RESUMO
Hot-carrier transistors are a class of devices that leverage the excess kinetic energy of carriers. Unlike regular transistors, which rely on steady-state carrier transport, hot-carrier transistors modulate carriers to high-energy states, resulting in enhanced device speed and functionality. These characteristics are essential for applications that demand rapid switching and high-frequency operations, such as advanced telecommunications and cutting-edge computing technologies1-5. However, the traditional mechanisms of hot-carrier generation are either carrier injection6-11 or acceleration12,13, which limit device performance in terms of power consumption and negative differential resistance14-17. Mixed-dimensional devices, which combine bulk and low-dimensional materials, can offer different mechanisms for hot-carrier generation by leveraging the diverse potential barriers formed by energy-band combinations18-21. Here we report a hot-emitter transistor based on double mixed-dimensional graphene/germanium Schottky junctions that uses stimulated emission of heated carriers to achieve a subthreshold swing lower than 1 millivolt per decade beyond the Boltzmann limit and a negative differential resistance with a peak-to-valley current ratio greater than 100 at room temperature. Multi-valued logic with a high inverter gain and reconfigurable logic states are further demonstrated. This work reports a multifunctional hot-emitter transistor with significant potential for low-power and negative-differential-resistance applications, marking a promising advancement for the post-Moore era.
RESUMO
Osteoarthritis is a highly prevalent joint disease; however, effective treatments are lacking. Protopine (PTP) is an isoquinoline alkaloid with potent anti-inflammatory and antioxidant properties; however, it has not been studied in osteoarthritis. This study aimed to investigate whether PTP can effectively protect chondrocytes from ferroptosis. Primary mouse chondrocytes were treated with tert-butyl hydroperoxide (TBHP) to simulate oxidative stress in an in vitro model of osteoarthritis. Two concentrations of PTP (10 and 20 µg/mL) were validated for in vitro experiments. Cellular inflammation and metabolism were detected using RT-qPCR and western blotting (WB). Ferroptosis was assessed via WB, qPCR, reactive oxygen species (ROS) levels, lipid ROS, and immunofluorescence staining. In vitro, PTP significantly ameliorated chondrocyte inflammation and cytolytic metabolism and significantly suppressed chondrocyte ferroptosis through the activation of the Nrf2 pathway. The anterior cruciate ligament transection (ACLT) mouse model was used to validate the in vivo effects of PTP. The joint cartilage was assessed using the Osteoarthritis Research Society International (OARSI) score, Safranin O staining, and immunohistochemistry. The intra-articular administration of PTP alleviated cartilage inflammation and ferroptosis, as evidenced by the expression of MMP3, MMP13, COL2A1, GPX4, and Nrf2. Overall, we find that PTP exerted anti-ferroptosis and anti-inflammatory effects on chondrocytes to protect the articular cartilage.
Assuntos
Benzofenantridinas , Alcaloides de Berberina , Ferroptose , Osteoartrite , Animais , Camundongos , Anti-Inflamatórios/farmacologia , Benzofenantridinas/farmacologia , Alcaloides de Berberina/farmacologia , Condrócitos/efeitos dos fármacos , Condrócitos/metabolismo , Ferroptose/efeitos dos fármacos , Inflamação/metabolismo , Fator 2 Relacionado a NF-E2/metabolismo , Osteoartrite/tratamento farmacológico , Osteoartrite/metabolismo , Osteoartrite/patologia , Espécies Reativas de Oxigênio/metabolismoRESUMO
BACKGROUND: Sjögren's Syndrome (SS) is a rare chronic autoimmune disorder primarily affecting adult females, characterized by chronic inflammation and salivary and lacrimal gland dysfunction. It is often associated with systemic lupus erythematosus, rheumatoid arthritis and kidney disease, which can lead to increased mortality. Early diagnosis is critical, but traditional methods for diagnosing SS, mainly through histopathological evaluation of salivary gland tissue, have limitations. METHODS: The study used 100 labial gland biopsy, creating whole-slide images (WSIs) for analysis. The proposed model, named Cell-tissue-graph-based pathological image analysis model (CTG-PAM) and based on graph theory, characterizes single-cell feature, cell-cell feature, and cell-tissue feature. Building upon these features, CTG-PAM achieves cellular-level classification, enabling lymphocyte recognition. Furthermore, it leverages connected component analysis techniques in the cell graph structure to perform SS diagnosis based on lymphocyte counts. FINDINGS: CTG-PAM outperforms traditional deep learning methods in diagnosing SS. Its area under the receiver operating characteristic curve (AUC) is 1.0 for the internal validation dataset and 0.8035 for the external test dataset. This indicates high accuracy. The sensitivity of CTG-PAM for the external dataset is 98.21%, while the accuracy is 93.75%. In comparison, the sensitivity and accuracy for traditional deep learning methods (ResNet-50) are lower. The study also shows that CTG-PAM's diagnostic accuracy is closer to skilled pathologists compared to beginners. INTERPRETATION: Our findings indicate that CTG-PAM is a reliable method for diagnosing SS. Additionally, CTG-PAM shows promise in enhancing the prognosis of SS patients and holds significant potential for the differential diagnosis of both non-neoplastic and neoplastic diseases. The AI model potentially extends its application to diagnosing immune cells in tumor microenvironments.
