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BACKGROUND:Based on different algorithms of machine learning,how to carry out clinical research on lumbar disc herniation with the help of various algorithmic models has become a trend and hot spot in the development of intelligent medicine at present. OBJECTIVE:To review the characteristics of different algorithmic models of machine learning in the diagnosis and treatment of lumbar disc herniation,and summarize the respective advantages and application strategies of algorithmic models for the same purpose. METHODS:The computer searched PubMed,Web of Science,EMBASE,CNKI,WanFang,VIP and China Biomedical(CBM)databases to extract the relevant articles on machine learning in the diagnosis and treatment of lumbar disc herniation.Finally,96 articles were included for analysis. RESULTS AND CONCLUSION:(1)Different algorithm models of machine learning provide intelligent and accurate application strategies for clinical diagnosis and treatment of lumbar disc herniation.(2)Traditional statistical methods and decision trees in supervised learning are simple and efficient in exploring risk factors and establishing diagnostic and prognostic models.Support vector machine is suitable for small data sets with high-dimensional features.As a nonlinear classifier,it can be applied to the recognition,segmentation and classification of normal or degenerative intervertebral discs,and to establish diagnostic and prognostic models.Ensemble learning can make up for the shortcomings of a single model.It has the ability to deal with high-dimensional data and improve the precision and accuracy of clinical prediction models.Artificial neural network improves the learning ability of the model,and can be applied to intervertebral disc recognition,classification and making clinical prediction models.On the basis of the above uses,deep learning can also optimize images and assist surgical operations.It is the most widely used model with the best performance in the diagnosis and treatment of lumbar disc herniation.The clustering algorithm in unsupervised learning is mainly used for disc segmentation and classification of different herniated segments.However,the clinical application of semi-supervised learning is relatively less.(3)At present,machine learning has certain clinical advantages in the identification and segmentation of lumbar intervertebral discs,classification and grading of the degenerative intervertebral discs,automatic clinical diagnosis and classification,construction of the clinical predictive model and auxiliary operation.(4)In recent years,the research strategy of machine learning has changed to the neural network and deep learning,and the deep learning algorithm with stronger learning ability will be the key to realizing intelligent medical treatment in the future.
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ObjectiveTo explore the possible mechanism of the Yiqi Jiedu formula （YQ） in treating ischemic stroke （IS） from the perspective of the microbial-gut-brain axis （MGBA）. MethodRats were randomly divided into five groups， with six in each group， including sham surgery group， model group， and low， medium， and high dose YQ groups （1， 5， and 25 mg·kg-1）. Except for the sham surgery group， all other groups were established with a middle cerebral artery occlusion （MCAO） model using the thread occlusion method. The success of modeling was determined through neurobehavioral scoring， and the protective effect of YQ on IS was evaluated. Then， the changes in gut microbiota before and after MCAO modeling and YQ administration were compared using 16S rDNA sequencing technology， and the possible biological pathways related to the effect of this formula were analyzed. The expression of inflammatory factors such as interleukin-6 （IL-6）， interleukin-17A （IL-17A）， and interleukin-10 （IL-10） in serum was detected by enzyme-linked immunosorbent assay （ELISA）. Western blot was used to detect the expression of tight junction proteins ZO-1 and Occludin in brain and intestinal tissue， and hematoxylin-eosin staining （HE） was used to observe pathological changes in the cerebral cortex and colon， so as to validate the possible mechanism of action. ResultYQ significantly improved the neurobehavioral score of MCAO rats （P<0.01） and played a good regulatory role in intestinal microbial disorders caused by enriched pathogens and opportunistic pathogens during the acute phase. Among them， significantly changed microorganisms include Morgentia， Escherichia Shigella， Adlercreutzia， and Androbacter. Bioinformatics analysis found that these bacteria may be related to the regulation of inflammation in the brain. Compared with the blank group， the detection of inflammatory factors in the serum of IS model rats showed an increase in inflammatory factors IL-6 and IL-17A （P<0.01） and a decrease in the content of anti-inflammatory factor IL-10 （P<0.01）. Compared with the model group， the content of inflammatory factors IL-6 and IL-17A in the serum of the treatment group decreased （P<0.05）， and that of anti-inflammatory factor IL-10 increased （P<0.01）. The expression results of barrier proteins ZO-1 and Occludin in brain and intestinal tissue showed that the expression levels of both decreased in IS model rats （P<0.05）， while the expression levels of both increased in the treatment group （P<0.05）. ConclusionAcute cerebral ischemia can lead to an imbalance of intestinal microbiota and damage to the intestinal barrier， and it can increase intestinal permeability. YQ can regulate intestinal microbiota imbalance caused by ischemia， inhibit systemic inflammatory response， and improve the disruption of the gut-blood brain barrier， preventing secondary cascade damage to brain tissue caused by inflammation. The MGBA may be an important mechanism against the IS.
