Systemic sclerosis (SSc) is an autoimmune disease characterized by skin and internal organ fibrosis and microvascular impairment, which can affect major organs, including the heart. Arrhythmias are ...responsible for approximately 6% of deaths in patients with SSc, and mainly occur due to myocardial fibrosis, which causes electrical inhomogeneity. The aim of this study was to determine the frequency of arrhythmias and conduction disturbances in SSc cohorts, and to identify the characteristics and risk factors associated with the occurrence of dysrhythmias in patients with SSc. A systematic literature review using PubMed, Embase, Web of Science and Scopus databases was performed. Full-text articles in English with arrhythmias as the main topic published until 21 April 2022 were included. Most prevalent arrhythmias were premature supraventricular and ventricular contractions, while the most frequent conduction disturbance was represented by right bundle branch block (RBBB). Elevated concentrations of N-terminal prohormones of brain natriuretic peptides (NT-pro BNP) were associated with numerous types of atrial and ventricular arrhythmias, and with the occurrence of RBBB. A lower value of the turbulence slope (TS) emerged as an independent predictor for ventricular arrhythmias. In conclusion, dysrhythmias are frequent in SSc cohorts. Paraclinical and laboratory parameters are useful instruments that could lead to early diagnosis in the course of the disease.
Antibiotics are an essential tool of modern medicine, contributing to significantly decreasing mortality and morbidity rates from infectious diseases. However, persistent misuse of these drugs has ...accelerated the evolution of antibiotic resistance, negatively impacting clinical practice. The environment contributes to both the evolution and transmission of resistance. From all anthropically polluted aquatic environments, wastewater treatment plants (WWTPs) are probably the main reservoirs of resistant pathogens. They should be regarded as critical control points for preventing or reducing the release of antibiotics, antibiotic-resistant bacteria (ARB), and antibiotic-resistance genes (ARGs) into the natural environment. This review focuses on the fate of the pathogens
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(ESCAPE) in WWTPs. All ESCAPE pathogen species, including high-risk clones and resistance determinants to last-resort antibiotics such as carbapenems, colistin, and multi-drug resistance platforms, were detected in wastewater. The whole genome sequencing studies demonstrate the clonal relationships and dissemination of Gram-negative ESCAPE species into the wastewater via hospital effluents and the enrichment of virulence and resistance determinants of
and enterococci in WWTPs. Therefore, the efficiency of different wastewater treatment processes regarding the removal of clinically relevant ARB species and ARGs, as well as the influence of water quality factors on their performance, should be explored and monitored, along with the development of more effective treatments and appropriate indicators (ESCAPE bacteria and/or ARGs). This knowledge will allow the development of quality standards for point sources and effluents to consolidate the WWTP barrier role against the environmental and public health AR threats.
Imaging software has become critical tools in the diagnosis and decision making for the treatment of abdominal aortic aneurysms (AAA). However, the interobserver reproducibility of the maximum ...cross-section diameter is poor. This study aimed to present and assess the quality of a new fully automated software (PRAEVAorta) that enables fast and robust detection of the aortic lumen and the infrarenal AAA characteristics including the presence of thrombus.
To evaluate the segmentation obtained with this new software, we performed a quantitative comparison with the results obtained from a semiautomatic segmentation manually corrected by a senior and a junior surgeon on a dataset of 100 preoperative computed tomography angiographies from patients with infrarenal AAAs (13,465 slices). The Dice similarity coefficient (DSC), Jaccard index, sensitivity, specificity, volumetric similarity (VS), Hausdorff distance, maximum aortic transverse diameter, and the duration of segmentation were calculated between the two methods and, for the semiautomatic software, also between the two observers.
The analyses demonstrated an excellent correlation of the volumes, surfaces, and diameters measured with the fully automatic and manually corrected segmentation methods, with a Pearson's coefficient correlation of greater than 0.90 (P < .0001). Overall, a comparison between the fully automatic and manually corrected segmentation method by the senior surgeon revealed a mean Dice similarity coefficient of 0.95 ± 0.01, a Jaccard index of 0.91 ± 0.02, sensitivity of 0.94 ± 0.02, specificity of 0.97 ± 0.01, VS of 0.98 ± 0.01, and mean Hausdorff distance per slice of 4.61 ± 7.26 mm. The mean VS reached 0.95 ± 0.04 for the lumen and 0.91 ± 0.07 for the thrombus. For the fully automatic method, the segmentation time varied from 27 seconds to 4 minutes per patient vs 5 minutes to 80 minutes for the manually corrected methods (P < .0001).
By enabling a fast and fully automated detailed analysis of the anatomic characteristics of infrarenal AAAs, this software could have strong applications in daily clinical practice and clinical research.
