Establishing prediction model of community-acquired pneumonia complicated with acute respiratory distress syndrome based on artificial neural network / 中华危重病急救医学

Objective:To investigate the independent risk factors of community-acquired pneumonia (CAP) complicated with acute respiratory distress syndrome (ARDS), and the accuracy and prevention value of ARDS prediction based on artificial neural network model in CAP patients.Methods:A case-control study was conducted. Clinical data of 414 patients with CAP who met the inclusion criteria and were admitted to the comprehensive intensive care unit and respiratory department of Changzhou Second People's Hospital Affiliated to Nanjing Medical University from February 2020 to February 2021 were analyzed. They were divided into two groups according to whether they had complicated with ARDS. The clinical data of the two groups were collected within 24 hours after admission, the influencing factors of ARDS were screened out by univariate analysis, and the artificial neural network model was constructed. Through the artificial neural network model, the importance of input layer independent variables (that was, the influence factors obtained from univariate analysis) on the output layer dependent variables (whether ARDS occurred) was drawn. The artificial neural network modeling data pairs were randomly divided into training group ( n = 290) and verification group ( n = 124) in a ratio of 7∶3. The overall prediction accuracy of the training group and the verification group was calculated respectively. At the same time, the receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated. Results:All 414 patients were enrolled in the analysis, including 82 patients with ARDS and 332 patients without ARDS. Univariate analysis showed that gender, age, heart rate (HR), maximum systolic blood pressure (MSBP), maximum respiratory rate (MRR), source of admission, C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), neutrophil count (NEUT), eosinophil count (EOS), fibrinogen equivalent unit (FEU), activated partial thromboplastin time (APTT), total bilirubin (TBil), albumin (ALB), lactate dehydrogenase (LDH), serum creatinine (SCr), hemoglobin (Hb) and blood glucose (GLU) were significantly different between the two groups, which might be the risk factors of CAP patients complicated with ARDS. Taking the above 19 risk factors as the input layer and whether ARDS occurred as the output layer, the artificial neural network model was constructed. Among the input layer independent variables, the top five indicators with the largest influence weight on the neural network model were LDH (100.0%), PCT (74.4%), FEU (61.5%), MRR (56.9%), and APTT (51.6%), indicating that that these five indicators had a greater impact on the occurrence of ARDS in patients with CAP. The overall prediction accuracy of the artificial neural network model in the training group was 94.1% (273/290), and that of the verification group was 89.5% (111/124). The AUC predicted by the aforementioned artificial neural network model for ARDS in CAP patients was 0.977 (95% confidence interval was 0.956-1.000).Conclusion:The prediction model of ARDS in CAP patients based on artificial neural network model has good prediction ability, which can be used to calculate the accuracy of ARDS in CAP patients, and specific preventive measures can be given.

Diagnosis and management of gallbladder-duodenal fistula / 中华消化外科杂志

Gallbladder-duodenal fistula is a rare disease in clinical practice, and difficult to diagnosis. One patient with high suspicion of gallbladder-duodenal fistula in preoperative examination was performed with percutaneous transhepatic gallbladder drainage due to could not tolerate surgical operation, and gallbladder-duodenal fistula was diagnosed with the gastric and intestinal fluids extracted from the drainage tube. In the later of fistula repair and the patient′s nutritional support management, the jejunal nutrition tube is inserted through the bile duct, and then the nutrition support was performed through this jejunal nutrition tube. This patients was recovered well.

Three-dimensional imaging reconstruction of pancreatic head based on embryological fusion plane of the pancreas / 中华肝胆外科杂志

