Automated extraction,labelling and analysis of the coronary vasculature from arteriograms

For clinical decision-making and documentation purposes we have developed techniques to extract, label and analyze the coronary vasculature from arteriograms in an automated, quantitative manner. Advanced image processing techniques were applied to extract and analyze the vasculatures from non-subtracted arteriograms while artificial intelligence techniques were employed to assign anatomical labels. Lumen diameters of 11 phantom vessels were assessed with an accuracy of 0.27±0.19 mm (d _true = 0.45 + 0.92d _measured ; r> 0.99) and 0.21±0.15 mm (d _true =0.42+0.91d _measured ; r> 0.99), from cine and digital images, respectively. We collected a total of 15 routinely acquired cine-arteriograms showing 74 vessel segments with 18 stenoses (severity larger than 30% assessed quantitatively), and 53 digital arteriograms showing 236 vessel segments with 69 stenoses. From the cine arteriograms we extracted 64 (86%) of the vessel segments without manual correction and 196 (83%) from the digital arteriograms. Repeated analysis (3 times) of the arteriograms by the same operator resulted in a standard deviation of the mean segment diameters (precision) of 0.064 mm for the cine-images and 0.020 mm for the digital images, while the standard deviations in the measurement of the minimal luminal diameter of the observed stenoses were 0.020 mm and 0.019 mm, respectively. The LAD artery, the septal and diagonal branches were correctly identified automatically in 86% of the segments. From these evaluations we conclude that our automated approach provides reliable tools for the assessment of multi-vessel disease, both in an offand on-line environment.     

Staging of hepatocellular carcinoma by ultrasonography,computed tomography,and angiography: The role of CT combined with arterial portography

A series of 60 patients with hepatocellular carcinoma (HCC) were evaluated over a 2-year period of ultrasonography (US), computed tomography (CT), and angiography. The angiographic studies carried out with intraarterial digital technology were compared to both US and CT of the liver. In 16 of 60 patients, we observed discordance of the findings obtained with angiography, CT, and US. We therefore compared these three methodologies in those cases where diagnostic discordance was noted. In our experience, US had a sensitivity of 73.4%, 76.7% for CT, and 95% for angiography. In 13 of 60 patients, we performed CT with arterial portography (CTAP) which demonstrated a better resolution than conventional CT. In view of the sensitivity of US — comparable to that of CT — and for the even greater sensitivity of intraarterial digital angiography, we performed an US study of patients at risk of HCC. CT was found to play a diagnostic/staging role after angio graphic study has been performed, especially when enhanced by arterial portography.     

Common Causes of Pain in Systemic Sclerosis: Frequency,Severity, and Relationship to Disease Status,Depression, and Quality of Life

BackgroundIn routine clinical practice, healthcare professionals draw little attention to pain in patients with systemic sclerosis (SSc). Pain has adverse effects on functional ability, social and emotional wellbeing.AimsThis study aims to assess the frequency and severity of different types of pain in patients with SSc, and the relationship of pain with disease status, depression and quality of life.DesignConsecutive patients with SSc were included in this cross-sectional study. Patients with previously diagnosed painful diseases or conditions (other rheumatic diseases, angina pectoris, neurological disorders, etc.) were excluded.SettingsPatients, who visited our rheumatology outpatient clinic from February to November 2016, participated in this study.Participants/Subjects42 consecutive patients with SSc (38 women and 4 men), mean age 56.5 years, mean disease duration 9.5 years, were included.MethodsAll patients filled in a questionnaire, to indicate the presence or absence of some predefined pain syndromes. Disease status was assessed using the Scleroderma Assessment Questionnaire (SAQ), symptoms of depression by the Beck’s Depression Inventory (BDI), whilst the quality of life was evaluated using the EuroQol questionnaire.ResultsIt was found that 92.9% of SSc patients suffer from different types of pain, and 45.2% of patients have pain every day. Joint pain was the most common type of pain, present in 78.6% of patients, followed by pain associated with Raynaud’s phenomenon (69%), back pain (47.6%), headache (31%), chest pain (23.8%), odynophagia (21.4%) and painful digital ulcers (19%). Symptoms of neuropathic pain were noticed in 26.2% of patients. Severe joint pain, everyday pain and symptoms of neuropathic pain in SSc were associated with more severe disease and poorer quality of life. Pain related to Raynaud’s phenomenon, digital ulcers, odynophagia and joint pain were associated with significant symptoms of depression.ConclusionThe majority of patients with SSc suffer from different types of pain. Pain is associated with more severe disease, depression and poor quality of life.     

