Performance of a generative adversarial network using ultrasound images to stage liver fibrosis and predict cirrhosis based on a deep-learning radiomics nomogram.

AIM: To investigate the performance of a generative adversarial network (GAN) model for staging liver fibrosis and its radiomics-based nomogram for predicting cirrhosis. MATERIALS AND METHODS: This two-centre retrospective study included 434 patients for whom input data of ultrasound images and histopathological data (obtained within 1 month of ultrasound examinations) were assigned to the training cohort (249 patients), the internal cohort (92 patients), and the external (93 patients) cohort. A data augmentation method based on a GAN model was used. The discriminative performance was evaluated for classifying fibrosis of S4 and ≥S3. Deep-learning radiomics features were extracted for the prediction of cirrhosis (S4). To perform feature reduction and selection, the least absolute shrinkage and selection operator (LASSO) algorithm was applied. Radiomics scores, along with clinical factors, were incorporated into a nomogram using multivariable logistic regression analysis. The performance of the models was estimated with respect to discrimination power, calibration, and clinical benefits. RESULTS: The areas under the receiver operating characteristic curve (AUCs) values of the GAN were 0.832/0.762 (≥S3), and 0.867/0.835 (S4) for internal/external test sets, respectively. The radiomics nomogram that intergrated radiomics scores and clinical factors showed good calibration and discrimination ability of 0.922 (AUC) in the training dataset, 0.896 in the internal dataset, and 0.861 in the external dataset. Decision curve analysis (DCA) demonstrated that the nomogram outperformed radiologist and haematological indices in terms of the most clinical benefits. CONCLUSIONS: The GAN model could be applied to discriminate fibrosis stages, and a favourable predictive accuracy for diagnosing cirrhosis was achieved using a deep-learning radiomics nomogram.

[Effect and influence factors of cardiopulmonary resuscitation in children with congenital heart disease in pediatric intensive care unit].

Objective: To investigate the prognostic factors of children with congenital heart disease (CHD) who had undergone cardiopulmonary resuscitation (CPR) in pediatric intensive care unit (PICU) in China. Methods: From November 2017 to October 2018, this retrospective multi-center study was conducted in 11 hospitals in China. It contained data from 281 cases who had undergone CPR and all of the subjects were divided into CHD group and non-CHD group. The general condition, duration of CPR, epinephrine doses during resuscitation, recovery of spontaneous circulation (ROSC), discharge survival rate and pediatric cerebral performance category in viable children at discharge were compared. According to whether malignant arrhythmia is the direct cause of cardiopulmonary arrest or not, children in CHD and non-CHD groups were divided into 2 subgroups: arrhythmia and non-arrhythmia, and the ROSC and survival rate to discharge were compared. Data in both groups were analyzed by t-test, chi-square analysis or ANOVA, and logistic regression were used to analyze the prognostic factors for ROSC and survival to discharge after cardiac arrest (CA). Results: The incidence of CA in PICU was 3.2% (372/11 588), and the implementation rate of CPR was 75.5% (281/372). There were 144 males and 137 females with median age of 32.8 (5.6, 42.7) months in all 281 CPA cases who received CPR. CHD group had 56 cases while non-CHD had 225 cases, with the percentage of 19.9% (56/281) and 80.1% (225/281) respectively. The proportion of female in CHD group was 60.7% (34/56) which was higher than that in non-CHD group (45.8%, 103/225) (χ2=4.00, P=0.045). There were no differences in ROSC and rate of survival to discharge between the two groups (P>0.05). The ROSC rate of children with arthythmid in CHD group was 70.0% (28/40), higher than 6/16 for non-arrhythmic children (χ2=5.06, P=0.024). At discharge, the pediatric cerebral performance category scores (1-3 scores) of CHD and non-CHD child were 50.9% (26/51) and 44.9% (92/205) respectively. Logistic regression analysis indicated that the independent prognostic factors of ROSC and survival to discharge in children with CHD were CPR duration (odds ratio (OR)=0.95, 0.97; 95%CI: 0.92~0.97, 0.95~0.99; both P<0.05) and epinephrine dosage (OR=0.87 and 0.79, 95%CI: 0.76-1.00 and 0.69-0.89, respectively; both P<0.05). Conclusions: There is no difference between CHD and non-CHD children in ROSC and survival rate of survival to discharge was low. The epinephrine dosage and the duration of CPR are related to the ROSC and survival to discharge of children with CHD.

