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Changes in the functional connections of the brain at rest in patients with acute ischemic stroke and hypersomnia 急性缺血性中风和嗜睡症患者静息状态下大脑功能连接的变化
Pub Date : 2024-07-03 DOI: 10.17816/dd627000
L. I. Trushina
BACKGROUND: Brain damage after ischemic stroke results in changes in a wide range of structural and functional brain networks [1]. Scientific studies show that although stroke is primarily a focal lesion, it also affects the functional connectivity of anatomical and functional regions, often resulting in altered integration of brain networks and affecting whole-brain function, leading to cognitive and emotional impairment [2, 3]. AIM: The aim of the study was to determine changes in functional brain connectivity during hypersomnia in patients with acute ischemic stroke. MATERIALS AND METHODS: A total of 44 patients with acute ischemic stroke were examined. The participants were divided into two groups based on the presence of sleep disorders. Group 1 included 22 patients with hypersomnia, which was objectively confirmed by polysomnography. Group 2 also included 22 patients who did not have sleep disorders and constituted the control group. The age of patients in both groups ranged from 45 to 65 years. All patients underwent magnetic resonance imaging on tomographs with a magnetic field induction strength of 1.5 Tesla, using the standard protocol and special pulse sequences of T-gradient echo 3D MPRAGE and BOLD. Resting-state functional magnetic resonance imaging of the brain was employed to assess functional connectivity. Postprocessing was conducted on specialized software, CONN-TOOLBOX, which generated appropriate graphical representations of quantitative results based on the selection of zones of interest. RESULTS: In patients experiencing the acute phase of ischemic stroke, hypersomnia results in the strengthening of functional connections, predominantly in the temporo-occipital and parietal regions. This may be associated with impaired visual perception, memory, and spatial orientation. Additionally, there is a weakening of functional connections in the frontal and occipital cortex, which may indicate confusion of thinking and disorders of speech, arbitrary movements, and the regulation of complex behaviors. The disruption of the functional connections between the medial prefrontal cortex and the posterior cingulate cortex and the cerebellum is indicative of impaired coordination and regulation of balance and muscle tone. However, it also has the potential to affect emotional, cognitive, and behavioral changes in the brain. CONCLUSIONS: Resting-state functional magnetic resonance imaging is a technique that allows for the determination of changes in functional brain connections during hypersomnia in patients with acute ischemic stroke. Additionally, it enables the identification of neuroimaging markers corresponding to this pathology.
背景:缺血性脑卒中后的脑损伤会导致广泛的脑结构和功能网络的改变[1]。科学研究表明,虽然脑卒中主要是一种局灶性病变,但它也会影响解剖和功能区域的功能连接,往往导致脑网络整合的改变,影响全脑功能,从而导致认知和情感障碍[2, 3]。目的:本研究旨在确定急性缺血性脑卒中患者嗜睡时脑功能连接的变化。材料与方法:共对 44 名急性缺血性脑卒中患者进行了研究。根据患者是否存在睡眠障碍将其分为两组。第 1 组包括 22 名嗜睡症患者,多导睡眠图客观证实了这一点。第二组包括 22 名没有睡眠障碍的患者,构成对照组。两组患者的年龄在 45 至 65 岁之间。所有患者都在磁场感应强度为 1.5 特斯拉的断层扫描机上进行了磁共振成像,使用标准方案和 T 梯度回波 3D MPRAGE 和 BOLD 特殊脉冲序列。大脑静息态功能磁共振成像用于评估功能连接性。后处理由专业软件 CONN-TOOLBOX 进行,该软件可根据感兴趣区的选择生成适当的定量结果图表。结果:缺血性脑卒中急性期患者嗜睡会导致功能连接加强,主要集中在颞枕叶和顶叶区域。这可能与视觉感知、记忆和空间定位受损有关。此外,额叶和枕叶皮层的功能连接也会减弱,这可能会导致思维混乱以及言语、任意动作和复杂行为的调节失调。内侧前额叶皮层和后扣带回皮层与小脑之间的功能联系中断,表明协调和调节平衡及肌肉张力的能力受损。然而,它也有可能影响大脑的情绪、认知和行为变化。结论静息态功能磁共振成像是一种可以确定急性缺血性中风患者嗜睡时大脑功能连接变化的技术。此外,它还能确定与这种病理变化相对应的神经影像标记。
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引用次数: 0
Postmortem liver hypostases in newborns: radiation and pathological characteristics 新生儿死后肝脏下垂:辐射和病理特征
Pub Date : 2024-07-03 DOI: 10.17816/dd625987
O. V. Savva, U. N. Tumanova, V. Bychenko, A. I. Shchegolev
BACKGROUND: During pathological and forensic autopsies, the bodies of the deceased are examined to identify nonspecific cadaveric changes. These changes include internal hypostases, which are characterized by the redistribution of blood in tissues and organs under the influence of gravity [1, 2]. Such postmortem hypostases reflect the age of death, but they also complicate the differential diagnosis of lifetime pathological processes and lesions with nonspecific cadaveric changes [3, 4]. Postmortem magnetic resonance imaging represents an objective and noninvasive method of investigation, particularly in cases of neonatal death characterized by relative immaturity of organs and tissues. It may therefore prove to be a promising approach to visualize and evaluate cadaveric hypostases [5, 6]. AIM: The aim of this study was to investigate the manifestations of cadaveric hypostases in the liver of deceased neonates, with a focus on the impact of postmortem period duration. This was achieved through the use of postmortem magnetic resonance imaging and morphologic examination. MATERIALS AND METHODS: The study was based on a comprehensive postmortem radiology and pathological anatomical examination of the bodies of 62 newborns and infants who died at the age of 1.5 hours to 49 