Evaluation of Cone-Beam Computed Tomography Scans to Develop a Staging Method of External Carotid Artery Calcification.

Background: The objective of this study was to develop a practical staging method for reporting external carotid artery calcifications (ECACs) using cone-beam computed tomography (CBCT) imaging, specifically to standardize reporting for oral and maxillofacial radiologists. Methods: This retrospective study evaluated 489 CBCT scans for the presence of ECACs. Two calibrated evaluators assessed the scans in all three orthogonal planes, using the axial plane to develop the staging system. Calcifications were graded on a scale from 0 to 5. Results: ECACs were found in 170 out of 489 scans (34.7%). There was a statistically significant increase in ECAC distribution with age progression. The prevalence of ECACs was similar between genders. Grade 1 calcifications were most common in the 51-60 age group, Grade 2 in the 61-70 and 71-80 groups, and Grades 3 and 4 in the 81-90 group. No Grade 5 calcifications were observed in any age group. The inter-rater reliability showed an excellent correlation in the identification and grading of ECACs. Conclusions: The proposed grading system enables oral and maxillofacial radiologists to quantitatively report ECACs, facilitating timely referrals to physicians for further evaluation and early intervention, thereby potentially reducing the risk of cardiovascular events.

Improving Drug-Drug Interaction Extraction with Gaussian Noise.

Drug-Drug Interactions (DDIs) produce essential and valuable insights for healthcare professionals, since they provide data on the impact of concurrent administration of medications to patients during therapy. In that sense, some relevant works, related to the DDIExtraction2013 Challenge, are available in the current technical literature. This study aims to improve previous results, using two models, where a Gaussian noise layer is added to achieve better DDI relationship extraction. (1) A Piecewise Convolutional Neural Network (PW-CNN) model is used to capture relationships among pharmacological entities described in biomedical databases. Additionally, the model incorporates multichannel words to enrich a person's vocabulary and reduce unfamiliar words. (2) The model uses the pre-trained BERT language model to classify relationships, while also integrating data from the target entities. After identifying the target entities, the model transfers the relevant information through the pre-trained architecture and integrates the encoded data for both entities. The results of the experiment show an improved performance, with respect to previous models.

Effective doses of dental cone beam computed tomography: effect of 360-degree versus 180-degree rotation angles.

OBJECTIVES: The aims of this study were to compare radiation absorbed dose (AD) and effective dose (ED) to tissues from cone beam computed tomography (CBCT) scans with 360-degree versus 180-degree rotations with use of different fields of view (FOV), to compare EDs calculated from measured ADs versus dose area product (DAP) values, and to compare doses to the lens of the eye (LOE) from different scan parameters. STUDY DESIGN: ADs for each protocol were measured in tissues, including the LOE, by using an anthropometric phantom. EDs were calculated on the basis of dosimetry (EDm) and DAP values (EDd). Dose differences were determined with analysis of variance (ANOVA). RESULTS: ADs and EDs were substantially lower for 180-degree rotation scans compared with 360-degree rotation scans (P < .01). Remainder tissues had the greatest effect on effective dose for most FOVs. Doses were generally lower with small FOVs compared with large FOVs. Most EDm values were lower than EDd values in large FOVs but higher in small FOVs. Differences in EDm and EDd were variable and unpredictable. LOE doses were smaller with the 180-degree scans and smaller FOVs. CONCLUSIONS: Radiation doses were generally lower with 180-degree rotation scans and smaller FOVs. These parameters should be used for CBCT acquisitions, whenever possible, and should be made available in all units.

Differentiating Cystic Liver Lesions: A Review of Imaging Modalities, Diagnosis and Management.

Hepatic cysts (HCs) are frequently discovered incidentally on abdominal imaging. The prevalence of HCs has been reported as high as 15-18% in the United States. Although most cysts are benign, some are malignant or premalignant. It is important to diagnose cystic lesions in order to properly manage them. Imaging with conventional ultrasound, computed tomography, magnetic resonance imaging, or contrast-enhanced ultrasound can be used to further characterize and diagnose HCs. Ultrasound is typically the first-line imaging modality, whereas more advanced imaging can help narrow down the specific lesion. Contrast-enhanced ultrasound is a newer modality, recently approved in the United States, which offers non-invasive evaluation in real-time. The first step in diagnosis is stratifying risk by differentiating simple and complex cysts. There are several features that can help identify HCs, including septae, mural consistency, calcifications, and quality of cystic fluid. Simple cysts are mainly congenital cysts, but also occur in polycystic liver disease. Complex cysts include mucinous neoplasms, echinococcal cysts, hemorrhagic cysts, cystic hepatocellular carcinoma and other rare lesions. Treatment is indicated in symptomatic cysts or those suspicious for malignant or premalignant features. Treatment modalities include fenestration, aspiration sclerotherapy, or surgical resection.

Classification of auditory brainstem responses through symbolic pattern discovery.

