Automated graded prognostic assessment for patients with hepatocellular carcinoma using machine learning.

BACKGROUND: Accurate mortality risk quantification is crucial for the management of hepatocellular carcinoma (HCC); however, most scoring systems are subjective. PURPOSE: To develop and independently validate a machine learning mortality risk quantification method for HCC patients using standard-of-care clinical data and liver radiomics on baseline magnetic resonance imaging (MRI). METHODS: This retrospective study included all patients with multiphasic contrast-enhanced MRI at the time of diagnosis treated at our institution. Patients were censored at their last date of follow-up, end-of-observation, or liver transplantation date. The data were randomly sampled into independent cohorts, with 85% for development and 15% for independent validation. An automated liver segmentation framework was adopted for radiomic feature extraction. A random survival forest combined clinical and radiomic variables to predict overall survival (OS), and performance was evaluated using Harrell's C-index. RESULTS: A total of 555 treatment-naïve HCC patients (mean age, 63.8 years ± 8.9 [standard deviation]; 118 females) with MRI at the time of diagnosis were included, of which 287 (51.7%) died after a median time of 14.40 (interquartile range, 22.23) months, and had median followed up of 32.47 (interquartile range, 61.5) months. The developed risk prediction framework required 1.11 min on average and yielded C-indices of 0.8503 and 0.8234 in the development and independent validation cohorts, respectively, outperforming conventional clinical staging systems. Predicted risk scores were significantly associated with OS (p < .00001 in both cohorts). CONCLUSIONS: Machine learning reliably, rapidly, and reproducibly predicts mortality risk in patients with hepatocellular carcinoma from data routinely acquired in clinical practice. CLINICAL RELEVANCE STATEMENT: Precision mortality risk prediction using routinely available standard-of-care clinical data and automated MRI radiomic features could enable personalized follow-up strategies, guide management decisions, and improve clinical workflow efficiency in tumor boards. KEY POINTS: • Machine learning enables hepatocellular carcinoma mortality risk prediction using standard-of-care clinical data and automated radiomic features from multiphasic contrast-enhanced MRI. • Automated mortality risk prediction achieved state-of-the-art performances for mortality risk quantification and outperformed conventional clinical staging systems. • Patients were stratified into low, intermediate, and high-risk groups with significantly different survival times, generalizable to an independent evaluation cohort.

Automated MRI liver segmentation for anatomical segmentation, liver volumetry, and the extraction of radiomics.

OBJECTIVES: To develop and evaluate a deep convolutional neural network (DCNN) for automated liver segmentation, volumetry, and radiomic feature extraction on contrast-enhanced portal venous phase magnetic resonance imaging (MRI). MATERIALS AND METHODS: This retrospective study included hepatocellular carcinoma patients from an institutional database with portal venous MRI. After manual segmentation, the data was randomly split into independent training, validation, and internal testing sets. From a collaborating institution, de-identified scans were used for external testing. The public LiverHccSeg dataset was used for further external validation. A 3D DCNN was trained to automatically segment the liver. Segmentation accuracy was quantified by the Dice similarity coefficient (DSC) with respect to manual segmentation. A Mann-Whitney U test was used to compare the internal and external test sets. Agreement of volumetry and radiomic features was assessed using the intraclass correlation coefficient (ICC). RESULTS: In total, 470 patients met the inclusion criteria (63.9±8.2 years; 376 males) and 20 patients were used for external validation (41±12 years; 13 males). DSC segmentation accuracy of the DCNN was similarly high between the internal (0.97±0.01) and external (0.96±0.03) test sets (p=0.28) and demonstrated robust segmentation performance on public testing (0.93±0.03). Agreement of liver volumetry was satisfactory in the internal (ICC, 0.99), external (ICC, 0.97), and public (ICC, 0.85) test sets. Radiomic features demonstrated excellent agreement in the internal (mean ICC, 0.98±0.04), external (mean ICC, 0.94±0.10), and public (mean ICC, 0.91±0.09) datasets. CONCLUSION: Automated liver segmentation yields robust and generalizable segmentation performance on MRI data and can be used for volumetry and radiomic feature extraction. CLINICAL RELEVANCE STATEMENT: Liver volumetry, anatomic localization, and extraction of quantitative imaging biomarkers require accurate segmentation, but manual segmentation is time-consuming. A deep convolutional neural network demonstrates fast and accurate segmentation performance on T1-weighted portal venous MRI. KEY POINTS: • This deep convolutional neural network yields robust and generalizable liver segmentation performance on internal, external, and public testing data. • Automated liver volumetry demonstrated excellent agreement with manual volumetry. • Automated liver segmentations can be used for robust and reproducible radiomic feature extraction.

