Magnetic resonance imaging (MRI) plays a crucial role in the diagnosis of ischemic stroke. Accurate segmentation of the infarct is of great significance for selecting intervention treatment methods and evaluating the prognosis of patients. To address the issue of poor segmentation accuracy of existing methods for multiscale stroke lesions, a novel encoder-decoder architecture network based on depthwise separable convolution is proposed. Firstly, this network replaces the convolutional layer modules of the U-Net with redesigned depthwise separable convolution modules. Secondly, an modified Atrous spatial pyramid pooling (MASPP) is introduced to enlarge the receptive field and enhance the extraction of multiscale features. Thirdly, an attention gate (AG) structure is incorporated at the skip connections of the network to further enhance the segmentation accuracy of multiscale targets. Finally, Experimental evaluations are conducted using the ischemic stroke lesion segmentation 2022 challenge (ISLES2022) dataset. The proposed algorithm in this paper achieves Dice similarity coefficient (DSC), Hausdorff distance (HD), sensitivity (SEN), and precision (PRE) scores of 0.816 5, 3.668 1, 0.889 2, and 0.894 6, respectively, outperforming other mainstream segmentation algorithms. The experimental results demonstrate that the method in this paper effectively improves the segmentation of infarct lesions, and is expected to provide a reliable support for clinical diagnosis and treatment.
Objective To investigate the characteristics, complications, and influencing factors of pediatric foreign body ingestion, providing clinical references for prevention and management. Methods A retrospective analysis was conducted on pediatric cases of foreign body ingestion treated at West China Hospital of Sichuan University between June 2007 and September 2019. Patients were stratified by age into ≤5 years, 6-10 years, and >10 years groups. Foreign body types, impaction sites, and complication rates were compared across age groups. Univariate analysis and multivariate logistic regression were performed to identify risk factors for complications. Results A total of 610 pediatric cases of foreign body ingestion were enrolled. Foreign body ingestion predominantly occurred in children ≤5 years (n=472, 77.38%), followed by 6-10 years (n=100, 16.39%) and >10 years (n=38, 6.23%). Foreign body types varied significantly by age (P<0.05): coins predominated in ≤5-year-olds (57.20%), while food-related objects were most common in >10-year-olds (52.63%). The most frequent impaction site was the upper esophagus, accounting for 48.31%, 44.00%, and 60.53% in the three age groups, respectively. Univariate analysis identified age, foreign body type, and location as significant predictors of complications (P<0.05). Multivariate logistic regression demonstrated that oropharynx and esophageal impaction (reference: stomach) [odds ratio (OR)=4.699, 95% confidence interval (CI) (2.456, 8.996), P<0.001] and high-risk foreign body types [OR=3.538, 95%CI (2.045, 6.122), P<0.001] were independent risk factors for complications, whereas increasing age had a protective effect [OR=0.418, 95%CI (0.252, 0.694), P=0.001]. Conclusions Younger children are at higher risk of foreign body ingestion, while increasing age is protective against complications. High-risk foreign body types and oropharynx and esophageal impaction significantly increase complication risks. Strengthening parental education, preventive measures against high-risk objects, and enhancing clinicians’ vigilance for complex cases are essential to reduce complications.
ObjectiveTo systematically review the factors influencing plasma concentration of lamotrigine (LTG) in the treatment of epilepsy in children.Methods Databases including PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM were electronically searched to collect clinical studies on the factors influencing plasma concentration of LTG in the treatment of epilepsy in children from database inception to December 2020. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. A systematic review was then performed to analyze the factors influencing plasma concentration of LTG in the treatment of epilepsy in children. ResultsA total of 21 studies were included. The results of systematic review suggested that dosage and some combination drugs (valproic acid, carbamazepine, phenytoin sodium, topiramate, ethosuximide, rufinamide, fluoxetine, clonazepam, clobazam and ethinylestradiol) were potential factors influencing LTG concentration. Four gene polymorphisms (UGT1A4 142T>G, UGT1A4 219C>T, UGT1A4 163G>A, and OCT1 M408V A>G), age, weight, sex, and combination drugs (phenobarbital and levetiracetam) might affect the plasma concentration of LTG in children. The effects of oxcarbazepine, 16 gene polymorphisms (UGT1A4 *3 T>G, UGT2B7 211G>T, UGT2B7 372A>G, UGT2B7 735A>G, UGT2B7 801T>A, UGT2B7 802C>T, UGT2B7 161C>T, SCN1A IVS591G>A, SCN2A c.56G>A, SCN2A c.59G>A, MDR1 1236 C>T, MDR1 2677 G>T/A, MDR1 3435 C>T, SLC22A1 1022C>T, ABCB1 3435 C>T and ABCB1 1236C>T), ketogenic diet, and ethnicity (Uygur/Han) on the plasma concentration of LTG in children were not found. Conclusion The plasma concentration of LTG in the treatment of epilepsy in children is affected by many factors, and more high-quality prospective studies should be carried out to further clarify the factors influencing the plasma concentration of LTG in children.
ObjectiveTo systematically review the research status of therapeutic drug monitoring (TDM) for traditional Chinese medicine. MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, CBM, VIP databases, official websites of governments and societies associated with TDM were electronically searched to collect studies on TDM for traditional Chinese medicine from inception to January, 2022. Two reviewers independently screened literature and extracted data. Then, a qualitative systematic review was conducted. ResultsA total of 13 studies were included, all of which came from China and were small sample size studies. The studied population consisted mainly of healthy volunteers (85%), followed by patients of coronary artery disease with blood stasis pattern (31%), patients of rheumatoid arthritis (8%), and patients of acquired immune deficiency syndrome (8%). There were two types of medicine, including proprietary Chinese medicine (69%) and Chinese herbal pieces (31%). The research topics were all theoretical research of TDM, mainly concentration detection methods (77%), followed by influence factors of blood drug concentration (15%), the selection of specimen (15%), the selection of monitoring object (8%) and the concentration reference range (8%). There was no clinical practice study on TDM of traditional Chinese medicine. ConclusionTDM of traditional Chinese medicine is still in the exploratory stage in China. Published studies are mainly on the theoretical research of TDM, and no relevant studies is on clinical practice of TDM of traditional Chinese medicine.
