Choledochal cysts are characterized by single or multiple cystic dilatations of the intrahepatic and / or extrahepatic biliary ducts. The typical presentation of this condition is non-specific. Clinicians must have a high clinical suspicion of choledochal cysts while investigating patients with jaundice, abdominal pain, and abdominal mass. There are multiple classifications for choledochal cysts . The Todani classification system is the most widely used in clinical practice. Based on clinical practice and thinking, we established a new “three regions and five types” classification system on the basis of Todani classification to guide clinical work, but further verification is needed. Surgery is the mainstay of treatment for choledochal cysts and the approach depends on the cyst type and the extent of hepatobiliary pathology. The principles of treatment include complete excision of the cyst and restoration of biliary-intestinal continuity. In view of the risk of biliary malignancy continues to be high after surgery, long-term follow-up is strongly recommended.
OBJECTIVE: To investigate the characteristics and the pathologic classification of electrical-injury nerve using somatosensory evoked potential(SEP) technique. METHODS: SEP were detected and evaluated in 12 cases with electrical-injury nerve during operation, electrical stimulation was commenced from distal side of nerve where the structure of nerve looks normal under operating microscope, up to proximal side until evoking out a stable SEP predeterminate virtual value. Pathological examination and the following functional evaluation were compared with the values of SEP. RESULTS: At the site of nerve looking normal under operating microscope, perineurium appears normal or slightly thicken. But there are obvious fibrosis and fibrotic proliferation between fascicular and intrafascicular. Vessel plexus is not seen. At SEP stabilizely evoked site, nervous construction is normal, there are visible interfascicular vessel plexus and connective tissue appears loose. Comparing SEP values with pathological section, amplitude and latency of SEP is positively correlative with the quality of nerve. Eight cases repaired with SEP technique to select the anastomosis site for nerve transplantation were followed up, two-point discrimination reached grade III (America hand surgery association criterion) within 62.5% cases. CONCLUSION: SEP technique is valuable method for functional evaluation of electrical- injury nerve which has a complicated pathology. The pathology of electrical-injury nerve can be classified into 4 types, type A: fibrosis of nerve; type B: nerve looking normal under operation microscope, perineurium appears thicken, and there are obvious fibrosis and fibrotic proliferation between fascicular and intrafascicular, vessel plexus is rarely to see; type C: nerve looks normal, lymphocyte infiltration exists and it is obvious that there are many physalis-like, retrogressive construction in the section; type D: nervous construction is normal, there are visible interfascicular vessel plexus, and connective tissue appears loose, SEP always can be stably evoked.
Objective To observe the prognosis of visual acuity (VA) of patients with different classification of polypoidal choroidal vasculopathy (PCV). Methods Sixty-seven PCV patients (68 eyes) diagnosed by fundus photography, fundus fluorescein angiography, indocyanine green angiography (ICGA) and ocular coherence tomography were enrolled in this retrospective study. The patients were classified into static, exudative, small hemorrhage and large hemorrhage according to activity and pathological characteristics of lesions. The patients were classified into aciniform, single or several single, combined branching choroidal vascular network (BVN) according to morphological characteristics and combination with BVN of lesions on ICGA. The patients also were classified into macular, vascular arcade, peripapillary and mixing zone according to distribution of lesions. The VA of all the types were observed. Results There were 16, 19, 19, 14 eyes in the type of static, exudative, small hemorrhage and large hemorrhage PCV, which with logMAR VA of 0.34plusmn;0.52, 0.70plusmn;0.98, 0.60plusmn;0.50, 0.91plusmn;0.75 respectively. The VA of static PCV patients was better than that in exudative, small hemorrhage and large hemorrhage PCV patients (q=4.75, 4.26, 5.13; P＜0.05). There was no significant difference of VA between exudative and small hemorrhage PCV patients (q=0.98, P＞0.05). There were 22, 38 and eight eyes in the type of aciniform, single or several single, combined BVN PCV, which with logMAR VA of 0.52plusmn;0.55, 0.59plusmn;0.43, 0.80plusmn;0.95 respectively. The VA of combined BVN PCV patients was worse than that in aciniform and single or several single PCV patients (q=3.81, 3.02;P＜0.05). There were 34, 13, 8 and 13 eyes in the type of macular, vascular arcade, peripapillary and mixing zone PCV, which with logMAR VA of 0.78plusmn;0.43, 0.57plusmn;0.37, 0.38plusmn;0.27, 0.74plusmn;0.41 respectively. The VA of macular PCV patients was less than that in vascular arcade and peripapillary PCV patients (q=4.61,5.11;P＜0.05). There was no significant difference of VA between macula and mixing zone PCV patients (q=0.73,P＞0.05). Conclusions The VA of PCV patients is variable.It is related to activity and pathological characteristics of lesions, morphological characteristics and combination with BVN of lesions on ICGA, and distribution of lesions.
