ObjectiveTo evaluate the diagnostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) level in bronchoalveolar lavage fluid (BALF) for discrimination of Acinetobacter baumannii (A. baumannii) colonization from infection.MethodsSixty patients with tracheal intubation or tracheotomy who were admitted in intensive care unit from July 2016 to July 2018, were divided into an infection group (n=20), a colonization group (n=20) and a control group (n=20). The serum and BALF samples were collected from the patients on the day when lower respiratory tract sample culture was positive so as to detect sTREM-1, serum procalcitonin (PCT) and interleukin-6 (IL-6). The value of serum PCT, IL-6, sTREM-1 and BALF sTREM-1 in differentiation of infection or colonization for A. baumannii was analyzed by mean of receiver operating characteristic (ROC) curve.ResultsThere were no significant differences in gender composition, age or Glasgow coma score among the three groups (P>0.05). The clinical pulmonary infection score (CPIS) of the infection group was higher than that in the control group (P<0.05). Compared with the control group, while the sTREM-1 concentration of BALF with A. baumannii colonization increased significantly but levels of PCT, IL-6 and sTREM-1 remained unchanged in serum. The levels of PCT, IL-6 and sTREM-1 in serum, and sTREM-1 in BALF increased significantly in the infection group (P<0.001). Compared with the colonization group, the levels of PCT, IL-6 and sTREM-1 in serum, and sTREM-1 in BALF increased significantly in the infection group (P<0.05). The area under the ROC curve (AUC) of serum PCT was 0.67 with the sensitivity of 0.55 and the specificity of 0.90 (95%CI 0.52 - 0.82). AUC of serum IL-6 was 0.72 with the sensitivity of 0.60 and the specificity of 0.95 (95%CI 0.58 - 0.85). AUC of serum sTREM-1 was 0.72 with the sensitivity of 0.75 and the specificity of 0.60 (95%CI 0.55 - 0.85). AUC of sTREM-1 in BALF was 0.92 with the sensitivity of 0.95 and the specificity of 0.70 (95%CI 0.79 - 0.98). The diagnostic accuracy of sTREM-1 in BALF was higher than that of PCT, IL-6 and sTREM-1 in serum (P<0.05).ConclusionssTREM-1 in BALF has good diagnostic performance in differentiating patients with infection of colonization for A. baumannii. Its sensitivity and specificity are higher than serum PCT, IL-6 and sTREM-1.
ObjectiveTo understand the prevalence of anorectal diseases in the elderly in the community, and to evaluate the role of electronic rectosigmoidoscope in the screening of anorectal diseases.MethodThe resident population aged 60–74 in the Xichang’an Street Area of Xicheng District of Beijing were collected to complete the initial screening by filling in the risk factor assessment questionnaire, and who were classified as the high-risk with positive initial screening were admitted to the diagnostic re-screening by electronic rectosigmoidoscope.ResultsThere were 4 782 screening subjects, while 4 347 people actually participated in the initial screening, and 2 997 people were positive (positive rate was 68.9%). Among them, 2 312 participated in the electronic rectosigmoidoscope screening, and the compliance rate was 77.1%. A total of 2 275 patients with various anorectal diseases were detected by electronic rectosigmoidoscope, 1 311 (56.7%) of whom were hemorrhoids, 458 (19.8%) were rectal polyps, 154 (6.7%) were anal papillary hypertrophy, 147 (6.4%) were proctitis, 103 (4.4%) were anal fissure, 52 (2.2%) were anal fistula , 33 (1.4%) were rectal melanoma , and 17 (0.7%) were suspected rectal cancer. The detection rates of rectal polyps, proctitis, and anal fistula in the men were higher than those in the women (P<0.05), while the detection rates of hemorrhoids, anal papilla hypertrophy, anal fissure, and rectal melanosis in the women were higher than those in the men (P<0.05).ConclusionsAs a screening tool, electronic rectosigmoidoscope has the characteristics of simple operation, good compliance of the subject, and high compliance rate for re-screening. It is suitable for large-scale screening of anorectal diseases for elderly residents in the community.
