Reliability and Interpretability of Sonographic Measurements of Palmar Dupuytren Nodules

Purpose: In the future, it is expected that treatment of Dupuytren disease (DD) may shift toward control of early disease. Ultrasound might be an accurate method to measure the outcome of such treatment. The aim of this study was to assess the reliability of sonographic measurement of palmar nodules. Methods: Fifty patients with nodules characteristic for early disease were assessed with ultrasound by 2 observers. Four different aspects of DD nodules were measured in the transversal and sagittal planes, width, depth, circumference, and area. The intra- and interobserver reliabilities were calculated using the intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and the smallest detectable change (SDC) were also calculated for each aspect. Results: The intraobserver reliability was good (ICC, 0.724 [0.562–0.833] to 0.886 [0.808–0.934]), except for width in the sagittal direction (ICC, 0.671 [0.484–0.799]). The interobserver reliability was moderate (ICC, 0.385 [0.126–0.596] to 0.757 [0.538–0.869]). The intraobserver ICCs of area were highest (transverse, 0.847 [0.744–0.893]; sagittal, 0.886 [0.808–0.934]). The SEM and SDC of area were 6.1 and 16.9 mm2 in the transverse and 8.0 and 22.2 mm2 in the sagittal plane. Conclusions: The intraobserver reliability of sonographic assessment of DD nodules is good. The measurement of area is the most reliable and is, therefore, recommended for future studies. However, even single-observer measurements have a clear dispersion, and a change beyond 16.9 (61%) and 22.2 mm2 (79%) has to be observed in the transverse and sagittal planes, respectively, before it can be considered as regression or progression. Clinical relevance: Repeated ultrasonographic measurements in DD should ideally be done by a single observer, using area of the nodule in the sagittal plane. Change beyond 16.9 (transverse) and 22.2 (sagittal) mm2 can be considered as a real change in nodule size

The association between echogenicity and progression of Dupuytren's disease (DD):Birth of an imaging biomarker?

BACKGROUND: The shift of focus towards disease-controlling treatments to prevent DD progression at an early stage underlines the need for objective and reliable measurements that can monitor and predict the course of disease. Ultrasound has been studied as a potential tool for this purpose. This study examined to what extent echogenicity of early DD nodules predicts clinical progression.METHODS: Sonographic assessments of Dupuytren's nodules were performed by the same observer on 151 participants as part of an ongoing prospective cohort study on the course of DD. Echogenicity was assessed by determining the greyness of a nodule relative to the surrounding tissue, using ImageJ software. Progression of disease was defined as 1) an increase in total passive extension deficit (TPED) of ≥15 degrees and 2) surgical intervention of the examined ray, both occurring after the sonographic assessment. The associations between echogenicity and time to progression were estimated using Cox-regression models.RESULTS: The association between echogenicity and time to TPED progression showed that for every additional decrease of 1% in relative greyness (darker image) of a nodule, the risk of TPED progression during follow-up increases by 3.4% (hazard ratio [HR] = 0.966, 95% confidence interval [CI]: 0.935-0.966). Similarly, echogenicity was also associated with time to surgical intervention (HR = 0.967, 95% CI: 0.938-0.997), which indicates a higher risk for surgery during follow-up for darker nodules.CONCLUSIONS: These results suggest that echogenicity is predictive of the prognosis of the early stages of DD and might potentially be used as a prognostic imaging biomarker in the future.</p

Imaging for Dupuytren disease:a systematic review of the literature

BACKGROUND: As treatment of Dupuytren disease (DD) is expected to shift towards prevention of progression, the use of imaging in patients with DD becomes more important. In this systematic review an overview is given of the different methods for and applications of imaging for DD that have been described. METHODS: The MEDLINE and EMBASE databases were searched for articles reporting the use of imaging in patients with DD, published before May 17, 2018. Studies were systematically examined in two rounds by two observers according to the PRISMA systematic. All studies containing original data on imaging for DD were considered for inclusion. RESULTS: Three hundred and seven unique studies were identified, of which 23 were included in the study. Only studies on the use of ultrasound (US) and magnetic resonance imaging (MRI) were identified. Broadly, articles could be divided into 5 categories. Seven studies were found on diagnosis, two on measurement of disease extent, four on measurement of disease activity, seven on guidance of minimally invasive procedures and five studies on evaluation of treatment. According to the Oxford CEBM, the levels of evidence were low, ranging from level 3 to 5. CONCLUSIONS: A variety of applications for US and MRI for patients with DD has been described. Based on the results of this review, the largest value for imaging lies in the measurement of disease activity and the follow-up of treatment of patients with early stage disease. Unfortunately, the overall level of evidence of the available literature was low. Future research is necessary to define the exact value of US and MRI in the management of patients with DD

Single-cell analysis of peptide expression and electrophysiology of right parietal neurons involved in male copulation behavior of a simultaneous hermaphrodite

