Diagnosis of focal liver lesions from ultrasound using deep learning

PURPOSE: The purpose of this study was to create an algorithm that simultaneously detects and characterizes (benign vs. malignant) focal liver lesion (FLL) using deep learning. MATERIALS AND METHODS: We trained our algorithm on a dataset proposed during a data challenge organized at the 2018 Journées Francophones de Radiologie. The dataset was composed of 367 two-dimensional ultrasound images from 367 individual livers, captured at various institutions. The algorithm was guided using an attention mechanism with annotations made by a radiologist. The algorithm was then tested on a new data set from 177 patients. RESULTS: The models reached mean ROC-AUC scores of 0.935 for FLL detection and 0.916 for FLL characterization over three shuffled three-fold cross-validations performed with the training data. On the new dataset of 177 patients, our models reached a weighted mean ROC-AUC scores of 0.891 for seven different tasks. CONCLUSION: This study that uses a supervised-attention mechanism focused on FLL detection and characterization from liver ultrasound images. This method could prove to be highly relevant for medical imaging once validated on a larger independent cohort

First principles fluid modelling of magnetic island stabilization by ECCD

International audienceTearing modes are MHD instabilities that reduce the performances of fusion devices. They can however be controlled and suppressed using Electron Cyclotron Current Drive (ECCD) as demonstrated in various tokamaks. In this work, simulations of islands stabilization by ECCD-driven current have been carried out using the toroidal nonlinear 3D full MHD code XTOR-2F, in which a current-source term modeling the ECCD has been implemented. The efficiency parameter is computed and its variations with respect to source width and location are computed. The influence of parameters such as current intensity, source width and position with respect to the island is evaluated and compared to the Modified Rutherford Equation. We retrieve a good agreement between the simulations and the analytical predictions concerning the variations of control efficiency with source width and position. We also show that the 3D nature of the current source term can lead to the onset of an island if the source term is precisely applied on a rational surface. We report the observation of a flip phenomenon in which the O-and X-Points of the island rapidly switch their position in order for the island to take advantage of the current drive to grow

On Symmetries of Extremal Black Holes with One and Two Centers

After a brief introduction to the Attractor Mechanism, we review the appearance of groups of type E7 as generalized electric-magnetic duality symmetries in locally supersymmetric theories of gravity, with particular emphasis on the symplectic structure of fluxes in the background of extremal black hole solutions, with one or two centers. In the latter case, the role of an "horizontal" symmetry SL(2,R) is elucidated by presenting a set of two-centered relations governing the structure of two-centered invariant polynomials.Comment: 1+13 pages, 2 Tables. Based on Lectures given by SF and AM at the School "Black Objects in Supergravity" (BOSS 2011), INFN - LNF, Rome, Italy, May 9-13 201

Bioinspired hybrid eumelanin-TiO2 antimicrobial nanostructures: the key role of organo-inorganic frameworks in tuning eumelanin's biocide action mechanism through membrane interaction

Intrinsic biocide efficacy of eumelanins can be markedly enhanced through a templated formation in the presence of a TiO2-sol, leading to hybrid TiO2-melanin nanostructures. However, mechanisms and processes behind biocide activity still remain poorly understood. This paper discloses the fundamental mechanism of action of these systems providing mechanistic information on their peculiar interaction with Escherichia coli strains. To this purpose biocide characterization is combined with Electron Paramagnetic Resonance (EPR) spectroscopy to investigate radical species produced by the hybrids as well as their interactions with Gram(-) external bacterial membranes. Experimental results indicate that TiO2 mediated eumelanin polymerization leads to a peculiar mechanism of action of hybrid nanostructures, whose strong interactions with bacterial membranes enhance the action of reactive oxygen species (ROS) produced by eumelanin degradation itself, also concurring with the final biocide action. These findings provide strategic information for the development of eumelanin-based systems with enhanced activity against drug-resistant strains

Gravitational theory without the cosmological constant problem, symmetries of space-filling branes and higher dimensions

We showed that the principle of nongravitating vacuum energy, when formulated in the first order formalism, solves the cosmological constant problem. The most appealing formulation of the theory displays a local symmetry associated with the arbitrariness of the measure of integration. This can be motivated by thinking of this theory as a direct coupling of physical degrees of freedom with a "space - filling brane" and in this case such local symmetry is related to space-filling brane gauge invariance. The model is formulated in the first order formalism using the metric and the connection as independent dynamical variables. An additional symmetry (Einstein - Kaufman symmetry) allows to eliminate the torsion which appears due to the introduction of the new measure of integration. The most successful model that implements these ideas is realized in a six or higher dimensional space-time. The compactification of extra dimensions into a sphere gives the possibility of generating scalar masses and potentials, gauge fields and fermionic masses. It turns out that remaining four dimensional space-time must have effective zero cosmological constant.Comment: 26 page

