A prospective study to compare the diagnostic accuracy of 99mTc-CNDG SPECT/CT and contrast-enhanced CT in staging of non-small cell lung cancer.

OBJECTIVE: To explore the value of 99mTc-isonitrile deoxyglucosamine (CNDG) SPECT/CT in the staging and resectability diagnosis of non-small cell lung cancer (NSCLC) compared with contrast-enhanced CT (CECT). METHODS: This research was approved by the hospital ethics review committee. Sixty-three patients with NSCLC received 99mTc-CNDG SPECT/CT, CECT and initial TNM staging before treatment. Thirty-three patients who underwent radical surgery underwent postoperative pathological TNM staging as the reference standard. Another thirty patients underwent radiochemotherapy; among them, the reference standard of 7 patients of N staging and 5 patients of M staging was based on biopsy pathology, and the diagnosis of the remaining lesions was confirmed by at least one different image or clinical imaging follow-up for more than 3 months. The McNemar test and receiver operating characteristic (ROC) curve analysis were used to compare the diagnostic accuracy of staging and resectability of 99mTc-CNDG SPECT/CT and CECT in NSCLC, respectively. RESULTS: For all patients and surgical patients, the accuracies of 99mTc-CNDG SPECT/CT in diagnosing the T stage and N stage were higher than those of CECT (all patients: 90.5%, 88.9% vs. 79.4%, 60.3%; surgical patients: 81.8%, 78.8% vs. 60.6%, 51.5%), and the differences were statistically significant (all patients: T stage, P = 0.016; N stage, P = 0.000; surgical patients: T stage, P = 0.016; N stage, P = 0.004). For all patients, the accuracy of 99mTc-CNDG SPECT/CT in diagnosing the M stage was higher than that of CECT (96.8% vs. 90.5%), but the difference was not statistically significant (P = 0.289). ROC curve analysis showed that the accuracy of 99mTc-CNDG SPECT/CT in diagnosing the potential resectability of NSCLC was significantly better than that of CECT (P = 0.046). CONCLUSION: This preliminary clinical study shows that 99mTc-CNDG SPECT/CT is of great value for accurate clinical staging of NSCLC compared with CECT and can significantly improve the accuracy of resectability diagnosis.

BiT-MAC: Mortality prediction by bidirectional time and multi-feature attention coupled network on multivariate irregular time series.

Mortality prediction is crucial to evaluate the severity of illness and assist in improving the prognosis of patients. In clinical settings, one way is to analyze the multivariate time series (MTSs) of patients based on their medical data, such as heart rates and invasive mean arterial blood pressure. However, this suffers from sparse, irregularly sampled, and incomplete data issues. These issues can compromise the performance of follow-up MTS-based analytic applications. Plenty of existing methods try to deal with such irregular MTSs with missing values by capturing the temporal dependencies within a time series, yet in-depth research on modeling inter-MTS couplings remains rare and lacks model interpretability. To this end, we propose a bidirectional time and multi-feature attention coupled network (BiT-MAC) to capture the temporal dependencies (i.e., intra-time series coupling) and the hidden relationships among variables (i.e., inter-time series coupling) with a bidirectional recurrent neural network and multi-head attention, respectively. The resulting intra- and inter-time series coupling representations are then fused to estimate the missing values for a more robust MTS-based prediction. We evaluate BiT-MAC by applying it to the missing-data corrupted mortality prediction on two real-world clinical datasets, i.e., PhysioNet'2012 and COVID-19. Extensive experiments demonstrate the superiority of BiT-MAC over cutting-edge models, verifying the great value of the deep and hidden relations captured by MTSs. The interpretability of features is further demonstrated through a case study.

Impact of Mean Arterial Pressure Fluctuation on Mortality in Critically Ill Patients.

OBJECTIVE: The purpose of this study was to investigate the association between mean arterial pressure fluctuations and mortality in critically ill patients admitted to the ICU. DESIGN: Retrospective cohort. SETTING: All adult ICUs at a tertiary care hospital. PATIENTS: All adult patients with complete mean arterial pressure records were selected for analysis in the Multiparameter Intelligent Monitoring in Intensive Care II database. Patients in the external cohort were newly recruited adult patients in the Medical Information Mart for Intensive Care III database. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The records of 8,242 patients were extracted. Mean arterial pressure fluctuation was calculated as follows: (mean nighttime mean arterial pressure - mean daytime mean arterial pressure)/mean arterial pressure. Patients were divided into two groups according to the degree of mean arterial pressure fluctuation: group A (between -5% and 5%) and group B (<-5% and >5%). The endpoints of this study were ICU and hospital mortality. Patients in group A (n = 4,793) had higher ICU and hospital mortality than those in group B (n = 3,449; 11.1% vs 8.1%, p < 0.001 and 13.8% vs 10.1%, p < 0.001, respectively). After adjusting for other covariates, the mean arterial pressure fluctuations between -5% and 5% were significantly correlated with ICU mortality (odds ratio, 1.296; 95% CI, 1.103-1.521; p = 0.002) and hospital mortality (odds ratio, 1.323; 95% CI, 1.142-1.531; p < 0.001). This relationship remained remarkable in patients with low or high Sequential Organ Failure Assessment scores in the sensitive analysis. Furthermore, external validation on a total of 4,502 individuals revealed that patients in group A still had significantly higher ICU (p < 0.001) and hospital mortality (p < 0.001) than those in group B. CONCLUSIONS: The reduced mean arterial pressure fluctuation (within -5% and 5%) may be associated with ICU and hospital mortality in critically ill patients.