Impact of perioperative enhanced recovery after surgery on wound infection in patients undergoing orthopaedic surgery: A meta-analysis.

The aim of this study was to evaluate the effects of perioperative application of enhanced recovery after surgery (ERAS) concepts on wound infections and post-operative complications in patients receiving orthopaedic surgery, to provide a theoretical basis for post-operative care. Randomised controlled trials (RCTs) on the application of ERAS to patients receiving orthopaedic surgery, published up to October 2023, were identified in PubMed, Web of Science, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database and China National Knowledge Infrastructure databases. Literature was screened and evaluated by two reviewers based on the inclusion and exclusion criteria, and data were extracted from the final included articles. Data were analysed using RevMan 5.4 software. A total of 20 RCTs were included in the analysis, which included 1875 patients undergoing orthopaedic surgery, of whom 938 and 937 were in the ERAS and control groups, respectively. The analysis revealed that in patients undergoing orthopaedic surgery, implementation of ERAS in the perioperative period was associated with a significantly reduced the rate of wound infections (1.6% vs. 6.19%, risk ratio [RR]: 0.30, 95% confidence interval [CI]: 0.18-0.50, p < 0.001) and complication (5.12% vs. 21.88%, RR: 0.23, 95% CI: 0.17-0.32, p < 0.001) and can effectively shorten the hospital length of stay (standardised mean difference [SMD]: -2.50 days, 95% CI: -3.17 to -1.83 days, p < 0.001) compared with that of conventional care. The available evidence suggests that the implementation of ERAS in the perioperative period of patients undergoing orthopaedic surgery could effectively reduce the rate of wound infections and complications, shorten the hospital length of stay and promote the early recovery of patients.

DMCA-GAN: Dual Multilevel Constrained Attention GAN for MRI-Based Hippocampus Segmentation.

Precise segmentation of the hippocampus is essential for various human brain activity and neurological disorder studies. To overcome the small size of the hippocampus and the low contrast of MR images, a dual multilevel constrained attention GAN for MRI-based hippocampus segmentation is proposed in this paper, which is used to provide a relatively effective balance between suppressing noise interference and enhancing feature learning. First, we design the dual-GAN backbone to effectively compensate for the spatial information damage caused by multiple pooling operations in the feature generation stage. Specifically, dual-GAN performs joint adversarial learning on the multiscale feature maps at the end of the generator, which yields an average Dice coefficient (DSC) gain of 5.95% over the baseline. Next, to suppress MRI high-frequency noise interference, a multilayer information constraint unit is introduced before feature decoding, which improves the sensitivity of the decoder to forecast features by 5.39% and effectively alleviates the network overfitting problem. Then, to refine the boundary segmentation effects, we construct a multiscale feature attention restraint mechanism, which forces the network to concentrate more on effective multiscale details, thus improving the robustness. Furthermore, the dual discriminators D1 and D2 also effectively prevent the negative migration phenomenon. The proposed DMCA-GAN obtained a DSC of 90.53% on the Medical Segmentation Decathlon (MSD) dataset with tenfold cross-validation, which is superior to the backbone by 3.78%.

BSCN: bidirectional symmetric cascade network for retinal vessel segmentation.

BACKGROUND: Retinal blood vessel segmentation has an important guiding significance for the analysis and diagnosis of cardiovascular diseases such as hypertension and diabetes. But the traditional manual method of retinal blood vessel segmentation is not only time-consuming and laborious but also cannot guarantee the accuracy and efficiency of diagnosis. Therefore, it is especially significant to create a computer-aided method of automatic and accurate retinal vessel segmentation. METHODS: In order to extract the blood vessels' contours of different diameters to realize fine segmentation of retinal vessels, we propose a Bidirectional Symmetric Cascade Network (BSCN) where each layer is supervised by vessel contour labels of specific diameter scale instead of using one general ground truth to train different network layers. In addition, to increase the multi-scale feature representation of retinal blood vessels, we propose the Dense Dilated Convolution Module (DDCM), which extracts retinal vessel features of different diameters by adjusting the dilation rate in the dilated convolution branches and generates two blood vessel contour prediction results by two directions respectively. All dense dilated convolution module outputs are fused to obtain the final vessel segmentation results. RESULTS: We experimented the three datasets of DRIVE, STARE, HRF and CHASE_DB1, and the proposed method reaches accuracy of 0.9846/0.9872/0.9856/0.9889 and AUC of 0.9874/0.9941/0.9882/0.9874 on DRIVE, STARE, HRF and CHASE_DB1. CONCLUSIONS: The experimental results show that compared with the state-of-art methods, the proposed method has strong robustness, it not only avoids the adverse interference of the lesion background but also detects the tiny blood vessels at the intersection accurately.

