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Chagas cardiomyopathy (CC) has a worse prognosis than other forms of cardiomyopathy and up to 10% of patients may progress to end-stage heart failure. In this article, we have performed a comprehensive literature review of heart transplantation (HT) for CC, including results after HT, management of immunosuppression, and Chagas disease (CD) reactivation. CD used to be considered a contraindication to HT due to the risks of disease reactivation with immunosuppression. Nonetheless, multiple reports have consistently demonstrated the feasibility and safety of HT for refractory CC. CD reactivation must be routinely screened in the first-year post-transplant, and in recent years, polymerase chain reactions (PCR)-based techniques have been used more often. HT is now considered the best treatment for end-stage Chagas heart disease. In addition, studies of immunosuppressive medications have shown that these patients require a lesser degree of immunosuppression, mainly to balance reactivation risks.

Objective Infective endocarditis (IE) may cause devastating complications with high morbidity and mortality rates. The aim of the present study was to study the demographic, cardiological, microbiologic, and dental profiles of patients with oral bacteria–related IE. Study Design We present a retrospective study of patients with oral bacteria–related IE treated at Instituto do Coracao, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil, between January 2009 and December 2019. Results Of the 100 patients included, 70% were male with a mean age of 45.4 years at diagnosis. The most affected sites were aortic and mitral valves, 60% in prosthetic heart valves, 34% in native valves, and 3% in pacemakers. The most common cause of valvular disease was rheumatic cardiopathy (51.9%), and the most frequent complications were valvular and perivalvular damage (26%). Streptococcus viridans was the most common species (96%), dental caries were present in 57% of the patients, 78% had tooth loss, 45% had apical periodontitis, and 77% were at high/moderate risk for periodontal disease. Conclusion Oral bacteria–related IE among Brazilians was predominant in the prosthetic heart valves of young male adults previously affected by rheumatic cardiopathy. Streptococcus viridans was the main cause of IE, which was linked to patients with a poor oral health status.

Carta de Apresentacao O objetivo deste posicionamento e informar clinicos, cardiologistas e imaginologistas sobre procedimentos, fluxos e protocolos recomendados para o periodo da pandemia do SARS-CoV-2 (COVID-19), visando a protecao mais eficiente de profissionais de saude e pacientes. As recomendacoes sao baseadas na melhor evidencia cientifica disponivel no momento e no consenso de especialistas com grande experiencia na area. Desde o primeiro caso de COVID-19 no Brasil, passamos por inumeras mudancas nas recomendacoes e grande debate cientifico sobre algumas delas [...]

Although autonomic disturbances are known to precede hypertension onset, the risks underlying different ranges of blood pressure and impaired cardiac autonomic modulation are still unknown. This study aimed to identify the risk of hypertension incidence related to low heart-rate variability profile in normotensive blood pressure subcategories: normal (

Objetivo: E mostrar por meio de uma revisao de literatura, as alteracoes pos-operatorias em pacientes submetidos ao procedimento de frenectomia lingual. Revisao Bibliografica: A anquiloglossia e/ou lingua presa e uma alteracao assintomatica que acomete a prega lingual, caracteriza-se pela insercao do frenulo e/ou freio lingual na regiao do dorso da lingua com extensao ao assoalho da boca. De etiologia desconhecida, a alteracao tem causado problemas na fonetica, mastigacao, degluticao e dinâmica dos movimentos da lingua. O diagnostico precoce permite que as funcoes do sistema estomatognatico sejam restabelecidas com o procedimento cirurgico por meio da tecnica de frenectomia. No entanto, em casos de alteracoes pos-operatorias torna-se importante o acompanhamento do paciente com o fonoaudiologo para que se consiga corrigir os danos a lingua. Consideracoes finais: As alteracoes no frenulo lingual causam impactos significativos na qualidade de vida do individuo. Desse modo e evidente que a execucao cirurgica do procedimento de frenectomia lingual e as tecnicas dos exercicios fonoterapeuticos sao as alternativas mais eficientes no proposito de conseguir restabelecer as funcoes do sistema estomatognatico e garantir a recuperacao da dinâmica dos movimentos da lingua, degluticao, mastigacao e fala corretamente e e importante que o cirurgiao dentista e fonoaudiologo atuem juntos no diagnostico, planejamento, tratamento e terapias, para promover maior sucesso clinico ao paciente.

A paralisia de Bell (PB) e caracterizada por uma paralisia unilateral dos musculos inervados pelo nervo facial e pode ser causada por infeccao pelo herpes-virus, inflamacao do nervo facial, neuropatia isquemica, insuficiencia na microcirculacao, diabetes e hipertensao. Essa paralisia desencadeia diminuicao da sensibilidade gustativa e paresia do reflexo de piscar. A toxina botulinica foi considerada como principal tratamento de assimetrias temporarias ou definitivas em pacientes com paralisia facial. O uso da toxina e cada vez mais crescente dentro da odontologia. Nesse sentido, atraves de uma revisao bibliografica e de artigos publicados em bancos de dados telematicos, o objetivo deste trabalho e evidenciar a eficacia do tratamento odontologico utilizando toxina botulinica para pacientes com paralisia facial de Bell.

Introdução: A telessaúde é uma das estratégias de qualificação da atenção primária. Não há trabalho que analise sua utilização no Programa Mais Médicos. Logo, buscou-se analisar a utilização das ferramentas de telessaúde no Mais Médicos do estado do Espírito Santo, em 2016. Objetivo: Analisar a utilização das ferramentas de telessaúde no Mais Médicos do estado do Espírito Santo em 2016. Métodos: Trata-se de um estudo transversal, com aplicação de questionário estruturado ao total de médicos presente em seminários regionais em telessaúde. A análise incluiu frequência absoluta e relativa e análise bivariada com teste exato de Fisher. Resultados: Como resultado, 211 médicos (48,6% do total de profissionais do Mais Médicos) participaram, na maioria cubanos que atuavam em grande centro urbano com especialização em Medicina de Família e Comunidade. A maior parte (n=130, 61,9%) já havia utilizado algum serviço de telessaúde, mas de forma descontínua, sendo a teleducação o mais utilizado (n=101; 77,7%). Conhecer o Programa Telessaúde Brasil Redes e suas ferramentas e vê-las como relevantes para a melhoria do serviço associou-se a maior uso das tecnologias. A facilidade e o tipo de dispositivo utilizado para acessar a internet não influenciam a utilização do programa. Conclusões: Conclui-se que o conhecimento das ferramentas de telessaúde e a relevância dada a elas pelos profissionais e seu entorno estão mais associados a seu uso que as condições estruturais de trabalho.

