Diagnosis of obsessive-compulsive disorder via spatial similarity-aware learning and fused deep polynomial network

Obsessive-compulsive disorder (OCD) is a type of hereditary mental illness, which seriously affect the normal life of the patients. Sparse learning has been widely used in detecting brain diseases objectively by removing redundant information and retaining monitor valuable biological characteristics from the brain functional connectivity network (BFCN). However, most existing methods ignore the relationship between brain regions in each subject. To solve this problem, this paper proposes a spatial similarity-aware learning (SSL) model to build BFCNs. Specifically, we embrace the spatial relationship between adjacent or bilaterally symmetric brain regions via a smoothing regularization term in the model. We develop a novel fused deep polynomial network (FDPN) model to further learn the powerful information and attempt to solve the problem of curse of dimensionality using BFCN features. In the FDPN model, we stack a multi-layer deep polynomial network (DPN) and integrate the features from multiple output layers via the weighting mechanism. In this way, the FDPN method not only can identify the high-level informative features of BFCN but also can solve the problem of curse of dimensionality. A novel framework is proposed to detect OCD and unaffected first-degree relatives (UFDRs), which combines deep learning and traditional machine learning methods. We validate our algorithm in the resting-state functional magnetic resonance imaging (rs-fMRI) dataset collected by the local hospital and achieve promising performance.     

Useful histopathologic features for diagnosing focal liver lesions with spindle cell morphology: A clinicopathologic study

BackgroundFocal liver lesions with spindle cell morphology are rare in the daily practice of pathology. The differential diagnosis is broad, including both tumors and tumor-like lesions. Initial radiologic assessment is sometimes inaccurate. Histopathology is needed to arrive at the correct diagnosis. This study analyzed discrepancies between histopathology and radiologic findings of focal liver lesions with spindle cell morphology.MethodsA six-year retrospective analysis was conducted at a tertiary hospital in Thailand. All focal liver lesions with spindle cell morphology were retrieved. Clinicopathologic features of these cases were analyzed. The pathological diagnosis was rendered primarily based on routine histopathology, using other ancillary studies as an adjunct.Results287 biopsies and 151 resection specimens with focal liver lesions were identified. In 12 (2.7%) cases, tumors or tumor-like lesions with spindle cell morphology were retrieved. A total of five cases had discrepancies between histopathology and radiologic findings. These lesions encompassed primary liver tumors (EBV-associated smooth muscle tumor and leiomyosarcoma); metastatic tumors (gastrointestinal stromal tumor, small cell neuroendocrine carcinoma); and a tumor-like lesion (endometriosis). Several morphologic findings (i.e., cytologic grades, dense and loose areas, intratumoral lymphocytes, distinct perinuclear vacuoles, and hemosiderin) are important clues to diagnose these spindle cell lesions.ConclusionsPathologists play a critical role in diagnosing focal liver lesions with spindle cell morphology, particularly those with limited clinical data at the initial presentation. A thorough evaluation of histomorphology on routine hematoxylin and eosin-stained slides is essential for correct diagnosis.     

Challenges and limitation of MTAP immunohistochemistry in diagnosing desmoplastic mesothelioma/sarcomatoid pleural mesothelioma with desmoplastic features

AimGenomic-based ancillary assays including immunohistochemistry (IHC) for BRCA-1 associated protein-1 (BAP1) and methylthioadenosine phosphorylase (MTAP), and fluorescence in situ hybridization (FISH) for CDKN2A are effective for differentiating pleural mesothelioma (PM) from reactive mesothelial proliferations. We previously reported a combination of MTAP and BAP1 IHC effectively distinguishes sarcomatoid PM from fibrous pleuritis (FP). Nevertheless, cases of sarcomatoid PM with desmoplastic features (desmoPM) are encountered where the IHC assessment is unclear.Methods and resultsWe evaluated assessment of MTAP IHC, BAP1 IHC, and CDKN2A FISH in 20 desmoPM compared to 24 FP. MTAP and BAP1 IHC could not be assessed in 11 (55 %) and 10 (50 %) cases, respectively, due to loss or faint immunoreactivity of internal positive control cells, while CDKN2A FISH could be evaluated in all cases. The sensitivities for MTAP loss, BAP1 loss, and CDKN2A homozygous deletion in desmoPM were 40 %, 10 %, and 100 %. A combination of MTAP loss and BAP1 loss yielded 45 % of sensitivity.ConclusionsMTAP IHC is a useful surrogate diagnostic marker in differentiating ordinary sarcomatoid PM from FP, but its effectiveness is limited in desmoPM. CDKN2A FISH is the most effective diagnostic assays with 100 % sensitivity and specificity in discriminating desmoPM from FP in the facilities where the FISH assay is available.     

Conditional survival in patients with spontaneous tumor rupture of hepatocellular carcinoma after partial hepatectomy: a propensity score matching analysis

BackgroundSpontaneous tumor rupture (STR) of hepatocellular carcinoma (HCC) is a life-threatening condition. This study investigates the influences of STR on the observed survival and conditional survival of patients received hepatectomy.MethodsA retrospective cohort of patients who underwent hepatectomy from 2009 to 2013 was divided into tumor rupture group and non-rupture group. Propensity score matching (PSM) was used for comparison of the observed survival and conditional survival probabilities between these two groups.Results89 pairs of patients who had comparable background and tumor characteristics were created using PSM analysis. There was significant association between STR and increased risk of OS no matter when before or after PSM (p < 0.01). STR was significantly associated with increased risks of PFS before, while not after PSM. Multivariate Cox regression analyses demonstrated that STR was an independent risk factor associated with OS. There were significant differences in two groups for conditional probabilities of OS and PFS for an additional 6 months and 1 year before PSM, while not after PSM.ConclusionsThis study identified STR but not PFS as an independent risk factor influencing OS, in patients with HCC following hepatectomy. In selected patients with STRHCC, hepatectomy should be performed with acceptable outcomes.     

中医药院校药事管理专业人才素质培养的研究

国内药事管理专业起步较晚，对该领域人才需求突出；中医药行业药事管理专业人才培养及储备尤为重要。从药事管理学科背景出发，结合中医药行业特点，以北京中医药大学为例；提出中医药院校在药事管理专业教育中，应让学生传承中国传统文化，重视以哲学思维为引领，培养以人为本及融合中庸之道的管理能力，掌握中医药理论+通识管理的特色专业课程知识，具备继承不泥古、创新不离宗等综合素质。     

关于加强临床营养教育的若干建议

临床营养学作为一门重要的综合学科,已经成为临床治疗中重要的组成部分.临床营养教育是依靠临床营养学这门课程,为培养更加专业的临床营养学人才开展的一门新的教育课程.目前我国的临床营养学教育现状不容乐观,医学院校对临床营养学课程重视不够,在专业教学内容和课程建设方面均无法满足社会需求.通过借鉴国外营养教育制度,并结合国内临床营养人才需求现状,应注意不同专业的医学生在日后工作对临床营养的需求,逐渐开展临床营养学必修课教学,加强营养在临床应用的实践教学;并完善毕业后教育体系,对所有规范化培训的医师增加要求到临床营养科轮转培训且不少于1个月,对非临床医学的营养师要求到临床科室轮转至少2个月.提高进修临床医师继续教育及培训营养支持治疗的认识.临床营养专业的教学改革任重而道远,仍需我们不断完善理论体系,积极践行学科理论和知识,满足我国临床营养的人才需求,使社会认识到临床营养对促进健康、预防和治疗疾病的重要性.