Improving the Accuracy and Speed of Visual Field Testing in Glaucoma With Structural Information and Deep Learning

Purpose: To assess the performance of a perimetric strategy using structure–function predictions from a deep learning (DL) model. Methods: Visual field test–retest data from 146 eyes (75 patients) with glaucoma with (median [5th–95th percentile]) 10 [7, 10] tests per eye were used. Structure–function predictions were generated with a previously described DL model using cicumpapillary optical coherence tomography (OCT) scans. Structurally informed prior distributions were built grouping the observed measured sensitivities for each predicted value and recalculated for each subject with a leave-one-out approach. A zippy estimation by sequential testing (ZEST) strategy was used for the simulations (1000 per eye). Groundtruth sensitivities for each eye were the medians of the test–retest values. Two variations of ZEST were compared in terms of speed (average total number of presentations [NP] per eye) and accuracy (average mean absolute error [MAE] per eye), using either a combination of normal and abnormal thresholds (ZEST) or the calculated structural distributions (S-ZEST) as prior information. Two additional versions of these strategies employing spatial correlations were tested. Results: S-ZEST was significantly faster, with a mean average NP of 213.87 (SD = 28.18), than ZEST, with a mean average NP of 255.65 (SD = 50.27) (P < 0.001). The average MAE was smaller for S-ZEST (1.98; SD = 2.37) than ZEST (2.43; SD = 2.69) (P < 0.001). Spatial correlations further improved both strategies (P < 0.001), but the differences between ZEST and S-ZEST remained significant (P < 0.001). Conclusions: DL structure–function predictions can significantly improve perimetric tests. Translational Relevance: DL structure–function predictions from clinically available OCT scans can improve perimetry in glaucoma patients

Improving statistical power of glaucoma clinical trials using an ensemble of cyclical generative adversarial networks

Albeit spectral-domain OCT (SDOCT) is now in clinical use for glaucoma management, published clinical trials relied on time-domain OCT (TDOCT) which is characterized by low signal-to-noise ratio, leading to low statistical power. For this reason, such trials require large numbers of patients observed over long intervals and become more costly. We propose a probabilistic ensemble model and a cycle-consistent perceptual loss for improving the statistical power of trials utilizing TDOCT. TDOCT are converted to synthesized SDOCT and segmented via Bayesian fusion of an ensemble of GANs. The final retinal nerve fibre layer segmentation is obtained automatically on an averaged synthesized image using label fusion. We benchmark different networks using i) GAN, ii) Wasserstein GAN (WGAN) (iii) GAN + perceptual loss and iv) WGAN + perceptual loss. For training and validation, an independent dataset is used, while testing is performed on the UK Glaucoma Treatment Study (UKGTS), i.e. a TDOCT-based trial. We quantify the statistical power of the measurements obtained with our method, as compared with those derived from the original TDOCT. The results provide new insights into the UKGTS, showing a significantly better separation between treatment arms, while improving the statistical power of TDOCT on par with visual field measurements

Transtendinous course of the infrapatellar branch of saphenous nerve. A contribution to the aetiology of entrapment neuropathy and modification of the existing classification

Background: The course of the infrapatellar branch of saphenous nerve (IPBSN) in relation to the Sartorius muscle has been classified into presartorial, transsartorial and retrosartorial types. Mechanical compression of the IPBSN within the Sartorius tendon has been surgically recognised as a cause of entrapment neuropathy. Purpose of the present study was to differentiate the IPBSNs penetrating the Sartorius tendon from those penetrating the Sartorius muscle, from an anatomical and clinical point of views and thus modifying the existing classification. Materials and methods: The IPBSN was bilaterally dissected in 27 cadavers. The cases of the IPBSNs penetrating the Sartorius tendon were recorded separately from those penetrating the Sartorius muscle belly. Results: In 11 out of 54 limbs (20.4%) the IPBSN ran through the Sartorius muscle belly. In 3 out of 54 (5.6%) limbs, the IPBSN penetrated the Sartorius tendon. Conclusions: The penetrating type of IPBSN includes two distinct subtypes: the muscle-penetrating type and the tendon-penetrating type. These subtypes are also distinct from a clinical point of view, since only the tendon-penetrating type has been associated with the IPBSN entrapment neuropathy. According to these findings we suggest a modification of the current classification. Further clinical studies are necessary to fully demonstrate whether the tendon-penetrating type should be considered as a predisposing factor for the IPBSN entrapment neuropathy. Distinguishing the two subtypes might be helpful for that purpose

