Detection of metallic objects on digital radiographs with convolutional neural networks: A MRI screening tool.

INTRODUCTION: Screening for metallic implants and foreign bodies before magnetic resonance imaging (MRI) examinations, are crucial for patient safety. History of health are supplied by the patient, a family member, screening of electronic health records or the picture and archive systems (PACS). PACS securely store and transmits digital radiographs (DR) and related reports with patient information. Convolutional neural networks (CNN) can be used to detect metallic objects in DRs stored in PACS. This study evaluates the accuracy of CNNs in the detection of metallic objects on DRs as an MRI screening tool. METHODS: The musculoskeletal radiographs (MURA) dataset consisting of 14.863 upper extremity studies were stratified into datasets with and without metal. For each anatomical region: Elbow, finger, hand, humerus, forearm, shoulder and wrist we trained and validated CNN algorithms to classify radiographs with and without metal. Algorithm performance was evaluated with area under the receiver-operating curve (AUC), sensitivity, specificity, predictive values and accuracies compared with a reference standard of manually labelling. RESULTS: Sensitivities, specificities and area under the ROC-curves (AUC) for the six anatomic regions ranged from 85.33% (95% CI: 78.64%-90.57%) to 100.00% (95% CI: 98.16%-100.00%), 75.44% (95% CI: 62.24%-85.87%) to 93.57% (95% CI: 88.78%-96.75%) and 0.95 to 0.99, respectively. CONCLUSION: CNN algorithms classify DRs with metallic objects for six different anatomic regions with near-perfect accuracy. The rapid and iterative capability of the algorithms allows for scalable expansion and as a substitute MRI screening tool for metallic objects. IMPLICATIONS FOR PRACTICE: All CNNs would be able to assist in metal detection of digital radiographs prior to MRI, an substantially decrease screening time.

Demonstration of 26-hydroxylation of C27-steroids in human skin fibroblasts, and a deficiency of this activity in cerebrotendinous xanthomatosis.

26-Hydroxylation of 5 beta-cholestane-3 alpha, 7 alpha, 12 alpha-triol and other C27-steroids was demonstrated in cultured skin fibroblasts from healthy individuals. Activities in skin fibroblasts were approximately 5-10% of those previously found in human liver homogenates, and were inhibited by CO. The apparent Km was lowest for 5 beta-cholestane-3 alpha, 7 alpha, 12 alpha-triol (1.3 mumol/liter) and highest for 5-cholestene-3 beta, 7 alpha-diol (12 mumol/liter). The rate of 26-hydroxylation was highest with 7 alpha-hydroxy-4-cholesten-3-one. These characteristics are similar to those of hepatic mitochondrial C27-steroid 26-hydroxylase. In skin fibroblasts from three patients with cerebrotendinous xanthomatosis (CTX), 26-hydroxylation of C27-steroids proceeded at a rate of only 0.2-2.5% of healthy controls. No accumulation of endogenous 5 beta-cholestane-3 alpha, 7 alpha, 12 alpha-triol could be demonstrated in these cells, and the lowered formation of radioactive, 26-hydroxylated products could not be explained by dilution of the labeled exogenous substrate. The present results add strong evidence to the concept that the primary metabolic defect in CTX is a deficiency of C27-steroid 26-hydroxylase.

Long-term results in children with AML: NOPHO-AML Study Group--report of three consecutive trials.

In all, 447 children with acute myeloid leukaemia (AML) have been treated on three consecutive NOPHO studies from July 1984 to December 2001. NOPHO-AML 84 was of moderate intensity with an induction of three courses of cytarabine, 6-thioguanine and doxorubicin followed by four consolidation courses with high-dose cytarabine. The 5-year event-free survival (EFS), disease free survival (DFS) and overall survival (OS) were 29, 37 and 38%. NOPHO-AML 88 was of high intensity with the addition of etoposide and mitoxantrone in selected courses during induction and consolidation. The interval between the induction courses should be as short as possible, that is, time intensity was introduced. The 5-year EFS, DFS and OS were 41, 48 and 46%. In NOPHO-AML 93, the treatment was stratified according to response to first induction course. The protocol utilised the same induction blocks as NOPHO-AML 88, but after the first block, children with a hypoplastic, nonleukaemic bone marrow were allowed to recover before the second block. Consolidation was identical with NOPHO-AML 88. The 5-year EFS, DFS and OS in NOPHO-AML 93 were 48, 52 and 65%. The new NOPHO-AML protocol has been based on experiences from previous protocols with stratification of patients with regard to in vivo response and specific cytogenetic aberrations.

Differential chromatin structure-dependent binding of 7-aminoactinomycin D in normal and malignant bone marrow hematopoietic cells.

