Objective An association between uveitis and multiple sclerosis (MS) is well-established, but the actual nature of that association remains poorly understood. We sought to determine the association ...between the presence of a uveitis diagnosis prior to an MS diagnosis compared to no pre-existing uveitis diagnosis in MS patients. Methods Patients in whom the presentation of uveitis preceded the presentation of MS (study group) and patients with MS and no uveitis (control group) were randomly selected at a ratio of 1:3 from the Sheba Multiple Sclerosis Center computerized database. Results Eleven patients presented with uveitis prior to MS diagnosis (study group), and 31 randomly selected patients had MS without uveitis (control group). Only one patient in the study group deteriorated to EDSS 3 during the follow-up period, compared to 15 patients in the control group (9.1% vs 48.4%, P = 0.049). None of the patients in the study group reached EDSS 6 during the 10 years of follow-up compared to 6 (19.4%) patients in the control group (P = 0.194). Conclusions MS patients who presented with uveitis that preceded their neurological symptoms of MS demonstrated a clinically significant better neurological prognosis, than our MS patients with no uveitis.
Eales' disease is an idiopathic peripheral retinal vasculopathy characterized by retinal phlebitis, ischemia, retinal neovascularization, and recurrent vitreous hemorrhages. But CRAO is an unusual ...presentation.
A 27-year-old healthy female nurse of Indian descent presented with sudden vision loss in her right eye upon awakening. Central retinal artery occlusion (CRAO), combined with mild central retinal vein occlusion (CRVO), was diagnosed. During the second of three consecutive sessions of hyperbaric oxygen treatments, her vision rapidly improved. One week later, she developed peripheral phlebitis in the same eye. Infectious, inflammatory, and hematologic etiologies were excluded. The systemic evaluation was normal except for a positive Mantoux tuberculin skin test. Following systemic steroidal treatment, she experienced gradual improvement of her vasculitis. Two weeks later, mild retinal phlebitis appeared in her left eye. Eales' disease was diagnosed after the exclusion of other diseases.
This is an unusual Eales' disease case, which presented as combined CRAO with mild CRVO. The association of CRAO and Eales' disease is reported here for the first time, to our best knowledge.
Purpose: To describe the demographics and clinical characteristics of patients with herpetic anterior uveitis (HAU), and compare characteristics by pathogen, recurrence, and association to iris ...atrophy.
Methods: Multicenter, retrospective study of AU patients diagnosed clinically and by polymerase chain reaction (PCR).
Results: The study included 112 eyes in 109 patients: 54 (48.2%) HSV, 34 (30.4%) VZV, 2 (1.8%) CMV, and 22 (19.6%) unspecified diagnosis. HSV eyes, compared to VZV, had a higher recurrence rate, corneal involvement, KPs, iris atrophy, elevated IOP and posterior synechia (p < 0.05). VZV patients had more frequent immunomodulatory treatments and history of systemic herpetic disease (p < 0.05). Fifty-nine (52.7%) eyes had recurrent disease. Iris atrophy was associated with a higher prevalence of posterior synechia, dilated distorted pupil, and high IOP (p < 0.05).
Conclusion: Different HAU-causing Herpesviridae produce common clinical findings; therefore, PCR should be used more often to confirm specific diagnosis. Iris atrophy was associated with more severe disease.
Purpose: To report cases of uveitis induced by biological therapy given for cancer.
Methods: Retrospective review of medical charts of patients.
Results: Included were six patients aged 14-81 years. ...Three were treated with vemurafenib and one each with nivolumab, ipilimumab, and osimertinib. The oncological diagnoses were metastatic thyroid carcinoma, pleomorphic xanthoastrocytoma, metastatic melanoma, adenocarcinoma of the lung, and metastatic breast cancer. Ocular manifestations appeared 4-82 weeks after the biological treatment was initiated. The most common ocular presentation was anterior uveitis. Onset was sudden in all cases. The median duration of uveitis was 70 weeks. Treatment included topical or systemic corticosteroids; one patient received a single intravitreal steroid injection in one eye.
Conclusions: Uveitis may rarely be induced by treatment with biological agents for cancer. Both oncologists and ophthalmologists should be aware of this potential side effect. Early detection and management can prevent permanent complications and save the patient's vision.
An association between uveitis and multiple sclerosis (MS) is well-established, but the actual nature of that association remains poorly understood. We sought to determine the association between the ...presence of a uveitis diagnosis prior to an MS diagnosis compared to no pre-existing uveitis diagnosis in MS patients. Eleven patients presented with uveitis prior to MS diagnosis (study group), and 31 randomly selected patients had MS without uveitis (control group). Only one patient in the study group deteriorated to EDSS 3 during the follow-up period, compared to 15 patients in the control group (9.1% vs 48.4%, P = 0.049). None of the patients in the study group reached EDSS 6 during the 10 years of follow-up compared to 6 (19.4%) patients in the control group (P = 0.194). MS patients who presented with uveitis that preceded their neurological symptoms of MS demonstrated a clinically significant better neurological prognosis, than our MS patients with no uveitis.
