【摘要】 目的 擬初步建立孕28~34周的雙胎胎兒生長參數超聲測量值的正常范圍，比較晚孕期單、雙胎妊娠胎兒的宮內生長發育模式。 方法 對2009年5月-2010年4月超聲診斷為正常宮內雙活胎、單活胎孕婦，采用超聲測量胎兒相關生長發育指標，包括雙頂徑、頭圍、腹圍、股骨長等，測量其中部分雙胎的小腦橫徑并應用虛擬器官計算機輔助分析技術測量其小腦容積，比較晚孕期單、雙胎胎兒生長發育的差異。 結果 ①自妊娠30周以后，雙胎胎兒的雙頂徑發育速度比單胎胎兒延緩，單、雙胎胎兒平均每周增長分別約2.3、1.7 mm；②自妊娠32周以后， 雙胎胎兒的頭圍的發育速度比單胎胎兒延緩，單、雙胎胎兒平均每周增長分別約6.7、5.8 mm；③自妊娠30周以后， 雙胎胎兒的腹圍的發育速度比單胎胎兒延緩，單、雙胎胎兒平均每周增長分別約6.9、5.3 mm；④雙胎胎兒股骨長從孕28~34周發育速度均較單胎胎兒緩慢，單、雙胎胎兒平均每周增長分別約2.0、1.7 mm；⑤多元分析孕28~34周的雙胎胎兒雙頂徑、頭圍、腹圍和股骨長，相對于單胎胎兒而言，自28周起，雙胎妊娠胎兒的生長發育較延緩；⑥自孕28~34周，雙胎胎兒小腦橫徑、小腦容積與單胎胎兒無明顯差異。 結論 雙胎妊娠胎兒與單胎妊娠胎兒在晚孕期有著不同的生長發育規律。【Abstract】 Objective To initially establish the growth parameters of normal twin pregnancy in 28-34 gestational ages according to the ultrasound measurement, and to compare the intrauterine growth patterns between the singleton and twin pregnancy. Methods The relevant index of the twin pregnancy, including the biparietal diameter (BPD), femur length, head circumference (HC), abdominal circumference (AC), were measured. The transverse cerebellar diameter (TCD) was measured and the virtural organ computer-aided analysis was used to detect the fetal cerebellar volume (FCV). The intrauterine growth patterns between the singleton and twin pregnancy was compared. Results After the gestational age of 30 weeks, the mean values of BPD of the twins pregnancies (1.7 mm) were lower than those of the singleton pregnancies (2.3 mm). After the gestational age of 32 weeks, the mean value of HC of the twins pregnancies (5.8 mm) was lower than that of the singleton pregnancies (6.7 mm). After the gestational age of 30 weeks, the mean values of AC of the twins pregnancies (5.3 mm) were lower than those of the singleton pregnancies (6.9 mm). After the gestational age of 28 weeks, the mean value of FL of the twins pregnancies (1.7 mm) was lower than the singleton pregnancies (2.0 mm). After the gestational age of 28 weeks, the growth of twin pregnancy fetuses is more slowly. After the gestational age of 28-34 weeks, the differences in mean values of TCD and FCV between the twin pregnancy and singleton pregnancy was not significant. Conclusion The twin pregnancy and singleton pregnancy have different growth patterns in the third trimester pregnancy.
Mitral stenosis includes mitral stenosis due to rheumatic fever and non-rheumatic valve stenosis characterized by degenerative changes. Rheumatic mitral stenosis is common in developing countries and occurs in young adults, while degenerative mitral stenosis is common in developed countries and increases in incidence with aging. Mitral stenosis of different etiologies can lead to changes in heart structure and function, which affects the quality of life and prognosis of patients, so lifelong management of mitral stenosis is crucial. This article provides a comprehensive reference for clinicians in the management of mitral stenosis, with a detailed overview of the emerging prevalence features, imaging diagnosis, and treatment methods.
Commissural misalignment of biological valve and autologous valve during transcatheter aortic valve replacement may affect the filling of coronary artery, reduce the feasibility of redo-aortic valve intervention and damage the valve function, which will adversely affect long-term prognosis of patients. Some studies have obtained achievement by changing the axial direction of valve and using individualized computer simulation technology to improve the alignment technology. However, there are still many unknown problems about the impact of commissural misalignment on patients, and accurate commissural alignment techniques still need to be further explored. This article systematically expounds the possible impact of commissural misalignment between biological valve and autologous valve in transcatheter aortic valve replacement, possibly effective accurate commissural alignment techniques and related research progress.
Currently, the development of deep learning-based multimodal learning is advancing rapidly, and is widely used in the field of artificial intelligence-generated content, such as image-text conversion and image-text generation. Electronic health records are digital information such as numbers, charts, and texts generated by medical staff using information systems in the process of medical activities. The multimodal fusion method of electronic health records based on deep learning can assist medical staff in the medical field to comprehensively analyze a large number of medical multimodal data generated in the process of diagnosis and treatment, thereby achieving accurate diagnosis and timely intervention for patients. In this article, we firstly introduce the methods and development trends of deep learning-based multimodal data fusion. Secondly, we summarize and compare the fusion of structured electronic medical records with other medical data such as images and texts, focusing on the clinical application types, sample sizes, and the fusion methods involved in the research. Through the analysis and summary of the literature, the deep learning methods for fusion of different medical modal data are as follows: first, selecting the appropriate pre-trained model according to the data modality for feature representation and post-fusion, and secondly, fusing based on the attention mechanism. Lastly, the difficulties encountered in multimodal medical data fusion and its developmental directions, including modeling methods, evaluation and application of models, are discussed. Through this review article, we expect to provide reference information for the establishment of models that can comprehensively utilize various modal medical data.
