Clinical Reference Research Articles

Prognostic utility of a multi-biomarker panel in patients with suspected myocardial infarction

Abstract Background The accurate identification of patients with high cardiovascular risk in suspected myocardial infarction (MI) is an unmet clinical need. Therefore, we sought to investigate the prognostic utility of a multi-biomarker panel with 29 different biomarkers in in 748 consecutive patients with symptoms indicative of MI using a machine learning-based approach. Methods Incident major cardiovascular events (MACE) were documented within 1 year after the index admission. The selection of the best multi-biomarker model was performed using the least absolute shrinkage and selection operator (LASSO). The independent and additive utility of selected biomarkers was compared to a clinical reference model and the Global Registry of Acute Coronary Events (GRACE) Score, respectively. Findings were validated using internal cross-validation. Results Median age of the study population was 64 years. At 1 year of follow-up, 160 cases of incident MACE were documented. 16 of the investigated 29 biomarkers were significantly associated with 1-year MACE. Three biomarkers including NT-proBNP (HR per SD 1.24), Apolipoprotein A-I (Apo A-I; HR per SD 0.98) and kidney injury molecule-1 (KIM-1; HR per SD 1.06) were identified as independent predictors of 1-year MACE. Although the discriminative ability of the selected multi-biomarker model was rather moderate, the addition of these biomarkers to the clinical reference model and the GRACE score improved model performances markedly (∆C-index 0.047 and 0.04, respectively). Conclusion NT-proBNP, Apo A-I and KIM-1 emerged as strongest independent predictors of 1-year MACE in patients with suspected MI. Their integration into clinical risk prediction models may improve personalized risk stratification. Graphical abstract Prognostic utility of a multi-biomarker approach in suspected myocardial infarction. In a cohort of 748 patients with symptoms indicative of myocardial infarction (MI) to the emergency department, we measured a 29-biomarker panel and performed regressions, machine learning (ML)-based variable selection and discriminative/reclassification analyses. We identified three biomarkers as top predictors for 1-year major adverse cardiovascular events (MACE). Their integration into a clinical risk prediction model and the Global Registry of Acute Coronary Events (GRACE) Score allowed for marked improvement in discrimination and reclassification for 1-year MACE. Apo apolipoprotein; CRP C-reactive protein; CRS clinical risk score; ECG electrocardiogram; EN-RAGE extracellular newly identified receptor for advanced glycation end-products binding protein; FABP fatty acid–binding protein; GS Grace Score; hs-cTnI high-sensitivity cardiac troponin I; KIM-1 kidney injury molecule–1; LASSO least absolute shrinkage and selection operator; MACE major adverse cardiovascular events; MI myocardial infarction; NRI net reclassification improvement; NT-proBNP N-terminal prohormone of brain natriuretic peptide.

A ROI-based quantitative pipeline for 18F-FDG PET metabolism and pCASL perfusion joint analysis: Validation of the 18F-FDG PET line

In Mild Cognitive Impairment (MCI), the study of brain metabolism, provided by 18F-FluoroDeoxyGlucose Positron Emission Tomography (18F-FDG PET) can be integrated with brain perfusion through pseudo-Continuous Arterial Spin Labeling Magnetic Resonance sequences (MR pCASL). Cortical hypometabolism identification generally relies on wide control group datasets; pCASL control groups are instead not publicly available yet, due to lack of standardization in the acquisition parameters. This study presents a quantitative pipeline to be applied to PET and pCASL data to coherently analyze metabolism and perfusion inside 16 matching cortical regions of interest (ROIs) derived from the AAL3 atlas. The PET line is tuned on 36 MCI patients and 107 healthy control subjects, to agree in identifying hypometabolic regions with clinical reference methods (visual analysis supported by a vendor tool and Statistical Parametric Mapping, SPM, with two parametrizations here identified as SPM-A and SPM-B). The analysis was conducted for each ROI separately. The proposed PET analysis pipeline obtained accuracy 78 % and Cohen's к 60 % vs visual analysis, accuracy 79 % and Cohen's к 58 % vs SPM-A, accuracy 77 % and Cohen's к 54 % vs SPM-B. Cohen's к resulted not significantly different from SPM-A and SPM-B Cohen's к when assuming visual analysis as reference method (p-value 0.61 and 0.31 respectively). Considering SPM-A as reference method, Cohen's к is not significantly different from SPM-B Cohen's к as well (p-value = 1.00). The complete PET-pCASL pipeline was then preliminarily applied on 5 MCI patients and metabolism-perfusion regional correlations were assessed. The proposed approach can be considered as a promising tool for PET-pCASL joint analyses in MCI, even in the absence of a pCASL control group, to perform metabolism-perfusion regional correlation studies, and to assess and compare perfusion in hypometabolic or normo-metabolic areas.

