Machine learning based on automated breast volume scanner radiomics for differential diagnosis of benign and malignant BI-RADS 4 lesions / 中华超声影像学杂志

Objective:To evaluate the performance of machine learning (ML) based on automated breast volume scanner (ABVS) radiomics in distinguishing benign and malignant BI-RADS 4 lesions.Methods:Between May to December 2020, patients with BI-RADS 4 lesions from the Affiliated Hospital of Southwest Medical University (Center 1) and Guangdong Provincial Hospital of Traditional Chinese Medicine (Center 2) were prospectively collected and divided into training cohort (Center 1) and external validation cohort (Center 2). The radiomics features of BI-RADS 4 lesions were extracted from the axial, sagittal and coronal ABVS images by MaZda software. In the training cohort, 7 feature selection methods and thirteen ML algorithms were combined in pairs to construct different ML models, and the 6 models with the best performance were verified in the external validation cohort to determine the final ML model. Finally, the diagnostic performance and confidence (5-point scale) of radiologists (R1, R2 and R3, with 3, 6 and 10 years of experience, respectively) with or without the model were evaluated.Results:①A total of 251 BI-RADS 4 lesions were enrolled, including 178 lesions (91 benign, 87 malignant) in the training cohort and 73 lesions (44 benign, 29 malignant) in the external validation cases. ②In the training cohort, the 6 ML models (DNN-RFE, AdaBoost-RFE, LR-RFE, LDA-RFE, Bagging-RFE and SVM-RFE) had the best diagnostic performance, and their AUCs were 0.972, 0.969, 0.968, 0.968, 0.967 and 0.962, respectively. ③In the external validation cohort, the DNN-RFE still had the best performance with the AUC, accuracy, sensitivity, specificity, PPV and NPV were 0.886, 0.836, 0.934, 0.776, 86.8% and 82.5%, respectively. ④Before model assistance, R1 had the worst diagnostic performance with the accuracy, sensitivity, specificity, PPV and NPV were 0.680, 0.750, 0.640, 57% and 81%, respectively. After model assistance, the diagnostic performance of R1 was significantly improved ( P=0.039), and its diagnostic sensitivity, specificity, accuracy, PPV and NPV improved to 0.730, 0.810, 0.930, 68% and 94%; while the improvement of R2 and R3 were not significantly ( P=0.811, 0.752). Meanwhile, the overall diagnostic confidence of the 3 radiologists increased from 2.8 to 3.3 ( P<0.001). Conclusions:The performance of ML based on ABVS radiomics in distinguishing between benign and malignant BI-RADS 4 lesions is good, which may improve the diagnostic performance of inexperienced radiologists and enhance diagnostic confidence.

The effect and influencing factors of percutaneous microwave ablation for the treatment of benign thyroid nodules / 中国医师杂志

Objective:To investigate the effect and influencing factors of microwave ablation (MVA) in the treatment of benign thyroid nodules.Methods:The clinical data of ultrasound-guided microwave ablation for thyroid benign nodules in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from April 2017 to April 2019 were retrospectively analyzed. At 1, 3 and 6 months after operation, conventional ultrasound examination was performed to calculate the volume reduction rate of the nodules. The nodules were divided into groups according to gender, age, nodule blood supply, nodule size, nodule nature and Hashimoto′s thyroiditis background, and the related factors influencing microwave ablation were analyzed.Results:68 patients (106 nodules) with benign thyroid nodules were treated with microwave ablation. The volume of benign thyroid nodules after the MWA treatment was significantly reduced after 1, 3, 6 months, and their nodule volume reduction ratio (VRR) were (39.7±6.1)% (1 months), (56.2±5.9)% (3 months), (70.3±5.4)% (6 months), respectively. There were significant differences in the volume reduction ratio of nodules at 1, 3 and 6 months after operation among different nodule size, nodule nature and Hashimoto′s thyroiditis background, with statistically significant difference ( P<0.05). However, there was no significant difference in the reduction ratio of nodules in different gender, age and nodule blood supply at 1, 3 and 6 months after operation ( P>0.05). Pearson correlation analysis showed that VRR was negatively correlated with ablation time per unit volume, with statistically significant difference ( P<0.05). Logistic regression analysis indicated that only nodule nature and ablation time per unit volume entered the regression equation. Conclusions:The size and nature of the nodules, Hashimoto′s thyroiditis background and ablation time per unit volume will affect the postoperative volume reduction rate.

