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列线图 1

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Fertility outcome analysis after modified laparoscopic microsurgical tubal anastomosis

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《医学前沿（英文）》 2011年 第5卷 第3期   页码 310-314 doi: 10.1007/s11684-011-0152-8

摘要：

Modified laparoscopic microsurgical tubal anastomosis is an alternative for microsurgical anastomosis via laparotomy to reverse sterilization in women with renewed child wish. The current study aims to evaluate the fertility outcome after modified laparoscopic microsurgical tubal anastomosis. A retrospective study was performed. Fifty-eight women who underwent modified laparoscopic microsurgical tubal anastomosis were monitored to investigate the fertility outcome and characteristics of this new technology. Of the 58 patients, the cumulative pregnancy rate (PR) in the 42 patients with follow-up data was 23.8% (10/42), 57.1% (24/42), 66.7% (28/42), and 73.8% (31/42) within 6, 12, 24, and 36 months after surgery, respectively. The intrauterine PR was 69.0% (29/42). Two patients (4.8%) had ectopic pregnancies that occurred within 24 months of surgery; three cases ended in spontaneous abortion. The delivery rate was 83.9% (26/31). The length of operating time was 1.2±0.3 h, with a range of 1.0–2.5 h (60–145 min), and the mean time was approximately 75 min. The blood loss was relatively small, between 10 and 50 ml with an average amount of 22 ml. Thus, the modified laparoscopic tubal anastomosis is a highly successful procedure and a viable alternative to open abdominal microsurgical approaches. Compared with the traditional laparoscopic tubal sterilization reversal, this modified approach has three advantages: (1) less invasive approach via a trocar reduction; (2) remodeling of tube is better performing tied together after 3–4 sutures; and (3) faster operating time.

关键词： modified laparoscopy     tubal anastomosis     microsurgery    

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FMO3--TMAO axis modulates the clinical outcome in chronic heart-failure patients with reduced ejection

《医学前沿（英文）》 2022年 第16卷 第2期   页码 295-305 doi: 10.1007/s11684-021-0857-2

摘要： The association among plasma trimethylamine-N-oxide (TMAO), FMO3 polymorphisms, and chronic heart failure (CHF) remains to be elucidated. TMAO is a microbiota-dependent metabolite from dietary choline and carnitine. A prospective study was performed including 955 consecutively diagnosed CHF patients with reduced ejection fraction, with the longest follow-up of 7 years. The concentrations of plasma TMAO and its precursors, namely, choline and carnitine, were determined by liquid chromatography-mass spectrometry, and the FMO3 E158K polymorphisms (rs2266782) were genotyped. The top tertile of plasma TMAO was associated with a significant increment in hazard ratio (HR) for the composite outcome of cardiovascular death or heart transplantation (HR=1.47, 95% CI=1.13–1.91, P=0.004) compared with the lowest tertile. After adjustments of the potential confounders, higher TMAO could still be used to predict the risk of the primary endpoint (adjusted HR=1.33, 95% CI=1.01–1.74, P=0.039). This result was also obtained after further adjustment for carnitine (adjusted HR=1.33, 95% CI=1.01–1.74, P=0.039). The FMO3 rs2266782 polymorphism was associated with the plasma TMAO concentrations in our cohort, and lower TMAO levels were found in the AA-genotype. Thus, higher plasma TMAO levels indicated increased risk of the composite outcome of cardiovascular death or heart transplantation independent of potential confounders, and the FMO3 AA-genotype in rs2266782 was related to lower plasma TMAO levels.

关键词： chronic heart failure     trimethylamine-N-oxide     flavin monooxygenase 3     single nucleotide polymorphism    

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Artificial intelligence in radiotherapy: a technological review

Ke Sheng

《医学前沿（英文）》 2020年 第14卷 第4期   页码 431-449 doi: 10.1007/s11684-020-0761-1

摘要： Radiation therapy (RT) is widely used to treat cancer. Technological advances in RT have occurred in the past 30 years. These advances, such as three-dimensional image guidance, intensity modulation, and robotics, created challenges and opportunities for the next breakthrough, in which artificial intelligence (AI) will possibly play important roles. AI will replace certain repetitive and labor-intensive tasks and improve the accuracy and consistency of others, particularly those with increased complexity because of technological advances. The improvement in efficiency and consistency is important to manage the increasing cancer patient burden to the society. Furthermore, AI may provide new functionalities that facilitate satisfactory RT. The functionalities include superior images for real-time intervention and adaptive and personalized RT. AI may effectively synthesize and analyze big data for such purposes. This review describes the RT workflow and identifies areas, including imaging, treatment planning, quality assurance, and outcome prediction, that benefit from AI. This review primarily focuses on deep-learning techniques, although conventional machine-learning techniques are also mentioned.

