An Effective Pixel-Wise Approach for Skin Colour Segmentation- Using Pixel Neighbourhood Technique

This paper presents a novel technique for skin colour segmentation that overcomes the limitations faced by existing techniques such as Colour Range Thresholding. Skin colour segmentation is affected by the varied skin colours and surrounding lighting conditions, leading to poorskin segmentation for many techniques. We propose a new two stage Pixel Neighbourhood technique that classifies any pixel as skin or non-skin based on its neighbourhood pixels. The first step calculates the probability of each pixel being skin by passing HSV values of the pixel to a Deep Neural Network model. In the next step, it calculates the likeliness of pixel being skin using these probabilities of neighbouring pixels. This technique performs skin colour segmentation better than the existing techniques

Common Genetic Polymorphisms Influence Blood Biomarker Measurements in COPD

Implementing precision medicine for complex diseases such as chronic obstructive lung disease (COPD) will require extensive use of biomarkers and an in-depth understanding of how genetic, epigenetic, and environmental variations contribute to phenotypic diversity and disease progression. A meta-analysis from two large cohorts of current and former smokers with and without COPD [SPIROMICS (N = 750); COPDGene (N = 590)] was used to identify single nucleotide polymorphisms (SNPs) associated with measurement of 88 blood proteins (protein quantitative trait loci; pQTLs). PQTLs consistently replicated between the two cohorts. Features of pQTLs were compared to previously reported expression QTLs (eQTLs). Inference of causal relations of pQTL genotypes, biomarker measurements, and four clinical COPD phenotypes (airflow obstruction, emphysema, exacerbation history, and chronic bronchitis) were explored using conditional independence tests. We identified 527 highly significant (p 10% of measured variation in 13 protein biomarkers, with a single SNP (rs7041; p = 10−392) explaining 71%-75% of the measured variation in vitamin D binding protein (gene = GC). Some of these pQTLs [e.g., pQTLs for VDBP, sRAGE (gene = AGER), surfactant protein D (gene = SFTPD), and TNFRSF10C] have been previously associated with COPD phenotypes. Most pQTLs were local (cis), but distant (trans) pQTL SNPs in the ABO blood group locus were the top pQTL SNPs for five proteins. The inclusion of pQTL SNPs improved the clinical predictive value for the established association of sRAGE and emphysema, and the explanation of variance (R2) for emphysema improved from 0.3 to 0.4 when the pQTL SNP was included in the model along with clinical covariates. Causal modeling provided insight into specific pQTL-disease relationships for airflow obstruction and emphysema. In conclusion, given the frequency of highly significant local pQTLs, the large amount of variance potentially explained by pQTL, and the differences observed between pQTLs and eQTLs SNPs, we recommend that protein biomarker-disease association studies take into account the potential effect of common local SNPs and that pQTLs be integrated along with eQTLs to uncover disease mechanisms. Large-scale blood biomarker studies would also benefit from close attention to the ABO blood group

A Demonstration of the Vitom to Provide Post Laceration Repair Follow Up Using Telemedicine Technology—A Useful Methodology for Far Forward Surgical Telementoring

Surgical care must often be provided in remote areas where surgical subspecialists are not available.  Telemedicine offers a means of linking a specialist with a remote medical provider to virtually provide the highest level of expertise.  This paper describes the first known clinical usage of the Vitom exoscope to transmit images from a remote site to a specialty care provider for surgical evaluation.  The Vitom is a low cost, portable endoscopic solution for linking remote general medical providers with specialists in tertiary care centres.  This system has high potential utility for the far forward battlefield area

Bone Graft Options in Spinal Fusion: A Review of Current Options and the Use of Mesenchymal Cellular Bone Matrices.