Predicting protein submitochondrial locations by incorporating the pseudo-position specific scoring matrix into the general Chou's pseudo-amino acid composition.

Mitochondrion is important organelle of most eukaryotes and play an important role in participating in various life activities of cells. However, some functions of mitochondria can only be achieved in specific submitochondrial location, the study of submitochondrial locations will help to further understand the biological function of protein, which is a hotspot in proteomics research. In this paper, we propose a new method for protein submitochondrial locations prediction. Firstly, the features of protein sequence are extracted by combining Chou's pseudo-amino acid composition (PseAAC) and pseudo-position specific scoring matrix (PsePSSM). Then the extracted feature information is denoised by two-dimensional (2-D) wavelet denoising. Finally, the optimal feature vectors are input to the SVM classifier to predict the protein submitochondrial locations. We obtained the ideal prediction results by jackknife test and compared with other prediction methods. The results indicate that the proposed method is significantly better than the existing research results, which can provide a new method to predict protein locations in other organelles. The source code and all datasets are available at https://github.com/QUST-BSBRC/PseAAC-PsePSSM-WD/ for academic use.

Mammogram mass segmentation and classification based on cross-view VAE and spatial hidden factor disentanglement.

Breast masses are the most important clinical findings of breast carcinomas. The mass segmentation and classification in mammograms remain a crucial yet challenging topic in computer-aided diagnosis systems, as the masses show their irregularities in shape, size and texture. In this paper, we propose a new framework for mammogram mass classification and segmentation. Specifically, to utilize the complementary information within the mammographic cross-views, cranio caudal and mediolateral oblique, a cross-view based variational autoencoder (CV-VAE) combined with a spatial hidden factor disentanglement module is presented, where the two views can be reconstructed from each other through two explicitly disentangled hidden factors: class related (specified) and background common (unspecified). Then, the specified factor is not only divided into two categories: benign and malignant by a new introduced feature pyramid networks based mass classifier, but also used to predict the mass mask label based on a U-Net-like decoder. By integrating the two complementary modules, more discriminative morphological and semantic features can be learned to solve the mass classification and segmentation problems simultaneously. The proposed method is evaluated on two most used public mammography datasets, CBIS-DDSM and INbreast, achieving the Dice similarity coefficient (DSC) of 92.46% and 93.70% for segmentation and the area under receiver operating characteristic curve (AUC) of 93.20% and 95.01% for classification, respectively. Compared with other state-of-the-art approaches, it gives competitive results.

MHL-Net: A Multistage Hierarchical Learning Network for Head and Neck Multiorgan Segmentation.

Accurate segmentation of head and neck organs at risk is crucial in radiotherapy. However, the existing methods suffer from incomplete feature mining, insufficient information utilization, and difficulty in simultaneously improving the performance of small and large organ segmentation. In this paper, a multistage hierarchical learning network is designed to fully extract multidimensional features, combined with anatomical prior information and imaging features, using multistage subnetworks to improve the segmentation performance. First, multilevel subnetworks are constructed for primary segmentation, localization, and fine segmentation by dividing organs into two levels-large and small. Different networks both have their own learning focuses and feature reuse and information sharing among each other, which comprehensively improved the segmentation performance of all organs. Second, an anatomical prior probability map and a boundary contour attention mechanism are developed to address the problem of complex anatomical shapes. Prior information and boundary contour features effectively assist in detecting and segmenting special shapes. Finally, a multidimensional combination attention mechanism is proposed to analyze axial, coronal, and sagittal information, capture spatial and channel features, and maximize the use of structural information and semantic features of 3D medical images. Experimental results on several datasets showed that our method was competitive with state-of-the-art methods and improved the segmentation results for multiscale organs.

