US2Mask: Image-to-mask generation learning via a conditional GAN for cardiac ultrasound image segmentation.

Cardiac ultrasound (US) image segmentation is vital for evaluating clinical indices, but it often demands a large dataset and expert annotations, resulting in high costs for deep learning algorithms. To address this, our study presents a framework utilizing artificial intelligence generation technology to produce multi-class RGB masks for cardiac US image segmentation. The proposed approach directly performs semantic segmentation of the heart's main structures in US images from various scanning modes. Additionally, we introduce a novel learning approach based on conditional generative adversarial networks (CGAN) for cardiac US image segmentation, incorporating a conditional input and paired RGB masks. Experimental results from three cardiac US image datasets with diverse scan modes demonstrate that our approach outperforms several state-of-the-art models, showcasing improvements in five commonly used segmentation metrics, with lower noise sensitivity. Source code is available at https://github.com/energy588/US2mask.

Diagnostic biomarkers and aortic dissection: a systematic review and meta-analysis.

BACKGROUND: Aortic dissection (AD) is a serious and fatal vascular disease. The earlier the condition of AD patients can be assessed precisely, the more scientifically controlled the patient's condition will be. Therefore, timely and accurate diagnosis is significant for AD. Blood biomarker testing as a method of liquid biopsy can improve the diagnostic efficiency of AD. This study conducted a systematic review of the current blood diagnostic biomarkers of AD. METHODS: The PubMed, Cochrane Library, Web of Science, and Embase electronic databases were systematically searched from inception to January 1, 2023, using the terms "aortic dissection", "serum", "plasma" and "diagnosis". Stata 12.0 software was used to perform Random effects meta-analysis was performed using Stata 12.0 software to determine the effect sizes and corresponding 95% confidence intervals. Then, a summary receiver operator characteristic (SROC) curve was drawn, and the area under the ROC curve (AUC) was calculated. RESULTS: D-dimer had the best sensitivity and AUC for AD, with values of 0.96 (95% CI: 0.93-0.98) and 0.95 (95% CI: 0.93-0.97), respectively. The sensitivity and AUC values for D-dimer with a cut-off value of 500 ng/mL were 0.97 (95% CI: 0.95-0.99) and 0.94 (95% CI: 0.92-0.96), respectively. In contrast, microRNA had a better specificity value for AD, at 0.79 (95% CI: 0.73-0.83). CONCLUSIONS: D-dimer and microRNA have good accuracy in the diagnosis of AD, but the specificity of D-dimer is worse, and studies of microRNA are insufficient. The combination of different biomarkers can improve the diagnostic accuracy. Other blood biomarkers are related to the pathological progression of AD and can be selected according to pathological progress.

Association Between Serum Trace Heavy Metals and Liver Function Among Adolescents.

BACKGROUND: Exposure to metals has been associated with liver-related disease. Few studies have explored the effect of sex stratification on adolescent liver function. METHOD: From the National Health and Nutrition Examination Survey (2011-2016), 1143 subjects aged 12-19 years were selected for analysis. The outcome variables were the levels of alanine aminotransferase (ALT), aspartate aminotransferase, and gamma-glutamyl transpeptidase. RESULTS: The results showed a positive association between serum zinc and ALT in boys (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.11-5.06). Serum mercury was associated with an increase in ALT level in girls (OR, 2.73; 95% CI, 1.14-6.57). Mechanistically, the efficacy mediated by total cholesterol accounted for 24.38% and 6.19% of the association between serum zinc and ALT. CONCLUSIONS: The results imply that serum heavy metals were associated with the risk of liver injury, possibly mediated by serum cholesterol, in adolescents.

Binary amplitude switch for photoacoustic transducer toward dynamic spatial acoustic field modulation.

