CT-derived relationship between low relative muscle mass and bone damage in patients with multiple myeloma undergoing stem cells transplantation

Objectives: Sarcopenia or low muscle mass is related to worse prognosis in cancer patients. We investigated whether muscle mass is related to bone damage on Computed Tomography in patients with multiple myeloma. Methods: Approval from the institutional review board was obtained. N = 74 consecutive patients (mean age, 60.8 years ± 9.24 [standard deviation]; range, 36–89 years) for MM who underwent transplant were included. Sarcopenia cut-off points defined as Skeletal Muscle Index (SMI) used were <41 cm2/m2. To assess bone damage in MM the MSBDS (Myeloma Spine and Bone Damage Score) was used. One-way analysis of variance and the X2 test were used. Kaplan–Meier analysis was performed to generate progression and survival curves according to SMI and MSBDS. The testing level was set at 0.05. Results: The median SMI was 47.1 ± 14.2 and according to SMI 18/74 (24%) had sarcopenia which was more prevalent in female s(p.001). A strong and significant association between patients with low muscle mass and elevated bone damage (24/74, 32.4%) and patients with normal/non-low muscle mass low bone damage (30/74, 40.5%) was present. Multiple Logistic regression did not show any significant relationship or confounding influence among SMI and MSBDS regarding sex (p.127), cytogenetic status (p.457), staging (p.756) and relapse (.126). Neither SMI nor MSBDS resulted significantly related to overall survival as shown in Kaplan–Meier analysis. Conclusions: Sarcopenia and bone damage affected MM patients undergoing stem cell transplantation and are significantly associated. Advances in knowledge: Quantitative measurement of sarcopenia and bone damage on CT resulted present in MM patients undergoing stem cell transplantation and are significantly associated.

Artificial Intelligence and COVID-19 Using Chest CT Scan and Chest X-ray Images: Machine Learning and Deep Learning Approaches for Diagnosis and Treatment

Objective: To report an overview and update on Artificial Intelligence (AI) and COVID-19 using chest Computed Tomography (CT) scan and chest X-ray images (CXR). Machine Learning and Deep Learning Approaches for Diagnosis and Treatment were identified. Methods: Several electronic datasets were analyzed. The search covered the years from January 2019 to June 2021. The inclusion criteria were studied evaluating the use of AI methods in COVID-19 disease reporting performance results in terms of accuracy or precision or area under Receiver Operating Characteristic (ROC) curve (AUC). Results: Twenty-two studies met the inclusion criteria: 13 papers were based on AI in CXR and 10 based on AI in CT. The summarized mean value of the accuracy and precision of CXR in COVID-19 disease were 93.7% ± 10.0% of standard deviation (range 68.4–99.9%) and 95.7% ± 7.1% of standard deviation (range 83.0–100.0%), respectively. The summarized mean value of the accuracy and specificity of CT in COVID-19 disease were 89.1% ± 7.3% of standard deviation (range 78.0–99.9%) and 94.5 ± 6.4% of standard deviation (range 86.0–100.0%), respectively. No statistically significant difference in summarized accuracy mean value between CXR and CT was observed using the Chi square test (p value > 0.05). Conclusions: Summarized accuracy of the selected papers is high but there was an important variability; however, less in CT studies compared to CXR studies. Nonetheless, AI approaches could be used in the identification of disease clusters, monitoring of cases, prediction of the future outbreaks, mortality risk, COVID-19 diagnosis, and disease management.

LSB steganography detection in monochromatic still images using artificial neural networks

Embedding graphic content in multimedia through steganography is a useful and fast practice to hide information. However, detecting the use of this technique is complex and sometimes unsuccessful because variations are not visually perceptible. This article proposes the use of a binary classification model based on artificial neural networks to detect the presence of LSB steganography on monochromatic still images of 256x256 and 8 bits, based on the Standford Genome Project. The steganograms were generated by varying the payload from 0.1 to 0.5 to obtain image pairs of carriers and steganograms. For each steganogram, the following features were extracted from image histograms: kurtosis, skewness, standard deviation, range, median, harmonic mean, Hjorth mobility, and complexity. The results show that the classifier reaches a 91.45% accuracy in detecting LSB steganography when learning from all payloads, as well as a 96.78% individual classification accuracy in the best case with a payload of 0.5.

