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1.
Semin Ophthalmol ; : 1-9, 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38717910

RESUMO

PURPOSE: This systematic review studies the relationship between Macular Pigment Optical Density (MPOD) values and cognitive and visual function in childhood. METHODS: It included cross-sectional, observational studies or controlled clinical trials in humans between 0 and 18 years of age, analyzing MPOD values in 3 main databases: PubMed, Scopus and Web of Science. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. RESULTS: Thirteen studies were included in this systematic review. The relationship of cognitive function, visual function and diverse variables with MPOD was analyzed in 4, 4 and 5 studies, respectively. The age of the participants ranged between premature infants to 12 years. Most of the studies used Heterochromatic Flicker Photometry (HFP) with macular densitometer to obtain MPOD values. MPOD values ranged between 0 (undetectable) to 0.66 ± 0.03 d.u. Only 4 articles studied the relationship between MPOD values and dietary intake of lutein and zeaxanthin using questionnaires about diet. CONCLUSIONS: Lutein and zeaxanthin accumulation plays an important role during the maturational stage and childhood development. Although cognitive function is more strongly correlated with MPOD values, the relationship with visual function remains unclear, and further studies are required to support this relationship.

2.
Life (Basel) ; 13(12)2023 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-38137914

RESUMO

The aim of this study was to evaluate the biomechanical changes in the cornea after wearing soft contact lenses (CLs) in healthy myopic patients measured with a Corvis ST® (CST, Oculus Optikgeräte GmbH, Wetzlar, Germany) analyser. This prospective, cross-sectional, single-centre study was performed on twenty-two Caucasian patients aged between 19 and 24 years (20.64 ± 1.21 years) range. Five device-specific biomechanical parameters, the central corneal thickness (CCT), and biomechanically corrected intraocular pressure (bIOP) were measured prior to fitting and one month after CL wear. Differences between the means of the deflection amplitude ratio (DA Ratio) and the standard deviation of the DA Ratio (SD DA Ratio) pre- and post-CL wear were found to be significant (p value = 0.002 in both cases). Significant differences were found between pre- and post-CL wear values in CCT (p value = 0.013). For all other biomechanical measures, no significant differences were observed before and after treatment. A significant association was found between changes in bIOP and classification according to changes in Int. Radius (p value = 0.047) and SSI (p value = 0.026) standard deviations. The corneal biomechanical indices provided by CST demonstrate that the fitting of soft CLs is a safe optical compensation method for the stability of corneal stiffness. No significant differences were found pre- and post-CL wear in the assessment of bIOP.

3.
J Clin Med ; 12(20)2023 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-37892784

RESUMO

This study evaluated the effectiveness of hyaluronic acid and trehalose (HA/trehalose) eyedrops in managing dry eye disease (DED) symptoms by measuring tear stability and administering a DED questionnaire. Sixty patients were treated with either HA/trehalose eyedrops (Tear A) or carmellose sodium eyedrops (Tear B) as controls. The tear breakup time (TBUT) and non-invasive breakup time (NIBUT) were monitored, and patients completed the standard patient evaluation of eye dryness (SPEED) questionnaire. After two months of twice-daily applications, patients treated with the HA/trehalose eyedrops demonstrated significant improvements in the NIBUT (12.98 ± 3.22 s) and TBUT (12.95 ± 2.98 s), indicating increased tear stability. Moreover, they reported lower dry eye sensation (6.70 ± 4.94 SPEED score points), suggesting a reduction in DED symptoms. These findings underscore the efficacy of HA/trehalose eyedrops in improving both the objective and subjective signs of DED, with twice-daily application enhancing ocular surface conditions and reducing patient-reported symptoms.

