Automatic detection of adenoid hypertrophy on lateral nasopharyngeal radiographs of children based on deep learning.

Background: Adenoid hypertrophy is a prevalent cause of upper airway obstruction in children, potentially leading to various otolaryngological complications and even systemic sequelae. The lateral nasopharyngeal radiograph is routinely employed for the diagnosis of adenoid hypertrophy. This study aimed to evaluate the accuracy and reliability of deep learning, using lateral nasopharyngeal radiographs, for the diagnosis of adenoid hypertrophy in pediatric patients. Methods: In the retrospective study, the lateral nasopharyngeal X-ray images were collected from children receiving therapy in the Children's Hospital of Soochow University, the 983th Hospital of Joint Logistics Support Forces of Chinese PLA and the Suzhou Wujiang District Children's Hospital from January 2023 to November 2023. Five deep learning models, i.e., AlexNet, VGG16, Inception v3, ResNet50 and DenseNet121, were used for model training and validation. Receiver operating characteristic (ROC) curve analyses were used to evaluate the performance of each model. The best algorithm was compared with interpretations from three radiologists on 208 images in the internal validation group. Results: The lateral nasopharyngeal X-ray images were collected from 1,188 children, including 705 males (59.3%) and 483 females (40.7%), aged 8 months to 13 years, with a mean age of 5.57±2.66 years. Among the five deep learning models, DenseNet-121 performed the best, with area under the curve (AUC) values of 0.892 and 0.872, with accuracy of 0.895 and 0.878, sensitivity of 0.870 and 0.838, and specificity of 0.913 and 0.906 in the internal and external validation groups, respectively. The diagnostic performance of DenseNet-121 was higher than that of the junior and mid-level radiologists (0.892 vs. 0.836, 0.892 vs. 0.869), close to the senior radiologist (0.892 vs. 0.901). However, Delong's test revealed no significant difference between DenseNet121 and each radiologist in the validation group (P=0.24, P=0.52, P=0.79). Conclusions: All the five deep learning models in the study showed good performance for the diagnosis of adenoid hypertrophy, with DenseNet121 being the best, which was clinically relevant for the automatic identification of adenoid hypertrophy.

Study on the Physical and Chemical Properties of Cement-Based Grout Containing Coal-Fly Ash.

To study the physical and chemical properties of grout containing fly ash, Class II fly ash was used as a mineral admixture and mixed with silicate cement to produce grout, and the rheological properties, strength properties, hydration properties, and microscopic mechanism were studied. The results of the study showed the following. The incorporation of fly ash reduced the thixotropic area of the composite cement slurry, which facilitated pumping in the pipeline conveying process. The inclusion of fly ash reduced the yield stress and plastic viscosity of the cement paste, but the rheological index increased and then decreased with the increase in fly ash, and the composite paste had the lowest degree of shear thinning at 30% fly ash inclusion. The incorporation of fly ash reduced the hydration exothermic rate and total hydration exothermic amount of the composite slurry and prolonged the hydration induction period, but the promotion effect of fly ash on the hydration rate of cement was obvious at 10% fly ash admixture. The admixture of fly ash increased the empty volume of the composite slurry, but the effect on the most probable aperture was not significant, and the porosity of the system increased, resulting in a decrease in compressive strength. The effect of adding fly ash on the hydration products was reflected mainly by the C-S-H gel produced by cement hydration and the change in calcium alumina and Ca(OH)2. Fly ash does not directly participate in the hydration reaction of cement, but it can promote cement hydration and increase the reaction rate of cement. By analyzing the rheological properties, mechanical properties, and hydration properties of fly ash composite cement paste, the comprehensive analysis found that the rheological properties are excellent when the fly ash admixture is 20-30%, and the water-cement ratio can be reduced to improve the strength without affecting the pumping demand.

Factors affecting the formation of iodo-trihalomethanes during oxidation with chlorine dioxide.

