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1.
ESMO Open ; 9(2): 102236, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38350335

RESUMO

BACKGROUND: Sexual concerns are a major unaddressed need among survivors of breast cancer (BC) with significant negative effects on quality of life. We longitudinally analyzed sexual health over time, using patient-reported outcomes. METHODS: Patients with stage I-III BC prospectively included from the CANcer TOxicity cohort (CANTO) provided data at diagnosis, then 1, 2, and 4 years afterward. Sexual concerns outcomes included poor body image (score ≤91/100), poor sexual functioning (≤16/100), poor sexual enjoyment (≤66/100), and sexual inactivity (EORTC QLQ-B23). Multivariate generalized estimating equation models assessed associations with sexual concerns after diagnosis, adjusting for age, sociodemographic, tumor, treatment, and clinical characteristics. RESULTS: Nearly 78.1% among 7895 patients reported at least one sexual concern between diagnosis and 4 years' follow-up. Over time, the proportion of patients reporting sexual concerns either increased or remained constant with diagnosis. Less than half (46%, range 11.4-57) of the patients with sexual concerns reported the use of supportive care strategies, including gynecological or psychological consultations (range 11.4-57.4). Factors consistently associated with sexual concerns up to 4 years after diagnosis included already reporting the same concern at diagnosis [odds ratio (OR)poor body image 3.48 [95% confidence interval (CI) 3.11-3.89]; ORsexual inactivity 9.94 (95% CI 8.84-11.18), ORpoor sexual function 9.75 (95% CI 8.67-10.95), ORpoorsexual enjoyment 3.96 (95% CI 3.34-4.69)], endocrine therapy use [ORpoor body image 1.15 (95% CI 1.01-1.31); ORsexual inactivity 1.19 (95% CI 1.02-1.39), ORpoor sexual function 1.17 (95% CI 1.01-1.37), ORpoor sexual enjoyment 1.23 (95% CI 1.00-1.53)], and depression [ORpoor body image 2.00 (95% CI 1.72-2.34); ORsexual inactivity 1.66 (95% CI 1.40-1.97), ORpoor sexual function 1.69 (95% CI 1.43-2.00), ORpoor sexual enjoyment 1.94 (95% CI 1.50-2.51)]. Outcome-specific associations were also identified. CONCLUSIONS: Sexual concerns seem frequent, persistent, and insufficiently addressed. Pretreatment concerns, endocrine therapy, and emotional distress are commonly associated factors. A proactive evaluation of sexual health across the care continuum is needed, to promptly identify patients suitable for multidisciplinary counseling, referral, and supportive interventions.


Assuntos
Neoplasias da Mama , Saúde Sexual , Humanos , Feminino , Neoplasias da Mama/terapia , Neoplasias da Mama/psicologia , Qualidade de Vida , Sobreviventes/psicologia , Medidas de Resultados Relatados pelo Paciente
2.
Cancer Radiother ; 28(1): 111-118, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37838605

RESUMO

Stereotactic body radiation therapy is effective for the local management of oligometastases (at most five metastases) with a benefit in survival and local control. Most studies on the management of oligometastases focus on all oligometastatic sites in primary cancer and very few focus on a single oligometastatic site. In particular, there are few data on bone oligometastases, which represent one of the preferred sites for secondary cancer locations. This article focuses on the benefit of stereotactic radiotherapy for bone oligometastases of all cancers by histological types, and reviews the results of major studies in this field.


Assuntos
Segunda Neoplasia Primária , Neoplasias , Radiocirurgia , Humanos , Neoplasias/patologia , Radiocirurgia/métodos
3.
J Pediatr Urol ; 20(2): 225.e1-225.e8, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38030430

