Deep Learning Nomogram for the Identification of Deep Stromal Invasion in Patients With Early-Stage Cervical Adenocarcinoma and Adenosquamous Carcinoma: A Multicenter Study.

BACKGROUND: Deep stromal invasion (DSI) is one of the predominant risk factors that determined the types of radical hysterectomy (RH). Thus, the accurate assessment of DSI in cervical adenocarcinoma (AC)/adenosquamous carcinoma (ASC) can facilitate optimal therapy decision. PURPOSE: To develop a nomogram to identify DSI in cervical AC/ASC. STUDY TYPE: Retrospective. POPULATION: Six hundred and fifty patients (mean age of 48.2 years) were collected from center 1 (primary cohort, 536), centers 2 and 3 (external validation cohorts 1 and 2, 62 and 52). FIELD STRENGTH/SEQUENCE: 5-T, T2-weighted imaging (T2WI, SE/FSE), diffusion-weighted imaging (DWI, EPI), and contrast-enhanced T1-weighted imaging (CE-T1WI, VIBE/LAVA). ASSESSMENT: The DSI was defined as the outer 1/3 stromal invasion on pathology. The region of interest (ROI) contained the tumor and 3 mm peritumoral area. The ROIs of T2WI, DWI, and CE-T1WI were separately imported into Resnet18 to calculate the DL scores (TDS, DDS, and CDS). The clinical characteristics were retrieved from medical records or MRI data assessment. The clinical model and nomogram were constructed by integrating clinical independent risk factors only and further combining DL scores based on primary cohort and were validated in two external validation cohorts. STATISTICAL TESTS: Student's t-test, Mann-Whitney U test, or Chi-squared test were used to compare differences in continuous or categorical variables between DSI-positive and DSI-negative groups. DeLong test was used to compare AU-ROC values of DL scores, clinical model, and nomogram. RESULTS: The nomogram integrating menopause, disruption of cervical stromal ring (DCSRMR), DDS, and TDS achieved AU-ROCs of 0.933, 0.807, and 0.817 in evaluating DSI in primary and external validation cohorts. The nomogram had superior diagnostic ability to clinical model and DL scores in primary cohort (all P < 0.0125 [0.05/4]) and CDS (P = 0.009) in external validation cohort 2. DATA CONCLUSION: The nomogram achieved good performance for evaluating DSI in cervical AC/ASC. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

Neonatal outcome in 29 pregnant women with COVID-19: A retrospective study in Wuhan, China.

BACKGROUND: As of June 1, 2020, coronavirus disease 2019 (COVID-19) has caused more than 6,000,000 infected persons and 360,000 deaths globally. Previous studies revealed pregnant women with COVID-19 had similar clinical manifestations to nonpregnant women. However, little is known about the outcome of neonates born to infected women. METHODS AND FINDINGS: In this retrospective study, we studied 29 pregnant women with COVID-19 infection delivered in 2 designated general hospitals in Wuhan, China between January 30 and March 10, 2020, and 30 neonates (1 set of twins). Maternal demographic characteristics, delivery course, symptoms, and laboratory tests from hospital records were extracted. Neonates were hospitalized if they had symptoms (5 cases) or their guardians agreed to a hospitalized quarantine (13 cases), whereas symptom-free neonates also could be discharged after birth and followed up through telephone (12 cases). For hospitalized neonates, laboratory test results and chest X-ray or computed tomography (CT) were extracted from hospital records. The presence of antibody of SARS-CoV-2 was assessed in the serum of 4 neonates. Among 29 pregnant COVID-19-infected women (13 confirmed and 16 clinical diagnosed), the majority had higher education (56.6%), half were employed (51.7%), and their mean age was 29 years. Fourteen women experienced mild symptoms including fever (8), cough (9), shortness of breath (3), diarrhea (2), vomiting (1), and 15 were symptom-free. Eleven of 29 women had pregnancy complications, and 27 elected to have a cesarean section delivery. Of 30 neonates, 18 were admitted to Wuhan Children's Hospital for quarantine and care, whereas the other 12 neonates discharged after birth without any symptoms and had normal follow-up. Five hospitalized neonates were diagnosed as COVID-19 infection (2 confirmed and 3 suspected). In addition, 12 of 13 other hospitalized neonates presented with radiological features for pneumonia through X-ray or CT screening, 1 with occasional cough and the others without associated symptoms. SARS-CoV-2 specific serum immunoglobulin M (IgM) and immunoglobulin G (IgG) were measured in 4 neonates and 2 were positive. The limited sample size limited statistical comparison between groups. CONCLUSIONS: In this study, we observed COVID-19 or radiological features of pneumonia in some, but not all, neonates born to women with COVID-19 infection. These findings suggest that intrauterine or intrapartum transmission is possible and warrants clinical caution and further investigation. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000031954 (Maternal and Perinatal Outcomes of Women with coronavirus disease 2019 (COVID-19): a multicenter retrospective cohort study).

