Clinical Validation of a Deep Learning-Based Software for Lumbar Bone Mineral Density and T-Score Prediction from Chest X-ray Images.

Screening for osteoporosis is crucial for early detection and prevention, yet it faces challenges due to the low accuracy of calcaneal quantitative ultrasound (QUS) and limited access to dual-energy X-ray absorptiometry (DXA) scans. Recent advances in AI offer a promising solution through opportunistic screening using existing medical images. This study aims to utilize deep learning techniques to develop a model that analyzes chest X-ray (CXR) images for osteoporosis screening. This study included the AI model development stage and the clinical validation stage. In the AI model development stage, the combined dataset of 5122 paired CXR images and DXA reports from the patients aged 20 to 98 years at a medical center was collected. The images were enhanced and filtered for hardware retention such as pedicle screws, bone cement, artificial intervertebral discs or severe deformity in target level of T12 and L1. The dataset was then separated into training, validating, and testing datasets for model training and performance validation. In the clinical validation stage, we collected 440 paired CXR images and DXA reports from both the TCVGH and Joy Clinic, including 304 pared data from TCVGH and 136 paired data from Joy Clinic. The pre-clinical test yielded an area under the curve (AUC) of 0.940, while the clinical validation showed an AUC of 0.946. Pearson's correlation coefficient was 0.88. The model demonstrated an overall accuracy, sensitivity, and specificity of 89.0%, 88.7%, and 89.4%, respectively. This study proposes an AI model for opportunistic osteoporosis screening through CXR, demonstrating good performance and suggesting its potential for broad adoption in preliminary screening among high-risk populations.

Early experience of endobronchial ultrasound-guided transbronchial nodal cryobiopsy: a case series from Sabah, Malaysia.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established minimally invasive method for the diagnosis of benign and malignant conditions. Continuous efforts are underway to improve the material adequacy of EBUS-TBNA, including the introduction of a new technique called EBUS-guided transbronchial nodal cryobiopsy (EBUS-TBNC). This method allows for the retrieval of larger and well-preserved histologic samples from the mediastinum. We present a case series of four patients who underwent combined EBUS-TBNA and EBUS-TBNC procedures in our centre. All procedures were performed under general anaesthesia using a convex probe EBUS scope (Pentax EB-1970UK). Two patients were diagnosed with malignancy and two with benign disorders (silicosis and tuberculosis). In the malignant cases, both EBUS-TBNA/cell block and cryobiopsy provided a diagnosis but cryobiopsy yielded more material for ancillary tests in one patient. However, in the benign cases, there was discordance between EBUS-TBNA/cell block and cryobiopsy. Only cryobiopsy detected granuloma in the patient with TB (tuberculosis), and in the patient with silicosis, TBNC provided a better overall histological evaluation, leading to a definitive diagnosis. No complications were observed. This case series supports the potential diagnostic value of combining EBUS-TBNA and EBUS-TBNC, particularly in benign mediastinal lesions (granulomatous diseases), and in cases requiring additional molecular tests in cancer diagnosis.

Exploring a new lymph node biopsy technique: case series from Sabah, MalaysiaWe explored a new technique for lung diagnosis called EBUS-guided transbronchial nodal cryobiopsy (EBUS-TBNC). This method helps get larger and well-preserved tissue samples from the chest area. In our study, we used this technique on four patients alongside the established method called EBUS-guided transbronchial needle aspiration (EBUS-TBNA). All procedures were done with the patient under general anesthesia using a specific type of scope. Two patients were found to have cancer, and two had non-cancerous conditions (silicosis and tuberculosis). In the cancer cases, both methods provided a diagnosis, but the cryobiopsy gave more material for additional tests in one patient. However, in non-cancer cases, there were differences between the two methods. Only the cryobiopsy detected granulomas in the tuberculosis patient, and in the silicosis patient, cryobiopsy gave a better overall tissue evaluation, leading to a clear diagnosis. No complications were seen in any of the cases. This study suggests that combining EBUS-TBNA and EBUS-TBNC can be valuable, especially for non-cancerous chest lesions (like granulomatous diseases) and when extra tests are needed for cancer diagnosis.

