Topology-Aware Focal Loss for 3D Image Segmentation

The efficacy of segmentation algorithms is frequently compromised by topological errors like overlapping regions, disrupted connections, and voids. To tackle this problem, we introduce a novel loss function, namely Topology-Aware Focal Loss (TAFL), that incorporates the conventional Focal Loss with a topological constraint term based on the Wasserstein distance between the ground truth and predicted segmentation masks' persistence diagrams. By enforcing identical topology as the ground truth, the topological constraint can effectively resolve topological errors, while Focal Loss tackles class imbalance. We begin by constructing persistence diagrams from filtered cubical complexes of the ground truth and predicted segmentation masks. We subsequently utilize the Sinkhorn-Knopp algorithm to determine the optimal transport plan between the two persistence diagrams. The resultant transport plan minimizes the cost of transporting mass from one distribution to the other and provides a mapping between the points in the two persistence diagrams. We then compute the Wasserstein distance based on this travel plan to measure the topological dissimilarity between the ground truth and predicted masks. We evaluate our approach by training a 3D U-Net with the MICCAI Brain Tumor Segmentation (BraTS) challenge validation dataset, which requires accurate segmentation of 3D MRI scans that integrate various modalities for the precise identification and tracking of malignant brain tumors. Then, we demonstrate that the quality of segmentation performance is enhanced by regularizing the focal loss through the addition of a topological constraint as a penalty term

Biomechanical Evaluation of Lumbar Interbody Fixation Techniques: A Comparative Study of Standalone Cages vs. 360-Fixation Constructs

Low fusion rates and cage subsidence have been reported as the main drawbacks of lumbar fixation with static interbody cages [1]. Although several clinical and biomechanical studies have evaluated the efficacy of 360 interbody fixation constructs (Anterior cage plus posterior fixation) [2,3], no study has reported the biomechanical comparison between such constructs and more novel techniques which use standalone fixation implants [4]. A cadaver validated computational model of lumbar spine was used to compare the biomechanics of spine instrumented with 360 fixations versus standalone cage with screw and cage with lateral plate systems. To compare the mechanical stability of different interbody fixation techniques in lumbar spinal segments with standalone interbody versus static cage with posterior fixation or lateral plate system. <br/

Autonomous vehicles implementation in Lebanon: Opportunities, challenges, and ethical decisions

The Autonomous Vehicle (AV) technology allows people to travel without intervening. The quick progress in this technology and the efforts of manufacturers companies to reach fully Autonomous Vehicles (AVs) using artificial intelligent, forecast a bright future. Researches have estimated that on average, one passenger in a vehicle traveling one kilometer in Lebanon costs about $ 48, including externality components of crashes, travel time, congestion and pollution. Thus, the main purpose of this research is to highlight the opportunities of implementing AVs in Lebanon, such as reduction in traffic accidents and congestion, improvement of accessibility, human health, economic and social life. Moreover, this paper highlight the barriers standing in front of implementing this technology, like the missing of Intelligent Transportation System (ITS) and the funds needed for its execution, and gives some policy recommendations. Finally, the authors present their statistics conducted in Lebanon about ethical decisions that AVs should take particularly in case of a crash in different scenarios through the participants’ responses

How the type of sagittal alignment defined by Roussouly determines the gait of asymptomatic adult subject

While curvatures of the sagittal spine are known to greatly differ among asymptomatic adult subjects, there are no studies that determine whether this heterogeneous normality affects gait. This study aimed to elucidate the relationships between normal sagittal spine profiles and gait in asymptomatic adult subjects. Ninety-one asymptomatic adult subjects (age = 21.6 ±2.2, 47 M & 44F) with no prior orthopedic treatment underwent full body biplanar X rays with 3D reconstruction of the spine and pelvis. The following sagittal spino-pelvic parameters were generated from the 3D reconstructions: pelvic incidence, sacral slope, pelvic tilt, L1L5 lordosis, L1-S1 lordosis, T1-T12 kyphosis and T4-T2 kyphosis. Lower limb kinematics was assessed using 3D gait analysis. Each subject was classified into one of the 4 types of normal sagittal alignment previously described by Roussouly. Kruskal-Wallis test was used to evaluate the differences in gait and spino-pelvic parameters between the Roussouly types

Roussouly's sagittal spino-pelvic morphotypes as determinants of gait in asymptomatic adult subjects.

Sagittal alignment is known to greatly vary between asymptomatic adult subjects; however, there are no studies on the possible effect of these differences on gait. The aim of this study is to investigate whether asymptomatic adults with different Roussouly sagittal alignment morphotypes walk differently. Ninety-one asymptomatic young adults (46M & 45W), aged 21.6±2.2years underwent 3D gait analysis and full body biplanar X-rays with three-dimensional (3D) reconstructions of their spines and pelvises and generation of sagittal alignment parameters. Subjects were divided according to Roussouly's sagittal alignment classification. Sagittal alignment and kinematic parameters were compared between Roussouly types. 17 subjects were classified as type 2, 47 as type 3, 26 as type 4 but only 1 as type 1. Type 2 subjects had significantly more mean pelvic retroversion (less mean pelvic tilt) during gait compared to type 3 and 4 subjects (type 2: 8.2°; type 3:11.2°, type 4: 11.3°) and significantly larger ROM pelvic obliquity compared to type 4 subjects (type 2: 11.0°; type 4: 9.1°). Type 2 subjects also had significantly larger maximal hip extension during stance compared to subjects of types 3 and 4 (type 2: -11.9°; type 3: -8.8°; type 4: -7.9°) and a larger ROM of ankle plantar/dorsiflexion compared to type 4 subjects (type 2: 31.1°; type 4: 27.9°). Subjects with type 2 sagittal alignment were shown to have a gait pattern involving both increased hip extension and pelvic retroversion which could predispose to posterior femoroacetabular impingement and consequently osteoarthritis.This study was supported by the research council of the University of Saint-Joseph (grant number: FM189). The study sponsors were involved in neither the study design, collection, analysis and interpretation of data nor in the writing of the manuscript; nor in the decision to submit the manuscript for publication

