Noonan Syndrome (NS) is a rare genetic syndrome typically evident at birth and often linked to early-onset severe heart disease. NS is part of a group of diseases termed RASopathies that are caused by activating mutations of proteins belonging to the Ras and mitogen-activated protein kinase families. In a new study, researchers at Université de Montréal and CHU Sainte-Justine Research Center show that a MEK inhibitor called trametinib can reverse hypertrophic cardiomyopathy (HCM) and valvular obstruction in patients with RIT1-associated NS. “Up to this finding, our therapeutic options were limited to surgery, including heart transplant, and symptomatic relief with medication,” said the study’s author, Dr. Gregor Andelfinger, a paediatric cardiologist at CHU Sainte-Justine, a researcher at Sainte-Justine University Hospital Research Center in the fetomaternal and neonatal pathologies axis, and an associate research professor in the pediatrics department of Université de Montréal. “Trametinib treatment is the first approach specifically targeted to the molecular cause of RASopathies,” said Dr. Andelfinger. “While our numbers are still very limited, we report the first patients in whom we were not only able to stabilize, but to reverse the disease of the heart. These results pave the way for larger trials, which are now needed.” Infants less than six months old with NS, HCM and congestive heart failure normally have a poor prognosis, with a one-year survival rate of 34 per cent. In the new study, the Sainte Justine clinical teams used trametinib, an inhibitor targeted specifically against the activating nature of the mutations, to try to treat NS in two patients. They observed dramatic improvement of clinical and cardiac status in the patients only three months after treatment. Hypertrophy regressed in both patients, with sustained improvement over a total of 17 months of treatment, and normalization of laboratory values. One of the patients, who required ventilation, could be extubated after six weeks of treatment. Both patients showed better overall growth after treatment was started. "The findings described in this report suggest that a life-threatening form of heart disease affecting young infants might be treatable, which, if true, would be unprecedented and so meaningful for the families whose lives this devastating problem touches,” commented Dr. Bruce Gelb, director of the Mindich Child Health and Development Institute at the Icahn School of Medicine at Mount Sinai, in New York City. “Now we need to perform a proper clinical trial to prove that this drug is definitely working for this particular problem," he said. Santé Montréalhttps://tinyurl.com/y5xcgh43
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As the COVID-19 pandemic upends life as people know it, changing daily routines, limiting social interactions and shaking their sense of safety, a mental health experts from U.S. hospital Cleveland Clinic’s Mellen Center is stressing that it is perfectly acceptable to feel sad about all of it.
She points out that grief is a natural response to loss – whether it is the loss of a loved one, or the loss of a sense of normalcy.
“We are experiencing a lot of disappointment right now – in both small and big ways – and grief is going to be a factor,” says clinical health psychologist Amy Sullivan, PsyD, ABPP.
“It’s really important that we process this and stay connected to other people in safe ways,” she adds.
Regarding how people should go about dealing with all of these difficult and unexpected feelings bubbling up, she says there is no right or wrong way. However, she offers four suggestions that can help people to cope with current events. 1. Look through the lens of grief and process emotions
She says that the stages of grief can provide a helpful framework for navigating these complex emotions. Experts recognize these stages as denial, anger, bargaining, despair, and acceptance. However, these experts also know that people do not step neatly from one stage to the next in this exact order, she says.
“Grief can come in waves and change on a very regular basis. Our feelings can change on a daily, or even an hourly, basis,” she explains.
Dr. Sullivan adds it is normal to go from feeling despair one day to anger the next.
“The first thing we need to do is to recognize that it is normal to have these waves of emotions that are happening on a regular basis,” Dr. Sullivan says.
Next, she says, acknowledge the loss whether it is knowing or losing someone with COVID-19, losing jobs, missing friends or family.
“Those are all very sad, difficult things for people to manage,” Dr. Sullivan says.
“Feel what you are feeling – whether it is being overwhelmed, anxious, powerless or anything else, it can help to identify and name these emotions,” she advises.
