Objective: To develop a machine learning (ML) pipeline based on radiomics to predict Coronavirus Disease 2019 (COVID-19) severity and the future deterioration to critical illness using CT and clinical variables. Materials and Methods: Clinical data were collected from 981 patients from a multi-institutional international cohort with real-time polymerase chain reaction-confirmed COVID-19. Radiomics features were extracted from chest CT of the patients. The data of the cohort were randomly divided into training, validation, and test sets using a 7:1:2 ratio. A ML pipeline consisting of a model to predict severity and time-to-event model to predict progression to critical illness were trained on radiomics features and clinical variables. The receiver operating characteristic area under the curve (ROC-AUC), concordance index (C-index), and time-dependent ROC-AUC were calculated to determine model performance, which was compared with consensus CT severity scores obtained by visual interpretation by radiologists. Results: Among 981 patients with confirmed COVID-19, 274 patients developed critical illness. Radiomics features and clinical variables resulted in the best performance for the prediction of disease severity with a highest test ROC-AUC of 0.76 compared with 0.70 (0.76 vs. 0.70, p = 0.023) for visual CT severity score and clinical variables. The progression prediction model achieved a test C-index of 0.868 when it was based on the combination of CT radiomics and clinical variables compared with 0.767 when based on CT radiomics features alone (p < 0.001), 0.847 when based on clinical variables alone (p = 0.110), and 0.860 when based on the combination of visual CT severity scores and clinical variables (p = 0.549). Furthermore, the model based on the combination of CT radiomics and clinical variables achieved time-dependent ROC-AUCs of 0.897, 0.933, and 0.927 for the prediction of progression risks at 3, 5 and 7 days, respectively. Conclusion CT radiomics features combined with clinical variables were predictive of COVID-19 severity and progression to critical illness with fairly high accuracy.

Objective: To develop a machine learning (ML) pipeline based on radiomics to predict Coronavirus Disease 2019 (COVID-19) severity and the future deterioration to critical illness using CT and clinical variables. Materials and Methods: Clinical data were collected from 981 patients from a multi-institutional international cohort with real-time polymerase chain reaction-confirmed COVID-19. Radiomics features were extracted from chest CT of the patients. The data of the cohort were randomly divided into training, validation, and test sets using a 7:1:2 ratio. A ML pipeline consisting of a model to predict severity and time-to-event model to predict progression to critical illness were trained on radiomics features and clinical variables. The receiver operating characteristic area under the curve (ROC-AUC), concordance index (C-index), and time-dependent ROC-AUC were calculated to determine model performance, which was compared with consensus CT severity scores obtained by visual interpretation by radiologists. Results: Among 981 patients with confirmed COVID-19, 274 patients developed critical illness. Radiomics features and clinical variables resulted in the best performance for the prediction of disease severity with a highest test ROC-AUC of 0.76 compared with 0.70 (0.76 vs. 0.70, p = 0.023) for visual CT severity score and clinical variables. The progression prediction model achieved a test C-index of 0.868 when it was based on the combination of CT radiomics and clinical variables compared with 0.767 when based on CT radiomics features alone (p < 0.001), 0.847 when based on clinical variables alone (p = 0.110), and 0.860 when based on the combination of visual CT severity scores and clinical variables (p = 0.549). Furthermore, the model based on the combination of CT radiomics and clinical variables achieved time-dependent ROC-AUCs of 0.897, 0.933, and 0.927 for the prediction of progression risks at 3, 5 and 7 days, respectively. Conclusion CT radiomics features combined with clinical variables were predictive of COVID-19 severity and progression to critical illness with fairly high accuracy.

BACKGROUNDHippophae rhamnoides L. (HL) exerts antioxidant activities against various oxidative stress conditions. In this study, we investigated effects of extract from HL leaves (HLE) on cell proliferation and neuroblast differentiation in the subgranular zone (SGZ) of the dentate gyrus (DG) of aged gerbils.

