Multiparametric Cardiovascular Magnetic Resonance in Acute Myocarditis: Comparison of 2009 and 2018 Lake Louise Criteria With Endomyocardial Biopsy Confirmation

Background: Cardiac magnetic resonance (CMR) has been shown to improve the diagnosis of myocarditis, but no systematic comparison of this technique is currently available. The purpose of this study was to compare the 2009 and 2018 Lake Louise Criteria (LLC) for the diagnosis of acute myocarditis using 3.0 T MRI with endomyocardial biopsy (EMB) as a reference and to provide the cutoff values for multiparametric CMR techniques.Methods: A total of 73 patients (32 ± 14 years, 71.2% men) with clinically suspected myocarditis undergoing EMB and CMR with 3.0 T were enrolled in the study. Patients were divided into two groups according to EMB results (EMB-positive and -negative groups). The CMR protocol consisted of cine-SSFP, T2 STIR, T2 mapping, early and late gadolinium enhancement (EGE, LGE), and pre- and post-contrast T1 mapping. Their potential diagnostic ability was assessed with receiver operating characteristic curves.Results: The myocardial T1 and T2 relaxation times were significantly higher in the EMB-positive group than in the EMB-negative group. Optimal cutoff values were 1,228 ms for T1 relaxation times and 58.5 ms for T2 relaxation times with sensitivities of 86.0 and 83.7% and specificities of 93.3 and 93.3%, respectively. The 2018 LLC had a better diagnostic performance than the 2009 LLC in terms of sensitivity, specificity, positive predictive value, and negative predictive value. T1 mapping + T2 mapping had the largest area under the curve (0.95) compared to other single or combined parameters (2018 LLC: 0.91; 2009 LLC: 0.76; T2 ratio: 0.71; EGEr: 0.67; LGE: 0.73; ). The diagnostic accuracy for the 2018 LLC was the highest (91.8%), followed by T1 mapping (89.0%) and T2 mapping (87.7%).Conclusion: Emerging technologies such as T1/ T2 mapping have significantly improved the diagnostic performance of CMR for the diagnosis of acute myocarditis. The 2018 LLC provided the overall best diagnostic performance in acute myocarditis compared to other single standard CMR parameters or combined parameters. There was no significant gain when 2018LLC is combined with the EGE sequence.

Digital Technology in Remote Training and the Perspectives in Identifying and Validating Knowledge and Skills

In the new digital environment and due to the need for competitive professional specialists, it has become increasingly necessary to create a modern educational model that is consistent with the digital development period. The need to combine training and work requires students to be evaluated in a virtual environment which involves the development of online testing and evaluation systems, as well as authorship verification, authentication of test subjects and support of the exam process with real student results. The EU-funded Horizon 2020 (TeSLA) project has a similar purpose: to develop and implement an online testing and evaluation system by identifying subjects with a group of combined parameters in terms of avoiding time limits for the authentication and verification of authorship.

Identifying patients with metformin associated lactic acidosis in the emergency department

Background Metformin associated lactic acidosis (MALA) is a serious adverse event with a high mortality rate of 30–50%. Early recognition of MALA and timely starting treatment may reduce its morbidity and mortality. Objective The aim of this study was to explore clinical parameters to identify patients with MALA in patients with suspected sepsis induced lactic acidosis in the emergency department ED. Setting A retrospective single centre study was conducted at the Deventer Teaching Hospital in the Netherlands. Method Patients with lactate concentration > 4.0 mmol/l admitted at the ED between 2010 and 2017 with suspected sepsis or confirmed MALA and referred to the Intensive Care Unit were included. Baseline characteristics (pH, lactate, creatinine and CRP) of MALA patients were compared with patients with suspected sepsis induced lactic acidosis. Creatinine and lactate concentration were selected as potential relevant parameters. Main outcome measure Sensitivity and specificity of the highest tertiles of the creatinine and the lactate concentrations separately, in combination, and both combined with metformin use, were calculated. Results Thirteen MALA and 90 suspected sepsis induced lactic acidosis patients were included. Lactate (14.7 vs 5.9 mmol/l, p < 0.01) and creatinine concentration (642 vs 174 μmol/l, p < 0.01) were significantly higher in the MALA group and arterial pH (7.04 vs 7.38, p < 0.01) and CRP (90 vs 185 mg/l, p < 0.01) were significantly lower. The combined parameters lactate ≥ 8.4 mmol/l, creatinine ≥ 256 μmol/l had a sensitivity of 85% and a specificity of 95% for identifying MALA in suspected sepsis induced lactic acidosis patients in the ED. When combined with metformin use the specificity increased to 99%. Conclusion When managing lactic acidosis in the ED the diagnosis MALA should be considered in patients with a creatinine concentration ≥ 256 μmol/l and lactate concentration ≥ 8.4 mmol/l.