Photoacoustic (PA) transducers are an attractive method of producing high-amplitude, high-frequency, broad-bandwidth ultrasound signals with excellent immunity to electromagnetic interference, when compared with their traditional electroacoustic counterparts. However, the lack of effective control over the spatial sound field prohibits PA transducer technology from further widespread application. This paper presents the first, to the best of our knowledge, experimental study on the dynamic spatial ultrasound modulation strategy for the use of PA transducers, in which a novel PA transducer element is designed. This consists of a suspended compound PA conversion film, whose backing condition can be switched between air and glass through pneumatic actuation to create destructive and constructive acoustic wave interference, respectively. As a result, nearly an order of magnitude contrast in the output acoustic amplitude can be obtained by switching the device's backing condition given the same laser excitation, thus achieving a binary amplitude tuning. Furthermore, a linear PA transducer array consisting of three independently controllable elements is used for a proof-of-concept demonstration of the dynamic spatial sound field manipulation. To the best of the authors' knowledge, this is the first time that such a unique capability has been successfully applied to PA transducer technology.

Dynamic acoustic focusing in photoacoustic transmitter.

Photoacoustic transmitter represents a promising substitute for conventional piezoelectric counterparts. However, lack of easy and effective method for dynamically manipulating the focused acoustic field is a common and tricky problem faced by current photoacoustic technology. In this paper, a new strategy for constructing focus tunable photoacoustic transmitter is proposed. Different from existed prevailing device architecture, a sandwich like photoacoustic conversion layer is innovatively designed into a suspending elastic membrane with clamped boundary and it can be deformed using integrated pneumatic actuator. Owing to the membrane deflection property, concave spherical contours with variable radius of curvature can be obtained. Considering the shape determined sound emission characteristic, continuous tuning on the axial focusing length of the acoustic field has been successfully demonstrated in the photoacoustic transmitter for the first time. Besides, acoustic signal with significantly improved negative pressure has also been achieved especially at the focus, bringing additional advantage for applications.

Comparative study of one-stage and the novel two-stage urethroplasty using the transected urethral plate and transverse preputial island flap (TPIF) for severe hypospadias: a single-center experience.

BACKGROUND: To evaluate a novel two-stage method of urethroplasty using a transected urethral plate and transverse preputial island flap (TPIF) for proximal hypospadias with severe chordee. METHODS: We retrospectively analyzed 91 cases of proximal hypospadias, who had undergone either one-stage or two-stage urethroplasty. Comparisons between the two groups were made based on age, glans diameter, the length of the urethral defect, and the rate of complications. RESULTS: There was no significant difference in age at surgery, glans diameter, and the length of urethral defect between the two groups. In the one-stage group, 18 cases of urinary fistula and one case each of glans dehiscence, urethral diverticulum, and urethral diverticulum with concurrent glans dehiscence, were reported. All patients were treated using urinary fistula repair or urethroplasty. In the novel two-stage group, no cases of urinary fistula were reported after the secondary urethroplasty. However, 4 cases showed dehiscence at the glans, 2 were treated through reoperation but the 2 other 2 patients reoperation. The success rate was 62.50% and 88.57% in the one-stage and two-stage groups, respectively (P<0.05). CONCLUSIONS: Two-stage urethroplasty using a tubularized urethral plate and TPIF can significantly reduce the incidence of urethral fistula of the proximal hypospadias with severe chordee. However, it may increase the number of operations that need to be performed on children who do not need staged surgery. Although we could not prove it through this study, we believe that the necessity of two-stage urethroplasty should be determined based on the development of the glans, the severity of penile curvature, and the length of the urethra defect.

Patient transfer influences the prognosis of pediatric patients operated for testicular torsion: a single-center experience.

