【Abstract】Objective To look for a feasible way to evaluate hepatic reserve function completely by retention rate of indocyanine green at 15 minutes （ICGR15）and Child-Pugh classification supplemented by hepatic clearance of D-sorbitol (CLh-s). Methods The ICGR15, Child-Pugh classification and CLh-s were examined in 186 patients with liver cirrhosis. Relations between CLh-s and operative complications were further studied when ICGR15 and Child-Pugh classification was superposed. ResultsThe superpositions of ICGR15 (40% being boundary) and Child-Pugh classification was centralized between Child-Pugh B and C. ICGR15 of 17 examples were higher than 40% in 63 examples of Child-Pugh B. Eight examples of them had some complications, CLh-s=(584.52±98.27) ml/min (CLh-s＜700 ml/min), while 9 examples of them had no complications, CLh-s=(801.25±75.04) ml/min (CLh-s＞700 ml/min). Conclusion The CLh-s could be interrelated with operative complication, and it is considered as an effective supplement to ICGR15 and Child-Pugh classification for the evaluation of hepatic reserve function, CLh-s (700 ml/min being boundary) could be used to predict operative complication, to evaluate hepatic reserve function effectively, and to provide the basis for choosing the right time for operation.
ObjectiveTo construct a multimodal imaging radiomics model based on enhanced CT features to predict tumor regression grade (TRG) in patients with locally advanced rectal cancer (LARC) following neoadjuvant chemoradiotherapy (NCRT). MethodsA retrospective analysis was conducted on the Database from Colorectal Cancer (DACCA) at West China Hospital of Sichuan University, including 199 LARC patients treated from October 2016 to October 2023. All patients underwent total mesorectal excision after NCRT. Clinical pathological information was collected, and radiomics features were extracted from CT images prior to NCRT. Python 3.13.0 was used for feature dimension reduction, and univariate logistic regression (LR) along with Lasso regression with 5-fold cross-validation were applied to select radiomics features. Patients were randomly divided into training and testing sets at a ratio of 7∶3 for machine learning and joint model construction. The model’s performance was evaluated using accuracy, sensitivity, specificity, and the area under the curve (AUC). Receiver operating characteristic curve (ROC), confusion matrices, and clinical decision curves (DCA) were plotted to assess the model’s performance. ResultsAmong the 199 patients, 155 (77.89%) had poor therapeutic outcomes, while 44 (22.11%) had good outcomes. Univariate LR and Lasso regression identified 8 clinical pathological features and 5 radiomic features, including 1 shape feature, 2 first-order statistical features, and 2 texture features. LR, support vector machine (SVM), random forest (RF), and eXtreme gradient boosting (XGBoost) models were established. In the training set, the AUC values of LR, SVM, RF, XGBoost models were 0.99, 0.98, 1.00, and 1.00, respectively, with accuracy rates of 0.94, 0.93, 1.00, and 1.00, sensitivity rates of 0.98, 1.00, 1.00, and 1.00, and specificity rates of 0.80, 0.67, 1.00, and 1.00, respectively. In the testing set, the AUC values of 4 models were 0.97, 0.92, 0.96, and 0.95, with accuracy rates of 0.87, 0.87, 0.88, and 0.90, sensitivity rates of 1.00, 1.00, 1.00, and 0.95, and specificity rates of 0.50, 0.50, 0.56, and 0.75. Among the models, the XGBoost model had the best performance, with the highest accuracy and specificity rates. DCA indicated clinical benefits for all 4 models. ConclusionsThe multimodal imaging radiomics model based on enhanced CT has good clinical application value in predicting the efficacy of NCRT in LARC. It can accurately predict good and poor therapeutic outcomes, providing personalized clinical surgical interventions.