[Analysis of risk factors for readmission of pneumoconiosis patients in Hunan].

Objective: To explore the risk factors of pneumoconiosis patients' re-admission to provide a scientific basis for improving the treatment effect of pneumoconiosis, reducing the rate of re-admission, and reducing the burden of disease. Methods: In June 2020, The clinical data of 470 patients with pneumoconiosis who had hospitalization records from February 8, 2014, to February 8, 2020, in the Hunan Provincial Occupational Disease Prevention and Treatment Institute were retrospectively analyzed. The patients' general data and emotional state at the first admission were collected through questionnaires and telephone follow-ups. The entire group of patients completed at least one follow-up, with readmission as the end event. First, the Kaplan-Meier method was used for univariate analysis. The multivariate COX regression model analysis was performed on meaningful variables to explore the risk factors that affect the patient's re-admission. Results: A total of 470 patients with pneumoconiosis were included in this study, with an average age of 55.88 years (34-81 years old) and all the participants were male. During the first admission, the number of participants diagnosed as stage III pneumoconiosis, with complications of COPD, fatty liver, or severe pulmonary diffusion dysfunction was 215 (45.74%) , 179 (38.09%) , 51 (10.85%) , and 44 (9.36%) , respectively. Six patients (1.28%) have had suicidal tendencies almost every day since they became ill. A total of 345 patients (73.40%) were re-admitted to the hospital. Multivariate Cox regression model analysis showed that compared with the suspected pneumoconiosis group, patients in the first, second, and third-stage pneumoconiosis groups had an increased risk of readmission (OR=2.43, 2.96, 2.35, P=0.000) . Compared with the age of 30-50 years old, 50-70 years old and ≥70 years old have an increased risk of readmission (OR=1.28, 2.32, P<0.05) . Patients with tricuspid regurgitation (OR=1.33, P<0.05) and elevated triglyceride level (>2.26 mmol/L) (OR=1.40, P<0.05) have increased risks of readmission. Compared with the normal group, patients with severe pulmonary diffusion dysfunction in pneumoconiosis have an increased risk of readmission (OR=1.96, P<0.05) . Compared with the normal group, pneumoconiosis patients in the suicidal group had an increased risk of re-admission to the hospital almost every day (OR=2.92, P<0.05) . Conclusion Age of onset, stage of pneumoconiosis, tricuspid regurgitation, high triglycerides, severe diffuse pulmonary dysfunction, and suicidal tendency are independent risk factors that affect the readmission of patients with pneumoconiosis. The management of chronic diseases and mental health of patients with pneumoconiosis should be strengthened to reduce the risk of readmission. Conclusion: Age of onset, stage of pneumoconiosis, tricuspid regurgitation, high triglycerides, severe diffuse pulmonary dysfunction, and suicidal tendency are independent risk factors that affect the readmission of patients with pneumoconiosis. The management of chronic diseases and the mental health of patients with pneumoconiosis should be strengthened to reduce the risk of readmission.

[Treatment strategies of complex lesions in patients with acute Stanford type A dissection of important branches involvement].

Acute Stanford type A aortic dissection with important branches involved is more complex, could lead to organ malperfusion syndrome even organ failure. The understanding of pathological anatomy, classification, staging, and the pathophysiological change has increasingly mature, but not complete. In addition, the treatment strategy for complex lesions is diversified, some questions may not reach consensus. Fully understanding of the anatomical and pathophysiology is very important for surgeons to choose reasonable treatment strategy. As the rapid development of the basic research, imaging techniques and the concept of surgery procedures, the manage technique of Stanfrod type A dissection and branch vessels at the same time is getting seriously, the related issues also need further discussions.

[Application of evoked potentials monitoring in total thoracoabdominal aorta aneurysm repair].

