Initial experience with dual-layer detector spectral CT for diagnosis of blood or contrast after endovascular treatment for ischemic stroke.

PURPOSE: To determine whether spectral detector CT (SDCT) with a plain non-enhanced monochromatic CT, a water-weighted image after iodine removal, an iodine map, and Mono energetic images changes the diagnosis and classification of intracranial hemorrhage based on single energy CT after endovascular treatment (EVT) for ischemic stroke. METHODS: Two readers evaluated single energy and SD CT data collected from 63 patients within one week after EVT. They diagnosed ICH or contrast staining, and graded ICH according to the Heidelberg and Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) classification. Differences in diagnosis between single energy and SD CT were tested with Pearson's chi-squared test. Diagnostic values of single energy CT were calculated. Interrater agreement was based on Cohen's Kappa. RESULTS: When spectral data were added to single energy CT, the diagnosis of ICH changed in 8 CT scans (13%): in 4, the diagnosis of ICH was rejected and in 4, initially undetected ICH was diagnosed. In an additional 3 patients, the ICH grade was modified. CT alone had 88% sensitivity, 87% specificity, 88% positive diagnostic value, 87% negative diagnostic value, and 87% overall accuracy for ICH compared to SDCT. Interreader agreement on the presence of ICH was 0.84 (95% CI 0.51-0.86) for spectral CT and 0.84 (95% CI 0.73-0.97) for single energy CT. CONCLUSION: SD CT after endovascular treatment contributes to the distinction between intracranial hemorrhage and contrast staining.

Unusual Tissue - Unusual Issue: Pancreatic Heterotopia Presenting as Gastric Outlet Obstruction.

Pancreatic heterotopia (PH) is a common, but typically small (<1 cm), incidental and asymptomatic finding; however, PH should be considered even for large and symptomatic upper gastrointestinal masses. A 27-year-old white woman presented with a 3-week history of burning epigastric pain, nausea, early satiety, and constipation. Physical examination revealed epigastric and right upper quadrant tenderness with normal laboratory workup, but imaging revealed a 5-cm, partly cystic mass arising from the gastric antrum with resulting pyloric stenosis and partial gastric outlet obstruction. Endoscopic ultrasound-guided fine needle aspiration revealed PH - an anomalous pancreatic tissue lying in a nonphysiological site. The patient ultimately underwent a resection and recovered uneventfully, with a complete pathologic examination revealing normal exocrine pancreatic tissue (PH type 2) without malignant transformation. We report a case of heterotopic pancreas manifesting as severe gastric outlet obstruction, in addition to a thorough diagnostic workup and surgical follow-up, in a young adult. Differential diagnoses and features that speak to benignity of a large, symptomatic mass lesion (PH in particular) are discussed.

A novel abdominal wall entry suction device to increase Veress needle safety: A prospective cohort pilot study.

BACKGROUND: In laparoscopic surgery, the Veress needle technique is most often used to initiate a pneumoperitoneum. Although low, entry-related injuries of the intestines and major vascular structures occur in 0.04-0.1% of cases. Up to 50% of these injuries remain undiagnosed at the time of surgery, resulting in mortality rates between 2.5 and 30%. In an effort to minimize such injuries we objectively assessed a novel abdominal wall entry suction device (AWESD) that was hypothesized to lift the abdominal wall and create an additional post-peritoneum safe margin for safer Veress needle introduction. MATERIALS AND METHODS: A prospective pilot study was conducted in which CT-scans with and without AWESD application (centered above the umbilicus) were assessed to determine its effect on the distance from the linea alba to the intestines, vena cava and abdominal aorta. Paired measurements were subjected to the Wilcoxon signed rank test. RESULTS: Twelve participants were included. The AWESD significantly increased the median distance towards the intestines in the axial and sagittal plane (P = 0.01 and P = 0.006) from 0.93 (Inter Quartile Range (IQR): 0.33-1.51) and 0.85 (IQR: 0.32-1.47) to 1.35 (IQR: 0.39-2.27) and 1.25 (IQR: 0.42-2.10) centimeters, respectively. Similarly, for the median axial distances towards the vena cava and abdominal aorta (both P = 0.002) that were increased from 10.00 (IQR: 7.18-11.12) and 9.33 (IQR: 6.55-10.28) to 13.23 (IQR: 11.76-14.31) and 12.49 (IQR: 10.98-13.32) centimeters, respectively. CONCLUSION: The AWESD significantly increased the distances between the peritoneum and main intra-abdominal structures. However, conclusions on subsequent increased safety cannot be drawn as high-volume studies are required to determine its clinical relevance.