Cov-TransNet: Dual branch fusion network with transformer for COVID-19 infection segmentation.

Segmentation of COVID-19 infection is a challenging task due to the blurred boundaries and low contrast between the infected and the non-infected areas in COVID-19 CT images, especially for small infection regions. COV-TransNet is presented to achieve high-precision segmentation of COVID-19 infection regions in this paper. The proposed segmentation network is composed of the auxiliary branch and the backbone branch. The auxiliary branch network adopts transformer to provide global information, helping the convolution layers in backbone branch to learn specific local features better. A multi-scale feature attention module is introduced to capture contextual information and adaptively enhance feature representations. Specially, a high internal resolution is maintained during the attention calculation process. Moreover, feature activation module can effectively reduce the loss of valid information during sampling. The proposed network can take full advantage of different depth and multi-scale features to achieve high sensitivity for identifying lesions of varied sizes and locations. We experiment on several datasets of the COVID-19 lesion segmentation task, including COVID-19-CT-Seg, UESTC-COVID-19, MosMedData and COVID-19-MedSeg. Comprehensive results demonstrate that COV-TransNet outperforms the existing state-of-the-art segmentation methods and achieves better segmentation performance for multi-scale lesions.

DMCT-Net: dual modules convolution transformer network for head and neck tumor segmentation in PET/CT.

Objective.Accurate segmentation of head and neck (H&N) tumors is critical in radiotherapy. However, the existing methods lack effective strategies to integrate local and global information, strong semantic information and context information, and spatial and channel features, which are effective clues to improve the accuracy of tumor segmentation. In this paper, we propose a novel method called dual modules convolution transformer network (DMCT-Net) for H&N tumor segmentation in the fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) images.Approach.The DMCT-Net consists of the convolution transformer block (CTB), the squeeze and excitation (SE) pool module, and the multi-attention fusion (MAF) module. First, the CTB is designed to capture the remote dependency and local multi-scale receptive field information by using the standard convolution, the dilated convolution, and the transformer operation. Second, to extract feature information from different angles, we construct the SE pool module, which not only extracts strong semantic features and context features simultaneously but also uses the SE normalization to adaptively fuse features and adjust feature distribution. Third, the MAF module is proposed to combine the global context information, channel information, and voxel-wise local spatial information. Besides, we adopt the up-sampling auxiliary paths to supplement the multi-scale information.Main results.The experimental results show that the method has better or more competitive segmentation performance than several advanced methods on three datasets. The best segmentation metric scores are as follows: DSC of 0.781, HD95 of 3.044, precision of 0.798, and sensitivity of 0.857. Comparative experiments based on bimodal and single modal indicate that bimodal input provides more sufficient and effective information for improving tumor segmentation performance. Ablation experiments verify the effectiveness and significance of each module.Significance.We propose a new network for 3D H&N tumor segmentation in FDG-PET/CT images, which achieves high accuracy.

Unsupervised deep consistency learning adaptation network for cardiac cross-modality structural segmentation.

Deep neural networks have recently been succeessful in the field of medical image segmentation; however, they are typically subject to performance degradation problems when well-trained models are tested in another new domain with different data distributions. Given that annotated cross-domain images may inaccessible, unsupervised domain adaptation methods that transfer learnable information from annotated source domains to unannotated target domains with different distributions have attracted substantial attention. Many methods leverage image-level or pixel-level translation networks to align domain-invariant information and mitigate domain shift issues. However, These methods rarely perform well when there is a large domain gap. A new unsupervised deep consistency learning adaptation network, which adopts input space consistency learning and output space consistency learning to realize unsupervised domain adaptation and cardiac structural segmentation, is introduced in this paper The framework mainly includes a domain translation path and a cross-modality segmentation path. In domain translation path, a symmetric alignment generator network with attention to cross-modality features and anatomy is introduced to align bidirectional domain features. In the segmentation path, entropy map minimization, output probability map minimization and segmentation prediction minimization are leveraged to align the output space features. The model conducts supervised learning to extract source domain features and conducts unsupervised deep consistency learning to extract target domain features. Through experimental testing on two challenging cross-modality segmentation tasks, our method has robust performance compared to that of previous methods. Furthermore, ablation experiments are conducted to confirm the effectiveness of our framework.

