bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deep Learning-Based Classification of Inflammatory Arthritis by Identification of Joint Shape Patterns—How Neural Networks Can Tell Us Where to “Deep Dive” Clinically
Authors: Folle Lukas , Simon David , Tascilar Koray , Krönke Gerhard , Liphardt Anna-Maria , Maier Andreas , Schett Georg , Kleyer Arnd 
Published: March 2022

Objective:We investigated whether a neural network based on the shape of joints can differentiate between rheumatoid arthritis (RA), psoriatic arthritis (PsA), and healthy controls (HC), which class patients with undifferentiated arthritis (UA) are assigned to, and whether this neural network is able to identify disease-specific regions in joints.MethodsWe trained a novel neural network on 3D articular bone shapes of hand joints of RA and PsA patients as well as HC. Bone shapes were created from high-resolution peripheral-computed-tomography (HR-pQCT) data of the second metacarpal bone head. Heat maps of critical spots were generated using GradCAM. After training, we fed shape patterns of UA into the neural network to classify them into RA, PsA, or HC.ResultsHand bone shapes from 932 HR-pQCT scans of 617 patients were available. The network could differentiate the classes with an area-under-receiver-operator-curve of 82% for HC, 75% for RA, and 68% for PsA. Heat maps identified anatomical regions such as bare area or ligament attachments prone to erosions and bony spurs. When feeding UA data into the neural network, 86% were classified as “RA,” 11% as “PsA,” and 3% as “HC” based on the joint shape.ConclusionWe investigated neural networks to differentiate the shape of joints of RA, PsA, and HC and extracted disease-specific characteristics as heat maps on 3D joint shapes that can be utilized in clinical routine examination using ultrasound. Finally, unspecific diseases such as UA could be grouped using the trained network based on joint shape.
Effect of 3-Month Aerobic Dance on Hippocampal Volume and Cognition in Elderly People With Amnestic Mild Cognitive Impairment: A Randomized Controlled Trial
Authors: Zhu Yi , Gao Yaxin , Guo Chuan , Qi Ming , Xiao Ming , Wu Han , Ma Jinhui , Zhong Qian , Ding Hongyuan , Zhou Qiumin , Ali Nawab , Zhou Li , Zhang Qin , Wu Ting , Wang Wei , Sun Cuiyun , Thabane Lehana , Zhang Ling , Wang Tong 
Published: March 2022

As an intermediate state between normal aging and dementia, mild cognitive impairment (MCI), especially amnestic MCI (aMCI), is a key stage in the prevention and intervention of Alzheimer’s disease (AD). Whether dancing could increase the hippocampal volume of seniors with aMCI remains debatable. The aim of this study was to investigate the influence of aerobic dance on hippocampal volume and cognition after 3 months of aerobic dance in older adults with aMCI. In this randomized controlled trial, 68 elderly people with aMCI were randomized to either the aerobic dance group or the control group using a 1:1 allocation ratio. Ultimately, 62 of 68 participants completed this study, and the MRI data of 54 participants were included. A specially designed aerobic dance routine was performed by the dance group three times per week for 3 months, and all participants received monthly healthcare education after inclusion. MRI with a 3.0T MRI scanner and cognitive assessments were performed before and after intervention. High-resolution three-dimensional (3D) T1-weighted anatomical images were acquired for the analysis of hippocampal volume. A total of 35 participants (mean age: 71.51 ± 6.62 years) were randomized into the aerobic dance group and 33 participants (mean age: 69.82 ± 7.74 years) into the control group. A multiple linear regression model was used to detect the association between intervention and the difference of hippocampal volumes as well as the change of cognitive scores at baseline and after 3 months. The intervention group showed greater right hippocampal volume (β [95% CI]: 0.379 [0.117, 0.488], p = 0.002) and total hippocampal volume (β [95% CI]: 0.344 [0.082, 0.446], p = 0.005) compared to the control group. No significant association of age or gender was found with unilateral or global hippocampal volume. There was a correlation between episodic memory and intervention, as the intervention group showed a higher Wechsler Memory Scale-Revised Logical Memory (WMS-RLM) score (β [95% CI]: 0.326 [1.005, 6.773], p = 0.009). Furthermore, an increase in age may cause a decrease in the Mini-Mental State Examination (MMSE) score (β [95% CI]: −0.366 [−0.151, −0.034], p = 0.002). In conclusion, 3 months of aerobic dance could increase the right and total hippocampal volumes and improve episodic memory in elderly persons with aMCI.Clinical Trial Registration: This study was registered on the Chinese Clinical Trial Registry [www.chictr.org.cn], identifier [ChiCTR-INR-15007420].
A New Nomogram for Predicting the Risk of Intracranial Hemorrhage in Acute Ischemic Stroke Patients After Intravenous Thrombolysis
Authors: Weng Ze-An , Huang Xiao-Xiong , Deng Die , Yang Zhen-Guo , Li Shu-Yuan , Zang Jian-Kun , Li Yu-Feng , Liu Yan-Fang , Wu You-Sheng , Zhang Tian-Yuan , Su Xuan-Lin , Lu Dan , Xu An-Ding 
Published: March 2022

