Objective:To investigate the performance of real-time RT-PCR for the detection of SARS-CoV-2 nucleic acid in clinical diagnosis of COVID-19.Methods:Laboratory test data and basic case information of Henan COVID-19 cases were collected from the China′s Infectious Disease Information System as of March 5, 2020. All information was entered by local hospitals and Center for Disease Control and Prevention (CDC). Local hospitals or country CDC were responsible for sampling and municipal CDC was responsible for nucleic acid testing.Results:A total of 6 714 specimens were detected and the positive rate of SARS-CoV-2 nucleic acid was 23.82%. The specimens were collected from 1 200 confirmed cases, 2 178 suspected cases and 77 asymptomatic cases. The nucleic acid diagnosis rate of COVID-19 was 36.96% (1 277/3 455). In all cases, the positive rates of SARS-CoV-2 nucleic acid in nasal swabs, sputum samples and throat swabs were 19.38%, 28.59% and 23.53%, respectively (χ 2=15.896, P<0.01). The positive rate of SARS-CoV-2 nucleic acid in confirmed COVID-19 cases was 63.10%. The positive rates in nasal swabs, sputum samples and throat swabs were 50.80%, 58.71% and 65.21 (χ 2=18.612, P<0.01). The positive rates of SARS-CoV-2 nucleic acid were 43.51%, 23.98%, 22.82%, 12.17%, 14.46% and 13.21% in samples collected on the day of symptom onset and one week, two weeks, three weeks, four weeks, five weeks and above five weeks after the onset, respectively. The positive rates in confirmed cases were respectively 89.03%, 86.57%, 52.30%, 17.53%, 17.69% and 24.14% at those time points. Conclusions:Real-time RT-PCR is the most effective method for early pathogenic diagnosis of COVID-19. The highest detection rate of nucleic acid is achieved within one week after the onset of COVID-19, and the latest time for nucleic acid detection is 38 d after the onset.

Objective:To compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty in treatment of intertrochanteric fractures in elderly patients aged 90 years or more.Methods:A retrospective case-control study was conducted to analyze the clinical data of 43 elderly patients aged 90 years or more with intertrochanteric fractures admitted to Henan Provincial People's Hospital from January 2017 to June 2018. There were 12 males and 31 females, aged 90-102 years [(92.3±2.5)years]. A total of 31 patients were treated by PFNA (PFNA group) and 12 patients by bipolar hemiarthroplasty (hemiarthroplasty group). Comparisons were made between the two groups in terms of operation time, intraoperative blood loss, time of weight bearing after operation, rate of blood transfusion, incidence of complications 2 weeks and 3 months after operation, Harris score 12 months after operation and mortality 12 months after operation.Results:All patients were followed up for 1-30 months [(19.1±9.8)months] in PFNA group and for 0.5-29 months [(18.6±10.6)months] in hemiarthroplasty group. Operative time was (95.8±31.0)minutes in PFNA group, shorter than (128.8±40.5)minutes in hemiarthroplasty group ( P<0.05). Intraoperative blood loss was (71.3±25.7)ml in PFNA group and (212.5±113.1)ml in hemiarthroplasty group ( P<0.05). Time of weight bearing after operation was (43.9±31.9)days in PFNA group, longer than (5.9±2.8)days in hemiarthroplasty group ( P<0.05). The perioperative blood transfusion rate in PFNA group (29%) was less than hemiarthroplasty group (75%) ( P<0.05). Incidence of complications 2 weeks after operation was similar between PFNA group (23%) and hemiarthroplasty group (42%) ( P>0.05). Incidence of complications 3 months after operation in PFNA group was 26%, similar with 42% in hemiarthroplasty group ( P>0.05). Harris score 12 months after operation in PFNA group was (56.3±32.3)points, comparable to (59.3±36.7)points in hemiarthroplasty group ( P>0.05). Mortality rate 12 months after operation was 19% in PFNA group and 25% in hemiarthroplasty group ( P>0.05). Conclusion:For intertrochanteric fractures in elderly patients aged 90 years or more, PFNA and bipolar hemiarthroplasty are both effective treatments, but PFNA may be a better choice with shorter operation time and less intraoperative blood loss.

