A predictive score for retinopathy of prematurity by using clinical risk factors and serum insulin-like growth factor-1 levels

AIM：To detect the impact of insulin-like growth factor-1（IGF-1）and other risk factors for the early prediction of retinopathy of prematurity（ROP）and to establish a scoring system for ROP prediction by using clinical criteria and serum IGF-1 levels.METHODS：The study was conducted with 127 preterm infants.IGF-1 levels in the 1st day of life,1st,2nd,3rd and4th week of life was analyzed.The score was established after logistic regression analysis,considering the impact of each variable on the occurrences of any stage ROP.A validation cohort containing 107 preterm infants was included in the study and the predictive ability of ROP score was calculated.RESULTS：Birth weights（BW）,gestational weeks（GW）and the prevalence of breast milk consumption were lower,respiratory distress syndrome（RDS）,bronchopulmonarydysplasia（BPD）and necrotizing enterocolitis（NEC）were more frequent,the duration of mechanical ventilation and oxygen supplementation was longer in patients with ROP（P〈0.05）.Initial serum IGF-1 levels tended to be lower in newborns who developed ROP.Logistic regression analysis revealed that low BW（〈1250 g）,presence of intraventricular hemorrhage（IVH）and formula feeding increased the risk of ROP.Afterwards,the scoring system was validated on 107 infants.The negative predictive values of a score less than 4 were 84.3%,74.7%and 79.8%while positive predictive values were 76.3%,65.5%and71.6%respectively.CONCLUSION：In addition to BW〈1250 g and IVH,formula consumption was detected as a risk factor for the development of ROP.Breastfeeding is important for prevention of ROP in preterm infants.

精神分裂症皮纹学特征及其诊断应用的探讨

报告１０６例精神分裂症患者的手纹研究结果，发现患者皱褶掌及掌褶末端分叉的出现率均非常显著地高于对照，（Ｐ＜０．０１），ａｔｄ角偏大（４３．８９°±５．４９°），ａ－ｂＴＲＣ值偏低（３３．３４±５．６０）；总指纹嵴数高于对照；掌褶四种变异型（除悉尼线外）出现率与对照组相比亦有非常显著差异。本次观察最后选取皱褶掌等四项指标，确定它们的权重，对患者手纹进行评分，判总分在６０分以上者为阳性；结果阳性率为６２．２４％。

多域特征提取和极限学习机的滚动轴承智能诊断

针对现实复杂工况下的振动以及噪声问题,提出了基于多域特征提取、Fisher得分和极限学习机(Extreme Learn⁃ing Machine,ELM)的滚动轴承诊断方法。首先,通过多域特征提取方法构造多域特征集,其次利用Fisher得分算法按照多域特征集特征值的重要性进行排序,选择具有代表性的敏感故障特征,最后,将重新构造的多域特征集输入极限学习机中实现智能诊断。利用美国西储大学轴承试验数据进行分析,为贴近现实工况,在原始振动信号上加50dB的白噪声,结果表明,提出的方法能够有效识别滚动轴承的故障大小和类别,并具有良好的抗噪性。

Role of multi-parametric MRI of the prostate for screening and staging:Experience with over 1500 cases

Objective:Contemporary prostate cancer(PCa)screening modalities such as prostate specific antigen(PSA)and digital rectal examination(DRE)are limited in their ability to predict the detection of clinically significant disease.Multi-parametric magnetic resonance imaging(mpMRI)of the prostate has been explored as a staging modality for PCa.Less is known regarding its utility as a primary screening modality.We examined our experience with mpMRI as both a screening and staging instrument.Methods:mpMRI studies performed between 2012 and 2014 in patients without PCa were cross-referenced with transrectal ultrasonography(TRUS)biopsy findings.Statistical analyses were performed to determine association of mpMRI findings with overall cancer diagnoses and clinically significant(Gleason score≥7)disease.Subgroup analyses were then performed on patients with a history of prior negative biopsy and those without a history of TRUS biopsy.mpMRI studies were also cross-referenced with RP specimens.Statistical analyses determined predictive ability of extracapsular extension(ECE),seminal vesicle involvement(SVI),and pathologic evidence of clinically significant disease(Gleason score
7).Results:Four hundred biopsy naive or prior negative biopsy patients had positive mpMRI studies.Overall sensitivity,specificity,positive and negative predictive values were 94%,37%,58%,and 87%,respectively and 95%,31%,42%,and 93%,respectively for overall cancer detection and Gleason score≥7 disease.In patients with no prior biopsy history,mpMRI sensitivity,specificity,positive and negative predictive values were 94%,36%,65%,and 82%,for all cancers,and 95%,30%,50%,and 89%for Gleason score
7 lesions,respectively.In those with prior negative biopsy sensitivity,specificity,positive and negative predictive values were 94%,37%,52%,and 90% for all cancers,and 96%,32%,36%,and 96% for Gleason score
7 lesions,respectively.Seventy-four patients underwent radical prostatectomy(RP)after mpMRI.Lesion size on mpMRI correlated with the presence of Gleason score
7 cancers(p Z 0.005).mpMRI sensitivity,specificity,positive and negative predictive values were 84%,39%,81%,and 44% respectively,for Gleason
7 cancer.For ECE and SVI,sensitivity and specificity were 58% and 98% and 44% and 97%,respectively.Conclusion:mpMRI is an accurate predictor of TRUS biopsy and RP outcomes.mpMRI has significant potential to change PCa management,particularly in the screening population,in whom a significant proportion may avoid TRUS biopsy.Further studies are necessary to determine how mpMRI should be incorporated into the current PCa screening and staging paradigms.

