EUS-guided tissue samples for the diagnosis of patients with a thickened gastric wall and prior negative endoscopic biopsies.

AIM: Evaluate the diagnostic yield of biopsies obtained by EUS guidance in patients with gastric wall thickening and prior negative endoscopic biopsies. MATERIAL AND METHODS: Data collected from October 2008 to January 2016 were analyzed in a retrospective manner. All included patients had undergone at least one endoscopy with a negative biopsy and showed evidence of gastric wall thickening by tomography, confirmed by endoscopy. All patients gave their written informed consent before the procedure. Demographics and baseline characteristics, including age, sex, number of previous endoscopies, and histopathological diagnosis were recorded. Follow-up data were obtained from a review of the electronic medical records. RESULT: In total, 22 patients with previous negative endoscopic biopsies and gastric wall thickening were included. Using EUSFNA/FNB, the diagnosis was made in the first procedure in 19/22 (86.30%) cases, while in 1/22 (4.5%) patients the diagnosis was made in the second EUS-FNA. A total of 18 (81.82%) patients with EUS-FNA were assessed using a standard Echo-tip, while the remaining four (18.18%) patients underwent EUS-FNB and using a ProCore needle. All patients with a final diagnosis of malignancy had a thickened gastric wall with impaired gastric distension and a loss of wall structure determined by EUS. Of patients with a benign final diagnosis, all (n=8) showed a thickened gastric wall by EUS but with preservation of the deep layers. CONCLUSION: EUS-FNA/FNB is necessary in patients with a thickened gastric wall and prior negative biopsy on endoscopy. The procedure is safe and has a good diagnostic.

Survival and detection of Bacillus cereus in the presence of Escherichia coli, Salmonella enteritidis, Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans after rechallenge in make-up removers.

OBJECTIVE: Pathogenic contamination of cosmetics intended to be applied on or around the eye area, including make-up removers, may lead to severe eye infections. To assess the efficacy of antimicrobial preservatives in these products, we investigated the survival and detection of Bacillus cereus F 4227A spiked into make-up removers, alone and in the presence of other relevant micro-organisms. METHODS: Four brands of make-up removers, A, B, C and D, were challenged three times (day 0, day 7 and day 14) using B. cereus, in pure and mixed cultures, at a final concentration of 5 log CFU per mL of Bacillus cereus or 6 log CFU per mL for other micro-organisms. Inoculated samples were diluted and spiral-plated after 30 min and 24 h of each challenge onto selective media for recovery of surviving micro-organisms: BACARA (B. cereus), MacConkey (E. coli), ChromID (P. aeruginosa), XLT4 (S. enteritidis), Baird Parker agar (Staph. aureus) and PDA+chlortetracycline HCL (C. albicans). RESULTS: The population of B. cereus spiked as a pure culture increased significantly from the first to the third challenge after 30-min exposure time, going from 0.73 to 2.59 in A, from 0.80 to 2.69 in B and from 0.80 to 1.67 log CFU per mL in C (P < 0.05). Likewise, the B. cereus population from the mixed cultures had a significantly higher survival count at the third challenge: from 0.12 log MPN per mL to 2.16 log CFU per mL in A, 0.57 to 2.27 log CFU per mL in B and from undetected (LOD = 0.48 log MPN) to 0.98 log CFU per mL in C, respectively. After challenges, Staph. aureus, C. albicans and P. aeruginosa increased in B; Staph. aureus and C. albicans in C; and E. coli and Staph. aureus in D. The growth of other bacteria types was unaffected by the number of challenges, but B. cereus population was detected with the third challenge. CONCLUSION: It is appropriate to assess the antimicrobial efficacy of preservatives using at least three challenges, especially for cosmetics that are subjected to repetitive contamination by users.

Graphene flakes obtained by local electro-exfoliation of graphite with a STM tip.

Graphite surfaces can be manipulated by several methods to create graphene structures of different shapes and sizes. Scanning tunneling microscopy (STM) can be used to create these structures either through mechanical contact between the tip and the surface or through electro-exfoliation. In the latter, the mechanisms involved in the process of exfoliation at an applied voltage are not fully understood. Here, we show how a graphite surface can be locally exfoliated in a systematic manner by applying an electrostatic force with a STM tip at the edge of a terrace, forming triangular flakes several nanometers in length. We demonstrate, through experiments and simulations, how these flakes are created by a two-step process: first a voltage ramp must be applied at the edge of the terrace, and then the tip must be scanned perpendicular to the edge. Ab initio electrostatic calculations reveal that the presence of charges on the graphite surface weakens the interaction between layers allowing for exfoliation at voltages in the same range as those used experimentally. Molecular dynamics simulations show that a force applied locally on the edge of a step produces triangular flakes such as those observed under STM. Our results provide new insights into surface modification that can be extended to other layered materials.

