Application of MRI Radiomics-Based Machine Learning Model to Improve Contralateral BI-RADS 4 Lesion Assessment

Objective

This study aimed to explore the potential of magnetic resonance imaging (MRI) radiomics-based machine learning to improve assessment and diagnosis of contralateral Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions in women with primary breast cancer.

Materials and Methods

A total of 178 contralateral BI-RADS 4 lesions (97 malignant and 81 benign) collected from 178 breast cancer patients were involved in our retrospective dataset. T1 + C and T2 weighted images were used for radiomics analysis. These lesions were randomly assigned to the training (n = 124) dataset and an independent testing dataset (n = 54). A three-dimensional semi-automatic segmentation method was performed to segment lesions depicted on T2 and T1 + C images, 1,046 radiomic features were extracted from each segmented region, and a least absolute shrinkage and operator feature selection method reduced feature dimensionality. Three support vector machine (SVM) classifiers were trained to build classification models based on the T2, T1 + C, and fusion image features, respectively. The diagnostic performance of each model was evaluated and tested using the independent testing dataset. The area under the receiver operating characteristic curve (AUC) was used as a performance metric.

Results

The T1+C image feature-based model and T2 image feature-based model yielded AUCs of 0.71 ± 0.07 and 0.69 ± 0.07 respectively, and the difference between them was not significant (P > 0.05). After fusing T1 + C and T2 imaging features, the proposed model’s AUC significantly improved to 0.77 ± 0.06 (P < 0.001). The fusion model yielded an accuracy of 74.1%, which was higher than that of the T1 + C (66.7%) and T2 (59.3%) image feature-based models.

Conclusion

The MRI radiomics-based machine learning model is a feasible method to assess contralateral BI-RADS 4 lesions. T2 and T1 + C image features provide complementary information in discriminating benign and malignant contralateral BI-RADS 4 lesions.

[The epidemic, prophylaxis and treatment of cholera in Su-Wan Liberated Area in 1946]

Rugao and Haian belonging to First Branch of Su-Wan Liberated Area found fulminant cholera in 1946. The fulminant cholera spread throughout the Su-Wan Liberated Area in a short period of time. Thus, local mass and military led by CPC actively launched the Movement of Epidemic Prevention. They took some actions to clear up the circumstance, eliminate the pathogen, prevent the food contamination and cut off the route of transmission. Vaccination was carried out on a large scale. As a result of these measure, the fulminant cholera was efficiently controlled.

How to increase the value of self-reported health service data by using data linkage: a case study

Background

This is a case study for recurrent stroke prevention. Lifestyle factors account for about 80% of the risk of recurrent stroke. Most health services studies examining stroke prevention rely on stroke survivors' self-reported lifestyle behaviour data. How can researchers increase the value of collected self-reported data to provide additional information for more comprehensive assessments?

Methods

45 and Up Study is the largest ongoing study in the Southern Hemisphere focusing on the health of people aged 45 years and older living in NSW, Australia. This case study linked self-reported longitudinal lifestyle data in the 45 and Up Study, with corresponding mortality data (i.e. NSW Registry of Births, Deaths and Marriages & NSW Cause of Death Unit Record File) and hospital data (i.e. NSW Admitted Patient Data Collection) via the Centre for Health Record Linkage (CHeReL). The main outcome measures are health services, clinical outcomes, and mortality rates for stroke care. The analyses will include descriptive analysis, multivariate regression analysis, and survival analysis.

Results

A total of 8410 stroke survivors who participated in the 45 and Up Study were included in this data linkage study. From January 2006 to December 2015, 99249 hospital claims (mean: 13 times admission to hospital per person) and 2656 death registration records have been linked to these participants. The mean age of the stroke survivors was 72 (SD = 11) years, with 56% being males. These results are preliminary and more analyses will be conducted by using quality of life status, clinical diagnosis, comorbidities, and procedures.

Conclusions

Data linkage enables researchers to generate comprehensive findings on health services studies and gain a more holistic understanding of the determinants and outcomes of stroke prevention with lower data collection costs and less burden on participants.

Key messages

Data linkage brings about a new opportunity for self-reported data on health services utilisation. It is a cost-effective way to enhance existing self-reported data via the data linkage approach to increase its usefulness for informing health service planning.

High-risk lifestyle and all-cause mortality in older Australians with stroke: A data linkage study

Background

Stroke prevention via lifestyle modification is a public health priority in developed countries. Few studies have examined the association of high-risk lifestyle factors with long-term mortality of stroke survivors. Therefore, this study aims to explore the effect of key lifestyle factors on all-cause mortality after stroke.