Diagnosing Internal Herniation After Roux-en-Y Gastric Bypass Surgery: Literature Overview, Cadaver Study and the Added Value of 3D CT Angiography.

PURPOSE: The purposes of the study are to outline the complexity of diagnosing internal herniation after Roux-en-Y gastric bypass (RYGB) surgery and to investigate the added value of computed tomography angiography (CTA) for diagnosing internal herniation. MATERIALS AND METHODS: A cadaver study was performed to investigate the manifestations of internal hernias and mesenteric vascularization. Furthermore, a prospective, ethics approved study with retrospective interpretation was conducted. Ten patients, clinically suspected for internal herniation, were prospectively included. After informed consent was obtained, these subjects underwent abdominal CT examination, including additional arterial phase CTA. All subjects underwent diagnostic laparoscopy for suspected internal herniation. The CTA was used to create a 3D reconstruction of the mesenteric arteries and surgical staples (3D CTA). The 3D CTA was interpreted, taking into account the presence and type of internal hernia that was found upon laparoscopy. RESULTS: Cadaveric analysis demonstrated the complexity of internal herniation. It also confirmed the expected changes in vascular structure and surgical staple arrangement in the presence of internal herniation. 3D CTA studies of the subjects with active internal hernias demonstrated remarkable differences when compared to control 3D CTA studies. The blood supply of herniated intestinal limbs in particular showed abnormal trajectories. Additionally, enteroenterostomy staple lines had migrated or altered orientation. CONCLUSION: 3D CTA is a promising technique for diagnosing active internal hernias. Our findings suggest that for diagnosing internal hernias, focus should probably shift from routine abdominal CT examination towards the 3D assessment of the mesenteric vasculature and surgical staples.

Characterization of virulence factors of vaginal and anal isolates of Candida albicans sequentially obtained from patients with vulvovaginal candidiasis in north-east Brazil.

In order to better understand the pathogenesis of VVC, focusing on the role of C. albicans virulence factors in triggering this infirmity; we evaluated four virulence factors of 62 clinical isolates of C. albicans sequentially obtained from the vagina and anus of patients with sporadic and recurrent VVC. Virulence factors were phenotypically evaluated in vitro, including: adhesion capacity to epithelial cells obtained from healthy individuals, morphogenesis in the presence of fetal bovine serum, biofilm formation in polystyrene microtiter plates and proteinase activity using bovine serum albumin. Colonizing anal isolates were as able as infecting vaginal isolates to express the virulence factors evaluated in vitro. It was observed an association between the expression of virulence factors studied and the signs and symptoms of VVC presented by the patients. No statistically significant difference was observed in the expression of virulence factors between vaginal isolates of C. albicans obtained from patients with sporadic VVC and those obtained from patients with recurrent VVC. Our results suggest that the ability to express virulence factors is important for the pathogenesis of VVC, but it seems not to be crucial for the transition from colonization to infection.

The Pinocchio effect and the Cold Stress Test: Lies and thermography.

We applied the use of thermography to cognitive neuropsychology, particularly as an objective marker of subjective experiences, in the context of lying. We conducted three experiments: (a) An important lie was invented by the participants in 3 min, and it was recounted by phone to a significant person while they were recorded by the thermographic camera, obtaining a face and hands map of the lie. (b) A similar methodology was carried out, but adding the Cold Stress Test (CST) of the dominant hand during the phone call, obtaining a second physiologic marker (the percentage of thermal recovery) to detect the lie. Further, it established a control condition where it generated anxiety in the participants using IAPS images with negative valence and high arousal, which were described by phone to a loved one. We obtained results that showed significant correlations between changes in body temperature and mental set. Of particular interest was the temperature of the nose and hand, which tended to decrease during lying (Experiment 1). The participants also showed a lower recovery of the temperature after the CST when they were lying (Experiment 2). (c) Experiment 3 is a replication of Experiment 2 but with a different type of lie (a more ecological task) in a different scenario (following the ACID interview, with the use of the phone eliminated and participants motivated to lie well). The main pattern of results was replicated. We obtained an accuracy of 85% in detection of deception with 25% of false alarms.

