Objective:To evaluate the performance of an artificial intelligent (AI)-based automated digital cell morphology analyzer (hereinafter referred as AI morphology analyzer) in detecting peripheral white blood cells (WBCs).Methods:A multi-center study. 1. A total of 3010 venous blood samples were collected from 11 tertiary hospitals nationwide, and 14 types of WBCs were analyzed with the AI morphology analyzers. The pre-classification results were compared with the post-classification results reviewed by senior morphological experts in evaluate the accuracy, sensitivity, specificity, and agreement of the AI morphology analyzers on the WBC pre-classification. 2. 400 blood samples (no less than 50% of the samples with abnormal WBCs after pre-classification and manual review) were selected from 3 010 samples, and the morphologists conducted manual microscopic examinations to differentiate different types of WBCs. The correlation between the post-classification and the manual microscopic examination results was analyzed. 3. Blood samples of patients diagnosed with lymphoma, acute lymphoblastic leukemia, acute myeloid leukemia, myelodysplastic syndrome, or myeloproliferative neoplasms were selected from the 3 010 blood samples. The performance of the AI morphology analyzers in these five hematological malignancies was evaluated by comparing the pre-classification and post-classification results. Cohen′s kappa test was used to analyze the consistency of WBC pre-classification and expert audit results, and Passing-Bablock regression analysis was used for comparison test, and accuracy, sensitivity, specificity, and agreement were calculated according to the formula.Results:1. AI morphology analyzers can pre-classify 14 types of WBCs and nucleated red blood cells. Compared with the post-classification results reviewed by senior morphological experts, the pre-classification accuracy of total WBCs reached 97.97%, of which the pre-classification accuracies of normal WBCs and abnormal WBCs were more than 96% and 87%, respectively. 2. The post-classification results reviewed by senior morphological experts correlated well with the manual differential results for all types of WBCs and nucleated red blood cells (neutrophils, lymphocytes, monocytes, eosinophils, basophils, immature granulocytes, blast cells, nucleated erythrocytes and malignant cells r>0.90 respectively, reactive lymphocytes r=0.85). With reference, the positive smear of abnormal cell types defined by The International Consensus Group for Hematology, the AI morphology analyzer has the similar screening ability for abnormal WBC samples as the manual microscopic examination. 3. For the blood samples with malignant hematologic diseases, the AI morphology analyzers showed accuracies higher than 84% on blast cells pre-classification, and the sensitivities were higher than 94%. In acute myeloid leukemia, the sensitivity of abnormal promyelocytes pre-classification exceeded 95%. Conclusion:The AI morphology analyzer showed high pre-classification accuracies and sensitivities on all types of leukocytes in peripheral blood when comparing with the post-classification results reviewed by experts. The post-classification results also showed a good correlation with the manual differential results. The AI morphology analyzer provides an efficient adjunctive white blood cell detection method for screening malignant hematological diseases.

Objective:To analyze the radiological protection situation in the workplace of medical X-ray diagnostic equipment in primary medical institutions in south Xinjiang Uygur Autonomous Region, and then put forward necessary measures and suggestions.Methods:In accordance with the national medical radiation protection monitoring program and the requirements of relevant standards for radiological health, medical X-ray diagnostic equipment in radialogical diagnosis and treatment institutions was tested selectively for workplace radiological protection, with the result statistically analyzed.Results:From 2018 to 2021, radiological protection test was conducted for 84 workplaces in 15 radiological diagnosis and treatment institutions in 4 districts of south Xinjiang, with a pass rate of 98.8%, which was consistent with the mainland including the eastern and central regions in the country.Conclusions:Based on the current situation in radiological diagnosis and treatment institutions on medical radiation protection in south Xinjiang, it is recommended to strengthen the supervision and management of radiological diagnosis and treatment equipment, improve the testing and technical capabilities of the local medical radiation monitoring technical teams and raise the level of radiological health work in the south Xinjiang.

