Hemi-diaphragm detection of chest X-ray images based on convolutional neural network and graphics.

BACKGROUND: Chest X-rays (CXR) are widely used to facilitate the diagnosis and treatment of critically ill and emergency patients in clinical practice. Accurate hemi-diaphragm detection based on postero-anterior (P-A) CXR images is crucial for the diaphragm function assessment of critically ill and emergency patients to provide precision healthcare for these vulnerable populations. OBJECTIVE: Therefore, an effective and accurate hemi-diaphragm detection method for P-A CXR images is urgently developed to assess these vulnerable populations' diaphragm function. METHODS: Based on the above, this paper proposes an effective hemi-diaphragm detection method for P-A CXR images based on the convolutional neural network (CNN) and graphics. First, we develop a robust and standard CNN model of pathological lungs trained by human P-A CXR images of normal and abnormal cases with multiple lung diseases to extract lung fields from P-A CXR images. Second, we propose a novel localization method of the cardiophrenic angle based on the two-dimensional projection morphology of the left and right lungs by graphics for detecting the hemi-diaphragm. RESULTS: The mean errors of the four key hemi-diaphragm points in the lung field mask images abstracted from static P-A CXR images based on five different segmentation models are 9.05, 7.19, 7.92, 7.27, and 6.73 pixels, respectively. Besides, the results also show that the mean errors of these four key hemi-diaphragm points in the lung field mask images abstracted from dynamic P-A CXR images based on these segmentation models are 5.50, 7.07, 4.43, 4.74, and 6.24 pixels,respectively. CONCLUSION: Our proposed hemi-diaphragm detection method can effectively perform hemi-diaphragm detection and may become an effective tool to assess these vulnerable populations' diaphragm function for precision healthcare.

Elevated Hemi-diaphragms as a Cause of ST-segment Elevation: A case report and review of literature.

While ST-segment elevation (STE) on ECG is widely recognized as representing myocardial infarction or injury such as coronary occlusion or pericarditis, STE may occasionally ensue from non-cardiac etiologies. Indeed, gastrointestinal disorders causing STE are not well documented in the literature. We present a case wherein extreme abdominal distension and hemi-diaphragm elevation resulted in extrinsic cardiac and epicardial coronary compression manifesting as STE. Subsequent relief of the abdominal distension resulted in resolution of STE representing a noncoronary cause of STE. A brief literature review, illustrating the importance of considering abdominal etiologies as a cause of STE is provided.

Phrenic Nerve Palsy as Initial Presentation of Large Retrosternal Goitre.

Unilateral phrenic nerve palsy as initial presentation of the retrosternal goitre is extremely rare event. This is a case report of a 57-year-old woman with history of cough and breathlessness of 3 months duration, unaware of the thyroid mass. She had large cervico-mediastinal goiter and chest radiograph revealed raised left sided hemidiaphragm. Chest CT scan did not reveal any lung parenchymal or mediastinal pathology. The patient underwent a total thyroidectomy through a cervical approach. The final pathology was in favor of multinodular goitre. Even after 1 year of follow up, phrenic nerve palsy did not improve indicating permanent damage. Phrenic nerve palsy as initial presentation of the retrosternal goitre is unusual event. This case is reported not only because of the rare nature of presentation, but also to make clinicians aware of the entity so that early intervention may prevent attendant morbidity.

Accessory hemi diaphragm.

BACKGROUND/PURPOSE: Accessory hemi diaphragm (AHD) is an uncommon condition. Its clinical features, diagnosis and management have not been clearly defined. METHODS: We reviewed the world literature and added a case of our own. RESULTS: There are 40 proven cases in the literature. The lesion occurs almost exclusively in the right hemithorax. Twenty seven cases presented with cardiovascular and/or respiratory symptoms while 3 had symptoms pertaining to other systems. In the remaining 10 patients the diagnosis was either made accidentally or information pertaining to their presentation is missing. Abnormalities of pulmonary and systemic blood vessels often accompany the abnormality. The diagnosis is usually suspected because of an abnormal chest radiograph and confirmed by a variety of tests. CONCLUSIONS: If the AHD prevents proper aeration of the lung it should be excised. If vascular abnormalities coexist they should be treated along with the AHD. Asymptomatic patients may be observed after confirming the diagnosis.