动脉瘤、动静脉瘘模型在CDFI、CTA、MRA、DSA的表现

目的探讨创伤性动脉瘤(PA)、动静脉瘘(tAVF)在CDFI、CTA、MRA、DSA表现上的特点.方法用显微外科技术在40只新西兰白兔股部建立PA、tAVF模型,模型建成后行CDFI、CTA、MRA及DSA检测.结果在20个手术部位建成16个PA模型,在30个手术部位建成26个tAVF模型,成功率分别为80%和87%,模型在CDFI、CTA、MRA、DSA上的表现各具特点.结论显微外科技术建立兔股部PA,tAVF模型,方法切实可行;在各检测手段上,其表现各具特点,互相补充,根据需要选用,可提高诊断治疗水平.     

Comparative study between ultrasound,computed tomography,intra-arterial digital subtraction angiography,and magnetic resonance imaging in the differentiation of tumors of the liver

Forty-one patients with liver tumor have been evaluated with ultrasound (US), computed tomography (CT), intra-arterial digital subtraction angiography (IA-DSA), and magnetic resonance imaging (MRI) in order to establish the accuracy of each technique. In group A (24 patients), in which all four imaging modalities were performed, our results show that MRI detected all hemangiomas (25/25) compared to 22/25, 21/25, and 20/25 with US, CT, and IA-DSA, respectively. No difference between the various methods was seen in the case of hepatoma. Finally, in the patients with metastases, all four techniques had the same sensitivity (100%) but the specificity of MRI was also 100%, compared to 33% for IA-DSA and 66% for US and CT.     

Comparative accuracy of the AW3D30 DSM,ASTER GDEM,and SRTM1 DEM: A case study on the Zaoksky testing ground,Central European Russia

Quasi-global, medium-resolution land surface models – the Shuttle Radar Topography Mission digital elevation model (SRTM1 DEM), the Advanced Spaceborne Thermal Emission and Reflection Radiometer Global DEM (ASTER GDEM), and the Advanced Land Observing Satellite World 3D digital surface model (AW3D30 DSM) – are widely used in geosciences. We carried out a comparative analysis of accuracy for these models exemplified by the Zaoksky testing ground, Central European Russia. First, we extracted related portions from the SRTM1 DEM, ASTER GDEM, and AW3D30 DSM for the study area. In the further analysis, we used 69 ground control points (GCPs) within the testing ground, as well as a reference DEM photogrammetrically generated from aerial stereo images. For each GCP, we determined an elevation value in four models and a related vertical error. For each model, we carried out a statistical analysis of vertical errors. To visualize the spatial distribution of vertical errors, we calculated matrices of residuals between the reference DEM and the quasi-global models. The results demonstrate that the AW3D30 DSM can be considered the most accurate quasi-global, medium-resolution land surface model. We do not recommend the use of the ASTER GDEM because it is marked by high errors with chaotically distributed hummock-like patterns.     

Statistical and visual quality assessment of nearly-global and continental digital elevation models of Trentino,Italy

