Clinical Focus

Application of artificial intelligence in neurocritical care

Nie Ximing1, Wang Long2, Liu Liping1,Yang Zhonghua1

2018, 33(4): 277-281. doi:10.3969/j.issn.1004-583X.2018.04.001

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The rapid development of artificial intelligence（AI） is staggering, and AI is now widely applied to various fields of medicine. As innovation has been made in the fields of neurointensive care, neurology and interdiscipline and against the backdrop of the rapid development of information technology, the application of AI in data analysis of neurointensive care, prognosis evaluation of diseases, intensive monitoring, prognosis and treatment has became a new target of research. This article reviews the research in application of AI in NICU and ICU in recent years. And AI technology in the clinical application still needs further exploration.

Monitoring of noninvasive intracranial pressure

Zhang Zhe, Pu Yuehua, Mi Donghua, Wei Na, Liu Liping, Wen Miao

2018, 33(4): 282-285. doi:10.3969/j.issn.1004-583X.2018.04.002

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Noninvasive intracranial pressure (ICP) measurement is an intriguing area of neurocritical care, with significance of guiding treatment while avoiding the risks and shortage of traditional invasive ICP monitoring. To date, noninvasive ICP monitoring mostly relies on cerebral blood flow monitoring, indirect ICP conduct detection, neuroelectrophysiological monitoring, brain metabolic monitoring, which are essentially indirect reflection of ICP alterations. All of these methods cannot determine ICP accurately and reliably, therefore the invasive measurements are still irreplaceable. Researches for exploring more ideal methods are needed.

Hemodynamics in cerebrovascular disease

Liu Xin, Pu Yuehua, Liu Liping

2018, 33(4): 286-289. doi:10.3969/j.issn.1004-583X.2018.04.003

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Atherosclerosis is the major cause of ischemic cerebrovascular disease.Traditionally, the degree of responsibility artery stenosis has always been a major factor for predicting recurrence in stroke patients. The CICAS study revealed that the annual recurrence rate of stroke patients with a narrowed degree of less than 50% was between 0.58% and 5.88%, indicating that the degree of stenosis did not necessarily determine the dangerous arteries of the patients. Therefore, we should pay more attention to the blood flow of the responsible artery, rather than the degree of arterial stenosis. The concept of flow fraction reserve (FFR) is introduced from the cardiovascular field, which removes the traditional concept of coronary stenosis, and can also be applied to the study of cerebrovascular disease. Based on the similarity between coronary heart disease and stroke, coronary circulation may provide the best reference for FFR measurement of cerebral vessels. The degree of stenosis of contrast examination can not tell whether the degree of stenosis is accompanied by changes in hemodynamics, thus reducing the value of functional assessment and inaccurately judging the high risk of plaque. Paying attention to the state of hemodynamics may play a patienttailored role in the treatment of ischemic stroke patients.

Treatments of aneurysmal subarachnoid hemorrhage

Zheng Lina, Liu Liping

2018, 33(4): 290-293,297. doi:10.3969/j.issn.1004-583X.2018.04.004

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Aneurysmal subarachnoid hemorrhage (aSAH) is a kind of acute hemorrhagic cerebrovascular disease with high morbidity and mortality. Surgical clipping and endovascular coiling are the two most common treatments for aSAH, both of which have their respective advantages and disadvantages. To date, the choice of surgical method is based on the shape, diameter, location and the neck size of the aneurysms, but there still exists controvesy in specific clinical choice. Through looking back on related documents, this review aims to expound comprehensively on the different treatment methods of aSAH and their respective effects.

Expression and clinical significance of follistatinlike protein 1 in serum in patients with Sjogren’s syndrome

