Evaluation of the clinical effect of an artificial intelligence-assisted diagnosis and treatment system for neonatal seizures in the real world: a multicenter clinical study protocol / 中国当代儿科杂志

Neonatal seizures are the most common clinical manifestations of critically ill neonates and often suggest serious diseases and complicated etiologies. The precise diagnosis of this disease can optimize the use of anti-seizure medication, reduce hospital costs, and improve the long-term neurodevelopmental outcomes. Currently, a few artificial intelligence-assisted diagnosis and treatment systems have been developed for neonatal seizures, but there is still a lack of high-level evidence for the diagnosis and treatment value in the real world. Based on an artificial intelligence-assisted diagnosis and treatment systems that has been developed for neonatal seizures, this study plans to recruit 370 neonates at a high risk of seizures from 6 neonatal intensive care units (NICUs) in China, in order to evaluate the effect of the system on the diagnosis, treatment, and prognosis of neonatal seizures in neonates with different gestational ages in the NICU. In this study, a diagnostic study protocol is used to evaluate the diagnostic value of the system, and a randomized parallel-controlled trial is designed to evaluate the effect of the system on the treatment and prognosis of neonates at a high risk of seizures. This multicenter prospective study will provide high-level evidence for the clinical application of artificial intelligence-assisted diagnosis and treatment systems for neonatal seizures in the real world.

Adenoma pleomórfico del espacio parafaríngeo: una entidad escondida / Pleomorphic adenoma of the parapharyngeal space: a hidden entity

Resumen Los tumores del espacio parafaríngeo son poco frecuentes. Dentro de ellos, las neoplasias benignas son las más frecuentes, destacando principalmente los adenomas pleomorfos. Estos tumores suelen permanecer asintomáticos hasta alcanzar el tamaño suficiente para producir alteraciones debido al efecto de masa. A pesar de su naturaleza benigna, es necesario realizar resección completa dada su alta tasa de recurrencia y potencial de transformación maligna. Presentamos el caso de un paciente de 52 años que en estudio de vértigo se detecta incidentalmente una masa tumoral del espacio parafaríngeo de 45 mm × 32 mm de diámetro, de etiología incierta. Se realizó una biopsia incisional endoscópica que evidenció un adenoma pleomórfico, que actualmente se encuentra en etapa de evaluación y planificación de escisión completa. En conclusión, dado que los hallazgos clínicos y radiológicos no siempre son suficientes para determinar la naturaleza de las lesiones del espacio parafaríngeo, es importante contar con un diagnóstico histológico. Los avances en las técnicas de cirugía endoscópica sinusal han permitido acceder a esta zona con una mínima morbilidad y estadía hospitalaria. Debido a la posibilidad de transformación maligna los adenomas pleomórficos requieren un manejo activo.

Abstract Tumors of the parapharyngeal space are rare. Benign neoplasms are the most frequent and, among them, pleomorphic adenomas stand out. These tumors are usually asymptomatic until they reach a size large enough to produce symptoms due to mass effect. Despite its benign nature, it is necessary to perform a complete resection given its high recurrence rate and its potential for malignant transformation. We present the case of a 52-year-old man in whom a study of vertigo incidentally detected a mass in the parapharyngeal space measuring 45 mm × 32 mm in diameter, of unknown etiology. An endoscopic incisional biopsy was performed, showing a pleomorphic adenoma, which is currently under assessment to plan complete removal. In conclusion, as clinical and radiological findings are not always sufficient to determine the nature of parapharyngeal space lesions, it is important to obtain a histological diagnosis. Advances in endoscopic sinus surgery techniques have allowed access to this area with minimal morbidity and hospital stay. Due to the possibility of malignant transformation pleomorphic adenomas require active management.

A Diagnostic Study on the Development of a Health Promotion Program for Vinyl House Farmers

PURPOSE: The purpose of this study was to investigate influencing factors of health problems which the vinyl house farmers had experienced. METHOD: Based on PRECEDE model, this study was done with 110 respondents(50 to 69 years old), working in vinyl house and living in the remote area where the primary health post located. RESULTS: Quality of life was low in economical status, emotional status, and physical function. Health problems were founded as pain and chronic fatigue that were caused by physical symptoms, weakened physical strength, and increased blood pressure and cholesterol. Behavioral and environmental factors were related with lack of exercise, irregular eating habit, curtailed sleep, overwork, wrong working postures, stress, and non-fulfillment of safety standard during spraying pesticide. Self efficacy was low in excercise practice, working way, and stress management. CONCLUSION: The Health Promotion Program for vinyl house farmers should be developed to improve health promoting behavior and self efficacy, to reduce stress, and to strengthen physical function.

