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1.
Rev Med Suisse ; 17(732): 624-629, 2021 Mar 31.
Artigo em Francês | MEDLINE | ID: mdl-33793099

RESUMO

The development of in vivo skin imaging technologies has been booming for several decades. Their advantages are indisputable, especially as they are non-invasive. Their place is already well established in onco-dermatology and it is just a question of time for them to be used with success in other fields of dermatology, including pediatric dermatology. In this paper we will discuss 3 of these skin imaging techniques used in dermatology at the CHUV, including Optical Coherence Tomography (OCT), Reflectance Confocal Microscopy (RCM) and the most recent: Line-field Confocal Optical Coherence Tomography (LC-OCT).


Assuntos
Dermatologia , Neoplasias Cutâneas , Criança , Humanos , Microscopia Confocal , Pele/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Tomografia de Coerência Óptica
2.
J Vis Exp ; (168)2021 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-33645565

RESUMO

Understanding the ephemeral changes that occur during brain development and maturation requires detailed high-resolution imaging in space and time at cellular and subcellular resolution. Advances in molecular and imaging technologies have allowed us to gain numerous detailed insights into cellular and molecular mechanisms of brain development in the transparent zebrafish embryo. Recently, processes of refinement of neuronal connectivity that occur at later larval stages several weeks after fertilization, which are for example control of social behavior, decision making or motivation-driven behavior, have moved into focus of research. At these stages, pigmentation of the zebrafish skin interferes with light penetration into brain tissue, and solutions for embryonic stages, e.g., pharmacological inhibition of pigmentation, are not feasible anymore. Therefore, a minimally invasive surgical solution for microscopy access to the brain of awake zebrafish is provided that is derived from electrophysiological approaches. In teleosts, skin and soft skull cartilage can be carefully removed by micro-peeling these layers, exposing underlying neurons and axonal tracts without damage. This allows for recording neuronal morphology, including synaptic structures and their molecular contents, and the observation of physiological changes such as Ca2+ transients or intracellular transport events. In addition, interrogation of these processes by means of pharmacological inhibition or optogenetic manipulation is feasible. This brain exposure approach provides information about structural and physiological changes in neurons as well as the correlation and interdependence of these events in live brain tissue in the range of minutes or hours. The technique is suitable for in vivo brain imaging of zebrafish larvae up to 30 days post fertilization, the latest developmental stage tested so far. It, thus, provides access to such important questions as synaptic refinement and scaling, axonal and dendritic transport, synaptic targeting of cytoskeletal cargo or local activity-dependent expression. Therefore, a broad use for this mounting and imaging approach can be anticipated.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/crescimento & desenvolvimento , Imageamento Tridimensional , Pele/diagnóstico por imagem , Crânio/diagnóstico por imagem , Peixe-Zebra/crescimento & desenvolvimento , Anestesia , Animais , Encéfalo/irrigação sanguínea , Larva/fisiologia , Neurônios/fisiologia , Vigília/fisiologia
3.
Sensors (Basel) ; 21(4)2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33670225

RESUMO

The regular monitoring of erythema, one of the most important skin lesions in atopic (allergic) dogs, is essential for successful anti-allergic therapy. The smartphone-based dermatoscopy enables a convenient way to acquire quality images of erythematous skin. However, the image sampling to evaluate erythema severity is still done manually, introducing result variability. In this study, we investigated the correlation between the most popular erythema indices (EIs) and dermatologists' erythema perception, and we measured intra- and inter-rater variability of the currently-used manual image-sampling methods (ISMs). We showed that the EIBRG, based on all three RGB (red, green, and blue) channels, performed the best with an average Spearman coefficient of 0.75 and a typical absolute disagreement of less than 14% with the erythema assessed by clinicians. On the other hand, two image-sampling methods, based on either selecting specific pixels or small skin areas, performed similarly well. They achieved high intra- and inter-rater reliability with the intraclass correlation coefficient (ICC) and Krippendorff's alpha well above 0.90. These results indicated that smartphone-based dermatoscopy could be a convenient and precise way to evaluate skin erythema severity. However, better outlined, or even automated ISMs, are likely to improve the intra- and inter-rater reliability in severe erythematous cases.


