Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 792
Filtrar
2.
Neurol Sci ; 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33057978

RESUMO

Stroke-associated infection (SAI) is a major medical complication in acute ischemic stroke patients (AIS) treated with endovascular therapy (EVT). Three hundred thirty-three consecutive patients with AIS caused by a large vessel occlusion in the anterior circulation who received EVT (142 (42.6%) of them were given IV tPA as bridging therapy) and 337 AIS patients who received IV tPA only (non-EVT) were enrolled in the study and evaluated to determine the association of inflammatory factors on admission with SAI. Among the 333 AIS patients undergoing EVT, SAI occurred in 219 (65.8%) patients. Patients with SAI had higher baseline National Institutes of Health Stroke Scale (NIHSS) total scores, white blood cell (WBC) and neutrophil counts, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) than those without SAI (P < 0.05). The multivariable logistic regression analyses showed that older age in addition to higher diastolic blood pressure (DBP), NIHSS score, fasting blood glucose, WBC and neutrophil counts, NLR, and PLR were significantly associated with SAI (P < 0.05). However, these associations were not revealed in 337 non-EVT AIS patients. Furthermore, based on the inflammatory markers, we developed a nomogram that provided the opportunity for more accurate predictions (compared with conventional factors) and appeared a better prognostic tool for SAI according to the decision curve analysis. In summary, if proven externally valid, our nomogram that included WBC count, NLR, and PLR may be a useful tool for SAI prediction in clinical practice.

3.
J Immunother Cancer ; 8(2)2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33055204

RESUMO

BACKGROUND: Tertiary lymphoid structures (TLS) are associated with favorable survival and play a critical role in most solid tumors. However, investigations of TLS are lacking in patients with grade 1 or grade 2 (G1/G2) non-functional pancreatic neuroendocrine tumors (NF-PanNETs). This study aimed to investigate the presence, cellular composition, association with tumor-infiltrating immune cells, and prognostic value of TLS in G1/G2 NF-PanNETs. METHODS: Tumor tissues from a 182-patient Fudan cohort and a 125-patient external validation set were assessed by H&E staining, immunohistochemistry, and/or multispectral fluorescent immunohistochemistry. RESULTS: TLS were identified in more than one-third of patients with G1/G2 NF-PanNETs and were located peritumorally, either just outside the tumor tissue or in the stromal area. TLS were mainly composed of B-cell follicles with germinal centers and T-cell zones with dendritic cells. Kaplan-Meier analyses showed that the presence of TLS correlated with both longer recurrence-free survival (RFS, p<0.001) and overall survival (OS, p=0.001), but the number of TLS had no prognostic significance. Multivariate Cox-regression analyses demonstrated that the presence of TLS, WHO classification, and 8th edition American Joint Committee on Cancer (AJCC8th) tumor-node-metastasis (TNM) stage were independent prognostic factors for RFS (p=0.004, p=0.001, and p<0.001, respectively) and OS (p=0.009, p=0.008, and p=0.019, respectively). These results were confirmed using an external validation set. Finally, a nomogram incorporating the presence of TLS was constructed to predict the probability of 5-year RFS of resected G1/G2 NF-PanNETs, which improved on the current WHO classification and AJCC8th TNM stage. CONCLUSIONS: The presence of TLS is an independent and favorable predictor of resected G1/G2 NF-PanNETs, which may play a role in cancer immunobiology.

