A retrospective study correlating sonographic features of thyroid nodules with fine-needle aspiration cytology in a South African setting

Background

Thyroid nodules are prevalent worldwide. Detection rates are increasing because of the use of ultrasonography. Ultrasound has become the first-choice imaging modality in evaluating nodules. The decision to perform an US-guided fine-needle aspiration (FNA) is based on a nodule’s sonographic features. Thus, it is essential to accurately risk stratify thyroid nodules so that they are appropriately referred for FNA.

Objectives

The aim of this study was to correlate the ultrasound imaging features of thyroid nodules with FNA cytology and surgical histopathology results, and to risk stratify patients using the American Thyroid Association (ATA) classification for each imaging characteristic with the likelihood of the nodule being malignant.

Method

Retrospective analysis of a thyroid ultrasound database at Chris Hani Baragwanath Academic Hospital, over the period 2015–2017. Frequencies and percentages were used to summarise the data. Univariate logistic regression analyses were used to assess the accuracy of sonographic features in predicting the histologically determined diagnosis for thyroid tumours.

Results

A total of 113 nodules underwent FNA, of which 104 were diagnostic. The best three ultrasound features that pose a higher risk for malignancy are absent halo, presence of microcalcifications and hypoechoic appearance. No single nodule feature is an absolute indicator for malignancy. There is a high agreement between ATA classification and cytopathology or histology when nodule features are grouped into clusters. Agreement between the ATA classification and cytopathology/histology was 86.7% with a kappa of 0.714. The agreement between the cytopathology FNA results and lobectomy histopathology was 98.8% with a kappa of 0.973.

Conclusion

This study contributes to the paucity of data available for sub-Saharan Africa and provides reassurance that our results are consistent with international studies. The study confirms that the usage of a thyroid nodule classification system improves characterisation and increases accuracy in detecting thyroid malignancies, thus sparing many patients the morbidity of unnecessary thyroid surgery.

Integrating the Americans With Disabilities Act of 1990 into client intervention

Testimony provided by Kemp (1991) before the Subcommittee on Employment Opportunities of the U.S. House of Representatives provided occupational therapists with an open invitation to become involved with the implementation of the ADA: [The] EEOC's [Equal Employment Opportunity Commission's] Office of General Counsel anticipates that a significant portion of the ADA cases will require the use of medical, architectural, ergonomics or vocational specialists. These experts will be called on to provide advice and guidance on general and specific ADA issues and to provide specific advice and testimony in certain cases. (Kemp, 1991 [no page no.]) We need to rally to this opportunity. Occupational therapists' knowledge and understanding of the Americans With Disabilities Act of 1990 is an important component to providing comprehensive services to clients. It is crucial that we as occupational therapists become sophisticated regarding the implications of the ADA and advocate for its implementation for our clients.

Trace element content in tea brewed in traditional metallic and stainless steel teapots

The migration of metals in tea brewed in metallic teapots was investigated. The teapots were obtained from North Africa stores in Brussels in 2005-2006 and in 2011. Chinese gunpowder green tea, the most commonly used tea in the Moroccan community, was used to prepare the tea. Tea brewed in metallic teapots was compared to tea brewed in a glass vessel in order to evaluate the contribution of the tea and the teapots to the metal concentrations in the brewed tea. Tea samples were also collected in Moroccan households and in tearooms in Brussels. The elements As, Cd, Pb, Sn, Mn, Fe, Cr, Co, Ni, Cr, Cu, Zn, and Al were analyzed by high-resolution sector field inductively coupled mass spectrometry. The relationship between the metal composition of the alloy of the teapot and the metal concentration in tea was also investigated. Migration of Pb and to a lesser amount Ni, Cu, and Zn was observed in brass teapots and migration of Cd from a number of stainless steel teapots was observed. The soldering connecting the sprout to the teapot was shown to be an important source of Pb to the tea. High levels of Mn and Al were also observed in the brewed tea and these elements where shown to originate from the tea itself. Metal exposure from tea drinking was calculated for different tea consumption levels and different metal concentration levels and compared to toxicological reference values.

