Medical image is a powerful tool to assist doctors in the diagnosis and treatment planning.Nowadays,the segmentation of medical images is no longer limited to manual segmentation methods.Traditional methods and deep learning methods have been used to achieve more accurate results in medical image segmentation.Herein some innovative medical image segmentation methods in recent years are reviewed.By elaborating on the innovations of deep learning methods(SAM,SegNet,Mask R-CNN,and U-NET)and traditional methods(active contour model and threshold segmentation model),the differences and similarities between them are compared.The summary of medical image segmentation methods and the prospect is expected to help researchers better grasp and familiarize themselves with research status and development trend.

OBJECTIVES: Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding. The purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation (RCA) combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis (IHD) treatment. METHODS: Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments, and were randomly divided into RCA group and saline flushing group. In the RCA group, 0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber. The sodium citrate was stopped after 3 h of dialysis, which was changed to sequential dialysis without anticoagulant. The hazard ratios for coagulation were according to baseline. RESULTS: A total of 159 patients and 208 sessions were enrolled, including RCA group (80 patients, 110 sessions) and saline flushing group (79 patients, 98 sessions). The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group (3.64% vs. 20.41%, P<0.001). The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group ((238.34±9.33) min vs. (221.73±34.10) min, P<0.001). The urea clearance index (Kt/V) in the RCA group was similar to that in the saline flushing group with no statistically significant difference (1.12±0.34 vs. 1.08±0.34, P=0.41). CONCLUSIONS Compared with saline flushing, the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.
Humans ; Citric Acid/adverse effects* ; Prospective Studies ; Sodium Citrate ; Hemorrhage/chemically induced* ; Citrates/adverse effects* ; Anticoagulants/adverse effects* ; Renal Dialysis/adverse effects*

[Objective] To investigate the anatomical relation between manubrium sternum incisure(MSI)with the level of upper thoracic vertebrae(UTV)and to find out the basis of operative approach of UTV.[Method]Standing pan chest radiographs of 400 male and 400 female were equally divided into 4 year groups:≤19 years,20～39 years,40～59 years and ≥60 years and were used to observe the relationship between MSI with the level of UTV.On the basis of this relationship,a suitable UTV approach was advocated.There were fracture and dislocation of UTV 7 cases,UTV tumor 9 cases,tuberculosis of UTV 3 cases;OPLL ossification of UTV 2 cases.Diseases located at T1 6 cases,T2 7 cases,T3 2 cases,T4 3 cases,T1、2 2 cases,T2、3 1 case.Lower anterior cervical approach was performed for 7 cases including T1、2 one case and T2 one case,improved T3 1 case,and right subscapular transthoracic posterolateral approach was used for 5 cases.[Result]The number of UTV in relationship with the level of MSI was successively increased from T1 to T3 and was gradually decreased on T4,i.e.rate of cases of level of MST in relationship with T1、2 level was 1%,to T2 level 5.5%,to T2、3 level 15.87%,to T3 level 43.5%,to T3、4 level 20.75%,to T4 13.375%.No relationship was found in trend of distribution with the age and gender.The operative approach of UTV according its relationship with MSI was performed with the advantages of satisfactory exposure easily manipulation and satisfactory clinic results in most follow-up cases.One case died of metastasis of tumor in 9 months,3 cases were complicated with cerebrospinal fluid leakage and 3 cases with injury of recurrent laryngeal nerve.[Conclusion]Approach to UTV should be selected according to its relationship between MSI and diseased UTV preoperatively.The operative approach of UTV according to its relationship with MST has the advantages of satisfactory exposure,easily manipulation and satisfactory clinic results.