4.
Sensors (Basel) ; 23(15)2023 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-37571754

RESUMO

This paper presents GAVT, a highly accurate audiovisual 3D tracking system based on particle filters and a probabilistic framework, employing a single camera and a microphone array. Our first contribution is a complex visual appearance model that accurately locates the speaker's mouth. It transforms a Viola & Jones face detector classifier kernel into a likelihood estimator, leveraging knowledge from multiple classifiers trained for different face poses. Additionally, we propose a mechanism to handle occlusions based on the new likelihood's dispersion. The audio localization proposal utilizes a probabilistic steered response power, representing cross-correlation functions as Gaussian mixture models. Moreover, to prevent tracker interference, we introduce a novel mechanism for associating Gaussians with speakers. The evaluation is carried out using the AV16.3 and CAV3D databases for Single- and Multiple-Object Tracking tasks (SOT and MOT, respectively). GAVT significantly improves the localization performance over audio-only and video-only modalities, with up to 50.3% average relative improvement in 3D when compared with the video-only modality. When compared to the state of the art, our audiovisual system achieves up to 69.7% average relative improvement for the SOT and MOT tasks in the AV16.3 dataset (2D comparison), and up to 18.1% average relative improvement in the MOT task for the CAV3D dataset (3D comparison).

5.
Graefes Arch Clin Exp Ophthalmol ; 261(9): 2497-2505, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37039937

RESUMO

PURPOSE: To determine whether patients with type 1 diabetes mellitus (T1DM), without any sign of diabetic retinopathy, have any alteration in Contrast Sensitivity Function (CSF), in relation to patients without this disease, and whether CSF assessment in three different light conditions can be an effective test in the early detection of diabetic retinopathy. METHODS: A prospective, cross-sectional, case-control study was preformed including 80 patients (40 with T1DM without diabetic retinopathy and 40 controls) between 11 and 47 years old. CSF was assessed at four spatial frequencies (3, 6, 12 and 18 cycles/degree) using the CSV-1000E test, under three light conditions: high (550 lx), medium (200 lx) and low (< 2 lx). RESULTS: A lower CSF in the T1DM group was found at the three light conditions studied. The most spatial frequency affected was 18 cpd, 0.08 log units (p = 0.048) in high, 0.10 log units (p = 0.010) in medium (p = 0.010) and 0.16 log units (p < 0.001) in low-light conditions in mean CS values. The least spatial frequency affected was 3 cpd (p > 0.05 in all three light conditions). CONCLUSION: Patients with T1DM, without diabetic retinopathy, presented a loss of CS to sine-wave gratings, with respect to people with the same characteristics without the disease, mainly at medium and high frequencies, and in medium and low-light conditions.


Assuntos
Diabetes Mellitus Tipo 1 , Retinopatia Diabética , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/diagnóstico , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/etiologia , Sensibilidades de Contraste , Estudos Transversais , Estudos de Casos e Controles , Estudos Prospectivos
6.
Artigo em Inglês | MEDLINE | ID: mdl-36673988

RESUMO

Under the umbrella of assistive technologies research, a lot of different platforms have appeared since the 1980s, trying to improve the independence of people with severe mobility problems. Those works followed the same path coming from the field of robotics trying to reach users' needs. Nevertheless, those approaches rarely arrived on the market, due to their specificity and price. This paper presents a new prototype of an intelligent wheelchair (IW) that tries to fill the gap between research labs and market. In order to achieve such a goal, the proposed solution balances the criteria of performance and cost by using low-cost hardware and open software standards in mobile robots combined together within a modular architecture, which can be easily adapted to different profiles of a wide range of potential users. The basic building block consists of a mechanical chassis with two electric motors and a low-level electronic control system; driven by a joystick, this platform behaves similar to a standard electrical wheelchair. However, the underlying structure of the system includes several independent but connected nodes that form a distributed and scalable architecture that allows its adaptability, by adding new modules, to tackle autonomous navigation. The communication among the system nodes is based on the controller area network (CAN) specification, an extended standard in industrial fields that have a wide range of low-cost devices and tools. The system was tested and evaluated in indoor environments and by final users in order to ensure its usability, robustness, and reliability; it also demonstrated its functionality when navigating through buildings, corridors, and offices. The portability of the solution proposed is also shown by presenting the results on two different platforms: one for kids and another one for adults, based on different commercial mechanical platforms.


