Intracranial pressure monitoring (ICP) is based on the doctrine proposed by Monroe and Kellie centuries ago. With the advancement of technology and science, various invasive and non-invasive modalities of monitoring I...Intracranial pressure monitoring (ICP) is based on the doctrine proposed by Monroe and Kellie centuries ago. With the advancement of technology and science, various invasive and non-invasive modalities of monitoring ICP continue to be developed. An ideal monitor to track ICP should be easy to use, accurate, reliable, reproducible, inexpensive and should not be associated with infection or haemorrhagic complications. Although the transducers connected to the extra ventricular drainage continue to be Gold Standard, its association with the likelihood of infection and haemorrhage have led to the search for alternate noninvasive methods of monitoring ICP. While Camino transducers, Strain gauge micro transducer based ICP monitoring devices and the Spiegelberg ICP monitor are the emerging technology in invasive ICP monitoring, optic nerve sheath diameter measurement, venous opthalmodynamometry, tympanic membrane displacement, tissue resonance analysis, tonometry, acoustoelasticity, distortionproduct oto-acoustic emissions, trans cranial doppler, electro encephalogram, near infra-red spectroscopy, pupillometry, anterior fontanelle pressure monitoring, skull elasticity, jugular bulb monitoring, visual evoked response and radiological based assessment of ICP are the non-invasive methods which are assessed against the gold standard.展开更多
To investigated the relationship between postoperative bleeding following gastric endoscopic submucosal dissection (ESD) and individual antithrombotic agents. METHODSA total of 2488 gastric neoplasms in 2148 consecuti...To investigated the relationship between postoperative bleeding following gastric endoscopic submucosal dissection (ESD) and individual antithrombotic agents. METHODSA total of 2488 gastric neoplasms in 2148 consecutive patients treated between May 2001 and June 2016 were studied. The antithrombotic agents were categorized into antiplatelet agents, anticoagulants, and other antithrombotic agents, and we included combination therapies [e.g., dual antiplatelet therapy (DAPT)]. The risk factors associated with post-ESD bleeding, namely, antithrombotic agents overall, individual antithrombotic agents, withdrawal or continuation of antithrombotic agents, and bleeding onset period (during the first six days or thereafter), were analyzed using univariate and multivariate analyses. RESULTSThe en bloc resection and complete curative resection rates were 99.2% and 91.9%, respectively. Postoperative bleeding occurred in 5.1% cases. Bleeding occurred in 10.3% of the patients administered antithrombotic agents. Being male (P = 0.007), specimen size (P < 0.001), and antithrombotic agent used (P < 0.001) were independent risk factors for postoperative bleeding. Heparin bridging therapy (HBT) (P = 0.002) and DAPT/multidrug combinations (P < 0.001) were independent risk factors associated with postoperative bleeding. The bleeding rate of the antithrombotic agent continuation group was significantly higher than that of the withdrawal group (P < 0.01). Bleeding within postoperative day (POD) 6 was significantly higher in warfarin (P = 0.015), and bleeding after POD 7 was significantly higher in DAPT/multidrug combinations (P = 0.007). No thromboembolic events were reported. CONCLUSIONWe must closely monitor patients administered HBT and DAPT/multidrug combinations after gastric ESD, particularly those administered multidrug combinations after discharge.展开更多
提出了一种基于卷积神经网络(convolutional neural networks,CNN)加条件随机场(conditional random fields,CRF)的眼底图像出血点检测方法。首先,为了避免图像背景区域对后续检测的影响,参考眼底图像中的灰度信息并根据眼底中心位置到...提出了一种基于卷积神经网络(convolutional neural networks,CNN)加条件随机场(conditional random fields,CRF)的眼底图像出血点检测方法。首先,为了避免图像背景区域对后续检测的影响,参考眼底图像中的灰度信息并根据眼底中心位置到其边缘的长度,将图像调整到合适的尺寸,再对图像进行线性加权增强其亮度和对比度;然后,用裁剪到的图像块在仿照VGG网络构建的CNN架构上去训练检测出血点的CNN模型;最后,为了克服CNN模型在出血点检测中误检、漏检等问题,采用CRF对CNN模型输出的概率图进行后处理,以实现眼底图像出血点的精确检测。提出的检测方法在公开的Kaggle与Messidor数据库上进行训练和验证,获得了98.8%的准确率、99.4%的召回率和99.1%的F-score。另外,在DIARETDB1数据库上测试的灵敏度达到98.5%,F-score为96.1%。实验结果表明,从图像视觉和定量检测2个方面均说明了提出方法的有效性和优越性。展开更多