Nearly-global digital elevation models (DEMs) – Shuttle Radar Topography Mission DEM (SRTM1 DEM), Advanced Spaceborne Thermal Emission and Reflection Radiometer Global DEM (ASTER GDEM), and Advanced Land Observing Satellite World 3D digital surface model (AW3D30 DSM) – are widely used in geosciences. A nearly-continental European DEM (EU-DEM) is also publicly available. We assess statistical accuracy and artefact occurrence of the latest versions of these models for Trentino, Italian Alps. We used a set of 111 geodetic network points and a lidar-based reference DEM. Statistically, AW3D30 DSM has the highest accuracy, while EU-DEM is marked by the worst characteristics. To visualize the spatial distribution of errors, we calculated residuals between the reference and validated DEMs. Voids abound in SRTM1 DEM that makes problematic its application in the Alpine region. Randomly distributed, grain-like artefacts are common for ASTER GDEM. AW3D30 DSM includes artefacts caused by to the Gibbs phenomenon. Retaining defects of SRTM1 DEM and ASTER GDEM, EU-DEM has artefacts caused by its hydrological correction. Usual statistical evaluation of DEM accuracy is not capable to describe completely DEM quality. A robust spatial analysis, including interactive visual inspection, should be adopted for a quality control of DEMs.     

Digital Transformation of Cancer Care in the Era of Big Data,Artificial Intelligence and Data-Driven Interventions: Navigating the Field

ObjectivesTo navigate the field of digital cancer care and define and discuss key aspects and applications of big data analytics, artificial intelligence (AI), and data-driven interventions.Data SourcesPeer-reviewed scientific publications and expert opinion.ConclusionThe digital transformation of cancer care, enabled by big data analytics, AI, and data-driven interventions, presents a significant opportunity to revolutionize the field. An increased understanding of the lifecycle and ethics of data-driven interventions will enhance development of innovative and applicable products to advance digital cancer care services.Implications for Nursing PracticeAs digital technologies become integrated into cancer care, nurse practitioners and scientists will be required to increase their knowledge and skills to effectively use these tools to the patient's benefit. An enhanced understanding of the core concepts of AI and big data, confident use of digital health platforms, and ability to interpret the outputs of data-driven interventions are key competencies. Nurses in oncology will play a crucial role in patient education around big data and AI, with a focus on addressing any arising questions, concerns, or misconceptions to foster trust in these technologies. Successful integration of data-driven innovations into oncology nursing practice will empower practitioners to deliver more personalized, effective, and evidence-based care.     

Impact of image spatial, temporal, and velocity resolutions on cardiovascular indices derived from color-Doppler echocardiography

Quantitative processing of color-Doppler echocardiographic images has substantially improved noninvasive assessment of cardiac physiology. Many indices are computed from the velocity fields derived either from color-Doppler tissue imaging (DTI), such as acceleration, strain and strain-rate, or from blood-flow color-Doppler, such as intracardiac pressure gradients (ICPG). All of these indices are dependent on the finite resolution of the ultrasound scanner. Therefore, we developed an image-dependent method for assessing the influence of temporal, spatial, and velocity resolutions, on cardiovascular parameters derived from velocity images. In order to focus our study on the spatial, temporal, and velocity resolutions of the digital image, we did not consider the effect of other sources of noise such as the interaction between ultrasound and tissue. A simple first-order Taylor's expansion was used to establish the functional relationship between the acquired image velocity and the calculated cardiac index. Resolutions were studied on: (a) myocardial acceleration, strain, and strain-rate from DTI, and (b) ICPG from blood-flow color-Doppler. The performance of Taylor's-based error bounds (TBEB) was demonstrated on simulated models and illustrated on clinical images. Velocity and temporal resolution were highly relevant for the accuracy of DTI-derived parameters and ICPGs. TBEB allow to assess the effects of ideal digital image resolution on quantitative cardiovascular indices derived from velocity measurements obtained by cardiac imaging techniques.     

Image storage,transmission and manipulation

Summary

Medical imaging is the study of human functions and anatomy through pictorial information. During the past 15 years all new medical imaging modalities introduced are digital-based systems. Firstly the concept of digital imaging, the meaning of spatial and density resolutions, and signal-to-noise ratio is reviewed. Based on these definitions, the current technology in image storage and transmission is discussed including the magnetic disk, the parallel transfer disk, the optical disk, Ethernet, the fibre distributed data interface (FDDI), and Ultranet.

Among many image manipulation functions, two simple types which are commonly used in clinical applications are discussed, one for visualization enhancement and the other for quantification.     

