Behavioral scoring based on clinical observations remains the gold standard for screening,diagnosing,and evaluating infantile epileptic spasm syndrome(IESS).The accurate identification of seizures is crucial for clini...Behavioral scoring based on clinical observations remains the gold standard for screening,diagnosing,and evaluating infantile epileptic spasm syndrome(IESS).The accurate identification of seizures is crucial for clinical diagnosis and assessment.In this study,we propose an innovative seizure detection method based on video feature recognition of patient spasms.To capture the temporal characteristics of the spasm behavior presented in the videos effectively,we incorporate asymmetric convolutions and convolution–batch normalization–ReLU(CBR)modules.Specifically within the 3D-ResNet residual blocks,we split the larger convolutional kernels into two asymmetric 3D convolutional kernels.These kernels are connected in series to enhance the ability of the convolutional layers to extract key local features,both horizontally and vertically.In addition,we introduce a 3D convolutional block attention module to enhance the spatial correlations between video frame channels efficiently.To improve the generalization ability,we design a composite loss function that combines cross-entropy loss with triplet loss to balance the classification and similarity requirements.We train and evaluate our method using the PLA IESS-VIDEO dataset,achieving an average seizure recognition accuracy of 90.59%,precision of 90.94%,and recall of 87.64%.To validate its generalization capability further,we conducted external validation using six different patient monitoring videos compared with assessments by six human experts from various medical centers.The final test results demonstrate that our method achieved a recall of 0.6476,surpassing the average level achieved by human experts(0.5595),while attaining a high F1-score of 0.7219.These findings have substantial significance for the long-term assessment of patients with IESS.展开更多
BACKGROUNDA mid-esophageal diverticulum is an outpouching located in the midsection ofthe esophagus, posterior to the bifurcation of the right and left bronchi. The conditionis characterized by an outward protrusion o...BACKGROUNDA mid-esophageal diverticulum is an outpouching located in the midsection ofthe esophagus, posterior to the bifurcation of the right and left bronchi. The conditionis characterized by an outward protrusion of the inner esophageal wall. Midesophagealdiverticula are relatively rare and may coexist with diffuse esophagealspasm. However, the potential esophageal motility disorders associated withthese lesions are frequently overlooked in clinical practice. The use of endoscopicinterventions may offer a novel approach for the alleviation of dysphagia associatedwith this condition.CASE SUMMARYWe present a case of a 74-year-old woman with dysphagia, diagnosed with midesophagealdiverticulum and diffuse esophageal spasm. Due to her physical condition,submucosal tunneling endoscopic septum division (STESD) was initiallyperformed for the diverticulum. One month later, the esophageal spasm wastreated using per-oral endoscopic myotomy (POEM). This combined treatmentsignificantly improved her dysphagia, and she was discharged.CONCLUSIONSTESD and POEM are effective and safe for the treatment of dysphagia caused bymid-esophageal diverticula with diffuse esophageal spasm.展开更多
基金the National Social Science Foundation of China(No.21BTQ106),the Natural Science Foundation of Beijing(No.7222187),and the Key Project of Innovation Cultivation Fund of the Seventh Medical Center of PLA General Hospital(No.qzx-2023-1)。
文摘Behavioral scoring based on clinical observations remains the gold standard for screening,diagnosing,and evaluating infantile epileptic spasm syndrome(IESS).The accurate identification of seizures is crucial for clinical diagnosis and assessment.In this study,we propose an innovative seizure detection method based on video feature recognition of patient spasms.To capture the temporal characteristics of the spasm behavior presented in the videos effectively,we incorporate asymmetric convolutions and convolution–batch normalization–ReLU(CBR)modules.Specifically within the 3D-ResNet residual blocks,we split the larger convolutional kernels into two asymmetric 3D convolutional kernels.These kernels are connected in series to enhance the ability of the convolutional layers to extract key local features,both horizontally and vertically.In addition,we introduce a 3D convolutional block attention module to enhance the spatial correlations between video frame channels efficiently.To improve the generalization ability,we design a composite loss function that combines cross-entropy loss with triplet loss to balance the classification and similarity requirements.We train and evaluate our method using the PLA IESS-VIDEO dataset,achieving an average seizure recognition accuracy of 90.59%,precision of 90.94%,and recall of 87.64%.To validate its generalization capability further,we conducted external validation using six different patient monitoring videos compared with assessments by six human experts from various medical centers.The final test results demonstrate that our method achieved a recall of 0.6476,surpassing the average level achieved by human experts(0.5595),while attaining a high F1-score of 0.7219.These findings have substantial significance for the long-term assessment of patients with IESS.
基金Supported by Natural Science Foundation of Shandong Province,No.81700472Clinical+X Project Fund of Binzhou Medical College,No.BY2021LCX11and Binzhou Medical University Science and Technology Program Projects,No.BY2019KJ13.
文摘BACKGROUNDA mid-esophageal diverticulum is an outpouching located in the midsection ofthe esophagus, posterior to the bifurcation of the right and left bronchi. The conditionis characterized by an outward protrusion of the inner esophageal wall. Midesophagealdiverticula are relatively rare and may coexist with diffuse esophagealspasm. However, the potential esophageal motility disorders associated withthese lesions are frequently overlooked in clinical practice. The use of endoscopicinterventions may offer a novel approach for the alleviation of dysphagia associatedwith this condition.CASE SUMMARYWe present a case of a 74-year-old woman with dysphagia, diagnosed with midesophagealdiverticulum and diffuse esophageal spasm. Due to her physical condition,submucosal tunneling endoscopic septum division (STESD) was initiallyperformed for the diverticulum. One month later, the esophageal spasm wastreated using per-oral endoscopic myotomy (POEM). This combined treatmentsignificantly improved her dysphagia, and she was discharged.CONCLUSIONSTESD and POEM are effective and safe for the treatment of dysphagia caused bymid-esophageal diverticula with diffuse esophageal spasm.