Compared to rodents, sheep offer several attractive features as an experimental model for testing different medical and surgical interventions related to pathological gait caused by neurological diseases and injuries. To use sheep for development of novel treatment strategies in the field of neuroscience, it is key to establish the relevant kinematic features of locomotion in this species. To use sheep for development of novel treatment strategies in the field of neuroscience, it is crucial to understand fundamental baseline characteristics of locomotion in this species. Despite their relevance for medical research, little is known about the locomotion in the ovine model, and next to nothing about the three-dimensional (3D) kinematics of the hindlimb. This study is the first to perform and compare two-dimensional (2D) and 3D hindlimb kinematics of the sagittal motion during treadmill walking in the ovine model. Our results show that the most significant differences took place throughout the swing phase of the gait cycle were for the distal joints, ankle and metatarsophalangeal joint, whereas the hip and knee joints were much less affected. The results provide evidence of the inadequacy of a 2D approach to the computation of joint kinematics in clinically normal sheep during treadmill walking when the interest is centered on the hoof's joints. The findings from the present investigation are likely to be useful for an accurate, quantitative and objective assessment of functionally altered gait and its underlying neuronal mechanisms and biomechanical consequences.

A 34-year-old G2P1, with no relevant medical history, had an increased risk of trisomy 21 on first trimester combined screening. Ultrasound at 12 weeks’ gestation showed a normal nuchal translucency, present nasal bone and increased ductus venosus pulsatility index. Furthermore, no obvious stomach

In offshore petroleum exploration, subsea systems are susceptible to a variety of undesirable events or faults, in which oil wells operation is considered abnormal. Proper detection and classification of such events is crucial in order to reduce downtime, maintenance costs, and even damage to installations. Flow instability is a type of event inherently related to hydrocarbon multiphase flow and root cause of equipment stress and failure. This work investigates applying binary machine learning classifiers on real world captured data for the task of flow instability fault detection. Four different evaluation scenarios were considered. The mostly common scenarios used by the machine learning research community showed that even simple algorithms can reach high classification performance. The remaining scenarios, however, try to avoid the similarity bias problem and showed more realistic results.

Introduction: The coronavirus disease 2019 (COVID-19) has negatively impacted healthcare services worldwide. We hypothesized that the pandemic would affect our case mix and mortality. Our objective was to study this impact. Methods: We retrospectively studied all patients who underwent congenital heart surgeries from March 21st to August 21st in 2019 and 2020 using the institutional electronic database. We compared demographic data, preoperative and postoperative length of stay (LOS), risk stratification using Risk Adjustment for Congenital Heart Surgery (RACHS) classification and outcomes in both periods. Results: We observed a 66.7% decrease in our surgical volume (285 × 95 patients). Patients operated in the pre-pandemic period were older (911.3 [174.8 - 5953.8] days-old) compared to the pandemic period (275 days-old; P

BACKGROUND: Heart transplant (HT) recipients may be at higher risk of acquiring SARS-CoV-2 infection and developing critical illness. The aim of this study is to describe characteristics and outcomes of HT recipients infected by SARS-COV-2, from a high-volume transplant center. METHODS: We have described data of all adult HT recipients with confirmed COVID-19 by RT-PCR in nasopharyngeal samples from April 5th,2020 to January 5th, 2021. Outcomes and follow-up were recorded until February 5th, 2021. RESULTS: Forty patients were included. Twenty-four patients (60%) were men; the median age was 53 (40-60) years old; median HT time was 34 months and median follow-up time 162 days. The majority needed hospitalization (83%). Immunosuppressive therapy was reduced/withdrawn in the majority of patients, except from steroids, which were maintained. Seventeen patients (42.5%) were classified as having severe disease according to the ordinal scale developed by the WHO Committee. They tended to have lower absolute lymphocyte count (p

A major challenge for remote patient monitoring (RPM) systems is processing data collected from a large number of healthcare devices and developing suitable algorithms and approaches to react accordingly to a wide spectrum of situations of interest, which must be properly detected. Flow-based programming, whose operation is based on state changes, is a promising approach to overcome this challenge, facilitating the personalization of data processing according to patients' health conditions. However, this approach is not suited to the detection of complex contextual situations, thereby hindering its adoption in RPM systems for data processing. In this regard, we propose an approach that combines situation awareness and flow-based programming to widen the capability of RPM systems to handle many-sided scenarios, which requires the monitoring of complex patient healthcare conditions. An evaluation of the proposed approach was conducted to demonstrate the flexibility of the solution for processing heterogeneous health information.

Background Chagas disease reactivation (CDR) after heart transplantation is characterized by relapse of the infectious disease with proliferation and dissemination of Trypanosoma cruzi parasites. Serial blood PCR testing is consensually recommended for CDR monitoring, but there is uncertainty about the incremental value in performing the molecular tests in endomyocardial biopsies (EMB). Methods We compared qualitative and quantitative results of PCR for T. cruzi DNA in 62 pairs of blood and EMB collected with a maximum time interval of 7 days, from 34 heart-transplanted, chagasic patients. Results Blood PCR resulted positive in 39/62 (62.9%) samples, with PL ranging from 0.14 to 1,610.73 (median: 3.31). PCR resulted positive in 8/60 (13.3%) EMB, with PL ranging from 2.82 to 1,670.55 (median: 65.63). All blood samples which tested negative presented a paired EMB which also tested negative. However, 31/39 (79.5%) blood samples which tested positive presented a paired EMB which tested negative. There was poor agreement between blood and EMB PCR (kappa=0.153). CDR affecting the myocardium (myo-CDR) was diagnosed in three occasions. PCR resulted positive in both blood and EMB at the time of myo-CDR, with PL ranging from 0.61 to 1,610.73 in blood and 13.8 to 1,670.55 in EMB. Conclusions Negative PCR for T. cruzi in blood rules out myo-CDR, with no value of testing EMB. Positive PCR in blood with high PL is diagnostic for myo-CDR. If PCR in blood results positive with low PL, testing EMB is useful: negative PCR turns unlikely, and positive PCR reinforces greatly the possibility of myo-CDR.

