神经心理发育障碍儿童静态眼睛照片深度学习的病例对照初步研究

背景：目前对儿童神经心理发育障碍的诊断主要靠临床表现，尚缺乏客观的生物学指标，一些神经心理发育障碍儿童的眼睛特征可能具有重要的临床价值。 目的：评价静态眼睛图像是否可以作为儿童神经心理发育障碍的一个潜在的筛查测试。 设计：病例对照研究。 方法：双眼图像采集应用Google人脸图片搜索引擎进行图片搜索，以“autism and child/autistic child”和“normal child/healthy child”关键词搜索到的图片分别归为神经心理发育障碍组和对照组。人工删除完全重复的照片、卡通照片、有面部畸形的照片、没有儿童脸的照片和有多个儿童脸部的照片；应用图像工具识别和挖取每张儿童人脸照片中的双眼图像。生成的眼睛图像调整至128×28分辨率(8位灰度)。卷积神经网络（CNN）是基于一台安装了Kera、Scipy和Python成像库(PIL)的Windows 7计算机。采用二进制交叉熵损失函数和RMSprop算法优化器对模型进行训练。将图像数据分为训练集、验证集和测试集。神经心理发育障碍组测试分数>0.5为分类正确，对照组≤0.5为分类正确，训练25次停止。以分组检索结果为“金标准”，以深度学习训练模型分组为待测标准。计算准确率和损失率。 主要结局指标：根据深度学习训练模型两组特征生成的眼睛图像。 结果：通过双眼图像采集到826张儿童眼睛图像，神经心理发育障碍组413张，对照组413张。训练集736张（89.1%），验证集44张（5.3%），测试集46张（5.6%）。训练集和验证集准确率随训练次数增加呈升高趋势，训练集和验证集损失率随训练次数增加而逐渐下降。神经心理发育障碍组和对照组测试分数分别为0.66±0.20和0.20±0.15，差异有统计学意义（t=9.03，P<0.001），正确分类例数分别为18/23例(78.3%)和22/23例(95.6%)。准确率为87.0%，敏感度为78.3%（95%CI：58.1%~90.3%），特异度为95.6%（95%CI：79.0%~99.2%）。深度学习训练模型ROC曲线显示，AUC=0.962。由CNN卷积图层的可视化生成神经心理发育障碍组和对照组的眼间距宽，像素数分别为90和70。 结论：深度学习训练模型可以获得神经心理发育障碍儿童的眼睛特征，这将有利于通过评价眼睛图片提高儿童神经心理发育障碍的早期筛查水平。     

Ischemic "cross" tolerance in hypoxic ischemia of immature rat brain

The phenomenon of ischemic tolerance has been closely associated with the expression of heat shock proteins but recently, stress tolerance not related to hsp72 has been reported. In the present study, we focused on ischemic tolerance induced by hypoxia and hyperthermia in neonatal rat brain and analyzed the expression of hsp72. In a neonatal rat model of hypoxic ischemia (H-I), preconditioning by whole-body hyperthermia or hypoxia was induced 24 h prior to the ischemia. Brain damage was histologically evaluated and the expressions of hsp72 were analyzed. Hyperthermic preconditioning at 41 degrees C for 15 min, as well as hypoxic preconditioning with 8% hypoxia for 3 h, had almost complete neuroprotective effects. However, we failed to detect the expression of hsp72 in any of preconditioning. Only the H-I insult itself induced hsp72 in the dorsal striatum and slightly in the thalamus and the hippocampus. Hyperthermic preconditioning has neuroprotective effects which are comparable to hypoxic preconditioning in immature brain. The expression of hsp72 is not likely necessary for the ischemic tolerance in immature brain.     

