Simultaneous Ipsilateral Vascularized Lymph Node Transplantation and Contralateral Lymphovenous Anastomosis in Bilateral Extremity Lymphedema with Different Severities.

BACKGROUND: Extremity lymphedema can occur bilaterally with different severities on each side. The aim of this study is to investigate the treatment outcomes of such patients with bilateral extremity lymphedema of different severities. PATIENTS AND METHODS: Between 2013 and 2017, patients with bilateral extremity lymphedema of different severities according to the Taiwan Lymphoscintigraphy Staging (TLS) system were retrospectively reviewed. Ipsilateral vascularized lymph node transplantation (VLNT) was indicated in TLS total obstruction and contralateral lymphovenous anastomosis (LVA) in TLS partial obstruction with patent lymphatic vessels on indocyanine green lymphography. Outcomes were assessed using circumference improvement, frequency of cellulitis, and lymphedema-specific quality of life (LYMQoL) questionnaires. RESULTS: A total of 10 patients with bilateral extremity lymphedema with median age of 63 (range 12-75) years were included. The median symptom duration of the lymphedematous limb was 60 (range 36-168) months and 12 (range 1-60) months in the VLNT and LVA group, respectively (p < 0.05). At average follow-up of 37.5 (range 14-58) months, the average limb circumference improvement was 2.4 (range - 3.3 to 7.8) cm in the VLNT group and 2.3 (range 0.3-7) cm in the LVA group (p = 1). The median episodes of cellulitis decreased significantly from 4 to 0.5 and 1 to 0 times/year in the VLNT and LVA group, respectively (p = 0.02, p = 0.06). The overall LYMQoL score improved from 4.5 preoperatively to 7.5 postoperatively (p < 0.01). CONCLUSIONS: Limb-specific VLNT and LVA selected by TLS effectively treated bilateral extremity lymphedema with different severities.

Effect of clinical signs, endocrinopathies, timing of surgery, hyperlipidemia, and hyperbilirubinemia on outcome in dogs with gallbladder mucocele.

Gallbladder mucocele (GBM) is a common extra-hepatic biliary syndrome in dogs with death rates ranging from 7 to 45%. Therefore, the aim of this study was to identify the association of survival with variables that could be utilized to improve clinical decisions. A total of 1194 dogs with a gross and histopathological diagnosis of GBM were included from 41 veterinary referral hospitals in this retrospective study. Dogs with GBM that demonstrated abnormal clinical signs had significantly greater odds of death than subclinical dogs in a univariable analysis (OR, 4.2; 95% CI, 2.14-8.23; P<0.001). The multivariable model indicated that categorical variables including owner recognition of jaundice (OR, 2.12; 95% CI, 1.19-3.77; P=0.011), concurrent hyperadrenocorticism (OR 1.94; 95% CI, 1.08-3.47; P=0.026), and Pomeranian breed (OR, 2.46; 95% CI 1.10-5.50; P=0.029) were associated with increased odds of death, and vomiting was associated with decreased odds of death (OR, 0.48; 95% CI, 0.30-0.72; P=0.001). Continuous variables in the multivariable model, total serum/plasma bilirubin concentration (OR, 1.03; 95% CI, 1.01-1.04; P<0.001) and age (OR, 1.17; 95% CI, 1.08-1.26; P<0.001), were associated with increased odds of death. The clinical utility of total serum/plasma bilirubin concentration as a biomarker to predict death was poor with a sensitivity of 0.61 (95% CI, 0.54-0.69) and a specificity of 0.63 (95% CI, 0.59-0.66). This study identified several prognostic variables in dogs with GBM including total serum/plasma bilirubin concentration, age, clinical signs, concurrent hyperadrenocorticism, and the Pomeranian breed. The presence of hypothyroidism or diabetes mellitus did not impact outcome in this study.

Gly972Arg of IRS-1 and Lys121Gln of PC-1 polymorphisms act in opposite way in polycystic ovary syndrome.

