Acceptance of artificial intelligence (AI) and machine learning (ML) among radiologists in Saudi Arabia

Artificial intelligence (AI) and machine learning (ML), in the new age of technological progress, provide huge benefits to every area of employment, ranging from IT to health care. To assess the knowledge of, attitude towards, and in-practice use of artificial intelligence and machine learning among radiology residents and faculty radiologists. A web-based questionnaire was distributed via Google Drive to 55 radiologists in the central region of the Kingdom of Saudi Arabia. The questionnaire comprised two sections: three questions regarding demographics and three questions regarding the knowledge, attitudes, and practices (KAP) of AI and ML in radiology. A total of 55 respondents (100%) completed the survey. The majority of respondents claimed familiarity with AI and ML (61.8%). Most radiologists (54.5%) expressed mixed feelings regarding the benefits of AI and ML applications in radiology. Regarding usability, a mixed response was received: 49.1% supported its usability and 45.5% were uncertain of the usability of AI and ML in radiology. Several studies have been conducted which have suggested the usability of AI and ML and their incorporation into the radiology department. The majority of radiologists in Saudi Arabia support the use of AI and ML. Further investigation into the usability of these tools is needed.

Low Cost, User-Controlled Peroneal Stimulator for Foot Drop in Patients With Stroke

Foot drop is a common disabling condition following stroke. It has been conventionally managed using an ankle foot orthosis (AFO). An alternate rehabilitation option is the functional electrical stimulation (FES) systems that has undergone numerous improvisations over past few decades to make it more efficient and user friendly. This chapter aims to evaluate a prototype low-cost FES device in an Indian rehabilitation set-up to match the patients' cultural and socio-economic needs. It illustrates a pilot study designed to test the orthotic and clinical efficacy of the device in terms of dynamic ankle angle change during ambulation and comparing the walking speed and endurance with the AFO. A significant change with nearly two-thirds of normal ankle angle change during swing phase of the gait cycle was observed with nearly equivalent orthotic effects in terms of walking endurance and speed. In terms of receptivity, the device received a mixed response from the patients regarding its effectiveness as an orthosis.

Assessment of Psychology, Behaviour and Self-Medication Potential Among Indian People During CovID-19 Pandemic

Aim: This research work was done during the Indian festive season of 2020 to assess the attitude, mentality and psychological pattern of Indians. Also, the effect of yoga and meditation in combating the Covid-19 pandemic related stress was analyzed in the present research work. As Paracetamol and Diclofenac are OTC medications which are widely available without doctor’s prescription, the potential of self-medication for these drugs amidst the pandemic need to be studied, this study further attempted to analyze the rate and extent of self-medication of these drugs among Indians. Materials and Methods: An e-questionnaire survey bearing questions on pandemic-related mental stress, sleep duration, yoga, meditation practice, and extent of self-medication in combating the pandemic was floated to the residents of Bengaluru to collect their response. The collected data were analyzed using Statistical Package for the Social Sciences software version 17. Results: A mixed response regarding their stress, anxiety, and fear expressed on a higher scale was the same before or during Covid could be perceived. The sleep pattern before and during CoVid had no significant variation (p>0.05) and appeared the same. All the respondents agreed that they spend considerable time with electronic gadgets during the Covid lockdown period. Most of the respondents (60%) practice yoga and meditation occasionally or daily. The high rate of self-medication with Paracetamol and Diclofenac drugs among Indian people in the current pandemic situation shows they are OTC and readily available. The self-medication practice is of real concern as it may cause a long-term impact on the consumers.

Durable Metastatic Melanoma Remission Following Pembrolizumab and Radiotherapy: A Case Report of Prophylactic Immunosuppression in a Patient with Myasthenia Gravis and Immune-Mediated Colitis

Immune checkpoint inhibitors (ICIs) and radiotherapy (RT) combinations for various metastatic cancers are increasingly utilized, yet the augmentation of anti-cancer immunity including distant tumor responses by RT remains ill-characterized. Immunosuppressive tumor microenvironments and defective anti-tumor immune activation including immune-related adverse events (irAEs) likely limit dramatic immuno-radiotherapy combinations, though it remains unclear which immune characteristics mediate dramatic systemic tumor regression in only a small subset of patients. Moreover, the efficacy of ICI treatment in patients receiving immunosuppressive therapies for autoimmune conditions or irAEs is convoluted, yet clinically valuable. Here, we report a case of a 75-year-old man with myasthenia gravis and metastatic melanoma who experienced complete and durable systemic regression after receiving pembrolizumab and single-lesion RT while on prednisone for myasthenia gravis prophylaxis and vedolizumab for immune-mediated colitis after previously experiencing mixed response on pembrolizumab monotherapy. We discuss the potential paradoxical effects and clinical considerations of immunosuppressive regimens in patients with underlying autoimmune disease or adverse immune reactions while receiving immuno-radiotherapy combinations.