“It can be quite powerful to sit with those feelings for a few moments – to really recognize those emotions and normalize them,” she says.
However, she advises people to set a time limit on this, suggesting they give themselves five minutes to feel that emotion, and then move on to something that they know is a positive coping skill for them.
“It is important for us to accept where our feelings are at the moment and process through them, and then move into a more positive position of acceptance,” she says.
She says this can be done by identifying their own best coping mechanisms
“This is a time when people need to become innovative and develop their own individual sense of coping that works for them during this time,” she says. Examples might include deep breathing, mindfulness exercises, journaling, talking with another person, or going for a walk.
“If it comes to a point where someone cannot handle these feelings on their own, they need to seek mental health help,” Dr. Sullivan says. 2. Fight the urge to disengage
Dr. Sullivan stresses that staying connected is a powerful tool for coping during hard times. Whether that comes in the form of video chatting or sending a good old-fashioned letter, staying in touch with family, friends, neighbours and coworkers can help people to keep a positive attitude, she says.
She adds that many trained mental and behavioural health professionals are currently seeing patients through virtual visits, so that if people are having trouble coping, this could be a solution. 3. Focus on what can be controlled
Dr. Sullivan says that when there is so much uncertainty about the future, it is easy for people to get carried away, playing out the worst-case scenarios in their heads, for example worrying about themselves or someone else getting COVID-19, or wondering if things will ever get back to normal.
“Anticipating negative events can bring a sense of anxiety or fear,” Dr. Sullivan says.
She advises that, instead of agonizing over the things that cannot be known or controlled, people should be aware of what they do have control over. For example, they can choose how much news or social media they consume in a day, and they can decide what they eat. She recommends being mindful about these choices, and focusing on staying in the present. 4. Be open to joy
Lastly, Dr. Sullivan advises people to find joy and gratitude in the small things, like a video chat with family members, or the rush of fresh air when they open a window or step outside. She adds that if they are under a lockdown order, they can find ways to appreciate the opportunity to step back from the hustle and bustle of everyday life and being home.
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Sanofi and GSK will partner to develop an adjuvanted vaccine for COVID-19, using technology from both companies.
Sanofi will contribute its S-protein COVID-19 antigen, which is based on recombinant DNA technology. This technology has produced an exact genetic match to proteins found on the surface of the virus, and the DNA sequence encoding this antigen has been combined into the DNA of the baculovirus expression platform, the basis of Sanofi’s licensed recombinant influenza product in the US.
GSK will contribute its proven pandemic adjuvant technology. The use of an adjuvant can be of particular importance in a pandemic situation since it may reduce the amount of vaccine protein required per dose, allowing more vaccine doses to be produced and therefore contributing to protect more people.
The companies plan to initiate phase I clinical trials in the second half of 2020 and, if successful, subject to regulatory considerations, aim to complete the development required for availability by the second half of 2021.
Paul Hudson, Chief Executive Officer, Sanofi, commented: “As the world faces this unprecedented global health crisis, it is clear that no one company can go it alone. That is why Sanofi is continuing to complement its expertise and resources with our peers, such as GSK, with the goal to create and supply sufficient quantities of vaccines that will help stop this virus.”
Emma Walmsley, Chief Executive Officer, GSK, said: “This collaboration brings together two of the world’s largest vaccines companies. By combining our scientific expertise, technologies and capabilities, we believe that we can help accelerate the global effort to develop a vaccine to protect as many people as possible from COVID-19.”
The combination of a protein-based antigen together with an adjuvant is well-established and used in a number of vaccines available today. An adjuvant is added to some vaccines to enhance the immune response and has been shown to create a stronger and longer- lasting immunity against infections than the vaccine alone. It can also improve the likelihood of delivering an effective vaccine that can be manufactured at scale.
