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Battery design efforts often prioritize enhancing the energy density of the active materials and their utilization. However, optimizing thermal management systems at both the cell and pack levels is also key to achieving mission-relevant battery design. Battery thermal management systems, responsible for managing the thermal profile of battery cells, are crucial for balancing the trade-offs between battery performance and lifetime. Designing such systems requires accounting for the multitude of heat sources within battery cells and packs. This paper provides a summary of heat generation characterizations observed in several commercial Li-ion battery cells using isothermal battery calorimetry. The primary focus is on assessing the impact of temperatures, C-rates, and formation cycles. Moreover, a module-level characterization demonstrated the significant additional heat generated by module interconnects. Characterizing heat signatures at each level helps inform manufacturing at the design, production, and characterization phases that might otherwise go unaccounted for at the full pack level. Further testing of a 5 kWh battery pack revealed that a considerable temperature non-uniformity may arise due to inefficient cooling arrangements. To mitigate this type of challenge, a combined thermal characterization and multi-domain modeling approach is proposed, offering a solution without the need for constructing a costly module prototype.

In the long-term absence of major disturbances ecosystems enter a state of retrogression, which involves declining soil fertility and consequently a reduction in decomposition rates. Recent studies have looked at how plant traits such as specific leaf mass and amounts of secondary compounds respond to declining soil fertility during retrogression, but there are no comparable studies for lichen traits despite increasing recognition of the role that lichens can play in ecosystem processes. We studied a group of 30 forested islands in northern Sweden differing greatly in fire history, and collectively representing a retrogressive chronosequence, spanning 5000 years. We used this system to explore how specific thallus mass (STM) and carbon based secondary compounds (CBSCs) change in three common epiphytic lichen species (Hypogymnia phsyodes, Melanohalea olivacea and Parmelia sulcata) as soil fertility declines during this retrogression. We found that STMs of lichens increased sharply during retrogression, and for all species soil N to P ratio (which increased during retrogression) was a strong predictor of STM. When expressed per unit area, medullary CBSCs in all species and cortical CBSCs in P. sulcata increased during retrogression. Meanwhile, when expressed per unit mass, only cortical CBSCs in H. physodes responded to retrogression, and in the opposite direction. Given that lichen functional traits are likely to be important in driving ecological processes that drive nutrient and carbon cycling in the way that plant functional traits are, the changes that they undergo during retrogression could potentially be significant for the functioning of the ecosystem.

EDs restricted visitors during the COVID-19 pandemic on the assumption that the risks of disease spread outweighed the psychological benefits of liberal visitation. But data suggest that beyond providing emotional support, family and caregivers can clarify history, improve patient monitoring, and advocate for patients-actions that can improve quality of care. Our objective was to assess whether removing visitors from the bedside contributed to errors in emergency care. We reviewed a database of medical errors covering visits from 11/15/17 to 7/30/22 at an urban, tertiary-care, academic ED for five types of error amenable to visitor intervention: inadequate history gathering, inadequate monitoring, falls, giving a medication to which a patient is allergic, and inappropriate medication dosing. These records were reviewed by two investigators to determine the likelihood visitor presence could have prevented the error. For those errors judged susceptible to visitor intercession, the number in each category was compared for the period before and after strict restrictions took effect. Our review found 27/781 (3.5%) errors in the pre-pandemic period and 27/568 (4.8%) errors in the pandemic period fell into one of these five categories (p = 0.29). Visitors prevented harm from reaching the patient in three of 27 pre-pandemic errors (11.1%), compared to 0 out of 27 peri-pandemic errors (p = 0.23). On review by two attendings, 17/24 (70.8%) errors that reached the patient in the pre-pandemic period were judged amenable to visitor intervention, compared to 25/27 (92.6%) in the pandemic period (p = 0.09). There were no statistically significant differences in the categories of error between the two groups; monitoring errors came the closest: 1/17 (5.9%) pre-COVID errors amenable to visitor intervention in these categories were monitoring related, whereas 7/25 (28.0%) post-COVID errors were (p = 0.16). While this study did not demonstrate a statistically significant difference in error between lenient and restrictive visitation eras, we did find multiple cases in the pre-COVID era in which family presence prevented error, and qualitative review of post-COVID errors suggested many could have been prevented by family presence. Larger trials are needed to determine how frequent and consequential such errors are and how to balance the public health imperative of curbing disease spread with the harm caused by restricting visitation., (© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)

Objective: To investigate the advantages of using modified signal intensity measurements on chemical shift imaging alone or in conjunction with proton magnetic resonance spectroscopy in the differential diagnosis of adrenal adenomas., Materials and Methods: This was a prospective study involving 97 patients with adrenal nodules or masses. The signal intensity index (SII) was calculated as [( signal intensity on the in-phase image - signal intensity on the out-of-phase image) ∕ ( signal intensity on the in-phase image )] × 100% . We determined the averages of the minimum, mean, and maximum signal intensity values measured on three consecutive images. When that was not possible (for smaller lesions), we used one or two images. We employed a region of interest that covered one half to two thirds of the mass. All indices were compared with metabolite ratios derived from spectroscopy: lactate/creatine; glutamine-glutamate/creatine; choline/creatine; choline/lipid; 4.0-4.3 ppm/Cr; and lipid/creatine., Results: Of the 97 patients evaluated, 69 were diagnosed with adenomas and 28 were diagnosed with nonadenomas. All SII measurements and spectroscopy-derived metabolite ratios were significant to the differentiation between adenomas and nonadenomas, except for the lipid/creatine and choline/lipid ratios. In 37.8% of the cases, it was not possible to perform spectroscopy. When it was possible, the lactate/creatine ratio was found to have higher accuracy than did the SII., Conclusion: Determining the SII and metabolite ratios increased the accuracy of the differential diagnosis of adrenal adenomas.

