Abstract： Objective To explore a new videoassisted thoracoscopic surgical treatment for lone atrial fibrillation, in order to seek better efficacy, reduce invasiveness, and devise an easiertooperate surgical treatment for atrial fibrillation. Methods In June 2011, 3 women aged 40 years, 60 years, and 66 years with lone atrial fibrillation were treated in the Cardiovascular Surgery Department of West China Hospital. The patients underwent a videoassisted thoracoscopic “Box Lesion” bipolar radiofrequency atrial fibrillation therapy (bilateral pulmonary vein + left atrial posterior wall isolation), including three 5 to 10 mm small incisions on each side of the chest wall. The complications and sinus rhythm maintenance of the patients were observed. Results The operative times were 140 min, 170 min, and 155 min. The three patients were in sinus rhythm immediately after the surgery. Mean blood loss was approximately 80 ml, mean intensive care unit (ICU) stay was 1 day, and average hospital stay was 7 days. No deaths and serious complications occurred. The three patients were still in sinus rhythm one week and one month after the operation, as measured by electrocardiogram. Conclusion Box Lesion bipolar radiofrequency treatment for atrial fibrillation therapy shows fast postoperative recovery. It is a promising procedure in atrial fibrillation treatment and is worthy of further study.
ObjectiveTo investigate the feasibility and safety of spleen-preserving distal pancreatectomy (SpDP), and to discuss the indications and techniques of SpDP. MethodsThe clinical data of seven patients underwent SpDP between January 2004 and December 2007 in Xinhua Hospital were analyzed retrospectively. ResultsOut of the seven cases, one case received the SpDP combined with partial splenic vessel resection, while the other cases received the SpDP with splenic vessel preservation. The operation time was (2.93±0.38) h and the intraoperative blood loss was (392.86±109.65) ml. Only one case suffered from pancreatic fistula, who finally recovered after medicine therapy and percutaneous drainage. There was no other complication or operative mortality. The postoperative platelet count was (273±43.76)×109/L and the postoperative hospital stay was (17.86±8.07) d. For six cases of patients, no recurrence and metastasis was found after the followup (49.2±14.4) months （30-72 months）. ConclusionSpDP is a safe and feasible procedure, which is worthy for selected cases such as benign neoplasm of the body and tail of the pancreas.
Objective To study the effectiveness of avascular necrosis of the femoral head treated by lesions clearance, compact bone grafting, and porous tantalum rod implantation. Methods Between March 2008 and May 2010, 14 patients (16hips) with avascular necrosis of the femoral head were treated by lesions clearance, compact bone grafting, and implantation of porous tantalum rod. Of 15 cases, 13 were male (15 hips) and 1 was female (1 hip) with a median age of 42.2 years (range, 18-73 years), including traumatic in 1 case (1 hip), alcohol ic in 4 cases (4 hips), and steroid-induced in 9 cases (11 hips); 3 hips were at Association Research Circulation Osseous (ARCO) stage I and 13 hips were at ARCO stage II. The Harris score was 51.89 ± 12.42, and the X-ray score was 31.88 ± 4.03. All the cases were diagnosed by X-ray films and MRI. The median disease duration was 2.5 years (range, 6 months to 7 years). All the patients accepted the operation of lesions clearance by slotting at the neck of femur, then, compact bone grafting, and implantation of porous tantalum rod were performed. The affected l imb could not bear weight loading at 1-3 months after operation and partly bear weight loading after 3 months of operation. Results Primary heal ing of incision was achieved in all patients and no compl ication occurred. The patients were followed up 24 months on average (range, 13-36 months). Two patients underwent total hip arthroplasty at 4 months and 2 years respectively because of even worsened pain and collapsed femoral heads; 12 patients achieved obvious pain rel ief with a survival rate 87.5%(14/16). The postoperative Harris score was 84.89 ± 17.96, showing significant difference when compared with preoperative score (t= —8.038,P=0.001). The X-ray examination showed definite ossification, increased density, regular arrangement of the trabeculae and no collapsed femoral head. The X-ray score was 32.19 ± 6.57, showing no significant difference when compared with preoperative score (t= —2.237, P=0.819). Conclusion Lesions clearance, compact bone grafting, and implantation of porous tantalum rod for avascular necrosis of the femoral head have a good short-term cl inical result.
