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Here we present a Rb-^{129}Xe spin-exchange optical pumping polarizer capable of rapid generation of large volumes of highly polarized ^{129}Xe gas. Through modeling and measurements we maximize the ^{129}Xe nuclear spin polarization output to enable the generation of polarized ^{129}Xe gas imaging volumes (300 cm^{3}) every 5 min within a clinical setting. Our model is verified by experiment to correctly predict the optimum Rb vapor density for maximum ^{129}Xe nuclear polarization for a flux 3.4 W/cm^{2} of circularly polarized Rb D_{1} photons incident on an 80 cm long cylindrical optical cell. We measure a ^{129}Xe magnetization production efficiency of η_{pr}=1.8%, which approaches the photon efficiency limit η_{γ}=3.3% of this system and enables the polarization of 2.72×10^{22} ^{129}Xe spins per hour, corresponding to 1013 cm^{3} of 100% polarized ^{129}Xe at STP. This magnetization production rate is threefold higher than the highest previously published ^{129}Xe magnetization production rate and has enabled routine clinical lung magnetic resonance imaging (MRI) with hyperpolarized ^{129}Xe doses available on demand at run time, as well as high-SNR ^{129}Xe MRI of the human brain and kidneys.
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PURPOSE: Pulmonary hypertension (PH) is associated with a poor outcome in chronic obstructive pulmonary disease (COPD) and is diagnosed invasively. We aimed to assess the diagnostic accuracy and prognostic value of non-invasive cardiovascular magnetic resonance (CMR) models. METHODS: Patients with COPD and suspected PH, who underwent CMR and right heart catheter (RHC) were identified. Three candidate models were assessed: 1, CMR-RV model, based on right ventricular (RV) mass and interventricular septal angle; 2, CMR PA/RV includes RV mass, septal angle and pulmonary artery (PA) measurements; 3, the Alpha index, based on RV ejection fraction and PA size. RESULTS: Of 102 COPD patients, 87 had PH. The CMR-PA/RV model had the strongest diagnostic accuracy (sensitivity 92%, specificity 80%, positive predictive value 96% and negative predictive value 63%, AUC 0.93, p<0.0001). Splitting RHC-mPAP, CMR-RV and CMR-PA/RV models by 35mmHg gave a significant difference in survival, with log-rank chi-squared 5.03, 5.47 and 7.10. RV mass and PA relative area change were the independent predictors of mortality at multivariate Cox regression (p=0.002 and 0.030). CONCLUSION: CMR provides diagnostic and prognostic information in PH-COPD. The CMR-PA/RV model is useful for diagnosis, the RV mass index and PA relative area change are useful to assess prognosis. KEY POINTS: ⢠Pulmonary hypertension is a marker of poor outcome in COPD. ⢠MRI can predict invasively measured mean pulmonary artery pressure. ⢠Cardiac MRI allows for estimation of survival in COPD. ⢠Cardiac MRI may be useful for follow up or future trials. ⢠MRI is potentially useful to assess pulmonary hypertension in patients with COPD.
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Ventrículos Cardíacos/diagnóstico por imagen , Hipertensión Pulmonar/diagnóstico , Imagen por Resonancia Cinemagnética/métodos , Arteria Pulmonar/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Función Ventricular Derecha/fisiología , Anciano , Cateterismo Cardíaco/métodos , Femenino , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Arteria Pulmonar/diagnóstico por imagen , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/fisiopatologíaRESUMEN
Atrial fibrillation is a common cardiac arrhythmia and can occur de novo following a surgical procedure. It is associated with increased inpatient and long-term mortality. There is limited evidence concerning new-onset atrial fibrillation following abdominal surgery. This study aimed to identify the prevalence of and risk factors for postoperative atrial fibrillation in the general surgical population. A systematic search of the Embase, MEDLINE and Cochrane (CENTRAL) databases was conducted. Studies were included in the review if they reported cases of new-onset atrial fibrillation within 30 days of the index operation. Results were evaluated qualitatively due to substantial clinical heterogeneity. Incidence rates were pooled using a weighted random-effects meta-analysis model. A total of 835 records were initially identified, from which 32 full texts were retrieved. Following review, 13 studies were included that involved 52,959 patients, of whom 10.94% (95%CI 7.22-15.33) developed atrial fibrillation. Five studies of patients undergoing oesophagectomy (n = 376/1923) had a weighted average rate of 17.66% (95%CI 12.16-21.47), compared with 7.63% (95%CI 4.39-11.98) from eight studies of non-oesophageal surgery (n = 2927/51,036). Identified risk factors included: increasing age; history of cardiac disease; postoperative complications, particularly, sepsis, pneumonia and pleural effusions. New-onset postoperative atrial fibrillation is common, and is more frequent after surgery involving the thorax. Future work should focus on stratifying risk to allow targeted prophylaxis of atrial fibrillation and other peri-operative complications.