A task-unified network with transformer and spatial-temporal convolution for left ventricular quantification.

Quantification of the cardiac function is vital for diagnosing and curing the cardiovascular diseases. Left ventricular function measurement is the most commonly used measure to evaluate the function of cardiac in clinical practice, how to improve the accuracy of left ventricular quantitative assessment results has always been the subject of research by medical researchers. Although considerable efforts have been put forward to measure the left ventricle (LV) automatically using deep learning methods, the accurate quantification is yet a challenge work as a result of the changeable anatomy structure of heart in the systolic diastolic cycle. Besides, most methods used direct regression method which lacks of visual based analysis. In this work, a deep learning segmentation and regression task-unified network with transformer and spatial-temporal convolution is proposed to segment and quantify the LV simultaneously. The segmentation module leverages a U-Net like 3D Transformer model to predict the contour of three anatomy structures, while the regression module learns spatial-temporal representations from the original images and the reconstruct feature map from segmentation path to estimate the finally desired quantification metrics. Furthermore, we employ a joint task loss function to train the two module networks. Our framework is evaluated on the MICCAI 2017 Left Ventricle Full Quantification Challenge dataset. The results of experiments demonstrate the effectiveness of our framework, which achieves competitive cardiac quantification metric results and at the same time produces visualized segmentation results that are conducive to later analysis.

MFD-Net: Modality Fusion Diffractive Network for Segmentation of Multimodal Brain Tumor Image.

Automatic brain tumor segmentation using multi-parametric magnetic resonance imaging (mpMRI) holds substantial importance for brain diagnosis, monitoring, and therapeutic strategy planning. Given the constraints inherent to manual segmentation, adopting deep learning networks for accomplishing accurate and automated segmentation emerges as an essential advancement. In this article, we propose a modality fusion diffractive network (MFD-Net) composed of diffractive blocks and modality feature extractors for the automatic and accurate segmentation of brain tumors. The diffractive block, designed based on Fraunhofer's single-slit diffraction principle, emphasizes neighboring high-confidence feature points and suppresses low-quality or isolated feature points, enhancing the interrelation of features. Adopting a global passive reception mode overcomes the issue of fixed receptive fields. Through a self-supervised approach, the modality feature extractor effectively utilizes the inherent generalization information of each modality, enabling the main segmentation branch to focus more on multimodal fusion feature information. We apply the diffractive block on nn-UNet in the MICCAI BraTS 2022 challenge, ranked first in the pediatric population data and third in the BraTS continuous evaluation data, proving the superior generalizability of our network. We also train separately on the BraTS 2018, 2019, and 2021 datasets. Experiments demonstrate that the proposed network outperforms state-of-the-art methods.

A pixelated liquid perovskite array for high-sensitivity and high-resolution X-ray imaging scintillation screens.

Scintillators with high spatial resolution at a low radiation dose rate are desirable for X-ray medical imaging. A low radiation dose rate can be achieved using a sufficiently thick scintillator layer to absorb the incident X-ray energy completely, however, often at the expense of low spatial resolution due to the issue of optical crosstalk of scintillation light. Therefore, to achieve high sensitivity combined with high-resolution imaging, a thick scintillator with perfect light guiding properties is in high demand. Herein, a new strategy is developed to address this issue by embedding liquid scintillators into lead-containing fiber-optical plates (FOPs, n = 1.5) via the siphon effect. The liquid scintillator is composed of perovskite quantum dots (QDs)/2,5-diphenyloxazole (PPO) and the non-polar high-refractive index (n = 1.66) solvent α-bremnaphthalene. Benefiting from the pixelated and thickness-adjustable scintillators, the proposed CsPbBr3 QDs/PPO liquid scintillator-based X-ray detector achieves a detection limit of 79.1 µGy s-1 and a spatial resolution of 4.6 lp mm-1. In addition, it displays excellent tolerance against radiation (>34 h) and shows outstanding stability under ambient conditions (>160 h). This strategy could also be applied to other liquid scintillators (such as CsPbCl3 QDs and Mn:CsPbCl3 QDs). The combination of high sensitivity, high spatial resolution and stability, easy fabrication and maintenance, and a reusable substrate matrix makes these liquid scintillators a promising candidate for practical X-ray medical imaging applications.

