A Comparison of Artificial Intelligence and Human Diabetic Retinal Image Interpretation in an Urban Health System

Introduction:Artificial intelligence (AI) diabetic retinopathy (DR) software has the potential to decrease time spent by clinicians on image interpretation and expand the scope of DR screening. We performed a retrospective review to compare Eyenuk’s EyeArt software (Woodland Hills, CA) to Temple Ophthalmology optometry grading using the International Classification of Diabetic Retinopathy scale.Methods:Two hundred and sixty consecutive diabetic patients from the Temple Faculty Practice Internal Medicine clinic underwent 2-field retinal imaging. Classifications of the images by the software and optometrist were analyzed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and McNemar’s test. Ungradable images were analyzed to identify relationships with HbA1c, age, and ethnicity. Disagreements and a sample of 20% of agreements were adjudicated by a retina specialist.Results:On patient level comparison, sensitivity for the software was 100%, while specificity was 77.78%. PPV was 19.15%, and NPV was 100%. The 38 disagreements between software and optometrist occurred when the optometrist classified a patient’s images as non-referable while the software classified them as referable. Of these disagreements, a retina specialist agreed with the optometrist 57.9% the time (22/38). Of the agreements, the retina specialist agreed with both the program and the optometrist 96.7% of the time (28/29). There was a significant difference in numbers of ungradable photos in older patients (≥60) vs younger patients (<60) (p=0.003).Conclusions:The AI program showed high sensitivity with acceptable specificity for a screening algorithm. The high NPV indicates that the software is unlikely to miss DR but may refer patients unnecessarily.     

大螺距和双低剂量CT血管成像在心脑一站式联合扫描中的应用研究

目的探讨Force CT大螺距和双低剂量CT血管成像在心脑一站式联合扫描中的应用价值。方法回顾性分析178例患者CTA资料。A组58例:头颈心一站式联合扫描CTA,应用大螺距、双低剂量及前瞻性心电门控行冠状动脉、头颈部动脉一站式联合扫描; B组60例:冠状动脉CTA:前瞻性心电门控行常规冠状动脉成像; C组60例:常规头颈部动脉CTA。对各组图像质量进行主、客观评价,对A组与B组冠状动脉图像质量及A组与C组头颈部动脉图像质量进行主观评分,客观记录并比较各组升主动脉根部、左前降支、颈总动脉分叉处、大脑中动脉M1段图像CT值、对比噪声比（CNR）及图像噪声（SD）,计算并比较各组的辐射剂量（ED）和平均碘摄入量。结果 A组与B组冠状动脉图像质量评分、升主动脉根部及左前降支CT值和图像噪声差异无统计学意义（P>0.05）; A组与C组头颈部动脉图像质量评分、颈总动脉分叉处及大脑中动脉M1段CT值和图像噪声差异均无统计学意义（P>0.05）。A组与（B+C）组辐射剂量、平均碘摄入量差异有统计学意义（P<0.001）,辐射剂量降低约79.7%,平均碘摄入量降低约46.1%。结论大螺距双低剂量CT血管成像心脑一站式检查在保证图像质量的同时大幅度降低了辐射剂量,减少了对比剂碘量的摄入。     

罗替高汀与普拉克索治疗帕金森病的成本效果分析

目的:分析罗替高汀与普拉克索(常释剂/缓释剂)治疗帕金森病的成本效果.方法:基于卫生服务体系的角度,根据临床指南中的标准临床路径及H&Y分级,采用动态Markov模型,模拟患者终生的直接医疗成本和质量调整生命年.结果:在治疗帕金森病中,与普拉克索常释剂相比,罗替高汀提高0.062 9个质量调整生命年,费用提高70 36...     

Self-assembled morphologies of polyelectrolyte-grafted nanoparticles directed by oppositely charged polymer matrices

Self-assembled structure of polymer grafted nanoparticles is an interesting and growing subject in the field of hybrid electronics and high energy density materials. In light of this, the self-assembled morphologies of polyelectrolyte (PE) sparsely grafted nanoparticles tuned by oppositely charged matrix chains are studied using molecular dynamics simulations. Our focus is to elucidate the effect of matrix chain polymerization on modulating the stretching properties of tethered PE layers, on the self-assembled structuring of nanoparticles. Through varying the matrix chain length and stiffness as well as electrostatic interaction strength, rich phase behaviors of PE coated nanoparticles are predicted, including spherical micelle-like structures being preferred with short matrix chains and percolating network morphologies favored with long matrix chains, which is more pronounced with an enhanced matrix chain rigidness. To pinpoint the mechanisms of self-assembled structure formation, the thickness of grafted layers, the gyration radius of tethered chains, and pair correlation functions between nanoparticles are analyzed carefully. Additionally, electrostatic correlations, manifested as the bridging via matrix chains, are examined by identifying three states of matrix PE chains. Our simulation results may be useful for designing smart polymer nanocomposites based on PE coated nanoparticles.

