A novel neuroprotective method against ischemic stroke by accelerating the drainage of brain interstitial fluid.

Ischemic stroke is a leading cause of death and disability worldwide. Inflammatory response after stroke determines the outcome of ischemic injury. A recent study has reported an efficient method, epidural arterial implantation (EAI), for accelerating interstitial fluid (ISF) drainage, which provides a promising strategy to clear pro-inflammatory cytokines in the brain extracellular space (ECS). In this study, the method of EAI was modified (m-EAI) to control its function of accelerating the ISF drainage at different time points following ischemic attack. The neuroprotective effect of m-EAI on ischemic stroke was evaluated with the transient middle cerebral artery occlusion (tMCAO) rat model. The results demonstrated the accumulation of IL-1ß, IL-6, and TNF-α was significantly decreased by activating m-EAI at 7 d before and immediately after ischemic attack in tMCAO rats, accompanied with decreased infarct volume and improved neurological function. This study consolidates the hypothesis of exacerbated ischemic damage by inflammatory response and provides a new perspective to treat encephalopathy via brain ECS. Further research is essential to investigate whether m-EAI combined with neuroprotective drugs could enhance the therapeutic effect on ischemic stroke.

Neglected role of iron redox cycle in direct interspecies electron transfer in anaerobic methanogenesis: Inspired from biogeochemical processes.

Anaerobic digestion is an indispensable technical option towards green and low-carbon wastewater treatment, with interspecies electron transfer (IET) playing a key role in its efficiency and operational stability. The exogenous semiconductive iron oxides have been proven to effectively enhance IET, while the cognition of the physicochemical-biochemical coupling stimulatory mechanism was circumscribed and remains to be elucidated. In this study, semiconductive iron oxides, α-Fe2O3, γ-Fe2O3, α-FeOOH, and γ-FeOOH were found to significantly enhance syntrophic methanogenesis by 76.39, 72.40, 37.33, and 32.64% through redirecting the dominant IET pathway from classical interspecies hydrogen transfer to robust direct interspecies electron transfer (DIET). Their alternative roles as electron shuttles potentially substituting for c-type cytochromes were conjectured to establish an electron transport matrix associated with conductive pili. Distinguished from the conventional electron conductor mechanism of conductive Fe3O4, semiconductive iron oxides facilitated DIET intrinsically through the capacitive Fe(III/II) redox cycles coupled with secondary mineralization. The growth of Aminobacterium, Sedimentibacter, and Methanothrix was enriched and the gene copy numbers of Geobacteraceae 16S ribosomal ribonucleic acid were selectively flourished by 2.0-∼4.5- fold to establish a favorable microflora for DIET pathway. Metabolic pathways of syntrophic acetogenesis from propionate/butyrate and CO2 reduction methanogenesis were correspondingly promoted. The above findings provide new insights into the underlying mechanism of iron minerals enhancing the DIET-oriented pathway and offer paradigms for redox-mediated energy harvesting biological wastewater treatment.

Alzheimer's disease diagnosis from multi-modal data via feature inductive learning and dual multilevel graph neural network.

Multi-modal data can provide complementary information of Alzheimer's disease (AD) and its development from different perspectives. Such information is closely related to the diagnosis, prevention, and treatment of AD, and hence it is necessary and critical to study AD through multi-modal data. Existing learning methods, however, usually ignore the influence of feature heterogeneity and directly fuse features in the last stages. Furthermore, most of these methods only focus on local fusion features or global fusion features, neglecting the complementariness of features at different levels and thus not sufficiently leveraging information embedded in multi-modal data. To overcome these shortcomings, we propose a novel framework for AD diagnosis that fuses gene, imaging, protein, and clinical data. Our framework learns feature representations under the same feature space for different modalities through a feature induction learning (FIL) module, thereby alleviating the impact of feature heterogeneity. Furthermore, in our framework, local and global salient multi-modal feature interaction information at different levels is extracted through a novel dual multilevel graph neural network (DMGNN). We extensively validate the proposed method on the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset and experimental results demonstrate our method consistently outperforms other state-of-the-art multi-modal fusion methods. The code is publicly available on the GitHub website. (https://github.com/xiankantingqianxue/MIA-code.git).

Lanthanum-modified pyroaurite as a geoengineering tool to simultaneously sink Microcystis cyanobacteria and immobilize phosphorus in eutrophic water.

