A deep convolutional neural network ensemble for composite identification of pulmonary nodules and incidental findings on routine PET/CT.

AIM: To evaluate primary and secondary pathologies of interest using an artificial intelligence (AI) platform, AI-Rad Companion, on low-dose computed tomography (CT) series from integrated positron-emission tomography (PET)/CT to detect CT findings that might be overlooked. MATERIALS AND METHODS: One hundred and eighty-nine sequential patients who had undergone PET/CT were included. Images were evaluated using an ensemble of convolutional neural networks (AI-Rad Companion, Siemens Healthineers, Erlangen, Germany). The primary outcome was detection of pulmonary nodules for which the accuracy, identity, and intra-rater reliability was calculated. For secondary outcomes (binary detection of coronary artery calcium, aortic ectasia, vertebral height loss), accuracy and diagnostic performance were calculated. RESULTS: The overall per-nodule accuracy for detection of lung nodules was 0.847. The overall sensitivity and specificity for detection of lung nodules was 0.915 and 0.781. The overall per-patient accuracy for AI detection of coronary artery calcium, aortic ectasia, and vertebral height loss was 0.979, 0.966, and 0.840, respectively. The sensitivity and specificity for coronary artery calcium was 0.989 and 0.969. The sensitivity and specificity for aortic ectasia was 0.806 and 1. CONCLUSION: The neural network ensemble accurately assessed the number of pulmonary nodules and presence of coronary artery calcium and aortic ectasia on low-dose CT series of PET/CT. The neural network was highly specific for the diagnosis of vertebral height loss, but not sensitive. The use of the AI ensemble can help radiologists and nuclear medicine physicians to catch CT findings that might be overlooked.

Self-blood pressure measurement as compared to office blood pressure measurement in a large Indian population; the India Heart Study.

OBJECTIVE: India Heart Study (IHS) is aimed at investigating the agreement between office blood pressure measurement (OBPM) and self (S)BPM in a hypertension-naive population. METHODS: A total of 18 918 individuals (aged 42.6 ±â€Š11.7 years, 62.7% men), visiting 1237 primary care physicians across India, underwent OBPM. They performed SBPM for a period of 1 week using a validated oscillometric BP monitor that was preprogrammed to adhere to a guideline-based SBPM-schedule and blinded to the results. Thereafter, individuals underwent a second OBPM. Available laboratory results were obtained. Thresholds for elevated OBPM and SBPM were 140/90 and 135/85 mmHg, respectively. RESULTS: On the basis of first-visit OBPM and SBPM, there were 5787 (30.6%) individuals with normotension; 5208 (27.5%) with hypertension; 4485 (23.7%) with white-coat hypertension (WCH) and 3438 (18.2%) with masked hypertension. Thus, a diagnosis contradiction between SBPM and first-visit OBPM was seen in 9870 (41.9%) individuals. On the basis of second-visit OBPM, the normotension, hypertension, WCH and masked hypertension prevalence values were 7875 (41.6%); 4857 (25.7%); 2397 (12.7%) and 3789 (20.0%). There was poor agreement (kappa value 0.37) between OBPM of visit 1 and 2 with a diagnosis difference in 6027 (31.8%) individuals. The majority of masked hypertension and WCH individuals had BP values close to thresholds. CONCLUSION: There was a poor agreement between OBPM of visit1 and visit 2. Likewise, the agreement between OBPM at both visits and SBPM was poor. SBPM being considered to have a better correlation with patient prognosis should be the preferred method for diagnosing hypertension.

Emerging role of Geographical Information System (GIS), Life Cycle Assessment (LCA) and spatial LCA (GIS-LCA) in sustainable bioenergy planning.

Sustainability of a bioenergy project depends on precise assessment of biomass resource, planning of cost-effective logistics and evaluation of possible environmental implications. In this context, this paper reviews the role and applications of geo-spatial tool such as Geographical Information System (GIS) for precise agro-residue resource assessment, biomass logistic and power plant design. Further, application of Life Cycle Assessment (LCA) in understanding the potential impact of agro-residue bioenergy generation on different ecosystem services has also been reviewed and limitations associated with LCA variability and uncertainty were discussed. Usefulness of integration of GIS into LCA (i.e. spatial LCA) to overcome the limitations of conventional LCA and to produce a holistic evaluation of the environmental benefits and concerns of bioenergy is also reviewed. Application of GIS, LCA and spatial LCA can help alleviate the challenges faced by ambitious bioenergy projects by addressing both economics and environmental goals.

