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@#AIM: To study the precise segmentation of pterygium lesions using the convolutional neural networks from artificial intelligence.<p>METHODS: The network structure of Phase-fusion PSPNet for the segmentation of pterygium lesions is proposed based on the PSPNet model structure. In our network, the up-sampling module is connected behind the pyramid pooling module, which gradually increase the sampling based on the principle of phased increase. Therefore, the information loss is reduced, it is suitable for segmentation tasks with fuzzy edges. The experiments conducted on the dataset provided by the Affiliated Eye Hospital of Nanjing Medical University, which includes 517 ocular surface photographic images of pterygium were divided into training set(330 images), validation set(37 images)and test set(150 images), which the training set and the validation set images are used for training, and the test set images are only used for testing. Comparing results of intelligent segmentation and expert annotation of pterygium lesions.<p>RESULTS: Phase-fusion PSPNet network structure for pterygium mean intersection over union(MIOU)and mean average precision(MPA)were 86.31% and 91.91%, respectively, and pterygium intersection over union(IOU)and average precision(PA)were 77.64% and 86.10%, respectively.<p>CONCLUSION: Convolutional neural networks can segment pterygium lesions with high precision, which is helpful to provide an important reference for doctors' further diagnosis of disease and surgical recommendations, and can also visualize the pterygium intelligent diagnosis.
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@#AIM: To study the precise segmentation of pterygium lesions using the convolutional neural networks from artificial intelligence.<p>METHODS: The network structure of Phase-fusion PSPNet for the segmentation of pterygium lesions is proposed based on the PSPNet model structure. In our network, the up-sampling module is connected behind the pyramid pooling module, which gradually increase the sampling based on the principle of phased increase. Therefore, the information loss is reduced, it is suitable for segmentation tasks with fuzzy edges. The experiments conducted on the dataset provided by the Affiliated Eye Hospital of Nanjing Medical University, which includes 517 ocular surface photographic images of pterygium were divided into training set(330 images), validation set(37 images)and test set(150 images), which the training set and the validation set images are used for training, and the test set images are only used for testing. Comparing results of intelligent segmentation and expert annotation of pterygium lesions.<p>RESULTS: Phase-fusion PSPNet network structure for pterygium mean intersection over union(MIOU)and mean average precision(MPA)were 86.31% and 91.91%, respectively, and pterygium intersection over union(IOU)and average precision(PA)were 77.64% and 86.10%, respectively.<p>CONCLUSION: Convolutional neural networks can segment pterygium lesions with high precision, which is helpful to provide an important reference for doctors' further diagnosis of disease and surgical recommendations, and can also visualize the pterygium intelligent diagnosis.
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Objective: Robot-assisted radical prostatectomy (RARP) requires pneumoperitoneum (Pnp) and a steep head-down position that may disturb respiratory system compliance (Crs) during surgery. Our aim was to compare the effects of different degrees of neuromuscular block (NMB) on Crs with the same Pnp pressure during RARP. Methods: One hundred patients who underwent RARP were enrolled and randomly allocated to a deep or moderate NMB group with 50 patients in each group. Rocuronium was administered to both groups: in the moderate NMB group to maintain 1–2 responses to train-of-four (TOF) stimulation; and in the deep NMB group to maintain no response to TOF stimulation and 1–2 responses in the post-tetanic count. Pnp pressure in both groups was 10 mmHg (1 mmHg=133.3 Pa). Peak inspiratory pressure (Ppeak), mean pressure (Pmean), Crs, and airway resistance (Raw) were recorded after anesthesia induction and at 0, 30, 60, and 90 min of Pnp and post-Pnp. Surgical space conditions were evaluated after the procedure on a 4-point scale. Results: Immediately after the Pnp, Ppeak, Pmean, and Raw significantly increased, while Crs decreased and persisted during Pnp in both groups. The results did not significantly differ between the two groups at any of the time points. There was no difference in surgical space conditions between groups. Body movements occurred in 14 cases in the moderate NMB group and in one case in the deep NMB group, and all occurred during obturator lymphadenectomy. A significant difference between the two groups was observed. Conclusions: Under the same Pnp pressure in RARP, deep and moderate NMBs resulted in similar changes in Crs, and in other respiratory mechanics and surgical space conditions. However, deep NMB significantly reduced body movements during surgery.
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There are differences in individual cardiovascular responses to the administration of dexmedetomidine, a highly selective α2A-adrenergic receptor (ADRA2A) agonist. The aim of this study was to investigate ADRA2A gene polymorphisms in the Chinese Han population and their association with the cardiovascular response to intravenous dexmedetomidine infusion. Sixty elective surgery patients of Chinese Han nationality were administered 1 µg/kg dexmedetomidine intravenously over 10 min as a premedication. ADRA2A C-1291G and A1780G polymorphism status was determined in these patients, and their relationships to changes in blood pressure and heart rate after dexmedetomidine administration were analyzed. There were neither significant differences in systolic or diastolic blood pressure changes in individuals with different A1780G and C-1291G genotypes after dexmedetomidine administration, nor in heart rates among the different A1780G genotypes. However, there were significant differences in changes in heart rates in patients with different C-1291G genotypes. There were no significant differences in the sedative effects of dexmedetomidine among different A1780G and C-1291G genotypes. Logistic regression revealed that the C-1291G polymorphism was associated with differential decreases in heart rate after intravenous infusion of dexmedetomidine. These findings indicate that the ADRA2A C-1291G polymorphism can affect heart rate changes in patients after intravenous infusion of dexmedetomidine.
