Restless legs syndrome/Willis–Ekbom disease prevalence in beta thalassemia patients

Purpose Both beta thalassemia and restless legs syndrome (RLS) patients share some common pathophysiological characteristics related to iron handling. In the present study, the aim was to explore the prevalence of RLS as well as to explore potential association between the syndrome and various quality of life-related parameters in a sample of beta thalassemia patients. Methods One hundred fourteen (age 40 ± 11 yr, 59 M/55F) beta thalassemia patients participated in this cross-sectional descriptive study. Patients were screened for RLS based on the international RLS study group diagnostic criteria as well as a battery of validated questionnaires. Results The prevalence of RLS in this sample of beta thalassemia patients was zero. The quality of life score was low (78 ± 18). Iron levels were within normal range (191 ± 66 mcg/dL) while ferritin levels were high as expected (1836 ± 225 ng/dL). Conclusions Our sample of patients comes from central Greece where the prevalence of RLS in the general population is 4% while in renal failure patients is 27%. To our surprise, there was no presence of RLS among this sample of beta thalassemia patients. The adequate levels of iron and ferritin often seen in these patients could be the reason of the absence of RLS symptoms

Evaluation of the generalized gamma as a tool for treatment planning optimization

Purpose: The aim of that work is to study the theoretical behavior and merits of the Generalized Gamma (generalized dose response gradient) as well as to investigate the usefulness of this concept in practical radiobiological treatment planning.Methods: In this study, the treatment planning system RayStation 1.9 (Raysearch Laboratories AB, Stockholm, Sweden) was used. Furthermore, radiobiological models that provide the tumor control probability (TCP), normal tissue complication probability (NTCP), complication-free tumor control probability (P+) and the Generalized Gamma were employed. The Generalized Gammas of TCP and NTCP, respectively were calculated for given heterogeneous dose distributions to different organs in order to verify the TCP and NTCP computations of the treatment planning system. In this process, a treatment plan was created, where the target and the organs at risk were included in the same ROI in order to check the validity of the system regarding the objective function P+ and the Generalized Gamma. Subsequently, six additional treatment plans were created with the target organ and the organs at risk placed in the same or different ROIs. In these plans, the mean dose was increased in order to investigate the behavior of dose change on tissue response and on Generalized Gamma before and after the change in dose. By theoretically calculating these quantities, the agreement of different theoretical expressions compared to the values that the treatment planning system provides could be evaluated. Finally, the relative error between the real and approximate response values using the Poisson and the Probit models, for the case of having a target organ consisting of two compartments in a parallel architecture and with the same number of clonogens could be investigated and quantified. Results: The computations of the RayStation regarding the values of the Generalized Gamma and the objective function (P+) were verified by using an independent software. Furthermore, it was proved that after a small change in dose, the organ that is being affected most is the organ with the highest Generalized Gamma. Apart from that, the validity of the theoretical expressions that describe the change in response and the associated Generalized Gamma was verified but only for the case of small change in dose. Especially for the case of 50% TCP and NTCP, the theoretical values (ΔPapprox.) and those calculated by the RayStation show close agreement, which proves the high importance of the D50 parameter in specifying clinical response levels. Finally, the presented findings show that the behavior of ΔPapprox. looks sensible because, for both of the models that were used (Poisson and Probit), it significantly approaches the real ΔP around the region of 37% and 50% response. The present study managed to evaluate the mathematical expression of Generalized Gamma for the case of non-uniform dose delivery and the accuracy of the RayStation to calculate its values for different organs. Conclusion: A very important finding of this work is the establishment of the usefulness and clinical relevance of Generalized Gamma. That is because it gives the planner the opportunity to precisely determine which organ will be affected most after a small increase in dose and as a result an optimal treatment plan regarding tumor control and normal tissue complications can be found

Imaging performance of a CaWO4/CMOS sensor

The aim of this study was to investigate the modulation transfer function (MTF) and the effective gain transfer function (eGTF) of a non-destruc­­tive testing (NDT)/industrial inspection complementary metal oxide semi­conductor (CMOS) sensor in conjunction with a thin calcium tungstate (CaWO4) screen. Thin screen samples, with dimensions of 2.7x3.6 cm2 and thick­ness of 118.9 μm, estimated from scanning electron microscopy-SEM im­ages, were extracted from an Agfa Curix universal screen and coupled to the active area of an active pixel (APS) CMOS sensor. MTF was assessed using the slanted-edge method, following the IEC 62220-1-1:2015 method. MTF values were found high across the examined spatial frequency range. eGTF was found maximum when CaWO4 was combined with charge-coupled devices (CCD) of broadband anti-reflection (AR) coating (17.52 at 0 cycles/mm). The com­bi­nation of the thin CaWO4 screen with the CMOS sensor provided very pro­mis­ing image resolution and adequate efficiency properties, thus could be also con­sidered for use in CMOS based X-ray imaging devices, for various applications

