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Semantic Segmentation of Lumbar Vertebrae Using Meijering U-Net(MU-Net)on Spine Magnetic Resonance Images

Computer Modeling in Engineering & Sciences 2025年第1期142卷 733-757页

作者： Lakshmi S V V Shiloah Elizabeth Darmanayagam sunil Retmin Raj Cyril Department of Computer Science and Engineering College of Engineering GuindyAnna UniversityChennai600025India Department of Information Technology Madras Institute of TechnologyAnna UniversityChrompetChennai600044India

Lower back pain is one of the most common medical problems in the world and it is experienced by a huge percentage of people *** to its ability to produce a detailed view of the soft tissues,including the spinal cord,nerves,intervertebral discs,and vertebrae,Magnetic Resonance Imaging is thought to be the most effective method for imaging the *** semantic segmentation of vertebrae plays a major role in the diagnostic process of lumbar *** is difficult to semantically partition the vertebrae in Magnetic Resonance Images from the surrounding variety of tissues,including muscles,ligaments,and intervertebral discs.U-Net is a powerful deep-learning architecture to handle the challenges of medical image analysis tasks and achieves high segmentation *** work proposes a modified U-Net architecture namely MU-Net,consisting of the Meijering convolutional layer that incorporates the Meijering filter to perform the semantic segmentation of lumbar vertebrae L1 to L5 and sacral vertebra ***-colour mask images were generated and used as ground truth for training the *** work has been carried out on 1312 images expanded from T1-weighted mid-sagittal MRI images of 515 patients in the Lumbar Spine MRI Dataset publicly available from Mendeley *** proposed MU-Net model for the semantic segmentation of the lumbar vertebrae gives better performance with 98.79%of pixel accuracy(PA),98.66%of dice similarity coefficient(DSC),97.36%of Jaccard coefficient,and 92.55%mean Intersection over Union(mean IoU)metrics using the mentioned dataset.

关键词： Computer aided diagnosis(CAD) magnetic resonance imaging(MRI) semantic segmentation lumbar vertebrae deep learning U-Net model

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Innovative pathways allow safe discharge of mild acute pancreatitis from the emergency room

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World Journal of Gastroenterology 2024年第11期30卷 1475-1479页

作者： Darshan J Kothari sunil G sheth Division of Gastroenterology Duke University Medical CenterDurhamNC 27710United States Division of Gastroenterology&Hepatology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA 02215United States

Acute pancreatitis(AP)is a leading cause of gastrointestinal-related hospitalizations in the United States,resulting in 300000 admissions per year with an estimated cost of over$2.6 billion *** severity of AP is determined by the presence of pancreatic complications and end-organ *** moderate/severe pancreatitis can be associated with significant morbidity and mortality,the majority of patients have a mild presentation with an uncomplicated course and mortality rate of less than 2%.Despite favorable outcomes,the majority of mild AP patients are admitted,contributing to healthcare cost and *** this Editorial we review the performance of an emergency department(ED)pathway for patients with mild AP at a tertiary care center with the goal of reducing hospitalizations,resource utilization,and costs after several years of implementation of the *** discuss the clinical course and outcomes of mild AP patients enrolled in the pathway who were successfully discharged from the ED compared to those who were admitted to the hospital,and identify predictors of successful ED discharge to select patients who can potentially be triaged to the *** conclude that by implementing innovative clinical pathways which are established and reproducible,selected AP patients can be safely discharged from the ED,reducing hospitalizations and healthcare costs,without compromising clinical *** also identify a subset of patients most likely to succeed in this pathway.

