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Abstract Background A deep learning (DL) model that can automatically detect and classify cervical canal and neural foraminal stenosis using cervical spine magnetic resonance imaging (MRI) can improve diagnostic accuracy and efficiency. Methods A method comprising region-of-interest (ROI) detection and cascade prediction was formulated for diagnosing cervical spinal stenosis based on a DL model. First, three part-specific convolutional neural networks were employed to detect the ROIs in different parts of the cervical MR images. Cascade prediction of the stenosis categories was subsequently performed to record the stenosis level and position on each patient slice. Finally, the results were combined to obtain a patient-level diagnostic report. Performance was evaluated based on the accuracy (ACC), area under the curve (AUC), sensitivity, specificity, F1 Score, diagnosis time of the DL model, and recall rate for ROI detection localization. Results The average recall rate of the ROI localization was 89.3% (neural foramen) and 99.7% (central canal) under the five-fold cross-validation of the DL model. In the dichotomous classification (normal or mild vs. moderate or severe), the ACC and AUC of the DL model were comparable to those of the radiologists, and the F1 score (84.8%) of the DL model was slightly higher than that of the radiologists (83.8%) for the central canal. Diagnosing whether the central canal or neural foramen of a slice is narrowed in the cervical MRI scan required an average of 15 and 0.098 s for the radiologists and DL model, respectively. Conclusions The DL model demonstrated comparable performance with subspecialist radiologists for the detection and classification of central canal and neural foraminal stenosis on cervical spine MRI. Moreover, the DL model demonstrated significant timesaving ability.

Abstract Background The contribution of interspecies interactions between coinfecting pathogens to chronic refractory infection by affecting pathogenicity is well established. However, little is known about the impact of intraspecific interactions on infection relapse, despite the cross-talk of different strains within one species is more common in clinical infection. We reported a case of chronic refractory pulmonary infection relapse, caused by two methicillin-sensitive S. aureus (MSSA) strains (SA01 and SA02) and revealed a novel strategy for relapse via intraspecific cooperation. Methods The hemolytic ability, growth curve, biofilm formation, virulence genes and response of G. mellonella larvae to S. aureus infection were analysed to confirm this hypothesis. Results SA02 hemolytic activity was inhibited by SA01, along with the expression of hemolysin genes and the virulence factor Hla. Additionally, SA01 significantly enhanced the biofilm formation of SA02. AIP-RNAIII may be a possible pathway for this interaction. Compared with mono-infection, a worse outcome (decreased larval survival and increased microbial burden) of the two MSSA strains coinfected with G. mellonella confirmed that intraspecific interactions indeed enhanced bacterial survival in vivo. Conclusion The intraspecific interaction of S. aureus could lead to chronic refractory infection via pathogenicity changes.

Abstract Background Accurate prognostic assessment is vital for the personalized treatment of endometrial cancer (EC). Although radiomics models have demonstrated prognostic potential in EC, the impact of region of interest (ROI) delineation strategies and the clinical significance of peritumoral features remain uncertain. Our study thereby aimed to explore the predictive performance of varying radiomics models for the prediction of LVSI, DMI, and disease stage in EC. Methods Patients with 174 histopathology-confirmed EC were retrospectively reviewed. ROIs were manually delineated using the 2D and 3D approach on T2-weighted MRI images. Six radiomics models involving intratumoral (2Dintra and 3Dintra), peritumoral (2Dperi and 3Dperi), and combined models (2Dintra + peri and 3Dintra + peri) were developed. Models were constructed using the logistic regression method with five-fold cross-validation. Area under the receiver operating characteristic curve (AUC) was assessed, and was compared using the Delong’s test. Results No significant differences in AUC were observed between the 2Dintra and 3Dintra models, or the 2Dperi and 3Dperi models in all prediction tasks (P > 0.05). Significant difference was observed between the 3Dintra and 3Dperi models for LVSI (0.738 vs. 0.805) and DMI prediction (0.719 vs. 0.804). The 3Dintra + peri models demonstrated significantly better predictive performance in all 3 prediction tasks compared to the 3Dintra model in both the training and validation cohorts (P

Abstract Background Acute complete gastric volvulus is a rare and life-threatening disease, which is prone to gastric wall ischemia, perforation, and necrosis. If it is not treated by surgery in time, the mortality rate can range from 30 to 50%. Clinical presentations of acute gastric volvulus are atypical and often mimic other abdominal conditions such as gastritis, gastroesophageal reflux, gastric dilation, and pancreatitis. Imaging studies are crucial for diagnosis, with barium meal fluoroscopy being the primary modality for diagnosing gastric volvulus. Cases of acute gastric volvulus diagnosed by ultrasound are rarely reported. Case presentation We reported a rare case of acute gastric volvulus in a 4-year-old Chinese girl who presented with vomiting and abdominal pain. Ultrasound examination revealed the “whirlpool sign” in the cardia region, raising suspicion of gastric volvulus. Diagnosis was confirmed by X-ray barium meal fluoroscopy, which indicated left-sided diaphragmatic hernia and obstruction at the cardia region. Surgical intervention confirmed our suspicion of acute complete gastric volvulus combined with diaphragmatic hernia. Conclusion In this case, we reported an instance of acute complete gastric volvulus. Ultrasound revealed a “whirlpool sign” in the cardia, which is likely to be a key sign for the diagnosis of complete gastric volvulus.

