Next generation of ventricular catheters for hydrocephalus based on parametric designs.

BACKGROUND: The flow pattern of the cerebrospinal fluid is probably the most important factor related to obstruction of ventricular catheters during the normal treatment of hydrocephalus. To better comprehend the flow pattern, we have carried out a parametric study via numerical models of ventricular catheters. In previous studies, the flow was studied under steady and, recently, in pulsatile boundary conditions by means of computational fluid dynamics (CFD) in three-dimensional catheter models. OBJECTIVE: This study aimed to bring in prototype models of catheter CFD flow solutions as well to introduce the theory behind parametric development of ventricular catheters. METHODS: A preceding study allowed deriving basic principles which lead to designs with improved flow patterns of ventricular catheters. The parameters chosen were the number of drainage segments, the distances between them, the number and diameter of the holes on each segment, as well as their relative angular position. RESULTS: CFD results of previously unreleased models of ventricular catheter flow solutions are presented in this study. Parametric development guided new designs with better flow distribution while lowering the shear stress of the catheters holes. High-resolution 3D printed catheter solutions of three models and basic benchmark testing are introduced as well. CONCLUSIONS: The next generation of catheter with homogeneous flow patterns based on parametric designs may represent a step forward for the treatment of hydrocephalus, by possibly broadening their lifespan.

Texture analysis of pulmonary parenchymateous changes related to pulmonary thromboembolism in dogs - a novel approach using quantitative methods.

BACKGROUND: Diagnosis of pulmonary thromboembolism (PTE) in dogs relies on computed tomography pulmonary angiography (CTPA), but detailed interpretation of CTPA images is demanding for the radiologist and only large vessels may be evaluated. New approaches for better detection of smaller thrombi include dual energy computed tomography (DECT) as well as computer assisted diagnosis (CAD) techniques. The purpose of this study was to investigate the performance of quantitative texture analysis for detecting dogs with PTE using grey-level co-occurrence matrices (GLCM) and multivariate statistical classification analyses. CT images from healthy (n = 6) and diseased (n = 29) dogs with and without PTE confirmed on CTPA were segmented so that only tissue with CT numbers between -1024 and -250 Houndsfield Units (HU) was preserved. GLCM analysis and subsequent multivariate classification analyses were performed on texture parameters extracted from these images. RESULTS: Leave-one-dog-out cross validation and receiver operator characteristic (ROC) showed that the models generated from the texture analysis were able to predict healthy dogs with optimal levels of performance. Partial Least Square Discriminant Analysis (PLS-DA) obtained a sensitivity of 94% and a specificity of 96%, while Support Vector Machines (SVM) yielded a sensitivity of 99% and a specificity of 100%. The models, however, performed worse in classifying the type of disease in the diseased dog group: In diseased dogs with PTE sensitivities were 30% (PLS-DA) and 38% (SVM), and specificities were 80% (PLS-DA) and 89% (SVM). In diseased dogs without PTE the sensitivities of the models were 59% (PLS-DA) and 79% (SVM) and specificities were 79% (PLS-DA) and 82% (SVM). CONCLUSION: The results indicate that texture analysis of CTPA images using GLCM is an effective tool for distinguishing healthy from abnormal lung. Furthermore the texture of pulmonary parenchyma in dogs with PTE is altered, when compared to the texture of pulmonary parenchyma of healthy dogs. The models' poorer performance in classifying dogs within the diseased group, may be related to the low number of dogs compared to texture variables, a lack of balanced number of dogs within each group or a real lack of difference in the texture features among the diseased dogs.

Pulsatile flow in ventricular catheters for hydrocephalus.

The obstruction of ventricular catheters (VCs) is a major problem in the standard treatment of hydrocephalus, the flow pattern of the cerebrospinal fluid (CSF) being one important factor thereof. As a first approach to this problem, some of the authors studied previously the CSF flow through VCs under time-independent boundary conditions by means of computational fluid dynamics in three-dimensional models. This allowed us to derive a few basic principles which led to designs with improved flow patterns regarding the obstruction problem. However, the flow of the CSF has actually a pulsatile nature because of the heart beating and blood flow. To address this fact, here we extend our previous computational study to models with oscillatory boundary conditions. The new results will be compared with the results for constant flows and discussed. It turns out that the corrections due to the pulsatility of the CSF are quantitatively small, which reinforces our previous findings and conclusions.This article is part of the themed issue 'Mathematical methods in medicine: neuroscience, cardiology and pathology'.

