Image Processing and Machine Learning-Based Classification and Detection of Liver Tumor.

The liver is in charge of a plethora of tasks that are critical to healthy health. One of these roles is the conversion of food into protein and bile, which are both needed for digestion. Inhaled and possibly harmful chemicals are flushed from the body. It destroys numerous nutrients acquired through the gastrointestinal system and limits the release of cholesterol by utilizing vitamins, carbohydrates, and minerals stored in the liver. The body's tissues are made up of tiny structures known as cells. Cells proliferate and divide in order to create new ones in the normal sequence of events. When an old or damaged cell has to be replaced, a new cell must be synthesized. In other circumstances, the procedure is a total and utter failure. If the tissues of dead or damaged cells that have been cleared from the body are not removed, they may give birth to nodules and tumors. The liver can produce two types of tumors: benign and malignant. Malignant tumors are more dangerous to one's health than benign tumors. This article presents a technique for the classification and identification of liver cancers that is based on image processing and machine learning. The approach may be found here. During the preprocessing stage of picture creation, the fuzzy histogram equalization method is applied in order to bring about a reduction in image noise. After that, the photographs are divided into many parts in order to zero down on the area of interest. For this particular classification task, the RBF-SVM approach, the ANN method, and the random forest method are all applied.

Appropriate Supervised Machine Learning Techniques for Mesothelioma Detection and Cure.

Mesothelioma is a dangerous, violent cancer, which forms a protecting layer around inner tissues such as the lungs, stomach, and heart. We investigate numerous AI methodologies and consider the exact DM conclusion outcomes in this study, which focuses on DM determination. K-nearest neighborhood, linear-discriminant analysis, Naive Bayes, decision-tree, random forest, support vector machine, and logistic regression analyses have been used in clinical decision support systems in the detection of mesothelioma. To test the accuracy of the evaluated categorizers, the researchers used a dataset of 350 instances with 35 highlights and six execution measures. LDA, NB, KNN, SVM, DT, LogR, and RF have precisions of 65%, 70%, 92%, 100%, 100%, 100%, and 100%, correspondingly. In count, the calculated complication of individual approaches has been evaluated. Every process is chosen on the basis of its characterization, exactness, and calculated complications. SVM, DT, LogR, and RF outclass the others and, unexpectedly, earlier research.

Identification of chronic thromboembolic pulmonary hypertension on CTPAs performed for diagnosing acute pulmonary embolism depending on level of expertise.

BACKGROUND: Expert reading often reveals radiological signs of chronic thromboembolic pulmonary hypertension (CTEPH) or chronic PE on computed tomography pulmonary angiography (CTPA) performed at the time of acute pulmonary embolism (PE) presentation preceding CTEPH. Little is known about the accuracy and reproducibility of CTPA reading by radiologists in training in this setting. OBJECTIVES: To evaluate 1) whether signs of CTEPH or chronic PE are routinely reported on CTPA for suspected PE; and 2) whether CTEPH-non-expert readers achieve comparable predictive accuracy to CTEPH-expert radiologists after dedicated instruction. METHODS: Original reports of CTPAs demonstrating acute PE in 50 patients whom ultimately developed CTEPH, and those of 50 PE who did not, were screened for documented signs of CTEPH. All scans were re-assessed by three CTEPH-expert readers and two CTEPH-non-expert readers (blinded and independently) for predefined signs and overall presence of CTEPH. RESULTS: Signs of chronic PE were mentioned in the original reports of 14/50 cases (28%), while CTEPH-expert radiologists had recognized 44/50 (88%). Using a standardized definition (≥3 predefined radiological signs), moderate-to-good agreement was reached between CTEPH-non-expert readers and the experts' consensus (k-statistics 0.46; 0.61) at slightly lower sensitivities. The CTEPH-non-expert readers had moderate agreement on the presence of CTEPH (κ-statistic 0.38), but both correctly identified most cases (80% and 88%, respectively). CONCLUSIONS: Concomitant signs of CTEPH were poorly documented in daily practice, while most CTEPH patients were identified by CTEPH-non-expert readers after dedicated instruction. These findings underline the feasibility of achieving earlier CTEPH diagnosis by assessing CTPAs more attentively.

