Artificial intelligence-based computer-aided diagnosis system supports diagnosis of lymph node metastasis in esophageal squamous cell carcinoma: A multicenter study.

Background: This study aimed to develop an artificial intelligence-based computer-aided diagnosis system (AI-CAD) emulating the diagnostic logic of radiologists for lymph node metastasis (LNM) in esophageal squamous cell carcinoma (ESCC) patients, which contributed to clinical treatment decision-making. Methods: A total of 689 ESCC patients with PET/CT images were enrolled from three hospitals and divided into a training cohort and two external validation cohorts. 452 CT images from three publicly available datasets were also included for pretraining the model. Anatomic information from CT images was first obtained automatically using a U-Net-based multi-organ segmentation model, and metabolic information from PET images was subsequently extracted using a gradient-based approach. AI-CAD was developed in the training cohort and externally validated in two validation cohorts. Results: The AI-CAD achieved an accuracy of 0.744 for predicting pathological LNM in the external cohort and a good agreement with a human expert in two external validation cohorts (kappa = 0.674 and 0.587, p < 0.001). With the aid of AI-CAD, the human expert's diagnostic performance for LNM was significantly improved (accuracy [95% confidence interval]: 0.712 [0.669-0.758] vs. 0.833 [0.797-0.865], specificity [95% confidence interval]: 0.697 [0.636-0.753] vs. 0.891 [0.851-0.928]; p < 0.001) among patients underwent lymphadenectomy in the external validation cohorts. Conclusions: The AI-CAD could aid in preoperative diagnosis of LNM in ESCC patients and thereby support clinical treatment decision-making.

Coronary artery calcification and risk of mortality and adverse outcomes in patients with COVID-19: a Chinese multicenter retrospective cohort study.

Background: Coronary artery calcification (CAC) is an independent risk factor of major adverse cardiovascular events; however, the impact of CAC on in-hospital death and adverse clinical outcomes in patients with coronavirus disease 2019 (COVID-19) remains unclear. Objective: To explore the association between CAC and in-hospital mortality and adverse events in patients with COVID-19. Methods: This multicenter retrospective cohort study enrolled 2067 laboratory-confirmed COVID-19 patients with definitive clinical outcomes (death or discharge) admitted from 22 tertiary hospitals in China between January 3, 2020 and April 2, 2020. Demographic, clinical, laboratory results, chest CT findings, and CAC on admission were collected. The primary outcome was in-hospital death and the secondary outcome was composed of in-hospital death, admission to intensive care unit (ICU), and requiring mechanical ventilation. Multivariable Cox regression analysis and Kaplan-Meier plots were used to explore the association between CAC and in-hospital death and adverse clinical outcomes. Results: The mean age was 50 years (SD,16) and 1097 (53.1%) were male. A total of 177 patients showed high CAC level, and compared with patients with low CAC, these patients were older (mean age: 49 vs. 69 years, P < 0.001) and more likely to be male (52.0% vs. 65.0%, P = 0.001). Comorbidities, including cardiovascular disease (CVD) ([33.3%, 59/177] vs. [4.7%, 89/1890], P < 0.001), presented more often among patients with high CAC, compared with patients with low CAC. As for laboratory results, patients with high CAC had higher rates of increased D-dimer, LDH, as well as CK-MB (all P < 0.05). The mean CT severity score in high CAC group was also higher than low CAC group (12.6 vs. 11.1, P = 0.005). In multivariable Cox regression model, patients with high CAC were at a higher risk of in-hospital death (hazard ratio [HR], 1.731; 95% CI 1.010-2.971, P = 0.046) and adverse clinical outcomes (HR, 1.611; 95% CL 1.087-2.387, P = 0.018). Conclusion: High CAC is a risk factor associated with in-hospital death and adverse clinical outcomes in patients with confirmed COVID-19, which highlights the importance of calcium load testing for hospitalized COVID-19 patients and calls for attention to patients with high CAC. Supplementary Information: The online version contains supplementary material available at 10.1007/s42058-021-00072-4.

Comparative Study of Amide Proton Transfer-Weighted Imaging and Intravoxel Incoherent Motion Imaging in Breast Cancer Diagnosis and Evaluation.

