Semi-automatic outlining of levator hiatus.

OBJECTIVE: To create a semi-automated outlining tool for the levator hiatus, to reduce interobserver variability and and speed up analysis. METHODS: The proposed automated hiatus segmentation (AHS) algorithm takes a C-plane image, in the plane of minimal hiatal dimensions, and manually defined vertical hiatal limits as input. The AHS then creates an initial outline by fitting predefined templates on an intensity-invariant edge map, which is further refined using the B-spline explicit active surfaces framework. The AHS was tested using 91 representative C-plane images. Reference hiatal outlines were obtained manually and compared with the AHS outlines by three independent observers. The mean absolute distance (MAD), Hausdorff distance and Dice and Jaccard coefficients were used to quantify segmentation accuracy. Each of these metrics was calculated both for computer-observer differences (COD) and for interobserver differences. The Williams index was used to test the null hypothesis that the automated method would agree with the operators at least as well as the operators agreed with each other. Agreement between the two methods was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman plots. RESULTS: The AHS contours matched well with the manual ones (median COD, 2.10 (interquartile range (IQR), 1.54) mm for MAD). The Williams index was greater than or close to 1 for all quality metrics, indicating that the algorithm performed at least as well as did the manual references in terms of interrater variability. The interobserver differences using each of the metrics were significantly lower, and a higher ICC was achieved (0.93), when obtaining outlines using the AHS compared with manually. The Bland-Altman plots showed negligible bias between the two methods. Using the AHS took a median time of 7.07 (IQR, 3.49) s, while manual outlining took 21.31 (IQR, 5.43) s, thus being almost three-fold faster. Using the AHS, in general, the hiatus could be outlined completely using only three points, two for initialization and one for manual adjustment. CONCLUSIONS: We present a method for tracing the levator hiatal outline with minimal user input. The AHS is fast, robust and reliable and improves interrater agreement. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Epithelial clara cell injury occurs in bronchiolitis obliterans syndrome after human lung transplantation.

Bronchiolitis obliterans syndrome (BOS) is a condition of progressive airflow obstruction that affects a majority of lung transplant recipients and limits long-term posttransplant survival. Although epithelial injury appears central to the development of BOS, little is known regarding the specific epithelial cell types that are affected in this condition. We hypothesized that BOS would involve preferential injury to the secretory Clara cells that function in innate defense and epithelial repair. To test this hypothesis, we assessed tissue transcript, tissue protein and lung fluid protein expression of Clara cell secretory protein (CCSP), a marker for Clara cells, in lung transplant recipients with BOS, BOS-free patients and in donor controls. Our results demonstrate that CCSP tissue transcript and protein expression are significantly reduced in lung transplant recipients with BOS compared to BOS-free or donor controls. In addition, we demonstrate that CCSP protein levels are significantly reduced in the lung fluid of patients with BOS compared to BOS-free controls, in cross-sectional and longitudinal analysis. Collectively, these complementary results illustrate that BOS involves a selective alteration in the distribution and function of bronchiolar Clara cells.

Experimental techniques for studying poroelasticity in brain phantom gels under high flow microinfusion.

Convection enhanced delivery is an attractive option for the treatment of several neurodegenerative diseases such as Parkinson, Alzheimer, and brain tumors. However, the occurrence of a backflow is a major problem impeding the widespread use of this technique. In this paper, we analyze experimentally the force impact of high flow microinfusion on the deformable gel matrix. To investigate these fluid structure interactions, two optical methods are reported. First, gel stresses during microinfusion were visualized through a linear polariscope. Second, the displacement field was tracked using 400 nm nanobeads as space markers. The corresponding strain and porosity fields were calculated from the experimental observations. Finally, experimental data were used to validate a computational model for fluid flow and deformation in soft porous media. Our studies demonstrate experimentally, the distribution and magnitude of stress and displacement fields near the catheter tip. The effect of fluid traction on porosity and hydraulic conductivity is analyzed. The increase in fluid content in the catheter vicinity enhances the gel hydraulic conductivity. Our computational model takes into account the changes in porosity and hydraulic conductivity. The simulations agree with experimental findings. The experiments quantified solid matrix deformation, due to fluid infusion. Maximum deformations occur in areas of relatively large fluid velocities leading to volumetric strain of the matrix, causing changes in hydraulic conductivity and porosity close to the catheter tip. The gradual expansion of this region with increased porosity leads to decreased hydraulic resistance that may also create an alternative pathway for fluid flow.