Preliminary study to identify severe from moderate cases of COVID-19 using NLR&RDW-SD combination parameter

ObjectivesInvestigate the characteristics and rules of hematology changes in patients with COVID-19, and explore the possibility to identify moderate and severe patients using conventional hematology parameters or combined parameters.MethodsThe clinical data of 45 moderate and severe type patients with SARS-CoV-2 infections in Jingzhou Central Hospital from January 23 to February 13, 2020 were collected. The epidemiological indexes, clinical symptoms and laboratory test results of the patients were retrospectively analyzed. Those parameters with significant differences between the two groups were analyzed, and the combination parameters with best diagnostic performance were selected using the LDA method.ResultsOf the 45 patients with COVID-19 (35 moderate and 10 severe cases), 23 were male and 22 female, aged 16-62 years. The most common clinical symptoms were fever (89%) and dry cough (60%). As the disease progressed, WBC, Neu#, NLR, PLR, RDW-CV and RDW-SD parameters in the severe group were significantly higher than that in the moderate group (P<0.05); meanwhile, Lym#, Eos#, HFC%, RBC, HGB and HCT parameters in the severe group were significantly lower than that in the moderate group (P<0.05). For NLR, the AUC, the best cut-off value, the sensitivity and the specificity were 0.890, 13.39, 83.3% and 82.4% respectively, and for PLR, the AUC, the best cut-off, the sensitivity and the specificity were 0.842, 267.03, 83.3% and 74.0% respectively. The combined parameter NLR&RDW-SD had the best diagnostic efficiency (AUC was 0.938) and when the cut-off value was 1.046, the sensitivity and the specificity were 90.0% and 84.7% respectively, followed by the fitting parameter NLR&RDW-CV (AUC = 0.923). When the cut-off value was 0.62, the sensitivity and the specificity for distinguishing severe type from moderate cases of COVID-19 were 90.0% and 82.4% respectively.ConclusionsThe combined parameter NLR&RDW-SD is the best hematology index and can help clinicians to predict the severity of COVID-19 patients, and it can be used as a useful indicator to help prevent and control the epidemic.

Point Shear Wave Elastography of the Spleen in Predicting the Presence of Esophageal Varices in Cirrhosis: Liver Stiffness vs. Spleen Stiffness

Objective: To determine the diagnostic ability of the spleen and liver stiffness in predicting the presence of esophageal varices (EVs). Methods: A sample of cirrhotic patients, diagnosed with sonography, was recruited. The cohorts’ liver stiffness (LS) and spleen stiffness (SS) were measured with the Philips’ Elast PQ technique. Platelet count and spleen size were also documented. The endoscopic report was used as the diagnostic gold standard. Singular and combined parameters were assessed to determine the presence of EV using an independent variable t test, area under the receiver operating characteristic curve, and multilogistic regression analysis statistical tests. Results: In predicting the presence of EV, there was a statistically significant difference in means of SS (2.13 ± 0.69 m/s vs. 3.23 ± 1.32 m/s) and LS (2.33 ± 1.20 m/s vs. 3.05 ± 1.4 m/s), as well as discriminating between groups of patients, with and without EV. The ability to diagnostically classify EV with SS and LS was fair while the remaining parameters were deemed poor, using a SS cutoff value of 1.99 m/s. Conclusion: Despite the difference in means, none of the assessed parameters demonstrated a better classification ability than endoscopy. LS and SS were equal in the prediction of EV in these patients. The LS estimate of fibrosis would have grossly predicted the presence of varices. However, the addition of SS, for the estimation of varices, provided no significant benefit.

Piezoelectric Energy Harvesting From Roadways Based on Pavement Compatible Package

Scavenging mechanical energy from the deformation of roadways using piezoelectric energy transformers has been intensively explored and exhibits a promising potential for engineering applications. We propose here a new packaging method that exploits MC nylon and epoxy resin as the main protective materials for the piezoelectric energy harvesting (PEH) device. Wheel tracking tests are performed, and an electromechanical model is developed to double evaluate the efficiency of the PEH device. Results indicate that reducing the embedded depth of the piezoelectric chips may enhance the output power of the PEH device. A simple scaling law is established to show that the normalized output power of the energy harvesting system relies on two combined parameters, i.e., the normalized electrical resistive load and normalized embedded depth. It suggests that the output power of the system may be maximized by properly selecting the geometrical, material, and circuit parameters in a combined manner. This strategy might also provide a useful guideline for optimization of piezoelectric energy harvesting system in practical roadway applications.

Research on Fault Extraction Method of Variational Mode Decomposition Based on Immunized Fruit Fly Optimization Algorithm

In recent years, a new method of fault diagnosis, named variational mode decomposition (VMD), has been widely used in industrial production, but the decomposition accuracy of VMD is determined by two parameters, which are respectively the decomposition layer number k and the penalty factor α, if the parameters are not properly selected, there will be over-decomposition or under-decomposition. In order to find an approach to determine the parameters adaptively, a method to optimize VMD by using the immune fruit fly optimization algorithm (IFOA) is proposed in this paper. In this method, permutation entropy is used as the fitness function, firstly, the immune fruit fly optimization algorithm is used to search the combined parameters of k and α in VMD, searching for the best combination parameters of k and α by iteration, and then uses the combined parameters to perform VMD, finally, the center frequency is determined through frequency spectrum analysis. The method mentioned is applied to the fault extraction of a simulated signal and a measured signal of a wind turbine gearbox, and the fault frequency is successfully extracted. Using ensemble empirical mode decomposition (EEMD) and singular spectrum decomposition (SSD) to compare with the proposed method, which validated feasibility of the proposed method.