Orientadores: Konradin Metze, Randall Luis Adam / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T05:29:25Z (GMT). No. of bitstreams: 1 Elston_LilianBarreto_D.pdf: 2689434 bytes, checksum: 2eeb1a5a1e47810949c3286be8cd9633 (MD5) Previous issue date: 2009 / Resumo: O sistema de graduação histológica desenvolvido por Patnaik et al. (1984), provou ser de relevância prognóstica nos Mastocitomas Cutâneos Caninos (MCC). Os parâmetros subjetivos utilizados em sua graduação têm levado patologistas veterinários a conferir diferentes graus a uma mesma amostra. Este fato pode refletir negativamente no estabelecimento do protocolo terapêutico baseado em tal método. A ampliação das possibilidades de ferramentas prognósticas objetivas pode auxiliar a diminuir o problema da concordância da graduação. Este estudo tem por objetivo calcular a concordância entre observadores no processo de graduação, estabelecer quais os parâmetros são de relevância prognóstica, desenvolver nova técnica simplificada de graduação baseada em parâmetros histológicos de concordância adequada, e estabelecer a relevância prognóstica das variáveis de sociologia celular como ferramenta prognóstica objetiva e confiável. Grau de Patnaik, parâmetros histológicos e o coeficiente kappa livre de margens foram calculados para cada uma das amostras dos 81 cães de diferentes raças, sexo, e idade. De 56 destas amostras foram obtidos dados quanto à sobrevida e, de suas lâminas histológicas, foram adquiridas imagens digitalizadas para fins de análise sintática estrutural (ASE). ASE das amostras, mediante construção de grafos como Mosaico Voronoi (MV), Triangulação Delaunay (TD) e Árvore Geradora Mínima (AGM), foi automaticamente realizada pelo programa "Sociology" desenvolvido pelo Dr. Randall Luiz Adam. Nossos resultados confirmaram a fraca concordância do método de Patnaik para graduação dos MCCs por três experimentados patologistas veterinários (Kfree=0,28). A avaliação mitótica (quanto maior o seu número pior o prognóstico) e a granulação intracitoplasmática (quanto mais granulação melhor o prognóstico) revelaram-se como variáveis independentes de relevância prognóstica (B=0.760 e -0,989; p=0,045 e 0,014 respectivamente) e com razoável concordância (Kfree?0,35), quando todas as variáveis relevantes (p?0,05) quanto à sobrevida e de razoável concordância foram submetidas à análise multivariada pela Regressão de Cox. Deste modo, desenvolveu-se um método simples, sob a forma de escore o qual variava de -2 a +2 (porquanto a granulação tem caráter protetor sendo B = - 0,989) e se mostrava estatisticamente significativo para sobrevida (p?0,004). Por outro lado, o estudo da sociologia celular revelou que, os coeficientes de variação (CV) do perímetro, da esfericidade e da área dos polígonos do MV (p=0.029, p=0,028 e p= 0,031 respectivamente), o CV dos ângulos máximos dos triângulos da TD (p=0,026), provaram ser variáveis objetivas significativas, indicando a relação entre desordem arquitetural e malignidade. Desta forma o estudo matemático da arquitetura tissular de MCCs revelou-se como uma nova e promissora ferramenta na avaliação prognóstica de MCCs. / Abstract: Histological based grading system developed by Patnaik et al. (1984) has proved to be of prognostic relevance in Cutaneous Mast cell tumors (CMC). The subjective histological parameters used in grading may lead different veterinary pathologists to access different grade for the same MCC, this fact may negatively reflect in the treatment protocol based on this grading system. Disclosing new objective prognostic tools may help to minimize the problem of grading. The aim of this study is to calculate interobserver agreement in the grading process, to establish which histological parameters are of prognostic relevance, to reveal a novel simplified prognostic technique based on these parameters and to establish the prognostic relevance of cellular sociology parameters as an objective prognostic tool. Patnaik's grade, histological parameters and the Kappa free coefficient were calculate for each one of eighty-one dogs from different