Identification of recurring scapular fracture patterns using 3-dimensional computerized fracture mapping.

BACKGROUND: Scapular fracture fixation and implant selection are guided by the fracture pattern and classification, which requires accurate understanding and interpretation of the fracture lines. Three-dimensional (3D) computed tomography (CT)-based fracture pattern analysis enhances a more accurate understanding of the scapular fracture patterns. The purpose of this study was to create scapular fracture maps and identify the frequent fracture patterns using 3D reconstructed CT images. METHOD: Seventy patients treated for scapular fractures, in a single hospital, were considered for this study. Their CT images were reconstructed into 3D models and the fracture fragments were virtually reduced. The reduced 3D models were first aligned on a 3D template and 2D images were captured on the anterior, posterior, and lateral views. Then each fracture image was aligned on a corresponding 2D template and the fracture lines were transferred to the template. The 3 separate views were used to accurately capture the propagation and exit of the fractures through the scapular anatomy. These fracture lines were compiled and heat maps were generated to identify the frequent fracture zones of the scapula. RESULT: The observed scapular fractures propagated through multiple regions of the bone. Overall, the 3 most common exit zones in the scapula were the lateral (69%), medial (67%), and superior borders (60%). More specifically, the superior lateral border, medial base of the scapula spine, spinoglenoid notch, and mid-superior border were the most frequent zones of fracture in the scapular body. Simple intra-articular fractures (transverse or oblique type) were the most common (92%) fracture type in the glenoid region. CONCLUSION: Scapular fractures reveal repeatable patterns. The zones of recurrent fracture patterns can be identified from fracture and heat maps. Graphical plots of fracture and heat maps may assist surgical planning and implant design optimization.

High-throughput analysis of T cell-monocyte interaction in human tuberculosis.

The lack of efficient tools for identifying immunological correlates of tuberculosis (TB) protection or risk of disease progression impedes the development of improved control strategies. To more clearly understand the host response in TB, we recently established an imaging flow cytometer-based in-vitro assay, which assesses multiple aspects of T cell-monocyte interaction. Here, we extended our previous work and characterized communication between T cells and monocytes using clinical samples from individuals with different TB infection status and healthy controls from a TB endemic setting. To identify T cell-monocyte conjugates, peripheral blood mononuclear cells (PBMC) were stimulated with ds-Red-expressing Mycobacterium bovis bacille Calmette-Guérin or 6-kDa early secreted antigenic target (ESAT 6) peptides for 6 h, and analyzed by imaging flow cytometer (IFC). We then enumerated T cell-monocyte conjugates using polarization of T cell receptor (TCR) and F-actin as markers for synapse formation, and nuclear factor kappa B (NF-κB) nuclear translocation in the T cells. We observed a reduced frequency of T cell-monocyte conjugates in cells from patients with active pulmonary tuberculosis (pTB) compared to latent TB-infected (LTBI) and healthy controls. When we monitored NF-κB nuclear translocation in T cells interacting with monocytes, the proportion of responding cells was significantly higher in active pTB compared with LTBI and controls. Overall, these data underscore the need to consider multiple immunological parameters against TB, where IFC could be a valuable tool.

Biological Brain Age Prediction Using Cortical Thickness Data: A Large Scale Cohort Study.

Brain age estimation from anatomical features has been attracting more attention in recent years. This interest in brain age estimation is motivated by the importance of biological age prediction in health informatics, with an application to early prediction of neurocognitive disorders. It is well-known that normal brain aging follows a specific pattern, which enables researchers and practitioners to predict the age of a human's brain from its degeneration. In this paper, we model brain age predicted by cortical thickness data gathered from large cohort brain images. We collected 2,911 cognitively normal subjects (age 45-91 years) at a single medical center and acquired their brain magnetic resonance (MR) images. All images were acquired using the same scanner with the same protocol. We propose to first apply Sparse Group Lasso (SGL) for feature selection by utilizing the brain's anatomical grouping. Once the features are selected, a non-parametric non-linear regression using the Gaussian Process Regression (GPR) algorithm is applied to fit the final age prediction model. Experimental results demonstrate that the proposed method achieves the mean absolute error of 4.05 years, which is comparable with or superior to several recent methods. Our method can also be a critical tool for clinicians to differentiate patients with neurodegenerative brain disease by extracting a cortical thinning pattern associated with normal aging.

Update in Management of Severe Hypoxemic Respiratory Failure.

