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The inverse problem in electrocardiography is an ill-posed problem where the objective is to reconstruct the electrical activity of the epicardial surface of the heart, given the electrical activity on the thorax’ surface. In the forward problem, the electrical propagation from heart to thorax is modeled by the volume conductor equation with Dirichlet boundary conditions in the heart's surface, and null flux coming from the thorax. The inverse problem, however, does not have a unique solution. In order to find solutions for the inverse problem, techniques such as Tikhonov regularization are classically used, but they often deliver unrealistic solutions. As an alternative, we propose a novel approach, where a fixed solution of the volume conductor model with a source in a forward scheme is used to solve the inverse problem. The unknown values for parameters of the fixed solution can be found using optimization techniques. Due to the characteristics of the problem, where each single evaluation of the cost function is expensive, we use a specialized CMA-ES-based Bayesian optimization technique, that can deliver good results even with a reduced number of function evaluations. Experiments show that the proposed approach can deliver improved results for in-silico simulations.

The number of the Computed Tomography (CT) examinations has increased greatly over the past decade; This has made CT doses the largest source of the individual effective dose from medical exposures worldwide. Evaluation of image quality in CT is an important issue to ensure diagnostic accuracy, while keeping the radiation dose especially to the pediatric patient as low as reasonably possible. The purpose of this study was to assess the physical and psychophysical image quality in pediatric CT for different iterative reconstruction (IR) algorithms. The image quality was measured on each CT system using pediatric QRM abdomen and thorax phantoms for clinical thorax and abdomen examination scanning parameters and using the Catphan 600 phantom for head examination scanning parameters. The performance of each CT systems was evaluated individually using conventional filtered back-projection (FBP) and IR algorithm employed in that system. Noise, contrast-to-noise ratio (CNR), inverse image quality figure (IQFinv), modulation transfer function (MTF) and noise power spectrum (NPS) were assessed for FBP and wide range of iteration level of different IR algorithms. Figure of Merit (FOM) parameter was calculated to characterize the dose efficiency of each CT system. The CTDIvol values were changed from 20.6 to 45.7, 0.9 to 7.4 and 2.4–9.6 mGy for pediatric head, thorax and abdomen scanning protocols between CT systems, respectively. With increasing iteration level, image noise decreased while CNR and IQFinv increased. NPS peak was decreased with increasing iteration level for both two (2D) and three dimensional (3D) NPS and the ratio of the 3D NPS to 2D NPS varied from 4.5 to 8.3 for pediatric head, from 4.6 to 8.7 for pediatric thorax and from 4.0 to 14.0 for pediatric abdomen scanning protocols. For all IR algorithms employed with CT systems used in this study, the FOM values were increased with increasing iteration level. © 2024 Elsevier Ltd, Türkiye Bilimsel ve Teknolojik Araştırma Kurumu, TÜBİTAK: 122F015; Türkiye Bilimsel ve Teknolojik Araştırma Kurumu, TÜBİTAK

Introduction: Hemothorax is a pathology constitutes a health problem and is life-threatening if not diagnosed and treated in time. A thorough physical examination is important to rule out injuries that require emergency treatment. In addition to preventing complications, we take into account the patient's general condition in order to select the appropriate methods of clinical diagnosis and treatment. Development: The development addresses everything related to the surgical perspectives of hemothorax. In addition, the etiology, diagnosis, treatment, pathophysiology, complications and outcomes in general surgery are addressed. Reaching the conclusion. with future lines of research with respect to the subject matter addressed in the article. Conclusions: Early diagnosis is key in the evolution of hemothorax. The disease carries a non-negligible risk of complications that may put the patient's life at risk or remain with sequelae that affect a poor quality of life. Therefore, the pathology should be studied in depth, since its clinical presentation is dynamic and complex., Introducción: El hemotórax es una patología constituye un problema de salud y pone en peligro la vida del paciente si no se diagnostica y trata a tiempo. Un examen físico exhaustivo es importante para descartar lesiones que requieran tratamiento de emergencia. Además de prevenir complicaciones, tomamos en del estado general de los pacientes para lugar seleccionar los métodos adecuados de diagnóstico clínico y tratamiento Desarrollo: El desarrollo aborda todo lo relacionado con las perspectivas quirúrgica del hemotórax. Además, se aborda la etiología, diagnóstico, tratamiento, fisiopatología, complicaciones y los resultados en la cirugía general. Llegando a la conclusión. con las futuras líneas de investigación con respecto a la temática abordada en el artículo. Conclusiones: El diagnóstico temprano es clave en la evolución del hemotórax. La enfermedad conlleva un riesgo no despreciable de complicaciones que pueden poner en riesgo la vida de los pacientes o permanecer con secuelas que incidan en una mala calidad de vida. Por lo que la patología se debe estudiar a profundidad, ya que su presentación clínica es dinámica y compleja.

Objective - Unobtrusive long-term monitoring of cardiac parameters is important in a wide variety of clinical applications, such as the assessment of acute illness severity and unobtrusive sleep monitoring. Here we determined the accuracy and robustness of heartbeat detection by an accelerometer worn on the chest.Approach - We performed overnight recordings in 147 individuals (69 female, 78 male) referred to two sleep centers. Two methods for heartbeat detection in the acceleration signal were compared: one previously described approach, based on local periodicity, and a novel extended method incorporating maximum a-posterior estimation and a Markov decision process to approach an optimal solution. Main Results - The maximum a-posterior estimation significantly improved performance, with a mean absolute error for the estimation of inter-beat intervals of only 3.5 ms, and 95% limits of agreement of -1.7 to +1.0 beats per minute for heart rate measurement. Performance was held during posture changes and was only weakly affected by the presence of sleep disorders and demographic factors.Significance - The new method may enable the use of a chest-worn accelerometer in a variety of applications such as ambulatory sleep staging and in-patient monitoring.

Sexual dimorphism is important for intraspecific variation and well studied in the human skeleton. In the thoracic part of the spine sexual dimorphism is expected for differences in the respiratory system related to body mass, lung capacity, and energetics, and in the reproductive system for adaptations to pregnancy (lower spine lordosis, posture). However, little is known about sexual dimorphism in this anatomical region. We use three-dimensional (3D)-geometric morphometrics to test hypotheses on sexual dimorphism in the first 10 thoracic vertebrae (T1–T10). Forty-six 3D-landmarks were measured on vertebrae of 24 adult females and males of known age and sex. Results confirm that male vertebrae are consistently larger than female ones. Males show more dorsally oriented transverse processes and relatively larger vertebral bodies in upper and lower thoracic vertebrae. Sexual dimorphism in lower thoracic vertebrae affects the orientation of the spinous processes, which is more horizontal in females but more caudal in males. Such regional pattering of sexual dimorphism emerges also from principal component analyses reflecting a complex interaction between the effects of sex and serial position on shape variation. Greater dorsal orientation of male transverse processes reorients the ribs and could lead to greater radial thorax diameters. This fits with greater male respiratory capacities, but may indicate also greater invagination of the male spine within the thorax. Horizontal orientation of the spinous processes in females could allow for a greater thoraco-lumbar lordosis during pregnancy, but more comparative research is necessary to test these hypotheses., Ministerio de Economía y Competitividad (MINECO), The Leakey Foundation, Depto. de Biodiversidad, Ecología y Evolución, Fac. de Ciencias Biológicas, TRUE, pub

