【Abstract】Objective To look for a feasible way to evaluate hepatic reserve function completely by retention rate of indocyanine green at 15 minutes （ICGR15）and Child-Pugh classification supplemented by hepatic clearance of D-sorbitol (CLh-s). Methods The ICGR15, Child-Pugh classification and CLh-s were examined in 186 patients with liver cirrhosis. Relations between CLh-s and operative complications were further studied when ICGR15 and Child-Pugh classification was superposed. ResultsThe superpositions of ICGR15 (40% being boundary) and Child-Pugh classification was centralized between Child-Pugh B and C. ICGR15 of 17 examples were higher than 40% in 63 examples of Child-Pugh B. Eight examples of them had some complications, CLh-s=(584.52±98.27) ml/min (CLh-s＜700 ml/min), while 9 examples of them had no complications, CLh-s=(801.25±75.04) ml/min (CLh-s＞700 ml/min). Conclusion The CLh-s could be interrelated with operative complication, and it is considered as an effective supplement to ICGR15 and Child-Pugh classification for the evaluation of hepatic reserve function, CLh-s (700 ml/min being boundary) could be used to predict operative complication, to evaluate hepatic reserve function effectively, and to provide the basis for choosing the right time for operation.
Objective To observe the etiologies and vision outcomes of inpatients with no light perception (NLP). Methods A total of 367 inpatients (430 eyes) with NLP in Zhongshan Ophthalmic Center were enrolled in this study. The visual acuity examination followed the international standard methods. NLP was detected by torch light in a dark room and the pupil light reflection state was also considered. The patients included 208 males (235 eyes) and 159 females (195 eyes). Sixtythree patients (126 eyes) were bilateral and 304 patients (304 eyes) were unilateral cases including 159 right eyes and 145 left eyes. The patients' ages ranged from 2.5 to 86.0 years, with a mean age of (40.85plusmn;18.03) years. All the patients were treated according to their diseases. The ratio of different eye disease and visual outcome were recorded and analyzed. Results Among 430 eyes, there were 157 eyes (36.5%) with optic neuritis, 68 eyes (15.8%) with uveitis, 54 eyes (12.6%) with retinal vascular disease, 35 eyes (8.1%) with ischemic optic neuropathy, 29 eyes (6.7%) with traumatic optic neuropathy, 28 eyes (6.5%) with optic atrophy, 18 eyes (4.2%) with trauma, 17 eyes (4.0%) with radiation optic neuropathy, 10 eyes (23%) with glaucoma, five eyes (1.2%) with retinal detachment, four eyes (0.9%) with compressive optic neuropathy, two eyes (0.5%) with orbital apex syndrome, two eyes (0.5%) with hysteria, and one eye (0.2%) with orbital cellulitis. After active treatment, 269 eyes (62.6%) remained NLP, 161 eyes (37.4%) got improved visual acuity, including light perception- 0.02 in 74 eyes (17.2%), ge;0.02-＜0.05 in 25 eyes (5.8%), ge;0.05 -＜0.1 in 14 eyes (3.3%), ge;0.1 -＜0.3 in 11 eyes (2.6%) and ge;0.3 in 37 eyes (8.6%). Conclusions The main causes of nonsurgical and non-trauma NLP are retinal disease and optic neuropathy. Some patients with NLP may restore useful vision if they received prompt referral and active intervention.
Objective To explore the effectiveness of maintaining the stability between the fourth and the fifth metacarple base during the treatment in the hamate-metacarpal joint injury. Methods Between September 2015 and June 2017, 13 cases of hamate-metacarpal joint injury were treated, including 12 males and 1 female, aged from 17 to 55 years (mean, 30.8 years). The injury causes included heavy boxing in 10 cases and falling in 3 cases. There were 2 cases of simple fourth metacarpal basal fracture, 1 basal fracture of the fourth metacarpal bone combined with intermetacarpal ligament fracture, 7 fractures of the fourth and fifth metacarpal base, 2 fourth metacarpal basal fractures combined with the fifth metacarpal basal fracture dislocation, and 1 base fracture of fourth and fifth metacarpal bone combined with hamate bone fracture. The time from injury to operation was 5-11 days (mean, 7.2 days). According to different damage degree and stability change between the fourth and the fifth metacarple base, a preliminary classification was made for different degrees of injury: 2 cases of type Ⅰ, 1 case of type Ⅱ, 7 cases of type Ⅲ, 2 cases of type Ⅳ, and 1 case of type Ⅴ. The patients were treated with corresponding internal fixation methods under the principle of stability recovery between the fourth and fifth metacarple base. Results All the incisions healed by first intention without infection or skin necrosis. All the 13 patients were followed up 6-18 months with an average of 9.4 months. All fractures healed clinically, and the healing time was 5.5-8.0 weeks with an average of 6.3 weeks. No complication such as plate breakage, fracture dislocation, fracture malunion, and bone nonunion occurred. Hand function was evaluated according to the total active motion (TAM) functional evaluation standard of hand surgery at 6 months after operation, and the results was excellent in 9 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 92.3%. Conclusion Stability between the fourth and fifth metacarple base is of great significance to the classification and the treatment of the hamate-metacarpal joint injury.
