Application of deep convolutional neural networks in the diagnosis of laryngeal squamous cell carcinoma based on narrow band imaging endoscopy / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the possibility of using artificial intelligence (AI) technology based on convolutional neural network (CNN) to assist the clinical diagnosis of laryngeal squamous cell carcinoma (LSCC) through deep learning algorithm. Methods: A deep CNN was developed and applied in narrow band imaging (NBI) endoscopy of 4 799 patients with laryngeal lesions, including 3 168 males and 1 631 females, aged from 21 to 87 years, from 2015 to 2017 in Beijing Tongren Hospital, Capital Medical University. A simple randomization method was used to select the laryngeal NBI images of 2 427 patients (1 388 benign lesions and 1 039 LSCC lesions) for the training and correction the CNN model. The remaining laryngeal NBI images of 2 372 patients (including 1 276 benign lesions and 1 096 LSCC lesions) were used as validation data set to compare performance between CNN and otolaryngologists. SPSS 21.0 software was used for Chi-square test to calculate the accuracy, sensitivity and specificity of AI and otolaryngologists. The area under the curve (AUC) of receiver operating curve (ROC) was used to evaluate the diagnostic ability of the algorithm for NBI images. Results: The accuracy, sensitivity and specificity for NBI predictions were respectively 90.91% (AUC=0.96), 90.12% and 91.53%, which were equivalent to those for otolaryngologists' predictions (accuracy, sensitivity and specificity were (91.93±3.20)%, (91.33±3.25)% and (93.02±2.59)%, t values were 0.64, 0.75 and 1.17, and P values were 0.32, 0.28 and 0.21, respectively). The diagnostic efficiency of CNN was significantly higher than that of otolaryngologists (0.01 vs. 5.50, t =9.15, P<0.001). Conclusion: AI based on deep CNN is effective for using in the laryngeal NBI image diagnosis, showing a good application prospect in the diagnosis of LSCC.

Efficacy analysis of esophageal ultrasound-guided percutaneous femoral artery closure for ventricular septal defect / 中国胸心血管外科临床杂志

@#Objective    To investigate the effectiveness and safety of esophageal ultrasound-guided percutaneous femoral artery closure of ventricular septal defect (VSD). Methods    The clinical data of 24 patients with congenital VSD in our hospital from March 2017 to December 2019 were retrospectively analyzed, including 6 males and 18 females, with a median age of 12 (3-42) years, weight of 32 (12-91) kg, and VSD diameter of 4 (3-7) mm. There were 3 patients with VSD combined with atrial septal defect. Results    Twenty-four patients successfully underwent interventional closure of percutaneous femoral artery under esophageal ultrasound guidance, and the position and shape of the occluders were good. The operation time was 45 (39-54) min, and the waist size of the occluders was 7 (5-12) mm. Among the patients, 14 patients used symmetric ventricular occlusion devices, 8 patients used asymmetric ventricular occlusion devices, and 2 patients used ventricular occlusion muscle occluders. Small amount of residual shunt occurred in 2 patients after the operation and it disappeared 3 months after the operation. One patient with right bundle branch block, which disappeared after 1 week of observation. There were no complications such as occluder closure, pericardial effusion or valve regurgitation during the perioperative period. During the follow-up period [3-18 (9.25±5.04) months], no serious complication occurred. Conclusion    Transesophageal ultrasound-guided transfemoral artery occlusion for VSD is simple and safe, and it avoids the damage of radiation and contrast medium. It has advantages over traditional percutaneous interventional occlusion therapy.

Clinical efficacy and application value of percutaneous interventional treatment for / 中国胸心血管外科临床杂志

@#Objective    To investigate the clinical efficacy and application value of percutaneous interventional treatment for structural heart diseases under guidance of ultrasound. Methods    The clinical data of 1 010 patients with structural heart diseases treated by transcutaneous ultrasound-guided occlusion in our hospital from December 2, 2015 to December 31, 2019 were retrospectively reviewed, including 360 males and 650 females, aged 1-50 years. There were 692 patients of atrial septal defect (603 with central type, 9 combined with arterial catheter, 80 with ethmoid type), 116 patent foramen ovale, 25 ventricular septal defects (3 combined with atrial septal defect), 132 patent ductus arteriosus, 32 pulmonary valve stenosis (3 combined with atrial defect), 1 main pulmonary artery window, and 3 aneurysm rupture of aortic sinus. All patients were diagnosed by transthoracic echocardiography (TTE) before operation. Treatment was accomplished intraoperatively through TTE or transesophageal echocardiography (TEE) via the femoral artery or femoral vein. After operation, echocardiography, electrocardiogram and chest radiograph were reexamined. Results    Satisfactory results were obtained in 1 005 patients, and 1 patient failed to seal the ventricular defect and was repaired under direct vision, occluder detachment occurred in 5 patients after operation (3 patients of atrial septal defects underwent thoracotomy for Amplatzer device and were repaired, 1 patient of atrial septal defects was closed after removing Amplatzer device, 1 patient of patent ductus arteriosus underwent thoracotomy for Amplatzer device and was sutured), mild pulmonary valve regurgitation occurred after balloon dilation in 2 patients with pulmonary stenosis, a small amount  of residual shunt was found in 2 patients with ventricular defect, which disappeared after 3 months of follow-up, and 1 patient of right bundle branch block occurred and disappeared after 1 week. After follow-up of 1-24 months, 3 patients of ethmoidal atrial septal defect were reexamined with mild shunt. The occluder was in good position and the pressure difference of pulmonary valve was significantly reduced. There was no complication such as hemolysis, arrhythmia, embolism or rupture of chordae tendinae. Conclusion    Percutaneous transfemoral artery and vein guided by TTE or TEE is safe and effective, with little trauma, no radiation or contrast agent damage, and has significant clinical efficacy and application values.