This research was funded by the Spanish Ministry of Economy and Competitivity (no. CGL 2015-63648-P) to M.B. D.G.-M. was funded by IdEx University of Bordeaux Investments for the Future programme (no. ANR-10-IDEX-03-02) and the European Commission’s Research Infrastructure Action via the Synthesys Projects (nos. SE-TAF-6406, DE-TAF-6404, BE-TAF-5639). Financial support for M.H. was provided by the Swiss National Science Foundation (no. 31003A_176319/1) and the Mäxi Foundation. A.G.-O. received support from the Spanish FEDER/Ministerio de Ciencia e Innovación-AEI (project no. PGC2018-093925-B-C33) and Research Group (no. IT1418-19) from Eusko Jaurlaritza-Gobierno Vasco. A.G.-O. is funded by a Ramón y Cajal fellowship (no. RYC-2017-22558)., The tall and narrow body shape of anatomically modern humans (Homo sapiens) evolved via changes in the thorax, pelvis and limbs. It is debated, however, whether these modifications first evolved together in African Homo erectus, or whether H. erectus had a more primitive body shape that was distinct from both the more ape-like Australopithecus species and H. sapiens. Here we present the first quantitative three-dimensional reconstruction of the thorax of the juvenile H. erectus skeleton, KNM-WT 15000, from Nariokotome, Kenya, along with its estimated adult rib cage, for comparison with H. sapiens and the Kebara 2 Neanderthal. Our three-dimensional reconstruction demonstrates a short, mediolaterally wide and anteroposteriorly deep thorax in KNM-WT 15000 that differs considerably from the much shallower thorax of H. sapiens, pointing to a recent evolutionary origin of fully modern human body shape. The large respiratory capacity of KNM-WT 15000 is compatible with the relatively stocky, more primitive, body shape of H. erectus., Depto. de Biodiversidad, Ecología y Evolución, Fac. de Ciencias Biológicas, TRUE, pub

We thank the many funding agencies that supported this work, in particular the National Geographic Society, the National Research Foundation, the Lyda Hill Foundation, and the Lee R. Berger Foundation for Exploration for particularly significant funding of the discovery, recovery, and analysis of this material. DGM and MB were funded through CGL2012-37279, MINECO, Spain, and a Leakey Research Grant to DGM. A visit to the Royal Museum for Central Africa (RMCA; Tervuren, Belgium) by DGM was funded by the European Commission's Research Infrastructure Action via the Synthesys Project (BE-TAF-5639). SAW was funded through the New York University Research Challenge Fund., Hominin evolution featured shifts from a trunk shape suitable for climbing and housing a large gut to a trunk adapted to bipedalism and higher quality diets. Our knowledge regarding the tempo, mode, and context in which these derived traits evolved has been limited, based largely on a small-bodied Australopithecus partial skeleton (A.L. 288-1; “Lucy”) and a juvenile Homo erectus skeleton (KNM-WT 15000; “Turkana Boy”). Two recent discoveries, of a large-bodied Australopithecus afarensis (KSD-VP-1/1) and two Australopithecus sediba partial skeletons (MH1 and MH2), have added to our understanding of thorax evolution; however, little is known about thorax morphology in early Homo. Here we describe hominin vertebrae, ribs, and sternal remains from the Dinaledi chamber of the Rising Star cave system attributed to Homo naledi. Although the remains are highly fragmented, the best-preserved specimens—two lower thoracic vertebrae and a lower rib—were found in association and belong to a small-bodied individual. A second lower rib may belong to this individual as well. All four of these individual elements are amongst the smallest known in the hominin fossil record. H. naledi is characterized by robust, relatively uncurved lower ribs and a relatively large spinal canal. We expect that the recovery of additional material from Rising Star Cave will clarify the nature of these traits and shed light on H. naledi functional morphology and phylogeny., Depto. de Biodiversidad, Ecología y Evolución, Fac. de Ciencias Biológicas, TRUE, pub

This work was funded by the IdEx University of Bordeaux Investments for the Future program (ANR-10-IDEX-03-02); projects CGL2012-37279 and CGL2015-63648P (Spanish Ministry of Economy, Industry, and Competitiveness), CGL2015-65387-C3-2-P (MINECO/FEDER), and PGC2018-093925-B-C33 (FEDER/Ministerio de Ciencia e Innovación-Agencia Estatal de Investigación); and Research Group IT1044-16 from the Eusko Jaurlaritza-Gobierno Vasco and Group PPG17/05 from the Universidad del País Vasco-Euskal Herriko Unibertsitatea. The “Juan de la Cierva Formación” program (FJCI-2017-32157), from the Spanish Ministry of Science, Innovation, and Universities, funds D.G.-M. A.G.-O. is funded by a Ramón y Cajal fellowship (RYC-2017-22558)., Ontogenetic studies provide clues for understanding important paleobiological aspects of extinct species. When compared to that of modern humans, the adult Neanderthal thorax was shorter, deeper, and wider. This is related to the wide Neanderthal body and is consistent with their hypothetical large requirements for energy and oxygen. Whether these differences were already established at birth or appeared later during development is unknown. To delve into this question, we use virtual reconstruction tools and geometric morphometrics to recover the 3D morphology of the ribcages of four Neanderthal individuals from birth to around 3 years old: Mezmaiskaya 1, Le Moustier 2, Dederiyeh 1, and Roc de Marsal. Our results indicate that the comparatively deep and short ribcage of the Neanderthals was already present at birth, as were other skeletal species-specific traits. This morphology possibly represents the plesiomorphic condition shared with Homo erectus, and it is likely linked to large energetic requirements., Depto. de Biodiversidad, Ecología y Evolución, Fac. de Ciencias Biológicas, TRUE, pub

Adaptive gain theory proposes that the dynamic shifts between exploration and exploitation control states are modulated by the locus coeruleus-norepinephrine system and reflected in tonic and phasic pupil diameter. This study tested predictions of this theory in the context of a societally important visual search task: the review and interpretation of digital whole slide images of breast biopsies by physicians (pathologists). As these medical images are searched, pathologists encounter difficult visual features and intermittently zoom in to examine features of interest. We propose that tonic and phasic pupil diameter changes during image review may correspond to perceived difficulty and dynamic shifts between exploration and exploitation control states. To examine this possibility, we monitored visual search behavior and tonic and phasic pupil diameter while pathologists (N = 89) interpreted 14 digital images of breast biopsy tissue (1,246 total images reviewed). After viewing the images, pathologists provided a diagnosis and rated the level of difficulty of the image. Analyses of tonic pupil diameter examined whether pupil dilation was associated with pathologists difficulty ratings, diagnostic accuracy, and experience level. To examine phasic pupil diameter, we parsed continuous visual search data into discrete zoom-in and zoom-out events, including shifts from low to high magnification (e.g., 1× to 10×) and the reverse. Analyses examined whether zoom-in and zoom-out events were associated with phasic pupil diameter change. Results demonstrated that tonic pupil diameter was associated with image difficulty ratings and zoom level, and phasic pupil diameter showed constriction upon zoom-in events, and dilation immediately preceding a zoom-out event. Results are interpreted in the context of adaptive gain theory, information gain theory, and the monitoring and assessment of physicians diagnostic interpretive processes.

For accurate diagnosis of interstitial lung disease (ILD), a consensus of radiologic, pathological, and clinical findings is vital. Management of ILD also requires thorough follow-up with computed tomography (CT) studies and lung function tests to assess disease progression, severity, and response to treatment. However, accurate classification of ILD subtypes can be challenging, especially for those not accustomed to reading chest CTs regularly. Dynamic models to predict patient survival rates based on longitudinal data are challenging to create due to disease complexity, variation, and irregular visit intervals. Here, we utilize RadImageNet pretrained models to diagnose five types of ILD with multimodal data and a transformer model to determine a patient's 3-year survival rate. When clinical history and associated CT scans are available, the proposed deep learning system can help clinicians diagnose and classify ILD patients and, importantly, dynamically predict disease progression and prognosis.

BACKGROUND: Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. METHODS: A bibliographic search using major databases was performed using the terms emergency surgery diaphragmatic hernia, traumatic diaphragmatic rupture and congenital diaphragmatic hernia. GRADE methodology was used to evaluate the evidence and give recommendations. RESULTS: CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients. CONCLUSIONS: Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.