Methods

Sample is derived from the 45 and Up Study, the largest ongoing study in the Southern Hemisphere focusing on the health of people aged 45 years and older living in NSW, Australia. The lifestyle data in the 45 and Up Study between 2006 to 2015 were linked with data from the NSW Registry of Births, Deaths and Marriages, NSW Cause of Death Unit Record File, and NSW Admitted Patient Data Collection by the Centre for Health Record Linkage. We defined a high-risk lifestyle as no vigorous exercise, smokers, or &gt; 10 alcoholic drinks/week. Multivariate Cox regression model is used to examine the effect of high-risk lifestyle on survival using 10-year all-cause mortality as the main outcome, adjusted for key confounders.

Results

We analysed information on 8410 adults with a stroke event occurring prior to the baseline 45 and Up Study, and 31% of them died in 10 years. 6219 participants were identified as having a high-risk lifestyle at baseline. Being a current smoker and without vigorous exercise were associated with 41% (95% CI: 16%, 73%) and 52% (95% CI: 30%, 78%) increase in the likelihood of death in 10 years, respectively. However, high-risk alcohol drinking was not significantly associated with survival. Of note, having cardiovascular-related comorbidities showed greater risks of mortality (HR range, 3.6-7.2).

Conclusions

High-risk lifestyle factors were associated with an increased risk of long-term all-cause mortality, suggesting that enhancing public health initiatives to promote 'healthy' lifestyle behaviours can be of great benefit to stroke survivors.

Key messages

It is essential for stroke survivors to maintain a healthy lifestyle to delay all-cause mortality. Stroke survivors with high-risk lifestyle may be associated with increased likelihood of death if they have comorbidities such as diabetes and hypertension.

A Network Pharmacology Analysis of the Active Components of the Traditional Chinese Medicine Zuojinwan in Patients with Gastric Cancer

BACKGROUND Zuojinwan (ZJW) is a traditional Chinese prescription normally used for gastritis. Several studies indicated that it could fight against gastric cancer. This study was designed to determine the potential pharmacological mechanism of ZJW in the treatment of gastric cancer. MATERIAL AND METHODS Bioactive compounds and potential targets of ZJW and related genes of gastric cancer were retrieved from public databases. Pharmacological mechanisms including crucial ingredients, potential targets, and signaling pathways were determined using protein-protein interaction (PPI) and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. Virtual docking was performed to validate the findings. RESULTS Network analysis identified 47 active ZJW compounds, and 48 potential ZJW target genes linked to gastric cancer. Quercetin, beta-sitosterol, isorhamnetin, wogonin, and baicalein were identified as potential candidate agents. Our PPI analysis results combined with previously published results indicated that matrix metalloproteinases family members MMP9, MMP1, and MMP3 may play key roles in the anti-gastric cancer effect of ZJW. Molecular docking analysis showed that these crucial targets had good affinity for the representative components in ZJW. GO and KEGG enrichment analysis showed that ZJW target genes functioned in multiple pathways for treating gastric cancer, including interleukin-17 signaling and platinum drug resistance. CONCLUSIONS Our results illuminate the active ingredients, associated targets, biological processes, and signaling pathways of ZJW in the treatment of gastric cancer. This study enhances our understanding of the potential effects of ZJW in gastric cancer and demonstrates a feasible method for discovering potential drugs from Chinese medicinal formulas.

Air and surface contamination by SARS-CoV-2 virus in a tertiary hospital in Wuhan, China

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Twelve air samples and 355 surface samples from a hospital were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

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Only one air sample, which was obtained during an intubation procedure, tested positive.

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A low level of surface contamination was found, and most occurred on high-touch surfaces.

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No association was found between surface contamination and patient characteristics.

Background

Few studies have explored air and surface contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in healthcare settings.

Methods

Air and surface samples were collected from the isolation wards and intensive care units designated for coronavirus disease 2019 (COVID-19) patients. Clinical data and the results of nasopharyngeal specimen and serum antibody testing were also collected for the patient sample.

Results

A total of 367 air and surface swab samples were collected from the patient care areas of 15 patients with mild COVID-19 and nine patients with severe/critical COVID-19. Only one air sample taken during the intubation procedure tested positive. High-touch surfaces were slightly more likely to be contaminated with SARS-CoV-2 RNA than low-touch surfaces. Contamination rates were slightly higher near severe/critical patients than near mild patients, although this difference was not statistically significant (p > 0.05). Surface contamination was still found near the patients with both positive IgG and IgM.

Conclusions

Air and surface contamination with viral RNA was relatively low in these healthcare settings after the enhancement of infection prevention and control. Environmental contamination could still be found near seroconverted patients, suggesting the need to maintain constant vigilance in healthcare settings to reduce healthcare-associated infection during the COVID-19 pandemic.

Network Pharmacology-Based Prediction and Verification of the Active Ingredients and Potential Targets of Zuojinwan for Treating Colorectal Cancer

Background

Zuojinwan (ZJW), a famous Chinese medicine formula, has been widely used to treat colorectal cancer (CRC). However, its bioactive compounds, potential targets, and molecular mechanism remain largely elusive.