Persistent median artery in the carpal tunnel: anatomy, embryology, clinical significance, and review of the literature

The median artery usually regresses after the eighth week of intrauterine life, but in some cases it persists into adulthood. The persistent median artery (PMA) passes through the carpal tunnel of the wrist, accompanying the median nerve. During anatomical dissection in our department, we found two unilateral cases of PMA originating from the ulnar artery. In both cases the PMA passed through the carpal tunnel, reached the palm, and anastomosed with the ulnar artery, forming a medio-ulnar type of superficial palmar arch. In addition, in both cases we observed a high division of the median nerve before entering the carpal tunnel. Such an artery may result in several complications such as carpal tunnel syndrome, pronator syndrome, or compression of the anterior interosseous nerve. Therefore, the presence of a PMA should be taken into consideration in clinical practice. This study presents two cases of PMA along with an embryological explanation, analysis of its clinical significance, and a review of the literature. The review of the literature includes cases observed during surgical procedures or anatomical dissections. Cases observed by means of imaging techniques were not included in the study

Ancient human genomes suggest three ancestral populations for present-day Europeans

We sequenced the genomes of a 7,000-year-old farmer from Germany and eight 8,000-year-old hunter-gatherers from Luxembourg and Sweden. We analysed these and other ancient genomes¹-₄ with 2,345 contemporary humans to show that most present-day Europeans derive from at least three highly differentiated populations:west European hunter-gatherers, who contributed ancestry to all Europeans but not to Near Easterners; ancient north Eurasians related to Upper Palaeolithic Siberians³, who contributed to both Europeans and Near Easterners; and early European farmers, who were mainly of Near Eastern origin but also harboured west European hunter-gatherer related ancestry.We model these populations’ deep relationships and show that early European farmers had 44% ancestry from a ‘basal Eurasian’ population that split before the diversification of other non-African lineage

Identitarian Populism in Britain

This chapter examines the role of 'identitarian populism' in 'othering' and hate incidents, with a focus on three 'populist groups' in Britain, the United Kingdom Independence Party (UKIP), the British National Party (BNP) and the English Defence League (EDL). For the purpose of this chapter, fieldwork data from the RAGE project have been used, including interviews and ethnographic work with both the 'populist groups' along with a range of organisations who work with those who are presumed to be the victims of 'populist othering' and hate incidents or crime. Evidence suggest that the leadership of UKIP, BNP and EDL recognise the importance of a more popularised rhetoric, in order to attract the attention of the public. UKIP's approach against EU migration or the party’s homophobic sentiments and similarly, EDL's Islamophobic tactics, place the ‘other’ in the centre of their discourse. With the victim representatives agreeing on Gilroy’s (2012) point that it is mainstream culture and politics that have a greater impact on e.g. hate speech and hate crime in general the chapter concludes that the violent acts of the EDL, the rhetoric of UKIP and BNP and the inconsistent media coverage create a breeding environment for politics of fear.FSW – Publicaties zonder aanstelling Universiteit Leide

Isolated descemetorhexis for anterior synechiolysis prior to endothelial keratoplasty - case report and technique.

To describe the utilization of descemetorhexis for reformation of the anterior chamber in eyes with central iridocorneal synechiae before endothelial keratoplasty (EK). A 71-year-old man with a history of trabeculectomy complicated by hypotony presented with bullous keratopathy in the presence of extensive iridocorneal synechiae and a flat anterior chamber. In order to proceed with EK, synechiolysis with the use of viscoelastic and scissors was attempted. Despite successful dissection of the peripheral strands, the pupillary margin of the iris remained attached to the endothelium. Therefore, descemetorhexis was performed to detach the Descemet membrane along with central synechiae and create sufficient space for safe EK at a later stage. Corneal clarity was restored by ultrathin Descemet stripping automated endothelial keratoplasty, leaving a fibrous membrane in the pupillary plane, which was excised 2 months later, allowing an improvement of best-corrected visual acuity to 0.5. Isolated descemetorhexis was successfully employed to reform the anterior chamber and proceed with EK in a case of bullous keratopathy and resistant iridocorneal synechiae. This stepwise approach may be considered in similar cases in order to avoid a more invasive treatment, ie, penetrating keratoplasty and synechiolysis