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Fibrilación Atrial/epidemiología , Complicaciones Posoperatorias/epidemiología , Abdomen/cirugía , Fibrilación Atrial/etiología , Humanos , Incidencia , Complicaciones Posoperatorias/etiología , Factores de RiesgoRESUMEN
The chiral magnet Cu_{2}OSeO_{3} hosts a Skyrmion lattice that may be equivalently described as a superposition of plane waves or a lattice of particlelike topological objects. A thermal gradient may break up the Skyrmion lattice and induce rotating domains, raising the question of which of these scenarios better describes the violent dynamics at the domain boundaries. Here, we show that in an inhomogeneous temperature gradient caused by illumination in a Lorentz transmission electron microscope different parts of the Skyrmion lattice can be set into motion with different angular velocities. Tracking the time dependence, we show that the constant rearrangement of domain walls is governed by dynamic 5-7 defects arranging into lines. An analysis of the associated defect density is described by Frank's equation and agrees well with classical 2D Monte Carlo simulations. Fluctuations of boundaries show a surgelike rearrangement of Skyrmion clusters driven by defect rearrangement consistent with simulations treating Skyrmions as point particles. Our findings underline the particle character of the Skyrmion.
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BACKGROUND: Lymph node metastasis (LNM) is prognostic in colorectal cancer (CRC). However, evaluation by routine haematoxylin and eosin histology (HE) limits nodal examination and is subjective. Missed LNMs from tissue allocation bias (TAB) might under-stage disease, leading to under-treatment. One-step nucleic acid amplification (OSNA) for CK19 messenger ribonucleic acid (mRNA), a marker of LNM, analyses the whole node. The aim of the present systematic review and meta-analysis was to assess recent studies on OSNA versus HE and its implications for CRC staging and treatment. METHODS: Databases including OVID, Medline and Google Scholar were searched for OSNA, LNM and CRC. Study results were pooled using a random-effects model. Summary receiver operator curves (SROC) assessed OSNA's performance in detecting LNM when compared to routine HE histology. RESULTS: Five case-control studies analysing 4080 nodes from 622 patients were included. The summary estimates of pooled results for OSNA were sensitivity 0.90 [95% confidence interval (CI) 0.86-0.93], specificity 0.94 (95% CI 0.93-0.95) and diagnostic odds ratio 179.5 (CI 58.35-552.2, p < 0.0001). The SROC curve indicated a maximum joint sensitivity and specificity of 0.88 and area under the curve of 0.94, p < 0.0001. On average, 5.4% HE-negative nodes were upstaged by OSNA. CONCLUSIONS: OSNA is as good as routine HE. It may avoid TAB and offer a more objective and standardised assay of LNM. However, for upstaging, its usefulness as an adjunct to HE or superiority to HE requires further assessment of the benefits, if any, of adjuvant therapy in patients upstaged by OSNA.