The Extra-Oral Measuring Technique of Initial Restoring Force Produced by Orthodontic Archwire Based on Dental Model / 医用生物力学

Objective To realize the extra-oral measurement of initial recovery force produced by orthodontic wire using simulated dental model. Methods A clinical patient was selected as the study objective, and maxillary dental models, which were in accordance with the real dentition of patient, were fabricated by three-dimensional printing. An orthodontic force measuring system was constructed using Nano17 F/T mechanical sensors to measure the initial recovery forces on two maxillary central incisors, which were produced by a standard circle Ni-Ti wire with the diameter of 355.6 μm after the archwire was assembled on the dental model. Results Central incisor 21 suffered a lager initial orthodontic force compared with incisor 11, and the force systems on two incisors were both adverse to tooth ideal movement, therefore, an assistive device was necessary to improve force status of the teeth. When the orthodontic treatment plan was optimized, a satisfactory result was obtained after 18 months of treatment. Conclusions Force systems caused by orthodontic wire and exerted on the teeth could be accurately measured using the simulated dental model of patient, so as to predict the teeth moving type, and improve teeth treatment plan on this basis. The extra-oral measuring technique of orthodontic force provides an important reference for clinical orthodontic treatment, and creates a novel idea for the optimal design of orthodontic plan.

Effect of electro-acupuncture at Zusanli acupoint on postoperative T cell immune function in rats / 南方医科大学学报

OBJECTIVE@#To study the effect of electro- acupuncture at Zusanli acupoint in regulating perioperative cell immune functions in rats.@*METHODS@#Forty-two SD rats were divided into blank control group (=6), model group (=18), and electroacupuncture group (=18). The rats in the latter two groups underwent thigh incision and femoral dissection under anesthesia; the rats in electro-acupuncture group received electro-acupuncture at bilateral Zusanli acupoint for 15 min before anesthesia and 1 h after the surgery. The rats in the model group and electro-acupuncture group were sacrificed at 6 h, 24 h, and 72 h after the operation and blood samples were taken from the ventricle for analyzing CD3, CD4, and CD8 T cell subpopulations and calculation of CD4/CD8 using flow cytometry. ELISA was used to detect the levels of interleukin-1 (IL-1) and IL-6.@*RESULTS@#The CD3 T cell subpopulation was significantly lower in the model group and electro-acupuncture group than in the blank group at 6 h and 24 h after the operation. At 72 h after the operation, CD3 subpopulation levels still remained low in the model group, but recovered the control level in electro-acupuncture group. At each time point of measurement, CD3 level was significantly lower in the model group than in the electro-acupuncture group. CD4 level in the model group was significantly lowered at 6 h and 24 h after the operation, and recovered the control level at 72 h. In the electro-acupuncture group, CD4 level was significantly lowered at 6 h after the operation, but recovered the control level at 24 h. At 24 h and 72 h, the levels of CD4 were significantly lower in the model group than in the electro-acupuncture group. CD8 level underwent no significant changes after the operation in either the model group or electro-acupuncture group. CD4/CD8 was significantly lowered at 24 h and 72 h after the operation in the model group but showed no significant variation in the electro-acupuncture group. Compared with that in the control group, IL-1 level was significantly lowered in both the model group and electroacupuncture group at 6 h, 24 h, and 72 h after the operation, and was significantly lower in the model group than in the electroacupuncture group at these time points. IL-6 level increased significantly in the model group and the electro- acupuncture group at 6 h and 24 h. at 72 h, IL-6 level was obviously lowered in the electro-acupuncture group but remained elevated in the model group.@*CONCLUSIONS@#Electro-acupuncture alleviates postoperative immune suppression and promotes recovery of the immune function in rats, suggesting a protective effect of electro-acupuncture at Zusanli acupoint on cellular immune function after surgery.

