Antibiotics being currently the most extensively used medicine in clinical practice and abuse of them being prevalent, it is thus necessary to monitor in an effective and systematic manner the rational use of them. Based on the existing database and network of hospital information system, a monitoring system for the rational use of antibiotics was successfully developed using the development tool of PowerBuild. This functionally powerful and easy-to-use system, which provides comprehensive and reliable information, improved work efficiency and managerial level by automatically monitoring many chief indicators of antibiotic usage, including dosage, resistance, combination with other drugs, course, pathway, usage during the perioperative period, usage for preventive purposes, therapeutic effect, and the ratio of hospital infection occurrence resulting from the use of antibiotics under different circumstances.

Objective To analyze MRI features of real tears and pseudotears of posterior horn of the lateral meniscus (PHLM) at the insertion site of meniscofemoral ligament(MFL), and to discuss main points of differential diagnosis. Methods MR images of 32 patients with PHLM tears and 30 patients with anterior cruciate ligament tears but without PHLM tears confirmed by arthroscopy were analyzed retrospectively. Another 20 asymptomatic volunteers as controls underwent MR examination and analyzed. The number of consecutive slices displaying longitudinal increased signal in sagittal images and the length in axial images were evaluated. The one?way analysis of variance, χ2 test and ROC curve were used to analyze diagnostic value of different MRI findings. Results Longitudinal line with abnormal increased signal (pseudotear) was found in 82.0% (41/50) normal insertion site of MFLs. The typical MRI finding of real tears was peripheral longitudinal linear high signal in PHLM which reached the margin of articular surface. In sagittal images, longitudinal linear high signal was shown in (5.8 ± 1.2) slices in knees of real tears, which was more than (2.6±1.1) slices and (2.7±1.4) slices in pseudo?tear groups (F=60.9, P<0.01). The area under ROC curve was 0.96 for differentiating real tear from pseudo-tear using the number of consecutive slices displaying longitudinal increased signal in sagittal images. With a threshold of five or more consecutive images with abnormal longitudinal increased signal as the positive standard of continuous?line sign, the overall sensitivity, specificity and accuracy for diagnosing real tear were 90.6%(29/32), 90.2%(37/41) and 90.4%(66/73), respectively. The axial images showed that the length of increased signal line in the outer of PHLM was (16.4±4.9) mm in patients with real tears, which was longer than pseudo?tear groups with length of (8.1 ± 3.2) mm and (6.0 ± 3.1) mm (F=17.0, P<0.01). The area under ROC curve was 0.92 for differentiating real tear from pseudo?tear using the length in axial images. The zip sign was defined when its length was not less than 10 mm. The sensitivity, specificity and accuracy of the zip sign was 84.4%(27/32), 90.2%(37/41) and 87.7%(64/73) respectively. In coronal images, high signal of MFL attachment insertion was shown in 71.9%(23/32), 60.0%(15/25) and 10/16 cases, there was no significant difference (χ2=0.98, P=0.61). Conclusion The continuous?line sign and zip sign are characteristic findings of PHLM tears at the insertion site of MFL attachment, which are valuable for differential diagnosis with pseudotears at the insertion site of MFL.

