Measuring the arterial phase of the right coronary artery in the patients suspected of coronary artery disease: a dual study by dynamic angiography and deep learning program

Funding Acknowledgements

Type of funding sources: None.

Background. In the diagnosis of coronary artery disease (CAD), coronary angiography (CA) plays a crucial role in determining the location and severity of the stenosis, the anatomical aspect of a lesion. It does not accurately reflect the flow dynamics in the coronary artery. This study aimed to evaluate the coronary flow abnormalities based on our new angiographic technique and Deep Learning (DL) program in patients suspected of CAD.

Methods. We randomly selected patients who were admitted with suspected CAD. All patients underwent our new technique of CA. After the index coronary artery was filled completely with contrast, we stopped the injection. At that time, the blood in white color flew in. The flow characteristics, the shape of the tip, borders, and direction could be clearly observed above a black background of the contrast. In this study, we measured the arterial phase (AP) from the beginning when the blood moved in until the end when all contrasts in black color washed out of the distal vasculature. In the DL protocol, the U-Net model combined with Dense-Net-121 and a binary image classification model are used to predict the beginning and ending frame. To obtain the best image for the DL program, we analyzed only the flow of the right coronary artery (RCA).

Results. 81 patients were enrolled. In patients with normal coronary angiography, the mean AP was 1.86s (27.4 +/- 5.4 frames). In patients with one significant lesion, the mean AP value was 2.35s (35.3 +/- 7.7 frames). The mean difference of the AP between the two groups was 0.49s (95% confidence interval: 0.295 to 0.694). This difference is statistically significant. Our DL has the mean root square error in predicting the AP was 0.34s.

Conclusion. In patients with CAD, the prolonged arterial phase could be accurately estimated using the DL program, reflecting the slow circulation of highly oxygenated blood. It could be used as a marker of coronary perfusion in future studies.

Slow flow or prolonged arterial phase in coronary arteries is the cause of ischemia or sudden death in patients with dilated cardiomyopathy

Background

In patients with dilated cardiomyopathy (DCM), the patients could be symptomatic or presented with recurrent fluid overload, syncope or sudden cardiac death (SCD) while the coronary arteries were patent. The aim of our study was to use the coronary flow abnormalities to stratify the high risk symptomatic versus the low risk asymptomatic patient with DCM.

Methods

Consecutive patients with DCM were enrolled. Twenty patients with normal ejection fraction (EF) without coronary artery disease served as control. The study patients were checked for symptoms (fluid overload, syncope, SCD) and re-admission. All patients underwent a new coronary angiographic technique with injection of contrast until all the coronary arteries were completely filled. As the injection of contrast stopped, the blood in white color moved in and the blood movement could be clearly observed. The angiogram was recorded from the entry of blood flow until all the contrast was cleared. During the review, the investigators downloaded, selected the angiogram from the electronic medical record, tapped on the Key Image and used the Up and Down arrow to move the images, frame-by-frame. Each frame represented a 0.06-second recording. The duration of the arterial phase was calculated starting the time when the blood entered the ostium of the index artery until all the contrast disappeared from the distal vasculature. At the same time, an AI program was trained to measure the length of the arterial phase by Machine learning, supervised and unsupervised Deep Learning and Convoluted Neural Networks. (Figure 1) The AI programs compared the time when the arteries were full with contrast until there was no contrast left in the distal vasculature. (Figure 2)

Results

One hundred patients with DCM were consecutively enrolled. Twenty patients served as control. In the control group with normal flow and EF, the duration of the arterial phase was 24–30 frames (1.44 to 2 seconds). In the study group, seventy patients had extremely prolonged arterial phase (average of 120 frames or >8 seconds (p<0.05). These patients were very symptomatic and had recurrent hospitalizations. Thirty patients had normal arterial phase of <2 seconds. These patients had shorter length of stay (<3 days), became asymptomatic after only 2 days of treatment and had rare readmission. (p<0.05) The AI programs confirmed the results of the arterial phases calculated manually by junior investigators.

Conclusions

In patients with DCM, the extreme prolonged arterial phase caused ischemia in the myocardium even there was no coronary artery disease. This ischemic burden triggered recurrent ventricular dysfunction, arrhythmia, syncope and SCD. The patients with normal arterial phase became asymptomatic after optimal medical treatment. With these results, more effective prevention and management could be achieved for high risk symptomatic patients with high mortality and readmissions.

Funding Acknowledgement

Type of funding sources: None. U Net architectureArterial Phase

Comprehensive review of the incisive branch of the inferior alveolar nerve

The incisive branch of the inferior alveolar nerve is a vital anatomical structure within the anterior mandible that has not been thoroughly defined and outlined in reports in the literature until recent years. Advances in radiological imaging, particularly the widespread use of cone-beam computed tomography has allowed for accurate visualization of the mandibular incisive canal (MIC) and its associated incisive branch of the inferior alveolar nerve. Surgical damage to the MIC, which could result in hemorrhage and sensory disturbance, may occur in commonly practiced oral and maxillofacial procedures, such as chin bone harvesting, implant placement, fracture repair and removal of pathologic entities of the anterior mandible. Knowledge of both the presence, dimensions and location of the incisive branch is a vital component to pre and peri-operative planning of oral and maxillofacial surgeries performed within the mandible, particularly within the interforaminal zone. In this article, the terminology, anatomy, imaging, surgical consideration, and pathology of the incisive branch will be discussed.

