Dilation Rate Research Articles

A novel rabbit model of abdominal aortic aneurysm: Construction and evaluation

Prior research has indicated that animal models of abdominal aortic aneurysm (AAA) utilizing porcine pancreatic elastase (PPE) exhibit a perfusion duration of 30 min, and extended perfusion durations are associated with elevated mortality rates. Similarly, the AAA model, which relies solely on balloon dilation (BD), is limited by the occurrence of self-healing aneurysms. Consequently, we constructed a novel AAA model by PPE combined with balloon expansion to shorten the modeling time and improve the modeling success rate. The findings indicated that 5 min was the optimal BD time for rabbits, 3 min BD was ineffective for aneurysm formation, and 10 min BD had a high mortality rate. The model, constructed in combination with PPE and 5 min BD, exhibited a 100% model formation rate and a 244.7% ± 9.83% dilation rate. HE staining exhibited that severe disruption of the inner, middle, and outer membranes of the abdominal aorta, with a marked decrease in smooth muscle cells and elastase, and a marked increase in fibroblasts of the middle membrane, and many infiltrating inflammatory cells were seen in all three layers, especially in the middle membrane. EVG staining displayed that the elastic fibers of the abdominal aortic wall were fractured and degraded, and lost their normal wavy appearance. The protein expression of inflammatory factor (IL-1β, IL-6 and TNF-α) as well as extracellular matrix components (MMP-2 and MMP-9) were significantly increased compared to PPE and 5 min BD alone. In conclusion, PPE combined with BD allows the establishment of a novel AAA model that closely mimics human AAA in terms of histomorphology, inflammatory cell infiltration, and vascular stromal destruction. This model provides an ideal animal model for understanding the pathogenesis of AAA.

Clinical evaluation of a novel drill dilator as the first-line tract dilation technique during EUS-guided biliary drainage by nonexpert hands (with videos).

In cases in which tract dilation fails using the initially selected dilation device during EUS-guided hepaticogastrostomy (EUS-HGS), dilation should be re-attempted using another device. However, switching from one device to another during the procedure is often associated with prolonged procedure time and deviation from the correct axis. Therefore, it is highly desired that the initial tract dilation succeeds on the first attempt. Recently, a novel drill dilator has become available in Japan. Because there have been no previous studies comparing this novel device versus others as an initial dilation device, this article reports on the technical feasibility of this novel device for use during EUS-HGS and compares it with a balloon catheter. This retrospective study included patients who underwent EUS-HGS using a self-expandable metal stent between October 2021 and October 2022. Excluded from the study were patients who underwent EUS-HGS using a plastic stent or stent deployment without tract dilation. The primary outcome in this study was the technical success rate of initial tract dilation using the drill dilator. This dilator has been available at our hospital since June 2022. Thus, EUS-HGS was performed using this device as the primary dilation device from June 2022 to October 2022. As the control group, we corrected patients who underwent EUS-HGS using a 4-mm balloon catheter as the primary dilation device from October 2021 to May2022. A total of 49 patients were included: 19 underwent EUS-HGS using the drill dilator and 30 underwent EUS-HGS using a balloon catheter. EUS-HGS using the drill dilator initially was performed mainly by nonexpert hands (n= 19), whereas only some procedures in the balloon catheter group were performed by nonexpert hands (n= 2). Although the initial tract dilation was successful in all patients in the drill dilator group (19 of 19 [100%]) and in 29 (97%) of 30 in the balloon catheter group, additional tract dilation was needed in 73.7% (14 of 19) of the drill dilator group upon insertion of the 8.5F stent delivery system. In contrast, the stent delivery system insertion was successful without additional tract dilation in all patients in the balloon catheter group. The novel drill dilator might be useful as a dilation device; however, the balloon dilation technique should be selected first upon deploying a dedicated metal stent with an 8.5F stent delivery system.

