Predicting long-term outcomes after cardiac arrest by using serum neutrophil gelatinase-associated lipocalin

Objectives

Neutrophil gelatinase-associated lipocalin (NGAL) is secreted by various tissues in pathologic states. Previous studies reported that post-cardiac arrest serum NGAL levels correlate with short-term neurologic outcomes and survival. The aim of this study was to examine the associations between NGAL levels post-cardiac arrest and long-term outcomes and survival.

乳腺结节超声BI-RADS分类3~5类的量化评分研究

目的探讨基于超声BI-RADS分类的量化评分方法在乳腺结节良恶性风险评估中的应用价值。方法回顾性分析486个最大直径>1 cm的乳腺结节,将其超声征象与患者年龄作为评分指标并进行赋值,计算每个结节的总分并根据设定的BI-RADS 3~5类的分值界限进行BI-RADS分类。绘制ROC曲线,寻找最佳诊断分值界限。结果 486个乳腺结节中良性结节368个,恶性结节118个。ROC曲线下面积为0.952,以总分9分作为诊断界值,其灵敏度、特异度、准确度分别为91.52%、83.69%、85.60%。BI-RADS 3、4a、4b、4c、5类的恶性构成比分别为0%、8.06%、29.09%、65.22%、92.54%。结论基于乳腺结节超声BI-RADS分类的量化评分方法可行性大,对常规超声下乳腺结节的良恶性风险评估有较高的准确度,有助于BI-RADS分类的推广应用。     

Risk Stratification Among Survivors of Cardiac Arrest Considered for Coronary Angiography

BackgroundThe American College of Cardiology Interventional Council published consensus-based recommendations to help identify resuscitated cardiac arrest patients with unfavorable clinical features in whom invasive procedures are unlikely to improve survival.ObjectivesThis study sought to identify how many unfavorable features are required before prognosis is significantly worsened and which features are most impactful in predicting prognosis.MethodsUsing the INTCAR (International Cardiac Arrest Registry), the impact of each proposed “unfavorable feature” on survival to hospital discharge was individually analyzed. Logistic regression was performed to assess the association of such unfavorable features with poor outcomes.ResultsSeven unfavorable features (of 10 total) were captured in 2,508 patients successfully resuscitated after cardiac arrest (ongoing cardiopulmonary resuscitation and noncardiac etiology were exclusion criteria in our registry). Chronic kidney disease was used in lieu of end-stage renal disease. In total, 39% survived to hospital discharge. The odds ratio (OR) of survival to hospital discharge for each unfavorable feature was as follows: age >85 years OR: 0.30 (95% CI: 0.15 to 0.61), time-to-ROSC >30 min OR: 0.30 (95% CI: 0.23 to 0.39), nonshockable rhythm OR: 0.39 (95% CI: 0.29 to 0.54), no bystander cardiopulmonary resuscitation OR: 0.49 (95% CI: 0.38 to 0.64), lactate >7 mmol/l OR: 0.50 (95% CI: 0.40 to 0.63), unwitnessed arrest OR: 0.58 (95% CI: 0.44 to 0.78), pH <7.2 OR: 0.78 (95% CI: 0.63 to 0.98), and chronic kidney disease OR: 0.96 (95% CI: 0.70 to 1.33). The presence of any 3 or more unfavorable features predicted <40% survival. Presence of the 3 strongest risk factors (age >85 years, time-to-ROSC >30 min, and non-ventricular tachycardia/ventricular fibrillation) together or ≥6 unfavorable features predicted a ≤10% chance of survival to discharge.ConclusionsPatients successfully resuscitated from cardiac arrest with 6 or more unfavorable features have a poor long-term prognosis. Delaying or even forgoing invasive procedures in such patients is reasonable.     

Top-down attention switches coupling between low-level and high-level areas of human visual cortex

Top-down attention is an essential cognitive ability, allowing our finite brains to process complex natural environments by prioritizing information relevant to our goals. Previous evidence suggests that top-down attention operates by modulating stimulus-evoked neural activity within visual areas specialized for processing goal-relevant information. We show that top-down attention also has a separate influence on the background coupling between visual areas: adopting different attentional goals resulted in specific patterns of noise correlations in the visual system, whereby intrinsic activity in the same set of low-level areas was shared with only those high-level areas relevant to the current goal. These changes occurred independently of evoked activity, persisted without visual stimulation, and predicted behavioral success in deploying attention better than the modulation of evoked activity. This attentional switching of background connectivity suggests that attention may help synchronize different levels of the visual processing hierarchy, forming state-dependent functional pathways in human visual cortex to prioritize goal-relevant information.     

Linguistic Indicators of a False Confession

To date, most investigations of false confessions have focused on their prevention rather than their identification. In this study we investigated whether certain linguistic variables might help to distinguish between false confessional statements and true accounts. Using a within-subjects design, we elicited both false confessional statements and true accounts from 85 participants. We examined these for the presence of nouns, verbs and adjectives. Additionally, participants completed the Depression, Anxiety and Stress Scale (DASS) to determine the relationship between noun, verb and adjective use and self-reported measures of state anxiety. Results showed that whereas nouns and verbs failed to discriminate between false confessions and true accounts, adjective use significantly decreased during false confessions. Anxiety was not associated with veracity. The current findings suggest that there are measurable linguistic differences between false confessions and true accounts that cannot be attributed to level of state anxiety.     