Effect of Tai Chi and Resistance Training on Cancer-Related Fatigue and Quality of Life in Middle-Aged and Elderly Cancer Patients / 中国结合医学杂志

OBJECTIVE@#To study the effect of Tai Chi (TC) and resistance training (RT) with different intensity on the cancer-related fatigue (CRF) and quality of life (QoL) of middle-aged and elderly cancer patients.@*METHODS@#Totally 120 cancer patients were enrolled and randomly assigned to 4 groups by a random number table, including TC group, high-intensity 60% one repetition maximum (1-RM) RT group (HIRT), low-intensity (30% 1-RM) RT group (LIRT) and control group, 30 patients in each group. Participants in the TC group received 24-form simplified Yang-style TC training at a frequency of 40 min per day, 3 days per week for 12 weeks. Patients in the two RT groups received 10 sessions, 6 designated movements per day, 3 days per week for 12 weeks. The 1-RM of 6 muscle groups, fat mass (FM), lean body mass (LBM), along with the scores of Brief Fatigue Inventory (BFI), QoL questionnaire for Chinese cancer patients receiving chemobiotherapy (QLQ-CCC), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9) and Pittsburgh Sleep Quality Index (PSQI) were measured before and after training. The adverse effect was also observed.@*RESULTS@#After 12-week intervention, patients in both TC and RT groups showed significant improvements in CRF and QLQ-CCC compared to pre-treatment (P<0.05). Compared with the LIRT and TC groups, patients in the HIRT group improved more significantly in increasing muscle strength and LBM, and reducing in FM (P<0.05). Patients in the TC group significantly increased in lower limb muscle strength compared with the LIRT group (P<0.05). In addition, patients in the TC group showed more significant improvements in scores of GAD-7, PHQ-9 and PSQI than 2 RT groups (P<0.05).@*CONCLUSIONS@#TC and RT, both low- and high-intensity training, can significantly increase muscle strength, reduce CRF and improve QoL in the middle-aged and elderly cancer patients. TC has a better effect than RT in terms of sleep quality and mental health. The long-term application is needed to substantiate the effect of TC as an alternative exercise in cancer patients.

Clinical efficacy analysis of percutaneous balloon pulmonary valvuloplasty for pulmonary valve stenosis guided by ultrasound / 中国胸心血管外科临床杂志

@#Objective    To analyze the efficacy and safety of percutaneous balloon pulmonary valvuloplasty (PBPV) for pulmonary valve stenosis guided by ultrasound. Methods    From March 2016 to July 2019, 32 patients with pulmonary valve stenosis were treated in our hospital. There were 19 males and 13 females with an average age of 1-12 (6.2±3.1) years and weight of 7-45 (22.7±9.2) kg. The clinical efficacy of PBPV guided by transthoracic echocardiography (TTE) was evaluated. Results    The transvalvular pressure gradient (PG) of the patients before PBPV was 65.4±11.9 mm Hg. All patients successfully received PBPV under TTE guidance. The PG was 19.7±4.0 mm Hg immediately after operation, which was significantly decreased (P<0.001). All patients survived without any serious complications. The PG values at 3 months, 6 months and 12 months after operation were 18.4±4.0 mm Hg, 16.4±3.9 mm Hg, 15.2±3.3 mm Hg, respectively, which were significantly lower than that before the operation (P<0.001). Conclusion    PBPV guided by echocardiography is safe and effective in the treatment of pulmonary valve stenosis with low complications rate.

