Whole-body CT in polytrauma patients: effect of arm positioning on thoracic and abdominal image quality

The purpose of this study is to assess the influence of different arm positioning techniques on thoracic and abdominal image quality and radiation dose of whole-body trauma CT (wbCT). One hundred and fifty polytrauma patients (104 male, mean age 47 ± 19) underwent wbCT with arms elevated above the head (group A, n = 50), alongside the abdomen (group B, n = 50), and on a pillow ventrally to the chest with both arms flexed (group C, n = 50). Two blinded, independent observers measured image noise and rated image quality (scores 1-3) of the liver, aorta, spleen, spine, and lower lungs. Radiation dose parameters were noted, and the abdomens' anterior-posterior diameter and scan lengths were measured. Interreader agreements for image noise (r = 0.86; p < 0.001) and subjective image quality (k = 0.71-0.84) were good. Noise was lower (p < 0.05), image quality of the liver, aorta, spleen, and spine was higher, and radiation dose lower in group A than in groups B and C (p < 0.001, each). Image quality of the spleen, liver, and aorta were higher in group C than in group B (p < 0.05, each). No significant differences in scan length (p = 0.61) were found among groups. Abdominal anterior-posterior diameter correlated significantly with noise (r = 0.82; p < 0.01) and dose (r = 0.47; p < 0.001). Estimated effective radiation doses were significantly (p < 0.001) higher in groups B (21.2mSv) and C (21.9mSv) as compared to A (16.1mSv). In wbCT for polytrauma patients, positioning of the arms above the head results in better image quality and lower radiation dose. Placing the flexed arms on a large pillow ventrally to the chest significantly improves image quality as compared to positioning alongside the abdome

Magnetic resonance imaging frequently changes classification of acute traumatic thoracolumbar spine injuries

Objective: To evaluate the influence of additional (MRI) compared with computed tomography (CT) alone for the classification of traumatic spinal injuries using the Arbeitsgemeinshaft für Osteosynthesefragen (AO) system and the Thoraco-Lumbar Injury Classification and Severity (TLICS) scale. Materials and methods: Images from 100 consecutive patients with at least one fracture on CT were evaluated retrospectively by three radiologists with regard to the AO and TLICS classification systems in 2 steps. First, all images from the initial CT examination were analyzed. Second, 6weeks later, CT and MR images were analyzed together. Descriptive statistics and Wilcoxon tests were performed to identify changes in the number of fractures and ligamentous lesions detected and their corresponding classification. Results: CT and MRI together revealed a total of 196 fractures (CT alone 162 fractures). The AO classification changed in 31%, the TLICS classification changed in 33% of the patients compared with CT alone. Based on CT and MRI together, the TLICS value changed from values < 5 (indication for conservative therapy) to values ≥ 5 (indication for surgical therapy) in 24%. Conclusion: MRI of patients with thoracolumbar spinal trauma considerably improved the detection of fractures and soft tissue injuries compared with CT alone and significantly changed the overall trauma classificatio

OPIEC: An open information extraction corpus

Open information extraction (OIE) systems extract relations and their arguments from natural language text in an unsupervised manner. The resulting extractions are a valuable resource for downstream tasks such as knowledge base construction, open question answering, or event schema induction. In this paper, we release, describe, and analyze an OIE corpus called OPIEC, which was extracted from the text of English Wikipedia. OPIEC complements the available OIE resources: It is the largest OIE corpus publicly available to date (over 340M triples) and contains valuable metadata such as provenance information, confidence scores, linguistic annotations, and semantic annotations including spatial and temporal information. We analyze the OPIEC corpus by comparing its content with knowledge bases such as DBpedia or YAGO, which are also based on Wikipedia. We found that most of the facts between entities present in OPIEC cannot be found in DBpedia and/or YAGO, that OIE facts often differ in the level of specificity compared to knowledge base facts, and that OIE open relations are generally highly polysemous. We believe that the OPIEC corpus is a valuable resource for future research on automated knowledge base construction

Differences in Fabry Cardiomyopathy Between Female and Male Patients Consequences for Diagnostic Assessment