Peripheral nerve injury remains a clinical challenge with severe physiological and functional consequences. Despite the existence of multiple possible therapeutic approaches, until now, there is no consensus regarding the advantages of each option or the best methodology in promoting nerve regeneration. Regenerative medicine is a promise to overcome this medical limitation, and in this work, chitosan nerve guide conduits and olfactory mucosa mesenchymal stem/stromal cells were applied in different therapeutic combinations to promote regeneration in sciatic nerves after neurotmesis injury. Over 20 weeks, the intervened animals were subjected to a regular functional assessment (determination of motor performance, nociception, and sciatic indexes), and after this period, they were evaluated kinematically and the sciatic nerves and cranial tibial muscles were evaluated stereologically and histomorphometrically, respectively. The results obtained allowed confirming the beneficial effects of using these therapeutic approaches. The use of chitosan NGCs and cells resulted in better motor performance, better sciatic indexes, and lower gait dysfunction after 20 weeks. The use of only NGGs demonstrated better nociceptive recoveries. The stereological evaluation of the sciatic nerve revealed identical values in the different parameters for all therapeutic groups. In the muscle histomorphometric evaluation, the groups treated with NGCs and cells showed results close to those of the group that received traditional sutures, the one with the best final values. The therapeutic combinations studied show promising outcomes and should be the target of new future works to overcome some irregularities found in the results and establish the combination of nerve guidance conduits and olfactory mucosa mesenchymal stem/stromal cells as viable options in the treatment of peripheral nerves after injury. This research was supported by projects PEst-OE/AGR/UI0211/2011 from FCT and COMPETE 2020 from ANIProjetos ID&T Empresas em Copromoção, by the project “insitu.Biomas – Reinvent biomanufacturing systems by using an usability approach for in situ clinic temporary implants fabrication” with the reference POCI-01-0247-FEDER-017771, by the project “Print-on-Organs – Engineering bioinks and processes for direct printing on organs” with the reference POCI-01- 0247-FEDER-033877, and by the project “Bone2Move – Development of “in vivo” experimental techniques and modelling methodologies for the evaluation of 4D scaffolds for bone defect in sheep model: an integrative research approach” with the reference POCI-01-0145-FEDER-031146. Mariana Vieira Branquinho (SFRH/BD/146172/2019), Ana Catarina Sousa (SFRH/BD/146689/2019), and Rui Damásio Alvites (SFRH/BD/116118/2016) acknowledge FCT for the financial support. The Reaxon® NGCs used in this work were kindly provided by Medovent GmbH (Mainz, Germany).

Analysis of locomotion is often used as a measure for impairment and recovery following experimental peripheral nerve injury. Compared to rodents, sheep offer several advantages for studying peripheral nerve regeneration. In the present study, we compared for the first time, two-dimensional (2D) and three-dimensional (3D) hindlimb kinematics during obstacle avoidance in the ovine model. This study obtained kinematic data to serve as a template for an objective assessment of the ankle joint motion in future studies of common peroneal nerve (CP) injury and repair in the ovine model. The strategy used by the sheep to bring the hindlimb over a moderately high obstacle, set to 10% of its hindlimb length, was pronounced knee, ankle and metatarsophalangeal flexion when approaching and clearing the obstacle. Despite the overall time course kinematic patterns about the hip, knee, ankle, and metatarsophalangeal were identical, we found significant differences between values of the 2D and 3D joint angular motion. Our results showed that the most apparent changes that occurred during the gait cycle were for the ankle (2D-measured STANCEmax: 157±2.4 degrees vs. 3D-measured STANCEmax: 151±1.2 degrees; P

This study presents a virtual reality system for maintenance training of motors used in locomotives responsible for transportation of ore. Considering the cost and impact on the logistics chain of a mining company, preventive maintenance is required to reduce fault events and increase motor life. Technical staff training in a real locomotive has been difficult since the motor is long and heavy and hence not available for training. Thus, a virtual reality system offers a low-cost and efficient solution for maintenance training. This work consists in developing the 3D model for the virtual reality engine Unity 3D and proposing an XML module for motor part selection and the game design. We evaluated the simulator with 59 users, obtaining satisfactory results regarding comfort, immersion, usability, and user experience. Tests performed by technical staff validated the potential use in the training routine.

Background We aimed to analyse if the effects of coexistent diabetes and subclinical hypothyroidism extend to the cardio autonomic nervous system, using heart rate variability baseline data from the Brazilian Longitudinal Study of Adult Health. Materials and methods Heart rate variability analyses were performed by linear time and frequency domains in 5-minute time series collected in the supine position. The associations of diabetes and subclinical hypothyroidism with the lowest quartile group for heart rate and the highest quartile group for each heart rate variability parameter were analysed using additive and multiplicative terms in logistic models. For the first approach, the subsample was categorized into four groups: subjects without diabetes and normal thyroid function (controls); subjects without diabetes and subclinical hypothyroidism; patients with diabetes and normal thyroid function; and patients with diabetes and subclinical hypothyroidism. For the interaction alnalysis, diabetes and subclinical hypothyroidism diagnoses were included in separate, along with a multiplicative interaction term between them. Results Point odds ratio estimates for the 4th quartiles of heart rate, and 1st quartiles of all heart rate variability measurements were higher for subjects with combined diabetes and subclinical hypothyroidism than for diabetes only, independently of main sociodemographic and clinical variables (HR: 8.33 vs 2.63; SDNN: 2.59 vs 1.61; RMSSD: 2.37 vs 1.42; LF: 2.83 vs 1.71; HF: 3.06 vs 1.39), but not independently of HbA1c and TSH. Only the interaction term for the association with heart rate, adjusted for sociodemographic and clinical variables, had borderline statistical significance. Conclusion Diabetes and subclinical hypothyroidism exert a potential joint impact on cardiac autonomic control, showed by additive effects between diabetes and subclinical hypothyroidism, as well as a significant interaction term for the association with heart rate.

Clustering is a recurrent task in machine learning. The application of traditional heuristics techniques in large sets of data is not easy. They tend to have at least quadratic complexity with respect to the number of points, yielding prohibitive run times or low quality solutions. The most common approach to tackle this problem is to use weaker, more randomized algorithms with lower complexities to solve the clustering problem. This work proposes a novel approach for performing this task, allowing traditional, stronger algorithms to work on a sample of the data, chosen in such a way that the overall clustering is considered good. Preliminary experimental results indicate that the proposed approach is competitive to classical algorithms in large datasets with the advantage of automatically adapting to many different datasets.

Machine learning classification algorithms are highly dependent of a dataset composed of high-level features. In this paper, a deep learning approach is combined with traditional machine learning classifiers in order to circumvent the need of a specialist for extracting relevant features from one dimensional frequency-domain vibration signals. Our approach relies on a convolutional architecture trained with a triplet loss function for extracting relevant features directly from the raw data. A previously hand-crafted feature set, created by a specialist over the course of many years of research, is compared with the newly extracted feature set. Six conventional classifiers models (K-Nearest Neighbors, Support Vector Machine, Decision Tree, Random Forest, Quadratic Discriminant Analysis and Naive Bayes) are trained in both features set separately and compared in terms of macro F-measure. Results shows statistical evidence towards to the acceptance that the extracted feature set is as good as or better than the hand-crafted feature set, for classification purposes.

