An evaluation of overlying tissues to determine fetal exposure to ultrasound during the third trimester

Measurements of minimum and average total tissue thicknesses overlying the fetus during the third trimester were taken on 52 patients between 24 and 40 weeks gestation. Minimum total thickness of tissues constantly along the ultrasound path had a mean value of 1.75 cm, ranging from 0.40 to 3.70 cm. This corresponded to a mean attenuation of 0.87 dB MHz-1, ranging from 0.30 to 1.68 dB MHz-1. Average total thickness of tissues constantly along the ultrasound path had a mean value of 2.16 cm, ranging from 1.00 to 4.10 cm. This corresponded to a mean attenuation of 1.16 dB MHz-1, ranging from 0.64 to 2.03 dB MHz-1. Average attenuation was also calculated for all soft tissues along the ultrasound path, including the placenta. The resulting average attenuation was 0.47 dB cm-1 MHz-1. Maternal weight at the time of ultrasound examination had significant correlation with minimum and average ultrasound attenuation by tissues constantly along the ultrasound path. The R2 value was 46.7% for minimum attenuation (p-value p-value 2 value of the model that included all three variables was 57.2% (p-value p-value < 0.0001) for average attenuation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31864/1/0000814.pd

Tamoxifen for treatment of abnormal uterine bleeding in etonorgstrel implant users: a randomized clinical trial

Background: The current study aims to compare the use of tamoxifen and oral contraceptive pills in women using implanon and complain with irregular uterine bleeding.Methods: Women attended family planning clinic using implanon presented by bleeding were invited to participate in the study. They were randomized into two groups: Group A: 100 women received Tamoxifen 10 mg twice daily for 10 days taken at the onset of an episode of bleeding or spotting episode. Group B: 100 women received Combined oral contraceptive pills (microcept) once daily for 21 days take at the onset of an episode of bleeding or spotting episode.Results: No difference regarding the baseline criteria of both groups. No difference between both groups regarding the duration of irregular bleeding in the implanon users (p=0.090). Additionally, the number of bleeding days and spotting in the last month was similar in both groups (p=0.554). The percentage of women who stopped bleeding during the period of treatment is 84% in the tamoxifen group and 92% in the COCs group, but the COCs needs longer treatment time, where the mean of days required to stop bleeding is 5.03±1.8 days in the tamoxifen group and 6.5±2.5 in the COCs group. Headache and nausea were the most prominent adverse effects found in the COCs group (p=0.000).Conclusions: Oral administration of tamoxifen 10 mg twice daily for 10 days is effective on stopping bleeding attacks in implanon users

Supervised Learning Algorithms in Educational Data Mining: A Systematic Review

The academic institutions always looking for tools that improve their performance and enhance individuals outcomes. Due to the huge ability of data mining to explore hidden patterns and trends in the data, many researchers paid attention to Educational Data Mining (EDM) in the last decade. This field explores different types of data using different algorithms to extract knowledge that supports decision-making and academic sector development. The researchers in the field of EDM have proposed and adopted different algorithms in various directions. In this review, we have explored the published papers between 2010-2020 in the libraries (IEEE, ACM, Science Direct, and Springer) in the field of EDM are to answer review questions. We aimed to find the most used algorithm by researchers in the field of supervised machine learning in the period of 2010-2020. Additionally, we explored the most direction in the EDM and the interest of the researchers. During our research and analysis, many limitations have been examined and in addition to answering the review questions, some future works have been presented

cardiotoxicity with immune system targeting drugs a meta analysis of anti pd pd l1 immunotherapy randomized clinical trials

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Multidisciplinary Care of Patients with Intrahepatic Cholangiocarcinoma: Updates in Management

Cholangiocarcinoma is a highly fatal primary cancer of the bile ducts which arises from malignant transformation of bile duct epithelium. While being an uncommon malignancy with an annual incidence in the United States of 5000 new cases, the incidence has been increasing over the past 30 years and comprises 3% of all gastrointestinal cancers. Cholangiocarcinoma can be classified into intrahepatic (ICC) and extrahepatic (including hilar and distal bile duct) according to its anatomic location within the biliary tree with respect to the liver. This paper reviews the management of ICC, focusing on the epidemiology, risk factors, diagnosis, and surgical and nonsurgical management