Evidence of Increased Muscle Atrophy and Impaired Quality of Life Parameters in Patients with Uremic Restless Legs Syndrome

BACKGROUND: Restless Legs Syndrome is a very common disorder in hemodialysis patients. Restless Legs Syndrome negatively affects quality of life; however it is not clear whether this is due to mental or physical parameters and whether an association exists between the syndrome and parameters affecting survival. METHOD#ENTITYSTARTX003BF;LOGY/PRINCIPAL FINDINGS: Using the Restless Legs Syndrome criteria and the presence of Periodic Limb Movements in Sleep (PLMS/h >15), 70 clinically stable hemodialysis patients were assessed and divided into the RLS (n = 30) and non-RLS (n = 40) groups. Physical performance was evaluated by a battery of tests: body composition by dual energy X ray absorptiometry, muscle size and composition by computer tomography, while depression symptoms, perception of sleep quality and quality of life were assessed through validated questionnaires. In this cross sectional analysis, the RLS group showed evidence of thigh muscle atrophy compared to the non-RLS group. Sleep quality and depression score were found to be significantly impaired in the RLS group. The mental component of the quality of life questionnaire appeared significantly diminished in the RLS group, reducing thus the overall quality of life score. In contrast, there were no significant differences between groups in any of the physical performance tests, body and muscle composition. CONCLUSIONS: The low level of quality of life reported by the HD patients with Restless Legs Syndrome seems to be due mainly to mental health and sleep related aspects. Increased evidence of muscle atrophy is also observed in the RLS group and possibly can be attributed to the lack of restorative sleep

Effect of exercise training and dopamine agonists in patients with uremic restless legs syndrome: A six-month randomized, partially double-blind, placebo-controlled comparative study

© 2013 The Authors. Published by BMC. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1186/1471-2369-14-194Background: Restless Legs Syndrome is very common in hemodialysis patients however there are no comparative studies assessing the effectiveness of a non-pharmacological treatment to a classical treatment on parameters related to syndromes' severity and quality of life. Methods. In this randomized, partially double blind, placebo controlled trial, thirty two hemodialysis patients with restless legs syndrome were randomly assigned into three groups: 1) the exercise training group (N = 16), 2) the dopamine agonists group (ropinirole 0.25 mg/d) (N = 8) and 3) the placebo group (N = 8). The intervention programs lasted 6 months. Restless Legs Syndrome severity was assessed using the international severity scale, physical performance by a battery of tests, muscle size and composition by computed tomography, body composition by Dual Energy X Ray Absorptiometry, while depression score, sleep quality, daily sleepiness and quality of life were assessed through questionnaires. Results: Exercise training and dopamine agonists were effective in reducing syndrome's symptoms by 46% (P = 0.009) and 54% (P = 0.001) respectively. Within group changes revealed that both approaches significantly improved quality of life (P 0.05) in various tests. Between group changes detect significant improvements with both exercise and dopamine agonists in depression score (P = 0.003), while only the dopamine agonist treatment was able to significantly improve sleep quality, compared to exercise and placebo (P = 0.016). Conclusions: A 6-month exercise training regime was as effective as a 6-month low dosage dopamine agonist treatment in reducing restless legs syndrome symptoms and improving depression score in uremic patients. Further research is needed in order to show whether a combination treatment could be more beneficial for the amelioration of RLS. Trial registration. NCT00942253. © 2013 Giannaki et al.; licensee BioMed Central Ltd.This study was supported by the National and Community Funds of the Greek Ministry of Development-General Secretariat of Research and Technology and by the European Social Fund.Published versio

