Effect of Deep Learning Image Reconstruction Algorithms on Radiomic Features of Pulmonary Nodules in Ultra-Low-Dose CT.

OBJECTIVE: The purpose of this study is to explore the impact of deep learning image reconstruction (DLIR) algorithm on the quantification of radiomic features in ultra-low-dose computed tomography (ULD-CT) compared with adaptive statistical iterative reconstruction-Veo (ASIR-V). METHODS: One hundred eighty-three patients with pulmonary nodules underwent standard-dose computed tomography (SDCT) (4.30 ± 0.36 mSv) and ULD-CT (UL-A, 0.57 ± 0.09 mSv or UL-B, 0.33 ± 0.04 mSv). SDCT was the reference standard using (ASIR-V) at 50% strength (50%ASIR-V). ULD-CT was reconstructed with 50%ASIR-V, DLIR at medium and high strength (DLIR-M, DLIR-H). Radiomics analysis extracted 102 features, and the intraclass correlation coefficient (ICC) quantified reproducibility between ULD-CT and SDCT reconstructed by 50%ASIR-V, DLIR-M, and DLIR-H for each feature. RESULTS: Among 102 radiomic features, the percentages of reproducibility of 50%ASIR-V, DLIR-M, and DLIR-H were 48.04% (49/102), 49.02% (50/102), and 52.94% (54/102), respectively. Shape and first order features demonstrated high reproducibility across different reconstruction algorithms and radiation doses, with mean ICC values exceeding 0.75. In texture features, DLIR-M and DLIR-H showed improved mean ICC values for pure ground glass nodules (pGGNs) from 0.69 ± 0.23 to 0.75 ± 0.18 and 0.81 ± 0.12, respectively, compared with 50%ASIR-V. Similarly, the mean ICC values for solid nodules (SNs) increased from 0.60 ± 0.19 to 0.66 ± 0.14 and 0.69 ± 0.13, respectively. Additionally, the mean ICC values of texture features for pGGNs and SNs in both ULD-CT groups decreased with reduced radiation dose. CONCLUSIONS: DLIR can improve the reproducibility of radiomic features at ultra-low doses compared with ASIR-V. In addition, pGGNs showed better reproducibility at ultra-low doses than SNs.

Depression and risk of arthritis: A Mendelian randomization study.

INTRODUCTION: Observational studies have found that most patients with arthritis have depression. We aimed to determine the causal relationship between various types of arthritis and depression. METHODS: We conducted a two-sample bidirectional Mendelian randomized (MR) analysis to determine whether there was a significant causal relationship between depression and multiple types of arthritis. The data of our study were derived from the publicly released genome-wide association studies (GWASs) and the largest GWAS meta-analysis. MR analysis mainly used inverse-variance weighted method; supplementary methods included weighted median, weighted mode, and MR-Egger using MR pleiotropy residual sum and outlier to detect and correct for the presence of pleiotropy. RESULTS: After adjusting for heterogeneity and horizontal pleiotropy, we found that depression was associated with an increased risk of osteoarthritis (OA) (OR = 1.02, 95%CI: 1.01-1.02, p = 2.96 × E - 5). In the reverse analysis, OA was also found to increase the risk of depression (OR = 1.10, 95%CI: 1.04-1.15, p = .0002). Depression only increased the risk of knee OA (KOA) (OR = 1.25, 95%CI: 1.10-1.42, p = 6.46 × E - 4). Depression could potentially increase the risk of spondyloarthritis (OR = 1.52, 95%CI: 1.19-1.94, p ≤ 8.94 × E - 4). CONCLUSION: There is a bidirectional causal relationship of depression with OA. However, depression only augments the risk of developing KOA. Depression may increase the risk of spondyloarthritis and gout.

Functionality of chimeric TssA proteins in the type VI secretion system reveals sheath docking specificity within their N-terminal domains.

The genome of Pseudomonas aeruginosa encodes three type VI secretion systems, each comprising a dozen distinct proteins, which deliver toxins upon T6SS sheath contraction. The least conserved T6SS component, TssA, has variations in size which influence domain organisation and structure. Here we show that the TssA Nt1 domain interacts directly with the sheath in a specific manner, while the C-terminus is essential for oligomerisation. We built chimeric TssA proteins by swapping C-termini and showed that these can be functional even when made of domains from different TssA sub-groups. Functional specificity requires the Nt1 domain, while the origin of the C-terminal domain is more permissive for T6SS function. We identify two regions in short TssA proteins, loop and hairpin, that contribute to sheath binding. We propose a docking mechanism of TssA proteins with the sheath, and a model for how sheath assembly is coordinated by TssA proteins from this position.

