Magnetic resonance imaging assessment of articular disc position in temporomandibular disorder subjects with various bite registrations.

Objective: This study aimed to evaluate the validity and reliability of three bite registrations on articular disc position in temporomandibular disorder patients using magnetic resonance imaging (MRI). Materials and Methods: Fifteen clinically symptomatic and orthodontically untreated temporomandibular disorder patients within the age range of 17-40 years (mean age: 28.5 years) were examined. Each patient was subjected to three bite registrations, namely maximum intercuspation, initial contact bite and Roth power centric bite, and evaluated with MRI. Results: On the right side, the mean vertical and horizontal measurement values of the point in the most posterior aspect of the posterior band of the articular disc in relation to horizontal reference line (HRL) and vertical reference line (VRL) in the sagittal view in the Roth power centric bite were lesser (2.720 ± 1.239 mm and 2.380 ± 1.185 mm, respectively), in comparison with the other two bites, and on the left side too, it was lesser in the Roth power centric bite (2.293 ± 0.979 mm and 2.360 ± 1.078 mm, respectively), when compared to the other two bites. Statistical analysis also showed the significance of Roth power centric bite over the other two bites. Conclusions: Favourable articular disc positional changes were observed in the Roth power centric bite followed by the initial contact bite and that maximum disc recapture was observed in most patients with the Roth power centric bite rather than in initial contact bite and maximum intercuspation positions. The Roth power centric bite could be assumed to be the ideal method for articulation and fabrication of gnathological splints for treating patients with temporomandibular disorders.

Machine learning based congestive heart failure detection using feature importance ranking of multimodal features.

In this study, we ranked the Multimodal Features extracted from Congestive Heart Failure (CHF) and Normal Sinus Rhythm (NSR) subjects. We categorized the ranked features into 1 to 5 categories based on Empirical Receiver Operating Characteristics (EROC) values. Instead of using all multimodal features, we use high ranking features for detection of CHF and normal subjects. We employed powerful machine learning techniques such as Decision Tree (DT), Naïve Bayes (NB), SVM Gaussian, SVM RBF and SVM Polynomial. The performance was measured in terms of Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Accuracy, False Positive Rate (FPR), and area under the Receiver Operating characteristic Curve (AUC). The highest detection performance in terms of accuracy and AUC was obtained with all multimodal features using SVM Gaussian with Sensitivity (93.06%), Specificity (81.82%), Accuracy (88.79%) and AUC (0.95). Using the top five ranked features, the highest performance was obtained with SVM Gaussian yields accuracy (84.48%), AUC (0.86); top nine ranked features using Decision Tree and Naïve Bayes got accuracy (84.48%), AUC (0.88); last thirteen ranked features using SVM polynomial obtained accuracy (80.17%), AUC (0.84). The findings indicate that proposed approach with feature ranking can be very useful for automatic detection of congestive heart failure patients and can be very helpful for further decision making by the clinicians and physicians in order to decrease the mortality rate.

Machine learning based classification of normal, slow and fast walking by extracting multimodal features from stride interval time series.

The gait speed affects the gait patterns (biomechanical and spatiotemporal parameters) of distinct age populations. Classification of normal, slow and fast walking is fundamental for understanding the effects of gait speed on the gait patterns and for proper evaluation of alternations associated with it. In this study, we extracted multimodal features such as time domain and entropy-based complexity measures from stride interval signals of healthy subjects moving with normal, slow and fast speeds. The classification between different gait speeds was performed using machine learning classifiers such as classification and regression tree (CART), support vector machine linear (SVM-L), Naïve Bayes, neural network, and ensemble classifiers (random forest (RF), XG boost, averaged neural network (AVNET)). The performance was evaluated in term of accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), p-value, area under the receiver operating characteristic curve (AUC). To distinguish the slow and normal gait walking, the highest performance was yielded in terms of accuracy (100%), p-value (0.004), and AUC (1.00) using RF, XGB-L followed by XGB-Tree with accuracy (88%), p-value (0.04) and AUC (1.00). To classify the fast and normal walking, the highest performance was obtained with accuracy (88%), p-value (0.04) using XGB-L, XGB-Tree and AVNET. The highest AUC (0.94) was obtained using NB. To discriminate the fast and slow gait walking, the highest performance was obtained using SVM-R, NNET, RF, AVNET with accuracy (88%), p-value (0.04) and AUC (0.94) using RF and AUC (0.96) using XGB-L.

