An indirect estimation of x-ray spectrum via convolutional neural network and transmission measurement.

Objective.In this work, we aim to propose an accurate and robust spectrum estimation method by synergistically combining x-ray imaging physics with a convolutional neural network (CNN).Approach.The approach relies on transmission measurements, and the estimated spectrum is formulated as a convolutional summation of a few model spectra generated using Monte Carlo simulation. The difference between the actual and estimated projections is utilized as the loss function to train the network. We contrasted this approach with the weighted sums of model spectra approach previously proposed. Comprehensive studies were performed to demonstrate the robustness and accuracy of the proposed approach in various scenarios.Main results.The results show the desirable accuracy of the CNN-based method for spectrum estimation. The ME and NRMSE were -0.021 keV and 3.04% for 80 kVp, and 0.006 keV and 4.44% for 100 kVp, superior to the previous approach. The robustness test and experimental study also demonstrated superior performances. The CNN-based approach yielded remarkably consistent results in phantoms with various material combinations, and the CNN-based approach was robust concerning spectrum generators and calibration phantoms.Significance. We proposed a method for estimating the real spectrum by integrating a deep learning model with real imaging physics. The results demonstrated that this method was accurate and robust in estimating the spectrum, and it is potentially helpful for broad x-ray imaging tasks.

Rupture of a giant jejunal mesenteric cystic lymphangioma misdiagnosed as ovarian torsion: A case report.

BACKGROUND: Cystic lymphangioma is a rare benign tumor that affects the lymphatic system. Mesenteric lymphangiomas in the small bowel are extremely uncommon. CASE SUMMARY: We present a 21-year-old female patient who complained of abdominal pain. The diagnosis of ovarian torsion was suspected after abdominopelvic unenhanced computed tomography and ultrasound revealed a large cyst in contact with the bladder, ovary, and uterus. The patient underwent emergency laparotomy performed by gynecologists, but it was discovered that the cystic tumor originated from the jejunum. Gastrointestinal surgeons were then called in to perform a cystectomy. Pathological examination confirmed the diagnosis of cystic lymphangioma of the mesentery. The patient had an uneventful postoperative recovery. CONCLUSION: Mesenteric lymphangiomas can cause abdominal pain, and imaging techniques can help determine their characteristics, location, and size. Complete surgical excision and pathological examination are considered the standard treatment and diagnostic method.

A qualitative study of improving megavoltage computed tomography image quality and maintaining dose accuracy using cycleGAN-based image synthesis.

BACKGROUND: Due to inconsistent positioning, tumor shrinking, and weight loss during fractionated treatment, the initial plan was no longer appropriate after a few fractional treatments, and the patient will require adaptive helical tomotherapy (HT) to overcome the issue. Patients are scanned with megavoltage computed tomography (MVCT) before each fractional treatment, which is utilized for patient setup and provides information for dose reconstruction. However, the low contrast and high noise of MVCT make it challenging to delineate treatment targets and organs at risk (OAR). PURPOSE: This study developed a deep-learning-based approach to generate high-quality synthetic kilovoltage computed tomography (skVCT) from MVCT and meet clinical dose requirements. METHODS: Data from 41 head and neck cancer patients were collected; 25 (2995 slices) were used for training, and 16 (1898 slices) for testing. A cycle generative adversarial network (cycleGAN) based on attention gate and residual blocks was used to generate MVCT-based skVCT. For the 16 patients, kVCT-based plans were transferred to skVCT images and electron density profile-corrected MVCT images to recalculate the dose. The quantitative indices and clinically relevant dosimetric metrics, including the mean absolute error (MAE), structural similarity index measure (SSIM), peak signal-to-noise ratio (PSNR), gamma passing rates, and dose-volume-histogram (DVH) parameters (Dmax , Dmean , Dmin ), were used to assess the skVCT images. RESULTS: The MAE, PSNR, and SSIM of MVCT were 109.6 ± 12.3 HU, 27.5 ± 1.1 dB, and 91.9% ± 1.7%, respectively, while those of skVCT were 60.6 ± 9.0 HU, 34.0 ± 1.9 dB, and 96.5% ± 1.1%. The image quality and contrast were enhanced, and the noise was reduced. The gamma passing rates improved from 98.31% ± 1.11% to 99.71% ± 0.20% (2 mm/2%) and 99.77% ± 0.18% to 99.98% ± 0.02% (3 mm/3%). No significant differences (p > 0.05) were observed in DVH parameters between kVCT and skVCT. CONCLUSION: With training on a small data set (2995 slices), the model successfully generated skVCT with improved image quality, and the dose calculation accuracy was similar to that of MVCT. MVCT-based skVCT can increase treatment accuracy and offer the possibility of implementing adaptive radiotherapy.

