Practical utility of liver segmentation methods in clinical surgeries and interventions.

Clinical imaging (e.g., magnetic resonance imaging and computed tomography) is a crucial adjunct for clinicians, aiding in the diagnosis of diseases and planning of appropriate interventions. This is especially true in malignant conditions such as hepatocellular carcinoma (HCC), where image segmentation (such as accurate delineation of liver and tumor) is the preliminary step taken by the clinicians to optimize diagnosis, staging, and treatment planning and intervention (e.g., transplantation, surgical resection, radiotherapy, PVE, embolization, etc). Thus, segmentation methods could potentially impact the diagnosis and treatment outcomes. This paper comprehensively reviews the literature (during the year 2012-2021) for relevant segmentation methods and proposes a broad categorization based on their clinical utility (i.e., surgical and radiological interventions) in HCC. The categorization is based on the parameters such as precision, accuracy, and automation.

Early clinical prediction of neurological outcome following out of hospital cardiac arrest managed with therapeutic hypothermia.

BACKGROUND: Therapeutic hypothermia (TH) may improve neurological outcome in comatose patients following out of hospital cardiac arrest (OHCA). The reliability of clinical prediction of neurological outcome following TH remains unclear. In particular, there is very limited data on survival and predictors of neurological outcome following TH for OHCA from resource-constrained settings in general and South Asia in specific. OBJECTIVE: The objective was to identify factors predicting unfavorable neurological outcome at hospital discharge in comatose survivors of OHCA treated with hypothermia. DESIGN: Retrospective chart review. SETTING: Urban 200-bed hospital in Chennai, India. METHODS: Predictors of unfavorable neurological outcome (cerebral performance category score [3-5]) at hospital discharge were evaluated among patients admitted between January 2006 and December 2012 following OHCA treated with TH. Hypothermia was induced with cold intravenous saline bolus, ice packs and cold-water spray with bedside fan. Predictors of unfavorable neurological outcome were examined through multivariate exact logistic regression analysis. RESULTS: A total of 121 patients were included with 106/121 (87%) experiencing the unfavorable neurological outcome. Independent predictors of unfavorable neurological outcome included: Status myoclonus <24 h (odds ratio [OR] 21.79, 95% confidence interval [CI] 2.89-Infinite), absent brainstem reflexes (OR 50.09, 6.55-Infinite), and motor response worse than flexion on day 3 (OR 99.41, 12.21-Infinite). All 3 variables had 100% specificity and positive predictive value. CONCLUSION: Status myoclonus within 24 h, absence of brainstem reflexes and motor response worse than flexion on day 3 reliably predict unfavorable neurological outcome in comatose patients with OHCA treated with TH.

In-hospital mode of death after out-of-hospital cardiac arrest.

Introduction: Factors associated with in-hospital mortality after out-of-hospital cardiac arrest (OHCA), such as mode of death and withdrawal of life-sustaining treatment (WLST), are not well established. This study aimed to compare clinical characteristics, timing of WLST and death, and precipitating aetiology between modes of death for OHCAs treated at hospital within a local health network. Methods: Retrospective cohort study of adult non-traumatic OHCAs included in a hospital based OHCA registry between 2011 and 2016 and deceased at hospital discharge, excluding cases retrieved to external hospitals. Mode of death was defined as (1) cardiovascular instability, (2) non-neurological WLST, (3) neurological WLST, and (4) formal brain death. Relevant data were extracted from the registry and stratified according to mode of death and timing of death as early (within the emergency department) or late (after admission). Results: Mode of death data was available for 69 early and 144 late deaths. Cardiovascular instability was the primary mode for 75% of early deaths, while 72% of late deaths were attributed to neurological injury (47% neurological WLST and 24% brain death, combined). Cardiovascular instability was associated with cardiac aetiology, brain death was associated with younger age and highest rates of organ donation, and neurological WLST was associated with highest rates of targeted temperature management, and longest time from arrest to death (p < 0.05). Conclusions: This is the first study to compare clinical characteristics of adult patients resuscitated from OHCA according to in-hospital mode of death. A consensus on the definition of mode of death with standardised classification is needed.

