Evaluating Picture Description Speech for Dementia Detection using Image-text Alignment

Using picture description speech for dementia detection has been studied for 30 years. Despite the long history, previous models focus on identifying the differences in speech patterns between healthy subjects and patients with dementia but do not utilize the picture information directly. In this paper, we propose the first dementia detection models that take both the picture and the description texts as inputs and incorporate knowledge from large pre-trained image-text alignment models. We observe the difference between dementia and healthy samples in terms of the text's relevance to the picture and the focused area of the picture. We thus consider such a difference could be used to enhance dementia detection accuracy. Specifically, we use the text's relevance to the picture to rank and filter the sentences of the samples. We also identified focused areas of the picture as topics and categorized the sentences according to the focused areas. We propose three advanced models that pre-processed the samples based on their relevance to the picture, sub-image, and focused areas. The evaluation results show that our advanced models, with knowledge of the picture and large image-text alignment models, achieve state-of-the-art performance with the best detection accuracy at 83.44%, which is higher than the text-only baseline model at 79.91%. Lastly, we visualize the sample and picture results to explain the advantages of our models

Proton pump inhibitor has no effect in the prevention of post-endoscopic sphincterotomy delayed bleeding: a prospective randomized controlled trial

Background and aimsBleeding is one of the common adverse events of endoscopic retrograde cholangiopancreatography (ERCP), which is mainly caused by endoscopic sphincterotomy (EST). At present, it remains unclear whether proton pump inhibitor (PPI) should be used to prevent post-EST bleeding. Therefore, we performed a randomized controlled trial to investigate whether PPI is effective in the prevention of post-EST delayed bleeding.MethodsConsecutive eligible patients were randomly assigned (1:1) to experimental group (PPI group) or control group (normal saline, NS group). The patients in PPI group received intravenous esomeprazole 40  mg and normal saline 100  mL every 12  h for 2  days after ERCP immediately, and followed by oral esomeprazole (Nexium) 20  mg once a day for 7  days. Correspondingly, patients in the control group received intravenous normal saline 100  mL and did not take PPIs or any acid-suppressing drugs during hospitalization and after discharge. All patients were followed up for 30  days after ERCP. The primary endpoint was the incidence and severity of post-EST delayed bleeding.ResultsBetween July 2020 and July 2022, 290 patients were randomly assigned to PPI group (n = 146) or NS group (n = 144). 5 patients from each group were excluded from the final analysis. There were 6 patients with post-EST delayed bleeding, with an incidence rate of 2.14%. The median time of delayed bleeding was 2.5  days after ERCP. 3 cases (2.12%, 3/141) occurred in the PPI group, with 1 case of mild and 2 cases of moderate bleeding. 3 cases (2.16%, 3/139) occurred in the NS group, with 2 cases of mild and 1 case of moderate bleeding. There was no significant difference in the incidence and the severity of post-EST delayed bleeding between the two groups (p = 1.000).ConclusionProphylactic use of PPI after EST does not reduce the incidence and severity of post-EST delayed bleeding in patients.Clinical Trial Registrationhttps://www.chictr.org.cn/searchproj.aspx, identifier ChiCTR2000034697

The clinical effect of a strategy called transcystic gallbladder-preserving cholecystolithotomy based on endoscopic retrograde cholangiopancreatography for cholecystolithiasis: A retrospective study from a single center