RESUMO

INTRODUCTION: Ureteroscopy (URS) can be proposed as first-line therapy for the management of pelvic stones from 10 to 20 mm and for lower ureteric stones in children. However, little is known about the success and the morbidity of URS in young children. Ureteroscopic treatment may present matters in young children because of the small size of the pediatric kidney and the small size of the collecting system. OBJECTIVE: To assess safety and efficacy of URS for the treatment of urinary stones in children aged of 5 years or less. STUDY DESIGN: After the institutional ethical board approval was obtained, we conducted a retrospective, analytic, multicentric study that included all URS performed between January 2016 and April 2022 in children aged of 5 years or less. In this non-comparative case series, anonymized pooled data were collected from 7 tertiary care centers of pediatric patients. Endpoints were the one-session SFR at 3 months and per and postoperatives complications. Descriptive statistics were applied to describe the cohort. RESULTS: Eighty-three patients were included. For them, 96 procedures were performed at the median age of 3.5 years (IQR: 0.8-5) and median weight of 14 Kg (6.3-23). Median stone size was 13 mm (4-45). There were 65 (67 %) renal stones treated with flexible URS, most of which were in the renal pelvis (30 %) and in the lower calix (33 %). A ureteral access sheath was used in 91 % procedures. Preoperative ureteral stent was placed in 52 (54 %) of patients. None of patients had ureteral dilatation. The single-session SFR was 67.4 % (56.3 and 89.2 % for flexible URS and semi-rigid URS respectively) and children require 1.4 procedures to achieve complete stone clearance. The overall complication rate was 18.7 %, most of them were minor (Clavien I-II). Intraoperative perirenal extravasation (Clavien IIIb) due to forniceal rupture was documented in 6.2 % of cases, related to an increased intrapelvic pressure (IPP) performed in a closed pelvicalyceal system. DISCUSSION: Pediatric urologists should be aware of forniceal rupture based on the presence of extravasation of contrast during endourological procedures especially when they have difficulties to reach lower caliceal stone in small patient. CONCLUSION: URS in patients aged of 5 years or less, is a complex minimally invasive procedure with reasonable efficacy and low morbidity. Intrarenal stones treated by RIRS in young children carries the risk of additional procedures to complete stone clearance.

4.
Front Public Health ; 11: 1239231, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38074720

RESUMO

Background: Infectious keratitis (IK) is a sight-threatening condition requiring immediate definite treatment. The need for prompt treatment heavily depends on timely diagnosis. The diagnosis of IK, however, is challenged by the drawbacks of the current "gold standard." The poorly differentiated clinical features, the possibility of low microbial culture yield, and the duration for culture are the culprits of delayed IK treatment. Deep learning (DL) is a recent artificial intelligence (AI) advancement that has been demonstrated to be highly promising in making automated diagnosis in IK with high accuracy. However, its exact accuracy is not yet elucidated. This article is the first systematic review and meta-analysis that aims to assess the accuracy of available DL models to correctly classify IK based on etiology compared to the current gold standards. Methods: A systematic search was carried out in PubMed, Google Scholars, Proquest, ScienceDirect, Cochrane and Scopus. The used keywords are: "Keratitis," "Corneal ulcer," "Corneal diseases," "Corneal lesions," "Artificial intelligence," "Deep learning," and "Machine learning." Studies including slit lamp photography of the cornea and validity study on DL performance were considered. The primary outcomes reviewed were the accuracy and classification capability of the AI machine learning/DL algorithm. We analyzed the extracted data with the MetaXL 5.2 Software. Results: A total of eleven articles from 2002 to 2022 were included with a total dataset of 34,070 images. All studies used convolutional neural networks (CNNs), with ResNet and DenseNet models being the most used models across studies. Most AI models outperform the human counterparts with a pooled area under the curve (AUC) of 0.851 and accuracy of 96.6% in differentiating IK vs. non-IK and pooled AUC 0.895 and accuracy of 64.38% for classifying bacterial keratitis (BK) vs. fungal keratitis (FK). Conclusion: This study demonstrated that DL algorithms have high potential in diagnosing and classifying IK with accuracy that, if not better, is comparable to trained corneal experts. However, various factors, such as the unique architecture of DL model, the problem with overfitting, image quality of the datasets, and the complex nature of IK itself, still hamper the universal applicability of DL in daily clinical practice.


