Effect of a sustained silver-releasing dressing on ulcers with delayed healing: the CONTOP study

OBJECTIVE

To compare the effect of the sustained silver-releasing foam dressing Contreet Foam (ColoplastA/S) with local best practice (LBP) on delayed healing ulcers using a real-life setting.

METHOD

A total of 619 patients with ulcers of varying aetiologies were treated for four weeks with either the silver foam dressing or LBP.

RESULTS

Wound area was reduced by 50% with the silver foam and 34% with LBP Less slough and maceration, a faster reduction in exudate level and more positive wound progress was achieved with the silver foam. In addition, exudate handling, ease of use, odour and pain improved. Less time was spent on dressing changes, and mean wear time was longer for the silver foam (3.1 days) than for LBP (2.1 days). All differences were statistically significant (p < 0.05). The silver foam dressing outperformed all of the other dressing categories including moist wound healing products and other silver dressings.

CONCLUSION

This large-scale comparative real-life study shows that the silver foam dressing supports faster healing of delayed healing wounds.

Accuracy of stereotactic localisation with magnetic resonance compared to CT scan: experimental findings

BACKGROUND

Stereotactic localisation of proper targets can be obtained with Magnetic Resonance imaging (MRI), pending correction of the well-known inaccuracy of MRI in reproducing exact geometrical dimension. The aim of the experimental work was to determine the real extent of the MRI distortion and to correct it.

METHODS

PVC phantoms and fixed human brains were used as target simulators: stereotactic targeting was obtained with CT and MRI: the results were compared and, finally, the real stereotactic values were measured on a commercial stereotactic device. To optimise MRI targeting it was necessary to abate the "chemical-shift", to modify the head-coil receiver (tuning the "off-resonance" frequencies) and to correct the targeting directly on the images (especially for the Y axis values); careful quality control and environmental tests were also necessary to maintain good performances along the time.

RESULTS

172 measurements were carried out using both CT, plain X-ray and MRI on PVC phantom. The values obtained from CT were considered as reference. Significant geometrical accuracy was found with CT targeting, except for the Z co-ordinate, due to the slice thickness. Mean value differences between the targets on MRI and their real geometric position are about 1 mm on X and Z axises and about 2 mm on Y axis. Similar results were obtained on fixed brains, where absolute values of X and Y co-ordinates of the simulators were measured using a millimetre grid placed over the brain slice.

INTERPRETATION

Experimental findings concerning stereotactic targeting with MRI suggest accuracy adequate for clinical practice, even when extreme geometrical precision is required, such as in radiosurgery or functional stereotaxy. Careful quality control and intensive experimental setting of the MRI device are mandatory to obtain satisfactory results.

Photonic realization of the quantum Rabi model

We realize a photonic analog simulator of the quantum Rabi model, based on light transport in femtosecond-laser-written waveguide superlattices, which provides an experimentally accessible test bed to explore the physics of light-matter interaction in the deep strong coupling regime. Our optical setting enables us to visualize dynamical regimes not yet accessible in cavity or circuit quantum electrodynamics, such as the bouncing of photon number wave packets in parity chains of Hilbert space.

Flexibility of the axial central pattern generator network for locomotion in the salamander

In tetrapods, limb and axial movements are coordinated during locomotion. It is well established that inter- and intralimb coordination show considerable variations during ongoing locomotion. Much less is known about the flexibility of the axial musculoskeletal system during locomotion and the neural mechanisms involved. Here we examined this issue in the salamander Pleurodeles waltlii, which is capable of locomotion in both aquatic and terrestrial environments. Kinematics of the trunk and electromyograms from the mid-trunk epaxial myotomes were recorded during four locomotor behaviors in freely moving animals. A similar approach was used during rhythmic struggling movements since this would give some insight into the flexibility of the axial motor system. Our results show that each of the forms of locomotion and the struggling behavior is characterized by a distinct combination of mid-trunk motor patterns and cycle durations. Using in vitro electrophysiological recordings in isolated spinal cords, we observed that the spinal networks activated with bath-applied N-methyl-d-aspartate could generate these axial motor patterns. In these isolated spinal cord preparations, the limb motor nerve activities were coordinated with each mid-trunk motor pattern. Furthermore, isolated mid-trunk spinal cords and hemicords could generate the mid-trunk motor patterns. This indicates that each side of the cord comprises a network able to generate coordinated axial motor activity. The roles of descending and sensory inputs in the behavior-related changes in axial motor coordination are discussed.

