An intelligent quantification system for fetal heart rhythm assessment: A multicenter prospective study.

BACKGROUND: The motion relationship and time intervals of the pulsed-wave Doppler (PWD) spectrum are essential for diagnosing fetal arrhythmia. However, few technologies currently are available to automatically calculate fetal cardiac time intervals (CTIs). OBJECTIVE: The purpose of this study was to develop a fetal heart rhythm intelligent quantification system (HR-IQS) for the automatic extraction of CTIs and establish the normal reference range for fetal CTIs. METHODS: A total of 6498 PWD spectrums of 2630 fetuses over the junction between the left ventricular inflow and outflow tracts were recorded across 14 centers. E, A, and V waves were manually labeled by 3 experienced fetal cardiologists, with 17 CTIs extracted. Five-fold cross-validation was performed for training and testing of the deep learning model. Agreement between the manual and HR-IQS-based values was evaluated using the intraclass correlation coefficient and Spearman's rank correlation coefficient. The Jarque-Bera test was applied to evaluate the normality of CTIs' distributions, and the normal reference range of 17 CTIs was established with quantile regression. Arrhythmia subset was compared with the non-arrhythmia subset using the Mann-Whitney U test. RESULTS: Significant positive correlation (P <.001) and moderate-to-excellent consistency (P <.001) between the manual and HR-IQS automated measurements of CTIs was found. The distribution of CTIs was non-normal (P <.001). The normal range (2.5th to 97.5th percentiles) was successfully established for the 17 CTIs. CONCLUSIONS: Using our HR-IQS is feasible for the automated calculation of CTIs in practice and thus could provide a promising tool for the assessment of fetal rhythm and function.

Technical note: Evaluation of the dose enhancement effect for a novel transmission-type x-ray tube using the Monte Carlo method.

PURPOSE: Transmission-target x-ray tubes generate more x-rays than reflection thick-target x-ray tubes. A transmission x-ray tube combined with radiosensitizers has a better radiation enhancement effect. This study investigated the feasibility of using a transmission x-ray tube with radiosensitizers in clinical radiotherapy and its effect on radiation dose enhancement. METHODS: This study used MCNP6.2 to simulate the model of a transmission x-ray tube and Co-60 beam.   The radiation enhancement effect of radiosensitizers was examined with iodine-127 (I-127), radioiodinated iododeoxyuridine (IUdR), and gold nanoparticles (GNPs). RESULTS: The study results showed that the dose enhancement factor (DEF) of the transmission x-ray tube with GNPs was 10.27, which was higher than that of I-127 (6.46) and IUdR (3.08). The DEF of the Co-60 beam with GNPs, I-127, and IUdR was 1.23, 1.19, and 1.2, respectively. The Auger electron flux of the transmission x-ray tube with GNPs was 1.19E+05 particles/cm2 . CONCLUSIONS: This study found that a transmission x-ray tube with appropriate radiosensitizers could produce a high rate of Auger electrons to fulfill the radiation enhancement effect, and this procedure has the potential to become a radiotherapy modality.

Automated quantification and statistical assessment of proliferating cardiomyocyte rates in embryonic hearts.

The use of digital image analysis and count regression models contributes to the reproducibility and rigor of histological studies in cardiovascular research. The use of formalized computer-based quantification strategies of histological images essentially removes potential researcher bias, allows for higher analysis throughput, and enables easy sharing of formalized quantification tools, contributing to research transparency, and data transferability. Moreover, the use of count regression models rather than ratios in statistical analysis of cell population data incorporates the extent of sampling into analysis and acknowledges the non-Gaussian nature of count distributions. Using quantification of proliferating cardiomyocytes in embryonic murine hearts as an example, we describe how these improvements can be implemented using open-source artificial intelligence-based image analysis tools and novel count regression models to efficiently analyze real-life data.

Ultrasonography in the assessment of primary myxofibrosarcoma in the left atrium: a case report.