Validation of an imaging based cardiovascular risk score in a Scottish population.

OBJECTIVES: A radiological risk score that determines 5-year cardiovascular disease (CVD) risk using routine care CT and patient information readily available to radiologists was previously developed. External validation in a Scottish population was performed to assess the applicability and validity of the risk score in other populations. METHODS: 2915 subjects aged ≥40 years who underwent routine clinical chest CT scanning for non-cardiovascular diagnostic indications were followed up until first diagnosis of, or death from, CVD. Using a case-cohort approach, all cases and a random sample of 20% of the participant's CT examinations were visually graded for cardiovascular calcifications and cardiac diameter was measured. The radiological risk score was determined using imaging findings, age, gender, and CT indication. RESULTS: Performance on 5-year CVD risk prediction was assessed. 384 events occurred in 2124 subjects during a mean follow-up of 4.25 years (0-6.4 years). The risk score demonstrated reasonable performance in the studied population. Calibration showed good agreement between actual and 5-year predicted risk of CVD. The c-statistic was 0.71 (95%CI:0.67-0.75). CONCLUSIONS: The radiological CVD risk score performed adequately in the Scottish population offering a potential novel strategy for identifying patients at high risk for developing cardiovascular disease using routine care CT data.

Incidental findings on chest CT imaging are associated with increased COPD exacerbations and mortality.

BACKGROUND: This study aimed to evaluate whether incidental CT findings of emphysema, airway thickening and bronchiectasis, as seen on CT scans performed for other non-pulmonary clinical indications, are associated with future acute exacerbations of COPD resulting in hospitalisation or death. METHODS: This multicentre prospective case-cohort study comprised 6406 subjects who underwent routine diagnostic chest CT for non-pulmonary indications. Using a case-cohort approach, we visually graded CT scans from cases and a random sample of ∼10% of the baseline cohort (n=704) for emphysema severity (range 0-20), airway thickening (range 0-5) and bronchiectasis (range 0-5). We used weighted Cox proportional hazards analysis to assess the independent association between CT findings and hospitalisation or death due to COPD exacerbation. RESULTS: During a median follow-up of 4.4 years (maximum 5.2 years), 338 COPD events were identified. The risk of experiencing a future acute exacerbation of COPD resulting in hospitalisation or death was significantly increased in subjects with severe emphysema (score ≥7) and severe airway thickening (score ≥3). The respective HRs were 4.6 (95% CI 3.0 to 7.1) and 5.9 (95% CI 3.4 to 10.5). Severe bronchiectasis (score ≥3) was not significantly associated with increased risk of adverse events (HR 1.5; 95% CI 0.9 to 2.5). CONCLUSIONS: Morphological correlates of COPD such as emphysema and airway thickening detected on CT scans obtained for other non-pulmonary indications are strong independent predictors of subsequent development of acute exacerbations of COPD resulting in hospitalisation or death.

Cardiovascular disease prediction: do pulmonary disease-related chest CT features have added value?

OBJECTIVE: Certain pulmonary diseases are associated with cardiovascular disease (CVD). Therefore we investigated the incremental predictive value of pulmonary, mediastinal and pleural features over cardiovascular imaging findings. METHODS: A total of 10,410 patients underwent diagnostic chest CT for non-cardiovascular indications. Using a case-cohort approach, we visually graded CTs from the cases and from an approximately 10 % random sample of the baseline cohort (n = 1,203) for cardiovascular, pulmonary, mediastinal and pleural findings. The incremental value of pulmonary disease-related CT findings above cardiovascular imaging findings in cardiovascular event risk prediction was quantified by comparing discrimination and reclassification. RESULTS: During a mean follow-up of 3.7 years (max. 7.0 years), 1,148 CVD events (cases) were identified. Addition of pulmonary, mediastinal and pleural features to a cardiovascular imaging findings-based prediction model led to marginal improvement of discrimination (increase in c-index from 0.72 (95 % CI 0.71-0.74) to 0.74 (95 % CI 0.72-0.75)) and reclassification measures (net reclassification index 6.5 % (p < 0.01)). CONCLUSION: Pulmonary, mediastinal and pleural features have limited predictive value in the identification of subjects at high risk of CVD events beyond cardiovascular findings on diagnostic chest CT scans. KEY POINTS: • Incidental cardiovascular findings on routine chest CT can predict cardiovascular disease • Non-cardiovascular chest CT abnormalities are associated with cardiovascular disease • Non-cardiovascular chest CT features have limited predictive value beyond cardiovascular features.

Age and sex based reference values for incidental coronary artery and thoracic aorta calcifications on routine clinical chest CT: a powerful tool to appreciate available imaging findings.

OBJECTIVE: To establish age and gender specific reference values for incidental coronary artery and thoracic aorta calcification scores on routine diagnostic CT scans. These reference values can aid in structured reporting and interpretation of readily available imaging data by chest CT readers in routine practice. METHODS: A random sample of 1572 (57% male, median age 61 years) was taken from a study population of 12,063 subjects who underwent diagnostic chest CT for non-cardiovascular indications between January 2002 and December 2005. Coronary artery and thoracic aorta calcifications were graded using a validated ordinal score. The 25th, 50th and 75th percentile cut points were calculated for the coronary artery and thoracic aorta calcification scores within each age/gender stratum. RESULTS: The 75th percentile cut points for coronary artery calcification scores were higher for men than for women across all age groups, with the exception of the lowest age group. The 75th percentile cut points for thoracic aorta calcifications scores were comparable for both genders across all age groups. Based on the obtained age and gender reference values a calculation tool is provided, that allows one to enter an individual's age, gender and calcification scores to obtain the corresponding estimated percentiles. CONCLUSIONS: The calculation tool as provided in this study can be used in daily practice by CT readers to examine whether a subject has high calcifications scores relative to others with the same age and gender.

Incidental imaging findings from routine chest CT used to identify subjects at high risk of future cardiovascular events.

PURPOSE: To investigate the contribution of incidental findings at chest computed tomography (CT) in the detection of subjects at high risk for cardiovascular disease (CVD) by deriving and validating a CT-based prediction rule. MATERIALS AND METHODS: This retrospective study was approved by the ethical review board of the primary participating facility, and informed consent was waived. The derivation cohort comprised 10 410 patients who underwent diagnostic chest CT for noncardiovascular indications. During a mean follow-up of 3.7 years (maximum, 7.0 years), 1148 CVD events (cases) were identified. By using a case-cohort approach, CT scans from the cases and from an approximately 10% random sample of the baseline cohort (n = 1366) were graded visually for several cardiovascular findings. Multivariable Cox proportional hazards analysis with backward elimination technique was used to derive the best-fitting parsimonious prediction model. External validation (discrimination, calibration, and risk stratification) was performed in a separate validation cohort (n = 1653). RESULTS: The final model included patient age and sex, CT indication, left anterior descending coronary artery calcifications, mitral valve calcifications, descending aorta calcifications, and cardiac diameter. The model demonstrated good discriminative value, with a C statistic of 0.71 (95% confidence interval: 0.68, 0.74) and a good overall calibration, as assessed in the validation cohort. This imaging-based model allows accurate stratification of individuals into clinically relevant risk categories. CONCLUSION: Structured reporting of incidental CT findings can mediate accurate stratification of individuals into clinically relevant risk categories and subsequently allow those at higher risk of future CVD events to be distinguished.

Impact of cardiovascular calcifications on the detrimental effect of continued smoking on cardiovascular risk in male lung cancer screening participants.

BACKGROUND: Current smokers have an increased cardiovascular disease (CVD) risk compared to ex-smokers due to reversible as well as irreversible effects of smoking. We investigated if current smokers remain to have an increased CVD risk compared to ex-smokers in subjects with a long and intense smoking history. We in addition studied if the effect of smoking continuation on CVD risk is independent of or modified by the presence of cardiovascular calcifications. METHODS: The cohort used comprised a sample of 3559 male lung cancer screening trial participants. We conducted a case-cohort study using all CVD cases and a random sample of 10% (n = 341) from the baseline cohort (subcohort). A weighted Cox proportional hazards model was used to estimate the hazard ratios for current smoking status in relation to CVD events. RESULTS: During a median follow-up of 2.6 years (max. 3.7 years), 263 fatal and non-fatal cardiovascular events (cases) were identified. Age, packyears and cardiovascular calcification adjusted hazard ratio of current smokers compared to former smokers was 1.33 (95% confidence interval 1.00-1.77). In additional analyses that incorporated multiplicative interaction terms, neither coronary nor aortic calcifications modified the association between smoking status and cardiovascular risk (P = 0.08). CONCLUSIONS: Current smokers have an increased CVD risk compared to former smokers even in subjects with a long and intense smoking history. Smoking exerts its hazardous effects on CVD risk by pathways partly independent of cardiovascular calcifications.

Prevalence of hypertension in a rural community of central India.

OBJECTIVES: (1) To study prevalence of hypertension. (2) To study association between various factors and hypertension in a rural community of Central India. METHODS: A community based cross sectional study was carried out in rural community. 924 study subjects aged 30 years and above were selected using systematic random sampling of houses. Anthropometry, blood glucose, and blood pressure were measured with standard instruments and methodology for all the study subjects. Statistical tests like Chi square, Student's t test and chi square trend were used to analyze the data where ever applicable. RESULTS: Prevalence of hypertension was 19.04%. It was higher in females (23.4%) than males (14.4%). It was seen that prevalence of hypertension increased with age. Prevalence of Pre hypertension was high (18.8%). 4.3% had isolated systolic hypertension and 0.9% had isolated diastolic hypertension. Older age, increased body mass index and waist hip ratio were significantly higher among hypertensive compared to normotensive. Factors like upper social class, sedentary physical activity, tobacco use and diabetes were significantly associated with hypertension. Alcohol intake was not associated with hypertension. CONCLUSION: The prevalence of hypertension is high and is associated with socio-demographic factors. Hence there is need for primordial prevention efforts on large scale.

Small coronary calcifications are not detectable by 64-slice contrast enhanced computed tomography.

Recently, small calcifications have been associated with unstable plaques. Plaque calcifications are both in intravascular ultrasound (IVUS) and multi-slice computed tomography (MSCT) easily recognized. However, smaller calcifications might be missed on MSCT due to its lower resolution. Because it is unknown to which extent calcifications can be detected with MSCT, we compared calcification detection on contrast enhanced MSCT with IVUS. The coronary arteries of patients with myocardial infarction or unstable angina were imaged by 64-slice MSCT angiography and IVUS. The IVUS and MSCT images were registered and the arteries were inspected on the presence of calcifications on both modalities independently. We measured the length and the maximum circumferential angle of each calcification on IVUS. In 31 arteries, we found 99 calcifications on IVUS, of which only 47 were also detected on MSCT. The calcifications missed on MSCT (n = 52) were significantly smaller in angle (27° ± 16° vs. 59° ± 31°) and length (1.4 ± 0.8 vs. 3.7 ± 2.2 mm) than those detected on MSCT. Calcifications could only be detected reliably on MSCT if they were larger than 2.1 mm in length or 36° in angle. Half of the calcifications seen on the IVUS images cannot be detected on contrast enhanced 64-slice MSCT angiography images because of their size. The limited resolution of MSCT is the main reason for missing small calcifications.

Gastric lymphoma presenting as phlegmonous gastritis.

Phlegmonous gastritis is an uncommon local or diffuse bacterial infection of the stomach wall. It is an extremely rare disease with a fulminating course and a high mortality rate. A majority of cases are diagnosed only postmortem, and early diagnosis is crucial for survival. This used to be common in the preantibiotic era; a resurgence of cases has occurred of late due to the spread of acquired immunodeficiency syndrome. There are varying local and systemic associations like gastric ulcer, gastric carcinoma, post-therapeutic endoscopy, postsurgery, human immunodeficiency virus infection, malnutrition, Kaposi's sarcoma, myeloma, leukemia, Sjogren's syndrome, and glucocorticoid use. We report a case of phlegmonous gastritis in a 70-year-old lady associated with gastric lymphoma. She succumbed to death on the fifth day of hospitalization despite broad-spectrum antibiotic therapy. She could not be operated upon due to the onset of multiorgan dysfunction syndrome and multiple comorbidities. To our knowledge, gastric lymphoma presenting as phlegmonous gastritis has not been reported in published English literature.

The social, moral, ethical, legal and political implications of today's biological technologies: an Indian point of view.

The last 50 years have seen an increasing emphasis on ethical, moral, social, legal, political and economic implications of science for reasons that are discussed in this article. Biotechnology has been no exception to this trend. Areas of biotechnology where the above implications have been important, are briefly described. Ethical and related issues in today's biology-based technologies are discussed with special reference to India. Examples of technological exploitation within a country, or of one country by another, using modern biology-based technologies are given. The possible implications of one new and emerging biology-based technology are discussed. It is concluded that a well-informed and knowledgeable society is the only assured insurance against possible misuse of biology-based technologies of today and tomorrow, including their use for the exploitation of people. The recent decision of the Prime Minister of India to set up a National Knowledge Commission is mentioned in this context.

On the critical assessment of the impact of the recent European Union Tissues and Cells Directive.

In this commentary it is argued that David Mortimer's contention (Mortimer, 2005) that 'there are grave problems with the feasibility, effectiveness and likely adverse impact of applying clean room and air quality standards to assisted conception facilities, especially IVF laboratories', as envisaged in the European Union's Tissues and Cells Directive (2004), is fully justified. As he says, 'effective regulations need to recognize what is impossible, what is possible and what is realistic'. The Directive, while necessary in principle, does not take into account the fact that what may appear to be ideal from a narrow technical point of view may, in fact, in a larger context, defeat its purpose by actually being harmful.

Response to 'No country is an island: comment on the House of Commons report Human Reproductive Technologies and the Law'.

Edgar Dahl supports sex selection, e.g. through separation of X and Y sperm or through PGD. It is argued in this commentary that while such sex selection would seem reasonable for balancing a family (wanting a daughter if one already has a son, or vice-versa), it is likely to lead to skewing of female-male ratios, not only in India where it is already as low as 0.8 in certain parts, but possibly also in Great Britain as male chauvinism is not a thing of the past anywhere.

Ethical issues in modern biological technologies.

Today's biology-based technologies have emerged from a historical imperative and as an inevitable consequence of developments in modern biology beginning in the last half-century. They can be classified into almost 30 different areas, ranging from the use of gene therapy for human beings, enzyme engineering, stem cells and cloning, to marine biotechnology, bioinformatics, nanotechnology and biological warfare among many others. Many of them have major sociopolitico-economic, moral, ethical and legal implications. They include genetic engineering, gene therapy, tissue culture, stem cell work, the new DNA technologies, commercialization of traditional plant-based drug formulations, assisted reproduction techniques, cloning technologies, organ transplantation, bioinformatics, and biological weapons. Examples of the ethical implications of several of these items will be considered. They will be assessed with special reference to ethical implications in respect of assisted reproduction techniques, of worldwide importance today, particularly for a country such as India.