days. The subjects were selected to exclude those with developmental anomalies and liver diseases. A postmortem magnetic resonance imaging examination was conducted on a 3T Siemens Magnetom Verio apparatus, followed by a subsequent pathological and anatomic autopsy. The T1- and T2-weighted images were evaluated to determine the presence and severity of the magnetic resonance signal intensity gradient line in the ventral (superior) and dorsal (inferior) regions of the liver tissue. Following the autopsy, tissue samples were obtained from the ventral and dorsal regions of the liver, and subsequently subjected to microscopic analysis of hematoxylin and eosin-stained preparations. RESULTS: The results of postmortem magnetic resonance imaging have enabled the establishment of the radiation characteristics and histological changes in liver tissue caused by cadaveric hypostases. The most notable manifestation of cadaveric hypostases in the liver at postmortem magnetic resonance imaging is the change in magnetic resonance signal intensities in the above and below-located regions of the organ, accompanied by the emergence of a signal intensity gradient. This gradient reflects the location of the body after death and varies depending on the duration of the postmortem period. The signal intensity gradient was more frequently observed on T1-weighted images compared to T2-weighted images. Histological examination of liver tissue preparations revealed an increase in the size of sinusoids and a decrease in the area of hepatic beams, which was observed to progress with increasing age at death and was expressed to a greater extent in the lower liver region. These changes are undoubtedly a morpho
背景:在病理和法医尸体解剖过程中,会对死者尸体进行检查,以确定尸体的非特异性变化。这些变化包括内出血,其特点是在重力作用下组织和器官中的血液重新分布[1, 2]。这种死后内膜增生反映了死亡年龄,但也使非特异性尸变的生前病理过程和病变的鉴别诊断变得复杂[3,4]。死后磁共振成像是一种客观、无创的检查方法,尤其适用于器官和组织相对不成熟的新生儿死亡病例。因此,它可能被证明是一种很有前途的方法,可用于观察和评估尸体的后遗症[5, 6]。目的:本研究的目的是调查已故新生儿肝脏中尸变的表现,重点是尸变持续时间的影响。为此,我们使用了死后磁共振成像和形态学检查。材料和方法:该研究基于对 62 名死亡时间在 1.5 小时至 49 天的新生儿和婴儿尸体进行的全面死后放射学和病理解剖检查。在选择研究对象时,排除了发育异常和患有肝脏疾病的婴儿。在 3T 西门子 Magnetom Verio 仪器上进行了死后磁共振成像检查,随后进行了病理解剖。对 T1 和 T2 加权图像进行了评估,以确定肝组织腹侧(上部)和背侧(下部)磁共振信号强度梯度线的存在和严重程度。解剖后,从肝脏腹侧和背侧区域获取组织样本,然后对苏木精和伊红染色的制备物进行显微分析。结果:死后磁共振成像的结果确定了尸变引起的肝组织辐射特征和组织学变化。在尸体磁共振成像中,尸体肝脏骨质增生最显著的表现是器官上方和下方区域的磁共振信号强度发生变化,并伴有信号强度梯度的出现。这种梯度反映了尸体死后的位置,并随着死后时间的长短而变化。与T2加权图像相比,在T1加权图像上更常观察到信号强度梯度。肝组织制片的组织学检查显示,肝窦的大小增加,肝梁的面积减少,这种变化随着死亡年龄的增加而加剧,在肝下部表现得更为明显。这些变化无疑是辐射特征的形态学基础。结论:尸检磁共振成像和形态学研究揭示了尸体肝下垂的具体特征,在分析结果和确定死亡新生儿肝下垂发生的联系时,应将其考虑在内。
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引用次数: 0
Digital approach to estimate clinical images of the cervix with ImageJ software 利用 ImageJ 软件估算宫颈临床图像的数字化方法
Pub Date : 2024-07-03 DOI: 10.17816/dd626768
A. Dushkin, M. Afanasiev, S. S. Afanasiev, T. Grishacheva, A. Karaulov
BACKGROUND: Visual inspection and colposcopy are subjective methods of cervical evaluation. Currently, the majority of colposcopes are equipped with the capacity to digitally transmit and record cervical images, in addition to modern software for image processing. For the objective assessment, prevention of development, and risk assessment of precancerous changes (SIL+) and cervical cancer, it is essential to use modern methods of image processing. AIM: The study aimed at demonstrating the capabilities of digital analysis of cervical images based on ImageJ software [1]. MATERIALS AND METHODS: A total of 500 colposcopic images of the Schiller test were obtained during dilated colposcopy. Digital analysis was performed using ImageJ software, which employed minimum (MinGV) and maximum (MaxGV) gray pixel values (0–255) and lesion surface area (%Area) as parameters. The images were divided into 4 groups according to the cytologic examination performed: healthy donors (n=19; 3.8%), mild grade squamous cell intraepithelial lesion (n=113; 22.6%), severe grade squamous cell intraepithelial lesion (n=327; 65.4%), and invasive cervical cancer (n=41; 8.2%). Mathematical and statistical analysis of the obtained data was performed using Python programming language packages in the Google Colab environment. Comparisons of quantitative measures between three or more groups were conducted using the Kruskal-Wallis criterion and posteriori comparisons by Dunn’s criterion with Holm’s correction. RESULSTS: Statistical significance was observed in the increase of MinGV (p=0.035), MaxGV (p0.001) and %Area (p=0.022) from the mild (88/141/31) to the severe (83/142/32) degree of squamous cell intraepithelial lesion and cervical cancer (88/162/36). Objective parameters for the assessment of the degree of cervical surface lesions during digital colposcopy were obtained. Digital analysis of the cervical surface may assist the clinical specialist in determining further management strategies, including scarification or incisional biopsy with subsequent morphological examination. CONCLUSIONS: The application of digital analysis to colposcopic images has the potential to reduce the subjective assessment of cervical condition, enhance the efficiency of the initial appointment with a gynecologist, and facilitate the selection of patients for cytologic examination.
