Objective:To explore the application value of singular value decomposition(SVD)in optimizing the image quality of contrast-enhanced ultrasound(CEUS)and perioperative CEUS assessment of microwave ablation(MWA)for thyroid nodule.Methods:The data sets of two-dimensional ultrasound and CEUS images of two patients with thyroid nodules,who underwent MWA in China Resources&Wisco General Hospital affiliated to Wuhan University of Science and Technology from April 2023,were collected.The contrast images based on CEUS images after SVD filtering were obtained according to the normalized cross-correlation algorithm,and the differences of signal-to-noise ratio(SNR)and micro-vessel density(MVD)between the contrast images after SVD filtering and original CEUS images were compared.Results:Compared with the original CEUS images of thyroid nodules before and after MWA,the contrast images that were processed by SVD filtering can more clearly show the vascular structure with thyroid nodules,and can detect more signals of blood flow.The results showed that the average SNR of the original CEUS images after operation was(1.07±0.66)dB,and the average SNR of the contrast images by SVD filtering after operation was(6.21±1.01)dB(t=-6.015,P=0.038).The average MVD of the original CEUS images after operation was(0.60±0.33)%,and the average MVD of the contrast images of SVD filtering after operation was(5.42±0.67)%(t=-9.076,P=0.029).It can show that the SNR and MVD of the contrast images of SVD-filtering after operation were significantly higher than these of the original CEUS images after operation,and the results of these studies were significant.Conclusion:SVD filtering can effectively suppress noise and enhance the signals of micro-blood flow.The improved quality of contrast images can be used in the accurate diagnosis of perioperative MWA of thyroid nodules,it can sensitively detect the residually incomplete areas of ablation after operation,so as to guide clinicians to carry out more thorough ablation treatment and provide decision support for the assessment of curative effect of accurate ablation.

Objective:To determine the erythromycin resistance of Bordetella pertussis isolates and their ptxP1 and ptxP3 phenotypic composition and compare clinical manifestations of children with pertussis caused by the two types of strains. Methods:This was a cross-sectional study, the pertussis cases diagnosed using bacterial culture from January 2019 to December 2022 in Beijing Children′s Hospital and the First People′s Hospital of Wuhu were collected.Any suspected Bordetella pertussis colonies were identified by the slide agglutination test.The susceptibility of isolates to erythromycin was detected by the E-test and K-B test.The ptxP gene was amplified by polymerase chain reaction and sequenced to determine its genotype. t-test, Mann-Whitney U-test, Chi-square test and Fisher′s exact test were use to statistical analysis. Results:A total of 192 strains of Bordetella pertussis were identified, including 188 (97.9%) erythromycin-resistant strains.Among the 188 strains, 30.3%(57/188) belonged to the ptxP1 genotype and 69.7%(131/188) belonged to the ptxP3 genotype.In children aged below 1 year old, the incidence of paroxysmal cough caused by infection with the ptxP3 strain was higher than that with the ptxP1 strain (57.1% vs.29.4%, P<0.05), and children infected with the ptxP3 strain were more likely to develop apnea or asphyxia (23.8% vs.17.6%), post-tussive vomiting (44.4% vs.32.4%), whooping cough (72.0% vs.50.0%) and pneumonia or bronchitis (85.7% vs.73.5%) compared to those infected with the ptxP1 strain, but the differences were not statistically significant(all P>0.05). In children aged 1 year old and above, the white blood cell count of children infected with the ptxP1 strain was higher than that of infections with the ptxP3 strain [13.5(9.9, 24.5)×10 9/L, 10.3 (7.0, 16.4)×10 9/L, P<0.05], and children infected with the ptxP1 strain were more likely to contract other pathogen infections than those infected with the ptxP3 strain (17.4% vs.4.4%, P>0.05). Conclusions:ptxP3 erythromycin-resistant Bordetella pertussis has become the main pathogen of pertussis.Infants with pertussis caused by the ptxP3 erythromycin-resistant strain show more significant manifestations and a higher possibility of severe symptoms than those infected with the ptxP1 erythromycin-resistant strain.