INTRODUCTION: Numeric time series are present in a very wide range of domains, including many branches of medicine. Data mining techniques have proved to be useful for knowledge discovery in this type of data and for supporting decision-making processes. OBJECTIVES: The overall objective is to classify time series based on the discovery of frequent patterns. These patterns will be discovered in symbolic sequences obtained from the time series data by means of a temporal abstraction process. METHODS: Firstly, we transform numeric time series into symbolic time sequences, where the symbols aim to represent the relevant domain concepts. These symbols can be defined using either public or expert domain knowledge. Then we apply a symbolic pattern discovery technique to the output symbolic sequences. This technique identifies the subsequences frequently found in a population group. These subsequences (patterns) are representative of population groups. Finally, we employ a classification technique based on the identified patterns in order to classify new individuals. Thanks to the inclusion of domain knowledge, the classification results can be explained using domain terminology. This makes the results easier to interpret for the domain specialist (physician). RESULTS: This method has been applied to brainstem auditory evoked potentials (BAEPs) time series. Preliminary experiments were carried out to analyse several aspects of the method including the best configuration of the pattern discovery technique parameters. We then applied the method to the BAEPs of 83 individuals belonging to four classes (healthy, conductive hearing loss, vestibular schwannoma-brainstem involvement and vestibular schwannoma-8th-nerve involvement). According to the results of the cross-validation, overall accuracy was 99.4%, sensitivity (recall) was 97.6% and specificity was 100% (no false positives). CONCLUSION: The proposed method effectively reduces dimensionality. Additionally, if the symbolic transformation includes the right domain knowledge, the method arguably outputs a data representation that denotes the relevant domain concepts more clearly. The method is capable of finding patterns in BAEPs time series and is very accurate at correctly predicting whether or not new patients have an auditory-related disorder.

The Evolving Nature of Hepatic Abscess: A Review.

Hepatic abscess (HA) remains a serious and often difficult to diagnose problem. HAs can be divided into three main categories based on the underlying conditions: infectious, malignant, and iatrogenic. Infectious abscesses include those secondary to direct extension from local infection, systemic bacteremia, and intra-abdominal infections that seed the portal system. However, over the years, the etiologies and risks factors for HA have continued to evolve. Prompt recognition is important for instituting effective management and obtaining good outcomes.

Hepatic Echinococcal Cysts: A Review.

Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with metacestodes (larval stage) of the Echinococcus granulosus tapeworm. E. granulosus are common parasites in certain parts of the world, and are present on every continent with the exception of Antarctica. As a result, a large number of people are affected by CE. The increased emigration of populations from endemic areas where prevalence rates are as high as 5-10% and the relatively quiescent clinical course of CE pose challenges for accurate and timely diagnoses. Upon infection with CE, cyst formation mainly occurs in the liver (70%). Diagnosis involves serum serologic testing for antibodies against hydatid antigens, but preferably with imaging by ultrasound or CT/MRI. Treatment methods include chemotherapy with benzimidazole carbamates and/or surgical approaches, including percutaneous aspiration injection and reaspiration. The success of these methods is influenced by the stage and location of hepatic cysts. However, CE can be clinically silent, and has a high risk for recurrence. It is important to consider the echinococcal parasite in the differential diagnosis of liver cystic lesions, especially in patients of foreign origin, and to perform appropriate long-term follow-ups. The aim of this review is to highlight the epidemiology, natural history, diagnostic methods, and treatment of liver disease caused by E. granulosus.

Thrombotic Venous Diseases of the Liver.

Thrombotic venous diseases of the liver do not occur frequently, but when they do, they can present as difficult diagnostic and therapeutic challenges. The aim of this article is to review the epidemiology, pathogenesis, diagnosis, and therapeutic options of these serious vascular problems.

Cardiac remodeling in Drosophila arises from changes in actin gene expression and from a contribution of lymph gland-like cells to the heart musculature.

Understanding the basis of normal heart remodeling can provide insight into the plasticity of the cardiac state, and into the potential for treating diseased tissue. In Drosophila, the adult heart arises during metamorphosis from a series of events, that include the remodeling of an existing cardiac tube, the elaboration of new inflow tracts, and the addition of a layer of longitudinal muscle fibers. We have identified genes active in all these three processes, and studied their expression in order to characterize in greater detail normal cardiac remodeling. Using a Transglutaminase-lacZ transgenic line, that is expressed in the inflow tracts of the larval and adult heart, we confirm the existence of five inflow tracts in the adult structure. In addition, expression of the Actin87E actin gene is initiated in the remodeling cardiac tube, but not in the longitudinal fibers, and we have identified an Act87E promoter fragment that recapitulates this switch in expression. We also establish that the longitudinal fibers are multinucleated, characterizing these cells as specialized skeletal muscles. Furthermore, we have defined the origin of the longitudinal fibers, as a subset of lymph gland cells associated with the larval dorsal vessel. These studies underline the myriad contributors to the formation of the adult Drosophila heart, and provide new molecular insights into the development of this complex organ.

