Quantification of coronary arterial stenoses in CTA using fuzzy distance transform

Quantification of coronary arterial stenoses is useful for the diagnosis of several coronary heart diseases. Being noninvasive, economical and informative, computed tomographic angiography (CTA) has become a common modality for monitoring disease status and treatment effects. Here, we present a new method for detecting and quantifying coronary arterial stenosis in CTA using fuzzy distance transform (FDT) approach and a new coherence analysis of observed data for computing expected local diameter. FDT allows computing local depth at each image point in the presence of partial voluming and thus, eliminates the need for binarization, commonly, associated with inclusion of additional errors. In the current method, coronary arterial stenoses are detected and their severities are quantified by analyzing FDT values along the medial axis of an arterial tree obtained by its skeletonization. A new skeletal pruning algorithm has been developed toward improving the quality of medial axes and thereby, enhancing the accuracy of stenosis detection and quantification. Further, we have developed a new method to estimate “expected diameter” along a given arterial branch using a new coherence analysis of observed diameter values along the branch. The overall method is completed in the following steps - (1) fuzzy segmentation of coronary artery in CTA, (2) FDT computation of coronary arteries, (3) medial axis computation, (4) estimation of observed and expected diameters along arteries and (5) detection of stenoses and quantification of arterial blockage. The performance of this method has been quantitatively evaluated on a realistic coronary artery phantom dataset with randomly simulated stenoses and the results have been compared with a binary distance transform based and a conventional binary algorithm. The method has also been applied on a clinical CTA dataset from thirteen heart patients and the results have been compared with an expert's quantitative assessment of stenoses. Results of the phantom experiment indicate that the new method (error: 0.53%) is significantly more accurate as compared to both binary distance transform based (error 2.11%) and conventional binary (error 3.71%) methods. Also, the results of the clinical study indicate that the new FDT-based method (kappa coefficient = 87.9%) is highly in agreement with the expert's assessments and, in this respect, outperforms the other two methods (kappa coefficients = 75.2% and 69.5%).     

眼底炫彩成像联合光相干断层扫描对视网膜动脉阻塞快速诊断及分类

目的:探讨眼底炫彩成像(MCI)联合光相干断层扫描成像(OCT)在视网膜动脉阻塞(RAO)的快速诊断及分类中的应用。方法:对本院2018-02/2020-07诊断为RAO的患者19例19眼进行回顾性研究。所有患者在经过眼科检查后确诊为RAO,均为单眼发病,其中视网膜中央动脉阻塞(CRAO)13眼,视网膜分支动脉阻塞(BRAO)5眼,睫状视网膜动脉残留的CRAO 1眼。所有患者行最佳矫正视力、裂隙灯、OCT、MCI、FFA及视野检查及分析。结果:经裂隙灯检查,12眼(63%)出现瞳孔对光反射迟钝或消失,16眼(84%)可发现全部或部分后极部视网膜苍白水肿,10眼(53%)可发现视网膜动脉变细。行FFA检查的患者为10例(53%),其余9例未行检查,其中6例患有严重的系统性疾病,2例拒绝检查、1例有药物过敏史。所有患者经MCI及OCT检查可发现特征性眼底表现,OCT特征性改变为弥漫性内层视网膜反射增强与MCI图像绿色缺血区域形成严密的一对一关系。结论:联合MCI及OCT检查可快速确诊RAO,而且结合两者的图像特征可更精确辨认出视网膜缺血区域,有助于疾病分类及预后判断。     

Polyostotic fibrous dysplasia involving the thoracic spine with myelopathy: case report and review of the literature

Background contextPolyostotic fibrous dysplasia (PFD) seldom involves the thoracic spine and usually presents with back pain.PurposeTo describe an extremely rare presentation of an uncommon disease.Study design/settingWe present a case report from a university hospital.MethodsWe report a case of symptomatic thoracic PFD associated with myelopathy and pathologic fracture. A thorough search of PubMed/MEDLINE was performed for the terms “polyostotic fibrous dysplasia,” “spine,” and “neurological deficit.”ResultsThe patient was treated by posterior laminectomy, vertebroplasty, and pedicle screw fixation and fusion. Satisfactory results were achieved, and there were no complications.ConclusionsIn the spine, PFD may lead to pathologic fracture and myelopathy even after adolescence. Vertebroplasty with or without decompression and fixation may be the appropriate option for cases with myelopathy.     

