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Heart sound analysis is significant for early diagnosis of congenital heart disease. A novel method of heart sound classification was proposed in this paper, in which the traditional mel frequency cepstral coefficient (MFCC) method was improved by using the Fisher discriminant half raised-sine function (F-HRSF) and an integrated decision network was used as classifier. It does not rely on segmentation of the cardiac cycle. Firstly, the heart sound signals were framed and windowed. Then, the features of heart sounds were extracted by using improved MFCC, in which the F-HRSF was used to weight sub-band components of MFCC according to the Fisher discriminant ratio of each sub-band component and the raised half sine function. Three classification networks, convolutional neural network (CNN), long and short-term memory network (LSTM), and gated recurrent unit (GRU) were combined as integrated decision network. Finally, the two-category classification results were obtained through the majority voting algorithm. An accuracy of 92.15%, sensitivity of 91.43%, specificity of 92.83%, corrected accuracy of 92.01%, and F score of 92.13% were achieved using the novel signal processing techniques. It shows that the algorithm has great potential in early diagnosis of congenital heart disease.
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Humans , Heart Sounds , Algorithms , Neural Networks, Computer , Heart Defects, Congenital/diagnosis , Signal Processing, Computer-AssistedABSTRACT
Objective:To explore the efficacy of different unipolar electrocoagulation power on pathological injury of porcine kidney suffering suture-free partial nephrectomy (SFPN).Methods:From April 2018 to July 2018, nine Guizhou pigs were selected, with an average age of 3 years and an average weight of 48 kg. According to different hemostatic power of unipolar electrocoagulation during open partial nephrectomy, they were divided into three groups(60W group, 80W group, and 100W group), with 3 in each group. The left kidney was exposed with a surgical incision, parallel to the lumbosacral muscle.The left renal artery was clamped and about 2 cm renal tissue was excised at the middle pole of the left kidney. 60W, 80W and 100W were used by unipolar electrocoagulation for hemostasis until no bleeding occurred after the artery clamp was released. The total ischemia time was controlled within 20 min. Temperature was measured by a multi-channel thermometer probe which was inserted into the healthy kidney tissue at a distance of 2 mm, 5 mm, and 10 mm away from the unipolar electrocoagulation hook, and the upper pole of the kidney far away from the operation area. The time of operation, the volume of renal bleeding, the time of hemostasis and the temperature were recorded. On the 7th day after operation, the left kidneys were taken and the pathological changes were observed by toluidine blue staining.Results:All operations were completed safely and successfully. The operation time in 60W group, 80W group, and 100W group was (41.2±5.5)min, (35.1±3.7)min, (31.3±2.2)min , respectively. There was no significant difference of operation time among those group ( P>0.05). The blood loss of renal was (35.3±4.1)ml, (21.4±4.7)ml, (15.3±4.1)ml, respectively. The blood loss in the 100W group and 80W group was less than that in the 60W group ( P<0.05). And the blood loss in the 100W group was less than that in the 80W group ( P<0.05). The hemostasis time was (15.2±1.9)min, (10.1±1.4)min, (6.4±0.8)min. The hemostasis time in the 100W and 80W groups was less than that in the 60W group ( P<0.05). And the hemostasis time in the 100W group was less than that in the 80W group ( P<0.05). At the place of 10 mm away from the electrocoagulation hook, the temperature in the three groups were (33.1±1.1)℃, (34.0±1.0)℃, (34.3±0.6)℃, which was not significantly different from that of the respective upper poles. And there was no significant difference between the three groups( P>0.05). At the place of 5 mm and 2 mm away from the electrocoagulation hook, the temperature in the 100W group (41.7±1.3)℃, (61.4±6.4)℃ and the 80W group (38.6±2.4)℃, (50.3±6.0)℃ was higher than that in the 60W group (36.9±4.1)℃, (42.0±4.7)℃, and the temperature in 100W group is higher than that in 80W group ( P<0.05). When the power was 60W, 80W or 100W, the temperature in the place 10 mm away from the electrocoagulation hook was less than that in the place 5 mm away from the electrocoagulation hook ( P<0.05), and the temperature of the place 5 mm away from the electrocoagulation hook was lower than that of the place 2 mm away from the electrocoagulation hook ( P<0.05). The total pathological injury depth of wounds in 60W, 80W, 100W group was (7 323±50)μm, (8 119±100)μm, (8 896±40)μm, respectively. The depth in 100W group and 80W group was deeper than that in 60W group ( P<0.05), and the depth in 100W group was deeper than that in 80W group ( P<0.05). Conclusions:In SFPN, the hemostatic effect of three different monopolar electrocoagulation output power is satisfactory. With the increase of power, the hemostasis speed is faster. However, the temperature of surrounding healthy renal tissue would be higher, and the total pathological injury depth would be deeper.