Studying the dynamics of interbeat interval time series of healthy and congestive heart failure subjects using scale based symbolic entropy analysis.

Considerable interest has been devoted for developing a deeper understanding of the dynamics of healthy biological systems and how these dynamics are affected due to aging and disease. Entropy based complexity measures have widely been used for quantifying the dynamics of physical and biological systems. These techniques have provided valuable information leading to a fuller understanding of the dynamics of these systems and underlying stimuli that are responsible for anomalous behavior. The single scale based traditional entropy measures yielded contradictory results about the dynamics of real world time series data of healthy and pathological subjects. Recently the multiscale entropy (MSE) algorithm was introduced for precise description of the complexity of biological signals, which was used in numerous fields since its inception. The original MSE quantified the complexity of coarse-grained time series using sample entropy. The original MSE may be unreliable for short signals because the length of the coarse-grained time series decreases with increasing scaling factor τ, however, MSE works well for long signals. To overcome the drawback of original MSE, various variants of this method have been proposed for evaluating complexity efficiently. In this study, we have proposed multiscale normalized corrected Shannon entropy (MNCSE), in which instead of using sample entropy, symbolic entropy measure NCSE has been used as an entropy estimate. The results of the study are compared with traditional MSE. The effectiveness of the proposed approach is demonstrated using noise signals as well as interbeat interval signals from healthy and pathological subjects. The preliminary results of the study indicate that MNCSE values are more stable and reliable than original MSE values. The results show that MNCSE based features lead to higher classification accuracies in comparison with the MSE based features.

Influences for Gender Disparity in Academic Neuroradiology.

BACKGROUND AND PURPOSE: There has been extensive interest in promoting gender equality within radiology, a predominately male field. In this study, our aim was to quantify gender representation in neuroradiology faculty rankings and determine any related factors that may contribute to any such disparity. MATERIALS AND METHODS: We evaluated the academic and administrative faculty members of neuroradiology divisions for all on-line listed programs in the US and Canada. After excluding programs that did not fulfill our selection criteria, we generated a short list of 85 US and 8 Canadian programs. We found 465 faculty members who met the inclusion criteria for our study. We used Elsevier's SCOPUS for gathering the data pertaining to the publications, H-index, citations, and tenure of the productivity of each faculty member. RESULTS: Gender disparity was insignificant when analyzing academic ranks. There are more men working in neuroimaging relative to women (χ2 = 0.46; P = .79). However, gender disparity was highly significant for leadership positions in neuroradiology (χ2 = 6.76; P = .009). The median H-index was higher among male faculty members (17.5) versus female faculty members (9). Female faculty members have odds of 0.84 compared with male faculty members of having a higher H-index, adjusting for publications, citations, academic ranks, leadership ranks, and interaction between gender and publications and gender and citations (9). CONCLUSIONS: Neuroradiology faculty members follow the same male predominance seen in many other specialties of medicine. In this study, issues such as mentoring, role models, opportunities to engage in leadership/research activities, funding opportunities, and mindfulness regarding research productivity are explored.

Immunophenotypic aberrancies in acute lymphoblastic leukemia from 282 Iraqi patients.

