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The endoplasmic reticulum (ER) serves as a hub for various cellular processes, and maintaining ER homeostasis is essential for cell function. Reticulophagy is a selective process that removes impaired ER subdomains through autophagy-mediatedlysosomal degradation. While the involvement of ubiquitination in autophagy regulation is well-established, its role in reticulophagy remains unclear. In this study, we screened deubiquitinating enzymes (DUBs) involved in reticulophagy and identified USP20 (ubiquitin specific peptidase 20) as a key regulator of reticulophagy under starvation conditions. USP20 specifically cleaves K48- and K63-linked ubiquitin chains on the reticulophagy receptor RETREG1/FAM134B (reticulophagy regulator 1), thereby stabilizing the substrate and promoting reticulophagy. Remarkably, despite lacking a transmembrane domain, USP20 is recruited to the ER through its interaction with VAPs (VAMP associated proteins). VAPs facilitate the recruitment of early autophagy proteins, including WIPI2 (WD repeat domain, phosphoinositide interacting 2), to specific ER subdomains, where USP20 and RETREG1 are enriched. The recruitment of WIPI2 and other proteins in this process plays a crucial role in facilitating RETREG1-mediated reticulophagy in response to nutrient deprivation. These findings highlight the critical role of USP20 in maintaining ER homeostasis by deubiquitinating and stabilizing RETREG1 at distinct ER subdomains, where USP20 further recruits VAPs and promotes efficient reticulophagy.Abbreviations: ACTB actin beta; ADRB2 adrenoceptor beta 2; AMFR/gp78 autocrine motility factor receptor; ATG autophagy related; ATL3 atlastin GTPase 3; BafA1 bafilomycin A1; BECN1 beclin 1; CALCOCO1 calcium binding and coiled-coil domain 1; CCPG1 cell cycle progression 1; DAPI 4',6-diamidino-2-phenylindole; DTT dithiothreitol; DUB deubiquitinating enzyme; EBSS Earle's Balanced Salt Solution; FFAT two phenylalanines (FF) in an acidic tract; GABARAP GABA type A receptor-associated protein; GFP green fluorescent protein; HMGCR 3-hydroxy-3-methylglutaryl-CoA reductase; IL1B interleukin 1 beta; LIR LC3-interacting region; MAP1LC3/LC3 microtubule associated protein 1 light chain 3; PIK3C3/Vps34 phosphatidylinositol 3-kinase catalytic subunit type 3; RB1CC1/FIP200 RB1 inducible coiled-coil 1; RETREG1/FAM134B reticulophagy regulator 1; RFP red fluorescent protein; RHD reticulon homology domain; RIPK1 receptor interacting serine/threonine kinase 1; RTN3L reticulon 3 long isoform; SEC61B SEC61 translocon subunit beta; SEC62 SEC62 homolog, preprotein translocation factor; SIM super-resolution structured illumination microscopy; SNAI2 snail family transcriptional repressor 2; SQSTM1/p62 sequestosome 1; STING1/MITA stimulator of interferon response cGAMP interactor 1; STX17 syntaxin 17; TEX264 testis expressed 264, ER-phagy receptor; TNF tumor necrosis factor; UB ubiquitin; ULK1 unc-51 like autophagy activating kinase 1; USP20 ubiquitin specific peptidase 20; USP33 ubiquitin specific peptidase 33; VAMP8 vesicle associated membrane protein 8; VAPs VAMP associated proteins; VMP1 vacuole membrane protein 1; WIPI2 WD repeat domain, phosphoinositide interacting 2; ZFYVE1/DFCP1 zinc finger FYVE-type containing 1.