Ultrasound-guided percutaneous laser ablation of liver tissue in a rabbit model

The present report evaluates the efficacy and safety of percutaneous interstitial laser tissue ablation of the liver in nine New Zealand rabbits. A Nd: YAG laser was coupled to a quartz fibreoptic guide (600 m) with a flat tip. The fibre and a thermocouple were placed in the lumen of two Chiba needles (18G) and these were inserted into the liver 10 mm apart under ultrasound guidance. The laser was fired for 5 min at 1, 3 and 5 W power, respectively, in three groups of rabbits. There were no acute complications and all the rabbits except one survived until the established time of sacrifice. The procedure induced a cavity surrounded by a zone (about 10 mm) of coagulative necrosis. After 2 weeks a strong peripheral inflammatory response was evident and after 4 weeks a capsule of connective tissue enclosed the lesions. Our study seems to offer a safe and rapid technique producing a guaranteed kill radius for the treatment of small hepatic neoplasms. Correspondence to: C. M. Pacella     

Comparative study of low power neodymium-YAG laser interstitial hyperthermia versus ethanol injection for controlled hepatic tissue destruction

A solitary hepatic metastasis is amenable to surgery. However, if surgery is contraindicated or if multiple lesions are present in both liver lobes, other treatment modalities have to be considered. We compared the effect of interstitial laser hyperthermia with damage caused by alcoholization. Six anaesthetized beagle dogs were studied. Three animals were treated with laser hyperthermia. A bare laser fibre (400m diameter) was introduced through a 17-gauge needle, length 170 mm, positioned into the liver under real time ultrasonographic guidance. Lesions were produced by continuous 500-s exposure of 1W YAG laser (Medilas MBB 40N) power. Three dogs were subjected to an injection of 4 ml of 98% pure ethanol into the liver through the same needle system. Two days after the procedure the animals were killed and the livers examined. The surface of the livers treated with the YAG laser were entirely normal; superficial lesions were, however, clearly visible. Laserinduced lesions were well reproducible, clearly demarcated, roughly spherical with a mean diameter of 1.01±0.23 cm (n=16). In contrast, the dogs treated with alcohol had free intraperitoneal serohaemorrhagic fluid and the surface of the liver was diffusely abnormal. The lesions had a more or less cylindrical shape, 1.22±0.43 cm on 0.40±0.10 cm (n=12) although exact measurement was often difficult. The border of the lesions was irregular and there was a clear necrotic zone along the puncture track. On microscopic examination the laser-induced lesions consisted of a central evaporation area, a zone of carbonized material and an outer zone of coagulation necrosis. The alcohol-induced lesions were characterized by both fixation necrosis and coagulative necrosis but surprisingly, there was also necrosis present at a distance of the lesions extending along the centrilobular and even portal veins. These data show that laser-induced interstitial necrosis in the liver is better controlled and more reproducible than necrosis induced by injection of pure ethanol. Moreover, pure ethanol may cause damage to the liver surface and even at a distance of the injection site.     

Neuroleptic influence on hyperthermia induced by 5-hydroxytryptophan and p-methoxy-amphetamine in MAOI-pretreated rabbits

5-Hydroxytryptophan (5-HTP) and p-methoxyamphetamine (p-MA) induced dose-dependent, lethal hyperthermia when applied intravenously to monoamine oxidase inhibitor (MAOI) pretreated rabbits. The time course of hyperthermia and the doses required to induce hyperthermia varies between the two substances. Results with -MT and PCPA suggest that 5-HTP hyperthermia depends on 5-HT formation, release of endogenous 5-HT, and the presence of catecholamines, whereas p-MA-induced hyperthermia most likely is a result of indirect 5-HT release.Some neuroleptics (piflutixol, spiroperidol and methiotepine) are extremely potent inhibitors of the induced hyperthermia. Also the 5-HT receptor blocking agent methergoline antagonizes hyperthermia induced by the two substances in rather low doses. On the other hand cis (Z)-flupenthixol is a very weak antagonist of 5-HTP but a more potent inhibitor of p-MA hyperthermia. It is concluded that both 5-HT and catecholamine (dopamine) receptor blockade is required to antagonize 5-HTP hyperthermia and that antagonism of p-MA induced hyperthermia is primarily a result of influence on the 5-HT system.Part of this work was presented at the 7th International Congress of Pharmacology, Paris, 1978     

