Classification of the severity of diabetic neuropathy: a new approach taking uncertainties into account using fuzzy logic

OBJECTIVE:

This study proposes a new approach that considers uncertainty in predicting and quantifying the presence and severity of diabetic peripheral neuropathy.

METHODS:

A rule-based fuzzy expert system was designed by four experts in diabetic neuropathy. The model variables were used to classify neuropathy in diabetic patients, defining it as mild, moderate, or severe. System performance was evaluated by means of the Kappa agreement measure, comparing the results of the model with those generated by the experts in an assessment of 50 patients. Accuracy was evaluated by an ROC curve analysis obtained based on 50 other cases; the results of those clinical assessments were considered to be the gold standard.

RESULTS:

According to the Kappa analysis, the model was in moderate agreement with expert opinions. The ROC analysis (evaluation of accuracy) determined an area under the curve equal to 0.91, demonstrating very good consistency in classifying patients with diabetic neuropathy.

CONCLUSION:

The model efficiently classified diabetic patients with different degrees of neuropathy severity. In addition, the model provides a way to quantify diabetic neuropathy severity and allows a more accurate patient condition assessment.     

A method for fast determination of psoralens in oral solutions of phytomedicines using liquid chromatography

A method for sample preparation and analysis by high performance liquid chromatography with UV detection (HPLC-UV) has been developed for routine analysis of psoralen and bergapten, photosensitizing compounds, in oral solutions of phytomedicines employed in Brazil for some illnesses. The linearity, accuracy, the inter- and intra-day precision of the procedure were evaluated. Calibration curves for psoralen and bergapten were linear in the range of 1.0-600.0 microg ml(-1) and 1.0-400.0 microg ml(-1) respectively. The recoveries of the psoralens in the oral solutions analysed were 94.43-99.97%. The percentage coefficient of variation (CV) of the quantitative analysis of the psoralens in the products analysis was within 5%. In inter-equipment study was employed gas chromatography-flame ionization (CG-FID) detection.     

Protective activity of Lentinan in experimental tuberculosis

Protective effects of Lentinan (Ajinomoto, Japan) against Mycobacterium tuberculosis infection were studied by in vitro and in vivo mouse models. The effectiveness of Lentinan administrated intraperitoneally (i.p.) before infection at a dose of 1 mg/kg three times at 2-day intervals was monitored in vivo by several parameters (body temperature; spleen weight; CFU counts of M. tuberculosis in spleen, liver and lung; and histomorphological observations). Peritoneal macrophages obtained from animals treated with Lentinan were greatly stimulated, as assayed by establishing their number, acid phosphatase activity, H2O2 production and killing ability against M. tuberculosis in vitro. The in vivo model demonstrated that administration of Lentinan before infection can mobilize host defense potential and reduce mycobacterial infection.     

Cytogenetic findings in a case of nodular fasciitis of subclavicular region

We report a case of nodular fasciitis with a reciprocal translocation involving both homologues of chromosome 15 [46,XX,t(15;15)(q13;q25)]. This is the third case of nodular fasciitis with involvement of chromosome 15. Two genes that are involved in either wound healing and/or tumorigenesis have been mapped to chromosome 15. One of the genes, the keratinocyte growth factor or fibroblast growth factor 7 (KGF or FGF7) was mapped to the 15q22 region, which was involved in a cytogenetic rearrangement in one case of nodular fasciitis. KGF is implicated in wound healing, healing lung injuries and tumorigenesis of various cancers such as breast and prostate. The second gene involved is TRKC or NTRK3 mapped to the 15q25 region. TRKC is implicated in congenital fibrosarcoma, a benign proliferation of fibroblasts. The breakpoint and overexpression of the protein in our case further suggest a possible involvement of TRKC.     

