Automatic prostate segmentation of magnetic resonance imaging using Res-Net.

OBJECTIVES: Segmenting the prostate from magnetic resonance images plays an important role in prostate cancer diagnosis and in evaluating the treatment response. However, the lack of a clear prostate boundary, heterogeneity of prostate tissue, large variety of prostate shape and scarcity of annotated training data makes automatic segmentation a very challenging task. In this work, we proposed a novel two stage segmentation method to automatically segment prostate to support accurate and reproducible results with multisite and multivendor dataset. In the proposed method, we use the combination U-Net with residual blocks. METHODS: The proposed method comprises two stage neural network, first is 2D U-Net, used find the approximate location of prostate, the second is the combination of U-Net and Res-Net used for accurate segmentation of prostate. The network was trained on 116 patient datasets from three publicly available data sources. 80% of data is used for training, 10% for validation, and 10% for testing. The commonly used segmentation evaluation metrics Dice similarity coefficient (DSC), Sensitivity, and Specificity are used for quantitative evaluation of the network. RESULTS: With the proposed method average DSC value of 93.8%, Sensitivity value of 94.6% and Specificity of 99.3% was achieved on test datasets. CONCLUSIONS: Our experimental results show that the segmentation accuracy can be improved significantly using two stage neural networks.

A Case Report of Whitmore's Disease: A True Masquerader.

Melioidosis is an uncommon bacterial infection that is endemic to countries like Southeast Asia and Northern Australia but less common in temperate zones than when seen in returned travelers. This disease can affect almost every organ, with the lung being the most common organ to be involved. Here, we present a 21-year-old diabetic male who came with complaints of fever, nonproductive cough, and sore throat with grade III-IV shortness of breath. Laboratory investigations revealed hypokalemia and isolates of Burkholderia pseudomallei on blood culture and sensitivity. High-resolution computed tomography (HRCT) of the chest showed widespread, variable-sized nodules with central cavitations diffusely scattered in bilateral lungs.

A Dreaded Complication of Corrosive Poisoning Leading to Gangrene of the Stomach and Duodenum: A Rare Case.

Corrosive poisoning is common in developing countries like India. It is mainly due to accidental consumption in children, whereas suicide is the usual intent in adults. It leads to devastating injuries, to the upper gastrointestinal tract such as necrosis and perforation. The long-term complications include stricture formation and gastric outlet obstruction. Here, we present the case of a 50-year-old male with an alleged history of corrosive acid ingestion. On contrast-enhanced computed tomography (CECT) of the abdomen, there was an absence of wall enhancement of the stomach and the first part of the duodenum, which was suggestive of necrosis or gangrenous changes with signs of impending perforation of the stomach and the first part of the duodenum. The patient was immediately taken up for surgery, and the intraoperative findings were consistent with the imaging findings.

Long-Segment Epidural Hemorrhage of the Cervical and Dorsal Spine: A Case Report of a Rare Complication of Dengue Virus Disease.

Dengue hemorrhagic fever is a severe form of dengue virus disease, characterized by minor to major bleeding, thrombocytopenia, and plasma leakage. Common hemorrhagic manifestations include epistaxis, gum bleeding, gastrointestinal bleeding, hypermenorrhea, and hematuria. Intracranial hemorrhage is one of the most fatal manifestations of central nervous system involvement by dengue disease which is a part of the expanded dengue syndrome. Here we present a case of A 37-year-old male patient who presented with complaints of intermittent high-grade fever and generalized weakness four days prior to consultation. Laboratory investigations revealed mild thrombocytopenia and positive dengue serology. Magnetic resonance imaging of the brain and spine revealed mild diffuse subarachnoid hemorrhage in bilateral parieto-occipital lobes with long segment cervical and dorsal spinal epidural hemorrhage.

A Study to Evaluate the Role of Three-Dimensional Pseudo-Continuous Arterial Spin Labelling in Acute Ischemic Stroke.