Assuntos
Inteligência Artificial , Ceratite , Humanos , Ceratite/diagnóstico , Algoritmos , Aprendizado de Máquina , Redes Neurais de Computação
5.
Cancer Radiother ; 27(6-7): 524-530, 2023 Sep.
Artigo em Francês | MEDLINE | ID: mdl-37541797

RESUMO

Radiation therapy is a corner stone of breast cancer treatment as it has been shown postoperatively that it improves local control and overall survival. In recent years, multidisciplinary therapeutic strategies have evolved considerably for early-stage breast cancer, both surgically and in terms of systemic treatments or radiation therapy. Each of these developments affects other treatment components and open up new questions allowing even more personalized treatments. Essentially normofractionated a few years ago, breast radiation therapy is today very largely moderately or even ultra hypofractionated. De-escalation of the surgery of the axilla has changed the indications for lymph node radiation therapy keeping similar efficacy with reduced toxicity. Indications for radiation therapy after neoadjuvant chemotherapy remain based on pre-chemotherapy staging pending the results of ongoing randomized studies. The addition of a boost to the tumor bed significantly reduces the risk of local recurrence, but the magnitude of this benefit decreases with increasing age. The main risk factors for local recurrence are young age, the associated extended ductal in situ component, hormone receptor negative and high-grade status. The results of the simultaneous integrated boost (SIB) seem similar with normo- or moderately hypofractionated radiation therapy regimen.


Assuntos
Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/patologia , Mama , Radioterapia Adjuvante/métodos , Terapia Neoadjuvante , Hipofracionamento da Dose de Radiação , Mastectomia Segmentar
7.
Elife ; 122023 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-37261432

RESUMO

Matrix remodeling is a salient feature of idiopathic pulmonary fibrosis (IPF). Targeting cells driving matrix remodeling could be a promising avenue for IPF treatment. Analysis of transcriptomic database identified the mesenchymal transcription factor PRRX1 as upregulated in IPF. PRRX1, strongly expressed by lung fibroblasts, was regulated by a TGF-ß/PGE2 balance in vitro in control and IPF human lung fibroblasts, while IPF fibroblast-derived matrix increased PRRX1 expression in a PDGFR-dependent manner in control ones. PRRX1 inhibition decreased human lung fibroblast proliferation by downregulating the expression of S phase cyclins. PRRX1 inhibition also impacted TGF-ß driven myofibroblastic differentiation by inhibiting SMAD2/3 phosphorylation through phosphatase PPM1A upregulation and TGFBR2 downregulation, leading to TGF-ß response global decrease. Finally, targeted inhibition of Prrx1 attenuated fibrotic remodeling in vivo with intra-tracheal antisense oligonucleotides in bleomycin mouse model of lung fibrosis and ex vivo using human and mouse precision-cut lung slices. Our results identified PRRX1 as a key mesenchymal transcription factor during lung fibrogenesis.


Assuntos
Fibrose Pulmonar Idiopática , Fatores de Transcrição , Camundongos , Animais , Humanos , Proliferação de Células , Fibrose Pulmonar Idiopática/genética , Fibrose Pulmonar Idiopática/metabolismo , Fator de Crescimento Transformador beta/metabolismo , Proteínas de Homeodomínio/genética , Proteína Fosfatase 2C
8.
ERJ Open Res ; 9(2)2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37077558

RESUMO

In this review, the Basic and Translational Science Assembly of the European Respiratory Society provides an overview of the 2022 International Congress highlights. We discuss the consequences of respiratory events from birth until old age regarding climate change related alterations in air quality due to pollution caused by increased ozone, pollen, wildfires and fuel combustion as well as the increasing presence of microplastic and microfibres. Early life events such as the effect of hyperoxia in the context of bronchopulmonary dysplasia and crucial effects of the intrauterine environment in the context of pre-eclampsia were discussed. The Human Lung Cell Atlas (HLCA) was put forward as a new point of reference for healthy human lungs. The combination of single-cell RNA sequencing and spatial data in the HLCA has enabled the discovery of new cell types/states and niches, and served as a platform that facilitates further investigation of mechanistic perturbations. The role of cell death modalities in regulating the onset and progression of chronic lung diseases and its potential as a therapeutic target was also discussed. Translational studies identified novel therapeutic targets and immunoregulatory mechanisms in asthma. Lastly, it was highlighted that the choice of regenerative therapy depends on disease severity, ranging from transplantation to cell therapies and regenerative pharmacology.

9.
Am J Physiol Lung Cell Mol Physiol ; 324(6): L737-L746, 2023 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-36976924

RESUMO

Idiopathic pulmonary fibrosis (IPF) is a rare interstitial lung disease with a poor prognosis. Chronic microinjuries, mainly caused by environmental factors to an aging alveolar epithelium, would lead to the aberrant differentiation and accumulation of aberrant mesenchymal cells with a contractile phenotype, known as fibrosis-associated myofibroblasts, which trigger abnormal extracellular matrix accumulation and fibrosis. The origin of those pathological myofibroblasts in pulmonary fibrosis is not fully understood to date. Lineage tracing methods using mouse models have opened new avenues for studying cell fate in a pathological context. This review aims to present a nonexhaustive list of different potential sources of those harmful myofibroblasts during lung fibrosis, based on these in vivo approaches, and considering the normal and fibrotic lung cellular atlas recently established by single-cell RNA sequencing.