4.
PLoS One ; 15(10): e0240559, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33057441

RESUMO

The long-term impact of human exploitation and environmental changes has led to a decline in grassland productivity and soil fertility, which eventually results in grassland degradation. The application of organic fertilizer is an effective improvement measure; however, it is still not fully understood how the addition of organic fertilizer influences grassland soil fertility and plant composition. A set of experiments were conducted in Inner Mongolia in China to reveal the tradeoff between steppe plants and soil microorganisms and the eco-physiological mechanisms involved, and how the addition of vermicompost and mushroom residues affect microbial diversity, enzyme activities, and the chemical properties of soil in degraded Leymus chinensis grassland. Organic fertilizer improved the soil nutrient status and shaped distinct bacterial communities. Compared with the control the available phosphorus (AP) and available potassium (AK) contents were highest under treatments a3 and b3, and the aboveground biomass was highest under the b3 treatment. Soil sucrase activities increased by 7.88% under the b3 treatment. Moreover, the richness index significantly increased by 7.07% and 7.23% under the a1 and b2 treatments, respectively. The most abundant Actinobacteria and Proteobacteria were detected in the organic fertilizer treatment. A linear discriminant analysis effect size (LEfSe) indicated that the bacterial community was significantly increased under the b3 treatment. A canonical correspondence analysis (RDA) and spearman correlation heatmap confirmed that total P (TP) and urease were the key driving factors for shaping bacterial communities in the soil. Our results indicated that the application of large amounts of vermicompost and mushroom residues increased the availability of nutrients and also enhanced the biodiversity of soil bacterial communities in L. chinensis grasslands, which will contribute to the sustainable development of agro-ecosystems.

5.
Comput Med Imaging Graph ; 86: 101795, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33070051

RESUMO

We propose a spatiotemporal model for cardiac magnetic resonance images (MRI) named SptDenNet. The proposed model is based on DenseNet and extracts spatial and temporal features simultaneously to exploit three-dimensional information on the heart over the cardiac loop cycle. To balance the model performance and efficiency, we construct a shared end-to-end framework, in which all frames of each selected short-axis (SAX) view slices are input to SptDenNet individually to extract spatiotemporal features. Then, the extracted features of all selected SAX view slices of a patient are concatenated and input to the subsequent fully connected layer and then a softmax layer to predict the left ventricular ejection fraction directly. To address the problem of class imbalance, we use FocalLoss function by reshaping the standard cross-entropy loss such that it down-weights the loss assigned to well-classified samples. We validate our proposed framework on the Second Annual Data Science Bowl dataset. Our prediction for the left ventricular ejection fraction obtains results comparable with state-of-the-art end-to-end approaches but without segmentation. The average mean absolute error of the ejection fraction is 6.84. To further verify the effectiveness of the proposed framework, we use 4-chamber view images from the same dataset to predict the cardiac function; we obtain an accuracy of 86.07%. Our approach constructs an end-to-end model to predict the ejection fraction automatically without using image segmentation, which helps reduce manual work. Moreover, the proposed approach is computationally efficient.

6.
Med Image Anal ; 67: 101826, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33075638

RESUMO

Accurate vertebrae recognition is crucial in spinal disease localization and successive treatment planning. Although vertebrae detection has been studied for years, reliably recognizing vertebrae from arbitrary spine MRI images remains a challenge. The similar appearance of different vertebrae and the pathological deformations of the same vertebrae makes it difficult for classification in images with different fields of view (FOV). In this paper, we propose a Category-consistent Self-calibration Recognition System (Can-See) to accurately classify the labels and precisely predict the bounding boxes of all vertebrae with improved discriminative capabilities for vertebrae categories and self-awareness of false positive detections. Can-See is designed as a two-step detection framework: (1) A hierarchical proposal network (HPN) to perceive the existence of the vertebrae. HPN leverages the correspondence between hierarchical features and multi-scale anchors to detect objects. This correspondence tackles the image scale/resolution challenge. (2) A Category-consistent Self-calibration Recognition (CSRN) Network to classify each vertebra and refine their bounding boxes. CSRN leverages the dictionary learning principle to preserve the most representative features; it imposes a novel category-consistent constraint to force vertebrae with the same label to have similar features. CSRN then innovatively formulates message passing into the deep learning framework, which leverages the label compatibility principle to self-calibrate the wrong pre-recognitions. Can-See is trained and evaluated on a capacious and challenging dataset of 450 MRI scans. The results show that Can-See achieves high performance (testing accuracy reaches 0.955) and outperforms other state-of-the-art methods.

