Intima-Media Thickness and Pulsatility Index of Common Carotid Arteries in Acute Ischaemic Stroke Patients with Diabetes Mellitus.

Ultrasonographic parameters such as the common carotid artery (CCA) pulsatility index (PI) and CCA intima-media thickness (IMT) have been associated with an increased mortality and risk of recurrent stroke, respectively. We hypothesized that these ultrasonographic parameters may be useful for monitoring diabetic patients after an acute stroke. We analysed retrospective data of consecutive acute ischaemic stroke patients from the ASTRAL registry who underwent pre-cerebral ultrasonographic evaluation within 7 days of symptom onset. We compared clinical, demographic, radiological and ultrasonographic parameters in diabetic versus non-diabetic patients (univariable and multivariable analyses) and the association of these parameters with CCA PI and CCA IMT. We analysed 1507 carotid duplex ultrasound examinations from patients with a median age of 74 years. Cardiovascular co-morbidities, including hypertension, hypercholesterolemia, obstructive sleep apnoea syndrome, higher body-mass index (BMI) and peripheral artery disease, were associated with diabetes mellitus (DM). Diabetics were more often under antiplatelet therapy and had atrial fibrillation at admission. Diabetic patients showed an increased CCA PI and IMT in line with more atherosclerotic changes on acute CTA compared to non-diabetic patients. Taking IMT as the dependent variable in a second analysis, DM, higher age, hypertension, smoking and CCA PI were associated with higher IMT. Taking CCA PI as the dependent variable in a third analysis, DM, higher age and higher NIHSS at admission were associated with higher CCA PI values. Increased IMT was also associated with higher PI. We show that CCA PI and IMT are higher in diabetic patients in the first week after an initial stroke

Supervised learning based multimodal MRI brain tumour segmentation using texture features from supervoxels

BACKGROUND: Accurate segmentation of brain tumour in magnetic resonance images (MRI) is a difficult task due to various tumour types. Using information and features from multimodal MRI including structural MRI and isotropic (p) and anisotropic (q) components derived from the diffusion tensor imaging (DTI) may result in a more accurate analysis of brain images. METHODS: We propose a novel 3D supervoxel based learning method for segmentation of tumour in multimodal MRI brain images (conventional MRI and DTI). Supervoxels are generated using the information across the multimodal MRI dataset. For each supervoxel, a variety of features including histograms of texton descriptor, calculated using a set of Gabor filters with different sizes and orientations, and first order intensity statistical features are extracted. Those features are fed into a random forests (RF) classifier to classify each supervoxel into tumour core, oedema or healthy brain tissue. RESULTS: The method is evaluated on two datasets: 1) Our clinical dataset: 11 multimodal images of patients and 2) BRATS 2013 clinical dataset: 30 multimodal images. For our clinical dataset, the average detection sensitivity of tumour (including tumour core and oedema) using multimodal MRI is 86% with balanced error rate (BER) 7%; while the Dice score for automatic tumour segmentation against ground truth is 0.84. The corresponding results of the BRATS 2013 dataset are 96%, 2% and 0.89, respectively. CONCLUSION: The method demonstrates promising results in the segmentation of brain tumour. Adding features from multimodal MRI images can largely increase the segmentation accuracy. The method provides a close match to expert delineation across all tumour grades, leading to a faster and more reproducible method of brain tumour detection and delineation to aid patient management

Effect of thermomechanical processing defects on fatigue and fracture behaviour of forged magnesium

