Quzhou People Research Articles

DAAM-Net: A dual-encoder U-Net network with adjacent auxiliary module for pituitary tumor and jaw cyst segmentation

In the diagnosis of various diseases, accurate segmentation of lesions in medical images is crucial. However, when faced with the challenges of blurred edges, noise, and low contrast in images of pituitary tumors and jaw cysts, existing methods do not perform well in solving these problems. To overcome these problems, we present a new approach based on U-Net architecture. Firstly, a more comprehensive semantic information capture is realized by superimposing two U-Net network structures. Following that, the method incorporates atrous spatial pyramid pooling (ASSP) technology to enable adjustable multi-scale feature extraction. Thirdly, an adjacent auxiliary module (AAM) is designed to smoothly fuse features from different levels, effectively suppressing noise interference and reducing feature ambiguity. By testing on the dataset provided by Quzhou People’s Hospital, the IoU, Dice, Specificity, and Mcc of the method were 77.46%, 87.18%, 99.64% and 86.97% on the pituitary tumor dataset, and 81.32%, 89.53%, 99.91% and 89.55% on the jaw cyst dataset, respectively. Compared with existing algorithms, our method exhibits superior segmentation performance and is expected to become a more reliable auxiliary tool in the diagnosis of medical diseases.

MARes-Net: multi-scale attention residual network for jaw cyst image segmentation.

Jaw cyst is a fluid-containing cystic lesion that can occur in any part of the jaw and cause facial swelling, dental lesions, jaw fractures, and other associated issues. Due to the diversity and complexity of jaw images, existing deep-learning methods still have challenges in segmentation. To this end, we propose MARes-Net, an innovative multi-scale attentional residual network architecture. Firstly, the residual connection is used to optimize the encoder-decoder process, which effectively solves the gradient disappearance problem and improves the training efficiency and optimization ability. Secondly, the scale-aware feature extraction module (SFEM) significantly enhances the network's perceptual abilities by extending its receptive field across various scales, spaces, and channel dimensions. Thirdly, the multi-scale compression excitation module (MCEM) compresses and excites the feature map, and combines it with contextual information to obtain better model performance capabilities. Furthermore, the introduction of the attention gate module marks a significant advancement in refining the feature map output. Finally, rigorous experimentation conducted on the original jaw cyst dataset provided by Quzhou People's Hospital to verify the validity of MARes-Net architecture. The experimental data showed that precision, recall, IoU and F1-score of MARes-Net reached 93.84%, 93.70%, 86.17%, and 93.21%, respectively. Compared with existing models, our MARes-Net shows its unparalleled capabilities in accurately delineating and localizing anatomical structures in the jaw cyst image segmentation.

PKSEA-Net: A prior knowledge supervised edge-aware multi-task network for retinal arteriolar morphometry

Retinal fundus images serve as a non-invasive modality to obtain information pertaining to retinal vessels through fundus photography, thereby offering insights into cardiovascular and cerebrovascular diseases. Retinal arteriolar morphometry has emerged as the most convenient and fundamental clinical methodology in the realm of patient screening and diagnosis. Nevertheless, the analysis of retinal arterioles is challenging attributable to imaging noise, stochastic fuzzy characteristics, and blurred boundaries proximal to blood vessels. In response to these limitations, we introduce an innovative methodology, named PKSEA-Net, which aims to improve segmentation accuracy by enhancing the perception of edge information in retinal fundus images. PKSEA-Net employs the universal architecture PVT-v2 as the encoder, complemented by a novel decoder architecture consisting of an Edge-Aware Block (EAB) and a Pyramid Feature Fusion Module (PFFM). The EAB block incorporates prior knowledge for supervision and multi-query for multi-task learning, with supervision information derived from an enhanced Full Width at Half Maximum (FWHM) algorithm and gradient map. Moreover, PFFM efficiently integrates multi-scale features through a novel attention fusion method. Additionally, we have collected a Retinal Cross-Sectional Vessel (RCSV) dataset derived from approximately 200 patients in Quzhou People’s Hospital to serve as the benchmark dataset. Comparative evaluations with several state-of-the-art (SOTA) networks confirm that PKSEA-Net achieves exceptional experimental performance, thereby establishing its status as a SOTA approach for precise boundary delineation and retinal vessel segmentation.