Differentiation between small hepatocellular carcinoma (<3 cm) and benign hepatocellular lesions in patients with Budd-Chiari syndrome: the role of multiparametric MR imaging

ObjectiveTo investigate the value of multiparametric MR imaging to differentiate between small hepatocellular carcinoma (s-HCC) versus benign liver lesions in patients with Budd-Chiari syndrome.Methods12 patients with benign hepatocellular lesions and 32 patients with small (&lt;3 cm) HCCs were assessed. MRI images were reviewed by two radiologists blinded to the patient background information; lesion T1 and T2 signal intensities and ADC values were compared with the background liver. Enhancement of lesion relative to hepatic parenchyma [(T1Enh-T1liver)/T1liver] in the arterial, venous, and delayed phases was also compared between the two groups. A multivariable logistic model was developed using these categorical measures; the predictive value of the model was tested using the Area Under the Receiver operating characteristic (AU-ROC) curve for logistic models. P-values &lt;0.05 were considered statistically significant.ResultsThere were consistent differences in T1lesion/T1liver, and T2lesion/T2liver, and ADClesion/ADCliver between benign hepatocellular lesions versus the sHCC group (p&lt;0.001, p&lt;0.001, p = 0.045, respectively). Lesion-to-background liver enhancement in the portal venous and delayed phases was different between the benign lesions versus sHCC (p=0.001). ROC analysis for the logistic model that included the T1 ratio, T2 ratio, and portal venous enhancement ratio demonstrated excellent discriminatory power with the area under the curve of 0.94.ConclusionMultiparametric MR imaging is a useful method to help differentiate benign liver lesions from sHCC in patients with Budd-Chiari syndrome

Diffuse interstitial fibrosis assessed by cardiac magnetic resonance is associated with dispersion of ventricular repolarization in patients with hypertrophic cardiomyopathy

Background Hypertrophic cardiomyopathy (HCM) is characterized by myocyte hypertrophy, disarray, fibrosis, and increased risk for ventricular arrhythmias. Increased QT dispersion has been reported in patients with HCM, but the underlying mechanisms have not been completely elucidated. In this study, we examined the relationship between diffuse interstitial fibrosis, replacement fibrosis, QTc dispersion and ventricular arrhythmias in patients with HCM. We hypothesized that fibrosis would slow impulse propagation and increase dispersion of ventricular repolarization, resulting in increased QTc dispersion on surface electrocardiogram (ECG) and ventricular arrhythmias. Methods ECG and cardiac magnetic resonance (CMR) image analyses were performed retrospectively in 112 patients with a clinical diagnosis of HCM. Replacement fibrosis was assessed by measuring late gadolinium (Gd) enhancement (LGE), using a semi-automated threshold technique. Diffuse interstitial fibrosis was assessed by measuring T1 relaxation times after Gd administration, using the Look?Locker sequence. QTc dispersion was measured digitally in the septal/anterior (V1?V4), inferior (II, III, and aVF), and lateral (I, aVL, V5, and V6) lead groups on surface ECG. Results All patients had evidence of asymmetric septal hypertrophy. LGE was evident in 70 (63%) patients; the median T1 relaxation time was 411±38æms. An inverse correlation was observed between T1 relaxation time and QTc dispersion in leads V1?V4 (p\u3c 0.001). Patients with HCM who developed sustained ventricular tachycardia had slightly higher probability of increased QTc dispersion in leads V1?V4 (odds ratio, 1.011 [1.004?1.0178, p=0.003). We found no correlation between presence and percentage of LGE and QTc dispersion. Conclusion Diffuse interstitial fibrosis is associated with increased dispersion of ventricular repolarization in leads, reflecting electrical activity in the hypertrophied septum. Interstitial fibrosis combined with ion channel/gap junction remodeling in the septum could lead to inhomogeneity of ventricular refractoriness, resulting in increased QTc dispersion in leads V1?V4