The application prospects and challenges of artificial intelligence in interventional radiology / 介入放射学杂志

With the gradual deepening of artificial intelligence(AI)research in the medical field,the workflow of interventional diagnosis and treatment will be greatly changed.This paper aims to make a detailed introduction about the application of AI in interventional diagnosis and treatment,focusing on the use of predictive model for the screening of high-risk patients,the selection of treatment options,the use of augmented reality(AR)technology for improving surgical treatment,the training of young physicians,etc.Besides,the difficulties and challenges currently encountered in the clinical practice of AI are also discussed.(J Intervent Radiol,2023,32:1251-1255)

Design and Verification of a COPD Screening Equipment Based on Dual-differential Pressure Throttling Technique / 中国医疗器械杂志

This study was to design a chronic obstructive pulmonary disease (COPD) screening equipment, based on the dual-differential pressure throttling technique. The technique combined a wide range, but low-resolution ratio sensor and a narrow range, but high-resolution ratio one. It can accurately detect the indexes of forced vital capacity (FVC), forced expiratory volume in one second (FEV), one second rate(FEV/FVC (%)), and achieve them in a low-cost way. The new designed machine will be compared with a British machine, named ML-3500. The correlations of FVC and FEV between new machine and ML-3500 were 0.998 and 0.999, respectively. The P values of paired test of these two indexes were over 0.05. Bland-Altman analysis of FVC, FEV and FEV/FVC (%) showed that more than 90% of the scatter points of the three parameters fell within the consistency interval. This machine can be used to accurately screen COPD and its low-cost would be advantage to promote in large population.

Intraoperative cerebral perfusion monitoring by evoked potential and transcranial doppler ultrasonography in carotid endarterectomy: a comparative study / 中华神经医学杂志

Objective To investigate the effectiveness of evoked potential in monitoring cerebral perfusion during carotid endarterectomy by a retrospective cohort study.Methods A retrospective cohort survey of clinical data of 59 patients,who underwent carotid endarterectomy in our hospital from September 2013 to December 2016,was performed.All patients were monitored by transcranial doppler ultrasonography (TCD) and somatosensory evoked potential (SEP),motor evoked potential (MEP) for changes of cerebral blood flow;the monitoring of TCD was defaulted as "gold standard",recording monitoring results at different time points.By drawing the four table,the sensitivity,specificity,positive predictive value,negative predictive value of SEP and MEP during cerebral hypoperfusion were calculated,and correlation analyses between SEP and TCD,and between MEP and TCD were performed.Through receiver operating characteristic (ROC) curve,SEP monitoring threshold of cerebral hypoperfusion was predicted.Results The sensitivity,specificity,positive predictive value,and negative predictive value of SEP in predicting intra-operative cerebral hypoperfusion were 60.00％,91.84％,60.00％,and 91.84％ when SEP amplitude declined beyond 50％;the sensitivity,specificity,positive predictive value and negative predictive value of SEP in predicting intra-operative cerebral hypoperfusion were 70.00％,93.88％,70.00％ and 93.88％ when SEP latency extended beyond 10％.The sensitivity,specificity,positive predictive value,and negative predictive value of MEP in predicting intra-operative cerebral hypoperfusion were 30.00％,97.96％,75.00％,and 87.27％ when MEP amplitude declined beyond 50％.Decline of SEP and MEP amplitudes and extension of SEP latency have positive correlations with TCD.ROC indicated that the amplitude of somatosensory evoked potentials could predict intraoperative hypoperfusion when it decreased by 51.0％ than the baseline monitoring value after carotid artery occlusion,with sensitivity of 100.0％,specificity of 89.8％ and area under the curve of 0.918 (95％CI:0.846～0.990,P=0.024).ROC also showed that the latent phase of somatosensory evoked potentials could predict intraoperative hypoperfusion when it was prolonged ＞9.8％ compared to the baseline monitoring value after carotid artery occlusion,with sensitivity of 100.0％,specificity of 92.9％and area under the curve of 0.941 (95％CI 0.878～0.995,P=0.014).Conclusion Evoked potentials can real-time monitor intra-operative cerebral hypoperfusion continuously in carotid endarterectomy,enjoying high sensitivity and specificity;in addition,decline of SEP amplitude and extension of SEP latency have higher sensitivity than MEP.