Excessive phosphorus (P) in eutrophic water induces cyanobacterial blooms that aggravate the burden of in-situ remediation measures. In order to ensure better ecological recovery, Flock & Lock technique has been developed to simultaneously sink cyanobacteria and immobilize P but requires a combination of flocculent and P inactivation agent. Here we synthesized a novel lanthanum-modified pyroaurite (LMP), as an alternative for Flock & Lock of cyanobacteria and phosphorus at the background of rich humic acid and suspended solids. LMP shows a P adsorption capacity of 36.0 mg/g and nearly 100 % removal of chlorophyll-a (Chl-a), turbidity, UV254 and P at a dosage (0.3 g/L) much lower than the commercial analogue (0.5 g/L). The resultant sediment (98.2 % as immobile P) exhibits sound stability without observable release of P or re-growth of cyanobacteria over a 50-day incubation period. The use of LMP also constrains the release of toxic microcystins to 1.4 µg/L from the sunk cyanobacterial cells, outperforming the commonly used polyaluminum chloride (PAC). Similar Flock & Lock efficiency could also be achieved in real eutrophic water. The outstanding Flock & Lock performance of LMP is attributable to the designed La modification. During LMP treatment, La acts as not only a P binder by formation of LaPO4, but also a coagulant to create a synergistic effect with pyroaurite. The controlled hydrolysis of surface La(III) over pyroaurite aided the possible formation of La(III)-pyroaurite networking structure, which significantly enhanced the Flock & Lock process through adsorption, charge neutralization, sweep flocculation and entrapment. In the end, the preliminary economic analysis is performed. The results demonstrate that LMP is a versatile and cost-effective agent for in-situ remediation of eutrophic waters.

Association between human blood metabolome and the risk of pre-eclampsia.

Pre-eclampsia is a complex multi-system pregnancy disorder with limited treatment options. Therefore, we aimed to screen for metabolites that have causal associations with preeclampsia and to predict target-mediated side effects based on Mendelian randomization (MR) analysis. A two-sample MR analysis was firstly conducted to systematically assess causal associations of blood metabolites with pre-eclampsia, by using metabolites related large-scale genome-wide association studies (GWASs) involving 147,827 European participants, as well as GWASs summary data about pre-eclampsia from the FinnGen consortium R8 release data that included 182,035 Finnish adult female subjects (5922 cases and 176,113 controls). Subsequently, a phenome-wide MR (Phe-MR) analysis was applied to assess the potential on-target side effects associated with hypothetical interventions that reduced the burden of pre-eclampsia by targeting identified metabolites. Four metabolites were identified as potential causal mediators for pre-eclampsia by using the inverse-variance weighted method, including cholesterol in large HDL (L-HDL-C) [odds ratio (OR): 0.88; 95% confidence interval (95% CI): 0.83-0.93; P = 2.14 × 10-5), cholesteryl esters in large HDL (L-HDL-CE) (OR: 0.88; 95% CI: 0.83-0.94; P = 5.93 × 10-5), free cholesterol in very large HDL (XL-HDL-FC) (OR: 0.88; 95% CI: 0.82-0.94; P = 1.10 × 10-4) and free cholesterol in large HDL (L-HDL-FC) (OR: 0.89; 95% CI: 0.84-0.95; P = 1.45 × 10-4). Phe-MR analysis showed that targeting L-HDL-CE had beneficial effects on the risk of 24 diseases from seven disease chapters. Based on this systematic MR analysis, L-HDL-C, L-HDL-CE, XL-HDL-FC, and L-HDL-FC were inversely associated with the risk of pre-eclampsia. Interestingly, L-HDL-CE may be a promising drug target for preventing pre-eclampsia with no predicted detrimental side effects. The study consists of a two-stage design that conducts MR at both stages. First, we assessed the causality for the associations between 194 blood metabolites and the risk of pre-eclampsia. Second, we investigated a broad spectrum of side effects associated with the targeting identified metabolites in 693 non-preeclampsia diseases. Our results suggested that Cholesteryl esters in large HDL may serve as a promising drug target for the prevention or treatment of pre-eclampsia with no predicted detrimental side effects.

Chinese expert consensus on the diagnosis, treatment, and management of asthma in women across life.