Enhancing diagnostic performance and image quality in coronary CT angiography: Impact of SnapShot Freeze 2 algorithm across varied heart rates in stent patients.

PURPOSE: To investigate the enhancement of image quality achieved through the utilization of SnapShot Freeze 2 (SSF2), a comparison was made against the results obtained from the original SnapShot Freeze algorithm (SSF) and standard motion correction (STND) in stent patients undergoing coronary CT angiography (CCTA) across the entire range of heart rates. MATERIALS AND METHODS: A total of 118 patients who underwent CCTA, were retrospectively included in this study. Images of these patients were reconstructed using three different algorithms: SSF2, SSF, and STND. Objective assessments include signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), diameters of stents and artifact index (AI). The image quality was subjectively evaluated by two readers. RESULTS: Compared with SSF and STND, SSF2 had similar or even higher quality in the parameters (AI, SNR, CNR, inner diameters) of coronary artery, stent, myocardium, MV (mitral valve), TV (tricuspid valve), AV (aorta valve), and PV (pulmonary valve), and aortic root (AO). Besides the above structures, SSF2 also demonstrated comparable or even higher subjective scores in atrial septum (AS), ventricular septum (VS), and pulmonary artery root (PA). Furthermore, the enhancement in image quality with SSF2 was significantly greater in the high heart rate group compared to the low heart rate group. Moreover, the improvement in both high and low heart rate groups was better in the SSF2 group compared to the SSF and STND group. Besides, when using the three algorithms, an effect of heart rate variability on stent image quality was not detected. CONCLUSION: Compared to SSF and STND, SSF2 can enhance the image quality of whole-heart structures and mitigate artifacts of coronary stents. Furthermore, SSF2 has demonstrated a significant improvement in the image quality for patients with a heart rate equal to or higher than 85 bpm.

Assessment of chemotherapy resistance changes in human colorectal cancer xenografts in rats based on MRI histogram features.

Purpose: We investigated the value of magnetic resonance imaging (MRI) histogram features, a non-invasive method, in assessing the changes in chemoresistance of colorectal cancer xenografts in rats. Methods: A total of 50 tumor-bearing mice with colorectal cancer were randomly divided into two groups: control group and 5-fluorouracil (5-FU) group. The MRI histogram characteristics and the expression levels of p53 protein and MRP1 were obtained at 24 h, 48 h, 72 h, 120 h, and 168 h after treatment. Results: Sixty highly repeatable MRI histogram features were obtained. There were 16 MRI histogram parameters and MRP1 resistance protein differences between groups. At 24 h after treatment, the MRI histogram texture parameters of T2-weighted imaging (T2WI) images (10%, 90%, median, energy, and RootMeanSquared) and D images (10% and Range) were positively correlated with MRP1 (r = 0.925, p = 0.005). At 48 h after treatment, histogram texture parameters of apparent diffusion coefficient (ADC) images (Energy) were positively correlated with the presence of MRP1 resistance protein (r = 0.900, p = 0.037). There was no statistically significant difference between MRI histogram features and p53 protein expression level. Conclusions: MRI histogram texture parameters based on T2WI, D, and ADC maps can help to predict the change of 5-FU resistance in colorectal cancer in the early stage and provide important reference significance for clinical treatment.

Resting-State Functional Magnetic Resonance Imaging as an Indicator of Neuropsychological Changes in Type 1 Narcolepsy.

