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Marzahl C, Aubreville M, Bertram CA, Stayt J, Jasensky AK, Bartenschlager F, Fragoso-Garcia M, Barton AK, Elsemann S, Jabari S, Krauth J, Madhu P, Voigt J, Hill J, Klopfleisch R, Maier A. Deep Learning-Based Quantification of Pulmonary Hemosiderophages in Cytology Slides. Sci Rep 2020; 10:9795. [PMID: 32747665 PMCID: PMC7398908 DOI: 10.1038/s41598-020-65958-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 05/04/2020] [Indexed: 11/28/2022] Open
Abstract
Exercise-induced pulmonary hemorrhage (EIPH) is a common condition in sport horses with negative impact on performance. Cytology of bronchoalveolar lavage fluid by use of a scoring system is considered the most sensitive diagnostic method. Macrophages are classified depending on the degree of cytoplasmic hemosiderin content. The current gold standard is manual grading, which is however monotonous and time-consuming. We evaluated state-of-the-art deep learning-based methods for single cell macrophage classification and compared them against the performance of nine cytology experts and evaluated inter- and intra-observer variability. Additionally, we evaluated object detection methods on a novel data set of 17 completely annotated cytology whole slide images (WSI) containing 78,047 hemosiderophages. Our deep learning-based approach reached a concordance of 0.85, partially exceeding human expert concordance (0.68 to 0.86, mean of 0.73, SD of 0.04). Intra-observer variability was high (0.68 to 0.88) and inter-observer concordance was moderate (Fleiss' kappa = 0.67). Our object detection approach has a mean average precision of 0.66 over the five classes from the whole slide gigapixel image and a computation time of below two minutes. To mitigate the high inter- and intra-rater variability, we propose our automated object detection pipeline, enabling accurate, reproducible and quick EIPH scoring in WSI.
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Affiliation(s)
- Christian Marzahl
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
- Research and Development, EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany.
| | - Marc Aubreville
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christof A Bertram
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Jason Stayt
- VetPath Laboratory Services, Ascot, Western, Australia
| | | | | | | | - Ann K Barton
- Equine Clinic, Freie Universität Berlin, Berlin, Germany
| | - Svenja Elsemann
- Department of Neurosurgery, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Samir Jabari
- Institute of Neuropathology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Jens Krauth
- Research and Development, EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Prathmesh Madhu
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jörn Voigt
- Research and Development, EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Jenny Hill
- VetPath Laboratory Services, Ascot, Western, Australia
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Hohmann E, Glatt V, Tetsworth K. Swimming induced pulmonary oedema in athletes - a systematic review and best evidence synthesis. BMC Sports Sci Med Rehabil 2018; 10:18. [PMID: 30410770 PMCID: PMC6211602 DOI: 10.1186/s13102-018-0107-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 10/23/2018] [Indexed: 12/16/2022]
Abstract
Background Swimming induced pulmonary oedema is an uncommon occurrence and usually presents during strenuous distance swimming in cold water. The prevalence is most likely underreported and the underlying mechanisms are controversial. The purpose of this study was to summarize the evidence with regards to prevalence, pathophysiology and treatment of swimming induced pulmonary oedema in endurance athletes. Methods Medline, Embase, Scopus and Google Scholar were searched and level I-IV from 1970 to 2017 were included. For clinical studies, only publications reporting on swimming-induced pulmonary oedema were considered. Risk of bias was assessed with the ROBINS-I tool, and the quality of evidence was assessed with the Cochrane GRADE system. For data synthesis and analysis, a best evidence synthesis was used. Results A total of 29 studies were included (174 athletes). The most common symptom was cough, dyspnoea, froth and haemoptysis. The risk of bias for the clinical studies included 13 with moderate risk, 3 with serious, and 4 with critical. Four of the pathophysiology studies had a moderate risk, 3 a serious risk, and 1 a critical risk of bias. A best evidence analysis demonstrated a strong association between cold water immersion and in increases of CVP (central venous pressure), MPAP (mean pulmonary arterial pressure), PVR (peripheral vascular resistance) and PAWP (pulmonary arterial wedge pressure) resulting in interstitial asymptomatic oedema. Conclusion The results of this study suggest a moderate association between water temperature and the prevalence of SIPE. The presence of the clinical symptoms cough, dyspnoea, froth and haemoptysis are strongly suggestive of SIPE during or immediately following swimming. There is only limited evidence to suggest that there are pre-existing risk factors leading to SIPE with exposure to strenuous physical activity during swimming. There is strong evidence that sudden deaths of triathletes are often associated with cardiac abnormalities.
