Generative models : an upcoming innovation in musculoskeletal radiology? A preliminary test in spine imaging

Background Deep learning is a ground-breaking technology that is revolutionising many research and industrial fields. Generative models are recently gaining interest. Here, we investigate their potential, namely conditional generative adversarial networks, in the field of magnetic resonance imaging (MRI) of the spine, by performing clinically relevant benchmark cases. Methods First, the enhancement of the resolution of T2-weighted (T2W) images (super-resolution) was tested. Then, automated image-to-image translation was tested in the following tasks: (1) from T1-weighted to T2W images of the lumbar spine and (2) vice versa; (3) from T2W to short time inversion-recovery (STIR) images; (4) from T2W to turbo inversion recovery magnitude (TIRM) images; (5) from sagittal standing x-ray projections to T2W images. Clinical and quantitative assessments of the outputs by means of image quality metrics were performed. The training of the models was performed on MRI and x-ray images from 989 patients. Results The performance of the models was generally positive and promising, but with several limitations. The number of disc protrusions or herniations showed good concordance (\u3ba = 0.691) between native and super-resolution images. Moderate-to-excellent concordance was found when translating T2W to STIR and TIRM images (\u3ba 65\u20090.842 regarding disc degeneration), while the agreement was poor when translating x-ray to T2W images. Conclusions Conditional generative adversarial networks are able to generate perceptually convincing synthetic images of the spine in super-resolution and image-to-image translation tasks. Taking into account the limitations of the study, deep learning-based generative methods showed the potential to be an upcoming innovation in musculoskeletal radiology

Trends In Social And Demographic Inequalities In The Prevalence Of Chronic Diseases In Brazil. Pnad: 2003-2008 [tendências Das Desigualdades Sociais E Demográficas Na Prevalência De Doenças Crônicas No Brasil, Pnad: 2003-2008.]