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Neoplasias Colorrectales/diagnóstico , Ganglios Linfáticos/patología , Técnicas de Amplificación de Ácido Nucleico/estadística & datos numéricos , Adulto , Anciano , Estudios de Casos y Controles , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/patología , Eosina Amarillenta-(YS)/análisis , Femenino , Hematoxilina/análisis , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Técnicas de Amplificación de Ácido Nucleico/métodos , Oportunidad Relativa , Pronóstico , Curva ROC , Sensibilidad y EspecificidadRESUMEN
The avian hippocampal formation differs considerably from that of mammals both in terms of position and cytoarchitecture. On the basis of fiber connections in pigeons, however, we previously proposed that the dorsomedial subdivision (DM) and the V-shaped layer of the hippocampal formation correspond to Ammon's horn and the dentate gyrus of mammals, respectively. In the present study, we provide evidence in support of this hypothesis by double staining hippocampal neurons using tract-tracing and gene expression. After cholera toxin subunit B (CTB) was injected into the lateral septal nucleus (SL), and vesicular glutamate transporter 2 (vGluT2) mRNA, a gene marker for glutamatergic neurons, was visualized in the same retrogradely labeled neurons with in situ hybridization, most CTB+/vGluT2+ neurons were concentrated in DM, but were rare in the V-shaped layer. The distribution pattern of CTB+/vGluT2+ neurons in the hippocampal formation did not change when CTB injection sites were shifted in a rostrocaudal direction in SL. SL expresses a variety of mRNAs for ionotropic glutamate receptor subunits (GluA1, GluA2, GluK2, GluK4, and GluN1). The findings indicate that DM neurons provide descending glutamatergic axons to SL. Additionally, the present study showed that Prox1 mRNA, a gene marker for the dentate gyrus in mammals, was intensely expressed in the V-shaped layer in the pigeon hippocampus. Together these results strengthen our original hypothesis that DM and the V-shaped layer in the pigeon hippocampus are homologous to Ammon's Horn and the dentate gyrus, respectively. © 2016 Wiley Periodicals, Inc.
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Columbidae/anatomía & histología , Hipocampo/anatomía & histología , Animales , Proteínas Aviares/metabolismo , Toxina del Cólera , Columbidae/metabolismo , Femenino , Ácido Glutámico/metabolismo , Hipocampo/metabolismo , Proteínas de Homeodominio/metabolismo , Inmunohistoquímica , Hibridación in Situ , Masculino , Técnicas de Trazados de Vías Neuroanatómicas , Trazadores del Tracto Neuronal , Neuronas/citología , Neuronas/metabolismo , Receptores de Glutamato/metabolismo , Especificidad de la Especie , Proteína 2 de Transporte Vesicular de Glutamato/metabolismoRESUMEN
BACKGROUND: It is unclear which potentially modifiable risk factors best predict post-trauma psychiatric disorders. We aimed to identify pre-trauma risk factors for post-traumatic stress disorder (PTSD) or major depression (MD) that could be targeted with resilience interventions. METHOD: Newly recruited paramedics (n = 453) were assessed for history of mental disorders with structured clinical interviews within the first week of their paramedic training and completed self-report measures to assess hypothesized predictors. Participants were assessed every 4 months for 2 years to identify any episodes of PTSD and MD; 386 paramedics (85.2%) participated in the follow-up interviews. RESULTS: In all, 32 participants (8.3%) developed an episode of PTSD and 41 (10.6%) an episode of MD during follow-up. In all but nine cases (2.3%), episodes had remitted by the next assessment 4 months later. At 2 years, those with episodes of PTSD or MD during follow-up reported more days off work, poorer sleep, poorer quality of life, greater burn-out; and greater weight-gain for those with PTSD. In line with theories of PTSD and depression, analyses controlling for psychiatric and trauma history identified several pre-trauma predictors (cognitive styles, coping styles and psychological traits). Logistic regressions showed that rumination about memories of stressful events at the start of training uniquely predicted an episode of PTSD. Perceived resilience uniquely predicted an episode of MD. CONCLUSIONS: Participants at risk of developing episodes of PTSD or depression could be identified within the first week of paramedic training. Cognitive predictors of episodes of PTSD and MD are promising targets for resilience interventions.