BACKGROUND: Testicular torsion (TT) remains an emerging issue for pediatric patients. This study's objective was to determine risk factors of TT outcomes in the Chinese pediatric cohort from a single center. METHODS: We performed a retrospective cohort study of patients who met the inclusion criteria in our center from 2013 to 2018. Clinical demographics, and TT-related data, including laterality, torsion degree, torsion direction, position to the cavity of tunica vaginalis, enorchia, and outcomes, were reviewed and extracted from medical charts and databases. Statistical analysis was conducted to compare and figure out the risk factors of TT outcomes. RESULTS: A total of 84 pediatric patients were enrolled in this study. Among these variables, age, duration of symptoms, and the patient transfer were significantly associated with the outcomes of TT (P<0.005). Patients transferred from other medical facilities underwent more orchiectomy than those without transfer (univariate analysis, P<0.0001; multivariate analysis, P=0.001). No difference was found in other variables between patients with or without transfer (P>0.05). Moreover, transferred patients tended to show worse testicular function. CONCLUSIONS: We have reported that age, duration of symptoms, and patient transfer were three significant risk factors in this cohort. Patients with transfer tended to suffer from more orchiectomy and worse prognosis of TT.

Air-backed photoacoustic transmitter for significantly improving negative acoustic pressure output.

Aiming to pursue an ultrasound signal with a significantly improved negative acoustic pressure level, which is one of the critical characteristics for exciting the ultrasound cavitation effect, a real applicable air-backed photoacoustic transmitter is presented. Different from the conventional solution of relying on a complicated focusing structure design, it works based on an acoustic signal phase reversal and amplitude superposition strategy. By using an innovative sandwich-like suspending photoacoustic layer with optimized structure design, the initial backward-propagating positive sound pressure can be converted into the forward-propagating negative one efficiently. For proof-of-concept demonstration, photoacoustic transmitter prototypes adopting a polydimethylsiloxane (PDMS)/candle soot nanoparticle/PDMS-PDMS composite as a photoacoustic conversion layer were fabricated and characterized. From experiment results, an acoustic signal with a remarkable ratio of negative pressure level to a positive one of 1.3 was successfully realized, which is the largest value ever reported, to the best of our knowledge. Moreover, when compared to the commonly used glass and PDMS-backing conditions in the photoacoustic area, nearly 200% and 400% enhancements in negative pressure output were achieved, respectively.

Lich-Gregoir vesico-ureteral reimplantation for duplex kidney anomalies in the pediatric population: a retrospective cohort study between laparoscopic and open surgery.

BACKGROUND: The aim of the study is to compare the Lich-Gregoir vesico-ureteral reimplantation in laparoscopy and open surgery. METHODS: In this case control study, we enrolled pediatric patients who were diagnosed with unilateral duplex kidney and had underwent surgical treatment. The surgical treatments were either conventional open surgery or laparoscopic surgery. We collected the basic demographic data and extracted the operative-related statistics such as operation time, blood loss, length of hospital stay, pain level, and post-operative complications. The two groups were compared using Student's t-test. RESULTS: A total of 90 subjects were enrolled. Of the enrolled subjects, 35 underwent open surgery and 55 underwent laparoscopic surgery. There were no observable difference in the basic demographics between two groups (P>0.05). The duration of operation in laparoscopic surgery group was significantly shorter than in the open surgery group (95.60±5.25 vs. 108.70±3.12 min, P=0.040). It was also noted that the amount of blood loss, length of hospital stay, drainage level, and the mean visual analog scale in laparoscopic group were significantly lower (P<0.05). The total incidence of complications in the laparoscopic and open surgery groups were 16.36% and 37.14%, respectively. CONCLUSIONS: Laparoscopic Lich-Gregoir vesico-ureteral reimplantation surgery management can be successful, clinically effective, and safe for pediatric population with functional duplex kidneys, and is better than the open surgery techniques.

Use of double-J ureteric stents post-laparoscopic pyeloplasty to treat ureteropelvic junction obstruction in hydronephrosis for pediatric patients: a single-center experience.