Management of extensive subcutaneous emphysema using negative pressure wound therapy dressings.

Subcutaneous emphysema (SE) is a common but usually self-limiting complication of cardiothoracic procedures. Rarely, it can be life threatening and is characterized by extensive cutaneous tension and airway compromise requiring immediate intervention. There is a paucity of data on the most efficacious treatment methods for extensive SE. We report an 80-year-old gentleman who developed massive SE necessitating intubation for airway protection following a right chest tube insertion for spontaneous secondary pneumothorax. His SE persisted despite adequate thoracic drainage via a new chest tube. It was then decided to insert two negative pressure wound therapy dressings (NPWTD) or vacuum dressings in the patient's subcutaneous tissue layer via incisions made at anterior chest wall. The dressings were removed after four days in view of significant improvements. NPWTD appears to be an effective, well-tolerated, safe, and inexpensive approach that hastens the resolution of SE without the need for invasive thoracic surgeries.

Genetic Predisposition and Disease Expression of Bipolar Disorder Reflected in Shape Changes of the Anterior Limbic Network.

Bipolar disorder (BD) is a genetically and phenotypically complex psychiatric disease. Although previous studies have suggested that the relatives of BD patients have an increased risk of experiencing affective disturbances, most relatives who have similar genotypes may not manifest the disorder. We aim to identify the neuroimaging alterations-specifically, the cortical folding structures of the anterior limbic network (ALN)-in BD patients and their siblings, compared to healthy controls. The shared alterations in patients and their siblings may indicate the hereditary predisposition of BD, and the altered cortical structures unique to BD patients may be a probe of BD expression. High-resolution, T1-weighted magnetic resonance images for 17 euthymic patients with BD, 17 unaffected siblings of BD patients, and 22 healthy controls were acquired. We categorized the cortical regions within the ALN into sulcal and gyral areas, based on the shape index, followed by the measurement of the folding degree, using the curvedness. Our results revealed that the changes in cortical folding in the orbitofrontal and temporal regions were associated with a hereditary predisposition to BD. Cortical folding structures in multiple regions of the ALN, particularly in the striatal-thalamic circuit and anterior cingulate cortex, could be used to differentiate BD patients from healthy controls and unaffected siblings. We concluded that the cortical folding structures of ALN can provide potential biomarkers for clinical diagnosis of BD and differentiation from the unaffected siblings.

Programmable ExG biopotential front-end IC for wearable applications.

This paper presents a configurable CMOS integrated circuit front-end for the recording of a wide range of biopotentials (ExG). The system offers a choice between a single-differential or double-differential recording channel topology, wide continuously adjustable gain range (37-66 dB), selectable CMOS or BJT input stages, offset compensation, differential and buffered single-ended voltage output. Measured results from a prototype manufactured in 0.35 µm CMOS technology are presented. Practical recording examples of the electrocardiogram (ECG) and electromyogram (EMG) confirm its operation. The chip consumes between 110 and 324 µW depending on configuration, occupies a core area of 0.16 mm(2), achieves a CMRR > 97 dB , and 21 nV/√Hz input-referred noise. The chip is suited for combination with a microcontroller in long-term wearable physiological sensing applications.

Altered resting-state functional connectivity of striatal-thalamic circuit in bipolar disorder.

Bipolar disorder is characterized by internally affective fluctuations. The abnormality of inherently mental state can be assessed using resting-state fMRI data without producing task-induced biases. In this study, we hypothesized that the resting-state connectivity related to the frontal, striatal, and thalamic regions, which were associated with mood regulations and cognitive functions, can be altered for bipolar disorder. We used the Pearson's correlation coefficients to estimate functional connectivity followed by the hierarchical modular analysis to categorize the resting-state functional regions of interest (ROIs). The selected functional connectivities associated with the striatal-thalamic circuit and default mode network (DMN) were compared between bipolar patients and healthy controls. Significantly decreased connectivity in the striatal-thalamic circuit and between the striatal regions and the middle and posterior cingulate cortex was observed in the bipolar patients. We also observed that the bipolar patients exhibited significantly increased connectivity between the thalamic regions and the parahippocampus. No significant changes of connectivity related to the frontal regions in the DMN were observed. The changed resting-state connectivity related to the striatal-thalamic circuit might be an inherent basis for the altered emotional and cognitive processing in the bipolar patients.