BACKGROUND: Amide proton transfer-weighted imaging (APTWI) and intravoxel incoherent motion imaging (IVIM) are valuable MRI techniques applied to cancer. PURPOSE: To compare APTWI and IVIM in the diagnosis of benign and malignant breast lesions and to evaluate the correlations between different parameters (MTRasym [3.5 ppm], D, D*, and f) and prognostic factors for breast cancer. STUDY TYPE: Retrospective. POPULATION: In all, 123 breast lesions were studied before treatment, including 58 benign lesions and 65 malignant lesions. FIELD STRENGTH/SEQUENCE: Conventional MRI (T1 WI, T2 WI, and diffusion-weighted imaging [DWI]), APTWI, and IVIM MRI at 3T. ASSESSMENT: The magnetization transfer ratio asymmetry at 3.5 ppm (MTRasym [3.5 ppm]), diffusion coefficient (D), pseudo diffusion coefficient (D*), and perfusion fraction (f) values were compared between the benign and malignant groups and between groups with different expression levels of prognostic factors. STATISTICAL TESTS: Individual sample t-test, χ2 test, Spearman correlation, logistic regression, and the Delong test. RESULTS: The D and MTRasym (3.5 ppm) values of the malignant group were lower than those of the benign group; however, D* and f values were higher than those of the benign group (all P < 0.05). The areas under the curve (AUCs) of D, MTRasym (3.5 ppm), D*, and f were 0.809, 0.778, 0.670, and 0.766, respectively; however, only the difference between AUC (D) and AUC (D*) was significant (Z = 2.374, P < 0.05). The D value showed a low correlation with the pathological grade and Ki-67 expression (| r | = 0.294, 0.367); the f value showed a low correlation with estrogen receptor (ER) expression (| r | = 0.382); and the MTRasym (3.5 ppm) value showed a low correlation with pathological grade (| r | = 0.371). DATA CONCLUSION: This analysis revealed that both IVIM and APTWI could be used for the differential diagnosis of benign and malignant breast lesions, and APTWI-derived MTRasym (3.5 ppm), IVIM-derived D, D*, and f values showed correlations with some prognostic factors for breast cancer. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:1175-1186.

Semiautomatic Segmentation of Glioma on Mobile Devices.

Brain tumor segmentation is the first and the most critical step in clinical applications of radiomics. However, segmenting brain images by radiologists is labor intense and prone to inter- and intraobserver variability. Stable and reproducible brain image segmentation algorithms are thus important for successful tumor detection in radiomics. In this paper, we propose a supervised brain image segmentation method, especially for magnetic resonance (MR) brain images with glioma. This paper uses hard edge multiplicative intrinsic component optimization to preprocess glioma medical image on the server side, and then, the doctors could supervise the segmentation process on mobile devices in their convenient time. Since the preprocessed images have the same brightness for the same tissue voxels, they have small data size (typically 1/10 of the original image size) and simple structure of 4 types of intensity value. This observation thus allows follow-up steps to be processed on mobile devices with low bandwidth and limited computing performance. Experiments conducted on 1935 brain slices from 129 patients show that more than 30% of the sample can reach 90% similarity; over 60% of the samples can reach 85% similarity, and more than 80% of the sample could reach 75% similarity. The comparisons with other segmentation methods also demonstrate both efficiency and stability of the proposed approach.

NSCs promote hippocampal neurogenesis, metabolic changes and synaptogenesis in APP/PS1 transgenic mice.

Adult neurogenesis and synaptic remodeling persist as a unique form of structural and functional plasticity in the hippocampal dentate gyrus (DG) and subventricular zone (SVZ) of the lateral ventricles due to the existence of neural stem cells (NSCs). Transplantation of NSCs may represent a promising approach for the recovery of neural circuits. Here, we aimed to examine effects of highly neuronal differentiation of NSCs transplantation on hippocampal neurogenesis, metabolic changes and synaptic formation in APP/PS1 mice. 12-month-old APP/PS1 mice were used for behavioral tests, immunohistochemistry, western blot, transmission electron microscopy and proton magnetic resonance spectroscopy (1H-MRS). The results showed that N-acetylaspartate (NAA) and Glutamate (Glu) levels were increased in the Tg-NSC mice compared with the Tg-PBS and Tg-AD mice 10 weeks after NSCs transplantation. NSC-induced an increase in expression of synaptophysin and postsynaptic protein-95, and the number of neurons with normal synapses was significantly increased in Tg-NSC mice. More doublecortin-, BrdU/NeuN- and Nestin-positive neurons were observed in the hippocampal DG and SVZ of the Tg-NSC mice. This is the first demonstration that engrafted NSCs with a high differentiation rate to neurons can enhance neurogenesis in a mouse model of AD and can be detected by 1H-MRS in vivo. It is suggested that engraft of NSCs can restore memory and promote endogenous neurogenesis and synaptic remodeling, moreover, 1H-MRS can detect metabolite changes in AD mice in vivo. The observed changes in NAA/creatine (Cr) and glutamate (Glu)/Cr may be correlated with newborn neurons and new synapse formation.

