Image segmentation is a key step of image processing,and it is a hard work too. The experts of this field have tried to find a suitable algorithm for image segmentation for a long term,however,there is not a algorithm is generally accepted till now. J. Holland created genetic algorithm(abbreviation :GA) in 1973. This algorithm has been used in many fields successfully ,and has been introduced to image segmentation field by exports. The principles of image segmentation and algorithm are stated in this article. The author mainly expounded the application of GA in medical image segmentation field in recently years.

Objective To discuss the diagnostic value of multi-slice spiral CT (MSCT) in distinguishing the severe acute respiratory syndrome (SARS) from community acquired pneumonia (CAP), and to evaluate the prognosis in these two groups. Methods A retrospective study was performed on 64 cases with SARS (28 men, 36 women, aged 18-93 yrs, mean age 42.3 yrs) and 46 inpatients with CAP (29 men,17 women, aged 28-88 yrs, mean age 70.1 yrs). Pathogens of respiratory tract were found in 23 patients of CAP. All of patients underwent MSCT scanning of the chest. Results The sensitivity, specificity, and accuracy for diagnosis of SARS using a combination of 3 factors, including ground-glass opacities of lung parenchyma in chest CT, age, and WBC counts were 93.8%, 60.9% and 80.0%, respectively. The sensitivity, specificity, and accuracy for excluding SARS using a combination of consolidation of lung lesions, fiber stripe components and thicken bronchus wall of lung CT in CAP patients were 91.3%, 82.8%, and 86.4%, respectively. The death in SARS and CAP was 7 (10.9%) and 4 (8.7%), respectively. The late follow-up results indicated that 48.8% (21/43 cases) of SARS cases left abnormal manifestations in the lung. The lung sequela of the patients over 50 yrs tended to be severe with the age. Conclusion In outbreak region of SARS, MSCT plays an important role in early diagnosis, but we need to closely combine the density features of lung lesions and other manifestations of lung with clinical condition of patients to increase the accuracy for the differential diagnosis of SARS from CAP. The prognosis of patients over 50 yrs with SARS is relatively poor.

Objective:To explore the application value of video-electroencephalogram(VEEG) monitoring in the diagnosis and localization of children with epilepsy.Methods:The clinical data of 310 children with clinical epilepsy symptoms diagnosed and treated in Tangshan Maternal and Child Health Care Hospital and Qilu Children′s Hospital Affiliated to Shandong University from May 2018 to April 2020 were analyzed. All children underwent routine EEG (REEG), VEEG monitoring, and positron emission computed tomography (PET-CT) for children undergoing surgery. REEG and VEEG was compared to monitor epileptic form discharges; the location of epileptic lesions was compared by different examination methods, and children were followed up after surgery.Results:Among the 310 children, 247 children were diagnosed with epilepsy and 63 children were suspected of epilepsy. The detection rate of VEEG epileptic form discharge was higher than that of REEG: 87.4% (216/247) vs. 45.7% (113/247), and the difference was statistically significant ( χ2 = 6.3042, P<0.05). Among 247 children with epilepsy, during the VEEG test, 81 children (32.8%) had clinical symptoms, of whom 65 had seizures and 16 had non-epileptic seizures. The detection rate of VEEG for epilepsy was higher than that of clinical seizures: 87.5% (216/247) vs. 32.8% (81/247), and the difference was statistically significant ( χ2 = 8.6148, P<0.05). Among the 247 children with epilepsy diagnosed, 144 children had epilepsy syndrome, temporal lobe epilepsy accounted for 54.17% (78/144), and frontal lobe epilepsy accounted for 34.2% (50/144). The accuracy of preoperative VEEG localization of epilepsy lesions in 50 children undergoing surgery was higher than that of PET-CT and REEG: 80.0% (40/50) vs. 56.0% (28/50), 54.0% (27/50), and the differences were statistical significance ( χ2 = 5.3014, 5.6031, P<0.05). Postoperative follow-up of 50 children who had underwent surgery showed that 50.0% (25/50) of the children had no seizures, and 38.0% (19/50) of the children had significant improvements in postoperative seizure time, seizure period, and clinical manifestations. 12.0% (6/50) of the children had no significant improvement in clinical symptoms. Conclusions:VEEG can improve the detection rate of epileptic form discharges, and provide an important basis for clinical diagnosis of epilepsy, and have important value in locating epilepsy lesions before surgery.

Objective To investigate the risk factors for the occurrence of cerebral infarction in patients with capsular warning syndrome (CWS). Methods Consecutive patients with transient ischemic attack (TIA) meeting the CWS clinical manifestations were col ected retrospectively. They were divided into either a cerebral infarction group or a non-cerebral infarction group according to the brain diffusion weighted imaging findings. The independent risk factors for patients with CWS were identified through the comparison of demographic and baseline clinical data. Results A total of 39 patients were enrol ed, including 25 males (64. 1%) and 14 females (35. 9%), and their mean age was 58. 9 ± 10. 3 years. There were 21 patients in the cerebral infarction group and 18 in the non-cerebral infarction group. Compared with the non-cerebral infarction group, the age of patients in the cerebral infarction group was older (62. 5 ± 9. 3 years vs. 54. 8 ± 10. 2 years;t=2. 470, P=0. 018). The constituent ratio of the patients with a history of previous stroke or transient ischemic attack was higher (33. 3% vs. 5. 6%; P=0. 049), the fasting blood glucose level was higher (8. 2 ± 3. 2 mmol/L vs. 6. 0 ± 1. 3 mmol/L; t=2. 748, P=0. 009), and ABCD2 score was higher (5. 2 ± 1. 1 vs. 3. 5 ± 1. 1;t=4. 734, P<0. 001). Multivariate logistic regression analysis showed that the ABCD2 score was an independent risk factor for cerebral infarction in patients with CWS (odds ratio, 4. 529, 95% confidence interval 1. 233-16. 627;P=0. 023). Conclusions The higher ABCD2 score was an independent risk factor for the occurrence of cerebral infarction in patients with CWS. It can be used as an evaluation tool for predicting the risk of cerebral infarction in patients with CWS.