Classification of bipolar disorder using basal-ganglia-related functional connectivity in the resting state.

The emotional and cognitive symptoms of bipolar disorder (BD) are suggested to involve in a distributed neural network. The resting-state functional magnetic resonance imaging (fMRI) offers an important tool to investigate the alterations in brain network level of BD. The aim of this study was to discriminate BD patients from healthy controls using whole-brain resting-state functional connectivity patterns. The majority of most discriminating functional connectivities were between the basal ganglia and three core neurocognitive networks, including the default mode, executive control and salience networks. Using these resting-state functional connectivities between the basal ganglia and three core neurocognitive networks as the features, the clustering accuracy achieved 90%.

Dynamics of hemoglobin states in the sensorimotor cortex during motor tasks: a functional near infrared spectroscopy study.

In this study, we used functional near infrared spectroscopy (fNIRS) imaging to investigate the independent levels of oxygenated, deoxygenated, and total hemoglobin (oxy-Hb, deoxy-Hb, and total-Hb, respectively) at the sensorimotor cortex during hand-grasping motor tasks. Our results showed that the activation of contralateral primary motor cortex (M1) exhibited increased oxy-Hb and reduced dexoy-Hb after hand grasping began. Meanwhile, the contralateral primary somatosensory cortex (S1) was deactivated with reductions of both oxy-Hb and deoxy-Hb concentration. The Hb circulation patterns indicated that the hand grasping demanded rapid and sufficient O2 supply at contralateral M1, which was achieved by the local vasodilation. The contralateral S1 presented decreased total-Hb via the mechanism of vasoconstriction, and maintained the local oxygenation level in a relatively stable state (mostly with O2 debt) to compensate the blood demanding at nearby M1. This study presented that fNIRS data can efficiently differentiate the activation of M1 from the deactivation of S1 during motor tasks, which can provide full interpretations of hemodynamic response to the neuronal activation in comparison with the Blood Oxygenation Level Dependent signal of functional magnetic resonance imaging.

Sculpting the Intrinsic Modular Organization of Spontaneous Brain Activity by Art.

Artistic training is a complex learning that requires the meticulous orchestration of sophisticated polysensory, motor, cognitive, and emotional elements of mental capacity to harvest an aesthetic creation. In this study, we investigated the architecture of the resting-state functional connectivity networks from professional painters, dancers and pianists. Using a graph-based network analysis, we focused on the art-related changes of modular organization and functional hubs in the resting-state functional connectivity network. We report that the brain architecture of artists consists of a hierarchical modular organization where art-unique and artistic form-specific brain states collectively mirror the mind states of virtuosos. We show that even in the resting state, this type of extraordinary and long-lasting training can macroscopically imprint a neural network system of spontaneous activity in which the related brain regions become functionally and topologically modularized in both domain-general and domain-specific manners. The attuned modularity reflects a resilient plasticity nurtured by long-term experience.

Disrupted cerebellar connectivity reduces whole-brain network efficiency in multiple system atrophy.

Multiple system atrophy of the cerebellar type is a sporadic neurodegenerative disorder of the central nervous system. We hypothesized that the white matter degeneration of the cerebellum and pons in this disease may cause a breakdown of cerebellar structural networks and further reduce the network efficiency of cerebellar-connected cerebral regions. Diffusion tensor tractography was used to construct the structural networks of 19 cerebellar-type multiple system atrophy patients, who were compared with 19 age- and sex-matched controls. Graph theory was used to assess the small-world properties and topological organization of structure networks in both the control and patient groups. Our results showed that the cerebellar-type multiple system atrophy patients exhibited altered small-world architecture with significantly increased characteristic shortest path lengths and decreased clustering coefficients. We also found that white matter degeneration in the cerebellum was characterized by reductions in network strength (number and integrity of fiber connections) of the cerebellar regions, which further induced extensively decreased network efficiency for numerous cerebral regions. Finally, we found that the reductions in nodal efficiency of the cerebellar lobules and bilateral sensorimotor, prefrontal, and basal ganglia regions negatively correlated with the severity of ataxia for the cerebellar-type multiple system atrophy patients. This study demonstrates for the first time that the brains of cerebellar-type multiple system atrophy patients exhibit disrupted topological organization of white matter structural networks. Thus, this study provides structural evidence of the relationship between abnormalities of white matter integrity and network efficiency that occurs in cerebellar-type multiple system atrophy.