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Trastorno Depresivo Mayor , Auxiliares de Urgencia , Enfermedades Profesionales , Trastornos por Estrés Postraumático , Adulto , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/fisiopatología , Trastorno Depresivo Mayor/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/fisiopatología , Enfermedades Profesionales/psicología , Pronóstico , Factores de Riesgo , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/fisiopatología , Trastornos por Estrés Postraumático/psicología , Adulto JovenRESUMEN
OBJECTIVE/BACKGROUND: Microarray-based gene expression profiling studies may detect transcriptional signatures carrying prognostic value in abdominal aortic aneurysms (AAA). A gene expression profiling study was conducted to compare individuals with AAA with screened controls. METHODS: The peripheral blood transcriptome was compared between 12 individuals with AAA and 12 age- and sex-matched controls using microarray. Validation by Taqman real-time quantitative (qPCR) was performed in an independent group as described. Peripheral blood RNA was hybridized to Illumina microarrays, each representing 37,846 genes, allowing comparison of gene expression between cases and controls. Eleven differentially expressed genes were re-quantified by qPCR in the independent group with AAA (n = 95), controls (n = 92), pre- and postendovascular AAA repair (EVAR, n = 31); or open AAA repair (n = 13), AAA wall biopsies (n = 11), and in matched smooth muscle cultures (n = 7). RESULTS: Microarray detected 47 significantly differentially expressed genes in AAA after correction for multiple testing (p < .05). These genes conferred roles in regulation of apoptosis, proteolysis, the electron transport chain, leukocyte migration, and the humoral immune response. Gene quantification in the independent group demonstrated three genes to be downregulated in AAA compared with controls: MSN, PSMB10, and STIM1; however, their expression remained unchanged post-AAA repair. PSMB10 was the only gene conferring a consistent direction of effect in both the discovery and validation analyses (downregulated). EIF3G, SIVA, PUF60, CYC1, FIBP, and CARD8 were downregulated post-EVAR. Expression of all 11 genes of interest was detected in aortic biopsies and matched smooth muscle cultures. CONCLUSION: This study demonstrates differential expression of transcripts in peripheral blood of individuals with AAA, with functional roles in proteolysis, inflammation, and apoptotic processes. These were modulated by aneurysm exclusion from the circulation and expressed in matched aortic biopsies and smooth muscle cultures. These observations further support the key roles for these pathways in the pathogenesis of AAA.
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Aneurisma de la Aorta Abdominal/genética , Perfilación de la Expresión Génica/métodos , Anciano , Aneurisma de la Aorta Abdominal/sangre , Aneurisma de la Aorta Abdominal/diagnóstico , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Marcadores Genéticos/genética , Humanos , Masculino , Análisis de Secuencia por Matrices de Oligonucleótidos/métodos , Reacción en Cadena en Tiempo Real de la Polimerasa , Transcriptoma/genéticaRESUMEN
We evaluated the prevalence and prognostic value of CT-pulmonary angiographic (CTPA) measures in 292 treatment naive patients with pulmonary arterial hypertension (PAH). Pulmonary artery calcification (13%) and thrombus (10%) were exclusively seen in PAH-congenital heart disease. Oesophageal dilation (46%) was most frequent in PAH-systemic sclerosis. Ground glass opacification (GGO) (41%), pericardial effusion (38%), lymphadenopathy (19%) and pleural effusion (11%) were common. On multivariate analysis, inferior vena caval area, the presence of pleural effusion and septal lines predicted outcome. In PAH, CTPA provides diagnostic and prognostic information. In addition, the presence of GGO on a CT performed for unexplained breathlessness should alert the physician to the possibility of PAH.
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Hipertensión Pulmonar/diagnóstico por imagen , Adulto , Anciano , Aortografía/métodos , Femenino , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnóstico por imagen , Hemodinámica/fisiología , Humanos , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/fisiopatología , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Pronóstico , Arteria Pulmonar/diagnóstico por imagen , Sistema de Registros , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: MicroRNAs are crucial in the regulation of cardiovascular disease and represent potential therapeutic targets to decrease abdominal aortic aneurysm (AAA) expansion. The aim of this study was to identify circulating microRNAs associated with AAA. METHODS: Some 754 microRNAs in whole-blood samples from 15 men with an AAA and ten control subjects were quantified using quantitative reverse transcriptase-PCR. MicroRNAs demonstrating a significant association with AAA were validated in peripheral blood and plasma samples of men in the following groups (40 in each): healthy controls, controls with peripheral arterial disease (PAD), men with a small AAA (30-54 mm), those with a large AAA (over 54 mm), and those following AAA repair. MicroRNA expression was also assessed in aortic tissue. RESULTS: Twenty-nine differentially expressed microRNAs were identified in the discovery study. Validation study revealed that let-7e (fold change (FC) -1·80; P = 0·001), miR-15a (FC -2·24; P < 0·001) and miR-196b (FC -2·26; P < 0·001) were downregulated in peripheral blood from patients with an AAA, and miR-411 was upregulated (FC 5·90; P = 0·001). miR-196b was also downregulated in plasma from the same individuals (FC -3·75; P = 0·029). The same miRNAs were similarly expressed differentially in patients with PAD compared with healthy controls. Validated and predicted microRNA targets identified through miRWalk revealed that these miRNAs were all regulators of AAA-related genes (vascular cell adhesion molecule 1, intercellular cell adhesion molecule 1, DAB2 interacting protein, α1-antitrypsin, C-reactive protein, interleukin 6, osteoprotegerin, methylenetetrahydrofolate reductase, tumour necrosis factor α). CONCLUSION: In this study, circulating levels of let-7e, miR-15a, miR-196b and miR-411 were differentially expressed in men with an AAA compared with healthy controls, but also differentially expressed in men with PAD. Modulation of these miRNAs and their target genes may represent a new therapeutic pathway to affect the progression of AAA and atherosclerosis.
