Use of neural networks to improve quality control of interpretations in myocardial perfusion imaging

Background: The aim of this study was to explore the feasibility of using a technique based on artificial neural networks for quality assurance of image reporting. The networks were used to identify potentially suboptimal or erroneous interpretations of myocardial perfusion scintigrams (MPS). Methods: Reversible perfusion defects (ischaemia) in each of five myocardial regions, as interpreted by one experienced nuclear medicine physician during his daily routine of clinical reporting, were assessed by artificial neural networks in 316 consecutive patients undergoing stress/rest 99mTc-sestamibi myocardial perfusion scintigraphy. After a training process, the networks were used to select the 20 cases in each region that were more likely to have a false clinical interpretation. These cases, together with 20 control cases in which the networks detected no likelihood of false clinical interpretation, were presented in random order to a group of three experienced physicians for a consensus re-interpretation; no information regarding clinical or neural network interpretations was provided to the re-evaluation panel. Results: The clinical interpretation and the re-evaluation differed in 53 of the 200 cases. Forty-six of the 53 cases (87%) came from the group selected by the neural networks, and only seven (13%) were control cases (P < 0.001). The disagreements between clinical routine interpretation by an experienced nuclear medicine expert and artificial networks were related to small and mild perfusion defects and localization of defects. Conclusion: The results demonstrate that artificial neural networks can identify those myocardial perfusion scintigrams that may have suboptimal image interpretations. This is a potentially highly cost-effective technique, which could be of great value, both in daily practice as a clinical decision support tool and as a tool in quality assurance.     

Cognitive development and the interpretation of anxiety-related physical symptoms in 4-13-year-old non-clinical children

The present study examined developmental patterns in children's interpretation of anxiety-related physical symptoms and emotional reasoning (i.e., the tendency to infer danger on the basis of physical response information). A sample of 171 children aged between 4 and 13 years were interviewed after listening to a number of vignettes in which the presence and absence of physical symptoms was systematically varied. Results revealed the expected developmental pattern for anxiety-related interpretations of physical symptoms. More precisely, from age 7, children were increasingly capable of linking physical symptoms to the emotion of anxiety. Furthermore, support was obtained for an emotional reasoning effect. That is, children rated vignettes with physical symptoms as more dangerous than vignettes without such symptoms. While the emotional reasoning effect was present in children of all ages, this phenomenon was more salient among older children. Finally, cognitive development as measured by Piagetian conservation tasks appeared to influence children's anxiety-related interpretations of physical symptoms and emotional reasoning. Altogether, these findings are relevant for researchers who are interested in "physical symptoms-based" theories of childhood anxiety.     

Memory cueing during sleep modifies the interpretation of ambiguous scenes in adolescents and adults

The individual tendency to interpret ambiguous situations negatively is associated with mental disorders. Interpretation biases are already evident during adolescence and due to the greater plasticity of the developing brain it may be easier to change biases during this time. We investigated in healthy adolescents and adults whether stabilizing memories of positive or negative scenes modulates the later interpretation of similar scenes. In the evening, participants learnt associations between ambiguous pictures and words that disambiguate the valence of the pictures in a positive or negative direction. Half of the words were acoustically presented (i.e. cued) during post-learning sleep which is known to benefit memory consolidation by inducing reactivation of learned information. Cued compared to un-cued stimuli were remembered better the next morning. Importantly, cueing positively disambiguated pictures resulted in more positive interpretations whereas cueing negatively disambiguated pictures led to less positive interpretations of new ambiguous pictures with similar contents the next morning. These effects were not modulated by participants’ age indicating that memory cueing was as efficient in adolescents as in adults. Our findings suggest that memory cueing during sleep can modify interpretation biases by benefitting memory stabilization and generalization. Implications for clinical settings are discussed.     

2021年英国皮肤科医师协会《玫瑰痤疮管理指南》解读

2021年5月,英国皮肤科医师协会发布了《玫瑰痤疮管理指南》,对玫瑰痤疮的病因、疾病发展史、诊断及鉴别诊断、治疗及其预后随访等方面提出了全面的临床指导意见。本文对该指南进行解读,并与中国2021年版玫瑰痤疮管理指南进行对比,以期为我国玫瑰痤疮的诊治提供参考。     

Working to Understand Our Role in the Patient's Mind: Countertransference and the Problems of Immersion