We describe the curation, annotation methodology, and characteristics of the dataset used in an artificial intelligence challenge for detection and localization of COVID-19 on chest radiographs. The chest radiographs were annotated by an international group of radiologists into four mutually exclusive categories, including typical, indeterminate, and atypical appearance for COVID-19, or negative for pneumonia, adapted from previously published guidelines, and bounding boxes were placed on airspace opacities. This dataset and respective annotations are available to researchers for academic and noncommercial use.

IntroductionForensic pathologists are frequently confronted with questions about the likelihood that an injury is inflicted by an assault or is self-inflicted. However, little is known of epidemiological variables applicable to differentiate between homicides and suicides in deaths caused by single stab injuries to the trunk. MethodUsing the Swedish forensic autopsy register we identified 94 homicides and 45 suicides between 2010 and 2021 that died following a single stab injury to the trunk. We extracted characteristics from the cases and performed statistical analyses using Mann-Whitney U and Chi-square test.ResultVictims of homicides were younger than suicide victims (median age 33 years vs. 52 years, p < 0.05), and males were in majority in both groups (93% vs. 82%). Some homicidal stab wounds were placed on the posterior (12%) and axillar trunk (11%) unlike the suicidal stabs which were all placed on the anterior trunk. Most stab wounds of all examinations were placed on the left side of the anterior thorax (60%). In suicides, single stab injuries to the heart were more common than in homicides (67% vs. 48%, p < 0.05). Vasculature injuries were more common in homicides (51% vs. 9%, p < 0.05).DiscussionThe epidemiological variables could be used as a tool when assessing the manner of death in single stabs. Further research on variables associated with manner of death are needed and we suggest also including surviving victims in such analyses.

The vital sign measurement systems inside vehicles have taken great or impulse in recent years, and the technologies that have been most welcomed are based on wireless measurements that do not interrupt driving and are imperceptible to the driver. There are disorders in breathing patterns, which include the movement of different regions of the human thorax mainly. In this sense, the objective of this paper is to determine the dimensions of a lens-based antenna system and the pointing angles of the radiation main lobe of the six antenna-elements to measure the elongation of six regions of the human torso and determine breathing patterns. The pointing angle is controlled by the position of the antenna behind the lens, and the beamwidth of the lobe depends on the directivity achieved by the antenna. An electronic system to simulate torso elongation is also presented to calibrate and test the sensitivity of the system., This work was supported by the Spanish “Comisión Interministerial de Ciencia y Tecnologia” (CICYT) under projects PID2019-107885GB-C31 and MDM2016-O6OO; Catalan Research Group 2017 SGR 219; and ”Secretaría Nacional de Educación Superior, Ciencia, Tecnología e Innovación” (SENESCYT) from the Ecuadorian government., Peer Reviewed, Postprint (author's final draft)

Congenital thoracic anomalies are uncommon malformations that require a precise diagnosis to guide parental counseling and possible prenatal treatment. Prenatal ultrasound (US) is the gold standard imaging modality to first detect and characterize these abnormalities and the best modality for follow-up. Fetal magnetic resonance imaging (MRI) is a complementary tool that provides multiplanar assessment and tissue characterization and can help estimate prognosis. Prenatal treatment is increasingly being used in fetuses with signs of distress and to potentially decrease morbidity and mortality. In this essay, the authors illustrate side-by-side US, MRI and therapeutic options for congenital thoracic anomalies in cases that presented to a tertiary pediatric hospital during the 7-year period 2014–2021. Entities included are congenital diaphragmatic hernia, congenital pulmonary airway malformation, bronchopulmonary sequestration, hybrid lesions, foregut duplications cysts and congenital lobar overinflation. Treatment options include maternal steroids, thoraco-amniotic shunt and fetal endotracheal occlusion. Recognition of typical findings in congenital thoracic anomalies is helpful to establish diagnosis, predict prognosis and plan perinatal treatment.

Objectives An accurate and rapid diagnosis is crucial for the appropriate treatment of pulmonary tuberculosis (TB). This study aims to develop an artificial intelligence (AI)-based fully automated CT image analysis system for detection, diagnosis, and burden quantification of pulmonary TB. Methods From December 2007 to September 2020, 892 chest CT scans from pathogen-confirmed TB patients were retrospectively included. A deep learning-based cascading framework was connected to create a processing pipeline. For training and validation of the model, 1921 lesions were manually labeled, classified according to six categories of critical imaging features, and visually scored regarding lesion involvement as the ground truth. A "TB score" was calculated based on a network-activation map to quantitively assess the disease burden. Independent testing datasets from two additional hospitals (dataset 2, n = 99; dataset 3, n = 86) and the NIH TB Portals (n = 171) were used to externally validate the performance of the AI model. Results CT scans of 526 participants (mean age, 48.5 +/- 16.5 years; 206 women) were analyzed. The lung lesion detection subsystem yielded a mean average precision of the validation cohort of 0.68. The overall classification accuracy of six pulmonary critical imaging findings indicative of TB of the independent datasets was 81.08-91.05%. A moderate to strong correlation was demonstrated between the AI model-quantified TB score and the radiologist-estimated CT score. Conclusions The proposed end-to-end AI system based on chest CT can achieve human-level diagnostic performance for early detection and optimal clinical management of patients with pulmonary TB.

Two-dimensional (2D) engineered nanomaterials are widely used in consumer and industrial goods due to their unique chemical and physical characteristics. Engineered nanomaterials are incredibly small and capable of being aerosolized during manufacturing, with the potential for biological interaction at first-contact sites such as the eye and lung. The unique properties of 2D nanomaterials that make them of interest to many industries may also cause toxicity towards epithelial cells. Using murine and human respiratory epithelial cell culture models, we tested the cytotoxicity of eight 2D engineered nanomaterials: graphene (110 nm), graphene oxide (2 um), graphene oxide (400 nm), reduced graphene oxide (2 um), reduced graphene oxide (400 nm), partially reduced graphene oxide (400 nm), molybdenum disulfide (400 nm), and hexagonal boron nitride (150 nm). Non-graphene nanomaterials were also tested in human corneal epithelial cells for ocular epithelial cytotoxicity. Hexagonal boron nitride was found to be cytotoxic in mouse tracheal, human alveolar, and human corneal epithelial cells. Hexagonal boron nitride was also tested for inhibition of wound healing in alveolar epithelial cells; no inhibition was seen at sub-cytotoxic doses. Nanomaterials should be considered with care before use, due to specific regional cytotoxicity that also varies by cell type. Supported by U01ES027288 and T32HL007013 and T32ES007059.

The mammalian airways and lungs are exposed to a myriad of inhaled particulate matter, allergens, and pathogens. The immune system plays an essential role in protecting the host from respiratory pathogens, but a dysregulated immune response during respiratory infection can impair pathogen clearance and lead to immunopathology. Furthermore, inappropriate immunity to inhaled antigens can lead to pulmonary diseases. A complex network of epithelial, neural, stromal, and immune cells has evolved to sense and respond to inhaled antigens, including the decision to promote tolerance versus a rapid, robust, and targeted immune response. Although there has been great progress in understanding the mechanisms governing immunity to respiratory pathogens and aeroantigens, we are only beginning to develop an integrated understanding of the cellular networks governing tissue immunity within the lungs and how it changes after inflammation and over the human life course. An integrated model of airway and lung immunity will be necessary to improve mucosal vaccine design as well as prevent and treat acute and chronic inflammatory pulmonary diseases. Given the importance of immunology in pulmonary research, the American Thoracic Society convened a working group to highlight central areas of investigation to advance the science of lung immunology and improve human health.

