RESUMO
Objective.Despite the widespread use and technical improvement of cochlear implant (CI) devices over past decades, further research into the bioelectric bases of CI stimulation is still needed. Various stimulation modes implemented by different CI manufacturers coexist, but their true clinical benefit remains unclear, probably due to the high inter-subject variability reported, which makes the prediction of CI outcomes and the optimal fitting of stimulation parameters challenging. A highly detailed full-head model that includes a cochlea and an electrode array is developed in this study to emulate intracochlear voltages and extracochlear current pathways through the head in CI stimulation.Approach.Simulations based on the finite element method were conducted under monopolar, bipolar, tripolar (TP), and partial TP modes, as well as for apical, medial, and basal electrodes. Variables simulated included: intracochlear voltages, electric field (EF) decay, electric potentials at the scalp and extracochlear currents through the head. To better understand CI side effects such as facial nerve stimulation, caused by spurious current leakage out from the cochlea, special emphasis is given to the analysis of the EF over the facial nerve.Main results.The model reasonably predicts EF magnitudes and trends previously reported in CI users. New relevant extracochlear current pathways through the head and brain tissues have been identified. Simulated results also show differences in the magnitude and distribution of the EF through different segments of the facial nerve upon different stimulation modes and electrodes, dependent on nerve and bone tissue conductivities.Significance.Full-head models prove useful tools to model intra and extracochlear EFs in CI stimulation. Our findings could prove useful in the design of future experimental studies to contrast FNS mechanisms upon stimulation of different electrodes and CI modes. The full-head model developed is freely available for the CI community for further research and use.
Assuntos
Cóclea , Implantes Cocleares , Estimulação Elétrica , Humanos , Cóclea/fisiologia , Cabeça , Modelos Biológicos , Análise de Elementos Finitos , EletricidadeRESUMO
BACKGROUND: Fibroblasts and others mesenchymal cells have recently been identified as critical cells triggering tissue-specific inflammatory responses. Persistent activation of fibroblasts inflammatory program has been suggested as an underlying cause of chronic inflammation in a wide range of tissues and pathologies. Nevertheless, the role of fibroblasts in the emergence of chronic inflammation in the upper airway has not been previously addressed. We aimed to elucidate whether fibroblasts could have a role in the inflammatory response in chronic rhinosinusitis with nasal polyps (CRSwNP). METHODOLOGY: We performed whole-transcriptome microarray in fibroblast cultured from CRSwNP samples and confirmed our results by qRT-PCR. We selected patients without other associated diseases in upper airway. To investigate shifts in transcriptional profile we used fibroblasts from nasal polyps and uncinate mucosae from patient with CRSwNP, and fibroblasts from uncinate mucosae from healthy subjects as controls. RESULTS: This study exposes activation of a pro-inflammatory and pro-fibrotic transcriptional program in nasal polyps and CRSwNP fibroblasts when compared to controls. Our Gene-set Enrichment Analysis (GSEA) pointed to common up-regulation of several pro-inflammatory pathways in patients-derived fibroblasts, along with higher mRNA expression levels of cytokines, growth factors and extracellular matrix components. CONCLUSIONS: Our work reveals a potential new source of inflammatory signaling in CRSwNP. Furthermore, our results suggest that deregulated inflammatory signaling in tissue-resident fibroblasts could support a Type-2 inflammatory response. Further investigations will be necessary to demonstrate the functionality of these novel results.
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Pólipos Nasais , Rinite , Sinusite , Humanos , Rinite/patologia , Pólipos Nasais/patologia , Doença Crônica , Inflamação/patologia , Sinusite/metabolismo , Fibroblastos/metabolismo , Fibroblastos/patologiaRESUMO
BACKGROUND: Although extended endoscopic sinus surgery (ESS) constitutes an alternative approach in patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), the surgical techniques proposed so far do not allow for an optimal control of the disease. This study introduces bilateral mucoplasty as a complementary technique to extended ESS such as reboot surgery, analyzing its benefits in healing and quality of life (QoL). METHODS: Patients diagnosed with severe Type-2 CRSwNP were selected for a prospective cohort study in two surgery groups: reboot surgery plus bilateral mucoplasty versus reboot surgery only. In the first group, an autologous endonasal mucosal graft from the nostril floor was placed bilaterally onto the ethmoidal roof. Endoscopic, radiological and QoL outcomes were compared before and one year after surgery between the two groups using Modified Lund Kennedy (LKM), Meltzer and Lund Mackay (LM) scores, and the Sino-Nasal Outcome Test 22 (SNOT-22). RESULTS: 64 patients with homogeneous baseline characteristics were included: 17 patients underwent a reboot surgery plus a bilateral mucoplasty and 47 a reboot surgery only. LKM, Meltzer and SNOT-22 scores showed significant differences before and after surgery in both groups, with higher improvement in the mucoplasty group. A greater mean improvement of 20.5 ± 6.4 points in SNOT-22 change was associated with bilateral mucoplasty. CONCLUSION: Bilateral mucoplasty plus reboot surgery constitutes a useful surgical resource in Type-2 CRSwNP patients, showing improved endoscopic, radiological and QoL outcomes one year after surgery. Further studies are needed to determine their long-term benefits.
