Establishment and validation of multiclassification prediction models for pulmonary nodules based on machine learning

Abstract Background Lung cancer is the leading cause of cancer‐related death worldwide. This study aimed to establish novel multiclassification prediction models based on machine learning (ML) to predict the probability of malignancy in pulmonary nodules (PNs) and to compare with three published models. Methods Nine hundred fourteen patients with PNs were collected from four medical institutions (A, B, C and D), which were organized into tables containing clinical features, radiologic features and laboratory test features. Patients were divided into benign lesion (BL), precursor lesion (PL) and malignant lesion (ML) groups according to pathological diagnosis. Approximately 80% of patients in A (total/male: 632/269, age: 57.73 ± 11.06) were randomly selected as a training set; the remaining 20% were used as an internal test set; and the patients in B (total/male: 94/53, age: 60.04 ± 11.22), C (total/male: 94/47, age: 59.30 ± 9.86) and D (total/male: 94/61, age: 62.0 ± 11.09) were used as an external validation set. Logical regression (LR), decision tree (DT), random forest (RF) and support vector machine (SVM) were used to establish prediction models. Finally, the Mayo model, Peking University People's Hospital (PKUPH) model and Brock model were externally validated in our patients. Results The AUC values of RF model for MLs, PLs and BLs were 0.80 (95% CI: 0.73–0.88), 0.90 (95% CI: 0.82–0.99) and 0.75 (95% CI: 0.67–0.88), respectively. The weighted average AUC value of the RF model for the external validation set was 0.71 (95% CI: 0.67–0.73), and its AUC values for MLs, PLs and BLs were 0.71 (95% CI: 0.68–0.79), 0.98 (95% CI: 0.88–1.07) and 0.68 (95% CI: 0.61–0.74), respectively. The AUC values of the Mayo model, PKUPH model and Brock model were 0.68 (95% CI: 0.62–0.74), 0.64 (95% CI: 0.58–0.70) and 0.57 (95% CI: 0.49–0.65), respectively. Conclusions The RF model performed best, and its predictive performance was better than that of the three published models, which may provide a new noninvasive method for the risk assessment of PNs

Magnetic resonance susceptibility-weighted imaging versus other imaging modalities in detecting splenic siderotic lesions.

BACKGROUND: Susceptibility-weighted imaging (SWI) has been proven to be superior to T2*-weighted imaging and also other existing magnetic resonance imaging (MRI) techniques for the detection of iron content and hemorrhage in the brain. The purpose of this study was to compare SWI with T1WI, T2WI and T2*WI in detecting splenic siderotic lesions. METHODOLOGY/PRINCIPAL FINDINGS: Twenty-two patients with splenic siderotic nodule were imaged with non-contrast MRI T1WI, T2WI, T2*WI and SWI at 3.0 Tesla. Imaging data were independently analyzed by two experienced radiologists. The number of splenic siderotic nodules was counted, and the size (largest diameter) was measured. The conspicuity was calculated as the nodule to background parenchyma intensity ratio. We found that SWI detected a larger average number of splenic siderotic nodules than T1WI, T2WI, or T2*WI (all P<0.05). The average size of the nodules detected by SWI was larger than that of those detected by T1WI, T2WI or T2*WI (all P<0.05). SWI provided superior contrast and visibility for splenic siderotic nodules compared to any other sequence (all P<0.001). CONCLUSIONS: SWI may be a better detection scheme for splenic siderotic nodules than T1WI, T2WI and T2*WI

Abnormal intrinsic brain activity patterns in patients with subcortical ischemic vascular dementia.

OBJECTIVES: To investigate the amplitude of low-frequency fluctuations (ALFF) alteration of whole brain in patients with subcortical ischemic vascular dementia (SIVD). MATERIALS AND METHODS: Thirty patients with SIVD and 35 control subjects were included in this study. All of them underwent structural MRI and rs-fMRI scan. The structural data were processed using the voxel-based morphometry 8 toolbox (VBM8). The rs-fMRI data were processed using Statistical Parametric Mapping (SPM8) and Data Processing Assistant for Resting-State fMRI (DPARSF) software. Within-group analysis was performed with a one-sample Student's t-test to identify brain regions with ALFF value larger than the mean. Intergroup analysis was performed with a two-sample Student's t-test to identify ALFF differences of whole brain between SIVD and control subjects. Partial correlations between ALFF values and Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) scores were analyzed in the SIVD group across the parameters of age, gender, years of education, and GM volume. RESULTS: Within-group analysis showed that the bilateral anterior cingulate cortex (ACC), posterior cingulate cortex, medial prefrontal cortex (MPFC), inferior parietal lobe (IPL), occipital lobe, and adjacent precuneus had significantly higher standardized ALFF values than the global mean ALFF value in both groups. Compared to the controls, patients with SIVD presented lower ALFF values in the bilateral precuneus and higher ALFF values in the bilateral ACC, left insula and hippocampus. Including GM volume as an extra covariate, the ALFF inter-group difference exhibited highly similar spatial patterns to those without GM volume correcting. Close negative correlations were found between the ALFF values of left insula and the MoCA and MMSE scores of SIVD patients. CONCLUSION: SIVD is associated with a unique spontaneous aberrant activity of rs-fMRI signals, and measurement of ALFF in the precuneus, ACC, insula, and hippocampus may aid in the detection of SIVD