Targeting the vivid facets of apolipoproteins as a cardiovascular risk factor in rheumatoid arthritis.

Mostly, cardiovascular diseases are blamed for casualties in rheumatoid arthritis (RA) patients. Customarily, dyslipidemia is probably the most prevalent underlying cause of untimely demise in people suffering from RA as it hastens the expansion of atherosclerosis. The engagement of inflammatory cytokines like tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), etc., is crucial in the progression and proliferation of both RA and abnormal lipid parameters. Thus, lipid abnormalities should be monitored frequently in patients with both primary and advanced RA stages. An advanced lipid profile examination, i.e., direct role of apolipoproteins associated with various lipid molecules is a more dependable approach for better understanding of the disease and selecting suitable therapeutic targets. Therefore, studying their apolipoproteins is more relevant than assessing RA patients' altered lipid profile levels. Among the various apolipoprotein classes, Apo A1 and Apo B are primarily being focused. In addition, it also addresses how calculating Apo B:Apo A1 ratio can aid in analyzing the disease's risk. The marketed therapies available to control lipid abnormalities are associated with many other risk factors. Hence, directly targeting Apo A1 and Apo B would provide a better and safer option.

Meta-GGA study of 2D AlN/BN planer heterostructure and performance enhancement via strain engineering.

CONTEXT: The 2D AlN/BN planer heterostructure is a promising wide band gap semiconductor, but systematic studies of its bandgap and optical characteristics under applied strain are scarce. Here, the engineering property of 2D AlN/BN comprising bandgap nature transition and optical absorption capability (from unstrained to strained) have been investigated using density functional theory calculations. The formation energy calculations confirm the stability of the simulated nanoheterostructure. The electronic band structure calculations demonstrate that nanoheterostructure is an indirect bandgap material with a large bandgap of 5.26 eV, which can be modified effectively by applying strain. According to the calculations, the transition from indirect to direct band gap behavior has been observed at +15% biaxial strain with 2.71 eV band gap energy. Meanwhile, calculations for optical absorption and dielectric function reveal that the system has significant absorption peaks in the ultraviolet region which are very sensitive to applied strain. As strain increases, the first absorption peaks are shifted towards a lower energy range from 5.73 eV (Ꜫ= 0 %) to 3.76 eV (Ꜫ = +15%), which features an enhancement of optical absorption for solar and solar-blind regions. Furthermore, we determined that the band edge positions in 2D AlN/BN straddled the water redox potential under strain, indicating its effectiveness as a proficient photocatalyst. These characteristics make 2D AlN/BN planer nanoheterostructure a promising candidate for applications in optoelectronics and photocatalytic water splitting performance. METHODS: First principles computations based on density functional theory were employed to carry out all the calculations with a self-consistent approach. For solving the Kohn-Sham equations, the first principles dependent full-potential linearized augmented plane wave scheme were adopted. For addressing the exchange-correlation effects, the generalized gradient approximation of PBEsol functional was used. To prevent interaction between the periodic images, we have inserted a vacuum region of 10 Šin the z-direction. Non-negligible weak dispersion corrections in nanoheterostructure were considered by using the DFT-D3 method of Grimme's. The locally modified Becke-Johnson (lmBJ) exchange potential has also been applied to compute electronic and optical properties in this research to obtain more accurate information.

Ab-initio study of strain-tunable g-GaN/BN nanoheterostructure for optoelectronic and photocatalytic applications.