Assuntos
Pólipos Nasais , Rinite , Sinusite , Doença Crônica , Endoscopia/métodos , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/diagnóstico , Pólipos Nasais/cirurgia , Estudos Prospectivos , Qualidade de Vida , Rinite/complicações , Rinite/diagnóstico , Rinite/cirurgia , Sinusite/complicações , Sinusite/diagnóstico , Sinusite/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: The main objective of this study was to determine the prevalence of work-related musculoskeletal symptoms in otolaryngology and head and neck surgery specialists and trainees in Spain, and to measure the effect that physical exercise could have on muscular discomfort. METHOD: A cross-sectional survey was administered between September and December 2017 to practising otolaryngologists. RESULTS: Four hundred and three ENT surgeons responded, with a median age of 44.9 years, and 89.8 per cent reported discomfort or physical symptoms that they attributed to surgical practice. More female surgeons reported musculoskeletal symptoms (92.8 per cent vs 87.1 per cent; p = 0.04). When the level of physical activity was compared with the frequency of physical discomfort, no significant difference was found. CONCLUSION: This study has shown a high prevalence of musculoskeletal disorders among ENT surgeons in Spain but has failed to demonstrate an important role of physical exercise in the prevention of musculoskeletal disorders.
Assuntos
Terapia por Exercício/métodos , Doenças Musculoesqueléticas/epidemiologia , Doenças Profissionais/reabilitação , Adulto , Idoso , Estudos Transversais , Ergonomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/etiologia , Doenças Musculoesqueléticas/prevenção & controle , Doenças Profissionais/complicações , Doenças Profissionais/epidemiologia , Prevalência , Espanha/epidemiologia , Cirurgiões , Inquéritos e Questionários , Falha de TratamentoRESUMO
BACKGROUND: We report a novel surgical technique based on an endonasal free mucosal graft (mucoplasty) for improving clinical results and local healing in chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS: Patients diagnosed with bilateral CRSwNP scheduled for endoscopic sinus surgery were included. They underwent complete removal of anterior and posterior ethmoid cells, in addition to bilateral type III frontal sinusotomy. An endoscopic mucoplasty was performed in the left nasal cavity, whereas the right nasal cavity served as control. Patients were evaluated before surgery and 6 months after operation, including Sino-Nasal Outcome Test (SNOT-22), Visual Analogue Scale (VAS) for olfaction, endoscopic evaluation using the Modified und-Kennedy (MLK) scoring system and healing evaluation. RESULTS: Ten patients (mean age 53.6 years) were included. A significa t decrease of SNOT-22 score from 57.0 (21.1) to 20.3 (20.6) (P = 0.024) and a non-significa t decrease of VAS for olfaction score from 9.3 (0.5) to 4.6 (3.9) were found. Preoperative mean MLK score was 4.9 (0.7) in the right nostril and 4.8 (1.0) in the left one. After operation, there was a greater decrease of MLK score in the left nostril than in the right (1.9 [1.0] vs. 1.3 [0.8], P = 0.034). Better healing was proved in the nostril with the mucoplasty. CONCLUSION: Endonasal mucoplasty could be an effective, safe and feasible complementary surgical procedure in the treatment of CRSwNP. The reduced local edema associated with lower amount of secretions may confer a better control in the frontal recess, orbital wall and nasal roof.