Objective:To construct a three-dimensional imaging model of the pancreatic head based on the embryological fusion plane, and to provide morphological parameters of the pancreatic head for future developments of basic and clinical researches on the pancreas.Methods:Histologic cross-sections of the pancreatic head with its adjacent structures were made from healthy cadavers. Immunohistochemical analysis of pancreatic polypeptide antibody was then performed to verify the existence and location of the embryological fusion plane reported previously. The histologically positioning method of the embryological fusion plane was then applied to the corresponding sections on computed tomography (CT). Based on the results of the above work, volunteers from the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University were then used as research objects. A three-dimensional visualization reconstruction software was used to perform CT image-based structures to include the abdominal pancreas, dorsal pancreas head, and embryo fusion surface. Three-dimensional reconstruction of the pancreatic head, and morphological measurements of the relevant structures of the pancreatic head were then made.Results:Immunohistochemical analysis verified the existence and the position of the embryological fusion plane. The histologically positioning method was then successfully applied to the CT sections. The three-dimensional imaging model of the pancreatic head containing the embryological fusion plane, dorsal segment and ventral segment of head were built based on CT images. A total of 35 volunteers were included, including 19 males and 16 females, aged (48.26±8.26) years, and with a BMI of (22.29±1.78) kg/m 2. The morphological results showed that the volume of the pancreatic head, dorsal pancreas and abdominal pancreas were (32.80±8.15) cm 3, (22.21±6.94) cm 3, (10.59±3.87) cm 3, and the area of the embryo fusion surface was (12.46±3.20) cm 2. All volunteers were then grouped according to gender. Statistical analysis showed that there were no significant differences in the total pancreatic head volume, dorsal pancreatic head volume, abdominal pancreatic volume, and embryo fusion area among the groups ( P>0.05). Conclusions:It was feasible and practical to build a three-dimensional imaging model of the pancreatic head based on the embryological fusion plane by using a 3D computer system. This model and its morphological parameters could provide a new tool for research on pancreas.

The safety and effectiveness of yttrium-90 radioembolization for hepatocellular carcinoma with portal vein tumor thrombosis / 中华普通外科杂志

Objective To assess the safety and effectiveness of yttrium-90 (90Y) radioembolization for patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT).Methods The PubMed was searched for all clinical reports from 1991 to 2017.Results A total of 17 clinical studies including 662 patients were qualified for the analysis.The median time to progression was 5.8 months,and median disease control rate was 68.4％.The median survival was 10 months in all patients,including the median OS of 13.8,6.5 months of Child-Pugh class A and B patients,respectively,the median OS were 13.4,5.4 months respectively in branch and main PVTT patients,and the median OS were 3.7,9.5 months of patients who received resin and glass based microspheres,respectively.The median radioembolization induced liver disease was 36.3％.The median abdominal pain,nausea/vomiting,fatigue,and fever were 18.8％,17.6％,11.1％,and 1.4％.Conclusion 90y radioembolization is an effective treatment for HCC and PVTT,which is an alternative treatment choice for HCC and PVTT.

Classification and management progress of isolated mesenteric artery dissection / 中华胸心血管外科杂志

Isolated mesenteric artery dissection (IMAD) is not rare.Although there are five classification methods,all of them are based on imaging findings,and all have limitations.According to patient's symptoms,signs and imaging findings,the IMAD were divided into emergency and non-emergency types,and a management flow chart of IMAD is established according to this classification.The emergency type needs surgery or endovascular treatment immediately after the diagnosis,and conservative management to non-emergency patients.Majority of IMAD patients have stable disease after conservative treatment,and only a few patients with disease progression requiring invasive intervention,and endovascular stent placement should be the first choice of those patients.

Yttrium-90 radioembolization for unresectable liver metastases of melanoma:efficacy and safety / 中华肝胆外科杂志

Studies correlated with yttrium-90 ( 90 Y) radioembolization for unresectable liver metasta-ses of melanoma ( LMM) were analyzed during January 1st, 1991 to September 1st, 2018. A total of 9 reports involving 207 patients were included for the analysis. The most common primary site of melanoma was choroid, followed by cutaneous and rectal. A total of 199 cases were followed-up, and in 181 patient the complete response rate was 1. 1％(2/181), partial response rate was 18. 2％(33/181), stable disease rate was 46. 4％ ( 84/181 ) , and cancer control rate was 65. 7％ ( 119/181 ) . The median survival was 10 months. Complications were found in 42 cases (21. 5％, 42/195), including radioembolization induced liver disease ( n =39 ) , gastric ulceration ( n =2 ) , cholecystitis ( n =1 ) , and liver failure ( n =3 ) . Adverse reaction included fatigue ( 14. 3％ ～44. 0％) , nausea ( 6. 3％ ～23. 0％) , and abdominal pain (7. 0％ ～38. 0％). 90Y radioembolization is a promising alternative therapy for the treatment of unresectable LMM, with encouraging effects on disease control and survival. Some complications can occur, and adverse reaction are frequent but mild.

