Deep learning algorithm performs similarly to radiologists in the assessment of prostate volume on MRI.

OBJECTIVES: Prostate volume (PV) in combination with prostate specific antigen (PSA) yields PSA density which is an increasingly important biomarker. Calculating PV from MRI is a time-consuming, radiologist-dependent task. The aim of this study was to assess whether a deep learning algorithm can replace PI-RADS 2.1 based ellipsoid formula (EF) for calculating PV. METHODS: Eight different measures of PV were retrospectively collected for each of 124 patients who underwent radical prostatectomy and preoperative MRI of the prostate (multicenter and multi-scanner MRI's 1.5 and 3 T). Agreement between volumes obtained from the deep learning algorithm (PVDL) and ellipsoid formula by two radiologists (PVEF1 and PVEF2) was evaluated against the reference standard PV obtained by manual planimetry by an expert radiologist (PVMPE). A sensitivity analysis was performed using a prostatectomy specimen as the reference standard. Inter-reader agreement was evaluated between the radiologists using the ellipsoid formula and between the expert and inexperienced radiologists performing manual planimetry. RESULTS: PVDL showed better agreement and precision than PVEF1 and PVEF2 using the reference standard PVMPE (mean difference [95% limits of agreement] PVDL: -0.33 [-10.80; 10.14], PVEF1: -3.83 [-19.55; 11.89], PVEF2: -3.05 [-18.55; 12.45]) or the PV determined based on specimen weight (PVDL: -4.22 [-22.52; 14.07], PVEF1: -7.89 [-30.50; 14.73], PVEF2: -6.97 [-30.13; 16.18]). Inter-reader agreement was excellent between the two experienced radiologists using the ellipsoid formula and was good between expert and inexperienced radiologists performing manual planimetry. CONCLUSION: Deep learning algorithm performs similarly to radiologists in the assessment of prostate volume on MRI. KEY POINTS: • A commercially available deep learning algorithm performs similarly to radiologists in the assessment of prostate volume on MRI. • The deep-learning algorithm was previously untrained on this heterogenous multicenter day-to-day practice MRI data set.

Dorsomedial prefrontal theta burst stimulation to treat anhedonia, avolition, and blunted affect in schizophrenia or depression - a randomized controlled trial.

BACKGROUND: Intermittent theta burst stimulation (iTBS) over the dorsomedial prefrontal cortex (DMPFC) has shown promise in open-label trials of depression. METHODS: In this randomized, double-blind, sham controlled trial we evaluate iTBS over the DMPFC for anhedonia, avolition, and blunted affect in patients with schizophrenia or depression. Active iTBS was delivered over the DMPFC with 1200 pulses per session, twice daily over ten weekdays at target intensity with an angled figure-of eight coil. Sham condition comprised the magnetically shielded side of the coil and simultaneous transcutaneous electrical nerve stimulation. Primary outcome was change on the Clinical Assessment Interview for Negative Symptoms (CAINS). RESULTS: Twenty-eight patients were randomized to active iTBS and 28 to sham. Mean (standard deviation) change in CAINS score from baseline to the day after last treatment was -5.3 (8.1) in active iTBS and -2.1 (7.1) in sham. A linear model showed no significant effect of treatment, accounting for baseline scores p=.088. Sub analyses per diagnostic group showed a significant effect in patients with depression, p=.038, but not in the schizophrenia group, p=.850. However, overall depressive symptoms did not change significantly in patients with depression. There were three serious adverse events, all in the sham group. LIMITATIONS: Possibly too short treatment course and few patients with schizophrenia. CONCLUSION: In this first transdiagnostic randomized controlled trial of iTBS over DMPFC for anhedonia, avolition, and blunted affect it can be concluded that it was generally tolerable and safe but only more effective than sham in the subgroup of patients with depression.

Autonomic modulation networks in schizophrenia: The relationship between heart rate variability and functional and structural connectivity in the brain.

