Transfer learning-based PET/CT three-dimensional convolutional neural network fusion of image and clinical information for prediction of EGFR mutation in lung adenocarcinoma.

BACKGROUND: To introduce a three-dimensional convolutional neural network (3D CNN) leveraging transfer learning for fusing PET/CT images and clinical data to predict EGFR mutation status in lung adenocarcinoma (LADC). METHODS: Retrospective data from 516 LADC patients, encompassing preoperative PET/CT images, clinical information, and EGFR mutation status, were divided into training (n = 404) and test sets (n = 112). Several deep learning models were developed utilizing transfer learning, involving CT-only and PET-only models. A dual-stream model fusing PET and CT and a three-stream transfer learning model (TS_TL) integrating clinical data were also developed. Image preprocessing includes semi-automatic segmentation, resampling, and image cropping. Considering the impact of class imbalance, the performance of the model was evaluated using ROC curves and AUC values. RESULTS: TS_TL model demonstrated promising performance in predicting the EGFR mutation status, with an AUC of 0.883 (95%CI = 0.849-0.917) in the training set and 0.730 (95%CI = 0.629-0.830) in the independent test set. Particularly in advanced LADC, the model achieved an AUC of 0.871 (95%CI = 0.823-0.919) in the training set and 0.760 (95%CI = 0.638-0.881) in the test set. The model identified distinct activation areas in solid or subsolid lesions associated with wild and mutant types. Additionally, the patterns captured by the model were significantly altered by effective tyrosine kinase inhibitors treatment, leading to notable changes in predicted mutation probabilities. CONCLUSION: PET/CT deep learning model can act as a tool for predicting EGFR mutation in LADC. Additionally, it offers clinicians insights for treatment decisions through evaluations both before and after treatment.

Effect of metformin and exenatide on pregnancy rate and pregnancy outcomes in overweight or obese infertility PCOS women: long-term follow-up of an RCT.

PURPOSE: The majority of Polycystic ovary syndrome (PCOS) are overweight or obese with increased infertility and high risk of pregnancy complications. We aim to compare efficacy of metformin and exenatide on spontaneous pregnancy rate, overall pregnancy rate after assisted reproductive technology treatment (ART) and pregnancy outcomes in overweight or obese infertility PCOS. METHODS: In this long-term follow-up study, 160 overweight or obese infertility Chinese PCOS were randomized to exenatide or metformin treatment for 12 weeks. Afterward, all were treated with metformin alone until pregnancy confirmed and followed until delivery. If patients failed spontaneous pregnancy during the second 12 weeks, ART could be offered until end of 64 weeks. The primary outcome was spontaneous pregnancy rate. RESULTS: At week 24, 29.2% of women in exenatide group conceived spontaneously while 14.7% in metformin group (p = 0.03). At week 64, total pregnancy rates were 79.2% in exenatide group and 76% in metformin group without significant difference (p = 0.65). Between two groups, there was no significant difference of pregnancy outcomes (p > 0.05). A stepwise logistic regression showed that spontaneous pregnancy was positively associated with body weight reduction and HOMA-IR improvement in either group. CONCLUSION: In overweight or obese infertility Chinese PCOS, 12 weeks pregestational exenatide treatment resulted in more spontaneous pregnancy likely due to greater weight reduction and improvement of insulin resistance compared with metformin treatment without obvious benefit on overall pregnancy rate after ART or pregnancy outcomes of successful conceived women. TRIAL REGISTRATION: This clinical trial was registered at Chinese Clinical Trials Registry (ChiCTR-IIR-16008084) on 13/3/2016.

Hierarchical Nanocapsules of Cu-Doped MoS2@H-Substituted Graphdiyne for Magnesium Storage.

Hierarchical nanocomposites, which integrate electroactive materials into carbonaceous species, are significant in addressing the structural stability and electrical conductivity of electrode materials in post-lithium-ion batteries. Herein, a hierarchical nanocapsule that encapsulates Cu-doped MoS2 (Cu-MoS2) nanopetals with inner added skeletons in an organic-carbon-rich nanotube of hydrogen-substituted graphdiyne (HsGDY) has been developed for rechargeable magnesium batteries (RMB). Notably, both the incorporation of Cu in MoS2 and the generation of the inner added nanoboxes are developed from a dual-template of Cu-cysteine@HsGDY hybrid nanowire; the synthesis involves two morphology/composition evolutions by CuS@HsGDY intermediates both taking place sequentially in one continuous process. These Cu-doped MoS2 nanopetals with stress-release skeletons provide abundant active sites for Mg2+ storage. The microporous HsGDY enveloped with an extended π-conjugation system offers more effective electron and ion transfer channels. These advantages work together to make this nanocapsule an effective cathode material for RMB with a large reversible capacity and superior rate and cycling performance.

