988 resultados para Lung nodule malignancy prediction
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics
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Dissertação para obtenção do Grau de Mestre em Engenharia Geológica (Georrecursos)
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RESUMO:RESUMO: Nos últimos anos a ultrassonografia emergiu como um instrumento importante no diagnóstico da patologia torácica. O progresso tecnológico possibilitou a conceção de novos equipamentos como a ecoendoscopia brônquica radial e linear. Verificou-se, igualmente, o aparecimento de indicações para a realização de ecografia transtorácica. Uma das principais doenças impulsionadoras da técnica ultrassonográfica no tórax foi o cancro do pulmão, primeira causa de morte oncológica a nível mundial. A aplicabilidade e conhecimento do papel dos ultrassons no âmbito do diagnóstico e estadiamento do cancro do pulmão não se encontram esgotados, persistindo focos de controvérsia e dúvida científica que se pretendem esclarecer. A presente tese foi organizada em cinco capítulos: o primeiro abordou de forma geral e introdutória o estado da arte referente à ultrassonografia torácica, cancro do pulmão e a sua conjugação; o segundo destacou os principais objetivos; o terceiro sumarizou a metodologia utilizada; o quarto englobou os cinco estudos publicados, descritos subsequentemente, e o quinto incluiu uma discussão concisa, as principais conclusões e perspetivas futuras. O primeiro estudo avaliou a rentabilidade diagnóstica, segurança e curva de aprendizagem num coorte de 179 doentes submetidos a ecoendoscopia brônquica linear. De acordo com as indicações para este procedimento os doentes foram subdivididos em três grupos: (1) diagnóstico, (2) diagnóstico e estadiamento e (3) estadiamento. Para o primeiro, segundo e terceiro grupos a sensibilidade da ecoendoscopia foi 86.1%, 86.7% e 95% respetivamente e a precisão técnica foi 87.5%, 93.1% e 97.7% respetivamente. O treino originou um aumento progressivo do número de locais puncionados por doente, com menor duração e sem complicações, comprovando a eficácia e segurança do método quando realizado na população Portuguesa por broncologistas com experiência. O segundo estudo foi conduzido para averiguar a eficácia e custo da ecoendoscopia brônquica linear realizada através da via aérea e/ou esófago no diagnóstico de lesões sugestivas de neoplasia do pulmão, após ineficácia das técnicas convencionais. Nos doentes incluídos prospetivamente alcançou-se um diagnóstico definitivo em 106 casos (87.6%). A sensibilidade global para o diagnóstico de cancro do pulmão foi 89.8%, a especificidade foi 100%, o valor preditivo positivo foi 100%, o valor preditivo negativo foi 20% e a precisão foi 90.1%. Esta estratégia ultrassonográfica abrangente evitou intervenções cirúrgicas diagnósticas em doentes anteriormente submetidos a broncoscopia flexível ou punção aspirativa transtorácica guiada por tomografia computorizada, proporcionando uma redução significativa dos custos. No terceiro estudo investigou-se a viabilidade e papel da conjugação da ecoendoscopia brônquica linear com técnicas moleculares na avaliação de antigénios tumorais e padrões de metastização ganglionar em doentes com cancro do pulmão de não-pequenas células (CPNPC). Os marcadores citoqueratina 19 (CK-19), antigénio carcinoembrionário (CEA), molécula de adesão celular epitelial (EPCAM), sialyl-Lewis X e CD44 foram determinados nos aspirados ganglionares de 33 doentes com neoplasia e 17 controlos 10 Ultrassonografia através de citometria de fluxo (CF) e reação em cadeia da polimerase em tempo real (RTPCR). Os doentes com CPNPC possuíam um compartimento celular epitelial significativamente aumentado e com marcação superior de CK-19 comparativamente ao grupo de controlo. O compartimento imune foi também analisado nestas amostras e revelou-se alterado no CPNPC com aumento da população de monócitos e diminuição das subpopulações linfocitárias. Os transcriptos de CK-19, CEA e EPCAM estavam elevados nos doentes com cancro do pulmão, identificando-se uma correlação positiva entre estes marcadores e o tamanho da lesão primária. Concluiu-se que a identificação de CK-19, CEA e EPCAM nas amostras obtidas por ecoendoscopia e avaliadas por CF e RTPCR foi viável, podendo auxiliar na deteção de metástases ganglionares no