Long- and short-term outcomes of balloon dilation for benign choledochojejunal anastomotic stricture using balloon endoscopy-assisted ERCP: a multi-center retrospective cohort study

BackgroundBenign choledochojejunal anastomotic stricture (CJS) is a common complication of pancreaticoduodenectomy and choledochojejunostomy. CJS is generally treated with balloon dilation, using balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP); however, its long- and short-term outcomes have not been fully evaluated. Therefore, we evaluated the treatment outcomes of balloon dilation with BE-ERCP for CJS.MethodsWe retrospectively analyzed 40 patients who had undergone balloon dilation with BE-ERCP for CJS between January 2009 and December 2022. The primary outcomes were technical and clinical success, and adverse event rates of balloon dilation using BE-ERCP for CJS. The secondary outcomes were long-term treatment outcomes for CJS recurrence, and evaluation of risk factors for recurrence.ResultTechnical and clinical success rates were 93% (37/40) and 100% (37/37), respectively. CJS recurrence occurred in 32% (20/37). No procedure-related adverse events were observed. The significant risk factors of CJS after balloon dilation were its early occurrence after surgery (unit hazard ratio [HR] for month, 0.87; 95% confidence interval [CI], 0.76–0.99; p-value = 0.04) and residual waist during balloon dilation (HR, 5.46; 95% CI, 1.18–25.1; p-value = 0.03). Receiver operating characteristic curve analysis of time from surgery to balloon dilation revealed an area under the curve of 0.80 (95% CI, 0.65–0.94) and the cut-off value was 13.2 months.ConclusionTreatment of CJS with balloon dilation was effective, although CJS recurrence occurred in one-third of the patients. The risk factors for recurrence were early occurrence of CJS after surgery and remaining waist circumference during balloon dilation.

Cross-scale Graph Interaction Network for Semantic Segmentation of Remote Sensing Images

Semantic segmentation of remote sensing (RS) images plays a vital role in a variety of fields, including urban planning, natural disaster monitoring, and land resource management. Due to the complexity and low resolution of RS images, many approaches have been proposed to handle the related task. However, these previously developed approaches dedicate to contextual interaction but ignore the cross-scale semantic correlation and multi-scale boundary information. Therefore, we propose a Cross-scale Graph Interaction Network (CGIN) to address semantic segmentation problems of RS images, which consists of a semantic branch and a boundary branch. In the semantic branch, we first apply atrous convolution to extract multi-scale semantic features of RS images. Particularly, based on the multi-scale semantic features, a Cross-scale Graph Interaction (CGI) module is introduced, which establishes cross-scale graph structures and performs adaptive graph reasoning to capture the cross-scale semantic correlation of RS objects. In the boundary branch, we propose a Multi-scale Boundary Feature Extraction (MBFE) module that utilizes atrous convolutions with different dilation rates to extract multi-scale boundary features. Finally, to address the problem of sparse boundary pixels in the fusion process of the two branches, we propose a Multi-scale Similarity-guided Aggregation (MSA) module by calculating the similarity of semantic features and boundary features at the corresponding scale, which can emphasize the boundary information in semantic features. Our proposed CGIN outperforms state-of-the-art approaches in numerical experiments conducted on two benchmark remote sensing datasets.

DPA‐UNet rectal cancer image segmentation based on visual attention

SummaryLow segmentation accuracy and background noise exisit in rectal cancer lesion segmentation. To segment colorectal tumors in CT images accurately, we propose an improved U‐Net network for colorectal tumor image segmentation dilated‐pyramid‐attention U‐Net (DPA‐UNet). In this paper, we use the U‐Net network and combine techniques such as dilated convolution, weighted feature pyramid structure (W‐FPN), and convolutional block attention module (CBAM) mechanism. Firstly, CBAM and W‐FPN are combined to extract dense pixel‐level features for pixel labeling. Secondly, after the third network output layer, three serially dilated depth‐separable dilated convolutional layers with dilation rates of 1, 2, and 4, are added respectively to expand the feature map receptive field. Finally, the DPA‐UNet model is compared and analyzed with other new network structures. The experimental results show that DPA‐UNet achieves automatic segmentation of the colorectal cancer image region of interest (ROI).