Background: The aim of this retrospective study was to determine changes in outcomes after surgical aortic valve replacement (SAVR) for aortic stenosis (AS) in Iceland over a 15-year period., Methods: We included 587 patients who underwent SAVR for AS in Iceland during the period 2002-2016, with a total follow-up of 3245 patient-years. Short-term and long-term outcomes, 30-day mortality, and long-term survival (Kaplan-Meier) were analyzed. Univariate linear regression and univariate and multinomial logistic regression analyses were performed on preoperative and perioperative variables. Poisson regression analysis was used to evaluate changes in rates of short-term outcomes., Results: Mean age was 71 years, 65.1% were males, and mean EuroSCORE II was 3.9. Mean preoperative aortic valve area increased significantly (0.013 cm 2 /year; P < .001) and mean aortic cross-clamp time declined (108 minutes, 2.8 min/year; P < .001). The rate of complications decreased, including new-onset atrial fibrillation (60.9% overall, decreased by 3.1%/year, P = .02), acute kidney injury (17.1%, 7.6%/year, P < .001), and reoperation for bleeding (12.5%, 6.3%/year, P = .02). Operative mortality did not change (5.4%); nor did 1- and 5-year overall survival (92.5% and 81.6%, respectively). Notable long-term events were chronic heart failure (27.7 admissions/100 patient-years), embolic event (15.9/100 patient-years), and bleeding (13.0/100 patient-years)., Conclusions: Results of SAVR in this well-defined nationwide cohort of patients in Iceland have improved. This may be related to the patients having less severe AS at the time of operation and shorter operating times, as reflected by lower rates of short-term complications. However, the rate of long-term complications did not change significantly, with prosthetic valve-specific events being rare., (© 2019 Wiley Periodicals, Inc.)

Objectives: To evaluate cardiovascular involvement in children and adolescents with End Stage Renal Disease (ESRD) and to characterize the main risk factors associated with this outcome., Methods: Cross-sectional study of 69 children and adolescents at renal transplantation and 33 healthy individuals matched by age and gender. The study outcomes were left ventricular mass z-score (LVMZ) and carotid artery intima-media thickness (CIMT). The potential risk factors considered were age, gender, CKD etiology, use of oral vitamin D and calcium-based phosphate binders, systolic and diastolic blood pressure, body mass index z-score, time since diagnosis, dialysis duration, serum levels of ionic calcium, phosphorus, parathyroid hormone, fibroblast growth factor (FGF 23), uric acid, homocysteine, cholesterol, triglycerides, C-reactive protein (CRP), vitamin D and hemoglobin., Results: In the multivariate analysis, the factors associated with LVMZ were dialysis duration, age, systolic blood pressure, serum hemoglobin and HDL cholesterol levels. Regarding CIMT, in the multivariate analysis, systolic blood pressure was the only factor associated with the outcome., Conclusion: Children exhibited important cardiovascular involvement at the time of the renal transplantation. Both of the studied outcomes were independently associated with systolic blood pressure. For this reason, controlling blood pressure seems to be the main therapy to minimize cardiovascular involvement in children with ESRD.

Purpose: To assess the accuracy of prostate-specific antigen (PSA) adjusted for the transition zone volume (PSATZ) in predicting prostate cancer by comparing the ability of several PSA parameters in predicting prostate cancer in men with intermediate PSA levels of 2.6 - 10.0 ng/mL and its ability to reduce unnecessary biopsies., Materials and Methods: This study included 656 patients referred for prostate biopsy who had a serum PSA of 2.6 - 10.0 ng/mL. Total prostate and transition zone volumes were measured by transrectal ultrasound using the prolate ellipsoid method. The clinical values of PSA, free-to-total (F/T) ratio, PSA density (PSAD) and PSATZ for the detection of prostate cancer were calculated and statistical comparisons between biopsy-positive (cancer) and biopsy-negative (benign) were conducted., Results: Cancer was detected in 172 patients (26.2%). Mean PSA, PSATZ, PSAD and F/T ratio were 7.5 ng/mL, 0.68 ng/mL/cc. 0.25 ng/mL/cc and 0.14 in patients with prostate cancer and 6.29 ng/mL, 0.30 ng/mL/cc, 0.16 ng/mL/cc and 0.22 in patients with benign biopsies, respectively. ROC curves analysis demonstrated that PSATZ had a higher area under curve (0,838) than F/T ratio (0,806) (P<0.001) and PSAD (0,806) (P<0.001). With a cut-off value of 0.22 ng/mL/cc, PSATZ had 100% of sensitivity and could have prevented 24% of unnecessary biopsies., Conclusions: PSATZ may be useful in enhancing the specificity of serum PSA. Compared to other PSA related parameters, it was better in differentiating between prostate cancer and benign prostatic enlargement. Also, PSATZ could reduce a significant number of unnecessary biopsies., Competing Interests: Conflict of interest: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Objective: To evaluate the carotid intima-media complex (CIMC) thickness and lipid metabolism biomarkers associated with cardiovascular risk (CR) in parents of patients with ataxia-telangiectasia and verify an association with gender., Method: A cross-sectional and controlled study with 29 ATM heterozygotes and 14 healthy controls. Biochemical tests and CIMC thickness measurement were performed., Results: The mean CIMC measurement in heterozygous ATM was 0.72 ± 0.1 mm (minimum: 0.5 mm and maximum: 1.0 mm). Noticed high percentage of amounts above 75 percentile compared to the population referential (16 [76.2%]), without any significant statistical differences between the female and the male gender (11/15 [73.3%] vs. 5/6 [83.3%]; p=0.550). The comparison between heterozygous and controls, stratified by gender, showed that in heterozygous ATMs, women had higher concentrations of HDL-c compared to men, as well as higher values of hs-CRP in relation to the control women. In heterozygous ATMs, stratified by gender, the correlation between HDL-c and hs-CRP was inversely proportional and stronger among women, with a tendency to statistical significance., Conclusion: Heterozygous ATMs did not differ from controls in relation to the biomarkers studied related to CR. However, most of them presented increased CIMC, independent predictor of death, risk for myocardial infarction and stroke, compared to the referential for the same age group. This finding suggests CR in the heterozygous ATM and shows to the need to monitor CIMC thickness and nutritional orientations.