Chromatin structure-dependent binding of the DNA-specific dye 7-aminoactinomycin D (7-AMD) in leukemic and normal cells in bone marrow aspirates from childhood acute leukemia patients and patients without bone marrow neoplasia was assessed by multiparameter flow cytometry. Simultaneous staining with fluorescein isothiocyanate-labeled antibodies was needed in many cases for determination of the immunophenotype of the cells that exhibited differential binding of 7-AMD. 7-AMD binding was enhanced in normal (4 patients) and malignant (8 patients) myeloid cells, and was generally low in normal and leukemic lymphocytes and normoblasts. Four of 18 aspirates from 16 patients with acute lymphoblastic leukemia contained neoplastic cells with increased 7-AMD binding capability. The 7-AMD binding of the leukemic cells was not correlated to S-phase fraction (P = 0.07), but was significantly correlated to cell size as measured by forward angle light scattering (r = 0.49, P = 0.007). Patients with tumor cells exhibiting low 7-AMD binding at last aspirate survived significantly longer than the patients with leukemic cells binding high amounts of 7-AMD (P = 0.03). Neither cell size, S-phase fraction, nor ploidy status predicted patient survival in this small scale study.

Protein requirements in infants and children: a longitudinal study of children treated for phenylketonuria.

Two groups of children with phenylketonuria were followed from birth for several years. The Recommended Dietary Allowance group received a protein intake as recommended by the Food and Nutrition Board. The Food and Agricultural Organization (FAO) group received a protein intake as recommended by FAO. The children were followed very closely for the biochemical control of the disease. The children were also followed very closely to evaluate the adequacy of the protein intake using length, weight, routine hematology, chemical analysis, and x-ray of the hand. The results indicated two groups of healthy children. However, a decline in length growth percentile was found in some of the FAO children. A possible osteoporosis developed in two of the FAO children. The possible conclusion that the FAO "safe level of intakes of egg or milk protein" is marginal is discussed.

Children in the Norwegian health care system.

Norway is a large, sparsely populated country with a long tradition of socialized health care. The health status of Norwegians is good, with life expectancy among the highest in Europe. Indicators of infant health are also good, although not among the best. Health services in Norway are in principle free of charge to all citizens, and the current health expenditure is about 6.8% of the Gross National Product. Preventive and curative pediatric services account for only 3% of this total. The structure of Norwegian health and social services is presented in this discussion, both in general terms and with particular attention to services for children.

Postneonatal mortality in Norway: a study of recent trends and comparison with other mortality rates in Norwegian children.

Postneonatal mortality in Norway decreased rapidly from 1956 to 1980 but subsequently remained stable. In recent years the postneonatal death rate appears to be increasing, primarily due to greater numbers of deaths attributed to the Sudden Infant Death Syndrome. During the same period, mortality among older children has also decreased, with the decline evident in all leading causes. Only among people aged 15 to 19 years have recent trends been less than encouraging, with the number of fatal traffic accidents in particular remaining stable or increasing. Although there is room for continued improvement, the widely held belief that the health status of Norwegian children is good is supported by the trends in mortality.

VACTERL or MURCS association in a girl with neurenteric cyst and identical thoracic malformations in the father: a case of gonosomal mosaicism?

We report on a female infant with lethal congenital malformations including extreme hydrocephalus due to aqueductal stenosis, vertebral segmentation anomalies, fused costae, anal atresia, renal dysplasia, and bicornuate uterus with a double blind vagina. The VACTERL and the MURCS associations are possible diagnoses. Her father had a neurenteric cyst in infancy. He has identical vertebral and costal malformations as his daughter but is otherwise healthy. The possibility of dominant inheritance with gonosomal mosaicism in the father is discussed.

Clinical and pharmacologic studies with adriamycin-DNA complex in children with malignant disease.

During the last 4 years, we have studied the adriamycin-DNA complex originally developed by Trouet and co-workers (1972). This paper summarizes the results of our pharmacologic and clinical studies. The complex is taken up by cells through an adsorptive pinocytosis, with DNA as the binding molecule. Excess DNA prevents uptake of the drug. Administration of the drug as the complex results in much higher serum concentration and a reduced urinary excretion. The complex is well tolerated, but side effects are probably of the same order as those seen with the free drug. An exception may be the heart. The acute toxicity is not seen when infusing the complex. Our experience with 20 children who have received more than 500 mg/m2 indicates that the chronic cardiac toxicity may be reduced, too. Spectacular, but anecdotal, results have been observed in a variety of solid tumors. Of 16 children with acute myelogenous leukemia, 14 went into a complete remission on a protocol of cytosine arabinoside in combination with the complex. Three of these children are now off therapy, with the longest observation period being 4 years and 4 months.