Objective To investigate the influence of experimental scotoma on multifocal visual evoked potential (mf-VEP). Methods The mf-VEP of 10 healthy individuals (20 eyes) was measured with VERIS Science 4.0. Every eye was measured for 3 times. The right eye was measured with full field stimulation and upper hemi-field or lower hemi-field masked. The left eye was measured with full field stimulation and central three-rings area or lower nasal field masked. The first slice responses of the second order in different field were analyzed and compared by VERIS software. Results The mf-VEP in masked area was undetectable or obviously decreased in all subjects. In most unmasked field, the amplitudes of mf-VEP were not changed, except that in some place decreased slightly with statistically significant difference in comparison to the full field stimulation mode. Conclusion mf-VEP is influenced with experimental scotoma. The mf-VEP changes are consistent with the visual field masked.

OBJECTIVETo study the effect of radiotherapy of nasopharyngeal carcinoma on visual evoked potential (VEP).

METHODSVEP of 63 patients with nasopharyngeal carcinoma were tested before, at the end of, half a year, one year, 2 years and 3 years after their radiotherapy.

RESULTSWithin the male group, one year after radiotherapy, the latency of VEP was significantly delayed than that before and at the end of radiotherapy, while the amplitude was decreased significantly. Two years after radiotherapy, the latency of VEP was significantly delayed more than that before radiotherapy. However there was no significant difference among VEP at the end of, half a year and 3 years after radiotherapy. Within the female group, 2 years after radiotherapy, the latency of VEP was significantly delayed than that before radiotherapy. Three years after radiotherapy, the latency of VEP was significantly delayed than that before, at the end of, half a year and one year after radiotherapy. There was no significant difference in VEP amplitudes before and after radiotherapy.

CONCLUSIONWithin the male group, the abnormal delay of VEP latency mostly happens one or two years after radiotherapy. Within the female group, the significant delay of VEP latency happens at the end of radiotherapy and lasts for 3 years, while the VEP amplitude does not change significantly during the 3 years after radiotherapy. The result indicates that the sustained radiation damage within the female visual nerve system starts at the end of radiotherapy, but to a lesser degree. It was shown that radiotherapy of nasopharyngeal carcinoma certainly damages the visual nerve system, though there is sex difference in the impairment.

Adult ; Evoked Potentials, Visual ; radiation effects ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Sex Factors ; Time Factors

BACKGROUNDTo investigate the efficacy of combined hyperfractionated radiation therapy (HFX RT) plus accelerated HFX RT and concomitant chemotherapy (CHT) in stage IIIA or IIIB non-small-cell lung cancer (NSCLC) compared with HFX RT alone.

METHODSFrom August 1998 to December 2001, 56 patients with NSCLC were randomized into the following groups: HFX RT alone group (group I, n=28), HFX RT with 1.2 Gy twice daily to a total dose of 45.6 Gy, followed by accelerated HFX RT with 1.6 Gy twice daily, the total planned radiation dose was 68.0 Gy in tumour; HFX RT/CHT concomitant group (group II, n=28), same RT with CHT consisting of 20 mg/m² of cisplatin (DDP) on days 1 to 3 and 50 mg/m² of etoposide (VP 16) on days 1 to 3, repeated every two weeks during the RT course.

RESULTSThe overall response rate was 78.6% in group II, including 10 patients with complete response and 12 with partial response; 39.3% in group I, including 11 patients with partial response. Group II had a higher overall response rate compared to Group I (P=0.003). The median survival time was 16 months for group II, 13 months for group I. There was a significant difference in the median survival time between two groups (P= 0.000 3 ). Group II (57.1%) had a lower distant metastasis rate compared with group I (85.7%) (P= 0.018 ). Patients in group II showed a higher incidence of acute and/or late high-grade toxicity (hematologic toxicity, esophagitis, late lung toxicity) compared with group I patients, but no significant difference was observed between the two groups.

CONCLUSIONSThe HFX RT plus accelerated HFX RT and concomitant PDD/VP-16 CHT is tolerable and substantially increases the response rate and prolongs survival in IIIA/IIIB NSCLC patients.

