Kerley A-lines represent thickened septal plates between lung segments in patients with lymphangitic carcinomatosis: confirmation using 3D-CT lung segmentation analysis

Purpose Kerley A-lines are generally apparent in patients with pulmonary edema or lymphangitic carcinomatosis. There are two main thoughts regarding the etiology of Kerley A-lines, but no general agreement. Specifically, the lines are caused by thickened interlobular septa or dilated anastomotic lymphatics. Our purpose was to determine the anatomic structure represented as Kerley A-lines using 3D-CT lung segmentation analysis. Materials and methods We reviewed 139 charts of patients with lymphangitic carcinomatosis of the lung who had CT and X-ray exams with a maximum interval of 7 days. The presence of Kerley A-lines on X-ray was assessed by a radiologist. The A-lines on X-ray were defined as follows: dense; fine (< 1 mm thick); ≥ 2 cm in length, radiating from the hilum; no bifurcation; and not adjacent to the pleura. For cases with Kerley A-lines on X-ray, three radiologists agreed that the lines on CT corresponded with Kerley A-lines. The incidence of A-lines and the characteristics of the lines were investigated. The septal lines between lung segments were identified using a 3D-CT lung segmentation analysis workstation. The percentage of agreement between the A-lines on CT and lung segmental lines was assessed. Results On chest X-ray, 37 Kerley A-lines (right, 16; left, 21) were identified in the 22 cases (16%). Of these, 4 lungs with 12 lines were excluded from analysis due to technical reasons. Nineteen of the 25 lines (76%) corresponded to the septal lines on CT. Of these, 11 lines matched with automatically segmented lines (intersegmental septa, 4; intersubsegmental septa, 7) by the workstation. Two lines (8%) represented fissures. Four lines corresponded to the bronchial wall/artery (3 lines, 12%) or vein (1 line, 4%). Conclusion Kerley A-lines primarily represented thickened and continued interlobular septal lines that corresponded to the septa between lung segments and subsegments.

Mathematical interpretation of avian egg shapes

The general principles of ovoid shapes and their mathematical interpretation were considered concerning previous data and experience. Previously, bird egg description was carried out using the composite ovoid model. According to this model, an ovoid is considered as a set of arcs with a smooth transition between them. The studied group of eggs was named true ovoid. They differ from other forms in size of their infundibular zone radius (thick end) that is almost equal to half of the diameter (0.5D ± 0.01 ˂ ri = 0.5D).We suggested that this commonality, a priori, implies the presence of an abstract geometric model, which is a satisfactory solution and logical approach for analyzing the diversity of natural ovoids. Such a model is a system of circles passing into each other. This allows, within a single system, to assign a vendor code to each form, which involves the name, geometric shape, and quantitative parameters that can be implemented in bird taxonomy.Early, 0.01 D was chosen as the model difference value and the ratio of symmetrical eggs in the analyzed database was 1.1%. In this research, we extended the difference value to 0.05 D and this covered 6.0% of the egg shapes. This is the maximum interval at which the curvature of the polar zones does not visually differ. We revealed that the variability in the egg shapes depends on the radii of curvature of the lateral and polar arcs. The larger the radius of the lateral arches, the greater the degree of freedom for variation of the lateral arches. We supposed that our data could associate any form of bird egg with its biological content. In turn, many ovoid features relevant to other natural objects can be used in bird taxonomical study.

Recurrence of Falciparum Malaria under Coartem Treatment in the City of Mâncio Lima, Acre, Brazil: A Retrospective Study

Background: Malaria remains a health problem in the Amazon and since 2005 the state of Acre has high incidence of malaria. Treatment with Coartem® for cases of falciparum malaria was introduced in Acre in August 2012. In Brazil, there is still no published study on the effectiveness of Coartem in endemic areas. Methods: This study was conducted in Mâncio Lima, Acre, in the western Brazilian Amazon region. All malaria cases notified in Mâncio Lima between August 01st, 2012 and October 31st, 2013 were revised. The therapeutic response to Coartem in Mâncio Lima, Acre, was evaluated. A recurrence of falciparum malaria was defined as a malaria case occurring in the same patient in a maximum interval of 40 days between the day treatments was started and the day the next diagnosis was made. Results: All malaria cases (7,171) notified between August 2012 and July 2013 were revised. About 23.72% (n = 1,701) were falciparum malaria. There were six cases of recurrent falciparum malaria that can be classified as treatment failure. All cases had low parasitemia. The minimum and maximum interval between the first and the recurrent malaria episode was 17 days and 33 days. Age range was 9 to 50 years. Two patients were from rural areas, while all others were from riverine areas. Conclusion: Possible failure to Coartem treatment was identified, however causes are not clear. Further studies are needed.