A taxonomic re-evaluation of Phialocephala phycomyces

Phialocephala was established for species that produce their conidia from phialides at the apex of dark mononematous conidiophores. Phialocephala phycomyces (Auersw.) Kendrick was described more than a century ago as the only species of the genus Hantzschia. The phialides of P. phycomyces are not as deep-seated as those found in Phialocephala dimorphospora Kendrick, the type of Phialocephala, and conidium development occurs near the apex of the conidiogenous cell. Furthermore, P. phycomyces is characterized by reddish-brown conidiophores and is cycloheximide resistant. Based on morphological, as well as molecular comparisons, we concluded that P. phycomyces is a distinct genus, Kendrickiella gen.nov.Key words: Leptographium complex, morphology, phylogeny, Phialocephala, Kendrickiella.

Swedish use and validation of Valpar work samples for patients with musculoskeletal neck and shoulder pain

I studien beskrivs vad e bedömning av arbetskapacitet (BAK) innehåller Vid en bedömning av arbetskapacitet jämförs kraven för att utföra ett specifikt arbete, definierat i "The dictionary of Occupational Titles" (DOT), och patientens förmåga att utföra ett arbote vilket definieras med hjälp av sju variabler. Allmän utbildnings nivä. Speciella yrkesförberedelser. Anlag, Intresseområden, Personlig läggning. Fysiska drav och Miljöpåverkan. En bedömning av arbetskapaciteten kan ske antingen genom att observera patienten under arbete påarbetsplatsen eller under simulerat arbete tex genom att använda Valpar systemets arbetsprover.Vid Rehabiliteringsmedicinska kliniken, Karolinska Sjukhuset har tvä av de standardiserade arbetsprovema använts. VCWS 8 "Simulerad moontering" och VCWS 9 "Simulerade rorelser for hela kroppen" for att förbättra bedömningen av patientens arbetskapacitet. VCWS 8 mäter "en persons förmaga att utföra ett monteringsarbete som kräver repetetiva fysiska manipulationer" och VCWS 9 mäter "en persons formåga att röra på bålen, nacken, armarna, händerna och fingrama när de relaterar till funktionellt utförande av ett arbete". Valideringen av arbetsprovema för Svensk anvandning gjordes på en grupp patienter (n = 97) med muskuloskelettal nack- och skulder smärta som deltog i ett rehabiliteringsprogram. VCWS 9 utfördes av åttiofem patienter och VCWS 9 av sextionic patienter.Medelvärdet for patienterna som slutförde VCWS 8 var 83.1% av industriell standard nivå (mätt enligt MTM-Method-Time-Measurement) där den lä gsta gränsen är 87.5% för ett godkännt utförende. Detta innebär att de "inte moter" kraven för detta specifika arbete. I motsats till detta sä nädde patientema som utförde VCWS 9 ett medelvärde pä 108.6% vilket overstiger kravet (87.5%) för industriell standard. Det oväntade resultatet kan kanske förklaras av att patienternas intresseområden vad gäller arbetsfalt endast sammanfoll med iintresseområdena för VCWS 8 och yeWS 9 i 32% av fallen. En retrospective jämförelse mellan att vara sjukskriven eller inte vara sjukskriven och deras förmåga att utföra ett arbetsprov och uppnå minimi kravet for industriell standard visade inte på något samband. Mänga faktorer kan ha påverkat resultatet som tex patientens motivation, andra psyko-sociala omstandigheter och arbetsterapeutemas beslut att endast använda sig av två stycken av ett flertal arbetsprov.Konklusiionen ar att en bedörning av patientens arbetskapacitet skall utföras prospektivt och bör ta i beräknng de krav arbetet ställer enligt DOT och därefter bör rätt arbetsprov väijas för den individuella patienten. Sker detta på ett riktigt sätt så år Valpars arbetsprover valida och till stor hjälp vid en medicinsk bedomning och för beslut när det gäller fortsatt sjukskrivning eller vid yrkesrådgivning.