关键词： Emergency department Mild pancreatitis Pathways Hospitalization Predictors

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Pain management in chronic pancreatitis incorporating safe opioid practices: Challenge accepted

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World Journal of Gastroenterology 2021年第23期27卷 3142-3147页

作者： Ishani Shah sunil G sheth Darshan J Kothari Department of Gastroenterology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA 02215United States Department of Gastroenterology Duke University Medical CenterDurhamNC 27710United States

Patients with chronic pancreatitis often experience severe,unrelenting abdominal pain,which can significantly impact their quality of *** control,therefore,remains central to the overall management of chronic *** of the strategies aimed at treating the pain of chronic pancreatitis are based on expert opinion and vary from one institution to another,as there are no uniform guidelines to direct a stepwise approach towards achieving this *** this editorial,we comment on best practice strategies targeted towards pain control in chronic pancreatitis,specifically highlighting the use of opioid medications in this patient *** discuss various safe and efficacious prescription monitoring practices in this article.

关键词： Chronic pancreatitis Chronic pain Pain management Opioid use disorder Prescription opioid misuse Prescription opioid abuse

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Bone disease in chronic pancreatitis

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World Journal of Clinical Cases 2020年第9期8卷 1574-1579页

作者： Awais Ahmed Aman Deep sunil G sheth Darshan J Kothari Division of Gastroenterology Beth Israel Deaconess Medical CenterBostonMA 02215United States Division of Gastroenterology Duke University Medical CenterDurhamNC 27710United States

Bone disease(osteopenia or osteoporosis)is a highly prevalent condition in society and presents a tremendous,preventable public health *** procedures,such as,dual-energy X-ray absorptiometry scans,have allowed early identification and intervention to improve bone health,and reduce the risk of osteoporotic fractures,which carry significant morbidity and *** association of bone disease has been recognized in several diseases of the gastrointestinal tract,resulting in established guidelines for screening in patients with malabsorptive disorders such as inflammatory bowel disease and celiac ***,the risk of bone disease has been recognized in patients with chronic pancreatitis(CP),who share similar risk factors as patients with other high gastrointestinal *** a result,there have been a number of studies examining the prevalence and risks of bone disease and fractures in patients with *** review aims to summarize the recent literature and current recommendations related to bone disease in CP.

关键词： Bone disease Osteopenia Osteoporosis Fracture risk Chronic pancreatitis Malabsorption

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Tackling clinical complexity: how inpatient subspecialty gastroenterology services enhance patient care

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Gastroenterology Report 2021年第6期9卷 606-607页

作者： Cinthana Kandasamy Darshan J.Kothari sunil G.sheth Department of Internal Medicine Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Division of Gastroenterology Duke University Medical CenterDurhamNCUSA Division of Gastroenterology Durham VA Medical CenterDurhamNCUSA Division of Gastroenterology&Hepatology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA

Introduction Over the past three decades,the field of gastroenterology(GI)has undergone tremendous *** in research have led to a substantial growth in clinical knowledge across many GI ***,over this time,the prevalence of patient complexity,including the number of co-morbidities,mental illness burden,socioeconomic factors,and multidisciplinary needs,have continued to ***,subspecialization within GI has been an adaptive response to keep pace with the rapid expansion of medical knowledge and evolving patient needs.

关键词： patient clinical gastro

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Natural history,clinical characteristics,outcomes,and long-term follow-up of pain-free chronic pancreatitis

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Gastroenterology Report 2023年第1期11卷 309-315页

作者： Awais Ahmed Ishani Shah Rachel Bocchino Steven D.Freedman Darshan J.Kothari sunil G.sheth Department of Medicine Division of GastroenterologyBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Department of Medicine Division of Internal MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Department of Medicine Division of GastroenterologyDuke UniversityDurhamNCUSA

