A survey on deep learning for skin lesion segmentation.

Skin cancer is a major public health problem that could benefit from computer-aided diagnosis to reduce the burden of this common disease. Skin lesion segmentation from images is an important step toward achieving this goal. However, the presence of natural and artificial artifacts (e.g., hair and air bubbles), intrinsic factors (e.g., lesion shape and contrast), and variations in image acquisition conditions make skin lesion segmentation a challenging task. Recently, various researchers have explored the applicability of deep learning models to skin lesion segmentation. In this survey, we cross-examine 177 research papers that deal with deep learning-based segmentation of skin lesions. We analyze these works along several dimensions, including input data (datasets, preprocessing, and synthetic data generation), model design (architecture, modules, and losses), and evaluation aspects (data annotation requirements and segmentation performance). We discuss these dimensions both from the viewpoint of select seminal works, and from a systematic viewpoint, examining how those choices have influenced current trends, and how their limitations should be addressed. To facilitate comparisons, we summarize all examined works in a comprehensive table as well as an interactive table available online3.

A clinical model to predict successful renal replacement therapy (RRT) discontinuation in patients with Acute Kidney Injury (AKI)

Abstract Introduction Ideal timing of Renal Replacement Therapy (RRT) discontinuation in Acute Kidney Injury (AKI) is still unknown. We aimed to study the role of creatinine-related variables in predicting RRT successful discontinuation and to propose a clinical predictive score. Methods In this single-centre retrospective study, we evaluated all AKI patients in whom RRT was interrupted for at least 48 hours. Patients who were still RRT-independent 7 days after initial RRT cessation were included in the "Success" group and opposed to the "Failure" group. We evaluated baseline characteristics and variables collected at the time of RRT interruption, as well as the Kinetic estimated Glomerular Filtration Rate (KeGFR), the simple variation in serum Creatinine (ΔsCr), and the incremental creatinine ratio on the first three days after RRT interruption. Multivariable analysis was performed to evaluate prediction of success. Internal validation using a simple binomial generalized regression model with Lasso estimation and 5-fold cross validation method was performed. Results We included 124 patients, 49 in the "Failure" group and 75 in the "Success" group. All creatinine-related variables predicted success in simple and multiple logistic regression models. The best model generated a clinical score based on the odds ratio obtained for each variable and included urine output, non-renal SOFA score, fluid balance, serum urea, serum potassium, blood pH, and the variation in sCr values after RRT discontinuation. The score presented an area under the ROC of 0.86 (95% CI 0.76‒1.00). Conclusion Creatinine variation between the first 2 consecutive days after RRT discontinuation might predict success in RRT discontinuation. The developed clinical score based on these variables might be a useful clinical decision tool to guide hemodialysis catheter safe removal.

Chlamydia trachomatis Infection, when Treated during Pregnancy, Is Not Associated with Preterm Birth in an Urban Safety-Net Hospital.

Preterm birth is a major public health problem, occurring in more than half a million births per year in the United States. A number of maternal conditions have been recognized as risk factors for preterm birth, but for the majority of cases, the etiology is not completely understood. Chlamydia trachomatis is one of the most prevalent sexually transmitted infections in the world. However, its role in adverse pregnancy outcome in women is still debated. In order to determine if genitourinary tract infection with C. trachomatis during pregnancy was associated with preterm birth, we conducted a case-control study on women who delivered at Boston Medical Center, an urban "safety-net" hospital that serves a socioeconomically disadvantaged and racially diverse population. Women with known risk factors for preterm birth or immune suppression were excluded. Variables collected on enrolled subjects included demographics; diagnosis of C. trachomatis during or prior to pregnancy; tobacco, alcohol, and illicit substance use; gestational age; and birthweight and gender of the newborn. We also collected urine for chlamydia testing at the time of delivery and placental biopsies for nucleic acid amplification and histological studies. A total of 305 subjects were enrolled: 100 who delivered preterm and 205 who delivered full term. Among those subjects, we identified 19 cases of pregnancy-associated C. trachomatis infection: 6/100 preterm and 13/205 full term, a difference which was not statistically significant. Only two cases of untreated chlamydia infection were identified postpartum, and both occurred in women who delivered at term. We conclude that genitourinary tract infection with C. trachomatis during pregnancy, when appropriately treated, is not associated with preterm birth.

