Multi-layer perceptron (MLP) neural network belongs to multi-layer feedforward neural network, and has the ability and characteristics of high intelligence. It can realize the complex nonlinear mapping by its own learning through the network. Bipolar disorder is a serious mental illness with high recurrence rate, high self-harm rate and high suicide rate. Most of the onset of the bipolar disorder starts with depressive episode, which can be easily misdiagnosed as unipolar depression and lead to a delayed treatment so as to influence the prognosis. The early identifica- tion of bipolar disorder is of great importance for patients with bipolar disorder. Due to the fact that the process of early identification of bipolar disorder is nonlinear, we in this paper discuss the MLP neural network application in early identification of bipolar disorder. This study covered 250 cases, including 143 cases with recurrent depression and 107 cases with bipolar disorder, and clinical features were statistically analyzed between the two groups. A total of 42 variables with significant differences were screened as the input variables of the neural network. Part of the samples were randomly selected as the learning sample, and the other as the test sample. By choosing different neu- ral network structures, all results of the identification of bipolar disorder were relatively good, which showed that MLP neural network could be used in the early identification of bipolar disorder.
Bipolar Disorder ; diagnosis ; Humans ; Neural Networks (Computer)

AIM: To explore the serum levels of certain adhesion mole cules and its significance in acute coronary syndrome(ACS). METHODS: The subjects included 40 patients with acute myocardial infarction(AMI) and 40 patients with unstable angina pectoris (UAP). Among the 80 patients, 60 patients accepted a follow- up 4 months. At the same time we selected 40 controls from people who atte nded a routine health check in the university. Serum levels of E-selectin,sICAM -1,sVCAM-1 were measured by ELISA. RESULTS: Serum level s of E-selectin ,sICAM-1,sVCAM-1 were significantly higher in the ACS group(AMI or UAP) than in the control group. Four months later, the levels of E-selectin,sICAM-1 bec ame sig nificantly lower in the follow-up group than in the ACS group, while sVCAM- 1 showed no significant difference. CONCLUSION: Serum levels of E-se lectin ,sICAM-1 may have certain diagnostic value for ACS, and can be a useful marker reflecting th e stability of the disease.

Objective To explore the effects of HMGCoA agents and ACE inhibitor on serum inflammatory markers in patients with acute coronary syndrome (ACS). Methods The 60 patients with ACS were randomly divided into two groups, one treated with lipid lowered by HMGCoA agents and the other treated with HMGCoA agents added with ACE inhibitor. After 4 months, serum levels of some inflammatory markers were measured by means of ELISA. Results Serum levels of certain inflammatory markers were significantly higher in the ACS group than in the control group and became significantly lower 4 months later in the follow-up group. There were no differences in all the inflammatory markers between the two groups receiving different therapies 4 months later. Conclusion Serum levels of some inflammatory markers may have certain diagnostic value for ACS and may reflect the stability of the disease. HMGCoA agents seem to have no effect on inflammatory responses in a short period.

Objective To study the findings of 256‐slice CT angiography in atherosclerosis of the intracranial carotid arteary . Methods 402 cases of atherosclerotic lesions in the neck and brain were collected from 2013 to 2014 in our hospital ,in which there were 274 cases of male and 128 cases female .All patients underwent 256‐slice CT angiography of the head and neck .The incidence of atherosclerosis involvement in the intracranial carotid artery was analysed .The characteristics of carotid plaque on different sexes , age(≤60 years and >60 years) and location (right and left ) were observed .The length and property of plaque ,and stenostic rate of the artery were measured respectively .Results There were 164 cases (40 .80% ) of intracranial carotid artery athrosclerosis in 402 cases of atherosclerotic lesions of the neck and brain ,in which the incident rate of male was 38 .32% and female 46 .09% (χ2 =2 .182 ,P=0 .140) .The incident rate of >60 years group was more than that of ≤60 years group (χ2 <31 .105 ,P<0 .001)for both sexes . There were no differences on lesion location (right or left)for different sexes or age groups (χ2 <0 .035 ,P>0 .088) .And there were also no differences on lesion length (≤10 mm ,11-20 mm ,>20 mm) for different sexes or age groups (χ2 <0 .027 ,P>0 .091) . Calcified plaques were seen the most (79 .81% ) ,mixed plaques were seen more (15 .46% ) ,and lipid plaques (1 .58% ) and fibrous plaques (3 .15% ) were seen less .The mixed plaques were more seen on >60 years group than that on ≤60 years group for male pa‐tients (χ2 =12 .204 ,P=0 .001) ,but no other difference was found for plaque property in other different sexes or age groups .Mild stenosis of the corated artery was found in 54 .57% lesions ,moderate stenosis in 39 .75% and severe stenosis in 5 .68% ,and there were no any difference in different sexes or age groups (χ2 <2 .062 ,P>0 .151) .Conclusion CT angiography of the head and neck is of important significance for diagnosis of atherosclerosis in the intracranial carotid artery .