Gut microbes enlarged the protective effect of transplanted regulatory B cells on rejection of cardiac allografts.

BACKGROUND: Regulatory B cells (Bregs) play an important role in maintaining immune homeostasis and have the potential to induce tolerance. Previous work has found that Breg cells are involved in heart transplantation tolerance. However, the effect of Breg on the transplantation tolerance and the underlying mechanisms remain to be clarified. METHODS: Using a within-species heart transplantation model, we aimed to investigate the role of CD19+CD5+CD1dhigh Bregs isolated from transplanted mice in preventing transplant rejection in vivo. We also explored the effects of CD40 and tumor necrosis factor receptor-associated factor 6 (TRAF6) ubiquitin ligase on Breg-mediated prolongation of survival in heart transplant (HT) mice, and the regulatory effects of downstream Cdk4 and Cdk6 proteins on dendritic cells (DCs), which clarified the function and molecular mechanism of Breg cells in HT mice. RESULTS: Our data suggest that adoptive transfer of the transplanted Bregs served as an effective tolerance-inducing mechanism in HT mice and was involved in the CD40-TRAF6 signaling pathway in DCs. Moreover, DCs collected from the Breg treated HT mice also prolonged the survival of HT mice. Furthermore, DC-specific knockout of TRAF6 diminished Breg-mediated prolongation of survival in HT mice. Interestingly, gut microbes from donors increased the survival of cardiac allografts both in both the absence and presence of Bregs but were not implicated in CD40-TRAF6 signaling. CONCLUSIONS: These findings reveal a role of Breg cells in the induction of transplantation tolerance through the blockade of the CD40-TRAF6 signaling pathway, which might be used in the treatment of HT in the clinic.

Ensemble learning accurately predicts the potential benefits of thrombolytic therapy in acute ischemic stroke.

BACKGROUND: Finding methods to accurately predict the final infarct volumes for acute ischemic stroke patients with full or no recanalization would significantly help to evaluate the potential benefits of thrombolytic therapy. We proposed such a method by constructing a model of ensemble deep learning and machine learning using diffusion-weighted imaging (DWI) only. METHODS: The proposed prediction model (named AUNet) combines an adaptive linear ensemble model (ALEM) of machine learning and a deep U-Net network with an accelerated non-local module (U-NL-Net) to learn voxel-wise and spatial features, respectively. Of 40 patients with acute ischemic stroke who received thrombolytic therapy, 17 were fully recanalized, 14 were not recanalized, and nine were partially recanalized. The AUNet was separately trained for full recanalization conditions (AUNetR) and no recanalization (AUNetN) as the best and worst outcomes of thrombolysis, respectively. RESULTS: AUNet performed significantly better in predicting the final infarct volumes in both the recanalization and non-recanalization conditions [area under the receiver operating characteristic curve (AUC) =0.898±0.022, recanalization; AUC =0.875±0.036, non-recanalization: Matthew's correlation coefficient (MCC) =0.863±0.033, recanalization; MCC =0.851±0.025, non-recanalization] than the fixed-thresholding method (AUC =0.776±0.021, P<0.0001, recanalization; AUC =0.692±0.023, P<0.0001, non-recanalization: MCC =0.742±0.035, recanalization; MCC =0.671±0.024, non-recanalization), the logistic regression method (AUC =0.797±0.023, P<0.003, recanalization; AUC =0.751±0.030, P<0.003, non-recanalization: MCC =0.762±0.035, recanalization; MCC =0.730±0.031, non-recanalization), and a recently developed convolutional neural network (AUC =0.814±0.013, P<0.003, recanalization; AUC =0.781±0.027, P<0.003, non-recanalization: MCC =792±0.022, recanalization; MCC =0.758±0.016, non-recanalization). The potential benefit of thrombolysis calculated from AUNetR and AUNetN showed large individual differences (from 12.81% to 239.73%). CONCLUSIONS: AUNet improved predictive accuracy over current state-of-the-art methods. More importantly, the accurate prediction of infarct volumes under different recanalization conditions may provide benefitial information for physicians in selecting suitable patients for thrombolytic therapy.