Indoor transmission dynamics of expired SARS-CoV-2 virus in a model African hospital ward.

Cough and sneeze droplets' interactions with indoor air of a typical hospital clinic that could be majorly found in developing African countries were studied to investigate the effectiveness of existing guidelines/protocols being adopted in the control of the widespread coronavirus disease (COVID-19) transmission. The influences of indoor air velocity, the type, size distribution, residence time in air, and trajectory of the droplets, were all considered while interrogating the effectiveness of physical distancing measures, the use of face covers, cautionary activities of the general public, and the plausibility of community spread of the SARS-CoV-2 virus through airborne transmission. Series of 3-D, coupled, discrete phase models (DPM) were implemented in the numerical studies. Based on DPM concentration maps as function of particle positions and particle residence times that were observed under different droplets release conditions, the virus-laden droplets could travel several meters away from the source of release (index patient), with smaller-sized particles staying longer in the air. The behavior of indoor air was also found to indicate complex dynamics as particle transports showed no linear dependence on air velocity. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40201-020-00606-5.

Long-term Outcome following Percutaneous Intervention of Intra-stent Coronary Occlusion and Evaluating the Different Treatment Modalities.

BACKGROUND: Angioplasty for ISR remains a challenge with relatively high rates of recurrence. Although there is a plethora of data on ISR, there is relatively less data on intra-stent-CTO. In this study, we explore the long-term clinical outcomes following angioplasty to intra-stent CTO and study the differences in clinical outcomes between three treatment-arms: POBA vs. DES vs. DCB. METHODS AND RESULTS: We evaluated all patients who underwent PCI to intra-stent CTO between 2011 and 2017. The endpoints used were: cardiac-death, TVMI, TLR, TVR, and MACE.During the study period, 403-patients with a mean age of 69.2 years had successful PCI to intra-stent CTO. 50% were diabetic, 38% had CKD and 32% had left ventricular dysfunction. 93% of cases were stable angina. 22% (n = 88) received only POBA, 28% (n = 113) received DCB and 50% (n = 202) received DES. During the median follow-up of 48-months, cardiac-death occurred in 5.8% (n = 23), TVMI in 4% (n = 16), TLR in 45.6% (n = 182), TVR in 48.7% (n = 194) and MACE of 46%. There were no differences in the hard endpoints between the 3treatment arms. However, the TLR and overall MACE were better in DCB and DES-groups as compared to POBA (TLR: 33%vs.42%vs.49%; p = 0.06); MACE (34% vs. 45% vs. 52%; p = 0.05). CONCLUSION: This is the first study that has focussed on the outcomes following angioplasty to intra-stent CTOs with a very long-term follow-up. The hard endpoints were low, although the TLR rates were high. In regards to treatment strategy, the DCB and DES provide relatively better outcomes than POBA.

Overcoming challenges of establishing a hospital-based out-of-hospital cardiac arrest registry: accuracy of case identification using administrative data and clinical registries.

INTRODUCTION: Comprehensive identification of out-of-hospital cardiac arrest (OHCA) cases for inclusion in registries remains challenging due to the inherent diversity of OHCA aetiology, presentation, and management. The Northern Adelaide Local Health Network (NALHN) OHCA registry identifies OHCAs presenting to NALHN hospitals using existing data sources to monitor in-hospital treatment and survival. This study aimed to investigate the accuracy of hospital-based data sources for identifying OHCA cases treated at hospital. METHODS: Retrospective analysis of all OHCAs aged >18 years included in the NALHN OHCA registry between 2011-16. Registry cases are identified from an emergency medical service (EMS) OHCA registry, Emergency Department (ED) and ICD-10 coding datasets, and key-word searches of two in-hospital clinical registries. Sensitivity and positive predictive values (PPV) of each hospital-based data source were analysed with respect to (a) the number of cases expected to be identified by that source, (b) total OHCA. Non-OHCAs yielded by each source were explored and a sub-analysis of ICD-10 codes was performed. RESULTS: Between 2011-16, the four hospital-based sources yielded 992 cases, of which 383 were confirmed as OHCA. The ED coding dataset was the most accurate with a sensitivity and PPV of 78%. The ICD-10 coding dataset had good sensitivity but low PPV (33%). The ED coding dataset, combined with the two in-hospital clinical registries, identified 93% of OHCAs. CONCLUSIONS: No single dataset identified all OHCAs presenting to NALHN hospitals. Combined hospital-based data sources provide a valid method of identifying OHCAs treated at hospital that may be adapted to augment EMS-based data.