Pattern recognition of forced oscillation technique measurement results using deep learning can identify asthmatic patients more accurately than setting reference ranges

No official clinical reference values have been established for MostGraph, which measures total respiratory resistance and reactance using the forced oscillation technique, complicating result interpretation. This study aimed to establish a reference range for MostGraph measurements and examine its usefulness in discriminating participants with asthma from controls (participants without any respiratory diseases). The study also aimed to investigate the effectiveness of deep learning in discriminating between the two aforementioned groups. To establish reference ranges, the MostGraph measurements of healthy controls (n = 215) were power-transformed to distribute the data more normally. After inverse transformation, the mean ± standard deviation × 2 of the transformed values were used to establish the reference ranges. The number of measured items outside the reference ranges was evaluated to discriminate patients with asthma (n = 941) from controls. Additionally, MostGraph measurements were evaluated using deep learning. Although reference ranges were established, patients with asthma could not be discriminated from controls. However, with deep learning, we could discriminate between the two groups with 78% accuracy. Therefore, deep learning, which considers multiple measurements as a whole, was more effective in interpreting MostGraph measurement results than use of reference ranges, which considers each result individually.

Establishment and Validation of Models Based on Clinical Parameters/Symptoms for Diagnostic and Prognostic Assessment of Neonatal Sepsis

Background: We aimed to establish and validate diagnostic models for distinguishing bacterial/viral infections among sepsis neonates and also a model for prognostic evaluation. Methods: Training data sets (cohorts) of neonatal sepsis patients were derived retrospectively from 2017 to 2019, and the verifying sets were followed up from 2019 to 2021. The backward elimination method of logistic regression was used in identifying the optimum feature combination by adding all potential factors to the regression equation. Results: The current study established 3 models. For distinguishing bacterial sepsis patients and bacterial culture-negative patients, we found Y=1.930+0.105X1+0.891X2-1.389X3-0.774X4 (Y symbolizes the status of bacterial infectious sepsis, X1 is age increase, X2 is intra-amniotic infection (mother), X3 is vomiting sign, and X4 is cough sign). Similarly, for distinguishing bacterial infectious sepsis patients and bacterial/viral double-positive patients, we found Y=2.918+1.568X1+1.882X2-0.113X3-2.214X4-2.255X5-2.312X6 (Y means the bacterial/viral double-positive status, X1 is IL-6 increase, X2 means CRP increase, X3 means age increase, X4 means high fever sign, X5 is cyanotic sign, and X6 is HGB increase). For predicting hospital days as one of the prognoses, we found Y=-1.993+0.073X1+1.963X2+0.466X3-0.791X4-0.633X5 (Y means worse prognosis, which is hospital days longer than 7 days, X1 means age increase, X2 means intra-amniotic infection (mother), X3 is IL-6 increase, X4 is convulsion with unconsciousness, and X5 is cough sign). Then, the ROC curves of the models from the verifying cohort indicated that all of the 3 models had good performance among sepsis children. Conclusions: Two diagnostic models and one prognostic model were established for clinical reference from the current first-step analysis with excellent model performance, which could be suggested as new useful diagnostic tools and a therapeutic strategy guiding marker for neonatal sepsis in the future.

