Joint Segmentation and Groupwise Registration of Cardiac Perfusion Images Using Temporal Information

We propose a joint segmentation and groupwise registration method for dynamic cardiac perfusion images that uses temporal information. The nature of perfusion images makes groupwise registration especially attractive as the temporal information from the entire image sequence can be used. Registration aims to maximize the smoothness of the intensity signal while segmentation minimizes a pixel’s dissimilarity with other pixels having the same segmentation label. The cost function is optimized in an iterative fashion using B-splines. Tests on real patient datasets show that compared with two other methods, our method shows lower registration error and higher segmentation accuracy. This is attributed to the use of temporal information for groupwise registration and mutual complementary registration and segmentation information in one framework while other methods solve the two problems separately.     

基于THE和QS评价指标的医学学科排名体系构建

目的：分析医学学科国际排名的影响因素，为我国医学学科发展提供参考。方法：在THE、QS排名指标的基础上，构建新的医学学科排名指标体系，运用统计学软件SPSS 24.0分析100所高水平医学大学的类型、特征，揭示不同类型大学的优势、劣势。结果：教育教学是各类型大学学科发展核心，亚洲大学国际化水平偏低，科研论文在THE和QS排名中作用有限，国内大学享有较好的国际声誉。结论：在我国医学学科建设中，应注重教学品质，重视高质量科研成果的产出，加快国际交流与合作、继续提升国际声誉。     

A concomitant case of giant cell arteritis and microscopic polyangiitis with hemoperitoneum by rupture of the gastroepiploic artery

Abstract

Giant cell arteritis (GCA) mainly involves large-sized arteries, while microscopic polyangiitis (mPA), characterized by pauci-immune necrotizing vasculitis, mainly affects small-sized vessels. We report a very rare concomitant case of GCA diagnosed by temporal artery biopsy and mPA with a high titer of myeloperoxidase antineutrophil cytoplasmic antibody, exacerbation of interstitial pneumonia, and suspected rapidly progressive glomerulonephritis. The patient died by sudden rupture of the gastroepiploic artery (medium-sized vessel), which may have been triggered by GCA and/or mPA.     

Marked decrease in acquired resistance to antiretrovirals in latest years in Italy

ObjectivesThe aim of this study was to evaluate acquired drug resistance in Italy in the 2009–2018 period.MethodsWe analysed 3094 patients from the Italian ARCA database who had failed antiretroviral treatment and who had received a genotypic test after 6 months of treatment. Drug resistance mutations were identified using International AIDS Society (IAS)-USA tables and the Stanford HIVdb algorithm. The global burden of acquired resistance was calculated among all subjects with antiretroviral failure. Time trends and correlates of resistance were analysed using standard statistical tests.ResultsPatients of non-European origin and non-B subtypes increased significantly from 11.5% (103/896) to 19.2% (33/172) and from 13.1% (141/1079) to 23.8% (53/223), respectively, over time. Overall, 14.5% (448/3094), 12.1% (374/3094) and 37.8% (1169/3094) of patients failed first, second and later lines, respectively. According to both IAS and HIVdb, in the study period resistance to any class, nucleoside reverse inhibitor, non-nucleoside reverse inhibitor, and protease inhibitors (PIs) declined significantly. Integrase strand transfer inhibitor (INSTI) resistance declined significantly from 31% (36/116) to 20.8% (41/197) according to HIVdb but not to IAS. Divergent data were highlighted regarding the proportion of non-European patients carrying any, PI and INSTI resistance using IAS tables compared with the Stanford HIVdb algorithm, as the former failed to detect a decrease in resistance while the latter indicates a reduction of 1.6-, 5- and 1.8-fold resistance for such drug classes. In the multivariate analysis, the risk of resistance increased in patients with a larger number of treatment lines and higher viraemia and decreased in those starting therapy in the last biennium of the study.DiscussionA marked reduction in drug resistance was observed over 10 years, compatible with higher genetic barrier and potency of new antiretrovirals. Nonetheless, concerns remain for subjects with non-B subtypes when using mutation lists instead of interpretation systems because of the extensive polymorphism of the protease region.     

Reading impairment in an adolescent with temporo-occipital epilepsy. Pre- and post-surgical evaluation

We present a 16 year-old right-handed case who underwent a left temporo-occipital resection to treat intractable epilepsy. Pre- and post-surgical evaluations showed an average intellectual quotient, preserved abilities in language and visuo-spatial functions and increased reading and spelling deficits (difficulties with irregular words, homophones and phonologically valid spelling errors of irregularly spelled words, associated with preserved performances in non-words). This pattern of characteristic lexical route deficits highlights the major role of the temporo-occipital areas in reading acquisition. We discussed the consequences of temporo-occipital dysfunction on reading.     