ObjectivesWe hypothesized that Fabry cardiomyopathy in female patients might differ substantially from that in male patients and sought to prove this hypothesis in a large cohort consisting of 104 patients with Fabry disease.BackgroundFabry cardiomyopathy in male patients is characterized by left ventricular (LV) hypertrophy, impaired myocardial function, and subsequent progressive myocardial fibrosis. In contrast, the occurrence of these 3 cardiomyopathic hallmarks in female patients remains unknown.MethodsIn 104 patients (58 females, age 42 ± 16 years; 46 males, age 42 ± 13 years) with genetically proven Fabry disease, LV hypertrophy, regional myocardial deformation and myocardial fibrosis were assessed by standard echocardiography, strain rate imaging, and cardiac magnetic resonance (CMR) imaging–guided late enhancement (LE).ResultsIn men, end-diastolic left ventricular wall thickness (LVWT) ranged from 6 to 19.5 mm (LV mass CMR 55 to 200 g/m2), and LE was never seen with LVWT <12 mm (LV mass <99 g/m2). In contrast in female patients, LVWT ranged from 5 to 15.5 mm, LV mass ranged from 39 to 146 g/m2, and LE was already detectable with an LVWT of 9 mm (LV mass 56 g/m2). When LV mass was examined in CMR, LE was detected in 23% of the female patients without hypertrophy (n = 9), whereas LE was never seen in male patients with normal LV mass. LE was always associated with low systolic strain rate, but the severity of impairment was independent of LVWT in female patients (lateral strain rate in patients with LV hypertrophy with LE −0.7 ± 0.2 s−1; patients without LV hypertrophy with LE −0.8 ± 0.2 s−1; p = 0.45).ConclusionsIn contrast to male patients, the loss of myocardial function and the development of fibrosis do not necessarily require myocardial hypertrophy in female patients with Fabry disease. Thus, in contrast to actual recommendations, initial cardiac staging and monitoring should be based on LV hypertrophy and on replacement fibrosis in female patients with Fabry disease

Análise de timol em cera de abelha por micro-extracção em fase sólida (SPME)

A aplicação contínua de acaricídas lipofílicos sintéticos no tratamento das abelhas conduz a uma acumulação que depende da frequência, lipofilicidade e quantidade de princípio activo utilizada. Este efeito é mais acentuado na cera de abelha que no mel, no entanto, e porque a persistência destes resíduos é elevada, provoca o aparecimento de resistências e a perda do seu efeito acaricida.[1] Esta razão levou à pesquisa de outros compostos alternativos não tóxicos e não persistentes, com efeito sobre o ácaro das abelhas, Varroa Jacobsoni. Entre estes compostos encontra-se o timol, um composto fenólico, volátil, presente no tomilho. Dos diversos componentes dos óleos essenciais este é sem dúvida o que demonstrou maior efeito acaricida, utilizando-se no tratamento das abelhas directamente ou como componente de diversas formulações.[2] Em Portugal, foi introduzido muito recentemente sob a forma comercial de APIGUARD: um gel, à base de timol, que controla termicamente a libertação do princípio activo. O controlo dos resíduos de timol na cera de abelha e no mel é assim um desafio actual quer do ponto de vista sanitário quer de qualidade alimentar. A micro-extracção em fase sólida (SPME) é uma técnica de preparação de amostras que se baseia na sorção de analítos no revestimento de uma fibra de sílica fundida e posterior desorção térmica no injector de um cromatógrafo em fase gasosa (GC). Para além de combinar num único processo etapas de extracção, purificação e concentração dos analitos, a técnica de SPME apresenta uma série de vantagens relativamente às técnicas de extracção convencionais, como a extracção líquido-líquido e extracção em fase sólida, nomeadamente a sua relativa simplicidade e rapidez, reduzido custo e não utilização de solventes para a extracção de analitos, para além de permitir a extracção por imersão directa na amostra gasosa ou líquida e extracção por amostragem do espaço-de-cabeça da amostra líquida ou sólida.[3] Ao contrário das técnicas tradicionais, que permitem uma extracção quantitativa dos analitos, a técnica de SPME baseia-se num equilíbrio de partição do analito. Esta particularidade torna a técnica de SPME bastante sensível a parâmetros experimentais que possam afectar os coeficientes de partição dos analitos e, consequentemente, a sensibilidade e reprodutibilidade dos resultados.[4] O objectivo deste trabalho é o desenvolvimento de uma metodologia para a análise de timol em ceras contaminadas, utilizando como padrão interno a benzofenona. Em primeiro lugar, procedeu-se à optimização da técnica através da determinação da quantidade de cera, temperatura de análise e período de contacto da fibra com o espaço-de-cabeça da amostra mais adequados para o caso em estudo. Numa segunda fase, procedeu-se à análise de diversas lâminas de cera contaminadas propositadamente com timol e sujeitas a diferentes condições de armazenamento: em frio, ao ar e em estufa. Finalmente, procedeu-se à construção da curva de calibração e quantificação do timol presente nas diversas amostras de cera analisadas. Considerando-se os resultados, para os níveis de contaminação avaliados, as condições analíticas mais adequadas ocorrem com a utilização de 1 g de cera, mantendo-se a fibra em contacto com o espaço-de-cabeça durante 40 minutos a uma temperatura de 60 ºC. Nestas condições experimentais foi possível obter uma boa correlação linear (r2=0,990) no intervalo de concentrações [3,5-14 mg/g]. A quantidade de timol encontrada nas amostras é significativamente inferior à colocada durante o processo de fabrico das lâminas, pelo que o processo de conservação não é o mais adequado, sendo evidente uma menor quantidade de timol quando a lâmina de cera é colocada na estufa

