Monte Carlo-based Noise Compensation in Coil Intensity Corrected Endorectal MRI

Background: Prostate cancer is one of the most common forms of cancer found in males making early diagnosis important. Magnetic resonance imaging (MRI) has been useful in visualizing and localizing tumor candidates and with the use of endorectal coils (ERC), the signal-to-noise ratio (SNR) can be improved. The coils introduce intensity inhomogeneities and the surface coil intensity correction built into MRI scanners is used to reduce these inhomogeneities. However, the correction typically performed at the MRI scanner level leads to noise amplification and noise level variations. Methods: In this study, we introduce a new Monte Carlo-based noise compensation approach for coil intensity corrected endorectal MRI which allows for effective noise compensation and preservation of details within the prostate. The approach accounts for the ERC SNR profile via a spatially-adaptive noise model for correcting non-stationary noise variations. Such a method is useful particularly for improving the image quality of coil intensity corrected endorectal MRI data performed at the MRI scanner level and when the original raw data is not available. Results: SNR and contrast-to-noise ratio (CNR) analysis in patient experiments demonstrate an average improvement of 11.7 dB and 11.2 dB respectively over uncorrected endorectal MRI, and provides strong performance when compared to existing approaches. Conclusions: A new noise compensation method was developed for the purpose of improving the quality of coil intensity corrected endorectal MRI data performed at the MRI scanner level. We illustrate that promising noise compensation performance can be achieved for the proposed approach, which is particularly important for processing coil intensity corrected endorectal MRI data performed at the MRI scanner level and when the original raw data is not available.Comment: 23 page

Monte Carlo Framework for Prostate Cancer Correction and Reconstruction in Endorectal Multi-parametric MRI

Prostate cancer is one of the leading causes of cancer death in the male population. The detection of prostate cancer using imaging has been challenging until recently. Multi-parametric MRI has been shown to allow accurate localization of the cancers and can help direct biopsies to cancer foci which is required to plan treatment. The interpretation of MRI, however, requires a high level of expertise and review of large multi-parametric data sets. An endorectal receiver coil is often used to improve signal-to-noise ratio (SNR) and aid in detection of smaller cancer foci. Despite increased SNR, intensity bias fields can exist where nearest the endorectal coil the signal is greater than those regions farther from the coil. Weak delineation of the prostate as well as poor prostate gland visualization can greatly impact the ease and accuracy of diagnosis. For this reason, there is a need for an automated system which can correct endorectal multi-parametric MRI for enhanced visualization. A framework using Monte Carlo sampling techniques has been developed for prostate cancer correction and reconstruction in endorectal multi-parametric MRI. Its performance against state-of-the-art approaches demonstrate improved results for visualization and prostate delineation. The first step in the proposed framework involves reconstructing an intensity bias-free image. Using importance-weighted Monte Carlo sampling, the intensity bias field is estimated to approximate the bias-free result. However, the reconstruction is still pervaded by noise which becomes amplified and non-stationary as a result of intensity bias correction. The second step in the framework applies a spatially-adaptive Rician distributed Monte Carlo sampling approach while accounting for the endorectal coil's underlying SNR characteristics. To evaluate the framework, the individual steps are compared against state-of-the-art approaches using phantoms and real patient data to quantify visualization improvement. The intensity bias correction technique is critiqued based on detail preservation and delineation of the prostate from the background as well as improvement in tumor identification. The noise compensation approach is considered based on the noise suppression, contrast of tissue as well as preservation of details and texture. Utilizing quantitative and qualitative metrics in addition to visual analysis, the experimental results demonstrated that the proposed framework allows for improved visualization, with increased delineation of the prostate and preservation of tissue textures and details. This allows radiologists to more easily identify characteristics of cancerous and healthy tissue leading to more accurate and confident diagnoses

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Exploring the impact of social media influencer qualities, in-game advertisements, and app store optimization on the intent of undergraduate students to download mobile games while being moderated by wi-fi restrictions

Mobile gaming has been on the rise in recent years as it has become accessible to many consumers today. In the Philippines, around 60% of Filipinos play games on a regular basis. The topic is relevant because the industry is rapidly expanding, the study aims to find out “What is the influence of social media influencer qualities, in-game advertisements, and app store optimization towards the Intent of ID 120 undergraduate students from the College of Business at the De La Salle University - Manila to download mobile games while being moderated by their Wi-Fi restrictions?” The study has identified the independent variable to be Social Media Influencer Qualities, In-game Advertisements, and App Store Optimization. The dependent variable on the other hand is identified to be the Download Intention. Lastly, the moderating variable is Wi-Fi Restriction. The study conducted surveys and interviews to gather a qualitative and quantitative perspective on the topic. The survey targeted ID 120 undergraduate students of De La Salle University - Manila taking up any course from RVR-COB. While the interviews consisted of two different groups of interviewees. The first are from the same demographic as those who answered the survey and the second group consisted of people who are experts in the field such as professional gamers. The main method used to analyze the relationship between all the variables is Structural Equation Modeling (SEM) which consists of the following steps: Exploratory Factor Analysis, Confirmatory Factor Analysis, and running the SEM analysis. After conducting the statistical analysis, it was concluded that the relationship between Social Media Influencer Qualities and App Store Optimization with Download Intention both have a significant and positive relationship while In-game Advertisements does not have a significant relationship with Download Intention. Furthermore, Wi-Fi Restrictions is found to have a significant moderating effect on Social Media Influencer Qualities and App Store Optimization. It does not have a significant moderating effect on In-game advertisements. However, after conducting the post-hoc test, it was concluded that Wi-Fi Restrictions is not a suitable moderator for the study. Keywords: Social Media Influencer Qualities, In-game Advertisements, App Store Optimization, Download Intention, Wi-Fi Restriction, Mobile Games, Marketing, Gaming Industry, Structural Equation Modelin

Prospective analysis of association between statin use and breast cancer risk in the women's health initiative.