Anastomotic Stricture After Minimally Invasive Esophagectomy

BackgroundDespite improved outcomes, minimally invasive esophagectomy (MIE) continues to be associated with anastomotic strictures. Most resolve after a single dilation; however, some become refractory. Little is known about strictures after MIE in North America. MethodsWe performed a single-institution retrospective review of MIEs from 2015 to 2019. Primary outcomes were the proportion of patients requiring anastomotic dilation and the dilation rate per year. Univariate analyses of patients undergoing dilation by various risk factors were performed with nonparametric tests, and multivariate analyses of the dilation rate were conducted using generalized linear models. ResultsOf 391 included patients, 431 dilations were performed on 135 patients (34.5%, 3.2 dilations per patient who required at least 1 per patient). One complication occurred after dilation. Comorbidities, tumor histology, and tumor stage were not significantly associated with stricture. Three-field MIE was associated with a higher percentage of patients undergoing dilation (48.9% vs 27.1%, P < .001) and a higher rate of dilations (0.944 vs 0.441 dilations per year, P = .007) than 2-field MIE, and this association remained significant after controlling for covariates. When accounting for surgeon variability, this difference was no longer significant. Among patients with 1 or more dilations, those receiving dilation within 100 days of surgery needed more subsequent dilations (2.0 vs 0.6 dilations per year, P < .001). ConclusionsAfter controlling for multiple variables, a 3-field MIE approach was associated with a higher rate of repeat dilations in patients undergoing MIE. A shorter interval between esophagectomy and initial dilation is strongly associated with the need for repeated dilations.

Improved perturbation solution for two-dimensional viscous flow between expanding or contracting permeable walls

Despite the continuing interest in the transport of biological fluid within contracting or expanding vessels, our knowledge is yet to be fully developed, even in the two-dimensional case. For example, explicit solutions and close approximations to these models remain unknown, and the physical problem has been restricted to the “slow” expansion or contraction of the walls. Thus, the purpose of this short communication is to partially address such challenges and gaps by generating explicit solutions and improving approximations to the flow problem without the “slowness” restriction being imposed. We show that when the Reynolds number is zero (i.e., the inviscid case), the corresponding homogeneous differential equation under consideration may be completely solved. We then illustrate how this exact solution may be leveraged to form more precise approximations to the flow via perturbation techniques when the Reynolds number is small. Our perturbation approach is only in one parameter (the Reynolds number) instead of the usual two parameters (the Reynolds number and wall dilation rate), and thus we make no restriction regarding the “slowness” of wall expansion or contraction for our general perturbation scheme. Our act of “shining new light through old windows” improves and extends the results of Majdalani, Zhou and Dawson and, moreover, our method has significant potential to be applied by researchers to form more precise one-parameter perturbation approximations to flow problems in contrast to the limitations of the traditional two-parameter perturbation approaches that have dominated the literature.

CB-D2RNet – An efficient context bridge network for glioma segmentation

The recent automatic glioma segmentation and localization techniques obtained promising results, but there is much scope for improvement in execution complexity and segmentation efficiency. These methods often fail to pinpoint small and isolated target locations in necrotic and enhancing glioma sub-regions. Moreover, the computational complexity and number of model parameters utilized in these techniques are also high. To address such issues, a Context Bridge-Dense Dilated Residual Net (CB-D2RNet) is proposed in this paper which reflects the five novel contributions. Firstly, a Dense Dilated Convolutional (DDC) block is formed with four cascade branches to cope with large morphological differences in gliomas. Secondly, the skip connections in traditional UNet are redesigned to overcome the large contextual gap between encoder-decoder. Thirdly, a new loss function is proposed that handles unequal class distribution in gliomas and provides a regularization impact. Fourthly, the precise selection of dilation rates is made for each dilated convolutional block in the feature encoder to gather a more receptive view of complex and multiple tumor regions. Lastly, only a single convolutional operation is included in the feature encoder and decoder, unlike other state-of-the-art models. The experiments are conducted on BraTS 2018 and BraTS 2019 benchmarks, demonstrating that the proposed model performs competitively in all three glioma sub-regions. It achieves dice similarity coefficient for the whole tumor, tumor core, and enhancing tumor as 0.982, 0.987, and 0.976, respectively for the BraTS 2018 dataset, whereas 0.983, 0.989, and 0.977 respectively for the BraTS 2019 dataset. Besides this, the model uses only 6.7 million parameters, the lowest among other compared models.

