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Objective: To explore the types and clinical characteristics of chronic rhinosinusitis with nasal polyps (CRSwNP) based on artificial intelligence and whole-slide imaging (WSI), and to explore the consistency of the diagnostic criteria of the Japanese epidemiological survey of refractory eosinophilic chronic rhinosinusitis (JESREC) in Chinese CRSwNP patients. Methods: The data of 136 patients with CRSwNP (101 males and 35 females, aging 14 to 70 years) who underwent endoscopic sinus surgery from 2018 to 2019 in the Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University were analysed retrospectively. The preoperative clinical characteristics of patients were collected, such as visual analogue scale (VAS) of nasal symptoms, peripheral blood inflammatory cell count, total immunoglobulin E (IgE), Lund-Kennedy score and Lund-Mackay score. The proportion of inflammatory cells such as eosinophils, lymphocytes, plasma cells and neutrophils were calculated on the WSI of each patient through artificial intelligence chronic rhinosinusitis evaluation platform 2.0 (AICEP 2.0), and the specific type of nasal polyps was then obtained as eosinophilic CRSwNP (eCRSwNP) or non-eosinophilic CRSwNP (non-eCRSwNP). In addition, the JESREC diagnostic criteria was used to classify the nasal polyps, and the classification results were compared with the current gold standard for nasal polyps diagnosis (pathological diagnosis based on WSI). The accuracy, sensitivity and specificity of the diagnostic criteria of JESREC were evaluated. The data were expressed in M (Q1, Q3) and statistically analyzed by SPSS 17.0. Results: There was no significant difference between eCRSwNP and non-eCRSwNP in age distribution, gender, time of onset, total VAS score, Lund-Kennedy score or Lund-Mackay score. However, there was a significant difference in the ratio of nasal polyp inflammatory cells (eosinophils 40.5% (22.8%, 54.7%) vs 2.5% (1.0%, 5.3%), neutrophils 0.3% (0.1%, 0.7%) vs 1.3% (0.5%, 3.6%), lymphocytes 49.9% (39.3%, 65.9%) vs 82.0% (72.8%, 87.5%), plasma cells 5.1% (3.6%, 10.5%) vs 13.0% (7.4%, 16.3%), χ2 value was 9.91, 4.66, 8.28, 5.06, respectively, all P<0.05). In addition, eCRSwNP had a significantly higher level of proportion of allergic symptoms (nasal itching and sneezing), asthma, peripheral blood eosinophil and total IgE (all P<0.05). The overall accuracy, sensitivity and specificity of the JESREC diagnostic criteria was 74.3%, 81.3% and 64.3%, respectively. Conclusions: The eCRSwNP based on artificial intelligence and WSI has significant high level of allergic symptoms, asthma, peripheral blood eosinophils and total IgE, and the percentages of inflammatory cells in nasal polyps are different from that of non-eCRSwNP. The JESREC diagnostic criteria has good consistency in our research.
Assuntos
Feminino , Humanos , Masculino , Inteligência Artificial , Doença Crônica , Eosinófilos/metabolismo , Pólipos Nasais/patologia , Estudos Retrospectivos , Rinite/patologia , Sinusite/patologiaRESUMO
@#【Objective】To investigate the predictive value of blood eosinophil in eosinophilic chronic rhinosinusitis with nasal polyps（eosCRSwNP）by analyzing the characteristics of eosCRSwNP adult patients in Guangdong Province， China.【Method】From Oct.2017 to Sep.2018，a total of 108 eosCRSwNP adult inpatients scheduled for surgery in Department of Otorhinolaryngology，Head and Neck Surgery，The Third Affiliated Hospital，Sun Yat-sen University were enrolled. They were divided into eosCRSwNP（n = 39） and non-eosCRSwNP（n = 69） group by the pathologic features. The demographic and clinical features were collected and compared.【Results】The eosCRSwNP group accounted for 36.1% while non-eosCRSwNP group accounted for 63.9% in our study. A higher prevalence of allergic rhinitis，asthma and higher blood IgE level，bilateral Lund-Mackay score of posterior ethmoid sinus，ethmoid to maxillary Lund-Mackay score ratio， peripheral blood eosinophil absolute count and percentage and peripheral blood basophil absolute count and percentage were found in eosCRSwNP patients. Only peripheral blood eosinophil absolute count and percentage were independent predictors of eosCRSwNP. The cutoff absolute value of 0.275×109/L demonstrated a sensitivity of 74.4% and a specificity of 72.5% while the cutoff relative value of 4.32% demonstrated a sensitivity of 74.4% and a specificity of 73.9%.【Conclusion】Non-eosCRSwNP was predominant in Guangdong. EosCRSwNP differs from non-eosCRSwNP in many clinical features，while peripheral blood eosinophil count and percentage were independent predictors of eosCRSwNP.