Diagnostic value of Video Electroencephalography combined with Magnetic Resonance Imaging-diffusion tensor imaging in epilepsy.

To explore the diagnostic value of video electroencephalography (VEEG) combined with magnetic resonance imaging diffusion tensor imaging (MRI-DTI) in epilepsy. In this retrospective observational study, clinical data of 60 patients who underwent both VEEG and MRI examinations at the Neurosurgery Department of Quzhou People's Hospital from December 2020 to March 2023 were retrospectively reviewed, and a total of 55 patients were finally included. We evaluated the diagnostic value of combining VEEG and MRI to determine seizure type, location of epileptic focus, and structural abnormalities of brain tissue, using surgical and pathological results as the gold standard. The accuracy of the combined approach for determining the seizure type was 98.18%, which was higher than the accuracy of MRI (85.45%, P<0.05) or VEEG (81.82%, P<0.05) alone. The accuracy of joint examination for lesion location was 100.00%, which was higher than those of MRI (85.45%, P<0.05) or VEEG (83.64%, P<0.05) alone. Similar abnormal brain tissue structure detection rates was found for both MRI and VEEG (P>0.05). The application of MRI-DTI combined with VEEG to diagnose patients with epilepsy allows for the identification of abnormal structural changes in brain and the location of lesions. Combining both approaches can improve the diagnostic accuracy of each technique alone and provide a reference for the formulation and adjustment of disease management plans.

A semantic segmentation method to analyze retinal vascular parameters of diabetic nephropathy.

By using spectral domain optical coherence tomography (SD-OCT) to measure retinal blood vessels. The correlation between the changes of retinal vascular structure and the degree of diabetic nephropathy is analyzed with a full-pixel Semantic segmentation method. A total of 120 patients with diabetic nephropathy who were treated in the nephrology department of Quzhou People's Hospital from March 2023 to March 2024 were selected and divided into three groups according to the urinary albumin creatinine ratio (UACR). The groups included simple diabetes group (UACR < 30 mg/g), microalbuminuria group (30 mg/g ≤ UACR <300 mg/g) and macroalbuminuria group (UACR ≥300 mg/g). SD-OCT was used to scan the arteries and veins in the superior temporal area B of the retina. The semantic segmentation method built into the SD-eye software was used to automatically identify the morphology and structure of the vessels and calculate the parameters of arteriovenous vessels. The parameters of arteriovenous vessels are as follows: outer diameter of the retinal artery (RAOD); inner diameter of the retinal artery (RALD); arterial wall thickness (AWT); arterial wall to lumen ratio (AWLR); cross sectional area of arterial wall (AWCSA); retinal vein outer diameter (RVOD); retinal vein inner diameter (RVLD); vein wall thickness (VWT); vein wall to lumen ratio (VWLR); cross sectional area of vein wall (VWCSA). Statistical analysis software was used to compare and analyze the parameters of retinal arteriovenous vessels of the three groups. The study revealed statistically significant differences in RAOD and RALD among the three groups (p < 0.05) with the RAOD and RALD of the macroalbuminuria group and microalbuminuria group being lower than those of the simple diabetes group. Conversely, there were no significant differences in AWT, AWLR and AWCSA among the three groups (p > 0.05). Additionally, the differences in RVOD and RVLD among the three groups were found to be statistically significant (p < 0.05) with the RVOD and RVLD of the simple diabetes group being lower than those of the microalbuminuria group and macroalbuminuria group. No significant differences were observed in VWT and VWL among the groups. Additionally, RVOD and RVLD were weakly associated with UACR (R = 0.247, p = 0.007; R = 0.210, p = 0.021). Full-pixel semantic segmentation method combined with OCT images is a new retinal vascular scanning technology, which can be used as a new method for early diagnosis of diabetic nephropathy. The structural changes of retinal vessels can be used to predict the severity of diabetic nephropathy during the development of diabetic nephropathy.