Background: The epidemiology and severity of asthma vary by sex and age. The diagnosis, treatment, and management of asthma in female patients are quite challenging. However, there is hitherto no comprehensive and standardized guidance for female patients with asthma. Methods: Corresponding search strategies were determined based on clinical concerns regarding female asthma. Search terms included "sex hormones and lung development", "sex hormone changes and asthma", "hormones and asthma immune response", "women, asthma", "children, asthma", "puberty, asthma", "menstruation, asthma", "pregnancy, asthma", "lactation, asthma", "menopause, asthma", "obesity, asthma", and "women, refractory, severe asthma". Literature was retrieved from PubMed/Medline, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, Wanfang Data with the search date of July 30, 2022 as the last day. This consensus used the Grading of Recommendations Assessment, Development, and Evaluation to evaluate the strength of recommendation and quality of evidence. Results: We collected basic research results and clinical evidence-based medical data and reviewed the effects of sex hormones, classical genetics, and epigenetics on the clinical presentation and treatment response of female patients with asthma under different environmental effects. Based on that, we formulated this expert consensus on the management of female asthma throughout the life cycle. Conclusions: This expert consensus on the management of asthma in women throughout the life cycle provides diagnosis, treatment, and research reference for clinical and basic medical practitioners.

Structure Evolution of Iron (Hydr)oxides under Nanoconfinement and Its Implication for Water Treatment.

In the development of nanoenabled technologies for large-scale water treatment, immobilizing nanosized functional materials into the confined space of suitable substrates is one of the most effective strategies. However, the intrinsic effects of nanoconfinement on the decontamination performance of nanomaterials, particularly in terms of structural modulation, are rarely unveiled. Herein, we investigate the structure evolution and decontamination performance of iron (hydr)oxide nanoparticles, a widely used material for water treatment, when confined in track-etched (TE) membranes with channel sizes varying from 200 to 20 nm. Nanoconfinement drives phase transformation from ferrihydrite to goethite, rather than to hematite occurring in bulk systems, and the increase in the nanoconfinement degree from 200 to 20 nm leads to a significant drop in the fraction of the goethite phase within the aged products (from 41% to 0%). The nanoconfinement configuration is believed to greatly slow down the phase transformation kinetics, thereby preserving the specific adsorption of ferrihydrite toward As(V) even after 20-day aging at 343 K. This study unravels the structure evolution of confined iron hydroxide nanoparticles and provides new insights into the temporospatial effects of nanoconfinement on improving the water decontamination performance.

Occurrences and fates of per- and polyfluoralkyl substances in textile dyeing wastewater along full-scale treatment processes.

Industrial wastewater is a substantial source of per- and polyfluoroalkyl substances (PFASs) in the environment. However, very limited information is available on the occurrences and fates of PFASs along industrial wastewater treatment processes, particularly for the textile dyeing industry where PFASs occur extensively. Herein, the occurrences and fates of 27 legacy and emerging PFASs were investigated along the processes of three full-scale textile dyeing wastewater treatment plants (WWTPs) based on UHPLC-MS/MS in combination with self-developed solid extraction protocol featuring selective enrichment for ultrasensitive analysis. The total PFASs ranged at 630-4268 ng L-1 in influents, 436-755 ng L-1 in effluents, and 91.5-1182 µg kg-1 in the resultant sludge. PFAS species distribution varied among WWTPs, with one WWTP dominated by legacy perfluorocarboxylic acids while the other two dominated by emerging PFASs. Perfluorooctane sulfonate (PFOS) was trivial in the effluents from all the three WWTPs, indicating its diminished use in textile industry. Various emerging PFASs were detected at different abundances, demonstrating their use as alternatives to legacy PFASs. Most conventional processes of the WWTPs were inefficient in removing PFASs, especially for the legacy PFASs. The microbial processes could remove the emerging PFASs to different extents, whereas commonly elevated the concentrations of legacy PFASs. Over 90% of most PFASs could be removed by reverse osmosis (RO) and was enriched into the RO concentrate accordingly. The total oxidizable precursors (TOP) assay revealed that the total concentration of PFASs was increased by 2.3-4.1 times after oxidation, accompanied by formation of terminal perfluoroalkyl acids (PFAAs) and degradation of emerging alternatives to various extents. This study is believed to shed new light on the monitoring and management of PFASs in industries.

First experience of evaluation of the impact of high-matrix size reconstruction in image quality in arterial CT runoff studies of the lower extremities.