7.
Med Image Anal ; 67: 101861, 2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-33075640

RESUMO

Accurate vertebral body (VB) detection and segmentation are critical for spine disease identification and diagnosis. Existing automatic VB detection and segmentation methods may cause false-positive results to the background tissue or inaccurate results to the desirable VB. Because they usually cannot take both the global spine pattern and the local VB appearance into consideration concurrently. In this paper, we propose a Sequential Conditional Reinforcement Learning network (SCRL) to tackle the simultaneous detection and segmentation of VBs from MR spine images. The SCRL, for the first time, applies deep reinforcement learning into VB detection and segmentation. It innovatively models the spatial correlation between VBs from top to bottom as sequential dynamic-interaction processes, thereby globally focusing detection and segmentation on each VB. Simultaneously, SCRL also perceives the local appearance feature of each desirable VB comprehensively, thereby achieving accurate detection and segmentation result. Particularly, SCRL seamlessly combines three parts: 1) Anatomy-Modeling Reinforcement Learning Network dynamically interacts with the image and focuses an attention-region on the VB; 2) Fully-Connected Residual Neural Network learns rich global context information of the VB including both the detailed low-level features and the abstracted high-level features to detect the accurate bounding-box of the VB based on the attention-region; 3) Y-shaped Network learns comprehensive detailed texture information of VB including multi-scale, coarse-to-fine features to segment the boundary of VB from the attention-region. On 240 subjects, SCRL achieves accurate detection and segmentation results, where on average the detection IoU is 92.3%, segmentation Dice is 92.6%, and classification mean accuracy is 96.4%. These excellent results demonstrate that SCRL can be an efficient aided-diagnostic tool to assist clinicians when diagnosing spinal diseases.

8.
Cancer Res Treat ; 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33091968

RESUMO

A 61-year-old male patient was simultaneously diagnosed with lung adenocarcinoma and inflammatory myofibroblastic tumor (IMT). The lung adenocarcinoma and IMT harbored two distinct types of ALK translocation, LOC101927285-ALK and TPM3-ALK, respectively. The ALK Ventana showed strong positivity on both lesions. The patient was therefore given an endobronchial cryotherapy and ALK inhibitor crizotinib. The tumors showed durable response however the left lung adenocarcinoma relapsed at 17th month post crizotinib treatment. Tissue re-biopsy on the resistant tumor revealed an ALK exon 23 C1156Y missense mutation in addition to LOC101927285-ALK mutation. Further RNA-based sequence uncovered that the noncoding region rearrangement is the fusion mutation of EML4-ALK. The patient was therefore received alectinib, and the tumor exhibited partly response. Overall, it is very rare that two types of pulmonary tumors exist in one patient driven by two distinct ALK fusions, which emphasizes the necessity of gene sequencing in clinical decision-making and individualized therapy.

9.
Hum Vaccin Immunother ; : 1-9, 2020 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-33016814

RESUMO

OBJECTIVES: To evaluate cost-utility of universal Hepatitis B vaccination program in the Beijing city (Beijing). METHODS: A decision-Markov model was constructed to determine the cost-utility of the universal immunization program for infants (universal vaccination program) by comparing with a hypothetic nonvaccination strategy in Beijing. Parameters in models were extracted from Beijing Center for Disease Control and Prevention (CDC) annual work report, Beijing health statistical yearbook, National Health Survey report, Beijing 1% population sample survey report, Beijing Health and Medical Price Monitoring Data Platform, and public literatures. The incremental cost­utility ratio (ICUR) was used to compare alternative scenarios. One-way sensitivity analysis and probabilistic sensitivity analysis were used to assess parameter uncertainties. RESULTS: The universal vaccination program had increased the utility and reduced cost among infants born in 2016 in Beijing. The ICUR was CNY -24,576.61 (US$ -3779.16) per QALY for universal vaccination program comparing with non-vaccination scenario from healthcare perspective. It was estimated that the universal vaccination would save direct medical treatment cost of CNY 2,262,869,173.50 (US$ 347,962,414.43) and prevent loss of 18322.25 QALYs within lifetime of target cohort. Discount rate accounted for the most remarkable influence on ICUR in one-way sensitivity analysis. The result of probabilistic sensitivity analysis illustrated that all of the ICURs were located in the fourth quadrant of the cost-utility incremental plot undergone 5000 times of Monte Carlo simulation. CONCLUSIONS: Current universal hepatitis B vaccination program in Beijing was highly cost utility. The investment was reasonable for current universal vaccination program in Beijing.

