Objectives Myocardial strain is reported to be a sensitive indicator of myocardial mechanical changes in patients with hypertrophic cardiomyopathy (HCM). The changes in the mechanics of the myocardium of normal wall thickness (< 12 mm) have yet to be well studied. This study aimed to evaluate the function of myocardial segments of normal thickness in patients with HCM. Methods Sixty-three patients with HCM and 30 controls were retrospectively enrolled in this retrospective study. Cine imaging, native and post-contrast T1 maps, T2 maps, and late gadolinium enhancement were performed. In addition, regional myocardial strain was assessed by cardiac magnetic resonance-tissue tracking. Strain parameters were compared between the controls and HCM patients with segments of the myocardium of normal thickness. Subgroup analysis was conducted in obstructive and non-obstructive HCM. Lastly, p < 0.05 was considered statistically significant. Results In normal-thickness myocardial segments of HCM (n = 716), diastolic peak strain rates (PSRs) were significantly lower than in the control group (n = 480) (radial, − 2.43 [− 3.36, − 1.78] vs. − 2.67 [− 3.58, − 1.96], p = 0.002; circumferential, 1.28 [1.01,1.60] vs. 1.39 [1.14, 1.78], p < 0.001; and longitudinal, 1.16 [0.75,1.51] vs. 1.28 [0.90, 1.71], p < 0.001). The normal-thickness segments showed no significant difference in systolic PSRs between HCM and the controls. In the subgroup analysis, significantly decreased diastolic PSRs were noted in both obstructive and non-obstructive HCM, compared with the controls ( p < 0.05). Conclusions Diastolic changes in myocardial mechanics were observed in normal-thickness segments of HCM, occurring before morphological remodeling and systolic dysfunction developed. This finding contributed to a better understanding of the mechanical pathophysiology of HCM with preserved left ventricular ejection fraction. It may potentially aid in predicting disease progression and risk stratification.

PURPOSE:To develop a machine-learning-based radiomics signature of ADC for discriminating between benign and malignant testicular masses and compare its classification performance with that of minimum and mean ADC. METHODS:A total of ninety-seven patients with 101 histopathologically confirmed testicular masses (70 malignancies, 31 benignities) were evaluated in this retrospective study. Eight hundred fifty-one radiomics features were extracted from the preoperative ADC map of each lesion. The mean and minimum ADC values are part of the radiomics features. Thirty lesions were randomly selected to estimate the reliability of the features. The redundant features were eliminated using univariate analysis (independent t test and Mann-Whitney U test, where appropriate) and Spearman's rank correlation. The least absolute shrinkage and selection operator (LASSO) algorithm was employed for feature selection and radiomics signature generation. The classification performance of the radiomics signature and minimum and mean ADC values were evaluated by receiver operating characteristic (ROC) curve analysis and compared by DeLong's test. RESULTS:The whole lesion-based mean ADC showed no difference between benign and malignant testicular masses (P = 0.070, training cohort; P = 0.418, validation cohort). Compared with the minimum ADC, the ADC-based radiomics signature yielded a higher area under the curve (AUC) in both the training (AUC: 0.904, 95% confidence interval [CI]: 0.832-0.975) and validation cohorts (AUC: 0.868, 95% CI: 0.728-1.00). CONCLUSIONS:Conventional mean ADC values are not always helpful in discriminating between testicular benignities and malignancies. The minimum ADC and radiomics signature might be better alternatives, with the radiomics signature performing better than the minimum ADC.