Objective To investigate the feasibility of b value threshold maps based on MRI diffusion weighted imaging ( DWI ) in the diagnosis of pancreatic adenocarcinoma .Methods The preoperative MRI DWI [ b value=0( b0 ) and 1000 ( b1000 ) s/mm2 ] data of 14 patients who were postoperatively histologically confirmed as pancreatic ductal adenocarcinoma from September 2016 to May 2015 admitted in Shanghai Changhai Hospital were retrospectively analyzed .The b value threshold maps were calculated .Computed DWI images at b value of 1500 s/mm2 ( cDWIb1500 ) was calculated based on the scanned DWI images of b 0 and b1000 s/mm2 . The efficacy of DWIb 1000 , b value threshold map and cDWIb 1500 in manifesting pancreatic adenocarcinoma was assessed by a four-point scale .The non-parametric Friedman test was used to compare the three methods , and Conover adjusted method was applied to compare any two of the three methods .Results The conspicuity score of DWIb 1000 , b value threshold map and cDWIb 1500 in showing pancreatic cancer was 2.9 ±0.8, 3.7 ±0.5 and 3.6 ±0.5, respectively, and the differences among the three methods were statistically significant (F=19.5, P value <0.001), but the differences on tumor conspicuity scores of b value threshold map and cDWIb 1500 were not statistically different .Conclusions The calculation of b value threshold map based on DWI images could show pancreatic cancer in high contrast quickly by adjusting window width and window level , and could achieve comparable performance as cDWIb 1500 .

Objective To investigate the feasibility of computer-aided pancreas segmentation based on three-dimensional (3D) Dixon MRI at 3.0-T.Methods Five volunteers with health pancreas underwent upper abdominal 3D Dixon MRI at 3.0T with the same scan parameters while holding breath.The automatic segmentation of pancreas is based on the Medical Imaging Interaction ToolKit (MITK) with homemade software.A experienced radiologist performed manual segmentation and computer aided segmentation of the pancreas on the opposed phase and water phase images twice.Similarity was analyzed and compared for the manual and automated segmentations for the two group images.Similarity was presented as Dice coefficients.Results Both of the oppose phase and water phase images of Dixon MRI showed that the signal intensity of pancreas was higher than that of the surrounding tissue,the similarity of water phase was obviously higher than that of oppose phase and the differences were statistically significant.Based on Dixon MRI water phase and oppose phase images,the mean dice coefficients for the manual segmentations were 0.81 ± 0.01 and 0.85 ±0.03,respectively,for both the oppose phase and water phase images (P=0.013).For the automated segmentations,the dice coefficients were 0.69 ± 0.08 and 0.75 ± 0.03 for water phase images and the oppose images,respectively,and the difference was not statistically significant (P =0.155).Conclusions 3.0T oppose phase and water phase of Dixon images could clearly show the pancreas,and automated pancreas segmentation based on water phase Dixon MRI obtained higher similarity,which was feasible.

Objective To observe the feasibility of combining dezocine with fentanyl in the application of single integral high in‐tensity focused ultrasound(HIFU)ablation of uterine fibroids .Methods One hundred and sixty patients with uterine fibroids trea‐ted by HIFU under conscious sedation were randomly divided into 2 groups(n=80):group A with treatment combined fentanyl and midazolam and group B treated with combined dezocine ,fentanyl and midazolam .Analgesic effect was evaluated with visual analog scale (VAS) .Variation of patients′vital signs (blood pressure ,heart rate ,electrocardiogram ,oxygen saturation) ,pain scores ,com‐fort scores ,sedation scores ,analgesic consumption and side effects were recorded before treatment (T0 ) ,during drug delivery (T1 ) , at the beginning of the treatment(T2 ) ,30 minutes after drug delivery (T3 ) ,at the end of the treatment(T4 ) ,2 hours after treatment (T5 ) ,4 hours after treatment (T6 ) ,8 hours after treatment (T7 )and 24 hours after treatment(T8 ) .Results Both groups showed reliable analgesic effects and vital signs of each time point were stable .VAS scores and Ramsay scores of group A were higher than those of group B ,but there was no statistical difference (P>0 .05) .Three patients in group A showed dysuria and relieved after symptomatic treatment .No respiratory depression occurred in both groups .But compared to group A ,the incidence of the analgesic side effects of group B was significantly lower and patients satisfaction was significantly higher(P<0 .05) .Conclusion The analge‐sic effects of dezocine combined with fentanyl are reliable in HIFU ablation of uterine fibroids with fewer side effects ,and could be worthy to be promoted in clinical use .