Learning objectives typically indicate subject matter judged to be important or that represents essential material to be learned during a course. We report here on our efforts to identify essential course content and determine our effectiveness teaching and assessing this content in our preclinical human anatomy course. Using a consensus driven approach, we identified anatomical structures, relationships, and functional concepts judged to represent essential material in our unit on the thorax that students were expected to be familiar with. We then determined performance on specific examination questions that focused directly on the essential material. Thirty-seven of 48 students (77%) correctly answered all 34 of 51 questions that directly focused on content we defined as essential. The remaining 11 students answered the majority of these questions correctly. The overall mean score was 86% (range 61%-98%). Our review of student performance on the End of Block thorax examination confirmed our belief that we were successful in helping students learn material we defined as essential. We found the process described here to be helpful in defining essential content and for helping focus and improve medical education and learning assessment based on that material. We believe the idea of defining essential content that can be efficiently taught and effectively learned within a proscribed period of time is an important and necessary objective. We believe the approach used here might be successfully utilized in other programs in efforts aimed at quality improvement.

BackgroundRadiation dose metrics vary by the calibration reference phantom used to report doses. By convention, 16-cm diameter cylindrical polymethyl-methacyrlate phantoms are used for head imaging and 32-cm diameter phantoms are used for body imaging in adults. Actual usage patterns in children remain under-documented.ObjectiveThis study uses the University of California San Francisco International CT Dose Registry to describe phantom selection in children by patient age, body region and scanner manufacturer, and the consequent impact on radiation doses.Materials and methodsFor 106,837 pediatric computed tomography (CT) exams collected between Jan. 1, 2015, and Nov. 2, 2020, in children up to 17 years of age from 118 hospitals and imaging facilities, we describe reference phantom use patterns by body region, age and manufacturer, and median and 75th-percentile dose-length product (DLP) and volume CT dose index (CTDIvol) doses when using 16-cm vs. 32-cm phantoms.ResultsThere was relatively consistent phantom selection by body region. Overall, 98.0% of brain and skull examinations referenced 16-cm phantoms, and 95.7% of chest, 94.4% of abdomen and 100% of cervical-spine examinations referenced 32-cm phantoms. Only GE deviated from this practice, reporting chest and abdomen scans using 16-cm phantoms with some frequency in children up to 10 years of age. DLP and CTDIvol values from 16-cm phantom-referenced scans were 2-3 times higher than 32-cm phantom-referenced scans.ConclusionREFERENCE PHANTOM SELECTION IS HIGHLY CONSISTENT, WITH A SMALL BUT SIGNIFICANT NUMBER OF ABDOMEN AND CHEST SCANS (~5%) USING 16-CM PHANTOMS IN YOUNGER CHILDREN, WHICH PRODUCES DLP VALUES APPROXIMATELY TWICE AS HIGH AS EXAMS REFERENCED TO 32-CM PHANTOMS.

Two-dimensional (2D) engineered nanomaterials are widely used in consumer and industrial goods due to their unique chemical and physical characteristics. Engineered nanomaterials are incredibly small and capable of being aerosolized during manufacturing, with the potential for biological interaction at first-contact sites such as the eye and lung. The unique properties of 2D nanomaterials that make them of interest to many industries may also cause toxicity towards epithelial cells. Using murine and human respiratory epithelial cell culture models, we tested the cytotoxicity of eight 2D engineered nanomaterials: graphene (110 nm), graphene oxide (2 um), graphene oxide (400 nm), reduced graphene oxide (2 um), reduced graphene oxide (400 nm), partially reduced graphene oxide (400 nm), molybdenum disulfide (400 nm), and hexagonal boron nitride (150 nm). Non-graphene nanomaterials were also tested in human corneal epithelial cells for ocular epithelial cytotoxicity. Hexagonal boron nitride was found to be cytotoxic in mouse tracheal, human alveolar, and human corneal epithelial cells. Hexagonal boron nitride was also tested for inhibition of wound healing in alveolar epithelial cells; no inhibition was seen at sub-cytotoxic doses. Nanomaterials should be considered with care before use, due to specific regional cytotoxicity that also varies by cell type. Supported by U01ES027288 and T32HL007013 and T32ES007059.

The mammalian airways and lungs are exposed to a myriad of inhaled particulate matter, allergens, and pathogens. The immune system plays an essential role in protecting the host from respiratory pathogens, but a dysregulated immune response during respiratory infection can impair pathogen clearance and lead to immunopathology. Furthermore, inappropriate immunity to inhaled antigens can lead to pulmonary diseases. A complex network of epithelial, neural, stromal, and immune cells has evolved to sense and respond to inhaled antigens, including the decision to promote tolerance versus a rapid, robust, and targeted immune response. Although there has been great progress in understanding the mechanisms governing immunity to respiratory pathogens and aeroantigens, we are only beginning to develop an integrated understanding of the cellular networks governing tissue immunity within the lungs and how it changes after inflammation and over the human life course. An integrated model of airway and lung immunity will be necessary to improve mucosal vaccine design as well as prevent and treat acute and chronic inflammatory pulmonary diseases. Given the importance of immunology in pulmonary research, the American Thoracic Society convened a working group to highlight central areas of investigation to advance the science of lung immunology and improve human health.

The mesosoma is the power core of the ant, containing critical structural and muscular elements for the movement of the head, legs, and metasoma. It has been hypothesized that adaptation to ground locomotion and the loss of flight led to the substantial rearrangements in the mesosoma in worker ants and that it is likely the ant mesosoma has undergone functional modifications as ants diversified into different ecological and behavioral niches. Despite this importance, studies on the anatomy of the ant mesosoma are still scarce, and there is limited understanding of important variation of internal structures across the ant phylogeny. Recent advances in imaging techniques have made it possible to digitally dissect small insects, to document the anatomy efficiently and in detail, and to visualize these data in 3D. Here we document the mesosomal skeletomuscular system of workers of the red wood ant, Formica rufa Linnaeus, 1761, and use it to establish a 3D atlas of mesosomal anatomy that will serve as reference work for further studies. We discuss and illustrate the configuration of the skeletomuscular components and the function of the muscles in interaction with the skeletal elements. This anatomical evaluation of a ‘generalized’ ant provides a template for future studies of the mesosoma across the radiation of Formicidae, with the ultimate objective of synthesizing structural, functional, and transformational information to understand the evolution of a crucial body region of ants., source:https://academic.oup.com/isd/article/6/2/2/6553779

The COVID-19 pandemic has affected clinicians in many different ways. Clinicians have their own experiences and lessons that they have learned from their work in the pandemic. This article outlines a few lessons learned from the eyes of CHEST Critical Care Editorial Board members, namely practices which will be abandoned, novel practices to be adopted moving forward, and proposed changes to the health care system in general. In an attempt to start the discussion of how health care can grow from the pandemic, the editorial board members outline their thoughts on these lessons learned.

The objective of this study was to evaluate the effects of sex, loading rate, and age on the compressive and tensile material properties of human costal cartilage over a wide range of subject ages and sexes. Cylindrical compression samples and dog-bone shaped tension samples were tested to failure on a material testing system using target strain rates of 0.005 strain/s and 0.5 strain/s. Compression data were obtained from forty (n = 40) subjects (M = 26, F = 14) ranging in age from 11 – 69 years (Avg. = 39.1 ± 18.2 yrs.), and matched loading rate data were obtained for thirty-four (n = 34) samples. Tension data were obtained from forty-one (n = 41) subjects (M = 30, F = 11) ranging in age from 10 – 59 years (Avg. = 32.9 ± 14.9 yrs.), and matched loading rate data were obtained for seventeen (n = 17) samples. For both compression and tension, load and sample deflection data were collected and used to calculate stress and strain. For the compression data, the toe region was fit using a second-order polynomial, and the toe transition stress, toe transition strain, second-order polynomial coefficient A, and second-order polynomial coefficient B were calculated. In addition, the elastic modulus, ultimate stress, ultimate strain, and strain energy density (SED) were also calculated for each test. For the tension data, only the elastic modulus, ultimate stress, ultimate strain, and SED were calculated for each test. There were no effects of sex on the material properties for either method of loading or strain rate. Therefore, male and female data were combined for the age and loading rate analyses. For compression, toe transition stress, toe transition strain, A, elastic modulus, ultimate stress, and SED were all found to be significantly higher at 0.5 strain/s compared to 0.005 strain/s. For tension, no material properties were found to differ with respect to loading rate. Regarding the effects of age, toe transition stress, toe transition strain, A, B, ultimate stress, u

