A comprehensive set of ultrashort echo time magnetic resonance imaging biomarkers to assess cortical bone health: A feasibility study at clinical field strength

INTRODUCTION

Conventional bone imaging methods primarily use X-ray techniques to assess bone mineral density (BMD), focusing exclusively on the mineral phase. This approach lacks information about the organic phase and bone water content, resulting in an incomplete evaluation of bone health. Recent research highlights the potential of ultrashort echo time magnetic resonance imaging (UTE MRI) to measure cortical porosity and estimate BMD based on signal intensity. UTE MRI also provides insights into bone water distribution and matrix organization, enabling a comprehensive bone assessment with a single imaging technique. Our study aimed to establish quantifiable UTE MRI-based biomarkers at clinical field strength to estimate BMD and microarchitecture while quantifying bound water content and matrix organization.

METHODS

Femoral bones from 11 cadaveric specimens (n = 4 males 67-92 yrs of age, n = 7 females 70-95 yrs of age) underwent dual-echo UTE MRI (3.0 T, 0.45 mm resolution) with different echo times and high resolution peripheral quantitative computed tomography (HR-pQCT) imaging (60.7 μm voxel size). Following registration, a 4.5 mm HR-pQCT region of interest was divided into four quadrants and used across the multi-modal images. Statistical analysis involved Pearson correlation between UTE MRI porosity index and a signal-intensity technique used to estimate BMD with corresponding HR-pQCT measures. UTE MRI was used to calculate T1 relaxation time and a novel bound water index (BWI), compared across subregions using repeated measures ANOVA.

RESULTS

The UTE MRI-derived porosity index and signal-intensity-based estimated BMD correlated with the HR-pQCT variables (porosity: r = 0.73, p = 0.006; BMD: r = 0.79, p = 0.002). However, these correlations varied in strength when we examined each of the four quadrants (subregions, r = 0.11-0.71). T1 relaxometry and the BWI exhibited variations across the four subregions, though these differences were not statistically significant. Notably, we observed a strong negative correlation between T1 relaxation time and the BWI (r = -0.87, p = 0.0006).

CONCLUSION

UTE MRI shows promise for being an innocuous method for estimating cortical porosity and BMD parameters while also giving insight into bone hydration and matrix organization. This method offers the potential to equip clinicians with a more comprehensive array of imaging biomarkers to assess bone health without the need for invasive or ionizing procedures.

A dual-stage deep convolutional neural network for automatic diagnosis of COVID-19 and pneumonia from chest CT images

In the Coronavirus disease-2019 (COVID-19) pandemic, for fast and accurate diagnosis of a large number of patients, besides traditional methods, automated diagnostic tools are now extremely required. In this paper, a deep convolutional neural network (CNN) based scheme is proposed for automated accurate diagnosis of COVID-19 from lung computed tomography (CT) scan images. First, for the automated segmentation of lung regions in a chest CT scan, a modified CNN architecture, namely SKICU-Net is proposed by incorporating additional skip interconnections in the U-Net model that overcome the loss of information in dimension scaling. Next, an agglomerative hierarchical clustering is deployed to eliminate the CT slices without significant information. Finally, for effective feature extraction and diagnosis of COVID-19 and pneumonia from the segmented lung slices, a modified DenseNet architecture, namely P-DenseCOVNet is designed where parallel convolutional paths are introduced on top of the conventional DenseNet model for getting better performance through overcoming the loss of positional arguments. Outstanding performances have been achieved with an F1 score of 0.97 in the segmentation task along with an accuracy of 87.5% in diagnosing COVID-19, common pneumonia, and normal cases. Significant experimental results and comparison with other studies show that the proposed scheme provides very satisfactory performances and can serve as an effective diagnostic tool in the current pandemic.