breeds, sex, and ages. From 56 with defined survival time we achieved digitalized images with cellular sociology purposes. The "Sociology" software then performed syntactic Structural Analysis (SSA) with Voronoi Tessellation (VT), Delaunay Triangulation (DT) and Minimum Spanning Tree (MST). Our results statistically confirmed the poor interobserver agreement in the MCC grading (Kfree= 0,28). When all agreement and prognostic relevant parameters were submitted to multivariate analyses with Cox regression, mitotic evaluation and intracitoplasmatic granulation showed to be independents parameters with prognostic relevance (B= 0,760 e -0,989; p= 0,045 and p=0,014) and with reasonable agreement (Kfree<0,35). We performed a score that varies from -2 to +2 (since granulation is a protective one) with these two relevant parameters. This new simple score system significantly correlated to survival (p ? 0,004). In the other hand, the prognostic relevance of cellular sociology, reveals that coefficient of variation (CV) of perimeter, area and roundness from Voronoi polygons (p=0,029; 0,031; 0,028 respectively) and CV of maximum angle of DTs (p=0,026) are significant objective parameters. These findings indicated the relationship between structural disorder and malignancy of MCTs and pointed out SSA as a new reliable tool to prognosticate MCTs. / Doutorado / Biologia Estrutural, Celular, Molecular e do Desenvolvimento / Doutor em Fisiopatologia Medica

Realizamos um estudo, que avaliou o equilíbrio corporal de 120 idosos, 60 com queixa de desequilíbrio e/ou tontura, 60 sem queixa e como controle 58 indivíduos adultos normais. Usamos o teste de integração sensorial da posturografia dinâmica computadorizada. Nossos resultados mostraram piores valores de equilíbrio no grupo de idosos sintomáticos comparados ao grupo assintomático, que por sua vez foram piores que os adultos normais, estatisticamente significante. Os sistemas de equilíbrio que se revelaram mais comprometidos com o envelhecimento foram o visual e o vestibular / Using dynamic posturography we studied the balance of 120 elderly subjects, sixty with imbalance and dizziness and sixty without this symtom, as well as fifty- eight normal adults. We found worse results in the elderly symtomatic compared with assintomatic that have better results that normal adults, statistically significant. Equilibrium systems that showed age-related worse were visual and vestibular

Tsang, Man Ho. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 57-60). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese.

Yip Lung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references. / Abstracts in English and Chinese. / Chapter 1 --- Introduction / Chapter 1.1 --- Heart and Lung Diseases --- p.1 / Chapter 1.1.1 --- Hong Kong --- p.1 / Chapter 1.1.2 --- China --- p.2 / Chapter 1.1.3 --- the United States of America (USA) --- p.3 / Chapter 1.2 --- Auscultation --- p.3 / Chapter 1.2.1 --- Introduction of Auscultation --- p.4 / Chapter 1.2.2 --- Comparison between Auscultation and Ultrasound --- p.6 / Chapter 1.3 --- Stethoscope --- p.7 / Chapter 1.3.1 --- History of Stethoscope --- p.7 / Chapter 1.3.2 --- New Electronic Stethoscope --- p.14 / Chapter 1.4 --- Main Purpose of the Study --- p.16 / Chapter 1.5 --- Organization of Thesis --- p.16 / References --- p.18 / Chapter 2 --- A New Electronic Stethoscope's Head / Chapter 2.1 --- Introduction --- p.20 / Chapter 2.2 --- Biopotential Electrode --- p.21 / Chapter 2.2.1 --- Flexible Electrode --- p.21 / Chapter 2.2.2 --- Laplacian Electrocardiogram --- p.22 / Chapter 2.3 --- Transducer --- p.25 / Chapter 2.4 --- Design of the Head of Stethoscope --- p.26 / Chapter 2.5 --- Experimental Results --- p.27 / Chapter 2.5.1 --- Bias Voltage of Condenser Microphone --- p.27 / Chapter 2.5.2 --- Frequency Response of New Stethoscope's Head --- p.29 / Chapter 2.6 --- Discussion --- p.30 / Chapter 2.7 --- Section Summary --- p.31 / References --- p.33 / Chapter 3 --- Signal Pre-processing Unit / Chapter 3.1 --- Introduction --- p.35 / Chapter 3.2 --- High Input Impedance