Current applications of deep-learning in neuro-oncological MRI.

PURPOSE: Magnetic Resonance Imaging (MRI) provides an essential contribution in the screening, detection, diagnosis, staging, treatment and follow-up in patients with a neurological neoplasm. Deep learning (DL), a subdomain of artificial intelligence has the potential to enhance the characterization, processing and interpretation of MRI images. The aim of this review paper is to give an overview of the current state-of-art usage of DL in MRI for neuro-oncology. METHODS: We reviewed the Pubmed database by applying a specific search strategy including the combination of MRI, DL, neuro-oncology and its corresponding search terminologies, by focussing on Medical Subject Headings (Mesh) or title/abstract appearance. The original research papers were classified based on its application, into three categories: technological innovation, diagnosis and follow-up. RESULTS: Forty-one publications were eligible for review, all were published after the year 2016. The majority (N = 22) was assigned to technological innovation, twelve had a focus on diagnosis and seven were related to patient follow-up. Applications ranged from improving the acquisition, synthetic CT generation, auto-segmentation, tumor classification, outcome prediction and response assessment. The majority of publications made use of standard (T1w, cT1w, T2w and FLAIR imaging), with only a few exceptions using more advanced MRI technologies. The majority of studies used a variation on convolution neural network (CNN) architectures. CONCLUSION: Deep learning in MRI for neuro-oncology is a novel field of research; it has potential in a broad range of applications. Remaining challenges include the accessibility of large imaging datasets, the applicability across institutes/vendors and the validation and implementation of these technologies in clinical practise.

Distal 5q deletion syndrome: phenotypic correlations.

We describe the phenotypes of two male sibs with partial monosomy of chromosome 5 [46,XY,der(5)inv ins(1;5)(p32;q35.4q34)]; maternally derived from a balanced insertion of 1 and 5 [inv ins (1;5)(p.32;q35.4q34)]. One sib had microcephaly, cleft lip and palate, facial anomalies, atrial (ASD) and ventricular (VSD) septal defects, camptodactyly 4th and 5th fingers, and developmental delay. The other sib showed microcephaly, facial anomalies, ASD, hypotonia, primary optic nerve hypoplasia, and developmental delay. Only seven other patients with 5q deletions distal to 5q33 have been reported and none showed the putative breakpoints identified in our two patients. All nine showed developmental delay or malformations of the CNS and facial anomalies; six of nine had defects of cardiac septation. Our two patients and one other were shown to have only one copy of the cardiac specific hCSX gene that defines in part the etiology of their ASD and VSD. The other components of their phenotypes cannot be related at present to genes identified in the deleted segments.

The week, inherited in neonatal human twins, found also in geomagnetic pulsations in isolated Antarctica.

About 7-day (circaseptan) components, found at different levels of organization, notably in relation to growth, regeneration, repair and development, are often viewed as reflecting no more than the 7-day societal schedule, ample evidence for a built-in feature notwithstanding. Herein, we resolve circaseptans in geomagnetic pulsations recorded by a stand-alone magnetometer residing in Antarctica, far away from societal influences. Human physiological data, collected in the neonatal intensive care unit, show by intra-class correlation analysis that the nonlinearly assessed circaseptan period of heart rate, diastolic blood pressure and body weight is more similar between same-gender twins than among twin pairs, lending additional support for the endogenicity of circaseptans. Like circadians, about-weekly features in environmental variables such as geomagnetic pulsations were genetically acquired in the course of evolution.

High-pressure injection injuries of the hand.

In high-pressure injection injuries to the hand the most commonly injected materials are automotive grease, diesel oil, and paint. We treated twenty-six patients with high-pressure injection injuries of the hand and found that the injection of paint resulted in a poorer prognosis than did the injection of grease. Amputation is often necessary with paint injections into a digit, while injections into the palm have a somewhat better prognosis. The disability time of patients with paint-injection injuries appeared to be directly related to the time elapsed until amputation of the involved digit. Although we were unable to specifically relate the ultimate result to the time elapsed between injury and proper treatment, we continue to recommend early aggressive wide débridement of these injuries.

Ulnar variance in Kienböck's disease.

The distal extent of the radius and ulna (ulnar variance) was compared on roentgenograms of normal wrists in randomly selected black and white patients and of fifteen affected wrists in patients with Kienbock's disease. The results establish a statistically significant association between negative ulnar variance and Kienbock's disease. Blacks have more positive ulnar variance and the disease is less likely to develop in them than in whites.

Antibiotic resistance of E. coli in sewage and sludge.