Crossed cerebellar diaschisis detected by arterial spin-labeled perfusion magnetic resonance imaging in subacute ischemic stroke.

BACKGROUND: Crossed cerebellar diaschisis (CCD) was a common radiological phenomenon manifested as reduced blood flow and metabolism in the cerebellar hemisphere contralateral to a supratentorial cerebral lesion. The hypoperfusion and hypometabolism in the contralateral cerebellum in CCD was traditionally detected by positron emission tomography (PET) and single-photon emission computed tomography (SPECT). The present prospective study aimed to assess the detection of CCD in subacute stage ischemic stroke by arterial spin-labeling (ASL) perfusion technique with a 3.0-T magnetic resonance imaging (MRI) scanner. METHODS: ASL images were obtained from 46 patients with supratentorial ischemic stroke at subacute stage. Regional cerebral blood flow values in the cerebellar hemispheres were measured on a region of interest basis. RESULTS: Twenty-four of 46 (52%) patients showed CCD phenomenon by ASL-MRI method, which was in line with the PET/SPECT series. Infarctions in basal ganglia areas are prone to cause CCD. CONCLUSIONS: With advantages in easy acquisition and no radiation, ASL-MRI seems to be an ideal tool for the detection and follow-up of CCD.

Quantitative 3-T diffusion tensor imaging in detecting optic nerve degeneration in patients with glaucoma: association with retinal nerve fiber layer thickness and clinical severity.

INTRODUCTION: To investigate the association of quantitative 3-T diffusion tensor imaging (DTI) with retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) and clinical severity in detecting optic nerve degeneration in patients with primary closed-angle glaucoma. METHODS: Twenty three patients (42 eyes; 9 men, 14 women) with primary closed-angle glaucoma and 20 healthy controls were enrolled in this study. Both DTI and OCT were performed on the optic nerves of all subjects. The mean diffusivity (MD), fractional anisotropy (FA), and eigenvalue maps were obtained for quantitative analysis. RNFL thickness and quantitative electrophysiology were also performed on all subjects. The association of quantitative DTI with RNFL thickness and glaucoma stage was analyzed. RESULTS: Compared with control nerves, the FA, λ[parallel], and λ[perpendicular] values, and RNFL thickness in affected nerves decreased, while MD increased in patients with primary glaucoma (p < 0.05). There was a significant correlation between FA, MD, λ[parallel], and λ[perpendicular] and the mean RNFL thickness (P < 0.01). The mean FA and λ[perpendicular] values derived with DT MR imaging correlated well with glaucoma stage (P < 0.05), but the mean MD and λ[parallel] values did not correlate with glaucoma stage (P > 0.05). CONCLUSION: DTI measurement could detect abnormality of the optic nerve in patients with glaucoma and may serve as a biomarker of disease severity.

Susceptibility weighted imaging: a new tool in the diagnosis of prostate cancer and detection of prostatic calcification.