OBJECTIVES: To determine whether image reconstruction with a higher matrix size improves image quality for lower extremity CTA studies. METHODS: Raw data from 50 consecutive lower extremity CTA studies acquired on two MDCT scanners (SOMATOM Flash, Force) in patients evaluated for peripheral arterial disease (PAD) were retrospectively collected and reconstructed with standard (512 × 512) and higher resolution (768 × 768, 1024 × 1024) matrix sizes. Five blinded readers reviewed representative transverse images in randomized order (150 total). Readers graded image quality (0 (worst)-100 (best)) for vascular wall definition, image noise, and confidence in stenosis grading. Ten patients' stenosis scores on CTA images were compared to invasive angiography. Scores were compared using mixed effects linear regression. RESULTS: Reconstructions with 1024 × 1024 matrix were ranked significantly better for wall definition (mean score 72, 95% CI = 61-84), noise (74, CI = 59-88), and confidence (70, CI = 59-80) compared to 512 × 512 (wall = 65, CI = 53 × 77; noise = 67, CI = 52 × 81; confidence = 62, CI = 52 × 73; p = 0.003, p = 0.01, and p = 0.004, respectively). Compared to 512 × 512, the 768 × 768 and 1024 × 1024 matrix improved image quality in the tibial arteries (wall = 51 vs 57 and 59, p < 0.05; noise = 65 vs 69 and 68, p = 0.06; confidence = 48 vs 57 and 55, p < 0.05) to a greater degree than the femoral-popliteal arteries (wall = 78 vs 78 and 85; noise = 81 vs 81 and 84; confidence = 76 vs 77 and 81, all p > 0.05), though for the 10 patients with angiography accuracy of stenosis grading was not significantly different. Inter-reader agreement was moderate (rho = 0.5). CONCLUSION: Higher matrix reconstructions of 768 × 768 and 1024 × 1024 improved image quality and may enable more confident assessment of PAD. CLINICAL RELEVANCE STATEMENT: Higher matrix reconstructions of the vessels in the lower extremities can improve perceived image quality and reader confidence in making diagnostic decisions based on CTA imaging. KEY POINTS: • Higher than standard matrix sizes improve perceived image quality of the arteries in the lower extremities. • Image noise is not perceived as increased even at a matrix size of 1024 × 1024 pixels. • Gains from higher matrix reconstructions are higher in smaller, more distal tibial and peroneal vessels than in femoropopliteal vessels.

Enhanced H2O2 utilization efficiency in Fenton-like system for degradation of emerging contaminants: Oxygen vacancy-mediated activation of O2.

Hydrogen peroxide (H2O2) is the most commonly used oxidant in advanced oxidation processes for emerging organic contaminant degradation. However, the activation of H2O2 to generate reactive oxygen species is always accompanied by O2 generation resulting in H2O2 waste. Here, we prepare a Ti doped Mn3O4/Fe3O4 ternary catalyst (Ti-Mn3O4/Fe3O4) to create abundant oxygen vacancies (OVs), which yields electron delocalization impacts on enhancing the electrical conductivity, accelerating the activation of O2 to produce H2O2. In Ti-Mn3O4/Fe3O4/H2O2 system, OVs-mediated O2/O2•-/H2O2 redox cycles trigger the activation of locally generated O2, boost the regeneration of O2•- and on site produce H2O2 for replenishment. This leads to a 100% removal of tiamulin in 30 min at an unprecedented H2O2 utilization efficiency of 96.0%, which is 24 folds higher than that with Fe3O4/H2O2. Importantly, further integration of Ti-Mn3O4/Fe3O4 catalysts into membrane filtration achieved high rejections of tiamulin (> 83.9%) from real surface water during a continuous 12-h operation, demonstrating broad pH adaptability, excellent catalytic stability and leaching resistance. This work demonstrates a feasible strategy for developing OVs-rich catalysts for improving H2O2 utilization efficiency via activation of locally generated oxygen during the Haber-Weiss reaction.

Identification of Parameters Representative of Immune Dysfunction in Patients with Severe and Fatal COVID-19 Infection: a Systematic Review and Meta-analysis.

