Whole-body diffusion-weighted imaging with background body signal suppression and quantitative apparent diffusion coefficient in the detection, staging, and grading of non-Hodgkin lymphoma

Purpose: Assess reproducibility of detection, staging, and grading of non-Hodgkin lymphoma (NHL) using wholebody diffusion-weighted imaging with background body signal suppression (WB-DWIBS). Material and methods: Thirty NHL patients underwent WB-DWIBS, divided into 2 groups according to staging and grading. Image analysis and apparent diffusion coefficient (ADC) measurement of the largest lymph node in each group were performed by 2 observers. Inter-observer agreement was performed. Results: Overall inter-observer agreement for detection of NHL was excellent (k = 0.843; 92.05%) with excellent inter-observer agreement of nodal disease (cervical, thoracic and abdominal) (k = 0.783, 0.769, and 0.856; 96.67%, 90.0%, and 93.3% respectively), extra-nodal disease (k = 1; 100%), and splenic involvement (k = 0.67; 83.3%). The overall inter-observer agreement of DWIBS in staging of NHL was excellent (k = 0.90; 94.9%) with excellent inter-observer agreement for stage I (k = 0.93; 96.4%), stage II (k = 0.90; 94.8%), stage III (k = 0.89; 94.6%), and stage IV (k = 0.88; 94.0%). There was significant difference between ADC in stage I, II (0.77 ± 0.13, 0.85 ± 0.09 × 10-3 mm2/s), and stage III, IV (0.63 ± 0.08, 0.64 ± 0.11 × 10-3 mm2 /s, p < 0.002, < 0.001). Interclass correlation showed almost perfect agreement for ADC measurement in staging and grading groups (r = 0.96 and r = 0.85, respectively, p < 0.001). There was significant difference between ADC in aggressive lymphoma (0.65 ± 0.1, 0.67 ± 0.13 × 10-3 mm2/s) and indolent lymphoma (0.76 ± 0.14, 0.84 ± 0.09 × 10-3 mm2/s, p < 0.028, < 0.001). Conclusion: DWIBS is reproducible for detection and staging of nodal and extra-nodal involvement in patients with NHL. ADC can quantitatively participate in the staging and grading of NHL

ESTUDOS SOBRE O ESTABELECIMENTO E DESENVOLVIMENTO DE ESPÉCIES COM AMPLA OCORRÊNCIA EM MATA CILlAR

As investigações realizadas neste trabalho fazem parte de um projeto mais amplo, cujo objetivo principal é o estabelecimento de modelos para recuperação de trechos degradados de matas ciliares. As pesquisas foram desenvolvidas com base em ensaios de campo na região de Campinas (SP), onde foram plantadas mudas de dez espécies de ampla ocorrência em matas ciliares da região. De um total de 1.743 indivíduos, foram amostrados 30% de cada espécie, para avaliação do estabelecimento, incremento em altura e mortalidade das mudas, realizados em cinco meses subseqüentes ao último plantio. Os resultados indicam que a porcentagem média de mortalidade foi maior em Platycyamus regnelli Benth. (22,50%) e Croton urucurana Baill. (14,58%) e menores em Cyclolobium vecchii A Samp. ex Hoehne (1,78%) e Genipa americana L. (2,15%). Quanto ao incremento em altura verificou-se que C. urucurana (9,20 cm) e Erythrina cristagalli L.(7,89 cm) apresentaram os maiores valores, enquanto P. regnelli (1,10 cm) e G. americana (1,54 cm) tiveram um desenvolvimento mais lento. As demais espécies tiveram comportamento compatível com o estádio sucessional. O trabalho conclui pela relação existente entre os fatores analisados (incremento e mortalidade) com os estádios sucessionais característicos de cada uma das dez espécies amostradas

Assessment of Left Ventricular Dyssynchrony after Permanent Cardiac Pacing by Using Two Dimensional Speckle Tracking Echocardiography

