Factors affecting the labelling accuracy of brain MRI studies relevant for deep learning abnormality detection.

Unlocking the vast potential of deep learning-based computer vision classification systems necessitates large data sets for model training. Natural Language Processing (NLP)-involving automation of dataset labelling-represents a potential avenue to achieve this. However, many aspects of NLP for dataset labelling remain unvalidated. Expert radiologists manually labelled over 5,000 MRI head reports in order to develop a deep learning-based neuroradiology NLP report classifier. Our results demonstrate that binary labels (normal vs. abnormal) showed high rates of accuracy, even when only two MRI sequences (T2-weighted and those based on diffusion weighted imaging) were employed as opposed to all sequences in an examination. Meanwhile, the accuracy of more specific labelling for multiple disease categories was variable and dependent on the category. Finally, resultant model performance was shown to be dependent on the expertise of the original labeller, with worse performance seen with non-expert vs. expert labellers.

Outcome study of the Pipeline Vantage Embolization Device (second version) in unruptured (and ruptured) aneurysms (PEDVU(R) study).

BACKGROUND: The Pipeline Vantage Embolization Device (PEDV) is the fourth-generation pipeline flow diverter for intracranial aneurysm treatment. There are no outcome studies for the second PEDV version. We aimed to evaluate safety and efficacy outcomes. Primary and secondary objectives were to determine outcomes for unruptured and ruptured cohorts, respectively. METHODS: In this multicenter retrospective and prospective study, we analyzed outcome data from eight centers using core laboratory assessments. We determined 30-day and ≥3-month mortality and morbidity rates, and 6- and 18-month radiographic aneurysm occlusion rates for procedures performed during the period July 2021-March 2023. RESULTS: We included 121 consecutive patients with 131 aneurysms. The adequate occlusion rate for the unruptured cohort at short-term and medium-term follow up, and also for the ruptured cohort at short-term follow up, was >90%. Two aneurysms (1.5%) underwent retreatment. When mortality attributed to a palliative case in the unruptured cohort, or subarachnoid hemorrhage in the ruptured cohort, was excluded then the overall major adverse event rate in respective cohorts was 7.5% and 23.5%, with 0% mortality rates for each. When all event causes were included on an intention-to-treat basis, the major adverse event rates in respective cohorts were 8.3% and 40.9%, with 0.9% and 22.7% mortality rates. CONCLUSIONS: For unruptured aneurysm treatment, the second PEDV version appears to have a superior efficacy and similar safety profile to previous-generation PEDs. These are acceptable outcomes in this pragmatic and non-industry-sponsored study. Analysis of ruptured aneurysm outcomes is limited by cohort size. Further prospective studies, particularly for ruptured aneurysms, are needed.

Early Outcomes of the Pipeline Vantage Flow Diverter : A Multicentre Study.

PURPOSE: The recently introduced Pipeline Vantage Embolization Device with Shield Technology is the fourth generation of Pipeline flow diverter devices. Due to the relatively high rate of intraprocedural technical complications, modifications were subsequently made to the device after a limited release of the device in 2020. This study aimed to evaluate the safety and efficacy of the modified version of this device. METHODS: This was a multicentre retrospective series. The primary efficacy endpoint was aneurysm occlusion in the absence of retreatment. The primary safety endpoint was any neurological morbidity or death. Ruptured and unruptured aneurysms were included in the study. RESULTS: A total of 52 procedures were performed for 60 target aneurysms. Treatment was performed on 5 patients with ruptured aneurysms. The technical success rate was 98%. The mean clinical follow-up time was 5.5 months. In patients presenting with unruptured aneurysms there were no deaths, 3 (6.4%) major complications and 7 (13%) minor complications. In the five patients presenting with subarachnoid haemorrhage there were 2 (40%) major complications with 1 (20%) of these resulting in death, and 1 (20%) minor complication. Of the patients 29 (56%) had undergone 6­monthly postprocedural angiographic imaging with a mean time of 6.6 months demonstrating that 83% of patients had achieved adequate occlusion (RROC1/2) of the aneurysm. CONCLUSIONS: In this non-industry-sponsored study, the occlusion rates and safety outcomes were similar to those seen in previously published studies with flow diverter devices and earlier generation Pipeline devices. Modifications to the device appear to have improved ease of deployment.