CONTEXT: Two-dimensional (2D) nanoheterostructures of materials, integrating various phase or materials into a single nanosheet have stimulated large-scale research interest for designing novel two dimensional devices. In contemporary analysis present work, we examined the structural and electronic properties of the isolated 2D BN and GaN monolayers. We have investigated the structural stability and optoelectronic and photocatalytic response of the g-GaN/BN nanoheterostructure along with its response to strain. Nanoheterostructure g-GaN/BN is predicted to be a direct bandgap semiconductor with wide gap of 4.45 eV, whose value can be effectively modulated by applied strain ( ϵ ) , ranging from 4.55 ( ϵ = - 4%) to 3.58 eV ( ϵ = 8%). We also discovered that the tensile strain of 8% can substantially tune the direct bandgap of nanoheterostructure to indirect band gap nature. Even more important, the biaxial tensile strain engineering accentuates an enhancement of optical absorption in the UV region, broadening the light harvesting of the g-GaN/BN nanoheterostructure with the shifting of first absorption peak from 4.64 ( ϵ = - 4%) to 3.71 eV ( ϵ = 8%). Furthermore, strain-tuned band edge potentials arrangement perfectly fits the water reduction and oxidation redox potentials. Our findings portend that the g-GaN/BN nanoheterostructure has application in prospective nanoscale optoelectronic devices and photocatalytic hydrogen evolution system. METHODS: First principles calculations in this study are performed using density functional theory. Generalized gradient approximation within PBEsol functional employed to address the electron-electron exchange-correlation effects. For avoiding periodic interactions between the layers, we have inserted a vacuum region of thickness 10 Å in the z-direction. For ensuring the convergence accuracy of the computed results, convergence criteria of the iteration process is set to be 0.0001 eV. Local modified Becke-Johnson, a semi local functional, is applied for calculating electronic and optical properties for more accuracy of results. As in layered 2D nanoheterostructure, a factual depiction of the van der Waals interactions cannot be provided by conventional DFT techniques. Accordingly, in order to incorporate these interactions, we had employed the dispersion correction method of Grimme's.

Mechanical strain effect on the optoelectronic properties and photocatalysis applications of layered AlN/GaN nanoheterostructure.

CONTEXT: The aim of this work is to use first principles calculations to examine the effects of different mechanical strains on the optoelectronic and photocatalytic capabilities of the 2D/2D nanoheterostructure of AlN/GaN. By utilizing the lmBJ (Meta-GGA) and PBEsol (GGA) functional, the bandgap of the nanoheterostructure is calculated and found to be 4.89 eV and 3.24 eV. Simulated 2D AlN/GaN nanoheterostructure exhibits exceptional optical and electronic characteristics under applied biaxial tensile and compressive strains. The band gap changes from 4.89 to 3.77 eV, while the energy gap nature transitions from direct to indirect during tensile strain fluctuations of 0% to 8%. Strain is also found to have a significant effect on the optical absorption peaks. And a 0-8% rise in tensile strain causes the initial absorption peak of the 2D AlN/GaN nanoheterostructure to shift from 4.88 to 4.20 eV, which results in a 14% red shift in photon energy for every 2% change in strain. Furthermore, the optimum bandgap and band edge positions of the 2D AlN/GaN nanoheterostructure enable the water redox process to produce hydrogen and oxygen for wide range of pH. Thus, modification via strain may be an effective method for altering the optical as well as electronic characteristics of a 2D AlN/GaN nanoheterostructure, and this study may pave the way for new applications of this material in optoelectronic devices in the future. METHODS: In the current work, density functional theory is used to explore every attribute of the 2D AlN/GaN nanoheterostructure. To characterize the electronic exchange-correlation, we used the PBEsol functional. In order to prevent any interlayer contact between periodicity of images, a vacuum is produced along the z-direction of approximately 10 Å. To increase the precision of bandgap prediction, the electronic and optical characteristics were computed using the meta-GGA lmBJ functional. To account for interlayer van der Waals interactions, nanoheterostructure computations were performed using the DFT-D3 functional.