OBJECTIVES:To investigate the image quality and capability of generalized auto-calibrating partially parallel acquisition (GRAPPA) accelerated Three-dimensional (3D) susceptibility weighted imaging (SWI) of the whole spine at 3T. METHODS:A total of 37 pregnant women (gestation age 22 to 39 weeks, average 29 ± 3 weeks) with suspected fetal vertebral anomalies by ultrasound (US) screening underwent 3.0T MR imaging with 3D SWI, conventional two-dimensional (2D) half-flourier acquisition single-shot turbo spin-echo (HASTE) and 3D true fast imaging with steady-state precession (True FISP). The acquisition time of each protocol was recorded. Signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) were determined in representative interest regions of fetal thoracic vertebrae and compared among three pulse sequences. Two radiologists rated image quality independently in random order on a 5-point scale. Kappa coefficients were computed to assess inter-observer reliability. Receiver operating characteristic curves were generated, and the area under the curve (AUC) was used to compare the diagnostic performance of each protocol in vertebral deformities. RESULTS:The acquisition time was 15 s for 3D-SWI and 17 s for 3D True FISP, significantly shorter than conventional HASTE (37 s; both P < 0.01). Of the three protocols, The SNR was highest on 3D True FISP, while the CNR was highest on 3D SWI. Visualization of all segments of the whole spine by 3D SWI was comparable with 3D True FISP. In contrast, 3D SWI and 3D True FISP depicted cervical and sacrococcygeal vertebrae better than HASTE. The weighted kappa statistic was 0.70-0.89 to evaluate the image quality of all segments of the whole spine, indicating good to excellent interobserver agreement. 3D SWI had the highest diagnostic performance for detecting fetal vertebral anomalies (AUC = 0.92). CONCLUSIONS:3D-SWI is feasible for improved visualization of the whole fetal vertebral column and its congenital malformations with adequate image quality and high accuracy, thereby providing a supplementary method to conventional MR imaging.

Objectives: To investigate the chest high-resolution CT (HRCT) findings in coronavirus disease 2019 (COVID-19) pneumonia patients with acute respiratory distress syndrome (ARDS) and to evaluate its relationship with clinical outcome.Materials and Methods In this retrospective study, seventy-nine COVID-19 patients with ARDS were recruited. Clinical data were extracted from electronic medical records and analyzed. HRCT scans, obtained within 3 days before clinical ARDS onset, were evaluated by three independent observers and graded into six findings according to the extent of fibroproliferation. Multivariable Cox proportional hazard regression analysis was used to assess the independent predictive value of the CT score and radiologically fibroproliferation. Patient survival was determined by Kaplan-Meier analysis.Results: Compared with survivors, non-survivors showed higher of lung fibroproliferation, whereas there no significant differences in the area of increased attenuation without traction bronchiolectasis or bronchiectasis. A HRCT score <230 enabled prediction of survival with 73.5% sensitivity and 93.3% specificity (AUC= 0.9; 95% CI 0.831 to 0.968). Multivariate Cox proportional hazards model showed that the HRCT score is a significant independent risk factor for mortality (HR 13.007; 95% CI 3.935 to 43.001). Kaplan-Meier analysis revealed HRCT score≥230 was associated with higher fatality rate. Organ injury occurred less frequently in patients with HRCT score<230 compared to those with HRCT score≥230.Conclusion: Early pulmonary fibroproliferative changes in HRCT predicts increased mortality and susceptibility to organ injury in COVID-19 pneumonia patients with early ARDS.

Objective To investigate the CT and clinical features of 2019 novel coronavirus (NCP) pneumonia. Methods Chest CT and clinical data of confirmed 103 patients with 2019 novel coronavirus pneumonia in January 2020, retrospectively. According to diagnosis and treatment of NCP infected pneumonia (trial version 5), all the patients were classified into mild(n=58), severe (n=36) and very severe (n=9) type, and their clinical findings, laboratory examination and CT finding were analyzed. CT features included lesions’ distribution, location, size, shape, edge, number, density, percentage of pneumonia lesions of the whole lung and extra-pulmonary manifestations. The CT features of different clinical subtypes were compared using χ2test or Fisher's exact probability. Comparisons between the percentage of pneumonic lesions to total lung volume were computed by using analysis of variance (normal distribution) or Kruskal-Wallis rank sum test (non-normal distribution). Results In terms of clinical manifestations, the patients with severe NCP were more common in elderly men, with a median age of 65 years. Fever was the first symptom in 49 (84%) of 58 patients with NCP, and fever was the first symptom in both severe and critical NCP patients. The incidence of cough in severe (25 / 36, 69%) and critical (6 /9, 67%) NCP patients was higher than that in general (20 /58, 34%). All critical patients have dyspnea. In terms of CT findings, common NCP showed double lung (40/58,71%) multiple (40 / 58,69%) ground glass (31/58,52%) or mixed (25 / 58,43%) lesions (56 / 58,97%); severe and critical NCP showed double lung lesions, heavy NCP mainly showed multiple (34 / 36,96%) patches (33 / 36,92%) mixed density lesions (26 / 36,72%); 9 severe NCP lesions were more than 3 cm Mixed density lesions. The percentage of pneumonia focus in the whole lung volume: the common type (12.5% ± 6.1%) was significantly lower than the severe type (25.9% ± 10.7%) and the critical type (47.2% ± 19.2%) NCP, the difference was statistically significant (P values were < 0.001 and 0.002 respectively), and the severe type NCP was also significantly lower than the critical type (P = 0.032). Conclusions CT and clinical features of different clinical types of NCP pneumonia are different. Chest CT findings have unique characteristic, which can not only make early diagnosis, but also evaluate its clinical course and severity. Key words: Coronavirus infection; Pneumonia; Tomography, X-ray computed