Using air, soil and vegetation to assess the environmental behaviour of siloxanes.

This study aimed to contribute to the enhancement of the knowledge of levels, trends and behaviour of eight siloxanes (four linear and four cyclic) in the environment. Adding to the prioritised scrutiny of the incidence in the atmosphere through passive samplers (sorbent-impregnated polyurethane foam disks­SIPs), the sampling of pine needles and soil was also performed, thus closing the circle of atmospheric exposure in the areas of study. Two sampling campaigns (one in summer and one in winter) were done in a total of eight sampling points in the Portuguese territory, which covered a wide range of human presence and land uses (urban, industrial, remote and beach areas). By adopting a "green" approach in terms of analytical methods, namely reducing the clean-up steps for the passive air samples and using the quick, easy, cheap, effective, rugged and safe (QuEChERS) technology for soils and pine needles, the results showed total concentration of siloxanes between 5 and 70 ng g−1 (dry weight) for soils and from 2 to 118 ng g−1 (dry weight (dw)) for pine needles, with no clear seasonal trend. For SIPs, the levels varied from 0.6 to 7.8 ng m−3 and were higher in summer than in winter in all sites. Overall, the cyclic siloxanes were found in much higher concentrations, with D5 and D6 being the most predominant in a great majority of cases. Also, the urban and industrial areas had the highest incidence, suggesting a strong anthropogenic fingerprint, in line with their main uses.

Using air, soil and vegetation to assess the environmental behaviour of siloxanes.

This study aimed to contribute to the enhancement of the knowledge of levels, trends and behaviour of eight siloxanes (four linear and four cyclic) in the environment. Adding to the prioritised scrutiny of the incidence in the atmosphere through passive samplers (sorbent-impregnated polyurethane foam disks--SIPs), the sampling of pine needles and soil was also performed, thus closing the circle of atmospheric exposure in the areas of study. Two sampling campaigns (one in summer and one in winter) were done in a total of eight sampling points in the Portuguese territory, which covered a wide range of human presence and land uses (urban, industrial, remote and beach areas). By adopting a "green" approach in terms of analytical methods, namely reducing the clean-up steps for the passive air samples and using the quick, easy, cheap, effective, rugged and safe (QuEChERS) technology for soils and pine needles, the results showed total concentration of siloxanes between 5 and 70 ng g(-1) (dry weight) for soils and from 2 to 118 ng g(-1) (dry weight (dw)) for pine needles, with no clear seasonal trend. For SIPs, the levels varied from 0.6 to 7.8 ng m(-3) and were higher in summer than in winter in all sites. Overall, the cyclic siloxanes were found in much higher concentrations, with D5 and D6 being the most predominant in a great majority of cases. Also, the urban and industrial areas had the highest incidence, suggesting a strong anthropogenic fingerprint, in line with their main uses.

A chemical status predictor. A methodology based on World-Wide sediment samples.

As a consequence of the limited resources of underdeveloped countries and the limited interest of the developed ones, the assessment of the chemical quality of entire water bodies around the world is a utopia in the near future. The methodology described here may serve as a first approach for the fast identification of water bodies that do not meet the good chemical status demanded by the European Water Framework Directive (WFD). It also allows estimating the natural background (or reference values of concentration) of the areas under study using a simple criterion. The starting point is the calculation the World-Wide Natural Background Levels (WWNBLs) and World-Wide Threshold Values (WWTVs), two indexes that depend on the concentration of seven elements present in sediments. These elements, As, Cd, Cr, Cu, Ni, Pb and Zn, have been selected taking into account the recommendations of the UNEP (United Nations Environment Programme) and USEPA (United States Environmental Protection Agency), that describe them as elements of concern with respect to environmental toxicity. The methodology has been exemplified in a case study that includes 134 sediment samples collected in 11 transitional water bodies from 7 different countries and 4 different continents. Six of the water bodies considered met the good chemical status demanded by the WFD. The rest of them exceeded the reference WWTVs, at least for one of the elements. The estuaries of the Nerbioi-Ibaizabal (Basque Country) and Cavado (Portugal), the sea inlet of Río San Pedro (Spain), the Sepetiba Bay (Brazil) and the Yucateco lagoon (Mexico) belong to that group.