Predictors of mortality following emergency open colectomy for ischemic colitis: A single-center experience

Background: Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. Additionally, we compared postoperative outcomes of patients undergoing emergent colectomy due to aortic surgery-related IC (AS-IC group) vs. other IC etiologies (Other-IC group). Methods: We analyzed records of consecutive patients who underwent emergency open colectomy for IC between 2008 and 2019. Logistic regression analysis was performed to identify clinical and operative parameters associated with postoperative mortality. The AS-IC and Other-IC groups were compared for mortality, morbidity, ICU stay, hospital stay, and survival. Results: During the study period, 94 patients (mean age, 67.4 ± 13.7 years) underwent emergent open colectomy for IC. In the majority of cases, IC involved the entire colon (53.2%) and vasopressor agents were required preoperatively (63.8%) and/or intraoperatively (78.8%). Thirty-four patients underwent surgery due to AS-IC, whereas 60 due to Other-IC causes. In the AS-IC group, 9 patients had undergone endovascular aortic repair and 25 open aortic surgery; 61.8% of patients needed aortic surgery for ruptured abdominal aortic aneurism (AAA). Overall, 66 patients (70.2%) died within 90 days from surgery. The AS-IC and Other-IC groups showed similar operative outcomes and postoperative complication rates. However, the duration of the ICU stay (19 days vs. 11 days; p = 0.003) and of the total hospital stay (22 days vs. 16 days; p = 0.016) was significantly longer for the AS-IC group than for the Other-IC group. The rate of intestinal continuity restoration at 1 year after surgery was higher for the Other-IC group than for the AS-IC group (58.8% vs. 22.2%; p = 0.05). In the multivariate model, preoperative increased lactate levels, a delay between signs/symptoms' onset and surgery > 12 h, and the occurrence of postoperative acute kidney injury were statistically associated with postoperative mortality. Neither IC etiology (aortic surgery vs. other etiology) nor ruptured AAA was associated with postoperative mortality. Conclusion: Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, > 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality

Synergetic effects of collisions, turbulence and sawtooth crashes on impurity transport

This paper investigates the interplay of neoclassical, turbulent and MHD processes, which are simultaneously at play when contributing to impurity transport. It is shown that these contributions are not additive, as assumed sometimes. The interaction between turbulence and neoclassical effects leads to less effective thermal screening, i.e. lowers the outward flux due to temperature gradient. This behavior is attributed to poloidal asymmetries of the flow driven by turbulence. Moreover sawtooth crashes play an important role to determine fluxes across the q = 1 surface. It is found that the density profile of a heavy impurity differs significantly in sawtoothing plasmas from the one predicted by neoclassical theory when neglecting MHD events. Sawtooth crashes impede impurity accumulation, but also weaken the impurity outflux due to the temperature gradient when the latter is dominant

Safety of dabigatran etexilate for the secondary prevention of venous thromboembolism in children

This open-label, single-arm, prospective cohort trial is the first phase 3 safety study to describe outcomes in children treated with dabigatran etexilate for secondary venous thromboembolism (VTE) prevention. Eligible children aged 12 to <18 years (age stratum 1), 2 to <12 years (stratum 2), and >3 months to <2 years (stratum 3) had an objectively confirmed diagnosis of VTE treated with standard of care (SOC) for ‡3 months, or had completed dabigatran or SOC treatment in the DIVERSITY trial (NCT01895777) and had an unresolved clinical thrombosis risk factor requiring further anticoagulation. Children received dabigatran for up to 12 months, or less if the identified VTE clinical risk factor resolved. Primary end points included VTE recurrence, bleeding events, and mortality at 6 and 12 months. Overall, 203 children received dabigatran, with median exposure being 36.3 weeks (range, 0-57 weeks); 171 of 203 (84.2%) and 32 of 203 (15.8%) took capsules and pellets, respectively. Overall, 2 of 203 children (1.0%) experienced on-treatment VTE recurrence, and 3 of 203 (1.5%) experienced major bleeding events, with 2 (1.0%) reporting clinically relevant nonmajor bleeding events, and 37 (18.2%) minor bleeding events. There were no on-treatment deaths. On-treatment postthrombotic syndrome was reported for 2 of 162 children (1.2%) who had deep vein thrombosis or central-line thrombosis as their most recent VTE. Pharmacokinetic/pharmacodynamic relationships of dabigatran were similar to those in adult VTE patients. In summary, dabigatran showed a favorable safety profile for secondary VTE prevention in children aged from >3 months to <18 years with persistent VTE risk factor(s). This trial was registered at www.clinicaltrials.gov as #NCT02197416. (Blood. 2020;135(7):491-504