Assuntos
Fibrose Pulmonar Idiopática , Doenças Pulmonares Intersticiais , Camundongos , Animais , Miofibroblastos/patologia , Fibrose Pulmonar Idiopática/genética , Fibrose Pulmonar Idiopática/patologia , Fibrose , Doenças Pulmonares Intersticiais/patologia , Análise de Sequência de RNA , Pulmão/patologia , Fibroblastos/patologia
11.
An Acad Bras Cienc ; 94(2): e20190996, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35544842

RESUMO

The present study aimed to evaluate the effect of alkaline treatments with urea, NaOH and Ca(OH)2 on chemical composition and in situ ruminal degradability of dry matter, crud protein and neutral detergent fiber of sugarcane tip hay. Samples were incubated in the rumen of three cannulated cattle for up to 72 hours in a split plot randomized block design. Ammoniation with 6% urea increased (p<0.05) the crude protein content by 13% and reduced the neutral detergent fiber and insoluble nitrogen content of the hay. When treated with the highest doses of the compounds, there was a high potential degradability of dry matter, crude protein and neutral detergent fiber, and a shorter neutral detergent fiber lag time. Ammoniation with urea promotes a reduction in the content of NDF, hemicellulose and insoluble nitrogen, with an increase in the content of CP in the hay, with emphasis for the level of 6% urea. The ruminal degradation of sugarcane tip hay increases with alkaline treatments using 6% urea or 3% NaOH, however, ammoniation with urea is indicated for the treatment of hay, as this is low cost and can be easily adopted by farmers in the semiarid region.


Assuntos
Rúmen , Saccharum , Ração Animal/análise , Animais , Bovinos , Detergentes/metabolismo , Detergentes/farmacologia , Dieta/veterinária , Fibras na Dieta/análise , Digestão , Grão Comestível/química , Fermentação , Nitrogênio/metabolismo , Rúmen/metabolismo , Saccharum/metabolismo , Hidróxido de Sódio/metabolismo , Hidróxido de Sódio/farmacologia , Ureia/farmacologia
13.
Eur Urol ; 81(1): 64-72, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34563412

RESUMO

BACKGROUND: Boys with posterior urethral valves (PUVs) have an increased risk of febrile urinary tract infections (fUTIs). Circumcision is believed to reduce the risk of fUTIs in boys, although there are no randomized trials demonstrating this. OBJECTIVE: To determine the effect of circumcision on the risk of fUTIs in boys with PUVs. DESIGN, SETTING, AND PARTICIPANTS: A clinical randomized trial that ran between August 2012 and July 2017 was conducted. The trial was multicentric, including 13 referral centers for pediatric urology. Male boys, aged 1-28 d, diagnosed with posterior urethral valves, confirmed by voiding cystogram, were included. The exclusion criteria included presence of a genital malformation contraindicating performing a circumcision. INTERVENTION: Participants were randomized to neonatal circumcision + antibiotic prophylaxis (CATB) or antibiotic prophylaxis alone (ATB), and followed for 2 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was a risk of presenting fUTIs in each group. An fUTI was defined as fever (>38.5 °C) with evidence of pyuria and culture-proven infection on urinalysis, obtained by urethral catheterization or suprapubic aspiration. A bivariate analysis of the primary outcome was performed using the Kaplan-Meier method. RESULTS AND LIMITATIONS: In total, 91 patients were included: 49 in group CATB and 42 in group ATB. The probability of presenting an fUTI was 20% in group ATB versus 3% in group CATB. The hazard ratio of presenting an fUTI within 2 yr in the ATB group compared with that in the CATB group was 10.3 (95% confidence interval: 1.3-82.5). Sixty-four children (70.3%) had a complete follow-up at 2 yr of age. CONCLUSIONS: Circumcision significantly decreases the risk of presenting an fUTI in boys with PUVs. PATIENT SUMMARY: In this report, we compared, in a multicentric trial, the number of febrile urinary tract infections (UTIs) in boys with posterior urethral valves who had either antibiotic prophylaxis alone or antibiotic prophylaxis and circumcision. We found that those who had a circumcision had a significantly lower risk of febrile UTIs.


