Machine learning in medicine: what clinicians should know

With the advent of artificial intelligence (AI), machines are increasingly being used to complete complicated tasks, yielding remarkable results. Machine learning (ML) is the most relevant subset of AI in medicine, which will soon become an integral part of our everyday practice. Therefore, physicians should acquaint themselves with ML and AI, and their role as an enabler rather than a competitor. Herein, we introduce basic concepts and terms used in AI and ML, and aim to demystify commonly used AI/ML algorithms such as learning methods including neural networks/deep learning, decision tree and application domain in computer vision and natural language processing through specific examples. We discuss how machines are already being used to augment the physician's decision-making process, and postulate the potential impact of ML on medical practice and medical research based on its current capabilities and known limitations. Moreover, we discuss the feasibility of full machine autonomy in medicine.

Research progress of mesenchymal stem cells therapy for right heart failure associated with pulmonary arterial hypertension / 中华胸心血管外科杂志

Pulmonary hypertension is a progressive disease characterized by pulmonary vascular remodeling and eventually develops into right heart failure, which seriously affects the quality of life and safety of patients. Traditional drug therapy can alleviate disease progression, but the prognosis is poor.Mesenchymal stem cells have been shown to be effective in experimental pulmonary hypertension and right heart failure, which is an important research direction in the future.In this paper, the research progress of mesenchymal stem cells in pulmonary hypertension and right heart failure is reviewed.

Chitinase-3-like protein 1 plays a role in lumbar facet joint degeneration / 中华骨科杂志

Objective:To investigate the effect of CHI3L1 on the biological function of chondrocytes and its role in lumbar facet joint degeneration.Methods:The human lumbar facet joint articular cartilage were collected, and the relative mRNA expression of CHI3L1 gene detected by quantitative fluorescence PCR. Then explored the correlation between joint degeneration and gender, age and relative mRNA expression of CHI3L1. Human chondrocytes were cultured in vitro. The effects of CHI3L1 on chondrocyte proliferation, cycling, and apoptosis, as well as expression of related inflammatory factors, were investigated. The mechanism by which CHI3L1 regulates the degeneration of articular cartilage was investigated using the signal transduction pathway protein chip.Results:There was a positive correlation between the grade of degeneration in lumbar facet joint and the relative expression of CHI3L1 gene mRNA ( r=0.76, P<0.001). There was no correlation with the patient's gender ( r=-0.12, P=0.500). A positive correlation between the age of patients and the relative expression of CHI3L1 gene mRNA was found ( r=0.47, P=0.005). Compared with the non-degenerative group, the expression of CHI3L1 gene mRNA significantly increased in the degenerative group, and the expression of CHI3L1 gradually increased with the aggravation in the grade of degeneration ( F=18.90, P<0.001). Compared with the non-degenerative group, the chondrocytes in the CHI3L1 group had significantly lower proliferation at 48 h (OD 490/fold=7.132), 72 h (OD 490/fold=4.803), 96 h (OD 490/fold=2.431) and 120 h (OD 490/fold=0.009). The ratio of chondrocytes in G1 phase, S phase and G2/M phase were 85.03%±3.05%, 12.78%±2.29% and 0.90%±0.76% in the CHI3L1 group, and 73.93%±2.73%, 22.81%±1.93% and 0.99%±0.87% in control group, respectively. There were significant differences in the percentage of chondrocytes in G1 phase ( t=4.70, P<0.001) and S phase ( t=5.80, P<0.001) between the two groups. The percentages of apoptosis in chondrocyte in CHI3L1 group and control group were 8.64%±0.76% and 5.68%±1.13%, which has a statistically difference ( t=4.47, P<0.001). The expression of IL-6 in chondrocytes of CHI3L1 group was 49.60±0.01 pg/ml, which was higher than that of 47.88±0.01 pg/ml in the control group ( t=132.70, P<0.001). The expression of TNF-α was 95.93±0.02 pg/ml, which was higher than 90.69±0.02 pg/ml in the control group ( t=376.10, P<0.001). There was significant difference in expression of IL-6 in chondrocytes between the CHI3L1 group and the control group ( t=132.72, P<0.001). The expression of TNF-α ( t=376.10, P<0.001) was statistically difference. Protein chip detected 53 proteins with significant differences in expression and 43 proteins with significant differences in protein phosphorylation levels. Bioinformatics analysis was used to identify 16 signaling pathways in which the above different proteins might be involved, including ErbB, PI3K, Akt, Ras, JAK, STAT3, MAPK pathway. In the MAPK pathway, the expression of MAPK1 and RAF1 proteins was higher in the chondrocytes of the CHI3L1 group than in the control group (1.094±0.00 vs. 0.814±0.00, 0.988±0.00 vs. 0.786±0.00; t=103.16, P<0.001; t=54.32, P<0.001). Compared with the control group, the expression of MAPK1 and RAF1 proteins was significantly increased in the chondrocytes of the CHI3L1 group. Conclusion:The expression of CHI3L1 is corrected to articular cartilage degeneration. CHI3L1 is able to inhibit the proliferation of articular chondrocytes, which regulated the cycling of chondrocytes from G1 phase to S phase, promote the apoptosis of chondrocytes, and promote the expression of IL-6 and TNF-α in chondrocytes. Regulation of chondrocytes biological function through the MAPK pathway, which is a potential biomarker for the clinical diagnosis and treatment of lumbar joint degeneration.

