Fully Automated MRI Segmentation and Volumetric Measurement of Intracranial Meningioma Using Deep Learning.

BACKGROUND: Accurate and rapid measurement of the MRI volume of meningiomas is essential in clinical practice to determine the growth rate of the tumor. Imperfect automation and disappointing performance for small meningiomas of previous automated volumetric tools limit their use in routine clinical practice. PURPOSE: To develop and validate a computational model for fully automated meningioma segmentation and volume measurement on contrast-enhanced MRI scans using deep learning. STUDY TYPE: Retrospective. POPULATION: A total of 659 intracranial meningioma patients (median age, 59.0 years; interquartile range: 53.0-66.0 years) including 554 women and 105 men. FIELD STRENGTH/SEQUENCE: The 1.0 T, 1.5 T, and 3.0 T; three-dimensional, T1 -weighted gradient-echo imaging with contrast enhancement. ASSESSMENT: The tumors were manually segmented by two neurosurgeons, H.K. and C.-K.P., with 10 and 26 years of clinical experience, respectively, for use as the ground truth. Deep learning models based on U-Net and nnU-Net were trained using 459 subjects and tested for 100 patients from a single institution (internal validation set [IVS]) and 100 patients from other 24 institutions (external validation set [EVS]), respectively. The performance of each model was evaluated with the Sørensen-Dice similarity coefficient (DSC) compared with the ground truth. STATISTICAL TESTS: According to the normality of the data distribution verified by the Shapiro-Wilk test, variables with three or more categories were compared by the Kruskal-Wallis test with Dunn's post hoc analysis. RESULTS: A two-dimensional (2D) nnU-Net showed the highest median DSCs of 0.922 and 0.893 for the IVS and EVS, respectively. The nnU-Nets achieved superior performance in meningioma segmentation than the U-Nets. The DSCs of the 2D nnU-Net for small meningiomas less than 1 cm3 were 0.769 and 0.780 with the IVS and EVS, respectively. DATA CONCLUSION: A fully automated and accurate volumetric measurement tool for meningioma with clinically applicable performance for small meningioma using nnU-Net was developed. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.

Development of a deep learning-based auto-segmentation algorithm for hepatocellular carcinoma (HCC) and application to predict microvascular invasion of HCC using CT texture analysis: preliminary results.

BACKGROUND: Automatic segmentation has recently been developed to yield objective data. Prediction of microvascular invasion (MVI) of hepatocellular carcinoma (HCC) using radiomics has been reported. PURPOSE: To develop a deep learning-based auto-segmentation algorithm (DL-AS) for the detection of HCC and to predict MVI using computed tomography (CT) texture analysis. MATERIAL AND METHODS: We retrospectively collected training data from 249 patients with HCC and validation set from 35 patients. Lesions of the training set were manually drawn by radiologist, in the delayed phase. 2D U-Net was selected as the DL architecture. Using the validation set, one radiologist manually drew 2D and 3D regions of interest twice, and the developed DL-AS was performed twice with a one-month time interval. The reproducibility was calculated using intraclass correlation coefficients (ICC). Logistic regression was performed to predict MVI. RESULTS: ICC was in the range of 0.190-0.998/0.341-0.997 in the manual 3D/2D segmentation. In contrast, it was perfect in 3D/2D using DL-AS, with a success rate of 88.6% for the detection of HCC. For predicting MVI, sphericity was a significant parameter (odds ratio <0.001; 95% confidence interval <0.001-0.206; P = 0.020) for predicting MVI using 2D DL-AS. However, 3D DL-AS segmentation did not yield a predictive parameter. CONCLUSION: The auto-segmentation of HCC using DL-AS provides perfect reproducibility, although it failed to detect 11.4% (4/35). However, the extracted parameters yielded different important predictors of MVI in HCC. Sphericity was a significant predictor in 2D DL-AS and 3D manual segmentation, while discrete compactness was a significant predictor in 2D manual segmentation.

Polyaniline/Graphene-Functionalized Flexible Waste Mask Sensors for Ammonia and Volatile Sulfur Compound Monitoring.