Assuntos
Interface Usuário-Computador , Cadeiras de Rodas , Adulto , Humanos , Reprodutibilidade dos Testes , Desenho de Equipamento , Software
7.
Semin Ophthalmol ; 38(4): 319-332, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36047470

RESUMO

INTRODUCTION: The purpose of this systematic review was to study whether contrast sensitivity assessment in people with diabetes could be a reliable test in early detection of diabetic retinopathy. A systematic search based on population, intervention, comparison, and outcome strategy was performed. METHODS: PubMed, Scopus, and Web of Science were searched for English articles of human patients with type 1 and type 2 diabetes and contrast sensitivity measurements as domain studied. RESULTS: Twentyone comparative cross-sectional studies were included. All of them showed significant loss of contrast sensitivity in people with diabetes and diabetic retinopathy regarding control patients of the same age, regardless of the method used. However, those without diabetic retinopathy, involve a loss of contrast sensitivity, although not always significant. CONCLUSION: Changes in contrast sensitivity suggest that there is damage to the retina prior to the vascular ones and that they could be detected by this test.


Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Humanos , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Sensibilidades de Contraste , Estudos Transversais , Diagnóstico Precoce
8.
Front Med (Lausanne) ; 9: 938484, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36035382

RESUMO

We describe the role of OSA as a new instrument in the study of dry eye, and we recommend a protocol for conducting the tests as well as describe the advantages and disadvantages compared with other instruments. A comparison with other ocular surface devices (Tearscope Plus, Keratograph 5M, anterior-segment ocular coherence tomography, Easy Tear View-Plus, LipiView, IDRA, and LacryDiag) were presented due to manual or automatic procedure and objective or subjective measurements. The purpose of this study was to describe the OSA as new non-invasive dry eye disease diagnostic device. The OSA is a device that can provide accurate, non-invasive and easy-to-use parameters to specifically interpret distinct functions of the tear film. This OSA protocol proposed a lesser to higher non-invasive ocular surface dry eye disease tear film diagnostic methodology. A complete and exhaustive OSA and OSA Plus examination protocol was presented within the subjective questionnaire (Dry Eye Questionnaire 5, DEQ5), limbal and bulbar redness classification (within the Efron grade Scale, interferometry lipid layer thickness (LLT) (according to Guillon pattern), tear meniscus height (manually or automatic), first and mean non-invasive break up time (objective and automatic) and meibomian gland (MG) dysfunction grade and percentage (objective and automatic). The OSA and OSA Plus devices are novel and relevant dry eye disease diagnostic tools; however, the automatization and objectivity of the measurements can be increased in future software or device updates. The new non-invasive devices supposed represent a renewal in the dry eye disease diagnosis and introduce a tendency to replace the classic invasive techniques that supposed less reliability and reproducibility.

9.
Physiol Behav ; 254: 113891, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35752349

RESUMO

Lutein and zeaxanthin-xanthophyll carotenoids with antioxidant and anti-inflammatory characteristics-are present in the retina and the brain. High concentrations of these carotenoids have been positively related to cognitive performance. Therefore, this systematic review analyses the relationship between macular pigment density and cognitive functions. Most relevant databases were scoured for studies on healthy people relating cognitive functions to macular pigment optical density (MPOD). There were no age, sex, or race limitations. PROSPERO registration: CRD42021254833. Nineteen studies were included, seven randomized controlled trials (RCT) and eleven observational studies. The general aim of the studies was to examine the association between carotenoids (lutein, meso­zeaxanthin and zeaxanthin) and cognitive function. Most observational studies correlates MPOD levels with cognitive function or brain activity. Besides, RCTs compared the cognitive function and/or brain activity after increasing lutein and zeaxanthin intake though dietary supplementation or avocado consumption. Dietary lutein and zeaxanthin intake increased MPOD in six of the seven clinical trials and significantly improved most of the cognitive functions studied. A wide variety of test and methodologies for measuring cognitive functions were observed. Memory, processing speed, attention and reasoning were the cognitive function significantly related to MPOD levels in adults. Brain activity also was related to MPOD, but the results were inconsistent. Only four of the eleven observational studies were based on young people and all studies showed a significant relationship between MPOD and cognitive functions. This systematic review showed a direct relationship among cognitive functions, macular pigment and the intake of lutein and zeaxanthin.