RATIONALE AND OBJECTIVES: To explore indicators of neuropsychological changes in patients with type 1 narcolepsy (NT1) using resting-state functional magnetic resonance imaging (rs-fMRI). MATERIALS AND METHODS: Thirty-four NT1 patients and 34 age- and sex-matched healthy volunteers were recruited for neuropsychiatric assessments and rs-fMRI data acquisition. Fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity (ReHo), and related brain functional connectivity (FC) were calculated for the two groups and compared using a two-sample t test with cluster-level FDR correction. Moreover, partial correlation analysis was performed between these functional values of changed brain regions and clinical scales. RESULTS: Compared to those of healthy controls, spontaneous functional activities were significantly weakened in patients with NT1 in regions such as the left/right posterior cerebellum lobe, left inferior temporal gyrus, and left dorsolateral superior frontal gyrus, whereas those in regions such as the left middle occipital gyrus, right inferior occipital gyrus, and left/right lingual gyrus were significantly strengthened. Furthermore, NT1 patients displayed significantly changed FCs between the left/right anterior cingulate gyrus (ACG) and regions such as the left/right cerebellum, left middle occipital gyrus, and left inferior frontal gyrus in the operculum. In partial correlation analysis, the functions in the left dorsolateral superior frontal gyrus were significantly related to the Trail Making Tests (TMT) score. Moreover, the FC between the left ACG and left inferior frontal gyrus in the operculum was highly correlated with anxiety and depression features, including the Hamilton Anxiety Scale (HAMA) score and Hamilton Depression Rating Scale (HAMD-17) score. CONCLUSION: Patients with NT1 exhibited abnormalities in the anterior cingulate cortex, frontal-parietal cortex, hippocampus, and left/right posterior cerebellum lobe. The deactivation of the left frontal-temporal cortex is stronger, which is involved in the cognitive decline and mental disorders in these patients. Damage to the ACG may affect its FC with other regions and cause cognition and emotion dysregulation, perhaps by impairing patients' visual pathways and frontal-temporal-parietal networks. Hence, these could be important biomarkers for their neuropsychological changes.

Purine and carbohydrate availability drive Enterococcus faecalis fitness during wound and urinary tract infections.

IMPORTANCE: Although E. faecalis is a common wound pathogen, its pathogenic mechanisms during wound infection are unexplored. Here, combining a mouse wound infection model with in vivo transposon and RNA sequencing approaches, we identified the E. faecalis purine biosynthetic pathway and galactose/mannose MptABCD phosphotransferase system as essential for E. faecalis acute replication and persistence during wound infection, respectively. The essentiality of purine biosynthesis and the MptABCD PTS is driven by the consumption of purine metabolites by E. faecalis during acute replication and changing carbohydrate availability during the course of wound infection. Overall, our findings reveal the importance of the wound microenvironment in E. faecalis wound pathogenesis and how these metabolic pathways can be targeted to better control wound infections.

Kinesin-14 KIFC1 promotes acrosome formation and chromatin maturation during mouse spermiogenesis.

KIFC1, a member of kinesin-14 subfamily motors, is essential for meiotic cell division and acrosome formation during spermatogenesis. However, the functions of KIFC1 in the formation and maintenance of the acrosome in male germ cells remain to be elucidated. In this study, we report the structural deformities of acrosomes in the in vivo KIFC1 inhibition mouse models. The proacrosomal vesicles diffuse into the cytoplasm and form atypical acrosomal granules. This phenotype is consistent with globozoospermia patients and probably results from the failure of the Golgi-derived vesicle trafficking and actin filament organization. Moreover, the multinucleated and undifferentiated spermatogenic cells in the epidydimal lumen after KIFC1 inhibition reveal the specific roles of KIFC1 in regulating post-meiotic maturation. Overall, our results uncover KIFC1 as an essential regulator in the trafficking, fusion and maturation of acrosomal vesicles during spermiogenesis.

Auranofin inhibits virulence pathways in Pseudomonas aeruginosa.

Pseudomonas aeruginosa is widely attributed as the leading cause of hospital-acquired infections. Due to intrinsic antibiotic resistance mechanisms and the ability to form biofilms, P. aeruginosa infections are challenging to treat. P. aeruginosa employs multiple virulence mechanisms to establish infections, many of which are controlled by the global virulence regulator Vfr. An attractive strategy to combat P. aeruginosa infections is thus the use of anti-virulence compounds. Here, we report the discovery that FDA-approved drug auranofin attenuates virulence pathways in P. aeruginosa, including quorum sensing (QS) and Type IV pili (TFP). We show that auranofin acts via multiple targets, one of which being Vfr. Consistent with inhibition of QS and TFP expression, we show that auranofin attenuates biofilm maturation, and when used in combination with colistin, displays strong synergy in eradicating P. aeruginosa biofilms. Auranofin may have immediate applications as an anti-virulence drug against P. aeruginosa infections.

Structurally diverse polycyclic polyprenylated acylphloroglucinols with protective effect on human vein endothelial cells injured by high-glucose from Hypericum acmosepalum N. Robson.

