Automatic SCOring of Atopic Dermatitis Using Deep Learning: A Pilot Study.

Atopic dermatitis (AD) is a chronic, itchy skin condition that affects 15-20% of children but may occur at any age. It is estimated that 16.5 million US adults (7.3%) have AD that initially began at age >2 years, with nearly 40% affected by moderate or severe disease. Therefore, a quantitative measurement that tracks the evolution of AD severity could be extremely useful in assessing patient evolution and therapeutic efficacy. Currently, SCOring Atopic Dermatitis (SCORAD) is the most frequently used measurement tool in clinical practice. However, SCORAD has the following disadvantages: (i) time consuming-calculating SCORAD usually takes about 7-10 minutes per patient, which poses a heavy burden on dermatologists and (ii) inconsistency-owing to the complexity of SCORAD calculation, even well-trained dermatologists could give different scores for the same case. In this study, we introduce the Automatic SCORAD, an automatic version of the SCORAD that deploys state-of-the-art convolutional neural networks that measure AD severity by analyzing skin lesion images. Overall, we have shown that Automatic SCORAD may prove to be a rapid and objective alternative method for the automatic assessment of AD, achieving results comparable with those of human expert assessment while reducing interobserver variability.

Detection and Concentration of Neonicotinoids and Other Pesticides in Honey from Honey Bee Colonies Located in Regions That Differ in Agricultural Practices: Implications for Human and Bee Health.

This is a preliminary study conducted to analyze the presence and concentration of pesticides in honey obtained from honey bee colonies located in two regions with managed ecosystems that differ in the intensity and technification of agricultural practices. Fourteen pesticides at variable concentrations were detected in 63% of the samples analyzed. The pesticides most frequently found at higher concentrations were insecticides (neonicotinoids, followed by organophosphates), herbicides, and fungicides. The number, frequency, and concentration of pesticides were higher in samples collected from hives located where intensive and highly-technified agriculture is practiced. Forty-three percent of the samples from that zone had residues of imidacloprid, compared with only 13% of the samples from the less-technified zone. Furthermore, 87.5% of those samples had imidacloprid concentrations that were above sublethal doses for honey bees (>0.25 ng/g) but that are not considered hazardous to human health by the European Commission. The results of this study suggest that honey can be used as a bioindicator of environmental contamination by pesticides, which highlights the need to continue monitoring contaminants in this product to determine the risks of pesticide impacts on pollinator health, on ecosystems, and on their potential implications to human health and other non-target organisms.

Symptomatic bilateral medial discoid meniscus treated with arthroscopic meniscal remodeling: clinical case. / Menisco discoideo medial bilateral sintomático tratado con remodelación meniscal artroscópica: caso clínico.

Medial discoid meniscus is a rare entity with a reported incidence of 0.12 to 0.3%, although the real incidence may be greater because not all the patients are symptomatic. Like lateral discoid menisci, medial discoid menisci are prone to degeneration that may prompt the presence of mechanical symptoms at early age. We present the case of a 14 year old male patient with bilateral knee symptoms of insidious onset without a traumatic event. Magnetic resonance revealed bilateral medial discoid menisci. Arthroscopic medial meniscus remodelling was performed in the right knee and, three months later, in the left knee, due to limitating mechanical symptoms. At the latest follow up -6 months for the right knee, 3 months for the left knee-, the patient resumed his sports activities.

Corticosteroids deeply depress the in vitro steroidogenic capacity of Eurasian perch ovary at the end of the reproductive cycle.

