RESUMO
Measuring the plasma parathyroid hormone (PTH) concentration is crucial to evaluate renal bone disease in patients with renal failure. Although frequent measurement is needed to avoid inadequate prescription of phosphate binders and vitamin D preparations, artificial intelligence can repeatedly perform the forecasting tasks and may be a satisfactory substitute for laboratory tests. Neuro-fuzzy technology represents a promising forecasting application in clinical medicine. We therefore constructed a coactive neuro-fuzzy inference system (CANFIS) to predict plasma PTH concentrations in hemodialysis patients. The CANFIS was constructed with clinical parameters (patient age, plasma albumin, calcium, phosphorus, alkaline phosphatase, and calcium-phosphorus product) from a cohort of hemodialysis patients, and plasma PTH concentration measured by radioimmunoassay (RIA) was the supervised outcome. The accuracy of the CANFIS was prospectively compared with RIA in another hospital. Plasma PTH concentrations measured by RIA and predicted by CANFIS were 179.04 +/- 38.18 ng/l and 179.34 +/- 37.76 ng/l, respectively (p = 0.15). The CANFIS was able to precisely estimate plasma PTH concentrations in hemodialysis patients. These results suggest that the neuro-fuzzy technology, based on limited clinical parameters, is an excellent alternative to RIA for accurately predicting plasma PTH concentration in hemodialysis patients.
Assuntos
Lógica Fuzzy , Redes Neurais de Computação , Hormônio Paratireóideo/sangue , Diálise Renal , Idoso , Algoritmos , Fosfatase Alcalina/sangue , Análise Química do Sangue/métodos , Cálcio/sangue , Feminino , Humanos , Hiperparatireoidismo Secundário/sangue , Hiperparatireoidismo Secundário/diagnóstico , Hiperparatireoidismo Secundário/etiologia , Masculino , Pessoa de Meia-Idade , Fósforo/sangue , Radioimunoensaio , Análise de Regressão , Insuficiência Renal/complicações , Insuficiência Renal/terapia , Albumina Sérica/análiseRESUMO
A 16-year-old female who had end-stage renal disease on 2-month continuous ambulatory peritoneal dialysis (CAPD) presented with perineal pain 4 days before admission. The physical examination revealed bilateral labial edema. Peritoneal scintigraphy was requested after infusing 2 L peritoneal dialysate with direct administration of 370 MBq (10mCi) technetium-99m diethylenetriamine pentra-acetic acid into peritoneal cavity via Tenckhoff catheter. Radioactive uptake from right inguinal to labial region was clearly demonstrated, and this indicated the site of peritoneal leakage. After surgical intervention unilaterally, she continued CAPD without any recurrence.
Assuntos
Adolescente , Humanos , Feminino , Pentetato de Tecnécio Tc 99m , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritônio , Cavidade Abdominal , Dor Abdominal/etiologia , Edema , Extravasamento de Materiais Terapêuticos e Diagnósticos , Genitália FemininaRESUMO
Acupuncture is a well-known alternative therapy in practice worldwide. Its dramatic effect on hiccups has been rarely reported. We describe a 77-year-old male who had hiccups after an acute myocardial infarction. Despite aggressive treatment including breath-holding to interrupt the respiratory rhythm, continuous positive airway pressure, and medication with metoclopramine, prochlorperazine, chlorpromazine, haloperidol, mephenesin, diphenylhydantoin, baclofen, and phenobarbital, the hiccups persisted for 7 days. Eventually, the hiccups were rapidly terminated by acupuncture at acupoint GV14 (Da zhui). To the best of our knowledge, this is the first report of acupuncture's reversing intractable hiccups after an acute myocardial infarction. Acupuncture may be considered for patients with hiccups refractory to conventional therapy.