Deep learning-based ultrasonic dynamic video detection and segmentation of thyroid gland and its surrounding cervical soft tissues.

BACKGROUND: The prevalence of thyroid diseases has been increasing year by year. In this study, we established and validated a deep learning method (Cascade region-based convolutional neural network, R-CNN) based on ultrasound videos for automatic detection and segmentation of the thyroid gland and its surrounding tissues in order to reduce the workload of radiologists and improve the detection and diagnosis rate of thyroid disease. METHODS: Seventy-one patients with normal thyroid ultrasound were included. The ultrasound videos of 59 patients were used as the training dataset, the data of 12 patients were used as the validation dataset, and in addition, the data of 9 patents were used as the testing dataset. Ultrasound videos of thyroid examination, including five standard sections (left and right lobe transverse scan, central isthmus transverse scan, left and right lobe longitudinal scan), were collected from all patients. The radiologists labeled the neck tissues, including anterior cervical muscle, cricoid cartilage, trachea, thyroid gland, endothyroid vessels, carotid artery, internal jugular vein, and esophagus. A large dataset was constructed to train and test the deep learning method. The performance was evaluated using the COCO metrics AP, AP50, and AP75. We compared the Cascade R-CNN with a state-of-the-art method CenterMask in the test dataset. RESULTS: We annotated 166817, 34364, and 29227 regions in training, validation and testing samples. The model could achieve a good detection performance for the thyroid left lobe, right lobe, isthmus, muscles, trachea, carotid artery, and jugular vein; the AP50 of these tissues were 86.5%, 87.5%, 89.1%, 96.1%, 96.6%, 97.7%, and 91.8%, respectively. In addition, the model showed good segmentation performance for the muscles, trachea, and carotid artery; the AP50 of these tissues were 96%, 96.6%, and 97.8%, respectively. For the left lobe, right lobe, isthmus, esophagus, and jugular vein, AP50 was ≥86%. However, the segmentation results for the cricoid cartilage and endothyroid vessels were not high (AP50 of 53.9% and 48.5%, respectively). For fair comparison, the performance of Cascade R-CNN is better than that of CenterMask for detection and segmentation tasks. The difference was statistically significant (p < 0.05). CONCLUSIONS: The new method could successfully detect and segment the thyroid gland and its surrounding tissues.

Diagnostic performance of US-based FNAB criteria of the 2020 Chinese guideline for malignant thyroid nodules: comparison with the 2017 American College of Radiology guideline, the 2015 American Thyroid Association guideline, and the 2016 Korean Thyroid Association guideline.

BACKGROUND: To investigate the diagnostic performance of the ultrasonography-based fine-needle aspiration biopsy criteria of the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) for malignant nodules compared to 3 other guidelines. METHODS: This study included 2,309 thyroid nodules in 1,697 patients with histopathological and cytopathological diagnoses of benign and malignant nodules from January 2018 to August 2020. The clinical and ultrasonographic features of the nodules were retrospectively reviewed and classified according to the Chinese guideline (C-TIRADS), the American College of Radiology guideline (ACR-TIRADS), the American Thyroid Association guideline (ATA guideline), and the Korean Thyroid Association guideline (K-TIRADS). The diagnostic performance of the guidelines and their unnecessary fine-needle aspiration biopsy rates were calculated using randomized, blinded trials. RESULTS: Of the 2,309 nodules, 1,418 (61.4%) were benign and 891 (38.6%) were malignant, with 884 (99.21%) papillary carcinomas. The accuracy of C-TIRADS was 84.71%, followed by the guidelines of ACR-TIRADS (82.11%), K-TIRADS (81.64%), and the ATA guideline (78.56%). Furthermore, the area under the receiver operating characteristic curve (AUC) was the highest for the C-TIRADS (0.905). Similar results were revealed for both the diagnostic performance and AUC of nodules smaller and larger than 10 mm. The ACR-TIRADS showed the lowest unnecessary biopsy rate (17.54%), followed by the C-TIRADS (22.61%), ATA guideline (27.90%), and the K-TIRADS (28.67%). CONCLUSIONS: The C-TIRADS demonstrated high diagnostic performance and a relatively low unnecessary biopsy rate in detecting thyroid cancer compared to the 3 other guidelines. However, further understanding of the ultrasonography-based fine-needle aspiration biopsy criteria of the C-TIRADS should be gained in the future.

