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Objective: To review theories and technologies of big data mining and their application in clinical medicine. Data Sources: Literatures published in English or Chinese regarding theories and technologies of big data mining and the concrete applications of data mining technology in clinical medicine were obtained from PubMed and Chinese Hospital Knowledge Database from 1975 to 2015. Study Selection: Original articles regarding big data mining theory/technology and big data mining's application in the medical field were selected. Results: This review characterized the basic theories and technologies of big data mining including fuzzy theory, rough set theory, cloud theory, Dempster-Shafer theory, artificial neural network, genetic algorithm, inductive learning theory, Bayesian network, decision tree, pattern recognition, high-performance computing, and statistical analysis. The application of big data mining in clinical medicine was analyzed in the fields of disease risk assessment, clinical decision support, prediction of disease development, guidance of rational use of drugs, medical management, and evidence-based medicine. Conclusion: Big data mining has the potential to play an important role in clinical medicine.

Background: Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) is more complex than the normal hip, with large replacement risks and many complications. Although nonosteotomy THA is convenient to perform, femoral osteotomy shortening can avoid blood vessel and nerve traction injuries. This study aimed to compare osteotomy THA with nonosteotomy to determine reasonable options for operative management of DDH. Methods: Data on 48 DDH patients who underwent THA were analyzed retrospectively. The patients were divided into two groups: Group A 29 cases (nonosteotomy), and group B 19 cases (osteotomy). Harris and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, limb length discrepancy (LLD), radiological data on the hip, and claudication were evaluated. Data were analyzed by using paired-sample Student's t-test, independent-sample Student's t-test, and Pearson's Chi-square test; the test level was α =0.05. Results: Postoperative Harris (90.7 ± 5.1) and WOMAC scores (88.0 ± 10.6) were significantly improved compared with preoperative Harris (44.8 ± 5.7) and WOMAC scores (42.0 ± 5.3) in group A (P < 0.05). Postoperative Harris (90.4 ± 2.8) and WOMAC scores (88.2 ± 5.9) were significantly improved compared with preoperative Harris (44.4 ± 4.2) and WOMAC scores (43.2 ± 4.3) in group B (P < 0.05). One case of dislocation occurred in group A; after closed reduction, dislocation did not recur. In group A, 2 patients developed cutaneous branch injury of the femoral nerve, which spontaneously recovered without treatment. Postoperative LLD >2 cm was seen in one case in group A and five cases in group B. Postoperative claudication showed no significant difference between the two groups (P > 0.05). No patients developed infection; postoperative X-rays showed that the location of the prosthesis was satisfactory, and the surrounding bone was not dissolved. Conclusions: THA is effective and safe for DDH. For unilateral high dislocation DDH patients with limb lengthening ≤4 cm and good tissue conditions, THA without femoral osteotomy may be considered.

