Leiomiomatose Peritoneal Disseminada: Relato de um Caso Raro numa Mulher sem História Prévia de Leiomiomas Uterinos

Disseminated peritoneal leiomyomatosis (DPL) is a rare disease characterized by multiple leiomyomas disseminated throughout the peritoneal cavity, occurring most commonly in women of childbearing age. Although typically benign, DPL may degenerate into malignancy. As the majority are asymptomatic, these tumors are usually incidentally found incidentally. Differential diagnosis includes peritoneal carcinomatosis peritoneal or abdominal disseminated malignancy; the clinical and radiological context can help differentiate these entities, but only histopathological examination achieves the final diagnosis. The authors present a case of a woman with DPL found during infertility workup. She had undergone laparoscopic broad ligament myomectomy 5 years previously, but there was no prior history of uterine leiomyomas. A revision of the clinical, pathological and imaging features of this entity was also performed.info:eu-repo/semantics/publishedVersio

Combining Fine- and Coarse-Grained Classifiers for Diabetic Retinopathy Detection

Visual artefacts of early diabetic retinopathy in retinal fundus images are usually small in size, inconspicuous, and scattered all over retina. Detecting diabetic retinopathy requires physicians to look at the whole image and fixate on some specific regions to locate potential biomarkers of the disease. Therefore, getting inspiration from ophthalmologist, we propose to combine coarse-grained classifiers that detect discriminating features from the whole images, with a recent breed of fine-grained classifiers that discover and pay particular attention to pathologically significant regions. To evaluate the performance of this proposed ensemble, we used publicly available EyePACS and Messidor datasets. Extensive experimentation for binary, ternary and quaternary classification shows that this ensemble largely outperforms individual image classifiers as well as most of the published works in most training setups for diabetic retinopathy detection. Furthermore, the performance of fine-grained classifiers is found notably superior than coarse-grained image classifiers encouraging the development of task-oriented fine-grained classifiers modelled after specialist ophthalmologists.Comment: Pages 12, Figures

Functionalisation of terpenoids at C-4 via organopalladium dimers: cyclopropane formation during oxidation of homoallylic sigma-organopalladium intermediates with lead tetraacetate

The synthesis of new potential adjuvant saponin aglycons was investigated by selective palladium mediated C-H functionalisation of appropriately functionalised derivatives of lanosterol, cholesterol, and friedelin. The desired equatorial aldehyde functionality was successfully introduced into the lanosterol skeleton as expected. Cyclopalladation of a cholesterol derivative proceeded as expected, but during oxidation of the organopalladium intermediate, participation of the adjacent alkene functionality led to stereoselective formation of a cyclopropane and introduction of an acetate group into the steroid backbone at C-6. Further investigation of this unusual cyclopropane formation on a model decalin system confirmed the result, but C-H activation on a related open chain system was prevented by complexation of the alkene functionality to the palladium. (c) 2007 Elsevier Ltd. All rights reserved

Investigation into impact of train speed for behaviour of ballasted railway track foundations

Traffic congestion of highways in many countries around the world has led railways to become the most popular means of public transportation, which increased the demand for faster and heavier trains. High-speed trains and heavy train loads are normally accompanied with strong vibrations in the track-ground system, which increases the risk of train derailment and track damages. Therefore, to allow for safer and reliable operation of high-speed trains, an investigation into the behavior of ballasted railway track foundations subjected to train moving loads at various speeds is a subject of prime importance in design of railway tracks. In the current study, sophisticated three dimensional (3D) finite elements (FE) numerical modelling was developed to investigate the impact of train speed on the dynamic response of track-ground system. In addition, some factors of the track-ground system affecting the critical speed including the modulus and thickness of track subgrade and ballast materials, and amplitude of train loading were investigated. The results were analyzed and presented, and their practical implications were discussed

Improving Cultural Approaches to Pediatric Palliative Care in Central Massachusetts