BACKGROUND: Spinal fusion is the mainstay treatment for various spinal conditions ranging from lumbar and cervical stenosis to degenerative spondylolisthesis as well as extensive deformity corrections. A new emerging category of allograft is cellular bone matrices (CBMs), which take allogeneic mesenchymal stem cells and incorporate them into an osteoconductive and osteoinductive matrix. This study reviewed the current spinal fusion options and new emerging treatment options. METHODS: Articles were searched using PubMed. The search included English publications since January 1, 2014, using the search terms cellular bone matrix, mesenchymal stem cells spinal fusion, spinal arthrodesis AND mesenchymal stem cells, and spine fusion AND cellular bone matrix. RESULTS: Spinal fusion is accomplished through the use of allografts, autografts, and bone graft substitutes in combination or alone. An emerging category of allograft is CBMs, in which an osteoconductive and osteoinductive matrix is filled with mesenchymal stem cells. Studies demonstrate that CBMs have achieved equivalent or better fusion rates compared with traditional options for anterior cervical discectomy and fusions and posterolateral lumbar fusions; however, the studies have been retrospective and lacking control groups and therefore not ideal. CONCLUSIONS: Many treatment options have been successfully used in spinal fusion. Newer allografts such as CBMs have shown promising results in both animal and clinical studies. Further research is needed to determine the therapeutic dose of mesenchymal stem cells delivered within CBMs

An Investigation of a Novel Dural Repair Device for Intraoperative Incidental Durotomy Repair.

Incidental durotomies, or dural tears, can be very difficult and time consuming to repair properly when they are encountered in confined spaces. A novel dural repair device was developed to address these situations. In this paper, the novel device was assessed against the use of traditional tools and techniques for dural repairs in two independent studies using an intricate clinical simulation model. The aim was to examine the results of the two assessments and link the outcomes to the clinical use of the novel device in the operating room. The novel device outperformed conventional techniques as measured by dural repair time, CSF leak pressure and nerve root avoidance in the simulation. The results were generally replicable clinically, however, numerous additional clinical scenarios were also encountered that the simulation model was unable to capture due to various inherent limitations. The simulation model design, potential contributors to watertightness, clinical experiences, and limitation are discussed

High Altitude Is an Independent Risk Factor for Developing a Pulmonary Embolism, but Not a Deep Vein Thrombosis Following a 1- to 2-Level Lumbar Fusion

Study Design: Retrospective study. Objective: To identify if a 1- to 2-level posterior lumbar fusion at higher altitude is an independent risk factor for postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE). Methods: A national Medicare database was queried for all patients undergoing 1- to 2-level lumbar fusions from 2005 to 2014. Those with a prior history of DVT, PE, coagulopathy, or peripheral vascular complications were excluded to better isolate altitude as the dependent variable. The groups were matched 1:1 based on age, gender, and comorbidities to limit potential cofounders. Using ZIP codes of the hospitals where the procedure occurred, we separated our patients into high (>4000 feet) and low (4000 feet incurred higher PE rates in the first 90 days compared with patients receiving the same surgery at <100 feet but did not incur higher rates of postoperative DVTs

Arthroscopic Repair of Hip Labrum With Suture Anchors

The acetabular labrum and the transverse acetabular ligament form a continuous ring of tissue on the periphery of the acetabulum that provides a seal for the hip joint and increases the surface area to spread load distribution during weight-bearing. When a labral tear is suspected, the treatment algorithm always begins with conservative management, including physical therapy and nonsteroidal anti-inflammatory drugs. When conservative management fails, patients become candidates for arthroscopic labral repair. In the last 2 decades, the rate of hip arthroscopy has increased nearly 4-fold. However, as hip arthroscopy is performed more frequently, there is a need for a proper technique to minimize morbidity, because hip arthroscopy has been known to have a steep learning curve. We present a method for arthroscopic hip labral repair using suture anchors without a capsular repair. This Technical Note highlights our technique for labral repair, along with pearls and pitfalls of hip arthroscopy

Social media accessibility, shorter office wait times, and review website personalization are correlated with better online review scores for spine surgeons