Human chromosomes karyotyping is an important means to diagnose genetic diseases. Chromosome image type recognition is a key step in the karyotyping process. Accurate and efficient identification is of great significance for automatic chromosome karyotyping. In this paper, we propose a model named segmentally recalibrated dense convolutional network (SR-DenseNet). In each stage of the model, the dense connected network layers is used to extract the features of different abstract levels of chromosomes automatically, and then the concatenation of all the layers which extract different local features is recalibrated with squeeze-and-excitation (SE) block. SE blocks explicitly construct learnable structures for importance of the features. Then a model fusion method is proposed and an expert group of chromosome recognition models is constructed. On the public available Copenhagen chromosome recognition dataset (G-bands) the proposed model achieves error rate of only 1.60%, and with model fusion the error further drops to 0.99%. On the Padova chromosome dataset (Q-bands) the model gets the corresponding error rate of 6.67%, and with model fusion the error further drops to 5.98%. The experimental results show that the method proposed in this paper is effective and has the potential to realize the automation of chromosome type recognition.
ObjectiveTo explore the relationship between myocardial viability in patients with coronary artery disease who underwent elective coronary artery bypass grafting (CABG) and early application of intra-aortic balloon pump (IABP) after coronary revascularization, and to provide relevant clinical reference for the pre-implantation of 16G single-lumen catheter in the femoral artery of high-risk patients to facilitate the addition of IABP after operation.MethodsThis retrospective study included 521 patients (414 males and 107 females, aged 62.50±8.82 years) who underwent positron emission tomography (PET)-computed tomography (CT) perfusion-metabolism imaging prior to CABG surgery in our institution from December 2015 to August 2020. The myocardial viability information and left ventricular functional parameters were measured, including the proportion of non-viable myocardium (perfusion-metabolic imaging match), hibernating myocardium (perfusion-metabolic imaging mismatch) and dysfunctional myocardium (non-viable+viable myocardium), left ventricular ejection fraction, left ventricular end-diastolic volume and left ventricular end-systolic volume (LVESV). The patients were divided into an IABP group and a non-IABP group according to whether they received IABP treatment after revascularization. The clinical data were reviewed and compared to explore significant impact factors between the two groups. And the multivariate logistic regression analysis was performed to investigate the correlation between preoperative myocardial viability and early use of IABP after CABG.ResultsIn multivariate logistic regression analysis, the amount of non-viable, dysfunctional myocardium and LVESV value were identified as the independent predictors for the probability of IABP use in the initial postoperative period. Receiver operating characteristic analysis showed that 9.5% non-viable myocardium, 19.5% dysfunctional myocardium, and LVESV of 114.5 mL were the optimal cutoff for predicting early IABP implantation during CABG.ConclusionThe myocardial survival status displayed by preoperative PET-CT myocardial perfusion-metabolism imaging can predict the possibility of applying IABP in CABG perioperative period. In addition to routine pre-anesthesia assessment, anesthesiologists can conduct risk stratification assessment for patients with CABG according to the results of preoperative myocardial viability imaging, which is of great significance to ensure the perioperative safety of high-risk patients with CABG.
ObjectiveTo explore the predictive value of myocardial vitality in the improvement of cardiac function after coronary artery bypass grafting (CABG) in patients with ischemic heart failure.MethodsFrom December 8, 2015 to November 12, 2018, 46 patients with ischemic heart failure who underwent CABG operation alone were collected retrospectively. There were 41 males and 5 females with an average age of 60.4±8.0 years. The myocardial vitality and number of different types of myocardium were measured. The clinical data of patients in the left ventricular ejection fraction (LVEF) improvement group (≥5%) and non-improvement group (<5%) were compared and analyzed. The correlation between each index and LVEF improvement was analyzed by logistic multivariate regression analysis, and the boundary value of hibernating myocardium between LVEF improvement and non-improvement was obtained by receiver operating characteristic (ROC) curve.ResultsThere were significant differences in the number of hibernating myocardium (15.0%±12.3% vs. 4.3%±4.5%, P=0.000), the number of normal myocardium (74.7%±13.7% vs. 82.4%±8.6%, P=0.027), and cardiac function classification (NYHA) development (−0.7±0.7 vs. −0.3±0.5, P=0.047) between the two groups, but there was no significant difference in other indexes between the two groups (P>0.05). Logistic regression analysis showed that the number of hibernating myocardium was an independent factor affecting the improvement of LVEF after CABG in patients with ischemic heart failure (OR=1.366, 95%CI 1.033-1.807, P=0.029). The ROC curve showed that the threshold value, sensitivity and specificity of hibernating myocardium were 15.0%, 43.8% and 100.0%, respectively.ConclusionThe percentage of hibernating myocardium to left ventricular wall area ≥15.0% can accurately predict the improvement of LVEF in patients with ischemic heart failure after CABG. Preoperative myocardial vitality assessment has important diagnostic value in predicting the improvement of cardiac function in patients with ischemic heart failure after simple CABG.