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1.
BMJ Open ; 11(3): e045120, 2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33674378

RESUMO

OBJECTIVES: Lung ultrasound (LUS) is a portable, low-cost respiratory imaging tool but is challenged by user dependence and lack of diagnostic specificity. It is unknown whether the advantages of LUS implementation could be paired with deep learning (DL) techniques to match or exceed human-level, diagnostic specificity among similar appearing, pathological LUS images. DESIGN: A convolutional neural network (CNN) was trained on LUS images with B lines of different aetiologies. CNN diagnostic performance, as validated using a 10% data holdback set, was compared with surveyed LUS-competent physicians. SETTING: Two tertiary Canadian hospitals. PARTICIPANTS: 612 LUS videos (121 381 frames) of B lines from 243 distinct patients with either (1) COVID-19 (COVID), non-COVID acute respiratory distress syndrome (NCOVID) or (3) hydrostatic pulmonary edema (HPE). RESULTS: The trained CNN performance on the independent dataset showed an ability to discriminate between COVID (area under the receiver operating characteristic curve (AUC) 1.0), NCOVID (AUC 0.934) and HPE (AUC 1.0) pathologies. This was significantly better than physician ability (AUCs of 0.697, 0.704, 0.967 for the COVID, NCOVID and HPE classes, respectively), p<0.01. CONCLUSIONS: A DL model can distinguish similar appearing LUS pathology, including COVID-19, that cannot be distinguished by humans. The performance gap between humans and the model suggests that subvisible biomarkers within ultrasound images could exist and multicentre research is merited.


Assuntos
COVID-19/diagnóstico por imagem , Aprendizado Profundo , Pulmão/diagnóstico por imagem , Redes Neurais de Computação , Edema Pulmonar/diagnóstico por imagem , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Canadá , Diagnóstico Diferencial , Humanos
2.
Proc Natl Acad Sci U S A ; 118(5)2021 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-33468630

RESUMO

Precise, quantitative measurements of the hydration status of skin can yield important insights into dermatological health and skin structure and function, with additional relevance to essential processes of thermoregulation and other features of basic physiology. Existing tools for determining skin water content exploit surrogate electrical assessments performed with bulky, rigid, and expensive instruments that are difficult to use in a repeatable manner. Recent alternatives exploit thermal measurements using soft wireless devices that adhere gently and noninvasively to the surface of the skin, but with limited operating range (∼1 cm) and high sensitivity to subtle environmental fluctuations. This paper introduces a set of ideas and technologies that overcome these drawbacks to enable high-speed, robust, long-range automated measurements of thermal transport properties via a miniaturized, multisensor module controlled by a long-range (∼10 m) Bluetooth Low Energy system on a chip, with a graphical user interface to standard smartphones. Soft contact to the surface of the skin, with almost zero user burden, yields recordings that can be quantitatively connected to hydration levels of both the epidermis and dermis, using computational modeling techniques, with high levels of repeatability and insensitivity to ambient fluctuations in temperature. Systematic studies of polymers in layered configurations similar to those of human skin, of porcine skin with known levels of hydration, and of human subjects with benchmarks against clinical devices validate the measurement approach and associated sensor hardware. The results support capabilities in characterizing skin barrier function, assessing severity of skin diseases, and evaluating cosmetic and medication efficacy, for use in the clinic or in the home.


Assuntos
Eletrônica , Pele/patologia , Água , Tecnologia sem Fio , Adolescente , Adulto , Pré-Escolar , Análise de Elementos Finitos , Humanos , Temperatura
3.
Ear Nose Throat J ; 100(5): 314-319, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33356521