Assuntos
Pigmento Macular , Adolescente , Adulto , Cognição , Suplementos Nutricionais/análise , Humanos , Luteína/farmacologia , Zeaxantinas/farmacologia
10.
Toxics ; 10(1)2022 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-35051084

RESUMO

Pharmaceuticals and personal care products (PPCPs) are partially degraded in wastewater treatment plants (WWTPs), thereby leading to the formation of more toxic metabolites. Bacterial populations in bioreactors operated in WWTPs are sensitive to different toxics such as heavy metals and aromatic compounds, but there is still little information on the effect that pharmaceuticals exert on their metabolism, especially under anaerobic conditions. This work evaluated the effect of selected pharmaceuticals that remain in solution and attached to biosolids on the metabolism of anaerobic biomass. Batch reactors operated in parallel under the pressure of four individual and mixed PPCPs (carbamazepine, ibuprofen, triclosan and sulfametoxazole) allowed us to obtain relevant information on anaerobic digestion performance, toxicological effects and alterations to key enzymes involved in the biodegradation process. Cell viability was quantitatively evaluated using an automatic analysis of confocal microscopy images, and showed that triclosan and mixed pollutants caused higher toxicity and cell death than the other individual compounds. Both individual pollutants and their mixture had a considerable impact on the anaerobic digestion process, favoring carbon dioxide production, lowering organic matter removal and methane production, which also produced microbial stress and irreversible cell damage.

11.
Graefes Arch Clin Exp Ophthalmol ; 260(2): 529-535, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34562113

RESUMO

PURPOSE: To study the treatment efficacy of hyaluronic acid 0.3%, cyanocobalamin (vitamin B12), electrolytes, and P-Plus in menopausal patients with moderate dry eye disease. METHODS: Thirty female patients of mean age 53.06 ± 5.20 years (45-65) were enrolled in this prospective longitudinal study. Meibomian gland loss assessment was determined using a scale with four levels. The Ocular Surface Disease Index (OSDI) questionnaire, phenol red thread (PRT) test, and tear film break-up time (TFBUT) were also completed by the patients. Tear eye drops were formulated with 0.3 g of sodium hyaluronate, P-Plus ™, vitamin B12, sodium chloride, potassium chloride, calcium chloride, magnesium chloride, and SCO® (stabilized complex oxychloride). After 30 days, the patients were re-evaluated. RESULTS: The mean meibomian gland loss percentage was 37.97 ± 19.02 % (7.20 to 88.30%). Before treatment, the OSDI was 22.53 ± 14.03 score points (6.25 to 77.08). Posterior OSDI decreased to 16.26 ± 13.69 score points (0.00 to 70.83) (W = 58.00, P < 0.01). Before treatment, PRT was 10.31 ± 4.48 mm (4.00 to 21.00). Posterior PRT increased to 15.41 ± 6.27 mm (4.00 to 21.00) (W = 1520.50, P < 0.01). Before treatment, TFBUT was 6.23 ± 1.75 s (3.00 to 9.00). The posterior TFBUT increased to 8.10 ± 2.06 s (4.00 to 14.00) (W= 1382.50, P < 0.01). CONCLUSION: The hyaluronic acid 0.3% and vitamin B12 eye drops effectively decreased dry eye symptoms in menopausal women and improved tear stability and volume.


