Evaluation Of Such Conditions Research Articles

Primary leiomyosarcoma of bones – a rare entity in two different presentations

Introduction. Leiomyosarcomas (LMS) originate from smooth muscle cells. They are very rare malignant neoplasms. Bony Leiomyosarcoma is a variant of spindle cell sarcoma, primarily affecting long bones, predominantly the distal femur and the proximal tibia followed by craniofacial skeleton. Aim. To describe clinical presentation and diagnostic approach of primary leiomyosarcoma of bones in two different patients. Description of the cases. Case 1. A 64-year-old male with a fracture of left distal femur after a fall was investigated and found to have a pathological fracture. An open biopsy of the fracture site confirms leiomyosarcoma. Case 2. A 58-year-old previously healthy female presented with a swelling on right side mandibular region. Orthopantomogram radiograph (OPG) of mandible and Cone beam CT (CBCT) mandible was taken initially and revealed a large area of bone destruction of the right side of the mandible associated with a soft tissue mass. Initial incisional biopsy made the diagnosis of spindle cell sarcoma followed by excisional biopsy, which confirms the diagnosis of moderately differentiated leiomyosarcoma. Conclusion. Primary leiomyosarcoma of bones is very rare. Imaging features are helpful in the evaluation of such conditions, but final diagnosis should be based on histopathologic and immunohistochemical features.

Multimodality Cardiovascular Imaging in Patients with Pericardial Diseases. Practical Recommendations

Pericardial pathology has wide distribution in population and is observed in various therapeutic areas, including primary care, intensive care and resuscitation, as well as such subspecialties as rheumatology, infectious diseases, oncology and namely cardiology. It may significantly contribute to morbidity and mortality growth. Therefore, diagnosis and management of patients with pericardial pathology may be challenging, including such nosology as a “mixed” constrictive pericarditis, exudative-constrictive pericarditis or localized postoperative tamponade. Clinical evaluation of such conditions may be rather complicated. That is why the use of multimodality imaging including echocardiography, heart MRI and MSCT grows continuously in the diagnosis and treatment in such patients.
 The aim of this document is to provide expert evaluation for comprehensive and appropriate use of multimodality imaging in the diagnosis and management of patients with pericardial diseases.
 This document is based on the American Society of Echocardiography Clinical Recommendations for Multimodality Cardiovascular Imaging of Patients with Pericardial Disease endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography (2013) adopted for local specificities.

Compiler-Assisted Loop Hardening Against Fault Attacks

Secure elements widely used in smartphones, digital consumer electronics, and payment systems are subject to fault attacks. To thwart such attacks, software protections are manually inserted requiring experts and time. The explosion of the Internet of Things (IoT) in home, business, and public spaces motivates the hardening of a wider class of applications and the need to offer security solutions to non-experts. This article addresses the automated protection of loops at compilation time, covering the widest range of control- and data-flow patterns, in both shape and complexity. The security property we consider is that a sensitive loop must always perform the expected number of iterations; otherwise, an attack must be reported. We propose a generic compile-time loop hardening scheme based on the duplication of termination conditions and of the computations involved in the evaluation of such conditions. We also investigate how to preserve the security property along the compilation flow while enabling aggressive optimizations. We implemented this algorithm in LLVM 4.0 at the Intermediate Representation (IR) level in the backend. On average, the compiler automatically hardens 95% of the sensitive loops of typical security benchmarks, and 98% of these loops are shown to be robust to simulated faults. Performance and code size overhead remain quite affordable, at 12.5% and 14%, respectively.