Conjunctivitis and other ocular findings in patients with COVID-19 infection

BACKGROUND: COVID-19 is an acute respiratory illness caused by a novel coronavirus (SARS-CoV-2). COVID-19 that might affect the eye in the form of conjunctivitis and other ocular features. OBJECTIVES: Assess the frequency and clinical profile of conjunctivitis and other ocular findings in Iraqi patients with confirmed COVID-19 infection. DESIGN: Analytical cross-sectional study. SETTING: Secondary care center. PATIENTS AND METHODS: This study involved patients diagnosed with SARS-CoV-2 viral infection of variable disease severity from June 2020 to December 2020. Ocular history and the severity of SARS-CoV-2 viral infection was assessed for all of the patients. MAIN OUTCOME MEASURES: Frequency of conjunctival inflammation and other ocular findings in patients with coronavirus infection. SAMPLE SIZE: 186 patients. RESULTS: The patients had a mean (standard deviation, range) age of 44.4 (18.8, 18–78) years. Conjunctivitis was present in 25 patients (13.4%). There was no significant association between prevalence of conjunctivitis and patient gender ( P =.868). However, conjunctivitis was significantly associated with the severity of the disease ( P =.018): the rate of conjunctivitis was significantly higher in cases with severe disease (28%) in comparison with those with mild to moderate clinical presentation (9.3%). The natural course of conjunctivitis seemed to be mild with no effect on visual acuity and no short-term complications. CONCLUSION: Conjunctivitis can occur in patients with SARS-CoV-2 viral infection, and could be a presenting sign. Conjunctivitis is more common in cases of severe COVID-19 infection and since it could be a presenting sign it might be of benefit in the early diagnosis and treatment of COVID-19. LIMITATION: Single-center study, safety limitations in the examination of the patients. CONFLICT OF INTEREST: None.

Anatomy of the Sciatic Nerve in Relation to the Bernese Periacetabular Osteotomy: A Cadaveric Study

Prior studies have examined the role of hip and knee positioning, specifically hip extension and knee flexion, to reduce the risk of sciatic nerve palsy during the Bernese periacetabular osteotomy. They have qualitatively noted that the sciatic nerve moves farther from the connection between the ischial and posterior column osteotomies in hip extension than flexion but has not precisely measured this change in position. This cadaveric study aimed to quantitatively evaluate how hip positioning affects the location of the sciatic nerve relative to the connection between the ischial and posterior column osteotomies. We dissected four cadaveric specimens (three females and one male) with a mean age of 83.0 ± 7.8. An anterior Smith–Peterson approach was performed to allow the cuts for the periacetabular osteotomy (PAO). A posterolateral approach was taken to identify the sciatic nerve and its emergence from the pelvis. Measurements were performed on the width of the posterior column and, in both hip flexion and extension, the distance from the emergence of the sciatic nerve from the pelvis to the connection point between the ischial and posterior column osteotomies. Each measurement was performed independently by two observers. All data are reported as a mean ± standard deviation (range). The width of the posterior column was 4.84 ± 0.48 cm (range: 4.20–5.35 cm). The distances from the sciatic nerve's emergence to the osteotomy connection point in extension and flexion were 4.73 ± 0.79 and 2.93 ± 0.85 cm, respectively. The distance from the sciatic nerve's emergence to the osteotomy connection point was significantly greater in hip extension than hip flexion (p = 0.021). When the hip is flexed, the distance from the sciatic nerve to the posterior column osteotomy connection point is significantly less than when it is in extension. This anatomic finding is essential for surgical safety, as it provides further evidence on the importance of positioning for reducing the risk of sciatic nerve injury during a PAO.