10.
Int J Food Sci Nutr ; : 1-11, 2020 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-33043722

RESUMO

Previous randomised controlled trials have shown the controversial effectiveness of oral vitamin D supplementation in preventing osteoporotic fractures. PubMed, EMBASE and Cochrane Library electronic databases were searched. Pairwise meta-analysis, Bayesian network meta-analysis and meta-regression were applied. A total of 33 studies containing 83,083 participants were included. Oral vitamin D supplementation showed no statistically significant on reducing the risk of total fractures (RR = 0.96, 95%CI = 0.87-1.05 p = 0.389). Vitamin D3 (700-800IU/d) plus calcium showed statistical significance in reducing the incidence of total, hip and non-vertebral fractures in the pairwise meta-analysis. Significant reductions were specifically identified in female in total and hip fractures. However, we did not observe any above significant results using Bayesian network meta-analyses. Strikingly, a meta-regression analysis identified an inverse association between the efficacy of fracture prevention and increased body mass index. Thus, we recommended that the vitamin D dose should be adjusted according to BMI based on further confirmation.

11.
Hortic Res ; 7: 163, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33082970

RESUMO

The essential role of ethylene in fruit ripening has been thoroughly studied. However, the involvement of brassinosteroids (BRs) in the regulation of fruit ripening and their relationship with the ethylene pathway are poorly understood. In the current study, we found that BRs were actively synthesized during tomato fruit ripening. We then generated transgenic lines overexpressing or silencing SlCYP90B3, which encodes a cytochrome P450 monooxygenase that catalyzes the rate-limiting step of BR synthesis. The expression level of SlCYP90B3 was positively related to the contents of bioactive BRs as well as the ripening process in tomato fruit, including enhanced softening and increased soluble sugar and flavor volatile contents. Both carotenoid accumulation and ethylene production were strongly correlated with the expression level of SlCYP90B3, corroborated by the altered expression of carotenoid biosynthetic genes as well as ethylene pathway genes in transgenic tomato fruits. However, the application of the ethylene perception inhibitor 1-methycyclopropene (1-MCP) abolished the promotion effect of SlCYP90B3 overexpression on carotenoid accumulation. Taken together, these results increase our understanding of the involvement of SlCYP90B3 in bioactive BR biosynthesis as well as fruit ripening in tomato, thus making SlCYP90B3 a target gene for improvement of visual, nutritional and flavor qualities of tomato fruits with no yield penalty.

12.
BMJ Open ; 10(10): e040437, 2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-33040017

RESUMO

OBJECTIVES: This study investigates the disparities in the utilisation of patient health services for patients who had a stroke covered by different urban basic health insurance schemes in China. DESIGN: We conducted descriptive analysis based on a 5% random sample from claims data of China Urban Employees' Basic Medical Insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) in 2015, supplied by the China Health Insurance Research Association. SETTING: Chinese urban social insurance system. PARTICIPANTS: A total of 56 485 patients who had a stroke were identified, including 36 487 UEBMI patients and 19 998 URBMI patients. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measures include annual number of hospitalisations, average length of stay (ALOS) and average hospitalisation cost. Out-of-pocket (OOP) cost is the secondary outcome measure. RESULTS: The annual mean number of hospitalisations of UEBMI patients was 1.21 and 1.15 for URBMI patients. The ALOS was significantly longer for UEBMI than for URBMI patients (13.93 vs 10.82, p<0.001). Hospital costs were significantly higher for UEBMI than for URBMI patients (US$1724.02 vs US$986.59 (p<0.001), while the OOP costs were significantly higher for URBMI than for UEBMI patients (US$423.17 vs US$407.81 (p<0.001). Patients with UEBMI had higher reimbursement rate than URBMI patients (79.41% vs 66.92%, p<0.001) and a lower self-paid ratio than URBMI patients (23.65% vs 42.89%, p<0.001). CONCLUSIONS: Significant disparities were found in the utilisation of hospital services between UEBMI and URBMI patients. Our results call for a systemic strategy to improve the fragmented social health insurance system and narrow the gaps in China's health insurance schemes.