Perception of disability in a public health perspective: a model based on fuzzy logic

Measures of functional levels, commonly used to assess the safety and quality of life of individuals and populations, have not yet been derived from a fuzzy framework. The aim of this study is to estimate the degree of disability associated with varying functional levels, through a model based on fuzzy sets theory. A fuzzy linguistic model was developed to measure varying levels of functional disability, in accordance with the definitions of an individual's social and physical activities and mobility. One year of an adult's life whose mobility, social and physical activities were somewhat limited, was judged to be equivalent to 0.575 years free of functional disability. Results obtained from the fuzzy model approach those obtained with the quality of well-being scale (QWB), used as a conceptual framework. Such findings are encouraging, since the QWB is considered a consistent and valid approach for disability assessment and quality-of-life evaluation.     

Prenatal diagnosis of a fetus with unbalanced translocation (4;13)(p16;q32) with overlapping features of Patau and Wolf-Hirschhorn syndromes

Wolf-Hirschhorn syndrome (WHS) and Patau syndrome are two of the most severe conditions resulting from chromosome abnormalities. WHS is caused by a deletion of 4p16, while Patau syndrome is caused by trisomy for some or all regions of chromosome 13. Though the etiologies of these syndromes differ, they share several features including pre- and postnatal growth retardation, microcephaly, cleft lip and palate, and cardiac anomalies. We present here a female fetus with deletion of 4p16 --> pter and duplication of 13q32 --> qter due to unbalanced segregation of t(4;13)(p16;q32) in the father. She displayed overlapping features of both of these syndromes on ultrasound. To the best of our knowledge, this is the first report of a fetus with both partial trisomy 13 and deletion of 4p16, the critical region for WHS.     

Fuzzy linguistic model for evaluating the risk of neonatal death

OBJECTIVE: To introduce a fuzzy linguistic model for evaluating the risk of neonatal death. METHODS: The study is based on the fuzziness of the variables newborn birth weight and gestational age at delivery. The inference used was Mamdani's method. Neonatologists were interviewed to estimate the risk of neonatal death under certain conditions and to allow comparing their opinions and the model values. RESULTS: The results were compared with experts' opinions and the Fuzzy model was able to capture the expert knowledge with a strong correlation (r=0.96). CONCLUSIONS: The linguistic model was able to estimate the risk of neonatal death when compared to experts' performance.     

The Impact of Exogenous Factors on Respiratory Pathogen-Induced Innate Alveolar Macrophage Responses in COPD

Alveolar macrophages in chronic obstructive pulmonary disease (COPD) have fundamentally impaired innate immune responses to toll-like receptor (TLR) ligands of nontypeable Haemophilus influenzae (NTHI). However, whether dysfunctional inflammatory responses in COPD extend to macrophage interactions with intact respiratory pathogens beyond NTHI has not been explored. Furthermore, the influences of exogenous factors, including active smoking and medications, on pathogen-induced innate immune responses have only begun to be investigated. We hypothesized that distinct alveolar macrophage impairments in COPD are not limited to NTHI TLR ligands and that active smoking and select COPD medications modulate innate responses.

Alveolar macrophages, obtained from COPD ex-smokers (n = 32) and active smokers (n = 64) by bronchoalveolar lavage (BAL), were incubated with NTHI, Moraxella catarrhalis, and Streptococcus pneumoniae, and with TLR2 and TLR4 ligands. Elicited IL-8 and TNF-α were measured by multianalyte microsphere flow cytometry to determine proinflammatory responsiveness.

Induced IL-8, but not TNF-α, was greater from alveolar macrophages of active smokers compared with ex-smokers, in response to NTHI (p = 0.04), M. catarrhalis (p = 0.003), and S. pneumoniae (p = 0.03). Both IL-8 and TNF-α induction by TLR2 and TLR4 ligands were greater in active smokers. While intergroup NTHI- and M. catarrhalis-induced TNF-α levels were no different, they were notably lower among ex-smokers taking anticholinergic medications (p < 0.04 for each), but not with any other bronchoactive medications. Our results support a paradigm of distinct immunologic responses of COPD alveolar macrophages of ex- and active smokers to diverse respiratory pathogens and highlight a subset of ex-smokers whose diminished alveolar macrophage responsiveness may be associated with anticholinergic agents.