Objective To explore the matrix effect on cyclosporine A (CsA) test by fluorescence polarization immunoassay (FPIA) and enzyme-multiplied immunoassay technique (EMIT), explain the discrepancy of external quality control results between these two methods and find the corrective action.Methods One hundred whole blood samples with various concentrations were adopted and CsA levels were detected by FPIA and EMIT.The results were compared with each other.Moreover, the influence of residual metal ions upon immunoreactions was assessed by adding Cu2+ and Zn2+.The effect of non-whole blood matrix on extraction efficiency for quality control materials and CsA calibrator was evaluated by adding identical volume of Hb-rich reagents followed with re-extraction.Results There is good correlation between results measured with FPIA(X) and EMIT(Y) methods ( Y=0.926 8X -8.115,R2 =0.996 9).Neither FPIA nor EMIT was affected by residual metal ions ( P ＞ 0.05 ). Non-whole blood matrix decreased the extraction efficiency of two methods, but it could be corrected by supplementation of the Hb-rich reagents (≥30 g/L).Conclusions Non-whole blood matrix may be the main reason for the inconsistent results measured by FPIA and EMIT methods.It could be corrected by using Hb-rich reagents.In addition,we should consider the influence of low lib on CsA test,espocially for organ transplant patients with lower Hb ( ＜30 g/L).

ObjectiveTo explore the function of intraoperative monitoring by brainstem auditory evoked potential and free electromyography during the operation of large acoustic neuroma for improving the operation more accurately and safely. MethodsThe intraoperative monitoring of affected cranial nerve and brainstem function respectively by brainstem auditory evoked potential and free electromyography was performed in 26 patients with large acoustic neuroma. According to the monitoring result the strategy and method of surgery was adjusted. Facial nerve function was assessed using the House-Brackmann facial nerve grading system immediately after two weeks of surgery.Results23 cases (88 ％) achieved total resection,3 cases(12 ％)achieved subtotal resection. The facial nerve was preserved anatomically in 25 patients.According to the House-Brackmann facial nerve grading system,21 cases (80 ％) got preserve of facial nerve function in grade Ⅰ - Ⅱ, 3 cases(12 ％)got preserve of facial nerve function in grade ]Ⅲ-Ⅳ and 1 cases (4 ％) got preserve of facial nerve function in grade Ⅴ after two weeks of surgery.ConclusionIntraoperative physiological monitoring may increase the anatomical and functional preservation rate of affected cranial nerve and also may improve the operation more accurately and safely.

Predicting the termination of paroxysmal atrial fibrillation (AF) may provide a signal to decide whether there is a need to intervene the AF timely. We proposed a novel RdR RR intervals scatter plot in our study. The abscissa of the RdR scatter plot was set to RR intervals and the ordinate was set as the difference between successive RR intervals. The RdR scatter plot includes information of RR intervals and difference between successive RR intervals, which captures more heart rate variability (HRV) information. By RdR scatter plot analysis of one minute RR intervals for 50 segments with non-terminating AF and immediately terminating AF, it was found that the points in RdR scatter plot of non-terminating AF were more decentralized than the ones of immediately terminating AF. By dividing the RdR scatter plot into uniform grids and counting the number of non-empty grids, non-terminating AF and immediately terminating AF segments were differentiated. By utilizing 49 RR intervals, for 20 segments of learning set, 17 segments were correctly detected, and for 30 segments of test set, 20 segments were detected. While utilizing 66 RR intervals, for 18 segments of learning set, 16 segments were correctly detected, and for 28 segments of test set, 20 segments were detected. The results demonstrated that during the last one minute before the termination of paroxysmal AF, the variance of the RR intervals and the difference of the neighboring two RR intervals became smaller. The termination of paroxysmal AF could be successfully predicted by utilizing the RdR scatter plot, while the predicting accuracy should be further improved.
Atrial Fibrillation ; diagnosis ; Computer Systems ; Heart Rate ; Humans ; Machine Learning

OBJECTIVE:To observe the effects of clarithromycin and fleroxacin on Pseudomonas aeruginosa(PA) biofilm METHODS:Clinical isolates of 7 strains of PA from respiratory tract were cultured with modified plate culture method;bacterial biofilm model was identified by silver nitrate staining;MICs were determined by broth microdilution The number of viable bacteria in biofilm was measured by using MTT method and bacterial adherence was measured by crystal violet staining RESULTS:1/16MIC and 1/4MIC of clarithromycin could inhibit the adherence of PA to silica-gel film(P