Investigation on by-products of bioenergy systems (anaerobic digestion and gasification) as potential crop nutrient using FTIR, XRD, SEM analysis and phyto-toxicity test.

Success and acceptability of the bio energy conversion technology to a large extent depend upon management of the inevitable by-products generated during the conversion process. By-products can be considered favourable as organic fertilizer as they retain nutrients with varying composition depending upon input biomass. However, characteristics of these heterogeneous resources with respect to feedstock and processing conditions have to be assessed to state on their agricultural and environmental benefits. Therefore, 3 types of anaerobic digestion by-products (digestate) from surplus biomass viz. cow dung, Ipomoea carnea:cow dung (60:40 dry weight basis) and rice straw:green gram stover:cow dung (30:30:40 dry weight basis) and one gasification by-product (biochar) from rice husk are considered to understand the fertilizer prospects. Considering 3 potential application options, digestate from each feedstock option was further processed as separated solid, separated liquid and ash from solid digestates. Thus, a total of 10 by-products were investigated for understanding their prospects as fertilizer using Fourier Transform Infrared Spectroscopy (FTIR), X-ray diffraction (XRD), Scanning Electron Microscopy (SEM) and Energy Dispersive X ray Spectroscopy (EDX) and phyto-toxicity test to have a broad insight in terms of their organic, mineral, elemental composition, morphological feature and potential phyto-toxicity. In general, irrespective of origin of feedstock, solid digestate, ash digestate and char showed similarity in terms of composition of functional groups with some degree of variation in relative content as reflected by FTIR analysis. Dominance of organic functional groups in separated solid digestates compared to liquid fraction indicated the former as favourable organic amendments. Quartz was the prevalent mineral phase in all separated solid, ash digestate and rice husk char. Digestates in ash phase represent more concentrated plant nutrient source with higher content of K, Ca, P, Na and Mg than their respective solid phase. Application of ash digestates and char is likely to improve adsorptive capacity of soil for water and nutrient due to presence of relatively uniformly distributed porous particles. Liquid fraction of Ipomoea digestates exhibited inhibitory effect on seed germination of greengram (Vigna radiate) with significant reduction of germination index. Inhibitory effects of by-products were found to correlate negatively with their electrical conductivity and ammonia-nitrogen content. Understanding on spectroscopic, morphological and phytotoxic properties of different application options of bioenergy by-products would be useful for assessment of their appropriate use in agriculture.

Assessment of by-products of bioenergy systems (anaerobic digestion and gasification) as potential crop nutrient.

Alternative fertilizer resources have drawn attention in recent times in order to cope up with ever increasing demand for fertilizer. By-products of bioenergy system are considered favourable as organic fertilizer due to their ability to recycle plant nutrients. Present study evaluates fertilizer suitability of by-products of two bioenergy systems viz. 3 types of anaerobic digestion by-products (digestate) from local surplus biomass such as cowdung, Ipomoea carnea:cowdung (60:40) and ricestraw:green gram stover:cowdung (30:30:40) and one gasification by-product (biochar) from rice husk. Digestates were assessed considering 4 different application options of each viz. whole, solid, liquid and ash from solid digestates. Digestate characteristics (organic matter, macronutrients, micronutrients and heavy metal content) were found to be a function of feedstock and processing (solid liquid separation and ashing). Ipomoea carnea based digestates in all application options showed comparatively higher N, P, K, NH4+-N, Ca, Mg, S and micro nutrient content than other digestates. Separation concentrated plant nutrients and organic matter in solid digestates, making these suitable both as organic amendments and fertilizer. Separated liquid digestate shared larger fraction of ammonium nitrogen (61-91% of total content), indicating their suitability as readily available N source. However, fertilizer application of liquid digestate may not match crop requirements due to lower total nutrient concentration. Higher electrical conductivity of the liquid digestates (3.4-9.3mScm-1) than solid digestates (1.5-2mScm-1) may impart phyto-toxic effect upon fertilization due to salinity. In case of by-products with unstable organic fraction i.e. whole and solid digestates of rice straw:green gram stover:cowdung digestates (Humification index 0.7), further processing (stabilization, composting) may be required to maximize their fertilizer benefit. Heavy metal contents of the by-products were found to be within the permitted range specified for organic fertilizer (vermicompost) in India. However, higher Al content of the digestates in whole, solid and ash phase (0.06-16.97gkg-1 fresh matter) can be a concern in acid soil which may cause Al toxicity. Understanding on agrochemical characteristics of bioenergy by-products with varying feedstock and application option is expected to promote their valorization opportunities considering user specific requirements. In the context of agriculturally dominant but energy deficient rural Indian scenario, integrated production of bioenergy and by-product based fertilizer could be very significant to meet the critical additional requirement of both energy and fertilizer.