Heart rate variability (HRV), a measurement of autonomic nervous system (ANS) activity, has been found reduced in schizophrenia. The anterior cingulate cortex (ACC), which is important in regulating the ANS, is structurally and functionally affected in schizophrenia. We investigate the relationship between HRV and functional and structural connectivity of the ACC in patients with schizophrenia and healthy controls. Ten patients with a diagnosis of schizophrenia and ten healthy controls were recruited. Heart rate was monitored in a naturalistic out-of-clinic setting. Magnetic resonance imaging (MRI) was performed, including resting-state functional MRI and diffusion tensor imaging. Patients with schizophrenia had significantly lower HRV compared to controls. A positive correlation between ACC connectivity with the bilateral cerebellum and HRV was found in the patients. HRV was also positively correlated with amplitude of low frequency fluctuations (ALFF) in the cerebellum, and with axial diffusivity in the middle cerebellar peduncle, in the patients. There was a significant negative relationship between antipsychotic medication dosage, HRV and all neuroimaging measures related to HRV. We conclude that ACC connectivity seems to be affected in schizophrenia, both structurally and functionally, and that the ACC-cerebellum connectivity, as well as cerebellar function, is associated with ANS regulation in patients with schizophrenia.

Quantum Szilard Engine with Attractively Interacting Bosons.

We show that a quantum Szilard engine containing many bosons with attractive interactions enhances the conversion between information and work. Using an ab initio approach to the full quantum-mechanical many-body problem, we find that the average work output increases significantly for a larger number of bosons. The highest overshoot occurs at a finite temperature, demonstrating how thermal and quantum effects conspire to enhance the conversion between information and work. The predicted effects occur over a broad range of interaction strengths and temperatures.

Effect of probiotics (Lactobacillus plantarum 299 plus Bifidobacterium Cure21) in patients with poor ileal pouch function: a randomised controlled trial.

OBJECTIVE: Poor pouch function after restorative proctocolectomy for ulcerative colitis is a considerable problem. Pouchitis and functional disorders are the most common reasons. Probiotics seem to have a beneficial effect in pouchitis but have not been assessed in functional pouch disorders. The aim was to analyse the effects of probiotics in patients with poor pouch function. METHODS: Thirty-three patients were randomized to probiotics (Lactobacillus plantarum 299 and Bifidobacterium infantis Cure 21) or placebo in a double blinded, 1:1 fashion. The treatment effect was assessed by the pouch functional score (PFS; 0-15, 15 worst), pouchitis disease activity index (PDAI; 0-18, 18 worst), and levels of four faecal biomarkers of inflammation (calprotectin, lactoferrin, myeloperoxidase [MPO] and eosinophilic cationic protein [ECP]). RESULTS: Thirty-two patients were included (probiotics = 17, placebo = 16). There was no difference in change in the PFS from before to after treatment between the groups (median difference: -1.00, 95% C.I. -3.00 to 0.00, p = 0.119). Furthermore, probiotics had no effect on PDAI (median difference: 0.00, 95% C.I. 0.00-1.00, p = 0.786), or on faecal biomarkers. Significant correlations were observed between PDAI and each of the faecal biomarkers at study start. There were no correlations between PFS or PDAI symptom subscore and the biomarkers. PDAI endoscopic and histologic subscores correlated significantly to each of the biomarkers. CONCLUSION: The hypothesis that probiotics improves pouch-related dysfunction was not confirmed. Faecal biomarkers could play a future role in the management of pouch patients.

Demonstration of post-growth wavelength setting of VCSELs using high-contrast gratings.

We demonstrate, for the first time, post-growth wavelength setting of electrically-injected vertical-cavity surface-emitting lasers (VCSELs) by using high-contrast gratings (HCGs) with different grating parameters. By fabricating HCGs with different duty cycle and period, the HCG reflection phase can be varied, in effect giving different optical cavity lengths for HCG-VCSELs with different grating parameters. This enables fabrication of monolithic multi-wavelength HCG-VCSEL arrays for wavelength-division multiplexing (WDM). The GaAs HCG is suspended in air by removing a sacrificial layer of InGaP. Electrically-injected 980-nm HCG-VCSELs with sub-mA threshold currents indicate high reflectivity from the GaAs HCGs. Lasing over a wavelength span of 15 nm was achieved, enabling a 4-channel WDM array with 5 nm channel spacing. A large wavelength setting span was enabled by an air-coupled cavity design and the use of only the HCG as top mirror.

