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Objective:To develop a deep learning method to predict the anatomical images of nasopharyngeal carcinoma patients during the treatment course, which could detect the anatomical variation for specific patients in advance.Methods:Imaging data including planning CT (pCT) and cone-beam CT (CBCT) for each fraction of 230 patients with T 3-T 4 staging nasopharyngeal carcinoma who treated in Cancer Hospital Chinese Academy of Medical Sciences from January 1, 2020 to December 31, 2022 were collected. The anatomical images of week k+1 were predicted using a 3D Unet model with inputs of pCT, CBCT on days 1-3, and CBCT of weeks 2- k. In this experiment, we trained four models to predict anatomical images of weeks 3-6, respectively. The nasopharynx gross tumor volume (GTV nx) and bilateral parotid glands were delineated on the predicted and real images (ground truth). The performance of models was evaluated by the consistence of the delineation between the predicted and ground truth images. Results:The proposed method could predict the anatomical images over the radiotherapy course. The contours of interest in the predicted image were consistent with those in the real image, with Dice similarity coefficient of 0.96, 0.90, 0.92, mean Hausdorff distance of 3.28, 4.18 and 3.86 mm, and mean distance to agreement of 0.37, 0.70, and 0.60 mm, for GTV nx, left parotid, and right parotid, respectively. Conclusion:This deep learning method is an accurate and feasible tool for predicting the patient's anatomical images, which contributes to predicting and preparing treatment strategy in advance and achieving individualized treatment.
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Objective:To investigate a time series deep learning model for respiratory motion prediction.Methods:Eighty pieces of respiratory motion data from lung cancer patients were used in this study. They were divided into a training set and a test set at a ratio of 8∶2. The Informer deep learning network was employed to predict the respiratory motions with a latency of about 600 ms. The model performance was evaluated based on normalized root mean square errors (nRMSEs) and relative root mean square errors (rRMSEs).Results:The Informer model outperformed the conventional multilayer perceptron (MLP) and long short-term memory (LSTM) models. The Informer model yielded an average nRMSE and rRMSE of 0.270 and 0.365, respectively, at a prediction time of 423 ms, and 0.380 and 0.379, respectively, at a prediction time of 615 ms.Conclusions:The Informer model performs well in the case of a longer prediction time and has potential application value for improving the effects of the real-time tracking technology.
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Objective:To investigate the pseudo-CT generation from cone beam CT (CBCT) by a deep learning method for the clinical need of adaptive radiotherapy.Methods:CBCT data from 74 prostate cancer patients collected by Varian On-Board Imager and their simulated positioning CT images were used for this study. The deformable registration was implemented by MIM software. And the data were randomly divided into the training set ( n=59) and test set ( n=15). U-net, Pix2PixGAN and CycleGAN were employed to learn the mapping from CBCT to simulated positioning CT. The evaluation indexes included mean absolute error (MAE), structural similarity index (SSIM) and peak signal to noise ratio (PSNR), with the deformed CT chosen as the reference. In addition, the quality of image was analyzed separately, including soft tissue resolution, image noise and artifacts, etc. Results:The MAE of images generated by U-net, Pix2PixGAN and CycleGAN were (29.4±16.1) HU, (37.1±14.4) HU and (34.3±17.3) HU, respectively. In terms of image quality, the images generated by U-net and Pix2PixGAN had excessive blur, resulting in image distortion; while the images generated by CycleGAN retained the CBCT image structure and improved the image quality.Conclusion:CycleGAN is able to effectively improve the quality of CBCT images, and has potential to be used in adaptive radiotherapy.
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Objective:To investigate the method of simulating low-dose CT (LDCT) images using routine dose level scanning mode to generate LDCT images with correspondence to the routine dose CT (RDCT) images in the training sets for deep learning model, which would be used for LDCT noise reduction.Methods:The CT images reconstructed by different algorithms in Philips CT Big Core had different noise levels, where the noise was larger with iDose 4 algorithm and lower with IMR(knowledge-based iterative model reconstruction)algorithm. A new method of replacing LDCT image with noise equivalent reconstructed image was proposed. The uniform module of CTP712 was scanned with the exposure of 250 mAs for RDCT, 35 mAs for LDCT. The images were reconstructed using IMR algorithm for LDCT images and iDose 4 algorithm at multiple noise reduction levels for RDCT images, respectively. The noise distribution of each image set was analyzed to find the noise equivalent images of LDCT. Then, RDCT images, those selected images were used for training cycle-consistent adversarial networks (CycleGAN)model, and the noise reduction ability of the proposed method on real LDCT images of phantom was tested. Results:The RDCT images generated with iDose 4 level 1 could substitute the LDCT images reconstructed with IMR algorithm. The radiation dose was reduced by 86% in low dose scanning. Using CycleGAN model, the noise reduction degree was 45% for uniform module, and 50%, 13%, 7% for CIRS-SBRT 038 phantom in the specific regions of brain, spinal cord, bone, respectively. Conclusions:Equivalent noise level reconstructed images could potentially serve as the alternative of LDCT images for deep learning network training to avoid additional radiation dose. The generated CT images had substantially reduced noise relative to that of LDCT.
