RESUMO
Insights, characterized by sudden discoveries following unsuccessful problem-solving attempts, are fascinating phenomena. Dynamic systems perspectives argue that insight arises from self-organizing perceptual and motor processes. Entropy and fractal scaling are potential markers for emerging new and effective solutions. This study investigated whether specific features associated with self-organization in dynamical systems can distinguish between individuals who succeed and those who fail in solving insight tasks. To achieve this, we analyzed pupillary diameter fluctuations of children aged 6 to 12 during the 8-coin task, a well-established insight task. The participants were divided into two groups: successful (n = 24) and unsuccessful (n = 43) task completion. Entropy, determinism, recurrence ratio, and the ß scaling exponent were estimated using Recurrence Quantification and Power Spectrum Density analyses. The results indicated that the solver group exhibited more significant uncertainty and lower predictability in pupillary diameter fluctuations before finding the solution. Recurrence Quantification Analysis revealed changes that went unnoticed by mean and standard deviation measures. However, the ß scaling exponent did not differentiate between the two groups. These findings suggest that entropy and determinism in pupillary diameter fluctuations can identify early differences in problem-solving success. Further research is needed to determine the exclusive role of perceptual and motor activity in generating insights and investigate these results' generalizability to other tasks and populations.
RESUMO
Statistical sequential analysis of binary data is an important tool in clinical trials such as placebo-controlled trials, where a total of K individuals are randomly allocated into two groups, one of size κ1 receiving the treatment/drug, and the other of size κ2 for placebo. The ratio z=κ2/κ1, namely "matching ratio," determines the expected proportion of adverse events from the treatment group among the κ1+κ2 individuals. Bernoulli-based designs are used for monitoring the safety of post-licensed drugs and vaccines as well. For instance, in a self-control design, z is the ratio between the risk and the control time windows. Irrespective of the type of application, the choice of z is a critical design criterion as it determines the sample size, the statistical power, the expected sample size, and the expected time to signal the sequential procedure. In this paper, we run exact calculations to offer a statistical rule of thumb for the choice of z. All the calculations and examples are performed using the R Sequential package.
Assuntos
Projetos de Pesquisa , Vacinas , Humanos , Tamanho da AmostraRESUMO
Abstract Case description: A 5-year-old girl presented to the emergency department with a history of foreign body ingestion. A cervico-thoracoabdominal radiograph demonstrate a foreign body in the esophagus, which seemed to show a double rim sign suspecting a button battery. After an emetic episode and expelling a coin, the child became asymptomatic. Close inspection of the X-ray demonstrated that the image was formed by superimposition of 3 circumferential objects of different sizes. Another X-ray observed the persistence of two superimposed objects. Clinical findings: The girl presented with sialorrhea, odynophagia, and nausea. Vital signs and physical examination were normal. There was no significant medical history. Treatment and Outcome: With the suspicion of multiple impacted esophageal objects, the patient was then taken to the operating room. During the flexible esophagoscopy 2 coins were found in the esophagus, both were removed without difficulty. The patient had an uneventful postoperative recovery and there have been no long-term complications. Clinical relevance: Unusual radiographic findings regarding esophageal foreign bodies have been reported, however, we describe the first case of a child with 3 coins impacted in the esophagus and a new radiological finding in foreign bodies ingestions that allow to avoid misdiagnosis and improve outcomes.
Resumen Descripción del caso: Una niña de 5 años es llevada a urgencias tras la ingesta de un cuerpo extraño. La radiografía cérvico-toraco-abdominal evidenció un cuerpo extraño esofágico con signo de doble halo, lo que hizo sospechar una pila de botón. Tras un vómito con expulsión de una moneda los síntomas desaparecieron. Una inspección minuciosa de la radiografía demostró que la imagen estaba formada por la superposición de 3 objetos circunferenciales de diferentes tamaños. Una nueva radiografía mostró persistencia de dos objetos superpuestos. Hallazgos clínicos: La niña refería odinofagia, náuseas y tenía sialorrea. Los signos vitales y el examen físico eran normales. No tenía antecedentes médicos relevantes. Tratamiento y desenlace: Con la sospecha de impactación esofágica múltiple, la paciente fue llevada al quirófano. Durante la esofagoscopia se encontraron 2 monedas en el esófago que fueron extraídas sin dificultad. La evolución postoperatoria fue favorable y no hubo complicaciones a largo plazo. Relevancia clínica: Aunque se han reportado hallazgos radiográficos inusuales en cuerpos extraños esofágicos, describimos el primer caso de un niño con 3 monedas impactadas en el esófago y un nuevo hallazgo radiológico en la ingesta de cuerpos extraños que permite evitar diagnósticos erróneos y mejorar los desenlaces.
