CT arthrography of adhesive capsulitis of the shoulder: Are MR signs applicable?

To determine if diagnostic signs of adhesive capsulitis (AC) of the shoulder at Magnetic Resonance Imaging (MRI) and arthrography (MRA) are applicable to CT arthrography (CTA). 22 shoulder CTAs with AC were retrospectively reviewed for features described in MR literature. The control group was composed of 83 shoulder CTA divided into four subgroups 1) normal (N = 20), 2) omarthrosis (N = 19), 3) labral injury (N = 23), and 4) rotator cuff tear (N = 21). Two musculoskeletal radiologists assessed the rotator interval (RI) for obliteration, increased width and thickening of coracohumeral ligament (CHL). The width and capsule thickness of the axillary recess were measured. The width of the axillary recess was significantly decreased in the AC group (4.6 ± 2.6 mm versus 9.9 ± 4.6 mm, p ≤ 0.0001; sensitivity and specificity of 84% and 80%). Thickness of the medial and lateral walls of the axillary capsule was significantly increased in the AC group (5.9 ± 1.3 mm versus 3.7 ± 1.1 mm, p ≤ 0.0001 and 5.7 ± 1 mm versus 3.5 ± 1.3 mm, p ≤ 0.0001, respectively). CHL thickness was significantly increased in the AC group (4.1 ± 1 mm (p ≤ 0.001)) in comparison to others groups. Obliteration of the RI was statistically significantly more frequent in patients with AC (72.7% (16/22) vs. 12% (10/83), p < 0.0001). Width of the RI did not differ significantly between patients and controls (p ≥ 0.428). Decreased axillary width, and thickened axillary capsule are MR signs of AC applicable to CTA. Evaluation of rotator interval seems useful and reproducible only for obliteration

Blood pressure measurements for diagnosing hypertension in primary care:room for improvement

Background: In the adult population, about 50% have hypertension, a risk factor for cardiovascular disease and subsequent premature death. Little is known about the quality of the methods used to diagnose hypertension in primary care. Objectives: The objective was to assess the frequency of use of recognized methods to establish a diagnosis of hypertension, and specifically for OBPM, whether three distinct measurements were taken, and how correctly the blood pressure levels were interpreted. Methods: A retrospective population-based cohort study using electronic medical records of patients aged between 40 and 70 years, who visited their general practitioner (GP) with a new-onset of hypertension in the years 2012, 2016, 2019, and 2020. A visual chart review of the electronic medical records was used to assess the methods employed to diagnose hypertension in a random sample of 500 patients. The blood pressure measurement method was considered complete if three or more valid office blood pressure measurements (OBPM) were performed, or home-based blood pressure measurements (HBPM), the office- based 30-minute method (OBP30), or 24-hour ambulatory blood pressure measurements (24 H-ABPM) were used. Results: In all study years, OBPM was the most frequently used method to diagnose new-onset hypertension in patients. The OBP-30 method was used in 0.4% (2012), 4.2% (2016), 10.6% (2019), and 9.8% (2020) of patients respectively, 24 H-ABPM in 16.0%, 22.2%, 17.2%, and 19.0% of patients and HBPM measurements in 5.4%, 8.4%, 7.6%, and 7.8% of patients, respectively. A diagnosis of hypertension based on only one or two office measurements occurred in 85.2% (2012), 87.9% (2016), 94.4% (2019), and 96.8% (2020) of all patients with OBPM. In cases of incomplete measurement and incorrect interpretation, medication was still started in 64% of cases in 2012, 56% (2016), 60% (2019), and 73% (2020). Conclusion: OBPM is still the most often used method to diagnose hypertension in primary care. The diagnosis was often incomplete or misinterpreted using incorrect cut-off levels. A small improvement occurred between 2012 and 2016 but no further progress was seen in 2019 or 2020. If hypertension is inappropriately diagnosed, it may result in under treatment or in prolonged, unnecessary treatment of patients. There is room for improvement in the general practice setting.</p

Some Properties of a Transient New Coherent Condition of Matter Formed in High--Energy Hadronic Collisions

We investigate the dynamical possibility for the formation of a transient new coherent condition of matter in high--energy hadronic collisions. The coherent bosonic amplitude is characterized by a non--zero momentum and is sustained by $P$--wave interactions of quasi--pions in a dense fermionic medium. We make quantitative estimates of several essential properties: the condensate momentum and the fermionic density, the size of the coherent amplitude and the negative energy density contributed by the condensate, a characteristic proper time for the system to exist prior to breakdown into a few pions, and a characteristic extension of the system over the plane perpendicular to the collision axis. These quantities then allow us to make definite estimates of new signals: a few pions with anomalously small transverse momenta $\leq 50$ MeV/c; and a possible anomalous bremsstrahlung of very soft photons with characteristic transverse momenta as low as about 4 MeV/c.Comment: 23 pages, LaTeX. A complete postscript file is available via anonymous ftp at ttpux2.physik.uni-karlsruhe.de (129.13.102.139) as /ttp94-18 /ttp94-18.ps, Local preprint# TTP94-1