Factors of detection of Bacillus cereus strains in eye cream.

Bacillus cereus has been associated with clinical infections and is also the cause of post-traumatic endophthalmitis as well as endogenous eye infections, which can result in blindness. Cosmetics, although preserved, can be contaminated during manufacture or use and thus cause serious health issues. OBJECTIVE: We investigated the detection factors of Bacillus in eye cream preserved with parabens, including the non-ionic surfactants used as neutralizers such as Tween 80, a blend of Tween 60 and Span 80, Tween 20 and selective media. METHODS: Eye-cream samples were first mixed with neutralizers and individually inoculated with B. cereus strains, B. mycoides, B. subtilis or B. thuringiensis at a final concentration of 5 log CFU per g. The inoculated samples with and without neutralizers were analysed after 30 min and during 84-day storage at room temperature. Presumptive colonies of Bacillus were enumerated on the varieties of Bacillus agar by spiral-plating techniques and most probable number (MPN) method. RESULTS: The recovery counts of all Bacillus strains were between 4.10 and 4.58 log CFU per g in samples with Tween 80 and from 3.62 to 4.53 CFU per g in samples with TS after 30 min. Tween 20 was the least effective neutralizer. The challenged organisms, in samples without neutralizer, B. subtilis ATCC 15563 and B. cereus 4227A were detected at 1.83 and 1.49 log CFU per g after 30 min, respectively. CONCLUSION: This study showed that Tween 80 was the best neutralizer for reducing the antimicrobial effect of parabens. BACARA® and R&F plating media showed typical reaction of Bacillus cereus strains.

Lordosis manoeuvre in the diagnosis of lumbar facet syndrome. / Efectividad de la maniobra lordosante en el diagnóstico del síndrome facetario lumbar.

UNLABELLED: In lumbar pain patients an aetiopathogenic diagnosis leads to a better management. When there are alarm signs, they should be classified on an anatomical basis through anamnesis and physical examination. A significant group is of facet origin (lumbar facet syndrome [LFS]), but the precise clinical diagnosis remains cumbersome and time-consuming. In clinical practice it is observed that patients with an advanced degenerative disease do not perform extension or rotation of their lumbar spine when prompted to extend it, but rather knee flexion, making the manoeuvre meaningless. For this reason, a new simple and quick clinical test was developed for the diagnosis of lumbar facet syndrome, with a facet block-test as a confirmation. HYPOTHESIS: The new test is better than a classic one in the diagnosis of facet syndrome, and probably even better than imaging studies MATERIALS AND METHODS: A prospective study was conducted on a series of 68 patients (01/01/2012-30/06/2013). A comparison in between: classic manoeuvre (CM), imaging diagnostics (ID), and the new lordosis manoeuvre (LM) test. Examination and block test by one author, and evaluation of results by another one. EXCLUSION CRITERIA: Deformity and instability. using a physical. OBJECTIVE: To determine the effectiveness of a new clinical test (LM) for the diagnosis of LFS (as confirmed by a positive block-test of medial branch of dorsal ramus of the lumbar root, RMRDRL). STATISTICS: R package software. RESULTS: The LM was most effective (p<.0001; Kappa 0.524, p<.001). There was no correlation between either the CM or ID and the block-test results (Kappa, CM: 0.078; p=.487, and ID: 0.195; p=.105). There was a correlation between ID (CAT/MR) and LM (p=.024; Kappa 0.289 p=.014), although not with CM. There was no correlation between ID (plain X-rays) and CM or LM. CONCLUSIONS: A new test for diagnosis of LFS is presented that is reliable, quick, and simple. Clinical examination is more reliable than imaging test for the diagnosis of LFS.

