To test the feasibility of and improve a computer algorithm to automatically detect colonic polyps in real human computed tomographic (CT) colonographic data sets.
Twenty patients with known polyps ...underwent CT colonography in the supine position. CT colonographic data were processed by using a shape-based algorithm that depicts masses that protrude into the lumen. We studied nine shape criteria and three isosurface threshold settings. Results were compared with those of conventional colonoscopy performed the same day.
There were 50 polyps (28 were > or =10 mm in size; 12, 5-9 mm; 10, <5 mm). The sensitivity with optimal settings for detecting polyps 10 mm or greater was 64% (18 of 28). Sensitivity improved to 71% (10 of 14) for polyps 10 mm or greater in well-distended colonic segments. Performance decreased for polyps less than 10 mm, poorly distended colonic segments, and other shape algorithms. There was a mean of six false-positive lesion sites per colon. These sites were reduced 39% to 3.5 per colon by sampling CT attenuation at the lesion site and discarding sites having attenuation less than a threshold.
Automated detection of colonic polyps, especially clinically important large polyps, is feasible. Colonic distention is an important determinant of sensitivity. Further increases in sensitivity may be achieved by adding prone CT colonography.
Objectives
To compare the ionised calcium measured on a portable analyser (iSTAT, Abbott) to a reference method.
Materials and Methods
Blood samples from 39 apparently healthy dogs were analysed in ...duplicate using a portable analyser and a reference method (Radiometer ABL800 FLEX). Bland–Altman plots and Passing–Bablok regression were used to assess constant and proportional bias between the two instruments. A within‐assay percentage coefficient of variation and total error (TE) was calculated for both analysers. The reference interval was calculated for the portable analyser using the robust method with confidence interval bootstrapping.
Results
The Bland–Altman plot showed a −0.036 mmol/L difference between the two instruments (95% confidence limit −0.08 to 0.01 mmol/L; limits of agreement −0.07 to 0.006 mmol/L). Neither the Bland–Altman plot nor the Passing–Bablock regression (slope −0.03; 95% confidence interval −0.08 to 0.19 and intercept 1; 95% confidence interval 0.83 to 1.2) showed significant proportional bias. The coefficient of variation for the portable analyser was 1.08%, compared to 0.78% for the reference method with a total error of 3.5% for the portable analyser. The estimated population‐based reference interval for ionised calcium using the portable analyser is 1.23 to 1.42 mmol/L.
Clinical Significance
For the healthy dogs in this study, compared to the reference method, the portable analyser showed no significant bias for measurement of ionised calcium. Further studies including hyper and hypocalcaemic dogs are required to determine clinical impact of the use of this analyser.
Non‐alcoholic fatty liver disease (NAFLD) exists as a spectrum of disease ranging from excessive accumulation of fat within the liver (simple steatosis), inflammation (non‐alcoholic steatohepatitis) ...through to fibrosis, cirrhosis and end‐stage liver disease. There is also an increased risk of hepatocellular carcinoma. The principal risk factor for NAFLD is overweight or obesity, along with type 2 diabetes, and NAFLD itself is also a risk factor for incident type 2 diabetes. Overweight/obesity is synergistic with alcohol consumption in causing progressive and insidious liver damage. Recent consensus advocates a change in nomenclature from NAFLD to ‘metabolic associated fatty liver disease’ (MAFLD), reflective of the associated metabolic abnormalities (insulin resistance/type 2 diabetes and metabolic syndrome components). Additional extra‐hepatic manifestations of NAFLD include cardiovascular disease, chronic kidney disease and certain cancers. Unlike other micro‐ and macrovascular complications of type 2 diabetes, systematic screening or surveillance protocols have not been widely adopted in routine diabetes care to assess for presence/severity of NAFLD. Various screening tools are available (non‐invasive tests and biochemical indices) combined with imaging techniques (e.g. transient elastography) to detect steatosis and more importantly advanced fibrosis/cirrhosis to facilitate appropriate surveillance. Liver biopsy may be sometimes necessary. Treatment options for type 2 diabetes, including lifestyle interventions (dietary change and physical activity), glucose‐lowering therapies and metabolic surgery, can modulate hepatic steatosis and to a lesser extent fibrosis. Awareness of the impact of liver disease on the choice of glucose‐lowering medications in individuals with type 2 diabetes is also critical.