The aim of the study is the evaluation of resistance patterns of E. coli in wastewater treatment plants without an evaluation of basic antibiotic resistance mechanisms. Investigations have been done in sewage, sludge and receiving waters from three different sewage treatment plants in southern Austria. A total of 767 E. coli isolates were tested regarding their resistance to 24 different antibiotics. The highest resistance rates were found in E. coli strains of a sewage treatment plant which treats not only municipal sewage but also sewage from a hospital. Among the antimicrobial agents tested, the highest resistance rates in the penicillin group were found for Ampicillin (AM) (up to 18%) and Piperacillin (PIP) (up to 12%); in the cephalosporin group for Cefalothin (CF) (up to 35%) and Cefuroxime-Axetil (CXMAX) (up to 11%); in the group of quinolones for Nalidixic acid (NA) (up to 15%); and for Trimethoprime/Sulfamethoxazole (SXT) (up to 13%) and for Tetracycline (TE) (57%). Median values for E. coli in the inflow (crude sewage) of the plants were between 2.0 x 10(4) and 6.1 x 10(4)CFU/ml (Coli ID-agar, BioMerieux 42017) but showed a 200-fold reduction in all three plants in the effluent. Nevertheless, more than 10(2)CFU E. coli/ml reached the receiving water and thus sewage treatment processes contribute to the dissemination of resistant bacteria in the environment.

Secretan's disease: Post-traumatic hard edema of the dorsum of the hand.

Five cases are presented of hard, brawny edema of the dorsum of the hand, typical of Secretan's disease. We now believe splinting and active exercise to be the initial treatment of choice. Only after months of such conservative management should one resort to surgery.

Comparative investigation of airborne culturable microorganisms in sewage treatment plants.

The present study investigated emissions and emmissions of airborne microorganisms (mesophilic bacteria, Escherichia coli, molds, Aspergillus fumigatus, thermophilic actinomycetes/bacilli) in sewage treatment plants. For the aerobiological investigations three sewage treatment facilities with an activated-sludge process, capacities between 2000 and 28,000 PE and different cleaning steps were selected. The measurements of microorganism emission were conducted in the area of the intake (screen), in the area of biological treatment (activated sludge tank) and at a distance of 10 m from the activated sludge tanks. In order to determine the emmission, additional measurements were conducted leeward of the plant at a distance of 200 m. Samples were taken using four parallel six-stage Andersen 1 AFCM volumetric samplers. In the area of the intake counts for bacteria were 7.4 x 10(2) CFU/m3 (median), for thermophilic actinomycetes 1.8 x 10(1) CFU/m3, for thermophilic bacilli 7.1 x 10(1) CFU/m3, for molds 2.4 x 10(3) CFU/m3 and for Aspergillus fumigatus 1.8 x 10(1) CFU/m3. Only isolated airborne coliform recoveries, i.e. E. coli, were detected. In the area of the activated sludge tank, in the adjoining area (10 m) and in the vicinity of the plants (200 m), the counts for all microorganism groups investigated corresponded to natural conditions. The results show that the counts of culturable aerogenic microorganisms in and in the immediate surrounding of the sewage plants investigated are low. Although the possibility of an infection through inhalation cannot be ruled out, the direct contact with sewage is much more critical.

Comparison of extended-spectrum-ß-lactamase (ESBL) carrying Escherichia coli from sewage sludge and human urinary tract infection.

For many years, extended-spectrum-beta-lactamase (ESBL) producing bacteria were a problem mainly located in medical facilities. Within the last decade however, ESBL-producing bacteria have started spreading into the community and the environment. In this study, ESBL-producing Escherichia coli from sewage sludge were collected, analysed and compared to ESBL-E. coli from human urinary tract infections (UTIs). The dominant ESBL-gene-family in both sample groups was bla(CTX-M), which is the most prevalent ESBL-gene-family in human infection. Still, the distribution of ESBL genes and the frequency of additional antibiotic resistances differed in the two sample sets. Nevertheless, phenotyping did not divide isolates of the two sources into separate groups, suggesting similar strains in both sample sets. We speculate that an exchange is taking place between the ESBL E. coli populations in infected humans and sewage sludge, most likely by the entry of ESBL E. coli from UTIs into the sewage system.

Emergence of carbapenem-resistant Enterobacteriaceae in Austria, 2001-2010.

We report the emergence of carbapenem-resistant Enterobacteriaceae in Austria. Over a 10-year period, carbapenem-resistant Enterobacteriaceae isolates were obtained from 13 hospitalized patients, with the first isolation in the year 2005 and a remarkable increase in the number of involved patients in 2010. Carbapenem-resistant Enterobacteriaceae comprise eight Klebsiella pneumoniae isolates, four Klebsiella oxytoca isolates, and one Escherichia coli isolate. The detected carbapenemases were the metallo-ß-lactamases New Delhi ß-lactamase, VIM and IMP, and the serin-ß-lactamase Klebsiella pneumoniae carbapenemase.