Position Classification of the Endotracheal Tube with Automatic Segmentation of the Trachea and the Tube on Plain Chest Radiography Using Deep Convolutional Neural Network.

Background: This study aimed to develop an algorithm for multilabel classification according to the distance from carina to endotracheal tube (ETT) tip (absence, shallow > 70 mm, 30 mm ≤ proper ≤ 70 mm, and deep position < 30 mm) with the application of automatic segmentation of the trachea and the ETT on chest radiographs using deep convolutional neural network (CNN). Methods: This study was a retrospective study using plain chest radiographs. We segmented the trachea and the ETT on images and labeled the classification of the ETT position. We proposed models for the classification of the ETT position using EfficientNet B0 with the application of automatic segmentation using Mask R-CNN and ResNet50. Primary outcomes were favorable performance for automatic segmentation and four-label classification through five-fold validation with segmented images and a test with non-segmented images. Results: Of 1985 images, 596 images were manually segmented and consisted of 298 absence, 97 shallow, 100 proper, and 101 deep images according to the ETT position. In five-fold validations with segmented images, Dice coefficients [mean (SD)] between segmented and predicted masks were 0.841 (0.063) for the trachea and 0.893 (0.078) for the ETT, and the accuracy for four-label classification was 0.945 (0.017). In the test for classification with 1389 non-segmented images, overall values were 0.922 for accuracy, 0.843 for precision, 0.843 for sensitivity, 0.922 for specificity, and 0.843 for F1-score. Conclusions: Automatic segmentation of the ETT and trachea images and classification of the ETT position using deep CNN with plain chest radiographs could achieve good performance and improve the physician's performance in deciding the appropriateness of ETT depth.

Differential Effects of Dietary Methionine Isomers on Broilers Challenged with Acute Heat Stress.

In this study, we investigated the effect of methionine isomers (D- and L-methionine) on growth performance, blood metabolite levels, nutrient digestibility, intestinal morphology, and foot pad dermatitis in broilers challenged with acute heat stress. In total, 240 broilers were randomly allocated in a 2×2 factorial arrangement consisting of two dietary treatments (D- vs. L-methionine) and two thermal environmental conditions (thermo-neutral vs. acute heat stress). Methionine isomers were added to the diet as an ingredient according to the diet formulation. The broilers were exposed to acute heat stress at 33°C for 5 h on day 14. The average daily gain and feed conversion ratio of birds fed L-methionine were higher than those fed D-methionine (P<0.05) from the time of hatching till 21 days. Induced acute heat stress impaired (P<0.05) the daily gain and feed intake of the broilers on day 21. Furthermore, the blood urea nitrogen levels of birds subjected to acute heat stress on days 14 and 21 were higher (P<0.05) than those of their counterparts. Longer villi (P<0.05) were observed in broilers fed L-methionine-supplemented diet than in those fed D-methionine-supplemented diet on day 14, irrespective of thermal environmental conditions. Heat stress reduced (P<0.01) nutrient digestibility of the broilers on days 14 and 21. Higher incidence and severity of foot pad dermatitis were observed (P<0.05) in broilers fed diet containing D-methionine than in those fed L-methionine-supplemented diet. In conclusion, L-methionine-supplemented diet improved growth performance, overcame growth depression, and reduced the incidence of foot pad dermatitis when broilers were exposed to acute heat stress in the starter period.

Analysis of psychological distress after management of dizziness in old patients: multicenter study.

Dizziness is a common problem in older people, with a reported prevalence of 13-38%. A large percentage of patients with dizziness develop secondary psychiatric disorders over the course of their disease. In particular, clinical depression and anxiety are significant health problems for older adults. We investigated the relationship between dizziness and psychological distress (depression and anxiety) in elderly patients with dizziness, and the relationship with psychological symptoms after managing the dizziness. This study enrolled 126 patients with dizziness, who were 65 years or older. Dizziness and the psychological symptoms of all patients were measured using the Korean Version of the Vestibular Disorders Activities of Daily Living Scale (K-VADL), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI) before and after management. We found a significant decrease in the BDI and STAI state scores after treatment with a reduction in the K-VADL score. For the STAI, the decrease in the score was relatively small after management. Nevertheless, there were significant correlations between the K-VADL score and both the BDI and STAI scores before and after management. Therefore, in the management of elderly patients with dizziness, a psychiatric approach should be considered and psychological support may be needed after managing the dizziness.

The association between impaired fasting glucose and noise-induced hearing loss.

OBJECTIVES: This study was performed to determine whether there is an association between impaired fasting glucose and noise-induced hearing loss. METHODS: The study subjects were workers in one automobile manufacturing company. The data were obtained from results of health examinations during 2005 and 2009. The factors analyzed were age, smoking and alcohol history, work duration, environmental noise level, hearing thresholds, blood pressure, serum creatinine, initial hearing threshold and fasting glucose. RESULTS: The hearing thresholds at 4,000 Hz frequencies for both ears were significantly higher in 2009 than those in 2005. The changes in the hearing thresholds of the subjects with an impaired fasting glucose (100-125 mg/dl) and diabetes (≥126 mg/dl) were greater than those of the normal (<100 mg/dl) group. After adjusting for variables such as age, smoking and alcohol history, environmental noise, hypertension and serum creatinine, fasting glucose was found to be a significant variable. Impaired fasting glucose (100-125 mg/dl) was significant (ß=1.339, p=0.002) for the right ear, whereas it was not significant (ß=0.639, p=0.121) for the left ear. CONCLUSIONS: Impaired fasting glucose, as well as diabetes, might be risk factors for hearing loss in individuals with exposure to certain noise levels. The results of this study suggest that impaired fasting glucose should be considered a risk factor for hearing loss.

Rat model of platelet-activating factor-induced rhinosinusitis.

Platelet-activating factor (PAF) is known to be a potent inflammatory mediator, especially in allergic inflammation. However, the exact role of PAF in the pathogenesis of rhinosinusitis has not been clearly established. To understand the role of PAF in the pathogenesis of rhinosinusitis, it is necessary to develop an animal model of PAF-induced rhinosinusitis. The aim of this study was to develop a rat model of rhinosinusitis induced by intranasally applied PAF. Fifty microliters of 16 microg/mL PAF was applied intranasally through each naris in 4-week-old Sprague-Dawley rats, and the same amount of vehicle was applied in control rats. At 1, 3, or 5 days, the animals were painlessly sacrificed, and the nasal cavity and sinuses were prepared for histologic investigation. The histologic sections were examined in a blind manner for the appearance of neutrophil clusters in the sinonasal air space, and the numbers of eosinophils, areas of epithelial loss, goblet cells, and inducible nitric oxide synthase (iNOS)-positive inflammatory cells in the mucosa. Neutrophil clusters were observed in the air space, and the number of eosinophils, areas of epithelial loss, goblet cells, and iNOS-positive inflammatory cells in the mucosa were increased significantly in the PAF-applied rats. The amount of inflammation varied according to the time interval, showing a peak at day 3. We conclude that intranasally applied PAF induces rhinosinusitis in rats. The histologic evidence of rhinosinusitis revealed the appearance of neutrophil clusters in the sinonasal air space, infiltration of eosinophils and iNOS-positive inflammatory cells in the mucosa, areas of epithelial loss, and goblet cell hyperplasia in the epithelium. This rat model of PAF-induced rhinosinusitis may be applied for better understanding of the role of PAF in the pathogenesis of rhinosinusitis.