Hysteroscopic resection vs ultrasound-guided dilation and evacuation for treatment of cesarean scar ectopic pregnancy: a randomized clinical trial

Cesarean scar ectopic pregnancy is a type of ectopic pregnancy in which the fertilized egg is implanted in the muscle or fibrous tissue of the scar after a previous cesarean delivery. The condition can be catastrophic if not managed on time and can lead to significant morbidity and mortality. Several approaches have been studied for the management of cesarean scar ectopic pregnancy in women who opted for termination of pregnancy with no consensus on the best treatment modality reached so far. This study aimed to compare the success rate of hysteroscopic resection vs ultrasound-guided dilation and evacuation for the treatment of cesarean scar ectopic pregnancy. This was a parallel group, nonblinded, randomized clinical trial conducted at a single center in Italy. Women with singleton gestations at <8 weeks and 6 days of gestation were included in the study. Inclusion criteria were women with a cesarean scar ectopic pregnancy with positive embryonic heart activity who opted for termination of pregnancy. Patients were randomized 1:1 to receive either hysteroscopic resection (ie, intervention group) or ultrasound-guided dilation and evacuation (ie, control group). Both groups received 50 mg/m2 of methotrexate intramuscularly at the time of randomization (day 1) and another dose at day 3. A third dose of methotrexate was planned in case of persistence of positive fetal heart activity at day 5. Participants received either ultrasound-guided dilation and evacuation or hysteroscopic resection from 1 to 5 days after the last dose of methotrexate. Hysteroscopic resection was performed under spinal anesthesia using a 15 Fr bipolar mini-resectoscope. Dilation and evacuation were performed by vacuum aspiration with a Karman cannula, followed by sharp curettage, if necessary, under ultrasound guidance. The primary outcome was the success rate of the treatment protocol, defined as no further treatment required until the complete resolution of the cesarean scar ectopic pregnancy. Resolution of the cesarean scar ectopic pregnancy was evaluated based on decline of beta-hCG and the absence of residual gestational material in the endometrial cavity. Treatment failure was defined as the necessity for further treatment required until the complete resolution of the cesarean scar ectopic pregnancy. A sample size calculation indicated that 54 participants were required to test the hypothesis RESULTS: A total of 54 women were enrolled and randomized. Number of previous cesarean deliveries ranged from 1 to 3. Overall, 10 women received a third dose of methotrexate with 7 of 27 (25.9%) participants in the hysteroscopic resection group and 3 of 27 (11.1%) in the dilation and evacuation group. The success rate was 100% (27/27) in the hysteroscopic resection group and 81.5% (22/27) in the dilation and evacuation group (relative risk, 1.22; 95% confidence interval, 1.01-1.48). Additional procedures were required in 5 cases of the control group, namely 3 hysterectomies, 1 laparotomic uterine segmental resection, and 1 hysteroscopic resection. The length of stay in the hospital was 9.0±2.9 days in the intervention group and 10.0±3.5 days in the control group (mean difference,-1.00 days; 95% confidence interval,-2.71 to 0.71). No cases of admission to intensive care unit or maternal death were reported. Hysteroscopic resection was associated with an increased success rate in the treatment of cesarean scar ectopic pregnancy when compared with ultrasound-guided dilation and evacuation.

The impact of age on the vascular response to acute sauna exposure

Passive heat exposure has been shown to be a promising method to improve endothelial health. Sauna usage specifically, has been linked to reduced risk of cardiovascular disease in young and middle-aged populations. Increases in blood flow and shear rates associated with heat exposure are often considered to have a major influence on the observed improved endothelial function following repeated heat exposure; however, the magnitude of these shear and flow responses may potentially vary with age or starting endothelial function. Purpose: The purpose of this study was to determine if the vascular response to acute sauna heating is similar between healthy young and middle-aged adults and if the response is related to baseline endothelial function. Methods: 10 young (24.9 ± 4.2 years, 6 male and 4 female) and 8 middle aged adults (55.6 ± 3.9 years 4 males and 4 females) underwent 40 min of sauna exposure at 80ºC. Esophageal temperature was recorded throughout the duration of the experiment. Brachial artery flow-mediated dilation (FMD) blood flow, artery diameter, shear rates and blood pressure were recorded at baseline and following heat exposure. Results: The increase in core temperature (Tc) followed similar trends in both the young and middle-aged adults (young ΔTc = 1.386 ± 0.52 ºC vs middle-Age Δ Tc = 1.637 ± 0.56 ºC). Heat-induced brachial artery dilation and brachial artery shear rate also increased similarly in both age groups (young Δ diameter = 0.048 ± 0.022 cm vs middle-age Δ diameter = 0.074 ± 0.036 cm, young Δ shear = 164.5± 106.8 sec- 1 vs middle-age Δ shear = 150.3 ± 56.29 sec -1 ). Heat induced dilation was strongly correlated to baseline endothelial function in the young (r = 0.86, P=0.006). This relationship was not observed in the brachial artery of middle-aged adults (r = 0.257, P=0.539). Systolic blood pressure (SBP) was significantly reduced following sauna in the middle-aged participants from 135.25 ± 17.50 mmHg to 122.38 ± 19.7 mmHg (P=0.017). There was a slight elevation in SBP following sauna in the young participants from 119.4 ± 6.38 mmHg to 123.1 ± 7.65 mmHg (P=0.017). Diastolic blood pressure (DBP) was significantly reduced in both age groups (P&lt;0.001) with middle age seeing greater reductions (P=0.05) from 80.63 ± 10.97 mmHg to 69.75 ± 8.41 mmHg vs the young 71.2 ± 8.24 mmHg to 66.9 ± 4.56 mmHg. Conclusion: Young and middle-aged adults have similar changes in shear rate and brachial artery dilation in response to acute sauna heating, but the middle-aged adults exhibit significantly greater decreases in SBP and DBP than young adults. In young adults, endothelial function is strongly correlated to heat induced dilation in the brachial artery. This relationship is not present in the middle age population suggesting that heat-induced dilation may rely on mechanisms other than endothelial function in middle-aged adults. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

