Texture-based classification of lung disease patterns in chronic hypersensitivity pneumonitis and comparison to clinical outcomes

Computer-aided detection algorithms applied to CT lung imaging have the potential to objectively quantify pulmonary pathology. We aim to develop an automatic classification method based on textural features able to classify healthy and pathological patterns on CT lung images and to quantify the extent of each disease pattern in a group of patients with chronic hypersensitivity pneumonitis (cHP), in comparison to pulmonary function tests (PFTs).27 cHP patients were scanned via high resolution CT (HRCT) at full-inspiration. Regions of interest (ROIs) were extracted and labeled as normal (NOR), ground glass opacity (GGO), reticulation (RET), consolidation (C), honeycombing (HB) and air trapping (AT). For each ROI, statistical, morphological and fractal parameters were computed. For automatic classification, we compared two classification methods (Bayesian and Support Vector Machine) and three ROI sizes. The classifier was therefore applied to the overall CT images and the extent of each class was calculated and compared to PFTs. Better classification accuracy was found for the Bayesian classifier and the 16x16 ROI size: 92.1±2.7%. The extent of GGO, HB and NOR significantly correlated with forced vital capacity (FVC) and the extent of NOR with carbon monoxide diffusing capacity (DLCO).Clinical Relevance- Texture analysis can differentiate and objectively quantify pathological classes in the lung parenchyma and may represent a quantitative diagnostic tool in cHP.

Perspectives on the Delirium Experience and Its Burden: Common Themes Among Older Patients, Their Family Caregivers, and Nurses

BACKGROUND AND OBJECTIVES

While there are qualitative studies examining the delirium-related experiences of patients, family caregivers, and nurses separately, little is known about common aspects of delirium burden among all three groups. We describe common delirium burdens from the perspectives of patients, family caregivers, and nurses.

RESEARCH DESIGN AND METHODS

We conducted semistructured qualitative interviews about delirium burden with 18 patients who had recently experienced a delirium episode, with 16 family caregivers, and with 15 nurses who routinely cared for patients with delirium. We recruited participants from a large, urban teaching hospital in Boston, Massachusetts. Interviews were recorded and transcribed. We used interpretive description as the approach to data analysis.

RESULTS

We identified three common burden themes of the delirium experience: Symptom Burden (Disorientation, Hallucinations/Delusions, Impaired Communication, Memory Problems, Personality Changes, Sleep Disturbances); Emotional Burden (Anger/Frustration, Emotional Distress, Fear, Guilt, Helplessness); and Situational Burden (Loss of Control, Lack of Attention, Lack of Knowledge, Lack of Resources, Safety Concerns, Unpredictability, Unpreparedness). These burdens arise from different sources among patients, family caregivers, and nurses, with markedly differing perspectives on the burden experience.

DISCUSSION AND IMPLICATIONS

Our findings advance the understanding of common burdens of the delirium experience for all groups and offer structure for instrument development and distinct interventions to address the burden of delirium as an individual or group experience. Our work reinforces that no one group experiences delirium in isolation. Delirium is a shared experience that will respond best to systemwide approaches to reduce associated burden.

Assessment of Instruments for Measurement of Delirium Severity: A Systematic Review

Importance

Measurement of delirium severity has been recognized as highly important for tracking prognosis, monitoring response to treatment, and estimating burden of care for patients both during and after hospitalization. Rather than simply rating delirium as present or absent, the ability to quantify its severity would enable development and monitoring of more effective treatment approaches for the condition.

Objectives

To present a comprehensive review of delirium severity instruments, conduct a methodologic quality rating of the original validation study of the most commonly used instruments, and select a group of top-rated instruments.

Evidence Review

This systematic review was conducted using literature from Embase, PsycINFO, PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature, from January 1, 1974, through March 31, 2017, with the key words delirium, severity, tests, measures, and intensity. Inclusion criteria were original articles assessing delirium severity and using a delirium-specific severity instrument. Final listings of articles were supplemented with hand searches of reference listings to ensure completeness. At least 2 reviewers independently completed each step of the review process: article selection, data extraction, and methodologic quality assessment of relevant articles using a validated rating scale. All discrepancies between raters were resolved by consensus.