【摘要】 目的 探讨肝硬化食管静脉曲张程度与门脾静脉内径、肝功能Child-Pugh分级间的关系。 方法 对2007年1月-2010年1月间56例肝硬化患者行增强CT，测量门静脉主干及脾门部脾静脉直径，采用Child-Pugh分级标准进行肝功能分级，并行胃镜了解食管静脉曲张的程度。 结果 食管静脉曲张程度与门、脾静脉内径呈正相关，而Child-Pugh分级与门脾静脉内径、食管静脉曲张程度无相关性。 结论 根据门、脾静脉内径可预测肝硬化上消化道出血的可能性；在Child-Pugh分级基础上对患者上消化道出血的风险进行评估显得尤为重要。【Abstract】 Objective To discuss the relationship among the esophageal varices, the diameter of portal vein and spleen vein, and Child-Pugh score in patients with liver cirrhosis. Methods The study included 56 patients who had liver cirrhosis between January 2007 and January 2010. We measured their portal vein and spleen vein diameter with CT; used Child-Pugh score to grade their hepatic function; and detected the degree of the esophageal varices by endoscopy. Results There was a positive correlation between the degree of esophageal varices and diameter of portal vein and spleen vein, while no correlation showed between portal vein and spleen vein diameter, degree of esophageal varices, and Child-Pugh score. Conclusion The upper gastrointestinal bleeding in patients with liver cirrhosis can be predicted by the diameter of portal vein and spleen vein, assessment of upper gastrointestinal bleeding based on Child-Pugh score should also be taken into account.
Considering the small differences between different types in the diabetic retinopathy (DR) grading task, a retinopathy grading algorithm based on cross-layer bilinear pooling is proposed. Firstly, the input image is cropped according to the Hough circle transform (HCT), and then the image contrast is improved by the preprocessing method; then the squeeze excitation group residual network (SEResNeXt) is used as the backbone of the model, and a cross-layer bilinear pooling module is introduced for classification. Finally, a random puzzle generator is introduced in the training process for progressive training, and the center loss (CL) and focal loss (FL) methods are used to further improve the effect of the final classification. The quadratic weighted Kappa (QWK) is 90.84% in the Indian Diabetic Retinopathy Image Dataset (IDRiD), and the area under the receiver operating characteristic curve (AUC) in the Messidor-2 dataset (Messidor-2) is 88.54%. Experiments show that the algorithm proposed in this paper has a certain application value in the field of diabetic retina grading.
Day surgery is an important diagnosis and treatment modality to promote hierarchical diagnosis and treatment and form a “surgery in hospital, recovery in community” diagnosis and treatment mode. At the same time, the promotion and implementation of hierarchical diagnosis and treatment provides institutional support and promotion for the perfection of day surgery management. Based on the experience from the Day Surgery Centre of General Hospital of Eastern Theater Command, this paper investigates the role of “gate-keepers” and recovery guidance in community and secondary hospitals in the perfection of day surgery in tertiary hospitals. Taking orthopedic day surgery as an example, which accounts for the largest proportion in day surgery in General Hospital of Eastern Theater Command, this paper aims to explore a feasible model of hierarchical diagnosis and treatment of day surgery, which specifies the responsibilities and works of hospitals at all levels.
This article discusses the new needs and development direction of medical testing technology under the hierarchical diagnosis and treatment system in China, outlines the principles and advantages of new medical testing technology based on smartphones, and briefly describes the development status and research results of smartphone testing technology in specific medical testing directions such as immune analysis, nucleic acid analysis, biochemical analysis and cell morphology analysis. In addition, the article also discusses the current problems of smartphone medical testing technology, such as poor compatibility with different models of smartphones, few detection indicators, low automation, lack of clinical verification. Finally, a prospect is made for the possible future development direction of smartphone medical examination technology, aiming to provide a certain reference for the promotion and more reasonable application of smartphone medical examination technology.
Objective To investigate the risk factors for postoperative complications Clavien-Dindo classification≥grade Ⅱ after lung cancer surgery. Methods The patients who underwent lung cancer surgery in a multicenter observational study from November 2017 to January 2020 were included. The Clavien-Dindo classification of postoperative complications was analyzed. Logistic regression was used to identify the risk factors for complications≥ gradeⅡ. Results A total of 388 patients were enrolled, including 203 males and 185 females with a mean age of 56.14±10.36 years. The incidence of postoperative complications was 25.52% (99/388) after lung cancer surgery and the incidence of complications≥gradeⅡ was 20.10% (78/388). The five most common postoperative complications were pneumonia (6.96%), prolonged pulmonary air leak (>7 days, 5.67%), incision dehiscence (4.64%), arrhythmia (3.87%), and postoperative pleural effusion (3.35%). Multivariate analysis showed that open surgery [reference: uniportal thoracoscopic surgery, OR=2.18, 95%CI (1.01, 4.70), P=0.047], extended resection [reference: sublobar resection, OR=2.86, 95%CI (1.11, 7.19), P=0.030; reference: lobectomy, OR=2.20, 95%CI (1.10, 4.40), P=0.026] and operative time≥3 h [OR=2.07, 95%CI (1.12, 3.85), P=0.021] were independent risk factors for postoperative complications≥gradeⅡ after lung cancer surgery. Conclusion Surgical approach, extent of resection and operative time are independent influencing factors for postoperative complications≥gradeⅡ after lung cancer surgery.