RESUMO

OBJECTIVES: Corticosteroids represent one of the mainstays of medical management of chronic rhinosinusitis (CRS) in both locally acting topical and systemic derivations. The application of topical corticosteroids is limited by a variety of factors including patient compliance, positioning, and nasal anatomy. Systemic corticosteroids confer a risk of medical complication that restricts their ability to be used repeatedly. The objective of this publication is to review the evolution of the in-office intranasal placement of corticosteroids in the management of CRS. The efficacy, outcomes, and safety of a variety of corticosteroid-containing devices meant to be placed in an office setting are reviewed. METHODS: Pertinent literature was reviewed and summarized beginning with the earliest reports of direct intralesional injection of corticosteroids up through manufactured modern-day bioresorbable implants that contain corticosteroids. RESULTS: The utilization of in-office placement of corticosteroid-containing material and implants has rapidly evolved since the concept was introduced, particularly in the last decade. Modern-day corticosteroid-eluting implants are reliably placed in the office, yield results across a range of objective and subjective outcomes, may decrease the need for revision endoscopic sinus surgery, and have a favorable safety profile. CONCLUSIONS: In-office placement of corticosteroid-containing stents are a viable treatment option for select patients, particularly those wishing to avoid revision surgery, and should be considered an important adjunct for treatment of refractory CRS in an otolaryngologist's armamentarium.


Assuntos
Administração Intranasal/métodos , Corticosteroides/administração & dosagem , Procedimentos Cirúrgicos Ambulatórios/métodos , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Doença Crônica , Stents Farmacológicos , Humanos , Resultado do Tratamento
4.
Sci Rep ; 10(1): 16350, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33005006

RESUMO

Chronic rhinosinusitis (CRS) is a common condition associated with inflammation and tissue remodeling of the nose and paranasal sinuses, frequently occurring with nasal polyps and allergies. Here we investigate inflammation and the protease profile in nasal tissues and plasma from control non-CRS patients and CRS patients. Gene expression for several cytokines, proteases, and antiproteases was quantified in nasal tissue from non-CRS and CRS subjects with nasal polyps. Elevated expression of S100A9, IL1A, MMP3, MMP7, MMP11, MMP25, MMP28, and CTSK was observed in tissue from CRS subjects with nasal polyps compared to control tissue. Tissue protein analysis confirmed elevated levels of these targets compared to controls, and increased MMP3 and MMP7 observed in CRS subjects with nasal polyps compared to CRS subjects without polyps. Plasma concentrations of MMP3 and MMP7 were elevated in the CRS groups compared to controls. The nasal cell line, CCL-30, was exposed to S100A9 protein, resulting in increased MMP3, MMP7, and CTSK gene expression and elevated proliferation. Silencing MMP3 significantly reduced S100A9-mediated cell proliferation. Therefore, the elevated expression of S100A9 and MMPs are observed in CRS nasal tissue and S100A9 stimulated MMP3 responses to contribute to elevated nasal cell proliferation.


Assuntos
Calgranulina B/metabolismo , Metaloproteinases da Matriz/metabolismo , Mucosa Nasal/metabolismo , Pólipos Nasais/metabolismo , Rinite/metabolismo , Sinusite/metabolismo , Adulto , Citocinas/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
ERJ Open Res ; 6(3)2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32832531

RESUMO

Sinusitis is a common condition associated with inflammation in the sinuses and nasal mucosa. Calpain 14 is highly expressed in the nasal tissues of sinusitis subjects. Calpain 14 is associated with epithelial barrier disruption. https://bit.ly/3fyAwVO.

6.
Geoforum ; 117: 285-286, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32327764

RESUMO

In a recent paper in Geoforum, Margulies et al. (2019) outline what they perceive as a bias toward an "Asian super consumer". They argue that wildlife trade demand reduction campaigns are unfocused, untargeted, and therefore have a tendency to place blame on people of colour and communities in the Global South as key actors in driving illegal wildlife trade. As researchers and practitioners, we have been studying the demand for wildlife and wildlife products for many years. While we agree that it is vitally important to consider the cultural nuances of illegal and unsustainable wildlife trade and to operate in a manner that is respectful toward different cultures, we believe that the authors have overlooked the fact that modern wildlife trade demand reduction campaigns are already conducting in-depth research and using it to target their campaigns to specific groups.