Assuntos
Síndrome de Sjogren , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/patologia , Humanos , Feminino , Estudos de Coortes , Curva ROC , Processamento de Imagem Assistida por Computador/métodos , Pessoa de Meia-Idade , Aprendizado Profundo , Área Sob a Curva , Adulto , AutomaçãoRESUMO
OBJECTIVES: The objective of this systematic review was to offer a comprehensive overview and explore the associated outcomes from imaging referral guidelines on various key stakeholders, such as patients and radiologists. MATERIALS AND METHODS: An electronic database search was conducted in Medline, Embase and Web of Science to retrieve citations published between 2013 and 2023. The search was constructed using medical subject headings and keywords. Only full-text articles and reviews written in English were included. The quality of the included papers was assessed using the mixed methods appraisal tool. A narrative synthesis was undertaken for the selected articles. RESULTS: The search yielded 4384 records. Following the abstract, full-text screening, and removal of duplication, 31 studies of varying levels of quality were included in the final analysis. Imaging referral guidelines from the American College of Radiology were most commonly used. Clinical decision support systems were the most evaluated mode of intervention, either integrated or standalone. Interventions showed reduced patient radiation doses and waiting times for imaging. There was a general reduction in radiology workload and utilisation of diagnostic imaging. Low-value imaging utilisation decreased with an increase in the appropriateness of imaging referrals and ratings and cost savings. Clinical effectiveness was maintained during the intervention period without notable adverse consequences. CONCLUSION: Using evidence-based imaging referral guidelines improves the quality of healthcare and outcomes while reducing healthcare costs. Imaging referral guidelines are one essential component of improving the value of radiology in the healthcare system. CLINICAL RELEVANCE STATEMENT: There is a need for broader dissemination of imaging referral guidelines to healthcare providers globally in tandem with the harmonisation of the application of these guidelines to improve the overall value of radiology within the healthcare system. KEY POINTS: The application of imaging referral guidelines has an impact and effect on patients, radiologists, and health policymakers. The adoption of imaging referral guidelines in clinical practice can impact healthcare costs and improve healthcare quality and outcomes. Implementing imaging referral guidelines contributes to the attainment of value-based radiology.
