Deep learning system for malignancy risk prediction in cystic renal lesions: a multicenter study.

OBJECTIVES: To develop an interactive, non-invasive artificial intelligence (AI) system for malignancy risk prediction in cystic renal lesions (CRLs). METHODS: In this retrospective, multicenter diagnostic study, we evaluated 715 patients. An interactive geodesic-based 3D segmentation model was created for CRLs segmentation. A CRLs classification model was developed using spatial encoder temporal decoder (SETD) architecture. The classification model combines a 3D-ResNet50 network for extracting spatial features and a gated recurrent unit (GRU) network for decoding temporal features from multi-phase CT images. We assessed the segmentation model using sensitivity (SEN), specificity (SPE), intersection over union (IOU), and dice similarity (Dice) metrics. The classification model's performance was evaluated using the area under the receiver operator characteristic curve (AUC), accuracy score (ACC), and decision curve analysis (DCA). RESULTS: From 2012 to 2023, we included 477 CRLs (median age, 57 [IQR: 48-65]; 173 men) in the training cohort, 226 CRLs (median age, 60 [IQR: 52-69]; 77 men) in the validation cohort, and 239 CRLs (median age, 59 [IQR: 53-69]; 95 men) in the testing cohort (external validation cohort 1, cohort 2, and cohort 3). The segmentation model and SETD classifier exhibited excellent performance in both validation (AUC = 0.973, ACC = 0.916, Dice = 0.847, IOU = 0.743, SEN = 0.840, SPE = 1.000) and testing datasets (AUC = 0.998, ACC = 0.988, Dice = 0.861, IOU = 0.762, SEN = 0.876, SPE = 1.000). CONCLUSION: The AI system demonstrated excellent benign-malignant discriminatory ability across both validation and testing datasets and illustrated improved clinical decision-making utility. CRITICAL RELEVANCE STATEMENT: In this era when incidental CRLs are prevalent, this interactive, non-invasive AI system will facilitate accurate diagnosis of CRLs, reducing excessive follow-up and overtreatment. KEY POINTS: The rising prevalence of CRLs necessitates better malignancy prediction strategies. The AI system demonstrated excellent diagnostic performance in identifying malignant CRL. The AI system illustrated improved clinical decision-making utility.

In vivo cadmium-assisted dilute acid pretreatment of the phytoremediation sweet sorghum for enzymatic hydrolysis and cadmium enrichment.

Phytoremediation with energy crops is considered an integrated technology that provides both environment and energy benefits. Herein, the sweet sorghum cultivated on Cd-contaminated farmland (1.21 mg/kg of Cd in the soil) showed promising phytoremediation potential, and the approach for utilizing sorghum stalks was explored. Sweet sorghum bagasse with Cd contamination was pretreated with dilute acid in order to improve enzymatic saccharification and achieve Cd recovery, resulting in harmless and value-added utilization. After pretreatment, hemicelluloses were dramatically degraded, and the lignocellulosic structures were partially deconstructed with xylan removal up to 98.1%. Under the optimal condition (0.75% H2SO4), the highest total sugar yield was 0.48 g/g of raw bagasse; and nearly 98% of Cd was enriched in the liquid phase. Compared with normal biomass, Cd reduced the biomass recalcitrance and further facilitated the deconstruction of biomass under super dilute acid conditions. This work provided an example for the subsequent valorization of Cd-containing biomass and Cd recovery, which will greatly facilitate the development of phytoremediation of heavy metal contaminated soil.

Deep learning and radiomic feature-based blending ensemble classifier for malignancy risk prediction in cystic renal lesions.

BACKGROUND: The rising prevalence of cystic renal lesions (CRLs) detected by computed tomography necessitates better identification of the malignant cystic renal neoplasms since a significant majority of CRLs are benign renal cysts. Using arterial phase CT scans combined with pathology diagnosis results, a fusion feature-based blending ensemble machine learning model was created to identify malignant renal neoplasms from cystic renal lesions (CRLs). Histopathology results were adopted as diagnosis standard. Pretrained 3D-ResNet50 network was selected for non-handcrafted features extraction and pyradiomics toolbox was selected for handcrafted features extraction. Tenfold cross validated least absolute shrinkage and selection operator regression methods were selected to identify the most discriminative candidate features in the development cohort. Feature's reproducibility was evaluated by intra-class correlation coefficients and inter-class correlation coefficients. Pearson correlation coefficients for normal distribution and Spearman's rank correlation coefficients for non-normal distribution were utilized to remove redundant features. After that, a blending ensemble machine learning model were developed in training cohort. Area under the receiver operator characteristic curve (AUC), accuracy score (ACC), and decision curve analysis (DCA) were employed to evaluate the performance of the final model in testing cohort. RESULTS: The fusion feature-based machine learning algorithm demonstrated excellent diagnostic performance in external validation dataset (AUC = 0.934, ACC = 0.905). Net benefits presented by DCA are higher than Bosniak-2019 version classification for stratifying patients with CRL to the appropriate surgery procedure. CONCLUSIONS: Fusion feature-based classifier accurately distinguished malignant and benign CRLs which outperformed the Bosniak-2019 version classification and illustrated improved clinical decision-making utility.