Risk factors of hemorrhagic transformation in 335 patients with acute cerebral infarction / 重庆医学

Objective To investigate the risk factors of hemorrhagic transformation(HT) in patients with acute cerebral infarction(ACI).Methods A total of 335 patients with ACI from June 2013 to September 2016 was enrolled in this study,including 47 patients in hemorrhagic transform group(HT group) and 288 patients in non-hemorrhagic transformation group(NHT group).The general clinical situation,laboratory indexes,imaging features and treatment measures of the two groups were collected and compared,and then the risk factors of HT in the patients with ACI were analyzed by Logistic regression analysis.Results Univariate analysisshowed that there were significant differences between the two groups in the history of diabetes mellitus,hìstory of atrial fibrillation,NHISS score,systolic blood pressure at admission,fasting blood glucose,glycosylated hemoglobin,low density lipoprotein cholesterol,fibrinogen,infarct location,large area infarction and thrombolytic therapy(P＜0.05).Logistic regression analysis showed that history of atrial fibrillation(OR =2.703,95 ％ CI 1.169-6.250),high fasting blood glucose(OR =2.098,95 ％ CI 1.532-2.875),large area infarction(OR=9.999,95％CI 4.648-21.510) and thrombolytic therapy(OR=6.557,95％CI 1.954-22.003) were independent risk factors for HT.Conclusion The history of atrial fibrillation,high fasting blood glucose,large area infarction and thrombolytic therapy are the risk factors for HT in patients with ACI.Corresponding nursing measures should be arranged to facilitate the disease treatment.

Role of ultrasonography and Ki-67 expression in evaluation of neoadjuvant chemotherapy for breast can- cer / 实用医学杂志

Objective To analyze the changes of ultrasonography and Ki-67 before and after neoadjuvant chemotherapy for breast cancer ,and to assess the value of ultrasonography and Ki-67 in the evaluation of neoadju-vant chemotherapy for breast cancer. Methods The focus changes of 122 cases of breast cancer before and after neoadjuvant chemotherapy were observed by Color Doppler ultrasonography. The therapeutic effect was evaluated by RECIST standard,and the changes of Ki-67 before and after chemotherapy were observed. Results There were significant differences in size and internal blood flow signal of breast cancer before and after chemotherapy (P <0.05). The sensitivity of ultrasonography in the evaluation of neoadjuvant chemotherapy for breast cancer was 89.3%and specificity 53.8%. The clinical efficiency of neoadjuvant chemotherapy for breast cancer with high Ki-67 expression was higher than that with low Ki-67 expression. Conclusion Ultrasonography shows high clinical value in the evaluation of neoadjuvant chemotherapy for breast cancer ,and the expression of Ki-67 could predict the effi-cacy of neoadjuvant chemotherapy.

The coronal plane of automatic breast volume scaner for modified BI?RADS classification of clinical study / 实用医学杂志

Objective To investigate the clinical value of modified BI?RADS classification by using the coronal plane of automatic breast volume scaner. Methods The total of 201 BI?RADS 3~5 classification of breast masses were retrospectively analyzed. All masses underwent conventional ultrasound and ABVS examination. Using BI? RADS classification standard terms to describe various information of breast masses, and record the coronal image of the masses on the complete interface echo, convergence sign, angle, burr, which classified BI?RADS ultimately. Results The coronal plane of convergence sign, complete interface echo, angulation and burr were significantly different between benign and malignant tumors (P<0.0001). The sensitivity of ABVS convergent sign in diagnosing breast malignant tumors was 68.2%, specificity was 93.4% and accuracy was 82%. The conventional ultrasound combined with the coronal feature of ABVS modified by BI?RADS classification showed that 3 kinds of malignant rate reduced from 8.5%to 3.2%. The rate of malignant 4a decreased from 25.2%to 12.1%and the rate of malignant 5 increased from 94.2% to 98%. Conclusion The convergence sign of ABVS can be used as a significant independent predictor of breast malignant tumors;ultrasound combined with ABVS is helpful to improve the accuracy of ultrasound BI?RADS classification.

