Cavernous Sinus Thrombosis: Case Report

Case Report: 55y male, known diabetic, presents with headache, fever, left eye pain with swelling, ptosis, left eye vision loss, altered sensorium of acute onset.

MRI brain & orbits findings  ( CEMRI not done, in view of elevated serum creatinine) –

-     Proptosis of left eyeball with altered signal/fat stranding in intraconal & superomedial extraconal compartment of left orbit with bulky superior/medial rectus/superior oblique  muscles & bulky STIR hyperintense left optic nerve – suggesting orbital infective / inflammatory changes like cellulitis with acute optic neuritis.

    Patchy mucosal thickening with T2 iso to hypointense signal in ethmoid sinus & mild expansion of sinus with ill defined left lateral wall of the ethmoid sinus – suggesting sinusitis (like fungal/other bacterial). Fluid signal seen in sphenoid sinus along with mucosal thickening in both maxillary sinuses.

    Left cavernous sinus is ill defined/ bulky with T1 hypointense signal with effacement of fat signal in it & T2 altered isointense signal with thin soft tissue in its margin reaching upto left orbital apex – likely suggesting septic thrombosis of the left cavernous sinus.

-    Focal diffusion restriction in left hypothalamus / left anterior commissure near midline & left temporal lobe inferomedially – acute infarcts, likely due to infective vasculitis.  Ill defined mild diffusion restriction in left basifrontal lobe white matter – could be acute ischemic lesion or due to encephalitis. Loss of T2 flow void with smaller caliber of left ICA in carotid canal & cavernous segments ( cavernous more than carotid canal) – suggesting thrombosis.

Discussion by Dr MGK Murthy, Dr GA Prasad 

•          Cavernous sinus is extradural venous plexus surrounded by a dural fold in the middle cranial fossa containing internal carotid artery with its periarterial sympathetic plexus, abducens nerve lateral to the internal carotid artery, but medial to the oculomotor and trochlear nerves and the ophthalmic and maxillary divisions of the trigeminal nerve, which run superior to inferior within the lateral dural border of the cavernous sinus.
• 
  
•          Thrombosis of the cavernous sinus is usually caused by bacterial or fungal invasion complicating sinusitis in patients with poorly controlled diabetes or immunosuppression.
•           Clinically  characterized  by multiple cranial neuropathies with impairment of  ocular motor nerves, Horner's syndrome, and sensory loss of the first or second divisions  of the trigeminal nerve in various combinations. The pupil may or may not be involved.
•          CT and MR imaging direct signs are changes in signal intensity and in the size and contour of the cavernous sinus, and indirect signs are dilatation of the tributary veins, exophthalmos, and increased dural enhancement along the lateral border of the cavernous sinus.

  Few infective agents are-

Actinomycosis -  mostly immunocompetent patients( men >women), bacteria generally gain access to the central nervous system by direct extension from the ear or sinuses or hematogenous spread from a distant source &  may appear as an irregularly marginated, rim-enhancing abscess, meningoencephalitis, or as a mass lesion.

Rhinocerebral Mucormycosis fungi cause fulminant infection in immunocompromised and diabetic patients. After inhalation into  the nasal cavity and paranasal sinuses, the fungi cause necrotizing vasculitis, thrombosis, or infarction of the nose and sinuses and  can then rapidly extend into the orbits, deep  nervous system may be invaded directly by extension  through the skull base or indirectly  through involvement of the carotid artery and  cavernous sinus.

Aspergillosis  - most commonly as a  result of hematogenous spread and occasionally

by direct extension of infection from the  paranasal sinuses, middle ear, or orbit, mostly in immunocompromised patients, tend to invade vessels. Decreased signal intensity on T1-weighted  imaging and very low signal intensity on T2- weighted imaging are characteristic findings  in paranasal sinus aspergillosis and are attributed  to paramagnetic elements by hemorrhage or aspergillus fungal colonies, mainly iron and magnesium.

Noninfectious Inflammation of cavernous sinus are -

Tolosa-Hunt Syndrome -  recurrent painful ophthalmoplegia due to nonspecific granulomatous

inflammation in the anterior  cavernous sinus, superior orbital fissure, or orbital apex with  MR

findings include nonspecific inflammatory lesions isointense to T1- and T2-weighted images in the anterior cavernous sinus, the superior orbital fissure, or the orbital apex  with contrast enhancement.

Inflammatory Pseudotumor -  idiopathic inflammatory lesions with rare  skull base involvement.  MR findings include soft-tissue lesions infiltrating the skull base

with intracranial dural involvement, bone destruction, iso- to hypointensity on T2-weighted

images according to the fibrosis and high cellularity, and contrast enhancement

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Prognostic value of FDG-PET and DWI in breast cancer

Abstract

Objective

To investigate the prognostic value of preoperative FDG-PET/CT and diffusion weighted imaging (DWI) in patients with breast cancer.

Methods

A total of 73 patients with newly diagnosed invasive breast cancer who had undergone preoperative whole-body FDG-PET/CT and 3-Tesla breast MRI including DWI followed by surgery were identified. Effects of primary tumor PET parameters [maximum standardized uptake value (SUV_max), mean SUV (SUV_mean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)] and DWI parameters [mean apparent diffusion coefficient (ADC_mean) and minimum ADC (ADC_min)] including clinicopathologic factors on disease-free survival (DFS) were retrospectively evaluated using the log-rank and Cox methods.

Results

After a median overall follow-up of 32.3 months in all patients, 6 (8.2%) of the 73 patients had recurrence. Receiver operating characteristic curve analysis and log-rank tests showed that patients with a high primary tumor SUV_max (≥ 3.60), MTV (≥ 3.15), and TLG (≥ 16.0) had a significantly lower DFS rate than those with a low SUV_max (< 3.60), MTV (< 3.15), and TLG (< 16.0), respectively (p = 0.0054, p = 0.0054, and p < 0.0001, respectively). SUV_mean, ADC_mean, and ADC_min were not significantly associated with recurrence. Univariate analysis showed that SUV_max (p = 0.0054), MTV (p = 0.0054), TLG (p < 0.0001), tumor size (p = 0.0083), estrogen receptor negativity (p = 0.046), progesterone receptor negativity (p = 0.0023), human epidermal growth factor receptor 2 positivity (p = 0.043), and the presence of axillary lymph node metastasis (p = 0.0037) were also significantly associated with recurrence. However, in multivariate analysis, none of them were an independent factor.

Conclusions

The preoperative SUV_max, MTV, and TLG of primary breast cancer are prognostic factors for recurrence, whereas ADC values are not.

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European Society of Neuroradiology (ESNR)

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Clinical and angiographic outcomes in patients with intracranial aneurysms treated with the pipeline embolization device: intra-procedural technical difficulties, major morbidity, and neurological mortality decrease significantly with increased operator experience in device deployment and patient management

Abstract

Purpose

Flow diversion constitutes a pivotal advancement in endovascular intracranial aneurysm treatment, but requires development of a new skill set. The aim of this study is to determine whether outcomes after treatment with the Pipeline Embolization Device improve with experience.