METHODSAged gerbils (24 months) were divided into vehicle (saline)-treated- and HLE-treated-groups. The vehicle and HLE were orally administered with 200 mg/kg once a day for 20 days before sacrifice. Cell proliferation and neuroblast differentiation were examined in the DG using Ki67 and doublecortin (DCX), respectively. We also observed changes in immunoreactivities of superoxide dismutase 1 (SOD1) and superoxide dismutase 2 (SOD2), brain-derived neurotrophic factor (BDNF), and phospho-glycogen synthase kinase-3-beta (p-GSK-3β) to examine their relation with neurogenesis using immunohistochemistry.

RESULTSThe administration of HLE significantly increased the number of Ki67-positive cells and DCX-positive neuroblasts with well-developed processes in the SGZ of the DG of the HLE-treated-group. In addition, immunoreactivities of SOD1, SOD2, BDNF, and p-GSK-3β were significantly increased in granule and polymorphic cells of the DG in the HLE-treated-group compared with those in the vehicle-treated-group.

CONCLUSIONSHLE treatment significantly increased cell proliferation and neuroblast differentiation, showing that immunoreactivities of SOD1, SOD2, BDNF, and p-GSK-3β were significantly increased in the DG. These indicate that increased neuroblast differentiation neurogenesis may be closely related to upregulation of SOD1, SOD2, BDNF, and p-GSK-3β in aged gerbils.

Animals ; Brain-Derived Neurotrophic Factor ; metabolism ; Cell Differentiation ; drug effects ; Cell Proliferation ; drug effects ; Dentate Gyrus ; drug effects ; metabolism ; Gerbillinae ; Glycogen Synthase Kinase 3 ; metabolism ; Glycogen Synthase Kinase 3 beta ; Hippophae ; drug effects ; metabolism ; Immunohistochemistry ; Intrinsic Factor ; metabolism ; Male ; Neurogenesis ; drug effects ; Superoxide Dismutase ; metabolism ; Superoxide Dismutase-1

In the present study, we investigated the effect of Tetaus toxin (TeT) on cell proliferation and neuroblast differentiation using specific markers: 5-bromo-2-deoxyuridine (BrdU) as an exogenous marker for cell proliferation, Ki-67 as an endogenous marker for cell proliferation and doublecortin (DCX) as a marker for neuroblasts in the mouse hippocampal dentate gyrus (DG) after TeT treatment. Mice were intraperitoneally administered 2.5 and 10 ng/kg TeT and sacrificed 15 days after the treatment. In both the TeT-treated groups, no neuronal death occurred in any layers of the DG using neuronal nuclei (NeuN, a neuron nuclei maker) and Fluoro-Jade B (F-J B, a high-affinity fluorescent marker for the localization of neuronal degeneration). In addition, no significant change in glial activation in both the 2.5 and 10 ng/kg TeT-treated-groups was found by GFAP (a marker for astrocytes) and Iba-1 (a marker for microglia) immunohistochemistry. However, in the 2.5 ng/kg TeT-treated-group, the mean number of BrdU, Ki-67 and DCX immunoreactive cells, respectively, were apparently decreased compared to the control group, and the mean number of each in the 10 ng/kg TeT-treated-group was much more decreased. In addition, processes of DCX-immunoreactive cells, which projected into the molecular layer, were short compared to those in the control group. In brief, our present results show that low dosage (10 ng/kg) TeT treatment apparently decreased cell proliferation and neuroblast differentiation in the mouse hippocampal DG without distinct gliosis as well as any loss of adult neurons.
Adult ; Animals ; Bromodeoxyuridine ; Cell Proliferation ; Dentate Gyrus ; Exotoxins ; Fluoresceins ; Gliosis ; Humans ; Immunohistochemistry ; Mice ; Neurogenesis ; Neurons ; Tetanus ; Tetanus Toxin