关键词： artificial intelligence     radiation therapy     medical imaging     treatment planning     quality assurance     outcome prediction    

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Challenges and opportunities in improving left ventricular remodelling and clinical outcome following

《医学前沿（英文）》 2021年 第15卷 第3期   页码 416-437 doi: 10.1007/s11684-021-0852-7

摘要： Over the last half century, surgical aortic valve replacement (SAVR) has evolved to offer a durable and efficient valve haemodynamically, with low procedural complications that allows favourable remodelling of left ventricular (LV) structure and function. The latter has become more challenging among elderly patients, particularly following trans-catheter aortic valve implantation (TAVI). Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss, valvular-vascular impedance to myocardial activation, force-velocity relationship, and myocardial strain. LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour. Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome. Physiological pacing via the His-Purkinje system for conduction abnormalities, further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression, LV coordinate contraction, and global vascular function. TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions. Until comparable long-term durability and the resolution of TAVI related complications become available, SAVR remains the first choice for lower risk younger patients.

关键词： surgical aortic valve replacement     trans-catheter aortic valve implantation     left ventricular hypertrophy and fibrosis     myocardial force-velocity relationship     His-Purkinje pacing     renin-angiotensin system inhibitors     coronary access impairment    

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Outcome of Stretta radiofrequency and fundoplication for GERD-related severe asthmatic symptoms

null

《医学前沿（英文）》 2015年 第9卷 第4期   页码 437-443 doi: 10.1007/s11684-015-0422-y

摘要：

This study aimed to investigate the outcome of treatment with Stretta radiofrequency (SRF) or laparoscopic Nissen fundoplication (LNF). A total of 137 gastroesophageal reflux disease (GERD) patients with severe asthmatic symptoms who responded inadequately to medical treatment for asthma were investigated. The patients were followed up 1 year and 5 years after SRF (n = 82) or LNF (n = 55) treatment. A questionnaire covering 29 related symptoms and medication use was employed. Digestive, respiratory, and ear-nose-throat (ENT) symptom scores significantly decreased after antireflux treatment. Symptom scores respectively changed from 17.2±10.1, 31.9±6.6, and 21.1±11.8 to 5.0±6.2, 11.5±10.2, and 6.3±6.8 at 1 year and to 5.6±6.5, 13.1±10.1, and 7.8±7.2 at 5 years (P <0.001). The outcome of LNF was significantly better than that of SRF in terms of digestive (P <0.001, P = 0.001), respiratory (P = 0.006, P = 0.001), and ENT symptoms (P = 0.006, P = 0.003) at both 1 year and 5 years. SRF and LNF were both effective against the digestive symptoms of GERD as well as GERD-related severe asthmatic and ENT symptoms, with better outcomes exhibited by the LNF group. Severe asthmatic symptoms and GERD were closely associated, and this finding warrants further study.

关键词： asthma     gastroesophageal reflux     Stretta radiofrequency     laparoscopic Nissen fundoplication    

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Treatment outcomes of pulmonary tuberculosis in the past decade in the mainland of China: a meta-analysis

null

《医学前沿（英文）》 2013年 第7卷 第3期   页码 354-366 doi: 10.1007/s11684-013-0257-3

摘要：

Due to the implementation of directly observed treatment strategy (DOTS), China has made a significant achievement in tackling the tuberculosis (TB) epidemic in the 1990s. However, only half of regions in China met or exceeded the 85% rate of treatment success target. The aim of the present study is to summarize the treatment outcomes of smear-positive pulmonary TB in the mainland of China in the past decade using meta-analysis based on systematic review of published observational studies. A total of 50 eligible articles (58 studies) were identified and included in this study. The summarized treatment success rates were 93.9% (95% CI, 92.8%–94.7%) for new cases and 85.4% (95% CI, 83.0%–87.6%) for previously treated cases, and the summarized cured rate were 92.2% (95% CI, 90.9%–93.3%) and 81.2% (95% CI, 79.1%–83.1%), respectively. A remarkable increase of rates for treatment success and cure was observed in the 1990s. After 2000, the summarized treatment outcomes were tending towards stability. In addition, geographic areas, type of the data and administrative level of the hospital were also found to influence the estimates of the treatment outcomes. Results of the present study clearly show, in general, that the pulmonary TB treatment achieved significant success in the past decade in the mainland of China. However, it needs to be further strengthened in the central and west areas.