Assuntos
Circuncisão Masculina , Infecções Urinárias , Antibioticoprofilaxia , Criança , Circuncisão Masculina/efeitos adversos , Feminino , Humanos , Recém-Nascido , Masculino , Modelos de Riscos Proporcionais , Cateterismo Urinário , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
14.
Radiol Artif Intell ; 3(6): e210027, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34870218

RESUMO

PURPOSE: To determine whether deep learning algorithms developed in a public competition could identify lung cancer on low-dose CT scans with a performance similar to that of radiologists. MATERIALS AND METHODS: In this retrospective study, a dataset consisting of 300 patient scans was used for model assessment; 150 patient scans were from the competition set and 150 were from an independent dataset. Both test datasets contained 50 cancer-positive scans and 100 cancer-negative scans. The reference standard was set by histopathologic examination for cancer-positive scans and imaging follow-up for at least 2 years for cancer-negative scans. The test datasets were applied to the three top-performing algorithms from the Kaggle Data Science Bowl 2017 public competition: grt123, Julian de Wit and Daniel Hammack (JWDH), and Aidence. Model outputs were compared with an observer study of 11 radiologists that assessed the same test datasets. Each scan was scored on a continuous scale by both the deep learning algorithms and the radiologists. Performance was measured using multireader, multicase receiver operating characteristic analysis. RESULTS: The area under the receiver operating characteristic curve (AUC) was 0.877 (95% CI: 0.842, 0.910) for grt123, 0.902 (95% CI: 0.871, 0.932) for JWDH, and 0.900 (95% CI: 0.870, 0.928) for Aidence. The average AUC of the radiologists was 0.917 (95% CI: 0.889, 0.945), which was significantly higher than grt123 (P = .02); however, no significant difference was found between the radiologists and JWDH (P = .29) or Aidence (P = .26). CONCLUSION: Deep learning algorithms developed in a public competition for lung cancer detection in low-dose CT scans reached performance close to that of radiologists.Keywords: Lung, CT, Thorax, Screening, Oncology Supplemental material is available for this article. © RSNA, 2021.

15.
Ann Work Expo Health ; 65(8): 988-997, 2021 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-34254985

RESUMO

The ease of prescribing radiological examinations has prompted an expansion in radiological procedures and, consequently, an increase of occupational dose to medical imaging workers. However, little is known about radiation exposure in the workplace of medical radiology professionals in many countries, and in Benin particularly. The purpose of this study was to assess ambient radiation doses in diagnostic X-ray medical facilities in Benin and to observe whether exposure levels are below reference levels. A total of 72 public and private medical imaging centres participated in a cross-sectional study carried out from June 2019 to February 2020 in Benin. These centres had 59 X-ray, four chest and six computed tomography (CT) scan rooms. A calibrated radiameter able to measure short, pulsed or continuous X fields and gamma/beta (50 nSv to 10 Sv) was used to measure exposure levels in these functional rooms. Scattered X-ray doses and exposure time from radiological examinations both behind the lead glass of the control area to assess the levels of exposure of professionals and outside of the examination room to evaluate the level of exposure of the public (including non-exposed workers) have been provided. Equivalent doses estimated per hour were compared with the reference levels of 7.50 and 0.05 µSv per hour for workers and the public, respectively. At the control area, the mean/median (min-max) equivalent doses were 0.09/0.07 (0.00-0.21), 2.39/0.13 (0.00-75.67), and 228.39/28.65 (0.39-869.75) µSv per hour for the chest, X-ray, and CT-scan rooms, respectively. Among 69 examination rooms, 13.04% of the equivalent dose estimated in the workplace behind the lead glass was greater than 7.50 µSv per hour; 65 out of 69 examination rooms showed that 40.00% of the equivalent dose estimated behind the doors was greater than 0.05 µSv per hour. These results demonstrated that current controls, including leaded glass separating the control panel and leaded doors between the examination room and the corridor, are inadequate to limit radiation exposures. The controls must be upgraded and a dosimetry program should be implemented to monitor exposures of employees, patients, and visitors.