Corticosteroids play positive or negative role in the reproductive mechanisms of many fish species but the physiological contexts relating to such biphasic actions are not well defined. In the present study we investigated to what extent corticosteroids (cortisol-Co, 11-deoxycorticosterone-DOC) hormones may interfere with the steroidogenic capacity of Eurasian perch ovarian tissues, and we tested whether the negative effects of corticosteroids may be mitigated by potential stimulating endocrine factors, namely insulin-like growth factor-1 (IGF), human chorionic gonadotropin (HCG) or thyroid hormones (Triidothyronine-T3, thyroxine-T4). Ovarian tissues from six maturing fish at late vitellogenesis developmental stage (LVO) or at the start of the final meiotic oocyte maturation (FMO) were incubated during 6h in Cortland medium containing various endocrine compounds. Both corticosteroids drastically suppressed aromatase activity (AA) and sex-steroid production, namely 17-ß estradiol (E2), 17α-20ß-dihydroxy-4-pregnen-3-one (DHP) and testosterone (T). HCG significantly prevented the suppression of both AA and sex-steroid production by low and high cortisol doses, but a lesser AA protection was observed in the case of DOC. The protection of DHP and T productions by HCG from the negative effects by the two corticosteroids was higher at FMO than at LVO stage. IGF or thyroid hormone treatments were lesser effective or ineffective in mitigating the suppression of AA or sex-steroid production by cortisol. The results suggest that an increase in cortisol or DOC such as after mild or high stress intensity may inhibit drastically the ovarian steroidogenic capacity whatever the final oocyte maturation stage in percid fish by hampering AA and sex-steroid production. That inhibition may be partly mitigated by gonadotropins but not IGF nor thyroid hormones, especially at final meiotic oocyte maturation stage.

Essential Subcortical Tracts in Language and Reading. 3D-Tractography for Clinical Practice and Anatomic Correlation with Intraoperative Subcortical Electrostimulation.

Diffusion tensor imaging (DTI) and tractography provide the neurosurgeon with a valid 3D view of the white matter tracts of the brain for the presurgical planning of the treatment of lesions close to eloquent areas, this being one of the principal clinical applications of this technique. In this article, we describe through practical cases the anatomic relationships of white matter tracts that are essential for language and reading, based on DTI studies and the excellent anatomic correlation with the intraoperative subcortical map.

Clinical considerations and surgical approaches for low-grade gliomas in deep hemispheric locations: insular lesions.

Insula and paralimbic region represent a common location for gliomas in adulthood. However, limbic and paralimbic tumors are rare in children. Reports of pediatric insular tumors are scarce in literature, and most of them are included in adult's series, so their management and outcome can be outlined only after extracting data from these reports. Due to their predominantly low grade, they usually have a benign course for some time, what make them ideal candidates for total resection. However, their intricate location and spread to key areas, including the temporal lobe, make them a surgical challenge. The transsylvian route, with or without resection of the frontal and/or temporal operculae, which requires exposure of part or all of the insula is commonly selected for insular tumor approaches. Intraoperative functional mapping is a standard procedure for resection of central region tumors in adults. In children and young individuals, awake craniotomy is not always possible and surgical planning usually relay on functional and anatomical preoperative studies. The main goal when approaching an insular tumor is to achieve the largest extent of resection to increase overall patient survival while preserving the functional status, minimizing postoperative morbidity and increasing the quality of life. The extent of resection seems to be correlated also with the control of associated (and usually intractable) epilepsy.

An immunomagnetic separation/loop-mediated isothermal amplification method for rapid direct detection of thermotolerant Campylobacter spp. during poultry production.

AIMS: To develop a rapid test for thermotolerant Campylobacter in poultry faeces. METHODS AND RESULTS: The reported method is based on immunomagnetic separation and loop-mediated isothermal DNA amplification (IMS/LAMP). This LAMP assay is specific (demonstrated using 10 Campylobacter strains and 13 non-Campylobacter bacterial species) and sensitive (95% probability of detecting 22 genome copies). A competitive internal amplification control (IAC) has been incorporated to give unambiguous determination of negative results. Immunoseparation of Campylobacter allows direct LAMP detection from poultry boot swab samples in 90 min without enrichment or DNA purification (74% probability of detecting 10(4) CFU ml(-1) of a boot swab suspension). The analysis of 17 samples from commercial turkey farms showed 100% correlation with parallel results obtained by standard microbiological methods. CONCLUSIONS: A rapid test has been developed for direct detection of thermotolerant Campylobacter spp. in boot swab samples, thus bypassing culture enrichment or DNA extraction. The test has potential to be carried out by farm personnel on site. SIGNIFICANCE AND IMPACT OF THE STUDY: The method offers an inexpensive approach to monitor poultry infection in near real time, assisting flock management and controls to prevent introduction of Campylobacter into the food chain.