Analysis of structural, electronic and optical properties of Er-doped rock salt AlN using ab-initio calculations.

CONTEXT: This investigation includes the structural and optoelectronic characteristics of both pure and Er-doped rock salt aluminium nitride (AlN). Upon introducing Er doping into the AlN host, the calculations reveal a rise in the atomic parameter. Incorporating Er into the system leads to enhancements in the static dielectric coefficient ɛ1(0), static reflectivity R(0), as well as static refractive index n(0), at zero frequency. After doping, the peaks of imaginary dielectric tensor, extinction coefficient and absorption coefficient shift towards lower energy levels. Various exchange correlation potentials are incorporated to compare the results of electronic and optical characteristics. METHODS: We employed the full potential linearized augmented plane wave (FP-LAPW) approach with WIEN2k code in conjunction with the density functional theory (DFT). To explore the optoelectronic characteristics of both pure as well as doped systems, three distinct exchange correlation potentials are utilized: the Perdew-Burke-Ernzerhof Generalized Gradient Approximation (PBE-GGA), Modified Becke Johnson Generalized Gradient Approximations (mBJ + GGA) and Hubbard potential (GGA + U).

Diabetes: a review of its pathophysiology, and advanced methods of mitigation.

Diabetes mellitus (DM) is a long-lasting metabolic non-communicable disease often characterized by an increase in the level of glucose in the blood or hyperglycemia. Approximately, 415 million people between the ages of 20 and 79 years had DM in 2015 and this figure will rise by 200 million by 2040. In a study conducted by CARRS, it's been found that in Delhi the prevalence of diabetes is around 27% and for prediabetic cases, it is more than 46%. The disease DM can be both short-term and long-term and is often associated with one or more diseases like cardiovascular disease, liver disorder, or kidney malfunction. Early identification of diabetes may help avoid catastrophic repercussions because untreated DM can result in serious complications. Diabetes' primary symptoms are persistently high blood glucose levels, frequent urination, increased thirst, and increased hunger. Therefore, DM is classified into four major categories, namely, Type 1, Type 2, Gestational diabetes, and secondary diabetes. There are various oral and injectable formulations available in the market like insulin, biguanides, sulphonylureas, etc. for the treatment of DM. Recent attention can be given to the various nano approaches undertaken for the treatment, diagnosis, and management of diabetes mellitus. Various nanoparticles like Gold Nanoparticles, carbon nanomaterials, and metallic nanoparticles are some of the approaches mentioned in this review. Besides nanotechnology, artificial intelligence (AI) has also found its application in diabetes care. AI can be used for screening the disease, helping in decision-making, predictive population-level risk stratification, and patient self-management tools. Early detection and diagnosis of diabetes also help the patient avoid expensive treatments later in their life with the help of IoT (internet of medical things) and machine learning models. These tools will help healthcare physicians to predict the disease early. Therefore, the Nano drug delivery system along with AI tools holds a very bright future in diabetes care.

Combining platelet rich plasma with ablative laser for post acne scars: A review.

Background Acne scars are one of the most common sequelae of inflammatory acne. It commonly affects adolescents and young adults and hence is associated with significant psychological morbidity. It is historically resistant to oral as well as surgical modalities. In the last two decades, ablative lasers (fractional or otherwise) have proven to be effective in management of acne scars. Some studies have proven the efficacy of platelet rich plasma in reducing the adverse effects and improving the efficacy of lasers. Objective Review of the studies combining platelet rich plasma with ablative laser for post acne scars. Methods A literature review of the MEDLINE database for studies evaluating the combination of ablative lasers with platelet rich plasma was performed. Only studies with higher levels of evidence (randomised controlled trials and comparative studies) were included in this review. Results Adding intradermal platelet rich plasma to fractional ablative lasers in the management of post acne scars increases clinical efficacy, reduces downtime as well as frequency and duration of ablative lasers related adverse effects. The efficacy of topical platelet rich plasma is less as compared to intradermal platelet rich plasma. Limitations The studies analysed are heterogeneous in nature with varied protocols and duration of follow up. Conclusions It is recommended to combine the ablative lasers with intradermal platelet rich plasma for better clinical response and reduce adverse effects as well as downtime.