ObjectiveTo discuss the MRI diagnostic criteria, classification and lesion characteristics of medial discoid meniscus of the knee. MethodsWe retrospectively analyzed the clinical data of all patients who accepted MRI examination of knee from November 2009 to March 2015.Twenty-six of them (28 knees) with medial discoid meniscus were screened out.We measured and analyzed in all cases the ratio of the width of meniscus to that of tibial plateau on coronal slice, and the thickest thickness of the meniscus posterior horn on sagittal slice.All cases were divided into complete and incomplete type according to MRI findings, and then we compared the lesion rate of the two types of medial discoid meniscus. ResultsTwenty-eight cases were divided into complete type (n=16) and incomplete type (n=12);there were 17 cases of medial discoid meniscal tears, with a lesion rate of 60.7%.The ratio of the width of meniscus to that of tibial plateau on coronal slice was 0.29±0.06, and the thickest thickness of the meniscus posterior horn was (5.31±0.92) mm.The lesion rate of complete type was 81.2%, and 33.3% of the incomplete type.The lesion rate of the complete type was higher than that of the incomplete type, and the difference was statistically significant (P < 0.05). ConclusionsThree MRI diagnostic criteria for medial discoid meniscus are 3 or more than 3 consecutive layers discoid meniscus "tie-like" change in sagittal slice, the ratio of the width of meniscus to that of tibial plateau≥0.20, and the thickest thickness of the meniscus posterior horn≥4.40 mm.Medial discoid meniscuses are divided into complete and incomplete type; the lesion rate of complete type of medial discoid meniscus is higher than that of the incomplete type.
ObjectiveTo apply the multi-modal deep learning model to automatically classify the ultra-widefield fluorescein angiography (UWFA) images of diabetic retinopathy (DR). MethodsA retrospective study. From 2015 to 2020, 798 images of 297 DR patients with 399 eyes who were admitted to Eye Center of Renmin Hospital of Wuhan University and were examined by UWFA were used as the training set and test set of the model. Among them, 119, 171, and 109 eyes had no retinopathy, non-proliferative DR (NPDR), and proliferative DR (PDR), respectively. Localization and assessment of fluorescein leakage and non-perfusion regions in early and late orthotopic images of UWFA in DR-affected eyes by jointly optimizing CycleGAN and a convolutional neural network (CNN) classifier, an image-level supervised deep learning model. The abnormal images with lesions were converted into normal images with lesions removed using the improved CycleGAN, and the difference images containing the lesion areas were obtained; the difference images were classified by the CNN classifier to obtain the prediction results. A five-fold cross-test was used to evaluate the classification accuracy of the model. Quantitative analysis of the marker area displayed by the differential images was performed to observe the correlation between the ischemia index and leakage index and the severity of DR. ResultsThe generated fake normal image basically removed all the lesion areas while retaining the normal vascular structure; the difference images intuitively revealed the distribution of biomarkers; the heat icon showed the leakage area, and the location was basically the same as the lesion area in the original image. The results of the five-fold cross-check showed that the average classification accuracy of the model was 0.983. Further quantitative analysis of the marker area showed that the ischemia index and leakage index were significantly positively correlated with the severity of DR (β=6.088, 10.850; P＜0.001). ConclusionThe constructed multimodal joint optimization model can accurately classify NPDR and PDR and precisely locate potential biomarkers.
Corona virus disease 2019 (COVID-19) is an acute respiratory infectious disease with strong contagiousness, strong variability, and long incubation period. The probability of misdiagnosis and missed diagnosis can be significantly decreased with the use of automatic segmentation of COVID-19 lesions based on computed tomography images, which helps doctors in rapid diagnosis and precise treatment. This paper introduced the level set generalized Dice loss function (LGDL) in conjunction with the level set segmentation method based on COVID-19 lesion segmentation network and proposed a dual-path COVID-19 lesion segmentation network (Dual-SAUNet++) to address the pain points such as the complex symptoms of COVID-19 and the blurred boundaries that are challenging to segment. LGDL is an adaptive weight joint loss obtained by combining the generalized Dice loss of the mask path and the mean square error of the level set path. On the test set, the model achieved Dice similarity coefficient of (87.81 ± 10.86)%, intersection over union of (79.20 ± 14.58)%, sensitivity of (94.18 ± 13.56)%, specificity of (99.83 ± 0.43)% and Hausdorff distance of 18.29 ± 31.48 mm. Studies indicated that Dual-SAUNet++ has a great anti-noise capability and it can segment multi-scale lesions while simultaneously focusing on their area and border information. The method proposed in this paper assists doctors in judging the severity of COVID-19 infection by accurately segmenting the lesion, and provides a reliable basis for subsequent clinical treatment.