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There are differences in individual cardiovascular responses to the administration of dexmedetomidine, a highly selective α-adrenergic receptor (ADRA2A) agonist. The aim of this study was to investigate ADRA2A gene polymorphisms in the Chinese Han population and their association with the cardiovascular response to intravenous dexmedetomidine infusion. Sixty elective surgery patients of Chinese Han nationality were administered 1 µg/kg dexmedetomidine intravenously over 10 min as a premedication. ADRA2A C-1291G and A1780G polymorphism status was determined in these patients, and their relationships to changes in blood pressure and heart rate after dexmedetomidine administration were analyzed. There were neither significant differences in systolic or diastolic blood pressure changes in individuals with different A1780G and C-1291G genotypes after dexmedetomidine administration, nor in heart rates among the different A1780G genotypes. However, there were significant differences in changes in heart rates in patients with different C-1291G genotypes. There were no significant differences in the sedative effects of dexmedetomidine among different A1780G and C-1291G genotypes. Logistic regression revealed that the C-1291G polymorphism was associated with differential decreases in heart rate after intravenous infusion of dexmedetomidine. These findings indicate that the ADRA2A C-1291G polymorphism can affect heart rate changes in patients after intravenous infusion of dexmedetomidine.
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·AIM: To evaluate a deep learning - assisted diagnostic system with an artificial intelligence for the detection of diabetic retinopathy (DR). ·METHODS:A total of 186 patients (372 eyes) with diabetes were recruited from January to July 2017. Discrepancies between manual grades and artificial intelligence results were sent to a reading center for arbitration. The sensitivity and specificity in the detection of DR were determined by comparison with artificial intelligence diagnostic system and experts human grading. ·RESULTS:Based on manual grades, the results as follows:non DR (NDR) in 42 eyes (11.3%), 330 eyes (88.7%) in different stages of DR. Among 330 DR eyes, there were mild non proliferative DR (NPDR) in 62 eyes (16.7%), moderate NPDR in 55 eyes (14.8%), severe NPDR in 155 eyes (41.7%), and proliferative DR (PDR) in 58 eyes (15. 6%). Based on artificial intelligence diagnostic system, the results were as follows: NDR in 38 eyes (10.2%),PDR in 44 eyes (11.8%), others were NPDR. The sensitivity and specificity of artificial intelligence diagnostic system, compared with human expert grading, for the detection of any DR were 0.82 and 0.91, and the kappa value was 0.77 (x2=20.39, P<0.05). ·CONCLUSION:This study shows that a deep learning-assisted diagnostic system with an artificial intelligence for grading diabetic retinopathy is a reliable alternative to diabetic retinopathy assessment, thus the use of this system may be a valuable tool in evaluating the DR.
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<p><b>OBJECTIVE</b>To explore the effect of Ginkgo biloba extract (GBE) on the function of alveolar polymorphonuclear neutrophils (PMN) in severe acute pancreatitis (SAP) rats complicated with lung injury (LI).</p><p><b>METHODS</b>Forty-eight adult SD rats were randomly divided into three groups, i.e., the sham-operation group, the SAP group, and the GBE treatment group, 16 in each group. The SAP model was successfully induced by retrograde injection of 5% sodium taurocholate solution into the biliopancreatic duct. Rats in the sham-operation group only received flipping of the duodenum. Those in the GBE treatment group received GBE intervention based on SAP model. Equal volume of normal saline was given to rats in the sham-operation group and the SAP group. Rats were sacrificed at 6 and 12 h after operation respectively. The lung tissue was sampled to evaluate the LI score. The wet/dry ratio (W/D) of lung tissues was detected. The activity of myeloperoxidase (MPO) was measured. Alveolar PMN was harvested by bronchoalveolar lavage. The content of neutrophil elastase (NE) in bronchoalveolar lavage fluid (BALF) was measured by enzyme-linked immunoabsorbent assay (ELISA). The percentage of CD11b/CD18 double positive PMN was detected using flow cytometry. The expression of intercellular adhesion molecule-1 (ICAM-1) and NE protein in the lung tissue was detected by Western blot.</p><p><b>RESULTS</b>Compared with the sham-operation group, significant pathologic lesion occurred in the lung tissue of rats in the SAP group; the pathologic LI score, lung tissue W/D ratio, MPO, and NE content in BALF significantly increased, the expression of ICAM-1 and NE in the lung tissue was obviously up-regulated, and the percentage of CD11b/CD18 double positive PMN significantly increased (P < 0.01). Compared with the SAP group, pathological lesion of the lung tissue was obviously attenuated, and the above indices were all significantly declined in the GBE treatment group (P < 0.01).</p><p><b>CONCLUSIONS</b>Expression of ICAM-1 in the lung tissue and the percentage of D11b/ CD18 double positive PMN were up-regulated in SAP rats complicated with LI, resulting in the adherence of PMN to pulmonary vascular endothelial cells, and then activating PMN to release NE and aggravate LI. GBE could alleviate LI through down-regulating the expression ICAM-1 and CD11b/CD18, and hindering the adherence and activation of PMN to pulmonary vascular endothelial cells.</p>