Comparison of the value of superficial mark guided localization and hook-wire guided localization techniques for non-palpable breast microcalcifications: A retrospective clinical research.

AIM: The present study compares the effect and accuracy of the superficial mark guided localization (SGL) and hook-wire guided localization (WGL) techniques for non-palpable breast microcalcifications. METHODS: This retrospective study was conducted to compare SGL and WGL techniques. These techniques were performed on 51 patients with non-palpable breast microcalcifications from January 2015 to May 2016. RESULTS: Among these 51 patients, 25 (49.01%) patients were subjected to WGL and 26 patients (50.99%) were subjected to SGL. The SGL technique had a higher rate of malignant cancer detection (WGL = 12.0% and SGL = 23.0%). Furthermore, no significant differences were found with regard to average age, the rate of a second excision and the diameter of the excised tissue. Moreover, no complications were observed in the SGL group, while four (16.0%) patients in the WGL group experienced problems. CONCLUSION: The SGL technique is as accurate as the WGL technique. Furthermore, the procedure has advantages of being less expensive and causing less complications.

Abdominopelvic leiomyoma with large ascites: A case report and review of the literature.

BACKGROUND: Leiomyoma of the uterus is relatively common, but uterine leiomyoma of the greater omentum is rare. CASE SUMMARY: Here, we report the case of a 22-year-old woman who presented with a 3 mo history of progressive abdominal distension and a hypervascular abdominopelvic mass. Due to a high serum concentration of CA125, the preoperative diagnosis was unclear. During surgery, 5 L of ascites was removed. An 18.8 cm solid mass, which was pedunculated from the uterine fundus and exhibited complex adhesion to the greater omentum, was removed. The CA125 level was reduced postoperatively, and a pathologic study confirmed that the mass was a leiomyoma that originated in the uterus. CONCLUSION: Uterine leiomyoma can share vessels with the greater omentum. This case highlights the difficulty of diagnosing pseudo-Meigs syndrome and the importance of imaging and laboratory examinations.

[Effects of different anesthetic methods and anesthetic drugs on stress reaction during surgical operation].

OBJECTIVE: To investigate the effect of four different anesthetic methods (combined epidural with general anesthesia with endotracheal intubation or with laryngeal mask airway, total intravenous anesthesia or remifentanil intravenous infusion combined with inhalational anesthesia) on stress reaction in patients undergoing upper abdominal surgery. METHODS: Sixty ASAI-II patients, aged 18 - 65 y, scheduled for elective upper abdominal surgery were enrolled in the study. They were divided into four groups: epidural combine general anesthesia with intubation group (EG group) and with laryngeal mask group (EGL group), total intravenous remifentanil combined with propofol (RP group) and inhalational group (RI group). Blood pressure, ECG, SpO(2), PETCO(2) were monitored continuously. Level of epinephrine and norepinephrine, angiotensin I and angiotensin II, glicentin and blood glucose in blood plasma were measured before operation, after induction, after skin incision and at the end of operation. RESULTS: The Blood pressure in RP and RI groups was lower than that in EG and EGL groups at induction. Blood pressure and heart rate of EG group were higher than those in RP, RI and EGL groups during intubation. Heart rate of RP group changed least than the other groups at skin incision. Heart rate of EGL group was higher than that in the other groups at extubation. Epinephrine and norepinephrine were lowered slightly at intubation and skin incision, and were raised at the end of operation in all groups. Norepinephrine of RP group increased distinctly compared with preoperative level. Glicentin was decreased slightly at intubation in all groups, and dropped to the lowest at the end of operation, glicentin in RP group was decreased significantly compared with preoperative level. Blood glucose was lowered slightly at induction and intubation, and was raised distinctly at the end of operation in four groups. Glucagon and Blood glucose of RP and RI groups were lower than those of EG and EGL groups. CONCLUSION: Different anesthetic methods and anesthetic drugs had different effects on stress reaction (hormones) during surgical operation. Regardless of general anesthesia or intrathecal anesthesia, harmful stimulus could not be completely blocked by the intraoperative management and stress regulation during operation. Intrathecal anesthesia combined with general anesthesia could inhibit the stress reaction during upper abdominal surgery. Continuous remifentanil target controlled infusion could inhibit the degree of stress reaction, either.