Evaluación de un novedoso prototipo diseñado para el apoyo y la sujeción cefálica en pacientes con asistencia respiratoria mecánica / Evaluation of a novelty prototype designed for Support and cephalic support in patients with assistance mechanical respiratory

Objetivos: 1) Fabricar un prototipo de almohada para apoyo y sujeción cefálica para pacientes críticos con asistencia respiratoria mecánica, 2) comparar su eficacia con la de los métodos alternativos de apoyo y sujeción, 3) monitorizar la formación de escaras en contacto con el prototipo, 4) relevar la opinión del personal de enfermería. Diseño: Ensayo clínico con distribución aleatoria. Ámbito: Unidad de Cuidados Intensivos de un hospital privado. Pacientes: 52 hombres y mujeres con asistencia respiratoria mecánica, de entre 31 y 91 años de edad, reunidos en dos grupos: uno de 23 pacientes, que usaron métodos alternativos, y otro de 29 que utilizaron el prototipo. Intervenciones: Se registró la posición de la cabeza en los 52 pacientes por un lapso de entre 1 y 7 días corridos, 3 veces por día; y el desplazamiento del tubo endotraqueal se registró una vez por día. Catorce enfermeros/as respondieron un cuestionario. Variables de interés principales: Posición de la cabeza y desplazamiento del tubo endotraqueal. Resultados: La cabeza se mantuvo centrada en el 56,9% (métodos alternativos) y en el 87,3% (prototipo) (p <0,0001). El tubo endotraqueal no estaba desplazado en un 59,5% (métodos alternativos) y en un 61,9% (prototipo) (p >0,9). Doce de los 14 enfermeros/as encuestados prefirieron el prototipo a los métodos alternativos. Conclusiones: El prototipo resultó significativamente más eficaz que los mé- todos alternativos para mantener la cabeza centrada, mientras que no así para prevenir el desplazamiento del tubo endotraqueal. La mayoría del personal de enfermería prefirió el prototipo a los métodos alternativos.(AU)

Objectives: 1) To build a prototype of a pillow for cephalic holding and restraint for patients under mechanical ventilation. 2) To compare its efficiency against that of alternative methods. 3) To monitor bed sore formation in contact with the prototype. 4) To assess nursery personnel input on the usefullness and convenience of the prototype. Design: Randomized clinical trial. Setting: Intensive Care Unit of a private hospital. Patients and Participants: 52 patients under mechanical ventilation, men and women aged between 31 and 91 years old, randomly gathered in two groups: one of 23 in which alternative methods were used; and one of 29 in which the prototype was used. Interventions: The head position was registered in the 52 patients during a period of between 1 and 7 consecutive days, 3 times a day; the endotracheal tube displacement was recorded once a day. Fourteen nurses responded a questionnaire on the prototype usefulness. Main variables of interest: Head position and endotracheal tube displacement. Results: The head was centered in 56,9% of the records for the alternative methods group, and in 87.3% for the prototype group (p<0.0001). The endotracheal tube was not displaced in 59.5% (alternative methods) and 61.9% (prototype) of the records (p>0.9). Twelve of 14 nurses that answered the questionnaire preferred the prototype to the alternative methods. Conclusions: The prototype turned out more effective (with statistical significance) than the alternative methods to maintain the head centered, but not to prevent the displacement of the endotracheal tube. Most of the nurses preferred the prototype. (AU)

Giant hepatic hemangioma versus conventional hepatic hemangioma: clinical findings, risk factors, and management.

BACKGROUND: Giant hepatic hemangiomas (GHHs) are those that are larger than 4 cm in size. AIMS: The aim of this study was to describe GHH clinical findings, their risk factors, diagnostic approach and management, and to compare these data with those of conventional hemangiomas. METHODS: We performed a retrospective analysis of patients diagnosed with hemangiomas, whether by imaging studies or histopathology, at our hospital within the time frame of 1990-2008. The medical records of each patient were reviewed to obtain clinical and surgical data. RESULTS: Of the 57 patients with liver hemangioma, 41 (72%) were women and 32 (56%) had GHH. Liver hemangioma median size was 4.49 cm. In regard to the patients with GHH, 31.2% were asymptomatic and when symptoms presented, pain was the most common. Both symptoms and oral contraceptive exposure were more common in the GHH patients. Nine patients with GHH underwent surgery: 2 open biopsies due to diagnostic uncertainty, one enucleation, and 6 resections. CONCLUSIONS: GHHs are more prevalent in women and when symptomatic, pain is the most frequent complaint. Diagnosis is usually made through imaging studies, but when there is diagnostic doubt, surgical exploration is sometimes needed. Oral contraceptive use is most likely more of a risk factor for GHH than for conventional hemangioma, but this association needs to be studied further.

Blue-noise multitone dithering.