Male copulation is a complex behavior that requires coordinated communication between the nervous system and the peripheral reproductive organs involved in mating. In hermaphroditic animals, such as the freshwater snail Lymnaea stagnalis, this complexity increases since the animal can behave both as male and female. The performance of the sexual role as a male is coordinated via a neuronal communication regulated by many peptidergic neurons, clustered in the cerebral and pedal ganglia and dispersed in the pleural and parietal ganglia. By combining single-cell matrix-assisted laser mass spectrometry with retrograde staining and electrophysiology, we analyzed neuropeptide expression of single neurons of the right parietal ganglion and their axonal projections into the penial nerve. Based on the neuropeptide profile of these neurons, we were able to reconstruct a chemical map of the right parietal ganglion revealing a striking correlation with the earlier electrophysiological and neuroanatomical studies. Neurons can be divided into two main groups: (i) neurons that express heptapeptides and (ii) neurons that do not. The neuronal projection of the different neurons into the penial nerve reveals a pattern where (spontaneous) activity is related to branching pattern. This heterogeneity in both neurochemical anatomy and branching pattern of the parietal neurons reflects the complexity of the peptidergic neurotransmission involved in the regulation of male mating behavior in this simultaneous hermaphrodite

Recidivism report 2002-2008. Trends in the reconviction rate of Dutch offenders

Policy programmes in the field of Dutch criminal law often aim at the reduction of recidivism; measures are taken to lower the risk of prosecuted offenders relapsing into criminal behaviour. Some years ago, specific targets were formulated with respect to two major offender groups. For convicted juvenile offenders, and for adult ex-prisoners, the medium-term recidivism will have to be reduced by 10 percentage points between 2002 and 2010 (VbbV, 2007). The current government also endorses the need to suppress recidivism (DSP, 2011). A substantial part of crime in the Netherlands is committed by persons who have been prosecuted before. Therefore, crime prevention is also the prevention of recidivism. The Recidivism Monitor is an ongoing research project carried out by the WODC. With this instrument the realisation of the recidivism targets can be monitored. Each year, the WODC reports on the reconviction rate of Dutch offenders. Nearly all persons who were suspect in a penal case are included in the study. The standard measurements of the Recidivism Monitor relate to five offender populations: adult offenders sanctioned by court or Public Prosecutor’s Service (PPS), juvenile offenders sanctioned by court or PPS, ex-prisoners, former inmates of juvenile detention centres and former offenders placed under an entrustment order (tbs).1 The reconviction rates in the tbs-sector are reported on separately (see int. al. Bregman & Wartna, 2011). This fact sheet outlines known recidivism in the other four offender populations. Specifically, the study relates to juveniles and adults who were sanctioned by court or PPS or released from a penitentiary institution in the years between 2002, the first year of the target period, and 2008, the latest year for which statistics are currently available

Continuous Interaction with a Virtual Human

Attentive Speaking and Active Listening require that a Virtual Human be capable of simultaneous perception/interpretation and production of communicative behavior. A Virtual Human should be able to signal its attitude and attention while it is listening to its interaction partner, and be able to attend to its interaction partner while it is speaking – and modify its communicative behavior on-the-fly based on what it perceives from its partner. This report presents the results of a four week summer project that was part of eNTERFACE’10. The project resulted in progress on several aspects of continuous interaction such as scheduling and interrupting multimodal behavior, automatic classification of listener responses, generation of response eliciting behavior, and models for appropriate reactions to listener responses. A pilot user study was conducted with ten participants. In addition, the project yielded a number of deliverables that are released for public access

Vulnerability for new episodes in recurrent major depressive disorder:protocol for the longitudinal DELTA-neuroimaging cohort study

Introduction Major depressive disorder (MDD) is widely prevalent and severely disabling, mainly due to its recurrent nature. A better understanding of the mechanisms underlying MDD-recurrence may help to identify high-risk patients and to improve the preventive treatment they need. MDD-recurrence has been considered from various levels of perspective including symptomatology, affective neuropsychology, brain circuitry and endocrinology/metabolism. However, MDD-recurrence understanding is limited, because these perspectives have been studied mainly in isolation, cross-sectionally in depressed patients. Therefore, we aim at improving MDD-recurrence understanding by studying these four selected perspectives in combination and prospectively during remission.Methods and analysis In a cohort design, we will include 60 remitted, unipolar, unmedicated, recurrent MDD-participants (35-65years) with 2 MDD-episodes. At baseline, we will compare the MDD-participants with 40 matched controls. Subsequently, we will follow-up the MDD-participants for 2.5years while monitoring recurrences. We will invite participants with a recurrence to repeat baseline measurements, together with matched remitted MDD-participants. Measurements include questionnaires, sad mood-induction, lifestyle/diet, 3T structural (T1-weighted and diffusion tensor imaging) and blood-oxygen-level-dependent functional MRI (fMRI) and MR-spectroscopy. fMRI focusses on resting state, reward/aversive-related learning and emotion regulation. With affective neuropsychological tasks we will test emotional processing. Moreover, we will assess endocrinology (salivary hypothalamic-pituitary-adrenal-axis cortisol and dehydroepiandrosterone-sulfate) and metabolism (metabolomics including polyunsaturated fatty acids), and store blood for, for example, inflammation analyses, genomics and proteomics. Finally, we will perform repeated momentary daily assessments using experience sampling methods at baseline. We will integrate measures to test: (1) differences between MDD-participants and controls; (2) associations of baseline measures with retro/prospective recurrence-rates; and (3) repeated measures changes during follow-up recurrence. This data set will allow us to study different predictors of recurrence in combination.Ethics and dissemination The local ethics committee approved this study (AMC-METC-Nr.:11/050). We will submit results for publication in peer-reviewed journals and presentation at (inter)national scientific meetings.Trial registration number NTR3768.</p