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Objective:To develop a novel, flexible, dual-arm, master-slave digestive endoscopic minimally invasive surgical robot system named dual-arm robotic endoscopic assistant for minimally invasive surgery (DREAMS) and to evaluate its feasibility for endoscopic submucosal dissection (ESD) by using ex vivo porcine stomachs.Methods:A novel endoscopic robot (DREAMS) system was developed which was composed of a flexible two-channel endoscope, two flexible robotic manipulators, a master controller, a robotic arm, and a control system. A total of 10 artificial round-like lesions with diameters ranging from 15 to 25 mm were created (5 in gastric antrum and 5 in gastric body) by using fresh peeled stomach of healthy pigs as the model. Submucosal dissection was performed with the assistance of the DREAMS system by two operators. The main outcome was submucosal dissection speed, and the secondary outcomes included muscular injury rate, perforation rate, and grasping efficiency of the robot.Results:All 10 lesions were successfully dissected en bloc by using the DREAMS system. The diameter of the artificial lesions was 22.34±2.39 mm, dissection time was 15.00±8.90 min, submucosal dissection speed was 141.79±79.12 mm 2/min, and the number of tractions required by each ESD was 4.2 times. Muscular injury occurred in 4/10 cases of ESD. No perforation occurred. Conclusion:The initial animal experiment shows the DREAMS system is safe and effective.
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Objective:To investigate the effect of nonalcoholic fatty liver disease (NAFLD) on glucose and lipid metabolism during pregnancy.Methods:A retrospective analysis was performed in women who gave birth in Minhang Hospital Affiliated to Fudan University from January 2013 to June 2020. The data on demographic, clinical examination, and delivery were obtained via electronic medical record abstraction. According to the ultrasound imaging, all pregnant women were divided into NAFLD group and control group. The difference of glucose and lipid metabolism indexes, incidence of gestational diabetes mellitus, and gestational hypertension between two groups were compared. Logistic regression model was used to examine potential associations between NAFLD and metabolic related adverse pregnancy outcomes.Results:A total of 14 708 pregnant women with a mean age of (29.1±4.7) years and a mean body mass index of (21.0±2.8) kg/m 2 were included in our study. Of those eligible women, 554 (3.8%) were confirmed by ultrasound as NAFLD. Pregnant women with NAFLD presented higher circulating levels of fasting glucose [(4.2±0.5)mmol/L vs (4.1±0.5)mmol/L, P<0.01], 1 h plasma glucose [(7.4±1.7)mmol/L vs (6.6±1.6)mmol/L, P<0.01] and 2 h plasma glucose [(6.2±1.4)mmol/L vs (5.7±1.3)mmol/L, P<0.01] after glucose loading, HbA 1C [(5.2±0.4)% vs (5.1±0.5)%, P<0.01], triglyceride [(2.1±1.1)mmol/L vs (1.6±0.7)mmol/L, P<0.01], total cholesterol [(4.8±0.8)mmol/L vs (4.7±0.9)mmol/L, P<0.01], low density lipoprotein-cholesterol [(2.6±0.7)mmol/L vs (2.5±0.7)mmol/L, P<0.01], uric acid [(224.1±51.8)μmol/L vs (203.0±45.9)μmol/L, P<0.01] level. After adjusting for potential confounders, NAFLD significantly increased the risk of gestational diabetes mellitus ( OR=1.722, 95% CI 1.079-2.747, P=0.023) and gestational hypertension ( OR=3.845, 95% CI 2.247-6.582, P<0.001). Conclusions:Compared to non NAFLD, women with a diagnosis of NAFLD had more significant glucose and lipid metablic aberrations during pregnancy and increased incidence of gestational diabetes and gestational hypertension. Pregnant women with NAFLD should be closely monitored on glucose and lipid metabolism and blood pressure to prevent gestational diabetes mellitus and hypertension.