Incidence, number and topography of Wormian bones in Greek adult dry skulls

Background: Wormian bones (WBs) are irregularly shaped bones formed from independent ossification centres found along cranial sutures and fontanelles. Their incidence varies among different populations and they constitute an anthropo- logical marker. Precise mechanism of formation is unknown and being under the control of genetic background and environmental factors. The aim of the current study is to investigate the incidence of WBs presence, number and topographical distribution according to gender and side in Greek adult dry skulls.  Materials and methods: All sutures and fontanelles of 166 Greek adult dry skulls were examined for the presence, topography and number of WBs. One hundred and nineteen intact and 47 horizontally craniotomised skulls were examined for WBs presence on either side of the cranium, both exocranially and intracranially.  Results: One hundred and twenty-four (74.7%) skulls had WBs. No difference was detected between the incidence of WBs, gender and age. Sutures and fon- tanelles located in neurocranium showed a higher incidence of WBs, contrariwise to orbital sutures that indicated a low incidence. WBs most commonly located in the lambdoid suture (44.6%), followed in order of frequency by the coronal suture (39.8%), asterion (21% on the left and 15.3% on the right side) and parie- tomastoid suture (15.1% on the left and 13.9% on the right side). Other sutures with WBs were the occipitomastoid, sagittal, squamosal, zygomaticosphenoid, metopic, frontonasal and frontozygomatic. Regarding the skull fontanelles, WBs were found at pterion, posterior and anterior fontanelles.  Conclusions: The current study highlights a high incidence of WBs in a Greek population, indicating racial variation. The in depth knowledge of exact location, frequency and number of WBs is essential for clinicians intervening in the skull area, anthropologists and forensic surgeons investigating child abuse cases.

Abdominoperineal Resection for Rectal Cancer: Is the Pelvic Drain Externalization Site an Independent Risk Factor for Perineal Wound Healing?

Aim. The aim of this paper is to investigate if the insertion of the pelvic drainage tube via the perineal wound could be considered as an independent risk factor for perineal healing disorders, after abdominoperineal resection for rectal malignancy. Patients and Methods. The last two decades, 75 patients underwent elective abdominoperineal resection for malignancy. In 42 patients (56%), the pelvic drain catheter was inserted through the perineal wound (PW group), while in the remaining 33 (44%) through a puncture skin wound of the perineum (SW group). Patients' data with respect to age (P = 0.136), stage (P > 0.05), sex (P = 0.188) and comorbidity (P = 0.128) were similar in both groups. 25 patients (PW versus SW: 8 versus 17, P = 0.0026) underwent neoadjuvant radio/chemotherapy. Results. The overall morbidity rate was 36%, but a significant increase was revealed in PW group (52.4% versus 9%, P = 0.0007). In 33.3% of the patients in the PW group, perineal healing was delayed, while in the SW group, no delay was noted. Perineal healing disorders were revealed as the main source of increased morbidity in this group. Conclusion. The insertion of the pelvic drain tube through the perineal wound should be considered as an independent risk factor predisposing to perineal healing disorders

Placing limits on the stochastic gravitational-wave background using European Pulsar Timing Array data

Direct detection of low-frequency gravitational waves ($10^{-9} - 10^{-8}$ Hz) is the main goal of pulsar timing array (PTA) projects. One of the main targets for the PTAs is to measure the stochastic background of gravitational waves (GWB) whose characteristic strain is expected to approximately follow a power-law of the form $h_c(f)=A (f/\hbox{yr}^{-1})^{\alpha}$, where $f$ is the gravitational-wave frequency. In this paper we use the current data from the European PTA to determine an upper limit on the GWB amplitude $A$ as a function of the unknown spectral slope $\alpha$ with a Bayesian algorithm, by modelling the GWB as a random Gaussian process. For the case $\alpha=-2/3$, which is expected if the GWB is produced by supermassive black-hole binaries, we obtain a 95% confidence upper limit on $A$ of $6\times 10^{-15}$, which is 1.8 times lower than the 95% confidence GWB limit obtained by the Parkes PTA in 2006. Our approach to the data analysis incorporates the multi-telescope nature of the European PTA and thus can serve as a useful template for future intercontinental PTA collaborations.Comment: 14 pages, 8 figures, 3 tables, mnras accepte