT and EID CT showed no significant difference in median overall image quality for reader 1 (1.0 vs 1.0, p = .28) or reader 2 (1.0 vs 1.0, p = .17) or median motion artifacts for reader 1 (1.0 vs 1.0, p = .07) or reader 2 (1.0 vs 1.0, p = .22). CONCLUSION. PCD CT showed significantly reduced dose levels without a significant difference in objective or subjective image quality compared with EID CT. CLINICAL IMPACT. These data expand understanding of the capabilities of PCD CT and support its routine use in children.

Holistic Photoprotection, Broad Spectrum (UVA-UVB), and Biological Effective Protection Factors (BEPFs) from Baccharis antioquensis Hydrolysates Polyphenols.

Overexposure to solar radiation has become an increasingly worrying problem due to the damage to the skin caused by ultraviolet radiation (UVR). In previous studies, the potential of an extract enriched with glycosylated flavonoids from the endemic Colombian high-mountain plant Baccharis antioquensis as a photoprotector and antioxidant was demonstrated. Therefore, in this work we sought to develop a dermocosmetic formulation with broad-spectrum photoprotection from the hydrolysates and purified polyphenols obtained from this species. Hence, the extraction of its polyphenols with different solvents was evaluated, followed by hydrolysis and purification, in addition to the characterization of its main compounds by HPLC-DAD and HPLC-MS, and evaluation of its photoprotective capacity through the measurement of the Sun Protection Factor (SPF), UVA Protection Factor (UVAPF), other Biological Effective Protection Factors (BEPFs), and its safety through the cytotoxicity. In the dry methanolic extract (DME) and purified methanolic extract (PME), flavonoids such as quercetin and kaempferol were found, which demonstrated antiradical capacity, as well as UVA-UVB photoprotection and prevention of harmful biological effects, such as elastosis, photoaging, immunosuppression, DNA damage, among others, which demonstrates the potential of the ingredients in this type of extract to be applied in photoprotection dermocosmetics.

Remediation of Pb-contaminated soil using biochar-based slow-release P fertilizer and biomonitoring employing bioindicators.

Soil contamination by Pb can result from different anthropogenic sources such as lead-based paints, gasoline, pesticides, coal burning, mining, among others. This work aimed to evaluate the potential of P-loaded biochar (Biochar-based slow-release P fertilizer) to remediate a Pb-contaminated soil. In addition, we aim to propose a biomonitoring alternative after soil remediation. First, rice husk-derived biochar was obtained at different temperatures (450, 500, 550, and 600 °C) (raw biochars). Then, part of the resulting material was activated. Later, the raw biochars and activated biochars were immersed in a saturated KH2PO4 solution to produce P-loaded biochars. The ability of materials to immobilize Pb and increase the bioavailability of P in the soil was evaluated by an incubation test. The materials were incorporated into doses of 0.5, 1.0, and 2.0%. After 45 days, soil samples were taken to biomonitor the remediation process using two bioindicators: a phytotoxicity test and enzyme soil activity. Activated P-loaded biochar produced at 500 °C has been found to present the best conditions for soil Pb remediation. This material significantly reduced the bioavailability of Pb and increased the bioavailability of P. The phytotoxicity test and the soil enzymatic activity were significantly correlated with the decrease in bioavailable Pb but not with the increase in bioavailable P. Biomonitoring using the phytotoxicity test is a promising alternative for the evaluation of soils after remediation processes.

Coronary Artery Calcium Evaluation Using New Generation Photon-counting Computed Tomography Yields Lower Radiation Dose Compared With Standard Computed Tomography.

ABSTRACT: Prospective head-to-head comparison of coronary calcium scores between standard computed tomography (CT) and photon-counting CT show no significant differences, while photon-counting CT administers substantially lower radiation dose.

Sex differences in machine learning computed tomography-derived fractional flow reserve.