BACKGROUND: Cardiac myxofibrosarcoma is a rare cardiac malignant tumor, whose diagnosis is challenging due to its rare and non-specific manifestations. Ultrasound is the most important tool for detecting cardiac tumors. Yet, its diagnostic value in cardiac myxoidfibrosarcoma is rarely reported. Herein, we summarized the ultrasonic manifestations of myxofibrosarcoma in a 72-year-old Han woman. CASE PRESENTATION: The patient presented with crushing chest pain without obvious inducement, lasting 3-5 min each time, which would be relieved after rest, accompanied by palpitation, chest tightness, shortness of breath, dizziness, and syncope. The electrocardiogram (ECG) suggested atrial fibrillation. Ultrasound found two moderate echogenic masses in the left atrium; one was about 48 × 31 mm in size, and the other was about 25 × 24 mm in size. The clinical diagnosis was atrial mass and atrial fibrillation. The patient underwent the operation of left atrial tumor resection + mitral valvuloplasty + atrial fibrillation radiofrequency ablation + left atrial appendectomy. The tumor was completely removed, and the patient did not receive radiotherapy or chemotherapy after surgery. The patient was reexamined by ultrasound at 6, 42, and 91 days after surgery, and no obvious abnormalities were found. On day 115, moderate echoic mass was detected on the posterior wall of the left atrium, nearing the mitral valve ring, with a size of about 28 × 23 mm. Currently, the patient is under follow-up care. CONCLUSION: As the most important examination method for cardiac tumors, cardiac ultrasound has good diagnostic and differential diagnosis value and can be used regularly due to its simplicity and safety. The diagnosis rate of cardiac myxofibrosarcoma can be greatly improved by summarizing the ultrasonographic manifestations of cardiac myxofibrosarcoma and differentiating them from other lesions.

Results of the performance test for quality assessment of personal radiation dosimetry services including the influence of the dosimeter readout frequency.

This study was to determine the significance of factors considered for the measurement accuracy of personal dosimeter in dosimetry services such as dosimetry service, irradiation category, years of use and readout frequency. The investigation included management information questionnaire, on-site visit and blind test. The blind test with random selected personal badge was used in inter-comparison of eight dosimetry services, and the test results followed ANSI/HPS N13.11 criteria. This study also analyzed the measurement deviations if they felt in the criteria of ICRP 75 or not. One-way ANOVA tests were used to analyze the significant difference of the measurement deviations in different dosimetry services, irradiation categories, and years of use. Simple linear-regression test was performed for the significance of the prediction model between measurement deviations and readout frequencies. All visited dosimetry services followed the proper statue of basic management and passed the performance check of the tolerance level. The average deviations corresponding to category I, category II deep dose, and category II shallow dose were 6.08%, 9.49%, and 10.41% respectively. There had significant differences of measurement deviation in different dosimetry services (p < 0.0001) and irradiation categories (p = 0.016) but no significant difference in years of use (p = 0.498). There was no significance in the linear-regression model between measurement deviation and badge readout frequencies. Based on the regular calibration of the personal dosimeter, the deviation of the measured value is mainly affected by different dosimetry services and irradiation categories; and there shows no significant influence by years of use and readout frequency.

Risk Assessment of Early Lung Cancer with LDCT and Health Examinations.

Early detection of lung cancer has a higher likelihood of curative treatment and thus improves survival rate. Low-dose computed tomography (LDCT) screening has been shown to be effective for high-risk individuals in several clinical trials, but has high false positive rates. To evaluate the risk of stage I lung cancer in the general population not limited to smokers, a retrospective study of 133 subjects was conducted in a medical center in Taiwan. Regularized regression was used to build the risk prediction model by using LDCT and health examinations. The proposed model selected seven variables related to nodule morphology, counts and location, and ten variables related to blood tests and medical history, achieving an area under the curve (AUC) value of 0.93. The higher the age, white blood cell count (WBC), blood urea nitrogen (BUN), diabetes, gout, chronic obstructive pulmonary disease (COPD), other cancers, and the presence of spiculation, ground-glass opacity (GGO), and part solid nodules, the higher the risk of lung cancer. Subjects with calcification, solid nodules, nodules in the middle lobes, more nodules, and diseases related to thyroid, liver, and digestive systems were at a lower risk. The selected variables did not indicate causation.

Potato pomace: An efficient resource for Monascus pigments production through solid-state fermentation.