The microstructural origins of premature fatigue failures were investigated on a variety of forged components manufactured from AZ80 and ZK60 magnesium, both at the test specimen level and the full-scale component level. Both stress and strain-controlled approaches were used to characterize the macroscopically defect-free forged material behaviour as well as with varying levels of defect intensities. The effect of thermomechanical processing defects due to forging of a industrially relevant full-scale component were characterized and quantified using a variety of techniques. The fracture initiation and early crack growth behaviour was deterministically traced back to a combination of various effects having both geometric and microstructural origins, including poor fusion during forging, entrainment of contaminants sub-surface, as well as other inhomogeneities in the thermomechanical processing history.             At the test specimen level, the fracture behaviour under both stress and strain controlled uniaxial loading was characterized for forged AZ80 Mg and a structure-property relationship was developed. The fracture surface morphology was quantitatively assessed revealing key features which characterize the presence and severity of intrinsic forging defects.  A significant degradation in fatigue performance was observed as a result of forging defects accelerating fracture initiation and early crack growth, up to 6 times reduction in life (relative to the defect free material) under constant amplitude fully reversed fatigue loading.             At the full-scale component level, the fatigue and fracture behaviour under combined structural loading was also characterized for a number of ZK60 forged components with varying levels of intrinsic thermomechanical processing defects. A novel in-situ non-contact approach (utilizing Digital-Image Correlation) was used as a screening test to establish the presence of these intrinsic defects and reliably predict their effect on the final fracture behaviour in an accelerated manner compared to conventional methods

VEGFR1 signaling in retinal angiogenesis and microinflammation

Five vascular endothelial growth factor receptor (VEGFR) ligands (VEGF-A, -B, –C, -D, and placental growth factor [PlGF]) constitute the VEGF family. VEGF-A binds to VEGF receptors 1 and 2 (VEGFR1/2), whereas VEGF-B and PlGF only bind VEGFR1. Although much research has been conducted on VEGFR2 to elucidate its key role in retinal diseases, recent efforts have shown the importance and involvement of VEGFR1 and its family of ligands in angiogenesis, vascular permeability, and microinflammatory cascades within the retina. Expression of VEGFR1 depends on the microenvironment, is differentially regulated under hypoxic and inflammatory conditions, and it has been detected in retinal and choroidal endothelial cells, pericytes, retinal and choroidal mononuclear phagocytes (including microglia), Müller cells, photoreceptor cells, and the retinal pigment epithelium. Whilst the VEGF-A decoy function of VEGFR1 is well established, consequences of its direct signaling are less clear. VEGFR1 activation can affect vascular permeability and induce macrophage and microglia production of proinflammatory and proangiogenic mediators. However the ability of the VEGFR1 ligands (VEGF-A, PlGF, and VEGF-B) to compete against each other for receptor binding and to heterodimerize complicates our understanding of the relative contribution of VEGFR1 signaling alone toward the pathologic processes seen in diabetic retinopathy, retinal vascular occlusions, retinopathy of prematurity, and age-related macular degeneration. Clinically, anti-VEGF drugs have proven transformational in these pathologies and their impact on modulation of VEGFR1 signaling is still an opportunity-rich field for further research

Areas of normal pulmonary parenchyma on HRCT exhibit increased FDG PET signal in IPF patients

Purpose: Patients with idiopathic pulmonary fibrosis (IPF) show increased PET signal at sites of morphological abnormality on high-resolution computed tomography (HRCT). The purpose of this investigation was to investigate the PET signal at sites of normal-appearing lung on HRCT in IPF. Methods: Consecutive IPF patients (22 men, 3 women) were prospectively recruited. The patients underwent 18F-FDG PET/HRCT. The pulmonary imaging findings in the IPF patients were compared to the findings in a control population. Pulmonary uptake of 18F-FDG (mean SUV) was quantified at sites of morphologically normal parenchyma on HRCT. SUVs were also corrected for tissue fraction (TF). The mean SUV in IPF patients was compared with that in 25 controls (patients with lymphoma in remission or suspected paraneoplastic syndrome with normal PET/CT appearances). Results: The pulmonary SUV (mean ± SD) uncorrected for TF in the controls was 0.48 ± 0.14 and 0.78 ± 0.24 taken from normal lung regions in IPF patients (p < 0.001). The TF-corrected mean SUV in the controls was 2.24 ± 0.29 and 3.24 ± 0.84 in IPF patients (p < 0.001). Conclusion: IPF patients have increased pulmonary uptake of 18F-FDG on PET in areas of lung with a normal morphological appearance on HRCT. This may have implications for determining disease mechanisms and treatment monitoring. © 2013 The Author(s)

