Robust Radiomics Feature Quantification Using Semiautomatic Volumetric Segmentation

Due to advances in the acquisition and analysis of medical imaging, it is currently possible to quantify the tumor phenotype. The emerging field of Radiomics addresses this issue by converting medical images into minable data by extracting a large number of quantitative imaging features. One of the main challenges of Radiomics is tumor segmentation. Where manual delineation is time consuming and prone to inter-observer variability, it has been shown that semi-automated approaches are fast and reduce inter-observer variability. In this study, a semiautomatic region growing volumetric segmentation algorithm, implemented in the free and publicly available 3D-Slicer platform, was investigated in terms of its robustness for quantitative imaging feature extraction. Fifty-six 3D-radiomic features, quantifying phenotypic differences based on tumor intensity, shape and texture, were extracted from the computed tomography images of twenty lung cancer patients. These radiomic features were derived from the 3D-tumor volumes defined by three independent observers twice using 3D-Slicer, and compared to manual slice-by-slice delineations of five independent physicians in terms of intra-class correlation coefficient (ICC) and feature range. Radiomic features extracted from 3D-Slicer segmentations had significantly higher reproducibility (ICC = 0.85±0.15, p = 0.0009) compared to the features extracted from the manual segmentations (ICC = 0.77±0.17). Furthermore, we found that features extracted from 3D-Slicer segmentations were more robust, as the range was significantly smaller across observers (p = 3.819e-07), and overlapping with the feature ranges extracted from manual contouring (boundary lower: p = 0.007, higher: p = 5.863e-06). Our results show that 3D-Slicer segmented tumor volumes provide a better alternative to the manual delineation for feature quantification, as they yield more reproducible imaging descriptors. Therefore, 3D-Slicer can be employed for quantitative image feature extraction and image data mining research in large patient cohorts

A prospective study on feto-maternal outcome in patients with premature rupture of membranes at tertiary care center

Background: PROM is associated with increased risk of chorioamnionitis, unfavorable cervix and dysfunctional labour, increased cesarean rates, postpartum hemorrhage and endometritis in the mother. Possible neonatal outcomes in cases of PROM may include respiratory distress syndrome, hypothermia, hypoglycemia, intraventricular hemorrhage, broncho pulmonary dysplasia etc. Objective of this study the maternal and perinatal outcomes in premature rupture of membranes at term.Methods: This prospective study was done among 100 pregnant women with premature rupture of membranes after 37 completed weeks visited at department of obstetrics & Gynecology in RCSM Hospital, Kolhapur during June 2014 and June 2015. Inclusion Criteria was Gestational  age  of  >37  weeks  confirmed  by  dates,  clinical  examination  or ultrasound, cervical dilatation of <3 cms, Lack of uterine contractions for atleast 1 hour from PROM, Single live pregnancy in vertex presentation and PROM confirmed by Direct visualization or Litmus.Results: Present study found highest number of cases among age group 20-24 years and mean age was 22 years. Almost 70% cases were un-booked. Average duration to PROM to hospital admission was 9.6 hours. Most common maternal outcome was febrile illness Most common perinatal outcome was birth asphyxia and 3 perinatal death.Conclusions: Pregnancies complicated with PROM should have supervised labor preferably in an institution. Management of each case has to be individualised. A combined effort of obstetrician and neonatalogist is necessary. A good neonatal intensive care unit can be instrumental in reducing the perinatal morbidity and mortality

Evaluation of peripheral lymphadenopathy by fine needle aspiration cytology: a one year study at tertiary centre

Background: Lymphadenopathy is common presenting features in various non-neoplastic and neoplastic lesions. Fine needle aspiration cytology (FNAC) is simple, quick, inexpensive and minimally invasive technique that can be used as an outpatient procedure to diagnose them. The present study was undertaken to assess the various causes of lymphadenopathy through FNAC, and to see the distribution of lesions with respect to age and gender. To assess the diagnostic accuracy of lymph node fine needle aspiration (FNA) cytology in various non-neoplastic and neoplastic conditions.Methods: Total 555 cases of the lymph node FNAC were studied from January 2014 to December 2014 in Cytopathology department of Government Medical College, Surat .The cytomorphologic features seen in the aspirates were analyzed and correlated with their etiology.Results: In this study 555 cases of cervical lymphadenopathy were analysed. The age of the patients ranged from 5 months to 90 years of which 60.2% were males and 39.8% were females. Maximum numbers of cases 147(26.4%) were in the age group of 21- 30 years. The most common lesion encountered was tuberculous lymphadenitis 44.8% followed by metastatic tumors 31.3%, reactive lymph node 16.7%, acute lymphadenitis 5.4% and lymphoma 1.8%. Male showed predominance of metastatic carcinoma and lymphoma while chronic reactive hyperplasia and tuberculous lymphadenitis were equally distributed in both male &amp; female.Conclusions: FNAC is safe, rapid and cost effective method in establishing the diagnosis in large number of cases of lymphadenopathy. It can differentiate a neoplastic from a non-neoplastic process and therefore influence patient management preventing patient from being subjected to unnecessary surgery