Characterization of the porcine FABGL gene

The porcine major histocompatibility complex, also called swine lymphocyte antigen (SLA) complex, is of particular interest not only because of its central role in the immune response, but also because of its influence on many traits such as reproduction, fatness and meat quality. The porcine FABGL (FabG (beta-ketoacyl-[acyl-carrierprotein] reductase, Escherichia coli) like) gene, coding for a 17beta-hydroxysteroid dehydrogenase (17beta-HSD), is a candidate gene for these traits. The complete gene was sequenced and compared with human and mouse FABGL sequences. The deduced amino acid sequence showed 85 and 83% sequence identity to human and mouse sequences, respectively. Polymorphicic BbvI and DdeI restriction sites were found in the porcine FABGL gene. The promoter was compared with the promoter regions of human and mouse FABGL sequence in order to identify putative regulatory elements. The transcription profile of the porcine gene was determined and showed a widespread tissue distribution.

Comparisons of wrist postures in VDT operators using wrist rests and forearm supports

OBJECTIVE

The purpose of this study was to examine wrist motions in video display terminal (VDT) workers using the Greenleaf Medical WristSystem. This study was developed because of the limited research about the effectiveness of ergonomic equipment for VDT operators, as well as the recent increase in cumulative trauma disorders (CTDs) among these workers.

STUDY DESIGN

Twenty adult VDT operators with no history of CTD were recruited from Boston University and surrounding businesses. WristSensorTM gloves containing dual-axis sensors for detection of dynamic wrist movements were worn by participants. Calibrations were then performed through the Movement Analysis System (MAS) software, after which participants were requested to type using a wrist rest (condition A), using forearm supports (condition B), using the wrist rest and forearm supports together (condition C), and finally using no form of wrist or forearm support (condition D). It was assumed by the investigators that wrist extension and ulnar deviation would decrease when using the wrist rest or forearm support, with the greatest change occurring when using both types of support. Questionnaires requesting demographic information were completed by each participant. Contrast scores were also calculated and converted into t -tests and their corresponding P -values.

RESULTS

The average degrees of motion for both right and left hands were: flexion 4.5°, extension 18.9°, ulnar deviation 15.3°, and radial deviation 2.0°. P-values for all four conditions in the left hand were found to be significant and are as follows: extension t(19) = 2.35, P < 0.025, flexion t(19) = 2.17, P < 0.025, ulnar deviation t(19) = 3.41, P < 0.0025, and radial deviation t(19) = 2.5, P < 0.025. The only significant P-value in the right hand was during ulnar deviation: t(19) = 2.7, P < 0.01.

DISCUSSION

Research suggests that wrist extension greater than 15° and ulnar deviation greater than 20° can be predisposing factors to the development of CTDs. In this study, all four wrist motions remained under 20° during the three conditions using the wrist rest and forearm supports. A trend of continued decreases in ulnar deviation and wrist extension from using no supports to that requiring both types of supports was also observed. Specifically, the smallest degree of wrist extension appeared when participants used only the wrist rest; ulnar deviation was smallest when both supports were used. Right hand degree values were found to be generally larger than those for the left hand. It is hoped that these results can serve as a foundation for future investigation into the effectiveness of wrist and forearm supports in reducing CTDs.

Clinical significance of incidentally detected lead perforations by computed tomography

BACKGROUND

Computed tomography (CT) has an established role in detecting perforation of implanted pacemaker and defibrillator leads. The clinical significance of incidental finding of delayed lead perforation remains unclear. The aim of this study was to assess the prevalence of lead perforation as detected by CT in a cohort of patients undergoing transvenous laser lead extraction and characterize the association between finding of incidental lead perforation with periprocedural outcomes.

METHODS

Consecutive patients that underwent chest CT and lead extraction were retrospectively assessed for presence of lead perforation. A total of 143 patients and 348 leads were assessed. The finding of lead perforation was correlated with findings from peri-procedural transesophageal echocardiography (TEE) and outcomes of the lead extraction procedure.