Aim

A network pharmacology-based strategy combined with molecular docking studies and in vitro validation were employed to investigate bioactive compounds, potential targets, and molecular mechanism of ZJW against CRC.

Materials and Methods

Bioactive compounds and potential targets of ZJW, as well as related genes of CRC, were acquired from public databases. Important ingredients, potential targets, and signaling pathways were determined through bioinformatics analysis, including protein-protein interaction (PPI), the Gene Ontology (GO), and the Kyoto Encyclopedia of Genes and Genomes (KEGG). Subsequently, molecular docking and cell experiments were performed to further verify the findings.

Results

A total of 36 bioactive ingredients of ZJW and 163 gene targets of ZJW were identified. The network analysis revealed that quercetin, baicalein, wogonin, beta-sitosterol, and isorhamnetin may be candidate agents. The AKT1, JUN, CDKN1A, BCL2L1, and NCOA1 could become potential drug targets. The KEGG indicated that PI3K-AKT signaling pathway may play an important role in the effect of ZJW against CRC. Molecular docking suggested that quercetin, baicalein, and wogonin combined well with AKT1 and JUN. The in vitro experiment showed that quercetin, the most important ingredient of ZJW, could induce apoptosis of HCT116 cells through PI3K-Akt signaling pathway. This finding was congruent with the prediction obtained through the network pharmacology approach.

Conclusion

This study comprehensively illuminated the active ingredients, potential targets, and molecular mechanism of ZJW against CRC. It also provided a promising approach to uncover the scientific basis and therapeutic mechanism of traditional Chinese medicine (TCM) formula treating for disease.

Multimode tumor ablation therapy induced different diffusion and microvasculature related parameters change on functional magnetic resonance imaging compared to radiofrequency ablation in liver tumor: An observational study

To explore different posttreatment changes between multimode tumor ablation therapy (MTAT) and radiofrequency ablation (RFA) using intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and diffusion kurtosis imaging (DKI) in patients with hepatic malignancies.Eighty - seven patients with one hundred and twenty eight hepatic lesions receiving MTAT or RFA underwent IVIM-DWI and DKI before and after treatment. The mean value of apparent diffusion coefficient (ADC), IVIM-DWI parameters, including true diffusion coefficient (D), pseudo-diffusion coefficient (DP), perfusion fraction (f), and DKI parameters including diffusion coefficient (DK), apparent diffusional kurtosis (K) were retrospectively compared prior to and following treatment as well as between treatment groups. The degree of parameters change after ablation was compared between 2 treatment modalities.The mean value of ADC, D, and DK increased while f, and K decreased significantly in MTAT group. In RFA group, just ADC and K showed significantly change following treatment. The ADC and D value were higher in MTAT group than in RFA group 1 month after treatment. While f was lower in MTAT group after treatment compared with RFA group. The ADC, D and DK increased (21.89 ± 24.95% versus 8.76 ± 19.72%, P = .04 for ADC, 33.78 ± 54.01% versus 7.91 ± 25.16%, P = .03 for D, 25.91 ± 36.28% versus 1.75 ± 46.42%, P = .01 for DK) while f declined (-32.62 ± 41.48% versus 6.51 ± 44.16%, P < .001) more in MTAT group.The MTAT induced different posttreatment changes on water molecule diffusion and microvasculature related functional MR parameters compared to RFA in patients with liver tumors.

[Selection and effects of flap/myocutaneous flap repair methods for the defect after perineum tumor resection]