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Endoscopia , Pólipos Nasais , Sinusite , Doença Crônica , Endoscopia/métodos , Humanos , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Projetos Piloto , Sinusite/etiologia , Sinusite/cirurgia , Resultado do TratamentoRESUMO
PURPOSE: To calculate the incidence of subsequent acute cerebrovascular syndrome in emergency department patients with vertigo or dizziness symptoms and to determine predictors of subsequent acute cerebrovascular syndrome in these patients. METHODS: Descriptive and retrospective hospital based-population study among emergency department patients with vertigo or dizziness symptoms in 1 year. One year follow-up since the medical visit was performed. Chi-square and Fisher tests were used for qualitative variables; Mann-Whitney U test for quantitative variables. A multivariate model was created. RESULTS: 1243 dizzy patients who visited emergency department during 2015 were identified, finally 928 were included. 12 acute cerebrovascular syndromes were identified; 8 strokes and 4 transient ischemic attacks. Percentages over the sample size: 1.29% for acute cerebrovascular syndromes, 0.43% for transient ischemic attack and 0.86% for stroke. Odds ratio values to develop an event over the general population were 7.24 for acute cerebrovascular syndrome, 95% CI (3.98-13.12); 14.9 for transient ischemic attack, 95% CI (4.8-40.9) and 5.86 for stroke, 95% CI (2.72-12.0). Atrial fibrillation and diabetes mellitus were identified as significant risk factors to develop an acute cerebrovascular syndrome. CONCLUSION: Emergency department patients with symptoms of vertigo or dizziness had sevenfold higher risk of acute cerebrovascular syndromes than the general population. Atrial fibrillation and diabetes mellitus are risk factors associated with high risk of acute cerebrovascular syndromes in these patients.
Assuntos
Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/epidemiologia , Tontura/complicações , Serviço Hospitalar de Emergência , Vertigem/complicações , Doença Aguda , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Tontura/diagnóstico , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Síndrome , Vertigem/diagnóstico , Adulto JovemRESUMO
La atención a pacientes con comorbilidad y pluripatología supone un reto para cualquier sistema sanitario. Las guías de práctica clínica (GPC) presentan limitaciones cuando se aplican a esta población. El objetivo de este trabajo es realizar una propuesta terminológica y metodológica sobre el abordaje de la comorbilidad y la pluripatología en las GPC. De acuerdo a la revisión bibliográfica efectuada, se sugieren algunas propuestas para su abordaje en las diferentes fases de elaboración de las GPC, con especial atención a la inclusión de los clusters de comorbilidad en las preguntas clínicas iniciales, la incorporación de la evidencia indirecta, el peso de la carga de gestionar la enfermedad para el paciente y su entorno en la formulación de recomendaciones, así como las estrategias de difusión e implementación. Estas propuestas deben desarrollarse en mayor profundidad con la participación de más agentes para disponer de herramientas válidas y útiles en esta población
The management of patients with comorbidity and polypathology represents a challenge for all healthcare systems. Clinical practice guidelines (CPGs) have limitations when applied to this population. The aim of this study is to propose the terminology and methodology for optimally approach comorbidity and polypathology in the CPGs. Based on a literature review, we suggest a number of proposals for the approach in different phases of CPG preparation, with special attention to the inclusion of clusters of comorbidity in the initial questions the implementation of indirect evidence, the burden of disease management for patients and their environment, when establishing recommendations, as well as the strategies of dissemination and implementation. These proposals should be developed in greater depth with the implication of more agents in order to have valid and useful tools for this population
Assuntos
Humanos , Masculino , Feminino , Terminologia como Assunto , Current Procedural Terminology , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Comorbidade , Atenção Primária à Saúde/legislação & jurisprudência , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Doença Crônica/classificação , Doença Crônica/mortalidade , PrognósticoRESUMO
La atención a pacientes con comorbilidad y pluripatología supone un reto para cualquier sistema sanitario. Las guías de práctica clínica (GPC) presentan limitaciones cuando se aplican a esta población. El objetivo de este trabajo es realizar una propuesta terminológica y metodológica sobre el abordaje de la comorbilidad y la pluripatología en las GPC. De acuerdo a la revisión bibliográfica efectuada, se sugieren algunas propuestas para su abordaje en las diferentes fases de elaboración de las GPC, con especial atención a la inclusión de los clusters de comorbilidad en las preguntas clínicas iniciales, la incorporación de la evidencia indirecta, el peso de la carga de gestionar la enfermedad para el paciente y su entorno en la formulación de recomendaciones, así como las estrategias de difusión e implementación. Estas propuestas deben desarrollarse en mayor profundidad con la participación de más agentes para disponer de herramientas válidas y útiles en esta población (AU)