Methods

We retrospectively reviewed all patients with intracranial aneurysms treated with Pipeline at two centers over a 4.5-year period. Baseline patient and aneurysm characteristics, complications, and angiographic outcomes were analyzed.

Results

One hundred forty patients underwent 150 Pipeline procedures to treat 167 intracranial aneurysms during the study period, 109 women, mean age 55.4 years. One hundred twenty-six aneurysms were ICA, mean size 10.2 mm and mean neck 6.4 mm. Intra-procedural technical difficulties were higher during the first 75 procedures compared with the subsequent 75 (13.3 vs 2.7%; p = 0.03), as combined major morbidity and neurological mortality (14.7 vs 4%; p = 0.046). In multivariate regression analysis, increased operator experience with Pipeline remained an independent predictor of intra-procedural technical difficulties (p = 0.02, odds ratio (OR) 0.015, 95% CI 0.0004–0.55) and combined major morbidity and neurological mortality (p = 0.03, OR 0.16, 95% CI 0.03–0.84). At last follow-up, 123 aneurysms were completely occluded (81.5%, mean 24 months). In our cohort, age ≤ 53 years was an independent predictor of complete aneurysm occlusion at last follow-up (p = 0.001, OR 0.92, 95% CI 0.88–0.97). Five aneurysms were retreated (3.3%).

Conclusion

The Pipeline embolization device is an effective treatment for intracranial aneurysms. The risk of intra-procedural technical difficulties and combined major morbidity and neurological mortality decreases significantly with increased operator experience in Pipeline deployment and patient management.

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High-resolution vessel wall MRI for the evaluation of intracranial atherosclerotic disease

Abstract

High-resolution vessel wall MRI (vwMRI) of the intracranial arteries is an emerging diagnostic imaging technique with the goal of evaluating vascular pathology. vwMRI sequences have high spatial resolution and directly image the vessel wall by suppressing blood signal. With vwMRI, it is possible to identify distinct morphologic and enhancement patterns of atherosclerosis that can provide important information about stroke etiology and recurrence risk. We present a review of vwMRI research in relation to intracranial atherosclerosis, with a focus on the relationship between ischemic stroke and atherosclerotic plaque T1 post-contrast enhancement or plaque/vessel wall morphology. The goal of this review is to provide readers with the most current understanding of the reliability, incidence, and importance of specific vwMRI findings in intracranial atherosclerosis, to guide their interpretation of vwMRI research, and help inform clinical interpretation of vwMRI. We will also provide a translational perspective on the existing vwMRI literature and insight into future vwMRI research questions and objectives. With increased use of high field strength MRI, powerful gradients, and improved pulse sequences, vwMRI will become standard-of-care in the diagnosis and prognosis of patients with cerebrovascular disease, making a firm grasp of its strengths and weakness important for neuroimagers.

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Follow-up of pineal cysts in children: is it necessary?

Abstract

Purpose

Pineal cysts are common incidental findings in children undergoing magnetic resonance imaging (MRI). Several studies have suggested MRI follow-up if the cyst is larger than 10 mm. However, cysts do not usually change during follow-up. Prevalence, growth, and structure of the pineal cysts were analyzed to decide if follow-up MRI is necessary.

Methods

A retrospective review between 2010 and 2015 was performed using 3851 MRI examinations of children aged 0–16 years to detect pineal cysts having a maximum diameter ≥ 10 mm. Eighty-one children with pineal cysts were identified and 79 of them had been controlled by MRI. Cysts were analyzed for the size, growth, and structure.

Results

A total of 1.8% of the children had a pineal cyst with a diameter ≥ 10 mm. Cysts were present in 48 girls (59.3%) and 33 boys (40.7%). Most pineal cysts (70/79) did not significantly grow during the follow-up (median 10 months, range 3–145 months). A total of 11.4% (9/79) of the cysts grew with the biggest change measured from the outer cyst wall sagittal anteroposterior dimension (mean 3.4 mm ± 1.7 mm). Only one cyst grew more than 5 mm. We found no factors correlating with the cyst growth among 9 cysts that grew > 2 mm.

Conclusions

A majority of pineal cysts remained unchanged during the MRI follow-up. Results of this study suggest that routine MRI follow-up of pineal cysts is not necessary in the absence of unusual radiological characteristics or related clinical symptoms.

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European Society of Neuroradiology (ESNR)

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Ecotracer: analyzing concentration of contaminants and radioisotopes in an aquatic spatial-dynamic food web model

Publication date: January 2018
Source:Journal of Environmental Radioactivity, Volume 181
Author(s): William J. Walters, Villy Christensen
Ecotracer is a tool in the Ecopath with Ecosim (EwE) software package used to simulate and analyze the transport of contaminants such as methylmercury or radiocesium through aquatic food webs. Ecotracer solves the contaminant dynamic equations simultaneously with the biomass dynamic equations in Ecosim/Ecospace. In this paper, we give a detailed description of the Ecotracer module and analyze the performance on two problems of differing complexity. Ecotracer was modified from previous versions to more accurately model contaminant excretion, and new numerical integration algorithms were implemented to increase accuracy and robustness. To test the mathematical robustness of the computational algorithm, Ecotracer was tested on a simple problem for which we know an analytical solution. These results demonstrated the effectiveness of the program numerics. A much more complex model, the release of the cesium radionuclide ¹³⁷Cs from the Fukushima Dai-ichi nuclear accident, was also modeled and analyzed. A comparison of the Ecotracer results to sampled ¹³⁷Cs measurements in the coastal ocean area around Fukushima show the promise of the tool but also highlight some important limitations.



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Message from the President-Elect of the World Federation of Nuclear Medicine and Biology

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Real-time wireless tumor tracking during breast conserving surgery

Abstract

Purpose

To evaluate a novel surgical navigation system for breast conserving surgery (BCS), based on real-time tumor tracking using the Calypso \(\circledR \) 4D Localization System (Varian Medical Systems Inc., USA). Navigation-guided breast conserving surgery (Nav-BCS) was compared to conventional iodine seed-guided BCS ( \(^{125}\) I-BCS).

Methods

Two breast phantom types were produced, containing spherical and complex tumors in which wireless transponders (Nav-BCS) or a iodine seed ( \(^{125}\) I-BCS) were implanted. For navigation, orthogonal views and 3D volume renders of a CT of the phantom were shown, including a tumor segmentation and a predetermined resection margin. In the same views, a surgical pointer was tracked and visualized. \(^{125}\) I-BCS was performed according to standard protocol. Five surgical breast oncologists first performed a practice session with Nav-BCS, followed by two Nav-BCS and \(^{125}\) I-BCS sessions on spherical and complex tumors. Postoperative CT images of all resection specimens were registered to the preoperative CT. Main outcome measures were the minimum resection margin (in mm) and the excision times.

