An automatic deep learning approach for coronary artery calcium segmentation

Coronary artery calcium (CAC) is a significant marker of atherosclerosis and cardiovascular events. In this work we present a system for the automatic quantification of calcium score in ECG-triggered non-contrast enhanced cardiac computed tomography (CT) images. The proposed system uses a supervised deep learning algorithm, i.e. convolutional neural network (CNN) for the segmentation and classification of candidate lesions as coronary or not, previously extracted in the region of the heart using a cardiac atlas. We trained our network with 45 CT volumes; 18 volumes were used to validate the model and 56 to test it. Individual lesions were detected with a sensitivity of 91.24%, a specificity of 95.37% and a positive predicted value (PPV) of 90.5%; comparing calcium score obtained by the system and calcium score manually evaluated by an expert operator, a Pearson coefficient of 0.983 was obtained. A high agreement (Cohen's k = 0.879) between manual and automatic risk prediction was also observed. These results demonstrated that convolutional neural networks can be effectively applied for the automatic segmentation and classification of coronary calcifications

A distal renal tubular acidosis showing hyperammonemia and hyperlactacidemia

Introduction: distal renal tubular acidosis (dRTA) presents itself with variable clinical manifestations and often with late expressions that impact on prognosis. Case report: A 45-day-old male infant was admitted with stopping growth, difficult feeding and vomiting after meals. Clinical tests and labs revealed a type 1 renal tubular acidosis, even if the first blood tests showed ammonium and lactate increase. We had to exclude metabolic diseases before having a certain diagnosis. Conclusions: blood and urine investigations and genetic tests are fundamental to formulate dRTA diagnosis and to plan follow-up, according to possible phenotypic expressions of recessive and dominant autosomal forms in patients with dRTA

Systematic differences between BNP immunoassays: comparison of methods using standard protocols and quality control materials

Background: Recent studies suggested that there are marked systematic differences among BNP immunoassays. In this study we compared the BNP data and clinical results obtained with different immunoassays, including a new method (ST-AIA-PACK, TOSOH Corporation). Methods: BNP was measured on plasma-EDTA samples of healthy subjects (HS, n = 126) and patients with heart failure (HF, n = 31 NYHA I, II; n = 46 NYHA III, IV) using the ST-AIA-PACK and the Triage Biosite (Beckman Coulter) methods. Control samples distributed in the CardioOrmoCheck external quality assessment were also measured with TOSOH and the most used BNP immunoassays in Italy. Results: TOSOH method showed a good correlation (R = 0.976; n = 327) but a mean bias (−46.9%) compared to Triage Biosite. On the base of the results obtained in 10 samples of the CardioOrmoCheck study, TOSOH method showed a strict agreementwith ADVIA Centaur, while it underestimated BNP in comparisonwith Triage (−52.5%) and ARCHITECT methods (−39.4%). The agreement of ST-AIA-PACK and Triage Biosite methods for classification of HF patients was tested using 100 ng/L of BNP; the positive agreement between methods was 65%, overall agreement was 73%. Conclusions: Our results confirm that there are marked differences in measured values among commercial methods for BNP assay

A distal renal tubular acidosis showing hyperammonemia and hyperlactacidemia.

Introduction: distal renal tubular acidosis (dRTA) presents itself with variable clinical manifestations and often with late expressions that impact on prognosis. Case report: A 45-day-old male infant was admitted with stopping growth, difficult feeding and vomiting after meals. Clinical tests and labs revealed a type 1 renal tubular acidosis, even if the first blood tests showed ammonium and lactate increase. We had to exclude metabolic diseases before having a certain diagnosis. Conclusions: blood and urine investigations and genetic tests are fundamental to formulate dRTA diagnosis and to plan follow-up, according to possible phenotypic expressions of recessive and dominant autosomal forms in patients with dRTA

Cidadania e diversidade em saúde: necessidades e estratégias de promoção de equidade nos cuidados

Este artigo introduz o conceito de cidadania associado à sua concretização no âmbito da saúde em contextos de diversidade. Conjuga resultados de vários projetos de investigação de cariz qualitativo como forma de ilustrar algumas das estratégias concebi‐ das pelo Estado e pela sociedade civil em resposta às mudanças trazidas pelas migrações internacionais. Assim, identificam‐se as necessidades da população, as barreiras de acesso aos cuidados de saúde, as principais fontes de desigualdades e iniquidade e algumas das estratégias desenvolvidas na promoção da equidade em saúde, alertando para a impor‐ tância de levar em consideração as questões culturais e as de índole socioeconómica