Background: Ataxia telangiectasia (A-T) is a neurodegenerative disease that leads to mitochondrial dysfunction and oxidative stress. Insulin resistance (IR), type 2 diabetes and the risk for development of cardiovascular disease was recently associated as an extended phenotype of the disease. We aimed to assess IR; liver involvement; carotid intima-media thickness (cIMT) and metabolic alterations associated to cardiovascular risk in A-T patients, and relate them with age., Results: Glucose metabolism alterations were found in 54.6% of the patients. Hepatic steatosis was diagnosed in 11/17 (64.7%) A-T patients. AST/ALT ratio > 1 was observed in 10/17 (58.8%). A strong positive correlation was observed between insulin sum concentrations with ALT (r = 0.782, p < 0.004) and age (r = 0.818, p = 0.002). Dyslipidemia was observed in 55.5% of the patients. The apolipoprotein (Apo-B)/ApoA-I ratio (r = 0.619; p < 0.01), LDL/HDL-c (r = 0.490; p < 0.05) and the Apo-B levels (r = 0.545; p < 0.05) were positively correlated to cIMT., Conclusions: Metabolic disorders implicated in cardiovascular and liver diseases are frequently observed in adolescent A-T patients and those tend to get worse as they become older. Therefore, nutritional intervention and the use of drugs may be necessary.

Background: Primary Sjögren syndrome is a chronic inflammatory autoimmune disease. The delay in diagnosis allows the establishment of a chronic inflammatory state, which makes primary Sjögren syndrome an interesting model for the study of atherosclerosis., Objectives: The aim of this study was to evaluate subclinical atherosclerosis in 49 patients with Sjögren syndrome using noninvasive methods., Methods: We assessed traditional risk factors such as hypertension, diabetes, dyslipidemia, smoking, and family history of atherosclerosis. Patients with prior cardiovascular events and a history of atherosclerosis were excluded. Clinical and laboratory features were recorded, as well as the European League Against Rheumatism Sjögren's Syndrome Activity Index calculation. The atherosclerosis evaluation was done by carotid intima-media thickness, measured by ultrasonography, and ankle-brachial index (ABI)., Results: Fifteen patients (31%) had at least 1 traditional risk factor, and 65.3% had a European League Against Rheumatism Sjögren's Syndrome Activity Index score from mild to moderate. Only 2 patients had increased carotid intima-media thickness. However, 59% presented ABI alterations. Multiple correspondence analysis showed a clear correlation between low ABI and the positivity of autoantibodies (antinuclear antibodies, anti-SSA, rheumatoid factor)., Conclusions: The subgroup of patients with positive autoantibodies showed low ABI, which may represent a higher risk of early atherosclerosis and indicate the need for more careful monitoring in this group.

Purpose: To evaluate clinical and laboratory findings in patients undergoing radiofrequency (RF) ablation for functioning adrenal adenomas., Materials and Methods: Eleven adult patients, nine with Conn syndrome and two with Cushing syndrome, underwent percutaneous computed tomography-guided RF ablation for benign adrenal neoplasms. Systolic, diastolic, and mean blood pressure and the number of classes of antihypertensive drugs used by each patient were analyzed before and 1, 4, and 12 weeks after the procedure. Serum hormone levels were analyzed within 30 days before and 12 weeks after the procedure., Results: Of the nine patients with Conn syndrome, eight showed normal serum aldosterone levels after the procedure and one patient had a nodule located very close to the inferior vena cava, resulting in incomplete ablation. The two patients with Cushing syndrome had normal serum and salivary cortisol levels after the procedure. Mean aldosterone concentration at baseline was 63.3 ng/dL ± 28.0 and decreased to 13.3 ng/dL ± 13.5 at 12 weeks postoperatively (P = .008). Systolic, diastolic, and mean blood pressures decreased significantly in the first week after the procedure (P < .001) and remained stable during further follow-up., Conclusions: In patients with Conn syndrome or Cushing syndrome, percutaneous RF ablation of functioning adrenal adenomas may result in normalization of hormone secretion, improvement in blood pressure, and reduced need for antihypertensive drugs., (Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.)

Objective: To establish the main characteristics of the cervix in pregnant women with cervical insufficiency, by means of magnetic resonance imaging (MRI)., Methods: A prospective observational case-control study was conducted among 59 pregnant women with cervical insufficiency and 10 normal pregnant women, between their 10th and 28th weeks. The parameters analyzed in the MRI examinations were: precise identification of the cervix; presence of hyposignal at the internal orifice of the cervix; loss of definition of the periendocervical stromal zone (PESZ); presence of hyposignal content inside the amniotic sac (sludge sign) and anatomical and functional biometry of the cervix., Results: Peripheral hyposignal was found in 41 (85.4%) and loss of definition of the PESZ was observed in 36 pregnant women (73.5%) with cervical insufficiency. Sludge was observed in 46 pregnant women with cervical insufficiency, and this was seen on MRI in 27 cases (58.7%). The mean anatomical and functional lengths of the cervix on MRI in the pregnant women with cervical insufficiency were 3.5 ± 0.8 cm (0.8-4.9 cm) and 28.7 ± 6.3 mm (9-41 mm). None of the normal pregnant women presented hyposignal loss of the PESZ and the sludge sign., Conclusion: MRI may be useful for evaluating the cervix and for early identification of signs of cervical insufficiency during pregnancy.

