A YOLO-based AI system for classifying calcifications on spot magnification mammograms.

OBJECTIVES: Use of an AI system based on deep learning to investigate whether the system can aid in distinguishing malignant from benign calcifications on spot magnification mammograms, thus potentially reducing unnecessary biopsies. METHODS: In this retrospective study, we included public and in-house datasets with annotations for the calcifications on both craniocaudal and mediolateral oblique vies, or both craniocaudal and mediolateral views of each case of mammograms. All the lesions had pathological results for correlation. Our system comprised an algorithm based on You Only Look Once (YOLO) named adaptive multiscale decision fusion module. The algorithm was pre-trained on a public dataset, Curated Breast Imaging Subset of Digital Database for Screening Mammography (CBIS-DDSM), then re-trained and tested on the in-house dataset of spot magnification mammograms. The performance of the system was investigated by receiver operating characteristic (ROC) analysis. RESULTS: We included 1872 images from 753 calcification cases (414 benign and 339 malignant) from CBIS-DDSM. From the in-house dataset, 636 cases (432 benign and 204 malignant) with 1269 spot magnification mammograms were included, with all lesions being recommended for biopsy by radiologists. The area under the ROC curve for our system on the in-house testing dataset was 0.888 (95% CI 0.868-0.908), with a sensitivity of 88.4% (95% CI 86.9-8.99%), specificity of 80.8% (95% CI 77.6-84%), and an accuracy of 84.6% (95% CI 81.8-87.4%) at the optimal cutoff value. Using the system with two views of spot magnification mammograms, 80.8% benign biopsies could be avoided. CONCLUSION: The AI system showed good accuracy for classification of calcifications on spot magnification mammograms which were all categorized as suspicious by radiologists, thereby potentially reducing unnecessary biopsies.

Immediate clip migration after breast biopsy: a meta-analysis for potential risk factors.

OBJECTIVES: Immediate clip migration following breast biopsy is not a rare condition but its impact on future cancer management can be profound. However, there is limited knowledge on what causes the phenomenon and how to prevent it. METHODS: A systematic search was performed to identify articles discussing factors associated with clip migration, and a meta-analysis for each risk factor was conducted to determine the risk ratio. RESULTS: The most significant risk factor for immediate clip migration is globally fatty breast (RR = 2.00 [1.43-2.80], P<0.00001), while local heterogeneity has a moderate but insignificant protective effect (RR=0.68 [0.45-1.04], P=0.07). Clips with bioabsorbable carriers and biopsy along the superior/inferior breast axis do not change the rate of clip migration. CONCLUSION: Intrinsic breast composition is the most important determinant for accurate clip placement. Further research to identify potentially modifiable factors, such as clip design and biopsy techniques, is needed. ADVANCES IN KNOWLEDGE: Fatty breast composition has the highest risk of clip migration. Research on potentially modifiable factors such as clip design and biopsy techniques is needed.

Prediction of survival according to kinetic changes of cytokines and hepatitis status following radioembolization with yttrium-90 microspheres.

BACKGROUND/PURPOSE: Yttrium-90 radioembolization (Y90-RE) may exert an immunomodulatory effect on the tumor microenvironment of hepatocellular carcinoma (HCC). Whether the host immune alterations after Y90-RE correlated with outcomes and whether Y90-RE affects viral hepatitis reactivation remains unclear. METHODS: Between July 2014 and July 2015, 18 patients undergoing Y90-RE for HCC were prospectively enrolled. Serum levels of virological markers, cytokines and chemokines were measured at baseline, 2, 4, and 12 weeks after Y90-RE. Factors associated with the clinical outcomes were evaluated. RESULTS: The disease control rate of Y90-RE was 44.4% (8 of 18) at 12 weeks, including 1 case with complete response, 4 cases with partial response, and 3 cases with stable disease. Significant elevation from baseline to week 2 and week 4 were noted in IL-10 level (8.4 ± 33.8, 15.7 ± 31.6, and 16.0 ± 41.7 pg/mL, P = 0.041 and 0.013, respectively) and IP-10 level (113.5 ± 97.8, 189.1 ± 164.4, and 168.6 ± 150.5 pg/mL, P = 0.027 and 0.026, respectively). After Y90-RE, transient HBV reactivation occurred in 2 patients, and 1 out of 3 HCV-infected patients exhibited HCV reactivation. Univariate analysis revealed that lower baseline IP-10 (≤200 pg/mL) and alanine aminotransferase (ALT) (≤50 U/L) levels were associated with better overall survival. Multivariate analysis identified an IP-10 level of 200 pg/mL (HR = 4.374, P = 0.045) as a predictor of overall survival. CONCLUSION: Baseline serum IP-10 level is a predictor of survival for HCC patients undergoing Y90-RE. HBV and HCV reactivation may develop after Y90-RE treatment.

