Cell Blood Count Alterations and Patterns of Anaemia in Autoimmune Atrophic Gastritis at Diagnosis: A Multicentre Study

Background: Autoimmune atrophic gastritis (AAG) leads to iron and/or vitamin B12 malabsorption, with subsequent haematological alterations which could represent the sole clinical manifestation. We aimed to assess patterns of anaemia and micronutrient deficiencies in patients with AAG at the time of diagnosis. Methods: Observational, multicentre, cross-sectional study including consecutive adult patients diagnosed with AAG within the last ten years. Cell blood count, red cell distribution width, serum vitamin B12, and ferritin were collected. Multivariate analysis for predictive factors of anaemia was computed. Results: 654 AAG patients (mean age 59.2 ± 13.8 years, female (F): male (M) ratio = 2.3:1) were included. Anaemia was present in 316 patients (48.3%; mean age 60.1 ± 15.8 years, F:M ratio=2.3:1). Pernicious anaemia (132/316 cases, 41.7%) wasmore common inmales (27.1% versus 12.4%; p = 0.001) and in older patients (63.0 ± 14.6 versus 58.9 ± 14.9 years; p = 0.014), while iron deficiency anaemia (112/316 cases, 35.4%) was more common in females (16.9% versus 10.0%; p = 0.039) and in younger patients (56.8 ± 16.6 versus 60.2 ± 14.6 years; p = 0.043). The prevalence of iron deficiency was equally distributed between anaemic and non-anaemic patients (p = 0.9). Anisocytosis (odds ratio: 10.65, 95% confidence interval: 6.13–18.50, p < 0.0001) was independently associated with anaemia. Conclusions: Anaemia is a common manifestation in AAG patients, mostly due to micronutrient deficiencies. Scant haematologic alterations and micronutrient deficiencies may precede overt anaemia

Bounded Probabilistic Model Checking with the Murφ Verifier

In this paper we present an explicit verification algorithm for Probabilistic Systems defining discrete time/finite state Markov Chains. We restrict ourselves to verification of Bounded PCTL formulas(BPCTL), that is, PCTL formulas in which all Until operators arebounded, possibly with different bounds. This means that we consider only paths (system runs) of bounded length. Given a Markov Chain and a BPCTL formula Φ, our algorithm checks if Φ is satisfied in . This allows to verify important properties, such as reliability in Discrete Time Hybrid Systems. We present an implementation of our algorithm within a suitable extension of the Murφ verifier. We call FHP-Murφ (Finite Horizon Probabilistic Murφ) such extension of the Murφ verifier. We give experimental results comparing FHP-Murφ with (a finite horizon subset of) PRISM, a state-of-the-art symbolic model checker for Markov Chains. Our experimental results show that FHP-Murφ can effectively handle verification of BPCTL formulas for systems that are out of reach for PRISM, namely those involving arithmetic operations on the state variables (e.g. hybrid systems)

A comprehensive analysis of trends in extreme precipitation over southeastern coast of Brazil

Southeast Brazil (SE Brazil) is the most densely populated region in Brazil. Previous studies have shown evidence of positive trends in average precipitation and extreme events in a few locations, suggesting the increase in rainfall-related hazards with potential impacts to urbanized areas of SE Brazil. This study provides a comprehensive analysis of the spatial variability of trends in extreme precipitation over SE Brazil focusing on regional and local scales. We examine two daily rainfall datasets with more than 70 years of data: individual stations and gridded observed precipitation data. Our results indicate that the frequency of both rainy days and extreme daily precipitation events have increased in Sao Paulo state. Conversely, precipitation has become more concentrated in fewer events in Rio de Janeiro and Espirito Santo states where both data sets indicate positive trends in the intensity of extreme daily rainfall. The increases in frequency and intensity of extreme events have both contributed to positive trends in total seasonal and average daily precipitation over Sao Paulo. Additionally, the individual stations indicate negative trends in the number of light rainy days over large urbanized areas in the state of Sao Paulo. The spatial patterns of trends indicate that they are influenced by the proximity of large urban centres and topographic features, and also suggest variations and changes in the major climatic systems affecting precipitation regimes over SE

Exploiting transition locality in automatic verification of finite-state concurrent systems

In this paper we show that statistical properties of the transition graph of a system to be verified can be exploited to improve memory or time performances of verification algorithms. We show experimentally that protocols exhibit transition locality. That is, with respect to levels of a breadth-first state space exploration, state transitions tend to be between states belonging to close levels of the transition graph. We support our claim by measuring transition locality for the set of protocols included in the Murphi verifier distribution . We present a cache-based verification algorithm that exploits transition locality to decrease memory usage and a disk-based verification algorithm that exploits transition locality to decrease disk read accesses, thus reducing the time overhead due to disk usage. Both algorithms have been implemented within the Murphi verifier. Our experimental results show that our cache-based algorithm can typically save more than 40% of memory with an average time penalty of about 50% when using (Murphi) bit compression and 100% when using bit compression and hash compaction, whereas our disk-based verification algorithm is typically more than ten times faster than a previously proposed disk-based verification algorithm and, even when using 10% of the memory needed to complete verification, it is only between 40 and 530% (300% on average) slower than (RAM) Murphi with enough memory to complete the verification task at hand. Using just 300 MB of memory our disk-based Murphi was able to complete verification of a protocol with about 109 reachable states. This would require more than 5 GB of memory using standard Murphi

Target volume definition in high-risk prostate cancer patients using sentinel node SPECT/CT and ¹⁸ F-choline PET/CT

<p>Abstract</p> <p>Background</p> <p>To assess the influence of sentinel lymph nodes (SNs) SPECT/CT and ¹⁸ F-choline (¹⁸ F-FCH) PET/CT in radiotherapy (RT) treatment planning for prostate cancer patients with a high-risk for lymph node (LN) involvement.</p> <p>Methods</p> <p>Twenty high-risk prostate cancer patients underwent a pelvic SPECT acquisition following a transrectal ultrasound guided injection of ^99mTc-Nanocoll into the prostate. In all patients but one an ¹⁸ F-FCH PET/CT for RT treatment planning was performed. SPECT studies were coregistered with the respective abdominal CTs. Pelvic SNs localized on SPECT/CT and LN metastases detected by ¹⁸ F-FCH PET/CT were compared to standard pelvic clinical target volumes (CTV).</p> <p>Results</p> <p>A total of 104 pelvic SNs were identified on SPECT/CT (mean 5.2 SNs/patient; range 1–10). Twenty-seven SNs were located outside the standard pelvic CTV, 17 in the proximal common iliac and retroperitoneal regions above S1, 9 in the pararectal fat and 1 in the inguinal region. SPECT/CT succeeded to optimize the definition of the CTV and treatment plans in 6/20 patients due to the presence of pararectal SNs located outside the standard treatment volume. ¹⁸ F-FCH PET/CT identified abnormal tracer uptake in the iliac LN region in 2/19 patients. These abnormal LNs were negative on SPECT/CT suggesting a potential blockade of lymphatic drainage by metastatic LNs with a high tumour burden.</p> <p>Conclusions</p> <p>Multimodality imaging which combines SPECT/CT prostate lymphoscintigraphy and ¹⁸ F-FCH PET/CT identified SNs outside standard pelvic CTVs or highly suspicious pelvic LNs in 40% of high-risk prostate cancer patients, highlighting the potential impact of this approach in RT treatment planning.</p