Validation of deep-learning image reconstruction for coronary computed tomography angiography: Impact on noise,image quality and diagnostic accuracy

BackgroundAdvances in image reconstruction are necessary to decrease radiation exposure from coronary CT angiography (CCTA) further, but iterative reconstruction has been shown to degrade image quality at high levels. Deep-learning image reconstruction (DLIR) offers unique opportunities to overcome these limitations. The present study compared the impact of DLIR and adaptive statistical iterative reconstruction-Veo (ASiR-V) on quantitative and qualitative image parameters and the diagnostic accuracy of CCTA using invasive coronary angiography (ICA) as the standard of reference.MethodsThis retrospective study includes 43 patients who underwent clinically indicated CCTA and ICA. Datasets were reconstructed with ASiR-V 70% (using standard [SD] and high-definition [HD] kernels) and with DLIR at different levels (i.e., medium [M] and high [H]). Image noise, image quality, and coronary luminal narrowing were evaluated by three blinded readers. Diagnostic accuracy was compared against ICA.ResultsNoise did not significantly differ between ASiR-V SD and DLIR-M (37 vs. 37 HU, p = 1.000), but was significantly lower in DLIR-H (30 HU, p < 0.001) and higher in ASiR-V HD (53 HU, p < 0.001). Image quality was higher for DLIR-M and DLIR-H (3.4–3.8 and 4.2–4.6) compared to ASiR-V SD and HD (2.1–2.7 and 1.8–2.2; p < 0.001), with DLIR-H yielding the highest image quality. Consistently across readers, no significant differences in sensitivity (88% vs. 92%; p = 0.453), specificity (73% vs. 73%; p = 0.583) and diagnostic accuracy (80% vs. 82%; p = 0.366) were found between ASiR-V HD and DLIR-H.ConclusionDLIR significantly reduces noise in CCTA compared to ASiR-V, while yielding superior image quality at equal diagnostic accuracy.     

Hubs disruption in mesial temporal lobe epilepsy. A resting‐state fMRI study on a language‐and‐memory network

Mesial temporal lobe epilepsy (mTLE) affects the brain networks at several levels and patients suffering from mTLE experience cognitive impairment for language and memory. Considering the importance of language and memory reorganization in this condition, the present study explores changes of the embedded language‐and‐memory network (LMN) in terms of functional connectivity (FC) at rest, as measured with functional MRI. We also evaluate the cognitive efficiency of the reorganization, that is, whether or not the reorganizations support or allow the maintenance of optimal cognitive functioning despite the seizure‐related damage. Data from 37 patients presenting unifocal mTLE were analyzed and compared to 48 healthy volunteers in terms of LMN‐FC using two methods: pairwise correlations (region of interest [ROI]‐to‐ROI) and graph theory. The cognitive efficiency of the LMN‐FC reorganization was measured using correlations between FC parameters and language and memory scores. Our findings revealed a large perturbation of the LMN hubs in patients. We observed a hyperconnectivity of limbic areas near the dysfunctional hippocampus and mainly a hypoconnectivity for several cortical regions remote from the dysfunctional hippocampus. The loss of FC was more important in left mTLE (L‐mTLE) than in right (R‐mTLE) patients. The LMN‐FC reorganization may not be always compensatory and not always useful for patients as it may be associated with lower cognitive performance. We discuss the different connectivity patterns obtained and conclude that interpretation of FC changes in relation to neuropsychological scores is important to determine cognitive efficiency, suggesting the concept of “connectome” would gain to be associated with a “cognitome” concept.     

Which behaviours are first to emerge during recovery of consciousness after severe brain injury?

BackgroundEarly detection of consciousness after severe brain injury is critical for establishing an accurate prognosis and planning appropriate treatment.ObjectivesTo determine which behavioural signs of consciousness emerge first and to estimate the time course to recovery of consciousness in patients with severe acquired brain injury.MethodsRetrospective observational study using the Coma Recovery Scale-Revised and days to recovery of consciousness in 79 patients (51 males; 34 with traumatic brain injury; median [IQR] age 48 [26–61] years; median time since injury 26 [20–36] days) who transitioned from coma or unresponsive wakefulness syndrome (UWS)/vegetative state (VS) to the minimally conscious state (MCS) or emerged from MCS during inpatient rehabilitation.ResultsVisual pursuit was the most common initial sign of MCS (41% of patients; 95% CI [30–52]), followed by reproducible command-following (25% [16–35]) and automatic movements (24% [15–33]). Ten other behaviours emerged first in less than 16% of cases. Median [IQR] time to recovery of consciousness was 44 [33–59] days. Etiology did not significantly affect time to recovered consciousness.ConclusionRecovery of consciousness after severe brain injury is most often signalled by reemergence of visual pursuit, reproducible command-following and automatic movements. Clinicians should use assessment measures that are sensitive to these behaviours because early detection of consciousness is critical for accurate prognostication and treatment planning.     

