目的 探讨不同诊断或分类标准在脊柱关节病患者之间诊断效能、临床特点。 方法 收集2000年2月-2012年8月141例脊柱关节病患者及197例类风湿关节炎、未分化关节炎患者资料。采用3种诊断标准下对141例患者分为纽约标准(NY)组、欧洲脊柱关节病研究(ESSG)组及脊柱关节病国际评估(ASAS)组,统计患者的临床表现、骶髂关节CT、MRI、实验室指标,并加入197例类风湿关节炎未分化关节炎患者,计算和比较3种诊断的敏感性、特异性。 结果 在141例脊柱关节病中,62例符合NY标准,34例符合ESSG标准,45例只符合ASAS标准。3组患者在性别、胸廓受限、附着点炎及跖(指)炎、非甾体抗炎药及慢作用药使用、炎症因子水平方面差异无统计学意义(P>0.05);ASAS组则较19 NY组及ESSG组患者更年轻、病程较短,且表现有外周关节炎明显高于其余两组(P<0.05);NY组炎性腰背痛、脊柱活动受限、HLA-B27阳性率明显高于其余两组,且使用生物制剂比例最高,达48.38;在骨盆X线、骶髂关节CT表现关节侵蚀上,NY组较其他两组更严重。NY、ESSG、ASAS分类标准敏感性依次为43.97%、47.51%、73.76%,特异性依次为100.00%、90.86%、84.26%。 结论 ASAS分类标准敏感性高,患者更年轻、病程更短,炎性腰背痛、外周关节炎是ASAS诊断中非常重要的指标;NY组脊柱活动受限及关节侵蚀最显著,HLA-B27阳性可能是预测AS很好的指标。NY标准特异性最高,敏感性最低,而ASAS标准敏感性最高,特异性最低。
In this paper, a deep learning method has been raised to build an automatic classification algorithm of severity of chronic obstructive pulmonary disease. Large sample clinical data as input feature were analyzed for their weights in classification. Through feature selection, model training, parameter optimization and model testing, a classification prediction model based on deep belief network was built to predict severity classification criteria raised by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). We get accuracy over 90% in prediction for two different standardized versions of severity criteria raised in 2007 and 2011 respectively. Moreover, we also got the contribution ranking of different input features through analyzing the model coefficient matrix and confirmed that there was a certain degree of agreement between the more contributive input features and the clinical diagnostic knowledge. The validity of the deep belief network model was proved by this result. This study provides an effective solution for the application of deep learning method in automatic diagnostic decision making.
On September 27, 2022, the first international standard of Diagnosis and Classification of Optic Neuritis was published online in Lancet Neurology, the top journal of neurology. The publication of this standard fills the gap in the international diagnosis and classification of optic neuritis (ON), promotes the consistency of the global diagnosis classification of ON, and helps ophthalmologists and neurologists to diagnose ON more accurately in the future. In recent decades, although Chinese ophthalmologists have made great progress in their understanding of ON and diagnosis and treatment level, it is still necessary to continue to strengthen the standardized training of Chinese neuro-ophthalmologist specialists, cooperate to establish a national ON clinical epidemiology database, carry out Chinese multi-center clinical studies, and further verify and optimize the international ON diagnostic system in future clinical practice. The ON diagnostic standards and treatment standards are gradually improved for China.
Poland syndrome is a congenital anomaly characterized by unilateral underdeveloped or absent chest wall, accompanied by varying degrees of ipsilateral limb defects. In clinical practice, Poland syndrome is prone to misdiagnosis and missed diagnosis, which delays treatment timing and affects treatment effectiveness, as the current etiology is not yet clear and there is no unified and standardized clinical classification and treatment plan. This article summarizes and elaborates on the etiology, clinical manifestations, classification, diagnosis, and treatment of Poland syndrome by reviewing relevant literature on the diagnosis and treatment of Poland syndrome both domestically and internationally in recent years, in order to enhance understanding of Poland syndrome, provide reference for standardized clinical diagnosis and treatment, and improve the efficiency of diagnosis and treatment.