7.
Ophthalmology ; 126(12): 1627-1639, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31561879

RESUMO

PURPOSE: To develop and validate a deep learning (DL) algorithm that predicts referable glaucomatous optic neuropathy (GON) and optic nerve head (ONH) features from color fundus images, to determine the relative importance of these features in referral decisions by glaucoma specialists (GSs) and the algorithm, and to compare the performance of the algorithm with eye care providers. DESIGN: Development and validation of an algorithm. PARTICIPANTS: Fundus images from screening programs, studies, and a glaucoma clinic. METHODS: A DL algorithm was trained using a retrospective dataset of 86 618 images, assessed for glaucomatous ONH features and referable GON (defined as ONH appearance worrisome enough to justify referral for comprehensive examination) by 43 graders. The algorithm was validated using 3 datasets: dataset A (1205 images, 1 image/patient; 18.1% referable), images adjudicated by panels of GSs; dataset B (9642 images, 1 image/patient; 9.2% referable), images from a diabetic teleretinal screening program; and dataset C (346 images, 1 image/patient; 81.7% referable), images from a glaucoma clinic. MAIN OUTCOME MEASURES: The algorithm was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity for referable GON and glaucomatous ONH features. RESULTS: The algorithm's AUC for referable GON was 0.945 (95% confidence interval [CI], 0.929-0.960) in dataset A, 0.855 (95% CI, 0.841-0.870) in dataset B, and 0.881 (95% CI, 0.838-0.918) in dataset C. Algorithm AUCs ranged between 0.661 and 0.973 for glaucomatous ONH features. The algorithm showed significantly higher sensitivity than 7 of 10 graders not involved in determining the reference standard, including 2 of 3 GSs, and showed higher specificity than 3 graders (including 1 GS), while remaining comparable to others. For both GSs and the algorithm, the most crucial features related to referable GON were: presence of vertical cup-to-disc ratio of 0.7 or more, neuroretinal rim notching, retinal nerve fiber layer defect, and bared circumlinear vessels. CONCLUSIONS: A DL algorithm trained on fundus images alone can detect referable GON with higher sensitivity than and comparable specificity to eye care providers. The algorithm maintained good performance on an independent dataset with diagnoses based on a full glaucoma workup.


Assuntos
Aprendizado Profundo , Glaucoma de Ângulo Aberto/diagnóstico , Oftalmologistas , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Especialização , Idoso , Área Sob a Curva , Conjuntos de Dados como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Curva ROC , Encaminhamento e Consulta , Células Ganglionares da Retina/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade
8.
JAMA Ophthalmol ; 137(9): 987-993, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31194246

RESUMO

Importance: More than 60 million people in India have diabetes and are at risk for diabetic retinopathy (DR), a vision-threatening disease. Automated interpretation of retinal fundus photographs can help support and scale a robust screening program to detect DR. Objective: To prospectively validate the performance of an automated DR system across 2 sites in India. Design, Setting, and Participants: This prospective observational study was conducted at 2 eye care centers in India (Aravind Eye Hospital and Sankara Nethralaya) and included 3049 patients with diabetes. Data collection and patient enrollment took place between April 2016 and July 2016 at Aravind and May 2016 and April 2017 at Sankara Nethralaya. The model was trained and fixed in March 2016. Interventions: Automated DR grading system compared with manual grading by 1 trained grader and 1 retina specialist from each site. Adjudication by a panel of 3 retinal specialists served as the reference standard in the cases of disagreement. Main Outcomes and Measures: Sensitivity and specificity for moderate or worse DR or referable diabetic macula edema. Results: Of 3049 patients, 1091 (35.8%) were women and the mean (SD) age for patients at Aravind and Sankara Nethralaya was 56.6 (9.0) years and 56.0 (10.0) years, respectively. For moderate or worse DR, the sensitivity and specificity for manual grading by individual nonadjudicator graders ranged from 73.4% to 89.8% and from 83.5% to 98.7%, respectively. The automated DR system's performance was equal to or exceeded manual grading, with an 88.9% sensitivity (95% CI, 85.8-91.5), 92.2% specificity (95% CI, 90.3-93.8), and an area under the curve of 0.963 on the data set from Aravind Eye Hospital and 92.1% sensitivity (95% CI, 90.1-93.8), 95.2% specificity (95% CI, 94.2-96.1), and an area under the curve of 0.980 on the data set from Sankara Nethralaya. Conclusions and Relevance: This study shows that the automated DR system generalizes to this population of Indian patients in a prospective setting and demonstrates the feasibility of using an automated DR grading system to expand screening programs.