Liu Xi1， Chen Yong2， Xu Ting1， Ni Su3， Li Chenkai3， Wu Min1

2018, 33(4): 294-297. doi:10.3969/j.issn.1004-583X.2018.04.005

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Objective To investigate the expression level and clinical significance of the serum follistatinlike protein 1(FSTL1) in patients with Sjgren’s syndrome (SS). Methods The levels of serum FSTL1 in 41 SS patients and 30 healthy controls were tested by using enzymelinked immunosorbent assay (ELISA). The differences between patients group and normal controls were analyzed and the correlation was explored. Results The serum FSTL1 was significantly higher in SS patients (2.54±0.30) ng/ml than that in normal controls (2.08±0.82) ng/ml(P=0.0035). The expression of serum FSTL1 was positively correlated with IgG(r=0.332，P=0.039) and IgA (r=0.368，P=0.021). The expression of serum FSTL1 was negatively correlated with C3(r=-0.319，P=0.045). Serum FSTL1 level was not significantly associated with ESR， IgM， C4， peripheral white blood cells， peripheral blood platelets， peripheral blood hemoglobin and RF (P>0.05). There was no significant difference in FSTL1 level between ANA titer 1∶160 group and ANA titer 1∶320 group， antiSSB positive group and antiSSB negative group (P>0.05). The correlation among interstitial lung injury， hematological system， endocrine system， arthritis and FSTL1 were not statistically significant (P>0.05). Conclusion These results suggested that the serum FSTL1 may be the candidate biomarker in reflecting activities of SS.

Correlation study of apolipoprotein and plasma lipoproteinassociated phospholipase A2 with TOAST etiology subtypes in patients with ischemic stroke

Li Hao, Cai Yong, Huang Jinbo, Yuan Li, Yuan Li, Yang Zhi

2018, 33(4): 298-301. doi:10.3969/j.issn.1004-583X.2018.04.006

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Objective To explore the relationship between apolipoprotein, lipoproteinassociated phospholipase A2(LpPLA2) and TOAST ischemic stroke etiology subtypes. Methods A total of 388 ischemic stroke patients were enrolled as study subjects, and were classifyied into five groups according to the classical theory TOAST ischemic stroke etiology subtypes：cardiogenic cerebral embolism (CE), largeartery atherosclerosis stroke (LAA), small artery stroke/lacunar infarction (SAO), the other causes of ischemic stroke (SOE), unexplained ischemic stroke (SUE). Venous blood tests were comducted on all patients on the next morning of the admission day to determine the levels of apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), apolipoprotein H (Apo H) and plasma phospholipase A2 (LpPLA2) level. Results There was a significant difference in the exposure rate of hypertension, diabetes and blood lipid abnormal in the 5 groups(P<0.01); the LpPLA2 and ApoB levels in the LAA group and SAO group were significantly higher than those of CE, SOE and SUE groups(P<0.05); the ApoA1 level in the LAA group and SAO group was significantly lower than those of CE, SOE and SUE groups(P<0.05); whether the patient's stroke etiology subtypes is the LAA, SAO was defined as the dependent variable, age, hypertension, diabetes, alcohol consumption, smoking, dyslipidemia and LpPLA2, ApoA1, ApoB and ApoH level were defined as independent variables, multivariate binary logistic analysis showed that LpPLA2 and ApoB were the risk factors of LAA and SAO, while Apo a1 was a protective factor. Conclusion LpPLA2 and ApoB are the incidence risk factors of LAA and SAO, while ApoA1 whose level undergoing an increase is a protective factor. The level determinations of serum LpPLA2, ApoB and ApoA1 levels are helpful to pinpoint tne TOAST etiological subtypes of ischemic stroke.

Analysis of the different outcomes between immediate therapy and delayed therapy in patients with stable primary spontaneous pneumothorax

Cai Zhiming, Huang Songping

2018, 33(4): 302-305,310. doi:10.3969/j.issn.1004-583X.2018.04.007

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Objective To explore the different clinical outcomes in patients with stable primary spontaneous pneumothorax(PSP) treated with immediate therapy or delayed therapy. Methods Eightythree patients admitted in the hospital were randomly allocated to immediate group(n=41) and delayed group(n=42). The durations of hospital stays of the two groups and the success rate of their primary treatment were compared. The KaplanMeier method and the COX regression were used to analyze factors associated with hospital stay. Results The duration of hospital stay in immediate group was significantly longer than that of delayed group(P<0.01). Univariate analysis showed that delayed treatment and large pneumothorax (pneumothorax size ≥50%), as well as right side pneumothoraxes were associated with prolonged hospital stay. However, only delayed treatment and large pneumothorax were risk factors for prolonged hospital stay by multivariate COX proportional risk regression analysis(P＜0.05). The immediate group was better on both hospital stay and discharge rate on day 7 compared to the delayed group for patients with small PSP(P＜0.05). The immediate success rate for large PSP could be significantly improved by means of delayed treatment compared to the immediate treatment(P<0.01). Conclusion Without prolonging the duration of hospital stay, the delayed treatment shows higher immediate success rate for large stable PSP compared with that of the immediate treatment. Conservation may be choice of the outpatient management for some patients with stable small PSP.