Effects of cyclic tensile stress on biological function and degeneration of nucleus pulposus cells / 中华骨科杂志

Objective:To investigate the effects of cyclic tensile stress on the function and degeneration of nucleus pulposus cells.Methods:The human primary nucleus pulposus cells were isolated and cultured. The cyclic tensile stress (100 000 μ?, 10% tensile strain, 0.1 Hz, 8 640 cycles) was loaded on the cells for 24 h. The proliferation of the cells was examined by MTT method. The cell cycle and apoptosis were detected through flow cytometry. Gene expression profile chip was used to detect the differentially expressed genes between the tensile stress group and control group. The function of these gene was analyzed by bioinformatics. The expression of inflammatory related factors, TGF-β, matrix degrading enzymes and extracellular matrix molecules were examined by qRT-PCR.Results:The cyclic tensile stress significantly promoted proliferation and cell cycle of nucleus pulposus cells. The cell percentage of S phase ( t=5.336, P<0.05) and G2/M phase ( t=7.288, P<0.01) was significantly different between the tensile stress group and control group. The cyclic tensile stress inhibited apoptosis of nucleus pulposus cells (8.56%±0.48% vs 10.63%±0.32%, t=4.474, P<0.05). A total of 866 differentially expressed genes were detected. Gene ontology analysis showed the roles of these genes in cells including focal adhesion, extractable matrix, membrane raft, condensed chrome kinetochore, cytoskeleton, etc. The cyclic tensile stress significantly affected the mRNA expression of inflammatory related factors, TGF-β genes, matrix proteinase and extracellular matrix molecules. Compared with the control group, the mRNA expression of inflammatory related factors IL15 ( t=5.379, P<0.05), IGF1 ( t=5.454, P<0.05) and IGFBP7 ( t=13.57, P<0.01) were significantly decreased in the tensile stress group; The mRNA expression of TGF-β genes TGFB1 ( t=6.931, P<0.05), TGFB2 ( t= 15.56, P<0.01) and TGFB3 ( t=7.744, P<0.05) were significantly increased in the tensile stress group; The mRNA expression of matrix proteinase ADAMTS3 ( t=5.241, P<0.05) and MMP19 ( t=24.72, P<0.01) were significantly decreased, and TIMP3 ( t=8.472, P<0.01) increased in the tensile stress group; The mRNA expression of extracellular matrix molecules COL2A1 ( t=5.871, P<0.05), FLRT2 ( t=5.216, P<0.05) and FN1 ( t=4.289, P<0.05) were significantly increased. Conclusion:The cyclic tensile stress promoted cell cycle and proliferation and inhibited apoptosis of nucleus pulposus cells. The cyclic tensile stress may affect the function and degeneration of nucleus pulposus cells by regulating the expression of inflammatory related factors, TGF-β, matrix degradation enzymes and ECM molecules.

Protective effect of Rhubarb on newborn rats with bronchopulmonary dysplasia / 中华实用儿科临床杂志