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Objective:To investigate the expression of serum uric acid and cystatin C in older adult patients with diastolic heart failure and their correlation with ventricular remodeling.Methods:The clinical data of 173 older adult patients with diastolic heart failure (patient group) and 144 older adult patients who had normal heart function (control group) who received treatment in Liaoning Jinqiu Hospital from January 2018 to January 2020 were retrospectively analyzed. Left ventricular end-diastolic diameter, left ventricular mass index, serum uric acid and cystatin C levels were compared between the two groups. These indices were also compared between patients with different classes of heart failure. Serum uric acid and cystatin C levels were correlated with left ventricular end-diastolic diameter and left ventricular mass index.Results:Left ventricular end-diastolic diameter, left ventricular mass index, and serum uric acid and cystatin C levels in the patient group were (46.82 ± 4.56) mm, (117.45 ± 24.51) g/m 2, (380.23 ± 115.85) μmol/L, (1.41 ± 0.51) mg/L, respectively, which were significantly higher than (45.8 ± 3.96) mm, (111.19 ± 19.30) g/m 2, (333.65 ± 89.02) μmol/L, (1.06 ± 0.34) mg/L, respectively in the control group ( t = 2.10, 2.48, 3.95, 7.02, all P < 0.05). Serum uric acid level in patients with class IV heart failure was (432.48 ± 157.64) μmol/L, which was significantly higher than (355.22 ± 106.56) μmol/L and (379.89 ± 93.43) μmol/L in patients with class II and class III heart failure ( F = 5.18, P < 0.05). Pearson correlation analysis showed that serum uric acid level was positively correlated with left ventricular end-diastolic diameter ( r = 0.17, P < 0.05) and left ventricular mass index ( r = 0.18, P < 0.05) in older adult patients with diastolic heart failure. Conclusion:Serum uric acid plays an important role in the occurrence and development of diastolic heart failure in older adults. Serum uric acid level can help measure the degree of ventricular remodeling to some extent.
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Background: The benefits and risks of eradicating Helicobacter pylori (Hp) should be balanced in aged people. Aims: To investigate the efficacy, safety and antibiotic resistance status of Hp eradication treatment in the elderly. Methods: Four cohorts of subjects who received Hp eradication treatment in randomized controlled trials conducted in Chongqing Daping Hospital were reviewed; the demographic and clinical data were extracted and recorded. Propensity score matching was performed to select comparable elderly group (≥60 years old) and non-elderly group (0.05). Furthermore, there were no significant differences in the Hp eradication rates in terms of gender, cigarette smoking, alcohol consumption, comorbidities (hypertension, diabetes, surgical history, and inflammation), compliance, etc. in the elderly group (all P> 0.05). But in retreated elderly subjects, the resistance rate of clarithromycin was higher than that in naïve elderly subjects (P<0.05). Smoking and poor compliance were identified as independent risk factors for Hp eradication by multivariate Logistic regression analysis. Conclusions: Hp eradication in the elderly demonstrates comparable efficacy and safety with non-elderly subjects. Clarithromycin-containing regimens are not recommended for empirical retreatment in aged people.