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Aneurisma de la Aorta Abdominal/genética , Predisposición Genética a la Enfermedad , MicroARNs/genética , Enfermedad Arterial Periférica/genética , Aneurisma de la Aorta Abdominal/metabolismo , Aneurisma de la Aorta Abdominal/patología , Marcadores Genéticos , Humanos , Masculino , MicroARNs/metabolismo , Persona de Mediana Edad , Enfermedad Arterial Periférica/metabolismo , Enfermedad Arterial Periférica/patología , Reacción en Cadena de la Polimerasa , Reproducibilidad de los ResultadosRESUMEN
The song system of songbirds consists of an interconnected set of forebrain nuclei that has traditionally been regarded as dedicated to the learning and production of song. Here, however, we suggest that the song system could also influence muscles used in reproductive behaviour, such as the cloacal sphincter muscle. We show that the same medullary nucleus, retroambigualis (RAm), that projects upon spinal motoneurons innervating expiratory muscles (which provide the pressure head for vocalization) and upon vocal motoneurons for respiratory-vocal coordination also projects upon cloacal motoneurons. Furthermore, RAm neurons projecting to sacral spinal levels were shown to receive direct projections from nucleus robustus arcopallialis (RA) of the forebrain song system. Thus, by indicating a possible disynaptic relationship between RA and motoneurons innervating the reproductive organ, in both males and females, these results potentially extend the role of the song system to include consummatory as well as appetitive aspects of reproductive behaviour.
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Canarios/fisiología , Conducta Sexual Animal/fisiología , Vocalización Animal/fisiología , Animales , Encéfalo/anatomía & histología , Encéfalo/fisiología , Canarios/anatomía & histología , Cloaca/inervación , Femenino , Masculino , Neuronas Motoras/citología , Neuronas Motoras/fisiología , Vías Nerviosas/anatomía & histología , Vías Nerviosas/fisiología , Centro Respiratorio/anatomía & histología , Centro Respiratorio/fisiología , Médula Espinal/anatomía & histología , Médula Espinal/fisiologíaRESUMEN
The inability of solar cell materials to convert all incident photon energy into electrical current, provides a fundamental limit to the solar cell efficiency; the so called Shockley-Queisser (SQ) limit. A process termed upconversion provides a pathway to convert otherwise unabsorbed low energy photons passing through the solar cell into higher energy photons, which subsequently can be redirected back to the solar cell. The combination of a semi-transparent InGaP solar cell with lanthanide upconverters, consisting of ytterbium and erbium ions doped in three different host materials (Gd2O2S, Y2O3 and NaYF4) is investigated. Using sub-band gap light of wavelength range 890 nm to 1045 nm with a total accumulated power density of 2.7 kW m(-2), a distinct photocurrent was measured in the solar cell when the upconverters were applied whereas a zero current was measured without upconverter. Furthermore, a time delay between excitation and emission was observed for all upconverter systems which can be explained by energy transfer upconversion. Also, a quadratic dependence on the illumination intensity was observed for the NaYF4 and Y2O3 host material upconverters. The Gd2O2S host material upconverter deviated from the quadratic illumination intensity dependence towards linear behaviour, which can be attributed to saturation effects occurring at higher illumination power densities.