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Objective To investigate the relationship between renal vascular resistance index( RI) and serum Apelin level in type 2 diabetic mellitus ( T2DM )?Methods Seventeen cases newly diagnosed T2DM patients with RI increased but without microalbuminuraia in Minhang Hospital Affiliated to Fudan University from December 2011 to December 2014 were selected as observation group,17 newly diagnosed T2DM patients with RI normal during the same period were selected as control group?Fasting plasma glucose(FPG),glycosylated hemoglobin A1C(HbAlC),blood lipids and fasting insulin(FINS),hepatic functional and renal function were tested in all the subjects?Serum Apelin level was detected by enzyme?linked immunosorbent assay?Results Compared with control group,serum Apelin level was significantly higher in observation group((179?2±122?4)μg/L vs?(56?7±50?6) μg/L,t=3?814,P<0?05)?Partial correlation analysis showed that the RI was positive correlated with Apelin ( r= 0?364, P= 0?040 )?Conclusion The serum Apelin levels elevated in newly diagnosed T2DM patients with RI increased, and RI is positively correlated with Apelin, which indicate that Apelin play an important role in the pathophysiology of early renal damage in patients with TsDM.
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Objective To compare the application of Goldman , CARPREG and ZAHARA in predicting cardiac outcomes in pregnant women with congenital heart disease. Methods A retrospective analysis of 144 pregnant women with CHD , enrolled in The Third Affiliated Hospital of Guangzhou Medical University between Jan 1992 and June 2015 was conducted. The mortality and the incidence of cardiac events were counted by three risk estimation methods. The sensitivity and calibration of three systems were compared by using Hosmer-Lemeshow goodness of-fit analysis and Aera Under Curve (AUC). Results In terms of mortality rates, the sensitivity of CARPREG was higher than that of Goldman (AUC:0.874 and 0.889 respectively;P = 0.568 >0.05);. In terms of the incidence of cardiac events, the sensitivity of ZAHARA was higher than that of Goldman (AUC:0.912 and 0.773 respectively;P = 0.063 > 0.05); Conclusions All 3 risk estimation methods have good performance in sensitivity of predicting the incidence of cardiac events and mortality in pregnant women with CHD. The ZAHARA has a better calibration in predicting the incidence of cardiac events , and we recommend ZAHARA as the first choice of evaluation system for this kind of patients.
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To analyze and evaluate the knowledge of Chinese Guidelines of Diabetes Prevention and Treatment in Shanghai medical staff. 175 medical staff working in endocrinology or community health were enrolled and evaluated by a questionnaire of guidelines about the state of professional, training, and related knowledge. Only 16. 6% medical staffwere trained about the guidelines( 46. 67% from the general hospitals, 14. 75% from secod-level hospital and 7. 14% persons from the community hospitals, P＜0. 01 ). The total correct answer rate of the guidelines was 37. 36%. The correct rate of community hospitals was lower than others( P＜0. 05 ). The rate of doctors' was higher than nurses'( P＜0. 05 ). There were difference between doctors and nurses with the key point of diabetes care knowledge in different level hospitals. The effective method of clinical training in diabetes care should be explored. We still have to work hard to promote the effect of diabetes control and prevention. Effective training about the guidelines should be enhanced. The cooperation between general hospitals and community health institutions in diabetes prevention and treatment should be enhanced.