Combination CTLA-4 immunoglobulin treatment and ultrasound microbubble-mediated exposure improve renal function in a rat model of diabetic nephropathy.

OBJECTIVE: This study explored the therapeutic impact of combined cytotoxic T lymphocyte-associated antigen 4 immunoglobulin (CTLA-4-Ig) treatment and microbubble-mediated exposure in a rat model of diabetic nephropathy (DN). METHOD: We treated rats using CTLA-4-Ig and/or microbubble exposure. At 8 weeks post-intervention, key parameters were evaluated including blood biochemistry, damage to renal tissue, renal parenchymal elasticity, ultrastructural changes in podocytes, and renal parenchymal expression of CD31, CD34, IL-6, Fn, Collagen I, Talin, Paxillin, α3ß1, podocin, nephrin, and B7-1. RESULT: We found that renal function in the rat model of DN can be significantly improved by CTLA-4-Ig and CTLA-4-Ig + ultrasound microbubble treatment. Treatment efficacy was associated with reductions in renal parenchymal hardness, decreases in podocyte reduction, decreased IL-6, Fn and Collagen I expression, increased Talin, Paxillin and α3ß1 expression, elevated podocin and nephrin expression, and decreased B7-1 expression. In contrast, these treatments did not impact CD31 or CD34 expression within the renal parenchyma. CONCLUSION: These findings clearly emphasize that CTLA-4-Ig can effectively prevent podocyte damage, inhibiting inflammation and fibrosis, and thereby treating and preventing DN. In addition, ultrasound microbubble exposure can improve the ability of CTLA-4-Ig to pass through the glomerular basement membrane in order to access podocytes such that combination CTLA-4-Ig + microbubble exposure treatment is superior to treatment with CTLA-4-Ig only.

Review on experimental study and clinical application of low-intensity pulsed ultrasound in inflammation.

Low-intensity pulsed ultrasound (LIPUS), as physical therapy, is widely used in both research and clinical settings. It induces multiple bioeffects, such as alleviating pain, promoting tissue repair, and shortening disease duration. LIPUS can also mediate inflammation. This paper reviews the application of LIPUS in inflammation and discusses the underlying mechanism. In basic experiments, LIPUS can regulate inflammatory responses at the cellular level by affecting some signaling pathways. In a clinical trial, LIPUS has been shown to alleviate inflammatory responses efficiently. As a cheap, safe, and convenient physical method, LIPUS is promising as anti-inflammatory therapy.

Clinical value of virtual touch tissue imaging quantification in diagnosis and treatment of congenital muscular torticollis in children.

BACKGROUND: This study aimed to evaluate the clinical value of virtual touch tissue imaging quantification (VTIQ) in the diagnosis and treatment of congenital muscular torticollis (CMT) in children. METHODS: Sixty-two CMT children treated in the clinics of our hospital were collected, and then 62 CMT children treated with manipulation massage were followed up; 23 CMT children receiving surgery in the same period served as controls. Conventional ultrasonography and VTIQ were performed at bilateral sternocleidomastoid muscles (SCM), and the shear wave velocity (SWV) was measured. RESULTS: In 62 patients and 23 controls, the average SWV of affected SCM was higher than the contralateral SCM. The difference was statistically significant (P<0.01). There was no marked difference in the SWV of between the affected SCM and healthy SCM after massage (P>0.05). The SWV of SCM after treatment was lower than before treatment. The difference was statistically significant (P<0.01). The SWV of affected SCM in 23 controls was higher than the affected SCM in 62 patients before massage. The difference was statistically significant (P<0.01). CONCLUSIONS: VTIQ is helpful for the diagnosis of CMT in children and can also be employed for the monitoring of therapeutic effect.

Low-intensity pulsed ultrasound attenuates cardiac inflammation of CVB3-induced viral myocarditis via regulation of caveolin-1 and MAPK pathways.