Cortical and subcortical mapping of language areas: correlation of functional MRI and tractography in a 3T scanner with intraoperative cortical and subcortical stimulation in patients with brain tumors located in eloquent areas.

OBJECTIVE: To describe the detection of cortical areas and subcortical pathways involved in language observed in MRI activation studies and tractography in a 3T MRI scanner and to correlate the findings of these functional studies with direct intraoperative cortical and subcortical stimulation. MATERIAL AND METHODS: We present a series of 14 patients with focal brain tumors adjacent to eloquent brain areas. All patients underwent neuropsychological evaluation before and after surgery. All patients underwent MRI examination including structural sequences, perfusion imaging, spectroscopy, functional imaging to determine activation of motor and language areas, and 3D tractography. All patients underwent cortical mapping through cortical and subcortical stimulation during the operation to resect the tumor. Postoperative follow-up studies were done 24 hours after surgery. RESULTS: The correlation of motor function and of the corticospinal tract determined by functional MRI and tractography with intraoperative mapping of cortical and subcortical motor areas was complete. The eloquent brain areas of language expression and reception were strongly correlated with intraoperative cortical mapping in all but two cases (a high grade infiltrating glioma and a low grade glioma located in the frontal lobe). 3D tractography identified the arcuate fasciculus, the lateral part of the superior longitudinal fasciculus, the subcallosal fasciculus, the inferior fronto-occipital fasciculus, and the optic radiations, which made it possible to mark the limits of the resection. The correlation with the subcortical mapping of the anatomic arrangement of the fasciculi with respect to the lesions was complete. CONCLUSION: The best treatment for brain tumors is maximum resection without associated deficits, so high quality functional studies are necessary for preoperative planning.

Paradoxical functions of B7: CD28 costimulation in a MHC class II-mismatched cardiac transplant model.

Blockade of the B7: CD28 costimulatory pathway has emerged as a promising therapy to prevent allograft rejection. However, this pathway has also been demonstrated to be important for the generation and maintenance of regulatory T cells. In this study, we investigated the role of the B7: CD28 pathway in the 'bm12 into B6' MHC class II-mismatched vascularized cardiac transplant model of chronic rejection. Allograft rejection was remarkably accelerated in B6 background B7DKO and CD28KO recipients compared with B6 wild-type (WT) recipients. Allograft rejection was associated with a significantly enhanced Th1/Th2 alloreactivity and marked reduction in the ratio of regulatory T cells to CD4(+) effector/memory cells. We noted that administration of anti-B7-1 and anti-B7-2 mAb prior to transplantation also accelerated allograft rejection. Furthermore, depleting CD25(+) cells in B6 WT recipients of bm12 hearts prior to transplant also precipitated rejection at a similar rate. Neither B7/CD28 deficiency nor CD25 depletion affected graft survival in single MHC class I-mismatched (bm1 into B6) recipients. This study highlights the paradoxical functions of B7: CD28 costimulation in a MHC class II-mismatched model, in which the B7: CD28 pathway is demonstrated to be important in preventing rejection through the generation and maintenance of Tregs.