PURPOSE: Polycystic ovary syndrome (PCOS) was associated with a number of polymorphisms of genes involved in insulin signaling. So far, they have been studied separately. The aim of this study was to verify the impact of the coexistence of two polymorphisms of insulin signaling. METHODS: One hundred consecutive PCOS women (diagnosed by Rotterdam criteria) and 45 age-matched healthy women were genotyped for two polymorphisms: Gly972Arg of IRS-1 and Lys121Gln of PC-1. Also, they underwent clinical evaluation, blood sampling for measurement of metabolic and hormonal indices, and a 75-g oral glucose tolerance test (OGTT). RESULTS: Comparing PCOS women with controls, the rate of homo-/heterozygosity was significantly greater (50 vs. 24.5%, P = 0.004) for IRS-1 polymorphism, but insignificantly greater (20 vs. 13.3%, P = 0.33) for PC-1 polymorphism. In PCOS women, compared with controls, the genotypes IRS-1 hetero/PC-1 wild type (WT) (36 vs. 17.8%, P = 0.03) and IRS-1 hetero/PC-1 hetero (14 vs. 6.7%, P = 0.20) were overrepresented at the expense of IRS-1 WT/PC-1 WT (44 vs. 68.8%, P = 0.005), while IRS-1 WT/PC-1 hetero was similarly represented (6 vs. 6.7%). Based on genotype, metabolic and hormonal indices changed significantly. For instance, six indices (HOMA-IR, fasting insulin, insulin area under the curve at OGTT, triglycerides, total and calculated free testosterone) were the highest in IRS-1 hetero/PC-1 WT women. CONCLUSIONS: Genetic variations in insulin signaling contribute to the extent and the variability of metabolic and hormonal derangement.

18F-FDG PET/CT, cytoreductive surgery and intraperitoneal chemohyperthermia for the therapeutic management in peritoneal carcinomatosis: a pilot study / 18F-FDG PET/TC, cirugía citorreductora y quimiohipertermia intraperitoneal para el tratamiento terapéutico de la carcinomatosis peritoneal: estudio piloto

Aim. Peritoneal carcinomatosis is a common evolution of neoplasms and the terminal stage of disease. A new therapeutic technique, based on the total surgical removal of peritoneal lesions (peritonectomy procedure - PP) combined with the intraperitoneal chemohyperthermia (IPCH), has been developed. Proper patient selection is mandatory for optimizing the results of treatment. The aim of this study was to investigate the role of [(18)F]fluoro-2-deoxy-d-glucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) in patients with peritoneal carcinosis selected to undergo PP and IPCH. Furthermore, we aimed to identify characteristic patterns of abdominal18F-FDG uptake and to correlate these patterns with available anatomic findings after surgery. Methods. Patients with either histologically confirmed peritoneal carcinosis or suspected upon clinical follow-up and/or imaging findings were prospectively submitted to pre-surgery 18F-FDG PET/CT scan. Only those patients without evidence of extra-peritoneal metastases at PET/CT scan were treated with PP and IPCH. Results. 11 patients with peritoneal carcinomatosis (5 colorectal, 4 ovarian, 1 pancreatic) and 1 unknown primitive cancer, were eligible for the study. In all cases PET/CT scan showed multiple peritoneal implants. In 6 out of 11 cases (54%) metastases were evidenced by 18F-FDG PET/CT: 2 cases with liver metastases; 1 case with bone metastases; 3 patients with lymph-node lesions. Two distinct imaging patterns, with focal or diffuse increased 18F-FDG uptake, were recognized. Conclusions. PP + IPCH of patients selected by 18F-FDG PET/CT seems to be safe and feasible. PET/CT scan appears as a reliable tool for the detection, characterization of peritoneal implants with potential impact in the therapeutic management of these patients (AU)

