Multi-View Cross-Fusion Transformer Based on Kinetic Features for Non-Invasive Blood Glucose Measurement Using PPG Signal.

Noninvasive blood glucose (BG) measurement could significantly improve the prevention and management of diabetes. In this paper, we present a robust novel paradigm based on analyzing photoplethysmogram (PPG) signals. The method includes signal pre-processing optimization and a multi-view cross-fusion transformer (MvCFT) network for non-invasive BG assessment. Specifically, a multi-size weighted fitting (MSWF) time-domain filtering algorithm is proposed to optimally preserve the most authentic morphological features of the original signals. Meanwhile, the spatial position encoding-based kinetics features are reconstructed and embedded as prior knowledge to discern the implicit physiological patterns. In addition, a cross-view feature fusion (CVFF) module is designed to incorporate pairwise mutual information among different views to adequately capture the potential complementary features in physiological sequences. Finally, the subject- wise 5- fold cross-validation is performed on a clinical dataset of 260 subjects. The root mean square error (RMSE) and mean absolute error (MAE) of BG measurements are 1.129 mmol/L and 0.659 mmol/L, respectively, and the optimal Zone A in the Clark error grid, representing none clinical risk, is 87.89%. The results indicate that the proposed method has great potential for homecare applications.

A deep-learning system to help make the surgical planning of coil embolization for unruptured intracranial aneurysms.

BACKGROUND: Coil embolization is a common method for treating unruptured intracranial aneurysms (UIAs). To effectively perform coil embolization for UIAs, clinicians must undergo extensive training with the assistance of senior physicians over an extended period. This study aimed to establish a deep-learning system for measuring the morphological features of UIAs and help the surgical planning of coil embolization for UIAs. METHODS: Preoperative computational tomography angiography (CTA) data and surgical data from UIA patients receiving coil embolization in our medical institution were retrospectively reviewed. A convolutional neural network (CNN) model was trained on the preoperative CTA data, and the morphological features of UIAs were measured automatically using this CNN model. The intraclass correlation coefficient (ICC) was utilized to examine the similarity between the morphologies measured by the CNN model and those determined by experienced clinicians. A deep neural network model to determine the diameter of first coil was further established based on the CNN model within the derivation set (75% of all patients) using neural factorization machines (NFM) model and was validated using a validation set (25% of all patients). The general match ratio (the difference was within ± 1 mm) between the predicted diameter of first coil by model and that used in practical scenario was calculated. RESULTS: One-hundred fifty-three UIA patients were enrolled in this study. The CNN model could diagnose UIAs with an accuracy of 0.97. The performance of this CNN model in measuring the morphological features of UIAs (i.e., size, height, neck diameter, dome diameter, and volume) was comparable to the accuracy of senior clinicians (all ICC > 0.85). The diameter of first coil predicted by the model established based on CNN model and the diameter of first coil used actually exhibited a high general match ratio (0.90) within the derivation set. Moreover, the model performed well in recommending the diameter of first coil within the validation set (general match ratio as 0.91). CONCLUSION: This study presents a deep-learning system which can help to improve surgical planning of coil embolization for UIAs.

Serum IL-1, Pyroptosis and Intracranial Aneurysm Wall Enhancement: Analysis Integrating Radiology, Serum Cytokines and Histology.

