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To explore whether the post-left atrium space (PLAS) ratio would be useful for prenatal diagnosis of total anomalous pulmonary venous connection (TAPVC) using echocardiography and artificial intelligence.We retrospectively included 642 frames of four-chamber views from 319 fetuses (32 with TAPVC and 287 without TAPVC) in end-systolic and end-diastolic periods with multiple apex directions. The average gestational age was 25.6 ± 2.7 weeks. No other cardiac or extracardiac malformations were observed. The dataset was divided into a training set (n = 540; 48 with TAPVC and 492 without TAPVC) and test set (n = 102; 20 with TAPVC and 82 without TAPVC). The PLAS ratio was defined as the ratio of the epicardium-descending aortic distance to the center of the heart-descending aortic distance. Supervised learning was used in DeepLabv3+, FastFCN, PSPNet, and DenseASPP segmentation models. The area under the curve (AUC) was used on the test set.Expert annotations showed that this ratio was not related to the period or apex direction. It was higher in the TAPVC group than in the control group detected by the expert and the four models. The AUC of expert annotations, DeepLabv3+, FastFCN, PSPNet, and DenseASPP were 0.977, 0.941, 0.925, 0.856, and 0.887, respectively.Segmentation models achieve good diagnostic accuracy for TAPVC based on the PLAS ratio.

The purpose of the study is to analyze the incidence, manifestations, and treatment of blepharoptosis caused by long-term use of corticosteroid eyedrops. Retrospective case series include 46 patients with a history of using corticosteroid eyedrops unilaterally for at least 2 months. The palpebral fissure, MRD1, and levator function were evaluated. Among 46 patients, the differences of mean MRD1 (p

OBJECTIVE To explore the correlation between clinical factors and the prognosis of multiple myeloma (MM). STUDY DESIGN A cohort study. PLACE AND DURATION OF STUDY At the Third Affiliated Hospital of Inner Mongolia Medical University, Mongolia from January 2014 to December 2018. METHODOLOGY The clinical data of 81 patients with newly diagnosed MM were collected retrospectively. The correlation of prognosis with immunophenotype and (FISH) Fluorescence in situ hybridization was subjected to univariate and multivariate analyses. Overall and progression-free survival was determined. RESULTS The overall survival (OS) and progression-free survival (PFS) of patients with CD200+, CD81+, and CD27- were significantly shortened. CD200+ and CD27- were independent prognostic factors for OS and PFS in MM patients. The prognosis-related abnormal genes were analyzed, and univariate analysis revealed that OS and PFS were significantly shortened in patients with RB-1 deletion, CDKN2C deletion, and IGH rearrangement. CDKN2C deletion was an independent prognostic factor for OS and PFS in MM patients. CONCLUSION CDKN2C deletion is an independent prognostic factor of MM. CD200+ is an independent risk factor for poor prognosis of MM. Key Words: Multiple myeloma, Prognostic analysis, Fluorescence in situ hybridization, Immunity, Immunophenotype.