关键词： tuberculosis     treatment     outcome     China     meta-analysis    

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预测新型冠状病毒肺炎患者临床预后好转概率的列线图—— 以中国浙江省为例 Article

谢娇娇, 石鼎, 鲍明阳, 胡潇逸, 吴文瑞, 盛吉芳, 徐凯进, 王清, 吴静静, 王恺岑, 方戴琼, 李雅婷, 李兰娟

《工程（英文）》 2022年 第8卷 第1期   页码 122-129 doi: 10.1016/j.eng.2020.05.014

摘要：

本研究旨在为临床医生开发一种定量方法，以预测新型冠状病毒肺炎（COVID-19）患者临床预后好转的可能性。本研究收集了2020年1月10日至2月26日入院后经实验室确诊的104例COVID-19感染患者的数据，包括患者的临床基本信息和实验室检查结果，并比较好转和未好转患者的各项参数。本研究使用最小绝对收缩和选择算法（LASSO）logistics 回归模型和双向逐步策略的多因素logistics 回归模型筛选预测预后因素，使用一致性指数（C指数）评估模型，并通过重复抽样进行内部验证，以此构建了一项新的预测列线图。截至2020年2月26日，研究中包括的104位患者（中位年龄为55岁）中，75位（72.1%）预后好转，而29位（27.9%）没有明显好转迹象。临床预后好转的患者与未好转的患者在临床特征和实验室检查结果上存在许多差异。经过多步筛选过程后，本研究筛选出5项预后因素并将其纳入列线图的构建，包括免疫球蛋白A（IgA）、C反应蛋白（CRP）、肌酸激酶（CK）、急性生理学和慢性健康评估表II（APACHE II），以及CK和APACHE II之间的相互作用。本研究建立的模型的C指数为0.962 [95%置信区间（CI）为0.931~0.993]，并且通过重复抽样验证其值仍然达到0.948。预测列线图与理想模型相比，在校准图方面显示出接近的性能，并且决策曲线和临床影响曲线显示，其在临床上具有实用性。本研究构建的列线图有助于临床医生预测每位COVID-19患者的临床预后好转的可能性，将有助于个性化的咨询和治疗。

关键词： 新型冠状病毒肺炎（COVID-19）     列线图     临床预后    

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2010—2013年新疆HIV感染孕产妇妊娠结局分析

沙吾力·艾力卡,艾比拜·买买提明,王晓军

《中国工程科学》 2015年 第17卷 第6期   页码 50-52

摘要：

旨在了解新疆HIV感染孕产妇妊娠结局 。利用2010—2013年间在预防艾滋病母婴传播管理信息网络直报系统中报告的HIV感染孕产妇个案卡资料进行分析。2 256例HIV感染孕产妇平均年龄29.1岁，以维吾尔族为主，占90.65 %，初中及以下文化程度者占72.07 %，无业和农民占82.36 %（其中无业者占47.30 %），初婚占56.12 %，再婚占37.19 %。2次及以上妊娠者占69.68 %，有316例HIV感染孕产妇在知道自己的感染状况后仍然选择妊娠，占总数的14.01 %；再次妊娠的HIV感染孕产妇中人工终止妊娠的比例明显高于第一次接受服务的HIV感染孕产妇，两者有统计学差异（χ2=141.14，P=0.000）。新疆HIV感染孕产妇知道自身感染情况后仍有选择再次妊娠者，再次妊娠者中选择人工终止妊娠的比例明显高于第一次妊娠者，提示意外妊娠的存在，建议加强HIV感染妇女预防艾滋病母婴传播咨询服务和避孕指导，减少意外妊娠的发生，使HIV感染女性能够了解相关知识从而能够做出正确的生育或妊娠选择。