Contemporary trends in mitral valve surgery in East China: a 10-year experience.

BACKGROUND: Contemporary nationwide data from mainland China on trends in mitral valve surgery are scarce. The purpose of the present study was to review a single-center experience with mitral valve surgery over a 10-year period in East China. METHODS: Between July 2009 and June 2019, 3238 consecutive patients who underwent mitral valve surgery in our center were retrospectively reviewed. The patients were evenly divided into three periods: July 2009 to October 2012 (period I), November 2012 to February 2016 (period II), March 2016 to June 2019 (period III). RESULTS: The 3238 patients included 536 (16.6%) who had mitral valve repair and 2702 (83.4%) who had mitral valve replacement. Early mortalities for mitral valve repair and mitral valve replacement were 0.2% and 0.9%, respectively. There were trends towards a higher proportion of degenerative valve lesions (24.6%, 35.8%, 54.7% in periods I, II, and III, respectively) and a lower proportion of rheumatic valve lesions (71.0%, 62.6%, 38.0%) in more recent years. The proportions of minimally invasive surgery (0.7%, 2.1%, 30.2%), mitral valve repair (8.3%, 15.4%, 27.5%), use of a bioprosthesis (10.1%, 17.0%, 23.1%), and concomitant tricuspid valve procedures (13.2%, 28.5%, 46.0%) increased dramatically, while early mortality remained constant during the 10-year period (1.0%, 0.3%, 0.9%). CONCLUSIONS: In the past 10 years, the spectrum of mitral valve disease experienced a trend towards more degenerative valve lesions and less rheumatic valve lesions in East China. Mitral valve repair, bioprostheses, tricuspid valve repair, and minimally invasive surgery have been more often applied in recent years.

Impact of prosthesis-patient mismatch on short-term outcomes after aortic valve replacement: a retrospective analysis in East China.

BACKGROUND: Prosthesis-patient mismatch (PPM) may affect the clinical outcomes of patients undergoing aortic valve replacement (AVR). We aimed to determine the incidence of PPM, its effect on short-term mortality, and the factors contributing to PPM in China. METHODS: We retrospectively examined all consecutive patients with isolated or concomitant AVR at our hospital between January 1, 2013 and December 31, 2015. PPM was defined as an effective orifice area index (EOAi) of ≤ 0.85 cm2/m2. The baseline, echocardiographic, operative, and outcome data of all patients were collected from the national database. RESULTS: A total of 869 patients were included in the study. PPM was detected in 15.9% (138/869) of the patients. Four patients (0.5%) met the criteria for severe PPM. Patients with PPM were older and had a higher prevalence of diabetes, coronary heart disease, aortic stenosis (AS), and preoperative left ventricular dysfunction but a lower incidence of smoking history and aortic regurgitation. Logistic regression analysis showed that female gender (P < 0.001), AS (P = 0.014), higher body mass index (BMI) (P < 0.001), and bioprosthesis (P < 0.001) were independent predictors of PPM. We also found that PPM (P = 0.005) was associated with 30-day all-cause mortality, along with smoking history (P = 0.001) and low preoperative left ventricular ejection fraction (LVEF) (P = 0.004). CONCLUSIONS: PPM is associated with high short-term mortality after AVR in China. Female gender, aortic stenosis, bioprosthesis, and high BMI are risk factors for the incidence of PPM.

miR-223/FBW7 axis regulates doxorubicin sensitivity through epithelial mesenchymal transition in non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) is one of the leading causes of cancer-related deaths in the world. F-box/WD repeat-containing protein 7 (FBW7) plays important roles in human cancers, such as gastric cancer, breast cancer, and hepatocellular carcinoma. In this study, we found that high levels of FBW7 expression were associated with increased doxorubicin sensitivity in NSCLC cells. Down-regulation of FBW7 reduced the chemosensitivity in tumor cells. Twist is a critical transcription factor in epithelial-mesenchymal transition (EMT), and NSCLC cells with silenced Twist showed increased doxorubicin sensitivity. Treatment of cells with doxorubicin or hypoxia was shown to trigger EMT as evidenced by decreased E-cadherin and increased Vimentin. In contrast, ectopic expression of FBW7 prevented doxorubicin-or hypoxia-induced EMT. In addition, FBW7 was identified as a functional target of miR-223 in NSCLC cells. These findings define a critical role of miR-223/FBW7 pathway in regulating EMT and chemosensitivity in NSCLC cells.