Objective To investigate clinical effect of in vitro maturation(IVM)of immature oocytes transferred from conventional in vitro fertilization embryo transfer(IVF-ET) cycles.Methods From January 2008 to June 2009.medical documents of 155 infertile patients underwent IVF-ET in the Reproductive Medical Center of Fimt Affiliated Hospital of Wenzhou Medical College were analyzed retrospectively.If more than 20 oocytes were monitored after 5-7 days of ovulation induction or follicular developmental retardation were confirmed after 8-13 days of ovulation induction.according to patients' wish,IVM were transferred in 60 cycles(group A).In the mean time.IVF was continued in 95 cycles (group B).The mean dosage of gonadotropin,the cancel lation rate of cycles,the mean numbers of oocytes retrieved and maturation,the rate of fertilization and excellent quality embryos.pregnancy outcome and the incidence rate of ovarian hyperstimulation syndrome(OHSS)were compared and analyzed.Results The rates of embryo transfer were 92%(55/60)in group A and 63%(60/95)in group B,which showed significant differences (P<0.05).In group A,the mean dosage of the gonadotropin,the mean number of oocytes retrieved,the cleavage rate and OHSS rate were(1030±468)U,10±6,82.2%(231/281)and O,and were(1544±338)U,14±4,94.0%(502/534)and 35%(21/60)in group B,respectively,all data abeve exhibited statistieal difference between two groups(P<0.05).However,the rates of fertilization and excellent quality embryos had no significant differences between two groups(P>0.05).In group A,the rate of clinical pregnancy per transfer was 53%(29/55)and multiple pregnancy was 14%(4/29),and were 47%(28/60) and 32%(9/28)in group B,they all had no significant differences (P>0.05).Conclusion IVM of immature oocytes used in conventional IVF cycles not only obtained a high clinical pregnancy rate,but also reduced gonadotropin using dosage and avoided OHSS completely.

Objective To analysis the incidence and management of monozygotic twin (MZT) conceived by assisted reproductive techniques (ART). Methods A retrospective analysis of clinical pregnancies and MZT that resulted from ART was performed in Reproductive Medical Center,the First Affiliated Hospital,Wenzhou Medical University between January 2011 and January 2014. Results A total of 5 908 pregnancies were diagnosed: 2 012 twins, 157 high-order multiple pregnancy (HOMP), including 4 quadruplets. Overall, 51 MZT pregnancies were identified of them including 32 cases HOMP and 19 cases MZT. The incidence of MZT resulting from cleavage-stage embryo transfer was similar to blastocyst transfer (P=0.960). The percent of MZT resulting from in vitro fertilization [0.93% (28/3 022)], frozen-thawed embryo transfer [0.87% (13/1 502)] and intracytoplamic sperm injection [0.72% (10/1 384)] did not show statistical significance (P=0.794). The expectantly managed MZT was associated with a significantly greater likelihood of miscarriage [6/19 vs 5.11% (101/1 976)], and low birth weight infant [73.91% (17/23) vs 42.89% (1 453/3 388), P<0.01], when compared with dizygotic twin (DZT) did not undergo selective embryo reduction(SER). In monozygotic (MZ)-triplets with SER to 2 fetuses or to 1 fetus, there was no cases of preterm birth or low birth weight infant observed in MZ-triplets with SER to 1 fetus;when compared with MZ-triplets with SER to 2 fetuses, the low birth weight infant [56.00% (14/25), P=0.021] has statistical significance. The likelihood of the survival of two babies was lower in MZ-triplets with SER to 2 fetuses when compared with non-MZ triplets with SER to 2 fetuses [42.86%(9/21)vs 75.21%(91/121), P=0.003]. Conclusions The incidence of MZT pregnancies following ART is high. It plays a significant role in the occurrence of HOMP. MZT pregnancies are at an increased risk of adverse outcomes , it should transform to a single embryo thansfer (SET) program to reduce them incideuce. Reduction of MZT contained in multiple pregnancies appears to be a safe option.

