Review of deep learning and artificial intelligence models in fetal brain magnetic resonance imaging

Central nervous system abnormalities in fetuses are fairly common,happening in 0.1%to 0.2%of live births and in 3%to 6%of stillbirths.So initial detection and categorization of fetal Brain abnormalities are critical.Manually detecting and segmenting fetal brain magnetic resonance imaging(MRI)could be timeconsuming,and susceptible to interpreter experience.Artificial intelligence(AI)algorithms and machine learning approaches have a high potential for assisting in the early detection of these problems,improving the diagnosis process and follow-up procedures.The use of AI and machine learning techniques in fetal brain MRI was the subject of this narrative review paper.Using AI,anatomic fetal brain MRI processing has investigated models to predict specific landmarks and segmentation automatically.All gestation age weeks(17-38 wk)and different AI models(mainly Convolutional Neural Network and U-Net)have been used.Some models'accuracy achieved 95%and more.AI could help preprocess and postprocess fetal images and reconstruct images.Also,AI can be used for gestational age prediction(with one-week accuracy),fetal brain extraction,fetal brain segmentation,and placenta detection.Some fetal brain linear measurements,such as Cerebral and Bone Biparietal Diameter,have been suggested.Classification of brain pathology was studied using diagonal quadratic discriminates analysis,Knearest neighbor,random forest,naive Bayes,and radial basis function neural network classifiers.Deep learning methods will become more powerful as more large-scale,labeled datasets become available.Having shared fetal brain MRI datasets is crucial because there aren not many fetal brain pictures available.Also,physicians should be aware of AI's function in fetal brain MRI,particularly neuroradiologists,general radiologists,and perinatologists.

Sofosbuvir/Ribavirin therapy for patients experiencing failure of ombitasvir/paritaprevir/ritonavir + ribavirin therapy: Two cases report and review of literature

BACKGROUND The effectiveness of sofosbuvir/ribavirin(SOF/RBV) combination therapy,which is one of the 1 st-choice therapeutic options for patients with hepatitis C virus(HCV) genotype 2(HCV-G2) in Japan according to the most recent version of the Japan Society of Hepatology guideline, for patients who experienced failure of the ombitasvir/paritaprevir/ritonavir plus ribavirin(OBV/PTV/r+RBV) combination therapy, which was another option for patients with HCV-G2, is unknown.CASE SUMMARY We evaluated the effects of SOF/RBV combination therapy in two patients with genotype 2 a who could not achieve a sustained virological response(SVR) by OBV/PTV/r+RBV combination therapy. One patient was complicated with VogtKoyanagi-Harada(VKH) disease. Resistance-associated variations before SOF/RBV combination therapy were not detected in two patients. Both patients had an SVR at 12 wk after the treatment(SVR12). Regarding adverse events(AEs), itching, chill, a dull feeling in the throat and cough as well as increase of alanine transaminase level were shown in one patient, while a headache and deterioration of light aversion probably due to the recurrence of VKH disease were shown in the other patients. In addition, the latter patient developed arthralgia and morning stiffness approximately 7 wk after the therapy and turned out to be diagnosed with rheumatoid arthralgia.CONCLUSION SOF/RBV therapy might be effective for patients experiencing failure of OBV/PTV/r+RBV therapy, but caution should be taken regarding the AEs.

Variability of the Circle of Willis in North American Caucasian and Middle East Arabic Cohorts

The cerebral arterial circle (circle of Willis) plays an important role in the redistribution of the blood flow between the anterior and posterior territories and maintains the plasticity of the cerebral blood circulation. The anatomical variability of the vascular circle often alters the cerebral hemodynamics and determines the outcomes of acute and chronic cerebrovascular disease. The heritability and prevalence of certain variants of the circle of Willis in different ethnic and racial groups are frequently disputed by authors. Our cross-sectional retrospective study aims to compare the patterns of the cerebral arterial circle in 64 Caucasian cadavers with 64 Arabic living individuals, by methods of anatomic dissection and magnetic resonance angiography, respectively. The typical structure of the circle of Willis was revealed in 8.3% of the Caucasian study group, and in 22.2% of the Arabic one. The anterior part of the circle of Willis was incomplete in 6 out of 64 of the Caucasian specimens, where the anterior communicating artery was hypoplastic (6.3%) or absent (3.1%). The posterior part of the circle of Willis had hypoplastic or absent posterior communicating artery on one side in 20, and on both sides in 12 out of 64 Caucasian specimens. In the Arabic cohort, the posterior part of the circle of Willis was incomplete in 17 out of 64 specimens, with absence of the posterior communicating artery unilaterally (in 11 cases) or bilaterally (in 6 cases). The present study reveals that the configuration of the cerebral arterial circle and distribution of the blood flow between the anterior and posterior territories have certain differences in the Caucasian study group versus the Arabic one.