Objective To evaluate the expression and role of serum CXC chemokine ligand 13 (CXCL13) in Primary hepatic carcinoma (PHC) patients and explore the clinical value of PHC diagnosis and prognosis . Methods Serum samples were collected from 80 patients with PHC ,80 patients with chronic hepatitis B (CHB) and 36 healthy controls (HC) .Serum levels of CXCL13 in patients were measured by enzyme-linked immunosorbent assay (ELISA) .The relationship between clinicopathological features and laboratory parame-ters was analyzed by statistical software .The correlation between CXCL13 level and prognosis of liver func-tion were tested by spearman correlation analysis ,the diagnostic value of CXCL13 and AFP to PHC were ana-lysed by ROC curve .Results The levels of serum CXCL13 in patients with PHC were significantly higher than those in CHB and HC groups .The levels of serum CXCL13 in patients with advanced PHC (Ⅲ - Ⅳ) were significantly higher than those in patients with early PHC (Ⅰ - Ⅱ) .Serum levels of CXCL13 in patients with tumor diameter more than 5cm were significantly higher than those tumor diameter less than or equal 5 cm .Patients that metastatic serum levels of CXCL13 were significantly higher than without tumor metastasis in patients .The level of serum CXCL13 in patients with ascites was significantly higher than that in patients without ascites ,all the data were statistically significant (P＜0 .05) .Serum levels of CXCL13 in patients with PHC were correlated with hemoglobin ,serum albumin ,cholinesterase ,and international normalized ratios . There was a positive correlation between serum CXCL13 concentration and Child-Pugh score in PHC patients (r＝ 0 .459 ,P＝ 0 .001) ,and negatively correlated with serum albumin and cholinesterase (r＝ -0 .319 ,-0 .259 ,P＝0 .004 ,0 .008) .CXOC13 and AFP combination of the ROC curve were 0 .938 .Sensitivity and spe-cificity were 82 .8% and 100 .0% .Conclusion High expression of serum CXCL13 in PHC is closely related to tumor grow th and metastasis ,and has important clinical value in the diagnosis ,treatment and prognosis evalu-ation .

Objective To establish a Kawasaki disease mathematical diagnosis model in order to sup-port clinical decision-making. Methods Children with fever admitted to Shanghai Children's Hospital from Jan-uary 2013 to July 2017 were recruited and were divided into Kawasaki disease group and other disease control groups according to the final clinical diagnosis. The general clinical information and laboratory indicators were compared,a mathematical model was established and evaluated through the logistic regression analysis. Results A total of 1916 children were enrolled in this study,with an average age of 3. 47 ± 2. 83 years. Of these,1085 (56. 6％) were male,831 (43. 4％) were female,479 (25. 0％) were diagnosed with Kawasaki disease and 1099 (75. 0％) were with other diagnosis. Logistic regression analysis included dependent variables and inde-pendent variables,and the results showed that the Hosmer and Lemeshow test of this model was P=0. 944,the difference was not significant,indicating that the fitting equation and the true equation without deviation; age , fever days,ESR,CRP,WBC,ALB and DD dimers were independent risk factors for Kawasaki disease. The pre-dictive equation of Logistic regression is:ln P1-p( )= -7. 337 +2. 163 × CRP+1. 56 × DD+1. 612 × ESR+1. 392+age+1. 724 × days of fever +2. 295 × WBC +0. 808 × ALB. The patient model score and the ROC curve was calculated. The area under the curve was 0. 927 (95％ CI:0. 905-0. 950). When the score was 9,the Youden index was the highest(72. 9％),the sensitivity and specificity were 89. 7％ and 83. 2％. Conclusion The Kawasaki disease diagnosis mathematical model established in this study has good diagnostic efficacy,which need to be confirmed by further large-scale,multicenter studies.