The original version of this article, published on 10 June 2020, unfortunately contained a mistake. The presentation of Figure 5 was incorrect.

The purpose of this study was to observe the imaging characteristics of the novel coronavirus pneumonia. Sixty-three confirmed patients were enrolled from December 30, 2019 to January 31, 2020. High-resolution CT (HRCT) of the chest was performed. The number of affected lobes, ground glass nodules (GGO), patchy/punctate ground glass opacities, patchy consolidation, fibrous stripes and irregular solid nodules in each patient's chest CT image were recorded. Additionally, we performed imaging follow-up of these patients. CT images of 63 confirmed patients were collected. M/F ratio: 33/30. The mean age was 44.9 ± 15.2 years. The mean number of affected lobes was 3.3 ± 1.8. Nineteen (30.2%) patients had one affected lobe, five (7.9%) patients had two affected lobes, four (6.3%) patients had three affected lobes, seven (11.1%) patients had four affected lobes while 28 (44.4%) patients had 5 affected lobes. Fifty-four (85.7%) patients had patchy/punctate ground glass opacities, 14 (22.2%) patients had GGO, 12 (19.0%) patients had patchy consolidation, 11 (17.5%) patients had fibrous stripes and 8 (12.7%) patients had irregular solid nodules. Fifty-four (85.7%) patients progressed, including single GGO increased, enlarged and consolidated; fibrous stripe enlarged, while solid nodules increased and enlarged. Imaging changes in novel viral pneumonia are rapid. The manifestations of the novel coronavirus pneumonia are diverse. Imaging changes of typical viral pneumonia and some specific imaging features were observed. Therefore, we need to strengthen the recognition of image changes to help clinicians to diagnose quickly and accurately. • High-resolution CT (HRCT) of the chest is critical for early detection, evaluation of disease severity and follow-up of patients with the novel coronavirus pneumonia. • The manifestations of the novel coronavirus pneumonia are diverse and change rapidly. • Radiologists should be aware of the various features of the disease and temporal changes.

Objective:To investigate the CT and clinical features of COVID-19.Methods:Chest CT and clinical data of 103 patients who were confirmed as COVID-19 in January 2020 were collected retrospectively. According to diagnosis and treatment of COVID-19 (trial version 5), all the patients were classified into common( n=58), severe ( n=36) and critical ( n=9) types, and their clinical findings, laboratory examination and CT finding were analyzed. CT features included distribution, location, size, shape, edge, number and density of the lesion, percentage of pneumonia lesions of the whole lung and extra-pulmonary manifestations. The CT features among different clinical types were compared using χ 2 test or Fisher's exact probability. Comparisons of age, duration from onset to CT examination, and percentage of pneumonic lesions to total lung volume among different types were performed by using analysis of variance (normal distribution) or Kruskal-Wallis rank sum test (non-normal distribution). Results:In terms of clinical manifestations, the patients with critical COVID-19 were more common in elderly men, with a median age of 65 years. Fever was the first symptom in 49 (84%) of 58 common patients, and also the first symptom in both severe and critical COVID-19 patients. The incidence of coughing in severe (25/36, 69%) and critical (6/9, 67%) COVID-19 patients was higher than that in common patients (20/58, 34%). All critical patients had dyspnea. CT showed the common COVID-19 was located in bilateral lung (40/58, 71%)with multiple (40/58, 69%), ground glass (31/58, 52%) or mixed (25/58, 43%)opacities (56/58, 97%), while all the severe and critical COVID-19 were located in bilateral lung(100%) with multiple (34/36, 96%), patchy (33 /36, 92%), or mixed opacities (26/36, 72%) in severe patients, and with mixed opacities more than 3 cm in critical patients. As for the percentage of pneumonia focus in the whole lung volume, the common type (12.5%±6.1%) was significantly lower than the severe type (25.9%± 10.7%) and the critical type (47.2%±19.2%), with statistically significant differences( P< 0.001 and 0.002 respectively), and the severe type COVID-19 was also significantly lower than the critical type ( P= 0.032). Conclusions:CT and clinical features of different clinical types of COVID-19 pneumonia are different. Chest CT findings are characteristic, which can not only help the early diagnosis but also evaluate the clinical course and severity.

