Sonographic evaluation of cervical lymphadenopathy; Comparison of metastatic and reactive lymph nodes in patients with head and neck squamous cell carcinoma using gray scale and doppler techniques

Background: Cervical lymphadenopathy could be seen in several pathologic processes. An accurate differentiation between these conditions is of utmost importance to select an appropriate therapy and assess the prognosis. Gray scale and Doppler are appropriate sonographic techniques for evaluating internal and external features of lymph nodes. Although, various criteria have been proposed to differentiate metastatic lymph nodes from benign ones, the most valuable and specific sonographic features are still under dispute. Objectives: The present study was designed to determine valuable sonographic features for differentiating metastasis from benign nodes using gray scale and Doppler sonography. Patients and Methods: A prospective diagnostic study was performed on 63 patients with head and neck squamous cell carcinoma (SCC) treated and referred to surgery clinic of Hazrat Rasoul Akram hospital from November 2010 to June 2012 with complaint of palpable cervical lymph node. All patients� necks were scanned multidirectionally by gray-scale and Doppler techniques. After sonography, lymph nodes were biopsied and investigated to find out whether they were metastatic or reactive. Finally, demographic, sonographic and pathologic data were statistically analyzed by SPSS ver. 16 software using t-test, a nonparametric test and ROC analysis. Ninety five percent confidence interval was considered for all parameters. Results: The study included 41 males and 22 females with a mean age of 57.56 ± 13.79 years. The number of metastatic lymph nodes was 47, while the remaining 16 were reactive. There were significant differences in length (P = 0.037), width (P = 0.001), resistance index (P < 0.001), pulsatility index (P < 0.001) and systolic velocity (P < 0.001) of metastatic and reactive lymph nodes. Cut points for resistive and pulsatility indexes and systolic velocity were calculated as 0.695, 1.35 and 16.5, respectively. The most valuable factor for defining a lymph node as metastatic was circulation pattern with accuracy, sensitivity and specificity of 94, 85 and 93, respectively. Conclusion: Gray scale sonography in combination with Doppler sonography could be a trustworthy technique in differentiating metastatic lymph nodes from reactive ones. Although, circulation pattern had a higher diagnostic accuracy in the present study, combination of sonographic characteristics could be more beneficial in differentiating metastatic cervical nodes from reactive ones. © 2015, Tehran University of Medical Sciences and Iranian Society of Radiology

Cardiac vagal afferent neurotransmission in health and disease: review and knowledge gaps

The meticulous control of cardiac sympathetic and parasympathetic tone regulates all facets of cardiac function. This precise calibration of cardiac efferent innervation is dependent on sensory information that is relayed from the heart to the central nervous system. The vagus nerve, which contains vagal cardiac afferent fibers, carries sensory information to the brainstem. Vagal afferent signaling has been predominantly shown to increase parasympathetic efferent response and vagal tone. However, cardiac vagal afferent signaling appears to change after cardiac injury, though much remains unknown. Even though subsequent cardiac autonomic imbalance is characterized by sympathoexcitation and parasympathetic dysfunction, it remains unclear if, and to what extent, vagal afferent dysfunction is involved in the development of vagal withdrawal. This review aims to summarize the current understanding of cardiac vagal afferent signaling under in health and in the setting of cardiovascular disease, especially after myocardial infarction, and to highlight the knowledge gaps that remain to be addressed

Optimal Placement of Capacitors for Get the Best Total Generation Cost by Genetic Algorithm

Economic Dispatch(ED) is one of the most challenging problems of power system since it is difficult to determine the optimum generation scheduling to meet the particular load demand with the minimum fuel costs while all constraints are satisfied. The objective of the Economic Dispatch Problems (EDPs) of electric power generation is to schedule the committed generating units outputs so as to meet the required load demand at minimum operating cost while satisfying all units and system equality and inequality constraints. In this paper, an efficient and practical steady-state genetic algorithm (SSGAs) has been proposed for solving the economic dispatch problem. The objective is to minimize the total generation fuel cost and keep the power flows within the security limits. To achieve that, the present work is developed to determine the optimal location and size of capacitors in transmission power system where, the Participation Factor Algorithm and the Steady State Genetic Algorithm are proposed to select the best locations for the capacitors and determine the optimal size for them

