Left main bronchus compression due to main pulmonary artery dilatation in pulmonary hypertension: two case reports

Abstract. Pulmonary arterial dilatation associated with pulmonary hypertension may result in significant compression of local structures. Left main coronary artery and left recurrent laryngeal nerve compression have been described. Tracheobronchial compression from pulmonary arterial dilatation is rare in adults, and there are no reports in the literature of its occurrence in idiopathic pulmonary arterial hypertension. Compression in infants with congenital heart disease has been well described. We report 2 cases of tracheobronchial compression: first, an adult patient with idiopathic pulmonary arterial hypertension who presents with symptomatic left main bronchus compression, and second, an adult patient with Eisenmenger ventricular septal defect and right-sided aortic arch, with progressive intermedius and right middle lobe bronchi compression in association with enlarged pulmonary arteries

Stratified decision forests for accurate anatomical landmark localization in cardiac images

Accurate localization of anatomical landmarks is an important step in medical imaging, as it provides useful prior information for subsequent image analysis and acquisition methods. It is particularly useful for initialization of automatic image analysis tools (e.g. segmentation and registration) and detection of scan planes for automated image acquisition. Landmark localization has been commonly performed using learning based approaches, such as classifier and/or regressor models. However, trained models may not generalize well in heterogeneous datasets when the images contain large differences due to size, pose and shape variations of organs. To learn more data-adaptive and patient specific models, we propose a novel stratification based training model, and demonstrate its use in a decision forest. The proposed approach does not require any additional training information compared to the standard model training procedure and can be easily integrated into any decision tree framework. The proposed method is evaluated on 1080 3D highresolution and 90 multi-stack 2D cardiac cine MR images. The experiments show that the proposed method achieves state-of-theart landmark localization accuracy and outperforms standard regression and classification based approaches. Additionally, the proposed method is used in a multi-atlas segmentation to create a fully automatic segmentation pipeline, and the results show that it achieves state-of-the-art segmentation accuracy

Deep learning cardiac motion analysis for human survival prediction

Motion analysis is used in computer vision to understand the behaviour of moving objects in sequences of images. Optimising the interpretation of dynamic biological systems requires accurate and precise motion tracking as well as efficient representations of high-dimensional motion trajectories so that these can be used for prediction tasks. Here we use image sequences of the heart, acquired using cardiac magnetic resonance imaging, to create time-resolved three-dimensional segmentations using a fully convolutional network trained on anatomical shape priors. This dense motion model formed the input to a supervised denoising autoencoder (4Dsurvival), which is a hybrid network consisting of an autoencoder that learns a task-specific latent code representation trained on observed outcome data, yielding a latent representation optimised for survival prediction. To handle right-censored survival outcomes, our network used a Cox partial likelihood loss function. In a study of 302 patients the predictive accuracy (quantified by Harrell's C-index) was significantly higher (p < .0001) for our model C=0.73 (95$\%$ CI: 0.68 - 0.78) than the human benchmark of C=0.59 (95$\%$ CI: 0.53 - 0.65). This work demonstrates how a complex computer vision task using high-dimensional medical image data can efficiently predict human survival

Reduction of guide needle streak artifact in CT-guided biopsy

Purpose: Computed tomography (CT)–guided core needle biopsy (CNB) can be affected by streak artifact obscuring the needle tip. This study investigates factors that influence the occurrence and severity of streak artifact during CNB. Materials and Methods: Eight coaxial guide needles of two sizes from two manufacturers with and without stylets were imaged in a CT phantom, with CT reconstructed with adaptive statistical iterative reconstruction and filtered back projection. CNB-related streak artifact was quantified with profile analysis in an image-processing program. Differences between maximum attenuation at the needle tip and minimum attenuation in the streak artifact were compared for each variable. Diagnostic acceptability and streak artifact were subjectively assessed on each phantom image and on 40 clinical CNB procedures by three independent blinded reviewers following training case review. Results: Artifact was significantly less with the central stylet removed versus in situ (median, 1,145 HU vs 3,390 HU; P < .001) for all needles, and less for 19-gauge needles versus 17-gauge needles (median, 1,334 HU vs 2,780 HU, respectively; P = .006). There were no differences based on manufacturer (P = .906) or reconstruction algorithm (P = .524). Independent reviews found that streak artifact was significantly reduced when the central stylet was removed (κ = 0.875–1.0; P < .001), and needle tip position was better in cases in which the stylet was removed (κ = 0.231–0.711; P < .001). Conclusions: Streak artifact can be reduced and needle tip visualization improved by confirming final biopsy needle position with the central stylet removed on CT and using smaller-gauge guide needles

Aberrant phenotype in human endothelial cells of diabetic origin: Implications for saphenous vein graft failure?