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Autofagia , Retículo Endoplásmico , Proteínas de la Membrana , Ubiquitina Tiolesterasa , Ubiquitinación , Humanos , Autofagia/fisiología , Retículo Endoplásmico/metabolismo , Proteínas de la Membrana/metabolismo , Ubiquitina Tiolesterasa/metabolismo , Animales , Células HEK293 , Péptidos y Proteínas de Señalización Intracelular/metabolismo , Células HeLaRESUMEN
Accurate segmentation of the fetal head and pubic symphysis in intrapartum ultrasound images and measurement of fetal angle of progression (AoP) are critical to both outcome prediction and complication prevention in delivery. However, due to poor quality of perinatal ultrasound imaging with blurred target boundaries and the relatively small target of the public symphysis, fully automated and accurate segmentation remains challenging. In this paper, we propse a dual-path boundary-guided residual network (DBRN), which is a novel approach to tackle these challenges. The model contains a multi-scale weighted module (MWM) to gather global context information, and enhance the feature response within the target region by weighting the feature map. The model also incorporates an enhanced boundary module (EBM) to obtain more precise boundary information. Furthermore, the model introduces a boundary-guided dual-attention residual module (BDRM) for residual learning. BDRM leverages boundary information as prior knowledge and employs spatial attention to simultaneously focus on background and foreground information, in order to capture concealed details and improve segmentation accuracy. Extensive comparative experiments have been conducted on three datasets. The proposed method achieves average Dice score of 0.908 ±0.05 and average Hausdorff distance of 3.396 ±0.66 mm. Compared with state-of-the-art competitors, the proposed DBRN achieves better results. In addition, the average difference between the automatic measurement of AoPs based on this model and the manual measurement results is 6.157 °, which has good consistency and has broad application prospects in clinical practice.
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Cabeza , Sínfisis Pubiana , Ultrasonografía Prenatal , Humanos , Embarazo , Femenino , Ultrasonografía Prenatal/métodos , Cabeza/diagnóstico por imagen , Sínfisis Pubiana/diagnóstico por imagen , AlgoritmosRESUMEN
The accurate selection of the ultrasound plane for the fetal head and pubic symphysis is critical for precisely measuring the angle of progression. The traditional method depends heavily on sonographers manually selecting the imaging plane. This process is not only time-intensive and laborious but also prone to variability based on the clinicians' expertise. Consequently, there is a significant need for an automated method driven by artificial intelligence. To enhance the efficiency and accuracy of identifying the pubic symphysis-fetal head standard plane (PSFHSP), we proposed a streamlined neural network, PSFHSP-Net, based on a modified version of ResNet-18. This network comprises a single convolutional layer and three residual blocks designed to mitigate noise interference and bolster feature extraction capabilities. The model's adaptability was further refined by expanding the shared feature layer into task-specific layers. We assessed its performance against both traditional heavyweight and other lightweight models by evaluating metrics such as F1-score, accuracy (ACC), recall, precision, area under the ROC curve (AUC), model parameter count, and frames per second (FPS). The PSFHSP-Net recorded an ACC of 0.8995, an F1-score of 0.9075, a recall of 0.9191, and a precision of 0.9022. This model surpassed other heavyweight and lightweight models in these metrics. Notably, it featured the smallest model size (1.48 MB) and the highest processing speed (65.7909 FPS), meeting the real-time processing criterion of over 24 images per second. While the AUC of our model was 0.930, slightly lower than that of ResNet34 (0.935), it showed a marked improvement over ResNet-18 in testing, with increases in ACC and F1-score of 0.0435 and 0.0306, respectively. However, precision saw a slight decrease from 0.9184 to 0.9022, a reduction of 0.0162. Despite these trade-offs, the compression of the model significantly reduced its size from 42.64 to 1.48 MB and increased its inference speed by 4.4753 to 65.7909 FPS. The results confirm that the PSFHSP-Net is capable of swiftly and effectively identifying the PSFHSP, thereby facilitating accurate measurements of the angle of progression. This development represents a significant advancement in automating fetal imaging analysis, promising enhanced consistency and reduced operator dependency in clinical settings.
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The segmentation of the fetal head (FH) and pubic symphysis (PS) from intrapartum ultrasound images plays a pivotal role in monitoring labor progression and informing crucial clinical decisions. Achieving real-time segmentation with high accuracy on systems with limited hardware capabilities presents significant challenges. To address these challenges, we propose the real-time segmentation network (RTSeg-Net), a groundbreaking lightweight deep learning model that incorporates innovative distribution shifting convolutional blocks, tokenized multilayer perceptron blocks, and efficient feature fusion blocks. Designed for optimal computational efficiency, RTSeg-Net minimizes resource demand while significantly enhancing segmentation performance. Our comprehensive evaluation on two distinct intrapartum ultrasound image datasets reveals that RTSeg-Net achieves segmentation accuracy on par with more complex state-of-the-art networks, utilizing merely 1.86 M parameters-just 6 % of their hyperparameters-and operating seven times faster, achieving a remarkable rate of 31.13 frames per second on a Jetson Nano, a device known for its limited computing capacity. These achievements underscore RTSeg-Net's potential to provide accurate, real-time segmentation on low-power devices, broadening the scope for its application across various stages of labor. By facilitating real-time, accurate ultrasound image analysis on portable, low-cost devices, RTSeg-Net promises to revolutionize intrapartum monitoring, making sophisticated diagnostic tools accessible to a wider range of healthcare settings.