13.
World J Gastroenterol ; 26(36): 5508-5519, 2020 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-33024401

RESUMO

BACKGROUND: Gastric cancer (GC) is a heavy burden in China. Nutritional support for GC patients is closely related to postoperative rehabilitation. However, the role of early oral feeding after laparoscopic radical total gastrectomy in GC patients is unclear and high-quality research evidence is scarce. AIM: To prospectively explore the safety, feasibility and short-term clinical outcomes of early oral feeding after laparoscopic radical total gastrectomy for GC patients. METHODS: This study was a prospective cohort study conducted between January 2018 and December 2019 based in a high-volume tertiary hospital in China. A total of 206 patients who underwent laparoscopic radical total gastrectomy for GC were enrolled. Of which, 105 patients were given early oral feeding (EOF group) after surgery, and the other 101 patients were given the traditional feeding strategy (control group) after surgery. Perioperative clinical data were recorded and analyzed. The primary endpoints were gastrointestinal function recovery time and postoperative complications, and the secondary endpoints were postoperative nutritional status, length of hospital stay and expenses, etc. RESULTS: Compared with the control group, patients in the EOF group had a significantly shorter postoperative first exhaust time (2.48 ± 1.17 d vs 3.37 ± 1.42 d, P = 0.001) and first defecation time (3.83 ± 2.41 d vs 5.32 ± 2.70 d, P = 0. 004). In addition, the EOF group had a significant shorter postoperative hospitalization duration (5.85 ± 1.53 d vs 7.71 ± 1.56 d, P < 0.001) and lower postoperative hospitalization expenses (16.60 ± 5.10 K¥ vs 21.00 ± 7.50 K¥, P = 0.014). On the 5th day after surgery, serum prealbumin level (214.52 ± 22.47 mg/L vs 204.17 ± 20.62 mg/L, P = 0.018), serum gastrin level (246.30 ± 57.10 ng/L vs 223.60 ± 55.70 ng/L, P = 0.001) and serum motilin level (424.60 ± 68.30 ng/L vs 409.30 ± 61.70 ng/L, P = 0.002) were higher in the EOF group. However, there was no significant difference in the incidence of total postoperative complications between the two groups (P = 0.507). CONCLUSION: Early oral feeding after laparoscopic radical total gastrectomy can promote the recovery of gastrointestinal function, improve postoperative nutritional status, reduce length of hospital stay and expenses while not increasing the incidence of related complications, which indicates its safety, feasibility and potential benefits for gastric cancer patients.

14.
Oncol Rep ; 44(5): 2152-2164, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32901871

RESUMO

Leukemia, a malignant hematological disease, has poor therapeutic outcomes due to chemotherapeutic resistance. Increasing evidence has confirmed that the elevated capacity for DNA damage repair in cancer cells is a major mechanism of acquired chemotherapeutic resistance. Thus, combining chemotherapy with inhibitors of DNA damage repair pathways is potentially an ideal strategy for treating leukemia. Checkpoint kinase 1 (CHK1) is an important component of the DNA damage response (DDR) and is involved in the G2/M DNA damage checkpoint. In the present study, we demonstrated that shRNA­mediated CHK1 silencing suppressed cell proliferation and enhanced the cytotoxic effects of etoposide (VP16) in the chronic myeloid leukemia (CML) cell line K562 through the results of CCK­8, and comet assay. The results demonstrated that shRNA­induced CHK1 silencing can override G2/M arrest and impair homologous recombination (HR) repair by reducing breast cancer susceptibility gene 1 (BRCA1) expression. Cells had no time, and thus limited ability, to repair the damage and were thus more sensitive to chemotherapy after CHK1 downregulation. Second, we tested the therapeutic effect of VP16 combined with CCT245737, an orally bioavailable CHK1 inhibitor, and observed strong synergistic anticancer effects in K562 cells. Moreover, we discovered that CCT245737 significantly prevented the G2/M arrest caused by acute exposure to VP16. Interestingly, CCT245737 inhibited both BRCA1 and Rad51, the most important component of the HR repair pathway. In conclusion, these results revealed that CHK1 is potentially an ideal therapeutic target for the treatment of CML and that CCT245737 should be considered a candidate drug.

