Objective:To develop a U-Net-based quadruple numerical neural network (QU-Net) model for retinal vessel segmentation and to verify its precision and efficiency in extracting and segmenting retinal vessels from fundus images.Methods:This study used the concept of hypercomplex numbers, the three channels of color images, and a quaternion matrix representing all the information data of the images, which was then used as input for quaternion convolution and quaternion fully connected layers based on the U-Net architecture to form a QU-Net model.The QU-Net model was first tested on the DRIVE, STARE, and CHASE_DB1 datasets and compared with the traditional real-valued U-Net, M-Net, and SU-Net models in terms of accuracy, sensitivity, specificity, precision, F1 score, and Matthews correlation coefficient.Finally, the model was further optimized and the optimized QU-Net model was compared side-by-side with the well-known advanced models to comprehensively evaluate and analyze the efficiency and accuracy of the model in extracting and segmenting retinal blood vessels from fundus images.Results:The results showed that the QU-Net model achieved the following vessel segmentation results: accuracy 0.956 6, sensitivity 0.700 8, specificity 0.987 9, precision 0.595 4 on the DRIVE dataset, accuracy 0.975 5, sensitivity 0.890 7, specificity 0.984 2, precision 0.662 5 on the STARE dataset, and accuracy 0.979 4, sensitivity 0.747 0, specificity 0.990 6, precision 0.596 9 on the CHASE_DB1 dataset.Its specificity was better than U-Net, M-Net and SU-Net models, and its accuracy, sensitivity and precision were not inferior to the three models.After optimization, the sensitivity, precision and F1 value of the QU-Net model were effectively improved on the three datasets while maintaining its original accuracy and specificity.When compared with the performance indicators of other models on the three datasets, it was found that the optimized QU-Net model had good performance in accuracy, specificity, sensitivity, precision, and F1 score, indicating that its vessel segmentation ability was not inferior to the advanced models.Among all the models compared, the optimized QU-Net model had the best F1 score and Matthews correlation coefficient.Conclusions:The QU-Net model proposed in this study expands the data dimension space from the traditional real number space to the complex number space and greatly reduces the loss of data information.The optimized QU-Net model has good efficiency and accuracy in extracting retinal vessel segmentation from fundus images, and has certain advantages in detecting fine vessels.