The management of patients with comorbidity and polypathology represents a challenge for all healthcare systems. Clinical practice guidelines (CPGs) have limitations when applied to this population. The aim of this study is to propose the terminology and methodology for optimally approach comorbidity and polypathology in the CPGs. Based on a literature review, we suggest a number of proposals for the approach in different phases of CPG preparation, with special attention to the inclusion of clusters of comorbidity in the initial questions the implementation of indirect evidence, the burden of disease management for patients and their environment, when establishing recommendations, as well as the strategies of dissemination and implementation. These proposals should be developed in greater depth with the implication of more agents in order to have valid and useful tools for this population (AU)
Assuntos
Humanos , Masculino , Feminino , Comorbidade/tendências , Morbidade , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/tendências , Terminologia como Assunto , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Prognóstico , Sistemas Nacionais de SaúdeRESUMO
The current validated endotoxin detection methods, in spite of being highly sensitive, present several drawbacks in terms of reproducibility, handling and cost. Therefore novel approaches are being carried out in the scientific community to overcome these difficulties. Remarkable efforts are focused on the development of endotoxin-specific biosensors. The key feature of these solutions relies on the proper definition of the capture protocol, especially of the bio-receptor or ligand. The aim of the presented work is the screening and selection of a synthetic peptide specifically designed for LPS detection, as well as the optimization of a procedure for its immobilization onto gold substrates for further application to biosensors.
Assuntos
Técnicas Biossensoriais/métodos , Proteínas Imobilizadas/química , Lipopolissacarídeos/análise , Peptídeos/química , Bactérias , Ensaio de Imunoadsorção Enzimática , Concentração de Íons de Hidrogênio , Proteínas Imobilizadas/metabolismo , Lipopolissacarídeos/química , Peptídeos/metabolismo , Técnicas de Microbalança de Cristal de QuartzoRESUMO
The management of patients with comorbidity and polypathology represents a challenge for all healthcare systems. Clinical practice guidelines (CPGs) have limitations when applied to this population. The aim of this study is to propose the terminology and methodology for optimally approach comorbidity and polypathology in the CPGs. Based on a literature review, we suggest a number of proposals for the approach in different phases of CPG preparation, with special attention to the inclusion of clusters of comorbidity in the initial questions the implementation of indirect evidence, the burden of disease management for patients and their environment, when establishing recommendations, as well as the strategies of dissemination and implementation. These proposals should be developed in greater depth with the implication of more agents in order to have valid and useful tools for this population.
Assuntos
Doença Crônica , Guias de Prática Clínica como Assunto , Doença Crônica/epidemiologia , Doença Crônica/terapia , Comorbidade , HumanosRESUMO
The management of patients with comorbidity and polypathology represents a challenge for all healthcare systems. Clinical practice guidelines (CPGs) have limitations when applied to this population. The aim of this study is to propose the terminology and methodology for optimally approach comorbidity and polypathology in the CPGs. Based on a literature review, we suggest a number of proposals for the approach in different phases of CPG preparation, with special attention to the inclusion of clusters of comorbidity in the initial questions the implementation of indirect evidence, the burden of disease management for patients and their environment, when establishing recommendations, as well as the strategies of dissemination and implementation. These proposals should be developed in greater depth with the implication of more agents in order to have valid and useful tools for this population.
RESUMO
Shigellosis is one of the leading causes of diarrhea worldwide with more than 130 million cases annually. Hence, the research of an effective vaccine is still a priority. Unfortunately, a safe and efficacious vaccine is not available yet. We have previously demonstrated the capacity of outer membrane vesicles (OMVs) to protect mice against an experimental infection with Shigella flexneri. Now, we present results on the capacity of this antigenic complex to confer a longer-term protection by oral or nasal routes when encapsulated into nanoparticles. OMVs were encapsulated in poly(anhydride) nanoparticles (NP) prepared by a solvent displacement method with the copolymer poly methyl vinyl ether/maleic anhydride. OMVs loaded into nanoparticles (NP-OMVs) were homogeneous and spherical in shape, with a size of 148nm (PdI=0.2). BALB/c mice were immunized with OMVs either free or encapsulated in nanoparticles by nasal (20µg or 10µg of OMVs) or oral route (100µg or 50µg of OMVs). All immunized animals remained in good health after administration. Challenge infection was performed intranasally on week 8th with a lethal dose of 5×10(7)CFU/mouse of S. flexneri 2a. The number of dead mice after challenge was recorded daily. Results confirmed the value of OMVs as a vaccine. By oral route, the OMV-vaccine was able to protect independently either the dose or the formulation. When vaccine was delivered by nasal route, encapsulation into NPs resulted beneficial in increasing protection from 40% up to 100% when low dose was administered. These results are extraordinary promising and put in relevance the positive effect of nanoencapsulation of the OMV subcellular vaccine.