OBJECTIVE: To evaluate the application value of evoked potentials (EP) monitoring in patients undergoing aorta-iliac bypass for total thoracoabdominal aorta aneurysm repair (tTAAAR). METHODS: A prospective study, with a total of 31 patients undergoing tTAAAR and intraoperative EP monitoring from June 2014 to April 2015 was carried out. The results of intraoperative evoked potentials, clinical outcomes and follow-up data of patients were collected for further evaluation. RESULTS: The EP wave disappeared [motor evoked potentials for (55.6±18.1) min, somatosensory evoked potentials for (50.3±18.7) min] after proximal descending aorta being clamped, and gradually recovered after the segment arteries of spine cord were reconstructed. The EP wave was restored to normal level at the end of operation in all the cases. The somatosensory evoked potentials remained unchanged in 2 cases (false negative). One case died after operation. No spinal cord injury occurred. The median follow-up after operation was 10 months (5-14 months). There was no delayed neurological deficit. CONCLUSION: EP provided an on-line monitoring of the condition of spinal cord function, which become an intraoperative protocol to avoid the irreversible injury of spinal cord.

Hematopoietic stem cells: cancer involvement and myeloid leukemia.

Hematopoietic stem cells (HSCs) are rare multipotent cells that possess ability to self-renew and differentiate to progenitor cells, which give rise to all blood cell lineages. The process involves specific regulation of gene transcription and its deregulation resulting in imbalance between self-renew and differentiation, can lead to cellular transformation and cancers. Substantial evidence indicates that accumulated mutations in HSCs contribute to the initiation and pathogenesis of at least some hematopoietic cancers. In particular, myeloid leukemias have been extensively characterized with regard to HSC and progenitor involvement. Thus, as a focal point for scientific and therapeutic endeavours, formation of cancer cells from HSCs represents a critical area of investigation. Consequently, understanding how HSCs function and how they undergo to transformation, is of fundamental importance to get insight in their contribution to the hematopoietic cancer development.

Clinical value of ultrasound-guided percutaneous biopsy of pulmonary lesions.

The purpose of this study was to evaluate the applica-bility of ultrasound-guided percutaneous biopsy for the diagnosis and differentiation of various pulmonary lesions in a Chinese population. A total of 338 pulmonary lesions were biopsied with 18-gauge cutting needles, guided by ultrasound, and sent for histopathological analy-sis. The ultrasonographic characteristics of these lesions, procedure complications, and histopathological diagnoses were analyzed. Suffi-cient specimen for histopathologic analysis was obtained in 95.64% (351/367), and mild complications occurred in 2.72% (10/367) of the patients. Accurate diagnosis was obtained in 94.03% (315/335) of the patients; 16 were lost to follow-up. Using the combination of shape and echogenicity to distinguish benign vs malignant lesions, diagnos-tic sensitivity and specificity were 57.39 and 95.65%, respectively. No significant difference was found between malignant and benign lesions in blood flow signals. Ultrasound-guided core biopsy is valuable for the diagnosis, management, and prognosis of unknown pulmonary lesions. Shape and echogenicity on ultrasonography correlate well with histo-pathology and provide useful information for distinguishing between benign and malignant lesions. On the contrary, color Doppler is of little value for this purpose.

Carotid arterial intima­media thickness and arterial stiffness in pre-eclampsia: analysis with a radiofrequency ultrasound technique.