Effects of immunological processes and mild ambient atmosphere alterations on the brain in health and disease

Immunological processes in the brain and periphery are well known to affect brain function in health and disease.However,our knowledge about the crosstalk between the immune system and the central nervous system is far from being complete.Ongoing research in this field is uncovering the complex interactions between these"supersystems,"often involving additional organs such as the gut with its microbiome,as well as pathophysiological factors such as hyperglycemia,hypertension,or dyslipidemia.

Computed tomography-guided transpulmonary radiofrequency ablation for hepatocellular carcinoma located in hepatic dome

AIM： To determine the feasibility of performing computed tomography （CT）-guided transpulmonary radiofrequency ablation （RFA） for hepatocellular carcinoma （HCC） located in the hepatic dome. METHODS： A total of seven patients with HCC comprising seven nodules located in the hepatic dome were treated from April 2004 to December 2004. CTguided transpulmonary RFA was performed using a cool-tip type electrode （Radionics Company） based on a standardized energy protocol. All tumors located in the hepatic dome were not detectable by the usual ultrasound （US） methods. The lesion diameters ranged from 15 to 27 mm. RESULTS： RFA was technically feasible in all the patients. The puncture procedure was performed twice or less and the total average performance time was 40.6 min. Local tumor control was achieved in all the patients. The necrosis diameter ranged from 25 to 35 mm. The mean follow-up period was 9.6 （7-14 mo） mo. There was no local recurrenceat the follow-up points. Pneumothorax requiring pleural drainage was the main complication, which was observed in two of the seven patients （28.6%）. However, it improved with chest drainage tube, and the tube could be removed within 2-3 d. No other major complications were observed.CONCLUSION： CT-guided puncture is useful for the treatment of tumors located in the hepatic dome which are hardly detectable by US, even though pneumothorax sometimes may occur as a complication. In the cases with adhesion in the pleura for which artificial pleural effusion methods are not appropriate, CT-guided RFA is thus considered to be an alternative treatment for HCC located in the hepatic dome.

Lymphoepithelioma-like carcinoma of the breast presenting as breast abscess

Lymphoepithelioma-like carcinoma(LELC) is a rare type of neoplasm in which only twenty cases have been reported in the breast. This type of tumor can be difficult to distinguish from other breast tumors particularly medullary carcinoma and lymphoma in the breast. We present a case of LELC of the breast presenting as an abscess along with a review of the literature. This is the 21 st reported case of LELC of the breast and the first case to present as an abscess. Her clinical picture could have been mistaken for other infectious or inflammatory diseases. Given the potential for favorable outcome, early detection and general knowledge of this neoplasm are essential to expedite treatment for this rare tumor type.

Application of Unenhanced Computed Tomography Texture Analysis to Differentiate Pancreatic Adenosquamous Carcinoma from Pancreatic Ductal Adenocarcinoma

Objective:The objective of this study was to investigate the application of unenhanced computed tomography(CT)texture analysis in differentiating pancreatic adenosquamous carcinoma(PASC)from pancreatic ductal adenocarcinoma(PDAC).Methods:Preoperative CT images of 112 patients(31 with PASC,81 with PDAC)were retrospectively reviewed.A total of 396 texture parameters were extracted from AnalysisKit software for further texture analysis.Texture features were selected for the differentiation of PASC and PDAC by the Mann-Whitney U test,univariate logistic regression analysis,and the minimum redundancy maximum relevance algorithm.Furthermore,receiver operating characteristic(ROC)curve analysis was performed to evaluate the diagnostic performance of the texture feature-based model by the random forest(RF)method.Finally,the robustness and reproducibility of the predictive model were assessed by the 10-times leave-group-out cross-validation(LGOCV)method.