Experienced and inexperienced observers achieved relatively high within-observer agreement on video mobility scoring of dairy cows.

Assessment of lameness prevalence and severity requires visual evaluation of thelocomotion of a cow. Welfare schemes including locomotion assessments are increasingly being adopted, and more farmers and their veterinarians might implement a locomotion-scoring routine together. However, high within-observer agreement is a prerequisite for obtaining valid mobility scorings, and within-observer agreement cannot be estimated in a barn, because the gait of cows is dynamic and may change between 2 occasions. The objective of this study was to estimate the within-observer agreement according to the observers' educational background and experience with cattle, based on video recordings with very diverse types of gait. Groups of farmers, bovine veterinarians, first- and fourth-year veterinary students, researchers, and cattle-inexperienced sensory assessors evaluated mobility using a 5-point mobility score system developed specifically for walking cows (n=102 observers). The evaluation sessions were similar for all groups, lasted 75 min, and were organized as follows: introduction, test A, short training session, break, and test B. In total, video recordings of 22 cows were displayed twice in a random order (11 cows in each test × 2 replicates). Data were analyzed applying kappa coefficient, logistic regression, and testing for random effects of observers. The crude estimates of 95% confidence interval for weighted kappa in test A and B ranged, respectively, from 0.76 to 0.80 and 0.70 to 0.75. When adjusting for the fixed effects of video sample and gait scoring preferences, the probability of assigning the same mobility score twice to the same cow varied from 55% (sensory assessors) to 72% (fourth-year veterinary students). The random effect of the individual observers was negligible. That is, in general observers could categorize the mobility characteristics of cows quite well. Observers who preferred to assess the attributes back arch or the overall mobility score (based on uneven gait) had the highest agreement, respectively, 69 or 68%. The training session seemed insufficient to improve agreement. Nonetheless, even novice observers were able to achieve perfect agreement up to 60% of the 22 scorings with merely the experience obtained during the study (introduction and training session). The relatively small differences between groups, together with a high agreement, demonstrate that the new system is easy to follow compared with previously described scoring systems. The mobility score achieves sufficiently high within-observer repeatability to allow between-observer agreement estimates, which are reliable compared with other more-complex scoring systems. Consequently, the new scoring scale seems feasible for on-farm applications as a tool to monitor mobility within and between cows, for communication between farmers and veterinarians with diverse educational background, and for lamenessbenchmarking of herds.

Infragranular layers lead information flow during slow oscillations according to information directionality indicators.

The recurrent circuitry of the cerebral cortex generates an emergent pattern of activity that is organized into rhythmic periods of firing and silence referred to as slow oscillations (ca 1 Hz). Slow oscillations not only are dominant during slow wave sleep and deep anesthesia, but also can be generated by the isolated cortical network in vitro, being a sort of default activity of the cortical network. The cortex is densely and reciprocally connected with subcortical structures and, as a result, the slow oscillations in situ are the result of an interplay between cortex and thalamus. Due to this reciprocal connectivity and interplay, the mechanism responsible for the initiation of waves in the corticothalamocortical loop during slow oscillations is still a matter of debate. It was our objective to determine the directionality of the information flow between different layers of the cortex and the connected thalamus during spontaneous activity. With that purpose we obtained multilayer local field potentials from the rat visual cortex and from its connected thalamus, the lateral geniculate nucleus, during deep anaesthesia. We analyzed directionality of information flow between thalamus, cortical infragranular layers (5 and 6) and supragranular layers (2/3) by means of three information theoretical indicators: transfer entropy, symbolic transfer entropy and transcript mutual information. These three indicators coincided in finding that infragranular layers lead the information flow during slow oscillations both towards supragranular layers and towards the thalamus.

Visualization and prediction of porosity in roller compacted ribbons with near-infrared chemical imaging (NIR-CI).

The porosity of roller compacted ribbon is recognized as an important critical quality attribute which has a huge impact on the final product quality. The purpose of this study was to investigate the use of near-infrared chemical imaging (NIR-CI) for porosity estimation of ribbons produced at different roll pressures. Two off-line methods were utilized as reference methods. The relatively fast method (oil absorption) was comparable with the more time-consuming mercury intrusion method (R(2)=0.98). Therefore, the oil method was selected as the reference off line method. It was confirmed by both reference methods that ribbons compressed at a higher pressure resulted in a lower mean porosity. Using NIR-CI in combination with multivariate data analysis it was possible to visualize and predict the porosity distribution of the ribbons. This approach is considered important for process monitoring and control of continuously operating roller compaction line.