The combination of a protein-based antigen together with an adjuvant is well-established and used in a number of vaccines available today. An adjuvant is added to some vaccines to enhance the immune response and has been shown to create a stronger and longer- lasting immunity against infections than the vaccine alone. It can also improve the likelihood of delivering an effective vaccine that can be manufactured at scale.
Rick A. Bright, Ph.D., BARDA Director, said: “Strategic alliances among vaccine industry leaders are essential to make a coronavirus vaccine available as soon as possible. Development of the adjuvanted recombinant-based COVID-19 vaccine candidate holds the potential to lower the vaccine dose to provide vaccine to a greater number of people to end this pandemic, and help the world become better prepared or even prevent future coronavirus outbreaks.”
The companies have set up a Joint Task Force, co-chaired by David Loew, Global Head of Vaccines, Sanofi and Roger Connor, President Vaccines, GSK. The taskforce will seek to mobilize resources from both companies to look for every opportunity to accelerate the development of the candidate vaccine.
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A strain in ICU capacity has been linked to adverse patient outcomes. New research suggests that near-simultaneous ICU admissions are frequent and may also have an adverse effect on patient outcomes. Researchers conducted an observational study of patients admitted to an academic adult ICU of a tertiary medical centre. Over the five-year period of the study, they found a correlation between the elapsed time between two consecutive admissions and mortality. Researchers examined 13,234 consecutive ICU admissions. A quarter of these admissions had an elapsed time between two consecutive admissions of less than 55 minutes. They found a “dose-dependent” and inverse relationship between the elapsed time between admissions and mortality. In summary, the shorter the interval between admissions, the higher the odds of death. Specifically, the adjusted odds ratio (OR) of death gradually decreased by an additional average of 0.93 (95% CI 0.9‒0.97, P=.001) for each log(unit) of time separating admissions. “This study shows that providing the same level of care during multiple admissions is difficult when patients of equal severity arrive at the same time. Further studies are needed to confirm these findings and work towards ways to improve mechanisms, structures and processes to improve patient outcomes regardless of admission rates,” says Dr. Markos Kashiouris, lead researcher.
CHESThttps://tinyurl.com/y46pl9lf
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The use of antibiotics drives the development of antibiotic resistance, a major threat to public health worldwide. But these drugs also carry the risk of harm to individual patients, including children. According to a new analysis antibiotics led to nearly 70,000 estimated emergency room visits in the U.S. each year from 2011-2015 for allergic reactions and other side effects in children. The study helps quantify the risk posed by specific antibiotics in children across different age ranges. “For parents and other caregivers of children, these findings are a reminder that while antibiotics save lives when used appropriately, antibiotics also can harm children and should only be used when needed,” said lead author Maribeth C. Lovegrove, MPH, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention. “For healthcare providers, these findings are a reminder that adverse effects from antibiotics are common and can be clinically significant and consequential for pediatric patients.” For their analysis, researchers used nationwide estimates for outpatient antibiotic prescriptions and data from a nationally representative sample of hospitals for emergency room visits attributed to the use of antibiotics by children aged 19 and younger. Most of the visits (86 percent) were for allergic reactions, such as a rash, pruritus (itching), or angioedema (severe swelling beneath the skin). The risk of a visit varied by child age and type of antibiotic, but for most antibiotics, children aged 2 or younger had the highest risk of an adverse drug event. Forty-one percent of visits involved children in this age group. Amoxicillin was the most commonly implicated antibiotic in adverse drug events among children aged 9 or younger, while sulfamethoxazole/trimethoprim was most commonly implicated among children 10-19 years old. Antibiotics are among the most commonly prescribed medications for children, but prior research has suggested that nearly a third, if not more, of outpatient pediatric prescriptions for antibiotics are unnecessary. Efforts to reduce antibiotic overprescribing have largely focused on reducing antibiotic resistance. However, studies have shown that these longer-term societal risks are not always prioritized when clinicians are making decisions about treatment. “By considering available data on the immediate risks to individual patients, clinicians, and parents and caregivers, can better weigh the risks and benefits of antibiotic treatment,” Lovegrove said. The researchers were not able to determine which antibiotic prescriptions were unnecessary or inappropriate in the study, because data for antibiotic indications, doses, and durations of therapy were not available. The study also likely underestimates how often children experience adverse side effects from antibiotics because the analysis includes only adverse drug events that resulted in a visit to an emergency room. Adverse drug events treated in other settings, such as an urgent care facility or a doctor’s office, or cases for which no healthcare was sought, were not included. Also, adverse events that are less likely to be diagnosed in the emergency room setting (e.g., Clostridium difficile infections that can cause severe diarrhea after antibiotic use) were not included. Pediatric Infectious Disease Society
https://tinyurl.com/yctsaxrn
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MilliporeSigma, a global life science tools and equipment supplier, is responding to the COVID-19 pandemic with products and solutions for scientists to detect and characterize viruses and to develop vaccines and therapies.