Objetivo. La carcinomatosis peritoneal es una evolución común de las neoplasias y constituye el estadio terminal de la enfermedad. Se ha desarrollado una nueva técnica, basada en la extirpación quirúrgica de las lesiones peritoneales (procedimiento de peritonectomía - PP), combinada con quimiohipertermia intraperitoneal (IPCH). La adecuada selección de los pacientes es primordial, a fin de optimizar los resultados del tratamiento. El objetivo de este estudio fue investigar el papel de la tomografía de emisión de positrones con [(18)F]fluoro-2-deoxy-d-glucosa/tomografía computarizada (18F-FDG PET/TC) en pacientes con carcinomatosis peritoneal, seleccionados para someterse a PP e IPCH. Además, tratamos de identificar los patrones característicos de la captación abdominal de 18F-FDG y correlacionar dichos patrones con los hallazgos anatómicos disponibles tras la cirugía. Métodos. Se realizaron exámenes 18F-FDG PET/TC de manera prospectiva, y previamente a la cirugía, a los pacientes con carcinomatosis peritoneal histológicamente confirmada, o sospechada mediante seguimiento clínico y/o hallazgos de imagen. Solo puede tratarse con PP y IPCH a aquellos pacientes que no reflejen evidencia de metástasis extraperitoneales en los exámenes PET/TC. Resultados. Se seleccionó para el estudio a 11 pacientes con carcinomatosis peritoneal (5 colorrectales, 4 ováricas, una pancreática) y un cáncer primitivo desconocido. En todos los casos, el examen PET/TC reflejó múltiples implantes peritoneales. En 6 de los 11 casos (54%) las metástasis fueron evidenciadas mediante 18F-FDG PET/TC: 2 casos con metástasis hepáticas, un caso con metástasis óseas, y 3 pacientes con lesiones ganglionares. Se reconocieron 2 patrones de imagen distintos, con aumento de captación focal o difusa de 18F-FDG. Conclusiones. La combinación PP + IPCH de los pacientes seleccionados mediante 18F-FDG PET/TC parece ser una técnica segura y factible. La PET/TC se revela como una herramienta fiable para la detección y caracterización de los implantes peritoneales, con un impacto potencial sobre el tratamiento terapéutico de dichos pacientes (AU)

Caspase-3 activation in human melanoma A375 cell line by a novel selective sigma-2 agonist.

Two novel 8-azabicyclo[3.2.1]octan-3-ol derivatives, 11a and 11b, with high affinity for sigma-2 receptors and a very good sigma-1/sigma-2 selectivity ratio were synthesized. In comparison with several well established sigma-2 selective ligands, 11 b showed a very low sigma-1 receptor affinity. Functional assays demonstrated that 11b acts as an agonist and in A-375 human melanoma cell line is able to lower levels of procaspase-3, thus confirming a potential major role for sigma-2 pure agonists in the treatment of rapid proliferating melanoma cells.

(18)F-FDG PET/CT, cytoreductive surgery and intraperitoneal chemohyperthermia for the therapeutic management in peritoneal carcinomatosis: A pilot study.

AIM: Peritoneal carcinomatosis is a common evolution of neoplasms and the terminal stage of disease. A new therapeutic technique, based on the total surgical removal of peritoneal lesions (peritonectomy procedure - PP) combined with the intraperitoneal chemohyperthermia (IPCH), has been developed. Proper patient selection is mandatory for optimizing the results of treatment. The aim of this study was to investigate the role of [(18)F]fluoro-2-deoxy-d-glucose Positron Emission Tomography/Computed Tomography ((18)F-FDG PET/CT) in patients with peritoneal carcinosis selected to undergo PP and IPCH. Furthermore, we aimed to identify characteristic patterns of abdominal(18)F-FDG uptake and to correlate these patterns with available anatomic findings after surgery. METHODS: Patients with either histologically confirmed peritoneal carcinosis or suspected upon clinical follow-up and/or imaging findings were prospectively submitted to pre-surgery (18)F-FDG PET/CT scan. Only those patients without evidence of extra-peritoneal metastases at PET/CT scan were treated with PP and IPCH. RESULTS: 11 patients with peritoneal carcinomatosis (5 colorectal, 4 ovarian, 1 pancreatic) and 1 unknown primitive cancer, were eligible for the study. In all cases PET/CT scan showed multiple peritoneal implants. In 6 out of 11 cases (54%) metastases were evidenced by (18)F-FDG PET/CT: 2 cases with liver metastases; 1 case with bone metastases; 3 patients with lymph-node lesions. Two distinct imaging patterns, with focal or diffuse increased (18)F-FDG uptake, were recognized. CONCLUSIONS: PP+IPCH of patients selected by (18)F-FDG PET/CT seems to be safe and feasible. PET/CT scan appears as a reliable tool for the detection, characterization of peritoneal implants with potential impact in the therapeutic management of these patients.