ObjectiveTo compare the value of apparent diffusion coefficients (ADCs) of MR-DWI at different b values in evaluating the progression of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE).MethodsAll of 168 patients with HCC who met the inclusion and exclusion criteria and received the TACE for the first time in the Characteristic Medical Center of PAPF were collected retrospectively, who were divided into a stable group and progressive group according to the results of MRI evaluation at the 6th month after the TACE treatment. The clinical and imaging data of the two groups were compared before the TACE treatment. The Cox proportional hazard regression model was used to analyze the risk factors for the disease progression after the TACE treatment. The receiver operating characteristic curve (ROC) was used to analyze the predicting of efficacy evaluation of TACE by the ADC values at different b values.ResultsCompared with the stable group, the proportions of hepatitis B cirrhosis history, portal vein tumor thrombus, and arteriovenous fistula were higher (P<0.05), and the BCLC stage and Child Pugh grade were worse (P<0.05), and the ADC values were higher (P<0.05) in the progressive group. The results of Cox analysis showed that the ADC values at b=600 and 800 s/mm2 before the TACE, history of hepatitis B cirrhosis, portal vein tumor thrombus, arteriovenous fistula, advanced BCLC stage and Child-Pugh grade were the risk factors for the progression at the 6th month after the TACE treatment. When the b value was 800 s/mm2, the ADC value had the highest efficacy in predicting the outcome of patients (area under ROC curve was 0.746), and the best diagnostic cut-off point was 1.20×10–3 mm2/s, the sensitivity was 73.3% and the specificity was 71.8%.ConclusionADC value of MR-DWI could predict progression after TACE in patients with HCC, and ADC value of 800 s/mm2 has a better predictive value for them.
目的 探討聯合康復新液治療復治菌陽肺結核的臨床效果。 方法 選取2011年1月－12月復治菌陽肺結核患者120例，隨機分為對照組57例，觀察組63例。兩組患者均采取異煙肼、利福平、吡嗪酰胺、乙胺丁醇、鏈霉素聯合治療；觀察組在此基礎上再聯用康復新液予以輔助治療。治療期間隨訪患者臨床癥狀、痰菌陰轉、病灶吸收情況，并就兩組患者治療效果進行評價。 結果 治療2、3、6、8個月時觀察組患者痰菌轉陰率分別為46.03%、73.02%、90.48%和95.23%，明顯高于對照組（26.32%、49.12%、66.66%、84.21%）；治療6個月后胸部CT檢查示觀察組患者空洞閉合率為73.58%；對照組患者空洞閉合率為52.08%，兩組比較差異有統計學意義（χ2=5.016，P=0.025）；治療過程中的不良反應發生率觀察組為19.04%，對照組為19.30%，兩組比較差異無統計學意義（χ2=0.001，P=0.972）。 結論 對復治菌陽肺結核聯合康復新液進行治療是一種安全而有效的治療方法。
Objective To compare the outcomes of 23G and 20G vitrectomy in treatment of proliferative diabetic retinopathy (PDR). Methods This was a prospective randomized study. One hundred twenty six patients (142 eyes) suffering from PDR with symptoms requiring vitrectomy were randomly divided into 20G vitrectomy group (66 patients, 74 eyes) and 23G vitrectomy group (60patients,68eyes). Visual acuity, intraocular pressures,indirect ophthalmoscopy, B-scan ultrasound, tear film break up time (BUT), Schirmer Ⅰ test (S Ⅰ T), astigmatic power and the astigmatic axial at 6 mm area of anterior and posterior corneal surface were observed and measured before surgery. The follow-up period was 15.0 and 12.5 months separately in 20G and 23G groups. Intraoperative complications, operation time, postoperative visual acuity, intraocular pressure, postoperative complications, reoperation, and postoperative ocular conditions including changes of astigmatic power and the astigmatic axial measurements were analyzed. Results At last follow-up, there was 49 eyes (66.2%) and 47 eyes (69.1%) with visual acuity ge;0.05 in 20G and 23G groups. Comparing visual acuity ge;0.05, there was no statistical difference between the groups (chi;2=0.14, P＞0.05). The eyes suffering from iatrogenic injuries were 18 (24.3%) and seven (10.3%). There was obvious difference in iatrogenic injury between the two groups (chi;2=4.81, P＜0.05). The mean surgical times were (69.0plusmn;8.2) and (51.0plusmn;6.3) minutes in 20G and 23G group, which was significantly different (t=3.65, P＜0.05). The postoperative third day, hypotony was detected in three (4.1%) and 11 eyes (14.7%) in 20G and 23G group, which was a significantly different (chi;2=5.85, P＜0.05). Postoperatively high intraocular pressures were not significantly different between the two groups (chi;2=2.54,P＞0.05). There were 24 (32.4%) and 14 eyes (20.6%) in 20G and 23G group. There were significant differences in BUT, SⅠT, astigmatic power and the astigmatic axial measurements compared with those preoperatively at the first month after operation (t=3.35, 4.12, -3.12, -3.22; P＜0.05), but no significant differences in them at the third and sixth month after operation (third month: t=0.45, 0.98, -2.12, -1.02; P＞0.05, and the sixth month: t=0.95, 1.48, -1.02, -2.11; P＞0.05). In 23G group, there were no significant differences in BUT, SⅠT, astigmatic power and the astigmatic axial measurements compared with those preoperatively at the first, third and sixth month after operation (first month: t=1.21, 1.46, -2.32, -1.61; P＞0.05, third month: t=1.45, 2.21, -2.19, -1.89; P＞0.05, and sixth month: t=1.92, 1.25, -1.76, -2.35; P＞0.05). Conclusion 23G vitrectomy is a safe and effective treatment for PDR with shorter surgery time, fewer surgical complications and postoperative ocular surface changes.