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Cabeza , Sínfisis Pubiana , Ultrasonografía Prenatal , Humanos , Femenino , Embarazo , Cabeza/diagnóstico por imagen , Ultrasonografía Prenatal/métodos , Sínfisis Pubiana/diagnóstico por imagen , Aprendizaje Profundo , Feto/diagnóstico por imagenRESUMEN
During the process of labor, the intrapartum transperineal ultrasound examination serves as a valuable tool, allowing direct observation of the relative positional relationship between the pubic symphysis and fetal head (PSFH). Accurate assessment of fetal head descent and the prediction of the most suitable mode of delivery heavily rely on this relationship. However, achieving an objective and quantitative interpretation of the ultrasound images necessitates precise PSFH segmentation (PSFHS), a task that is both time-consuming and demanding. Integrating the potential of artificial intelligence (AI) in the field of medical ultrasound image segmentation, the development and evaluation of AI-based models rely significantly on access to comprehensive and meticulously annotated datasets. Unfortunately, publicly accessible datasets tailored for PSFHS are notably scarce. Bridging this critical gap, we introduce a PSFHS dataset comprising 1358 images, meticulously annotated at the pixel level. The annotation process adhered to standardized protocols and involved collaboration among medical experts. Remarkably, this dataset stands as the most expansive and comprehensive resource for PSFHS to date.
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Inteligencia Artificial , Cabeza , Sínfisis Pubiana , Ultrasonografía Prenatal , Humanos , Sínfisis Pubiana/diagnóstico por imagen , Femenino , Embarazo , Cabeza/diagnóstico por imagen , Feto/diagnóstico por imagenRESUMEN
The current challenge in effectively treating atrial fibrillation (AF) stems from a limited understanding of the intricate structure of the human atria. The objective and quantitative interpretation of the right atrium (RA) in late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) scans relies heavily on its precise segmentation. Leveraging the potential of artificial intelligence (AI) for RA segmentation presents a promising solution. However, the successful implementation of AI in this context necessitates access to a substantial volume of annotated LGE-MRI images for model training. In this paper, we present a comprehensive 3D cardiac dataset comprising 50 high-resolution LGE-MRI scans, each meticulously annotated at the pixel level. The annotation process underwent rigorous standardization through crowdsourcing among a panel of medical experts, ensuring the accuracy and consistency of the annotations. Our dataset represents a significant contribution to the field, providing a valuable resource for advancing RA segmentation methods.
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Fibrilación Atrial , Atrios Cardíacos , Imagen por Resonancia Magnética , Humanos , Inteligencia Artificial , Fibrilación Atrial/patología , Gadolinio , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/patología , Imagen por Resonancia Magnética/métodosRESUMEN
Persistent atrial fibrillation (AF) is not effectively treated due to a lack of adequate tools for identifying patient-specific AF substrates. Recent studies revealed that in 30-50% of patients, persistent AF is maintained by localized drivers not only in the left atrium (LA) but also in the right atrium (RA). The chamber-specific atrial wall thickness (AWT) features underlying AF remain elusive, though the important role of AWT in AF is widely acknowledged. We aimed to provide direct evidence of the existence of distinguished RA and LA AWT features underlying AF drivers by analysing functionally and structurally mapped human hearts ex vivo. Coronary-perfused intact human atria (n = 7, 47 ± 14 y.o.; two female) were mapped using panoramic near-infrared optical mapping during pacing-induced AF. Then the hearts were imaged at approximately 170 µm3 resolution by 9.4 T gadolinium-enhanced MRI. The heart was segmented, and 3D AWT throughout atrial chambers was estimated and analysed. Optical mapping identified six localized RA re-entrant drivers in four hearts and four LA drivers in three hearts. All RA AF drivers were anchored to the pectinate muscle junctions with the crista terminalis or atrial walls. The four LA AF drivers were in the posterior LA. RA (n = 4) with AF drivers were thicker with greater AWT variation than RA (n = 3) without drivers (5.4 ± 2.6 mm versus 5.0 ± 2.4 mm, T-test p < 0.05; F-test p < 0.05). Furthermore, AWT in RA driver regions was thicker and varied more than in RA non-driver regions (5.1 ± 2.5 mm versus 4.4 ± 2.2 mm, T-test p < 0.05; F-test p < 0.05). On the other hand, LA (n = 3) with drivers was thinner than the LA (n = 4) without drivers. In particular, LA driver regions were thinner than the rest of LA regions (3.4 ± 1.0 mm versus 4.2 ± 1.0 mm, T-test p < 0.05). This study demonstrates chamber-specific AWT features of AF drivers. In RA, driver regions are thicker and have more variable AWT than non-driver regions. By contrast, LA drivers are thinner than non-drivers. Robust evaluation of patient-specific AWT features should be considered for chamber-specific targeted ablation.
