人工智能在中医药领域的应用进展及现状思考

人工智能（Artificial Intelligence，AI）的蓬勃兴起为现代社会带来了前所未有的机遇，中医药是中华民族传承千年的文化瑰宝。随着人工智能技术不断在中医药领域的科技创新中崭露头角，二者的融合不断加深，人工智能在中医药领域的发展前景、争议挑战也引发了诸多思考。本文将从人工智能在中医药领域的应用入手，对人工智能辅助中医诊断、智能决策与数据挖掘、健康管理及中草药现代化研究等方面，就近年来国内外研究进展进行总结与分析，以期为AI视域下实现中医药现代化、智能化赋能。     

Overall survival and PD-L1 expression in patients with recurrent or metastatic head and neck cancer treated with nivolumab

ObjectiveOur facility measures programmed cell death ligand 1 (PD-L1) expression in all patients before administering nivolumab. The aim of the present study is to clarify the association between overall survival (OS) and PD-L1 expression.Patients and MethodsSubjects in this study were 52 patients with R/M-HNC cancer (45 men, 7 women) administered nivolumab in our facility between June 1, 2017 and January 31, 2019. Mean age was 62.2 years (median, 65 years; range, 28–81 years). Histopathological type was squamous cell carcinoma (SCC) in 48 cases, and non-SCC in 4 cases. We set OS as the primary endpoint and progression-free survival (PFS), overall response rate (ORR), association of OS and PD-L1 expression and association of PFS and PD-L1 expression as secondary endpoints. The cut-off for PD-L1 expression was set using the receiver operating characteristic (ROC) curve. We compared OS, PES and ORR using this PD-L1 cut-off for all patients and for the SCC group. OS and PFS were calculated using Kaplan-Meier methods. The log-rank test was used for statistical analysis, with values of p < 0.05 taken as significant. For PD-L1 immunohistochemistry assays, Dako 28-8 antibody was used.ResultsIn the all-patients group, median OS was 9.6 months and 1-year OS rate was 40.4%. Median PFS was 4.0 months and 1-year PFS rate was 37.8%. The cut-off value of PD-L1 expression for OS was 40% for all patients and the SCC group. When PD-L1 expression was ≥40%, OS was significantly better in both all patients and the SCC group (p = 0.004, 0.007). The cut-off value of PD-L1 expression for PFS was also 40%. When PD-L1 expression was ≥40%, PFS was better in all patients and the SCC group (P = 0.003, 0.009). In the all-patients group, ORR was 19.2% and disease control rate (DCR) was 44.2%. When PD-L1 expression was ≥40%, ORR was 44.4% and DCR 83.3%.ConclusionIn the present study, when PD-L1 expression was high (≥40%), OS was significantly better (p = 0.004). This finding has not been reported in other research on R/M-HNC. PFS and ORR were also better with high PD-L1 expression. Regarding patterns of progression with a PD-L1 expression cut-off of 40%, hyperprogression was significantly more frequent for PD-L1 expression <40% (p = 0.039). Therefore, high PD-L1 expression could offer a predictor of prognosis and efficacy for nivolumab. The present findings may prove useful in considering treatment strategies.     

H7N9禽流感病毒疫苗及其预防控制

<正>禽流感病毒有6个内部基因来自于H9N2,部分血凝素(hemagglutinin,HA)和神经氨酸酶(neuramidinase,NA)基因源自H7N3和H1N9。禽流感病毒能够感染人类,可能与HA和NA基因发生了Q226L和E627K关键位点突变有关,这两个突变被认为是病毒适应人类气道上皮的表现。此外,H7N9具有哺乳动物流感病毒的特性,如HA蛋     

UMAC / UMAR : Aspects matériels

Mobile ECMO support for remote cardiac or respiratory assistance (MESRCA and MESRRA) allows mobilization of the medical and paramedical team 24/7 in a very large geographical area. Mobility and autonomy require adapted devices. During many years, teams had to deal with non useful equipment. Recently, thanks to interest of medical world and laboratories, many materials especially suitable for this activity are developed. We describe our local experience and solutions we tented to fi nd to deal with material diffi culties.     

护理本科生临床实践能力的研究现状

目的：综述当前我国护理本科生临床实践能力的研究现状及存在的问题,并预测其未来发展趋势。方法：查阅中国知网、万方和Pubmed数据库关于临床实践能力的相关文章,进行整理、归纳和总结。结果：目前国内护理本科生临床实践能力的培养还不能适应市场的需求。结论：护理教育应对培养护生的临床实践能力引起足够重视。     

Structure-adaptive sparse denoising for diffusion-tensor MRI

Diffusion tensor magnetic resonance imaging (DT-MRI) is becoming a prospective imaging technique in clinical applications because of its potential for in vivo and non-invasive characterization of tissue organization. However, the acquisition of diffusion-weighted images (DWIs) is often corrupted by noise and artifacts, and the intensity of diffusion-weighted signals is weaker than that of classical magnetic resonance signals. In this paper, we propose a new denoising method for DT-MRI, called structure-adaptive sparse denoising (SASD), which exploits self-similarity in DWIs. We define a similarity measure based on the local mean and on a modified structure-similarity index to find sets of similar patches that are arranged into three-dimensional arrays, and we propose a simple and efficient structure-adaptive window pursuit method to achieve sparse representation of these arrays. The noise component of the resulting structure-adaptive arrays is attenuated by Wiener shrinkage in a transform domain defined by two-dimensional principal component decomposition and Haar transformation. Experiments on both synthetic and real cardiac DT-MRI data show that the proposed SASD algorithm outperforms state-of-the-art methods for denoising images with structural redundancy. Moreover, SASD achieves a good trade-off between image contrast and image smoothness, and our experiments on synthetic data demonstrate that it produces more accurate tensor fields from which biologically relevant metrics can then be computed.     

紫菀散加甘草对离体豚鼠气管解痉作用的研究

实验结果表明,紫菀、甘草高浓度对组织胺引起的气管收缩有抑制作用;对乙酰胆碱引起的气管收缩作用不明显。甘草、紫菀和款冬花对抑制组织胺和乙酰胆碱引起的气管收缩有协同作用。     

玻璃体切除联合超声乳化术治疗晶状体脱位

目的：探讨玻璃体切除联合超声乳化术治疗晶状体脱位的临床疗效。 方法：晶状体脱位患者92例92眼,采用标准三通道经睫状体扁平部玻璃体切除术清除玻璃体基底部及睫状体平部,再行晶状体超声乳化术,观察患者术后视力恢复以及并发症情况。 结果：所有患者的视力与术前相比均有所提高,无严重并发症。 结论：玻璃体切除联合超声乳化术疗效显著安全可靠,值得临床推广。