Initial clinical evaluation of observer performance using a tablet computer with a 4K high-resolution display for detection of breast cancer by digital mammography

Purpose:To compare observer performance using medical‐purpose 5‐megapixel liquid crystal display monitors (5‐MP LCDs) and a tablet PC with a 4K high‐resolution display for detection of breast cancer by digital mammography. Materials and methods: Mammograms from 40 patients with primary breast cancer (18 mass, 16 microcalcifications, 3 artificial distortions, and 3 focal asymmetries) and 60 control patients were consecutively collected. Four experienced radiologists assessed 100 mammograms to rate using the BI‐RADS lexicon. The BI‐RADS assessments were subjected to receiver operating characteristic (ROC) curve analysis. Also, the observers assessed the image quality in terms of brightness, contrast, sharpness, and noise using 5‐step Likert scale. Results: The average under the curve (AUC) values for use of the 5‐MP LCDs and 4K monitors were 0.921 and 0.936; the difference between them was small and not significant. In terms of image quality, the 4K was rated better for brightness, contrast, and sharpness. Conclusion: Observer performance for detecting breast cancer on a 4K tablet PC with a high‐resolution display is similar to that using a 5‐MP LCD. This appears adequate for displaying mammograms of diagnostic quality and could be useful for patient consultations, clinical demonstrations, or educational and teaching purposes

PREDICT DIABETES INCIDENCE WITH HBA1C AND OTHER ITEMS

In diabetes screening with hemoglobin A1c in lieu of plasma glucose, the optimum cut-off point for predicting the incidence of diabetes mellitus in the four-year period was examined. In addition, considerations were given on items in the screening and questionnaire aside from hemoglobin A1c, which would be useful in predicting diabetes aside from hemoglobin A1c. The optimum cut-off point of hemoglobin A1c to predict diabetes, based on receiver operating characteristic curve, was 5.3 percent (sensitivity, 84.2%; specificity, 92.1%). Based on the logistic regression analysis, useful items (other than hemoglobin A1c) were alanine aminotransferase and γ-glutamyl transpeptidase. A combined application of hemoglobin A1c with alanine aminotransferase and γ-glutamyl transpeptidase for predicting the incidence of diabetes in the four-year period resulted in the sensitivity of 86.8% and the specificity of 96.3%. When the combined application was compared with the sole use of hemoglobin A1c at 5.3%, the combined use was superior to the latter in terms of both sensitivity and specificity, resulting in the reduction of false positives by more than 50%

CEA OF INFLUENZA-PNEUMOCOCCAL VACCINATIONS

During the periods of seasonal flu in 2003 and 2004, it was found that about 45 percent of elderly people in Japan had been inoculated with influenza vaccines. Comparatively, however, the proportion of inoculation with pneumococcal vaccine was only 0.1 percent. Taking into account such incongruent proportions, this study assesses health and economic benefits of vaccination strategies for both influenza and pneumonia particularly for the elderly population in Japan. To accomplish this objective, a cost-effectiveness analysis was conducted with the use of the Monte Carlo simulation based on the data from medical literature as well as from the public organizations, wherein three strategic patterns were delineated and compared (i) no vaccination (ii) influenza vaccine only, and (iii) combined influenza with pneumococcal vaccines. The cost for one year of life saved by each strategy was compared with the scenario of no vaccinations. It was found that for 100,000 elderly people over 65 years of age in Japan, the cost-effectiveness ratio of influenza-only vaccination was 516,332 Japanese yen per one year of life saved, while the combined vaccinations of influenza with pneumococcal was 459,874 Japanese yen for the same benefit. The incremental cost-effectiveness ratio of the strategies (iii) versus (ii) was 426,698 Japanese yen per one year of life saved for 100,000 people. Consequently it was indicated that the combined vaccinations would be more cost-effective than the vaccination for influenza only

Quantitative laser diffraction method for the assessment of protein subvisible particles

Shinichiro Totoki, Gaku Yamamoto, Kouhei Tsumoto, Susumu Uchiyama, Kiichi Fukui. Quantitative Laser Diffraction Method for the Assessment of Protein Subvisible Particles. Journal of Pharmaceutical Sciences, Volume 104, Issue 2, 2015, Pages 618-626. https://doi.org/10.1002/jps.24288

B. I. T. : Development of a dynamic visualization tool for Bayesian inference on normal distributions

Bayesian inference Tool (B. I. T.) is a software program developed to support medical professionals and students in the application of Bayesian inference to medical decision-making and education. This software program makes it possible to visualize the posterior probability distributions of Bayesian inference. In addition, its interface aims to facilitate the intuitive understanding of the operative procedures. For many cases of Bayesian inference with normal distributions, the graphical representation of the posterior probability distribution changes dynamically when the input value is assigned by the user with the use of a computer mouse; this procedure also enables the dynamic calculation of the posterior probability. When operating this software, it is desirable for the user to have basic knowledge and understanding of the presuppositions as well as applications of Bayesian inference

Fibrinolytic Activity and Platelet Function in Subjects with Obstructive Sleep Apnoea and a Patent Foramen Ovale: Is There an Option for Prevention of Ischaemic Stroke?