Assuntos
Doenças do Cão/diagnóstico por imagem , Eritema/veterinária , Interpretação de Imagem Assistida por Computador , Pele/diagnóstico por imagem , Animais , Cães , Eritema/diagnóstico por imagem , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Manejo de Espécimes
4.
Hautarzt ; 72(3): 199-206, 2021 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-33471130

RESUMO

Optical coherence tomography (OCT) and reflectance confocal laser microscopy (RCM) allow noninvasive imaging diagnostics of the skin. Since the indication for a biopsy in children is generally made cautiously, OCT and KLM can be helpful in the clarification of pediatric skin lesions. In addition, biopsies only represent a snapshot of a small area of the skin, while noninvasive methods allow several locations to be examined over time, so that dynamic changes and the course of therapy can also be determined. In pediatric dermatology, these diagnostic methods are particularly suitable for the clarification of atypical pigment lesions, for infectious dermatoses such as scabies or tinea, and for the diagnosis of inflammatory and degenerative dermatoses.


Assuntos
Dermatologia , Dermatopatias , Criança , Humanos , Microscopia Confocal , Pele/diagnóstico por imagem , Dermatopatias/diagnóstico por imagem , Tomografia de Coerência Óptica
5.
Int J Pharm ; 595: 120242, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33484919

RESUMO

Platelet-rich plasma (PRP) is rich in cytokines and growth factors and is a novel approach for tissue regeneration. It can be used for skin rejuvenation but the large molecular size of the actives limits its topical application. In this study, low-fluence laser-facilitated PRP was delivered to evaluate its effect on absorption through the skin, infection-induced wound, and photoaging. The PRP permeation enhancement was compared for two ablative lasers: fractional (CO2) laser and fully-ablative (Er:YAG) laser. In the Franz cell experiment, pig skin was treated with lasers with superficial ablation followed by the application of recombinant cytokines, growth factors, or PRP. The transport of interferon (IFN)-γ and tumor necrosis factor (TNF)-α was negligible in intact skin and stratum corneum (SC)-stripped skin. Both lasers significantly elevated skin deposition of IFN-γ and TNF-α from PRP, and fully-ablative laser showed a higher penetration enhancement. A similar tendency was found for vascular endothelial growth factor and epidermal growth factor. Er:YAG laser-exposed skin displayed 1.8- and 3.9-fold higher skin deposition of platelet-derived growth factor (PDGF)-BB and transforming growth factor (TGF)-ß1 from PRP, respectively. According to the confocal images, both laser interventions led to an extensive and deep distribution of IFN-γ and PDGF-BB in the skin. In the in vivo methicillin-resistant Staphylococcus aureus (MRSA) infection model, CO2 laser- and Er:YAG laser-assisted PRP delivery reduced bacterial load from 1.8 × 106 to 5.9 × 105 and 1.4 × 104 colony-forming units, respectively. The open wound induced by MRSA was closed by the laser-assisted PRP penetration. In the mouse photoaging model, elastin and collagen deposition were fully restored by combined PRP and full-ablative laser but not by PRP alone and PRP combined with fractional laser. Laser-facilitated PRP delivery even with a low fluence setting can be considered a promising strategy for treating some dermatological disorders.


Assuntos
Terapia com Luz de Baixa Intensidade/métodos , Staphylococcus aureus Resistente à Meticilina/efeitos da radiação , Plasma Rico em Plaquetas/metabolismo , Envelhecimento da Pele/efeitos da radiação , Dermatopatias/terapia , Pele/efeitos da radiação , Infecções Cutâneas Estafilocócicas/terapia , Administração Cutânea , Animais , Terapia Combinada , Citocinas/farmacocinética , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/farmacocinética , Lasers de Gás/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Pele/diagnóstico por imagem , Pele/efeitos dos fármacos , Pele/metabolismo , Absorção Cutânea/efeitos da radiação , Envelhecimento da Pele/efeitos dos fármacos , Suínos , Cicatrização/efeitos dos fármacos , Cicatrização/efeitos da radiação
6.
Elife ; 92020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33317696