Is endoscopic retrograde appendicitis therapy a better modality for acute uncomplicated appendicitis? A systematic review and metaanalysis

BACKGROUND Previous studies had shown endoscopic retrograde appendicitis therapy(ERAT)is an effective treatment for acute appendicitis.However,different studies reported conflicting outcomes regarding the effectiveness of ERAT in comparison with laparoscopic appendectomy(LA).AIM To compare the effectiveness of ERAT with LA.METHODS Randomized controlled trials(RCTs)and retrospective studies of ERAT for acute uncomplicated appendicitis were searched in PubMed,Cochrane Library,Web of Science,Embase database,China National Knowledge Infrastructure(CNKI),the WanFang Database,and Chinese Scientific Journals Database(VIP)from the establishment date to March 12021.Heterogeneity was assessed using the Isquared statistic.Pooled odds ratios(OR),weighted mean difference(WMD),and standard mean difference(SMD),with 95%confidence intervals(CI)were calculated through either fixed-effects or random-effects model.Sensitivity analysis was also performed.Publication bias was tested by Egger's test,and Begg’s test.The quality of included RCT were evaluated by the Jadad scale,while Newcastle-Ottawa scale is adopted for assessing the methodological quality of case-control studies.All statistical analysis was performed using Stata 15.1 statistical software.All statistical analysis was performed using Stata 15.1 statistical software.This study is registered with PROSPERO,CRD42021243955.RESULTS After screening,10 RCTs and 2 case-control studies were included in the current systematic review.Firstly,the length of hospitalizations[WMD=-1.15,95%CI:-1.99,-0.31;P=0.007]was shorter than LA group.Secondly,the level of postoperative CRP[WMD=-10.06,95%CI:(-17.39,-2.73);P=0.007],TNF-α[WMD=-7.70,95%CI:(-8.47,-6.93);P<0.001],and IL-6 Levels[WMD=-9.78,95%CI:(-10.69,-8.88);P<0.001;P<0.001]in ERAT group was significantly lower than LA group.Thirdly,ERAT group had a lower incidence of intestinal obstruction than LA group.[OR=0.19,95%CI:(0.05,0.79);P=0.020].Moreover,the quality of 10 RCTs were low with 0-3 Jadad scores,while the methodological quality of two case-control studies were fair with a score of 2(each).CONCLUSION Compared with LA,ERAT reduces operation time,the level of postoperative inflammation,and results in fewer complications and shorter recovery time,with preserving the appendix and its immune and biological functions.

Application of Dual-Energy Computed Tomography for Breast Cancer Diagnosis

The present study aimed to investigate the possibility of using dual-energy computed tomography (CT) before therapy to discriminate between normal breast tissue and tumor tissue in patients with breast cancer, without the need to use a contrast medium. The following patient data were extracted by interview and from the hospital’s radiology information system: height, weight, age, menstrual cycle, CT images of normal tissue and tumors with or without contrast medium, and the histopathological diagnosis of the aspiration biopsy. The median age of the 43 participants was 56 years (range, 30 - 80 years). The CT values were evaluated using a clinical analytical program based on the three-material decomposition technique. Breast cancer was classified into ductal carcinoma in situ, invasive ductal carcinoma, invasive lobular carcinoma, fibromatosis-like metaplastic carcinoma, and apocrine carcinoma. In all conditions, regardless of contrast medium, the CT values of tumor tissues were higher than those of normal breast tissue, indicating the effectiveness of dual-energy CT (DE-CT) in the diagnosis of breast cancer. By contrast, DE-CT showed limited potential for distinguishing ductal carcinoma in situ from invasive ductal carcinoma. There have only been a few reports regarding CT examination of breast cancer, and it is expected this study encourage the development of DE-CT imaging to improve tumor detection in patients with breast cancer.

Mitigating the impact of mechanisms causing neuronal degeneration

Primary and secondary neurodegeneration is a pathological hallmark of numerous central nervous system(CNS)disorders.Although many mechanisms leading to neurodegeneration are well understood,previous approaches aiming at providing protection from neurodegeneration were often futile.A potential explanation may be that recent research discovered additional pathomechanisms leading to neurodegeneration.Thus,simply targeting single neurodegenerative mechanisms may only have minor therapeutic impact.Addressing multiple neurodegenerative mechanisms may be a more viable strategy.Moreover,the restoration of lost brain tissue turned out to be a very complex endeavor.1 Despite making some initial progress with the use of biocompatible scaffolds and hydrogels.

