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Objective:To construct three image recognition models of manikin′s glottis using visual laryngoscopy based on deep-learning algorithm.Methods:The tracheal intubation manikin′s epiglottis was visualized using a videolaryngoscope, and then epiglottis was elevated to expose the glottis and acquire glottic images. A total of 149 images were obtained from various angles and orientations and randomly divided into training set and test set, and the annotation of image data was completed. Three glottal image recognition models of CenterNet, YOLOv3 and YOLOv4 were developed. The training set was used to complete the training of the models, and finally the test set was used to evaluate the model performance.Results:CenterNet, YOLOv3 and YOLOv4 three models were successfully constructed, the mean average precision of CenterNet, YOLOv3 and YOLOv4 was 92.33%, 89.52% and 89.02% respectively, the recall rates were 87.50%, 90.00% and 90.00% respectively, the precision rates reached 97.22%, 94.74% and 94.74% respectively, and the accuracy rates were 90.91%, 85.11% and 88.89% respectively. All three algorithms demonstrated an identical F1 score of 91.00%.Conclusions:The CenterNet, YOLOv3 and YOLOv4 models are successfully constructed, and three recognition models can accurately identify the glottis in the image, with the CenterNet model demonstrating the highest recognition precision.
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Purpose@#This study explored the performance of prenatal ultrasonography in the differential diagnosis of cystic biliary atresia (CBA) and choledochal cyst (CC). @*Methods@#Fetuses diagnosed with hepatic hilar cyst in the second trimester were included in this study. A series of prenatal ultrasound examinations were performed in the second and third trimesters. The diameter of the gallbladder (GB) and hepatic cyst were measured, as well as the wall thickness of the GB. The GB-cyst connection, visibility of the right hepatic artery (RHA), and other concomitant abnormalities were carefully evaluated. A neonatal transabdominal ultrasound examination was performed within 1 week after birth, and clinical data were followed up to 6 months after birth. @*Results@#Between January 1, 2016 and January 31, 2020, 53 fetuses diagnosed with hepatic hilar cyst were recruited. Eight were excluded because they were lost to follow-up. Among the 45 cases included in this study, 10 were diagnosed with CBA and 35 with CC after birth. Statistically significant differences were found in GB width, wall thickness, change in GB width, change in cyst length, GB-cyst connection, and RHA visibility between the CBA and CC groups. GB width showed the best diagnostic performance with an area under the curve (AUC) of 0.899. The combination of GB width, GB wall thickness, and GB-cyst connection yielded a comparable AUC of 0.971. @*Conclusion@#The GB should be carefully evaluated in fetuses with hepatic hilar cyst. Prenatal ultrasound findings could provide suggestive parameters for the differential diagnosis of CBA from CC.
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Objective:To analyze KCNJ5 mutation of adenomas in patients with aldosterone-producing adenoma (APA) companying with hypokalemia, and to compare the clinical characteristics of patients with and without KCNJ 5 mutations.Methods:Clinical data of 144 APA patients were retrospectively analyzed. DNA were extracted from adenoma tissues, and amplified and sequenced for KCNJ5 gene. The serum potassium level and cardiac complications in patients with and without KCNJ5 gene mutation were compared.Results:Among 144 tumors, 131 tumors (91%) had KCNJ5 mutation, including 68 tumors with G151R, 56 tumors with L168R, 5 tumors with E145Q, and two tumors with novel mutations, V156_K160delITE and G151delinsVR. Compared with patients without KCNJ5 mutation, patients with KCNJ5 mutation had lower preoperative serum potassium levels, more cardiac complications, lower postoperative systolic blood pressure, and better postoperative hypertension relief. There were no statistical differences in age, gender, blood pressure, serum potassium level, plasma renin activity or plasma aldosterone concertration.Conclusion:91% adenomas in patients with APA and hypokalemia had KCNJ5 mutation, suggesting that KCNJ5 mutation is the main cause in these patients.
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Objective:To investigate the value of superb micro-vascular imaging (SMI) in evaluating carotid neovascularization in patients with Takayasu arteritis (TA).Methods:SMI was used to analyze the wall thickness and neovascularization in a total of 38 common carotid arteries in 23 patients with TA diagnosed in Shengjing Hospital of China Medical University, and the results were compared with contrast-enhanced ultrasound (CEUS).Results:SMI could clearly show the thickening wall of the common carotid artery in TA patients, and could show very tiny blood flow channels in the thickening wall. Neovascularization was detected in a total of 34 common carotid arteries by SMI, 23 of which showed 1 point of score with scattered low-velocity blood flow and the rest of which showed 2 points of score with diffused spots or strips with low-velocity blood flow. Correspondingly, neovascularization was detected in a total of 34 common carotid artery by CEUS, 22 of which showed 1 point of score and the rest of which showed 2 points of score. The scores of the two groups were consistent ( Kappa=0.641, P<0.01). Conclusions:SMI can be used as one of the important screening methods for neovascularization assessment in thickened carotid wall in patients with TA, which shows potential application value in the diagnosis, treatment and follow-up for TA patients.