胫骨横向搬移术联合VSD技术治疗糖尿病足的疗效及其对血管生成相关因子水平的影响

目的:探究胫骨横向搬移术联合负压引流(VSD)技术治疗糖尿病足的疗效及其对血管生成相关因子水平的影响.方法:根据治疗方法不同将60例糖尿病足患者分为观察组(n=28)和对照组(n=32).对照组采用VSD技术治疗,观察组在对照组的基础上采用胫骨横向搬移术治疗.观察两组的治疗效果,对比治疗前及治疗后3个月患肢踝肱指数(ABI)、视觉模拟评分法(VAS)评分、足部血流指标(足背动脉内径、足背动脉血流速度)及血清血管生成相关因子[血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)、表皮生长因子(EGF)]水平.结果:观察组的临床有效率为89.29％,高于对照组的59.38％(P<0.05);治疗后,观察组ABI以及VEGF、bFGF、EGF水平均高于对照组(P<0.05),且足背动脉内径及血流速度均大于对照组(P<0.05),而VAS评分低于对照组(P<0.05).结论:胫骨横向搬移术联合VSD技术治疗糖尿病足的临床疗效高于单用VSD,可能与其增加血管生成因子的表达水平、改善足部血供相关.     

舒洛地特加替米沙坦对2型糖尿病视网膜病变疗效观察

目的通过舒洛地特联合替米沙坦对2型糖尿病视网膜病变（diabeticretinopathy，DR）减少眼底微动脉瘤、延缓DR进展速度有效性的观察，评价舒洛地特和替米沙坦联合应用对DR的疗效。方法162例DR患者随机分为三组，替米沙坦组、舒洛地特组和联合治疗组，所有患者随访6个月，随访过程中定期检查眼底，空腹血糖、糖化血红蛋白、谷丙转氨酶、谷草转氨酶、纤维蛋白原。结果三组患者眼底微动脉瘤治疗后较治疗前均明显较少，差异有统计学意义（P〈0．05），治疗后三组间患者眼底微动脉瘤比较，差异无统计学意义（P〉0．05），联合治疗组与替米沙坦组、舒洛地特组相比，可延缓DR增殖型进展速度，差异有统计学意义（P〈0．05）。结论舒洛地特联合替米沙坦治疗DR能有效减少眼底微动脉瘤、延缓DR进展速度，疗效优于单一治疗组。     

Recognition of moyamoya disease and its hemorrhagic risk using deep learning algorithms:sourced from retrospective studies

Although intracranial hemorrhage in moyamoya disease can occur repeatedly, predicting the disease is difficult. Deep learning algorithms developed in recent years provide a new angle for identifying hidden risk factors, evaluating the weight of different factors, and quantitatively evaluating the risk of intracranial hemorrhage in moyamoya disease. To investigate whether convolutional neural network algorithms can be used to recognize moyamoya disease and predict hemorrhagic episodes, we retrospectively selected 460 adult unilateral hemispheres with moyamoya vasculopathy as positive samples for diagnosis modeling, including 418 hemispheres with moyamoya disease and 42 hemispheres with moyamoya syndromes. Another 500 hemispheres with normal vessel appearance were selected as negative samples. We used deep residual neural network(Res Net-152) algorithms to extract features from raw data obtained from digital subtraction angiography of the internal carotid artery, then trained and validated the model. The accuracy, sensitivity, and specificity of the model in identifying unilateral moyamoya vasculopathy were 97.64 ± 0.87%, 96.55 ± 3.44%, and 98.29 ± 0.98%, respectively. The area under the receiver operating characteristic curve was 0.990. We used a combined multi-view conventional neural network algorithm to integrate age, sex, and hemorrhagic factors with features of the digital subtraction angiography. The accuracy of the model in predicting unilateral hemorrhagic risk was 90.69 ± 1.58% and the sensitivity and specificity were 94.12 ± 2.75% and 89.86 ± 3.64%, respectively. The deep learning algorithms we proposed were valuable and might assist in the automatic diagnosis of moyamoya disease and timely recognition of the risk for re-hemorrhage. This study was approved by the Institutional Review Board of Huashan Hospital, Fudan University, China(approved No. 2014-278) on January 12, 2015.     

2010—2013年大连口岸出入境人员传染病监测及流行病学特征分析

目的统计2010—2013年大连口岸出入境人员传染病的感染情况,评估出入境人员的健康风险,为传染病监测和防控工作提供科学依据。方法对2010-2013年大连口岸出入境人员的传染病监测资料和流行病学特征进行统计分析。结果 2010—2013年在大连口岸进行传染病监测体检共150232人,检出各种传染病4174例,总检出率2.7784%;其中乙肝病毒表面抗原(HBsAg)阳性为3 444例,丙肝病毒抗体(Anti-HCV)阳性326例,梅毒250例,活动性肺结核130例,艾滋病24例。不同年份、不同职业、不同性别传染病检出率有统计学意义(P0.01或P0.05)。结论 HBsAg阳性、梅毒和HCV-Ab阳性是大连口岸出入境人员中的主要传染病,应加强出入境人员的传染病监测。