Author(s): Sandefur, Benjamin J.; Oliveira J. e Silva, Lucas; Lohse, Christine M.; Goyal, Kiran A.; Barbara, David W.; Castaneda-Guarderas, Ana; Liu, Xiao-wei; Campbell, Ronna L. | Abstract: Introduction: Angioedema represents self-limited, localized swelling of submucosal or subcutaneous tissues. While the underlying etiology may be undeterminable in the emergent setting, nonhistaminergic and histaminergic angioedema respond differently to therapeutic interventions, with implications for empiric treatment. Clinical features and outcome differences among nonhistaminergic vs histaminergic angioedema patients in the emergency department (ED) are poorly characterized. We aim to describe the clinical characteristics and outcomes among ED patients with angioedema by suspected etiology.Methods: This was a 10-year retrospective study of adult ED patients with angioedema, using data abstracted from the electronic health record. We evaluated univariable associations of select clinical features with etiology and used them to develop a multivariable logistic regression model for nonhistaminergic vs histaminergic angioedema.Results: Among 450 adult angioedema patients, the mean +/- standard deviation age was 57 +/- 18 years, and 264 (59%) were female. Among patients, 30% had suspected nonhistaminergic angioedema, 30% had suspected histaminergic angioedema, and 40% were of unknown etiology. As compared to histaminergic angioedema, nonhistaminergic angioedema was associated with angiotensin-converting enzyme inhibitors (ACEI) or use of angiotensin II receptor blockers (ARB) (odds ratio [OR] [60.9]; 95% confidence interval [CI], 23.16-160.14) and time of onset one hour or more prior to ED arrival (OR [5.91]; 95% CI,1.87-18.70) and was inversely associated with urticaria (OR [0.05]; 95% CI, 0.02-0.15), dyspnea (OR [0.23]; 95% CI, 0.08-0.67), and periorbital or lip edema (OR [0.25]; 95% CI, 0.08-0.79 and OR [0.32]; 95% CI, 0.13-0.79, respectively).Conclusion: As compared to histaminergic angioedema, patients with nonhistaminergic angioedema were more likely to present one hour or more after symptom onset and take ACEI or ARB medications, and were less likely to have urticaria, dyspnea, or periorbital or lip angioedema. Identification of characteristics associated with the etiology of angioedema may assist providers in more rapidly initiating targeted therapies.

Purpose The aim of this study was to evaluate the effects of noninvasive positive pressure ventilation (NIPPV) on oxygenation status and prognosis in patients with acute lung injury induced by paraquat (PQ) poisoning. Methods Patients with acute PQ-induced lung injury treated with NIPPV were admitted to an emergency intensive care unit. Changes in oxygenation status (respiratory rate and the partial pressure of alveolar O 2 and CO 2 [PaO 2 and PaCO 2 , respectively]) after initial NIPPV were observed. Differences in inspiratory pressure (PI) between nonsurvivors and survivors were compared. The relationship between PI and the prognosis of patients with acute PQ-induced lung injury was evaluated. Findings A total of 86 patients (47 women, 39 men; mean age, 33.5 [24.5] years [range, 22–61 years]) were included. There were significant differences in respiratory rate, PaO 2 , and PaCO 2 from before to after initial NIPPV (respiratory rate, 35 [14] vs 26 [16] min –1 [ P = 0.037]; PaO 2 , 61.8 [19.6] vs 73.5 [26.8] mm Hg [ P = 0.046]; and PaCO 2 , 27.7 [16.4] vs 34.6 [19.2] mm Hg [ P = 0.039]). The overall mortality rate was 75.6% (65/86) during a 28-day follow-up period. We observed a significant difference in initial PI (PI init ) between nonsurvivors and survivors (8.2 [4.3] vs 6.6 [3.8] cm H 2 O; P = 0.043). Furthermore, nonsurvivors had a greater maximal PI (PI max ) than did survivors (21.6 [9.8] vs 15.4 [8.5] cm H 2 O; P = 0.022). Correlation analysis revealed that both PI init and PI max were associated with a poor prognosis in patients with acute PQ-induced lung injury (PI init , r = –0.29 [ P = 0.038]; PI max , r = –0.31 [ P = 0.042]). Implications NIPPV may effectively improve oxygenation status in patients with acute PQ-induced lung injury, thereby relieving dyspnea and promoting the recovery of pulmonary function. PI init and PI max may be important determinants of prognosis in acute PQ-induced lung injury. These findings need further verification in a large-scale, multicenter, randomized controlled study that combines other factors with a relatively long-term follow-up.