关键词： HIV感染孕产妇     非意愿性妊娠     生殖健康    

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Poor adherence to P2Y12 antagonists increased cardiovascular risks in Chinese PCI-treated patients

null

《医学前沿（英文）》 2017年 第11卷 第1期   页码 53-61 doi: 10.1007/s11684-017-0502-2

摘要：

Low adherence to secondary prevention medications (ATM) of patients after acute coronary syndrome (ACS) is associated with poor clinical outcomes. However, literature provides limited data on assessment of ATM and risks associated with poor in Chinese patients with ACS. In the current work, ATM was assessed in consecutively recruited patients with ACS in Tongji Hospital from November 5, 2013 to December 31, 2014. A total of 2126 patients were classified under low adherence (proportion of days covered (PDC)<50%) and high adherence (PDC>50%) groups based on their performance after discharge. All patients were followed up at the 1st, 6th, and 12th month of discharge while recording ATM and major adverse cardiac events (MACE). Bivariate logistic regression was used to identify the factors associated with ATM. Cox regression was used to analyze the association between ATM and MACE within one year after discharge. Results showed that coronary artery bypass grafting (CABG) alone had significantly lower proportion of high adherence to P2Y12 antagonists (83.0% vs. 90.7%, P<0.01) than patients treated with percutaneous coronary intervention (PCI) only. Moreover, in patients undergoing PCI, high adherence to P2Y12 antagonists decreased the risk of MACE (hazard ratio=0.172, 95% confidence interval: 0.039–0.763; P=0.021). In conclusion, PCI-treated patients are more prone to remaining adherent to medications than CABG-treated patients. High adherence to P2Y12 antagonists was associated with lower risk of MACE.

关键词： acute coronary syndromes     adherence to secondary prevention medications     clinical outcome    

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Comparison of CT-guided aspiration to key hole craniotomy in the surgical treatment of spontaneous putaminal hemorrhage: a prospective randomized study

ZHAO Jizong, WANG Dejiang, WANG Shuo, YUAN Ge, KANG Shuai, JI Nan, ZHAO Yuanli, YE Xun, ZHOU Liangfu, ZHOU Dingbiao, WANG Renzhi, WANG Mei

《医学前沿（英文）》 2007年 第1卷 第2期   页码 142-146 doi: 10.1007/s11684-007-0027-1

摘要： This study was designed to compare the approaches and efficacies of two different ways of neurosurgical management for spontaneous putaminal hemorrhage (SPH): computed tomographic-guided aspiration (CTGA) and the key-hole approach (KHA). The indications of the two approaches are also explored. From September 2001 to 2003, a total of 1077 cases of SPH distributed in 135 hospitals all over the mainland of China were included for analysis. All cases had three-month follow-up data. The study was designed in a single-blinded manner to compare the efficacies of the different approaches. There were 563 cases in the CTGA group, 165 in the KHA group, and 217 cases in the conventional open craniotomy (COC) group. In the CTGA and KHA groups, the mortalities at one month after operation (M1m) were 17.9% and 18.3%, respectively, while the mortalities at three months after operation (M3m) were 19.4% and 19.4%, respectively (>0.05). The postoperative complications due to CTGA (23.7%) were not significantly different from those due to KHA (25.7%) ( = 0.420). The M3m of patients with Glasgow coma scale (GCS) "d8 was 3.45 and 4.0 times as much as those with GCS>8, respectively. The M3m of patients with complications was 3.92 times as much as those without complications. The M3m of patients with hemorrhage volume "e70 mL was 2.67 times as much as those <70 mL. The CTGA is not better than KHA in the treatment of SPH in terms of a more favorable outcome or less mor tality and morbidity, but CTGA could be the first choice for those with bleeding volumes "d50mL, while KHA is the first choice for those with bleeding volumes >50 mL.

关键词： tomographic-guided aspiration     single-blinded manner     favorable outcome     operation     Glasgow    