CPNPC. O quarto estudo envolveu a combinação da ecoendoscopia brônquica radial com uma criosonda para o diagnóstico de lesões pulmonares sólidas periféricas. Foi determinada a viabilidade, rentabilidade diagnóstica, tamanho das amostras e segurança do método. Lesões inferiores a 40mm foram localizadas por ultrassonografia sendo os doentes randomizados para a realização de biópsias transbrônquicas com pinça seguidas por criosonda ou vice-versa. Nos 39 casos incluídos a lesão foi visualizada pela minisonda em 31 doentes (79.5%), com 80.6% de prevalência de cancro do pulmão na amostra. A rentabilidade diagnóstica da pinça de biópsia foi 61.3% e da criosonda foi 74.2%. O tamanho do tecido adquirido pelas criobiópsias foi significativamente maior do que o alcançado por pinça (11.17mm2 vs. 4.69mm2, p<0.001). Ocorreu um único caso de hemorragia moderada, controlada através de medidas conservadoras. As biópsias transbrônquicas com criosonda sob orientação de ecoendoscopia radial foram seguras e eficazes na obtenção de amostras histológicas. O quinto estudo determinou o valor diagnóstico da ecografia transtorácica na identificação de malignidade em doentes com derrame pleural de natureza indeterminada. Foram examinados de forma prospetiva 154 doentes. Os resultados clínicos e radiológicos de cada caso foram ocultados ao executante do exame que gerou imagens estáticas e vídeos ultrassonográficos relevantes. Estes foram posteriormente visualizados, sendo as suas características classificadas por revisores independentes e comparadas com o diagnóstico definitivo. Em 66 casos o diagnóstico foi de derrame pleural maligno (68.2% com cancro do pulmão) e em 67 de derrame benigno. A ecografia torácica obteve 80.3% de sensibilidade, 83.6% de especificidade, 81.2% de valor preditivo negativo e 82.8% de valor preditivo positivo na deteção de malignidade. A nodularidade pleural ou diafragmática, espessamento pleural superior a 10mm e sinal de swirling foram significativamente diferentes (p<0.001) sendo sugestivos de derrame maligno. A existência de nodularidade pleural e ausência de broncograma aéreo ecográfico aumentaram a probabilidade de malignidade (OR 29.0 e OR 10.4, respetivamente). A ecografia transtorácica permitiu diferenciar derrame pleural maligno do benigno. A existência de nódulos pleurais constituiu o fator discriminador mais relevante. Em conclusão, os resultados desta tese possibilitam uma melhor compreensão do papel da ecoendoscopia brônquica (linear e radial) e ecografia transtorácica no diagnóstico e estadiamento do cancro do pulmão, com implicações e aplicabilidade na prática clínica.------------- ABSTRACT: In recent years ultrasonography has emerged as an important instrument in the diagnosis of thoracic diseases. Technological progress has enabled the design of new equipment such as radial and linear endobronchial ultrasound. In addition, indications for transthoracic echography were established. One of the main diseases responsible for the progression of chest sonography was lung cancer, the leading cause of cancer mortality worldwide. The applicability and knowledge of the role of ultrasonography in diagnosing and staging lung cancer is not depleted, persisting foci of controversy and scientific doubt that we intend to elucidate. The present thesis was organized into five chapters: the first included a general introduction regarding chest ultrasound, lung cancer and their combination; the second emphasized the main objectives; the third summarized the methodology used; the fourth encompassed the five published studies, subsequently described, and the fifth included a concise discussion, the main findings and future perspectives. The first study evaluated the diagnostic yield, safety and learning curve in a cohort of 179 patients submitted to linear endobronchial ultrasound. According to procedure indications, the patients were divided into three groups: (1) diagnosis, (2) diagnosis and staging, and (3) staging. For the first, second and third groups, endobronchial ultrasound sensitivity was 86.1%, 86.7% and 95% respectively and accuracy was 87.5%, 93.1% and 97.7% respectively. Practise led to an increase number of punctured sites per patient, in a shorter period of time and without complications, proving the safety and efficacy of the method when performed in the Portuguese population by