Monascus pigments are the important natural additives in food industrial production. To obtain more economic pigments production processes, the present study was performed to evaluate the feasibility of using pomace resource as substrate for pigments production. Petri dish fermentation was designed to seek the optimal process parameters, and the value of red, yellow and total pigments per dry fermented substrate could achieve 654.6, 1268.1 and 1922.7 OD units/g, respectively. Shallow tray fermentation experiments were used for investigating the potential industrial production of pigments using potato pomace as sole carbon. The final total pigments of 200 g and 1000 g shallow tray experiments could reach 1886.9 and 1737.4 OD units/g. The results in this work indicating that potato pomace could be an efficient and low cost substrate for the production of Monascus pigments, and will supply a valuable reference for the comprehensive utilization of potato resources and seeking the economical natural pigments process.

Duration of atrial high-rate episodes and CHA2DS2-VASc score to predict cardiovascular and cerebrovascular events in patients with dual chamber permanent pacemakers.

BACKGROUND: Patients with atrial high-rate episodes (AHRE) have a high risk of cardiovascular and cerebrovascular events (CCE); however, the optimal cut-off threshold for AHRE duration and the prediction power of AHRE with CHA2DS2-VASc score is unknown. METHODS: We enrolled 355 consecutive patients undergoing dual chamber pacemaker implantations. The primary endpoint was subsequent CCE after AHRE ≥ 30 seconds, 1 minute, 2 minutes, 5 minutes, 6 hours, and 24 hours. AHRE was defined as >175 bpm (Medtronic, Dublin, Ireland) or >200 bpm (Biotronik, Berlin, Germany) lasting ≥30 seconds. Multivariate Cox regression analysis with time-dependent covariates was used to determine the variables associated with higher risks of CCE. RESULTS: The average age of the patients was 75.6 ± 11.3 years, and 162 patients (45.6%) developed AHRE ≥ 30 seconds, 145 (40.8%) ≥1 minute, 125 (35.2%) ≥2 minutes, 107 (30.1%) ≥5 minutes, 55 (15.5%) ≥6 hours, and 37 (10.4%) ≥24 hours. During follow-up (mean 42.1 ± 31.2 months), 145 CCE occurred in 107 patients (incidence rate 11.64/100 patient-years, 95% CI 9.99-13.70). The optimal AHRE cut-off value was 1 minute (sensitivity, 57.9%; specificity, 66.0%; area-under-the-curve, 0.631; 95% CI, 0.563-0.698; p < 0.001). Multivariate Cox regression analysis demonstrated that all categories of AHRE duration were independently associated with CCE. The occurrence of CCE increased with AHRE ≥30 seconds and CHA2DS2-VASc score ≥2 (males) or ≥3 (females). CONCLUSION: Patients with dual chamber pacemakers who develop AHRE ≥ 30 seconds have an increased risk of CCE. The combination of AHRE duration ≥30 seconds and CHA2DS2-VASc score ≥2 (males) or ≥3 (females) is a useful risk-stratification predictor for subsequent CCE.

Real-world geographic variations in the use of cardiac implantable electronic devices-The PANORAMA 2 observational cohort study.

BACKGROUND: Currently, several geographies around the world remain underrepresented in medical device trials. The PANORAMA 2 study was designed to assess contemporary region-specific differences in clinical practice patterns of patients with cardiac implantable electronic devices (CIEDs). METHODS: In this prospective, multicenter, observational, multinational study, baseline and implant data of 4,706 patients receiving Medtronic CIEDs (Medtronic plc, Minneapolis, MN, USA; either de novo device implants, replacements, or upgrades) were analyzed, consisting of: 54% implantable pulse generators (IPGs), 20.3% implantable cardiac defibrillators (ICDs), 15% cardiac resynchronization therapy -defibrillators, and 5.1% cardiac resynchronization therapy -pacemakers, from 117 hospitals in 23 countries across four geographical regions between 2012 and 2016. RESULTS: For all device types, in all regions, there were fewer females than males enrolled, and women were less likely to have ischemic cardiomyopathy. Implant procedure duration differed significantly across the geographies for all device types. Subjects from emerging countries, women, and older patients were less likely to receive a magnetic resonance imaging-compatible device. Defibrillation testing differed significantly between the regions. European patients had the highest rates of atrial fibrillation (AF), and the lowest number of implanted single-chamber IPGs. Evaluation of stroke history suggested that the general embolic risk is more strongly associated with stroke than AF. CONCLUSIONS: We provide comprehensive descriptive data on patients receiving Medtronic CIEDs from several geographies, some of which are understudied in randomized controlled trials. We found significant variations in patient characteristics. Several medical decisions appear to be affected by socioeconomic factors. Long-term follow-up data will help evaluate if these variations require adjustments to outcome expectations.

