目的:探讨癫痫发作致烧伤的临床特点及防治措施。方法:在系统抗癫痫的前提下，在抗休克、预防感染、营养支持等全身治疗同时，积极采用手术方法及早修复创面，结合良好的心理调试及护理。结果:该组43例患者除3例未完成治疗外，其余40例均痊愈出院，住院时间10~42天，住院期间出现癫痫再发作1例，经调整用药后控制，均无并发症发生。结论:采取系统的抗癫痫药物治疗与早期积极进行烧伤创面手术，全身和心理治疗并重的综合治疗方法，可使创面及早痊愈，明显降低癫痫再发作，是治疗癫痫合并烧伤的有效方法。
Abstract： Objective To evaluate the diagnostic accuracy for the the assessment of coronary artery stenosesusing 64-multislice spiral computed tomography （64-MSCT） scanner compared with selective coronary angiography（SCA）. Methods 64-MSCT and SCA were both performed in 93 patients with 74 males and 19 females at mean age of （58.2±8.5） years in West China Hospital between April 2004 and December 2010. The cardiacrhythm of all the patients was stably sinus. Patients with initial heart rates≥90 time/min were received treatments of β-blockers. All available coronary segments（internal diameter ≥ 2.0 mm）were included in the evaluation. Lesions with ≥ 50％ luminalnarrowing were considered as significant stenosis. According to the image detail of segments and existance of artfacts,the image quality was randed Ⅰ to Ⅳ ,with rank Ⅰ to Ⅲ meeting demands of image evaluation. Evaluations had been done concerning the 64-MSCT scanner for detecting the stenosis of the variant branches or segments of the coronary artery. Results 64-MSCTprovided a full image correspondence(100%,1 238/1 238)of all the segments clearly displayed in the SCA. All of the coronary segments involved （n=1 238） met the quality demands of being evaluated as rankⅠ to Ⅲ. Considering SCA as the golden standard， overall sensitivity for classifying stenosis using 64-MSCT scannerwas 88.8%（427/481）， specificity was 91.7%（694/757）， positive predictive value was 87.1%（427/490），and negative predictive value was 92.8%（ 694/748）.While the stenosis diagnostic accuracy of proximal left circumflexbranch and the first obtuse marginal branch of left coronay artery is lower than other branches： the sensitivity of the proximal left circumflex branch was 68.3%（41/60），specificity was 60.6%（20/33），positive predictive value was 75.9%（41/54），negative predictive value was 51.3%（20/39）；the sensitivity of the first obtuse marginalbranch was 58.8%（10/17），specificity was 93.5%（58/62），positive predictive value was 71.4%（10/14），negative predictive value was 89.2%（58/65）. Arterial wall calcification and false image of cardiac movements were the maininfluence factors for accuracy of the the assessment of coronary artery stenosis with 64-MSCT scanner. Conclusion 64-MSCT scanner provids a high diagnostic accuracy in assessing stenosis of the coronary artery. The anatomical location and luminal area of coronary artery were the main influence factors of diagnostic accuracy. Thus the diagnostic accuracy in proximal left circumflex branch and the first obtuse marginal branch of left coronary artery was lower than other coronarysegments.
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.
Feature representation is the crucial factor for the magnetic resonance imaging (MRI) based computer-aided diagnosis (CAD) of Parkinson’s disease (PD). Deep polynomial network (DPN) is a novel supervised deep learning algorithm, which has excellent feature representation for small dataset. In this work, a stacked DPN (SDPN) based ensemble learning framework is proposed for diagnosis of PD, which can improve diagnostic accuracy for small dataset. In the proposed framework, SDPN was performed on each subset of extracted features from MRI images to generate new feature representation. The support vector machine (SVM) was then adopted to perform classification task on each subset. The ensemble learning algorithm was then performed on all the SVM classifiers to generate the final diagnosis for PD. The experimental results on the Parkinson’s Progression Markers Initiative dataset (PPMI) showed that the proposed algorithm achieved the classification accuracy, sensitivity and specificity of 90.15%, 85.48% and 93.27%, respectively, with the brain network features, and it also got the classification accuracy of 87.18%, sensitivity of 86.90% and specificity of 87.27% on the multi-view features extracted from different brain regions. Moreover, the proposed algorithm outperformed other algorithms on the MRI dataset from PPMI. It suggests that the proposed SDPN-based ensemble learning framework has the feasibility and effectiveness for the CAD of PD.
Transcatheter aortic valve replacement (TAVR) has been confirmed to be safety and efficacy for high-risk elderly aortic stenosis, and the clinical effect of TAVR for medium and low-risk aortic stenosis is not worse than that of surgery. The development of surgical techniques and instruments has made cardiologists attempt to broaden the surgical indications. Many elderly and high-risk patients with pure native aortic regurgitation have been treated “off label” with similar techniques, completing artificial valve replacement, restoring valve function and improving the prognosis. However, due to the high requirements of surgical techniques and surgical complications, there is a lack of randomized controlled studies to confirm its safety and effectiveness. Unlike aortic stenosis, native aortic regurgitation presents unique challenges for transcatheter valves. In this article, the authors review current advances in the treatment of aortic valve regurgitation with TAVR.
