On the possibility of using temperature to aid in thyroid nodule investigation.

Thyroid nodules are common, and their investigation is very important to exclude the possibility of cancer. The increase in blood vessels of malignant tumours may be related to local temperature augmentation detectable on the skin surface. The objective of this paper is to evaluate the feasibility of Infrared Thermography for cancer identification. For this purpose, two studies were performed. One used numerical modelling to simulate regional metabolic temperature propagation to evaluate whether a nodule is perceptible on the skin surface. A second study considered thyroid nodule identification by using convolutional neural networks (CNNs). First, variations in nodular size and fat thickness were investigated, showing that the fat layer has an important role in regional heat transfer. In the second study, the training process achieved accuracy of 96% for in-sample and 95% for validation. In the testing phase, 92% accuracy, 100% precision and 80% recall were achieved. Thus, the presented studies suggest the feasibility of using Infrared Thermography with the CNN Artificial Intelligence technique as additional information in the investigation of thyroid nodules for patients without a very thick subcutaneous fat layer.

Automated recognition of the pericardium contour on processed CT images using genetic algorithms.

This work proposes the use of Genetic Algorithms (GA) in tracing and recognizing the pericardium contour of the human heart using Computed Tomography (CT) images. We assume that each slice of the pericardium can be modelled by an ellipse, the parameters of which need to be optimally determined. An optimal ellipse would be one that closely follows the pericardium contour and, consequently, separates appropriately the epicardial and mediastinal fats of the human heart. Tracing and automatically identifying the pericardium contour aids in medical diagnosis. Usually, this process is done manually or not done at all due to the effort required. Besides, detecting the pericardium may improve previously proposed automated methodologies that separate the two types of fat associated to the human heart. Quantification of these fats provides important health risk marker information, as they are associated with the development of certain cardiovascular pathologies. Finally, we conclude that GA offers satisfiable solutions in a feasible amount of processing time.

Machine learning in the prediction of cardiac epicardial and mediastinal fat volumes.

We propose a methodology to predict the cardiac epicardial and mediastinal fat volumes in computed tomography images using regression algorithms. The obtained results indicate that it is feasible to predict these fats with a high degree of correlation, thus alleviating the requirement for manual or automatic segmentation of both fat volumes. Instead, segmenting just one of them suffices, while the volume of the other may be predicted fairly precisely. The correlation coefficient obtained by the Rotation Forest algorithm using MLP Regressor for predicting the mediastinal fat based on the epicardial fat was 0.9876, with a relative absolute error of 14.4% and a root relative squared error of 15.7%. The best correlation coefficient obtained in the prediction of the epicardial fat based on the mediastinal was 0.9683 with a relative absolute error of 19.6% and a relative squared error of 24.9%. Moreover, we analysed the feasibility of using linear regressors, which provide an intuitive interpretation of the underlying approximations. In this case, the obtained correlation coefficient was 0.9534 for predicting the mediastinal fat based on the epicardial, with a relative absolute error of 31.6% and a root relative squared error of 30.1%. On the prediction of the epicardial fat based on the mediastinal fat, the correlation coefficient was 0.8531, with a relative absolute error of 50.43% and a root relative squared error of 52.06%. In summary, it is possible to speed up general medical analyses and some segmentation and quantification methods that are currently employed in the state-of-the-art by using this prediction approach, which consequently reduces costs and therefore enables preventive treatments that may lead to a reduction of health problems.

A novel approach for the automated segmentation and volume quantification of cardiac fats on computed tomography.