Pulmonary nodules detection based on multi-scale attention networks.

Pulmonary nodules are the main manifestation of early lung cancer. Therefore, accurate detection of nodules in CT images is vital for lung cancer diagnosis. A 3D automatic detection system of pulmonary nodules based on multi-scale attention networks is proposed in this paper to use multi-scale features of nodules and avoid network over-fitting problems. The system consists of two parts, nodule candidate detection (determining the locations of candidate nodules), false positive reduction (minimizing the number of false positive nodules). Specifically, with Res2Net structure, using pre-activation operation and convolutional quadruplet attention module, the 3D multi-scale attention block is designed. It makes full use of multi-scale information of pulmonary nodules by extracting multi-scale features at a granular level and alleviates over-fitting by pre-activation. The U-Net-like encoder-decoder structure is combined with multi-scale attention blocks as the backbone network of Faster R-CNN for detection of candidate nodules. Then a 3D deep convolutional neural network based on multi-scale attention blocks is designed for false positive reduction. The extensive experiments on LUNA16 and TianChi competition datasets demonstrate that the proposed approach can effectively improve the detection sensitivity and control the number of false positive nodules, which has clinical application value.

DCAU-Net: dense convolutional attention U-Net for segmentation of intracranial aneurysm images.

Segmentation of intracranial aneurysm images acquired using magnetic resonance angiography (MRA) is essential for medical auxiliary treatments, which can effectively prevent subarachnoid hemorrhages. This paper proposes an image segmentation model based on a dense convolutional attention U-Net, which fuses deep and rich semantic information with shallow-detail information for adaptive and accurate segmentation of MRA-acquired aneurysm images with large size differences. The U-Net model serves as a backbone, combining dense block and convolution block attention module (CBAM). The dense block is composed of a batch normalization layer, an randomly rectified linear unit activation function, and a convolutional layer, for mitigation of vanishing gradients, for multiplexing of aneurysm features, and for improving the network training efficiency. The CBAM is composed of a channel attention module and a spatial attention module, improving the segmentation performance of feature discrimination and enhancing the acquisition of key feature information. Owing to the large variation of aneurysm sizes, multi-scale fusion is performed during up-sampling, for adaptive segmentation of MRA-acquired aneurysm images. The model was tested on the MICCAI 2020 ADAM dataset, and its generalizability was validated on the clinical aneurysm dataset (aneurysm sizes: < 3 mm, 3-7 mm, and > 7 mm) supplied by the Affiliated Hospital of Qingdao University. A good clinical application segmentation performance was demonstrated.

MLRD-Net: 3D multiscale local cross-channel residual denoising network for MRI-based brain tumor segmentation.

The precise segmentation of multimodal MRI images is the primary stage of tumor diagnosis and treatment. Current segmentation strategies often underutilize multiscale features, which can easily lead to loss of contextual information, reduction of low-level features and noise interference. To overcome these issues, a 3D multiscale local cross-channel residual denoising network (MLRD-Net) for an MRI-based brain tumor segmentation algorithm is proposed in this paper. Specifically, we employ encoder-decoder structure to connect local and global features, and enhance the receptive field of the network. Random slice operation has been conducted to enhance robustness. Then, residual blocks with pre-activation operation are developed in down-sampling stage, which effectively improves signal propagation along the network and alleviates network overfitting. Finally, the local cross-channel denoising mechanism is established to eliminate unimportant features without dimensionality reduction. Our proposal was evaluated in Brain Tumor Segmentation 2020 dataset (BraTS 2020), obtaining significantly improved results with mean Dice Similarity Coefficient metric of 0.91, 0.79, and 0.73 for the complete, tumor core, and enhancing tumor regions respectively. Besides, we conduct further practice on BraTS 2019, with the mean Dice Similarity Coefficient metric of 0.89, 0.80, and 0.75. Massive experiments demonstrate that our method is powerful and reliable. It increases little model complexity while achieving very competitive performance.