Klasifikasi Makna Tangisan Bayi Menggunakan CNN Berdasarkan Kombinasi Fitur MFCC dan DWT

Menangis merupakan cara bayi untuk berkomunikasi. Suara tangisan tersebut dapat digunakan untuk mengidentifikasi masalah pada bayi, seperti kelaparan, kesakitan, rasa kantuk, kelelahan, rasa tidak nyaman, kedinginan atau kepanasan, dan lain-lain. Namun, tidak semua orang dapat mengenali makna tangisan bayi tersebut. Kombinasi dari fitur MFCC dan DWT digunakan pada penelitian ini sebagai fitur ekstraksi pada suara tangisan bayi. Pada penelitian ini, metode Convolutional Neural Network (CNN) digunakan untuk klasifikasi makna suara dari tangisan bayi. Dataset yang digunakan pada penelitian ini adalah dataset publik yang terdiri dari total 61 data training dan 30 data testing. Jenis tangisan bayi yang digunakan pada penelitian ini adalah lapar, lelah, rasa tidak nyaman, dan sakit perut. Berdasarkan hasil pengujian, fitur MFCC dan CNN didapatkan precision sebesar 32,76%, recall sebesar 32,63%, dan accuracy sebesar 73,33%. Kombinasi fitur MFCC dan DWT (Mean, Standard Deviation, Range, Max) dan CNN didapatkan precision sebesar 50,91%, recall sebesar 44,23%, dan accuracy sebesar 73,33%.

The prevalence of spondylolysis and intervertebral disc degeneration in male pole vaulters

BACKGROUND: The lower back is the most common injury location in pole vaulters, but the prevalence of lumbar spondylolysis and intervertebral disc degeneration is not known. OBJECTIVE: This study aimed to determine the prevalence of lumbar spondylolysis and intervertebral disc degeneration in pole vaulters. METHODS: This cross-sectional study was conducted in the Tokai area of Japan and included 21 pole vaulters (mean ± standard deviation [range]: age, 22.2 ± 3.2 [18–28] years; height, 172.2 ± 4.7 [165.0–182.0] cm; body weight, 67.6 ± 7.3 [54.0– 80.0] kg). The majority of pole vaulters were collegiate athletes. We performed anterior, lateral, and oblique radiography at 45∘ and magnetic resonance imaging in the sagittal and coronal planes of the lumbar spine. The evaluation was performed independently of whether the athletes had lower back pain (LBP). Moreover, we investigated the duration of pole-vaulting experience and history and current presence of LBP using a questionnaire. RESULTS: The prevalence of lumbar spondylolysis and intervertebral disc degeneration was 28.6% (6/21) and 38.1% (8/21), respectively. Herniation was found in six discs in four vaulters (19.0%). All athletes had a history of LBP. The prevalence of lumbar spondylolysis was high (28.6%). CONCLUSIONS: Sport-specific movements performed by pole vaulters may be a risk factor for lumbar spondylolysis.

Assessment of Hypofluorescent Foci on Late-Phase Indocyanine Green Angiography in Central Serous Chorioretinopathy

To assess the hypofluorescent foci (HFF) on late-phase indocyanine green angiography (ICGA) in central serous chorioretinopathy (CSC) using short-wavelength fundus autofluorescence (SW-FAF), near-infrared autofluorescence (NIR-AF), and fluorescein angiography (FA). The HFF area on late-phase ICGA for at least 20 min was compared with the area of abnormal foci on SW-FAF, NIR-AF, and FA. In 14 consecutive patients (12 men, including 1 with bilateral CSC; and 2 women with unilateral CSC), four kinds of images of 27 eyes were acquired. The mean age ± standard deviation (range) was 46 ± 9.2 years (31–69 years). The HFF on late-phase ICGA were found in 23 eyes (in all 15 CSC eyes and the contralateral 8 eyes). From the results of simple regression analysis, we obtained the following three formulas. The HFF area on ICGA = 1.058 × [abnormal SW-FAF area] + 0.135, the HFF area on ICGA = 1.001 × [abnormal NIR-AF area] + 0.015, and the HFF area on ICGA = 1.089 × [abnormal FA area] + 0.135. Compared to SW-FAF and FA, NIR-AF was found to be the easiest method to detect the HFF on late-phase ICGA, which may indicate melanin abnormalities, especially a decrease, in the retinal pigment epithelium.