Objective To analyze the etiology trends, etiological characteristics treatment effects of endophthalmitis in 10 years which from 2000 to 2009 in our hospital. Methods 165 patients (172 eyes) of endophthalmitis in hospital from January 2000 to December 2009 were enrolled in this study. The patients included 122 males and 43 females. The median age was (39.0plusmn;23.7) years. The best visual acuity (BCVA) was non light perception in 16 eyes, light perception 0.05 in 135 eyes, ＞0.05 in 12 eyes. Nine children did not have visual acuity records. There were 141 patients (85.45%) with exogenous endophthalmitis which including 89 patients of trauma, 43 patients after intraocular surgery and nine others; 24 patients (14.55%) with endogenous endophthalmitis. 113 eyes were received intravitreal injection with vancomycin 0.1 ml (10 mg/ml). 152 eyes had pathogenic microorganisms culture records of aqueous humor or aqueous humor and vitreous. The positive records were given drug sensitivity test. The types of endophthalmitis, pathogenic microbial culture and drug sensitivity test results and treatment effects were analyzed. Software of SPSS was used for the clinical data statistical analysis in this study. Results Of 152 eyes with a record of aqueous/vitreous samples pathogenic bacteria culture, 42 eyes (27.63%) had a positive result. In which, 28 eyes showed positive in bacteria culture, 12 eyes was positive in fungus culture and two eyes had a positive in culture of fungus and bacteria growing. The culture positive rate was higher in exogenous endophthalmitis than that in endogenous endophthalmitis (chi;2=4.721 9,P=0.029 8).Most of the G+ positive bacteria were resistance to cephalosporin and quinolones except levofloxacin; but sensitive to vancomycin, rifampin and sulfamethoxazole. The intervention effect was more available for postoperative endophthalmitis than that for traumatic endophthalmitis and endogenous endophthalmitis, the difference was statistically significant（chi;2=38.941 3，P=0.000 0).The BCVA of 23 cases was ＞0.05 after the treatment, compared with before the treatment, the difference was statistically significant (chi;2=3.867 3,P=0.049 2).Compared the ratio of past five yearsprime; to that of recent five years, endogenous endophthalmitis was increased from 7.89% to 20.23% (chi;2=5.014 0，P=0.025 1); postoperative endophthalmitis decreased from 27.63% to 24.72%, and traumatic endophthalmitis decreased from 60.53% to 48.31%, other causes linked endophthalmitis raised from 3.95% to 6.74%. Conclusions In recent 10 years (from 2000 to 2009), the patients with endogenous endophthalmitis are growing. The positive rate of pathogenic agent culture is low, but the culture positive rate of the specimens from endogenous endophthalmitis is higher than that from exogenous endophthalmitis.The treatment was more available for postoperative endophthalmitis than that for other two types of endophthalmitis. The general visual prognosis is poor.
The in-vivo electron paramagnetic resonance (EPR) method can be used for on-site, rapid, and non-invasive detection of radiation dose to casualties after nuclear and radiation emergencies. For in-vivo EPR spectrum analysis, manual labeling of peaks and calculation of signal intensity are often used, which have problems such as large workload and interference by subjective factors. In this study, a method for automatic classification and identification of in-vivo EPR spectra was established using support vector machine (SVM) technology, which can in-batch and automatically identify and screen out invalid spectra due to vibration and dental surface water interference during in-vivo EPR measurements. In this study, a spectrum analysis method based on genetic algorithm optimization neural network (GA-BPNN) was established, which can automatically identify the radiation-induced signals in in-vivo EPR spectra and predict the radiation doses received by the injured. The experimental results showed that the SVM and GA-BPNN spectrum processing methods established in this study could effectively accomplish the automatic spectra classification and radiation dose prediction, and could meet the needs of dose assessment in nuclear emergency. This study explored the application of machine learning methods in EPR spectrum processing, improved the intelligence level of EPR spectrum processing, and would help to enhance the efficiency of mass EPR spectra processing.
