The use of spectrograms improves the classification of wheezes and crackles in an educational setting.

Chest auscultation is a widely used method in the diagnosis of lung diseases. However, the interpretation of lung sounds is a subjective task and disagreements arise. New technological developments like the use of visSual representation of sounds through spectrograms could improve the agreement when classifying lung sounds, but this is not yet known. In this study, we tested if the use of spectrograms improves the agreement when classifying wheezes and crackles. To do this, we asked twenty-three medical students at UiT the Arctic University of Norway to classify 30 lung sounds recordings for the presence of wheezes and crackles. The sample contained 15 normal recordings and 15 with wheezes or crackles. The students classified the recordings in a random order twice. First sound only, then sound with spectrograms. We calculated kappa values for the agreement between each student and the expert classification with and without display of spectrograms and tested for significant improvement between these two coefficients. We also calculated Fleiss kappa for the 23 observers with and without the spectrogram. In an individual analysis comparing each student to an expert annotated reference standard we found that 13 out of 23 students had a positive change in kappa when classifying wheezes with the help of spectrograms. When classifying crackles 16 out of 23 showed improvement when spectrograms were used. In a group analysis we observed that Fleiss kappa values were k = 0.51 and k = 0.56 (p = 0.63) for classifying wheezes without and with spectrograms. For crackles, these values were k = 0.22 and k = 0.40 (p = <0.01) in the same order. Thus, we conclude that the use of spectrograms had a positive impact on the inter-rater agreement and the agreement with experts. We observed a higher improvement in the classification of crackles compared to wheezes.

Prevalence and clinical associations of wheezes and crackles in the general population: the Tromsø study.

BACKGROUND: Wheezes and crackles are well-known signs of lung diseases, but can also be heard in apparently healthy adults. However, their prevalence in a general population has been sparsely described. The objective of this study was to determine the prevalence of wheezes and crackles in a large general adult population and explore associations with self-reported disease, smoking status and lung function. METHODS: We recorded lung sounds in 4033 individuals 40 years or older and collected information on self-reported disease. Pulse oximetry and spirometry were carried out. We estimated age-standardized prevalence of wheezes and crackles and associations between wheezes and crackles and variables of interest were analyzed with univariable and multivariable logistic regressions. RESULTS: Twenty-eight percent of individuals had wheezes or crackles. The age-standardized prevalence of wheezes was 18.6% in women and 15.3% in men, and of crackles, 10.8 and 9.4%, respectively. Wheezes were mostly found during expiration and crackles during inspiration. Significant predictors of expiratory wheezes in multivariable analyses were age (10 years increase - OR 1.18, 95%CI 1.09-1.30), female gender (1.45, 1.2-1.8), self-reported asthma (1.36, 1.00-1.83), and current smoking (1.70, 1.28-2.23). The most important predictors of inspiratory crackles were age (1.76, 1.57-1.99), current smoking, (1.94, 1.40-2.69), mMRC ≥2 (1.79, 1.18-2.65), SpO2 (0.88, 0.81-0.96), and FEV1 Z-score (0.86, 0.77-0.95). CONCLUSIONS: Nearly over a quarter of adults present adventitious lung sounds on auscultation. Age was the most important predictor of adventitious sounds, particularly crackles. The adventitious sounds were also associated with self-reported disease, current smoking and measures of lung function. The presence of findings in two or more auscultation sites was associated with a higher risk of decreased lung function than solitary findings.

Prevalencia y características morfométricas del foramen venoso en cráneos del Noreste de México / Prevalence and morphometric characteristics foramen venosum in Northeastern Mexico skulls