Computed tomography arterial portography for assessment of portal vein injury after blunt hepatic trauma.

PURPOSE: Intrahepatic portal vein injuries secondary to blunt abdominal trauma are difficult to diagnose and can result in insidious bleeding. We aimed to compare computed tomography arterial portography (CTAP), reperfusion CTAP (rCTAP), and conventional computed tomography (CT) for diagnosing portal vein injuries after blunt hepatic trauma. METHODS: Patients with blunt hepatic trauma, who were eligible for nonoperative management, underwent CTAP, rCTAP, and CT. The number and size of perfusion defects observed using the three methods were compared. RESULTS: A total of 13 patients (seven males/six females) with a mean age of 34.5±14.1 years were included in the study. A total of 36 hepatic segments had perfusion defects on rCTAP and CT, while there were 47 hepatic segments with perfusion defects on CTAP. The size of perfusion defects on CT (239 cm3; interquartile range [IQR]: 129.5, 309.5) and rCTAP (238 cm3; IQR: 129.5, 310.5) were significantly smaller compared with CTAP (291 cm3; IQR: 136, 371) (both, P = 0.002). CONCLUSION: Perfusion defects measured by CTAP were significantly greater than those determined by either rCTAP or CT in cases of blunt hepatic trauma. This finding suggests that CTAP is superior to rCTAP and CT in evaluating portal vein injuries after blunt liver trauma.

Assessment of atrial fibrillation and vulnerability in patients with Wolff-Parkinson-White syndrome using two-dimensional speckle tracking echocardiography.

PURPOSE: The aim was to assess atrial fibrillation (AF) and vulnerability in Wolff-Parkinson-White (WPW) syndrome patients using two-dimensional speckle tracking echocardiography (2D-STE). METHODS: All patients were examined via transthoracic echocardiography and 2D-STE in order to assess atrial function 7 days before and 10 days after RF catheter ablation. A postoperative 3-month follow-up was performed via outpatient visit or telephone calls. RESULTS: Results showed significant differences in both body mass index (BMI) and supraventricular tachycardia (SVT) duration between WPW patients and DAVNP patients (both P<0.05). Echocardiography revealed that the maximum left atrial volume (LAVmax) and the left ventricular mass index (LVMI) in diastole increased noticeably in patients with WPW compared to patients with DAVNP both before and after ablation (all P<0.05). Before ablation, there were obvious differences in the levels of SRs, SRe, and SRa from the 4-chamber view (LA) in the WPW patients group compared with patients in the DAVNP group (all P<0.05). In the AF group, there were significant differences in the levels of systolic strain rate (SRs), early diastolic strain rate (SRe), and late diastolic strain rate (SRa) from the 4-chamber view (LA) both before and after ablation (all P<0.05). In the non-AF group, there were decreased SRe levels from the 4-chamber view (LA/RA) pre-ablation compared to post-ablation (all P<0.05). CONCLUSION: Our findings provide convincing evidence that WPW syndrome may result in increased atrial vulnerability and contribute to the development of AF. Further, RF catheter ablation of AAV pathway can potentially improve atrial function in WPW syndrome patients. Two-dimensional speckle tracking echocardiography imaging in WPW patients would be necessary in the evaluation and improvement of the overall function of RF catheter ablation in a long-term follow-up period.

Trends in the incidence and management of acute myocardial infarction from 1999 to 2008: get with the guidelines performance measures in Taiwan.