Abstract Congenital fibrinogen disorders are a group of coagulation deficiencies caused by fibrinogen defects and are divided into four types, including afibrinogenemia, hypofibrinogenemia, dysfibrinogenemia, and hypodysfibrinogenemia. In this study, we collected a family with hypofibrinogenemia, and genetics analysis identify a novel pathogenic variants (c.668G > C, p.Arg223Thr) in the FGG gene. And electron microscope observation revealed significant changes in the ultrastructure of fibrin of the proband. Our research expands the phenotypic and genetic spectrum associated with the FGG gene, which would facilitate in genetic counselling and prenatal genetic diagnosis.

Abstract Background We aimed to compare the clinical efficacy of three surgical methods in the treatment of various types of cesarean scar pregnancy (CSP). Methods Herein, 314 cases of CSP were treated in the department of Obstetrics and Gynecology of the First Affiliated Hospital of Gannan Medical University between June 2017 and June 2020. The patients were divided into three groups based on the treatment received: group A (n = 146; curettage by pituitrin combined with ultrasonic monitoring and hysteroscopy-guided surgery), group B [n = 90; curettage after methotrexate (MTX) injection into the local gestational sac], and group C (n = 78; laparoscopic, transvaginal, and transabdominal cesarean scar resection). These groups were divided into three subgroups (type I, type II, and type III) according to the CSP type of the patients. Results The intraoperative blood loss, length of hospital stay, hospitalization cost, menstrual recovery time, and serum β-HCG normalization time were lower in groups A than in groups B or C with type I, II and III CSP (P

Abstract Objective To compare the diagnostic accuracy of diffusion-weighted imaging (DWI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for differentiating pulmonary nodules and masses. Methods We systematically searched six databases, including PubMed, EMBASE, the Cochrane Library, and three Chinese databases, to identify studies that used both DWI and PET/CT to differentiate pulmonary nodules. The diagnostic performance of DWI and PET/CT was compared and pooled sensitivity and specificity were calculated along with 95% confidence intervals (CIs). The Quality Assessment of Diagnostic Accuracy Studies 2 was used to assess the quality of the included studies, and STATA 16.0 software was utilized to perform statistical analysis. Results Overall, 10 studies that enrolled a total of 871 patients with 948 pulmonary nodules were included in this meta-analysis. DWI had greater pooled sensitivity (0.85 [95% CI 0.77–0.90]) and specificity (0.91 [95% CI 0.82–0.96]) than PET/CT (sensitivity, 0.82 [95% CI 0.70–0.90]); specificity, (0.81, [95% CI 0.72–0.87]). The area under the curve of DWI and PET/CT were 0.94 (95% CI 0.91–0.96) and 0.87 (95% CI 0.84–0.90) (Z = 1.58, P > 0.05), respectively. The diagnostic odds ratio of DWI (54.46, [95% CI 17.98–164.99]) was superior to that of PET/CT (15.77, [95% CI 8.19–30.37]). The Deeks’ funnel plot asymmetry test showed no publication bias. The Spearman correlation coefficient test revealed no significant threshold effect. Lesion diameter and reference standard could be potential causes for the heterogeneity of both DWI and PET/CT studies, and quantitative or semi-quantitative parameters used would be a potential source of bias for PET/CT studies. Conclusion As a radiation-free technique, DWI may have similar performance compare with PET/CT in differentiating malignant pulmonary nodules or masses from benign ones.

Abstract Background The Amur tiger (Panthera tigris altaica) is the largest and one of the most endangered cats in the world. In wild and captive cats, communication is mainly dependent on olfaction. However, vocal communication also plays a key role between mother and cubs during the breeding period. How cubs express their physiological and psychological needs to their mother and companions by using acoustic signals is little known and mainly hindered by the difficult process of data collection. Here, we quantitatively summarized the vocal repertoire and behavioral contexts of captive Amur tiger cubs. The aim of the present work was to investigate the behavioral motivations of cub calls by considering influential factors of age, sex, and rearing experiences. Results The 5335 high-quality calls from 65 tiger cubs were classified into nine call types (Ar-1, Ar-2, Er, eee, Chuff, Growl, Hiss, Haer, and Roar) produced in seven behavioral contexts. Except for Er, eight of the nine call types were context-specific, related to Play (Ar-2, eee, and Roar), Isolation (Ar-1), Offensive Context (Haer, Growl, and Hiss), and a friendly context (Chuff). Conclusions The results suggest that cubs are not quiet, but instead they express rich information by emitting various call types, which are probably crucial for survival in the wild. We herein provide the first detailed spectrogram classification to indicate vocal repertoires of calls and their coding with respect to behavioral contexts in Amur tiger cubs, and we pave the steps for revealing their social communication system, which can be applied for conservation of populations. These insights can help tiger managers or keepers to improve the rearing conditions by understanding the feline cubs’ inner status and needs by monitoring their vocal information expressions and exchanges.

