Ecohydraulics-based environmental flow assessment in two arid North African rivers.

North Africa is among the most water-stressed regions in the world; still, the habitat requirements of its freshwater biota are largely unknown. In this study, (i) we developed habitat suitability curves (HSCs) for freshwater macroinvertebrates in two poorly studied, regulated North African rivers (Ziz and Oum Er-Rbia), and (ii) assessed environmental flows downstream of each river dam by incorporating the HSCs in two-dimensional ecohydraulic models. We demonstrate a low-cost sampling methodology combined with freely distributed ecohydraulic modeling software. The results showed that macroinvertebrates in the arid-desert Ziz River could tolerate a wide range of habitats in terms of flow velocity and water depth compared to the arid-steppe Oum Er-Rbia River, probably due to their adaptation to extreme (arid-desert) environmental conditions. Optimal environmental flows downstream of the Al Hassan Addakhil (Ziz River) and the Al Massira (Oum Er-Rbia River) dams were 1 m3/s and 2 m3/s, respectively. However, environmental flows at 0.5 m3/s and 1 m3/s, respectively, could still maintain sustainable freshwater biota downstream of the dams. The results further highlight the critical status of the Ziz River, which was completely dry, and the alarming status of the Oum Er-Rbia River due to the significant reduction in the water levels of the Al Massira Dam. In a continuously changing climate, we suggest that the proposed environmental flows should be immediately delivered to prevent droughts and ensure healthy freshwater communities downstream of the dams, within a basin-wide freshwater management framework. In this water scarce region, more research is necessary to increase ecological awareness about these understudied freshwater systems and achieve a balance between human needs and ecosystem requirements.

Traumatismo torácico grave no cardiovascular: claves diagnósticas en tomografía computarizada / Severe non-cardiovascular thoracic trauma: diagnostic clues on computed tomography

Objetivo: El traumatismo torácico ocurre en aproximadamente el 60% de los pacientes politraumatizados y es causa de muerte en un 10%. La tomografía computarizada (TC) es la prueba de imagen más sensible y específica en el diagnóstico de patología aguda y contribuye en el manejo y valoración del pronóstico en los pacientes con un traumatismo de alto impacto. El objetivo de este artículo es mostrar puntos clave y prácticos para el diagnóstico con TC de patología no cardiovascular en el traumatismo torácico grave.ConclusiónEl conocimiento de los aspectos clave en la TC de patología aguda en el traumatismo torácico grave es crucial para evitar errores diagnósticos. El radiólogo tiene un papel fundamental en el diagnóstico correcto y precoz de dicha patología, ya que de ello dependerá en gran parte el manejo y evolución de los pacientes.(AU)

Objective: About 60% of polytrauma patients present thoracic traumatic injuries, accounting for approximately 10% of trauma-related deaths. Computed tomography (CT) is the most sensitive and specific imaging modality for the diagnosis of acute injuries, and it improves management and prognostic evaluation of patients with high-impact trauma. This paper aims to show practical clues that are key for diagnosing severe non-cardiovascular thoracic trauma by CT.ConclusionKnowing the key features of severe acute thoracic trauma on CT is crucial to avoid diagnostic errors. Radiologists play a fundamental role in the accurate early diagnosis of severe non-cardiovascular thoracic trauma, because the patient's management and outcome will depend largely on the imaging findings.(AU)

Severe non-cardiovascular thoracic trauma: diagnostic clues on computed tomography.

OBJECTIVE: About 60% of multiple trauma patients have thoracic trauma, and thoracic trauma results in the death of 10% of these patients. Computed tomography (CT) is the most sensitive and specific imaging modality for the diagnosis of acute disease, and it helps in the management and prognostic evaluation of patients with high-impact trauma. This paper aims to show the practical points that are key for diagnosing severe non-cardiovascular thoracic trauma by CT. CONCLUSION: Knowing the key features of severe acute thoracic trauma on CT is crucial to avoid diagnostic errors. Radiologists play a fundamental role in the accurate early diagnosis of severe non-cardiovascular thoracic trauma, because the patient's management and outcome will depend largely on the imaging findings.