Objective To investigate the effect of Rhubarb on bronchopulmonary dysplasia(BPD) and its potential mechanism.Methods Neonatal Sprague-Dawley rats (postnatal day 4) were exposed to 600 mL/L 02 to induce BPD.The experimental rats were randomly divided into 4 groups with 16 in each group:air + saline group,air +Rhubarb (600 mg/kg)group,and hyperoxia + saline group,and hyperoxia + Rhubarb group.The rats were sacrificed and lung tissues were obtained on day 14 and 21 after birth.Hematoxylin-easin staining was used to detect the pathomorphology of the lungs.Apoptosis of the lung tissue was detected by means of TdT-mediated dUTP nick-end labeling (TUNEL).The expression of Fas was detected by adopting Western blot.The activity of Caspase-8 and Caspase-3was detected by using spectrophotometer.Results The lung structure of rats was markedly abnormal (decreased,enlarged and simplified alveoli) after being exposed to hyperoxia at any time point.The apoptosis indexes (39.91 ± 1.91vs.10.11 ± 1.64,48.80 ± 4.51 vs.12.90 ± 3.18),the expression levels of Fas (0.47 ± 0.02 vs.0.21 ± 0.01,0.55 ±0.02 vs.0.22 ±0.01) and the activities of Caspase-8 (52.59 ± 1.23 vs.40.74 ± 1.08,60.20 ± 3.48 vs.40.39 ±2.47) and Caspsase 3 (57.17 ± 1.88 vs.42.00 ± 1.19,64.57 ± 2.79 vs.41.54 ± 1.27) were all increased in the hyperoxia + saline group compared with those in the air + saline group on day 14 and 21,and the differences were statistically significant(all P ＜ 0.001).However,compared with the hyperoxia + saline group,Rhubarb administration dramatically decreased pulmonary apoptosis index (26.49 ± 2.65 vs.22.97 ± 3.66),Fas protein level (0.27 ± 0.03 vs.0.31 ± 0.01) and the activity of Caspase-8 (32.70 ± 2.69 vs.30.66 ± 4.48) and Caspase-3 (44.94 ± 1.60 vs.44.59 ± 1.66),and the differences were statistically significant (all P ＜ 0.001).Meanwhile,lung damage after hyperoxia was significantly attenuated in the hyperoxia + Rhubarb group.Conclusion Rhubarb can reduce the hyperoxic lung injury of BPD by reducing the apoptosis of newborn rat lung tissue cells,and the mechanism may involve the apoptosis pathway of Fas.

Can Robots Accelerate the Learning Curve for Surgical Training? An Analysis of Residents and Medical Students

Surgical traineeship has traditionally been based on a master apprentice model where learning takes place in the operating theatre. This approach has changed over the past few years with greater emphasis on surgical training taking place within the surgical skills laboratory. We developed a high fidelity simulator, the Image-guided Robotic Assisted Surgical simulator (IRAS) with an incorporated robotic guidance feature. The robot system is developed to mimic the process of an experienced surgeon physically holding a trainee's hands to demonstrate maneuvering of the laparoscopic instruments. We aimed to assess the efficacy of incorporating robotic guidance into this high fidelity surgical simulator. Forty-two participants (13 surgical residents and 29 medical students) were recruited. Participants had one practice run for familiarisation and subsequently performed the virtual laparoscopic cholecystectomy (LC) once. Among the medical students, they were ransomised to either a control or intervention group. They were tasked to perform a second- and third-timed LC assessment. Participants were asked to rate the simulator using a 5-point Likert scale Questionnaire. IRAS rated favourably in hand-eye coordination and training bimanual dexterity (mean score: 4.1 and 4.0 among students, 3.4 and 3.4 among residents) though it faired suboptimally in realism. At baseline, residents were statistically faster compared to students (overall time: 418.9 vs 586.8 seconds,= 0.001). Participants randomised to the intervention group consistently scored better. However, their overall time were not statistically significant from the control group. The robotic guidance capability of the IRAS is a key advantage of this simulator platform over the conventional platform.

The prognostic value of the international prognostic index, the national comprehensive cancer network IPI and the age-adjusted IPI in diffuse large B cell lymphoma / 中华血液学杂志

Objective@#To explore the prognostic value of the international prognostic index (IPI), the national comprehensive cancer network IPI(NCCN-IPI)and the age-adjusted IPI (aa-IPI) in diffuse large B cell lymphoma.@*Methods@#A total of 311 patients with de novo diffuse large B-cell lymphoma (DLBCL) diagnosed from 2003 to 2012 in Nanfang hospital were included. All patients were divided into CHOP (cyclophosphamide, vincristine, doxorubicin, and prednisone) and R-CHOP (rituximab, CHOP) groups. Survival analysis was compared among IPI, NCCN-IPI and aa-IPI models. Discrimination of three different prognostic models was assessed using the Harrell’s C statistic.@*Results@#A total of 311 patients were analyzed. Among them, 128 patients were treated with CHOP regimen and other 183 patients were treated with R-CHOP regimen. In CHOP groups, both NCCN-IPI (5-year OS: 59.7% vs 26.8%, P<0.001) and aa-IPI (5-year OS: 71.0% vs 25.0%, P<0.001) showed better risk stratification for low-intermediate and high-intermediate group than the IPI (5-year OS: 47.6% vs 36.6%, P=0.003). However, in the patients treated with R-CHOP, NCCN-IPI showed better risk stratification in low, low-intermediate, high-intermediate groups (5-year OS: 96.0% vs 83.0% vs 66.5%, P=0.009). According to the Harrell’s C statistic, C-index of IPI, NCCN-IPI and aa-IPI for overall survival (OS) were 0.546, 0.667, 0.698 in CHOP group and 0.611,0.654, 0.695 in R-CHOP group respectively. In patients younger than 60 years old, C-index of IPI, NCCN-IPI and aa-IPI for OS were 0.534, 0.675, 0.698 in CHOP group and 0.584, 0.648, 0.695 in R-CHOP respectively.@*Conclusion@#The NCCN-IPI is more powerful than IPI and aa-IPI in DLBCL patients receiving R-CHOP. aa-IPI is a preferable model in predicting prognosis than IPI and NCCN-IPI in anthracycline-based chemotherapy without rituximab.