Evaluation of curative effect of KunXian capsule on knee osteoarthritis by high frequency ultrasound

Qi Xuan, Sun Chao, Tian Yu, Ding Meng

2018, 33(4): 306-310. doi:10.3969/j.issn.1004-583X.2018.04.008

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Objective To evaluate the curative effect of Kun Xian capsule on knee osteoarthritis (KOA) by the changes of the knee joint cartilage with high frequency ultrasound.Methods A total of 43 cases of KOA patients were enrolled and randomly divided into control group (n=24) and treatment group(n=19). The control group were treated with glucosamine hydrochloride plus meloxicam, while the treatment group were treated with Kun Xian capsule on the basis of the control group. The degree of knee joint pain in all patients was assessed by visual analogue scoring（VAS） before treatment and 3 months after treatment. In the meantime, the cartilage of the femoral trochlear groove(TG), medial femoral condyle(MFC) and lateral femoral condyle(LFC) were detected by ultrasound to grade the degrees of cartilage injury. Results Compared with the conditions before treatment，the VAS scores of the treatment group and the control group decreased after 3 month treatment(P<0.01), while, there was no significant change between MFC and LFC ultrasonic grade after 3month treatment in the control group. However, TG and the total score of ultrasonic grade witnessed increases(P<0.05). In the treatment group， there was no significant change between TG，MFC，LFC and the total score of ultrasonic grade after 3month treatment. Compared with the control group， the VAS score of the treatment group decreased more obviously(P<0.01) , TG and the total ultrasonic score of the treatment group were significantly lower than those of the control group(P<0.05), and there was no significant difference between MFC and LFC.Conclusion Kun Xian capsule combined with glucosamine hydrochloride and meloxicam can relieve pain and delay disease progression in KOA. High frequency ultrasound can be applied to evaluate the degree of articular cartilage injury as a method to evaluate the curative effect of KOA， which can be popularized in clinical application.

Role of microbiological agents combined with mesalazine sustainedrelease granules in treatment of ulcerative colitis

Wu Deming, Zhou Yuehong, Duan Tingwang

2018, 33(4): 311-313,318. doi:10.3969/j.issn.1004-583X.2018.04.009

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Objective To study the role of microbiological agents combined with mesalazine in the treatment of ulcerative colitis (UC). Methods A total of 126 UC patients were enrolled amd randomly divided into two groups, and the control group was given 4 g/d of mesalazin sustainedrelease granules. On the basis of the control group. the combined group also took 500 mg of live combined bacillus subtilis and enterococcus faecium entericcoated capsules 3 times per day for one month. The levels of hemoglobin (HB), albumin (ALB),hypersensitive C reactive protein (hsCRP), erythrocyte sedimentation rate (ESR). interleukin (IL) 6, IL10 and serum calcium binding protein were monitored before and after the treatment. Results The total effective rate in combined group was significantly higher than that of control group (P<0.01). Compared with control group, ALB and IL10 witnessesd increases in combined group (P<0.05), while hsCRP, ESR, IL6 and serum S100A12 decreased. Conclusion Microbiological agents can improve the efficiency, safety and reliability of mesalazin in the treatment of UC.

Genetic diagnosis of two children with congenital neutropenia

Qiao Mingyin， Liu Wei， Li Yange， Mao Yanna， Guan Yujie

2018, 33(4): 314-318. doi:10.3969/j.issn.1004-583X.2018.04.010

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Objective To improve the understanding and diagnosis of congenital neutropenia(CN) in children and explore the procedures by the use of gene mutation.Methods Direct DNA sequencing of PCR were applied to analyze the whole genome. The database were screened to conduct relevant sequence alignment. The mutations were confirmed by reverse sequencing. Results Propositus 1 had double heterozygous mutations, IVS3+1 G> T and c.915(E6):, while was in lack of G. Propositus 2 had heterozygous mutations: c.1004(exon1)c.1005(exon1) ,while in lack of AA.Conclusion Both of the two children with congenital neutropenia had abnormal gene mutation. Gene diagnosis is of great significance to define congenital neutropenia and provide the background for further clinical research as well as therapy in these patients.