Coronary computed tomography angiography (CCTA) derived machine learning fractional flow reserve (ML-FFRCT) can assess the hemodynamic significance of coronary artery stenoses. We aimed to assess sex differences in the association of ML-FFRCT and incident cardiovascular outcomes. We studied a retrospective cohort of consecutive patients who underwent clinically indicated CCTA and single photon emission computed tomography (SPECT). Obstructive stenosis was defined as ≥ 70% stenosis severity in non-left main vessels or ≥ 50% in the left main coronary. ML-FFRCT was computed using a machine learning algorithm with significant stenosis defined as ML-FFRCT < 0.8. The primary outcome was a composite of death or non-fatal myocardial infarction (D/MI). Our study population consisted of 471 patients with mean (SD) age 65 (13) years, 53% men, and multiple comorbidities (78% hypertension, 66% diabetes, 81% dyslipidemia). Compared to men, women were less likely to have obstructive stenosis by CCTA (9% vs. 18%; p = 0.006), less multivessel CAD (4% vs. 6%; p = 0.25), lower prevalence of ML-FFRCT < 0.8 (39% vs. 44%; p = 0.23) and higher median (IQR) ML-FFRCT (0.76 (0.53-0.86) vs. 0.71 (0.47-0.84); p = 0.047). In multivariable adjusted models, there was no significant association between ML-FFRCT < 0.8 and D/MI [Hazard Ratio 0.82, 95% confidence interval (0.30, 2.20); p = 0.25 for interaction with sex.]. In a high-risk cohort of symptomatic patients who underwent CCTA and SPECT testing, ML-FFRCT was higher in women than men. There was no significant association between ML-FFRCT and incident mortality or MI and no evidence that the prognostic value of ML-FFRCT differs by sex.

Interoperator reliability of an on-site machine learning-based prototype to estimate CT angiography-derived fractional flow reserve.

BACKGROUND: Advances in CT and machine learning have enabled on-site non-invasive assessment of fractional flow reserve (FFRCT). PURPOSE: To assess the interoperator and intraoperator variability of coronary CT angiography-derived FFRCT using a machine learning-based postprocessing prototype. MATERIALS AND METHODS: We included 60 symptomatic patients who underwent coronary CT angiography. FFRCT was calculated by two independent operators after training using a machine learning-based on-site prototype. FFRCT was measured 1 cm distal to the coronary plaque or in the middle of the segments if no coronary lesions were present. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to evaluate interoperator variability effect in FFRCT estimates. Sensitivity analysis was done by cardiac risk factors, degree of stenosis and image quality. RESULTS: A total of 535 coronary segments in 60 patients were assessed. The overall ICC was 0.986 per patient (95% CI 0.977 to 0.992) and 0.972 per segment (95% CI 0.967 to 0.977). The absolute mean difference in FFRCT estimates was 0.012 per patient (95% CI for limits of agreement: -0.035 to 0.039) and 0.02 per segment (95% CI for limits of agreement: -0.077 to 0.080). Tight limits of agreement were seen on Bland-Altman analysis. Distal segments had greater variability compared with proximal/mid segments (absolute mean difference 0.011 vs 0.025, p<0.001). Results were similar on sensitivity analysis. CONCLUSION: A high degree of interoperator and intraoperator reproducibility can be achieved by on-site machine learning-based FFRCT assessment. Future research is required to evaluate the physiological relevance and prognostic value of FFRCT.

Selected Extracts from High Mountain Plants as Potential Sunscreens with Antioxidant Capacity.

The photoprotective and antioxidant activities of extracts of six species of plants collected in a high mountain ecosystem at 3150 m.a.s.l. were evaluated. In vitro photoprotection according to UVA-UVB absorption spectrum, Sun Protection Factor (SPF), UVA Protection Factor (UVAPF), (critical wavelength) λc and UVA/UVB Ratio were assessed. Also, the antioxidant activity was determined using the DPPH radical assay and the inhibition of lipid peroxidation in methyl linoleate (MeLo). Total anthocyanins content (TAC) and total polyphenolic content (TPC) were evaluated. Among the extracts evaluated, the extract of B. antioquensis, an endemic plant of Colombia, showed a significant photoprotection against UVA-UVB range, with SPF values of 15 ± 2 and UVAPF of 7 ± 1, λc : 378, UVA/UVB Ratio: 0.78. Furthermore, this extract presented an excellent antioxidant activity, with EC50 of 0.17 ± 0.04 g of dry extract/mmol DPPH, a value of TPC of 464 ± 9 mg gallic acid equivalents (GAE)/g dry extract and significant inhibition of MeLo peroxidation. The results suggest that the extract of B. antioquensis has the best quality to be a source of new UV filters, with a broad spectrum of protection and antioxidant properties.

