Evaluation of pulmonary sequestration with multidetector computed tomography angiography in a select cohort of patients: A retrospective study

OBJECTIVES: This study aimed to evaluate the role of multidetector computed tomography angiography in diagnosing patients with pulmonary sequestration. METHODS: We retrospectively analyzed the computed tomography studies and clinical materials of 43 patients who had undergone preoperative multidetector computed tomography angiography in our hospital and had pathologically proven pulmonary sequestration. Each examination of pulmonary sequestration was reviewed for type, location, parenchymal changes, arterial supply and venous drainage on two-dimensional and three-dimensional computed tomography images. RESULTS: Multidetector computed tomography successfully detected all pulmonary sequestrations in the 43 patients (100%). This included 40 patients (93.0%) with intralobar sequestration and 3 patients (7.0%) with extralobar sequestration. The locations of pulmonary sequestration were left lower lobe (28 cases, 70% of intralobar sequestrations), right lower lobe (12 cases, 30% of intralobar sequestrations) and costodiaphragmatic sulcus (3 cases). Cases of sequestered lung presented as mass lesions (37.2%), cystic lesions (32.6%), pneumonic lesions (16.3%), cavitary lesions (9.3%) and bronchiectasis (4.6%). The angioarchitecture of pulmonary sequestration, including feeding arteries from the thoracic aorta (86.1%), celiac truck (9.3%), abdominal aorta (2.3%) and left gastric artery (2.3%) and venous drainage into inferior pulmonary veins (86.0%) and the azygos vein system (14.0%), was visualized on multidetector computed tomography. Finally, the multidetector computed tomography angiography results of the sequestered lungs and angioarchitectures were surgically confirmed in all the patients. CONCLUSIONS: As a noninvasive modality, multidetector computed tomography angiography is helpful for making diagnostic decisions regarding pulmonary sequestration with high confidence and for visualizing the related parenchymal characteristics, arterial supply, and venous drainage features to help plan surgical strategies

An integrated convolutional neural network for classifying small pulmonary solid nodules

Achieving accurate classification of benign and malignant pulmonary nodules is essential for treating some diseases. However, traditional typing methods have difficulty obtaining satisfactory results on small pulmonary solid nodules, mainly caused by two aspects: (1) noise interference from other tissue information; (2) missing features of small nodules caused by downsampling in traditional convolutional neural networks. To solve these problems, this paper proposes a new typing method to improve the diagnosis rate of small pulmonary solid nodules in CT images. Specifically, first, we introduce the Otsu thresholding algorithm to preprocess the data and filter the interference information. Then, to acquire more small nodule features, we add parallel radiomics to the 3D convolutional neural network. Radiomics can extract a large number of quantitative features from medical images. Finally, the classifier generated more accurate results by the visual and radiomic features. In the experiments, we tested the proposed method on multiple data sets, and the proposed method outperformed other methods in the small pulmonary solid nodule classification task. In addition, various groups of ablation experiments demonstrated that the Otsu thresholding algorithm and radiomics are helpful for the judgment of small nodules and proved that the Otsu thresholding algorithm is more flexible than the manual thresholding algorithm

Atrial and Ventricular Strain Imaging Using CMR in the Prediction of Ventricular Arrhythmia in Patients with Myocarditis

(1) Objective: Myocarditis can be associated with ventricular arrhythmia (VA), individual non-invasive risk stratification through cardiovascular magnetic resonance (CMR) is of great clinical significance. Our study aimed to explore whether left atrial (LA) and left ventricle (LV) myocardial strain serve as independent predictors of VA in patients with myocarditis. (2) Methods: This retrospective study evaluated CMR scans in 141 consecutive patients diagnosed with myocarditis based on the updated Lake Louise criteria (29 females, mean age 41 ± 20). The primary endpoint was VA; this encompassed ventricular fibrillation, sustained ventricular tachycardia, nonsustained ventricular tachycardia, and frequent premature ventricular complexes. LA and LV strain function were performed on conventional cine SSFP sequences. (3) Results: After a median follow-up time of 23 months (interquartile range (18–30)), 17 patients with acute myocarditis reached the primary endpoint. In the multivariable Cox regression analysis, LA reservoir (hazard ratio [HR] and 95% confidence interval [CI]: 0.93 [0.87–0.99], p = 0.02), LA booster (0.87 95% CI [0.76–0.99], p = 0.04), LV global longitudinal (1.26 95% CI [1.02–1.55], p = 0.03), circumferential (1.37 95% CI [1.08–1.73], p = 0.008), and radial strain (0.89 95% CI [0.80–0.98], p = 0.01) were all independent determinants of VA. Patients with LV global circumferential strain &gt; −13.3% exhibited worse event-free survival compared to those with values ≤ −13.3% (p &lt; 0.0001). (4) Conclusions: LA and LV strain mechanism on CMR are independently associated with VA events in patients with myocarditis, independent to LV ejection fraction, and late gadolinium enhancement location. Incorporating myocardial strain parameters into the management of myocarditis may improve risk stratification.</p

Atrial and Ventricular Strain Imaging Using CMR in the Prediction of Ventricular Arrhythmia in Patients with Myocarditis