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Magnetic compass information has a key role in bird orientation, but the physiological mechanisms enabling birds to sense the Earth's magnetic field remain one of the unresolved mysteries in biology. Two biophysical mechanisms have become established as the most promising magnetodetection candidates. The iron-mineral-based hypothesis suggests that magnetic information is detected by magnetoreceptors in the upper beak and transmitted through the ophthalmic branch of the trigeminal nerve to the brain. The light-dependent hypothesis suggests that magnetic field direction is sensed by radical pair-forming photopigments in the eyes and that this visual signal is processed in cluster N, a specialized, night-time active, light-processing forebrain region. Here we report that European robins with bilateral lesions of cluster N are unable to show oriented magnetic-compass-guided behaviour but are able to perform sun compass and star compass orientation behaviour. In contrast, bilateral section of the ophthalmic branch of the trigeminal nerve in European robins did not influence the birds' ability to use their magnetic compass for orientation. These data show that cluster N is required for magnetic compass orientation in this species and indicate that it may be specifically involved in processing of magnetic compass information. Furthermore, the data strongly suggest that a vision-mediated mechanism underlies the magnetic compass in this migratory songbird, and that the putative iron-mineral-based receptors in the upper beak connected to the brain by the trigeminal nerve are neither necessary nor sufficient for magnetic compass orientation in European robins.
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Migración Animal/fisiología , Magnetismo , Orientación/fisiología , Pájaros Cantores/fisiología , Visión Ocular/fisiología , Animales , Vuelo Animal/fisiología , Sistema Solar , Nervio Trigémino/fisiología , Percepción Visual/fisiologíaRESUMEN
The purpose of this work was to assess the reproducibility of percentage of ventilated lung volume (PV) measured from hyperpolarized (HP) (3)He and (1)H anatomical images acquired in the same breath-hold when compared with PV measured from (3)He and (1)H images from separate breath-holds. Volumetric (3)He ventilation and (1)H anatomical images of the same resolution were acquired during the same breath-hold. To assess reproducibility, this procedure was performed twice with a short gap between acquisitions. In addition, (1)H images were also acquired in a separate breath for comparison. PV ((3)He ventilated volume divided by (1)H total lung volume) was calculated using the single-breath-hold images (PV(single)) and the separate-breath-hold images (PV(separate)). Short-term reproducibility of PV measurement was assessed for both single- and separate-breath acquisitions. Dice similarity coefficients (DSCs) were calculated to quantify spatial overlap between (3)He and (1)H segmentations for the single- and separate-breath-hold acquisitions. The efficacy of using the separate-breath method combined with image registration was also assessed. The mean magnitude difference between the two sets of PV values (±standard deviation) was 1.49 ± 1.32% for PV(single) and 4.19 ± 4.10% for PV(separate), with a significant difference (p < 0.01). The mean magnitude difference between the two PV values for the registered separate-breath technique (PV(sep-registered)) was 2.27 ± 2.23%. Bland-Altman analysis showed that PV measured with single-breath acquisitions was more repeatable than PV measured with separate-breath acquisitions, regardless of image registration. DSC values were significantly greater (p < 0.01) for single-breath acquisition than for separate-breath acquisition. Acquisition of HP gas ventilation and (1)H anatomical images in a single breath-hold provides a more reproducible means of percentage lung ventilation volume measurement than the previously used separate-breath-hold scan approach, and reduces errors.
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Helio , Mediciones del Volumen Pulmonar/métodos , Imagen por Resonancia Magnética , Protones , Ventilación Pulmonar/fisiología , Respiración , Adulto , Anciano , Humanos , Procesamiento de Imagen Asistido por Computador , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
Tumours of the appendix are very rare tumours that can and often present with a mucocele. This is a case report highlighting the associated pathology of appendix tumours and the management of a large mucocele. Specifically, how a right hemicolectomy is very rarely needed in these cases regardless of size and local anatomical relationships and some important considerations for the practicing surgeon in the non-tertiary centre that encounters a case like this.