A flexible resistive-type polyaniline-based gas sensor was fabricated by simple dip-coating of graphene combined with in situ polymerization of aniline on a flexible waste mask substrate. The prepared polypropylene/graphene/polyaniline (PP/G/PANI) hybrid sensor demonstrated a fast response (114 s) and recovery time (23 s), ppb-level detection limit (100 ppb), high response value (250% toward 50 ppm NH3, which is over four times greater than that of the pristine PANI sensor), acceptable flexibility, excellent selectivity, and long-term stability at room temperature. The morphological and structural properties of the composite sensor materials were characterized by scanning electron microscopy and energy-dispersive spectroscopy characterization, and the surface chemistry of the hybrid sensors was analyzed by Fourier transform infrared spectroscopy. The excellent sensing performance was mainly ascribed to the larger specific surface area and efficient conducting paths of the porous PP/G/PANI network. Moreover, the PP/G/PANI hybrid gas sensor exhibited excellent sensing capability on volatile sulfur compounds contained in human breath, indicating that the hybrid sensor can be applied to breath analysis and kidney disease diagnosis.

Comparison of the Incidence of Postoperative Hypothyroidism in Patients Undergoing Conventional Thyroid Lobectomy and Pyramid- and Isthmus-Preserving Lobectomy.

Hypothyroidism is a recognized sequela of conventional thyroid lobectomy. However, there have been no studies on the incidence of hypothyroidism following the preservation of the isthmus and pyramid during lobectomy. Therefore, in the present study, we compared the incidence of hypothyroidism following conventional lobectomy and lobectomy during which the isthmus and pyramidal lobe were preserved. Data for a total of 65 patients collected between September 2018 and April 2019 were reviewed retrospectively. Circulating thyroid-stimulating hormone (TSH) concentration was measured before and after surgery in a group who underwent conventional thyroid lobectomy (n = 29) and in a group in which the isthmus and pyramid were preserved (n = 36). We found no significant difference in TSH concentration between the two groups before surgery, or 3 months or 1 year after surgery. Thus, there might be no difference in the incidence of postoperative hypothyroidism between patients who undergo conventional thyroid lobectomy and those in which the isthmus and pyramid are preserved.

Clinical application of 3D virtual and printed models for cerebrovascular diseases.

OBJECTIVE: Three-dimensional (3D) printing techniques are rapidly advancing in the medical industry and in clinical practice. We aimed to evaluate the usefulness of 3D virtual and printed models of 6 representative cerebrovascular diseases using the software we developed. METHODS: Six cases consisted of 4 intracranial aneurysms (IAs) including complex ones with intrasaccular thrombosis, large size and a skull base location; 1 cavernous malformation in the pons; and 1 arteriovenous malformation in the parietal lobe. The 3D modeling process was performed retrospectively in 3 cases and prospectively in 1 IA. Segmentation of raw data and rendering and modification for 3D virtual models were processed mostly automatically. RESULTS: Most intracranial structures were satisfactorily made, including the skull, brain, vessels, thrombus, tentorium and major cranial nerves. Based on 3D modeling, surgical plan was changed in 1 prospective IA case. However, it was still difficult to discriminate small vessels and cranial nerves, to feel a realistic tactile sense and to directly perform presurgical simulations, such as dissection, removal, clipping and microanastomosis. CONCLUSIONS: The 3D modeling was thought to be very helpful in experiencing the operative views from various directions in advance, in selecting an appropriate surgical approach, and in educating physicians and patients. With advancements in radiological resolution, processing techniques and material properties, 3D modeling is expected to simulate real brain tissues more closely.

Clinical application of patient-specific 3D printing brain tumor model production system for neurosurgery.

The usefulness of 3-dimensional (3D)-printed disease models has been recognized in various medical fields. This study aims to introduce a production platform for patient-specific 3D-printed brain tumor model in clinical practice and evaluate its effectiveness. A full-cycle platform was created for the clinical application of a 3D-printed brain tumor model (3D-printed model) production system. Essential elements included automated segmentation software, cloud-based interactive communication tools, customized brain models with exquisite expression of brain anatomy in transparent material, adjunctive devices for surgical simulation, and swift process cycles to meet practical needs. A simulated clinical usefulness validation was conducted in which neurosurgeons assessed the usefulness of the 3D-printed models in 10 cases. We successfully produced clinically applicable patient-specific models within 4 days using the established platform. The simulated clinical usefulness validation results revealed the significant superiority of the 3D-printed models in surgical planning regarding surgical posture (p = 0.0147) and craniotomy design (p = 0.0072) compared to conventional magnetic resonance images. The benefit was more noticeable for neurosurgeons with less experience. We established a 3D-printed brain tumor model production system that is ready to use in daily clinical practice for neurosurgery.