Comparison Of An Experimental Root Canal Irrigant (Sapindus Mukorossi) And Ethylenediaminetetraacetic Acid On Microhardness Of Human Dentin.

BACKGROUND: The treatment of infected root canals is one of the most essential areas in dentistry. The endodontic therapy comprises of a sequence of steps that includes the purging of disease and infectious tissues from the root canal system. The objective of the study is to compare the effect of an experimental herbal root canal irrigant (Sapindus mukorossi) and Ethylenediaminetetraacetic acid, on the micro hardness of human dentin. METHODS: Ninety single rooted teeth were collected displayed intact external morphology the selected teeth were than divided randomly into 3 groups (n=30); 1 control and 2 experimental groups: Group A consisted of specimen treated with Ethanolic extract of Sapindus mukorossi. Group B consisted of specimen treated with 17% Ethylenediaminetetraacetic acid and Group C (control group) consisted of specimen of roots were sectioned immersed in distilled water. After the removal of crowns, the roots were sectioned embedded in the polymer resin leaving the root dentine exposed, the micro hardness was determined. Then, the samples from each group were treated with respective irrigant solution for 15 minutes and then observation regarding the micro hardness were noted again by using Vickers micro hardness tester. Analysis of data were obtained by application of Wilcoxon signed rank test. RESULTS: The study revealed that there was no significant difference noted in dentin microhardness of group "A" sample after dipping in experimental irrigant solution (Sapindus mukorossi). However, the study found significant difference in context of decrease in dentin microhardness after dipping a sample in a group "B" irrigant solution (17% Ethylenediaminetetraacetic acid). CONCLUSIONS: In order to preserve the strength of dentin that will ultimately be beneficial for increase in survival of teeth in function, probably the herbal extract of Sapindus mukorossi would be better candidate for future endeavour and presented as an economic and effective alternative amongst root canal irrigants.

Deep learning to automate the labelling of head MRI datasets for computer vision applications.

OBJECTIVES: The purpose of this study was to build a deep learning model to derive labels from neuroradiology reports and assign these to the corresponding examinations, overcoming a bottleneck to computer vision model development. METHODS: Reference-standard labels were generated by a team of neuroradiologists for model training and evaluation. Three thousand examinations were labelled for the presence or absence of any abnormality by manually scrutinising the corresponding radiology reports ('reference-standard report labels'); a subset of these examinations (n = 250) were assigned 'reference-standard image labels' by interrogating the actual images. Separately, 2000 reports were labelled for the presence or absence of 7 specialised categories of abnormality (acute stroke, mass, atrophy, vascular abnormality, small vessel disease, white matter inflammation, encephalomalacia), with a subset of these examinations (n = 700) also assigned reference-standard image labels. A deep learning model was trained using labelled reports and validated in two ways: comparing predicted labels to (i) reference-standard report labels and (ii) reference-standard image labels. The area under the receiver operating characteristic curve (AUC-ROC) was used to quantify model performance. Accuracy, sensitivity, specificity, and F1 score were also calculated. RESULTS: Accurate classification (AUC-ROC > 0.95) was achieved for all categories when tested against reference-standard report labels. A drop in performance (ΔAUC-ROC > 0.02) was seen for three categories (atrophy, encephalomalacia, vascular) when tested against reference-standard image labels, highlighting discrepancies in the original reports. Once trained, the model assigned labels to 121,556 examinations in under 30 min. CONCLUSIONS: Our model accurately classifies head MRI examinations, enabling automated dataset labelling for downstream computer vision applications. KEY POINTS: • Deep learning is poised to revolutionise image recognition tasks in radiology; however, a barrier to clinical adoption is the difficulty of obtaining large labelled datasets for model training. • We demonstrate a deep learning model which can derive labels from neuroradiology reports and assign these to the corresponding examinations at scale, facilitating the development of downstream computer vision models. • We rigorously tested our model by comparing labels predicted on the basis of neuroradiology reports with two sets of reference-standard labels: (1) labels derived by manually scrutinising each radiology report and (2) labels derived by interrogating the actual images.

