Principal Uncertainty Quantification With Spatial Correlation for Image Restoration Problems

Uncertainty quantification for inverse problems in imaging has drawn much attention lately. Existing approaches towards this task define uncertainty regions based on probable values per pixel, while ignoring spatial correlations within the image, resulting in an exaggerated volume of uncertainty. In this paper, we propose PUQ (Principal Uncertainty Quantification) - a novel definition and corresponding analysis of uncertainty regions that takes into account spatial relationships within the image, thus providing reduced volume regions. Using recent advancements in generative models, we derive uncertainty intervals around principal components of the empirical posterior distribution, forming an ambiguity region that guarantees the inclusion of true unseen values with a user-defined confidence probability. To improve computational efficiency and interpretability, we also guarantee the recovery of true unseen values using only a few principal directions, resulting in more informative uncertainty regions. Our approach is verified through experiments on image colorization, super-resolution, and inpainting; its effectiveness is shown through comparison to baseline methods, demonstrating significantly tighter uncertainty regions.

Computing Speed-of-Sound From Ultrasound: User-Agnostic Recovery and a New Benchmark

OBJECTIVE

Medical ultrasound is one of the most accessible imaging modalities, but is a challenging modality for quantitative parameters comparison across vendors and sonographers. B-Mode imaging, with limited exceptions, provides a map of tissue boundaries; crucially, it does not provide diagnostically relevant physical quantities of the interior of organ domains.This can be remedied: the raw ultrasound signal carries significantly more information than is present in the B-Mode image. Specifically, the ability to recover speed-of-sound and attenuation maps from the raw ultrasound signal transforms the modality into a tissue-property modality. Deep learning was shown to be a viable tool for recovering speed-of-sound maps. A major hold-back towards deployment is the domain transfer problem, i.e., generalizing from simulations to real data. This is due in part to dependence on the (hard-to-calibrate) system response.

METHODS

We explore a remedy to the problem of operator-dependent effects on the system response by introducing a novel approach utilizing the phase information of the IQ demodulated signal.

RESULTS

We show that the IQ-phase information effectively decouples the operator-dependent system response from the data, significantly improving the stability of speed-of-sound recovery. We also introduce an improvement to the network topology providing faster and improved results to the state-of-the-art. We present the first publicly available benchmark for this problem: a simulated dataset for raw ultrasound plane wave processing.

CONCLUSION

The consideration of the phase of the IQ-signals presents a promising appeal to traversing the transfer learning problem, advancing the goal of real-time speed-of-sound imaging.

Photon-counting CT urogram: optimal acquisition potential (kV) determination for virtual noncontrast creation

PURPOSE

To quantitatively and qualitatively compare the degree of iodine removal in the collecting system from PCCT urographic phase-derived virtual noncontrast (VNC) images obtained at 140 kV versus 120 kV.

METHODS

A retrospective PACS search identified adult patients (>18 years) who underwent a PCCT urogram for hematuria from 4/2022 to 4/2023 with available urographic phase-derived VNC images in PACS. Tube voltage (120 kV, 140 kV), body mass index, CTDIvol, dose length product (DLP), and size-specific dose estimate (SSDE) were recorded. Hounsfield Unit (HU) in both renal pelvises and the urinary bladder on urographic-derived VNC were recorded. Three radiologists qualitatively assessed the degree of iodine removal (renal pelvis, urinary bladder) and diagnostic confidence for urinary stone detection. Continuous variables were compared for 140 kV versus 120 kV with the Wilcoxon rank sum test. A p < .05 indicated statistical significance.

RESULTS

63 patients (34 male; median (Q1, Q3) age: 30 (26, 34) years; 140 kV/120 kV: 30 patients/33 patients) were included. BMI, CTDIvol, DLP, and SSDE were not different for 140 kV and 120 kV (all p > .05). Median (Q1, Q3) collecting system HU (renal pelvis and bladder) was 0.9 (- 3.6, 4.4) HU at 140 kV and 10.5 (3.6, 26.7) HU at 120 kV (p = .04). Diagnostic confidence for urinary calculi was 4.6 [1.1] at 140 kV and 4.1 [1.4] at 120 kV (p = .005). Diagnostic confidence was 5/5 (all readers) in 82.2% (74/90) at 140 kV and 59.6% (59/99) at 120 kV (p < .001).

CONCLUSION

PCCT urographic phase-derived VNC images obtained at 140 kV had better collecting system iodine removal than 120 kV with similar patient radiation exposure. With excellent PCCT urographic phase iodine removal at 140 kV, consideration can be made to utilize a single-phase CT urogram in young patients.