Evaluation of pulmonary toxicity of benzalkonium chloride and triethylene glycol mixtures using in vitro and in vivo systems.

Benzalkonium chloride (BAC) is a widely used disinfectant/preservative, and respiratory exposure to this compound has been reported to be highly toxic. Spray-form household products have been known to contain BAC together with triethylene glycol (TEG) in their solutions. The purpose of this study was to estimate the toxicity of BAC and TEG mixtures to pulmonary organs using in vitro and in vivo experiments. Human alveolar epithelial (A549) cells incubated with BAC (1-10 µg/mL) for 24 hours showed significant cytotoxicity, while TEG (up to 1000 µg/mL) did not affect cell viability. However, TEG in combination with BAC aggravated cell damage and inhibited colony formation as compared to BAC alone. TEG also exacerbated BAC-promoted production of reactive oxygen species (ROS) and reduction of glutathione (GSH) level in A549 cells. However, pretreatment of the cells with N-acetylcysteine (NAC) alleviated the cytotoxicity, indicating oxidative stress could be a mechanism of the toxicity. Quantification of intracellular BAC by LC/MS/MS showed that cellular distribution/absorption of BAC was enhanced in A549 cells when it was exposed together with TEG. Intratracheal instillation of BAC (400 µg/kg) in rats was toxic to the pulmonary tissues while that of TEG (up to 1000 µg/kg) did not show any harmful effect. A combination of nontoxic doses of BAC (200 µg/kg) and TEG (1000 µg/kg) promoted significant lung injury in rats, as shown by increased protein content and lactate dehydrogenase (LDH) activity in bronchoalveolar lavage fluids (BALF). Moreover, BAC/TEG mixture recruited inflammatory cells, polymorphonuclear leukocytes (PMNs), in terminal bronchioles and elevated cytokine levels, tumor necrosis factor α (TNF-α), and interleukin 6 (IL-6) in BALF. These results suggest that TEG can potentiate BAC-induced pulmonary toxicity and inflammation, and thus respiratory exposure to the air mist from spray-form products containing this chemical combination is potentially harmful to humans.

Enhanced Gas-Sensing Performance of GO/TiO2 Composite by Photocatalysis.

Few studies have investigated the gas-sensing properties of graphene oxide/titanium dioxide (GO/TiO2) composite combined with photocatalytic effect. Room temperature gas-sensing properties of the GO/TiO2 composite were investigated towards various reducing gases. The composite sensor showed an enhanced gas response and a faster recovery time than a pure GO sensor due to the synergistic effect of the hybridization, such as creation of a hetero-junction at the interface and modulation of charge carrier density. However, the issue of long-term stability at room temperature still remains unsolved even after construction of a composite structure. To address this issue, the surface and hetero-junction of the GO/TiO2 composite were engineered via a UV process. A photocatalytic effect of TiO2 induced the reduction of the GO phase in the composite solution. The comparison of gas-sensing properties before and after the UV process clearly showed the transition from n-type to p-type gas-sensing behavior toward reducing gases. This transition revealed that the dominant sensing material is GO, and TiO2 enhanced the gas reaction by providing more reactive sites. With a UV-treated composite sensor, the function of identifying target gas was maintained over a one-month period, showing strong resistance to humidity.

Potentiation of Sodium Metabisulfite Toxicity by Propylene Glycol in Both in Vitro and in Vivo Systems.