Background: Echocardiography is important in assessing left ventricular mechanical dyssynchrony (LVMD) and left ventricular (LV) function after implant of a permanent pacemaker. Global longitudinal strain (GLS) and Left ventricular dyssynchrony assessment enable clinicians to detect early signs of LV dysfunction after cardiac pacing. This study assessed LV mechanical asynchrony and LV function in different pacing modes after permanent cardiac pacing by using tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE). Patients and Methods: Seventy female (42) and male (28) patients were enrolled in this prospective observational case study (mean age 60.99 ± 13.77 years) at Mansoura Specialized Medical Hospital over a period of 1 year from April 2018 to April 2019. All the patients were assessed by thorough history taking, clinical examination, conventional Echocardiography, TDI and two-dimensional (2D) STE. Results: Regarding parameters assessed by STE, there was a significant decrease in global longitudinal strain GLS (P = 0.034*) while there was a significant increase in time to peak strain standard deviation (TP-SD) by STE (P < 0.001*). Also, there was significant decrease in GLS (P < 0.001*) and significant increase in TP-SD by STE (P = 0.001*) in dual chamber pacemaker (DDD) group. Similarly, there was a significant decrease in GLS (P < 0.001*) and a significant increase in TP-SD by STE (P < 0.001*) in ventricular demanding pacing (VVI) group. Conclusion: The results show that GLS by 2D STE can help in detection of subclinical left ventricular dysfunction (LVD) after permanent pacemaker implantation before appearance of clinical symptoms. In addition, cardiac pacing can still lead to LVMD irrespective of the degree of the pacing mode. However, this may need upgrading later on to cardiac resynchronization therapy (CRT)

Digitalization during Covid-19 : A study of how elderly experienced that the increased digitalization affected them during the Covid-19-pandemic

Covid-19-pandemin har satt fart på digitaliseringen i en takt utöver det normala. I samband med skiftet till distansarbete och utbildning, samt rekommendationerna om att begränsa den fysiska kontakten, har det vardagliga livet tagits över av digitala enheter och tjänster. För att kunna vara en del av det digitala samhället krävs det att individen besitter en digital kompetens. Däremot finns det flera individer som saknar den digitala kompetensen – framför allt äldre individer. Äldre individer utgör merparten av de individer som befinner sig i ett digitalt utanförskap, och som riskerar att hamna i ett sådant utanförskap. Särskilt i en tid som Covid-19 när det digitala blivit det första alternativet. Därmed är syftet med denna studie att förhindra att flera hamnar i ett digitalt utanförskap, och det genom att undersöka hur äldre individer upplevt den ökade digitaliseringen under Covid-19-pandemin. Studien har utgått ifrån en kvalitativ forskningsmetod, där respondenter över 65 år har intervjuats för att fånga informationsrika data om hur de upplevt den ökade digitaliseringen under Covid-19. Resultatet som presenterades visade att det fanns delade meningar om hur den ökade digitaliseringen upplevdes, vissa hade en mer positiv inställning till den digitala samhällsutvecklingen jämfört med andra. Däremot upplevde samtliga att den digitala utvecklingen gick för fort fram och att det skapade en viss orolighet över att hamna efter. På samma gång, upplevdes känslan av isolering och ensamhet, samt en känsla av att vara en börda. Resultatet visade även att ett digitalt utanförskap före Covid-19, var ett utanförskap enklare att hantera och leva

Digitalization during Covid-19 : A study of how elderly experienced that the increased digitalization affected them during the Covid-19-pandemic

Covid-19-pandemin har satt fart på digitaliseringen i en takt utöver det normala. I samband med skiftet till distansarbete och utbildning, samt rekommendationerna om att begränsa den fysiska kontakten, har det vardagliga livet tagits över av digitala enheter och tjänster. För att kunna vara en del av det digitala samhället krävs det att individen besitter en digital kompetens. Däremot finns det flera individer som saknar den digitala kompetensen – framför allt äldre individer. Äldre individer utgör merparten av de individer som befinner sig i ett digitalt utanförskap, och som riskerar att hamna i ett sådant utanförskap. Särskilt i en tid som Covid-19 när det digitala blivit det första alternativet. Därmed är syftet med denna studie att förhindra att flera hamnar i ett digitalt utanförskap, och det genom att undersöka hur äldre individer upplevt den ökade digitaliseringen under Covid-19-pandemin. Studien har utgått ifrån en kvalitativ forskningsmetod, där respondenter över 65 år har intervjuats för att fånga informationsrika data om hur de upplevt den ökade digitaliseringen under Covid-19. Resultatet som presenterades visade att det fanns delade meningar om hur den ökade digitaliseringen upplevdes, vissa hade en mer positiv inställning till den digitala samhällsutvecklingen jämfört med andra. Däremot upplevde samtliga att den digitala utvecklingen gick för fort fram och att det skapade en viss orolighet över att hamna efter. På samma gång, upplevdes känslan av isolering och ensamhet, samt en känsla av att vara en börda. Resultatet visade även att ett digitalt utanförskap före Covid-19, var ett utanförskap enklare att hantera och leva