To quantitatively measure the morphology parameters of the right auricle with 256-slice multidetector computed tomography angiography (MDCTA) in healthy people. A retrospective analysis of 200 patients who had undergone coronary MDCTA with negative findings was performed. The raw imaging data were reconstructed and the right auricular volume, right atrial volume, right auricle height, base long and short axes, base perimeter and area, normal angle, and distance were quantitatively measured. Men had significantly (P

To compare the pre- and post-operative radiographic data of a single-level anterior cervical corpectomy and fusion (ACCF)or a two-level anterior cervical discectomy and fusion (ACDF) for patients with two-level cervical spondylotic myelopathy.We retrospectively reviewed the lateral cervical radiographs of 110 patients undergoing a single-level ACCF or a two-level ACDF for the treatment of cervical myelopathy from March 2005 to May 2008. All of them underwent anterior cervical fusion using poly ether ether ketone (PEEK) cage or titanium meshes packed with autogenous bone and fixed-screw titanium plate fixation. A single-level ACCF (group of ACCF, n = 48) or a two-level ACDF (group of ACDF, n = 62) was performed. The following parameters were analyzed: cervical sagittal alignment, Cobb angles of fusion segments, graft collapse, adjacent-segmental degeneration and rate of bone fusion.During a follow-up period of 24 - 60 months, no significant differences existed in sagittal alignment, adjacent-segmental degeneration and rate of bone fusion between two groups. Graft subsidence and loss of Cobb angles of fusion occurred significantly more during the first 2 months post-operation than after 2 months in each group (P0.01). However, the group of ACCF subsided and lost more than the group of ACDF (P0.05). Caudal endplate subsidence significantly progressed after the first 2 months in the Group of ACCF (P0.05).Graft subsidence and loss of fusion segmental lordosis of two groups occur mainly in an early post-operation stage (first 2 months). The group of ACDF with PEEK cage is superior to the group of ACCF with titanium meshes in maintaining the height and lordosis of fusion segments. Single-level ACCF with titanium meshes continues subsiding at the caudal endplate of fusion segments even after 2 months.

To evaluate the changes of visual field and retinal nerve fiber layer (RNFL) thickness during 24 months follow up in primary open-angle glaucoma (POAG) patients.In this retrospective case series study, visual field and RNFL were detected by using GDx-VCC system and Octopus perimeter in 60 patients with POAG in early stage (60 eyes), 32 in moderate stage (32 eyes) and 30 in advanced stage (30 eyes). The parameters of the RNFL thickness and mean defect (MD) of the visual fields were recorded and analyzed by repeated measures analysis of variance among the same group and by one-factor analysis of variance for different stages of POAG groups at each time of follow-up.The baseline MD of visual field in POAG was (1.93 ± 1.66) dB in early group, (5.83 ± 1.95) dB in moderate group and (14.62 ± 3.53) dB in advanced group, respectively. At 24 months, MD in POAG was significant (F = 9.47, P0.05) increased to (7.24 ± 2.17) dB in moderate group, but not in other two groups (F = 2.03, 1.40; P0.05). Compared with baseline of total average RNFL thickness in POAG at temporal-superior-nasal-inferior-temporal [TSNIT: (53.72 ± 8.07) µm, (49.73 ± 7.16) µm, and (41.42 ± 8.30) µm in each group, respectively], RNFL thickness in each group was significant (F = 21.39, 18.65, 16.63; P0.05) decreased (50.43 ± 7.08) µm, (45.47 ± 6.50) µm, and (37.62 ± 7.28) µm (respectively) at 24 months. The inferior RNFL was significantly (F = 30.25, P0.05) reduced from (61.85 ± 9.77) µm to (54.35 ± 7.47) µm in early stage group, while the superior RNFL was changed more dramatically from (55.67 ± 9.50) µm to (49.75 ± 9.54) µm in moderate stage group (F = 31.72, P0.05). Both baselines of MD and RNFL thickness were significantly different in each group (F = 428.99, 21.32; P0.05).Our results demonstrate that GDx-VCC system is useful to evaluate the progression of POAG in early and moderate stage by detecting the change of the RNFL thickness with long term follow up.

To analyze the ocular features of multiple endocrine neoplasia type 2b (MEN 2b).Three cases with MEN 2b were reviewed and their ocular features analyzed.All patients had medullary thyroid carcinoma and thickened corneal nerve fibers. Adrenal pheochromocytoma, oral mucosal neuroma, marfanoid body habitus, eyelid nodule and conjunctival nodule were found in two patients. And iris nodule was found in one patient.The most common ocular manifestations of MEN 2b is thickened corneal nerve fibers.