The deposits of fat on the surroundings of the heart are correlated to several health risk factors such as atherosclerosis, carotid stiffness, coronary artery calcification, atrial fibrillation and many others. These deposits vary unrelated to obesity, which reinforces its direct segmentation for further quantification. However, manual segmentation of these fats has not been widely deployed in clinical practice due to the required human workload and consequential high cost of physicians and technicians. In this work, we propose a unified method for an autonomous segmentation and quantification of two types of cardiac fats. The segmented fats are termed epicardial and mediastinal, and stand apart from each other by the pericardium. Much effort was devoted to achieve minimal user intervention. The proposed methodology mainly comprises registration and classification algorithms to perform the desired segmentation. We compare the performance of several classification algorithms on this task, including neural networks, probabilistic models and decision tree algorithms. Experimental results of the proposed methodology have shown that the mean accuracy regarding both epicardial and mediastinal fats is 98.5% (99.5% if the features are normalized), with a mean true positive rate of 98.0%. In average, the Dice similarity index was equal to 97.6%.

Streptococcus pyogenes: vigilancia de su resistencia a los antibióticos en un hospital pediátrico / Streptococcus pyogenes: surveillance of resistance to antimicrobial at a pediatric hospital

En varios países del mundo comenzaron a aislarse en forma creciente cepas de Streptococcus pyogenes resistentes a eritromicina. Este trabajo tuvo por objeto verificar la sensibilidad a penicilina, lincosamidas y macrólidos de los estreptococos del grupo A aislados en nuestro hospital entre 1989 y 1994. Se estudió un total de 373 cepas aisladas principalmente de exudados faríngeos por el método de dilución en medio sólido. Ninguna cepa resultó resistente a penicilina y sólo en 1989 se aislaron cepas resistentes a eritromicina (1,6 por ciento para ese año). Las dos cepas resistentes presentaron un patrón de sensibilidad compatible con el mecanismo MLS inducible. En conclusión, S. pyogenes continúa siendo uniformemente sensible a penicilina mientras que tanto la eritromicina como los nuevos macrólidos y las lincosamidas mantienen su efectividad in vitro como para seguir siendo considerados como alternativas para el tratamiento de infecciones estreptocócicas en nuestro medio

Reliability of 24-hour home esophageal pH monitoring in diagnosis of gastroesophageal reflux.

Twenty-four-hour home esophageal pH monitoring is proposed in order to study gastroesophageal reflux (GER) so that prolonged use of costly hospital equipment and staff can be curtailed and the diagnostic accuracy of the examination improved. Eighty-six patients affected by GER symptoms and 20 healthy volunteers underwent 24-hr home esophageal pH monitoring, x-rays, and endoscopy of the upper gastrointestinal tract to investigate reliability of outpatient recording. Fifteen more patients consecutively underwent out- and inpatient recording to detect possible differences between these methods in the two daily periods. Outpatient monitoring was well tolerated in 94.7% of the patients; 14.3% of them markedly reduced their routine activities. The range of normality of outpatient recording does not differ from that of inpatients. In the 15 patients who consecutively underwent out- and inpatient monitoring, no significant differences were reported. The sensitivity of 24-hr home esophageal pH recording is 0.85, the specificity 1, the accuracy for negative prediction 0.68, and the accuracy for positive prediction 1. The reliability of 24-hr home esophageal pH monitoring is comparable to inpatient recording. It allows hospital cost reduction and is also better tolerated by patients but has not greatly improved the diagnostic accuracy of the gastroesophageal reflux pH monitoring.

Surgical therapy in "early gastric cancer".

Regarding early gastric cancer (E.G.C.) some authors propose total gastrectomy while others believe that partial resection is the best solution especially when the site is in the distal portion. The histological characteristics of E.G.C. in 49 patients were examined: 95.9% of the EGCs were found in the antropyloric region and 4.1% in the corpus-fundus. 47 patients were submitted to distal gastrectomy and 2 to total gastrectomy due to localization in the fundus. The overall survival rate after 5 yrs. is 83%. The incidence of the antropyloric localization, the rarity of metastases to the lymph node stations of the 2nd and 3rd level, the way in which intramural spread, occurs and, above all, the optimal survival rate obtained after partial resection, indicate that partial gastrectomy for distal gastric tumors is a radical operation, with a low surgical mortality rate, followed by a prolonged symptom-free survival.