RESUMO
To evaluate the vaccination status and clinical practice of patients with rheumatic diseases (RD) during the COVID-19 pandemic in China and to explore the impact of vaccination on infection severity in patients with RD. A cross-sectional survey was conducted among RD patients in outpatient and inpatient settings of the Rheumatology and Immunology Department in our hospital. Participants' characteristics, vaccination status, COVID-19 infection status, and medication for acute COVID-19 were collected. A total of 749 valid surveys were included in the study. A total of 271 (36.2%) patients were not vaccinated, and 478 (63.8%) patients received at least one dose of COVID-19 vaccine. 83.3% of patients were vaccinated with inactivated vaccines. Several patients with RD experienced the disease flare (57, 11.9%) and some adverse reactions (31, 6.5%) after COVID-19 vaccination. The COVID-19 infection rate was 84.1% in our study, which was not reduced by vaccination. However, vaccinated patients with RD showed decreased frequencies of pneumonia and hospitalization, compared with those of unvaccinated patients. Independent factors associated with hospitalization were COVID-19 vaccination (OR = 0.422, 95% CI 0.227-0.783), advanced age (OR = 1.070, 95% CI 1.046-1.095), ILD (OR = 1.245, 95% CI 1.082-1.432), and glucocorticoid (OR = 4.977, 95% CI 2.326-10.647). Adverse reactions to vaccines and disease flare are not common in RD patients. Although COVID-19 vaccination could not reduce the risk of COVID-19 infection in RD patients, it may effectively decrease the frequencies of pneumonia and hospitalization after infection. It is recommended that patients with RD should receive COVID-19 vaccination if there are no contraindications because the benefits outweigh the risks.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Doenças Reumáticas , Humanos , China/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Estudos Transversais , Pacientes Ambulatoriais , Pandemias , Doenças Reumáticas/complicações , Exacerbação dos Sintomas , Vacinação/efeitos adversosRESUMO
BACKGROUND: This study aims to analyze the longitudinal variation of occlusal force distribution prior to and after fixed restoration for molar full-crowns with T-SCAN III which provide reference for occlusal adjustment and long-term maintenance. METHODS: We enrolled a total of 20 patients who received conventional restorative treatment for molars. The occlusion examination was conducted in 3 stages (before placement, immediately after placement, and 3 months after placement) using T-SCAN III (Tekscan South Boston, MA, USA, 10.0) to examine and measure the occlusal contact areas of the full dentition. RESULTS: The results indicated that the occlusal force distribution in the molar region of the patients changed before and after the fixed restoration, but the percentages of occlusal force in the dental arch of the molar did not differ significantly before and after the restoration (P > 0.05). Three months after the fixed restoration, the percentage of occlusal force in the restored dental arches of lateral teeth increased significantly (P < 0.05). CONCLUSION: The results of this study indicated that the occlusal forces of the patients changed with tooth movement and adaptation, which is mainly reflected in the increasing occlusal force. Quantitative occlusal force analysis using T-SCAN III occlusal analyzer can provide more objective and accurate data to effectively guide clinical occlusion adjustments.
Assuntos
Força de Mordida , Oclusão Dentária , Humanos , Dente Molar , Coroas , DentadurasRESUMO
Integrating a graphene transparent electrode (TE) matrix with driving circuits is essential for the practical use of graphene in optoelectronics such as active-matrix organic light-emitting diode (OLED) display, however it is disabled by the transport of carriers between graphene pixels after deposition of a semiconductor functional layer caused by the atomic thickness of graphene. Here, the carrier transport regulation of a graphene TE matrix by using an insulating polyethyleneimine (PEIE) layer is reported. The PEIE forms an ultrathin uniform film (≤10 nm) to fill the gap of the graphene matrix, blocking horizontal electron transport between graphene pixels. Meanwhile, it can reduce the work function of graphene, improving the vertical electron injection through electron tunneling. This enables the fabrication of inverted OLED pixels with record high current and power efficiencies of 90.7 cd A-1 and 89.1 lm W-1 , respectively. By integrating these inverted OLED pixels with a carbon nanotube-based thin-film transistor (CNT-TFT)-driven circuit, an inch-size flexible active-matrix OLED display is demonstrated, in which all OLED pixels are independently controlled by CNT-TFTs. This research paves a way for the application of graphene-like atomically thin TE pixels in flexible optoelectronics such as displays, smart wearables, and free-form surface lighting.
RESUMO
Promyelocytic leukemia protein (PML) is a tumor suppressor possessing multiple modes of action, including induction of apoptosis. We unexpectedly find that PML promotes necroptosis in addition to apoptosis, with Pml-/- macrophages being more resistant to TNF-mediated necroptosis than wild-type counterparts and PML-deficient mice displaying resistance to TNF-induced systemic inflammatory response syndrome. Reduced necroptosis in PML-deficient cells is associated with attenuated receptor-interacting protein kinase 1 (RIPK1) activation, as revealed by reduced RIPK1[S166] phosphorylation, and attenuated RIPK1-RIPK3-MLKL necrosome complex formation. We show that PML deficiency leads to enhanced TNF-induced MAPK-activated kinase 2 (MK2) activation and elevated RIPK1[S321] phosphorylation, which suppresses necrosome formation. MK2 inhibitor treatment or MK2 knockout abrogates resistance to cell death induction in PML-null cells and mice. PML binds MK2 and p38 MAPK, thereby inhibiting p38-MK2 interaction and MK2 activation. Moreover, PML participates in autocrine production of TNF induced by cellular inhibitors of apoptosis 1 (cIAP1)/cIAP2 degradation, since PML-knockout attenuates autocrine TNF. Thus, by targeting MK2 activation and autocrine TNF, PML promotes necroptosis and apoptosis, representing a novel tumor-suppressive activity for PML.