The introduction of the blue-noise spectra-high-frequency white noise with minimal energy at low frequencies-has had a profound impact on digital halftoning for binary display devices, such as inkjet printers, because it represents an optimal distribution of black and white pixels producing the illusion of a given shade of gray. The blue-noise model, however, does not directly translate to printing with multiple ink intensities. New multilevel printing and display technologies require the development of corresponding quantization algorithms for continuous tone images, namely multitoning. In order to define an optimal distribution of multitone pixels, this paper develops the theory and design of multitone, blue-noise dithering. Here, arbitrary multitone dot patterns are modeled as a layered superposition of stack-constrained binary patterns. Multitone blue-noise exhibits minimum energy at low frequencies and a staircase-like, ascending, spectral pattern at higher frequencies. The optimum spectral profile is described by a set of principal frequencies and amplitudes whose calculation requires the definition of a spectral coherence structure governing the interaction between patterns of dots of different intensities. Efficient algorithms for the generation of multitone, blue-noise dither patterns are also introduced.

Genotype profiles for the Costa Rican population at 7 PCR-based loci

Complete electronic DNA profiles of 2006 randomly selected Costa Ricans, typed for 7 PCR-based loci, are presented. Such data may prove valuable for anthropological and forensic studies of the Costa Rican population.

Polimorfismo del gen de la banda 3 eritrocítica en grupos étnicos de Costa Rica / Polymorphism of the erythrocyte band 3 gene (EPB3) in ethnic groups of Costa Rica

Band 3 (AE1) is one of the most abundant proteins in the membrane of the human erythrocyte. This protein works as an anionic CI - and HCO3- exchanger and it also functions as an anchor for several proteins of the erythrocyte's cytoesqueleton. Several mutations have been described and many polymorphic variants have been associated to hereditary spherocytosis. The identification of a genetic marker at position 5' of the AEl gene could be associated to several molecular defects of the erythrocyte. This genetic marker is a restriction fragment length polymorphism (RFLP) produced by restriction enzime Pst I. For this polymorphism a total of 216 individuals belonging to seven different populations were analyzed: one from the Central Valley, two African descendants (Lim6n and Guanacaste) and four Amerindians (Bribri, Cabecar, Maleku and Guaymi). The most frequent allele in the Amerindian population was no 1. No significant differences were found with respect to the Hardy-Weinberg equilibrium in six of the populations, although the Guaymi group does present significative differences.

[Polymorphism of the erythrocyte band 3 gene (EPB3) in ethnic groups of Costa Rica]. / Polimorfismo del gen de la banda 3 eritrocítica en grupos étnicos de Costa Rica.

Band 3 (AE1) is one of the most abundant proteins in the membrane of the human erythrocyte. This protein works as an anionic CI - and HCO3- exchanger and it also functions as an anchor for several proteins of the erythrocyte's cytoesqueleton. Several mutations have been described and many polymorphic variants have been associated to hereditary spherocytosis. The identification of a genetic marker at position 5' of the AEl gene could be associated to several molecular defects of the erythrocyte. This genetic marker is a restriction fragment length polymorphism (RFLP) produced by restriction enzime Pst I. For this polymorphism a total of 216 individuals belonging to seven different populations were analyzed: one from the Central Valley, two African descendants (Lim6n and Guanacaste) and four Amerindians (Bribri, Cabecar, Maleku and Guaymi). The most frequent allele in the Amerindian population was no 1. No significant differences were found with respect to the Hardy-Weinberg equilibrium in six of the populations, although the Guaymi group does present significative differences

Genotype profiles for the Costa Rican population at 7 PCR-based loci.

Complete electronic DNA profiles of 2006 randomly selected Costa Ricans, typed for 7 PCR-based loci, are presented. Such data may prove valuable for anthropological and forensic studies of the Costa Rican population.

Fatiga del material de los sistemas de ventilación mecanica como factor de riesgo en neumonía asociada a ventilación mecanica / Waste of material employed in mechanical ventilator systems as a risk factor for ventilator-associated pneumonia

La neumonía asociada a ventilación mecanica (NAVM) en Chile, es una de las infecciones intrahospitalarias (IIH) mas frecuentes y de mayor impacto en morbimortalidad. A pesar de las medidas habituales de prevención de IIH aplicadas en nuestro hospital, se presentó en el año 2002 un aumento en la tasa de NAVM, junto al aislamiento de un mayor porcentaje de Acinetobacter baumannii, cepa endémica en nuestro hospital. Con el fin de identificar posibles nichos de microorganismos nosocomiales, se realizó un plan de estudio, que involucró al paciente (secreción traqueal) y los sistemas de ventilación, humidificadores, tubo endotraqueal, tubo en Y, mangueras del sistema de ventilación. Se estudió por microscopia de barrido las mangueras de ventilación para precisar características del material. Se observó, al cabo de 7 días, tiempo de recambio establecido por el Comité Nacional de IIH, colonización por A. baumannii, Pseudomonas aeruginosa y Klebsiella pneumoniae, agentes asociados a NAVH en 2 pacientes. Se estudió el circuito de ventilación mecanica perteneciente a un paciente con NAVM tanto preesterilización como postesterilización, aislandose en ambos cultivos microorganismos multiresistentes. Al analizar porciones del circuito por microscopia de barrido se observó un desgaste de las mangueras con múltiples grietas con formas cocoides y bacilares incluidas en la trama. Al estudiar diferentes circuitos pre y posesterilización, se observó en 2 circuitos cultivos positivos con posterioridad a la esterilización en oxido de etileno. Nuestros datos dan enfasis a la necesidad de incorporar en forma rutinaria dentro de las normas de control de IIH las relacionadas a material reutilizable.