Outcome analysis in 270 radiologically guided implantations of totally implantable venous access ports via basilic vein.

BACKGROUND: Totally implantable venous access ports (TIVAPs) are widely applied in patients who require chemotherapy, parenteral nutrition, or frequent intravenous drug infusion. Although various venous access routes are possible for TIVAP insertion, the best method remains a topic of controversy. We present a single-center retrospective study of radiologically guided placement of TIVAPs through the basilic vein, with analysis of technical feasibility, patient safety, and device-related complications. METHODS: We retrospectively reviewed 270 patients who received TIVAP implantation through the basilic vein from November 2013 to July 2016, under imaging guidance by an interventional radiology team at our institution. Fluoroscopic images, chest radiographs, computed tomography scans, and medical records were reviewed after port implantation. Catheter maintenance days were calculated and catheter-related complications were recorded. RESULTS: The procedural success rate was 99.3%. In total, 270 TIVAPs were implanted in 270 patients, of which 150 remained functional at the end of the study period. The total catheter maintenance days was 77 543 days, and the mean catheter indwelling duration was 287 ± 207 days. In 20 (7.4%) patients, TIVAP-related complications occurred during the follow-up period, resulting in a postprocedural complication rate of 0.26 incidences per 1000 catheter days. No significant relationship was observed between complications and gender (p = 0.188), age (p = 0.528), body mass index (p = 0.547), the type of primary malignancy (p = 0.914), or between the left and right basilic veins (p = 0.319). CONCLUSION: Real-time ultrasound and fluoroscopic guidance provides a safe method for TIVAP implantation through the basilic vein, with a high technical success rate and few device-related complications.

Effects of simulated microgravity on the expression profiles of RNA during osteogenic differentiation of human bone marrow mesenchymal stem cells.

OBJECTIVES: Exposure to microgravity induces many adaptive and pathological changes in human bone marrow mesenchymal stem cells (hBMSCs). However, the underlying mechanisms of these changes are poorly understood. We revealed the gene expression patterns of hBMSCs under normal ground (NG) and simulated microgravity (SMG), which showed an interpretation for these changes by gene regulation and signal pathways analysis. MATERIALS AND METHODS: In this study, hBMSCs were osteogenically induced for 0, 2, 7 and 14 days under normal ground gravity and simulated microgravity, followed by analysis of the differences in transcriptome expression during osteogenic differentiation by RNA sequencing and some experimental verification for these results. RESULTS: The results indicated that 837, 399 and 894 differentially expressed genes (DEGs) were identified in 2, 7 and 14 days samples, respectively, out of which 13 genes were selected for qRT-PCR analysis to confirm the RNA-sequencing results. After analysis, we found that proliferation was inhibited in the early stage of induction. In the middle stage, osteogenic differentiation was inhibited, whereas adipogenic differentiation benefited from SMG. Moreover, SMG resulted in the up-regulation of genes specific for tumorigenesis in the later stage. CONCLUSION: Our data revealed that SMG inhibits the proliferation and inhibits the differentiation towards osteoblasts but promotes adipogenesis. SMG also selects highly tumorigenic cells for survival under prolonged SMG.

TRIB3 inhibits proliferation and promotes osteogenesis in hBMSCs by regulating the ERK1/2 signaling pathway.

Osteogenic differentiation in human bone marrow-derived mesenchymal stem cells (hBMSCs) is regulated by various factors, including bone morphogenetic proteins (BMPs), Notch, growth hormones and mitogen-activated protein kinases (MAPKs). Tribbles homolog 3 (TRIB3), a pseudokinase, plays an important role in cancer cells and adipocytes. However, TRIB3 function in osteogenic differentiation is unknown, although it is involved in regulating signaling pathways associated with osteogenic differentiation. Here, we found that TRIB3 was highly expressed during osteogenic differentiation in hBMSCs. Inhibition of focal adhesion kinase (FAK) or phosphatidylinositol 3-kinase (PI3K) resulted in a significant decrease in TRIB3 expression, and expression of TRIB3 was restored by increasing insulin-like growth factor-1 (IGF-1) via activating phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) signaling. TRIB3 knock-down enhanced proliferation and decreased osteogenic differentiation at the middle stage of differentiation, and these effects were reversed by inhibiting the activation of extracellular signal-regulated kinase (ERK)-1/2. In conclusion, TRIB3 plays an important role in proliferation and osteogenic differentiation by regulating ERK1/2 activity at the middle stage of differentiation, and expression of TRIB3 is regulated by FAK in a PI3K/AKT-dependent manner.