ObjectiveTo assess the correlation of WHO pathological classification and Masaoka stage of thymomas with its prognosis.MethodsA total of 468 patients with thymomas who received surgeries during 2009-2019 in Huashan Hospital, Fudan University, were collected. There were 234 males and 234 females with an average age of 21-83 (49.6±18.7) years. A total of 132 patients underwent video-assisted thoracic surgery (VATS) and 336 patients underwent thymectomy with median sternal incision. The follow-up time was 5.7±2.8 years. The clinical data of the patients were analyzed.ResultsThe amount of intraoperative bleeding was 178.3±133.5 mL in the median sternal incision group, and 164.8±184.1 mL in the VATS group (P=0.537). The operative time was 3.3±0.7 h in the median sternal incision group and 3.4±1.2 h in the VATS group (P=0.376). Postoperative active bleeding, phrenic nerve injury and chylothorax complications occurred in 8 patients, 9 patients and 1 patient in the VATS group, respectively, and 37 patients, 31 patients and 7 patients in the median sternal incision group, respectively. There was no statistical difference between the two groups (P=0.102, 0.402, 0.320). The 5-year cumulative progression free survival (PFS) rates of patients with WHO type A, AB, B1, B2, B3 and C thymomas were 100.0%, 100.0%, 95.7%, 81.4%, 67.5% and 50.0%, respectively (P<0.001). The 5-year PFS rates of patients with Masaoka stageⅠ-Ⅳ thymomas were 96.1%, 89.2%, 68.6% and 19.3%, respectively (P<0.001). The 5-year PFS rate was 87.3% in patients with myasthenia gravis (MG) and 78.2% in patients without MG (P<0.001). The 5-year PFS rates of patients with different surgeries were 82.4% and 83.8%, respectively (P=0.904). ConclusionWHO pathological classification and Masaoka stage have significant clinical prognosis suggestive effect. Thymoma patients combined with MG have better prognosis, which suggests early diagnosis and treatment of thymoma are important.
The eye-computer interaction technology based on electro-oculogram provides the users with a convenient way to control the device, which has great social significance. However, the eye-computer interaction is often disturbed by the involuntary eye movements, resulting in misjudgment, affecting the users’ experience, and even causing danger in severe cases. Therefore, this paper starts from the basic concepts and principles of eye-computer interaction, sorts out the current mainstream classification methods of voluntary/involuntary eye movement, and analyzes the characteristics of each technology. The performance analysis is carried out in combination with specific application scenarios, and the problems to be solved are further summarized, which are expected to provide research references for researchers in related fields.
ObjectiveTo analyze the predictive value of ensemble classification algorithm of random forest for delirium risk in ICU patients with cardiothoracic surgery. MethodsA total of 360 patients hospitalized in cardiothoracic ICU of our hospital from June 2019 to December 2020 were retrospectively analyzed. There were 193 males and 167 females, aged 18-80 (56.45±9.33) years. The patients were divided into a delirium group and a control group according to whether delirium occurred during hospitalization or not. The clinical data of the two groups were compared, and the related factors affecting the occurrence of delirium in cardiothoracic ICU patients were predicted by the multivariate logistic regression analysis and the ensemble classification algorithm of random forest respectively, and the difference of the prediction efficiency between the two groups was compared.ResultsOf the included patients, 19 patients fell out, 165 patients developed ICU delirium and were enrolled into the delirium group, with an incidence of 48.39% in ICU, and the remaining 176 patients without ICU delirium were enrolled into the control group. There was no statistical significance in gender, educational level, or other general data between the two groups (P>0.05). But compared with the control group, the patients of the delirium group were older, length of hospital stay was longer, and acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, proportion of mechanical assisted ventilation, physical constraints, sedative drug use in the delirium group were higher (P<0.05). Multivariate logistic regression analysis showed that age (OR=1.162), length of hospital stay (OR=1.238), APACHEⅡ score (OR=1.057), mechanical ventilation (OR=1.329), physical constraints (OR=1.345) and sedative drug use (OR=1.630) were independent risk factors for delirium of cardiothoracic ICU patients. The variables in the random forest model for sorting, on top of important predictor variable were: age, length of hospital stay, APACHEⅡ score, mechanical ventilation, physical constraints and sedative drug use. The diagnostic efficiency of ensemble classification algorithm of random forest was obviously higher than that of multivariate logistic regression analysis. The area under receiver operating characteristic curve of ensemble classification algorithm of random forest was 0.87, and the one of multivariate logistic regression analysis model was 0.79.ConclusionThe ensemble classification algorithm of random forest is more effective in predicting the occurrence of delirium in cardiothoracic ICU patients, which can be popularized and applied in clinical practice and contribute to early identification and strengthening nursing of high-risk patients.