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Cavidad Abdominal , Neoplasias del Apéndice , Apéndice , Enfermedades del Ciego , Anomalías del Sistema Digestivo , Mucocele , Humanos , Mucocele/diagnóstico , Mucocele/diagnóstico por imagen , Enfermedades del Ciego/diagnóstico , Enfermedades del Ciego/cirugía , Apéndice/diagnóstico por imagen , Apéndice/cirugía , Apéndice/patología , Neoplasias del Apéndice/complicaciones , Neoplasias del Apéndice/diagnóstico , Neoplasias del Apéndice/cirugíaRESUMEN
Adding prior knowledge to compressed sensing reconstruction can improve image reconstruction. In this work, two approaches are investigated to improve reconstruction of two-dimensional hyperpolarized (3)He lung ventilation images using prior knowledge. When compared against a standard compressed sensing reconstruction, the proposed methods allowed acquisition of images with higher under-sampling factors and reduction of the blurring effects that increase with higher reduction factors when fixed flip angles are used. These methods incorporate the prior knowledge of polarization decay of hyperpolarized (3)He and the mutual anatomical information from a registered (1)H image acquired in the same breath. Three times accelerated two-dimensional images reconstructed with compressed sensing and prior knowledge gave lower root-mean square error, than images reconstructed without introduction of any prior information. When introducing the polarization decay as prior knowledge, a significant improvement was achieved in the lung region, the root mean square value decreased by 45% and from the whole image by 36%. When introducing the mutual anatomical information as prior knowledge, the root mean square decreased by 21% over the lung region and by 15% over the whole image.
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Algoritmos , Compresión de Datos/métodos , Helio , Interpretación de Imagen Asistida por Computador/métodos , Pulmón/anatomía & histología , Imagen por Resonancia Magnética/métodos , Adulto , Medios de Contraste , Femenino , Gases , Humanos , Aumento de la Imagen/métodos , Isótopos , Masculino , Radiofármacos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Compressed sensing has been of great interest to speed up the acquisition of MR images. The k-t group sparse (k-t GS) method has recently been introduced for dynamic MR images to exploit not just the sparsity, as in compressed sensing, but also the spatial group structure in the sparse representation. k-t GS achieves higher acceleration factors compared to the conventional compressed sensing method. However, it assumes a spatial structure in the sparse representation and it requires a time consuming hard-thresholding reconstruction scheme. In this work, we propose to modify k-t GS by incorporating prior information about the sorted intensity of the signal in the sparse representation, for a more general and robust group assignment. This approach is referred to as group sparse reconstruction using intensity-based clustering. The feasibility of the proposed method is demonstrated for static 3D hyperpolarized lung images and applications with both dynamic and intensity changes, such as 2D cine and perfusion cardiac MRI, with retrospective undersampling. For all reported acceleration factors the proposed method outperforms the original compressed sensing method. Improved reconstruction over k-t GS method is demonstrated when k-t GS assumptions are not satisfied. The proposed method was also applied to cardiac cine images with a prospective sevenfold acceleration, outperforming the standard compressed sensing reconstruction.
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Algoritmos , Compresión de Datos/métodos , Aumento de la Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Angiografía por Resonancia Magnética/métodos , Imagen por Resonancia Cinemagnética/métodos , Humanos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
OBJECTIVES: Currently most abdominal aortic aneurysm screening programmes discharge patients with aortic diameter of less than 30 mm. However, sub-aneurysmal aortic dilatation (25 mm-29 mm) does not represent a normal aortic diameter. This observational study aimed to determine the outcomes of patients with screening detected sub aneurysmal aortic dilatation. DESIGN AND METHODS: Individual patient data was obtained from 8 screening programmes that had performed long term follow up of patients with sub aneurysmal aortic dilatation. Outcome measures recorded were the progression to true aneurysmal dilatation (aortic diameter 30 mm or greater), progression to size threshold for surgical intervention (55 mm) and aneurysm rupture. RESULTS: Aortic measurements for 1696 men and women (median age 66 years at initial scan) with sub-aneurysmal aortae were obtained, median period of follow up was 4.0 years (range 0.1-19.0 years). Following Kaplan Meier and life table analysis 67.7% of patients with 5 complete years of surveillance reached an aortic diameter of 30 mm or greater however 0.9% had an aortic diameter of 54 mm. A total of 26.2% of patients with 10 complete years of follow up had an AAA of greater that 54 mm. CONCLUSION: Patients with sub-aneurysmal aortic dilatation are likely to progress and develop an AAA, although few will rupture or require surgical intervention.