Objective:To investigate the distribution and antimicrobial resistance patterns of common pathogens in children with urinary tract infections in a single center in Shanghai, and to provide basis for the selection of empirical antibiotics in the clinical practice.Methods:The clinical data, urine culture and drug sensitivity tests results of children with urinary tract infections between 0 to 14 years admitted to the Children′s Hospital of Fudan University from January 2016 to December 2019 were retrospectively analyzed. According to the time of onset and the complicated factors, the patients were divided into different groups. The distributions and antimicrobial resistance patterns of common pathogens were compared among the groups. The chi-square test was used for statistical analysis.Results:Among the 1 832 children, 1 042 cases had positive urine culture, with the culture positive rate of 56.9%. The top five pathogens detected were Escherichia coli (375 strains, 36.0%), Enterococcus faecium (164 strains, 15.7%), Klebsiella pneumoniae (133 strains, 12.8%), Enterococcus faecalis (95 strains, 9.1%) and Pseudomonas aeruginosa (44 strains, 4.2%). The annual detection rates of gram-negative bacteria (65.3% to 72.9%) were always higher than those of gram-positive bacteria (22.6% to 30.1%). The distributions of pathogens among the years were not significantly different ( χ2 =27.79, P=0.146). In patients with complicated urinary tract infections, the detection rates of Pseudomonas aeruginosa (5.8%(40/688) vs 1.1%(4/354)) and fungi (6.5%(45/688) vs 1.7%(6/354)) were significantly higher than those in patients with simple urinary tract infections ( χ2=12.68 and 11.79, respectively, both P<0.050). Both of Escherichia coli and Klebsiella pneumoniae had the highest resistance rates to ampicillin, which were 87.2%(301/345) and 87.1%(115/132), respectively. The resistance rates of Escherichia coli to amikacin, nitrofurantoin, fosfomycin, cefmetazole, piperacillin/tazobactam, ertapenem, imipenem and meropenem were 1.4%(5/345), 6.1%(21/345), 6.1%(21/345), 8.3%(11/132), 11.6%(40/345), 6.4%(22/345), 4.6%(16/345) and 4.6%(16/345), respectively. The resistance rates of Klebsiella pneumoniae to these drugs were 6.1%(8/132), 37.9%(50/132), 15.2%(20/132), 23.2%(13/56), 26.5%(35/132), 23.5%(31/132), 17.4%(23/132) and 16.7%(22/132), respectively, which were all higher than those of Escherichia coli, and the differences were all statistically significant ( χ2=6.02, 76.17, 9.99, 7.94, 16.04, 28.29, 20.79 and 18.84, respectively, all P<0.050). The resistance rates of Pseudomonas aeruginosa to cefoperazone/sulbactam, piperacillin/tazobactam and ceftazidime were 6.8%(3/44), 4.5%(2/44) and 2.3%(1/44), respectively, while those to carbapenems, amikacin and ciprofloxacin were all 0(0/44). The resistance rate of Enterococcus faecium to ampicillin was 96.8%(153/158), while that of Enterococcus faecalis was 9.1%(8/88). There was no Enterococcus strain resistant to vancomycin, teicoplanin or linezolid. When dynamically comparing the trends of the antimicrobial resistance from 2016 to 2019, the resistance rates of Escherichia coli and Klebsiella pneumoniae to β-lactams (including carbapenems) antimicrobial agents had shown a downward trend. Conclusions:Gram-negative bacteria are still the main pathogens of urinary tract infections in children, with a downward trend of drug resistance rates to β-lactams (including carbapenems) antimicrobial agents.

Objective:To explore the characteristics of diagnosis, treatment and prognosis of intermittent testicular torsion (ITT) in children.Methods:Retrospective review was conducted for the clinical data of 9 ITT cases from April 2014 to December 2019. The average age of all patients was 11.9 years (range 4.7-13.9 years). The involved side was left ( n=4), right ( n=4) and bilateral ( n=1). The main symptoms included severe pain of rapid onset and rapid resolution associated with nausea and lower abdominal pain ( n=1). The average number of painful episode was 2.4(1-5). There was a number of 1 painful episode in 4 emergency operative cases and more than 1 in 4 elective operative cases and 1 emergency operative cases. One patient of recurrent scrotal pain was relieved by manual detorsion. Among the five emergency operative cases, scrotal swelling and tenderness were found on the affected side, and the cremasteric reflex disappeared. Ultrasonic examination showed that two had absent testicular flow, one had decreased testicular flow, one had normal testicular flow with swelling epididymis and one with torsion of spermatic cord above testis. While among the 4 elective operative cases, the lie of the affected testis with cremasteric reflex was low on physical examination in all patients, compared with the contralateral testis. Atrophy of the affected testis were found in one case and horizontal lie in another one. The duration of prehospital symptoms ranged 4-24 hours during acute presentation in the 5 emergency patients, and 5-24 months in the 4 elective patients. All patients underwent testicular surgical exploration and bilateral orchidopexy. Results:Surgical exploration revealed no testicular ischemic infarction, and the rate of testicular salvage was 100%. A bell-clapper deformity (BCD) was found on all the affected testis and 2 contralateral testis as well. The median time of follow-up time was 10 months (range 1-69 months). No recurrence of testicular pain and other complications was found. Except for one case of testicular atrophy in the affected side before operation, the testicles of all patients recovered well without testicular atrophy.Conclusions:Intermittent testicular torsion is mainly manifested as repeated episodes of sudden onset unilateral scrotal pain that could be spontaneously resolved. The positive clinical findings include a horizontal position of the testes while standing and discrepancy in size of the testes. The ultrasonic examination is diversified because testicular torsion can be spontaneously relieved. Although the rate of testicular salvage is high in ITT, surgical exploration and bilateral scrotal orchiopexy should be carried out as early as possible to prevent recurrent painful episodes and testicular ischemic damage.