INTRODUCTION: The identification of aberrancies in leukemia-associated immunophenotype (LAIP) of acute lymphoblastic leukemia (ALL) is quite important in the assessment of minimal residual disease (MRD). This study, the first from Iraq, aimed to assess the frequency and patterns of LAIP among Iraqi patients with ALL, to establish future strategies for evaluating MRD. METHODS: A total of 282 newly diagnosed Iraqi ALL cases were analyzed with six-parameter flow cytometry using a panel of 29 monoclonal antibodies. RESULTS: Immunological subtyping revealed that 85.5% of cases were B-ALL and the remainder T-ALL. LAIP was detected in 97.1% of B-ALL, and in 26.8% of T-ALL. The asynchronous maturation-associated antigen patterns in B-ALL were CD10strong+ /TdTdim+ , CD38dim+ /CD34+ , CD10dim+ /CD34+ , CD10strong /CD20strong+ , CD20strong+ /CD34+, and CD45dim+ /CD20strong+ in 84.6%, while the cross-lineage myeloid expression was seen in 81.3% and aberrant T-cell antigen expression in 6.2%. For T-ALL, asynchronous maturation-associated antigen patterns included the following: CD1a+ /CD5+ /sCD3+ and CD34+ /sCD3+ in 12.2%. Myeloid and B-cell antigen expression were each identified in 7.3% of T-ALL. No significant differences in LAIP were found between children and adults. CONCLUSION: The high rates and the patterns of LAIP particularly in Iraqi B-ALL patients may allow the development of more cost-effective strategies for MRD monitoring.

Symbolic time series analysis of electroencephalographic (EEG) epileptic seizure and brain dynamics with eye-open and eye-closed subjects during resting states.

OBJECTIVE: Epilepsy is a neuronal disorder for which the electrical discharge in the brain is synchronized, abnormal and excessive. To detect the epileptic seizures and to analyse brain activities during different mental states, various methods in non-linear dynamics have been proposed. This study is an attempt to quantify the complexity of control and epileptic subject with and without seizure as well as to distinguish eye-open (EO) and eye-closed (EC) conditions using threshold-based symbolic entropy. METHODS: The threshold-dependent symbolic entropy was applied to distinguish the healthy and epileptic subjects with seizure and seizure-free intervals (i.e. interictal and ictal) as well as to distinguish EO and EC conditions. The original time series data was converted into symbol sequences using quantization level, and word series of symbol sequences was generated using a word length of three or more. Then, normalized corrected Shannon entropy (NCSE) was computed to quantify the complexity. The NCSE values were not following the normal distribution, and the non-parametric Mann-Whitney-Wilcoxon (MWW) test was used to find significant differences among various groups at 0.05 significance level. The values of NCSE were presented in a form of topographic maps to show significant brain regions during EC and EO conditions. The results of the study were compared to those of the multiscale entropy (MSE). RESULTS: The results indicated that the dynamics of healthy subjects are more complex compared to epileptic subjects (during seizure and seizure-free intervals) in both EO and EC conditions. The comparison of the dynamics of epileptic subjects revealed that seizure-free intervals are more complex than seizure intervals. The dynamics of healthy subjects during EO conditions are more complex compared to those during EC conditions. Further, the results clearly demonstrated that threshold-dependent symbolic entropy outperform MSE in distinguishing different physiological and pathological conditions. CONCLUSION: The threshold symbolic entropy has provided improved accuracy in quantifying the dynamics of healthy and epileptic subjects during EC an EO conditions for each electrode compared to the MSE.

Home fortification with calcium reduces Hb response to iron among anaemic Bangladeshi infants consuming a new multi-micronutrient powder formulation.

OBJECTIVE: To investigate whether the recommended dietary intake of Ca in anaemic infants compromises the expected Hb response, via home fortification with a new Ca- and Fe-containing Sprinkles™ micronutrient powder (MNP). DESIGN: A double-blind, randomized controlled, 2-month trial was conducted in Bangladesh. Infants were randomized to one of two MNP intervention groups containing Fe and other micronutrients, with or without Ca. Hb, anthropometrics and dietary intake were measured pre- and post-intervention while family demographics were collected at baseline. SETTING: Twenty-six rural villages in the Kaliganj sub-district of Gazipur, Bangladesh. SUBJECTS: One hundred infants aged 6-11 months. RESULTS: A significant increase in Hb (MNP, 13·3 (sd 12·6) g/l v. Ca-MNP, 7·6 (sd 11·6) g/l; P < 0·0001) was noted in infants from both groups. However, infants receiving MNP without Ca had a significantly higher end-point Hb concentration (P = 0·024) and rate of anaemia recovery (P = 0·008). Infants receiving MNP with Ca were more likely to remain anaemic (OR 3·2; 95 % CI 1·4, 7·5). Groups did not differ in dietary intake or demographic and anthropometric indicators. CONCLUSIONS: Although both groups showed significant improvement in Hb status, the nutrient-nutrient interaction between Fe and Ca may have diminished the Hb response in infants receiving the Ca-containing MNP.