Background: Diabetes and subclinical hypothyroidism are frequently coexisting conditions. The separated effects of each one on the cardiovascular system and cardio autonomic function are known. However, it has not been investigated yet whether the presence of both diseases has a joint influence on the cardiac autonomic system. As the autonomic nervous system is involved in cardiovascular, endocrine, and metabolic control, the association of diabetes and subclinical hypothyroidism might have combined effects, leading to cardio autonomic impairment and rising cardiovascular risk. Aim: To analyze the interaction effects of diabetes and subclinical hypothyroidism on Heart Rate Variability parameters among adults. using the participants enrolled at the baseline data of t Methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a cohort of 15015 men and women aged 35 to 74 years-old recruited in 2008-10. Participants were categorized into four groups: non-diabetes with normal thyroid function (controls), non-diabetes with subclinical hypothyroidism; diabetes with normal thyroid function; and diabetes with subclinical hypothyroidism. Heart Rate Variability analyses were performed in time and frequency domains: Standard Deviation of NN interval (SDNN); Root of the Mean of the Sum of the Squares of Differences between adjacent NN intervals (RMSSD, Low-Frequency (LF) and High-Frequency (HF) on 5-minute time series collected in the supine position. For each Heart Rate Variability parameter, we divided the sample into quartile groups, using the fourth quartile as reference. We analyzed the associations with the highest quartile group for each Heart Rate Variability parameter using additive and multiplicative terms in logistic models. Results: Point Odds Ratio, and 95% Confidence Intervals (95%CI) estimates for the first quartiles of all Heart Rate Variability measures were higher for subjects with the combination of both, “diabetes plus subclinical hypothyroidism” than for people with only the diagnosis of diabetes: SDNN: 2.61 (95%CI = 1.13 to 6.05) vs. 1.52 (95%CI =1.25 to 1.85); RMSSD: 2.70 (95%CI =1.18 to 6.18) vs. 1.48 (95%CI =1.21 to 1.80); LF: 2.82 (95%CI =1.05 to 7.56) vs. 1.73 (95%CI =1.40 to 2.13); HF: 3.07 (95%CI =1.21 to 7.75) vs. 1.41 (95%CI =1.16 to 1.71). Nonetheless, no significant multiplicative interaction terms between diabetes and subclinical hypothyroidism were found for the association with HRV variables. Conclusion: There is a potential joint impact on Heart Rate Variability showed by additive effects between diabetes and subclinical hypothyroidism.

Background: Both conditions as a more width common carotid artery intima-media thickness (cIMT), and a low heart rate variability (HRV) have been associated with cardiovascular health-adverse outcomes. Although previous studies have somehow explored the relationship between these markers, they have not credited the influences exerted by factors such as aging, demographics, and lifestyle variables. Aim: to investigate whether cardio autonomic alterations are accompanied or not by subclinical atherosclerosis, in apparently healthy men and women aged 35 to 74 years-old examined at the baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: The Heart Rate Variability was evaluated on 5-min segments of beat-to-beat heart rate recordings using linear time and frequency domain analyses. The c-IMT images were performed using a Toshiba (Aplio XG™) with a 7.5 MHz linear transducer. The c-IMT was measured in the outer wall during three cardiac cycles. The images were analyzed with specific software (MIA™, Coralville, IA). For this study, c-IMT was defined as the average between the mean left and mean right c-IMT values, and it was analyzed as a continuous and categorized variable (P= 75). Multiple linear models using continuous variables and multivariate logistic regression with categorized cIMT and HRV quartiles were performed. Results: Out of 7,201 participants eligible for analyses, 1,685 (23.4%) presented cIM >= 75th percentile. We found significantly reduced HRV variables in subjects with cIMT>=P75 in comparison to those with cIMTvs. 37.0ms( P< 0.001); root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD) 22.0 ms vs. 26.0ms (P< 0.001); Low-Frequency 191.0ms 2 vs. 260.0ms 2 ( P< 0.001); High-Frequency 164.0 ms 2 vs. 238.5ms 2 ( P< 0.001). In a crude analysis, an increased Odds Ratio (OR)and 95% Confidence Intervals for cIMT >=P75 was verified within the lowest two quartiles of Low-Frequency:1st quartile, OR = 1.75 (95%CI: 1.39 to 2.19); 2nd quartile, OR= 1.53 (1.25 to 1.87).The same was observed for High-Frequency:1st quartile, OR = 1.94 (1.38 to 2.73); 2nd quartile, OR= 1.60 (1.20 to 2.15). However, those associations did not remain after adjustments for anthropometric and clinical variables for Low-Frequency (1st quartile, OR= 1.08 (0.83 to 1.40); 2nd quartile, OR= 1.22 (0.97 to1.55), and for High Frequency, 1st quartile, OR= 1.16 (0.77 to 1.73); 2nd quartile, OR= 1.17 (0.83 to 1.64). Conclusions: Subjects with cIMT greater or equal to 75th percentile presented lower HRV values. However, no independent relationships were detected between cIMT and HRV after multivariate adjustment, suggesting that they may assess different and complementary domains and provide relevant, useful, and non-redundant information of cardiovascular risk.

Detecting the early signs of diabetic retinopathy (DR) is essential, as timely treatment might reduce or even prevent vision loss. Moreover, automatically localizing the regions of the retinal image that might contain lesions can favorably assist specialists in the task of detection. In this study, we designed a lesion localization model using a deep network patch-based approach. Our goal was to reduce the complexity of the model while improving its performance. For this purpose, we designed an efficient procedure (including two convolutional neural network models) for selecting the training patches, such that the challenging examples would be given special attention during the training process. Using the labeling of the region, a DR decision can be given to the initial image, without the need for special training. The model is trained on the Standard Diabetic Retinopathy Database, Calibration Level 1 (DIARETDB1) database and is tested on several databases (including Messidor) without any further adaptation. It reaches an area under the receiver operating characteristic curve of 0.912-95%CI(0.897-0.928) for DR screening, and a sensitivity of 0.940-95%CI(0.921-0.959). These values are competitive with other state-of-the-art approaches.

This study was fully funded by Nestlé Purina Research Despite appropriate antiseizure drug (ASD) treatment, around two-thirds of dogs with idiopathic epilepsy (IE) have seizures long-term and 20-30per cent of affected dogs remain poorly controlled. The current study aim is to test in a field trial the efficacy and tolerability of a commercially available diet enriched with 6.5per cent medium chain triglyceride (MCT) oil in dogs (n=21) with at least a tier 1 idiopathic epilepsy diagnosis, without cluster seizures, in 10 veterinary practices across Europe. Each dog's quality of life (QoL), ataxia, sedation and frequency and severity of seizures were recorded by owners throughout the study. The mean seizure frequency per month, averaged over the entire 84-day study, significantly (P=0.04) decreased 32per cent compared with the baseline monthly seizure frequency recorded during the month immediately before feeding the diet. Similarly, the seizure days rate (days/month) also declined (P8.5/10) in 20 of the 21 dogs before starting the diet and this remained unchanged during the trial. This study demonstrates the use of a diet enriched with MCTs as an adjunct to ASD treatment may have some antiseizure properties for dogs diagnosed with IE, as demonstrated in previous studies.