Introduction Magnetic resonance imaging (MRI) is well known to detect ischemic brain tissue and evaluate the tissue vulnerable to infarction. Diffusion-weighted imaging (DWI) has been a mainstay of stroke evaluation but has a few shortcomings, as it generally indicates only the core of ischemia and does not provide information regarding the tissue at risk or the ischemic penumbra surrounding the infarct. Perfusion imaging identifies brain tissue that has reduced blood flow as a potential target for reperfusion therapy. Arterial spin labelling (ASL) is a new non-invasive, non-contrast MRI perfusion sequence used to detect areas of hypoperfusion qualitatively and quantitatively and also identify the area at risk, i.e., the penumbra, in acute ischemic stroke. The most important component of the imaging is to determine the ischemic penumbra. One of the working definitions of penumbra is brain tissue that is ischemic but not yet infarcted and is at risk of further damage unless the flow is rapidly restored. Hence, perfusion-diffusion mismatch provides a realistic target for potential intervention. The aim of our study is to assess the role of ASL imaging in identifying the penumbra and providing insight into the management of acute ischemic stroke. Materials and methods Patients who presented with symptoms of acute ischemic stroke were included in the study, and an MRI stroke protocol comprising DWI, fluid-attenuated inversion recovery (FLAIR), ASL, and magnetic resonance angiogram (MRA) sequences was done. Post-thrombolysis, a follow-up MRI was done using DWI, ASL, and MRA to see the restoration of perfusion in the ischemic penumbra. Three-dimensional pseudo-continuous ASL (in our study, ASL refers to pseudo-continuous ASL) is included in the stroke protocol in cases of acute ischemic stroke and assessed qualitatively. Results Our study included 43 patients (n = 43), of whom 39.5% (17 patients) belong to the age group of 51-60 years and 2.3% (one patient) are in the age group of 21-30 years. All 43 cases demonstrated DWI-FLAIR mismatch, suggestive of ischemic stroke within the window period, and all 43 cases showed DWI-ASL mismatch, suggestive of a large yet potentially salvageable peri-infarct ischemic penumbra. The most common territory involved was the middle cerebral artery (MCA), and the posterior cerebral artery (PCA) was the least commonly involved territory. We had one case involving the MCA-PCA watershed zone. Conclusion Arterial spin labelling is a novel, non-invasive, non-contrast MRI sequence with the capability to provide qualitative information regarding the salvageable ischemic penumbra, and timely management prevents the progression of the penumbra. The incorporation of ASL as part of the standard neuroimaging protocol aids in the management of acute stroke, giving insight into the prediction of outcome.

Right Vertebral Artery Arising From Ipsilateral Common Carotid Artery With Severe Stenosis of Ostio-proximal Segment of Aberrant Right Subclavian Artery: A Rare Life-Saving Variant.

Anomalous origins of vertebral arteries are rare vascular anomalies that are incidentally identified during computed tomography, magnetic resonance imaging, or digital subtraction angiograms. We present the case of a 45-year-old male who had gangrene of the right ring finger associated with absent radial, ulnar, and brachial artery pulses. A computed tomography angiogram of the upper limb including the arch of aorta showed an aberrant right subclavian artery having near-total stenosis at the origin. An anomalous origin of the right vertebral artery from the right common carotid artery was also noted. This incidental variant anomaly of the vertebral artery was vital in this case as it spared the posterior cerebral circulation from vascular insufficiency complications. It is also important for future head and neck endovascular interventions to avoid inadvertent arterial injury.

Proximal Interruption of Pulmonary Artery: Spectrum of Radiological Findings With Emphasis on Chest Radiograph and Contrast-Enhanced Computed Tomography (CECT).