MRBENet: A Multiresolution Boundary Enhancement Network for Salient Object Detection.

Salient Object Detection (SOD) simulates the human visual perception in locating the most attractive objects in the images. Existing methods based on convolutional neural networks have proven to be highly effective for SOD. However, in some cases, these methods cannot satisfy the need of both accurately detecting intact objects and maintaining their boundary details. In this paper, we present a Multiresolution Boundary Enhancement Network (MRBENet) that exploits edge features to optimize the location and boundary fineness of salient objects. We incorporate a deeper convolutional layer into the backbone network to extract high-level semantic features and indicate the location of salient objects. Edge features of different resolutions are extracted by a U-shaped network. We designed a Feature Fusion Module (FFM) to fuse edge features and salient features. Feature Aggregation Module (FAM) based on spatial attention performs multiscale convolutions to enhance salient features. The FFM and FAM allow the model to accurately locate salient objects and enhance boundary fineness. Extensive experiments on six benchmark datasets demonstrate that the proposed method is highly effective and improves the accuracy of salient object detection compared with state-of-the-art methods.

A hierarchically trained generative network for robust facial symmetrization.

Face symmetrization has extensive applications in both medical and academic fields, such as facial disorder diagnosis. Human face possesses an important characteristic, which is as known as symmetry. However, in many scenarios, the perfect symmetry doesn't exist in human faces, which yields a large number of studies around this topic. For example, facial palsy evaluation, facial beauty evaluation based on facial symmetry analysis, and many among others. Currently, there are still very limited researches dedicated for automatic facial symmetrization. Most of the existing studies only utilized their own implantations for facial symmetrization to assist their interdisciplinary academic researches. Limitations thus can be noticed in their methods, such as the requirements for manual interventions. Furthermore, most existing methods utilize facial landmark detection algorithms for automatic facial symmetrization. Though accuracies of the landmark detection algorithms are promising, the uncontrolled conditions in the facial images can still negatively impact the performance of the symmetrical face production. To this end, this paper presents a joint-loss enhanced deep generative network model for automatic facial symmetrization, which is achieved by a full facial image analysis. The joint-loss consists of a pair of adversarial losses and an identity loss. The adversarial losses try to make the generated symmetrical face as realistic as possible, while the identity loss helps to constrain the output to have the same identity of the person in the original input as much as possible. Rather than an end-to-end learning strategy, the proposed model is constructed by a multi-stage training process, which avoids the demand for a large size of the symmetrical face as training data. Experiments are conducted with comparisons with several existing methods based on some of the most popular facial landmark detection algorithms. Competitive results of the proposed method are demonstrated.

Design, synthesis and antimicrobial evaluation of novel benzimidazole-incorporated sulfonamide analogues.

A novel series of benzimidazole-incorporated sulfonamide analogues were designed and synthesized with an effort to overcome the increasing antibiotic resistance. Compound 5c gave potent activities against Gram-positive bacteria and fungi, and 2,4-dichlorobenzyl derivative 5g showed good activities against Gram-negative bacteria. Both of these two active molecules 5c and 5g could effectively intercalate into calf thymus DNA to form compound-DNA complex respectively, which might block DNA replication to exert their powerful antimicrobial activity. Molecular docking experiments suggested that compounds 5c and 5g could insert into base-pairs of DNA hexamer duplex by the formation of hydrogen bonds with guanine of DNA. The transportation behavior of these highly active compounds by human serum albumin (HSA) demonstrated that the electrostatic interactions played major roles in the strong association of active compounds with HSA, and which was also confirmed by the full geometry calculation optimizations.