LCD-OpenPACS: sistema integrado de telerradiologia com auxílio ao diagnóstico de nódulos pulmonares em exames de tomografia computadorizada

Lung cancer is one of the most common types of cancer and has the highest mortality rate. Patient survival is highly correlated with early detection. Computed Tomography technology services the early detection of lung cancer tremendously by offering aminimally invasive medical diagnostic tool. However, the large amount of data per examination makes the interpretation difficult. This leads to omission of nodules by human radiologist. This thesis presents a development of a computer-aided diagnosis system (CADe) tool for the detection of lung nodules in Computed Tomography study. The system, called LCD-OpenPACS (Lung Cancer Detection - OpenPACS) should be integrated into the OpenPACS system and have all the requirements for use in the workflow of health facilities belonging to the SUS (Brazilian health system). The LCD-OpenPACS made use of image processing techniques (Region Growing and Watershed), feature extraction (Histogram of Gradient Oriented), dimensionality reduction (Principal Component Analysis) and classifier (Support Vector Machine). System was tested on 220 cases, totaling 296 pulmonary nodules, with sensitivity of 94.4% and 7.04 false positives per case. The total time for processing was approximately 10 minutes per case. The system has detected pulmonary nodules (solitary, juxtavascular, ground-glass opacity and juxtapleural) between 3 mm and 30 mm.

Ventilação e prescrições urbanísticas: uma aplicação simulada no bairro de Petrópolis em Natal/RN

The present work studies the natural ventilation and its relationship with the urban standards, which establishes the form of occupation and use of the land in our cities. The method simulates the application of the urban standards of the City Master Plan over the last three years. The simulation takes place in the District of Petrópolis, in the city of Natal , Brazil and analyses the effects of the standards of natural ventilation. The formulated hypothesis states that the reductions in the urban spaces between buildings rises up the vertical profile of ventilation, reducing, therefore, the velocity of the wind at the lower levels of the buildings. To develop the study, occupation models were built, using computerized, three-dimensional models. These occupation models were analyzed using the CFD (Computational Fluid Dynamics) code. The conclusion is that the more we reduce the urban space between buildings, the more we reduce the wind speed in constructed areas, increasing, therefore, the possibility to generate heat islands

Anormalidades cardiovasculares e metabólicas em pacientes com a síndrome de Berardinelli - SEIP

A Síndrome de Berardinelli-Seip (SBS) ou Lipodistrofia Generalizada Congênita acomete freqüentemente o aparelho cardiovascular e também promove anormalidades metabólicas envolvendo os metabolismos glicídico e lipídico. O objetivo do nosso trabalho foi avaliar a prevalência das anormalidades cardiovasculares e metabólicas em portadores da SBS. Vinte e dois pacientes do estado do Rio Grande do Norte (Brasil), com diagnóstico da SBS, foram submetidos à avaliação clinica, eletrocardiograma de repouso, ecodopplercardiograma, radiografia de tórax, eletrocardiografia dinâmica de 24 horas, teste ergométrico e análise laboratorial. Os pacientes eram predominantemente adultos jovens (n=22) , sendo 14 do sexo feminino. O mais novo tinha 8 e o mais velho 44 anos(22,4±9,7 anos). A totalidade da amostra apresentou resistência à insulina, acanthosis nigricans e HDL-colesterol diminuído. A presença de esplenomegalia, hepatomegalia, diabetes mellitus tipo II e triglicérides elevados eram constantes. A síndrome metabólica foi caracterizada em 81,8% dos pacientes com predominância para sexo feminino e com um alto grau de consangüinidade paterna (86,4%). A hipertensão arterial sistêmica e pré-hipertensão foram encontradas em mais da metade dos pacientes (77.3%). O eletrocardiograma e a radiografia de tórax não foram úteis para identificar a presença de anormalidades cardíacas na SBS, em particular a presença de hipertrofia ventricular esquerda. Para identificar o acometimento cardiovascular foi indispensável o estudo ecodopplercardiografico. Este exame mostrou a presença de hipertrofia concêntrica do ventrículo esquerdo (50%), hipertrofia excêntrica do ventrículo esquerdo (4,5%) e geometria normal do ventrículo esquerdo (45,5%). Disfunção sistólica do ventrículo esquerdo foi encontrada em apenas um paciente (4,5%) e disfunção diastólica em nenhum. Elevada taxa de arritmia foi evidenciada no Holter, tais como, extra-sístoles ventriculares, extra-sístoles supraventriculares e taquicardia supraventricular sustentada. Incompetência cronotrópica (54,5%) foi observada no teste ergométrico. Anormalidades cardiovasculares e metabólicas foram encontradas em elevada prevalência em indivíduos jovens e assintomáticos com SBS. Esses achados xii apontam para a necessidade de acompanhamento cardiológico sistemático e de medidas preventivas nesse grupo de risco