Flavona e análogos como radioligantes para imageamento cerebral. Síntese, marcação com radioiodo e estudos in vivo frente a sítios receptores benzodiazepínicos / Flavone and analogues as radioligands for brain images. Synthesis, radiolabelled and in vivo studies in benzodiazepine receptor sites

O desenvolvimento de radioligantes para o sistema nervoso central (SNC) com características radiotraçadoras que justifiquem seu uso em diagnóstico por geração de imagens é esperado pela comunidade médica nuclear. Os benzodiazepínicos flumazenil-‘ANTPOT. 11’C e iomazenil-‘ANTPOT. 123’I são utilizados, com limitações, para investigações clínicas de densidade de sítios receptores benzodiazepínicos no cérebro em patologias como Alzheimer, epilepsia e depressão, entre outras. No Brasil, entretanto, estes traçadores ainda não estão disponíveis para uso clínico. Neste sentido, os flavonóides têm despertado interesses como perspectiva de nova classe de compostos com atividade no SNC podendo originar radiotraçadores com perspectivas para aplicação em imageamento cerebral. Baseado no exposto, a proposta deste estudo envolve o planejamento, a síntese e a marcação com radioiodo (‘ANTPOT. 131’I e ‘ANTPOT. 123’I) de flavona e análogos, o controle de qualidade radioquímico, os estudos de biodistribuição e o imageamento, para a avaliação do perfil de captação desses compostos e potencial aplicação em estudos cerebrais, frente a sítios receptores benzodiazepínicos. Os compostos estudados neste trabalho foram obtidos empregando-se a transformação de Baker-Venkataraman. A flavona e análogos foram identificados através de espectros de RMN-1H, RMN-13Ce IV. O grau de pureza das substâncias obtidas foi confirmado através da medição da faixa de fusão. Os compostos radiomarcados foram obtidos com alta pureza radioquímica por substituição eletrofílica aromática direta. Esta marcação propiciou estabilidade in vitro após 24 horas e, para a flavona radiomarcada estabilidade in vivo, uma vez que a tireóide não apresentou captação significativa em tempos menores que 1 hora e excreção favorável no tempo de 24 horas

The development of radioligands for the Central Nervous System (CNS) with adequate radiotracer characteristics for the use in imaging diagnostic has been long expected by the medical community. Benzodiazepines flumazenil-11C and iomazenil-123I are employed with limitations in clinical investigations of the density of receptor sites in the brain in pathologies such as Alzheimer, epilepsy, and depression. Nevertheless, in Brazil these radiotracers are not available in market, yet. In this respect, flavonoids has drawing attention as a perspective of a new class of compounds wit CNS activity and potential of originating radiotracers to be employed in brain imaging. Therefore, the goal of this work consisted in the planning, synthesis, and labeling with radioiodine (131I and 123I) of flavone and analogs, as well as to perform radiochemical quality control, biodistribuction, and imaging studies of the radiotracers obtained in order to evaluate the uptake profile and potential for use in cerebral studies of benzodiazepinic receptors sites. To obtain the compounds, we utilized the Baker-Venkataraman transformation, and NMR-1H, NMR-13C, and IR spectroscopy were employed for identification of the molecules. The purity of the compounds obtained was assessed by means of melting point determinations. The radiolabeled compounds were obtained by aromatic electrophilic substitution with a high degree of radiochemical purity. The labeling allowed in vitro stability after 24 hours and in vivo stability of the radiolabeled flavone, provided that the thyroid did not presented significant uptake in less than one hour and favorable excretion in 24 hours. Biodistribution studies were carried out employing Swiss mice. The results indicated high concentrations of flavone-I131 in the brain, especially in the first 30 minutes after intravenous injection, as well as favorable elimination after 24 hours. Brain images were obtained from New Zeland rabbit and Wistar rats in analogical gamma camera, suggesting that short-time brain uptake of the radioligand (up to 30 minutes) allows the acquisition of cynthilographic images. Additionally, molecular modeling studies of the flavone were performed employing the semi-empiric method of AM1. The results corroborate the chemical reactivity of the compound for labeling with radioiodine by aromatic electrophilic substitution, process that is governed mainly by electrostatic interactions. The individual values of Mulliken, Natural, and Electrostatic charges of each carbon atom in flavone structure were calculated and topographic maps of charge distribution were then generated. The analysis of the maps indicates that positions 6 and 8 in the flavone molecule are most likely to present the radioiodine substitution