Black-blood Venous Imaging (BBVI): A Contrast-Free and High-Resolution Magnetic Resonance Approach for Diagnosing IVCS - a Proof of Concept Study.

BACKGROUND: Iliac vein compression syndrome (IVCS) diagnosis heavily relies on an imaging test. However, non-invasive and contrast-free imaging test for the diagnosis of IVCS remains a big challenge. To address this issue, this prospective study aimed to assess the image quality and diagnostic performance of a magnetic resonance imaging technique, black-blood venous imaging (BBVI), in detecting IVCS by comparing it with contrast-enhanced computed tomography venography (CTV) and using invasive digital subtraction angiography (DSA) as the reference. METHODS: We enrolled 105 patients, and all patients underwent BBVI, CTV, and DSA examinations. We compared the consistency of CTV and BBVI image quality and their consistency in diagnosing the rate of iliac vein stenosis in IVCS patients. Using the consensus DSA as a reference, the sensitivity, specificity, positive and negative predictive values, and accuracy of BBVI and CTV and their diagnostic agreement with DSA were calculated. RESULTS: BBVI demonstrated high sensitivity, specificity, and accuracy for the diagnosis of IVCS, without contrast agents. BBVI and CTV are quite in diagnosis IVCS. Quite SE (67.8% vs 68.3%), SP (94.8% vs 94.8%), PPV (98.0% vs 98.0%), NPV (46.2% vs 46.9%) and ACC (75.3% vs 75.7%) were obtained by BBVI in comparison with CTV. CONCLUSION: BBVI has comparable diagnostic performance with CTV. It may be a viable alternative to CTV techniques in screening the IVCS without contrast agents and free of ionizing radiation.

A Cascaded Multi-Task Generative Framework for Detecting Aortic Dissection on 3-D Non-Contrast-Enhanced Computed Tomography.

Contrast-enhanced computed tomography (CE-CT) is the gold standard for diagnosing aortic dissection (AD). However, contrast agents can cause allergic reactions or renal failure in some patients. Moreover, AD diagnosis by radiologists using non-contrast-enhanced CT (NCE-CT) images has poor sensitivity. To address this issue, we propose a novel cascaded multi-task generative framework for AD detection using NCE-CT volumes. The framework includes a 3D nnU-Net and a 3D multi-task generative architecture (3D MTGA). Specifically, the 3D nnU-Net was employed to segment aortas from NCE-CT volumes. The 3D MTGA was then employed to simultaneously synthesize CE-CT volumes, segment true & false lumen, and classify the patient as AD or non-AD. A theoretical formulation demonstrated that the 3D MTGA could increase the Jensen-Shannon Divergence (JSD) between AD and non-AD for each NCE-CT volume, thus indirectly improving the AD detection performance. Experiments also showed that the proposed framework could achieve an average accuracy of 0.831, a sensitivity of 0.938, and an F1-score of 0.847 in comparison with seven state-of-the-art classification models used by three radiologists with junior, intermediate, and senior experiences, respectively. The experimental results indicate that the proposed framework obtains superior performance to state-of-the-art models in AD detection. Thus, it has great potential to reduce the misdiagnosis of AD using NCE-CT in clinical practice. The source codes and supplementary materials for our framework are available at https://github.com/yXiangXiong/CMTGF.

A Cascaded Deep Learning Framework for Detecting Aortic Dissection Using Non-contrast Enhanced Computed Tomography.

Aortic dissection (AD) is a rare but potentially fatal disease with high mortality. The aim of this study is to synthesize contrast enhanced computed tomography (CE-CT) images from non-contrast CT (NCE-CT) images for detecting aortic dissection. In this paper, a cascaded deep learning framework containing a 3D segmentation network and a synthetic network was proposed and evaluated. A 3D segmentation network was firstly used to segment aorta from NCE-CT images and CE-CT images. A conditional generative adversarial network (CGAN) was subsequently employed to map the NCE-CT images to the CE-CT images non-linearly for the region of aorta. The results of the experiment suggest that the cascaded deep learning framework can be used for detecting the AD and outperforms CGAN alone.

[LUNX mRNA in regional lymph nodes of non-small cell lung cancer patients by RT-PCR and its clinical significance].

OBJECTIVE: To evaluate the detection of humen-lung-specific X protein (LUNX) gene in micrometastases of patients with non-small cell lung cancer. METHODS: The expression of LUNX gene in tumor tissue, lung and lymph nodes was detected by reverse transcriptase-polymerase chain reaction(RT-PCR) both in 43 non-small-cell lung cancer patients (the experimental group) and 15 lung benign patients (the control group). LUNX mRNA expression in clinic pathology,stage of cancer cell differentiation, clinic stage, age, sex, smoking history, and 4 lung cancer blood markers (CEA,CA125,NSE, and CYFRA211) were evaluated. RESULTS: The expression of LUNX gene was positive in the 2 groups. LUNX gene expression was positive in 33 of the 87 lymph nodes of the 43 patients in the experimental group (37.93%), and in 2 of the 26 lymph nodes in the control group (7.69%). The LUNX mRNA positive in the lymph nodes was closely related to the pathological type, cancer cell differentiation and clinic stage(r=0.660,0.500,0.460; P=0.011,0.017,0.022, all P<0.05), while not closely related to age, sex, smoking history and 4 lung cancer blood markers (CEA,CA125, NSE, and CYFRA211) (r=0.111, 0.135,0.083,0.354; P=0.739,0.714,0.773,0.125,all P>0.05). CONCLUSION: The LUNX mRNA expression detected by RT-PCR is more sensitive than by traditional ways. The expression of LUNX gene mRNA in the lymph nodes is a valuable index for the detection of micrometastases in patients with non-small cell lung cancer.