Observation of surface states with algebraic localization

We introduce and experimentally demonstrate a class of surface bound states with algebraic decay in a one-dimensional tight-binding lattice. Such states have an energy embedded in the spectrum of scattered states and are structurally stable against perturbations of lattice parameters. Experimental demonstration of surface states with algebraic localization is presented in an array of evanescently coupled optical waveguides with tailored coupling rates.

Grayscale calibration and quality assurance of diagnostic monitors in a PACS system

PURPOSE

The aim of this study was to calibrate monitors used in soft-copy review of diagnostic images in a pictures archiving and communication system (PACS) and to assess critical quality assurance (QA) parameters through appropriate checks.

MATERIALS AND METHODS

Barco [cathode ray tube (CRT) and liquid crystal display (LCD)] and EIZO (LCD) monitors were evaluated. Calibration and QA controls were carried out during acceptance tests on the systems and every 6 months according to the Task Group 18 (TG18) report by the American Association of Physicists in Medicine (AAPM). The parameters in question include: maximum luminance, contrast ratio, luminance response, spatial resolution and angular response. A subjective evaluation of image quality was also conducted by a number of radiologists.

RESULTS

Barco medical monitors' results were well within tolerances, with significant parameters persisting over time. EIZO nonmedical monitors showed rapid performance deterioration below the minimum requirements. Calibration had to be repeated only in a few cases. Radiologists' evaluations showed that monitor quality is equal to or even better than that of conventional films.

CONCLUSIONS

Medical monitors turned out to be fully adequate to the task. Periodic QA tests are, however, absolutely necessary to ensure constant quality levels.

Paramagnetic solid-state NMR assignment and novel chemical conversion of the aldehyde group to dihydrogen ortho ester and hemiacetal moieties in copper(ii)- and cobalt(ii)-pyridinecarboxaldehyde complexes

The complex chemical functionalization of aldehyde moieties in Cu(ii)- and Co(ii)-pyridinecarboxaldehyde complexes was studied. X-ray studies demonstrated that the aldehyde group (RCHO) of the four pyridine molecules is converted to dihydrogen ortho ester (RC(OCH₃)(OH)₂) and hemiacetal (RCH(OH)(OCH₃)) moieties in both 4-pyridinecarboxaldehyde copper and cobalt complexes. In contrast, the aldehyde group is retained when the 3-pyridinecarboxaldehyde ligand is complexed with cobalt. In the different copper complexes, similar paramagnetic ¹H resonance lines were obtained in the solid state; however, the connectivity with the carbon structure and the ¹H vicinities were done with 2D ¹H–¹³C HETCOR, ¹H–¹H SQ/DQ and proton spin diffusion (PSD) experiments. The strong paramagnetic effect exerted by the cobalt center prevented the observation of ¹³C NMR signals and chemical information could only be obtained from X-ray experiments. 2D PSD experiments in the solid state were useful for the proton assignments in both Cu(ii) complexes. The combination of X-ray crystallography experiments with DFT calculations together with the experimental results obtained from EPR and solid-state NMR allowed the assignment of NMR signals in pyridinecarboxaldehyde ligands coordinated with copper ions. In cases where the crystallographic information was not available, as in the case of the 3-pyridinecarboxaldehyde Cu(ii) complex, the combination of these techniques allowed not only the assignment of NMR signals but also the study of the functionalization of the substituent group.

The complex chemical functionalization of the aldehyde group was elucidated in copper and cobalt complexes for 4- and 3-pyridinecarboxaldehyde ligands.

Implementing constrained multi-time approach with bootstrap analysis in ME-2: An application to PM2.5 data from Florence (Italy)

Advanced receptor models have been recently developed and tested in order to improve the resolution of apportionment problems reducing rotational ambiguity of results and aiming at identifying a larger number of sources. In particular, multi-time model is a factor analysis method able to compute source profiles and contributions using aerosol compositional data with different time resolutions. Unlike traditional factor analysis, each measured value can be inserted into multi-time model with its original time schedule, thus all temporal information can be effectively used in the modelling process. In this work, multi-time model was expanded in order to impose constraints on modelled factors aiming at improving the source identification. Moreover, as far as we know for the first time, a suitable bootstrap technique was implemented in the multi-time scheme to estimate the uncertainty of the final constrained solutions. These implemented approaches were tested on a PM2.5 (particulate matter with aerodynamic diameter <2.5 μm) dataset composed of 24-h samples collected during one year and hourly data sampled in parallel for two shorter periods in Florence (Italy). The daily samples were chemically characterised for elements, ions and carbonaceous components while elemental concentrations only were available for high-time resolved samples. The application of the advanced model revealed the major contribution from traffic (accounting for 37% of PM2.5 as annual average) and allowed an accurate characterisation of involved emission processes. In particular, exhaust and non-exhaust emissions were identified. The constraints imposed in the continuation run led to a better description of the factor associated to nitrates and also of biomass burning profile and the bootstrap results gave useful information to assess the reliability of source apportionment solutions. Finally, the comparison with the results computed by ME-2 base model applied to daily and hourly compositional data separately demonstrated the advantages provided by the multi-time approach.