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Objective@#To explore the mechanism and influencing factors of mirror-image artifact of color blood flow (MACBF) due to longitudinal strong echo big interface (LSEBI).@*Methods@#Fifty suspicious patients with MACBF beside the main pulmonary artery and/or the left pulmonary artery undergoing echocardiography examination from November 2018 to April 2019 in Shengjing Hospital of China Medical University were chosen as the subjects. Image characteristics of the MACBF were observed, and mechanism and influence factors of the MACBF were explored with Doppler imaging principle.@*Results@#Of all the subjects with MACBF, 36 subjects occurred only on the left side of the main pulmonary artery, 14 subjects occurred on both the left side of the main pulmonary artery and the left pulmonary artery. The LSEBI was found between the real color blood flow (RCBF) and the MACBF, there was a mirror relationship between the RCBF and the MACBF. The LSEBI on the left of the main pulmonary artery and the left pulmonary artery were the interface of the left lung and pleural. The signal strength of MACBF enhanced as the distance between the blood flow and the LSEBI got closer or the gain of the color blood flow got bigger.@*Conclusions@#MACBF may caused by LSEBI beside vessel. The formation of MACBF and its signal strength are influenced by the distance between blood flow and LSEBI and the gain of the color blood flow.
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Objective To explore the mechanism and influencing factors of mirror-image artifact of color blood flow (MACBF) due to longitudinal strong echo big interface (LSEBI).Methods Fifty suspicious patients with MACBF beside the main pulmonary artery and/or the left pulmonary artery undergoing echocardiography examination from November 2018 to April 2019 in Shengjing Hospital of China Medical University were chosen as the subj ects.Image characteristics of the MACBF were observed, and mechanism and influence factors of the MACBF were explored with Doppler imaging principle.Results Of all the subjects with MACBF,36 subjects occurred only on the left side of the main pulmonary artery,14 subj ects occurred on both the left side of the main pulmonary artery and the left pulmonary artery.The LSEBI was found between the real color blood flow (RCBF) and the MACBF,there was a mirror relationship between the RCBF and the MACBF.The LSEBI on the left of the main pulmonary artery and the left pulmonary artery were the interface of the left lung and pleural.The signal strength of MACBF enhanced as the distance between the blood flow and the LSEBI got closer or the gain of the color blood flow got bigger.Conclusions MACBF may caused by LSEBI beside vessel.The formation of MACBF and its signal strength are influenced by the distance between blood flow and LSEBI and the gain of the color blood flow.
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Lung cancer is one of the most common cancers in the world,which seriously affects people's physical and mental health.About 85％ of them are non-small cell lung cancers.In recent years,with the rapid development of low-dose computed tomography,Da Vinci robotic surgery and targeted therapy,the therapeutic effect of lung cancer has been greatly improved.However,due to the lack of early diagnosis of biomarkers,therapeutic targets and signs of prognosis,most patients have metastases when they are at the time of treatment.Lung cancer remains the leading cause of cancer-related death.CircRNA is a special endogenous non coding RNA,which is formed by the reverse splicing of the 3'splice donor site and the 5'splice acceptor site to form a covalent closed loop.It is highly conservative and stable.The expression level of circRNA in non-small cell lung cancer is obviously abnormal,which is closely related to the occurrence,development and metastasis of non-small cell lung cancer.It is expected to become an ideal biomarker,which is used for early diagnosis of non-small cell lung cancer,and provides new therapeutic targets and prognostic markers.
