【摘要】 目的 拟初步建立孕28~34周的双胎胎儿生长参数超声测量值的正常范围，比较晚孕期单、双胎妊娠胎儿的宫内生长发育模式。 方法 对2009年5月-2010年4月超声诊断为正常宫内双活胎、单活胎孕妇，采用超声测量胎儿相关生长发育指标，包括双顶径、头围、腹围、股骨长等，测量其中部分双胎的小脑横径并应用虚拟器官计算机辅助分析技术测量其小脑容积，比较晚孕期单、双胎胎儿生长发育的差异。 结果 ①自妊娠30周以后，双胎胎儿的双顶径发育速度比单胎胎儿延缓，单、双胎胎儿平均每周增长分别约2.3、1.7 mm；②自妊娠32周以后， 双胎胎儿的头围的发育速度比单胎胎儿延缓，单、双胎胎儿平均每周增长分别约6.7、5.8 mm；③自妊娠30周以后， 双胎胎儿的腹围的发育速度比单胎胎儿延缓，单、双胎胎儿平均每周增长分别约6.9、5.3 mm；④双胎胎儿股骨长从孕28~34周发育速度均较单胎胎儿缓慢，单、双胎胎儿平均每周增长分别约2.0、1.7 mm；⑤多元分析孕28~34周的双胎胎儿双顶径、头围、腹围和股骨长，相对于单胎胎儿而言，自28周起，双胎妊娠胎儿的生长发育较延缓；⑥自孕28~34周，双胎胎儿小脑横径、小脑容积与单胎胎儿无明显差异。 结论 双胎妊娠胎儿与单胎妊娠胎儿在晚孕期有着不同的生长发育规律。【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.
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.
目的 探讨联合康复新液治疗复治菌阳肺结核的临床效果。 方法 选取2011年1月－12月复治菌阳肺结核患者120例，随机分为对照组57例，观察组63例。两组患者均采取异烟肼、利福平、吡嗪酰胺、乙胺丁醇、链霉素联合治疗；观察组在此基础上再联用康复新液予以辅助治疗。治疗期间随访患者临床症状、痰菌阴转、病灶吸收情况，并就两组患者治疗效果进行评价。 结果 治疗2、3、6、8个月时观察组患者痰菌转阴率分别为46.03%、73.02%、90.48%和95.23%，明显高于对照组（26.32%、49.12%、66.66%、84.21%）；治疗6个月后胸部CT检查示观察组患者空洞闭合率为73.58%；对照组患者空洞闭合率为52.08%，两组比较差异有统计学意义（χ2=5.016，P=0.025）；治疗过程中的不良反应发生率观察组为19.04%，对照组为19.30%，两组比较差异无统计学意义（χ2=0.001，P=0.972）。 结论 对复治菌阳肺结核联合康复新液进行治疗是一种安全而有效的治疗方法。
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.
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.