PDC-Net: parallel dilated convolutional network with channel attention mechanism for pituitary adenoma segmentation.

Accurate segmentation of the medical image is the basis and premise of intelligent diagnosis and treatment, which has a wide range of clinical application value. However, the robustness and effectiveness of medical image segmentation algorithms remains a challenging subject due to the unbalanced categories, blurred boundaries, highly variable anatomical structures and lack of training samples. For this reason, we present a parallel dilated convolutional network (PDC-Net) to address the pituitary adenoma segmentation in magnetic resonance imaging images. Firstly, the standard convolution block in U-Net is replaced by a basic convolution operation and a parallel dilated convolutional module (PDCM), to extract the multi-level feature information of different dilations. Furthermore, the channel attention mechanism (CAM) is integrated to enhance the ability of the network to distinguish between lesions and non-lesions in pituitary adenoma. Then, we introduce residual connections at each layer of the encoder-decoder, which can solve the problem of gradient disappearance and network performance degradation caused by network deepening. Finally, we employ the dice loss to deal with the class imbalance problem in samples. By testing on the self-established patient dataset from Quzhou People's Hospital, the experiment achieves 90.92% of Sensitivity, 99.68% of Specificity, 88.45% of Dice value and 79.43% of Intersection over Union (IoU).

Prediction model of adjacent vertebral compression fractures after percutaneous kyphoplasty: a retrospective study

ObjectivesThe purpose of this study was to develop a prediction model to assess the risk of adjacent vertebral compression fractures (AVCFs) after percutaneous kyphoplasty (PKP) surgery.DesignA retrospective chart review.Setting and...

Sequential Enteral and Parenteral Nutrition Support Assisted by Nutritional Risk Screening Improves Outcome in the Colorectal Cancer Patients Undergoing Radical Surgery

We have examined the influence of sequential enteral and parenteral nutrition support, assisted by nutritional risk screening, on colorectal cancer patients undergoing radical surgery. This cohort included 100 colorectal cancer patients receiving radical surgery in Zhejiang Quzhou People’s Hospital between May 2021 and April 2022. The control group received treat¬ment with early enteral nutrition support only. The experimental group, however, received sequential enteral and parenteral nutrition support, assisted by nutritional risk screening. The indicators of nutrition adequacy, gastrointestinal function, early postoperative complications, and quality of life were compared. The albumin, hemoglobin, and albumin levels presented no difference between the two groups before treatment. After treatment, these indicators in the experimental group were elevated relative to those in the control group. The time of bowel sound recovery, the time of first anal exhaustion, time of first defecation, and the incidence of surgical complications in the experimental group decreased relative to those in the control group. A 36-item short-form health survey showed an elevation in the experimental group relative to the control group. Application of sequential enteral and parenteral nutritional support assisted by nutritional risk screening in colorectal cancer patients has a significant effect, which helps improve postoperative nutritional status, facilitate gastrointestinal function recovery, reduce incidence of complications, and accelerate postoperative recovery.

Construction and validation of a clinical predictive nomogram for intraductal carcinoma of the prostate based on Chinese multicenter clinical data.

Intraductal carcinoma of the prostate (IDC-P) is a special pathological type of prostate cancer that is highly aggressive with poor prognostic outcomes. To establish an effective predictive model for predicting IDC-P. Data for 3185 patients diagnosed with prostate cancer at three medical centers in China from October 2012 to April 2022 were retrospectively analyzed. One cohort (G cohort) consisting of 2384 patients from Zhejiang Provincial People's Hospital was selected for construction (Ga cohort) and internal validate (Gb cohort)of the model. Another cohort (I cohort) with 344 patients from Quzhou People's Hospital and 430 patients from Jiaxing Second People's Hospital was used for external validation. Univariate and multivariate binary logistic regression analyses were performed to identify the independent predictors. Then, the selected predictors were then used to establish the predictive nomogram. The apparent performance of the model was evaluated via externally validated. Decision curve analysis was also performed to assess the clinical utility of the developed model. Univariate and multivariate logistic regression analyses showed that alkaline phosphatase (ALP), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), prostate specific antigen (PSA) and lactate dehydrogenase were independent predictors of IDC-P. Therefore, a predictive nomogram of IDC-P was constructed. The nomogram had a good discriminatory power (AUC = 0.794). Internal validation (AUC = 0.819)and external validation (AUC = 0.903) also revealed a good predictive ability. Calibration curves showed good agreement between the predicted and observed incidences of IDC-P. We developed a clinical predictive model composed of alkaline phosphatase (ALP), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), prostate specific antigen (PSA) and lactate dehydrogenase (LDH) with a high precision and universality. This model provides a novel calculator for predicting the diagnosis of IDC-P and different treatment options for patients at an early stage.