MFF: An effective method of solving the ill regions in stereo matching

AbstractIn the current stereo matching field, the accuracy of the derived disparity map is highly dependent on the processing capability of ill regions. Fortunately, we find that the use of local information will eliminate the negative effects associated with ill regions. As a result of the above discovery, we propose the Concatenated Dilated Convolution (CDC) block and the Multi‐scale Feature Fusion module (MFF), which are capable of effectively extracting regional context by increasing the receptive field in parallel and channel‐wise ways. The CDC block can expand the receptive field by applying multiple dilated convolutions at different dilation rates in parallel to enhance the smoothness of the feature map. By constructing parallel CDC blocks in a multiple dilated manner, the MFF module can improve the smoothness of the feature map. In addition, to control the number of parameters in the MFF network, a high‐performance channel‐distribution algorithm is proposed, capable of adjusting the weights of each module and convolution in an adaptive manner while reducing the number of parameters. Extensive experiments have demonstrated that MFF and CDC can effectively improve the performance of ill areas and networks with a minimal number of parameters.

Long-term Evaluation of Proximal Aortic Neck Dilatation After Endovascular Abdominal Aortic Aneurysm Repair With a Variety of Contemporary Endografts

To measure the long-term proximal aortic neck dilatation (AND) after elective endovascular aortic aneurysm repair (EVAR) with a variety of contemporary, third-generation, endograft devices. This is a noninterventional prospective cohort study of 157 patients that underwent standard EVAR with self-expanding abdominal endografts. Patients' recruitment lasted from 2013 to 2017, and postoperative follow-up was up to 5 years. A computed tomography angiography (CTA) was performed at the first month and then at 1, 2, and 5 years. Proximal aortic neck's (PAN) basic morphological characteristics (diameter, length, angulation) were measured based on the analysis of CTA in a standardized fashion. Neck-related adverse events, such as migration, endoleak or rupture, and reinterventions were recorded. Significant straightening of the PAN was evident even in the first-month CTA with concurrent neck shortening that became significant at 5 years. Both the suprarenal aorta and the PAN significantly dilated overtime, with PAN dilating more progressively. Mean neck dilatation at the juxtarenal level was 0.8±0.4 mm at 1 year, 1.8±0.8 mm at 2 years, and 3.9±1.7 mm at 5 years, with a mean neck dilatation rate of 0.07 mm/month overall. The incidence of AND ≥2.5 mm was 37.2% at 2 years and 58.1% at 5 years after EVAR and was considered important (≥5 mm) in 11.5% of patients at 2 years and 30.6% of patients at 5 years. A multivariate analysis performed showed that the endograft oversizing, the preoperative neck diameter, and the preoperative abdominal aortic aneurysm sac diameter served as independent predictors of AND at 5 years. At the 5-year follow-up, 8 late type Ia endoleaks (6.5%) and 7 caudal migrations (5.6%) were identified, while no late ruptures were reported. In total, 11 late endovascular reinterventions (8.9%) were performed. Overall, proximal neck-related adverse outcomes (5/7 migrations and 5/8 endoleaks) and reinterventions (7/11) were significantly associated with the presence of important late AND. Proximal AND after EVAR is common. It can influence the long-term durability of proximal endograft fixation and is significantly associated with adverse outcomes, often leading to reinterventions. A systemic and extended surveillance protocol is needed for maintenance of good long-term results. This is a thorough and systematic analysis of the long-term geometric remodeling of the proximal aortic neck after EVAR, that highlights the importance of a strict, and extended surveillance protocol for maintenance of good long-term results of EVAR.