RESUMO

The ontogenetic trajectory of a marginal jawbone of Lophosteus superbus (Late Silurian, 422 Million years old), the phylogenetically most basal stem osteichthyan, visualized by synchrotron microtomography, reveals a developmental relationship between teeth and dermal odontodes that is not evident from the adult morphology. The earliest odontodes are two longitudinal founder ridges formed at the ossification center. Subsequent odontodes that are added lingually to the ridges turn into conical teeth and undergo cyclic replacement, while those added labially achieve a stellate appearance. Stellate odontodes deposited directly on the bony plate are aligned with the alternate files of teeth, whereas new tooth positions are inserted into the files of sequential addition when a gap appears. Successive teeth and overgrowing odontodes show hybrid morphologies around the oral-dermal boundary, suggesting signal cross-communication. We propose that teeth and dermal odontodes are modifications of a single system, regulated and differentiated by the oral and dermal epithelia.


Assuntos
Evolução Biológica , Dentição , Peixes/anatomia & histologia , Fósseis , Odontogênese , Pele/anatomia & histologia , Dente/anatomia & histologia , Animais , Filogenia , Pele/diagnóstico por imagem , Síncrotrons , Dente/diagnóstico por imagem , Microtomografia por Raio-X
8.
Medicine (Baltimore) ; 99(39): e22417, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991475

RESUMO

It has become evident that positron emission tomography/computed tomography (PET-CT) using 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) (FDG PET-CT) can detect anti-tumor immune response induced by various immunotherapies. To evaluate whether FDG PET-CT could detect anti-cancer immune response caused by cancer vaccine therapy, we performed a retrospective analysis of FDG PET-CT imaging of patients who were treated with Wilms Tumor 1 (WT1) vaccine therapy in Osaka University during July 2008 and June 2018. Increased FDG uptakes were detected in WT1-vaccinated skin and their draining lymph nodes during the repeated vaccination. While the FDG uptakes seemed to decrease with time after the cessation of WT1 peptide vaccinations, persistence of FDG uptakes for years in WT1-vaccinated skin were also observed in 2 cases who showed good clinical course. Moreover, the FDG uptakes of patients treated with the combination vaccine of WT1 specific cytotoxic T cell (CTL) and helper peptides were significantly stronger than of those treated with the WT1 CTL peptide alone. Since it is evident that the combination vaccine can induce a more robust anti-tumor immunity than can CTL peptide vaccine alone, the FDG uptakes in WT1-vaccinated skin might reflect the degree of immune response. These results suggest that PET-CT might be a good tool for prediction of anti-tumor immune response induced by WT1 vaccine therapy. Larger scale prospective studies therefore seem to be warranted.


Assuntos
Vacinas Anticâncer , Fluordesoxiglucose F18/metabolismo , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Pele/diagnóstico por imagem , Proteínas WT1/imunologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Pele/imunologia , Pele/metabolismo
9.
Zhonghua Shao Shang Za Zhi ; 36(9): 853-860, 2020 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-32972071