The diagnostic value of an interferon gamma release assay in new cases of active pulmonary tuberculosis and the factors influencing its negative results

ObjectiveThe aim of the study was to investigate the diagnostic value of an interferon gamma release assay (IGRA) - QuantiFERON-TB GOLD in-tube (QFT-GIT) - to identify new cases of active pulmonary tuberculosis (PTB) in Quzhou City, and to assess possible factors associated with false-negative IGRA results in bacteriologically confirmed PTB. MethodsThis study collected clinical data of suspected adult PTB patients who underwent QFT-GIT in Quzhou People's Hospital between January 1, 2020 and December 31, 2020, and calculated the total sensitivity, specificity of QFT-GIT in new case of active PTB patients were 90.9% (401/448) and 72.9%(929/1275), respectively. Univariate and multivariate logistic regression were used to analyze the influencing factors of the false-negative results of QFT-GIT. ResultsA total of 1723 patients were enrolled, including 448(448/1723,26.0%) with new case of active PTB (389 cases were bacteriologically confirmed and 59 cases were clinically diagnosed) and 1275 non-PTB patients. There were 747(747/1723,43.4%) patients with positive results of QFT-GIT, among whom 401 were new case of active PTB patients (347 cases were bacteriologically confirmed and 54 cases were clinically diagnosed) and 346 were non-PTB patients. The total sensitivity and specificity of QFT-GIT in the diagnosis of new case of active PTB patients were 90.9% and 72.8% respectively. In bacteriologically comfirmed PTB patients, multivariate conditional logistic regression analysis showed that BMI and diabetes, malignant tumors and severe infections were all independent risk factors for the false-negative results of QFT-GIT. ConclusionQFT-GIT showed high sensitivity and relatively low specificity in the diagnosis of new case of active PTB patients. In clinical practice, we should analyze the suspected PTB patients comprehensively in terms of whether they are overweight or complicated with diabetes, malignant tumors or severe infections, and avoid missing the diagnosis of PTB.

Improved U-Net based on cross-layer connection for pituitary adenoma MRI image segmentation.

Pituitary adenoma is a common neuroendocrine neoplasm, and most of its MR images are characterized by blurred edges, high noise and similar to surrounding normal tissues. Therefore, it is extremely difficult to accurately locate and outline the lesion of pituitary adenoma. To sovle these limitations, we design a novel deep learning framework for pituitary adenoma MRI image segmentation. Under the framework of U-Net, a newly cross-layer connection is introduced to capture richer multi-scale features and contextual information. At the same time, full-scale skip structure can reasonably utilize the above information obtained by different layers. In addition, an improved inception-dense block is designed to replace the classical convolution layer, which can enlarge the effectiveness of the receiving field and increase the depth of our network. Finally, a novel loss function based on binary cross-entropy and Jaccard losses is utilized to eliminate the problem of small samples and unbalanced data. The sample data were collected from 30 patients in Quzhou People's Hospital, with a total of 500 lesion images. Experimental results show that although the amount of patient sample is small, the proposed method has better performance in pituitary adenoma image compared with existing algorithms, and its Dice, Intersection over Union (IoU), Matthews correlation coefficient (Mcc) and precision reach 88.87, 80.67, 88.91 and 97.63%, respectively.

Analysis of blood coagulation indexes, thromboelastogram and autoantibodies in patients with recurrent pregnancy loss.