Prognostic Value of Computed Tomography-Derived Fractional Flow Reserve Comparison With Myocardial Perfusion Imaging.

OBJECTIVES: The aim of this study was to compare the incremental prognostic value of coronary computed tomography (CT) angiography (CCTA)-derived machine learning fractional flow reserve CT (ML-FFRct) versus that of ischemia detected on single-photon emission-computed tomography (SPECT) myocardial perfusion imaging (MPI) on incident cardiovascular outcomes. BACKGROUND: SPECT MPI and ML-FFRct are noninvasive tools that can assess the hemodynamic significance of coronary atherosclerotic disease. METHODS: We studied a retrospective cohort of consecutive patients who underwent clinically indicated CCTA and SPECT MPI. ML-FFRct was computed using a ML prototype. The primary outcome was all-cause mortality and nonfatal myocardial infarction (D/MI), and the secondary outcome was D/MI and unplanned revascularization, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) occurring more than 90 days postimaging. Multiple nested multivariate cox regression was used to model a scenario wherein an initial anatomical assessment was followed by a functional assessment. RESULTS: A total of 471 patients (mean age: 64 ± 13 year; 53% males) were included. Comorbidities were prevalent (78% hypertension, 66% diabetes, 81% dyslipidemia). ML-FFRct was <0.8 in at least 1 proximal/midsegment was present in 41.6% of patients, and ischemia on MPI was present in 13.8%. After a median follow-up of 18 months, 7% of patients (n = 33) experienced D/MI. On multivariate Cox proportional analysis, the presence of ischemia on MPI but not ML-FFRct significantly predicted D/MI (HR: 2.3; 95% CI: 1.0-5.0; P = 0.047; or HR: 0.7; 95% CI: 0.3-1.4; P = 0.306 respectively) when added to CCTA obstructive stenosis. Furthermore, the model with SPECT ischemia had higher global chi-square result and significantly improved reclassification. Results were similar using the secondary outcome and on several sensitivity analyses. CONCLUSIONS: In a high-risk patient cohort, SPECT MPI but not ML-FFRct adds independent and incremental prognostic information to CCTA-based anatomical assessment and clinical risk factors in predicting incident outcomes.

Photoprotection and Photostability of a New Lignin-Gelatin-Baccharis antioquensis-Based Hybrid Biomaterial.

The aim of this study was to develop a new hybrid biomaterial that could photo-stabilize and improve the photoprotective capacity of a Baccharis antioquensis extract. Different combinations of lignin/gelatin/natural extract were applied to prepare hybrid biomaterial nanoparticles (NPs), which were then incorporated into an emulsion. The in vitro photoprotection and photostability were evaluated. The methanolic extract showed high phenolic content (646.4 ± 9.5 mg GAE/g dry extract) and a DPPH radical assay revealed that the antiradical capacity of the extract (0.13 to 0.05 g extract/mmol DPPH) was even better than that of BHT. The particle size of the hybrid biomaterial ranged from 100 to 255 nm; a polydispersity index (PdI) between 0.416 and 0.788 is suitable for topical use in dermocosmetic products. The loading capacity of the extract ranged from 27.0 to 44.5%, and the nanoparticles (NPs) showed electrostatic stability in accordance with the zeta potential value. We found that the formulation based on lignin: extract (1:1 ratio) and gelatin: lignin: extract (0.5:0.5:1 ratio) demonstrated photoprotection qualities with a sun protection factor (SPF) ranging from 9.4 to 22.6. In addition, all the hybrid NP-formulations were time-stable with %SPFeff and %UVAPFeff greater than 80% after exposure to 2 h of radiation. These results suggest that the hybrid biopolymer-natural extract improved the photoprotection and photostability properties, as well as the antiradical capacity, of the B. antioquensis extract, and may be useful for trapping high polyphenol content from natural extracts, with potential application in cosmeceutical formulations.