Splenic artery aneurysm, without obvious symptoms, is a direct threat to the patient's life, once it ruptures as hemorrhagic shock. Imaging examinations have been the main diagnostic methods of splenic artery aneurysm, including ultrasound, computed tomography (CT), magnetic resonance imaging, and digital subtraction angiography (DSA). Although various inspective methods have their own advantages and disadvantages, abdominal CT examination is the most comprehensively applied method in clinical settings. The representative images of splenic artery aneurysm from a relatively large number of patients examined by CT are presented in this study. A total of 327 cases with splenic artery aneurysm were enrolled from 1998 to 2014, including 142 males and 185 females, with the age ranging from 37 to 78 years and an average age of 51.8 years old. The diagnosis of splenic artery aneurysm was confirmed by ultrasonography and CT examination. There were 20 cases accompanied with cirrhosis, 13 with hypertension, 12 with systemic multiple sclerosis, 10 with diabetes, 6 with gastrointestinal tumor, and 10 with cerebral infarction. Diagnostic criteria of CT imaging were as follows.[1] The diagnostic criteria for true aneurysm were limited expansion of splenic artery with intact wall and clear boundaries from the normal splenic artery, with the maximum width of the neck more than 1.5 times greater than that of the normal vascular. The diagnostic criteria for pseudoaneurysm were one discontinuous side of damaged splenic arterial wall and aneurysm body being on one side of the artery with a high density of contrast agent in angiography at the center, but no imaging in the aneurysm wall. The diagnostic criteria of dissecting aneurysm were eccentric expanded blood vessels with a double vascular wall of different density at cross-section in vascular reconstruction. All of the 327 cases were diagnosed with splenic artery aneurysm, including 306 cases with single tumor and 21 with multiple 2–5 tumors. The aneurysm diameter ranged from 2 to 15 cm with an average of 4.97 ± 2.28 cm. The shuttle aneurysms were found in 196 cases, approximately round in 56 cases, oval in 19 cases, hemisphere in 13 cases, and irregular in 22 cases. Aneurysm wall calcification was found in 249 cases. True aneurysms were confirmed in 288 cases, including multiple aneurysms in 21 cases, pseudoaneurysm in 31 cases, and dissecting aneurysm in 8 cases. There were 276 aneurysms in the middle and distal segment of the splenic artery, 40 adjacent to the splenic porta, and 11 adjacent to the splenic artery origin. A total of 314 aneurysms arose from the initial segment of splenic artery and in normal celiac trunk, 4 from abdominal aorta, 3 from the superior mesenteric artery, and 6 with abnormal combination of hepatic artery, splenic artery, and mesenteric artery. The representative images of splenic artery aneurysm are shown in Figure 1. Figure 1 Representative computed tomography images of splenic artery aneurysm. (a) Splenic artery aneurysm with calcified wall and mural thrombus located in the rear of the pancreas. (b) Branching artery aneurysm of the splenic artery. (c) Aneurysm at the initial ... A total of 285 cases underwent endovascular intervention treatment, 21 cases were pseudoaneurysms, and 264 were true aneurysms located in the middle and distal segment of the splenic artery. Moreover, 41 cases underwent traditional surgery, 11 cases were at the initial segment of the splenic artery, 6 were giant aneurysms, 5 were aneurysms adjacent to splenic portal, 5 were combined with wide and irregular aneurysm neck, 5 were abnormally combined with celiac trunk and superior mesenteric artery, 4 were multiple aneurysms, and 5 were general aneurysms in the middle and distal segment of splenic porta. There was 1 case of true aneurysm in the middle segment of the splenic artery underwent laparoscopic splenic artery aneurysm resection. No life-threatening complications were observed. There were 11 of 285 cases treated with intervention, which showed mild to moderate partial splenic infarction with abdominal pain and low fever and improved after conservative treatment. Moreover, 2 of 41 cases treated with traditional operations showed mild stenosis of anastomosis. All cases satisfied the clinical cure standard and without perioperative death when they were discharged without recurrence in the 6 months to 12 years’ follow-up using the CT angiography examination. Abdominal ultrasound is widely used in clinical settings due to economical, convenient, and noninvasive character; however, obesity, gastrointestinal gas, and serious arteriosclerosis impaired its positive rate and accurate rate. Enhanced magnetic resonance angiography is often used for the diagnosis of aneurysm, but often accompanied with certain restrictions due to in vivo metal implants such as pacemaker or aneurysm clip and claustrophobic fear of long time examination. DSA has been considered the “gold standard” for the diagnosis of vascular diseases. However, its gold standard status was challenged by the development of noninvasive imaging technologies, especially the development of multi slice CT angiography imaging technology. The data of abdominal CT examination in arterial phase were directly used for vascular reconstruction in the background through various reconstruction techniques to obtain aneurysm information from different angles, especially the structural characteristics of giant complex aneurysm and combined malformation of visceral artery.[2,3] From this study, CT angiography helped to determine the size, number, shape, location, and internal structure of splenic artery aneurysm, display the anatomic relationship between aneurysm and its surrounding organs, and clarify the relationship between the origin of the aneurysm and visceral artery. In recent years, vast majority of splenic aneurysm have received therapy through the vascular intervention.[4] Meanwhile, traditional surgical operation is still a reliable method for patients with complex splenic artery aneurysm who are unable to choose interventional therapy, such as splenic artery aneurysm adjacent to splenic artery or celiac artery, with proximal broad aneurysm distorted neck, with complicated arteriovenous fistula, with huge aneurysm body, and have close relationship with spleen and pancreas.[5] Therefore, multi-slice spiral CT angiography is a relatively accurate and efficient inspective method to clearly show the structural features of splenic artery aneurysm and provide anatomical and pathological information for the clinicians, and it may be helpful in making different treatment regimens according to the clinical characteristics of the aneurysm. Financial support and sponsorship This study was supported by a grant from the Hainan Provincial Research Program (No. YJJC20130009). Conflicts of interest There are no conflicts of interest.

Safe placement of the screws is a critical aspect of trans-pedicle internal fixation, and little information on in vivo morphology of the cervical vertebrae pedicle measured with imaging methods is available. The aim of this study was to measure the dimensions of cervical vertebrae C3 to C7 and provide screw length, screw diameter and tilt angle for clinical cervical vertebra trans-pedicle internal fixation.Thirty Chinese men and women underwent high-speed spiral computed tomography measurements to obtain data for C3 to C7, and the morphology of the cervical vertebra pedicles was reconstructed.Reconstructed computer tomography image data revealed that: (1) pedicle sponge width increased incrementally from C3 to C7, (2) pedicle depth was similar for C3 to C7, (3) pedicle angle decreased incrementally from 47.20° to 33.76° for C3 to C7, and (4) pedicle point to midline distance was similar for C3 to C7. There were no statistical differences in morphological data between the right and the left side. Men had statistically larger values than women for all morphological parameters.Reconstructed computed tomography images can provide useful data for clinical cervical vertebra trans-pedicle internal fixation. The individual measurement of cervical vertebra pedicles is recommended for safe placement of trans-vertebra pedicle screws.

