After a brief description of standards for HL7 and its application in foreign countries and China, the lo-calization and implementation principles of HL7-based application of integrated medical information system, and its advantages and disadvantages were analyzed with its development trend in China pointed out.

The effects of minimally invasive surgery on the blood-brain barrier (BBB) of 30 patients with cerebral hemorrhage were investigated. Difference of the BBB index and serum MBP concentration were assessed in 15 cases of conservative treatment group and 15 cases of minimally invasive surgery group. The BBB index in minimally invasive surgery group was significantly lower than in conservative treatment group (P<0.05), and the BBB index in the two treatment groups was significantly higher than in control group (P<0.01). Serum MBP concentration in minimally invasive surgery group was significantly lower than in conservative treatment group (P<0.05), and that in the two treatment groups was significantly higher than in control group (P<0.01). It was suggested the permeability of BBB in patients with cerebral hemorrhage was increased, and BBB index and serum MBP concentration in patients with cerebral hemorrhage were increased. Minimally invasive surgery can reduce the lesion of cytotoxicity to BBB and cerebral edema.

Objective To investigate the molecular epidemiology and mechanism of carbapenem resistance of Escherichia coli collected from intensive care units(ICUs)of general surgery.Methods Agardilution were carried out to confirmed the drug-susceptibility,pulsed-field gel electrophoresis(PFGE)were performed to analyze the molecular epidcmiology of carbapenem-resistance isolates.Specific PCR,DNA sequencing,conjugation experiments,plasmids extraction,plasmid transformation assays and SDS-PAGE of outer membrane proteins(OMPs)were carried to confirm genotype of carbapenemase and its transmission mechanism.Results PFGE showed the isolates belonged to 10 clonotype,and all the clinical isolates were resistant to β-lactams including imipenem and meropenem,but uncertain to aminoglycosides,specific PCR and DNA sequencing revealed that all isolates encoded carbapenem-hydrolyzing enzyme gene,KPC-2.Plasmid DNA extraction and plasmid transformation assays from some isolates comfirmed that KPC-2 encoded on a 56 kb plasmid.SDS-PAGE analysis confirmed that there are alterations in OMPs of Escherichia coli.Conclusion Escherichia coli isolates with carbapenem resistance are collected from our hospital,production of KPC-2 carbapenemase mainly contributed to reduced susceptibility of carbapenem in Escherichia coli,the alterations in OMPs may as a cofactor in high-level drug-resistance in Escherichia coli.

Objective: To explore the diagnostic effects of detection algorithm based on deep learning (DL) on pulmonary nodules with different sizes. Methods: CT images of 344 patients with pulmonary nodules were retrospectively analyzed. The detection rates of the model based on DL for pulmonary nodules with different sizes (relative to the physician's diagnosis) were calculated and compared, and the false positive nodules detected by the model were analyzed. Results: On 344 CT images, physicians diagnosed 710 pulmonary nodules of 0-30 mm. A total of 2 495 candidate pulmonary nodules were detected by the model, among which 675 were true positive relative to the physician's diagnosis. The detection rate of nodules of the model was 95.07% (675/710), of 0-4 mm was 82.80% (77/93), of 0-5 mm was 90.15% (238/264), of 0-6 mm was 92.94% (395/425), of 5-10 mm was 97.94% (381/389), of 10-20 mm was 98.21% (55/56), and of 20-30 mm was 100% (1/1). There was no statistically significant difference of detection rate for pulmonary nodules with different sizes of the model(χ2=21.72, P>0.05). Among the false positive nodules detected by the model, 50.38% (917/1 820) were missed by physicians, and 32.53% (592/1 820) were vascular sections. Conclusion: The overall detection rate of pulmonary nodules of DL model is high (95.07%), which is not affected by the size of nodules.

Objective We established the animal models of obesity induced by high-fat diet, in order to study the mRNA and protein expression of regulation molecules related with iron metabolism about hepcidin, lipocalin-2 ( LCN2 ) , ferroportin-1 (FPN1) in obese mice’ s liver and the molecular regulation mechanism.Methods C57BL/6J (4 ~6 weeks) mice were randomly divided into control group and obesity model group, each group of ten.The obesity group were fed with a high-fat diet and the control group were given the normal diet for lasting 15 weeks.After we successfully established the obesity animal model, the expression level of hepcidin, LCN2 and FPN1 mRNA in the liver were measured by Real-time fluorescent quantitative PCR method and the protein expression level of LCN2 and FPN1 were measured by Western-Blot.Results Compared with the control group, the expression level of hepcidin mRNA in the liver was increased in obesity group (P <0.05), however, the expression level of LCN2, FPN1 was no significant difference (P >0.05).Conclusion Obesity can increase the expression of hepcidin mRNA, however, there was no significantly effect on the expression of LCN2, FPN1.So, we can’t think that obesity can affect the expression of LCN2 and FPN1, lead to the ability of cells uptake and release iron abnormal, then appear iron metabolism disorders.As a result, leading to iron deficiency.Maybe obesity can affect other regulatory molecules related with iron metabolism through up-regulation the expression of Hepcidin or the more complex regulatory mechanisms.We still need further experimental research and exploration.This research also provides the basis of theoretical and experimental for the further study the effects of obesity on the expression of regulation molecules related with iron metabolism in obesity mice’ s liver and the mechanism of iron deficiency.