BackgroundWe aimed to develop and validate a new nomogram for predicting the risk of intracranial hemorrhage (ICH) in patients with acute ischemic stroke (AIS) after intravenous thrombolysis (IVT).MethodsA retrospective study enrolled 553 patients with AIS treated with IVT. The patients were randomly divided into two cohorts: the training set (70%, n = 387) and the testing set (30%, n = 166). The factors in the predictive nomogram were filtered using multivariable logistic regression analysis. The performance of the nomogram was assessed based on the area under the receiver operating characteristic curve (AUC-ROC), calibration plots, and decision curve analysis (DCA).ResultsAfter multivariable logistic regression analysis, certain factors, such as smoking, National Institutes of Health of Stroke Scale (NIHSS) score, blood urea nitrogen-to-creatinine ratio (BUN/Cr), and neutrophil-to-lymphocyte ratio (NLR), were found to be independent predictors of ICH and were used to construct a nomogram. The AUC-ROC values of the nomogram were 0.887 (95% CI: 0.842–0.933) and 0.776 (95% CI: 0.681–0.872) in the training and testing sets, respectively. The AUC-ROC of the nomogram was higher than that of the Multicenter Stroke Survey (MSS), Glucose, Race, Age, Sex, Systolic blood Pressure, and Severity of stroke (GRASPS), and stroke prognostication using age and NIH Stroke Scale-100 positive index (SPAN-100) scores for predicting ICH in both the training and testing sets (p &lt; 0.05). The calibration plot demonstrated good agreement in both the training and testing sets. DCA indicated that the nomogram was clinically useful.ConclusionsThe new nomogram, which included smoking, NIHSS, BUN/Cr, and NLR as variables, had the potential for predicting the risk of ICH in patients with AIS after IVT.
Factors Associated With the Improvement of Left Ventricular Systolic Function by Continuous Positive Airway Pressure Therapy in Patients With Heart Failure With Reduced Ejection Fraction and Obstructive Sleep Apnea
Authors: Naito Ryo , Kasai Takatoshi , Dohi Tomotaka , Takaya Hisashi , Narui Koji , Momomura Shin-ichi 
Published: March 2022