Objective:To detect the genotype of carbapenase and investigate the drug sensibility of Ceftazidime-avibactam (CAZ/AVI) on carbapenem-resistant Enterobacteriaceae (CRE), and to provide evidence for rational use of antibacterial drugs in clinical practice. Methods:A total of 179 strains of CRE were isolated from clinical specimens of patients treated in Linyi People′s Hospital from January 2019 to December 2020. mCIM/eCIM test and GeneXpert were used to detect the genotype of carbapenemases. The drug sensibility of CAZ/AVI was detected by K-B test.Results:One hundred and seventy-four out of 179 strains of CRE were positive upon to mCIM test (97.2%), 147strains were positive upon to eCIM test (84.5%). There were 27 serine carbapenemase (15.5%) and 147 metallo-β-lactamase (84.5%). The results of Fluorescent quantitative PCR rapid detection system developed by Saipei GeneXpert were consistent with the results detected by mCIM/eCIM. In the drug sensitivity test, 58 out of 174 mCIM positive strains were sensitive to CAZ (33.3%), of which the sensitivity of 27 strains producing serine carbapenemase was 96.3% (26/27) and all 147 strains producing metallo-β-lactamase were drug-resistant to CAZ/AVI.Conclusions:The carbapenase genotype of CRE in Linyi region is mainly metal β-lactamase. The CRE producing serine carbapenemase is highly sensitive to CAZ/AVI. It is helpful to guide the rational clinical use of the CAZ/AVI according to the detection results of CRE with or without carbapenemase production capacities.

Objective To investigate the clinical characteristics of granulomatosis with polyangiitis (GPA) patients with scleritis.Methods The completed clinical data of 102 GPA patients from March 2012 to July 2016 in Capital Medical University, Tong Ren Hospital were collected. Altogether 43 GPA patients with scleritis were enrolled, and the clinical data were analyzed respectively. The t test, Mann-Whitney U test and x2testwere used to analyze the data. Results The most common ocular manifestation in GPA was scleritis. The incidence of renal damage(37.2% vs 11.9%,x2=9.148,P=0.002),disease activity(BVAS/GPA score 8.9 vs 5.1,Z=7.847, P=0.000),DEI score (7 vs 4,Z=5.919, P=0.000),inflammation index(56 mm/1 h vs 36 mm/1 h, Z=2.456, P=0.016; CRP 51 mg/L vs 8 mg/L, Z=3.748, P=0.000), neutrophil percent (70% vs 61%, t=3.993, P=0.000),complement 3(1.2 g/L vs 1.0 g/L, t=2.652, P=0.009),plasma fibrinogen(3.5 g/L vs 3.3 g/L, t=3.947, P=0.000), D-dimmer (0.5 mg/L FEU vs 0.3 mg/L FEU, Z=2.371, P=0.018) and ANCA positive rate (90.7% vs 57.6%,x2=13.369,P=0.000)were higher in patients with scleritis,as well as a poor prognosis(2009-FFS 0.4 vs 0.1, Z=2.600, P=0.009). However, a lower rate of subglottic involvement was detected in scleritis group (4.7% vs 20.3%, x2=5.169, P=0.023). There were no significant differences between GPA patients with scleritis and episcleritis in clinical feature, disease activity, inflammatory index and prognosis. Aggressive immunosuppres-sive treatment was appropriate for GPA with scleritis. Tumor necrosis factor (TNF)-аinhibitor was an effective treatment. Conclusion GPA with scleritis usually suffered from higher disease activity index,broader DEI,as well as poorer prognosis. Aggressive treatment should be initiated in order to achieve disease remission. Subglottic involvement is less common in patients with scleritis. The phenotype of scleritis is not associated with disease severity.