The predictive value of continuous aEEG monitoring for neurodevelopmental outcome in infants with hypoxic ischemic encephalopathy receiving hypothermia treatment / 中国新生儿科杂志

Objective To study the predictive value of continuous amplitude-integrated electroencephalogram (aEEG) monitoring for the neurodevelopment outcome in infants with hypoxic-ischemic encephalopathy (HIE) receiving hypothermia treatment.Method From April 2014 to May 2016,neonates admitted to our NICU with HIE receiving hypothermia treatment were continuously monitored using aEEG for 96 h,and assigned into moderately and severely abnormal groups according to aEEG results.The aEEG results before hypothermia treatment,within 24 h,48 h,72 h and 96 h after hypothermia treatment were recorded.The Bayley Scales of Infant Development Ⅱ examination was performed at 6 months of age.The sensitivity,specificity,positive and negative predictive values and Youden's index of aEEG for poor outcome at these timepoints was compared.Result A total of 30 neonates were enrolled.Among them 13 were moderately abnormal and 17 were severely abnormal.The gender,gestational age,birth weight and delivery method between two groups were similar (P ＞ 0.05).The 1 min Apgar score,arterial pH,base excess (BE) were significantly lower in the severely abnormal group (P ＜ 0.05).The neurodevelopment assessment at 6 months of age showed unfavorable outcomes in 16 cases,while the remaining 14 cases had generally good outcomes.The sensitivity and specificity of aEEG before hypothermia treatment for the prediction of poor outcome was 81.3％ and 71.4％ respectively.The sensitivity and negative predictive values of aEEG within 24 and 48 after hypothermia treatment for poor outcome was 100％.The Youden's index of aEEG within 72 h after hypothermia treatment for abnormal outcome was the highest 0.661.Conclusion The aEEG before hypothermia treatment alone is not a reliable indicator of poor outcomes in HIE neonates.The aEEG within 72 h after hypothermia is better.Continuous aEEG monitoring during hypothermia in HIE infants is very important because it provides reliable prediction of outcome.

Regulation of rhubarb on heat shock protein 70 expression and lung protection in rats with hyperoxia-induced new bronchopulmonary dysplasia / 中国小儿急救医学

Objective To investigate the effect of rhubarb on hyperoxia-induced new bronchopulmo-nary dysplasia ( BPD) in rats. Methods Full-term Sprague-Dawley rats were exposed or not ( control group) in 600 ml/ L oxygen 4 days after birth and injected with normal saline (BPD group),rhubarb (BPD+ rhubarb group) or a combination of rhubarb with quercetin (BPD + rhubarb + quercetin group). Immuno-histochemical staining was used to detect the pathological changes of the rat lungs. HSP70 expression level was quantified by western blot. Results Compared with control group,BPD group showed decreased radial alveolar 14 and 21 days after the drug treatment,which was rescued by the coexistence of rhubarb. Quercetin, as an inhibitor of HSP70,counteracted the effect of rhubarb. The lung of the BPD + rhubarb + quercetin group showed a similar phenotypic change with that of the BPD group. In addition,the expressions of HSP70 in lung tissues of rhubarb group at 14 days and 21 days after the treatment were higher than those of other groups, there were significant differences between rhubarb group and other groups(F = 62. 46,P < 0. 01;F = 95. 90, P < 0. 01). Conclusion Rhubarb may attenuate the hyperoxia-induced new bronchopulmonary dysplasia in rats by activating HSP70 expression.