Research on Function and Mechanism of Tai Chi on Cardiac Rehabilitation / 中国结合医学杂志

With the increasing number of cardiovascular patients, more and more people are living with diseases. Cardiac rehabilitation (CR) is an effective treatment and prevention measure for cardiovascular disease (CVD), which aims to relieve both psychological and physiological stress of CVD, reduce risk of death from CVD, improve cardiovascular function and patients' quality of life. Tai Chi is popular in China and mainly used as a daily leisure activity for the elderly to strengthen their bodies. This review discusses whether Tai Chi could be taken as a positive intervention in CR and what is the exact role and its mechanisms as exercise therapy for CVD. The authors detail the role of Tai Chi on CR from the aspects of exercise capacity, risk factors of CVD and psychological factors, etc., as well as highlight the limitation of Tai Chi research at present.

Clinical study of transcervical occlusion of patent ductus arteriosus via femoral artery guided by ultrasound / 中国医师杂志

Objective To evaluate the efficacy and safety of transthoracic echocardiography (TTE) guided by transcatheter closure of patent ductus arteriosus (PDA) through the femoral artery.Methods From February 2016 to December 2017,53 patients with simple PDA were selected,the funnel type in 30 cases,cast type in 23 cases.All patients were guided by TTE and transcatheter closure of PDA through the femoral artery.The femoral artery was guided by TTE by establishing the orbit of the femoral artery-catheter-pulmonary artery to the right ventricle.The right ventricular septal defect was placed under the femoral artery approach,and the therapeutic effect was evaluated by echocardiography after occlusion.The outpatient visits were made at 1,3,and 6 months after operation.Results PDA closure was successfully completed under TTE guidance in 53 patients.In one adult PDA,the ultrasonic diagnosis of the inner diameter of the catheter was incorrect due to the image quality,which resulted in the replacement of the occluded device several times,but the occlusion was successful.The operative time was (30 ± 10)min.And the back diameter of the transcatheter closure device was (12 ± 6) mm and the murmur of the transmission sheath disappeared.There was no shunt between the main pulmonary artery and the main pulmonary artery,and the length of hospitalization was 3-4 days.No shunt signal was found at 1,3 and 6 months follow-up.Left atrial diameter (LAD) [(25.8 ± 6.1) mm vs (30.6 ± 8.4) mm] and left ventricular end diastolic diameter (LVEDD) [(38.5 ±9.1)mm vs (45.2 ± 11.5)mm],were decreased significantly (P ＜0.05).Conclusions It is safe and effective to block PDA by using femoral artery approach under the guidance of TTE,which avoids the damage of X-ray and contrast agent,and its prospect of clinical application is promising.

Relative factors of recent discovered atrial fibrillation following isolated coronary artery bypass grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To identify the relative factors of recent discovered atrial fibrillation (AF) following isolated coronary artery bypass grafting (CABG).</p><p><b>METHODS</b>Classified the 649 cases undergoing isolated CABG from January 2005 to December 2006 to two groups according to whether AF appeared after operation. Collected the peri-operative data and operative strategy, then analyzed with single-factor analysis and Logistic regression.</p><p><b>RESULTS</b>The incidence of AF was 8.0% (52 cases), and 84.6% (44 cases) recovered sinus-rhythm leaving hospital. Age, standard European system for cardiac operative risk evaluation (EuroSCORE), ratio of high-operative-risk, left atrium diameter and ratio of left coronary artery dominance were higher in AF group than in non-AF group. Age, eject fraction, left atrium diameter, operative risk evaluation, left coronary artery dominance and anastomosis on right coronary artery were the relative factors of recent discovered AF following isolated CABG. But off-pump operation, prescription of adrenergic beta-antagonists pre-operatively and degree of coronary artery stenosis had no influence to AF.</p><p><b>CONCLUSIONS</b>AF following CABG is a result of common influence by many factors. EuroSCORE might forecast partially the incidence of AF following CABG. Improve the myocardial protection and reduce the surgical damage during operative progress maybe the mostly approach to decrease the incidence of AF following CABG.</p>

Operation for Adult Interatrial Septal Defect With Pulmonary Hypertension / 中国医师杂志

Objective To report 49 cases of adult interatrial septal defect with pulmonary hypertension operated and to evaluate their results.Method Most of those cases were repaired with conventional operative procedures,but 2 cases among them with severe pulmonary hypertension were repaired with one-way valvular patch.Those with mitral or tricuspid remarkable regurgitation,were repaired with annuloplastic procedure at the same time.Results There were no operative death,and followed up for one to five months,the heart size,ECG and the data of blood gas analysis were retuned into normal value.Heart function of 47 case was raised to Ⅰ class(NYHA),and 2 case to Ⅱ class.Conclusions Operation for adult interatrial septal defect especially with pulmonary hyperteasion is highly indicated.Treatment of mitral or tricuspid regurgitation remarkably at the same time is important for recovery of cardiac function.One-way valvular patch used to repair ASD with severe pulmonary hypertension could reduce complication and mortality,so it is an effective procedure adapted.