Purpose: To test the use of diffusion-weighted magnetic resonance imaging (DW-MRI) to differentiate between different degrees of severity of acute pancreatitis (AP)., Method: Thirty-six patients who underwent DW-MRI and magnetic resonance cholangiopancreatography were divided into patients with mild AP (mAP, n = 15), patients with necrotizing AP (nAP, n = 8), and patients with a normal pancreas (nP, n = 15; controls). The pancreas was divided into head, body, and tail, and each segment was classified according to image features: pattern 1, normal; pattern 2, mild inflammation; and pattern 3, necrosis. Apparent diffusion coefficients (ADCs) were measured in each segment and correlated with clinical diagnoses., Results: A total of 108 segments was assessed (three segments per patient). Segments classified as pattern 1 in the nP and mAP groups showed similar ADC values (P = 0.29). ADC values calculated for the pancreatic segments grouped according to the different image patterns (1-3) were significantly different (P < 0.001). Comparisons revealed significant differences in signal intensity between all three patterns (P < 0.05)., Conclusions: DW-MRI was a compatible and safe image option to differentiate tissue image patterns in patients with mAP, nAP, and nP, mainly in those with contraindications to contrast-enhanced MRI (which is classically required for determining the presence of necrosis) or computed tomography. ADC measures allowed precise differentiation between patterns 1, 2, and 3.

Current data suggest that up to 60 % of patients presenting to the ED with syncope leave the hospital without a defined etiology. Although a relationship between syncope and substance abuse has been described, no study to date has looked at the relationship between syncope of unknown etiology and substance abuse in patients presenting to the ED. The objective of the study was to determine whether a history of or current substance abuse is associated with an increased incidence of syncope of unknown etiology in ED patients. A prospective, observational, cohort study of consecutive ED patients aged ≥18 who presented with syncope was conducted between 6/03 and 7/06. Patients were queried in the ED and charts reviewed about a history of or current substance abuse. Substance abuse was defined as consumption of >2 alcoholic beverages nightly, repetitive use of any illicit substances, or documentation by the patient's physician of concern regarding suspected substance abuse. Data were analyzed using SAS with Chi-squared and Fisher's exact tests. We enrolled 518 patients who presented to the ED after syncope, 161 of whom did not have an identifiable etiology for their syncopal event. 62 patients had a history of, or current substance abuse. Among patients with a history of, or current substance abuse, 45 % had unexplained syncope, as opposed to 29 % of patients without such a history (p = 0.01). Our results suggest that prior and current substance abuse is associated with increased incidence of syncope of unknown etiology. Patients evaluated in the ED or even hospitalized with syncope of unknown etiology may benefit from substance abuse screening and possibly detoxification referral.

Background: The aim of this study is to assess the evolution of renal size and function in pediatric transplant patients according to the graft mass/recipient size ratio., Methods: Fifty pediatric renal transplant recipients were followed over 2 years. Grafts were weighed, and three different graft mass/m(2) ratios were determined: (1) low graft mass (58 g/m(2), range 31-57 g/m(2)), (2) median (142 g/m(2), range 59-141 g/m(2)) and high (267 g/m(2), range 143-353 g/m(2)). Patients underwent repeated ultrasound Doppler scans and repeated measurements of estimated glomerular filtration rate (eGFR; 1 week and 1, 6, 12 and 24 months), urinary retinol-binding protein (RBP) and proteinuria (1 week and 6, 12 and 24 months)., Results: The volume of renal tissue increased by 12 ± 5.6 cm(3) at 24 months (p = 0.035) in the low graft mass and decreased by -14 ± 7 cm(3) (p = 0.046) in the high graft mass. The eGFR increased when either low (30 ± 5 ml/min/1.73 m(2), p < 0.001) or median (19 ± 4 ml/min/1.73 m(2), p < 0.001) graft mass was transplanted but remained stable when high graft mass was transplanted. The resistive index (RI) presented a significant decrease throughout early follow-up in the transplants involving low and median graft mass, whereas a slight rise was observed in those involving high graft mass. A significant difference was apparent 6 months post-transplant. Transplants of low and median graft mass were associated with an initial higher urinary RBP. No significant differences in proteinuria were detected., Conclusions: Small kidneys undergo increases in volume and function without escalation of either proteinuria or urinary RBP, characterizing an adequate adaptation to the recipient. Children receiving larger kidneys present a reduction in volume, stable GFR and higher RI at 6 months.

Context and Objective: The thickness of the carotid intima-media complex (C-IMC) is considered to be a marker of early atherosclerosis, but visual and echogenic changes to the C-IMC can also be noted. The objective here was to evaluate the relationship between cardiovascular risk factors and the echogenicity of the C-IMC and identify those most associated with an "abnormal" C-IMC., Design and Setting: Cross-sectional study in the ultrasound sector of the Department of Diagnostic Imaging, Universidade Federal de São Paulo., Methods: Eighty men were evaluated. Measurements of arterial blood pressure, waist circumference (WC), lipid profile, fasting glucose, uric acid and high-sensitivity C-reactive protein were obtained. The thickness of the C-IMC was measured by means of B-mode ultrasound, and the intima-media gray-scale mean (IM-GSM) and standard deviation (IM-SD) were calculated., Results: The following were discriminating variables: fasting glucose (r2 = 0.036; P = 0.013), uric acid (r2 = 0.08; P = 0.03), IM-SD (r2 = 0.43; P < 0.001), IM-GSM (r2 = 0.35; P < 0.001) and thickness of the C-IMC (r2 = 0.29; P < 0.001). IM-GSM showed significant correlations with WC (r = -0.22; P = 0.005), fasting glucose (r = -0.24; P = 0.002) and high-density lipoprotein cholesterol (HDL-C) (r = 0.27; P = 0.0007)., Conclusion: IM-GSM showed correlations with WC, fasting glucose and HDL-C. However, uric acid and IM-SD presented the greatest discriminating impact. These results suggest that visual changes in C-IMC may help identify patients with potential cardiovascular risk, independently of the thickness of the C-IMC.