Effectiveness of Mobile Medical Apps in Ensuring Medication Safety Among Patients With Chronic Diseases: Systematic Review and Meta-analysis.

BACKGROUND: Along with the rapid growth of the global aging society, the mobile and health digital market has expanded greatly. Countless mobile medical apps (mmApps) have sprung up in the internet market, aiming to help patients with chronic diseases achieve medication safety. OBJECTIVE: Based on the medication safety action plans proposed by the World Health Organization, we aimed to explore the effectiveness of mmApps in ensuring the medication safety of patients with chronic diseases, including whether mmApps can improve the willingness to report adverse drug events (ADEs), improve patients' medication adherence, and reduce medication errors. We hoped to verify our hypothesis through a systematic review and meta-analysis. METHODS: The meta-analysis was performed in strict accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included literature searched from 7 databases-PubMed, Web Of Science, Embase, CINAHL, China National Knowledge Infrastructure, Wanfang, and SinoMed. The publication time was limited to the time of database establishment to April 30, 2022. Studies were screened based on inclusion and exclusion criteria. The data extracted included authors, years of publication, countries or regions, participants' characteristics, intervention groups, and control groups, among others. Our quality assessment followed the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions, Version 6.3. RevMan 5.2 software (Cochrane Collaboration) was used to analyze the statistical data, and a sensitivity analysis was performed to assess data stability. The degree of stability was calculated by using a different statistical method and excluding large-sample studies from the analysis. RESULTS: We included 8 studies from 5 countries (China, the United States, France, Canada, and Spain) that were published from January 1, 2014, to December 31, 2021. The total number of participants was 1355, and we analyzed the characteristics of included studies, each app's features, the risk of bias, and quality. The results showed that mmApps could increase ADE reporting willingness (relative risk [RR] 2.59, 95% CI 1.26-5.30; P=.009) and significantly improve medication adherence (RR 1.17, 95% CI 1.04-1.31; P=.007), but they had little effect on reducing medication errors (RR 1.54, 95% CI 0.33-7.29; P=.58). CONCLUSIONS: We analyzed the following three merits of mmApps, with regard to facilitating the willingness to report ADEs: mmApps facilitate more communication between patients and physicians, patients attach more importance to ADE reporting, and the processing of results is transparent. The use of mmApps improved medication adherence among patients with chronic diseases by conveying medical solutions, providing educational support, tracking medications, and allowing for remote consultations. Finally, we found 3 potential reasons for why our medication error results differed from those of other studies. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42022322072; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322072.

Stratification of malignant renal neoplasms from cystic renal lesions using deep learning and radiomics features based on a stacking ensemble CT machine learning algorithm.

Using nephrographic phase CT images combined with pathology diagnosis, we aim to develop and validate a fusion feature-based stacking ensemble machine learning model to distinguish malignant renal neoplasms from cystic renal lesions (CRLs). This retrospective research includes 166 individuals with CRLs for model training and 47 individuals with CRLs in another institution for model testing. Histopathology results are adopted as diagnosis criterion. Nephrographic phase CT scans are selected to build the fusion feature-based machine learning algorithms. The pretrained 3D-ResNet50 CNN model and radiomics methods are selected to extract deep features and radiomics features, respectively. Fivefold cross-validated least absolute shrinkage and selection operator (LASSO) regression methods are adopted to identify the most discriminative candidate features in the development cohort. Intraclass correlation coefficients and interclass correlation coefficients are employed to evaluate feature's reproducibility. Pearson correlation coefficients for normal distribution features and Spearman's rank correlation coefficients for non-normal distribution features are used to eliminate redundant features. After that, stacking ensemble machine learning models are developed in the training cohort. The area under the receiver operator characteristic curve (ROC), calibration curve, and decision curve analysis (DCA) are adopted in the testing cohort to evaluate the performance of each model. The stacking ensemble machine learning algorithm reached excellent diagnostic performance in the testing dataset. The calibration plot shows good stability when using the stacking ensemble model. Net benefits presented by DCA are higher than the Bosniak 2019 version classification when employing any machine learning algorithm. The fusion feature-based machine learning algorithm accurately distinguishes malignant renal neoplasms from CRLs, which outperformed the Bosniak 2019 version classification, and proves to be more applicable for clinical decision-making.