expert echoscopists. The second study was conducted to determine the efficacy and cost of linear endobronchial ultrasound performed through the airway and/or oesophagus for diagnosis of lesions suggestive of lung cancer, after failure of conventional techniques. Of the patients prospectively enrolled a definitive diagnosis was reached in 106 cases (87.6%). The overall sensitivity for the diagnosis of lung cancer was 89.8%, specificity was 100%, positive predictive value was 100%, negative predictive value was 20% and accuracy was 90.1%. In conclusion, this global ultrasonographic strategy avoided diagnostic surgical procedures in patients that had undergone flexible bronchoscopy or computed tomography-guided transthoracic needle aspiration, providing a significant cost reduction. In the third study, the feasibility and role of linear endobronchial ultrasound combined with molecular techniques in the evaluation of tumour antigens and patterns of lymph node metastasis in patients with non-small cell lung cancer (NSCLC) was investigated. Cytokeratin 19 (CK-19), carcinoembryonic antigen (CEA), epithelial cell adhesion molecule (EPCAM), sialyl Lewis-X and CD44 were determined in lymph node aspirates of 33 lung cancer patients and 17 controls, using flow cytometry (FC) and reverse transcription polymerase chain reaction (RT-PCR). In patients with NSCLC the epithelial cell compartment was significantly increased nd showed brighter CK-19 staining, compared to the control group. In NSCLC patients the immune compartment revealed an increased monocyte population and decreased lymphocyte subsets. The transcripts of CK- 19, CEA and EPCAM were higher in lung cancer patients and a positive correlation between these markers and the size of the primary lesion was also found. We concluded that the identification of CK-19, CEA and EPCAM in endobronchial ultrasound samples, using RT-PCR and FC was feasible and might aid in the detection of NSCLC lymph node metastases. The fourth study involved the combination of the radial endobronchial ultrasound with the cryoprobe for diagnosing solid peripheral lung lesions. We determined the feasibility, diagnostic yield, sample size and safety of the method. Lesions less than 40mm were located by ultrasound and forceps or cryobiopsies were performed in a randomized order. Of the 39 cases included, the lesion could be visualized by the miniprobe in 31 patients (79.5%), and lung cancer prevalence was 80.6%. The diagnostic yield of the biopsy forceps was 61.3% and for the cryobiopsy was 74.2 %. Cryobiopsies were significantly larger than forceps biopsies (11.17mm2 vs. 4.69mm2, p<0.001). There was only one case of moderate bleeding that was controlled by conservative measures. Transbronchial cryobiopsies under radial endobronchial ultrasound guidance were safe and effective in obtaining histological samples. The fifth study determined the diagnostic value of transthoracic sonography in predicting malignancy in patients with an undiagnosed pleural effusion. One hundred and fifty four patients were prospectively scanned. Relevant ultrasound images and videos were generated by an operator blinded to clinical and radiological results. These were subsequently visualized, its characteristics classified by independent reviewers and compared to the final diagnosis. A malignant pleural effusion was diagnosed in 66 cases (68.2 % with lung cancer) and a benign effusion in 67 cases. Thoracic ultrasound had a sensitivity of 80.3 %, specificity of 83.6%, negative predictive value of 81.2 % and positive predictive value of 82.8% to detect malignancy. The presence of pleural or diaphragmatic nodularity, pleural thickening greater than 10mm and swirling signal were significantly different (p<0.001 ), being suggestive of malignant effusion. The existence of pleural nodularity and absence of lung air bronchogram were more likely to indicate malignancy (OR 29.0 and OR 10.4, respectively). Transthoracic ultrasonography permits the distinction between malignant and benign pleural effusions. Pleural nodules were the most relevant feature. In conclusion, the results of this thesis provide a better understanding of the role of endobronchial ultrasound (linear and radial) and transthoracic sonography in lung cancer diagnosis and staging, with direct implications and applicability in clinical practice.