Lameness detection challenges in automated milking systems addressed with partial least squares discriminant analysis.

Lameness causes decreased animal welfare and leads to higher production costs. This study explored data from an automatic milking system (AMS) to model on-farm gait scoring from a commercial farm. A total of 88 cows were gait scored once per week, for 2 5-wk periods. Eighty variables retrieved from AMS were summarized week-wise and used to predict 2 defined classes: nonlame and clinically lame cows. Variables were represented with 2 transformations of the week summarized variables, using 2-wk data blocks before gait scoring, totaling 320 variables (2 × 2 × 80). The reference gait scoring error was estimated in the first week of the study and was, on average, 15%. Two partial least squares discriminant analysis models were fitted to parity 1 and parity 2 groups, respectively, to assign the lameness class according to the predicted probability of being lame (score 3 or 4/4) or not lame (score 1/4). Both models achieved sensitivity and specificity values around 80%, both in calibration and cross-validation. At the optimum values in the receiver operating characteristic curve, the false-positive rate was 28% in the parity 1 model, whereas in the parity 2 model it was about half (16%), which makes it more suitable for practical application; the model error rates were, 23 and 19%, respectively. Based on data registered automatically from one AMS farm, we were able to discriminate nonlame and lame cows, where partial least squares discriminant analysis achieved similar performance to the reference method.

Characterisation of hydrogen bond perturbations in aqueous systems using aquaphotomics and multivariate curve resolution-alternating least squares.

Aquaphotomics is a new discipline that provides a framework for understanding changes in the structure of water caused by various perturbations, such as variations in temperature or the addition of solutes, using near infrared spectroscopy (NIRS). One of the main purposes of aquaphotomics is to identify water bands as main coordinates of future absorbance patterns to be used as biomarkers. These bands appear as consequence of perturbations in the NIR spectra. Curve resolution techniques may help to resolve and find new water bands or confirm already known bands. The aim of this study is to investigate the application of multivariate curve resolution-alternating least squares (MCR-ALS) to characterise the effects of various perturbations on the NIR spectra of water in terms of hydrogen bonding. For this purpose, the perturbations created by temperature change and the addition of four solutions of different ionic strength and Lewis acidity were studied (NaCl, KCl, MgCl(2) and AlCl(3), with concentrations ranging from 0.2 to 1 mol L(-1) in steps of 0.2 mol L(-1)). Transmission spectra of all salt solutions and pure water were obtained at temperatures ranging from 28 to 45°C. We have found that three distinct components with varying temperature dependence are present in water perturbed by temperature. The salt solutions studied exhibited similar trends with respect to the temperature perturbation, while the peak locations of their MCR-ALS pure components varied according to the ionic strength of the salt used.

Image analysis for maintenance of coating quality in nickel electroplating baths--real time control.

The aim of this paper is to show how it is possible to extract analytical information from images acquired with a flatbed scanner and make use of this information for real time control of a nickel plating process. Digital images of plated steel sheets in a nickel bath are used to follow the process under degradation of specific additives. Dedicated software has been developed for making the obtained results accessible to process operators. This includes obtaining the RGB image, to select the red channel data exclusively, to calculate the histogram of the red channel data and to calculate the mean colour value (MCV) and the standard deviation of the red channel data. MCV is then used by the software to determine the concentration of the additives Supreme Plus Brightner (SPB) and SA-1 (for confidentiality reasons, the chemical contents cannot be further detailed) present in the bath (these two additives degrade and their concentration changes during the process). Finally, the software informs the operator when the bath is generating unsuitable quality plating and suggests the amount of SPB and SA-1 to be added in order to recover the original plating quality.

Flatbed scanners as a source of imaging. Brightness assessment and additives determination in a nickel electroplating bath.