Application of peroral endoscopic-assisted laryngeal microsurgery in children with laryngeal neurofibromas

Objective:To investigate the clinical manifestations and the effect of peroral endoscopic-assisted laryngeal microsurgery for children with laryngeal neurofibroma, and to provide clinical reference for the diagnosis and treatment of this disease. Methods:The clinical data of 4 children with laryngeal tumors admitted to the Department of Otorhinolaryngology, Children's Hospital of Chongqing Medical University from January 2021 to June 2023 were retrospectively analyzed. Laryngeal tumors were removed by peroral endoscopic-assisted laryngeal microsurgery. One case underwent tracheotomy at the same time, and one case was simultaneously performed with laryngeal T tube placement and tracheotomy. Results:Surgical resection is the best treatment for laryngeal neurofibroma, and laryngeal microsurgery should be actively used for patients with surgical indications.This surgical method has the advantages of good efficacy, minimal invasion, aesthetics and preservation of laryngeal function, which not only ensures safety, but also improves the quality of life after surgery, and has the value of development and promotion.

Treatment of lactational mastitis with Gualou Xiaoyong soup and painless lactation promoting technique: A case series.

Lactational mastitis is a common and frequently disease in clinical practice, characterized by acute inflammation of the mammary ducts and surrounding connective tissues. The main manifestations are damage to the mammary gland acini, edema, and invasion of inflammatory cells. If not treated properly, it may lead to the formation of breast abscesses, or even sepsis, septic shock, and chronic inflammation of the breast, which may cause the disease to persist or recur multiple times, so that the patients suffer extreme pain, and the health of both the mother and child are directly affected. This disease not only causes suffering for women but also may result in the cessation of breastfeeding. Therefore, rapid and effective treatment is particularly important. We report 3 cases of lactation mastitis patients showing good clinical efficacy after being treated with the Chinese medicine Gualou Xiaoyong soup and painless lactation promoting techniques. Gualou Xiaoyong soup combined with painless lactation promotion techniques can significantly reduce and eliminate the clinical symptoms of patients in the short term, and rapidly restore inflammatory indicators such as total white blood cells, neutrophils, C-reactive protein, and procalcitonin to normal levels. The patchy low echo area of the breast under B-ultrasound also disappears quickly. Therefore, we believe that this method is a good way to treat lactational mastitis and is worthy of clinical reference and research. However, this study has certain limitations: this study lacks a large sample of prospective controlled studies. Next, we will continue to collect relevant cases and conduct prospective case randomized controlled clinical studies. The treatment of lactation mastitis with Gualou Xiaoyong soup and painless lactation promoting techniques can achieve good clinical results.

Facial nerve function training in patients with peripheral facial paralysis: an expert consensus.

Facial nerve training can prevent facial expression muscle atrophy and promote the recovery of facial para-lysis in patients with peripheral facial paralysis. However, there is still a lack of specific and unified technical standards for facial nerve training, which results in a variety of clinical training methods and uneven levels. In order to standardize the application of facial nerve function training technology for nursing staff, the study convened relevant domestic experts, based on evidence-based combination with the disease characteristics of peripheral facial paralysis and expert clinical experience, conducted in-depth interviews with experts, expert correspondence and expert meetings, and finally formulated the expert consensus on facial nerve function training in patients with peripheral facial paralysis. Overall, suggestions for standardizing the timing, training methods, evaluation methods, health education and other aspects were provided for clinical reference.

Role of Neuron-Specific Enolase, D-Dimer and C-Reactive Protein in the Cranial Nerve Injury After Surgery of Posterior Fossa Tumor