The aims of this study are: to evaluate the prevalence of chronic diseases in the Brazilian population comparing data of 2008 with those of 2003; to estimate the impact of chronic conditions on the use of health services and on the restriction of daily activities and to measure the differentials in the prevalence of specific diseases according to educational strata and the affiliation to a private health plan. Data were obtained from PNAD 2008 and 2003. The analysis included estimations of crude and adjusted prevalence ratios, using svy commands from Stata 11 software. The prevalence of at least one disease was higher in: the elderly, women, low schooling level, black or indigenous people, urban residents, migrants and people living in the south region of Brazil. The most frequent diseases were: hypertension, back and spinal cord disorders, arthritis and depression. Between 2003 and 2008, an increase in the prevalence of diabetes, hypertension, cancer and cirrhosis was observed, and there was a reduction in chronic kidney failure and tuberculosis. All the diseases analyzed, with the exception of cancer and tendinitis/tenossinovitis, revealed a higher prevalence in low educational level strata. The greatest social inequalities were in chronic kidney failure, cirrhosis, tuberculosis and arthritis/rheumatism.16937553768Viacava, F., Informações em saúde: A importância dos inquéritos populacionais (2002) Cien Saude Colet, 7 (4), pp. 607-621Barros, M.B.A., Inquéritos domiciliares de saúde: Potencialidades e desafios (2008) Rev Bras Epidemiol, 11 (SUPPL. 1), pp. 6-19(2006) Sobre a Recente Queda Da Desigualdade De Renda No Brasil: Nota Técnica, , http://www.ipea.gov.br/sites/000/2/publicacoes/NTquedaatualizada.pdf, Instituto de Pesquisa Econômica Aplicada (IPEA), Instituto de Pesquisa Econômica Aplicada (IPEA). Brasília: IPEA, [acessado 2010 nov 24]. 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(2005) Int J Epidemiol, 34 (6), pp. 1284-1290Gigante, D.P., Moura, E.C., Sardinha, L.M.V., Prevalência de excesso de peso e obesidade e fatores associados, Brasil, 2006 (2009) Rev Saude Publica, 43 (SUPPL. 2), pp. 83-89Florindo, A.A., Hallal, P.C., Moura, E.C., Malta, D.C., Prática de atividades físicas e fatores associados em adultos, Brasil, 2006 (2009) Rev Saude Publica, 43 (SUPPL. 2), pp. 65-73Lima-Costa, M.F., Loyola Filho, M.I., Matos, D.L., Tendências nas condições de saúde e uso de serviços de saúde entre idosos brasileiros: Um estudo baseado na Pesquisa Nacional por Amostra de domicílios (1998, 2003) (2007) Cad Saude Publica, 23 (10), pp. 2467-2478(2009) The Impact of Chronic Disease on U.S. Health and Prosperity, p. 92. , http://www.fightchronicdisease.org/pdfs/2009_PFCDAlmanac.pdf, PFCD - Partnership to Fight Chronic Disease. Almanac of Chronic Disease, [cited 2010 Nov 18], Available from:Pinheiro, R.S., Viacava, F., Travassos, C., Brito, A.S., Gênero, morbidade, acesso e utilização de serviços de saúde no Brasil (2002) Cien Saude Colet, 7 (4), pp. 687-707Lethbridge-Cejku, M., Schiller, J.S., Bernadel, L., Summary health statistics for U.S. adults: National Health Interview Survey, 2002 (2004) Vital Health Stat, 10 (222), pp. 1-151Almeida, M.F., Barata, R.B., Monteiro, C.V., Silva, Z.P., Prevalência de doenças crônicas auto-referidas e utilização de serviços de saúde, PNAD/1998, Brasil (2002) Cien Saude Colet, 7 (4), pp. 743-756Barreto, S.M., Figueiredo, R.C., Doença crônica, autoavaliação de saúde e comportamento de risco: Diferença de gênero (2009) Rev Saude Publica, 43 (SUPPL. 2), pp. 38-47Dalstra, J.A.A., Kunst, A.E., Borrell, C., Breeze, E., Cambois, E., Costa, G., Geurts, J.J., Mackenbach, J.P., Socioeconomic differences in the prevalence of common chronic diseases: An overview of eight European countries (2005) Int J Epidemiology, 34 (2), pp. 316-326(2004) Inquérito Domiciliary Sobre Comportamentos De Risco E Morbidade Referida De Doenças E Agravos Não Transmissíveis: Brasil, 15 Capitais E Distrito Federal, 2002-2003, , Brasil. Ministério da Saúde (MS), Rio de Janeiro: INCASilva, M.C., Fassa, A.C.G., Valle, N.C.J., Dor lombar crônica em uma população adulta do Sul do Brasil: Prevalência e fatores associados (2004) Cad Saude Publica, 20 (2), pp. 377-385Machado, G.P.M., Barreto, S.M., Passos, V.M.A., Lima-Costa, Projeto Bambuí: Prevalência de sintomas articulares crônicos em idosos (2004) Rev Assoc Med Bras, 50 (4), pp. 367-372Schoenborn, C.A., Heyman, K.M., Health characteristics of adults aged 55 years and over: United States, 2004-2007 (2009) Natl Health Stat Report, 8 (16), pp. 1-31Wang, J.L., Schmitz, N., Dewa, C.S., Socioeconomic status and the risk of major depression: The Canadian National Population Health Survey (2010) J Epidemiol Community Health, 64 (5), pp. 447-452Frazão, P., Costa, C.M., Almeida, M.F., Risks associated with tendinitis: Effects from demographic, socioeconomic, and psychological status among Brazilian workers (2010) Am J Ind Med, 53 (1), pp. 72-79Cricelli, C., Mazzaglia, G., Samani, F., Marchi, M., Sabatini, A., Nardi, R., Ventriglia, G., Caputi, A.P., Prevalence estimates for chronic diseases in Italy: Exploring the differences between self-report and primary care databases (2003) J Public Health Med, 25 (3), pp. 254-257Okura, Y., Urban, L.H., Mahoney, D.W., Jacobsen, S.J., Rodeheffer, R.J., Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure (2004) J Clin Epidemiol, 57 (10), pp. 1096-1103Chrestani, M.A., da Santos, S., Matijasevich, A.M., Selfreported hypertension: Validation in a representative cross-sectional survey (2009) Cad Saude Publica, 25 (11), pp. 2395-2406Liberatos, P., Link, B.G., Kelsey, J.L., The measurement of social class in epidemiology (1988) Epidemiol Rev, 10, pp. 87-121Jardim, R., Barreto, S.M., Giatti, L., Confiabilidade das informações obtidas de informante secundário em inquéritos de saúde (2010) Cad Saude Publica, 26 (8), pp. 1537-1548Mackenbach, J.P., Looman, C.W., van der Meer, J.B., Differences in the misreporting of chronic conditions, by level of education: The effect on inequalities in prevalence rates (1996) Am J Public Health, 86 (5), pp. 706-711Mackenbach, J.P., Stirbu, I., Roskam, A.J., Schaap, M.M., Menvielle, G., Leinsalu, M., Kunst, A.E., European Union Working Group on Socioeconomic Inequalities in Health. 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Physical Inactivity And Associated Factors In Adults, São Paulo, Brazil [inatividade Física E Fatores Associados Em Adultos, São Paulo, Brasil]