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This study aimed to use multi-scale atrial models to investigate pulmonary arterial hypertension (PAH)-induced atrial fibrillation mechanisms. The results of our computer simulations revealed that, at the single-cell level, PAH-induced remodelling led to a prolonged action potential (AP) (ΔAPD: 49.6 ms in the right atria (RA) versus 41.6 ms in the left atria (LA)) and an increased calcium transient (CaT) (ΔCaT: 7.5 × 10-2 µM in the RA versus 0.9 × 10-3 µM in the LA). Moreover, heterogeneous remodelling increased susceptibility to afterdepolarizations, particularly in the RA. At the tissue level, we observed a significant reduction in conduction velocity (CV) (ΔCV: -0.5 m s-1 in the RA versus -0.05 m s-1 in the LA), leading to a shortened wavelength in the RA, but not in the LA. Additionally, afterdepolarizations in the RA contributed to enhanced repolarization dispersion and facilitated unidirectional conduction block. Furthermore, the increased fibrosis in the RA amplified the likelihood of excitation wave breakdown and the occurrence of sustained re-entries. Our results indicated that the RA is characterized by increased susceptibility to afterdepolarizations, slow conduction, reduced wavelength and upregulated fibrosis. These findings shed light on the underlying factors that may promote atrial fibrillation in patients with PAH.
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The sinoatrial node (SAN), the primary pacemaker of the heart, is responsible for the initiation and robust regulation of sinus rhythm. 3D mapping studies of the ex-vivo human heart suggested that the robust regulation of sinus rhythm relies on specialized fibrotically-insulated pacemaker compartments (head, center and tail) with heterogeneous expressions of key ion channels and receptors. They also revealed up to five sinoatrial conduction pathways (SACPs), which electrically connect the SAN with neighboring right atrium (RA). To elucidate the role of these structural-molecular factors in the functional robustness of human SAN, we developed comprehensive biophysical computer models of the SAN based on 3D structural, functional and molecular mapping of ex-vivo human hearts. Our key finding is that the electrical insulation of the SAN except SACPs, the heterogeneous expression of If, INa currents and adenosine A1 receptors (A1R) across SAN pacemaker-conduction compartments are required to experimentally reproduce observed SAN activation patterns and important phenomena such as shifts of the leading pacemaker and preferential SACP. In particular, we found that the insulating border between the SAN and RA, is required for robust SAN function and protection from SAN arrest during adenosine challenge. The heterogeneity in the expression of A1R within the human SAN compartments underlies the direction of pacemaker shift and preferential SACPs in the presence of adenosine. Alterations of INa current and fibrotic remodelling in SACPs can significantly modulate SAN conduction and shift the preferential SACP/exit from SAN. Finally, we show that disease-induced fibrotic remodeling, INa suppression or increased adenosine make the human SAN vulnerable to pacing-induced exit blocks and reentrant arrhythmia. In summary, our computer model recapitulates the structural and functional features of the human SAN and can be a valuable tool for investigating mechanisms of SAN automaticity and conduction as well as SAN arrhythmia mechanisms under different pathophysiological conditions.