Objective To establish fingerprint of Hupulus lupulus by HPLC.Methods Diamonsil C18column (250mm×4.6mm, 5μm) was used.The mobile phase consisted of acetonitrile and 0.1％phosphoric acid, in gradient elution mode, detection wavelength was 358nm, column pressure at 10.2MPa, column temperature was 30℃, injection volume of 10μl and flow rate was 1.0ml/min.Results A common mode of HPLC fingerprint of Hupulus lupulus was established.19common peaks were calibrated, xanthohumol, cohumulone, humulone, adhumulone, colupulone, lupulone and adlupulone for identification.Among the 26batches of Hupulus lupulus, 5batches of herbs had similarities of less than or equal 0.9, which were all wild varieties.Conclusion The method was fast, effective, accurate and reliably to distinguish the cultivation and wildness Hupulus lupulus, which provided reference for quality control of Hupulus lupulus.

Objective To establish a method for measuring blood phosphatidylethanol by liquid chromatography coupled with tandem mass spectrometry(LC-MS/MS), which can be applied for objective and quantitative of alcohol intake.Methods Whole blood samples were treated with isopropanol to precipitate protein,and phosphopropanol(16:0/16:0)was used as the standard.After centrifugation, the supernatants were transferred and evaporated under a stream of nitrogen until dryness.Then the residuals were analyzed by LC-MS/MS.Various methodological parameters, including linearity, limit of detection (LOD), limit of quantitation(LOQ), recovery, and precision, were investigated.Finally, blood samples from 40 Chinese individuals with more than one year of regular drinking habits were analyzed, and distributions of phosphatidylethanol were evaluated.Results The correlation coefficients were higher than 0.9992.The LOD and LOQ were lower than 0.74 and 2.48 ng/ml, respectively.The inter-and total assay coefficient of variations were 0.77%-3.18% and 2.30%-6.95%, respectively, with recoveries ranged from 96.88% to 102.99%.The relationship between phosphatidylethanol level and self-reported alcohol consumption was significantly and positively correlated(r =0.769, P <0.001).Furthermore, Kruskal-Wallis analysis showed a significant difference in total phosphatidylethanol levels among individuals with different levels of alcohol intake(χ2=18.850,P<0.001).Conclusions An LC-MS/MS method for whole blood phosphatidylethanol detection has been developed.This method is simple,sensitive and accurate and can effectively reflect light,moderate and heavy alcohol intake.The method will be applied to the assessment of alcohol consumption and its association with the risks of drinking related diseases.

Objective To explore the clinical application value of combined detection of apolipoprotein A1(ApoA1)and alpha-fetoprotein(AFP)in young and middle-aged patients with pulmonary tuberculosis.Meth-ods A total of 82 young and middle-aged patients with pulmonary tuberculosis admitted to the hospital from December 2020 to December 2021 were selected as the observation group,and 85 healthy people who under-went physical examination in the hospital during the same period were selected as the control group.The clini-cal,lipid,inflammation and iron metabolism related indexes were compared between the two groups.Multiva-riate Logistic regression was used to analyze the influencing factors of pulmonary tuberculosis in young and middle-aged patients.The area under the receiver operating characteristic(ROC)curve(AUC)was used to e-valuate the application value of ApoA1,AFP and their combination in the diagnosis of pulmonary tuberculosis in young and middle-aged patients.Results Compared with the control group,the observation group had sig-nificantly higher levels of direct bilirubin,creatinine,AFP and high-sensitivity C-reactive protein(P<0.05),and significantly lower levels of triglyceride,total cholesterol,high-density lipoprotein cholesterol and ApoA1(P<0.05).Multivariate Logistic regression analysis showed that ApoA1 was an independent protective factor(OR=0.119,95%CI 0.019-0.754,P=0.024)and AFP was an independent risk factor(OR=1.554,95%CI 1.138-2.122,P=0.006)for pulmonary tuberculosis in young and middle-aged patients.ApoA1,AFP and the combined prediction of young and middle-aged tuberculosis AUC were 0.644(P=0.006),0.262(P<0.001),0.678(P=0.001),respectively.Conclusion The low level of ApoA1 is an independent protec-tive factor for pulmonary tuberculosis in young and middle-aged patients,and the high level of AFP is an inde-pendent risk factor for pulmonary tuberculosis in young and middle-aged patients.The combined detection of ApoA1 and AFP has good value in predicting pulmonary tuberculosis in young and middle-aged patients.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.