Hyperacmotone A, a polycyclic polyprenylated acylphloroglucinol (PPAP) with an unprecedented skeleton, along with five undescribed congeners and eleven reported ones, was isolated from Hypericum acmosepalum. Hyperacmotone A possesses a unique monocyclic ring skeleton based on a cyclopent-4-ene-1,3-dione acylphloroglucinol core. Their structures were elucidated by extensive analysis of HRESIMS, NMR, biogenetic pathway, and quantum-chemical calculations. In addition, hypercohone G exhibited significant protective effects on high-glucose-injured HUVECs.

A CT-Based Radiomics Nomogram Combined with Clinic-Radiological Characteristics for Preoperative Prediction of the Novel IASLC Grading of Invasive Pulmonary Adenocarcinoma.

RATIONALE AND OBJECTIVES: The novel International Association for the Study of Lung Cancer (IASLC) grading system of invasive lung adenocarcinoma (ADC) demonstrated a remarkable prognostic effect and enabled numerous patients to benefit from adjuvant chemotherapy. We sought to build a CT-based nomogram for preoperative prediction of the IASLC grading. MATERIALS AND METHODS: This work retrospectively analyzed the CT images and clinical data of 303 patients with pathologically confirmed invasive ADC. The histological subtypes and radiological characteristics of the patients were re-evaluated. Radiomics features were extracted, and the optimal subset of features was established by ANOVA, spearman correlation analysis, and the least absolute shrinkage and selection operator (LASSO). Univariate and multivariate analyses identified the independent clinical and radiological variables. Finally, multivariate logistic regression analysis incorporated clinical, radiological, and optimal radiomics features into the nomogram. Receiver operating characteristic (ROC) curve, and accuracy were applied to assess the model's performance. Decision curve analysis (DCA), and calibration curve were applied to assess the clinical usefulness. RESULTS: Nine selected CT image features were used to develop the radiomics model. The accuracy, precision, sensitivity, and specificity of the radiomics model outperformed the clinic-radiological model in the training and testing sets. Integrating Radscore with independent radiological characteristics showed higher prediction performance than clinic-radiological characteristics alone in the training (AUC, 0.915 vs. 0.882; DeLong, p < 0.05) and testing (AUC, 0.838 vs. 0.782; DeLong, p < 0.05) sets. Good calibration and decision curve analysis demonstrated the clinical usefulness of the nomogram. CONCLUSION: Radiomics features effectively predict high-grade ADC. The combined nomogram may facilitate selecting patients who benefit from adjuvant treatment.

Measuring the effects of mind wandering in people with insomnia: A driving simulator study.

Purpose: Studies have shown that individuals with insomnia experience more frequent and longer episodes of mind wandering (MW) while driving. However, the effect of the interaction between insomnia and MW on driving behavior is not fully understood. This study aimed to gain deeper insights into the relationships among insomnia, MW, and driving behavior. Patients and methods: Forty-two participants (21 diagnosed with insomnia and 21 controls) were recruited, and subjective sleep quality and cognitive function were assessed. A driving simulator experiment with a within-subject design was performed, involving two distraction tasks (no-distraction task versus MW task) and two driving scenarios (lane-keeping versus lane-changing). Results: In the lane-keeping scenario, there was no significant between-group difference (people with insomnia and controls) in longitudinal driving performance for the no-distraction task, although the interaction between MW and insomnia significantly increased drivers' longitudinal control variation. Correlation analysis confirmed that longitudinal driving performance was positively correlated with sleep quality and the cognitive level. Unlike longitudinal driving performance, lateral driving performance was significantly weaker in people with insomnia than in controls under both distraction tasks. In the lane-changing scenario, although there was no between-group difference in driving performance, the MW task led to significant changes in driving performance within each group compared with the no-distraction task, and these findings were associated with cognitive function, but not with sleep quality. Conclusion: These findings show that insomnia and MW combined can lead to reduced driving performance. Further research is needed to elucidate the factors that influence this phenomenon.

Hepatotoxicity and the role of the gut-liver axis in dogs after oral administration of zinc oxide nanoparticles.