Folic acid fortification of double fortified salt.

The addition of folic acid to Double Fortified Salt (with iron and iodine) aims to simultaneously ameliorate three major micronutrient deficiencies in vulnerable populations. To make Triple Fortified Salt, we added folic acid to the iodine solution (first method) and the iron premix (second method) that are used to fortify salt with iron and iodine. When added through the solution, sodium carbonate was needed to dissolve folic acid and to adjust pH. Alternately, folic acid was added either to the iron core or sandwiched between the core and TiO2 layer of the iron premix. Folic acid and iodine were stable in all cases, retaining more than 70% of the added micronutrients after six months at 45 °C/60-70% relative hu. Adding folic acid to the premix's iron core is preferred as folic acid retention was slightly higher, and the added folic acid did not impact the salt's colour. The additional cost for adding the micronutrients to salt is about 27¢/person per year. Folic acid in the fortified salt made with the preferred method was stable in cooking and did not affect selected cooked foods' sensory properties. The technology is a cost-effective approach for simultaneously combating iron, iodine, and folic acid deficiencies.

A life-threatening dental implant: A case report.

BACKGROUND: Intraoral bleeding complications in implant surgery are infrequent; nevertheless, serious and life-threatening complications have been described, generally related to mandibular implants. PURPOSE: This article presents the exceptional case of a 24-year-old woman who underwent repeated delayed life-threatening episodes of intraoral bleeding following uncovering of a maxillary dental implant. Local measures afforded only temporary control. RESULTS: The episodes were successfully managed by embolising the greater descending palatine artery, and the patient remains now under close follow-up. CONCLUSIONS: Early recognition of shock secondary to hemorrhage following intraoral surgery is of paramount importance.

Safety and Efficacy of the Neuroform Atlas Stent for Treatment of Intracranial Aneurysms : A Systematic Review and Meta-Analysis.

OBJECTIVE: The Neuroform Atlas (Stryker Neurovascular, Fremont, CA, USA) is a low-profile laser cut self-expanding nitinol stent designed to provide coil support and wall apposition during aneurysm embolisation. In this study, we performed a meta-analysis of outcomes after treatment with the Neuroform Atlas stent for the purpose of coil embolisation. METHODS: The primary objectives of this meta-analysis were to define the safety (treatment-related complications, neurologic outcomes, mortality rate) and the efficacy (aneurysm occlusion rate) of the treatment of intracranial aneurysms with the Neuroform Atlas stent. A systematic review and meta-analysis was performed by searching PubMed, EMBASE, and the Cochrane CENTRAL Library for all published studies on the treatment of intracranial aneurysms with the Neuroform Atlas device up to 6 April 2020. The review was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: A total of 14 studies were analysed (577 patients with 593 intracranial aneurysms). The mean age was 58.2 years and 35.6% were male. Technical success of the procedure was 100%. RROC1/RROC2 (Raymond-Roy occlusion classification (RROC) 1/2) (total occlusion/neck remnant) at a mean follow-up of 8.9 months was achieved in 94.8%. RROC3 was 4.9%. All-cause mortality was 1.8% and permanent residual neurological deficit or disability was 2.7%. Overall complications at follow-up were 6.2%. CONCLUSION: Our analysis demonstrated good rates of occlusion at follow-up for aneurysms treated with the Atlas device at follow-up. The safety profile appears similar to other low-profile intracranial stents.

Clostridium difficile enteritis: diffuse small bowel radiological changes in a patient with abdominal sepsis.

While imaging appearances of pseudomembranous colitis are commonly recognised, radiological manifestations of Clostridium difficile-associated enteritis are poorly understood which, combined with the rarity of this infection involving small bowel, makes establishing the correct diagnosis challenging. Therefore, in order to encourage awareness of readers, we present a case of C. difficile enteritis that manifested as abdominal sepsis complicating the postoperative period in a middle-aged woman with fistulating Crohn's disease and defunctioning ileostomy. Radiological appearances are described based on three consecutive CT studies performed 5 days prior to onset of symptoms, during the peak of enteritis, corresponding with the patient's clinical deterioration, and also 35 days later following treatment and resolution.