15.
mBio ; 11(5)2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32934085

RESUMO

Membrane-associated RING-CH-type 8 (MARCH8) strongly blocks human immunodeficiency virus type 1 (HIV-1) envelope glycoprotein (Env) incorporation into virions by downregulating its cell surface expression, but the mechanism is still unclear. We now report that MARCH8 also blocks the Ebola virus (EBOV) glycoprotein (GP) incorporation via surface downregulation. To understand how these viral fusion proteins are downregulated, we investigated the effects of MARCH8 on EBOV GP maturation and externalization via the conventional secretion pathway. MARCH8 interacted with EBOV GP and furin when detected by immunoprecipitation and retained the GP/furin complex in the Golgi when their location was tracked by a bimolecular fluorescence complementation (BiFC) assay. MARCH8 did not reduce the GP expression or affect the GP modification by high-mannose N-glycans in the endoplasmic reticulum (ER), but it inhibited the formation of complex N-glycans on the GP in the Golgi. Additionally, the GP O-glycosylation and furin-mediated proteolytic cleavage were also inhibited. Moreover, we identified a novel furin cleavage site on EBOV GP and found that only those fully glycosylated GPs were processed by furin and incorporated into virions. Furthermore, the GP shedding and secretion were all blocked by MARCH8. MARCH8 also blocked the furin-mediated cleavage of HIV-1 Env (gp160) and the highly pathogenic avian influenza virus H5N1 hemagglutinin (HA). We conclude that MARCH8 has a very broad antiviral activity by prohibiting different viral fusion proteins from glycosylation and proteolytic cleavage in the Golgi, which inhibits their transport from the Golgi to the plasma membrane and incorporation into virions.IMPORTANCE Enveloped viruses express three classes of fusion proteins that are required for their entry into host cells via mediating virus and cell membrane fusion. Class I fusion proteins are produced from influenza viruses, retroviruses, Ebola viruses, and coronaviruses. They are first synthesized as a type I transmembrane polypeptide precursor that is subsequently glycosylated and oligomerized. Most of these precursors are cleaved en route to the plasma membrane by a cellular protease furin in the late secretory pathway, generating the trimeric N-terminal receptor-binding and C-terminal fusion subunits. Here, we show that a cellular protein, MARCH8, specifically inhibits the furin-mediated cleavage of EBOV GP, HIV-1 Env, and H5N1 HA. Further analyses uncovered that MARCH8 blocked the EBOV GP glycosylation in the Golgi and inhibited its transport from the Golgi to the plasma membrane. Thus, MARCH8 has a very broad antiviral activity by specifically inactivating different viral fusion proteins.