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Objective To evaluated the clinical value of laparoscopic techniques in radical cystectomy surgery for the treatment of bladder cancer. Methods Clinical data of 49 patients underwent radical cystectomy with Bricker ileal conduit diversion were retrospectively analyzed from October 2009 to August 2014, which laparoscopic radical cystectomy with Bricker ileal conduit 20 cases (Group A), open radical cystectomy with Bricker ileal conduit 29 cas-es (Group B). The blood loss during operation, operating time, gastrointestinal function recovery after operation, hos-pital stay after operation and complications were observed between the two groups. Results The blood loss during operation was significantly lower in Group A (416.66 ± 232.73) ml than in Group B (964.16 ± 445.73) ml ( <0.05), and hospital stay after operation was significantly lower in Group A (14.93 ± 2.72) days than in Group B (19.50 ± 3.16) days ( < 0.05), complication after operation was significantly lower in Group A than in Group B ( < 0.05). The operating time and gastrointestinal function recovery has no significantly difference between the two groups. Conclusions Laparoscopic radical cystectomy have advantages of minimal invasion, less blood loss, rapid recovery and less postoperative complications. It is a safe and effective surgical method. Long term effect need evaluated by follow up.
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Objective To evaluate the effect of selective segmental renal artery clamping ( SSRAC) on the solitary-kidney, providing a foundamental basis for the using of SSRAC in partial nephrectomy. Methods A total of 18 pigs were randomized equally into 2 groups according to the method of renal artery clamping such as main renal artery clamping ( MRAC) group or SSRAC group.Each case underwent right radical nephrectomy and either MRAC or SSRAC for 60 minutes on the left kidney.Serum creatinine ( SCr) and blood urea nitrogen (BUN) were measured before surgery and at 6 time points thereafter (the 1st, 7th, 14th, 21st, 28th, 90th day).Magnetic resonance imaging was performed before surgery and at 4 time points thereafter (the 1st, 7th, 28th, 90th day) and T2 relaxation time and apparent diffusion coefficient (ADC) were determined.Inflammatory cell infiltration and interstitial fibrosis were detected using renal histology on the 1st and 90th day after operation.Results SCr and BUN of the two groups increased to peak value on the 1st day, and then decreased gradually to normal on the 90th day after the operation.On the 1st day, SCr [(266.43 ±31.12)umol/l] and BUN [(13.63 ±2.54)mmol/l)] of SSRAC group were significantly lower than that of MRAC [(386.37 ±40.40)umol/l,(26.83 ±5.96)mmol/l] (P0.05) on the 7th, 14th, 21st, 28th, 90th day.In the MRAC group, the T2 relaxation time of upper, middle and lower pole of the left kidney increased and the ADC decreased on the 1st day after operation.It arrived to the peak value on the 7th day, and decreased or increased respectively from then on to normal level on the 90th day.In the SSRAC group, there were no significant changes of T2 relaxation time and ADC in the upper and middle pole of left kidney (P>0.05), but it was similar to that in the MRAC group for lower pole.On the 1st, 7th, 28th day after operation, the T2 relaxation time of upper and middle pole of the left kidney in the MRAC group [(45.50 ±1.87),(51.82 ±2.27), and(40.37 ±1.93)ms ) ] were significantly higher than those in the SSRAC group [(36.67 ± 1.33),(35.15 ±1.27), and(37.48 ±1.37)ms](P0.05).On the 1st, 7th, 28th day after operation, the ADC of upper and middle pole of the left kidney in the MRAC group [(2.29 ±0.08) ×10 -3 mm2/s, (2.10 ±0.08) ×10 -3 mm2/s, (2.41 ±0.09) ×10 -3 mm2/s] were significantly lower than that of the SSRAC group [(2.69 ± 0.08) ×10 -3 mm2/s, ( 2.63 ±0.06 ) ×10 -3 mm2/s, ( 2.68 ±0.05 ) ×10 -3 mm2/s ] ( P <0.05 ) . However, on the 1st,7th, 28th, 90th day after operation, the ADC of lower pole of the left kidney in the SSRAC group [(1.93 ±0.08) ×10 -3mm2/s,(1.91 ±0.09) ×10-3mm2/s,(2.33 ±0.07) ×10 -3mm2/s, and (2.43 ±0.07) ×10 -3 mm2/s] were significantly lower than those of the MRAC group [ (2.37 ±0.05) ×10 -3 mm2/s, (2.06 ±0.07) ×10 -3 mm2/s, (2.46 ±0.09) ×10 -3 mm2/s, (2.61 ±0.08) ×10 -3 mm2/s](P<0.05).The whole left kidney in MRAC group experienced extensive tubular hydropic degeneration and limited inflammatory cell infiltration on the 1st day after operation.Moreover, renal tubular hydropic degeneration alleviated and no glomerular changes, fibrous tissue hyperplasia or inflammatory cell infiltration was found on the 90th day after operation.In SSRAC group, no changes were found in upper and middle pole of left kidney at the two time points, while the pathological injury of the lower pole of left kidney was more severe.Conclusions SSRAC has obvious protective effect on renal function in the early stage. However, compared with MRAC, the renal tissue injury in the ischemic area was more serious.Therefore, to protect renal function in partial nephrectomy, the ischemic renal area should be reduced as much as possible, even to zero-ischemic, when adopting SSRAC.
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Objective To investigate the clinical outcomes derived from Ningmitai combined with tamsulosin to prevent double-J stent syndrome after laser lithotripsy with ureteroscope. Methods 117 patients underwent laser lithotripsy with ureteroscope and then placed a double-J stent for draining were collected from January 2010 to January 2013. Patients with double-J stent placement were divided into four groups determined by dosage regimen. Tamsulosin group (30 cases) was treated with tamsulosin (0.4 mg once daily) lonely, Ningmitai group (29 cases) was treated with Ningmitai (1.52 g, trice time a day) lonely, tamsulosin combined Ningmitai group (30 cases) was treated with tamsulosin and Ningmitai at the same time, operation control group (28 cases) was neither tamsulosin nor Ningmitai. The catheter was removed on the 3rd day post-lithotripsy and then remained double-J stent for 1 month. The scores of urinary tract, pain and the incidence of gross hematuria were assessed. Results The significant differences in the improvement of symptom score (χ2=22.038, P=0.000), pain score (χ2=9.876, P=0.020) and hematuria (χ2=8.000, P=0.046) were found among tamsulosin group, Ningmitai group, and tamsulosin combined Ningmitai group. The number of patients with symptomless, slight symptom in tamsulosin combined Ningmitai group were higher than those of tamsulosin group, Ningmitai group, operation control group (symptomeless:14 vs. 6, 3 and 2 cases;slight symptom:13 vs. 9, 5, 4 cases). The number of patients with>Ⅱpain score (7 vs. 9, 14, 17 cases) and incidence of hematuriag [26.6%(8/30) vs. 56.7%(17/30), 58.6% (17/29), 53.6% (15/28)] were lower in tamsulosin combined Ningmitai group than those of tamsulosin group, Ningmitai group, operation control group. The drug combination of Ningmitai with tamsulosin had the synergism to relived symptom and pain, and showed the more obviousthan lonely use. Conclusion The drug combination of Ningmitai with tamsulosin can be used in clinic for prophylactic purpose to prevent double-J syndrome.
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Objective To explore the role and clinical significance of GSTM 3 ( glutathione S-trans-ferase mu 3) expression in prostate cancer (PCa). Methods We had used the two-dimensional fluores-cence difference gel electrophoresis ( 2D-DIGE) and mass spectral analysis to further verify the microarray data of mRNA expression profiling discovered .GSTM3 mRNA level was detected by Rael-time Quantitative PCR ( RT-QPCR) in 28 pairs of prostate cancer tissue and benign tissue .The relationship of GSTM 3 level with the serum PSA level and the clinical feature of PCa were analyzed . Results In 2D-DIGE study, we found that the expression of GSTM 3 protein in adjacent tissues was significantly higher than that in PCa tis-sues (P0.05) and prostate cancer clinical pathological parameters ( P>0.05). Conclusions GSTM3 expression is down-regulated in PCa tissues, and we may identify PCa by detecting the GSTM 3 expression .