Effects of water characteristics, reaction time, temperature, bromide and iodide ion concentrations, oxidant doses, and pH on formation of iodinated trihalomethanes (I-THM) during oxidation of iodide-containing water with chlorine dioxide (ClO2) were investigated. Among the water samples collected from ten water sources, iodoform (CHI3) was the predominant I-THM and trace amount of chlorodiiodomethane (CHClI2) was occasionally found. CHI3 yields correlated moderately with specific UV absorbance (SUVA) (R(2)=0.79), indicating that hydrophobic aromatic content were important precursors. Longer reaction time led to continued formation of CHI3. I-THM containing bromide was also found in waters containing both bromide and iodide, but CHI3 was dominant. The formation of CHI3 was higher at 25°C than 5°C and 35°C. CHI3 formation showed an increase followed by a decrease trend with increasing ClO2 doses and iodide concentrations and the highest yields occurred at iodide to ClO2 molar ratios of 1-2. pH 8 resulted in the highest CHI3 formation. It should be noted that a high iodide concentration was spiked to waters before adding ClO2 and the results may not reflect the formation yields of iodinated THMs in real conditions, but they provide information about formation trend of I-THM during oxidation of ClO2.

Formation of disinfection by-products after pre-oxidation with chlorine dioxide or ferrate.

The effect of pre-oxidation with chlorine dioxide (ClO2) or ferrate (Fe(VI)) on the formation of disinfection by-products (DBPs) during chlorination or chloramination was tested with natural waters from 12 sources (9 surface waters, 1 groundwater, and 2 wastewater effluents). DBPs investigated included trihalomethanes (THM), chloral hydrate (CH), haloketones (HK), haloacetonitriles (HAN) and trichloronitromethane (TCNM), chlorite and chlorate. Chlorite and chlorate were found in the ClO2-treated waters. Application of 1 mg/L ClO2 ahead of chlorination reduced the formation potential for THM by up to 45% and the formation of HK, HAN and TCNM in most of the samples. The CH formation results were mixed. The formation of CH and HK was enhanced with low doses of Fe(VI) (1 mg/L as Fe), but was greatly reduced at higher doses (20 mg/L Fe). Fe(VI) reduced the formation of THM, HAN and TCNM in most of the samples. Reduced potential for the formation of NDMA was observed in most of the samples after both ClO2 and Fe(VI) pre-oxidation.

The occurrence of disinfection by-products in municipal drinking water in China's Pearl River Delta and a multipathway cancer risk assessment.

Disinfection byproducts were measured in the finished drinking water from ten water treatment plants in three Chinese cities - Guangzhou, Foshan and Zhuhai. A total of 155 water samples were collected in 2011 and 2012. The median (range) of trihalomethane (THM) and haloacetic acid (HAA) levels were 17.7 (0.7-62.7) µg/L and 8.6 (0.3-81.3) µg/L, respectively. Chloroform, dichloroacetic acid and trichloroacetic acid were the dominant species observed in Guangzhou and Foshan water, while brominated THMs predominated in water from Zhuhai. Haloacetonitriles, haloketones, chloral hydrate and trichloronitromethane were usually detected at levels ranging from unquantifiable (<0.2µg/L) to 12.2µg/L (choral hydrate). THMs and HAAs showed clear seasonal variations with the total concentrations higher in winter than in summer. Correlations among DBP levels varied, with the strongest linear correlation observed between chloroform and chloral hydrate levels (R(2)=0.77). The risk of cancer from ingestion, inhalation and dermal contact exposure to THMs was estimated. CHCl2Br contributed the highest percentage of the cancer risk from ingestion pathway and CHCl3 contributed the highest of cancer risk from inhalation pathway.

Formation of disinfection byproducts upon chlorine dioxide preoxidation followed by chlorination or chloramination of natural organic matter.