Outcome and management of endoscopic retrograde cholangiopancreatography perforations: A community perspective.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) carries a small but significant risk of perforation. Recent data suggest that select patients can be managed non-operatively. We sought to evaluate the management of ERCP perforations at our community medical center. METHODS: ERCPs performed from 2004 to 2015 were reviewed. RESULTS: Twenty-one of 2423 patients who underwent ERCP had a perforation (0.9%). ERCP procedures included balloon sweep with/without sphincterotomy and pancreatic duct stent (71%), common bile duct brushing (10%), and pancreatic duct stenting (5%). Duodenal diverticula were present in 3 (14%), and altered anatomy was present in 6 (29%). Seventeen patients were treated nonoperatively; 3 (14%) underwent percutaneous drain placement. Two patients failed nonoperative treatment and required surgery. Four patients required ICU stay, and median post-ERCP LOS was 5 days. The 30-day mortality rate was 1/21 (4.8%). CONCLUSIONS: Perforations remain a rare, but serious, complication of ERCPs. Nonoperative management is highly successful in carefully selected patients. Early recognition with initiation of antibiotics is paramount. Our community-based practice patterns are similar to those previously published for successful nonoperative management of ERCP perforations.

Impact of imaging protocol on left ventricular ejection fraction using gated-SPECT myocardial perfusion imaging.

BACKGROUND: There are limited data on the impact of the imaging protocol (single-day stress-rest, SD, vs. dual-day, DD) on the change in left ventricular (LV) ejection fraction (EF) (post-stress-rest) in relation to ischemia and on outcome. METHODS: Using propensity score matching procedure, 490 of 1121 patients with known CAD, undergoing a SD or a DD in a multicenter study, were evaluated. Stress and rest gated-SPECT myocardial perfusion imaging was used to quantify LV perfusion, EF, and volumes. Outcome was assessed at an average follow-up time of 3.2 years. RESULTS: Post-stress LVEF in SD and DD were comparable across all degrees of ischemia. The change in LVEF in patients with severe ischemia was, however, higher in the DD protocol, independent of the extent of CAD. At follow-up, 240 patients (49.0%) required coronary revascularization (CR) and 52 patients (10.6%) had hard events. The ischemic burden was independently associated with CR and hard-events; the post-stress LVEF was associated with CR but the change in EF was not predictive of either CR or hard events. CONCLUSIONS: In patients with severe ischemia, underestimation of post-stress myocardial stunning could be observed with the SD protocol. Post-stress LVEF and the extent ischemia, but not the change in EF, are predictive of CR and hard events.

The mental and subjective skin: Emotion, empathy, feelings and thermography.

We applied thermography to investigate the cognitive neuropsychology of emotions, using it as a somatic marker of subjective experience during emotional tasks. We obtained results that showed significant correlations between changes in facial temperature and mental set. The main result was the change in the temperature of the nose, which tended to decrease with negative valence stimuli but to increase with positive emotions and arousal patterns. However, temperature change was identified not only in the nose, but also in the forehead, the oro-facial area, the cheeks and in the face taken as a whole. Nevertheless, thermic facial changes, mostly nasal temperature changes, correlated positively with participants' empathy scores and their performance. We found that temperature changes in the face may reveal maps of bodily sensations associated with different emotions and feelings like love.

Abnormal thermography in Parkinson's disease.

BACKGROUND: An autonomic denervation and abnormal vasomotor reflex in the skin have been described in Parkinson's disease (PD) and might be evaluable using thermography with cold stress test. METHODS: A cross-sectional pilot study was undertaken in 35 adults: 15 patients with PD and abnormal [(123)I]-metaiodobenzylguanidine cardiac scintigraphy and 20 healthy controls. Baseline thermography of both hands was obtained before immersing one in cold water (3 ± 1 °C) for 2 min. Continuous thermography was performed in: non-immersed hand (right or with lesser motor involvement) during immersion of the contralateral hand and for 6 min afterward; and contralateral immersed hand for 6 min post-immersion. The region of interest was the dorsal skin of the third finger, distal phalanx. RESULTS: PD patients showed a lower mean baseline hand temperature (p = 0.037) and greater thermal difference between dorsum of wrist and third finger (p = 0.036) and between hands (p = 0.0001) versus controls, regardless of the motor laterality. Both tests evidenced an adequate capacity to differentiate between groups: in the non-immersed hand, the PD patients did not show the normal cooling pattern or final thermal overshoot observed in controls (F = 5.29; p = 0.001), and there was an AUC of 0.897 (95%CI 0.796-0.998) for this cooling; in the immersed hand, thermal recovery at 6 min post-immersion was lesser in patients (29 ± 17% vs. 55 ± 28%, p = 0.002), with an AUC of 0.810 (95%CI 0.662-0.958). CONCLUSIONS: PD patients reveal abnormal skin thermal responses in thermography with cold stress test, suggesting cutaneous autonomic dysfunction. This simple technique may be useful to evaluate autonomic dysfunction in PD.

