Sex classification using long‐range temporal dependence of resting‐state functional MRI time series

A thorough understanding of sex differences that exist in the brains of healthy individuals is crucial for the study of neurological illnesses that exhibit phenotypic differences between males and females. Here we evaluate sex differences in regional temporal dependence of resting‐state brain activity in 195 adult male–female pairs strictly matched for total grey matter volume from the Human Connectome Project. We find that males have more persistent temporal dependence in regions within temporal, parietal, and occipital cortices. Machine learning algorithms trained on regional temporal dependence measures achieve sex classification accuracies up to 81%. Regions with the strongest feature importance in the sex classification task included cerebellum, amygdala, and frontal and occipital cortices. Secondarily, we show that even after strict matching of total gray matter volume, significant volumetric sex differences persist; males have larger absolute cerebella, hippocampi, parahippocampi, thalami, caudates, and amygdalae while females have larger absolute cingulates, precunei, and frontal and parietal cortices. Sex classification based on regional volume achieves accuracies up to 85%, highlighting the importance of strict volume‐matching when studying brain‐based sex differences. Differential patterns in regional temporal dependence between the sexes identifies a potential neurobiological substrate or environmental effect underlying sex differences in functional brain activation patterns.     

Myelodysplastic/myeloproliferative neoplasms: are morphology and immunophenotyping still relevant?

The term myelodysplastic/myeloproliferative neoplasm (MDS/MPN) refers to a group of clonal hematopoietic neoplasms with overlapping clinical, morphologic and genetic myelodysplastic and myeloproliferative features observed at the time of first presentation. Impaired hematopoiesis morphologically associated with evidence of myelodysplasia manifests clinically with cytopenia/s. Simultaneously, myeloproliferation is seen within the bone marrow and leads to cytosis in the peripheral blood.The diagnostic category of MDS/MPN encompasses a heterogeneous group of diseases which share similarities among them, but at the same time have distinct clinical and pathologic features and eventually diverse prognosis; such differences justify their separation in a classification scheme.In the era of genetic and genomic tests, their distinction from conventional myelodysplastic syndromes or myeloproliferative neoplasms still relies on close clinocopathological correlation, with evaluation of both peripheral blood and bone marrow samples being essential in this sense. A multiparametric integration of clinicopathologic data and cytogenetics and molecular genetics results is the preferred diagnostic approach.     

基于小波能量谱的先天或风湿性心脏病异常心音分类算法研究

目的为解决先天性心脏病或风湿性心脏病异常心音分辨问题,应用离散小波频带能量对异常心音分类算法进行研究。方法采集22人的正常心音和116人的异常心音,对心音信号做离散小波变换,根据病理性心杂音在频域内的分布范围划分5层频带,计算得到各层频带的能量占比,根据单因素方差分析方法,提出了基于小波能量谱的心音分类指标。结果对正常心音和异常心音的4个听诊区域进行了分类,最优分类准确率为92%。区分动脉导管未闭和其余异常心音的最优分类准确率为81.9%。结论基于小波能量谱的心音分类算法无需对心音信号进行分割,提取特征值少,可准确有效地对心音信号进行分类,相较于传统的心音听诊,算法的引入能够在异常心音临床诊断中提供参考数据。     

胃肠道间质瘤的MSCT表现与病理危险程度分析

目的研究胃肠道间质瘤的MSCT表现与病理危险程度分级的关系。方法此项研究对象为医院2014年1月—2018年12月经过手术、病理等确诊为胃肠道间质瘤的患者,共计50例,对其MSCT表现进行回顾分析,评估肿瘤最大径、生长方式等和病理危险程度分级关系。结果50例胃肠道间质瘤患者中,胃部18例,胃肠道外5例,肠道27例;病理分级中低度危险7例,中度危险8例,重度危险35例。不同危险程度肿瘤出现的位置和强化情况差异无统计学意义(P>0.05),肿瘤生长方式、形态、转移情况等对比差异有统计学意义(P<0.05)。结论胃肠道间质瘤的MSCT表现有特性,和病理危险程度分级密不可分,对治疗、确定预后等有积极影响。     

Cost of postoperative complications: How to avoid calculation errors

Postoperative complications(PC) are a basic health outcome, but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs. Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency. The payment system in place often rewards the volume of services provided rather than the quality of patients' clinical outcomes. Without a thorough registration of PC, the economic costs involved cannot be determined. An accurate, reliable appraisal would help identify areas for investment in order to reduce the incidence of PC,improve surgical results, and bring down the economic costs. This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index, discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established, and makes various recommendations. The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs. Patients, the health authorities, and society as a whole are sure to benefit.     

仝小林教授分类、分期、分证思想在甲状腺结节及甲状腺癌的治疗中的体现

甲状腺结节是指甲状腺细胞在局部异常生长所引起的散在病变。5%～15%的甲状腺结节为恶性。结合现代医疗，仝小林教授在传承传统辨证论治模式，又开启了“分类、分期、分证”的辨证辨病思想，系统阐述甲状腺结节及甲状腺癌的类型、发展及转归等内容，并构建基于甲状腺结节及甲状腺癌分类、分期(根据自然演变过程可以分为郁、瘀、虚3期)、分证思想体系指导下的甲状腺结节及甲状腺癌防治临床实践。分类、分期、分证思想综合考量疾病共性及患者个性，可为现代慢性病中医理论构建提供启示。     

转录激活因子-4、第二个线粒体衍生的半胱氨酸蛋白酶激活剂在卵巢癌组织中的表达及临床意义

目的探讨卵巢癌组织中转录激活因子-4(ATF-4)、第二个线粒体衍生的半胱氨酸蛋白酶激活剂(SMAC)蛋白的表达情况及临床意义。方法收集90例卵巢癌患者的卵巢癌组织标本和90例卵巢良性肿瘤患者的良性肿瘤组织标本。采用免疫组化染色法检测两种组织中ATF-4、SMAC蛋白的表达情况,并对卵巢癌组织中ATF-4、SMAC蛋白表达与卵巢癌患者病理特征的关系进行分析。结果免疫组化染色结果显示,卵巢癌组织中ATF-4的阳性表达率明显高于卵巢良性肿瘤组织(P﹤0.01)。卵巢癌组织中SMAC蛋白的阳性表达率明显低于卵巢良性肿瘤组织(P﹤0.01)。FIGO分期为Ⅲ~Ⅳ期、有淋巴结转移、组织学分级为G3级的上皮性卵巢癌患者上皮性卵巢癌组织中ATF-4蛋白的阳性表达率均高于FIGO分期为Ⅰ~Ⅱ期、无淋巴结转移、组织学分级为G1~G2级的患者(P﹤0.05);FIGO分期为Ⅲ~Ⅳ期、有淋巴结转移、组织学分级为G3级的上皮性卵巢癌患者上皮性卵巢癌组织中SMAC蛋白的阳性表达率均明显低于FIGO分期为Ⅰ~Ⅱ期、无淋巴结转移、组织学分级为G1~G2级的患者(P﹤0.01);不同病灶直径的上皮性卵巢癌组织中ATF-4、SMAC蛋白的阳性表达率比较,差异均无统计学意义(P﹥0.05)。结论上皮性卵巢癌组织中ATF-4蛋白的表达上调,SMAC蛋白的表达下调,且ATF-4、SMAC蛋白表达可能与上皮性卵巢癌患者的病情进展有一定关系。