背景:目视检查和阴道镜检查是评估宫颈的主观方法。目前,大多数阴道镜都配备了数字传输和记录宫颈图像的功能,以及用于图像处理的现代软件。为了对癌前病变(SIL+)和宫颈癌进行客观评估、预防发展和风险评估,必须使用现代图像处理方法。目的:本研究旨在展示基于 ImageJ 软件[1]的宫颈图像数字分析能力。材料与方法:在扩张阴道镜检查过程中,共获得 500 张席勒试验阴道镜图像。使用 ImageJ 软件进行数字分析,该软件采用最小(MinGV)和最大(MaxGV)灰色像素值(0-255)以及病变表面积(%Area)作为参数。根据细胞学检查结果将图像分为 4 组:健康供体(n=19;3.8%)、轻度鳞状细胞上皮内病变(n=113;22.6%)、重度鳞状细胞上皮内病变(n=327;65.4%)和浸润性宫颈癌(n=41;8.2%)。在谷歌 Colab 环境中使用 Python 编程语言包对获得的数据进行了数学和统计分析。采用 Kruskal-Wallis 标准对三组或更多组之间的定量指标进行比较,采用 Dunn 标准和 Holm 校正进行后验比较。结果:从轻度(88/141/31)到重度(83/142/32)鳞状细胞上皮内病变和宫颈癌(88/162/36)的 MinGV(p=0.035)、MaxGV(p0.001)和%Area(p=0.022)的增加具有统计学意义。数字阴道镜检查获得了评估宫颈表面病变程度的客观参数。宫颈表面的数字化分析可帮助临床专家确定进一步的治疗策略,包括瘢痕切除或切开活检及随后的形态学检查。结论:对阴道镜图像进行数字分析有可能减少对宫颈状况的主观评估,提高与妇科医生初次会面的效率,并有助于选择患者进行细胞学检查。
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引用次数: 0
The experience of using artificial intelligence for automated analysis of digital radiographs in a city hospital 一家市立医院使用人工智能自动分析数字 X 光片的经验
Pub Date : 2024-07-03 DOI: 10.17816/dd629896
B. Borodulin, Y.T. Gogoberidze, K. Zhilinskaya, I. A. Prosvirkin, R. A. Sabitov
BACKGROUND: The volume of medical diagnostic studies continues to increase annually, intensifying the desire to implement advanced technologies in the field of medical diagnostics. One of the promising approaches that has attracted attention is the use of artificial intelligence in this area. A study was conducted on the automated analysis of chest radiographs using the AI service PhthisisBioMed at a city hospital specializing in the treatment of respiratory diseases. AIM: The study aimed to assess the diagnostic accuracy of the artificial intelligence service “PhthisisBioMed” for the detection of respiratory pathologies in the context of a city hospital that provides 24-hour specialized care in the field of pulmonology. MATERIALS AND METHODS: This study employed a prospective design, with the results of the artificial intelligence service available to the physician on request. This enabled the physician to review the results of the service if an alternative opinion was needed. The reference test was conducted by radiologists at Samara City Hospital No. 4, who described the examinations performed during the testing period. The index test was performed on the software “Program for Automated Analysis of Digital Chest Radiographs/Fluorograms according to TU 62.01.29-001-96876180-2019” produced by PhthisisBioMed LLC. The PhthisisBioMed software was employed to analyze digital fluorograms of the lungs in direct anterior projection. The software automatically identified the following radiological signs of pathologies: pleural effusion, pneumothorax, atelectasis, darkening, infiltration/consolidation, dissemination, cavity, calcification/calcified shadow, and cortical layer integrity violation. Fluorograms of patients over the age of 18 were included in the analysis. The study was conducted within the framework of research and development work No. 121051700033-3, entitled “Lung Damage of Infectious Etiology. Improvement of Methods of Detection, Diagnosis and Treatment” (14.05.2021). RESULTS: Following the pilot operation of the PhthisisBioMed artificial intelligence service and subsequent ROC analysis, the diagnostic accuracy metrics claimed by the manufacturer of the artificial intelligence medical device were confirmed. The service provided the probability of the presence of various pathologies. According to the highlighted labels, 63 patients (4.8%) were suspected of tuberculosis based on characteristic radiologic features. The conclusion was made independently by the radiologist, and the results were evaluated by the attending physician. The attending physician had the opportunity to compare the results and discuss them with the radiologist if differences were found. The results of the survey of pulmonologists who participated in the study indicated that the conclusion of the artificial intelligence service was received automatically within 15 seconds, while the conclusion of the physician was received within 30 minutes or more. CONCLUSIONS:
背景:医学诊断研究的数量每年都在持续增长,这就更加激发了在医学诊断领域采用先进技术的愿望。人工智能在这一领域的应用是前景广阔、备受关注的方法之一。我们在一家专门治疗呼吸系统疾病的市立医院开展了一项关于使用人工智能服务 PhthisisBioMed 自动分析胸片的研究。目的:该研究旨在评估人工智能服务 "PhthisisBioMed "在一家提供 24 小时肺科专业治疗的市立医院中检测呼吸系统病变的诊断准确性。材料与方法:本研究采用前瞻性设计,医生可根据要求查看人工智能服务的结果。这样,如果需要其他意见,医生就可以查看人工智能服务的结果。参考测试由萨马拉市第四医院的放射科医生进行,他们描述了测试期间进行的检查。指标检测是在 PhthisisBioMed LLC 公司生产的 "根据 TU 62.01.29-001-96876180-2019 标准自动分析数字胸片/荧光造影的程序 "软件上进行的。PhthisisBioMed 软件用于分析直接前方投影的肺部数字荧光照片。该软件可自动识别以下病变的放射学征象:胸腔积液、气胸、肺不张、变黑、浸润/凝固、播散、空洞、钙化/钙化影和皮质层完整性破坏。18 岁以上患者的荧光造影被纳入分析范围。该研究是在第 121051700033-3 号研发项目 "感染性肺损伤 "的框架内进行的。改进检测、诊断和治疗方法"(2021 年 5 月 14 日)。结果:在 PhthisisBioMed 人工智能服务试运行和随后的 ROC 分析之后,人工智能医疗设备制造商声称的诊断准确性指标得到了证实。该服务提供了各种病症存在的概率。根据突出显示的标签,63 名患者(4.8%)根据特征性放射学特征被怀疑患有肺结核。结论由放射科医生独立做出,并由主治医生对结果进行评估。主治医生有机会对结果进行比较,并在发现差异时与放射科医生进行讨论。对参与研究的肺科医生的调查结果表明,人工智能服务的结论可在 15 秒内自动收到,而医生的结论则需要 30 分钟或更长时间才能收到。结论:研究结果表明,PhthisisBioMed 软件的实施无论是在医院门诊部评估人群年度透视检查方面,还是在城市、医院住院部和入院部的肺科服务方面,都是非常便捷的。
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引用次数: 0
Application of machine learning methods and medical image processing in solving the problem of detecting stenoses of the middle cerebral artery according to computed tomographic angiography data 应用机器学习方法和医学图像处理解决根据计算机断层扫描血管造影数据检测大脑中动脉狭窄的问题
Pub Date : 2024-07-03 DOI: 10.17816/dd626181
