Clinical validation of an artificial intelligence-enabled wound imaging mobile application in diabetic foot ulcers

There is a lifetime risk of 15% to 25% of development of diabetic foot ulcers (DFUs) in patients with diabetes mellitus. DFUs need to be followed up on and assessed for development of complications and/or resolution, which was traditionally performed using manual measurement. Our study aims to compare the intra- and inter-rater reliability of an artificial intelligence-enabled wound imaging mobile application (CARES4WOUNDS [C4W] system, Tetsuyu, Singapore) with traditional measurement. This is a prospective cross-sectional study on 28 patients with DFUs from June 2020 to January 2021. The main wound parameters assessed were length and width. For traditional manual measurement, area was calculated by overlaying traced wound on graphical paper. Intra- and inter-rater reliability was analysed using intra-class correlation statistics. A value of <0.5, 0.5–0.75, 0.75–0.9, and >0.9 indicates poor, moderate, good, and excellent reliability, respectively. Seventy-five wound episodes from 28 patients were collected and a total of 547 wound images were analysed in this study. The median wound area during the first clinic consultation and all wound episodes was 3.75 cm² (interquartile range [IQR] 1.40–16.50) and 3.10 cm² (IQR 0.60–14.84), respectively. There is excellent intra-rater reliability of C4W on three different image captures of the same wound (intra-rater reliability ranging 0.933–0.994). There is also excellent inter-rater reliability between three C4W devices for length (0.947), width (0.923), and area (0.965). Good inter-rater reliability for length, width, and area (range 0.825–0.934) was obtained between wound nurse measurement and each of the C4W devices. In conclusion, we obtained good inter-rater and intra-rater reliability of C4W measurements against traditional wound measurement. The C4W is a useful adjunct in monitoring DFU wound progress.     

低功率钬激光与等离子剜除治疗中等体积前列腺增生的比较

目的对中等体积前列腺增生,通过比较低功率钬激光（LP-HoLEP）与等离子剜除（PKEP）的临床疗效,探讨低功率钬激光剜除前列腺增生的临床特点。 方法收集我院自2018年6月至2020年6月104例前列腺增生（30 ml1、IPSS、Q_max、RUV、PSA、剜除时间、粉碎时间、膀胱冲洗时间、术后尿管留置时间、住院时间、切除腺体质量、血红蛋白下降量等。统计两组患者术前及术后7 d、14 d及21 d尿白细胞升高例数,及术后6个月的IPSS评分、PSA、前列腺体积V₂等。 结果两组患者年龄、Hb、V₁、IPSS、Q_max、RUV、PSA、剜除时间、粉碎时间、腺体切除质量、血红蛋白下降值差异无统计学意义。LP-HoLEP组与PKEP组膀胱冲洗时间为（42.63±13.25）min和（51.67±11.65）min,术后尿管留置时间为（1.80±0.56） d和（2.23±0.83）d,术后平均住院天数为（2.90±0.70）d和（3.58±0.68）d,差异有统计学意义。两组患者尿白细胞升高例数随时间发生趋势性变化（F=132.842,P<0.05）,两组患者术后尿白细胞增多差异无统计学意义,（F=1.960,P=0.183）。随访6个月,LP-HoLEP和PKEP组IPSS评分降至（5.23±1.67）和（5.70±1.89）,PSA降至（1.17±0.40）和（1.04±0.37）ng/dl,前列腺体积V₂降至（15.93±2.18）ml和（15.25±2.73） ml。两组尿失禁和尿道狭窄等并发症发生率差异无统计学意义。 结论随访6个月,两组均能够有效剜除前列腺且降低PSA,同时改善LUTS,说明对治疗中等体积BPH均安全有效。LP-HoLEP虽然学习曲线较长,但可以减少膀胱冲洗、尿管留置及住院时间。因此,低功率钬激光剜除中等体积前列腺增生具有可行性且可进一步推广应用。     