16.
Abdom Radiol (NY) ; 2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-32964274

RESUMO

PURPOSE: To determine the utility of diffusion kurtosis imaging (DKI) for assessing bowel fibrosis and to establish a new magnetic resonance imaging (MRI)-based classification based on DKI and conventional MRI parameters for characterizing intestinal strictures in Crohn's disease (CD) using the histological evaluation of resected intestine samples as the reference standard. METHODS: Thirty-one patients with CD undergoing preoperative conventional MRI and diffusion-weighted imaging (DWI) (b values = 0-2000 s/mm2) were consecutively enrolled. We classified the mural T2-weighted signal intensity and arterial-phase enhancement patterns on conventional MRI. We also measured DWI-derived apparent diffusion coefficients (ADCs) and DKI-derived apparent diffusion for non-Gaussian distribution (Dapp) and apparent diffusional kurtosis (Kapp). A new MRI-based classification was established to characterize intestinal strictures in CD. Its performance was validated in nine additional patients with CD. RESULTS: Histological inflammation grades were significantly correlated to T2-weighted signal intensity (r = 0.477; P < 0.001) and ADC (r = - 0.226; P = 0.044). Histological fibrosis grades were moderately correlated to Kapp (r = 0.604, P < 0.001); they were also correlated to Dapp (r = - 0.491; P < 0.001) and ADC (r = - 0.270; P = 0.015). T2-weighted signal intensity could differentiate between no-to-mild and moderate-to-severe bowel inflammation (sensitivity, 0.970; specificity, 0.479). Kapp could differentiate between no-to-mild and moderate-to-severe bowel fibrosis (sensitivity, 0.959; specificity, 0.781). The agreement between the new MRI-based classification and the histological classification was moderate in the test (κ = 0.507; P < 0.001) and validation (κ = 0.530; P < 0.001) sets. CONCLUSIONS: DKI can be used to assess bowel fibrosis. The new MRI-based classification can help to distinguish between fibrotic and inflammatory intestinal strictures in patients with CD.

17.
Eur Radiol ; 2020 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-32965573

RESUMO

OBJECTIVES: To illuminate the prognostic value of ADC (apparent diffusion coefficient), an important quantitative parameter of diffusion-weighted MRI, for multiple myeloma (MM). METHODS: A prospective single-center study which enrolled 114 consecutive newly diagnosed MM patients with baseline whole-body diffusion-weighted MRI (WB DW-MRI) results was conducted. Baseline clinical and MRI parameters were analyzed with univariate and multivariate approaches to identify independent risk factors for progression-free survival (PFS) and overall survival (OS). RESULTS: Five different DW-MRI patterns were seen, and the mean ADC value of the representative background bone marrow was 0.4662 ± 0.1939 × 10-3 mm2/s. After a mean follow-up of 50.2 months (range, 15.7-75.8 months), twenty-four patients died and seven were lost to follow-up. The mean ADC value of the representative background bone marrow was showed to be an independent risk factor for both PFS (HR 4.664; 95% confidence interval (CI) 1.138-19.121; p = 0.032) and OS (HR 14.130; 95% CI 1.544-129.299; p = 0.019). Normal/salt-and-pepper pattern on DW-MRI was associated with PFS using univariate analysis (p = 0.035) but lost the significance with multivariate Cox regression. CONCLUSIONS: Mean ADC value of the representative background bone marrow predicts both PFS and OS which suggests the role of baseline DW-MRI for risk stratification in newly diagnosed MM patients. KEY POINTS: • Whole-body diffusion-weighted MRI (WB DW-MRI) might be helpful to improve the current risk stratification systems for newly diagnosed multiple myeloma (MM). • Morphological parameters as MRI pattern and focal lesion-associated parameters have been reported to be related to survival. However, important functional parameters such as apparent diffusion coefficient (ADC) values were not incorporated into the current risk stratification model. • This study is one of the first endeavors to delineate the correlation of baseline ADC values and survival in MM patients. It is revealed that the mean ADC value of the representative background bone marrow (L3-S1 and iliac bone) was an independent risk factor for both PFS and OS.