Detection of Viral Infection and Bacterial Coinfection and Superinfection in Coronavirus Disease 2019 Patients Presenting to the Emergency Department Using the 29-mRNA Host Response Classifier IMX-BVN-3: A Multicenter Study.

Background Identification of bacterial coinfection in patients with coronavirus disease 2019 (COVID-19) facilitates appropriate initiation or withholding of antibiotics. The Inflammatix Bacterial Viral Noninfected (IMX-BVN) classifier determines the likelihood of bacterial and viral infections. In a multicenter study, we investigated whether IMX-BVN version 3 (IMX-BVN-3) identifies patients with COVID-19 and bacterial coinfections or superinfections. Methods Patients with polymerase chain reaction-confirmed COVID-19 were enrolled in Berlin, Germany; Basel, Switzerland; and Cleveland, Ohio upon emergency department or hospital admission. PAXgene Blood RNA was extracted and 29 host mRNAs were quantified. IMX-BVN-3 categorized patients into very unlikely, unlikely, possible, and very likely bacterial and viral interpretation bands. IMX-BVN-3 results were compared with clinically adjudicated infection status. Results IMX-BVN-3 categorized 102 of 111 (91.9%) COVID-19 patients into very likely or possible, 7 (6.3%) into unlikely, and 2 (1.8%) into very unlikely viral bands. Approximately 94% of patients had IMX-BVN-3 unlikely or very unlikely bacterial results. Among 7 (6.3%) patients with possible (n = 4) or very likely (n = 3) bacterial results, 6 (85.7%) had clinically adjudicated bacterial coinfection or superinfection. Overall, 19 of 111 subjects for whom adjudication was performed had a bacterial infection; 7 of these showed a very likely or likely bacterial result in IMX-BVN-3. Conclusions IMX-BVN-3 identified COVID-19 patients as virally infected and identified bacterial coinfections and superinfections. Future studies will determine whether a point-of-care version of the classifier may improve the management of COVID-19 patients, including appropriate antibiotic use

Mild cognitive impairment and kidney disease: clinical aspects.

Chronic kidney disease (CKD) is now seen as a systemic disease involving also the central nervous system [1], but the link between the kidney and different organ systems and disease went unnoticed for a long time. The king of Poland, Stephen Bathory (1533-86), suffered from CKD due to polycystic kidney disease and depression [2]. Similarly, Wolfgang Amadeus Mozart was also thought to have had CKD [3] and depression [4]. A list of 'Famous People Who Have Died from Kidney Disease' [5] includes many who suffered from both CKD and depression or other signs of mental illness. Is this a coincidence or actually evidence of a link between kidney disease and brain dysfunction? This is not merely an academic question because all forms of mental illness can seriously impair an individual's quality of life, and are frequently associated with progression of diseases and premature mortality, so it is worth the effort of trying to answer it. Europe and much of the industrialized countries are experiencing growing numbers of patients with CKD within their ageing populations [6]. CKD is complex and potentially fatal: (i) all organs are affected, sooner or later; (ii) the balance of plasma volume, electrolytes, acid-base and minerals, metabolites, hormones and proteins is disturbed; and (iii) patients often need a multidisciplinary team approach managing complex comorbidities, drug regimens and special diets. Although the prognosis of patients with CKD remains poor, their increasing life expectancy has shifted medical attention from life-threatening emergencies to long-term complications and sequelae, and how to improve quality of life [7]. Indeed, kidney failure has detrimental effects on health-related quality of life (HRQoL), reaching levels similar to those seen in patients with metastatic cancer [8]. This might be due to psychological factors, both kidney disease and cancer being chronic diseases with a bad prognosis. However, although the effect of CKD on quality of life is more evident in advanced stages (stage G4P) and in older patients [9, 10], a large study has shown a significant decrease in HRQoL as early as CKD stage G2 [11]. Notably, neurological and cognitive impairments [12], and depression [13] are among the most debilitating consequences of CKD contributing to the significantly reduced HRQoL [14]