Assuntos
Proteínas da Membrana Bacteriana Externa/imunologia , Membrana Celular/imunologia , Disenteria Bacilar/prevenção & controle , Nanopartículas , Vacinas contra Shigella/imunologia , Administração Intranasal , Administração Oral , Animais , Anticorpos Antibacterianos/sangue , Proteção Cruzada , Citocinas/imunologia , Disenteria Bacilar/imunologia , Maleatos , Camundongos , Camundongos Endogâmicos BALB C , Polianidridos , Polietilenos , Vacinas contra Shigella/administração & dosagem , Shigella flexneriRESUMO
BACKGROUND: Access to up-to-date and understandable health information is a growing citizen demand, as well as an ethical duty and a legal regulation. Written information reinforces information transmitted orally during the consultation and improves recall capacity. Adenoamigdalectomy is an intervention that affects a high number of patients, the majority from the child population that has a high emotional sensitivity, and it is experienced by parents with considerable anxiety. An informative guide on adenoamigdalectomy was elaborated and validated. The aim of this article is to describe the process of elaborating the document, emphasizing its validation and results. MATERIAL AND METHODS: The document was validated in three phases: A) Clinical content validated by professionals with a checklist and a consensus meeting; B) Analysis of grammatical legibility according to the Flesch index; C) Validation of lexical legibility with citizens by means of a validation guide and interviews. RESULTS: The validation by professionals and citizens was highly positive. The professionals stressed the accuracy of the content and corrected some imprecisions. They made suggestions concerning format, writing style and length. The citizens stressed understandable language, resolution of doubts, respectful tone and their satisfaction with the initiative. They also differed on aspects such as their opinion of the document's length. CONCLUSIONS: The validation of informative documents by both professionals and patients is a process of great interest. Lack of agreement in their analyses makes it clear why it is important to include both sectors. The document was improved by their contributions.
Assuntos
Adenoidectomia , Educação de Pacientes como Assunto , Tonsilectomia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
Objetivos. Las subcategorías BI-RADS®4A/B/C comprenden amplios rangos de valores predictivos positivos (VPP) y no se ha definido su correlación con descriptores específicos. Nuestro objetivo es analizar el VPP de las subcategorías y los descriptores asignados a ellas en lesiones mamográficas y ecográficas. Material y método. Analizamos 880 lesiones confirmadas histológicamente y subclasificadas prospectivamente como BI-RADS®4A/B/C entre 2003-2010. El estudio estadístico incluyó pruebas de significación, tablas de contingencia y estudio de riesgos relativos (RR) sobre 545 lesiones mamográficas y 627 ecográficas. Resultados. Los VPP por subcategoría fueron 8,8%-4A, 18,9%-4B y 58,3%-4C. La correlación entre VPP y lesiones fue la esperada, excepto: VPP 4A>4B en nódulos ecográficos irregulares/márgenes no circunscritos y microcalcificaciones con distribución segmentaria, asignación de BI-RADS®4 a lesiones BI-RADS®3 y consideración de lesiones idénticas en distintas subcategorías. En el estudio por tablas de contingencia, las lesiones mamográficas estuvieron en rangos de 4B/C y las ecográficas en 4B. Los RR fueron significativos en nódulos mamográficos para morfología irregular (RR=3,205) y márgenes espiculados (RR=2,469), y para microcalcificaciones pleomórficas (RR=2,531), amorfas (RR=0,334) y distribución segmentaria (RR=1,895). En la ecografía, los RR fueron significativos en todos los descriptores, con valores mayores de uno en morfología irregular (RR=1,977) y márgenes no circunscritos (RR=2,277). Conclusiones. Nuestros resultados concuerdan con los publicados. Las excepciones encontradas pueden justificarse por aspectos relacionados con la variabilidad y factores no radiológicos con posible influencia en la categorización y VPP. Es necesario elaborar modelos matemáticos que permitan la categorización objetiva e incluyan factores no relacionados con la imagen(AU)