OBJECTIVE: Whether arterial elasticity is reduced in preeclampsia has been investigated only rarely. This study aimed to characterize in vivo the carotid arterial intima­media thickness (IMT) and mechanical properties in women with pre-eclampsia by employing a radiofrequency ultrasound technique. METHODS: We included 22 late-onset pre-eclamptic pregnant women and 28 normotensive pregnant women who were matched for age (29 ± 6 vs. 27 ± 3, P=0.09) and gestational age (36.0 ± 3.2 vs. 35.8 ± 2.4 weeks, P=0.802). All women were nulliparous with singleton pregnancy. The pre-eclamptic women had a significantly higher arterial pressure than did the normotensive women (P<0.0001). All women underwent right common carotid arterial measurements with an ultrasound machine equipped with automatic Quality IMT (QIMT) and Quality Arterial Stiffness (QAS) capability. At follow-up examination 18 months after parturition, measurements were repeated in 10 of the pre-eclamptic women and 11 of the normotensive women. RESULTS: In pre-eclamptic compared with normotensive pregnancy, carotid arterial IMT (459 ± 95 vs. 351 ± 85 µm, P=0.0001), internal diameter (7.8 ± 0.5 vs. 7.2 ± 0.4 mm, P<0.0001), pulse wave velocity (7.1 ± 1.7 vs. 6.0 ± 1.5 m/s, P=0.007), augmentation index (7.9 ± 9.2 vs. −5.0 ± 5.6%, P<0.0001) and arterial wall tension (55.0 ± 6.5 vs. 38.6 ± 4.9 mmHg/cm, P<0.0001) were significantly greater, and the distensibility coefficient (0.020 ± 0.009 vs. 0.029 ± 0.011 1/kPa, P=0.006) was significantly smaller, remaining so after adjusting for body mass index and carotid arterial pressure. Eighteen months after parturition, carotid arterial internal diameter, pressure and wall tension remained greater in the pre-eclamptic group. CONCLUSION: Carotid arterial remodeling, including changes in arterial internal diameter and wall thickness, and arterial stiffening occur in pre-eclampsia but this may reverse, to some extent, postpartum. QIMT and QAS techniques together could provide a comprehensive assessment of carotid arterial remodeling.

Validation of a paternally imprinted QTL affecting pH24h distinct from PRKAG3 on SSC15.

We previously performed a genome scan in a White Duroc × Erhualian F(2) population and identified a QTL on SSC15 with strong effect on pH24h in M. Longissimus dorsi and M. Semimembranous muscle tissue. At that time, the mode of inheritance of this QTL was not clarified, and it was also unclear whether the observed QTL effect was completely or partially caused by mutations in the PRKAG3 gene, which is the only major gene on SSC15 so far known to influence pH24h. In this study, effects of the PRKAG3 gene on meat quality traits were estimated by association analyses. Two substitutions in PRKAG3, p.Ile199Val (p.I199V) and p.Thr30Asn (p.T30N), were found to be segregating in the F(2) population and to significantly affect pH24h and total glycogen in meat, respectively. However, we excluded PRKAG3 as a causative gene for the detected QTL based on the following reasons: (i) the gene was located outside of the QTL confidence interval; (ii) when the PRKAG3 substitution was included as a fixed effect in the QTL model, the F-ratio for the QTL increased rather than decreased; (iii) favourable alleles for pH24h at the QTL and at the PRKAG3 p.I199V locus originated from Erhualian and White Duroc founders, respectively; (iv) more importantly, this QTL showed exclusive maternal expression, differing from the Mendelian expression of PRKAG3. In conclusion, this study is the first to report a maternally-expressed QTL for pH24h on SSC15, which is distinct from PRKAG3.

Genome-wide identification of quantitative trait loci for pork temperature, pH decline, and glycolytic potential in a large-scale White Duroc x Chinese Erhualian resource population.

The pH values and temperatures at 45 min, and 3, 9, 15, and 24 h postmortem in the LM and semimembranosus muscle (SM) and glycolytic potential in LM were measured in 1,030 F(2) animals from a White Duroc x Erhualian resource population. A whole genome scan was performed with 183 microsatellites covering 19 porcine chromosomes to detect QTL for traits measured. A total of 73 QTL have been identified, including 1% genome-wise significant QTL for 24-h pH in LM and SM on SSC 15, and for glycolytic potential, total glycogen, and residual glycogen on SSC3, 6, and 7. Six 5% genome-wise significant QTL were detected for 9-h pH in SM on SSC3, pH decline from 3/9 h to 24 h in SM on SSC7, glycolytic potential on SSC1, and total glycogen on SSC1 and 6. This study confirmed QTL previously identified for pH except those on SSC1, 11, 12, and X, and found 11 new 5% genome-wise significant QTL for glycogen-related traits. This is the first time to report QTL for pH development during post-slaughter and for glycolytic potential at 5% genome-wise significance level. In addition, the observed different QTL for pH and pH decline at different times show that causal genes for pH postmortem play distinct roles at specific stages, in specific muscles, or both. These results provide a starting point for fine mapping of QTL for the traits measured and improve the understanding of the genetic basis of pH metabolism after slaughter.