Findings

Of 9409 articles identified, 228 underwent full text review, and we identified 42 different instruments of delirium severity. Eleven of the 42 tools were multidomain, delirium-specific instruments providing a quantitative rating of delirium severity; these instruments underwent a methodologic quality review. Applying prespecified criteria related to frequency of use, methodologic quality, construct or predictive validity, and broad domain coverage, an expert panel used an iterative modified Delphi process to select 6 final high-quality instruments meeting these criteria: the Confusion Assessment Method-Severity Score, Confusional State Examination, Delirium-O-Meter, Delirium Observation Scale, Delirium Rating Scale, and Memorial Delirium Assessment Scale.

Conclusions and Relevance

The 6 instruments identified may enable accurate measurement of delirium severity to improve clinical care for patients with this condition. This work may stimulate increased usage and head-to-head comparison of these instruments.

O porco Ribatejano: Renascimento de uma população autóctone? Primeiros dados de crescimento e de carcaça

No âmbito do projeto TREASURE e com o objectivo de avaliar o desempenho produtivo do porco Ribatejano, resultante do cruzamento entre porcos Alentejanos (AL) e Bísaros (BI), 10 machos castrados de cada um dos genótipos AL, BI, ALxBI e BIxAL, foram estudados. Os animais foram criados em sistema tradicional e alimentados com rações comerciais ad libitum, tendo sido abatidos a ~65 kg de peso vivo (PV). Os dados obtidos mostraram que os suínos BI, ALxBI e BIxAL atingiram o peso de abate mais rapidamente (P

Delirium Severity Post-Surgery and its Relationship with Long-Term Cognitive Decline in a Cohort of Patients without Dementia

BACKGROUND

Delirium has been associated with more rapid cognitive decline. However, it is unknown whether increased delirium severity is associated with a higher rate of long-term cognitive decline.

OBJECTIVE

To evaluate delirium severity and the presence and rate of cognitive decline over 36 months following surgery.

METHODS

We examined patients from the Successful Aging after Elective Surgery Study, who were age ≥70 years undergoing major elective surgery (N = 560). Delirium severity was determined by the peak Confusion Assessment Method-Severity (CAM-S) score for each patient's hospitalization and grouped based on the sample distribution: scores of 0-2, 3-7, and 8-19. A neuropsychological composite, General Cognitive Performance (GCP), and proxy-reported Informant Questionnaire for Cognitive Decline (IQCODE) were used to examine cognitive outcomes following surgery at 0, 1, and 2 months, and then every 6 months for up to 3 years.

RESULTS

No significant cognitive decline was observed for patients with peak CAM-S scores 0-2 (-0.17 GCP units/year, 95% confidence interval [CI] -0.35, 0.01). GCP scores decreased significantly in the group with peak CAM-S scores 3-7 (-0.30 GCP units/year, 95% CI -0.51, -0.09), and decreased almost three times faster in the highest delirium severity group (peak CAM-S scores 8-19; -0.82 GCP units/year, 95% CI -1.28, -0.37). A similar association was found for delirium severity and the proportion of patients who developed IQCODE impairment over time.

CONCLUSION

Patients with the highest delirium severity experienced the greatest rate of cognitive decline, which exceeds the rate previously observed for patients with dementia, on serial neuropsychological testing administered over 3 years, with a dose-response relationship between delirium severity and long-term cognitive decline.

Liver transplant recipients have a higher prevalence of anal squamous intraepithelial lesions

Background:

Anal squamous intraepithelial lesions (ASIL) are precancerous lesions of anal squamous cell carcinoma, with a higher prevalence in immunosuppressed patients. There are some studies in kidney transplant recipients, but there is no information regarding prevalence in liver transplantation. Our aim was to evaluate the prevalence of ASIL in this setting.

Methods:

Prospective case–control study involving liver transplant recipients without any other known risk factor for ASIL (n=59), which were compared with a healthy control group (n=57). All were submitted to anal cytology and high-resolution anoscopy was performed in those with abnormal results.

Results:

Ten (17%) of liver transplant recipients had abnormal cytological results, seven patients had atypical squamous cells of undetermined significance (ASC-US), one patient had atypical squamous cells that cannot exclude high-grade (ASC-H) and two patients had high-grade squamous intraepithelial lesions (HSIL). In the control group, one patient (2%) had an ASC-US result (P=0.005). Anal squamous intraepithelial lesions were confirmed in 7 out of 10 of liver transplant patients and 0 out of 1 in the controls (P=0.013) by high-resolution anoscopy with biopsies. Current smoking was the only risk factor for abnormal cytology (odds ratio=5.87, 95% confidence intervals=1.22–28.12, P=0.027).

