Multi-scale attention network for diabetic retinopathy classification

Diabetic Retinopathy (DR) is a highly prevalent complication of diabetes mellitus, which causes lesions on the retina that affect vision which may lead to blindness if it is not detected and diagnosed early. Convolutional neural networks (CNN) are becoming the state-of-the-art approach for automatic detection of DR by using fundus images. The high-level features extracted by CNN are mostly utilised for the detection and classification of lesions on the retina. This high-level representation is capable of classifying different DR classes; however, more effective features for detecting the damages are needed. This paper proposes the multi-scale attention network (MSA-Net) for DR classification. The proposed approach applies the encoder network to embed the retina image in a high-level representational space, where the combination of mid and high-level features is used to enrich the representation. Then a multi-scale feature pyramid is included to describe the retinal structure in a different locality. Furthermore, to enhance the discriminative power of the feature representation a multi-scale attention mechanism is used on top of the high-level representation. The model is trained in a standard way using the cross-entropy loss to classify the DR severity level. In parallel as an auxiliary task, the model is trained using the weakly annotated data to detect healthy and non-healthy retina images. This surrogate task helps the model to enrich its discriminative power for distinguishing the non-healthy retina images. The proposed method when implemented has achieved outstanding results on two public datasets: EyePACS and APTOS

TransNorm: Transformer Provides a Strong Spatial Normalization Mechanism for a Deep Segmentation Model

In the past few years, convolutional neural networks (CNNs), particularly U-Net, have been the prevailing technique in the medical image processing era. Specifically, the U-Net model, as well as its alternatives, have successfully managed to address a wide variety of medical image segmentation tasks. However, these architectures are intrinsically imperfect as they fail to exhibit long-range interactions and spatial dependencies leading to a severe performance drop in the segmentation of medical images with variable shapes and structures. Transformers, preliminary proposed for sequence-to-sequence prediction, have arisen as surrogate architectures to precisely model global information assisted by the self-attention mechanism. Despite being feasibly designed, utilizing a pure Transformer for image segmentation purposes can result in limited localization capacity stemming from inadequate low-level features. Thus, a line of research strives to design robust variants of Transformer-based U-Net. In this paper, we propose Trans-Norm, a novel deep segmentation framework which concomitantly consolidates a Transformer module into both encoder and skip-connections of the standard U-Net. We argue that the expedient design of skip-connections can be crucial for accurate segmentation as it can assist feature fusion between the expanding and contracting paths. In this respect, we derive a Spatial Normalization mechanism from the Transformer module to adaptively recalibrate the skip connection path. Extensive experiments across three typical tasks for medical image segmentation demonstrate the effectiveness of TransNorm. The codes and trained models are publicly available at github

Deep Learning Prediction of Response to Anti-VEGF among Diabetic Macular Edema Patients: Treatment Response Analyzer System (TRAS)

Diabetic macular edema (DME) is the most common cause of visual impairment among patients with diabetes mellitus. Anti-vascular endothelial growth factors (Anti-VEGFs) are considered the first line in its management. The aim of this research has been to develop a deep learning (DL) model for predicting response to intravitreal anti-VEGF injections among DME patients. The research included treatment naive DME patients who were treated with anti-VEGF. Patient’s pre-treatment and post-treatment clinical and macular optical coherence tomography (OCT) were assessed by retina specialists, who annotated pre-treatment images for five prognostic features. Patients were also classified based on their response to treatment in their post-treatment OCT into either good responder, defined as a reduction of thickness by >25% or 50 µm by 3 months, or poor responder. A novel modified U-net DL model for image segmentation, and another DL EfficientNet-B3 model for response classification were developed and implemented for predicting response to anti-VEGF injections among patients with DME. Finally, the classification DL model was compared with different levels of ophthalmology residents and specialists regarding response classification accuracy. The segmentation deep learning model resulted in segmentation accuracy of 95.9%, with a specificity of 98.9%, and a sensitivity of 87.9%. The classification accuracy of classifying patients’ images into good and poor responders reached 75%. Upon comparing the model’s performance with practicing ophthalmology residents, ophthalmologists and retina specialists, the model’s accuracy is comparable to ophthalmologist’s accuracy. The developed DL models can segment and predict response to anti-VEGF treatment among DME patients with comparable accuracy to general ophthalmologists. Further training on a larger dataset is nonetheless needed to yield more accurate response predictions

Intra-articular injection of expanded autologous bone marrow mesenchymal cells in moderate and severe knee osteoarthritis is safe: a phase I/II study

Abstract Background Knee osteoarthritis (KOA) is a major health problem especially in the aging population. There is a need for safe treatment that restores the cartilage and reduces the symptoms. The use of stem cells is emerging as a possible option for the moderate and severe cases. This study aimed at testing the safety of autologous bone marrow mesenchymal stem cells (BM-MSCs) expanded in vitro when given intra-articularly to patients with stage II and III KOA. As a secondary end point, the study tested the ability of these cells to relieve symptoms and restore the knee cartilage in these patients as judged by normalized knee injury and Osteoarthritis Outcome Score (KOOS) and by magnetic resonance imaging (MRI). Methods Thirteen patients with a mean age of 50 years suffering from KOA stages II and III were given two doses of BM-MSCs 1 month apart totaling 61 × 106 ± 0.6 × 106 by intra-articular injection in a phase I prospective clinical trial. Each patient was followed for a minimum of 24 months for any adverse events and for clinical outcome using normalized KOOS. Cartilage thickness was assessed by quantitative MRI T2 at 12 months of follow-up. Results No severe adverse events were reported up to 24 months follow-up. Normalized KOOS improved significantly. Mean knee cartilage thickness measured by MRI improved significantly. Conclusion BM-MSCs given intra-articularly are safe in knee osteoarthrosis. Despite the limited number of patients in this study, the procedure described significantly improved the KOOS and knee cartilage thickness, indicating that they may enhance the functional outcome as well as the structural component. Trial registration ClinicalTrials.gov, NCT0211851