Study progress of near-infrared spectroscopy in neonatal necrotizing enterocolitis / 中华实用儿科临床杂志

Near-infrared spectroscopy(NIRS) is a technique for continuous,noninvasive,bedside monitoring of inadequate tissue perfusion and oxygenation.Intestinal ischemia is an important pathophysiologic in mucosal injury and the development of necrotizing enterocolitis (NEC).So somebody thinks that NIRS might be a useful tool to diagnose the earliest stages of NEC and to predict its progression.This review will describe the feasibility,safety,sensor location and associated research result of NIRS in NEC.

Rodent brain extraction using B-spline based deformable model.

Accurate rodent brain extraction is one of the basic steps for many translational study using Magnetic Resonance Imaging (MRI). In this paper, we present a new approach to model the rodent brain variation using non-rigid B-spline image registration for the brain extraction in MRI images. We model the shape and appearance with the B-spline parameters together with a mean brain image. Followed by a method using multi-expert, we refine the brain extraction region. Compared with the image-based template model using cross-correlation, the performance for rodent brain extraction has shown much improvement on one data set while maintaining the similar yet more consistent performance for another. Both template based methods however outperform the voxel based method (3D PCNN) and a modified BET version for rodent brain extraction.

Epidemiology investigation on capillary leakage syndrome in critically ill newborns / 中国小儿急救医学

Objective To investigate the clinical features of capillary leakage syndrome ( CLS ) occurring in critically ill newborns in Guangzhou. Methods Three tertiary hospitals in Guangzhou were chosen as research field;critically ill newborns with diagnosis as CLS in NICU of three hospitals were retro-spectively studied from January 2011 to December 2015; and the morbidity,mortality,causes,treatment and outcome of CLS neonates were analyzed. Results There were 49 cases diagnosed as CLS, accounting for 1. 62%(49/3 029)of the total number of critically ill newborns admitted to NICUs in the same period. The common primary factors were preterm low birth weight(34 cases,69. 4%),respiratory distress syndrome(38 cases,77. 5%),congenital anomaly(19 cases,38. 8%),asphyxia(17 cases,34. 7%),and intrauterine infec-tion(12 cases,24. 5%). The 83. 7%(41/49) of CLS occurred within 72 hours after admission. The overall mortality of CLS was 30. 6%( 15/49 ) . The main lethal cause was multiple organ dysfunction syndrome (60. 0%,9/15). Treatment included antibiotics,vasoactive drugs,fluid resuscitation,corticosteroids,and me-chanical ventilation. Conclusion CLS is a common critical illness in NICU with high mortality and poor prognosis. Early prediction and early intervention could improve survival and prognosis in critically ill neonates with CLS.

Risk factors for ligamentum flavum hypertrophy in lumbar spinal stenosis patients from the Xinjiang Uygur Autonomous Region, China: protocol for a retrospective, single-center study / 中国组织工程研究

BACKGROUND: Ligamentum flavum hypertrophy is one important cause of spinal stenosis. Ligamentum flavum thickness of more than 4 mm measured on computed tomography (CT) and magnetic resonance imaging is considered hypertrophy, but causes of hypertrophy and distribution characteristics remain poorly understood. Previous studies showed that the ligamentum flavum thickness at the segments L2/3, L3/4, L4/5 and L5/S1 was positively correlated with age.It remains unclear whether ligamentum flavum thickness is associated with nationality, sex and obesity. OBJECTIVE: To retrospectively analyze the risk factors for ligamentum flavum hypertrophy in lumbar spinal stenosis patients from the Xinjiang Uygur Autonomous Region, China.METHODS: We conducted a retrospective, single-center, case analysis at the Sixth Affiliated Hospital, Xinjiang Medical University, China. We collected lumbar CT imaging data of 104 patients diagnosed with lumbar spinal stenosis in the Sixth Affiliated Hospital, Xinjiang Medical University from May 2012 to May 2016. The primary outcome was the ligamentum flavum thickness of patients with different nationalities, sexes, heights, ages, and weights. The secondary outcomes were the morphology of lumbar vertebrae in patients with different nationalities, sexes, heights, ages, and weights; the correlation of nationality, sex, height, age, and weight with ligamentum flavum thickness; results of multiple linear regression analysis of relevant factors for ligamentum flavum hypertrophy. This trial has been registered at clinical Trials.gov (indentifier: NCT03057353). This protocol has been approved by the Medical Ethics Committee of Xinjiang Medical University and will be performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Signed informed consent regarding trial procedure and treatment will be obtained from each participant.DISCUSSION: This study will determine the variations in the ligamentum flavum thickness of lumbar spinal stenosis patients of different nationalities, sexes, heights, ages, and weights in the Xinjiang Uygur Autonomous Region by measuring the ligamentum flavum thickness using CT, and analyzing risk factors for ligamentum flavum hypertrophy; the findings will provide quantitative reference data for preventing lumbar spinal stenosis induced by ligamentum flavum hypertrophy in the Xinjiang Uygur Autonomous Region.

