Objective To establish and evaluate a gas chromatography-tandem mass spectrometry(GC-MS/MS)method for the detection of six common drugs(methamphetamine,meperidine,caffeine,codeine,cocaine and ketamine)in blood,and to improve the determination basis of results.Methods The above six drugs were added into the blank blood,and GC-MS/MS was used for detection after ether extraction.The collection,quantification and confirmation were carried out under the mode of multi-reaction monitoring(MRM).The qualitative results of the above six drugs were evaluated based on the maximum allowable deviation of the retention time and relative ion abundance ratio in the qualitative results of GC-MS/MS.Results There was a good linear relationship between the six common drugs,among which ketamine and caffeine had the lowest detection limit(0.01 μg/mL),methamphetamine had the highest detection limit(0.5 μg/mL).The retention time(RT)and relative retention time(RRT)of the target substance were stable under the six supplemental levels,and the absolute deviation(ΔRTabsolute)of RT was within±0.025 min.The absolute deviation of RRT(ΔRRTabsolute)was within±0.004.The relative ion abundance ratio absolute deviation(ΔIabsolute)is±20%,and the relative ion abundance ratio relative deviation(ΔIrelative)is±50%.Conclusion This study clarified the reference range for qualitative determination of six common drugs in blood matrix detected by GC-MS/MS,and effectively supplemented the qualitative determination indicators of existing instrumental analysis methods.

Objective To establish a gas chromatography-mass spectrometry(GC-MS)method for blood samples of death cases with nitrite poisoning and examine the stability of nitrite in blood,so as to provid a reference for inferring the concentration of nitrite in blood at the time of death and determining whether the death was caused by nitrite poisoning.Methods The 1,8-diaminonaphthalene(1,8-DAN)derivatized GC-MS method was used to detect the blood samples of people who died of nitrite poisoning;Blank blood was taken with nitrite standards,and the content was measured regularly.The stability of nitrite in blood was observed,and its concentration change trend was obtained.Results The concentration in blood of 11 cases of nitrite poisoning deaths ranged from 1.165 μg/mL to 351.551 μg/mL;With the increase of time,the concentration of nitrite in the labeled blood samples gradually decreased.Conclusion The detection method established in this research is easy to operate,has high accuracy and good precision.Nitrite is unstable in blood,it is recommended to detect it as soon as possible to prevent missed detection.

Objective To establish a HS-GC test method for the determination of enflurane,isoflurane,diflurane,sevoflurane and its metabolite hexafluoroisopropanol(HFIP)in blood,and to establish a LC-MS/MS method for the determination of trifluoroacetic acid(TFA),the co-metabolite of enflurane,isoflurane,and deflurane in blood.Methods Place 0.5 mL blood sample in a 10 mL headspace bottle,add 1.0 mL ultrapure water to mix,then add 0.5 mL n-butanol internal standard solution,sealed and heated at 70℃for 20 min,take the upper layer of gas for HS-GC analysis,qualitatived by dual-column retention time and quantified by the internal standard curve;Blood sample was acetonitrile precipitated protein,separated by liquid chromatography,scanned with electrospray ionization(ESI),negative ion mode,and examined in multiple reaction monitoring mode(MRM),qualitatived by retention time and characteristic ions,quantified by standard curve.Results The detection limits(LOD)of enflurane,isoflurane,desflurane,heptaflurane,HFIP and TFA are 0.05,0.2,0.5,0.05,0.5 μg/mL and 0.5 ng/mL,and linear range as 1～100 μg/mL(TFA:1～100 ng/mL),with correlation coefficients greater than 0.999.The extraction recovery rate is between 30%and 80%,and the intra-day and inter-day precision are less than 5%.The accuracy is between 85%and 115%.Conclusion This method is quick and simple,and can be used for qualitative and quantitative analysis of enflurane,isoflurane,desflurane,sevoflurane and their metabolites in blood.

Objective: To develop and validate a deep learning model based on fundus photos for the identification of coronary heart disease (CHD) and associated risk factors. Methods: Subjects aged>18 years with complete clinical examination data from 149 hospitals and medical examination centers in China were included in this retrospective study. Two radiologists, who were not aware of the study design, independently evaluated the coronary angiography images of each subject to make CHD diagnosis. A deep learning model using convolutional neural networks (CNN) was used to label the fundus images according to the presence or absence of CHD, and the model was proportionally divided into training and test sets for model training. The prediction performance of the model was evaluated in the test set using monocular and binocular fundus images respectively. Prediction efficacy of the algorithm for cardiovascular risk factors (e.g., age, systolic blood pressure, gender) and coronary events were evaluated by regression analysis using the area under the receiver operating characteristic curve (AUC) and R² correlation coefficient. Results: The study retrospectively collected 51 765 fundus images from 25 222 subjects, including 10 255 patients with CHD, and there were 14 419 male subjects in this cohort. Of these, 46 603 fundus images from 22 701 subjects were included in the training set and 5 162 fundus images from 2 521 subjects were included in the test set. In the test set, the deep learning model could accurately predict patients' age with an R² value of 0.931 (95%CI 0.929-0.933) for monocular photos and 0.938 (95%CI 0.936-0.940) for binocular photos. The AUC values for sex identification from single eye and binocular retinal fundus images were 0.983 (95%CI 0.982-0.984) and 0.988 (95%CI 0.987-0.989), respectively. The AUC value of the model was 0.876 (95%CI 0.874-0.877) with either monocular fundus photographs and AUC value was 0.885 (95%CI 0.884-0.888) with binocular fundus photographs to predict CHD, the sensitivity of the model was 0.894 and specificity was 0.755 with accuracy of 0.714 using binocular fundus photographs for the prediction of CHD. Conclusion: The deep learning model based on fundus photographs performs well in identifying coronary heart disease and assessing related risk factors such as age and sex.
Humans ; Male ; Retrospective Studies ; Deep Learning ; Fundus Oculi ; ROC Curve ; Algorithms ; Risk Factors ; Coronary Disease/diagnostic imaging*