An End-to-End Platform for Digital Pathology Using Hyperspectral Autofluorescence Microscopy and Deep Learning-Based Virtual Histology

Conventional histopathology involves expensive and labor-intensive processes that often consume tissue samples, rendering them unavailable for other analyses. We present a novel end-to-end workflow for pathology powered by hyperspectral microscopy and deep learning. First, we developed a custom hyperspectral microscope to nondestructively image the autofluorescence of unstained tissue sections. We then trained a deep learning model to use autofluorescence to generate virtual histologic stains, which avoids the cost and variability of chemical staining procedures and conserves tissue samples. We showed that the virtual images reproduce the histologic features present in the real-stained images using a randomized nonalcoholic steatohepatitis (NASH) scoring comparison study, where both real and virtual stains are scored by pathologists (D.T., A.D.B., R.K.P.). The test showed moderate-to-good concordance between pathologists' scoring on corresponding real and virtual stains. Finally, we developed deep learning-based models for automated NASH Clinical Research Network score prediction. We showed that the end-to-end automated pathology platform is comparable with an independent panel of pathologists for NASH Clinical Research Network scoring when evaluated against the expert pathologist consensus scores. This study provides proof of concept for this virtual staining strategy, which could improve cost, efficiency, and reliability in pathology and enable novel approaches to spatial biology research.

Considerations in the Management of Functional Neurological Disorders in Patients with Hearing Loss

CASE

Adam is a 14-year-old adolescent boy with hearing loss who presented to the pediatric neurology clinic accompanied by his father for evaluation of new-onset left hand tremor for a duration of 1 month. An American Sign Language interpreter was present and used throughout the visit.Adam has bilateral sensorineural hearing loss related to premature birth at 28 weeks' gestation. He uses sign language and attends a school for the hearing impaired. He has been diagnosed with attention-deficit/hyperactivity disorder (ADHD) and a nonspecific learning disorder. His ADHD symptoms are well controlled with a stimulant medication. He is independent in activities of daily living, and there is no concern for intellectual disability. His father is concerned that Adam may have anxiety, but this has not been evaluated.After careful history, it is found that the tremor was first noted the day after burglars broke into his home and stole precious belongings. Current stressors include difficulties with schoolwork and a strained relationship with an extended family member. There is no family history of tremor.The tremor was intermittent initially, with episodes lasting around 30 minutes. Over time, the tremor became more persistent. Adam is left-handed, and the tremor is now interfering with handwriting, eating, and other fine motor skills. The tremor worsens when Adam is tired or stressed and improves with relaxation. No tremor has been noted in other body parts. Adam denies any other neurological symptoms, including headache, vision changes, or gait abnormalities.On examination, Adam seemed anxious but showed no significant distress and had normal vital signs. His general examination was unremarkable. His neurological examination showed intact cranial nerves, apart from the hearing impairment. He had normal muscle tone, intact strength and coordination, and a normal casual gait. Rhythmic shaking of the left upper extremity was present with action, while maintaining posture. Using specific examination techniques, the examiner was able to alter the rhythm of the tremor, and the tremor was noted to subside when the patient was engaged with the examiner. These findings in addition to signs of suggestibility and variable frequency/direction were consistent with a functional etiology.The diagnosis of a functional neurological disorder manifesting in the form of functional tremor was discussed with the patient and his father with assistance from the sign language interpreter. Counseling regarding management consisting mainly of cognitive behavioral therapy and evaluation of possible coexisting conditions, such as anxiety, was discussed.What factors would you consider in diagnosis and management of functional neurological disorder in a hearing-impaired child/adolescent?

Artificial intelligence for phase recognition in complex laparoscopic cholecystectomy

BACKGROUND

The potential role and benefits of AI in surgery has yet to be determined. This study is a first step in developing an AI system for minimizing adverse events and improving patient's safety. We developed an Artificial Intelligence (AI) algorithm and evaluated its performance in recognizing surgical phases of laparoscopic cholecystectomy (LC) videos spanning a range of complexities.

METHODS

A set of 371 LC videos with various complexity levels and containing adverse events was collected from five hospitals. Two expert surgeons segmented each video into 10 phases including Calot's triangle dissection and clipping and cutting. For each video, adverse events were also annotated when present (major bleeding; gallbladder perforation; major bile leakage; and incidental finding) and complexity level (on a scale of 1-5) was also recorded. The dataset was then split in an 80:20 ratio (294 and 77 videos), stratified by complexity, hospital, and adverse events to train and test the AI model, respectively. The AI-surgeon agreement was then compared to the agreement between surgeons.

RESULTS

The mean accuracy of the AI model for surgical phase recognition was 89% [95% CI 87.1%, 90.6%], comparable to the mean inter-annotator agreement of 90% [95% CI 89.4%, 90.5%]. The model's accuracy was inversely associated with procedure complexity, decreasing from 92% (complexity level 1) to 88% (complexity level 3) to 81% (complexity level 5).

CONCLUSION

The AI model successfully identified surgical phases in both simple and complex LC procedures. Further validation and system training is warranted to evaluate its potential applications such as to increase patient safety during surgery.