Thoracolumbar pedicle anatomy in Han and Uygur male population in Xinjiang Uygur Autonomous Region: a computed tomography-based morphometric study / 中国组织工程研究

BACKGROUND: Thoracolumbar segments (T11-L2) prone to damage due to its special anatomical and biomechanical characteristics. Therefore, fully understanding the shape of pedicle of vertebral arch and finding the visible, constant, and the point of insertion of the pedicle axis is very important to the safety of pedicle screw placement.OBJECTIVE: To measure the surgically relevant parameters of thoracolumbar pedicles between Han and Uygur males using computed tomography (CT) scan to provide some anatomic reference data for pedicle screw fixation.METHODS: The vertebral bodies and pedicles of adult males were scanned (60 cases of Han people and 60 cases of Uygur people) from T10-L3 with CT. The parameters were processed by three-dimensional reconstruction. Transverse pedicle width, pedicle axis length, transverse pedicle angle, and sagittal pedicle angle were measured by using length and angle measurement tool of browser in bone-window CT images. The age and stature information were recorded. All the data above were processed by SPSS 13.0 software.RESULTS AND CONCLUSION: (1) The mean transverse pedicle width of T12 and L1 in Han was bigger than that in the Uygur. (2) The mean transverse pedicle angle of T12 and L2 in Han was bigger than that in the Uygur. (3) The mean pedicle axis length and sagittal pedicle angle of T11 and L1 in Han were bigger than that in the Uygur (P < 0.05). (4) There were some differences among some parameters of the thoracolumbar pedicles between the Han and Uygur people.Data from any study only can be used as a guide for pedicle screw fixation. Preoperative CT evaluation may provide an individualized strategy to reduce the incidence of postoperative complications caused by misplacement.

Analysis of the risk factors of persistent pulmonary hypertension in neonates / 中华实用儿科临床杂志

Objective To investigate the high risk factors of persistent pulmonary hypertension (PPHN) in preterm and full-term neonates.Methods Fifty-six newborns with PPHN were divided into preterm neonates group and the full-term neonates group according to their gestational ages.The relationship between PPHN and high risk factors such as the primary diseases,mother's complications during pregnancy,and the prognosis were analyzed retrospectively in each group.A retrospective review of lung samples of 3 neonates who died of respiratory failure were carried out.Results Thirty-one (55.36％) out of 56 neonates with PPHN including 27 preterm and 29 full-term newborns had parenchyma diseases.The first and the second primary diseases were meconium aspiration syndrome (MAS,9/29 cases,31.03％) and congenital heart diseases (8/29 cases,27.59％) in the full-term group,and respiratory distress syndrome (RDS,16/27 cases,59.26％) and infection (8/27 cases,29.63％) in preterm group,respectively.There were 15 cases (55.56％) whose mothers had complications during pregnancy among the 27 preterm neonates,and 8 ca ses (27.59％) among the 29 full-term neonates.The morbidity of mothers' complications during pregnancy in preterm neonates was higher than that in full-term neonates (x2 =4.519,P =0.034).The mortality rate was 33.33％ (9/27cases) in the preterm neonates group while 27.59％ (8/29 cases) in the full-term neonates group.There was no significant difference in mortality rate between each group (x2 =0.218,P =0.640).The primary diseases were RDS (9/9cases,100％) and MAS (4/8 cases,50％) in preterm and full-term neonates who died of PPHN,respectively.One case of pulmonary hypertensive vascular remodeling,1 case of alveolar capillary dysplasia (ACD) and 1 case of interstitial pneumonia were found in 3 lung samples of neonates died of PPHN.Conclusions The ratio of preterm increased in neonates with PPHN.RDS and infection were the first two primary diseases in preterm neonates with PPHN.MAS was the first primary disease in full-term neonates with PPHN.Primary pulmonary hypertension should be considered for neonates with severe PPHN.