Objective: To explore the selection and effects of flap/myocutaneous flap repair methods for the defect after perineum tumor resection. Methods: From January 2011 to February 2017, 31 patients with vulvar tumor who were admitted to Hunan Cancer Hospital underwent repair of wound after tumor resection with various flaps/myocutaneous flaps. The patients were composed of 5 males and 26 females, aged 39-76 years, with 27 vulvar cancer and 4 Paget's disease in primary diseases. The size of defects after vulvar tumor radical resection ranged from 8.0 cm×4.5 cm to 27.5 cm×24.0 cm. According to the theory of perforasome, the defects were repaired by the external pudendal artery perforator flap, deep inferior epigastric artery perforator flap, rectus abdominis myocutaneous flap, anterolateral thigh flap, internal pudendal artery perforator flap, gracilis myocutaneous flap, and profunda artery perforator flap based on the specific size and location of perineum and groin where the defect was located. According to the blood supply zone of flap, totally 17 local translocation flaps, 18 axial flaps/myocutaneous flaps, and 7 V-Y advancement flaps were resected, with an area of 7.0 cm×4.0 cm to 21.0 cm×13.0 cm. All the flaps/myocutaneous flaps were transferred in pedicled fashion, and the donor sites were closed without tension. The number of flaps/myocutaneous flaps, wound closure, flaps/myocutaneous flaps survival, and follow-up were observed and recorded. Results: Altogether 42 flaps/myocutaneous flaps were harvested in 31 patients. Two flaps/myocutaneous flaps were used in 11 cases for large circular defect repair. All the defects achieved tension-free primary closure. The blood supply of 32 flaps/myocutaneous flaps was good, while insufficient blood supply was noted in the other 10 flaps/myocutaneous flaps. Seventeen flaps/myocutaneous flaps survived smoothly. Wound dehiscence occurred in 5 flaps/myocutaneous flaps 8 to 14 days postoperatively, which was healed with dressing change. Temporary congestion was noted in 7 flaps/myocutaneous flaps 2 to 5 days postoperatively, which recovered without special treatment. Three flaps/myocutaneous flaps had infection 7 to 15 days postoperatively, two of which recovered after dressing change, while the other one had partial necrosis and received debridement and direct closure. Two flaps/myocutaneous flaps were totally necrotic 8 to 15 days postoperatively, which were repaired with pedicled rectus abdominis myocutaneous flap after debridement. Seven flaps/myocutaneous flaps had partial necrosis 7 to 20 days postoperatively and were healed after dressing change. Twenty-four patients were followed up for 9-38 months. The color of flaps/myocutaneous flaps was similar to that of the surrounding skin, the shape of vulva was natural, the movement of hip joint was not limited, the function of micturition and defecation was not affected, and tumor recurrence was noted in 3 patients. Conclusions: For the complicated large defect after perineum tumor resection, the flexible application of different forms of flaps/myocutaneous flaps to repair according to different areas regains the appearance and function. However, there are many complications, so it is necessary to further strengthen the postoperative care.

Integrated Metabolomic and Lipidomic Analysis Reveals the Neuroprotective Mechanisms of Bushen Tiansui Formula in an Aβ1-42-Induced Rat Model of Alzheimer's Disease

Bushen Tiansui Formula (BSTSF) is a traditional Chinese medicine prescription. It has been widely applied to treat Alzheimer's disease (AD) in the clinic; however, the mechanisms underlying its effects remain largely unknown. In this study, we used a rat AD model to study the effects of BSTSF on cognitive performance, and UPLC-MS/MS-based metabolomic and lipidomic analysis was further performed to identify significantly altered metabolites in the cerebral cortices of AD rats and determine the effects of BSTSF on the metabolomic and lipidomic profiles in the cerebral cortices of these animals. The results revealed that the levels of 47 metabolites and 30 lipids primarily associated with sphingolipid metabolism, glycerophospholipid metabolism, and linoleic acid metabolism were significantly changed in the cerebral cortices of AD rats. Among the altered lipids, ceramides, phosphatidylethanolamines, lysophosphatidylethanolamines, phosphatidylcholines, lysophosphatidylcholines, phosphatidylserines, sphingomyelins, and phosphatidylglycerols showed robust changes. Moreover, 34 differential endogenous metabolites and 21 lipids, of which the levels were mostly improved in the BSTSF treatment group, were identified as potential therapeutic targets of BSTSF against AD. Our results suggest that lipid metabolism is highly dysregulated in the cerebral cortices of AD rats, and BSTSF may exert its neuroprotective mechanisms by restoring metabolic balance, including that of sphingolipid metabolism, glycerophospholipid metabolism, alanine, aspartate, and glutamate metabolism, and D-glutamine and D-glutamate metabolism. Our data may lead to a deeper understanding of the AD-associated metabolic profile and shed new light on the mechanism underlying the therapeutic effects of BSTSF.

[Anatomical classification and application of chimeric myocutaneous medial thigh perforator flap in head and neck reconstruction]