Polypoidal choroidal vasculopathy (PCV) is a fundus disease characterized by choroidal anomalous branch vascular network and terminal polypoidal dilatation. According to its fundus feature, lesion location, imaging feature and disease progression, PCV can be divided into different types or stages. It can be divided into hemorrhage and exudation PCV according to the fundus features, into macular, peripapillary, periphery and mixed types according to the lesion locations. It can also be divided into type 1 and 2 according to the ICGA (indocyanine green angiography) manifestations, and can be classified as early stage and late stage according to disease progression. There were different correlations between different types of PCV and some risk genetic loci, such as ARMS2 (age-related macular degeneration factor 2)/ HTRA1 (high temperature essential protein A1) , C2, complement factor B, complement factor H, and elastin genes. The response to therapy and prognosis are also different between different types. It is important to further study the clinical classification of PCV, to explore the genetic characteristics, influencing factors and treatment or prognosis features of different types of PCV. The results will improve the differential diagnosis of PCV, and the effectiveness of individualized treatment.
Objective To introduce an integral classification method of thoracic deformity. Methods From March 2015 to March 2017, 869 patients with thoracic deformity were observed. The patients were classified according to the traditional classification method at first, and then were classified according to the integral classification method. According to the standard plane of the normal chest wall, the chest deformities were classified into types Ⅰ and Ⅱ: those below the plane belonged to type Ⅰ, and those above the plane belonged to type Ⅱ. Then two types were divided into subtypes Ⅰ-a, Ⅰ-b, Ⅰ-c, Ⅰ-d, Ⅰ-e, Ⅰ-f, Ⅰ-g and Ⅱ-a, Ⅱ-b, Ⅱ-c, Ⅱ-d according to the specific characteristics of malformation. Results There were 840 patients included in the classification system, accounting for 96.7% of the total patients, and the remaining 29 (3.3%) were complicated malformations, which could not be accurately described by using a single classification type. Compared with the traditional classification methods, patients with pectus excavatum and pectus carinatum were divided into different subtypes. Poland syndrome did not exist any longer, and Dove chest alone became the type Ⅱ-c. Conclusion Integral classification method is a simple and practical classification method. Since the method directly depends on the characteristics of malformation which is related to the operation, it plays a guiding role in the operation. But its superiority needs to be further confirmed.
At present the prediction method of epilepsy patients is very time-consuming and vulnerable to subjective factors, so this paper presented an automatic recognition method of epilepsy electroencephalogram (EEG) based on common spatial model (CSP) and support vector machine (SVM). In this method, the CSP algorithm for extracting spatial characteristics was applied to the detection of epileptic EEG signals. However, the algorithm did not consider the nonlinear dynamic characteristics of the signals and ignored the time-frequency information, so the complementary characteristics of standard deviation, entropy and wavelet packet energy were selected for the combination in the feature extraction stage. The classification process adopted a new double classification model based on SVM. First, the normal, interictal and ictal periods were divided into normal and paroxysmal periods (including interictal and ictal periods), and then the samples belonging to the paroxysmal periods were classified into interictal and ictal periods. Finally, three categories of recognition were realized. The experimental data came from the epilepsy study at the University of Bonn in Germany. The average recognition rate was 98.73% in the first category and 99.90% in the second category. The experimental results show that the introduction of spatial characteristics and double classification model can effectively solve the problem of low recognition rate between interictal and ictal periods in many literatures, and improve the identification efficiency of each period, so it provides an effective detecting means for the prediction of epilepsy.
Objective To investigate the risk factors for early progression in patients with acute respiratory distress syndrome (ARDS), and to provide a reference for early detection and intervention of high-risk patients with ARDS progression. Methods Data from multicenter mechanically ventilated patients with mild to moderate ARDS were retrospectively analyzed. According to the severity grade of 72 h ARDS, the patients were divided into an early progressive group and a non-progressive group. Chi-square test was used to compare the risk factors of ARDS patients and the prognosis of the two groups were analyzed by Logistic regression. Results A total of 355 patients with mild to moderate ARDS were included in invasive mechanical ventilation, of which 97 patients (27.3%) progressed after 72 hours. 78.4% were female in the progressive group and 64.0% were female in the non-progressive group. Compared with the non-progressive group, the patients with ARDS in the progressive group had shorter 28-day no mechanical ventilation, higher ICU mortality, and lower survival rate at 30 days and 60 days（P<0.05）, but there was no significant difference in the length of ICU stay between the two groups (P>0.05). Univariate and multivariate regression analysis showed that the patients with ARDS in the progressive group had lower baseline oxygenation index (OR=0.979, 95%CI 0.961 - 0.986, P<0.01), higher peak airway pressure (OR=1.068, 95%CI 1.017 - 1.121, P<0.01), higher lactate level (OR=1.224, 95%CI 1.057 - 1.417, P<0.01), higher tidal volume (OR=1.159, 95%CI 1.002 - 1.341, P<0.05), higher age (OR=1.373, 95%CI 1.051 - 1.082, P<0.01), and more male patients (OR=2.583, 95%CI 1.336 - 4.995, P<0.05). Conclusions Early progression is common in mild to moderate ARDS patients with mechanical ventilation. The progressive group has shorter duration of 28 days without mechanical ventilation, higher ICU mortality and lower 30-day and 60-day survival rate than the non-progressive group. Male, low baseline oxygenation index levels, high peak airway pressure, tidal volume, lactate levels, and higher age are risk factors for early progression in patients with mild to moderate ARDS.