RESUMO

Objective: To observe the differences in normal facial skin thickness and echo density by different ages and sites of healthy adults of the same sex using 50 MHz high-frequency ultrasound. Methods: From January to June 2019, 200 healthy adult volunteers with normal facial skin who were from Sichuan, Yunnan, Guizhou, and Chongqing and met the inclusion criteria were recruited by the Affiliated Hospital of Southwest Medical University with simple random sampling method, and then were included in this cross-sectional investigation study. Then 50 MHz high-frequency ultrasound was used to obtain skin ultrasonogram of volunteers' forehead, canthus, eyelid, and cheek. According to the ages, 100 female volunteers were divided into 20-29 years old (30 females), 30-39 years old (25 females), 40-49 years old (20 females), and 50-70 years old (25 females) groups; 100 male volunteers were divided into 20-29 years old (30 males), 30-39 years old (25 males), 40-49 years old (20 males), and 50-70 years old (25 males) groups. The thickness of full-skin, the upper dermal echo density, and the lower dermal echo density of the female and male volunteers'forehead, canthus, eyelid, and cheek were recorded respectively. Data were statistically analyzed with one-way analysis of variance, analysis of variance for repeated measurement, least significant difference test, and Bonferroni correction. Results: (1) The thickness of full-thickness skin in forehead, canthus, eyelid, and cheek of female and male volunteers in 20-29 years old group were (1.86±0.26), (1.36±0.11), (1.24±0.25), and (1.90±0.21) mm, (2.45±0.37), (1.64±0.19), (1.44±0.16), and (2.53±0.26) mm, respectively, in 30-39 years old group were (1.98±0.24), (1.43±0.13), (1.15±0.15), and (2.12±0.13) mm, (2.34±0.27), (1.63±0.27), (1.50±0.38), and (2.43±0.40) mm, respectively, in 40-49 years old group were (1.90±0.21), (1.43±0.18), (1.24±0.27), and (1.98±0.12) mm, (2.14±0.24), (1.54±0.25), (1.28±0.14), and (2.39±0.36) mm, respectively, in 50-70 years old group were (1.64±0.25), (1.36±0.19), (1.16±0.12), and (1.89±0.29) mm, (2.28±0.27), (1.73±0.25), (1.58±0.18), and (2.38±0.32) mm, respectively. There were no statistically significant differences between female volunteers in the 4 groups and male volunteers in the 4 groups in thickness of full-thickness skin in canthus, eyelid, and cheek (F=0.677, 0.666, 0.136, 0.697, 0.294, 0.888, P>0.05). The thickness of full-thickness skin in forehead and cheek of the female volunteers in the 4 groups and male volunteers in the 4 groups was similar (P>0.05), and was significantly higher than that of canthus and eyelid (P<0.05). The thickness of full-thickness skin in canthus and eyelid of female volunteers in 20-29 years old, 40-49 years old, and 50-70 years old group was similar (P>0.05), while thickness of full-thickness skin in canthus and eyelid of male volunteers in the 4 groups was similar (P>0.05). (2) The upper dermal echo density of forehead, canthus, eyelid, and cheek of female volunteers in 50-70 years old group was significantly lower than that in 20-29 years old and 30-39 years old groups (P<0.05). The upper dermal echo density of forehead, canthus, eyelid, and cheek of male volunteers in 50-70 years old group was significantly lower than that in 20-29 years old group (P<0.05). The upper dermal echo density of forehead, canthus, eyelid, and cheek of female and male volunteers in 20-29 years old and 30-39 years old groups was similar (P>0.05). The upper dermal echo density of forehead and cheek of female volunteers in 20-29 years old, 40-49 years old, and 50-70 years old groups was significantly lower than that of canthus and eyelid (P<0.05). The echo density of upper dermis of cheek of male volunteers in the 4 groups was significantly lower than that of canthus and eyelid (P<0.05). The upper dermal echo density of canthus and eyelid of female volunteers in the 4 groups and male volunteers in the 4 groups was similar (P>0.05), the upper dermal echo density of forehead and cheek was similar (P>0.05). (3) The lower dermal echo density of forehead, canthus, eyelid, and cheek of female volunteers in 50-70 years old group was significantly higher than that in 20-29 years old and 30-39 years old groups (P<0.05). The lower dermal echo density of forehead, canthus, eyelid, and cheek of male volunteers in 50-70 years old group was significantly higher than that in 20-29 years old group (P<0.05). The echo density of the lower dermis of forehead, eyelid, and cheek of female and male volunteers in 20-29 years old, 30-39 years old, and 40-49 years old groups was similar (P>0.05). The lower dermal echo density of forehead and cheek of female volunteers in the 4 groups was significantly lower than that of canthus and eyelid (P<0.05). The lower dermal echo density of forehead and cheek of male volunteers in 30-39 years old, 40-49 years old, and 50-70 years old groups was significantly lower than that of canthus and eyelid (P<0.05). The lower dermal echo density between canthus and eyelid and between forehead and check of female volunteers in the 4 groups and male volunteers in the 4 groups was similar (P>0.05). Conclusions: The 50 MHz high-frequency ultrasonography shows that the thickness of full-thickness skin of canthus, eyelid, and cheek is similar in all age groups of female and male adult volunteers with normal facial skin. In the same age group, the thickness of full-thickness skin of forehead and cheek of male and female volunteers is significantly higher than that of canthus and eyelid. The upper dermal echo density of forehead, canthus, eyelid, and cheek of female and male volunteers shows a decreasing trend with age, while the lower dermal echo density shows an increasing trend with age. In addition, the echo density of upper and lower dermis of canthus and eyelid was significantly higher than that of cheek in all the four age groups.