IC Amplifier --- p.36 / Chapter 3.3 --- Voltage Control Voltage Source High Pass Filter Circuit --- p.37 / Chapter 3.4 --- Multiple Feed Back Low Pass Filter Circuit --- p.39 / Chapter 3.5 --- Overall Circuit --- p.41 / Chapter 3.6 --- Experimental Results --- p.43 / Chapter 3.7 --- Discussion --- p.46 / Chapter 3.8 --- Section Summary --- p.47 / References --- p.48 / Chapter 4 --- Central Platform / Chapter 4.1 --- Introduction --- p.49 / Chapter 4.2 --- Adaptive Filter --- p.49 / Chapter 4.2.1 --- Introduction to Adaptive Filtering --- p.49 / Chapter 4.2.2 --- Least-Mean-Square (LMS) Algorithm --- p.51 / Chapter 4.2.3 --- Applications --- p.52 / Chapter 4.3 --- Offline Processing --- p.54 / Chapter 4.3.1 --- WINDAQ and MATLAB --- p.55 / Chapter 4.3.2 --- Direct Reference Algorithm --- p.57 / Chapter 4.3.3 --- Determination of Parameters in DRA --- p.62 / Chapter 4.3.4 --- Experimental Results of DRA --- p.67 / Chapter 4.3.5 --- Acoustic Waveform Based Algorithm --- p.72 / Chapter 4.3.6 --- Experimental Results of AWBA --- p.81 / Chapter 4.4 --- Online Processing --- p.85 / Chapter 4.4.1 --- LABVIEW --- p.85 / Chapter 4.4.2 --- Automated Gain Control --- p.88 / Chapter 4.4.3 --- Implementation of LMS adaptive filter --- p.89 / Chapter 4.4.4 --- Experimental Results of Online-AGC --- p.92 / Chapter 4.5 --- Discussion --- p.93 / Chapter 4.6 --- Section Summary --- p.97 / References --- p.98 / Chapter 5 --- Conclusion and Further Development / Chapter 5.1 --- Conclusion of the Main Contribution --- p.100 / Chapter 5.2 --- Future Works --- p.102 / Chapter 5.2.1 --- Modification of the Head of Stethoscope --- p.102 / Chapter 5.2.2 --- Validation of Abnormal Breath --- p.102 / Chapter 5.2.3 --- Low Frequency Analysis --- p.102 / Chapter 5.2.4 --- AGC-AWBA Approach --- p.102 / Chapter 5.2.5 --- Standalone Device --- p.103 / Chapter 5.2.6 --- Demand on Stethoscope --- p.109 / References --- p.110 / Appendix / Chapter A.1 --- Determination of parameters in VCVS High Pass Filter --- p.106 / Chapter A.2 --- Determination of parameters in MFB Low Pass Filter --- p.110 / Chapter A.3 --- Source code of DRA (MATLAB) --- p.114 / Chapter A.4 --- Source code of AWBA (MATLAB) --- p.129 / Chapter A.5 --- Source code of online AGC (LABVIEW) --- p.134

The Neonatal Intensive Care Unit (NICU) is a hospital ward specializing in looking after premature and ill newborn babies. Working in such a busy and complex environment is not easy and sophisticated equipment is used to help the daily work of the medical staff . Computers are used to analyse the large amount of monitored data and extract hidden information, e.g. to detect interesting events. Unfortunately, one group of important events lacks features that are recognizable by computers. This group includes the actions taken by the medical sta , for example two actions related to the respiratory system: inserting an endotracheal tube into a baby’s trachea (ET Intubating) or sucking out the tube (ET Suctioning). These events are very important building blocks for other computer applications aimed at helping the sta . In this research, a strategy for detecting these medical actions based on contextual knowledge is proposed. This contextual knowledge specifies what other events normally occur with each target event and how they are temporally related to each other. The idea behind this strategy is that all medical actions are taken for di erent purposes hence may have di erent procedures (contextual knowledge) for performing them. This contextual knowledge is modelled using a point based framework with special attention given to various types of uncertainty. Event detection consists in searching for consistent matching between a model based on the contextual knowledge and the observed event instances - a Temporal Constraint Satisfaction Problem (TCSP). The strategy is evaluated by detecting ET Intubating and ET Suctioning events, using a specially collected NICU monitoring dataset. The results of this evaluation are encouraging and show that the strategy is capable of detecting complex events in an NICU.