9.
Int J Pediatr Otorhinolaryngol ; 124: 190-192, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31202037

RESUMO

OBJECTIVES: Upper lip tie, without concomitant tongue tie, can prevent proper flanging of the upper lip during breastfeeding, resulting in a poor seal and suck for the infant with nipple pain and maternal dissatisfaction. Due to the lack of published studies on this subject, we report our technique and outcomes for in-office release of isolated upper lip tie. METHODS: Using CPT Code 40,806 for 'incision of labial frenulum', 22 mother-infant dyads with infant age under 60 days with breastfeeding problems and a restrictive upper lip frenum were identified. These infants underwent in-office release of upper lip tie as detailed below. Outcomes of the procedure were assessed by a telephone survey to mothers within the 4-week period post-procedure. RESULTS: 82% of mothers reported an improved latch and 73% noted increased satisfaction with breastfeeding. Lip pain, if present, resolved within 24 h for most children. Recurrence was reported by 9% of mothers; no infection or other complications occurred. CONCLUSION: Upper lip frenotomy, in properly selected infants, has favorable short-term outcomes with mild transient discomfort and a low rate of recurrence. Since our study was short-term and did not include a control group, we are unable to comment on procedure efficacy or long-term impact.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Aleitamento Materno , Freio Labial/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Mucosa Bucal/cirurgia , Recidiva , Comportamento de Sucção , Resultado do Tratamento
10.
J Endocr Soc ; 3(4): 748-762, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30937420

RESUMO

Currently, the early preclinical detection of left ventricular dysfunction is difficult because biomarkers are not specific for the cardiomyopathic process. The underlying molecular mechanisms leading to heart failure remain elusive, highlighting the need for identification of cardiac-specific markers. The growth hormone secretagogue receptor (GHSR) and its ligand ghrelin are present in cardiac tissue and are known to contribute to myocardial energetics. Here, we examined tissue ghrelin-GHSR levels as specific markers of cardiac dysfunction in patients who underwent cardiac transplantation. Samples of cardiac tissue were obtained from 10 patients undergoing cardiac transplant at the time of organ harvesting and during serial posttransplant biopsies. Quantitative fluorescence microscopy using a fluorescent ghrelin analog was used to measure levels of GHSR, and immunofluorescence was used to measure levels of ghrelin, B-type natriuretic peptide (BNP), and tissue markers of cardiomyocyte contractility and growth. GHSR and ghrelin expression levels were highly variable in the explanted heart, less in the grafted heart biopsies. GHSR and ghrelin were strongly positively correlated, and both markers were negatively correlated with left ventricular ejection fraction. Ghrelin had stronger positive correlations than BNP with the signaling markers for contractility and growth. These data suggest that GHSR-ghrelin have potential use as an integrated marker of cardiac dysfunction. Interestingly, tissue ghrelin appeared to be a more sensitive indicator than BNP to the biochemical processes that are characteristic of heart failure. This work allows for further use of ghrelin-GHSR to interrogate cardiac-specific biochemical mechanisms in preclinical stages of heart failure (HF).