Objective To investigate the perioperative risk factors associated with prognoses of patients with acute ischemic stroke accepted mechanical thrombectomy under general anesthesia.Methods The clinical data of 108 patients with acute ischemic stroke,admitted to and accepted mechanical thrombectomy under general anesthesia in our hospital from January l,2016 to October 31,2018,were collected.According to modified Rankin scale (mRS) scores 90 d after surgery,patients were divided into good prognosis group (mRS scores ≤2) and poor prognosis group (mRS scores ≥3).Univariate analysis was used to compare the general data (age,gender,body mass index,and underlying diseases) and perioperative conditions (immediate heart rate,systolic and diastolic blood pressures immediately after admission,operative time,and anesthesia time) between the two groups of patients.Multivariate Logistic regression analysis was used to identify the perioperative risk factors influencing the prognoses of patients with acute ischemic stroke accepted mechanical thrombectomy.Results Among the 108 patients,65 had good prognosis and 43 had poor prognosis.Univariate analysis showed that there was no significant difference in general data between the two groups (P＞0.05),but there were significant differences in heart rate immediately after admission,National Institutes of Health Stroke Scale (NIHSS) scores immediately after admission and 3 d after operation,maximum hemoglobin and blood glucose values from immediately after admission to 3rd d of operation,and thrombolysis in myocardial infarction (TIMI) blood flow classification (P＜0.05).Multivariate Logistic regression analysis showed that heartrate immediately after admission (OR=1.035,95％CI:1.002-1.067,P=0.037) and NIHSS scores 3 d after operation (OR=1.153,95％CI:1.016-1.272,P=0.030) were the perioperative risk factors influencing the prognoses of patients with acute ischemic stroke accepted mechanical thrombectomy.Conclusion For patients with acute ischemic stroke who have rapid heart rate immediately after admission and high NIHSS scores 3 d after mechanical thrombectomy,possibility of poor prognosis should be noticed.

Objective To study the influence of clinical nutritional support on the effects of mechanical ventilation (MV), and to find the factors affecting the outcome of patients undergoing MV. Methods A case-control study was conducted. The clinical data of 235 patients undergoing MV admitted to intensive care unit (ICU) of Tongde Hospital of Zhejiang Province from January 2015 to June 2017 were retrospectively analyzed. The patients were divided into two groups according to whether weaning successfully within 7 days. The clinical data of patients in the two groups were collected including gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, underlying disease, nutritional indicators, nutritional support, and complications. The outcome of withdrawal within 7 days was served as a dependent variable, all observed indicators were served as independent variables, and Logistic regression analysis was carried out to screen the influencing factors of the weaning results within 7 days. Results 235 patients undergoing MV were enrolled, 128 patients were successfully withdrawn within 7 days, and 107 were unsuccessfully withdrawn. Compared with the successful weaning group, the patients of weaning failure group were older, and had higher APACHEⅡ score and lower albumin (Alb) and hemoglobin (Hb), more patients with internal medical underlying diseases and receiving parenteral nutrition (PN) and mixed nutrition, and the incidences of secondary infection, vomiting, abdominal distension, abnormal bowel sound, gastric retention, and diarrhea were higher. However, there was no statistical significance in gender between the two groups. The variables of statistical significance in univariate analysis were enrolled in the multifactor analysis model showing that age [odds ratio (OR) = 1.269, 95% confidence interval (95%CI) = 1.119-1.439, P < 0.001], APACHEⅡ score (OR = 1.643, 95%CI = 1.423-1.897, P < 0.001), internal medical underlying diseases (OR = 6.298, 95%CI = 4.012-9.887, P < 0.001), secondary infection (OR = 8.323, 95%CI = 2.568-26.975, P < 0.001), abdominal distension (OR = 3.368, 95%CI = 1.586-7.152, P = 0.002), abnormal bowel sounds (OR = 2.856, 95%CI = 1.215-6.713, P = 0.017), gastric retention (OR = 1.996, 95%CI = 1.183-3.368, P = 0.010), diarrhea (OR = 3.035, 95%CI = 1.337-6.890, P = 0.008) were risk factors for unsuccessful weaning,and compared with PN, enteral nutrition (EN; OR = 0.191, 95%CI = 0.098-0.372, P < 0.001) and mixed nutrition (OR = 0.375, 95%CI = 0.150-0.938, P = 0.037) were protective factors of successful weaning. The gender, Alb and Hb before and after MV, vomiting, gastrointestinal hemorrhage were not associated with weaning outcome within 7 days. Conclusions Elder, high APACHEⅡ score, internal medical underlying diseases, or secondary infection, abdominal distension, abnormal bowel sounds, gastric retention, diarrhea were risk factors of weaning failure within 7 days in patients undergoing MV. Compared with PN, EN and mixed nutrition were protective factors for successful weaning. For patients undergoing MV, EN should be performed early in the case of full recovery, hemodynamic stability, and serious metabolic disorders.