Objective:To compare the efficacy and safety of drug-coated balloons (DCB) combined with bare metal stents (BMS) and BMS only for superficial femoral atherosclerosis obliterans.Methods:The clinical and follow-up data of 80 patients (82 limbs) who received combined treatment or BMS implantation at Cardiovascular Surgery Department of China Japan Friendship Hospital from Jan 2017 to Aug 2022 were retrospectively analyzed.Results:43 patients (43 limbs) were included in combined treatment group. 37 patients (39 limbs) were in BMS only. The average lesion length of combined group was longer than BMS group (19.54±7.04 cm vs. 16.25±6.43 cm, P=0.031). The primary patency rate of combined group at 36 months was not statistically different with BMS only group (56.9% vs. 38.5%, P=0.171). The subgroup analysis of superficial femoral artery TASC C/D (Trans-Atlantic Inter-Society Consensus) and CTO (chronic total occlusion) lesions indicated that efficacy of the combined group was superior to BMS only group. The patency rates of the combined group compared with the BMS group at 36 months were 57.6% vs. 23.8%, P=0.046, 60.2% vs. 31.4%, P=0.028, respectively. There was no significant difference in the FCD-TLR (free from clinical driven target lesion revascularization) between the two groups at 36 months (72.6% vs. 66.5%, P=0.706). There was no significant difference in major adverse events between the two groups ( P>0.05). Conclusion:Paclitaxel drug-coated balloon combined with bare metal stent is a safe and effective treatment for superficial femoral atherosclerosis obliterans, which is superior to bare metal stent, especially in TASC C/D and chronic total occlusive lesions.

Objective:To explore the exfoliative value of multi-slice CT (MSCT) on conversion therapy of gastric cancer patients with positive evaluation cytology (P 0CY 1) . Methods:A total of 36 P 0CY 1 gastric cancer patients receiving conversion therapy in a prospective, single-center, phase Ⅱ clinical trial were enrolled. MSCT examinations were performed before and after conversion therapy. Its solid tumor efficacy evaluation criteria (response evaluation criteria in solid tumors, Recist) 1.1 score and tumor volume reduction rate were evaluated. The Spearman correlation test was used to analyze the correlation between Recist 1.1 score and tumor volume reduction rate and the results of conversion therapy. The ROC curve was used to determine the defined value of the volume reduction rate to identify the effectiveness of conversion therapy, and formulate new grading standards. Results:According to the conversion of free cancer cells in the abdominal cavity , 15 of 36 patients had successful conversion therapy and 21 had failed. The rate of tumor volume reduction in the successful and failed conversion groups was 44.38%±37.86% and -54.96%±156.92%, respectively( P=0.016). The Recist 1.1 score was moderate correlated with the results of conversion therapy ( R=0.540, P=0.001), and the rate of tumor volume reduction was significantly correlated with the results of conversion therapy ( R=0.657, P<0.001). When the tumor volume reduction rate of 26.27% was used as the effective threshold for evaluating conversion therapy, the AUC under the ROC curve was the largest, and the sensitivity and specificity were 80.0% and 85.7%, respectively. Conclusion:Both the MSCT-measured Recist 1.1 score and the tumor volume reduction rate can be used to evaluate the efficacy of conversion therapy in patients with pure exfoliated cytology-positive gastric cancer, and CT tumor volume measurement significantly correlates with conversion therapy results.

Objective:To evaluate the safety and efficacy at 1-year follow-up of the use of drug-coated balloon (DCB) for the treatment of femoropopliteal in-stent restenosis (ISR).Methods:This study enrolled 252 patients undergoing Orchid DCB angioplasty for peripheral arterial disease in the femoral-popliteal segment. The clinical data were retrospectively analyzed.Results:Forty-nine patients were eligible, including 29 (59.2%) chronic total occlusions belonging to TransAtlantic Inter-Society Consensus-Ⅱ(TASC Ⅱ) D, 7 (14.3%) thrombosis, and 14 (28.6%) moderate to severe calcifications. The mean lesion length was (215.9±97.1) mm. 69.4% were of occlusive lesions (Tosaka Ⅲ category). Only 1 provisional stent was implanted. 98% patients had severe claudication or even worse. Of these cases, 34 (73.9%) showed improvements in Rutherford category, while 11 (23.9%) did not change and 1 (2.2%) case deteriorated. The average value of ABI was 0.478±0.264 before surgery and 0.907±0.207 at the end of follow-up. The improvement in Rutherford category ( P<0.01) and ABI ( P<0.005) were both significant. The primary patency (PP) was 80.4%, and the freedom from clinically driven TLR was 84.8% at 1 year. During the follow-up period, there was no all-cause death and major limb amputation. Conclusion:This multicenter study demonstrated the effectiveness of DCB as a treatment for complicated and extensive ISR lesions within 12 months.