COVID-SegNet: encoder-decoder-based architecture for COVID-19 lesion segmentation in chest X-ray.

The coronavirus disease 2019, initially named 2019-nCOV (COVID-19) has been declared a global pandemic by the World Health Organization in March 2020. Because of the growing number of COVID patients, the world's health infrastructure has collapsed, and computer-aided diagnosis has become a necessity. Most of the models proposed for the COVID-19 detection in chest X-rays do image-level analysis. These models do not identify the infected region in the images for an accurate and precise diagnosis. The lesion segmentation will help the medical experts to identify the infected region in the lungs. Therefore, in this paper, a UNet-based encoder-decoder architecture is proposed for the COVID-19 lesion segmentation in chest X-rays. To improve performance, the proposed model employs an attention mechanism and a convolution-based atrous spatial pyramid pooling module. The proposed model obtained 0.8325 and 0.7132 values of the dice similarity coefficient and jaccard index, respectively, and outperformed the state-of-the-art UNet model. An ablation study has been performed to highlight the contribution of the attention mechanism and small dilation rates in the atrous spatial pyramid pooling module.

Image Inpainting with Parallel Decoding Structure for Future Internet

Image inpainting benefits much from the future Internet, but the memory and computational cost in encoding image features in deep learning methods poses great challenges to this field. In this paper, we propose a parallel decoding structure based on GANs for image inpainting, which comprises a single encoding network and a parallel decoding network. By adding a diet parallel extended-decoder path for semantic inpainting (Diet-PEPSI) unit to the encoder network, we can employ a new rate-adaptive dilated convolutional layer to share the weights to dynamically generate feature maps by the given dilation rate, which can effectively decrease the number of convolutional layer parameters. For the decoding network composed of rough paths and inpainting paths, we propose the use of an improved CAM for reconstruction in the decoder that results in a smooth transition at the border of defective areas. For the discriminator, we substitute the local discriminator with a region ensemble discriminator, which can attack the restraint of only the recovering square, like areas for traditional methods with the robust training of a new loss function. The experiments on CelebA and CelebA-HQ verify the significance of the proposed method regarding both resource overhead and recovery performance.

Comparative evaluation of valethamate bromide and hyoscine butyl bromide on cervical dilatation in water buffaloes after detorsion

After detorsion, incomplete cervical dilatation is major cause of dystocia. The present study aimed to investigate the comparative efficacy of valethamate bromide and hyoscine butyl bromide on cervical dilation after detorsion and their effect on haematological and biochemical parameters of torsion detorted water buffaloes. A total of 18 buffaloes were selected for study which were divided into three groups of six animals each. After detorsion by Sharma’s Modified Schaffer’s method, animals with grade I and grade II cervix were selected for the study. Group I (control group) buffaloes were administered with dexamethasone (40 mg, I/M), cloprostenol (500 μg, I/M) and mifex (450 mL, slow I/V) after successful detorsion. Along with these drugs, in group II and group III, valethamate bromide (100 mg, I/M) and hyoscine butyl bromide (160 mg, I/M) were administered, respectively. The cervical dilation rate (CDR) of each group was calculated and compared. Blood samples were collected three times: before detorsion, after treatment and at parturition. Group III (2.17±0.07 cm/h) had significantly higher CDR followed by group II (1.39±0.21 cm/h), and control group (0.47±0.19 cm/h). Serum calcium levels were also elevated after treatment. Both drug combinations were found safe haematologically and biochemically.

A two-stage segmentation of sublingual veins based on compact fully convolutional networks for Traditional Chinese Medicine images.