Artifacts in spiral CT protocols: The importance of the spatial reconstruction

Aim: The initial aim of this prospective study was to record and analyze the streak artifacts and the motion artifacts in spiral CT examinations. The second aim was to evaluate the possibility of elimination and minimization of these artifacts through spatial reconstruction. Further aim was to evaluate the possibility of elimination and minimization of these artifacts through alterations of the examination protocols from the beginning. Ultimate aim was to reduce the patient dose via the avoidance of repetitive scans. Material and method: A spiral CT (Philips 5000 SR) was used, with a scan time of 3 and 1.5 seconds per rotation. 100 thorax and 300 brain CT examinations, wereincluded in the study. They were selected randomly during the program, whenever the images contained artifacts, which could imitate pathology. An experienced Radiologist did the selection of the cases, and an experienced Radiographer applied the spatial resolution. Qualitative analysis of the images was done by two Radiologists. All the images were classified into four categories according to the improvement ofthe image quality. Results: The brain examinations demonstrated the following results: 10,9% of the cases had no improvement, 19,6% of the images were slightly improved, 31,5% of these images improved enough and the rest 38% of the cases had a significantimprovement. The results in the thorax examinations were the following: 27,3% of the cases had no improvement, 22,9% ofthe images were slightly improved, 26,7% of the images improved enough and 23,1% of the cases had a significant improvement. The spatial reconstruction was not effective in the brain examinations when the patient had moved during the whole scan time, and in the thorax examinations whenever streak and motion artifacts co-existed. As well, at thorax examinations the spatial reconstruction eliminates and minimizes the partial volume effect.Conclusions: The spatial reconstruction when applied in brain CT examinations and in thorax CT examinations improves the quality of the image and contributes to the extraction of more accurate conclusions. This process for the correction of the motion artifacts is not only suggested for safety reasons but as well as because it is difficult for an examination to be repeated when the patient is not cooperative. The spatial reconstruction is especially important in thorax examinations, because due to the maximum dose ofthe medium, the examination cannot be repeated in the same day.Σκοπός: Πρώτος σκοπός της προοπτικής μελέτης ήταν η καταγραφή και η ανάλυση των γραμμοειδών τεχνικών σφαλμάτων και των τεχνικών σφαλμάτων κίνησης σε εξετάσεις με Υπολογιστικούς Τομογράφους ελικοειδούς σάρωσης. Δεύτερος σκοπός ήταν ο έλεγχος δυνατότητας εξάλειψης και ελαχιστοποίησης των εν λόγω τεχνικών σφαλμάτων με την τεχνική της τμηματικής ανασύνθεσης. Περαιτέρω σκοπός ήταν ο έλεγχος δυνατότητας εξάλειψης - ελαχιστοποίησης των εν λόγω τεχνικών σφαλμάτων με διαφοροποιήσεις των πρωτοκόλλων εξέτασης εξ αρχής. Απώτερος σκοπός ήταν η μείωση της δόσης ακτινοβολίας στον εξεταζόμενο με την αποφυγή επαναληπτικών σαρώσεων. Υλικό — μέθοδος: Χρησιμοποιήθηκε Υ.Τ. ελικοειδούς σάρωσης (Philips 5000 SR) με χρόνο ακτινοβόλησης 3 και 1,5 δευτερόλεπτα ανά περιστροφή. Στη μελέτη συμπεριλήφθηκαν 100 εξετάσεις θώρακος και 300 εξετάσεις εγκεφάλου. Η επιλογή τους γινόταν τυχαία κατά τη διάρκεια του προγράμματος όταν οι εικόνες εμπεριείχαν τεχνικά σφάλματα τα οποία μπορούσαν να μιμηθούν παθολογία. Η επιλογή των περιστατικών έγινε από έναν συγκεκριμένο έμπειρο ιατρό Ακτινολόγο και η τμηματική ανασύνθεση πραγματοποιήθηκε από έναν επίσης έμπειρο τεχνολόγο Ακτινολόγο. Επίσης έγινε ποιοτική αξιολόγηση από δύο Ιατρούς Ακτινολόγους και κατάταξη των εικόνων σε τέσσερις κατηγορίες ανάλογα με το ποσοστό βελτίωσης των εικόνων. Αποτελέσματα: Στις εξετάσεις εγκεφάλου στο 10,9% των περιπτώσεων δεν υπήρξε βελτίωση, στο 19,6% των περιπτώσεων οι εικόνες βελτιώθηκαν ελάχιστα, στο 31,5% των περιπτώσεων οι εικόνες βελτιώθηκαν αρκετά και στο 38% των περιπτώσεων η βελτίωση είναι σημαντική. Στις εξετάσεις θώρακος στο 27,3% των περιπτώσεων, στις εικόνες δεν παρατηρήθηκε σχεδόν καμία βελτίωση, στο 22,9% των περιπτώσεων οι εικόνες βελτιώθηκαν ελάχιστα, στο 26,7% των περιπτώσεων οι εικόνες βελτιώθηκαν αρκετά και στο 23,1%των περιπτώσεων η βελτίωση ήταν σημαντική. Η τμηματική ανασύνθεση δεν ήταν αποτελεσματική για τις εξετάσεις του εγκεφάλου, κατά τις οποίες ο εξεταζόμενος κινήθηκε σε ολόκληρο τον χρόνο λήψης τομής και για τις εξετάσεις θώρακος όπου τα γραμμικά τεχνικά σφάλματα (streak artifact) υπήρχαν και σφάλματα κίνησης. Επίσης σε εξετάσεις θώρακος η τμηματική ανασύνθεση εξαλείφει ή περιορίζει το φαινόμενο μερικού όγκου. Συμπέρασμα: Η τμηματική ανασύνθεση στις εξετάσεις εγκεφάλου και στις εξετάσεις θώρακος, βελτιώνει την ποιότητα της εικόνας και βοηθάει να εξαχθούν πιο ακριβή συμπεράσματα. Η παραπάνω επεξεργασία για την διόρθωση τεχνικών σφαλμάτων κίνησης προτείνεται όχι μόνο για λόγους ακτινοπροστασίας αλλά και επειδή είναι δύσκολο σε έναν μη συνεργάσιμο εξεταζόμενο να επαναληφθεί η εξέταση. Ιδιαιτέρως σημαντική είναι η επεξεργασία στις εξετάσεις θώρακος, όπου λόγω της μεγάλης δόσης σκιαγραφικού η εξέταση δεν είναι δυνατόν να επαναληφθεί αυθημερόν