Children with Covid-19 in Wuhan, China A retrospective analysis of routine surveillance data involving children hospitalized in central Wuhan, China, for acute lower respiratory infection in early ...

This paper presents a medical image encryption algorithm using edge maps derived from a source image. The algorithm is composed by three parts: bit-plane decomposition, generator of random sequence, and permutation. It offers users the following flexibilities: (1) any type of images can be used as the source image; (2) different edge maps can be generated by various edge detectors and thresholds; (3) selection of appropriate bit-plane decomposition method is flexible; (4) many permutation methods can be cascaded with the proposed algorithm. A significantly large key space and strong key sensitive are possessed by the proposed algorithm to protect different types of medical images. Furthermore, it has a wider applicability than other methods for fuzzy edge maps. Experiments and security analysis further demonstrate that it has a strong resistance against various security attacks and outperforms other state-of-the-art methods.

Objective To evaluate the activation of the visual cortex in patients with primary openangle glaucoma (POAG) and to explore whether the neuronal activity corresponds with retinal nerve fiber layer (RNFL) and cup-to-disc (C/D) values.Methods Twenty-five patients and 25 gender-and agematched healthy volunteers were studied.Blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) and three-dimensional brain volume imaging (3 D BRAVO) sequences were obtained using 3 T MR imaging system.A full-screen black-white shift checkerboard was used for visual stimulus during the fMRI experiment and was performed on each eye of all subjects using a visual-acoustical system.All acquired data were postprocessed and analyzed by statistical parametric mapping (SPM).After analysis,individual activated mapping,intra-group mean activated mapping,and inter-group variant mapping were observed.The voxel number,intensity,and Montreal Neurological Institute (MNI) coordinate of the activated clusters were recorded.The Xjviewer software was utilized to obtain activated voxel numbers in occipital lobe.A Pearson correlated test was performed to test the correlation between the number of activated voxels and RNFL,C/D and Hodapp-Anderson-Parrish (HAP) clinical stage.Results Intra-group mean activated mappings of both patients and volunteers showed obvious activation in bilateral occipital lobes.As compared with healthy volunteers,the POAG patients exhibited statistically significantly decreased activation in bilateral occipital lobes,left hippocampus,and left cerebellum,along with lower mean RNFL [(71.56 ±21.54) i m versus (111.88 ± 9.96) μm] and higher C/D values (0.71 ± 0.18 versus 0.36 ± 0.08 ; t value was respectively-10.901 and 11.643,P ＜ 0.05).The number of activated voxels in the occipital lobes of POAG patients did not correlate with RNFL,C/D and HAP clinical stage of the corresponding eye (r value was respectively 0.157,-0.113 and-0.242,P ＞ 0.05).Conclusions fMRI demonstrated differences in visual cortex activation in POAG patients relative to healthy volunteers,suggesting it might be a promising complementary method for diagnosing glaucoma.However,fMRI findings did not correlate with POAG extent,as measured by RNFL and C/D values.Ophthalmological examination remains to play an important role in the evaluation of open-angle glaucoma.