Background:Chronic pancreatitis(CP)is characterized by chronic abdominal pain and functional ***,a small subset of patients with prior acute pancreatitis(AP)and/or underlying risk factors for developing CP may be pain-free at diagnosis and may have a different clinical *** aimed to compare the clinical characteristics,outcomes,and healthcare utilization between CP patients with and without ***:Reviewed patients with established CP were followed in our Pancreas Center between January 2016 and April *** without risk factors for developing CP and/or without AP prior to their diagnosis and only with incidental radiologic features of CP were excluded,so as tominimize confounding factors of pancreatopathy unrelated to *** were divided into painful and pain-free groups to analyze differences in demographics,outcomes,and healthcare ***:Of 368 CP patients,49(13.3%)were pain-free at diagnosis and had remained so for>9 *** were no significant differences in body mass index,race,sex,or co-morbidities between the two ***-free patients were older at diagnosis(53.9 vs 45.7,P=0.004)and had less recurrent AP(RAP)(43.8%vs 72.5%,P<0.001)and less exocrine pancreatic insufficiency(EPI)(34.7%vs 65.7%,P<0.001).Pain-free patients had less disability(2.2%vs 22.0%,P=0.003),mental illness(20.4%vs 61.0%,P<0.001),surgery(0.0%vs 15.0%,P=0.059),and therapeutic interventions(0.0%vs 16.4%,P=0.005)for ***:We described a unique subset of patients with underlying risk factors for CP and/or prior AP who were painfree at *** were older at diagnosis,had less EPI and RAP,and overall favorable outcomes with minimal resource utilization.

关键词： chronic pancreatitis pain-free pancreatic insufficiency diabetes

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Autoimmune pancreatitis

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Gastroenterology Report 2013年第1期1卷 27-32页

作者： Gyanprakash A.Ketwaroo sunil sheth Department of Gastroenterology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA

Autoimmune pancreatitis(AIP)is a rare,heterogeneous,fibroinflammatory disorder of the *** has gained increasing recognition due to a presentation that can mimic difficult-to-treat disorders such as pancreatic cancer,cholangiocarcinoma and primary sclerosing *** contrast,autoimmune pancreatitis is a benign disease that is very responsive to therapy with *** are two types of *** 1 disease is the most common worldwide and is associated with extrapancreatic manifestations and elevated levels of IgG4-positive *** 2 AIP is characterized by a paucity of IgG4-positive cells and is more difficult to *** review provides an update on the diagnosis,pathophysiology and treatment of AIP,with special emphasis on the two subtypes.

关键词： autoimmune pancreatitis review

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An open-access endoscopy screen correctly and safely identifies patients for conscious sedation

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Gastroenterology Report 2016年第4期4卷 281-286,I0001页

作者： Darshan Kothari Joseph D.Feuerstein Laureen Moss Julie D’Souza Kerri Montanaro Daniel A.Leffler sunil G.sheth Department of Medicine and Division of Gastroenterology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Department of Nursing Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA

Background and aims:Open-access scheduling is highly utilized for facilitating generally low-risk *** screening addresses sedation requirements;however,procedural safety may be compromised if screening is *** sought to determine the reliability of our open-access scheduling system for appropriate use of conscious ***:We prospectively and consecutively enrolled outpatient procedures booked at an academic center by open-access using screening after in-office gastroenterology(GI)*** collected the cases inappropriately booked for conscious sedation and compared the characteristics for significant ***:A total of 8063 outpatients were scheduled for procedures with conscious sedation,and 5959 were booked with *** 78 patients(0.97%,78/8063)were identified as subsequently needing anesthesiologist-assisted sedation;44(56.4%,44/78)were booked through open-access,of which chronic opioid(47.7%,21/44)or benzodiazepine use(34.1%,15/44)were the most common reasons for needing anesthesiologist-assisted *** on chronic benzodiazepines required more midazolam than those not on chronic benzodiazepines(P=0.03)of those patients who underwent conscious ***,patients with chronic opioid use required more fentanyl than those without chronic opioid use(P=0.04).Advanced liver disease and alcohol use were common reasons for patients being booked after in-office consultation and were significantly higher than those booked with open-access(both P<0.01).Conclusions:We observed that the majority of patients can be triaged for conscious sedation using a multi-tiered screening ***,few patients(<1.0%)were inappropriately booked for conscious *** most common reasons for considering anesthesiologist-assisted sedation were chronic opioid,benzodiazepine and/or alcohol use and advanced liver *** suggests that these entities could be included in screening proces