“We are committed to providing researchers with the necessary raw materials, products and services that can aid the global scientific effort to fight this novel virus. We have consolidated this product offering on a dedicated COVID-19 web page https://www.sigmaaldrich.com/covid-19.html, providing a one-stop-shop of approximately 125 products and corresponding information for academic labs and biopharmaceutical companies working to combat the virus, the company said in statement.
“We are not only focused on end-product solutions during this extraordinary time. To provide this level of support for the critical measures underway to contain and treat COVID-19 and to continue providing products that support the development and manufacturing of over-the-counter drugs to complex cell and gene therapies, we are working hard to ensure minimal disruption to our supply chain while remaining committed to the safety of our employees and customers.
“Our 59 manufacturing sites around the world remain operational to ensure that our biopharmaceutical customers have the products and services they need to serve the health needs of a global population.”
The company added that along with this, their top priority remains the safety and well-being of their employees.
“At each of our sites, we have stopped travel, arranged remote working whenever possible and implemented stringent safety measures, such as social distancing and enhanced hygiene protocol. We are leveraging virtual meeting technology to continue collaborating with the global scientific community.”
MilliporeSigma noted: “To aid the ongoing scientific response to COVID-19, we continue to monitor the global situation closely, establishing protocols and guidelines to minimize the impact whenever possible to our sites and supply. We have mobilized a global task force to actively evaluate the overall supply chain of both our products and key raw materials suppliers to mitigate any potential disruption. Leveraging business continuity plans, we remain dedicated to serving our customers in all markets. In China, our suppliers continue to increase their levels of resumed operations and, as shipping lanes in and out of China continue to improve, we are actively monitoring logistic routes and transportation options to fulfil our shipping requirements.
“Throughout all of this, we are following guidance outlined by the WHO, CDC and governments of impacted countries, and our global sites have relevant and approved preparedness plans and are empowered to act per their local scenarios, as necessary.”
