Optimized Reconstruction Algorithm-Processed CT Image in the Diagnosis of Correlation between Epicardial Fat Volume and Coronary Heart Disease

This study was to analyze the application value of a reconstruction algorithm in CT images of patients with coronary heart disease and analyze the correlation between epicardial fat volume and coronary heart disease. An optimized reconstruction algorithm was constructed based on compressed sensing theory in this study. Then, the optimized algorithm was applied to the image reconstruction of multislice spiral CT image data after testing its sensitivity, accuracy, and specificity. 60 patients with suspected angina pectoris were divided into lesion group (40 cases) and normal group (20 cases) according to whether there were coronary atherosclerotic plaques in cardiac vessels. The results showed that the sensitivity, specificity, and accuracy of the optimized reconstruction algorithm were 91.78%, 84.27%, and 95.32%, and the running time was (12.18 ± 2.49) s. The CT value of the liver and the CT ratio of the liver and spleen in the lesion group were (53.81 ± 5.91) and (3.88 ± 0.67), respectively. There was no significant difference between the two groups ( P > 0.05 ). The body mass index and epicardial fat volume in the lesion group were (31.93 ± 4.54) kg/m2 and (120.09 ± 22.01) cm3, respectively. The body mass index and fat volume in the lesion group were significantly higher than those in the normal group ( P < 0.05 ). The epicardial fat constitution increased with the increase of the number of coronary arteries involved, and there was a positive correlation between them. Among patients with different coronary atherosclerotic plaques, the epicardial fat volume in patients with mixed plaques was the largest ( P < 0.05 ). In summary, optimizing CT images under compressed a sensing reconstruction algorithm could effectively improve the diagnostic accuracy of doctors. Epicardial fat volume was positively correlated with coronary heart disease. Epicardial fat volume could be used as one of the important indexes to predict coronary heart disease.

Clinical Characteristics and Follow-Up of Seizures in Children With Anti-NMDAR Encephalitis

Objective: To analyze the seizure characteristics of children with anti-NMDAR encephalitis.Methods: This was a retrospective analysis of 50 children with anti-NMDAR encephalitis between July 1, 2013, and July 1, 2019.Results: Fifty children with anti-NMDAR encephalitis were included in this study, of which 34 (68.0%) had seizures. During the follow-up, three patients with anti-NMDAR encephalitis secondary to herpes simplex virus encephalitis had persistent seizures. The average duration of seizures in the remaining patients was 14.6 days (range 1–47 days). Compared to patients without seizures, those with seizures were more likely to experience consciousness disturbances (p = 0.008) and epileptic form discharge on electroencephalograms (p = 0.002). The Glasgow coma scale scores (p = 0.014), and Rankin scale scores (p = 0.019) were also different. The cranial MRI findings of children were reviewed, and clinical characteristics were compared between children without cranial lesions and those with lesions in the limbic system and neocortex. Compared to children in the non-lesion group, children with lesions in the limbic system and neocortex had a higher incidence of status epilepticus. Further, children in the limbic system and neocortical lesions groups were more likely to be taking anti-seizure medications (ASMs) and receive second-line drugs.Conclusion: Long-term oral ASMs are not recommended for most children with anti-NMDAR encephalitis. Children with involvement of the limbic system and neocortex are prone to status epilepticus, and sequelae of epilepsy may remain when the neocortex is involved.

Identifying Coronary Artery Lesions by Feature Analysis of Radial Pulse Wave: A Case-Control Study