Functional Neurological Disorders in Children - A Historical Perspective

The modern diagnosis of functional neurological disorders (FND) describes a diverse set of neurological symptoms without identifiable pathology. The history of FND and its prescientific predecessor, hysteria, is complex and deeply rooted in sexism. Key moments in this history have contributed to the advancement of understanding in functional disorders that neurologists should be aware of. Although pediatric FND has a much less extensive historical literature, there are many parallels between it and the initial interest in hysteria by Charcot and other early modern neurologists. This was followed by waning neurological attention as psychiatrists promoted conversion disorder in the early 1900s. Towards the end of the 20^th century, neurologists have taken a renewed, collaborative role with psychiatry and other disciplines to diagnose and study FND.

Novel device for nonsurgical correction of rigid forefoot adduction in children

Forefoot adduction deformity (FAD) (commonly called metatarsus adductus) is reported as the most common congenital foot deformity in newborns. Early diagnosis and treatment are important in rigid cases, as better outcomes have been reported if treatment was initiated before 9 months of age. While casting and splinting is the current standard of care for nonsurgical management of rigid FAD (RFAD), several orthoses have demonstrated equal benefit. The Universal Neonatal Foot Orthotic (UNFO) brace is below ankle orthosis that provides continuous pressure, thereby correcting the deformity without casting. To the best of our knowledge, UNFO is the first brace that operates below the ankle. The aim of this study was to compare the effectiveness of UNFO shoe to standard serial casting in the treatment of RFAD in infants. Between the years 2012 and 2019 we treated 147 feet (94 patients): 52 using the UNFO shoes and 95 by standard casting and splinting protocol. The treatment groups were compared based on treatment duration, complications, and recurrence of deformity. Mean full-time treatment duration was significantly shorter in the UNFO group, while no significant difference in the total duration of treatment was observed. Similar complication and recurrence rates were demonstrated. In conclusion, treatment with UNFO is equally effective to serial casting. The use of UNFO increases convenience and diminishes social burden, thus providing a distinct advantage over other treatment modalities.

Ciraparantag reverses the anticoagulant activity of apixaban and rivaroxaban in healthy elderly subjects

Aims 

Ciraparantag is a reversal agent for anticoagulants including direct oral anticoagulants. The aim was to evaluate the efficacy and safety of ciraparantag to reverse anticoagulation induced by apixaban or rivaroxaban in healthy elderly adults.

Methods and results 

Two randomized, placebo-controlled, dose-ranging trials conducted in healthy subjects aged 50–75 years. Subjects received apixaban (Study 1) 10 mg orally twice daily for 3.5 days or rivaroxaban (Study 2) 20 mg orally once daily for 3 days. At steady-state anticoagulation subjects were randomized 3:1 to a single intravenous dose of ciraparantag (Study 1: 30, 60, or 120 mg; Study 2: 30, 60, 120, or 180 mg) or placebo. Efficacy was based on correction of the whole blood clotting time (WBCT) at multiple timepoints over 24 h. Subjects and technicians performing WBCT testing were blinded to treatment. Complete reversal of WBCT within 1 h post-dose and sustained through 5 h (apixaban) or 6 h (rivaroxaban) was dose related and observed with apixaban in 67%, 100%, 100%, and 17% of subjects receiving ciraparantag 30 mg, 60 mg, 120 mg, or placebo, respectively; and with rivaroxaban in 58%, 75%, 67%, 100%, and 13% of subjects receiving ciraparantag 30 mg, 60 mg, 120 mg, 180 mg, or placebo, respectively. Adverse events related to ciraparantag were mild, transient hot flashes or flushing.

Conclusions 

Ciraparantag provides a dose-related reversal of anticoagulation induced by steady-state dosing of apixaban or rivaroxaban. Sustained reversal was achieved with 60 mg ciraparantag for apixaban and 180 mg ciraparantag for rivaroxaban. All doses of ciraparantag were well tolerated.

Learning Optimal Wavefront Shaping for Multi-Channel Imaging

Fast acquisition of depth information is crucial for accurate 3D tracking of moving objects. Snapshot depth sensing can be achieved by wavefront coding, in which the point-spread function (PSF) is engineered to vary distinctively with scene depth by altering the detection optics. In low-light applications, such as 3D localization microscopy, the prevailing approach is to condense signal photons into a single imaging channel with phase-only wavefront modulation to achieve a high pixel-wise signal to noise ratio. Here we show that this paradigm is generally suboptimal and can be significantly improved upon by employing multi-channel wavefront coding, even in low-light applications. We demonstrate our multi-channel optimization scheme on 3D localization microscopy in densely labelled live cells where detectability is limited by overlap of modulated PSFs. At extreme densities, we show that a split-signal system, with end-to-end learned phase masks, doubles the detection rate and reaches improved precision compared to the current state-of-the-art, single-channel design. We implement our method using a bifurcated optical system, experimentally validating our approach by snapshot volumetric imaging and 3D tracking of fluorescently labelled subcellular elements in dense environments.

