A Boolean Consistent Fuzzy Inference System for Diagnosing Diseases and Its Application for Determining Peritonitis Likelihood.

Fuzzy inference systems (FIS) enable automated assessment and reasoning in a logically consistent manner akin to the way in which humans reason. However, since no conventional fuzzy set theory is in the Boolean frame, it is proposed that Boolean consistent fuzzy logic should be used in the evaluation of rules. The main distinction of this approach is that it requires the execution of a set of structural transformations before the actual values can be introduced, which can, in certain cases, lead to different results. While a Boolean consistent FIS could be used for establishing the diagnostic criteria for any given disease, in this paper it is applied for determining the likelihood of peritonitis, as the leading complication of peritoneal dialysis (PD). Given that patients could be located far away from healthcare institutions (as peritoneal dialysis is a form of home dialysis) the proposed Boolean consistent FIS would enable patients to easily estimate the likelihood of them having peritonitis (where a high likelihood would suggest that prompt treatment is indicated), when medical experts are not close at hand.

Narrow band imaging versus conventional white light colonoscopy for the detection of colorectal polyps.

BACKGROUND: It has been suggested that narrow band imaging colonoscopy (NBI) might be better for detection of colorectal polyps than white light colonoscopy (WLC). OBJECTIVES: To compare standard or high definition white light colonoscopy with narrow band imaging colonoscopy for detection of colorectal polyps. SEARCH METHODS: We searched The Cochrane Library, MEDLINE, and EMBASE to August 2011. We scanned bibliographies of relevant publications and wrote to experts for additional trials. SELECTION CRITERIA: Two authors (NA and GB) independently applied the inclusion criteria and extracted the data to all potential studies without blinding. DATA COLLECTION AND ANALYSIS: Authors extracted data independently. Trials with adequate randomisation, allocation concealment, and complete outcome data reporting, as well as without selective outcome reporting or other bias were classified as having a lowest risk of bias. Random-effects and fixed-effect meta-analyses were conducted. MAIN RESULTS: We identified 11 randomised trials comparing WLC with NBI for detection of colorectal polyps. In total eight randomised trials with 3673 participants provided data for our analyses. There was no statistically significant difference between WLC (standard definition and high definition pooled) and NBI for the detection of patients with colorectal polyps (6 trials, n = 2832, RR 0.97, 95% CI 0.91 to 1.04), patients with colorectal adenomas (8 trials, n = 3673, RR 0.94, 95% CI 0.87 to 1.02), or patients with colorectal hyperplastic polyps (2 trials, n = 645, RR 0.87, 95% CI 0.76 to 1.00). Number of patients with at least one colorectal adenoma was not significantly different between WLC and NBI group irrespective of adenoma size (< 5 mm:RR 0.95, 95% CI 0.84 to 1.08, I(2) = 56%; 6 to 9 mm: RR 1.06, 95% CI 0.81 to 1.39, I(2) = 0%; ≥ 10 mm: RR 1.06, 95% CI 0.77 to 1.45, I(2) = 0%). Number of patients with at least one colorectal polyp, or colorectal adenoma was significantly lower in the standard definition WLC group compared to NBI group in fixed-effect meta-analysis (RR 0.87, 95% CI 0.78 to 0.97, I(2) = 78%; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively), but not significantly different in random-effects meta-analysis (RR 0.86, 95% CI 0.68 to 1.10, I(2) = 78%). There was no statistically significant difference between high definition WLC and NBI in the number of patiens with at least one colorectal polyp or colorectal adenoma (RR 1.10, 95% CI 0.95 to 1.28; RR 0.87, 95% CI 0.77 to 0.99, I(2) = 0%, respectively). AUTHORS' CONCLUSIONS: We could not find convincing evidence that NBI is significantly better than high definition WLC for the detection of patients with colorectal polyps, or colorectal adenomas. We found evidence that NBI might be better than standard definition WLC and equal to high definition WLC for detection the patients with colorectal polyps, or colorectal adenomas.

[Decidual transformation in adenomyosis during pregnancy as an indication for hysterectomy].