Reliability of automated brain volumetric analysis: A test by comparing NeuroQuant and volBrain software

Abstract Background and purpose Brain volume analysis from magnetic resonance imaging (MRI) is gaining an important role in neurological diagnosis. This study compares the volumes of brain segments measured by two automated brain analysis software, NeuroQuant (NQ), and volBrain (VB) in order to test their reliability in brain volumetry. Methods Using NQ and VB software, the same brain segment volumes were calculated and compared, taken from 56 patients scanned under the same MRI sequence. These segments were intracranial cavity, putamen, thalamus, amygdala, whole brain, cerebellum, white matter, and hippocampus. The paired t‐test method has been used to determine if there was a significant difference in these measurements. The interclass correlation (ICC) is used to test inter‐method reliability between the two software. Finally, regression analysis was used to examine the possibility of linear correlation. Results In all brain segments tested but hippocampus, significant differences were found. ICC presents satisfactory to excellent reliability in all brain segments except thalamus and amygdala for which reliability has been proven to be poor. In most cases, linear correlation was found. Conclusions The significant differences found in the majority of the tested brain segments are raising questions about the reliability of automated brain analysis as a quantitative tool. Strong linear correlation of the volumetric measurements and good reliability indicates that, each software provides good qualitative information of brain structures size

Evaluation of the generalized gamma as a tool for treatment planning optimization