Clinical observation of lymphocyte active immunotherapy in 380 patients with unexplained recurrent spontaneous abortion.

PURPOSE: This study aims to investigate the clinical curative effect of lymphocyte active immunotherapy (LAI) on unexplained recurrent spontaneous abortion (RSA). METHODS: A total of 749 RSA patients who received medical service in our hospital from October 2009 to June 2013 were enrolled into this study. These patients were randomly divided into two groups: LAI group (treatment group) and routine progesterone for maintenance tocolysis group (control group). A comparative analysis on the pregnancy outcomes in these two groups was conducted. RESULTS: Abortion rate was significantly lower in the LAI group than in the control group (P<0.05). Furthermore, pregnancy success rates were 89.7% and 32.2% in patients who received LAI and routine progesterone for maintenance tocolysis, respectively, and the difference was statistically significant (P<0.05). CONCLUSION: Our analysis suggested that LAI can treat RSA effectively and has an excellent clinical effect. Furthermore, the detection of blocking antibodies showed a positive prediction on pregnancy outcome.

Effect of ulinastatin on serum inflammatory factors in Asian patients with acute pancreatitis before and after treatment: a meta-analysis
.

OBJECTIVE: We applied a meta-analysis to explore the effect of ulinastatin (UTI) on the serum levels of C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) in Asian patients with acute pancreatitis (AP). METHODS: Various databases were searched based on stringent inclusion and exclusion criteria to extract relevant cohort studies. Comprehensive Meta-analysis 2.0 (Biostat Inc., Englewood, NJ, USA) was applied for statistical analyses. RESULTS: A total of 113 relevant studies (67 in Chinese, 46 in English) were initially retrieved. Finally, 11 eligible studies were enrolled in our meta-analysis with 399 pancreatitis patients. Meta-analysis results showed that after being treated with UTI, the serum levels of CRP, IL-6, and TNF-α were evidently decreased (CRP: SMD = -2.697, 95% CI = -4.399 ~ -0.994, p = 0.002; IL-6: SMD = -5.268, 95% CI = -9.850 ~ -0.687, p = 0.024; TNF-α: SMD = -5.666, 95% CI = -11.083 ~ -0.249, p = 0.040). CONCLUSION: UTI can effectively reduce the serum levels of CRP, IL-6, and TNF-α in Asian patients with AP, suggesting that UTI has anti-inflammatory effect on Asian patients with AP.
.

Genetic Correction of Induced Pluripotent Stem Cells From a Deaf Patient With MYO7A Mutation Results in Morphologic and Functional Recovery of the Derived Hair Cell-Like Cells.

UNLABELLED: The genetic correction of induced pluripotent stem cells (iPSCs) induced from somatic cells of patients with sensorineural hearing loss (caused by hereditary factors) is a promising method for its treatment. The correction of gene mutations in iPSCs could restore the normal function of cells and provide a rich source of cells for transplantation. In the present study, iPSCs were generated from a deaf patient with compound heterozygous MYO7A mutations (c.1184G>A and c.4118C>T; P-iPSCs), the asymptomatic father of the patient (MYO7A c.1184G>A mutation; CF-iPSCs), and a normal donor (MYO7A(WT/WT); C-iPSCs). One of MYO7A mutation sites (c.4118C>T) in the P-iPSCs was corrected using CRISPR/Cas9. The corrected iPSCs (CP-iPSCs) retained cell pluripotency and normal karyotypes. Hair cell-like cells induced from CP-iPSCs showed restored organization of stereocilia-like protrusions; moreover, the electrophysiological function of these cells was similar to that of cells induced from C-iPSCs and CF-iPSCs. These results might facilitate the development of iPSC-based gene therapy for genetic disorders. SIGNIFICANCE: Induced pluripotent stem cells (iPSCs) were generated from a deaf patient with compound heterozygous MYO7A mutations (c.1184G>A and c.4118C>T). One of the MYO7A mutation sites (c.4118C>T) in the iPSCs was corrected using CRISPR/Cas9. The genetic correction of MYO7A mutation resulted in morphologic and functional recovery of hair cell-like cells derived from iPSCs. These findings confirm the hypothesis that MYO7A plays an important role in the assembly of stereocilia into stereociliary bundles. Thus, the present study might provide further insight into the pathogenesis of sensorineural hearing loss and facilitate the development of therapeutic strategies against monogenic disease through the genetic repair of patient-specific iPSCs.

