In recent years, the diagnosis and management technology of type B aortic dissection (TBAD) has developed rapidly worldwide along with evidence-based medicine practice and clinical research data. But the standard clinical criteria are still limited. Based on this, the Society of Thoracic Surgeons (STS) and the American Association for Thoracic Surgery (AATS) established an expert group dominated by aortic surgeons to collate and analyze the comprehensive literature data of acute and chronic, complicated and uncomplicated TBAD. And then, the group formulated and officially released the clinical practice guidelines for TBAD in 2022. In this paper, we interpreted and analyzed the main contents of the guideline in combination with domestic research, in order to provide reference and help for the clinical diagnosis and treatment of TBAD at the present stage in China.
Cardiovascular disease (CVD) is one of the leading causes of death worldwide. Heart sound classification plays a key role in the early detection of CVD. The difference between normal and abnormal heart sounds is not obvious. In this paper, in order to improve the accuracy of the heart sound classification model, we propose a heart sound feature extraction method based on bispectral analysis and combine it with convolutional neural network (CNN) to classify heart sounds. The model can effectively suppress Gaussian noise by using bispectral analysis and can effectively extract the features of heart sound signals without relying on the accurate segmentation of heart sound signals. At the same time, the model combines with the strong classification performance of convolutional neural network and finally achieves the accurate classification of heart sound. According to the experimental results, the proposed algorithm achieves 0.910, 0.884 and 0.940 in terms of accuracy, sensitivity and specificity under the same data and experimental conditions, respectively. Compared with other heart sound classification algorithms, the proposed algorithm shows a significant improvement and strong robustness and generalization ability, so it is expected to be applied to the auxiliary detection of congenital heart disease.
ObjectiveTo analyze the predictive value of ensemble classification algorithm of random forest for delirium risk in ICU patients with cardiothoracic surgery. MethodsA total of 360 patients hospitalized in cardiothoracic ICU of our hospital from June 2019 to December 2020 were retrospectively analyzed. There were 193 males and 167 females, aged 18-80 (56.45±9.33) years. The patients were divided into a delirium group and a control group according to whether delirium occurred during hospitalization or not. The clinical data of the two groups were compared, and the related factors affecting the occurrence of delirium in cardiothoracic ICU patients were predicted by the multivariate logistic regression analysis and the ensemble classification algorithm of random forest respectively, and the difference of the prediction efficiency between the two groups was compared.ResultsOf the included patients, 19 patients fell out, 165 patients developed ICU delirium and were enrolled into the delirium group, with an incidence of 48.39% in ICU, and the remaining 176 patients without ICU delirium were enrolled into the control group. There was no statistical significance in gender, educational level, or other general data between the two groups (P>0.05). But compared with the control group, the patients of the delirium group were older, length of hospital stay was longer, and acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, proportion of mechanical assisted ventilation, physical constraints, sedative drug use in the delirium group were higher (P<0.05). Multivariate logistic regression analysis showed that age (OR=1.162), length of hospital stay (OR=1.238), APACHEⅡ score (OR=1.057), mechanical ventilation (OR=1.329), physical constraints (OR=1.345) and sedative drug use (OR=1.630) were independent risk factors for delirium of cardiothoracic ICU patients. The variables in the random forest model for sorting, on top of important predictor variable were: age, length of hospital stay, APACHEⅡ score, mechanical ventilation, physical constraints and sedative drug use. The diagnostic efficiency of ensemble classification algorithm of random forest was obviously higher than that of multivariate logistic regression analysis. The area under receiver operating characteristic curve of ensemble classification algorithm of random forest was 0.87, and the one of multivariate logistic regression analysis model was 0.79.ConclusionThe ensemble classification algorithm of random forest is more effective in predicting the occurrence of delirium in cardiothoracic ICU patients, which can be popularized and applied in clinical practice and contribute to early identification and strengthening nursing of high-risk patients.