Evaluación de un programa piloto de promoción de salud y prevención del estrés dirigido a estudiantes y profesionales de las carreras de Farmacia y Bioquímica / Evaluation of a pilot health promotion and stress management program for Pharmacy and Biochemistry students and professionals

Objetivos: Verificar la efectividad de un programa teórico-práctico de entrenamiento para el manejo del estrés, destinado a profesionales y estudiantes de las carreras de Farmacia y Bioquímica. Discutir la importancia del mismo como complemento de la educación académica clásica, así como su potencial aplicación en la atención farmacéutica. Materiales y métodos: Los participantes fueron 27 estudiantes y 26 profesionales. Se implementó un programa de 10 encuentros destinado a mejorar el afrontamiento del estrés. Como grupo control se asignaron al azar 10 estudiantes y 10 profesionales. Se utilizaron como indicadores de eficacia las mediciones pre-post de cortisol salival y el nivel de ansiedad. Resultados: Después del programa disminuyó significativamente el nivel de cortisol salival en los estudiantes y profesionales, mientras que en el grupo control de estudiantes aumentó significativamente. Por otro lado los niveles de ansiedad disminuyeron significativamente en estudiantes y profesionales. Conclusiones: Este tipo de programa piloto evidenció ser efectivo en estudiantes. En el caso de los profesionales se necesitaría aumentar el tamaño de la muestra para alcanzar una potencia estadística aceptable. Teniendo en cuenta la transformación del ejercicio profesional del farmacéutico hacia la atención farmacéutica, creemos valiosa la formación en competencias y actitudes como las descritas en este trabajo (AU)

Objectives: The beneficial results of a theory-practice pilot stress management program for Pharmacy and Biochemistry professionals and students. Its importance as a complement of traditional academic education, as well as its potential for Pharmaceutical Care is also discussed. Materials and methods: A total of 27 students and 26 professionals took part in a program of 10 sessions, aimed at improving stress management. Ten of the students and 10 professionals were randomly assigned to control groups. Salivary cortisol levels and anxiety level tests before and after the program were used to assess efficacy. Results: Both the cortisol and the anxiety levels significantly decreased among students and professionals after the program, whereas it significantly increased in the student control group. Anxiety levels significantly decreased in both students and professionals. Conclusions: This type of pilot program proved effective for students. In the case of health professionals, the sample size needs to be increased in order to achieve an acceptable level of statistical power. Considering the shift of the pharmaceutical profession towards Pharmaceutical Care, the training of competences and attitudes like those described in this work could be of value

[Evaluation of a pilot health promotion and stress management program for Pharmacy and Biochemistry students and professionals]. / Evaluación de un programa piloto de promoción de salud y prevención del estrés dirigido a estudiantes y profesionales de las carreras de Farmacia y Bioquímica.

OBJECTIVES: The beneficial results of a theory-practice pilot stress management program for Pharmacy and Biochemistry professionals and students. Its importance as a complement of traditional academic education, as well as its potential for Pharmaceutical Care is also discussed. MATERIALS AND METHODS: A total of 27 students and 26 professionals took part in a program of 10 sessions, aimed at improving stress management. Ten of the students and 10 professionals were randomly assigned to control groups. Salivary cortisol levels and anxiety level tests before and after the program were used to assess efficacy. RESULTS: Both the cortisol and the anxiety levels significantly decreased among students and professionals after the program, whereas it significantly increased in the student control group. Anxiety levels significantly decreased in both students and professionals. CONCLUSIONS: This type of pilot program proved effective for students. In the case of health professionals, the sample size needs to be increased in order to achieve an acceptable level of statistical power. Considering the shift of the pharmaceutical profession towards Pharmaceutical Care, the training of competences and attitudes like those described in this work could be of value.

Conocimiento y Actitud sobre Bioseguridad y Profilaxis post exposición ocupacional en odontólogos del posgrado de la Facultad de Odontología de la Universidad Nacional de Asunción en el año 2012 / Knowledge and Attitude on biosafety and occupational postexposure prophylaxis dentists graduate of the Faculty of Dentistry, National University of Asuncion in 2012

El conocimiento y actitud de los odontólogos sobre bioseguridad y profilaxis post exposición ocupacional juega un papel muy importante en la prevención y conductas frente a situaciones de riesgo de contagio de enfermedades como el virus de inmunodeficiencia humana, la hepatitis B y C, lo que ha llevado a los trabajadores de la salud a poner en práctica las normas de bioseguridad y control de infección en el consultorio odontológico. Se realizó un estudio observacional descriptivo de corte transversal aplicando un cuestionario autoadministrado a 154 odontólogos que cursan posgrado en la Facultad de Odontología de la Universidad Nacional de Asunción en el año 2012 con el objetivo de evaluar el nivel de conocimiento y actitud sobre bioseguridad y profilaxis post-exposición ocupacional. Se ha observado que la mayoría de los odontólogos que participaron en éste estudio fueron del sexo femenino en un 81,2%; el 56,5% poseían un nivel de conocimiento bueno y sólo el 3,2% malo. En cuanto a la actitud se observó un nivel favorable en el 91, 6 % de los encuestados. El 27,3 % desconoce el lugar de referencia para recibir atención y profilaxis post exposición ocupacional en caso de accidente con objeto punzocortante

Very high frequency of the polymorphism for the insulin receptor substrate 1 (IRS-1) at codon 972 (glycine972arginine) in Southern Italian women with polycystic ovary syndrome.