Maksim V. Solominov, Denis V. Pakhomov, Tatiana A. Zagriazkina
BACKGROUND: Ischemic stroke is a significant contributor to mortality rates in Russia and globally [1]. Computed tomographic angiography is a primary diagnostic tool for ischemic stroke, enabling the identification of stenosis or occlusion in cerebral arteries. The majority of ischemic strokes (51%) occur in the middle cerebral artery region [2], underscoring the growing interest in evaluating blood flow in this area of the brain. The manual detection of stenoses is characterised by subjective evaluation and requires a considerable amount of time. The automation of middle cerebral artery narrowing detection represents a significant challenge in computed tomographic angiography image analysis. AIM: The study aims to develop an algorithm for the automatic detection of stenoses in the middle cerebral artery on DICOM images of computed tomographic angiography based on the application of artificial neural networks, vascularity assessment and skeletonization algorithms. MATERIALS AND METHODS: A total of 262 computed tomographic angiography series from patients at the N.V. Sklifosovsky Emergency Medical Research Institute were analyzed. Of these, 94 series exhibited stenosis in the M1/M2 segment of the middle cerebral artery. The image processing was conducted using an artificial neural network with a CFPNet-M architecture [3]. The reconstruction of the vascular tree was based on the calculation of the "vesselness" measure [4] with subsequent skeletonization of the identified structures. RESULTS: In the initial stage, a neural network for the segmentation of the middle cerebral artery basin was trained. The training array was generated using the MNI152 template with affine transformations and subsequent expert evaluation. In this case, the IoU (Intersection over Union) measure was 0.81. The primary objective was the segmentation of the middle cerebral artery vascular tree, which was achieved through the use of the vesselness filter, followed by an evaluation of voxel intensities and the identification of the connected object with the longest length. The next stage involved the construction of the skeleton of the middle cerebral artery. This entailed determining the centerline of the vessel and representing the resulting skeleton as a graph with the vessels as edges and their bifurcation points as vertices. The subsequent stage was the calculation of morphological features (diameter, area, and perimeter) in the cross-sectional plane for each segment (the area between the bifurcation points). Finally, the area of constriction was determined based on the analysis of the behavior of the segment cross-sections and the identification of any deviation from the threshold value. The overall accuracy of the algorithm was 79.39% (95% confidence interval 73.98–84.12), with a sensitivity of 80.85% (95% confidence interval 71.44–88.24) and a specificity of 78.57% (95% confidence interval 71.59–84.52). CONCLUSIONS: Thus, we developed an algorithm for the detection
背景:缺血性中风是造成俄罗斯乃至全球死亡率的一个重要因素 [1]。计算机断层扫描血管造影是缺血性脑卒中的主要诊断工具,可确定脑动脉狭窄或闭塞。大多数缺血性脑卒中(51%)发生在大脑中动脉区域[2],这凸显了人们对评估大脑这一区域血流的兴趣与日俱增。人工检测狭窄具有主观评价的特点,需要花费大量时间。大脑中动脉狭窄检测的自动化是计算机断层扫描血管造影图像分析中的一项重大挑战。目的:本研究旨在应用人工神经网络、血管评估和骨架化算法,开发一种在计算机断层扫描血管造影 DICOM 图像上自动检测大脑中动脉狭窄的算法。材料与方法:共分析了来自 N.V. Sklifosovsky 急诊医学研究所患者的 262 个计算机断层扫描血管造影系列。其中 94 例显示大脑中动脉 M1/M2 段狭窄。图像处理采用 CFPNet-M 架构的人工神经网络进行[3]。血管树的重建基于 "血管度 "的计算[4],随后对识别出的结构进行骨架化处理。结果:在初始阶段,对大脑中动脉盆地分割神经网络进行了训练。训练阵列使用 MNI152 模板生成,并进行仿射变换和随后的专家评估。在这种情况下,IoU(交集大于联合)测量值为 0.81。首要目标是分割大脑中动脉血管树,这是通过使用血管度滤波器实现的,然后是评估体素强度和识别长度最长的连接对象。下一阶段是构建大脑中动脉的骨架。这需要确定血管的中心线,并将生成的骨架表示为一个图形,将血管作为边,将其分叉点作为顶点。随后的阶段是计算每个区段(分叉点之间的区域)横截面上的形态特征(直径、面积和周长)。最后,根据对管段横截面行为的分析以及对任何偏离阈值的识别,确定收缩的面积。该算法的总体准确率为 79.39%(95% 置信区间为 73.98-84.12),灵敏度为 80.85%(95% 置信区间为 71.44-88.24),特异度为 78.57%(95% 置信区间为 71.59-84.52)。结论因此,我们开发了一种基于大脑中动脉盆地分割、血管完整性评估和血管树骨架化的 M1/M2 节段狭窄检测算法。在经过验证和临床认可后,将所开发的算法应用于实践,将简化放射科医生对计算机断层扫描血管造影图像的常规评估,并为获得狭窄区域的客观评估提供机会。
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引用次数: 0
Expert assessment of the organization of comprehensive support for the prolongation of professional effective activity of a doctor 专家对延长医生专业有效活动的综合支持组织工作的评估
Pub Date : 2024-07-03 DOI: 10.17816/dd627052
A. Vorobeva, M. Yakushin
BACKGROUND: Medical workers are one of the professions that significantly strengthen the country’s economy [1, 2]. The development and implementation of health-saving technologies to prolong the effective professional life of medical workers of older age groups will preserve them as a labor resource of the country, which will exclude economic losses of the state. The results of a sociological survey of doctors providing medical care in the polyclinic segment of Moscow and the Moscow region were used to assess the professional competencies of specialists [3]. An organizational technology was then formed based on these findings, which was subsequently proposed for expert assessment. AIM: The aim of this study was to ascertain the significance of organizational technology measures for the professional longevity of doctors in older age groups. MATERIALS AND METHODS: The study employed a multi-methodological approach, integrating sociological, statistical, and expert evaluation techniques. A