BackgroundObstructive sleep apnea (OSA) is a potential risk factor in cardiovascular diseases, including arrhythmia, coronary artery disease, and heart failure (HF). Continuous positive airway pressure (CPAP) therapy is an effective therapy for OSA and the underlying HF, partly through a 5–9% increase in the left ventricular ejection fraction (LVEF). However, the data on the factors associated with the efficacy of CPAP on LVEF in patients with HF complicated by OSA are scarce. This study aimed to investigate whether LVEF improves in patients with OSA and HF after 1 month of CPAP therapy, and to clarify which factors are associated with the degree of LVEF improvement.MethodThis was a prospective, single-arm, open-label study. We enrolled moderate-to-severe patients with OSA and HF who were being followed up at the cardiovascular center of Toranomon Hospital (Tokyo, Japan). The parameters of sleep study and LVEF were assessed at the baseline and after 1 month of CPAP. The multivariate regression analyses, with changes in LVEF as a dependent variable, were performed to determine the factors that were associated with the degree of LVEF improvement.ResultsWe analyzed 55 consecutive patients with OSA and HF (mean age: 60.7 ± 12.2 years, mean LVEF value: 37.2 ± 9.8%). One month of CPAP treatment decreased the apnea-hypopnea index (AHI) from 45.3 ± 16.1 to 5.4 ± 4.1 per hour, and the LVEF improved from 37.2 ± 9.8 to 43.2 ± 11.7%. The multivariate regression analyses demonstrated that age and body mass index (BMI) were significant determinants of LVEF improvement.ConclusionThe LVEF improved significantly after 1 month of CPAP therapy in Japanese patients with OSA and HF. Multivariate regression analyses indicated that an improvement in LVEF was likely to be observed in young patients with obesity.
Incidence and Long-Term Survival of Spontaneous Intracerebral Hemorrhage Over Time: A Systematic Review and Meta-Analysis
Authors: Li Xianqi , Zhang Li , Wolfe Charles D. A. , Wang Yanzhong 
Published: March 2022

Background and PurposeRecent epidemiological data indicate that the absolute number of hemorrhagic stroke cases increased by 47% between 1990 and 2010 and continued to cause high rates of death and disability. The last systematic review and meta-analysis of incidence and long-term survival of intracerebral hemorrhage (ICH) were published 11 and 7 years ago, respectively, and lacked comparison between different income groups, therefore, a more up to date analysis is needed. We aim to investigate the ICH incidence and long-term survival data in countries of different income groups.Materials MethodsWe systematically searched Ovid Medline for population-based longitudinal studies of first-ever spontaneous ICH published from January 2000 to December 2020. We performed meta-analyses on the incidence and survival rate in countries of 4 different income groups with random-effects models (severe inconsistency). The I2 was used to measure the heterogeneity. Heterogeneity was further investigated by conducting the meta-regression on the study mid-year. Time trends of the survival rate were assessed by weighted linear regression.ResultsWe identified 84 eligible papers, including 68 publications reporting incidence and 24 publications on the survival rate. The pooled incidence of ICH per 100,000 per person-years was 26.47 (95% CI: 21.84–32.07) worldwide, 25.9 (95% CI: 22.63–29.63) in high-income countries (HIC), 28.45 (95% CI: 15.90–50.88) in upper-middle-income countries, and 31.73 (95% CI: 18.41–54.7) in lower-middle-income countries. The 1-year pooled survival rate was from 50% (95% CI: 47–54%; n = 4,380) worldwide to 50% (95% CI: 47–54%) in HIC, and 46% (95% CI: 38–55%) in upper-middle income countries. The 5-year pooled survival rate was 41% (95% CI: 35–48%; n = 864) worldwide, 41% (95% CI: 32–50%) in high-income and upper-middle countries. No publications were found reporting the long-term survival in lower-middle-income and low-income countries. No time trends in incidence or survival were found by meta-regression.ConclusionThe pooled ICH incidence was highest in lower-middle-income countries. About half of ICH patients survived 1 year, and about two-fifths survived 5 years. Reliable population-based studies estimating the ICH incidence and long-term survival in low-income and low-middle-income countries are needed to help prevention of ICH.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170140, PROSPERO CRD42020170140.
Quantitative Evaluation of the Association Between Fixation Stability and Phoria During Short-Term Binocular Viewing
Authors: Kim Sang-Yeob , Moon Byeong-Yeon , Cho Hyun Gug , Yu Dong-Sik 
Published: March 2022

