Background
Due to its smooth muscle relaxing properties, peppermint oil (PO) may relieve dysphagia and chest pain due to esophageal motility disorders.
Aim
To explore the impact of PO on dysphagia ...and/or chest pain in patients referred for motility testing.
Methods
Patients initiated on PO for dysphagia and/or chest pain from 2013 to 2016 were identified. We excluded patients with obstructing esophageal lesions, patients lost to follow-up, and those with preexisting cardiac conditions. Concentrated PO was given as commercially available dissolvable peppermint tablets; two tablets before meals were prescribed to patients with dysphagia and on an as-needed basis for patients with chest pain. Patient-reported symptom response was assessed using a modified five-point Likert scale.
Results
Thirty-eight patients were included. Twenty-four patients (63%) reported improvement; 12 were much better and 12 were slightly better. Fourteen experienced no change and none reported feeling worse. Based on pre-treatment HRM, patients with distal esophageal spasm (DES) (
n
= 10) and esophagogastric junction outflow obstruction (EGJOO) (
n
= 8) appeared to demonstrate the best subjective improvement (83% and 100%, respectively) (
P
< 0.05).
Conclusion
PO appears to provide symptomatic relief in some patients with dysphagia and CP. Presence of a well-defined manometric disorder, particularly DES or EGJOO, appeared to predict response.
Coronary artery disease (CAD), the most common manifestation of cardiovascular disease, remains the most common cause of mortality in the United States. Risk assessment is key for primary prevention ...of coronary events and coronary artery calcium (CAC) scoring using computed tomography (CT) is one such non-invasive tool. Despite the proven clinical value of CAC, the current clinical practice implementation for CAC has limitations such as the lack of insurance coverage for the test, need for capital-intensive CT machines, specialized imaging protocols, and accredited 3D imaging labs for analysis (including personnel and software). Perhaps the greatest gap is the millions of patients who undergo routine chest CT exams and demonstrate coronary artery calcification, but their presence is not often reported or quantitation is not feasible. We present two deep learning models that automate CAC scoring demonstrating advantages in automated scoring for both dedicated gated coronary CT exams and routine non-gated chest CTs performed for other reasons to allow opportunistic screening. First, we trained a gated coronary CT model for CAC scoring that showed near perfect agreement (mean difference in scores = -2.86; Cohen's Kappa = 0.89, P < 0.0001) with current conventional manual scoring on a retrospective dataset of 79 patients and was found to perform the task faster (average time for automated CAC scoring using a graphics processing unit (GPU) was 3.5 ± 2.1 s vs. 261 s for manual scoring) in a prospective trial of 55 patients with little difference in scores compared to three technologists (mean difference in scores = 3.24, 5.12, and 5.48, respectively). Then using CAC scores from paired gated coronary CT as a reference standard, we trained a deep learning model on our internal data and a cohort from the Multi-Ethnic Study of Atherosclerosis (MESA) study (total training n = 341, Stanford test n = 42, MESA test n = 46) to perform CAC scoring on routine non-gated chest CT exams with validation on external datasets (total n = 303) obtained from four geographically disparate health systems. On identifying patients with any CAC (i.e., CAC ≥ 1), sensitivity and PPV was high across all datasets (ranges: 80-100% and 87-100%, respectively). For CAC ≥ 100 on routine non-gated chest CTs, which is the latest recommended threshold to initiate statin therapy, our model showed sensitivities of 71-94% and positive predictive values in the range of 88-100% across all the sites. Adoption of this model could allow more patients to be screened with CAC scoring, potentially allowing opportunistic early preventive interventions.
Current imaging technologies are capable of acquiring volumetric data, but they are limited by the flat 2-dimensional representation of complex 3-dimensional data. This pictorial report illustrates ...the potential role of interactive virtual reality (VR) that enables physicians to visualize and interact with image data as if they were real physical objects. Increasing availability of tools that make the VR environment a possibility could potentially be valuable in the interventional radiology suite.