Results

The rate of incomplete tumor resections was 6.7% for Nav-BCS and 20% for \(^{125}\) I-BCS. The minimum resection margins on the spherical tumors were 3.0 ± 1.4 mm for Nav-BCS and 2.5 ± 1.6 mm for \(^{125}\) I-BCS (p = 0.63). For the complex tumors, these were 2.2 ± 1.1 mm (Nav-BCS) and 0.9 ± 2.4 mm ( \(^{125}\) I-BCS) (p = 0.32). Mean excision times on spherical and complex tumors were 9.5 ±  2.7 min and 9.4 ± 2.6 min (Nav-BCS), compared to 5.8 ± 2.2  min and 4.7 ± 3.4 min ( \(^{125}\) I-BCS, both (p < 0.05).

Conclusions

The presented surgical navigation system improved the intra-operative awareness about tumor position and orientation, with the potential to improve surgical outcomes for non-palpable breast tumors. Results are positive, and participating surgeons were enthusiastic, but extended surgical experience on real breast tissue is required.

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Back so soon? Is early recurrence of papillary thyroid cancer really just persistent disease?

Back so soon? Is early recurrence of papillary thyroid cancer really just persistent disease?

Surgery. 2017 Nov 08;:

Authors: Bates MF, Lamas MR, Randle RW, Long KL, Pitt SC, Schneider DF, Sippel RS

Abstract
BACKGROUND: Papillary thyroid carcinoma has excellent survival, yet recurrence remains a challenge. We sought to determine the proportion of reoperations performed for persistent, rather than truly recurrent, disease.
METHODS: We conducted a retrospective review of a prospectively maintained database. Patients with papillary thyroid carcinoma who underwent reoperation for disease from 2000-2016 were included. We defined recurrence as disease that developed after a patient had an undetectable thyroglobulin and a negative ultrasonography within 1 year of operation.
RESULTS: A total of 69 patients underwent 92 reoperations. On initial pathology, mean tumor size was 2.6 cm, 51% were multifocal, and 42% had extrathyroidal extension. Half (46%) of the patients underwent a central/lateral neck dissection at the initial operation, and 77% were treated with postoperative radioactive iodine. The median time to first reoperation was 21 months (range, 1-292), and 42% occurred within 1 year. Only 3 operations met criteria for true "recurrence," while 71 operations were categorized as persistent disease.
CONCLUSION: Many reoperations for papillary thyroid carcinoma are for management of persistent disease. More than half of the patients required reoperation within the first 2 years, which suggests strongly that improvements in the preoperative assessment and adequacy of initial operative therapy need to be made to improve the care of patients with thyroid cancer.

PMID: 29128176 [PubMed - as supplied by publisher]

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Functional evaluation of swallowing in patients with tongue cancer before and after surgery using high-speed continuous magnetic resonance imaging based on T2-weighted sequences.

Functional evaluation of swallowing in patients with tongue cancer before and after surgery using high-speed continuous magnetic resonance imaging based on T2-weighted sequences.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Oct 09;:

Authors: Nishimura S, Tanaka T, Oda M, Habu M, Kodama M, Yoshiga D, Osawa K, Kokuryo S, Miyamoto I, Kito S, Wakasugi-Sato N, Matsumoto-Takeda S, Joujima T, Miyamura Y, Hitomi S, Yamamoto N, Uehara M, Sasaguri M, Ono K, Yoshioka I, Tominaga K, Morimoto Y

Abstract
OBJECTIVES: The aim of this study was to determine the usefulness of evaluating the function of swallowing before and after surgery in patients with tongue cancer by using T2-weighted sequences of high-speed continuous magnetic resonance imaging (HSCMRI).
STUDY DESIGN: The imaging findings and related parameters on HSCMRI along with those on routine MRI examinations before and after surgery were examined in 19 patients with tongue cancer. In addition, changes in various parameters during 1 year after surgery were evaluated in 10 patients.
RESULTS: In most patients examined, the direction of flow to the esophagus could be seen on HSCMRI before and after surgery. Significant correlations were observed among 4 parameters and in the responses to a dysphagia questionnaire.
CONCLUSIONS: The results of the present study suggest that the dynamics of swallowing can be directly visualized on HSCMRI by using 4 parameters that permit the evaluation of changes before and after surgery, and this enables objective evaluation of patients' swallowing complaints.

PMID: 29128287 [PubMed - as supplied by publisher]

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Complex genetics of Tourette's Syndrome: Piecing the puzzle

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IJMS, Vol. 18, Pages 2409: Lactobacillus plantarum Enhanced IL-22 Production in Natural Killer (NK) Cells That Protect the Integrity of Intestinal Epithelial Cell Barrier Damaged by Enterotoxigenic Escherichia coli

IJMS, Vol. 18, Pages 2409: Lactobacillus plantarum Enhanced IL-22 Production in Natural Killer (NK) Cells That Protect the Integrity of Intestinal Epithelial Cell Barrier Damaged by Enterotoxigenic Escherichia coli

International Journal of Molecular Sciences doi: 10.3390/ijms18112409

Authors: Yueqin Qiu Zongyong Jiang Shenglan Hu Li Wang Xianyong Ma Xuefen Yang

Interleukin (IL)-22-producing Natural Killer (NK) cells protect the gut epithelial cell barrier from pathogens. A strain of probiotics, Lactobacillus plantarum (L. plantarum, LP), was previously found by our laboratory to significantly improve the mucosal barrier integrity and function of the small intestine in pigs. However, it was unclear whether LP benefited the intestinal mucosal barrier via interactions with the intestinal NK cells. The present study, therefore, was focused on the therapeutic effect of NK cells that were stimulated by LP on attenuating enterotoxigenic Escherichia coli (ETEC)-induced the damage to the integrity of the epithelial cell barrier. The results showed that LP can efficiently increase protein levels of the natural cytotoxicity receptor (NCR) family, and the expression levels of IL-22 mRNA and protein in NK cells. Transfer of NK cells stimulated by LP conferred protection against ETEC K88-induced intestinal epithelial barrier damage in NCM460 cells. We found that NK cells stimulated by LP could partially offset the reduction in NCM460 cell monolayers transepithelial electrical resistance (TEER) caused by ETEC K88, and increase ZO-1 and occludin mRNA and protein expressions by ETEC K88-infected NCM460 cells. Furthermore, adding NK cells that were stimulated by LP to ETEC K88-infected NCM460cells, IL-22R1, p-Stat3, and p-Tyk2 expression by NCM460 cells was increased. Mechanistic experiment showed that NK cells stimulated by LP lost the function of maintaining TEER of NCM460 cells challenged with ETEC K88, when polyclonal anti-IL-22 antibody was used to block IL-22 production. Collectively, our results suggested that LP stimulation of NK could enhance IL-22 production, which might be able to provide defense against ETEC-induced damage to the integrity of intestinal epithelial barrier.