PurposeFixation stability for binocular anomalies with a phoria cannot be detected by direct observations. This study aimed to quantitatively evaluate fixation stability using an eye tracker rather than direct directions in binocular vision with abnormal and normal phorias.MethodsThirty-five and 25 participants with abnormal and normal phoria, respectively, were included in the study. The horizontal and vertical gaze points and convergence were recorded for 10 s using a remote eye tracker while binocularly viewing a target on a display screen 550 mm away. Fixation stability was quantified using bivariate contour ellipse areas (BCEA).ResultsThe fixation stability for all participants-based evaluations as a single cluster in the abnormal phoria group was lower than that in the normal phoria group (p= 0.005). There was no difference between the two groups in the evaluation based on the BCEA for each participant-based evaluation (p= 0.66). Fixation stability was also more related to convergence for the abnormal phoria group than for the normal phoria group (r= 0.769,p&lt; 0.001;r= 0.417,p= 0.038, respectively).ConclusionAs the first study to evaluate fixation stability using an eye-tracker to differentiate between abnormal and normal phoria for non-strabismus, these findings may provide evidence for improving the evaluation of binocular vision not detected with clinical diagnostic tests.
The Application of Diffusion Kurtosis Imaging on the Heterogeneous White Matter in Relapsing-Remitting Multiple Sclerosis
Authors: Zhu Qiyuan , Zheng Qiao , Luo Dan , Peng Yuling , Yan Zichun , Wang Xiaohua , Chen Xiaoya , Li Yongmei 
Published: March 2022

ObjectivesTo evaluate the microstructural damage in the heterogeneity of different white matter areas in relapsing-remitting multiple sclerosis (RRMS) patients by using diffusion kurtosis imaging (DKI) and its correlation with clinical and cognitive status.Materials and MethodsKurtosis fractional anisotropy (KFA), fractional anisotropy (FA), mean kurtosis (MK), and mean diffusivity (MD) in T1-hypointense lesions (T1Ls), pure T2-hyperintense lesions (pure-T2Ls), normal-appearing white matter (NAWM), and white matter in healthy controls (WM in HCs) were measured in 48 RRMS patients and 26 sex- and age-matched HCs. All the participants were assessed with the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Symbol Digit Modalities Test (SDMT) scores as the cognitive status. The Kurtzke Expanded Disability Status Scale (EDSS) scores were used to evaluate the clinical status in RRMS patients.ResultsThe lowest KFA, FA, and MK values and the highest MD values were found in T1Ls, followed by pure-T2Ls, NAWM, and WM in HCs. The T1Ls and pure-T2Ls were significantly different in FA (p = 0.002) and MK (p = 0.013), while the NAWM and WM in HCs were significantly different in KFA, FA, and MK (p &lt; 0.001; p &lt; 0.001; p = 0.001). The KFA, FA, MK, and MD values in NAWM (r = 0.360, p = 0.014; r = 0.415, p = 0.004; r = 0.369, p = 0.012; r = −0.531, p &lt; 0.001) were correlated with the MMSE scores and the FA, MK, and MD values in NAWM (r = 0.423, p = 0.003; r = 0.427, p = 0.003; r = −0.359, p = 0.014) were correlated with the SDMT scores.ConclusionApplying DKI to the imaging-based white matter classification has the potential to reflect the white matter damage and is correlated with cognitive impairment.
CRMP4 CpG Hypermethylation Predicts Upgrading to Gleason Score ≥ 8 in Prostate Cancer
Authors: Qin Xiao-Ping , Lu Qi-Ji , Yang Cheng-Huizi , Wang Jue , Chen Jian-Fan , Liu Kan , Chen Xin , Zhou Jing , Pan Yu-Hang , Li Yong-Hong , Ren Shan-Cheng , Liu Jiu-Min , Liu Wei-Peng , Qian Hui-Jun , Yi Xian-Lin , Lai Cai-Yong , Qu Li-Jun , Gao Xin , Xu Yu-Sheng , Chen Zheng , Zhuo Yu-Min 
Published: March 2022