Zinc oxide nanoparticles (ZnO NPs) have been used in many fields, and people are concerned about its effects on health. The present study reported the changes in liver metabolites and intestinal microbiota induced by overused ZnO NPs in dogs and explored the related mechanisms of liver injury induced by ZnO NPs. The results showed that overused ZnO NPs promote zinc accumulation in the liver and increase liver coefficient and serum liver-related indexes. In addition, the overuse of ZnO NPs increase the reactive oxygen species levels, affecting the hepatocyte antioxidant capacity and mitochondrial function. Results showed that ZnO NPs significantly inhibited the hepatocyte apoptosis via the Cytc pathway and promoted the autophagy via activating the mTOR/ATG5 pathway. Metabolic analysis of liver tissue showed that 81 metabolites changed overall and mainly affected the glycerophospholipid metabolism. ZnO NPs can significantly change the richness and diversity of the intestinal bacteria in dogs, increasing the abundance of Firmicutes and Actinobacteria while reducing the bacterial abundance of Proteobacteria. In conclusion, the results suggest that overexposure to ZnO NPs can lead to the disruption of intestinal microbiome and liver metabolites in dogs, which ultimately leads to liver damage.

Value of IVIM in Differential Diagnoses between Benign and Malignant Solitary Lung Nodules and Masses: A Meta-analysis.

Purpose: This study aims to evaluate the accuracy of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in distinguishing malignant and benign solitary pulmonary nodules and masses. Methods: Studies investigating the diagnostic accuracy of IVIM-DWI in lung lesions published through December 2020 were searched. The standardized mean differences (SMDs) of the apparent diffusion coefficient (ADC), tissue diffusivity (D), pseudo-diffusivity (D*), and perfusion fraction (f) were calculated. The sensitivity, specificity, area under the curve (AUC), publication bias, and heterogeneity were then summarized, and the source of heterogeneity and the reliability of combined results were explored by meta-regression and sensitivity analysis. Results: A total of 16 studies including 714 malignant and 355 benign lesions were included. Significantly lower ADC, D, and f values were found in malignant pulmonary lesions compared to those in benign lesions. The D value showed the best diagnostic performance (sensitivity = 0.90, specificity = 0.71, AUC = 0.91), followed by ADC (sensitivity = 0.84, specificity = 0.75, AUC = 0.88), f (sensitivity = 0.70, specificity = 0.62, AUC = 0.71), and D * (sensitivity = 0.67, specificity = 0.61, AUC = 0.67). There was an inconspicuous publication bias in ADC, D, D* and f values, moderate heterogeneity in ADC, and high heterogeneity in D, D*, and f values. Subgroup analysis suggested that both ADC and D values had a significant higher sensitivity in "nodules or masses" than that in "nodules." Conclusions: The parameters derived from IVIM-DWI, especially the D value, could further improve the differential diagnosis between malignant and benign solitary pulmonary nodules and masses.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier: CRD42021226664.

Enterococcus faecalis Antagonizes Pseudomonas aeruginosa Growth in Mixed-Species Interactions.

Enterococcus faecalis is often coisolated with Pseudomonas aeruginosa in polymicrobial biofilm-associated infections of wounds and the urinary tract. As a defense strategy, the host innately restricts iron availability at infection sites. Despite their coprevalence, the polymicrobial interactions of these two species in biofilms and under iron-restricted conditions remain unexplored. Here, we show that E. faecalis inhibits P. aeruginosa growth within biofilms when iron is restricted. E. faecalis lactate dehydrogenase (ldh1) gives rise to l-lactate production during fermentative growth. We find that an E. faecalis ldh1 mutant fails to inhibit P. aeruginosa growth. Additionally, we demonstrate that ldh1 expression is induced under iron-restricted conditions, resulting in increased lactic acid exported and, consequently, a reduction in local environmental pH. Together, our results suggest that E. faecalis synergistically inhibits P. aeruginosa growth by decreasing environmental pH and l-lactate-mediated iron chelation. Overall, this study emphasizes the importance of the microenvironment in polymicrobial interactions and how manipulating the microenvironment can impact the growth trajectory of bacterial communities. IMPORTANCE Many infections are polymicrobial and biofilm-associated in nature. Iron is essential for many metabolic processes and plays an important role in controlling infections, where the host restricts iron as a defense mechanism against invading pathogens. However, polymicrobial interactions between pathogens are underexplored under iron-restricted conditions. Here, we explore the polymicrobial interactions between commonly coisolated E. faecalis and P. aeruginosa within biofilms. We find that E. faecalis modulates the microenvironment by exporting lactic acid which further chelates already limited iron and also lowers the environmental pH to antagonize P. aeruginosa growth under iron-restricted conditions. Our findings provide insights into polymicrobial interactions between bacteria and how manipulating the microenvironment can be taken advantage of to better control infections.