Objective To analyze the correlation between postoperative complications and combined deflection angle classification adduction type (CDAC-ADT) of femoral neck fractures after cannulated screw internal fixation. MethodsThe clinical data of 121 patients with CDAC-ADT femoral neck fracture admitted between January 2018 and December 2021 and met the selected criteria were retrospectively analyzed. There were 69 males and 52 females, the age ranged from 19 to 79 years (mean, 48.1 years). The causes of injury included 52 cases of traffic accident, 24 cases of falling from height, and 45 cases of fall. The time from injury to operation ranged from 2 to 12 days, with an average of 6.0 days. Among them, there were 18 cases of CDAC-ADT type Ⅰ, 46 cases of type Ⅱ, and 57 cases of type Ⅲ; 6 cases of Garden type Ⅱ, 103 cases of type Ⅲ, and 12 cases of type Ⅳ; and according to the location of the fracture line, there were 26 cases of subcapitate type, 88 cases of transcervical type, and 7 cases of basal type. All patients were treated with cannulated screw internal fixation. The occurrence of complications (including internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head) was recorded, and the correlation between complications and CDAC-ADT typing, Garden typing, and fracture line location were analyzed. Results The patients were followed up 8-44 months, with a mean of 24.9 months. There were 10 cases of internal fixation failure, 7 cases of fracture nonunion, and 30 cases of osteonecrosis of the femoral head after operation. Correlation analysis showed that patients’ CDAC-ADT typing was significantly correlated with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head (P<0.05), and the Pearson coefficient of contingency were 0.435, 0.251, 0.254, and 0.241, respectively. Garden typing did not correlate with the overall incidence of complication and the incidence of internal fixation failure and fracture nonunion (P>0.05), but correlated with the incidence of osteonecrosis of the femoral head (P<0.05), and the Pearson coefficient of contingency was 0.251. Fracture line position typing had no correlation with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head (P>0.05). Conclusion CDAC-ADT typing has obvious correlation with postoperative complications of femoral neck fracture and can be used to predict complications of femoral neck fracture.
ObjectiveTo evaluate the effectiveness of total hip arthroplasty (THA) combined with subtrochanteric osteotomy in the treatment of Crowe type Ⅳdevelopmental dysplasia of the hip (DDH).MethodsBetween April 2008 and June 2016, 71 patients with unilateral Crowe type Ⅳ DDH were treated with THA. Of 71 cases, 44 were performed with subtrochanteric osteotomy (osteotomy group) and 27 were performed without subtrochanteric osteotomy (non-osteotomy group). There was no significant difference in gender, age, body mass, height, body mass index, affected side, and preoperative Harris score between 2 groups (P>0.05). The complications were recorded and the effectiveness was assessed by Harris score. Besides, the femoral dislocation height and the settling depth of sleeve were measured in the pelvic anteroposterior X-ray film pre- and post-operatively.ResultsOsteotomy group was followed up 12-90 months (mean. 34.77 months), and non-osteotomy group was followed up 12-79 months (mean, 34.33 months). There was no significant difference in follow-up time between 2 groups (t=–0.088, P=0.930). There was 11 cases of intraoperative or postoperative complications in osteotomy group, and 3 cases of postoperative complications in non-osteotomy group. Among the osteotomy group, 1 case had nonunion due to infection and received revision after 20 months. No loosening or dislocation of the implant occurred in both 2 groups. Significant differences were found in femoral dislocation height and settling depth of sleeve between 2 groups (t=–8.452, P=0.000; t=6.783, P=0.000). Moreover, the osteotomy length was not correlated with the settling depth of sleeve (r=–0.038, P=0.806). At last follow-up, there was no significant difference in Harris score between 2 groups (t=–1.160, P=0.254).ConclusionTHA combined with subtrochanteric osteotomy can provide a favorable outcome for treating Crowe type Ⅳ DDH. Furthermore, patients with higher femoral dislocation and severely narrow femoral proximal canals are prone to be peformed with subtrochanteric osteotomy.
Objective To summarize a new type of proximal humerus fracture—proximal humerus degloving fracture, and discuss its injury mechanism, classification criteria, and treatment methods. Methods The clinical data of 23 patients with proximal humerus degloving fracture between September 2009 and September 2016 was retrospectively analyzed. There were 14 males and 9 females, with an average age of 39.7 years (range, 21-66 years). The causes of injury was sprain in 2 cases, falling from height in 8 cases, and traffic accident in 13 cases. The time from injury to operation was 3-116 days (mean, 17.1 days). There were 2 cases of posterior dislocation of humeral head, 3 cases of anterior dislocation of humeral head, 3 cases of other fractures, and 2 cases of brachial plexus injury. All patients had varying degrees of rotator cuff injuries. According to the self-determined fracture classification criteria, there were 6 cases of internal rotation type, 14 cases of external rotation type, and 3 cases of abduction type. All patients underwent open reduction and internal fixation. Results All patients were followed up 9-24 months (mean, 17 months). All incisions healed by the first intention. X-ray films showed that all fractures healed at 3-5 months after operation (mean, 3.6 months). According to the Neer’s shoulder functional evaluation criteria at 6 months, the shoulder function was rated as excellent in 16 cases, good in 5 cases, fair in 1 case, and poor in 1 case, and the excellent and good rate was 84.6%. The rotator cuff tear recurred in 1 case and was repaired again. Conclusion The injury mechanism of proximal humerus degloving fracture may be the extreme internal rotation, extreme external rotation, or extreme abduction. Reduction and internal fixation is an effective treatment. The focus of the treatment is not only the fixation of the fracture, but also the repair and reconstruction of the rotator cuff.