Selected Heavy Metals Removal From Electroplating Wastewater by Purified and Polyhydroxylbutyrate Functionalized Carbon Nanotubes Adsorbents.

This research investigated the removal of heavy metals (As, Pb, Cr, Cd, Ni, Cu, Fe, and Zn) via batch adsorption process from industrial electroplating wastewater using two different nano-adsorbents; purified carbon nanotubes (P-CNTs) and polyhydroxylbutyrate functionalized carbon nanotubes (PHB-CNTs), both produced through catalytic chemical vapour deposition (CCVD) method. HRSEM, HRTEM, XRD, DLS, BET, FTIR, XPS, TGA, pH drift and Raman spectroscopy were used to characterize the developed nano-adsorbents. In the batch adsorption process, the effects of contact time, dosage, temperature and pH were studied. Both nano-adsorbents gave optimum contact time, equilibrium time, optimum dosage, and pH of 10 minutes, 70 minutes, 20 mg, and 5.63-5.65 respectively. The heavy metals removal efficiencies by the nano-adsorbents followed the order of PHB-CNTs > P-CNTs based on ion exchange and electrostatic forces mechanism. For P-CNTs and PHB-CNTs, the equilibrium sorption isotherm suits temkin model, kinetic data fitted to pseudo-second order based on the linear regression correlation coefficient, and the thermodynamic study established spontaneity and endothermic nature of the adsorption process. The findings in this research conclude that both nano-adsorbents have exceptional capacity to remove heavy metals from the adsorbate, with PHB-CNTs possessing better quality. The treated adsorbate meets the standard for industrial or irrigation re-use.

A young pregnant woman with spontaneous carotid artery dissection--unknown mechanisms.

Spontaneous carotid artery dissection in pregnancy has not been reported before. We present a case of a 31-year-old Caucasian woman who was 11 weeks pregnant and presented with neck pain, headache, vomiting and left side Horner's syndrome. Subsequent investigations with MR angiography confirmed spontaneous left internal carotid artery dissection.

Asymptomatic coronary artery spasm with acute pathological ST elevation on routine ECG: is it common?

Asymptomatic spontaneous coronary artery spasm is rare and there are no case reports in literature presenting with acute ST elevation on routine ECG. We present the case of a 68-year-old Caucasian man who presented to a primary care physician for a routine ECG as part of hypertension follow-up. ECG revealed ST elevation in inferior leads II, III and aVF with reciprocal ST depression in leads I, aVL and also ST depression in anterior leads V1, V2 and V3 suggesting ongoing inferoposterior ST elevation myocardial infarction. The patient was completely well, stable and asymptomatic and he was rushed immediately to the coronary care unit via emergency ambulance. The patient was subjected to a battery of urgent investigations which were all normal. Also an urgent coronary angiogram was undertaken which showed completely normal coronary anatomy.

An unusual intracardiac electrogram showing cause for false electrical discharge from an ICD.

We describe a rare case of inappropriate implantable cardioverter defibrillator (ICD) therapy due to false sensing of electromechanical interference from diathermy as 'ventricular fibrillation (VF)'. This occurred during surgical removal of sternal wires under general anaesthesia. Postsurgical interrogation of ICD revealed the intracardiac electrogram showing the mechanical interference sensed as 'VF' by ICD and subsequent shock delivery.