Novel UV filters from Pentacalia pulchella extracts with photoprotective properties and antioxidant activity.

Most of the plant species found in the high mountain ecosystems of the tropics is unique and exceptional, because they have developed complex adaptations to survive in extreme environmental conditions, such as high levels of UVR and low temperatures of these ecological environments. In an exploratory study carried out on some plants of this ecosystem, we found that one of the most promising species was the Pentacalia pulchella (Kunth) Cuatrec. (Asteraceae) an endemic plant of Colombia, which grows between 2500 and 3500 m.a.s.l. Therefore, the objective of this work was to evaluate the photoprotective, antioxidant, and chemical composition of extracts from the leaves of P. pulchella. Extracts showed good absorption coefficients in UVA-UVB, high content of total phenols, with antioxidant activity comparable to that obtained with butylhydroxytoluene (BHT). Finally, the formulation labeled "7" with 10% extract presented adequate sensory characteristics for topical use, good in vitro photoprotection values in the UVA-UVB range (SPF (Sun Protection Factor): 7.3 ± 0.9, UVAPF (Ultraviolet A Protection Factor): 5.3 ± 0.6, λc 376), and antioxidant activity. Results obtained allow us to suggest that the extract of P. pulchella has a high potential as a source of new natural solar filters.

Deep learning based spectral extrapolation for dual-source, dual-energy x-ray computed tomography.

PURPOSE: Data completion is commonly employed in dual-source, dual-energy computed tomography (CT) when physical or hardware constraints limit the field of view (FoV) covered by one of two imaging chains. Practically, dual-energy data completion is accomplished by estimating missing projection data based on the imaging chain with the full FoV and then by appropriately truncating the analytical reconstruction of the data with the smaller FoV. While this approach works well in many clinical applications, there are applications which would benefit from spectral contrast estimates over the larger FoV (spectral extrapolation)-e.g. model-based iterative reconstruction, contrast-enhanced abdominal imaging of large patients, interior tomography, and combined temporal and spectral imaging. METHODS: To document the fidelity of spectral extrapolation and to prototype a deep learning algorithm to perform it, we assembled a data set of 50 dual-source, dual-energy abdominal x-ray CT scans (acquired at Duke University Medical Center with 5 Siemens Flash scanners; chain A: 50 cm FoV, 100 kV; chain B: 33 cm FoV, 140 kV + Sn; helical pitch: 0.8). Data sets were reconstructed using ReconCT (v14.1, Siemens Healthineers): 768 × 768 pixels per slice, 50 cm FoV, 0.75 mm slice thickness, "Dual-Energy - WFBP" reconstruction mode with dual-source data completion. A hybrid architecture consisting of a learned piecewise linear transfer function (PLTF) and a convolutional neural network (CNN) was trained using 40 scans (five scans reserved for validation, five for testing). The PLTF learned to map chain A spectral contrast to chain B spectral contrast voxel-wise, performing an image domain analog of dual-source data completion with approximate spectral reweighting. The CNN with its U-net structure then learned to improve the accuracy of chain B contrast estimates by copying chain A structural information, by encoding prior chain A, chain B contrast relationships, and by generalizing feature-contrast associations. Training was supervised, using data from within the 33-cm chain B FoV to optimize and assess network performance. RESULTS: Extrapolation performance on the testing data confirmed our network's robustness and ability to generalize to unseen data from different patients, yielding maximum extrapolation errors of 26 HU following the PLTF and 7.5 HU following the CNN (averaged per target organ). Degradation of network performance when applied to a geometrically simple phantom confirmed our method's reliance on feature-contrast relationships in correctly inferring spectral contrast. Integrating our image domain spectral extrapolation network into a standard dual-source, dual-energy processing pipeline for Siemens Flash scanner data yielded spectral CT data with adequate fidelity for the generation of both 50 keV monochromatic images and material decomposition images over a 30-cm FoV for chain B when only 20 cm of chain B data were available for spectral extrapolation. CONCLUSIONS: Even with a moderate amount of training data, deep learning methods are capable of robustly inferring spectral contrast from feature-contrast relationships in spectral CT data, leading to spectral extrapolation performance well beyond what may be expected at face value. Future work reconciling spectral extrapolation results with original projection data is expected to further improve results in outlying and pathological cases.