Assuntos
Síndromes do Olho Seco , Ácido Hialurônico , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/tratamento farmacológico , Eletrólitos , Feminino , Humanos , Estudos Longitudinais , Menopausa , Pessoa de Meia-Idade , Estudos Prospectivos , Lágrimas , Vitamina B 12
12.
Eye Contact Lens ; 47(12): 642-646, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34608028

RESUMO

OBJECTIVES: To investigate the effect of contact lenses with blue light filters on contrast sensitivity and any alteration in tear quantity and quality. METHODS: This prospective longitudinal pilot study required three visits by each participant. Monocular visual acuity, contrast sensitivity, phenol red thread test, and tear breakup time were measured at each visit. RESULTS: There were significant differences in logarithmic contrast sensitivity between the groups. The breakup time (BUT) was significantly lower after using video display terminals than before (P<0.05). No differences in BUT were found between groups video display terminals and contact lenses having the blue filter (P>0.05). However, higher mean values were observed in the group after video display terminal use with contact lenses having the blue filter than that with standard contact lenses (P>0.05 in both groups). Furthermore, the mean value of phenol red thread test on the group after video display terminal use with contact lenses having the blue filter was lower than the group before its use (P>0.05). CONCLUSION: The results establish a possible relationship between tear stability, improved contrast sensitivity, and the use of a blue filter in contact lenses.


Assuntos
Sensibilidades de Contraste , Lágrimas , Eletrônica , Humanos , Projetos Piloto , Estudos Prospectivos
13.
Sensors (Basel) ; 21(12)2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34207883

RESUMO

Surveillance cameras are being installed in many primary daily living places to maintain public safety. In this video-surveillance context, anomalies occur only for a very short time, and very occasionally. Hence, manual monitoring of such anomalies may be exhaustive and monotonous, resulting in a decrease in reliability and speed in emergency situations due to monitor tiredness. Within this framework, the importance of automatic detection of anomalies is clear, and, therefore, an important amount of research works have been made lately in this topic. According to these earlier studies, supervised approaches perform better than unsupervised ones. However, supervised approaches demand manual annotation, making dependent the system reliability of the different situations used in the training (something difficult to set in anomaly context). In this work, it is proposed an approach for anomaly detection in video-surveillance scenes based on a weakly supervised learning algorithm. Spatio-temporal features are extracted from each surveillance video using a temporal convolutional 3D neural network (T-C3D). Then, a novel ranking loss function increases the distance between the classification scores of anomalous and normal videos, reducing the number of false negatives. The proposal has been evaluated and compared against state-of-art approaches, obtaining competitive performance without fine-tuning, which also validates its generalization capability. In this paper, the proposal design and reliability is presented and analyzed, as well as the aforementioned quantitative and qualitative evaluation in-the-wild scenarios, demonstrating its high sensitivity in anomaly detection in all of them.


Assuntos
Algoritmos , Redes Neurais de Computação , Gravação em Vídeo , Reprodutibilidade dos Testes
14.
Sensors (Basel) ; 21(9)2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33922548

RESUMO

New processing methods based on artificial intelligence (AI) and deep learning are replacing traditional computer vision algorithms. The more advanced systems can process huge amounts of data in large computing facilities. In contrast, this paper presents a smart video surveillance system executing AI algorithms in low power consumption embedded devices. The computer vision algorithm, typical for surveillance applications, aims to detect, count and track people's movements in the area. This application requires a distributed smart camera system. The proposed AI application allows detecting people in the surveillance area using a MobileNet-SSD architecture. In addition, using a robust Kalman filter bank, the algorithm can keep track of people in the video also providing people counting information. The detection results are excellent considering the constraints imposed on the process. The selected architecture for the edge node is based on a UpSquared2 device that includes a vision processor unit (VPU) capable of accelerating the AI CNN inference. The results section provides information about the image processing time when multiple video cameras are connected to the same edge node, people detection precision and recall curves, and the energy consumption of the system. The discussion of results shows the usefulness of deploying this smart camera node throughout a distributed surveillance system.