Objective: To analyze the prevalence of overall and leisure time physical inactivity and associated factors and types of exercises or sports modalities according to schooling in 2,050 adults from 18 to 59 years of age - state of São Paulo, Brazil. Methods: Population-based cross-sectional study with a stratified sample of clusters performed in multiple stages. Physical inactivity was determined using the short version of the International Physical Activity Questionnaire - IPAQ and by a question on the regular practice of leisure time physical activity. Data analysis took the sample design into account. Results: Prevalence of physical inactivity during leisure was higher among women. Poisson multiple regression model in man indicated that overall sedentarism was lower among single and separated men, students and without car in the household. Leisure physical inactivity was greater among men over forty years, among those with less schooling and full-time students. Overall physical inactivity was more prevalent among woman with more schooling, with less qualified occupations and widows. Leisure physical inactivity decreased with age and schooling. Among modalities practiced for leisure, walking was more prevalent among women and football was more prevalent among men. Most modalities were directly associated with schooling; approximately 25% of the individuals with more than 12 years of schooling practiced walking. Conclusions: These results suggest that interventions and public policies to promote physical activity should consider differences in gender and socioeconomic status as well as the preferences for different modalities and the context in which the physical activity is practiced.133(2008) Physical activity guidelines advisory committee report, , U.S. Department of Health and Human Services, Washington, DC: U.S. Department of Health and Human ServicesMonteiro, C.A., Conde, W.L., Matsudo, S.M., Matsudo, V.R., Bonseñor, I.M., Lotufo, P.A., A descriptive epidemiology of leisure-time physical activity in Brazil, 1996-1997 (2003) Pan Am J Public Health, 14, pp. 246-254Shibata, A., Oka, K., Nakamura, Y., Muraoka, I., Prevalence and demographic correlates of meeting the physical activity recommendation among Japanese adults (2009) Journal of physical activity & health, 6 (1), pp. 24-32Dias-da-Costa, J.S., Hallal, P.C., Wells, J.C.K., Daltoé, T., Fuchs, S.C., Meneses, A.M.B., Epidemiology of leisure-time physical activity: A population-based study in southern Brazil (2005) Cad Saúde Pública, 21 (1), pp. 275-282Siqueira, F.V., Facchini, L.A., Piccini, R.X., Tomasi, E., Thume, E., Silveira, D.S., Hallal, P.C., Atividade física em adultos e idosos residentes em áreas de abrangência de unidade básicas de saúde de municípios das regiões Sul e Nordeste do Brasil (2008) Cad Saúde Pública, (24), pp. 39-54Ferreira, M.S., Najar, A.L., Programas e campanhas de promoção da atividade física (2005) Ciências da saúde coletiva, (SUPL.10), pp. 207-219Ministério da Saúde (2008) Diretrizes e recomendações cuidado integral de doenças crônicas não-transmissíveis, , Brasil, Promoção da saúde, vigilância, prevenção e assistência. Brasília: Ministério da SaúdePitanga, F.J.G., Lessa, I., Prevalência e fatores associados ao sedentarismo no lazer em adultos (2005) Cad Saúde Pública, 21 (3), pp. 870-877Guimarães, V.M.V., Cesar, C.L.G., (2005) Atividade física, , In: César CLG, et al Saúde e condição de vida em São Paulo. Inquérito Multicêntrico de Saúde no Estado de São Paulo. São Paulo: USP/FSPFlorindo, A.A., Guimarães, V.V., Cesar, C.L.G., Barros, M.B.A., Alves, M.C.G.P., Goldbaum, M., Carandina, L., Epidemiology of leisure, transportation, occupational and household physical activity: Prevalence and associated factors (2009) Journal of Physical Activity & Health leisure, 6, pp. 625-632Hallal, P.C., Matsudo, S.M., Matsudo, V.K.R., Araujo, T.L., Andrade, D.R., Bertoldi, A.D., Physical activity in adults from two Brazilian areas: Similarities and differences (2005) Cad Saúde Pública, 21 (2), pp. 