Macrophage migration inhibitory factor levels are associated with disease activity and possible complications in membranous nephropathy.

Membranous nephropathy (MN) is an autoimmune disease characterized by the deposition of immunoglobulin G (IgG) and complementary components in the epithelium of the glomerular capillary wall. Macrophage migration inhibitory factor (MIF) is an inflammatory mediator released by macrophages. MIF plays a key regulatory function in the pathogenesis of immune-mediated glomerulonephritis. This study aimed to investigate whether MIF level could be associated with the activity of MN. Plasma and urine samples from 57 MN patients and 20 healthy controls were collected. The MIF levels in plasma and urine were determined by an enzyme-linked immunosorbent assay (ELISA) kit. The expression of MIF in the renal specimens from 5 MN patients was detected by immunohistochemistry (IHC). The associations of the plasma and urinary levels of MIF and glomerular MIF expression with clinical and pathological characteristics were analyzed. It was revealed that with the increase of MIF levels in plasma and urine, the severity of renal pathological injury in MN patients gradually increased. Correlation analysis showed that the MIF levels in plasma were positively correlated with the platelet (PLT) count (r = 0.302, P = 0.022), and inversely correlated with the prothrombin time (PT) (r = - 0.292, P = 0.028) in MN patients. The MIF levels in plasma were positively correlated with the C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) (r = 0.651, P < 0.0001; r = 0.669, P < 0.0001) in MN patients. The urinary levels of MIF were positively correlated with ESR (r = 0.562, P < 0.0001). IHC suggested that MIF was expressed in glomerular basement membrane and tubulointerstitial areas. MIF levels in plasma and urine could reflect the severity of MN, and MIF levels in plasma and urine could be associated with venous thrombosis and infectious complications in MN patients. The glomerular MIF expression could be used to indicate the activity of MN.

A New Diagnostic Model to Distinguish Kawasaki Disease From Other Febrile Illnesses in Chongqing: A Retrospective Study on 10,367 Patients.

Objective: Kawasaki disease (KD) is one of the most prevailing vasculitis among infants and young children, and has become the leading cause of acquired heart disease in childhood. Delayed diagnosis of KD can lead to serious cardiovascular complications. We sought to create a diagnostic model to help distinguish children with KD from children with other febrile illnesses [febrile controls (FCs)] to allow prompt treatment. Methods: Significant independent predictors were identified by applying multivariate logistic regression analyses. A new diagnostic model was constructed and compared with that from diagnostic tests created by other scholars. Results: Data from 10,367 patients were collected. Twelve independent predictors were determined: a lower percentage of monocytes (%MON), phosphorus, uric acid (UA), percentage of lymphocyte (%LYM), prealbumin, serum chloride, lactic dehydrogenase (LDH), aspartate aminotransferase: alanine transaminase (AST: ALT) ratio, higher level of globulin, gamma-glutamyl transpeptidase (GGT), platelet count (PLT), and younger age. The AUC, sensitivity, and specificity of the new model for cross-validation of the KD diagnosis was 0.906 ± 0.006, 86.0 ± 0.9%, and 80.5 ± 1.5%, respectively. An equation was presented to assess the risk of KD, which was further validated using KD (n = 5,642) and incomplete KD (n = 809) cohorts. Conclusions: Children with KD could be distinguished effectively from children with other febrile illnesses by documenting the age and measuring the level of %MON, phosphorus, UA, globulin, %LYM, prealbumin, GGT, AST:ALT ratio, serum chloride, LDH, and PLT. This new diagnostic model could be employed for the accurate diagnosis of KD.

Macrophage migration inhibitory factor contributes to anti-neutrophil cytoplasmic antibody-induced neutrophils activation.