A major component of the polycystic ovary syndrome (PCOS) is the insulin resistance. Only a few studies have evaluated the IRS-1 polymorphism at codon 972, sometimes in the absence of a control group, and with great variability in frequency (0-23% in PCOS vs. 0-17% in controls), and with no unequivocal relationships between the polymorphism and clinical or biochemical indexes. The aim of the work was to evaluate the frequency of the IRS-1 polymorphism at codon 972 in PCOS, and correlate it to clinical and biochemical indexes. We assessed the rs 1801278 polymorphic variant in the IRS-1 gene (Gly972Gly=wild-type; Gly972Arg=heterozygosity; Arg972Arg=homozygosity) in genomic DNA by restriction fragment length polymorphism. The study was conducted at an academic medical center with the participation of 65 women with PCOS and 27 age-matched healthy women (controls). Compared to controls, Gly972Arg was very frequent in PCOS (77% vs. 18%, p<0.0001); one PCOS woman was homozygous. Compared to wild-type PCOS, heterozygous PCOS women had only three significantly different indexes: higher fasting insulin, insulin resistance index, and lower 120 min OGTT glucose. Moreover, in the correlation analysis between any two clinical or biochemical variables, the Pearson's correlation coefficients were frequently of different magnitude in heterozygous PCOS versus wild-type PCOS. Overall, heterozygous PCOS had a greater number of statistically significant relationships between different clinical, metabolic and hormonal indexes: 44 direct and 9 inverse versus 6 and 3, respectively. The IRS-1 Gly972Arg has the highest frequency reported world-wide for PCOS women. This variant is associated with insulin resistance and higher fasting insulin in PCOS women.

A molecular dynamics approach to the structural characterization of amyloid aggregation.

A novel computational approach to the structural analysis of ordered beta-aggregation is presented and validated on three known amyloidogenic polypeptides. The strategy is based on the decomposition of the sequence into overlapping stretches and equilibrium implicit solvent molecular dynamics (MD) simulations of an oligomeric system for each stretch. The structural stability of the in-register parallel aggregates sampled in the implicit solvent runs is further evaluated using explicit water simulations for a subset of the stretches. The beta-aggregation propensity along the sequence of the Alzheimer's amyloid-beta peptide (Abeta(42)) is found to be highly heterogeneous with a maximum in the segment V(12)HHQKLVFFAE(22) and minima at S(8)G(9), G(25)S(26), G(29)A(30), and G(38)V(39), which are turn-like segments. The simulation results suggest that these sites may play a crucial role in determining the aggregation tendency and the fibrillar structure of Abeta(42). Similar findings are obtained for the human amylin, a 37-residue peptide that displays a maximal beta-aggregation propensity at Q(10)RLANFLVHSSNN(22) and two turn-like sites at G(24)A(25) and G(33)S(34). In the third application, the MD approach is used to identify beta-aggregation "hot-spots" within the N-terminal domain of the yeast prion Ure2p (Ure2p(1-94)) and to design a double-point mutant (Ure2p-N4748S(1-94)) with lower beta-aggregation propensity. The change in the aggregation propensity of Ure2p-N4748S(1-94) is verified in vitro using the thioflavin T binding assay.

Berberis aetnensis C. Presl. extracts: antimicrobial properties and interaction with ciprofloxacin.

Previous research showed that berberine-containing Berberis species synthesise the substances 5'-methoxyhydnocarpin-D (5'-MHC-D) and pheophorbide a, which have no antimicrobial activity but inhibit the expression of multidrug resistant efflux pumps (MDRs) in Staphylococcus aureus and potentiate the action of berberine. The MDR pumps extrude synthetic and natural antimicrobials from bacterial cells. We searched for these compounds in Berberis aetnensis C. Presl. (Berberidaceae), an endemic plant of the volcano Mount Etna. This work confirms the presence of pheophorbide a and permits us to hypothesise the presence of 5'-MHC-D in leaf extracts. In fact, the activity of ciprofloxacin was improved when two chromatographic fractions isolated from leaf extracts were added. These results are indicative of the presence of MDR pump inhibitors. Moreover, crude extracts were tested on several micro-organisms and showed antimicrobial activity mainly against Gram-positive bacteria and yeasts.

