ANT-UNet: Accurate and Noise-Tolerant Segmentation for Pathology Image Processing

Pathology image segmentation is an essential step in early detection and diagnosis for various diseases. Due to its complex nature, precise segmentation is not a trivial task. Recently, deep learning has been proved as an effective option for pathology image processing. However, its efficiency is highly restricted by inconsistent annotation quality. In this article, we propose an accurate and noise-tolerant segmentation approach to overcome the aforementioned issues. This approach consists of two main parts: a preprocessing module for data augmentation and a new neural network architecture, ANT-UNet. Experimental results demonstrate that, even on a noisy dataset, the proposed approach can achieve more accurate segmentation with 6% to 35% accuracy improvement versus other commonly used segmentation methods. In addition, the proposed architecture is hardware friendly, which can reduce the amount of parameters to one-tenth of the original and achieve 1.7× speed-up.

Práškové částice pro plicní podání

The deposition of a drug to its required destination is crucial for effective lung treatment. It is important to design a suitable formulation that delivers the active ingredient to the desired site and resists the natural cleansing mechanisms of the airways. Large porous particles used as active substance carriers appear to be the most effective option for lung drug delivery. The present article provides a basic overview of the mechanisms of deposition of dry inhalable powders and methods of their preparation and evaluation. Spray drying together with micronization and crystallization techniques are among the most used methods of preparation of the discussed particles. Besides, these techniques can be combined with other production processes (encapsulation, emulsification, etc.). The evaluation of the properties of particles suitable for pulmonary application is based on specific requirements for their density, porosity, shape, aerodynamic parameters, and deposition in the lungs, which can now be simulated on an accurate model of artificial lungs.

The Use of Hydraulic Completion Snubbing Units HCU in Long Laterals in U.S. Shale Plays

Coiled tubing units (CTU) have been used to drill-out frac plugs in shorter horizontal shale wells for the last decade, but coil has mechanical limitations. The new innovative technology of Hydraulic Completion Snubbing Units (HCU) is gaining popularity across North and South America to drill-out frac plugs in long lateral, high-pressure, and multi-well pads. The HCU is designed for drill-outs and interventions where coil may not be the best option. This paper will summarize the recent evolution of the HCU system. Case histories will be provided from the Appalachian and Permian shale plays. The latest HCU consists of a stand-alone unit that mounts on the wellhead after completion. The primary components include the jack assembly, a gin pole, traveling/stationary slips, a redundant series of primary/secondary blowout preventers, a rotary table, power tongs, and an equalize/bleed off loop. Tubing up to 5 ½" is used to carry a downhole motor, dual back pressure values, and the drill bit. Slickwater is used for the drilling fluid to carry out parts from the frac plugs while the tubing is rotated via the jack rotary table. Torque and drag modeling are performed to guide downhole expectations that allow most wells to be drilled in one trip and with one bit without short trips back to the heel or bottom- hole vibration assembly tools. Finally, a remote telemetry data acquisition system has been added that summarizes the drilling data and key performance indicators. In 2016, a North American operator drilled and completed the first super lateral in the Appalachian Basin, setting the completed lateral record at over 18,500 ft. Since then, many operators have been routinely drilling laterals between 12,000 ft and 16,000 ft. HCU technology has been used in the longest laterals in onshore North America, including the lower 48 U.S records for completed lateral length (LL) at 20,800 ft and the total measured depth (MD) record at 30,677 ft. The average lateral contains between 60 to 90 plugs and can be drilled out in 3.5 to 4.5 days. The record number of plugs drilled out by an HCU is 144 and took 5.2 days. High-pressure wells are also routinely encountered where pressures range from 3000 to 8000 psi during operations. Operators are achieving faster drilling times per plug, less chemical usage, faster moves between wells, and running tubing immediately after the drill-out, thus eliminating the need for a service rig. Operator's desire to reach total depth with the least risk and as cost-efficiently as possible resulted in the HCU gaining market acceptance. This paper will showcase the novel evolution of the HCU system that has enabled it to be a safe and effective option for interventions outside of just frac plug drill-outs such as fishing for stuck/parted coil or wireline and installing production tubing/artificial lift systems.