Objective To compare the laboratory and clinical results between unstimulated in vitro maturation (IVM) and IVM converted from in vitro fertilization (IVF) in polycystic ovarian syndrome (PCOS) and non-PCOS patients.Methods We divided 591 IVM cycles in the First Affiliated Hospital of Wenzhou Medical Univesity from Jan.2008 to Dec.2013 into 4 groups:group A1B1,PCOS patients underwent unstimulated IVM protocol,240 cycles; group A1B2,PCOS patients underwent IVM converted from conventional stimulated IVF protocol,153 cycles; group A2B1,non-PCOS patients underwent unstimutlated IVM protocol,103 cycles; group A2B2,non-PCOS patient underwent IVM converted from conventional stimulated IVF protocol,95 cycles.Multiple linear regression method and binary logistic regression method were used to assess the influence of PCOS and protocols for IVM on laboratory and clinical outcomes.Results The mean number of oocytes retrieved was positively related with PCOS [partial regression coefficient (B)=3.37,P＜0.01].The maturation rate of oocytes was positively related with hCG-prime prior to oocyte aspiration (B=0.05,P=0.010).High-quality embryo rate was positively related with PCOS and IVM converted from IVF (B=0.08,P=0.010; B=0.09,P=0.001),as well as implantation rate related with them (B=0.07,P=0.010; B=0.10,P＜0.01).PCOS and IVM converted from IVF improved hCG positive (hCG＞10 U/L) rate (OR=1.636,95％CI:1.113-2.204,P＜0.05; OR=1.861,95％CI:1.307-2.649,P＜0.05) and the clinical pregnancy rate (OR=1.507,95％CI:1.041-2.240,P＜0.05; OR=1.881,95％CI:1.312-2.696,P＜0.05).IVM converted from IVF protocol decreased the spontaneous abortion rate (OR=0.490,95％CI:0.245-0.978,P＜0.05).Multiple gestation rate and ectopic pregnancy rate were not affected by PCOS condition and protocol used (P＞0.05).Conclusions PCOS and IVM converted from IVF protocol improved the high-quality embryo rate,implantation rate,hCG positive rate and clinical pregnancy rate.IVM converted from IVF protocol reduced the spontaneous abortion rate.PCOS patients may be more suitable for the IVM treatment.No matter PCOS or non-PCOS patients,IVM converted from IVF protocol had better pregnancy outcome than that of unstimulated cycle.

On the basis of the existing appointment process, artificial intelligence and Internet of things technologies were introduced to optimize such process. Thanks to the all appointment process management empowered by AI and IoT, patient waiting time is cut short and patient satisfaction enhanced as a result.

Objective:To evaluate the association of hyperuricemia with the risk for chronic kidney disease (CKD) in community adults.Methods:A community-based follow-up study comprising of 7 276 adults aged 20-74 years who attended the natural population cohort in Eastern China and had no CKD at baseline survey was performed in the Songjiang district, Shanghai. CKD was diagnosed according to the National Kidney Foundation Practice Guidelines for Chronic Kidney Disease criteria. Hyperuricemia was defined as serum uric acid level >420 μmol/L for men and >360 μmol/L for women. Cox proportional hazards model was used to examine the association of hyperuricemia with the risk for CKD.Results:During a median follow-up period of 2.65 year, 301 participants were newly diagnosed with CKD. The cumulative incidence rate and incidence density of CKD were 4.14%, and 16.01/1 000 person-years (95% CI: 14.20-17.82), respectively. A higher prevalence of hyperuricemia was observed in subjects with CKD compared with those without CKD. Multivariate Cox regression model analysis showed that hyperuricemia was associated with the increased risk for CKD, with an adjusted HR of 1.92 (95% CI: 1.46-2.53). Their positive associations remained in almost all the subgroups, including sex, age (<60, ≥60 years), BMI (<25.0, ≥25.0 kg/m 2), type 2 diabetes, and hypertension. A significant synergistic effect of the interaction between age and hyperuricemia on CKD was found, and the synergy index was 1.78 (95% CI: 1.18-2.68). Conclusion:The incidence of CKD in adults in Songjiang district was relatively high. Hyperuricemia is an independent risk factor for the development of CKD.