Accuracy and cost- and time-effectiveness of digital clip versus videotape interpretation of echocardiograms in patients with valvular disease.

BACKGROUND: Although digital and videotaped images are known to be comparable for the evaluation of left ventricular function, their relative accuracy for assessment of more complex anatomy is unclear. We sought to compare reading time, storage costs, and concordance of video and digital interpretations across multiple observers and sites. METHODS: One hundred one patients with valvular (90 mitral, 48 aortic, 80 tricuspid) disease were selected prospectively, and studies were stored according to video and standardized digital protocols. The same reviewer interpreted video and digital images independently and at different times with the use of a standard report form to evaluate 40 items (e.g., severity of stenosis or regurgitation, leaflet thickening, and calcification) as normal or mildly, moderately, or severely abnormal. Concordance between modalities was expressed at kappa. Major discordance (difference of >1 level of severity) was ascribed to the modality that gave the lesser severity. CD-ROM was used to store digital data (20:1 lossy compression), and super-VHS videotape was used to store video data. The reading time and storage costs for each modality were compared. RESULTS: Measured parameters were highly concordant (ejection fraction was 52% +/- 13% by both). Major discordance was rare, and lesser values were reported with digital rather than video interpretation in the categories of aortic and mitral valve thickening (1% to 2%) and severity of mitral regurgitation (2%). Digital reading time was 6.8 +/- 2.4 minutes, 38% shorter than with video (11.0 +/- 3.0, range 8 to 22 minutes, P <.001). Compressed digital studies had an average size of 60 +/- 14 megabytes (range 26 to 96 megabytes). Storage cost for video was A$0.62 per patient (18 studies per tape, total cost A$11.20), compared with A$0.31 per patient for digital storage (8 studies per CD-ROM, total cost A$2.50). CONCLUSION: Digital and video interpretation were highly concordant; in the few cases of major discordance, the digital scores were lower, perhaps reflecting undersampling. Use of additional views and longer clips may be indicated to minimize discordance with video in patients with complex problems. Digital interpretation offers a significant reduction in reading times and the cost of archiving.     

米氮平与舍曲林治疗首发抑郁症对认知功能影响的对照研究

[目的]比较米氮平和舍曲林治疗首发抑郁症对认知功能的影响.[方法]198例首发抑郁症患者随机予以米氮平(n=98)与舍曲林(n=100)治疗,疗程6周.采用汉密尔顿抑郁量表(HAMD-17)评定疗效;采用威斯康星卡片分类测验(WCST)、连线测验(TMT)、词语流畅作业(VF)、数字符号和数字广度测验评定认知功能.[结果]治疗6周后,米氮平组的有效率为82.7％,舍曲林组的有效率为81.0％,两组比较差异无统计学意义(P＞0.05).治疗6周末,两组的WSCT正确数、分类个数较治疗前均有提高,错误数、持续错误数均有减少(P＜0.05);两组的TMT连线时间均较治疗前明显减少(P＜0.05);两组的VF总数均较治疗前明显增加(P＜0.05);两组的数字符号均较治疗前明显增加(P＜0.05);两组的数字广度治疗前后比较无显著性差异(P＞0.05).米氮平组患者在治疗6周后,WSCT非持续错误数降低、TMT-A连线时间减少、VF总数增加均较舍曲林组更为显著(P＜0.05).[结论]米氮平与舍曲林治疗抑郁症疗效相当,米氮平改善抑郁症伴发的认知功能障碍更为明显.     

Immediate and short-term effects of phototherapy on pain,muscle activity,and joint mobility in women with temporomandibular disorder: a randomized,double-blind,placebo-controlled,clinical trial

Objectives: The aim of the present study was to evaluate the immediate and short-term effects of phototherapy on pain intensity, the pressure pain threshold (PPT), maximum vertical mandibular movement, and the electrical activity of the masseter and temporal muscles in women with temporomandibular disorder (TMD).