OBJECTIVE: To investigate the characteristics and the pathologic classification of electrical-injury nerve using somatosensory evoked potential(SEP) technique. METHODS: SEP were detected and evaluated in 12 cases with electrical-injury nerve during operation, electrical stimulation was commenced from distal side of nerve where the structure of nerve looks normal under operating microscope, up to proximal side until evoking out a stable SEP predeterminate virtual value. Pathological examination and the following functional evaluation were compared with the values of SEP. RESULTS: At the site of nerve looking normal under operating microscope, perineurium appears normal or slightly thicken. But there are obvious fibrosis and fibrotic proliferation between fascicular and intrafascicular. Vessel plexus is not seen. At SEP stabilizely evoked site, nervous construction is normal, there are visible interfascicular vessel plexus and connective tissue appears loose. Comparing SEP values with pathological section, amplitude and latency of SEP is positively correlative with the quality of nerve. Eight cases repaired with SEP technique to select the anastomosis site for nerve transplantation were followed up, two-point discrimination reached grade III (America hand surgery association criterion) within 62.5% cases. CONCLUSION: SEP technique is valuable method for functional evaluation of electrical- injury nerve which has a complicated pathology. The pathology of electrical-injury nerve can be classified into 4 types, type A: fibrosis of nerve; type B: nerve looking normal under operation microscope, perineurium appears thicken, and there are obvious fibrosis and fibrotic proliferation between fascicular and intrafascicular, vessel plexus is rarely to see; type C: nerve looks normal, lymphocyte infiltration exists and it is obvious that there are many physalis-like, retrogressive construction in the section; type D: nervous construction is normal, there are visible interfascicular vessel plexus, and connective tissue appears loose, SEP always can be stably evoked.
Objective Based on the PSQ-18 scale, to evaluate the effects of disease classification early warning system (DCEWS) on operation quality of health examination center (HEC). Methods By means of the comparable and retrospective cohort study methods, using “PSQ-18” of American Rand Corporation as a tool, taking the date when HEC implemented DCEWS as node, and adopting statistic software for random sampling, it was divided into two groups: the traditional group (before implementing DCEWS, n=475) and the early warning group (after implementing DCEWS, n=473). The PSQ-18 scale scores of both groups were analyzed so as to assess the effects of DCEWS on HEC. Results Such factors as sex, age, education level and family average monthly income had certain effects on the score of PSQ-18, but there was no significant difference between the two groups (Pgt;0.05); in the following 4 dimensions as the ways of interpersonal communication, degree of doctor-patient communication, convenience degree and the overall satisfaction of patients, the PSQ-18 scores of the traditional group and the early warning group were 4.0±0.92/4.2±0.97, 3.8±0.94/4.0±0.96, 4.4±0.60/4.6±0.6, 4.2±0.87/4.4±0.94, respectively, with significant differences (all Plt;0.05). Conclusion The implementation of “Disease classification early waning system” can significantly increase the “patient satisfaction” of health examinees, and can significantly improve the operation quality of health examination center.
Sleep stage scoring is a hotspot in the field of medicine and neuroscience. Visual inspection of sleep is laborious and the results may be subjective to different clinicians. Automatic sleep stage classification algorithm can be used to reduce the manual workload. However, there are still limitations when it encounters complicated and changeable clinical cases. The purpose of this paper is to develop an automatic sleep staging algorithm based on the characteristics of actual sleep data. In the proposed improved K-means clustering algorithm, points were selected as the initial centers by using a concept of density to avoid the randomness of the original K-means algorithm. Meanwhile, the cluster centers were updated according to the 'Three-Sigma Rule' during the iteration to abate the influence of the outliers. The proposed method was tested and analyzed on the overnight sleep data of the healthy persons and patients with sleep disorders after continuous positive airway pressure (CPAP) treatment. The automatic sleep stage classification results were compared with the visual inspection by qualified clinicians and the averaged accuracy reached 76%. With the analysis of morphological diversity of sleep data, it was proved that the proposed improved K-means algorithm was feasible and valid for clinical practice.
Stem cells belong to a subgroup of undifferentiated cells in organisms, which has the features of proliferation, self maintaining, and self renewal, and may produce plentiful filial generation with functions. According to the researches on embryonic stem cells, retinal stem cells in adults, and intraocular tumor stem cells, stems cells exist in human embryo, adult retina, and also intraocular tumors like retinoblastoma and choroidal melanoma. Different stem cells transplanted into subretinal interspace or vitreous cavity may differentiate into structure of neurone or retina. Stem cells may become a newest target of the researches on pathogenesis and treatment of diseases. (Chin J Ocul Fundus Dis, 2007, 23: 83-86)