Experiencia clínica de un tratamiento a base de vitamina C glicosilada, ácido salicílico y zincadone ATM en hombres chilenos con piel mixta a grasa hasta acné inflamatorio leve / Action and tolerance of a formulation with glycosylated vitamin C, zincadone ATM and salicylic acid on Chilean male patients with greasy or mixed normal/greasy skin and/or mild inflammatory acne

Con el fin de evaluar la acción y tolerancia de una formulación a base de vitamina CG, Zincadone ATM y ácido salicílico se reclutaron 65 hombres con piel facial mixta, seborreica y/o con acné inflamatorio leve. Durante un período de 60 días se realizó un estudio clínico abierto y prospectivo en el cual se cuantificó clínicamente el número de lesiones no inflamatorias e inflamatorias, se evaluó el grado de dilatación de los poros a través de escala visual y con lente 30X, se cuantificó la presencia de sebo mediante sebumetría y el porcentaje de hidratación de la piel del rostro. Adicionalmente se utilizó el sistema VISIA para realizar un análisis de la dilatación de los poros, porfirinas cutáneas y textura de la piel. Se observó una mejoría significativa en cada uno de los parámetros medidos.

An open and prospective study was performed in order to evaluate the action and tolerance of a formulation with Glycosylated Vitamin C, Zincadone ATM and Salicylic Acid on 65 male patients with greasy or mixed normal/greasy skin and/or mild inflammatory acne during a period of sixty days. The degree of dilated pores was evaluated both visually and through a 30X lens. The number of inflammatory and non inflammatory lesions, sebumetry and moisture percentage were clinically quantified. Additionally, the VISIA system was utilized to evaluate dilated pores, cutaneous porphyrines and skin texture. There was a significant improvement in each one of the parameters studied.

Waist circumference, BMI and the prevalence of self-reported diabetes among the elderly of the United States and six cities of Latin America and the Caribbean.

Using data from the Salud Bienestar y Envejecimiento (SABE) project and the U.S. National Health and Nutrition Examination Survey (NHANES 1999-2004), we examined the prevalence of obesity and diagnosed diabetes among older adults in the Americas; we also examined the association of age, sex, level of education, weight status, waist circumference, smoking, and race/ethnicity with diabetes among older adults. The prevalence of diagnosed diabetes was highest in the US Blacks and Mexican Americans, followed by Bridgetown and Mexico City (22% for each) and lowest in Santiago, Montevideo, Havana, and US Whites (13-15%). Diagnosed diabetes was significantly associated with BMI among participants from Bridgetown, Sao Paulo, and the three US ethnic groups, while it was associated with waist circumference in all sites except Mexico City. Our findings suggest major geographical and ethnic variation in the prevalence of diagnosed diabetes among older adults. Waist circumference was more consistently associated with the prevalence of diagnosed diabetes than BMI. Higher prevalences of diabetes are found among the elderly of African or Mexican descent in the United States and in other countries of the Americas when compared to the prevalence among whites in the United States and in other Latin American countries with populations of predominant Western European descent.

[Neurosurgical treatment in childhood dystonias and dyskinesias]. / Tratamientos neuroquirúrgicos en las distonías y discinesias de la infancia.

AIM: To present the post-surgery clinical results of deep brain stimulation of the internal globus pallidus (GPi) in a group of paediatric patients with primary and secondary dystonic-dyskinetic syndrome. PATIENTS AND METHODS: Between November 1996 and May 2006, 121 patients were submitted to interventions with bilateral deep brain stimulation of the GPi, 58 of whom were children (age range: 5-16 years); 35 were cases of primary dystonia, of which 17 were carriers of the DYT1 mutation and 10 were not. A further 8 cases were myoclonic dystonias, 3 of whom presented the DYT11 mutation. With regard to the secondary dystonias, 4 were carriers of PKAN (pantothenate kinase-associated neurodegeneration) syndrome and 9 were cases of post-anoxic encephalopathies. RESULTS: Percentage improvements were as follows: in the case of DYT1+ primary dystonias, 80% at one year maintained at 3 years; in cases of DYT1-, 70% at one year maintained at 3 years, and in the myoclonic dystonias, 50% at one year and 85% at 3 years. In the group of patients with secondary dystonias due to post-anoxic encephalopathies, we found an improvement of 30% at one year and 40% at 3 years; in the group with PKAN syndrome, the figures were 60% at one year and 50% at two years. CONCLUSIONS: Treatment involving bilateral deep brain stimulation of the GPi nuclei in childhood cases of generalised dystonias is highly effective, the best prognoses being those offered by the group with primary dystonias and especially those related to the DYT1 mutation. Treatment also proved to be effective in the case of secondary dystonias, although with lower degrees of improvement.