Methods: Sixty women were randomly allocated to four different groups and submitted to phototherapy with a combination of super-pulsed laser (905?nm), red (640?nm), and infrared (875?nm) light emitting diodes in the same equipment on the masseter (three points) and temporal (two points) muscles bilaterally in a single session. The following doses were used in each point of application: Group 1 – 2.62 J; Group 2 – 5.24 J; Group 3 – 7.86 J; placebo group. Pain intensity was determined using the visual analog scale. The PPT was analyzed using a digital algometer. Vertical mandibular movement was measured using digital calipers. Myoelectrical activity of the masseter and temporal muscles was measured using electromyography. Four evaluations were performed: pre-intervention, immediately after, 24 and 48?hours after phototherapy.

Outcomes: A significant reduction in pain intensity during the post-treatment evaluations in comparison to the pretreatment evaluation was observed in group 1 (Median difference?=?2.60 [95% CI?=?1.35–3.85]) and group 2 (Median difference?=?2.2 [95% CI?=?0.98–3.42]) especially after 48?hours and group 3 (Median difference?=?2.50 [95% CI: 0.56–4.46]) especially after 24?hours, with a moderate effect size, but no effect was found regarding the other variables.

Conclusions: A single session of combined phototherapy was capable of reducing pain intensity in individuals patients with TMD.

ClinicalTrials.gov (NCT02018770).

• Implications for Rehabilitation

• Phototherapy device combining two light sources (LED and laser), and different densities in the same device is a novelty in the rehabilitation market, and has proved to be a useful intervention for people with temporomandibular disorders.

• This mode of phototherapy is another option that assists in the rapid intervention in pain symptoms, promoting a considerable degree of comfort to the patient moments after its application.

     

血管超声、经颅多普勒超声、计算机断层血管成像对后循环缺血患者椎基底动脉的评价

目的探讨血管超声、经颅多普勒超声（transcranial Doppler,TCD）、计算机断层血管成像（computertomography angiography,CTA）评价后循环缺血患者椎基底动脉异常的临床价值。方法对156例后循环缺血患者均行数字减影脑血管造影术（digital subtraction angiography,DSA）检查,回顾性分析患者入院后1周内血管超声、TCD、CTA检查结果,与DSA检查结果对照,系统评价其敏感度。结果以DSA为金标准评价,血管超声对椎基底动脉颅外段异常判断的敏感度为68.4%;TCD对椎基底动脉颅内段异常判断的敏感度为76.3%;CTA对椎基底动脉颅外和颅内段异常判断的敏感度为88.9%。结论血管超声、TCD、CTA可以作为椎基底动脉异常的初步筛查工具,而DSA仍然是金标准,并且DSA能准确判断脑血管的代偿情况。     

乳腺密度与年龄、月经状态及乳腺癌的相关性

目的 探讨乳腺密度与女性年龄、月经状态及乳腺癌之间的相关性。方法 收集我院2009年6月—2010年7月数字乳腺X线摄影检查资料,包括确诊乳腺癌患者79例(乳腺癌组)和健康体检人群481名(对照组)。DR原始图像经R2工作站Quantra软件处理,计算机自动计算出乳腺密度。比较对照组双侧乳腺密度差异;对照组乳腺密度与年龄及月经状态是否具有相关性。比较乳腺癌组与对照组的乳腺密度差异。结果 对照组双侧乳腺密度 差异无统计学意义。乳腺密度与年龄具有相关性(P＜0.001),随年龄增长乳腺密度降低;绝经人群的乳腺密度 显著低于未绝经人群 。50岁以下的平均乳腺密度在乳腺癌组高于对照组,但两者差异无统计学意义。结论 乳腺密度随着年龄增长而逐渐减低,绝经女性乳腺密度低于未绝经女性。     

Confusing delayed hematemesis,unusual arterial hemorrhage after pancreaticoduodenectomy: a case report

Pancreaticoduodenectomy (PD) is one of the most complex surgeries and is associated with a high rate of complications, including bleeding, delayed gastric emptying (DGE), and pancreatic fistula. Although the frequency of postoperative hemorrhage is not high, this complication results in severe adverse outcomes. A 67-year-old man was diagnosed with pancreatic cancer and underwent PD. On the tenth day after surgery, he developed hypovolemic shock with hematemesis. Urgent digital subtraction angiography identified the bleeding artery as the jejunal mesenteric artery at the afferent loop, and the bleeding artery was embolized with two coils. After digital subtraction angiography, the patient had an uneventful recovery with no further complications. Therefore, we concluded that it is possible that bleeding may occur in the afferent loop when hemorrhage occurs after PD.     