Objectives. The positive predictive values (PPV) of the subcategories of BI-RADS® 4 lesions (A/B/C) vary widely, and their correlation with specific descriptors has yet to be defined. We aimed to analyze the PPV of the subcategories and of the mammographic and ultrasonographic descriptors assigned to each. Material and methods. We analyzed 880 histologically confirmed lesions prospectively classified as BI-RADS® 4 A/B/C between 2003 and 2010. The statistical analysis included significance tests, contingency tables, and relative risk (RR) ratios, calculated for 545 mammographic lesions and 627 ultrasonographic lesions. Results. The PPV was 8.8% for subcategory 4A, 18.9% for subcategory 4B, and 58.3% for subcategory 4C. The correlation between PPV and lesions was what we expected, with three exceptions: a) the PPV of 4A was greater than that of 4B in nodules that were irregular or had uncircumscribed margins on ultrasonography and in microcalcifications with segmental distribution on mammography, b) BI-RADS® 3 lesions classified as BI-RADS® 4, and c) identical lesions classified in distinct subcategories. In the contingency table analysis, the mammographic lesions were 4B/C and the ultrasonographic lesions were 4B. On mammography, the RR was significant for nodules with irregular shape (RR=3.205) and for those with spiculated margins (RR=2.469), as well as for microcalcifications that were pleomorphic (RR=2.531) or amorphous (RR=0.334), and for those with segmental (RR=1.895). On ultrasonography, the RR were significant for all the descriptors, with values greater than 1 for irregular shape (RR=1.977) and uncircumscribed margins (RR=2.277). Conclusions. Our results corroborate previous reports. The exceptions can be explained by aspects related to variability and nonradiological factors that might influence the classification and PPV. Mathematical models should be developed to enable the objective classification and these should include factors not related to imaging(AU)
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Ultrassonografia Mamária/métodos , Ultrassonografia Mamária/tendências , Ultrassonografia Mamária , 28423 , Mama , Mama/patologia , Mama , Calcinose , Ultrassonografia Mamária/instrumentação , Razão de Chances , Planos de Contingência , Estudos Retrospectivos , Ultrassonografia/instrumentação , Ultrassonografia/métodos , UltrassonografiaRESUMO
OBJECTIVES: The positive predictive values (PPV) of the subcategories of BI-RADS(®) 4 lesions (A/B/C) vary widely, and their correlation with specific descriptors has yet to be defined. We aimed to analyze the PPV of the subcategories and of the mammographic and ultrasonographic descriptors assigned to each. MATERIAL AND METHODS: We analyzed 880 histologically confirmed lesions prospectively classified as BI-RADS(®) 4 A/B/C between 2003 and 2010. The statistical analysis included significance tests, contingency tables, and relative risk (RR) ratios, calculated for 545 mammographic lesions and 627 ultrasonographic lesions. RESULTS: The PPV was 8.8% for subcategory 4A, 18.9% for subcategory 4B, and 58.3% for subcategory 4C. The correlation between PPV and lesions was what we expected, with three exceptions: a) the PPV of 4A was greater than that of 4B in nodules that were irregular or had uncircumscribed margins on ultrasonography and in microcalcifications with segmental distribution on mammography, b) BI-RADS(®) 3 lesions classified as BI-RADS(®) 4, and c) identical lesions classified in distinct subcategories. In the contingency table analysis, the mammographic lesions were 4B/C and the ultrasonographic lesions were 4B. On mammography, the RR was significant for nodules with irregular shape (RR=3.205) and for those with spiculated margins (RR=2.469), as well as for microcalcifications that were pleomorphic (RR=2.531) or amorphous (RR=0.334), and for those with segmental (RR=1.895). On ultrasonography, the RR were significant for all the descriptors, with values greater than 1 for irregular shape (RR=1.977) and uncircumscribed margins (RR=2.277). CONCLUSIONS: Our results corroborate previous reports. The exceptions can be explained by aspects related to variability and nonradiological factors that might influence the classification and PPV. Mathematical models should be developed to enable the objective classification and these should include factors not related to imaging.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamografia , Neoplasias da Mama/classificação , Feminino , Humanos , Valor Preditivo dos Testes , Estudos Prospectivos , Estudos Retrospectivos , UltrassonografiaRESUMO