A Giant Coronary Sinus Aneurysm with Secondary Vena Cava Aneurysms.

Coronary sinus aneurysm (CSA) is an extremely rare entity. Herein, we present an unusual case of an 18-year-old symptomatic female patient with a giant CSA. Secondary vena cava aneurysms were also manifested. The final diagnosis was confirmed by enhanced computed tomography (CT) and cardiac catheterization. As far as we know, it is the first case that such a giant CSA coexists with secondary vena cava aneurysms. Considering the complexity of postoperative reconstruction, we believe that heart transplantation may be the optimal way for treatment. The patient received anticoagulant due to the superior vena cava (SVC) thrombosis while waiting for a donor.

Effect of exenatide, insulin and pioglitazone on bone metabolism in patients with newly diagnosed type 2 diabetes.

AIM: Preclinical studies suggested that insulin, incretin and thiazolidinediones had effect on regulation of bone metabolism. But clinical evidence is limited. We assessed the effects of these antihyperglycemic agents on bone metabolism in patients with newly diagnosed type 2 diabetes. METHODS: The present study was a two-center, randomized, parallel-group clinical trial. Sixty-two newly diagnosed and drug-naïve patients with type 2 diabetes were randomized to exenatide (EXE, n = 20), mixed protamine zinc recombinant human insulin lispro injection (25R; INS, n = 21) or pioglitazone (PIO, n = 21) group for a 24-week treatment. Glycosylated hemoglobin A1c (HbA1c), body weight, body mineral density (BMD) and fasting serum concentration of bone turnover markers including osteocalcin (OC), C-telopeptide of type I collagen (CTX) and tartrate-resistant alkaline phosphatase 5b (TRAcP5b) were assessed at baseline and week 24. RESULTS: Baseline characteristics were similar among groups. At week 24, HbA1c improved in all patients (EXE:-2.4 ± 0.3 %, INS:-2.4 ± 0.3 %, PIO:-2.0 ± 0.2 %; p > 0.05 among groups). Patients treated with exenatide lost body weight remarkably (-4.7 ± 0.8 kg). In spite of the amelioration of glucose control, no significant improvement of OC, CTX or TRAcP5b was observed at week 24 (EXE: OC -0.619 ± 0.728 ng/ml, CTX 0.147 ± 0.046 ng/ml, TRAcP5b 0.302 ± 0.149 U/L;INS: OC 0.637 ± 0.787 ng/ml, CTX -0.012 ± 0.074 ng/ml, TRAcP5b 0.124 ± 0.395 U/L; PIO: OC -0.150 ± 0.691 ng/ml, CTX 0.073 ± 0.094 ng/ml, TRAcP5b 0.586 ± 0.183 U/L; p > 0.05), as well as BMD measurement, regardless of the treatments. CONCLUSIONS: Twenty-four-week treatment with exenatide, insulin and pioglitazone improved glucose control in patients with newly diagnosed type 2 diabetes, but had no impact on bone turnover markers or BMD.

Hydrophobic Light-to-Heat Conversion Membranes with Self-Healing Ability for Interfacial Solar Heating.

Self-healing hydrophobic light-to-heat conversion membranes for interfacial solar heating are fabricated by deposition of light-to-heat conversion material of polypyrrole onto a porous stainless-steel mesh, followed by hydrophobic fluoroalkylsilane modification. The mesh-based membranes spontaneously stay at the water-air interface, collect and convert solar light into heat, and locally heat only the water surface for enhanced evaporation.

A Giant Right Coronary Artery of Diffuse Ectasia Induced by a Right Ventricular Fistula.