Challenges of rapid migration to fully virtual education in the age of the Corona virus pandemic: experiences from across the world

The social disruption caused by the sudden eruption of the Corona Virus pandemic has shaken the whole world, influencing all levels of education immensely. Notwithstanding there was a lack of preparedness for this global public health emergency which continues to affect all aspects of work and life. The problem is, naturally, multifaceted, fast evolving and complex, affecting everyone, threatening our well-being, the global economy, the environment and all societal and cultural norms and our everyday activities. In a recent UNESCO report it is noted that nearly a billion and a quarter (which is 67,7 % of the total number) of learners have been affected by the Corona Virus pandemic worldwide. The education sector at all levels has been one of the hardest hit sectors particularly as the academic/school year was in full swing. The impact of the pandemic is widespread, representing a health hazard worldwide. Being such, it profoundly affects society as a whole, and its members that are, in particular, i) individuals (the learners, their parents, educators, support staff), ii) schools, training organisations, pedagogical institutions and education systems, iii) quickly transformed policies, methods and pedagogies to serve the newly appeared needs of the latter. Lengthy developments of such scale usually take years of consultation, strategic planning and implementation. In addition to raising awareness across the population of the dangers of the virus transmission and instigating total lockdown, it has been necessary to develop mechanisms for continuing the delivery of education as well as demanding mechanisms for assuring the quality of the educational experience and educational results. There is often scepticism about securing quality standards in such a fast moving situation. Often in the recent past, the perception was that courses and degrees leading to an award are inferior if the course modules (and sometimes its assessment components) were wholly online. Over the last three decades most Higher Education institutions developed both considerable infrastructure and knowhow enabling distance mode delivery schools (Primary and Secondary) had hardly any necessary infrastructure nor adequate knowhow for enabling virtual education. In addition, community education and various training providers were mainly delivered face-to-face and that had to either stop altogether or rapidly convert materials, exercises and tests for online delivery and testing. A high degree of flexibility and commitment was demanded of all involved and particularly from the educators, who undertook to produce new educational materials in order to provide online support to pupils and students. Apart from the delivery mode of education, which is serving for certificated programmes, it is essential to ensure that learners’ needs are thoroughly and continuously addressed and are efficiently supported throughout the Coronavirus or any other future lockdown. The latter can be originated by various causes and reasons that vary in nature, such as natural or socioeconomical. Readiness, thus, in addition to preparedness, is the primary key question and solution when it comes to quality education for any lockdown. In most countries, the compulsory primary and secondary education sectors have been facing a more difficult challenge than that faced by Higher Education. The poor or in many cases non-existent technological infrastructure and low technological expertise of the teachers, instructors and parents, make the delivery of virtual education difficult or even impossible. The latter, coupled with phenomena such as social exclusion and digital divide where thousands of households do not have adequate access to broadband Internet, Wi-Fi infrastructure and personal computers hamper the promising and strenuous virtual solutions. The shockwaves of the sudden demands on all sectors of society and on individuals required rapid decisions and actions. We will not attempt to answer the question “Why was the world unprepared for the onslaught of the Coronavirus pandemic” but need to ascertain the level of preparedness and readiness particularly of the education sector, to effect the required rapid transition. We aimed to identify the challenges, and problems faced by the educators and their institutions. Through first-hand experiences we also identify best practices and solutions reached. Thus we constructed a questionnaire to gather our own responses but also experiences from colleagues and members of our environment, family, friends, and colleagues. This paper reports the first-hand experiences and knowledge of 33 co-authors from 27 institutions and from 13 different countries from Europe, Asia, and Africa. The communication technologies and development platforms used are identified; the challenges faced as well as solutions and best practices are reported. The findings are consolidated into the four areas explored i.e. Development Platforms, Communications Technologies, Challenges/Problems and Solutions/Best Practices. The conclusion summarises the findings into emerging themes and similarities. Reflections on the lasting impact of the effect of Coronavirus on education, limitations of study, and indications of future work complete the paper