Objective To compare the outcomes of Yang-Monti channels and appendix in the practice of catheterizable continent urinary conduits.Methods Retrospective analyses were conducted in 27 cases with neurogenic bladder from July 2009 to December 2015,including 8 male and 19 female patients whose average age at surgery was 7.6 years old (range:1.5-16 years).The average bladder volume is (203.8 ± 126.0) ml.The bladder compliance values of 24 cases are lower than 20 ml/cm H2O.Seventeen cases had urinary infection combined with fever before surgery,while 6 cases had stress urinary incontinence and 17 cases had dysuria.Seven cases including 2 male patients underwent urinary diversion with YangMonti channels (YM group) and the average age at surgery for patients was 6.7 years old (range:4-16years).Twenty cases including 6 male patients underwent urinary diversion with appendix (AP group) and the average age at surgery for patients was 8.0 years old(range:1.5-14 years).The 3-day urinary diaries were collected in all cases including their records of average catheterization interval,average catheterization volume,stoma stenosis and stoma leakage.The data between the two groups was compared and the statistical analysis was performed.Results Of the 7 patients undergoing Yang-Monti channels,2 cases underwent open surgery and 5 cases underwent laparoscopic surgery in which 2 cases transferred to open surgery.The stoma stenosis occurred in 1 case and the stoma leakage occurred in 1 case.The average catheterization volumc is (239.3 ± 76.2) ml and the average catheterization interval is (2.8 ± 0.9) h.Six patients in the group were followed up less than 3 years,of which the average catheterization interval is (2.6 ± 0.8) h.Of the 20 patients undergoing appendix channels,3 cases underwent open surgery and 17 cases underwent laparoscopic surgery in which 1 case transferred to open surgery.The stoma stenosis occurred in 1 case and the stoma leakage occurred in 2 cases.The average catheterization Volumee is (257.0 ± 67.4) ml and the average catheterization interval is (3.9 ± 0.9)h.Six patients in the group were followed up less than 3 years,of which the average catheterization interval is(3.5 ± 1.0) h.There was no difference in stoma stenosis and stoma leakage and average catheterization volume between the two groups (P ＞ 0.05).There was no difference in average catheterization interval between the patients of two groups who were followed up less than 3 years (P ＞ 0.05).Conclusions Yang-Monti conduits are durable and reliable,which was similar with appendix conduits.

Objective To explore the efficacy of Cohen ureteric reimplantation for congenital malformation of vesicoureteral junction in children.Methods From February 2014 to August 2016,12 children with congenital monstrositas of vesicoureteral junction obstruction who were treated with pneumoeystoscopic Cohen ureteric reimplantation in Guizhou Provincial People's Hospital were selected.In these cases,8 males and 4 females,their ages ranged from 2 months past 1 year to 11 years,and the average age was 5.26 years.In the 12 patients,there were 6 cases with left vesicoureteral junction obstruction,and 1 case with right vesicoureteral junction obstruction,1 case with left ureter cyst and duplication of ureter ectopic opening,1 case with right duplex kidney and ureter cyst,1 case with right primary vesicoureteric reflux and left vesicoureteral junction obstruction,2 cases with bilateral primary vesicoureteric reflux and 1 case with ureter cyst.A foley catheter and ureteral stent was indwelled in each patient but no bladder fistula was made.All of the patients underwent pneumocystoscopic Cohen ureteric reimplantation.The stenting catheters were removed in 1-3 months after surgery.B ultrasonography was used to follow the degree of the dilatation of ureter and hydronephrosis.Urinalysis was conducted to detect the urinary tract infection.Intravenous urography examination was conducted to detect anastomotic stenosis.Voiding cystourethrography was performed to show ureteral reflux.Results All procedures were accomplished without conversion.The duration of operations ranged from 100 to 330 min (mean 207 min).All patients were followed up for 3 to 10 months,but no urinary tract infection and anastomotic obstruction occurred,and B ultrasonography showed that hydronephrosis or dilatation of ureter were improved in different degrees or disappeared.Two cases of ureteral reflux occurred in the early follow-up,and these cases recovered after being given symptomatic treatment.Conclusions The pneumocystoscopic Cohen ureteric reimplantation is a safe and effective option for congenital malformation of vesicoureteral junction in children.