Evaluating Auditory Pathway by Electrical Auditory Middle Latency Response and Postoperative Hearing Rehabilitation

ABSTRACT

Objective: To establish an effective detection method to evaluate auditory pathway in patients by electrical evoked middle latency response (EMLR) before artificial cochlear implantation, and to analyze the relationship between postoperative hearing rehabilitation and auditory cortex functions. Methods: Twenty-three patients with artificial cochlear implant were recruited. EMLR was measured after adjusting the depth of anesthesia. The electrical auditory brainstem response (EABR) mode with monopolar stimulation and two-phase alternating current square waves was selected. The parameters of EMLR waveforms were recorded by the EABR measurement system. Nerve response telemetry (NRT) was examined by measuring threshold level (T value) and comfortable level (C value) 1 month after power-on, and hearing and speech development was followed up 12 months later.Results: The detection rate of EMLR was 95.65%. The waveforms of EMLR were comparable to those of auditory middle latency response (AMLR), showing decreased latency and interval but similar amplitude. The induction rate of NRT was 69.23%, which was much lower than that of EMLR. The EMLR thresholds were significantly correlated to the T and C values, and were comparable to the T values numerically. The Spearman's r value between EMLR waveforms and CAP scores after using the cochlear implant for 12 months was 0.673 (P < 0.01). Conclusion: An effective detection method to measure EMLR before artificial cochlear implant was established. The thresholds of EMLR were lower than those of NRT. The method can be useful for objective evaluation of auditory cortex functions and postoperative hearing rehabilitation.     

Effect of Training on Qualitative Mammographic Density Assessment

PurposeThe aim of this study was to evaluate the accuracy of visual mammographic breast density assessment and determine if training can improve this assessment, to compare the accuracy of qualitative density assessment before and after training with a quantitative assessment tool, and to evaluate agreement between qualitative and quantitative density assessment methods.MethodsConsecutive screening mammograms performed over a 4-month period were visually assessed by two study breast radiologists (the leads), who selected 200 cases equally distributed among the four BI-RADS density categories. These 200 cases were shown to 20 other breast radiologists (the readers) before and after viewing a training module on visual density assessment. Agreement between reader assessment and lead radiologist assessment was calculated for both reading sessions. Quantitative volumetric density of the 200 mammograms, determined using a commercially available tool, was compared with both sets of reader assessment and with lead radiologist assessment.ResultsCompared with lead radiologist assessment, reader accuracy of breast density assessment increased from 65% before training to 72% after training (odds ratio, 1.41; P < .0001). Training specifically improved assignment to BI-RADS categories 1 (P < .0001) and 4 (P < .10). Compared with quantitative assessment, reader accuracy showed statistically nonsignificant improvement with training (odds ratio, 1.1; P = .26). Substantial agreement between qualitative and quantitative breast density assessment was demonstrated (κ = 0.78).ConclusionsTraining may improve the accuracy of mammographic breast density assessment. Substantial agreement between qualitative and quantitative breast density assessment exists.     

汉语分类命名功能磁共振初步研究

目的 设计一种适合汉语分类命名的刺激任务,探索汉语词义分类命名(CF)的脑功能区分布特征.方法 对19名健康汉语志愿者进行CF语言任务刺激,同时采集血氧水平依赖性功能磁共振成像(BOLD-fMRI)数据,通过SPM8软件分析获取CF任务相关脑功能激活区位置、大小及强度.结果 任务态BOLD-fMRI图像显示汉语CF刺激在额、颞叶存在特定的激活区,主要分布于左额上回(BA8区)、右额上回(BA6区);负激活区位于右额上回(BA9区)、左颞中回(BA20区)及梭状回(BA37区).结论 利用该语言任务能有效激活汉语CF相关的脑功能区;同时BOLD-fMRI可以准确定位激活区,量化激活区的大小及激活强度,患者依从性好.此方法可适用于汉语分类联想相关脑功能疾病的研究.     

Computer aided classification system for breast ultrasound based on Breast Imaging Reporting and Data System (BI-RADS)

Clinically, the ultrasound findings are evaluated by its sonographic characteristics and then assigned to assessment categories according to the definitions of Breast Imaging Reporting and Data System (BI-RADS) developed by the American College of Radiology. In this study, a computer-aided classification (CAC) system was proposed to classify the masses into assessment categories 3, 4 and 5, which simulated the clinical diagnosis of radiologists. Compared with current computer-aided diagnosis systems, the proposed CAC system classifies the indeterminate cases into BI-RADS category 4 for further diagnosis. Six hundred twenty-six cases were collected from three ultrasound systems and confirmed by pathology and retrospectively classified into categories 3, 4 and 5 by radiologists. The multinomial logistic regression model was trained as the CAC system for predicting the assessment category from the computerized BI-RADS features and from a set of machine-dependent factors. By using the machine-dependent factors to indicate the adopted ultrasound systems, the same regression model could be applied for the cases acquired from different ultrasound systems. A basic CAC system was trained by using the classification result of radiologists. A weighted CAC system, to improve the capacity of the basic CAC system in differentiating benign from malignant lesions, was trained by adding the pathologic result. Between the radiologists and the basic CAC system, a substantial agreement was indicated by Cohen's kappa statistic and the differences in either the performance indices or the A(Z) of receiver operating characteristic (ROC) analysis were not statistically significant. For the weighted CAC system, the performance indices accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 73.00% (457 of 626), 98.17% (215 of 219), 59.46% (242 of 407), 56.58% (215 of 380) and 98.37% (242 of 246), respectively; the A(Z) was 0.94; and the correlation with the radiologists was also substantial agreement. The indices accuracy and specificity of weighted CAC system, compared with those of the radiologists, were improved by 5.91% and 8.85%, respectively and the indices of sensitivity and NPV, compared with those of a conventional CAD system, were improved by 10.5% and 5.21%, respectively; all improvements were statistically significant. To classify the mass into BI-RADS assessment categories by the CAC system is feasible. Moreover, the proposed CAC system is flexible because it can be used to diagnose the cases acquired from different ultrasound systems.