BACKGROUND AND PURPOSE: Aneurysm wall enhancement (AWE) is correlated with the rupture and growth risk of unruptured intracranial aneurysms (UIAs). Pyroptosis is a proinflammation mode of lytic cell death, mediated by pyroptosis-related proteins, i.e., gasdermin D and interleukin 1 ß (IL-1ß). Integrating serum cytokines and histology, this study aimed to investigate the correlation between AWE and pyroptosis in UIAs. METHODS: UIA patients receiving microsurgical clipping were prospectively enrolled from January 2017 and June 2020. UIA samples were collected, as well as the corresponding blood samples. In this study, high-resolution magnetic resonance was employed to identify the AWE. The serum 46-cytokines examination and the histological analysis were conducted to determine pyroptosis, CD68 and MMP2. The IL-1 ra/beta ratio was determined by complying with the serum IL-1ß and IL-1.ra. A comparison was drawn in the differences between UIAs with and without AWE. Lastly, the correlation between inflammation in UIA samples and serums was investigated. RESULTS: This study included 34 UIA patients. The serum proinflammatory cytokines [IL-1ß (P < 0.001) and TNF-α (P < 0.001)] were up-regulated, and serum anti-inflammatory cytokine (IL-1.ra, P = 0.042) were down-regulated in patients with AWE UIAs. The patients with AWE UIAs achieved a higher IL-1.ra/beta ratio (P < 0.001). The multivariate logistic analysis demonstrated IL-1ß [odds ratio (OR), 1.15; 95% confidence interval (CI), 1.02-1.30; P = 0.028] and IL-1.ra (OR, 0.998; 95% CI, 0.997-1.000; P = 0.017) as the risk factors correlated with the AWE. IL-1.ra/beta ratio achieved the highest predictive accuracy [area under the curve (AUC), 0.96] for AWE, followed by IL-1.ra (AUC, 0.90), IL-1ß (AUC, 0.88) and TNF-α (AUC, 0.85). As compared with the UIAs without AWE, the AWE UIAs were manifested as a severer wall remodeling, with higher relative levels of pyroptosis-related proteins, CD68 and MMP2. The serum IL-1ß, IL-1.ra and IL-1.ra/beta ratio had a positive correlation with the relative levels of pyroptosis-related proteins, CD68 and MMP2 in UIA tissues. CONCLUSION: The serum IL-1ß and IL-1.ra were correlated with the AWE. More pyroptosis-related proteins were identified in UIAs with AWE. The serum IL-1ß and IL-1.ra were correlated with the pyroptosis-related proteins in aneurysm tissues.

Multidimensional predicting model of intracranial aneurysm stability with backpropagation neural network: a preliminary study.

OBJECTIVES: The stability of intracranial aneurysms (IAs) may involve in multidimensional factors. Backpropagation (BP) neural network could be adopted to support clinical work. This preliminary study aimed to delve into the feasibility of BP neural network in assessing the risk of IA rupture/growth and to prove the advantage of multidimensional model over single/double-dimensional model. METHODS: Thirty-six IA patients were recruited from a prospective registration study (ChiCTR1900024547). All patients were followed up until aneurysm ruptured/grew or 36 months after being diagnosed with the IAs. The multidimensional data regarding clinical, morphological, and hemodynamic characteristics were acquired. Hemodynamic analyses were conducted with patient-specific models. Based on these characteristics, seven models were built with BP neural network (the ratio of training set to validation set as 8:1). The area under curves (AUC) was calculated for subsequent comparison. RESULTS: Forty-five characteristics were determined from 36 patients with 37 IAs. In the models based on the single dimension of IA characteristics, only morphological characteristics exhibited high performance in assessing 3-year IA stability (AUC = 0.703, P = 0.035). Among the models integrating two dimensions of IA characteristics, clinical-morphological (AUC = 0.731, P = 0.016), clinical-hemodynamic (AUC = 0.702, P = 0.036), and morphological-hemodynamic (AUC = 0.785, P = 0.003) models were capable of assessing the risk of 3-year IA rupture/growth. Moreover, the models including all three dimensions exhibited the maximum predicting significance (AUC = 0.811, P = 0.001). CONCLUSION: The present preliminary study reported that BP neural network might support assessing the 3-year stability of IAs. Models based on multidimensional characteristics could improve the assessment accuracy for IA rupture/growth.

Protective effects of asiatic acid in a spontaneous type 2 diabetic mouse model.