Optimal Placement of Capacitors for Get the Best Total Generation Cost by Genetic Algorithm

Economic Dispatch(ED) is one of the most challenging problems of power system since it is difficult to determine the optimum generation scheduling to meet the particular load demand with the minimum fuel costs while all constraints are satisfied. The objective of the Economic Dispatch Problems (EDPs) of electric power generation is to schedule the committed generating units outputs so as to meet the required load demand at minimum operating cost while satisfying all units and system equality and inequality constraints. In this paper, an efficient and practical steady-state genetic algorithm (SSGAs) has been proposed for solving the economic dispatch problem. The objective is to minimize the total generation fuel cost and keep the power flows within the security limits. To achieve that, the present work is developed to determine the optimal location and size of capacitors in transmission power system where, the Participation Factor Algorithm and the Steady State Genetic Algorithm are proposed to select the best locations for the capacitors and determine the optimal size for them

Optimal Placement of Capacitors for Get the Best Total Generation Cost by Genetic Algorithm

Economic Dispatch(ED) is one of the most challenging problems of power system since it is difficult to determine the optimum generation scheduling to meet the particular load demand with the minimum fuel costs while all constraints are satisfied. The objective of the Economic Dispatch Problems (EDPs) of electric power generation is to schedule the committed generating units outputs so as to meet the required load demand at minimum operating cost while satisfying all units and system equality and inequality constraints. In this paper, an efficient and practical steady-state genetic algorithm (SSGAs) has been proposed for solving the economic dispatch problem. The objective is to minimize the total generation fuel cost and keep the power flows within the security limits. To achieve that, the present work is developed to determine the optimal location and size of capacitors in transmission power system where, the Participation Factor Algorithm and the Steady State Genetic Algorithm are proposed to select the best locations for the capacitors and determine the optimal size for them

Molecular systematics of swifts of the genus Chaetura (Aves: Apodiformes: Apodidae)

Phylogenetic relationships among swifts of the morphologically conservative genus Chaetura were studied using mitochondrial and nuclear DNA sequences. Taxon sampling included all species and 21 of 30 taxa (species and subspecies) within Chaetura. Our results indicate that Chaetura is monophyletic and support the division of the genus into the two subgenera previously identified using plumage characters. However, our genetic data, when considered in combination with phenotypic data, appear to be at odds with the current classification of some species of Chaetura. We recommend that C. viridipennis, currently generally treated as specifically distinct from C. chapmani, be returned to its former status as C. chapmani viridipennis, and that C. andrei, now generally regarded as synonymous with C. vauxi aphanes, again be recognized as a valid species. Widespread Neotropical species C. spinicaudus is paraphyletic with respect to more range-restricted species C. fumosa, C. egregia, and C. martinica. Geographically structured genetic variation within some other species of Chaetura, especially notable in C. cinereiventris, suggests that future study may lead to recognition of additional species in this genus. Biogeographic analysis indicated that Chaetura originated in South America and identified several dispersal events to Middle and North America following the formation of the Isthmus of Panama

