Crohn's disease and intestinal tuberculosis: challenging from every angle.

A woman in her 20s with a recent diagnosis of Crohn's disease (CD) affecting the ileocaecal valve was started on adalimumab, after routine tuberculosis (TB) tests were negative. Her abdominal symptoms got worse and she started presenting respiratory distress and fever. Tomography revealed a left pleural effusion, pneumonia and peritonitis with pelvic abscess. The diagnosis of disseminated TB with digestive involvement was suggested and sputum cultures were positive for Mycobacterium tuberculosis Treatment for TB was started and immunosuppressants discontinued, leading to respiratory improvement. Abdominal imaging was repeated, showing worsening signs of multisegmental ileal wall thickening, ileocaecal valve obstruction and a persistent pelvic abscess. She was then submitted to a laparoscopic ileocaecal resection for suspicion of worsening CD. Histopathology showed chronic ileocolitis compatible with CD and ganglionic tuberculosis, revealing the diagnosis of intestinal tuberculosis superimposed in CD. Recovery was uneventful.

Pancreas- and Pylorus-Preserving Duodenectomy for Advanced Familial Duodenal Polyposis.

Most patients with familial adenomatous polyposis (FAP) will develop duodenal polyps and 5% progress to cancer. Those with Spigelman stage IV have a 36% risk of cancer at 10 years. Endoscopic surveillance is necessary with local ablation for early disease. Unresectable duodenal disease and severe dysplasia are an indication for prophylactic radical surgery by pancreaticoduodenectomy or pancreas-sparing duodenectomy. Some preliminary results have shown better outcomes with duodenectomy. A 45-year-old female with FAP had restorative proctocolectomy at 24 years, desmoid of the mesentery with regression after sulindac, two pregnancies, and at the age of 37 years had duodenal polyposis stage III carpeting the periampullary region. Endoscopic papillectomy and extensive piecemeal mucosectomy was performed but was unsuccessful due to recurrence. After 7 years of regular endoscopic surveillance, focal high-grade dysplasia was diagnosed at the last evaluation. Some diminutive polyps were seen in the small-bowel capsule endoscopy. MRCP showed a normal biliary and pancreatic duct without visualization of the Santorini duct. A pancreas and pylorus-preserving duodenectomy was performed with 3 main steps: (1) duodenectomy with preservation of the pancreas and the pylorus; (2) reconstruction with an advanced jejunal limb and duodenojejunostomy; (3) reimplantation of the biliary and pancreatic duct in the jejunal loop. The patient was discharged on the 11th postoperative day without complications. In conclusion, pancreas- and pylorus-preserving duodenectomy is a promising alternative to pancreaticoduodenectomy for advanced duodenal polyposis that allows complete endoscopic surveillance.

A maioria dos doentes portadores de polipose adenomatosa familiar (FAP) vem a desenvolver pólipos duodenais que poderão degenerar em 5% dos casos. Os casos que apresentem um estádio IV de Spigelman têm um risco de degenerescência de 36% ao fim de 10 anos. É necessária vigilância endoscópica e excisão das lesões iniciais. Os pólipos considerados irressecáveis e com displasia de alto grau têm indicação para exérese cirúrgica radical através de duodenopancreatectomia ou de duodenectomia com conservação do pâncreas. Existem alguns resultados preliminares a revelar melhores resultados com a duodenectomia. Uma doente de 45 anos portadora de FAP efetuou proctocolectomia reconstrutiva aos 24 anos. Desenvolveu tumor desmoide mesentérico após um ano e que regrediu com sulindac, teve dois filhos e aos 37 anos apresentou polipose duodenal, em toalha periampular, com estádio III. Foi submetida a papilectomia endoscópica e mucosectomia fragmentada da lesão circundante tendose verificado recorrência. Durante 7 anos procedeu-se a vigilância endoscópica regular com presença de displasia de alto grau focal na última avaliação. Na cápsula endoscópica foram observados alguns pólipos diminutos no intestino delgado. A CPRM revelou normalidade nos canais pancreático e biliar, sem evidência do Santorini. Foi efetuada uma duodenectomia com conservação do pâncreas e do piloro cujos passos cirúrgicos principais foram: (a) duodenectomia com conservação do pâncreas e do piloro; (b) reconstrução com ansa jejunal e duodenojejunostomia; (c) reimplantação dos canais biliar e pancreático à ansa jejunal. A doente teve alta ao 11o dia pós-operatório sem complicaçõs. Em conclusão, a duodenectomia com conservação do pâncreas e do piloro constitui uma boa alternativa à duodenopancreatectomia permitindo vigilância endoscópica completa.

Precise Pollen Grain Detection in Bright Field Microscopy Using Deep Learning Techniques.