Effects of hypothermia therapy on coagulopathy in neonates with hypoxic-ischemic encephalopathy of diffe-rent degrees / 中华实用儿科临床杂志

Objective To study the effects of hypothermia therapy on coagulopathy in neonates with hypoxic-ischemic encephalopathy(HIE) of different degrees.Methods Twenty-five newborns with HIE were divided into 2 groups (moderate HIE group and severe HIE group) by amplitude integrated electroencephalogram(aEEG).The platelet (PLT) count,activated partial thromboplastin time (APTT),prothrombin time(PT),thrombin time(TT),fibrinogen (Fbg) and international normalized ratio (INR) were measured before hypothermia therapy and those after 24 hours,48 hours,72 hours after hypothermia therapy were collected.The hematological parameters of 2 groups were analyzed by repeated measurement analysis of variance.Results The APTT(t=2.239,P0.05)showed no statistically significant difference between 2 groups after hypothermia therapy.The differences in INR(F=12.470,P0.05) between 2 groups.The differences in PLT(F=32.420,P0.05).But the degree of brain injury and time had interactive effects in PT(F=3.374,P0.05).Conclusion The coagulopathy function is worse in neonates with severe HIE in hypothermia therapy which may aggravate the hemorrhage risk.And the effect of hypothermia on neonates with moderate HIE is less evident.So hierarchical intervention on coagulopathy in neonates with HIE during hypothermia should be adopted to relieve the hemorrhage risk.

Template based rodent brain extraction and atlas mapping.

Accurate rodent brain extraction is the basic step for many translational studies using MR imaging. This paper presents a template based approach with multi-expert refinement to automatic rodent brain extraction. We first build the brain appearance model based on the learning exemplars. Together with the template matching, we encode the rodent brain position into the search space to reliably locate the rodent brain and estimate the rough segmentation. With the initial mask, a level-set segmentation and a mask-based template learning are implemented further to the brain region. The multi-expert fusion is used to generate a new mask. We finally combine the region growing based on the histogram distribution learning to delineate the final brain mask. A high-resolution rodent atlas is used to illustrate that the segmented low resolution anatomic image can be well mapped to the atlas. Tested on a public data set, all brains are located reliably and we achieve the mean Jaccard similarity score at 94.99% for brain segmentation, which is a statistically significant improvement compared to two other rodent brain extraction methods.

Expression of transcription factor CASZ1 and its relationship with pulmonary microvascular development in newborn rats after hyperoxia-exposure / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore the expression of CASZ1 and its relationship with the pulmonary microvascular development in lung tissue of newborn rats exposed to hyperoxia which induced bronchopulmonary dysplasia (BPD).</p><p><b>METHOD</b>Forty-eight newborn Sprague Dawley(SD) rats (male and female unlimited) were randomly divided into two groups: experimental group and control group according to random digits table with 24 in each.The rats in experimental group were exposed to high oxygen volume fraction of 800 ml/L and the rats in control group were exposed to normal air. Eight rats were randomly selected from each group on day 3 and 7 after oxygen exposure.The sections of lung were stained with HE method in order to assess lung histological changes, the alveolar development was evaluated by the number of radial alveolar count (RAC) and septal wall thickness. CD31 was detected by immunohistochemistry (IHC) method and the capillary density was calculated. The location, distribution and expression of CASZ1 in the lung tissue were detected by the immunohistochemistry, Western blotting, and quantitative PCR (qPCR).</p><p><b>RESULT</b>(1) Stained by HE, lungs of experimental group showed destroyed alveoli, alveoli fusion and increased septal wall thickness, RAC were significantly lower than those in control group(14 d: septal wall thickness (12.69 ± 0.63) μm vs. (6.53 ± 0.16) μm, RAC 5.9 ± 0.4 vs. 8.4 ± 1.0, t = 19.046, 4.760, P both = 0.000). (2) CD31 protein was expressed predominantly in cytoplasm of pulmonary microvascular endothelial cells. The experimental group CD31 average optical density (AIOD) were decreased compared with control group((16.6 ± 1.6) × 10(3) vs.(40.1 ± 2.4) × 10(3), (18.1 ± 1.4) × 10(3) vs.(83.2 ± 5.2) × 10(3), (49.2 ± 5.4) × 10(3) vs.(136.2 ± 28.1) × 10(3), t=16.185, 16.066 and 6.078, P<0.01 for all comparisons). Capillary density in experimental group was also significantly decreased compared with control group ((3.84 ± 0.15)% vs.(6.01 ± 0.22)%, (4.17 ± 0.38)% vs.(6.15 ± 0.24)%, (5.43 ± 0.44)% vs. (9.13 ± 0.25)%, t = 16.124, 8.773 and 14.076, P all < 0.01). (3)RT-qPCR and Western blotting showed that the CASZ1 mRNA significantly increased in experimental group compared with control group(0.56 ± 0.17 vs. 1.00 ± 0.26, 0.32 ± 0.29 vs. 0.58 ± 0.14, 0.14 ± 0.22 vs. 0.56 ± 0.15, t=3.890, 3.303 and 2.388, P < 0.05 for all comparisons), and the protein expression of CASZ1 also significantly increased in experimental group compared with control group (0.65 ± 0.02 vs. 0.78 ± 0.23, 0.46 ± 0.03 vs. 0.75 ± 0.05, 0.34 ± 0.22 vs. 0.75 ± 0.04, t=6.200 and 10.485 and 14.998, P < 0.05 for all comparisons). (4)The protein level of CASZ1 in experimental group was positively correlated with capillary density (r=0.519, P<0.01).</p><p><b>CONCLUSION</b>CASZ1 is involved in the whole process of newborn rats BPD and may be linked to pulmonary microvascular dysplasia.</p>