CMR in Phenotyping the Arrhythmic Substrate

The purpose of this review is to explore the role of cardiac magnetic resonance imaging (CMR) in the evaluation of myocardial disorders that can present with significant cardiac arrhythmias. In addition, we explore recent developments in the field of CMR in the evaluation of such conditions, such as T1 and T2 mapping techniques. The importance of CMR as a diagnostic tool in the evaluation of such conditions lies in the fact that in routine clinical practice these conditions are encountered relatively frequently, and often important clinical decisions are made based on the findings of cardiac investigations such as CMR, e.g., decisions surrounding revascularization or implantable cardioverter defibrillator (ICD) therapy. In fact, CMR is now included in many practice guidelines (American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines et al. in J Thorac Cardiovasc Surg, 142(6):e153–203, 2011; Authors/Task Force members et al. in Eur Heart J, 35(39):2733–79, 2014; Epstein et al. in Heart Rhythm, 5(6):934–55, 2008; Maron et al. in J Am Coll Cardiol, 42(9):1687–713, 2003) and is routinely used in the evaluation of cardiomyopathic and ischemic myocardial conditions in many institutions. Although late gadolinium enhancement (LGE)-CMR allows a very sensitive and reproducible qualitative assessment of myocardial replacement fibrosis, it is limited in regards to absolute quantification of myocardial fibrosis, and also, the assessment of diffuse fibrosis by CMR can be technically challenging. As a result, in recent years, T1 and T2 mapping techniques have been welcomed by the CMR community, as potential methods of quantitating myocardial fibrosis accurately. Areas of diffuse myocardial fibrosis have greater T1 values (by about 10–20%) than normal tissue, before intravenous Gd is given. Post-Gd administration, T1 values are lower than normal in diffuse myocardial fibrosis. Thus, using this technique maps can be generated that explore the myocardium in detail and can detect early myocardial fibrosis, often before the presence of LGE. T2-weighted CMR identifies myocardial edema before the onset of irreversible ischemic injury and has shown to have value in risk-stratifying patients with chest pain (Eitel and Friedrich in J Cardiovasc Magn Reson, 13:13, 2011). Clinical acceptance of T2-weighted CMR has, however, been limited by well-known technical problems associated with existing techniques. T2 quantification using T2 mapping in the future should overcome these problems. Both T1 and T2 mapping techniques are discussed in further detail below. The assessment of infarct heterogeneity, as measured by peri-infarct zone (PIZ) mass and percentage PIZ (%PIZ), as compared to normal myocardium, is a valuable CMR tool for the assessment of tissue characteristics in the peri-infarct region (Morgan and Kwong in Curr Treat Options Cardiovasc Med, 17(11):53, 2015). It has recently been shown to have useful prognostic information (Watanabe et al. in Circ Cardiovasc Imaging, 7(6):887–94, 2014) in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction referred for CMR. This is discussed in further detail below. A recent paper by Neilan et al. (JACC Cardiovasc Imaging, 8(4):414–23, (2015)) studied 137 patients who underwent CMR post-resuscitated cardiac arrest and found that in cases where the cause of sudden cardiac death (SCD) was not initially clear, the use of CMR provided a diagnosis in 104 patients (76%). In a multivariable analysis, the strongest predictors of recurrent events were the presence and the extent of LGE (p < 0.001). In summary, this paper, through recent evidence and clinical examples, explores those myocardial conditions which pose a significant clinical issue in the form of potentially dangerous cardiac dysrhythmias. Early detection of predictive myocardial characteristics beyond the traditional risk factors has been welcomed by cardiology and cardiac imaging communities. Much work is in progress to make new methods such as T1 and T2 mapping more clinically available and applicable and to ensure that imaging time is not lengthened beyond that which is comfortable for the patient.

Non-Obstructive Müllerian Anomalies

BackgroundThe nonobstructive group of anatomic variants involving the reproductive tract includes vaginal agenesis as well as the congenital anomalies of the vagina and uterus, occurring without pain during the pubertal years. ObjectiveThe objective is to discuss the non-obstructive morphologic variations in anatomy of the uterus and vagina. DesignSystematic review using the GRADE system. ResultsThese congenital anomalies are not associated with abnormalities of the external genitalia and therefore may be missed on routine physical examination. When these anomalies do cause symptoms they may be as minor as difficulty with menstrual hygiene or more significant such as primary amenorrhea, dyspareunia, recurrent pregnancy loss, and reproductive complications. ConclusionsWomen with non-obstructive reproductive tract anomalies present at various ages due to the asymptomatic nature or late symptom onset of certain conditions. An MRI is the gold standard in evaluation of such conditions to aid in confirming the müllerian variant. Each condition requires careful counseling because obstetric and gynecologic risks and consequences may differ. Treatment is individualized in cases of uterovaginal agenesis with both nonsurgical and surgical options available for neovagina creation. In cases of uterine or vaginal septae, the treatment timing may vary depending on patient history. Finally, in cases of non-obstructive communicating uterine horns, the risk of ectopic pregnancy is high in the remnant horn. Should a pregnancy occur in this small underdeveloped horn, therefore, excision is recommended.