Phosphorus recovery as struvite from farm, municipal and industrial waste: Feedstock suitability, methods and pre-treatments.

Global population growth requires intensification of agriculture, for which a sustainable supply of phosphorus (P) is essential. Since natural P reserves are diminishing, recovering P from wastes and residues is an increasingly attractive prospect, particularly as technical and economic potential in the area is growing. In addition to providing phosphorus for agricultural use, precipitation of P from waste residues and effluents lessens their nutrient loading prior to disposal. This paper critically reviews published methods for P recovery from waste streams (municipal, farm and industrial) with emphasis on struvite (MgNH4PO4·6H2O) crystallisation, including pre-treatments to maximise recovery. Based on compositional parameters of a range of wastes, a Feedstock Suitability Index (FSI) was developed as a guide to inform researchers and operators of the relative potential for struvite production from each waste.

Development of an effective and efficient DNA isolation method for Cinnamomum species.

Different species of Cinnamomum are rich in polysaccharide's and secondary metabolites, which hinder the process of DNA extraction. High quality DNA is the pre-requisite for any molecular biology study. In this paper we report a modified method for high quality and quantity of DNA extraction from both lyophilized and non-lyophilized leaf samples. Protocol reported differs from the CTAB procedure by addition of higher concentration of salt and activated charcoal to remove the polysaccharides and polyphenols. Wide utility of the modified protocol was proved by DNA extraction from different woody species and 4 Cinnamomum species. Therefore, this protocol has also been validated in different species of plants containing high levels of polyphenols and polysaccharides. The extracted DNA showed perfect amplification when subjected to RAPD, restriction digestion and amplification with DNA barcoding primers. The DNA extraction protocol is reproducible and can be applied for any plant molecular biology study.

Primary aspergillosis of the larynx: a case report.

Aspergillosis of larynx is very rare. Only a few cases have been reported in medical literature. Larynx is generally involved secondarily by aspergillosis. Only rarely the larynx happens to be the primary site of involvement. The lesions may be confined to the vocal folds or may involve various other sites of the larynx. There is, invariably, certain risk factors which may predispose for fungal infection like immune deficiency condition, use of inhaled or systemic steroids, long and continuous use of antibiotics etc. These lesions may mimic malignancy or a premalignant condition. Awareness of this entity is essential as the management depends on accurate diagnosis. These lesions invariably respond well to antifungal therapy with elimination of risk factors. Here we have reported a case of primary aspergillosis of the larynx without involvement of other part of the airway and without any generalized immune deficit in a 35 year old woman.

Ophthalmological Manifestations of ENT Diseases: An Overview.

A total number of 62 cases of ophthalmological manifestations caused by various ENT diseases, mostly paranasal tumour extensions, nasopharyngeal tumour and furunculosis of nose were analysed in a retrospective study in relation to their age, sex, clinical, radiological and HP profile. CT scan was considered as the most dependable investigating tool. Different modalities of medical and surgical treatment have been adopted according to location and nature of the disease. A close cooperation is needed between otolaryngologist and ophthalmologist to overcome this challenge.

Submitral aneurysm of the left ventricle.

Submitral aneurysm is a rare cardiac pathology of uncertain origin with varied clinical manifestations. Recent studies have revealed a congenital basis of this pathology, although genetic link has been suspected because of the racial predilection. The other suggested aetiologies are infection and inflammation. The case reported here is that of a young female with a large submitral aneurysm presenting in a state of cardiogenic shock. In addition, the presence of raised inflammatory parameters indicates that the cause of origin of this aneurysm is related to inflammation.

Use of intratympanic steroid as a primary treatment for sudden sensorineural hearing loss.

Dramatic nature of sudden sensorineural hearing loss sets it apart from most of the conditions, which the otologists face in their practice. It has a reported incidence of 5-20/1,00,000 of population with involvement of both sexes in any age group. Exact aetiology of the disease is not known and most of the cases are idiopathic. Treatment policy differs from centre to centre. This prospective study with intratympanic steroid injection as a primary treatment with or without oral corticosteried therapy results 64% success rate with average hearing gain of 25 dB.

Covered stent to treat saphenous venous graft perforation--a case report.