Neuroimaging technologies have been applied to the diagnosis of schizophrenia. In order to improve the performance of the single-modal neuroimaging-based computer-aided diagnosis (CAD) for schizophrenia, an ensemble learning algorithm based on learning using privileged information (LUPI) was proposed in this work. Specifically, the extreme learning machine based auto-encoder (ELM-AE) was first adopted to learn new feature representation for the single-modal neuroimaging data. Random project algorithm was then performed on the learned high-dimensional features to generate several new feature subspaces. After that, multiple feature pairs were built among these subspaces to work as source domain and target domain, respectively, which were used to train multiple support vector machine plus (SVM+) classifier. Finally, a strong classifier is learned by combining these SVM+ classifiers for classification. The proposed algorithm was evaluated on a public schizophrenia neuroimaging dataset, including the data of structural magnetic resonance imaging (sMRI) and functional MRI (fMRI). The results showed that the proposed algorithm achieved the best diagnosis performance. In particular, the classification accuracy, sensitivity and specificity of the proposed algorithm were 72.12% ± 8.20%, 73.50% ± 15.44% and 70.93% ± 12.93%, respectively, on the sMRI data, and it also achieved the classification accuracy of 72.33% ± 8.95%, sensitivity of 68.50% ± 16.58% and specificity of 75.73% ± 16.10% on the fMRI data. The proposed algorithm overcomes the problem that the traditional LUPI methods need the additional privileged information modality as source domain. It can be directly applied to the single-modal data for classification, and also can improve the classification performance. Therefore, it suggests that the proposed algorithm will have wider applications.
ObjectiveTo evaluate the early and mid-term outcomes of total thoracoscopic Box Lesion radiofrequency ablation in patients with atrial fibrillation.MethodsThe clinical data of 31 patients with atrial fibrillation who underwent total thoracoscopic Box Lesion radiofrequency ablation between November 2011 and March 2018 at the Department of Cardiac Surgery in our hospital were retrospectively analyzed, including 23 males and 8 females at an average age of 66.17±8.32 years. All patients did not have concomitant severe organic heart disease which required surgical intervention.ResultsThere were 20 patients with paroxysmal atrial fibrillation, 8 with persistent atrial fibrillation, and 3 with long-standing persistent atrial fibrillation. Twenty-nine patients got the 3-year follow-up, and 2 patients were lost to the follow-up 6 months after the surgery. The procedure was successfully performed in all patients, with an average operation time of 113.00±26.00 min. There was no perioperative death or related complication. All patients were restored to sinus rhythm immediately after surgery. Five patients got atrial fibrillation during postoperative hospitalization, which reverted to sinus rhythm after electrical cardioversion. The rate of sinus rhythm maintenance was 62.9%, 55.9% and 52.4% in postoperative 1, 2 and 3 years, respectively. No patient died during the period, and no procedure-related complication was observed.ConclusionTotal thoracoscopic Box Lesion radiofrequency ablation effectively shortens operation time, and reduces surgical trauma and procedure-related complications, meanwhile, ensures the surgical outcomes.
Transcatheter aortic valve replacement (TAVR) for severe aortic stenosis is growing rapidly. The use of new heart valves prosthesis has improved surgical safety and efficacy. This report described a 72-year-old male patient with severe aortic stenosis combined with severe aortic regurgitation, who was evaluated at moderate-high risk of surgery and received a transapical TAVR using the Ken-Valve heart valve. The transcatheter operation time was 8 min, and the blood loss was 50 mL. The tracheal intubation was removed immediately after the surgery. Transesophageal echocardiography on the 4th postoperative day showed that the aortic valve leaflets worked well, and there was no valve orifice and paravalvular leakage. The patient was discharged on the 5th day after the surgery without complications. Transapical TAVR using Ken-Valve was an easy surgical procedure for aortic valve disease, and had short operation time.
Transcatheter aortic valve replacement (TAVR) techniques have been rapidly developed in recent years. Current guidelines and studies mainly focus on aortic stenosis patients treated by transfemoral approach, but they are not completely appropriate to patients with isolated aortic regurgitation or other patients who need transapical TAVR (TA-TAVR), which affects the standardized treatment of those patients. Therefore, our team pronounced the operational standards for TA-TAVR, based on fully reviewing the literatures worldwide, combined with the opinions of experts from 15 heart centers with rich experience in carrying out TA-TAVR in China. This standard aims to provide clinicians with standardized diagnosis and treatment principles of TA-TAVR and improve the quality of TA-TAVR in China.
Transcatheter aortic valve implantation (TAVI) is an important alternative in treating high-risk patients with aortic valve regurgitation. Transcatheter tricuspid valve implantation (TTVI) is also an important treatment option for high-risk patients with tricuspid regurgitation. We reported a 72-year male patient who underwent TAVI due to severe aortic valve regurgitation using a J-Valve. During a two-year follow-up, the patient developed secondary tricuspid regurgitation to atrial fibrillation, and subsequently received TTVI using a LuX-Valve. Following the interventions, the patient's symptoms were significantly improved, and echocardiography indicated good hemodynamic performance of both transcatheter heart valves. This case highlights the feasibility and effectiveness of performing multiple valve implantations via transcatheter approaches in high-risk elderly patients.