BACKGROUND: Susceptibility weighted imaging (SWI) is a new MRI technique which has been proved very useful in the diagnosis of brain diseases, but few study was performed on its value in prostatic diseases. The aim of the present study was to investigate the value of SWI in distinguishing prostate cancer from benign prostatic hyperplasia and detecting prostatic calcification. METHODOLOGY/PRINCIPAL FINDINGS: 23 patients with prostate cancer and 53 patients with benign prostatic hyperplasia proved by prostate biopsy were scanned on a 3.0T MR and a 16-row CT scanner. High-resolution SWI, conventional MRI and CT were performed on all patients. The MRI and CT findings, especially SWI, were analyzed and compared. The analyses revealed that 19 out of 23 patients with prostate cancer presented hemorrhage within tumor area on SWI. However, in 53 patients with benign prostatic hyperplasia, hemorrhage was detected only in 1 patient in prostate by SWI. When comparing SWI, conventional MRI and CT in detecting prostate cancer hemorrhage, out of the 19 patients with prostate cancer who had prostatic hemorrhage detected by SWI, the prostatic hemorrhage was detected in only 7 patients by using conventional MRI, and none was detected by CT. In addition, CT demonstrated calcifications in 22 patients which were all detected by SWI whereas only 3 were detected by conventional MRI. Compared to CT, SWI showed 100% in the diagnostic sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) in detecting calcifications in prostate but conventional MRI demonstrated 13.6% in sensitivity, 100% in specificity, 75% in accuracy, 100% in PPV and 74% in NPV. CONCLUSIONS: More apparent prostate hemorrhages were detected on SWI than on conventional MRI or CT. SWI may provide valuable information for the differential diagnosis between prostate cancer and prostatic hyperplasia. Filtered phase images can identify prostatic calcifications as well as CT.

Measurement of tumor size in adult glioblastoma: classical cross-sectional criteria on 2D MRI or volumetric criteria on high resolution 3D MRI?

OBJECTIVE: To investigate the added value of volume on post-contrast three dimensional (3D) T1-weighted image (T1WI) over classical cross-sectional area on two dimensional (2D) T1WI in evaluating tumor response in glioblastoma multiforme (GBM). METHODS: Tumor cross-sectional area and volume measurements were performed on 104 MRI studies from 42 adult patients with GBM on post-contrast 5 mm 2D T1WI and isotropic high resolution 3D T1WI, respectively. 52 pairs of MRI scans were analyzed for relative change. Radiographic responses were determined based on change in either area or volume. RESULTS: A high correlation was revealed between tumor size measured by area on thick 2D and volume on high resolution 3D MRI in 104 scans (r=0.82, p<0.001). When four tumor response criteria were used according to the percentage changes (complete response/partial response/stable disease/progression), the kappa coefficient between the area on 2D and volume on 3D was 0.68 (p<0.05) with an overall agreement of 81%. CONCLUSIONS: Tumor cross-sectional area on post-contrast 2D T1WI appears comparable to volume on 3D T1WI and should still be a practical alternate of volume on 3D for evaluating tumor response.

Comparison of volumetric methods for tumor measurements on two and three dimensional MRI in adult glioblastoma.

INTRODUCTION: Change in tumor size is a frequent endpoint in cancer clinical trials, but whether change in size should be measured using volume on two-dimensional (2D) or three-dimensional (3D) images is not certain. We compared volumetric measurements on post-contrast 2D and high-resolution 3D T1-weighted MR images (T1WI) in evaluating tumor response in glioblastoma multiforme (GBM). METHODS: Tumor volume measurements were performed on 86 MRI studies from 37 adult patients with GBM on post-contrast 5 mm 2D T1WI and isotropic high-resolution T1WI. The means of the two volumes were compared and their association was analyzed. RESULTS: There is no significant difference between volumes measured on 2D and 3D in 86 scans (Z = 0.63, p = 0.53), and a high correlation was revealed between them (r = 0.95, 95% CI: 0.93-0.97, p < 0.001). When the percentage changes were categorized into traditional tumor response criteria (complete response/partial response/stable disease/progressive disease), the kappa coefficient between the volume on 2D and volume on 3D was 0.80 (95% CI: 0.57-1.03, p < 0.05) with an overall agreement of 84%. CONCLUSIONS: Volume on post-contrast 2D T1WI appears comparable to volume on 3D T1WI and should be a practical alternative to volume on 3D in evaluating tumor response.

Relationship among growth parameters for Clostridium butyricum, hydA gene expression, and biohydrogen production in a sucrose-supplemented batch reactor.