total of 50 experts were invited to rank the activities comprising the integrated technology in terms of their perceived importance for achieving the desired outcome, namely, the support of effective professional longevity of doctors in the event of the implementation of such technology. The experts were specialists in the field of health care and public health, including chief physicians and heads of departments of urban polyclinics in Moscow and the Moscow region, who were accredited in the specialty 03.02.03. They had experience of management in the field of health care ranging from one to 29 years. RESULTS: All experts concur that a medical organization should implement measures to prevent the deterioration of doctors due to aging. The necessity to test doctors over the age of 50 for cognitive disorders and dementia was confirmed by 90% of experts. Additionally, 60% of experts agreed that doctors over the age of 50 require a less demanding work schedule, including a reduction in intellectual workload and an extension of rest periods. At the same time, 20% of experts approve of the transition to a lighter work regime on an individual basis after testing, 10% agreed only with the prolongation of rest, and 10% gave a negative answer. In the opinion of 90% of experts, the widespread introduction of medical information systems (and training in working with them) will help to support the effective professional longevity of doctors of older age groups. A mere 40% of experts concurred that the transfer of senior physicians to monoprofile appointments would assist in prolonging their effective professional longevity. The majority of experts (80%) recommend regular cognitive training for doctors of advanced age, while 10% believe it is only necessary in specific cases and 10% are opposed to the idea. Only 70% of experts in the medical field implement organizational measures to maintain effective professional longevity, while the remaining 30% employ single measures.
背景:医务工作者是显著增强国家经济实力的职业之一[1, 2]。开发和实施保健技术以延长老年医务工作者的有效职业寿命,将保护他们作为国家的劳动力资源,从而避免国家的经济损失。对莫斯科和莫斯科地区综合医院提供医疗服务的医生进行社会学调查的结果被用来评估专家的专业能力[3]。然后根据这些结果形成了一种组织技术,随后提出了专家评估建议。目的:本研究旨在确定组织技术措施对老年组医生职业寿命的意义。材料与方法:本研究采用了多种方法,整合了社会学、统计学和专家评估技术。共邀请了 50 位专家,根据他们对实现预期结果(即在实施综合技术的情况下,支持医生有效延长职业寿命)的重要性的认识,对综合技术的各项活动进行排序。专家们都是医疗保健和公共卫生领域的专家,包括莫斯科和莫斯科州城市综合医院的主任医师和科室主任,他们都获得了 03.02.03 专业认证。他们在医疗保健领域的管理经验从 1 年到 29 年不等。结果:所有专家一致认为,医疗机构应采取措施防止医生因年龄增长而退化。90%的专家确认有必要对 50 岁以上的医生进行认知障碍和痴呆症测试。此外,60%的专家同意 50 岁以上的医生需要减轻工作强度,包括减少脑力劳动和延长休息时间。同时,20% 的专家同意在测试后根据个人情况过渡到较轻松的工作制度,10% 的专家只同意延长休息时间,10% 的专家给出了否定的答案。90% 的专家认为,广泛采用医疗信息系统(并对如何使用这些系统进行培训)将有助 于支持老年医生有效地延长职业寿命。仅有 40%的专家同意,将高龄医生转为单病种任命将有助于延长他们的有效职业寿命。大多数专家(80%)建议对高龄医生进行定期认知培训,10%的专家认为只有在特殊情况下才有必要,10%的专家表示反对。只有 70% 的医学领域专家采取组织措施来保持有效的职业寿命,而其余 30% 的专家则采取单一措施。治疗学习技术[5]得到了所有专家的积极评价。专家们提出的措施清单包括:在工作时间的午休之外引入 "暂停时间"、工业体操、由心理学家为医生提供心理援助以及举办计算机扫盲学校。结论:医疗保健和公共卫生领域的专家已经确认,有必要引入组织技术来延长医疗能力。不过,应根据专家意见对拟议技术进行调整。
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引用次数: 0
Using neural networks for non-invasive determination of glycated hemoglobin levels, illustrated by the application of an innovative portable glucometer in clinical practice 利用神经网络无创测定糖化血红蛋白水平,通过创新型便携式血糖仪在临床实践中的应用加以说明
Pub Date : 2024-07-03 DOI: 10.17816/dd627099
E. Poliker, Konstantin A. Koshechkin, Alexander M. Timokhin, Ekaterina V. Klyukina, Ekaterina D. Belyakova, Artem M. Brovko, Alina S. Lalayan, A. Ermolaeva
BACKGROUND: In the last decade, there has been a significant increase in interest in non-invasive monitoring of blood glucose levels [1]. This is driven by the desire to reduce patient discomfort, as well as the risk of infections associated with traditional invasive methods [2]. Raman spectroscopy, considered as a promising approach for non-invasive measurements [3], combined with machine learning, has the potential to lead to more accurate and faster diagnostic methods for conditions related to glucose imbalances [4]. AIMS: Development and validation of a new portable glucometer based on Raman spectroscopy using machine learning methods for non-invasive determination of glycated hemoglobin (HbA1c) levels. MATERIALS AND METHODS: The study was conducted on a sample of 100 volunteers of different age groups and genders, with varying health statuses, including individuals with type 1 and type 2 diabetes and those without diabetes. To collect data, we used a portable device developed by us, based on the registration of Raman spectra with laser excitation at 638 nm. The data were analyzed using Support Vector Machine neural networks. RESULTS: After processing the spectroscopic measurements using Support Vector Machine, the system showed sensitivity (95,7%) and specificity (84,2%) in determining HbA1c levels comparable to traditional methods such as high-performance liquid chromatography. It was found that the algorithm is sufficiently adaptive and can be used across a wide range of skin types, regardless of the age and gender of the participants. The results suggest the possibility of using the developed device in clinical practice. CONCLUSION: The developed portable glucometer based on Raman spectroscopy combined with machine learning algorithms could be a promising step towards non-invasive and continuous monitoring of glycemic levels in patients with diabetes.