Cranial nerve injury after posterior cranial fossa tumor surgery (PCFTS) is a common symptom in clinic. Intracranial pressure (ICP) monitoring has been widely used in patients with severe posterior cranial fossa injuries. By establishing a rat model of PCFT, we explore the correlation between neuron-specific enolase (NSE), D-Dimer (D-D) and C-reactive protein (CRP) and provide the better clinical reference to cranial fossa injury treatment. 30 SD female rats aged 20–22 months; randomly divided them into control groups and experimental groups and experimental rats were further divided into 12 for moderately increased group (21–40 mmHg) and 8 for severely increased group (>40 mmHg) to measure NSE, D-D, and CRP and analyze their relationship. NSE, DD, and CRP in severely increased group and moderately increased group were significantly higher than those in control group. NSE (103.69±7.84) μg/L, DD (1.52±0.25) mg/L, CRP (47.63)±8.59) mg/L in severely increased group was significantly higher than moderately increased group (NSE (61.77±30.11) μg/L, DD (0.97± 0.37) mg/L, CRP (30.65± 9.56) mg/L) (P < 0.05). ICP is positively correlated with NSE, DD and CRP (r = 0.775, P = 0.000, intracranial pressure=18.589+0.254NSE; r =0.872, P =0.000, IC=10.564+0.254 DD; r =0.825, P =0.000, ICP = 9.73+0.774CRP). There is a positive correlation between cranial nerve injury and NSE, D-dimer and CRP after PCFTS. It can be evaluated by detecting the above values to assess the degree of cranial nerve injury so as to predict the patient’s condition.

Normative data for interpreting the SNOT-22.

The Sino-Nasal Outcome Test 22 (SNOT-22) is a validated patient-reported outcome instrument to evaluate the health-related quality of life (HRQoL) in patients with chronic rhinosinusitis (CRS). There are no published normative SNOT-22 scores, limiting its interpretation. Symptom scores from 1,000 SNOT-22 questionnaires were analysed by principal component analysis (PCA) and exploratory factor analyses. Data were derived from a survey with 1,000 healthy Europeans (reference cohort) who were recruited using the Respondi panel for market and social science research. This subsample was quoted to the population distribution of the German Microcensus and selected from a non-probability panel. The overall normative SNOT-22 score can be detected to be 20.2 ± 19.44. Male (18.49 ± 19.15) and older (> 50 years old; 18.3 ± 17.49) participants had overall lower SNOT-22 mean results than females (21.8 ± 19.6) and younger (21.4 ± 20.55) participants, indicating higher levels of satisfaction. PCA proposed two SNOT-22 domains ("physiological well-being" and "psychological well-being"), which explained 65% of the variance. These are the first published (German) normative scores for the SNOT-22 and provide a clinical reference point for the interpretation of data.

Anti-Müllerian hormone and inhibin-B concentrations vary cyclically in nonovulating queens within reference ranges established for determining gonadal status in cats.

To define cyclic changes in anti-Müllerian hormone (AMH), inhibin-B, and progesterone concentrations and establish statistically valid, population-based clinical reference ranges in queens. Cyclic queens (fertile, n = 6; infertile, 6) from an institutional breeding colony were blood sampled longitudinally, each for over 2 months, between November 2021 and February 2022, and residual serum samples from intact (n = 205) and ovariohysterectomized (49) queens from clinical submissions were used to establish reference ranges for intact and spayed females. AMH and inhibin-B were measured using commercially available ELISAs, progesterone was measured using an in-house ELISA, and 90% CIs were calculated from these data. AMH and inhibin-B fluctuated in a highly correlated, cyclic pattern in 3 queens that did not ovulate immediately, whereas AMH declined as progesterone increased, indicative of ovulation, which occurred spontaneously early in the sampling period in 3 others; statistically valid reference ranges were established in intact and ovariohysterectomized females. Cyclic changes in hormone profiles were defined, providing relevant context for interpreting results in cases seeking to determine gonadal status (presence or absence of gonadal tissue) on the basis of established, population-based reference ranges reported here for cats for the first time.

Analyzing the dynamic measurement of growth and development in children born after the transplantation of poor quality blastocyst embryos: a propensity matching study

