A deep transfer learning method using plain radiographs for the differential diagnosis of osteonecrosis of the femoral head with other hip diseases / 中华骨科杂志

Objective:To develop a deep transfer learning method for the differential diagnosis of osteonecrosis of the femoral head (ONFH) with other common hip diseases using anteroposterior hip radiographs.Methods:Patients suffering from ONFH, DDH, and other hip diseases including primary hip osteoarthritis, non-infectious inflammatory hip disease, and femoral neck fracture treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2018 to December 2020 were enrolled in the study. A clinical data set containing anteroposterior hip radiographs of the eligible patients was created. Data augmentation by rotating and flipping images was performed to enlarge the data set, then the data set was divided equally into a training data set and a testing data set. The ResNet-152, a deep neural network model, was used in the study, but the original Batch Normalization was replaced with Transferable Normalization to construct a novel deep transfer learning model. The model was trained to distinguish ONFH and DDH from other common hip diseases using anteroposterior hip radiographs on the training data set and its classification performance was evaluated on the testing data set.Results:The clinical data set was comprised of anteroposterior hip radiographs of 1024 hips, including 542 with ONFH, 296 with DDH, and 186 with other common hip diseases (56 hips with primary osteoarthritis, 85 hips with non-infectious inflammatory osteoarthritis, 45 hips with femoral neck fracture). After data augmentation, the size of the data set multiplied to 6144. The model was trained 100 050 times in each task. Accuracy was used as the representative parameter to evaluate the performance of the model. In the binary classification task to identify ONFH, the best accuracy was 95.80%. As for the multi-classification task for classification of ONFH and DDH from other hip diseases, the best accuracy was 91.40%. The plateau of the model was observed in each task after 50 000 times of training. The mean accuracy in plateaus was 95.35% (95% CI: 95.33%, 95.37%), and 90.85% (95% CI: 90.82%, 90.87%), respectively. Conclusion:The present study proves the encouraging performance of a deep transfer learning method for the first-visit classification of ONFH, DDH, and other hip diseases using the convenient and economical anteroposterior hip radiographs.

Role of gut microbiota in perioperative neurocognitive disorders after cardiopulmonary bypass surgery in rats with humanized gut flora / 南方医科大学学报

OBJECTIVE@#To investigate whether gut microbiota disturbance after cardiopulmonary bypass (CPB) contributes to the development of perioperative neurocognitive disorders (PND).@*METHODS@#Fecal samples were collected from healthy individuals and patients with PND after CPB to prepare suspensions of fecal bacteria, which were transplanted into the colorectum of two groups of pseudo-germ-free adult male SD rats (group NP and group P, respectively), with the rats without transplantation as the control group (n=10). The feces of the rats were collected for macrogenomic sequencing analysis, and serum levels of IL-1β, IL-6 and TNF-α were measured with ELISA. The expression levels of GFAP and p-Tau protein in the hippocampus of the rats were detected using Western blotting, and the cognitive function changes of the rats were assessed with Morris water maze test.@*RESULTS@#In all the 3 groups, macrogenomic sequencing analysis showed clustering and clear partitions of the gut microbiota after the transplantation. The relative abundances of Klebsiella in the control group (P < 0.005), Akkermansia in group P (P < 0.005) and Bacteroides in group NP (P < 0.005) were significantly increased after the transplantation. Compared with those in the control group, the rats in group NP and group P showed significantly decreased serum levels of IL-1β, IL-6 and TNF-α and lowered expression levels of GFAP and p-Tau proteins (all P < 0.05). Escape platform crossings and swimming duration in the interest quadrant increased significantly in group NP (P < 0.05), but the increase was not statistically significant in group N. Compared with those in group P, the rats in group NP had significantly lower serum levels of IL-1β, IL-6 and TNF-α and protein expressions of GFAP and p-Tau (all P < 0.05) with better performance in water maze test (P < 0.05).@*CONCLUSION@#In patients receiving CPB, disturbances in gut mirobiota contributes to the development of PND possibly in relation with inflammatory response.

Effect of dexmedetomidine on perioperative cardiac function in patients with mild cardiac dysfunction undergoing laparoscopic surgery / 中国医师进修杂志