Environmental Risk Assessment of Fluctuating Diazinon Concentrations in an Urban and Agricultural Catchment Using Toxicokinetic–Toxicodynamic Modeling

Temporally resolved environmental risk assessment of fluctuating concentrations of micropollutants is presented. We separated the prediction of toxicity over time from the extrapolation from one to many species and from acute to sublethal effects. A toxicokinetic–toxicodynamic (TKTD) model predicted toxicity caused by fluctuating concentrations of diazinon, measured by time-resolved sampling over 108 days from three locations in a stream network, representing urban, agricultural and mixed land use. We calculated extrapolation factors to quantify variation in toxicity among species and effect types based on available toxicity data, while correcting for different test durations with the TKTD model. Sampling from the distribution of extrapolation factors and prediction of time-resolved toxicity with the TKTD model facilitated subsequent calculation of the risk of undesired toxic events. Approximately one-fifth of aquatic organisms were at risk and fluctuating concentrations were more toxic than their averages. Contribution of urban and agricultural sources of diazinon to the overall risk varied. Thus using fixed concentrations as water quality criteria appears overly simplistic because it ignores the temporal dimension of toxicity. However, the improved prediction of toxicity for fluctuating concentrations may be small compared to uncertainty due to limited diversity of toxicity data to base the extrapolation factors on

Diversity and distribution of oribatid mites (Acari:Oribatida) in a lowland rain forest in Peru and in several environments of the Brazilians states of Amazonas, Rondônia, Roraima and Pará

We are summarizing the current state of knowledge of the diversity and distribution of oribatid mites in 26 environments in northern Brazil and of a rain forest in Peru. The published studies were mostly concentrated in Central Amazon. Only one report is a result from an agricultural polyculture. We are providing the first lists of species for savannas and for the Brazilian states of Roraima and Pará. Up to date, 146 species are definitively identified from a total of 444 taxa with 188 known genera, reinforcing the notion of a rich biodiverse area. The high number of 298 non-described species (morphospecies) clearly shows the inadequacy of the current taxonomic knowledge for the region. Most of the registers are from forest environments. In the soil from primary forests, we registered the highest diversity (54-155 species/morphospecies). Eighty-nine species were unique to primary forests, followed by 34 for savannas, 32 in trees, 10 in "igapó", 4 in caatinga, 3 in secondary forests, two in "varzea" and one in polyculture. Twenty genera were the most speciose. The species with the largest home ranges were Rostrozetes foveolatus, Scheloribates sp. A, and Galumna sp. A. Our numbers reflect the lack of taxonomists and show that the taxonomic knowledge must be improved for the region or we will continue to work with taxonomic resolution of Order or Family and a high percentage of morphospecies, which will probably be appropriate to the question being asked in each study, but not for a comparison among environments

A medium-spatial scale distribution pattern of pseudoscorpionida (arachnida) in a gradient of topography (altitude and inclination), soil factors, and litter in a central Amazonia forest reserve, Brazil

In Amazonia, nothing is known about the distribution of the invertebrates on a medium-spatial scale pattern. In a trail system of 64 km2 at Ducke Reserve, we sampled 72 transects using the hand-sorting method and Berlese-Tullgren extraction. The reserve possesses ecosystems of "terra-firme" forest and the trail system represents a gradient of topographic soil factors and vegetation, avoiding categorizations. Considering the abundance and diversity of Pseudoscorpionida, we investigated the relation of the community to environmental factors tested (topography, clay percentage, litter, and soil pH), to the two major drainage basins of the reserve, and if these invertebrates can be used as biological indicators to monitor changes. We registered two species for the first time in the reserve, increasing the known diversity to 17 species. The lack of correlation with the predictor variables and the large home range, indicate that pseudoscorpions are not good biological indicators in the reserve. As the eastern and western watersheds are not separate management units for the community, our results show that they are generalist predators. In spite of our results and lack of knowledge concerning their biology, life history and taxonomy, pseudoscorpions are cosmopolitan and easy to find and measure. Compared with previous studies in the reserve, they have a consistent pattern of abundance and diversity throughout the years showing the stability of the community which can be checked mainly by comparison with environmental changes that would occur in the reserve. An investigation on a medium-spatial scale pattern and over a long-term period including other habitats, and also other predictor variables, like humidity, the structure of the vegetation and canopy closure, will be necessary to reinforce the observed tendencies