Many consumer products used in our daily lives result in inhalation exposure to a variety of chemicals, although the toxicities of the active ingredients are not well known; furthermore, simultaneous exposure to chemical mixtures occurs. Sodium metabisulfite (SM) and propylene glycol (PG) are used in a variety of products. Both the cytotoxicity and the sub-acute inhalation toxicity of each chemical and their mixtures were evaluated. Assays for cell viability, membrane damage, and lysosome damage demonstrated that SM over 100 µg/ml induced significant cytotoxicity; moreover, when PG, which was not cytotoxic, was mixed with SM, the cytotoxicity of the mixture was enhanced. Solutions of 1, 5, and 20% SM, each with 1% PG solution, were prepared, and the whole body of rats was exposed to aerosols of the mixture for 6 h/day, 5 days/week for 2 weeks. The rats were sacrificed 1 (exposure group) or 7 days (recovery group) after termination of the exposure. The actual concentration of SM in the low-, medium-, and high-exposure groups was 3.91 ± 1.26, 35.73 ± 6.01, and 80.98 ± 5.47 mg/m3, respectively, and the actual concentration of PG in each group was 6.47 ± 1.25, 8.68 ± 0.6, and 8.84 ± 1.77 mg/m3. The repeated exposure to SM and PG caused specific clinical signs including nasal sound, sneeze, and eye irritation which were not found in SM single exposure. In addition, the body weight of treatment group rats decreased compared to that of the control group rats in a time-dependent manner. The total protein concentration and lactate dehydrogenase activity in the bronchoalveolar lavage fluid (BALF) increased. Histopathological analysis of the lungs, liver, and nasal cavity was performed. Adverse effects were observed in the nasal cavity, with squamous cell metaplasia identified in the front of the nasal cavity in all high-exposure groups, which completely recovered 7 days after exposure was terminated. Whereas inhalation of SM for 2 weeks only reduced body weight in the high-dose group, inhalation of SM and PG mixtures for 2 weeks significantly decreased body weight and induced metaplasia of the respiratory epithelium into squamous cells in the medium- and high-dose groups. In conclusion, PG potentiated the toxicity of SM in human lung epithelial cells and the inhalation toxicity in rats.

Cytotoxic effects of air freshener biocides in lung epithelial cells.

This study evaluated the cytotoxicity of mixtures of citral (CTR) and either benzisothiazolinone (BIT, Mix-CTR-BIT) or triclosan (TCS, Mix-CTR-TCS) in human A549 lung epithelial cells. We investigated the effects of various mix ratios of these common air freshener ingredients on cell viability, cell proliferation, reactive oxygen species (ROS) generation, and DNA damage. Mix-CTR-BIT and Mix-CTR-TCS significantly decreased the viability of lung epithelial cells and inhibited cell growth in a dose-dependent manner. In addition, both mixtures increased ROS generation, compared to that observed in control cells. In particular, cell viability, growth, and morphology were affected upon increase in the proportion of BIT or TCS in the mixture. However, comet analysis showed that treatment of cells with Mix-CTR-BIT or Mix-CTR-TCS did not increase DNA damage. Taken together, these data suggested that increasing the content of biocides in air fresheners might induce cytotoxicity, and that screening these compounds using lung epithelial cells may contribute to hazard assessment.

Effects of topical lidocaine on successful extubation time among patients undergoing elective carotid endarterectomies.

Little research has been done on the effects that topical intratracheal anesthesia have on the length of time required to successfully extubate patients after surgical interventions. This retrospective case-control study, using a convenience sample (n = 100 patients), explored the effects of using topical lidocaine laryngotracheal anesthesia injected into the adult trachea before insertion of the endotracheal tube on patients undergoing surgical treatment for blockage of the carotid artery. Both descriptive and inferential analyses were performed to evaluate differences among all variables. Multiple linear regression was also performed while adjusting for the confounding factors (age, gender, and smoking status). Results revealed that the use of lidocaine laryngotracheal anesthesia during induction of anesthesia prolonged the mean times for postoperative removal of the endotracheal tube by nearly 2 minutes. Extended time for removal of endotracheal tubes may lead to increased costs to the healthcare institution and to the patient, which in turn may lead to dissatisfaction within healthcare teams and possibly to patient discontent with care provided.

Management of human resources associated with misuse of prescription drugs: analysis of a national survey.