15.
Hematology ; 23(9): 712-718, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29582705

RESUMO

OBJECTIVES: Whole blood-derived platelet concentrates can be obtained by the platelet-rich plasma (PRP-PCs) or the buffy-coat (BC-PCs) method. Few studies have shown that BC-PCs display lower in vitro platelet activation, but scarce information exists regarding transfusion efficacy. We have performed a retrospective study assessing platelet transfusion in patients undergoing allogeneic hematopoietic cell transplantation (AHCT) in our clinic, before and after the implementation of BC-PCs. METHODS: We reviewed clinical records corresponding to 70 PRP-PCs and 86 BC-PCs prophylactic transfusions, which were performed to 55 AHCT patients. Transfusion efficacy was assessed by the 24-h post-transfusion corrected count increment (24-h CCI) and bleeding events. Clinical factors affecting transfusion outcome were also investigated. RESULTS: Clinical characteristics and the total number of platelet transfusions were similar among groups. Mean donor exposure was 5.8 and 5.0 in each single PRP-PCs and BC-PCs transfusion, respectively (p < 0.01). The 24-h CCI was significantly higher in patients transfused with BC-PCs than in those receiving PRP-PCs (8.3[2.7-13.4] vs. 4.7[1.3-8.1]; p < 0.01). Independent predictors of poor platelet transfusion response included diagnosis other than acute leukemia (HR 8.30; 95% CI 1.96-35.22; p = 0.004), splenomegaly (HR 8.75; 95% CI 2.77-27.60; p < 0.001), graft versus host disease prophylaxis different from cyclosporine A and methotrexate (HR 3.96; 95% CI 1.55-10.14; p = 0.004) and PRP-PCs transfusion (HR 4.54; 95% CI 1.72-12.01; p = 0.002). There were no differences between both groups regarding the bleeding events. CONCLUSION: In the AHCT setting, we hypothesize that BC-PCs transfusion, when compared to PRP-PCs, results in higher CCI and reduced donor exposure, but provides no significant benefit regarding bleeding outcome.


Assuntos
Buffy Coat , Transplante de Células-Tronco Hematopoéticas , Hemorragia/prevenção & controle , Transfusão de Plaquetas , Plasma Rico em Plaquetas , Adulto , Aloenxertos , Feminino , Doença Enxerto-Hospedeiro/sangue , Doença Enxerto-Hospedeiro/prevenção & controle , Hemorragia/sangue , Humanos , Masculino
16.
J Gen Intern Med ; 33(6): 847-854, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29569024

RESUMO

BACKGROUND: Soluble fibrin monomer complex (SFMC) is a biomarker of fibrin formation abnormally elevated in clinical situations of hypercoagulability. OBJECTIVE: We investigated the association and predictive performance of SFMC for stroke, adverse cardiovascular events, cardiovascular mortality and all-cause mortality in a cohort of patients with atrial fibrillation (AF) receiving vitamin K antagonist (VKA) anticoagulant therapy. DESIGN: During the second semester of 2007, we included 1226 AF outpatients stable on VKAs (INR 2.0-3.0) over a period of 6 months. SFMC levels were assessed at baseline. During 6.5 (IQR 4.4-8.0) years of follow-up, we recorded all ischemic strokes, adverse cardiovascular events (composite of stroke, acute heart failure, acute coronary syndrome and cardiovascular death), cardiovascular deaths and all-cause deaths. PARTICIPANTS: All patients were recruited consecutively. We excluded patients with rheumatic mitral valves, prosthetic heart valves, acute coronary syndrome, stroke, hemodynamic instability, hospital admissions or surgical interventions within the preceding 6 months. MAIN MEASURES: SFMC levels were measured in plasma by immunoturbidimetry in an automated coagulometer (STALiatestFM, Diagnostica Stago, Asnieres, France). KEY RESULTS: We recorded 121 (1.52%/year) ischemic strokes, 257 (3.23%/year) cardiovascular events, 67 (0.84%/year) cardiovascular deaths and 486 (6.10%/year) all-cause deaths. SFMC >12 µg/mL was not associated with stroke but was associated with higher risk of cardiovascular events (HR 1.72, 95% CI 1.31-2.26), cardiovascular mortality (HR 2.16, 95% CI 1.30-3.57) and all-cause mortality (HR 1.26, 95% CI 1.03-1.55). When SFMC >12 µg/mL was added to the CHA2DS2-VASc, there were significant improvements in predictive performance, sensitivity and reclassification for adverse cardiovascular events (c-index: 0.645 vs. 0.660, p = 0.010; IDI = 0.013, p < 0.001; NRI = 0.121, p < 0.001) and cardiovascular mortality (c-index: 0.661 vs. 0.691, p = 0.006; IDI = 0.009, p = 0.049; NRI = 0.217, p < 0.001), but decision curves demonstrated a similar net benefit and clinical usefulness. CONCLUSIONS: In AF patients taking VKAs, high SFMC levels were associated with the risk of adverse cardiovascular events, cardiovascular mortality and all-cause mortality. The addition of SFMC to the CHA2DS2-VASc score improved its predictive performance for these outcomes, but failed to show an improvement in clinical usefulness.