573-580Graff-Iversen, S., Anderssen, S.A., Holme, I.M., Jenum, A.K., Raastad, T., An adapted version of the long International Physical Activity Questionnaire (IPAQ-L): Construct validity in a low-income, multiethnic population study from Oslo, Norway (2007) Int J Behav Nutr Phys Act, (4), p. 13Alves, M.C.G.P., Plano de amostragem (2005) Saúde e condição de vida em São Paulo. Inquérito Multicêntrico de Saúde no Estado de São Paulo, 1, pp. 47-62. , In: Cesar CLG, Carandina L, Alves MCGP, Barros MBA, Goldbaum M. (Org.), ISA-SP. 1 ed. São Paulo: Faculdade de Saúde Pública(2009) Vigitel Brasil 2008 - Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico, , VIGITEL, Brasília: Ministério da Saúde(2004) Inquérito domiciliar sobre comportamento de risco e morbidade referida de doenças e agravos não transmissíveis: Brasil, 15 capitais e distrito federal, 2002-2003, , Brasil, Rio de Janeiro: INCASjostrom, M., Oja, P., Hagstromer, M., Smith, B., Bauman, A., Health-enhancing physical activity across European Union countries: The Eurobarometer study (2006) J Public Health, 14, pp. 291-300Hallal, P.C., Dumith, S.C., Bastos, J.P., Reichert, F.F., Siqueira, F.V., Azevedo, M.R., Evolução da pesquisa epidemiológica em atividade física no Brasil: Uma revisão sistemática (2007) Revista de Saúde Pública / Journal of Public Health, 41, pp. 453-460Seclen-Palacin, J., Jacoby, E., Factores sociodemográficos y ambientales asociados com actividad física deportiva em la población urbana del Peru (2003) Rev Panam Salud Pública, 14 (3), pp. 255-264Bernstein, M.S., Costanza, M.C., Morabia, A., Physical activity of urban adults: A general population survey in Geneva (2001) Soz Praventivmed, 46 (1), pp. 49-59Rutten, A., Abu-Omar, K., Prevalence of physical activity in the European Union (2004) Soz Praventivmed, 49, pp. 281-289Gomez, L.F., Duperly, J., Lucumi, D.I., Gamez, R., Venegas, A.S., Physical activity levels in adults living in Bogota (Colombia): Prevalence and associated factors (2005) Gac Sanit, 19 (3), pp. 206-213Monteiro, C.A., Moura, E.C., Jaime, P.C., Surveillance of risk factors for chronic diseases through telephone interviews (2005) Rev Saúde Publica, 39 (1), pp. 47-57Varo, J.J., Martinez-Gonzalez, M.A., De Irala-Estevez, J., Kearney, J., Gibney, M., Martinez, J.A., Distribution and determinants of sedentary lifestyles in the European Union (2003) Int J Epidemiol, 32 (1), pp. 138-146(2003) Gender, health and aging. WHO, , http://www.who.int/gender/documents/en/Gender_Ageing.pdf, WHO - World Health Organization, Disponível emGal, D.L., Santos, A.C., Barros, H., Leisure-time versus full-day energy expenditure: A cross-sectional study of sedentarism in a Portuguese urban population (2005) BMC Public Health, 5, p. 16Bertrais, S., Preziosi, P., Mennen, L., Galan, P., Hercberg, S., Oppert, J.M., Sociodemographic and geographic correlates of meeting current recommendations for physical activity in middle-aged French adults (2004) Am J of Public Health, 94 (9), pp. 1560-1566Jurakić, D., Pedisić, Z., Andrijasević, M., Physical Activity of Croatian Population: Cross-sectional Study Using International Physical Activity Questionnaire (2009) Croat Med J, 50, pp. 165-173Lindstrom, M., Hanson, B.S., Ostergren, P., Socioeconomic differences in leisure-time physical activity: The role of social participation and social capital in shaping health related behaviour (2001) Social Science & Medicine, 52, pp. 441-451Burton, N.W., Turrell, G., Occupation, Hours Worked, and Leisure-Time Physical Activity (2000) Preventive Medicine, 31 (6), pp. 673-681Borrell, C., Dominguez-Berjón, F., Pasarín, M.I., Social inequalities in health related behaviors in Barcelona (2000) J Epidemiol Community Health, 54, pp. 24-30Ogilvie, D., Mitchell, R., Mutrie, N., Petticrew, M., Platt, S., Personal and environmental correlates of active travel and physical activity in a deprived urban population (2008) Int J Behav Nutr Phys Act., 5, p. 43Woodcock, J., Banister, D., Edwards, P., Prentice, A.M., Roberts, I., Energy and transport (2007) Lancet, 370 (9592), pp. 1078-108