Objective To determine the annual incidence of prosthetic valve endocarditis (PVE) and to evaluate its current classification based on the epidemiological distribution of agents identified and their sensitivity profiles. Methods Consecutive cases of PVE occurring within the first year of valve surgery during the period 1997–2014 were included in this prospective cohort study. Incidence, demographic, clinical, microbiological, and in-hospital mortality data of these PVE patients were recorded. Results One hundred and seventy-two cases of PVE were included, and the global annual incidence of PVE was 1.7%. Most PVE cases occurred within 120days after surgery (76.7%). After this period, there was a reduction in resistant microorganisms (64.4% vs. 32.3%, respectively; p =0.007) and an increase in the incidence of Streptococcus spp (1.9% vs. 23.5%; p =0.007). A literature review revealed 646 cases of PVE with an identified etiology, of which 264 (41%) were caused by coagulase-negative staphylococci and 43 (7%) by Streptococcus spp . This is in agreement with the current study findings. Conclusions Most PVE cases occurred within 120days after valve surgery, and the same etiological agents were identified in this period. The current cut-off level of 365days for the classification of early-onset PVE should be revisited.

The DBSCAN algorithm is a traditional density-based clustering method. This algorithm allows to identify clusters of different shapes, with the ability to manage noisy patterns in the data. DBSCAN usually presents good results, however it performs several distance calculations in the clustering process. This leads to a low efficiency and its application in large datasets is not recommended. This work presents a new method to apply DBSCAN to a reduced set of elements in order to cluster the entire dataset. Therefore, the method allows clustering large datasets with similar results to the outcoe of DBSCAN on the entire dataset. Experiments results suggest that the proposed technique presents good results and consistency compared to other algorithms with similar approach.

Introdução: a PAVM é considerada uma das principais infecções relacionadas à assistência à saúde com índices cada vez mais elevados em uma UTI, esses números podem variar de 9% a 67% de todos os pacientes em uso prolongado ou não, da ventilação mecânica. Objetivo Geral: conhecer os desafios enfrentados pelo odontologista na prevenção da PAVM em uma UTI. Metodologia: Para a realização desse estudo optou-se por uma pesquisa na modalidade de revisão integrativa de literatura. Resultados e Discussão: a integração do cirurgião-dentista na equipe multiprofissional atuante nas UTIs leva a ampliação do campo de ensino e atuação do profissional, possibilitando a formulação e adaptação de diretrizes e bundles, pois são os profissionais mais capacitados nessa área de conhecimento. Considerações Finais: Toda equipe multidisciplinar em saúde alocada nas UTIS’s, inclusive os odontologistas, devem agir em concordância, adotando medidas de prevenção da PAVM a fim de reduzir os riscos para a suas ocorrências, sempre seguindo uma linha de cuidado integrada, diminuindo assim, a taxa de mortalidade de seus pacientes.

Women diagnosed with Gestational Diabetes Mellitus (GDM) should be evaluated postpartum with an Oral Glucose Tolerance Test (OGTT). Nevertheless, women frequently fail to it. We intend to evaluate the performance of third trimester HbA1c in the prediction of postpartum diabetes mellitus (PDM).We conducted a retrospective study of 10245 women with GDM based on the National Registry of GDM. A receiver-operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance of third trimester HbA1c in PDM prediction.The mean third trimester HbA1c level was 5.81% (SD 0.69%) in women who developed PDM, 5.40% (SD 0.52%) in women with pre-diabetes and 5.21% (SD 0.43%) in women with normal glucose tolerance in postpartum OGTT, with statistically significant differences (p 0.0001). As to the ROC curve ability to predict PDM was fair, with an optimal cut-off point of HbA1c of 5.4%. Women presenting HbA1c values ≥ 5.4% were 6.1 times more likely to develop PDM.A third trimester HbA1c level ≥5.4% is associated with a significant higher risk of PDM (p 0.0001). It could be used as a reliable tool for screening women with GDM and detect who will benefit the most from a close follow-up after pregnancy.

The patient is a 28-year-old G2P1, with no relevant medical history and a non-consanguineous partner. She presented with an uncomplicated pregnancy, without known history of consumption of teratogenic drugs and a low risk first trimester combined screening for aneuploidies with normal nuchal

This paper presents an efficient method to measure real-world distance between interest points of a 3-D objectusing a camera, two laser distance sensors and Image Processing techniques. This method consists of calculating the distance between interest points of an object in the image plane. Two laser distance sensors placed next to the camera measure accurately the distance between the camera and the object. Moreover, the laser dots generated by the distance sensors are visible in the image, acting as a reference along with the distance measures in the calculations. As a result, thecalculation of the interest point's coordinate on the camera 3-D space is transformed in a real-world distance between interest points. Through a set of experiments, we show that the proposed system measures distancesup to 70 mm with sub-mm accuracy. The results suggest a potential use of our method in many other Computer Vision applications, including industrial applications.

Animal experiments have gained importance in human diseases studies, namely neurological diseases and its biomechanical and physiological aspects. As a model of human disease, the rat offers many advantages over other organisms. For the biomechanical aspects of locomotion these studies are based on the analysis of animals’ kinetic parameters, accessed through a locomotion measurement system. However, these systems are not yet thoroughly developed, are still scarce and are also very expensive when developed for studies using small rodents. In this paper, a system capable of measuring contact forces of small rodents is presented. The platform hardware is based on a 5 × 3 matrix of ultra-sensitive force sensors that produce a set of signals acquired in a LabVIEW TM environment, used for data acquisition and processing. The post processing steps include the removal of null data, curve normalization related to the rat’s weight and expressed as percentage of passage, resulting in a gait pattern. The proposed cost-effective system has achieved excellent results regarding the locomotion profile of healthy animals.

Introduction This paper presents a complete approach for the automatic classification of heartbeats to assist experts in the diagnosis of typical arrhythmias, such as right bundle branch block, left bundle branch block, premature ventricular beats, premature atrial beats and paced beats. Methods A pre-processing step was performed on the electrocardiograms (ECG) for baseline removal. Next, a QRS complex detection algorithm was implemented to detect the heartbeats, which contain the primary information that is employed in the classification approach. Next, ECG segmentation was performed, by which a set of features based on the RR interval and the beat waveform morphology were extracted from the ECG signal. The size of the feature vector was reduced by principal component analysis. Finally, the reduced feature vector was employed as the input to an artificial neural network. Results Our approach was tested on the Massachusetts Institute of Technology arrhythmia database. The classification performance on a test set of 18 ECG records of 30 min each achieved an accuracy of 96.97%, a sensitivity of 95.05%, a specificity of 90.88%, a positive predictive value of 95.11%, and a negative predictive value of 92.7%. Conclusion The proposed approach achieved high accuracy for classifying ECG heartbeats and could be used to assist cardiologists in telecardiology services. The main contribution of our classification strategy is in the feature selection step, which reduced classification complexity without major changes in the performance.