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Sistema de Conducción Cardíaco , Nodo Sinoatrial , Humanos , Nodo Sinoatrial/fisiología , Arritmias Cardíacas , Adenosina , Simulación por ComputadorRESUMEN
Background: This study aims to compare the fetal heart rate (FHR) baseline predicted by the cardiotocograph network (CTGNet) with that estimated by clinicians. Material and methods: A total of 1,267 FHR recordings acquired with different electrical fetal monitors (EFM) were collected from five datasets: 84 FHR recordings acquired with F15 EFM (Edan, Shenzhen, China) from the Guangzhou Women and Children's Medical Center, 331 FHR recordings acquired with SRF618B5 EFM (Sanrui, Guangzhou, China), 234 FHR recordings acquired with F3 EFM (Lian-Med, Guangzhou, China) from the NanFang Hospital of Southen Medical University, 552 cardiotocographys (CTG) recorded using STAN S21 and S31 (Neoventa Medical, Mölndal, Sweden) and Avalon FM40 and FM50 (Philips Healthcare, Amsterdam, The Netherlands) from the University Hospital in Brno, Czech Republic, and 66 FHR recordings acquired using Avalon FM50 fetal monitor (Philips Healthcare, Amsterdam, The Netherlands) at St Vincent de Paul Hospital (Lille, France). Each FHR baseline was estimated by clinicians and CTGNet, respectively. And agreement between CTGNet and clinicians was evaluated using the kappa statistics, intra-class correlation coefficient, and the limits of agreement. Results: The number of differences <3 beats per minute (bpm), 3-5â bpm, 5-10â bpm and ≥10â bpm, is 64.88%, 15.94%, 14.44% and 4.74%, respectively. Kappa statistics and intra-class correlation coefficient are 0.873 and 0.969, respectively. Limits of agreement are -6.81 and 7.48 (mean difference: 0.36 and standard deviation: 3.64). Conclusion: An excellent agreement was found between CTGNet and clinicians in the baseline estimation from FHR recordings with different signal loss rates.
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PURPOSE: In recent years, breast cancer has become the greatest threat to women. There are many studies dedicated to the precise segmentation of breast tumors, which is indispensable in computer-aided diagnosis. Deep neural networks have achieved accurate segmentation of images. However, convolutional layers are biased to extract local features and tend to lose global and location information as the network deepens, which leads to a decrease in breast tumors segmentation accuracy. For this reason, we propose a hybrid attention-guided network (HAG-Net). We believe that this method will improve the detection rate and segmentation of tumors in breast ultrasound images. METHODS: The method is equipped with multi-scale guidance block (MSG) for guiding the extraction of low-resolution location information. Short multi-head self-attention (S-MHSA) and convolutional block attention module are used to capture global features and long-range dependencies. Finally, the segmentation results are obtained by fusing multi-scale contextual information. RESULTS: We compare with 7 state-of-the-art methods on two publicly available datasets through five random fivefold cross-validations. The highest dice coefficient, Jaccard Index and detect rate ([Formula: see text]%, [Formula: see text]%, [Formula: see text]% and [Formula: see text]%, [Formula: see text]%, [Formula: see text]%, separately) obtained on two publicly available datasets(BUSI and OASUBD), prove the superiority of our method. CONCLUSION: HAG-Net can better utilize multi-resolution features to localize the breast tumors. Demonstrating excellent generalizability and applicability for breast tumors segmentation compare to other state-of-the-art methods.
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Neoplasias de la Mama , Procesamiento de Imagen Asistido por Computador , Humanos , Femenino , Procesamiento de Imagen Asistido por Computador/métodos , Ultrasonografía Mamaria , Redes Neurales de la Computación , Neoplasias de la Mama/diagnóstico por imagen , Diagnóstico por ComputadorRESUMEN
Cardiac magnetic resonance imaging (MRI) segmentation task refers to the accurate segmentation of ventricle and myocardium, which is a prerequisite for evaluating the soundness of cardiac function. With the development of deep learning in medical imaging, more and more heart segmentation methods based on deep learning have been proposed. Due to the fuzzy boundary and uneven intensity distribution of cardiac MRI, some existing methods do not make full use of multi-scale characteristic information and have the problem of ambiguity between classes. In this paper, we propose a dilated convolution network with edge fusion block and directional feature maps for cardiac MRI segmentation. The network uses feature fusion module to preserve boundary information, and adopts the direction field module to obtain the feature maps to improve the original segmentation features. Firstly, multi-scale feature information is obtained and fused through dilated convolutional layers of different scales while downsampling. Secondly, in the decoding stage, the edge fusion block integrates the edge features into the side output of the encoder and concatenates them with the upsampled features. Finally, the concatenated features utilize the direction field to improve the original segmentation features and generate the final result. Our propose method conducts comprehensive comparative experiments on the automated cardiac diagnosis challenge (ACDC) and myocardial pathological segmentation (MyoPS) datasets. The results show that the proposed cardiac MRI segmentation method has better performance compared to other existing methods.