Naltrexone Treatment for Pregnant Women With Opioid Use Disorder Compared With Matched Buprenorphine Control Subjects.

PURPOSE: The use of the opioid antagonist naltrexone (NTX) for pregnant women with opioid use disorder (OUD) remains understudied. The purpose of this pilot study was to examine pregnancy and neonatal outcomes in a cohort of NTX-treated women. METHODS: This single-center, retrospective cohort study included 6 mother-infant dyads taking NTX compared with 13 taking buprenorphine (BUP) between 2017 and 2019. Maternal demographic characteristics, any unprescribed or illicit opioid use per urine toxicology or provider report during the pregnancy or 6 months' postdelivery, delivery outcomes, gestational age, birth weight, Apgar scores, neonatal intensive care unit admission, and neonatal abstinence syndrome (NAS) outcomes (NAS diagnosis, pharmacologic treatment, and total hospital length of stay) were compared. FINDINGS: Maternal and infant demographic characteristics were similar between the 2 groups, with the exception of cigarette smoking in the BUP group being more common (92% vs 33%; P = 0.02). None of the women on NTX versus 23% of the women on BUP had documented opioid misuse (P = 0.52). No infants in the NTX group had a NAS diagnosis versus 92% in the BUP group (P < 0.001). Forty-six percent of the BUP-exposed infants were treated for NAS versus 0% in the NTX group (P < 0.001). NTX-exposed infants had a shorter length of stay (mean [SD], 3.2 [1.6] vs 10.9 [8.2] days; P = 0.008). IMPLICATIONS: Maintaining women on NTX during pregnancy was associated with favorable outcomes. These results support the need for larger multicenter studies sufficiently powered to detect possible differences between the medications on long-term maternal and child safety and efficacy outcomes.

El cuidado espiritual un camino para trascender en la razón de ser de la Enfermería / Spiritual care a way to transcend the reason of being of Nursing

Resumen

¿Cómo se relaciona la espiritualidad con el arte del cuidado?

La espiritualidad acompaña al hombre desde sus orígenes, al igual que el cuidado se reconoce como una dimensión humana; en la contemporaneidad, se explica dentro del paradigma de la Nueva Era como respuesta a las concepciones tradicionales. Se relaciona con la comunicación enfermera-persona durante el proceso de cuidado que, en esencia, se trata de recuperar el sentido de la vida-muerte, la conciencia de sí y su trascendencia.

La espiritualidad se fundamenta en procesos de vida, posee orientaciones y significados diferentes; así es como el cuidado espiritual se convierte en un proceso dinámico continuo de interacción, del estar ahí con la persona, de ayudarle en su necesidad de trascender y de vivir acorde con sus creencias y significados.

El profesional de enfermería, al apropiarse de estos conceptos y ponerlos en práctica desarrolla su propia espiritualidad, promueve en las personas preguntarse por el sentido de su existencia, elaborar proyectos de vida y comprender su historia de vida; dichas acciones, favorecen que el profesional de enfermería se identifique consigo mismo y con el otro en el momento de brindar cuidado, y convierte el acto del cuidado en una experiencia trascendente, donde convergen el crecimiento personal y profesional.

Abstract

How is spirituality related to the art of care?

Spirituality accompanies man from his origins just as care is recognized as a human dimension; in contemporaneity, it is explained within the paradigm of the New Age as a response to traditional conceptions. It is related to the nurse-person communication during the care process, which in essence, is about recovering the meaning of life-death, self-awareness and its transcendence. Spirituality is based on life processes, and it has different orientations and meanings; that is how, spiritual care becomes a continuous dynamic process of interaction, of being there with the person, of helping him in his need to transcend and live according to his beliefs and meanings.

The nursing professional, by appropriating these concepts and putting them into practice, develops his own spirituality; promotes in people, the question of the meaning of their existence, develop life projects and understand their life history; these actions favor that the nursing professional identifies himself with himself and with the other at the time of providing care, and turns the act of care into a transcendent experience, where personal and professional growth converge.