Objective: To explore the anatomical classification and application of chimeric myocutaneous medial thigh perforator (MTP) flap in head and neck reconstruction. Methods: From September 2015 to December 2018, the clinical data of 74 patients (62 males and 12 females, age ranging from 31 to 69 years, with a mean age of 50.2 years) with oral tumor, who underwent radical resection in Hunan Cancer Hospital, including 39 cases of tongue carcinoma, 24 cases of gingival carcinoma and 11 cases of buccal cancer, 26 cases of stage T4N1M0, 22 cases of stage T4N0M0,15 cases of stage T3N1M0, and 11 cases of stage T3N2M0 were retrospectively analyzed in this work.The arteries and the veins contributing to MTP were anastomosed respectively with superior thyroid arteries, while the venae comitans were anastomosed with superior thyroid venae veins or internal jugular venae vein. The size of soft tissue defect, the length, width and thickness of free medial thigh flap, the length and source of vascular pedicle were recorded. The flap survival, functional status and donor area recovery were observed. Results: The postoperative defects in size ranged from 4.0 cm×3.5 cm to 9.0 cm×5.5 cm, which were reconstructed by free chimeric myocutaneous MTP flaps. The mean length of MTP flaps was (12.5±0.4) cm, the mean width was (7.2±0.4) cm, the mean thickness was (3.5±0.2) cm. The mean pedicle length was (8.6±0.4) cm. The perforators existed consistently in all cases, and the vascular origins were classified into 6 types. There were 4 cases (5.4%) of the perforating branches originating from femoral artery between the medial femoris and the adductor longus, 6 cases (8.1%) of the perforating branches of the profunda femoral artery from the adductor longus, 16 cases (21.6%) of the perforating branches of the profunda femoral artery from the gracilis, 9 cases (12.2%) of the perforating branches of the profunda femoral artery between the gracilis and the adductor longus, 29 cases (39.2%) of the perforating branches of the profunda femoral artery from the adductor longus, and 10 cases (13.5%) of branches of the profunda femoral artery from the semimembranous muscle. All 74 flaps survived uneventfully. The donor sites and recipient sites were closed directly in all cases. All patients were followed up for 12-36 months with satisfied esthetic and functional results. Only linear scars were left in the donor sites, and the thigh function was not affected. Local recurrence happened in 4 cases, which were treated with radical resection and the left defects were reconstructed with pedicled pectoral major myocutaneous flaps. Conclusion: The chimeric myocutaneous MTP flap has good color match and texture, with abundant tissue, and consistent blood supply, and it can be harvested in various forms while leaving minimal morbidity at donor site, being an idea choice for reconstruction after surgery of oral cancer.

A perspective of stepwise utilization of hazardous zinc plant purification residue based on selective alkaline leaching of zinc

A new route for selective recovery of zinc from hazardous zinc plant purification residue was proposed by alkaline leaching process. The thermodynamic analysis revealed that by controlling solution pH in the range from 14.30 to 16.78 at 25 °C, basic zinc sulfate can be converted to ZnO₂^2- instead of Zn(OH)₂, while Cd will enter into alkaline leaching residue as a hydroxide. It is feasible to leach selectively Zn and to separate it with Cd by alkaline leaching, and the experimental results confirm that. Under the conditions of NaOH concentration of 3 mol/L, L/S of 20 ml/g, temperature of 40 °C, and time of 50 min, LR of Zn reached 96.14% while them of Pb and Cd were only 0.66% and 2.83% respectively. ZnO with hexagonal wurtzite structure and Cd(OH)₂ were the main phases of leaching residue. They crystallized and adhered to the surface of leaching residue particles, which result in the loose and random particle morphology. The findings confirm that alkaline leaching is efficient in separation of Zn and Cd in ZPPR. In addition, nano-ZnO with flowerlike was synthesized with the zinc-rich leaching solution by precipitation method and the its photocatalytic property was similar to that of nano-ZnO purchased.

[Effects of pedicled rectus abdominis myocutaneous flap combined with free deep inferior epigastric artery perforator flap carrying inguinal lymphatic flap in breast reconstruction and upper limb lymphedema treatment post radical mastectomy]

Objective: To explore the effects of pedicled rectus abdominis myocutaneous (PRAM)flap combined with free deep inferior epigastric artery perforator (DIEAP) flap carrying inguinal lymphatic flap in breast reconstruction and upper limb lymphedema treatment post radical mastectomy. Methods: From October 2014 to September 2016, 9 patients with upper limb lymphedema after mastectomy were treated with PRAM flap combined with free DIEAP flap carrying inguinal lymphatic flap for breast reconstruction and upper limb lymphedema treatment in Hunan Province Cancer Hospital. The patients were all females, aged 34-66 (44±7) years. The location of deep inferior epigastric artery perforator was detected by audible Doppler ultrasound blood stream detector and computed tomography angiography for designing combined tissue flap, with length of (25.32±0.27) cm, width of (13.14±0.76) cm, and thickness of (3.55±0.34) cm. The donor site of combined tissue flap was closed by suturing, and two or more tubes for negative pressure drainage were placed according to the situation of donor site and recipient site. Operation time and average placing time of negative pressure drainage tube, postoperative condition of combined tissue flap and the donor site, reconstructed breast condition, recovery of upper limb lymphedema were documented and followed up. Results: The operation time was 290-420 (396±55) min. The average retaining time of negative pressure drainage tube in breast was 5.9 d, while the average retaining time of negative pressure drainage tube in abdomen was 4.3 d. Ecchymoma occurred in DIEAP flap of one patient and in the flap donor site of another patient. Delayed healing was also seen in the rectus abdominis myocutaneous flap of a patient, which healed eventually after dressing change, and the other flaps survived well. The appearance of reconstructed breast was good with good elasticity, and no contracture or deformation occurred in the tissue flap. The upper limb lymphedema in 7 patients was alleviated in varying degrees, with 2.0-4.0 cm reduction in circumference. During follow-up of 12-24 months of 9 patients, averaged 17.5 months, with 6 patients received long term bandage pressure therapy and physical therapy to the affected limbs after operation and all patients were satisfied with appearances of the affected limbs. Neuropathic pain in affected limbs was significantly relieved in 2 patients and stopped aggravating in the other 2 patients. Only linear scar was seen in the donor site of abdomen without affecting obviously the function of abdomen. Conclusions: The PRAM flap combined with free DIEAP flap carrying inguinal lymphatic flap is an effective way for breast reconstruction and upper limb lymphedema treatment post mastectomy.