CD98 is a promising prognostic biomarker in biliary tract cancer

ABSTRACT： CD98 has been described to play a crucial role in tumor progression and survival. However, the role of CD98 in biliary tract cancer remains unclear. We found that 36.7% of all patients with biliary tract cancer had a high CD98 expression. Statistical analysis using Spearman＇s rank correlation showed that CD98 was significantly correlated with L-type amino acid transporter 1 （LAT1, r=0.562, P〈0.001）, Ki-67 （r=0.230, P=0.006） and CD34 （r=0.290, P=0.005）. Multivariate analysis confirmed that a high CD98 expression was an independent prognostic factor for predicting poor outcome. CD98 is closely associated with tumor growth, biological aggressiveness, and survival of patients. With these data we proposed that CD98 expression is necessary for the development and pathogenesis of biliary tract cancer.

应用计算机辅助检查系统检出胸部X线片漏诊的肺癌

目的研究计算机辅助检查（CAD）系统检出放射医生初次判读漏诊肺癌的能力。材料与方法本研究由学术审核委员会批准，无需病人知情同意；由于研究数据为回顾性收集,因而免除健康医疗保险批准。由2名放射医师评价2家医院1995-2006年诊断为肺癌病人发现肿瘤前的胸片，以找到漏诊的病变。记录结节的大小与部位，并对检出难度进行分级（1～4级，1级=非常难检出）。

Mesenchymal stem cell-derived exosomes:Shaping the next era of stroke treatment

Exosome-based treatments are gaining traction as a viable approach to addressing the various issues faced by an ischemic stroke.These extracellular vesicles,mainly produced by mesenchymal stem cells,exhibit many properties with substantial therapeutic potential.Exosomes are particularly appealing for stroke therapy because of their low immunogenicity,effective cargo transport,and ability to cross the blood–brain barrier.Their diverse effects include neuroprotection,angiogenesis stimulation,inflammatory response modulation,and cell death pathway attenuation,synergistically promoting neuronal survival,tissue regeneration,and functional recovery.Exosomes also show potential as diagnostic indicators for early stroke identification and customized treatment options.Despite these promising qualities,current exosome-based therapeutics have some limitations.The heterogeneity of exosome release among cell types,difficulty in standardization and isolation techniques,and complications linked to dosage and targeted administration necessitates extensive investigation.It is critical to thoroughly understand exosomal processes and their complicated interactions within the cellular milieu.To improve the practicality and efficacy of exosome-based medicines,research efforts must focus on improving production processes,developing robust evaluation criteria,and developing large-scale isolation techniques.Altogether,exosomes’multifunctional properties offer a new route for transforming stroke treatment and significantly improving patient outcomes.

MRI Findings in Post-Operative Bilateral Posterior Ischemic Optic Neuropathy

A 62-year-old female complained of vision loss following multiple abdominal surgeries for mesenteric ischemia. The patient’s visual acuity was no light perception (NLP) in the right eye and hand motion (HM) at 1’ in the left eye. Both pupils were unreactive and no relative afferent pupillary defect was noted. Anterior segment and fundus examination were unremarkable. T1 and T2 weighted MRI imaging of the brain was normal but diffusion weighted imaging (DWI) revealed areas of bright signal within both intraorbital optic nerves, confirming the diagnosis of posterior ischemic optic neuropathy.

3D printing-based frugal manufacturing of glass pipettes for minimally invasive delivery of therapeutics to the brain

Objective:Intracerebral delivery of agents in liquid form is usually achieved through commercially available and durable metal needles.However,their size and texture may contribute to mechanical brain damage.Glass pipettes with a thin tip may significantly reduce injection-associated brain damage but require access to prohibitively expensive programmable pipette pullers.This study is to remove the economic barrier to the application of minimally invasive delivery of therapeutics to the brain,such as chemical compounds,viral vectors,and cells.Methods:We took advantage of the rapid development of free educational online resources and emerging low-cost 3D printers by designing an affordable pipette puller(APP)to remove the cost obstacle.Results:We showed that our APP could produce glass pipettes with a sharp tip opening down to 20μm or less,which is sufficiently thin for the delivery of therapeutics into the brain.A pipeline from pipette pulling to brain injection using low-cost and open-source equipment was established to facilitate the application of the APP.Conclusion:In the spirit of frugal science,our device may democratize glass pipette-puling and substantially promote the application of minimally invasive and precisely controlled delivery of therapeutics to the brain for finding more effective therapies of brain diseases.

Join us on an amazing journey towards next-generation treatments for CNS disorders:Launch of Neuroprotection,a new high-quality journal in translational neuroscience

Translational medicine in neurodegenerative and neurovascular diseases is approaching a breakthrough point.Recent years have led to dramatic progress in both experimental and clinical research.Based on a much better and continuously increasing understanding of disease mechanisms,progression and pathophysiology,new therapies with an improved translational potential to protect tissue either against acute or chronic degeneration and even approaches potentially capable of repairing damaged brain tissue are emerging.