Chlorine dioxide (ClO2) is often used as an oxidant to remove taste, odor and color during water treatment. Due to the concerns of the chlorite formation, chlorination or chloramination is often applied after ClO2 preoxidation. We investigated the formation of regulated and emerging disinfection byproducts (DBPs) in sequential ClO2-chlorination and ClO2-chloramination processes. To clarify the relationship between the formation of DBPs and the characteristics of natural organic matter (NOM), changes in the properties of NOM before and after ClO2 oxidation were characterized by fluorescence, Fourier transform infrared spectroscopy (FTIR), and size and resin fractionation techniques. ClO2 preoxidation destroyed the aromatic and conjugated structures of NOM and transformed large aromatic and long aliphatic chain organics to small and hydrophilic organics. Treatment with ClO2 alone did not produce significant amount of trihalomethanes (THMs) and haloacetic acids (HAAs), but produced chlorite. ClO2 preoxidation reduced THMs, HAAs, haloacetonitriles (HANs) and chloral hydrate (CH) during subsequent chlorination, but no reduction of THMs was observed during chloramination. Increasing ClO2 doses enhanced the reduction of most DBPs except halonitromethanes (HNMs) and haloketones (HKs). The presence of bromide increased the formation of total amount of DBPs and also shifted DBPs to more brominated ones. Bromine incorporation was higher in ClO2 treated samples. The results indicated that ClO2 preoxidation prior to chlorination is applicable for control of THM, HAA and HAN in both pristine and polluted waters, but chlorite formation is a concern and HNMs and HKs are not effectively controlled by ClO2 preoxidation.

Nitrogen origins and the role of ozonation in the formation of haloacetonitriles and halonitromethanes in chlorine water treatment.

Nitrogenous disinfection byproducts (N-DBPs) such as haloacetonitriles (HANs) and halonitromethanes (HNMs) are formed during water chlorination. Preozonation is sometimes applied to control trihalomethane (THM) formation, but this may risk promoting the formation of HNMs and HANs. The role of ozone in the formation of HANs and HNMs in natural waters remains unclear. The nitrogen sources involved in HAN and HNM formation during the chloramination of dissolved organic matter (DOM) with and without preozonation were evaluated using (15)N-labeled monochloramine. The origin of the nitrogen involved in HAN formation was found to depend on the ratio of dissolved organic carbon to nitrogen. In nitrogen-rich solutions HAN nitrogen was mainly from DOM constituents. The formation of (15)N-labeled dichloroacetontrile (DCAN) accounted for approximately 30% of the DCAN produced from all hydrophilic acidic and neutral isolates, which have low carbon to nitrogen ratios, while it reached over 50% for the hydrophobic acidic, basic, and neutral isolates with high carbon to nitrogen ratios. Unlabeled trichloronitromethane (TCNM) accounted for over 90% of the total TCNM produced from most of the isolates. The remaining less than 10% of the TCNM was probably generated through an aldehyde pathway. Preozonation reduced DCAN but enhanced the yield of TCNM. The destruction of amino acids and amine structures and subsequent formation of nitro groups by preozonation may help explain the reduced DCAN and increased TCNM formation.

Effects of ozone and ozone/peroxide pretreatments on disinfection byproduct formation during subsequent chlorination and chloramination.

Ozone (O3) and ozone/hydrogen peroxide (O3/H2O2) can be used in water treatment facilities to remove many organic micropollutants with taste, odor, and color implications. The effects of O3 and O3/H2O2 on the formation of disinfection byproducts (DBPs) in subsequent chlorination and chloramination processes, however, are not well determined. In this study, we compared the yields of a series of regulated and emerging DBPs during sequenced O3-Cl2, O3/H2O2-Cl2, O3-NH2Cl, and O3/H2O2-NH2Cl oxidation of 11 samples, each with different hydrophobicity, bromide concentration, soluble microbial products, and humic substances. For most water, pretreatment with O3 and O3/H2O2 increased the formation of chloral hydrate (CH), trichloronitromethane (TCNM) and haloketones (HKs) but lowered the yields of haloacetonitriles (HANs) during chlorination processes. Compared with O3 alone, O3/H2O2 in combination generated more CH and HKs during chlorination, and their extents of formation appeared to depend on the O3 doses. In terms of chloramination, both O3 and O3/H2O2 reduced THM, HAA, and HAN formation significantly without increasing CH, TCNM, or HKs. These results suggest that O3 or O3/H2O2 pretreatments may provide some benefits for the chloramination process in controlling regulated and emerging DBPs in waters without high bromide content.