Conclusions:

Liver transplant patients have a higher risk of ASIL. Screening should be considered, especially in smokers.

Influence of outdoor rearing and oleic acid supplementation on lipid characteristics of muscle and adipose tissues from obese Alentejano pigs

Data evaluating the effect of oleic-acid-enriched diets and outdoor rearing (with access to pasture) on the quality of Alentejano (AL) pork and fat are limited. The aim of this work was to study the effects of feeding low (LO) or high oleic acid (HO) diets to AL pigs reared in individual pens (IND) or outdoors (OUT) with access to pasture. Biceps femoris and dorsal subcutaneous fat (DSF) samples were collected to analyse chemical composition and lipids fatty acid (FA) profile. The expression of seven genes involved in lipogenesis, lipolysis and FA transport, as well as two transcription factors were also evaluated in the muscle. B. femoris and DSF presented lower lipid content in OUT-reared than in IND-reared pigs. Two genes involved in lipogenesis, ACACA and FASN, were under-expressed in B. femoris from OUT-reared pigs, while two involved in lipolysis, LPL and HSL were over-expressed. HO diet also significantly reduced FASN expression. Both rearing system and diet affected the FA profile of tissues, particularly DSF. Overall, OUT-reared pigs presented lower n6 to n3 FA ratios in all tissues, and lower monounsaturated (MUFA) and higher polyunsaturated fatty acids (PUFA) content in DSF. When compared to LO-fed ones, HO-fed pigs presented higher oleic acid proportions in all tissues, and lower SFA, higher MUFA and PUFA levels, as well as lower saturation, atherogenic and thrombogenic indexes in DSF. This study shows that rearing system and oleic acid supplementation have complementary effects and influence the nutritional quality of pork and DSF.

Association Between Hospital Readmission and Acute and Sustained Delays in Functional Recovery During 18 Months After Elective Surgery: The Successful Aging after Elective Surgery Study

OBJECTIVES

To examine the effect of hospital readmission on functional recovery after elective surgery in older adults.

DESIGN

Prospective cohort of individuals aged 70 and older undergoing elective surgery, enrolled from June 2010 to August 2013.

SETTING

Two academic medical centers.

PARTICIPANTS

Community-dwelling older adults (N = 566; mean age ± standard deviation 77 ± 5) undergoing major elective surgery and expected to be admitted for at least 3 days.

MEASUREMENTS

Readmission was assessed in multiple interviews with participants and family members over 18 months and validated against medical record review. Physical function was assessed according to ability to perform instrumental activities of daily living (IADLs) and activities of daily living (ADL), Medical Outcomes Study 12-item Short-Form Survey Physical Component Summary score, and a standardized functional composite.

RESULTS

Two hundred fifty-five (45%) participants experienced 503 readmissions. Readmissions were associated with delays in functional recovery in all measures of physical function. Having two or more readmissions over 18 months was associated with persistent and significantly greater risk of IADL dependence (relative risk (RR) = 1.8, 95% confidence interval (CI) = 1.5-2.3) and ADL dependence (RR = 3.3, 95% CI = 1.7-6.4). Degree of functional impairment increased progressively with number of readmissions. Readmissions within 2 months resulted in delayed functional recovery to baseline by 18 months, and readmissions between 12 and 18 months after surgery resulted in loss of functional recovery previously achieved.

CONCLUSION

Readmission after elective surgery may contribute to delays in functional recovery and persistent functional deficits in older adults.