Dehydroepiandrosterone Sulfate, Cortisol and Adrenocorticotropic Hormone Levels in Drug-Naive, First Episode, Male and Female Patients With Psychosis

Introduction: Impaired response to stress and a pathological activation of the hypothalamic-pituitary-adrenal axis have been implicated in the pathophysiology of schizophrenia. We aimed to measure serum dehydroepiandrosterone sulfate (DHEA-S), cortisol and adrenocorticotropic hormone (ACTH) levels in drug-naïve, first episode patients with psychosis followed-up in a Greek tertiary center. Methods: Data were included from drug-naïve, first episode patients with psychosis and controls matched for age and sex. Serum DHEA-S, cortisol and ACTH levels were recorded. Results are reported as mean (standard deviation, range). Paired t-test or Wilcoxon signed rank test were performed for group comparisons. The level of significance was set at p less than 0.05. Statistical analysis was performed with Stata 15.1. Results: Data were included for 110 subjects (70 men, 40 women); 55 patients and 55 controls. Mean age was 31.3 years (8.7, 18.0-48.0) in patients and 31.4 years (8.9, 17.0-49.0) in controls. Serum DHEA-S was higher in patients [306.5 μg/dl (165.4, 70.0-790.0)] compared to controls [240.1 μg/dl (113.5, 46.0-597.0)] (p=0.011). Serum ACTH was similar between patients and controls [28.5 pg/ml (15.7, 6.2-73.9) versus 26.5 pg/ml (15.3, 7.0-70.5), p=0.636]. Serum cortisol levels and cortisol/DHEA-S ratio were statistically lower in patients [12.6 μg/dl (4.5, 3.5-24.5) and 5.3 (3.6, 1.3-19.5), respectively] compared to controls [15.5 μg/dl (4.9, 4.2-30.1) and 8.0 (4.7, 1.1-25.5), respectively] (p=0.007 and 0.001, respectively). Sub-analysis, revealed that in men, serum DHEA-S was similar between patients and controls [303.7 μg/dl (149.0, 85.0-744.0) versus 275.0 μg/dl (117.4, 89.0-597.0), respectively, p=0.271) whereas in women serum DHEA-S was higher in patients compared to controls [311.4 μg/dl (194.8, 70.0-790.0) versus 179.2 μg/dl (75.9, 46.0-314.0), respectively, p=0.005]. Serum cortisol and ACTH levels were not different in the above subgroups except serum cortisol in men which was lower in patients compared to controls [12.8 μg/dl (4.4, 3.5-21.6) and 15.9 μg/dl (5.4, 4.2-30.1), respectively, p=0.027]. Conclusions: Serum DHEA-S levels were higher in drug-naïve, first episode female patients, with psychosis compared to controls. DHEA-S levels in male patients and controls were similar.

Tractography for Subcortical Resection of Gliomas Is Highly Accurate for Motor and Language Function: ioMRI-Based Elastic Fusion Disproves the Severity of Brain Shift

When using preoperative tractography intraoperatively, inaccuracies due to brain shift might occur. Intraoperative tractography is rarely performed. Elastic fusion (EF) is a tool developed to compensate for brain shift, gravity, and tissue resection based on intraoperative images. Our hypothesis was that preoperative tractography is accurate and adjustments of tractography by intraoperative magnetic resonance imaging (ioMRI)-based EF (IBEF) compensate for brain shift. Between February 2018 and June 2019, 78 patients underwent eloquent (46 motor, 32 language) glioma resection in our department using intraoperative MRI. Mean distances between the resection cavity and tractography were analyzed and correlated with clinical outcomes. The mean ± standard deviation (range) distance after the application of IBEF was 5.0 ± 2.9 mm (0–10 mm) in patients without surgery-related motor deficits compared with 1.1 ± 1.6 mm (0–5 mm) in patients who showed new permanent surgery-related motor deficits postoperatively (p < 0.001). For language, the distance was 0.7 ± 1.2 mm (0–2 mm) in patients with new permanent deficits compared with 3.1 ± 4.5 mm (0–14 mm) in patients without new permanent surgery-related language deficits (p = 0.541). Preoperative tractography corrected by IBEF for subcortical resection of gliomas is highly accurate. However, at least for such subcortical anatomy, the severity of brain shift was considerably overestimated in the past.