Abstract Background Although acoustic communication plays an essential role in the social interactions of Rallidae, our knowledge of how Rallidae encode diverse types of information using simple vocalizations is limited. We recorded and examined the vocalizations of a common coot (Fulica atra) population during the breeding season to test the hypotheses that 1) different call types can be emitted under different behavioral contexts, and 2) variation in the vocal structure of a single call type may be influenced both by behavioral motivations and individual signature. We measured a total of 61 recordings of 30 adults while noting the behavioral activities in which individuals were engaged. We compared several acoustic parameters of the same call type emitted under different behavioral activities to determine how frequency and temporal parameters changed depending on behavioral motivations and individual differences. Results We found that adult common coots had a small vocal repertoire, including 4 types of call, composed of a single syllable that was used during 9 types of behaviors. The 4 calls significantly differed in both frequency and temporal parameters and can be clearly distinguished by discriminant function analysis. Minimum frequency of fundamental frequency (F0min) and duration of syllable (T) contributed the most to acoustic divergence between calls. Call a was the most commonly used (in 8 of the 9 behaviors detected), and maximum frequency of fundamental frequency (F0max) and interval of syllables (TI) contributed the most to variation in call a. Duration of syllable (T) in a single call a can vary with different behavioral motivations after individual vocal signature being controlled. Conclusions These results demonstrate that several call types of a small repertoire, and a single call with function-related changes in the temporal parameter in common coots could potentially indicate various behavioral motivations and individual signature. This study advances our knowledge of how Rallidae use “simple” vocal systems to express diverse motivations and provides new models for future studies on the role of vocalization in avian communication and behavior.

Abstract Background Increased liver stiffness exerts a detrimental role in driving hepatocellular carcinoma (HCC) malignancy and progression, and indicates a high risk of unfavorable outcomes. However, it remains largely unknown how liver matrix stiffness as an independent cue triggers epithelial-mesenchymal transition (EMT) and facilitates HCC metastasis. Methods Buffalo rat HCC models with different liver stiffness backgrounds and an in vitro Col I-coated cell culture system with tunable stiffness were used in the study to explore the effects of matrix stiffness on EMT occurrence and its underlying molecular mechanism. Clinical significance of liver stiffness and key molecules required for stiffness-induced EMT were validated in HCC cohorts with different liver stiffness. Results HCC xenografts grown in higher stiffness liver exhibited worse malignant phenotypes and higher lung metastasis rate, suggesting that higher liver stiffness promotes HCC invasion and metastasis. Cell tests in vitro showed that higher matrix stiffness was able to strikingly strengthen malignant phenotypes and independently induce EMT occurrence in HCC cells, and three signaling pathways converging on Snail expression participated in stiffness-mediated effect on EMT including integrin-mediated S100A11 membrane translocation, eIF4E phosphorylation, and TGF β1 autocrine. Additionally, the key molecules required for stiffness-induced EMT were highly expressed in tumor tissues of HCC patients with higher liver stiffness and correlated with poor tumor differentiation and higher recurrence. Conclusions Higher matrix stiffness as an initiator triggers epithelial-mesenchymal transition (EMT) in HCC cells independently, and three signaling pathways converging on Snail expression contribute to this pathological process. This work highlights a significant role of biomechanical signal in triggering EMT and facilitating HCC invasion and metastasis.

Abstract Background Medical laboratory staff are a high-risk population for colonization of Staphylococcus aureus (S. aureus) due to direct and dense contact with the pathogens; however, there is limited information about this colonization. This study sought to determine the prevalence and molecular characteristics of nasal colonization by S. aureus in medical laboratory staff in Guangzhou, southern China, and to compare the differences between microbiological laboratory (MLS) and non-microbiological laboratory (NMLS) staff. Methods S. aureus colonization was assessed by nasal swab cultures from 434 subjects, including 130 MLSs and 304 NMLSs from 33 hospitals in Guangzhou. All S. aureus isolates underwent the antimicrobial susceptibility test, virulence gene detection and molecular typing. Results The overall prevalence of S. aureus carriage was 20.1% (87/434), which was higher in MLSs than in NMLSs (26.2% vs. 17.4%, P

Abstract Background Cardiobacterium is a fastidious Gram-negative bacillus, and is a rare human pathogen in clinical settings. Herein, we describe a case of Cardiobacterium valvarum (C. valvarum) endocarditis with a rare complication of cerebral hemorrhage after mitral valve replacement (MVR), tricuspid valve prosthesis (TVP) and vegetation removal operation. Case presentation A 41-year-old woman who had a history of gingivitis developed into infective endocarditis due to the infection of C. valvarum. Then, she was hospitalized to receive MVR, TVP and vegetation removal operation. The indicators of patient tended to be normal until the abrupt cerebral hemorrhage occurred on day 15 after operation. This is the first well-described case of C. valvarum infection in China, and the first report of C. valvarum endocarditis with cerebral hemorrhage after MVR, TVP and vegetation removal operation worldwide. Conclusions We reported the first case of C. valvarum infection in China clinically, with a rare complication of cerebral hemorrhage after MVR, TVP and vegetation removal operation.