Objectives:Changes in coagulation indexes, thromboelastogram(TEG) and autoantibodies in patients with recurrent pregnancy loss (RPL) with different number of abortions were analyzed.Methods:Medical records of 48 patients with recurrent abortion, treated in Quzhou people’s Hospital from November 2019 to October 2020, were collected as the observation group. Based on the number of abortions, patients were divided into Group-A (Two abortions, n=21), Group-B (Three abortions, n=16) and group C (Abortion ≥ four times, n=11). Records of 50 healthy pregnant women in our hospital in the same period were selected as the control group. Coagulation indexes [prothrombin time (PT), activated partial prothrombin time (APTT), fibrinogen (FIB), D-Dimer (DD)], thromboelastogram (TEG) parameters [reaction time (R), coagulation time(K), maximum thrombus amplitude (MA), coagulation angle (α)], changes in the levels of autoantibodies [anticardiolipin antibody (ACA), anti-endometrial antibody (EmAb), anti-thyroid antibody(ATA)] were compared between the groups.Results:There were significant differences in the levels of ATPP, Pt, FIB and DD among the groups. Higher number of abortions correlated with lower the levels of ATPP and Pt, and higher levels of FIB and DD (P<0.05). Compared to the control group, R and K in Group-A,B and C decreased, while α and MA increased (P<0.05). There were significant differences in α and MA indexes. The positive rates of ACA, EmAb and ATA in Group-A were higher than those in the control group, but the difference was not statistically significant (P>0.05), while the above indexes in groups B and C were significantly higher than those in the control group (P<0.05). The positive rates of ACA and ATA in group C were significantly higher than those in Group-A (P<0.05), but there was no significant difference in the positive rate of EmAb (P>0.05).Conclusion:RPL was related to the decrease of APTT, PT, and the increase of FIB and DD levels. TEG indicated that the increase of α and MA values indicated that the risk of multiple abortion was increased. The positive rates of ACA, EmAb and ATA were closely related to multiple abortions, especially the positive rates of ACA and ATA.

Extraction of Cerebral Hemorrhage on CT Images Using Level Set Algorithm and Otsu Threshold

Extraction of cerebral hemorrhage on CT images has always been the focus of several research hotspots and is still challenging as it does not show clear boundary. In this paper, a novel segmentation framework is presented for extracting the cerebral hemorrhage in brain CT images with weak boundary. Firstly, we utilize the Otsu threshold algorithm to get the coarse outline approximate to the target boundary as the initial curve of level set algorithm. Then, the active contour model is employed using both edge information and global Gaussian distribution fitting energy of images to modify energy function of level set. The proposed approach is applied on real images which from Quzhou People’s Hospital. Compared to manual delineation, the proposed technique shows a higher JS value than the existing methods and requires less interaction which is listed in the literature.

Diagnostic value of magnetic resonance imaging and hydrogen ion magnetic resonance spectroscopy for central neurocytoma

Objective To analyze the clinical value of magnetic resonance imaging (MRI) and hydrogen proton magnetic resonance spectroscopy (~1H-MRS) in the diagnosis of central neurocytoma (CNC). Methods From February 2010 to February 2018, the clinical data of 12 patients with CNC confirmed by surgery and pathology in Quzhou People's Hospital were retrospectively analyzed.All patients underwent MRI diagnosis before operation.Among them, 9 patients received ~1H-MRS check. Results In this group of 12 patients, 9 patients occurred in the 2/3 area of the lateral ventricle, 2 cases occurred in the posterior third of the lateral ventricle, 1 case occurred in the frontal lobe; 11 cases were solid tumors, and 1 case was cystic tumors.MRI showed plaque calcification in the tumor, distortion of vascular shadow, T1WI was equal low signal, T2WI was contoured mixed signal; 8 cases showed uneven light and moderate enhancement, 3 cases showed uneven enhancement, 1 case showed ring enhancement; 8 cases of ~1H-MRS showed a significant increase in choline peak (Cho), N-acetylaspartate (NAA) peak decreased, and Cho/NAA increased.Meanwhile, 1 case of glycine peak (Gly) increased. Conclusion CNC has specific MRI performance, and plays an important role in preoperative diagnosis and differential diagnosis.Combined with ~1H-MRS examination, it can grasp the tumor biochemical index and metabolism from the molecular level and improve the accuracy of preoperative diagnosis. Key words: magnetic resonance imaging; hydrogen proton magnetic resonance spectroscopy; central neurocytoma; differential diagnosis