Acute ischemic stroke(AIS) is a common medical problem associated with significant morbidity and mortality worldwide. A small proportion of AIS patients meet eligibility criteria for intravenous thrombolysis(IVT) with...Acute ischemic stroke(AIS) is a common medical problem associated with significant morbidity and mortality worldwide. A small proportion of AIS patients meet eligibility criteria for intravenous thrombolysis(IVT) with recombinant tissue plasminogen activator, and its efficacy for large vessel occlusion is poor. Therefore, an increasing number of patients with AIS are being treated with endovascular mechanical thrombectomy when IVT is ineffective or contraindicated. Rapid advancement in catheter-based and endovascular device technology has led to significant improvements in rates of cerebral reperfusion with these devices. Stentrievers and modern aspiration catheters have now surpassed earlier generation devices in the degree and rapidity of revascularization. This progress has been achieved with no concurrent increase in risk of major complications or mortality, both when used alone or in combination with IVT. The initial randomized controlled trials comparing endovascular therapy to IVT for AIS failed to show superior outcomes with endovascular treatment, butkey limitations of each trial may limit the significance of these results to current practice. While endovascular devices and operator experience continue to evolve, we are optimistic that this will be accompanied by improvements in patient outcomes. This review highlights the major endovascular devices used in current practice and the trials which have investigated their efficacy.展开更多
BACKGROUND Factor XIII(FXIII)deficiency is a rare yet profound coagulopathy.FXIII plays a pivotal role in hemostasis,and deficiencies in this factor can precipitate unchecked or spontaneous hemorrhaging.Immunological ...BACKGROUND Factor XIII(FXIII)deficiency is a rare yet profound coagulopathy.FXIII plays a pivotal role in hemostasis,and deficiencies in this factor can precipitate unchecked or spontaneous hemorrhaging.Immunological assays for detecting FXIII inhibitors are indispensable for diagnosing acquired FXIII deficiency;however,the availability of suitable testing facilities is limited,resulting in prolonged turnaround times for these assays.CASE SUMMARY In this case study,a 53-year-old male devoid of significant medical history presented with recurrent intracranial hemorrhages and a hematoma in the right hip.Subsequent genetic analysis revealed a homozygous mutation in the ACE gene,confirming the diagnosis of acquired FXIII deficiency.CONCLUSION This case underscores the significance of considering acquired deficiencies in clotting factors when evaluating patients with unexplained bleeding episodes.展开更多
Damage of the blood vessels in retina due to diabetes is called diabetic retinopathy(DR).Hemorrhages is thefirst clinically visible symptoms of DR.This paper presents a new technique to extract and classify the hemorrh...Damage of the blood vessels in retina due to diabetes is called diabetic retinopathy(DR).Hemorrhages is thefirst clinically visible symptoms of DR.This paper presents a new technique to extract and classify the hemorrhages in fundus images.The normal objects such as blood vessels,fovea and optic disc inside retinal images are masked to distinguish them from hemorrhages.For masking blood vessels,thresholding that separates blood vessels and background intensity followed by a newfilter to extract the border of vessels based on orienta-tions of vessels are used.For masking optic disc,the image is divided into sub-images then the brightest window with maximum variance in intensity is selected.Then the candidate dark regions are extracted based on adaptive thresholding and top-hat morphological techniques.Features are extracted