Assuntos
Peptídeos e Proteínas de Sinalização Intracelular , Proteínas Serina-Treonina Quinases , Proteína Serina-Treonina Quinases de Interação com Receptores , Transdução de Sinais , Animais , Apoptose , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Camundongos , Necroptose , Fosforilação , Proteína da Leucemia Promielocítica/genética , Proteína da Leucemia Promielocítica/metabolismo , Proteínas Serina-Treonina Quinases/metabolismo , Proteína Serina-Treonina Quinases de Interação com Receptores/genética , Proteína Serina-Treonina Quinases de Interação com Receptores/metabolismo , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismoRESUMO
BACKGROUND: Acute appendicitis is one of the most common abdominal emergencies, with management approaches that vary depending on the available resources and setting. However, there is a lack of studies on the differences of surgical outcomes and quality of care between tertiary care hospitals and regional hospitals. METHODS: This multicenter retrospective study included 2158 consecutive adult patients between January 2014 and June 2018 at three hospitals. The patient cohort was divided into regional hospital group (N = 1223) and tertiary care hospital group (N = 935). Baseline characteristics and perioperative outcomes were compared, and factors associated with surgical delay and postoperative complication were investigated. RESULTS: Patients in tertiary care hospital group had longer surgical waiting time (17.3 vs. 12.0 h, p < 0.001), higher risks of surgical delay exceeding 24 h (OR = 2.94, 95% CI 2.17-4.01, p < 0.001), longer operation time (64 vs. 50 min, p < 0.001), more appendix perforation (22.4 vs. 13.3%, p < 0.001), and higher hospital cost compared with regional hospital group. In multivariate analysis, factors associated with surgical delay were tertiary care hospital (OR = 2.94, 95% CI 2.18-4.01, p < 0.001) and delay diagnosis (OR = 18.7, 95% CI 11.7-30.1, p < 0.001), while those associated with postoperative complications were older age (OR = 1.02, 95% CI 1.00-1.04, p = 0.013), male sex (OR = 2.38, 95% CI 1.11-5.52, p = 0.031), surgical delay (OR = 2.99, 95% CI 1.30-6.47, p = 0.007), and appendix perforation (OR = 5.61, 95% CI 2.72-11.85, p < 0.001). CONCLUSIONS: Patients at tertiary care hospitals had longer waiting time, more surgical delays, and appendix perforations, and these were risk factors of postoperative complications. Establishing an effective referral system to redirect appendicitis patients with less complex medical histories from tertiary care hospitals to regional hospitals may enhance the quality of patient care and outcomes, while also reducing medical costs.
Assuntos
Apendicite , Humanos , Adulto , Masculino , Apendicite/diagnóstico , Apendicite/cirurgia , Apendicite/etiologia , Estudos Retrospectivos , Centros de Atenção Terciária , Apendicectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do TratamentoRESUMO
Graphene has emerged as an attractive candidate for flexible transparent electrode (FTE) for a new generation of flexible optoelectronics. Despite tremendous potential and broad earlier interest, the promise of graphene FTE has been plagued by the intrinsic trade-off between electrical conductance and transparency with a figure of merit (σDC/σOp) considerably lower than that of the state-of-the-art ITO electrodes (σDC/σOp <123 for graphene vs. â¼240 for ITO). Here we report a synergistic electrical/optical modulation strategy to simultaneously boost the conductance and transparency. We show that a tetrakis(pentafluorophenyl)boric acid (HTB) coating can function as highly effective hole doping layer to increase the conductance of monolayer graphene by sevenfold and at the same time as an anti-reflective layer to boost the visible transmittance to 98.8%. Such simultaneous improvement in conductance and transparency breaks previous limit in graphene FTEs and yields an unprecedented figure of merit (σDC/σOp â¼323) that rivals the best commercial ITO electrode. Using the tailored monolayer graphene as the flexible anode, we further demonstrate high-performance green organic light-emitting diodes (OLEDs) with the maximum current, power and external quantum efficiencies (111.4 cd A-1, 124.9 lm W-1 and 29.7%) outperforming all comparable flexible OLEDs and surpassing that with standard rigid ITO by 43%. This study defines a straightforward pathway to tailor optoelectronic properties of monolayer graphene and to fully capture their potential as a generational FTE for flexible optoelectronics.
