基于心冲击信号的心率检测方法

针对现有基于心冲击描记图进行心率检测存在的抗干扰性不足问题，提出一种鲁棒的心率检测模型，首先对原始信号中受干扰的片段进行补偿重构，然后将J峰作为特征波形，通过基于J峰频段的滤波与差分增强处理放大特征，并设计改进的峰值提取算法定位心跳点，进而得到心率估计值。实验结果表明，所用模型对于不同情形下的心冲击描记图信号均表现出良好的适应性，逐拍检测平均覆盖率为98.3%，平均准确率为98.4%。心率输出结果与金标准一致性高，误差范围控制在[±]5%以内，且运算实时性好，可以为临床或家庭保健提供良好的心率检测方案。     

四肢骨肉瘤保肢治疗与预后影响因素分析

目的探究四肢骨肉瘤保肢治疗与预后的危险因素。方法 89例四肢骨肉瘤患者行保肢治疗后随访3年,依据3年预后结局分为生存组(71例)与死亡组(18例),比较两组患者临床特征,分析死亡的相关因素,将相关因素代入Cox比例风险模型分析危险因素。结果生存组及死亡组四肢骨肉瘤患者Enneking分期及是否术后肺转移、治疗后病理性骨折、术前乳酸脱氢酶升高、完成化疗情况比较,差异均有统计学意义(P﹤0.05)。术后出现肺转移、未完成化疗及Enneking分期为Ⅱ期或Ⅲ期为四肢骨肉瘤保肢治疗后3年内死亡的危险因素(P﹤0.05)。结论尽早确诊、尽早治疗、积极预防病理性骨折、完成规范化疗及预防肺转移的发生能够辅助提高四肢骨肉瘤患者保肢治疗后的生存率。     

Molecular mechanisms and cellular events involved in the neuroprotective actions of estradiol. Analysis of sex differences

Estradiol, either from peripheral or central origin, activates multiple molecular neuroprotective and neuroreparative responses that, being mediated by estrogen receptors or by estrogen receptor independent mechanisms, are initiated at the membrane, the cytoplasm or the cell nucleus of neural cells. Estrogen-dependent signaling regulates a variety of cellular events, such as intracellular Ca²⁺ levels, mitochondrial respiratory capacity, ATP production, mitochondrial membrane potential, autophagy and apoptosis. In turn, these molecular and cellular actions of estradiol are integrated by neurons and non-neuronal cells to generate different tissue protective responses, decreasing blood-brain barrier permeability, oxidative stress, neuroinflammation and excitotoxicity and promoting synaptic plasticity, axonal growth, neurogenesis, remyelination and neuroregeneration. Recent findings indicate that the neuroprotective and neuroreparative actions of estradiol are different in males and females and further research is necessary to fully elucidate the causes for this sex difference.     

Automatic graph-based method for localization of cochlear implant electrode arrays in clinical CT with sub-voxel accuracy

Cochlear implants (CIs) are neural prosthetics that provide a sense of sound to people who experience severe to profound hearing loss. Recent studies have demonstrated a correlation between hearing outcomes and intra-cochlear locations of CI electrodes. Our group has been conducting investigations on this correlation and has been developing an image-guided cochlear implant programming (IGCIP) system to program CI devices to improve hearing outcomes. One crucial step that has not been automated in IGCIP is the localization of CI electrodes in clinical CTs. Existing methods for CI electrode localization do not generalize well on large-scale datasets of clinical CTs implanted with different brands of CI arrays. In this paper, we propose a novel method for localizing different brands of CI electrodes in clinical CTs. We firstly generate the candidate electrode positions at sub-voxel resolution in a whole head CT by thresholding an up-sampled feature image and voxel-thinning the result. Then, we use a graph-based path-finding algorithm to find a fixed-length path that consists of a subset of the candidates as the localization result. Validation on a large-scale dataset of clinical CTs shows that our proposed method outperforms the state-of-art CI electrode localization methods and achieves a mean error of 0.12 mm when compared to expert manual localization results. This represents a crucial step in translating IGCIP from the laboratory to large-scale clinical use.     