Urbanization has increased the population density and exposure to environmental risk factors, accelerated changes of people's lifestyles and aggravated population health disparities. A general population cohort in eastern China, Shanghai Suburban Adult Cohort and Biobank (SSACB), was established to understand the incidence and prevalence of chronic and non-communicable diseases, and identify environmental, lifestyle, and genetic risk factors in adults (aged 20-74 years old) living in the suburban of Shanghai, where urbanization process is rapid, and provide evidence for the precise prevention and control of chronic diseases. The cohort study was launched by School of Public Health,Fudan University depended on "Discipline Construction Project Shanghai Peak for Public Health and Preventive Medicine". Four districts in Shanghai, i.e. Songjiang, Jiading, Minhang and Xuhui, were selected. A total of 69 116 permanent residents aged 20-74 years were recruited. Epidemiological investigation, physical examination and laboratory tests were conducted to collect the basic information of the study subjects. Blood and urine samples were collected from them to establish a biobank. An information platform was established, from which the baseline data of the study subjects in electronic medical record system, chronic disease management system, cancer registry, infectious disease reporting system, and death registry can be shared. This paper introduces the design concept, process and future plan of SSACB.

Objective:To explore the incidence of chronic obstructive pulmonary disease (COPD) in a cohort aged 40 years and above in Songjiang District, Shanghai, and to analyze the association of Mediterranean diet pattern and dietary approaches in stopping hypertension pattern (DASH) with the risk of developing COPD.Methods:Based on a natural population cohort in Songjiang District, Shanghai, 27 474 adults aged 40 years and above who did not have COPD at baseline were enrolled in the study. The Cox proportional risk regression model was used to analyze the association of baseline Mediterranean diet pattern score and DASH score with the risk of COPD, and the hazard ratio ( HR) of the risk and its 95% CI were calculated. Restricted cubic spline was used to analyze the nonlinear association between the two diet scores and the risk of COPD. Stratified analyses were performed according to gender, age, smoking status, etcetera. Sensitivity analyses were conducted by censoring cases diagnosed within one year after the baseline survey or people with a history of malignant tumor disease. Results:As of June 30, 2023, after a median follow-up time of 6.21 years, there were 1 089 (4.0%) new COPD cases with an incidence density of 64.00 per 10 000 person-years. After adjusting for relevant confounders, in the Mediterranean tertile subgroups under diet pattern score, the risk of developing COPD could be reduced by approximately 14% in the intermediate scoring group ( HR=0.86, 95% CI: 0.75-0.99) and 15% in the highest scoring group ( HR=0.85, 95% CI: 0.72-0.99) compared to the lowest scoring group. The association remained after censoring cases diagnosed within one year of the baseline survey ( HR=0.82, 95% CI: 0.70-0.95; HR=0.82, 95% CI: 0.68-0.97) or censoring people with a history of malignant tumor disease ( HR=0.84, 95% CI: 0.73-0.97; HR=0.84, 95% CI: 0.71-0.99). No statistical association was found between the DASH score and the risk of COPD. Conclusions:The Mediterranean diet pattern was associated with a lower risk of COPD. Increasing the intake of vegetables, fruits, legumes, and whole grains and decreasing the intake of red meat and others can reduce the risk of COPD. No association was found between the DASH dietary pattern and the risk of COPD in this community population.

OBJECTIVE: In order to solve the technical problems, clinical researchers face the process of medical imaging analysis such as data labeling, feature extraction and algorithm selection, a medical imaging oriented multi-disease research platform based on radiomics and machine learning technology was designed and constructed. METHODS: Five aspects including data acquisition, data management, data analysis, modeling and data management were considered. This platform provides comprehensive functions such as data retrieve and data annotation, image feature extraction and dimension reduction, machine learning model running, results validation, visual analysis and automatic generation of analysis reports, thus an integrated solution for the whole process of radiomics analysis has been generated. RESULTS: Clinical researchers can use this platform for the whole process of radiomics and machine learning analysis for medical images, and quickly produce research results. CONCLUSIONS This platform greatly shortens the time for medical image analysis research, decreasing the work difficulty of clinical researchers, as well as significantly promoting their working efficiency.
Machine Learning ; Diagnostic Imaging ; Algorithms ; Radiography