RESUMO
Cryptosporidium parvum is an important apicomplexan parasite causing severe diarrhea in both humans and animals. Calmodulin (CaM), a multifunctional and universal calcium-binding protein, contributes to the growth and development of apicomplexan parasites, but the role of CaM in C. parvum remains unknown. In this study, the CaM of C. parvum encoded by the cgd2_810 gene was expressed in Escherichia coli, and the biological functions of CpCaM were preliminarily investigated. The transcriptional level of the cgd2_810 gene peaked at 36 h post infection (pi), and the CpCaM protein was mainly located around the nucleus of the whole oocysts, in the middle of sporozoites and around the nucleus of merozoites. Anti-CpCaM antibody reduced the invasion of C. parvum sporozoites by 30.69%. The present study indicates that CpCaM is potentially involved in the growth of C. parvum. Results of the study expand our knowledge on the interaction between host and Cryptosporidium.
Assuntos
Criptosporidiose , Cryptosporidium parvum , Cryptosporidium , Animais , Humanos , Cryptosporidium parvum/genética , Cryptosporidium/genética , Criptosporidiose/parasitologia , Oocistos/metabolismo , Esporozoítos/metabolismoRESUMO
Residual oil from palm oil mill effluent (POME) can be valorized into value-added products like biofuel. However, the complex structure in POME limits the full recovery of intracellular lipids. To address this challenge, low-frequency ultrasonication was used as a pre-treatment prior to oil recovery to improve the yield by liberating the entrapped oil via the cell disruption technique. This study focused on optimizing the ultrasound conditions (i.e., ultrasonication amplitude, ultrasonication duration, and probe immersion depth) to maximize the improvement of oil recovery yield using response surface methodology. The optimized conditions were 30.074% ultrasonication amplitude, 0.167 min ultrasonication duration, and 2 cm probe immersion depth. This resulted in an additional 42.50% improvement in oil recovery yield over non-ultrasonicated POME, which is in close agreement with the model prediction. Additionally, a cost-benefit analysis was incorporated to determine the feasibility of ultrasonication for enhancing oil recovery. The study also explored the synthesis of biodiesel from POME-recovered oil and characterized the fuel attributes according to American Society for Testing and Materials- and European Standards-prescribed procedures. The attributes of biodiesel produced from POME-recovered oil are comparable to those of palm-based biodiesel in Malaysia, demonstrating its potential as an alternative source for biodiesel production.
Assuntos
Biocombustíveis , Óleo de Palmeira , Análise Custo-Benefício , MalásiaRESUMO
BACKGROUND: Previous studies have indicated an association between birth weight (BW) and type 2 diabetes mellitus (T2DM), but few studies have explored this relationship under different conditions of obesity in adulthood. METHODS: A total of 4,005 individuals from ten provinces of China were randomly selected to participate in this study. We used a questionnaire to collect age, BW, current weight, height, T2DM history, age at T2DM diagnosis, and other variables. The participants were divided into three groups were according to BW trisection (BW ≤ 2500 g for the lower BW group, 2500 g < BW ≤ 3500 g for the normal BW group, and BW > 3500 g for the higher BW group). The cutoff of overweight and obesity were 25 kg/m2 and 28 kg/m2, respectively. RESULTS: The prevalence rates of T2DM among women with lower BW, normal BW and higher BW were 5.2%, 3.6% and 2.0%, respectively. The obesity prevalence rates in the lower BW, normal BW and higher BW groups were 8.1%, 6.7% and 9.0%, respectively. In the obese population, we did not find a relationship between BW and T2DM, but in the nonobese population, we found that with increasing BW, the risk of developing T2DM was reduced. Obese status in adulthood modified the association between BW and the risk of T2DM. CONCLUSION: There is a "U" shape association between BW and risk of adulthood obesity in Chinese women, but this trend is not existed between BW and risk of developing T2DM. In non-overweight females, the risk of developing T2DM decreased with increasing BW, but this trend was not observed in overweight females.