Assuntos
Face , Pele , Adulto , Idoso , China , Estudos Transversais , Face/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pele/diagnóstico por imagem , Ultrassonografia , Adulto Jovem
10.
Obstet Gynecol ; 136(5): 1016-1020, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32649505

RESUMO

BACKGROUND: The risk of vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unknown. Positive reverse-transcription polymerase chain reaction (RT-PCR) test results for SARS-CoV-2 infection in neonates and placental tissue have been reported, and immunoglobulin M antibodies have been detected in neonates born to mothers with infection. CASES: The first case is a woman at 22 3/7 weeks of gestation with coronavirus disease 2019 (COVID-19) who was admitted to the intensive care unit. In the second case, the patient remained at home with mild symptoms, starting at 20 weeks of gestation. In both cases, fetal skin edema was observed on ultrasound examination while maternal SARS-COV-2 RT-PCR test results were positive and resolved when maternal SARS-COV-2 RT-PCR test results became negative. The RT-PCR test result for SARS-CoV-2 in amniotic fluid was negative in both cases. The two pregnancies are ongoing and uneventful. CONCLUSION: Transient fetal skin edema noted in these two patients with COVID-19 in the second trimester may represent results of fetal infection or altered fetal physiology due to maternal disease or may be unrelated to the maternal illness.


Assuntos
Infecções por Coronavirus , Monitorização Fetal/métodos , Hidropisia Fetal/diagnóstico , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Pele/diagnóstico por imagem , Adulto , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Idade Gestacional , Humanos , Imunoglobulina M/sangue , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pessoa de Meia-Idade , Placenta/virologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Respiração Artificial/métodos , Resultado do Tratamento , Ultrassonografia Pré-Natal/métodos
11.
Dermatol Online J ; 26(3)2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609438

RESUMO

Reflectance confocal microscopy (RCM) is a noninvasive real-time imaging technique that has been widely used for the diagnosis of skin cancer. More recently, it has been reported as a useful tool for the diagnosis and management of several inflammatory and infectious skin disorders. This article provides an overview of the current available applications of RCM use in cutaneous infections and infestations. PubMed was used to search the following terms in various combinations: reflectance confocal microscopy, skin, hair, nail, infection, parasitosis, mycosis, virus, bacteria. All papers were accordingly reviewed. In most cutaneous infections or infestations, the main alterations are found in the epidermis and upper dermis, where the accuracy of confocal microscopy is nearly similar to that of histopathology. The high resolution of this technique allows the visualization of most skin parasites, fungi, and a few bacteria. Although viruses cannot be identified because of their small size, viral cytopathic effects can be observed on keratinocytes. In addition, RCM can be used to monitor the response to treatment, thereby reducing unnecessary treatments.


Assuntos
Microscopia Confocal/métodos , Dermatopatias Infecciosas/diagnóstico por imagem , Dermatopatias Parasitárias/diagnóstico por imagem , Feminino , Humanos , Masculino , Pele/diagnóstico por imagem , Pele/microbiologia , Pele/parasitologia , Pele/patologia , Dermatopatias Infecciosas/patologia , Dermatopatias Parasitárias/patologia
13.
J Am Acad Dermatol ; 83(3): 958-959, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32531304
14.
Lasers Med Sci ; 35(8): 1821-1830, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32372237