AIM: To compare genotype polymorphism of cytochrome CYP2C19 between Chinese Meng subjects and Chinese Han subjects. METHODS: The genotype polymorphism was analyzed by PCR RFLP (Restriction Fragment Length Polymorphism) in 74 subjects of healthy Chinese Han and 6 subjects of Chinese Meng. RESULTS: Of the 74 genotyped healthy subjects, 31 ( 41.9 %) were homozygous for wildtype (wt/wt), 9 ( 12.2 %) were homozygous for CYP2C19m1 and CYP2C19m2 (m1/m1 or m1/m2 or m2/m2), and 34 ( 45.9 %) were heterozygous for CYP2C19m1 or CYP2C19m2 (m1/wt or m2/wt). Among the 6 genotyped Chinese Meng, 1 ( 16.7 %) was homozygous for wildtype (wt/wt), 2 ( 33.3 %) were homozygous for mutant allele CYP2C19m1 and CYP2C19m2 (m1/m1 or m1/m2 or m2/m2), and 3( 50.0 %) were heterozygous for CYP2C19m1 or CYP2C19m2 (m1/wt or m2/wt); no homozygous genotype for CYP2C19m2(m2/m2)was found in this study. CONCLUSION: There is no statistical difference in occurrence of wt/wt and m1/m1 between in 74 subjects of healthy Chinese Han and 6 subjects of Chinese Meng.

Purpose To measure and compare the difference of multifocal electroretinogram in normal subjects and patients with age related macular degeneration. Methods Seventeen cases(20 eyes)of normal subjects,7 cases(10 eyes)of dry form AMD(age related macular degeneration),8 cases(8 eyes)of wet form AMD and 11 cases(11 eyes)of idiopathic macular hole(IMH)were tested with VERIS Sciences TM 4.0 made by EDI company of America.The latencies and average response densities of 6 ring retinal regions in normal subjects were compared with those in various types of age related maculopathies. Results The N 1 and P 1 wave latencies of all 6 rings in wet form AMD and the N 1 wave latencies of 3～6 rings in dry form AMD were delayed statistically.The N 1 and P 1 wave average response densities of 1～4 rings in and the P 1 wave average response densities of 1～6 rings wet form AMD and the N 1 wave average response densities of 1～5 and the P 1 wave average response densties of 1～6 rings in dry form AMD were decreased statistically.The N 1 and P 1 wave average response densities of 1～2 and the P 1wave average response densities of 1～3 rings were decrease statistically in IMH. Conclusion Multifocal electroretinogram can be used to quantitate the visual function of the affected location in age related macular degeneration.

Purpose To observe the features of multi-focal electroretinogram (mERG) in Stargardt′s disease, and evaluate the validity of mERG on diagnosis of this disease. Methods mERG had been recorded in 7 cases (14 eyes) of Stargardt′s disease with VERIS 4.0,and the findings were compared with normal individuals. Results The mERG were remarkably abnormal in all cases of the disease, as the amplitudes of N 1 and P 1 waves were seriously decreased and the latencies were prolonged in all the 6 regions ( P

Objective To measure and compare the difference between the normal control and retinoschisis with multifocal electroretinography. Methods Nineteen cases (21 eyes) of normal control and 8 cases (15 eyes) of inherited retinoschisis were measured with VERIS Science TM 4.0. Three cases (6 eyes) of inherited retinoschisis were tested with Ganzfeld ERG. Results There was statistically significant difference of average response density and latencies in all 6 ring retinal regions between the normal control and retinoschisis. The topography of multifocal ERG showed that multifocal amplitude decreased with disappearing or decreasing of central peak amplitude in patients with retinoschisis. The P 1/N 1 ratio of the multifocal ERG average response densities in 6 ring retinal regions was different from the b/a ratio of the Ganzfeld ERG. Conclusion Each of the multifocal ERG and Ganzfeld ERG has its advantage in the diagnosis of the retinoschisis.