疗养院监控系统的设计与实现

该文通过对疗养院安全监控需求及分布式监控系统的研究,立足院内局域网,建立了36个数据采集点的基于数字硬盘录像机/数字视频服务器的客户端/服务器模式下的视频安全监控系统,实现对疗养院医疗和环境安全的实时监控。     

Personal digital assistants change management more often than paper texts and foster patient confidence.

INTRODUCTION: Rapid retrieval of information, including drug treatment options, is critical to emergency department practice. OBJECTIVES: To assess feasibility and patient acceptance of personal digital assistants and to determine the scope of management changes. METHODS: Emergency medicine residents (EMRs, n = 18) and emergency medicine attending (EMAs, n = 12) used personal digital assistants with drug database and clinical references. Text versions were also available in the emergency department. We did a prospective, random, cross-over time-motion study, recording retrieval time, source, and changes to patient care for 16 and 8 h for EMRs and EMAs, respectively. We surveyed patients for confidence in EMRs and EMAs with personal digital assistants, and perceived efficiency. RESULTS: EMRs accessed paper (n = 131) or personal digital assistant (n = 181) information on 92.3% of patients (n = 17, both). They accessed personal digital assistant on 61.4% of patients vs. 44.5% with texts (odds ratio 1.99, 95% confidence interval 1.4-2.80). Mean access times were 9.3 and 9.4 s, respectively, +1.4 for both. Personal digital assistant access was 75%/25% between pharmacopeia and clinical resource. Personal digital assistants changed drug choice in 39/181 patients (21.5%), and other management (diagnosis, treatment or disposition) in 15/181 patients (8.3%). Odds ratio for change in management for personal digital assistant vs. paper was 2.00 (95% confidence interval 1.11-3.60). We surveyed patient perception for 198 of 295 patients (67.1%). Fifty percent reported more confidence in their EMRs and EMAs with a personal digital assistant, while 5% reported less confidence. Sixty percent agreed strongly that there is too much medical information to remember. CONCLUSIONS: Personal digital assistants are feasible in an academic emergency department and change management more often than texts. EMRs accessed personal digital assistants more often than paper texts. Patient perceptions of physicians who use personal digital assistants are neutral or favorable.     

Archery-related injuries of the hand, forearm, and elbow.

The five patients reported herein had various archery-related injuries of the upper extremities. Acute injuries included arrow laceration of a digital nerve and artery, contusion of forearm skin and subcutaneous tissue, and compression neuropathy of digital nerves from the bowstring. Chronic injuries included bilateral medial epicondylitis and median nerve compression at the wrist, de Quervain's tenosynovitis, and median nerve compression at the elbow. Essential measures for archery safety include use of archery protective gear, use of a light-weight bow, conditioning of the forearm flexor muscles, and modifications in drawing the bowstring.     

小肠出血43例诊治分析

目的探讨小肠出血的病因及诊断、治疗方法。方法对我院1984年1月至2008年4月收治的43例小肠出血的病因及诊断方法进行回顾性分析。结果出血原因以肿瘤为多见(22例,占51.16%),其余依次为血管病变(9例,占20.93%),炎性肠病(8例,占18.60%),小肠憩室(4例,占9.30%)。经胃镜检查诊断4例,小肠气钡双重对比造影检查诊断6例,DSA检查诊断4例,剖腹探查结合术中内镜检查诊断29例。结论肿瘤是小肠出血的主要原因。气钡双重对比造影、数字减影血管造影、剖腹探查及术中肠镜检查是诊断小肠出血的主要手段。小肠部分切除术是治疗小肠出血的最有效方法。