Purpose: The aim of that work is to study the theoretical behavior and merits of the Generalized Gamma (generalized dose response gradient) as well as to investigate the usefulness of this concept in practical radiobiological treatment planning.Methods: In this study, the treatment planning system RayStation 1.9 (Raysearch Laboratories AB, Stockholm, Sweden) was used. Furthermore, radiobiological models that provide the tumor control probability (TCP), normal tissue complication probability (NTCP), complication-free tumor control probability (P+) and the Generalized Gamma were employed. The Generalized Gammas of TCP and NTCP, respectively were calculated for given heterogeneous dose distributions to different organs in order to verify the TCP and NTCP computations of the treatment planning system. In this process, a treatment plan was created, where the target and the organs at risk were included in the same ROI in order to check the validity of the system regarding the objective function P+ and the Generalized Gamma. Subsequently, six additional treatment plans were created with the target organ and the organs at risk placed in the same or different ROIs. In these plans, the mean dose was increased in order to investigate the behavior of dose change on tissue response and on Generalized Gamma before and after the change in dose. By theoretically calculating these quantities, the agreement of different theoretical expressions compared to the values that the treatment planning system provides could be evaluated. Finally, the relative error between the real and approximate response values using the Poisson and the Probit models, for the case of having a target organ consisting of two compartments in a parallel architecture and with the same number of clonogens could be investigated and quantified. Results: The computations of the RayStation regarding the values of the Generalized Gamma and the objective function (P+) were verified by using an independent software. Furthermore, it was proved that after a small change in dose, the organ that is being affected most is the organ with the highest Generalized Gamma. Apart from that, the validity of the theoretical expressions that describe the change in response and the associated Generalized Gamma was verified but only for the case of small change in dose. Especially for the case of 50% TCP and NTCP, the theoretical values (ΔPapprox.) and those calculated by the RayStation show close agreement, which proves the high importance of the D50 parameter in specifying clinical response levels. Finally, the presented findings show that the behavior of ΔPapprox. looks sensible because, for both of the models that were used (Poisson and Probit), it significantly approaches the real ΔP around the region of 37% and 50% response. The present study managed to evaluate the mathematical expression of Generalized Gamma for the case of non-uniform dose delivery and the accuracy of the RayStation to calculate its values for different organs. Conclusion: A very important finding of this work is the establishment of the usefulness and clinical relevance of Generalized Gamma. That is because it gives the planner the opportunity to precisely determine which organ will be affected most after a small increase in dose and as a result an optimal treatment plan regarding tumor control and normal tissue complications can be found.</p

Radiomics Texture Analysis of Bone Marrow Alterations in MRI Knee Examinations

Accurate diagnosis and timely intervention are key to addressing common knee conditions effectively. In this work, we aim to identify textural changes in knee lesions based on bone marrow edema (BME), injury (INJ), and osteoarthritis (OST). One hundred and twenty-one MRI knee examinations were selected. Cases were divided into three groups based on radiological findings: forty-one in the BME, thirty-seven in the INJ, and forty-three in the OST groups. From each ROI, eighty-one radiomic descriptors were calculated, encoding texture information. The results suggested differences in the texture characteristics of regions of interest (ROIs) extracted from PD-FSE and STIR sequences. We observed that the ROIs associated with BME exhibited greater local contrast and a wider range of structural diversity compared to the ROIs corresponding to OST. When it comes to STIR sequences, the ROIs related to BME showed higher uniformity in terms of both signal intensity and the variability of local structures compared to the INJ ROIs. A combined radiomic descriptor managed to achieve a high separation ability, with AUC of 0.93 ± 0.02 in the test set. Radiomics analysis may provide a non-invasive and quantitative means to assess the spatial distribution and heterogeneity of bone marrow edema, aiding in its early detection and characterization

Multifeature Quantification of Nuclear Properties from Images of H&E-Stained Biopsy Material for Investigating Changes in Nuclear Structure with Advancing CIN Grade

Background. Cervical dysplasia is a precancerous condition, and if left untreated, it may lead to cervical cancer, which is the second most common cancer in women. The purpose of this study was to investigate differences in nuclear properties of the H&E-stained biopsy material between low CIN and high CIN cases and associate those properties with the CIN grade. Methods. The clinical material comprised hematoxylin and eosin- (H&E-) stained biopsy specimens from lesions of 44 patients diagnosed with cervical intraepithelial neoplasia (CIN). Four or five nonoverlapping microscopy images were digitized from each patient’s H&E specimens, from regions indicated by the expert physician. Sixty-three textural and morphological nuclear features were generated for each patient’s images. The Wilcoxon statistical test and the point biserial correlation were used to estimate each feature’s discriminatory power between low CIN and high CIN cases and its correlation with the advancing CIN grade, respectively. Results. Statistical analysis showed 19 features that quantify nuclear shape, size, and texture and sustain statistically significant differences between low CIN and high CIN cases. These findings revealed that nuclei in high CIN cases, as compared to nuclei in low CIN cases, have more irregular shape, are larger in size, are coarser in texture, contain higher edges, have higher local contrast, are more inhomogeneous, and comprise structures of different intensities. Conclusion. A systematic statistical analysis of nucleus features, quantified from the H&E-stained biopsy material, showed that there are significant differences in the shape, size, and texture of nuclei between low CIN and high CIN cases