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Objective To investigate the diagnostic value of splenic elasticity measured with real-time shear wave elastography (SWE) in liver cirrhosis patients with portal hypertension.Methods Totally 64 cirrhotic patients with portal hypertension (PH group) and 62 liver cirrhosis patients without portal hypertension (control group) were enrolled.The elasticity,the thickness and the length of the spleen of both groups were compared.The areas under the ROC curve (AUC) of the SWE elasticity,the thickness and the length of the spleen were compared with a DeLong test.The optimal cutoff value of SWE elasticity was obtained,and the sensitivity and specificity were calculated,respectively.Results The differences of the SWE elasticity,the thickness and the length of the spleen between the two groups were statistically significant (all P＜0.001).AUC of SWE elasticity,thickness and length of the spleen was 0.979 (95％ CI[0.944,0.989]),0.917 (95％CI [0.854,0.926] and 0.865 (95％CI [0.775,0.928]),respectively.The differences between each two parameters were statistically significant (all P＜0.05).The optimal cutoff value of the spleen SWE elasticity was 19.98 kPa,the sensitivity and the specificity was 95.78％ and 94.27％,respectively.Conclusion The diagnostic efficacy of spleen SWE elasticity was higher than that of spleen thickness and spleen length,therefore having better diagnostic value for liver cirrhosis patients with portal hypertension.
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In recent years,the incidence of lung cancer,high mortality,become one of the main diseases that threaten human health and life.Preoperative staging of non-small cell lung cancer,especially mediastinal lymph node staging is the key to determine whether surgery and judge tne prognosis of patients.Therefore,how to achieve accurate staging of mediastinal lymph node before surgery is a clinical problem to be solved urgently.The traditional methods of preoperative staging of mediastinal lymph nodes include imaging,minimally invasive biopsy and surgery.In recent years,the development of relevant serum tumor markers,serum miRNAs and clinical prediction models provide some new references for the preoperative diagnosis and assessment of mediastinal lymph node metastasis.This paper reviews the methods of preoperative diagnosis of mediastinal lymph node metastasis of non-small cell lung cancer in recent years,and summarizes and analyzes the advantages and disadvantages of various methods.
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As a pioneering technology, 3D printing technology has good application prospects in the medical field. In thoracic surgery, 3D printing technology has been used clinically for preoperative evaluation, surgical design, disease treatment, etc. Some 3D printed tissue and organ replacements have been gradually applied in thoracic surgery. The current application status of 3D printing technology in the field of thoracic surgery was reviewed, and the existing problems and prospects of this technology were discussed.
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Objective To investigate the function of carotid artery elasticity,radial strain (RS),and radial strain rate (RSR) in pregnancyinduced hypertension (PIH),and to conduct a comparative study with healthy pregnant women by using the arterial analysis technique.Methods Twenty-eight women with PIH were included,and 30 age-and gestational age-matched normal pregnant women were included as the control group.The arterial analysis technique was performed to trace the movement of the carotid artery and obtain RS and RSR values automatically for statistical analysis.Results In the PIH group,stiffness parameter β3 and pulse-wave velocity were significantly higher than those in the normal pregnancy group.Arterial compliance,RS,and RSR were lower,with significant differences (P ＜ 0.05).The differences in augmentation index were insignificant.Pulse-wave velocity was negatively related with RS.Conclusion These sensitive parameters could potentially be applied for early evaluation of vascular structure,and RS is more sensitive than RSR.By using the arterial analysis technique,early detection of decreased artery elasticity function is possible before blood vessel structural impairment.
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Objective:To explore the application of fetal multi-organ hemodynamics in the detection and evaluation of oxygen supply and blood supply for fetus in the third trimester of pregnancy. Methods: 42 pregnant women with gestational diabetes mellitus and 42 healthy pregnant women were divided into observation group and control group, respectively. All of the fetuses of pregnant women received Doppler ultrasound examination, and the pulsatility index(PI), resistance index(RI) and systolic/diastolic(S/D) ratio of umbilical artery (UA)and middle cerebral artery (MCA) of every fetus in the two groups were observed. Besides, the number of fetal distress was recorded and the relationship between fetal distress rate and gestational diabetes mellitus were calculated.Results:The PI, RI and S/D of MCA of fetuses of pregnant women with gestational diabetes mellitus was significantly higher than that of healthy pregnant women (t=7.52,t=6.04, t=8.69,P<0.05). And the PI, RI and S/D of UA of fetuses of pregnant women with gestational diabetes mellitus also was significantly higher than that of health pregnant women (t=11.95,t=9.78,t=8.95, P<0.05). Besides, the fetal distress rate of observation group was significantly higher than that of control group (x2=19.56,P<0.05).Conclusion: The fetal blood flow information which obtained from Doppler ultrasound has very importantly value in the diagnosis of gestational diabetes mellitus, and it verifies the relationship between fetal distress rate and gestational diabetes mellitus. It provides beneficial basis for the prevention and treatment of the gestational diabetes mellitus in the clinical practice.