The COVID-19 infection is the greatest danger to humankind right now because of the devastation it causes to the lives of its victims. It is important that infected people be tested in a timely manner in order to halt the spread of the disease. Physical approaches are time-consuming, expensive, and tedious. As a result, there is a pressing need for a cost-effective and efficient automated tool. A convolutional neural network is presented in this paper for analysing X-ray pictures of patients' chests. For the analysis of COVID-19 infections, this study investigates the most suitable pretrained deep learning models, which can be integrated with mobile or online apps and support the mobility of diagnostic instruments in the form of a portable tool. Patients can use the smartphone app to find the nearest healthcare testing facility, book an appointment, and get instantaneous results, while healthcare professionals can keep track of the details thanks to the web and mobile applications built for this study. Medical practitioners can apply the COVID-19 detection model for chest frontal X-ray pictures with ease. A user-friendly interface is created to make our end-to-end solution paradigm work. Based on the data, it appears that the model could be useful in the real world.

Objectives The aim of this study was to assess the test-retest repeatability and interobserver variation in healthy tissue (HT) metabolism using 2-deoxy-2-[F-18]fluoro-d-glucose (F-18-FDG) PET/computed tomography (PET/CT) of the thorax in lung cancer patients. Methods A retrospective analysis was conducted in 22 patients with non-small cell lung cancer who had two PET/CT scans of the thorax performed 3 days apart with no interval treatment. The maximum, mean and peak standardized uptake values (SUVs) in different HTs were measured by a single observer for the test-retest analysis and two observers for interobserver variation. Bland-Altman plots were used to assess the repeatability and interobserver variation. Intrasubject variability was evaluated using within-subject coefficients of variation (wCV). Results The wCV of test-retest SUVmean measurements in mediastinal blood pool, bone marrow, skeletal muscles and lungs was less than 20%. The left ventricle (LV) showed higher wCV (>60%) in all SUV parameters with wide limits of repeatability. High interobserver agreement was found with wCV of less than 10% in SUVmean of all HT, but up to 22% was noted in the LV. Conclusion HT metabolism is stable in a test-retest scenario and has high interobserver agreement. SUVmean was the most stable metric in organs with low FDG uptake and SUVpeak in HTs with moderate uptake. Test-retest measurements in LV were highly variable irrespective of the SUV parameters used for measurements.

[Introduction]: From an evolutionary perspective, the ribcage has changed substantiallyin the subfamily Homininae. Among many other features, the amount of mineralizedtissues of the rib cross-section at the midshaft could be informative about potentialbiomechanical changes during Homininae evolution. These changes would be relatedto the different loading stresses that each costal level has to deal with. Nevertheless,this knowledge remains hypothetical and has never been properly addressed, [Materials and Methods]:This issue was assessed by analysing via micro-CT the inter-nal rib anatomy of the complete sets of ribs belonging to tenHomo sapiensand tenPan troglodytesadult individuals. Additionally, five fossil ribs ofAustralopithecusafricanusSts 14 (costal levels 5–9) were also included to evaluate similarities with thetwo tested extant species., [Results]:The mineralized area ofP.troglodytesrib cross-sections was higher than thatofH.sapiens. However, its serial change along the rib sequence (1–12/13) was similarin both species. The mineralized area of the Sts 14 rib cross-sections was closer toH.sapiensthan toP.troglodytesfor costal levels 7–9 (Sts 14w) but not for levels 5 and6, where it was distinct from both comparative samples., [Discussion]:The variation in the amount of mineralized tissues along the rib sequence in H.sapiens and P. troglodytes might indicate a common upper-lower thorax division

Objectives An accurate and rapid diagnosis is crucial for the appropriate treatment of pulmonary tuberculosis (TB). This study aims to develop an artificial intelligence (AI)-based fully automated CT image analysis system for detection, diagnosis, and burden quantification of pulmonary TB. Methods From December 2007 to September 2020, 892 chest CT scans from pathogen-confirmed TB patients were retrospectively included. A deep learning-based cascading framework was connected to create a processing pipeline. For training and validation of the model, 1921 lesions were manually labeled, classified according to six categories of critical imaging features, and visually scored regarding lesion involvement as the ground truth. A "TB score" was calculated based on a network-activation map to quantitively assess the disease burden. Independent testing datasets from two additional hospitals (dataset 2, n = 99; dataset 3, n = 86) and the NIH TB Portals (n = 171) were used to externally validate the performance of the AI model. Results CT scans of 526 participants (mean age, 48.5 +/- 16.5 years; 206 women) were analyzed. The lung lesion detection subsystem yielded a mean average precision of the validation cohort of 0.68. The overall classification accuracy of six pulmonary critical imaging findings indicative of TB of the independent datasets was 81.08-91.05%. A moderate to strong correlation was demonstrated between the AI model-quantified TB score and the radiologist-estimated CT score. Conclusions The proposed end-to-end AI system based on chest CT can achieve human-level diagnostic performance for early detection and optimal clinical management of patients with pulmonary TB.

Objectives The aim of this study was to assess the test-retest repeatability and interobserver variation in healthy tissue (HT) metabolism using 2-deoxy-2-[F-18]fluoro-d-glucose (F-18-FDG) PET/computed tomography (PET/CT) of the thorax in lung cancer patients. Methods A retrospective analysis was conducted in 22 patients with non-small cell lung cancer who had two PET/CT scans of the thorax performed 3 days apart with no interval treatment. The maximum, mean and peak standardized uptake values (SUVs) in different HTs were measured by a single observer for the test-retest analysis and two observers for interobserver variation. Bland-Altman plots were used to assess the repeatability and interobserver variation. Intrasubject variability was evaluated using within-subject coefficients of variation (wCV). Results The wCV of test-retest SUVmean measurements in mediastinal blood pool, bone marrow, skeletal muscles and lungs was less than 20%. The left ventricle (LV) showed higher wCV (>60%) in all SUV parameters with wide limits of repeatability. High interobserver agreement was found with wCV of less than 10% in SUVmean of all HT, but up to 22% was noted in the LV. Conclusion HT metabolism is stable in a test-retest scenario and has high interobserver agreement. SUVmean was the most stable metric in organs with low FDG uptake and SUVpeak in HTs with moderate uptake. Test-retest measurements in LV were highly variable irrespective of the SUV parameters used for measurements.

Learning objectives typically indicate subject matter judged to be important or that represents essential material to be learned during a course. We report here on our efforts to identify essential course content and determine our effectiveness teaching and assessing this content in our preclinical human anatomy course. Using a consensus driven approach, we identified anatomical structures, relationships, and functional concepts judged to represent essential material in our unit on the thorax that students were expected to be familiar with. We then determined performance on specific examination questions that focused directly on the essential material. Thirty-seven of 48 students (77%) correctly answered all 34 of 51 questions that directly focused on content we defined as essential. The remaining 11 students answered the majority of these questions correctly. The overall mean score was 86% (range 61%-98%). Our review of student performance on the End of Block thorax examination confirmed our belief that we were successful in helping students learn material we defined as essential. We found the process described here to be helpful in defining essential content and for helping focus and improve medical education and learning assessment based on that material. We believe the idea of defining essential content that can be efficiently taught and effectively learned within a proscribed period of time is an important and necessary objective. We believe the approach used here might be successfully utilized in other programs in efforts aimed at quality improvement.