11.
Ophthalmology ; 126(4): 552-564, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30553900

RESUMO

PURPOSE: To understand the impact of deep learning diabetic retinopathy (DR) algorithms on physician readers in computer-assisted settings. DESIGN: Evaluation of diagnostic technology. PARTICIPANTS: One thousand seven hundred ninety-six retinal fundus images from 1612 diabetic patients. METHODS: Ten ophthalmologists (5 general ophthalmologists, 4 retina specialists, 1 retina fellow) read images for DR severity based on the International Clinical Diabetic Retinopathy disease severity scale in each of 3 conditions: unassisted, grades only, or grades plus heatmap. Grades-only assistance comprised a histogram of DR predictions (grades) from a trained deep-learning model. For grades plus heatmap, we additionally showed explanatory heatmaps. MAIN OUTCOME MEASURES: For each experiment arm, we computed sensitivity and specificity of each reader and the algorithm for different levels of DR severity against an adjudicated reference standard. We also measured accuracy (exact 5-class level agreement and Cohen's quadratically weighted κ), reader-reported confidence (5-point Likert scale), and grading time. RESULTS: Readers graded more accurately with model assistance than without for the grades-only condition (P < 0.001). Grades plus heatmaps improved accuracy for patients with DR (P < 0.001), but reduced accuracy for patients without DR (P = 0.006). Both forms of assistance increased readers' sensitivity moderate-or-worse DR: unassisted: mean, 79.4% [95% confidence interval (CI), 72.3%-86.5%]; grades only: mean, 87.5% [95% CI, 85.1%-89.9%]; grades plus heatmap: mean, 88.7% [95% CI, 84.9%-92.5%] without a corresponding drop in specificity (unassisted: mean, 96.6% [95% CI, 95.9%-97.4%]; grades only: mean, 96.1% [95% CI, 95.5%-96.7%]; grades plus heatmap: mean, 95.5% [95% CI, 94.8%-96.1%]). Algorithmic assistance increased the accuracy of retina specialists above that of the unassisted reader or model alone; and increased grading confidence and grading time across all readers. For most cases, grades plus heatmap was only as effective as grades only. Over the course of the experiment, grading time decreased across all conditions, although most sharply for grades plus heatmap. CONCLUSIONS: Deep learning algorithms can improve the accuracy of, and confidence in, DR diagnosis in an assisted read setting. They also may increase grading time, although these effects may be ameliorated with experience.


Assuntos
Algoritmos , Aprendizado Profundo , Retinopatia Diabética/classificação , Retinopatia Diabética/diagnóstico , Diagnóstico por Computador/métodos , Feminino , Humanos , Masculino , Oftalmologistas/normas , Fotografação/métodos , Curva ROC , Padrões de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
12.
Int J Popul Data Sci ; 4(1): 939, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-34095529

RESUMO

Background: Income is one of the most important measures of well-being, but it is notoriously difficult to measure accurately. In the United States, income data are available from surveys, tax records, and government programs, but each of these sources has important strengths and major limitations when used alone. Objectives: We link multiple data sources to develop the Comprehensive Income Dataset (CID), a prototype for a restricted micro-level dataset that combines the demographic detail of survey data with the accuracy of administrative measures. Methods: By incorporating information on nearly all taxable income, tax credits, and cash and in-kind government transfers, the CID surpasses previous efforts to provide an accurate and comprehensive measure of income for the population of United States individuals, families, and households. We also evaluate the accuracy of different income sources and imputation methods. Conclusions: While still in development, we envision the CID enhancing Census Bureau surveys and statistics by investigating measurement error, improving imputation methods, and augmenting surveys with the best possible estimates of income. It can also be used for policy related research, such as forecasting and simulating changes in programs and taxes. Finally, the CID has substantial advantages over other sources to analyze numerous research topics, including poverty, inequality, mobility, and the distributional consequences of government transfers and taxes.

13.
Mol Imaging ; 17: 1536012118809587, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30394854

RESUMO

One-third of patients with heart disease develop heart failure, which is diagnosed through imaging and detection of circulating biomarkers. Imaging strategies reveal morphologic and functional changes but fall short of detecting molecular abnormalities that can lead to heart failure, and circulating biomarkers are not cardiac specific. Thus, there is critical need for biomarkers that are endogenous to myocardial tissues. The cardiac growth hormone secretagogue receptor 1a (GHSR1a), which binds the hormone ghrelin, is a potential biomarker for heart failure. We have synthesized and characterized a novel ghrelin peptidomimetic tracer, an 18F-labeled analogue of G-7039, for positron emission tomography (PET) imaging of cardiac GHSR1a. In vitro analysis showed enhanced serum stability compared to natural ghrelin and significantly increased cellular uptake in GHSR1a-expressing OVCAR cells. Biodistribution studies in mice showed that tissue uptake of the tracer was independent of circulating ghrelin levels, and there was negligible cardiac uptake and high uptake in the liver, intestines, and kidneys. Specificity of tracer uptake was assessed using ghsr -/- mice; both static and dynamic PET imaging revealed no difference in cardiac uptake, and there was no significant correlation between cardiac standardized uptake values and GHSR1a expression. Our study lays the groundwork for further refinement of peptidomimetic PET tracers targeting cardiac GHSR1a.