Purpose
Transarterial radioembolization (TARE) with yttrium-90 (
90
Y) microspheres is a liver-directed treatment for primary and secondary hepatic malignancies. Personalized dosimetry aims for ...maximum treatment effect and reduced toxicity. We aimed to compare pre-treatment voxel-based dosimetry from
99m
Tc macroaggregated albumin (MAA) SPECT/CT with post-treatment
90
Y PET/CT for absorbed dose values, and to evaluate image quality of
90
Y SiPM-based PET/CT.
Methods
Forty-two patients (28 men, 14 women, mean age: 67 ± 11 years) with advanced hepatic malignancies were prospectively enrolled. Twenty patients were treated with glass and 22 with resin microspheres. Radiation absorbed doses from planning
99m
Tc-MAA SPECT/CT and post-therapy
90
Y PET/CT were assessed.
90
Y PET/CT images were acquired for 20 min and reconstructed to produce 5-, 10-, 15-, and 20-min datasets, then evaluated using the 5-point Likert scale.
Results
The mean administered activity was 3.44 ± 1.5 GBq for glass and 1.62 ± 0.7 GBq for resin microspheres. The mean tumor absorbed doses calculated from
99m
Tc-MAA SPECT/CT and
90
Y PET/CT were 175.69 ± 113.76 Gy and 193.58 ± 111.09 Gy (
P
= 0.61), respectively for glass microspheres; they were 60.18 ± 42.20 Gy and 70.98 ± 49.65 Gy (
P
= 0.37), respectively for resin microspheres. The mean normal liver absorbed doses from
99m
Tc-MAA SPECT/CT and
90
Y PET/CT were 32.70 ± 22.25 Gy and 30.62 ± 20.09 Gy (
P
= 0.77), respectively for glass microspheres; they were 18.33 ± 11.08 Gy and 24.32 ± 15.58 Gy (
P
= 0.17), respectively for resin microspheres. Image quality of
90
Y PET/CT at 5-, 10-, 15-, and 20-min scan time showed a Likert score of 3.6 ± 0.54, 4.57 ± 0.58, 4.84 ± 0.37, and 4.9 ± 0.3, respectively.
Conclusions
99m
Tc-MAA SPECT/CT demonstrated great accuracy for treatment planning dosimetry. SiPM-based PET/CT scanner showed good image quality at 10-min scan time, acquired in one bed position. A PET/CT scan time of 5 min showed acceptable image quality and suffices for dosimetry and treatment verification. This allows for inclusion of
90
Y PET/CT in busy routine clinical workflows. Studies with larger patient cohorts are needed to confirm these findings.
Controlling a quadcopter is a challenging task because of the inherent high nonlinearity of a quadcopter system. In this paper, a new quaternion based nonlinear feedback controller for attitude and ...altitude regulation of a quadcopter is proposed. The dynamic model of the quadcopter is derived using Newton and Euler equations. The proposed controller is established based on a feedback linearization technique to control and regulate the quadcopter. Global asymptotic stability of the designed controller is verified using Lyapunov stability criterion. A comparison of the proposed controller performance and that of the state-of-the-art quadcopter controllers is performed to ensure the effectiveness of the proposed model. The efficiency of the proposed controller is clearly shown when the quadcopter is in or near a corner pose. Simulations are performed to assess the transient and steady state performance. Steady State Error (<inline-formula> <tex-math notation="LaTeX">E_{ss} </tex-math></inline-formula>) and Max Error (<inline-formula> <tex-math notation="LaTeX">E_{M} </tex-math></inline-formula>) are used as evaluation metrics of the proposed model performance.
Purpose
Obesity is associated with fat accumulation in ectopic sites such as the pancreas, the so-called pancreatic steatosis (PS). Bariatric surgery has been shown to be associated with reducing ...pancreatic fat. This study investigated the effect of laparoscopic sleeve gastrectomy (LSG) on pancreatic volume and its fat content and glucose homeostasis.
Methods
The study enrolled 54 patients subjected to LSG. Metabolic variables and pancreatic exocrine function were assessed immediately before surgery and 12 months after. MRI of the abdomen was performed to measure pancreatic fat content and its total volume and visceral adipose tissue (VAT).