Current data suggest that up to 60 % of patients presenting to the emergency department with syncope leave the hospital without a defined etiology. Prior studies suggest a prevalence of psychiatric disease as high as 26 % in patients with syncope of unknown etiology. The objective of this study was to determine whether psychiatric disease is associated with an increased incidence of syncope of unknown etiology. Prospective, observational, cohort study of consecutive ED patients >18 presenting with syncope was conducted from 6/03 to 7/06. Patients were queried in the ED and charts reviewed for a history of psychiatric disease and use of psychiatric medication. Data were analyzed using SAS v9.2 with Fisher's exact tests. We enrolled 518 patients who presented to the ED after syncope, 161 (31 %) did not have an identifiable etiology for their syncopal event; 166 patients (32 %) had a history of or current psychiatric disease. Among men with psychiatric disease, 37 % had an unknown etiology of their syncopal event, compared to 23 % of men without psychiatric disease (p = 0.04). However, among women with syncope of unknown etiology, there was no significant difference between those with and without psychiatric disease (34.4 vs. 32.7 %) with p = 0.77. Our results suggest that men with psychiatric disease have an increased incidence of syncope of unknown etiology. Given this relationship, clinicians might consider screening for psychiatric disorders in syncopal patients when no clear etiology can be identified.

Purpose: To compare two-dimensional ultrasonography (2DUS) and magnetic resonance imaging (MRI) for assessing brain and spine parameters in fetuses with spina bifida., Methods: A cross-sectional study was conducted on 15 fetuses with spina bifida (one with encephalocele, four with rachischisis and 10 with myelomeningocele). The size of the atrium of the lateral ventricle, percentage shortening of the cerebellum, degree of compromising of the first vertebra and total number of vertebras affected by herniation were assessed. The MRI examination was performed not more than 7 days after the 2DUS. To compare and correlate the parameters from the two techniques, the paired Student's t test and intraclass correlation coefficient (ICC) were used. To assess the correlations of atrium measurements from 2DUS and MRI with other parameters, Pearson's correlation coefficient (r) was used., Results: No significant difference was observed in any of the means of the parameters assessed using the two techniques (p > 0.05). Both 2DUS and MRI seemed to present satisfactory reliability in measurements on the size of the atrium of the lateral ventricle and the first vertebra affected (ICC = 0.88 and 0.75, respectively). Measurements on the atrium of the lateral ventricle from 2DUS correlated better with the other parameters than did measurements from MRI., Conclusions: In fetuses with spina bifida, 2DUS and MRI present similar results, but measurements on the atrium of the lateral ventricle from 2DUS correlated better with the other parameters.

The aims of this descriptive study were to determine the academic profile of nurses in a university hospital, assess their level of knowledge about magnetic resonance imaging (MRI) and verify whether this knowledge was acquired during their undergraduate or graduate education. Ninety randomly selected nurses working in inpatient wards and outpatient units of a university hospital participated in the study. Data were collected through a questionnaire completed by the participants between August and October 2009. Most nurses were females who have received specialized education. The participants had a limited knowledge about MRI, which was restricted to the procedures to prepare patients for MRI examination and MRI contraindications. Most of the nurses acquired information about MRI during the professional practice. The majority of nurses showed interest to know more about the MRI examination, especially regarding the exam environment, conditions and contraindications, in order to prevent accidents., (© 2012 Wiley Publishing Asia Pty Ltd.)

Objective. To verify if the placental thickness allows determining the gestational age, evaluating the correlation between the referred gestational age with the studied one, and the accuracy of the placental thickness measurement (biometry) with fetal morphologic parameters in bitches. Methods. The placental thickness of 336 bitches of diverse breeds was evaluated. Bitches were divided in three groups by body weight: small, medium, and big large size. The gestations pregnancies were evaluated by ultrasound from the third week of gestation. An analysis was performed between the mean values of the gestational age obtained of placental thickness by adjustment of curves and the reported gestational age. Student's t-test was applied to compare the mean of reported and placental thickness gestational age. Significance was defined as P < 0.05. Results. A positive and statistically significant correlation exists between the placental thickness and gestational age. The expression that presents the best correlation coefficient and explanation was thickness of placenta = 0.021x gestational age -0.314. Conclusion. It is possible to determine the gestational age in relation to the placental thickness measured by ultrasound in bitches with a satisfactory accuracy in relation to fetal morphologic parameters as gestational vesicle, ribs, or kidneys.

Background: Obesity derived from intra-abdominal fat deposition tends to increase hormonal and cytokine production, thus worsening insulin sensitivity and leading to endothelial dysfunction. Hyperinsulinemia is considered an independent risk factor for ischemic heart disease and cause of endothelial dysfunction in healthy individuals., Objective: To assess the impact of different degrees of insulin resistance, measured by HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), on endothelial function in obese, non-diabetic patients without prior history of cardiovascular events and different metabolic syndrome components., Methods: Forty obese individuals were submitted to anthropometric measurements, BP measurements at office and ABPM and laboratory tests, in addition to non-invasive ultrasound assessment of endothelial function. Patients were divided into 3 groups according to the level of insulin resistance: patients with HOMA-IR values from 0.590 to 1.082 were assigned to Group 1 (n=13), from 1.083 to 1.410 to Group 2 (n=14) and from 1.610 to 2.510 to Group 3 (n=13)., Results: We found a significant difference in flow-mediated dilation in group 3 compared to group 1 (9.2 ± 7.0 vs 18.0 ± 7.5 %, p=0.006). There was a negative correlation between endothelial function and insulin, HOMA-IR and triglycerides., Conclusion: Our data suggest that mild changes in insulin resistance levels assessed by HOMA-IR may have an impact on vasodilatatory endothelial function in uncomplicated obese individuals with different cardiovascular risk factors.