Actinella species (Bacillariophyta) from an Amazon black water floodplain lake (Amazonas - Brazil)

The genus Actinella Lewis was studied using planktonic samples from a black water floodplain lake in Central Amazon region. For species identification the taxa were morphological and morphometricaly analyzed on base in light microscope (LM) and scanning electronic microscope (SEM). Five species were registered: Actinella brasiliensis Grunow, A. guianensis Grunow, A. gracile Kociolek, A. mirabilis (Eulenstein ex Grunow) Grunow and A. robusta Hustedt. A. gracile is reported for the first time for Amazon State and black water systems and it is firstly documented with SEM. In addition, a review of geographic distribution of Actinella species in Brazilian Amazon region is given.O gênero Actinella Lewis foi estudado a partir de amostras coletadas em um lago de inundação de águas pretas na Amazônia Central. Para a identificação das espécies as características morfológicas e morfométricas dos táxons foram analisadas em microscopia óptica (MO) e eletrônica de varredura (MEV). Cinco espécies foram identificadas: Actinella brasiliensis Grunow, A. guianensis Grunow, A. gracile Kociolek, A. mirabilis (Eulenstein ex Grunow) Grunow e A. robusta Hustedt. A. gracile é referida pela primeira vez para o estado do Amazonas e para ambientes de águas pretas, sendo documentada pela primeira vez em MEV. Em adição, uma revisão sobre a distribuição geográfica das espécies de Actinella na região da Amazônia brasileira é apresentada

Machine learning algorithms performed no better than regression models for prognostication in traumatic brain injury

Objective: We aimed to explore the added value of common machine learning (ML) algorithms for prediction of outcome for moderate and severe traumatic brain injury. Study Design and Setting: We performed logistic regression (LR), lasso regression, and ridge regression with key baseline predictors in the IMPACT-II database (15 studies, n = 11,022). ML algorithms included support vector machines, random forests, gradient boosting machines, and artificial neural networks and were trained using the same predictors. To assess generalizability of predictions, we performed internal, internal-external, and external validation on the recent CENTER-TBI study (patients with Glasgow Coma Scale <13, n = 1,554). Both calibration (calibration slope/intercept) and discrimination (area under the curve) was quantified. Results: In the IMPACT-II database, 3,332/11,022 (30%) died and 5,233(48%) had unfavorable outcome (Glasgow Outcome Scale less than 4). In the CENTER-TBI study, 348/1,554(29%) died and 651(54%) had unfavorable outcome. Discrimination and calibration varied widely between the studies and less so between the studied algorithms. The mean area under the curve was 0.82 for mortality and 0.77 for unfavorable outcomes in the CENTER-TBI study. Conclusion: ML algorithms may not outperform traditional regression approaches in a low-dimensional setting for outcome prediction after moderate or severe traumatic brain injury. Similar to regression-based prediction models, ML algorithms should be rigorously validated to ensure applicability to new populations

Functional mechanisms underlying pleiotropic risk alleles at the 19p13.1 breast-ovarian cancer susceptibility locus

A locus at 19p13 is associated with breast cancer (BC) and ovarian cancer (OC) risk. Here we analyse 438 SNPs in this region in 46,451 BC and 15,438 OC cases, 15,252 BRCA1 mutation carriers and 73,444 controls and identify 13 candidate causal SNPs associated with serous OC (P=9.2 × 10-20), ER-negative BC (P=1.1 × 10-13), BRCA1-associated BC (P=7.7 × 10-16) and triple negative BC (P-diff=2 × 10-5). Genotype-gene expression associations are identified for candidate target genes ANKLE1 (P=2 × 10-3) and ABHD8 (P<2 × 10-3). Chromosome conformation capture identifies interactions between four candidate SNPs and ABHD8, and luciferase assays indicate six risk alleles increased transactivation of the ADHD8 promoter. Targeted deletion of a region containing risk SNP rs56069439 in a putative enhancer induces ANKLE1 downregulation; and mRNA stability assays indicate functional effects for an ANKLE1 3′-UTR SNP. Altogether, these data suggest that multiple SNPs at 19p13 regulate ABHD8 and perhaps ANKLE1 expression, and indicate common mechanisms underlying breast and ovarian cancer risk