SpecMEn-DL: spectral mask enhancement with deep learning models to predict COVID-19 from lung ultrasound videos

Lung Ultrasound (LUS) images are considered to be effective for detecting Coronavirus Disease (COVID-19) as an alternative to the existing reverse transcription-polymerase chain reaction (RT-PCR)-based detection scheme. However, the recent literature exhibits a shortage of works dealing with LUS image-based COVID-19 detection. In this paper, a spectral mask enhancement (SpecMEn) scheme is introduced along with a histogram equalization pre-processing stage to reduce the noise effect in LUS images prior to utilizing them for feature extraction. In order to detect the COVID-19 cases, we propose to utilize the SpecMEn pre-processed LUS images in the deep learning (DL) models (namely the SpecMEn-DL method), which offers a better representation of some characteristics features in LUS images and results in very satisfactory classification performance. The performance of the proposed SpecMEn-DL technique is appraised by implementing some state-of-the-art DL models and comparing the results with related studies. It is found that the use of the SpecMEn scheme in DL techniques offers an average increase in accuracy and F 1 score of 11 % and 11.75 % , respectively, at the video-level. Comprehensive analysis and visualization of the intermediate steps manifest a very satisfactory detection performance creating a flexible and safe alternative option for the clinicians to get assistance while obtaining the immediate evaluation of the patients.

An integrated autoencoder-based hybrid CNN-LSTM model for COVID-19 severity prediction from lung ultrasound

The COVID-19 pandemic has become one of the biggest threats to the global healthcare system, creating an unprecedented condition worldwide. The necessity of rapid diagnosis calls for alternative methods to predict the condition of the patient, for which disease severity estimation on the basis of Lung Ultrasound (LUS) can be a safe, radiation-free, flexible, and favorable option. In this paper, a frame-based 4-score disease severity prediction architecture is proposed with the integration of deep convolutional and recurrent neural networks to consider both spatial and temporal features of the LUS frames. The proposed convolutional neural network (CNN) architecture implements an autoencoder network and separable convolutional branches fused with a modified DenseNet-201 network to build a vigorous, noise-free classification model. A five-fold cross-validation scheme is performed to affirm the efficacy of the proposed network. In-depth result analysis shows a promising improvement in the classification performance by introducing the Long Short-Term Memory (LSTM) layers after the proposed CNN architecture by an average of 7-12%, which is approximately 17% more than the traditional DenseNet architecture alone. From an extensive analysis, it is found that the proposed end-to-end scheme is very effective in detecting COVID-19 severity scores from LUS images.

Routine versus clinically driven laboratory monitoring of HIV antiretroviral therapy in Africa (DART): a randomised non-inferiority trial

BACKGROUND

HIV antiretroviral therapy (ART) is often managed without routine laboratory monitoring in Africa; however, the effect of this approach is unknown. This trial investigated whether routine toxicity and efficacy monitoring of HIV-infected patients receiving ART had an important long-term effect on clinical outcomes in Africa.

METHODS

In this open, non-inferiority trial in three centres in Uganda and one in Zimbabwe, 3321 symptomatic, ART-naive, HIV-infected adults with CD4 counts less than 200 cells per microL starting ART were randomly assigned to laboratory and clinical monitoring (LCM; n=1659) or clinically driven monitoring (CDM; n=1662) by a computer-generated list. Haematology, biochemistry, and CD4-cell counts were done every 12 weeks. In the LCM group, results were available to clinicians; in the CDM group, results (apart from CD4-cell count) could be requested if clinically indicated and grade 4 toxicities were available. Participants switched to second-line ART after new or recurrent WHO stage 4 events in both groups, or CD4 count less than 100 cells per microL (LCM only). Co-primary endpoints were new WHO stage 4 HIV events or death, and serious adverse events. Non-inferiority was defined as the upper 95% confidence limit for the hazard ratio (HR) for new WHO stage 4 events or death being no greater than 1.18. Analyses were by intention to treat. This study is registered, number ISRCTN13968779.