Desktop flatbed scanners are very well-known devices that can provide digitized information of flat surfaces. They are practically present in most laboratories as a part of the computer support. Several quality levels can be found in the market, but all of them can be considered as tools with a high performance and low cost. The present paper shows how the information obtained with a scanner, from a flat surface, can be used with fine results for exploratory and quantitative purposes through image analysis. It provides cheap analytical measurements for assessment of quality parameters of coated metallic surfaces and monitoring of electrochemical coating bath lives. The samples used were steel sheets nickel-plated in an electrodeposition bath. The quality of the final deposit depends on the bath conditions and, especially, on the concentration of the additives in the bath. Some additives become degraded with the bath life and so is the quality of the plate finish. Analysis of the scanner images can be used to follow the evolution of the metal deposit and the concentration of additives in the bath. Principal component analysis (PCA) is applied to find significant differences in the coating of sheets, to find directions of maximum variability and to identify odd samples. The results found are favorably compared with those obtained by means of specular reflectance (SR), which is here used as a reference technique. Also the concentration of additives SPB and SA-1 along a nickel bath life can be followed using image data handled with algorithms such as partial least squares (PLS) regression and support vector regression (SVR). The quantitative results obtained with these and other algorithms are compared. All this opens new qualitative and quantitative possibilities to flatbed scanners.

Mutual information and redundancy in spontaneous communication between cortical neurons.

An important question in neural information processing is how neurons cooperate to transmit information. To study this question, we resort to the concept of redundancy in the information transmitted by a group of neurons and, at the same time, we introduce a novel concept for measuring cooperation between pairs of neurons called relative mutual information (RMI). Specifically, we studied these two parameters for spike trains generated by neighboring neurons from the primary visual cortex in the awake, freely moving rat. The spike trains studied here were spontaneously generated in the cortical network, in the absence of visual stimulation. Under these conditions, our analysis revealed that while the value of RMI oscillated slightly around an average value, the redundancy exhibited a behavior characterized by a higher variability. We conjecture that this combination of approximately constant RMI and greater variable redundancy makes information transmission more resistant to noise disturbances. Furthermore, the redundancy values suggest that neurons can cooperate in a flexible way during information transmission. This mostly occurs via a leading neuron with higher transmission rate or, less frequently, through the information rate of the whole group being higher than the sum of the individual information rates-in other words in a synergetic manner. The proposed method applies not only to the stationary, but also to locally stationary neural signals.

Trace-metal distribution of cigarette ashes as marker of tobacco brands.

The trace-metal distribution of cigarette ashes offers a potential interest from the point of view of forensics and criminology dealing with the determination and classification of tobacco brands. There is a vast bibliography related to the determination of different metals in tobacco leaves. Nevertheless, none of them are directly linked to this matter. Therefore, in this work we present a methodology to assess the viability of discriminating between different tobacco brands by analysing the ashes after smoking. This methodology encompasses the data analysis by atomic techniques (inductively coupled plasma) and further data analysis by principal component analysis and partial least squares-discriminant analysis. The metal distribution (Zn, B, Mn, Fe, Mg, Cu, Ti, Al, Sr, Ca, Ba, Na, Li, and K) of cigarette ashes of different tobacco brands was determined in 149 samples obtained from local stores, representing the most common brands of cigarettes readily available to consumers in Spain. Further analysis of the data with PCA denoted significant differences between different brands of tobacco in their metallic content. In that sense, blond tobaccos were found to contain different patterns in metallic content than black tobaccos. Intrinsic differences were found between different brands, being possible to study the relationship between each brand and its metallic concentration and compare this relationship with other brands. Moreover the possibility of developing classification models to be able to discriminate between different brands was also introduced.

Application of Lempel-Ziv complexity to the analysis of neural discharges.

Pattern matching is a simple method for studying the properties of information sources based on individual sequences (Wyner et al 1998 IEEE Trans. Inf. Theory 44 2045-56). In particular, the normalized Lempel-Ziv complexity (Lempel and Ziv 1976 IEEE Trans. Inf. Theory 22 75-88), which measures the rate of generation of new patterns along a sequence, is closely related to such important source properties as entropy and information compression ratio. We make use of this concept to characterize the responses of neurons of the primary visual cortex to different kinds of stimulus, including visual stimulation (sinusoidal drifting gratings) and intracellular current injections (sinusoidal and random currents), under two conditions (in vivo and in vitro preparations). Specifically, we digitize the neuronal discharges with several encoding techniques and employ the complexity curves of the resulting discrete signals as fingerprints of the stimuli ensembles. Our results show, for example, that if the neural discharges are encoded with a particular one-parameter method ('interspike time coding'), the normalized complexity remains constant within some classes of stimuli for a wide range of the parameter. Such constant values of the normalized complexity allow then the differentiation of the stimuli classes. With other encodings (e.g. 'bin coding'), the whole complexity curve is needed to achieve this goal. In any case, it turns out that the normalized complexity of the neural discharges in vivo are higher (and hence carry more information in the sense of Shannon) than in vitro for the same kind of stimulus.