[Squamous papillomas of the esophagus]

The paper reports 14 cases of squamous papilloma of the esophagus which were removed using an endoscopic method: this is a comparatively rare benign pathology of which an increasing number of cases have been recently observed. Endoscopic controls were carried out in all cases and the results of the follow-up are reported.

Performance of a SPECT collimator-detector response reconstruction algorithm: phantom studies and validation in inflammation clinical studies

AIM

To evaluate evolution for bone (EfB), one of the recent corrective collimator detector response (CDR) image reconstruction packages, resolution recovery and iterative reconstruction protocols were compared to the standard Filtered Back Projection (FBP) protocol and the possibility of time reduced acquisition (15 instead of 30 seconds/projection) was evaluated.

METHODS

Tomographic spatial resolution, contrast, noise and signal-to-noise ratio (SNR) were analyzed in phantom studies. Patient studies were conducted on sixteen [99mTc]HMPAO labeled leukocyte patients with suspected local inflammation, submitted to SPECT/CT and conventional leukocyte scintigraphy. Target background ratio (TBR) and boundary of each lesion were calculated. Images were also analyzed by visual inspection by two blinded expert physicians.

RESULTS

a) Phantom: resolution in phantom improves with the use of EfB mainly due to iterative reconstruction methods vs FBP. EfB shows a reduction in noise. No differences were found in contrast data, while SNR changes were mainly due to changes in noise. Time reduction, while increasing image noise, does not modify resolution; nevertheless, half-time EfB noise is the same as full-time FBP noise. b)

PATIENTS

lesion boundary is better defined in patient studies using iterative reconstruction vs FBP; no changes were observed for CDR vs iterative OSEM, or for full-time vs half-time acquisition. TBR is comparable in iterative and FBP protocols, while it is improved by EfB. At visual inspection, a higher score is always associated with EfB.

CONCLUSION

Resolution, noise, SNR and TBR improve when applying the resolution recovery. EfB permits reduction of acquisition time without compromising image quality.

[Digital storage phosphor radiography. Doses and image quality]

Digital radiography (DR) based on storage phosphor technology is progressively replacing conventional screen-film system radiographic techniques (CR). However, many questions about image quality and dose reduction are still open. Thus, since DR spatial resolution is always lower than that of high quality screen-film images and image noise is conversely higher, for general radiography examinations especially, the signal-to-noise ratio is always lower with DR than with CR at the same dose level. However, the wide dynamic range, the linear response of storage phosphor detectors and the automatic read-out control of the digital system, enable lower DR X-ray imaging efficiency to be overcome, producing a nearly perfect readout of the image data every time an exposure is made. Moreover, post-processing can make the detection of abnormalities easier. This is why in many ROC clinical accuracy studies DR performed equally or better than CR. Good quality DR images, similar to conventional ones at the same dose levels, are therefore achievable in chest, abdomen, bone and soft-tissues examinations. Dose evaluation protocols are strongly needed in DR since overexposures due to technical mistakes may be overlooked; moreover, doses can be adjusted to the peculiar diagnostic need. The S values shown on any hard-copy image can be used to this purpose, even though it must be pointed out that they do not express the actual mean dose to the detector.

[Malignant schwannoma of the mesentery. Presentation of a clinical case and clinical and histopathological considerations]

A case of malignant schwannoma of the mesentery is described which was treated with radical surgery. The natural history, diagnosis and therapy of neoplasias of the mesentery are discussed.

[The evaluation of the physical characteristics of a volumetric computer tomograph]