Novel therapeutic strategies for spinal osteosarcomas

At the dawn of the third millennium, cancer has become the bane of twenty-first century man, and remains a predominant public health burden, affecting welfare and life expectancy globally. Spinal osteogenic sarcoma, a primary spinal malignant tumor, is a rare and challenging neoplastic disease to treat. After the conventional therapeutic modalities of chemotherapy, radiation and surgery have been exhausted, there is currently no available alternative therapy in managing cases of spinal osteosarcoma. The defining signatures of tumor survival are characterised by cancer cell ability to stonewall immunogenic attrition and apoptosis by various means. Some of these biomarkers, namely immune-checkpoints, have recently been exploited as druggable targets in osteosarcoma and many other different cancers. These promising strides made by the use of reinvigorated immunotherapeutic approaches may lead to significant reduction in spinal osteosarcoma disease burden and corresponding reciprocity in increase of survival rates. In this review, we provide the background to spinal osteosarcoma, and proceed to elaborate on contribution of the complex ecology within tumor microenvironment giving arise to cancerous immune escape, which is currently receiving considerable attention. We follow this section on the tumor microenvironment by a brief history of cancer immunity. Also, we draw on the current knowledge of treatment gained from incidences of osteosarcoma at other locations of the skeleton (long bones of the extremities in close proximity to the metaphyseal growth plates) to make a case for application of immunity-based tools, such as immune-checkpoint inhibitors and vaccines, and draw attention to adverse upshots of immune-checkpoint blockers as well. Finally, we describe the novel biotechnique of CRISPR/Cas9 that will assist in treatment approaches for personalized medication.This work is funded by a grant (MPP 320133) from the American University of Beirut to Dr. Ali H. Eid

Autonomous vehicles implementation in Lebanon: Opportunities, challenges, and ethical decisions

The Autonomous Vehicle (AV) technology allows people to travel without intervening. The quick progress in this technology and the efforts of manufacturers companies to reach fully Autonomous Vehicles (AVs) using artificial intelligent, forecast a bright future. Researches have estimated that on average, one passenger in a vehicle traveling one kilometer in Lebanon costs about $ 48, including externality components of crashes, travel time, congestion and pollution. Thus, the main purpose of this research is to highlight the opportunities of implementing AVs in Lebanon, such as reduction in traffic accidents and congestion, improvement of accessibility, human health, economic and social life. Moreover, this paper highlight the barriers standing in front of implementing this technology, like the missing of Intelligent Transportation System (ITS) and the funds needed for its execution, and gives some policy recommendations. Finally, the authors present their statistics conducted in Lebanon about ethical decisions that AVs should take particularly in case of a crash in different scenarios through the participants’ responses

How the type of sagittal alignment dfined by Roussouly determines the gait of asymptomatic adult subject

International audienceWhile curvatures of the sagittal spine are known to greatly differ among asymptomatic adult subjects, there are no studies that determine whether this heterogeneous normality affects gait. This study aimed to elucidate the relationships between normal sagittal spine profiles and gait in symptomatic adult subjects. Ninety-one asymptomatic adult subjects (age = 21.6 ±2.2, 47 M & 44F) with no prior orthopedic treatment underwent full body biplanar X rays with 3D reconstruction of the spine and pelvis. The following sagittal spino-pelvic parameters were generated from the 3D reconstructions: pelvic incidence, sacral slope, pelvic tilt, L1L5 lordosis, L1-S1 lordosis, T1-T12 kyphosis and T4-T2 kyphosis. Lower limb kinematics was assessed using 3D gait analysis. Each subject was classified into one of the 4 types of normal sagittal alignment previously described by Roussouly. Kruskal-Wallis test was used to evaluate the differences in gait and spino-pelvic parameters between the Roussouly types.While curvatures of the sagittal spine are known to greatly differ among asymptomatic adult subjects, there are no studies that determine whether this heterogeneous normality affects gait. This study aimed to elucidate the relationships between normal sagittal spine profiles and gait in asymptomatic adult subjects. Ninety-one asymptomatic adult subjects (age = 21.6 ±2.2, 47 M & 44F) with no prior orthopedic treatment underwent full body biplanar X rays with 3D reconstruction of the spine and pelvis. The following sagittal spino-pelvic parameters were generated from the 3D reconstructions: pelvic incidence, sacral slope, pelvic tilt, L1L5 lordosis, L1-S1 lordosis, T1-T12 kyphosis and T4-T2 kyphosis. Lower limb kinematics was assessed using 3D gait analysis. Each subject was classified into one of the 4 types of normal sagittal alignment previously described by Roussouly. Kruskal-Wallis test was used to evaluate the differences in gait and spino-pelvic parameters between the Roussouly types