RESUMEN
Contrast-enhanced mammography (CEM) has shown to be superior to full-field digital mammography (FFDM), but current results are dominated by studies performed on systems by one vendor. Information on diagnostic accuracy of other CEM systems is limited. Therefore, we aimed to evaluate the diagnostic performance of CEM on an alternative vendor's system. We included all patients who underwent CEM in one hospital in 2019, except those with missing data or in whom CEM was used as response monitoring tool. Three experienced breast radiologists scored the low-energy images using the BI-RADS classification. Next, the complete CEM exams were scored similarly. Histopathological results or a minimum of one year follow-up were used as reference standard. Diagnostic performance and AUC were calculated and compared between low-energy images and the complete CEM examination, for all readers independently as well as combined. Breast cancer was diagnosed in 23.0% of the patients (35/152). Compared to low-energy images, overall CEM sensitivity increased from 74.3 to 87.6% (p < 0.0001), specificity from 87.8 to 94.6% (p = 0.0146). AUC increased from 0.872 to 0.957 (p = 0.0001). Performing CEM on the system tested, showed that, similar to earlier studies mainly performed on another vendor's systems, both sensitivity and specificity improved when compared to FFDM.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Mama/diagnóstico por imagen , Mama/patología , Mamografía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/etiología , Toma de Decisiones Clínicas , Medios de Contraste , Manejo de la Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética , Mamografía/normas , Tamizaje Masivo , Persona de Mediana Edad , Curva ROC , Intensificación de Imagen Radiográfica , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos XRESUMEN
At the so-called in-bore, MRI-guided prostate biopsy, the radiologist in the MRI suite manually directs a rectal biopsy needle guide at an abnormality confirmed by a previous prostate MRI. This manual technique of taking a biopsy is time-consuming and thus rather expensive, as the patient has to be moved in and out of the MRI several times. Since 2015, a remote-controlled manipulator robot (RCM) has been available. Using this apparatus the radiologist is able to position the needle guide remotely. This technique is simple to learn and less time-consuming than the in-bore biopsy without the RCM. In this article we discuss the findings from the first 201 patients in the Netherlands from whom robot-guided prostate biopsies have been taken.
Asunto(s)
Biopsia con Aguja/métodos , Biopsia Guiada por Imagen/métodos , Imagen por Resonancia Magnética , Neoplasias de la Próstata/diagnóstico , Robótica/métodos , Humanos , Masculino , Países Bajos , RectoRESUMEN
BACKGROUND: In many European countries, short-term 5 × 5 Gy radiotherapy has become the standard preoperative treatment of patients with resectable rectal cancer. Individualized risk assessment might allow a better selection of patients who will benefit from postoperative treatment and intensified follow-up. PATIENTS AND METHODS: From patient's data from three European rectal cancer trials (N = 2881), we developed multivariate cox nomograms reflecting the risk for local recurrence (LR), distant metastases (DM) and overall survival (OS). Evaluated variables were age, gender, tumour distance from the anal verge, the use of radiotherapy, surgical technique (total mesorectal excision/conventional surgery), surgery type (low anterior resection/abdominoperineal resection), time from randomization to surgery, residual disease (R0 versus R1 + 2), pT-stage, pN-stage and surgical complications. RESULTS: Pathological T- and N-status are of vital importance for an accurate prediction of LR, DM and OS. Short-course radiotherapy reduces the rate of LR. The developed nomograms are capable of predicting events with a validation c-index of 0.79 (LR), 0.76 (DM) and 0.75 (OS). The proposed stratification in risk groups allowed significant distinction between Kaplan-Meier curves for outcome. CONCLUSION: The developed nomograms can contribute to better individual risk prediction for LR, DM and OS for patients operated on rectal cancer. The practicality of the defined risk groups makes decision support in the consulting room feasible, assisting physicians to select patients for adjuvant therapy or intensified follow-up.
Asunto(s)
Técnicas de Apoyo para la Decisión , Terapia Neoadyuvante , Recurrencia Local de Neoplasia , Nomogramas , Dosis de Radiación , Neoplasias del Recto/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Europa (Continente) , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Terapia Neoadyuvante/efectos adversos , Terapia Neoadyuvante/mortalidad , Metástasis de la Neoplasia , Estadificación de Neoplasias , Selección de Paciente , Modelos de Riesgos Proporcionales , Radioterapia Adyuvante , Ensayos Clínicos Controlados Aleatorios como Asunto , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenAsunto(s)
Imagen por Resonancia Magnética , Neoplasias de las Glándulas Salivales/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Parótida/diagnóstico , Neoplasias de la Parótida/patología , Neoplasias de las Glándulas Salivales/patología , Glándulas Salivales Menores/patología , Sensibilidad y Especificidad , Neoplasias de la Glándula Submandibular/diagnóstico , Neoplasias de la Glándula Submandibular/patologíaRESUMEN
Mitochondria in excitable cells are recurrently exposed to pulsatile calcium gradients that activate cell function. Rapid calcium uptake by the mitochondria has previously been shown to cause uncoupling of oxidative phosphorylation. To test (i) if periodic nerve firing may cause oscillation of the cytosolic thermodynamic potential of ATP hydrolysis and (ii) if cytosolic adenylate (AK) and creatine kinase (CK) ATP buffering reactions dampen such oscillations, a lumped kinetic model of an excitable cell capturing major aspects of the physiology has been developed. Activation of ATP metabolism by low-frequency calcium pulses caused large oscillation of the cytosolic, but not mitochondrial ATP/ADP, ratio. This outcome was independent of net ATP synthesis or hydrolysis during mitochondrial calcium uptake. The AK/CK ATP buffering reactions dampened the amplitude and rate of cytosolic ATP/ADP changes on a timescale of seconds, but not milliseconds. These model predictions suggest that alternative sources of capacitance in neurons and striated muscles should be considered to protect ATP-free energy-driven cell functions.
Asunto(s)
Adenosina Trifosfato/metabolismo , Señalización del Calcio/fisiología , Calcio/metabolismo , Mitocondrias/fisiología , Modelos Neurológicos , Neuronas/fisiología , Potenciales de Acción/fisiología , Adaptación Fisiológica/fisiología , Animales , Simulación por Computador , Citosol/metabolismo , Metabolismo Energético , Humanos , CinéticaRESUMEN
The Care Windows development project demonstrated the feasibility of an approach designed to add the benefits of an event-driven, graphically-oriented user interface to an existing Medical Information Management System (MIMS) without overstepping economic and logistic constraints. The design solution selected for the Care Windows project incorporates three important design features: (1) the effective de-coupling of severs from requesters, permitting the use of an extensive pre-existing library of MIMS servers, (2) the off-loading of program control functions of the requesters to the workstation processor, reducing the load per transaction on central resources and permitting the use of object-oriented development environments available for microcomputers, (3) the selection of a low end, GUI-capable workstation consisting of a PC-compatible personal computer running Microsoft Windows 3.0, and (4) the development of a highly layered, modular workstation application, permitting the development of interchangeable modules to insure portability and adaptability.
Asunto(s)
Sistemas de Información Administrativa , Interfaz Usuario-Computador , Centros Médicos Académicos , Sistemas de Computación , Sistemas de Registros Médicos Computarizados , Michigan , Microcomputadores , Diseño de SoftwareRESUMEN
The demonstration of MIMS/CareWindows will include: (1) a review of the application environment and development history, (2) a demonstration of a very large, comprehensive clinical information system with a cost effective graphic user server and communications interface.