Aviptadil: Class Effect of a Synthetic Vasoactive Intestinal Peptide as a Treatment Option in Patients with COVID-19 with Severe Respiratory Failure

Despite dynamic drug and vaccine development processes to reduce the disease burden of COVID-19, the treatment options are still very limited. Vasoactive intestinal peptide (VIP) has a diversified physiological action with specific features of lung protection-related activities. VIP inhibits severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) gene replication in human monocytes and the viral replication in Calu-3 cells, thus further reducing the generation of proinflammatory mediators. Aviptadil, a synthetic form of VIP, is the only pulmonary therapeutic agent to have been granted ‘fast track’ status by the U.S. Food and Drug Administration (FDA) and to be allowed into both Phase II and III clinical trials. Initial binding of Aviptadil with non-structural protein (nsp) 10 and nsp16, which may inhibit the 2’-O-methyltransferase activity of the SARS-CoV-2 nsp10 and nsp16 complex. Aviptadil has already proved to be an effective option in the treatment of severe respiratory failures due to sepsis and other related lung injuries. Interim analysis results of this drug used in respiratory failure caused by SARS-CoV-2 has evolved a new hope in regard to safety and efficacy. The final results from a recently completed trial, as well as all currently ongoing trials, will clarify the class effect of this drug in the treatment of COVID-19 in future days.

Corrosion Resistance of Electroless Ni-P-W/ZrO2 Nanocomposite Coatings in Peracid Solutions

In current investigation, the Ni-P-W/ZrO2 electroless nanocomposite coatings are deposited upon mild steel substrate (AISI 1040 grade). The W/ZrO2 nanoparticles (50 to 130 nm range) were incorporated separately into acidic electroless Ni-P matrix as a second phase materials. The as-plated EL Ni-P-W/ZrO2 depositions were also heated at 400 οC in Argon atmosphere for one hour duration and analyzed by SEM/EDAX and XRD physical methods. The Ni-P-W/ZrO2 as-plated coupons revealed nebulous type structures while heated coupons showed crystalline structures in both cases. Furthermore Ni-P-ZrO2 coatings have very less cracks and gaps as compared to Ni-P-W coatings. The corrosion tests result in peracid (0.30 ± 0.02 % active oxygen) solutions point up that corrosivity of peracid ( 500 ppm Cl) is more than peracid (0 ppm Cl) and corrosion resistance of tested coupons varies as Ni-P-ZrO2 (as-plated) > Ni-P-ZrO2 (heated) > Ni-P-W (as-plated) > Ni-P-W (heated) > MS. The utilization of Ni-P-ZrO2 nanocomposite coatings in peracid solutions can be considered a cost effective option on the basis of its better cost/strength ratio in addition to its fair corrosion resistance.

Debridement, antibiotics, and implant retention in infected shoulder arthroplasty caused by Serratia marcescens: a case report

Periprosthetic joint infection (PJI) is one of the most devastating complications that can occur after shoulder arthroplasty. Although staged revision arthroplasty is the standard treatment in many cases, surgical intervention with debridement, antibiotics, and implant retention (DAIR) can be an effective option for acute PJI. We report a complex case of infected reverse shoulder arthroplasty (RSA) in a 73-year-old male. The patient had been previously treated for infected nonunion of a proximal humerus fracture caused by methicillin-resistant Staphylococcus epidermidis. He presented with a sinus tract 16 days after the implantation of RSA and was diagnosed with PJI caused by Serratia marcescens. The patient was successfully treated with DAIR and was free of infection at the last follow-up visit at four years postoperatively.