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IJMS, Vol. 18, Pages 2405: Structure and Functional Analysis of Promoters from Two Liver Isoforms of CPT I in Grass Carp Ctenopharyngodon idella

IJMS, Vol. 18, Pages 2405: Structure and Functional Analysis of Promoters from Two Liver Isoforms of CPT I in Grass Carp Ctenopharyngodon idella

International Journal of Molecular Sciences doi: 10.3390/ijms18112405

Authors: Yi-Huan Xu Zhi Luo Kun Wu Yao-Fang Fan Wen-Jing You Li-Han Zhang

Carnitine palmitoyltransferase I (CPT I) is a key enzyme involved in the regulation of lipid metabolism and fatty acid β-oxidation. To understand the transcriptional mechanism of CPT Iα1b and CPT Iα2a genes, we cloned the 2695-bp and 2631-bp regions of CPT Iα1b and CPT Iα2a promoters of grass carp (Ctenopharyngodon idella), respectively, and explored the structure and functional characteristics of these promoters. CPT Iα1b had two transcription start sites (TSSs), while CPT Iα2a had only one TSS. DNase I foot printing showed that the CPT Iα1b promoter was AT-rich and TATA-less, and mediated basal transcription through an initiator (INR)-independent mechanism. Bioinformatics analysis indicated that specificity protein 1 (Sp1) and nuclear factor Y (NF-Y) played potential important roles in driving basal expression of CPT Iα2a gene. In HepG2 and HEK293 cells, progressive deletion analysis indicated that several regions contained cis-elements controlling the transcription of the CPT Iα1b and CPT Iα2a genes. Moreover, some transcription factors, such as thyroid hormone receptor (TR), hepatocyte nuclear factor 4 (HNF4) and peroxisome proliferator-activated receptor (PPAR) family, were all identified on the CPT Iα1b and CPT Iα2a promoters. The TRα binding sites were only identified on CPT Iα1b promoter, while TRβ binding sites were only identified on CPT Iα2a promoter, suggesting that the transcription of CPT Iα1b and CPT Iα2a was regulated by a different mechanism. Site-mutation and electrophoretic mobility-shift assay (EMSA) revealed that fenofibrate-induced PPARα activation did not bind with predicted PPARα binding sites of CPT I promoters. Additionally, PPARα was not the only member of PPAR family regulating CPT I expression, and PPARγ also regulated the CPT I expression. All of these results provided new insights into the mechanisms for transcriptional regulation of CPT I genes in fish.

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IJMS, Vol. 18, Pages 2402: Clinical Usefulness of the Platelet-to Lymphocyte Ratio in Patients with Angiosarcoma of the Face and Scalp

IJMS, Vol. 18, Pages 2402: Clinical Usefulness of the Platelet-to Lymphocyte Ratio in Patients with Angiosarcoma of the Face and Scalp

International Journal of Molecular Sciences doi: 10.3390/ijms18112402

Authors: Gen Suzuki Hideya Yamazaki Norihiro Aibe Koji Masui Naomi Sasaki Daisuke Shimizu Takuya Kimoto Jun Asai Makoto Wada Satoshi Komori Norito Katoh Kei Yamada

Angiosarcoma of the face and scalp (ASFS) is an extremely aggressive tumor that frequently metastasizes, often leading to death. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) are inflammatory markers that predict outcome of various cancers. We aimed to examine the relationship between pretreatment inflammatory markers and ASFS outcome. We included 17 patients with ASFS and a control group of 56 age- and gender-matched healthy individuals. Total white blood counts, neutrophil, lymphocyte, monocyte, and platelet counts were recorded; NLR, PLR, and LMR were calculated. Kaplan–Meier curves were used to calculate overall survival (OS) and distant metastasis-free survival (DMFS). Optimal cut-off values for each inflammatory marker were calculated using receiver operating curve analysis. Median follow-up was 22 months (range, 6–75). There was a statistically significant difference in absolute neutrophil counts and NLR between patient and control groups. Two-year OS and DMFS rates were 41% and 35%, respectively. In patients with tumors &lt; 10 cm, PLR was highly correlated with DMFS, with the 2-year DMFS for those with a high PLR being 50% compared with 100% for those with a low PLR (p = 0.06). This study suggests that PLR is superior to NLR and LMR, and is a clinically useful marker in patients with ASFS with small tumors.

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Airyscan super-resolution microscopy of mitochondrial morphology and dynamics in living tumor cells

Abstract

Mitochondrial morphology is regulated by continuous fusion-and-fission events that are essential for maintaining normal function. Despite the prominence of mitochondrial function in energy generation and cell signaling, understanding of processes of fusion and fission dynamics has been hampered by the lack of high-resolution optical systems that accommodate live-cell imaging. We have examined different confocal modalities in terms of resolution and signal-to-noise ratio (SNR) in a point scanning confocal microscope with Airyscan super-resolution (AS-SR). Results indicated that Airyscan (AS) provided speed, super-resolution, and high SNR. This modality was then used for monitoring mitochondrial dynamics in live tumor cells modified to harbor green-fluorescent protein localized to mitochondria. We then compared regular AS and fast-Airyscan modalities in terms of gentleness on the live-cell samples. The fast mode provided unprecedented imaging speed that permits monitoring dynamics both in 2D and also in three-dimensional dataset with time lapses (4D). Alterations to the mitochondrial network in U87 glioblastoma cells occurred within seconds and the cells were not affected by modest inhibition of fission. The super-resolution permitted quantitative measurements of mitochondrial diameter with a precision that enabled detection of significant differences in mitochondrial morphology between cell lines. We have observed swelling of mitochondrial tubules in A549 lung cancer cells after 2 hr treatment with deoxynyboquinone, an ROS-generating pharmacologic drug. We also tested different 3D analytical parameters and how they can affect morphometric quantitation. The AS-SR imaging enabled high-speed imaging of mitochondrial dynamics without the compromise to cell morphology or viability that is common with conventional fluorescence imaging due to photo-oxidation.

Airyscan super-resolution microscopy provided higher speed, resolution, and SNR than confocal in imaging mitochondrial dynamics and physiological responses in living tumor cells.

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A New Paradigm? Peter Berger's "The Two Pluralisms"

The article discusses Peter Berger’s suggestion to replace the secularization theory by a "new paradigm" of a double plurality: the plurality of religions and the plurality (rather: polarity) of the religious and the secular sphere. Whether this constitutes a new paradigm seems just as questionable as whether it is a paradigm at all. After having discussed these two questions the article engages with the basic tenets of Berger’s concept by asking whether the paradigm is convincing. The discussion focusses on Berger’s concept of religion, which puts the secular and the religious sphere in opposition to each other – not only in the society but also in the consciousness of the religious subject.

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Wege einer pluralistischen Theologie der Religionen

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Wilhelm Martin Leberecht de Wette (1780–1849) : ein unfreiwilliger Wahlbasler

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Winter crisis? What crisis?