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Objective:To analyze the characteristics of total cerebral small vessel disease (CSVD) burden in octogenarians with CSVD and to investigate its correlation with serum uric acid.Methods:From January 2019 to December 2020, patients with CSVD diagnosed by 3.0 T magnetic resonance imaging (MRI) in Departments of Neurology and Departments of Geriatrics, Liaoning Jinqiu Hospital were enrolled retrospectively. The patients were scored and grouped according to the total CSVD burden assessment standard. Ordered logistic regression analysis was used to investigate the independent influencing factors of the total CSVD burden score, and the Spearman rank correlation method was used to conduct the correlation analysis between serum uric acid and the total CSVD burden score. Results:A total of 217 octogenarians with CSVD were enrolled in the study. Their age was 87.3±4.5 years, 150 were males (69.1%), and their median serum uric acid was 313.0 μmol/L. The total CSVD burden score: 50 patients (23.1%) in 1-point group, 79 (36.4%) in 2-point group, 68 (31.3%) in 3-point group, and 20 (9.2%) in 4-point group. The imaging subtypes of CSVD were mainly asymptomatic lacunar infarcts (ALIs; 98.2%) and white matter hyperintensities (WMHs; 77.0%). The CSVD subtype combination was different between different total CSVD burden score groups. There were only two subtypes in the 1-point group, mainly ALIs (92.0%), and WMHs accounted for only 8.0%. Four subtypes could be observed in other groups, among which ALIS+ WMHs mixed subtype (100% in the 3-point group and the 4-point group) accounts for the highest proportion. The detection rates of cerebral microbleeds (CMBs) and enlarged perivascular spaces (EPVS) increased significantly with the increase of the total CSVD burden score. The 3-point group was 44.1% and 55.9% respectively. Univariate analysis showed that there were significant differences in age, male, hypertension, coronary heart disease, serum uric acid level, high-density lipoprotein cholesterol and the highest quartile of serum uric acid between total CSVD burden score groups ( P<0.05). Multinomial ordinal logistic regression analysis showed that there was significant independent correlation between age (odds ratio 1.074, 95% confidence interval 1.013-1.140; P=0.017), serum uric acid (odds ratio 1.005, 95% confidence interval 1.000-1.009; P=0.032) and the total CSVD burden score. Spearman rank correlation analysis showed that there was a positive correlation between serum uric acid and the total CSVD burden score ( r=0.153, P=0.024). Conclusions:ALIs and WMHs are most common in octogenarians with CSVD. Four subtypes were observed in each group ≥2, and the proportion of EPVS and CMBs also increases with the increase of the total CSVD burden score. There is an independent correlation between serum uric acid and the total CSVD burden in the octogenarians.
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Objective To observe the alteration and clinical significances of blood coagulation indicators in patients with lymphoplasmacytic lymphoma (LPL). Methods Twenty patients who were newly diagnosed LPL in the First People's Hospital of Changzhou from January 2008 to October 2017 and twenty healthy controls were studied. The patients were treated by chemotherapy, plasma exchange, supplement of coagulation factor or other supportive therapy. The parameters of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), D-dimer (D-D), and platelet count (Plt) were detected in LPL group and healthy controls. Results The levels of PT and APTT in LPL group were dramatically higher than those in control group [(12.9±1.2) s vs. (11.6±0.9) s, (41.7±9.8) s vs. (24.7±2.9) s], and the level of Plt in LPL group was lower than that in control group [112×109/L (3×109/L - 379×109/L) vs. 210×109/L (170×109/L - 271×109/L)], and the differences were statistically significant (all P< 0.05). There were no significant differences in FIB, TT and D-D levels between LPL group and control group (all P ＞0.05). There were no statistical differences in PT, APTT, FIB, TT, D-D and Plt levels among LPL patients with different types of immunoglobins (all P ＞ 0.05). After treatment, all the coagulation abnormalities got relieved and no patient died of hemorrhage or thrombosis. Conclusions The LPL patients have coagulation disorders and hypercoagulability, and this is independent of the type of immunoglobulin. Clinical attention should be paid to monitoring coagulation indicators to prevent the occurrence of adverse reactions.
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Objective To evaluate the safety and feasibility of simplified fast track surgery in gastric surgery.Methods The study enrolled consecutive cases of elective gastric surgery from March 2010 to December 2011.The patients were randomized into two groups:simplified fast track surgery group (n =149) and traditional clinical pathway group (n =154).Demographic,intra-operative and post-operative data between two groups were compared.Results The outcome of demographic and intra-operative data between simplified fast track surgery group and traditional clinical pathway group were not different statistically (P ＞ 0.05).The time of post-operative recovery and discharge of simplified fast track surgery group was significantly shorter than traditional clinical pathway group (P ＜ 0.05).Difference of post-operative complications of two groups was not significant (P ＞ 0.05).Conclusion The programme of simplified fast track surgery in gastric surgery is safe and feasible.
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[Objective]To investigate the prophylactic effects of intra-articular injection of salvia miltiorrhiza on joint adhesion. [Methods]Twenty-four Japanese male rabbits were randomly divided into 3 groups.All right hind knees were made in this way: the auterior wall of suprapatellar bursae was scraped, the posterior wall of suprapatellar bursae and the infrapatellar fat pad were cut off. Each knee was injected with physiological saline 0.3 ml for group A, sodium hyaluronate injection 0.3 ml for group B, and salvia miltiorrhiza injection 0.3 ml for group C. All right hind knees were immobilized in the extension position with a long leg plaster cast for 4 weeks, and injected weekly.[Results]After 4 weeks, the joint movement range in group B or C was larger than that in group A (P<0.01), and there was no significant difference (P>0.05)compared to group B and group C. The scoring of joint adhesions in group B or C was smaller than that in group A (P<0.01), and there was no significant difference(P>0.05)compared to group B and group C. The scoring of histological changed of the synovial membrane in group B or C was smaller than that in group A (P<0.01), and there was no significant difference(P>0.05)compared to group B and group C.Total collagens content of the synovial membrane in group B or C was smaller than that in group A (P<0.01), while that of group C was less than in group B(P<0.01). [Conclusion]Similarly to sodium hyaluronate, salvia miltiorrhiza can effectively prevent joint adhesions.