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Hepatocellular carcinoma (HCC) is a malignant tumor with high incidence and mortality rates around the world.Radiofrequency ablation (RFA) is an effective therapy for HCC,especially in patients who experience recurrence after surgery for liver cancer,who are complicated by liver dysfunction and unable to undergo surgical resection,and who have multiple liver tumors and undergo palliative treatment.RFA can significantly improve patients' survival time and quality of life.This article reviews the mechanism of RFA in the treatment of HCC from the aspects of direct and indirect injuries and helps to further understand the role of RFA in local and systemic treatment of HCC,which has a potential value for multidisciplinary treatment of HCC in future.
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AIM:To explore the improving effect of osteocalcin on obesity-related insulin resistance and in-flammation in the adipose tissue of obese mice .METHODS:The C57BL/6 mice were fed with high-fat diet for 12 weeks to obtain obese mice.Osteocalcin (30 ng/kg or 3 ng/kg) and saline solution (control) were intraperitoneally injected for other 4 weeks.The fat mass, body weight, serum triglycerides and serum free fatty acid were analyzed .Intraperitoneal glu-cose tolerance test and insulin tolerance test were carried out .Macrophage infiltration degree in the adipose tissue was ob-served by immunohistochemical staining .The mRNA expression of monocyte chemotactic protein-1 ( MCP-1 ) and CD68 was detected by real-time fluorescence quantitative PCR .RESULTS:Osteocalcin (30 ng/kg or 3 ng/kg) treatment for 4 weeks significantly reduced the body weight , fat mass and insulin level , and improved abnormal glucose tolerance and insu-lin resistance in the obese mice .Moreover, the macrophage infiltration decreased , and the mRNA expression of MCP-1 and CD68 was down-regulated in the adipose tissue of obese mice treated with osteocalcin at 30 ng/kg.CONCLUSION:Os-teocalcin at 30 ng/kg significantly reduces body weight and fat mass , and attenuates the severity of insulin resistance through down-regulating the mRNA expression of MCP-1 and CD68 and inbihiting macrophage infiltration in the adipose tis-sue of obese mice induced by high-fat diet.
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Objective To assess left atrial reservoir function based on left atrial filling volume,the left atrial expansion index and left atrial ejection fraction (LAEF) were measured in patients with left ventricular non-compaction cardiomyopathy (LVNC),using real-time three-dimensional echocardiography (RT3DE),to determine the value for LVNC diagnosis.Methods The study included 20 patients diagnosed with LVNC,including 3 patients,aged 4-16 years;8 patients,aged 17-35 years;9 patients,aged 36-55 years;and 20 healthy age-matched control subjects.All patients underwent two-dimensional echocardiography and RT3DE.Results Two-dimensional echocardiography showed no differences between groups (P ＞ 0.05).RT3DE analysis showed that the average left atrial filling volume/BSA,left atrial expansion index,and LAEF were significantly higher in the LVNC group.Conclusion LVNC is associated with increased left atrial reservoir function.RT3DE shows promise for the diagnosis of LVNC.
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Pediatric hypertrophic cardiomyopathy (PHCM)is a heterogeneous heart muscle disorder which is characterized by unexplained ventricular hypertrophy.Successful determination of a specific diagnosis is likely to have significant impact on management and survival because of the differences in etiology-specific sur-vival.This review provides an overview of PHCM with a focus on its etiology and their heart features.
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Objective To investigate the clinical outcomes of patients with chronic hepatitis B and its influencing factors,and provide reference for the prognosis of patients with hepatitis B.Methods 102 patients with chronic hepatitis B from January 2009 to June 2014 were selected and divided into the case group of 32 patients and the control group of 70 patients according to whether to occur with cirrhosis or liver cancer.The two groups of patients were analyzed and compared for general information,HBV DNA,serum ALT and other indicators.Results The cumulative cases of negative HBsAg,chronical hepatitis B,liver cirrhosis and liver cancer were 5,65 and 32,respectively.Univariate Logistic regression analysis showed that the differences between the two groups in age,sex,drinking history,HBV DNA levels and serum ALT levels were statistically significant (all P ＜ 0.05).Whether to cirrhosis or liver cancer was the dependent variable,the statistically significant single factors between the two groups were the independent variable,multivariate Logistic regression analysis showed that older age,male sex,alcohol abuse,high level of HBV DNA and high level of serum ALT were the risk factors of leading to cirrhosis,liver cancer for the patients with chronic hepatitis B (OR values were 9.94,14.36,8.25,13.01,120.32,respectively).Conclusions The older age,male,alcohol history,high level of HBV DNA and high level of serum ALT are higher risk factors for patients with chronic hepatitis B to development of cirrhosis and liver cancer.Patients with risk factors should be gave systematic interventions to reduce progression to cirrhosis,liver cancer and improve the quality of life.