Objective To observe the value of ultrasound vector flow imaging(VFI)combined with singular value decomposition(SVD)filtering for depicting deep microvasculature flow velocity of liver.Methods Grayscale ultrasound,CDFI and contrast-enhanced ultrasound(CEUS)were prospectively performed in a patient with suspected liver hemangioma.Images of CEUS were dealt with SVD filtering.Cross-correlation algorithm was used to obtain images of VFI based on grayscale ultrasound,original CEUS and SVD filtered CEUS,respectively,and the ability of the above images for depicting liver microvascular flow direction and velocity were compared.Results The signal-to-noise ratio(SNR)of liver grayscale ultrasound,original CEUS and SVD filtered CEUS images was 7.56,17.65 and 22.43 dB,respectively,while their contrast-to-issue ratio(CTR)was 1.12,7.56 and 16.34 dB,respectively.Compared with VFI based on grayscale ultrasound and original CEUS,VFI based on SVD filtered CEUS could display faster velocity and more uniform direction of blood flow.Before and after SVD filtering,liver microvascular flow velocity measured with VFI was 1.91(0.81,4.11)and 6.83(4.25,9.41)mm/s,respectively,which were significantly different(Z=-10.671,P＜0.001).Conclusion Combined with SVD filtering could significantly improve the efficiency of VFI for depicting liver deep microvasculature flow velocity.

Objective:To examine whether the mixed infection rate in pertussis infants is significantly higher than that in non-pertussis infants with respiratory tract infection, to explore the mixed infection pathogen distribution in pertussis infants, and to provide reference for clinical diagnosis and treatment.Methods:A case-control study was conducted on 118 nasopharyngeal swabs collected from infants who applied for clinical pertussis etiological testing (culture and specific nucleic acid detection of Bordetella pertussis) in Beijing Children′s Hospital, Jiaxing Maternity and Child Health Care Hospital and Wuhu No.1 People′s Hospital from August 2018 to January 2021.According to the pertussis etiological testing results, the patients were divided into the pertussis group (65 cases) and non-pertussis group (53 cases). Thirty-three pairs of cases were matched according to age, onset season and city.All nasopharyngeal swabs were tested for infections of other pathogens using FilmArray RP2, which can detect 21 respiratory infection pathogens.The mixed infection rate was compared between groups by Chi- square test. Results:According to the FilmArray RP2 test results, 56.9%(37/65) cases in pertussis group and 15.1%(8/53) cases in the non-pertussis group were positive for multiple pathogens, and the difference was statistically significant ( χ2=21.651, P<0.001). The top 5 mixed infection pathogens in pertussis infants were human rhinovirus/enterovirus (HRV/EV) (38.5%, 25/65), parainfluenza virus (PIV) (18.5%, 12/65), respiratory syncytial virus (RSV) (10.8%, 7/65), coronavirus (Cov) (10.8%, 7/65), and adenovirus (ADV) (7.7%, 5/65). The mixed infection rates of the pertussis group in spring, summer, autumn and winter were 46.2% (6/13), 58.3%(14/24), 55.6%(5/9), and 63.2%(12/19), respectively.Comparison of matched and unmatched cases achieved similar results. Conclusions:Among clinical suspected pertussis infant specimens, the mixed infection rate in confirmed cases is tremendously higher than that in non-pertussis infants.The main mixed infection pathogens in pertussis infants are HRV/EV, PIV, RSV, Cov, and ADV.Mixed infection in pertussis children commonly occurs in four seasons, with the highest incidence in winter.

Alcoholic cardiomyopathy (ACM) is a dilated cardiomyopathy induced by excessive alcohol consumption that causes progressive cardiac dysfunction and chamber dilatation, leading to arrhythmias, heart failure, and death. Cardiac transplantation is the final measure for end-stage ACM. In this case, we used multimodal imaging for ACM diagnosis in a patient with refractory heart failure. The patient received a heart transplant with a good prognosis, and his pathological results after the transplant confirmed our suspected diagnosis. End-stage ACM may lead to refractory heart failure and multimodal imaging may play an important role in the diagnosis, prognosis prediction, and follow-up study of suspected ACM.

Alcoholic cardiomyopathy (ACM) is a dilated cardiomyopathy induced by excessive alcohol consumption that causes progressive cardiac dysfunction and chamber dilatation, leading to arrhythmias, heart failure, and death. Cardiac transplantation is the final measure for end-stage ACM. In this case, we used multimodal imaging for ACM diagnosis in a patient with refractory heart failure. The patient received a heart transplant with a good prognosis, and his pathological results after the transplant confirmed our suspected diagnosis. End-stage ACM may lead to refractory heart failure and multimodal imaging may play an important role in the diagnosis, prognosis prediction, and follow-up study of suspected ACM.