Jumping to Conclusions bias, BADE and Feedback Sensitivity in schizophrenia and schizotypy.

Several studies about schizophrenia have shown a cognitive bias named "Jumping to Conclusions" (JTC), defined as a decision made quickly on the basis of little evidence that occurs in these patients when performing probabilistic reasoning paradigms. The main objective of this study is to compare JTC bias and BADE (Bias Against Disconfirmatory Evidence) in patients with schizophrenia vs. participants with high/low schizotypy to understand the underlying mechanism of these cognitive biases. Probabilistic reasoning was assessed using a modified version of Drawing to Decision task. In addition to the traditional parameters of this task (Plausibility Rating (PR), Draws to Decision (DTD), BADE) we also calculated new parameters, overall accuracy and one named Feedback Sensitivity (FS) which lower scores shows greater use of feedback. The results of the study suggest a context effect: in the cued condition, there were not main differences between groups. In the uncued condition, we found higher JTC bias at stage 1 for patients. At the same time, PR at first stages related positively with Feedback Sensitivity and negatively with accuracy for patients and high schizotypy participants (high confidence is associated with worse performance and lower feedback use). BADE seems unrelated to JTC bias and FS. The results are discussed in terms of JTC like as a clinical bias and whether patients with schizophrenia are less able to use feedback.

Tailored imaging of islet cell tumors of the pancreas amidst increasing options.

Pancreatic islet cell tumors are neuroendocrine tumors, which can produce hormones and can arise as part of multiple endocrine neoplasia type 1 or von-Hippel-Lindau-disease, two genetically well-defined hereditary cancer syndromes. Currently, technical innovation improves conventional and specific molecular imaging techniques. To organize the heterogeneous results described for the imaging of these tumors, we distinguished three indications (1) imaging of a patient with hormone hypersecretion, (2) search for a pancreatic primary in case of proven neuroendocrine cancer of unknown primary, and (3) screening of asymptomatic mutation carriers. We searched for publications on imaging of islet cell tumors between 1995 and January 2010 and defined a Level of Evidence (LOE) for the applicability of each technique. For each technique, data were analyzed in a Forest plot and arranged per imaging indication and tumor subtype. LOEs are weak for all imaging techniques. Analyses indicate a prominent role for endoscopic ultrasound for all three indications.

Auras in mysticism and synaesthesia: a comparison.

In a variety of synaesthesia, photisms result from affect-laden stimuli as emotional words, or faces of familiar people. For R, who participated in this study, the sight of a familiar person triggers a mental image of "a human silhouette filled with colour". Subjective descriptions of synaesthetic experiences induced by the visual perception of people's figures and faces show similarities with the reports of those who claim to possess the ability to see the aura. It has been proposed that the purported auric perception may be easily explained by the presence of a specific subtype of cross-modal perception. We analyse the subjective reports of four synaesthetes who experience colours in response to human faces and figures. These reports are compared with descriptions of alleged auric phenomena found in the literature and with claims made by experts in esoteric spheres. The discrepancies found suggest that both phenomena are phenomenologically and behaviourally dissimilar.

Morphology and biochemical markers of people living with HIV/AIDS undergoing a resistance exercise program: clinical series.

This descriptive case study aimed at assessing body's composition and impact on biochemical markers of people living with HIV/AIDS (S1=male-1, S2=female-1) undergoing a four-month intervention program of resistance exercises. Was analyzed the lipid profile (total cholesterol, LDL, HDL and triglycerides serum), immunological parameters (CD4 and viral load/VL) and morphological parameters (body mass index BMI, waist/Hip/WHR, perimeters and skinfold). Blood samples and antropometric measures were obtained in the pre-exercise (pre-test) and immediately after (16 weeks) of exercise (post-test). An increase in HDL (38 pre, 42 post), LDL (89.6 pre, 95 post) was noted for S1 and a decrease in HDL (33 pre, 25 post) and LDL (121.6 pre, 121 post) for S2; a decrease in Triglyceride for S1 (292 pre, 214 post) and increase for S2 (102 pre, 166 post). Total cholesterol increased for both subjects (186 pre, 261 post S1 and 175 pre, 179 post S2). there was a decrease in CD4 for S1 (598 pre, 577 post) and an increase for S2 (748 pre, 1.071 post). With respect to viral load, we found that both subjects (S1 and S2) presented values below the minimum limit (pre and post test), with no significant changes. Body composition improved (LMpre S1=43.13% and S2=23.35% and LMpost S1=46.51 and S2=26.15%; BFpre S1=41.13 and S2=18.14% and BFpost S1=38.32 and S2=14.77%), as did BMI (25.27 pre, 27.44 post S1) and (24.24 pre, 24.74 post S2). The resistance exercise program as base in this intervention model promoted a healthy state for HIV and AIDS patients and did not pose any health risks to them.