Type 2 diabetes (T2DM) confers increased risk of endothelial dysfunction, coronary heart disease, and vulnerability to vein graft failure after bypass grafting, despite glycaemic control. This study explored the concept that endothelial cells (EC) cultured from T2DM and nondiabetic (ND) patients are phenotypically and functionally distinct. Cultured human saphenous vein-(SV-) EC were compared between T2DM and ND patients in parallel. Proliferation, migration, and in vitro angiogenesis assays were performed; western blotting was used to quantify phosphorylation of Akt, ERK, and eNOS. The ability of diabetic stimuli (hyperglycaemia, TNF-α, and palmitate) to modulate angiogenic potential of ND-EC was also explored. T2DM-EC displayed reduced migration (30%) and angiogenesis (40%) compared with ND-EC and a modest, nonsignificant trend to reduced proliferation. Significant inhibition of Akt and eNOS, but not ERK phosphorylation, was observed in T2DM cells. Hyperglycaemia did not modify ND-EC function, but TNF-α and palmitate significantly reduced angiogenic capacity (by 27% and 43%, resp.), effects mimicked by Akt inhibition. Aberrancies of EC function may help to explain the increased risk of SV graft failure in T2DM patients. This study highlights the importance of other potentially contributing factors in addition to hyperglycaemia that may inflict injury and long-term dysfunction to the homeostatic capacity of the endothelium

Metastatic meningioma: positron emission tomography CT imaging findings

The imaging findings of a case of metastasing meningioma are described. The case illustrates a number of rare and interesting features. The patient presented with haemoptysis 22 years after the initial resection of an intracranial meningioma. CT demonstrated heterogeneous masses with avid peripheral enhancement without central enhancement. Blood supply to the larger lesion was partially from small feeding vessels from the inferior pulmonary vein. These findings correlate with a previously published case in which there was avid uptake of fluoro-18-deoxyglucose peripherally with lesser uptake centrally. The diagnosis of metastasing meningioma was confirmed on percutaneous lung tissue biopsy

Sedimentation and subsidence history of the Lomonosov Ridge

During the first scientific ocean drilling expedition to the Arctic Ocean (Arctic Coring Expedition [ACEX]; Integrated Ocean Drilling Program Expedition 302), four sites were drilled and cored atop the central part of the Lomonosov Ridge in the Arctic Ocean at ~88°N, 140°E (see Fig. F18 in the "Sites M0001–M0004" chapter). The ridge was rifted from the Eurasian continental margin at ~57 Ma (Fig. F1) (Jokat et al., 1992, 1995). Since the rifting event and the concurrent tilting and erosion of this sliver of the outer continental margin, the Lomonosov Ridge subsided while hemipelagic and pelagic sediments were deposited above the angular rifting unconformity (see Fig. F7A in the "Sites M0001–M0004" chapter).The sections recovered from the four sites drilled during Expedition 302 can be correlated using their seismic signature, physical properties (porosity, magnetic susceptibility, resistivity, and P-wave velocity), chemostratigraphy (ammonia content of pore waters), lithostratigraphy, and biostratigraphy. The lithostratigraphy of the composite section combined with biostratigraphy provides an insight into the complex history of deposition, erosion, and preservation of the biogenic fraction. Eventually, the ridge subsided to its present water depth as it drifted from the Eurasian margin. In this chapter, we compare a simple model of subsidence history with the sedimentary record recovered from atop the ridge

DNA repair biomarkers XPF and phospho-MAPKAP kinase 2 correlate with clinical outcome in advanced head and neck cancer.

BackgroundInduction chemotherapy is a common therapeutic option for patients with locoregionally-advanced head and neck cancer (HNC), but it remains unclear which patients will benefit. In this study, we searched for biomarkers predicting the response of patients with locoregionally-advanced HNC to induction chemotherapy by evaluating the expression pattern of DNA repair proteins.MethodsExpression of a panel of DNA-repair proteins in formalin-fixed paraffin embedded specimens from a cohort of 37 HNC patients undergoing platinum-based induction chemotherapy prior to definitive chemoradiation were analyzed using quantitative immunohistochemistry.ResultsWe found that XPF (an ERCC1 binding partner) and phospho-MAPKAP Kinase 2 (pMK2) are novel biomarkers for HNSCC patients undergoing platinum-based induction chemotherapy. Low XPF expression in HNSCC patients is associated with better response to induction chemoradiotherapy, while high XPF expression correlates with a worse response (p = 0.02). Furthermore, low pMK2 expression was found to correlate significantly with overall survival after induction plus chemoradiation therapy (p = 0.01), suggesting that pMK2 may relate to chemoradiation therapy.ConclusionsWe identified XPF and pMK2 as novel DNA-repair biomarkers for locoregionally-advanced HNC patients undergoing platinum-based induction chemotherapy prior to definitive chemoradiation. Our study provides insights for the use of DNA repair biomarkers in personalized diagnostics strategies. Further validation in a larger cohort is indicated