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A case of invasive aspergillosis caused by Aspergillus niger in a lung transplant recipient is described. The patient presented hyperglycemia starting postoperatively, with other complications such as cytomegalovirus infection. The associated predisposing factors and other implications are discussed. Aspergillus niger seems to be a fungal species of low virulence that requires the presence of a severely immunosuppressed host to cause invasive disease.
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In the last few years, we have observed an exponential increasing of the information systems, and parking information is one more example of them. The needs of obtaining reliable and updated information of parking slots availability are very important in the goal of traffic reduction. Also parking slot prediction is a new topic that has already started to be applied. San Francisco in America and Santander in Spain are examples of such projects carried out to obtain this kind of information. The aim of this thesis is the study and evaluation of methodologies for parking slot prediction and the integration in a web application, where all kind of users will be able to know the current parking status and also future status according to parking model predictions. The source of the data is ancillary in this work but it needs to be understood anyway to understand the parking behaviour. Actually, there are many modelling techniques used for this purpose such as time series analysis, decision trees, neural networks and clustering. In this work, the author explains the best techniques at this work, analyzes the result and points out the advantages and disadvantages of each one. The model will learn the periodic and seasonal patterns of the parking status behaviour, and with this knowledge it can predict future status values given a date. The data used comes from the Smart Park Ontinyent and it is about parking occupancy status together with timestamps and it is stored in a database. After data acquisition, data analysis and pre-processing was needed for model implementations. The first test done was with the boosting ensemble classifier, employed over a set of decision trees, created with C5.0 algorithm from a set of training samples, to assign a prediction value to each object. In addition to the predictions, this work has got measurements error that indicates the reliability of the outcome predictions being correct. The second test was done using the function fitting seasonal exponential smoothing tbats model. Finally as the last test, it has been tried a model that is actually a combination of the previous two models, just to see the result of this combination. The results were quite good for all of them, having error averages of 6.2, 6.6 and 5.4 in vacancies predictions for the three models respectively. This means from a parking of 47 places a 10% average error in parking slot predictions. This result could be even better with longer data available. In order to make this kind of information visible and reachable from everyone having a device with internet connection, a web application was made for this purpose. Beside the data displaying, this application also offers different functions to improve the task of searching for parking. The new functions, apart from parking prediction, were: - Park distances from user location. It provides all the distances to user current location to the different parks in the city. - Geocoding. The service for matching a literal description or an address to a concrete location. - Geolocation. The service for positioning the user. - Parking list panel. This is not a service neither a function, is just a better visualization and better handling of the information.
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Zero valent iron nanoparticles (nZVI) are considered very promising for the remediation of contaminated soils and groundwaters. However, an important issue related to their limited mobility remains unsolved. Direct current can be used to enhance the nanoparticles transport, based on the same principles of electrokinetic remediation. In this work, a generalized physicochemical model was developed and solved numerically to describe the nZVI transport through porous media under electric field, and with different electrolytes (with different ionic strengths). The model consists of the Nernst–Planck coupled system of equations, which accounts for the mass balance of ionic species in a fluid medium, when both the diffusion and electromigration of the ions are considered. The diffusion and electrophoretic transport of the negatively charged nZVI particles were also considered in the system. The contribution of electroosmotic flow to the overall mass transport was included in the model for all cases. The nZVI effective mobility values in the porous medium are very low (10−7–10−4 cm2 V−1 s−1), due to the counterbalance between the positive electroosmotic flow and the electrophoretic transport of the negatively charged nanoparticles. The higher the nZVI concentration is in the matrix, the higher the aggregation; therefore, low concentration of nZVI suspensions must be used for successful field application.
