Surgical treatment of pediatric acute traumatic aortic injury (TAI) after blunt chest trauma is standard of care. Use of endovascular stent grafts for treatment of TAI in adults is common but has ...important limitations in children. We sought to describe the use of balloon-expandable covered endovascular stents for treatment of TAI in children and adolescents. Participants of the multicenter Coarctation of the Aorta Stent Trial (COAST) had access to investigational large-diameter, balloon-expandable, covered stents (covered Cheatham-platinum stents; NuMed, Inc., Hopkinton, New York) on an emergency-use basis. From 2008 through 2011, 6 covered stents were implanted in 4 patients at 3 COAST centers for treatment of TAI. Median patient age was 13.5 years (range 11 to 14) and weight was 58 kg (40 to 130). All patients sustained severe extracardiac injuries that were judged to preclude safe open surgical repair of TAI. Median aortic isthmus and stent implantation balloon diameters were 16.4 mm (13.2 to 19) and 19 mm (16 to 20), respectively. Stent implantation was technically successful in all attempts. Complete exclusion of aortic wall injury was achieved in all cases. There were no access site complications. At a median follow-up of 24 months, there was 1 early death (related to underlying head trauma) and 1 patient with recurrent aortic aneurysm who required additional stent implantation. In conclusion, balloon-expandable covered-stent implantation for treatment of pediatric TAI after blunt trauma is generally safe and effective. Availability of this equipment may alter the standard approach to treatment of pediatric TAI.
Superficial granulomatous pyoderma gangrenosum is a rare, superficial, vegetating form of pyoderma gangrenosum that tends to occur as a single lesion, most commonly on the trunk. Herein, we report a ...clinically confounding case of disseminated superficial granulomatous pyoderma gangrenosum in a patient with a 5-year history of painful and chronic ulcerations of the bilateral upper extremities and face in a sun exposed distribution. This was a diagnostically challenging case due to the treatment-refractory nature of our patient's skin lesions and the atypical clinical and histologic presentations encountered. We review our clinical decision process and acknowledge other entities that were considered during the clinical course of this case. Additionally, we discuss the lack of responsiveness to various treatment options with eventual successful clearance of this patient's active skin disease with initiation of adalimumab.
There are known interoperator, intraoperator, and intervendor software differences that can influence the reproducibility of quantitative CT perfusion values. The purpose of this study was to ...determine the relative impact of operator and software differences in CT perfusion variability.
CT perfusion imaging data were selected for 11 patients evaluated for suspected ischemic stroke. Three radiologists each independently postprocessed the source data twice, using four different vendor software applications. Results for cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) were recorded for the lentiform nuclei in both hemispheres. Repeated variables multivariate analysis of variance was used to assess differences in the means of CBV, CBF, and MTT. Bland-Altman analysis was used to assess agreement between pairs of vendors, readers, and read times.
Choice of vendor software, but not interoperator or intraoperator disagreement, was associated with significant variability (p < 0.001) in CBV, CBF, and MTT. The mean difference in CT perfusion values was greater for pairs of vendors than for pairs of operators.
Different vendor software applications do not generate quantitative perfusion results equivalently. Intervendor difference is, by far, the largest cause of variability in perfusion results relative to interoperator and intraoperator difference. Caution should be exercised when interpreting quantitative CT perfusion results because these values may vary considerably depending on the postprocessing software.
A Pruritic Annular Eruption: Answer Franco, Abigail; Sempler, Jessica; Moss, Richard ...
The American journal of dermatopathology
40, Številka:
5
Journal Article
Morphea presenting clinically with nodular or keloidal skin changes is extremely rare. Nodular scleroderma or keloidal morphea presenting in a linear distribution is even more uncommon. We present an ...otherwise healthy young woman with unilateral, linear, nodular scleroderma and review the somewhat confounding earlier literature in this area. To date, this young woman's skin changes have proven refractory to oral hydroxychloroquine and ultraviolet A1 phototherapy. Several aspects of this case including the patient's family history of Raynaud disease, her nodular sclerodermatous skin lesions, and the presence of U1RNP autoantibodies raised concern about her management with respect to future risk of developing systemic sclerosis.