Realizamos um estudo, que avaliou o equilíbrio corporal de 120 idosos, 60 com queixa de desequilíbrio e/ou tontura, 60 sem queixa e como controle 58 indivíduos adultos normais. Usamos o teste de integração sensorial da posturografia dinâmica computadorizada. Nossos resultados mostraram piores valores de equilíbrio no grupo de idosos sintomáticos comparados ao grupo assintomático, que por sua vez foram piores que os adultos normais, estatisticamente significante. Os sistemas de equilíbrio que se revelaram mais comprometidos com o envelhecimento foram o visual e o vestibular / Using dynamic posturography we studied the balance of 120 elderly subjects, sixty with imbalance and dizziness and sixty without this symtom, as well as fifty- eight normal adults. We found worse results in the elderly symtomatic compared with assintomatic that have better results that normal adults, statistically significant. Equilibrium systems that showed age-related worse were visual and vestibular

Several hundred inherited disorders of the skeleton have been delineated. Individually these conditions are rare, but as a group they cause much crippling and hardship. Several factors, including the rarity and complexity of the manifestations of these conditions, as well as semantic overlap, impede the accurate diagnosis which is essential for effective treatment. In this regard, the adoption of microcomputers warrants evaluation as a high technology aid. Microcomputers have developed tremendous capabilities during recent years. The state of the art has become such that a diagnostic aid facility on such a device has been demonstrated in various disciplines of medicine and may also be feasible in the area of inherited skeletal disorders. The study which forms the basis of this thesis, concerns the investigation of this feasibility and has led to the development of an effective working model which sets the basis for microcomputer-aided diagnosis. The design features followed in this project are similar to those conventionally employed for "Expert systems" on mainframe computers. A comprehensive knowledge base consisting of over 200 skeletal disorders and 700 radiographic and clinical manifestations, has resulted. Furthermore, the application is capable of "learning", although inference as employed by the inference engines of real expert systems, is not employed. In this context learning implies that the knowledge base, with the passage of time, improves considerably when used by experts. Serendipitous findings in this regard are: • 1) Considerable improvement of existing profile descriptions can occur without any increased demands on computer memory and storage space; • 2) Growth of the knowledge base in the form of additional disease profiles can be effected with very modest inroads on memory and storage resources. The computerized diagnostic aid which resulted from this thesis, has been demonstrated to be successful in both the Department of Human Genetics of the University of Cape Town and the Department of Paediatrics of the Johannes Gutenberg University in Mainz. Evaluated both in terms of efficiency and utility, the system provides an enhancement to the specialist genetic diagnostician. These achievements have been effected by means of a unique newly developed application of compressed bit-mapping, attained by writing the applicable programs in Turbo Pascal and 8086- assembler languages. Calculations indicate that much larger data bases may possibly be implemented on present-day microcomputers by means of the methods developed in this project.