Análise do estado da arte dos aspectos diagnóticos, periciais e jurisprudenciais das LER/DORT no contexto previdenciário das doenças do trabalho no Brasil

Objetivo: analisar o estado da arte dos aspectos diagnósticos, periciais e jurisprudenciais das LER/DORT (Lesões por Esforços Repetitivos / Distúrbios Osteomusculares Relacionados ao Trabalho) no Brasil. Materiais e Método: trata-se de pesquisa descritiva, de natureza qualitativa, com formato documental, utilizando-se a técnica de análise de conteúdo. A avaliação evolutiva da legislação previdenciária relacionada as LER/DORT foi realizada através da pesquisa no banco de dados disponibilizado pelo Governo Federal e mediante a consulta ao DATAPREV/Sislex. A avaliação dos aspectos diagnósticos foi instrumentalizada através, principalmente, de artigos científicos publicados entre 2003 e 2008, nas línguas portuguesa, inglesa, espanhola e francesa, relacionados com os métodos de diagnósticos complementares das LER-DORT (ressonância magnética, tomografia computadorizada, ultrassonografia e eletroneuromiografia). As jurisprudências foram obtidas através da busca dos julgados sobre o tema, entre 2003 e 2008, pertencentes ao Supremo Tribunal Federal, Superior Tribunal de Justiça, Tribunais Regionais Federais, Tribunal Superior do Trabalho e Tribunais Regionais do Trabalho. Resultados: foram identificados 48 artigos abordando os aspectos diagnósticos das LER-DORT, observando-se que os exames por ressonância magnética, ultrassonografia e eletromiografia demonstraram ser mais efetivos, dentro das suas especificidades, para a complementação do exame clínico de patologias relacionadas às LER-DORT. A análise das 123 jurisprudências selecionadas demonstrou, de forma geral, que as LER-DORT equiparam-se ao acidente de trabalho, devendo apresentar nexo de causalidade (atestado através de laudo médico-pericial) e, ainda, ensejam a ação por danos morais, a qual, devido à EC nº 45 passou a ser competência da Justiça do Trabalho. O Estado da arte dos aspectos periciais encontra-se representado pela vigência da Instrução Normativa n. 98/2003, a qual traz como aspecto fundamental a determinação de novos parâmetros a serem considerados na definição de um quadro de LER-DORT, dispondo, ainda, sobre a conduta ética que deve ser adotada pelo médico perito, bem como chama a atenção para a necessidade dessas doenças do trabalho serem comunicadas às autoridadades competentes, através da emissão da Comunicação de Acidente de Trabalho (CAT). Conclusão: as LER-DORT representam, hoje, um problema de importante impacto, não apenas previdenciário, mas também econômico em diversos países, nos quais o Brasil encontra-se inserido. Estudos sobre o estado da arte relacionados às LER-DORT são fundamentais para auxiliar na construção de um modelo crítico e consciente que colabore com a garantia de sustentabilidade do sistema previdenciário no Brasil

Função autonômica em pacientes portadores de lipodistrofia generalizada congênita - sindrome de berardinelli - SEIP