Correlation between atherogenic index of plasma and renal function change in the elderly patients with hypertension

Objective To observe the abnormality of lipid metabolism and renal function change in elderly patients with hypertension, and to evaluate the relationship between atherogenic index of plasma(AIP) and glomerular filtration rate(GFR). Methods From July 2015 to June 2017, in Quzhou People′s Hospital, 182 elderly patients with hypertension were selected as observation group, and 192 elderly healthy people with normal blood pressure were selected as control group.The total cholesterol(TC), triglyeride(TG), high density lipoprotein cholesterol(HDL-C) were detected, and the AIP=1og[TG/HDL-C]was calculated.The GFR was estimated by Cockcroft-Gault equation.The relationship between the estimated GFR (eGFR) and the blood lipid parameters was analyzed. Results The eGFR of the observation group and control group were (84.94±19.49)mL·min-1·(1.73m2)-1, (154.91±20.44)mL·min-1·(1.73m2)-1, respectively, the difference between the two groups was statistically significant (t=11.27, P<0.01). The AIP of the observation group and control group were (0.68±0.03), (-0.22±0.02), respectively, the difference between the two groups was statistically significant (t=3.43, P<0.01). There was a negative correlation between AIP and eGFR in the elderly patients with hypertension(r=-0.845, P<0.01). Conclusion The fact shows that abnormality of lipid metabolism in the elderly patients with hypertension is present.AIP can be used as a plasma marker of atherosclerosis and could be used as a useful and important parameter for clinical observation in the elderly hypertensive patients with renal impairment. Key words: Hypertension; Atherogenic index of plasma(AIP); Dyslipidemias; Glomerular filtration rate

Prevalence and molecular characteristics of mcr-1 gene in Salmonella typhimurium in a tertiary hospital of Zhejiang Province.

Objectivesmcr-1 gene has been widely reported in the world. This study aimed to analyze the prevalence and molecular characteristics of mcr-1 gene in Salmonella typhimurium from Quzhou People’s Hospital.Materials and methodsA total of 62 S. typhimurium isolates were isolated and preserved in our laboratory from 2007 to 2016. PCR was used to screen plasmid-mediated colistin resistance gene, mcr-1. For mcr-1-positive isolates, susceptibilities to colistin and other antibiotics were assessed using broth microdilution or agar dilution methods. The genetic location of mcr-1 was determined by analysis of pulsed-field gel electrophoresis profiles of S1-digested genomic DNA and subsequent Southern blot hybridization. The multi-locus sequence type and other drug resistance genes found in the mcr-1-positive isolates were analyzed by performing whole genome sequencing. Genetic environment of mcr-1 gene was analyzed by RAST and Easyfig.ResultsA total of three S. typhimurium isolates were identified to be mcr-1 positive, with the prevalence rate of 4.8% (3/62). The minimum inhibitory concentration values of colistin for all these isolates were 8 µg/mL. The three mcr-1-positive isolates carried mcr-1 gene on two different types of plasmids having the sizes of ~54.7–78.2 kb and 310.1 kb, respectively. All the three isolates belonged to ST34 and carried various resistant genes.ConclusionColistin-resistant, mcr-1-positive S. typhimurium isolates belonging to ST34 have been isolated from Quzhou People’s Hospital. Surveillance needs to be strengthened to identify colistin resistance and prevent the spread of drug-resistant bacteria in the hospital.