Assuntos
Radioisótopos de Flúor/química , Grelina/química , Miocárdio/metabolismo , Peptidomiméticos/química , Receptores de Grelina/metabolismo , Animais , Biomarcadores/metabolismo , Linhagem Celular Tumoral , Jejum , Comportamento Alimentar , Feminino , Grelina/sangue , Glucagon/sangue , Peptídeo 1 Semelhante ao Glucagon/sangue , Humanos , Insulina/sangue , Camundongos Endogâmicos C57BL , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Fatores de Tempo , Distribuição Tecidual
14.
Annu Int Conf IEEE Eng Med Biol Soc ; 2018: 5826-5829, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30441660

RESUMO

Differential gene expression profiles of mice in active and metabolically suppressed states were evaluated in response to a sublethal dose of gamma radiation to identify the beneficial protective effects of suspended animation. Results demonstrated that nearly 90% suppression of metabolic functions in mice lead to significant changes in gene expression profile of different metabolic pathways responsible for adaptation and maintenance of homeostasis in the new physiological state of suspended animation. This state was found sustainable during 18 hrs of experiment and can be reversed back to the normal active state without any visible effects on physiological and behavioral functions of mice. Gene expression during induced states was gathered via Illumina microarray methods. Further analysis of differential gene expressions yielded a result that a hypometabolic state may be responsible for short term and long-term radioprotection.


Assuntos
Raios gama , Redes e Vias Metabólicas/efeitos da radiação , Transcriptoma/efeitos da radiação , Animais , Camundongos , Análise em Microsséries
15.
Am J Rhinol Allergy ; 32(6): 485-490, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30160171

RESUMO

BACKGROUND: The use of systemic corticosteroids remains controversial in the treatment of orbital complications of sinusitis. OBJECTIVE: To compare and contrast the current practice patterns of the use of systemic corticosteroid in the management of orbital complications of acute bacterial rhinosinusitis (ABRS) among fellowship-trained members of American Society of Pediatric Otolaryngology (ASPO) and American Rhinologic Society (ARS). STUDY DESIGN: Cross-sectional survey. METHODS: A web-based survey was electronically distributed to 497 members of ASPO and 845 members of ARS focusing on the practice habits and opinions regarding the use of systemic corticosteroids in the treatment of ABRS with orbital complications in children and adults. RESULTS: Survey completion rate was 19.1% among ASPO membership and 10.3% from ARS; 45% of respondents utilized steroids almost always or frequently in children and 36% of the time in adults. Most commonly reported indication for the use of steroid was vision change. Fellowship-trained pediatric otolaryngologists are 2.88 times more likely to prescribe corticosteroids for children than rhinologists ( P < .02). The perceived level of evidence in the literature was split between expert opinions and cohort studies. CONCLUSION: In orbital complications of ABRS, practice patterns of the use of steroid differ significantly between fellowship-trained ASPO and ARS members with respect to its use in children. Overall, corticosteroids are administered with significant frequency, although there is little actual or perceived evidence to support their safety or efficacy. In alignment of practicing evidence-based medicine, further studies are needed to guide the use of steroids in complicated ABRS with respect to timing, dosing, route, duration, and indication.


Assuntos
Corticosteroides/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Órbita/patologia , Otorrinolaringologistas , Padrões de Prática Médica , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Doença Aguda , Adulto , Infecções Bacterianas/complicações , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Órbita/microbiologia , Guias de Prática Clínica como Assunto , Rinite/complicações , Sinusite/complicações
16.
Int J Pediatr Otorhinolaryngol ; 111: 93-96, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29958623