经皮肾镜与输尿管软镜治疗肾下盏小鹿角形结石的比较

目的比较经皮肾镜（PCNL）与输尿管软镜（FURS）治疗肾下盏小鹿角形结石的安全性及有效性。 方法回顾性纳入并分析我院2017年4月至2019年4月43例肾下盏小鹿角形结石,其中PCNL治疗20例（PCNL组）,FURS治疗23例（FURS组）,比较两组手术时间、结石清除率、手术并发症和术后住院天数等。 结果43例均顺利完成手术,PCNL组的手术时间、术后住院天数均显著长于FURS组（P<0.05）;术后1~4 d PCNL组结石清除率85.0%,显著高于FURS组52.2%,术后4周及术后半年两组结石清除率差异无统计学意义（P>0.05）,但FURS组的二次干预率更高（P<0.05）;两组在术后发热、出血及石街形成等方面差异无统计学意义（P>0.05）,但PCNL组的血红蛋白丢失量及术后止痛药使用率更高（P<0.05）。 结论PCNL与FURS在治疗肾下盏小鹿角形结石均安全、有效,两者远期疗效相当,但FURS比PCNL创伤更小,术后恢复更快,值得临床推广。     

59例恶性淋巴瘤的实验与临床研究

从病理学、免疫学、细胞遗传学、超微病理学四个方面对５９例恶性淋巴瘤（ＭＬ）进行系统研究。结果表明，ＭＬ是一组高度异质性恶性肿瘤，其异质性充分表现在上述四个方面的多样化改变，并与肿瘤细胞分化密切相关。该组病理诊断的准确率为８５％，电镜诊断的准确率为９５％，在病理分型的基础上，结合电镜检查、免疫分型，可提高ＭＬ亚型分类的准确性，有利于指导临床治疗及预后的判断。     

Differences between the pediatric and adult presentation of fibromuscular dysplasia: results from the US Registry

Background

Fibromuscular dysplasia (FMD) is a non-inflammatory arteriopathy that causes significant morbidity in children.

Methods

The clinical features, presenting symptoms, and vascular beds involved are reviewed in the first 33 patients aged <18 years who are enrolled in the United States Registry for FMD from five registry sites and compared with 999 adult patients from 12 registry sites.

Results

Mean age at diagnosis was 8.4?±?4.8 years (16 days to 17 years). Compared with adults, pediatric FMD occurs in more males (42.4 vs 6 %, p?<?0.001). Children with FMD have a stronger previous history of hypertension (93.9 vs 69.9 %, p?=?0.002). Hypertension (100 %), headache (55 %), and abdominal bruits (10.7 %) were the most common presenting signs and symptoms. FMD affects renal vasculature in almost all children (97 vs 69.7 %, p?=?0.003). The extra-cranial carotid vessels are less commonly involved in children (23.1 vs 73.3 %, p?<?0.001). The mesenteric arteries (38.9 vs 16.2 %, p?=?0.02) and aorta (26.3 vs 2.4 %, p?<?0.001) are more commonly involved in children.

Conclusions

In the United States Registry for FMD, pediatric FMD affects children from infancy throughout childhood. All children presented with hypertension and many presented with headache and abdominal bruits. In children, FMD most commonly affects the renal vasculature, but also frequently involves the mesenteric arteries and abdominal aorta; the carotid vessels are less frequently involved.

     

A report on the Academic Emergency Medicine 2015 consensus conference “Diagnostic imaging in the emergency department: a research agenda to optimize utilization”

In May 2015, the Academic Emergency Medicine consensus conference “Diagnostic imaging in the emergency department: a research agenda to optimize utilization” was held. The goal of the conference was to develop a high-priority research agenda regarding emergency diagnostic imaging on which to base future research. In addition to representatives from the Society of Academic Emergency Medicine, the multidisciplinary conference included members of several radiology organizations: American Society for Emergency Radiology, Radiological Society of North America, the American College of Radiology, and the American Association of Physicists in Medicine. The specific aims of the conference were to (1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging utilization and identify key opportunities, limitations, and gaps in knowledge; (2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and (3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Through a multistep consensus process, participants developed targeted research questions for future research in six content areas within emergency diagnostic imaging: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use.