Successful Management of Massive Air Embolism During Cardiopulmonary Bypass Using Multimodal Neuroprotection Strategies.

Complications and critical events during cardiopulmonary bypass (CPB) are very challenging, difficult to manage, and in some instances have the potential to lead to fatal outcomes. Massive cerebral air embolism is undoubtedly a feared complication during CPB. If not diagnosed and managed early, its effects are devastating and even fatal. It is a catastrophic complication and its early diagnosis and intraoperative management are still controversial. This is why the decision-making process during a massive cerebral air embolism represents a challenge for the entire surgical, anesthetic, and perfusion team. All caregivers involved in this event must synchronize their responses quickly, harmoniously, and in such a way that all interventions lead to minimizing the impact of this complication. Its occurrence leaves important lessons to the surgical team that faces it. The best management strategy for a complication of this type is prevention. Nevertheless, a surgical team may ultimately be confronted with such an occurrence at some point despite all the prevention strategies, as was the case with our patient. That is why, in each institution, no effort should be spared to establish cost-effective strategies for early detection and a clear and concise management protocol to guide actions once this complication is detected. It is the duty of each surgical team to determine and clearly organize which strategies will be followed. The purpose of this case study was to demonstrate that a massive air embolism can be rapidly detected using near-infrared spectroscopy monitoring and can be successfully corrected with a multimodal neuroprotection strategy.

Micropropagation of Baccharis antioquensis (Asteraceae) and photoinduction of polyphenols by UV radiation / Micropropagación de Baccharis antioquensis (Asteraceae) y fotoinducción de polifenoles mediante radiación UV

Abstract Polyphenols are a large diversity of chemical types and interactions that can be responsible for a multiplicity of protective functions ranging from toxicity and light/UV shielding to signal transduction. Bacharis antioquensis has been described as a potential source of new photoprotective compounds with antioxidant capacity associated to polyphenols compounds. The aim of the present work was to develop a micropropagation protocol of B. antioquensis and evaluate the production of polyphenols by in vitro plants exposure to UVB radiation. Branches in juvenile stage of B. antioquensis were collected, desinfected and cultured on half strength Murashige and Skoog medium, supplemented or not with growth regulators (TDZ, BA or GA3) on light/darkness conditions and liquid/solid media. After UV treatments, the absorption coefficient in the UVA-UVB range, the antioxidant capacity and the total phenol content (TPC) from all tissue cultures and the wild tissue were evaluated. Growth regulators, light conditions and type of culture medium (solid or liquid) had a favorable effect on the response of explants. Treatments containing BA + GA3 regulators (2 and 0.5 mg/L respectively) and TDZ (0.5 mg/L) showed positive results in bud growth in liquid medium and darkness. Results showed that UVR exhibited promoting effects on the accumulation of polyphenols, enhancing the absorption coefficient in the UVA-UVB range, the antiradical capacity and the TPC of B. antioquensis in vitro plants. Rev. Biol. Trop. 66(2): 754-764. Epub 2018 June 01.