INTRODUCTION: Incidence of adenomyosis is estimated on 20% in all of extracted uteruses. Clinically, it usually exists asymptomatically, but could be followed with dysmenorrhoea, menorrhagia and pelvic pain. One third of patients with adenomyosis are sterile, however in other two thirds, conception and pregnancy could have normal development, with delivery without complications. One of possible complications related to adenomyosis is rupture of uterus during delivery. CASE REPORT: A pregnant woman at the end of the 10th lunar month of pregnancy, showed minimal labour contractions, following amnion rupture and the delivery was terminated by section ceasar. Subtotal hysterectomy was performed because of concominant profuse bleeding. Myometrium was occupied with decidual cells in trabecular arrangement, among which elongated endometrial glands were placed. Surrounding muscle fascicles showed atrophic, apoptic, and occasionally necrotic changes. Myometrial stroma was edematous, and infiltrated with mesenchymal cells, as well as with adipose cells, which were extending toward serosa. DISCUSSION: The patient had been receiving treatment, for a long period, because of sterility without clear etiological factor. A small number of similar cases ends with complications. Here, it is evident that abundant decidual transformation of stromal cells in adenomiosis leads to atrophy and necrosis of muscle cells. The reduction of uterine muscle mass causes atony and threating rupture, through separation of muscle cells, and therefore the absence of their synchronized contractions. CONCLUSION: Atony of uterine muscle could be caused by decidual transformation in adenomyosal fields, atrophy of muscle fascicles, edema of the stroma, mesenchymal transformation, and fibrosis. This leads to a decrease in myometrial contractions, and prolonged postpartal bleeding.

[Postpartum hysterectomy performed as a consequence of chronic myometritis].

INTRODUCTION: As a diffuse chronic inflammation, myometritis is very rare and usually follows after postpartal placenta remains or postabortion infections, but it can be also associated with endometrial or ascendent infection. Chronic myometritis is often followed by profuse bleeding, though in most cases it cannot be recognized as it is asymptomatic. Histologically, that chronic process is characterized by the presence of fibriosis within the muscles and mononuclear cells (lymphoplasmocytic and histiocytic) infiltration. CASE REPORT: A 24 old woman's second child was delivered per vias naturalis but the next day the profuse bleeding occured which would not stop even after repeated curretages and suspecting a case of placenta accreta and uterus atony, subtotal hysterectomy was performed. Histologically, the disappearance of the regular arrangement of the smooth muscles and stroma could be seen with the devastation of myometrium due to the diffuse reduction of its smooth muscle bundles and cells, as well as their atrophy, necrobiosis and apoptosis with the minimal preservation of the muscle bundles and little cell groups of the myometrium, an abundant presence of the fibrocollagene and myxoid transformed connective tissue, group cells similar to the mesenchymal tissue and adipocytes. DISCUSSION: It was not possible to find this variant of the changes on the myometrium in the available literature. The present case is about the clinically unknown asymptomatic myometritis, possibly developed in the postpartal period of the previous pregnancy. It is our opinion that it is most probably an autoagressive process directed towards the smooth muscle cells of the myometrium, as shown by their reduction and inflammatory cells composition, which plays an important role in the immune reactions (lymphocytes, plasma cells, eosinophilis, histocytes). CONCLUSION: A subtotal hysterectomy was performed on a woman, 24 years old, who gave birth to her second child and had profuse postpartal bleeding in sprite of repeated curettages. On the basis of this uterus atony, there is the clinically non-manifested chronic myometritis. The chronic inflammation resulted in a subtotal reduction of myometrium muscle mass, its replacement sclerosis, the multiplication of adipocytes, mesenchymal cells, histiocytes, lymphomonocytes and dissection of muscle fascicles.

Generation of dose-volume histograms using Monte Carlo simulations on a multicellular model in radionuclide therapy.

An accurate calculation of the absorbed dose at the cellular level can lead to the optimization of the administered activity and the best clinical response in radionuclide therapy. This paper describes the implementation of dose-volume histograms (DVHs) for dosimetry at the cellular level in radionuclide therapy. The FOTELP code, based on Monte Carlo simulations of photon and electron transport, was used on a three-dimensional multicellular tumor model, which includes tumor morphometry and cell-labeling parameters. Differential and cumulated DVHs were generated for different radionuclides (Cu-67, I-131, Sm-153, Y-90, and Re-188) and labeled cell densities (10, 20, 40, 80, and 100%). DVHs were generated as a percentage of tumor cells in the function of a relative absorbed dose, defined as a cell-absorbed dose divided by an average tumor-absorbed dose. DVHs for high-energy beta emitters, such as Re-188 and Y- 90, were very close to the average tumor-absorbed dose. For low-energy beta emitters, such as Cu-67 and I-131, spectra showed that many cells absorbed a much lower dose than the average tumor-absorbed dose. Nonhomogeneity of the radionuclide distribution in tumor, presented by labeled cell density, had a greater influence on DVHs for low-energy beta emitters. Radionuclide therapy plans can be optimized using DVHs.