BackgroundThis study determined the predictive value of CRMP4 promoter methylation in prostate tissues collected by core needle biopsies for a postoperative upgrade of Gleason Score (GS) to ≥8 in patients with low-risk PCa.MethodA retrospective analysis of the clinical data was conducted from 631 patients diagnosed with low-risk PCa by core needle biopsy at multiple centers and then underwent Radical Prostatectomy (RP) from 2014-2019. Specimens were collected by core needle biopsy to detect CRMP4 promoter methylation. The pathologic factors correlated with the postoperative GS upgrade to ≥8 were analyzed by logistic regression. The cut-off value for CRMP4 promoter methylation in the prostate tissues collected by core needle biopsy was estimated from the ROC curve in patients with a postoperative GS upgrade to ≥8.ResultMultivariate logistic regression showed that prostate volume, number of positive cores, and CRMP4 promoter methylation were predictive factors for a GS upgrade to ≥8 (OR: 0.94, 95% CI: 0.91-0.98, P=0.003; OR: 3.16, 95% CI: 1.81-5.53, P&lt;0.001; and OR: 1.43, 95% CI: 1.32-1.55, P&lt;0.001, respectively). The positive predictive rate was 85.2%, the negative predictive rate was 99.3%, and the overall predictive rate was 97.9%. When the CRMP4 promoter methylation rate was &gt;18.00%, the low-risk PCa patients were more likely to escalate to high-risk patients. The predictive sensitivity and specificity were 86.9% and 98.8%, respectively. The area under the ROC curve (AUC) was 0.929 (95% CI: 0.883-0.976; P&lt;0.001). The biochemical recurrence (BCR)-free survival, progression-free survival (PFS), and cancer-specific survival (CSS) were worse in patients with CRMP4 methylation &gt;18.0% and postoperative GS upgrade to ≥8 than in patients without an upgrade (P ≤ 0.002).ConclusionA CRMP4 promoter methylation rate &gt;18.00% in prostate cancer tissues indicated that patients were more likely to escalate from low-to-high risk after undergoing an RP. We recommend determining CRMP4 promoter methylation before RP for low-risk PCa patients.
Pretreatment DCE-MRI-Based Deep Learning Outperforms Radiomics Analysis in Predicting Pathologic Complete Response to Neoadjuvant Chemotherapy in Breast Cancer
Authors: Peng Yunsong , Cheng Ziliang , Gong Chang , Zheng Chushan , Zhang Xiang , Wu Zhuo , Yang Yaping , Yang Xiaodong , Zheng Jian , Shen Jun 
Published: March 2022

PurposeTo compare the performances of deep learning (DL) to radiomics analysis (RA) in predicting pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) based on pretreatment dynamic contrast-enhanced MRI (DCE-MRI) in breast cancer.Materials and MethodsThis retrospective study included 356 breast cancer patients who underwent DCE-MRI before NAC and underwent surgery after NAC. Image features and kinetic parameters of tumors were derived from DCE-MRI. Molecular information was assessed based on immunohistochemistry results. The image-based RA and DL models were constructed by adding kinetic parameters or molecular information to image-only linear discriminant analysis (LDA) and convolutional neural network (CNN) models. The predictive performances of developed models were assessed by receiver operating characteristic (ROC) curve analysis and compared with the DeLong method.ResultsThe overall pCR rate was 23.3% (83/356). The area under the ROC (AUROC) of the image-kinetic-molecular RA model was 0.781 [95% confidence interval (CI): 0.735, 0.828], which was higher than that of the image-kinetic RA model (0.629, 95% CI: 0.595, 0.663;P&lt; 0.001) and comparable to that of the image-molecular RA model (0.755, 95% CI: 0.708, 0.802;P= 0.133). The AUROC of the image-kinetic-molecular DL model was 0.83 (95% CI: 0.816, 0.847), which was higher than that of the image-kinetic and image-molecular DL models (0.707, 95% CI: 0.654, 0.761; 0.79, 95% CI: 0.768, 0.812;P&lt; 0.001) and higher than that of the image-kinetic-molecular RA model (0.778, 95% CI: 0.735, 0.828;P&lt; 0.001).ConclusionsThe pretreatment DCE-MRI-based DL model is superior to the RA model in predicting pCR to NAC in breast cancer patients. The image-kinetic-molecular DL model has the best prediction performance.
Lung Ultrasound to Detect Pneumothorax in Children Evaluated for Acute Chest Pain in the Emergency Department: An Observational Pilot Study
Authors: Scialanga Barbara , Buonsenso Danilo , Scateni Simona , Valentini Piero , Schingo Paolo Maria Salvatore , Boccuzzi Elena , Mesturino Maria Alessia , Ferro Valentina , Chiaretti Antonio , Villani Alberto , Supino Maria Chiara , Musolino Anna Maria 
Published: March 2022