Detecting Deficient Coverage in Colonoscopies

Colonoscopy is tool of choice for preventing Colorectal Cancer, by detecting and removing polyps before they become cancerous. However, colonoscopy is hampered by the fact that endoscopists routinely miss 22-28% of polyps. While some of these missed polyps appear in the endoscopist's field of view, others are missed simply because of substandard coverage of the procedure, i.e. not all of the colon is seen. This paper attempts to rectify the problem of substandard coverage in colonoscopy through the introduction of the C2D2 (Colonoscopy Coverage Deficiency via Depth) algorithm which detects deficient coverage, and can thereby alert the endoscopist to revisit a given area. More specifically, C2D2 consists of two separate algorithms: the first performs depth estimation of the colon given an ordinary RGB video stream; while the second computes coverage given these depth estimates. Rather than compute coverage for the entire colon, our algorithm computes coverage locally, on a segment-by-segment basis; C2D2 can then indicate in real-time whether a particular area of the colon has suffered from deficient coverage, and if so the endoscopist can return to that area. Our coverage algorithm is the first such algorithm to be evaluated in a large-scale way; while our depth estimation technique is the first calibration-free unsupervised method applied to colonoscopies. The C2D2 algorithm achieves state of the art results in the detection of deficient coverage. On synthetic sequences with ground truth, it is 2.4 times more accurate than human experts; while on real sequences, C2D2 achieves a 93.0% agreement with experts.

Detecting muscle activation using ultrasound speed of sound inversion with deep learning

Functional muscle imaging is essential for diagnostics of a multitude of musculoskeletal afflictions such as degenerative muscle diseases, muscle injuries, muscle atrophy, and neurological related issues such as spasticity. However, there is currently no solution, imaging or otherwise, capable of providing a map of active muscles over a large field of view in dynamic scenarios.In this work, we look at the feasibility of applying longitudinal sound speed measurements to the task of dynamic muscle imaging of contraction or activation. We perform the assessment using a deep learning network applied to prebeamformed ultrasound channel data for sound speed inversion.Preliminary results show that dynamic muscle contraction can be detected in the calf and that this contraction can be positively assigned to the operating muscles. Potential frame rates in the hundreds to thousands of frames per second are necessary to accomplish this.

Publisher Correction: DeepSTORM3D: dense 3D localization microscopy and PSF design by deep learning

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Unsupervised Single Image Dehazing Using Dark Channel Prior Loss

Single image dehazing is a critical stage in many modern-day autonomous vision applications. Early prior-based methods often involved a time-consuming minimization of a hand-crafted energy function. Recent learning-based approaches utilize the representational power of deep neural networks (DNNs) to learn the underlying transformation between hazy and clear images. Due to inherent limitations in collecting matching clear and hazy images, these methods resort to training on synthetic data, constructed from indoor images and corresponding depth information. This may result in a possible domain shift when treating outdoor scenes. We propose a completely unsupervised method of training via minimization of the well-known, Dark Channel Prior (DCP) energy function. Instead of feeding the network with synthetic data, we solely use real-world outdoor images and tune the network's parameters by directly minimizing the DCP. Although our "Deep DCP" technique can be regarded as a fast approximator of DCP, it actually improves its results significantly. This suggests an additional regularization obtained via the network and learning process. Experiments show that our method performs on par with large-scale supervised methods.

1875. La Crosse Virus Neuroinvasive Disease in Children: A Contemporary Review and Evaluation for Predictors of Disease Severity

Background

La Crosse Virus (LACV) is the most common neuroinvasive arboviral disease in children. Contemporary data on clinical presentation, management, outcomes, and predictors of disease severity are lacking.

Methods

A retrospective analysis was performed of children (0–18 years) admitted to Nationwide Children’s Hospital from January 2009 to December 2018 diagnosed with LACV neuroinvasive disease (LACV-ND). LACV-ND diagnosis was defined as a compatible clinical illness and serum serologic detection of LACV in the absence of other infectious etiologies. Demographic, clinical, laboratory, electroencephalography (EEG), radiologic, and outcome data were recorded. Severe disease was defined as the presence of clinical or electroencephalographic status epilepticus, SIADH, PICU admission, mechanical ventilation (MV), parenteral/tube feeding, inpatient rehab, or intracranial pressure monitoring. Single variable and multivariate analyses were performed to determine factors predictive of disease severity.

