基于蒙特利尔病变部位分型的克罗恩病患者临床特征分析

目的 探讨回肠末段型（L1）、结肠型（L2）及回结肠型（L3）克罗恩病（CD）患者的临床特征、实验室检查、疾病行为等方面的差异。方法 回顾性研究2021年1月—2022年6月武汉大学人民医院181例CD患者的临床资料,其中L1型CD患者66例,L2型CD患者20例,L3型CD患者95例。收集患者临床资料和实验室检查结果等,分析3组患者在临床特征和实验室检查结果等方面的差异。多因素二元Logistic回归分析L1、L2和L3型CD患者临床特征。绘制受试者工作特征（ROC）曲线,分析部分临床特征预测CD病变部位的效能。结果 L1组患者平均年龄大于L3组患者（P <0.05）。L1组患者黏液脓血便构成比低于L2和L3组患者（P <0.05）。L1组患者平均血小板计数低于L3组患者（P <0.05）。L1组患者肛周病变构成比低于L2和L3组患者（P <0.05）。多因素二元Logistic回归分析结果显示,L2型CD［O^R =1.017（95% CI：1.004,1.031）］和L3型CD［O^R =1.026（95% CI：1.016,1.037）］与CD疾病活动指数（CDAI）相关（P <0.05）,L3型CD［O^R =7.088（95% CI：2.390,21.018）］与肛周病变风险增加相关（P <0.05）。ROC曲线分析结果显示,与L1型CD比较,当血沉为29.50 mm/h时,L2型CD的ROC曲线下面积（AUC）为0.724（95% CI：0.579,0.868）,此时预测L2型CD敏感性为77.8%（95% CI：0.519,0.926）,特异性为64.1%（95% CI：0.510,0.754）;当血小板计数取临界值307×10⁹/L时,L3型CD的AUC为0.702（95% CI：0.618,0.785）,此时预测L3型CD敏感性为72.3%（95% CI：0.602,0.826）,特异性为65.2%（95% CI：0.554,0.752）。结论 L1型、L2型及L3型CD患者的临床表现、实验室检查、疾病行为等均存在差异,基于这些特征将有助于鉴别CD患者的不同病变部位。     

Prognostic and immunohistochemical validation of the capella classification of pancreatic neuroendocrine tumours: an analysis of 82 sporadic cases

AIMS: To study the clinical outcome of 82 cases of pancreatic neuroendocrine tumours classified according to the recent histological and prognostic classification of Capella. METHODS AND RESULTS: Eighty-two surgical cases of pancreatic neuroendocrine tumours were examined histologically with immunohistochemical staining of paraffin sections using streptavidin-biotin complex and application of antibodies against chromogranin A and 10 hormonal peptides. Classification in four groups correlated with long follow-up and outcome of these cases. Histological examination showed 30 group I, four group II, 41 group III and seven group IV tumours. Twenty-one (70%) of group I tumours were insulinomas, whereas 25% of group III tumours were glucagonomas and 25% were unclassified. Most group IV tumours were unclassified, showing no immunohistochemical staining with any of the 10 hormonal peptides tested. Outcome was clearly correlated with tumour group. Among the 14 patients who died of the disease, four had group IV and 10 group III tumours. Thus, unclassified asymptomatic tumours without immunohistochemical staining had a poorer prognosis than asymptomatic tumours with staining. CONCLUSION: This study validates the Capella classification as easy to apply and useful in predicting clinical outcome.     

Classification of Breast Masses Using Selected Shape,Edge-sharpness,and Texture Features with Linear and Kernel-based Classifiers

Breast masses due to benign disease and malignant tumors related to breast cancer differ in terms of shape, edge-sharpness, and texture characteristics. In this study, we evaluate a set of 22 features including 5 shape factors, 3 edge-sharpness measures, and 14 texture features computed from 111 regions in mammograms, with 46 regions related to malignant tumors and 65 to benign masses. Feature selection is performed by a genetic algorithm based on several criteria, such as alignment of the kernel with the target function, class separability, and normalized distance. Fisher's linear discriminant analysis, the support vector machine (SVM), and our strict two-surface proximal (S2SP) classifier, as well as their corresponding kernel-based nonlinear versions, are used in the classification task with the selected features. The nonlinear classification performance of kernel Fisher's discriminant analysis, SVM, and S2SP, with the Gaussian kernel, reached 0.95 in terms of the area under the receiver operating characteristics curve. The results indicate that improvement in classification accuracy may be gained by using selected combinations of shape, edge-sharpness, and texture features.     