Efficacy of Lactated Ringer's versus Normal Saline in Treating Patients with Septic Shock

Objective To compare the clinical efficacy of lactated Ringer's (LR) and normal saline (NS) in treating patients with septic shock. Methods The clinical data of 198 patients with septic shock who received fluid resuscitation in the Intensive Care Unit of Quzhou People's Hospital from January 2014 to January 2016 were retrospectively analyzed. These patients were divided into NS group (n=100) and LR group (n=98) according to fluids used. The amounts of trial fluid,other liquids,and blood products and the average total fluid volume were recorded. The oxygenation index (PO2/FiO2),mean artery pressure (MAP),central venous pressure (CVP),and B-type natriuretic peptide (BNP) before and after treatment as well as the early goal-directed therapy (EGDT) 8 h (EGDT8),EGDT 24 h recovery rate,EGDT recovery time,28-day mortality rate were compared. Other secondary outcomes including bleeding,allergic reaction,acute kidney injury (AKI),venous blood filtration (RRT) rate,hyperkalemia,and ICU stay were also recorded. The 28-day survival rate was calculated using the Kaplan-Maier method,and the difference in survival rate was compared by log-rank test. Results The two groups showed no significant difference in gender,age,body weight,source of admission to ICU,procalcitonin level,source of sepsis,Acute Physiology and Chronic Health Evaluation Ⅱ score,number of AKI patients,amount of white blood cells,and C-reactive protein level (all P>0.05). The amount of blood products on the first day [(782±357)ml vs.(606±273)ml;t=2.044,P=0.046] and the average total amount of liquid on the first three days [(5470±1078)ml vs.(5092±929) ml;t=2.640,P=0.009] were significantly higher in NS group than in LR group. The amount of trial fluid and the volumes of other fluids were not significantly different (both P>0.05). The PO2/FiO2,MAP,CVP,and BNP levels significantly increased after treatment in both groups (all P<0.05);however,they were not significantly different between LR group and NS group at different time points before and after treatment (all P>0.05). The incidences of hyperlactacidemia (86.0% vs.71.4%,OR:2.457,95%CI:1.202-5.023,P=0.012) and hyperchloremia (25.0% vs.13.2%,OR:2.179,95%CI:1.041-4.562,P=0.036) were significantly higher in NS group than in LR group. These two groups showed no significant difference in EGDT8,24 h recovery rate,EGDT recovery time,28-day mortality rate,AKI,RRT rate,hyperkalemia,and ICU stay (all P>0.05). Kaplan-Meier survival analysis showed that the 28-day survival rate was not significantly different (χ2 log-rank=0.012,P=0.911). Conclusion When liquid resuscitation is applied in patients with septic shock,the use of LR can lower blood transfusion requirement on the first day and total liquid dosage on the first three days (compared with NR), along with lower incidences of hyperlactacidemia and hyperchloremia,although there was no significant difference in the 28-day mortality rate.

The expression levels of TNF-α and IL-6 in tumor tissues and change of serum ferritin concentration in patients with intracranial aneurysm and its clinical significance

Objective To investigate the expression levels of tumor necrosis factor alpha (TNF-α), interleukin-6(IL-6) and the change of serum ferritin in patients with intracranial aneurysm and its clinical significance. Methods 22 patients with intracranial aneurysm and 16 cases of traumatic brain injury who recevied operation in Department of Neurosurgery in Quzhou People's Hospital from Jan.2014 to Jan.2015 were enrolled as observation group and control group.The intracranial aneurysm tissues and normal cerebral vascular tissues were collected respectively to detect the situation of inflammatory cell infiltration, and the expression of TNF-α and IL-6 was detected by HE staining and immunohistochemical staining.The serum was collected on hospitalized, postoperative 3 days and postoperative 7 days to detect serum ferritin. Results The positive cells were observed in the observation group after immunohistochemical staining, in which the expression levels of TNF-α[(0.194±0.074) vs.(0.135±0.047), t=2.799]and IL-6[(0.152±0.057) vs.(0.103±0.028), t=3.494]were significantly higher than those in the control group(P=0.008, 0.001). The serum ferritin level in the observation group was significantly higher than that in the control group at postoperative 3d[(232.25±105.26)ng/mL vs.(169.51±66.24)ng/mL, t=2.097]and postoperative 7d[(263.39±114.73)ng/mL vs.(166.57±73.71)ng/mL, t=2.955](P=0.043, 0.005). The difference of serum ferritin on different day in the observation group also was statistically significant(F=8.625, P=0.003). Conclusion The expression levels of TNF-α and IL-6 in intracranial aneurysms were high, which may be one of the important factors in the formation of intracranial aneurysms, and it provides an important reference of early prevention and drug treatment for patients with intracranial aneurysm.The serum ferritin is related to the rupture and hemorrhage of intracranial aneurysm, which can be used to judge prognosis and guide rational treatment, and worth further study to confirm. Key words: Intracranial aneurysm; Tumor necrosis factor-α; Interleukin-6; Serum ferritin