The Impact of Dynamic Convergence on the Human Visual System in Head Mounted Displays

<p>The Accommodation-Vergence Conflict (AVC) is a phenomenon in the area of Head-Mounted Displays (HMDs) and one of the key issues hindering the popularity of HMDs largely due to it causing a large number of users to suffer from simulator sickness. There have been several proposed solutions developed by previous researchers, including the introduction of 'Dynamic Convergence' (DC) which, addresses the AVC problem in terms of the vergence depth cue. DC also helps in the performance of binocular fusion when viewing at a close vergence depth. As of yet however, DC has not undergone detailed testing for a number of important cases, which limits the amount of data that has been collected on DC's interaction with the human visual system. In addition, no DC research as of yet has dealt with the effect of a change in vergence depth, and how that change in the vergence angle of the focal plane would effect a user. Thus, this thesis adds to the growing body of research and knowledge in this field by implementing DC with the addition of some transitions between a change in vergence depth. This is done within the Unity3D game engine in order to further investigate the impact of DC with regard to viewing close virtual objects on HMDs through a number of cases. The added transitions are also tested to see if they have any beneficial effects for users when the vergence angle changes. The investigation is centered around a perception based performance/appreciation-oriented visual study whereby participants were asked about their ability to perform binocular fusion on close virtual objects that were either stationary or moving and varying distances and speeds. Participants were also asked to report any symptoms of discomfort. The research has adopted a mixed methodology experimental approach by conducting user experiments and surveys, before analysing the results through both in-depth quantitative statistical analysis and a variety of qualitative statistical techniques in order to measure and investigate the scale of the problem associated with the impact of DC on the human visual system in HMDs when viewing close virtual objects. From the investigation it was confirmed that the approximate effective vergence depth range for DC was 0.3m or less, with statistical significance confirmed at the 0.15m distance. Participants reported having an easier time performing binocular fusion at these closer distances while DC was enabled. As a result of this, the majority of cases and scenarios did not report any significant negative responses in terms of discomfort symptoms. However attempts at improving DC with a transition between vergence depths were met with a mixed response from participants. While the need of a transition way be dependent on the user, there still exists some demand for one, thus it should still be available as an option.</p>

The Impact of Dynamic Convergence on the Human Visual System in Head Mounted Displays

<p>The Accommodation-Vergence Conflict (AVC) is a phenomenon in the area of Head-Mounted Displays (HMDs) and one of the key issues hindering the popularity of HMDs largely due to it causing a large number of users to suffer from simulator sickness. There have been several proposed solutions developed by previous researchers, including the introduction of 'Dynamic Convergence' (DC) which, addresses the AVC problem in terms of the vergence depth cue. DC also helps in the performance of binocular fusion when viewing at a close vergence depth. As of yet however, DC has not undergone detailed testing for a number of important cases, which limits the amount of data that has been collected on DC's interaction with the human visual system. In addition, no DC research as of yet has dealt with the effect of a change in vergence depth, and how that change in the vergence angle of the focal plane would effect a user. Thus, this thesis adds to the growing body of research and knowledge in this field by implementing DC with the addition of some transitions between a change in vergence depth. This is done within the Unity3D game engine in order to further investigate the impact of DC with regard to viewing close virtual objects on HMDs through a number of cases. The added transitions are also tested to see if they have any beneficial effects for users when the vergence angle changes. The investigation is centered around a perception based performance/appreciation-oriented visual study whereby participants were asked about their ability to perform binocular fusion on close virtual objects that were either stationary or moving and varying distances and speeds. Participants were also asked to report any symptoms of discomfort. The research has adopted a mixed methodology experimental approach by conducting user experiments and surveys, before analysing the results through both in-depth quantitative statistical analysis and a variety of qualitative statistical techniques in order to measure and investigate the scale of the problem associated with the impact of DC on the human visual system in HMDs when viewing close virtual objects. From the investigation it was confirmed that the approximate effective vergence depth range for DC was 0.3m or less, with statistical significance confirmed at the 0.15m distance. Participants reported having an easier time performing binocular fusion at these closer distances while DC was enabled. As a result of this, the majority of cases and scenarios did not report any significant negative responses in terms of discomfort symptoms. However attempts at improving DC with a transition between vergence depths were met with a mixed response from participants. While the need of a transition way be dependent on the user, there still exists some demand for one, thus it should still be available as an option.</p>

Projections of CMIP5 evaporation data sets under future climate change scenarios and comparison with estimates from the observations over peninsular India

Present study commences from the time series analysis of evaporation data sets obtained from the Coupled Modeled Inter comparison Project of Phase 5 (CMIP5) for the study period 1979 to 2100 under the RCP 4.5 and 8.5 emission scenarios over Interior Peninsular region during the Northeast monsoon (October to December) period. Further, a comparative analysis has been carried out with the evapotranspiration (ET) estimated from the Hargreaves and Samani (1982) using the temperature data of India Meteorological Department for the period 1979 to 2005. Our results show that evaporation trends are increasing with more prominence in RCP 8.5 scenario. This increase in evaporation has been attributed to increase in air temperature which is an undisputed fact under future climate change scenario. Different climate models of CMIP5 show mixed response by displaying the positive and negative correlations with the Hargreaves ET over the study region. The results of the study will be useful in understanding the bias between the modeled data sets and the estimates of ET from the observations.