Propagation-independent fields.

Nondiffracting beams are solutions of the wave equation which keep their shape during free propagation. Because of this property, they are widely studied, both as mechanical and electromagnetic waves. Another scheme, however, can be devised in order to find beams that, even if do not maintain their shape upon propagation, are independent on the propagation distance, apart from a phase factor. In this sense it can be said that these beams are also nondiffracting. In this work, the scheme leading to this different kind of nondiffracting fields, which we term propagation-independent beams, is presented. Closed-form expressions for a few of these fields, for 1-D sources, are found. A method, which in principle is able to produce beams of this type, is given. This also clarifies some of their properties. Finally, the item of finite realizations of these beams, which in principle require infinite-dimension sources, is analyzed through numerical simulations. It is also shown that the practical feasibility of these fields poses some limitations on the bandwidth they can present.

PSpice modeling of capacitive microfabricated ultrasonic transducers.

Capacitive microfabricated ultrasonic transducers (cMUTs) are the newest and potentially the most promising devices to convert electrical into acoustic signals and vice-versa. These devices are based on the capacitance modulation of a microcondenser which is obtained by microfabrication onto a silicon substrate. The aim of this paper is to describe a PSpice model of the cMUT, based on an analytical distributed model previously reported (IEEE Trans. UFFC 49 (2) (2002) 159-168), which can be used to simulate the performances of a general ultrasound system, either in frequency or time domain. The PSpice model consists of a capacitor with a parallel resistor, which represent the static capacitance and the loss and bias resistances of the transducer, respectively, plus two quadrupoles (GLAPLACE) modeling the mechanical impedance of the membranes and the radiation impedance of the medium. The usefulness of a PSpice model is the possibility to simulate and optimize the cMUT transducers in transmission and reception, along with driving and receiving electronics, in a general ultrasound system. Experimental measurements on a 5 MHz cMUT operating in pulse-echo are in good agreement with model predictions.

[Neonatal vocal cord palsy. Clinical and therapeutical approaches]. / La paralisi delle corde vocali in età neonatale. Orientamenti clinici, chirurgici e contributo casistico.

Between 1998 and 2000, four newborns have been observed for laryngeal stridor occurred some hours after birth. Otorhinolaryngologic examinations, as well as cardiac, neuroradiologic and serologic investigations have been performed to formulate the diagnosis and verify the etiology. The fiberoptic laryngoscopy showed a bilateral paralysis of the vocal cord in two newborns, a monolateral paralysis of the left vocal cord in another and in the last one, instead, a bilateral cordal hypomobility. The follow-up performed till the age of one year showed a complete remission of the symptomatology in two newborns, respectively in the one with monolateral paralysis and in the other affected by hypomobility of the vocal cords; of the two newborns with bilateral paralysis, instead, one is dead because of Haemophilus Influenzae epiglottitis, three weeks after discharge without physicians' consensus, while in the other patient, affected by lobar holoprosencephaly, it was necessary to perform a tracheotomy because of a severe obstructive apnea. The lobar holoprosencephaly, is a cerebral malformation characterized by the partial separation of the cerebral hemispheres, and it is described for the first time associated with bilateral vocal cords paralysis.

Characterization of two new alleles at the goat CSN1S2 locus.

Two novel alleles at the goat CSN1S2 locus have been identified: CSN1S2(F) and CSN1S2(D). Sequence analyses revealed that the CSN1S2(F) allele is characterized by a G --> A transition at the 13th nucleotide in exon 3 changing the seventh amino acid of the mature protein from Val to Ile. The CSN1S2(D) allele, apparently associated with a decreased synthesis of alpha s2-casein, is characterized by a 106-bp deletion, involving the last 11 bp of the exon 11 and the first 95 bp of the following intron. Methods (PCR-RFLP and PCR) for identification of carriers of these alleles have been developed.

Frequency decomposition and compounding of ultrasound medical images with wavelet packets.