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免费孕前优生健康检查对象潜在危险因素接触和妊娠结局分析

车焱,周公望,王彩琴,张焕玲,张建娥,闫立新,陆珍,陆梅,沈洁,朱昊平

《中国工程科学》 2014年 第16卷 第5期   页码 56-59

摘要：

分析并报告上海市静安区免费孕前优生健康检查后待孕夫妇不良妊娠结局潜在影响因素接触情况以及妊娠率和妊娠结局，为免费孕前健康检查政府实施项目效果的评估提供基础数据。对2011 年8 月—2012 年11 月在静安区参加免费孕前优生健康检查的所有对象在其检查结束后的3 个月、6 个月、12 个月进行随访，重点关注不良妊娠结局潜在危险因素接触情况以及妊娠时间和妊娠结局。统计方法为χ2检验、寿命表、Logistic 回归分析。在目标时段内共有1 480 对夫妇参加了免费孕前优生健康检查，其中1 249 对服务对象接受了随访，随访率为84.4 %。截至2013 年4 月，48.7 %的随访对象已经受孕，孕前检查后3 个月调查累积妊娠率为23.9 %，6 个月调查累积妊娠率为45.0 %。365 人完成妊娠结局的随访，结果显示，早产率为3.0 %，低出生体重率为4.3 %，巨大儿发生率为3.3 %。自然流产率为6.3 %。另外，发现出生缺陷1 人，占妊娠妇女数的0.16 %，占有妊娠结局妇女数的0.27 %。烟酒等不良生活习惯丈夫的比例（18 %～20 %）高于妻子（1 %～3 %），77 %的丈夫和妻子接受潜在电磁辐射的时间超过8 h。9 %的夫妇自述生活和工作中接触重金属以及农药、化肥等潜在致畸物。超过10 %的妻子在怀孕以后接触了潜在致畸物。初步分析未发现上述因素与不良妊娠结局的关系。静安区孕前健康检查后半年内妇女妊娠率不到50 %，有必要在上海乃至全国开展免费孕前健康检查的成本效益评估。

关键词： 孕前优生健康检查     妊娠率     累积妊娠率     不良妊娠结局     危险因素    

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新冠病毒肺炎临床试验核心指标集（COS-COVID） Article

金鑫瑶, 庞博, 张俊华, 刘清泉, 杨忠奇, 封继宏, 刘学政, 张磊, 王保和, 黄宇虹, Alice Josephine Fauci, 马玉玲, Myeong Soo Lee, 元唯安, 谢雁鸣, 唐健元, 高蕊, 杜亮, 张硕, 祁寒梅, 孙宇, 郑文科, 杨丰文, 蔡慧姿, 王可仪, 欧益, 黄明, 朱彦, 喻佳洁, 田金徽, 赵敏, 胡镜清, 姚晨, 李幼平, 张伯礼

《工程（英文）》 2020年 第6卷 第10期   页码 1147-1152 doi: 10.1016/j.eng.2020.03.002

摘要： 本研究旨在构建COVID-19临床试验核心结局指标集（core outcome set, COS），为相关临床研究方案设计、开展和证据转化提供参考。

关键词： 核心指标集     COVID-19     2019-nCoV     冠状病毒疾病     临床试验    

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标题 作者 时间 类型 操作

Fertility outcome analysis after modified laparoscopic microsurgical tubal anastomosis

null

期刊论文

FMO3--TMAO axis modulates the clinical outcome in chronic heart-failure patients with reduced ejection

期刊论文

Artificial intelligence in radiotherapy: a technological review

Ke Sheng

期刊论文

Challenges and opportunities in improving left ventricular remodelling and clinical outcome following

期刊论文

Outcome of Stretta radiofrequency and fundoplication for GERD-related severe asthmatic symptoms

null

期刊论文

Treatment outcomes of pulmonary tuberculosis in the past decade in the mainland of China: a meta-analysis

null

期刊论文

预测新型冠状病毒肺炎患者临床预后好转概率的列线图—— 以中国浙江省为例

谢娇娇, 石鼎, 鲍明阳, 胡潇逸, 吴文瑞, 盛吉芳, 徐凯进, 王清, 吴静静, 王恺岑, 方戴琼, 李雅婷, 李兰娟

期刊论文

2010—2013年新疆HIV感染孕产妇妊娠结局分析

沙吾力·艾力卡,艾比拜·买买提明,王晓军

期刊论文

Poor adherence to P2Y12 antagonists increased cardiovascular risks in Chinese PCI-treated patients

null

期刊论文

Comparison of CT-guided aspiration to key hole craniotomy in the surgical treatment of spontaneous putaminal hemorrhage: a prospective randomized study

ZHAO Jizong, WANG Dejiang, WANG Shuo, YUAN Ge, KANG Shuai, JI Nan, ZHAO Yuanli, YE Xun, ZHOU Liangfu, ZHOU Dingbiao, WANG Renzhi, WANG Mei

期刊论文

免费孕前优生健康检查对象潜在危险因素接触和妊娠结局分析

车焱,周公望,王彩琴,张焕玲,张建娥,闫立新,陆珍,陆梅,沈洁,朱昊平

期刊论文

新冠病毒肺炎临床试验核心指标集（COS-COVID）

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