Objective To investigate the effect of dexmedetomidine on perioperative cardiac function in patients with mild cardiac dysfunction undergoing laparoscopic radical resection of rectal cancer. Methods Sixty patients scheduled with laparoscopic radical resection of rectal cancer with mild heart failure were selected, with New York Heart Association (NYHA) cardiac function gradingⅠtoⅡ, American Association of Anesthesiologists (ASA) grading Ⅱ to Ⅲ, and age from 63 to 72 years. The patients were divided into dexmedetomidine group (group D) and control group (group C) according to the random digits table method with 30 cases each. At the beginning of induction, the patients in group D were given intravenous infusion a loading dose of dexmedetomidine at 0.5 μg/kg for more than 10 min. Then continuous intravenous infusion of dexmedetomidine was given at 0.3 μg/(kg·h) for 60 min. The patients in group C were given 0.9% sodium chloride with the same method. The small vessel resistance (SVR), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), cardiac output (CO) and myocardial working index (Tei index) before induction (T0) and after administration of 20 min (T1), 40 min (T2), 60 min (T3) were measured by color Doppler ultrasound, and the heart rate (HR) and mean arterial pressure (MAP) were recorded at the same times. The time from the end of operation to extubation and incidences of agitation during recovery period were recorded. Results The T1to T3SVR in group D were significantly lower than those of T0: (883 ± 30), (827 ± 36) and (804 ± 38) dyn·s·cm-5vs. (1 075 ± 37) dyn·s·cm-5, and there were statistical differences (P＜0.05); compared with those in group C, the T1 to T3 SVR in group D were significantly lower, and there were statistical differences (P＜0.05). In group D, there were no statistical differences in CO between T1to T3 and T0(P＞0.05); compared with those in group D, the T1 to T3 CO in group C were significantly lower: (3.4 ± 0.6) L/min vs. (4.4 ± 1.0) L/min, (3.2 ± 0.7) L/min vs. (4.3 ± 0.8) L/min and (3.3 ± 0.9) L/min vs. (4.4 ± 0.9) L/min, and there were statistical differences (P＜0.05). In group D, there were no statistical differences in LVEF between T1to T3 and T0(P＞0.05); compared with those in group D, the T1to T2 LVEF in group C were significantly lower, and there were statistical differences (P＜0.05). In group D, there were no statistical differences in Tei index between T1 to T3 and T0(P＞0.05); compared with group D, the T1 to T2 Tei index in group C were significantly higher, and there were statistical differences (P＜0.05). There were no statistical differences in LVEDV after intra-group and inter-group comparison (P＞0.05). In group D, the T1 to T3 HR were significantly lower than T0: (68.1 ± 12.8), (67.3 ± 11.9) and (65.4 ± 11.7) times/min vs. (88.2 ± 15.1) times/min, and there were statistical differences (P＜0.05); compared with those in group C, the T1 to T3 HR in group were significantly slower. In group D, the T1 MAP significantly increased, significantly higher than those in T0 and in group C (P＜0.05). There was no statistical difference in the time from the end of operation to extubation between 2 groups (P＞0.05). The incidence of agitation during recovery period in group D was significantly lower than that in group C. Conclusions Dexmedetomidine can effectively promote the perioperative cardiac function recovery in patients with cardiac dysfunction undergoing laparoscopic radical resection of rectal cancer, suggesting that it has a certain myocardial protection effect.

Single or multiple encounters of general anaesthesia do not cause any cognitive dysfunction: Findings from a retrospective population-based, case-control study

General anesthesia and surgery have been associated with acute cognitive impairment in several elderly individuals. Present study was conducted to determine whether the general anaesthesia exposure and cognitive dysfunction are linked or not. This is a China-based retrospective, population-based and case-control study. Using Chinese database inhabitants of Shenyang, China, incident cases detected with cognitive abnormalities between January 2007 and December 2012 were identified. With respective to every incident case, age- and gender-matched control subject was chosen among the general population pool of Shenyang inhabitants who were not having cognitive anomalies in the year. Medical records were scrutinized to examine the exposures to surgical procedures necessitating anesthesia after 45-years of age. We examined 577 cases of cognition-impaired [dementia] patients, every incident case with a conforming control subject. Among the cognitive impaired patients, 414 [71.7%] underwent 821 surgical operations needing general anesthesia exposure; of the controls, 404 [70%] underwent 833 surgical procedures. The present study found that general anaesthetic agents encounter was not markedly associated with cognitive anomalies [odds ratio, 0.87; 95% CI, 0.71-1.09; P=0.29]. Moreover, no substantial relation was observed when the anaesthetic agents encounter was measured as number of surgical operations [odds ratios [OR], 0.83, 0.89, and 1.0 for 1, 2-3, and 4 exposures, correspondingly, matched with none; P=0.52]. Our present work witnessed no substantial link between surgical procedures requiring single or multiple general anesthesia exposure post 45-years of age and cognitive dysfunction

Effect of anesthesia and its related factors on one year recurrence after partial cystectomy for bladder cancer / 中国医师进修杂志

