A Perspective on Tongue Diagnosis in Patients with Breast Cancer

Introduction. Breast cancer (BC) is the most common cancer in women and patients with BC often undergo complex treatment. In Taiwan, nearly 80% of patients with BC seek traditional Chinese medicine (TCM) during adjuvant chemotherapy to relieve discomfort and side effects. This study investigated tongue features and pattern differentiation through noninvasive TCM tongue diagnosis in patients with BC. Materials and Methods. This cross-sectional, case-controlled, retrospective observational study collected patient data through a chart review. The tongue features were extracted using the automatic tongue diagnosis system (ATDS). Nine tongue features, including tongue shape, tongue color, fur thickness, fur color, saliva, tongue fissures, ecchymoses, teeth marks, and red dots, were analyzed. Results and Discussion. Objective image analysis techniques were used to identify significant differences in the many tongue features between BC patients and non-BC individuals. A significantly larger proportion of patients with BC had a small tongue ( p < 0.001 ), pale tongue ( p < 0.001 ), thick fur ( p < 0.001 ), yellow fur ( p < 0.001 ), wet saliva ( p < 0.001 ), thick tongue fur ( p < 0.001 ), fissures ( p = 0.040 ), and ecchymoses in the heart-lung area ( p = 0.013 ). According to logistic regression, small tongue shape, pale tongue color, yellow fur color, wet saliva, and the amounts of fissures were associated with a significantly increased odds ratio for BC. Conclusions. This study showed significant differences in tongue features, such as small tongue shape, pale tongue color, thick fur, yellow fur color, wet saliva, fissure, and ecchymoses in the heart-lung area in patients with BC. These tongue features would imply yin deficiency, deficiencies of blood, stagnation of heat, and phlegm/blood stasis in TCM theory. There is a need to investigate effective and safe treatment to enhance the role of TCM in integrated medical care for patients with BC.

Prenatal prognostic factors for isolated right congenital diaphragmatic hernia: a single center’s experience

Background Right-sided congenital diaphragmatic hernia (RCDH) is relatively rare compared with left-sided congenital diaphragmatic hernia (LCDH). Clinical data of RCDH, especially with respect to antenatal prediction of neonatal outcome, are lacking. The aim of this study was to report the treatment outcomes of patients with antenatally diagnosed RCDH and to evaluate the predictability of observed-to-expected lung area-to-head circumference ratio (O/E LHR) for perinatal outcomes, focused on mortality or extracorporeal membrane oxygenation (ECMO) requirement. Methods We retrospectively reviewed the medical records of newborn infants with isolated RCDH. We analyzed and compared the clinical and prenatal characteristics including the fetal lung volume, which was measured as the O/E LHR, between the survivors and the non-survivors. Results A total of 26 (66.7%) of 39 patients with isolated RCDH survived to discharge. The O/E LHR was significantly greater in survivors (64.7 ± 21.2) than in non-survivors (40.5 ± 23.4) (P =.027). It was greater in survivors without ECMO requirement (68.3 ± 15.1) than non-survivors or those with ECMO requirement (46.3 ± 19.4; P = .010). The best O/E LHR cut-off value for predicting mortality in isolated RCDH was 50. Conclusions The findings in this study suggest that O/E LHR, a well-characterized prognostic indicator in LCDH, could be applied to a fetus with antenatally diagnosed RCDH. A large cohort study is required to verify the association between O/E LHR values and the graded severity of RCDH.

Lung volume head ratio: A potential parameter for prediction of respiratory distress in newborn