Winter provides a test of NHS resilience, each year foreshadowed by evermore claims that this time there really will be a major breakdown. No winter since 2012-13 has passed without warnings of...

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Fatigue and risk: are train drivers safer than doctors?

Key messagesFatigue is a major risk factor for mistakes and poor decision making in the workplaceIndividual workers are very poor at assessing their own fatigue riskAttitudes to breaks and long hours...

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Eosinophilic esophagitis: update on management and controversies

Eosinophilic esophagitis is a chronic allergen driven immune mediated disease that is increasingly recognized as a leading cause of dysphagia and foregut symptoms in children and adults. Much...

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Equivalence in outcomes between Draf 2B vs Draf 3 frontal sinusotomy for refractory chronic frontal rhinosinusitis

Background

Endoscopic Draf 2B and Draf 3 frontal sinusotomies are frequently performed for chronic refractory frontal rhinosinusitis. The purpose of this study was to compare outcomes between Draf 2B and Draf 3 procedures.

Methods

A retrospective cohort study was conducted comparing patients undergoing bilateral Draf 2B vs Draf 3 procedures from 2000 to 2016. Patients with neoplasia, dysplasia, mucocele, cystic fibrosis, or ciliary dyskinesia were excluded. Preoperative disease parameters included number of prior surgeries, presence of polyps, preoperative 22-item Sino-Nasal Outcome Test (SNOT-22) score, frontal Lund-Mackay score, anterior-posterior diameter of the frontal ostium, and Global Osteitis Scoring Scale (GOSS). Postoperative outcomes included SNOT-22 score, neo-ostium patency, surgical revision rates, and complications.

Results

A total of 21 patients with bilateral Draf 2B and 17 patients with Draf 3 surgeries were compared. Mean follow-up time was 15.6 months. No significant differences were seen between groups for any preoperative disease parameter. Both cohorts showed statistically significant (p = 0.0001 [Draf 2B]; p = 0.0001 [Draf 3]) and clinically meaningful (Δ = 24.1; Δ = 24.9) improvements in SNOT-22 at last follow-up vs preoperatively. The Draf 2B group had greater improvement in SNOT-22 score than the Draf 3 group at 1 to 3 months (p = 0.003), but the magnitude of improvement equalized at 5 to 9 months (p = 0.66) and last follow-up (p = 0.90). No significant differences were noted between groups regarding patency, revision rates, or complications.

Conclusion

Both Draf 2B and Draf 3 procedures offer durable symptomatic improvement for patients with refractory frontal CRS. The Draf 2B is associated with earlier postoperative symptom improvement and overall shows comparable long-term outcomes to the Draf 3 sinusotomy.

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JPM, Vol. 7, Pages 6: Psychiatric Disorders Differently Correlate with Physical Self-Rated Health across Ethnic Groups

JPM, Vol. 7, Pages 6: Psychiatric Disorders Differently Correlate with Physical Self-Rated Health across Ethnic Groups

Journal of Personalized Medicine doi: 10.3390/jpm7040006

Authors: Shervin Assari

In this study, we compared 10 ethnic groups for associations between psychiatric disorders and physical self-rated health (SRH) in the United States. Data came from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001–2003. The study included 7587 non-Latino White, 4746 African American, 1442 Mexican, 1106 other Hispanic, 656 other Asian, 600 Chinese, 577 Cuban, 520 Vietnamese, 508 Filipino, and 495 Puerto Rican individuals. The Composite International Diagnostic Interview (CIDI) was used to measure psychiatric disorders, including major depressive disorder (MDD), general anxiety disorder (GAD), social phobia, panic disorder, post-traumatic stress disorder (PTSD), alcohol abuse, and binge eating disorders. A single-item measure was used to estimate physical SRH. Demographic (age and gender) and socioeconomic (education and income) factors were also measured. Unadjusted and adjusted correlations between psychiatric disorders and physical SRH were calculated. Major ethnic variations were found in the correlation between psychiatric disorders and physical SRH; as well as the role of demographic and socioeconomic status (SES) factors in explaining these associations. non-Hispanic Whites, Cubans, and African Americans showed more correlations between psychiatric disorders and physical SRH than other ethnic groups. In non-Hispanic Whites, the associations between psychiatric disorders and physical SRH were explained by demographic factors. In African Americans, the link between psychiatric disorders and poor physical SRH were explained by SES indicators. In conclusion, although single-item physical SRH measures are traditionally assumed to reflect the physical health needs of populations, they may also indicate psychiatric disorders in some ethnic groups, such as non-Hispanic Whites, Cubans, and African Americans. Demographic and socioeconomic factors also have differential roles in explaining the link between psychiatric disorders and physical SRH. Physical SRH does not exclusively reflect physical health, and it may be more biased by mental health across some ethnic groups.

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Pruritic and Painful Red Nodules and Papules

(See page 1953 for the Answer to the Photo Quiz.)

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In the Literature

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News

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Pruritic and Painful Red Nodules and Papules

(See page 1952 for the Photo Quiz.)

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Cover

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Erratum

An error appeared in the 1 March 2017 issue of the journal [Tamma PD, Avdic E, Keenan JF, et al. What Is the More Effective Antibiotic Stewardship Intervention: Preprescription Authorization or Postprescription Review With Feedback? Clin Infect Dis 2017; 64:537–43]. In Figure 3, the decrease in antibiotic use when these firms received PPRF after the washout period should be shown as a solid line to the right of vertical line; slope of −2.45 DOT per 1000 PD, P = .02; not a dotted line.

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Influenza Among Young Children in Bangladesh: Clinical Characteristics and Outcomes From a Randomized Clinical Trial

Abstract

Background

Influenza causes substantial morbidity in children worldwide, although influenza vaccine is seldom used in low-resource settings. More information on the clinical presentation of influenza and the efficacy of vaccine is needed to inform policy.

Methods

In 2013 we conducted a randomized, placebo-controlled clinical trial of live attenuated influenza vaccine (LAIV) in children aged 24–59 months in Bangladesh (N = 1761). If participants met prespecified specimen collection criteria, we collected nasopharyngeal washes for testing by singleplex reverse-transcription polymerase chain reaction (RT-PCR) for laboratory-confirmed influenza virus infection (LCI). A panel of RT-PCR assays was used to detect noninfluenza respiratory viruses. Primary efficacy results have been reported. In this analysis of prespecified and post hoc objectives from the trial, we compared signs and symptoms between LCI and non-LCI cases and estimated the efficacy of LAIV against moderate-to-severe LCI and other prespecified non-LCI clinical outcomes including all-cause pneumonia and acute otitis media.

Results

The most common signs and symptoms of LCI were fever, cough, and runny nose. The combination of subjective fever and cough had a 63% sensitivity for LCI. The combination of measured fever, cough, and runny nose was most specific (90%) but had low sensitivity (32%) for LCI. The efficacy of LAIV against vaccine-strain moderate-to-severe LCI was 56.7% (95% confidence interval, 9.5%–79.2%). No statistically significant vaccine efficacy was found against the non-laboratory-confirmed clinical outcomes.