BACKGROUND: Macrophage migration inhibitory factor (MIF) is an inflammatory mediator released by macrophages that is central to the innate immune system, with an upstream role in the inflammatory cascade. MIF is one of the most important pathogenic factors in the development of the autoimmune diseases. In the current study, we investigated the role of MIF in anti-neutrophil cytoplasmic antibody (ANCA)-induced neutrophil activation. METHODS: Plasma levels of MIF from 31 patients with active ANCA-associated vasculitis (AAV) were analyzed by ELISA. The various effects of MIF in ANCA-induced neutrophil respiratory burst and degranulation were measured. RESULTS: Plasma levels of circulating MIF were significantly higher in AAV patients with active disease compared with those in remission and healthy controls. Compared with MIF-primed neutrophils, the MFI value increased significantly in MIF-primed neutrophils further activated with MPO-ANCA-positive IgG or PR3-ANCA-positive IgG (270.8±9.7 vs. 421.5±9.7, P<0.001; 270.8±9.7 vs. 414.1±15.6, P<0.001, respectively). Compared with MIF-primed neutrophils, the lactoferrin concentration increased significantly in the supernatant of MIF-primed neutrophils further activated by MPO-ANCA-positive IgG (567.8±61.2ng/ml vs. 1677.0±42.5ng/ml, P<0.001) or PR3-ANCA-positive IgG (567.8±61.2ng/ml vs. 1546.0±116.2ng/ml, P<0.001), respectively. Interleukin-8 (IL-8), IL-6 and IL-23 were involved in ANCA-induced activation of MIF-primed neutrophils. CONCLUSIONS: MIF primes neutrophils by increasing ANCA antigen translocation. The primed neutrophils can be further induced by ANCA, resulting in respiratory burst and degranulation.

Genetic polymorphism of CCL2-2518, CXCL10-201, IL8+781 and susceptibility to severity of Enterovirus-71 infection in a Chinese population.

OBJECTIVE: The goal of this study was to examine the relationship between CCL2-2518A/G, CXCL10-201A/G, and IL8+781C/T gene polymorphism and severity of Enterovirus 71 (EV71) infection in a Chinese population. METHODS: A case-control study was conducted to compare the distribution of genotype and genetic frequency of the CCL2-2518A/G, CXCL10-201A/G, and IL8+781C/T gene polymorphisms among EV71-infected patients (n = 186), including mild cases (n = 103), severe cases (n = 83) and healthy control subjects (n = 233) with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and analyzed the relationship between the CCL2-2518A/G, CXCL10-201A/G, and IL8+781C/T gene polymorphism and the susceptibility to EV71 infection. RESULTS: No significant differences were found in the distribution of genotype CCL2-2518A/G, CXCL10-201A/G, and IL8+781C/T between the healthy control group and EV71-infected patients. However, three SNPs were associated with severity of EV71 infection: the G allele (genotypes AG or GG) in the CCL2-2518A/G (OR 2.34, 95 % CI 1.50-3.65, P < 0.001), the A allele (genotypes AA or AG) in the CXCL10-201A/G (OR 3.60, 95 % CI 1.73-7.47, P < 0.001), and the C allele (genotypes CC or CT) in the IL8+781C/T (OR 2.63, 95 % CI 1.67-4.13, P < 0.001) were more frequent in patients with severe EV71 infection. No significant difference was observed between EV71 encephalitis and severe cases. At the same time, there were significant differences in fever days, WBC, CRP and BG concentration, and CCL2, CXCL10 and IL-8 levels according to the three SNPs among 186 EV71-infected patients, but no significant differences were observed in gender, age, ALT, AST, CK-MB, and CSF evaluations. CONCLUSION: The G carrier of the CCL2-2518A/G, the A carrier of the CXCL10-201A/G, and the C carrier of the IL8+781C/T were found to be associated with severity of EV71 infection, and could be susceptibility factors in the development of EV71 infection in the Chinese population.

Impact of endothelial nitric oxide synthase gene polymorphism on severity of enterovirus 71-infection in Chinese children.

OBJECTIVES: Genetic polymorphism G894T on the endothelial nitric oxide synthase (eNOS) gene has been reported as a susceptibility factor in a number of diseases, but evidence of its effect on enterovirus 71 (EV71) infection is lacking. This study investigated the possible association between this polymorphism (rs1799983) and disease severity in Chinese children with EV71 infection. DESIGN AND METHODS: 185 children with EV71 infection (83 with severe and 102 with mild disease) and 234 control healthy children underwent testing with polymerase chain reaction-restriction fragment length polymorphism (PCR-RLFP) to detect G894T polymorphism. In addition, plasma levels of nitric oxide (NO), interleukin 1 beta (IL-1ß), interleukin 6 (IL-6), and tumor necrosis factor-alpha (TNF-α) and serum eNOS activity were measured according to genotype. RESULTS: The presence of GT+TT genotypes and T allele were associated with severe cases compared to genotype GG (OR 2.5, 95% CI 1.2-5.3, P=0.017) and G (OR 2.4, 95% CI 1.2-4.8, P=0.011). Furthermore, in EV71 encephalitis, GT+TT genotype and T allele were also more frequent than GG and G (P<0.05). The NO level and eNOS activity in T carriers (GT+TT) (84.3±2.5µmol/L and 14.4±1.8U/mL) were significantly less compared to in G carriers (GG) (92.0±1.5µmol/L and 19.1±1.7U/mL, P<0.001). But T carriers had higher plasma levels of IL-1ß, IL-6, and TNF-α than people without a T allele (P<0.001), and a significant negative correlation was observed between NO and cytokine levels. CONCLUSION: The results indicate that carrying the T allele of the eNOS G894T gene polymorphism was associated with EV71 infection, and could be a susceptibility factor in the development of EV71 infection in Chinese children.