A class of authentication digital watermarks for secure multimedia communication.

A new approach to digital signatures for imaging, which adapts well to multimedia communications in lossy channels is introduced. Rather than attaching the signature's bit-string as a file-header, it is invisibly etched into the image using a new watermarking algorithm. The watermark is "nonfragile," tolerating small distortions but not malicious tampering aimed at modifying the image's content. In particular, the rank-order relationship in local areas throughout the lowest level of the DWT is exploited to encode the watermark. An edge-based message digest is used. The signature is in the form of binary data and the wavelet decomposition coefficients are modified according to this binary sequence. The signature is also embedded and tested within the SPIHT compression algorithm. The information capacity is studied and the experimental results confirm a logarithm relation between the bit rate and the quantization level, which is similar to the Shannon's capacity theorem. Experiments are performed to examine the signature's transparency and robustness.

Nicaraguan population data on LDLR, GYPA, D7S8, HBGG, GC and HLA-DQA1 loci.

Nicaraguans have become the most numerous and fastest increasing minority in Costa Rica: at present they represent around 6% of the total population of the country. We have analyzed the allele and genotype frequencies of six PCR-based genetic markers (LDLR, GYPA, HBGG, D7S8, GC, and HLA-DQA1) in 100 unrelated Nicaraguans living in Costa Rica. All loci studied were in Hardy-Weinberg equilibrium. Some statistical parameters of forensic interest were also calculated (h, PD and CE). Allele frequencies of the markers HLA-DQA1 and GYPA were found to be significantly different between the populations of Nicaragua and Costa Rica. Nevertheless, genetic distances showed that Nicaragua is close to other Hispanic-admixed populations like those from Argentina, Chile, Colombia, Costa Rica, and USA Hispanics. The loci set was assessed to be useful for paternity testing and individual identification in the Nicaraguan population residing in Costa Rica.

Optimal digital filtering for tremor suppression.

Remote manually operated tasks such as those found in teleoperation, virtual reality, or joystick-based computer access, require the generation of an intermediate electrical signal which is transmitted to the controlled subsystem (robot arm, virtual environment, or a cursor in a computer screen). When human movements are distorted, for instance, by tremor, performance can be improved by digitally filtering the intermediate signal before it reaches the controlled device. This paper introduces a novel tremor filtering framework in which digital equalizers are optimally designed through pursuit tracking task experiments. Due to inherent properties of the man-machine system, the design of tremor suppression equalizers presents two serious problems: 1) performance criteria leading to optimizations that minimize mean-squared error are not efficient for tremor elimination and 2) movement signals show ill-conditioned autocorrelation matrices, which often result in useless or unstable solutions. To address these problems, a new performance indicator in the context of tremor is introduced, and the optimal equalizer according to this new criterion is developed. Ill-conditioning of the autocorrelation matrix is overcome using a novel method which we call pulled-optimization. Experiments performed with artificially induced vibrations and a subject with Parkinson's disease show significant improvement in performance. Additional results, along with MATLAB source code of the algorithms, and a customizable demo for PC joysticks, are available on the Internet at http:¿tremor-suppression.com.

Digital color halftoning with generalized error diffusion and multichannel green-noise masks.

In this paper, we introduce two novel techniques for digital color halftoning with green-noise--stochastic dither patterns generated by homogeneously distributing minority pixel clusters. The first technique employs error diffusion with output-dependent feedback where, unlike monochrome image halftoning, an interference term is added such that the overlapping of pixels of different colors can be regulated for increased color control. The second technique uses a green-noise mask, a dither array designed to create green-noise halftone patterns, which has been constructed to also regulate the overlapping of different colored pixels. As is the case with monochrome image halftoning, both techniques are tunable, allowing for large clusters in printers with high dot-gain characteristics, and small clusters in printers with low dot-gain characteristics.