Objectives: To determine the impact of a web tool developed to improve health care providers\u27 ability and comfort in caring for a diverse patient population in the hospital setting. Methods: The pediatric palliative care team including a pediatric oncologist and a nurse practitioner in association with a clinical medical librarian and a hospital-based interpreter, collaborated to create a resource using SpringShare software to create a library guide. The purpose is to provide cultural and palliative care information resources, books, and journal articles to assist health care workers at UMass Memorial Children\u27s Medical Center in caring for children from the diverse cultural backgrounds living in the region. In order to introduce and evaluate the usage of the library guide, we plan to survey Children\u27s Medical Center staff including nurses, residents, attending physicians, and child life staff at baseline and after visiting the library guide. As of this date, the usage of the guide has had over 400 hits per month or 1,200 hits in the last 3 months (libraryguides.umassmed.edu/diversity_guide). Results: We will be conducting a survey of all children\u27s medical center staff, nurses, and physicians to evaluate the usefulness and impact of this resource. Conclusions: The results of the survey will be complete in 2013

Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection

Objectives To evaluate the maternal and perinatal outcomes of pregnancies affected by SARS-CoV-2 infection. Methods This was a multinational retrospective cohort study including women with a singleton pregnancy and laboratory-confirmed SARS-CoV-2 infection, conducted in 72 centers in 22 different countries in Europe, the USA, South America, Asia and Australia, between 1 February 2020 and 30 April 2020. Confirmed SARS-CoV-2 infection was defined as a positive result on real-time reverse-transcription polymerase chain reaction (RT-PCR) assay of nasopharyngeal swab specimens. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit (ICU), use of mechanical ventilation and death. Results In total, 388 women with a singleton pregnancy tested positive for SARS-CoV-2 on RT-PCR of a nasopharyngeal swab and were included in the study. Composite adverse maternal outcome was observed in 47/388 (12.1%) women; 43 (11.1%) women were admitted to the ICU, 36 (9.3%) required mechanical ventilation and three (0.8%) died. Of the 388 women included in the study, 122 (31.4%) were still pregnant at the time of data analysis. Among the other 266 women, six (19.4% of the 31 women with first-trimester infection) had miscarriage, three (1.1%) had termination of pregnancy, six (2.3%) had stillbirth and 251 (94.4%) delivered a liveborn infant. The rate of preterm birth before 37 weeks' gestation was 26.3% (70/266). Of the 251 liveborn infants, 69/251(27.5%) were admitted to the neonatal ICU, and there were five (2.0%) neonatal deaths. The overall rate of perinatal death was 4.1% (11/266). Only one (1/251, 0.4%) infant, born to a mother who tested positive during the third trimester, was found to be positive for SARS-CoV-2 on RT-PCR. Conclusions SARS-CoV-2 infection in pregnant women is associated with a 0.8% rate of maternal mortality, but an 11.1% rate of admission to the ICU. The risk of vertical transmission seems to be negligible. (C) 2020 International Society of Ultrasound in Obstetrics and Gynecology.Peer reviewe

Local association of Trypanosoma cruzi chronic infection foci and enteric neuropathic lesions at the tissue micro-domain scale

Chagas disease (American trypanosomiasis) is caused by the protozoan parasite Trypanosoma cruzi. Chagas disease has two types, the cardiac form and the digestive form; some patients have symptoms of both. How the parasite causes digestive disease is poorly understood. It is known that damage to the gut’s nervous system is an important factor, but it has been unclear exactly where and when this damage occurs during the course of an infection and also why only a subset of infected people suffer from this outcome. We studied infections in mice and found certain combinations of strains of parasites and mice that exhibited symptoms similar to human digestive Chagas patients, including a problem with peristalsis that localised specifically to the colon. Using parasites that were genetically engineered to emit both bioluminescent and fluorescent light, we tracked infections over time and were able to analyse rare infected cells deep within the muscle tissue of the wall of the colon. We found evidence of damaged neurons in the same location as these infection foci over 6 months after initial infection. Our results show that digestive Chagas disease probably develops as a result of chronic infection and inflammation, which potentially changes approaches to treatment