RESUMO
Case description: A 5-year-old girl presented to the emergency department with a history of foreign body ingestion. A cervico-thoracoabdominal radiograph demonstrate a foreign body in the esophagus, which seemed to show a double rim sign suspecting a button battery. After an emetic episode and expelling a coin, the child became asymptomatic. Close inspection of the X-ray demonstrated that the image was formed by superimposition of 3 circumferential objects of different sizes. Another X-ray observed the persistence of two superimposed objects. Clinical findings: The girl presented with sialorrhea, odynophagia, and nausea. Vital signs and physical examination were normal. There was no significant medical history. Treatment and Outcome: With the suspicion of multiple impacted esophageal objects, the patient was then taken to the operating room. During the flexible esophagoscopy 2 coins were found in the esophagus, both were removed without difficulty. The patient had an uneventful postoperative recovery and there have been no long-term complications. Clinical relevance: Unusual radiographic findings regarding esophageal foreign bodies have been reported, however, we describe the first case of a child with 3 coins impacted in the esophagus and a new radiological finding in foreign bodies ingestions that allow to avoid misdiagnosis and improve outcomes.
Descripción del caso: Una niña de 5 años es llevada a urgencias tras la ingesta de un cuerpo extraño. La radiografía cérvico-toraco-abdominal evidenció un cuerpo extraño esofágico con signo de doble halo, lo que hizo sospechar una pila de botón. Tras un vómito con expulsión de una moneda los síntomas desaparecieron. Una inspección minuciosa de la radiografía demostró que la imagen estaba formada por la superposición de 3 objetos circunferenciales de diferentes tamaños. Una nueva radiografía mostró persistencia de dos objetos superpuestos. Hallazgos clínicos: La niña refería odinofagia, náuseas y tenía sialorrea. Los signos vitales y el examen físico eran normales. No tenía antecedentes médicos relevantes. Tratamiento y desenlace: Con la sospecha de impactación esofágica múltiple, la paciente fue llevada al quirófano. Durante la esofagoscopia se encontraron 2 monedas en el esófago que fueron extraídas sin dificultad. La evolución postoperatoria fue favorable y no hubo complicaciones a largo plazo. Relevancia clínica: Aunque se han reportado hallazgos radiográficos inusuales en cuerpos extraños esofágicos, describimos el primer caso de un niño con 3 monedas impactadas en el esófago y un nuevo hallazgo radiológico en la ingesta de cuerpos extraños que permite evitar diagnósticos erróneos y mejorar los desenlaces.
Assuntos
Corpos Estranhos , Numismática , Criança , Pré-Escolar , Ingestão de Alimentos , Fontes de Energia Elétrica , Esôfago/diagnóstico por imagem , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , LactenteRESUMO
Background Nummular headache is a rare, recently described topographic headache defined by the circumscribed coin-shaped area of pain. It is classified as a primary headache. There is debate about whether it is due to a peripheral or central disturbance, and its relationship to migraine. Case reports We report two patients with presumed nummular headache secondary to Langerhans cell histiocytosis, both with resolution of their headaches after surgical resection. Conclusion Imaging in patients with clinical features of nummular headache is recommended, as this and other cases highlight that it may be symptomatic. There are no distinguishing clinical features to separate nummular headache from secondary mimics, and treatment of the underlying cause may be curative.