Abnormal immunological indicators associated with disease severity and mortality in patients with COVID-19 have been reported in several observational studies. However, there are marked heterogeneities in patient characteristics and research methodologies in these studies. We aimed to provide an updated synthesis of the association between immune-related indicators and COVID-19 prognosis. We conducted an electronic search of PubMed, Scopus, Ovid, Willey, Web of Science, Cochrane library, and CNKI for studies reporting immunological and/or immune-related parameters, including hematological, inflammatory, coagulation, and biochemical variables, tested on hospital admission of COVID-19 patients with different severities and outcomes. A total of 145 studies were included in the current meta-analysis, with 26 immunological, 11 hematological, 5 inflammatory, 4 coagulation, and 10 biochemical variables reported. Of them, levels of cytokines, including IL-1ß, IL-1Ra, IL-2R, IL-4, IL-6, IL-8, IL-10, IL-18, TNF-α, IFN-γ, IgA, IgG, and CD4+ T/CD8+ T cell ratio, WBC, neutrophil, platelet, ESR, CRP, ferritin, SAA, D-dimer, FIB, and LDH were significantly increased in severely ill patients or non-survivors. Moreover, non-severely ill patients or survivors presented significantly higher counts of lymphocytes, monocytes, lymphocyte/monocyte ratio, eosinophils, CD3+ T,CD4+T and CD8+T cells, B cells, and NK cells. The currently updated meta-analysis primarily identified a hypercytokinemia profile with the severity and mortality of COVID-19 containing IL-1ß, IL-1Ra, IL-2R, IL-4, IL-6, IL-8, IL-10, IL-18, TNF-α, and IFN-γ. Impaired innate and adaptive immune responses, reflected by decreased eosinophils, lymphocytes, monocytes, B cells, NK cells, T cells, and their subtype CD4+ and CD8+ T cells, and augmented inflammation, coagulation dysfunction, and nonpulmonary organ injury, were marked features of patients with poor prognosis. Therefore, parameters of immune response dysfunction combined with inflammatory, coagulated, or nonpulmonary organ injury indicators may be more sensitive to predict severe patients and those non-survivors.

Allergic disease and sensitization disparity in urban and rural China: A EuroPrevall-INCO study.

BACKGROUND: Studies in comparison with allergic diseases and sensitization between rural and urban environments in westernized countries might be biased and not adequately reflect countries undergoing rapid transition. METHODS: A total of 5542 schoolchildren from urban area and 5139 from rural area were recruited for the EuroPrevall-INCO survey. A subsequent case-control sample with 196 children from urban area and 202 from rural area was recruited for a detailed face-to-face questionnaire and assessment of sensitization. Skin prick tests and serum-specific IgE measurements were used to assess sensitizations against food and aeroallergens. Logistic regression analysis was used to determine associations between risk/protective factors, food adverse reactions (FAR), allergic diseases, and sensitizations. RESULTS: Prevalence of self-reported allergic diseases, including asthma (6.6% vs.2.5%), rhinitis (23.2% vs.5.3%), and eczema (34.1% vs.25.9%), was higher in urban than in rural children. Urban children had a significantly higher prevalence of FAR and related allergic diseases, and lower food/inhalation allergen sensitization rate, than those of rural children. In urban children, frequent changing places of residency (odds ratio 2.85, 95% confidence interval: 1.45-5.81) and antibiotic usage (3.54, 1.77-7.32) in early life were risk factors for sensitization, while sensitization and family history of allergy were risk factors for allergic diseases. In rural children, exposure to rural environments in early life was protective against both allergen sensitizations (0.46, 0.21-0.96) and allergic diseases (0.03, 0.002-0.19). CONCLUSION: We observed a disparity in rates of allergic diseases and allergen sensitization between rural and urban children. In addition to family history, the development of allergic diseases and allergen sensitization were associated with specific urban/rural environmental exposures in early life.

A patient-informed approach to predict iodinated-contrast media enhancement in the liver.