Coronary artery fistula (CAF) is a rare entity. Sometimes it may associate with mild diffuse or segmental coronary ectasia. CAF with giant coronary artery is exceptionally rare. We present a unique case of a 49-year-old female patient with a giant right coronary artery of diffuse ectasia coexisting with a fistula draining into the right ventricle. To our best knowledge, CAF with diffuse coronary ectasia of such giant size has never been reported. The patient was treated successfully by resection of the dilated right coronary artery, fistula closure, and coronary artery bypass grafting.

Intracardiac leiomyomatosis: a comprehensive analysis of 194 cases.

Intracardiac leiomyomatosis is rare but has been increasingly reported in recent years. Owing to its rarity, intracardiac leiomyomatosis has been reported only as isolated case reports and case series. This disorder is thought to be underestimated and easily overlooked in the clinic, while it is dangerous owing to the risk of sudden death caused by total outflow tract obstruction. We performed an electronic literature search for intracardiac leiomyomatosis and identified 194 cases that were reported in English from 1974 (the first reported case) to September 2012. Our aim is to provide a detailed and comprehensive review of the clinical presentation, diagnosis, histopathological characterization, treatment and prognosis of this disorder. According to our analysis, intracardiac leiomyomatosis is most common in the fifth decade, and the mean age of detection is ~50 years. Most patients had undergone previous hysterectomy/myomectomy or had a coexisting uterine leiomyoma when admitted. The most common clinical presentations were dyspnoea, syncope, oedema of the lower extremities and palpitation. Transoesophageal echocardiography, computed tomography and magnetic resonance imaging are helpful in the preoperative diagnosis and to guide the surgical management. Complete removal guarantees an excellent outcome, with no recurrence or postoperative death, while incomplete removal leads to recurrence in one-third of patients. Anti-oestrogen therapy is not imperative after incomplete removal owing to its inability to prevent recurrence.

One-stage complete removal of intracardiac leiomyomatosis without cardiac arrest.

We present here a woman with an intracardiac leiomyoma originating from uterine leiomyomatosis. The tumor was completely removed in a one-stage procedure using cardiopulmonary bypass without cardiac arrest. Most one-stage operations were performed with total circulation arrest; however, using of on-pump beating-heart technique when removing the intracardiac mass has seldom been reported in detail. The patient was asymptomatic with no evidence of recurrence on 13-month follow-up.

Primary cardiac T cell lymphoma.

We report a case of primary cardiac T-cell lymphoma. The diagnosis and management of this unusual primary tumor is reviewed.

Diagnosis and treatment of pulmonary mucosa-associated lymphoid tissue lymphoma.

BACKGROUND: Primary non-Hodgkin's lymphoma in lung is very rare, and the most common among them is mucosa-associated lymphoid tissue lymphoma (MALToma), whose clinical features and laboratory characteristics are poorly defined, making diagnosis difficult. The purpose of this study was to study the diagnosis and treatment of pulmonary MALToma. METHODS: The clinical data of 12 patients treated for MALToma between August 1992 and December 2005 were analyzed. RESULTS: No specific symptoms or signs, or results of bronchoscopy, ultrasonagraphy or bone marrow examination could be found in the 12 patients. Only radiography was useful in diagnosis, though the final diagnosis of all the patients was based on histology and immunohistochemistry. Two patients also had gastric MALToma. Operations were performed on 6 patients, including 5 radical operations and 1 partial resection: 4 patients also received adjuvant chemotherapy. One patient experienced recurrence 152 months after the operation, while the other 5 patients have survived disease-free. Four patients were treated with chemotherapy alone, two of whom experienced complete remission and the others partial remission. The final 2 patients received no treatment and had survived for 7 and 27 months respectively. All the patients were still alive at the most recent follow-up, 7 to 160 months (mean 71.3 months). CONCLUSIONS: Except radiography, no specific clinical manifestations could be identified for pulmonary MALToma. The final diagnosis should be based on histology and immunohistochemistry. Several treatment methods can be used to achieve good outcomes.

[Diagnosis and treatment of primary pulmonary mucosa-associated lymphoid tissue lymphoma].