Resumen Los polifenoles son compuestos químicos con una diversidad de interacciones que pueden ser responsables de muchas funciones, que van desde la toxicidad hasta la protección y blindaje contra la luz/UV. Baccharis antioquensis es una fuente potencial de compuestos fotoprotectores con capacidad antioxidante. El objetivo del presente trabajo fue desarrollar un protocolo de micropropagación para B. antioquensis y evaluar la producción de polifenoles in vitro por exposición a la radiación UVB. Ramas juveniles fueron colectadas y cultivadas en medio de Murashige y Skoog (MS) y suplementadas o no con reguladores de crecimiento (TDZ, BA o GA3) en diferentes condiciones de luz/oscuridad y medios líquidos/sólidos. Después de los tratamientos UVR, se midió el espectro de absorción UV y se evaluó el coeficiente de absorción en la región UVA-UVB, la capacidad antioxidante y TPC tanto en las plantas in vitro como en las plantas silvestres. Los tratamientos que contenían reguladores BA + GA3 (2 y 0.5 mg / L respectivamente) y TDZ (0.5 mg / L) mostraron resultados positivos en el crecimiento del brote en medio líquido y en condiciones de oscuridad. Los resultados mostraron que la UVR tiene efectos promotores sobre la acumulación de metabolitos secundarios, aumentando el coeficiente de absorción en la región UVA-UVB, la capacidad antiradicalaria y TPC en las plantas in vitro.

Frequency of anesthetic overdose with mean alveolar concentration-guided anesthesia at high altitude.

This study reported the frequency of anesthetic overdose measured with the bispectral index in a high altitude city (Bogotá-Colombia, 2600 meters above sea level). We assembled a prospective cohort of patients. Preoperative variables were described, and 10 minutes after the surgical incision, bispectral index, mean alveolar concentration, mean arterial pressure, and oxygen saturation were recorded. Bispectral index was classified as superficial (60), adequate (40-60), and deep (> 40). Mean alveolar concentration was classified as low (< 0.8), normal (0.8-1.2), and high (> 1.2). We included 50 patients. The mean age of the patients was 36.3 ± 13.5 years; 48% were male and 78% were categorized as ASA I. Mean values of mean alveolar concentration and bispectral index were 1.14 ± 0.18 and 38.66 ± 6.9, respectively. Frequency of anesthetic overdose measured with bispectral index was 54% and only 20% with mean alveolar concentration. In total, 78% of patients received normal mean alveolar concentration values, and among these patients, 49% had deep bispectral index levels and 51% were adequate. There was no correlation between mean alveolar concentration and bispectral index (Pearson r = 0.161, P = 0.246) or between bispectral index and mean arterial pressure (Pearson r = 0.367, P = 0.08). All patients older than 60 years exhibited deep bispectral index levels, and although we did not identify a correlation between age and bispectral index, a tendency was observed (Pearson r = -0.087, P = 0.538). Safe and effective anesthesia overdose could be a common phenomenon. Bispectral index-guided anesthesia could be a helpful and reliable tool in the assessment and prevention of anesthesia overdose at high altitude. The study was approved by the ethics committee of the Fundación Cardioinfantil-Instituto de cardiología, Bogota, Colombia (approved number: 312017).

Effects of Dual-Energy Technique on Radiation Exposure and Image Quality in Pediatric Body CT.

OBJECTIVE: The purpose of this study was to assess the effects of dual-energy CT (DECT) on radiation exposure and image quality in pediatric body CT. MATERIALS AND METHODS: This retrospective study included 79 children (median age, 10.1 years; range, 12 days-18 years) who underwent thoracic or abdominal-pelvic CT or CT angiography with dual-energy technique between October 2014 and March 2015. The delivered volume CT dose index (CTDIvol) from DECT was recorded and compared with the estimated CTDIvol had the patient undergone scanning with a standard single-energy CT (SECT) protocol. Size-specific dose estimates were calculated for both DECT and SECT. Image quality was subjectively scored (scale, 1-4). For 16 of 79 patients who underwent both DECT and SECT, image contrast and noise were measured and contrast-to-noise ratio calculated. Parametric and nonparametric testing of independent and paired samples was performed. RESULTS: For all 79 studies, actual median CTDIvol and size-specific dose estimate were 3.7 and 5.9 mGy for DECT versus prescanning estimates of 4.4 and 7.7 mGy for SECT, resulting in 12.5% and 11.2% radiation exposure reduction (p < 0.01). Diagnostic image quality was achieved in all patients. In the 16-patient subset, the median CTDIvol values of DECT and SECT were 3.1 and 3.4 mGy (p < 0.05). Median noise was greater with DECT than with SECT (p < 0.01), but the mean contrast-to-noise ratios for the liver and portal vein were similar (liver, p = 0.32; portal vein, p = 0.21). CONCLUSION: In pediatric body CT, the use of DECT results in radiation exposures comparable to or less than those of SECT while maintaining contrast and contrast-to-noise ratio.