Self-rated Health And Associated Factors, Brazil, 2006

Objective: To assess prevalence of poor self-rated health and associated factors. Methods: Data from 54,213 individuals aged ≥18 years, collected by the Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL - Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases), in Brazilian state capitals and Federal District, in 2006, were analyzed. One resident of each household, with at least one fixed telephone line, was randomly selected from probability samples, subsequently answering the questionnaire. Independent variables analyzed were of a demographic, behavioral and self-reported morbidity nature. Prevalences and crude and adjusted prevalence ratios of poor self-rated health were estimated using Poisson regression. Results: Poor self-rated health was more frequent in women, older individuals and those with lower level of education, without an occupation and living in state capitals of the Northern and Northeastern regions; among men prevalence of poor self-rated health was higher in the Southeastern region than in the Southern region. Smoking ≥ 20 cigarettes/day, lack of regular physical activity in leisure time and low weight or obesity were associated with poor self-rated health in both sexes; pre-obesity and frequent consumption of fruits and vegetables were significant in women, while not watching television was significant in men. Prevalence of poor self-rated health increased with the growth in the number of self-reported morbidities. Having four or five morbidities resulted in PR=11.4 in men and PR=6.9 in women, compared to those who did not have morbidities. Conclusions: Regional, sex and level of education inequalities were observed in the prevalence of poor self-rated health. 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[physical Inactivity And Associated Factors In Adults, São Paulo, Brazil].

To analyze the prevalence of overall and leisure time physical inactivity and associated factors and types of exercises or sports modalities according to schooling in 2,050 adults from 18 to 59 years of age - state of São Paulo, Brazil. Population-based cross-sectional study with a stratified sample of clusters performed in multiple stages. Physical inactivity was determined using the short version of the International Physical Activity Questionnaire - IPAQ and by a question on the regular practice of leisure time physical activity. Data analysis took the sample design into account. Prevalence of physical inactivity during leisure was higher among women. Poisson multiple regression model in man indicated that overall sedentarism was lower among single and separated men, students and without car in the household. Leisure physical inactivity was greater among men over forty years, among those with less schooling and full-time students. Overall physical inactivity was more prevalent among woman with more schooling, with less qualified occupations and widows. Leisure physical inactivity decreased with age and schooling. Among modalities practiced for leisure, walking was more prevalent among women and football was more prevalent among men. Most modalities were directly associated with schooling; approximately 25% of the individuals with more than 12 years of schooling practiced walking. These results suggest that interventions and public policies to promote physical activity should consider differences in gender and socioeconomic status as well as the preferences for different modalities and the context in which the physical activity is practiced.13338739

The upper Messinian post-evaporitic succession of Serredi Quarry (southern Tuscany, Italy): new stratigraphic data and geochronology of an ash layer.