Introduction Proximal interruption of pulmonary artery (PIPA) is a congenital anomaly presenting with aberrant termination of the pulmonary artery at the hilum. It results in a variety of radiological and clinical manifestations. Clinically, isolated PIPA can be asymptomatic till late adulthood or can present with dyspnoea, chest discomfort, hemoptysis and recurrent infections. PIPA can be associated with multiple cardiovascular anomalies such as tetralogy of Fallot (TOF), ventricular septal defects (VSD), and scimitar syndrome. We present a spectrum of cases with both isolated proximal interruption of the pulmonary artery and cases associated with other cardiovascular abnormalities. Typical chest radiographs and chest contrast-enhanced computed tomography (CECT) findings are discussed and demonstrated in detail. Proper and early diagnosis is a crucial step as it can significantly modify the treatment choice, thereby reducing morbidity. Objective To document the different presentations of the proximal arrest of pulmonary arteries, to document associations with cardiovascular and pulmonary manifestations, and to elaborate on and demonstrate the various radiological imaging findings. Material and methods All the cases that were reported with proximal interruption of pulmonary artery on the CECT studies conducted between 2019 and 2022 at a tertiary care hospital in Telangana, India. The demographic data, clinical presentation, chest radiographs, and chest CECT were collected retrospectively. Data analysis was done using Microsoft Excel 2019 to calculate descriptive statistics. A total of 22 cases were identified of which three cases were excluded of as they were previously operated and 19 cases were taken as the study population. Results Nineteen patients were included in the study. Demographic details, clinical history, CECT, and chest radiographs were collected wherever available. The majority of the cases belonged to the ≤ 10 yrs age group with the most common clinical presentation being a previous diagnosis of tuberculosis or recurrent upper respiratory tract infections. The predominant findings on chest radiographs were deviation of the trachea to the affected side, volume loss in the ipsilateral lung field, and compensatory hyperinflation of the contralateral lung field. On the CECT chest, the main findings were interrupted pulmonary artery, hypoplastic lung fields with bronchiectasis, or ground glassing. Associated cardiovascular and pulmonary malformations were identified with notable cases: TOF, right-sided aortic arch and scimitar syndrome. Their typical imaging findings have been elucidated and discussed in detail. Conclusions Patients with recurrent respiratory infections or hemoptysis having hypoplastic lung field with hyperinflation of the contralateral lung on chest radiographs should be evaluated for pulmonary artery interruptions. Chest CECT allows evaluation of the bronchial tree and lung parenchyma at the same time which helps distinguish pulmonary interruption from conditions such as Swyer-James-Macleod syndrome, pulmonary hypoplasia, thromboembolism and arteritis. Cases with PIPA can also be associated with cardiovascular and pulmonary anomalies such as TOF, partial anomalous pulmonary venous connection (PAPVC), and VSD. The knowledge of these associations is essential as they can influence the mode of treatment and can help reduce the long-term morbidity and mortality associated with the condition.

Potentiation of antinociceptive effect of NSAIDs by a specific lipooxygenase inhibitor, acetyl 11-keto-beta boswellic acid.

The present study was aimed to assess the combined effects of cyclooxygenase and 5-lipoxygenase (COX/5-LOX) inhibitors in different animal models of nociception. Naproxen, nimesulide and rofecoxib are well-established antinociceptive agents acting via COX inhibition. AKBA (acetyl-keto-beta-boswellic acid) is a 5-LOX inhibitor. AKBA (50-200 mg/kg) produced a dose dependent and significant antinociceptive effect in different animal models of nociception. Based on the earlier reports from our laboratory, sub effective doses of all the three COX Inhibitors were selected and they were administered (naproxen, 5 mg/kg; nimesulide, 1 mg/kg; and rofecoxib, 1 mg/kg) with AKBA (100 mg/kg). This produced a more significant antinociceptive effect as compared to per se effect observed in all the three models of nociception. However, the effect of combination of nimesulide with AKBA was more pronounced as compared to naproxen and rofecoxib and their combination with AKBA. The present finding provided an evidence for the potentiation of antinociceptive effect of NSAIDs with AKBA. Such a combination may help to reduce the therapeutic doses of conventional NSAIDs and also reduce side effects (gastric, cardiac and renal) that are popularly associated with the NSAIDs.

One-year outcomes of a BioMime™ Sirolimus-Eluting Coronary Stent System with a biodegradable polymer in all-comers coronary artery disease patients: The meriT-3 study.

OBJECTIVES: The aim of the merit-3 study was to determine the safety and performance of the BioMime Sirolimus-Eluting Coronary Stent System (SES) in all-comer patients with coronary artery disease (CAD) in one-year clinical follow-up period. METHODS: The meriT-3 was a multi-centre, observational, post-marketing study conducted in 1161 patients with CAD who were implanted with BioMime SES at 15 sites in India. The primary endpoint was major adverse cardiac event (MACE) at one year defined as the composite of cardiac death, myocardial infarction (MI) and target lesion revascularization (TLR). Clinical follow-up was performed at 1, 6, and 12 months. Major adverse cardiac event occurred at 30 days and subsequently at 6 months and at long-term follow-up of 1 year was analyzed. RESULTS: MACE observed at 1 and 6 months follow-up was 16 (1.38%) and 21 (1.83%) respectively. Cumulative 1 year MACE was 26 (2.35%) with 16 (1.39%) all cause death, 4 (0.35%) MI and 6 (0.52%) TLR. In addition, ST was observed in 1 (0.09%) patient. CONCLUSIONS: The present study suggests that the BioMime SES is safe and effective in a "real-world", all-comers CAD patients, indicating low rates of MACE. CTRI ACKNOWLEDGEMENT NO: REF/2016/07/011808.