Optimal diagnosis and treatment for renal allograft fibrosis / 器官移植

Renal allograft fibrosis is one of the common and severe complications after kidney transplantation, which seriously affects the function and survival rate of renal allograft, and may even lead to organ failure and patient death. At present, the researches on renal allograft fibrosis are highly complicated, including immunity, ischemia-reperfusion injury, infection and drug toxicity, etc. The diagnosis and treatment of renal allograft fibrosis remain extremely challenging. In this article, the latest research progress was reviewed and the causes, novel diagnosis and treatment strategies for renal allograft fibrosis were investigated. By improving diagnostic accuracy and optimizing treatment regimen, it is expected to enhance clinical prognosis of kidney transplant recipients, aiming to provide reference for clinicians to deliver proper management for kidney transplant recipients.

Value of bedside echocardiography in diagnosis and risk assessment of in-hospital death for patients with Stanford type A aortic dissection / 中华心血管病杂志

Objective@#To investigate the value of bedside echocardiography in diagnosis and risk assessment of in-hospital death of patients with Stanford type A aortic dissection.@*Methods@#The clinical data of 229 patients with Stanford type A aortic dissection diagnosed by CT angiography in Zhongshan Hospital affiliated to Fudan University between January 2009 and January 2016 were retrospectively analyzed. The patients were divided into survival group(191 cases)and non-survival group(38 cases)according to presence or absence of in-hospital death. The bedside echocardiography features were analyzed, and influence factors of in-hospital death were determined by multivariate logistic regression analysis.@*Results@#(1) Compared with the survival group, the non-survival group had lower surgery rate (60.52%(23/38) vs. 85.34%(163/191), P<0.01). Age, gender and Debakey classification were similar between survival group and death group (all P>0.05). (2) The bedside echocardiography results showed that prevalence of aortic valve involvement(65.79%(25/38) vs.34.03%(65/191), P<0.01) and severe aortic regurgitation (44.74%(17/38) vs. 14.14%(27/191), P<0.01) were significantly higher in non-survival group than in survival group. The non-survival group had larger aortic root diameter than the survival group ((55.5±6.4)mm vs. (42.3±7.8)mm, P<0.01). There were no significant differences in pericardial effusion, expansion of aortic sinus, and left ventricular ejection fraction between survival group and non-survival group (all P>0.05). (3) The multivariate logistic regression analysis showed that aortic valve involvement(OR=3.275, 95%CI 1.290-8.313, P<0.05), aortic root diameter(OR=1.202, 95%CI 1.134-1.275, P<0.01), and surgery (OR=0.224, 95%CI 0.079-0.629, P<0.01) were independent risk factors for in-hospital death in patients with Stanford type A aortic dissection.@*Conclusions@#Bedside echocardiography has significant diagnostic value for Stanford type A aortic dissection. Aortic valve involvement, enlargement of aortic root diameter and without surgery are independent risk factors for patients with Stanford type A aortic dissection.

Relationship between multi-slice spiral CT angiography imaging features and in-hospital death of patients with aortic dissection / 中华心血管病杂志

Objective@#To explore the imaging manifestations of multi-slice spiral CT angiography (CTA) and relationship with in-hospital death in patients with aortic dissection (AD).@*Methods@#The clinical data of 429 patients with AD who underwent CTA in Zhongshan Hospital of Fudan University between January 2009 and January 2016 were retrospectively analyzed. AD patients were divided into 2 groups, including operation group who underwent surgery or interventional therapy (370 cases) and non-operation group who underwent medical conservative treatment(59 cases). The multi-slice spiral CTA imaging features of AD were analyzed, and multivariate logistic regression analysis was used to investigate the relationship between imaging manifestations and in-hospital death in AD patients.@*Results@#There were 12 cases (3.24%) of in-hospital death in operation group, and 28 cases (47.46%) of in-hospital death in non-operation group(P<0.001). AD involved different vascular branches. Multi-slice spiral CTA can clearly show the dissection of true and false lumen, and intimal tear was detected in 363 (84.62%) cases, outer wall calcification was revealed in 63 (14.69%) cases, and thrombus formation was present in 227 (52.91%) cases. The multivariate logistic regression analysis showed that the number of branch vessels involved (OR=1.374, 95%CI 1.081-1.745, P=0.009) and tearing false lumen range(OR=2.059, 95%CI 1.252-3.385, P=0.004) were independent risk factors of in-hospital death in AD patients, and the number of branch vessels involved (OR=1.600, 95%CI 1.062-2.411, P=0.025) was independent risk factor of in-hospital death in the operation group, while the tearing false lumen range (OR=2.315, 95%CI 1.019-5.262, P=0.045) was independent risk factor of in-hospital death of non-operation group.@*Conclusions@#Multi-slice spiral CTA can clearly show the entire AD, true and false lumen, intimal tear, wall calcification and thrombosis of AD patients. The number of branch vessels involved and tearing false lumen range are the independent risk factors of in-hospital death in AD patients.

Application of support vector machines to classification of blood cells / 生物医学工程学杂志

The support vector machine (SVM) is a new learning technique based on the statistical learning theory. It was originally developed for two-class classification. In this paper, the SVM approach is extended to multi-class classification problems, a hierarchical SVM is applied to classify blood cells in different maturation stages from bone marrow. Based on stepwise decomposition, a hierarchical clustering method is presented to construct the architecture of the hierarchical (tree-like) SVM, then the optimal control parameters of SVM are determined by some criterion for each discriminant step. To verify the performances of classifiers, the SVM method is compared with three classical classifiers using 3-fold cross validation. The preliminary results indicate that the proposed method avoids the curse of dimensionality and has greater generalization. Thus, the method can improve the classification correctness for blood cells from bone marrow.

Study on automatic segmentation of color images applied to blood cells / 生物医学工程学杂志

A hybrid segmentation algorithm is proposed for automatic segmentation of blood cell images based on adaptive multi-scale thresholding and seeded region growing techniques. Firstly, an adaptive and scale space filter (ASSF) is applied to image histogram and a scale space image is built. According to the properties of the scale space image, proper thresholds can be obtained to separate the nucleus from the original image and the white blood cells are located. Secondly, the local color similarity and global morphological criteria constrain seeded region growing in order to finish the segmentation of the cytoplasm. The detection accuracy of white blood cell is 98% and the segmentation accuracy based on the subjective evaluation is 93%. Test shows that this algorithm is effective for automatic segmentation of white blood cells.