As one of the key methods of Traditional Chinese Medicine inspection, tongue diagnosis manifests the advantages of simplicity and directness. Sublingual veins can provide essential information about human health. In order to automate tongue diagnosis, sublingual veins segmentation has become one important issue in the field of Chinese medicine medical image processing. At present, the primary methods for sublingual veins segmentation are traditional feature engineering methods and the feature representation methods represented by deep learning. The former, which mainly based on colour space, belongs to unsupervised classification method. The latter, which includes U-Net and other deep neural network models, belongs to supervised classification method. Current feature engineering methods can only capture low dimensional information, which makes it difficult to extract efficient features for sublingual veins. On the other hand, current deep learning methods use down-sampling structures, which manifest weak robustness and low accuracy. So, it is difficult for current segmentation approaches to recognize tiny branches of sublingual veins. To overcome the above limits, this paper proposes a novel two-stage semantic segmentation method for sublingual veins. In the first stage, a fully convolutional network without down-sampling is used to realize the accurate segmentation of the tongue that includes the sublingual veins to be segmented in the next stage. During the tongue segmentation, the proposed networks can effectively reduce the loss of medical images spatial feature information. At the same time, in order to expand the receptive field, the dilated convolution has been introduced to the proposed networks, which can capture multi-scale information of segmentation images. In the second stage, another fully convolutional network has been used to segment the sublingual veins on the base of the results from the first stage. In this model, proper dilated convolutional rates have been selected to avoid gridding issue. In order to keep the quality of the images to be segmented, several particular data pre-processing and post-processing have been used, which includes specular highlight removal, data augmentation, erosion and dilation. Finally, in order to evaluate the performance of the proposed model, segmentation results have been compared with the state-of-the-art methods on the base of the dataset from Shanghai University of Traditional Chinese Medicine. The effectiveness of sublingual veins segmentation has been proved.

Clinical outcome, quality of life, and mental health in long-gap esophageal atresia: comparison of gastric sleeve pull-up and delayed primary anastomosis

IntroductionPediatric surgeons have yet to reach a consensus whether a gastric sleeve pull-up or delayed primary anastomosis for the treatment of esophageal atresia (EA), especially of the long-gap type (LGEA) should be performed. Thus, the aim of this study was to evaluate clinical outcome, quality of life (QoL), and mental health of patients with EA and their parents.MethodsClinical outcomes of all children treated with EA from 2007 to 2021 were collected and parents of affected children were asked to participate in questionnaires regarding their Quality of Life (QoL) and their child’s Health-Related Quality of Life (HRQoL), as well as mental health.ResultsA total of 98 EA patients were included in the study. For analysis, the cohort was divided into two groups: (1) primary versus (2) secondary anastomosis, while the secondary anastomosis group was subdivided into (a) delayed primary anastomosis and (b) gastric sleeve pull-up and compared with each other. When comparing the secondary anastomosis group, significant differences were found between the delayed primary anastomosis and gastric sleeve pull-up group; the duration of anesthesia during anastomosis surgery (478.54 vs 328.82 min, p < 0.001), endoscopic dilatation rate (100% vs 69%, p = 0.03), cumulative time spent in intensive care (42.31 vs 94.75 days, p = 0.03) and the mortality rate (0% vs 31%, p = 0.03). HRQoL and mental health did not differ between any of the groups.ConclusionDelayed primary anastomosis or gastric sleeve pull-up appear to be similar in patients with long-gap esophageal atresia in many key aspects like leakage rate, strictures, re-fistula, tracheomalacia, recurrent infections, thrive or reflux. Moreover, HrQoL was comparable in patients with (a) gastric sleeve pull-up and (b) delayed primary anastomosis. Future studies should focus on the long-term results of either preservation or replacement of the esophagus in children.