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Objective To compare the safety and efficacy of the 2μm laser and the bipolar electrotome used in transurethral re-section of bladder tumor(TURBT)for treating non-muscle invasive bladder cancer(NMIBC).Methods The clinical data in the pa-tients with NMIBC treated by TURBT in our hospital from March 2009 to May 2013 were retrospectively analyzed.All patients were divided into the 2μum laser group(n=89)and the bipolar electrotome group(n=82).The operation time,complications,post-operative hospital stay and recurrence rate were compared between the two groups.Results There were no statistically significant differences in the operation time,postoperative hospital stay and recurrence rate between the two groups(P>0.05).Compared with the 2 μm laser group,the bipolar electrotome group showed significantly higher occurrence rate of the obturator nerve reflex (20.7%vs.0,P<0.05)and the bladder perforation(7.3% vs.0,P<0.05)and longer postoperative bladder irrigation time [(3.1±0.9)d vs.(2.2±1.0)d,P<0.05],the differences between the two groups had statistical significance.Conclusion Com-pared with bipolar electrotome,the 2μm laser used in TURBT is safe and effective with few complications for treating NMIBC.
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Objective To investigate the timing of super-selective renal artery embolization (SRAE) for the treatment of renal hemorrhage after percutaneous nephrolithotomy (PCNL) .Methods From June 2005 to February 2013 ,a total of 2 165 patients with upper urinary tract calculi underwent PCNL (2 384 PCNL procedures) and 16 of them suffered severe bleeding (0 .74% ) .In the 16 cases ,SRAE was used .The medical records of all the 16 cases were retrospectively analyzed .Results In 16 patients ,15 patients were successful with the first SRAE ,but 2 of them underwent an additional pure renal artery angiography (1 patient before SRAE and 1 patient after SRAE);1 healed after the second SRAE .The mean blood loss and transfusion volume were 32 .9 g/L and 250 mL before the first angiography/SRAE ,and an additional 3 .2 g/L and 0 mL before the second try .Although 1 patient died ,the oth-ers were recovered without complications .Conclusion SRAE should be adopted early for the treatment of severe renal hemorrhage after PCNL .However ,a second try should be considered for the repeated bleeding patients after the negative results of first renal artery angiography or SRAE .
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Objective To investigate the effect of preconditioning with emulsified isoflurane (eISO) on neuronal apoptosis in hippocampal CA1 region induced by focal cerebral ischemia-reperfusion (I/R) injury in rats. Methods Forty-eight healthy adult male SD rats weighing 250-300 g were randomly divided into 6 groups (n = 8 each): sham operation group (group S); I/R group; eISO + I/R group (group EI); LY294002 (a specific PI3K inhibitor) + eISO + I/R group (group L+ EI); LY294002 + I/R group (group L) and DMSO (solvent for LY294002) + I/R group (group DMSO). Focal cerebral I/R was induced by 2 h middle cerebral artery occlusion ( MCAO). A nylon thread (0.26 mm in diameter) with rounded tip was inserted into internal carotid artery and advanced cranially until resistance was met (depth of insertion about 18-20 mm) . eISO 10.5 ml/kg (120 mg/ml) was injected intraperitoneally (IP) in groups EI and L+ EI. LY294002 (25 mmol/L) 5 pi was injected into cerebral ventricle on the ischemic side in group L + EI ( at 30 min before eISO) and group L. DMSO 5 μl was injected into the cerebral ventricle on ischemic side before MCAO in group DMSO. Neurologic deficit was assessed and scored (0 = normal, 4 = unconscious) at 24 h of reperfusion. The animals were then killed and their brains were removed for detection of neuronal apoptosis (by TUNEL) and p-Akt expression (by immuno-histochemistry) in hippocampal CA1 region. Results Cerebral I/R significantly increased the neurologic deficit scores, the number of apoptotic cells and p-Akt expression in group I/R as compared with group S. Preconditioning with elSO attenuated the I/R-induced increase in neurologic deficit scores and number of apoptotic cells but further increased p-Akt expression. The neuroprotective effect of eISO preconditioning against I/R-induced changes was counteracted by LY294002. Conclusion eISO preconditioning can attenuate focal cerebral I/R-induced neuronal apoptosis in rats by activating PI3K/Akt pathway.