Background: Evidence regarding biomarkers for risk prediction in patients with infective endocarditis (IE) is limited. We aimed to investigate the value of a panel of biomarkers for the prediction of in-hospital mortality in patients with IE. Methods: Between 2016 and 2018, consecutive IE patients admitted to the emergency department were prospectively included. Blood concentrations of nine biomarkers were measured at admission (D0) and on the seventh day (D7) of antibiotic therapy: C-reactive protein (CRP), sensitive troponin I (s-cTnI), procalcitonin, B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin 6 (IL6), tumor necrosis factor α (TNF-α), proadrenomedullin, alpha-1-acid glycoprotein, and galectin 3. The primary endpoint was in-hospital mortality. Results: Among 97 patients, 56% underwent cardiac surgery, and in-hospital mortality was 27%. At admission, six biomarkers were independent predictors of in-hospital mortality: s-cTnI (OR 3.4; 95%CI 1.8–6.4; P

BACKGROUND Both increased carotid intima-media thickness (cIMT) and low heart rate variability (HRV) have been associated with cardiovascular mortality and morbidity. Thus, the aim of this study was to investigate whether cardio autonomic alterations are accompanied or not by subclinical atherosclerosis in participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS cIMT measures and 5-min HRV analyses were performed in apparently healthy adults. Heart rate variability was evaluated by linear time and frequency domain analyses. cIMT was defined as the average between the mean left and mean right cIMT values and was analysed as continuous and categorized variables (P≥75 or P

Background: Appropriate use of antimicrobials is essential to improve outcomes in sepsis. The aim of this study was to determine whether the use of a rapid molecular blood test - SeptiFast (SF) reduces the antibiotic consumption through early de-escalation in patients with nosocomial sepsis compared with conventional blood cultures (BCs). Methods: This was a prospective, randomized, superiority, controlled trial conducted at Sao Paulo Heart Institute in the period October 2012-May 2016. Adult patients admitted to the hospital for at least 48 h with a diagnosis of nosocomial sepsis underwent microorganism identification by both SF test and BCs. Patients randomized into the intervention group received antibiotic therapy adjustment according to the results of SF. Patients randomized into the control group received standard antibiotic adjustment according to the results of BCs. The primary endpoint was antimicrobial consumption during the first 14 days after randomization. Results: A total of 200 patients were included (100 in each group). The intention to treat analysis found no significant differences in median antibiotic consumption. In the subgroup of patients with positive SF and blood cultures (19 and 25 respectively), we found a statistically significant reduction in the median antimicrobial consumption which was 1429 (1071-2000) days of therapy (DOT)/1000 patients-day in the intervention group and 1889 (1357-2563) DOT/1000 patients-day in the control group (p = 0.017), in the median time of antimicrobial de-escalation (8 versus 54 h - p < 0.001), in the duration of antimicrobial therapy (p = 0.039) and in anti-gram-positive antimicrobial costs (p = 0.002). Microorganism identification was possible in 24.5% of patients (45/184) by SF and 21.2% (39/184) by BC (p = 0.45). Conclusion: This randomized clinical trial showed that the use of a rapid molecular-based pathogen identification test does not reduce the median antibiotic consumption in nosocomial sepsis. However, in patients with positive microbiological tests, the use of SeptiFast reduced antimicrobial consumption through early de-escalation compared to conventional blood cultures. These results were driven by a reduction in the consumption of antimicrobials used for Gram-positive bacteria. Trial registration: The trial was registered at ClinicalTrials.gov (NCT 01450358) on 12th October 2011, SCOPUS: ar.j, info:eu-repo/semantics/published

In this paper, we propose HealthDash, a framework for developing IoT solutions for health care. HealthDash employs the data-flow-oriented pro- gramming paradigm, from the cloud layer to the network edge (fog layer), unifying development technologies across layers, that is, from edge devices to decision making. We conducted an experiment to evaluate the proposal with the simulation of the transmission of data collected from home-monitored pati- ents with chronic diseases. In the simulation, we observed the performance of the two implemented solutions to both continuous and event-based scenarios of data transmission. The results showed that HealthDash solution provides flexi- ble infrastructure, consuming less bandwidth and spending little response time.

Aim To investigate whether heart rate variability (HRV) is a predictor for the incidence of diabetes in a 4-year follow-up. Materials and methods The HRV of 9192 participants free of diabetes was analysed in time and frequency domains and stratified based on the reference values presented in the literature. The participants were then allocated to one of three groups, according to age-specific value distributions for each HRV domain: lower than the 25th percentile, between the 25th and 75th percentiles, and higher than the 75th percentile. The association between HRV and diabetes incidence at 4-year follow-up was analysed using Poisson regression models with robust estimator. Results Six hundred thirty-four participants (6.90%) developed diabetes within 4 years and five out of six HRV analysed indices showed increased relative risk of developing diabetes associated with low HRV: SDNN (RR = 1.29; 95% CI, 1.09-1.52; .003), pNN50 (RR = 1.33; 95% CI, 1.11-1.58; .001), RMSSD (RR = 1.29; 95% CI, 1.09-1.53; .004), LF (RR = 1.25; 95% CI, 1.05-1.48; .012), and HF (RR = 1.39; 95% CI, 1.16-1.63; .001). Conclusions This study suggests that both overall variability and changes in parasympathetic modulation precede the incidence of diabetes. For four HRV indices below the 25th percentile, the risk for incident diabetes was 68% higher than for those participants who presented none. We concluded that HRV is an independent risk predictor of diabetes in a 4-year period.