What’s new?
Individuals with type 2 diabetes have a near threefold higher risk of dying from chronic liver disease.
The presence of non‐alcoholic fatty liver disease (NAFLD) has implications for liver disease progression, microvascular and macrovascular complications of diabetes, and additional extra‐hepatic manifestations.
Screening for NAFLD, followed by risk stratification to identify individuals with liver fibrosis, should be adopted into routine diabetes care.
Significant weight loss of 7–10% can cause regression of histological abnormalities including of fibrosis, in non‐alcoholic steatohepatitis, even at advanced stages.
Thiazolidinediones, glucagon‐like peptide‐1 (GLP1) receptor agonists and sodium–glucose co‐transporter 2 (SGLT2) inhibitors have all been shown to improve hepatic steatosis. The only currently available data on histological improvement relate to the use of thiazolidinediones and GLP1 receptor agonists but is lacking in the case of SGLT2 inhibitors.
Acute respiratory distress syndrome (ARDS) is a devastating critical illness that can be triggered by a wide range of insults and remains associated with a high mortality of around 40%. The search ...for targeted treatment for ARDS has been disappointing, possibly due to the enormous heterogeneity within the syndrome. In this perspective from the European Respiratory Society research seminar on "Precision medicine in ARDS", we will summarise the current evidence for heterogeneity, explore the evidence in favour of precision medicine and provide a roadmap for further research in ARDS. There is evident variation in the presentation of ARDS on three distinct levels: 1) aetiological; 2) physiological and 3) biological, which leads us to the conclusion that there is no typical ARDS. The lack of a common presentation implies that intervention studies in patients with ARDS need to be phenotype aware and apply a precision medicine approach in order to avoid the lack of success in therapeutic trials that we faced in recent decades. Deeper phenotyping and integrative analysis of the sources of variation might result in identification of additional treatable traits that represent specific pathobiological mechanisms, or so-called endotypes.
NASA's Solar Probe Plus (SPP) mission will make the first in situ measurements of the solar corona and the birthplace of the solar wind. The FIELDS instrument suite on SPP will make direct ...measurements of electric and magnetic fields, the properties of in situ plasma waves, electron density and temperature profiles, and interplanetary radio emissions, amongst other things. Here, we describe the scientific objectives targeted by the SPP/FIELDS instrument, the instrument design itself, and the instrument concept of operations and planned data products.
NASA's Solar Probe Plus (SPP) mission will make the first in situ measurements of the solar corona and the birthplace of the solar wind. The FIELDS instrument suite on SPP will make direct ...measurements of electric and magnetic fields, the properties of in situ plasma waves, electron density and temperature profiles, and interplanetary radio emissions, amongst other things. Here, we describe the scientific objectives targeted by the SPP/FIELDS instrument, the instrument design itself, and the instrument concept of operations and planned data products.