高温抑制舌癌细胞侵袭及转移机理的实验研究

目的探讨高温治癌与基质金属蛋白酶系统之间的关系,以期阐明高温抑制肿瘤细胞侵袭及转移的机理.方法对舌癌细胞Tca-8113进行体外43℃加温,通过免疫组化、流式细胞术及明胶酶谱活性分析等方法进行分析,以研究加温后该舌癌细胞MMP-9、MMP-2表达量及其活性的改变.结果加温与未加温细胞MMP-9、MMP-2均有表达,但加温后的细胞MMP-9和MMP-2蛋白表达量减少,并且加温后的细胞MMP-9和MMP-2的活性较未加温细胞明显下降.结论高温能通过调节基质金属蛋白酶(MMP-9、MMP-2)的表达量及其活性来抑制肿瘤细胞的侵袭、转移能力.     

高温热疗加放射粒子植入及化疗治疗转移性盆腔肿瘤

目的观察高温热疗加放射粒子植入及化疗治疗转移性盆腔肿瘤的疗效.方法将转移性盆腔肿瘤患者分为A、B两组,A组19例,B组22例.A组给予射频加热的同时从电极处灌注2.5%的盐水以扩大肿瘤凝固性坏死的范围.不能热疗的肿瘤边缘组织内植入碘-125粒子.术后第15天开始化疗.奥沙利铂100 mg/m2,静脉滴注,第1天;CF 200 mg/m2,在5-Fu滴注前经静脉滴注2 h,继以5-Fu 200 mg/m2经静脉推注,5-Fu 400 mg/m2经静脉滴注22 h,连续5 d,3周为1周期.B组只给予化疗,化疗用药、剂量及天数与A组相同.结果第6个周期末,A组与B组的有效率分别为84.2%和36.4%,两组有效率比较差异有显著性(P＜0.01).两组的毒副反应发生率差异无显著性.结论高温热疗加放射粒子植入及化疗治疗转移性盆腔肿瘤的近期疗效好,并发症少.     

高强度体外聚焦超声热疗治疗局部晚期胰腺癌的多中心临床研究

目的：探讨临床单用HIFU治疗局部晚期胰腺癌(local advanced pancreatic carcinoma，APC)的可能性。方法：4个中心共41例患者入选进行非随机病例对照研究，其中HIFU组24例，单用HIFU治疗；对照组17例，接受HIFU及吉西他滨综合治疗。比较两组的疗效、治疗费用及安全性，采用Cox回归分析进一步确定吉西他滨化疗对生存期的影响。结果：HIFU组临床受益率、平均生存期与对照组相似，分别为66．7％比76．5％(P=10．740)和141．5天比176．5天(P=0．3510)；而治疗费用较低，为20500元比51805元(P=0．000)；安全性更高。Cox回归分析显示仅体力状态、HIFU次数及临床受益进入方程(P=0．000)，化疗对生存期无影响。结论：单用HIFU治疗APC，其疗效等同于HIFU和吉西他滨的综合治疗，但较综合治疗经济、安全。推测可以单独应用HIFU治疗局部晚期胰腺癌．值得临床进一步验证。     

Quadruplet in vitro fertilization pregnancy complicated by fetal reduction and leiomyoma

A woman had a quadruplet IVF pregnancy with a leiomyomatous uterus. Pregnancy resulted in the birth of one baby after missed abortion of one fetus and selective reduction of two others. The woman had a left deep calf vein thrombosis in the first half of pregnancy.     

安宫牛黄丸配合西药治疗重型颅脑损伤78例

安宫牛黄丸配合西药治疗重型颅脑损伤７８例应月初，郑益明１９９０～１９９５年在西医常规治疗下加用安宫牛黄丸治疗重型极重型颅脑损伤患者７８例，结果疗效显著提高，现报道如下。临床资料治疗组７８例中男５４例，女２４例，年龄２～７５岁，平均３６．３岁；致伤原因...