Subject(s)
Animals , Rats , Bronchoalveolar Lavage Fluid , Cell Biology , Ginkgo biloba , Chemistry , Intercellular Adhesion Molecule-1 , Metabolism , Lung Injury , Drug Therapy , Metabolism , Neutrophils , Metabolism , Pancreatic Elastase , Metabolism , Pancreatitis , Drug Therapy , Metabolism , Plant Extracts , Pharmacology , Rats, Sprague-DawleyABSTRACT
<p><b>OBJECTIVE</b>To investigate the neoplastic nature of fibrous dysplasia by molecular clonality approaches.</p><p><b>METHODS</b>Twenty-one cases of fibrous dysplasia were examined by clonality assays based on X-chromosomal inactivation mosiacism. Lesional and non-lesional tissues were microdissected from paraffin sections followed by DNA extraction. The DNA was predigested by HpaII or HhaI, and then amplified by nested PCR targeting phosphoglycerate kinase (PGK) and androgen receptor (AR) genes. Single nucleotide polymorphism (SNP) at the PGK locus was identified by incubation of the PCR products with Bst XI and agarose gel electrophoresis, and CAG repeat length polymorphism at AR locus was determined by denaturing polyacrylamide gel electrophoresis and visualized by silver staining.</p><p><b>RESULTS</b>Microscopically, all 21 cases showed characteristic features of fibrous dysplasia, including spindle fibrous cell proliferation and immature bone trabeculae at various proportions. DNA polymorphisms at AR locus and SNP of PGK gene were found in 15 of 21, and 4 of 21 cases, respectively. All 19 cases were monoclonal in nature. Two cases showed no polymorphism at either AR or PGK gene locus.</p><p><b>CONCLUSIONS</b>Fibrous dysplasia is likely a clonal, neoplastic process. Additional studies of larger number of cases are needed for a definitive conclusion.</p>
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Middle Aged , Young Adult , Chromosomes, Human, X , Fibrous Dysplasia of Bone , Genetics , Pathology , Phosphoglycerate Kinase , Genetics , Polymorphism, Genetic , Receptors, Androgen , GeneticsABSTRACT
Two case reports of emergent anesthesia of critical tracheal stenosis are presented. The use of extracorporeal circulation may be a lifesaving method for these patients. Two patients both with severe lower tracheal stenosis were admitted with severe inspiratory dyspnea. The first patient had a tracheal tube inserted above the stenosis in the operating room, but ventilation was unsatisfactory, high airway pressure and severe hypercarbia developed, therefore extracorporeal circulation was immediately initiated. For the second patient, we established femoral-femoral cardiopulmonary bypass prior to induction of anaesthesia, and intubated above the tracheal tumor orally under general anesthesia, then adjusted the endotracheal tube to appropriate depth after the tumor had been resected. The patient was gradually weaned from cardiopulmonary bypass. The two patients all recovered very well after surgery. Surgery is lifesaving for patients with critical tracheal stenosis, but how to ensure effective gas exchange is crucial to the anesthetic management. Extracorporeal circulation by the femoral artery and femoral vein cannulation can gain good gas exchange even if the trachea is totally obstructed. Therefore, before the induction of anesthesia, we should assess the site and degree of obstruction carefully and set up cardiopulmonary bypass to avoid exposing the patient to unexpected risks and the anesthesiologist to unexpected challenges.
Subject(s)
Adult , Humans , Male , Anesthesia, General , Methods , Emergencies , Extracorporeal Circulation , Pulmonary Gas Exchange , Tracheal Stenosis , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To observe the relationship between skewed X-chromosomal inactivation (SXCI) and development of lung cancer in females.</p><p><b>METHODS</b>DNA was isolated from peripheral blood cells from patients with primary lung cancer (n = 148) and control subjects (n =289). Exon 1 of androgen receptor ( AR) gene was amplified, with its products from different alleles resolved on denaturing polyacrylamide gels and visualized by silver staining. The corrected ratio (CR) between products from different AR alleles before and after Hpa II pretreatment was calculated. All statistical tests were two-sided.</p><p><b>RESULTS</b>With CR> or = 10 adopted as the criterion, SXCI was found more frequently in the younger patients ( C50 years; 7. 9%) than in the controls of the same age group (1. 2% ; P = 0. 046). The SXCI frequency, however, were not significantly different between the old patients ( > 50 years; 4. 5% ) and the controls of the same age group (5. 4% ; P =0. 488). Whether taking CR> or =3 or CR> or =10 as the criteria, the average ages of the patients with SXCI were more than 10 years younger than those without SXCI (P < 0. 05).</p><p><b>CONCLUSION</b>SXCI in blood cells is associated with early development of lung cancer in females.</p>