The determination of daily concentrations of atmospheric pollen is important in the medical and biological fields. Obtaining pollen concentrations is a complex and time-consuming task for specialized personnel. The automatic location of pollen grains is a handicap due to the high complexity of the images to be processed, with polymorphic and clumped pollen grains, dust, or debris. The purpose of this study is to analyze the feasibility of implementing a reliable pollen grain detection system based on a convolutional neural network architecture, which will be used later as a critical part of an automated pollen concentration estimation system. We used a training set of 251 videos to train our system. As the videos record the process of focusing the samples, this system makes use of the 3D information presented by several focal planes. Besides, a separate set of 135 videos (containing 1234 pollen grains of 11 pollen types) was used to evaluate detection performance. The results are promising in detection (98.54% of recall and 99.75% of precision) and location accuracy (0.89 IoU as the average value). These results suggest that this technique can provide a reliable basis for the development of an automated pollen counting system.

Low-Power and Low-Cost Environmental IoT Electronic Nose Using Initial Action Period Measurements.

In this work, we present a complete hardware development and current consumption study of a portable electronic nose designed for the Internet-of-Things (IoT). Thanks to the technique of measuring in the initial action period, it can be reliably powered with a moderate-sized battery. The system is built around the well-known SoC (System on Chip) ESP8266EX, using low-cost electronics and standard sensors from Figaro's TGS26xx series. This SoC, in addition to a powerful microcontroller, provides Wi-Fi connectivity, making it very suitable for IoT applications. The system also includes a precision analog-to-digital converter for the measurements and a charging module for the lithium battery. During its operation, the designed software takes measurements periodically, and keeps the microcontroller in deep-sleep state most of the time, storing several measurements before uploading them to the cloud. In the experiments and tests carried out, we have focused our work on the measurement and optimization of current consumption, with the aim of extending the battery life. The results show that taking measurements every 4 min and uploading data every five measurements, the battery of 750 mAh needs to be charged approximately once a month. Despite the fact that we have used a specific model of gas sensor, this methodology is quite generic and could be extended to other sensors with lower consumption, increasing very significantly the duration of the battery.

Improving short term instability for quantitative analyses with portable electronic noses.

One of the main problems when working with electronic noses is the lack of reproducibility or repeatability of the sensor response, so that, if this problem is not properly considered, electronic noses can be useless, especially for quantitative analyses. On the other hand, irreproducibility is increased with portable and low cost electronic noses where laboratory equipment like gas zero generators cannot be used. In this work, we study the reproducibility of two portable electronic noses, the PEN3 (commercial) and CAPINose (a proprietary design) by using synthetic wine samples. We show that in both cases short term instability associated to the sensors' response to the same sample and under the same conditions represents a major problem and we propose an internal normalization technique that, in both cases, reduces the variability of the sensors' response. Finally, we show that the normalization proposed seems to be more effective in the CAPINose case, reducing, for example, the variability associated to the TGS2602 sensor from 12.19% to 2.2%.

A compact and low cost electronic nose for aroma detection.

This article explains the development of a prototype of a portable and a very low-cost electronic nose based on an mbed microcontroller. Mbeds are a series of ARM microcontroller development boards designed for fast, flexible and rapid prototyping. The electronic nose is comprised of an mbed, an LCD display, two small pumps, two electro-valves and a sensor chamber with four TGS Figaro gas sensors. The performance of the electronic nose has been tested by measuring the ethanol content of wine synthetic matrices and special attention has been paid to the reproducibility and repeatability of the measurements taken on different days. Results show that the electronic nose with a neural network classifier is able to discriminate wine samples with 10, 12 and 14% V/V alcohol content with a classification error of less than 1%.

Haemoptysis and left upper quadrant abdominal pain: an unusual presentation of partial thoracic migration of an adjustable gastric band's tube.

Laparoscopic gastric banding is considered the safest bariatric procedure, holding satisfactory long-term weight loss results, low rates of early complications and negligible mortality. Long-term follow-up are showing a high prevalence of late complications. We describe the case of a 40-year-old female patient, with a medical history of laparoscopic gastric banding, admitted in the emergency department complaining of haemoptysis, left upper quadrant abdominal pain and a slight tachycardia. After an exhaustive clinical evaluation with laboratorial and radiological assessments, diagnosis of partial thoracic migration of the band's tube was established. Despite the unusual clinical setting, this case emphasises the necessity of awareness for the potential long-term complications of gastric banding either from primary or secondary care providers.

Consistent performance measurement of a system to detect masses in mammograms based on blind feature extraction.