How many lymph nodes are necessary to stage early and advanced adenocarcinoma of the sigmoid colon and upper rectum?

The lymph-node yields in specimens resected for colorectal adenocarcinoma show considerable variations, raising the question whether the minimum lymph-node number recommended by the UICC (International Union Against Cancer) for pN0 classification represents an appropriate quality standard for specimen work-up. The number of pericolic lymph nodes recovered from 568 archival surgical colorectal carcinoma specimens located in the sigmoid or upper rectum showed a highly statistically significant correlation with both the pT category and the presence of metastases (P<0.0005). The median lymph-node yield in standardized (i.e., resembling in size surgically removed cancer specimens) tumor-free specimens obtained during autopsies was 13 lymph nodes, compared with 20.5 when diverticula were present and more than 30 in specimens with chronic inflammation or from patients with systemic infections. In 48 pT2 and pT3 carcinoma specimens prospectively dissected in the same way, median numbers of 18 (pT2) and 23 (pT3) lymph nodes were detected (range between 8 and 39 nodes). The lymph-node numbers recommended in previous studies and by the UICC often seem to be too low to declare a specimen free of metastases. Although the great variation in lymph-node counts requires the recovery of all lymph nodes for pN0 classification, recommendations considering the pT status and additional factors like diverticula and inflammatory changes can be useful as a quality standard for specimen work up.     

Event-Related Potential Correlates of Two Stages of Information Processing in Physical and Semantic Discrimination Tasks

Event-related potentials were studied while subjects performed physical and semantic discrimination tasks. Two negative components, N_A and N2, were observed in both kinds of discriminations. The earlier component, N_A, had a constant onset latency, but its peak latency varied as a function of stimulus complexity. N2 latency varied in relation to changes in the peak of N_A. RT and P3 followed N2 by similar amounts of time across tasks. The N_A and N2 components were interpreted as reflecting partially overlapping sequential stages of processing associated with pattern recognition and stimulus classification, respectively.     

Paraffin-immunohistochemical Analysis of 26 Non-Hodgkin's Malignant Lymphomas n the Endemic Area of Human T-cell Leukemia Virus Type 1

A study was conducted to evaluate the usefulness of paraffin immunohistochemistry for histopathological classification of non Hodgkin's malignant lymphomas (NHML). The phenotypes of lymphoma cells and other cells were examined using 11 monoclonal and 3 polyclonal antibodies by the ABC method on paraffin-embedded tissue sections of 226 cases of NHML, comprising 94 B cell lymphomas (B ML) and 132 T cell lymphomas (T-ML). In 219 NHML cases (96.8%), lymphoma cells reacted with more than one of these antibodies. A set of MB 1, Mx pan B, L26, LN 1, LN 2 and antiimmunoglobulin light chain antibodies characterized each subtype of B MLs, categorized according to the Kiel classification. Mantle-zone lymphoma (MzML) was added as one subtype. L26 stained the largest number of B MLs (82.8%). B cell chronic lymphocytic leukemia (B CLL) was labeled most frequently by MB 1. MzML was characterized by reactivity of lymphoma cells with LN 2 and by the appearance of monoclonal immunoglobulin light chain along the cell membrane. Follicle center cell lymphomas were stained by LN 1 and LN 2, although a small number of proliferating cells were labeled by LN 1 in B CLL, MzML and the im-munocytoma lymphoplasmacytic/cytoid variant. MT 1 and/or UCHL-1 showed various degrees of reactivity with the cell membranes of lymphoma cells in 94.8% of T-MLs. Among the T cell pleomorphic lymphomas of Suchi and Lennert, the adult T cell leukemia/lymphoma type, defined by stippled heterochromatin distribution and peculiar huge cells, reacted selectively (p<0.05) with anti phospho-kinase C antibody. Anaplastic large cell T-ML reacted with a set of Ber H2, LN 2 and Leu Ml. In T zone lymphomas without hyperplastic follicles, angioimmuno-blastic lymphadenopathy with dysproteinemia type T-ML, lymphoepithelioid cell lymphomas and some pleomorphic lymphomas comprising clear large lymphoma cells, there were many intermingling B cells, and their constitution varied. In some lymphoblastic lymphomas of both the T cell and B cell type, phenotypes of T cells and B cells were expressed. Consequently, it was shown that paraffin immunohistochemistry was useful for the practical histopathological diagnosis of NHML even in the area where human T cell leukemia virus type 1 is endemic.     