Blood ozonization in patients with mild to moderate COVID-19 pneumonia: a single centre experience

The emerging outbreak of the coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread worldwide. We prescribed some promising medication to our patients with mild to moderate pneumonia due to SARS-CoV-2, however such drugs as chloroquine, hydrossichloroquine, azithromycin, antivirals (lopinavir/ritonavir, darunavir/cobicistat) and immunomodulating agents (steroids, tocilizumab) were not confirmed as effective against SARS-CoV2. We, therefore, started to use auto-hemotherapy treated with an oxygen/ozone (O2/O3) gaseous mixture as adjuvant therapy. In Udine University Hospital (Italy) we performed a case\u2013control study involving hospitalized adult patients with confirmed COVID-19 with mild to moderate pneumonia. Clinical presentations are based upon clinical phenotypes identified by the Italian Society of Emergency and Urgency Medicine (SIMEU\u2014Societ\ue0 Italiana di Medicina di Emergenza-Urgenza) and patients that met criteria of phenotypes 2 to 4 were treated with best available therapy (BAT), with or without O3-autohemotherapy. 60 patients were enrolled in the study: 30 patients treated with BAT and O2/O3 mixture, as adjuvant therapy and 30 controls treated with BAT only. In the group treated with O3-autohemotherapy plus BAT, patients were younger but with more severe clinical phenotypes. A decrease of SIMEU clinical phenotypes was observed (2.70 \ub1 0.67 vs. 2.35 \ub1 0.88, p = 0.002) in all patients during hospitalization but this clinical improvement\ua0was statistically significant only in O3-treated patients (2.87 \ub1 0.78 vs. 2.27 \ub1 0.83, p < 0.001), differently to the control group (2.53 \ub1 0.51 vs. 2.43 \ub1 0.93, p = 0.522). No adverse events were observed associated with the application of O2/O3 gaseous mixture. O2/O3 therapy as adjuvant therapy could be useful in mild to moderate pneumonia due to SARS-CoV-2. Randomized prospective study is ongoing [Clinical Trials.gov ID: Z7C2CA5837]

D-Dimer as Biomarker for Early Prediction of Clinical Outcomes in Patients With Severe Invasive Infections Due to Streptococcus Pneumoniae and Neisseria Meningitidis

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection; no current clinical measure adequately reflects the concept of dysregulated response. Coagulation plays a pivotal role in the normal response to pathogens (immunothrombosis), thus the evolution toward sepsis-induced coagulopathy could be individuate through coagulation/fibrinolysis-related biomarkers. We focused on the role of D-dimer assessed within 24 h after admission in predicting clinical outcomes in a cohort of 270 patients hospitalized in a 79 months period for meningitis and/or bloodstream infections due to Streptococcus pneumoniae (n = 162) or Neisseria meningitidis (n = 108). Comparisons were performed with unpaired t-test, Mann-Whitney-test or chi-squared-test with continuity correction, as appropriate, and multivariable logistic regression analysis was performed with Bayesian model averaging. In-hospital mortality was 14.8% for the overall population, significantly higher in S. pneumoniae than in N. meningitidis patients: 19.1 vs. 8.3%, respectively (p = 0.014). At univariable logistic regression analysis the following variables were significantly associated with in-hospital mortality: pneumococcal etiology, female sex, age, ICU admission, SOFA score, septic shock, MODS, and D-dimer levels. At multivariable analysis D-dimer showed an effect only in N. meningitidis subgroup: as 500 ng/mL of D-dimer increased, the probability of unfavorable outcome increased on average by 4%. Median D-dimer was significantly higher in N. meningitidis than in S. pneumoniae patients (1,314 vs. 1,055 ng/mL, p = 0.009). For N. meningitidis in-hospital mortality was 0% for D-dimer 7,000 ng/mL. Kaplan-Meier analysis of in-hospital mortality showed for N. meningitidis infections a statistically significant difference for D-dimer >7,000 ng/mL compared to values <500 ng/mL (p = 0.021) and 500\u20133,000 ng/mL (p = 0.002). For S. pneumoniae the mortality risk resulted always high, over 10%, irrespective by D-dimer values. In conclusion, D-dimer is rapid to be obtained, at low cost and available everywhere, and can help stratify the risk of in-hospital mortality and complications in patients with invasive infections due to N. meningitidis: D-dimer <500 ng/mL excludes any further complications, and a cut-off of 7,000 ng/mL seems able to predict a significantly increased mortality risk from much <10% to over 25%

Comparación de frecuencias alélicas y genotípicas de los polimorfismos CAPN1-316 Y CAPN1-4751 del gen de la Calpaina en tres poblaciones de ganado criollo boliviano