from each candidate region based on ophthalmologist selection such as color and size and pattern recognition techniques such as texture and wavelet features.Three different types of Support Vector Machine(SVM),Linear SVM,Quadratic SVM and Cubic SVM classifier are applied to classify the candidate dark regions as either hemor-rhages or healthy.The efficacy of the proposed method is demonstrated using the standard benchmark DIARETDB1 database and by comparing the results with methods in silico.The performance of the method is measured based on average sensitivity,specificity,F-score and accuracy.Experimental results show the Linear SVM classifier gives better results than Cubic SVM and Quadratic SVM with respect to sensitivity and accuracy and with respect to specificity Quadratic SVM gives better result as compared to other SVMs.展开更多
文摘Intracranial pressure monitoring (ICP) is based on the doctrine proposed by Monroe and Kellie centuries ago. With the advancement of technology and science, various invasive and non-invasive modalities of monitoring ICP continue to be developed. An ideal monitor to track ICP should be easy to use, accurate, reliable, reproducible, inexpensive and should not be associated with infection or haemorrhagic complications. Although the transducers connected to the extra ventricular drainage continue to be Gold Standard, its association with the likelihood of infection and haemorrhage have led to the search for alternate noninvasive methods of monitoring ICP. While Camino transducers, Strain gauge micro transducer based ICP monitoring devices and the Spiegelberg ICP monitor are the emerging technology in invasive ICP monitoring, optic nerve sheath diameter measurement, venous opthalmodynamometry, tympanic membrane displacement, tissue resonance analysis, tonometry, acoustoelasticity, distortionproduct oto-acoustic emissions, trans cranial doppler, electro encephalogram, near infra-red spectroscopy, pupillometry, anterior fontanelle pressure monitoring, skull elasticity, jugular bulb monitoring, visual evoked response and radiological based assessment of ICP are the non-invasive methods which are assessed against the gold standard.
文摘To investigated the relationship between postoperative bleeding following gastric endoscopic submucosal dissection (ESD) and individual antithrombotic agents. METHODSA total of 2488 gastric neoplasms in 2148 consecutive patients treated between May 2001 and June 2016 were studied. The antithrombotic agents were categorized into antiplatelet agents, anticoagulants, and other antithrombotic agents, and we included combination therapies [e.g., dual antiplatelet therapy (DAPT)]. The risk factors associated with post-ESD bleeding, namely, antithrombotic agents overall, individual antithrombotic agents, withdrawal or continuation of antithrombotic agents, and bleeding onset period (during the first six days or thereafter), were analyzed using univariate and multivariate analyses. RESULTSThe en bloc resection and complete curative resection rates were 99.2% and 91.9%, respectively. Postoperative bleeding occurred in 5.1% cases. Bleeding occurred in 10.3% of the patients administered antithrombotic agents. Being male (P = 0.007), specimen size (P < 0.001), and antithrombotic agent used (P < 0.001) were independent risk factors for postoperative bleeding. Heparin bridging therapy (HBT) (P = 0.002) and DAPT/multidrug combinations (P < 0.001) were independent risk factors associated with postoperative bleeding. The bleeding rate of the antithrombotic agent continuation group was significantly higher than that of the withdrawal group (P < 0.01). Bleeding within postoperative day (POD) 6 was significantly higher in warfarin (P = 0.015), and bleeding after POD 7 was significantly higher in DAPT/multidrug combinations (P = 0.007). No thromboembolic events were reported. CONCLUSIONWe must closely monitor patients administered HBT and DAPT/multidrug combinations after gastric ESD, particularly those administered multidrug combinations after discharge.