Objectives: The aim of this study was to elaborate on and validate a score for the early diagnosis of mediastinitis after cardiothoracic surgery. Methods: Between 2007 and 2017, patients who experienced thoracic surgical-site infection after cardiothoracic surgery were enrolled. Laboratory, clinical, and chest CT findings were retrospectively analyzed. Patients were followed up until hospital discharge or intra-hospital death. Univariate and multivariate regression analyses were performed. Results: 950 surgical-site infections were found and analyzed (131 mediastinitis, 819 superficial/deep infections). Of the 131 mediastinitis episodes, 88% required surgical thoracic debridement,Staphylococcus aureus was identified in 43%, and overall mortality was 42%. The following variables were related to mediastinitis diagnosis: sternal diastasis (OR = 2.5; 95% confidence interval [95%CI]: 1.2–5.3; P = 0.012), bilateral pleural effusion (OR = 1.9; 95%CI: 1.0–3.6; P = 0.04), leukocyte count ≥14,000cells/mm3 (OR = 2.5; 95%CI: 1.3–4.7; P = 0.006), male sex (OR = 2; 95%CI: 1.11–4; P = 0.022), and positive blood culture (OR = 3.0; 95%CI: 1.6–5.6; P = 0.001). The score predicted with reasonable accuracy mediastinitis in the derivation cohort (AUC-ROC, 0.7476) and the validation cohort (AUC-ROC, 0.7149). Groups with high (31%) and low (5%) risk of mediastinitis were identified. Conclusions: An early diagnostic score in patients with surgical-site infection after cardiothoracic surgery identified groups with a low and high risk for mediastinitis. Keywords: Mediastinitis, Diagnosis, Surgical site infections

Agricultural greenhouses have improved productivity in the cultivation of specific crops. Efforts towards the automation of these environments have been carried out with the application of different technologies. However, the absence of a solution that comprises a complete chain of the automation process has been noted. Internet of Things (IoT) is a technology that can offer solutions for the modernization of agricultural environments, making it possible to automate processes, to predict situations, and to improve production activities. Moreover, IoT solutions and businesses process should be integrated into a common framework to provide a more efficient production process control, since business rules are often dynamic and might vary according to agriculture practices. In this fashion, we propose an architecture for sensing and actuating in controlled agricultural environments using business rules modeling as the central artifact for the automation of production chains. To validate the proposed architecture, we present a case study in which we describe the implementation and tools to support vegetable production. The study showed that the architecture is feasible to monitor crops, to collaborate to maximize yield and to control the use of inputs and agrochemicals. Furthermore, it caters for culture monitoring in real time, offering information to producers to aid decision making.

Nausea and vomiting are frequent side effects associated with chemotherapy treatments. The aim of this study was to evaluate the efficacy of laser acupuncture in relieving nausea and vomiting in children and adolescents undergoing laser treatment. This is an experimental, randomized, single-blind study. The research was carried out at the INCA (Instituto Nacional de Câncer), a reference institution in the control and treatment of cancer, located in the city of Rio de Janeiro, Brazil. The research project was approved by the INCA Research and Ethics Committee under Registration No. 164/14 and CAAE 3374551.0.3001.5274. Children and adolescents between the ages of 6 and 17 years who were undergoing chemotherapy with drugs of high and medium degrees of emetogenic toxicity were selected. The participants were divided into two groups, A and B. In A, the active acupuncture was applied, and in B, the placebo acupuncture was applied. Analysis of the data indicated that there was significant relief from nausea in the intervention group when compared with the placebo group. A decrease in the number of episodes of vomiting on the second and third days of chemotherapy was also observed. On Days 1, 4, and 5, there was no significant difference in the number of episodes of vomiting in the intervention group as compared with the placebo group. The study concluded that laser acupuncture was effective in relieving nausea within 5 days of chemotherapy and in reducing the number of episodes of vomiting on Days 2 and 3 after chemotherapy.

Background 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) has emerged as a useful diagnostic tool for suspected infective endocarditis (IE) in patients with prosthetic valves or implantable devices. However, there is limited evidence regarding use of 18F-FDG-PET/CT for the diagnosis of native valve endocarditis (NVE). Methods Between 2014 and 2017, 303 episodes of left-sided suspected IE (188 prosthetic valves/ascending aortic prosthesis and 115 native valves) were studied. 18F-FDG-PET/CT accuracy was determined in the subgroups of patients with NVE and prosthetic valve endocarditis (PVE)/ascending aortic prosthesis infection (AAPI). Associations between inflammatory infiltrate patterns and 18F-FDG-PET/CT uptake were investigated in an exploratory ad hoc histological analysis. Results Among 188 patients with PVE/AAPI, the sensitivity, specificity, and positive and negative predictive values of 18F-FDG-PET/CT focal uptake were 93%, 90%, 89%, and 94%, respectively, while among 115 patients with NVE, the corresponding values were 22%, 100%, 100%, and 66%. The inclusion of abnormal 18F-FDG cardiac uptake as a major criterion at admission enabled a recategorization of 76% (47/62) of PVE/AAPI cases initially classified as "possible" to "definite" IE. In the histopathological analysis, a predominance of polymorphonuclear cell inflammatory infiltrate and a reduced extent of fibrosis were observed in the PVE group only. Conclusions Use of 18F-FDG-PET/CT at the initial presentation of patients with suspected PVE increases the diagnostic capability of the modified Duke criteria. In patients who present with suspected NVE, the use of 18F-FDG-PET/CT is less accurate and could only be considered a complementary diagnostic tool for a specific population of patients with NVE.

Aspectos clinicos A doenca de Chagas foi primeiramente descrita pelo medico e cientista brasileiro Carlos Chagas em 1909. Essa doenca multifacetada e causada pelo protozoario Trypanossoma cruzi, que pode ser transmitido de diversas formas. A transmissao vetorial por meio de insetos hematofagos e a mais classica, mas diminuiu de importância nos ultimos anos com medidas para controle da populacao do vetor. A transmissao transfusional assim como a transmissao vetorial, tiveram uma reducao drastica nas ultimas decadas, sendo que nao se [...]