Assuntos
Exposição Ocupacional , Exposição à Radiação , Benin , Estudos Transversais , Humanos , Exposição Ocupacional/análise , Doses de Radiação , Radiografia , Local de Trabalho
16.
Radiology ; 300(2): 438-447, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34003056

RESUMO

Background Accurate estimation of the malignancy risk of pulmonary nodules at chest CT is crucial for optimizing management in lung cancer screening. Purpose To develop and validate a deep learning (DL) algorithm for malignancy risk estimation of pulmonary nodules detected at screening CT. Materials and Methods In this retrospective study, the DL algorithm was developed with 16 077 nodules (1249 malignant) collected -between 2002 and 2004 from the National Lung Screening Trial. External validation was performed in the following three -cohorts -collected between 2004 and 2010 from the Danish Lung Cancer Screening Trial: a full cohort containing all 883 nodules (65 -malignant) and two cancer-enriched cohorts with size matching (175 nodules, 59 malignant) and without size matching (177 -nodules, 59 malignant) of benign nodules selected at random. Algorithm performance was measured by using the area under the receiver operating characteristic curve (AUC) and compared with that of the Pan-Canadian Early Detection of Lung Cancer (PanCan) model in the full cohort and a group of 11 clinicians composed of four thoracic radiologists, five radiology residents, and two pulmonologists in the cancer-enriched cohorts. Results The DL algorithm significantly outperformed the PanCan model in the full cohort (AUC, 0.93 [95% CI: 0.89, 0.96] vs 0.90 [95% CI: 0.86, 0.93]; P = .046). The algorithm performed comparably to thoracic radiologists in cancer-enriched cohorts with both random benign nodules (AUC, 0.96 [95% CI: 0.93, 0.99] vs 0.90 [95% CI: 0.81, 0.98]; P = .11) and size-matched benign nodules (AUC, 0.86 [95% CI: 0.80, 0.91] vs 0.82 [95% CI: 0.74, 0.89]; P = .26). Conclusion The deep learning algorithm showed excellent performance, comparable to thoracic radiologists, for malignancy risk estimation of pulmonary nodules detected at screening CT. This algorithm has the potential to provide reliable and reproducible malignancy risk scores for clinicians, which may help optimize management in lung cancer screening. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Tammemägi in this issue.


Assuntos
Aprendizado Profundo , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Humanos , Neoplasias Pulmonares/patologia , Programas de Rastreamento , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/patologia , Doses de Radiação , Estudos Retrospectivos , Medição de Risco , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/patologia
17.
Med Image Anal ; 72: 102087, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34015595

RESUMO

Chest radiography is the most common radiographic examination performed in daily clinical practice for the detection of various heart and lung abnormalities. The large amount of data to be read and reported, with more than 100 studies per day for a single radiologist, poses a challenge in consistently maintaining high interpretation accuracy. The introduction of large-scale public datasets has led to a series of novel systems for automated abnormality classification. However, the labels of these datasets were obtained using natural language processed medical reports, yielding a large degree of label noise that can impact the performance. In this study, we propose novel training strategies that handle label noise from such suboptimal data. Prior label probabilities were measured on a subset of training data re-read by 4 board-certified radiologists and were used during training to increase the robustness of the training model to the label noise. Furthermore, we exploit the high comorbidity of abnormalities observed in chest radiography and incorporate this information to further reduce the impact of label noise. Additionally, anatomical knowledge is incorporated by training the system to predict lung and heart segmentation, as well as spatial knowledge labels. To deal with multiple datasets and images derived from various scanners that apply different post-processing techniques, we introduce a novel image normalization strategy. Experiments were performed on an extensive collection of 297,541 chest radiographs from 86,876 patients, leading to a state-of-the-art performance level for 17 abnormalities from 2 datasets. With an average AUC score of 0.880 across all abnormalities, our proposed training strategies can be used to significantly improve performance scores.