The p97 Inhibitor CB-5083 Is a Unique Disrupter of Protein Homeostasis in Models of Multiple Myeloma.

Inhibition of the AAA ATPase, p97, was recently shown to be a novel method for targeting the ubiquitin proteasome system, and CB-5083, a first-in-class inhibitor of p97, has demonstrated broad antitumor activity in a range of both hematologic and solid tumor models. Here, we show that CB-5083 has robust activity against multiple myeloma cell lines and a number of in vivo multiple myeloma models. Treatment with CB-5083 is associated with accumulation of ubiquitinated proteins, induction of the unfolded protein response, and apoptosis. CB-5083 decreases viability in multiple myeloma cell lines and patient-derived multiple myeloma cells, including those with background proteasome inhibitor (PI) resistance. CB-5083 has a unique mechanism of action that combines well with PIs, which is likely owing to the p97-dependent retro-translocation of the transcription factor, Nrf1, which transcribes proteasome subunit genes following exposure to a PI. In vivo studies using clinically relevant multiple myeloma models demonstrate that single-agent CB-5083 inhibits tumor growth and combines well with multiple myeloma standard-of-care agents. Our preclinical data demonstrate the efficacy of CB-5083 in several multiple myeloma disease models and provide the rationale for clinical evaluation as monotherapy and in combination in multiple myeloma. Mol Cancer Ther; 16(11); 2375-86. ©2017 AACR.

Encuesta sobre prácticas de prevención de infecciones asociadas a la broncoscopía en la República Argentina 2014 / Survey about Practices to Prevent Bronchoscopy-Associated Infections in the Republic of Argentina in 2014

Introducción y objetivo: Encuestas nacionales sobre la práctica broncoscópica se han repetido desde hace tres décadas en el mundo. En Argentina la broncoscopía tiene una larga historia, sin embargo, hay poca información disponible sobre esta práctica. El objetivo del estudio es obtener información sobre las características específicas de las prácticas de prevención de infecciones en los procedimientos broncoscópicos. Métodos: En 2014, distribuimos una encuesta para broncoscopistas y asistentes en la reunión anual de neumólogos. Resultados: Se completaron un total de 41 cuestionarios. No recibió capacitación específica en prevención de infecciones el 68%. Es neumonólogo el 85%. Infecciones, pseudoinfeciones o pseudoepidemias asociadas a broncoscopía fueron registradas por el 7%. No refiere haber sufrido un accidente laboral relacionado con la broncoscopía el 87%. Conoce la conducta a adoptar ante un accidente el 80%. Utiliza detergente enzimático para el proceso de limpieza 97%. Reutiliza este detergente 40%. Ortofitalaldehído, glutaraldehído o ambos es empleado como agente de desinfección de alto nivel (DAN) por el 95%. Realiza DAN sobre el broncoscopio siempre el 75%, lo hace a veces 9% y no lo hace el 14%. Realiza DAN o esterilización sobre material reutilizable el 87%. Los accesorios reutilizables (pinzas o cepillos) son esterilizados, reprocesados con DAN o ambas cosas por el 77%; y sometidos sólo a limpieza de nivel medio por el 12%. Emplea “Single Use Device” 78%, de ellos reprocesa este material 84%. Posee procesador automático el 5%. Conclusiones: Se identificaron características específicas locales de prácticas de prevención de infecciones en los procedimientos broncoscópicos.

Background and objective: Nationwide surveys about bronchoscopic practice have been carried out for three decades over the world. In Argentina, bronchoscopy has a long history; however, little information is available about this practice. The aim of this study is to obtain information regarding specific characteristics of practices to prevent in the bronchoscopy-associated infections. Methods: In 2014, we carried out a survey addressed to bronchoscopists and bronchoscopy assistants at the annual meeting of lung specialists. Results: 41 persons were surveyed. 68% did not receive any specific training in infection prevention practices. 85% were pulmonologists. 7% recorded infections, pseudoepidemics or pseudoinfections. 80% knew how to manage bronchoscopy-related accidents. 97% used enzymatic detergents in the cleaning process. 40% knew when to reuse the detergent. 95% used orthophthaldehyde, glutaraldehyde, or both of them as a high level disinfection agent (HLD). 75% used always HLD to clean the bronchoscope while 9% did it sometimes, and 14% never did it. 87% used HLD or sterilization for reusable materials. 77% sterilized reusable accessories (biopsy forceps or brushes), 77% reprocessed them with HLD, and 12% exposed them to mid level cleaning. 78% used a single device. 84% reprocessed the materials. 5% had an automatic processor. Conclusions: Local specific characteristics on the practice to prevent infections in the bronchoscopic procedures were identified.