OBJECTIVES: We aimed to investigate the safety concerns associated with placing double-J ureteric stents post-laparoscopic pyeloplasty surgery for congenital ureteropelvic junction obstruction (UPJO) and hydronephrosis. METHODS: A total of 1349 patients with postoperative double-J stent placement at our center were included. Clinical variables for enrolled patients were collected by two independent authors. We compared clinical variables and the efficacy of stenting post-laparoscopic pyeloplasty. RESULTS: The mean age of the patients was 4.23 ± 2.39 years. A total of 58.49% of patients were diagnosed with left UPJO with hydronephrosis and 33.95% were diagnosed with right UPJO. Furthermore, 7.56% of patients had bilateral UPJO. In all cases, 96.96% of indwelling double-J stents were successfully removed 4 weeks post-surgery. A total of 3.04% of the patients still required further management, including stent migration to the renal pelvis (0.37%), stent migration to the bladder (0.30%), prolapse of the stent through the ureter (0.15%), blockage of stents (1.85%), and fouling of stents (0.37%). CONCLUSIONS: Double-J ureteric stents used after laparoscopic pyeloplasty for treating UPJO in hydronephrosis for pediatric patients is a safe, feasible, and beneficial method, which can be recommended for routine procedures. However, caution should be practiced for follow-up and removal using this method.

Risk factors affecting the prognosis of urinary tract infection in Chinese pediatric patients: Single-center experience.

BACKGROUND: Urinary tract infection (UTI) is common in children. The purpose of this retrospective study was to determine the various risk factors that usually affect the prognosis of UTI in children diagnosed with the disease. METHODS: In the present retrospective study, we enrolled all pediatric patients diagnosed with UTI and hospitalized between 1 January 2013 and 31 July 2016 at Nanjing Children's Hospital. We then collected all the relevant patient clinical demographics and characteristics. RESULTS: The study involved 2,092 pediatric patients diagnosed with UTI. On logistic regression analysis, factors that could affect the prognosis of pediatric UTI were complications, hospitalization, intensive care unit (ICU) admission, type of UTI, urine culture results, blood lymphocytes, urine nitrites (NIT) and antibiotics (unstandardized coefficients, 0.06, <0.001, -0.28, 0.32, <0.001, 0.01, -0.11, 0.01, respectively, all P < 0.001). CONCLUSION: Complications, hospitalization, type of UTI, urine culture results, blood lymphocytes, and antibiotics had a significant, positive association with UTI prognosis. Meanwhile, ICU admission and urine NIT had a negative association with prognosis.

Nrf2 signaling attenuates epithelial-to-mesenchymal transition and renal interstitial fibrosis via PI3K/Akt signaling pathways.

BACKGROUND: Nrf2 constitutes a therapeutic reference point for renal fibrosis and chronic kidney diseases. Nrf2-related signaling pathways are recognized to temper endothelial-to-mesenchymal transition (EMT) in fibrotic tissue. Nevertheless, the mechanism by which Nrf2 mitigates renal interstitial fibrosis is imprecise. METHODS: The relationship between Nrf2 and renal interstitial fibrosis was investigated using the unilateral ureteral obstruction (UUO) model of Nrf2-/- mice. The mice were separated into four groups, based on the treatment and intervention: Nrf2-/- + UUO, Nrf2-/- + Sham, WT + UUO and WT + Sham. Histological examination of renal tissue following the hematoxylin-eosin and Masson staining was carried out, as well as immunohistochemical staining. Additionally, to confirm the in vivo discoveries, in vitro experiments with HK-2 cells were also performed. RESULTS: The Nrf2-/- + UUO group showed more severe renal interstitial fibrosis compared to the WT + UUO, Nrf2-/- + Sham and WT + Sham groups. Furthermore, the manifestations of α-SMA and Fibronectin significantly increased, and the manifestation of E-cadherin considerably decreased in kidney tissues from the group of Nrf2-/- + UUO, compared to the WT + UUO group. The Nrf2 protein level significantly decreased in HK-2 cells, in reaction to the TGF-ß1 concentration. In addition, the overexpression of Nrf2 presented contradictory results. What is more, the PI3K/Akt signaling pathway was discovered to be activated in the proteins extracted from cultured cells, and treated with Nrf2 siRNA and kidney tissues from the Nrf2-/- + UUO group. CONCLUSIONS: The results we obtained demonstrate that Nrf2 signaling pathway may perhaps offset the development of EMT, prompted by TGF-ß1 and renal interstitial fibrosis. Likewise, the anti-fibrotic effect of Nrf2 was imparted by the inactivation of PI3K/Akt signaling. From our discoveries, we deliver new insight related to the prevention and treatment of kidney fibrosis.

