OBJECTIVES: We propose a Contrastive Regional Attention and Prior Knowledge-Infused U-Transformer model (CRAKUT) to address the challenges of imbalanced text distribution, lack of contextual clinical knowledge, and cross-modal information transformation to enhance the quality of generated radiology reports. METHODS: The CRAKUT model comprises 3 key components, including an image encoder that utilizes common normal images from the dataset for extracting enhanced visual features, an external knowledge infuser that incorporates clinical prior knowledge, and a U-Transformer that facilitates cross-modal information conversion from vision to language. The contrastive regional attention in the image encoder was introduced to enhance the features of abnormal regions by emphasizing the difference between normal and abnormal semantic features. Additionally, the clinical prior knowledge infuser within the text encoder integrates clinical history and knowledge graphs generated by ChatGPT. Finally, the U-Transformer was utilized to connect the multi-modal encoder and the report decoder in a U-connection schema, and multiple types of information were used to fuse and obtain the final report. RESULTS: We evaluated the proposed CRAKUT model on two publicly available CXR datasets (IU-Xray and MIMIC-CXR). The experimental results showed that the CRAKUT model achieved a state-of-the-art performance on report generation with a BLEU-4 score of 0.159, a ROUGE-L score of 0.353, and a CIDEr score of 0.500 in MIMIC-CXR dataset; the model also had a METEOR score of 0.258 in IU-Xray dataset, outperforming all the comparison models. CONCLUSIONS The proposed method has great potential for application in clinical disease diagnoses and report generation.
Humans ; Radiology Information Systems ; Radiology

Objective To discuss the curative effect of hepatic arterial infusion chemotherapy(HAIC)combined with programmed death receptor-1(PD-1)inhibitors and anti-angiogenesis therapy for BCLC stage C hepatocellular carcinoma(HCC).Methods The patients with HCC of BCLC stage C,who received HAIC combined with PD-1 inhibitors and anti-angiogenesis therapy at the First Affiliated Hospital of Soochow University of China from January 2021 to December 2023,were collected for this study.The time from the start of treatment to complete remission(CR)of disease,the dynamic changes in alpha-fetoprotein(AFP)levels and the recurrence during follow-up period were analyzed.The relevant literature of the above triple regimen for HCC was searched from PubMed database and its curative effect was analyzed.Results Of the 214 HCC patients treated with triple therapy regimen,9(4.2％)achieved CR.The time from the start of treatment to CR was 2-10 months.The patients were followed up for 5-20 months.The time of AFP level returning to normal value was from 79 to 259 days.One patient developed recurrence 10 months after CR,and the other 8 patients maintained the CR status.A total of 12 articles were retrieved,the reported CR rates ranged from 0 to 16.5％.Conclusion A CR can be achieved in a few patients with advanced HCC treated with HAIC combined with PD-1 inhibitors and anti-angiogenesis therapy.

Objective:To compare the effect and safety of continuous veno-venous hemofiltration (CVVH)+double plasma molecular absorption (DPMA)+hemoperfusion (HP), CVVH+HP, and CVVH+plasma exchange (PE) in treatment of patient with severe wasp stings injury.Methods:Multicenter, historical cohort study and superiority test were used. From July 2020 to October 2022, patients with wasp sting injury and multiple organ damage admitted to the intensive care units (ICU) of five hospitals were consecutively screened and recruited into the CVVH+DPMA+HP group (intervention group). Propensity score matching was used to establish historical cohorts. Patients with severe wasp sting injury who hospitalized from January 2016 to June 2020 in each ICU were collected and matched 1∶1 with the intervention group, and divided into CVVH+HP group and CVVH+PE group according to their actual hemopurification protocols (historical control groups). The primary outcome was the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score on days 3 and 7 after initiation of treatment. Secondary outcomes included complications, length of ICU and hospital stays, and all-cause mortality. Multivariate Cox proportional risk regression was used to analyze the prognosis of patients.Results:After propensity score matching, 56 patients in intervention group and each of the two historical control groups were matched successfully. There were no significant differences in age, gender, comorbidities, biochemical test indices and critical illness scores among the groups. After treatment, APACHE Ⅱ score markedly declined in all groups, and the decrease was faster in the intervention group; treatment with DPMA [hazard ratio ( HR) = 1.04, 95% confidence interval (95% CI) was 1.02-1.08, P = 0.00], the decreased levels of body temperature ( HR = 1.02, 95% CI was 1.00-1.03, P = 0.02), serum creatine kinase (CK; HR = 0.98, 95% CI was 0.96-1.00, P = 0.05) and myoglobin (MYO; HR = 2.88, 95% CI was 1.24-6.69, P = 0.01) were independent risk factors for APACHE Ⅱ score decline to the target value (15 scores). There were no significant differences in the incidence of bleeding complications, filter or perfusion thrombosis, blood pressure reduction, catheter-related infection and anaphylaxis among the groups. Conclusion:CVVH+DPMA+HP regimen can significantly reduce the APACHE Ⅱ score of patients with severe wasp sting injury, and the efficacy is superior to CVVH+HP and CVVH+PE regimens, with safety.

Hematoma enlargement is a common harmful event after cerebral hemorrhage, which can lead to deterioration of neurological function and poor outcome. Early detection of high-risk patients can help prevent hematoma enlargement and improve the outcome of patients. Although the exact mechanism of hematoma enlargement is unclear, more and more evidence shows that many imaging signs may be related to hematoma enlargement, such as dot sign, mixed sign, black hole sign, island sign, etc. This article mainly reviews the relevant imaging prediction factors of hematoma enlargement from the perspective of imaging.