Short-term rate of milk synthesis and expression interval of preterm mothers

AimTo determine the impact of the pumping regimes of women with preterm infants on the daily milk production, and on the short-term rate of milk synthesis during early lactation to support evidence-based recommendations for optimising milk production.MethodsMothers of preterm infants (n=25) recorded start time, finish time and expression volumes from every breast expression on days 10, 15–20 postpartum.ResultsExpressing more often than five times per day did not result in a significant increase in daily milk production. Milk volume per expression per breast increased for intervals between expressions of between 2and6 hours then reached a plateau when the interval between expression was 7 hours or longer. The short-term rate of milk synthesis decreased as the interval between expressions increased until about 7.5 hours at which point it begun to increase (p value associated with interval between expressions^2<0.001).ConclusionThe strong inverse association between the short-term rate of milk synthesis and the interval between expressions for intervals up to 7 hours suggest that the maximum interval between expressions should be 7 hours. Data suggest that, on average, the mothers should express at least five times a day to maximise daily milk production. Considering inter-individual variation, determination of an individual mother’s maximum interval between expressions that does not compromise the short-term rate of milk synthesis will help to optimise daily milk production while minimising the demands on the mother’s time.

Screening interval recommendations following a normal colonoscopy in individuals with a familial risk of colorectal cancer

Background In view of the increased risk of developing colorectal cancer (CRC) in individuals with affected first-degree relatives (FDRs), the German evidence-based S3 guideline recommends having the first screening colonoscopy early and then, following a normal examination, repeating it at least every 10 years. The aim of this analysis was to explore colonoscopy interval recommendations in clinical practice among individuals aged < 55 years with a familial risk of CRC. Methods We analyzed data from the FRIDA.Frankfurt study. Patients aged 40 – 54 years with at least 1 reported FDR with CRC (excluding suspected/known hereditary cancer syndromes) and a normal colonoscopy result (no findings) were included. Data on colonoscopist recommendations for intervals between subsequent colonoscopies were extracted from colonoscopy reports. Results Of 63 reports of normal colonoscopies, 20 (32 %) did not include a recommendation on when to undergo a further colonoscopy. Of 43 reports with recommendations, 40 (93 %) suggested an interval that was shorter than the recommended maximum interval in the guideline: 1 (2 %) was for a 3-year interval, 37 (86 %) were for 5-year intervals, and 2 (5 %) were for 8-year intervals. Conclusions Although the low number of cases limits generalizability, the results indicate that recommended intervals in clinical practice are considerably shorter than the recommended maximum interval in the guideline.

Variability of Extreme Riser Responses due to Wave Frequency Motions of a Weather-Vaning FPSO

The variability of extreme responses of a flexible riser due to wave frequency motions of weather-vaning FPSO is investigated numerically. The objective of this study is to examine such variability in isolation from that caused by the low frequency (slow drift) vessel motions and vessel offsets. Investigation of the extreme value distributions of flexible risers provides the statistical foundation for flexible riser Response Based Analysis (RBA) for use in system design; the determination of the statistical properties of extreme flexible riser responses provides a method for the prediction of extreme responses of offshore systems in cyclonic conditions. A case study conducted in OrcaFlex included an FPSO vessel with a Lazy-S configured riser system. Five riser responses were selected in critical locations including tension, heave, and curvature responses. The environmental cases included two cyclonic storms consisting of multiple half-hour intervals. For each interval, time domain simulations included 40 wave realizations in order to provide a dataset for robust fitting of the extreme value distributions in the Gumbel format. Once the short term interval distributions were established, response distributions in a storm were generated by multiplying the short term distributions and the most probable maximum (MPM) response in a storm computed. A comparison of maximum interval, storm and 3-hour MPMs is presented, which indicates to what extent the MPM response in a storm exceeds the corresponding maximum interval response. Differences between the tension and heave responses are compared with those observed in the curvature responses. This study was limited to riser excitation by waves, current and wave frequency motions of a turret moored FPSO and it is expected that further inclusion of low frequency motions would contribute to the response variability. The inclusion of such variability will ultimately enable the storm-based statistical approach to be used for the development of long-term distribution of the riser responses.

FAKTOR-FAKTOR YANG BERPENGARUH TERHADAP AUDIT REPORT LAG (STUDI EMPIRIS PADA EMITEN INDUSTRI KEUANGAN DI BEI)

The timeliness of annual reports depend on the timeliness of auditor’s performance. The more timeline of publishing annual reports, more benefit can be delivered. This research investigates the factors influencing audit report lag in Indonesia. Sample of the research comprises 42 companies listed in Indonesian Stock Exchange during the year of 2010. The audit report lag for each sample companies ranged from a minimum interval of 25 days to a maximum interval of 129 days and 72 days in the average. Five hypotheses relating audit report lag to company size, profitability, leverage, auditor size, and audit opinion are tested in the research. The results of multiple linear regression support the alternate hypotheses put before except for the company size and leverage. Keywords: audit report lag, company size, profitability, leverage, auditor size, audit opinion.