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<p><b>OBJECTIVES</b>To identify differences in gene expression in renal and visceral adipose tissue in type 2 diabetic rats using cDNA representational difference analysis (RDA) and to explore the molecular pathogenesis of type 2 diabetes and its chronic vascular complications.</p><p><b>METHODS</b>A rat model of type 2 diabetes was generated by administration of a high fat and calorie diet combined with a low dose of streptozocin (STZ) injected into the tail vein. The difference bands were generated by cDNA representational difference analysis (cDNA RDA). The final difference products were ligated into the pUC-18 vector and sequenced. A bioformatics analysis was performed on the obtained expressed sequence tags (ESTs), and then the expression levels of known and novel genes were verified by semi-quantitative reverse transcription-PCR (RT-PCR). At the same time, full-length cDNA of a novel gene was cloned in silico.</p><p><b>RESULTS</b>The type 2 diabetic rats in this experiment experienced hyperglycemia, lipidemia, lower insulin sensitivity and normal body weight. We obtained 9 novel ESTs and 2 novel genes from renal tissue of rats and 6 novel ESTs and 1 known gene, the rat lipoprotein lipase (LPL) gene from their visceral adipose tissue. The 2 novel genes (RS91 and RS2) from the renal tissue were both very similar to serine (or cysteine) proteinase inhibitor, clade F and eukaryotic translation initiation factor 3 and subunit 5 (EIF-3 epsilon). The expression of both novel genes and the LPL gene were upregulated in renal and visceral adipose tissue of type 2 diabetic and fat-enriched rats. Full-length cDNA of the novel gene RS91 was cloned in silico.</p><p><b>CONCLUSIONS</b>(1) The rat model of type 2 diabetes generated in this study was ideal because the disease in the animals closely mimicked type 2 diabetic patients. (2) cDNA RDA is a flexible, inexpensive, more accurate, sensitive and highly effective technique for identifying differences in gene expression. (3) Six novel ESTs and 1 known gene were obtained from rat visceral adipose tissue. The LPL gene was upregulated in adipose tissue of type 2 diabetic and fat-enriched rats, a result possibly related to the diabetic animals' high fat and calorie diet, lipidemia, insulin resistance (RI) and molecular pathogenesis. (4) Nine novel ESTs and 2 novel genes were obtained from the renal tissue of rat. We believe the 2 novel genes to be the serine proteinase inhibitors clade F and EIF-3 epsilon in rats. The upregulation of the 2 novel genes in renal tissue of type 2 diabetic rats and may have been related to their renal impairment.</p>
الموضوعات
Animals , Male , Rats , Adipose Tissue , Metabolism , Cloning, Molecular , Diabetes Mellitus, Type 2 , Metabolism , Expressed Sequence Tags , Gene Expression Profiling , Kidney , Metabolism , Oligonucleotide Array Sequence Analysis , Plasmids , Rats, Sprague-Dawley , Reverse Transcriptase Polymerase Chain Reaction , Visceraالملخص
Purpose: To observe the efficacy of combined chemotherapy of navelbine( NVB) and cisplatin ( DDP) plus concurrent palliative local radiotherapy in the treatment of stage M, nasopharngeal carcinoma( NPC). Methods: 21 cases of stage M, NPC received combined chemotherapy of NVB 25 mg/m2 on dl, d8 and DDP 30 mg/m2 on day 1-3. The therapy was repeated every 28 days. All patients were concurrenly treated with palliative radiotherapy for to the distant metastases areas. The radiotherapy dose varied from 15 to 60 Gy. Results: 1.The 1-, 2- and 3- year survival rates of the patients were 71.43%, 14.29% and 9.25% respectively. The median survival time ( MST) was 17 months. 2.The Cox Regression analysis showed that the effect of treatment and the liver invasion are significant prognostic factors. The survival rate is the highest in the patients with lung metastases. Conclusions: This scheme combined chemotherapy of NVB and DDP plus concurrent palliative local radiotherapy can improve the MST of the patients with stage M1 of NPC.