Polar opposites? NGOs, left parties and the fight for social change in Nepal

In the early 1990s, when NGOs were rising to prominence as an ostensible force for social change in Nepal, the Maoists were also beginning to organise, and denounced NGOs as agents of imperialism. The Maoists came to prominence by fighting a People’s War launched in 1996, with the intention of improving life for the poor peasant and working-class majority. But after a decade-long struggle, the Maoists became incorporated into the parliamentary system. While Nepal’s first democratic revolution in 1990 met formal, popular political demands, which were consolidated in a subsequent revolution in 2006 overthrowing the monarchy and bringing the People’s War to an end, there was little socio-economic progress for the vast majority. The argument advanced in this article is that this lack of progress relied on the interplay of two phenomena: an anti-Maoist alliance consisting of the international community, the domestic ruling elite and NGOs, and a fundamental ambiguity at the heart of the Maoists’ political theory

A study on knowledge, awareness and preventive practice about tuberculosis among medical students in Udaipur, India

Background: Tuberculosis (TB) is a highly lethal infectious disease causing huge health burden worldwide, commonly involving the respiratory system. Medical students should also be empowered to impart awareness and reduce stigma related to TB. The objective of this study was to evaluate whether educational intervention would affect the level of TB awareness, knowledge, attitude and preventive practice of TB among medical students.Methods: The present study was carried out among the second year medical college students of Pacific Institute of Medical Sciences, Udaipur, India (n=142). A multiple-choice questionnaire of 45 questions was designed in English language, for pre- and post-tests. A 30-minute visual health education was given on TB and the assessment of knowledge, attitude and preventive practice of TB was done by a pre-test and post-test questionnaire.Results: Out of the total 150 student, 142 participated in the study making the response rate 94.66%. The total mean percentage of correct answers for TB knowledge was 48.59 (±20.44) which improved to 69.33 (±17.74) post-training. The total mean percentage of right attitude was 63.036 (±16.46) which improved to 77.06 (±15.58) post-training. The total mean percentage of correct answer for preventive practice were provided by 67.036 (±12.90) which changed to 79.50 (±12.01) post-training. There was significant difference in the knowledge, attitude and preventive practice of students in pre- and post-training tests (p=0.001).Conclusions: Our findings revealed that medical students had poor knowledge. A simple TB education session had a positive influence on knowledge, attitude and preventive practices about TB among them

Multisite Investigation of Outcomes With Implementation of CYP2C19 Genotype-Guided Antiplatelet Therapy After Percutaneous Coronary Intervention

OBJECTIVES: This multicenter pragmatic investigation assessed outcomes following clinical implementation of CYP2C19 genotype-guided antiplatelet therapy after percutaneous coronary intervention (PCI). BACKGROUND: CYP2C19 loss-of-function alleles impair clopidogrel effectiveness after PCI. METHODS: After clinical genotyping, each institution recommended alternative antiplatelet therapy (prasugrel, ticagrelor) in PCI patients with a loss-of-function allele. Major adverse cardiovascular events (defined as myocardial infarction, stroke, or death) within 12 months of PCI were compared between patients with a loss-of-function allele prescribed clopidogrel versus alternative therapy. Risk was also compared between patients without a loss-of-function allele and loss-of-function allele carriers prescribed alternative therapy. Cox regression was performed, adjusting for group differences with inverse probability of treatment weights. RESULTS: Among 1,815 patients, 572 (31.5%) had a loss-of-function allele. The risk for major adverse cardiovascular events was significantly higher in patients with a loss-of-function allele prescribed clopidogrel versus alternative therapy (23.4 vs. 8.7 per 100 patient-years; adjusted hazard ratio: 2.26; 95% confidence interval: 1.18 to 4.32; p = 0.013). Similar results were observed among 1,210 patients with acute coronary syndromes at the time of PCI (adjusted hazard ratio: 2.87; 95% confidence interval: 1.35 to 6.09; p = 0.013). There was no difference in major adverse cardiovascular events between patients without a loss-of-function allele and loss-of-function allele carriers prescribed alternative therapy (adjusted hazard ratio: 1.14; 95% confidence interval: 0.69 to 1.88; p = 0.60). CONCLUSIONS: These data from real-world observations demonstrate a higher risk for cardiovascular events in patients with a CYP2C19 loss-of-function allele if clopidogrel versus alternative therapy is prescribed. A future randomized study of genotype-guided antiplatelet therapy may be of value