背景:近十年来,人们对非侵入性血糖监测的兴趣显著增加[1]。这是由于人们希望减少病人的不适感以及传统侵入性方法带来的感染风险[2]。拉曼光谱被认为是一种很有前途的无创测量方法[3],它与机器学习相结合,有可能为葡萄糖失衡相关疾病提供更准确、更快速的诊断方法[4]。目的:利用机器学习方法开发和验证基于拉曼光谱的新型便携式血糖仪,用于无创测定糖化血红蛋白(HbA1c)水平。材料与方法:研究对象是 100 名不同年龄段和性别的志愿者,他们的健康状况各不相同,包括 1 型和 2 型糖尿病患者以及未患糖尿病者。为了收集数据,我们使用了自己开发的便携式设备,该设备基于 638 纳米激光激发下的拉曼光谱注册。使用支持向量机神经网络对数据进行分析。结果:使用支持向量机处理光谱测量结果后,该系统在确定 HbA1c 水平方面显示出与传统方法(如高效液相色谱法)相当的灵敏度(95.7%)和特异性(84.2%)。研究发现,该算法具有足够的适应性,可用于各种皮肤类型,与参与者的年龄和性别无关。结果表明,开发的设备有可能用于临床实践。结论:所开发的便携式血糖仪基于拉曼光谱与机器学习算法相结合,是实现无创、连续监测糖尿病患者血糖水平的重要一步。
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引用次数: 0
Predicting atrial fibrillation in comorbid patients with arterial hypertension and chronic obstructive pulmonary disease using laboratory research methods: a machine learning approach 利用实验室研究方法预测动脉高血压和慢性阻塞性肺病合并症患者的心房颤动:一种机器学习方法
Pub Date : 2024-07-03 DOI: 10.17816/dd626797
E. V. Kazantseva, A. Ivannikov, A. Tarzimanova, V. Podzolkov
BACKGROUND: Arterial hypertension and chronic obstructive pulmonary disease have a deleterious effect on the structure of the heart, leading to the development of atrial fibrillation, which remains the leading cause of cerebral stroke and premature death [1]. Consequently, the early identification of atrial fibrillation risk factors in patients with arterial hypertension and chronic obstructive pulmonary disease is of paramount importance for the prevention of such conditions. This is why predictive cardiology employs machine learning methods, which are demonstrably superior to classical statistical methods of prediction [2–4]. AIM: The study aimed to develop a prognostic model of atrial fibrillation in comorbid patients with arterial hypertension and chronic obstructive pulmonary disease based on multilayer perceptron. MATERIALS AND METHODS: The study included 419 patients treated at the University Clinical Hospital No. 4 of the I.M. Sechenov First Moscow State Medical University. Group 1 consisted of 91 (21.7%) patients with a verified diagnosis of atrial fibrillation, while Group 2 comprised 328 (78.3%) patients without atrial fibrillation. The random forest machine learning algorithm was used to identify predictors, which were then utilized to develop a neural network of the multilayer perceptron type. This consisted of two layers: an input layer of 12 neurons with the ReLU activation function and an output layer that receives input data from the previous layer and transmits them to one output with the sigmoid activation function. The threshold value, sensitivity, specificity, and diagnostic efficiency of the obtained model were determined using receiver operating characteristic analysis with the calculation of the area under the curve (AUC). RESULTS: By the first stage of prognostic model development, the most significant predictors of atrial fibrillation development were selected by the random forest machine learning algorithm. The model was developed using three variables: C-reactive protein concentration (odds ratio, OR 1.04; 95% confidence interval, CI 1.015–1.067; p=0.002), erythrocyte sedimentation rate (OR 1.04; 95% CI 1.019–1.069; p=0.002), and creatinine concentration (OR 1.03; 95% CI 1.011–1.042; p 0.001). These variables were used to train a multilayer perceptron model on a test sample for 500 epochs. Following training, the developed model exhibited a sensitivity of 85%, a specificity of 80%, and a diagnostic efficiency of 79.6%. AUC amounted to 0.900. CONCLUSIONS: The study resulted in the development of a prognostic model based on the application of machine learning methods, which exhibited favorable metrics. This model may be considered a valuable tool for clinical practice.