Assuntos
Fibrilação Atrial/sangue , Fibrilação Atrial/mortalidade , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/mortalidade , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Mortalidade/tendências , Valor Preditivo dos Testes , Espanha/epidemiologia
17.
Ann Med ; 50(1): 26-34, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28892413

RESUMO

BACKGROUND: Atrial fibrillation (AF)-European guidelines suggest the use of biomarkers to stratify patients for stroke and bleeding risks. We investigated if a multibiomarker strategy improved the predictive performance of CHA2DS2-VASc and HAS-BLED in anticoagulated AF patients. METHODS: We included consecutive patients stabilized for six months on vitamin K antagonists (INRs 2.0-3.0). High sensitivity troponin T, NT-proBNP, interleukin-6, von Willebrand factor concentrations and glomerular filtration rate (eGFR; using MDRD-4 formula) were quantified at baseline. Time in therapeutic range (TTR) was recorded at six months after inclusion. Patients were follow-up during a median of 2375 (IQR 1564-2887) days and all adverse events were recorded. RESULTS: In 1361 patients, adding four blood biomarkers, TTR and MDRD-eGFR, the predictive value of CHA2DS2-VASc increased significantly by c-index (0.63 vs. 0.65; p = .030) and IDI (0.85%; p < .001), but not by NRI (-2.82%; p < .001). The predictive value of HAS-BLED increased up to 1.34% by IDI (p < .001). Nevertheless, the overall predictive value remains modest (c-indexes approximately 0.65) and decision curve analyses found lower net benefit compared with the originals scores. CONCLUSIONS: Addition of biomarkers enhanced the predictive value of CHA2DS2-VASc and HAS-BLED, although the overall improvement was modest and the added predictive advantage over original scores was marginal. Key Messages Recent atrial fibrillation (AF)-European guidelines for the first time suggest the use of biomarkers to stratify patients for stroke and bleeding risks, but their usefulness in real world for risk stratification is still questionable. In this cohort study involving 1361 AF patients optimally anticoagulated with vitamin K antagonists, adding high sensitivity troponin T, N-terminal pro-B-type natriuretic peptide, interleukin 6, von Willebrand factor, glomerular filtration rate (by the MDRD-4 formula) and time in therapeutic range, increased the predictive value of CHA2DS2-VASc for cardiovascular events, but not the predictive value of HAS-BLED for major bleeding. Reclassification analyses did not show improvement adding multiple biomarkers. Despite the improvement observed, the added predictive advantage is marginal and the clinical usefulness and net benefit over current clinical scores is lower.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Biomarcadores/sangue , Hemorragia/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Hemorragia/induzido quimicamente , Humanos , Interleucina-6/metabolismo , Coeficiente Internacional Normatizado/estatística & dados numéricos , Masculino , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Valor Preditivo dos Testes , Medição de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/etiologia , Troponina T/metabolismo , Vitamina K/antagonistas & inibidores , Fator de von Willebrand/metabolismo
18.
Clin Case Rep ; 5(8): 1258-1260, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28781837