Vaccination appears to be the only rational prophylactic approach to control shigellosis. Unfortunately, there is still no safe and efficacious vaccine available. We investigated the protection conferred by a new vaccine containing outer membrane vesicles (OMVs) from Shigella flexneri with an adjuvant based on nanoparticles in an experimental model of shigellosis in mice. OMVs were encapsulated in poly(anhydride) nanoparticles prepared by a solvent displacement method with the copolymer PMV/MA. OMVs loaded into NPs (NP-OMVs) were homogeneous and spherical in shape, with a size of 197nm (PdI=0.06). BALB/c mice (females, 9-week-old, 20±1g) were immunized by intradermal, nasal, ocular (20µg) or oral route (100µg) with free or encapsulated OMV. Thirty-five days after administration, mice were infected intranasally with a lethal dose of S. flexneri (1×10(7)CFU). The new vaccine was able to protect fully against infection when it was administered via mucosa. By intradermal route the NP-OMVs formulation increased the protection from 20%, obtained with free extract, to 100%. Interestingly, both OMVs and OMV-NP induced full protection when administered by the nasal and conjuntival route. A strong association between the ratio of IL-12p40/IL-10 and protection was found. Moreover, low levels of IFN-γ correlate with protection. Under the experimental conditions used, the adjuvant did not induce any adverse effects. These results place OMVs among promising candidates to be used for vaccination against Shigellosis.
Assuntos
Disenteria Bacilar/prevenção & controle , Exossomos/imunologia , Vacinas contra Shigella/imunologia , Shigella flexneri/imunologia , Adjuvantes Imunológicos/administração & dosagem , Animais , Disenteria Bacilar/imunologia , Disenteria Bacilar/mortalidade , Interleucina-10/biossíntese , Interleucina-10/imunologia , Subunidade p40 da Interleucina-12/biossíntese , Subunidade p40 da Interleucina-12/imunologia , Camundongos , Camundongos Endogâmicos BALB C , Nanopartículas/administração & dosagem , Vacinas contra Shigella/administração & dosagem , Análise de SobrevidaRESUMO
Presentamos un caso de esta entidad en una paciente caucásica, con lesiones maculosas purpúricas en zona tibial posterior de pierna derecha, sin afectación sistémica, de curso crónico y persistente en la actualidad, tras dieciocho meses de seguimiento con mejoría parcial, después de recibir tratamiento con esteroides e inmunosupresores tópicos. Los anticonceptivos orales y la hipercolesterolemia leve, podrían ser datos asociados en nuestro caso a dicha entidad, aunque se necesitarían más estudios para confirmar esta hipótesis.
We present a case of this entity in a Caucasian, patient with purpuric macular lesion area with her right posterior tibial, without affecting systemic, chronic and persistent course now, after eighteen months of follow-up with partial improvement after treatment with topical steroids and immunosuppressors. Oral contraceptives and mild hypercholesterolemia may be associated data in our case to the entity, althought further studies are needed to confirm this hypothesis.
RESUMO
OBJECTIVE: The purpose of our study was to perform a prospective assessment of the impact of a CAD system in a screen-film mammography screening program during a period of 3 years. MATERIALS AND METHODS: Our study was carried out on a population of 21,855 asymptomatic women (45-65 years). Mammograms were processed in a CAD system and independently interpreted by one of six radiologists. We analyzed the following parameters: sensitivity of radiologist's interpretation (without and with CAD), detection increase, recall rate and positive predictive value of biopsy, CAD's marks, radiologist's false negatives and comparative analysis of carcinomas detected and non-detected by CAD. RESULTS: Detection rate was 4.3. CAD supposed an increase of 0.1 in detection rate and 1% in the total number of cases (p<0.005). The impact on recall rate was not significant (0.4%) and PPV of percutaneous biopsy was unchanged by CAD (20.23%). CAD's marks were 2.7 per case and 0.7 per view. Radiologist's false negatives were 13 lesions which were initially considered as CAD's false positives. CONCLUSIONS: CAD supposed a significant increase in detection, without modifications in recall rates and PPV of biopsy. However, better results could have been achieved if radiologists had considered actionable those cases marked by CAD but initially misinterpreted.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Interpretação de Imagem Radiográfica Assistida por Computador , Filme para Raios X/estatística & dados numéricos , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Espanha/epidemiologiaRESUMO
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