Dermal Delivery of Hypericum perforatum (L.)Loaded Nanogel: Formulation to Preclinical Psoriasis Assessment.

BACKGROUND: Nanophytosomes represent an effective choice for topical drug delivery systems thanks to their small size, general non-toxicity, ease of functionalization and high surface to volume ratio. The goal of the current study was to investigate the potential benefits of using Hypericum perforatum extract nanogel as a means of improving skin penetration and prolonging skin deposition in dermatitis similar to psoriasis. METHOD: Nanophytosomes (NPs) were developed, optimised and thoroughly characterised. The optimised NPs were then placed in a Carbopol gel base matrix and tested ex-vivo (skin penetration and dermatokinetic) and in-vivo (antipsoriatic activity in an Imiquimod-induced psoriatic rat model). RESULTS: The optimised NPs had a spherical form and entrapment efficiency of 69.68% with a nanosized and zeta potential of 168nm and -10.37mV, respectively. XRD spectra and transmission electron microscopy tests confirmed the plant botanical encapsulation in the NPs. Following 60 days of storage at 40 ± 2°C/75 ± 5% RH, the optimised formula remained relatively stable. As compared to extract gel, nano-gel showed a much-improved ex vivo permeability profile and considerable drug deposition in the viable epidermal-dermal layers. When developed nano-gel was applied topically to a rat model of psoriasis, it demonstrated distinct in vivo anti-psoriatic efficacy in terms of drug activity and reduction of epidermal thickness in comparison to other formulations and the control. ELISA and histopathologic studies also demonstrated that nano-organogel had improved skin integrity and downregulated inflammatory markers (IL-17, IL-6, IFN-γ and MCP-1). CONCLUSION: Findings suggest that a developed plant botanicals-based nanogel has a potential for the treatment of psoriasis-like dermatitis with better skin retention and effectiveness.

ENTEROBACTER CLOACAE CARDIAC IMPLANTABLE ELECTRONIC DEVICE INFECTION.

Enterobacter cloacae cardiac implantable electronic device infections are rare but can be associated with significant morbidity and mortality. We report an 11-year-old female with Enterobacter cloacae infection of a dual-chamber transvenous pacemaker pocket. The report is supplemented by a comprehensive review of the literature on Enterobacter cloacae cardiac implantable electronic device infections.

Physicochemical and antioxidant properties of kiwifruit as a function of cultivar and fruit harvested month

The present study was carried out to find the effect of fruit harvesting stage (October, November and December) on the physicochemical and antioxidant properties in five kiwi cultivars (Abbot, Bruno, Allison, Hayward, Monty). Results showed that soluble solid content (SSC) and pH increased while ascorbic acid (Vit C), titrated acidity (TAD) and SSC/TAD decreased in all the cultivars with delay in harvesting. Total polyphenols (TP) were decreased while total flavonoids (TF) increased in all tested cultivars with delay in harvesting. The highest concentration of TP (2.02 mg gallic acid equivalent/g fresh weight) and TF (51.12 mg catechin equivalent/100g FW) were found in cultivar 'Allison' in the month of October and December, respectively. Antioxidant activities (AA) were genotype depended and no trend was observed with month of harvesting. Principal component analysis (PCA) showed strong correlation between Vit C, TP and antioxidant activities. Two major clusters were computed using agglomerative hierarchical clustering (AHC). All the studied important traits may be used in the breeding programmes to increase the variability for different physiochemical and antioxidative characteristics and to make suitable selections that could be acceptable to consumers.

