A causal counterfactual graph neural network for arising-from-chair abnormality detection in parkinsonians.

The arising-from-chair task assessment is a key aspect of the evaluation of movement disorders in Parkinson's disease (PD). However, common scale-based clinical assessment methods are highly subjective and dependent on the neurologist's expertise. Alternate automated methods for arising-from-chair assessment can be established based on quantitative susceptibility mapping (QSM) images with multiple-instance learning. However, performance stability for such methods can be typically undermined by the presence of irrelevant or spuriously-relevant features that mask the intrinsic causal features. Therefore, we propose a QSM-based arising-from-chair assessment method using a causal graph-neural-network framework, where counterfactual and debiasing strategies are developed and integrated into this framework for capturing causal features. Specifically, the counterfactual strategy is proposed to suppress irrelevant features caused by background noise, by producing incorrect predictions when dropping causal parts. The debiasing strategy is proposed to suppress spuriously relevant features caused by the sampling bias and it comprises a resampling guidance scheme for selecting stable instances and a causal invariance constraint for improving stability under various interferences. The results of extensive experiments demonstrated the superiority of the proposed method in detecting arising-from-chair abnormalities. Its clinical feasibility was further confirmed by the coincidence between the selected causal features and those reported in earlier medical studies. Additionally, the proposed method was extensible for another motion task of leg agility. Overall, this study provides a potential tool for automated arising-from-chair assessment in PD patients, and also introduces causal counterfactual thinking in medical image analysis. Our source code is publicly available at https://github.com/SJTUBME-QianLab/CFGNN-PDarising.

A Causality-Aware Graph Convolutional Network Framework for Rigidity Assessment in Parkinsonians.

Rigidity is one of the common motor disorders in Parkinson's disease (PD), which lead to life quality deterioration. The widely-used rating-scale-based approach for rigidity assessment still depends on the availability of experienced neurologists and is limited by rating subjectivity. Given the recent successful applications of quantitative susceptibility mapping (QSM) in auxiliary PD diagnosis, automated assessment of PD rigidity can be essentially achieved through QSM analysis. However, a major challenge is the performance instability due to the confounding factors (e.g., noise and distribution shift) which conceal the truly-causal features. Therefore, we propose a causality-aware graph convolutional network (GCN) framework, where causal feature selection is combined with causal invariance to ensure that causality-informed model decisions are reached. Firstly, a GCN model that integrates causal feature selection is systematically constructed at three graph levels: node, structure, and representation. In this model, a causal diagram is learned to extract a subgraph with truly-causal information. Secondly, a non-causal perturbation strategy is developed along with an invariance constraint to ensure the stability of the assessment results under different distributions, and thus avoid spurious correlations caused by distribution shifts. The superiority of the proposed method is shown by extensive experiments and the clinical value is revealed by the direct relevance of selected brain regions to rigidity in PD. Besides, its extensibility is verified on other two tasks: PD bradykinesia and mental state for Alzheimer's disease. Overall, we provide a clinically-potential tool for automated and stable assessment of PD rigidity. Our source code will be available at https://github.com/SJTUBME-QianLab/Causality-Aware-Rigidity.

Early Diagnosis of Colorectal Cancer Based on Bisulfite-free Site-specific Methylation Identification PCR Strategy: High-Sensitivity, Accuracy, and Primary Medical Accessibility.

Due to its decade-long progression, colorectal cancer (CRC) is most suitable for population screening to achieve a significant reduction in its incidence and mortality. DNA methylation has emerged as a potential marker for the early detection of CRC. However, the current mainstream methylation detection method represented by bisulfite conversion has issues such as tedious operation, DNA damage, and unsatisfactory sensitivity. Herein, a new high-performance CRC screening tool based on the promising specific terminal-mediated polymerase chain reaction (STEM-PCR) strategy is developed. CRC-related methylation-specific candidate CpG sites are first prescreened through The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases using self-developed bioinformatics. Next, 9 homebrew colorectal cancer DNA methylated STEM‒PCR assays (ColoC-mSTEM) with high sensitivity (0.1%) and high specificity are established to identify candidate sites. The clinical diagnostic performance of these selected methylation sites is confirmed and validated by a case-control study. The optimized diagnostic model has an overall sensitivity of 94.8% and a specificity of 95.0% for detecting early-stage CRC. Taken together, ColoC-mSTEM, based on a single methylation-specific site, is a promising diagnostic approach for the early detection of CRC which is perfectly suitable for the screening needs of CRC in primary healthcare institutions.

Group-shrinkage feature selection with a spatial network for mining DNA methylation data.

Identifying disease-related biomarkers from high-dimensional DNA methylation data helps in reducing early screening costs and inferring pathogenesis mechanisms. Good discovery results have been achieved through spatial correlation methods of methylation sites, group-based regularization, and network constraints. However, these methods still have some key limitations as they cannot exclude isolated differential sites and only consider adjacent site ordering. Therefore, we propose a group-shrinkage feature selection algorithm to encourage the selection of clustered sites and discourage the selection of isolated differential sites. Specifically, a network-guided group-shrinkage strategy is developed to penalize weakly-correlated isolated methylation sites through a network structure constraint. The spatial network is constructed based on spatial correlation information of DNA methylation sites, where this information accounts for the uneven site distribution. The experimental simulations and applications demonstrated that the proposed method outperforms the advanced regularization methods, especially in rejecting isolated methylation sites; hence this study provides an efficient and clinical-valuable method for biomarker candidate discovery in DNA methylation data. Additionally, the proposed method exhibits enhanced reliability due to introducing biological prior knowledge into a regularization-based feature selection framework and could promote more research in the integration between biological prior knowledge and classical feature selection methods, thus facilitating their clinical application. Our source codes will be released at https://github.com/SJTUBME-QianLab/Group-shrinkage-Spatial-Network once this manuscript is accepted for publication.

A Causality-Driven Graph Convolutional Network for Postural Abnormality Diagnosis in Parkinsonians.

Abnormal posture is a common movement disorder in the progress of Parkinson's disease (PD), and this abnormality can increase the risk of falls or even disabilities. The conventional assessment approach depends on the judgment of well-trained experts via canonical scales. However, this approach requires extensive clinical expertise and is highly subjective. Considering the potential of quantitative susceptibility mapping (QSM) in PD diagnosis, this study explored the QSM-based method for the automated classification between PD patients with and without postural abnormalities. Nevertheless, a major challenge is that unstable non-causal features typically lead to less reliable performance. Therefore, we propose a causality-driven graph-convolutional-network framework based on multi-instance learning, where performance stability is enhanced through the invariant prediction principle and causal interventions. Specifically, we adopt an intervention strategy that combines a non-causal intervenor with causal prediction. A stability constraint is proposed to ensure robust integrated prediction under different interventions. Moreover, an intra-class homogeneity constraint is enforced for each individually-learned causality scoring module to promote the extraction of group-level general features, and hence achieve a balance between subject-specific and group-level features. The proposed method demonstrated promising performance through extensive experiments on a real clinical dataset. Also, the features extracted by our method coincide with those reported in previous medical studies on PD posture abnormalities. In general, our work provides a clinically-valuable approach for automated, objective, and reliable diagnosis of postural abnormalities in Parkinsonians. Our source code is publicly available at https://github.com/SJTUBME-QianLab/CausalGCN-PDPA.