Yttrium-90 radioembolization for unresectable liver metastases of melanoma: efficacy and safety / 中华肝胆外科杂志

Studies correlated with yttrium-90 (90Y) radioembolization for unresectable liver metastases of melanoma (LMM) were analyzed during January 1st, 1991 to September 1st, 2018. A total of 9 reports involving 207 patients were included for the analysis. The most common primary site of melanoma was choroid, followed by cutaneous and rectal. A total of 199 cases were followed-up, and in 181 patient the complete response rate was 1.1%(2/181), partial response rate was 18.2%(33/181), stable disease rate was 46.4%(84/181), and cancer control rate was 65.7%(119/181). The median survival was 10 months. Complications were found in 42 cases (21.5%, 42/195), including radioembolization induced liver disease (n=39), gastric ulceration (n=2), cholecystitis (n=1), and liver failure (n=3). Adverse reaction included fatigue (14.3%~44.0%), nausea (6.3%~23.0%), and abdominal pain (7.0%~38.0%). 90Y radioembolization is a promising alternative therapy for the treatment of unresectable LMM, with encouraging effects on disease control and survival. Some complications can occur, and adverse reaction are frequent but mild.

Series review of radioembolization with yttrium-90 microspheres (Part Ⅳ): dose calculation of yttrium-90 microspheres / 介入放射学杂志

Accurate doses of yttrium-90 (90Y) microspheres are critical for the treatment of liver malignancies,because it is closely related to the clinical efficacy and adverse reactions.The dose calculationis primarily based on the type of ~Y delivery medium,whether it is glass microsphere (TheraSpheres) or resin microsphere (SIR-Spheres).The dose calculation of glass microspheres is based on the assumption that the expected radiation dose of the liver and the microspheres can be evenly distributed throughout the liver,while the dose calculation of resin microspheres is based on the assumption that the microspheres are not uniformly distributed throughout the liver,and the degree of this inhomogeneous distribution depends on the extent to which the normal liver is replaced by the tumor tissue.Many other factors may also potentially affect the therapeutic dose of 90Y microspheres.This review will introduce the calculation methods of 90Y microsphere dose,and describe the factors that need to be considered in order to achieve maximum efficacy and avoid adverse effects.

The identification of inferior vena cava filters by images / 介入放射学杂志

So far, more than 20 types of inferior vena cava filter(IVCF) are used in clinical practice. Although several IVCFs have been unavailable in the market, most of the IVCFs are still in use. Clinically, the retrievable IVCFs have been widely employed, but their removal rate is low. Long term indwelling of these IVCFs in patient's body can induce many complications. This paper aims to summarize the characteristics and imaging manifestations of the commonly used IVCFs, so as to improve their clinical application and followup observation with imaging, as well as to improve the ability in identifying IVCF type and in early detecting IVCF-related complications.

Side effects and complications of yttrium-90 radioembolization therapy for hepatic malignancies. A series review of radioembolizat(i)on with 90Y microspheres(part V) / 介入放射学杂志

Radioembolization with yttrium-90(90Y) microspheres is an alternative treatment choice for hepatic malignancies and has become incorporated into guidelines by many international oncology and other professional organizations. The tumoricidal effects of radioembolization are predominantly derived from its radioactivity rather than ischemia. Therefore, the overall side effects that have been associated with this therapy, such as fatigue, nausea and vomiting, which are mild but common. Occasionally, severe complications may occur due to incidental embolization of non-target tissue by the microspheres. This review describes in detail the manifestation of side effects and various complications that may be associated with radioembolization using 90Y microspheres. Management and treatment options of these potential adverse events will also be discussed briefly.