Evaluation of retinyl palmitate and cytarabine treatment in a slowly growing rat leukemia model.

The slowly effect of retinyl palmitate in prolonging survival time in a slowly growing rat promyelocytic leukemia model (BNML) was tested. Retinyl palmitate was given in addition to cytarabine, which has previously been shown to prolong survival time in these rats. The effect of cytarabine on liver store and plasma level of retinol was also tested. The results show that retinyl palmitate did not prolong survival time in the leukemic rats. Similarly, cytarabine did not reduce the level of retinol in liver or plasma.

Second malignant neoplasms after cancer in childhood or adolescence. Nordic Society of Paediatric Haematology and Oncology Association of the Nordic Cancer Registries.

OBJECTIVE: To assess the relative risk of developing a second malignant neoplasm in people with a diagnosis of cancer in childhood and adolescence. DESIGN: Register based follow up study. SETTING: Populations of Nordic countries. SUBJECTS: 30,880 people under the age of 20 with a first malignant neoplasm diagnosed during the period 1943-87. MAIN OUTCOME MEASURES: Relative and attributable risks of second malignant neoplasms by type of first cancer, age at first diagnosis, calendar period, sex, and country. Expected figures were based on the appropriate national incidence rates for cancer. RESULTS: 247 cases of second malignant neoplasms were observed in 238 patients, yielding a relative risk for cancer of 3.6 (95% confidence interval 3.1 to 4.1). The risk changed significantly from 2.6 in people first diagnosed during the 1940s and 1950s to 6.9 among cohort members included in the late 1970s and 1980s. Increases were observed for most types of cancer. Highest levels of the relative risk were seen during the 10 years immediately after first malignant diagnosis. The incidence of second malignant neoplasms attributable to the first cancer and associated treatments, however, showed a consistent rise throughout the 45 years of follow up. CONCLUSION: The estimated risks for a second malignant neoplasm were significantly lower than those found in most large hospital based studies but compatible with the results from a similar population based study in the United Kingdom. Extent of risk and cancer pattern were similar among the Nordic countries and are believed to be representative for a large part of the European population.

[Second cancer. Risk of a second malignant neoplasm in persons with cancer in childhood and adolescence]. / Sekundaer cancer. Risiko for sekundoer malign neoplasi hos personer med cancer i barne- og ungdomsår.

Cancer treatments in early life have in previous studies been associated in with high risks of developing a second malignant neoplasm. This study reports on the relative and attributable risks of second malignant neoplasms among 30,880 people under the age of 20, who had been identified in the files of any of the five Nordic cancer registers, 1943-1987. Overall, 247 cases of second malignant neoplasms were observed in 238 patients, yielding a relative risk for cancer of 3.6 (95% confidence interval 3.1-4.1). The risk changed significantly from 2.6 in people first diagnosed during the 1940s and 1950s to 6.9 among cohort members included in the late 1970s and 1980s. Highest levels of the relative risk were seen during the ten years immediately after first malignant diagnosis. The incidence of second malignant neoplasms attributable to the first cancer and associated treatments, however, showed a consistent rise throughout the 45 years of follow up. It was concluded that the estimated risks for second malignant neoplasms were significantly lower than those found in most large hospital based studies but compatible with the results from a similar population based study in the United Kingdom. Extent of risk and cancer pattern were similar among the Nordic countries and are believed to be representative for a large part of the European population.

Screening for cystic fibrosis among newborns in Norway by measurement of serum/plasma trypsin-like immunoreactivity. Results of a 2 1/2-year pilot project.

A pilot project for neonatal screening for cystic fibrosis (CF) by measuring trypsin-like immunoreactivity (TLI) in liquid serum or plasma samples was carried out in Norway from May 1982 to December 1984. A total of 72,320 newborns was screened. Twelve infants were recalled for sweat testing; 11 were confirmed to have CF. One infant had normal sweat sodium and chloride levels and no clinical symptoms. The incidence of CF in this study was 1:6574, and the recall rate for second blood samples was 0.6%. No false-negative cases have yet been reported. The level of TLI was affected by the use of heparin in plasma preparation, being reduced by about 20% as compared to serum levels.

[Folling's disease]. / Føllings sykdom.

Norway is a small country and we have few examples of medical scientists that has discovered and cultivated unknown territory. One very good example is the man who discovered the first link between metabolic disease and brain development. Asbjørn Følling was born in 1888 and discovered "his disease" (phenylketonuria = PKU) in 1934. This article gives a description of his life, discovery and work.