Asunto(s)
Aorta Abdominal/patología , Aneurisma de la Aorta Abdominal/diagnóstico , Tamizaje Masivo , Anciano , Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/patología , Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/etiología , Rotura de la Aorta/patología , Dilatación Patológica , Progresión de la Enfermedad , Europa (Continente) , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Factores de Tiempo , Ultrasonografía , Procedimientos Quirúrgicos VascularesRESUMEN
Pulmonary hypertension (PH) is a heterogeneous condition. To date, no registry data exists reflecting the spectrum of disease across the five diagnostic groups encountered in a specialist referral centre. Data was retrieved for consecutive, treatment-naïve cases diagnosed between 2001 and 2010 using a catheter-based approach. 1,344 patients were enrolled, with a mean follow-up of 2.9 yrs. The 3-yr survival was 68% for pulmonary arterial hypertension (PAH), 73% for PH associated with left heart disease, 44% for PH associated with lung disease (PH-lung), 71% for chronic thromboembolic PH (CTEPH) and 59% for miscellaneous PH. Compared with PAH, survival was inferior in PH-lung and superior in CTEPH (p<0.05). Multivariate analysis demonstrated that diagnostic group independently predicted survival. Within PAH, Eisenmenger's survival was superior to idiopathic PAH, which was superior to PAH associated with systemic sclerosis (p<0.005). Within PH-lung, 3-yr survival in sleep disorders/alveolar hypoventilation (90%) was superior to PH-lung with chronic obstructive pulmonary disease (41%) and interstitial lung disease (16%) (p<0.05). In CTEPH, long-term survival was best in patients with surgically accessible disease undergoing pulmonary endarterectomy. In this large registry of consecutive, treatment-naïve patients identified at a specialist PH centre, outcomes and characteristics differed between and within PH groups. The current system of classification of PH has prognostic value even when adjusted for age and disease severity, emphasising the importance of systematic evaluation and precise classification.
Asunto(s)
Grupos Diagnósticos Relacionados/clasificación , Hipertensión Pulmonar/clasificación , Hipertensión Pulmonar/diagnóstico , Derivación y Consulta/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Adulto , Anciano , Grupos Diagnósticos Relacionados/estadística & datos numéricos , Endarterectomía/mortalidad , Femenino , Estudios de Seguimiento , Cardiopatías Congénitas/clasificación , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/mortalidad , Humanos , Hipertensión Pulmonar/mortalidad , Hipertensión Pulmonar/cirugía , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/clasificación , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Enfermedad Pulmonar Obstructiva Crónica/cirugía , Índice de Severidad de la Enfermedad , Trastornos del Sueño-Vigilia/clasificación , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/mortalidad , Análisis de Supervivencia , Tromboembolia/clasificación , Tromboembolia/diagnóstico , Tromboembolia/mortalidadRESUMEN
The (3)He MR diffusion signal is sensitive to lung microstructure, but it is also affected by the presence of background field inhomogeneities induced by the magnetic susceptibility difference at the air-tissue interface. These susceptibility-induced gradients, which are dependent on field strength, have been assumed negligible in theoretical models used to extract airway morphometric information from (3)He MR diffusion data at field strengths up to 4.7 T. In this work, the effect of susceptibility gradients on (3)He apparent diffusion coefficient is demonstrated with experiments in healthy volunteers at two B(0) field strengths: 1.5 and 3 T. Apparent diffusion coefficient values obtained at 3 T were systematically larger than at 1.5 T, demonstrating that susceptibility effects are statistically significant even at clinical field strengths (B(0) ≤ 3 T) and introduce biases in the estimates of airway dimensions (e.g., mean linear intercept up to 17% larger at 3 T than 1.5 T). Susceptibility effects should be taken into account in the development of theoretical models of lung (3)He MR diffusion and considered when interpreting (3)He apparent diffusion coefficients obtained at different B(0).