OBJECTIVE: To compare tension-free vaginal tape (TVT) and transobturator tape (TOT) for surgical treatment of stress urinary incontinence (SUI) associated with pelvic organ prolapse (POP). METHODS: Two hundred seventy eight consecutive patients affected by SUI associated with POP more than stage II were included in this retrospective study. Cure rate and postoperative complications such as hemoglobin difference between preoperative and postoperative period, vaginal hematoma, bladder and bowel injury, vaginal mesh erosion, urinary retention, de novo urgency, urinary tract infection were compared. Student's t-test and chi square test were used for statistical analysis. A P-value below 0.05 was considered statistically significant. RESULTS: The number of patients underwent TVT was 145 and TOT was 133. All patients were followed up for more than 12 months. The general characteristics of patients showed no significant difference between the two groups. There was no difference between two groups in cure rate. However, hemoglobin difference (TVT, 2.91+/-0.93 g/dL; TOT, 1.53+/-0.77 g/dL; P=0.04) was higher in TVT group than TOT group and urinary retention within 1 month (TVT, 35.17%; TOT, 21.05; P=0.02), and urinary tract infection (TVT, 11.72%; TOT, 3.75%; P=0.02) more frequently appeared in TVT group than TOT group. Other postoperative complications such as vaginal hematoma (TVT, 6.89%; TOT, 6.76%; P=0.86), bowel injury (TVT, 0%; TOT, 1.5%; P=0.64), vaginal mesh erosion (TVT, 7.58%; TOT, 4.51%; P=0.47), urinary retention after 1 month (TVT, 2.76%; TOT, 3.00%; P=0.35), de novo urgency (TVT 7.58%, TOT: 6.01%, P=0.48) were not different between two groups. CONCLUSION: Both procedures appear to be equally effective in the surgical treatment of SUI associated with POP. However, TOT seems to be a more safe procedure in postoperative complications.
Hematoma ; Hemoglobins ; Humans ; Pelvic Organ Prolapse ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Suburethral Slings ; Urinary Bladder ; Urinary Incontinence ; Urinary Retention ; Urinary Tract Infections

Peripheral nerve injury often results in abnormal neuropathic pain such as allodynia or hyperalgesia. Acupuncture, a traditional Oriental medicine, has been used to relieve pain and related symptoms. However, the efficiency of acupuncture in relieving neuropathic pain is not clear. The aim of this study was to investigate the anti-allodynic effects of acupuncture through behavioral and electrophysiological examinations. Male Sprague-Dawley rats were subjected to neuropathic surgery consisting of a tight ligation and transection of the left tibial and sural nerves, under pentobarbital anesthesia. The acupuncture experiment consisted of four different groups, one treated at each of three different acupoints (Zusanli (ST36), Yinlingquan (SP9), and a sham-acupoint) and a control group. Behavioral tests for mechanical allodynia and cold allodynia were performed for up to two weeks postoperatively. Extracellular electrophysiological recordings were made from the dorsal roots using platinum wire electrodes. Mechanical and cold allodynia were significantly reduced after acupuncture treatment at the Zusanli and Yinlingquan acupoints, respectively. Electrophysiological neural responses to von Frey and acetone tests were also reduced after acupuncture at the same two acupoints. These results suggest that acupuncture may be beneficial in relieving neuropathic pain.
Spinal Nerve Roots/*physiology ; Rats, Sprague-Dawley ; Rats ; Neuralgia/physiopathology/*therapy ; Male ; Electrophysiology ; Animals ; *Acupuncture Analgesia

Peripheral nerve injury often results in abnormal neuropathic pain such as allodynia or hyperalgesia. Acupuncture, a traditional Oriental medicine, has been used to relieve pain and related symptoms. However, the efficiency of acupuncture in relieving neuropathic pain is not clear. The aim of this study was to investigate the anti-allodynic effects of acupuncture through behavioral and electrophysiological examinations. Male Sprague-Dawley rats were subjected to neuropathic surgery consisting of a tight ligation and transection of the left tibial and sural nerves, under pentobarbital anesthesia. The acupuncture experiment consisted of four different groups, one treated at each of three different acupoints (Zusanli (ST36), Yinlingquan (SP9), and a sham-acupoint) and a control group. Behavioral tests for mechanical allodynia and cold allodynia were performed for up to two weeks postoperatively. Extracellular electrophysiological recordings were made from the dorsal roots using platinum wire electrodes. Mechanical and cold allodynia were significantly reduced after acupuncture treatment at the Zusanli and Yinlingquan acupoints, respectively. Electrophysiological neural responses to von Frey and acetone tests were also reduced after acupuncture at the same two acupoints. These results suggest that acupuncture may be beneficial in relieving neuropathic pain.
Spinal Nerve Roots/*physiology ; Rats, Sprague-Dawley ; Rats ; Neuralgia/physiopathology/*therapy ; Male ; Electrophysiology ; Animals ; *Acupuncture Analgesia