In order to solve the pathological grading of hepatocellular carcinomas (HCC) which depends on biopsy or surgical pathology invasively, a quantitative analysis method based on radiomics signature was proposed for pathological grading of HCC in non-contrast magnetic resonance imaging (MRI) images. The MRI images were integrated to predict clinical outcomes using 328 radiomics features, quantifying tumour image intensity, shape and text, which are extracted from lesion by manual segmentation. Least absolute shrinkage and selection operator (LASSO) were used to select the most-predictive radiomics features for the pathological grading. A radiomics signature, a clinical model, and a combined model were built. The association between the radiomics signature and HCC grading was explored. This quantitative analysis method was validated in 170 consecutive patients (training dataset: n = 125; validation dataset, n = 45), and cross-validation with receiver operating characteristic (ROC) analysis was performed and the area under the ROC curve (AUC) was employed as the prediction metric. Through the proposed method, AUC was 0.909 in training dataset and 0.800 in validation dataset, respectively. Overall, the prediction performances by radiomics features showed statistically significant correlations with pathological grading. The results showed that radiomics signature was developed to be a significant predictor for HCC pathological grading, which may serve as a noninvasive complementary tool for clinical doctors in determining the prognosis and therapeutic strategy for HCC.
ObjectivesTo evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) of lanthanum carbonate in the treatment of chronic kidney disease with hyperphosphatemia. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library, PROSPERO, CNKI, CBM, WanFang Data and VIP to collect systematic reviews and meta-analysis about lanthanum carbonate in the treatment of chronic kidney disease with hyperphosphatemia from inception to August 31st, 2016. Two reviewers independently screened literature and extracted data, then AMSTAR tool was used to assess the methodological quality of included studies and the GRADE tool was used to grade the evidence quality of outcome measures included in the SRs. ResultsA total of eight relevant SRs were included and containing three main outcome measures. The assessment results of AMSTAR tool suggested that:four SRs were of high quality, and the other four were of medium quality. GRADE results showed:for serum phosphorus level, compared with placebo, the quality of the evidence of three SRs were medium, low and very low; compared with calcium carbonate or conventional phosphorus binder, four SRs were low, low, low and very low; compared with sevelamer, one SR was low. For serum calcium level, compared with placebo, the quality of the evidence of three SRs were high, medium and low, respectively; compared with calcium carbonate or conventional phosphorus binder, five SRs were low, low, low, very low and very low; compared with sevelamer, one SR was very low. For serum iPTH level, compared with placebo, the quality of the evidence of three SRs were medium, low and very low; compared with calcium carbonate or conventional phosphorus binder, five SRs were medium, low, low, very low and very low; compared with sevelamer, one SR was low. ConclusionAt present, methodological quality assessment for the treatment of hyperphosphatemia in chronic kidney disease with lanthanum carbonate is generally not high and the level of evidence for the conclusion is generally low. In drug safety, especially in the occurrence of adverse events of the digestive system is still controversial, and a large amount of high quality experimental is needed to demonstrate the safety of its long-term use. Clinicians need to be cautious in using these evidence to make clinical decisions.
目的 探讨围手术期患者静脉血栓预防的分级护理方法，为静脉血栓的预防提供实证依据。 方法 2009年5月－2012年1月，以某市级乙等综合性医院各科室手术患者为对象，引入量化工具评估患者围手术期静脉血栓发生的危险，并根据评估结果采取分级护理方法进行防治，并在患者出院时用彩色多普勒超声判断是否存在静脉血栓，以验证分级护理防治效果。 结果 纳入的318患者经评估均存在发生静脉血栓的风险，其中低度危险患者65例，中度182例，高度危险71例。经分级护理治疗，出院时均未发生静脉血栓症状、肺栓塞。 结论 分级护理方法安全、简便，可操作性强，便于围手术期患者静脉血栓的早期、普遍预防，值得推广。