Objective To summarize the complications of the single-port transumbilical laparoscopic pyeloureteroplasty.Methods From August 2009 to December 2014, 162 surgical procedures were performed in our institute with the single-port transumbilical laparoscopic pyeloureteroplasty.Medical records of each procedure were retrospectively evaluated.139 patients were male and 23 female, aged from 1 month to 14 years and the median age of 2 years.127 patients were operated on the left side and 32 on the right side.3 patients were operated on the bilateral side.All children were supplemented with preoperative ultrasound, renal dynamic imaging and MRU to identify the ureteropelvic junction obstruction.Intraoperative and postoperative complications were graded according to the Satava and Clavien classifications respectively.Major complications were defined as Satava grade Ⅱ or higher, and Clavien grade Ⅲ or higher.Results There was no injury of vascular or visceral organs and no blood transfusion, and there was no serious intraoperative complications.One hundred and forty-three cases were followed up, and 23 cases (16.1％)presented with postoperative fever (＞ 38 ℃C) (Clavien Ⅰ), 2 cases (1.4％) with urinary extravasation diagnosed by perirenal fluid collection(Clavien Ⅰ).All these cases recovered after being given symptomatic treatment.7 cases (4.9％) presented with postoperative repeated urinary infection (Clavien Ⅱ).5 cases received postoperative reoperation due to the obstruction of the anastomic site (Clavien Ⅲ b), and 2 cases were under debridement as the greater omentum was drawn out along with the negative pressure drainage tube(Clavien Ⅲ a).In summary, the incidence of severe postoperative complications was 4.9％.Conclusions Though there existed some postoperative complications of the single-port transumbilical laparoscopic pyeloureteroplasty, the incidence of serious complications was low and the overall prognosis could be good.

OBJECTIVETo study and summarize the etiology of children patients with chronic kidney disease (CKD) stage 2 to 5 seen in Children's Hospital of Fudan University from Jan. 2004 to Dec. 2013.

METHODBy complying with the NKF-K/DOQI guidelines, we collected data of 264 cases of children patients with CKD stage 2-5 from Jan. 2004 to Dec. 2013 in the medical record system of Children's Hospital of Fudan University. And we retrospectively analyzed their age and CKD stage at first diagnosis, primary diseases, complications, etc.

RESULTIn the collected 264 cases, 52 cases (19.7%) were diagnosed at stage 2, 67 (25.4%) at stage 3, 52 (19.7%) at stage 4 and 93 (35.2%) at stage 5. For disease causes, 116 cases (43.9%) had congenital anomalies of the kidney and urinary tract (CAKUT), 61 cases (23.1%) had glomerular disease, 15 (5.7%) had hereditary kidney disease, 14 (5.3%) had other diseases and in 58 cases (22.0%) the causes of disease were unknown. In the group with age between 0 and 3.0 and 3.1 and 6.0 years, 57.1% (24 cases) and 60.0% (30 cases) had primary disease with CAKUT. In the group with age older than 10 years, 49.2% (30 cases) had primary disease with glomerular disease and 32.0% (32 cases) with unknown causes.

CONCLUSIONThe major cause of CKD stage 2-5 in children in our hospital during the last ten years was CAKUT (43.9%), followed by glomerular disease (23.1%). The primary diseases of CKD were significantly different between the 2 age groups. CAKUT was more common in infants and preschool children while for adolescents, glomerular disease was the major cause.