OBJECTIVE: To study the diagnosis and treatment for primary pulmonary mucosa-associated lymphoid tissue lymphoma. METHODS: The clinical data of 12 patients with primary pulmonary mucosa-associated lymphoid tissue lymphoma from August 1992 to May 2005 were analyzed. RESULTS: All the patients survived during the follow-up periods of 6 to 164 months (mean 70.3 months). Gastric mucosa-associated lymphoid tissue lymphoma was found to coexist in 2 patients. No specific symptoms or signs, or specific results of bronchoscopy, ultrasonography or bone marrow examination were found in these patients, except that radiography showed nodules with blurred margins with characteristic air bronchogram. The final diagnosis was based on histology and immunohistochemistry. Surgical resection was performed for 6 patients, including 5 radical operations and 1 partial resection, among which 4 patients received adjuvant chemotherapy. Recurrence occurred in 1 patient 12.7 years after the operation, while the other 5 patients got disease free survival. Chemotherapy alone was administered for 4 patients, among whom 2 patients got complete remission and the others got partial remission. The other 2 patients received no treatment and had survived for 6 and 26 months respectively. CONCLUSIONS: Except for the radiographic findings, there were no specific clinical manifestations for primary pulmonary mucosa-associated lymphoid tissue lymphoma. The final diagnosis should be made by histology and immunohistochemistry. Surgery and chemotherapy can be adopted for the patients with good outcomes.

Comparison of influence of esophageal carcinoma operations on pulmonary function.

OBJECTIVE: To study the change of pulmonary function after three kinds of esophageal carcinoma operations. METHODS: Esophageal carcinoma operations were performed on 60 consecutive patients, including 20 cases of supra-aortic gastro-esophageal anastomosis, 20 cases of sub-aortic gastro-esophageal anastomosis and 20 cases of apico-thoracic retro-aortic gastro-esophageal anastomosis. Lung function was checked for every patient 3 days before the operation and 3, 6, 12 months after the operation. RESULTS: VC%, FEV1% and MVV% are significantly lower in supra-aortic anastomosis group than in sub-aortic anastomosis group after the operation (P < 0.05). VC%, FEV1%, and MVV% are significantly lower in supra-aortic anastomosis group than in apico-thoracic retro-aortic anastomosis group after the operation (P<0.05). VC%, FEV1% and MVV% are not significantly different between apico-thoracic retro-aortic anastomosis group and sub-aortic anastomosis group after the operation (P > 0.05). CONCLUSIONS: Supra-aortic anastomosis has more negative influence on the post-operative pulmonary function than apico-thoracic retro-aortic anastomosis and sub-aortic anastomosis do.

Influence of esophageal carcinoma operations on gastroesophageal reflux.

BACKGROUND: Gastroesophageal reflux occurs more easily after esophageal carcinoma operations. Our objective was to compare the influence of three kinds of esophageal carcinoma operations on reflux. METHODS: From May 1999 to May 2002, esophageal carcinoma operations were performed on 30 consecutive patients through left thoracotomy, including 10 cases completed with supraaortic, ante-aortic gastroesophageal anastomosis, 10 cases with subaortic gastroesophageal anastomosis, and 10 cases with apicothoracic retro-aortic gastroesophageal anastomosis. A 24-hour esophageal pH was recorded for every patient 3 months after the operation. RESULTS: The number of reflux episodes per 24 hours (No. of episodes), the number of reflux episodes greater than or equal to 5 minutes per 24 hours (No. > or = 5 min), the time in minutes of the longest reflux episode recorded (longest episode) and the cumulative time of the esophageal pH less than 4 (total time that pH < 4) are all beyond normal limits. The difference in number of episodes between supraaortic, ante-aortic, and subaortic gastroesophageal anastomosis groups is not significant; but the other indexes are higher in the supraaortic, ante-aortic anastomosis group with significance (p < 0.05). The difference in number of episodes between supraaortic, ante-aortic, and apicothoracic retro-aortic gastroesophageal anastomosis groups is not significant while the other indexes are much higher in the supraaortic, ante-aortic anastomosis group with significance (p < 0.05); the difference in number of episodes between apicothoracic retro-aortic and subaortic gastroesophageal anastomosis groups is not significant while the other indexes are lower in the apicothoracic retro-aortic anastomosis group with significance (p < 0.05). CONCLUSIONS: Gastroesophageal reflux occurred after all three types of esophageal carcinoma operations. The reflux is less severe in the apicothoracic retro-aortic anastomosis group than in the other two groups. The esophageal carcinoma operation with apicothoracic retro-aortic gastroesophageal anastomosis has more advantages to alleviate postoperative gastroesophageal reflux.