[Aneurysmal bone cyst of the sphenoid sinus]. / Quiste óseo aneurismático del seno esfenoidal. A propósito de un caso

Aneurysmal bone cyst is an uncommon lesion that occurs mainly in long bones and vertebrae, being the location in the sphenoid sinus extremely rare. Its origin is unknown, but it can be considered as a vascular phenomenon secondary to a primary lesion. Other primary diseases that may be associated to aneurysmal bone cyst are polyostotic fibrous dysplasia and giant-cell tumors. We report the case of a patient with an aneurysmal bone cyst in the sphenoid sinus causing vision dysfunction.

The role of dominant striatum in language: a study using intraoperative electrical stimulations.

BACKGROUND: The role of the striatum in language remains poorly understood. Intraoperative electrical stimulation during surgery for tumours involving the caudate nucleus or putamen in the dominant hemisphere might be illuminating. OBJECTIVES: To study the role of these structures in language, with the aim of avoiding postoperative definitive aphasia. METHODS: 11 patients with cortico-subcortical low grade gliomas were operated on while awake, and striatal functional mapping was done. Intraoperative direct electrical stimulation was used while the patients carried out motor and naming tasks during the resection. RESULTS: In five cases of glioma involving the dominant putamen, stimulations induced anarthria, while in six cases of glioma involving the dominant caudate, stimulations elicited perseveration. There was no motor effect. The striatum was systematically preserved. Postoperatively, all patients except one had transient dysphasia which resolved within three months. CONCLUSIONS: There appear to be two separate basal ganglia systems in language, one mediated by the putamen which might have a motor role, and one by the caudate which might have a role in cognitive control. These findings could have implications for surgical strategy in lesions involving the dominant striatum.

A critical assessment of screening methods for cervical neoplasia.

The objective of cervical cancer screening is to reduce cervical cancer incidence and mortality by detecting and treating precancerous lesions. Conventional cytology is the most widely used cervical cancer screening test. Although cytology has been effective in reducing the incidence of and mortality from cervical cancer in developed countries in both opportunistic and--more dramatically--organized national programs, it has been less successful and largely ineffective in reducing disease burden in low-resource settings where it has been implemented. Liquid-based cytology, testing for infection with oncogenic types of human papillomaviruses, visual inspection with 3-5% acetic acid, magnified visual inspection with acetic acid, and visual inspection with Lugol's iodine have been evaluated as alternative tests. Their test characteristics, and the applications and limitations in screening, are discussed with an emphasis on the work of the Alliance for Cervical Cancer Prevention over the past 5 years.

Decrease of selective immunoglobulin E response to amoxicillin despite repeated administration of benzylpenicillin and penicillin V.