Purpose: To evaluate morphology of lateral ventricles of ventriculomegaly/hydrocephaly fetuses using 3D-sonography by virtual organ computer-aided analysis (VOCAL) technique and magnetic resonance imaging (MRI) and verify morphologic patterns related to etiology., Methods: Seventeen fetuses presenting with ventricular enlargement (atria > 10 mm) were evaluated. 3D datasets were acquired from a coronal reference plane and post-processed by the rotational imaging using VOCAL 30°. MRI study was analyzed in the three plans in all sequences. Morphologic aspects such as global shape, anterior, posterior and inferior horn characteristics, wall irregularities and deformities were analyzed and related to etiology factor., Results: Twenty-nine percent of the cases were secondary to Arnold-Chiari syndrome and presented with global dilation of the three-horns. Cases related to aqueduct stenosis presented with ependymal rupture and wall irregularities in advanced cases. Corpus callosum agenesis cases presented with small ventricular volumes, thin shape, normal or slightly enlarged anterior and inferior horns with dilation restricted to posterior horn. Cases related to trisomy 18 and cytomegalovirus presented irregular ventricular walls associated with anomalous ventricular shapes, suggesting parenchymal destruction., Conclusion: Ventricular morphology evaluation gives important information on etiology of ventricular enlargement, supporting prognosis prediction and decision making process of the affected fetuses and their families.

Background: Cerebral malformations may lead to permanent postnatal sequels. The antenatal detection of anomalous or absent fetal sulci and gyri may indicate abnormal brain development and future neurological and psychomotor problems in that infant. The prenatal diagnosis of these conditions allows genetic counseling, psychological support of the parents and optimization of obstetric management. Diagnosis is usually based on two-dimensional obstetric ultrasound (2DUS) and eventually fetal magnetic resonance imaging (MRI), to confirm findings. Fetal three-dimensional ultrasound (3DUS) using the rendering mode has been recently introduced but has not yet been extensively tested in clinical practice., Context: This study reviewed and compared three imaging modalities, 2DUS, 3DUS, and MRI, in the analysis of the development of the main sulci and gyri of central nervous system of normal fetuses between 20 and 32 weeks' gestation.

Context and Objective: Mammography is the best method for breast-cancer screening and is capable of reducing mortality rates. Studies that have assessed the clinical impact of mammography have been carried out using film mammography. Digital mammography has been proposed as a substitute for film mammography given the benefits inherent to digital technology. The aim of this study was to compare the performance of digital and film mammography., Design: Systematic review and meta-analysis., Method: The Medline, Scopus, Embase and Lilacs databases were searched looking for paired studies, cohorts and randomized controlled trials published up to 2009 that compared the performance of digital and film mammography, with regard to cancer detection, recall rates and tumor characteristics. The reference lists of included studies were checked for any relevant citations., Results: A total of 11 studies involving 190,322 digital and 638,348 film mammography images were included. The cancer detection rates were significantly higher for digital mammography than for film mammography (risk relative, RR = 1.17; 95% confidence interval, CI = 1.06-1.29; I² = 19%). The advantage of digital mammography seemed greatest among patients between 50 and 60 years of age. There were no significant differences between the two methods regarding patient recall rates or the characteristics of the tumors detected., Conclusion: The cancer detection rates using digital mammography are slightly higher than the rates using film mammography. There are no significant differences in recall rates between film and digital mammography. The characteristics of the tumors are similar in patients undergoing the two methods.

Background/aims: Pancreatic cystic lesions are increasingly being recognized. Magnetic resonance imaging (MRI) is the method that brings the greatest amount of information about the morphologic features of pancreatic cystic lesions. To establish if diffusion-weighted MRI (DW-MRI) can be used as a tool to differentiate mucinous from nonmucinous lesions., Methods: Fifty-six patients with pancreatic cystic lesions (benign, n = 46; malignant, n = 10) were prospectively evaluated with DW-MRI in order to differentiate mucinous from nonmucinous lesions. Final diagnosis was obtained by follow-up (n = 31), surgery (n = 16) or endoscopic ultrasound-guided fine needle aspiration (n = 9). Serous cystadenoma was identified in 32 (57%) patients., Results: The threshold value established for the differentiation of mucinous from nonmucinous lesions was 2,230.06 s/mm(2) for ADC of 700. DWI-MRI behavior between mucinous and nonmucinous groups revealed sensitivity, specificity, positive predictive value, negative predictive value and accuracy to be 80, 98, 92, 93 and 93%, respectively (p < 0.01, power of sample = 1.0). In the comparison of the diffusion behavior between mucinous (n = 13) and serous (n = 32) lesions, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100, 97, 92, 100 and 98%, respectively (p < 0.01, power of sample = 1.0). The results of endoscopic ultrasound-guided fine needle aspiration were similar to those of DW-MRI., Conclusions: DW-MRI can be included as part of the array of tools to differentiate mucinous from nonmucinous lesions and can help in the management of pancreatic cystic lesions. and IAP., (Copyright © 2011 S. Karger AG, Basel.)