A Síndrome de Berardinelli-Seip ou Lipodistrofia Generalizada Congênita (LGC) é uma doença rara, com transmissão autossômica recessiva, caracterizada principalmente pela ausência quase total de tecido adiposo. Os pacientes afetados apresentam resistência a insulina, dislipidemia e hipertensão arterial. Estudos têm evidenciado que estas alterações metabólicas interferem na modulação autonômica para o nó sinusal. O principal objetivo deste estudo foi investigar a modulação autonômica em pacientes portadores de LGC, através da variabilidade de freqüência cardíaca (VFC), pelo método linear de domínio de tempo na Eletrocardiografia Dinâmica de 24 horas e estabelecer um critério relativamente simples, não invasivo, para diagnóstico de disfunção autonômica nestes pacientes. Participou voluntariamente deste estudo transversal, um grupo de pacientes portadores de LGC (n=18) na faixa etária de 9,3 a 39,8 anos (21,3 ± 8,3) cuja variabilidade de freqüência cardíaca foi comparada com um grupo de pacientes controles (n=19) com idade de 9,3 a 39,1 anos (21,4 ± 7,8). Todos os voluntários foram submetidos à avaliação clínica, laboratorial, antropométrica e análise de VFC no domínio de tempo através de eletrocardiografia dinâmica de 24 horas. Para análise dos dados relativos aos índices temporais de VFC foram utilizados o MeanRR, SSDN e rMSSD. Pacientes com LGC apresentavam aumento da pressão arterial comparados com indivíduos do grupo controle (sistólica, 131,1 vs 106,3 mmHg, p<0,05); diastólica, 85,0 vs 68,2 mmHg, p<0,05) e 10 tinham critérios para diagnóstico de Hipertensão Arterial e Hipertrofia do Ventrículo Esquerdo. Os níveis de glicose, triglicerídeos, colesterol e HOMA-R eram elevados e 12 pacientes tinham critérios para diabetes mellitus tipo 2. Comparado com os controles, pacientes com LGC tinham diminuição dos índices MeanRR (639,8 vs 780,5 ms, p<0,001), SDNN (79,2 vs 168,5 ms, p<0,001), e rMSSD (15,8 vs 59,6 ms, p<0,001). Em pacientes com LGC, a redução da VFC foi independente de distúrbios metabólicos e hemodinâmicos. Os resultados de nosso experimento indicam que pacientes com LGC apresentavam modulação autonômica anormal caracterizada pelo aumento da freqüência cardíaca e pronunciada redução da VFC, independente de distúrbios metabólicos e hemodinâmicos observados nesta síndrome. O caráter multidisciplinar desse estudo fica contemplado pela interação de profissionais de diversas áreas como: cardiologia, endocrinologia, metabolismo, neurologia, nutrição, etc

Eficácia do treinamento de força sobre parâmetros cardiovasculares e antropométricos em adultos sedentários

This study aimed to determine the influence of strength training (ST), in three weekly sessions over ten weeks, on cardiovascular parameters and anthropometric measurements. It is a before and after intervention trial, with a sample composed of 30 individuals. Participants were adults aged between 18 and 40 years, from both sexes and sedentary for at least three months previously. Tests were computed ergospirometry, CRP, PWV and body composition (dependent variables) before and after the experiment. Independent variables, age and sex, were considered in order to determine their influence on the dependent variablesevaluatedend. By comparing the initial cardiovascular parameters with those obtained after intervention in patients undergoing the ST proposed (a Student s t-test was conducted within each group for samples matched to parameters with normal distribution, while the Wilcoxin was applied for those without), there was no significant difference in PWV(p =0469) or PCR(p =0.247), but there was an increase in anaerobic threshold(AT) (p=0.004) and Maximal Oxygen Uptake(VO2max) (p =0.052). In regard to anthropometric measures, individuals significantly reduced their body fat percentage (p<0.001) and fat mass (p<0,001), as well as increasing lean mass (p<0.001). However, no changes were recorded in the waist-to-hip ratio (WHR) (p= 0.777), body mass (p=0.226) or body mass index (BMI) (p =0.212). Findings of this study lead us to believe that the proposed ST, and did not increase the VOP or PCR improves cardiorespiratory capacity and body composition. Devotees of this training can therefore safely enjoy all its benefits without risk to the cardiovascular system

Desempenho muscular e equilíbriu postural em idosas frágeis residentes na comunidade

Human aging is physiological process causes alterations in several systems of the organism. In the musculoskeletal system, a main change is the decreased muscle strength, that in the lower extremity, compromises the ability to respond quickly with enough strength to prevent falls, causing alterations in postural balance. Currently, many researchers have study the human frailty, defined as a multifactorial syndrome, with excess of vulnerability to stressors, reducing ability in maintaining or regulating homeostasis. Its characteristics are directly related to physical function. Aim: To analyze muscle performance and postural balance in frail and pre-frail elderly women, and to compare them according with the frailty phenotypes criteria proposed by Fried 2001. Method: 39 frail elderly women living in the community, aged 65 years and older, were assessed muscle performance of lower extremity using isokinetic dynamometer and postural balance using Berg s balance scale and computerized baropodometry. Results: There was significant difference in plantar flexor, knee flexor and knee extensor strength, in anteroposterior (AP) oscillation with eyes open and on Berg s scores between groups. A weak correlation was observed between strength and balance. Conclusion: The results suggest that the frail elderly present worse muscle performance in lower extremity and worse postural balance compared to the pre-frail elderly. There were correlations between muscle performance and balance impairments in these elderly, but several variables are also involved in maintaining postural balance