(1) Objective: Myocarditis can be associated with ventricular arrhythmia (VA), individual non-invasive risk stratification through cardiovascular magnetic resonance (CMR) is of great clinical significance. Our study aimed to explore whether left atrial (LA) and left ventricle (LV) myocardial strain serve as independent predictors of VA in patients with myocarditis. (2) Methods: This retrospective study evaluated CMR scans in 141 consecutive patients diagnosed with myocarditis based on the updated Lake Louise criteria (29 females, mean age 41 ± 20). The primary endpoint was VA; this encompassed ventricular fibrillation, sustained ventricular tachycardia, nonsustained ventricular tachycardia, and frequent premature ventricular complexes. LA and LV strain function were performed on conventional cine SSFP sequences. (3) Results: After a median follow-up time of 23 months (interquartile range (18–30)), 17 patients with acute myocarditis reached the primary endpoint. In the multivariable Cox regression analysis, LA reservoir (hazard ratio [HR] and 95% confidence interval [CI]: 0.93 [0.87–0.99], p = 0.02), LA booster (0.87 95% CI [0.76–0.99], p = 0.04), LV global longitudinal (1.26 95% CI [1.02–1.55], p = 0.03), circumferential (1.37 95% CI [1.08–1.73], p = 0.008), and radial strain (0.89 95% CI [0.80–0.98], p = 0.01) were all independent determinants of VA. Patients with LV global circumferential strain &gt; −13.3% exhibited worse event-free survival compared to those with values ≤ −13.3% (p &lt; 0.0001). (4) Conclusions: LA and LV strain mechanism on CMR are independently associated with VA events in patients with myocarditis, independent to LV ejection fraction, and late gadolinium enhancement location. Incorporating myocardial strain parameters into the management of myocarditis may improve risk stratification.</p

Xiaoqinglong granules as add-on therapy for asthma: latent class analysis of symptom predictors of response.

Xiaoqinglong granules (XQLG) has been shown to be an effective therapy in asthma animal models. We reviewed the literature and conducted this study to assess the impact of XQLG as an add-on therapy to treatment with fluticasone/salmeterol (seretide) in adult patients with mild-to-moderate, persistent asthma. A total of 178 patients were randomly assigned to receive XQLG and seretide or seretide plus placebo for 90 days. Asthma control was assessed by asthma control test (ACT), symptoms scores, FEV(1), and PEF. Baseline patient-reported Chinese medicine (CM)-specific symptoms were analyzed to determine whether the symptoms may be possible indicators of treatment response by conducting latent class analysis (LCA). There was no statistically significant difference in ACT score between two groups. In the subset of 70 patients with symptoms defined by CM criteria, XQLG add-on therapy was found to significantly increase the levels of asthma control according to global initiative for asthma (GINA) guidelines (P = 0.0329). There was no significant difference in another subset of 100 patients with relatively low levels of the above-mentioned symptoms (P = 0.1291). Results of LCA suggest that patients with the six typical symptoms defined in CM may benefit from XQLG

Common pitfalls and recommendations for using machine learning to detect and prognosticate for COVID-19 using chest radiographs and CT scans

Abstract: Machine learning methods offer great promise for fast and accurate detection and prognostication of coronavirus disease 2019 (COVID-19) from standard-of-care chest radiographs (CXR) and chest computed tomography (CT) images. Many articles have been published in 2020 describing new machine learning-based models for both of these tasks, but it is unclear which are of potential clinical utility. In this systematic review, we consider all published papers and preprints, for the period from 1 January 2020 to 3 October 2020, which describe new machine learning models for the diagnosis or prognosis of COVID-19 from CXR or CT images. All manuscripts uploaded to bioRxiv, medRxiv and arXiv along with all entries in EMBASE and MEDLINE in this timeframe are considered. Our search identified 2,212 studies, of which 415 were included after initial screening and, after quality screening, 62 studies were included in this systematic review. Our review finds that none of the models identified are of potential clinical use due to methodological flaws and/or underlying biases. This is a major weakness, given the urgency with which validated COVID-19 models are needed. To address this, we give many recommendations which, if followed, will solve these issues and lead to higher-quality model development and well-documented manuscripts

Die Regulierung rechtswidriger Informationen im Internet unter besonderer Berücksichtigung von Sperrmaßnahmen gegen Access-Provider:Vergleich zwischen Deutschland und China

Online-Informationen werden sowohl in Deutschland als auch in China zur Be- kämpfung von Rechtsverletzungen gesperrt. Die Inhalteregulierung ist in der Literatur ein viel diskutiertes Thema in den letzten Jahren. Im Mittelpunkt der Darstellung dieser Arbeit geht es um zeitlich vorangehende Mechanismen zur Sicherstellung eines Internets, das frei von schädlichen oder rechtswidrigen Inhalten ist. Hierbei spielen Lizenzen eine Rolle. Von Bedeutung ist auch die Besetzung von Schlüsselpositionen in Redaktionen oder Online-Medienunternehmen, ebenso wie die Löschung von Inhalten auf Online-Plattformen. Der Fokus der Arbeit wird aber letztlich auf die Sperrmaßnahmen von Access-Provider gerückt, ob und ggf. Sperrmaßnahmen gegen Access-Provider erlaubt sind. Inwiefern sind in China und in Deutschland Sperrmaßnahmen gegenüber Access-Provider wegen rechtswidriger Inhalte möglich? Sind hierfür in beiden Ländern besondere Anforderungen zu beachten? Ausgehend von den Ergebnissen soll rechtsvergleichend erarbeitet werden, welche Verbesserungsmöglichkeiten in beiden Ländern – vor allem in China – bestehen