Precursors and nitrogen origins of trichloronitromethane and dichloroacetonitrile during chlorination/chloramination.

The formation of trichloronitromethane (TCNM) and dichloroacetonitrile (DCAN) was investigated during chlorination and chloramination of 31 organic nitrogen (org-N) compounds, including amino acids, amines, dipeptides, purines, pyrimidones and pyrroles. Tryptophan and alanine generated the greatest amount of TCNM during chlorination process and asparagine and tyrosine yielded the highest amount of TCNM during chloramination process. Tryptophan, tyrosine, asparagine, and alanine produced more DCAN than other org-N compounds regardless of chlorination or chloramination. TCNM and DCAN formation was higher by chlorination than by chloramination. NH(2)Cl:org-N molar ratios, reaction time, and pH affected N-DBPs formation in varying degrees. TCNM and DCAN yields were usually high during chloramination of tyrosine, asparagine, and methylpyrrole under the following reaction conditions: NH(2)Cl:org-N molar ratios greater than 10, reaction time for 1d, and at pH 7.2. NH(2)Cl as a major nitrogen origin in TCNM and DCAN was confirmed via labeled (15)N-monochloramine during chloramination of tyrosine, asparagine and methylpyrrole. In contrast, the majority of nitrogen in TCNM originated from glycine, and that in DCAN originated from pyrrole. Based on the intermediates identified by gas chromatography/mass spectrometry (GC/MS), a pathway scheme was proposed for TCNM and DCAN formation.

Formation of disinfection byproducts from chlor(am)ination of algal organic matter.

Algal cells and extracellular organic matter (EOM) of two algae species, Microcystis aeruginosa (blue-green algae) and Chlorella vulgaris (green algae), were characterized. The low specific UV absorbance (SUVA) values of EOM and cells from both algae species indicated the very hydrophilic nature of algal materials. Fluorescence excitation-emission matrix showed that algal EOM and cells were enriched with protein-like and soluble microbial by-product-like matters. The formation potential of a variety of disinfection by-products (DBPs) during chlorination and chloramination of algal cells and EOM were evaluated. Algal cells and EOM of Microcystis and Chlorella exhibited a high potential for DBP formation. Yields of total DBPs varied with the algae cultivation age. Cellular materials contributed more to DBP formation than EOM. The presence of bromide led to higher concentrations of total trihalomethanes (THMs), haloacetonitriles (HANs), and halonitromethanes (HNMs). Bromide also shifted the DBPs to brominated ones. Bromine incorporation was higher in HNMs than in THMs and HANs. Compared to natural organic matter, algae under bloom seasons can contribute significantly to the DBP precursor pool.

[Anteroposterior cricoid split interposition grafting for severe glottic and subglottic stenosis].

OBJECTIVE: To study the effect of anterior and posterior cricoid splitting interposition grafting for severe glottic and subglottic stenosis. METHODS: This is a retrospective study, from 1991 to 2001 years, 25 patients (male 15, female 10, aged 9 to 46 years) with severe glottic and subglottic stenosis were operated with anterior and posterior cricoid splitting interposition grafting method at Tangdu Hospital. All of 25 patients were tracheostomy dependent before reconstruction. 19 patients had previously undergone 1 to 7 (average 2) surgical procedures. The surgical technique consisted of laryngotracheostomy, cricoid lamina midline vertical incision; rib cartilage graft (17 cases), muscular fasciae, perichondrium or split-thickness skin graft (15 cases), pedicle arytenoid cartilage graft (2 cases) and thyroid cartilage graft (1 case) interposition and silicon T-tube stenting for 3 to 6 months. RESULTS: Twenty-four patients (96%) were successfully decannulated and got an effective phonation. One patient failed decannulation. The follow-up period ranged from 1 to 10 years. All of the 24 patients had a stable airway and effective phonation. CONCLUSIONS: The anteroposterior cricoid split interposition graft technique was a safe and effective method for the treatment of severe glottic and subglottic stenosis. Careful split of the cricoid, avoiding injury of esophageal musculature, careful hemostasis, a tight suture graft and using stent were the keys of successful operation.