Objective: To evaluate the role of fetal lung biometry profile including fetal lung volume head ratio (LVHR) in predicting the occurrence of respiratory distress (RD) in early preterm newborn. Material and Method: Prospective analytical cohort study was done to evaluate the clinical value of fetal sonographic measures such as the total lung area (TLA), total lung volume (TLV), total lung area head ratio (TLHR), lung volume head ratio (LVHR) was measured in pregnant women between 30 to 34 week gestation , expected to deliver within the next 72 hours. The cases with RD were compared with controls who had normal outcome. Result: Total 30(27.4%) out of 110 subjects undergoing early preterm delivery had RD rest 80(72.6%) were controls. The total lung area was 694.1±373.1 mm2 in cases whereas 1149.0 ± 506 .7 mm2 in controls, with significant difference between the two groups(p<0.001). Similarly the lung volume (p<0.001) and the lung volume head ratio was significantly less (P<0.001) in cases compared to controls. The total lung volume was a better parameter (sensitivity-73.7%; specificity-86.4%) compared to total lung area (Sensitivity - 68.4%, Specificity - 81.5%). Among the lung head ratios, LVHR had best sensitivity - 95.5%, Specificity - 80.3%, PPV-58.3%, NPV - 97.0% at the cut off of 46.5. Conclusion: Respiratory distress was observed in nearly one-third of the preterm infants born between 30 and 34 weeks and could be predicted accurately in over nine out of ten cases using the novel parameter TLVR.

CT-Based Risk Stratification for Intensive Care Need and Survival in COVID-19 Patients—A Simple Solution

We evaluated a simple semi-quantitative (SSQ) method for determining pulmonary involvement in computed tomography (CT) scans of COVID-19 patients. The extent of lung involvement in the first available CT was assessed with the SSQ method and subjectively. We identified risk factors for the need of invasive ventilation, intensive care unit (ICU) admission and for time to death after infection. Additionally, the diagnostic performance of both methods was evaluated. With the SSQ method, a 10% increase in the affected lung area was found to significantly increase the risk for need of ICU treatment with an odds ratio (OR) of 1.68 and for invasive ventilation with an OR of 1.35. Male sex, age, and pre-existing chronic lung disease were also associated with higher risks. A larger affected lung area was associated with a higher instantaneous risk of dying (hazard ratio (HR) of 1.11) independently of other risk factors. SSQ measurement was slightly superior to the subjective approach with an AUC of 73.5% for need of ICU treatment and 72.7% for invasive ventilation. SSQ assessment of the affected lung in the first available CT scans of COVID-19 patients may support early identification of those with higher risks for need of ICU treatment, invasive ventilation, or death.

Lung Cancer Diagnosis Based on an ANN Optimized by Improved TEO Algorithm

A quarter of all cancer deaths are due to lung cancer. Studies show that early diagnosis and treatment of this disease are the most effective way to increase patient life expectancy. In this paper, automatic and optimized computer-aided detection is proposed for lung cancer. The method first applies a preprocessing step for normalizing and denoising the input images. Afterward, Kapur entropy maximization is performed along with mathematical morphology to lung area segmentation. Afterward, 19 GLCM features are extracted from the segmented images for the final evaluations. The higher priority images are then selected for decreasing the system complexity. The feature selection is based on a new optimization design, called Improved Thermal Exchange Optimization (ITEO), which is designed to improve the accuracy and convergence abilities. The images are finally classified into healthy or cancerous cases based on an optimized artificial neural network by ITEO. Simulation is compared with some well-known approaches and the results showed the superiority of the suggested method. The results showed that the proposed method with 92.27% accuracy provides the highest value among the compared methods.

NeoAPACHE II. Relationship Between Radiographic Pulmonary Area and Pulmonary Hypertension, Mortality, and Hernia Recurrence in Newborns With CDH

Congenital diaphragmatic hernia is a rare disease with high mortality and morbidity due to pulmonary hypoplasia and pulmonary hypertension. The aim of the study is to investigate the relationship between radiographic lung area and systolic pulmonary artery pressure (sPAP) on the first day of life, mortality, and hernia recurrence during the first year of life in infants with a congenital diaphragmatic hernia (CDH). A retrospective data collection was performed on 77 CDH newborns. Echocardiographic sPAP value, deaths, and recurrence cases were recorded. Lung area was calculated by tracing the lung's perimeter, excluding mediastinal structures, and herniated organs, on the preoperative chest X-ray performed within 24 h after birth. Logistic and linear regression analyses were performed. Deceased infants showed lower areas and higher sPAP values. One square centimeter of rising in the total, ipsilateral, and contralateral area was associated with a 22, 43, and 24% reduction in mortality risk. sPAP values showed a decreasing trend after birth, with a maximum of 1.84 mmHg reduction per unitary increment in the ipsilateral area at birth. Recurrence patients showed lower areas, with recurrence risk decreasing by 14 and 29% per unit increment of the total and ipsilateral area. In CDH patients, low lung area at birth reflects impaired lung development and defect size, being associated with increased sPAP values, mortality, and recurrence risk.Clinical Trial Registration: The manuscript is an exploratory secondary analysis of the trial registered at ClinicalTrials.gov with identifier NCT04396028.

