小儿哮喘眼影分级与中医证候的相关性研究

目的观察小儿哮喘患者眼影分布情况及程度,并探索与中医证候的相关性。方法收集2014年12月—2015年11月于湖南中医药大学第一附属医院儿科就诊的小儿哮喘患者400例,其中风寒束肺证68例、痰热阻肺证156例、外寒内热证46例、肺实肾虚证12例、肺脾气虚证67例、脾肾阳虚证10例及肺肾阴虚证41例。统计患儿年龄、性别构成情况,分析发病季节、年龄与中医证候的相关性。对入选患儿进行眼影分级,分析眼影分级与小儿哮喘患者病程、中医证候等的相关性。结果(1)小儿哮喘于学龄前期(44.50%)及幼儿期(42.75%)的发病率高,各年龄段患儿的性别差异无统计学意义(P=0.59)。(2)哮喘患儿以痰热阻肺证(39.00%)多见,风寒束肺证(17.00%)及肺脾气虚证(16.75%)次之,风寒束肺证与痰热阻肺证哮喘患儿多发生在冬春、季(P<0.01)。(3)入选患儿眼影分级情况为:0、Ⅰ、Ⅱ、Ⅲ级分别为71、94、155、80例,其中以Ⅱ级最多见;眼影分级与小儿哮喘病程呈正相关(r=0.581,P<0.01)。风寒束肺证与外寒内热证以0级(39.7%、39.1%)与Ⅰ级(32.4%、34.8%)为主;痰热阻肺证与肺脾气虚证以Ⅱ级(55.8%、47.8%)为主;肺肾阴虚证以Ⅲ级(58.5%)最多,肺实肾虚证、脾肾阳虚证眼影分级差异无统计学意义(P>0.05)。小儿哮喘发作期眼影以Ⅰ级(24.1%)、Ⅱ级(39.4%)为主,缓解期眼影以Ⅱ级(37.3%)、Ⅲ级(28.0%)为主。(4)伴有家族哮喘史或者伴有过敏性鼻炎的小儿哮喘患者的眼影分布中,Ⅱ、Ⅲ级所占比例较大。结论小儿哮喘患儿病程越长,眼影分级越高;风寒束肺证、外寒内热证患者眼影分级低于痰热阻肺证、肺脾气虚证及肺肾阴虚证患者。有家族哮喘史或伴有过敏性鼻炎的患儿眼影分级越高。     

Emergency Department Chest Pain Patients With or Without Ongoing Pain: Characteristics,Outcome, and Diagnostic Value of the Electrocardiogram

BackgroundIn emergency department (ED) chest pain patients, it is believed that the diagnostic accuracy of the electrocardiogram (ECG) for acute coronary syndrome (ACS) is higher during ongoing than abated chest pain.ObjectivesWe compared patient characteristics and the diagnostic performance of the ECG in ED patients presenting with ongoing, vs. abated, chest pain.MethodsIn total, 1132 unselected ED chest pain patients were analyzed. The patient characteristics and diagnostic accuracy for index visit ACS of the emergency physicians’ interpretation of the ECG was compared in patients with and without ongoing chest pain. Logistic regression analysis was performed to control for possible confounders.ResultsPatients with abated chest pain (n = 508) were older, had more comorbidities, and had double the risk of index visit ACS (15%) and major adverse cardiac events (MACE) at 30 days (15.6%) compared with patients with ongoing pain (n = 631; ACS 7.3%, 30-day MACE 7.4%). Sensitivity of the ECG for ACS was 24% in patients with ongoing pain and 35% in those without, specificity was 97% in both groups, negative predictive value was 94% and 89%, respectively, and positive likelihood ratio 10.6 and 7.8, respectively. When the diagnostic performance was controlled for confounders, there was no significant difference between the groups.ConclusionOur results indicate that ED chest pain patients with ongoing pain at arrival are younger, healthier, and have less ACS and 30-day MACE than patients with abated pain, but that there is no difference in the diagnostic accuracy of the ECG for ACS between the two groups.     