Clinical characteristics and prognosis of patients with acute kidney injury in emergency intensive care unit

Wang Na, Li Peilan

2018, 33(4): 319-322,328. doi:10.3969/j.issn.1004-583X.2018.04.011

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Objective To analyze the incidence and prognosis of patients with acute kidney injury (AKI) in emergency intensive care unit (EICU) and to compare the clinical characteristics of patients with sepsis and nonsepsis and explore the prognosis of patints with AKI. Methods This study analyzed the baseline characteristics and laboratory data of 335 patients in EICU from January 1, 2014 to October 31, 2016. AKI patients were allocated into AKI+sepsis group and AKIsepsis group for analysis of clinical characteristics. The AKI severity was classified according to the KDIGO (Kidney Disease: Improving Global Outcomes) guidelines.The multivariable Logistic regression was applied to investigate risk factors for the progression and death of AKI. Results Of 335 patients, 175 cases (52.2%) developed AKI. Among them, there were 114 cases of septic AKI patients and 61 cases of nonseptic AKI patients. Patients with septic AKI had higher illness severity scores than nonseptic AKI patients, Vasoactive therapy and mechanical ventilation were used more commonly in septic AKI patients. The multivariable Logistic regression analysis revealed that the development of AKI was associated with infection, SOFA score, use of diuretics and cardiovascular. Infection, shock and the severity of AKI were identified as the risk factors for 28day mortality. Conclusion AKI patients have high morbidity and mortality in EICU, while patients with septic AKI had a worse prognosis than nonseptic AKI patients. A variety of factors are related to the prognosis of AKI.

Multidimensional independent predictors of cancerrelated fatigue in lung cancer patients in Gansu

Li Zhaoxia1a，2， Mi Denghai1a， Wen Zhizhen1b， Yu Xinlin1a， Shao Peng1a， Wang Yongxiang1c

2018, 33(4): 323-328. doi:10.3969/j.issn.1004-583X.2018.04.012

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Objective To analyze factors in the occurrence of cancer related fatigue(CRF) from the sociodemographic characteristics， clinical indicators， psychological factors. Methods In accordance with the definition of cancer related fatigue in international classification of diseases (10th edition)，we adopted questionnaire and grouped 242 lung cancer patients meeting inclusion and exclusion criteria in Gansu, and analyzed the impact of sociodemographic characteristics， clinical indicators and psychological factors on CRF. The independent factors of cancerrelated fatigue were explored. Results According to the inclusion/exclusion criteria, 242 valid questionnaires were completed, and the final statistical cases were 162 in the fatigued group and 80 in the nonfatigued group. Univariate analysis showed that gender, age, hemoglobin level， white blood cell count, family income, anxiety and depression were all associated with CRF. After multivariate logistic regression analysis，the aforementioned fatorsare all independent factors for CRF. Conclusion Age, gender and anxiety are risk factors of cancerrelated fatigue, while family income, hemoglobin level and white blood count are protective factors.

Prognostic significance of perioperative serum gammaglutamyl transferase level evaluating microwave ablation of patients with colorectal liver metastases

Zhao Guangyu1, Lu Chunhui1, Liu Yuanshui2, Zhang Xuede2, Zhao Wenhua2,

2018, 33(4): 329-333,337. doi:10.3969/j.issn.1004-583X.2018.04.013

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Objective To explore prognostic significance of perioperative serum gammaglutamyl transferase(GGT) level evaluating patients with colorectal liver metastases treated with microwave ablation(MWA). Methods A retrospective analysis was conducted on 80 patients with colorectal liver metastases who received MWA treatment.Survival rates and prognostic significance were compared between 45 patients (high GGT group, GGT≥60 U/L) and 35 patients (normal GGT group, GGT<60 U/L). The survival rates were calculated by using the KaplanMeier method. The Logrank method was used for univariate analysis, and the Cox regression model was used for multivariate analysis. Results After patients were treated with WMA,the 1, 2, 3 year survival rates were 62.22%, 46.67%,and 26.67%,and the median survival time was 15.3 months in the normal GGT group. The 1,2,3 year survival rates were 82.86%, 71.43%,and 48.57%,respectively,and the median survival time was 23.5 months in the high GGT group on the median survival time(P＜0.05).The COX multivariate survival analysis revealed that the level of perioperative serum GGT and metastases size were independent risk factors for patients with colorectal liver metastases,ChildPugh classification was independent protective factor for patients with colorectal liver etastases.Conclusion The level of perioperative serum GGT was an important prognostic factor to evaluate the effect of MWA on patients with colorectal liver metastases.