The aggressive immunological activity elicited by acute viral myocarditis contributes to a large amount of cardiomyocytes loss and poor prognosis of patients in clinic. Low-intensity pulsed ultrasound (LIPUS), which is an effective treatment modality for osteoarthropathy, has been recently illustrated regulating the overactive inflammatory response in various diseases. Here, we aimed to investigate whether LIPUS could attenuate coxsackievirus B3 (CVB3) infection-induced injury by coordinating the inflammatory response. Male BALB/c mice were inoculated intraperitoneally with CVB3 to establish the model of acute viral myocarditis. LIPUS treatment was given on Day 1, Day 1, 3 and Day 1, 3, 5 post-inoculation, respectively. All mice were followed up for 14 days. Day 1, 3, 5 LIPUS treatment significantly improved the survival rate, attenuated the ventricular dysfunction and ameliorated the cardiac histopathological injury of CVB3-infected mice. Western blotting analysis showed Day 1, 3, 5 LIPUS treatment decreased pro-inflammatory cytokines, increased the activation of caveolin-1 and suppressed p38 mitogen-activated protein kinase (MAPK) and extracellular signal-regulated kinase (ERK) signallings in heart tissue. RAW264.7 cells were treated with lipopolysaccharides (LPS) to simulate the augmented inflammatory response in vivo. LIPUS treatment on RAW264.7 inhibited the expression of pro-inflammatory cytokines, activated caveolin-1 and suppressed p38 MAPK and ERK signallings. Transfecting RAW264.7 with caveolin-1 siRNA blunted the suppression of pro-inflammatory cytokines and MAPK signallings by LIPUS treatment. Taken together, we demonstrated for the first time that LIPUS treatment attenuated the aggressive inflammatory response during acute viral myocarditis. The underlying mechanism may be activating caveolin-1 and suppressing MAPK signallings.

Antioxidant status of serum bilirubin and uric acid in patients with polymyositis and dermatomyositis.

OBJECTIVE: Oxidative stress and variations in antioxidant status are implicated in the pathogenesis of inflammatory and autoimmune diseases. Polymyositis and dermatomyositis (PM/DM) are autoimmune diseases with inflammatory cells infiltrating into skeletal muscles, and the antioxidant status is still controversial. The aim of our study was to investigate the correlation between PM/DM and the antioxidant status of serum bilirubin (Tbil, Dbil and Ibil) and uric acid (UA). MATERIALS AND METHODS: We measured serum concentrations of bilirubin (Tbil, Dbil and Ibil) and uric acid in 384 individuals, including 110 PM/DM patients and 274 healthy controls. RESULTS: We found that PM/DM patients had significantly lower serum concentrations of bilirubin (Tbil and Ibil) and uric acid than healthy controls, whether male or female. Also, after separately adjusting the covariances of age and gender, Tbil, Dbil, Ibil and UA were all relevant factors for PM/DM. Moreover, there were no significant differences in serum antioxidant molecule levels between PM and DM subgroups. CONCLUSION: Our study demonstrated the low serum levels of bilirubin and uric acid in patients with PM/DM. This suggested low antioxidant status in PM/DM patients with excessive oxidative stress.

[Effects of sowthistle-leaf Ixeris seedling injection on survival of random skin flap in rats].

OBJECTIVE: To observe the effects of Ixeri sonhifolia injection on random skin flap survival in rats. METHODS: Dorsal full-thickness skin flap model were harvested from 24 Sprague-Dawley rats in 2 to 3 months old. Twelve rats in experimental group were injected intraperitoneally with 5 ml/kg Ixeri sonhifolia injection immediately after the operation, the other rats in control group with an equal volume of saline. The rats were killed by cervical dislocation after 7 days' Ixeri sonhifolia injection. The area ratio of the survival tissue was measured at the 7th day,the tissue samples from proximal, middle, and distal portions were stained by HE and sectioned for histological and image analysis. VEGF was detected by immunohistochemistry. RESULTS: Seven days later, there was statistical significance between the percentage of the survival area of the flap between the experimental group (70.432 +/- 3.867)% and the control group (50.498 +/- 2.346)% (P < 0.05). In the middle portion, edema and infiltration of tissue in the experimental group were reduced than those of the control group, and new blood vessels increased in the experimental group (P < 0.05). A statistical significance of the expression of VEGF was detected between experimental group (4867.31 +/- 452.36) and control group (2387.45 +/- 768.46) (P < 0.05). CONCLUSION: Ixeri sonhifolia injection can promote the survival of random skin flap by increasing the quantity of capillary, reducing inflammatory infiltration of Europhiles and increasing the expression of VEGF, which promote a new approaching for the transpanting of the random flap research.