An interesting case of screen-detected breast cancer encasing a ventriculoperitoneal shunt.

A 67-year-old woman was diagnosed with a breast cancer via screening encasing the ventriculoperitoneal shunt. Triple assessment including MRI scan of the breast confirmed the presence of a breast mass and the tubing of the ventriculoperitoneal shunt was running directly through the mass. She underwent wide local excision of the breast cancer as well as rerouting of VP shunt as a joint procedure with the neurosurgery team and recovered uneventfully. This is a very rare and an interesting case and required management involving a different specialty.

Updated survival and outcomes for older adults with inoperable stage III non-small-cell lung cancer treated with cisplatin, etoposide, and concurrent chest radiation with or without consolidation docetaxel: analysis of a phase III trial from the Hoosier Oncology Group (HOG) and US Oncology.

BACKGROUND: Concurrent chemoradiation with etoposide and cisplatin (EP/XRT) is standard treatment for inoperable stage III locally advanced non-small-cell lung cancer (LA-NSCLC). Consolidation docetaxel (D; Taxotere) after EP/XRT resulted in increased toxicity but no improvement in survival compared with observation (O). We report updated survival for the entire study population and include an analysis of efficacy and tolerability of EP/XRT with or without D in patients aged ≥ 70 years. PATIENTS AND METHODS: Hoosier Oncology Group LUN 01-24 enrolled 243 patients with LA-NSCLC and randomized 166 after EP/XRT to three cycles of D versus O. the trial was terminated after an analysis of the first 203 patients demonstrated futility of D. RESULTS: Median survival time (MST) for the overall study population was 21.5 months, and 3-, 4-, and 5-year survival rates were 30.7%, 18.0%, and 13.9%, respectively. No differences in MST or 3-year survival were noted between D and O arms. Older patients had similar MST (17.1 versus 22.8 months for younger patients, P = 0.15) but higher rates of grade 3/4 toxicity and hospitalization during induction. CONCLUSIONS: Consolidation docetaxel after EP/XRT does not improve survival in LA-NSCLC. Fit older adults with LA-NSCLC benefit from concurrent chemoradiation similarly as younger patients but experience higher rates of hospitalization and toxicity.

Effect of amlodipine and lisinopril on microalbuminuria in patients with essential hypertension: A prospective study.

Microalbuminuria can be present in 25-100% of patients with essential hypertension and is associated with increased incidence of cardiovascular events. Our goal was to evaluate the effect of a commonly used calcium channel blocker, amlodipine, and an angiotensin converting enzyme inhibitor, lisinopril on urinary albumin excretion in patients with mild to moderate essential hypertension. We screened 324 patients with essential hypertension for microalbuminuria and documented it in 120 patients. These 120 patients with microalbuminuria were randomly divided into two groups of 60 each, matched for age, sex, arterial pressure, creatinine clearance, and urinary albumin excretion so as to receive amlodipine or lisinopril. We prospectively measured their urinary albumin excretion and creatinine clearance prior to treatment and, four and eight weeks after treatment with amlodipine or lisinopril. Mean arterial pressure (mean +/- SD) at baseline, after four weeks, and after eight weeks was 113.01 +/- 4.38,104.93 +/- 3.12, and 98.89 +/- 1.75 mmHg (P < 0.0000); and 114.13 +/- 7.11, 106.52 +/- 3.50, and 100.89 +/- 2.80 mmHg (P < 0.0000) in amlodipine and lisinopril groups, respectively. Urinary albumin excretion (mean +/- SEM) at baseline, after four, and after eight weeks was 79.30 +/- 3.74, 62.03 +/- 3.61, and 52.02 +/- 3.05 (P < 0.0000); and 73.96 +/- 4.10, 72.39 +/- 3.74, 66.12 +/- 3.94 (P = 0.1742) in lisinopril and amlodipine groups, respectively. Lisinopril but not amlodipine, reduced the urinary albumin excretion significantly despite their similar antihypertensive efficacy. The clinical and prognostic significance of these observations need to be established.