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The development of human cell models that recapitulate hepatic functionality allows the study of metabolic pathways involved in toxicity and disease. The increased biological relevance, cost-effectiveness and high-throughput of cell models can contribute to increase the efficiency of drug development in the pharmaceutical industry. Recapitulation of liver functionality in vitro requires the development of advanced culture strategies to mimic in vivo complexity, such as 3D culture, co-cultures or biomaterials. However, complex 3D models are typically associated with poor robustness, limited scalability and compatibility with screening methods. In this work, several strategies were used to develop highly functional and reproducible spheroid-based in vitro models of human hepatocytes and HepaRG cells using stirred culture systems. In chapter 2, the isolation of human hepatocytes from resected liver tissue was implemented and a liver tissue perfusion method was optimized towards the improvement of hepatocyte isolation and aggregation efficiency, resulting in an isolation protocol compatible with 3D culture. In chapter 3, human hepatocytes were co-cultivated with mesenchymal stem cells (MSC) and the phenotype of both cell types was characterized, showing that MSC acquire a supportive stromal function and hepatocytes retain differentiated hepatic functions, stability of drug metabolism enzymes and higher viability in co-cultures. In chapter 4, a 3D alginate microencapsulation strategy for the differentiation of HepaRG cells was evaluated and compared with the standard 2D DMSO-dependent differentiation, yielding higher differentiation efficiency, comparable levels of drug metabolism activity and significantly improved biosynthetic activity. The work developed in this thesis provides novel strategies for 3D culture of human hepatic cell models, which are reproducible, scalable and compatible with screening platforms. The phenotypic and functional characterization of the in vitro systems performed contributes to the state of the art of human hepatic cell models and can be applied to the improvement of pre-clinical drug development efficiency of the process, model disease and ultimately, development of cell-based therapeutic strategies for liver failure.
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This project focuses on the study of different explanatory models for the behavior of CDS security, such as Fixed-Effect Model, GLS Random-Effect Model, Pooled OLS and Quantile Regression Model. After determining the best fitness model, trading strategies with long and short positions in CDS have been developed. Due to some specifications of CDS, I conclude that the quantile regression is the most efficient model to estimate the data. The P&L and Sharpe Ratio of the strategy are analyzed using a backtesting analogy, where I conclude that, mainly for non-financial companies, the model allows traders to take advantage of and profit from arbitrages.
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RESUMO: O cancro do pulmão (LC), uma das principais causas de mortalidade relacionada com cancro em Portugal, pode levar à formação de metástases hematogénicas. A adesão das células tumorais ao endotélio é considerada um dos passos fundamentais envolvidos na metástase. Em células sanguíneas, esta adesão é mediada por ligandos de E-selectina (E-SL), glicoproteínas ou glicolípidos decorados principalmente com sialyl-Lewis x (sLex) e sialyl-Lewis a (sLea). Tem sido descrito a expressão destes antigénios em LC, contudo o seu papel funcional em permitir a adesão das células de LC ao endotélio é ainda pouco compreendido. Foram analisadas amostras emparelhadas normais e tumorais de pacientes com cancro de pulmão de não-pequenas células (NSCLC) e três linhas celulares de LC. Immunoblotting assays com anti-sLex/sLea e molécula quimérica de E-selectina demonstraram que tecidos tumorais de LC sobreexpressam significativamente E-SL e resultados de citometria de fluxo demonstraram uma expressão elevada de E-SL nas linhas celulares. Para compreender o mecanismo da sobreexpressão de E-SL em tecidos tumorais e linhas celulares de LC, foi analisada a expressão de genes envolvidos na biossíntese de E-SL, nomeadamente FUT3, FUT4, FUT6, FUT7, ST3GAL3, ST3GAL4, ST3GAL6, β4GALT1, GCNT1 e GALNT3. Observou-se a sobreexpressão das fucosiltransferases