Assuntos
Granuloma Eosinófilo/complicações , Cefaleia/etiologia , Crânio/patologia , Adulto , Criança , Craniotomia , Granuloma Eosinófilo/cirurgia , Humanos , Masculino , Crânio/cirurgiaRESUMO
OBJETIVO: Determinar a acurácia diagnóstica da positron emission tomography (tomografia por emissão de pósitrons)/tomografia computadorizada (PET/TC) com deoxiglicose marcada com flúor-18, conhecida como fluorodeoxiglicose (FDG[18F]), na avaliação de nódulo pulmonar solitário (NPS). MÉTODOS: Análise prospectiva de 53 pacientes consecutivos que realizaram PET/TC para avaliação de NPS, entre março de 2005 e maio de 2007. Destes 32 preencheram os critérios de inclusão. As lesões foram avaliadas quanto a sua localização e tamanho, grau de captação do radiofármaco e o standardized uptake value (SUV, valor padronizado de captação) máximo das lesões. Os achados dos estudos de FDG-PET/TC foram correlacionados com outros preditores de malignidade (idade, sexo, tabagismo, tamanho e localização do nódulo). O diagnóstico definitivo foi estabelecido por confirmação histopatológica ou acompanhamento clínico-radiológico por um período mínimo de um ano. RESULTADOS: Encontrados 14 NPS malignos. Após análise da curva ROC, o SUV de 2,5 foi considerado o melhor ponto de corte que identificou corretamente 13 dos 14 NPS malignos. Os resultados abaixo deste ponto de corte mostraram um exame falso positivo para neoplasia num total de 14. O método semiquantitativo apresentou sensibilidade de 92,9 por cento, especificidade de 72,2 por cento, valor preditivo positivo de 72,2 por cento, valor preditivo negativo de 92,9 por cento e acurácia de 81,2 por cento. Na análise multivariada, apenas a localização do nódulo nos lobos superiores (p = 0,048) e o SUV (p = 0,007) demonstraram significância estatística para malignidade no NPS. CONCLUSÕES: Os dados do estudo mostram que o SUV da FDG[18F] é um bom preditor de neoplasia em nódulos pulmonares e com alto valor preditivo negativo, o que oferece grande segurança em afastar presença de malignidade, indicando sua importância na abordagem diagnóstica do nódulo pulmonar.
OBJECTIVE: To determine the diagnostic accuracy of positron emission tomography/computed tomography (PET/CT) using fluorine-18-deoxyglucose ([18F]-FDG) for the evaluation of a solitary pulmonary nodule (SPN). METHODS: Prospective analysis of 53 consecutive patients submitted to PET/CT between March 2005 and May 2007 for the evaluation of an SPN. Of those, 32 met the criteria for inclusion in the present study. The lesions were evaluated for location, size, radiotracer uptake and maximum standardized uptake value (SUV). The FDG-PET/TC results were correlated with other predictors of malignance (age, gender, smoking status, nodule size and nodule location). The definitive diagnosis was established through histopathology or through clinical/radiological follow-up for at least one year. RESULTS: Fourteen malignant SPNs were found. Through analysis of the ROC curve, we established an SUV of 2.5 as the most appropriate cut-off point, since it correctly identified 13 of the 14 malignant SPNs. The results below that point revealed one false positive for neoplasia out of a total of 14. The semiquantitative method presented a sensitivity of 92.9 percent, specificity of 72.2 percent, positive predictive value of 72.2 percent, negative predictive value of 92.9 percent and accuracy of 81.2 percent. The multivariate analysis showed a statistically significant association with SPN malignancy only for nodule location in the upper lobes (p = 0.048) and SUV (p = 0.07). CONCLUSIONS: The results obtained suggest that the SUV of [18F]-FDG is a useful predictor of neoplasia in SPN, with a high negative predictive value, which allows malignancy to be safely ruled out, showing its relevance in the diagnostic approach to pulmonary nodules.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma , Neoplasias Pulmonares , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Nódulo Pulmonar Solitário , Distribuição por Idade , Fatores Etários , Adenocarcinoma/etiologia , Adenocarcinoma/patologia , Modelos Logísticos , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/patologia , Valor Preditivo dos Testes , Curva ROC , Distribuição por Sexo , Fatores Sexuais , Fumar/efeitos adversos , Nódulo Pulmonar Solitário/etiologia , Nódulo Pulmonar Solitário/patologia , Tomografia Computadorizada de Emissão/métodosRESUMO
OBJETIVOS: Avaliar o desempenho de um programa para auxílio na detecção de nódulos pulmonares em tomografia computadorizada com múltiplos detectores (TCMD). MÉTODOS: Foram avaliadas 24 tomografias computadorizadas de tórax consecutivas realizadas no Centro de Medicina Diagnóstica Fleury no período de 07/10/2006 a 19/10/2006 usando um tomógrafo helicoidal multidetectores de 64 canais. O estudo compreendeu 12 pacientes do sexo feminino e 12 do sexo masculino, com idades variando entre 35 e 77 anos, idade média de 57,9. As imagens foram analisadas independentemente pelo método da dupla leitura e pelo programa diagnóstico auxiliado por computador (DAC). Os nódulos encontrados nos diferentes processos foram registrados e os dados comparados. RESULTADOS: A sensibilidade total da detecção de nódulos pelo DAC nesse trabalho foi de 16,5 por cento, 55 por cento excluindo os nódulos medindo <4 mm. A sensibilidade separada por tamanho foi de 6,5 por cento para nódulos <4 mm, 45 por cento para nódulos de 4 a 6 mm, 100 por cento para nódulos de 6 mm a 1 cm, e 0 por cento para nódulos >1 cm. Menos de 1 por cento dos nódulos verdadeiros destacados pelo DAC não haviam sido registrados no processo de dupla leitura. CONCLUSÕES: Neste trabalho preliminar de 24 casos, o programa testado não conseguiu superar de forma significativa a sensibilidade da dupla leitura realizada de rotina neste serviço.