Simple yet universal fabrication strategy for a focused photoacoustic transmitter.

Aiming to address existing technical challenges and explore a simple yet effective and universal solution for making a polydimethylsiloxane (PDMS)-based focused photoacoustic transmitter, a novel fabrication strategy is proposed. Different from the traditional technical route based on direct photoacoustic layer coating on a rigid concave substrate, it works by utilizing an elastomeric molding process, through which the originally flat photoacoustic conversion layer, consisting of PDMS-candle soot nanoparticles/PDMS-PDMS composite, is transformed into a concave contour with controllable radius of curvature and finally merged into a soft PDMS substrate. For proof-of-concept demonstration, two types of focused photoacoustic transmitters (6.3 mm and 8 mm focal lengths) operating at 5.3 MHz with -6 dB bandwidth of 134% are successfully fabricated, showing both distinct acoustic focusing capability and high energy conversion efficiency. Moreover, different from conventional focused counterparts, acoustic signals with nearly symmetric bi-polar waveform can be obtained at the focuses, facilitating ultrasound cavitation-based applications.

Retroperitoneal malignant schwannoma in a child.

Retroperitoneal malignant schwannomas are extremely rare. Only a few cases have been reported, only one of which occurred in a child. We herein report a case of retroperitoneal malignant schwannoma in a 2-year-old boy who presented with a painless mass in the right lumbar region. The mass had gradually enlarged during a 1-year period, and it was about the size of the patient's fist at the time of consultation. Whole-abdomen computed tomography revealed a space-occupying lesion in the retroperitoneum infiltrating from the L1 to L4 spinal canal. A preoperative diagnosis of a retroperitoneal tumor was made, and complete tumorectomy was performed. Postoperative pathological examination showed a malignant schwannoma. The tumor recurred 1 month after the first operation, and a second complete excision was carried out; the postoperative pathologic examination findings were similar to the previous findings. The patient recovered well and continued to undergo close follow-up.

Etiology and antimicrobial resistance patterns in pediatric urinary tract infection.

BACKGROUND: Urinary tract infection (UTI) is one of most common pediatric infections. The aim of this study was to investigate the etiology and antimicrobial resistance patterns in children hospitalized at Children's Hospital of Nanjing Medical University. METHODS: We conducted a retrospective, descriptive study of all UTI from 1 January 2013 to 30 November 2016 in children discharged from Nanjing Children's Hospital. The isolated pathogens and their resistance patterns were examined using midstream urine culture. RESULTS: A total of 2,316 children with UTI were included in the study. The occurrence rates of isolated pathogens were as follows: Enterococcus spp., 35.15%; Escherichia coli, 22.32%; Staphylococcus aureus spp., 7.73%; Streptococcus spp., 7.51%; and Klebsiella spp., 6.95%. Uropathogens had a low susceptibility to linezolid (3.47%), vancomycin (0.92%), imipenem (5.74%), and amikacin (3.17%), but they had a high susceptibility to erythromycin (90.52%), penicillin G (74.01%), cefotaxime (71.41%), cefazolin (73.41%), cefuroxime (72.52%), and aztreonam (70.11%). CONCLUSIONS: There is high antibiotic resistance in hospitalized children with UTI. Susceptibility testing should be carried out on all clinical isolates, and the empirical antibiotic treatment should be altered accordingly.