关键词： open-access endoscopy sedation screen

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Extra-pancreatic complications,especially hemodialysis predict mortality and length of stay,in ICU patients admitted with acute pancreatitis

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Gastroenterology Report 2018年第3期6卷 202-209,I0001页

作者： Darshan Kothari Maarten R.Struyvenberg Michael C.Perillo Ghideon Ezaz Steven D.Freedman sunil G.sheth Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School330 Brookline AveBostonMA 02215USA

Background and aims:Patients in the intensive care unit(ICU)with acute pancreatitis(AP)are at risk for extra-pancreatic complications given their severe illness and prolonged length of *** sought to determine the rate of extra-pancreatic complications and its effect on length of stay(LOS)and mortality in ICU patients with ***:We performed a retrospective cohort study of ICU patients admitted to a tertiary-care center with a diagnosis of AP.A total of 287 ICU patients had a discharge diagnosis of AP,of which 163 met inclusion *** calculated incidence rates of extra-pancreatic complications and performed a univariate and multi-variable analysis to determine predictors of LOS and ***:There were a total of 158 extra-pancreatic complications(0.97 extra-pancreatic complications per patient).Ninetyfive patients had at least one extra-pancreatic complication,whereas 68 patients had no extra-pancreatic *** with extra-pancreatic complications had a significantly longer LOS(14.7 vs 8.8 days,p<0.01)when controlling for local pancreatic *** with non-infectious extra-pancreatic complications had a higher rate of mortality(24.0%vs 16.2%,p=0.04).Patients requiring dialysis was an independent predictor for LOS and mortality(incidence risk ratio[IRR]1.73,95%confidence interval[CI]:1.263–2.378 and IRR 1.50,95%CI 1.623–6.843,p<0.01)on multi-variable *** events were also a predictor for mortality(p=0.05).Other extra-pancreatic complications were not ***:Extra-pancreatic complications occur frequently in ICU patients with AP and impact *** with noninfectious extra-pancreatic complications have a higher mortality *** controlling for local pancreatic complications,patients requiring dialysis remained an independent predictor for LOS and mortality.

关键词： Severe acute pancreatitis extra-pancreatic complications intensive care unit length of stay in-hospital mortality infections

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AI/ML Enabled Automation System for Software Defined Disaggregated Open Radio Access Networks:Transforming Telecommunication Business

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Big Data Mining and Analytics 2024年第2期7卷 271-293页

作者： sunil Kumar Institute for Communication Systems University of SurreyGuildfordGU27XHUK

Open Air Interface(OAI)alliance recently introduced a new disaggregated Open Radio Access Networks(O-RAN)framework for next generation telecommunications and *** disaggregated architecture is open,automated,software defined,virtual,and supports the latest advanced technologies like Artificial Intelligence(AI)Machine Learning(AI/ML).This novel intelligent architecture enables programmers to design and customize automated applications according to the business needs and to improve quality of service in fifth generation(5G)and Beyond 5G(B5G).Its disaggregated and multivendor nature gives the opportunity to new startups and small vendors to participate and provide cheap hardware software solutions to keep the market *** paper presents the disaggregated and programmable O-RAN architecture focused on automation,AI/ML services,and applications with Flexible Radio access network Intelligent Controller(FRIC).We schematically demonstrate the reinforcement learning,external applications(xApps),and automation steps to implement this disaggregated O-RAN *** idea of this research paper is to implement an AI/ML enabled automation system for software defined disaggregated O-RAN,which monitors,manages,and performs AI/ML-related services,including the model deployment,optimization,inference,and training.

关键词： Artificial Intelligence(AI) Reinforcement Learning(RL) Open Radio Access Networks(O-RAN) Flexible Radio access network Intelligent Controller(FRIC) external Applications(xApps) Machine Learning(ML),sixth generation(6G)

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