Daratumumab Plus Chemotherapy Induces Complete Responses in a Consecutive Series of Four Patients with Plasmablastic Lymphoma

Introduction:Plasmablastic lymphoma (PBL) is a rare and aggressive lymphoma most commonly seen in the setting of chronic immunosuppression, such as HIV infection and organ transplantation, or in patients with pre-existing lymphoproliferative or autoimmune disorders. PBL commonly presents at extranodal sites and carries a poor prognosis with a global overall survival of 9-15 months after initial diagnosis. Despite poor prognosis for patients with PBL, therapeutic strategies to target this disease are limited, as CHOP-like regimens have failed to produce durable remission, and no standard of care has been established. The cell of origin for PBL is believed to be the plasmablast, as PBL cells possess immunoblastic morphology and contain an immunohistochemical profile positive for plasmablast markers, such as CD38, CD138, and MUM1/IRF4, and negative for B cell markers, such as CD20, CD19, and PAX5. The similarities between PBL cells and multiple myeloma (MM) cells, a plasma cell neoplasm, have led to investigations of the efficacy of MM therapeutics for the treatment of PBL. Daratumumab is a first-in-class monoclonal antibody directed against CD38 that has shown efficacy in treating relapsed/refractory and newly diagnosed MM. Here, we describe the treatment of four patients with advanced-stage PBL in the context of varying degrees of immunosuppression using combination treatment with daratumumab and EPOCH. Methods:Four consecutive patients were treated with daratumumab plus chemotherapy. Three of the four patients were treated in the frontline setting and received low-dose EPOCH (vincristine, doxorubicin, etoposide daily for 4 days; cyclophosphamide day 5) with 16mg/kg daratumumab dosed on days 1 and 8 for 6 cycles. Patient #4 showed partial CD20 positivity, prompting Rituximab co-administration (R-EPOCH). Patient #3 was treated in the relapsed setting with 16mg/kg daratumumab in combination with lenalidomide, dexamethasone, and doxorubicin. She was treated for 12 months. Responses were followed by PET/CT imaging. Results:The four consecutive patients (2 female, 2 male) ranged in age from 26-88 and all had advanced-stage PBL (Table 1). Three of the four patients had some degree of immunosuppression (Patient #1- post-transplantation lymphoproliferative disorder (PTLD), Patient #2- HIV/AIDS, Patient #3- Chron's disease, Patient #4- no history of immunosuppression). All patients had a Ki67 proliferation index over 70% and demonstrated extranodal involvement of disease (bone n=3, intestine n=2, liver n=2; kidney n=1; adrenal n=1). The three patients that received daratumumab in combination with EPOCH demonstrated a complete response at their first disease assessment by PET/CT scan after cycle 2 (Patient #1) or cycle 4 (Patients #2,4) (Fig1). Patient #3, who demonstrated a mixed response to previous therapy, achieved a complete response 5 months after starting treatment with daratumumab in combination with chemotherapy. As of July 2021, three of the four patients continued to have no evidence of disease for a median of 17 months (range 15-19 months). Patient #4 relapsed in July 2021, 3 months after demonstrating a complete response. Adverse events that required hospitalization were rarely noted following daratumumab treatment but included neutropenic fever (n=2, one event following treatment cycle 4 and the other event 2 months after completion of daratumumab administration), COVID-19 infection (n=1), and a PICC line-associated thrombus (n=1). Minor events were also noted and included self-limiting bradycardia (n=1), neuropathy (n=1), and rigor (n=1). Conclusions:We describe four patients with varying degrees of immunosuppression and HIV-status with aggressive-stage PBL that achieved complete response following treatment with daratumumab in combination with low-dose EPOCH or other chemotherapy. Three of four patients obtained durable responses. At the time of this writing, three additional HIV +patients have initiated treatment with daratumumab but have not yet reached their first disease assessment. Disease progression for these patients will be monitored and presented as part of this study. Our findings suggest a potential efficacy and warrant further investigation of using daratumumab for the treatment of HIV +and HIV - PBLs. Figure 1 Figure 1. Disclosures Amengual: Epizyme, Inc.: Speakers Bureau; Appia Pharmaceuticals: Research Funding; Daiichi Sankyo, Inc: Consultancy; Seagen: Consultancy. OffLabel Disclosure: our work uses daratumumab, a first-in-class monoclonal antibody against CD38 for the treatment of plasmablastic lymphoma