Sugar and volatile fatty acids dynamic during anaerobic treatment of olive mill wastewater

Biogas production has been the main route used to exploit olive mill wastewater (OMW), after pretreatment and/or in combination with other effluents, but more recently the production of chemicals and biopolymers by biotechnological routes has deserved increasing attention by the scientific community. The present paper aims to explore the potential of fresh OMW as a source of volatile fatty acids (VFAs) and biogas. The time profile of VFAs production and the corresponding sugar consumption was followed by high-performance liquid chromatography, in batch anaerobic assays. The experimental results have revealed the very high potential of the OMW for the production of VFAs, mainly due to the high sugar concentration in the effluent (37.8 g/L) and its complete conversion into VFAs, in a time period of 2-3 days. The most abundant VFAs were acetic (48-50%), n-butanoic (12-27%), iso-pentanoic (12-14%) and propanoic (5-13%). The ratio of VFA containing even and odd carbon chains increased with the reduction in the initial chemical oxygen demand concentration of the samples used in the experiments. The conversion of the VFAs to biogas was inhibited at concentrations of 3.5 g/L of VFAs.

The interface between delirium and dementia in elderly adults

Delirium and dementia are two of the most common causes of cognitive impairment in older populations, yet their interrelation remains poorly understood. Previous studies have shown that dementia is the leading risk factor for delirium and that delirium is an independent risk factor for subsequent development of dementia. However, a major area of controversy is whether delirium is simply a marker of vulnerability to dementia, whether the effect of delirium is solely related to its precipitating factors, or whether delirium itself can cause permanent neuronal damage and lead to dementia. Ultimately, all of these hypotheses are likely to be true. Emerging evidence from epidemiological, clinicopathological, neuroimaging, biomarker, and experimental studies lends support to a strong relation between delirium and dementia, and to both shared and distinct pathological mechanisms. New preventive and therapeutic approaches that target delirium might offer a sought-after opportunity for early intervention, preservation of cognitive reserve, and prevention of irreversible cognitive decline in ageing.

Toxicity reduction and biodegradability enhancement of cork processing wastewaters by ozonation

Biodegradability enhancement and detoxification of cork boiling wastewater (CBW) are required for the successful implementation of biological treatment options. We studied the possibility of achieving these goals through ozonation pre-treatment by experimenting on the effect of ozone dose and pH. The CBW used had a pH of 5.81, a chemical oxygen demand (COD) of 1,865 mg L(-1), a biochemical oxygen demand (BOD5) of 498 mg L(-1) and total phenol (TP) and tannin compounds concentrations of 523 and 399 mg L(-1), respectively. The ozone doses ranged from 0.27 to 2.63 for the O3(applied)/COD0 ratios with samples at natural pH and set to 3.33 and 9.96. Ozonation allowed the BOD20/COD ratio (biodegradability index) to increase from 0.37 to 0.63 and a toxicity reduction from 3.08 to 1.24 TU (Microtox). The corresponding removals obtained were 15.2-62.0%, 38.4-83.2% and 56.7-92.1% for COD, TP and colour, respectively. The best outcome of ozonation pre-treatment requires O3(applied)/COD0 ratios over 1.5 and an acid pH. The increase of TP removals with ozone dose at acid pH led to biodegradability enhancement and CBW detoxification. However, for similar conditions the highest COD removals were obtained at alkaline pH due to the hydroxyl radicals' high oxidation ability but lack of selectivity.

Biological and technical study of a partial-SHARON reactor at laboratory scale: effect of hydraulic retention time

This study was on the technical and biological characteristics of a partial-SHARON submerged-filter bioreactor of 3 L. The main focus was the influence of the hydraulic retention time (HRT) on biofilms. For this purpose, we used molecular tools based on the partial 16S rRNA genes. The results showed that the HRT may affect the nitrification processes of a bioreactor using synthetic wastewater containing 600 mg/L of ammonia. It was found that an HRT of 0.5 day transformed 100 % of the ammonium into nitrite. However, when the HRT was decreased to 0.4 day, there was a significant reduction (35 %) in the quantity of ammonia transformed, which confirmed the complexity of the system operation. Moreover, a PCR-TGGE approach highlighted the differences observed. The results obtained showed that an HRT of 0.5 day reduced bacterial biodiversity in the biofilms, which were mainly formed by Nitrosomonas and Diaphorobacter. In contrast, an HRT of 0.4 day facilitated the formation of heterogeneous biofilms formed by nitrifying bacteria, such as Nitrosomonas sp., Nitrosospira sp., and Nitrosovibrio sp.).