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The generalization ability of the fetal head segmentation method is reduced due to the data obtained by different machines, settings, and operations. To keep the generalization ability, we proposed a Fourier domain adaptation (FDA) method based on amplitude and phase to achieve better multi-source ultrasound data segmentation performance. Given the source/target image, the Fourier domain information was first obtained using fast Fourier transform. Secondly, the target information was mapped to the source Fourier domain through the phase adjustment parameter α and the amplitude adjustment parameter ß. Thirdly, the target image and the preprocessed source image obtained through the inverse discrete Fourier transform were used as the input of the segmentation network. Finally, the dice loss was computed to adjust α and ß. In the existing transform methods, the proposed method achieved the best performance. The adaptive-FDA method provides a solution for the automatic preprocessing of multi-source data. Experimental results show that it quantitatively improves the segmentation results and model generalization performance.
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Cabeza , Ultrasonografía Prenatal , Femenino , Embarazo , Humanos , Ultrasonografía , Cabeza/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodosRESUMEN
CTG (cardiotocography) has consistently been used to diagnose fetal hypoxia. It is susceptible to identifying the average fetal acid-base balance but lacks specificity in recognizing prenatal acidosis and neurological impairment. CTG plays a vital role in intrapartum fetal state assessment, which can prevent severe organ damage if fetal hypoxia is detected earlier. In this paper, we propose a novel deep feature fusion network (DFFN) for fetal state assessment. First, we extract spatial and temporal information from the fetal heart rate (FHR) signal using a multiscale CNN-BiLSTM network, increasing the features' diversity. Second, the multiscale CNN-BiLSM network and frequently used features are integrated into the deep learning model. The proposed DFFN model combines different features to improve classification accuracy. The multiscale convolutional kernels can identify specific essential information and consider signal's temporal information. The proposed method achieves 61.97%, 73.82%, and 66.93% of sensitivity, specificity, and quality index, respectively, on the public CTU-UHB database. The proposed method achieves the highest QI on the private database, verifying the proposed method's effectiveness and generalization. The proposed DFFN combines the advantages of feature engineering and deep learning models and achieves competitive accuracy in fetal state assessment compared with related works.
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Background: Accurate assessment of fetal descent by monitoring the fetal head (FH) station remains a clinical challenge in guiding obstetric management. Angle of progression (AoP) has been suggested to be a reliable and reproducible parameter for the assessment of FH descent. Methods: A novel framework, including image segmentation, target fitting and AoP calculation, is proposed for evaluating fetal descent. For image segmentation, this study presents a novel double branch segmentation network (DBSN), which consists of two parts: an encoding part receives image input, and a decoding part composed of deformable convolutional blocks and ordinary convolutional blocks. The decoding part includes the lower and upper branches, and the feature map of the lower branch is used as the input of the upper branch to assist the upper branch in decoding after being constrained by the attention gate (AG). Given an original transperineal ultrasound (TPU) image, areas of the pubic symphysis (PS) and FH are firstly segmented using the proposed DBSN, the ellipse contours of segmented regions are secondly fitted with the least square method, and three endpoints are finally determined for calculating AoP. Results: Our private dataset with 313 transperineal ultrasound (TPU) images was used for model evaluation with 5-fold cross-validation. The proposed method achieves the highest Dice coefficient (93.4%), the smallest Average Surface Distance (6.268 pixels) and the lowest AoP difference (5.993°) by comparing four state-of-the-art methods. Similar results (Dice coefficient: 91.7%, Average Surface Distance: 7.729 pixels: AoP difference: 5.110°) were obtained on a public dataset with >3,700 TPU images for evaluating its generalization performance. Conclusion: The proposed framework may be used for the automatic measurement of AoP with high accuracy and generalization performance. However, its clinical availability needs to be further evaluated.