Asiatic acid (AA) has been demonstrated to exhibit anti-diabetic activity. However, the mechanisms and underlying signaling pathways remain to be elucidated. The present study was performed to confirm the protective effect of AA and demonstrate its ability to regulate the phosphatidylinositol 3­kinase (PI3K)/protein kinase B (AKT)/glycogen synthase kinase­3ß (GSK­3ß) signaling pathway in db/db mice. Db/db mice fed on a high­fat diet were used to model diabetes mellitus. Modeled mice were divided randomly into the model control, pioglitazone hydrochloride tablet (PH) and AA groups. Age­matched C57 BL/6J mice served as normal controls. Lipid and glucose levels, and glycogen synthesis rates were assessed following treatment. Pathological changes were detected using hematoxylin and eosin staining. Expression of the PI3K/AKT/GSK­3ß signaling pathway at the mRNA level was measured using quantitative polymerase chain reaction analysis. The model control group revealed typical characteristics of obesity and diabetes, including high glucose and lipid levels, and decreased glycogen synthesis. Four weeks of treatment with AA or PH ameliorated these abnormalities. AA and PH treatments mitigated the upregulation of PI3K, AKT, insulin receptor, and insulin receptor substrate­1 mRNA expression in modeled mice. Furthermore, AA and PH treatments decreased GSK­3ß and glucose­6­phosphatase mRNA expression compared with the normal control group. The results of the present study confirmed that AA possesses anti­diabetic activity in db/db mice. The PI3K/AKT/GSK­3ß signaling pathway may mediate this protective effect.

Efficacy of Chinese herbal medicine on health-related quality of life (SF-36) in hypertensive patients: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: This study aims to evaluate published randomized controlled trials (RCTs) of Chinese Herbal Medicine (CHM) improving health-related quality of life (HRQL) in hypertensive patients that employ the Short-Form 36-Item Health questionnaire (SF-36) as an outcome measure. METHODS: Five electronic databases were searched up to October 2013 to identify RCTs of CHM for hypertension. The primary outcome was SF-36. Trial selection, data extraction, methodological quality assessment, and data analyses were conducted according to the Cochrane handbook. RESULTS: Eleven RCTs with total of 1043 participants were identified. The majority of the included trials were assessed to be of poor methodological quality and high clinical heterogeneity. Meta-analysis shows a significant improvement both in physical component summary (PCS) measure and mental component summary (MCS) measure of SF-36, with physical functioning (WMD=8.54[5.34, 11.74], p<0.001), role physical (WMD=13.32[7.03, 19.61], p<0.001), bodily pain (WMD=10.53[6.46, 14.60], p<0.001), general health (WMD=-5.56[2.09, 9.02], p<0.001), vitality (WMD=6.84[4.33, 9.53], p<0.001), social functioning (WMD=7.50[2.63, 12.36], p<0.001), role emotional (WMD=12.06[4.45, 19.68], p<0.001) and mental health (WMD=-5.68[2.90, 8.47], p<0.001). CHM can also decrease systolic blood pressure (WMD=-4.45 [-6.71, -2.19], p<0.001) and relieve symptoms related to hypertension. CONCLUSIONS: CHM appears to have beneficial effects on improvement of HRQL in hypertensive patients. However, the findings should be interpreted with caution due to the poor methodological quality and high clinical heterogeneity of the included trials. Further clinical trials should be carried out to provide more reliable evidence.

[Clinical and experimental study on jiangzhi tiaoya granule in treating essential hypertension and protecting function of vascular endothelium].

OBJECTIVE: To observe the therapeutic effect of Jiangzhi Tiaoya Granule (JZTYG) in treating essential hypertension and its protection on function of vascular endothelial cells (VEC). METHODS: Fifty-nine patients of essential hypertension divided into two groups were treated with JZTYG (the treated group) and Jinjia Yixintong (the control group) respectively. The changes of symptoms, signs, blood pressure, heart rate were observed and the levels of endothelin (ET), calcitonin gene related peptide (CGRP) content were determined by radioimmunoassay (RIA). RESULTS: The total effective rates of JZTYG in lowering blood pressure and improving symptoms were both 90.0%, markedly effective rate in lowering blood pressure and improving symptoms was 36.7% and 60.0% respectively. The symptom improved in the treated group was better than that in the control group (P < 0.05). It also could reduce the plasma ET level (P < 0.05) and ET/CGRP ratio (P < 0.01), and increase the CGRP level (P < 0.05). CONCLUSION: JZTYG has a promising clinical therapeutic effect in treating essential hypertension and is able to protect the VEC function.