Objective: To investigate the effect of circadian heart rate variation on short-term and long-term mortality in intensive care unit (ICU) patients. Methods: A retrospective cohort study was conducted. A total of 32 536 ICU patients were recorded from 2001 to 2008 published by Multiparameter Intelligent Monitoring in Intensive Care Ⅱ (MIMIC-Ⅱ v2.6) in April 2011. The circadian heart rate variation was defined as the ratio of mean nighttime (23:00 to 07:00) heart rate to mean daytime (07:00 to 23:00) heart rate. The 28-day mortality and 1-year mortality were defined as outcome events. The information such as age, gender, ethnicity, first sequential organ failure assessment (SOFA) score, first simplified acute physiology score Ⅰ (SAPSⅠ), usage of sedatives and catecholamines within 24 hours admission of ICU, clinical complications [hypertension, chronic obstructive pulmonary disease (COPD), diabetes with or without complications, congestive heart failure, liver disease, renal failure, etc.], and the complete heart rate records within 24 hours after ICU admission were collected. Cox proportional risk regression models were used to investigate the association between circadian heart rate variation and 28-day mortality and 1-year mortality in ICU patients. Besides, subgroup analysis was also performed in patients with different first SOFA scores. Results: Totally 15 382 ICU patients in MIMIC-Ⅱ database were enrolled, excluding the patients without heart rate records or death records, using pacemaker with arrhythmia, without SOFA or SAPSⅠ score records. Finally, 9 439 patients were enrolled in the study cohort. ① Cox regression analysis of the whole patient showed that the higher circadian heart rate variation was correlated with the increased 28-day mortality [hazard ratio (HR) = 1.613, 95% confidence interval (95%CI) was 1.338-1.943, P < 0.001] and 1-year mortality (HR = 1.573, 95%CI was 1.296-1.908, P < 0.001). After adjustment for demographic factors (age, gender and ethnicity), severity of illness (SOFA and SAPS Ⅰ scores), clinical complications (hypertension, COPD, diabetes with or without complications, congestive heart failure, liver disease, renal failure, etc.), and influence of medications (sedatives and catecholamines), the night-day heart rate ratio was also correlated with 28-day mortality (HR = 1.256, 95%CI was 1.018-1.549, P = 0.033) and 1-year mortality (HR = 1.249, 95%CI was 1.010-1.545, P = 0.040). ② According to the SOFA score (median value of 5), the patients were divided into two subgroups, in which 5 478 patients with SOFA score ≤ 5 and 3 961 patients with SOFA score > 5. Cox regression subgroup analysis showed that circadian heart rate variation was related with higher 28-day mortality (HR = 1.430, 95%CI was 1.164-1.756, P = 0.001) and 1-year mortality (HR = 1.393, 95%CI was 1.123-1.729, P = 0.003) in patients with SOFA score > 5. After adjustment for covariates, the 28-day mortality (HR = 1.279, 95%CI was 1.032-1.584, P = 0.025) and 1-year mortality (HR = 1.255, 95%CI was 1.010-1.558, P = 0.040) also increased with the increasing of night-day heart rate ratio in patients with SOFA score > 5. However, the relationships did not exist in patients with SOFA score ≤ 5. Conclusion In ICU patients, the 28-day mortality and 1-year mortality increase with the higher circadian heart rate variation, which indicates that the circadian heart rate variation in ICU patients is positively correlated with the short-term and long-term mortality, especially in patients with relatively severe illness.

Objective To analyze the clinical features of chronic rhino-sinusitis (CRS) in patients with immunoglobulin G4-related disease (IgG4-RD).Methods A retrospective analysis of the data from March 2013 to July 2015 in our Department of Rheumatology was conducted in patients who were diagnosed as IgG4-RD and were follow-up for over half a year.The clinical features and the results of laboratory tests were compared between of the case group and the control group.The t test,Mann-Whitney U test and Fisher'Exact Test (n ＜40) were used to analyze the data.Results Twenty-four cases in 44 cases of IgG4-RD were complicated with CRS (54％).The mean age was (49±13) years old,with the ratio of male:female was 2∶1;With the longer disease duration [4.0 (1.0,6.3) year vs 0.5 (0.2,4.3) year,U=-2.182,P=0.041],the more the number of organs involved [4.0 (3.8,5.3) vs 3.0 (1.0,4.0),U=-2.827,P=0.005],the higher the ratio of ocular involvement (89％ vs 42％,P=0.013).The higher the percentage of eosinophils in peripheral blood [8.5％(4.0,13.8) vs 3.3％(0.8,8.5),P=0.043],the more common the allergic manifestations (61％ vs 20％,P=0.026),the higher the operation times [1.5(1.0,3.0) vs1.0(0,10),U=2.096,P=0.048] before making the definitive diagnosis than the control group A.The level of ESR/CRP (56％ vs 0,P=0.004) and the number of IgG4 positive plasma cells [57.5(50.0,66.3)/HP vs 10.0(1.8,20.0)/HP,U=4.358,P＜0.01] and the percentage of IgG4/IgG positive plasma cell (40％ vs 10％,P＜0.01) in the nasal mucosal tissues of the IgG4-related chronic rhino-sinusitis were higher than patients with ordinary CRS (the control group B),but there was no difference in the severity of sinusitis manifestations between patients with IgG4-related chronic rhino-sinusitis and the regular CRS.Conclusion IgG4-related chronic rhino-sinusitis is different from regular CRS,and is closely associated with IgG4-related ocular lesion.IgG4-related chronic rhino-sinusitis has some clinical features which are different from other phenotypes of IgG4-related diseases.