Background. Cardiovascular diseases have been always the most common cause of morbidity and mortality worldwide. Health monitoring of high-risk and suspected patients is essential. Currently, invasive coronary angiography is still the most direct and accurate method of determining the severity of coronary artery lesions, but it may not be the optimal clinical choice for suspected patients who had clinical symptoms of coronary heart disease (CHD) such as chest pain but no coronary artery lesion. Modern medical research indicates that radial pulse waves contain substantial pathophysiologic information about the cardiovascular and circulation systems; therefore, analysis of these waves could be a noninvasive technique for assessing cardiovascular disease. Objective. The objective of this study was to analyze the radial pulse wave to construct models for assessing the extent of coronary artery lesions based on pulse features and investigate the latent value of noninvasive detection technology based on pulse wave in the evaluation of cardiovascular disease, so as to promote the development of wearable devices and mobile medicine. Method. This study included 529 patients suspected of CHD who had undergone coronary angiography. Patients were sorted into a control group with no lesions, a 1 or 2 lesion group, and a multiple (3 or more) lesion group as determined by coronary angiography. The linear time-domain features and the nonlinear multiscale entropy features of their radial pulse wave signals were compared, and these features were used to construct models for identifying the range of coronary artery lesions using the k -nearest neighbor (KNN), decision tree (DT), and random forest (RF) machine learning algorithms. The average precision of these algorithms was then compared. Results. (1) Compared with the control group, the group with 1 or 2 lesions had increases in their radial pulse wave time-domain features H2/H1, H3/H1, and W2 ( P < 0.05 ), whereas the group with multiple lesions had decreases in MSE1, MSE2, MSE3, MSE4, and MSE5 ( P < 0.05 ). (2) Compared with the 1 or 2 lesion group, the multiple lesion group had increases in T1/T ( P < 0.05 ) and decreases in T and W1 ( P < 0.05 ). (3) The RF model for identifying numbers of coronary artery lesions had a higher average precision than the models built with KNN or DT. Furthermore, average precision of the model was highest (80.98%) if both time-domain features and multiscale entropy features of radial pulse signals were used to construct the model. Conclusion. Pulse wave signal can identify the range of coronary artery lesions with acceptable accuracy; this result is promising valuable for assessing the severity of coronary artery lesions. The technique could be used to development of mobile medical treatments or remote home monitoring systems for patients suspected or those at high risk of coronary atherosclerotic heart disease.

Serum Levels of lncRNA CCHE1 and TCF21 in Patients with Coronary Artery Disease and Their Clinical Significances

Objective. To detect serum level changes of CCHE1 and TCF21 in coronary artery disease (CAD) patients and to explore their clinical significances. Patients and Methods. A total of 150 CAD patients were divided into the mild lesion group ( n = 52 ), moderate lesion group ( n = 48 ), and severe lesion group ( n = 50 ), respectively, according to the Gensini score. In addition, they were divided into single vessel lesion ( n = 42 ), two vessel lesions ( n = 49 ), and three vessel lesions group ( n = 59 ), respectively. Serum levels of CCHE1 and TCF21 in CAD patients were detected by quantitative real-time polymerase chain reaction (qRT-PCR). Spearman’s rank correlation was conducted to assess the relationship between levels of CCHE1 and TCF21 and severity and numbers of vessel lesions in CAD. Pearson’s correlation test was used for analyzing the correlation between CCHE1 and TCF21 levels. A multivariable logistic regression test was performed to evaluate the influences of CCHE1 and TCF21 levels on CAD severity and the occurrence of cardiovascular events within 3 years of follow-up. Results. Significant differences in incidences of diabetes and hypertension were identified in CAD patients divided according to CAD severity. In addition, significant differences in incidences of drinking, diabetes, and hypertension were identified in CAD patients divided according to numbers of vessel lesions. The serum level of CCHE1 was positively related to CAD severity and numbers of vessel lesions, while TCF21 displayed a negative relationship. During the 3-year follow-up, the incidence of cardiovascular events was 39.3% (59/150). CAD severity, numbers of vessel lesions, and serum levels of CCHE1 and TCF21 were independent factors influencing the occurrence of cardiovascular events in CAD patients. Conclusions. The increased serum level of CCHE1 and decreased TCF21 level are closely related to CAD severity, which are able to influence the prognosis in CAD patients.

Tumor-Specificity Growth Factor Combined with Tumor Markers in Nuclear Medicine Imaging to Identify Prostate Cancer Osteonosus

Objective. This study has explored the application value of malignant tumor SPE growth factor (TSGF) combined with tumor markers (TM) (TSGF + TM) in nuclear medicine imaging to identify prostate cancer osteonosus (PCO). Methods. A retrospective analysis for 70 patients with prostate cancer and bone disease admitted to our hospital was performed, 30 healthy persons in the same period were selected as the control group, and the advantages and disadvantages of various examinations were analyzed. All patients were diagnosed with PET whole body bone imaging. Suspicious lesions could be examined by MRI or CT. According to the results of imaging examination, patients were divided into 40 cases of malignant prostate cancer and 30 cases of benign prostate cancer. All the patients underwent 18F-FDG-PET imaging, alpha-fetoprotein (AFP), and TSGF + TM determination. The case diagnosis results were compared and analyzed, and the sensitivity (SEN), specificity (SPE), and accuracy (ACC) of various detection methods were calculated. The SEN, SPE, and ACC of positron emission tomography (PET) were 90.9%, 57.8%, and 81.2%, respectively; those of TM were 79.2%, 94.6%, and 69.8%, respectively; and those of TSGF + TM were 95.9%, 100%, and 97.3%, respectively. The accuracy of combined diagnosis of tumors can reach 100%. The AFP and TSGF levels of serum TM were compared and analyzed, and it was found that the benign lesion group and the malignant lesion group showed significant increases compared with the control group, and the difference between the malignant lesion group and the control group was obvious ( P < 0.05). SGF combined with TM could obtain a more definite diagnosis in PCO. Conclusion. TSGF + TM combined with 18F-FDG-PET imaging showed important clinical value to diagnose the PCO. The imaging accuracy of TSGF + TM combined with 18F-FDG-PET is 97.3%, and the specificity of tumor diagnosis is 100%. Therefore, the TSGF + TM applied in medical imaging and identification of PCO was worthy of clinical promotion.