Objective This study aimed to observe the dynamic measurement of growth and development in children (0–3 years) after transplantation of low-quality frozen-thawed single blastocysts. Methods This was a retrospective cohort study conducted from January 2016 to December 2019 at a single center. The follow-up data of the children were obtained from the Jiangsu Province Maternal and Child Database. A total of 350 singleton live births were included. Based on the blastocyst score, the live births were divided into good-quality blastocyst embryo (GQE) group (315 live births) and poor-quality blastocyst embryo (PQE) group (35 live births). To improve statistical efficiency and control for potential confounding factors, singletons conceived from PQEs were matched with a 3:1 ratio according to couple ages, BMI, occupation and women AMH levels. Ultimately, 32 children in the PQE group and 95 children (with one missing data) in the GQE group were included in the final analysis. Results After matching for parents’ age, BMI, occupation and maternal serum AMH level, there was no significant difference in growth and development of children between the PQE group and GQE group. However, the E2 level on trigger days, the rate of 2PN oocyte, and blastocyst formation rate in the PQE group were significantly lower than in the GQE group (p < .05). The number of embryo transfers (ETs) in the PQE group was higher than in the GQE group (p < .0001). The rate of cesarean section in the PQE group was significantly higher than in the GQE group (p < .05). The height (at 3 months) and head circumference (at 12 months) in the PQE group were lower than in the GQE group (p < .05). Conclusions Transplantation of PQEs did not affect the growth and development of offspring (0–3 years) compared to good-quality blastocysts. However, the oocyte and embryo development potential was lower in the PQE group than in the GQE group. These results provide clinical reference that the transfer of PQE could be acceptable for patients with only PQE embryos.

Anti-Quorum Sensing and Anti-Biofilm Activity of Ginger (Zingiber officinale) Rhizomes against Multidrug-Resistant Clinical Isolates of Pseudomonas aeruginosa.

The aim of this study was to determination of Anti-Quorum Sensing (AQS) and anti-biofilm potential of the methanol extract of ginger (Zingiber officinale) rhizomes against multidrug-resistant clinical isolates of Pseudomonas aeruginosa (P. aeruginosa). The AQS activity of ginger was determined against Chromobacterium violaceum (C. violaceum) ATCC 12472 (CV12472), a biosensor strain, in qualitative manner using the agar well diffusion method. The violacein pigment inhibition was assessed to confirm AQS activity of ginger. The AQS potential of sub-minimum Inhibitory Concentrations (sub-MICs) of the ginger extract was determined by targeting different QS regulated virulence factors, including swarming motility (using swarm diameter measurement method), pyocyanin pigment (using chloroform extraction method), Exopolysaccharide (EPS) (using phenol-sulphuric acid method), and biofilm formation (using microtiter plate assay), against clinical isolates (CIs 2, 3, and 4) and standard reference strain of P. aeruginosa (PA01). The AQS activity of methanol extract of ginger was confirmed against C. violaceum (CV12472) as inhibition of violacein pigment formation without effecting the growth of CIs and PA01 of P. aeruginosa. The ginger extract exhibited concentration-dependent inhibition of virulence factors and biofilm formation. The maximum reduction was found in swarming motility, pyocyanin, EPS and biofilm formation against PA01 (51.38%), CI3 (57.91%), PA01 (63.29%) and CI2 (64.37%), respectively at 1/2 MIC of ginger extract. The results of present study revealed the effective AQS and anti-biofilm potential of Zingiber officinale rhizome methanol extract at a reduced dose (sub-MICs). The extract may be explored as an agent of antimicrobial compounds having AQS and anti-biofilm activity for controlling microbial infection and also for reducing the chances of emergence of resistance in P. aeruginosa.

Optimization of the Reconstruction Settings for Low-Dose Ultra-High-Resolution Photon-Counting Detector CT of the Lungs

Photon-counting detector computed tomography (PCD-CT) yields improved spatial resolution. The combined use of PCD-CT and a modern iterative reconstruction method, known as quantum iterative reconstruction (QIR), has the potential to significantly improve the quality of lung CT images. In this study, we aimed to analyze the impacts of different slice thicknesses and QIR levels on low-dose ultra-high-resolution (UHR) PCD-CT imaging of the lungs. Our study included 51 patients with different lung diseases who underwent unenhanced UHR-PCD-CT scans. Images were reconstructed using three different slice thicknesses (0.2, 0.4, and 1.0 mm) and three QIR levels (2–4). Noise levels were determined in all reconstructions. Three raters evaluated the delineation of anatomical structures and conspicuity of various pulmonary pathologies in the images compared to the clinical reference reconstruction (1.0 mm, QIR-3). The highest QIR level (QIR-4) yielded the best image quality. Reducing the slice thickness to 0.4 mm improved the delineation and conspicuity of pathologies. The 0.2 mm reconstructions exhibited lower image quality due to high image noise. In conclusion, the optimal reconstruction protocol for low-dose UHR-PCD-CT of the lungs includes a slice thickness of 0.4 mm, with the highest QIR level. This optimized protocol might improve the diagnostic accuracy and confidence of lung imaging.