Results
Surgery resulted in a significant reduction in body weight and BMI. HbA1c, fasting insulin, C-peptide levels, HOMA-IR, and Hs-CRP levels decreased significantly. Surgery resulted in significant improvement in lipid profile except for HDL-cholesterol and liver function tests. Total VAT volume decreased significantly. Total pancreas volume decreased by a mean of 9.0 cm
3
(95% CI: 6.6–11.3). The median change of pancreatic fat was −26.1% (range: −55.6 to 58.3%). Pancreatic lipase decreased significantly (
P
< 0.001). There was a positive correlation between the percentage of total weight loss and decrease in pancreatic fat volume (
r
= 0.295,
P
= 0.030).
Conclusion
Weight loss after LSG is associated with a reduction of total VAT volume, total pancreatic volume, and pancreatic fat content. These changes are associated with improved glucose homeostasis, reduced systemic inflammation, and decreased pancreatic lipase secretion.
Unmanned aerial vehicle quadcopters have applications in different real-life areas. They are nonlinear systems that necessitate the utilization of nonlinear control techniques. In this paper, we ...propose a new quaternion-based tracking controller for an underactuated quadcopter based on the pseudo linear feedback linearization technique. The quadcopter dynamic model was derived using Newton and Euler equations, and the global asymptotic stability of the quadcopter was verified using the Lyapunov stability criterion. The proposed controller has been compared to three state-of-the-art quadcopter controllers. Through simulation results, it has been shown that the proposed model has an effective and better performance than others. The metrics used in this evaluation are the steady-state error, maximum error, overshoot, and settling time. The different metrics proved the good performance of the proposed model in most of the different states that are presented.
Summary Objectives This study investigated the prevalence of diverse Ambler class β-lactamase-encoding genes in 40 carbapenem-insensitive Acinetobacter baumannii isolates collected from two hospitals ...in Egypt during the period January–March 2012. Methods The resistance levels to different groups of antimicrobial agents were determined. PCR was used to detect the different Ambler class β-lactamases encoding the following genes: blaTEM , blaSHV , blaCTX-M , blaVEB , blaPER , blaGES , blaVIM , blaIMP , blaSIM , blaSPM , blaGIM , blaNDM , blaADC , blaOXA-23 , blaOXA-24 , blaOXA-51 , and blaOXA-58 . IS Aba1 and int1 were detected by PCR. Results The isolates were 100% resistant to amoxicillin–clavulanate, aztreonam, cefepime, cefotaxime, and ceftazidime. Of the isolates, 5% were resistant to colistin, 45% to amikacin, 70% to imipenem, and 85% to ciprofloxacin. The blaADC - and blaOXA-51 -like genes were detected in the entire collection. The prevalences of blaOXA-23 , blaOXA-24 , and blaOXA-58 were 50%, 7.5%, and 5%, respectively. However, the prevalences of blaTEM -, blaPER -, and blaGES -like genes were 87.5%, 55%, and 27.5%, respectively. SHV, CTX-M, VEB, KPC, and MBL encoding genes were not detected. The IS Aba1 was found upstream to blaOXA-51 , blaOXA-23 , and blaADC in 85%, 80%, and 50%, respectively. Of note, 45% (18/40) of the isolates co-produced extended-spectrum β-lactamases (PER and GES) and carbapenemases (OXA-23 and OXA-58). Conclusions The blaADC -, blaTEM -, blaPER -, blaOXA-23 -, and blaGES -like genes were found to be the most prevalent types of β-lactamase-encoding gene in A. baumannii collected from Egypt. A high level of carbapenem resistance is mediated by blaOXA-23 , blaOXA-24 , and blaOXA-58 (minimum inhibitory concentration (MIC) 32 to >256 μg/ml), and a low level of carbapenem resistance is mediated by blaGES (MIC 4–16 μg/ml) and by up-regulation of IS Aba1 –OXA-51 (MIC 1–4 μg/ml). Class B MBL was not identified to play a role in carbapenem resistance in A. baumannii isolates from Egypt.
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