Dysplasia surveillance in an ulcerative colitis patient: successful detection with narrow band imaging and magnification

One of the contemporary challenges gastroenterologists face is cancer screening and surveillance in long-term colitis patients. The search for a consensually practical and effective method to routinely detect dysplastic mucosa persists. In recent years, publications demonstrating the applicability of narrow band imaging (NBI) in this setting have sparked further research. We present a case report where NBI with magnification played a fundamental role in the detection of dysplasia in an ulcerative colitis patient. This case reinforces the potential widespread applicability of NBI as a surveillance tool in distinguishing dysplastic from nondysplastic colorectal lesions in ulcerative colitis.

Watermelon stomach, hemorrhagic pericarditis, small cell carcinoma of the lung and synchronous squamous cell carcinoma of the tongue base

Based on a case of gastric antral vascular ectasia (watermelon stomach) that was associated with hemorrhagic pericarditis, small cell lung carcinoma with mediastinal lymph node metastases and a synchronous squamous cell carcinoma of the base of the tongue, the authors made a review of the clinical, endoscopic and histopathological aspects of this type of gastropathy, and its association with other diseases, and of the results of its endoscopic therapy. The causes of hemorrhagic pericarditis are considered, emphasizing the necessity to know if the effusion has a malignant etiology. To the best of our knowledge the association of watermelon stomach to small cell lung carcinoma and squamous cell carcinoma of the base of the tongue has not yet been described. Extensive metastases to mediastal lymph nodes are common to small cell lung carcinoma.

Influence of bed media characteristics on ammonia and nitrate removal in shallow horizontal subsurface flow constructed wetlands

Two bed media were tested (gravel and Filtralite) in shallow horizontal subsurface flow (HSSF) constructed wetlands in order to evaluate the removal of ammonia and nitrate for different types of wastewater (acetate-based and domestic wastewater) and different COD/N ratios. The use of Filtralite allowed both higher mass removal rates (1.1 g NH(4)-N m(-2) d(-1) and 3 g NO(3)-N m(-2) d(-1)) and removal efficiencies (>62% for ammonia, 90-100% for nitrate), in less than 2 weeks, when compared to the ones observed with gravel. The COD/N ratio seems to have no significant influence on nitrate removal and the removal of both ammonia and nitrate seems to have involved not only the conventional pathways of nitrification-denitrification. The nitrogen loading rate of both ammonia (0.8-2.4 g NH(4)-N m(-2) d(-1)) and nitrate (0.6-3.2 g NO(3)-N m(-2) d(-1)) seem to have influenced the respective removal rates.

Removal of organic matter and nitrogen in an horizontal subsurface flow (HSSF) constructed wetland under transient loads

A monitoring campaign in a horizontal subsurface flow constructed wetland under the influence of transient loads of flow-rate, organic matter, nitrogen and suspended solids showed an irregular removal of COD and TSS and lower both removal efficiencies and mass removal rates than the ones observed in other studies for similar operating conditions. This circumstance is associated to the presence of large amount of particulate organic matter from non-point sources. The mass removal rate of ammonia increased 39% as both the water and soil temperatures increased from weeks 1-8 to weeks 9-14. A good correlation between mass load and mass removal rate was observed for all measured parameters, which attests a satisfactory response of the bed under to transient loads.

Physical chemistry of nanostructured molecular sieves by the study of phase diagrams: the case of the cetyltrimethylammonium bromide–tetramethylammonium silicate–water system

A phase diagram for the system cetyltrimethylammonium bromide (CTAB)/tetramethylammonium silicate (TMASi)/water has been constructed in order to better understand the interactions between these precursors of the MCM-41 mesoporous molecular sieves. Three different CTAB concentration regions were analyzed: the dilute and semidilute regions, where simple surfactant species, such as monomers and spherical and nonspherical CTAB micelles, are found, and the concentrated region, involving liquid-crystalline phases. In the dilute and semidilute regions, the formation of a white nanostructured solid, having a hexagonal array similar to that found in MCM-41 materials, was observed. Precipitation of this solid requires some degree of surfactant monomer aggregation, which is favored by the presence of silicate anions. If micelles have already been formed, the material can be obtained at any CTAB concentration above a threshold concentration of silicate anions. These facts suggest that silicate anions have an important role in changing the aggregation and/or the shape of the surfactant aggregates. In the concentrated region, precipitation of the solid was not observed, but the presence of the silicate anions alter the characteristics of the liquid-crystalline phase formed by the surfactant. The system shows very complex and rich behavior and its investigation may be very useful in understanding the processes of nanostructured solid formation.