RESUMO

The dismal outcome of pleuropericardial extramedullary multiple myeloma (EMM) reflects both the selection of resistant disease and absence of useful drugs. Carfilzomib and dexamethasone should be explored in advanced EMM patients, even for bortezomib-resistant patients, as may provide much longer overall survival than previously reported treatments.

19.
Sensors (Basel) ; 17(8)2017 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-28796177

RESUMO

In this paper, we address the generation of semantic labels describing the headgear accessories carried out by people in a scene under surveillance, only using depth information obtained from a Time-of-Flight (ToF) camera placed in an overhead position. We propose a new method for headgear accessories classification based on the design of a robust processing strategy that includes the estimation of a meaningful feature vector that provides the relevant information about the people's head and shoulder areas. This paper includes a detailed description of the proposed algorithmic approach, and the results obtained in tests with persons with and without headgear accessories, and with different types of hats and caps. In order to evaluate the proposal, a wide experimental validation has been carried out on a fully labeled database (that has been made available to the scientific community), including a broad variety of people and headgear accessories. For the validation, three different levels of detail have been defined, considering a different number of classes: the first level only includes two classes (hat/cap, and no hat/cap), the second one considers three classes (hat, cap and no hat/cap), and the last one includes the full class set with the five classes (no hat/cap, cap, small size hat, medium size hat, and large size hat). The achieved performance is satisfactory in every case: the average classification rates for the first level reaches 95.25%, for the second one is 92.34%, and for the full class set equals 84.60%. In addition, the online stage processing time is 5.75 ms per frame in a standard PC, thus allowing for real-time operation.

20.
Am J Hematol ; 90(8): 686-90, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25925613

RESUMO

Bone marrow infiltration (BMI), categorized as an extra-nodal site, affects stage and is associated with poor prognosis in newly diagnosed lymphoma patients. We have evaluated the accuracy of PET/CT and bone marrow biopsy (BMB) to assess BMI in 372 lymphoma patients [140 Hodgkin Lymphoma (HL) and 232 High Grade B-cell non-Hodgkin Lymphoma (HG B-NHL), among them 155 Diffuse Large B-Cell Lymphoma (DLCL)]. For HL cases, and taking into account PET/CT, sensitivity, negative predictive value (NPV) and accuracy were 96.7, 99.3, and 99.3% while those of BMB were 32.3, 83.8, and 85%, respectively. For HG B-NHL and considering PET/CT, sensitivity, NPV, and accuracy were 52.7, 81.7, and 84.1%, while those of BMB were 77.6, 90.2, and 90.7%, respectively. In the HG B-NHL group, 25 patients would have been under-staged without BMB. These results lead us to recommend PET/CT and the avoidance of BMB to assess BMI in HL. In the case of HG B-NHL, bone marrow status should be assessed firstly by means of PET/CT; only in either focal or diffuse PET/CT with low borderline SUV max values or in negative cases, should BMB be carried out afterwards. In the HG B-NHL setting and at the present moment, both techniques are complementary.


Assuntos
Medula Óssea/patologia , Doença de Hodgkin/diagnóstico , Linfoma não Hodgkin/diagnóstico , Adolescente , Adulto , Idoso , Biópsia , Feminino , Fluordesoxiglucose F18/metabolismo , Doença de Hodgkin/metabolismo , Doença de Hodgkin/patologia , Humanos , Linfoma não Hodgkin/classificação , Linfoma não Hodgkin/metabolismo , Linfoma não Hodgkin/patologia , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Gradação de Tumores , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
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