Assuntos
Pneumopatias , Pulmão , Humanos , Pulmão/diagnóstico por imagem , Radiografia
18.
An Acad Bras Cienc ; 93(1): e20181091, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33759949

RESUMO

The objective of this study was to evaluate the subjective, chemical and sensorial meat characteristics of ½ Santa Inês (SI) x ½ No Defined Racial Standard (NDRS) and ½ Brazilian Somalis (BS) x ½ No Defined Racial Standard (NDRS) crossbred lambs, finished in confinement. Sixteen uncastrated male lambs with initial weight of 19.7 ± 2.03 kg and approximately 90 days of age. A randomized block design was used, with blocks represented by the initial weight of each genetic group, with eight animals per group. There was a higher degree and distribution of marbling, percentage of lipids and meat color for ½ BS x ½ NDRS lambs. The conjugated linoleic acid profile was higher for ½ SI x ½ NDRS lambs. Considering the meat quality of the evaluated genetic groups, Santa Inês crossbred lambs have a better nutritional value for meat, especially taking into account the production of foods that are beneficial to human health.


Assuntos
Composição Corporal , Carneiro Doméstico , Ração Animal/análise , Animais , Brasil , Humanos , Masculino , Carne/análise , Ovinos/genética , Carneiro Doméstico/genética , Somália
19.
Anim Sci J ; 92(1): e13508, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33416198

RESUMO

The present study was conducted to evaluate the intake, digestibility and nitrogen balance of diets for finishing sheep, containing leucaena hay as a source of effective fibre and forage palm. Twenty-one male sheep were used in a randomized block design with three treatments, represented by total diets, where the forage was leucaena hay and forage palm in natura in proportions 350:650, 450:550 and 550:450 g/kg respectively. For the pH and NH3 -N in the ruminal fluid, and urea in the blood serum, plots split in time were adopted. Dry matter and nutrient digestibility, and the nitrogen balance were not influenced (p > .05) by the diets. The neutral detergent fibre digestibility decreased (p < .05) as the proportions of leucaena hay in the diets increased. The pH and NH3 -N were suitable for ruminal fermentation, and blood urea was maintained under normal physiological conditions for sheep. Combining 350 to 550 g/kg of leucaena hay with 450 to 650 g/kg of forage palm in total diets with a forage:concentrate ratio of 60:40 in late-maturing sheep meets the nutritional requirements for daily gain 200 g, characterizing leucaena hay as important source of effective fibre and nutrients in diets.


Assuntos
Ração Animal , Fenômenos Fisiológicos da Nutrição Animal/fisiologia , Dieta/veterinária , Fibras na Dieta/administração & dosagem , Fabaceae , Nutrientes/administração & dosagem , Ovinos/metabolismo , Ovinos/fisiologia , Animais , Brasil , Digestão/fisiologia , Metabolismo Energético , Masculino , Nitrogênio/metabolismo
20.
J Radiol Prot ; 40(4)2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-32640436

RESUMO

Dosimetric monitoring is useful to limit exposures to ionising radiation in medical occupational settings, and reduce subsequent health risks. Scientific literatures, such as the UNSCEAR report 2017 and International Atomic Energy Agency Report 2014b, updated information on this subject; however, few African works have been found. This is the reason why we undertook this study, which summarises existing information on monitoring external radiation exposure doses for the whole body, using data from medical workers on this continent. Using standard terms and combining different keyword searches for radiation dose monitoring among radiology healthcare workers in Africa, from the titles, abstracts, and full texts, we found 3139 articles in the PubMed/MEDLINE, Google Scholar and INIS databases. Two reviewers screened the retrieved publications based on predefined eligibility criteria to identify relevant studies, extract key information from each, and summarise the data in table form. A total of 20 potentially relevant articles were identified. Among these 20 articles, 15 reported the overall average annual effective dose. Studies included in this systematic review represent an inventory of the radiation protection of medical workers in various African countries, with a focus on the monitoring of occupational radiation exposure. The size of studied populations ranged between 81 and 5152 occupational exposed workers. The mean annual effective doses ranged from 0.44 to 8.20 mSv in all specialities of medical sectors, while diagnostic radiology ranged from 0.07 to 4.37 mSv. For the nuclear medicine and radiotherapy from medical groups, the mean annual effective dose varied between 0.56 and 6.30 mSv. Industrial and research/teaching sectors data varied between 0.38 to 19.40 mSv. In conclusion, more studies implemented on dosimetric monitoring in Africa are needed to get a real picture of occupational exposure in the continent.


Assuntos
Medicina Nuclear , Exposição Ocupacional , Monitoramento de Radiação , Proteção Radiológica , Pessoal de Saúde , Humanos , Exposição Ocupacional/análise , Doses de Radiação
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