Thromboelastography and conventional coagulation tests in detecting coagulation function of antiplatelet after endovascular treatments in acute ischemic stroke: an association study / 中华神经医学杂志

Objective To explore the association,consistency and complications prognostic value of thromboelastography and conventional coagulation tests in detecting coagulation function of antiplatelet after endovascular treatments in patients with acute ischemic stroke.Methods A retrospective cohort survey of 240 patients,admitted to our hospital from September 2012 to December 2017,was performed.All acute ischemic stroke patients accepted coagulation function monitoring 5 d after aspirin and clopidogrel and endovascular treatments by thromboelastography (R time,K time,α angle,maximum amplitude [MA]) and routine coagulation tests (prothrombin time [PT],activated partial thromboplastin time [APTT],fibrinogen [FIB],international normalized ratio [INR],blood platelet count).The association,consistency,and sensitivity,specificity,positive predictive value,negative predictive value of complications prognostic value of thromboelastography and conventional coagulation tests were analyzed.Results (1) R time and APTT,K time and APTT,α angle and FIB,and α angle and PLT were positively correlated;K time and FIB,R time and PLT,and α angle and APTT were negatively correlated.(2) R time and APTT (κ=0.266,P=0.000),K time and APTT (κ=0.134,P=0.024),and α angle and FIB (κ=0.162,P=0.007) had agreement in identifying hypercoagulability;R time and APTT (κ=0.211,P=0.001),K time and APTT (κ=0.198,P=0.002),and blood platelet count and K (κ=0.388,P=0.000),and α angle and PLT (κ=0.099,P=0.041) had agreement in identifying hypocoagulability.(3) The sensitivity of thromboelastography and routine coagulation tests in identifying early neurological deterioration was 17.65％ and 58.82％,and the sensitivity in identifying symptomatic hemorrhages by thromboelastography and routine coagulation tests was 73.68％ and 47.39％.Conclusions Some parameters has correlations in peroperative period,and has agreement in identifying hypercoagulability and hypocoagulability.Accordingly,routine coagulation tests might be superior in evaluating early neurological deterioration,and thromboelastography might be superior in evaluating symptomatic hemorrhages in patients with acute ischemic stroke.

Mechanical thrombectomy with the Solitaire AB device in acute ischemic stroke of posterior circulation: a series of 17 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of mechanical thrombectomy with the Solitaire AB device in recanalization of patients with acute ischemic stroke of posterior circulation.</p><p><b>METHODS</b>The clinical data of 17 consecutive patients with acute ischemic stroke of posterior circulation, treated with the Solitaire AB device from August 2011 to August 2015 in Department of Neurosurgery, the Military General Hospital of Beijing People's Liberation Army, were extracted and then retrospectively analyzed. There were 12 male and 5 female patients with a median age of 60 years (ranging from 44 to 75 years). Among them, 8 cases occluded in basilar artery, 4 cases occluded in vertebral artery and 5 cases occluded in vertebral plus basilar artery. Recanalization rate as well as complications after treatment were analysized. Also, neurological functions of the patients before and after treatment, measured by National Institute of Health stroke scale (NIHSS) score, were compared via t test and the clinical outcomes were assessed by modified Rankin score (mRS) at 90 days after treatment.</p><p><b>RESULTS</b>Fifteen patients resulted in successfully recanalization, and 2 cases failed both of whose onset to sheath time were above 7.5 hours. The NIHSS score at 7 days was 11±10, which was significantly decreased compared to the admission NIHSS score 17±5 (t=2.949, P=0.009). No symptomatic intracranial hemorrhage case was found after thrombectomy. At 90 days, one patient died(mRS 6), one patient seriously disabled (mRS 5), two patients moderately seriously disabled (mRS 4), four patients resulted in moderate outcome (mRS 3) and the other 9 patients achieved good outcome (mRS 0 to 2). The dead and seriously disabled cases were both due to failure in recanalization. Two moderately seriously disabled cases were probably attributed to their severe admission condition (NIHSS >20) and prolonged time (onset to sheath time >6 hours).</p><p><b>CONCLUSION</b>Mechanical thrombectomy with the Solitaire AB device contributes to a high rate of recanalization with a low probability of complication and improves functional outcome in patients with acute ischemic stroke of posterior circulation.</p>