This case report shows the immediate and long-term clinical result of percutaneous coronary intervention in a patient with total occlusion of saphenous venous graft. The case also highlights the management of venous graft perforation during percutaneous intervention using a covered stent.

Auricular trauma and its management.

Forty cases of external ear trauma have been studied during a period of three years from Jan '2001 to December 2004. It was observed that accidental trauma to the auricle may result in laceration, partial or complete loss of auricle. Injury of the tympanic membrane, temporal bone or facio maxillary region may be associated with auricular trauma. All wounds of auricle carry a risk of infection leading to perichondritis. Principles of successful treatment are conservation of tissue and prevention of infection.

Concurrent coronary, bilateral iliac and left renal artery direct stenting.

We describe a patient who underwent percutaneous coronary intervention combined with bilateral iliac and left renal artery angioplasty during the same sitting. Stenting of the coronary and peripheral arteries was performed employing the "direct stenting" technique. No complications occurred. The patient was discharged 2 days after the intervention and remains asymptomatic, leading a fully active life during 1 year of follow-up. To our knowledge, unstaged coronary stenting combined with direct stenting of the renal and both common iliac arteries has not been reported previously in India.

A comparative study of Prameha Roga from the Brihatrayee.

The study of this Prameha Roga reveals the rich knowledge of the Ayurveda developed since the time immemorial. Although descriptions of this disease are scattered in different classics of Ayurveda but here importance has been given to Brihatrayee. The aim and object of this paper review the well documented concept of the Ayurveda about the Prameha Roga as the trend of diabetes is increasing day by day in the society and is very difficult to prevent and manage owing to its complexity. The Ayurvedic concept of this Roga information on the subject regarding classification, characteristics, features etc. has been also made in this paper. This article highlights the wisdom of ancient Indian literature and some historical view of the disease i.e. Prameha Roga or Diabetes Mellitus.

Dual left anterior descending coronary artery: surgical revascularization in 4 patients.

Dual left anterior descending artery (or dual anterior interventricular artery) is a rare coronary anomaly. It is important to know the anatomic variants of this anomaly in patients with coronary artery disease who are undergoing either surgical myocardial revascularization or coronary angioplasty. We report the cases of 4 patients who had anatomic variants of dual left anterior descending coronary artery. These patients had developed coronary artery disease in the long or the short left anterior descending artery, or in both. The long left anterior descending artery was diseased in 1 patient, and the short left anterior descending artery was diseased in another In the 3rd and 4th patients, both the long and the short arteries were atherosclerotic and had developed severe stenosis. All 4 patients underwent successful myocardial revascularization. There was no electrocardiographic evidence of perioperative myocardial infarction. All patients were asymptomatic during the follow-up period, which ranged from 3 months to 1.5 years. Angiographers and surgeons alike must be aware of the variants of dual left anterior descending coronary artery, so that the diseased vessels can be correctly identified even if 1 of the dual arteries is 100% occluded.

Mifepristone in combination with methotrexate for the medical treatment of tubal pregnancy: a randomized, controlled trial.

In the search for a more potent alternative to a single i.m. injection of methotrexate for ectopic pregnancy, a randomized trial was organized. The efficacy of a combination of methotrexate and mifepristone was compared with methotrexate alone in the treatment of unruptured tubal pregnancies. The diagnosis of an unruptured tubal pregnancy was confirmed laparoscopically in 50 patients during a 2 year period. Women were randomized to receive a single i.m. injection of 50 mg/m2 methotrexate alone or a single dose of 600 mg oral mifepristone in combination with the same dose of methotrexate. Both treatment protocols were successful in achieving the resolution of unruptured ectopic pregnancy (18/25 in the methotrexate group and 22/25 in the combination group) following the initial intervention. A second injection was needed in four (16%) cases in the methotrexate group and in one (4%) case in the combination group. Overall, a complete resolution was achieved in 22/25 and 23/25 cases respectively. Unruptured ectopic pregnancy resolved faster in women given the combination of methotrexate and mifepristone compared to women given methotrexate only (P = 0.01). The effect of the methotrexate and mifepristone combination was more pronounced in women with higher human chorionic gonadotrophin concentrations.

Combined brachial and femoral approach to balloon angioplasty in coarctation of aorta.

Transfemoral balloon angioplasty of native aortic coarctation was initially not feasible in two patients, because of inability to cannulate the femoral artery percutaneously in one, and to cross the coarctation in the other. The percutaneous brachial approach helped overcome both these problems, after which utilization of intravascular snares allowed successful transfemoral completion of angioplasty.