BACKGROUND CONTEXT: In the next decade, health care reimbursement will be more aligned to patient clinical outcomes. A factor impacting these outcomes is the patient\u27s perceived opinion of his or her care, and specifically the surgical provider. An evaluation into the role of surgeon demographics, social media accessibility, and office wait times was conducted to identify correlations with these among three online review platforms. PURPOSE: To evaluate patient satisfaction scores for spine surgeons practicing in New York State using leading physician ratings websites. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: Spine surgeons with a review on Healthgrades.com (HG), Vitals.com (V), or Google.com (G) online rating websites as of 11/1/2019. OUTCOME MEASURES: Number of ratings, number of comments, overall rating, patient reported wait times, physician website presence and physician social media presence (SM). METHODS: A total of 206 (148 orthopedic, 58 neurosurgery-trained) spine surgeons were included after excluding those that no longer practiced, were still in training, or actually practiced outside of the selected geographic area. Spine surgeon ratings and demographics data from three physician rating websites (HG, V, G) were collected in November 2019. Using only the first 10 search results from Google.com we then identified if the surgeon had publicly accessible Facebook (FB), Twitter (TW) or Instagram (IG) accounts. RESULTS: The mean age of the cohort was 54.3 years (± 9.40 years) and 28.2% had one form of publicly accessible SM. Having any SM was significantly correlated with higher scores on HG and G. An IG account was associated with significantly higher scores on all three platforms and having a FB account correlated with significantly higher scores on HG in multivariate analysis. An office wait time between 16-30 minutes and greater than 30 minutes was associated with worse scores on all three platforms in multivariate analysis (all \u3c0.05). Neurosurgery training was associated with significantly worse scores on V in multivariate analysis. An academic practice was associated with higher scores on all three platforms (p\u3c0.05). Overall ratings between HG, V, and G all had significantly positive correlations on Pearson correlation analysis. CONCLUSIONS: A shorter office wait time and an academic setting practice are associated with higher patient satisfaction scores on all three physician review websites. Accessible social media accounts are also associated with higher ratings on physician review websites, particularly IG. While surgical outcomes are likely the most important influence of perceived patient satisfaction, additional factors should continue to be considered. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs

KIT inhibition by imatinib in patients with severe refractory asthma

BACKGROUND: Mast cells are present in the airways of patients who have severe asthma despite glucocorticoid treatment; these cells are associated with disease characteristics including poor quality of life and inadequate asthma control. Stem cell factor and its receptor, KIT, are central to mast-cell homeostasis. We conducted a proof-of-principle trial to evaluate the effect of imatinib, a KIT inhibitor, on airway hyperresponsiveness, a physiological marker of severe asthma, as well as on airway mast-cell numbers and activation in patients with severe asthma. METHODS: We conducted a randomized, double-blind, placebo-controlled, 24-week trial of imatinib in patients with poorly controlled severe asthma who had airway hyperresponsiveness despite receiving maximal medical therapy. The primary end point was the change in airway hyperresponsiveness, measured as the concentration of methacholine required to decrease the forced expiratory volume in 1 second by 20% (PC20). Patients also underwent bronchoscopy. RESULTS: Among the 62 patients who underwent randomization, imatinib treatment reduced airway hyperresponsiveness to a greater extent than did placebo. At 6 months, the methacholine PC20 increased by a mean (±SD) of 1.73±0.60 doubling doses in the imatinib group, as compared with 1.07±0.60 doubling doses in the placebo group (P=0.048). Imatinib also reduced levels of serum tryptase, a marker of mast-cell activation, to a greater extent than did placebo (decrease of 2.02±2.32 vs. 0.56±1.39 ng per milliliter, P=0.02). Airway mast-cell counts declined in both groups. Muscle cramps and hypophosphatemia were more common in the imatinib group than in the placebo group. CONCLUSIONS: In patients with severe asthma, imatinib decreased airway hyperresponsiveness, mast-cell counts, and tryptase release. These results suggest that KIT-dependent processes and mast cells contribute to the pathobiologic basis of severe asthma