Background: The recently published 2019 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) classification criteria for systemic lupus erythematosus (SLE) ...were developed to increase the reliability and identification of SLE, especially in early disease. With the emergence of several new drugs for SLE, identifying and treating patients early are more important than ever. Methods: Data of 446 SLE patients evaluated in our center between 1996−2019 and 226 controls with other autoimmune diseases evaluated between 2001−2022 were retrospectively analyzed. The sensitivity and specificity of the 2019 ACR/EULAR criteria were compared to the 2012 SLICC and the 1997 ACR criteria. Results: The 2019 ACR/EULAR criteria showed very good sensitivity (86.6%) compared to the 1997 ACR criteria (76.7%), p < 0.001, with a trend toward significance compared to the 2012 SLICC criteria (83.6%), p = 0.072. Their sensitivity remained high (87.6%) in patients with a short disease duration. The specificity of the 2019 ACR/EULAR criteria (91.2%) was statistically lower than the 2012 SLICC (96.0%) and 1997 ACR criteria (95.1%), p = 0.007 and p = 0.012, respectively, but still had a very high value. A total of 22 controls (9.7%) fulfilled at least one set of criteria (15 patients with MCTD, 5 with UCTD, and 2 with SSc). Conclusion: In this large real-life cohort, the 2019 ACR/EULAR criteria had very good performance compared to the 2012 SLICC and 1997 ACR criteria.
Imaging softwares have become critical tools in the diagnosis and decision making for the treatment of abdominal aortic aneurysms (AAA). However, the inter-observer reproducibility of maximum ...cross-section diameter is poor. This study aimed to present and assess the quality of a new fully automated software (PRAEVAorta) that enables fast and robust detection of the aortic lumen and the infra-renal AAA characteristics including the presence of thrombus.
To evaluate the segmentation obtained with this new software, we performed a quantitative comparison with the results obtained from a semi-automatic segmentation manually corrected by a senior and a junior surgeon on a dataset of 100 pre-operative CTAs from patients with infrarenal AAAs (i.e. 13465 slices). The Dice Similarity Coefficient (DSC), Jaccard index (JAC), Sensitivity, Specificity, volumetric similarity (VS), Hausdorff distance (HD), maximum aortic transverse diameter, and the duration of segmentation were calculated between the two methods and, for the semi-automatic software, also between the two observers.
The analyses demonstrated an excellent correlation of the volumes, surfaces, and diameters measured with the fully automatic and manually corrected segmentation methods, with a Pearson's coefficient correlation >0.90, P<0.0001. Overall, comparison between the fully automatic and manually corrected segmentation method by the senior surgeon revealed a mean DSC of 0.95±0.01, JAC of 0.91±0.02, sensitivity of 0.94±0.02, specificity of 0.97±0.01, VS of 0.98±0.01, and mean HD/slice of 4.61±7.26mm. The mean VS reached 0.95±0.04 for the lumen and 0.91±0.07 for the thrombus. For the fully automatic method, the segmentation time varied from 27 seconds to 4 minutes per patient vs 5 minutes to 80 minutes for the manually corrected methods (P<0.0001).
By enabling a fast and fully automated detailed analysis of the anatomic characteristics of infra-renal AAAs, this software could have strong applications in daily clinical practice and clinical research.
Abstract Introduction. Inflammatory rheumatic diseases are sometimes the first manifestation of neoplasia. Case presentation. A 57 year old female patient, heavy smoker, is admitted to our clinic for ...2 days old pulp necrosis of the third finger, right hand, with onset of ischemia 1 week before admission. Other manifestations were Raynaud’s phenomenon, dry mouth, dysphagia and shortness of breath after moderate physical activity with a duration of about 6 months. She was repeatedly followed-up by a pulmonologist with chest computer tomography, which detected a dimensional evolutionary mediastinal lymph node, but not investigated further. The patient had skin thickening of the hands and face, microstomia and an area of dry necrosis of 1.5/1cm in the pulp of the third finger, right hand. Laboratory tests show the presence of antinuclear antibodies with positive anti SS-A antibodies and elevated levels of serum inflammatory markers. Vascular surgery examination excludes thromboangiitis obliterans or other large vessel diseases. The presumptive diagnosis is undifferentiated connective tissue disease with systemic sclerosis and Sjögren syndrome elements, most likely secondary to the mediastinal tumor. Mediastinal biopsy shows a heterogeneous metastasis of unknown origin, and further investigations: immunohistochemistry, multiple gene mutations tests, computed tomography scan of the chest, abdomen, and pelvis, mammography, Papanicolaou test and positron emission tomography scan did not identify the primary tumor, thus delaying oncologic treatment. Conclusion. Case of undifferentiated connective tissue disease with elements of systemic sclerosis and Sjögren syndrome, most probably paraneoplastic, with chest metastasis of unknown origin, in which diagnosis and treatment were delayed due to lack of primary tumor identification.
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