文摘提出了一种基于卷积神经网络(convolutional neural networks,CNN)加条件随机场(conditional random fields,CRF)的眼底图像出血点检测方法。首先,为了避免图像背景区域对后续检测的影响,参考眼底图像中的灰度信息并根据眼底中心位置到其边缘的长度,将图像调整到合适的尺寸,再对图像进行线性加权增强其亮度和对比度;然后,用裁剪到的图像块在仿照VGG网络构建的CNN架构上去训练检测出血点的CNN模型;最后,为了克服CNN模型在出血点检测中误检、漏检等问题,采用CRF对CNN模型输出的概率图进行后处理,以实现眼底图像出血点的精确检测。提出的检测方法在公开的Kaggle与Messidor数据库上进行训练和验证,获得了98.8%的准确率、99.4%的召回率和99.1%的F-score。另外,在DIARETDB1数据库上测试的灵敏度达到98.5%,F-score为96.1%。实验结果表明,从图像视觉和定量检测2个方面均说明了提出方法的有效性和优越性。
文摘Acute ischemic stroke(AIS) is a common medical problem associated with significant morbidity and mortality worldwide. A small proportion of AIS patients meet eligibility criteria for intravenous thrombolysis(IVT) with recombinant tissue plasminogen activator, and its efficacy for large vessel occlusion is poor. Therefore, an increasing number of patients with AIS are being treated with endovascular mechanical thrombectomy when IVT is ineffective or contraindicated. Rapid advancement in catheter-based and endovascular device technology has led to significant improvements in rates of cerebral reperfusion with these devices. Stentrievers and modern aspiration catheters have now surpassed earlier generation devices in the degree and rapidity of revascularization. This progress has been achieved with no concurrent increase in risk of major complications or mortality, both when used alone or in combination with IVT. The initial randomized controlled trials comparing endovascular therapy to IVT for AIS failed to show superior outcomes with endovascular treatment, butkey limitations of each trial may limit the significance of these results to current practice. While endovascular devices and operator experience continue to evolve, we are optimistic that this will be accompanied by improvements in patient outcomes. This review highlights the major endovascular devices used in current practice and the trials which have investigated their efficacy.
基金Supported by the Medical and Health Science Foundation of Zhejiang,No.2023KY186Hangzhou Science and Technology Development Plan Guide Project,No.20220919Y023the Hangzhou Medical Key Discipline Construction Program,No.2021.
文摘BACKGROUND Factor XIII(FXIII)deficiency is a rare yet profound coagulopathy.FXIII plays a pivotal role in hemostasis,and deficiencies in this factor can precipitate unchecked or spontaneous hemorrhaging.Immunological assays for detecting FXIII inhibitors are indispensable for diagnosing acquired FXIII deficiency;however,the availability of suitable testing facilities is limited,resulting in prolonged turnaround times for these assays.CASE SUMMARY In this case study,a 53-year-old male devoid of significant medical history presented with recurrent intracranial hemorrhages and a hematoma in the right hip.Subsequent genetic analysis revealed a homozygous mutation in the ACE gene,confirming the diagnosis of acquired FXIII deficiency.CONCLUSION This case underscores the significance of considering acquired deficiencies in clotting factors when evaluating patients with unexplained bleeding episodes.
基金supported by the ministry of education and the deanship of scientific research-Najran University-Kingdom of Saudi Arabia for their financial and technical support under code number NU/-/SERC/10/640.
文摘Damage of the blood vessels in retina due to diabetes is called diabetic retinopathy(DR).Hemorrhages is thefirst clinically visible symptoms of DR.This paper presents a new technique to extract and classify the hemorrhages in fundus images.The normal objects such as blood vessels,fovea and optic disc inside retinal images are masked to distinguish them from hemorrhages.For masking blood vessels,thresholding that separates blood vessels and background intensity followed by a newfilter to extract the border of vessels based on orienta-tions of vessels are used.For masking optic disc,the image is divided into sub-images then the brightest window with maximum variance in intensity is selected.Then the candidate dark regions are extracted based on adaptive thresholding and top-hat morphological techniques.Features are extracted from each candidate region based on ophthalmologist selection such as color and size and pattern recognition techniques such as texture and wavelet features.Three different types of Support Vector Machine(SVM),Linear SVM,Quadratic SVM and Cubic SVM classifier are applied to classify the candidate dark regions as either hemor-rhages or healthy.The efficacy of the proposed method is demonstrated using the standard benchmark DIARETDB1 database and by comparing the results with methods in silico.The performance of the method is measured based on average sensitivity,specificity,F-score and accuracy.Experimental results show the Linear SVM classifier gives better results than Cubic SVM and Quadratic SVM with respect to sensitivity and accuracy and with respect to specificity Quadratic SVM gives better result as compared to other SVMs.