Pulmonary hypertension and right ventricular dysfunction in patients with left to right shunt coronary artery fistula: evaluation with cardiac CT.

In this study, we aimed to evaluate whether patients with left to right shunt coronary artery fistula (LRSCAF) are predisposed to developing pulmonary hypertension and right ventricular dysfunction compared with healthy individuals. The value of cardiac CT findings in determining the necessity of intervention for these patients was investigated. We retrospectively studied 19 patients with LRSCAF and 19 healthy patients. Several parameters were observed on cardiac CT by two radiologists, including pulmonary trunk diameter (PA diameter), right ventricular diameter (RVD), left ventricular diameter (LVD), RVD/LVD ratio, septal bowing and CT score of right ventricular dysfunction (CSRVD). Data from both groups were compared. The inter- and intra-observer variabilities and correlations were examined. The disease group was further divided into intervention (n = 9) and non-intervention (n = 10) groups, and their data were compared. All cardiac CT findings showed significant intra- and inter-observer correlation without significant variability. Mann-Whitney U tests and χ(2) analysis showed that PA diameter, RVD/LVD ratio acquired from two observers, and CSRVD were higher in the disease group than in the control group (all P values < 0.05 for χ(2) and almost all P values < 0.05 for Mann-Whitney U). The RVD/LVD ratio and CSRVD were higher in the intervention group than in the non-intervention group (all P values < 0.05). Receiver operating curve analysis identified RVD/LVD = 1.036 and CSRVD = 3.5 as the best cut-off values to determine the necessity of further intervention. Patients with LRSCAF are more predisposed to pulmonary hypertension and right ventricular dysfunction compared with the normal population. RVD/LVD > 1.0 and CSRVD ≥ 4.0 may determine the necessity of intervention for patients with LRSCAF.

Imaging spectrum after pancreas transplantation with enteric drainage.

Since the introduction of pancreas transplantation more than 40 years ago, surgical techniques and immunosuppressive regiments have improved and both have contributed to increase the number and success rate of this procedure. However, graft survival corresponds to early diagnosis of organ-related complications. Thus, knowledge of the transplantation procedure and postoperative image anatomy are basic requirements for radiologists. In this article, we demonstrate the imaging spectrum of pancreas transplantation with enteric exocrine drainage.

Role of TGF-ß1/Smads pathway in carotid artery remodeling in renovascular hypertensive rats and prevention by Enalapril and Amlodipine.

OBJECTIVE: To investigate the role of transforming growth factor-ß1 (TGF-ß1), Smad2/3 and Smad7 expressions in carotid artery remodeling in renovascular hypertensive rats, and also the therapeutic effect of Enalapril and Amlodipine. METHODS: The renovascular hypertensive rat (RHR) models with "two-kidney and one-clip" were established, including model group (n = 6), sham-operated group (n = 6), Enalapril group (10 mg/kg per day, n = 6), Amlodipine group (5 mg/kg per day, n = 6) and combination group (Amlodipine 2.5 mg/kg per day + Enalapril 5mg/kg per day, n = 6). The medication were continuous administrated for six weeks. Carotid artery morphological and structural changes in the media were observed by HE staining, Masson staining and immuno histochemical staining. Media thickness (MT), MT and lumen diameter ratio (MT/LD), and the expression levels of media α-smooth muscle actin (α-actin), proliferating cell nuclear antigen (PCNA), TGF-ß1, phosphorylated Smad2/3 (p-Smad2/3) and Smad7 in carotid arteries were measured. RESULTS: The media of carotid arteries in RHR model group was significantly thickened, the volume of smooth muscle cell was increased, and the array was in disorder; MT, MT/LD, the proliferation index of smooth muscle cell and collagen fiber area percentage of carotid arteries in the model group were significantly higher than those in the sham-operated group (P < 0.01). Compared to sham-operated group, the model group had significantly higher expressions of TGF-ß1 and p-Smad2/3 (P < 0.05) and lower Smad7 expression. Both Enalapril and Amlodipine improved smooth muscle hypertrophy and collagen deposition, reduced RHR carotid MT, MT/LD, proliferation index of smooth muscle cell, collagen fiber area percentage and the expressions of TGF-ß1 and p-Smad2/3 (P < 0.05), increased Smad7 expression (P < 0.05). Moreover, the combination treatment of Enalapril and Amlodipine had significantly better effects than single Amlodipine group (P < 0.05), but not single Enalapril group. CONCLUSIONS: TGF-ß1/Smads pathway may participate in the mechanism of carotid artery remodeling in RHR; the role of Amlodipine and Enalapril in inversing carotid artery remodeling may be related to the change of TGF-ß1/Smads pathway, the combination treatment of Amlodipine and Enalapril had better effects than single administration of Amlodipine.