RR3D: Uma solução para renderização remota de imagens médicas tridimensionais

The visualization of three-dimensional(3D)images is increasigly being sed in the area of medicine, helping physicians diagnose desease. the advances achived in scaners esed for acquisition of these 3d exames, such as computerized tumography(CT) and Magnetic Resonance imaging (MRI), enable the generation of images with higher resolutions, thus, generating files with much larger sizes. Currently, the images of computationally expensive one, and demanding the use of a righ and computer for such task. The direct remote acess of these images thruogh the internet is not efficient also, since all images have to be trasferred to the user´s equipment before the 3D visualization process ca start. with these problems in mind, this work proposes and analyses a solution for the remote redering of 3D medical images, called Remote Rendering (RR3D). In RR3D, the whole hedering process is pefomed a server or a cluster of servers, with high computational power, and only the resulting image is tranferred to the client, still allowing the client to peform operations such as rotations, zoom, etc. the solution was developed using web services written in java and an architecture that uses the scientific visualization packcage paraview, the framework paraviewWeb and the PACS server DCM4CHEE.The solution was tested with two scenarios where the rendering process was performed by a sever with graphics hadwere (GPU) and by a server without GPUs. In the scenarios without GPUs, the soluction was executed in parallel with several number of cores (processing units)dedicated to it. In order to compare our solution to order medical visualization application, a third scenario was esed in the rendering process, was done locally. In all tree scenarios, the solution was tested for different network speeds. The solution solved satisfactorily the problem with the delay in the transfer of the DICOM files, while alowing the use of low and computers as client for visualizing the exams even, tablets and smart phones

Análise cefalométrica: ortodontistas x radiologistas

Cephalometric analysis is the mensuration of linear and angular measures through demarcation points as distances and lines on teleradiography, and is considered of fundamental importance for diagnosis and orthodontic planning. In this manner, the objective of this research was to compare cephalometric measurements obtained by dentists and radiologists from the analysis of the same radiograph, in a computerized cephalometric analysis program. All research participants marked 18 cephalometric points on a 14-inch notebook computer, as directed by the program itself (Radiocef 2®). From there, they generated 14 cephalometric parameters including skeletal, dental-skeletal, dental and soft tissue. In order to verify the intra-examiner agreement, 10 professionals from each group repeated the marking of the points with a minimum interval of eight days between the two markings. The intra-group variability was calculated based on the coefficients of variation (CV). The comparison between groups was performed using the Student t-test for normally distributed variables, and using the Mann-Whitney test for those with non-normal distribution. In the group of orthodontists, the measurements of Pog and 1-NB, SL, S-Ls Line, S-Li Line and 1.NB showed high internal variability. In the group of radiologists, the same occurred with the values of Pog and 1-NB, S-Ls Line, S-Li Line and 1.NA. In the comparison between groups, all the analyzed linear values and two angular values showed statistically significant differences between radiologists and dentists (p <0.05). According to the results, the interexaminer error in cephalometric analysis requires more attention, but does not come from a specific class of specialists, being either dentists or radiologists.

Ventilação e prescrições urbanísticas: uma aplicação simulada no bairro de Petrópolis em Natal/RN

The present work studies the natural ventilation and its relationship with the urban standards, which establishes the form of occupation and use of the land in our cities. The method simulates the application of the urban standards of the City Master Plan over the last three years. The simulation takes place in the District of Petrópolis, in the city of Natal , Brazil and analyses the effects of the standards of natural ventilation. The formulated hypothesis states that the reductions in the urban spaces between buildings rises up the vertical profile of ventilation, reducing, therefore, the velocity of the wind at the lower levels of the buildings. To develop the study, occupation models were built, using computerized, three-dimensional models. These occupation models were analyzed using the CFD (Computational Fluid Dynamics) code. The conclusion is that the more we reduce the urban space between buildings, the more we reduce the wind speed in constructed areas, increasing, therefore, the possibility to generate heat islands