Conclusions

It was not possible to distinguish LCI from noninfluenza viral infections on clinical evaluations alone in this population of Bangladeshi children. LAIV was efficacious against moderate-to-severe LCI.

Clinical Trials Registration

NCT01797029.

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Antibody Kinetics and Response to Routine Vaccinations in Infants Born to Women Who Received an Investigational Trivalent Group B Streptococcus Polysaccharide CRM 197 -Conjugate Vaccine During Pregnancy

Abstract

Background

Maternal vaccination against group B Streptococcus (GBS) might provide protection against invasive GBS disease in infants. We investigated the kinetics of transplacentally transferred GBS serotype-specific capsular antibodies in the infants and their immune response to diphtheria toxoid and pneumococcal vaccination.

Methods

This phase 1b/2, observer-blind, single-center study (NCT01193920) enrolled infants born to women previously randomized (1:1:1:1) to receive either GBS vaccine at dosages of 0.5, 2.5, or 5.0 μg of each of 3 CRM₁₉₇-glycoconjugates (serotypes Ia, Ib, and III), or placebo. Infants received routine immunization: combination diphtheria vaccine (diphtheria-tetanus-acellular pertussis–inactivated poliovirus/Haemophilus influenzae type b vaccine; age 6/10/ 14 weeks) and 13-valent pneumococcal CRM₁₉₇-conjugate vaccine (PCV13; age 6/14 weeks and 9 months). Antibody levels were assessed at birth, day (D) 43, and D91 for GBS serotypes; 1 month postdose 3 (D127) for diphtheria; and 1 month postprimary (D127) and postbooster (D301) doses for pneumococcal serotypes.

Results

Of 317 infants enrolled, 295 completed the study. In infants of GBS vaccine recipients, GBS serotype-specific antibody geometric mean concentrations were significantly higher than in the placebo group at all timepoints and predictably decreased to 41%–61% and 26%–76% of birth levels by D43 and D91, respectively. Across all groups, ≥95% of infants were seroprotected against diphtheria at D127 and ≥91% of infants had seroprotective antibody levels against each PCV13 pneumococcal serotype at D301.

Conclusions

Maternal vaccination with an investigational CRM₁₉₇-glycoconjugate GBS vaccine elicited higher GBS serotype-specific antibody levels in infants until 90 days of age, compared with a placebo group, and did not affect infant immune responses to diphtheria toxoid and pneumococcal vaccination.

Clinical Trials Registration

NCT01193920.

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Effectiveness of Measles Vaccination and Immune Globulin Post-Exposure Prophylaxis in an Outbreak Setting—New York City, 2013

Abstract

Background

Measles, mumps, and rubella vaccine (MMR) or immune globulin (IG) are routinely used for measles post-exposure prophylaxis (PEP). However, current literature on the effectiveness of measles PEP is limited and variable. Here, we examined the effectiveness of MMR and IG PEP among children exposed to measles during an outbreak in New York City (NYC) in 2013.

Methods

Contacts were identified by the NYC Department of Health and Mental Hygiene between 13 March 2013 and 30 June 2013. Immunity to measles and receipt of PEP was determined for contacts. PEP effectiveness [(1 − relative risk of developing measles) × 100] was calculated for MMR, IG, and any PEP (MMR or IG) for nonimmune contacts aged <19 years.

Results

A total of 3409 contacts were identified, of which 208 (6.1%), 274 (8.0%), and 318 (9.3%) met the inclusion criteria for analysis of MMR, IG, and any PEP effectiveness, respectively. Of the contacts included, 44 received MMR PEP and 77 received IG PEP. Effectiveness of MMR PEP was 83.4% (95% confidence interval [CI], 34.4%, 95.8%). No contact who received IG PEP developed measles; effectiveness of IG PEP was 100% (approximated 95% CI, 56.2%, 99.8%). Effectiveness of receiving any PEP (MMR or IG) was 92.9% (95% CI, 56.2%, 99.8%).

Conclusions

Contacts who received PEP were less likely to develop disease. Our findings support current recommendations for administration of PEP following exposure to measles. These results highlight the importance of a rapid public health outbreak response to limit measles transmission following case identification.

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Epidemiology and Relative Severity of Influenza Subtypes in Singapore in the Post-Pandemic Period from 2009 to 2010

Abstract

Background

After 2009, pandemic influenza A(H1N1) [A(H1N1)pdm09] cocirculated with A(H3N2) and B in Singapore.

Methods

A cohort of 760 participants contributed demographic data and up to 4 blood samples each from October 2009 to September 2010. We compared epidemiology of the 3 subtypes and investigated evidence for heterotypic immunity through multivariable logistic regression using a generalized estimating equation. To examine age-related differences in severity between subtypes, we used LOESS (locally weighted smoothing) plots of hospitalization to infection ratios and explored birth cohort effects referencing the pandemic years (1957; 1968).

Results

Having more household members aged 5–19 years and frequent public transport use increased risk of infection, while preexisting antibodies against the same subtype (odds ratio [OR], 0.61; P = .002) and previous influenza infection against heterotypic infections (OR, 0.32; P = .045) were protective. A(H1N1)pdm09 severity peaked in those born around 1957, while A(H3N2) severity was least in the youngest individuals and increased until it surpassed A(H1N1)pdm09 in those born in 1952 or earlier. Further analysis showed that severity of A(H1N1)pdm09 was less than that for A(H3N2) in those born in 1956 or earlier (P = .021) and vice versa for those born in 1968 or later (P < .001), with no difference in those born between 1957 and 1967 (P = .632).

Conclusions

Our findings suggest that childhood exposures had long-term impact on immune responses consistent with the theory of antigenic sin. This, plus observations on short-term cross-protection, have implications for vaccination and influenza epidemic and pandemic mitigation strategies.

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Levofloxacin Prophylaxis During Induction Therapy for Pediatric Acute Lymphoblastic Leukemia

Abstract

Background

Infection is the most important cause of treatment-related morbidity and mortality in pediatric patients treated for acute lymphoblastic leukemia (ALL). Although routine in adults with leukemia, antibacterial prophylaxis is controversial in pediatrics because of insufficient evidence for its efficacy or antibiotic choice and concerns about promoting antibiotic resistance and Clostridium difficile infection.

Methods

This was a single-center, observational cohort study of patients with newly diagnosed ALL, comparing prospectively collected infection-related outcomes in patients who received no prophylaxis, levofloxacin prophylaxis, or other prophylaxis during induction therapy on the total XVI study. A propensity score–weighted logistic regression model was used to adjust for confounders.