Fabrication of a surgical template for orbital implant placement: a case report.

Implant placement in orbital sites is challenging because of limited bone volume and poor bone quality. Preoperative optimal implant planning and intraoperative guides are important to ensure success. This article describes the use of computer simulation for implant insertion and fabrication of a surgical template as a drilling guide for orbital implant placement. A 29-year-old woman with a right orbital defect underwent computerized tomographic scanning, and the data were processed with interactive software to simulate orbital implant placement. A surgical template that served as a drilling guide was designed and fabricated to transfer orbital recipient site information from the three-dimensional computer model into the actual orbital implant sites. Three craniofacial implants were placed in the 7:00, 8:00, and 11:00 positions. No unexpected complications or injuries were encountered during the surgery. Magnetic abutments were attached to the implants 2 weeks later. The definitive facial prosthesis was fitted 6 months later, with excellent esthetic results. The surgical template contributed to the success of this treatment.

Testicular microlithiasis: analysis of prevalence and associated testicular cancer in Taiwanese men.

PURPOSE: To determine the incidence of testicular microlithiasis (TM) in Taiwanese males who were referred for scrotal sonography (US) and to evaluate the association between TM and cancer, with state-of-the-art equipment. METHODS: This retrospective study included 513 males who underwent scrotal US in a period of 7 months. The US images and charts of each patient were reviewed to determine the presence of TM and note relevant clinical information. RESULTS: The data for all 513 patients were analyzed. Their age was 0-91 years (mean, 54.3 years). The overall incidence of TM was 14.4% (74/513); 6.2% (32/513) had classic TM, and 8.2% had limited TM. The incidence of testicular cancer in this population was 1.6% (8/513). Six of eight (75%) patients who had testicular cancer at presentation had classic TM or limited TM. There was a significant difference (P < 0.01) between the rate of malignancy in subjects with TM (6/74) and that in subjects without TM (2/439). CONCLUSION: The incidence of TM in Taiwanese people may be higher than previously reported, which may be due to the difference in methodology and increased awareness of the US findings. Although there was a significant difference in the rate of malignancy in males with TM compared with those without TM, the question remains whether TM independently increases the risk of testicular malignancy.

[CT multiplanar image anatomic study on orbital bone used for implant operation].

OBJECTIVE: To evaluate the orbital bone quantity by spiral computer tomography (CT) for orbital implant operation. METHODS: Fifty-two normal skull specimens with marks received spiral CT scan and their multiplanar images were obtained. The quantity (length x width) were measured on multiplanar images. RESULTS: The right orbital bone quantity at 7:00 was the highest, average 11.91 mm x 8.38 mm, and at 3:00 was the lowest, average 2.31 mm x 1.34 mm. The left orbital bone quantity at 5:00 was the highest, average 12.03 mm x 8.56 mm, and at 9:00 was the lowest, average 2.44 mm x 1.29 mm. There had no significance correlation with gender at the same position in both sides. CONCLUSION: Useful data had been obtained for the selection of the placement sites, direction, length, and diameter of orbital implants.

[Clinical application of computer assisted technology based spiral CT scan for locating impacted tooth].

OBJECTIVE: To evaluate clinical value of computer assisted technology for locating the impacted tooth. METHODS: Thirty-five patients with impacted tooth were received spiral CT scan. The DICOM data were processed by Simplant software for locating the impacted tooth. RESULTS: The reconstruction images clearly showed detail of the impacted teeth, including 3D surface image, eruption orientation, buccal and lingual location, medial and distal location and relationship with dentition and circumambient anatomic structure. CONCLUSION: The computer assisted technology can localize the impacted tooth precisely and provide valuable information for clinical treatment.

Duodenal angiosarcoma: an unusual cause of severe gastrointestinal bleeding.

Angiosarcoma is a rare soft-tissue neoplasm that occurs most often in the skin and the subcutaneous tissues but very rarely in the gastrointestinal tract. We report a case of primary intestinal angiosarcoma with severe gastrointestinal bleeding. This patient was referred to our institute for shock with tarry-bloody stool and severe anemia. Panendoscopy revealed multiple duodenal polypoid tumors, and initial biopsy specimen showed poorly differentiated adenocarcinoma. The tumors were treated with pancreaticoduodenectomy, but the patient died 2 weeks after the operation as a result of acute respiratory distress syndrome. The pathology was consistent with angiosarcoma of the duodenum. In our experience, this tumor may cause severe bleeding, and surgery should be performed as soon as possible to prevent complications of hypovolemic shock.