Comparison and Fusion of Deep Learning and Radiomics Features of Ground-Glass Nodules to Predict the Invasiveness Risk of Stage-I Lung Adenocarcinomas in CT Scan

For stage-I lung adenocarcinoma, the 5-years disease-free survival (DFS) rates of non-invasive adenocarcinoma (non-IA) is different with invasive adenocarcinoma (IA). This study aims to develop CT image based artificial intelligence (AI) schemes to classify between non-IA and IA nodules, and incorporate deep learning (DL) and radiomics features to improve the classification performance. We collect 373 surgical pathological confirmed ground-glass nodules (GGNs) from 323 patients in two centers. It involves 205 non-IA (including 107 adenocarcinoma in situ and 98 minimally invasive adenocarcinoma), and 168 IA. We first propose a recurrent residual convolutional neural network based on U-Net to segment the GGNs. Then, we build two schemes to classify between non-IA and IA namely, DL scheme and radiomics scheme, respectively. Third, to improve the classification performance, we fuse the prediction scores of two schemes by applying an information fusion method. Finally, we conduct an observer study to compare our scheme performance with two radiologists by testing on an independent dataset. Comparing with DL scheme and radiomics scheme (the area under a receiver operating characteristic curve (AUC): 0.83 ± 0.05, 0.87 ± 0.04), our new fusion scheme (AUC: 0.90 ± 0.03) significant improves the risk classification performance (p < 0.05). In a comparison with two radiologists, our new model yields higher accuracy of 80.3%. The kappa value for inter-radiologist agreement is 0.6. It demonstrates that applying AI method is an effective way to improve the invasiveness risk prediction performance of GGNs. In future, fusion of DL and radiomics features may have a potential to handle the classification task with limited dataset in medical imaging.

Comprehensive Comparison of the Combustion Behavior for Low-Temperature Combustion of n-Nonane

To meet the increasing need for clean combustion, improve the combustion efficiency of fuels, and reduce the pollutants produced in the combustion process, it is necessary to systematically study the combustion of hydrocarbon fuels. An accurate and detailed chemical kinetic model is an important prerequisite for understanding the combustion performance of hydrocarbon fuels and studying complex chemical reaction networks. Therefore, based on ReaxGen, new detailed mechanisms for the low-temperature combustion of n-nonane are proposed and verified in detail in this study. Meanwhile, some international mainstream combustion models such as the LLNL model and the JetSurf 2.0 model are compared with ours, showing that the proposed new mechanisms can better predict the ignition delay combustion characteristics of n-nonane, and they also hold in a wide range of conditions. In addition, the numerical simulation results of the concentration curve calculated for the new mechanisms, especially Model v2, are in good agreement with the experimental data, and the mechanisms can reproduce the performance of the negative-temperature-coefficient behavior toward n-nonane ignition. The numerical simulation results of the laminar flame propagation velocity varying with the equivalence ratio are also in good agreement with the available experimental data. Finally, the ignition delay sensitivity of n-nonane is analyzed by the sensitivity analysis method; the key reactions affecting the ignition mechanism are investigated; and the reaction path analysis is conducted to better understand the models' predicted performance. In a word, the new mechanisms are helpful to understand the ignition properties of large hydrocarbon fuels for high-speed aircrafts.

VISSA-PLS-DA-Based Metabolomics Reveals a Multitargeted Mechanism of Traditional Chinese Medicine for Traumatic Brain Injury

Metabolomics is an emerging tool to uncover the complex pathogenesis of disease, as well as the multitargets of traditional Chinese medicines, with chemometric analysis being a key step. However, conventional algorithms are not suitable for directly analyzing data at all times. The variable iterative space shrinkage approach-partial least squares-discriminant analysis, a novel algorithm for data mining, was first explored to screen metabolic varieties to reveal the multitargets of Xuefu Zhuyu decoction (XFZY) against traumatic brain injury (TBI) by the 7th day. Rat plasma from Sham, Vehicle, and XFZY groups was used for gas chromatography/mass spectrometry-based metabolomics. This method showed an improved discrimination ability (area under the curve = 93.64%). Threonine, trans-4-hydroxyproline, and creatinine were identified as the direct metabolic targets of XFZY against TBI. Five metabolic pathways affected by XFZY in TBI rats, were enriched using Metabolic Pathway Analysis web tool (i.e., phenylalanine, tyrosine, and tryptophan biosynthesis; phenylalanine metabolism; galactose metabolism; alanine, aspartate, and glutamate metabolism; and tryptophan metabolism). In conclusion, metabolomics coupled with variable iterative space shrinkage approach-partial least squares-discriminant analysis model may be a valuable tool for identifying the holistic molecular mechanisms involved in the effects of traditional Chinese medicine, such as XFZY.