Results

Of 344 included patients, 173 received no prophylaxis, 69 received levofloxacin prophylaxis, and 102 received other prophylaxis regimens. Patients receiving prophylaxis had longer duration of neutropenia. Prophylaxis reduced the odds of febrile neutropenia, likely bacterial infection, and bloodstream infection by ≥70%. Levofloxacin prophylaxis alone reduced these infections, but it also reduced cephalosporin, aminoglycoside, and vancomycin exposure and reduced the odds of C. difficile infection by >95%. No increase in breakthrough infections with antibiotic-resistant organisms was seen, but this cannot be excluded.

Conclusions

This is the largest study to date of antibacterial prophylaxis during induction therapy for pediatric ALL and the first to include a broad-spectrum fluoroquinolone. Prophylaxis prevented febrile neutropenia and systemic infection. Levofloxacin prophylaxis also minimized the use of treatment antibiotics and drastically reduced C. difficile infection. Although long-term antibiotic-resistance monitoring is needed, these data support using targeted prophylaxis with levofloxacin in children undergoing induction chemotherapy for ALL.

Clinical Trials Registration

NCT00549848

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Effectiveness of Intramuscular Immunoglobulin in Unvaccinated Family Members After Household Measles Exposure

To the Editor—The efficacy of intramuscular immunoglobulin (IGIM) after measles exposure in patients weighing >30 kg may be decreased, because these patients may not receive an adequate dose of measles antibodies from the maximum dose. The Advisory Committee on Immunization Practices and the California Department of Public Health (CDPH) recommend IGIM for measles prophylaxis if it can be administered within 6 days of exposure [1, 2]. The CDPH recommends 0.5 mL/kg of IGIM with a maximal dose of 15 mL to unvaccinated children who weigh <30 kg. There is no recommendation to administer IGIM to persons weighing >30 kg, presumably because they may not receive a sufficient amount of measles antibodies from the maximum dose of 15 mL [2]. We report the effectiveness of IGIM after household exposure to measles in 2 unvaccinated family members weighing >30 kg.

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Reply to Vos et al

To the Editor—Vos et al correctly point out that only 3 studies with reverse transcription polymerase chain reaction (RT-PCR)–based tests were included in our systematic review and metaanalysis. We were also surprised that despite the increasing popularity and rapid implementation of PCR-based rapid tests, only 3 high-quality studies with PCR-based methods that at that time met the inclusion criteria for our systematic review could be incorporated. RT-PCR methods may have great potential as future rapid tests, but implementation of PCR-based rapid tests should be based on data from high-quality studies. Therefore, we encourage the planning of high-quality evaluations of these tests, not only for diagnostic accuracy but also for clinical feasibility [1]. Pointing out possible drawbacks of a specific technique merely reflects our critical view, not a pessimistic attitude toward the future of rapid (PCR) testing. On the contrary, our aim was to encourage this field of research by our review and by expressing our opinion that “true” point-of-care testing requires novel strategies on logistics. In this context, the value of nonmolecular tests should not be underestimated.

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Rapid Tests for Common Respiratory Viruses

To the Editor—In the May 2017 issue of Clinical Infectious Diseases, Bruning and colleagues published a detailed review on currently available rapid tests for common respiratory viruses [1]. Based on the pooled estimates of 179 rapid tests from 125 studies, the authors concluded that the sensitivity of rapid tests for respiratory viruses is low.

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The Times They Are A-Changin’: Time-Dependent Exposures and Time-Dependent Confounders

To the Editor—We read with great interest the study by Violi et al [1], which investigated the incidence of cardiovascular events (CVEs) after community-acquired pneumonia (CAP), and subsequently estimated the association between CVEs and mortality. The authors concluded that the occurrence of CVEs is associated with a 5-fold increase in 30-day mortality (adjusted hazard ratio, 5.49; 95% confidence interval, 2.91–10.37). This finding could have important clinical implications and therefore it is essential that it be quantified accurately. In this respect we would like to point out 2 issues ignored in the statistical analysis, which could substantially bias the current estimate: time-dependency of the exposure and time-dependent confounders.

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One-Pot Aqueous Synthesis of Fluorescent Ag-In-Zn-S Quantum Dot/Polymer Bioconjugates for Multiplex Optical Bioimaging of Glioblastoma Cells

Cancer research has experienced astonishing advances recently, but cancer remains a major threat because it is one of the leading causes of death worldwide. Glioblastoma (GBM) is the most malignant brain tumor, where the early diagnosis is vital for longer survival. Thus, this study reports the synthesis of novel water-dispersible ternary AgInS2 (AIS) and quaternary AgInS2-ZnS (ZAIS) fluorescent quantum dots using carboxymethylcellulose (CMC) as ligand for multiplexed bioimaging of malignant glioma cells (U-87 MG). Firstly, AgInS2 core was prepared using a one-pot aqueous synthesis stabilized by CMC at room temperature and physiological pH. Then, an outer layer of ZnS was grown and thermally annealed to improve their optical properties and split the emission range, leading to core-shell alloyed nanostructures. Their physicochemical and optical properties were characterized, demonstrating that luminescent monodispersed AIS and ZAIS QDs were produced with average sizes of 2.2 nm and 4.3 nm, respectively. Moreover, the results evidenced that they were cytocompatible using in vitro cell viability assays towards human embryonic kidney cell line (HEK 293T) and U-87 MG cells. These AIS and ZAIS successfully behaved as fluorescent nanoprobes (red and green, resp.) allowing multiplexed bioimaging and biolabeling of costained glioma cells using confocal microscopy.

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Application of Image Processing Techniques in Molecular Imaging of Cancer

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Sedimentary Record of Polycyclic Aromatic Hydrocarbons from the Shuanglong Catchment, Southwest China

Polycyclic aromatic hydrocarbons (PAHs) in the dated sediments from the Shuanglong catchment in the southwest of China were measured to characterize source inputs. The PAHs concentrations in the priority controlling list of US EPA (∑PAHs) ranged within 102.47~563.24 ng g−1, with an average value of 207.18 ng g−1. The 2-3 rings PAHs were predominant, accounting for 73.77% of ∑PAH. According to the classification of pollution levels, ∑PAHs concentrations in the sediments are within the range of moderate pollution level. Both the total and individual PAH concentrations changed with the depth. The profile distribution of PAHs concentration in the sediments suggested that PAHs acted as an effective way to reconstruct the historical trends of socioeconomic changes in the study areas. Results of Ant/(Ant + Phe), Fla/(Fla + Pyr), and BaA/(BaA + Chry) show that petroleum and petrogenic matter are attributed to the potential pollution source in the Shuanglong catchment. The coal combustion and incomplete combustion of gasoline and fossil fuel are dominant. TOC contents had positive correlation with ∑PAHs (, ), 2-3 rings (, ), 4-ring (, ), and 5-6 rings (, ).