Objective To explore the impact of different anesthesia methods and anesthesia-related factors in initial bladder cancer patients with partial cystectomy, and to provide a reference for clinical anesthesia choice and the questions that should be concerned. Methods Ambispective cohort study was performed in consecutive case of illness with initial occurrence bladder cancer patients treatedwith partial cystectomy from 2009 to 2012. A historical cohort was from January 5, 2009 to January 4, 2011. A prospective cohort was from January 5, 2011 to December 31, 2011. Follow-up was terminated in December 31, 2012. All cases were followed up to one full year after surgery. The 402 cases who were diagnosed of initial occurrence bladder cancer and partial cystectomy patients, according to different anesthesia method, were divided into general anesthesia group and intraspinal anesthesia group. Postoperative recurrence was determined within 1 year of follow-up. Multivariate analysis was carried out based on univariate analysis to analyze the causal connection factors for one year recurrence in initial occurrence bladder cancer patients with partial cystectomy. Variables included gender, age, blood type, smoking history, drinking history , number of tumors, tumor size, pathologic TNM stage, anesthesia method, duration of anesthesia, postoperative visual analog scale (VAS) score at 12 h, tumor-associated factor Ki67, P53, CK20, VEGF (whether two or more positive). Tumor recurrence was considered the dependent variable (outcome). Univariate analysis used χ2 or rank sum test, and multivariate analysis used Logistic regression model fitting analysis and the maximum likelihood method. SPSS 16.0 software package was used for data analysis and processing. Results Four hundred and two patients were followed up and got a result of 396 cases (98.51％). Two hundred and eleven cases showed recurrence within one year (53.28％). Univariate analysis showed that age, smoking history, drinking history, duration of anesthesia, pathologic stage, postoperative VAS scores at 12 h less than 3 scores, blood type, tumor-associated factor Ki67, P53, CK20, VEGF (two or more positive) were associated with one year recurrence in initial occurrence bladder cancer patients (P 0.05). Multivariate Logistic regression model analysis showed that the following factors were associated with postoperative recurrence within a year in initial occurrence bladder cancer patients with partial cystectomy: age (RR = 0.371, 95％ CI 0.183-0.752), drinking history (RR=0.348, 95％CI 0.161-0.752), postoperative VAS scores at 12 h less than 3 scores (RR=0.023, 95％CI 0.011-0.050), duration of anesthesia (RR=3.042, 95％CI 1.495-6.192), and tumor-associated factor Ki67, P53, CK20, VEGF of two or more positive(RR=8.676, 95％CI 4.018-18.733). Among these, duration of anesthesia and tumor-associated factors Ki67, P53, CK20, VEGF of two or more positive were risk factors, and drinking history, age, and postoperative VAS scores at 12 h less than 3 scores were protection factors. Conclusions The impact of general anesthesia and intraspinal anesthesia on one year recurrence in initial occurrence bladder cancer patients with partial cystectomy is not statistically significant. Duration of anesthesia depends on the part of the surgical time which is associated with the postoperative recurrence within a year. Postoperative analgesic perfect (VAS score at 12 h less than 3 scores) is the protective factor. Age and drinking history are also the protective factors for one year recurrence in initial occurrence bladder cancer patients of partial cystectomy.

Effects of dexmedetomidine on oxygenation during one-lung ventilation for esophagectomy / 中国医师进修杂志

Objective To evaluate the effects of dexmedetomidine on hypoxic pulmonary vasoconstriction and oxygenation during one- lung ventilation (OLV) undergoing esophagectomy. Methods Fifty-six adult patients undergoing esophagectomy and requiring OLV were selected.During inhalational anesthesia with sevoflurane, patients were randomized to receive either dexmedetomidine (dexmedetomidine group,28 patients)or saline placebo(control group,28 patients). The bolus dose of 0.3 μg/kg over 10 min followed by a maintenance dose of 0.6 μg/(kg·h)was used in dexmedetomidine group. The arterial blood gas samples were obtained to evaluate the effects of dexmedetomidine on oxygenation in three times:T1:double-lung ventilation 10 min after anesthetic intubation;T2:OLV 10 min;T3:60 min after continuous infusion of dexmedetomidine. Outcomes included differences in hemodynamic parameters(heart rate and mean arterial pressure), end-tidal sevoflurane concentration, ephedrine dose and atropine dose.Results The levels of pH, arterial partial pressure of carbon dioxide(PaCO2)in two groups had no significant differences(P>0.05).The level of oxygenation index in two groups at T3had significant difference: (153.29 ± 19.00) mmHg(1 mmHg=0.133 kPa)vs. (117.79 ± 12.00) mmHg, 1 mmHg = 0.133 kPa, P < 0.01. At T3, the level of heart rate in dexmedetomidine group was significantly lower than that in control group:(68 ± 11)times/min vs.(89±13)tims/min;meanwhile, the level of end-tidal sevoflurane concentration in dexmedetomidine group was significantly lower than that in control group: (2.9 ± 0.8)% vs. (4.2 ± 0.1)%; there were significant differences (P < 0.01). The ephedrine dose in two groups had no significant difference(P>0.05).Conclusions Dexmedetomidine may provide clinically relevant benefits by improving oxygenation and decreasing the requirement of inhalational anaesthetic agents, thereby limiting its effect on hypoxic pulmonary vasoconstriction during OLV in adults undergoing esophagectomy surgical procedures.