Tectonic Structure and Relationship with Sinkhole Harzard in Bang Lung Area, Cho Don District, Bac Kan Province

By integration of remote sensing images analysis, geology, geomorphology, hydrogeology, geophysical method, and drilling data, the paper illustrates the structure tectonics, causes, and initial mechanism of a sinkhole forming in Bang Lung, Cho Don, Bac Kan province. The NE-SW normal slip faults are an essential fault system in the area, which created Bang Lung graben valley. This fault system also forms large fracture zones, creating advantage conditions for the groundwater runoff both vertically and horizontally to eroded and dissolved carbonate rock-forming underground karst caves. These are favorable natural conditions for forming a sinkhole. The sinkhole hazard in the Bang Lung area is initiated by some main factors such as tectonic activity, thickness, and characteristics of unconsolidated sediment layers, groundwater fluctuation, karst caves, and human activities. The most human impacts are mining exploitation and agricultural cultivation that promote sinkholes occurring faster and earlier. The horizontal and vertical movement of groundwater dragged the material on the ceiling karst caves into ground spaces. Thereby, weakening the cohesion of the unconsolidated sediment above caves leads to gravitational unbalance and creates a sinkhole. This study has also shown potential sinkhole areas in Bang Lung, which helps the authorities and local people in sinkhole prevention and mitigation mission.

Automatic Detection and Extraction of Lungs Cancer Nodules Using Connected Components Labeling and Distance Measure Based Classification

We introduce in this paper a method for reliable automatic extraction of lung area from CT chest images with a wide variety of lungs image shapes by using Connected Components Labeling (CCL) technique with some morphological operations. The paper introduces also a method using the CCL technique with distance measure based classification for the efficient detection of lungs nodules from extracted lung area. We further tested our complete detection and extraction approach using a performance consistency check by applying it to lungs CT images of healthy persons (contain no nodules). The experimental results have shown that the performance of the method in all stages is high.

Angiotensin-converting enzyme 2 (ACE2) expression increases with age in patients requiring mechanical ventilation

Mortality due to Covid-19 is highly associated with advanced age, owing in large part to severe lower respiratory tract infection. SARS-CoV-2 utilizes the host ACE2 receptor for infection. Whether ACE2 abundance in the lung contributes to age-associated vulnerability is currently unknown. We set out to characterize the RNA and protein expression profiles of ACE2 in aging human lung in the context of phenotypic parameters likely to affect lung physiology. Examining publicly available RNA sequencing data, we discovered that mechanical ventilation is a critical variable affecting lung ACE2 levels. Therefore, we investigated ACE2 protein abundance in patients either requiring mechanical ventilation or spontaneously breathing. ACE2 distribution and expression were determined in archival lung samples by immunohistochemistry (IHC). Tissues were selected from the specimen inventory at a large teaching hospital collected between 2010–2020. Twelve samples were chosen from patients receiving mechanical ventilation for acute hypoxic respiratory failure (AHRF). Twenty samples were selected from patients not requiring ventilation. We compared samples across age, ranging from 40–83 years old in the ventilated cohort and 14–80 years old in the non-ventilated cohort. Within the alveolated parenchyma, ACE2 expression is predominantly observed in type II pneumocytes (or alveolar type II / AT2 cells) and alveolar macrophages. All 12 samples from our ventilated cohort showed histologic features of diffuse alveolar damage including reactive, proliferating AT2 cells. In these cases, ACE2 was strongly upregulated with age when normalized to lung area (p = 0.004) or cellularity (p = 0.003), associated with prominent expression in AT2 cells. In non-ventilated individuals, AT2 cell reactive changes were not observed and ACE2 expression did not change with age when normalized to lung area (p = 0.231) or cellularity (p = 0.349). In summary, ACE2 expression increases with age in the setting of alveolar damage observed in patients on mechanical ventilation, providing a potential mechanism for higher Covid-19 mortality in the elderly.