Discovery of a First-in-Class, Potent, Selective, and Orally Bioavailable Inhibitor of the p97 AAA ATPase (CB-5083).

The AAA-ATPase p97 plays vital roles in mechanisms of protein homeostasis, including ubiquitin-proteasome system (UPS) mediated protein degradation, endoplasmic reticulum-associated degradation (ERAD), and autophagy. Herein we describe our lead optimization efforts focused on in vitro potency, ADME, and pharmaceutical properties that led to the discovery of a potent, ATP-competitive, D2-selective, and orally bioavailable p97 inhibitor 71, CB-5083. Treatment of tumor cells with 71 leads to significant accumulation of markers associated with inhibition of UPS and ERAD functions, which induces irresolvable proteotoxic stress and cell death. In tumor bearing mice, oral administration of 71 causes rapid accumulation of markers of the unfolded protein response (UPR) and subsequently induces apoptosis leading to sustained antitumor activity in in vivo xenograft models of both solid and hematological tumors. 71 has been taken into phase 1 clinical trials in patients with multiple myeloma and solid tumors.

Targeting the AAA ATPase p97 as an Approach to Treat Cancer through Disruption of Protein Homeostasis.

p97 is a AAA-ATPase with multiple cellular functions, one of which is critical regulation of protein homeostasis pathways. We describe the characterization of CB-5083, a potent, selective, and orally bioavailable inhibitor of p97. Treatment of tumor cells with CB-5083 leads to accumulation of poly-ubiquitinated proteins, retention of endoplasmic reticulum-associated degradation (ERAD) substrates, and generation of irresolvable proteotoxic stress, leading to activation of the apoptotic arm of the unfolded protein response. In xenograft models, CB-5083 causes modulation of key p97-related pathways, induces apoptosis, and has antitumor activity in a broad range of both hematological and solid tumor models. Molecular determinants of CB-5083 activity include expression of genes in the ERAD pathway, providing a potential strategy for patient selection.

[Rituximab-induced interstitial lung disease]. / Enfermedad pulmonar intersticial asociada a rituximab.

The introduction of the anti-CD20 antibody rituximab into clinical practice has improved substantially the prognosis of a variety of haematological and autoimmune diseases. The interstitial lung disease is one of most serious and potentially fatal complications of rituximab therapy. This diagnosis should be considered in patients who have received the drug and present with dyspnea, fever and cough without clear evidence of infection. We report a case of rituximab-induced interstitial lung disease.

Enfermedad pulmonar intersticial asociada a rituximab / Rituximab-induced interstitial lung disease

La introducción en la práctica clínica del anticuerpo anti-CD20 rituximab ha mejorado sustancialmente el pronóstico de diversas enfermedades autoinmunes y hematológicas. Con el incremento de su uso ha aumentado el registro de efectos adversos, entre ellos la toxicidad pulmonar. Una de sus complicaciones más serias es la enfermedad pulmonar intersticial, entidad potencialmente fatal que debe ser considerada en pacientes que han recibido rituximab y presentan disnea, fiebre y tos sin clara evidencia de infección. Presentamos un caso de enfermedad pulmonar intersticial asociada a rituximab.

The introduction of the anti-CD20 antibody rituximab into clinical practice has improved substantially the prognosis of a variety of haematological and autoimmune diseases. The interstitial lung disease is one of most serious and potentially fatal complications of rituximab therapy. This diagnosis should be considered in patients who have received the drug and present with dyspnea, fever and cough without clear evidence of infection. We report a case of rituximab-induced interstitial lung disease.