18.
Neurology ; 2020 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-32913026

RESUMO

OBJECTIVE: To identify common genetic variants associated with the presence of brain microbleeds (BMB). METHODS: We performed genome-wide association studies in 11 population-based cohort studies and 3 case-control or case-only stroke cohorts. Genotypes were imputed to the Haplotype Reference Consortium or 1000 Genomes reference panel. BMB were rated on susceptibility-weighted or T2*-weighted gradient echo magnetic resonance imaging sequences, and further classified as lobar, or mixed (including strictly deep and infratentorial, possibly with lobar BMB). In a subset, we assessed the effects of APOE ε2 and ε4 alleles on BMB counts. We also related previously identified cerebral small vessel disease variants to BMB. RESULTS: BMB were detected in 3,556 of the 25,862 participants, of which 2,179 were strictly lobar and 1,293 mixed. One locus in the APOE region reached genome-wide significance for its association with BMB (lead SNP rs769449; ORany BMB (95% CI)=1.33 (1.21-1.45); p=2.5x10-10). APOE ε4 alleles were associated with strictly lobar (OR (95% CI)=1.34 (1.19-1.50); p=1.0x10-6) but not with mixed BMB counts (OR (95% CI)=1.04 (0.86-1.25); p=0.68). APOE ε2 alleles did not show associations with BMB counts. Variants previously related to deep intracerebral haemorrhage and lacunar stroke, and a risk score of cerebral white matter hyperintensity variants, were associated with BMB. CONCLUSIONS: Genetic variants in the APOE region are associated with the presence of BMB, most likely due to the APOE ε4 allele count related to a higher number of strictly lobar BMB. Genetic predisposition to small vessel disease confers risk of BMB, indicating genetic overlap with other cerebral small vessel disease markers.

19.
Echocardiography ; 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32931069

RESUMO

PURPOSE: Lung ultrasonography (LU) is useful to assess lung lesions and variations at bedside. To investigate the results of LU in severe and critical patients with coronavirus disease 2019 (COVID-19), we performed a single-institution study to evaluate the related lung lesions and variations, and prophylactic strategies, in a large referral and treatment center. METHODS: We included 91 adult patients with severe and critical COVID-19, namely 62 males and 29 females, with an average age of 59 ± 11 years, who underwent LU. We collected the following patient information: sex, age, days in hospital, and days in ICU. In the ultrasound examinations, we recorded the presence of discrete B lines, confluent B lines, consolidation, pleural thickening, pleural effusion, and pneumothorax (PTX). RESULTS: Among the 91 severe and critical patients, 59 cases had scattered B lines, 56 cases had confluent B lines, 58 cases had alveolar-interstitial syndrome (AIS), 48 cases had lung consolidation, six cases had pleural thickening, 39 cases had pleural effusion (average depth of the pleural effusion: 1.0 ± 1.5 cm), and 20 patients developed PTX. In the Cox multivariate analysis, there were significant differences in age, hospitalization days, ICU days, and lung consolidation. CONCLUSION: Lung ultrasonography performed at the bedside can detect lung diseases, such as B lines, PTX, pulmonary edema, lung consolidation, pleural effusion, and variations of these findings. Our findings support the use of LU and measurements for estimating factors, and monitoring response to therapy in severe and critical COVID-19 patients.

20.
Artif Intell Med ; 108: 101936, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32972665

RESUMO

Diabetic retinopathy (DR) is the most common eye complication of diabetes and one of the leading causes of blindness and vision impairment. Automated and accurate DR grading is of great significance for the timely and effective treatment of fundus diseases. Current clinical methods remain subject to potential time-consumption and high-risk. In this paper, a hierarchically Coarse-to-fine network (CF-DRNet) is proposed as an automatic clinical tool to classify five stages of DR severity grades using convolutional neural networks (CNNs). The CF-DRNet conforms to the hierarchical characteristic of DR grading and effectively improves the classification performance of five-class DR grading, which consists of the following: (1) The Coarse Network performs two-class classification including No DR and DR, where the attention gate module highlights the salient lesion features and suppresses irrelevant background information. (2) The Fine Network is proposed to classify four stages of DR severity grades of the grade DR from the Coarse Network including mild, moderate, severe non-proliferative DR (NPDR) and proliferative DR (PDR). Experimental results show that proposed CF-DRNet outperforms some state-of-art methods in the publicly available IDRiD and Kaggle fundus image datasets. These results indicate our method enables an efficient and reliable DR grading diagnosis in clinic.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA