Automatic prostate and prostate zones segmentation of magnetic resonance images using DenseNet-like U-net

Magnetic resonance imaging (MRI) provides detailed anatomical images of the prostate and its zones. It has a crucial role for many diagnostic applications. Automatic segmentation such as that of the prostate and prostate zones from MR images facilitates many diagnostic and therapeutic applications. However, the lack of a clear prostate boundary, prostate tissue heterogeneity, and the wide interindividual variety of prostate shapes make this a very challenging task. To address this problem, we propose a new neural network to automatically segment the prostate and its zones. We term this algorithm Dense U-net as it is inspired by the two existing state-of-the-art tools—DenseNet and U-net. We trained the algorithm on 141 patient datasets and tested it on 47 patient datasets using axial T2-weighted images in a four-fold cross-validation fashion. The networks were trained and tested on weakly and accurately annotated masks separately to test the hypothesis that the network can learn even when the labels are not accurate. The network successfully detects the prostate region and segments the gland and its zones. Compared with U-net, the second version of our algorithm, Dense-2 U-net, achieved an average Dice score for the whole prostate of 92.1± 0.8% vs. 90.7 ± 2%, for the central zone of 89.5±2% vs. 89.1±2.2 %, and for the peripheral zone of 78.1± 2.5% vs. 75±3%. Our initial results show Dense-2 U-net to be more accurate than state-of-the-art U-net for automatic segmentation of the prostate and prostate zones

Fully automated quantification of in vivo viscoelasticity of prostate zones using magnetic resonance elastography with Dense U-net segmentation

Magnetic resonance elastography (MRE) for measuring viscoelasticity heavily depends on proper tissue segmentation, especially in heterogeneous organs such as the prostate. Using trained network-based image segmentation, we investigated if MRE data suffice to extract anatomical and viscoelastic information for automatic tabulation of zonal mechanical properties of the prostate. Overall, 40 patients with benign prostatic hyperplasia (BPH) or prostate cancer (PCa) were examined with three magnetic resonance imaging (MRI) sequences: T2-weighted MRI (T2w), diffusion-weighted imaging (DWI), and MRE-based tomoelastography yielding six independent sets of imaging data per patient (T2w, DWI, apparent diffusion coefficient (ADC), MRE magnitude, shear wave speed, and loss angle maps). Combinations of these data were used to train Dense U-nets with manually segmented masks of the entire prostate gland (PG), central zone (CZ), and peripheral zone (PZ) in 30 patients and to validate them in 10 patients. Dice score (DS), sensitivity, specificity, and Hausdorff distance were determined. We found that segmentation based on MRE magnitude maps alone (DS, PG: 0.93$\pm$0.04, CZ: 0.95$\pm$0.03, PZ: 0.77$\pm$0.05) was more accurate than magnitude maps combined with T2w and DWI_b (DS, PG: 0.91$\pm$0.04, CZ: 0.91$\pm$0.06, PZ: 0.63$\pm$0.16) or T2w alone (DS, PG: 0.92$\pm$0.03, CZ: 0.91$\pm$0.04, PZ: 0.65$\pm$0.08). Automatically tabulated MRE values were not different from ground-truth values (P>0.05). In conclusion: MRE combined with Dense U-net segmentation allows tabulation of quantitative imaging markers without manual analysis and independent of other MRI sequences and can thus contribute to PCa detection and classification

Clinical quantitative coronary artery stenosis and coronary atherosclerosis imaging: a Consensus Statement from the Quantitative Cardiovascular Imaging Study Group

The detection and characterization of coronary artery stenosis and atherosclerosis using imaging tools are key for clinical decision-making in patients with known or suspected coronary artery disease. In this regard, imaging-based quantification can be improved by choosing the most appropriate imaging modality for diagnosis, treatment and procedural planning. In this Consensus Statement, we provide clinical consensus recommendations on the optimal use of different imaging techniques in various patient populations and describe the advances in imaging technology. Clinical consensus recommendations on the appropriateness of each imaging technique for direct coronary artery visualization were derived through a three-step, real-time Delphi process that took place before, during and after the Second International Quantitative Cardiovascular Imaging Meeting in September 2022. According to the Delphi survey answers, CT is the method of choice to rule out obstructive stenosis in patients with an intermediate pre-test probability of coronary artery disease and enables quantitative assessment of coronary plaque with respect to dimensions, composition, location and related risk of future cardiovascular events, whereas MRI facilitates the visualization of coronary plaque and can be used in experienced centres as a radiation-free, second-line option for non-invasive coronary angiography. PET has the greatest potential for quantifying inflammation in coronary plaque but SPECT currently has a limited role in clinical coronary artery stenosis and atherosclerosis imaging. Invasive coronary angiography is the reference standard for stenosis assessment but cannot characterize coronary plaques. Finally, intravascular ultrasonography and optical coherence tomography are the most important invasive imaging modalities for the identification of plaques at high risk of rupture. The recommendations made in this Consensus Statement will help clinicians to choose the most appropriate imaging modality on the basis of the specific clinical scenario, individual patient characteristics and the availability of each imaging modality

Fluorosis and Oral Health Status in Adolescents Living in a High-Fluoride Groundwater Area: A Case Study of Nairobi Suburbs (Kenya)

Dental fluorosis is an irreversible defect in dental enamel caused by long-term undesired fluoride intake during tooth formation. The clinical manifestations may range from white spots to dark brown areas, which can initially represent only an aesthetic problem, but they can also lead to functional problems-in severe cases, pitting and fractures can occur. The aim of this cross-sectional study in a cluster of 215 Kenyan adolescents was to evaluate oral health status-especially with respect to fluorosis and dental caries risk factors-in the Nairobi suburbs. Clinical data were recorded using DMFT and TF indices in accordance with the WHO standards. A multivariate model with logistic regression was carried out. In total, 36.7% of individuals presented carious lesions. The DMFT index was 0.87 in the total sample. Around 78.6% were affected by mild-to-severe forms of fluorosis. Statistically significant associations were found between the presence of caries and consuming sweets during (OR = 3.9) and between meals (OR = 3.6), consuming soft drinks during (OR = 2.8) and between meals (OR = 4.3), tooth-brushing frequency (OR = 2.8), use of toothbrush and toothpaste (OR = 3.8), presence of bleeding (OR = 10.2), and calculus (OR = 12.1). It is critical to give people sufficient knowledge and to educate the communities to mobilize the implementation of preventive measures, such as reducing fluoride ingestion and paying attention to the dangers of drinking untreated water, in order to develop strategies to ensure equitable access to medical services and promote oral prevention programs to significantly reduce the impact of oral diseases

Determining Risk Factors for the Development of Temporomandibular Disorders during Orthodontic Treatment

Temporomandibular disorders (TMD) represent a complex disease with a multifactorial etiology. Despite several studies on the subject, a causal relationship between orthodontic treatment and different forms of TMD has not been established. The aim of this study was to analyze the effect of orthodontic treatment on two aspects of TMD: myofascial pain and disc displacement. This retrospective cohort study followed 224 orthodontic adult patients at three points in time: before treatment (T0), immediately after treatment (T1), and one year after treatment (T2). Disc displacement and myofascial pain were evaluated through a clinical assessment and with a semi-structured interview, along with headache, neck, and shoulder pain parameters and behavioral and somatic accompanying symptoms. Multivariate logistic regression was used to identify risk factors that could influence the development of TMD in these patients. There was a non-significant increase in disc displacement during orthodontic treatment, which mostly resolved after completion of treatment. Myofascial pain scores worsened during treatment, but improved when compared with the baseline once treatment was complete (T0 = 51.3%, T1 = 64.6%, T2 = 44.9%). Female gender (aOR = 1.9, CI 95%, 1.23–2.36), the presence of somatic symptoms (aOR = 3.6, CI 95%, 2.01–5.84), and symptoms of anxiety or depression (aOR = 2.2, CI 95%, 1.14–4.51) were significant risk factors associated with the development of TMD. There is a low and not significant risk of TMD development during orthodontic treatment. When TMD occurred, they resolved within 1 year of the end of treatment

Probabilistic graphical modelling of early childhood caries development.