Characterizing the pH-Dependent Release Kinetics of Food-Grade Spray Drying Encapsulated Iron Microcapsules for Food Fortification.

Iron deficiency is the primary cause of many widespread nutritional diseases including anemia, pregnancy complications, and infant mortality. Release kinetics of iron premixes to be mixed with food items like salt, rice, and tea is a key research objective of many globally active iron fortification efforts. Iron release kinetics of microcapsules of two reverse-enteric coating materials (chitosan and Eudragit EPO) encapsulating various amounts of ferrous sulfate (10-40% of total other solids) were done at three pH values (1, 4, 7) for 2 hours. Chitosan and Eudragit microcapsules contained 2.8-5.3% (w/w) and 1.7-9.6% (w/w) iron, respectively, depicting higher iron loading capacity of Eudragit microcapsules. More than 90% iron was released from most samples within 30 min under stomach conditions (pH 1) and less than 15% iron was released in 2 h under ambient conditions (pH 7), showing suitability of both chitosan and Eudragit EPO as reverse-enteric coatings for iron encapsulation. In terms of reverse-enteric behavior (RE), Eudragit EPO (RE = 2.4) was found to be slightly better than chitosan, suggesting the use of fillers in future research. Higuchi model and Hixson-Crowell model were found to best fit the data, suggesting a transport phenomenon governed by both (a) the diffusion process through the coating material and (b) the dissolution phenomenon resulting in decrease in size of the capsules. Results from this study shall provide guidance for technology development aspects of various food fortification initiatives and an understanding of the iron release from these fortificants during the food preparation and digestion stages.

The spectrum of traumatic injuries at the craniocervical junction: a review of imaging findings and management.

The craniocervical junction is an area with unique biomechanical properties and injuries conferred often represent high-impact trauma. The vital structures traversing this region are susceptible to injury with frequent, only subtle findings identified on unenhanced CT, with MRI and CT angiography often revealing the full extent of injuries. This article reviews the osseous and ligamentous anatomy of the region and common injury patterns. Endovascular and neurosurgical management will also be discussed.

A multidisciplinary audit of head and neck referrals: considerations for patients' timelines and outcomes.

The Rapid Diagnostic Clinic (RDC) was introduced to comply with NICE recommendations for improving head and neck cancer services (National Institute of Clinical Excellence 2004 Improving outcomes in head and neck cancer: the manual. NICE, London). It provides multi-modality specialist assessment for new referrals, with on-site sonography and cytology. We have critically appraised the efficacy of our RDC, with respect to its impact on patients' timelines and outcomes. A retrospective audit of new referrals to the head and neck clinic during a 6-month period was conducted (pre-RDC period); areas in delay in patients reaching a definitive outcome were identified. Following implementation of the RDC, a second cycle, prospective audit was performed and its impact on timelines for patients' journey and outcomes determined. One hundred and ninety-seven patients were seen during the pre-RDC period. The average time from referral to being seen was 11 days for 2-week wait (2WW) referrals and 34 days for other sources. During the RDC period, 299 patients were seen in total. The average waiting time was reduced to 9 days for 2WW referrals and 23 days for other referrals. During the RDC period, over one-third of patients utilised the provision of ultrasound ± FNAC, and consequently, the majority reached a definitive outcome (discharged or scheduled for surgery) following their first consultation. This was a significant improvement compared to the pre-RDC period, where the main outcome was referral for an investigation, with consequently longer waiting time for surgery. We report the first study to consider the effect of a 'one-stop' clinic on patients' journey timelines and outcomes. Our study has shown that the RDC provides an efficient and effective system, which facilitates the patients' pathway to a definitive management plan.

Dysphagia due to thoracic aortic aneurysm, relieved by thoracic endovascular aneurysm repair: a case report and review of the literature.