Assuntos
Diabetes Mellitus Tipo 2 , Humanos , Feminino , Adulto , Pré-Escolar , Diabetes Mellitus Tipo 2/etiologia , Diabetes Mellitus Tipo 2/complicações , Peso ao Nascer , Obesidade/epidemiologia , Obesidade/complicações , Sobrepeso/epidemiologia , Sobrepeso/complicações , Aumento de Peso , China/epidemiologiaRESUMO
BACKGROUND/PURPOSE: The appropriate management of postoperative upper alimentary tract fistula (UATF) remains uncertain. The efficacy of esophagogastroduodenoscopy (EGD) tissue glue repair in the treatment of patients with postoperative UATF was explored. We also conducted a systematic review of the literature regarding the inpatient management of UATF. METHODS: Totally 24 patients received EGD tissue glue repair for postoperative UATF at our institute from April 2014 to April 2020. Independent characteristics of size of fistula, location of the UATF, complications, and recurrences were analyzed. PubMed and Cochrane Library databases were reviewed. A pooled analysis was performed, and subgroup analysis was conducted separately for different anatomic locations and techniques. RESULTS: With a mean follow-up of 40 months, the fistula failed to close with EGD tissue glue repair in 2 of 24 patients (8.3%). Eight patients required repeated EGD tissue glue repair, which was more frequent in oral or thoracic UATF (p = 0.053), but all achieved a successful seal in the EGD tissue after glue repair alone (n = 22). The fistula size was correlated with the demand for repeated EGD tissue glue repair (p = 0.017). Besides, a total of 30 studies regarding 2356 cases of postoperative UATF between 2010 and 2021 were retrieved and analyzed. Several non-operative methods were generally accepted as the initial approach, with a non-inferior success rate compared to operative techniques. CONCLUSION: The results suggest that no single approach toward UATF is superior in terms of success rate and healing time. The potential advantages of EGD tissue glue repair after drainage were more suitable for patients with postoperative UATF and multiple comorbidities.
Assuntos
Fístula , Adesivos Teciduais , Endoscopia/métodos , Adesivo Tecidual de Fibrina , Fístula/complicações , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Resultado do TratamentoRESUMO
Palm oil is the most utilized vegetable globally which is mostly produced in countries such as Malaysia, Indonesia and Thailand. The great amount of POME generation from palm oil mills is now a threat to the environment and require a suitable treatment of POME to reduce the organic strength in accordance with the standard discharge limit before releasing to the environment. Currently, the technology to combine the anaerobic process and biofilm system in bioreactors have produced a fresh idea in treatments of high strength wastewater like POME. Anaerobic biofilm reactor is a convincing method for POME treatment due to its significant advantages over the conventional biological treatments consisting of anaerobic, aerobic and facultative pond systems. Overall, integrated anaerobic-aerobic bioreactor (IAAB) can remove more than 99% of chemical oxygen demand (COD), biochemical oxygen demand (BOD) and total suspended solids (TSS) with the combination of anaerobic and aerobic digestion for POME treatment. It has better performance as compared to up-flow anaerobic sludge blanket (UASB) and up-flow anaerobic filter (UAF) with 80% and 88-94% COD removal efficiency respectively. Anaerobic pond was found to perform well also by removing 97.8% of COD in POME but require long retention time and larger land. Hence, this study aims to provide intensive review of the performance of the anaerobic biofilm reactor in treating POME and the recent advancements in this technology. The limitations and future perspectives in utilization of anaerobic biofilm reactor during its operation in treating POME are discussed.
Assuntos
Reatores Biológicos , Óleos de Plantas , Anaerobiose , Biofilmes , Resíduos Industriais , Óleo de Palmeira , Eliminação de Resíduos Líquidos/métodosRESUMO
Young children often present at the emergency department (ED) with foreign bodies in their mouths, including the occasional bottles and cans. Previous reports of tongue entrapment have presented cases where bottles were mostly made of glass or metal. A 4-year-old girl presented to the ED with her tongue entrapped in a uniquely designed plastic bottle. Attempts at conservative methods of removal such as gentle traction, breaking of the vacuum seal and use of lubricants were unsuccessful. The child was brought to the operating theatre for further management. Anaesthesia induction with a facemask was not possible as the plastic bottle was protruding from the tongue and would not allow an adequate seal around the nose and mouth. To overcome such challenges of a shared airway and workspace, the child was placed under intravenous propofol sedation initially until the prompt removal of foreign body allowed subsequent mask placement and oral intubation. The foreign body was eventually removed by sectioning the inflexible plastic into two pieces with a water-cooled high speed dental diamond bur. The child remained stable intra-operatively and subsequent post-operative recovery was uneventful. This report highlights the importance of multidisciplinary coordination to reduce delays when liberating the entrapped tongue so as to minimize potential complications from the injury.