Results

Of the 140 patients, 76 (54%) males with a median age of 8 years [10 months-16 years], were identified with LACV-ND. Symptoms at presentation, laboratory abnormalities, EEG, radiography, and outcomes are shown in Table 1. Fifty-seven (41%) patients met criteria for severe disease, notably for PICU admission (n = 41), status epilepticus (n = 35), MV (n = 13), and inpatient rehab (11). No in-patient deaths were observed. Exploratory analysis revealed that patients with severe disease were often younger at presentation, had higher rates of altered mental status (AMS), and seizures. Elevated serum white blood cell counts (WBC) and polymorphonuclear cell (PMN) predominance in serum and cerebrospinal fluid (CSF) were observed more frequently in severe disease. Multivariate analysis revealed presentation with seizures (OR 4.7 [95% CI 1.7–12.6], P = 0.001), elevated serum WBC (OR 1.7 [95% CI 1.2–2.5], P = 0.004), and a higher CSF PMN% (OR 1.03 [95% CI 1.01–1.06, P = 0.003) to be independent predictors of severe disease.

Conclusion

At presentation, patients with severe disease tended to be younger, have greater rates of neurologic symptoms, and leukocytosis with PMN predominance in blood and CSF. These clinical and laboratory findings may serve as useful biomarkers to predict disease severity.

Disclosures

All Authors: No reported Disclosures.

Summer Camp Health Initiative: An Overview of Injury and Illness in Two Canadian Summer Camps

Introduction: Summer camp is an important part of the lives of millions of youth worldwide. Injuries and illnesses at general residential camps have not been quantified in a Canadian setting. The objective of this study was to examine the incidence of injuries and illnesses that present to camp health centres at two Canadian residential summer camps.

Method: This prospective cross-sectional study examined the incidence of new-onset injuries and illnesses that presented to camp infirmaries and circumstances surrounding their occurrence. Data collection forms were completed by trained infirmary staff during each camper’s presentation to the infirmary at two general residential camps in Canada in the summers of 2015 and 2016.

Results: There were 1872 infirmary presentations, resulting in a frequency of 52.6 presentations per 1000 camp days (CD). The incidence of illness was 34.8 per 1000 CD and the incidence of injury was 17.9 per 1000 CD. Communicable disease was the most common diagnosis (15.2/1000 CD), most often an upper respiratory tract infection. The most common symptoms upon presentation were sore throat (14.1/1000 CD), headache (9.9/1000 CD), runny nose/congestion (6.2/1000 CD), cough (6.0/1000 CD) and nausea and vomiting (4.8/1000 CD). The most common injuries were cuts/lacerations/bruises (4.9/1000 CD), followed by muscle/tendon injury (4.9/1000 CD). The most frequent cause of injuries was participation in sports (3.9/1000 CD) and sports fields and courts were the most frequent location for injuries to occur (2.7/1000 CD). Females accounted for 52.8% of infirmary presentations. Senior campers (ages 12-16 years) presented most frequently (43.4%), followed by junior campers (ages 6-11 years; 38.1%) and staff (age ≥17 years; 18.0%). When age-specific CDs were calculated, junior campers had the highest frequency of infirmary presentations relative to their time spent at camp (79.7/1000 CD). Fifty people (1.4/1000 CD) were sent to a hospital for further assessment.

Conclusion: Injuries and illnesses presenting for infirmary care in summer camp are generally minor in nature. Canadian data compares similarly to United States (US) studies. Future studies should focus on interventions to reduce these injuries and illnesses, particularly communicable illnesses.

Cerebral organoids reveal early cortical maldevelopment in schizophrenia-computational anatomy and genomics, role of FGFR1

Studies of induced pluripotent stem cells (iPSCs) from schizophrenia patients and control individuals revealed that the disorder is programmed at the preneuronal stage, involves a common dysregulated mRNA transcriptome, and identified Integrative Nuclear FGFR1 Signaling a common dysregulated mechanism. We used human embryonic stem cell (hESC) and iPSC-derived cerebral organoids from four controls and three schizophrenia patients to model the first trimester of in utero brain development. The schizophrenia organoids revealed an abnormal scattering of proliferating Ki67+ neural progenitor cells (NPCs) from the ventricular zone (VZ), throughout the intermediate (IZ) and cortical (CZ) zones. TBR1 pioneer neurons and reelin, which guides cortico-petal migration, were restricted from the schizophrenia cortex. The maturing neurons were abundantly developed in the subcortical regions, but were depleted from the schizophrenia cortex. The decreased intracortical connectivity was denoted by changes in the orientation and morphology of calretinin interneurons. In schizophrenia organoids, nuclear (n)FGFR1 was abundantly expressed by developing subcortical cells, but was depleted from the neuronal committed cells (NCCs) of the CZ. Transfection of dominant negative and constitutively active nFGFR1 caused widespread disruption of the neuro-ontogenic gene networks in hESC-derived NPCs and NCCs. The fgfr1 gene was the most prominent FGFR gene expressed in NPCs and NCCs, and blocking with PD173074 reproduced both the loss of nFGFR1 and cortical neuronal maturation in hESC cerebral organoids. We report for the first time, progression of the cortical malformation in schizophrenia and link it to altered FGFR1 signaling. Targeting INFS may offer a preventive treatment of schizophrenia.