Objective To evaluate the correlation between the endolymphatic hydrops in vestibule and symp‐toms ,audiovestibular functions in patients with Meniere's disease .Methods Twenty -four hours after bilateral intra-tympanic 8 times diluted gadolinium administration , three - dimensional fluid - attenuated inversion recovery MRI ,using a three-Tesla unit ,was performed in 34 patients .The extent of endolymphatic hydrops in the MRI images was assessed and compared the hydrops with age ,duration ,stage of the disease ,frequency of attacks ,pure tone audiometry ,caloric test ,electrocochleography and vestibular evoked myogenic potentials .Results Thirty -four patients showed different levels of enhancement of perilymth in the inner ears .In these patients ,obvious signs of endolymphatic hydrops were visualized ,including 8 slight hydrops ,11 mild hydrops and 15 significant hydrops . In all 34 patients ,the results of PTA were 9 dB HL to 90 dB HL ,with average of 43 .56 dB HL and there were 21 abnormal and 13 normal patients in caloric test with a diagnostic rate 61 .76% ;17 normal ,7 abnormal and 10 not elicited patients in VEMP with a diagnostic rate 50% ;22 abnormal and 12 normal patients in electrocochleography with a diagnostic rate 64 .71% .There were almost no complications in all 34 patients after bilateral intra-tympanic injec‐tion except short vertigo among 5 of them .A statistically significant correlation was found between degrees of en‐dolymphatic hydrops in vestibule and age ,stage of the disease and VEMP (P<0 .05) ,whereas no significant corre‐lation was found between the extent of endolymphatic hydrops and duration ,frequency of attacks ,pure tone audi‐ometry ,caloric test ,electrocochleography(P> 0 .05) and the correlation coefficient were 0 .494 ,0 .568 ,0 .590 , 0 .495 ,respectively .Conclusion The degree of endolymphatic hydrops in Ménière's disease has significant correlation with age ,VEMP ,stage of the disease and pure tone audiometry .No significant correlation was found between hy‐drops and duration ,frequency of attacks ,functional level scale ,caloric test and electrocochleography .

OBJECTIVE: To evaluate the extent of endolymphatic hydrops as shown by three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D FLAIR MRI) performed 24 hours after bilateral intratympanic gadolinium administration and discuss the positive rate of endolymphatic hydrops in vestibule and cochlea. METHOD: Twenty-four hours after bilateral intra-tympanic 8 times diluted gadolinium administration, three-dimensional fluid-attenuated inversion recovery MRI, using a three-Tesla unit, was performed in 48 patients, and then assessed the extent of endolymphatic hydrops in the MRI images. RESULT: Forty-eight patients showed different levels of enhancement of perilymth in the inner ear. In these patients, obvious signs of endolymphatic hydrops were visualized in vestibule,including 8 slight hydrops, 17 mild hydrops and 23 severe hydrops with a diagnostic rate of 83.3%. There were almost no complications in all 48 patients after bilateral intra-tympanic injection except short vertigo in some of them. CONCLUSION 3D FLAIR MRI resonance imaging has a high positive diagnostic rate in assessing endolymphatic hydrops of Ménière's disease and provides direct imaging evidence for diagnosing Ménière's disease.
Cochlea ; Contrast Media ; Ear, Inner ; Ear, Middle ; Gadolinium DTPA ; Humans ; Imaging, Three-Dimensional ; Injections ; Magnetic Resonance Imaging ; Meniere Disease ; diagnosis ; Vestibule, Labyrinth