BackgroundStatins are a class of cholesterol-lowering drugs that affect many intracellular pathways that may have implications for chemoprevention against cancer. Epidemiologic data on statins and breast cancer are conflicting. We analyzed updated data from the Women's Health Initiative (WHI) to assess the relationship between statins and breast cancer risk.MethodsThe population included 154,587 postmenopausal women ages 50 to 79 years, with 7,430 pathologically confirmed cases of breast cancer identified over an average of 10.8 (SD, 3.3) years. Information on statins was collected at baseline and years one, three, six, and nine. Self- and interviewer-administered questionnaires were used to collect information on risk factors. Cox proportional hazards regression was used to calculate HRs with 95% confidence intervals (CI) to evaluate the relationship between statin use and cancer risk. Statistical tests were two-sided.ResultsStatins were used by 11,584 (7.5%) women at baseline. The annualized rate of breast cancer was 0.42% among statin users and 0.42% among nonusers. The multivariable adjusted HR of breast cancer for users versus nonusers was 0.94 (95% CI, 0.83-1.06). In the multivariable-adjusted, time-dependent model, the HR for simvastatin was 0.87 (95% CI, 0.71-1.07). There was no significant trend by overall duration of use (P value for trend 0.68). There was no effect of tumor stage, grade, or hormone receptor status.ConclusionOverall, statins were not associated with breast cancer risk.ImpactOur study is one of the largest prospective observational studies on this topic, and substantially adds to the literature suggesting no relationship between statins and breast cancer risk

Prospective analysis of association between statin use and breast cancer risk in the women\u27s health initiative

Background: Statins are a class of cholesterol-lowering drugs that affect many intracellular pathways that may have implications for chemoprevention against cancer. Epidemiologic data on statins and breast cancer are conflicting. Weanalyzed updated data from the Women\u27s Health Initiative (WHI) to assess the relationship between statins and breast cancer risk. Methods: The population included 154,587 postmenopausal women ages 50 to 79 years, with 7,430 pathologically confirmed cases of breast cancer identified over an average of 10.8 (SD, 3.3) years. Information on statins was collected at baseline and years one, three, six, and nine. Self- and interviewer-administered questionnaires were used to collect information on risk factors. Cox proportional hazards regression was used to calculate HRs with 95% confidence intervals (CI) to evaluate the relationship between statin use and cancer risk. Statistical tests were two-sided. Results: Statins were used by 11,584 (7.5%) women at baseline. The annualized rate of breast cancer was 0.42% among statin users and 0.42% among nonusers. The multivariable adjusted HR of breast cancer for users versus nonusers was 0.94 (95% CI, 0.83-1.06). In the multivariable-adjusted, time-dependent model, the HR for simvastatin was 0.87 (95% CI, 0.71-1.07). There was no significant trend by overall duration of use (P value for trend 0.68). There was no effect of tumor stage, grade, or hormone receptor status. Conclusion: Overall, statins were not associated with breast cancer risk. Impact: Our study is one of the largest prospective observational studies on this topic, and substantially adds to the literature suggesting no relationship between statins and breast cancer risk. © 2013 American Association for Cancer Research

PKM2 expression in human HCC.

<p>(A) mRNA expression of PKL, PKM1, and PKM2 in HCC and NT tissues. Values = 2^ΔΔCT, ΔΔCT = (CT_PK – CT_HPRT) of HCC - (CT_PK– CT_HPRT) of NT. <i>P</i> values, Wilcoxin signed rank test (B) Waterfall plot shows that, at the mRNA level, PKM2 was up-regulated (HCC/NT2 folds) in 29/60 (48.33%) human HCC samples. (C) Representative pictures of IHC staining with antibody against PKM2 in HCC tissue microarray. PKM2 protein was drastically up-regulated in human HCCs as compared to the paired NT tissues. (D) Mann Whitney test showed that PKM2 over-expression was associated with multiple aggressive clinicopathological features in HCC including the presence of tumor microsatellites, presence of venous invasion, and absence of tumor encapsulation. (E) Over-expression of PKM2 in human HCC was associated with poor prognosis. HCC patients were categorized into two groups: PKM2 over-expression and PKM2 normal/under-expression. PKM2 was considered to be over-expressed when HCC/NT2 folds and was considered to be normal/under-expressed otherwise. HCC patients with PKM2 over-expression had a higher 1-year tumor recurrence rate after surgical resection than HCC patients without PKM2 over-expression, 46.667% Vs 25%. (F) Patients with PKM2 over-expression had lower 5-year overall survival rates after surgical resection. <i>P</i> values were calculated by Kaplan-Meir log rank test.</p