FUSegNet: A Deep Convolutional Neural Network for Foot Ulcer Segmentation

This paper presents FUSegNet, a new model for foot ulcer segmentation in diabetes patients, which uses the pre-trained EfficientNet-b7 as a backbone to address the issue of limited training samples. A modified spatial and channel squeeze-and-excitation (scSE) module called parallel scSE or P-scSE is proposed that combines additive and max-out scSE. A new arrangement is introduced for the module by fusing it in the middle of each decoder stage. As the top decoder stage carries a limited number of feature maps, max-out scSE is bypassed there to form a shorted P-scSE. A set of augmentations, comprising geometric, morphological, and intensity-based augmentations, is applied before feeding the data into the network. The proposed model is first evaluated on a publicly available chronic wound dataset where it achieves a data-based dice score of 92.70%, which is the highest score among the reported approaches. The model outperforms other scSE-based UNet models in terms of Pratt's figure of merits (PFOM) scores in most categories, which evaluates the accuracy of edge localization. The model is then tested in the MICCAI 2021 FUSeg challenge, where a variation of FUSegNet called x-FUSegNet is submitted. The x-FUSegNet model, which takes the average of outputs obtained by FUSegNet using 5-fold cross-validation, achieves a dice score of 89.23%, placing it at the top of the FUSeg Challenge leaderboard. The source code for the model is available on https://github.com/mrinal054/FUSegNet

Integrated Image and Location Analysis for Wound Classification: A Deep Learning Approach

The global burden of acute and chronic wounds presents a compelling case for enhancing wound classification methods, a vital step in diagnosing and determining optimal treatments. Recognizing this need, we introduce an innovative multi-modal network based on a deep convolutional neural network for categorizing wounds into four categories: diabetic, pressure, surgical, and venous ulcers. Our multi-modal network uses wound images and their corresponding body locations for more precise classification. A unique aspect of our methodology is incorporating a body map system that facilitates accurate wound location tagging, improving upon traditional wound image classification techniques. A distinctive feature of our approach is the integration of models such as VGG16, ResNet152, and EfficientNet within a novel architecture. This architecture includes elements like spatial and channel-wise Squeeze-and-Excitation modules, Axial Attention, and an Adaptive Gated Multi-Layer Perceptron, providing a robust foundation for classification. Our multi-modal network was trained and evaluated on two distinct datasets comprising relevant images and corresponding location information. Notably, our proposed network outperformed traditional methods, reaching an accuracy range of 74.79% to 100% for Region of Interest (ROI) without location classifications, 73.98% to 100% for ROI with location classifications, and 78.10% to 100% for whole image classifications. This marks a significant enhancement over previously reported performance metrics in the literature. Our results indicate the potential of our multi-modal network as an effective decision-support tool for wound image classification, paving the way for its application in various clinical contexts

Risk Prediction for Clonal Cytopenia: Multicenter Real-World Evidence.

Clonal cytopenia of undetermined significance (CCUS) represents a distinct disease entity characterized by myeloid-related somatic mutations with a variant allele fraction of ≥2% in individuals with unexplained cytopenia(s) but without a myeloid neoplasm (MN). Notably, CCUS carries a risk of progressing to MN, particularly in cases featuring high-risk mutations. Understanding CCUS requires dedicated studies to elucidate its risk factors and natural history. Our analysis of 357 CCUS patients investigated the interplay between clonality, cytopenia, and prognosis. Multivariate analysis identified 3 key adverse prognostic factors: the presence of splicing mutation(s) (score = 2 points), platelet count <100×109/L (score = 2.5), and ≥2 mutations (score = 3). Variable scores were based on the coefficients from the Cox proportional hazards model. This led to the development of the Clonal Cytopenia Risk Score (CCRS), which stratified patients into low- (score <2.5 points), intermediate- (score 2.5-<5), and high-risk (score ≥5) groups. The CCRS effectively predicted 2-year cumulative incidence of MN for low- (6.4%), intermediate- (14.1%), and high- (37.2%) risk groups, respectively, by Gray's test (P <.0001). We further validated the CCRS by applying it to an independent CCUS cohort of 104 patients, demonstrating a c-index of 0.64 (P =.005) in stratifying the cumulative incidence of MN. Our study underscores the importance of integrating clinical and molecular data to assess the risk of CCUS progression, making the CCRS a valuable tool that is practical and easily calculable. These findings are clinically relevant, shaping the management strategies for CCUS and informing future clinical trial designs