Background: Renal grafts have demonstrated capacity to adapt to the recipient. The aim of this study was to assess the growth of renal grafts transplanted to children, during the first year posttransplant., Methods: We conducted a 1 year prospective study comparing the growth of renal grafts from children and adults donors transplanted in children, and correlated this growth with graft function. Two groups were studied: (a) group 1-32 children transplanted with pediatric deceased kidneys from donors younger than 16 years and (b) group 2-31 children transplanted with organs from adult living donors. Anthropometric assessment, sonographic measurement of the graft, and serum creatinine at 1 week, 1, 6, and 12 months posttransplantation were performed., Results: Children from group 1 presented an 18% increase in graft volume after the sixth month of transplant, whereas in group 2 grafts presented a 14% reduction in volume, mainly during the first month; the variation in renal diameters was not uniform. Children from group 1 presented a glomerular filtration rate (GFR) increase during the follow-up (46-102 mL/min/1.73 m). After 1 year, GFR and graft volume were similar. Growth of individuals from both groups was comparable., Conclusions: In the short term, pediatric kidneys raise volume and GFR, whereas adult kidneys slightly lower volume and GFR when transplanted in children. Taking our and other studies results into consideration, we can hypothesize that in addition to compensatory hypertrophy, pediatric grafts are likely capable of continued somatic growth.

Objective: The purpose of this systematic review was to obtain summary estimates of the diagnostic accuracy of color Doppler ultrasonography (CDU) in predicting malignancy in thyroid follicular neoplasms (FNs)., Methods: We searched Medical Subject Headings together with the search terms "follicular," "thyroid," and "Doppler" in the MEDLINE, Web of Science, and Excerpta Medica databases as well as the Latin American and Caribbean Health Sciences Literature database, after which we performed manual searches of the reference lists to locate additional studies. There were no language restrictions. We included studies that assessed the diagnostic accuracy of CDU in identifying malignancy in thyroid FNs. The assessments of the quality and extraction of data were performed by 3 independent reviewers., Results: We included 4 studies, which collectively evaluated 457 thyroid FNs, 67 of which had been classified as malignant based on the evaluation of surgical biopsy samples. Moderate, rich, predominant, or exclusive internal flow on CDU of thyroid FNs was considered indicative of malignancy. The overall sensitivity of CDU was 85% (95% confidence interval [CI], 74%-93%), with an overall specificity of 86% (95% CI, 82%-89%). The overall prevalence was 14.7%, and the positive and negative predictive values were 51% and 97%, respectively. The positive likelihood ratio was 6.07, and the negative likelihood ratio was 0.18., Conclusions: Predominant internal flow seen on CDU is associated with malignancy of thyroid FNs. Absence of internal flow or predominantly peripheral flow indicates a low probability of thyroid FN malignancy.

Purpose: This is a study of performance based on an In-training Examination for Radiology and Diagnostic Imaging targeting residents (R) and specialization trainees (ST) in Radiology. The radiological training may differ between R and ST in some centers. The authors present their experience and thoughts regarding the first three years of application of the In-training Examination administered by The Brazilian College of Radiology., Methods: Three hundred and eight-six tests were analyzed in 1999, 715 in 2000, and 731 in 2001. The yearly tests consisted of multiple-choice answers, some with interpretation of digital images, and were divided into 9 specialties: neurology, thorax, physics, pediatrics, digestive system, urinary system, musculoskeletal system, mammography, and gynecology-obstetrics. Each specialty was analyzed separately. The tests were given simultaneously in 12 Brazilian cities. The subspecialty scores of examinees at different stages of training were compared (1st, 2nd, and 3rd year residents and specialization trainees), by the Kruskal-Wallis test (P<0.001)., Results: The 1999 examination did not reveal any significant difference between the R and ST groups (P>0.05). Generally, in 2000 and 2001, R achieved higher scores than ST (P<0.001). The performance in physics was poor for both groups for the 3 years covered by the study., Conclusion: The performance of residents was better than that of the specialization trainees in the majority of the subspecialties, mainly in the last two years. The In-training Examination provides a system for evaluating future specialists and identifying the centers that need to revise their teaching methods and the regional differences in radiological training.

Unlabelled: Atherosclerosis is considered an important cause of morbidity and mortality in systemic lupus erythematosus (SLE). Endothelial dysfunction represents an important factor in the onset of atherosclerosis., Objective: To assess endothelial function and the risk factors for atherosclerosis in adolescents with SLE., Subjects: Thirty-five adolescents with SLE aged between 10-18 years and 27 age- and sex-matched controls., Methods: Endothelial function was assessed using a high-resolution ultrasound device (Philips ATL, HDI-3000 model) with a linear array transducer (4.0-7.0 MHz). Measures of diameter and flow were performed at rest, during reactive hyperemia and after glyceryl trinitrate. Total cholesterol and fractions, triglycerides, creatinine, fasting glucose, anticardiolipin antibodies, lupus anticoagulant and plasma homocysteine, as well as, cumulative oral corticoid dose were considered in order to establish the risk factors for atherosclerosis., Results: No significant difference was found between the two groups regarding endothelial function. Although dilation at 90" after cuff deflation had been smaller in patients than in controls, the difference was not statistically significant. Patients had higher levels of total cholesterol (p = 0.02), VLDL (p = 0.01), triglycerides (p = 0.01), and homocysteine (p < .001) compared with controls. Sixty eight percent of our patients showed hyperhomocysteinemia, yet, we did not find any correlation between these values and flow-mediated dilation., Conclusion: According to our results, adolescents with SLE do not present alterations in endothelial function as assessed by ultrasound. However, these patients did demonstrate risk factors such as dyslipidemia and hyperhomocysteinemia for the development of atherosclerosis.

Background/aim: The level of agreement concerning the diagnosis of nephrocalcinosis (NC) based on ultrasonography (US), computed tomography (CT) or kidney/ureter/bladder (KUB) X-ray was assessed., Methods: Sequences of KUB+US+CT from 62 patients, 48 with at least one exam suggesting NC and 14 with pelvicalyceal calcifications (nephrolithiasis) were reviewed twice by 3 radiologists (firstly randomized and secondly presenting KUB+US+CT of each patient together)., Results: The intraobserver concordance varied from 76 to 90% for KUB, 77 to 85% for US and 82 to 89% for CT. There was a significant change in diagnosis between the 1st and 2nd reviews for observer 1 in KUB and CT, for observer 2 in US, but not for observer 3. Evaluating patients' exams together did not provide a better agreement. The highest sensitivity and specificity (92 and 89%, respectively) were only attained when 2 exams suggested NC diagnosis, being CT one of them. These enabled us to suggest that 33 out of 48 (62.5%) patients had NC (evidenced in US+CT+KUB (81.8%), US+CT (12.1%) or KUB+CT (6.1%)., Conclusion: The low level of concordance renders the radiological diagnosis of NC difficult. Nephrocalcinosis should be confirmed by CT combined with either US or KUB., (Copyright 2007 S. Karger AG, Basel.)