BackgroundCholedocholithiasis complicated with cholecystolithiasis is a common disease. This study explores a novel strategy, called ERCP-based transcystic gallbladder-preserving cholecystolithotomy, for the simultaneous removal of common bile duct stones and gallbladder stones.MethodsFrom December 2018 to June 2021, all patients with cholecystolithiasis and common bile duct stones who met the criteria for gallbladder preservation in our hospital were included in the study and prospectively followed up.ResultsWe included 48 patients, including 20 patients with acute biliary pancreatitis. All patients successfully underwent ERCP to remove common bile duct stones. One patient had gallbladder perforation during gallbladder-preserving cholecystolithotomy. The guide wire successfully entered the gallbladder, and the transpapillary gallbladder metal-covered stent was successfully placed in 44 patients. The technical success rate was 91.67% (44/48). All stones were removed in 34 patients, for a clinical success rate of 77.27% (34/44). The total postoperative complication rate was 6.25% (3/48), with 2 cases of pancreatitis (4.17%) and 1 case of cholangitis (2.08%). Three patients were lost to follow-up. Among the 31 patients who were followed up for a mean of 27 months (6–40), 5 patients (16.13%) experienced gallstone recurrence. The recurrence rates at 12 months, 18 months, 24 months, 30 months and 36 months were 0%, 3.23%, 6.45%, 12.9%, and 16.13%, respectively.ConclusionFor patients with cholecystolithiasis and common bile duct stones, ERCP-based transcystic gallbladder-preserving cholecystolithotomy without gallbladder incision can preserve gallbladder structure, and this procedure is safe and feasible for the protection of gallbladder function.Clinical trial registration: The study was registered in the Chinese Clinical Trial Registry, and the registry number is ChiCTR1900028006

Neuroform stent-assisted coiling of large and giant intracranial aneurysms: Angiographic and clinical outcomes in 71 consecutive patients

Background: Large and giant aneurysms still remain a therapeutic challenge both surgically and endovascularly. Objective: The authors report their clinical experience and follow-up results using Neuroform stent, as an adjunct in the treatment of large and giant aneurysms. Materials and Methods: A total of 71 consecutive patients with 72 large or giant intracranial aneurysms were treated with the Neuroform stent-assisted coiling. Both sequential technique and parallel technique were used. In all cases, embolization was completed by packing the aneurysm sac with a variety of commercially available coils. The technical feasibility of the procedure, procedure-related complications, angiographic results, clinical outcome, and follow-up angiography were evaluated. Results: In all the patients, the Neuroform stent system was delivered and deployed accurately, and occlusion was achieved. Immediate angiography demonstrated complete occlusion of the aneurysm in 59.7% of the patients, neck remnant in 26.4%, and incomplete occlusion in 13.9%. Procedure-related complication, morbidity, and mortality were 15.3, 4.2, and 1.4%, respectively. Favorable clinical outcome (modified Rankin Scale score 0-2) was observed in 83.3% of the patients (average follow-up time: 37.1 months). None of the treated aneurysm had rebleeding. Angiography follow-up was obtained in 81.7% (58/71 patients; 59/72 aneurysms; average follow-up time, 43.2 months). The overall recanalization rate was 28.8%. No delayed coil or stent migration was found. In-stent stenosis occurred as a delayed complication in one patient. Conclusions: The Neuroform stent-assisted coiling for large and giant intracranial aneurysms is safe and feasible with comparable incidences of morbidity and mortality

Experimental and Numerical Studies on Local Scour around Closely Spaced Circular Piles under the Action of Steady Current

Scour at coastal structures is a serious problem that causes damage to structures. Focusing on scour around typical gravity-type breakwaters, previous studies have revealed that scour is mainly caused by standing waves in the front of structures. For breakwaters, which consist of closely spaced circular piles, scour caused by flow may occupy a dominant position. In the present work, the scour caused by a small velocity intensity flow was studied using both experimental and numerical models. The experiments revealed that the scour depth around closely spaced circular piles was significantly larger than that of a single pile with the same diameter. The numerical model was verified by theoretical values of flow field and experimental values of scour topography. More detailed flow field information is described using a numerical model that can improve the understanding of scour mechanics. Both experimental and numerical models demonstrate that scour first occurs on the side of piles owing to the shrinkage effect of streamlining and then extends forward and backward. In addition, the scour mechanics change with the increase of the pile spacing

Experimental and Numerical Studies on Local Scour around Closely Spaced Circular Piles under the Action of Steady Current