Sono e aprendizagem / Sleep and learning

É grande a importância do sono na vida diária, especialmente pensando no desenvolvimento físico e psicológico da criança, e suas influências sobre o comportamento infantil e o aprendizado. Objetivo: A identificação dos distúrbios do sono em crianças. Método: O questionário do sono de Reimão e Lefèvre (QRL) aborda diversos distúrbios do sono na infância, com questões respondidas pelos pais. Foi tomada uma amostra de 258 escolares, na faixa etária de 6 a 9 anos, em cinco escolas de ensino fundamental na cidade de Poços de Caldas, em Minas Gerais. Resultados: Entre os resultados, verificou-se que apenas 13 (5%) pais admitiam a influência do sono na aprendizagem. Discussão: A literatura relata as relações do sono com a aprendizagem, atenção e memória, porém poucos trabalhos avaliam o grau de informação dos pais quanto às conseqüências dos distúrbios do sono para a aprendizagem. Conclusão: A utilização do QRL para pesquisas sobre o sono pode facilitar o diagnóstico e possibilitar tratamentos eficazes, especialmente quando a grande maioria dos pais e pessoal envolvido na escola, ainda desconhece a relação entre problemas no sono e transtornos na aprendizagem.

Bronquiectasias en pacientes HIV positivos / Bronchiectasis in patients infected with HIV

Entre el 1 de julio de 1995 y 30 de junio de 1997 se internaron 295 pacientes con serología positiva para HIV. En 25 de ellos (18 hombres y 7 mujeres) se hizo diagnóstico de bronquiectasias (BE). La edad media fue de 32 años, en su mayoría adictos endovenosos, en todos los casos se detectó antecedentes de infección pulmonar previa (neumonía por Pneumocystis carinii en 14 pacientes, tuberculosis en 9, neumonía recurrente en 6) y compromiso de la inmunidad celular (CD4 media = 64.8 mm3). La presencia de expectoración purulenta habitual, infecciones respiratorias bajas reiteradas y radiología patológica se correlacionó con el hallazgo de BE en la tomografía computada de tórax (TC). Hemos observado que la frecuencia de BE en esta población fue notoriamente mayor a la de la población general adulta (sin factores de riesgo para HIV) que se internó en nuestro Hospital en el mismo período de tiempo, utilizando la misma metodología diagnóstica (8.5 por ciento vs 0.12 por ciento); por lo tanto la BE constituyen una patología relativamente frecuente en los pacientes con HIV, son motivo de internaciones repetidas por infección respiratoria baja bacteriana, y de aumento de morbimortalidad en estos pacientes.

Diferencias entre la tuberculosis pulmonar con baciloscopia positiva y negativa / Differences between smear positive and smear negative pulmonary tuberculosis

En el análisis de 318 pacientes con tuberculosis (TB) pulmonar activa, tratados entre enero de 1980 y diciembre de 1990, en un Hospital General del Gran Buenos Aires, el grupo (n = 48) con baciloscopía negativa (D-) tuvo diferencias clínicas y radiológicas significativas con respecto al grupo (n = 270) con baciioscopía positivia (D+). Estas diferencias fueron la mayor edad, la mayor frecuencia de otras enfermedades pulmonares y de Rx "secuela", con menos antecedentes clínicos y cavidades pulmonares radiológicas. Dos subgrupos se distinguem en el grupo D-, de acuerdo a la iniciación empírica del tratamiento. Por un lado un subgrupo con características similares al grupo D+, lo que facilitó la decisión de comenzarlo aún con la baciloscopía negativa (D-TI). El otro subgrupo tuvo características totalmente diferentes al grupo D+, lo que hizo pensar en otros diagnósticos, difiriendo así la decisión del tratamiento hasta la obtención del cultivo (D-TD).