OBJECTIVES: To evaluate the performance of a computer program designed to facilitate the detection of pulmonary nodules using multidetector computed tomography (MDCT) scans of the chest. METHODS: We evaluated 24 consecutive MDCT scans of the chest at the Fleury Diagnostic Imaging Center during the period from October 7 to October 19 of 2006, using a 64-channel CT scanner. The study comprised 12 females and 12 males, ranging from 35 to 77 years of age (mean, 57.9 years). Double reading and a computer-aided diagnosis (CAD) system were used in order to perform two independent analyses of the data. The nodules found using both methods were recorded, and the data were compared. RESULTS: The total sensitivity of CAD for the detection of nodules was 16.5 percent, increasing to 55 percent when nodules <4 mm in diameter were excluded. Sensitivity by diameter was 6.5 percent for nodules <4 mm, 45 percent for nodules of 4-6 mm, 100 percent for nodules of 6 mm-10 cm, and 0 percent for nodules >1 cm. More than 99 percent of true nodules detected by CAD were registered in the image double reading process. CONCLUSIONS: In this preliminary 24-case study, the sensitivity of computer program tested was not significantly greater than that of the double-reading process that is routinely performed in this facility.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nódulo Pulmonar Solitário , Interpretação de Imagem Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Imageamento Tridimensional , Interpretação de Imagem Assistida por Computador/instrumentação , Neoplasias Pulmonares , Pulmão , Variações Dependentes do Observador , Sensibilidade e Especificidade , Software , Design de Software , Tomografia Computadorizada por Raios X/normasRESUMO
O pseudotumor inflamatório de pulmão é uma neoplasia benigna rara que geralmente se manifesta como um nódulo pulmonar solitário. A apresentação endobrônquica é infreqüente. O tratamento de escolha continua sendo a cirurgia conservadora e deve-se sempre procurar obter margens livres devido à possibilidade de recidiva local. Esse artigo relata o caso de um paciente de 36 anos, com crises de sibilância e tosse, que foi submetido, com sucesso, à broncoplastia para ressecção de um pseudotumor inflamatório endobrônquico.
Inflammatory pseudotumor of the lung is a rare form of benign neoplasia and is generally characterized by a solitary pulmonary nodule. The endobronchial presentation is uncommon. Conservative surgery remains the treatment of choice, and surgeons should always strive to achieve tumor-free margins due to the possibility of local recidivism. This article reports the case of a 36-year-old male patient with recurrent attacks of wheezing and cough. The patient underwent successful bronchoplasty for the resection of an endobronchial inflammatory pseudotumor.
Assuntos
Adulto , Humanos , Masculino , Broncopatias/diagnóstico , Granuloma de Células Plasmáticas Pulmonar/diagnóstico , Biópsia , Broncoscopia , Broncopatias/patologia , Broncopatias/cirurgia , Tosse , Granuloma de Células Plasmáticas Pulmonar/patologia , Granuloma de Células Plasmáticas Pulmonar/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Doença de Castleman é uma doença rara que se manifesta geralmente como nódulo mediastinal, com grande variabilidade de apresentação em relação a idade, manifestações clínicas e evolução. Descreve-se paciente do sexo feminino de 40 anos de idade, com dor torácica incaracterística há alguns anos, com imagem hipotransparente à direita em raio X de tórax. A tomografia computadorizada e a arteriografia pulmonar não elucidaram o diagnóstico. O mesmo só foi possível ao exame anatomopatológico após ressecção cirúrgica do nódulo, que evidenciou características de hiperplasia angiofolicular ou doença de Castleman. O artigo ressalta a importância de se acrescentar esta doença na lista de morbidades para diagnóstico diferencial em nódulos pulmonares solitários.
Castleman disease is a rare disorder generally characterized by a mediastinal nodule, with a great variety of alternative presentations regarding age, clinical manifestations and evolution. This case report describes a 40-year-old female patient presenting with uncharacteristic chest pain for a few years. A chest X-ray revealed a hypotransparency on the right side. Computed tomography and pulmonary arteriography did not elucidate the diagnosis, which was made through surgical resection and anatomopathological examination of the nodule, which presented characteristics of angiofollicular hyperplasia, or Castleman disease. This article emphasizes the importance of adding this disease to the list of morbidities in the differential diagnosis of pulmonary solitary nodules.