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Objective To investigate the effect of postconditioning with 8 % emulsified isoflurane (EI) on focal cerebral ischemia-reperfusion (I/R) injury in rats. Methods Forty-eight male SD rats weighing 260-300 g were randomly divided into 6 groups ( n = 8 each): group Ⅰ sham operation (group S); group Ⅱ I/R; group Ⅲ,Ⅳ, Ⅴ 3 different doses of EI (group L-EI, M-EI, H-.EI) and group Ⅵ lipid emulsion (group LE). Right middle cerebral artery occlusion (MCAO) was induced by inserting a nylon thread 0.24 mm in diameter into right internal carotid artery. The thread was threaded cranially until resistance was met. MCAO was maintained for 2 h followed by 24 h reperfusion in group Ⅱ-Ⅵ. In group Ⅲ-Ⅴ EI 3.5, 7.0 and 10.5 ml/kg were injected intraperitoneally (IP) immediately before reperfusion respectively. In group LE 30% lipid emulsion 10.5 ml/kg was given instead of EI. The neurologic deficit was assessed and scored (0 = normal, 4 = unable to move and unconscious). The animals were then killed and infarct size was measured. Results IP 8% emulsified isoflurane 7.0 and 10.5 ml/kg injected before reperfusion significantly reduced neurologic deficit scores and infarct size in group M-EI and H-EI as compared with group I/R. Conclusion Postconditioning with 8% emulsified isoflurane can protect the brain against focal cerebral I/R injury.
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Objective To investigate the effect of preconditioning with different doses of emulsified isoflurane on focal cerebral ischemia-reperfusion (I/R) injury in rats. Methods Ninety-six male SD rats were randomly divided into 6 groups ( n = 16 each): sham operation group (group S), I/R group, low, median and high doses of emulsified isoflurane preconditioning group (group L, M, H) and intralipid group (group IL). Middle cerebral artery occlusion was produced by inserting a nylon thread. In group S, intraperitoneal normal saline (NS)10.5 ml/kg was injected, but the artery was only exposed 24 h later. In group I/R, intraperitoneal NS 10.5 ml/kg was injected, and the model was established 24 h later. In group L, M, H and IL, 8% emulsified isoflurane 3.5 ml/kg+NS 7.0 ml/kg, 8% emulsified isoflurane 7.0 ml/kg + NS 3.5 ml/kg, 8% emulsified isoflurane 10.5 ml/kg and 30% intralipid 10.5 ml/kg were injected intraperitoneally respectively, and then the model was established 24 h later. The temperature, HR and RR were recorded at 10 min before ischemia and at 10 min of reperfusion. The neurological deficit was scored, the cerebral infarct volume and apoptosis in neurons were detected, and microscopic examination of ischemic penumbra region was performed at 24 h of reperfusion. Results The rectal temperature and HR were significantly increased, while RR was significantly decreased duing cerebral I/R.The neurological deficit score was significantly higher, cerebral infarct volume and the number of apoptotic neurons were significantly larger in the other groups than in group S. Emulsified isoflurane preconditioning reduced neurological deficit scores, cerebral infarct volume and the number of apoptotic neurons dose-dependently. Conclusion Emulsified isoflurane preconditioning can reduce focal cerebral I/R injury in a dose-dependent manner in rats.
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Objective To evaluate the safety and efficacy of retroperitoneal laparoscopic resec-tion and reconstructive surgeries in urology. Methods Retroperitoneal laparoseopic resection and re-constructive surgeries were performed on 245 patients including 17 cases of adrenalectomies, 32 cases of radical nephrectomies, 12 cases of partial nephrectomies, 53 cases of nephrectomies, 5 cases of nephroureterectomies, 6 cases of unroofing of peripelvie renal cysts, 46 cases of unroofing of renal cysts, 4 cases of unroofing of polyeystic kidneys, 12 cases of pyeloplasties, 58 cases of ureterolithoto-roles. Results All 245 surgeries were successfully completed. The mean operation time was 59 (20-250) min and the estimated blood loss was 5-300 ml with no transfusion. There was no serious complication during perioperative period. Conclusion Retroperitoneal laparoscopic resection and re-conatruetive surgery in urology is safe and effective with the advantages of minimal invasion, quick re-covery and few complications.