Transthoracic lung biopsy for pulmonary nodules ≤20mm in the routine clinical care

BACKGROUNDComputed tomography (CT) screening has improved lung cancer survival, yet increasingly detected small lung lesions. The number of transthoracic lung biopsies (TTLB) for small nodules is thus expected to rise significantly.RESEARCH QUESTIONTo evaluate the diagnostic accuracy and safety of CT-guided TTLB for nodules ≤20 mm versus nodules >20mm.STUDY DESIGN AND METHODSData for CT-guided TTLBs from 474 consecutive patients were prospectively collected over a 3-year period (198 lesions ≤20 mm and 276 lesions >20 mm) in a teaching hospital and analysed in terms of diagnostic performance and complications.RESULTSThere were more conclusive biopsies in the >20 mm lesion group (n=236; 85.5%) than in ≤20 mm lesion group (n=140; 70.7%; p<0.001). The overall accuracy, sensitivity, specificity, and negative predictive value for diagnosing malignant lesions after first TTLB were 88.4%, 84%, 100%, and 70.1% for ≤20 mm lesions and 94.2%, 93%, 100%, and 74.6% for >20 mm lesions, respectively. Pneumothorax requiring drainage was significantly more common for ≤20 mm lesions, compared to TTLB of larger lesions (9.6% versus 4.3%; p=0.02). Prolonged hospital stay due to pneumothorax occurred in 27 (17.4%) TTLBs of ≤20 mm lesions and 15 (7%) TTLBs of >20mm lesions (p=0.002). There were no deaths. The only variable significantly associated with diagnostic failure in the ≤20mm lesion group was the radiologist's experience.INTERPRETATIONTTLBs for lesions ≤20 mm were associated with slightly lower diagnostic performance, whereas the higher rate of major complications was still inferior to that extrapolated from United States insurance databases.

The Expression of YKL-40 in Peripheral Blood of Colorectal Cancer and Its Effect on the Proliferation and Angiogenesis of Colorectal Cancer Cells

Objective To observe the expression of YKL-40 in the serum of patients with colorectal cancer, and to study the effect of YKL-40 gene on the proliferation and angiogenesis of colon cancer cell lines. Methods The serum of patients with colorectal cancer, precancerous lesions, and healthy controls were collected, and the expression of YKL-40 was detected by enzyme-linked immunosorbent assay (ELISA) technology. Screened cell lines with high expression of YKL-40 from colon cancer cell lines HCT-15, HCT-116, SW480, interfered with YKL-40 gene expression through siRNA technology, and co-cultured with bevacizumab, and detected cells with CCK8 method Proliferation, cell formation test to detect blood vessel formation. Results The mean values of serum YKL-40 in the colorectal cancer group, precancerous lesion group and control group were (178.50±71.91) μg/L, (91.37±35.79) μg/L and (78.23±26.52) μg/L, respectively. The colorectal cancer group (preoperative) was significantly higher than the precancerous lesion group and the control group (P <0.01). The precancerous lesion group was higher than the control group, but the difference between the two was not statistically significant (P = 0.244). The expression of YKL-40 was positively correlated with the stage of colorectal cancer (P <0.05). There was no significant difference in the expression of serum YKL-40 before and after surgery (p=0.07). HCT-116 is a YKL-40 highly expressing cell line. After inhibiting the expression of this gene, the survival rate of the experimental group was 78.75%, which was significantly lower than that of the control group (p<0.05). The angiogenesis test is used to detect the angiogenesis ability. siRNA interference with YKL-40 gene and the addition of bevacizumab can inhibit the angiogenesis ability in vitro. Moreover,the vascular inhibitory effect of bevacizumab in the experimental group was stronger than that in the control group. Conclusion YKL-40 is highly expressed in the peripheral blood of patients with colorectal cancer and is related to the tumor stage. The HCT-116 colon cancer cell line has a high expression of YKL-40. Interfering with the expression of YKL-40 can inhibit cell proliferation and angiogenesis. It suggests that YKL-40 plays an important role in the occurrence and development of colorectal cancer.