Macrophage and dendritic cell subsets in IBD: ALDH+ cells are reduced in colon tissue of patients with ulcerative colitis regardless of inflammation.

Disruption of the homeostatic balance of intestinal dendritic cells (DCs) and macrophages (MQs) may contribute to inflammatory bowel disease. We characterized DC and MQ populations, including their ability to produce retinoic acid, in clinical material encompassing Crohn's ileitis, Crohn's colitis and ulcerative colitis (UC) as well as mesenteric lymph nodes (MLNs) draining these sites. Increased CD14(+)DR(int) MQs characterized inflamed intestinal mucosa while total CD141(+) or CD1c(+) DCs numbers were unchanged. However, CD103(+) DCs, including CD141(+)CD103(+) and CD1c(+)CD103(+) DCs, were reduced in inflamed intestine. In MLNs, two CD14(-) DC populations were identified: CD11c(int)HLADR(hi) and CD11c(hi)HLADR(int) cells. A marked increase of CD11c(hi)HLADR(int) DC, particularly DR(int)CD1c(+) DCs, characterized MLNs draining inflamed intestine. The fraction of DC and MQ populations expressing aldehyde dehydrogenase (ALDH) activity, reflecting retinoic acid synthesis, in UC colon, both in active disease and remission, were reduced compared to controls and inflamed Crohn's colon. In contrast, no difference in the frequency of ALDH(+) cells among blood precursors was detected between UC patients and non-inflamed controls. This suggests that ALDH activity in myeloid cells in the colon of UC patients, regardless of whether the disease is active or in remission, is influenced by the intestinal environment.

Comprehensive analysis of electrically-pumped GaSb-based VCSELs.

This paper discusses several performance-related aspects of electrically-pumped GaSb-based buried tunnel junction VCSELs with an emission wavelength of 2.6 µm based on theoretical and experimental results. These results allow a deeper insight into the internal device physics, such as radial diffusion of carriers, maximum continuous-wave operating temperature, diffraction loss, internal temperature, gain and loss parameters, internal quantum efficiency of the active region etc. These parameters can be taken into account while designing mid-infrared lasers which leads to an improved device performance. A simple thermal model of the devices based on the two-dimensional (2-D) finite element method using the material data from the literature is also presented. In addition, an application-based result utilizing these lasers for the measurement of absolute water vapor concentration by wavelength modulation spectroscopy (WMS) method are also described, hinting that devices are well-suited for the targeted sensing applications.

The influence of age on the distribution of morphine and morphine-3-glucuronide across the blood-brain barrier in sheep.

BACKGROUND AND PURPOSE: The effect of age on the distribution of morphine and morphine-3-glucuronide (M3G) across the blood-brain barrier (BBB) was studied in a sheep model utilizing intracerebral microdialysis. The effect of neonatal asphyxia on brain drug distribution was also studied. EXPERIMENTAL APPROACH: Microdialysis probes were inserted into the cortex, striatum and blood of 11 lambs (127 gestation days) and six ewes. Morphine, 1 mg x kg(-1), was intravenously administered as a 10 min constant infusion. Microdialysis and blood samples were collected for up to 360 min and analysed using liquid chromatography-tandem mass spectrometry. The half-life, clearance, volume of distribution, unbound drug brain : blood distribution ratio (K(p,uu)) and unbound drug volume of distribution in brain (V(u,brain)) were estimated. KEY RESULTS: Morphine K(p,uu) was 1.19 and 1.89 for the sheep and premature lambs, respectively, indicating that active influx into the brain decreases with age. Induced asphyxia did not affect transport of morphine or M3G across the BBB. Morphine V(u,brain) measurements were higher in sheep than in premature lambs. The M3G K(p,uu) values were 0.27 and 0.17 in sheep and premature lambs, indicating a net efflux from the brain in both groups. CONCLUSIONS AND IMPLICATIONS: The morphine K(p,uu) was above unity, indicating active transport into the brain; influx was significantly higher in premature lambs than in adult sheep. These results in sheep differ from those in humans, rats, mice and pigs where a net efflux of morphine from the brain is observed.