Can we predict Acute Medical readmissions using the BOOST tool? A retrospective case note review

BACKGROUND

Readmissions within 30-days of hospital discharge are a problem. The aim was to determine if the Better Outcomes for Older Adults through Safe Transitions (BOOST) risk assessment tool was applicable within the UK.

METHODS

Patients over 65 readmitted were identified retrospectively via a casenote review. BOOST assessment was applied with 1 point for each risk factor.

RESULTS

324 patients were readmitted (mean age 77 years) with a median of 7 days between discharge and readmission. The median BOOST score was 3 (IQR 2-4) with polypharmacy evident in 88% and prior hospitalisation in 70%. The tool correctly predicted 90% of readmissions using two or more risk factors and 99.1% if one risk factor was included.

CONCLUSION

The BOOST assessment tool appears appropriate in predicting readmissions however further analysis is required to determine its precision.

Ruthenium-arene complexes of curcumin: X-ray and density functional theory structure, synthesis, and spectroscopic characterization, in vitro antitumor activity, and DNA docking studies of (p-cymene)Ru(curcuminato)chloro

The in vitro antiproliferative activity of the title compound on five tumor cell lines shows preference for the colon-rectal tumor HCT116, IC(50) = 13.98 μM, followed by breast MCF7 (19.58 μM) and ovarian A2780 (23.38 μM) cell lines; human glioblastoma U-87 and lung carcinoma A549 are less sensitive. A commercial curcumin reagent, also containing demethoxy and bis-demethoxy curcumin, was used to synthesize the title compound, and so (p-cymene)Ru(demethoxy-curcuminato)chloro was also isolated and chemically characterized. The crystal structure of the title compound shows (1) the chlorine atom linking two neighboring complexes through H-bonds with two O(hydroxyl), forming an infinite two-step network; (2) significant twist in the curcuminato, 20° between the planes of the two phenyl rings. This was also seen in the docking of the Ru-complex onto a rich guanine B-DNA decamer, where a Ru-N7(guanine) interaction is detected. This Ru-N7(guanine) interaction is also seen with ESI-MS on a Ru-complex-guanosine derivative.

Imported human African trypanosomiasis in Europe, 2005-2009

Physicians in Europe are likely to see more African trypanosomiasis cases because of the increasing popularity of travel to Africa. In this paper the literature on imported cases in Europe, since 2005 is reviewed. Because of the high mortality risk associated with acute Rhodesian trypanosomiasis, travellers should be informed about preventive measures and the early disease manifestations.

Imported human African trypanosomiasis in Europe, 2005-2009

Physicians in Europe are likely to see more African trypanosomiasis cases because of the increasing popularity of travel to Africa. In this paper the literature on imported cases in Europe, since 2005 is reviewed. Because of the high mortality risk associated with acute Rhodesian trypanosomiasis, travellers should be informed about preventive measures and the early disease manifestations.

An assessment of the psychometric properties of Lithuanian versions of DSM-IV-MR-J and SOGS-RA

OBJECTIVE

Since no Lithuanian instrument focuses specifically on the measurement of pathological gambling in adolescence, we aimed to adapt commonly used international instruments (SOGS-RA, DSM-IV-MR-J) and assess their psychometric properties.

METHODS

Cross-cultural adaptation of DSM-IV-MR-J and SOGS-RA was performed in several steps including translations, synthesis of translations, back-translations, expert committee review, and pre-testing. Adapted instruments were administered to randomly selected adolescents in grades V through XII from all schools in the second largest Lithuanian city (Kaunas).

RESULTS

The DSM-IV-MR-J identified 4.2% of the representative sample as pathological gamblers, whereas the SOGS-RA generated prevalence of 5.2%. Cronbach's alpha for DSM-IV-MR-J in this sample was 0.80 and 0.75 for the SOGS-RA. The correlation coefficient between the SOGS-RA and the DSM-IV-MR-J was statistically significant (Pearson correlation = 0.892, P < 0.001). Using the DSM-IV-MR-J as the baseline for pathological gambling in adolescence, the overall classification accuracy of the SOGS-RA was judged to be adequate, correctly identifying 34 out of 35 pathological gamblers (Kappa = 0.833, P < 0.001).

CONCLUSIONS

The Lithuanian versions of DSM-IV-MR-J and SOGS-RA exhibited acceptable validity and reliability. The DSM-IV-MR-J was found to be a more conservative measure of pathological gambling.

Joint segmentation-registration of organs using geometric models

In this paper, we present a novel method for the segmentation of the organs found in CT and MR images. The proposed algorithm utilizes the shape model of the target organ to gain robustness in the case where the objective organ is surrounded by other organs or tissue with the similar intensity profile. The algorithm labels the image based on the graph-cuts technique and incorporates the shape prior using a technique based on level-sets. The method requires proper registration of the shape template for an accurate segmentation, and we propose a unified registration-segmentation framework to solve this problem. Furthermore, to reduce the computational cost, the algorithm is designed to run on watershed regions instead of voxels. The accuracy of the algorithm is shown on the medical examples.