Nonmedical use of prescription drugs is increasingly prevalent in the United States, but limited research is available on prescription drugs misuse in the workforce. We investigated whether absenteeism and turnover are associated with having problems linked to prescription drug misuse among employees. We also further explored the moderating effects of employee drug policy and testing on the relation between having problems linked to misuse of prescription pain relievers (PPRs) and absenteeism and turnover. This is a cross-sectional study (n = 2,249) using the 2007 U.S. national survey data ("National Survey on Drug Use and Health"). The multivariate logistic analysis results illustrate, after controlling confounding factors (gender, age, tobacco use, and heroin use), absenteeism and turnover linked to having problems of PPRs misuse. Our findings suggest the moderating effects of employee drug policy on the association between absenteeism and turnover and having problems linked to misuse of PPRs. Also, drug testing was found to moderate the link between having negative outcomes of misuse of PPRs and absenteeism. Having problems associated with misuse of PPRs is linked to absenteeism and turnover. A drug policy program including drug testing may play a significant role in reducing absenteeism and turnover in relation to having problems linked to misuse of PPRs.

The urban poor's economic profile of tobacco use.

OBJECTIVES: Low-income minority tobacco users are price sensitive and are more likely to quit when tobacco prices go up. No prior research documents economic characteristics of low-income tobacco users. The study investigates economic profile of tobacco use among urban low-income African Americans. METHODS: In this baseline study (n = 338), tobacco users and nonusers were compared, and their economic conditions of tobacco use including (current and past) employment barriers were examined. RESULTS: The study results demonstrate that tobacco use status appeared to be associated with employment barriers among low income populations. Controlling for other independent variables in the multivariate logistic regression model, previous criminal activity, planning to move out, and female gender were found to be linked to labor force status. CONCLUSIONS: More research efforts on how indigent tobacco-using individuals develop their employment skills and become economically independent are needed.

Residential mobility and gateway drug use among Hispanic adolescents in the U.S.: evidence from a national survey.

Residential mobility has been an important topic in public health for the past decades. More than 22 million Americans migrated from state to state in 2000, but characteristics of minority American movers are not well documented in the aspect of public health. Using the U.S. national survey, we examined the association between residential mobility and gateway drug use among Hispanic adolescents in the U.S. Frequent movers and never movers were compared in the study. The study results indicate that frequent movers (moved more than 4 times for the past 5 years) were more likely than never movers to smoke and use marijuana. We also found that frequent residential relocation, females, and older teenagers (14-1714, 15, 16, 17) are risk factors of gateway drug use among Hispanic adolescents.

Association between tobacco use and lifestyle in a sample of lower income urban African-Americans in the American south.

There has been little research evaluating links between low-income populations' lifestyles and their tobacco use status. We surveyed 398 low-income individuals living in Housing Authority complexes in Columbus, Georgia. Current, former, and never tobacco users were compared for their health-related behaviors and lifestyles. Study findings suggest that current tobacco users were less healthy than comparisons, but had less unfavorable obesity measurements. In lifestyle choices, tobacco users were more likely than comparisons to be interested in sports (football, basketball, etc.), shopping, and participate in church activities.

Tobacco use and low-income African Americans: policy implications.

BACKGROUND: Tobacco use has declined in the United States over the past decade, but smoking among low-income populations remains high in comparison. Although many studies have linked poverty and tobacco use, few studies have examined the prevalence and predictors of tobacco use among low-income African Americans in the South. METHODS: A total sample of 388 residents of a Housing Authority complex in the South were surveyed. This cross-sectional study examined the prevalence and predictors for current tobacco use among sampled participants. RESULTS: Results show that low-income populations in the South have high rates of smoking. Of the sample, about 43% were current tobacco users. Findings indicate that tobacco users were more likely to be older, have been exposed to secondhand smoke, have positive attitudes toward tobacco commercials, and have been arrested in the past. Results found several predictors of tobacco use in the study population including age, secondhand smoke, attitude toward tobacco media, and criminal activity. CONCLUSIONS: Housing Authority apartment complexes may be an important target for tobacco use prevention and treatment interventions. Other policy implications are recommended.

The marketing and demarketing of tobacco products to low-income African-Americans.

This study examines the attitudes and behaviors of 399 low-income, primarily African-American residents of a public housing project toward tobacco usage. First, 46 percent of respondents over 18 years of age reported using a tobacco product. A number of other differences were apparent between users and non-users, with tobacco users reporting positive attitudes toward displaying clothing or products with tobacco brand names or logos. Tobacco users were also more likely to approve the use of tobacco and of tobacco commercials in magazines. As might be expected, users were less likely to support smoking bans in restaurants and increase taxes on tobacco products. As a result of the findings, recommendations are provided to reduce the smoking rates of this sub-population.