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An Edge Correlation Based Differentially Private Network Data Release Method

Differential privacy (DP) provides a rigorous and provable privacy guarantee and assumes adversaries’ arbitrary background knowledge, which makes it distinct from prior work in privacy preserving. However, DP cannot achieve claimed privacy guarantees over datasets with correlated tuples. Aiming to protect whether two individuals have a close relationship in a correlated dataset corresponding to a weighted network, we propose a differentially private network data release method, based on edge correlation, to gain the tradeoff between privacy and utility. Specifically, we first extracted the Edge Profile (PF) of an edge from a graph, which is transformed from a raw correlated dataset. Then, edge correlation is defined based on the PFs of both edges via Jenson-Shannon Divergence (JS-Divergence). Secondly, we transform a raw weighted dataset into an indicated dataset by adopting a weight threshold, to satisfy specific real need and decrease query sensitivity. Furthermore, we propose -correlated edge differential privacy (CEDP), by combining the correlation analysis and the correlated parameter with traditional DP. Finally, we propose network data release (NDR) algorithm based on the -CEDP model and discuss its privacy and utility. Extensive experiments over real and synthetic network datasets show the proposed releasing method provides better utilities while maintaining privacy guarantee.

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Abdominopelvic Tuberculosis Secondary to a Nontuberculous Mycobacterium in an Immunocompetent Patient

Tuberculosis (TB) remained as one of the top 10 causes of death worldwide despite an overall decline in its incidence rate globally. Extrapulmonary TB is uncommon and only accounts for 10–20% of overall TB disease burden. Abdominopelvic TB is the sixth most common location of extrapulmonary TB. The symptoms and signs are often insidious and nonspecific. Diagnosing abdominopelvic TB can be very challenging at times and poses great difficulties to the clinician. Infection with nontuberculous Mycobacterium (NTM) is even rarer especially in an immunocompetent patient. We report a case of NTM in abdominopelvic TB. A 37-year-old foreign worker, para 3, presented with a one-week history of suprapubic pain associated with fever. An assessment showed presence of a right adnexal mass. She was treated as tuboovarian abscess with intravenous antibiotics. Unfortunately, she did not respond. She underwent exploratory laparotomy. Intraoperatively, features of the mass were suggestive of a right mature cystic teratoma with presence of slough and cheesy materials all over the abdominal cavity as well as presence of ascites. Diagnosis of NTM was confirmed with PCR testing using the peritoneal fluid. This case was a diagnostic dilemma due to the nonspecific clinical presentation. Management of such rare infection was revisited.

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The Fusion Model of Multidomain Context Information for the Internet of Things

The Internet of Things aims to provide the user with deep adaptive intelligence services according to the user’s personalized characteristics. Most of the characteristics are presented in the form of high-level context. But it often lacks methods to obtain high-level context information directly in the Internet of Things. In this paper, so as to achieve the corresponding high-level context information using the specific low-level multidomain context directly obtained by different sensors in the Internet of Things, we present a machine learning method to construct a context fusion model based on the feature selection algorithm and the multiclassification algorithm. First, we propose a wrapper feature selection method based on the genetic algorithm to obtain a simpler and more important subset of the context features from the low-level multidomain context, by defining a suitable fitness function and a convergence condition. Then, we use the decision tree algorithm which is a multiclassification algorithm, based on the rules obtained by training the subset of context features, to determine which high-level context the record set of the low-level context information belongs to. Experiments confirm that the model can be used to achieve higher classification accuracy without more significant time consumption.

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Behandlungsalgorithmus CUP

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Diabetes und Krebs – den Zusammenhängen auf der Spur

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Gottesdienst

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Child and Adolescent Psychiatric Disorders in a Public Service Over Seventy Years

The entire sample of N=45554 patients attending the child and adolescent psychiatric service of the Canton of Zurich, Switzerland between 1921 and 1990 was analyzed with regard to age, sex, and diagnoses. Data were based on annual reports of the institution for the period between 1921 and 1978. From 1979 onwards, electronically stored data on each patient were available. ICD-9 diagnoses were applied between 1979 and 1987. The ICD-10 system was introduced in 1988. The total administrative prevalence rate varied between 0.15 and 0.40 percent with an increasing trend over time. On the average, boys outnumbered girls by a sex ratio of 2:1. The age distribution showed peaks at 8 to 9 years and during adolescence. The distributions of the most common diagnoses showed remarkable differences over time. It is assumed that changes in diagnostic categories rather than changes in true prevalence rates play a major role in the latter trend.

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Fragmentarische Lebensgestaltung. Herausforderungen für kirchliche Bildungsbemühungen

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Der Praktische Theologe als Freibeuter

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Religion and aging in international and intercultural perspectives - Mapping the field

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Prophet oder Priester? Plädoyer für den Propheten

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Correlates of the DSM-III-R Global Assessment of Functioning Scale in Patients Attending a Child and Adolescent Psychiatric Service

Sex, socioeconomic status, intelligence, a clinical symptom score, and an index of abnormal psychosocial situations as proposed by a recent WHO draft were studied as correlates of the Global Assessment of Functioning Scale (GAFS), which comprises Axis V of the DSM-III-R . Whereas all parameters correlated significantly with the GAFS score, only total symptom domain score displayed a meaningful association. It was concluded that the GAFS contributes significantly to clinical information as an independent source.

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A Follow-Up Study of Child Psychiatric Clinic Attenders with Minor Neurological Dysfunction

Thirty-two child psychiatric patients with minor neurological dysfunction (MND) were followed-up after a mean interval of 5.3 years. Six clusters were analyzed that measured posture and muscle tonus, reflexes, coordination and balance, fine manipulative ability, choreiform dyskinesia, and associated movements. In the majority of cases, remission occurred for posture and muscle tonus, and choreiform dyskinesia and reflexes. Problems with fine manipulative ability and associated movements, however, persisted in most cases. Change in the total MND-abnormality score was also analyzed. Elevated scores and greater age at the initial assessment, and longer intervals between the initial assessment and follow-up were associated with greater improvement, indicating that biological maturation is an important factor in symptom remission. Slow background activity was the predominant EEG-pattern that tended to persist rather than to remit over time. A wide spectrum of psychiatric diagnoses was recorded on both occasions. In general, the tendency for remission of psychiatric disorders was stronger than that of persistence and new manifestation. In addition, with regard to behavioural abnormalities, the total score and subscore for emotional disorders diminished over time.

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Mutant gene network in colon cancer identified

The principles of the gene network for colon tumourigenesis have been identified by a KAIST research team. The principles will be used to find the molecular target for effective anti-cancer drugs in the future. Further, this research gained attention...

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Patients with depression and advanced cancer survive longer with palliative care intervention

A new study finds that patients with depression and advanced cancer live longer when exposed to palliative care interventions designed to improve quality of life. Published in Health Psychology as an online first publication, the findings provide new...

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Listening: a neglected aspect of safe handover

Merten and colleagues’ guide to safe handover caused me to reflect on a neglected aspect: listening.1Handovers in emergency departments are both delivered and made with unique frequency and in...

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