Ultrastructural elucidation of lignin macromolecule from different growth stages of Chinese pine.

Understanding of the morphological changes at different growth stages and lignin accumulation pattern for pine biomass plays the key role in facilitating the further development of value-added utilization and downstream conversion processes. This work systematically revealed the morphological change and lignin accumulation pattern in Chinese pine branches cell walls via confocal Raman microscopy (CRM) technology. Meanwhile, the structural characteristics of isolated lignin samples from different growth stages were synthetically characterized by nuclear magnetic resonance (NMR) and gel permeation chromatography (GPC) techniques. The results indicated that the content of pith in adult pine new branch was bigger than juvenile trees. With the increase of physiological age, the branches in adult pine could accumulate more lignin both in overall content and the concentration of cell corner middle layer. Moreover, the significantly increases of molecular weights and the ß-O-4, ß-ß linkages content revealed that the lignin macromolecule of pine would polymerize faster in the adult stage (14, 35 years). The panorama generated from the structural and chemical features of pine native lignin not only benefited to understand the biosynthetic pathways and lignin macromolecules structural variation in plant cell walls from different growth stages but also contributed to the valorization and deconstruction of biomass.

Analysis of hospitalization costs related to fall injuries in elderly patients.

BACKGROUND: With the aging world population, the incidence of falls has intensified and fall-related hospitalization costs are increasing. Falls are one type of event studied in the health economics of patient safety, and many developed countries have conducted such research on fall-related hospitalization costs. However, China, a developing country, still lacks large-scale studies in this area. AIM: To investigate the factors related to the hospitalization costs of fall-related injuries in elderly inpatients and establish factor-based, cost-related groupings. METHODS: A retrospective study was conducted. Patient information and cost data for elderly inpatients (age ≥ 60 years, n = 3362) who were hospitalized between 2016 and 2019 due to falls was collected from the medical record systems of two grade-A tertiary hospitals in China. Quantile regression (QR) analysis was used to identify the factors related to fall-related hospitalization costs. A decision tree model based on the chi-squared automatic interaction detector algorithm for hospitalization cost grouping was built by setting the factors in the regression results as separation nodes. RESULTS: The total hospitalization cost of fall-related injuries in the included elderly patients was 180479203.03 RMB, and the reimbursement rate of medical benefit funds was 51.0% (92039709.52 RMB/180479203.03 RMB). The medical material costs were the highest component of the total hospitalization cost, followed (in order) by drug costs, test costs, treatment costs, integrated medical service costs and blood transfusion costs The QR results showed that patient age, gender, length of hospital stay, payment method, wound position, wound type, operation times and operation type significantly influenced the inpatient cost (P < 0.05). The cost grouping model was established based on the QR results, and age, length of stay, operation type, wound position and wound type were the most important influencing factors in the model. Furthermore, the cost of each combination varied significantly. CONCLUSION: Our grouping model of hospitalization costs clearly reflected the key factors affecting hospitalization costs and can be used to strengthen the reasonable control of these costs.

Unmasking the heterogeneity of carbohydrates in heartwood, sapwood, and bark of Eucalyptus.

In this study, the cellulose and hemicelluloses in heartwood, sapwood, and bark of E. urophylla × E. grandis were comprehensively investigated. The ultrastructural topochemistry of carbohydrates in cell walls was examined in situ by confocal Raman microscopy. Cellulose and alkali-extractable hemicelluloses samples were isolated from different tissues and comparatively characterized by compositional carbohydrate analyses, determination of molecular weights, FT-IR spectroscopy, and XRD and NMR techniques. It was found that among all of the samples, heartwood cellulose had the highest molecular weight as well as the lowest degree of crystallinity. Meanwhile the hemicelluloses in heartwood had higher xylose content, lower degree of branching, slightly lower molecular weights but narrower polydispersity than those in sapwood. The eucalyptus hemicelluloses mainly consisted of (1→4)-ß-D-xylan backbone with glucuronic acid side chains. Furthermore, the hemicelluloses isolated from sapwood had a higher degree of substitution with terminal galactose than those isolated from heartwood and bark.