Retrospective analysis of individual risk factors for urethrocutaneous fistula after onlay hypospadias repair in pediatric patients.

BACKGROUND: To retrospectively identify the individual risk factors for the urethrocutaneous fistula (UCF) in pediatric patients after hypospadias repair (HR) with onlay island flap urethroplasty. METHODS: A total of 167 patients who underwent primary HR at Nanjing Medical University Affiliated Children Hospital from January 2009 to December 2012 were enrolled. Clinical data including the patient' age at HR, hypospadias type and urethral defect length were documented. RESULTS: Among 167 patients, 12.6% patients (n = 21) developed UCF after HR. Postoperative UCF occurred in 3.9% (3/76) cases at age of 0-2 years, 14.3% (9/63) at 2-4 years, 20.0% (2/10) at 4-6 years and 38.9% (7/18) at 6-12 years. The incidences of UCF were 12.0% (3/25), 11.4% (5/132) and 30.0% (3/10) for distal, middle and proximal types of hypospadias. As to the urethral defect length, the incidences of UCF were 8.2% (5/61) in patients with a length of ≤ 2 cm, 12.8% (9/70) in 2-3 cm, 22.6% (7/31) in 3-4 cm and 0% (0/5) in above 4 cm. Older age at HR was significantly associated with the high incidence of UCF formation (P = 0.004), while the hypospadias type and urethral defect length did not affect it (P = 0.264 and P = 0.312, respectively). CONCLUSIONS: The patient' age at HR was a risk factor for the UCF formation after HR, and treatment of HR within two years old might be with the least incidence of UCF.

[Transumbilical single-site laparoscopic orchiopexy for inguinal cryptorchidism in children: report of 33 cases].

OBJECTIVE: To explore the feasibility and effect of transumbilical single-site laparoscopic surgery in the treatment of inguinal cryptorchidism in children. METHODS: From August to November 2013, 33 children with inguinal cryptorchidism (41 testes) underwent transumbilical single-site laparoscopic orchiopexy. The undescended testes were palpable in the inguen intra-operatively in all the cases, 14 on the right, 11 on the left, and 8 bilaterally. RESULTS: All the operations were performed successfully with neither intraoperative complications nor conversion to operi surgery. Adequate length of spermatic cord was pulled down to allow the testis to descend through the inguinal canal into the scrotum in all the cases. Totally, 39 testes in 31 cases were fixed at the bottom and 2 testes in 2 cases in the middle of the scrotum. Follow-up ranged from 6 to 9 months, which showed normal development of the testes, but no such postoperative complications as testicular retraction and atrophy, indirect hernia, and hydrocele. CONCLUSION: Transumbilical single-site laparoscopic orchiopexy is a feasible and effective technique for the treatment of inguinal palpable undescended testis in children, and its cosmetic results were desirable.

[Comparisons of efficacy and safety of tolterodine and oxybutynin in children with idiopathic overactive bladder].

OBJECTIVE: To compare the efficacy and safety of tolterodine and oxybutynin in the treatment of idiopathic overactive bladder in children. METHODS: A total of 204 children with idiopathic overactive bladder were randomly divided into three groups (n=68 each): placebo, tolterodine-treated and oxybutynin-treated. The efficacy and safety were evaluated two weeks after treatment. RESULTS: The effective rate was 25% in the placebo group, 89% in the tolterodine-treated group, and 92% in the oxybutynin-treated group. The effective rate in the two treatment groups was significantly higher than that in the placebo group (P<0.05). There was a similar efficacy between the two treatment groups. The incidence of adverse events in the tolterodine-treated group (28%) was significantly lower than that in the oxybutnin-treated group (57%) (P<0.05). CONCLUSIONS: Tolterodine has a similar efficacy to oxybutynin in the treatment of idiopathic overactive bladder in children, with better safety in pharmacotherapy.