Impact of metoclopramide on image quality in myocardial perfusion imaging

Background: The effectiveness of metoclopramide in reducing gastrointestinal-induced artifacts in myocardial perfusion imaging (MPI) is a subject of debate. We examined the significance of this pharmacological intervention in the quality of images obtained from MPI studies. Patients and Methods: A total of 211 suspected or known cases with coronary artery disease routinely referred to our nuclear medicine department for MPI were randomly assigned to group A and group B. Group A (N=125) comprised patients who received 10 mg of metoclopramide orally after the injection of the radiotracer technetium-99m-labeled methoxyisobutyl isonitril (Tc-MIBI) 1 h before image acquisition, and group B (N=86) comprised patients who did not receive any pharmacological intervention and were considered the control group. All the scans in each group were assessed in the rest phase of a routine 2-day protocol. The single-photon emission computerized tomography (SPECT) images were visually evaluated in terms of extracardiac activities and their effects on image quality by three nuclear medicine physicians, who were blinded to the details of the protocol. Results: Of the 125 patients who had received metoclopramide, 16 (13%) had nonacceptable, 72 (57.6%) had acceptable (interpretable), and 37 (29.6%) had good image quality. The image quality in group B was nonacceptable in 10 (11.23%), acceptable in 48 (50.23%), and good in 28 (33.56%) patients. The overall interobserver agreement was good (κ: 0.6-0.9, P<0.05) among the three readers. Conclusion: There was no statistically significant difference in terms of MPI-SPECT image quality between patients who received metoclopramide and those in the control group. Metoclopramide, therefore, did not exert a remarkable effect on the quality of our MPI scans. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Thoracic Epidural Anesthesia Can Be Effective for the Short‐Term Management of Ventricular Tachycardia Storm

Background Novel therapies aimed at modulating the autonomic nervous system, including thoracic epidural anesthesia (TEA), have been shown in small case series to be beneficial in treating medically refractory ventricular tachycardia (VT) storm. However, it is not clear when these options should be considered. We reviewed a multicenter experience with TEA in the management of VT storm to determine its optimal therapeutic use.Methods and Results Data for 11 patients in whom TEA was instituted for VT storm between July 2005 and March 2016 were reviewed to determine the clinical characteristics, outcomes, and role in management. The clinical presentation was incessant VT in 7 (64%), with polymorphic VT in 3 (27%) and monomorphic VT in 8 (73%). The underlying conditions were nonischemic cardiomyopathy in 5 (45%), ischemic cardiomyopathy in 3 (27%), and hypertrophic cardiomyopathy, Brugada syndrome, and cardiac lipoma in 1 (9%) each. Five (45%) had a complete and 1 (9%) had a partial response to TEA; 4 of the complete responders had incessant VT. All 4 patients with a documented response to deep sedation demonstrated a complete response to TEA.Conclusions More than half of the patients with VT storm in our series responded to TEA. TEA may be effective and should be considered as a therapeutic option in patients with VT storm, especially incessant VT, who are refractory to initial management. Improvement in VT burden with deep sedation may suggest that sympathoexcitation plays a key role in perpetuating VT and predict a positive response to TEA

Diagnostic accuracy of twinkling artifact sign seen in color doppler ultrasonography in detecting microlithiasis of kidney

Background: Ultrasonography (US) is a safe and cost-efficient modality which is used to assess patients with urinary tract lithiasis. Objectives: In this study, we aimed to evaluate the accuracy of the twinkling artifact of color Doppler sonography in detecting renal stones smaller than 4 mm in diameter. Methods: Of all patients referring to a tertiary medical center with a probable diagnosis of urolithiasis during April 2019 to Septem-ber 2019, 99 patients with a renal stone smaller than 4 mm in non-contrast computed tomography (CT) scan entered our study. Both gray scale and color Doppler US were performed to assess the presence of any renal stones, the accompanying posterior shadowing, and the twinkling artifact for all patients. Results: Of 99 patients with confirmed renal stone on non-contrast CT scan, 91 patients had an echogenic focus on grayscale (sensi-tivity = 91.9), 70 patients had posterior shadowing sign (sensitivity = 70.7), and 76 patients had twinkling artifact on color Doppler US. The sensitivity, specificity, positive predictive value, and negative predictive value of this imaging finding for detecting renal stones smaller than 4 mm were 76.8, 100, 100, and 32.4, respectively. Conclusions: Our study revealed that twinkling artifact on color Doppler US is a reliable sign for detecting renal stones smaller than 4 mm. However, the sensitivity of this sign could be increased in combination with gray scale findings (echogenic focus and posterior shadowing). © 2020, Author(s)