COGKNOW development and evaluation of an ICT-device for people with mild dementia.

Dementia is a progressive, chronic disease affecting 5% of all persons above 65 and over 40% of people over 90. The aim of the COGKNOW project is to achieve a breakthrough with research that addresses the needs of those with dementia, particularly those with mild dementia living in the community. This entails cognitive reinforcement in four main areas: helping people to remember, helping to maintain social contact, helping with performing daily life and recreational activities and finally enhance feelings of safety. Based on a sound foundation of needs reported in dementia literature, workshops and individual interviews have been carried out with dementia sufferers and their carers in three European countries. A ranked analysis of information from workshops and interviews, and the state of the art of successful ICT solutions will be the basis for formulating the functionalities of the technical solution and for the development of a cognitive prosthetic device with associated services for people with mild dementia. The research and evaluation will be conducted from human factors, technology, and business perspectives in three phases of one year each. In this paper we discuss the design of the COGKNOW project, the first results of the user needs inquiry workshops and the ICT solutions the COGKNOW project will focus on in the first year.

Can a failed ileal pouch anal anastomosis be left in situ?

OBJECTIVE: Failure after ileal pouch-anal anastomosis (IPAA) is reported with a frequency of 10-20%. The failed IPAA can be excised or defunctioned. Indications for excision and further management of an indefinitely diverted pouch are poorly described. The aim of the present investigation was to investigate pouch-related problems and the histopathological pattern of the pouch mucosa in this group of patients. METHOD: In a cohort of 620 patients having IPAA with a median follow-up of 14 years, 56 patients with failure were identified. The patients with defunctioned pouches were assessed with regard to pouch-related problems and endoscopy with biopsies was performed. Biopsies were stained with haematoxylin-eosin, PAS for neutral mucins and Alcian blue/high iron diamine for sialomucins/sulphomucins. Morphological changes were grouped into three types modified according to Veress and assessed for dysplasia. RESULTS: Twenty-two patients with an indefinitely diverted pouch were found. The follow-up time after surgery for failure was 10 years. Thirteen patients completed the follow-up. Except for two patients with pelvic/perineal pain, there were no clinical problems. The majority of patients displayed mild to moderate macroscopic signs of inflammation. Morphologically, findings ranged from a preserved mucosal pattern to intense inflammatory reaction. No case of dysplasia or carcinoma was found. CONCLUSION: Most patients with an indefinitely diverted pouch had no complaints regarding the pouch. There was no case of dysplasia. Indefinite diversion may be preferable to pouch excision, especially given the associated morbidity.

Simulation of nitrification of municipal wastewater in a Moving Bed biofilm process: a bottom-up approach based on a 2D-continuum model for growth and detachment.

This paper presents a complete mathematical model of a Moving Bed biofilm process for waste-water treatment, in particular for the nitrification process. The model is based on a bottom up approach adopting a multidimensional model for the biofilm growth and metabolism and a global mass balance model for the whole reactor. The model shows that oxygen is limiting the amount of biomass involved in the nitrification process. Furthermore, it suggests the existence of an optimal amount biomass for an optimal reactor turnover rate. Studies of two specific new suspended carriers show that the model output is dependable on the geometry of the carrier, and to a satisfactory extent agreeable with measurements.

Long-term function and manovolumetric characteristics after ileal pouch-anal anastomosis for ulcerative colitis.