Scour at coastal structures is a serious problem that causes damage to structures. Focusing on scour around typical gravity-type breakwaters, previous studies have revealed that scour is mainly caused by standing waves in the front of structures. For breakwaters, which consist of closely spaced circular piles, scour caused by flow may occupy a dominant position. In the present work, the scour caused by a small velocity intensity flow was studied using both experimental and numerical models. The experiments revealed that the scour depth around closely spaced circular piles was significantly larger than that of a single pile with the same diameter. The numerical model was verified by theoretical values of flow field and experimental values of scour topography. More detailed flow field information is described using a numerical model that can improve the understanding of scour mechanics. Both experimental and numerical models demonstrate that scour first occurs on the side of piles owing to the shrinkage effect of streamlining and then extends forward and backward. In addition, the scour mechanics change with the increase of the pile spacing

Evaluating Voice-Assistant Commands for Dementia Detection

Early detection of cognitive decline involved in Alzheimer’s Disease and Related Dementias (ADRD) in older adults living alone is essential for developing, planning, and initiating interventions and support systems to improve users’ everyday function and quality of life. In this paper, we explore the voice commands using a Voice-Assistant System (VAS), i.e., Amazon Alexa, from 40 older adults who were either Healthy Control (HC) participants or Mild Cognitive Impairment (MCI) participants, age 65 or older. We evaluated the data collected from voice commands, cognitive assessments, and interviews and surveys using a structured protocol. We extracted 163 unique command-relevant features from each participant’s use of the VAS. We then built machine-learning models including 1-layer/2-layer neural networks, support vector machines, decision tree, and random forest, for classification and comparison with standard cognitive assessment scores, e.g., Montreal Cognitive Assessment (MoCA). Our classification models using fusion features achieved an accuracy of 68%, and our regression model resulted in a Root-Mean-Square Error (RMSE) score of 3.53. Our Decision Tree (DT) and Random Forest (RF) models using selected features achieved higher classification accuracy 80%–90%. Finally, we analyzed the contribution of each feature set to the model output, thus revealing the commands and features most useful in inferring the participants’ cognitive status. We found that features of overall performance, features of music-related commands, features of call-related commands, and features from Automatic Speech Recognition (ASR) were the top-four feature sets most impactful on inference accuracy. The results from this controlled study demonstrate the promise of future home-based cognitive assessments using Voice-Assistant Systems

Albumin infusion may decrease the mortality of hypoalbuminemia patients with severe acute pancreatitis: a retrospective cohort study

Abstract Background At present, the relationship between severe acute pancreatitis (SAP) and albumin infusion is not clear. We aimed to identify the impact of serum albumin on the prognosis of SAP and the association between albumin infusions and mortality for hypoalbuminemia patients. Methods This was a retrospective cohort study that analyzed 1000 patients with SAP who were admitted to the First Affiliated Hospital of Nanchang University between January 2010 and December 2021 using data from a prospectively maintained database. Multivariate logistic regression analysis was conducted to reveal the relationship between serum albumin within 1 week after admission and poor prognosis of SAP. Propensity score matching (PSM) analysis was adopted to evaluate the effect of albumin infusion for hypoalbuminemia patients with SAP. Results The prevalence of hypoalbuminemia (≤ 30 g/L) was 56.9% within 1 week after admission. Multivariate logistic regression identified that age (OR: 1.02; 95% CI: 1.00-1.04; P = 0.012), serum urea (OR: 1.08; 95% CI: 1.04–1.12; P  100 g within 1 week after admission for hypoalbuminemia patients with albumin infusions was associated with lower mortality than doses ≤ 100 g (OR: 0.51, 95% CI: 0.28–0.90, P = 0.020). Conclusions Hypoalbuminemia in early-stage SAP is significantly related to poor prognosis. However, albumin infusions could significantly decrease mortality in hypoalbuminemia patients with SAP. Additionally, infusing sufficient albumin within a week after admission may decrease mortality in hypoalbuminemia patients