El foramen venoso es una estructura inconstante que se encuentra posterior al foramen redondo y medial al foramen oval, y da paso a una vena que anastomosa al plexo venoso pterigoideo con el seno cavernoso. La existencia de éste foramen puede ser motivo de complicaciones clínicas, entre ellas que es una potencial vía de acceso al seno cavernoso de trombos infectados y constituye una posible falsa vía durante la rizotomía percutánea del trigémino pudiendo puncionar la vena y ocasionar hematomas subdurales. Se utilizó la colección de cráneos del Departamento de Anatomía de la Facultad de Medicina UANL. Se observó la frecuencia y se midieron los siguientes parámetros del foramen: Ancho y largo; en la cara interna de la base del cráneo se midieron las distancias a: foramen redondo, foramen oval, plano sagital mediano y entre forámenes venosos; en la cara externa de la base del cráneo se midieron las distancias con: foramen oval, plano sagital medio y entre los forámenes venosos. Las medidas fueron llevadas a cabo por tres observadores distintos a través de medición directa con vernier y con microfotografías con escalas milimétricas. Se encontró una frecuencia del 20 por ciento con medidas medias de 1,66mm de largo, 1,06mm de ancho; en la cara interna de la base del cráneo: 11,31mm de distancia al foramen redondo, 4,13mm al foramen oval, 17,75mm al plano sagital medio y 31,91mm entre los forámenes; en la cara externa de la base: 2,50mm al foramen oval, 19,54mm al plano sagital medio y 36,05mm entre forámenes venoso. La distancia al foramen oval varía en la cara interna y la cara externa de la base del cráneo debido a un trayecto oblicuo del foramen que tiende a aproximarse al foramen oval y por tanto a separarse del plano sagital medio. Los forámenes derechos fueron generalmente más grandes.

Foramen venosum (foramen Vesalius) is an inconstant structure which is located posterior to the foramen rotundum and medial to the foramen ovale, and it gives pace to an emissary vein that communicates the plexus pterigoideus and the sinus cavernosus. The existence of this anatomical structure can be of interest in certain procedures like percutaneous trigeminal rhizotomy where this foramen can be the cause of a false pathway and be punctured causing a subdural hematoma. It also can be an access to the sinus cavernosus for infected thrombus coming from dental and facial infections. For this study the skull collection of the Anatomy Department, Faculty of Medicine UANL, was used. We observed the frequency and measured the following parameters: Length and width; in the basis cranii we measured: Distances to the foramen rotundum, foramen ovale, planum medianum and between two foramina venosum (one on each side). In basis cranii externa we measured: distances to foramen ovale, planum medianum, and between two foramina venosum. Three independent observers blinded among them, measured the parameters using a Vernier and microphotographs with milimetrical scales. A 20 percent frequency was found and the following median measures: Length 1.66mm, width 1.06mm; basis cranii: distance to foramen rotundum 11.31mm, distance to foramen ovale 4.13mm, distance to planum medianum 17.75mm and 31.91mm between both foramina venosum. Basis cranii externa: distance to foramen ovale 2.49mm, distance to planum medianum 19.54mm and distance between foramenina venosum 36.05. The distance to the foramen ovale varies between basis cranii and basis cranii externa because the foramen has an oblique trajectory and it approximates to the foramen ovale (from superior to inferior) and separates from the planum medianum. It was found bilaterally only in one skull. There are differences between the left and right foramens, the latter being generally larger.

[The assessment of varicocele by ultrasound]. / Evaluación del varicocele por ultrasonido.

OBJECTIVE: Evaluating the utility that has the scrotal ultrasound in the patient with varicocele. METHODS: 34 patients with varicocele, 28 unilateral, y 6 bilateral, 9 right and 31 left, was evaluated by means of scrotal ultrasound in high-resolution real-time united, we utilized an ATL with transducers 7-12 Mhz. The age oscillates between 13-36 years. Five patient adolescent went for pain, 23 infertile patients, and 6 adults for pain/or discomfort scrotal. RESULTS: For ultrasound we observed 10/40 testicular atrophy, the texture was homogeneous 35/40. Five testicles had decrease of the echogenicity. The ultrasound confirms varicocele in the clinical cases 31/31, we detect 3/9 subclinical. The images that were gotten being the of a group of 2 or 3 tubular structures, or liquid cords dilated of a diameter between 1.5 and 2 mm in the subclinical, and superior to 2 mm in the clinical, or one greater of 3 mm, located in the cord or in the groin canal, up and behind of the head of the epididymis, in the voluminous cases could be observed behind and below the testicle. CONCLUSIONS: The scrotal ultrasound is an adequate method, rapid, easy not obnoxious, useful in the evaluation preoperative and postoperative of the varicocele.

Anabolic implant and frame size effects on growth regulation, nutrient repartitioning and energetic efficiency of feedlot steers.