Mortality related to severe-moderate and severe ARDS remains high. We searched the literature to update this topic. We defined severe hypoxemic respiratory failure as Pao2/Fio2 < 150 mm Hg (ie, severe-moderate and severe ARDS). For these patients, we support setting the ventilator to a tidal volume of 4 to 8 mL/kg predicted body weight (PBW), with plateau pressure (Pplat) ≤ 30 cm H2O, and initial positive end-expiratory pressure (PEEP) of 10 to 12 cm H2O. To promote alveolar recruitment, we propose increasing PEEP in increments of 2 to 3 cm provided that Pplat remains ≤ 30 cm H2O and driving pressure does not increase. A fluid-restricted strategy is recommended, and nonrespiratory causes of hypoxemia should be considered. For patients who remain hypoxemic after PEEP optimization, neuromuscular blockade and prone positioning should be considered. Profound refractory hypoxemia (Pao2/Fio2 < 80 mm Hg) after PEEP titration is an indication to consider extracorporeal life support. This may necessitate early transfer to a center with expertise in these techniques. Inhaled vasodilators and nontraditional ventilator modes may improve oxygenation, but evidence for improved outcomes is weak.

Light-emitting diode with various sputum smear preparation techniques to diagnose tuberculosis.

SETTING: Mawenzi Regional Hospital, northern Tanzania. OBJECTIVE: To determine the value of light-emitting diode (LED) microscopy in diagnosing tuberculosis (TB) on bleach-treated and direct sputum smears. DESIGN: Sputum samples were collected from patients suspected of pulmonary TB who presented consecutively at the laboratory for smear evaluation between December 2009 and February 2010. Four smears were prepared from each specimen: conventional Ziehl-Neelsen (ZN), direct auramine, bleach centrifugation and bleach short sedimentation auramine smears. A light microscope was used to examine ZN smears and an LED fluorescent microscope to examine auramine-stained smears. RESULTS: Of the 267 sputum samples examined, respectively 78 (29%), 62 (23%), 74 (28%) and 48 (18%) were acid-fast bacilli (AFB) positive by the bleach centrifugation, bleach short sedimentation, direct auramine and ZN methods. Bleach centrifugation identified 30 (11%) more positives than ZN microscopy (P < 0.001), but was not superior to the direct auramine method (P = 0.46), which yielded 26 (10%) more positives than ZN microscopy (P < 0.001). Fluorescent LED required a shorter smear reading time (1.5 min on average), while the light microscope took 4 min (P < 0.001). CONCLUSION: Fluorescent LED microscopy with direct smear preparation is rapid and effective. Further studies are needed to ascertain its performance under routine conditions.

Bovine tuberculosis in Ethiopian wildlife.

Bovine tuberculosis (BTB) is endemic in Ethiopian cattle. However, the status of the disease in wildlife populations that often share habitat with livestock is unknown. We screened for BTB in wildlife in five regions in Ethiopia. Blood and tissue samples from 133 mammals of 28 species were collected from 2006 to 2008. We used a rapid serology test (RT) based on lateral flow technology, and performed culture of lymph node specimens inoculated onto Lowenstein-Jensen and Middlebrook 7H11 media. Acid-fast colonies were further analyzed by molecular typing. Sera from 20 of 87 animals (23%) were positive for BTB by RT; acid-fast bacilli were cultured from 29 of 89 animals (32.5%). None of the positive cultures yielded mycobacteria from the Mycobacterium tuberculosis complex but many environmental mycobacteria were isolated. Among these, Mycobacterium terrae was the most common. We demonstrated a high prevalence of environmental mycobacteria in wildlife, the role of which is unknown. Flagship rare endemic species such as the mountain nyala (Tragelaphus buxtoni) and the Ethiopian wolf (Canis simensis) may be at risk for BTB. We also assessed the utility of RT for field purposes.

Transmission of Schistosoma Mansoni in Tikur Wuha Area; Southern Ethiopia

Background: Although the epidemiology of schistosomiasis is well established and the disease distribution has also been mapped in Ethiopia; discovery of new foci has continuously been reported. Objectives: The objective of this study was to assess the establishment of transmission of schistosomiasis mansoni in Tikur Wuha area; southern Ethiopia. Methods: A cross-sectional epidemiological study involving 375 school children in Tikur Wuha Elementary School was conducted in December 2007 and January 2008. Stool specimens were collected and microscopically examined using Kato-Katz method. Snail survey was also conducted using scoop in Tikur Wuha River and littoral zone of Lake Awassa on the side of Tikur Wuha Kebele (administrative unit). The snails collected were checked for trematode infection by shedding. Laboratory-bred mice were exposed to schistosome cercariae and definite identification of the schistosome was made using eggs and adult worm morphology. Results: The prevalence and intensity of schistosomiasis mansoni was 12and 69 eggs per gram (epg) of stool; respectively. Biomphalaria sudanica collected in Tikur Wuha River shed schistosome cercariae. Adult S. mansoni worms were harvested from laboratory-bred mice after 6 weeks of laboratory maintenance. Conclusion: The prevalence and intensity of schistosomiasis mansoni among school children was low and the area represents low-risk community. The finding of S. mansoni infected young children; the collection of B. sudanica infected with schistosome cercariae; and the establishment of infection in lab-bred mice all confirmed the transmission of schistosomiasis mansoni in Tikur Wuha area. Appropriate intervention measures need to be in place to reduce morbidity and transmission of intestinal schistosomiasis in the area. [Ethiop. J. Health Dev. 2010;24(3):180-184]