Efeito de um programa näo-invasivo na progressäo da cárie dentária / The non-invasive program effect in dental carie progress

O estudo foi conduzido em uma creche na favela do Vidigal, Rio de Janeiro. Noventa e três crianças entre 5 e 7 anos de idade, as quais nunca haviam recebido nenhum tipo de tratamento operatório, foram examinadas em relaçäo ao CPO-S. As lesöes de cárie foram avaliadas quanto à sua profundidade (PLC). Um programa näo-invasivo foi iniciado, o qual consistia de escovaçäo semanal supervisionada, usando dentifrício contendo flúor e xilitol. Avaliaram-se o CPO-S e o PLC após 12 e 24 meses depois de iniciado o programa. O CPO-S näo apresentou diferença estatisticamente significativa entre o baseline e o primeiro ano. Houve, no entanto, um declínio estatisticamente significativo entre o baseline e o segundo ano (p=0.0075). Observou-se uma tendência das lesöes de cárie entre o baseline e o segundo ano, através do índice PLC, e estas observaçöes foram estatisticamente significativas (p=0.0029)

Efeitos dos tratamentos com fluoretos tópicos sobre a liberaçäo de fluoreto das restauraçöes com cimento de ionômero de vidro / Effects of treatments with topical fluorides over the release of fluoride from glass-ionomer restaurations

Os autores verificaram os efeitos dos tratamentos com fluoretos tópicos (verniz, gel e dentifrício) sobre a liberaçäo de fluoreto das restauraçöes com cimento de ionômero de vidro, realizadas sobre secçöes de esmalte que apresentavam lesöes de cáries artificiais, e que foram coladas em dispositivos intra-orais utilizados durante 14 dias por 16 voluntários

Incremento de fluoreto pelo esmalte humano, in vitro, após aplicaçäo de fio e fita dental com flúor / Fluoride increment into sound enamel fluoride dental floss after fluoride dental tape application \"in vitro\"

Os autores verificaram "in vitro" o incremento de fluoreto sob a forma de fluoreto de cálcio, no esmalte dental humano hígido tratado com fio e fita dental com flúor, encontrando concentraçöes 3,1 e 5,7 vezes maior após aplicaçäo de fio e fita, respectivamente

Estudo comparativo do efeito de duas escovas dentais sobre a placa bacteriana / The effect of two toothbrushes over dental plaque: a comparative study

Os autores verificaram clinicamente, em crianças de 11-12 anos de idade, o efeito de duas escovas dentais (termossensível e convencional) sobre a placa bacteriana, ao final de sete e 21 dias, e compararam a duraçäo da escovaçäo em ambos os grupos. Um terceiro grupo foi utilizado como controle, näo recebendo nenhum tipo de escova dental. A escova termossensível (G1) apresentou percentual de reduçäo de placa bacteriana 32,40 (por cento) (sete dias) e 18,47 por cento (21 dias) maior do que a escova convencional (G2); sendo 175,52 por cento (sete dias) e 100 por cento (21 dias) mais efetiva do que o controle (G3). Comparando-se a efetividade entre o G2 e G3, o percentual registrado foi de 106,98 por cento (sete dias) e 68,82 por cento (21 dias) para a escova convencional. Analisando o tempo de escovaçäo entre dois grupos, G1 escovou 69 por cento mais do que G2 durante os sete primeiros dias do experimento e 88 por cento mais do que o G2 ao final do experimento

Estudo "in vivo" da concentraçäo de flúor em saliva após utilizaçäo de fio e fita dental fluoretados / In vivo study of fluoride concentration in saliva after utilization of dental floss and dental tape with fluoride

Os autores verificaram "in vivo" a concentraçäo de fluoreto nos fluídos orais de 10 voluntários, após o uso de fio e fita dental com flúor durante um minuto em cada arco dental. O grupo que usou fio fluoretado mostrou logo após o uso do produto, um incremento médio estatisticamente significativo de 0,0025 ppm, D.P.=0,0014 (12,82 por cento), enquanto o grupo que usou a fita fluoretada teve um incremento médio estatisticamente significativo de 0,0045 ppm, D.P.=0,0026 (22,61 por cento). Cinco minutos após o uso do início do experimento da ordem de -7,69 por cento e -10,10 por cento, respectivamente. Ao final, verificou-se que houve uma eliminaçäo total do fluoreto na saliva, obtendo-se valores -3,6 por cento, e -7,0 por cento, respectivamente, menores que os iniciais