Quantization-aware training for low precision photonic neural networks.

Recent advances in Deep Learning (DL) fueled the interest in developing neuromorphic hardware accelerators that can improve the computational speed and energy efficiency of existing accelerators. Among the most promising research directions towards this is photonic neuromorphic architectures, which can achieve femtojoule per MAC efficiencies. Despite the benefits that arise from the use of neuromorphic architectures, a significant bottleneck is the use of expensive high-speed and precision analog-to-digital (ADCs) and digital-to-analog conversion modules (DACs) required to transfer the electrical signals, originating from the various Artificial Neural Networks (ANNs) operations (inputs, weights, etc.) in the photonic optical engines. The main contribution of this paper is to study quantization phenomena in photonic models, induced by DACs/ADCs, as an additional noise/uncertainty source and to provide a photonics-compliant framework for training photonic DL models with limited precision, allowing for reducing the need for expensive high precision DACs/ADCs. The effectiveness of the proposed method is demonstrated using different architectures, ranging from fully connected and convolutional networks to recurrent architectures, following recent advances in photonic DL.

Virtual reality and cardiac anatomy: Exploring immersive three-dimensional cardiac imaging, a pilot study in undergraduate medical anatomy education.

Cardiac anatomy can be challenging to grasp because of its complex three-dimensional nature and remains one of the most challenging topics to teach. In light of some exciting technological advances in the field of virtual reality (VR), we sought to test the viability and the assess efficacy of this computer-generated model for the purposes of teaching cardiac anatomy. Before learning cardiac anatomy, first-year undergraduate medical students participated in an anatomically correct VR simulation of the heart. Students were randomly distributed into control and variable groups. Each student completed a pre-intervention quiz, consisting of 10 multiple choice questions with 5 conventional cardiac anatomy questions and 5 visual-spatial (VS) questions. The control group continued to independent study, whereas the variable group subjects were exposed to a 30-min immersive cardiac VR experience. At the end of the intervention, both the groups underwent a separate post-intervention 10-question quiz. Forty-two students participated in the cardiac VR experiment, separated into 14 control and 28 variable subjects. They scored 50.9% on average on the pre-intervention quiz (SD = 16.5) and 70.2% on the post-intervention quiz (SD = 18.7). Compared to the control group, the students exposed to VR scored 21.4% higher in conventional content (P = 0.004), 26.4% higher in VS content (P < 0.001), and 23.9% higher overall (P < 0.001). VR offers an anatomically correct and immersive VS environment that permits learner to interact three-dimensionally with the heart's anatomy. This study demonstrates the viability and the effectiveness of VR in teaching cardiac anatomy. Clin. Anat. 32:238-243, 2019. © 2018 Wiley Periodicals, Inc.

Aortic Elongation and Stanford B Dissection: The Tübingen Aortic Pathoanatomy (TAIPAN) Project.

OBJECTIVE/BACKGROUND: Aortic elongation has not yet been considered as a potential risk factor for Stanford type B dissection (TBD). The role of both aortic elongation and dilatation in patients with TBD was evaluated. METHODS: The aortic morphology of a healthy control group (n = 236) and patients with TBD (n = 96) was retrospectively examined using three dimensional computed tomography imaging. Curved multiplanar reformats were used to examine aortic diameters at defined landmarks and aortic segment lengths. RESULTS: Diameters at all landmarks were significantly larger in the TBD group. The greatest diameter difference (56%) was measured in dissected descending aortas (p < .001). The segment with the most considerable difference between the study groups with regard to elongation was the non-dissected aortic arch of patients with TBD (36%; p < .001). Elongation in the aortic arch was accompanied by a diameter increase of 21% (p < .001). In receiver-operating curve analysis, the area under the curve was .85 for the diameter and .86 for the length of the aortic arch. CONCLUSIONS: In addition to dilatation, aortic arch elongation is associated with the development of TBD. The diameter and length of the non-dissected aortic arch may be predictive for TBD and may possibly be used for risk assessment in the future. This study provides the basis for further prospective evaluation of these parameters.