The Hox gene abdominal-A specifies heart cell fate in the Drosophila dorsal vessel.

The Drosophila melanogaster dorsal vessel is a linear organ that pumps blood through the body. Blood enters the dorsal vessel in a posterior chamber termed the heart, and is pumped in an anterior direction through a region of the dorsal vessel termed the aorta. Although the genes that specify dorsal vessel cell fate are well understood, there is still much to be learned concerning how cell fate in this linear tube is determined in an anteroposterior manner, either in Drosophila or in any other animal. We demonstrate that the formation of a morphologically and molecularly distinct heart depends crucially upon the homeotic segmentation gene abdominal-A (abd-A). abd-A expression in the dorsal vessel was detected only in the heart, and overexpression of abd-A induced heart fate in the aorta in a cell-autonomous manner. Mutation of abd-A resulted in a loss of heart-specific markers. We also demonstrate that abd-A and sevenup co-expression in cardial cells defined the location of ostia, or inflow tracts. Other genes of the Bithorax Complex do not appear to participate in heart specification, although high level expression of Ultrabithorax is capable of inducing a partial heart fate in the aorta. These findings for the first time demonstrate a specific involvement for Hox genes in patterning the muscular circulatory system, and suggest a mechanism of broad relevance for animal heart patterning.

Secondary hyperparathyroidism after removal of a parathyroid adenoma.

OBJECTIVE: To report a case of secondary hyperparathyroidism after successful extirpation of a single parathyroid adenoma. METHODS: We present the clinical, pathologic, and laboratory findings in a 29-year-old woman with primary hyperparathyroidism. Serum calcium, phosphorus, and parathyroid hormone (PTH) concentrations, bone turnover, and results of densitometry studies before and after parathyroidectomy were evaluated. RESULTS: A young woman had noted fatigue, nervousness, weight loss, back pain, and polyuria for 3 months. She had hypercalcemia, hypophosphatemia, high PTH concentrations, and increased markers of bone turnover. Subperiosteal bone resorption of the distal phalanges, femoral and spine osteopenia, and osteoporosis in the radius were found. A nodule was palpated in the right side of the neck and localized by ultrasonography, nuclear medicine imaging studies, and computed tomography. A single parathyroid adenoma was removed; no other parathyroid lesions were found. Postoperatively, hypoparathyroidism developed. Supplementation with intravenously and orally administered calcium and vitamin D relieved her symptoms and normalized the serum calcium and phosphate concentrations. Subsequently, however, PTH levels were high and remained above the upper normal range for 27 weeks of follow-up, while calcium concentrations remained normal. These findings were consistent with physiologic secondary hyperparathyroidism due to "hungry bone syndrome," in the setting of normal renal function. Postoperatively, markers of bone resorption declined faster than those of bone formation, and sequential densitometry studies showed increments in bone mineral density. CONCLUSION: This patient with primary hyperparathyroidism fulfilled the criteria for surgical extirpation of the neck mass. The prolonged postoperative increase in PTH level was indicative of physiologic secondary hyperparathyroidism that resolved gradually, along with the normalization of the increased bone turnover and bone mineral density during the 40-week observation period.

Estudo aberto, randomizado, comparativo, para avaliar a eficácia da enoxaparina comparada à heparina näo fracionada na profilaxia do trombo-embolismo venoso em pacientes submetidos a artroplastia total do quadril pela mesma equipe ortopédica / Open, randomized, comparative study to evaluate the efficacy of enoxaparin as compared to unfractionated heparin in the prophylaxis of venous thromboembolism in patients who underwent total hip replacement

O presente estudo tem como objetivo avaliar a eficácia e segurança da enoxaparina na profilaxia do tromboembolismo venoso em pacientes submetidos a artroplastia total do quadril, comparada com a heparina convencional não fracionada. Setenta pacientes foram submetidos a artroplastia total do quadril de dezembro de 1996 a junho dw 1997. Destes, 34 fizeram uso de heparina não fracionada para prevenir tromboembolismo venoso. Dos 70 pacientes, 11 tiveram trombose profunda no pós-operatório, comprovada por flebografia, sendo que 5 pertenciam ao grupo enoxaparina e 6 ao grupo heparina não fracionada. Um paciente evoluiu para óbito por embolia pulmonar...

"Debris" em prótese total do quadril näo cimentada: novo caso clínico / Debris in non-cemented total hip prosthesis: a new clinical report

Os autores relatam caso de luxaçao do componente de polietileno do acetábulo de uma prótese total do quadril do tipo Harris-Galante. O contato metal-metal dos componentes protéticos provavelmente gerou os debris da liga de titânio com a formaçao de pseudotumoraçao de partes moles na regiao periprotética. Foi realizada revisao da prótese através de artroplastia híbrida do tipo CO-10.