Integrated network pharmacology analysis and serum metabolomics to reveal the cognitive improvement effect of Bushen Tiansui formula on Alzheimer's disease

ETHNOPHARMACOLOGICAL RELEVANCE

Bushen Tiansui Formula (BSTSF) is a traditional Chinese medicine formula used clinically to treat Alzheimer's disease (AD) for many years. Previously, we have partially elucidated the mechanisms involved in the therapeutic effects of BSTSF on AD. However, the underlying mechanisms remain largely unclear.

AIM OF THE STUDY

The aim of this study was to further investigate the therapeutic effects of BSTSF on AD using an integrated strategy of network pharmacology and serum metabolomics.

MATERIALS AND METHODS

The rat models of AD were established using Aβ 1-42 injection, and morris water maze test was used to evaluate the efficacy of BSTSF on AD. Next, network pharmacology analysis was applied to identify the active compounds and target genes, which might be responsible for the effect of BSTSF. Then, a metabolomics strategy has been developed to find the possible significant serum metabolites and metabolic pathway induced by BSTSF. Additionally, two parts of the results were integrated to confirm each other.

RESULTS

The results of the network pharmacology analysis showed 37 compounds and 64 potential target genes related to the treatment of AD with BSTSF. The functional enrichment analysis indicated that the potential mechanism was mainly associated with the tumor necrosis factor signaling pathway and phosphatidylinositol 3 kinase/protein kinase B signaling pathway. Based on metabolomics, 78 differential endogenous metabolites were identified as potential biomarkers related to the BSTSF for treating AD. These metabolites were mainly involved in the relevant pathways of linoleic acid metabolism, α-linolenic acid metabolism, glycerophospholipid metabolism, tryptophan metabolism, and arginine and proline metabolism. These findings were partly consistent with the findings of the network pharmacology analysis.

CONCLUSIONS

In conclusion, our results solidly supported and enhanced out current understanding of the therapeutic effects of BSTSF on AD. Meanwhile, our work revealed that the proposed network pharmacology-integrated metabolomics strategy was a powerful means for identifying active components and mechanisms contributing to the pharmacological effects of traditional Chinese medicine.

Integrated 16S rRNA Sequencing, Metagenomics, and Metabolomics to Characterize Gut Microbial Composition, Function, and Fecal Metabolic Phenotype in Non-obese Type 2 Diabetic Goto-Kakizaki Rats

Type 2 diabetes mellitus (T2DM) is one of the most prevalent endocrine diseases in the world. Recent studies have shown that dysbiosis of the gut microbiota may be an important contributor to T2DM pathogenesis. However, the mechanisms underlying the roles of the gut microbiome and fecal metabolome in T2DM have not been characterized. Recently, the Goto-Kakizaki (GK) rat model of T2DM was developed to study the clinical symptoms and characteristics of human T2DM. To further characterize T2DM pathogenesis, we combined multi-omics techniques, including 16S rRNA gene sequencing, metagenomic sequencing, and metabolomics, to analyze gut microbial compositions and functions, and further characterize fecal metabolomic profiles in GK rats. Our results showed that gut microbial compositions were significantly altered in GK rats, as evidenced by reduced microbial diversity, altered microbial taxa distribution, and alterations in the interaction network of the gut microbiome. Functional analysis based on the cluster of orthologous groups (COG) and Kyoto Encyclopedia of Genes and Genomes (KEGG) annotations suggested that 5 functional COG categories belonged to the metabolism cluster and 33 KEGG pathways related to metabolic pathways were significantly enriched in GK rats. Metabolomics profiling identified 53 significantly differentially abundant metabolites in GK rats, including lipids and lipid-like molecules. These lipids were enriched in the glycerophospholipid metabolic pathway. Moreover, functional correlation analysis showed that some altered gut microbiota families, such as Verrucomicrobiaceae and Bacteroidaceae, significantly correlated with alterations in fecal metabolites. Collectively, the results suggested that an altered gut microbiota is associated with T2DM pathogenesis.