There are a variety of factors contributing to pertussis resurgence, which is related to short duration of immunity provided by the vaccine, the difference of vaccination strategies, the change of epidemiological characteristics, antibiotic resistance, the variation of bordetella pertussis, the improvement of diagnostic criteria and the advancement of the monitoring system.There has been a decrease in the number of cases of natural infection since the vaccination, leading to a change in the prevalence of pertussis currently.The decline in population group immunity causes a decrease of serum antibody titer transmitted from the mother to the newborn.As a result, unvaccinated infants have poor immunity against pertussis in the early stage, and infants under 1 year old are prone to severe pertussis.Children and adolescents are also susceptible to pertussis owing to the short-term efficacy of the vaccine.They often present with chronic cough after infection.Adults infected with pertussis are unheeded because of atypical symptoms or occult infection, and they would infect young babies.To improve the diagnosis and treatment of pertussis, it is necessary to meliorate the laboratory diagnosis, study bacterial variation and drug resistance, strengthen disease surveillance, seek more optimized immunization strategies and develop new vaccines.In this paper, the causes of pertussis resurgence were reviewed, in order to provide reference for prevention and control of pertussis in China.

Objective:To evaluate the auxiliary diagnosis value of bacterial culture, polymerase chain reaction (PCR) and serum anti-pertussis toxin immunoglobulin G (AntiPT-IgG) level detection in suspected pertussis.Methods:A total of 110 suspected cases of pertussis treated in the Department of Pediatrics of Wuhu No.1 People′s Hospital from June 2018 to May 2019 were recruited for the study.The nasopharyngeal swabs of all cases were collected for Bordetella pertussis culture and specific nucleic acid PCR detection.Serum samples of 78 cases were collected for the detection of AntiPT-IgG level by enzyme linked immunosorbent assays.Results:The positive rates of bacterial culture group and PCR group were 21.8% and 30.0%, respectively, with no statistically significant difference ( χ2=1.198, P>0.05). The culture positive rate of cases with the duration of cough<2 weeks was 32.1%, which was signi-ficantly higher than that of cases with the duration of cough about 2-4 weeks (14.3%) or >4 weeks (9.1%) ( χ2=6.522, P<0.05). The PCR positive rate of cases with the duration of cough <2 weeks was 39.6%, which was also significantly higher than that of cases with the duration of cough about 2-4 weeks (25.7%) or > 4 weeks (13.6%) ( χ2=6.126, P<0.05). The mean value for serum AntiPT-IgG level of 78 cases was (75.727±78.454) IU/mL, the median AntiPT-IgG levels of cases with the duration of cough<2 weeks and about 2-4 weeks were 5.909 IU/mL and 20.948 IU/mL, respectively, and the positive rates were 14.7% and 38.1%, respectively.The AntiPT-IgG level of cases with the duration of cough> 4 weeks and that at convalescent stage were (79.281±68.254) IU/mL and (107.242±75.750) IU/mL, and the positive rates were 39.1% and 57.1%, respectively. Conclusions:In the vaccine era, the results of pathogenic and serological tests should be combined to assist the clinical diagnosis of pertussis.The positive rate of bacterial culture and specific nucleic acid pathogen detection in children with cough duration less than 2 weeks is high, and the serological diagnosis is more effective after the duration of cough is over 4 weeks.

A 3-year-old girl received phenobarbital 20 mg thrice daily for the prophylaxis of febrile seizure at the beginning of each fever. Twelve hours after the first oral administration,the patient developed red spots on her perioral skin. About 1 hour after the second oral therapy,the patient developed the same rash on her perioral skin and right upper limb. The same symptoms occurred three times in succession after each dose. About one hour after treatment with phenobarbital again,the patient developed the same rash on her perioral skin,right upper limb and bilateral buttocks. The patient was diagnosed as fixed drug eruption induced by phenobarbital. Phenobarbital was stopped and the oral diazepam 1.25 mg thrice daily was given in order to prevent febrile convulsions. All above mentioned symptoms did not recur.

A 3-year-old girl received phenobarbital 20 mg thrice daily for the prophylaxis of febrile seizure at the beginning of each fever. Twelve hours after the first oral administration,the patient developed red spots on her perioral skin. About 1 hour after the second oral therapy,the patient developed the same rash on her perioral skin and right upper limb. The same symptoms occurred three times in succession after each dose. About one hour after treatment with phenobarbital again,the patient developed the same rash on her perioral skin,right upper limb and bilateral buttocks. The patient was diagnosed as fixed drug eruption induced by phenobarbital. Phenobarbital was stopped and the oral diazepam 1.25 mg thrice daily was given in order to prevent febrile convulsions. All above mentioned symptoms did not recur.