Two-dimensional spot tracking technology(STI) to evaluate the changes of the function of myocardium of left ventricle of Coronary heart disease after PCI / 实用医学杂志

Objective Using STI and WMSI to evaluate the change of the heart sarcomere local systolic function which suffered from coronary heart disease (CHD), to evaluate the improvement of ischemic heart sarcomere local systolic function after PCI. Methods There are 40 CHD patients after PCI called the treatment group and 40 healthy persons called the control group. Echocardiogram was used to evaluate the change of ventricular wall motion score in the treatment group which was before and 1 week after PCI , compared with the control group. STI is used to get the SLs, GSL and SrLe of the left ventricle six walls in basal segment,middle segmentand apical segment systole. Results The ventricular wall motion index of the left ventricular myocardium obviously rose in CHD patients which was after PCI, compared with the control group (P < 0.05). And it obviously reduced in CHD patients after PCI, compared with CHD patients before PCI(P < 0.05). The results of SLs,GSL and SrLe are reduced in myocardial ischemia segment of CHD patients before PCI,compared with the control group (P < 0.05). But they are significantly improved in the the treatment group 1 week after PCI, compared to which is before PCI(P < 0.05). Conclusion STI and WMS can be used to evaluate the abnormal of regional and global function of myocardium which is caused to coronary artery stenosis the effect of PCI. The left ventricular motion function of CHD is decreased, but the left ventricle regional systolic function of hypokinetic segments in patients with CHD after PCI is significantly increased.

A pilot clinical study on quantitative evaluating the degree of diffuse fatty liver by acoustic radiation ;force impulse imaging in patients with T2DM complicated with NAFLD / 实用医学杂志

Objective To investigate the influencing factors of the controlled virtual touch tissue quantification (VTQ) in liver of patients with type 2 diabetes mellitus (T2DM) complicated withnon-alcoholic fatty liver disease (NAFLD). Methods Two hundred and twenty-seven patients with T2DM complicated with NAFLD were enrolled in this study,and the shear wave speed of the liver was measured by VTQ. Levels of the fasting plasma glucose, glycated hemoglobin,total cholesterol three acids glyceride, low density lipoprotein, high density lipoprotein , aspertate aminotransferase , alanine aminotransferase , gamma glutamyl transpeptidase and uric acid were measured. The relationships among VTQ and the severity of NAFLD , and those quantitative indexes were analyzed. Results Univariate analysis showed that the value of shear wave speed was negatively correlated with age,duration of diabetes,INS and HDL-C,while was positively correlated with HbA1c and AST. Conclusion Age, sex and levels of serum HbA1c,INS,AST and HLD-C might affect the values of shear wave speed in patients with T2DM complicated with NAFLD.

Effect of dexmedetomidine on proliferation and differentiation of rat embryonic neural stem cells in vitro / 实用医学杂志

Objective To investigate the effect of dexmedetomidine (DEX) on proliferation and differentiation of rat embryonic neural stem cells in vitro. Methods Embryonic neuraI stem cells of fetal SD rats were separated from rats with gestational age of 14-16 days , and underwent primary culture for nestin expression. Cells were divided into control group, low-dose DEX group, and high-dose DEX group, which were cultured with 0,1 and 10 ng/mL DEX respectively. Cell viability was detected by MTT assay;the proliferation rate was estimated by BrdU incorporation; the phosphorylation of ERK1/2 in the proliferation phases was detected by western blot; the differentiation of neuronal cells,astrocytes,oligodendrocyte and neural stem cells were assessed by immunocytochemistry of cell specific markers. Results More than 95% of the embryonic neural stem cells in primary culture were Nestin-positive. Cell viability , BrdU-positive cells and phosphorylation of ERK1/2 in low-dose DEX group increased significantly (P 0.05). Conclusions The proliferation of neuraI stem cells can be promoted by low-dose DEX and depressed by high-dose DEX , as well as regulated by DEX of the phosphorylation of ERK1/2. DEX induces neural stem cells non-selective differentiation.

Changes of endoplasmic reticulum stress- and apoptosis-related factors in rat cerebral cortex following controlled hypotension / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the changes of endoplasmic reticulum stress (ERS)- and apoptosis-related factors in rat cerebral cortex following controlled hypotension.</p><p><b>METHODS</b>Twenty-four healthy male SD rats were randomly divided into 4 equal groups, including a sham hypotension group (group A) and 3 hypotension groups with the mean arterial pressure maintained for 60 min at 70 mmHg (group B), 50 mmHg (group) and 30 mmHg (group D) with sodium nitroprusside and esmolol. All the rats received an equal volume of fluid infusion. Twelve hours after controlled hypotension, the rats were sacrificed to examine the protein expressions of Bax, Bcl-2, glucose-regulated protein 78 (GRP78), C/EBP homologous protein (CHOP) and caspase-12 in the cortex with Western blotting. GRP78 mRNA expression was measured by RT-PCR, and the cell apoptosis was evaluated by TUNEL staining.</p><p><b>RESULTS</b>Compared with those in group A, GRP78 mRNA and protein expressions of GRP78, CHOP, caspase-12 related with ERS increased significantly in groups C and D (P<0.05), especially in group D (P<0.05), but not in group B (P>0.05). Apoptotic cells and Bax expression increased and Bcl-2 expression decreased significantly in groups C and D (P<0.05), but not in group B (P>0.05); such changes were more prominent in group D than in group C (P<0.05).</p><p><b>CONCLUSION</b>Mild controlled hypotension (70 mmHg) does not induce neuronal injury in rat cerebral cortex, but severe hypertension (lower than 50 mmHg) can cause neuronal ERS and apoptosis.</p>