Assessment of the Impact of Skeletonization on Pleuropulmonary Changes after Bilateral Internal Thoracic Artery Harvest for Coronary Artery Bypass Grafting.

BACKGROUND AND AIMS: Skeletonization has been proposed as a technique to minimize the risk of sternal devascularization during bilateral internal thoracic artery harvest for coronary artery bypass grafting. The impact of this strategy on late radiologic pleuropulmonary changes has not been addressed. MATERIAL AND METHODS: Post-operative chest radiographs from patients (n = 253 per group) undergoing bilateral internal thoracic artery harvest using skeletonized and non-skeletonized techniques were reviewed by blinded radiologists. The primary outcome was the incidence of atelectasis and pleural effusion. Multivariable linear regression models were derived to assess the relationship of radiologic pleuropulmonary outcomes to patients and operative variables. RESULTS AND CONCLUSION: Patients in the skeletonized group were older (p < 0.0001), had a lower preoperative hematocrit (p = 0.014), had higher prevalence of peripheral vascular disease (p = 0.001), were of female gender (p = 0.015), underwent off-pump surgery (p < 0.001), had urgent/emergent status (p = 0.024), and had chronic obstructive pulmonary disease (p = 0.019). There was no difference in the incidence of post-operative complications, ventilation time, or intensive care unit stay. There was no difference in the severity of post-operative atelectasis in both groups. More patients in the non-skeletonized group had a grade 2/3 left pleural effusion on the late post-operative chest X-ray (p = 0.007). The independent effect of skeletonization on the development of a late left pleural effusion was significant (odds ratio = 0.558, 95% confidence interval = 0.359-0.866, p = 0.009). Skeletonization results in a decreased incidence of late post-operative left pleural effusion with no difference in early or late atelectasis. Further studies are warranted to assess the mechanism of these pleuropulmonary changes and the impact of other factors such as pleural violation during surgery.

Juxtacortical clavicular chondrosarcoma: diagnostic dilemmas: case report and review of literature.

Juxtacortical chondrosarcoma is a rare primary malignant cartilaginous tumor accounting for 0.2% of all bone tumors. Wide surgical resection is the treatment of choice for juxtacortical chondrosarcomas. Accurate preoperative diagnosis is important in ensuring appropriate management, staging, and treatment of the patient. A combination of radiographs, three-dimensional imaging with computerized tomography (CT) scan and magnetic resonance imaging (MRI) can typically allow accurate diagnosis of juxtacortical chondrosarcomas. Bone scan and chest x-ray or CT chest scans are indicated for appropriate staging of the patient. Pet scan, ultrasound, bone scan, etc. are not typically needed for the diagnosis. Certainly, pulmonary imaging and bone scan are required for staging and could be commented upon.

Combined elemental analysis of ancient glass beads by means of ion beam, portable XRF, and EPMA techniques.

Ion beam analysis (IBA)- and X-ray fluorescence (XRF)-based techniques have been well adopted in cultural-heritage-related analytical studies covering a wide range of diagnostic role, i.e., from screening purposes up to full quantitative characterization. In this work, a systematic research was carried out towards the identification and evaluation of the advantages and the limitations of laboratory-based (IBA, electron probe microanalyzer) and portable (milli-XRF and micro-XRF) techniques. The study focused on the analysis of an Archaic glass bead collection recently excavated from the city of Thebes (mainland, Greece), in order to suggest an optimized and synergistic analytical methodology for similar studies and to assess the reliability of the quantification procedure of analyses conducted in particular by portable XRF spectrometers. All the employed analytical techniques and methodologies proved efficient to provide in a consistent way characterization of the glass bead composition, with analytical range and sensitivity depending on the particular technique. The obtained compositional data suggest a solid basis for the understanding of the main technological features related to the raw major and minor materials utilized for the manufacture of the Thebian ancient glass bead collection.

Pott's disease in a two-year-old girl.