FUT3, FUT6 e FUT7 em tecidos tumorais de LC e FUT3 em linhas celulares de LC, sendo que neste último, esta expressão é correlacionada com um aumento da adesão das células de LC às selectinas endoteliais. Foi observado que uma baixa expressão de FUT4 em tecidos tumorais está associada com estadios menos avançados de NSCLC. Foram analisadas ainda proteínas decoradas com sLex/sLea, tendo-se identificado como E-SL o antigénio carcinoembrionário em NSCLC. Em resumo, esta tese contribuiu para uma melhor compreensão das alterações glicosídicas e moléculas que podem influenciar a progressão tumoral do LC, podendo permitir identificar futuramente novos biomarcadores de diagnóstico/prognóstico e potenciais alvos terapêuticos para o NSCLC.--------------------------ABSTRACT: Lung cancer (LC), one of the major causes of mortality related to cancer in Portugal, may lead to hematogenous metastasis. Adhesion of cancer cells to endothelium is considered one of the crucial steps involved in metastasis. In blood cells, this adhesion is initiated by endothelial selectin ligands (E-SL) that are glycoproteins or glycolipids decorated mostly with sialyl-Lewis x (sLex) and sialyl-Lewis a (sLea). While LC has been described as expressing these sialyl Lewis antigens, its functional role in allowing LC adhesion to endothelium is still poorly understood. We analyzed paired tumor and normal tissues samples from non-small cell lung cancer (NSCLC) patients and three LC cell lines. Immunoblotting assays with anti-sLex/sLea and E-selectin chimera demonstrated that LC tumor tissues significantly overexpress E-SL and flow cytometry results indicated that E-SL are also abundantly expressed in LC cell lines. To understand the mechanism behind the overexpression of E-SL in LC tissues and cell lines, we analyzed the expression of genes involved in its biosynthesis, namely FUT3, FUT4, FUT6, FUT7, ST3GAL3, ST3GAL4, ST3GAL6, β4GALT1, GCNT1 and GALNT3. It was observed the overexpression of fucosyltransferases FUT3, FUT6 and FUT7 in LC tumor tissues and FUT3 in LC cell lines, being this last one correlated with an increased reactivity of the LC cells to endothelial selectins. It was described that low expression of FUT4 in tumor tissues is correlated with early stages of NSCLC. We also analyzed scaffolds proteins of sLex/sLea and it was identified the carcinoembryonic antigen as an E-SL in NSCLC. In summary, this thesis contributed to a better understanding of the glycosidic changes and molecules that can influence tumor progression of LC, allowing identifying in the future new diagnosis/prognosis biomarkers and potential therapeutic targets for NSCLC.
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Many conditions are associated with hyperglycemia in preterm neonates because they are very susceptible to changes in carbohydrate homeostasis. The purpose of this study was to evaluate the occurrence of hyperglycemia in preterm infants undergoing glucose infusion during the first week of life, and to enumerate the main variables predictive of hyperglycemia. This prospective study (during 1994) included 40 preterm neonates (gestational age <37 weeks); 511 determinations of glycemic status were made in these infants (average 12.8/infant), classified by gestational age, birth weight, glucose infusion rate and clinical status at the time of determination (based on clinical and laboratory parameters). The clinical status was classified as stable or unstable, as an indication of the stability or instability of the mechanisms governing glucose homeostasis at the time of determination of blood glucose; 59 episodes of hyperglycemia (11.5%) were identified. A case-control study was used (case = hyperglycemia; control = normoglycemia) to derive a model for predicting glycemia. The risk factors considered were gestational age (<=31 vs. >31 weeks), birth weight (<=1500 vs. >1500 g), glucose infusion rate (<=6 vs. >6 mg/kg/min) and clinical status (stable vs. unstable). Multivariate analysis by logistic regression gave the following mathematical model for predicting the probability of hyperglycemia: 1/exp{-3.1437 + 0.5819(GA) + 0.9234(GIR) + 1.0978(Clinical status)} The main predictive variables in our study, in increasing order of importance, were gestational age, glucose infusion rate and, the clinical status (stable or unstable) of the preterm newborn infant. The probability of hyperglycemia ranged from 4.1% to 36.9%.