FINDINGS

Two participants assigned to CDM and three to LCM were excluded from analyses. 5-year survival was 87% (95% CI 85-88) in the CDM group and 90% (88-91) in the LCM group, and 122 (7%) and 112 (7%) participants, respectively, were lost to follow-up over median 4.9 years' follow-up. 459 (28%) participants receiving CDM versus 356 (21%) LCM had a new WHO stage 4 event or died (6.94 [95% CI 6.33-7.60] vs 5.24 [4.72-5.81] per 100 person-years; absolute difference 1.70 per 100 person-years [0.87-2.54]; HR 1.31 [1.14-1.51]; p=0.0001). Differences in disease progression occurred from the third year on ART, whereas higher rates of switch to second-line treatment occurred in LCM from the second year. 283 (17%) participants receiving CDM versus 260 (16%) LCM had a new serious adverse event (HR 1.12 [0.94-1.32]; p=0.19), with anaemia the most common (76 vs 61 cases).

INTERPRETATION

ART can be delivered safely without routine laboratory monitoring for toxic effects, but differences in disease progression suggest a role for monitoring of CD4-cell count from the second year of ART to guide the switch to second-line treatment.

FUNDING

UK Medical Research Council, the UK Department for International Development, the Rockefeller Foundation, GlaxoSmithKline, Gilead Sciences, Boehringer-Ingelheim, and Abbott Laboratories.

Blood concentration profiles of acetaminophen following oral administration of fatty acid esters of acetaminophen with pancreatic lipase to dogs

Fatty acid esters of acetaminophen were administered orally to dogs, and blood concentrations of acetaminophen were determined at various time intervals. Blood concentrations of acetaminophen following oral administration of a short chain ester, p-acetamidophenyl acetate, were not significantly different from those found using acetaminophen. Blood concentrations of acetaminophen following oral administration of intermediate hydrocarbon chain-length compounds were less than those of the control at 1 and 3 hr postdosing. There appears to be a direct relationship between the in vitro hydrolysis rates and the blood concentration in vivo. Concomitant oral administration of acetaminophen derivatives, pancreatic lipase, and calcium salts resulted in an increase in the blood levels of acetaminophen as compared to administration of the esters alone. Calcium carbonate was included as a source of calcium ion to activate the lipase involved in the hydrolysis of the fatty acid esters. A combination of p-acetamidophenyl acetate, p-acetamidophenyl dodecanoate, pancreatic lipase, and calcium carbonate was shown to achieve a prolonged release of acetaminophen. p-Acetamidopheny acetate was thought to provide the initial release of acetaminophen; p-acetamidophenyl dodecanoate, being hydrolyzed more slowly, provided the prolonged release, which maintained therapeutic blood concentrations for 13 hr following a single dose of the combination in dogs.

Hydrolysis of fatty acid esters of acetaminophen in buffered pancreatic lipase systmes I

A series of fatty acid esters of acetaminophen were prepared beginning with acetate, the propionate, and all even-numbered fatty acids and going through the octadecanoate. The enzymatic hydrolysis of all derivatives was studied in vitro with varying amounts of lipase assed to the hydrolysis mixtures. Under the conditions of the in vitro hydrolysis, it was observed that all derivatives were hydrolyzed more readily in an aqueous medium at pH 7.8. A positive relationship was seen between the hydrolysis rates and the concentration of lipase at this pH. There was a negative relationship between the chain length of the acyl moiety and the corresponding hydrolysis rates. The short chain esters were hydrolyzed at rates many times more rapid than the long chain esters. The intermediate chain-lenght ester, p-acetamidophenyl decanoate, p-acetamidophenyl laurate, and p-acetamidophenyl myristate, were hydrolyzed at intermedediate time periods extending over 12 hr, approaching completion at 97.5, 87.5, and 80.5%, respectively, when 18 Wilson units of lipase was used in each milliliter of hydrolysis mixture. The longer chain esters, p-acetamidophenyl palmitate and p-acetamidophenyl stearate, were hydrolyzed to the extent of 16 and 8%, respectively, over 12 hr under the same in vitro conditions.