Higher incidence of acute respiratory distress syndrome in cardiac surgical patients with elevated serum procalcitonin concentration: a prospective cohort study.

BACKGROUND: Inflammatory response is activated during cardiopulmonary bypass (CPB), which may lead to acute respiratory distress syndrome (ARDS) and procalcitonin (PCT) increases during this inflammatory response. The objective of the study was to validate whether patients with higher serum PCT concentrations have a higher incidence of ARDS. METHODS: The study was a prospective, single-center, observational cohort study. All patients who received cardiac surgery with CPB were screened for study eligibility. Patients were assigned to the PCT-elevated cohort or the control cohort according to serum PCT concentration on the first postoperative day with a cut-off value of 7.0 ng/mL. Patients were followed up until the 7th postoperative day. The primary endpoint was the incidence of ARDS, which was diagnosed according to the Berlin definition. RESULTS: A total of 296 patients were enrolled, 64 patients were assigned to the PCT-elevated cohort and 232 patients were assigned to the control cohort. PCT concentration was 16.23 ± 5.9 ng/mL in the PCT-elevated cohort, and 2.70 ± 1.43 ng/mL in the control cohort (p < 0.001). The incidence of ARDS was significantly higher in the PCT-elevated cohort than in the control cohort (21.9% versus 5.6%, p < 0.001). The incidence of moderate-to-severe ARDS was also significantly higher in the PCT-elevated cohort than in the control cohort (10.9% versus 0.4%, p < 0.001). The hazard ratio of ARDS at 7 days in the PCT-elevated cohort, as compared with the control cohort, was 6.8 (95% confidence interval 2.7 to 17.4). The hazard ratio of moderate-to-severe ARDS in the PCT-elevated cohort was 57.3 (95% confidence interval 10.4 to 316.3). The positive predictive value of PCT for ARDS and moderate-to-severe ARDS were 0.242 and 0.121, respectively; the negative predictive value of PCT for ARDS and moderate-to-severe ARDS were 0.952 and 1.0, respectively. CONCLUSION: Cardiac surgical patients with elevated PCT concentration have a higher incidence of ARDS. Elevated PCT may serve as a warning signal of postoperative ARDS in patients undergoing cardiac surgery with CPB. Study registration Chinese Clinical Trial Registry (ChiCTR-OCH-14005076).

Thrombolytic treatment of prosthetic valve thrombosis: a study using Urokinase.

OBJECTIVE: We analysed the efficacy and safety of thrombolytic therapy with urokinase in patients with prosthetic valve thrombosis. METHODS: Twenty-three patients with valve thrombosis received thrombolytic treatment using urokinase. First, a 250,000 IU intravenous bolus injection was administered as a loading dose, followed by intravenous infusion of 100,000 IU/h for 10 h and anticoagulation with low molecular weight heparin every day. The maximum treatment time was 5 days, i.e., until the transvalvular pressure gradient was normal or close to normal. Transthoracic echocardiography (TTE) was used every 12 h to monitor whether the thrombus was reduced and whether there was haemodynamic improvement. Routine blood tests, the prothrombin time (PT), international normalized ratio (INR) and complications were observed every day. RESULTS: Sixteen (69.6%) patients were successfully treated with thrombolytic therapy: 2/2 (100%) aortic valves and 14/21 (66.7%) mitral valves. The partial success rate of this study was 13.0% (3/23). Four patients did not show any improvement in haemodynamics. Two cases had slight urine haemorrhage. One patient died of severe cerebral haemorrhage and shock. The overall mortality was 13.0% (3/23), including two patients who died after subsequent surgery. CONCLUSION: Urokinase is more convenient and successful in the treatment of PVT. More experience may make TT the optimal treatment for PVT, especially in high-risk surgical situations.

Procalcitonin as a predictor of moderate to severe acute respiratory distress syndrome after cardiac surgery with cardiopulmonary bypass: a study protocol for a prospective cohort study.

INTRODUCTION: Procalcitonin (PCT) is activated during cardiopulmonary bypass (CPB) and may be a predictor of acute respiratory distress syndrome (ARDS). The objective of this study is to determine whether patients with different serum PCT concentrations exhibit different rates of developing moderate to severe ARDS. METHODS AND ANALYSIS: This is a prospective, single centre, observational cohort study. All patients admitted to the cardiosurgery department for cardiac surgery with CPB were screened for study eligibility. All eligible patients received a CPB procedure. Blood samples were obtained to determine white cell counts as well as N-terminal pro-B-type natriuretic peptide, C reactive protein and PCT levels. Patients were assigned to the PCT elevated cohort or the control cohort based on serum PCT concentrations on the first postoperative day with a cut-off value of 7.0 ng/mL. Data, including baseline, perioperative and outcome data, were collected daily for 7 days. The primary end point was the incidence of moderate to severe ARDS, which was diagnosed according to the Berlin definition. ETHICS AND DISSEMINATION: The study was approved by the Institutional Review Board of Fujian Provincial Hospital. Study findings are disseminated through peer-reviewed publications and conference presentations. STUDY REGISTRATION: Chinese Clinical Trial Registry (ChiCTR-OCH-14005076).