Characteristics and treatment outcomes of co-infected tuberculosis patients with human immunodeficiency virus in Southeast China, 2012–2021

Abstract Background Tuberculosis (TB) is a chronic respiratory infection. Co-infection with human immunodeficiency virus (HIV) has been a significant obstacle to TB control. Insufficient attention has been given to TB/HIV, and more information is needed to address this issue. We conducted an observational study to investigate the epidemiological characteristics, treatment outcomes and its associated factors of HIV-positive TB patients in Southeast China. Methods An observational study was conducted based on data collected directly from China National TB Surveillance System during 2012–2021. Epidemiological characteristics, drug resistance and outcomes were described as frequency (n) and percentage (%). Risk factors for unsuccessful outcomes were determined using univariate (chi-squared) and multivariate logistic regression analysis. Results A total of 347 TB/HIV cases were included, and the proportion of HIV-positive cases among all TB cases increased significantly from 0.06% to 2012 to 0.40% in 2021. The majority of cases were males (86.5%), non-local household registers (139, 40.1%), farmers or workers (179, 51.6%), and aged 40–59 (142, 40.9%). Of 347 cases, 290 (83.6%) had pulmonary TB (PTB), 10 (2.9%) had extra pulmonary TB (EPTB) and 47(13.5%) had both PTB and EPTB. A total A total of 258 (74.4%) were HIV positive prior to TB diagnosis. 8.0% (4/50) of cases were resistant to rifampicin (RIF) and 274 patients (83.8%) had successful outcomes. Being non-local (AOR = 2.193, 95% CI = 1.196–4.022, P = 0.011) and diagnosed HIV infection after TB (AOR = 2.365, 95% CI = 1.263–4.430, P = 0.007) were independent risk factors for unsuccessful outcomes of anti-TB treatment. Conclusion During 2012–2021, the proportion of HIV-positive cases among all TB cases increased significantly in Southeast China. HIV-positive TB patients were significantly more likely to develop resistance to RIF and INH and unsuccessful anti-TB treatment. Non-local registration and becoming HIV positive after TB diagnosis were independent risk factors associated with unsuccessful outcomes

Dissociable Self Effects for Emotion Regulation: A Study of Chinese Major Depressive Outpatients

Reappraisal is an adaptive emotion regulation strategy while the role of self-perspective in reappraisal process of depressed patients is largely unknown in terms of goals (valence/arousal) and tactics (detachment/immersion). In this study, 12 depressed individuals and 15 controls were scanned with MRI during which they either attend naturally to emotional stimuli, or adopt detachment/immersion strategy. Behaviorally, no group differences in self-reported emotion regulation effectiveness were found. In addition, we observed that (1) patients were less able to downregulate amygdala activation with recruitment of more dorsal lateral prefrontal cortex (dlPFC) when adopting detachment strategy regardless of valence, and this preserved ability to regulate emotion was inversely associated with severity of symptoms; (2) patients had deficits in upregulating amygdala activation when adopting immersion strategy, with less inferior frontal gyrus (IFG) activation and strengthening coupling of dlPFC and ventral medial prefrontal cortex (vmPFC) with amygdala; (3) comparison between groups yielded that patients showed stronger vmPFC activation under either self-detached or self-immersed condition. In conclusion, impaired modulatory effects of amygdala in depressed patients are compensated with strengthening cognitive control resources, with dissociable effects for different self-perspectives in reappraisal. These results may help clarify the role of self-perspective underlying reappraisal in major depression

A plot of the number of siderotic nodules detected by MRI in each patient.

<p>The horizontal axis indicates the patient number, and the vertical axis indicates the number of siderotic nodules. Black rhombus, red squares, yellow triangles and blue star represent T1-weighted imaging, T2-weighted imaging, T2*-weighted imaging, and susceptibility-weighted imaging, respectively.</p

Representative T1-weighted image (T1WI), T2-weighted image (T2WI), T2*-weighted image (T2*WI) and susceptibility-weighted imaging (SWI) of a 42 year-old patient with splenic siderotic nodules.

<p>SWI shows more siderotic nodules than T1WI, T2WI or T2*WI.</p

Comparison of medial temporal measures between Binswanger's disease and Alzheimer's disease.

Binswanger's disease (BD) is a common cause of vascular dementia in elderly patients; however, few studies have investigated the medial temporal lobe (MTL) atrophy in BD, and the differences in the atrophic patterns between BD and Alzheimer's disease (AD) remain largely unknown. Such knowledge is essential for understanding the pathologic basis of dementia. In this study, we collected structural magnetic resonance imaging (MRI) data from 16 normal controls, 14 patients with AD and 14 patients with BD. The volumes of the hippocampus and amygdala, and morphologic parameters (volume, surface area, cortical thickness and mean curvature) of the entorhinal cortex (ERC) and perirhinal cortex (PRC) were calculated using an automated approach. Volume reduction of the hippocampus, amygdala and ERC, and disturbance of the PRC curvature was found in both AD and BD patients compared with the controls (p<0.05, uncorrected). There were no significant differences among all the structural measures between the AD and BD patients. Finally, partial correlation analyses revealed that cognitive decline could be attributed to ERC thinning in AD and volume reduction of PRC in BD. We conclude that AD and BD exhibit similar atrophy patterns in the medial temporal cortices and deep gray matter but have distinct pathologic bases for cognitive impairments. Although atrophy of the MTL structures is a sensitive biomarker for AD, it is not superior for discrimination between AD and BD