Risk factors for severe low anterior resection syndrome in patients with rectal cancer undergoing sphincter‑preserving resection: A systematic review and meta‑analysis.

The present study aimed to evaluate the incidence and risk factors of severe low anterior resection syndrome (LARS) in patients with rectal cancer undergoing sphincter-preserving resection, and to provide the clinical basis and reference for the treatment of rectal cancer and the prevention of LARS. Studies on the incidence and risk factors for severe LARS in patients with rectal cancer undergoing sphincter-preserving resection were searched using PubMed, Embase, Cochrane Library, Scopus and Web of Science, according to the inclusion and exclusion criteria. After evaluating the study quality and extracting relevant data, RevMan 5.2 and STATA software were used to conduct a meta-analysis. A total of 12 articles were considered eligible for the present meta-analysis. Within these articles, there were 3,877 cases of sphincter-preserving resection for rectal cancer and 1,589 cases of severe LARS; the incidence of severe LARS was 40.99%. The results of the meta-analysis revealed that sex [female; odds ratio (OR), 6.54; 95% CI, 3.63-11.76; Z, 6.27; P<0.00001], radiotherapy and chemotherapy (OR, 3.45; 95% CI, 2.29-5.21; Z, 5.91; P<0.00001), total mesorectal excision (TME; OR, 4.39; 95% CI, 3.32-5.79; Z, 10.41; P<0.00001), and distance between tumor and anal margin (OR, 2.74; 95% CI, 0.86-8.72; Z, 1.70; P<0.00001) may be the risk factors for severe LARS.

Device-Assisted Therapy for Lingual Function Rehabilitation: A “How To” Guide for Clinicians

Purpose: Lingual function rehabilitation is a frequently targeted area of exercise-based dysphagia treatment. This tutorial aims to provide a detailed guideline for clinicians on how to apply currently available evidence for implementation of lingual rehabilitation exercises both with and without device-assisted modalities. Method: We provide a detailed review of existing definitions of lingual function parameters (e.g., strength and endurance) with currently available normative values for clinical reference. Guidelines are also provided on how to use available lingual manometry (Iowa Oral Performance Instrument and Tongueometer) to aid in both assessment and treatment. With respect to determining exercise targets based on the lingual function assessment, we review the importance of leveraging principles of exercise physiology into the rehabilitation planning. Strategies for incorporating exercise physiology principles into strength and endurance training are provided along with a case example illustrating these concepts. Conclusions: This tutorial serves as a framework for clinical implementation of comprehensive lingual function assessment and rehabilitation. Considerations regarding barriers in access to equipment and clinical advocacy are also discussed.

Cuidados Paliativos: Disfagia, perspectivas clínicas y psicosociales

Comprehensive nursing care in situations of health vulnerability implies a complete analysis from clinical and psychosocial references. Dysphagia, difficulty in swallowing, is an important risk, caused by organic lesions or neuromuscular dysfunctions. Normal swallowing is divided into four phases, any of which can be affected and lead to dysphagia. Dysphagia is associated with diseases such as Parkinson's disease, esophageal cancer, and pulmonary disorders. Its prevalence is high in older patients, with 30% in those over 65 years of age and up to 86% in older adults hospitalized with pneumonia. Its early detection is crucial, as it can lead to comorbidities such as dehydration, malnutrition and aspiration pneumonia. Tolerance tests with foods of different textures and liquids of various viscosities are used to assess dysphagia. Results may indicate impaired chewing, oral storage of food, reduced laryngeal elevation, and more. In addition, instrumental tests such as videofluoroscopy and endoscopic examination are used to detect aspiration and other abnormalities. The goal of comprehensive diagnosis is to find solutions and early oral rehabilitation, adopt appropriate therapeutic measures, improve posture and ergonomics, strengthen the oropharyngeal musculature and prevent associated risks. Quality of life in people with chronic dysphagia is addressed in the context of advanced chronic diseases or palliative care.