BACKGROUND: Long-term pouch function and physiological characteristics after ileal pouch-anal anastomosis (IPAA) are poorly described. The aim of this study was to undertake a prospective investigation of long-term pouch function and manovolumetric characteristics. METHODS: Forty-two patients with a median follow-up of 16 years after IPAA were included. Function was assessed using a questionnaire and a score was calculated ranging from 0 to 15 (15 being the worst). Manovolumetry was performed and pouchitis recorded. A paired analysis was conducted, as the results were compared with previous data for each patient. RESULTS: The median functional score was 3.5 (range 0-10) at 2 years and 5 (range 1-11) at 16 years (P = 0.013). Resting anal canal pressures were higher (P < 0.001) and squeeze pressures lower (P = 0.008) at long-term follow-up. Ileal pouch volumes at distension pressures of 10, 20 and 40 cm H(2)O were diminished at 16 years (P < 0.001, P = 0.005 and P = 0.058 respectively). The volume and pressure for first sensation and urge to defaecate were reduced. Increased age correlated positively with a poor functional score. A history of pouchitis did not affect functional or physiological characteristics. CONCLUSION: Ileal pouch function declines in the long term. The reasons are unclear, but the ageing process may have an impact.

Pedagogical encounters between nurses and patients in a medical ward--a field study.

BACKGROUND: Patient teaching is regarded as an important aspect of nursing care as well as an essential part of the nursing profession. In nursing practice, a distinction can be made between formal (planned) and informal (spontaneous) patient teaching. The major part of patient teaching research is within the area of formal teaching. In spite of the fact that spontaneous teaching occurs in everyday nursing practice, there is a lack of knowledge in this area. OBJECTIVES: The aim was to illuminate pedagogical dimensions in nursing situations and informal teaching. DESIGN: The study is a fieldwork study within the frames of a life-world phenomenological tradition. PARTICIPANTS AND SETTING: Fifteen registered nurses in a general medical ward of a university hospital in Sweden were followed in their daily work with patients. Twelve patients suffering from various chronic diseases were interviewed. METHODS: The observations comprised a total of 173 h on 34 separate occasions. Informal dialogues with nurses were carried through. Further, formal interviews were conducted with 12 of the observed patients. The data were analysed by means of a life-world phenomenological approach. RESULTS: Two different pedagogical encounters are presented: "Players in different field pedagogical encounters", in which there is a breakdown in the pedagogical dialogue, and "Players in same field pedagogical encounters", in which the pedagogical dialogue develops. Patients' experiences of seeking and acquiring knowledge within these two types of encounter are characterised as "worry" versus "preparedness". Patients' dignity is either threatened or supported, depending on the type of encounter. CONCLUSIONS: Health care organisations have to create a pedagogical climate where "Same field pedagogical encounters" can be created. The nurse has to view the patient as a learning person in order to help the patient to achieve "preparedness". "Preparedness" is described as a cognitive-emotive-existential state and emphasised as an important goal of patient teaching.

The dynamics of social-ecological systems in urban landscapes: Stockholm and the National Urban Park, Sweden.

This study addresses social-ecological dynamics in the greater metropolitan area of Stockholm County, Sweden, with special focus on the National Urban Park (NUP). It is part of the Millennium Ecosystem Assessment (MA) and has the following specific objectives: (1) to provide scientific information on biodiversity patterns, ecosystem dynamics, and ecosystem services generated; (2) to map interplay between actors and institutions involved in management of ecosystem services; and (3) to identify strategies for strengthening social-ecological resilience. The green areas in Stockholm County deliver numerous ecosystem services, for example, air filtration, regulation of microclimate, noise reduction, surface water drainage, recreational and cultural values, nutrient retention, and pollination and seed dispersal. Recreation is among the most important services and NUP, for example, has more than 15 million visitors per year. More than 65 organizations representing 175,000 members are involved in management of ecosystem services. However, because of population increase and urban growth during the last three decades, the region displays a quite dramatic loss of green areas and biodiversity. An important future focus is how management may reduce increasing isolation of urban green areas and enhance connectivity. Comanagement should be considered where locally managed green space may function as buffer zones and for management of weak links that connect larger green areas; for example, there are three such areas around NUP identified. Preliminary results indicate that areas of informal management represent centers on which to base adaptive comanagement, with the potential to strengthen biodiversity management and resilience in the landscape.

Respiratory effects of the kneeling prone position for low back surgery.