RESUMO

Pseudoxanthoma elasticum (PXE, OMIM 264800) is a rare autosomal recessive disorder with ectopic mineralization and fragmentation of elastin fibers. It is caused by mutations of the ABCC6 gene that leads to decreased serum levels of inorganic pyrophosphate (PPi) anti-mineralization factor. The occurrence of severe complications among PXE patients highlights the importance of early diagnosis so that prompt multidisciplinary care can be provided to patients. We aimed to examine dermal connective tissue with nonlinear optical (NLO) techniques, as collagen emits second-harmonic generation (SHG) signal, while elastin can be excited by two-photon excitation fluorescence (TPF). We performed molecular genetic analysis, ophthalmological and cardiovascular assessment, plasma PPi measurement, conventional histopathological examination, and ex vivo SHG and TPF imaging in five patients with PXE and five age- and gender-matched healthy controls. Pathological mutations including one new variant were found in the ABCC6 gene in all PXE patients and their plasma PPi level was significantly lower compared with controls. Degradation and mineralization of elastin fibers and extensive calcium deposition in the mid-dermis was visualized and quantified together with the alterations of the collagen structure in PXE. Our data suggests that NLO provides high-resolution imaging of the specific histopathological features of PXE-affected skin. In vivo NLO may be a promising tool in the assessment of PXE, promoting early diagnosis and follow-up.


Assuntos
Microscopia Óptica não Linear/métodos , Pseudoxantoma Elástico/diagnóstico por imagem , Pele/diagnóstico por imagem , Estudos de Casos e Controles , Colágeno/metabolismo , Tecido Conjuntivo/patologia , Elastina/metabolismo , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pseudoxantoma Elástico/metabolismo , Pseudoxantoma Elástico/patologia , Pele/metabolismo , Pele/patologia
15.
Hautarzt ; 71(8): 627-646, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32377768

RESUMO

Dermatoscopy as a noninvasive diagnostic tool is not only useful in the differentiation of malignant and benign skin tumors, but is also effective in the diagnosis of inflammatory, infiltrative and infectious dermatoses. As a result, the need for diagnostic punch biopsies in dermatoses could be reduced. Hereby the selection of affected skin areas is essential. The diagnostic accuracy is independent of the skin type. Helpful dermatoscopic features include vessels morphology and distribution, scales colors and distribution, follicular findings, further structures such as colors and morphology as well as specific clues. The dermatoscopic diagnosis is made based on the descriptive approach in clinical routine, teaching and research. In all clinical and dermatoscopic diagnoses that remain unclear, a punch biopsy with histopathology should be performed. The dermatoscope should be cleaned after every examination according to the guidelines.


Assuntos
Dermoscopia/métodos , Dermatopatias Infecciosas/diagnóstico , Neoplasias Cutâneas/diagnóstico , Pele/diagnóstico por imagem , Humanos
17.
Sci Rep ; 10(1): 5829, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32242131

RESUMO

This article presents a real-time approach for classification of burn depth based on B-mode ultrasound imaging. A grey-level co-occurrence matrix (GLCM) computed from the ultrasound images of the tissue is employed to construct the textural feature set and the classification is performed using nonlinear support vector machine and kernel Fisher discriminant analysis. A leave-one-out cross-validation is used for the independent assessment of the classifiers. The model is tested for pair-wise binary classification of four burn conditions in ex vivo porcine skin tissue: (i) 200 °F for 10 s, (ii) 200 °F for 30 s, (iii) 450 °F for 10 s, and (iv) 450 °F for 30 s. The average classification accuracy for pairwise separation is 99% with just over 30 samples in each burn group and the average multiclass classification accuracy is 93%. The results highlight that the ultrasound imaging-based burn classification approach in conjunction with the GLCM texture features provide an accurate assessment of altered tissue characteristics with relatively moderate sample sizes, which is often the case with experimental and clinical datasets. The proposed method is shown to have the potential to assist with the real-time clinical assessment of burn degrees, particularly for discriminating between superficial and deep second degree burns, which is challenging in clinical practice.