BACKGROUND: Subjects with IgE responses to betalactams can develop selective or cross-reactive responses after the administration of penicillin derivatives. After the reaction, however, the hapten induces a boosting phenomenon, which may increase the titre and the affinity of the antibody, with the resulting risk of developing allergic reactions to other penicillins. OBJECTIVE: To determine in subjects with selective responses to amoxicillin (AX) and good tolerance to benzylpenicillin (BP) and penicillin V (PV) whether the administration of these compounds induced any change in specificity, measured by either skin or in vitro testing, which could predict the appearance of cross-reactivity. METHODS: Ten subjects with a selective response to AX were followed-up for 2 years with the periodic administration of penicillin G and V (Group A) and compared with another group composed of 10 persons with identical clinical characteristics but without repeated penicillin administration (Group B). Periodic in vitro and in vivo measurements of specific IgE antibodies were performed at 6-month intervals. Patients were randomized to Group A or B according to their order of inclusion. RESULTS: In both groups, skin test reactivity tended to decrease, and although greater in Group A, the difference was not significant compared with Group B. Median RAST values also decreased over time and showed no differences in the exposed group compared with the controls. One patient in Group A became positive to benzylpenicilloyl (BPO), despite becoming negative to AX. CONCLUSION: Subjects with selective IgE responses to side-chain-specific determinants seem to become negative, with no influence from subsequent administration of a closely related penicillin.

Perceived barriers and benefits to cervical cancer screening in Latin America.

BACKGROUND: This article describes the results of studies on the barriers and benefits of cervical cancer screening from the perspective of women, men, and health providers in five Latin American countries and compares them to other findings from the literature. METHODS: Five separate qualitative studies (focus groups and interviews) were conducted among low-income women in Venezuela, Ecuador, Mexico, El Salvador, and Peru regarding barriers and benefits of cervical cancer screening. Views from health providers and men were also included. RESULTS: The main barriers identified by all participants are accessibility and availability of quality services, facilities that lack comfort and privacy, costs, and courtesy of providers, which interact with poor service delivery. Barriers that pertain to women's beliefs are anxiety borne by women awaiting test results, associated with negligence and fear of cancer (although not to a particular cancer or a particular procedure). Benefits of screening are peace of mind and being in control of their health, which then enable other life activities to continue unhindered. CONCLUSIONS: Except for the accessibility and availability of quality services, these results are consistent with findings from other studies in developed and developing countries. Barriers could be lifted if health service delivery was enhanced, for instance, through quality improvement techniques that are available at low cost. Women's anxiety over test results still needs to be further assessed to devise risk communication strategies that take into account broader cultural frameworks. It is to be noted that such strategies should permeate the way health services are provided for cervical cancer prevention regardless of the specific test used. Vulnerability perceived by low-income women with respect to their capacity to cope with diseases and trust the health services and how this affects their perceptions of risk and their behaviors have not been studied as yet.

Evaluación preoperatoria / Preoperative evaluation

La evaluación preoperatorio pediátrica en atención primaria abarca, a aquellos pacientes que van a ser sometidos a una cirugía electiva y generalmente ambulatoria. Estos individuos corresponden a niños básicamente sanos, sin enfermedades crónicas. La valoración médica preoperatoria ayuda a reducir la morbimortalidad atribuible a la cirugía y procedimiento anestésico. El estudio preoperatorio incluye fundamentalmente la anamnesis y el examen físico y secundariamente exámenes de laboratorio que corresponden a: hemograma con recuento plaquetario, tiempo parcial de tromboplastina, tiempo de protrombina y el tiempo de sangría.

A tool for assessing the usefulness of prevalence studies done for surveillance purposes: the example of hypertension.

Every year dozens of cross-sectional studies are carried out that estimate the prevalence of risk factors for chronic noncommunicable diseases. Given that, there is potentially a large amount of information that could be extremely useful for risk factor surveillance. However, there are good reasons to question the methodological rigor and the reliability of the results coming from many of these studies. The potential benefits of the data are curtailed by the studies' shortcomings, in part often because there is no clear and explicit methodological information providing the details needed to assess the procedures that were actually used, as well as a failure to apply a uniform methodology that would allow comparisons over time or across studies. This paper is intended to be both a didactic and practical tool. It describes the construction of an instrument for assessing the usefulness of prevalence studies done within the context of surveillance activities, using the example of hypertension. The paper discusses and illustrates the most common pitfalls found with prevalence studies, and it also offers methodological standards that can guide future prevalence studies as well as stimulate future research efforts in this area.