NIMG-28. PROSPECTIVE HISTOPATHOLOGY-VALIDATED MACHINE LEARNING FOR DISTINGUISHING TRUE PROGRESSION FROM TREATMENT-RELATED CHANGES IN GLIOBLASTOMA PATIENTS

PURPOSE Decision making about the best course of treatment for glioblastoma patients becomes challenging when a new enhancing lesion appears in the vicinity of the surgical bed on follow-up MRI (after maximal safe tumor resection and chemoradiation), raising concerns for tumor progression (TP). Literature indicates 30-50% of these new lesions describe primarily treatment-related changes (TRC). We hypothesize that quantitative analysis of specific and sensitive features extracted from multi-parametric MRI (mpMRI) via machine learning (ML) techniques may yield non-invasive imaging signatures that distinguish TP from TRC and facilitate better treatment personalization. METHODS We have generated an ML model on a retrospective cohort of 58 subjects, and prospectively evaluated on an independent cohort of 58 previously unseen patients who underwent second resection for suspicious recurrence and had availability of advanced mpMRI (T1, T1-Gd, T2, T2-FLAIR, DTI, DSC). The features selected by our retrospective model, representing principal components analysis of intensity distributions, morphological, statistical, and texture descriptors, were extracted from the mpMRI of the prospective cohort. Integration of these features revealed signatures distinguishing between TP, mixed response, and TRC. Independently, a board-certified neuropathologist evaluated the resected tissue by blindly classifying it in the above three categories, based on mitotic figures, pseudopalisading necrosis, geographic necrosis, dystrophic calcification, vascular changes, and Ki67. RESULTS Tissues classified as TRC by the neuropathologist were associated with imaging phenotypes of lower angiogenesis (DSC-derived features), lower cellularity (DTI-derived features), and higher water concentration (T2, T2-FLAIR features). Our ML model characterized TP with 78% accuracy (sensitivity:86%, specificity:70%, AUC:0.80 (95%CI, 0.68-0.92)) and TRC with 81% accuracy (sensitivity:80%, specificity:81%, AUC:0.87 (95%CI, 0.72-1.00)). CONCLUSION Our proposed ML model reveals distinct non-invasive markers of TP and TRC, directly associated with histopathological changes in prospective glioblastoma patients. Reliable stratification of TP and TRC entities may help to noninvasively determine whether the course of treatment should change.

7,8-Dihydroxiflavone Maintains Retinal Functionality and Protects Various Types of RGCs in Adult Rats with Optic Nerve Transection

To analyze the neuroprotective effects of 7,8-Dihydroxyflavone (DHF) in vivo and ex vivo, adult albino Sprague-Dawley rats were given a left intraorbital optic nerve transection (IONT) and were divided in two groups: One was treated daily with intraperitoneal (ip) DHF (5 mg/kg) (n = 24) and the other (n = 18) received ip vehicle (1% DMSO in 0.9% NaCl) from one day before IONT until processing. At 5, 7, 10, 12, 14, and 21 days (d) after IONT, full field electroretinograms (ERG) were recorded from both experimental and one additional naïve-control group (n = 6). Treated rats were analyzed 7 (n = 14), 14 (n = 14) or 21 d (n = 14) after IONT, and the retinas immune stained against Brn3a, Osteopontin (OPN) and the T-box transcription factor T-brain 2 (Tbr2) to identify surviving retinal ganglion cells (RGCs) (Brn3a+), α-like (OPN+), α-OFF like (OPN+Brn3a+) or M4-like/α-ON sustained RGCs (OPN+Tbr+). Naïve and right treated retinas showed normal ERG recordings. Left vehicle-treated retinas showed decreased amplitudes of the scotopic threshold response (pSTR) (as early as 5 d), the rod b-wave, the mixed response and the cone response (as early as 10 d), which did not recover with time. In these retinas, by day 7 the total numbers of Brn3a+RGCs, OPN+RGCs and OPN+Tbr2+RGCs decreased to less than one half and OPN+Brn3a+RGCs decreased to approximately 0.5%, and Brn3a+RGCs showed a progressive loss with time, while OPN+RGCs and OPN+Tbr2+RGCs did not diminish after seven days. Compared to vehicle-treated, the left DHF-treated retinas showed significantly greater amplitudes of the pSTR, normal b-wave values and significantly greater numbers of OPN+RGCs and OPN+Tbr2+RGCs for up to 14 d and of Brn3a+RGCs for up to 21 days. DHF affords significant rescue of Brn3a+RGCs, OPN+RGCs and OPN+Tbr2+RGCs, but not OPN+Brn3a+RGCs, and preserves functional ERG responses after IONT.