Interleukin 8 as a vaso-occlusive marker in Brazilian patients with sickle cell disease

Sickle cell disease has a worldwide distribution and is a public health problem in Brazil. Although vaso-occlusive crisis (VOC) is one of the most important clinical features of the disease, there are still several steps of its pathogenesis which are unknown. The increase of the chemotactic factor interleukin 8 (IL-8) has been reported to be involved in sickle cell disease crisis, but this has not been demonstrated conclusively. In the present study we analyzed serum IL-8 levels by ELISA and hematological parameters and hemoglobin patterns by standard techniques in 23 (21 SS and 2 SC) Brazilian patients with sickle cell syndromes during VOC caused by different inducing factors, 22 (21 SS and 1 SC) sickle cell patients out of crisis, and 11 healthy controls. Increased IL-8 levels were observed in 19 of 23 VOC patients (79.2%), 3 of them with more than 1,000 pg/ml. Seventeen of 22 (77.3%) non-crisis patients showed low IL-8 levels (less than 15 pg/ml). Healthy controls had low IL-8 levels. A significant difference in serum IL-8 levels was observed between crisis and non-crisis sickle cell patients (P<0.0001). There was no correlation between IL-8 levels and hematological data or hemoglobin patterns. High serum IL-8 levels were observed in VOC patients independently of the crisis-inducing factor. We conclude that in the studied population, IL-8 concentration may be a useful VOC marker, although the mechanism of the pathogenic process of sickle cell VOC syndromes remains unclear.

[Arterial blood pressure behavior during the administration of intravenous streptokinase, in patients with acute myocardial infarction]

OBJECTIVE

To evaluate the effect on blood pressure (BP) of intravenous (i.v.) streptokinase (SK) in patients (PTS) with acute myocardial infarction (AMI).

DESIGN

Retrospective study with analysis of BP registers ten minutes before and during SK infusion.

SETTING

PTS admitted to the Coronary Care Unit (CCU) of Santo António Hospital, Oporto.

PATIENTS

Thirty-eight male PTS, average ages of 54, ranging from 38 to 67, AMI confirmed, and criteria to thrombolytic therapy. One patient was excluded on account of persistent hypotension since admission.

MATERIAL AND METHODS

I.v. infusion of 1.500.000 U of SK over 60 minutes, preceded by 200 mg i.v. of prednisolone. BP and heart rate (HR) were evaluated with Datascope Accutorr 1A set. The lowest value of the systolic BP (SBP) recorded ten minutes before SK infusion was considered the baseline value. We valued the reduction of SBP above 15%, defining its fall as the difference between the baseline value and the minimum value of SBP recorded during the infusion. Hypertension was defined to SBP values below 90 mmHg.

MAIN RESULTS

The fall was 40.4 +/- 22.1 mmHg (range 9 to 102, having been recorded the minimum value at 22.9 +/- 10.9 minutes. It was accompanied by diastolic BP (DBP) fall of 30.6 +/- 18.9 mmHg (range -2 to 76) and by a HR increasing from 76.2 +/- 13.7 beats/min. to 80.8 +/- 14.1 beats/min. (p < 0.01). In 86% of the PTS this fall was transient, lasting 8.9 +/- 6.3 minutes, and was corrected by slowing or stopping the infusion for a few minutes and placing the patient in Trendelenburg position. Two PTS needed sympaticomimetic amines because of persistent BP reduction despite the previous measures. 92% of the PTS had a SBP fall higher than 15% in relation to the baseline value. The SBP was kept over 90 mmHg in 20 PTS (54%); hypotension was recorded in the remaining 14 PTS (38%), and in 10 (27%) of these the SBP fell below 80 mmHg. We couldn't prove that the infarction and the extension of the ischemic lesion had influenced this BP fall.

CONCLUSIONS

The BP reduction during treatment with high doses of SK deserves some attention because, although transient and easily reversible, it is frequent and sometimes significative. It demands then careful monitoring in order to avoid the hypoperfusion to the ischemic myocardium, that could jeopardize the potential benefits of reperfusion in the reduction of infarction area, the main objective of the thrombolytic treatment.