6 research outputs found
A 17 year-old girl with a demyelinating disease requiring mechanical ventilation: a case report
Digital Mammography texture analysis by computer assisted image processing
We investigate the use of mammograms texture features in a clinical
evaluation in mammography in order to assist in the classification of an
image based on the breast tissue index. Breast tissue! indices give the
possibility to analyze images and determine the similarity of the
Images. and evaluate the classification of the obtained image The
measures of similarity of images used for the texture analysis are based
upon textural characteristics and the distribution of density in the
breast. The features used include the gray-level histogram, and texture
features based upon the gray-level co-occurrence matrix, moment-based
features obtained by Matlab program application. The performance of the
method was measured in terms of precision of retrieval measurements. The
results indicate improvement that is related to breast density
classification in mammograms. Image processing assisted by computer give
the characterization of masses and micro-calcification texture. The
methodology proposed in the present work is generic, and can be applied
also to other imaging modalities and clinical applications, as for
example, Ultrasound breast evaluation and Scintimammograph
New Cerebral Ischemic Lesions After Carotid Endarterectomy
Background: We sought to investigate the incidence and location of new
cerebral ischemic lesions after carotid endarterectomy (CEA) using
diffusion-weighted magnetic resonance imaging (DW-MRI).
Methods: Sixty-six consecutive patients (50 males with a mean [+/- SD]
age of 69 +/- 9 years) who underwent CEA were included in this
prospective study. Seventeen patients were symptomatic and 49 patients
were asymptomatic. CEA was performed with patch closure without using a
shunt. Carotid plaque echostructure was evaluated with the grayscale
median (GSM) score. DW-MRI scanning of the brain was performed 24 hours
before and 48 to 72 hours after the procedure.
Results: Thirty-day stroke and mortality rates were 0%. The mean GSM
score for symptomatic patients was 27 +/- 15; for asymptomatic patients,
the mean GSM score was 39 +/- 18 (P = 0.006). Patients were divided into
2 groups according to GSM score: GSM scores <= 25 (22 patients) and GSM
scores >26 (44 patients). New brain lesions were detected after 6
endarterectomies (8.9%), and all were clinically silent. These lesions
were ischemic in 5 cases (7.5%) and micro-hemorrhagic in 1 case
(1.4%). In 3 cases, new ischemic lesions were located within the
treated carotid artery territory. In 2 cases, new lesions on DW-MRI were
located outside of the treated carotid artery territory. There was no
significant difference in the incidence of ischemic lesions between the
2 groups (GSM scores <= 25, 2 lesions; GSM scores >26, 3 lesions; P =
0.544).
Conclusions: New ischemic lesions on DW-MRI are detected in 7.5% of
patients after CEA, and most of these lesions are clinically silent.
Plaque echogenicity does not affect their incidence. New lesions seen on
DW-MRI may be generated outside of the treated carotid artery territory
Recurrent Inguinal Hernia Repair: What is the Evidence of Case Series? A Meta-Analysis and Metaregression Analysis
To examine, if case series considered together with observational
studies tend to produce similar results as randomized-controlled trials
(RCTs), on recurrent hernia repair. A systematic literature review and
meta-analysis between 1990 and 2013 revealed 46 nonrandomized studies
(NRCTs) and 5 RCTs including 25,730 patients. A direct comparison of the
summary estimates between RCTs and NRCTs is presented. Outcomes, within
or across studies, were compared. Comparisons of all outcomes in NRCTs
and RCTs failed to show statistical significance.
Prospective/retrospective cohort studies, case series, and RCTs did not
differ significantly in their estimates. Adjusted testing for
metaregression disclosed that rerecurrence among NRCTs was independent
of the study design. The number of included patients and study setting
were independent predictors of outcome. Our proposed methodology for a
systematic review could potentially give answers where level I evidence
is missing or could be a tool for optimization of a RCT design
Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
Background
Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.
Methods
The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.
Results
A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).
Conclusion
Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)