Midwives’ adherence to guidelines on the management of birth asphyxia in Malawi

A study was conducted to determine midwives adherence to guidelines on management of birth asphyxia at Queen Elizabeth Central Hospital in Blantyre district, Malawi. The study design was descriptive cross sectional using quantitative data analysis method on 75 midwives that were working in the maternity unit of the hospital. A structured questionnaire was used to collect data on participant’s demographic characteristics and midwives’ comprehension of birth asphyxia and an observational check list was used to observe midwives’ adherence to WHO resuscitation guidelines. In addition midwives were observed on their adherence to the Integrated Maternal and Neonatal Health guidelines that were developed by the Malawi Ministry of Health. The findings indicate that the midwives had knowledge of birth asphyxia in general. However, there were gaps in their ability to identify warning signs of birth asphyxia through partograph use. In addition the midwives did not adhere to 9 out of the 21 steps of the resuscitation guideline. Generally there was substandard adherence to guidelines on identification of warning signs of birth asphyxia and neonatal resuscitation. On the other hand, the facility did not have adequate resuscitation equipment and supplies. The results are discussed in relation to the importance of adhering to resuscitation guidelines in the management of birth asphyxia for babies that do not breathe at birth. Training of the midwives on partograph use and resuscitation to improve neonatal outcomes is recommended. It is recommended further that the health facility should have adequate resuscitation equipment and supplies.

Mis-estimation of coronary lesions and rectification by SYNTAX score feedback for coronary revascularization appropriateness

Background::Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization.Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score is a comprehensive system to evaluate the complexity of the overall lesions.We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease(CAD).Methods::In this single-center,historical control study,patients with stable CAD with coronary lesion stenosis≥50%were consecutively recruited.During the control period,SYNTAX scores were calculated by treating cardiologists.During the intervention period,SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making.The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.Results::A total of 3245 patients were enrolled and assigned to the control group(08/2016-03/2017,n=1525)or the intervention group(03/2017-09/2017,n=1720).For SYNTAX score tertiles,17.9%patients were overestimated and 4.3%were underestimated by cardiologists in the control group.After adjustment,inappropriate revascularization significantly decreased in the intervention group compared with the control group(adjusted odds ratio[OR]:0.83;95%confidence interval[CI]:0.73-0.95;P=0.007).Both inappropriate percutaneous coronary intervention(adjusted OR:0.82;95%CI:0.74-0.92;P<0.001)and percutaneous coronary intervention utilization(adjusted OR:0.88;95%CI:0.79-0.98;P=0.016)decreased significantly in the intervention group.There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.Conclusions::Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD.Clinical trial registration::Nos.NCT03068858 and NCT02880605;https://www.clinicaltrials.gov.

Does Internet Use Improve the Income of Residents? -Empirical Evidence from CGSS2017

The Internet penetration rate rises sharply in recent years in China.This change has had a significant impact on residents’income.By using Chinese General Social Survey(CGSS)data set,this paper investigates whether residents who use the Internet earn a higher income than similar residents who do not use the Internet by using propensity score matching.The results show that there is a premium associated with Internet use.Estimates suggest that a premium for residents who use the Internet is around twice as much for residents who do not use the Internet.Additionally,this paper fi nds that the inlome differences between using the Internet and not using the Internet for groups of middle-aged and elderly resident and agricultural household registration residents are more significant.Based on the research results,several relevant policy implications are presented to improve resident’s income.