La terneza de la carne está en parte determinada por el sistema proteico calpaína (CAPN1) / calpastatina (CAST). Bolivia posee en los llanos tres biotipos de ganado Criollo: los Yacumeños, los Chaqueños y los Saavedreños. El objetivo del presente trabajo fue determinar la frecuencia alélica y genotípica del gen de la CAPN1 en tres poblaciones de ganado Criollo de Bolivia. Se obtuvieron muestras de sangre de 28 Criollos del Chaco (CCH), 85 Criollos Yacumeños (CYA) y 30 Criollos Saavedreños (CSV). El ADN se extrajo utilizando el kit comercial Wizard® Genomic Purification, y posteriormente se tipificaron dos polimorfismos (CAPN1-316 y CAPN1-4751) del gen CAPN1 mediante el método ARMS-PCR. La frecuencias alélicas y genotípicas, las heterocigosidades esperadas y observadas, así como, el índice FIS y el desequilibrio de ligamiento (LD) fueron calculadas mediante los programas MS-Tools y Genepop. Las frecuencias de los alelos asociados a mayor terneza para las poblaciones de CCH, CYA y CSV fueron: 23%, 22% y 33 % para el alelo C del SNP CAPN1-316 y 75%, 76% y 60% para el alelo C del CAPN1-4751. La heterocigocidad observada en las tres poblaciones se hallan en un rango de 0,30 a 0,46 para el marcador CAPN1-316 y de 0,21 a 0,60 para el polimorfismo CAPN1-4751. Los resultados demuestran que los bovinos criollos en las poblaciones analizadas poseen altas frecuencias alélicas para las variantes asociadas a mayor terneza de la carne. Por otra parte, no se observaron valores significativos de LD (P>0,01) entre los dos polimorfismos tipificados en las poblaciones estudiadas. Sería necesario tipificar ambos polimorfismos en futuros programas de selección asistida por marcadores genéticos.Meat tenderness is in part determined by the calpain (CAPN1) / calpastatin (CAST) genes. In the lowlands of Bolivia, three well differentiated Creole cattle populations can be distinguished: the Yacumeños, Chaqueños and Saavedreños. The main objective of this research was to determine the allelic and genotypic frequencies of two polymorphisms of the calpain gene in three Creole cattle populations in Bolivia. Blood samples of 28 Creole cattle from Chaqueño cattle (CCH), 85 from Yacumeño cattle (CYA) and 30 from Saavadreño cattle (CSV) were collected. Total DNA was extracted using the commercial kit Wizard® Genomic Purification and subsequently two polymorphisms (CAPN1-316 and CAPN1- 4751) of the CAPN1 gene were genotyped by the amplification refractory mutation system (ARMS-PCR) method. Allelic and genotypic frequencies, expected and observed heterozygosities, the FIS index and the magnitude of linkage disequilibrium (LD) were calculated using the software MS-Tools and Genepop. The allelic frequencies of variants associated with tenderness in the three populations CCH, CYA and CSV were 23%, 22% and 23% for the CAPN1- 316 and 75%, 76% and 60% for the CAPN1-4751. The observed heterozygosities in the three populations fluctuated between 0.30 and 0.46 for the CAPN1-316 marker and between 0.21 and 0.60 for the CAPN1-4751 marker. The results showed that the analysed populations of Creole cattle presented high frequencies of the alleles previously associated with tenderness in meat. The analysis of LD, however, did not show evidence of linkage between the two markers. It is necessary to perform a genetic analysis for both polymorphisms if included in future selection programs.Fil: Pereira, J. A. C.. Universidad Autónoma Gabriel René Moreno; BoliviaFil: Falomir Lockhart, Agustin Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Genética Veterinaria "Ingeniero Fernando Noel Dulout"; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias; ArgentinaFil: Loza, A.. Universidad Autónoma Gabriel René Moreno; BoliviaFil: Villegas Castagnasso, Egle Etel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Genética Veterinaria "Ingeniero Fernando Noel Dulout"; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias; ArgentinaFil: Rojas, P.. Universidad Autónoma Gabriel René Moreno; BoliviaFil: Carino, M. . Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Genética Veterinaria "Ingeniero Fernando Noel Dulout"; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias; ArgentinaFil: Ripoli, María Verónica. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Genética Veterinaria "Ingeniero Fernando Noel Dulout"; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias; ArgentinaFil: Giovambattista, Guillermo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Genética Veterinaria "Ingeniero Fernando Noel Dulout"; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias; Argentin