MTAN: A semi-supervised learning model for kidney tumor segmentation.

Medical image segmentation is crucial in disease diagnosis and treatment planning. Deep learning (DL) techniques have shown promise. However, optimizing DL models requires setting numerous parameters, and demands substantial labeled datasets, which are labor-intensive to create. This study proposes a semi-supervised model that can utilize labeled and unlabeled data to accurately segment kidneys, tumors, and cysts on CT images, even with limited labeled samples. An end-to-end semi-supervised learning model named MTAN (Mean Teacher Attention N-Net) is designed to segment kidneys, tumors, and cysts on CT images. The MTAN model is built on the foundation of the AN-Net architecture, functioning dually as teachers and students. In its student role, AN-Net learns conventionally. In its teacher role, it generates objects and instructs the student model on their utilization to enhance learning quality. The semi-supervised nature of MTAN allows it to effectively utilize unlabeled data for training, thus improving performance and reducing overfitting. We evaluate the proposed model using two CT image datasets (KiTS19 and KiTS21). In the KiTS19 dataset, MTAN achieved segmentation results with an average Dice score of 0.975 for kidneys and 0.869 for tumors, respectively. Moreover, on the KiTS21 dataset, MTAN demonstrates its robustness, yielding average Dice scores of 0.977 for kidneys, 0.886 for masses, 0.861 for tumors, and 0.759 for cysts, respectively. The proposed MTAN model presents a compelling solution for accurate medical image segmentation, particularly in scenarios where the labeled data is scarce. By effectively utilizing the unlabeled data through a semi-supervised learning approach, MTAN mitigates overfitting concerns and achieves high-quality segmentation results. The consistent performance across two distinct datasets, KiTS19 and KiTS21, underscores model's reliability and potential for clinical reference.

A preliminary evaluation of targeted nanopore sequencing technology for the detection of Mycobacterium tuberculosis in bronchoalveolar lavage fluid specimens.

To evaluate the efficacy of targeted nanopore sequencing technology for the detection of Mycobacterium tuberculosis(M.tb.) in bronchoalveolar lavage fluid(BALF) specimens. A prospective study was used to select 58 patients with suspected pulmonary tuberculosis(PTB) at Henan Chest Hospital from January to October 2022 for bronchoscopy, and BALF specimens were subjected to acid-fast bacilli(AFB) smear, Mycobacterium tuberculosis MGIT960 liquid culture, Gene Xpert MTB/RIF (Xpert MTB/RIF) and targeted nanopore sequencing (TNS) for the detection of M.tb., comparing the differences in the positive rates of the four methods for the detection of patients with different classifications. Among 58 patients with suspected pulmonary tuberculosis, there were 48 patients with a final diagnosis of pulmonary tuberculosis. Using the clinical composite diagnosis as the reference gold standard, the sensitivity of AFB smear were 27.1% (95% CI: 15.3-41.8); for M.tb culture were 39.6% (95% CI: 25.8-54.7); for Xpert MTB/RIF were 56.2% (95% CI: 41.2-70.5); for TNS were 89.6% (95% CI: 77.3-96.5). Using BALF specimens Xpert MTB/RIF and/or M.tb. culture as the reference standard, TNS showed 100% (30/30) sensitivity. The sensitivity of NGS for pulmonary tuberculosis diagnosis was significantly higher than Xpert MTB/RIF, M.tb. culture, and AFB smear. Besides, P values of <0.05 were considered statistically significant. Using a clinical composite reference standard as a reference gold standard, TNS has the highest sensitivity and consistency with clinical diagnosis, and can rapidly and efficiently detect PTB in BALF specimens, which can aid to improve the early diagnosis of suspected tuberculosis patients.