Objective To investigate clinical and imaging characteristics of patients with relapsing polychondritis (RP) with insidious airway involvement.Methods Data collected prospectively and consecutively for patients with the diagnosis of RP and their disease activity evaluation was analyzed.The t-test and Mann-Whitney U test were used for statistical analysis between the two groups forquantitative datain normal distri-bution and non-normal distribution respectively,while Chi-square test was use for qualitative data analysis.Results Two hundred and sixteen patients with complete data from Dec 1,2007 to Jul 31,2016 were enrolled with a M:F ratio of 1:1.Mean age of disease onset was (44±16)(8～86) years.The median disease duration was 12 (0.3～480) month.The median relapsing polychondritis disease activity index (RPDAI) was 35 (8～67),the median RPODI was 2.4 (0.1～84).The top three initial presentation were auricular chondritis (28.7％),airway chondritis (24.1％) and ocular involvement (22.2％) respectively.RPODI was significantly higher in auricular chondritis (4.4) (Z=-2.084,P＜0.05) and lower in nose chondritis (0.6) (Z=-2.425,P＜0.05).Up to 81.5％ of the patients were found with airway damage and 52.3％ of them were asymptomatic.Airway damage was mostly located in trachea (79.0％ 139/176) and common features on CT scan werecharacterized by airway wail thickening (72.7％,128/176).Airway narrowing was mostly seen in symptomatic patients while calcification was seen more in asymptomatic patients.Insidious hearing-loss and nose chondritis were found not related to airway damage while obvious auricular chondritis (x2=15.580,P＜0.01),ocular involvement (x2=8.105,P＜0.01) were found to be more in patients with asymptomatic airway damage.All diagnosis before RP was organ-driven.Conclusion Airway involvement in RP is one of the three most common disease initial presentation-sand half of them are asymptomatic.RPODI is a reasonable marker for disease evaluation.Routine follow-up of airway damage (wall thickness,calcification and lumen narrowing) is essential for early RP recognition.

Objective To investigate the clinical and audiological characteristics of non-elder patients with relapsing polychondritis (RP).Methods Clinical and audiological data of patients with RP under 60 years old were collected consecutively and analyzed.The t-test and Mann-Whitney U test were used for statistical analysis between the two groups in quantitative data in normal distribution and non-normal distribution respectively,while Chi-square test was use for qualitative data analysis.Results One hundred and seventy four patients with complete data who fulfilled the Michet criteria were enrolled with a M∶F=1∶1.1.The mean age of disease onset was (39±13) (8-60) years;the median time of disease duration was 12 (1-480) months;the median relapsing polychondritis disease activity index (RPDAI) was 38(10-77) and the median RPODI was 2.4(0.1-56).Auricular chondritis (32.8％,57/174),ocular involvement (24.7％,43/174) and airway chonchritis (21.3％,37/174) were the top three onset-pattern.All parts of external,middle and inner ear were involved in RP.Inner-ear damage was the most common (95.4％,166/174) with insidious cochlea and vestibule equally distributed.Auricular chondritis was predominant in external ear involvement (55.2％,96/174);ET dysfunction was included in eardrum abnormalities of neglected middle-ear involvement (29.9％,52/174).Positive HL by active detection was 71.8％(125/174) with 14.3(25/174) HL fulfilled world health organization (WHO)-2006 criteria,including 52.0％(13/25) disabling HL.Sensorineural hearing loss (SNHL) was predominant in RP after 21 years old while 60.0％(6/10) was seen in childhood RP with non-SNHL.At least two parts of ear involvement were seen in almost all patients with heavy overlap.Conclusion All parts of ear are involved in non-elder RP with age related clinical characteristics.Active detection is a key to find insidious middle-and inner-ear involvement for early RP recognition.RPODI is a potential marker for RP evaluation.