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The angle of progression (AoP) for assessing fetal head (FH) descent during labor is measured from the standard plane of transperineal ultrasound images as the angle between a line through the long axis of pubic symphysis (PS) and a second line from the right end of PS tangentially to the contour of the FH. This paper presents a multitask network with a shared feature encoder and three task-special decoders for standard plane recognition (Task1), image segmentation (Task2) of PS and FH, and endpoint detection (Task3) of PS. Based on the segmented FH and two endpoints of PS from standard plane images, we determined the right FH tangent point that passes through the right endpoint of PS and then computed the AoP using the above three points. In this paper, the efficient channel attention unit is introduced into the shared feature encoder for improving the robustness of layer region encoding, while an attention fusion module is used to promote cross-branch interaction between the encoder for Task2 and that for Task3, and a shape-constrained loss function is designed for enhancing the robustness to noise based on the convex shape-prior. We use Pearson's correlation coefficient and the Bland-Altman graph to assess the degree of agreement. The dataset includes 1964 images, where 919 images are nonstandard planes, and the other 1045 images are standard planes including PS and FH. We achieve a classification accuracy of 92.26%, and for the AoP calculation, an absolute mean (STD) value of the difference in AoP (∆AoP) is 3.898° (3.192°), the Pearson's correlation coefficient between manual and automated AoP was 0.964 and the Bland-Altman plot demonstrates they were statistically significant (P < 0.05). In conclusion, our approach can achieve a fully automatic measurement of AoP with good efficiency and may help labor progress in the future.
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Presentación en Trabajo de Parto , Ultrasonografía Prenatal , Femenino , Feto/diagnóstico por imagen , Humanos , Redes Neurales de la Computación , Embarazo , Reproducibilidad de los Resultados , Ultrasonografía Prenatal/métodosRESUMEN
Atrial fibrillation (AF) with multiple complications, high morbidity and mortality, and low cure rates, has become a global public health problem. Although significant progress has been made in the treatment methods represented by anti-AF drugs and radiofrequency ablation, the therapeutic effect is not as good as expected. The reason is mainly because of our lack of understanding of AF mechanisms. This field has benefited from mechanistic and (or) statistical methodologies. Recent renewed interest in digital twin techniques by synergizing between mechanistic and statistical models has opened new frontiers in AF analysis. In the review, we briefly present findings that gave rise to the AF pathophysiology and current therapeutic modalities. We then summarize the achievements of digital twin technologies in three aspects: understanding AF mechanisms, screening anti-AF drugs and optimizing ablation strategies. Finally, we discuss the challenges that hinder the clinical application of the digital twin heart. With the rapid progress in data reuse and sharing, we expect their application to realize the transition from AF description to response prediction.
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Background: Complete electronic health records (EHRs) are not often available, because information barriers are caused by differences in the level of informatization and the type of the EHR system. Therefore, we aimed to develop a deep learning system [deep learning system for structured recognition of text images from unstructured paper-based medical reports (DeepSSR)] for structured recognition of text images from unstructured paper-based medical reports (UPBMRs) to help physicians solve the data-sharing problem. Methods: UPBMR images were firstly preprocessed through binarization, image correction, and image segmentation. Next, the table area was detected with a lightweight network (i.e., the proposed YOLOv3-MobileNet model). In addition, the text of the table area was detected and recognized with the model based on differentiable binarization (DB) and convolutional recurrent neural network (CRNN). Finally, the recognized text was structured according to its row and column coordinates. DeepSSR was trained and validated on our dataset with 4,221 UPBMR images which were randomly split into training, validation, and testing sets in a ratio of 8:1:1. Results: DeepSSR achieved a high accuracy of 91.10% and a speed of 0.668 s per image. In the system, the proposed YOLOv3-MobileNet model for table detection achieved a precision of 97.8% and a speed of 0.006 s per image. Conclusions: DeepSSR has high accuracy and fast speed in structured recognition of text based on UPBMR images. This system may help solve the data-sharing problem due to information barriers between hospitals with different EHR systems.