Rates of growth and partitioning of nutrients among tissues were measured in large (Simmental x [Hereford x Brahman]; n = 34) and very large (Chianina x Angus and Maine Anjou x Angus; n = 37) steers implanted with different anabolic growth regulators. All cattle were fed individually a whole shelled corn (13% crude protein) diet. Implant strategies were: none (n = 13), Ralgro 36 mg (n = 15), Ralgro 72 mg (n = 14), Synovex-S (n = 15) and Ralgro 36-Synovex-S (n = 14) administered at d 0 and 90. Empty body composition of all cattle was measured initially and at 90 d by D2O dilution procedures and at slaughter (average, 182 +/- 4.1 d) by carcass specific gravity. Empty body weight for large and very large cattle averaged 274 and 324 kg (P less than .05) initially and 497 and 603 kg (P less than .05) at slaughter. Empty body protein differed (P less than .05) for large and very large steers and averaged 51 and 61, 67 and 79, and 87 and 103 kg initially, at midpoint and at slaughter, respectively. Percentage empty body fat was lower for very large steers (13.5 vs 15.6%) initially (P less than .05) but was similar for very large and large steers at the midpoint (18.7 vs 18.1%) and at slaughter (23.2 vs 21.9%). Daily rates of empty body gain (DEBG) were greater (P less than .05) for very large vs large steers for both growing and finishing periods and averaged 1.53 vs 1.26 kg/d overall. Daily rates of protein gain (DPG) were similar for very large and large steers for the growing phase (204 vs 202 g/d) but greater (P less than .05) in very large steers for the finishing phase and overall (253 vs 204, and 229 vs 202 g/d). All implant strategies, except R36, increased DEBG and DPG and tended to decrease the percentage of fat in daily gain. In both large and very large cattle, implant growth regulators increased growth rate and partitioned nutrient use away from fat toward protein accretion, with the magnitude of partitioning toward protein increasing with greater rates of growth. These data indicate that anabolic growth regulators are viable strategies to enhance lean beef production in steers, regardless of animal size.

Maintenance requirements and energetic efficiency of cows of different breed types.

Dry, nonpregnant, mature cows (greater than 10 yr) of five breeds (Angus, A; Brahman, B; Hereford, He; Holstein, Ho; and Jersey, J) and their crosses (n = 60) were used in a 428-d experiment to determine maintenance energy requirements and efficiency of energy exchange. Cows were fed individually (via Calan electronic gates) a 70% cottonseed hull diet for four consecutive periods (127, 105, 97 and 99 d) at each of four levels (50, 83, 117 and 150% of each animal's estimated maintenance requirement). Each of four cows/breed group was assigned to one of the four feeding levels each period, with one cow fed each level each period. Body composition was measured initially and following each period in all cows via D2O dilution with a two-pool kinetics model procedure. Average ending live weight and empty body weight, protein and fat were similar to beginning values, indicating that cows began and ended in similar body composition. Dry matter digestibility (DMD) following the last period averaged 54.7%. Average DMD was 53.5, 57.8, 52.0, 55.0 and 51.7% (standard error of mean [SE] = 2.1) for A, B, He, Ho and J; values for He and J were lower (P less than .05) than for B. Diet digestible energy (DE) was similar for all breed types and averaged 62.4% of gross energy (GE). A small decrease in DE with increasing GE intake was noted for all breed types. The daily metabolizable energy requirement for weight equilibrium for A, B, He, Ho and J differed (P less than .01) and was 100, 98, 108, 119 and 152 kcal/kg.75 (SE 4.8), respectively, with an overall mean of 107. The ME for maintenance (MEm) was 91.6, 93.8, 95.3, 115.7 and 140.4 kcal/kg.75 for A, B, He, Ho and J (SE 6.0), respectively, with an overall mean of 101.9. Efficiency of weight change for A, B, He, Ho and J differed (P less than .01) and was 116, 135, 80, 116 and 58 g/Mcal ME intake, respectively, with an overall mean of 96. The respective efficiency of ME use for tissue energy gain or loss was 80.6, 66.8, 66.0, 36.5 and 36.2% for A, B, He, Ho and J, with an average energetic efficiency of 60.1%. In general, maintenance requirements for weight and energy equilibrium were lower in beef breeds and their crosses than in dairy breeds and their crosses. Efficiency of ME use also favored the beef breeds over the dairy breeds.(ABSTRACT TRUNCATED AT 400 WORDS)