Objective:To investigate the prognosis and the factors that influence it in patients with non-gastric gastrointestinal stromal tumors (GISTs) who are at low risk of recurrence.Methods:This was a retrospective cohort study. Clinicopathologic and prognostic data from patients with non-gastric GISTs and at low risk of recurrence (i.e., very low-risk or low-risk according to the 2008 version of the Modified NIH Risk Classification), who attended 18 medical centers in China between January 2000 and June 2023, were collected. We excluded patients with a history of prior malignancy, concurrent primary malignancy, multiple GISTs, and those who had received preoperative imatinib. The study cohort comprised 1,571 patients with GISTs, 370 (23.6%) of whom were at very low-risk and 1,201 (76.4%) at low-risk of recurrence. The cohort included 799 (50.9%) men and 772 (49.1%) women of median age 57 (16–93) years. Patients were followed up to July 2024. The prognosis and its influencing factors were analyzed. Receiver operating characteristic curves for tumor diameter and Ki67 were established, and the sensitivity, specificity, area under the curve (AUC) and optimal cut-off value with 95% confidence intervals were calculated. Propensity score matching was implemented using the 1:1 nearest neighbor matching method with a matching tolerance of 0.02.Results:With a median follow-up of 63 (12–267) months, the 5- and 10-year overall survival (OS) rates of the 1,571 patients were 99.5% and 98.0%, respectively, and the 5- and 10-year disease-free survival (DFS) rates were 96.3% and 94.4%, respectively. During postoperative follow-up, 3.8% (60/1,571) patients had disease recurrence or metastasis, comprising 0.8% (3/370) in the very low-risk group and 4.7% (57/1,201) in the low-risk group. In the low-risk group, recurrence or metastasis occurred in 5.5% (25/457) of patients with duodenal GISTs, 3.9% (25/645) of those with small intestinal GISTs, 9.2% (6/65) of those with rectal GISTs, and 10.0% (1/10) of those with colonic GISTs. Among the 60 patients with metastases, 56.7% (34/60) of the metastases were located in the abdominal cavity, 53.3% (32/60) in the liver, and 3.3% (2/60) in bone. During the follow-up period, 13 patients (0.8%) died of disease. Receiver operating characteristic curves were plotted for tumor diameter and Ki67 and assessed using the Jordon index. This showed that the difference in DFS between the two groups was statistically significant when the cutoff value for tumor diameter was 3.5 cm (AUC 0.731, 95% CI: 0.670–0.793, sensitivity 77.7%, specificity 64.1%). Furthermore, the difference in DFS between the two groups was statistically significant when the cutoff value for Ki67 was 5% (AUC 0.693, 95% CI: 0.624–0.762, sensitivity 60.7%, specificity 65.3%). Multifactorial analysis revealed that tumor diameter ≥3.5 cm, Ki67 ≥5%, and R1 resection were independent risk factors for DFS in patients with non-gastric GISTs at low risk of recurrence (all P<0.05). Furthermore, age >57 years, Ki67 ≥5%, and R1 resection were also independent risk factors for OS in patients with non-gastric GISTs at low risk of recurrence (all P<0.05). We also grouped the patients according to whether they had received postoperative adjuvant treatment with imatinib for 1 or 3 years. This yielded 137 patients in the less than 1-year group, 139 in the 1-year plus group; and 44 in both the less than 3 years and 3-years plus group. After propensity score matching for age, tumor diameter, Ki67, and resection status, the differences in survival between the two groups were not statistically significant (all P>0.05). The 10-year DFS and OS were 87.5% and 95.5%, respectively, in the group treated with imatinib for less than 1 year and 88.5% and 97.8%, respectively, in the group treated for more than 1 year. The 10-year DFS and OS were 89.6% and 92.6%, respectively, in the group treated with imatinib for less than 3 years and 88.0% and 100.0%, respectively, in the group treated with imatinib for more than 3 years. Conclusion:The overall prognosis of primary, non-gastric, low recurrence risk GISTs is relatively favorable; however, recurrences and metastases do occur. Age, tumor diameter, Ki67, and R1 resection may affect the prognosis. For some patients with low risk GISTs, administration of adjuvant therapy with imatinib for an appropriate duration may help prevent recurrence and improve survival.