Cochlear Compartments Segmentation and Pharmacokinetics using Micro Computed Tomography Images

Local drug delivery to the inner ear via micropump implants has the potential to be much more effective than oral drug delivery for treating patients with sensorineural hearing loss and to protect hearing from ototoxic insult due to noise exposure. Delivering appropriate concentrations of drugs to the necessary cochlear compartments is of paramount importance; however, directly measuring local drug concentrations over time throughout the cochlea is not possible. Indirect measurement using otoacoustic emissions and auditory brainstem response are ineffective as they only provide an estimate of concentration and are susceptible to non-linear sensitivity effects. Imaging modalities such as MRI with infused gadolinium contrast agent are limited due to the high spatial resolution requirement for pharmacokinetic analysis, especially in mice with cochlear length in the micron scale. We develop an intracochlear pharmacokinetic model using micro-computed tomography imaging of the cochlea during in vivo infusion of a contrast agent at the basal end of scala tympani through a cochleostomy. This approach requires accurately segmenting the main cochlear compartments: scala tympani (ST), scala media (SM) and scala vestibuli (SV). Each scan was segmented using 1) atlas-based deformable registration, and 2) V-Net, a encoder-decoder style convolutional neural network. The segmentation of these cochlear regions enable concentrations to be extracted along the length of each scala. These spatio-temporal concentration profiles are used to learn a concentration dependent diffusion coefficient, and transport parameters between the major scalae and to clearance. The pharmacokinetic model results are comparable to the current state of the art model, and can simulate concentrations for cases involving different infusion molecules and drug delivery protocols. While our model shows promising results, to extend the approach to larger animals and to generate accurate further experimental data, computational constraints, and time requirements of previous segmentation methods need to be mitigated. To this end, we extended the V-Net architecture with inclusion of spatial attention. Moreover, to enable segmentation in hardware restricted environments, we designed a 3D segmentation network using Capsule Networks that can provide improved segmentation performance along with 90% reduction in trainable parameters. Finally, to demonstrate the effectiveness of these networks, we test them on multiple public datasets. They are also tested on the cochlea dataset and pharmacokinetic model simulations will be validated against existing results

Consider this SGLT2 inhibitor for patients with HF with preserved ejection fraction

Consider adding empagliflozin 10 mg to usual therapy to reduce hospitalization of symptomatic patients with heart failure with preserved ejection fraction (HFpEF; EF > 40%) and an N-terminal pro–B-type natriuretic peptide (NT-proBNP) level > 300 pg/mL, regardless of diabetes status.Sanketh Produttur, MD; Gregory Castelli, PharmD, BCPS, BC-ADM, CDCES, (UPMC St. Margaret Family Medicine Residency Program)Includes bibliographical reference

Named Cells and Bodies in Oral Pathology - Part II: A Ready Reckoner

It is important for the Oral pathologist to be familiar with the different pathological cells and bodies as they very often tend to appear in various diseases and conditions. In spite of most of these inclusions not being pathognomic, they inevitably help the pathologist in making a diagnosis. Besides assisting in recognition of a lesion, this article will also be of immense help to the student population. This article is split into two parts for the ease of the reader. Part I provided  an overview of  various pathological cells and bodies pertaining to diseases, metabolic disorders and neoplasms. Part II will brief about those associated with cysts, tumors and infections

Named Cells and Bodies in Oral Pathology - Part I: A Ready Reckoner

Oral pathology is a visual speciality which navigates a pathologist in the arena of micro details amidst complex tissues. At times we get stuck or entrapped in a state of flux when we come across certain pathological cells or bodies as our eyes are more conditioned viewing at normal morphology of cell & structures. Although they may be deceptive in their appearance, at the same time aids the pathologist in diagnosis as they are pathognomonic of certain diseases & conditions.  For the ease of description, this article has been split into two parts. Part I provides an overview of various pathological cells and bodies pertaining to diseases, metabolic disorders and neoplasm’s reflecting its significance in Oral Pathology. Besides being an instant reckoner to the student population, it aids in diagnosing different pathological conditions