Comparative Study on the Three Algorithms of T-wave End Detection: Wavelet Method, Cumulative Points Area Method and Trapezium Area Method / 生物医学工程学杂志

In order to find the most suitable algorithm of T-wave end point detection for clinical detection, we tested three methods, which are not just dependent on the threshold value of T-wave end point detection, i. e. wavelet method, cumulative point area method and trapezium area method, in PhysioNet QT database (20 records with 3 569 beats each). We analyzed and compared their detection performance. First, we used the wavelet method to locate the QRS complex and T-wave. Then we divided the T-wave into four morphologies, and we used the three algorithms mentioned above to detect T-wave end point. Finally, we proposed an adaptive selection T-wave end point detection algorithm based on T-wave morphology and tested it with experiments. The results showed that this adaptive selection method had better detection performance than that of the single T-wave end point detection algorithm. The sensitivity, positive predictive value and the average time errors were 98.93%, 99.11% and (--2.33 ± 19.70) ms, respectively. Consequently, it can be concluded that the adaptive selection algorithm based on T-wave morphology improves the efficiency of T-wave end point detection.

Influence of carotid endarterectomy in cognitive functions / 中华神经医学杂志

Objective To observe the influence of carotid endarterectomy in cognitive functions of patients with symptomatic carotid stenosis.Methods Forty-three patients admitted to our hospital and performed carotid endarterectomy from February 2013 to August 2014, were enrolled in the study.Cognitive functions of the patients were evaluated by Montreal cognitive function assessment (MoCA) and cerebral blood flow (CBF) by cerebral perfusion CT scan three days before and three months after operation, respectively.According to the MoCA scores after operation, the patients were divided into significant improvement group and non-significant improvement group, and their cerebral hemodynamics indexes were compared.Results (1) As compared with those before operation (24.1±2.2, 0.97±0.08), the MoCA scores (26.02±2.9) and relative cerebral blood volumes (rCBV, 1.00±0.08) three months after operation were significantly different (P＜0.05).(2) The postoperative relative CBF, rCBV and relative mean transmit time in the significant improvement group were significantly improved as compared with those preoperative indexes (P＜0.05);whereas, these values in the non-significant improvement group didn't show significant difference between preoperative and postoperative indexes(P＞0.05).Conclusion Carotid endarterectomy may help to improve the cognitive function in those patients with symtompatic carotid stenosis, and the effect might be associated with the improvement of cerebral perfusion.

Impact of diabetes and stress hyperglycemia on thrombolytic effect and prognosis in patients with acute cerebral infarction / 中国脑血管病杂志

Objective To observe the impact of diabetes and stress hyperglycemia on thrombolytic effect and short-term prognosis in patients with acute cerebral infarction. Methods A total of 127 patients with acute cerebral infarction (≤4. 5 h) who received thrombolytic therapy with alteplase at General Hospital of Beijing Military Command from January 2012 to August 2013 were enrolled retrospectively. They were divided into three groups:Diabetes group (n=35),stress hyperglycemia group (n=49),and normal glucose group (n=43) according to whether they had a history of diabetes,random glucose on admission, and oral glucose tolerance test at day 7. At 24 h after thrombolysis,the National Institute of Health Stroke Scale (NIHSS) scores,recanalization rate,and the modified Rankin Scale (mRS) scores at day 90 were compared between the 2 groups. Results Before thrombolysis,the NIHSS scores of the diabetic group, stress hyperglycemia group,and normal glucose group were 14. 2 ± 5. 1,12. 8 ± 5. 6,and 13. 0 ± 4. 6,respectively (P>0.05);at 24 h after thrombolysis,they were 14.7 ±6.0,11.9 ±4.9,and 8.0 ±2.9,respectively (P0. 05);the NIHSS score of the normal glucose group was lower than before thrombolysis. There was significant difference (P <0. 05). After thrombolysis,the patients with good recanalization were 54. 3% (n=19),57. 1% (n=28),and 67. 4% (n=29),respectively in the three groups;the hemorrhagic conversion rate was 14. 3% (n=5),6. 1% (n=3),and 2. 3% (n=1),respectively. There were no significant differences. At day 90 after thrombolysis,the mRS scores in the 3 groups showed that the good prognosis rate of the normal glucose group was 72. 1% (n=31);it was significantly higher than 51. 0% (n=25) of the stress hyperglycemia group and 29. 6% (n=10) of the diabetes group. There were significant differences (P<0. 05,P<0. 01). There was also significant difference between the stress hyperglycemia group and the diabetes group. Conclusion Diabetes and stress hyperglycemia have varying degrees of adverse effects on the efficacy and prognosis of the thrombolytic therapy for acute cerebral infarction.