Design, synthesis and glucose uptake activity of some novel glitazones.

Herein, we report a library consisting of some novel glitazones containing thiazolidinedione and its bioisosteres, rhodanine and oxadiazolidine ring structures as their basic scaffold for their antidiabetic activity. Twelve novel glitazones with diverse chemical structures were designed and synthesized by adopting appropriate synthetic schemes and analyzed. Later, subjected to in vitro glucose uptake assay in the absence and presence of insulin to confirm their antidiabetic activity using rat hemi-diaphragm. The titled compounds exhibited glucose uptake activity ranging weak to significant activity. Compounds 4, 5, 9, 11, 15, 16, 19 and 20 showed considerable glucose uptake activity apart from rosiglitazone, a standard drug. Compound 16 happens to be the candidate compound from this study to investigate further. The illustration about their design, synthesis, analysis and glucose uptake activity is reported here along with the in vitro and in silico study based structure-activity relationships.

Antioxidant and Antidiabetic Activity of Helicteres isora (L.) Fruits.

The present investigations evaluated the antioxidant and antidiabetic activity of Helicteres isora (L.) fruits belonging to the family Sterculiaceae. The hot water extract of Helicteres isora fruits was prepared and screened for its in vitro antioxidant activity using 1,1-diphenyl,2-picryl hydrazyl assay, ss-carotene-linoleate model and microsomal lipid peroxidation or thiobarbituric acid reactive species assays and the IC(50) values were calculated. Antidiabetic effect was studied using the in vitro glucose uptake in the isolated rat hemi-diaphragm model. The hot water extract of Helicteres isora showed maximum activity with IC(50) value 25.12+/-0.18 mug/ml for 1,1-diphenyl,2-picryl hydrazyl assay method, and low activity with IC(50) value 740.64+/-4.76 mug/ml for microsomal lipid peroxidation assay. In the ss-carotene-linoleate model, the extract showed 45.63% antioxidant activity. The extract produce a significant (P<0.05) uptake of glucose by isolated rat hemi-diaphragm but less effective to that of the reference drug, metformin. The hot water extract of fruit of Helicteres isora exhibited significant antioxidant activity and moderate antidiabetic activity and merits further investigation in animal models and isolation of its active constituents.

Effect of Tetraethylammonium on the Contractile Reponse in the Isolated Rat Phrenic: Hemidiaphra / 대한마취과학회지

BACKGROUND: Recently, the phannacologic and therapeutic significance of various types of potassium channels are being realized. Thus it was attempted to delineate the role of voltage-gated K+ -channels on the excitation-contraction coupling in skeletal muscle. METHODS: The effects of tetraethylammonium, a well known K+ -channel blocker, on the electrically-evoked twitch response, train-of-four and tetanic stimulation, and the influence of various agents on the these effects were studied in the isolated rat hemi-diaphragm preparation. RESULTS: Tetraethylammonium (1 & 3 mM) increased the electrically-evoked twitch response, but the large dose (10 mM) decreased the twitch response. And tetraethylammonium decreased the TOF- and tetanus-ratio in a dose-related fashion. d-Tubocurarine(1 microM) decreased the twitch response, and tetraethylammonium recovered the d-tubocurarine-induced-depression of twitch response. When the Ca++(6x) and K+ (2x) concentration of the medium were increased, the twitch response caused by tetraethylammonium were slightly inhibited than that observed in the normal solution, but the fade phenomenon was potentiated. The tetraethylammonium (10 mM)-induced depression of twitch response were reduced by reducing the stimulus frequency to 0.01 Hz and choline (400 microM) treatment. And N-ethylmaleimide inhibited the tetraethylammonium-induced increment of twitch response and also potentiated the tetraethylammonium-induced fade phenomenon. However, it is noteworth the 4-aminopy- ridine, another K+ -channel bloker, potentiated the electrically-evoked twitch response but did not affect the TOF-and tetanusratio. CONCLUSION: These result indicate that tetraethylammonium elicited two districtive types of response in the rat phrenic-hemidiaphragm preparation. The potentiating effects of twitch response is mediated by blocking delayed K+ -rectifier channel and decreasing effects of twitch response, TOF-and tetanus-ratio is may be due to decreased the acetylcholine release from presynaptic nerve terminal.