BACKGROUND: Breast cancer continues to be a leading cause of cancer deaths among women, especially in Western countries. In the last two decades, many methods have been proposed to achieve a robust mammography-based computer aided detection (CAD) system. A CAD system should provide high performance over time and in different clinical situations. I.e., the system should be adaptable to different clinical situations and should provide consistent performance. METHODS: We tested our system seeking a measure of the guarantee of its consistent performance. The method is based on blind feature extraction by independent component analysis (ICA) and classification by neural networks (NN) or SVM classifiers. The test mammograms were from the Digital Database for Screening Mammography (DDSM). This database was constructed collaboratively by four institutions over more than 10 years. We took advantage of this to train our system using the mammograms from each institution separately, and then testing it on the remaining mammograms. We performed another experiment to compare the results and thus obtain the measure sought. This experiment consists in to form the learning sets with all available prototypes regardless of the institution in which them were generated, obtaining in that way the overall results. RESULTS: The smallest variation from comparing the results of the testing set in each experiment (performed by training the system using the mammograms from one institution and testing with the remaining) with those of the overall result, considering the success rate for an intermediate decision maker threshold, was roughly 5%, and the largest variation was roughly 17%. But, if we considere the area under ROC curve, the smallest variation was close to 4%, and the largest variation was about a 6%. CONCLUSIONS: Considering the heterogeneity in the datasets used to train and test our system in each case, we think that the variation of performance obtained when the results are compared with the overall results is acceptable in both cases, for NN and SVM classifiers. The present method is therefore very general in that it is able to adapt to different clinical situations and provide consistent performance.

Acetic acid detection threshold in synthetic wine samples of a portable electronic nose.

Wine quality is related to its intrinsic visual, taste, or aroma characteristics and is reflected in the price paid for that wine. One of the most important wine faults is the excessive concentration of acetic acid which can cause a wine to take on vinegar aromas and reduce its varietal character. Thereby it is very important for the wine industry to have methods, like electronic noses, for real-time monitoring the excessive concentration of acetic acid in wines. However, aroma characterization of alcoholic beverages with sensor array electronic noses is a difficult challenge due to the masking effect of ethanol. In this work, in order to detect the presence of acetic acid in synthetic wine samples (aqueous ethanol solution at 10% v/v) we use a detection unit which consists of a commercial electronic nose and a HSS32 auto sampler, in combination with a neural network classifier (MLP). To find the characteristic vector representative of the sample that we want to classify, first we select the sensors, and the section of the sensors response curves, where the probability of detecting the presence of acetic acid will be higher, and then we apply Principal Component Analysis (PCA) such that each sensor response curve is represented by the coefficients of its first principal components. Results show that the PEN3 electronic nose is able to detect and discriminate wine samples doped with acetic acid in concentrations equal or greater than 2 g/L.

Study of a mammographic CAD performance dependence on the considered mammogram set.

This work analyzes the influence of the set of mammograms used in the training processes of a computer aided diagnosis system on the overall performance. We used the mammograms provided by the Digital Database for Screening Mammography, one of the most extended research database. The obtained results seem to suggest an effect on the performance values obtained in a CAD system with different database subsets. Therefore, in order to make valid comparisons between CAD systems, the specification of the mammogram set used to test the system is of the utmost importance.

Microcalcifications detection in digital mammograms.

A method is presented for detecting minimally sized microcalcifications on ma mammograms to add extra security to the radiologist's classification. The method imitates the normal procedure followed by the specialist, and is easily implemented on low-cost PCs. As input, it accepts the usual digital mammograms. Tested against one of the most extensive databases - the DDSM of the University of South Florida - it gave a 100% success rate. For any suspicious regions (the so-called regions-of-interest or ROI) a separate image of suitable size is generated and displayed. The system also allows feature vectors to be generated for use in an automatic classifying system - such as a neural network (NN) - to determine the malignancy of the ROIs that were detected.

El papel de la agenda visoespacial en la adquisicióndel vocabulario ortográfico / The role of the visuo-spatial sketch pad in writing adquisition

El primer objetivo de este estudio fue comprobar la implicación de la agenda visoespacial en el aprendizaje y en la producción ortográfica. También pretende comprobar los efectos de dos tareas secundarias de naturaleza auditiva y espacial, respectivamente, en la escritura de palabras sujetas a norma ortográfica presentadas oral y visualmente. En el estudio participaron 178 niños de segundo y quinto curso de Educación Primaria, distribuidos en cuatro grupos según la condición experimental (control, supresión articulatoria, rotación mental y doble tarea). Cada participante escribió la misma serie de palabras de una determinada dificultad ortográfica bajo tres tipos de presentación diferentes. El primer tipo fue auditivo, el segundo fue visual y el tercero fue de nuevo auditivo. Los resultados sugieren la participación de la agenda visoespacial en el aprendizaje ortográfico visual y la eficacia de las presentaciones visuales en la automatización y afianzamiento de dicho aprendizaje; también muestran la formación progresiva del lexicón ortográfico en los niños (AU)

The first goal of the study was to show the implication of the visuospatial sketch pad in learning to write orthographic words. The second goal was to study the effects of two secondary tasks (one visual and one auditory) on writing words of especial orthographic difficulty. In the study, 178 second and fifth grade school children performed a writing task under one of the following experimental conditions: control, articulatory suppression, mental rotation or double task. Each participant wrote the same series of words under three modes of presentation. The first presentation was auditory, the second was visual, and the third was auditory. The results suggest the implication of working memory in learning to write and the effectiveness of visual presentations. The study also shows the gradual development of orthographic lexicon in children (AU)