Association of IP-10 gene polymorphism with susceptibility to Enterovirus 71 infection.

Enterovirus 71 (EV71) often causes large outbreaks of diseases among children worldwide and its pathogenesis remains unclear. The aim of the present study was to investigate the association between interferon-inducible protein 10 (IP-10) polymorphism in children with EV71 infection. Polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) were performed to analyze the gene polymorphisms of IP-10 (-1596C/T) in 58 EV71-infected and 48 control patients. The results showed that in EV71-infected patients the frequency of carrying CT + TT genotype and T allele is 10.3 and 6.0%, respectively, which is significantly lower than that of the controls (29.2 and 15.6%, respectively). Individuals with T allele had a lower risk of EV71 infection [odds ratio (OR) = 0.35, 95% confidence interval (CI), 0.13-0.89]. The results of this study indicated that -1596T allele for the IP-10 gene may be a beneficial factor for EV71 infection.

Association of interleukin 10 and interferon gamma gene polymorphisms with enterovirus 71 encephalitis in patients with hand, foot and mouth disease.

Enterovirus 71 (EV71) is one of the common causative agents of hand, foot and mouth disease (HFMD), and is associated with several outbreaks with neurological complications including encephalitis. This study investigated the polymorphisms of interferon gamma (IFN-γ)+874 T/A and interleukin 10 (IL-10)-1082 G/A in 65 Chinese patients with EV71 encephalitis and 113 Chinese HFMD patients without complications. The polymorphisms of IFN-γ+874 T/A and IL-10-1082 G/A were determined by polymerase chain reaction (PCR)-amplification refractory mutation system (ARMS) and PCR-sequence-specific primer (SSP) analysis, respectively. The IFN-γ + 874 A allele was observed with significantly greater frequency in patients with EV71 encephalitis (76.2%) compared with HFMD patients without complications (61.1%, p < 0.01). Similarly, the IL-10 - 1082 A allele was observed with significantly greater frequency in patients with EV71 encephalitis (86.2%) compared with HFMD patients without complications (77.0%, p < 0.05). IFN-γ + 874 A and IL-10 - 1082 A alleles are associated with susceptibility to EV71 encephalitis in Chinese patients.

[Effects of Xuebijing injection on serum protein level in early phase of septic rats].

OBJECTIVE: To observe the effect of Xuebijing injection on serum protein level in the early phase of septic rats and explain the mechanism from the perspective of molecular biology. METHOD: Fifty-four healthy wistar rats were randomly divided into control group, sepsis group and Xuebijing treatment group. The rat model of sepsis was established with injecting lipopolysaccharide (LPS) through caudal vein. Serum total protein (TP) and albumin (ALB) were measured at the point of 6, 12 and 24 h with the established model. The expression of AMPK, eEF2 protein in liver in the three groups were detected by Western blot analysis. RESULT: Compared with control gruop, the concentrations of TP and ALB of sepsis group and Xuebijing group were no significant difference with 6, 12 h treatment TP and ALB in sepsis group was lower (P<0.01) than control group after 24 h, and the expression of phos-AMPK, pho-eEF2 protein in livers was increased (P<0.01) simultaneously. All measured indexes in Xuebijing group has no difference with control group. Compared with sepsis group, TP and ALB of Xuebijing group was significantly higher (P<0.05), but litle lower than control group, the expression of phos-AMPK, pho-eEF2 protein in livers was decreased (P<0.05) simultaneously. CONCLUSION: These data suggest that Xuebijing injection prohibits catabolising serum albumin and inhibit liver protein catabolism by method of AMPK way.