[The effect of melatonin on the regulation of collagen accumulation and matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 mRNA and protein in a murine model of chronic asthma].

OBJECTIVE: To investigate the effect of melatonin on the regulation of collagen accumulation and the underlying mechanisms. METHODS: Ninety-six BALB/c mice were randomly divided into five groups. The mice were injected i.p. with normal saline in the control group (n = 21) and the asthma group (n = 22), melatonin in the melatonin group (n = 23), dexamethasone in the dexamethasone group (n = 24), and melatonin antagonist luzindole in the luzindole group (n = 7) respectively. The mice of the control group, asthma group, melatonin group, dexamethasone group were sensitized and repeatedly challenged with ovalbumin for 2, 4, 8 weeks(the number of control group were 7, 7, 7 respectively at 2, 4, 8 weeks; the number of asthma group were 7, 7, 8 respectively at 2, 4, 8 weeks; the number of melatonin group were 7, 8, 8 respectively at 2, 4, 8 weeks; the number of dexamethasone group were 7, 8, 8 respectively at 2, 4, 8 weeks). The mice of the luzindole group (n = 7) were sensitized and repeatedly challenged with ovalbumin for 2 weeks, to establish the murine model of chronic asthma. Masson staining was used to stain collagen fibers and immunohistochemistry to stain protein expression. MetaMorph image analysis software was used to measure the positive area per micrometer perimeter of basement membrane (Wcol/Pbm), to evaluate collagen accumulation in lung tissue. The immuno-positive area per unit area (PA/UA) was measured to evaluate the protein level of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1). Semi-quantitative reverse transcriptase polymerase chain reaction (RT-PCR) was used to evaluate the mRNA levels. RESULTS: The collagen area per unit perimeter of basement membrane (Wcol/Pbm) in the melatonin group was (11.8 +/- 1.3), (12.3 +/- 1.1), (12.7 +/- 1.4) microm(2)/microm respectively at 2, 4, and 8 weeks, which were decreased as compared with (14.5 +/- 1.5), (15.8 +/- 1.8), (16.2 +/- 1.4) microm(2)/microm in the asthma group (t(d) = 3.89, 5.96, 5.50 respectively, all P < 0.01). The PA/UA of MMP-9 was (9.7 +/- 4.9) pixel, (14.8 +/- 4.9) pixel, (11.0 +/- 6.8) pixel respectively at 2, 4, 8 weeks in the melatonin group, (15.65 +/- 6.11) pixel, (26.2 +/- 6.9) pixel, (24.6 +/- 6.0) pixel respectively at 2, 4, 8 weeks in the asthma group, the difference being statistically significant between the two groups (t(d) = 3.00, 4.83, 5.50 respectively at 2, 4, 8 weeks, all P < 0.01). The MMP-9 mRNA level was 0.80 +/- 0.40, 0.68 +/- 0.15, 0.67 +/- 0.24 in the melatonin group at 2, 4, 8 weeks respectively, and was 1.48 +/- 0.29, 1.40 +/- 0.50, 1.20 +/- 0.40 in the asthma group at 2, 4, 8 weeks respectively (t(d) = 3.92, 4.50, 3.29 respectively at 2, 4, 8 weeks, all P < 0.01). The Wcol/Pbm [(11.6 +/- 1.3), (12.3 +/- 1.0), (13.0 +/- 1.7) microm(2)/microm], protein [(12.5 +/- 5.6), (14.0 +/- 4.7), (13.6 +/- 4.8) pixel] and mRNA (0.69 +/- 0.11, 0.61 +/- 0.16, 1.10 +/- 0.40) level were reduced in the dexamethasone group as compared with the asthma group at 2, 4, 8 weeks respectively. The above mentioned parameters in the luzindole group were not statistically different as compared with the asthma group at 2 weeks. CONCLUSIONS: The results suggest that early treatment with melatonin inhibits airway collagen accumulation, probably mediated by the inhibition of MMP-9.