Methodology for constructing guidance

Although guidance exists for the use of many laboratory tests in a wide range of clinical situations, this guidance is spread among a range of literature sources, and is often directed at laboratory specialists rather than test users. Individual general practices display large variations in standardised test requesting, yet much of their testing activity involves a relatively small range of tests. This paper describes a methodological approach to review the available evidence and guidance and to extract relevant primary research work to examine a range of testing scenarios in general practice, with the aim of formulating guidance based on the best available evidence or consensus opinions.

Model-based segmentation of medical imagery by matching distributions

The segmentation of deformable objects from three-dimensional (3-D) images is an important and challenging problem, especially in the context of medical imagery. We present a new segmentation algorithm based on matching probability distributions of photometric variables that incorporates learned shape and appearance models for the objects of interest. The main innovation over similar approaches is that there is no need to compute a pixelwise correspondence between the model and the image. This allows for a fast, principled algorithm. We present promising results on difficult imagery for 3-D computed tomography images of the male pelvis for the purpose of image-guided radiotherapy of the prostate.

Improving performance of distribution tracking through background mismatch

This paper proposes a new density matching method based on background mismatching for tracking of nonrigid moving objects. The new tracking method extends the idea behind the original density-matching tracker, which tracks an object by finding a contour in which the photometric density sampled from the enclosed region most closely matches a model density. This method can be quite sensitive to the initial curve placements and model density. The new method eliminates these sensitivities by adding a second term to the optimization: The mismatch between the model density and the density sampled from the background. By maximizing this term, the tracking algorithm becomes significantly more robust in practice. Furthermore, we show the enhanced ability of the algorithm to deal with target objects which possess smooth or diffuse boundaries. The tracker is in the form of a partial differential equation, and is implemented using the level-set framework. Experiments on synthesized images and real video sequences show our proposed methods are effective and robust; the results are compared with several existing methods.

Active contours for tracking distributions

A new approach to tracking using active contours is presented. The class of objects to be tracked is assumed to be characterized by a probability distribution over some variable, such as intensity, color, or texture. The goal of the algorithm is to find the region within the current image, such that the sample distribution of the interior of the region most closely matches the model distribution. Two separate criteria for matching distributions are examined, and the curve evolution equations are derived in each case. The flows are shown to perform well in experiments.

Vulvar squamous cell carcinoma in young women: a clinicopathologic study of 21 cases

OBJECTIVES

Invasive squamous cell carcinoma (ISCC) of the vulva occurs most often in older women and the clinical, pathological, and immunohistochemical features of vulvar ISCC in young women are poorly characterized. The aim of this study was to examine clinical and pathological features of ISCC presenting in women younger than 40 years of age.

METHODS

Patients younger than 40 years of age who presented with vulvar ISCC were identified in the population-based tumor registry of the British Columbia Cancer Agency (BCCA) for the period 1970-1998. Clinical data and follow-up were obtained. The pathologic material was reviewed and morphologic features assessed. Immunohistochemical staining for MIB-1 and p53 proteins was done and the presence of human papillomavirus (HPV) DNA was assessed by microdissection/PCR.

RESULTS

Twenty-one cases, accounting for 5% of all cases of vulvar ISCC encountered at BCCA during this period, were identified, with patient's ages ranging from 17 to 39 years (mean 33). The number of cases of vulvar ISCC in young women, as a percentage of all cases of vulvar ISCC, increased significantly over the study period. Lichen sclerosus was seen in 3 cases. Vulvar intraepithelial neoplasia (VIN) was present in 20 of 21 cases and was multifocal in 4 of them. VIN was subclassified as warty in 7 cases, mixed warty and basaloid in 6, basaloid in 4, and differentiated in 3. There was MIB-1 immunostaining throughout the full thickness of warty and basaloid VIN. Only basal cells stained for MIB-1 in differentiated VIN. Increased p53 expression was present in only 2 cases; both were differentiated-type VIN. HPV DNA was detected in 17 of 20 cases. The tumors were staged as follows: stage IA, 3 cases; stage IB, 13 cases; stage II, 3 cases; stage III, 2 cases. Depth of invasion ranged from <1 to 8.5 mm. The definitive surgical procedure was vulvectomy with lymph node dissection in 14 cases, wide local excision in 6, and excisional biopsy in 1. Clinical follow-up of 1 to 28 years (median, 5 years) showed that 5 patients had local recurrence and 2 died of disease. Of the 21 patients in this study, 1 had concurrent HIV infection and 1 patient with Crohn's disease was treated with corticosteroids; the remaining patients had no clinical evidence of depressed immune function.