Whole-body diffusion-weighted imaging with background body signal suppression in the detection of osseous and extra-osseous metastases

Purpose: To assess the reproducibility of detection of osseous and extra-osseous metastases in cancer patients using whole-body diffusion-weighted imaging with background body signal suppression (WB-DWIBS). Material and methods: A prospective study was conducted on 39 consecutive patients (21 females, 18 males; mean age 48 years) with metastases, who underwent WB-DWIBS on a 1.5-T MR scanner. Image analysis was performed independently by two blinded observers. Inter-observer agreement was assessed for the detection of osseous (spinal, appendicular) and extra-osseous (hepatic, pulmonary, nodal, and peritoneal) metastases. Results: The overall inter-observer agreement of WB-DWIBS in the detection of osseous and extra-osseous metastases was excellent (k = 0.887, agreement = 94.44%, p = 0.001). There was excellent inter-observer agreement of both observers for the detection of osseous spinal (k = 0.846, agreement = 92.3%), osseous appendicular (k = 0.898, agreement = 94.8 %), hepatic (k = 0.847, agreement = 92.3%), pulmonary (k = 0.938, agreement = 97.4%), nodal metastases (k = 0.856, agreement = 94.9%), and peritoneal metastasis (k = 0.772, agreement = 94.9%). Conclusion: We concluded that WB-DWIBS is reproducible for detection of osseous and extra-osseous metastases in cancer patients

Audiometria

Nestes 10 anos de trabalho junto ao Deficiente Auditivo, desenvolvido no Instituto de Educação de Surdos e em Clínicas particulares, tivemos a oportunid~de de avaliar as dificuldades, principalmente dos professores, no que se refere à interpretação do gráfico audiométrico e de outros exames audiológicos. Na maioria das vezes o profissional interessa-se pelo laudo a fim de obter as informações necessárias para a inscrição do indivíduo em um determinado grupo de trabalho. Ora, este laudo está baseado em regras pré-estabelecidas universalmente com a finalidade de padronização, porém com pequenas diferenças dependendo da linha que o audiologista segue.</p

Therapeutic reduction mammoplasty in large-breasted women with cancer using superior and superomedial pedicles

Adel Denewer,1 Fayez Shahatto,1 Waleed Elnahas,1 Omar Farouk,1 Sameh Roshdy,1 Ashraf Khater,1 Osama Hussein,1 Saleh Teima,2 Mohammed Hafez,1 Samir Zidan,1 Nazem Shams,1 Sherif Kotb11Surgical Oncology Department, Oncology Center, 2Clinical Oncology and Nuclear Medicine Department, Mansoura University, Mansoura, EgyptBackground: Surgical management of breast cancer in large-breasted women presents a real challenge. This study aims to evaluate the outcome of therapeutic reduction mammoplasty in large-breasted women with breast cancer using superior and superomedial pedicles, situated at any breast quadrant except for the central and upper medial quadrants.Methods: Fifty women with breast cancer and large breasts underwent simultaneous bilateral reduction mammoplasty. The weight of the tissue removed ranged from 550 g to 1050 g and the tumor-free safety margins by frozen section were in the range of 4 cm to 12 cm.Results: The age of the patients ranged from 36 to 58 (median 43) years and tumor size ranged from 1 cm to 4 cm. The cosmetic outcomes were excellent in 32 patients (64%), good in 15 (30%) patients, and fair in three patients (6%). The follow-up period was 8&amp;ndash;36 (mean 20) months, with no local recurrence or systemic metastasis.Conclusion: Therapeutic reduction mammoplasty using superior and superomedial pedicles was shown to be oncologically safer than traditional conservative surgery. This oncoplastic procedure yields a satisfactory esthetic outcome with lower morbidity in large-breasted women with breast cancer.Keywords: breast cancer, oncoplastic surgery, reduction mammoplasty, conservation surger