Effect of lesion characteristics on diagnostic performance of CT-derived fractional flow reserve: exploring the indications for application based on CT-FFR CHINA trial (Preprint)

BACKGROUND High diagnostic performance of coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFR; CT-FFR) in identifying flow-limiting stenosis has been confirmed. CT-FFR is recommended to assess the hemodynamic significance of coronary lesions. However, the optimal indications of CT-FFR relies on its ability to discriminating ischemia in situations of different types of lesions. And the effect of lesion-dependent factors on determining the diagnostic accuracy of CT-FFR have not been comprehensively evaluated yet. OBJECTIVE We aimed to investigate the effect of lesion-related factors on the diagnostic performance of CT-FFR with computational fluid dynamics algorithm, to promote the clinical application of it. METHODS This multicenter prospective clinical trial enrolled 317 patients with 30%–90% stenosis undergoing CCTA and invasive FFR from 5 centers across China. All target lesions were assigned into different lesion characteristics (target vessels, lesion location, lesion length, bifurcation lesions, and coronary calcification) subgroups. Diagnostic performance (accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under receiver operating characteristics curve (AUC)) of CT-FFR identifying ischemia were calculated and compared in all sub-groups. RESULTS Three hundred and sixty-six target vessels from 317 patients (mean age: 59.3 ± 9.6 years) were analyzed. The overall vessel-based diagnostic accuracy, sensitivity, specificity, PPV, NPV, and AUC of CT-FFR were 87.2%, 86.4%, 88.8%, 86.9%, 88.4%, and 0.90. Absence of bifurcation lesion group possessed the higher NPV of CT-FFR than presence of bifurcation lesion group (92.8% vs. 78.9%, p = 0.006). Whereas there was no statistically significant difference in diagnostic performance of CT-FFR among different target vessels, lesion location, lesion length, and coronary calcification sub-groups (all p > 0.05). CONCLUSIONS This study supported CT-FFR as a powerful noninvasive functional assessment tool for coronary lesions with different lesion characteristics, involving target vessel, lesion location, lesion length, and coronary calcification. While the diagnostic performance of CT-FFR was negatively affected by the presence of bifurcation lesions. CLINICALTRIAL https://clinicaltrials.gov; Unique identifier: NCT03692936.

The Role of Serotonin in MDMA Self-administration in Rats

<p>Rationale: The profile of acquisition for MDMA self-administration differs from that of amphetamine and cocaine self-administration in that fewer rats meet an acquisition criterion and the latency to acquisition is longer. These characteristics of MDMA self-administration may be because it preferentially stimulates serotonin (5HT) release whereas self-administration has generally been attributed to enhanced dopamine (DA) neurotransmission. Because 5HTergic agonists are not self-administered and increased synaptic 5HT decreased self-administration of other drugs, MDMA self-administration may be initially inhibited by the pronounced 5HT response. Accordingly, the acquisition of MDMA self-administration might proceed as a result of deficits in 5HT neurotransmission and a corresponding disinhibition of DA neurotransmission. Objective: The primary objective was to determine the role of 5HT in the acquisition and maintenance of MDMA self-administration. Methods: MDMA-induced increases of extracellular 5HT and DA and their primary metabolites were measured in the DA terminal regions of the nucleus accumbens (NAc) using in vivo microdialysis, prior to the commencement of MDMA self-administration. The relationship between MDMA-induced increases of neurotransmitter levels and the acquisition of MDMA self-administration was assessed. A subsequent study depleted brain 5HT by administering the neurotoxin, 5,7 – DHT, or vehicle into the lateral ventricle of the left hemisphere, prior to the commencement of MDMA self-administration. The proportion of subjects that acquired MDMA self-administration and the latency to acquire MDMA self-administration was compared for the two groups. In order to determine effects of MDMA self-administration on 5HT and DA responses, behaviours that reflect 5HT and/or DA neurotransmission were measured 5 or 14 days after self-administration of 165 mg/kg MDMA, or 14 days after vehicle self-administration. These time periods were chosen because they reflect a period of 5HT deficits (5 days) and recovery (14 days). Finally, the effect of abstinence on MDMA self-administration was measured. Results: The MDMA-induced increase of extracellular 5HT was significantly lower for the group that subsequently acquired MDMA self-administration but the MDMA-induced increase in DA was not different from the group that failed to acquire self-administration. 5, 7-DHT administration significantly decreased tissue levels of 5HT, but not DA. MDMA self-administration was facilitated by the lesion; 100% of the lesion group acquired MDMA self-administration, whereas only 50% of the control group acquired self-administration. Five days following the last MDMA self-administration session, DAergic behaviours were enhanced and 5HTergic behaviours were reduced relative to the control group. These differences in 5HTergic mediated behaviours were not apparent 14 days after self-administration but the DAergic behaviours remained elevated. The pattern of self-administration did not differ as a function of the length of the abstinence period. Conclusions: The variability in acquisition of MDMA self-administration was related to the magnitude of the 5HT response evoked by initial exposure to MDMA. These findings suggested that predisposing differences in the 5HT response might explain differences in the variability in acquisition of MDMA self-administration. The negative impact of 5HT on the acquisition of MDMA self-administration was clearly demonstrated following a 5, 7-DHT lesion. Thus, 5HT limits the development of MDMA self-administration. With repeated exposure to self-administered MDMA, behavioural responses indicative of 5HT activation were reduced whereas behavioural indices of DA activation were increased. The maintenance of MDMA self-administration was comparable regardless of whether there was a forced abstinence period or not. These data are consistent with the hypotheses that 5HT is inhibitory to the acquisition, but not the maintenance, of MDMA self-administration. Rather, the maintenance of self-administration might reflect sensitised DA responses that became apparent following repeated exposure.</p>