Ultrasound beams propagating in biological tissues undergo distortions due to local inhomogeneities of the acoustic parameters and the nonlinearity of the medium. The spectral analysis of the radio-frequency (RF) backscattered signals may yield important clinical information in the field of tissue characterization, as well as enhancing the detectability of tissue parenchymal diseases. In this paper, we propose a new tissue spectral imaging technique based on the wavelet packets (WP) decomposition. In a conventional ultrasound imaging system, the received echo-signals are generally decimated to generate a medical image, with a loss of information. With the proposed approach, all the RF data are processed to generate a set of frequency subband images. The ultrasound echo signals are simultaneously frequency decomposed and decimated, by using two quadrature mirror filters, followed by a dyadic subsampling. In addition, to enhance the lesion detectability and the image quality, we apply a nonlinear filter to reduce noise in each subband image. The proposed method requires simple additional signal processing and it can be implemented on any real-time imaging system. The frequency subband images, which are available simultaneously, can be either used in a multispectral display or summed up together to reduce speckle noise. To localize the different frequency response in the tissues, we propose a multifrequency display method where three different subband images, chosen among those available, are encoded as red, green, and blue intensities (RGB) to create a false-colored RGB image. According to the clinical application, different choices can evidence different spectral proprieties in the biological tissue under investigation. To enhance the lesion contrast in a grey-level image, one of the possible methods is the summation of the images obtained from narrow frequency subbands, according to the frequency compounding technique. We show that by adding the denoised subband images created with the WP decomposition, the contrast-to-noise ratio in two phantom images is largely increased.

Optimization of wide-band linear arrays.

An optimization method is proposed for linear arrays to be used in ultrasound systems under wide-band operation. A fast algorithm, the threshold accepting, has been utilized to determine the element positions and weight coefficients of a linear array that generates a desired beam pattern. To reduce the computational burden in the optimization procedure, an efficient numerical routine for the beam pattern evaluation has been implemented. We address the optimization problem of both dense and sparse wide-band arrays. In the first case, the goal is to minimize the side-lobe energy by varying the element weights; we compare the optimized beam pattern with that obtained with classical shading functions, showing that better results can be achieved with a wide-band optimization. We also consider the optimization of the layout (positions and weights) of a sparse linear array to achieve a desired beam pattern with a fixed or minimum number of array elements. The comparison of the proposed method with a narrow-band optimization algorithm is presented, showing that better performances (about -7 dB further reduction of the side-lobe level) can be achieved with a wide-band sparse array optimization. Further numerical simulations are given, showing that the proposed method yields better results than wide-band sparse random arrays and periodic arrays with the same aperture width.

[Helical CT without contrast media as alternative to other methods in urolithiasis]. / La Tc spirale senza mdc in alternativa alle altre metodiche nella urolitiasi.

PURPOSE: During the last five years the use of unenhanced helical CT (HTC) has been proposed as a preliminary diagnostic approach in patients with typical renal colics or with nonspecific flank pain. The aim of this study was to describe our experience in this field. MATERIAL AND METHODS: 130 consecutive patients (82 men and 48 women, with an average age of 54 years) were studied; 94 of them presented typical renal colics, while 36 presented acute flank pain. The parameters used were: 5-mm-thick sections, a pitch of 1.6, a reconstruction interscan spacing at 3 mm, an examination area extending from the kidneys to the base of the bladder. Depending on the case, examinations were carried out using urography in the instrumental or surgical pretreatment phase, ultrasonography to check urinary dilatation and juxtavesical calculi, pyeloMR, ureteroscopic extraction, surgical operation, extracorporeal lithotripsy, and finally the expulsion of the calculi was checked. RESULTS: 81 cases of urolithiasis, 6 cases of renal abnormalities and other renal pathologies, 23 cases of extraurinary pathologies correlated to the symptoms, 5 cases of extraurinary pathologies not correlated to the symptoms and 15 normal cases, were diagnosed. The results obtained were a) a sensitivity of 96.8%, a specificity of 98.4% and a diagnostic accuracy of 97.6% in identifying ureteral calculi; b) a diagnostic accuracy of 100% in identifying urinary tract dilatation; c) a sensitivity of 100% and a specificity of 96.7% in determining the level of obstruction; d) a sensitivity of 92.9% and a specificity of 100% in determining the cause of obstruction. CONCLUSIONS: Confirming the data in the medical literature, helical CT has yielded for more reliable results than the other procedures in identifying the following: calculi, acute obstruction of the urinary tract and other urinary and extraurinary pathologies correlated to the symptoms. Therefore helical CT, where available, must be accepted as the method of preliminary evaluation in all patients with typical renal colics or with nonspecific flank pain.