Objective To investigate the feasibility of pancreatic DWI at a 3T MR imager and its value for the qualitative diagnosis of pancreatic tumors. Methods For 20 normal healthy volunteers and 47 patients with pancreatic tumors [21 pancreatic carcinoma (PC), 7 mass-forming chronic pancreatitis (MFCP)and 19 cystic lesions), routine pancreatic MRI and pancreatic DWI using b values (500 and 1000 mm2/s)were obtained, the DWI signal intensity (SI) and apparent diffusion coefficient (ADC) value of pancreatic lesions and adjacent tissue was measured. Results In the b = 500 and 1000 mm2/s DWI images, there was no significant difference in ADC value between different parts of normal pancreas. But PC and MFCP were shown as hyperintensity mass, in addition, the related SI1000 of PC at b = 1000 mm2/s DWI was significantly higher than that of MFCP (1.238 +0.448 vs. 0.371 +0.293, P＜0. 01). Compared with normal pancreas,beth PC and MFCP presented as decreased ADC500 and ADC1000 value. The ADC1000 of PC was significantly lower than that of MFCP [ ( 1. 087 + 0. 175 ) mm2/s vs. ( 1. 279 ± 0.213 ) mm2/s]. Pancreatic cystic lesions were shown as hyperintensity in DWI at b = 500 mm2/s, but were depicted as iso-intense signal or low-signal lesions in DWI using b = 1000 mm2/s. Both ADC500 and ADC1000 of pancreatic cystic lesions were higher than that of normal pancreas. Conclusions 3T-MR DWI is helpful to differentiate pancreatic lesions. High b value DWI is more valuable for the qualitative diagnosis of pancreatic mass.

Objective To explore the feasibility of contrast enhanced-MRA (CE-MRA) in testifying atherosclerosis model of rabbits with Care-bolus. Methods A total of 24 female New Zealand rabbits were fed with high cholesterol diet for 8 weeks. The whole body arteries of rabbits were inspected with CE-MRA and Care-bolus technology at 1.5T MR scanner before and after high cholesterol diet, and the images were compared accordingly. The survival conditions of rabbits were observed 1 week after scanning, and then the arteries with appeared plaques and angiostegnosis level more than 50% were taken out, sliced and dyed. Results No rabbit died unexpectedly during the study. Before feeding with high cholesterol diet, the arteries were smooth and lumens uniformity. After feeding high cholesterol diet, the inner walls of all aorta became rugose. The lumen stenosis of 32 common carotid arteries, 10 superior mesenteric arteries and 36 renal arteries were more than 50%. Pathological slices showed that 100% vessel had plaques. Compared with pathological findings, CE-MRA exaggerated lumen stenosis level in 26.92%, but no more than 25%. Conclusion To testify atherosclerosis model of rabbits using CE-MRA with Care-blous technology is reliable, causing tiny trauma and good at animal survival rate.

Objective To study the clinical value of grafting the musculocutaneous flap with uncovered in the special region to treat the open fracture and infection of tibia. Methods Twenty-eight patients including 19 males and 9 females with ankle and leg tissue defect were applied to graft the musculocutaneous flap with uncovered in the special region from July 2007 to January 2010. The tissue defeat in proximal part of the tibia were 6 cases, and 21 cases in middle and distal part, 1 case almost in whole part of the tibia. The bone occurred a defeat and infection in 23 cases, the bone necrosis occurred in 5 cases. The patients treated with iliac bone flap were 5 cases, anterolateral thigh flap were 21 cases, anterolateral thigh flap combined with fibula flap were 2 cases, the flap were transplanted by anastomosis in 26 cases. Results The tissue grafting were all survival and the survival rate were 100%. The callus formation were appear after operation from 3 to 6 months, and necrosis bone tissue almost were abstracted about 6 months. The wound were primary closure and not happened infection in 26 cases, the wound appeared infection under deep tissue in 2 cased,but being cured after 6 months by operation. The 21 patients were followed up from 3 months to one and helf year. The long-term was satisfaction and the donor area was perfect. Compared with closed graft, its area of the flap was small and need spend little time to treat the repair the defeat, and harness to recover the healthy of body and mind, also decrease the chance of infection in deep tissue. Conclusion It is demonstrated that grafting the tissue flap with uncovered in the special region is an ideal approach to treat the open fracture and infection of tibia.