Structural characterization of lignin in heartwood, sapwood, and bark of eucalyptus.

Understanding the distribution and structural features of lignin in heartwood, sapwood, and bark of terrestrial plants is important to optimize the industrial utilization of lignocellulose. In this work, the lignins in heartwood, sapwood, and bark of Eucalyptus urophylla × E. grandis were comparatively studied. Confocal Raman microscopy was used to probe the heterogeneity of lignin distribution in situ. The swollen residual enzyme lignin samples were isolated and systematically characterized to determine the structural differences. The results showed that the content and molecular weights of lignin gradually decreased in the order of heartwood, sapwood, and bark. The S/G ratios of heartwood lignin (3.45) and sapwood lignin (2.74) suggested the increase of deposited S-type lignin with the maturity of wood. The bark lignin exhibited a high frequency of ß-O-4' linkages and showed a unique substructural pattern with the absence of spirodienone substructures and p-hydroxycinnamyl alcohol end-groups.

The effectiveness of exercise for fall prevention in nursing home residents: A systematic review meta-analysis.

AIM: The aim of this study was to determine the effectiveness of exercise on fall prevention in nursing home residents. BACKGROUND: Nursing home residents have a high risk of falling. No conclusive evidence exists on the effectiveness of exercise on fall prevention in nursing home residents. DESIGN: Systematic review and meta-analysis of randomized controlled trials. DATA RESOURCES: Databases of PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature and China Biology Medicine were searched from inception to March 2017, with no language limitation. REVIEW METHODS: The review was conducted according to the guidelines of the Cochrane Collaboration. Studies on exercise interventions to prevent falls in nursing home residents were eligible. The primary outcome was the odds ratio with 95% confidence intervals of falls. RESULTS: Nine studies were included in the meta-analysis where exercise was compared with daily routine, social activities, and other methods in preventing falls. About falls, the pooled effect size of seven studies showed that exercise had no effect on fall prevention in nursing home residents. There was low heterogeneity. No significant publication bias was observed. CONCLUSIONS: The results of the systematic review and meta-analysis suggested that exercise did not play a role in preventing falls. Further studies with high quality and larger samples are required to support or counter the results.

Construction of Nursing Quality Control Information System in Large Hospitals.

Based on the process and framework of nursing quality management in the "Third-level General Ho Accreditation Criteria", with the help of computer and mobile information technology, development of nursing quality control informatics system computer operation and mobile operating. The system has implanted PDCA several scientific management tools into the mobile applications, insteads of replace traditional paper methods, improve working efficiency in process control and Data Operation.

Cough Test during Tension-Free Vaginal Tape Procedure in Preventing Postoperative Urinary Retention.

Objective. To discuss the practical value of the cough test during the tension-free vaginal tape (TVT) procedure. Methods. In the first group, 41 patients of female stress incontinence received TVT operations which were performed according to the Ulmsten's method strictly, only that the stress of tape was adjusted in light of the cough test. In the second group, 44 patients of female stress incontinence received TVT operations in which the tape was put under the urethral tract without stress, not adjusted by cough test. Results. The cure rate was 38/41 (92.6%) in the cough test group and 41/44 (93.1%) in the noncough test group; detrusor pressure-uroflow study indicated that there were 11 cases in the obstruction zone in the cough test group while only 3 cases were in the obstruction zone in the noncough test group; 4 cases of urinary retention and 5 cases of voiding dysfunction were found in the cough test group, while difficulties of urination were not found in the non-cough test group. Conclusion. Adjusting the tape stress in accordance with the cough test during the TVT can increase the opportunity of urinary retention or difficulty of urination after operation. So there is no benefit of the cough test during tension-free vaginal tape procedure in preventing post-operative urinary retention.

Tamsulosin alters levofloxacin pharmacokinetics in prostates derived from rats with acute bacterial prostatitis.