BACKGROUND: The American Heart Association Get With the Guidelines (GWTG) program has improved care quality of acute myocardial infarction (AMI) with important implications for other countries in the world. This study evaluated the incidence and care of AMI in Taiwan and assessed the compliance of GWTG in Taiwan. METHODS AND RESULTS: We used the Taiwan National Health Insurance Research Database (1999-2008) to identify hospitalized patients ≥18 years of age presenting with AMI. The temporal trends of annual incidence and care quality of AMI were evaluated. The age-adjusted incidence of AMI (/100 000 person-years) increased from 28.0 in 1999 to 44.4 in 2008 (P<0.001). The use of guideline-based medications for AMI was evaluated. The use of dual antiplatelet therapy (DAPT) increased from 65% in 2004 to 83.9% in 2008 (P<0.001). Angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) was used in 72.6% in 2004 and 71.7% in 2008 (P=NS) and ß-blocker was used in 60% in 2004 and 59.7% in 2008 (P=NS). Statin use increased from 32.1% to 50.1% from 2004 to 2008 (P<0.001). The in-hospital mortality decreased from 15.9% in 1999 to 12.3% in 2008 (P<0.0001). Multivariable analysis showed that DAPT, ACE inhibitor/ARB, ß-blocker, and statin use during hospitalization were all associated with reduced in-hospital mortality in our AMI patients. CONCLUSIONS: AMI incidence was increasing, but the guideline-based medications for AMI were underutilized in Taiwan. Quality improvement programs, such as GWTG, should be promoted to improve AMI care and outcomes in Taiwan.

Usefulness of vascular wall deformation for assessment of carotid arterial stiffness and association with previous stroke in elderly.

BACKGROUND: Carotid arterial stiffness measured by techniques of speckle tracking echocardiography is helpful to assess vascular wall deformation. We conducted a study to investigate the relationship between vascular deformation of the carotid artery and ischemic stroke in the elderly. METHODS: We recruited 89 consecutive individuals aged ≥60 years (mean age = 72±6 years; 31 men) from a community health survey program. Ten (11%) had a history of ischemic stroke. Carotid B-mode images were acquired using a high-resolution vascular probe equipped on an echocardiographic system. Circumferential strain (CS) and strain rate (CSR) were obtained by speckle tracking techniques with a region of interest covering the entire depth of the common carotid arterial wall. RESULTS: Both CS and CSR were significantly correlated with beta index and distensibility but not with carotid intima-medial thickness and pulse wave velocity. In the comparison between patients with or without history of stroke, carotid CS (1.46% ± 0.54% vs. 2.75% ± 1.23%; P = 0.002) and CSR (0.30±0.13 1/s vs. 0.47±0.18 1/s; P = 0.007) were significantly lower in patients with stroke. Multivariable analysis showed that both carotid CS and CSR were independent factors associated with previous strokes. CONCLUSIONS: Carotid wall deformation indices are useful for assessment of local carotid arterial stiffness. CS and CSR of carotid artery measured by speckle tracking techniques were associated with previous ischemic stroke in the elderly.

Comparison study of postdischarge care provided to suicide patients by family members in East and South Taiwan.

BACKGROUND: Care provided by the families of those who have attempted suicide affects their healing and recovery process. Data on care provided by families to suicidal individuals in different areas of Taiwan are extremely limited. PURPOSE: This study explored care provided by families living in eastern and southern Taiwan to relatives admitted to hospitals and subsequently discharged after a suicide attempt. METHODS: The study used a grounded theory approach. Interviews were conducted in two distinct geographical areas in 3 years and included two sample groups. Group 1 comprised suicidal participants (n = 15) and family caregivers (n = 15) in East Taiwan. Group 2 comprised suicidal participants (n = 15) and family caregivers (n = 15) in South Taiwan. Data were analyzed using open, axial, and selective coding. RESULTS: The East Taiwan group was less prosperous than the South Taiwan group. Suicide attempt methods were more lethal in eastern than in southern Taiwan. Alcohol and family violence were more important factors in suicides in eastern than in southern Taiwan. Consequently, families in East Taiwan focused less on protecting the safety of suicidal family members than families in South Taiwan. Participants in East Taiwan received less support from their families than those in South Taiwan. CONCLUSIONS/IMPLICATION FOR PRACTICE: Suicidal participants in East Taiwan received less care from family caregivers than did participants in South Taiwan. However, all families require education to provide optimal care for suicidal relatives. Study results may help promote more appropriate education for clinical nursing professionals with a responsibility to care for suicidal patients.

A well-designed online transfusion reaction reporting system improves the estimation of transfusion reaction incidence and quality of care in transfusion practice.