In this work we present a novel system for generation of virtual PET images using CT scans. We combine a fully convolutional network (FCN) with a conditional generative adversarial network (GAN) to ...generate simulated PET data from given input CT data. The synthesized PET can be used for false-positive reduction in lesion detection solutions. Clinically, such solutions may enable lesion detection and drug treatment evaluation in a CT-only environment, thus reducing the need for the more expensive and radioactive PET/CT scan. Our dataset includes 60 PET/CT scans from Sheba Medical center. We used 23 scans for training and 37 for testing. Different schemes to achieve the synthesized output were qualitatively compared. Quantitative evaluation was conducted using an existing lesion detection software, combining the synthesized PET as a false positive reduction layer for the detection of malignant lesions in the liver. Current results look promising showing a 28% reduction in the average false positive per case from 2.9 to 2.1. The suggested solution is comprehensive and can be expanded to additional body organs, and different modalities.
•An automated method to synthesize PET images from CT images is proposed.•A combination of cGAN and FCN is shown to achieve the best performance.•Custom loss function is shown to improve performance in clinically important regions.•Results are provided showing improvement in existing lesion detection frameworks when using the virtual-PET images .
This study is motivated by the puzzle of diminishing gains in the European Union budget bargaining for governments with a Eurosceptic domestic audience, even as Euroscepticism is increasingly ...represented in national legislatures. Engaging literature on fiscal federalism in the European Union and the institutionalist politics of its budgetary process, we argue that European integration diminishes the ability of member states’ governments to leverage Euroscepticism to extract concessions from the European Union budget. This is because Euroscepticism is becoming less exceptional, and greater differentiation in integration reduces the will to reward those seen as systematically less committed to integration. Running panel-corrected standard errors regressions on Operating Budgetary Balances since 1977, we find that in intergovernmental bargaining, domestic popular Euroscepticism is an advantage, but parliamentary Euroscepticism is not.
In recent years, the pooling of authority among the member states of the euro area has intensified, expanding the remit of the Council, Commission and ECB. While it is commonly thought that large ...states dominate these institutions, a growing literature emphasizes the ability of small states to pursue their interests too. We explore whether the empowerment of euro area institutions was associated with relative net gains for small member states over large ones, and with relative losses during the euro crisis. We estimate the relationship between the relative amount of resources of different institutions, and the distribution of gains among members, throughout 1999-2016. We find that empowering the Council, the Commission or the ECB provides relative gains to small member states, although not against Germany.
Traumatic knee injuries are challenging to diagnose accurately through radiography and to a lesser extent, through CT, with fractures sometimes overlooked. Ancillary signs like joint effusion or ...lipo-hemarthrosis are indicative of fractures, suggesting the need for further imaging. Artificial Intelligence (AI) can automate image analysis, improving diagnostic accuracy and help prioritizing clinically important X-ray or CT studies.
To develop and evaluate an AI algorithm for detecting effusion of any kind in knee X-rays and selected CT images and distinguishing between simple effusion and lipo-hemarthrosis indicative of intra-articular fractures.
This retrospective study analyzed post traumatic knee imaging from January 2016 to February 2023, categorizing images into lipo-hemarthrosis, simple effusion, or normal. It utilized the FishNet-150 algorithm for image classification, with class activation maps highlighting decision-influential regions. The AI's diagnostic accuracy was validated against a gold standard, based on the evaluations made by a radiologist with at least four years of experience.
Analysis included CT images from 515 patients and X-rays from 637 post traumatic patients, identifying lipo-hemarthrosis, simple effusion, and normal findings. The AI showed an AUC of 0.81 for detecting any effusion, 0.78 for simple effusion, and 0.83 for lipo-hemarthrosis in X-rays; and 0.89, 0.89, and 0.91, respectively, in CTs.
The AI algorithm effectively detects knee effusion and differentiates between simple effusion and lipo-hemarthrosis in post-traumatic patients for both X-rays and selected CT images further studies are needed to validate these results.
Purpose
The purpose of this study is to evaluate the efficacy of an artificial intelligence (AI) model designed to identify active bleeding in digital subtraction angiography images for upper ...gastrointestinal bleeding.
Methods
Angiographic images were retrospectively collected from mesenteric and celiac artery embolization procedures performed between 2018 and 2022. This dataset included images showing both active bleeding and non-bleeding phases from the same patients. The images were labeled as normal versus images that contain active bleeding. A convolutional neural network was trained and validated to automatically classify the images. Algorithm performance was tested in terms of area under the curve, accuracy, sensitivity, specificity, F1 score, positive and negative predictive value.
Results
The dataset included 587 pre-labeled images from 142 patients. Of these, 302 were labeled as normal angiogram and 285 as containing active bleeding. The model’s performance on the validation cohort was area under the curve 85.0 ± 10.9% (standard deviation) and average classification accuracy 77.43 ± 4.9%. For Youden’s index cutoff, sensitivity and specificity were 85.4 ± 9.4% and 81.2 ± 8.6%, respectively.
Conclusion
In this study, we explored the application of AI in mesenteric and celiac artery angiography for detecting active bleeding. The results of this study show the potential of an AI-based algorithm to accurately classify images with active bleeding. Further studies using a larger dataset are needed to improve accuracy and allow segmentation of the bleeding.
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