BACKGROUND AND OBJECTIVE: The kneeling prone position is often used for low back surgery in order to decrease intraoperative bleeding and increase the surgical exposure of the vertebral canal. The aim of this study was to assess effects of the kneeling prone position on respiratory gas exchange focusing on oxygen consumption and early changes in oxygenation. METHODS: Thirty ASA I-II patients scheduled for low back surgery in the kneeling prone position were studied. Anaesthesia was maintained with isoflurane, 1.2% end-tidal concentration. Respiratory gas exchange was measured with indirect calorimetry. RESULTS: When the patients were turned into the kneeling prone position their oxygenation was immediately improved--measured by arterial oxygen tension and arterial oxygen saturation. The oxygen uptake rate did not change from a baseline supine level of 76 mL min(-1) m(-2), but the carbon dioxide excretion rate decreased from a baseline supine value of 71 mL min(-1) m(-2) to 66 mL min(-1) m(-2) at 5 and 10 min after the kneeling prone position was adopted. Alveolar ventilation decreased in the kneeling prone position. CONCLUSIONS: The present study demonstrates that the kneeling prone position improves oxygenation and that the mechanisms involved are fast in onset. Furthermore, the prone position does not change oxygen consumption although alveolar ventilation is significantly reduced. The changes in alveolar ventilation could possibly be the result of circulatory changes caused by the prone position, but further studies are needed to clarify that hypothesis.

A descriptive cross-sectional study of annoyance from low frequency noise installations in an urban environment.

In order to improve the living conditions for respondents highly exposed to traffic noise, it has been recommended that one side of the building should face a "quiet side". Quiet may, however, be spoilt by noise from installations such as ventilation and air-conditioning systems. The noises generated by installations of this kind often have a dominant portion of low frequencies (20-200 Hz) and may be a source of great annoyance and sleep disturbance. This paper describes the cross-sectional part of an intended intervention study among residents exposed to traffic noise on one side of the building and to low frequency noise from installations on the other side of the building. A questionnaire masked as a general living environment study was delivered to a randomly selected person in each household. In total 41 respondents answered the questionnaire (71% response rate). Noise from installations was measured indoors in a bedroom facing the courtyard in a selection of apartments and outdoors in the yard. 24h traffic noise outdoor and indoor levels were calculated. The noise levels from installations were slightly above or at the Swedish recommendations for low frequency noise indoors with the window closed and exceeded the recommendations by about 10 dB SPL when the window was slightly opened. The proportion of persons who reported that they were very or extremely annoyed indoors from noise from installations was more than twice as high as for traffic noise. Installation noise also affected respondents' willingness to have their windows open and to sleep with an open window. The high disturbance of installation noises found in this study indicates the importance of also regulating the noise exposure on the "quiet side" of buildings. Further studies will give a better base for the extent of annoyance and acceptable levels of installation noises.

Mitochondrial transcription factor A and respiratory complex IV increase in response to exercise training in humans.

Protein levels of mitochondrial transcription factor A (Tfam) and nuclear- and mitochondrial-encoded subunits of respiratory chain complex IV (COX I and COX IV) as well as citrate synthase activity were analysed in muscle biopsy samples of vastus lateralis in six healthy male subjects before and after 4 weeks of one-legged cycle training. One leg was trained with restricted blood flow. The other leg was trained with the same power profile but with non-restricted blood flow. Tfam, COX I and COX IV levels all increased with training, with no differences observed between the legs. The training-induced increase in citrate synthase activity was greater in the leg trained with restricted blood flow. These findings indicate that changed expression of Tfam protein could be one mechanism of exercise-induced mitochondrial biogenesis. The increases of COX I and COX IV indicate a concurrent increase of nuclear- and mitochondrial-encoded subunits of respiratory enzyme complex IV at the protein level in skeletal muscle in response to increased muscle activity. In this study, it was not possible to demonstrate that the greater energy disturbance induced by reduced blood flow further stimulates the expression of mitochondrial proteins, even though it did cause a greater enhancement of citrate synthase activity in concordance with earlier studies.