背景:动脉高血压和慢性阻塞性肺病会对心脏结构产生有害影响,导致心房颤动的发生,而心房颤动仍是脑卒中和过早死亡的主要原因[1]。因此,及早发现动脉高血压和慢性阻塞性肺病患者心房颤动的危险因素对预防此类疾病至关重要。因此,预测性心脏病学采用了机器学习方法,这种方法明显优于传统的统计预测方法[2-4]。目的:本研究旨在开发一种基于多层感知器的合并动脉高血压和慢性阻塞性肺病患者心房颤动预后模型。材料与方法:研究对象包括在莫斯科第一国立医科大学第四临床医院接受治疗的 419 名患者。第 1 组包括 91 名(21.7%)确诊为心房颤动的患者,第 2 组包括 328 名(78.3%)无心房颤动的患者。随机森林机器学习算法用于识别预测因子,然后利用这些预测因子开发多层感知器类型的神经网络。该网络由两层组成:一层是由 12 个神经元组成的输入层,具有 ReLU 激活函数;另一层是输出层,接收前一层的输入数据,并将其传输到一个具有 sigmoid 激活函数的输出端。利用接收器操作特征分析法确定了所获模型的阈值、灵敏度、特异性和诊断效率,并计算了曲线下面积(AUC)。结果:在建立预后模型的第一阶段,随机森林机器学习算法选出了对房颤发展最有意义的预测因子。该模型由三个变量组成C反应蛋白浓度(几率比,OR 1.04;95% 置信区间,CI 1.015-1.067;P=0.002)、红细胞沉降率(OR 1.04;95% CI 1.019-1.069;P=0.002)和肌酐浓度(OR 1.03;95% CI 1.011-1.042;P 0.001)。这些变量被用于对测试样本的多层感知器模型进行 500 次历时训练。训练后,所开发模型的灵敏度为 85%,特异度为 80%,诊断效率为 79.6%。AUC 为 0.900。结论:这项研究在应用机器学习方法的基础上开发了一个预后模型,该模型显示出良好的指标。该模型可被视为临床实践的重要工具。
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引用次数: 0
Comparison of the methods of operation of the artificial intelligence system in the ultra-high sensitivity mode for the autonomous description of chest X-rays without pathology 比较人工智能系统在超高灵敏度模式下自主描述无病理胸部 X 射线的操作方法
Pub Date : 2024-07-03 DOI: 10.17816/dd626001
E. D. Nikitin, Nikita S. Plaksin, Maria B. Garetz, Evgeniy M. Gutin
BACKGROUND: Up to 95% of digital fluoroscopy screening studies are free of pathologic changes. Radiologists typically spend the majority of their time reviewing and describing such studies. In these cases, artificial intelligence systems can be used to automate the description, thereby saving physicians’ time [1–3]. AIM: The aim of this study was to compare the efficacy of various algorithms within an existing artificial intelligence system in an ultra-high sensitivity scenario and to estimate the percentage of X-rays that could be automatically characterized. MATERIALS AND METHODS: The artificial intelligence system “Cels.Fluorography” version 0.15.3 was used for the analysis. A dataset derived from disparate medical organizations, comprising 11,707 studies devoid of pathology and 5,846 studies exhibiting pathology, was selected for comparison. A subsample of 500 studies with pathology and 9,500 studies without pathology (5% to 95% balance) was randomly selected 1,000 times from the dataset to calculate the metrics. The resulting metrics were then averaged. The markup of two physicians was used as the source of the target variable. In the event of a discrepancy in opinion, the study was subjected to an expert physician evaluation. An X-ray was considered pathological if the final markup contained at least one of 12 radiological features [4]. Five methods were used to compare metrics: by maximum (1) and mean (2) probability of radiological features localized by the neural network-detector; by maximum (3) and mean (4) probability of feature presence derived from dedicated “heads” of the neural network trained to determine the presence of each feature on the image (0 for no feature, 1 for presence); by probability (5) derived from a separate “head” of the neural network trained to determine the binary presence of pathology on the study (0 for normal, 1 for pathology). For each method, a response threshold was selected to ensure that no more than one missed pathology was identified per 1,000 examinations in the current subsample. The percentage of X-rays that could be correctly identified as pathology-free by artificial intelligence was calculated as the main quality metric. RESULTS: The methods demonstrated the following average percentages of norm dropout: 66.4%, 72.2%, 69.0%, 74.1%, 68.7%—and the following area under the ROC curve: 0.948, 0.957, 0.964, 0.967, 0.971. The 95% confidence interval for the dropout rate associated with the optimal method was found to be 66.1% to 79.4%. CONCLUSIONS: Modern artificial intelligence systems can be used to automate the description of a significant portion of screenings. The most efficacious method for norm screening (over 74% of the flow) was demonstrated by the averaging of probabilities derived from special “heads” of the neural network trained to identify the presence of pathology.