Signal-dependent wavelets for electromyogram classification

In the study, an efficient method to perform supervised classification of surface electromyogram (EMG) signals is proposed. The method is based on the choice of a relevant representation space and its optimisation with respect to a training set. As EMG signals are the summation of compact-support waveforms (the motor unit action potentials), a natural tool for their representation is the discrete dyadic wavelet transform. The feature space was thus built from the marginals of a discrete wavelet decomposition. The mother wavelet was designed to minimise the probability of classification error estimated on the learning set (supervised classification). As a representative example, the method was applied to simulate surface EMG signals generated by motor units with different degrees of short-term synchronisation. The proposed approach was able to distinguish surface EMG signals with degrees of synchronisation that differed by 10%, with a misclassification rate of 8%. The performance of a spectral-based classification (error rate approximately 33%) and of the classification with Daubechies wavelet (21%) was significantly poorer than with the proposed wavelet optimisation. The method can be used for a number of different application fields of surface EMG classification, as the feature space is adapted to the characteristics of the signal that discriminate between classes. An erratum to this article is available at .     

Wigner-Ville analysis and classification of electrocardiograms during thrombolysis

Non-stationary analysis of electrocardiograms (ECGs) using Wigner-Ville distribution is presented. Analysis was performed on subjects with acute myocardial infarction who had undergone thrombolysis, in Holter recordings of lead V1. The distinction between successfully and non-successfully thrombolysed patients was evaluated, based on time-frequency features of the Wigner-Ville transformed ECGs at the sixth hour after lysis. Characteristic parameters were extracted from time-frequency areas, and linear discriminant analysis was performed on these parameters, leading to a prediction index to distinguish the two classes. Thirteen features were found statistically significant by t-test and were used for the classification with linear modelling. Out of these features, four corresponded to frequencies lower than 25 Hz and higher than 50 Hz for, roughly, the QRS complex, five features corresponded to all the frequency bands of, roughly, the ST area, and the last four features corresponded to the T-wave. The feature-vector used in linear modelling was iteratively generated, and the iterative prediction found all 18 features significant. The iterative method resulted in better classification than that of the standard statistical procedure (3.8% error against 18.1% with the classic method). The evolution of the prediction index with time for the first 12 h was different for the successfully and non-successfully thrombolysed groups. Specifically, in the successful thrombolysis group, oscillations and variation with time were more obvious, indicating a possible difference in the dynamics of the cardiac system.     

Selecting relevant electrode positions for classification tasks based on the electro-encephalogram

The aim is to describe a general approach to determining important electrode positions when measured electro-encephalogram signals are used for classification. The approach is exemplified in the frame of the brain-computer interface, which crucially depends on the classification of different brain states. To classify two brain states, e.g. planning of movement of right and left index fingers, three different approaches are compared: classification using a physiologically motivated set of four electrodes, a set determined by principal component analysis and electrodes determined by spatial pattern analysis. Spatial pattern analysis enhances the classification rate significantly from 61.3±1.8% (with four electrodes) to 71.8±1.4%, whereas the classification rate using principal component analysis is significantly lower (65.2±1.4%). Most of the 61 electrodes used have no influence on the classification rate, so that, in future experiments, the setup can be simplified drastically to six to eight electrodes without loss of information.