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Affiliation(s)
- Erik Hohmann
- 1Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Department of Orthopaedic Surgery and Sports Medicine, Dubai, United Arab Emirates.,Valiant Clinic/Houston Methodist Group, PO Box 414296, City Walk, 13th street, Dubai, United Arab Emirates
| | - Vaida Glatt
- 4University of Texas Health Science Center, San Antonio, TX USA
| | - Kevin Tetsworth
- 5Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia.,6Department of Surgery, School of Medicine, University of Queensland, Brisbane, Australia.,7Orthopaedic Research Institute of Australia, Queensland University of Technology, Brisbane, Australia
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Ness SL, Frye AH, Divers TJ, Rishniw M, Erb HN, Brooks MB. Randomized placebo-controlled study of the effects of Yunnan Baiyao on hemostasis in horses. Am J Vet Res 2017; 78:969-976. [DOI: 10.2460/ajvr.78.8.969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Different Training Schedules Influence Serum Electrophoretic Protein Profile in the Athletic Horse. J Equine Vet Sci 2015. [DOI: 10.1016/j.jevs.2015.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pifferi M, Di Cicco M, Bush A, Caramella D, Chilosi M, Boner AL. Uncommon Pulmonary Presentation of IgG 4 -Related Disease in a 15-Year-Old Boy. Chest 2013; 144:669-671. [DOI: 10.1378/chest.12-3088] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Plasma protein changes in horse after prolonged physical exercise: A proteomic study. J Proteomics 2012; 75:4494-504. [DOI: 10.1016/j.jprot.2012.04.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 03/26/2012] [Accepted: 04/10/2012] [Indexed: 11/19/2022]
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Watson M. Furosemide. J Exot Pet Med 2011. [DOI: 10.1053/j.jepm.2010.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Giordano A, Meazza C, Salvadori M, Paltrinieri S. Thromboelastometric profiles of horses affected by exercise-induced pulmonary hemorrhages. Vet Med Int 2010; 2010. [PMID: 20953331 PMCID: PMC2952972 DOI: 10.4061/2010/945789] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 08/31/2010] [Accepted: 09/18/2010] [Indexed: 11/29/2022] Open
Abstract
Exercise-induced pulmonary hemorrhage (EIPH) commonly occurs in race horses. Thromboelastometry (TEM) investigates the whole hemostatic process by evaluating the viscoelastic properties of the blood clot from its formation to fibrinolysis. The aim of this study was to assess whether horses with EIPH have abnormal thromboelastometric profiles. Intrinsic and extrinsic pathways, fibrinogen activity and fibrinolysis were investigated by TEM before and after the race in negative controls and in horses on which EIPH was confirmed by bronchoscopy. Compared with controls, horses with EIPH had an increased coagulability in both pre- and postrace samplings, especially for the intrinsic pathway and for the fibinrolytic activity. These results suggest that coagulation is preactivated in horses prone to develop EIPH, possibly due to recent or recurrent hemorrhage.