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OBJECTIVE: To study the effects of tobacco smoking exposure on cough among construction workers. METHODS: Convenient sampling method was adopted to choose 204 construction workers as the study objects. The relationship of cough and tobacco smoking exposure was investigated. The objects were divided into no-smoking( 18 workers),passive-smoking( 66 workers) and active-smoking( 120 workers) groups according to different tobacco smoking exposure situation. RESULTS: The occurrence of active smoking for 204 construction workers was 58. 8%( 120 /204) and the daily active smoking rate was 51. 5%( 105 /204). The occurrence of passive smoking for the non-smokers was 78. 6%( 66 /84) and the daily passive smoking rate was 66. 7%( 56 /84). Among the construction workers,15. 2%( 31 /204) had occasional cough,and 52. 4%( 107 /204) had frequent cough,total cough occurrence was 67. 6%( 138 /204). The occurrence of occasional cough in active-smoking group was higher than that of the passive-smoking group( 23. 3% vs 1. 5%,P < 0. 01); the occurrence of frequent cough in passive-smoking group and active-smoking group were higher than that of the no-smoking group( 54. 5% vs 22. 2%,55. 8% vs 22. 2%,P < 0. 017); the total cough occurrence in active-smoking group was higher than those of the no-smoking group and passive-smoking group( 79. 2% vs 33. 3%,79. 2% vs 56. 1%,P < 0. 01). There was an association between tobacco smoking exposure and cough frequency among the construction workers. Active-smokers had higher risks than non-smokers in both occasional cough and frequent cough( odds ratio were 5. 958 and 6. 990,P <0. 05); the passive smokers had a higher risk of frequent cough than non-smokers( odds ratio was 3. 536,P < 0. 05).CONCLUSION: Tobacco smoking exposure was an important risk factor for coughing among construction workers. Effective approach should be taken into account to control tobacco usage in the construction work site.
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<p><b>OBJECTIVE</b>To compare the diagnostic performance of prospective electrocardiogram (ECG)-triggered computed tomography coronary angiography (CTCA) versus retrospective ECG-gated CTCA.</p><p><b>METHODS</b>Patients with suspected coronary artery disease divided into two groups which underwent 64-slice CTCA with prospective ECG-triggered or retrospective ECG-gated scanning (n = 100 each, HR < or = 65 bpm). Multi-planar reconstruction (MPR), curved-planar reconstruction (CPR), maximum intensity projection (MIP) and volume rendering (VR) were made to demonstrate the coronary arteries. The image quality was defined as excellent, good and poor by motion and stair-step artifacts. Individual radiation exposure dose was estimated from the dose-length product.</p><p><b>RESULTS</b>The mean effective radiation dose of prospective ECG-triggered CTCA [(2.81 +/- 0.48) mSv] was significantly lower than that of retrospective ECG-gated CTCA [(10.16 +/- 1.09) mSv, P < 0.01]. Segments of diagnostic image quality (95.2%, 1165/1224) and non-diagnostic coronary segments (4.8%, 59/1224) in prospective ECG-triggered group were similar as those of retrospective ECG-gated group (94.1%, 1186/1261 and 5.9%, 75/1261, all P > 0.05).</p><p><b>CONCLUSION</b>Though the radiation exposure dose required is significantly lower, the diagnostic performance of prospective ECG-triggered 64 slice CTCA is comparable with that of retrospective ECG-gated 64 slice CTCA on patients with stable heart rates up to 65 bpm.</p>