Background: Kidneys from child donors are very efficient at adapting to the recipient organism. This research aims to verify the size of kidney grafts from pediatric donors after transplant and to identify factors responsible for the size attained by these kidneys. Moreover, it aims to seek relationships between size and function of the transplanted pediatric kidney., Methods: Seventy-seven renal transplants performed at least 6 months earlier, with cadaver donor 15 years old or younger, had ultrasound measurements of the graft and renal function assessment. Potential factors for graft volume were analyzed using bivariate analysis, followed by multiple linear regression., Results: After a follow up of 4.2+/-3.3 years posttransplant, the grafts presented the following range of measures: length 10.61+/-1.13 cm, width 4.67+/-0.84 cm, and depth 4.76+/-0.99 cm. Graft volumes were 126.62+/-47.76 cm. Bivariate analysis showed that (1) age of both donor and recipient at transplantation; (2) sex of recipient; (3) occurrence of acute rejection episodes were statistically significant. After multivariate analysis, age and sex of recipients were the only significant factors influencing graft volume; child kidneys reached greater volumes when transplanted into adult and male individuals. Larger volume kidneys presented significantly more proteinuria. No difference was evident with regard to creatinine clearance values or urinary retinol binding protein among kidneys of differing sizes., Conclusions: The size of the recipient (age and sex) is the main factor responsible for volumes achieved by kidneys from pediatric donors. The volume attained by these kidneys demonstrated no relationship with glomerular or tubular function of the organ.

In vivo studies indicated that the primary effects of E. coli endotoxin on hepatic clearance of sulfobromophthalein were at the excretory level. Newborns were more sensitive to the LPS than older animals.

The length of immunoelectrophoretic separation patterns obtained with a reference mycobacterial antigen was reduced significantly when a continuous buffer system was used in place of the recommended discontinuous system. Varying the supporting medium by using 1% concentrations of different agar preparations in the discontinuous system also affected the separation length and resolution of the reference pattern. Measurement of the electrical resistivity of the agar medium provided an explanation of these differences on the basis of current density or field intensity applied per slide. Variation in the reference pattern obtained in differently designed electrophoresis chambers also was attributed to differences in field intensity. To avoid these obvious alterations in the separation pattern of the reference antigen, it was suggested that separation procedures described originally for the reference system be used without modification.

Rose, Michael J., Jr. (Veterans Administration Hospital, Washington, D.C.), Stephen A. Aron, and Bernard W. Janicki. Influence of nonionic surfactants on bacteriophage infections. I. Effect of Triton WR-1339 on T(2) coliphage infection. J. Bacteriol. 87:933-938. 1964.-Plaques formed by T(2) phage on cultures of Escherichia coli strain B from nutrient broth which contained 0.5% Triton WR-1339 were considerably smaller than those formed on cultures from control broth. Pretreatment of phage particles with Triton did not result in small plaques. Results of population studies showed that treated and control cultures had the same growth rates. Similarly, characteristic physiological reactions of treated cultures were the same as those of the controls. Investigation of the phage growth cycle demonstrated that neither the adsorptive phase nor the latent period was affected by cultivation of the host in Triton. However, the burst size of treated cultures was significantly less than that of control cultures. Analysis of the one-step growth curve data showed that Triton did not inhibit bursting of infected cells. It was concluded that the smaller plaque size was a reflection of a reduced yield of mature virulent phage particles from the Triton-treated cultures.

Rose, Michael J., Jr. (Veterans Administration Hospital, Washington, D.C.), Stephen A. Aron, and Bernard W. Janicki. Effect of various nonionic surfactants on growth of Escherichia coli. J. Bacteriol. 91:1863-1868. 1966.-Escherichia coli cultivated in media containing 0.5, 1.0, 2.0, or 4.0% concentrations of surface-active polyoxyethylene derivatives of formaldehyde polymers of octyl phenol (Triton WR-1339; Macrocyclon) or of sorbitan mono-fatty acid esters (Tween 20, 40, 60, and 80) exhibited significantly retarded growth only at the highest concentration. To determine the mechanism of bacteriostasis, certain derivatives and compounds related to the surfactants were investigated. Experiments with compounds related to the Triton-type agents demonstrated that incorporation of monomeric substances (Triton X-205, X-305, Igepal CA-730, or Dowfax 9N20) into the medium at a concentration of 4.0% did not inhibit the growth of E. coli. It was concluded that the formaldehyde polymer was essential for growth inhibition by the polyoxyethylene derivatives of octyl phenol. The inhibitory activity of the Tween compounds, in contrast, appeared to result from the unesterified fatty acids which contaminate the commercial preparations. Polyol (60), the sorbitan polyoxyethylene derivative of Tween 60 and the basic structural unit of all the Tween-type compounds, and a Tween 80 preparation which was purified by extraction of the unesterified oleic acid, were not inhibitory. Moreover, the amount of free oleic acid present as a contaminant of Tween 80 was found to be sufficient to cause significant growth inhibition. These results and the observation that E. coli does not appear to hydrolyze the esterified fatty acid of Tween 80 led to the conclusion that growth inhibition obtained with various Tween compounds probaby is a function of their respective fatty acid contaminants.