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FUJIFILM SonoSite has announced the launch of a strategic relationship with Partners HealthCare to apply artificial intelligence to improve the utility and functionality of portable ultrasound. The two organizations will collaborate to enhance ultrasound technology with AI to enable clinicians to perform scans at the point-of-care, further expanding the accessibility of this technology for clinicians and their patients. The collaboration will be executed through the MGH & BWH Center for Clinical Data Science and leverage the extensive data assets, computational infrastructure and clinical expertise of the Partners HealthCare system. “Allowing for even greater integration of ultrasound into our healthcare delivery system requires smarter machines,” said Keith Dreyer, DO, PhD, FACR, FSIIM, Chief Data Science Officer, Partners HealthCare. “In emergency settings, the efficiency and cost-effectiveness of portable ultrasound makes is a critical companion to other imaging modalities.” The first project under the collaboration will target some of the more complex emergency medicine procedures using AI-enabled portable ultrasound. Andrew Liteplo, MD, MGH Department of Emergency Medicine, explains, “If we build scanners that can be used by non-expert users both inside and outside the hospital, we can likely reduce the time delay between trauma and diagnosis, which will translate to more rapid interventions and improved outcomes.” Diku Mandavia, MD, FACEP, FRCPC, Senior Vice President and Chief Medical Officer of FUJIFILM SonoSite emphasizes, “This collaboration is really focused on embedding AI in portable ultrasound with the goal of providing assistance in 2D image interpretation along with the automation of measurements and calculations – the type of automation that will allow us to increase the accessibility of this critical technology while still delivering high diagnostic value.” FUJIFILM SonoSite introduced ultrasound systems designed for use at the point of care to the healthcare system over 20 years ago. We have always listened carefully to our customers to ensure their needs are being met and I am proud that we will be able to offer them AI-enhanced technology to expand their utilization of ultrasound, increasing the quality of care they can provide while saving our healthcare system money,” said Rich Fabian, President and Chief Operating Officer of FUJIFILM SonoSite. Both parties agree that high fidelity, affordable medical imaging could have an impact on a global scale, particularly in the developing world, where access to care is a fundamental challenge. As an important diagnostic tool in the fields of obstetrics and emergency medicine, increased accessibility to, and utilization of, point-of-care ultrasound holds
substantial promise. Through the collaboration, the collective clinical and technical expertise of the organizations will be harnessed to advance the field of point-of-care ultrasound.
www.sonosite.com
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Recent years have witnessed an explosion in the number of medical images. Growth has been fuelled by technology, regulations and demographic trends. According to one estimate cited by GE , as much as 90 percent of all healthcare data comes from medical imaging.
Technology has made it possible to expect ever-higher resolution imaging, which has directly led to a burgeoning volume of data. Meanwhile, standard-of-care rules require that such imaging be provided across different medical departments and that the data be retained. Finally, there is also the effect of demographics: an ageing population requires more healthcare, and this too has driven demand for more imaging.
Enormous quantum
Digital images are stored in data storage devices after preprocessing. They are transmitted and reprocessed for final applications.
The numbers are impressive. In settings like emergency rooms, imaging per patient can work out to approximately 250 GB of data. Radiologists often examine 200-plus cases a day. A ‘pan scan’ CT of a trauma patient can render 4,000 images.
Given this enormous quantum of digital data provided to an image processor, sophisticated compression techniques have been developed to reduce the size of an image. This reduction is accompanied by a high level of fault tolerance as well as sufficiently good quality of the decoded image at the end of the process.
Medicine’s Holy Grail
Many see machine-assisted analysis of imaging data to be the Holy Grail of medicine, with vital information about organ function and disease states. These, they say, can provide insights not only for the benefit of a single patient but for all victims of a medical condition. For their proponents, gamechanging mathematical tools, in the shape of increasingly sophisticated, quantitative pixel-based analysis, advanced deep learning analytics and artificial intelligence, will pave the way for dramatic advances in the effectiveness of healthcare.
Indeed, there are enough research papers, proofs-of-concept and pilot projects demonstrating how data-based screening algorithms can highlight the subtlest of changes in a nodule or a lesion. Such algorithms learn over time, and become better at what they do, resulting in even greater speed and confidence in the future.
Powering up Big Data
The above processes have been driven by the steady acceleration, over the years, in raw computer processing power. While training an algorithm at the turn of the century took 2-3 months, the same results can now be achieved and iterated within minutes.
Big Data-based pattern analysis has demonstrated the capacity to detect areas of opacities, honeycombing, reticular densities and fibrosis, and thereby provide a list of differentials, using computer aided diagnostic tools. These have been backed up with dynamic contrast enhancement (DCE) texture analysis or 3D multi-planar reconstructions on highly-targeted data subsets, instead of making the time-consuming effort of interrogating and querying a complete imaging dataset.
Data quality and content
In spite of such promise, many problems need to be overcome before medical imaging data can be used to its full potential.