OBJECTIVE: To determine if the placental size is disproportionately increased in the large-for-gestational age infants in pregnancies complicated by impaired glucose tolerance controlled with insulin. PATIENS AND METHODS: A retrospective study was performed on 104 singleton pregnancies complicated by gestational impaired glucose tolerance controlled with insulin. The cases were categorized by the infant birthweight percentile into three groups, i.e. small-for-gestational age (<10(th) percentile), appropriate-for- gestational age (10(th) to 90(th) percentile) and large-for-gestational age (>90th percentile). Maternal and infant anthropometric data, glycemic status, and placental weight-to-birthweight ratio were compared among three groups. RESULTS: The maternal glucose level just after delivery, infant body mass index and placental weight showed a significant increment from the small-for-gestational age to the large-for-gestational age groups (p<0.05). The placental weight-to-birthweight ratio was significantly higher in the small-for-gestational group. On the other hand, there was no significant difference in the values of the oral glucose test, hemoglobin A1c and maternal body mass index among three groups. Maternal body mass index showed a increasing trend from the small-for gestational age to the large-for-gestational age groups. Placental weight-to-birthweight ratio was not significantly correlate with maternal glucose level. CONCLUSIONS: The results indicate that the placenta is disproportionately bigger, and rigid control of maternal blood glucose does not prevent the development of placental overgrowth. Maternal obesity in well- controlled gestational diabetes mellitus may be more significant than glucose control in the development of large-for-gestational-age infants. Different management strategies for women with gestational diabetes mellitus with different pregravid weights are warranted.
Blood Glucose ; Body Mass Index ; Diabetes, Gestational* ; Female ; Gestational Age ; Glucose ; Hand ; Humans ; Infant* ; Insulin* ; Obesity ; Placenta ; Pregnancy ; Retrospective Studies ; Weights and Measures

A case of mucinous cystadenocarcinoma arising from a mature cystic teratoma in the right ovary of a 37-year-old woman is reported. Malignant transformation of a mature teratoma is a rare event and the commonest malignant neoplasm to develop is squamous cell carcinoma.(83%) Adenocarcinoma occurs with less frequency.(6.8%) The patient was treated by staging operation followed by adjuvant chemotherapy. After six courses of combination chemotherapy, oncological investigations, including chest X-ray, abdominopelvic CT scan and tumor markers, all revealed no evidence of recurrence.
Adenocarcinoma ; Adult ; Chemotherapy, Adjuvant ; Cystadenocarcinoma, Mucinous* ; Drug Therapy, Combination ; Female ; Humans ; Mucins* ; Ovary* ; Recurrence ; Teratoma* ; Thorax ; Tomography, X-Ray Computed ; Biomarkers, Tumor

Inflammatory pseudotumor (IPT) is an uncommon benign neoplasm of unknown etiology presenting as an incidental mass, fever, malaise, anemia, and weight loss. Generally, IPT in the lung is asymptomatic. A case of pulmonary IPT presenting as prolonged fever in a 59 year old man is presented with clinicopathological findings. The patient had been febrile for three months before admission. Five months before admission, a chest X-ray showed a small left pulmonary mass which was regarded as old tuberculosis. An chest X-ray taken on admission revealed a left pulmonary mass two times the size of the one on the first x-ray. Percutaneous needle aspiration and biopsy were performed, and the microscopic examination revealed a plasma cell reaction with myofibroblastic proliferation, consistent with IPT. As prolonged unexplained fever is a frequent symptom in patients with IPTs, this disease entity should be included in the differential diagnosis of fever of unknown origin.
Anemia ; Biopsy ; Diagnosis, Differential ; Fever of Unknown Origin* ; Fever* ; Granuloma, Plasma Cell ; Humans ; Lung ; Middle Aged ; Myofibroblasts ; Needles ; Plasma Cell Granuloma, Pulmonary* ; Plasma Cells ; Thorax ; Tuberculosis ; Weight Loss