Effect of Diltiazem on Pancuronium - and Vecuronium - induced Neuromuscular Blockade / 대한마취과학회지

The effects and interactions of pancuronium and vecuronium with diltiazem on the electri- cally-evoked twitch response, train-of-four and tetanic stimulation were studied in the isolated rat hemi-diaphragm preparation. Pancuronium(3 X 10(-7) -10(-5) M) and vecuronium(3 X 10(-6)-15 X 10(-6) M) decreased the electrically evoked(nerve stimulation, 0.1Hz, 0.5ms, 10V) twitch response, train-of-four and tetanus ratio in a dose-related fashion and pancuronium was more potent than vecuronium. The inhibitory effects of pancuronium and vecuronium were potentiated by pretreatment with 5 & 10 uM diltiazem, a Ca++-channel blocker, in which the concentration of diltiazem has no obvious effects on the twitch response itself. Furthermore, it is noteworth that the inhibitory effects of pancuronium and vecuronium were markedly potentiated by 150 uM hemicholinium pretreatment. In cases of the direct(muscle, 0.1 Hz, 5 ms, 10 V) stimulation, pancuronium and vecuronium decreased the electrically evoked twitch response dose dependently, but the amplitudes of inhibition were less than those in indirect(nerve) stimulation. The inhibitory effects were not affected by diltiazem pretreatment except low doses of vecuronium. On the basis of these findings, the result of the present study suggests that the muscle relaxation by pancuronium and vecuronium is mediated by pre- and post-junctional receptor blockade, and that diltiazem intensifies neuromuscular blockade produced by muscle relaxants. The potentiating effect of diltiazem may be due to blocking influx of calcium and/or release of acetylcholine from presynaptic nerve terminals.

Effect of Diltiazem on Pancuronium - and Vecuronium - induced Neuromuscular Blockade / 대한마취과학회지

The effects and interactions of pancuronium and vecuronium with diltiazem on the electri- cally-evoked twitch response, train-of-four and tetanic stimulation were studied in the isolated rat hemi-diaphragm preparation. Pancuronium(3 X 10(-7) -10(-5) M) and vecuronium(3 X 10(-6)-15 X 10(-6) M) decreased the electrically evoked(nerve stimulation, 0.1Hz, 0.5ms, 10V) twitch response, train-of-four and tetanus ratio in a dose-related fashion and pancuronium was more potent than vecuronium. The inhibitory effects of pancuronium and vecuronium were potentiated by pretreatment with 5 & 10 uM diltiazem, a Ca++-channel blocker, in which the concentration of diltiazem has no obvious effects on the twitch response itself. Furthermore, it is noteworth that the inhibitory effects of pancuronium and vecuronium were markedly potentiated by 150 uM hemicholinium pretreatment. In cases of the direct(muscle, 0.1 Hz, 5 ms, 10 V) stimulation, pancuronium and vecuronium decreased the electrically evoked twitch response dose dependently, but the amplitudes of inhibition were less than those in indirect(nerve) stimulation. The inhibitory effects were not affected by diltiazem pretreatment except low doses of vecuronium. On the basis of these findings, the result of the present study suggests that the muscle relaxation by pancuronium and vecuronium is mediated by pre- and post-junctional receptor blockade, and that diltiazem intensifies neuromuscular blockade produced by muscle relaxants. The potentiating effect of diltiazem may be due to blocking influx of calcium and/or release of acetylcholine from presynaptic nerve terminals.