Traditionally, access has been a major barrier. Large healthcare organizations, which generate the bulk of imaging data, tend to keep it siloed in departmental picture archiving and communications systems (PACS).
Analysis is also handicapped by data quality. Medical imaging, as we have mentioned above, covers a gamut of areas from data acquisition and compression, to transmission, enhancement and segmentation.
Denoising and reconstruction
The biggest pre-processing step consists of cleaning up the data by denoising and reconstruction, to eliminate undesirable source signals and highlight the useful ones.
Denoising is a central challenge for all medical imaging modalities, be it ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET).
Typical examples include electronic noise, reverberation artefact with multi-path reflections, and echoes from tissue structures in applications such as blood flow estimation, perfusion or targeted molecular imaging.
Cleaning data in ultrasound
Medical ultrasound offers several advantages over other modalities, such as superior temporal and spatial resolution and the lack of ionising radiation risk. It is also very often more convenient.
Nevertheless, high levels of image artefact prevalence (or ‘clutter’) frequently leads to demand for more expensive modalities, such as magnetic resonance imaging (MRI) or computed tomography (CT). However, (as we shall see), the latter too face their own denoising challenges.
One of the most frequent sources of artefact in ultrasound is off-axis scattering and multi-path reverberation. Clutter from the latter, most pronounced in a patient’s sternum and rib cage, occurs when a reflective tissue structure repeatedly reflects a returning acoustic wave vis-a-vis the ultrasound transducer face.
Such limitations serve to obscure dynamic tissue in regions of interest.
Filtering clutter
There have been two broad approaches to clearing up data clutter in ultrasound. The first consists of classical filters, which operate only in the temporal dimension.
Clutter directly degrades image performance by biasing functional image measurements. Its impact is especially profound in critical areas such as displacement estimation in elastography and blood flow imaging or myocardium strain in cardiac imaging. This impacts adversely on diagnosis of cardiac function through motion tracking or visual inspection of imaging data.
Although efforts continue to be made to improve interpolation from artefact-free regions and modelling to infer heart motion while compensating for image degradation from reverberation artefacts, it is not possible to interpolate abnormal myocardial motion in diseased hearts from statistical models alone. Filtering has therefore been the preferred choice to suppress image artefacts and allow for computing accurate motion tracking from the entire myocardium.
In medical ultrasound, filtering strategies for suppression of clutter have been directed to involve the linear decomposition of received echo signals. This approach seeks to reformulate and express the original data along a new coordinate system, which separates the clutter and signal of interest along different bases. Filtering rejects the clutter, but retains the bases which describe the signal of interest.
SVD: Adding a spatial dimension
Newer techniques add a spatial element to provide a fourdimensional approach (three spatial plus time providing the fourth).
The best example of this is singular value decomposition (SVD), which leverages differences in tissue and blood motion in terms of spatio-temporal coherence. Along with wavelet transform, SVD was developed as one of the most useful linear algebra tools for image compression. SVD is essentially a factorization and iterative approximation technique to reduce any matrix into a smaller invertible and square matrix.
The impact of SVD has been profound, making possible techniques such as ultra-fast ultrasonic imaging, which is based on the unfocused transmission of plane or diverging ultrasound waves. Larger synchronous ultrasound imaging datasets greatly improve the discrimination between tissue and blood motion in Doppler imaging.
SVD has been shown to be far superior to traditional temporal clutter rejection filters, in terms of contrast-to-noise ratio and removal of tissue or probe motion artefacts. Tests have detected completely new microvascular blood flow networks. In the clinical field, this has led to dramatic improvements in the application of high-tech imaging in areas such as the neonate brain.
The case of CT images
CT offers a different set of challenges. Firstly, the process of denoising and reconstruction of CT images depends on statistically-uncertain baseline measurements such as radiation dose. In addition, in spite of huge advancements in acquisition speed, increased signal-to-noise ratio (SNR) and superior image resolution, images are still affected by noise and artefacts.