Humans ; Gastrointestinal Microbiome ; Diabetes Mellitus, Type 2/complications* ; Cholelithiasis

Sjögren's syndrome(SS)is a chronic autoimmune disease that affects exocrine glands, especially salivary and lacrimal glands. The main clinical manifestations are dry mouth and dry eyes, but also multi-organ and multi-system can be involved. Cold agglutinin disease(CAD)is an autoimmune disease characterized by red blood cell agglutination in the blood vessels of extremities caused by cold agglutinin at low temperature, resulting in skin microcirculation disturbance, or hemolytic anemia. Cold agglutinin disease is divided into two categories, primary cold agglutinin disease and secondary cold agglutinin disease. Primary cold agglutinin disease is characterized with cold agglutinin titer of 1 ∶4 000 or more and positive Coomb's test. However, the Coomb's test is not necessarily positive and the cold agglutinin titer is between 1 ∶32 and 1 ∶4 000 in secondary cold agglutinin disease. Here, we reported an elderly patient admitted to hospital due to fever. He was diagnosed with respiratory infection, but he showed incompletely response to the anti-infection treatment. Further laboratory tests showed the patient with positive ANA and anti-SSA antibodies. Additionally, the patient complained that he had dry mouth and dry eyes for 1 year. Schirmer test and salivate gland imaging finally confirmed the diagnosis Sjogren's syndrome. During the hospital stay, the blood clots were found in the anticoagulant tubes. Hemolytic anemia was considered as the patient had anemia with elevated reticulocytes and indirect bilirubin. In addition, further examination showed positive cold agglutination test with a titer of 1 ∶1 024, and cold agglutinin disease was an important type of cold-resistant autoimmune hemolytic anemia. Furthermore, the patient developed cyanosis after ice incubating at the tip of the nose. Hence, the patient was diagnosed as CAD and he was successfully treated with glucocorticoids instead of anti-infection treatments. Hence, the patient was diagnosed with SS combined with secondary CAD. SS combined CAD are rarely reported, and they are both autoimmune diseases. The abnormal function of B lymphocytes and the production of autoantibodies might be the common pathogenesis of them. Cold agglutinin disease can lead to severe hemolytic anemia, even life-threatening. In clinical practice, timely recognizing and dealing with CAD might promote the prognosis of the patient.
Male ; Humans ; Aged ; Anemia, Hemolytic, Autoimmune/diagnosis* ; Sjogren's Syndrome/diagnosis* ; Anemia, Hemolytic/complications* ; Dry Eye Syndromes/complications* ; Autoantibodies

Aged ; Colonic Neoplasms ; diagnosis ; Humans ; Male ; Paraneoplastic Syndromes ; diagnosis ; Pemphigus ; diagnosis

Objective:To investigate the value of ultrasound in the diagnosis of hourglass-like fascicular constrictions of the anterior interosseous nerve.Methods:From July 2010 to July 2020, 12 patients with hourglass-like fascicular constrictions of the anterior interosseous nerve diagnosed in Shandong Medical Imaging Research Institute Affiliated to Shandong University were retrospectively analyzed. The characteristics of the high-frequency ultrasonographic images were summarized and compared with clinical surgery.Results:The hourglass-like fascicular constrictions of the anterior interosseous nerve were all located in the median nerve of the distal upper arm in 12 patients, including 9 cases of single hourglass change and 3 cases of multiple hourglass like changes. High-frequency ultrasound can accurately locate the location of the hourglass-like fascicular constrictions of the anterior interosseous nerve and the extent of neuropathy. The sonogram of hourglass-like fascicular constrictions of the anterior interosseous nerve showed single or multiple hourglass-like changes in the median nerve of the distal upper arm. The nerve fasciculars on both sides of hourglass-like changes were thickened. There was significant difference between the diameter of the affected fascicular and the corresponding position of the contralateral fascicular[(0.20±0.04)cm vs (0.11±0.03)cm, P<0.01]. There was significant difference between the cross-sectional area of the median nerve at the widest part of the lesion side and the corresponding position of the contralateral side[(0.14±0.03)cm 2 vs (0.09±0.03)cm 2, P<0.01]. Conclusions:High-frequency ultrasound is the preferred image method for the diagnosis of hourglass-like fascicular constrictions of the anterior interosseous nerve.

Given the current ethical issues such as unknown high risks in the clinical application of new biomedical technology， thus， medical institutions need to establish new technology management systems， including clarifying the concept， the assessment and admission mechanism， and ethical management systems of new technology. According to the direction of the development of new technology in the medical institution， the ethics review committee should also perfect the management system of ethics committees and the professional composition of ethics review committee members， improve the ability of ethics committee members to evaluate new biomedical technology， increase the assessment of ethical risks of new technology in the preliminary review stage， strengthen the requirements for emergency plan formulation， as well as set the frequency of the follow-up review based on the risk level of new technology. The ethics review committee should work together with the medical management department to formulate an ethical standardization training system for the clinical application of medical technology in the institution， and regularly conduct training for all staff， to promote medical workers’ understanding of the management requirements of biomedical technologies. Different types of new biomedical technology have different ethical risks. Therefore， the medical management departments and ethics review committees of medical institutions should formulate specific management rules based on the characteristics of new technology types. However， it should be noted that when new biomedical technology generally is first introduced into clinical practice， there are often issues regarding fairness and justice in the use of the technology.