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Affiliation(s)
- Alessia Giordano
- Unit of General Pathology and Parasitology, Department of Veterinary Pathology, Hygiene and Public Health, University of Milan, Via Celoria 10, 20133 Milano, Italy
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Costa MFM, Thomassian A. Evaluation of race distance, track surface and season of the year on exercise-induced pulmonary haemorrhage in flat racing Thoroughbreds in Brazil. Equine Vet J 2010:487-9. [PMID: 17402471 DOI: 10.1111/j.2042-3306.2006.tb05592.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
REASONS FOR PERFORMING STUDY To our knowledge no studies evaluating risk factors to EIPH have been undertaken with such a population of horses in Brazil, which is one of the few countries in the racing community to accept the use of frusemide (FUR) as a prerace medication for bleeders. We also compared national results with those already in the literature. OBJECTIVES To verify the influence of variables such as distance of the race, racetrack surface, going and season of the year in the recurrence and severity of EIPH and its effect on the finishing position of flat racing Thoroughbreds in Brazil. METHODS 2118 post race respiratory endoscopies were recorded, in a total of 1003 individual horses. All horses in the study were certified bleeders (deemed positive by registered veterinarians following one or more endoscopies) and were administered FUR prior to each race. Data was analysed using both ordinary logistic regression and multiple logistic regression. RESULTS The results suggest that race distance, season of the year and racetrack surface affect the recurrence of EIPH. Also, despite the use of FUR, the majority (62%) of horses continued to display some degree of haemorrhage. CONCLUSIONS There was a tendency for horses that remained positive despite the use of FUR to finish unplaced in a race. Horses which had a significant reduction in bleeding and became HPIE negative after the use of FUR, tended to finish in top positions. It was not possible to determine a pattern of severity of EIPH in horses with more than one endoscopy. Further studies are required to improve our understanding of this syndrome and its correlations to performance in the racing Thoroughbred, together with the role of FUR and its possible enhancing performance effects and efficacy in consistently diminishing EIPH. POTENTIAL RELEVANCE This study enabled a better understanding of the use of FUR in Brazilian Thoroughbred racehorses and showed there was a tendency towards improvement in performance after administrion of FUR in bleeders. The fact that a large number of horses remained positive for EIPH despite the use of FUR should encourage the scientific community to search for better ways of reducing, or preventing, this syndrome.
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Affiliation(s)
- M F M Costa
- Department of Surgery, Júlio de Mesquita Filho College of Veterinary Medicine, São Paulo State University, Distrito Rubião Jr, s/n, Botucatu, São Paulo, 18.618-000, Brazil
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Mader DR, Yike I, Distler AM, Dearborn DG. Acute pulmonary hemorrhage during isoflurane anesthesia in two cats exposed to toxic black mold (Stachybotrys chartarum). J Am Vet Med Assoc 2007; 231:731-5. [PMID: 17764432 DOI: 10.2460/javma.231.5.731] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION Acute pulmonary hemorrhage developed during isoflurane anesthesia in 2 Himalayan cats undergoing routine dental cleaning and prophylaxis. CLINICAL FINDINGS The cats were siblings and lived together. In both cats, results of pre-operative physical examinations and laboratory testing were unremarkable. Blood pressure and oxygen saturation were within reference ranges throughout the dental procedure. Approximately 15 to 20 minutes after administration of isoflurane was begun, frothy blood was noticed within the endotracheal tube. Blood was suctioned from the endotracheal tube, and the cats were allowed to recover from anesthesia. TREATMENT AND OUTCOME 1 cat initially responded to supportive care but developed a second episode of spontaneous pulmonary hemorrhage approximately 30 hours later and died. The other cat responded to supportive care and was discharged after 4 days, but its condition deteriorated, and the cat died 10 days later. Subsequently, it was discovered that the home was severely contaminated with mold as a result of storm damage that had occurred approximately 7 months previously. Retrospective analysis of banked serum from the cats revealed satratoxin G, a biomarker for Stachybotrys chartarum, commonly referred to as "toxic black mold." CLINICAL RELEVANCE Findings highlight the potential risk of acute pulmonary hemorrhage in animals living in an environment contaminated with mold following flood damage.
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Affiliation(s)
- Douglas R Mader
- Marathon Veterinary Hospital, 11187 Overseas Hwy, Marathon, FL 33050, USA
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Norris JW, Pratt SM, Auh JH, Wilson SJ, Clutter D, Magdesian KG, Ferraro GL, Tablin F. Investigation of a Novel, Heritable Bleeding Diathesis of Thoroughbred Horses and Development of a Screening Assay. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb00765.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Araya O, Palma P, Salvi M, Bustamante H, Vits L. Endoscopic determination of exercise-induced pulmonary haemorrhage in Chilean Criollo horses. Vet J 2005; 169:311-3. [PMID: 15727928 DOI: 10.1016/j.tvjl.2004.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2004] [Indexed: 10/26/2022]
Affiliation(s)
- O Araya
- Institute of Veterinary Clinical Sciences, Universidad Austral de Chile, Casilla 567, Valdivia, Chile.
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Sánchez A, Couëtil L, Ward M, Clark S. Effect of Airway Disease on Blood Gas Exchange in Racehorses. J Vet Intern Med 2005. [DOI: 10.1111/j.1939-1676.2005.tb02663.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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