To be fully helpful, in a way that respects both the internal and external needs and conflicts of our patients in analytic treatment, we must become immersed in their emotional perspective and have a feel for how they view and value themselves and their objects. Allowing ourselves to be carried into their inner phantasies and to be in touch with their strivings towards and away from love, hate, and knowledge is important in the analytic process. Countertransference is unavoidable but, if properly monitored and contained, it can provide a beneficial therapeutic device. However, when treating disturbed patients who draw us into more paranoid transference states or primitive depressive position conflicts, we are often involved in various degrees of enactment. Even then, the countertransference, if carefully studied, can help us rebalance ourselves therapeutically and start to better understand how the patient is using us in their internal world and why they need to or desire to organize their object relational world in such terms. We cannot help but be immersed within the patient's unconscious belief system but, by being aware of our thoughts and feelings and reactions, we can keep our head above the choppy countertransference waters enough to act out less and offer constant interpretations that are more informed and focused on the patient's unique and personal object relational conflicts and internal belief system. From an object relational, post‐Kleinian tradition, the author examines one case in depth. The patient consulted the analyst with concerns about her grown children and her perception of how damaged they were emotionally. The subsequent meetings involved intense transference and countertransference experiences that are explored. The author's approach builds on prior clinical understanding based on the Kleinian method (Waska, 2002, 2004, 2012, 2013).     

中医临床留学生教育口译话语分析

目的:研究中医临床留学生教育模式及相应口译的话语特征。方法和材料:自行创建小型中医临床口语语料库。利用语料库分析软件WordSmith Tools分析话语特征。结果:发现当前中医临床带教主要有三种模式:灌输式、评论式、讨论式,其相应口译有着自己的话语特征。     

《骨髓增生异常综合征诊断与治疗中国专家共识(2014年版)》解读

对中华医学会血液学分会制订的《骨髓增生异常综合征诊断与治疗中国专家共识(2014年版)》进行解读,针对其科学性、合理性进行探讨,并提出一些看法和建议,期望对中国骨髓增生异常综合征诊疗提供帮助.     

Exploring the Optimal Erectile Function Domain Score Cutoff That Defines Sexual Satisfaction After Radical Prostatectomy

IntroductionThe International Index of Erectile Function (IIEF) is the gold standard validated instrument for defining erectile function (EF) and its response to treatment. The EF domain (EFD) contains six questions and is a sensitive and specific measurement of treatment-related changes in EF. The EFD score has been widely used as a primary assessment end point for clinical trials of EF recovery after radical prostatectomy (RP). Various EFD scores have been used to define functional erections. Recently, an EFD score of at least 22 has been used as a threshold in major post-RP penile rehabilitation studies.AimTo define the EFD score that optimally defines “functional” erections after RP.MethodsWe assessed men 24 months after RP using the IIEF and specifically analyzed the scores of the EFD and intercourse satisfaction domain (ISD).Main Outcome MeasuresWe used two questions on satisfaction (score = 0–5) and enjoyment (score = 0–5) from the ISD to classify IS (score = 0–10). We tested the following intercourse satisfaction classifications: ISD score equal to 10, ISD score of at least 8, and a score of at least 4 for the ISD questions on satisfaction and enjoyment. We used the classification that produced the largest area under the curve (AUC) using a receiver operating characteristic (ROC) curve. Then, we used a three-step process to determine the optimal EFD score cutoff using sensitivity and specificity analysis.ResultsOne hundred seventy-eight men had an average age at RP of 58 ± 7 years and a 24-month EFD score of 20 ± 9. Sixty-four percent had complete nerve-sparing surgery, 35% had partial nerve-sparing surgery, and 1% had the nerves fully resected. Thirty-three percent had laparoscopic RP and 67% had open RP. The ROC curves produced AUCs of 0.80 (ISD score = 10), 0.85 (ISD score ≥ 8), and 0.86 (ISD scores for satisfaction and enjoyment ≥ 4; P < .001 for all comparisons). Using the IS criterion of ISD scores for satisfaction and enjoyment of at least 4 (largest AUC), the sensitivity and specificity values were 0.89 and 0.66 for an ESD score equal to 22, 0.78 and 0.71 for a score equal to 23, 0.78 and 0.80 for a score equal to 24, 0.77 and 0.82 for a score equal to 25, and 0.73 and 0.85 for a score equal to 26. The scores of 24 and 25 met the criteria outlined in the first two steps of analysis. The score of 24 was selected as the cutoff using face valid judgment and the previous literature.ConclusionThese data support an EFD score of 24 as a valid cutoff defining “functional” erection in men with erectile dysfunction after RP. These data are important for clinicians in counseling patients and to researchers to define inclusion criteria and treatment end points for trials of erectile dysfunction after RP.Terrier JE, Muhall JP, Nelson CJ. Exploring the Optimal Erectile Function Domain Score Cutoff That Defines Sexual Satisfaction After Radical Prostatectomy. J Sex Med 2017;14:804–809.     

加强药物基因组学研究报告规范（STROPS）及解读

药物基因组学研究旨在探究遗传变异与药物的疗效和不良反应之间的关联,对样本量有很高的要求。为有效进行Meta分析以探究药物遗传关联,亟需提高药物基因组学研究报告质量。2020年制定的加强药物基因组学研究报告规范（Strengthening the Reporting of Pharmacogenetic Studies,...