Photoprotective Potential of Baccharis antioquensis (Asteraceae) as Natural Sunscreen.

In the quest for new natural agents of photoprotection, we evaluated the photoprotective and antioxidant activity of B. antioquensis leaf extracts as well as its phenolic composition. The methanolic extract treated with activated carbon showed the highest absorption coefficients for UVA-UVB radiation, as well as an antioxidant capacity comparable to butylated hydroxy toluene. Furthermore, the formulation containing this extract showed suitable sensorial and photostable characteristics for topical use, and significant values of UVAPF, critical wavelength (λc ), UVA/UVB ratio and sun protection factor (5.3, 378 nm, 0.78 and 9.1 ± 0.1, respectively). In addition, three glycoside derivatives of quercetin, a kaempferol glycoside and a derivative of caffeic acid were the main polyphenolic compounds identified. These results demonstrate the potential of B. antioquensis extracts to be used as active components of novel, natural sunscreens.

Novel In Vitro Antioxidant and Photoprotection Capacity of Plants from High Altitude Ecosystems of Colombia.

Currently, plants have gained widespread interest as a source of natural sunscreen. Specifically, plants from high altitude ecosystems are exposed to high UVR levels; therefore, they must produce an adaptive chemical response. The aim of this study was to evaluate the photo-protection and antioxidant capacity in vitro of nine plants from high altitude ecosystems in Antioquia, Colombia (Sphagnum meridense, Calamagrostis effusa, Lycopodiella alopecuroides, Morella parvifolia, Baccharis antioquensis, Pentacalia pulchella, Castilleja fissifolia, Hesperomeles ferruginea and Hypericum juniperinum). B. antioquensis and P. pulchella extracts showed the best results over a broad spectrum UVA-UVB with antioxidant capacity in vitro. However, B. antioquensis extracts presented the highest absorption coefficient in UVB-UVA range among plants under study. Furthermore, the gel formulation containing the crude extract of B. antioquensis showed significant values of UVAPF, UVA/UVB ratio, critical wavelength (λc ) and SPF (3, 0.78 380 nm and 4.73 ± 0.26; respectively), indicating interesting photostability and antiradical capacities. All of these properties could be improve in order to satisfy the requirements for broad-spectrum UVB/UVA protection. Finally, P. pulchella and B. antioquensis extracts could be a potential source of a new natural sunscreen compounds with photostable and antiradical properties.

Effects of automatic tube potential selection on radiation dose index, image quality, and lesion detectability in pediatric abdominopelvic CT and CTA: a phantom study.

OBJECTIVES: To assess the effect of automatic tube potential selection (ATPS) on radiation dose, image quality, and lesion detectability in paediatric abdominopelvic CT and CT angiography (CTA). METHODS: A paediatric modular phantom with contrast inserts was examined with routine pitch (1.4) and high pitch (3.0) using a standard abdominopelvic protocol with fixed 120 kVp, and ATPS with variable kVp in non-contrast, contrast-enhanced, and CTA mode. The volume CT dose index (CTDIvol), contrast-to-noise ratio (CNR) and lesion detectability index (d') were compared between the standard protocol and ATPS examinations. RESULTS: CTDIvol was reduced in all routine pitch ATPS examinations, with dose reductions of 27-52 % in CTA mode (P < 0.0001), 15-33 % in contrast-enhanced mode (P = 0.0003) and 8-14 % in non-contrast mode (P = 0.03). Iodine and soft tissue insert CNR and d' were improved or maintained in all ATPS examinations. kVp and dose were reduced in 25 % of high pitch ATPS examinations and in none of the full phantom examinations obtained after a single full phantom localizer. CONCLUSIONS: ATPS reduces radiation dose while maintaining image quality and lesion detectability in routine pitch paediatric abdominopelvic CT and CTA, but technical factors such as pitch and imaging range must be considered to optimize ATPS benefits. KEY POINTS: ATPS automatically individualizes CT scan technique for each patient. ATPS lowers radiation dose in routine pitch pediatric abdominopelvic CT and CTA. There is no loss of image quality or lesion detectability with ATPS. Pitch and scan range impact the effectiveness of ATPS dose reduction.