针灸的简称

History of the two words “acupuncture” and “moxibustion” is briefly reviewed. By etymological analysis, the reason to coin these two words are given. Due to their inconvenience of being lengthy, efforts have been done to find a concise expression for the phrase “acupuncture and moxibustion”. However, present expressions are either not short enough or awkward to be understood by western readers. Since acronyms are widely used nowadays and become part of human life, it is suggested to use “AnM” for “acupuncture and moxibustion” based upon detailed analysis in three aspects: concise in from; not awkward in expression; not ambiguous in meaning.     

Combined Heart-Kidney Transplant Versus Sequential Kidney Transplant in Heart Transplant Recipients

ObjectivesIn patients with reduced kidney function there are no established guidelines to suggest combined heart-kidney transplant (HKTx) versus sequential kidney transplant (SKTx) using preoperative value of estimated glomerular filtration (eGFR).MethodsThe United Network for Organ Sharing database was queried from 2000 to 2015 to evaluate survival of HKTx and SKTx population stratified by preoperative eGFR rate <45 mL/min. Aim of the study was to assess the eGFR rate that is most beneficial to perform a concomitant or a SKTx at time of transplant evaluation.ResultsIn our analysis, patients who required SKTx are recipients that, after heart transplantation, developed or worsened kidney insufficiency due to calcineurin inhibitor nephrotoxicity. In recipients with eGFR <30 or dialysis, a total of 545 received HKTx and 80 received SKTx. The median waiting time between heart and kidney transplant in SKTx group was 6 years. The overall post-transplant survival was 81% and 80% and 75% and 59% at 5 and 1 years for the HKTx and SKTx groups, respectively (P = .04). In recipients with eGFR from 30 to 44, a total of 107 received HKTx and 112 received SKTx. The median waiting time between heart and kidney transplant in SKTx group was 4 years. Overall post-transplant survival showed no statistically significant differences in HKTx group (n=107) compared with SKTx group (n=112) and was 90% and 95% at 1 year and 74% and 52% at 5 years, respectively (P = .4) .ConclusionsTo optimize organ and patient survival, eGFR value can be utilized to discern between HKTx versus SKTx in patients with decreased renal function at the time of heart transplantation. Patients with eGFR<30 or in dialysis presented better survival with HKTx, while both SKTx and HKTx are suitable for patients with eGFR between 30 and 45.     

Motor unit number index (MUNIX) in the quantitative assessment of severity and surgical outcome in cervical spondylotic amyotrophy

ObjectiveTo assess the feasibility of motor unit number index (MUNIX) in the quantitative assessment of the cervical spondylotic amyotrophy (CSA).MethodsMUNIX was recorded bilaterally on the abductor pollicis brevis, abductor digiti minimi, biceps brachii and middle deltoid in 41 normal controls and 47 patients with CSA (distal-type to proximal-type ratio: 25 to 22). Additionally, patients were assessed on handgrip strength (HGS), the disabilities of arm, shoulder and hand (DASH) and Medical Research Council (MRC) scales. These examinations were re-evaluated approximately 18 months after surgery in 37 of these CSA patients.ResultsMUNIX values were noticeably lower in the mainly affected muscles of CSA patients than those in controls (P < 0.05), and 49.0% (51/104) of the tested muscles with abnormal MUNIX measurements showed normal muscle strength. Significant correlations between MUNIX measurements and both DASH and MRC scores were observed in both CSA patient groups (P < 0.05). Postoperative longitudinal follow-up analysis identified significant increase in motor unit number in both CSA patient groups within approximately 18 months (P < 0.05), with or without improved measures of motor function.ConclusionsA significant reduction in MUNIX values related to motor impairment was observed in CSA patients, even in the subclinical stage. Compared to measures of motor function, the MUNIX measurements in the patients with CSA improved more noticeably after surgical intervention.SignificanceMUNIX may serve as an available supplementary test to quantitatively evaluate the motor dysfunction in CSA and to track its progression, that is complementary to conventional electromyography.     