Despite the possibilities of routine clinical measures and assays on readily accessible bio-samples, it is not always essential in animals to investigate the dynamics of disease longitudinally. In this regard, minimally invasive imaging methods provide powerful tools in preclinical research. They can contribute to the ethical principle of gathering as much relevant information per animal as possible. Besides, with an obvious parallel to clinical diagnostic practice, such imaging platforms are potent and valuable instruments leading to a more refined use of animals from a welfare perspective. Non-human primates comprise highly relevant species for preclinical research to enhance our understanding of disease mechanisms and/or the development of improved prophylactic or therapeutic regimen for various human diseases. In this paper, we describe parameters that critically affect the quality of integrated positron emission tomography and computed tomography (PET-CT) in non-human primates. Lessons learned are exemplified by results from imaging experimental infectious respiratory disease in macaques; specifically tuberculosis, influenza, and SARS-CoV-2 infection. We focus on the thorax and use of 18F-fluorodeoxyglucose as a PET tracer. Recommendations are provided to guide various stages of PET-CT-supported research in non-human primates, from animal selection, scan preparation, and operation, to processing and analysis of imaging data.

Chest-X ray (CXR) radiography can be used as a first-line triage process for non-COVID-19 patients with pneumonia. However, the similarity between features of CXR images of COVID-19 and pneumonia caused by other infections makes the differential diagnosis by radiologists challenging. We hypothesized that machine learning-based classifiers can reliably distinguish the CXR images of COVID-19 patients from other forms of pneumonia. We used a dimensionality reduction method to generate a set of optimal features of CXR images to build an efficient machine learning classifier that can distinguish COVID-19 cases from non-COVID-19 cases with high accuracy and sensitivity. By using global features of the whole CXR images, we successfully implemented our classifier using a relatively small dataset of CXR images. We propose that our COVID-Classifier can be used in conjunction with other tests for optimal allocation of hospital resources by rapid triage of non-COVID-19 cases.

Extramammary Paget disease (EMPD) is a rare skin cancer that affects areas with a high concentration of apocrine glands including genital, axillary, and anal skin. When it affects other locations it is called ectopic extramammary Paget disease (E-EMPD) and is uncommon. To date, there are only 45 case reports to the best of our knowledge. The clinical manifestation is typically a soft, red or bright pink patch or plaque with scattered white islands of hyperkeratosis and erosion. Diagnostic confirmation requires conventional histology with immunohistochemistry. The importance of immunohistochemical staining for the diagnosis of primary neoplasia, without underlying malignancy, is highlighted. We report the first Latin American confirmed case, to our knowledge, of primary E-EMPD in a 55-year-old man with a 1-year history of asymptomatic thoracic plaque.

Introduction CT Fluoroscopy (CTF) guided interventions have become the preferred technique for spinal injections, biopsies and drainages in many clinics [1]. However, studies indicate that operators may be subject to high radiation exposures. RADPAD, a commercially available antimony and bismuth radioprotective patient drape, aims to reduce operator dose by attenuating scattered radiation originating from within the patient. This study aims to evaluate RADPAD's dose reduction benefits to the operator in CTF. Method A Toshiba AcquilionOne CT was used to image an anthropomorphic phantom at the typical parameters and anatomical location of a lung biopsy. An ED3 dosimeter measured the surface dose at the chest and eye lens level of the operator. The use of different combinations of RADPAD, PPE (radioprotective apron and glasses) and lead shielding on the patient allowed for the assessment of the operator radiation exposure while using different combinations of radioprotective tools. Statistical analysis was performed to determine whether the use of RADPAD resulted in a significant dose reduction for the operator when used in conjunction with typical PPE. Results Analysis indicates RADPAD provides a statistically significant dose reduction to the chest and eye lens. However, standard PPE provided a more significant dose reduction to these regions. Additionally, the combination of RADPAD and standard PPE provides no further significant dose reduction to shielded areas. (Figure Presnted) Conclusion The use of RADPAD results in a significant radiation dose reduction to the operators. However, when used in conjunction with standard PPE, it offers no further statistically significant dose reduction to the protected areas of the operator.

Introduction/Aim. The Australian Bronchiectasis Registry (ABR), established in 2015, is a common nation-wide research platform to improve longitudinal data collection in children and adults with bronchiectasis unrelated to cystic fibrosis. Current descriptions of paediatric cohorts with bronchiectasis are largely unicentric and ABR is thus the leading paediatric cohort in Australia. Using ABR, we described the baseline characteristics of paediatric participants and sought to determine regional variations in this cohort. Methods. We analysed the baseline data of paediatric patients (<18 years) with radiologically confirmed bronchiectasis using ABRas centralised database. Results. From March 2016-August 2019, 496 children [222 females; 321 Indigenous; median age = 8 years (IQR 6-11)] were enrolled from 4 Australian sites. The aetiology was considered post-infectious in 70% of children, with 40% having had bronchiectasis for >5 years. Asthma (24%) was the most common reported co-morbidity and non-respiratory comorbidities were uncommon. Spirometry was available only in 21% of the cohort, with median FEV1 = 59.1% predicted (IQR 50.8-69.48), FVC = 66% (58.56-74.6). On CT chest, left (80%) and right (78%) lower lobes were the most common lobes affected, majority with cylindrical bronchiectasis, 6 children had cystic bronchiectasis. 6% children isolated Pseudomonas aeruginosa (PsA) from the lower airways, significantly higher proportion of these had Primary Ciliary Dyskinesia (PCD, 13.3% vs 2.1% in nonPsA; P < 0.001). Macrolide therapy was used in 43.5% of the cohort, with nearly a quarter of the group on short acting bronchodilator therapy. 244/488 (50%) children had at least 1 exacerbation requiring hospital an admission in the last 12 months, with exacerbations in 6.5% of the cohort treated with outpatient intra-venous antibiotic therapy. Conclusion. The largest cohort of Australian children with bronchiectasis has been described. Some regional differences exist in the

With advances in digital stethoscopes, internet of things, signal processing and machine learning, chest sounds can be easily collected and transmitted to the cloud for remote monitoring and diagnosis. However, low quality of recordings complicates remote monitoring and diagnosis, particularly for neonatal care. This paper proposes a new method to objectively and automatically assess the signal quality to improve the accuracy and reliability of heart rate (HR) and breathing rate (BR) estimation from noisy neonatal chest sounds. A total of 88 10-second long chest sounds were taken from 76 preterm and full-term babies. Six annotators independently assessed the signal quality, number of detectable beats, and breathing periods from these recordings. For quality classification, 187 and 182 features were extracted from heart and lung sounds, respectively. After feature selection, class balancing, and hyperparameter optimization, a dynamic binary classification model was trained. Then HR and BR were automatically estimated from the chest sound and several approaches were compared. The results of subject-wise leave-one-out cross-validation, showed that the model distinguished high and low quality recordings in the test set with 96% specificity, 81% sensitivity and 93% accuracy for heart sounds, and 86% specificity, 69% sensitivity and 82% accuracy for lung sounds. The HR and BR estimated from high quality sounds resulted in significantly less median absolute error (4bpm and 12bpm difference, respectively) compared to those from low quality sounds. The methods presented in this work, facilitates automated neonatal chest sound auscultation for future telehealth applications.Copyright IEEE

Medical imaging provides a non-invasive method to diagnose, monitor, and plan the treatment of disease inside the human body. The increasing prevalence of radiological scanners and prescription of their use has presented a significant challenge for radiologists in accurately diagnosing disease whilst dealing with a growing number of scans to review. Recent advances in Artificial Intelligence (AI), especially in machine learning, are enabling researchers to improve the patient experience, enhance the planning of medical treatments and increase the rate of examination of scans. In this study, a 2-dimensional (2D) U-net based deep learning model was used to automatically segment five organs of interest from Computed Tomography (CT) scans of the thoracic region. Comparable results were achieved in comparison to the top seven models from a prior thoracic organ segmentation challenge. The framework can perform the segmentation tasks within 20 seconds, reducing workload for radiologists and increasing throughput. This study shows that a simple U-net based framework can be sufficient for the task at hand rather than pursuing much more complicated architectures, depending upon the complexity of the problem. Furthermore, we investigated the effect of 3D interpolation on dice scores in anticipation of further research applications in mapping segments to a 3D volume render. We find performance degradation with respect to the dice score after mapping the masks to original dimensions.