Reorganization of functional connectivity during the motor task using EEG time-frequency cross mutual information analysis.

OBJECTIVE: This study investigates the functional organization of cortical networks during self-determinant arm movement using the time sequences of the alpha (8-12 Hz) and beta (16-25 Hz) bands. METHODS: The time-frequency cross mutual information (TFCMI) method was used to estimate the EEG functional connectivity in the alpha and beta bands for seven healthy subjects during four functional states: the resting, preparing, movement-onset, and movement-offset states. RESULTS: In the preparing state, the maintenance of the central-executive network (CEN, prefrontal-parietal connection) suppressed the motor network in the alpha band to plan the next movement, whereas the CEN was deactivated in the beta band to retain visual attention (the frontal-occipital connection). A significant decrease of the CEN in the alpha band occurred after a visual cue in the movement-onset state, followed by a significant increase in motor-network connectivity in the beta band until the movement-offset state. CONCLUSIONS: The temporal-spectral modulation mechanism allows the brain to manifest multiple functions subject to energy budget. SIGNIFICANCE: The TFCMI method was employed to estimate EEG functional connectivity and effectively demonstrate the reorganization process between four functional states.

Early detection of periodic sharp wave complexes on EEG by independent component analysis in patients with Creutzfeldt-Jakob disease.

Sporadic Creutzfeldt-Jakob disease (sCJD) is the most common human prion disease. EEG is the method of choice to support the diagnosis of a human prion disease. Periodic sharp wave complexes (PSWCs) on the EEG usually indicate a progressive stage of CJD. However, PSWCs only become obvious at around 8 to 12 weeks after the onset of clinical symptoms, and in a few cases, even later. Independent component analysis (ICA) is a new technique to separate statistically independent components from a mixture of data. This study recruited seven patients who fit the criteria of CJD between 2002 and 2005 and 10 patients with Alzheimer's disease (AD) as control subjects. Using an ICA algorithm, we were able to split typical PSWCs into several independent temporal components in conjunction with spatial maps. The PSWCs were not observed in the initial EEG studies of patients with either AD or CJD. However, the ICA algorithm was able to extract periodic discharges and epileptiform discharges from raw EEG of patients with CJD at as early as 3 to 5 weeks after disease onset. Such discharges otherwise could hardly be discerned by visual inspection. In conclusion, ICA may increase the sensitivity of EEG and facilitate the early diagnosis of CJD.

Blind source separation of concurrent disease-related patterns from EEG in Creutzfeldt-Jakob disease for assisting early diagnosis.

Creutzfeldt-Jakob disease (CJD) is a rare, transmissible and fatal prion disorder of brain. Typical electroencephalography (EEG) patterns, such as the periodic sharp wave complexes (PSWCs), do not clearly emerge until the middle stage of CJD. To reduce transmission risks and avoid unnecessary treatments, the recognition of the hidden PSWCs forerunners from the contaminated EEG signals in the early stage is imperative. In this study, independent component analysis (ICA) was employed on the raw EEG signals recorded at the first admissions of five patients to segregate the co-occurrence of multiple disease-related features, which were difficult to be detected from the smeared EEG. Clear CJD-related waveforms, i.e., frontal intermittent rhythmical delta activity (FIRDA), fore PSWCs (triphasic waves) and periodic lateralized epileptiform discharges (PLEDs), have been successfully and simultaneously resolved from all patients. The ICA results elucidate the concurrent appearance of FIRDA and PLEDs or triphasic waves within the same EEG epoch, which has not been reported in the previous literature. Results show that ICA is an objective and effective means to extract the disease-related patterns for facilitating the early diagnosis of CJD.