A novel region-based level set method initialized with mean shift clustering for automated medical image segmentation

Appropriate initialization and stable evolution are desirable criteria to satisfy in level set methods. In this study, a novel region-based level set method utilizing both global and local image information complementarily is proposed. The global image information is extracted from mean shift clustering without any prior knowledge. Appropriate initial contours are obtained by regulating the clustering results. The local image information, as extracted by a data fitting energy, is employed to maintain a stable evolution of the zero level set curves. The advantages of the proposed method are as follows. First, the controlling parameters of the evolution can be easily estimated by the clustering results. Second, the automaticity of the model increases because of a reduction in computational cost and manual intervention. Experimental results confirm the efficiency and accuracy of the proposed method for medical image segmentation.     

Directional Hearing,Temporal Order and Auditory Pattern in Peripheral and Brain Stem Lesions

Tests have been applied to the following subjects: (1) 25 normal individuals; (2) the same individuals during temporary impairment of the brain stem by barbiturate (3 mg/kg); (3) 32 patients affected by acute nucleo-reticular vestibular syndrome; (4) 7 patients affected by unilateral Menière's disease, and (5) 1 patient affected by acoustic neuroma with well preserved hearing

Directional hearing was tested by changing the DLi and DLt two pure tones (400 and 600 Hz) presented through earphones or two fixed loudspeakers placed at 30 from the azimuth and with balanced intensity: temporal order and auditory patterns were tested with the same frequencies by changing the DLt or the order of presentation of the stimuli at fixed intensity

On the basis of the results obtained in the normal subjects, a distinction can be made between the patients affected by brain stem impairment and those affected by Menière's disease. In these patients it was very difficult to obtain reliable discriminations due to the failure of the affected cochlea, especially during an acute phase of the disease, to perform adequate time, intensity and frequency analysis

In brain stem patients, spontaneous or pharmacological, the directional hearing judgments were impaired whereas temporal order and auditory pattern discrimination were normal. It is suggested, therefore, that these various central-hearing tests do not investigate analogous performances, but on the contrary different ones. This difference can be attributed to different structures, or to different performance along the same pathways but also to an identical structure of different sensitivity to the noxious agents     

Brief-Tone Audiometry in Persons Treated with Salicylate

The ability to integrate acoustic energy over a period of time has been measured by brief-tone audiometry on 14 young persons treated with salicylate and after the salicylate has been excreted. The investigation showed that the temporal integration can be reversible reduced by salicylate treatment, and a relation was demonstrated between the change in temporal integration and the salicylate concentration in the blood. As the test persons had had general anaesthesia, a control test was performed on seven persons. It was shown that anaesthesia does not influence temporal integration. Experimental investigations have shown that the hearing loss produced by salicylate is due to an inhibition of enzymatic systems in the cochlea

Taking into consideration the results of brief-tone audiometry and the cochlear effect of the salicylates, one must conclude that reduced cochlear function caused reduced temporal integration     

Inflammation of Embryonic Connective Tissue in the Middle Ear Spaces

Objective --Persistent embryonic connective tissue has been considered to be a cause of chronic otitis media with effusion in neonates and of cholesteatoma in later life. As part of a study of pneumatization and resorption of embryonic connective tissue from the middle ear of pre- and postnatal infants, inflammatory processes of variable extents have been observed within the embryonic connective tissue. The aim of the present study was to characterize this inflammation and to detect patterns in its presence and distribution. Material and Methods --Twenty fetal temporal bones obtained at 4-8 months of development and 31 temporal bones from children who died of sudden infant death syndrome aged < 1 year were studied to assess the inflammation within the middle ear cleft and specifically in the embryonic connective tissue. Results --Sixteen of 27 (59.3%) pre- and 10/31 (32.2%) postnatal specimens displayed a non-specific inflammatory lymphocytic infiltration without signs of bacterial infection or the presence of or reaction to amniotic contents. Eleven of 27 prenatal temporal bones (40.7%) and 16/31 (51.6%) postnatal specimens showed no evidence of histologic middle ear inflammation. The presence or absence of inflammation was independent of age. Conclusion --Our observations indicate resorption of the embryonic connective tissue with individual variations indicating that genetic factors are responsible for the development of the middle ear spaces during the phases of development studied.