Boolean and Modular Abstractions for Programmable Logic Controllers

This paper introduces a Boolean and a modular abstraction of programs for programmable logic controllers in order to make them amenable for formal verification. In the Boolean abstraction, complex control-flow conditions are replaced by fresh Boolean input variables to defer the evaluation of such conditions. The modular abstraction replaces function block calls by so-called function block summaries, which over-approximate their possible return values. Both abstractions can subsequently be refined in an automatic process to allow for checking of complex programs using expressive formulae. The approach has been implemented in the Arcade.PLC model checker, which is used to show the effectiveness in a case-study.

Synthesis and In Vitro Evaluation of Novel Nortropane Derivatives as Potential Radiotracers for Muscarinic M2 Receptors

Disturbances of the cerebral cholinergic neurotransmitter system are present in neurodegenerative disorders. SPECT or PET imaging, using radiotracers that selectively target muscarinic receptor subtypes, may be of value for in vivo evaluation of such conditions. 6β-acetoxynortropane, a potent muscarinic M2 receptor agonist, has previously demonstrated nanomolar affinity and high selectivity for this receptor. Based on this compound we synthesized four nortropane derivatives that are potentially suitable for SPECT imaging of the M2 receptor. 6β-acetoxynortropane and the novel derivatives were tested in vitro for affinity to the muscarinic M1−3 receptors. The original 6β-acetoxynortropane displayed high affinity (K i = 70–90 nM) to M2 receptors and showed good selectivity ratios to the M1 (65-fold ratio) and the M3 (70-fold ratio) receptors. All new derivatives showed reduced affinity to the M2 subtype and loss of subtype selectivity. It is therefore concluded that the newly synthesized derivatives are not suitable for human SPECT imaging of M2 receptors.

ON THE HEALTH RISK OF THE LUMBAR SPINE DUE TO WHOLE-BODY VIBRATION—THEORETICAL APPROACH, EXPERIMENTAL DATA AND EVALUATION OF WHOLE-BODY VIBRATION

The guidance on the effects of vibration on health in standards for whole-body vibration (WBV) does not provide quantitative relationships between WBV and health risk. The paper aims at the elucidation of exposure–response relationships. An analysis of published data on the static and dynamic strength of vertebrae and bone, loaded with various frequencies under different conditions, provided the basis for a theoretical approach to evaluate repetitive loads on the lumbar spine (“internal loads”). The approach enabled the calculation of “equivalent”—with respect to cumulative fatigue failure—combinations of amplitudes and numbers of internal cyclic stress. In order to discover the relation between external peak accelerations at the seat and internal peak loads, biodynamic data of experiments (36 subjects, three somatotypes, two different postures—relaxed and bent forward; random WBV,aw, r.m.s. 1·4 ms−2, containing high transients) were used as input to a biomechanical model. Internal pressure changes were calculated using individual areas of vertebral endplates. The assessment of WBV was based on the quantitative relations between peak accelerations at the seat and pressures predicted for the disk L5/S1. For identical exposures clearly higher rates of pressure rise in the bent forward compared to the relaxed posture were predicted. The risk assessment for internal forces considered the combined internal static and dynamic loads, in relation to the predicted individual strength, and Miner's hypothesis. For exposure durations between 1 min and 8 h, energy equivalent vibration magnitudes (formula B.1, ISO 2631-1, 1997) and equivalent vibration magnitudes according to formula B.2 (time dependence over-energetic) were compared with equivalent combinations of upward peak accelerations and exposure durations according to predicted cumulative fatigue failures of lumbar vertebrae. Formula B.1 seems to underestimate the health risk caused by high magnitudes, formula B.2 is recommended for the evaluation of such conditions.