Peer reviewe

Activation of the Non-receptor Tyrosine Kinase cSrc in Macrophage-rich Atherosclerotic Plaques of Human Carotid Arteries

To determine the involvement of the non-receptor tyrosine kinase cSrc in plaque destabilization in carotid atherosclerosis (CAS), which is responsible for cerebral infarction, we performed quantitative and morphological detection of phosphorylated active cSrc (p-cSrc) and histopathological examination in CAS lesions. We examined carotid endarterectomy specimens obtained from 32 CAS patients. Each specimen was used for immunoblot and immunohistochemical analyses of p-cSrc, histopathological analysis, and image analysis of macrophage content. There was a strong positive correlation between cSrc activation on blots and macrophage content on sections. When we defined the macrophage-rich plaque (MRP) and the macrophage-poor plaque (MPP) as having macrophage content more and less than 5%, respectively, the p-cSrc density and the occurrence of plaque hemorrhage and thrombus formation were significantly increased in the MRP group (n=18) compared to the MPP group (n=14). p-cSrc immunoreactivity was localized in lesional endothelial cells, macrophages, and smooth muscle cells, which contained proinflammatory substances: the upstream oxidized low density lipoprotein, tissue factor and osteopontin, and the downstream active forms of extracellular signal-activated kinase and p38 and nuclear factor-κB. Our results suggest that cSrc activation in lesional cells contributes to plaque destabilization in CAS via persistent inflammation

Dendritic retraction, but not atrophy, is consistent in amyotrophic lateral sclerosis-comparison between Onuf’s neurons and other sacral motor neurons-

BACKGROUND: Fundamental cytological changes of amyotrophic lateral sclerosis (ALS) were looked for by comparing relatively preserved Onuf’s nucleus (ON) and severely affected neighboring motor neuron groups (dorsolateral alpha motoneurons (DL) and other anterior horn neurons (OAH)). The second sacral segments from 11 ALS patients and 5 controls were initially quadruple-labeled for phosphorylated and non-phosphorylated TAR DNA-binding protein of 43 kDa (TDP43), and p62 with DAPI to identify TDP43-related changes. After digital recording of these fluorescence data encompassing the entire specimen at a high resolution, the same sections were stained with Klüver-Barrera method to obtain their exact bright-field counterparts. This novel approach facilitated exact identification of ON. Furthermore, this cell to cell comparison enabled to correlate quantitative indices of the neuronal cell bodies: perimeter, area and circularity index (CI) i.e. the ratio of (perimeter/2π) divided by the square root of (area/π), which decreases with dendritic retraction, overall number of neurons and inclusions. RESULTS: In addition to known preservation of ON neuron number relative to DL and OAH, size reduction of ON neurons was not significant even in the advanced stage. Significant size reduction in DL was counteracted in the presence of TDP43-positive inclusions. Early increase of neuronal size in OAH was further enhanced by the presence of TDP43-positive inclusions. Even with these heterogeneous cytopathological changes, a decrease in CI was consistent in all groups at an early phase and was correlated with neuronal loss. CONCLUSIONS: Among variable cytological changes of ALS, a decrease in CI is a consistent early feature shared between non-atrophic ON neurons and other anterior horn neurons with either decreased (DL) or even increased (OAH) size and profounder neuronal loss. This decrease in CI, representative of dendritic retraction, is fundamental to ALS pathogenesis, not necessarily linked to cell size and pathological inclusions

One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke

BACKGROUND Previous studies conducted between 1997 and 2003 estimated that the risk of stroke or an acute coronary syndrome was 12 to 20% during the first 3 months after a transient ischemic attack (TIA) or minor stroke. The TIAregistry.org project was designed to describe the contemporary profile, etiologic factors, and outcomes in patients with a TIA or minor ischemic stroke who receive care in health systems that now offer urgent evaluation by stroke specialists. METHODS We recruited patients who had had a TIA or minor stroke within the previous 7 days. Sites were selected if they had systems dedicated to urgent evaluation of patients with TIA. We estimated the 1-year risk of stroke and of the composite outcome of stroke, an acute coronary syndrome, or death from cardiovascular causes. We also examined the association of the ABCD2 score for the risk of stroke (range, 0 [lowest risk] to 7 [highest risk]), findings on brain imaging, and cause of TIA or minor stroke with the risk of recurrent stroke over a period of 1 year. RESULTS From 2009 through 2011, we enrolled 4789 patients at 61 sites in 21 countries. A total of 78.4% of the patients were evaluated by stroke specialists within 24 hours after symptom onset. A total of 33.4% of the patients had an acute brain infarction, 23.2% had at least one extracranial or intracranial stenosis of 50% or more, and 10.4% had atrial fibrillation. The Kaplan–Meier estimate of the 1-year event rate of the composite cardiovascular outcome was 6.2% (95% confidence interval, 5.5 to 7.0). Kaplan–Meier estimates of the stroke rate at days 2, 7, 30, 90, and 365 were 1.5%, 2.1%, 2.8%, 3.7%, and 5.1%, respectively. In multivariable analyses, multiple infarctions on brain imaging, large-artery atherosclerosis, and an ABCD2 score of 6 or 7 were each associated with more than a doubling of the risk of stroke. CONCLUSIONS We observed a lower risk of cardiovascular events after TIA than previously reported. The ABCD2 score, findings on brain imaging, and status with respect to large-artery atherosclerosis helped stratify the risk of recurrent stroke within 1 year after a TIA or minor stroke. (Funded by Sanofi and Bristol-Myers Squibb.)Supported by an unrestricted grant from Sanofi and Bristol-Myers Squibb