Association of gut microbiota composition and function with a senescence-accelerated mouse model of Alzheimer's Disease using 16S rRNA gene and metagenomic sequencing analysis

Although an intriguing potential association of the gut microbiome with Alzheimer's disease (AD) has attracted recent interest, few studies have directly assessed this relationship or underlying mechanism. Here, we compared the gut microbiota composition and functional differentiation of senescence-accelerated mouse prone 8 (SAMP8) mice with control senescence-accelerated mouse resistant 1 (SAMR1) mice using 16S rRNA gene and metagenomic sequencing analysis, respectively. Specifically, 16S sequencing results showed that the SAMP8 mice displayed a characteristic composition of the gut microbiome that clearly differed from that of the SAMR1 mice. Moreover, network analysis revealed that the gut microbiota of SAMP8 mice had decreased correlation density and clustering of operational taxonomic units. Metagenomic results revealed that the predominant Cluster of Orthologous Groups functional category related to these changes was the metabolism cluster in SAMP8 mice. The Kyoto Encyclopedia of Genes and Genomes (KEGG) annotation further demonstrated enrichment of the relative abundance of some dominant metabolism-related KEGG pathways in the SAMP8 mice, consistent with the suggested pathogenic mechanisms of AD. In conclusion, this study suggests that perturbations of the gut microbiota composition and the functional metagenome may be associated with AD. Further studies are warranted to elucidate the potential new mechanism contributing to AD progression.

Differentiation between idiopathic granulomatous mastitis and invasive breast carcinoma, both presenting with non-mass enhancement without rim-enhanced masses: The value of whole-lesion histogram and texture analysis using apparent diffusion coefficient

PURPOSE

The aim of this study was to investigate whether whole-lesion histogram and texture analysis using apparent diffusion coefficient can discriminate between idiopathic granulomatous mastitis (IGM) and invasive breast carcinoma (IBC), both of which appeared as non-mass enhancement lesions without rim-enhanced masses.

METHOD

This retrospective study included 58 pathology-proven female patients at two independent study sites (27 IGM patients and 31 IBC patients). Diffusion-weighted imaging (3b values, 50, 400 or 500, and 800 s/mm²) was performed using 1.5 T or 3 T MR scanners from the same vendor. Whole-lesions were segmented and 11 features were extracted. Univariate analysis and multivariate logistic regression analysis were performed to identify significant variables for differentiating IGM from IBC. Receiver operating characteristic curve was assessed. The interobserver reliability between two observers for the histogram and texture measurement was also reported.

RESULTS

The 5th percentile, difference entropy and entropy of apparent diffusion coefficient showed significant differences between the two groups. An area under the curve of 0.778 (95 % CI: 0.648, 0.908), accuracy of 79.3 %, and sensitivity of 87.1 % was achieved using these three significant features. No significant feature was found with the multivariate analysis. For the interobserver reliability, all apparent diffusion coefficient parameters except skewness and kurtosis indicated good or excellent agreement, while these two features showed moderate agreement.

CONCLUSIONS

Whole-lesion histogram and texture analysis using apparent diffusion coefficient provide a non-invasive analytical approach to the differentiation between IGM and IBC, both presenting with non-mass enhancement without rim-enhanced masses.

A deep residual learning network for predicting lung adenocarcinoma manifesting as ground-glass nodule on CT images

OBJECTIVE

To develop a deep learning-based artificial intelligence (AI) scheme for predicting the likelihood of the ground-glass nodule (GGN) detected on CT images being invasive adenocarcinoma (IA) and also compare the accuracy of this AI scheme with that of two radiologists.

METHODS

First, we retrospectively collected 828 histopathologically confirmed GGNs of 644 patients from two centers. Among them, 209 GGNs are confirmed IA and 619 are non-IA, including 409 adenocarcinomas in situ and 210 minimally invasive adenocarcinomas. Second, we applied a series of pre-preprocessing techniques, such as image resampling, rescaling and cropping, and data augmentation, to process original CT images and generate new training and testing images. Third, we built an AI scheme based on a deep convolutional neural network by using a residual learning architecture and batch normalization technique. Finally, we conducted an observer study and compared the prediction performance of the AI scheme with that of two radiologists using an independent dataset with 102 GGNs.

RESULTS

The new AI scheme yielded an area under the receiver operating characteristic curve (AUC) of 0.92 ± 0.03 in classifying between IA and non-IA GGNs, which is equivalent to the senior radiologist's performance (AUC 0.92 ± 0.03) and higher than the score of the junior radiologist (AUC 0.90 ± 0.03). The Kappa value of two sets of subjective prediction scores generated by two radiologists is 0.6.

CONCLUSIONS

The study result demonstrates using an AI scheme to improve the performance in predicting IA, which can help improve the development of a more effective personalized cancer treatment paradigm.

KEY POINTS

• The feasibility of using a deep learning method to predict the likelihood of the ground-glass nodule being invasive adenocarcinoma. • Residual learning-based CNN model improves the performance in classifying between IA and non-IA nodules. • Artificial intelligence (AI) scheme yields higher performance than radiologists in predicting invasive adenocarcinoma.