Spiral or volumetric computed tomography (CT) is a new scanning technique which allows the scanning of body regions with a continuously rotating system based on the slip ring technology; the patient is also moved continuously, synchronously with data acquisition. The physical characteristics of spiral CT image acquisition were compared with those of conventional CT images. The modulation transfer function (MTF) has the same values for medium-resolution filters, but lower values for spiral CT for high-resolution and frequency-enhancement filters. The slice sensitivity profile (SSP) describes the longitudinal image resolution for multiplanar reconstructions and was measured in terms of FWHM of the SSP curve. We obtained, for 10-mm slice thickness, a FWHM = 10.4 mm (conventional CT), versus 10.7 mm (Spiral CT), while, for 5-mm slice thickness, the corresponding values were 5.2 mm (conventional CT) and 5.5 mm (spiral CT). Noise was evaluated simply by measuring the standard deviation of the CT numbers, in a region of interest, of a uniform image and with the power spectrum or Wiener spectrum of the same image. To assess overall image quality and yield, the noise equivalent quanta (NEQ) value was also calculated. The values were a little lower for the spiral technique, particularly with high-resolution and enhancement or convolution filters. Dosimetric evaluation of the computed tomography dose index (CTDI) and of the multiple scan average dose (MSAD) was done using an acquisition protocol for average lung dose, in an anthropomorphic phantom and with TL dosimeters. The MSAD was 6.17 +/- 0.20 cGy for conventional CT and 5.98 +/- 0.23 cGy for Spiral CT, while lung dose was 3.25 +/- 0.12 cGy and 3.01 +/- 0.16 cGy, respectively.

Shared Hydrogen Atom Location and Chemical Composition in Picolinic Acid and Pyridoxal Hydrochloride Derivatives Determined by X-ray Crystallography

Three new single-crystal structures were isolated for picolinic acid (2), the trifluoroacetate salt of picolinic acid (1), and pyridoxal hydrochloride (3). These compounds displayed unconventional crystallographic features that must be considered when structural refinements are carried out. Thus, the generated Fourier differences map obtained with the diffraction data collected at 100 K was crucial to visualize electron densities, which were balanced by either one hydrogen atom or a hydrogen atom with an occupancy factor of 1/2 located between either two carboxylate moieties, two phenolic oxygen atoms, or two pyridinic nitrogen atoms. Moreover, NMR studies were conducted to analyze the bulk chemical composition of single crystals of 2-pyridinecarboxylic acid obtained from the gem-diol/hemiacetal forms and the polymerization products after the treatment of 2-pyridinecarboxaldehyde with TFA:H₂O (1) or a diluted Cu(NO₃)₂ solution (2). The quantitative yield of the pyridoxal hydrochloride crystalline material (3) obtained from a diluted CuCl₂ solution was exhaustively characterized by solid-state NMR methods. These methods allowed the resolution of the signals corresponding to the protons of the hydroxyl moiety of the intramolecular hemiacetal group and the phenolic hydrogen. Theoretical calculations using DFT methods were done to complement the atomic location of the hydrogen atoms obtained from the X-ray analysis.

Reactivity of Imidazole- and Pyridine-Carboxaldehydes for Gem-Diol and Hemiacetal Generation: Theoretical and Experimental Insights

Gem-diols are defined as organic molecules carrying two hydroxyl groups at the same carbon atom, which is the result of the nucleophilic addition of water to a carbonyl group. In this work, the generation of the hydrated or hemiacetal forms using pyridine- and imidazole-carboxaldehyde isomers in different chemical environments was studied by Nuclear Magnetic Resonance (NMR) recorded in different media and combined with theoretical calculations. The change in the position of aldehyde group in either the pyridine or the imidazole ring had a clear effect in the course of the hydration/hemiacetal generation reaction, which was favored in protic solvents mainly in the presence of methanol. For pyridinecarboxaldehydes, the acidity/basicity degree of the reaction medium influenced not only the generation of the gem-diol or hemiacetal forms but also the oxidation to the corresponding carboxylic acid. However, imidazolecarboxaldehyde was found to be less reactive to the nucleophilic addition of water and methanol than the other compounds in all the environments evaluated. Furthermore, both the gem-diol/hemiacetal generation and the Cannizzaro reaction products were studied in alkaline medium.

[The detectability of osteoarticular lesions of the extremities on the television monitor]

The diagnostic accuracy of the light-box reading of conventional (film screen) radiographs of the extremities was compared with that of the same set of images displayed on a 1 k x 1 k interactive monitor after laser digitization. 389 alterations (23 nondisplaced fractures, 129 soft-tissue calcifications and 237 articular bone erosions), identified by two experienced radiologists on 66 conventional radiographs, were the reference standard. ROC statistical analysis was performed on 1,556 observations expressed by four readers. The overall diagnostic performance of the two display modalities were substantially equivalent: no statistically significant differences resulted on the whole, but two individual readers performed better with conventional images. No overall nor individual statistically significant difference was reobserved for the subset of articular erosions either. Light-box reading of conventional radiographs allowed a higher number of calcifications in the soft-tissues and of proximal (carpal) abnormalities to be detected. Although our results indicate the overall high fidelity of monitor-displayed laser-digitized images, major improvements in the performance of digital diagnostic workstations are still required before adopting monitors for routine radiologic activity.