As more diagnostic testing options become available to physicians, it becomes more difficult to combine various types of medical information together in order to optimize the overall diagnosis. To improve diagnostic performance, here we introduce an approach to optimize a decision-fusion technique to combine heterogeneous information, such as from different modalities, feature categories, or institutions. For classifier comparison we used two performance metrics: The receiving operator characteristic (ROC) area under the curve [area under the ROC curve (AUC)] and the normalized partial area under the curve (pAUC). This study used four classifiers: Linear discriminant analysis (LDA), artificial neural network (ANN), and two variants of our decision-fusion technique, AUC-optimized (DF-A) and pAUC-optimized (DF-P) decision fusion. We applied each of these classifiers with 100-fold cross-validation to two heterogeneous breast cancer data sets: One of mass lesion features and a much more challenging one of microcalcification lesion features. For the calcification data set, DF-A outperformed the other classifiers in terms of AUC (p < 0.02) and achieved AUC=0.85 +/- 0.01. The DF-P surpassed the other classifiers in terms of pAUC (p < 0.01) and reached pAUC=0.38 +/- 0.02. For the mass data set, DF-A outperformed both the ANN and the LDA (p < 0.04) and achieved AUC=0.94 +/- 0.01. Although for this data set there were no statistically significant differences among the classifiers' pAUC values (pAUC=0.57 +/- 0.07 to 0.67 +/- 0.05, p > 0.10), the DF-P did significantly improve specificity versus the LDA at both 98% and 100% sensitivity (p < 0.04). In conclusion, decision fusion directly optimized clinically significant performance measures, such as AUC and pAUC, and sometimes outperformed two well-known machine-learning techniques when applied to two different breast cancer data sets. / Dissertation

No desenvolvimento cardíaco infantil, a mudança na dinâmica vetorial do miocárdio influencia os parâmetros de normalidade, especialmente nos primeiros dias de vida. Estes limites são idade-dependentes, o que torna a análise do eletrocardiograma (ECG) potencialmente mais difícil em crianças que em adultos. Para facilitar esta tarefa, desenvolvemos um sistema interpretativo computadorizado para análise segmentar no ECG pediátrico. Para validar esta ferramenta, 15 cardiologistas pediátricos foram randomicamente distribuídos em três diferentes grupos, segundo abordagem quali-quantitativa, aqui definidas como avaliação livre (AL), dirigida (AD) e automatizada (AA), na análise de 20 ECGs pediátricos, distribuídos em uma proporção mínima de 35% para exames anormais, com 16 segmentos estudados em cada ECG. Na AL, o cardiologista foi solicitado a responder se o segmento em análise estava normal ou não, com liberdade para medir cada segmento antes de responder. Na AD, a mesma pergunta foi formulada, porém com a imposição de uma aferição prévia do segmento em análise. Consultar a tabela de normalidade foi permitida em ambas situações. Na AA, apenas a aferição foi solicitada e o resultado submetido a um software de interpretação segmentar para ECG pediátrico, com a tabela de normalidade em seu banco de dados. As respostas foram comparadas às análises de dois cardiologistas controle e os resultados conflitantes foram considerados discordantes. Foram observadas discordâncias em 11,6%, 10,7% e 6,2% nas AL, AD e AA, respectivamente. O viés de interpretação foi reduzido em 45% (p<0,0001) com o uso da AA. Observou-se maior benefício com a AA nos estudos das ondas Q em avF e em V6 e R em V1. Em análises não automatizadas, a aferição precedente não mudou a avaliação segmentar do ECG. Concluindo, a AA reduziu significativamente o viés interpretativo em análises não automatizadas, a aferição precedente não mudou a interpretação do ECG e o uso deste software permitiu reduzir o erro de análise segmentar em 45%. / During the cardiac development of children, changes in the vectorial dynamics of the myocardium influence upon normality standards, especially during the first days in life. These are age-dependent limits that make the analysis of EKG of children potentially harder than that of adults. Aiming to make this task easier, we designed a computerized interpretation system for segmental analysis of pediatric EKGs. In order to validate this tool, 15 pediatric cardiologists were randomly allocated to three different groups according to qualitative-quantitative evaluation methods herein defined as free (FE), guided (GE) and automatized (AE) evaluation, for the purpose of analyzing 20 pediatric EKG tracings distributed in a proportion of at least 35% abnormal examinations, with 16 segments being studied in each EKG tracing. In FE, cardiologists were asked to answer whether the segment was normal or not, with freedom to measure each segment before giving their answer. In GE, the same question was made, however they were requested to measure the segment before answering. In both situations they were allowed to refer to a table of normality standards. In AE, only the measurement was asked, and the result was then entered into the software for segmental interpretation of pediatric EKGs, whose database included the table of normality standards. Answers were all compared with those given by two control cardiologists. Discordant results were seen in 11.6%, 10.7% and 6.2% of FE, GE and AE, respectively. Interpretation bias was reduced by 45% (p<0.0001) with the use of AE. In the not automatized types of analyses, previous measurement of segments did not alter the segmental evaluation of EKGs . In conclusion, the automatized evaluation significantly reduced interpretation bias, previous measurement did not change the EKG interpretation with the other not automatized methods and the use of this software allowed to reduce the error of segmental analysis in 45%.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2009. / Härtill 4 uppsatser.