The relationship between intra-operative ultrasonography and pathological grade in cerebral glioma.

The value of intra-operative ultrasound as a tool in guiding resection of cerebral gliomas and the relationship between the appearance of brain tissue on intra-operative ultrasonography and pathological grade of cerebral glioma were investigated in 98 patients who underwent neurosurgical tumour removal. Lesions were classified according to pathological grade. Intra-operative ultrasonography orientated all the cerebral gliomas accurately and helped the neurosurgeon in assessing the tumour prior to removal. All lesions were hyperechoic compared with normal brain tissue, and the majority of lesions displayed irregular shapes and indistinct margins. Different pathological grades of glioma presented different ultrasonographic appearances. The majority of low-grade (I and II) cerebral gliomas were homogeneous, with distinct margins and clear surrounding oedema compared with adjacent brain tissue. High-grade (III and IV) cerebral gliomas mostly exhibited poorly defined borders and central necrosis, and the surrounding oedema was difficult to distinguish from the lesions. Residual tumour or haematoma were identified. In conclusion, intra-operative ultrasonography is of great value in locating and assessing the grade of cerebral glioma, and is conducive to enabling early evaluation and total removal of the lesion.

A study of intra-cochlear electrodes and tissue interface by electrochemical impedance methods in vivo.

This paper presents methods, results and analysis for measurements of the electrochemical impedance of platinum electrodes (approximately 0.43 mm2) over a 6-month implantation in the cat cochlea. The study aimed to improve our understanding of the effects of tissue response on impedance behaviour. An increase in impedance in the post-operative period was evident with a rise of the distorted arc at high frequencies in the complex plane, correlating to anomalous charge transport at the electrode-tissue interface. The impedance at low frequencies generally showed a capacitive dispersion modelled as a constant phase element, indicating a blocking characteristic of the electrodes. The study suggests that a reduction and changes in composition of perilymph or extracellular fluid adjacent to the electrodes, as a consequence of tissue response, causes the elevated "contact impedance". This affects the efficiency and quality of neural stimulating electrodes and neural recording electrodes. The finding of the crucial role of perilymph or extracellular fluid thin layer provides a new strategy for surface materials of neural electrodes, which is discussed in the paper. The interface characteristics must be considered during interpretation of studies undertaken in vitro or in acute experiments in vivo, where physiological fluid is abundant.

[Occupational toluene diisocyanate (TDI) asthma--inhalation challenge test and TDI-HSA (human serum albumin) skin test and detection of specific IgE].

Using a self-made bag inhalation challenge device. We diagnosed 12 TDI asthmatics, who were from 18 symptomatic workers. Of the 12 cases there were three types of airway reaction to TDI: three showed an immediate response; six, a late response; three, a dual response. After inhalation challenge, FEV1 PEFR, V50, and V25 descended obviously, suggesting that airway response to TDI in TDI asthmatics might occur in either larger or small airway. As a result of methacholine challenge nonspecific bronchial reactivity in 12 TDI asthmatics was markedly increased. After inhalation of TDI, the further descending of PC20 FEV1 showed that TDI could increase airway reaction to methacholine. Patients received skin test with TDI-HSA conjugate. There were positive response in 11 of the 12 TDI asthmatics and in 11 of the 62 TDI workers who had no symptoms after exposure to TDI, and no positive response in 18 common asthma patients. Therefore, TDI-HSA skin test can be used to a assist diagnosis of TDI asthma and a differential diagnosis from ordinary asthma. Specific IgE antibody levels showed no difference between TDI asthma and normal control group before TDI challenge. A marked increase in TDI asthma occurred after TDI challenge.