急性心肌梗死青年患者的超声心动图表现及临床特点

目的:分析急性心肌梗死(AMI)的青年患者经超声心动图检查的临床表现极其特点。方法:对本院2018年5月~2019年2月收治的32例AMI青年患者的临床资料加以回顾性分析,观察其超声心动图的表现及其临床特点。结果:AMI患者的年龄均小于40岁,男性患者比女性患者多,并发症相对较少,住院病死率控制效果好,超声心动图表现无心腔大小变化,且心功能无明显异常。结论:AMI的年轻患者其心脏功能和结构改变并不明显,可取得较好的预后效果。     

Differentiating autoimmune pancreatitis from pancreatic ductal adenocarcinoma with CT radiomics features

PurposeThe purpose of this study was to determine whether computed tomography (CT)-based machine learning of radiomics features could help distinguish autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC).Materials and MethodsEighty-nine patients with AIP (65 men, 24 women; mean age, 59.7 ± 13.9 [SD] years; range: 21–83 years) and 93 patients with PDAC (68 men, 25 women; mean age, 60.1 ± 12.3 [SD] years; range: 36–86 years) were retrospectively included. All patients had dedicated dual-phase pancreatic protocol CT between 2004 and 2018. Thin-slice images (0.75/0.5 mm thickness/increment) were compared with thick-slices images (3 or 5 mm thickness/increment). Pancreatic regions involved by PDAC or AIP (areas of enlargement, altered enhancement, effacement of pancreatic duct) as well as uninvolved parenchyma were segmented as three-dimensional volumes. Four hundred and thirty-one radiomics features were extracted and a random forest was used to distinguish AIP from PDAC. CT data of 60 AIP and 60 PDAC patients were used for training and those of 29 AIP and 33 PDAC independent patients were used for testing.ResultsThe pancreas was diffusely involved in 37 (37/89; 41.6%) patients with AIP and not diffusely in 52 (52/89; 58.4%) patients. Using machine learning, 95.2% (59/62; 95% confidence interval [CI]: 89.8–100%), 83.9% (52:67; 95% CI: 74.7–93.0%) and 77.4% (48/62; 95% CI: 67.0–87.8%) of the 62 test patients were correctly classified as either having PDAC or AIP with thin-slice venous phase, thin-slice arterial phase, and thick-slice venous phase CT, respectively. Three of the 29 patients with AIP (3/29; 10.3%) were incorrectly classified as having PDAC but all 33 patients with PDAC (33/33; 100%) were correctly classified with thin-slice venous phase with 89.7% sensitivity (26/29; 95% CI: 78.6–100%) and 100% specificity (33/33; 95% CI: 93–100%) for the diagnosis of AIP, 95.2% accuracy (59/62; 95% CI: 89.8–100%) and area under the curve of 0.975 (95% CI: 0.936–1.0).ConclusionsRadiomic features help differentiate AIP from PDAC with an overall accuracy of 95.2%.     

Radiomics for classification of bone mineral loss: A machine learning study

PurposeThe purpose of this study was to develop predictive models to classify osteoporosis, osteopenia and normal patients using radiomics and machine learning approaches.Materials and methodsA total of 147 patients were included in this retrospective single-center study. There were 12 men and 135 women with a mean age of 56.88 ± 10.6 (SD) years (range: 28–87 years). For each patient, seven regions including four lumbar and three femoral including trochanteric, intertrochanteric and neck were segmented on bone mineral densitometry images and 54 texture features were extracted from the regions. The performance of four feature selection methods, including classifier attribute evaluation (CLAE), one rule attribute evaluation (ORAE), gain ratio attribute evaluation (GRAE) and principal components analysis (PRCA) along with four classification methods, including random forest (RF), random committee (RC), K-nearest neighbor (KN) and logit-boost (LB) were evaluated. Four classification categories, including osteopenia vs. normal, osteoporosis vs. normal, osteopenia vs. osteoporosis and osteoporosis + osteopenia vs. osteoporosis were examined for the defined seven regions. The classification model performances were evaluated using the area under the receiver operator characteristic curve (AUC).ResultsThe AUC values ranged from 0.50 to 0.78. The combination of methods RF + CLAE, RF + ORAE and RC + ORAE yielded highest performance (AUC = 0.78) in discriminating between osteoporosis and normal state in the trochanteric region. The combinations of RF + PRCA and LB + PRCA had the highest performance (AUC = 0.76) in discriminating between osteoporosis and normal state in the neck region.ConclusionThe machine learning radiomic approach can be considered as a new method for bone mineral deficiency disease classification using bone mineral densitometry image features.     