In order to develop a statistical model for complex interactions among factors affecting early childhood caries development (ECC), 234 children from the "XXXX oral growth longitudinal study" were analysed at ages 3, 4 and 5. A questionnaire for children's parents (clinical history, nutritional and oral hygiene habits) and clinical oral examinations were recorded each year. The probabilistic dependence structure on the most significant factors was modelled with an Undirected Graphical Model (UGM or Markov random fields) which provides a probabilistic reasoning approach for the establishment of multi-way associations. The best fitting UGM was estimated through the maximum likelihood principle and two-way factor associations were verified through Fisher's exact statistical hypothesis tests for count data. The effect of sugar intake on caries incidence is mediated by oral hygiene; for caries incidence, oral hygiene quality is more relevant than toothbrushing time; the effect of pacifier on caries incidence is statistically significant only when considered in combination with breastfeeding time. Among behavioural ECC risk factors, the quality of oral hygiene, and not the toothbrushing frequency, is a primary factor that modulates the sugar intake in his primary role of the ECC developer. School-based oral health programs for ECC prevention should be improved with supervised toothbrushing program. UGM analysis could improve the school-based oral health programs with more effective and efficient prevention strategies based on the hierarchical interactions among the ECC risk factors. Oral hygiene plays a pivotal role in early childhood caries and can modulate positively or negatively their development. Supervised toothbrushing is a crucial intervention to be included in the daily educational and clinical practice and in the school-based oral health promotion programs. Trial registration: Clinical trial registration number: NCT02798809

Mental Health Disorders and Summer Temperature-Related Mortality: A Case Crossover Study

Identifying the most vulnerable subjects is crucial for the effectiveness of health interventions aimed at limiting the adverse consequences of high temperatures. We conducted a case crossover study aimed at assessing whether suffering from mental health disorders modifies the effect of high temperatures on mortality. We included all deaths occurred in the area of Bologna Local Health Trust during the summers 2004–2017. Subjects with mental disorders were identified by using the local Mental Health Registry. A conditional logistic model was applied, and a z-test was used to study the effect modification. Several models were estimated stratifying by subjects’ characteristics. For every 1 °C above 24 °C, mortality among people without mental disorders increased by 1.9% (95% CI 1.0–2.6, p < 0.0001), while among mental health service users, mortality increased by 5.5% (95% CI 2.4–8.6, p < 0.0001) (z-test equal to p = 0.0259). The effect modification varied according to gender, residency and cause of death. The highest probability of dying due to an increase in temperature was registered in patients with depression and cognitive decline. In order to reduce the effects of high temperatures on mortality, health intervention strategies should include mental health patients among the most vulnerable subjects taking account of their demographic and clinical characteristics

Final-year medical students’ perspective: a survey on the use of computed tomography in sepsis