There are few researches for the healing of metaphyseal fractures; moreover, the animal models to study the metaphyseal fractures are usually made by the oscillating saw osteotomy without reliable fixation, which is not in accordance with our current clinical practice. In this study, we established a new model to observe the healing process of metaphyseal fractures.Eighteen New Zealand rabbits were used in the study. The fracture model was created by splitting the medial tibial plateau in rabbits, then reset, and fixed with compression screws. At 1, 2, 3, 4, 6, and 8 weeks postoperatively, the tibial specimens were collected; firstly, a general observation and an X-ray examination of the specimens was done, and then they were embedded in methylmethacrylate and cut into sections with hard tissue slicer. The sections were stained with Giemsa reagent and examined under light microscopy.There was no fracture displacement in the tibial specimens of all time points, except for one showing a collapse. No external callus formation could be observed by X-ray and general examination. After 1 week of the operation, the fracture gap was filled by mesenchymal tissue; 2 weeks postoperatively, a large number of woven bones were formed; from the third week onwards, the woven bone began to turn into lamellar bone, and new trabecular structure began to form. In all of the slices, no obvious chondrocytes formed in fracture areas; thus, there was no endochondral ossification.This model was an ideal fracture animal model and suitable for the study of metaphyseal fracture healing. The X-ray and histological images demonstrated that metaphyseal fracture healing was a process of direct bone healing through intramembranous bone formation under the conditions of minor trauma, good reduction, and firm fixation.

The current theory of dyspnea perception presumes a multidimensional conception of dyspnea. However, its validity in patients with cardiopulmonary dyspnea has not been investigated.A respiratory symptom checklist incorporating spontaneously reported descriptors of sensory experiences of breathing discomfort, affective aspects, and behavioral items was administered to 396 patients with asthma, chronic obstructive pulmonary disease (COPD), diffuse parenchymal lung disease, pulmonary vascular disease, chronic heart failure, and medically unexplained dyspnea. Symptom factors measuring different qualitative components of dyspnea were derived by a principal component analysis. The separation of patient groups was achieved by a variance analysis on symptom factors.Seven factors appeared to measure three dimensions of dyspnea: sensory (difficulty breathing and phase of respiration, depth and frequency of breathing, urge to breathe, wheeze), affective (chest tightness, anxiety), and behavioral (refraining from physical activity) dimensions. Difficulty breathing and phase of respiration occurred more often in COPD, followed by asthma (R(2) = 0.12). Urge to breathe was unique for patients with medically unexplained dyspnea (R(2) = 0.12). Wheeze occurred most frequently in asthma, followed by COPD and heart failure (R(2) = 0.17). Chest tightness was specifically linked to medically unexplained dyspnea and asthma (R(2) = 0.04). Anxiety characterized medically unexplained dyspnea (R(2) = 0.08). Refraining from physical activity appeared more often in heart failure, pulmonary vascular disease, and COPD (R(2) = 0.15).Three dimensions with seven qualitative components of dyspnea appeared in cardiopulmonary disease and the components under each dimension allowed separation of different patient groups. These findings may serve as a validation on the multiple dimensions of cardiopulmonary dyspnea.

Calcitonin gene-related peptide (CGRP), a sensory neuropeptide, affects osteoblast proliferation and bone formation. However, the mechanisms are not fully understood. Monocyte chemoattractant protein-1 (MCP-1) is a chemokine that stimulates the migration of monocytes and plays important roles in regulating bone remolding during fracture repair. In this study, we investigated the effects of CGRP on proliferation and MCP-1 expression in cultured rat osteoblasts.Primary rat osteoblasts were isolated from fetal rats calvariae. Cells were exposed to gradient concentrations (10(-9) to 10(-7) mol/L) of CGRP. Protein and mRNA levels of MCP-1 were quantified by Western blotting and semiquantitative reverse transcription-polymerase chain reaction, respectively. The protein level of MCP-1 was investigated and compared in cell culture media by enzyme linked immunosorbent assay (ELISA). Phospho-extracellular signal-regulated kinase (ERK) expression was detected by Western blotting. Cell proliferative activity was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and BrdU assay. The effects of MAPK/ERK kinase (MEK)-inhibitor U0126 on CGRP-induced MCP-1 expression in primary rat osteoblasts were examined.CGRP effectively enhanced primary rat osteoblast proliferation and led to significant increases in the expression of MCP-1 mRNA and protein in time- and dose-dependent manners. CGRP activated the ERK pathway. Pretreatment of cultured rat osteoblasts with MEK inhibitor U0126 resulted in dose-dependent inhibitions of CGRP-induced MCP-1 mRNA and protein levels. Thus, CGRP promoted cell proliferation and stimulated MCP-1 expression in cultured rat osteoblasts.These studies document novel links between CGRP and MCP-1 and illuminate the effects of CGRP in regulating bone remodeling.