The combination of levofloxacin and α1 adrenergic antagonist treatment is the current preferred choice for both bacterial and non-bacterial prostatitis. The aim of this study is to explore the influence of α1 adrenergic antagonists on the pharmacokinetics of levofloxacin using rat models with acute bacterial prostatitis (ABP) induced by direct injection with Escherichia coli (ATCC25922). A total of 96 model rats were randomly assigned into two groups: the experimental group (treated with both tamsulosin and levofloxacin, n=48) and the control group (treated with levofloxacin and solvents, n=48). Six rats from each group were euthanized to collect blood, liver, kidney and prostate samples at the time points of 0.125, 0.25, 0.5, 1, 2, 4, 8 and 12 h after drug administration. The levofloxacin concentrations were detected by high performance liquid chromatography (HPLC), and the pharmacokinetic parameters were calculated using the 3p97 software program. There were no obvious differences (P>0.05) between the experimental and control groups in the major pharmacokinetic parameters of levofloxacin, including the halftime (t1/2), time to peak (tpeak), clearance rate (CL), maximum concentration (Cmax) and area under the curve (AUC0∼12), in the plasma or in the hepatic and kidney tissues of the model rats. However, in the prostatic tissues, tamsulosin increased the Cmax, prolonged the t1/2 and decreased the CL of levofloxacin (P<0.05). These results indicate that tamsulosin may enhance the effect of levofloxacin in the treatment of bacterial prostatitis without changing the drug concentration in the liver and kidney.

PDIA3 mRNA expression and IL-2, IL-4, IL-6, and CRP levels of acute kidney allograft rejection in rat.

Kidney transplantation to treat end-stage renal disease has evolved rapidly from the first successful transplantations to the current widespread use of grafts from both cadaveric and living donors. But acute rejection is still a strong risk factor for chronic rejection in recipients of renal grafts. To investigate possible mechanisms, we describe a comparison between differentially proteins expression and immune markers profile (IL-2, IL-4, IL-6, and CRP) of acute rejection and the controls. Through quantitative real-time RT-PCR confirmation, PDIA3 mRNA and protein expression levels in serum and transplanted kidney in experiment group was significantly (P < 0.05) higher than that in control group. Immunity analysis showed that plasma IL-2, IL-4, IL-6, and CRP levels were higher in experimental rats than those in control rats. Our data thus indicate that PDIA3 might be potentially involve into the occurence and development of acute rejection response in renal transplantation and increased plasma IL-2, IL-4, IL-6, and CRP levels play an important role to prevent acute kidney allograft rejection in rats.

[Present status of clinical researches on the screening for prostate cancer biomarkers].

Researches on the biomarkers of tumors are very important for their early diagnosis and treatment. Although PSA has been used for over 20 years for screening prostate cancer and evaluating its treatment, the results are not entirely satisfactory. With the deepening of the researches on prostate cancer, a variety of prostate cancer biomarkers have been found. This article presents an overview on the recent advances in the screening for prostate cancer biomarkers.

Transplantation of endothelial progenitor cells transfected with VEGF165 to restore erectile function in diabetic rats.

The present study investigated the effect of transplanting endothelial progenitor cells (EPCs) transfected with the vascular endothelial growth factor gene (VEGF165) into the corpora cavernosa of rats with diabetic erectile dysfunction (ED). A rat model of diabetic ED was constructed via intraperitoneal injection of streptozotocin. After streptozotocin treatment, pre-treated EPCs from each of three groups of rats were transplanted into their corpora cavernosa. Our results, following intracavernosal pressure (ICP) monitoring, showed that ICP increased significantly among rats in the trial group when compared to the results from rats in the blank-plasmid and control groups during basal conditions and electrical stimulation (P<0.01 for both comparisons). Histological examination revealed extensive neovascularisation in the corpora cavernosa of rats in the trial group. Fluorescence microscopy indicated that many of the transplanted EPCs in the trial group survived, differentiated into endothelial cells and integrated into the sites of neovascularisation. Based on the results of this study, we conclude that transplantation of VEGF165-transfected EPCs into the corpora cavernosa of rats with diabetic ED restores erectile function.

[Diagnosis and treatment of urethral condyloma acuminatum in male patients].

OBJECTIVES: To present experience on the diagnosis and treatment of urethral condyloma acuminatum (CA) in male patients. METHODS: Twenty-one cases of urethral CA were studied. The lesion of urethral meatus and intraurethal were resected by electrofulguration or operation and Urethroscopy, respectively. All patients were received intraurethral instillation and local therapy of 5% 5-fluorouracil solution. RESULTS: The patients had been followed up for three to twelve months. Cure rate was 76.2%, recurrence rate was 23.89%. CONCLUSIONS: Transurethral endoscopy is a reliable diagnosis and treatment method. Intraurethral instillation and local therapy of 5% 5-fluorouracil solution may prevent the recurrence of CA.