CT Dose Optimization in Pediatric Radiology: A Multiyear Effort to Preserve the Benefits of Imaging While Reducing the Risks.

The marked increase in radiation exposure from medical imaging, especially in children, has caused considerable alarm and spurred efforts to preserve the benefits but reduce the risks of imaging. Applying the principles of the Image Gently campaign, data-driven process and quality improvement techniques such as process mapping and flowcharting, cause-and-effect diagrams, Pareto analysis, statistical process control (control charts), failure mode and effects analysis, "lean" or Six Sigma methodology, and closed feedback loops led to a multiyear program that has reduced overall computed tomographic (CT) examination volume by more than fourfold and concurrently decreased radiation exposure per CT study without compromising diagnostic utility. This systematic approach involving education, streamlining access to magnetic resonance imaging and ultrasonography, auditing with comparison with benchmarks, applying modern CT technology, and revising CT protocols has led to a more than twofold reduction in CT radiation exposure between 2005 and 2012 for patients at the authors' institution while maintaining diagnostic utility.

Anestesia cardiovascular ¿Cardiología de salas de cirugía?: Cardiovascular Anesthesia. Operating rooms cardiology? / Cardiovascular Anesthesia. Operating rooms cardiolog

"El 16 de octubre de 1846, a las diez de la mañana, los espectadores llenaron rápidamente el anfiteatro del quirófano-auditorio de la escuela de Medicina de Harvard (Boston-USA)... el paciente Gilbert Abbott, el cirujano Profesor Warren quien se disponía a resecar un tumor en el cuello de Abbott. El Dr. Odontólogo de profesión Tomas Green Morton, apareció quince minutos tarde luego de perfeccionar el equipo para administrar el medicamento, hizo abrir la boca del paciente e insertó un tubo de madera, lo inició cautelosamente en la inhalación del Ether; luego de 10 minutos consiguió en el paciente un estado de narcosis y relajamiento... Se dirigió al Dr. Warren. ­Ya puede usted empezar, ­dijo Morton­. Warren dio inicio a la cirugía palideciendo de sorpresa... Abbott no reaccionó. Efectivamente era posible operar sin dolor. ­Esta vez bien lo sabe Dios, no ha sido una farsa ­exclamó Warren. ­Dentro de poco no se efectuará ninguna intervención quirúrgica sin anestesia ­concluyen los asistentes quienes acababan de vivir uno de los momentos estelares de la medicina. A pesar de las múltiples referencias acerca del uso de diferentes agentes anestésicos y analgésicos previos al momento descrito en la cita histórica anterior, este evento se considera como la primera anestesia y el punto de partida de una nueva era en la historia de la medicina. Allí comienza una interminable secuencia de hechos conducentes al desarrollo de la cirugía, de todas sus especialidades y de nuevas técnicas anestésicas, al tiempo que se origina el desarrollo académico de una nueva especialidad médica de progresión acelerada: la Anestesiología. En la actualidad, ésta ocupa los primeros lugares de solicitudes de ingreso a programas de especialización en los ámbitos internacional y nacional; en este último se cuenta con 24 programas universitarios de especialización que entregan cada año un promedio de 100 especialistas nuevos para un total de 2.249 anestesiólogos actualmente en ejercicio, distribuidos en el territorio colombiano.