Recognizing and reporting a transfusion reaction is important in transfusion practice. However, the actual incidence of transfusion reactions is frequently underestimated. We designed an online transfusion reaction reporting system for nurses who take care of transfusion recipients. The common management before and after transfusion and the 18 most common transfusion reactions were itemized as tick boxes. We found the overall documented incidence of transfusion reaction increased dramatically, from 0.21% to 0.61% per unit of blood, after we started using an online reporting system. Overall, 94% (30/32) of nurses took only 1 week to become familiar with the new system, and 88% (28/32) considered the new system helpful in improving the quality of clinical transfusion care. By using an intranet connection, blood bank physicians can also identify patients who are having a reaction and provide appropriate recommendations immediately. A well-designed online reporting system may improve the ability to estimate the incidence of transfusion reactions and the quality of transfusion care.

[Environmental quality assessment of water body and surface sediment in the sea area of Jiaozhou Bay wetland].

Based on the investigation data from 48 sampling stations in the sea area of Jiaozhou Bay wetland in 2009, and by using Nemerow index, eutrophication index (EI), and Hakanson potential ecological risk index, an assessment was conducted on the environmental quality of water body and surface sediment in the sea area. According to the assessment on the 16 indicators including pH, dissolved oxygen (DO), dissolved inorganic nitrogen (DIN), dissolved inorganic phosphorous (DIP), chemical oxygen demand (COD(Mn)), petroleum hydrocarbons, Cu, Zn, Pb, Cd, Hg, As, hexachlorocyolohexane (HCH), dichlorodiphenyltrichloroethane (DDT), coliform, and faecal coliform, the water quality was at moderate and serious pollution level in the tidal reach of Dagu River, at slight and moderate pollution level in the intertidal zone, and at slight pollution level in the shallow sea. The eutrophication level differed markedly with the regions, being very serious in the tidal reach of Dagu River (EI value 58.13-327.89), serious in the intertidal zone (EI value 1.34-19.96), and slight in the shallow sea (EI value 0.65-2.10). The surface sediments in the sea area were basically at slight pollution level. The sediment quality was at slight pollution level in the tidal reach of Dagu River, at slight and moderate pollution level in the intertidal zone, and at cleaner and slight pollution level in the shallow sea. The pollution parameter (C(f)(i)) and contamination index (Cd) of the heavy metals in the surface sediments were low, suggesting that the pollution degree was at a lower level. The Cu and Zn were the primary pollution factors in the sediments. The potential ecological risk parameter (E(r)(i)) and risk index (RI) of the heavy metals in the surface sediments were lower, indicating a slight ecological risk of heavy metals pollution.

A global overall dietary index: ODI-R revised to emphasize quality over quantity.

Incorporating the Healthy Eating Index concept, we have developed a global dietary quality index, the Overall Dietary Index (ODI). We have evaluated the relationships between ODI and chronic disease in a 1998 Taiwanese Health Screening program with over 46,000 members (51.2% females) aged 19-84. However, it could not predict health status adequately. Therefore, we revised this ODI which became ODI-R (Revised). The revision added a quality evaluation for staples (whole grains) and protein-rich foods (fish and soy) and reduced the impact of dietary fat quantity. ODI-R comprises nine items with a maximal score of 100. It has 5 food categories: dairy products, protein rich foods (eggs/legumes/fish/meats), vegetables, fruits and cereals; 2 dietary fat qualities (P/S ratio and cholesterol); and 2 descriptors: dietary moderation (alcohol, salt and sugar as one item) and dietary variety. The mean ODI-R was lower than ODI (64.4 vs. 68.1 in men and 65.5 vs. 69.0 in women) and the distribution. The correlations between macronutrients and ODI-R were weaker than for ODI, especially for fat (from +/-0.52 to +/-0.07) as well as for cholesterol and all fatty acid types by degree of saturation. For dietary fiber and micronutrients, the correlations became either less negative or more positive, signaling that the ODI-R reflects food quality more appropriately than ODI in regard to micronutrients. Empirically, a subtraction scoring approach for the overeating of protein rich foods, did not meaningfully decrease ODI-R in Taiwanese elderly or children. ODI-R provides an effective measure of dietary quality over quantity.