Clinical characteristics of severe mycoplasma pneumoniae pneumonia in hospitalized infants younger than one year old

Chen Yuyun, Wang Chengyi, Wu Lin, Chen Qin

2018, 33(4): 334-337. doi:10.3969/j.issn.1004-583X.2018.04.014

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Objective To study the clinical characteristics of severe mycoplasma pneumoniae pneumonia (MPP) in different monthage groups of infants. Methods Retrospective analysis was utilized on the clinical data of the 65 infants who were enrolled by Fujian Maternity and Children Health Hospital due to severe MPP between January 2014 and December 2016. Results All of the 65 infants had the same symptoms of cough, wheezing and rale. Among different monthage groups, the proportions of male, mechanical ventilation, fever and the length of hospitalization were not significantly different. The levels of white blood cell count, platelet count (PLT) , Creactive protein, lactate dehydrogenase, MB isoenzyme of creatine kinase, Ddimer and alanine aminotransferase were different but had no statistical significance; As the monthage grows, the proportion of maximum body temperature (>39.0 ℃) and duration of fever (≥11 days) increased with statistical significance. The proportion of pulmonary complications（including atelectasis, emphysema, lung consolidation and hydrothorax）and Pediatric Critical Illness Score decreased with statistical significance among four groups. Prealbumin (PA) differ significantly among four groups, among which the 10 to 12 months group had a higher PA level than the others. Conclusion The clinical features of severe MPP differs among infants of different monthages. Younger infants may have greater severity of MPP, more pulmonary complications and greater reduction of prealbumin, while the elder infants have higher probability of duration of fever (≥11 days).

Effect of nicorandil on prevention of contrastinduced nephropathy: a metaanalysis

Liu Xijian, Du Songmei, Zhou Jingqun

2018, 33(4): 338-341,348. doi:10.3969/j.issn.1004-583X.2018.04.015

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ObjectiveTo investigate the effect of nicorandil on the prevention of contrastinduced nephropathy(CIN).MethodsDatabases including PubMed, Cochrane Library (Issue 9,2017),VIP,WanFang Data and CNKI were electronically searched,to collect randomized controlled trials(RCTs) about nicorandil for the prevention of CIN from inception to September 2017. Two reviewers independently screened literatures, extracted data and assessed the risk of bias of included studies. Metaanalysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs involving 805 patients were included. The results of metaanalysis indicated that the incidence rate of CIN was significantly decreased in the nicorandil group (P=0.0002). ConclusionCurrent evidence shows that nicorandil can reduce incidence of CIN in cardiac intervention surgery patients.

Optimal time of initiating adjuvant chemotherapy for Ⅲ postoperative colorectal neoplama metaanalysis

Xiao Liuniu1, Chen Yingming2

2018, 33(4): 342-348. doi:10.3969/j.issn.1004-583X.2018.04.016

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Objective To gain access to the suitable interval of postoperative adjuvant chemotherapy(PAC) for stage Ⅲ colorectal cancer patients by metaanalysis and identify the effects of postoperative complications on interval as well. Methods Casecontrol studies assessing the interval time between curative resection surgery and first PAC for Ⅲ CRC patients were identified from Cochrane Library, PubMed, Web of Science, China National Knowledge Internet(CNKI). Overall Survival(OR), RelapseFree Survival(RFS), as well as the associations between postoperative complications and interval were concluded and statistically analyzed by Forest Plot.Results Eleven casecontrol studies which covered a total of 47 775 patients（26 499 males；21 276 females）were contained in this metaanalysis. We chose eight weeks for the cutoff,beyond which was related to worse OS（OR=1.75；95% CI=1.352.25,P<0.01）. If a variety of cutoffs were included,longer delay was similarly associated to a worse OS（OR=1.55,95%CI=1.231.93,P=0.0001）, but not a worse RFS（P=0.10). Postoperative complications became a key point of the delays of PAC（OR=2.43,95%CI=1.194.96,P=0.01）. Conclusion The first PAC should be performed within eight weeks in patients with stage Ⅲ colorectal cancer. Delayed PAC results in poor OS, while RFS has no significant impact. Effective control of postoperative complications is a necessary factor to ensure PAC on schedule.

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