性别对缺氧缺血性脑损伤新生大鼠脑发育的影响

目的探讨不同性别缺氧缺血性脑损伤(HIBI)新生大鼠脑发育的差异。方法2018年1月1日至12月31日,新生7日龄SD大鼠60只(雌性30只、雄性30只),按随机数字表法将大鼠分为HIBI组40只(雄性20只、雌性20只),对照组20只(雌性10只、雄性10只)。HIBI组大鼠采用Rice-Vannucci方法制作缺氧缺血性脑损伤模型,分离左侧颈总动脉,双重结扎后切断,再置于8%O2和92%N2的混合气体的缺氧箱中90 min;对照组不进行任何处理。缺氧缺血处理后2周,应用步迹分析评价各组大鼠21日龄运动发育功能,头颅磁共振成像(MRI)测量大鼠脑组织的残存脑容量,透射电镜下分析运动区域神经元突触结构的破坏程度。采用方差分析和χ^2检验进行组间统计学比较,同组步长及趾间距比较采用配对t检验。结果HIBI-雄性组大鼠的病死率明显高于HIBI-雌性组[20%(4/20)比10%(2/20),χ^2=40.000,P=0.001];HIBI-雄性组和HIBI-雌性组大鼠脑损伤对侧(右侧)步长及趾间距均明显小于对照组[(7.5±0.3)和(7.9±0.5)比(8.2±0.5)cm,(0.9±0.1)和(1.0±0.0)比(1.1±0.1)cm,F=9.605、71.437,P均<0.01];且HIBI-雄性组均明显小于雌性组(P均<0.01)。HIBI-雄性组和HIBI-雌性组大鼠右侧步长及趾间距均明显小于同组左侧步长[(8.3±0.4)和(8.3±0.5)cm,t=5.289、10.580,P=0.001、0.010]及趾间距[(1.1±0.1)和(1.1±0.1)cm,t=7.953、6.435,P均<0.01]。HIBI-雄性组与HIBI-雌性组的残存脑容量明显小于对照组[(67±4)%和(75±5)%比100%,F=406.122,P<0.01],其中HIBI-雄性组小于HIBI-雌性组(t=-5.281,P<0.01)。HIBI-雄性组和HIBI-雌性组左侧中央前回神经元突触间隙均明显大于对照组[(23.4±1.3)和(19.7±1.6)比(18.9±0.6)nm,F=71.719,P<0.01],其中HIBI-雄性组大于HIBI-雌性组(t=7.645,P<0.01)。结论雄性新生大鼠更易受到HIBI的危害,具有更严重的脑损伤程度及偏瘫症状,对不同性别HIBI患儿应采用不同的更合适的治疗策略。     

自发性硬脊膜外血肿15例诊治分析

目的 探讨自发性硬脊膜外血肿（SSEH）的临床特点、治疗方法及效果。方法 回顾性分析2015年3月至2019年11月收治的15例SSEH的临床资料，保守治疗1例，手术治疗14例:椎板减压血肿清除10例，其中行脊柱固定融合7例，血肿清除后椎板还纳1例，半椎板入路血肿清除3例。结果 首次发病9例，两次以上6例。1例保守治疗ASIA分级由入院时C级恢复至出院时E级，后来失访。手术治疗的14例术后随访3个月~4年:4例术前ASIA分级A级中，1例术后随访3个月时仍为A级，随后失访；1例术后2年恢复至D级，2例术后3个月均恢复至E级；术前ASIA分级B~D级的10例术后3个月全部恢复至E级。13例3个月以后随访没有再发病，MRI复查未见复发；X线检查未见脊柱畸形和内固定松动。结论 部分SSEH有反复发病的特点，尽早手术可改善病人预后，不同的病例应该个体化选择手术方式