Objective To pay more attention to the adverse drug reactions caused by tigecycline. Methods Four cases in our hospital which happened acute or subacute liver failure after the uses of tigecycline were analyzed, including age, basic disease, drug combination,the time when liver function failure happen ,dosage of tigecycline and the course of treatment. Results The aged of four patients was 49-77 years old, the average age (67.5±12.79)years; the time when liver failure happened from 6 d to 20 d, the average(11.75±6.24) d; the course of treatment was 9 d to 23 d, the average(9.75±6.63) d; the total dose of tigecycline was 900 mg to 3650 mg, the average (1812.5±1243.23) mg.The four patients have many basic diseases, combined with many drugs, all of them have mechanical ventilation. Conclusion More attention should be paid to adverse events caused by tigecycline.

Objective To assess the value of apparent diffusion coefficient (ADC)map with low b-value to monitor the ablated tissue after high-intensity focused ultrasonic (HIFU)treatment for uterine fibroids.Methods 25 patients with 34 uterine fibroids were treated with HIFU.All patients underwent the routine MRI scans (including pre-and post-contrast scanning)and monoexponential model DWI with b values of 150,600 and 1 000 s/mm2 before the surgery and within 24 hours after the surgery.The mean ADC values with different b-values of the ablated and non-ablated tissues between pre-and post-treatment were analyzed by one-way ANOVA test.The consistency of the ablation area between ADC maps with different b-values and contrast enhancement MRI were evaluated. Results With the b-value of 150 s/mm2 ,the mean ADC value of the ablated tissue was (1.48±0.27)×10-3 mm2/s,which was less significantly than that of pre-treatment (2.06±0.21)×10-3 mm2/s and non-ablated tissue (1.98±0.23)×10-3 mm2/s (P<0.05). However,there were no significant differences in ADC values with the b values of 600 s/mm2 and 1 000 s/mm2 among those areas (P>0.05).A fine consistency of the ADC map with the low b-value (150 s/mm2 )was found with non-perfusion volume on contrast-enhanced T1 WI,which was superior to that with high b-values (600 s/mm2 and 1 000 s/mm2 )(P<0.05).Conclusion ADC map with low b-value (150 s/mm2 )can be used to evaluate the blood-supply changes and ablated volume of uterine fibroids indirectly,which helps to assess the treatment effect of HIFU.

Objective To investigate and analyze the accuracy and correlation between the fast blood glucose meter and the bio-chemical analyzer in detecting blood glucose level.Methods 500 cases of blood glucose detection in the hospital from March 2011 to March 2013 were collected and divided into 3 groups according to the blood sugar level.The fast blood glucose meter and the bio-chemical analyzer were adopted to measure and record the blood sugar level.The differences in the measured results were compared between the two methods.Results According to the the glucose POCT application criteria issued by US National Committee for Clinical Laboratory Standards(NCCLS)2002,among 15 fast blood glucose meters,4 blood glucose meters were in the high blood glucose level and 1 meter was in the low blood glucose level,all exceeded the required range.Conclusion The blood glucose meter can quickly provide the blood glucose values,but when the blood glucose level is high,the detection results have large difference, which should be paid much attention in clinc.