Assuntos
Queimaduras/diagnóstico por imagem , Algoritmos , Animais , Pele/diagnóstico por imagem , Máquina de Vetores de Suporte , Suínos , Ultrassonografia/métodos
18.
Eur J Cancer ; 131: 18-26, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32248071

RESUMO

BACKGROUND: Anti-[programmed cell death protein 1 (PD-1)] antibodies nivolumab and pembrolizumab were approved for adjuvant treatment of melanoma as they demonstrated improved relapse-free survival. Currently, combined anti-PD-1 plus anti-[cytotoxic T-lymphocyte-associated protein 4 (CTLA4)] blockade is being investigated in adjuvant and neoadjuvant trials. Sarcoidosis-like reactions have been described for immune checkpoint inhibitors and are most likely drug-induced. The reported rate of sarcoidosis/sarcoidosis-like reactions within clinical melanoma trials is <2%. We observed that a remarkably higher number of melanoma patients (10/45 patients, 22%) treated with immune checkpoint inhibitor (ICI) within an adjuvant clinical trial-developed drug induced sarcoidosis-like reaction (DISR) mimicking metastasis. CASE PRESENTATION: Of 45 stage III melanoma patients who were treated at our institute with adjuvant ICI (either nivolumab alone or in combination with ipilimumab) within a two-armed, blinded clinical trial, ten developed a DISR. Three of the ten patients were men, median age was 52 years (range, 32-70 years). DISRs were asymptomatic and generally detected radiographically at first radiographic imaging after the start of therapy (median time, 2.8 months) and described as a differential diagnosis to tumour progression. In one patient, DISR was only apparent 13.1 months after start of therapy and 4 weeks after the end of ICI treatment. DISR presented as mediastinal/hilar lymphadenopathy in 8/10 patients (as only site or in addition to lung, skin and/or bone involvement), one patient had only lung and cutaneous, one patient only cutaneous DISR. Biopsies from lymph nodes, skin and bone were taken in 8/10 patients, and histology confirmed sarcoidosis-like reactions (SLRs). As patients were asymptomatic, no treatment for DISR was required, and study treatment was stopped for DISR in only one patient due to bone involvement. DISRs have resolved or are in remission in all patients. At a median follow-up time of 15.3 months (range, 12-17.6 months), two patients experienced melanoma relapse. CONCLUSIONS: In most cases, sarcoidosis could only be differentiated from melanoma progression on biopsy. Treating physicians as well as radiologists have to be aware of the potentially higher rate of DISR in patients receiving adjuvant ICI. A thorough interdisciplinary workup is required to discriminate from true melanoma progression and to decide on continuation of adjuvant ICI treatment.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Neoplasias Pulmonares/diagnóstico , Melanoma/diagnóstico , Sarcoidose/diagnóstico , Neoplasias Cutâneas/terapia , Adulto , Idoso , Biópsia , Quimioterapia Adjuvante/efeitos adversos , Diagnóstico Diferencial , Progressão da Doença , Feminino , Seguimentos , Humanos , Ipilimumab/efeitos adversos , Pulmão/diagnóstico por imagem , Pulmão/imunologia , Pulmão/patologia , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/secundário , Imagem por Ressonância Magnética , Masculino , Melanoma/imunologia , Melanoma/secundário , Melanoma/terapia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/imunologia , Nivolumabe/efeitos adversos , Sarcoidose/induzido quimicamente , Sarcoidose/epidemiologia , Sarcoidose/imunologia , Pele/diagnóstico por imagem , Pele/imunologia , Pele/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/patologia , Tomografia Computadorizada por Raios X
19.
Spine (Phila Pa 1976) ; 45(8): E465-E476, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32224807