On the number of states of the neuronal sources.

In a previous paper (Proceedings of the World Congress on Neuroinformatics (2001)) the authors applied the so-called Lempel-Ziv complexity to study neural discharges (spike trains) from an information-theoretical point of view. Along with other results, it is shown there that this concept of complexity allows to characterize the responses of primary visual cortical neurons to both random and periodic stimuli. To this aim we modeled the neurons as information sources and the spike trains as messages generated by them. In this paper, we study further consequences of this mathematical approach, this time concerning the number of states of such neuronal information sources. In this context, the state of an information source means an internal degree of freedom (or parameter) which allows outputs with more general stochastic properties, since symbol generation probabilities at every time step may additionally depend on the value of the current state of the neuron. Furthermore, if the source is ergodic and Markovian, the number of states is directly related to the stochastic dependence lag of the source and provides a measure of the autocorrelation of its messages. Here, we find that the number of states of the neurons depends on the kind of stimulus and the type of preparation ( in vivo versus in vitro recordings), thus providing another way of differentiating neuronal responses. In particular, we observed that (for the encoding methods considered) in vitro sources have a higher lag than in vivo sources for periodic stimuli. This supports the conclusion put forward in the paper mentioned above that, for the same kind of stimulus, in vivo responses are more random (hence, more difficult to compress) than in vitro responses and, consequently, the former transmit more information than the latter.

A new interpretation and practical aspects of the direct-methods modulus sum function. VIII.

Since the first publication of the direct-methods modulus sum function [Rius (1993). Acta Cryst. A49, 406-409], the application of this function to a variety of situations has been shown in a series of seven subsequent papers. In this way, much experience about this function and its practical use has been gained. It is thought by the authors that it is now the right moment to publish a more complete study of this function which also considers most of this practical knowledge. The first part of the study relates, thanks to a new interpretation, this function to other existing phase-refinement functions, while the second shows, with the help of test calculations on a selection of crystal structures, the behaviour of the function for two different control parameters. In this study, the principal interest is focused on the function itself and not on the optimization procedure which is based on a conventional sequential tangent formula refinement. The results obtained are quite satisfactory and seem to indicate that, when combined with more sophisticated optimization algorithms, the application field of this function could be extended to larger structures than those used for the test calculations.

Tetramicra brevifilum (Matthews & Matthews, 1980) (Microsporida: Tetramicriidae) in a new fish host, Lophius budegassa (Spinola, 1807) in Spain.

Tetramicra brevifilum, a microsporidian parasite of Scophthalmus maximus, was found in Lophius budegassa for the first time. This parasite was detected in 5 of 199 hosts captured in the coastal waters of Barcelona (Northwest Mediterranean), which enlarges the geographic distribution of this microsporidian. Affected fish did not show any external sign of disease, and cysts of T. brevifilum were found associated with the body musculature but were easily differentiated from those of Spraguea lophii, another microsporidian present in this host. A case of simultaneous infection by both T. brevifilum and S. lophii was found.

The pathologic cycle of the infection of the microsporidian Microgemma ovoidea (Thèl., 1895) Amigó et al. 1996 in the liver of the Red Band fish (Cepola macrophthalma L.).

Pathologic study of the lesions caused by Microgemma ovoidea has shown that after the formation of the xenoma (stage 1), the parasitized cell is infiltrated by host macrophages (stage 2) and quickly encysted by the activity of fibroblasts that form a xenoma wall composed of collagenous fibers (stage 3). The phagocytic activity of the macrophages leads to the formation of a granuloma (stage 4) in which the cyst contents comprise macrophages filled with phagocytosed spores. This phagocytic activity is limited by the fact that some parts of the microsporidian spores, such as the spore walls, cannot be lysed by macrophages, which leads to the formation of fused giant cells containing nondigestible spore remanants. The final step in the process is healing (stage 5), in which some cells may start proliferating to regenerate the damaged area. Nevertheless, the host occasionally fails to control M. ovoidea infections. This failure can take two forms: bursting of the granuloma, or the appearance of secondary infections in granulomas, probably through parasitism of macrophages.