This study was undertaken to identify the relationship between the performance of dark H2 fermentation and expression of the key functional gene (i.e., hydrogenase gene) involved in the bioH2 production process. Clostridium butyricum CGS5 isolated from anaerobic sewage sludge was used as the model strain for this study. Copy number of the hydrogenase gene (hydA) and mRNA transcripts (cDNA hydA) (after amplification) and the total DNA and RNA (before amplification) were measured over the course of the growth of strain CGS5. Cell concentration was also determined by optical density and converted to dry weight. After amplification, the hydA gene increased 1,500-fold during late exponential growth phase after normalization to the copy number at time 0, and cDNA from mRNA transcripts of hydA also increased 500-fold after normalization. mRNA transcripts of hydA lagged behind the increase of total DNA and RNA, and increases in hydA more closely mimicked those of total DNA. Increases in both of these parameters corresponded with hydrogen production. Transcripts of 16s ribosomal RNA reached a maximum value earlier (38 h) than did those of hydA (47 h). All molecular characteristics matched those for sucrose utilization, growth, and hydrogen production. These experiments indicated that transcription as measured by cDNA can be related to hydrogen production and possesses the potential to be used as tool for process control.

Improving PCR and qPCR detection of hydrogenase A (hydA) associated with Clostridia in pure cultures and environmental sludges using bovine serum albumin.

Detection of hydA genes of Clostridia spp. using degenerative and species specific primers for C. butyricum were optimized by the addition of bovine serum albumin (BSA) to polymerase chain reaction (PCR) and quantitative PCR (qPCR) reactions. BSA concentrations ranging from 100 to 400 ng/microl were examined using pure cultures and a variety of environmental samples as test targets. A BSA concentration of 100 ng/microl, which is lower than previously reported in the literature, was found to be most effective in improving the detection limit. The brightness of amplicons with 100 ng/mul BSA increased in ethidium bromide-treated gels, the minimum detection limit with BSA was at least one log greater, and cycle threshold (C(T)) values were lower than without BSA in qPCR indicating improved detection of target deoxyribonucleic acid for most samples tested. Although amplicon visualization was improved at BSA concentrations greater than or equal to 100 ng/microl, gene copy numbers detected by qPCR were less, C(T) values were increased, and T(m) values were altered. SYBR Green dissociation curves of qPCR products of DNA from pure culture or sludge samples showed that BSA at 100 ng/microl reduced the variability of peak areas and T(m) values.

[Heterosis of photosynthetic performance of maize].

Taking four maize inbred lines with different photosynthetic rate and their two hybrids as test materials, the diurnal variations of their photosynthesis parameters in silking stage were measured to study the heterosis of photosynthetic performance. The results showed that the net photosynthetic rate (P), transpiration rate (Tr) and stomatal conductance (Gs) all presented obvious single-peaked curve in a day, with the peak value occurred at 10:00-12:00, 12:00 and 10:00-12:00, respectively, while water use efficiency (WUE) had a "V" type variation trend, with the lowest value appeared at 12:00. The diurnal variation of Pn and Tr correlated markedly with Gs, suggesting that Gs played an important role in regulating the diurnal variation of Pn and Tr. Pn, Tr and Gs had higher heterosis in the afternoon than in the morning, while WUE was in reverse, indicating that maize hybrid had higher resistance to high temperature and dehydration in the afternoon, which provided a new path to select varieties with high net photosynthetic rate.

Use of active consortia of constructed ternary bacterial cultures via mixture design for azo-dye decolorization enhancement.

This first-attempt study used constructed bacterial consortia containing Escherichia coli DH5alpha (a weak decolorizer) and its UV-irradiated mutants (E. coli UVT1 and UV68; strong decolorizers) via equilateral triangle diagram and mixture experimental design to assess color removal during species evolution. The results showed that although strain DH5alpha was not an effective decolorizer, its presence might still played a significant role in affecting optimal color removal capabilities of mixed consortia (e.g., E. coli DH5alpha, UVT1 and UV68) for two model azo dyes; namely, reactive red 22 (RR22) and reactive black 5 (RB5). Contour analysis of ternary systems also clearly showed that decolorization of RR22 and RB5 by DH5alpha-containing active mixed consortia was more effective than mono-cultures of the stronger decolorizer alone (e.g., UVT1). The optimal composition of the mixed consortium (UV68, UVT1, DH5alpha) achieving the highest specific decolorization rate was (13%:58%:29%) and (0%:74%:26%) for decolorization of RR22 and RB5, respectively, with initial total cell density fixed at OD(600)=3.5+/-0.28.