A transcriptomic analysis based on aberrant methylation levels revealed potential novel therapeutic targets for nasopharyngeal carcinoma.

Background: This study aimed to identify potential novel therapeutic targets for nasopharyngeal carcinoma (NPC) by identifying aberrantly methylated-differentially expressed genes (DEGs) and pathways based on a comprehensive bioinformatics analysis. Methods: Eight gene expression data sets and 2 methylation microarray data sets that included NPC and control groups from the Gene Expression Omnibus were identified. Meta-analyses of the DEGs were performed using the online analysis database "NetworkAnalyst". Aberrantly methylated gene loci were obtained from the GEO2R. Aberrantly methylated DEGs were obtained from Venn diagrams. The enrichment analysis was carried out on the "Metascape" website, and the protein-protein interaction (PPI) network construction, network analysis, and visualization of the analysis results were carried out on the "String" website using "Cytoscape" software. Results: In total, 544 hypomethylation high-expression genes and 164 hypermethylation low-expression genes were obtained. The enrichment and PPI network analyses suggested that several pathways and hub genes with abnormal gene expression accompanied by methylation change, including inositol-trisphosphate 3-kinase B (ITPKB), G protein subunit beta 5 (GNB5), FYN proto-oncogene, Src family tyrosine kinase (FYN), LCK proto-oncogene, Src family tyrosine kinase (LCK), nuclear factor of activated T cells 1 (NFATC1), GNAS complex locus (GNAS), protein kinase C beta (PRKCB), zeta chain of T cell receptor associated protein kinase 70 (ZAP70), lysophosphatidic acid receptor 1 (LPAR1), protein kinase C epsilon (PRKCE), tumor protein p53 (TP53), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), fibronectin 1 (FN1), cyclin D1 (CCND1), vascular endothelial growth factor A (VEGFA), HRas proto-oncogene, GTPase (HRAS), signal transducer and activator of transcription 3 (STAT3), fibroblast growth factor 2 (FGF2), amyloid beta precursor protein (APP), and matrix metallopeptidase 2 (MMP2), may be related to the occurrence of nasopharyngeal carcinoma . Conclusions: The identification of novel and important pathways and hub genes and their roles in the occurrence and development of NPC will guide clinical research and the development of pharmaceutical targets.

Design and application of unplanned extubation quality index management system based on direct data acquisition / 中国实用护理杂志

Objective:To acquire more scientific, accurate and efficient unplanned extubation (UEX) quality management data by using information technology to directly take the quality index data of unplanned extubation from the nursing medical record system.Methods:From June 2019 to August 2019, a knowledge base of pipeline management including the name of pipeline, pipeline evaluation, pipeline care measures, and reasons for unplanned extubation of pipeline was established in Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine. Through the analysis of each node of pipeline management, pipeline management system was established. And the non-planned pipeline management data set was directly collected to the nursing quality management system for statistics and analysis, which was verified.Results:In clinical application from September 2019 to september 2020, the direct collection of unplanned extubation quality index data saved 496 hours of nursing labor costs per month, and the accuracy of direct data collection increased from 95.8% (161/168) in trial operation to 100.0% (494/494). The underreporting rate of adverse events decreased to 0. Satisfaction with the application of the quality index management system for unplanned extubation was (4.35 ± 0.73) points.Conclusions:The direct collection of quality index data for unplanned extubation improves the accuracy of the data. Nurses no longer need to report unplanned extubation incidents. The clinical nursing information system and the nursing management system are interconnected to improve the management efficiency of unplanned extubation. It is worthy of application and promotion in clinic.

Pre-operative Prediction of Ki-67 Expression in Various Histological Subtypes of Lung Adenocarcinoma Based on CT Radiomic Features.