ObjectiveThis study aims to compare different references for the fetal risk of drugs used in pregnancy to provide evidence for the safety of drug use in pregnancy.MethodsFour drug databases, including Lexicomp, Micromedex, TERIS, and Reprotox, as well as two books of drugs in pregnancy edited by Briggs and Schaefer, were searched. Descriptive analysis was performed regarding the definition of pregnancy recommendations and the specific content of medication.ResultsThe six references employed slightly different approaches to drugs in pregnancy, however, all of them included summaries of the risk in pregnancy, data of crossing the placenta, and human and animal data. The databases of Micromedex, TERIS, and a book edited by Briggs had their risk classification systems for drug use during pregnancy. For specific drugs, the summary of different information in pregnancy was different, the amount and content of listed evidence varied, and there was no evaluation of the quality and relevance of evidence among the references.ConclusionsThere is no consensus on the risk assessment of drugs in pregnancy. Risk classification systems for drugs in pregnancy are still an important method for determining the fetal risk of drugs. The existing references merely list studies of drugs in pregnancy, without comprehensive quality assessment. A methodological study of assessment of the risk of drugs in pregnancy is required.
Objective To assess the combined management of lower limb chronic venous diseases according to the CEAP classification. Methods One hundred and twenty patients were classified according to the CEAP classification. Based on clinical presentation and image study, all patients were treated with combined management plan including oppression, medication and surgery. Results All 120 patients (135 limbs) were followed up in clinic, the local recurrence rate was 18.52%(25/135). Conclusion CEAP classification expounds the developing process of lower limb chronic venous diseases. With CEAP, we can avoid the blind spot in the treatment and expand the extent of combined therapy. Accordingly, CEAP classification is useful in the treatment and diagnosis of chronic venous diseases.
The eye-computer interaction technology based on electro-oculogram provides the users with a convenient way to control the device, which has great social significance. However, the eye-computer interaction is often disturbed by the involuntary eye movements, resulting in misjudgment, affecting the users’ experience, and even causing danger in severe cases. Therefore, this paper starts from the basic concepts and principles of eye-computer interaction, sorts out the current mainstream classification methods of voluntary/involuntary eye movement, and analyzes the characteristics of each technology. The performance analysis is carried out in combination with specific application scenarios, and the problems to be solved are further summarized, which are expected to provide research references for researchers in related fields.
The pathogenesis of Alzheimer's disease (AD), a common neurodegenerative disease, is still unknown. It is difficult to determine the atrophy areas, especially for patients with mild cognitive impairment (MCI) at different stages of AD, which results in a low diagnostic rate. Therefore, an early diagnosis model of AD based on 3-dimensional convolutional neural network (3DCNN) and genetic algorithm (GA) was proposed. Firstly, the 3DCNN was used to train a base classifier for each region of interest (ROI). And then, the optimal combination of the base classifiers was determined with the GA. Finally, the ensemble consisting of the chosen base classifiers was employed to make a diagnosis for a patient and the brain regions with significant classification capability were decided. The experimental results showed that the classification accuracy was 88.6% for AD vs. normal control (NC), 88.1% for MCI patients who will convert to AD (MCIc) vs. NC, and 71.3% for MCI patients who will not convert to AD (MCInc) vs. MCIc. In addition, with the statistical analysis of the behavioral domains corresponding to ROIs (i.e. brain regions), besides left hippocampus, medial and lateral amygdala, and left para-hippocampal gyrus, anterior superior temporal sulcus of middle temporal gyrus and dorsal area 23 of cingulate gyrus were also found with GA. It is concluded that the functions of the selected brain regions mainly are relevant to emotions, memory, cognition and the like, which is basically consistent with the symptoms of indifference, memory losses, mobility decreases and cognitive declines in AD patients. All of these show that the proposed method is effective.
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.