Synthesis and Characterization of Solution Processable Poly(pyrazolines)

Solution‐processable poly(dibenzalacetone) and poly(dibenzalcyclohexanone) are prepared by the condensation of 1,4‐dialkoxy‐bisbenzaldehyde and acetone/cyclohexanone using classic Claisen–Schmidt condensation. The prepared polymers are readily soluble in common organic solvents due to the presence of alkoxy chains present on the aromatic ring. The availability of α,β‐unsaturated ketone on the backbone is readily functionalized with hydrazine hydrate to obtain poly(pyrazoline acetate), a nonconjugated polymer on the backbone, which shows enhanced emission characteristics on comparison with the pristine polymer and small molecule analogues. The highest occupied molecular orbital–lowest unoccupied molecular orbital (HOMO–LUMO) of levels of poly(pyrazolines) has a band gap of 1.54 eV as calculated from cyclic voltammetry and UV–vis studies. Uniform thin film is obtained by spin casting as 1% solution on chlorobenzene and annealing under vacuum. Atomic force microscopy analysis shows fine morphology of the thin film. I–V characterization of the film shows low turn‐on voltage of 5.3 V. HOMO–LUMO is calculated by density functional theory and the result suggests that these molecules have great potential toward polymer organic light‐emitting diode applications.     

2017年ACC/AHA高血压指南对贵阳城区40~79岁不同糖代谢状态人群高血压患病情况的可能影响

目的探讨2017年美国心脏病学会/美国心脏协会(ACC/AHA)指南提出的新的高血压诊断标准下贵阳城区40~79岁不同糖代谢状态人群的高血压患病情况,为高血压的诊断标准及高血压的治疗策略提供线索。方法回顾性分析了中国2型糖尿病患者肿瘤发生风险的流行病学(REACTION)研究贵阳分中心的10140名40~79岁居民,根据糖尿病病史及口服葡萄糖耐量试验结果分为血糖正常组、空腹血糖受损(IFG)组、糖耐量受损(IGT)组、IFG+IGT组、既往诊断糖尿病组及新诊断糖尿病组,计算在美国预防、检测、评估与治疗高血压全国联合委员会第七次报告(JNC 7)及2017年ACC/AHA的高血压指南标准下不同糖代谢状态人群的高血压患病情况。结果在JNC 7标准下,贵阳城区40~79岁血糖正常人群、糖尿病前期人群、糖尿病人群的高血压标准化患病率分别为8.19%、9.57%、8.19%。在2017年ACC/AHA标准下,高血压的标准化患病率分别为20.27%、16.35%、11.59%。相比之下,以血糖正常及IGT人群的高血压患病率增加最为显著。新增的高血压患者共1739例,其中25.8%需应用降压药物治疗。根据2010年第六次人口普查贵州省人口数据,估计贵阳市40~79岁糖尿病前期人群中新增的高血压患者约12.3万人,新增需治疗人数约2.0万人;糖尿病人群中新增高血压患者约6.8万人,新增需治疗人数约2.1万余人。结论2017年ACC/AHA高血压指南会使贵阳市城区40~79岁不同糖代谢状态人群的高血压患病率明显增加,糖尿病及糖尿病前期的高血压人群的需治疗比例也会相当高,社会医疗负担加重。     

