A deep learning algorithm for the detection of aortic dissection on non-contrast-enhanced computed tomography via the identification and segmentation of the true and false lumens of the aorta.

Background: Aortic dissection is a life-threatening clinical emergency, but it is often missed and misdiagnosed due to the limitations of diagnostic technology. In this study, we developed a deep learning-based algorithm for identifying the true and false lumens in the aorta on non-contrast-enhanced computed tomography (NCE-CT) scans and to ascertain the presence of aortic dissection. Additionally, we compared the diagnostic performance of this algorithm with that of radiologists in detecting aortic dissection. Methods: We included 320 patients with suspected acute aortic syndrome from three centers (Beijing Anzhen Hospital Affiliated to Capital Medical University, Fujian Provincial Hospital, and Xiangya Hospital of Central South University) between May 2020 and May 2022 in this retrospective study. All patients underwent simultaneous NCE-CT and contrast-enhanced CT (CE-CT). The cohort comprised 160 patients with aortic dissection and 160 without aortic dissection. A deep learning algorithm, three-dimensional (3D) full-resolution U-Net, was continuously trained and refined to segment the true and false lumens of the aorta to determine the presence of aortic dissection. The algorithm's efficacy in detecting dissections was evaluated using the receiver operating characteristic (ROC) curve, including the area under the curve (AUC), sensitivity, and specificity. Furthermore, a comparative analysis of the diagnostic capabilities between our algorithm and three radiologists was conducted. Results: In diagnosing aortic dissection using NCE-CT images, the developed algorithm demonstrated an accuracy of 93.8% [95% confidence interval (CI): 89.8-98.3%], a sensitivity of 91.6% (95% CI: 86.7-95.8%), and a specificity of 95.6% (95% CI: 91.2-99.3%). In contrast, the radiologists achieved an accuracy of 88.8% (95% CI: 83.5-94.1%), a sensitivity of 90.6% (95% CI: 83.5-94.1%), and a specificity of 94.1% (95% CI: 72.9-97.6%). There was no significant difference between the algorithm's performance and radiologists' mean performance in accuracy, sensitivity, or specificity (P>0.05). Conclusions: The algorithm proficiently segments the true and false lumens in aortic NCE-CT images, exhibiting diagnostic capabilities comparable to those of radiologists in detecting aortic dissection. This suggests that the algorithm could reduce misdiagnoses in clinical practice, thereby enhancing patient care.

Evaluation of ferritin and TfR level in plasma neural-derived exosomes as potential markers of Parkinson's disease.

Introduction: Early diagnosis of Parkinson's disease (PD) remains challenging. It has been suggested that abnormal brain iron metabolism leads to excessive iron accumulation in PD, although the mechanism of iron deposition is not yet fully understood. Ferritin and transferrin receptor (TfR) are involved in iron metabolism, and the exosome pathway is one mechanism by which ferritin is transported and regulated. While the blood of healthy animals contains a plentiful supply of TfR-positive exosomes, no studies have examined ferritin and TfR in plasma neural-derived exosomes. Methods: Plasma exosomes were obtained from 43 patients with PD and 34 healthy controls. Neural-derived exosomes were isolated with anti-human L1CAM antibody immunoabsorption. Transmission electron microscopy and western blotting were used to identify the exosomes. ELISAs were used to quantify ferritin and TfR levels in plasma neural-derived exosomes of patients with PD and controls. Receivers operating characteristic (ROC) curves were applied to map the diagnostic accuracy of ferritin and TfR. Independent predictors of the disease were identified using logistic regression models. Results: Neural-derived exosomes exhibited the typical exosomal morphology and expressed the specific exosome marker CD63. Ferritin and TfR levels in plasma neural-derived exosomes were significantly higher in patients with PD than controls (406.46 ± 241.86 vs. 245.62 ± 165.47 ng/µg, P = 0.001 and 1728.94 ± 766.71 vs. 1153.92 ± 539.30 ng/µg, P < 0.001, respectively). There were significant positive correlations between ferritin and TfR levels in plasma neural-derived exosomes in control group, PD group and all the individuals (rs = 0.744, 0.700, and 0.752, respectively). The level of TfR was independently associated with the disease (adjusted odds ratio 1.002; 95% CI 1.000-1.003). ROC performances of ferritin, TfR, and their combination were moderate (0.730, 0.812, and 0.808, respectively). However, no relationship was found between the biomarkers and disease progression. Conclusion: It is hypothesized that ferritin and TfR in plasma neural-derived exosomes may be potential biomarkers for PD, and that they may participate in the mechanism of excessive iron deposition in PD.

Predictive performance of the STarT Back tool for poor outcomes in patients with low back pain: protocol for a systematic review and meta-analysis.