Lie-group method solutions for a viscous flow in a dilating-squeezing permeable channel with velocity slip

The investigation focuses on the effects of wall velocity slip on the solution of a viscous, laminar, incompressible channel flow subjected to small-scaled contraction and expansion of the weakly permeable walls. The study of such flow systems is often contextual for fluid transport in biological organisms. In the considered flow configuration, the vertically moving porous walls enable the fluid to enter or exit with a constant rate. The tangential slip velocity of the flow at the porous walls is modeled with the Navier slip boundary condition. The flow dynamics inside the channel is governed by the full Navier–Stokes equations. The Lie symmetry analysis and the invariant method are adopted to reduce the number of independent variables in the system of governing equations. Consequently, a single fourth-order ordinary differential equation is obtained, which is solved analytically by the double perturbation method and the variation of iteration method. The solutions are compared for different arrangements. Furthermore, the approximated analytical solutions are likened to the numerical solutions obtained from a fourth-order Runge–Kutta solver embedding the Shooting method to check the accuracy. It is observed that the boundary layers are formed, and the flow rapidly turns near the walls, when suction and wall contraction coexist. Alternatively, if injection and wall expansion are paired, the flow adjacent to the walls is delayed. The existence of wall velocity slip advances the near-wall velocity and cuts down the speed of centerline velocity. It results in a change in the volumetric flow rate and shear rate. The overall pressure is also varied by higher wall velocity slip. The results are explored for different values of the permeation Reynold number and the dimensionless wall dilation rate to capture all possible impacts of the flow parameters. The current analysis rectifies the existing errors in the work of Boutros et al. [“Lie-group method solution for two-dimensional viscous flow between slowly expanding or contracting walls with weak permeability,”Appl. Math. Model. 31(6), 1092–1108 (2007)] with the no-slip boundary condition and discusses the overall influences of slip boundary condition on the Lie symmetry solution of the flow system.

Effect of Entonox on Duration of First Stage and Cervical Dilatation in Women During Labour

Introduction: Labour pain is one of the most severe types of pain ever to be experienced. Entonox is a nitrous oxide (N2O), a self administered patient controlled inhalational analgesia. Our research is focused to study about this aspect of Entonox that is reduction in the duration of labour by making cervical dilatation faster. The aims and objectives of our study was to determine the effect of entonox on duration of first stage of labour and to determine the effect of entonox on rate of cervical dilatation. Methodology: A prospective observational study was carried out Pushpagiri Institute of Medical Sciences and Research Centre in Kerala, India, for a period of 6 months consecutive sampling: sample size obtained is 20 per group, grouped them into two groups depending upon the analgesic of choice. The study tool was a Performa and variables entered into Microsoft excel spreadsheet and analysed SPSS 18.0 software package. Results presented as frequency and percentages for categorical data and descriptive statistics for continuous data. The duration of labour was presented as mean and SD and cervical dilatation rate is calculated as cm in dilatation divided by duration of first stage and this also was presented as mean and SD. These two outcome variables was compared between entonox and control Mann-Whitney U Test. Results: There was 20 study participants each in the two groups. 10 primigravidas and 10 multigravidas, with mean age was 28.15 ± 2.66 years and majority of them belong to normal BMI. Although there was no difference with respect to the cervical dilatation at the onset of usage of Entonox, it was observed that there was significant reduction in the duration of labour and usage of Entonox as there was a increase in cervical dilatation rate when compared to women who chose other analgesics. All these factors also found to be statistically significant. Conclusion: A part from analgesic effect nitrous oxide also is shown to decrease the duration of active phase of labour by making cervical dilatation faster and lowering the duration of usage of labour analgesics, which makes labour a pleasant experience for woman.

Lightweight pyramid residual features with attention for person re-identification

Person re-identification is one of the problems in the computer vision field that aims to retrieve similar human images in some image collections (or galleries). It is very useful for people searching or tracking in a closed environment (like a mall or building). One of the highlighted things on person re-identification problems is that the model is usually designed only for performance instead of performance and computing power consideration, which is applicable for devices with limited computing power. In this paper, we proposed a lightweight residual network with pyramid attention for person re-identification problems. The lightweight residual network adopted from the residual network (ResNet) model used for CIFAR dataset experiments consists of not more than two million parameters. An additional pyramid features extraction network and attention module are added to the network to improve the classifier's performance. We use CPFE (Context-aware Pyramid Features Extraction) network that utilizes atrous convolution with different dilation rates to extract the pyramid features. In addition, two different attention networks are used for the classifier: channel-wise and spatial-based attention networks. The proposed classifier is tested using widely use Market-1501 and DukeMTMC-reID person re-identification datasets. Experiments on Market-1501 and DukeMTMC-reID datasets show that our proposed classifier can perform well and outperform the classifier without CPFE and attention networks. Further investigation and ablation study shows that our proposed classifier has higher information density compared with other person re-identification methods.