背景:多达 95% 的数字透视筛查研究无病理变化。放射科医生通常要花费大部分时间来审查和描述这类研究。在这种情况下,人工智能系统可用于自动描述,从而节省医生的时间[1-3]。目的:本研究旨在比较现有人工智能系统中各种算法在超高灵敏度情况下的功效,并估算可自动描述特征的 X 射线的百分比。材料与方法:分析使用的是人工智能系统 "Cels.Fluorography "0.15.3 版。我们选择了一个来自不同医疗机构的数据集进行比较,该数据集包括 11,707 项无病理特征的研究和 5,846 项有病理特征的研究。从数据集中随机抽取 500 项有病理变化的研究和 9500 项无病理变化的研究(5% 至 95% 的平衡)作为子样本,进行 1000 次计算。然后对计算出的指标取平均值。两名医生的标记被用作目标变量的来源。如果出现意见分歧,则由专家医师对研究进行评估。如果最终标记包含 12 个放射学特征中的至少一个,则 X 光片被视为病理[4]。比较指标的方法有五种:神经网络探测器定位的放射学特征概率的最大值(1)和平均值(2);根据为确定图像上是否存在每个特征而训练的神经网络专用 "头 "得出的特征存在概率的最大值(3)和平均值(4)(0 表示无特征,1 表示存在);根据为确定研究中是否存在二元病理而训练的神经网络单独 "头 "得出的概率(5)(0 表示正常,1 表示病理)。对于每种方法,都选择了一个响应阈值,以确保在当前的子样本中,每 1,000 次检查中漏检的病理情况不超过一次。人工智能可正确识别为无病理的 X 光片的百分比作为主要质量指标进行计算。结果:这些方法的平均标准遗漏率分别为:66.4%、72.2%、69.0%、74.1%、68.7%,ROC 曲线下的面积分别为:0.948、0.95%、0.948、0.95%:0.948, 0.957, 0.964, 0.967, 0.971.与最佳方法相关的辍学率的 95% 置信区间为 66.1% 至 79.4%。结论:现代人工智能系统可用于自动描述大部分筛查结果。最有效的规范筛查方法(超过 74% 的流量)是通过平均神经网络的特殊 "头 "得出的概率来识别是否存在病变。
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引用次数: 0
Assessment of ovarian follicular reserve according to ultrasound data based on machine learning methods 基于机器学习方法,根据超声波数据评估卵巢卵泡储备功能
Pub Date : 2024-07-03 DOI: 10.17816/dd626171
Fedor A. Laputin, Ivan V. Sidorov, Andrey S. Moshkin
BACKGROUND: Ovarian reserve reflects a woman's ability to successfully realize reproductive function. The assessment of ovarian reserve is an urgent task for clinical practice [1] and is important in scientific research. The use of computerized diagnostic image processing methods can accelerate and facilitate the performance of routine tasks in clinical practice. Their use in retrospective data analysis for scientific purposes allows to increase the objectivity of the study and supplement it with auxiliary information [2]. The issue of ovarian localization and follicle segmentation on ultrasound images has been previously investigated in other works. For instance, Z. Chen et al. [3] employed the U-net model to identify follicles on ultrasound images. Similarly, V.K. Singh et al. [4] addressed a related problem using a variant of U-net, namely UNet++ [5], which has gained considerable traction in the field of medical image analysis [6]. AIM: The study aimed to develop machine learning models for analyzing ovarian images obtained from an ultrasound machine. MATERIALS AND METHODS: An open dataset with a labeled ovary region was used for pre-training ovarian segmentation and follicle detection models. Subsequently, the dataset, which contains marked-up ovarian and follicle regions, was employed for training and testing. It encompasses a total of approximately 800 examples from 50 unique patients. The localization of follicles in an ultrasound image is a challenging task. To address this, the designed detector system was divided into two parts: ovary segmentation and follicle detection within the selected region. This approach allows the model to focus on a region where there are no other organs and various ultrasound artifacts that can be falsely perceived as the object under investigation. For the purpose of ovarian segmentation, the UNet++ architecture [5] was employed in conjunction with the ResNeSt encoder [8], which incorporates the SE-Net [9] and SK-Net [10] attention mechanisms. The object detection model is employed to identify the location of follicles within the ovary, as it enables precise enumeration of the number of follicles, even in the presence of overlapping structures, a capability that the segmentation model lacks. In our study, we used the YOLOv8 model [11]. Furthermore, data preprocessing has been employed to enhance the quality of model predictions. This has involved the identification and removal of regions with auxiliary information, the reduction of noise, and the augmentation of data. RESULTS: Two ovarian localization models are presented based on the results of this study. The first model is a segmentation model with an IoU quality of at least 50%. The second model is a detection model with a mAP quality of at least 65%. A third model is a model for follicle detection with subsequent follicle counting. This model has an MAPE error not exceeding 35%. CONCLUSIONS: The study resulted in the proposal of a method for app
背景:卵巢储备功能反映了女性成功实现生育功能的能力。卵巢储备功能的评估是临床实践中的一项紧迫任务[1],在科学研究中也具有重要意义。计算机诊断图像处理方法的使用可加快和促进临床实践中常规任务的执行。在以科学为目的的回顾性数据分析中使用这些方法,可以提高研究的客观性并补充辅助信息[2]。关于超声图像上的卵巢定位和卵泡分割问题,此前已有其他研究。例如,Z. Chen 等人[3] 采用 U-net 模型在超声图像上识别卵泡。同样,V.K. Singh 等人[4]使用 U-net 的一个变体,即 UNet++ [5],解决了一个相关问题。目的:本研究旨在开发机器学习模型,用于分析从超声波机获得的卵巢图像。材料与方法:使用带有标记卵巢区域的开放数据集对卵巢分割和卵泡检测模型进行预训练。随后,使用包含标记卵巢和卵泡区域的数据集进行训练和测试。该数据集共包含来自 50 名患者的约 800 个实例。在超声图像中定位卵泡是一项具有挑战性的任务。为此,设计的检测系统分为两部分:卵巢分割和选定区域内的卵泡检测。这种方法可使模型专注于没有其他器官和各种超声伪影的区域,这些伪影可能会被误认为是调查对象。为了进行卵巢分割,采用了 UNet++ 架构[5]和 ResNeSt 编码器[8],其中包含 SE-Net [9] 和 SK-Net [10] 注意机制。对象检测模型用于识别卵巢内卵泡的位置,因为即使在结构重叠的情况下,它也能精确枚举卵泡的数量,而这正是分割模型所缺乏的能力。在我们的研究中,我们使用了 YOLOv8 模型[11]。此外,我们还采用了数据预处理来提高模型预测的质量。这包括识别和移除带有辅助信息的区域、减少噪音和增加数据。结果:根据这项研究的结果,提出了两个卵巢定位模型。第一个模型是一个分割模型,IoU 质量至少为 50%。第二个模型是一个检测模型,mAP 质量至少达到 65%。第三个模型是卵泡检测模型,随后进行卵泡计数。该模型的 MAPE 误差不超过 35%。结论:这项研究提出了一种将机器学习技术应用于超声图像分析任务的方法。开发的分割和检测模型减少了分析图像中卵巢和卵泡的时间和误差。注意力机制和数据预处理的使用提高了模型的质量。用于卵泡检测的神经网络即使在卵泡重叠的情况下也能进行卵泡计数。
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Digital Diagnostics
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