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Objective To evaluate the clinical effect of regulating expiratory airway pressure of noninvasive ventilation(NIV)to treat overlap syndrome(OS)with respiratory failure by pressure titration in monitor during sleep.Method Individuals who met the following criteria were selected for the study:(1)OS with respiratory failure confiemed by polysomnogram(PSC)and pulmonary function tests;(2)ability to tolerate PSG tests all night;(3)lucid consciousness and spontaneous breathing upon awaken and(4)ability to tolerate NIV.The criteria of exclusion were:(1)frequent expectoration of blood or hemoptysis;(2)spontaneous pneumothorax;(3)severe prosopo-trauma or facial ulcer and(4)large amount of secretion in the airway.From August 2005 to Decentber 2008,27 patients were selected with two patients excluded.The remaining 25 patients treated with noninvasive bi-level positive airway pressure(BiPAP)were randomly assigned to titration group or control group.During sleep,the patients of titration group were put under the optimal expiratory airway pressure[EPAP,(8.8 ± 0.5)cmH2O]which was got from titration by AutoCPAP ventilator and the EPAP decreased immediately to 5 cmH2O when the patients wake up next day.In the patients of control group,the EPAP was maintained at 5 cm H2O round the clock.The degree of apnoea and the hypopnea index(AHI),the results of arterial blood gas analysis(pH,PaO2,PaCO2)in the morning,the lowest pulse oxygen saturation(SPO2LOW)and the arterial blood gas level at 10 am before and after ventilation,duration of taking off ventilator at night,complications of NIV,incidence of air leakage and invasive ventilation after NIV were comparatively analyzed between the two groups.Results Compared with the control group,the titration group showed a notably increase in the value of SPO2LOW[(25.9± 11.3)%vs.(14.9±8.4)%;P＜0.05].The PaO2 level was significantly higher in the titration group(29.4±4.4)mmHg than that in the control group(22.6 ± 2.1)mmHg(P＜0.0001);however,the PaCO2 level in the titration group(16.8 ±7.3)mmHg was not significant different from that in the control group(20.0±6.3)mmHg(P＞0.05).The PaO2 level at 10am in the titration group(28.9 ± 6.7)mmHg was not significant different from that in the control group(31.3 ± 7.7)mmHg(P＞0.05);however,the PaCO2 level in the titration group(23.3 ±5.7)mmHg was higher than that in the control group(18.2 ±5.0)mmHg(P＜0.05).Conclusions Regulating EPAP of NIV to treat overlap syndrome with respiratory failure by pressure titration in monitor during sleep was more effective at improving hypoxemia and carbon dioxide retention than traditional methods without adjusting the EPAP to the optimal level.The optimal didn't increase carbon dioxide retention at night,confirming that the method was safe.
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Objective To study a novel method of laparoscopic treatment for indirect inguinal hernia in children. Methods Forty-eight children with indirect inguinal hernia (right: 31 cases, left: 13 cases, bilateral: 4 cases) were treated by one port laparoscopic surgery. Among those with unilateral hernia, contralateral latent hernia was found in 5 children. All the patients underwent high ligation of internal annulus under laparoscope. Results The duration of operation was 7～14 min (mean, 9 min). The mean postoperative hospital stay was 24 h. Skin sutures were not required. Follow-up for 3～15 months (mean, 9 5 months) revealed no recurrence. Conclusions One port laparoscopic high ligation of internal annulus is effective, minimally invasive and simple.
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Objective To investigate the adaptive immune responses in elderly patients with chronic obstructive pulmonary disease during acute exacerbations (ECOPD) and effects of the immunostimulating agent Pidotimod in ECOPD patients. Methods A randomized, prospective clinical trial was held, and 103 patients with ECOPD were recruited into the study. Seventy-five patients aged 65 years and over were divided into two groups: 38 patients with general treatment as a control group and 37 patients with general treatment plus pidotimod as an experimental group. Another non-elderly groups comprised 28 patients younger than 65, and 20 healthy individuals served as the healthy elderly control. Levels of CD3+ , CD4+ , CD8+ , CD4+ /CD8+ in peripheral blood were measured by flow cytometry at baseline (the 1st day) and at the 15th and 30th treatment day, meanwhile, the clinical conditions were evaluated. Results Ninety-one patients completed the trial (32 in experimental group,34 in control group and 25 in non-eldely group). The experimental group and control group were statistically homogeneous. The aged COPD intervention group and aged COPD control had a more decreased CD4+ level, CD4+/CD8+ ratio and more increased CD8+ level, while compared with aged health control and non-elderly COPD control (all P