Allogeneic Hematopoietic Cell Transplantation for Blastic Plasmacytoid Dendritic Cell Neoplasm: A CIBMTR Analysis

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy with a poor prognosis and considered incurable with conventional chemotherapy. Small observational studies reported allogeneic hematopoietic cell transplantation (allo-HCT) offers durable remissions in patients with BPDCN. We report an analysis of patients with BPDCN who received an allo-HCT, using data reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). We identified 164 patients with BPDCN from 78 centers who underwent allo-HCT between 2007 and 2018. The 5-year overall survival (OS), disease-free survival (DFS), relapse, and nonrelapse mortality (NRM) rates were 51.2% (95% confidence interval [CI], 42.5-59.8), 44.4% (95% CI, 36.2-52.8), 32.2% (95% CI, 24.7-40.3), and 23.3% (95% CI, 16.9-30.4), respectively. Disease relapse was the most common cause of death. On multivariate analyses, age of ≥60 years was predictive for inferior OS (hazard ratio [HR], 2.16; 95% CI, 1.35-3.46; P = .001), and higher NRM (HR, 2.19; 95% CI, 1.13-4.22; P = .02). Remission status at time of allo-HCT (CR2/primary induction failure/relapse vs CR1) was predictive of inferior OS (HR, 1.87; 95% CI, 1.14-3.06; P = .01) and DFS (HR, 1.75; 95% CI, 1.11-2.76; P = .02). Use of myeloablative conditioning with total body irradiation (MAC-TBI) was predictive of improved DFS and reduced relapse risk. Allo-HCT is effective in providing durable remissions and long-term survival in BPDCN. Younger age and allo-HCT in CR1 predicted for improved survival, whereas MAC-TBI predicted for less relapse and improved DFS. Novel strategies incorporating allo-HCT are needed to further improve outcomes

Evaluation of Vitamin D Levels In Pregnancy Induced Hypertension

Background:Pregnancy hypertension increases maternal and foetal morbidity and mortality. Vitamin D deficiency has been identified as a causative factor for hypertension, in addition to other risk factors.Aim:To evaluate the level of serum vitamin D in pregnancy induced hypertension and also to compare with normotensive pregnant women.Material And Methods:This prospective comparative study was conducted in the Department of biochemistry, govt. medical college Kathua India from August 2019 to December 2019. The levels of serum vitamin D were evaluated in fifty pregnant women with hypertension and were compared with equal number of normotensive pregnant women. Pearson's correlation was used to examine the relationship between vitamin D deficiency and hypertension. Comparisons between groups were performed using Student’s t test for continuous variables and the chi-square test for categorical variables. Statistical significance was taken <0.05.Results: The prevalence of vitamin D deficiency in hypertensive pregnant women was 90% and in normotensive was 82%. Mean vitamin D levels in hypertensive pregnant females were significantly lower than those of normotensive pregnant females. A significant negative correlation was seen between systolic and diastolic blood pressure and vitamin D levels in hypertensive pregnant females.Conclusion: Vitamin D levels are low in Pregnancy induced hypertension patients, and vitamin D deficiency is more common in PIH patients, suggesting that vitamin D deficiency may be a risk factor for the pregnancy induced hypertension

Double orifice mitral valve: An incidental finding

A double orifice mitral valve (DOMV) represents a rare congenital malformation characterized by two valve orifices with two separate subvalvular apparatus. We present an interesting case of an asymptomatic 1 year and 8 months old male child with DOMV who successfully underwent surgery

Characterization of the effect of in-process annealing using a novel print head assembly on the ultimate tensile strength & toughness of Fused Filament Fabrication (FFF) parts