RESUMO

INTRODUCTION/OBJECTIVE: In laryngotracheal reconstruction (LTR) with sutureless posterior cricoid grafting (PCG), the inset graft's thickness may not precisely approximate the anterior-posterior depth of the divided posterior cricoid plate. This case series highlights this phenomenon and describes the clinical profiles and airway characteristics of children with similar subglottic stenosis grades undergoing LTR with PCG with varying degrees of graft-cricoid mismatch. METHODS: This is a case series with retrospective chart review of children who underwent LTR with PCG by a single surgeon at a tertiary care urban children's hospital from 2008 to 2014. RESULTS: Twenty-one patients with twenty-two operations were identified. Varying degrees of graft-cricoid mismatch were present. Of the 22 operations, 15 were classified as grade I (flush), 5 grade II (<3 mm), and 2 grade III (>3 mm). Median preoperative grade of stenosis was III in all groups. Mean one month granulation grade was 1.84, compared to 1.92 in grade I, 1.6 in grade II mismatch, 2 in grade III mismatch, and 1.7 in any mismatch (p = 0.65). Mean follow up was 24 months. CONCLUSION: Graft-cricoid mismatch may occur at variable degrees during laryngotracheal reconstruction utilizing sutureless posterior cricoid grafting. Our preliminary data suggest several millimeters of graft-cricoid mismatch can be tolerated without significantly affecting postoperative granulation formation or adding to postoperative morbidity.


Assuntos
Cartilagem Cricoide/transplante , Laringoestenose/cirurgia , Laringe/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traqueia/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
17.
J Endocr Soc ; 2(2): 178-189, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29450407

RESUMO

Ghrelin and its receptor, the growth hormone secretagogue receptor 1a (GHSR1a), are present in cardiac tissue. Activation of GHSR1a by ghrelin promotes cardiomyocyte contractility and survival, and changes in myocardial GHSR1a and circulating ghrelin track with end-stage heart failure, leading to the hypothesis that GHSR1a is a biomarker for heart failure. We hypothesized that GHSR1a could also be a biomarker for diabetic cardiomyopathy (DCM). We used two models of streptozotocin (STZ)-induced DCM: group 1, adult mice treated with 35 mg/kg STZ for 3 days; and group 2, neonatal mice treated with 70 mg/kg STZ at days 2 and 5 after birth. In group 1, mild fasting hyperglycemia (11 mM) was first detected 8 weeks after the last injection, and in group 2, severe fasting hyperglycemia (20 mM) was first detected 1 to 3 weeks after the last injection. In group 1, left ventricular function was slightly impaired as measured by echocardiography, and Western blot analysis showed a significant decrease in myocardial GHSR1a. In group 2, GHSR1a levels were also decreased as assessed by Cy5-ghrelin(1-19) fluorescence microscopy, and there was a significant negative correlation between GHSR1a levels and glucose tolerance. There were significant positive correlations between GHSR1a and ghrelin and between GHSR1a and sarcoplasmic reticulum Ca2+-ATPase 2a (SERCA2a), a marker for contractility, but not between GHSR1a and B-type natriuretic peptide, a marker for heart failure. We conclude that the subclinical stage of DCM is accompanied by alterations in the myocardial ghrelin-GHSR1a system, suggesting the possibility of a biomarker for DCM.

19.
Int J Pediatr Otorhinolaryngol ; 93: 37-41, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28109495

RESUMO

INTRODUCTION: Infants with bilateral vocal fold immobility (BVFI) often have poor swallow function in addition to potential airway compromise. While there are several reports on BVFI and its effect on patients' airway status, little is known about long term swallow function. OBJECTIVES: We aim to characterize the swallowing function over time in pediatric patients with bilateral vocal fold immobility. METHODS: A retrospective review of medical records of infants diagnosed with BVFI at a tertiary care children's hospital between 2005 and 2014 was conducted. Patient demographics, nature and etiology of immobility, laryngoscopy findings, comorbidities, and swallow outcomes at diagnosis and follow-up were recorded. Swallowing outcomes as measured by presence or absence of a gastrostomy tube were compared by etiology, vocal fold status, and normal or developmentally delay using the Fisher's exact test. RESULTS: 110 patients with a diagnosis of vocal fold immobility were identified. Twenty-nine (26%) had BVFI and twenty-three had complete medical records. Etiologies of vocal fold immobility include cardiac related in 13% (3/23), idiopathic in 30% (7/23) prolonged intubation in 26% (6/23) central neurologic in 22% (5/23), trauma in 4% (1/23), and infection in 4% (1/23). Average follow-up time was 44 months (range 5-94 months). Ten patients (56.5%) required a gastrostomy tube at time of diagnosis. Of this cohort who received gastrostomy tubes, three (30%) ultimately transitioned to complete oral feeds. Return of vocal fold mobility did not correlate with swallow function. In those with non-neurologic etiologies, the need for gastrostomy tube at end of follow up was unlikely. There was a statistically significant difference in the percentage of gastrostomy tube-free children at most recent follow up in patients who were normally developed (86%) versus those who were developmentally delayed (33%) (p = 0.02). CONCLUSION: We characterized the swallowing function of 23 pediatric patients with BVFI. Comorbidities are significant predictors of long term swallow function in patients with BVFI while return of vocal fold function is not.