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Objective To investigate the changing characteristics of myocardial movement in patients with dilated cardiomyopathy by three?di?mensional speckle tracking echocardiography(3D?STE). Methods The peak systolic global longitudinal train(GLS),global radial strain(GRS), global circumferential stain(GCS)and global area strain(GAS)of left ventricle were measured by 3D?STE technology in 69 patients with dilated cardiomyopathy. According to the left ventricular ejection fraction(LVEF),all patients were divided into group A(35%≤LVEF<50%)and group B (LVEF<35%). The differences of measurements were compared between two groups. The correlation between global myocardial strain in all direc?tions and left ventricular ejection fraction was analyzed. Results The GLS,GRS,GCS and GAS were significantly higher in group A than those in group B(P<0.01). The GLS,GRS,GCS and GAS were correlated with LVEF in group A(r=-0.871,0.610,-0.423,-0.797;P<0.05).The GCS,GRS and GAS were correlated with LVEF in group B(r=-0.517,0.368,-0.438;P<0.05). There was no significant correlation between GLS and LVEF in group B. Conclusion 3D?STE technology can be applied to evaluate the change of the myocardial movement. GLS is a promis?ing marker of the prognosis in patients with DCM.
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Purpose To analyze the echocardiographic features of peripartum cardiomyopathy (PPCM) using Logistic regression, and to screen the indexes which can be used for the prognosis of PPCM. Materials and Methods Fifty patients who were diagnosed as PPCM by echocardiography were divided into recovered group (30 cases) and non-recovered group (20 cases), all the patients underwent echocardiography, left ventricular end-diastolic diameter (LVEDd) was measured in the parasternal long axis view, left ventricular ejection fraction (LVEF) was measured using Simpson biplane method in the apical four-chamber and two-chamber view to look for the evidence of left ventricular thrombosis, if complicated with pulmonary hypertension, continuous wave Doppler was used for measuring the peak velocity of tricuspid valve regurgitation, and estimating of pulmonary artery systolic pressure, Logistic regression model was established and receiver operating characteristic (ROC) curve was generated to evaluate the prediction value of Logistic regression model. Results Compared with non-recovered group, there was statistically significant difference of LVEDd, LVEF, left ventricular thrombosis, pulmonary hypertension and re-checked LVEF (t= -4.33, 7.64 and 11.54, P0.05). Three sonographic features LVEDd, LVEF and left ventricular mural thrombus) could be used for the establishment of Logistic model (χ2=5.14, 11.59 and 14.58, P<0.05). The prediction accuracy of the model was 90.0% (45/50, P<0.001) and the area under ROC curve was 0.945±0.030 (P<0.001). Conclusion Logistic regression analysis can be applied for the screening of ultrasound index for PPCM, LVEDD, LVEF and left ventricular wall thrombus can predict the prognosis of PPCM accurately.
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Objective To discuss the diagnostic value of two-dimensional speckle tracking imaging in the evaluation of left ventricular rotation and torsion in pre-apical hypertrophic cardiomyopathy(PAHCM)patients. Methods A total of 26 patients with PAHCM,26 patients with hyperten-sive left ventricular hypertrophy(HLVH)and 26 healthy volunteers were recruited for the study. Two-dimensional echocardiographs were performed carefully. Two-dimensional images were obtained from the left ventricular apical four-chamber section,two-chamber section and two short-axis sec-tions,including mitral valve and apical levels. The peak subendocardial rotation(endo-rot),epicardial rotation(epi-rot),transmural torsion(mural-tor)and bulk rotation(bulk-rot)of each short-axis section were measured and analyzed using QLAB 9.1 software. Results In the mitral level, there was no statistically significant difference in endo-rot,epi-rot,mural-tor and bulk-rot between the PAHCM group and normal control group (P>0.05). There was statistically significant difference in endo-rot,epi-rot,mural-tor and bulk-rot between the PAHCM group and HLVH group (all P0.05). There was statisti-cally significant difference in endo-rot,mural-tor and bulk-rot between each two groups(P<0.05). There was statistically significant difference in G-tor between each two groups(P<0.05). The receiver operating characteristic curve analysis showed that the accuracy of differential diagnosis of G-tor PAHCM was high(the area under the receiver operating characteristic curve is 0.89),the sensitivity was 73.08%,and the specificity was 92.31%. Conclusion Two-dimensional speckle tracking imaging could accurately and quantitatively measure the left ventricular rotation and tor-sion in PAHCM patients. The G-tor could accurately screen and identify between PAHCM and HLVH.