Low resistivity Pt interconnects developed by electron beam assisted deposition using novel gas injector system

Electron beam-induced deposition (EBID) is a direct write process where an electron beam locally decomposes a precursor gas leaving behind non-volatile deposits. It is a fast and relatively in-expensive method designed to develop conductive (metal) or isolating (oxide) nanostructures. Unfortunately the EBID process results in deposition of metal nanostructures with relatively high resistivity because the gas precursors employed are hydrocarbon based. We have developed deposition protocols using novel gas-injector system (GIS) with a carbon free Pt precursor. Interconnect type structures were deposited on preformed metal architectures. The obtained structures were analysed by cross-sectional TEM and their electrical properties were analysed ex-situ using four point probe electrical tests. The results suggest that both the structural and electrical characteristics differ significantly from those of Pt interconnects deposited by conventional hydrocarbon based precursors, and show great promise for the development of low resistivity electrical contacts

Expedition 302 geophysics: integrating past data with new results

In preparation for IODP Expedition 302, Arctic Coring Expedition (ACEX), a site survey database comprising geophysical and geological data from the Lomonosov Ridge was compiled. The accumulated database includes data collected from ice islands, icebreakers, and submarines from 1961 to 2001. In addition, seismic reflection profiles were collected during Expedition 302 that complement the existing seismic reflection data and facilitate integration between the acoustic stratigraphy and the Expedition 302 drill cores. An overview of these data is presented in this chapter.It is well recognized that collecting geophysical data in ice-covered seas, in particular the Arctic Ocean, is a challenging endeavor. This is because much of the Arctic Ocean is continuously covered with ice thicknesses that vary from 1 to 6 m. Over the continental shelves, sea ice can be absent during summer months, but it is present year-round in the central basins. This ice cover is the most dominant feature of the Arctic Ocean environment. It circulates in the ocean basin in two main circulation patterns: the Transpolar Drift and the Beaufort Gyre (see the "Expedition 302 summary" chapter; Rudels et al., 1996).Expedition 302 sites are located within the less severe of these two ice circulation systems, the Transpolar Drift, which primarily moves sea ice from the shelves where it is formed (the Laptev and East Siberian Seas) across the basin and exits through the Fram Strait. During late summer, concentrations of Arctic sea ice can be &lt;100% (10/10 ice cover), making it possible for icebreakers to operate. Average ice concentrations in the central Arctic Ocean during summer months can locally vary from partially open water (6/10) to completely ice covered (10/10). This sea-ice cover can move at speeds up to 0.5 kt.Early Arctic Ocean geophysical exploration was performed from ice-drift stations (Weber and Roots, 1990). However, the tracks from these drifting ice stations were controlled "by the whims of nature" (Jackson et al., 1990), preventing detailed, systematic surveys of predetermined target areas. These ice-drift stations were set up on stable icebergs that were trapped in sea ice and moved generally with the large drift patterns, but locally they were erratic, so preselected locations could not be surveyed. In the late 1980s, single icebreakers began to be used for oceanographic survey work in the Arctic Ocean. Between 1991 and 2001, four scientific icebreaker expeditions to the Lomonosov Ridge took place. These cruises all experienced local sea-ice conditions varying between 8/10 and 10/10. During these expeditions, towed geophysical equipment was occasionally damaged or lost, either because of a rapidly closing wake caused by local ice pressure or because ice had cut the air gun array.Conventionally powered icebreakers reached as far as the North Pole for the first time during the 1991 Expedition (Andersen and Carlsonn, 1992; Fütterer, 1992). Geophysical results from this expedition collected two important reflection profiles, AWI-91090 and AWI-91091, that crossed the Lomonosov Ridge between 87° and 88°N. These profiles imaged a ~450 m thick, well-stratified and apparently undisturbed drape of sediments overlying a prominent acoustic unconformity (Jokat et al., 1992) that spawned the idea to conduct a paleoceanographic drilling expedition to this Ridge.The use of US Navy nuclear submarines for geophysical mapping was implemented through the Science Ice Exercise program (SCICEX) (Newton, 2000). The development of the Seafloor Characterization and Mapping Pods (SCAMP), which hold a Chirp subbottom profiler, swath bathymetric profiler, and side scan sonar, was an essential part of the SCICEX program (Chayes et al., 1996). In 1999, the Lomonosov Ridge geophysical database was augmented with acoustic data acquired during the SCICEX program using the SCAMP system mounted on the US nuclear submarine USS Hawkbill (Edwards and Coakley, 2003)