Introduction CT Fluoroscopy (CTF) guided interventions have become the preferred technique for spinal injections, biopsies and drainages in many clinics [1]. However, studies indicate that operators may be subject to high radiation exposures. RADPAD, a commercially available antimony and bismuth radioprotective patient drape, aims to reduce operator dose by attenuating scattered radiation originating from within the patient. This study aims to evaluate RADPAD's dose reduction benefits to the operator in CTF. Method A Toshiba AcquilionOne CT was used to image an anthropomorphic phantom at the typical parameters and anatomical location of a lung biopsy. An ED3 dosimeter measured the surface dose at the chest and eye lens level of the operator. The use of different combinations of RADPAD, PPE (radioprotective apron and glasses) and lead shielding on the patient allowed for the assessment of the operator radiation exposure while using different combinations of radioprotective tools. Statistical analysis was performed to determine whether the use of RADPAD resulted in a significant dose reduction for the operator when used in conjunction with typical PPE. Results Analysis indicates RADPAD provides a statistically significant dose reduction to the chest and eye lens. However, standard PPE provided a more significant dose reduction to these regions. Additionally, the combination of RADPAD and standard PPE provides no further significant dose reduction to shielded areas. (Figure Presnted) Conclusion The use of RADPAD results in a significant radiation dose reduction to the operators. However, when used in conjunction with standard PPE, it offers no further statistically significant dose reduction to the protected areas of the operator.

Introduction/Aim. The Australian Bronchiectasis Registry (ABR), established in 2015, is a common nation-wide research platform to improve longitudinal data collection in children and adults with bronchiectasis unrelated to cystic fibrosis. Current descriptions of paediatric cohorts with bronchiectasis are largely unicentric and ABR is thus the leading paediatric cohort in Australia. Using ABR, we described the baseline characteristics of paediatric participants and sought to determine regional variations in this cohort. Methods. We analysed the baseline data of paediatric patients (<18 years) with radiologically confirmed bronchiectasis using ABRas centralised database. Results. From March 2016-August 2019, 496 children [222 females; 321 Indigenous; median age = 8 years (IQR 6-11)] were enrolled from 4 Australian sites. The aetiology was considered post-infectious in 70% of children, with 40% having had bronchiectasis for >5 years. Asthma (24%) was the most common reported co-morbidity and non-respiratory comorbidities were uncommon. Spirometry was available only in 21% of the cohort, with median FEV1 = 59.1% predicted (IQR 50.8-69.48), FVC = 66% (58.56-74.6). On CT chest, left (80%) and right (78%) lower lobes were the most common lobes affected, majority with cylindrical bronchiectasis, 6 children had cystic bronchiectasis. 6% children isolated Pseudomonas aeruginosa (PsA) from the lower airways, significantly higher proportion of these had Primary Ciliary Dyskinesia (PCD, 13.3% vs 2.1% in nonPsA; P < 0.001). Macrolide therapy was used in 43.5% of the cohort, with nearly a quarter of the group on short acting bronchodilator therapy. 244/488 (50%) children had at least 1 exacerbation requiring hospital an admission in the last 12 months, with exacerbations in 6.5% of the cohort treated with outpatient intra-venous antibiotic therapy. Conclusion. The largest cohort of Australian children with bronchiectasis has been described. Some regional differences exist in the

With advances in digital stethoscopes, internet of things, signal processing and machine learning, chest sounds can be easily collected and transmitted to the cloud for remote monitoring and diagnosis. However, low quality of recordings complicates remote monitoring and diagnosis, particularly for neonatal care. This paper proposes a new method to objectively and automatically assess the signal quality to improve the accuracy and reliability of heart rate (HR) and breathing rate (BR) estimation from noisy neonatal chest sounds. A total of 88 10-second long chest sounds were taken from 76 preterm and full-term babies. Six annotators independently assessed the signal quality, number of detectable beats, and breathing periods from these recordings. For quality classification, 187 and 182 features were extracted from heart and lung sounds, respectively. After feature selection, class balancing, and hyperparameter optimization, a dynamic binary classification model was trained. Then HR and BR were automatically estimated from the chest sound and several approaches were compared. The results of subject-wise leave-one-out cross-validation, showed that the model distinguished high and low quality recordings in the test set with 96% specificity, 81% sensitivity and 93% accuracy for heart sounds, and 86% specificity, 69% sensitivity and 82% accuracy for lung sounds. The HR and BR estimated from high quality sounds resulted in significantly less median absolute error (4bpm and 12bpm difference, respectively) compared to those from low quality sounds. The methods presented in this work, facilitates automated neonatal chest sound auscultation for future telehealth applications.Copyright IEEE

Pulmonary artery agenesis is a rare and infrequent malformation and pathology that has a prevalence of 1 in 200 - 300 thousand individuals. Its appearance is more frequent on the right side, its diagnosis is given in the first years of life, since it is very infrequent in adulthood and it can be asymptomatic or present symptoms more associated with ischemic heart disease. A clinical case of a 44-year-old male patient is presented, who arrives at the medical center with a clinical picture of 6 hours of evolution, characterized by oppressive chest pain of great intensity that radiates to the left arm and ipsilateral neck, also accompanied by dyspnea that progresses From medium to minimal efforts with nausea and vomiting, a chest x-ray and echocardiogram were performed, no abnormalities were found, and the patient was discharged. Days later, the patient returned with respiratory problems, for which he was readmitted, performing echocardiography studies again. In conclusion, it was a case of mild left pulmonary artery agenesis, associated with ischemic heart disease, diagnosed by echocardiography. An infrequent finding in the literature both due to the location and the age of the patient., La agenesia de la arteria pulmonar, es una malformación y patología rara e infrecuente que tiene una prevalencia de 1 de cada 200 – 300 mil individuos. Es más frecuente su aparición del lado derecho, su diagnóstico se da en los primeros años de vida, ya que es muy infrecuente en la edad adulta y pude ser asintomática o presentar síntomas más asociados a cardiopatías isquémicas. Se presenta caso clínico de paciente masculino 44 años edad, que llega a centro médico con cuadro clínico de 6 horas de evolución, caracterizado por dolor precordial tipo opresivo de gran intensidad que irradia a brazo izquierdo y cuello ipsilateral, además se acompaña de disnea que progresa de medianos a mínimos esfuerzos con náuseas y vómito, se realiza radiografía de tórax y ecocardiograma no encontrándose ninguna anomalía, dándose de alta. Días después paciente regresa con problemas respiratorios para lo cual se reingresa volviéndose a realizar estudios de ecocardiograma. En conclusión, se trató de un caso de agenesia de arteria pulmonar izquierda leve, asociada por una cardiopatía isquémica, diagnosticada por ecocardiograma. Hallazgo infrecuente dentro de la literatura tanto por la locali-zación como por la edad del paciente