Purpose: The aims of this study were to combine CT images with Ki-67 expression to distinguish various subtypes of lung adenocarcinoma and to pre-operatively predict the Ki-67 expression level based on CT radiomic features. Methods: Data from 215 patients with 237 pathologically proven lung adenocarcinoma lesions who underwent CT and immunohistochemical Ki-67 from January 2019 to April 2021 were retrospectively analyzed. The receiver operating curve (ROC) identified the Ki-67 cut-off value for differentiating subtypes of lung adenocarcinoma. A chi-square test or t-test analyzed the differences in the CT images between the negative expression group (n = 132) and the positive expression group (n = 105), and then the risk factors affecting the expression level of Ki-67 were evaluated. Patients were randomly divided into a training dataset (n = 165) and a validation dataset (n = 72) in a ratio of 7:3. A total of 1,316 quantitative radiomic features were extracted from the Analysis Kinetics (A.K.) software. Radiomic feature selection and radiomic classifier were generated through a least absolute shrinkage and selection operator (LASSO) regression and logistic regression analysis model. The predictive capacity of the radiomic classifiers for the Ki-67 levels was investigated through the ROC curves in the training and testing groups. Results: The cut-off value of the Ki-67 to distinguish subtypes of lung adenocarcinoma was 5%. A comparison of clinical data and imaging features between the two groups showed that histopathological subtypes and air bronchograms could be used as risk factors to evaluate the expression of Ki-67 in lung adenocarcinoma (p = 0.005, p = 0.045, respectively). Through radiomic feature selection, eight top-class features constructed the radiomic model to pre-operatively predict the expression of Ki-67, and the area under the ROC curves of the training group and the testing group were 0.871 and 0.8, respectively. Conclusion: Ki-67 expression level with a cut-off value of 5% could be used to differentiate non-invasive lung adenocarcinomas from invasive lung adenocarcinomas. It is feasible and reliable to pre-operatively predict the expression level of Ki-67 in lung adenocarcinomas based on CT radiomic features, as a non-invasive biomarker to predict the degree of malignant invasion of lung adenocarcinoma, and to evaluate the prognosis of the tumor.

Evaluation of axial length/total corneal refractive power ratio as a potential marker for ocular diagnosis of Marfan's syndrome in children.

AIM: To investigate whether the axial length (AL)/total corneal refractive power (TCRP) ratio is a sensitive and simple factor that can be used for the early diagnosis of Marfan's syndrome (MFS) in children. METHODS: The relationship between the AL/TCRP ratio and the diagnosis of MFS for 192 eyes in 97 children were evaluate. The biological characteristics, including age, sex, AL, and TCRP, were collected from medical records. Receiver operating characteristic (ROC) curve analysis was performed to investigate whether the AL/TCRP ratio effectively distinguishes MFS from other subjects. The Youden index was used to re-divide the whole population into two groups according to an AL/TCRP ratio of 0.59. RESULTS: Of 96 subjects (mean age 7.46±3.28y) evaluated, 56 (110 eyes) had a definite diagnosis of MFS in childhood based on the revised Ghent criteria, 41 (82 eyes) with diagnosis of congenital ectopia lentis (EL) were included as a control group. AL was negatively correlated with TCRP, with a linear regression coefficient of -0.36 (R 2=0.08). A significant correlation was found between age and the AL/TCRP ratio (P=0.023). ROC curve analysis showed that the AL/TCRP ratio distinguished MFS from the other patients at a threshold of 0.59. MFS patients were present in 24/58 (41.38%) patients with an AL/TCRP ratio of ≤0.59 and in 34/39 (87.18%) patients with an AL/TCRP ratio of >0.59. CONCLUSION: An AL/TCRP ratio of >0.59 is significantly associated with the risk of MFS. The AL/TCRP ratio should be measured as a promising marker for the prognosis of children MFS. Changes in the AL/TCRP ratio should be monitored over time.

Acmoxanthones A-E, New Lavandulated Xanthones from Hypericum acmosepalum N. Robson.

Acmoxanthones A-E (1-5), five new lavandulylated xanthones, were isolated from the aerial parts of Hypericum acmosepalum, together with four known xanthones. Their structures with absolute configurations were elucidated on the basis of analysis of MS, NMR and chiroptical properties. A bioassay against high glucose-induced damage on human umbilical vein endothelial cells (HUVECs) showed ananixanthone (6) and osajaxanthone (7) had potential antioxidative damage activity with EC50 values of 10.5 µg/mL and 7.6 µg/mL, respectively, while 3-hydroxy-2,4-dimethoxyxanthone (8) exhibited cytotoxic effect on the damaged cells with IC50 values of 7.1 µg/mL.