老年高级别胶质瘤的临床特点和治疗

目的探讨老年高级别胶质瘤患者的临床特点和治疗方案。方法回顾性分析2012年4月至2017年8月中国医学科学院,北京协和医院神经外科连续收治的32例老年高级别胶质瘤患者的临床资料,总结其临床表现、术前Karnofsky功能状态评分(KPS)、合并症情况(查尔森合并症指数)、肿瘤病理学分型、治疗方法以及患者的总生存期。所有患者均行手术切除肿瘤或活组织检查术,术后辅以放化疗、单纯化疗或靶向治疗。采用Kaplan-Meier法探讨手术方式、合并症情况以及术前KPS对患者总生存期的影响。结果32例患者中,男21例,女11例;年龄为(71.9±6.9)岁(65~79岁);其中世界卫生组织(WHO)Ⅳ级(胶母细胞瘤)22例(68.7%),Ⅲ级10例(31.3%);术前中位KPS(范围)为78.1分(40~90分);中位查尔森合并症指数(范围)为5.7(4~8)。32例患者中,行病灶切除术21例(65.6%),行活组织检查术11例(34.4%)。术后行标准Stupp方案治疗7例,行替莫唑胺辅助化疗9例,行靶向治疗1例,未行进一步治疗11例。失访4例。32例患者的总生存期为1.2~73.3个月,中位值为15.8个月。生存分析结果表明,手术方式、术前KPS以及查尔森合并症指数并非患者总生存期的影响因素(均P>0.05)。结论老年高级别胶质瘤患者的一般情况较差,合并症多,通过采用手术、放化疗等综合治疗后生存期仍较短。在进行治疗方案的选择时,应根据患者的具体情况选择相对有利的治疗方案。     

Avoidable hospitalisation for diabetes mellitus among immigrants and natives: Results from the Italian Network for Longitudinal Metropolitan Studies

Background and aimsItaly has experienced a relevant increase in migration inflow over the last 20 years. Although the Italian Health Service is widely accessible, immigrants can face many barriers that limit their use of health services. Diabetes mellitus (DM) has a different prevalence across ethnic groups, but studies focusing on DM care among immigrants in Europe are scarce. This study aimed to compare the rates of avoidable hospitalisation (AH) between native and immigrant adults in Italy.Methods and resultsA multi-centre open cohort study including all 18- to 64-year-old residents in Turin, Venice, Reggio-Emilia, Modena, Bologna and Rome between 01/01/2001 and 31/12/2013–14 was conducted. Italian citizens were compared with immigrants from high migratory pressure countries who were further divided by their area of origin. We calculated age-, sex- and calendar year-adjusted rate ratios (RRs) and 95% confidence intervals (95% CIs) of AH for DM by citizenship using negative binomial regression models. The RRs were summarized using a random effects meta-analysis. The results showed higher AH rates among immigrant males (RR: 1.63, 95% CI: 1.16–2.23), whereas no significant difference was found for females (RR: 1.14, 95% CI: 0.65–1.99). Immigrants from Asia and Africa showed a higher risk than Italians, whereas those from Central-Eastern Europe and Central-Southern America did not show any increased risk.ConclusionAdult male immigrants were at higher risk of experiencing AH for DM than Italians, with differences by area of origin, suggesting that they may experience lower access to and lower quality of primary care for DM. These services should be improved to reduce disparities.     

Proteases and their inhibitors as prognostic factors for high-grade serous ovarian cancer

Ovarian carcinoma is one of the most lethal malignancies, but only very few prognostic biomarkers are known. The degradome, comprising proteases, protease non-proteolytic homologues and inhibitors, have been involved in the prognosis of many cancer types, including ovarian carcinoma. The prognostic significance of the whole degradome family has not been specifically studied in high-grade serous ovarian cancer. A targeted DNA microarray known as the CLIP-CHIP microarray was used to identify potential prognostic factors in ten high-grade serous ovarian cancer women who had early recurrence (<1.6 years) or late/no recurrence after first line surgery and chemotherapy. In women with early recurrence, we identified seven upregulated genes (TMPRSS4, MASP1/3, SPC18, PSMB1, IGFBP2, CFI – encoding Complement Factor I – and MMP9) and one down-regulated gene (ADAM-10). Using immunohistochemistry, we evaluated the prognostic effect of these 8 candidate genes in an independent cohort of 112 high-grade serous ovarian cancer women. Outcomes were progression, defined according to CA-125 criteria, and death. Multivariate Cox proportional hazard regression models were done to estimate the associations between each protein and each outcome. High ADAM-10 expression (intensity of 2–3) was associated with a lower risk of progression (adjusted hazard ratio (HR): 0.51; 95% confidence interval (CI): 0.29-0.87). High complement factor I expression (intensity 2–3) was associated with a higher risk of progression (adjusted HR: 2.30, 95% CI: 1.17–4.53) and death (adjusted HR: 3.42; 95% CI: 1.72–6.79). Overall, we identified the prognostic value of two proteases, ADAM-10 and complement factor I, for high-grade serous ovarian cancer which could have clinical significance.