Protocol for the development of consensus-based clinical case reporting guideline extension: CARE for acupuncture

BackgroundHealth research reporting guidelines for case reports (CARE - CAse REport) published in 2013 and 2017 have become a generally accepted standard for publishing case reports. The CARE guidelines represent an architectural framework for writing an evidence-based case report that can be customized as need for a specialty (or disease) if needed. We aim to develop a CARE guideline extension for acupuncture following the EQUATOR Network (Enhancing the QUAlity and Transparency Of health Research) and the 2010″Guidance for Developers of Health Research Reporting". We have established a group of international experts including; clinicians, researchers and methodologists. We performed a needs assessment based on a review of acupuncture case reports published in the indexed medical literature. The needs assessment will be followed by (1) a series of expert interviews to establish a draft, (2) a modified Delphi process, and (3) a consensus meeting. Following the consensus meeting we will pilot test the CARE draft before publishing the CARE extension for acupuncture.MethodsWe will develop the CARE extensions for acupuncture following recommendations of the EQUATOR Network and the 2010 "Guidance for Developers of Health Research Reporting". We will establish an international multidisciplinary group including clinical practitioners, acupuncturists, researchers of reporting guidelines on acupuncture, clinical epidemiologists and statisticians.We performed a needs assessment, reviewing published case reports using acupuncture as a therapeutic intervention from indexed medical journals (PubMed-PMC and Medline, Scopus, Embase, the Allied and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Wan Fang database, Chinese BioMedicine database (CBM), China National Knowledge Infrastructure (CNKI), and VIP). In consultations with advisors we will develop a draft of potential items to be included in the CARE extension for acupuncture. Then we will conduct a modified Delphi process of at least three rounds, hold a face-to-face consensus meeting, pilot test and submit the CARE extension for acupuncture for publication.ConclusionThe development of a widely accepted CARE extension for acupuncture for case reports published in indexed medical journals. These guidelines will follow the EQUATOR Network recommendations and the 2010 "Guidance for Developers of Health Research Reporting".     

Automatic needle detection and real-time Bi-planar needle visualization during 3D ultrasound scanning of the liver

2D ultrasound (US) image guidance is used in minimally invasive procedures in the liver to visualize the target and the needle. Needle insertion using 2D ultrasound keeping the transducer position to view needle and reach target is challenging. Dedicated needle holders attached to the US transducer help to target in plane and at a specific angle. A drawback of this is that, the probe is fixed to the needle and cannot be rotated to assess the position of the needle in a perpendicular plane. In this study, we propose an automatic needle detection and tracking method using 3D US imaging to improve image guidance and visualization of the target in the liver with respect to the needle during these interventional procedures. The method utilizes a convolutional neural network for detection of the needle in 3D US images. In a subsequent step, the output of the convolutional neural network is used to detect needle candidates, which are fed into a final tracking step to determine the real needle position. The needle position is used to present two perpendicular cross-sectional planes of the 3D US image containing the needle in both directions. Performance of the method was evaluated in phantoms and in-vivo data by calculating the needle position distance and needle orientation angle between segmented needles and reference ground truth needles, which were manually annotated by an observer. The method successfully detects the needle position and orientation with mean errors of 1 mm and 2°, respectively. The proposed method yields a robust automatic needle detection and visualization at a frame rate of 3 Hz in 3D ultrasound imaging of the liver.     

Brain impedance variation of directional leads implanted in subthalamic nuclei of Parkinsonian patients

ObjectiveConventional deep brain stimulation (DBS) systems with ring-shaped leads generate spherical electrical fields. In contrast, novel directional leads use segmented electrodes. Aim of this study was to quantify the impedance variations over time in subjects with the directional Cartesia-Boston® system.MethodsImpedance records, programming settings, and clinical data of 11 consecutive Parkinsonian patients implanted with DBS directional leads in two Italian centers (Udine and Vicenza) were retrospectively evaluated. Data were collected before starting stimulation (in the operating room and at days 5 and 40) and after switching stimulation on at the successive follow-up visits (1, 6 and 12 months).ResultsDirectional leads have significantly higher impedance than ring leads. Stimulated contacts had always lower impedance compared to non-stimulated contacts. Before DBS-on, all contacts had higher impedance in the operating room, with an initial decrease five days post-surgery and a subsequent increase at day 40, more evident for directional contacts. The impedance of directional leads increased post-implantation at 1 and 6 months with a plateau at 12 months.ConclusionsThere was a significant difference between the directional and ring leads at baseline (before activation of DBS) and during follow-up (chronic DBS).SignificanceOur study reveals new information about the impedance of segmented electrodes that is useful for patient management during the initial test period, as well as during long-term DBS follow-up.