OBJECTIVE:The purpose of this study was to evaluate the sensitivities and specificities of four single-slab 3D MRI sequences in the detection of cranial metastases: double inversion recovery (IR), T2 FLAIR, contrast-enhanced T2 FLAIR, and contrast-enhanced IR-prepared fast spoiled gradient-echo (FSPGR) sequences.SUBJECTS AND METHODS:Eighty-four patients underwent double IR and T2 FLAIR imaging using 3-T MRI. Then, 49 of 84 patients were randomly selected to undergo contrast-enhanced IR-prepared FSPGR before contrast-enhanced T2 FLAIR, and the other 35 patients underwent contrast-enhanced T2 FLAIR before contrast-enhanced IR-prepared FSPGR. Two experienced neuroradiologists reviewed the images by consensus on a workstation. Metastases were scored a negative, equivocal, or positive. For each metastasis, we recorded the anatomic area and size, and checked whether edema was present.RESULTS:A total of 210 cranial metastases in 56 of 84 patients were revealed. The sensitivities of double IR, T2 FLAIR, contrast-enhanced IR-prepared FSPGR, and contrast-enhanced T2 FLAIR sequences were 66.2%, 56.7%, 80.5%, and 99%, respectively. The specificities were 68.3%, 73%, 75.7%, and 82.4%. The areas under the receiver operating characteristic curve were 0.763, 0.709, 0.865, and 0.993. Contrast-enhanced T2 FLAIR imaging was found to have the highest sensitivity especially for detecting lesions in meninges (98.2%; p<0.0001) and gray matter (GM) (100%; p<0.0001). The double IR sequence was superior to the T2 FLAIR sequence for imaging metastases located in ependyma (81.8% vs 36.4%) and GM (66.7% vs 48.1%). Delayed enhancement did not affect the sensitivities of the contrast-enhanced T2 FLAIR and contrast-enhanced IR-prepared FSPGR sequences.CONCLUSION:Contrast-enhanced T2 FLAIR is the most sensitive sequence of the four MR sequences evaluated for the detection of cranial metastases despite its delay time after contrast enhancement.

To analyze MR manifestations of postoperative spinal complications and investigate the value of MRI in the diagnosis and differentiated diagnosis, 114 cases of spinal postoperative complications were analyzed retrospectively and compared with the clinical data. The results showed that the main postoperative spinal complications included spinal stenosis (n=33, consisting of 21 cases of epidural fibrosis and 12 cases of epidural hematoma or epidural abscess), lack of spinal stability (n=43), infection (n=23, consisting of 7 cases of para-spinal soft-tissue infection, 5 cases of vertebral discitis, 4 cases of vertebral and appendix infection, 3 cases of epidural abscess, 2 cases of myelitis, 2 cases of spinal arachnoiditis), others (n=28, consisting of 12 cases of inner fixation failure, 9 cases of epidural hematoma, 7 cases of cerebrospinal fluid gusher). It is concluded that MRI can specifically display all kinds of postoperative spinal complications, and is of significant value in the diagnosis and differentiated diagnosis of postoperative spinal complications.

Purpose: To evaluate whether line-scan diffusion-weighted imaging (LSDWI) can provide temporal information of epiphyseal ischemia. Materials andMethods: Ischemia was induced by ligation of arteries of the unilateral femoral head in piglets (N = 25). LSDWI was performed at several time points after ligation. A comparison of apparent diffusion coefficients (ADCs) was made between ischemic and control sides. The difference in percentage change of ADC in the ischemic hips between two neighboring time points was evaluated. A histological study was made after MR scanning.Results: Three hours after ligation, ADCs were significantly lower in the ischemic hips than in the contralateral (control) hips. At 72 hours after surgery, ADCs in the ischemic hips were significantly higher than in the control hips and continued to rise up until the sixth week after operation. Histological study revealed necrosis of chondrocytes and osteocytes and abnormal thickening of the epiphyseal cartilage in the ischemic femoral head.Conclusion: The ADCs may be used as a marker of ischemia and necrosis in the femoral head; changes in the ADCs after the acute ischemia may reflect the evolution of ischemia and subsequent necrosis. LSDWI can be used for the evaluation of the duration and extent of ischemic injury in the epiphysis.

Clustering ensembles have emerged as a powerful method for improving quality as well as robustness of unsupervised classification solutions. However, finding the consensus clustering is still a difficult problem. Based on mutual information, Strehl & Ghosh proposed the object function for "hard" clustering ensemble, but they do not point out how to solve this function. In this paper, we extended this function and further presented a new algorithm similar to information bottleneck to solve the object function. This algorithm can combine "soft" partitions and need not establish label correspondence between different partitions. To compare our algorithm with the other four ensemble algorithms, we conducted experiments on four real-world data sets, namely, CSPA, HGPA, MCLA, QMI. The results prove that our algorithm provides solutions of improved quality.