Assuntos
Corpos Estranhos , Língua , Bebidas Gaseificadas , Criança , Pré-Escolar , Feminino , Corpos Estranhos/cirurgia , Humanos , Boca , Plásticos , Língua/lesõesRESUMO
Background Obtaining ventricular volumetry and mass is key to most cardiac MRI but challenged by long multibreath-hold acquisitions. Purpose To assess the image quality and performance of a highly accelerated, free-breathing, two-dimensional cine cardiac MRI sequence incorporating deep learning (DL) reconstruction compared with reference standard balanced steady-state free precession (bSSFP). Materials and Methods A DL algorithm was developed to reconstruct custom 12-fold accelerated bSSFP cardiac MRI cine images from coil sensitivity maps using 15 iterations of separable three-dimensional convolutions and data consistency steps. The model was trained, validated, and internally tested in 10, two, and 10 adult human volunteers, respectively, based on vendor partner-supplied fully sampled bSSFP acquisitions. For prospective external clinical validation, consecutive children and young adults undergoing cardiac MRI from September through December 2019 at a single children's hospital underwent both conventional and highly accelerated short-axis bSSFP cine acquisitions in one MRI examination. Two radiologists scored overall and volumetric three-dimensional mesh image quality of all short-axis stacks on a five-point Likert scale and manually segmented endocardial and epicardial contours. Scan times and image quality were compared using the Wilcoxon rank sum test. Measurement agreement was assessed with intraclass correlation coefficient and Bland-Altman analysis. Results Fifty participants (mean age, 16 years ± 4 [standard deviation]; range, 5-30 years; 29 men) were evaluated. The mean prescribed acquisition times of accelerated scans (non-breath-held) and bSSFP (excluding breath-hold time) were 0.9 minute ± 0.3 versus 3.0 minutes ± 1.9 (P < .001). Overall and three-dimensional mesh image quality scores were, respectively, 3.8 ± 0.6 versus 4.3 ± 0.6 (P < .001) and 4.0 ± 1.0 versus 4.4 ± 0.8 (P < .001). Raters had strong agreement between all bSSFP and DL measurements, with intraclass correlation coefficients of 0.76 to 0.97, near-zero mean differences, and narrow limits of agreement. Conclusion With slightly lower image quality yet much faster speed, deep learning reconstruction may allow substantially shorter acquisition times of cardiac MRI compared with conventional balanced steady-state free precession MRI performed for ventricular volumetry. © RSNA, 2021 Online supplemental material is available for this article.
Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Aprendizado Profundo , Interpretação de Imagem Assistida por Computador/métodos , Imagem Cinética por Ressonância Magnética/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , RespiraçãoRESUMO
PURPOSE: To propose a novel combined parallel imaging and deep learning-based reconstruction framework for robust reconstruction of highly accelerated 2D cardiac cine MRI data. METHODS: We propose DL-ESPIRiT, an unrolled neural network architecture that utilizes an extended coil sensitivity model to address SENSE-related field-of-view (FOV) limitations in previously proposed deep learning-based reconstruction frameworks. Additionally, we propose a novel neural network design based on (2+1)D spatiotemporal convolutions to produce more accurate dynamic MRI reconstructions than conventional 3D convolutions. The network is trained on fully sampled 2D cardiac cine datasets collected from 11 healthy volunteers with IRB approval. DL-ESPIRiT is compared against a state-of-the-art parallel imaging and compressed sensing method known as l1 -ESPIRiT. The reconstruction accuracy of both methods is evaluated on retrospectively undersampled datasets (R = 12) with respect to standard image quality metrics as well as automatic deep learning-based segmentations of left ventricular volumes. Feasibility of DL-ESPIRiT is demonstrated on two prospectively undersampled datasets acquired in a single heartbeat per slice. RESULTS: The (2+1)D DL-ESPIRiT method produces higher fidelity image reconstructions when compared to l1 -ESPIRiT reconstructions with respect to standard image quality metrics (P < .001). As a result of improved image quality, segmentations made from (2+1)D DL-ESPIRiT images are also more accurate than segmentations from l1 -ESPIRiT images. CONCLUSIONS: DL-ESPIRiT synergistically combines a robust parallel imaging model and deep learning-based priors to produce high-fidelity reconstructions of retrospectively undersampled 2D cardiac cine data acquired with reduced FOV. Although a proof-of-concept is shown, further experiments are necessary to determine the efficacy of DL-ESPIRiT in prospectively undersampled data.