Apolipoprotein A-IV concentrations and cancer in a large cohort of chronic kidney disease patients: results from the GCKD study

Background Chronic kidney disease (CKD) is highly connected to inflammation and oxidative stress. Both favour the development of cancer in CKD patients. Serum apolipoprotein A-IV (apoA-IV) concentrations are influenced by kidney function and are an early marker of kidney impairment. Besides others, it has antioxidant and anti-inflammatory properties. Proteomic studies and small case–control studies identified low apoA-IV as a biomarker for various forms of cancer; however, prospective studies are lacking. We therefore investigated whether serum apoA-IV is associated with cancer in the German Chronic Kidney Disease (GCKD) study. Methods These analyses include 5039 Caucasian patients from the prospective GCKD cohort study followed for 6.5 years. Main inclusion criteria were an eGFR of 30–60 mL/min/1.73m2 or an eGFR > 60 mL/min/1.73m2 in the presence of overt proteinuria. Results Mean apoA-IV concentrations of the entire cohort were 28.9 ± 9.8 mg/dL (median 27.6 mg/dL). 615 patients had a history of cancer before the enrolment into the study. ApoA-IV concentrations above the median were associated with a lower odds for a history of cancer (OR = 0.79, p = 0.02 when adjusted age, sex, smoking, diabetes, BMI, albuminuria, statin intake, and eGFRcreatinine). During follow-up 368 patients developed an incident cancer event and those with apoA-IV above the median had a lower risk (HR = 0.72, 95%CI 0.57–0.90, P = 0.004). Finally, 62 patients died from such an incident cancer event and each 10 mg/dL higher apoA-IV concentrations were associated with a lower risk for fatal cancer (HR = 0.62, 95%CI 0.44–0.88, P = 0.007). Conclusions Our data indicate an association of high apoA-IV concentrations with reduced frequencies of a history of cancer as well as incident fatal and non-fatal cancer events in a large cohort of patients with CKD

Comparative genomic, proteomic and exoproteomic analyses of three Pseudomonas strains reveals novel insights into the phosphorus scavenging capabilities of soil bacteria

Bacteria that inhabit the rhizosphere of agricultural crops can have a beneficial effect on crop growth. One such mechanism is the microbial-driven solubilisation and remineralisation of complex forms of phosphorus (P). It is known that bacteria secrete various phosphatases in response to low P conditions. However, our understanding of their global proteomic response to P stress is limited. Here, exoproteomic analysis of Pseudomonas putida BIRD-1 (BIRD-1), Pseudomonas fluorescens SBW25 and Pseudomonas stutzeri DSM4166 was performed in unison with whole-cell proteomic analysis of BIRD-1 grown under phosphate (Pi) replete and Pi deplete conditions. Comparative exoproteomics revealed marked heterogeneity in the exoproteomes of each Pseudomonas strain in response to Pi depletion. In addition to well-characterised members of the PHO regulon such as alkaline phosphatases, several proteins, previously not associated with the response to Pi depletion, were also identified. These included putative nucleases, phosphotriesterases, putative phosphonate transporters and outer membrane proteins. Moreover, in BIRD-1, mutagenesis of the master regulator, phoBR, led us to confirm the addition of several novel PHO-dependent proteins. Our data expands knowledge of the Pseudomonas PHO regulon, including species that are frequently used as bioinoculants, opening up the potential for more efficient and complete use of soil complexed P

Modelling climate and societal resilience in the Eastern Mediterranean in the last Millennium

This article analyses high-quality hydroclimate proxy records and spatial reconstructions from the Central and Eastern Mediterranean and compares them with two Earth System Model simulations (CCSM4, MPI-ESM-P) for the Crusader period in the Levant (1095–1290 CE), the Mamluk regime in Transjordan (1260–1516 CE) and the Ottoman crisis and Celâlî Rebellion(1580–1610 CE). During the three time intervals, environmental and climatic stress tested the resilience of complex societies.We find that the multidecadal precipitation and drought variations in the Central and Eastern Mediterranean cannot be explained by external forcings (solar variations, tropical volcanism); rather they were driven by internal climate dynamics. Our research emphasises the challenges, opportunities and limitations of linking proxy records, palaeoreconstructions and model simulations to better understand how climate can affect human history