Chromosomal mechanisms of aminoglycoside resistance in Pseudomonas aeruginosa isolates from cystic fibrosis patients.

In total, 40 Pseudomonas aeruginosa isolates from cystic fibrosis (CF) patients were included in this study. Twenty of these were collected in 1994 and 1997, from six CF patients, and the rest were collected from different CF patients in 2000 and 2001. The relative expression of mRNA for the efflux pump protein MexY was determined by real-time PCR and correlated with susceptibilities to amikacin and tobramycin. The chromosomal genes mexZ, rplY, galU, PA5471 and nuoG, which were found to have a role in the gradual increase in MICs of aminoglycoside antibiotics in laboratory mutants of P. aeruginosa, were analysed. MexY mRNA overproduction was found in 17/20 isolates collected in 1994 and 1997, and was correlated with decreased susceptibility to aminoglycosides. Alteration of the MexXY-OprM efflux system has been the main mechanism of resistance to aminoglycoside antibiotics in CF P. aeruginosa isolates over the 3-year period. In several isolates, expression of the PA5471 gene product might have some effect on elevated MICs of aminoglycosides. Inactivation of rplY, galU and/or nuoG may explain the gradual increase in MICs of aminoglycosides in laboratory mutants but probably not in the CF environment, as rplY and galU were unaltered in all isolates, and nuoG was not expressed in only one isolate. No 16S rRNA A-site mutations were found in any of the four copies of the gene in 13 investigated isolates.

Cryptic duplication of 12q24.33 --> qter in a child with Angelman syndrome-simultaneous occurrence of two unrelated cytogenetic events.

Simultaneous occurrence of two unrelated cytogenetic events is rare. We present a case of Angelman Syndrome (AS) deletion and 12q duplication in a child with a history of developmental delay, microcephaly, cerebral palsy, and seizures. Traditional cytogenetic studies showed a normal 46,XY karyotype. Fluorescence in situ hybridization (FISH) using probe D15S10 (AS region/15q11.2) revealed a deletion. In addition, we serendipitously detected 12q24.3 duplication by FISH with 12q subtelomere probe. He inherited this duplication from the mother who presented with a balanced translocation karyotype 46,XX,add(12)(q24.3).ish t(12;13)(q24.3;p11.2)(12qtel-;12qtel+,D13Z1/D21Z1+,RB1+). Array comparative genomic hybridization (array-CGH) revealed a duplication of three bacterial artificial chromosome (BAC) clones (RP11-46H11, RP11-386I8, and RP11-309H3) covering about 423 Kb of DNA sequence. The published 12q terminal duplication cases had a detectable segment by classical banded cytogenetics techniques. To our knowledge, this is the smallest 12q cryptic rearrangement characterized by array-CGH and confirmed by BAC-clone FISH analysis. Based on these findings, we attempted to separate the clinical features associated with AS deletion and those features that are probably due to partial 12q duplication. We then reviewed the genes mapped in the duplicated region using the human genome database to understand the clinical significance. A subsequent pregnancy in the mother revealed an apparently balanced t(12;13) karyotype. We compare our case with the published cases, and discuss the implications of our findings and its relevance in addressing genetic counseling issues.

6q deletion in Waldenström macroglobulinemia is associated with features of adverse prognosis.

Fluorescence in situ hybridisation (FISH) is an effective technique for the cytogenetic analysis of Waldenström macroglobulinemia (WM), but the potential impact of molecular cytogenetics on disease evolution and as a prognostic marker is still unknown. Deletion of the long arm of chromosome 6 (6q-) is the most frequent cytogenetic abnormality in WM. This study analysed the prevalence of this aberration in 102 WM patients, and correlated it with disease characteristics. The incidence of 6q21 deletion was 7% by conventional cytogenetics and 34% when analysed by FISH (54% when cytoplasmic immunoglobulin M-FISH was used). Patients with deletion of 6q displayed features of adverse prognosis, such as higher levels of beta2-microglobulin and monoclonal paraprotein and a greater tendency to display anaemia and hypoalbuminemia. Interestingly, there was a correlation between the presence of 6q deletion and the International Staging System prognostic index (incidence of 6q- among patients stratified in stages 1, 2 and 3 was 24%, 42% and 67% respectively). Those patients diagnosed with smouldering WM who displayed the abnormality showed a trend to an earlier requirement of treatment. Finally, the survival analysis did not show differences between the two groups of patients, probably due to the short follow up of our series.