Abstract Objectives To determine the perspective of final-year medical students on the use of computed tomography (CT) in patients with sepsis. Methods A total of 207 questionnaires were distributed to final-year medical students at a large university medical center, and 113 returned questionnaires met the criteria for inclusion in the analysis. Questions referred to sepsis guidelines, CT indications, and the use of contrast agents. Control variables included a level of practical experience as a final-year student (trimester of student’s practical year) and previous radiological experience. Statistical hypothesis tests such as the Mann-Whitney U test and chi-square test were performed. Results The majority of participating students, 85% (n = 91/107), considered a Systemic Organ Failure Assessment (SOFA) score ≥ 2 as a diagnostic criterion for sepsis. The presence of ≥ 2 positive systemic inflammatory response syndrome (SIRS) criteria was considered relevant for diagnosing sepsis by 34% (n = 34/100). Ninety-nine percent (n = 64/65) of the participants who fully agreed with a SOFA score ≥ 2 being relevant for diagnosing sepsis would also use it as an indication for a CT scan. Seventy-six percent (n = 78/103) of the students rated a known severe allergic reaction to contrast agents as an absolute contraindication for its administration. Ninety-five percent (n = 78/82) considered radiation exposure as problematic in CT examinations, especially in repeat CTs. Conclusion Most final-year medical students were familiar with the sepsis criteria. Still, some referred to outdated diagnostic criteria. Participants saw the ability to plan further patient management based on CT as a major benefit. Most participants were aware of radiation as a risk of CT. Critical relevance statement More detailed knowledge of CT in septic patients should be implemented in the medical curriculum. Retraining of medical students could help increase student confidence potentially improving patient care. Key points 1. Whereas the majority of final-year medical students were familiar with sepsis criteria, some referred to outdated diagnostic criteria. 2. Participants saw the ability to plan further patient management based on CT as a major benefit. 3. Most participants were aware of radiation as a risk of CT. Graphical Abstrac

Screening patterns within organized programs of Italian women with invasive cervical cancer

Background: The efficacy of organized cervical screening programs (OCSPs) in reducing, through the Pap-smear test, the burden of invasive cervical cancer (ICC) is well established. Opportunistic screening is widespread in Italy, while OCSP implementation is demanded to regional governments. In some regions, OCSPs have been implemented since the \u201890s whereas in others OSCPs do not cover the entire population yet. Objective: To describe screening patterns of women diagnosed with ICC, and to identify difficulties and limitations of OCSPs at a population level in Italy. Methods: OCSPs invite women aged 25-64 years to perform a free of charge Pap smear every 3 years. This study focused on 3268 women aged 25-65 years, diagnosed with ICC between 1995 and 2008, who lived in areas covered by population-based cancer registries (CRs) with active OCSPs. CRs and OCSPs databases were linked to classify each woman according to OCSP invitation, compliance with invitation, and Pap-smear results. Odds ratios (OR- adjusted for age at diagnosis) and 95% confidence intervals (CI) were computed using logistic regression models to assess the association between women characteristics, screening patterns, and ICC features. Among 2911 women (out of 3268) with updated vital status, hazard ratios (HR- adjusted for age and tumor stage) and 95% CI were computed using the Cox model to assess the impact of screening patterns on death risk. Results: Out of 3268 women with ICC, 657 (20.1%) were never invited for screening. Non invitation by OCSPs was inversely related with time elapsed between program activation and ICC diagnosis (OR=4.6, 95% CI: 3.7-5.9, for \uf0a33 years vs \uf0b36 years). Of the 2611 women with ICC invited by OCSPs, 1181 (45.2%) were non compliant. Non compliance was highest in southern Italy (80.6% vs 45.2% in the North -OR=4.9), and it significantly increased with ageing. 66.8% of women with advanced ICC stage at diagnosis (FIGO III-IV) were non compliant, as compared to 25.6% of those with micro-invasive stage (IA-IA1, OR=5.7). Among the 1430 compliant women, ICC was screen-detected by OCSPs in 1075 cases (75.2%) -in 794 cases at first Pap-smear and in 281 cases at a subsequent tests. Conversely, in 355 cases (24.8%) ICC was non screen-detected -all Pap-smears made within OCSPs were negative. As compared to compliant women with screen-detected ICC, the risk of death was significantly higher in never compliant women (HR=2.0; 95%CI: 1.6-2.5), in never invited ones (HR=1.8; 95% CI 1.4-2.3), and in women with non screen-detected ICC (HR=1.7, 95%CI: 1.2-2.2). Conclusions: In Italy, about 56% of ICC cases diagnosed between 1995 and 2008 occurred in women from target populations for OCSPs who were never invited for screening, or who were non compliant. Factors associated with lack of invitation and with non-adherence to OCSPs deserve attention in view of the associated high risks of death. Screening history outside OCSPs should also be considered to fully evaluate non screen-detected ICC cases