Background : Urinary tract infection in dogs is usually associated with the presence of bacteria, with a higher prevalence of Gram-negative bacteria, represented mainly by enteric bacteria such as Escherichia coli and Proteus spp., followed by Gram-positive bacteria such as Staphylococcus spp., and Streptococcus spp. There are scant reports of Salmonella spp. as the causative agent of urinary tract infection in dogs. Indeed, the literature describes only a few cases, most of which involve the isolation of these bacteria in feces. This paper reports a case of canine cystitis caused by Salmonella enterica subsp. enterica in the northeast region of Brazil. Case : A female dog of the Fila Brasileiro breed, about 9 year-old, wormed but unvaccinated, was evaluated at the Veterinary Hospital of the Federal University of Pernambuco – UFRPE. The dog showed clinical signs of apathy, cachexia, polyphagia, polyuria and opacity of the crystalline lens. The dog’s owner stated that the animal was fed with commercial dog food. In the clinical exam, the patient presented pale mucosa, cachexia, absence of ectoparasites, and her rectal temperature was 39.5°C. Moreover, cardiorespiratory auscultation of the patient revealed tachycardia (190 bpm) and tachypnea (36 bpm). The owner’s main complaint was the clinical condition of frequent urination (polyuria). A urinalysis and urine culture with antibiogram were requested as complementary exams, after collecting the urine by cystocentesis. The volume obtained in the physical examination of urinalysis was 7 mL of yellow urine with a putrid smell, cloudy appearance and density of 1.024. The chemical examination revealed pH 6.5, protein (+++), bilirubin (+), normal urobilinogen and negative reactions for glycoses, ketone, nitrite and urine occult blood. Bacteriuria and pyuria were detected in a urine sediment test. Urine was cultured on blood agar and Levine agar in a bacteriological incubator at 37°C under aerobiosis, for 24 h. This culture produced an exuberant and pure growth of glossy grey bacterial colonies on blood agar and glossy colonies on Levine agar. The Gram test revealed gram-negative bacilli. The sample was subjected to biochemical tests to identify Gram-negative enterobacteria, whose results provided a presumptive identification of Salmonella species. The microbial species was identified using a VITEK 2 Compact ® , and was followed by a serology test for the identification of the serogroup using a polyvalent serum, which enabled the identification of Salmonella enterica subsp. enterica . The antibiogram showed sensitivity to ciprofloxacin, gentamicin and penicillin, and resistance to amoxicillin and ampicillin. Discussion : Clinical signs of cachexia and polyuria may be related to canine urinary tract infection caused by Salmonella enterica subsp. enterica , since these symptoms had already been recorded previously in a case of a bacterial infection by the same serogroup. Isolation of Salmonella spp. in a non-selective medium was determinant in identifying these bacteria. Since these are not commensal bacteria of the canine urinary tract, their isolation in this tract indicates that they are responsible for the infection or disease, although such cases are rare. Another aspect that should be highlighted is the risk of human infection, because of the zoonotic potential of Salmonella spp., which may be transmitted by contact with dog urine. This is the first report of the isolation of Salmonella enterica subsp. enterica in a case of canine cystitis on the northeast region of Brazil, and underscores the importance of complementary diagnostic exams such as urine culture.

Supplemental Digital Content is available in the text, Subclinical hypothyroidism (SCHypo) is associated with autonomic disturbances that can interfere in physiological responses. This study was designed to evaluate linear and nonlinear variables of heart rate variability (HRV) following postural change, comparing subjects with SCHypo to euthyroid subjects. HRV analyses were performed in 5-minute time series collected in the supine and standing positions from a subsample of 855 participants of the ELSA-Brasil study. The cardiac autonomic nervous function was evaluated by linear time and frequency domain analyses (SDNN, RMSSD, LFms2, HFms2, and LF/HF ratio) as well as by nonlinear symbolic dynamics (0, 1, and 2 V). After exclusions, 509 (92.0%) euthyroid and 44 (8.0%) SCHypo participants were eligible for analyses. At the baseline supine rest measurement, the 0 V symbolic pattern was higher (27.7 vs 25.4, P = .02) and 2 V was lower (18.0 vs 22.9, P = .02) than in the euthyroid group. Comparing the variation between positions, the 0 V pattern showed a lower delta in SCHypo than in Euthyroid subjects (8.0 vs 10.8%, P = .04). SCHypo presented lower sympathetic and parasympathetic tonus at rest and a blunted sympathetic response to active postural change, marked by reduced variation in the 0 V of symbolic analysis (SA). Additionally, it is suggested that SA of HR dynamics is an alternative and, possibly, a more sensitive method for cardiac autonomic assessment following orthostatism in this population.

This paper presents a systematic procedure to fairly compare experimental performance scores for machine learning methods for fault diagnosis based on vibration signals. In the vast majority of related scientific publications, the estimated accuracy and similar performance criteria are the sole quality parameter presented. However, the experimental design giving rise to these results is mostly biased, based on unacceptably simple validation methods and on recycling identical patterns in test data sets, previously used for training. Moreover, the methods in general overfit their hyperparameters, introducing additional overoptimistic results. In order to remedy this defect, we critically analyse the usual training-validation-test division and propose an algorithmic guideline in the form of a validation framework. This allows a well defined comparison of experimental results. In order to illustrate the ideas of the paper, the Case Western Reserve University Bearing Data benchmark is used as a case study. Four distinct classifiers are experimentally compared, under gradually more difficult generalization tasks using the proposed evaluation framework: K-Nearest-Neighbor, Support Vector Machine, Random Forest and One-Dimensional Convolutional Neural Network. An extensive literature review suggests that most vibration based research papers, particularly for the Case Western Reserve University Bearing Data, use similar patterns for training and testing, making their classification an easy task.

Purpose Heart transplant(HT) recipients with SARS-CoV-2 infection may be at high risk of developing critical illness. The aim was to describe the characteristics and clinical outcomes of HT recipients with coronavirus-19 disease(COVID-19). Methods We prospectively included all adult HT recipients who received the diagnosis of COVID-19 in our institution. Inclusion criteria were one or more clinical symptoms of SARS-CoV-2 infection in the previous seven days and positive SARS-CoV-2 RT-PCR in nasopharyngeal samples. The enrollment was carried out from April to June, 2020. Demographic features, clinical characteristics, modes of transmission, laboratory data and other known prognosis markers at admission and through follow up were recorded. Patients were categorized according to the ordinal scale developed by WHO Committee. Outcomes and follow up were recorded until Aug/2020. Results Twenty-one HT recipients were included, most of them were men (57%); with median age of 48 years old and median HT time of 12 mo. The majority needed hospitalization. Immunosuppressive therapy was reduced or withdrawn in the majority of patients, except from steroids. Ten patients were classified as having severe disease according to WHO Committee scale. Lymphopenia was an independent predictor of severe disease and absolute lymphocyte count

O estudo teve como objetivo caracterizar a produção científica sobre uso da acupuntura na Doença de Parkinson. Método: Revisão integrativa da literatura realizada em novembro de 2020, nas bases de dados LILACS, MEDLINE e PUBMED com os descritores: Acupuntura e Doença de Parkinson. Para seleção das produções foram critérios de inclusão: artigos publicados entre 2015 a 2020, nos idiomas português e inglês e de exclusão: editoriais, revisões de literatura, modelos animais e estudos duplicados. Resultados: Identificaram-se 29 artigos que, após leitura dos resumos e títulos e aplicação dos critérios de inclusão e exclusão culminou na seleção de quatro artigos como amostra deste estudo. Dentre os quatro artigos todos foram escritos em inglês, três eram estudos randomizados e um do tipo antes e depois; dois realizaram a intervenção durante oito semanas, um durante cinco e o outro durante três semanas. Os estudos abordaram o uso da acupuntura para as sintomatologias fadiga, distúrbios do sono e alterações motoras e os autores concluíram que a acupuntura é efetiva para melhorar a qualidade de vida dos pacientes com Doença de Parkinson. Conclusão: a acupuntura é viável de ser utilizada para amenizar sintomas do Parkinson. Contudo, constatou-se que o tema ainda é pouco explorado nas pesquisas e aponta necessidade de novos estudos para ampliar as evidências científicas sobre a efetividade do uso da acupuntura como prática não farmacológica no tratamento da Doença de Parkinson.