Changes of platelet mitochondria in rats with tourniquet-induced limb ischemia- reperfusion injury / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the changes of platelet mitochondria in rats with tourniquet-induced limb ischemia-reperfusion (IR) injury.</p><p><b>METHODS</b>Thirty SD rats were randomized equally into 5 groups including a control group and 4 limb IR injury groups for blood sampling at 2, 6, 12, or 24 h following IR injury induced by tourniquet on the thighs for 4 h. Platelet was separated from the blood samples for measurement of ATP content, mitochondrial membrane potentials, plasma cytochrome C level, and hydroperoxides.</p><p><b>RESULTS</b>Compared with the control group, the rats with tourniquet-induced limb IR injury showed significantly decreased ATP content, lowered mitochondrial membrane potential, and increased plasma cytochrome C and hydroperoxide levels in the platelets at 2 and 6 h following the injury (P<0.05 or 0.01). These alterations recovered partially but remained significantly different from the control levels at 12 h (P<0.05 or 0.01) until full recovery at 24 h. Limb IR injury did not cause significant variations of the platelet counts.</p><p><b>CONCLUSION</b>Tourniquet-induced limb IR injury can cause mitochondrial damage in the platelets, which occurs mainly in the early stage (6 h) and recovers gradually afterwards without significant impact on platelet counts.</p>

Value of contrast-enhanced sonography in early diagnosis of breast cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the clinical value of contrast-enhanced ultrasonography (CEUS) in early diagnosis of breast cancer.</p><p><b>METHODS</b>CEUS was performed in 107 cases of ultrasound BI-RADS(®) category 3 or category 4 small breast tumors (diameter no greater than 10 mm) before surgery. The range, type and patter of enhancement of the tumor and the surrounding tissues were observed, and the time-intensity curve (TIC) was analyzed for TIC curve type, basic and peak intensity, enhancement intensity, rising slope, and enhancement intensity. The results were analyzed comparatively between benign and malignant tumors.</p><p><b>RESULTS</b>The peak intensity, enhancement intensity index and peak time in CEUS were statistically significant between benign and malignant breast tumor (t=-2.310, -2.592, -2.127, P=0.021, 0.010, 0.033), and the intensity difference and rising slope also differed significantly (t=-3.422, -3.388, P=0.001, 0.001). TIC curve type, enhancement pattern, enhancement types and enhancement range were statistically significantly between benign and malignant breast tumor (P<0.001).</p><p><b>CONCLUSION</b>Benign and malignant BI-RADS(®) category 3 or 4 small breast tumors differ in the peak intensity, enhancement intensity index and peak time in CEUS. More nodular hyperplasia showed no enhancement in CEUS, and 97.8% of the lesions without enhancement are benign. In enhanced breast nodules, malignant breast lesions show more quick wash-in and wash-out type and quick wash-in and slow wash-out type, and the latter is more common; benign lesions often show a slow wash-in and slow wash-out type. In CEUS, the range of enhancement in malignant nodules is wider than that in two-dimensional ultrasound.</p>

Imaging progress of uterine cervical carcinoma / 肿瘤研究与临床

Along with clinical medicine improvement and imageology development, The early diagnosis and treatment of uterine cervical cancer becomes possible. Especially computer tomography(CT) and magnetic resonance imaging(MRI) as well as positron emission tomography/computed tomography(PET/CT) are widespread applied in clinical medicine. These imaging examinational means supply important bases for diagnosis, staging and therapeutic means to uterine cervical cancer.