Clinical anatomy of the inferior labial gland: a narrative review

Objective

In this article we review the literature on the inferior labial gland from a clinical and anatomical perspective.

Background

Regardless of its importance in clinical practice, there are no medical literature that comprehensively reviewed the inferior labial gland.

Methods

A database search using PubMed and Google Scholar was conducted. The following keywords were used in the search: "lower labial salivary gland", "lower labial gland", "inferior labial salivary gland", AND "inferior labial gland".

Conclusions

The human labial glands are types of minor salivary gland that continuously secrete small amounts of mucous and serous substances to maintain oral health. The inferior labial glands are innervated by the inferior labial branch of the mental nerve, and the inferior labial branch of the facial artery is the main arterial supply to the lower lip. Although they only have an auxiliary role in saliva production compared to the major salivary glands, minor salivary glands provide a certain amount of lubrication in the oral cavity by the continuous outflow of saliva. The inferior labial gland not only promotes moisturization in the oral cavity but also secretes substances with antibacterial effects, which is important for the function of the oral cavity. A recent study showed that the rate of salivary secretion from the inferior labial glands does not change with age, and in some cases the inferior labial glands are used for diagnosing intractable diseases such as Sjogren's syndrome and cystic fibrosis. In addition, since the inferior labial glands themselves can be the site of cyst and/or neoplasia development, we should be careful to distinguish them from other diseases. Elucidation of the anatomy, physiology, and pathology of the inferior labial glands, is important for understanding human health and diseases.

Dual innervation of the mylohyoid muscle by the trigeminal and hypoglossal nerves: A case report

During the routine dissection of a cadaveric specimen, the left mylohyoid muscle was found to be innervated by both the trigeminal and hypoglossal nerves. This variation was found unilaterally. To our knowledge this dual innervation of the mylohyoid muscle is an extremely rare variation. The possibility of these variants may lead to clinical consequences such as anesthesia failure and iatrogenic injury during surgical procedures in this region. We discuss this anatomical variation and possible developmental etiologies.

A rare case of trifid mandibular canal with bilateral retromolar foramina

There are many reported anatomical variations of the mandibular canal. Consequently, there is great variation in the retromolar area, such as the quantity, size, and location of the retromolar foramen (RMF), the bony entrance of the retromolar canal (RMC). These variations allow for different accessory innervations to the mandibular molars and their adjacent buccal tissue because the RMC contains neurovascular bundles. Consideration of these anatomical variations is crucial for avoiding complications in anesthesia, implant placement, and surgery. However, the rarer canal types are often only imaged by computed tomography (CT) or cone beam computed tomography (CBCT). We present a rare case with bilateral RMF and a unilateral trifid mandibular canal in a cadaver.

A Forensically Sound Adversary Model for Mobile Devices

In this paper, we propose an adversary model to facilitate forensic investigations of mobile devices (e.g. Android, iOS and Windows smartphones) that can be readily adapted to the latest mobile device technologies. This is essential given the ongoing and rapidly changing nature of mobile device technologies. An integral principle and significant constraint upon forensic practitioners is that of forensic soundness. Our adversary model specifically considers and integrates the constraints of forensic soundness on the adversary, in our case, a forensic practitioner. One construction of the adversary model is an evidence collection and analysis methodology for Android devices. Using the methodology with six popular cloud apps, we were successful in extracting various information of forensic interest in both the external and internal storage of the mobile device.

Evidence from CD spectra and melting temperatures for stable Hoogsteen-paired oligomer duplexes derived from DNA and hybrid triplexes

The pyr*pur.pyr type of nucleic acid triplex has a purine strand that is Hoogsteen-paired with a parallel pyrimidine strand (pyr*pur pair) and that is Watson-Crick-paired with an antiparallel pyrimidine strand (pur.pyr pair). In most cases, the Watson-Crick pair is more stable than the Hoogsteen pair, although stable formation of DNA Hoogsteen-paired duplexes has been reported. Using oligomer triplexes of repeating d(AG)12 and d(CT)12 or r(CU)12 sequences that were 24 nt long, we found that hybrid RNA*DNA as well as DNA*DNA Hoogsteen-paired strands of triplexes can be more stable than the Watson-Crick-paired strands at low pH. The structures and relative stabilities of these duplexes and triplexes were evaluated by circular dichroism (CD) spectroscopy and UV absorption melting studies of triplexes as a function of pH. The CD contributions of Hoogsteen-paired RNA*DNA and DNA*DNA duplexes were found to dominate the CD spectra of the corresponding pyr*pur.pyr triplexes.