Child ; Child, Preschool ; China ; Humans ; Infant ; Infant, Newborn ; Kidney ; physiopathology ; Renal Insufficiency, Chronic ; etiology ; Retrospective Studies

Objective To compare the clinical results of the ureteral reimplantation with the traditional open approach and laparcocopic pneumovesical approach. Methods A retrospective review of 108 patients who underwent ureteral reimplantation from December 2004 to October 2010 was conducted.The patients were divided into open and pneumovesical groups according to the surgical approach.Perioperative results were compared between the two groups in terms of operative time,postoperative intravenous antibiotics duration,catheterization duration,postoperative stay,average total cost and surgical cost,respectively.And the pneumovesical group was divided into two stages by time,compared the operative time of the two stages and between the later stage and the open group. Results The postoperative hospital stay of pneumovesical group was shorter than the open group (6.8 ± 1.9 d and 8.9 ± 2.9 d,P =0.002 ).For catheterization duration,the pneumovesical group was shorter than the open group as well (5.2 ± 1.2 d and 6.2 ±2.2 d,P=0.057).For the postoperative intravenous antibiotics duration,the pneumovesical group was 5.0 ± 1.3 h,the open group was 5.4 ±1.6 h (P =0.159).For the total cost,the pneumovesical group was 16 067.9 ±4 295.8 RMB,the open group was 15 617.7 ± 5 486.5 R MB (P =0.168).For the surgical cost,the pneumovesical group was 9369.4 ± 1366.6 RMB,the open group was 7397.9 ± 1797.3 RMB ( P =0.083 ).Operative duration of the pneumovesical group and open group were 3.2 ± 1.1 h and 2.3 ± 1.1 h ( P =0.003).For pneumovesical group,the mean operative durations of the two stages were 3.6 h and 2.8 h (P =0.286).And the later stage of pneumovesical group was a little longer than the open group,but no significant difference ( P =0.234 ).No major complication was found in the 2 groups during the operative time and the postoperative hospital stay.Twenty-four patients (38 ureters) of the pneumovesical group were followed up with micturating cystourethrography ( MCU),ureterovesical reflux recurred in 3 patients.Two patients changed from grade Ⅲ to grade Ⅰ and 1 patient changed from grade Ⅴ to grade Ⅲ after the surgery.Five patients (9 ureters) of the open group were followed up,1 patient found bladder diverticulum; 1 patient found ureteral stricture 6 months after the surgery and got improved after secondary ureteral relimplantation surgery. Conclusions The pneumovesical approach is shorter than the open group in postoperative hospital stay and catheterization reserved duration.The pneumovesical approach is a safe and effective option for ureteral reimplantation.

A high-performance liquid chromatography coupled ultraviolet (HPLC-UV) method was developed for a chemical fingerprint analysis ofViscum coloratum. Eighteen peaks were selected as the common peaks and Homoeriodictyol-7-O-β-D-apiosiyl-(1→2)-β-D-glucoside was used as a reference.The relative areas of common peaks were used for hierarchical clustering analysis and similarity calculation.Thirty-seven samples collected from different sources were classified imo five groups.The similarities of 21 batches Viscum coloratuma samples were beyond 0.90.The results obtained suggest that the chromatographic fingerprint can efficiently identify Viscum coloratum.Additionally,the fingerprints can then be used to evaluate the correlation between Viscum coloratum and hosts.

A high-performance liquid chromatography coupled ultraviolet （HPLC-UV） method was developed for a chemical fingerprint analysis of Viscum coloratura. Eighteen peaks were selected as the common peaks and Homoeriodictyol-7-O-β-D-apiosiyl-（1→2）-β-D-glucoside was used as a reference. The relative areas of common peaks were used for hierarchical clustering analysis and similarity calculation. Thirty-seven samples collected from different sources were classified into five groups. The similarities of 21 batches Viscum coloratura samples were beyond 0.90. The results obtained suggest that the chromatographic fingerprint can efficiently identify Viscum coloratum. Additionally, the fingerprints can then be used to evaluate the correlation between Viscum coloratura and hosts.