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Objective To compare the local control and survival rates of hyperfractionated radiotherapy plus concurrent chemotherapy with hyperfractionated radiotherapy alone in the treatment of stage Ⅲ-Ⅳ nasopharyngeal carcinoma (NPC).Methods Between December 1992 and December 1995, 150 NPC patients were randomized into hyperfractionated radiotherapy plus concurrent chemotherapy (R+C) and hyperfractionated radiotherapy alone (R alone) groups. Radiotherapy were similar in the two groups: 1.2 Gy/f, twice a day. Chemotherapy was given to R+C patients before and during the course of radiotherapy. Results The overall 5-year survival (OS), disease-free survival and distant metastasis-free survival rates were 57.3%, 55.9% and 55.9% . The 5-year survival rates of the R+C and R alone groups were 64.0% and 50.7%, with the difference statistically significant (P=0.037). One patient in the R+C group and 5 patients in the R alone group developed nasopharyngeal recurrence and the corresponding 5-year local control rates were 98.7% and 93.4%. The acute mucosal reaction in the R+C patients was severer than that of the R alone, but well tolerated and did not develop any severe complications. Conclusions Hyperfractionated radiotherapy plus concurrent chemotherapy can improve the local control and survival in patients with stage Ⅲ-Ⅳ nasopharyngeal carcinoma with well tolerated mucosal reactions. Chemotherapy gives greater benefit on the survival of stage Ⅳ patients.
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Objective To investigate the effect of Qingjing Capsule (QC) in treating advance menorrhea (AM) and to evaluate its safety. Methods Double- blind, double- imitating, parallel- controlled and randomized trial was performed in 63 cases of AM with deficiency- heat syndrome.Thirty- two cases was in QC group(Group A) and other 31 in Gujing pill group(Group B).The menstrual cycle, clinical symptoms and signs, basal body temperature (BBT), serum levels of estradiol (E2) and progesterone and endometrium biopsy were observed to evaluate the effects of QC. Results The short- term markedly- effective rate was 90.63% and 77.42% and the short- term effective rate was 96.88% and 93.55% in Group A and Group B respectively. The long- term markedly- effective rate was 83.87% and 67.74% and the long- term effective rate was 93.55% and 80.65% in Group A and Group B respectively. The long- term markedly- effective rate in QC group is superior to that in Gujing pill group, the differences being significant(P
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Objective To investigate the difference of gene expression in the visceral adipose tissue of the lean type 2 diabetic rats. Methods The difference bands were generated by the representational difference analysis ( cDNA RDA) ; the final difference products was ligated into the pUC-18 vector, subcloned and sequenced, and the obtained expressed sequence tags ( ESTs) were given bioinformatics analysis, and then the expression level of known gene was verified by semi-quantitative RT-PCR preliminarily. Results Six novel ESTs and 1 known gene [ rat lipoprotein lipase ( LPL) gene) were obtained in visceral adipose tissue of rat. One of the ESTs was partially similar to mouse musculus ERA-like GTPase (Era) gene. LPL gene was up-regulated in the visceral adipose tissue of the lean type 2 diabetic rats and those fed with fat-enriched food. Conclusion Six novel ESTs and 1 known gene in high expression are obtained from visceral adipose tissue of rat. LPL gene among them is up-regulated and may be related to the high fat and high calorie diet, hyperlipidemia, insulin resistance and molecular pathogenesis of the lean type 2 diabetic rat.