RESUMO

STUDY DESIGN: Retrospective cohort. OBJECTIVE: To describe our technique for and evaluate the time demand, radiation exposure and outcomes of skin-anchored intraoperative three-dimensional navigation (ION) in minimally invasive (MIS) lumbar surgery, and to compare these parameters to 2D fluoroscopy for MI-TLIF. SUMMARY OF BACKGROUND DATA: Limited visualization of anatomic landmarks and narrow access corridor in MIS procedures result in greater reliance on image guidance. Although two-dimensional fluoroscopy has historically been used, ION is gaining traction. METHODS: Patients who underwent MIS lumbar microdiscectomy, laminectomy, or MI-TLIF using skin-anchored ION and MI-TLIF by the same surgeon using 2D fluoroscopy were selected. Operative variables, radiation exposure, and short-term outcomes of all procedures were summarized. Time-demand and radiation exposure of fluoroscopy and ION for MI-TLIF were compared. RESULTS: Of the 326 patients included, 232 were in the ION cohort (92 microdiscectomies, 65 laminectomies, and 75 MI-TLIFs) and 94 in the MI-TLIF using 2D fluoroscopy cohort. Time for ION setup and image acquisition was a median of 22 to 24 minutes. Total fluoroscopy time was a median of 10 seconds for microdiscectomy, 9 for laminectomy, and 26 for MI-TLIF. Radiation dose was a median of 15.2 mGy for microdiscectomy, 16.6 for laminectomy, and 44.6 for MI-TLIF, of this, 93%, 95%, and 37% for microdiscectomy, laminectomy, and MI-TLIF, respectively were for ION image acquisition, with the rest attributable to the procedure. There were no wrong-level surgeries. Compared with fluoroscopy, ION for MI-TLIF resulted in lower operative times (92 vs. 108 min, P < 0.0001), fluoroscopy time (26 vs. 144 s, P < 0.0001), and radiation dose (44.6 vs. 63.1 mGy, P = 0.002), with equivalent time-demand and length of stay. ION lowered the radiation dose by 29% for patients and 55% for operating room personnel. CONCLUSION: Skin-anchored ION does not increase time-demand compared with fluoroscopy, is feasible, safe and accurate, and results in low radiation exposure. LEVEL OF EVIDENCE: 3.


Assuntos
Imageamento Tridimensional/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Exposição à Radiação , Adulto , Idoso , Estudos de Coortes , Discotomia/efeitos adversos , Discotomia/métodos , Feminino , Fluoroscopia/efeitos adversos , Fluoroscopia/métodos , Humanos , Imageamento Tridimensional/efeitos adversos , Monitorização Neurofisiológica Intraoperatória/efeitos adversos , Laminectomia/efeitos adversos , Laminectomia/métodos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Neuronavegação/efeitos adversos , Neuronavegação/métodos , Estudos Prospectivos , Exposição à Radiação/efeitos adversos , Estudos Retrospectivos , Pele/diagnóstico por imagem , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos
20.
PLoS One ; 15(4): e0228923, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32236132

RESUMO

Dengue diagnostics have come a long way. Attempts at breaking away from lab-oriented dengue detection, such as NS1 antigen, IgM or IgG antibodies detection have extensively received numerous coverage. As a result, rapid detection tests (RDTs) have started to gain inroads in medical practice. Rapid detection tests notwithstanding, analysis of blood serum is still a relatively complicated task. This includes the necessity of phlebotomy, centrifugation for blood serum, and other reagent-based tests. Therefore, a non-invasive method of dengue detection was considered. In this study, we present the utility of diffuse reflectance skin spectroscopy (bandwidth of 200-2500nm) on the forearm during the triaging period for dengue screening potential. This is performed with multivariate analysis of 240 triaged febrile/suspected dengue patients. The data is then scrutinized for its clinical validity to be included as either confirmed or probable dengue, or a control group. Based on discriminant analysis of several data normalization models, we can predict the patients' clinical dengue-positivity at ranges of accuracy between ~93-98% depending on mode of the data, with a probably optimal sensitivity and specificity to the clinical diagnosis of ~89% and ~100% respectively. From the outcomes of this study, we recommend further trials with cautious optimism. With these findings, it is hoped that the elusive non-invasive detection of tropical diseases may gain platform in the near future.


Assuntos
Dengue/diagnóstico por imagem , Programas de Rastreamento/métodos , Pele/diagnóstico por imagem , Análise Espectral/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Sensibilidade e Especificidade , Adulto Jovem
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