Pulmonary artery agenesis is a rare and infrequent malformation and pathology that has a prevalence of 1 in 200 - 300 thousand individuals. Its appearance is more frequent on the right side, its diagnosis is given in the first years of life, since it is very infrequent in adulthood and it can be asymptomatic or present symptoms more associated with ischemic heart disease. A clinical case of a 44-year-old male patient is presented, who arrives at the medical center with a clinical picture of 6 hours of evolution, characterized by oppressive chest pain of great intensity that radiates to the left arm and ipsilateral neck, also accompanied by dyspnea that progresses From medium to minimal efforts with nausea and vomiting, a chest x-ray and echocardiogram were performed, no abnormalities were found, and the patient was discharged. Days later, the patient returned with respiratory problems, for which he was readmitted, performing echocardiography studies again. In conclusion, it was a case of mild left pulmonary artery agenesis, associated with ischemic heart disease, diagnosed by echocardiography. An infrequent finding in the literature both due to the location and the age of the patient., La agenesia de la arteria pulmonar, es una malformación y patología rara e infrecuente que tiene una prevalencia de 1 de cada 200 – 300 mil individuos. Es más frecuente su aparición del lado derecho, su diagnóstico se da en los primeros años de vida, ya que es muy infrecuente en la edad adulta y pude ser asintomática o presentar síntomas más asociados a cardiopatías isquémicas. Se presenta caso clínico de paciente masculino 44 años edad, que llega a centro médico con cuadro clínico de 6 horas de evolución, caracterizado por dolor precordial tipo opresivo de gran intensidad que irradia a brazo izquierdo y cuello ipsilateral, además se acompaña de disnea que progresa de medianos a mínimos esfuerzos con náuseas y vómito, se realiza radiografía de tórax y ecocardiograma no encontrándose ninguna anomalía, dándose de alta. Días después paciente regresa con problemas respiratorios para lo cual se reingresa volviéndose a realizar estudios de ecocardiograma. En conclusión, se trató de un caso de agenesia de arteria pulmonar izquierda leve, asociada por una cardiopatía isquémica, diagnosticada por ecocardiograma. Hallazgo infrecuente dentro de la literatura tanto por la locali-zación como por la edad del paciente

Pulmonary artery agenesis is a rare and infrequent malformation and pathology that has a prevalence of 1 in 200 - 300 thousand individuals. Its appearance is more frequent on the right side, its diagnosis is given in the first years of life, since it is very infrequent in adulthood and it can be asymptomatic or present symptoms more associated with ischemic heart disease. A clinical case of a 44-year-old male patient is presented, who arrives at the medical center with a clinical picture of 6 hours of evolution, characterized by oppressive chest pain of great intensity that radiates to the left arm and ipsilateral neck, also accompanied by dyspnea that progresses From medium to minimal efforts with nausea and vomiting, a chest x-ray and echocardiogram were performed, no abnormalities were found, and the patient was discharged. Days later, the patient returned with respiratory problems, for which he was readmitted, performing echocardiography studies again. In conclusion, it was a case of mild left pulmonary artery agenesis, associated with ischemic heart disease, diagnosed by echocardiography. An infrequent finding in the literature both due to the location and the age of the patient., La agenesia de la arteria pulmonar, es una malformación y patología rara e infrecuente que tiene una prevalencia de 1 de cada 200 – 300 mil individuos. Es más frecuente su aparición del lado derecho, su diagnóstico se da en los primeros años de vida, ya que es muy infrecuente en la edad adulta y pude ser asintomática o presentar síntomas más asociados a cardiopatías isquémicas. Se presenta caso clínico de paciente masculino 44 años edad, que llega a centro médico con cuadro clínico de 6 horas de evolución, caracterizado por dolor precordial tipo opresivo de gran intensidad que irradia a brazo izquierdo y cuello ipsilateral, además se acompaña de disnea que progresa de medianos a mínimos esfuerzos con náuseas y vómito, se realiza radiografía de tórax y ecocardiograma no encontrándose ninguna anomalía, dándose de alta. Días después paciente regresa con problemas respiratorios para lo cual se reingresa volviéndose a realizar estudios de ecocardiograma. En conclusión, se trató de un caso de agenesia de arteria pulmonar izquierda leve, asociada por una cardiopatía isquémica, diagnosticada por ecocardiograma. Hallazgo infrecuente dentro de la literatura tanto por la locali-zación como por la edad del paciente

Pulmonary artery agenesis is a rare and infrequent malformation and pathology that has a prevalence of 1 in 200 - 300 thousand individuals. Its appearance is more frequent on the right side, its diagnosis is given in the first years of life, since it is very infrequent in adulthood and it can be asymptomatic or present symptoms more associated with ischemic heart disease. A clinical case of a 44-year-old male patient is presented, who arrives at the medical center with a clinical picture of 6 hours of evolution, characterized by oppressive chest pain of great intensity that radiates to the left arm and ipsilateral neck, also accompanied by dyspnea that progresses From medium to minimal efforts with nausea and vomiting, a chest x-ray and echocardiogram were performed, no abnormalities were found, and the patient was discharged. Days later, the patient returned with respiratory problems, for which he was readmitted, performing echocardiography studies again. In conclusion, it was a case of mild left pulmonary artery agenesis, associated with ischemic heart disease, diagnosed by echocardiography. An infrequent finding in the literature both due to the location and the age of the patient., La agenesia de la arteria pulmonar, es una malformación y patología rara e infrecuente que tiene una prevalencia de 1 de cada 200 – 300 mil individuos. Es más frecuente su aparición del lado derecho, su diagnóstico se da en los primeros años de vida, ya que es muy infrecuente en la edad adulta y pude ser asintomática o presentar síntomas más asociados a cardiopatías isquémicas. Se presenta caso clínico de paciente masculino 44 años edad, que llega a centro médico con cuadro clínico de 6 horas de evolución, caracterizado por dolor precordial tipo opresivo de gran intensidad que irradia a brazo izquierdo y cuello ipsilateral, además se acompaña de disnea que progresa de medianos a mínimos esfuerzos con náuseas y vómito, se realiza radiografía de tórax y ecocardiograma no encontrándose ninguna anomalía, dándose de alta. Días después paciente regresa con problemas respiratorios para lo cual se reingresa volviéndose a realizar estudios de ecocardiograma. En conclusión, se trató de un caso de agenesia de arteria pulmonar izquierda leve, asociada por una cardiopatía isquémica, diagnosticada por ecocardiograma. Hallazgo infrecuente dentro de la literatura tanto por la locali-zación como por la edad del paciente

Pulmonary artery agenesis is a rare and infrequent malformation and pathology that has a prevalence of 1 in 200 - 300 thousand individuals. Its appearance is more frequent on the right side, its diagnosis is given in the first years of life, since it is very infrequent in adulthood and it can be asymptomatic or present symptoms more associated with ischemic heart disease. A clinical case of a 44-year-old male patient is presented, who arrives at the medical center with a clinical picture of 6 hours of evolution, characterized by oppressive chest pain of great intensity that radiates to the left arm and ipsilateral neck, also accompanied by dyspnea that progresses From medium to minimal efforts with nausea and vomiting, a chest x-ray and echocardiogram were performed, no abnormalities were found, and the patient was discharged. Days later, the patient returned with respiratory problems, for which he was readmitted, performing echocardiography studies again. In conclusion, it was a case of mild left pulmonary artery agenesis, associated with ischemic heart disease, diagnosed by echocardiography. An infrequent finding in the literature both due to the location and the age of the patient., La agenesia de la arteria pulmonar, es una malformación y patología rara e infrecuente que tiene una prevalencia de 1 de cada 200 – 300 mil individuos. Es más frecuente su aparición del lado derecho, su diagnóstico se da en los primeros años de vida, ya que es muy infrecuente en la edad adulta y pude ser asintomática o presentar síntomas más asociados a cardiopatías isquémicas. Se presenta caso clínico de paciente masculino 44 años edad, que llega a centro médico con cuadro clínico de 6 horas de evolución, caracterizado por dolor precordial tipo opresivo de gran intensidad que irradia a brazo izquierdo y cuello ipsilateral, además se acompaña de disnea que progresa de medianos a mínimos esfuerzos con náuseas y vómito, se realiza radiografía de tórax y ecocardiograma no encontrándose ninguna anomalía, dándose de alta. Días después paciente regresa con problemas respiratorios para lo cual se reingresa volviéndose a realizar estudios de ecocardiograma. En conclusión, se trató de un caso de agenesia de arteria pulmonar izquierda leve, asociada por una cardiopatía isquémica, diagnosticada por ecocardiograma. Hallazgo infrecuente dentro de la literatura tanto por la locali-zación como por la edad del paciente