Early corticosteroids requirement after the diagnosis of ulcerative colitis diagnosis can predict a more severe long-term course of the disease - a nationwide study of 1035 patients.

BACKGROUND: There are limited data regarding clinical outcomes in ulcerative colitis (UC) patients who require early corticosteroids (CS) use. AIM: To evaluate the rate of early CS utilisation (within 30 days of diagnosis) as a predictive marker for long-term outcomes, colectomy and CS dependency, in a population-based cohort of incident UC cases. METHODS: Nationwide data were obtained from the Veterans Affairs (VA) health care system for the period 2001-2011. Incident UC cases were identified. A retrospective cohort design and time-to-event survival analysis were used to track outcomes of interest. Cox regression multivariate analysis was employed. RESULTS: One thousand and thirty-five newly diagnosed patients with UC were identified and included in the analysis; 236 (23%) of those patients required early CS therapy. Patients were followed-up over a median time of 4.7 years (IQR 2.8-6.8) after UC diagnosis. The 5-year cumulative probability of requiring colectomy varied significantly by early CS use status (13% among early CS users compared to 4% among those who did not require early CS treatment, P < 0.001). Similar variation in the 5-year cumulative probability of CS dependency by early CS status was observed. Early CS users were more likely to require colectomy 2.9 (CI 1.7-5.0, P < 0.001) and to become CS dependent 4.5 (95% CI 3.6-5.7, P < 0.001) than non-users. CONCLUSIONS: Early CS use can help identify those patients who have a more active disease course of UC. Recognising this can be among the indicators that can help physicians identify patients who may require early initiation of more aggressive therapy.

Image processing algorithms for digital mammography: a pictorial essay.

Digital mammography systems allow manipulation of fine differences in image contrast by means of image processing algorithms. Different display algorithms have advantages and disadvantages for the specific tasks required in breast imaging-diagnosis and screening. Manual intensity windowing can produce digital mammograms very similar to standard screen-film mammograms but is limited by its operator dependence. Histogram-based intensity windowing improves the conspicuity of the lesion edge, but there is loss of detail outside the dense parts of the image. Mixture-model intensity windowing enhances the visibility of lesion borders against the fatty background, but the mixed parenchymal densities abutting the lesion may be lost. Contrast-limited adaptive histogram equalization can also provide subtle edge information but might degrade performance in the screening setting by enhancing the visibility of nuisance information. Unsharp masking enhances the sharpness of the borders of mass lesions, but this algorithm may make even an indistinct mass appear more circumscribed. Peripheral equalization displays lesion details well and preserves the peripheral information in the surrounding breast, but there may be flattening of image contrast in the nonperipheral portions of the image. Trex processing allows visualization of both lesion detail and breast edge information but reduces image contrast.

Radiologists' preferences for digital mammographic display. The International Digital Mammography Development Group.

PURPOSE: To determine the preferences of radiologists among eight different image processing algorithms applied to digital mammograms obtained for screening and diagnostic imaging tasks. MATERIALS AND METHODS: Twenty-eight images representing histologically proved masses or calcifications were obtained by using three clinically available digital mammographic units. Images were processed and printed on film by using manual intensity windowing, histogram-based intensity windowing, mixture model intensity windowing, peripheral equalization, multiscale image contrast amplification (MUSICA), contrast-limited adaptive histogram equalization, Trex processing, and unsharp masking. Twelve radiologists compared the processed digital images with screen-film mammograms obtained in the same patient for breast cancer screening and breast lesion diagnosis. RESULTS: For the screening task, screen-film mammograms were preferred to all digital presentations, but the acceptability of images processed with Trex and MUSICA algorithms were not significantly different. All printed digital images were preferred to screen-film radiographs in the diagnosis of masses; mammograms processed with unsharp masking were significantly preferred. For the diagnosis of calcifications, no processed digital mammogram was preferred to screen-film mammograms. CONCLUSION: When digital mammograms were preferred to screen-film mammograms, radiologists selected different digital processing algorithms for each of three mammographic reading tasks and for different lesion types. Soft-copy display will eventually allow radiologists to select among these options more easily.

Case studies of pronoun development in two hearing-impaired children: normal, delayed or deviant?

This paper is a study of first and second person pronoun development in the spoken language of two young hearing-impaired children. Pronoun development was examined over a period of 11 months, starting at the age of 29 and 28 months, to determine whether the children's acquisition of these pronouns would reflect normal, delayed or deviant patterns of development. Comparison of data from these children with data regarding normally developing children shows the hearing-impaired children's acquisition to be within normal expectations for hearing age and overall linguistic level, and only slightly delayed in terms of chronological age. These results lend support to the view that differences in the hearing-impaired child's language ability are probably the result of a relative lack of auditory and linguistic experience, rather than reorganisation of the hearing-impaired child's psychological and cognitive processing abilities.

Caregiver-child interactive behaviours: a clinical procedure for the development of spoken language in hearing-impaired children.

Much recent research emphasises the importance of pre-verbal communicative behaviour in the language development of children. A child normally becomes a competent user of spoken language through communicative interaction with caregivers in the course of everyday activities and play. When acquisition of spoken language is problematic due to hearing loss, the need to restore and/or maintain the integrity of the caregiver-child interactions is acute. However, relatively few attempts have been made to organise our knowledge of pre-verbal behaviour so that it can be used in developing spoken language in hearing-impaired children. This paper presents a clinical procedure for analysing caregiver-child interactive behaviours, which was derived from language acquisition research and literature. The procedure is intended for use by teachers/clinicians with hearing-impaired children prior to the use of conventional words in connected sentences. A videotape analysis is developed to meet two clinical aims. The first aim is to identify systematically those elements of the interaction which promote the child's communicative development, as well as those which are counterproductive to it. The second aim is to use this information to facilitate communication between caregiver and hearing-impaired child. Illustrative examples from analyses of caregiver-child dyads are provided to demonstrate the clinically useful information which results.