The role of topical papaverine in microvascular surgery

Background: Intraoperative vasospasm during microvascular surgery can significantly impact surgical outcomes, leading to reduced blood flow and potential flap failure. This study evaluates the effects of local application of topical Papaverine, a nonspecific phosphodiesterase inhibitor, in enhancing vessel diameter, preventing vasospasm, and improving flap survival. A total of 1,000 microvascular anastomoses were analysed across multiple reconstruction types. Results showed an average of 66% increase in arterial diameter, reduced incidence of thrombus formation, and improvement in flap survival rates. Papaverine demonstrated immediate vasodilatory effects, solidifying its role as a gold-standard agent in microsurgery. Methods: A retrospective study evaluated 1,000 microvascular anastomoses performed in a single year.       reconstruction such as head and neck, post-oncological, extremity, and digital re-implantations were included. Papaverine was sprayed topically over vessels. Vessel diameter changes were measured before and 10 minutes after application. Results: Significant improvement in vessel diameter following Papaverine application. Arterial diameter increased by an average of 66%, while venous dilation was observed at a 23% increase. Papaverine’s strong vasodilatory effects, particularly in arteries with higher smooth muscle content. The rapid onset of action (within 1–5 minutes) was consistent, ensuring immediate resolution of vasospasm. overall flap survival rate improved by 15%, and re-exploration rates decreased from 8% to 3%, emphasizing its role in enhancing surgical outcomes. Conclusions: Papaverine effectively prevents intraoperative vasospasm, enhances vessel diameter, and improves overall flap survival by reducing re exploration rates. These findings validate its role as a gold-standard vasodilator in microvascular surgery

Experience with a synthetic bilayer biodegradable temporising matrix in complex wounds

Bilayer Biodegradable Temporising Matrix (BTM) is a synthetic polyurethane dermal matrix used to reconstruct complex wound with exposed bone and tendon, chronic wound. We hope to further explore its potential applications in this series. Patients who received BTM application across our centres over a 12-months period were included. Patients were followed up to assess BTM and graft take, substitute for flap in small wound, stable coverage, cover in trophic ulcer and prevent recurrence. A total 15 patients with wounds were identified with a range of aetiologies. wounds had 100% integration of BTM at the time of sealing membrane removal. Two wounds had partial graft loss that later healed by secondary intention. BTM offers a safe and reliable reconstructive option in challenging wounds that would otherwise require more complex operations

Neurofibromin Deficiency Induces Endothelial Cell Proliferation and Retinal Neovascularization

Purpose: Neurofibromatosis type 1 (NF1) is the result of inherited mutations in the NF1 tumor suppressor gene, which encodes the protein neurofibromin. Eye manifestations are common in NF1 with recent reports describing a vascular dysplasia in the retina and choroid. Common features of NF1 retinopathy include tortuous and dilated feeder vessels that terminate in capillary tufts, increased endothelial permeability, and neovascularization. Given the retinal vascular phenotype observed in persons with NF1, we hypothesize that preserving neurofibromin may be a novel strategy to control pathologic retinal neovascularization. Methods: Nf1 expression in human endothelial cells (EC) was reduced using small hairpin (sh) RNA and EC proliferation, migration, and capacity to form vessel-like networks were assessed in response to VEGF and hypoxia. Wild-type (WT), Nf1 heterozygous (Nf1+/-), and Nf1flox/+;Tie2cre pups were subjected to hyperoxia/hypoxia using the oxygen-induced retinopathy model. Retinas were analyzed quantitatively for extent of retinal vessel dropout, neovascularization, and capillary branching. Results: Neurofibromin expression was suppressed in response to VEGF, which corresponded with activation of Mek-Erk and PI3-K-Akt signaling. Neurofibromin-deficient EC exhibited enhanced proliferation and network formation in response to VEGF and hypoxia via an Akt-dependent mechanism. In response to hyperoxia/hypoxia, Nf1+/- retinas exhibited increased vessel dropout and neovascularization when compared with WT retinas. Neovascularization was similar between Nf1+/- and Nf1flox/+;Tie2cre retinas, but capillary drop out in Nf1flox/+;Tie2cre retinas was significantly reduced when compared with Nf1+/- retinas. Conclusions: These data suggest that neurofibromin expression is essential for controlling endothelial cell proliferation and retinal neovascularization and therapies targeting neurofibromin-deficient EC may be beneficial