BackgroundSpontaneous pneumothorax is a relatively uncommon and poorly studied condition in children. While several protocols have been developed to evaluate the use of lung ultrasound for dyspneic adult patients in the emergency department, no specific guidelines are present for pediatric emergency physicians.ObjectivesWe prospectively analyzed children with acute chest pain and clinical suspicion of pneumothorax evaluated at the pediatric emergency department.MethodsWe consecutively enrolled children aged 5–17 years presenting to the pediatric emergency department with clinically suspected pneumothorax based on sudden onset of acute chest pain. After clinical examination, all children underwent lung ultrasound followed by chest X-ray (reference standard). We enrolled 77 children, of which 13 (16.9%) received a final diagnosis of pneumothorax.ResultsThe lung point had a sensitivity of 92.3% (95% CI 77.8–100) and a specificity of 100% (95% CI 94.4–100) for the detection of pneumothorax. The “barcode sign” had a sensitivity of 100% (95% CI 75.3–100) and a specificity of 100% (95% CI 94.4–100) for the detection of pneumothorax.ConclusionLung ultrasound is highly accurate in detecting or excluding pneumothorax in children with acute chest pain evaluated in the pediatric emergency department. If pneumothorax is suspected, but the lung point is not visible, the barcode sign should always be sought as it could be a form of massive pneumothorax.
Biomarkers for Diagnosing Febrile Illness in Immunocompromised Children: A Systematic Review of the Literature
Authors: van der Velden Fabian J. S. , Gennery Andrew R. , Emonts Marieke 
Published: March 2022

ObjectiveThis study aims to assess the performance of biomarkers used for the prediction of bacterial, viral, and fungal infection in immunocompromised children upon presentation with fever.MethodsWe performed a literature search using PubMed and MEDLINE and In-Process &amp; Other Non-indexed Citations databases. Cohort and case–control studies assessing biomarkers for the prediction of bacterial, viral, or fungal infection in immunocompromised children vs. conventional microbiological investigations were eligible. Studies including adult patients were eligible if pediatric data were separately assessable. Data on definitions used for infections, fever, and neutropenia and predictive values were collected. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool.ResultsFifty-two studies involving 13,939 febrile episodes in 7,059 children were included. In total, 92.2% were in cancer patients (n = 48), and 15.7% also included hematopoietic stem cell transplantation patients (n = 8). Forty-three biomarkers were investigated, of which 6 (CRP, PCT, IL-8, IL-6, IL-10, and TNFα) were significantly associated with bacterial infection at admission, studied in multiple studies, and provided predictive data. Literature on the prediction of viral and fungal infection was too limited. Eight studies compared C-reactive protein (CRP) and procalcitonin (PCT), with PCT demonstrating superiority in 5. IL-6, IL-8, and IL-10 were compared with CRP in six, four, and one study, respectively, with mixed results on diagnostic superiority. No clear superior biomarker comparing PCT vs. IL-6, IL-8, or IL-10 was identified.DiscussionThere is great heterogeneity in the biomarkers studied and cutoff values and definitions used, thus complicating the analysis. Literature for immunocompromised children with non-malignant disease and for non-bacterial infection is sparse. Literature on novel diagnostics was not available. We illustrated the challenges of diagnosing fever adequately in this study population and the need for improved biomarkers and clinical decision-making tools.