Endoscopic ultrasound for non-gastroenterologists: what you need to know.

Endoscopic ultrasound (EUS) combines the use of flexible fiberoptic endoscopes with high-resolution ultrasound technology. It is increasingly used for the evaluation, staging, and diagnosis of many luminal and extraluminal gastrointestinal (GI) cancers, as well as non-GI tract ailments, including the staging of lung cancer. In the past decade, EUS has become available on a wide scale, with an increasing number of indications. The technology has been shown to be comparable with and often more sensitive than computed tomography scan and magnetic resonance imaging in staging many malignancies. The use of fine-needle aspiration and ultrasound-guided injection also allows for accurate tissue diagnosis and therapy of GI ailments. Despite increasing availability and indications for EUS over the past decade, general internists may not be aware of EUS technology, when to order an EUS, and how to integrate the results of an EUS into their management decisions. This article will review the general indications for EUS referral, limitations, and role of EUS in the practice of general medicine.

ENCODE tiling array analysis identifies differentially expressed annotated and novel 5' capped RNAs in hepatitis C infected liver.

Microarray studies of chronic hepatitis C infection have provided valuable information regarding the host response to viral infection. However, recent studies of the human transcriptome indicate pervasive transcription in previously unannotated regions of the genome and that many RNA transcripts have short or lack 3' poly(A) ends. We hypothesized that using ENCODE tiling arrays (1% of the genome) in combination with affinity purifying Pol II RNAs by their unique 5' m7GpppN cap would identify previously undescribed annotated and unannotated genes that are differentially expressed in liver during hepatitis C virus (HCV) infection. Both 5'-capped and poly(A)+ populations of RNA were analyzed using ENCODE tiling arrays. Sixty-four annotated genes were significantly increased in HCV cirrhotic as compared to control liver; twenty-seven (42%) of these genes were identified only by analyzing 5' capped RNA. Thirty-one annotated genes were significantly decreased; sixteen (50%) of these were identified only by analyzing 5' capped RNA. Bioinformatic analysis showed that capped RNA produced more consistent results, provided a more extensive expression profile of intronic regions and identified upregulated Pol II transcriptionally active regions in unannotated areas of the genome in HCV cirrhotic liver. Two of these regions were verified by PCR and RACE analysis. qPCR analysis of liver biopsy specimens demonstrated that these unannotated transcripts, as well as IRF1, TRIM22 and MET, were also upregulated in hepatitis C with mild inflammation and no fibrosis. The analysis of 5' capped RNA in combination with ENCODE tiling arrays provides additional gene expression information and identifies novel upregulated Pol II transcripts not previously described in HCV infected liver. This approach, particularly when combined with new RNA sequencing technologies, should also be useful in further defining Pol II transcripts differentially regulated in specific disease states and in studying RNAs regulated by changes in pre-mRNA splicing or 3' polyadenylation status.

Annual variations of the plasmatic levels of glucose and amino acid and daily changes under different natural conditions of temperature and photoperiod in Gilthead Sea bream (Sparus aurata, L.).

Daily and annual changes in the plasmatic glucose and amino acid concentration have been determined in Sparus aurata L. Fish (average weight 330 g) were kept in cages under natural conditions of temperature and photoperiod and fed with a commercial diet. The months studied were chosen to establish whether there is any influence on the plasmatic glucose and amino acid concentration due to the change in temperature and photoperiod (equal photoperiod and different temperature, March and October; different photoperiod and equal temperature, May and November; and different photoperiod and temperature, June and January). To study the daily profile of glucose and amino acids concentrations, blood was extracted from six fish every 3 h during 24 h. Annual changes were determined as the average of the samples obtained during 1 day. Results show an annual rhythm with acrophase in June with a positive correlation with photoperiod for glucose and amino acids and with temperature only for amino acids. Daily profiles are rhythmical with a period of 24 h except in November with a period of 8 h for amino acids.