Automatic segmentation of ultrasound images of gastrocnemius medialis with different echogenicity levels using convolutional neural networks

The purpose of this study was to develop an automatic method for the segmentation of muscle cross-sectional area on transverse B-mode ultrasound images of gastrocnemius medialis using a convolutional neural network(CNN). In the provided dataset images with both normal and increased echogenicity are present. The manually annotated dataset consisted of 591 images, from 200 subjects, 400 relative to subjects with normal echogenicity and 191 to subjects with augmented echogenicity. From the DICOM files, the image has been extracted and processed using the CNN, then the output has been post-processed to obtain a finer segmentation. Final results have been compared to the manual segmentations. Precision and Recall scores as mean ± standard deviation for training, validation, and test sets are 0.96 ± 0.05, 0.90 ± 0.18, 0.89 ± 0.15 and 0.97 ±0.03, 0.89± 0.17, 0.90 ± 0.14 respectively. The CNN approach has also been compared to another automatic algorithm, showing better performances. The proposed automatic method provides an accurate estimation of muscle cross-sectional area in muscles with different echogenicity levels

Neuralgic amyotrophy and hepatitis E virus infection

Objective:To determine whether there is an association between an acute preceding hepatitis E virus (HEV) infection and neuralgic amyotrophy (NA), and if so, whether patients with HEV-related NA differ from patients without an associated HEV infection.Methods:HEV testing was conducted in a retrospective cohort of 28 Cornish patients with NA (2011-2013) and a prospective cohort of 38 consecutive Dutch patients with NA (2004-2007). Acute-phase serum samples were analyzed for the presence of anti-HEV immunoglobulin (Ig) M and IgG and HEV RNA (quantitative real-time PCR).Results:Five cases (10.6%) of acute hepatitis E infection were identified in a total group of 47 patients with NA of whom serum samples were available. In 4 patients, HEV RNA was detected in serum samples taken at presentation. All patients with HEV-associated NA had clinical and electrophysiologic evidence of bilateral brachial plexus involvement. Anti-HEV IgM positivity was not related to age, sex, disease severity, disease course, or outcome.Conclusions:Acute hepatitis E is found in 10% of patients with NA from the United Kingdom and the Netherlands. Further research is required to investigate the role of HEV in NA in other geographical locations and to determine pathophysiologic mechanisms

Intestinal IFN-γ–producing type 1 regulatory T cells coexpress CCR5 and programmed cell death protein 1 and downregulate IL-10 in the inflamed guts of patients with inflammatory bowel disease

BACKGROUND: IL-10 is an anti-inflammatory cytokine required for intestinal immune homeostasis. It mediates suppression of T-cell responses by type 1 regulatory T (TR1) cells but is also produced by CD25+ regulatory T (Treg) cells. OBJECTIVE: We aimed to identify and characterize human intestinal TR1 cells and to investigate whether they are a relevant cellular source of IL-10 in patients with inflammatory bowel diseases (IBDs). METHODS: CD4+ T cells isolated from the intestinal lamina propria of human subjects and mice were analyzed for phenotype, cytokine production, and suppressive capacities. Intracellular IL-10 expression by CD4+ T-cell subsets in the inflamed guts of patients with IBD (Crohn disease or ulcerative colitis) was compared with that in cells from noninflamed control subjects. Finally, the effects of proinflammatory cytokines on T-cell IL-10 expression were analyzed, and IL-1\u3b2 and IL-23 responsiveness was assessed. RESULTS: Intestinal TR1 cells could be identified by coexpression of CCR5 and programmed cell death protein 1 (PD-1) in human subjects and mice. CCR5+PD-1+ TR1 cells expressed IFN-\u3b3 and efficiently suppressed T-cell proliferation and transfer colitis. Intestinal IFN-\u3b3+ TR1 cells, but not IL-7 receptor-positive TH cells or CD25+ Treg cells, showed lower IL-10 expression in patients with IBDs. TR1 cells were responsive to IL-23, and IFN-\u3b3+ TR1 cells downregulated IL-10 with IL-1\u3b2 and IL-23. Conversely, CD25+ Treg cells expressed higher levels of IL-1 receptor but showed stable IL-10 expression. CONCLUSIONS: We provide the first ex vivo characterization of human intestinal TR1 cells. Selective downregulation of IL-10 by IFN-\u3b3+ TR1 cells in response to proinflammatory cytokines is likely to drive excessive intestinal inflammation in patients with IBDs

The natural history of hereditary neuralgic amyotrophy in the Dutch population.

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