Assuntos
Transtornos de Deglutição/fisiopatologia , Deglutição/fisiologia , Paralisia das Pregas Vocais/fisiopatologia , Prega Vocal/fisiopatologia , Criança , Feminino , Seguimentos , Gastrostomia/estatística & dados numéricos , Humanos , Lactente , Laringoscopia , Masculino , Estudos Retrospectivos
20.
JAMA ; 316(22): 2402-2410, 2016 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-27898976

RESUMO

Importance: Deep learning is a family of computational methods that allow an algorithm to program itself by learning from a large set of examples that demonstrate the desired behavior, removing the need to specify rules explicitly. Application of these methods to medical imaging requires further assessment and validation. Objective: To apply deep learning to create an algorithm for automated detection of diabetic retinopathy and diabetic macular edema in retinal fundus photographs. Design and Setting: A specific type of neural network optimized for image classification called a deep convolutional neural network was trained using a retrospective development data set of 128 175 retinal images, which were graded 3 to 7 times for diabetic retinopathy, diabetic macular edema, and image gradability by a panel of 54 US licensed ophthalmologists and ophthalmology senior residents between May and December 2015. The resultant algorithm was validated in January and February 2016 using 2 separate data sets, both graded by at least 7 US board-certified ophthalmologists with high intragrader consistency. Exposure: Deep learning-trained algorithm. Main Outcomes and Measures: The sensitivity and specificity of the algorithm for detecting referable diabetic retinopathy (RDR), defined as moderate and worse diabetic retinopathy, referable diabetic macular edema, or both, were generated based on the reference standard of the majority decision of the ophthalmologist panel. The algorithm was evaluated at 2 operating points selected from the development set, one selected for high specificity and another for high sensitivity. Results: The EyePACS-1 data set consisted of 9963 images from 4997 patients (mean age, 54.4 years; 62.2% women; prevalence of RDR, 683/8878 fully gradable images [7.8%]); the Messidor-2 data set had 1748 images from 874 patients (mean age, 57.6 years; 42.6% women; prevalence of RDR, 254/1745 fully gradable images [14.6%]). For detecting RDR, the algorithm had an area under the receiver operating curve of 0.991 (95% CI, 0.988-0.993) for EyePACS-1 and 0.990 (95% CI, 0.986-0.995) for Messidor-2. Using the first operating cut point with high specificity, for EyePACS-1, the sensitivity was 90.3% (95% CI, 87.5%-92.7%) and the specificity was 98.1% (95% CI, 97.8%-98.5%). For Messidor-2, the sensitivity was 87.0% (95% CI, 81.1%-91.0%) and the specificity was 98.5% (95% CI, 97.7%-99.1%). Using a second operating point with high sensitivity in the development set, for EyePACS-1 the sensitivity was 97.5% and specificity was 93.4% and for Messidor-2 the sensitivity was 96.1% and specificity was 93.9%. Conclusions and Relevance: In this evaluation of retinal fundus photographs from adults with diabetes, an algorithm based on deep machine learning had high sensitivity and specificity for detecting referable diabetic retinopathy. Further research is necessary to determine the feasibility of applying this algorithm in the clinical setting and to determine whether use of the algorithm could lead to improved care and outcomes compared with current ophthalmologic assessment.


Assuntos
Algoritmos , Retinopatia Diabética/diagnóstico por imagem , Fundo de Olho , Aprendizado de Máquina , Edema Macular/diagnóstico por imagem , Redes Neurais de Computação , Fotografação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Oftalmologistas , Sensibilidade e Especificidade
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