OBJECTIVE: To devise a patient-informed time series model that predicts liver contrast enhancement, by integrating clinical data and pharmacokinetics models, and to assess its feasibility to improve enhancement consistency in contrast-enhanced liver CT scans. METHODS: The study included 1577 Chest/Abdomen/Pelvis CT scans, with 70-30% training/validation-testing split. A Gaussian function was used to approximate the early arterial, late arterial, and the portal venous phases of the contrast perfusion curve of each patient using their respective bolus tracking and diagnostic scan data. Machine learning models were built to predict the Gaussian parameters of each patient using the patient attributes (weight, height, age, sex, BMI). Pearson's coefficient, mean absolute error, and root mean squared error were used to assess the prediction accuracy. RESULTS: The integration of the pharmacokinetics model with a two-layered neural network achieved the highest prediction accuracy on the test data (R2 = 0.61), significantly exceeding the performance of the pharmacokinetics model alone (R2 = 0.11). Applying the model demonstrated that adjusting the contrast administration directed by the model may reduce clinical enhancement inconsistency by up to 40 %. CONCLUSIONS: A new model using a Gaussian function and supervised machine learning can be used to build liver parenchyma contrast enhancement prediction model. The model can have utility in clinical settings to optimize and improve consistency in contrast-enhanced liver imaging.

Rural environment reduces allergic inflammation by modulating the gut microbiota.

Rural environments and microbiota are linked to a reduction in the prevalence of allergies. However, the mechanism underlying the reduced allergies modulated by rural residency is unclear. Here, we assessed gut bacterial composition and metagenomics in urban and rural children in the EuroPrevall-INCO cohort. Airborne dusts, including mattress and rural henhouse dusts, were profiled for bacterial and fungal composition by amplicon sequencing. Mice were repeatedly exposed to intranasal dust extracts and evaluated for their effects on ovalbumin (OVA)-induced allergic airway inflammation, and gut microbiota restoration was validated by fecal microbiota transplant (FMT) from dust-exposed donor mice. We found that rural children had fewer allergies and unique gut microbiota with fewer Bacteroides and more Prevotella. Indoor dusts in rural environments harbored higher endotoxin level and diversity of bacteria and fungi, whereas indoor urban dusts were enriched with Aspergillus and contained elevated pathogenic bacteria. Intranasal administration of rural dusts before OVA sensitization reduced respiratory eosinophils and blood IgE level in mice and also led to a recovery of gut bacterial diversity and Ruminiclostridium in the mouse model. FMT restored the protective effect by reducing OVA-induced lung eosinophils in recipient mice. Together, these results support a cause-effect relationship between exposure to dust microbiota and allergy susceptibility in children and mice. Specifically, rural environmental exposure modulated the gut microbiota, which was essential in reducing allergy in children from Southern China. Our findings support the notion that the modulation of gut microbiota by exposure to rural indoor dust may improve allergy prevention.

Ceramic nanofiber membrane anchoring nanosized Mn2O3 catalytic ozonation of sulfamethoxazole in water.

Catalytic ceramic nanofiber membranes (Mn@CNMs) were prepared by anchoring Mn2O3 nanoparticles on the pits of attapulgite (APT) nanofibers via an impregnation and in-situ precipitation method. An integrated catalytic ozonation/membrane filtration process applying Mn@CNM was employed to degrade sulfamethoxazole (SMX) and the removal achieved up to 81.3% during a 7-h continuous filtration. The reactive oxygen species (ROS) quenching and radical detection experiments were conducted to determine the contribution of 1O2, ·OH and O2·- towards the catalytic degradation of SMX. Moreover, Mn@CNM exhibited wide applicability for real water matrix and the total removal of various kinds of emerging contaminants in real hospital wastewater reached up to 98.5%. The excellent performances of Mn@CNM were attributed to the nano-confinement effect in the membrane layer. First, anchoring Mn2O3 nanoparticles on the pits of the APT surface suppressed the growth and aggregation of nanosized Mn2O3, providing abundant reactive sites for catalytic ozonation. Second, the interlaced APT nanofibers formed nano-sized network structures, where ROS and SMX were confined in close vicinity and ROS have more chances to attack SMX. This work provides a promising strategy for the preparation of catalytic ceramic membrane with high catalytic efficiency for degradation of emerging contaminants in water.

Classification of Multiple Diseases on Body CT Scans Using Weakly Supervised Deep Learning.