Combination of MGIT liquid culture and Xpert MTB/RIF test in the rapid diagnosis and drug resistance detection in Mycobacterium tuberculosis

Objective To evaluate the feasibility of Mycobacteria growth indicator tube (MGIT) liquid culture combined with rifampin resistance test real-time PCR (Xpert MTB/RIF test) in the diagnosis of tuberculosis. Methods 652 cases of suspected pulmonary tuberculosis from October 2014 to March 2015 in Quzhou People's Hospital were enrolled. The morning sputum samples were collected for acid-fast staining, Lowenstein-Jensen (L-J) culture, BACTEC MGIT culture and Xpert MTB/RIF test. Samples with positive results of MGIT liquid culture were subjected to strain identification and drug sensitivity test with fluid method.Methodological comparison between four methods was made and the performance of MGIT liquid culture combined with Xpert MTB/RIF test in the rapid diagnosis and drug resistance detection in Mycobacterium tuberculosis was evaluated by chi-square test. Results Among the samples from 399 confirmed tuberculosis patients, the diagnostic sensitivity of the 4 methods (acid-fast staining, L-J culture, MGIT culture and Xpert MTB/RIF test) were 17.0% (68/399), 23.8% (95/399), 37.8% (151/399) and 37.3% (149/399) respectively. The sensitivity and specificity of MGIT culture combined with Xpert MTB/RIF test was 39.8% (159/399) and 94.8% (240/253). The sensitivity of MGIT culture combined with Xpert MTB/RIF test was significantly higher than acid-fast staining (χ2=50.9, P<0.01) and L-J culture (χ2=23.7, P<0.01). The average detection time of MGIT culture was 7.5 days (smear positive and Xpert MTB/RIF positive), 13.4 days (smear negative and Xpert MTB/RIF positive) and 16.9 days (smear negative and Xpert MTB/RIF negative). The sensitivity and specificity of Xpert MTB/RIF test in rifampin resistance detection were 9/9 and 97.3% (129/132) respectively. The average detection time of fluid method for drug sensitivity test was 8.3 days. Conclusions MGIT liquid culture combined with Xpert MTB/RIF test can detect Mycobacterium tuberculosis and the drug sensitivity rapidly. The method is highly sensitive and specific. It is important for clinical diagnosis and treatment of tuberculosis.(Chin J Lab Med, 2016, 39: 272-276) Key words: Mycobacterium tuberculosis; Rifampin; Tuberculosis, multidrug-resistant; Polymerase chain reaction; Microbial sensitivity tests

Efficacy of endoscopic transcaruncular approach to reconstruct isolated medial orbital fracture

To study the efficacy of endoscopic transcaruncular approach in the repair of isolated medial orbital fracture. It was a retrospective case series study.Retrospective chart was reviewed in 21 patients (21 eyes) receiving endoscopic transcaruncular approach to reconstruct isolated medial orbital fracture at Quzhou People's Hospital from May 2011 to May 2012. of visual acuity, diplopia, protrusion degree of both eyes and the movement of eye balls was recorded for analysis. All patients were followed up for 8-20 months. There was no extrusion, rejection, infection or other complications of Medpor surgical implant during follow-up. There was no instance of decreased visual acuity at post-operation. The post-operative protrusion degree of both eyes was almost identical at less than 2 mm. The movement of eye balls was satisfactory in all directions. Diplopia disappeared in 13 cases, 1 case improved. Endoscopic transcaruncular approach is a safe and effective treatment in the repair of isolated medial orbital fracture.