RESULTS

Lead perforations (including perforations <5 mm and ≥5 mm) were detected in 66 (46%) patients and 73 (21%) leads. Lead perforation ≥5 mm were less common and detected in 13 (9%) of patients and 14 (4%) of leads. There was no significant difference in the rates of peri-procedural death, cardiac avulsion, cardiac tamponade or post-extraction pericardial effusion in patients with and without lead perforation.

CONCLUSIONS

Incidental delayed lead perforations detected by CT are common and do not correlate with significant TEE findings or adverse peri-procedural outcomes in patients undergoing lead extraction. Larger studies are needed to further characterize the frequency and safety of these findings.

Protease and antiprotease responses in lung and peripheral blood in experimental canine pneumococcal pneumonia

We studied the effects of pulmonary infection with type III pneumococcus in dogs on the degree of granulocyte elastase-like esterase activity and on the degree of antiproteases in peripheral blood and lung lavage fluid. In 9 infected dogs the peripheral blood granulocyte esterase activity increased from a preinfection level of 361.3 +/- 51 units/10(8) leukocytes to 593.8 +/- 80 units/10(8) leukocytes (mean +/- SE) 24 h after pneumonia had been induced (p less than .02). Parallel changes were measured in granulocytes obtained from bronchial lavage fluid. The antitrypsin activity and esterase inhibitory activity of peripheral blood increased by 15% after infection was induced. The esterase inhibitory activity of lung lavage fluid increased from a preinfection level of 776 +/- 160 units/mg of lavage protein to 1,390 +/- 200 units/mg of lavage protein (p less than .05). These findings indicate that whereas both circulating and lung lavage granulocytes contain increased concentrations of proteolytic activity during infection, serum antiproteases and, to a larger extent, lung antiproteases, also are increased.

Work center

Changing one's role from student to worker is often a difficult transition, especially today when options for employment are linked with specialized training. For the handicapped adolescent it is almost impossible without very special training and guidance. Recent legislation affecting the handicapped mandated that efforts to assist this process shall begin two years prior to the student's graduation or at age twenty. Some writers insist that such supportive programming should begin when students are quite young and that it should be conducted within realistic "work" environments. Recognizing this need, the occupational therapy staff in a private school for special needs children and adolescents have taken a proactive stance and have initiated a work program for all students beginning as early as age 10. This paper describes the pilot Work Center, organized within a school and structured on a rehabilitation workshop model.

Radiologist-supervised Transfer Learning: Improving Radiographic Localization of Pneumonia and Prognostication of Patients With COVID-19

PURPOSE

To assess the potential of a transfer learning strategy leveraging radiologist supervision to enhance convolutional neural network-based (CNN) localization of pneumonia on radiographs and to further assess the prognostic value of CNN severity quantification on patients evaluated for COVID-19 pneumonia, for whom severity on the presenting radiograph is a known predictor of mortality and intubation.

MATERIALS AND METHODS

We obtained an initial CNN previously trained to localize pneumonia along with 25,684 radiographs used for its training. We additionally curated 1466 radiographs from patients who had a computed tomography (CT) performed on the same day. Regional likelihoods of pneumonia were then annotated by cardiothoracic radiologists, referencing these CTs. Combining data, a preexisting CNN was fine-tuned using transfer learning. Whole-image and regional performance of the updated CNN was assessed using receiver-operating characteristic area under the curve and Dice. Finally, the value of CNN measurements was assessed with survival analysis on 203 patients with COVID-19 and compared against modified radiographic assessment of lung edema (mRALE) score.

RESULTS

Pneumonia detection area under the curve improved on both internal (0.756 to 0.841) and external (0.864 to 0.876) validation data. Dice overlap also improved, particularly in the lung bases (R: 0.121 to 0.433, L: 0.111 to 0.486). There was strong correlation between radiologist mRALE score and CNN fractional area of involvement (ρ=0.85). Survival analysis showed similar, strong prognostic ability of the CNN and mRALE for mortality, likelihood of intubation, and duration of hospitalization among patients with COVID-19.

CONCLUSIONS

Radiologist-supervised transfer learning can enhance the ability of CNNs to localize and quantify the severity of disease. Closed-loop systems incorporating radiologists may be beneficial for continued improvement of artificial intelligence algorithms.