Clustering is an important way to organize the large amount of information on the Web. In this paper, we study how to incorporate many information of Web document, such as content, anchor, URL etc, to improve the performance of clustering. We propose a novel algorithm: multi-view information bottleneck (MVIB), to cluster Web documents with multi-type features. In this algorithm, the compatible constraint maximizing the agreement between clustering hypotheses on different views is imposed on the individual views to cluster instances. Based on the compatible constraints, the set of clustering hypotheses revealing lots of information about correct one is obtained. The final hypothesis can be deduced from these hypotheses. We study the performance of MVIB in different views setting. Experiments on two real datasets indicate that MVIB with 3-view setting based on content, anchor text and URL can improve the quality of clusters more effectively.

Objective To investigate the metabolic alterations in the brain of neonates with HIE and correlate those alterations with clinical grading and prognosis of HIE.Methods Fourty-six eases of full-term neonates diagnosed as HIE clinically were performed MRI and 1~H-MRS,9 healthy neonates without the evidence of asphyxia were studied as controls,1~H-MRS techniques included single voxel proton MRS and two dimensional muhi-voxel chemical shift spectroscopy imaging,point resolved spectroscopy sequence was used for 1~H-MRS.Metabolic changes in the spectroscopy were analyzed in neonates with HIE,and study the relationgship between MRS findings and prognosis.Results(1)The typical 1~H-MRS manifestations of full- term neonates suffering from HIE were as follows:the peaks of Lac were elevated,GLx-α were elevated and NAA were decreased.(2)GLx-α/Cr ratio in control,mild,moderate and severe HIE group was 0.16, 0.21,0.64,and 1.31,respectively.Lac/Cr ratio in control,mild,moderate and severe HIE group was 0.12,0.14,0.19,and 0.26,respectively.There was a significant difference in the ratio of GLx-α and Lac/Cr between HIE group and control group(t=5.01,P0.01;t=2.78,P0.05),and there was a significant difference in the ratio of GLx-α and Lac/Cr between different HIE groups(F=63.29,P0.05; F=11.74;P0.05).Spearman rank correlation test confirmed that the ratio of GLx-α/Cr and Lac/Cr had significant positive correlation with clinical grading of HIE(r=0.76 and 0.59,P0.01).The ratio of NAA/Cr was much lower in severe group than those in mild-moderate group.(3)Spearman rank correlation test confirmed that the ratio of GLx-α/Cr and Lac/Cr had significant negative correlation with prognosis of HIE,especially GLx-α/Cr ratio was much more correlative(r=-0.83,P0.01),so it could be used as an effective predicter to evaluate outcome of HIE.Conclusion 1~H-MRS is a useful tool for monitoring the brain metabolic changes noninvasively,evaluating the severity and prognosis of HIE.The higher ratio of GLx-α/Cr in basal ganglia and thalamus predicts a poor outcome in neonates with HIE.

Clustering ensemble is a new topic in machine learning. It can find a combined clustering with better quality from multiple partitions. But how to find the combined clustering is a difficult problem. In this paper, we extend the object function proposed by Strehl & Ghosh which is based on mutual information and we present a new algorithm similar to information bottleneck to solve the object function. This algorithm can combine "soft" partitions and need not establish label correspondence between different partitions. We conducted experiments on four real-world data sets to compare our algorithm with other five ensemble algorithms, including CSPA, HGPA, MCLA, QMI. The results indicate that our algorithm provides solutions of improved quality.

In order to evaluate the value of magnetic resonance cholangiography (MRC) and dynamic examination of duodenal fluid in the differential diagnosis between extrahepatic biliary atresia (EHBA) and infantile hepatitis syndrome (IHS), 52 patients with infantile cholestatic jaundice were examined by MRC and duodenal fluid examination. Original interpretations were compared with clinical outcome. Calculated sensitivity of duodenal fluid examination in diagnosis of EHBA was 100 %, and specificity was 91.1 %. Sensitivity of MRC in the diagnosis of EHBA was 94.4 % and specificity 88.24 %. The sensitivity of MRC and examination of duodenal fluid combined in diagnosis of EHBA was 94.4 % and specificity 97.06 %. We are led to conclude that MRC and dynamic examination of duodenal fluid are useful in the differential diagnosis between IHS and EHBA and the combined use of the two techniques yield better resutls.