A Pruritic Annular Eruption: Challenge Franco, Abigail; Sempler, Jessica; Moss, Richard ...
The American journal of dermatopathology
40, Številka:
5
Journal Article
Darier disease (DD) is a rare autosomal dominant keratinizing disorder often characterized by brown scaly pruritic papules over the face, neck, and trunk. Herein is reported a patient who developed ...secondary cutaneous herpes simplex virus (HSV) following exacerbation of his DD as a result of radiation therapy. In November 2020, a 78-year-old man presented to clinic for a pruritic rash on his back consistent with DD. He had developed the rash after the conclusion of chemoradiation therapy for recently diagnosed urothelial carcinoma of the bladder with squamous differentiation. However, he returned two weeks later complaining of a marked worsening of the rash associated with a pain and burning sensations. Histopathology was non-conclusive, but the lesions were found to be positive for HSV-1 by PCR. The patient recovered without complication over a period of two weeks following a course of valacyclovir. There is precedent in the literature for ionizing radiation inducing flares of DD lesions in overlying skin. In addition, DD has been shown to put a patient at increased risk for secondary infections such as HSV. This case report demonstrates that HSV could pose a significant risk to those with DD receiving radiation therapy and thus could warrant prophylactic treatment.
Although dynamic, first-pass cerebral CT perfusion is used in the evaluation of acute ischemic stroke, a lack of standardization restricts the value of this imaging modality in clinical ...decision-making. The purpose of this study was to comprehensively review the reported sources of variability and error in cerebral CT perfusion results.
A systematic literature review was conducted, 120 articles were reviewed, and 23 published original research articles were included. Sources of variability and error were thematically categorized and presented within the context of the 3 stages of a typical CT perfusion study: data acquisition, postprocessing, and results interpretation.
Seven factors that caused variability were identified and described in detail: 1) contrast media, the iodinated compound injected intravascularly to permit imaging of the cerebral vessels; 2) data acquisition rate, the number of images obtained by CT scan per unit time; 3) user inputs, the subjective selections that operators make; 4) observer variation, the failure of operators to repeatedly measure a perfusion parameter with precision; 5) software operational mode, manual, semiautomatic, or automatic; 6) software design, the mathematical algorithms used to perform postprocessing; and 7) value type, absolute versus relative values.
Standardization at all 3 stages of the CT perfusion study cycle is warranted. At present, caution should be exercised when interpreting CT perfusion results as these values may vary considerably depending on a variety of factors. Future research is needed to define the role of CT perfusion in clinical decision-making for acute stroke patients and to determine the clinically acceptable limits of variability in CT perfusion results.
Smart City Traffic Intersection: Impact of Video Quality and Scene Complexity on Precision and Inference Duan, Zhuoxu; Yang, Zhengye; Samoilenko, Richard ...
2021 IEEE 23rd Int Conf on High Performance Computing & Communications; 7th Int Conf on Data Science & Systems; 19th Int Conf on Smart City; 7th Int Conf on Dependability in Sensor, Cloud & Big Data Systems & Application (HPCC/DSS/SmartCity/DependSys),
2021-Dec.
Conference Proceeding
Traffic intersections are prime locations for deployment of infrastructure sensors and edge computing nodes to realize the vision of a smart city. It is expected that the needs of a smart city, in ...regards to traffic and pedestrian traffic systems monitored by cameras/video, can be met by using state-of-the-art artificial-intelligence (AI) based object detectors and trackers. A critical component in designing an effective real-time object detection/tracking pipeline is the understanding of how object density, i.e., the number of objects in a scene, and image-resolution and frame rate influence the performance metrics. This study explores the accuracy and speed metrics with the goal of supporting pipelines that meet the precision and latency needs of a real-time environment. We examine the impact of varying image-resolution, frame rate and object-density on the object detection performance metrics. The experiments on the COSMOS testbed dataset show that varying the frame width from 416 pixels to 832 pixels, and cropping the images to a square resolution, result in the increase in average precision for all object classes. Decreasing the frame rate from 15 fps to 5 fps preserves more than 90% of the highest F1 score achieved for all object classes. The results inform the choice of video preprocessing stages, modifications to established AI-based object detection/tracking methods, and suggest optimal hyper-parameter values.
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