Perceptual watersheds for cell segmentation in fluorescence microscopy images

Ankara : The Department of Computer Engineering and the Graduate School of Engineering and Science of Bilkent University, 2012.Thesis (Master's) -- Bilkent University, 2012.Includes bibliographical refences.High content screening aims to analyze complex biological systems and collect quantitative data via automated microscopy imaging to improve the quality of molecular cellular biology research in means of speed and accuracy. More rapid and accurate high-throughput screening becomes possible with advances in automated microscopy image analysis, for which cell segmentation commonly constitutes the core step. Since the performance of cell segmentation directly a ects the output of the system, it is of great importance to develop e ective segmentation algorithms. Although there exist several promising methods for segmenting monolayer isolated and less con uent cells, it still remains an open problem to segment more con uent cells that grow in aggregates on layers. In order to address this problem, we propose a new marker-controlled watershed algorithm that incorporates human perception into segmentation. This incorporation is in the form of how a human locates a cell by identifying its correct boundaries and piecing these boundaries together to form the cell. For this purpose, our proposed watershed algorithm de nes four di erent types of primitives to represent di erent types of boundaries (left, right, top, and bottom) and constructs an attributed relational graph on these primitives to represent their spatial relations. Then, it reduces the marker identi cation problem to the problem of nding prede ned structural patterns in the constructed graph. Moreover, it makes use of the boundary primitives to guide the ooding process in the watershed algorithm. Working with uorescence microscopy images, our experiments demonstrate that the proposed algorithm results in locating better markers and obtaining better cell boundaries for both less and more con uent cells, compared to previous cell segmentation algorithms.Arslan, SalimM.S

Clinical approach for the classification of congenital uterine malformations

A more objective, accurate and non-invasive estimation of uterine morphology is nowadays feasible based on the use of modern imaging techniques. The validity of the current classification systems in effective categorization of the female genital malformations has been already challenged. A new clinical approach for the classification of uterine anomalies is proposed. Deviation from normal uterine anatomy is the basic characteristic used in analogy to the American Fertility Society classification. The embryological origin of the anomalies is used as a secondary parameter. Uterine anomalies are classified into the following classes: 0, normal uterus; I, dysmorphic uterus; II, septate uterus (absorption defect); III, dysfused uterus (fusion defect); IV, unilateral formed uterus (formation defect); V, aplastic or dysplastic uterus (formation defect); VI, for still unclassified cases. A subdivision of these main classes to further anatomical varieties with clinical significance is also presented. The new proposal has been designed taking into account the experience gained from the use of the currently available classification systems and intending to be as simple as possible, clear enough and accurate as well as open for further development. This proposal could be used as a starting point for a working group of experts in the field

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Connectivity-driven parcellation methods for the human cerebral cortex

The macro connectome elucidates the pathways through which brain regions are structurally connected or functionally coupled to perform cognitive functions. It embodies the notion of representing, analysing, and understanding all connections within the brain as a network, while the subdivision of the brain into interacting cortical units is inherent in its architecture. As a result, the definition of network nodes is one of the most critical steps in connectivity network analysis. Parcellations derived from anatomical brain atlases or random parcellations are traditionally used for node identification, however these approaches do not always fully reflect the functional/structural organisation of the brain. Connectivity-driven methods have arisen only recently, aiming to delineate parcellations that are more faithful to the underlying connectivity. Such parcellation methods face several challenges, including but not limited to poor signal-to-noise ratio, the curse of dimensionality, and functional/structural variations inherent in individual brains, which are only limitedly addressed by the current state of the art. In this thesis, we present robust and fully-automated methods for the subdivision of the entire human cerebral cortex based on connectivity information. Our contributions are four-fold: First, we propose a clustering approach to delineate a cortical parcellation that provides a reliable abstraction of the brain's functional organisation. Second, we cast the parcellation problem as a feature reduction problem and make use of manifold learning and image segmentation techniques to identify cortical regions with distinct structural connectivity patterns. Third, we present a multi-layer graphical model that combines within- and between-subject connectivity, which is then decomposed into a cortical parcellation that can represent the whole population, while accounting for the variability across subjects. Finally, we conduct a large-scale, systematic comparison of existing parcellation methods, with a focus on providing some insight into the reliability of brain parcellations in terms of reflecting the underlying connectivity, as well as, revealing their impact on network analysis. We evaluate the proposed parcellation methods on publicly available data from the Human Connectome Project and a plethora of quantitative and qualitative evaluation techniques investigated in the literature. Experiments across multiple resolutions demonstrate the accuracy of the presented methods at both subject and group levels with regards to reproducibility and fidelity to the data. The neuro-biological interpretation of the proposed parcellations is also investigated by comparing parcel boundaries with well-structured properties of the cerebral cortex. Results show the advantage of connectivity-driven parcellations over traditional approaches in terms of better fitting the underlying connectivity. However, the benefit of using connectivity to parcellate the brain is not always as clear regarding the agreement with other modalities and simple network analysis tasks carried out across healthy subjects. Nonetheless, we believe the proposed methods, along with the systematic evaluation of existing techniques, offer an important contribution to the field of brain parcellation, advancing our understanding of how the human cerebral cortex is organised at the macroscale.Open Acces

Three-dimensional wind-turbine wake characterization via tomographic particle-image velocimetry

Wind turbines are often sited on different topographical features. In the current work, we performed wind-tunnel measurements of the wake behind a single wind turbine sited on two escarpments differing in the windward side shape using tomographic particle-image velocimetry. The escarpments are classified as forward facing step (FFS) and ramp-shape. The turbine sited on the FFS experiences an inflow with high flow shear and turbulence due to flow separation from the escarpment leading edge compared to the one on the ramp-shaped escarpment. As a consequence, the wake characteristics behind the turbine are strongly affected by the shape of the topography. The velocity deficit in the wake of the turbine is relatively higher in the forward facing step shape, but it also shows a faster recovery. The rotation of the wake is stronger for the turbine on the ramp-shaped escarpment, whereas the meandering of the wake is higher for the FFS case. The spatial coherence is observed to be higher in the near wake of the turbine sited on the FFS escarpment, while it is very similar in the far wake for both cases. Instantaneous vortices identified by the Q-criterion show that the development of tip and hub vortices is affected by the topography as well