"KAIZEN" method realizing implementation of deep-learning models for COVID-19 CT diagnosis in real world hospitals.

Numerous COVID-19 diagnostic imaging Artificial Intelligence (AI) studies exist. However, none of their models were of potential clinical use, primarily owing to methodological defects and the lack of implementation considerations for inference. In this study, all development processes of the deep-learning models are performed based on strict criteria of the "KAIZEN checklist", which is proposed based on previous AI development guidelines to overcome the deficiencies mentioned above. We develop and evaluate two binary-classification deep-learning models to triage COVID-19: a slice model examining a Computed Tomography (CT) slice to find COVID-19 lesions; a series model examining a series of CT images to find an infected patient. We collected 2,400,200 CT slices from twelve emergency centers in Japan. Area Under Curve (AUC) and accuracy were calculated for classification performance. The inference time of the system that includes these two models were measured. For validation data, the slice and series models recognized COVID-19 with AUCs and accuracies of 0.989 and 0.982, 95.9% and 93.0% respectively. For test data, the models' AUCs and accuracies were 0.958 and 0.953, 90.0% and 91.4% respectively. The average inference time per case was 2.83 s. Our deep-learning system realizes accuracy and inference speed high enough for practical use. The systems have already been implemented in four hospitals and eight are under progression. We released an application software and implementation code for free in a highly usable state to allow its use in Japan and globally.

Disturbed biopterin and folate metabolism in the Qdpr-deficient mouse.

Quinonoid dihydropteridine reductase (QDPR) catalyzes the regeneration of tetrahydrobiopterin (BH4), a cofactor for monoamine synthesis, phenylalanine hydroxylation and nitric oxide production. Here, we produced and analyzed a transgenic Qdpr(-/-) mouse model. Unexpectedly, the BH4 contents in the Qdpr(-/-) mice were not decreased and even increased in some tissues, whereas those of the oxidized form dihydrobiopterin (BH2) were significantly increased. We demonstrated that unlike the wild-type mice, dihydrofolate reductase regenerated BH4 from BH2 in the mutants. Furthermore, we revealed wide alterations in folate-associated metabolism in the Qdpr(-/-) mice, which suggests an interconnection between folate and biopterin metabolism in the transgenic mouse model.

[Historical study on traditional Chinese formulations and crude drugs used for bad breath].

Bad breath is a topic of general interest. In this study, the treatment for bad breath in traditional Chinese medicine was reviewed with a special focus on pathologic diagnosis and crude drug prescriptions. It was shown that bad breath developed based on both systemic and local diseases. Some systemic conditions, including nasal, paranasal, pulmonary and digestive diseases, are considered to cause bad breath. The morbid state of a patient with bad breath has been recognized as being based on "heat syndrome" and "Qi-stagnation syndrome." Bad breath based on "heat syndrome" is manifested as thirst and ulceration of the oral cavity, and has been treated with crude drugs such as Coptis rhizome, Scutellaria root and gypsum. One case study reported that bad breath resulting from a dry mouth was treated with byakkokaninjinto, a Kampo formulation containing gypsum. "Qi" is considered to be the vital energy of all life forms including for the functioning of organs and mental and emotional activity. "Qi-stagnation syndrom," referring to the dysfunction of organs, is manifested as psychosomatic symptoms such as irritability, a flushed face and restlessness. Bad breath based on "Qi-stagnation syndrome" has been treated with crude drugs such as Cnidium rhizome, clove and cinnamon bark. Modern dental and medical treatment both accept the participation of psychogenic agents in the development of bad breath. Bad breath also develops based on periodontal and oral diseases. This type of bad breath has been treated with mouth-wash (collutorium) containing Asiasarum root, Angelica dahurica root and Cnidium rhizome. This historical evidence regarding crude drug prescriptions contributes to the development of mouth care products for preventing and treating bad breath.

A new portable monitor for measuring odorous compounds in oral, exhaled and nasal air.

BACKGROUND: The B/B Checker®, a new portable device for detecting odorous compounds in oral, exhaled, and nasal air, is now available. As a single unit, this device is capable of detecting several kinds of gases mixed with volatile sulfur compounds (VSC) in addition to other odorous gasses. The purpose of the present study was to evaluate the effectiveness of the B/B Checker® for detecting the malodor level of oral, exhaled, and nasal air. METHODS: A total of 30 healthy, non-smoking volunteers (16 males and 14 females) participated in this study. The malodor levels in oral, exhaled, and nasal air were measured using the B/B Checker® and by organoleptic test (OT) scores. The VSCs in each air were also measured by gas chromatography (GC). Associations among B/B Checker® measurements, OT scores and VSC levels were analyzed using Spearman correlation coefficients. In order to determine the appropriate B/B Checker® level for screening subjects with malodor, sensitivity and specificity were calculated using OT scores as an identifier for diagnosing oral malodor. RESULTS: In oral and nasal air, the total VSC levels measured by GC significantly correlated to that measured by the B/B Checker®. Significant correlation was observed between the results of OT scores and the B/B Checker® measurements in oral (r = 0.892, p < 0.001), exhaled (r = 0.748, p < 0.001) and nasal air (r = 0.534, p < 0.001). The correlation between the OT scores and VSC levels was significant only for oral air (r = 0.790, p < 0.001) and nasal air (r = 0.431, p = 0.002); not for exhaled air (r = 0.310, p = 0.096). When the screening level of the B/B Checker® was set to 50.0 for oral air, the sensitivity and specificity were 1.00 and 0.90, respectively. On the other hand, the screening level of the B/B Checker® was set to 60.0 for exhaled air, the sensitivity and specificity were 0.82 and 1.00, respectively. CONCLUSION: The B/B Checker® is useful for objective evaluation of malodor in oral, exhaled and nasal air and for screening subjects with halitosis. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01139073.

Recent advances in evaluation of health effects on mercury with special reference to methylmercury-A minireview.

Mercury is a metal that has long been used because of its many advantages from the physical and chemical points of view. However, mercury is very toxic to many life forms, including humans, and mercury poisoning has repeatedly been reported. The main chemical forms of mercury are elemental mercury (Hg(0)), divalent mercury (Hg(2+)) and methylmercury (CH(3)-Hg(+)), the toxicities and metabolisms of which differ from each other. Methylmercury is converted from divalent mercury and is a well-known neurotoxicant, having been identified as the cause of Minamata disease. It bioaccumulates in the environment and is biomagnified in the food web. Human exposure to methylmercury is mainly through fish and seafood consumption. Methylmercury easily penetrates the blood-brain barrier and causes damage to the central nervous system, particularly in fetuses. In this paper, we summarize the global mercury cycle and mercury metabolism, toxicity and exposure evaluation, and the thresholds for the onset of symptoms after exposure to different chemical forms of mercury, particularly methylmercury.