It is always important (and difficult) to strike a correct balance in the trade-off between reduction in noise on one side, and the conservation of genuine details – such as edges, corners and other structures – in order to maintain or even enhance clinically relevant image content on the other.
Real life choice of methodology poses its own set of challenges, as denoising techniques themselves often provide the means to understand the noise in CT images.
Nevertheless, a variety of algorithm-based techniques have been developed to suppress noise from the CT scanned images. Each has its own merits and demerits. Broadly, these include the use of filters, wavelet decomposition, wave atom transformation, anisotropic diffusion etc. Each produces its own set of metrics to enable comparison, based on key parameters for any imaging modality – MSE (mean square error), SNR and PSNR (peak signal-to-noise ratio), S/MSE (signal to mean square error ratio) and MAD (mean absolute difference).
Practically, interest in denoising CT has also been driven by the recent increase in awareness of radiation-induced cancer. This has made it important to enhance the diagnostic quality of low dose CT, by increasing the signal-to-noise ratio.
There have been several approaches to denoising low-dose CT images. Some researchers have used deep neural networks to improve image quality, based on the use of convolutions with different dilation rates. Compared to standard convolution, this has enabled the image to capture a greater level of contextual information in fewer layers as well as create shortcut connections to transmit information from early layers to later ones.
Approaches in MRI
One of the most prominent methods for denoising MR images has been NLM (non local means). This seeks to reduce noise by exploiting the similarity of image patterns by averaging similar image patterns (typically image patches), and is also used for CT.
Researchers have however developed new approaches. Some of the most exciting use deep learning via feature regression as well as image self-similarity, in order to permit a high degree of automatic denoising. Deep learning in MRI was typically focused on segmentation and classification of reconstructed magnitude images. Its application in lower levels of MRI measurement techniques is more recent and covers a range of processes including image acquisition and signal processing in MR fingerprinting, before denoising and image synthesis.
An intriguing approach to denoising MR images has been proposed by researchers from France’s University of Bordeaux and the Universitat Politecnica de Valencia in Spain.
The method involves a two-stage approach. In the first stage, an over-complete patch-based convolutional neural network blindly removes the noise without specific estimation of the local noise variance to produce a preliminary estimation of the noise-free image. The second stage uses this preliminary denoised image as a guide image within a rotationally invariant non-local means filter to robustly denoise the original noisy image.
The proposed approach has been compared with related state-of-the-art methods and showed competitive results in all the studied cases while being much faster than comparable filters. They present a denoising method that can be blindly applied to any type of MR image since it can automatically deal with both stationary and spatially varying noise patterns. References
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Sectra is extending its pre-operative orthopedic planning solution for trauma cases with 3D templates from one of the largest orthopedic companies, DePuy Synthes. Pre-operative planning for trauma cases using templating in combination with 3D CT images enables improved surgical outcomes.
“We are excited to provide orthopedic surgeons with DePuy Synthes 3D templates in our pre-operative planning solution. We strongly believe that this capability will help surgeons to provide patients with efficient care,” says Gustaf Schwang, General Manager Business Unit Orthopedic Solutions at Sectra.
Sectra’s 3D pre-operative planning solution enables surgeons to visualize a fracture in a dynamic 3D environment. With tools such as advanced bone segmentation, the surgeon can study and understand the fracture and determine a treatment plan prior to surgery. The ability to plan the surgical reduction and treatment pre-operatively minimizes the risk of surprises and stress during surgery, and consequently can shorten the time spent in the operating room.