Relationship between blood glucose fluctuations and the prognosis of thrombolytic therapy in patients with acute cerebral infarction and type 2 diabetes mellitus / 中国脑血管病杂志

Objective To study the effect of blood glucose fluctuations on the prognosis of thrombolytic therapy in patients with acute cerebral infarction. Methods A total of 83 consecutive patients with acute cerebral infarction admitted to the Department of Neurology,General Hospital of Beijing Military Command ( the Affiliated 81st Brain Hospital ) from January to November 2013 were enrolled retrospectively. They were divided into cerebral infarction with type 2 diabetes mellitus group (DMCI group,n=47) and cerebral infarction without type 2 diabetes mellitus group (NDMCI group,n=36) according to whether they had diabetes mellitus or not and the results of oral glucose tolerance test at day 7 after admission. Continuous glucose monitoring system ( CGMS) was used to monitor glucose for 72 hours at day 7 after admission. The mean blood glucose, standard deviation of blood glucose level, mean blood glucose fluctuation,and hemorrhagic transformation during the follow-up period,as well as vascular recanalization were observed and compared. At day 90,the modified Rankin scale (mRS) score was used to evaluate the prognosis of the patients. Results ( 1 ) Comparing the dynamic glucose parameters of the patients with acute cerebral infarction in both groups,the mean blood glucose,standard deviation of blood glucose level,mean blood glucose fluctuations at 24 hours in patients of the DMCI group were higher than those of the NDMCI group ( 8 . 3 ± 2 . 6 mmol/L vs. 5 . 8 ± 1 . 3 mmol/L,2. 1 ± 0. 4 mmol/L vs. 1. 6 ± 0. 6 mmol/L,4. 3 ± 0. 8 mmol/L vs. 3. 6 ± 0. 5 mmol/L). There were significant differences (t=31. 419, 15.537,and 15. 372,respectively;all P<0. 01). (2) Four patients (8.5%) in the DMCI group had hemorrhagic transformation during the follow-up period,17 cases (36. 2%) had good recanalization,and 15 cases (31.9%) had good prognosis (the mRS score < 2 at day 90);1 patient (2.8%) in the NDMCI group had hemorrhagic transformation,21 patients (58. 3%) had good recanalization,and 21 cases (58. 3%) had good prognosis. There was significant difference between the recanalization after thrombolysis and the prognosis in patients of both groups (P<0. 05). Conclusion The great fluctuations of blood glucose in acute cerebral infarction patients with type 2 diabetes mellitus may be an important factor of affecting its prognosis of thrombolytic therapy.

Hyper-early embolotherapy in treatment of intracranial ruptured aneurysm / 中国医师进修杂志

Objective To explore the clinical efficacy and safety of hyper-early embolotherapy in treatment of intracranial ruptured aneurysm.Methods A retrospective analysis was made on 33 patients with intracranial ruptured aneurysm.Preoperative Hunt-Hess grade:grade Ⅰ-Ⅱ in 16 patients,gradeⅢin 5 patients,grade Ⅳ in 9 patients,grade Ⅴ in 3 patients.All patients were confirmed with subarachnoid hemorrhage (SAH) by angiography and then underwent embolization under general anesthesia by detachable coils within 6 h from onset.Results After operation,25 patients (75.8％) recovered well,4 patients (12.1％) were with mild disability with paralysis and aphasia,4 patients (12.1％) were dead (1 patient for intraoperative aneurysm rupture,1 patient for postoperative pneumonia,1 patient for infection of hematoma at puncture site and 1 patient for postoperative gastrointestinal bleeding).Followed up 1-6 months,no rebleeding occurred.Conclusions Hyper-early embolotherapy could avoid rebleeding of the aneurysm,and relieve the vasespasm,without increasing the intra-operative rebleeding rate.Moreover hyper-early embolotherapy could greatly decrease the mortality of poor-grade SAH patients.