INTRODUCTION: Subgroups for Targeted Treatment Back Tool (SBT) is a brief multiple-construct risk prediction tool for patients with low back pain (LBP). Thus far, the predictive ability of this tool has been inconsistent. Therefore, we aim to conduct a literature review on the predictive ability of the SBT to determine the outcomes of patients with LBP. The results of this review should improve the ability of the SBT to predict poor outcomes in patients with LBP. METHODS AND ANALYSIS: Databases including PubMed, EMBASE, Cochrane Central, Web of Science, Chinese National Knowledge Infrastructure Databases, Chinese Science and Technology Journal Database, and Wanfang will be searched for studies on SBT and LBP from their inception until 31 March 2023. Longitudinal studies investigating the association between SBT subgroups and LBP outcomes, including pain, disability and quality of life, will be included. The identified studies will be independently screened for eligibility by two reviewers. A standardised sheet will be used to extract data. The Newcastle-Ottawa Scale will be used to assess the methodological quality of the included studies. Heterogeneity will be evaluated by the χ2 test with Cochran's Q statistic and quantified by the I2 statistic. The results will be synthesised qualitatively and presented as pooled risk ratios or beta coefficients quantitatively. The results will also be presented using their 95% confidence limits. Publication bias will be assessed using the method proposed by Egger and by visual inspection of funnel plots. ETHICS AND DISSEMINATION: This study is a secondary analysis of original studies that received ethics approval. Therefore, prior ethical approval is not required for this study. The findings will be submitted to relevant peer-reviewed journals for publication and presented at profession-specific conferences. TRIAL REGISTRATION NUMBER: PROSPERO registration numberCRD42022309189.

Effects of Remote Expressive Arts Program in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial.

BACKGROUND: Mild cognitive impairment (MCI) is a stage of cognitive ability loss with intact activities of daily living and an increased risk for the development of dementia. OBJECTIVE: This study evaluated the intervention effect of remote expressive arts program (rEAP) on cognitive function in older adults with MCI and investigated the underlying neurobiological mechanisms. METHODS: We assigned 73 older MCI patients to receive rEAP or health education (HE), who underwent neuropsychological evaluation and resting-state functional magnetic resonance imaging before and after treatment. Neuropsychological scores were analyzed using SPSS software, and regional homogeneity (ReHo) values and seed-based functional connectivity (FC) were analyzed using Matlab software. RESULTS: The rEAP group showed more significant improvements in cognitive function than the HE group. rEAP affected spontaneous brain activity and brain networks. The ReHo values in the right anterior cingulate/paracingulate cortex and the left dorsolateral superior frontal gyrus significantly increased and decreased, respectively, in the rEAP and HE groups. Further, ReHo value changes were significantly associated with the corresponding neuropsychological test score changes in the rEAP group. Moreover, the rEAP group showed decreased FC between the posterior cingulate cortex and the right middle temporal gyrus and increased FC between the ventromedial prefrontal cortex and left angular gyrus. CONCLUSION: The 12-week rEAP improved cognitive function in MCI patients. Additionally, the alterations of spontaneous brain network connections and activity helped improve and maintain cognitive function in MCI patients.

Corrigendum: Evaluation of ferritin and TfR level in plasma neural-derived exosomes as potential markers of Parkinson's disease.

[This corrects the article DOI: 10.3389/fnagi.2023.1216905.].

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.

Video-assisted thoracoscopic right upper lobectomy in a patient with a right-sided aortic arch and Kommerell diverticulum.

BACKGROUND: It is a very rare condition for a patient to have right lung cancer and a right-sided aortic arch simultaneously. Right lobectomy under video-assisted thoracoscopic surgery (VATS) in such a patient is a challenging procedure that is seldom reported. We successfully performed a VATS right upper lobectomy in a 77-year-old female with a right-sided aortic arch and Kommerell diverticulum. CASE PRESENTATION: A 77-year-old woman was referred to our division for a mixed ground-glass opacity lesion in the right upper lung. A right-sided aortic arch with Kommerell diverticulum was identified by preoperative 3D CT reconstruction. A VATS right upper lobectomy with radical mediastinal lymph node dissection was performed, and the final histological staging was Ia3 (pT1cN0M0). The patient was discharged without any complications. CONCLUSIONS: We conclude that the video-assisted thoracic surgery can be safely performed in such conditions. It is difficult to determine the extent of upper mediastinal lymph node dissection in such cases.

A comparison of cervical delta-shaped anastomosis and circular stapled anastomosis after esophagectomy.

BACKGROUND: The delta-shaped anastomosis has been reported to reduce anastomotic complications for a decade. However, little has been written comparing this technique with the circular stapler technique. The objective of this retrospective study was to assess the safety and efficacy of cervical delta-shaped anastomosis after esophagectomy. METHODS: Medical records of patients with esophageal squamous cell carcinoma who underwent McKeown (three-incision) esophagectomy between September 2013 and June 2015 were reviewed. Either circular stapled anastomosis (CSA) or delta-shaped anastomosis (DSA) was performed at the cervical stage. The clinical characteristics and short-term outcome were retrospectively assessed to identify the differences between the two groups. RESULTS: A total of 81 patients were included in this study. The clinical characteristics were similar between the two groups. Cervical anastomotic leakage occurred in 3 (7.7%) of 39 patients in the DSA group and in 8 (19%) of 42 patients in the CSA group (P = 0.197). The average anastomotic orifice width was 16.1 ± 4.9 mm and 11.7 ± 2.2 mm, respectively (P < 0.001). The incidence of anastomotic stenosis was 2.6% (1/39) and 23.5% (10/42) in the DSA and CSA groups, respectively (P = 0.007). There was no significant difference in surgical duration, blood loss, pulmonary complication, postoperative mortality, time of hospitalisation and time of ICU stay between the two groups. CONCLUSIONS: Delta-shaped anastomosis may be an effective alternative method for gastroesophageal anastomosis after esophagectomy, with lower incidence of leakage and stenosis.