Self-assembled structure of polymer grafted nanoparticles is an interesting and growing subject in the field of hybrid electronics and high energy density materials.     

糖尿病神经病变的评估和预防

糖尿病神经病变是糖尿病最常见和最复杂的并发症之一,可累及全身神经系统的任何部分,大约发生在近50%的糖尿病患者中.通常在1型糖尿病患者中,它出现较晚,而在2型糖尿病的早期就能发现.     

RNA干扰技术抑制类风湿关节炎成纤维细胞COX-2合成

目的 体外合成针对人环氧化酶-2（hCOX-2）的小分子干扰RNA（siRNA）,并转染人人滑膜成纤维细胞,通过比较不同siRNA抑制COX-2 mRNA表达、COX-2蛋白合成以及下游产物PGE2水平,旨在确定特异性阻断人滑膜成纤维细胞COX-2的siRNA.方法 分离、培养和传代人类风湿关节炎（类风关）滑膜成纤维细胞.设计合成4条针对hCOX-2 mRNA siRNA（1#-4#siRNA）,1条随机序列siRNA.设立1#-4#siRNA和随机序列siRNA组（NC）及未转染对照组（CTL组）.应用Lipofect AMINE 2000将上述siRNA分别转染人滑膜成纤维细胞,4 h后各培养孔加入终浓度为100 nmol/L的佛波酯.转染36 h、48 h后,各组提取蛋白质和总RNA,应用RT-PCR检测hCOX-2 mRNA表达水平,通过Western Blot检测hCOX-2蛋白表达水平.采用ELISA方法检测各组上清液PGE2的水平.结果 转染36 h,PCR结果显示,CTL、NC、1#siRNA、2#RNA、3#RNA、4#siRNA、阳性对照HeLa细胞组hCOX-2 mRNA电泳条带密度值分别为1、0.72、0.3、0.25、0.4、0.04、2.1.Western Blot结果提示上述各组hCOX-2蛋白密度值分别为1、1.04、0.52、0.39、0.9、0和2.48.转染48 h后,各组hCOX-2蛋白条带密度值分别为0.05、0.52、0.51、0.9和0.15.转染24 h、48 h和72 h后,4#siRNA组培养上清液PGE2的水平较其他各组低.结论 4#siRNA能有效抑制人滑膜成纤维细胞COX-2 mRNA表达和COX-2蛋白的合成,且上清液中PGE2水平最低,证实4#siRNA能特异性阻断COX-2在滑膜成纤维细胞表达.     

17-AAG-M诱导人NSCLC-A549细胞差异表达miRNA的筛选及对放射敏感性影响

目的:筛选17-AAG-M诱导的人非小细胞肺癌(NSCLC) A549细胞在X线下差异表达miRNA并研究其对放射敏感性的影响。方法:对17-AAG-M及4Gy处理的A549细胞完成芯片筛选,公共数据库观察兴趣miRNA在肿瘤中的表达,GO及KEGG分析目标miRNA并通过qPCR验证。MTT及克隆形成实验分别检测目标...     

2005年世界药品销售与上海市样本医院用药分析

目的对2005年世界药品销售与上海市样本医院用药进行比较分析。方法世界药品销售资料来源于2005年IMSHEALTH编辑的WorldReview,与上海市84家样本医院2005年购药数据比较,结合临床应用作分析。结果2005年世界药品销售金额增长6.9%,上海市84家样本医院药品销售金额增长16.64%。在世界药品销售中名列前茅的主要是调脂药、抗精神障碍药、抗心血管疾病药等,上海市样本医院用药名列前茅的是抗感染药和输液等品种。结论上海市医院用药水平与世界发达地区逐渐接近,但药品结构上仍有较大的差异。     

应激性认知障碍小鼠脑内同型半胱氨酸的代谢变化研究

目的 通过检测应激小鼠海马和前额叶皮质同型半胱氨酸(Hcy)及其代谢酶水平,了解应激对脑内Hcy代谢的影响,为应激性认知障碍的Hcy损伤机制补充新的证据.方法 24只C57小鼠随机分为对照组和3周慢性束缚应激组,采用高压液相色谱分别检测血浆以及海马和前额叶皮质组织匀浆液中Hcy水平,采用皮质酮酶联免疫吸附(ELISA)...