Sample return missions to Phobos are the subject of future exploration plans. Given the proximity of Phobos to Mars, Mars’ potential to have supported life, and the possibility of material transfer ...from Mars to Phobos, careful consideration of planetary protection is required. If life exists, or ever existed, on Mars, there is a possibility that material carrying organisms could be present on Phobos and be collected by a sample return mission such as the Japanese Martian Moons eXplorer (MMX). Here we describe laboratory experiments, theoretical modelling and statistical analysis undertaken to quantify whether the likelihood of a sample from Phobos material containing unsterilized material transferred from Mars is less than 10−6, the threshold to transition between restricted and unrestricted sample return classification for planetary protection. We have created heat, impact and radiation sterilization models based on the Phobos environment, and through statistical analyses investigated the level of sterilization expected for martian material transferred to Phobos. These analyses indicate that radiation is the major sterilization factor, sterilizing the Phobos surface over timescales of millions of years. The specific events of most relevance in the Phobos sample return context are the ‘young’ cratering events on Mars that result in Zunil-sized craters, which can emplace a large mass of martian material on Phobos, in a short period of time, thus inhibiting the effects of radiation sterilization. Major unknowns that cannot yet be constrained accurately enough are found to drive the results – the most critical being the determination of exact crater ages to statistical certainty, and the initial biological loading on Mars prior to transfer. We find that, when taking a conservative perspective and assuming the best-case scenario for organism survival, for a 100 g sample of the Phobos regolith to be below the planetary protection requirement for unrestricted sample return, the initial biological loading on Mars must be <8.2 × 103cfu kg-1. For the planned MMX mission, a ∼10 g sample to be obtained from a 25–30 mm diameter core as planned would require an initial martian biological loading to be <1.6 × 104cfu kg-1, in order to remain compliant with the planetary protection threshold
Die sukseskoers van uitkontraktering in Suid-Afrika is taamlik laag. Organisasies wat die verkeerde besluit neem rakende die uitkontraktering van instandhouding verhoog die risiko van swak vertoning ...vir instandhouding, hoër bedryfskoste vir instandhouding en koste om 'n interne vermoë vir instandhouding te skep. Die identifisering van toepaslike faktore vir die besluit om instandhouding uit te kontrakteer kan die basis vorm van 'n raamwerk vir besluitneming. So 'n raamwerk of model het die potensiaal om die kwaliteit van besluitneming in instandhoudingsbestuur te verbeter. Hierdie artikel bespreek die resultate van 'n vraelys wat versprei is om te bepaal watter faktore die belangrikste is wanneer instandhoudings- en batebestuurders moet besluit of sekere instandhoudingswerk uitgekontrakteer moet word. Die meeste van die 62 respondente was werksaam in die olie en energie sektor of die chemiese sektor van die Suid-Afrikaanse nywerheid. Die belangrikste faktore wat geVdentifiseer is, was ondervinding van die kontrakteur, beskikbaarheid van 'n geskikte kontrakteur, en 'n tekort aan vaardighede en personeel. Die resultate van hierdie vraelys is nuttig vir instandhoudings- en batebestuurders om te besluit of n aktiwiteit uitgekontrakteer moet word, en om potensiële kontrakteurs in 'n rangorde te plaas.
We have identified a novel human relaxin gene, designated H3 relaxin, and an equivalent relaxin gene in the mouse from the Celera Genomics data base. Both genes encode a putative prohormone sequence ...incorporating the classic two-chain, three cysteine-bonded structure of the relaxin/insulin family and, importantly, contain the RXXXRXX(I/V) motif in the B-chain that is essential for relaxin receptor binding. A peptide derived from the likely proteolytic processing of the H3 relaxin prohormone sequence was synthesized and found to possess relaxin activity in bioassays utilizing the human monocytic cell line, THP-1, that expresses the relaxin receptor. The expression of this novel relaxin gene was studied in mouse tissues using RT-PCR, where transcripts were identified with a pattern of expression distinct from that of the previously characterized mouse relaxin. The highest levels of expression were found in the brain, whereas significant expression was also observed in the spleen, thymus, lung, and ovary. Northern blotting demonstrated an approximately 1.2-kb transcript present in mouse brain poly(A) RNA but not in other tissues. These data, together with the localization of transcripts in the pars ventromedialis of the dorsal tegmental nucleus of C57BLK6J mouse brain by in situ hybridization histochemistry, suggest a new role for relaxin in neuropeptide signaling processes. Together, these studies describe a third member of the human relaxin family and its equivalent in the mouse.
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