Objective:To investigate the clinicopathological characteristics of primary gastrointestinal stromal tumors (GIST) with PDGFRα mutation and analyze the prognosis of different subtypes.Methods:From Jun 2010 to Jun 2019, the clinicopathological data of 35 patients with primary PDGFRα mutation GIST, who underwent surgical therapy in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively.Results:The main symptoms was abdominal pain (28 cases, 80%), followed by abdominal mass (6 cases, 17%), and hemafecia (1 case, 3%). 31 primary lesions (89%) were located in the stomach and 4 (11%) in other than stomach. 13 cases (37%) were of epithelioid cells, 14 cases (40%) were of spindle cells and 8 cases (23%) were of mixed cells. 27 cases (77%) were CD117 positive , 28 cases (80%) CD34 positive , and 30 cases (86%) were DOG-1 positive. 19 cases (54%) had D842V mutation and 16 cases (46%) had non-D842V mutation. Complete surgical resection was performed in all patients, with no perioperative death. The 3-year recurrence-free survival rate of the D842V mutation group was lower than that of the non-D842V mutation group (84% vs. 100%, P=0.045). Conclusions:The mutation rate of PDGFRα gene was low, mostly derived from the stomach. PDGFRα mutation GIST presents inert biological behavior and the overall prognosis was good.

Objective:To investigate the application of 3D printing technique in percutaneous nephrolithotomy (PCNL) of patients with complicated kidney stones.Methods:From January 2015 to December 2017, 60 patients with complicated kidney stones were enrolled in the First Affiliated Hospital of Hebei North University for prospective study, and PCNL was proposed.All the patients were randomly divided into 3D print group (30 cases) and conventional image inspection group (30 cases, control group). Before operation, CT urography (CTU) was used in both groups.In 3D printing group, digital imaging and communications in medicine (DICOM) files of CT were extracted for 3D image postprocessing, and thermoplastic materials were used to print 3D model.In the 3D printing group, the digital imaging and communications in medicine (DICOM) files of CT were extracted for 3D image post-processing, and the 3D model was printed with thermoplastic materials.According to the comprehensive planning of 3D kidney model, a virtual safe and reliable percutaneous renal access was established for each patient, and PCNL was executed.The patients in the two groups were compared before, during and after operation.Preoperative: age, sex, body mass index, blood creatinine, stone size and CT value.During the operation: (1) the target renal calices location time; (2) the conformity between the preoperative planning and the actual operation; (3) the operation completion time.After operation: (1) stone removal rate; (2) hemoglobin reduction level; (3) postoperative recovery.Results:All the 60 patients successfully completed the operation, 30 patients successfully printed out the 3D model, which can accurately express the relationship between the stone and the adjacent anatomical structure, the internal renal artery and the collecting system.Positioning time of 3D printing group in target renal calices((2.9 ± 1.5) min vs.(5.8 ± 1.7) min, P=0.023), coincidence between simulated and actual puncture calices((89.5 ± 3.5)% vs.(60.2 ± 5.7)%, P=0.005), postoperative stone removal rate ((89.9 ± 4.5)% vs.(75.9 ± 5.2)%, P=0.009), and hemoglobin levels((1.4 ± 0.5) g/L vs.(2.9 ± 1.4) g/L, P=0.032) were superior to the control group, and the difference was statistically significant.But there was no significant difference between the two groups (all P>0.05). Conclusion:The 3D printed kidney model truly restores the anatomical details around the kidneys and stones, providing a stereoscopic and intuitive way to perform surgery, so it maybe has a significance guidance for percutaneous nephrolithotomy.

Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery.Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan.2019 to Dec.2019 in Beijing United Family Hospital and other 18 medical centers,including 78 cases of renal tumor,2 cases of bladder cancer,2 cases of adrenal gland tumor,1 cases of renal cyst,1 case of prostate cancer,1 case of sweat gland carcinoma with lymph node metastasis,1 case of pelvic metastasis after radical cystectomy.All the patients underwent operations.In the laparoscopic surgery group,there were 27 cases of partial nephrectomy,1 case of radical prostatectomy,2 cases of radical cystectomy and 2 cases of adrenalectomy.In the da Vinci robotic surgery group of 54 cases,there were 51 cases of partial nephrectomy,1 case of retroperitoneal lymph node dissection,1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis.There were 41 partial nephrectomy patients with available clinical data for statistic,with a median age of 53.5 years (range 24-76),including 26 males and 15 females.The median R.E.N.A.L score was 7.8 (range 4-11).Before the operation,the engineers established the holographic image based on the contrast CT images and reports.The surgeon applied the holographic image for preoperative planning.During the operation,the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen.Results All the procedures had been complete uneventfully.The holographic images helped surgeon in understanding the visual three-dimension structure and relation of vessels supplying tumor or resection tissue,lymph nodes and nerves.By manipulating the holographic images extracorporeally,the fused image guide surgeons about location vessel,lymph node and other important structure and then facilitate the delicate dissection.For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy,the median operation time was 140 (range 50-225) min,the median warm ischemia time was 23 (range 14-60) min,the median blood loss was 80(range 5-1 200) ml.In the robotic surgery group,the median operation time was 140 (range 50-215)min,the median warm i schemia time was 21 (range 17-40)min,the median blood loss was 150(range 30-1 200)ml.In the laparoscopic surgery group,the median operation time was 160(range 80-225)min,the median warm ischemia time was 25 (range 14-60)min,the median blood loss was 50 (range 5-1 200) ml.All the patients had no adjacent organ injury during operation.There were 2 cases with Clavien Ⅱ complications.One required transfusion and the other one suffered hematoma post-operation.However,the tumors were located in the renal hilus for these 2 cases and the R.E.N.A.L scores were both 11.Conclusions Holographic image navigation can help location and recognize important anatomic structures during the surgical procedures..This technique will reduce the tissue injury,decrease the complications and improve the success rate of surgery.

Objective To study on the procedure, safety and effectiveness of polyetheretherketone (PEEK) implant applied to cranioplasty of skull defect. Methods A total of 11 cases (10 male, 1 female) of unilateral skull defect, more than 6 months post operation, were included in this study. PEEK implant was custom-made by three-dimensional numerically controlled processing depended on the data obtained from 1 mm-slice CT scan before cranioplasty individually. Autoclaved implants were applied to cranioplastic surgeries under general anesthesia. Findings of imaging examination and vital signs were compared before and after operation. Vital sign changes and circumstances during procedure were noted, and following-up reviews were performed on 2-week, 3-month and 1 year after operation respectively. Results Wounds healing were uneventful in 11 cases, no postoperative paresthesia presented. Surgical complications including temporary subcutaneous exudates were cleared up by puncture and aspiration in 5 cases, subcutaneous hematoma duo to drainage removal in 1 case, of which an emergency evacuation was performed and the implant was still with instant incision closure and then smooth recovery eventually. No significant abnormal fluctuation of laboratory examination was reported, moreover no artifact interference was found on postoperative CT scan or MR image. The subjective feelings and external sensory effects are satisfactory in patients. No emerging dysfunction of central nervous system or other organs was found, and no long-term complication was appeared. Conclusion It is feasible and safe to apply PEEK implant to cranioplasty without additional operative difficulty. This kind of material is an ideal alternative for repairing skull defect to patients with good financial condition and specific demands for postoperative status especially.

Objective To establish the quality standards of Zizhu ointment. Methods The TLC was applied to identify Radix arnebiae and borneol of Zizhu ointment, and the content of borneol was determined by gas chromatography. Results The TLC spots were clear, well-separated and easy to identify. The good linear range of borneol reference substance on calibration curve was 0.048 4-1.210 0 μg, and the recovery was 90%-110%, the relative standard deviation was less than 5%. Conclusion The method is simple and feasible, can be used as the quality control method of Zizhu ointment.

Objective Medical ethical problems have become underlying risks since the introduce of Negative pressure wound therapy ( NPWT) in Wound Care Center .The article was to analyze ethical problems in applying new technology in wound care and take intervention countermeasures to investigate the effects . Methods Patients treated by NPWT from January 2009 to Decem-ber 2012 were collected as objectives of investigation from the indexes of compliance rate , cure rate and adverse event rate .The ethical problems related to efficacy ,safety and conflicts of patients′economic interests during the application of NPWT were analyzed .On the basis of the ethnical core principle which was harmless , beneficial, respectful and justifiable , the details of effectiveness and safety of NPWT technique , informed consent form and emergency response protocols of the adverse events were designed according to interna -tional guidelines .Nurses received standardized training to learn new technology . Results 78 cases with chronic wounds accepted negative pressure wound therapy and all cooperated to complete treatment , compliance rate was 100%, no adverse events , the average cure rate was 91 .03%.The treatment costs are less than international and national costs from 75%to 66%. Conclusion Following the ethical principle , informed consent , good communication , strict entry system and standardized operation process make sure the safety and effectiveness of new technology and optimize patients′benefits .