Clinical outcomes of poly ether ether ketone rods and pedicle screw system for lumbar degenerative diseases / 中华骨科杂志

Objective To explore the reliability and validity of poly ether ether ketone (PEEK) rods and pedicle screw system for lumbar degenerative diseases.Methods Sixty-three patients,including 23 men and 40 women with the mean age of 56.2±5.1 years (range,35-75 years),treated by PEEK rods pedicle screw system from September 2012 to March 2013 were retrospectively recruited.Fusion procedure were performed in 10 patients,with 2 cases at L3,4,5 cases at L4,5,3 cases at L5S1; nonfusion procedure were performed in 17 patients,with 4 cases at L3,4,10 cases at L4,5,3 cases at L5S1; hybrid procedure were performed in 36 patients,with 22 case fusion at L4,5 and nonfusion at L3,4,with 2 cases fusion at L3,4 and nonfusion at L4,5,with 12 cases fusion at L5S1 and nonfusion at L4,5.Clinical effects were evaluated via Japanese Orthopedics Association (JOA) score and Oswestry disfunction index (ODI) at 3 months,6 months and 24 months postoperatively.Disc heights were measured by disc height index on lateral lumbar radiograph.Range of motion (ROM) was measured by extension-flexion lumbar X-ray.Three-dimensional CT reconstruction was achieved to observe the integrity of PEEK rods at the final follow-up.Results The mean follow-up were 23.4±3.3 months.The mean operation time were 110±17 min in the fusion group,98±22 min in the non-fusion group and 121±25 min in the hybrid group.The mean blood loss were 270±85 ml in the fusion group,255±72 ml in the non-fusion group and 316±80 ml in the hybrid group.The JOA score improved from 10.5±2.6 preoperatively to 24.0±3.1 at the final follow-up in the fusion group,from 10.3±2.2 to 24.3±3.4 in the non-fusion group and from 11.1±2.3 to 23.9±3.3 in the hybrid group (P＜0.05).The ODI decreased from 51.8％±10.3％ preoperatively to 14.1％±3.7％ at the final follow-up in the fusion group,from 52.2％±11.1％ to 13.2％±3.2％ in the non-fusion group and from 53.4％±9.2％ to 13.8％±2.5％ in the hybrid group.There was no significantly statistical difference in the disc height index at 3 months,6 months and 24 months postoperatively compared with that at preoperative.The ROM decreased from 8.8°±1.8° preoperatively to 2.2°±0.3° at the final follow-up (P＜0.05).One case demonstrated cage migration at one month follow-up,bony fusion in situ at 3 months follow-up,and the patient had no related symptoms during the follow-up.No screw loosening or breakage and rods breakage was observed during the follow-up.Conclusion PEEK rods and pedicle screw system for lumbar degenerative diseases by fusion,non-fusion and hybrid procedure can achieve considerable clinical outcome with low complication rate.

Quantification of coronary artery Stenosis by Area Stenosis from cardiac CT angiography.

Non-invasive cardiac computed tomography angiography (CTA) is widely used to assess coronary artery stenosis and give clinical decision-making support to clinicians. The severity of stenosis lesion is commonly graded by a range of percent Diameter Stenosis (DS), which can introduce false positive diagnoses or over-estimation, triggering unnecessary further procedures. In this paper, a system and the associate methods to quantify stenosis by the percent Area Stenosis (AS) from cardiac CTA is presented. In the process, coronary artery tree is segmented and the centerline is extracted by Hessian filtering and the minimal path method. After a serial of 2D cross-sectional artery images along the artery centerline are obtained, lumen areas are segmented by ellipse-fitting with deformable models, and consequently to compute the lesion's AS. Experimental results on 5 CTA data sets show that compared to DS, AS better correlates to the reference standard for stenosis quantification, suggesting the efficacy of the proposed system.