PURPOSE: To design multidisease classifiers for body CT scans for three different organ systems using automatically extracted labels from radiology text reports. MATERIALS AND METHODS: This retrospective study included a total of 12 092 patients (mean age, 57 years ± 18 [standard deviation]; 6172 women) for model development and testing. Rule-based algorithms were used to extract 19 225 disease labels from 13 667 body CT scans performed between 2012 and 2017. Using a three-dimensional DenseVNet, three organ systems were segmented: lungs and pleura, liver and gallbladder, and kidneys and ureters. For each organ system, a three-dimensional convolutional neural network classified each as no apparent disease or for the presence of four common diseases, for a total of 15 different labels across all three models. Testing was performed on a subset of 2158 CT volumes relative to 2875 manually derived reference labels from 2133 patients (mean age, 58 years ± 18; 1079 women). Performance was reported as area under the receiver operating characteristic curve (AUC), with 95% CIs calculated using the DeLong method. RESULTS: Manual validation of the extracted labels confirmed 91%-99% accuracy across the 15 different labels. AUCs for lungs and pleura labels were as follows: atelectasis, 0.77 (95% CI: 0.74, 0.81); nodule, 0.65 (95% CI: 0.61, 0.69); emphysema, 0.89 (95% CI: 0.86, 0.92); effusion, 0.97 (95% CI: 0.96, 0.98); and no apparent disease, 0.89 (95% CI: 0.87, 0.91). AUCs for liver and gallbladder were as follows: hepatobiliary calcification, 0.62 (95% CI: 0.56, 0.67); lesion, 0.73 (95% CI: 0.69, 0.77); dilation, 0.87 (95% CI: 0.84, 0.90); fatty, 0.89 (95% CI: 0.86, 0.92); and no apparent disease, 0.82 (95% CI: 0.78, 0.85). AUCs for kidneys and ureters were as follows: stone, 0.83 (95% CI: 0.79, 0.87); atrophy, 0.92 (95% CI: 0.89, 0.94); lesion, 0.68 (95% CI: 0.64, 0.72); cyst, 0.70 (95% CI: 0.66, 0.73); and no apparent disease, 0.79 (95% CI: 0.75, 0.83). CONCLUSION: Weakly supervised deep learning models were able to classify diverse diseases in multiple organ systems from CT scans.Keywords: CT, Diagnosis/Classification/Application Domain, Semisupervised Learning, Whole-Body Imaging© RSNA, 2022.

Corrections to "iPhantom: A Framework for Automated Creation of Individualized Computational Phantoms and its Application to CT Organ Dosimetry".

In [1], the dose estimation accuracy using the alternative baseline method under modulated tube current was not correctly calculated due to an unintentional simulation error.

Development and validation of an automated methodology to assess perceptual in vivo noise texture in liver CT.

Purpose: Developing, validating, and evaluating a method for measuring noise texture directly from patient liver CT images (i.e., in vivo). Approach: The method identifies target regions within patient scans that are least likely to have major contribution of patient anatomy, detrends them locally, and measures noise power spectrum (NPS) there using a previously phantom-validated technique targeting perceptual noise-non-anatomical fluctuations in the image that may interfere with the detection of focal lesions. Method development and validation used scanner-specific CT simulations of computational, anthropomorphic phantom (XCAT phantom, three phases of contrast-enhancement) with known ground truth of the NPS. Simulations were based on a clinical scanner (Definition Flash, Siemens) and clinically relevant settings (tube voltage of 120 kV at three dose levels). Images were reconstructed with filtered backprojection (kernel: B31, B41, and B50) and Sinogram Affirmed Iterative Reconstruction (kernel: I31, I41, and I50) using a manufacturer-specific reconstruction software (ReconCT, Siemens). All NPS measurements were made in the liver. Ground-truth NPS were taken as the sum of (1) a measurement in parenchymal regions of anatomy-subtracted (i.e., noise only) scans, and (2) a measurement in the same region of noise-free (pre-noise-insertion) images. To assess in vivo NPS performance, correlation of NPS average frequency ( f avg ), was reported. Sensitivity of accuracy [root-mean-square-error (RMSE)] to number of pixels included in measurement was conducted via bootstrapped pixel-dropout. Sensitivity of NPS to dose and reconstruction kernel was assessed to confirm that ground truth NPS similarities were maintained in patient-specific measurements. Results: Pearson and Spearman correlation coefficients 0.97 and 0.96 for f avg indicated good correlation. Results suggested accurate NPS measurements (within 5% total RMSE) could be acquired with ∼ 10 6 pixels . Conclusions: Relationships of similar NPS due to reconstruction kernel and dose were preserved between gold standard and observed in vivo estimations. The NPS estimation method was further deployed on clinical cases to demonstrate the feasibility of clinical analysis.