The Role of Serotonin in MDMA Self-administration in Rats

<p>Rationale: The profile of acquisition for MDMA self-administration differs from that of amphetamine and cocaine self-administration in that fewer rats meet an acquisition criterion and the latency to acquisition is longer. These characteristics of MDMA self-administration may be because it preferentially stimulates serotonin (5HT) release whereas self-administration has generally been attributed to enhanced dopamine (DA) neurotransmission. Because 5HTergic agonists are not self-administered and increased synaptic 5HT decreased self-administration of other drugs, MDMA self-administration may be initially inhibited by the pronounced 5HT response. Accordingly, the acquisition of MDMA self-administration might proceed as a result of deficits in 5HT neurotransmission and a corresponding disinhibition of DA neurotransmission. Objective: The primary objective was to determine the role of 5HT in the acquisition and maintenance of MDMA self-administration. Methods: MDMA-induced increases of extracellular 5HT and DA and their primary metabolites were measured in the DA terminal regions of the nucleus accumbens (NAc) using in vivo microdialysis, prior to the commencement of MDMA self-administration. The relationship between MDMA-induced increases of neurotransmitter levels and the acquisition of MDMA self-administration was assessed. A subsequent study depleted brain 5HT by administering the neurotoxin, 5,7 – DHT, or vehicle into the lateral ventricle of the left hemisphere, prior to the commencement of MDMA self-administration. The proportion of subjects that acquired MDMA self-administration and the latency to acquire MDMA self-administration was compared for the two groups. In order to determine effects of MDMA self-administration on 5HT and DA responses, behaviours that reflect 5HT and/or DA neurotransmission were measured 5 or 14 days after self-administration of 165 mg/kg MDMA, or 14 days after vehicle self-administration. These time periods were chosen because they reflect a period of 5HT deficits (5 days) and recovery (14 days). Finally, the effect of abstinence on MDMA self-administration was measured. Results: The MDMA-induced increase of extracellular 5HT was significantly lower for the group that subsequently acquired MDMA self-administration but the MDMA-induced increase in DA was not different from the group that failed to acquire self-administration. 5, 7-DHT administration significantly decreased tissue levels of 5HT, but not DA. MDMA self-administration was facilitated by the lesion; 100% of the lesion group acquired MDMA self-administration, whereas only 50% of the control group acquired self-administration. Five days following the last MDMA self-administration session, DAergic behaviours were enhanced and 5HTergic behaviours were reduced relative to the control group. These differences in 5HTergic mediated behaviours were not apparent 14 days after self-administration but the DAergic behaviours remained elevated. The pattern of self-administration did not differ as a function of the length of the abstinence period. Conclusions: The variability in acquisition of MDMA self-administration was related to the magnitude of the 5HT response evoked by initial exposure to MDMA. These findings suggested that predisposing differences in the 5HT response might explain differences in the variability in acquisition of MDMA self-administration. The negative impact of 5HT on the acquisition of MDMA self-administration was clearly demonstrated following a 5, 7-DHT lesion. Thus, 5HT limits the development of MDMA self-administration. With repeated exposure to self-administered MDMA, behavioural responses indicative of 5HT activation were reduced whereas behavioural indices of DA activation were increased. The maintenance of MDMA self-administration was comparable regardless of whether there was a forced abstinence period or not. These data are consistent with the hypotheses that 5HT is inhibitory to the acquisition, but not the maintenance, of MDMA self-administration. Rather, the maintenance of self-administration might reflect sensitised DA responses that became apparent following repeated exposure.</p>