Medically unexplained dyspnea refers to a condition characterized by a sensation of dyspnea and is typically applied to patients presenting with anxiety and hyperventilation without underlying cardiopulmonary pathology. We were interested to know how anxiety triggers hyperventilation and elicits subjective symptoms in those patients. Using an imagery paradigm, we investigated the role of fearful imagery in provoking hyperventilation and in eliciting symptoms, specifically dyspnea.Forty patients with medically unexplained dyspnea and 40 normal subjects matched for age and gender were exposed to scripts and asked to imagine both fearful and restful scenarios, while end-tidal PCO(2) (PetCO(2)) and breathing frequency were recorded and subjective symptoms evaluated. The subject who had PetCO(2) falling more than 5 mmHg from baseline and persisting at this low level for more than 15 seconds in the imagination was regarded as a hyperventilation responder.In patients with medically unexplained dyspnea, imagination of fearful scenarios, being blocked in an elevator in particular, induced anxious feelings, and provoked a significant fall in PetCO(2) (P0.05). Breathing frequency tended to increase. Eighteen out of 40 patients were identified as hyperventilation responders compared to 5 out of 40 normal subjects (P0.01). The patients reported symptoms of dyspnea, palpitation or fast heart beat in the same fearful script imagery. Additionally, PetCO(2) fall was significantly correlated with the intensity of dyspnea and palpitation experienced during the mental imagery on one hand, and with anxiety symptoms on the other.Fearful imagery provokes hyperventilation and induces subjective symptoms of dyspnea and palpitation in patients with medically unexplained dyspnea.

Previous research indicated that the development of diabetic retinopathy (DR) is closely related to the excessive expression of growth factors. This paper was to study the relationship of DR with vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and the retinal vascular pathological change.Fifty-five Wistar rats, weighing 100 - 200 g, were selected and randomly divided into four groups: control group (no streptozocin injection, n = 10), M1 group (streptozocin induced diabetes for 1 month, n = 15), M3 group (streptozocin induced diabetes for 3 months, n = 15), and M5 group (streptozocin induced diabetes for 5 months, n = 15). In situ hybridization and immunohistochemistry were used to investigate the expressions of bFGF and VEGF on retinal vascular, and retinal vessels were observed by transmission electron microscope.There was no difference in the number of pericytes between M1 and control group (P0.05), but the number of pericytes decreased obviously in M3 and M5 groups compared with the control group (P0.01, P0.001, respectively). Capillary embolization and non-cell capillary were seen in M5 group. Positive expression of VEGF was found in M5 group using in situ hybridization and immunohistochemistry respectively. Positive expression of bFGF could be seen in M3 (78%) and M5 group (89%). Most remarkable changes of vessels were observed in M5 group including fragmental thickness, split of basement membrane, swelling and distortion of endothelial cells.In retinal vascular of the streptozocin (STZ) rats, there shows the expression of bFGF at the third month and that of VEGF at the fifth month.

Medically unexplained dyspnea occurs commonly in medical settings and remains poorly understood. This study was conducted to investigate the psychophysiological characteristics of medically unexplained dyspnea and the efficacy of breathing retraining for these patients.A group of patients with medically unexplained dyspnea were compared to patients with a variety of organic lung diseases and healthy subjects. In another group of patients, the influence of breathing therapy on complaints, anxiety, and breath-holding was evaluated for an average of 1.5 years.Patients with medically unexplained dyspnea reported more intense dyspnea than patients with a variety of organic lung diseases. Additionally, they were anxious and presented a broad range of symptoms in daily life and under challenge, for instance voluntary hyperventilation. More than one third of them qualified for panic disorder. They had shorter breath-holding time at rest, less increase in breath-holding time and higher chances of showing a "paradoxical" decrease of breath-holding time after hyperventilation. A combination of PaO2, forced expiratory volume in one second (FEV1), and anxiety measures distinguished them from organic dyspnea. Breathing retraining profoundly improved their symptoms and decreased the level of state and trait anxiety. Moreover, they better tolerated the voluntary hyperventilation and the symptoms induced were also markedly decreased after therapy. Breath-holding time was prolonged and PetCO2 in a representative group of patients increased.Patients with medically unexplained dyspnea appear to have the feature of a "psychosomatic" patient: an anxious patient with a wide variety of symptoms of different organ systems that do not have an organic basis. They can be distinguished from organic dyspnea using a small set of physiological and psychological measures. Breathing retraining turns out to be an effective therapy for those "difficult to treat patients".