Molecular detection and identification of Candida and Aspergillus spp. from clinical samples using real-time PCR.

This report describes the development of a real-time LightCycler assay for the detection and identification of Candida and Aspergillus spp., using the MagNa Pure LC Instrument for automated extraction of fungal DNA. The assay takes 5-6 h to perform. The oligonucleotide primers and probes used for species identification were derived from the DNA sequences of the 18S rRNA genes of various fungal pathogens. All samples were screened for Aspergillus and Candida to the genus level in the real-time PCR assay. If a sample was Candida-positive, typing to species level was performed using five species-specific probes. The assay detected and identified most of the clinically relevant Aspergillus and Candida spp. with a sensitivity of 2 CFU/mL blood. Amplification was 100% specific for all Aspergillus and Candida spp. tested. To assess clinical applicability, 1,650 consecutive samples (1,330 blood samples, 295 samples from other body fluids and 25 biopsy samples) from patients with suspected invasive fungal infections were analysed. In total, 114 (6.9%) samples were PCR-positive, 5.3% for Candida and 1.7% for Aspergillus spp. In patients with positive PCR results for Candida and Aspergillus, verification with conventional methods was possible in 83% and 50% of cases, respectively. In conclusion, the real-time PCR assay allows sensitive and specific detection and identification of fungal pathogens in vitro and in vivo.

Prognostic factors for hyperdiploid-myeloma: effects of chromosome 13 deletions and IgH translocations.

Chromosomal hyperdiploidy is the defining genetic signature in 40-50% of myeloma (MM) patients. We characterize hyperdiploid-MM (H-MM) in terms of its clinical and prognostic features in a cohort of 220 H-MM patients entered into clinical trials. Hyperdiploid-myeloma is associated with male sex, kappa immunoglobulin subtype, symptomatic bone disease and better survival compared to nonhyperdiploid-MM (median overall survival 48 vs 35 months, log-rank P = 0.023), despite similar response to treatment. Among 108 H-MM cases with FISH studies for common genetic abnormalities, survival is negatively affected by the existence of immunoglobulin heavy chain (IgH) translocations, especially those involving unknown partners, while the presence of chromosome 13 deletion by FISH did not significantly affect survival (median overall survival 50 vs 47 months, log-rank P = 0.47). Hyperdiploid-myeloma is therefore a unique genetic subtype of MM associated with improved outcome with distinct clinical features. The existence of IgH translocations but not chromosome 13 deletion by FISH negatively impacts survival and may allow further risk stratification of this population of MM patients.

Ploidy status rarely changes in myeloma patients at disease progression.

Hyperdiploid and non-hyperdiploid multiple myeloma represents distinct biological entities characterized by different patterns of genetic changes. We sought to determine whether ploidy category (non-hyperdiploid versus hyperdiploid) remains stable over time from diagnosis to progression. Of the 43 patients studied (39 by flow cytometry DNA index and 4 by a FISH-based index), only five (12%) altered their ploidy status at progression. In three of these patients, the change may possibly be attributable to technical artifacts because of the low absolute change in DNA index. For those who retain their ploidy subtypes, the DNA index change minimally (3.75+/-4.87%). It would appear that the initiating genetic events underlying hyperdiploid and non-hyperdiploid MM that marks them out as distinct entities continue to dominate and persist during disease evolution and progression.

Four cases of Candida albicans infections with isolates developing pink colonies on CHROMagar Candida plates.

Candida albicans, the most commonly isolated yeast species, is typically identified by its green colony-colour on CHROMagar Candida plates. We here report four cases of Candida albicans infections, in which the initial identification was non-albicans isolates due to a clear pink colour of the colonies on CHROMagar Candida plates. However, classical phenotypic criteria, biochemical assimilation pattern and molecular characterisation identified all four isolates as C. albicans isolates.