Establishing national clinical diagnostic reference levels and achievable doses for CT examinations in Brazil: A prospective study

PurposeDiagnostic reference levels (DRL) and achievable doses (AD) are important tools for radiation dose optimization. Therefore, a prospective study was performed which aimed to establish a multi-parametric, clinical indication based – DRL(DRLCI) and clinical indication – AD (ADCI) for adult CT in Brazil. MethodsThe prospective study included 4787 patients (50 ± 18 years old; male:female 2041:2746) at 13 Brazilian sites that have been submitted to head, paranasal sinus, cervical spine, chest, or abdomen-pelvis CT between January and October 2021 for 13 clinical indications. The sites provided the following information: patient age, gender, weight, height, body mass index[BMI], clinical indications, scanner information(vendor, model, detector configuration), scan parameters (number of scan phases, kV, mA, pitch) and dose-related quantities (CT dose index volume- CTDIvol, dose length product- DLP). Median(AD) and 75th(DRL) percentile CTDIvol and DLP values were estimated for each body region and clinical indications. Non-normal data were analyzed with the Kruskal-Wallis test. ResultsIn majority of Brazilian sites, body region and clinical indications based DRLs were at or lower than the corresponding DRLs in the US and higher than Europe. Although radiation doses varied significantly for patients in different body mass index groups (p < 0.001), within each body region, there were no differences in radiation doses for different clinical indications (p > 0.1). Radiation doses for 7/13 clinical indications were higher using iterative reconstruction technique than for the filtered back projection. ConclusionsThere was substantial variation in Brazil DRLCI across different institutions with higher doses compared to the European standards. There was also a lack of clinical indication-based protocol and dose optimization based on different clinical indications for the same body region.

GelMA/TCP nanocomposite scaffold for vital pulp therapy

Pulp capping is a necessary procedure for preserving the vitality and health of the dental pulp, playing a crucial role in preventing the need for root canal treatment or tooth extraction. Here, we developed an electrospun gelatin methacryloyl (GelMA) fibrous scaffold incorporating beta-tricalcium phosphate (TCP) particles for pulp capping. A comprehensive morphological, physical-chemical, and mechanical characterization of the engineered fibrous scaffolds was performed. In vitro bioactivity, cell compatibility, and odontogenic differentiation potential of the scaffolds in dental pulp stem cells (DPSCs) were also evaluated. A pre-clinical in vivo model was used to determine the therapeutic role of the GelMA/TCP scaffolds in promoting hard tissue formation. Morphological, chemical, and thermal analyses confirmed effective TCP incorporation in the GelMA nanofibers. The GelMA+20%TCP nanofibrous scaffold exhibited bead-free morphology and suitable mechanical and degradation properties. In vitro, GelMA+20%TCP scaffolds supported apatite-like formation, improved cell spreading, and increased deposition of mineralization nodules. Gene expression analysis revealed upregulation of ALPL, RUNX2, COL1A1, and DMP1 in the presence of TCP-laden scaffolds. In vivo, analyses showed mild inflammatory reaction upon scaffolds’ contact while supporting mineralized tissue formation. Although the levels of Nestin and DMP1 proteins did not exceed those associated with the clinical reference treatment (i.e., mineral trioxide aggregate), the GelMA+20%TCP scaffold exhibited comparable levels, thus suggesting the emergence of differentiated odontoblast-like cells capable of dentin matrix secretion. Our innovative GelMA/TCP scaffold represents a simplified and efficient alternative to conventional pulp-capping biomaterials. Statement of significanceVital pulp therapy (VPT) aims to preserve dental pulp vitality and avoid root canal treatment. Biomaterials that bolster mineralized tissue regeneration with ease of use are still lacking. We successfully engineered gelatin methacryloyl (GelMA) electrospun scaffolds incorporated with beta-tricalcium phosphate (TCP) for VPT. Notably, electrospun GelMA-based scaffolds containing 20% (w/v) of TCP exhibited favorable mechanical properties and degradation, cytocompatibility, and mineralization potential indicated by apatite-like structures in vitro and mineralized tissue deposition in vivo, although not surpassing those associated with the standard of care. Collectively, our innovative GelMA/TCP scaffold represents a simplified alternative to conventional pulp capping materials such as MTA and Biodentine™ since it is a ready-to-use biomaterial, requires no setting time, and is therapeutically effective.