Objective To investigate the effect of continuous veno-venous hemofiltration (CVVH) on pulmonary vascular permeability in the early stage of septic shock.Methods Fifty-one patients of septic shock admitted in intensive care unit of the First Affiliated Hopsital of Medical College,Zhejiang University between June 2010 and December 2011 were randomized into two groups by simple random method.Routine treatment was carried out to patients in group A,and routine treatment plus CVVH to patients in group B in the first 72 hours.Repeated respiratory mechanic hemodynamic measurements were done at baseline (Tb) before treatment,at 48 hours (T48) and 72 hours (T72) after the treatment.Pulmonary compliance (Cst),platform pressure (Pplat),oxygenation index (PaO2/FiO2),extravascular lung water index (EVLWI) and E-selectin determined at each time point were recorded in two groups.Results (1) Pplat were decreased significantly after treatment in two groups,and the Pplat in group B were all lower than those in group A at T48 and T72 (t =2.215,P ＜ 0.05 ; t =4.266,P ＜ 0.01).Cst were elevated after treatment in two groups,and Cst in group B were all higher than those in group A at T48 and T72 (t =2.516,P ＜0.05 ; t =3.052,P ＜ 0.01).(2) Compared to before treatment,PaO2/FiO2 increased significantly after treatment in two groups,and PaO2/FiO2 in group B were all higher than those in group A at T48 and T72 (t =2.732,P ＜0.01 ; t =3.511,P ＜0.01).(3) EVLWI were decreased significantly after treatment in two groups,and the EVLWI in group B were all lower than those in group A at T48 and T72 (t =2.597,P ＜0.05; t =2.125,P ＜ 0.05).ITBVI,CI,SVRI and MAP did not change over time in two groups compared with those at Tb (all P ＞ 0.05).(4) E-selectin were decreased significantly after treatment in two groups,and the E-selectin in group B were all lower than those in group A at T48 and T72 (t =2.154,P ＜0.05 ; t =3.581,P ＜ 0.01).Conclusion CVVH in early stage of septic shock can improve pulmonary vascular permeability and oxygenation,increase Cst,and decline EVLWI,with neither increased hemodynamics.

Objective To investigate the clinical characteristics of sever acute pancreatitis (SAP) with high triglyceride(TG). Methods 82 patients with onset of SAP within 72 hours were involved in this study. These patients were divided into high TG group (n=26) and normal TG group (n=56) according to serum TG lev-els tested (high TG group≥1.7 mmoL/L;normal TG group<1.7 mmol/L on admission). Results 31.71% (26/82) SAP patients were discovered with high TG APACHE-Ⅱ grade of high TG group was higher than that of normal TG group on admission[(14.62±7.58) vs (10.68±5.21),P<0.01]. Within the onset of 72 hours,the incidence of cardiac,pulmonary and kidney dysfunction in high TG group was higher than those of normal TG group (34.62%,34.62% and 19.23% vs 5.36%,3.57% and 1.79%,P<0.01),and the incidence of pancreatic pseudocysts was higher in high TG group than that of normal group(42.31% vs 7.14%,P<0.01). No emergency and early-stage surgical cases in high TG group but 13 cases(23.21%) in normal group. There were 2 cases of high TG group and 4 of normal group averting to operation. Conclusion SAP patients with high TG have high incidence of early-stage organ dysfunction and local complication,in this case nonsurgical intervention is the first choice.

In early stage of the severe acute pancreatitis, mediators of inflammation make the permeability of the microcirculation blood vessel increasing and more fluidify aggregates in tissue space. Pancreatic tissue is dropsical and necrotic ; a great quantity of body fluid accumulates in abdominal cavity, which induce utility circulation volume and returned blood volume decreasing rapidly. As more and more utility circulation volume decreases, the blood current of the coronary arterY is insufficient and the cardiac muscle cell is ischemic, the cardiac muscle is suffering injury to different extent. The cardiac load is overweight relatively. The cardiac muscle fiber is prolonged and interchanged idand cardiac muscle cellular membrane is damaged. The chain reaction and magnification of the mediators of inflammation let body delivery generous cell factors such as TNF-α,interleukin, oxygen free radical and so on, which make cardiac muscle cell's integrality damage,apoptosis,cardiac functional disturbance even exhaustion. In addition, abdominal compartment syndrome,pancreatitis associated ascetic fluid and electrolyte disturbances etc are also the important factors that affect the development of the disease.