Fractures in children require a specific treatment depending on age. While obstetric fractures usually heal well even in case of significant dislocations and conservative therapy, the proportion of operative interventions among all pediatric fractures is increasing with age. Though the vast majority of fractures in childhood are still treated non-operatively, a trend towards early operative interventions and cast-free mobilization has been noticeable in the recent years. The methods of operative stabilization differ between the respective age groups: While K-wire osteosynthesis and a minimal invasive approach using elastic stable intramedullary nailing (ESIN) are common in the group of school aged children, the use of external fixation and plate osteosynthesis has been accepted for the treatment of fractures in adolescents. Bioresorbable implants do not yet play a decisive role in the management of pediatric fractures. This review is focusing on the current indications and concepts for stabilization of frequent pediatric fractures.

An integrated evaluation of socioeconomic and clinical factors in the survival from childhood acute lymphoblastic leukaemia: a study in Greece.

An evaluation of the role of socioeconomic factors in the survival of children with leukaemia, controlling for major clinical prognostic indicators, has been attempted in very few studies and the role of these factors may be different in various cultural settings. Our investigation aims to study the independent role of socioeconomic factors on the prognosis of childhood acute lymphoblastic leukaemia (ALL) in Greece. During a 7-year period (1996-2002) 293 cases of incident ALL were diagnosed and followed up in four Childhood Haematology-Oncology Units, which covered over half of all childhood ALL cases nationwide. At the time of diagnosis, information concerning age, gender, maternal schooling, maternal marital status, sibship size, distance of residence from the treating centre, attendance of day care centre and clinical information was recorded. The influence of these factors on survival was studied by modelling the data through Cox's proportional-hazards regression. After adjustment for clinical prognostic factors, children of mothers who were not currently married, were of low educational level or were living far from the treating centre tended to have lower survival (P-values 0.02, 0.14 and 0.08, respectively). There was also evidence that two factors that are predictive of disease occurrence, that is sibship size and attendance of day care centre, may also predict survival (P-values 0.04 and 0.26, respectively). In conclusion, socioeconomic factors are likely to influence survival from ALL at least in some sociocultural contexts. Moreover, there is evidence that factors that could affect incidence of ALL through modulation of herd immunity may also have prognostic implications for this disease.

IRiS: an interactive reality system for breast self-examination training.

This paper presents a novel interactive reality video playback approach developed for biomedical training purposes, and tested on a prototype breast self-examination (BSE) multimedia training application. The system is developed in order to improve on existing video playback approaches as used in multimedia applications by providing control over not only time, as in conventional video playback, but also space. The benefits of interactive reality video playback are presented and the approach is compared with other similar approaches, such as QuickTime and iPIX. The design, development, final implementation, testing and evaluation plan of the IRiS system are presented. The paper also discusses future plans and the use of the system in other biomedical training scenarios.

Doppler-ultrasound as a predictor of uterine fibroid response to GnRH therapy.

OBJECTIVES: GnRH agonists (GnRHa) are able to reduce the bleeding and size of fibroids. We monitored the response of fibroids to GnRHa with power-Doppler ultrasound. METHODS: Thirty-five women with fibroids, aged 32-48, received a 6-month course with the GnRHa triptorelin (Decapeptyl, Ipsen, France). The resistance index (RI) of the uterine artery was measured with power-Doppler ultrasound. RESULTS: The uterine volume reduced from 470+/-347 to 297+/-295 cm3 (P<0.01) at the 6th month of treatment. The fibroid volume reduced after 3 months of treatment from 62+/-81 to 44+/-78 cm3 (P<0.05) and after 6 months of treatment to 30+/-70 cm3 (P<0.001 from baseline). Uterine artery RI increased from 0.73+/-0.16 to 1.05+/-0.27 at the 3rd month of treatment (P<0.001). The percent reduction of fibroid volume at the 6th month correlated with the percent increase of uterine RI at the 3rd month of treatment (r=0.45, P=0.01). CONCLUSIONS: The administration of triptorelin reduced fibroid dimensions. The increase of the uterine artery resistance index (RI) at the 3rd month correlated with fibroid shrinkage at the 6th month of treatment and may be used to predict the response to this therapeutic maneuver.