Assuntos
Aprendizado Profundo , Coração , Imagem Cinética por Ressonância Magnética , Coração/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Estudos RetrospectivosRESUMO
OBJECTIVES: This study draws on qualitative insights on the barriers and facilitators to HIV testing, as well as perceptions of HIV self-testing (HIVST), to propose a framework to understand not only the benefits but also potential knock-on implications of introducing HIVST in the context of other STI testing. METHODS: We conducted semistructured, in-depth interviews with 30 gay, bisexual and other men who have sex with men aged 18 and 39 years old in Singapore. Interview topics included barriers and facilitators to HIV and other STI testing, as well as perceptions of HIVST. Interviews were audio-recorded, transcribed, coded and analysed using thematic analysis. RESULTS: For HIV testing, participants cited the perceived risk of acquiring, susceptibility to and symptoms of HIV as internal motivators, while social influence and accessibility of HIV testing services were external motivators. For STI testing, perceived symptoms and partner notification of STI were reported as internal and external motivators, respectively. Availability of bundle tests, starting a new relationship and instances of mandatory testing motivated both simultaneous HIV and other STI testing. The fear of a positive diagnosis and lack of confidentiality were cited as internal and external barriers to HIV testing, respectively, while low perceived severity of other STI and the cost of STI tests were cited as internal and external barriers to other STI testing, respectively. We identified pathways to HIV and other STI testing and discussed how the introduction of HIVST may reduce opportunities for other STI testing. CONCLUSIONS: The findings of this study suggest that introducing HIVST might weaken linkages to other STI testing if alternative strategies of promoting other STI testing are not simultaneously implemented. We recommend that future interventions address both the risks of HIV and other STI simultaneously, and that structural interventions promoting HIV and other STI preventions be balanced accordingly.
Assuntos
Infecções por HIV/diagnóstico , Infecções Sexualmente Transmissíveis/diagnóstico , Adulto , Medo , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Motivação , Pesquisa Qualitativa , Autoteste , Minorias Sexuais e de Gênero , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/psicologia , Singapura/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: Voluntary HIV testing rates are still low in several Asian countries including Singapore. HIV self-testing (HIVST) has the potential to increase testing, leading to earlier diagnosis and better prognosis. However, the views of at-risk individuals, especially heterosexual men (HSM), who are not coming forward for testing are still poorly understood. In this study, we examined the barriers and facilitators to and delivery preferences for HIVST in order to implement an effective intervention in Singapore. METHODS: From May 2017 to June 2018, 48 in-depth interviews were conducted with HSM aged 21-66 years and at risk of HIV infection. Participants were purposively sampled based on ethnicity, age and testing behaviour. Recruitment was done mainly at brothels and entertainment establishments in Singapore. Participants gave their views on HIV testing, factors affecting HIVST use and their preferred HIVST service delivery model. RESULTS: Most participants preferred HIVST over conventional testing for its convenience, privacy, anonymity and autonomy, but older men still preferred conventional testing. Low self-perceived risk, low awareness and self-efficacy for HIVST, and non-comprehensive test for other STIs were reported as barriers to HIVST. There were mixed opinions on kit preference. A blood-based kit was favoured for higher accuracy, while the oral-fluid-based kit was favoured for ease of use. Participants wanted a human touch for post-test counselling and linkage to care only if they self-tested positive. Traditional media, internet and social media, and venue-based outreach were potential advertising platforms mentioned. CONCLUSIONS: A locally acceptable and feasible HIVST intervention must address the barriers and facilitators of using HIVST in order to improve HIV testing rates among this at-risk population who might otherwise delay or fail to present for testing.