Ion-exchange resin complexation: Masking the bitter taste of cefuroxime axetil / Complejación de la resina de intercambio de iones: enmascaramiento del sabor amargo de cefuroxime acetil

OBJECTIVE: the purpose of this research was to formulate taste masked complexes of cefuroxime axetil and to evaluate them for taste, drug loading and characterized by FTIR, XRD. Tablets were formulated of selected batches and evaluated for drug release and physical parameters. METHODS: complexation technique is used to prepare complexes of drug where ion exchange resins such as Indion® 214, Indion® 234 and Indion® 414 were used with a drug-resin ratio of 1:0.5, 1:1, 1:2. The drug resinates were characterized by Infrared Spectroscopy, DSC and X-Ray Diffraction pattern and evaluated for drug loading and taste. Direct compression method was used to formulate tablets. In vitro dissolution was carried out using USP II apparatus. RESULT: potential taste masking increased with increasing concentration of resin. Indion® 214 resin showed better taste masking effect as compared to Indion® 234 and Indion® 414. Percent of drug loading was maximum at drug : resin ratio of 1:1, after that it decreased. Prolonged (upto 5 h) and slow drug release was observed with resin 214 at higher concentration. CONCLUSIONS: out of three resins chosen, Indion® 214 at higher concentration exhibit excellent taste masking as well as sustained drug release action.

OBJETIVO: el objetivo de esta investigación fue formular los complejos con sabor amargo de cefuroxime acetil y evaluarlos por sabor, carga medicamentosa y caracterización por FTIR, XRD. Las tabletas fueron formuladas a partir de lotes seleccionados y evaluados en busca de la liberación medicamentosa y parámetros físicos. MÉTODOS: la técnica de complejación se utilizó para preparar complejos farmacológicos donde las resinas de intercambio iónico como Indion® 214, Indion® 234 y el Indion® 414 se emplearon a una proporción resina-medicamento de 1:0.5, 1:1, 1:2. Los resinados medicamentosos fueron caracterizados mediante espectroscopia infrarroja, DSC y el patrón de difracción-rayos-X, y evaluados para determinar la carga medicamentosa y el sabor. El método de compresión directa fue empleado para formular las tabletas. Se efectuó una disolución in vitro utilizando el equipo USP II. RESULTADOS: el posible enmascaramiento del sabor aumentó con la creciente concentración de resina. La resina Indion® 214 mostró el mejor enmascaramiento del gusto amargo en comparación con Indion® 234 e Indion® 414. El porcentaje de carga medicamentosa fue máximo en el fármaco: proporción de la resina 1:1, después disminuyó. Se observó una liberación medicamentosa prolongada (hasta 5 h) y lenta con la resina 214 a una mayor concentración. CONCLUSIONES: de las 3 resinas escogidas, Indion®214 a una mayor concentración muestra un excelente enmascaramiento del sabor así como una mantenida acción liberadora del fármaco.

Role of the Parasight-F test in the diagnosis of complicated Plasmodium falciparum malarial infection

An evaluation was made of the diagnostic efficacy and utility of the Parasight-F test in diagnosing Plasmodium falciparum malaria, compared with conventional microscopy, particularly in severe and complicated cases. This study was designed as a prospective, case control hospital-based study. Febrile patients suspected to be suffering from malaria were selected randomly and were subjected to peripheral smear examinations (thick and thin) and Parasight-F tests till the required number of at least 30 cases of P. falciparum infection were identified, including at least 15 complicated cases. In addition 20 cases of P. vivax malarial infection as well as 20 healthy age and sex-matched individuals were taken as two control groups. The outcome measure was the number of cases with positive Parasight-F test results compared with conventional microscopy. Thirty-two patients with P. falciparum malaria were identified, with 15 severe and complicated cases. Peripheral smears were positive in 29 (91 percent) of these, while parasight-F test was positive in 31 out of 32 (97 percent) cases. Parasites were detected only by bone marrow examination in one case. Diagnostic sensitivity and specificity of peripheral smears for detecting falciparum infection were 90.6 percent and 100 percent respectively while that of the Parasight-F test were 96.8 percent and 100 percent, respectively (P>.05). The Parasight-F test has high sensitivity and specificity in diagnosing P. falciparum malarial infection, comparable to or even higher than microscopy exams, particularly in severe and complicated cases, with additional advantages of speed, simplicity and objectivity.