Thoracic aortic aneurysm is a rare clinical entity that is usually asymptomatic. Failure to treat this type of aneurysm can prove fatal. Here, the authors report a case of thoracic aortic aneurysm causing chronically worsening compressive symptoms including dysphagia. This was diagnosed following a suspicious chest radiograph, and confirmed with thoracic CT angiogram. These symptoms remitted over a period of months following thoracic endovascular repair of the aneurysm. Aneurysmal compression and deviation of the oesophagus is noticeably reduced following repair. This is one of few cases in the literature of a remittance of dysphagia following endovascular aneurysm repair, and highlights that rare causes of dysphagia ought not to be disregarded.

Activating glucokinase (GCK) mutations as a cause of medically responsive congenital hyperinsulinism: prevalence in children and characterisation of a novel GCK mutation.

OBJECTIVE: Activating glucokinase (GCK) mutations are a rarely reported cause of congenital hyperinsulinism (CHI), but the prevalence of GCK mutations is not known. METHODS: From a pooled cohort of 201 non-syndromic children with CHI from three European referral centres (Denmark, n=141; Norway, n=26; UK, n=34), 108 children had no K(ATP)-channel (ABCC8/KCNJ11) gene abnormalities and were screened for GCK mutations. Novel GCK mutations were kinetically characterised. RESULTS: In five patients, four heterozygous GCK mutations (S64Y, T65I, W99R and A456V) were identified, out of which S64Y was novel. Two of the mutations arose de novo, three were dominantly inherited. All the five patients were medically responsive. In the combined Danish and Norwegian cohort, the prevalence of GCK-CHI was estimated to be 1.2% (2/167, 95% confidence interval (CI) 0-2.8%) of all the CHI patients. In the three centre combined cohort of 72 medically responsive children without K(ATP)-channel mutations, the prevalence estimate was 6.9% (5/72, 95% CI 1.1-12.8%). All activating GCK mutations mapped to the allosteric activator site. The novel S64Y mutation resulted in an increased affinity for the substrate glucose (S(0.5) 1.49+/-0.08 and 7.39+/-0.05 mmol/l in mutant and wild-type proteins respectively), extrapolating to a relative activity index of approximately 22 compared with the wild type. CONCLUSION: In the largest study performed to date on GCK in children with CHI, GCK mutations were found only in medically responsive children who were negative for ABCC8 and KCNJ11 mutations. The estimated prevalence (approximately 7%) suggests that screening for activating GCK mutations is warranted in those patients.

Mutations in the genes encoding the pancreatic beta-cell KATP channel subunits Kir6.2 (KCNJ11) and SUR1 (ABCC8) in diabetes mellitus and hyperinsulinism.

The beta-cell ATP-sensitive potassium channel is a key component of stimulus-secretion coupling in the pancreatic beta-cell. The channel couples metabolism to membrane electrical events, bringing about insulin secretion. Given the critical role of this channel in glucose homeostasis, it is not surprising that mutations in the genes encoding for the two essential subunits of the channel can result in both hypo- and hyperglycemia. The channel consists of four subunits of the inwardly rectifying potassium channel Kir6.2 and four subunits of the sulfonylurea receptor 1. It has been known for some time that loss of function mutations in KCNJ11, which encodes for Kir6.2, and ABCC8, which encodes for SUR1, can cause oversecretion of insulin and result in hyperinsulinemia (HI) of infancy; however, heterozygous activating mutations in KCNJ11 that result in the opposite phenotype of diabetes have recently been described. This review focuses on reported mutations in both genes, the spectrum of phenotypes, and the implications for treatment when patients are diagnosed with mutations in these genes.

Lipoxygenase inhibiting and antioxidant oligostilbene and monoterpene galactoside from Paeonia emodi.

Paeoninol and paeonin C, oligostilbene and monoterpene galactoside, have been isolated from the methanolic extract of the fruits of Paeonia emodi. Their structures have been assigned on the basis of spectral analysis including 1D and 2D NMR techniques. In addition, 4-hydroxybenzoic acid 3, gallic acid 4 and methyl gallate 5 have also been reported for the first time from this species. Compounds 1 and 2 have displayed potent inhibitory potential against enzyme lipoxygenase in a concentration-dependent fashion with the IC(50) values 0.77 and 99.5 microM, along with ABTS(.+) radical quenching activity with IC(50) values of 147.5 and 498.2 microM, respectively.