CONCLUSIONS

The incidence of vulvar ISCC in young women has increased over time; this increase cannot be accounted for by ISCC in immunocompromised patients. The overall disease outcome was excellent, with 2 of 21 patients dead of disease. Most tumors were associated with HPV, but cases of ISCC in the absence of HPV, and associated with differentiated VIN, were encountered. p53 staining of the basal layer can aid in recognition of differentiated VIN while MIB-1 staining within the upper layers of the squamous epithelium is consistently present in warty and basaloid VIN, but not in differentiated VIN.

Heteroleptic lanthanide compounds with chalcogenolate ligands: reduction of PhNNPh/PhEEPh (E = Se or Te) mixtures with Ln (Ln = Ho, Er, Tm, Yb). Thermolysis can give LnN or LnE

Lanthanide metals reduce mixtures of azobenzene and PhEEPh (E = Se or Te) in pyridine to give the bimetallic compounds [(py)2Ln(EPh)(PhNNPh)]2 (E = Se, Ln = Ho (1), Er (2), Tm (3), Yb (4); E = Te, Ln = Ho (5), Er (6), Tm (7), Yb (8)). The structures of [(py)2Er(mu-eta 2-eta 2-PhNNPh)(SePh)](2).2py (2) and [(py)2Ho(mu-eta 2-eta 2-PhNNPh)(TePh)](2).2py (5) have been determined by low-temperature single-crystal X-ray diffraction, and the nearly identical unit cell volumes of the remaining compounds indicate they are most likely isomorphous to 2 or 5. In all compounds, the Ln(III) ions are bridged by a pair of mu-eta 2-eta 2-PhNNPh ligands that, from the N-N bond length, have clearly been reduced to dianions. Charge is balanced by the single terminal EPh ligand on each Ln, and the coordination sphere is saturated by two pyridine donors to give seven coordinate metal centers. Thermal decomposition of 5 gives HoTe, 8 gives a mixture of YbN and YbTe, and 1 does not give a crystalline solid-state product. Crystal data (Mo K alpha, 153(2) K) are as follows: 2, monoclinic group P2(1)/n, a = 11.864(3) A, b = 14.188(2) A, c = 17.624(2) A, beta = 91.62(2) degrees, V = 2965(1) A3, Z = 4; 5, triclinic space group P1, a = 10.349(2) A, b = 17.662(4) A, c = 17.730(8) A, alpha = 75.82(3) degrees, beta = 74.11(3) degrees, gamma = 89.45(2) degrees, V = 3016(2) A3, Z = 2.

Precursors of lethal violence: a death row sample

A qualitative methodology based on the standards of criminal defense investigation was used to analyze the social and family histories of 16 men sentenced to death in California. Using a multisource cross-validation methodology, we assessed patterns of impairment, injury and deficit at each of four ecological levels: family, individual, community and social institutions. Investigation documented consistent and pervasive patterns of serious impairment, injury and deficit across the cases and levels. The men share numerous risk factors and few resiliency factors associated with violence. We found family violence in all 16 cases, including severe physical and/or sexual abuse in 14 cases; individual impairments in 16, including 14 with post-traumatic stress disorder, 13 with severe depression and 12 with histories of traumatic brain injury; community isolation and violence in 12; and institutional failure in 15, including 13 cases of severe physical and/or sexual abuse while in foster care or under state youth authority jurisdiction. Appropriate interventions might have made a difference in reducing lethal violence and its precursor conditions.

Divalent samarium compounds with heavier chalcogenolate (EPh; E = Se, Te) ligands

Crystalline coordination complexes of Sm(EPh)2 (E = Se, Te) are described. The selenolate compound Sm(SePh)2 is unstable in solution, but a divalent selenolate can be prepared and isolated when precisely 1 equiv of Zn(SePh)2 is present to form heterometallic [(THF)3Sm(mu 2-SePh)3Zn(mu 2-SePh)]n (1). This compound is a 1D coordination polymer with alternating Sm(II) and Zn(II) ions connected by an alternating (1,3) number of bridging selenolate ligands and three THF ligands bound to each Sm(II) ion. The tellurolate Sm(TePh)2 forms a stable pyridine coordination compound (py)5Sm(TePh)2 (2) that is isostructural with known Eu and Yb benzenetellurolates. Both compounds were characterized by conventional spectroscopic methods. Polymer 1 was characterized by low-temperature single-crystal X-ray diffraction, and the unit cell of the tellurolate was determined. Crystal data (Mo K alpha, 153(5) (K) are as follows. 1: monoclinic space group P21, a = 10.666(2) A, b = 16.270(3) A, c = 12.002(3) A, beta = 114.81(2) degrees, Z = 2.2: orthorhombic space group Pbca, with a = 13.865(3) A, b = 16.453(5) A, c = 31.952(7) A, Z = 8.