Improving the quality of parts printed using Fused Filament Fabrication (FFF) is of critical importance in a number of engineering applications. Providing additional thermal energy during printing by external means, or by an integrated heater has been investigated in the past to prolong the cooling curve, and therefore, ensure good adhesion with adjacent filaments. This work presents a modified heater block assembly to apply in-process thermal load during the upright printing of a Polylactic Acid (PLA) part. The design overcomes key shortcomings of past work and, in particular, addresses effective printing of thin, tall structures, where filament adhesion between layers is of particular importance. Cross-section imaging and tensile testing is combined with a comprehensive statistical design of experiments in order to fully understand the impact of process parameters on improved mechanical strength of printed parts. This work contributes towards improved properties and performance of realistic and practical FFF-printed parts

Disruption of the quorum sensing regulated pathogenic traits of the biofilm-forming fish pathogen <i>Aeromonas hydrophila</i> by tannic acid, a potent quorum quencher

<p>The quorum sensing (QS) phenomenon regulates a myriad of pathogenic traits in the biofilm forming fish pathogen, <i>Aeromonas hydrophila</i>. Blocking the QS mechanism of <i>A. hydrophila</i> is a novel strategy to prevent disease in fish. This study evaluated the effect of tannic acid, a QS inhibitor, on <i>A. hydrophila</i>-associated QS regulated phenomena. A streaking assay with <i>Chromobacterium violaceum</i> (CVO26) reported the presence of N-acyl homoserine lactone (AHL) in <i>A. hydrophila</i>, which was confirmed by HPLC and GC-MS analysis. Tannic acid-treated <i>A. hydrophila</i> showed a considerable reduction in violacein production, blood haemolysis activity and the pattern of swarming motility. Biofilm formation was significantly reduced (<i>p</i> < 0.001) (up to 95%), after tannic acid treatment for 48 h. Analysis by qRT-PCR revealed significant downregulation (<i>p</i> < 0.001) of AhyI and AhyR transcripts in <i>A. hydrophila</i> after tannic acid treatment. Co-stimulation of <i>Catla catla</i> with <i>A. hydrophila</i> and tannic acid attenuated pathogen-induced skin haemorrhages and increased the relative survival rate up to 86.6%. The study provides a mechanistic basis of tannic acid as a QS blocker and indicates its therapeutic potential against <i>A. hydrophila</i>-induced pathogenesis.</p

Tricuspid surgery at time of mitral surgery improves survival free from severe tricuspid regurgitation but not quality of lifeCentral MessagePerspective

Objective: The choice to operate on moderate tricuspid regurgitation (TR) during mitral surgery is challenging owing to limited mid-term data. We assess whether concomitant tricuspid operations improve mid-term quality of life, morbidity, or mortality. Methods: An institutional database identified mitral surgery recipients with moderate TR at the time of surgery from 2010 to 2019. Patients were stratified by the presence of a concomitant tricuspid operation. Quality of life at the last follow-up was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Morbidity was compared using the χ2 test, Mann-Whitney U test, and Student t test. Survival was analyzed with Kaplan-Meier estimation. Results: Of 210 mitral surgery recipients, 67 (31.9%) underwent concomitant tricuspid surgery. The concomitant tricuspid surgery cohort had greater preoperative dialysis use (10.5% vs 3.5%; P = .043) but similar age, New York Heart Association class, and cardiac surgery history relative to the nonconcomitant cohort (P > .05 for all). The concomitant tricuspid surgery cohort had a longer cardiopulmonary bypass time (144 minutes vs 122 minutes; P = .005) but a similar rate of mitral repair (P = .220). Postoperative KCCQ-12 scores reflected high quality of life in both cohorts (95.1 vs 89.1; P = .167). The concomitant tricuspid surgery cohort trended toward a higher perioperative pacemaker placement rate (22.8% vs 12.7%; P = .088) but were less likely to develop severe TR (0.0% vs 13.0%; P = .004). Overall survival was comparable between the 2 cohorts at 1 year (84.9% vs 81.6%; P = .628) and 5 years (73.5% vs 57.9%; P = .078). Five-year survival free from severe TR was higher in the concomitant cohort (73.5% vs 54.3%; P = .032). Conclusions: Concomitant tricuspid surgery for moderate TR is associated with increased 5-year survival free from severe TR but not with increased quality of life