Percutaneous Radiofrequency Ablation Combined With Chemotherapy Versus Chemotherapy Only for Ovarian Cancer Liver Metastasis

PurposeTo compare the feasibility and efficacy of radiofrequency ablation (RFA) combined with chemotherapy and chemotherapy alone in patients with ovarian cancer liver metastasis (OCLM).MethodsIn this retrospective study, a total of 60 patients diagnosed with OCLM between May 2015 to February 2017 were included. All patients with ovarian cancer received chemotherapy and primary cytoreductive surgery before. Thirty patients underwent RFA and chemotherapy, and thirty patients only took chemotherapy. The overall survival (OS), CA-125 levels, and serum AST and ALT levels were compared between the two groups.ResultsIn the RFA group, the 1-,2-, and 3-year OS rates after RFA were 93.3%, 80.0%, and 53.3%, respectively. Serum AST and ALT levels were both elevated after RFA (p=0.0004, p<0.0001). In the chemotherapy group, the 1-,2-, and 3-year OS rates were 79.5%, 60.1%, and 42.1%, respectively. Levels of serum AST and ALT were stable. CA-125 levels for both groups were also available.ConclusionBased on our analysis of a single institution’s series of patients with OCLM, RFA could be a feasibly effective option in the management of OCLM.

Endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence

Background and study aims The role of endoscopic submucosal dissection (ESD) for colorectal lesions in Western communities is unclear and its adoption is still limited. The aim of this study is to assess the long-term outcomes of a large cohort of patients treated with colorectal ESD in a tertiary Western center. Patients and methods A retrospective analysis was conducted on patients treated by ESD for superficial colorectal lesions between February 2011 and November 2019. The primary outcome was the recurrence rate. Secondary outcomes were en-bloc and R0 resection rates, procedural time, adverse events (AEs), and need for surgery. The curative resection rate was assessed for submucosal invasive lesions. Results A total of 327 consecutive patients, median age 69 years (IQR 60–76); 201 men (61.5 %) were included in the analysis. Of the lesions, 90.8 % were resected in an en-bloc fashion. The rate of R0 resection was 83.1 % (217/261) and 44.0 % (29/66) for standard and hybrid ESD techniques, respectively. Submucosal invasion and piecemeal resection independently predicted R1 resections. A total of 18(5.5 %) intra-procedural AEs (perforation:11, bleeding:7) and 12(3.7 %) post-procedural AEs occurred (perforation:2, bleeding: 10). Eighteen adenoma recurrences per 1,000 person-years (15cases, 5.6 %) were detected after a median follow-up time of 36 months. All recurrences were detected within 12 months. No carcinoma recurrences were observed. R1 resection status and intra-procedural AEs independently predicted recurrences with seven vs 150 recurrences per 1,000 person-years in the R0 vs R1 group, respectively. Conclusions Colorectal ESD is a safe and effective option for managing superficial colorectal neoplasia in a Western setting, with short and long-terms outcomes comparable to Eastern studies. En-bloc R0 resection and absence of intra-procedural AEs are associated with reduced risk of recurrence.

Artichoke and Bergamot Phytosome Alliance: A Randomized Double Blind Clinical Trial in Mild Hypercholesterolemia

Botanicals are natural alternatives to pharmacological therapies that aim at reducing hypercholesterolemia. In this context, despite bergamot being effective in modulating lipid profile, some subjects failed to achieve a satisfactory response to supplementation. The aim of this study was to evaluate whether the association of 600 mg of bergamot phytosome® (from Citrus Bergamia Risso) and 100 mg of artichoke leaf standardized dry extract (from Cynara cardunculus L.) can be an alternative in patients with mild hypercholesterolemia who are poor responders to bergamot in a 2-month randomized placebo-controlled trial. Sixty overweight adults were randomized into two groups: 30 were supplemented and 30 received a placebo. The metabolic parameters and DXA body composition were evaluated at the start, after 30 and 60 days. Between the two groups, total and LDL cholesterol in the supplemented group (compared to placebo) showed significant decreases overtime. A significant reduction of waist circumference and visceral adipose tissue (VAT) was recorded in the supplemented group (compared to placebo), even in subjects who did not follow a low-calorie diet. In conclusion, the synergism between Citrus Bergamia polyphenols and Cynara cardunculus extracts may be an effective option and may potentially broaden the therapeutic role of botanicals in dyslipidemic patients.