Preserving cognitive function in patients with Alzheimer's disease:The Alzheimer's disease neuroprotection research initiative(ADNRI)

The global trend toward aging populations has resulted in an increase in the occurrence of Alzheimer's disease(AD)and associated socioeconomic burdens.Abnormal metabolism of amyloid-β(Aβ)has been proposed as a significant pathomechanism in AD,supported by results of recent clinical trials using anti-Aβantibodies.Nonetheless,the cognitive benefits of the current treatments are limited.The etiology of AD is multifactorial,encompassing Aβand tau accumulation,neuroinflammation,demyelination,vascular dysfunction,and comorbidities,which collectively lead to widespread neurodegeneration in the brain and cognitive impairment.Hence,solely removing Aβfrom the brain may be insufficient to combat neurodegeneration and preserve cognition.To attain effective treatment for AD,it is necessary to(1)conduct extensive research on various mechanisms that cause neurodegeneration,including advances in neuroimaging techniques for earlier detection and a more precise characterization of molecular events at scales ranging from cellular to the full system level;(2)identify neuroprotective intervention targets against different neurodegeneration mechanisms;and(3)discover novel and optimal combinations of neuroprotective intervention strategies to maintain cognitive function in AD patients.The Alzheimer's Disease Neuroprotection Research Initiative's objective is to facilitate coordinated,multidisciplinary efforts to develop systemic neuroprotective strategies to combat AD.The aim is to achieve mitigation of the full spectrum of pathological processes underlying AD,with the goal of halting or even reversing cognitive decline.

Exploring novel experimental treatments for major neurodegenerative disorders

Acute and chronic neurodegenerative disorders such as ischemic stroke or Alzheimer's disease(AD)impose a major burden on patients,their relatives,caregivers,and health care systems in general.The socioeconomic impact of neurodegenerative disorders is anticipated to escalate due to a globally ageing population and the increasing prevalence of sedentary lifestyle and inappropriate dietary habits.On the contrary.

功能磁共振成像时域功能熵及其在脑疾病中的应用

熵,这一原本热力学概念被引入功能磁共振成像(fMRI)中,用于度量时间尺度上的规律性和不可预测性。时域功能熵和功能连接之间存在负的时空线性相关,被认为是大脑处理信息能力的重要指标,能提供区域灌注、低频波动幅度所不能提供的信息。作为大脑功能信号的一项基本特征,fMRI的时域功能熵已用于揭示意识、衰老等生理和病理状态(如阿尔茨海默病、精神分裂症、重度抑郁症、自闭症谱系障碍、成瘾和多发性硬化等疾病),为认识脑疾病提供了新的利器。本篇文章从fMRI时域功能熵及其分析技术的优势及局限性、生理基础及意义、临床应用和未来方向几个方面进行描述,以期能为相关专业领域的同道们进一步了解功能熵提供帮助。

心血管器械感染的分子影像:靶向细菌或宿主病原体免疫反应?

快速、准确诊断心血管器械感染仍是临床的一大挑战。解剖影像技术,如超声心动图、心脏CT或CT血管造影术是临床疑似心内膜炎的一线检查。其能检出赘生物和瓣膜周边并发症。既往研究表明,^(18)F-脱氧葡萄糖(FDG)PET/CT功能影像与解剖影像相比,具有独特优点。其可在发生形态学损伤前诊断早期心脏器械感染,并识别感染源或在体内其他部位的细菌栓子。尽管^(18)F-FDG PET/CT的异常结果已作为器械相关和人工瓣膜心内膜炎的主要诊断标准,被纳入到2015年的欧洲心脏病学会指南,但美国指南尚未纳入这一标准。除了这些临床可用的影像学手段,研究者们还致力于开发靶向细菌的示踪剂用于特异性感染显像,包括细菌麦芽糖糊精转运体、细菌胸苷激酶、抗生素、抗菌肽、细菌抗体、噬菌体和细菌DNA/RNA杂交核苷酸寡聚物的示踪剂。在上述示踪剂中,放射性标记的抗生素已在人体中进行了研究,但未能成功在临床上用于感染显像。其余大多数示踪剂仅在实验动物中进行了研究。本文比较了解剖和功能影像在心脏器械感染中的作用,并讨论了^(18)F-FDG和细菌靶向示踪剂的优缺点。