An ash layer, about 1 cm thick, has been found during a reinvestigation of the upper Messinian-Zanclean succession exposed at Serredi Quarry (Fine Basin, Northern Apennines), one of the best known Neogene Tuscan sections. The Serredi Quarry succession (about 175 m thick) has been subdivided into three intervals: the lower (18 m thick) and middle (132 m thick) ones are separated by an unconformity and are both referable to the Messinian post-evaporitic phase, whereas the upper interval (25 m thick) represents marl deposition following the Pliocene transgression. The lower interval consists of relatively deep-lacustrine, anoxic, thinly laminated mudstones with subordinate sands, whereas the middle one includes lacustrine mudstones (occasionally with pedogenic features) with sands, diagenetic gypsum-rich mudstones, limestones, gravels and selenite gypsum draped by gypsarenites. These lithofacies are typically arranged into marginal-lake, cyclical stacking patterns. The ash layer is located in the lower interval. It is faintly laminated and composed of almost pure fine-grained glass shards and rare pumices. These characteristics suggest a primary deposition from a pyroclastic fallout. Chemical analyses were carried out on well preserved pumices and glass shards were used for fission-tracks dating, which provided an age of 5.35 + 0.32 Ma. Nevertheless, its age can be further constrained by the fact that i) the ash layer is about 145 m below the Miocene-Pliocene boundary, and ii) the intervening deposits mainly consist of mudstones with occasional pedogenic features, which are likely to comprise sedimentary hiatuses. Accordingly, the ash layer probably emplaced in the older part of the determined age interval. On the whole, the geochronology, geochemistry and the stratigraphic framework of the first ash layer found in the post-evaporitic deposits of Tuscany could represent valuable tools for regional stratigraphic studies on the Lago Mare phase and long-distance correlation

MRI radiomics-based machine-learning classification of bone chondrosarcoma

Purpose: To evaluate the diagnostic performance of machine learning for discrimination between low-grade and high-grade cartilaginous bone tumors based on radiomic parameters extracted from unenhanced magnetic resonance imaging (MRI). Methods: We retrospectively enrolled 58 patients with histologically-proven low-grade/atypical cartilaginous tumor of the appendicular skeleton (n = 26) or higher-grade chondrosarcoma (n = 32, including 16 appendicular and 16 axial lesions). They were randomly divided into training (n = 42) and test (n = 16) groups for model tuning and testing, respectively. All tumors were manually segmented on T1-weighted and T2-weighted images by drawing bidimensional regions of interest, which were used for first order and texture feature extraction. A Random Forest wrapper was employed for feature selection. The resulting dataset was used to train a locally weighted ensemble classifier (AdaboostM1). Its performance was assessed via 10-fold cross-validation on the training data and then on the previously unseen test set. Thereafter, an experienced musculoskeletal radiologist blinded to histological and radiomic data qualitatively evaluated the cartilaginous tumors in the test group. Results: After feature selection, the dataset was reduced to 4 features extracted from T1-weighted images. AdaboostM1 correctly classified 85.7 % and 75 % of the lesions in the training and test groups, respectively. The corresponding areas under the receiver operating characteristic curve were 0.85 and 0.78. The radiologist correctly graded 81.3 % of the lesions. There was no significant difference in performance between the radiologist and machine learning classifier (P = 0.453). Conclusions: Our machine learning approach showed good diagnostic performance for classification of low-to-high grade cartilaginous bone tumors and could prove a valuable aid in preoperative tumor characterization