Sectra’s 3D pre-operative planning solution is part of Sectra’s enterprise imaging solution, which allows for consolidation of image handling, while ensuring clinical workflow efficiency. The enterprise imaging solution is modular and supports the most image-intense departments-radiology, pathology, cardiology and orthopaedics. Being built on the same technical platform, customers can easily extend a departmental solution to create a comprehensive vendor-neutral archive (VNA) and enterprise image management solution without major investments or the replacement of existing components. https://medical.sectra.com/
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As chronic kidney disease (CKD) progresses, the kidneys become less able to maintain a healthy balance of acids in the body, a condition known as metabolic acidosis. To maintain healthy acid levels, people with CKD are treated with alkaline substances such as sodium bicarbonate, also commonly used to neutralize heartburn and indigestion. The UBI study, a large randomized controlled trial, shows that sodium bicarbonate halves the risk of kidney disease progression, the likelihood of starting renal replacement therapy (RRT; dialysis or transplantation) and the overall risk of death in people with CKD [1]. Defined as serum bicarbonate less than 22 mmol/L [2], metabolic acidosis is common in people with CKD stages 4-5 (eGFR < 30 ml/min/1.73 m2) and is directly related to worsening kidney function. Metabolic acidosis is a problem because it is associated with complications such as bone disease, muscle wasting, high levels of blood potassium (hyperkalaemia), insulin resistance, high cholesterol (hyperlipidaemia), and with a more rapid decline in kidney function—shown by rising blood creatinine—and increased risk of death [3]. International guidelines recommend that, when serum bicarbonate concentration falls below 22 mmol/l, CKD patients should be treated with oral sodium bicarbonate to maintain serum bicarbonate within the normal range, unless contraindicated [2]. However, until recently, very few studies have tested the effectiveness of bicarbonate therapy in improving metabolic acidosis or its potential benefits in patients with CKD. Results of the UBI trial announced for the first time during the ERA-EDTA Congress in Budapest, now provide strong evidence for the benefits of correcting metabolic acidosis with sodium bicarbonate in people with late-stage CKD. The prospective, open-label, randomized controlled trial assigned 740 patients with CKD-3b and CKD stage 4 to either sodium bicarbonate (376 patients) or standard care without sodium bicarbonate (364 patients). The patients had a mean age of 67.8 years, creatinine clearance 30 ml/min, and serum bicarbonate 21.5 mmol/l. At the end of three years, doubling of creatinine occurred in significantly fewer patients randomized to sodium bicarbonate: 6.6% versus 17.0% receiving standard care, p<0.001. This translates into a relative risk reduction of 64% in kidney disease progression (hazard ratio [HR] 0.36; 95% confidence interval [CI] 0.22-0.58; p<0.001). Similarly, the likelihood of starting RRT was also significantly lower in the sodium bicarbonate group. At the end of the study, 6.9% of patients receiving sodium bicarbonate had started RRT compared to 12.3% of the standard care group—a relative risk reduction of 50% (p=0.004; HR: 0.5; 95% CI: 0.31-0.81; p=0.005). The risk of death was also significantly lower among sodium bicarbonate-treated patients at 3.1% compared to 6.8 % of the standard care group—a relative risk reduction of 57% (p=0.004; HR 0.43; 95%CI 0.22-0.87; p=0.01). Treatment with sodium bicarbonate was well tolerated, with no significant effects on blood pressure, total body weight or hospitalizations. “There are relatively few treatments that have been shown to slow progression of CKD. As nephrologist, we have used sodium bicarbonate to correct metabolic acidosis in people with CKD for some time, but definite evidence of benefit has been lacking. Our study shows that this very cost-effective treatment is safe and improves kidney and patient survival,” concluded lead investigator Dr Antonio Bellasi. [1] Bellasi A, et al. Treatment of metabolic acidosis with sodium bicarbonate delays progression of chronic kidney disease: the UBI study. LBCT Abstract ERA-EDTA Congress 2019, Budapest [2] KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 3(1) January 2013 [3] Ahmed AR, Lappin D. Oral alkali therapy and the management of metabolic acidosis of chronic kidney disease: A narrative literature review. World J Nephrol 2018 0; 7(6): 117–122.www.era-edta.org
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