Objective:To assess the value of the ROX index in evaluating the efficacy of high-flow nasal cannula oxygen therapy (HFNC) in patients with coronavirus infected disease (COVID-19).Methods:This is a retrospective study. The included patients were diagnosed as COVID-19 in the intensive care unit (ICU) of the Cancer Center of Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from February 15, 2020 to March 15, 2020. All the patients were treated by HFNC. According to whether the patient subsequently received non-invasive positive pressure ventilation or invasive positive pressure ventilation, patients were divided into the HFNC success group and the HFNC failure group. Parameters in the two groups such as basic characteristics, lactic acid, number of chest radiographs, APACHE II, lymphocyte count, baseline respiratory rate, baseline percutaneous oxygen saturation, baseline PaO 2/FiO 2, baseline ROX index, and ROX index after 2, 6 and 12 h HFNC treatment were analyzed with t test, Chi-square test or rank sum test. Results:A total of 57 cases were included in this study. There were no significant differences in sex, age, comorbidities, lactic acid, quadrants of chest radiograph lung infection, APACHE II, lymphocyte count, and baseline respiratory frequency, transcutaneous oxygen saturation, oxygenation index, and ROX index between the HFNC success group and the HFNC faliure group ( P>0.05). Logistic regression analysis showed that ROX index after 2 h HFNC treatment ( OR=0.069), ROX index after 6 h HFNC treatment ( OR=0.194) and ROX index after 12 h HFNC treatment ( OR=0.036) were all protective factors for the therapeutic effect of HFNC treatment in COVID-19 patients. ROC curve showed that there were significant differences in ROX index after 2 h HFNC treatment, ROX index after 6 h HFNC treatment, and ROX index after 12 h HFNC treatment ( P<0.05). In the evaluation index, the area under the ROC curve of the ROX index after 2 h HFNC treatment was 0.838, the sensitivity was 64.5%, and the specificity was 100%. After 6 h HFNC treatment, the area under the ROX index ROC curve was 0.762, the sensitivity was 64.5%, and the specificity was 92.3%. After 12 h HFNC treatment, the ROX index ROC curve area was 0.866, the sensitivity was 67.7%, and the specificity was 100%. Conclusions:The ROX index can be used to evaluate the efficacy of HFNC in COVID-19 patients in a timely, simple and real-time manner.

Objective To investigate the value of automatic segmentation of carotid vessel wall in multicontrast MR images using U?Net neural network. Methods Patients were retrospectively collected from 2012 to 2015 in Carotid Atherosclerosis Risk Assessment (CARE II) study. All patients who recently suffered ischemic stroke and/or transient ischemic attack underwent identical, state?of?the?art multicontrast MRI technique. A total of 17 568 carotid vessel wall MR images from 658 subjects were included in this study after inclusion criteria and exclusion criteria. All MR images were analyzed using customized analysis platform (CASCADE). Randomly, 10 592 images were assigned into training dataset, 3 488 images were assigned into validating dataset and 3 488 images were assigned into test dataset according to a ratio of 6∶2∶2. Data augmentation was performed to avoid over fitting and improve the ability of model generalization. The fine?tuned U?Net model was utilized in the segmentation of carotid vessel wall in multicontrast MR images. The U?Net model was trained in the training dataset and validated in the validating dataset. To evaluate the accuracy of carotid vessel wall segmentation, the sensitivity, specificity and Dice coefficient were used in the testing dataset. In addition, the interclass correlation and the Bland?Altman analysis of max wall thickness and wall area were obtained to demonstrate the agreement of the U?Net segmentation and the manual segmentation. Results The sensitivity, specificity and Dice coefficient of the fine?tuned U?Net model achieved 0.878,0.986 and 0.858 in the test dataset, respectively. The interclass correlation (95% confidence interval) was 0.921 (0.915-0.925) for max wall thickness and 0.929 (0.924-0.933) for wall area. In the Bland?Altman analysis, the difference of max wall thickness was (0.037±0.316) mm and the difference of wall area was (1.182±4.953) mm2. The substantial agreement was observed between U?Net segmentation method and manual segmentation method. Conclusion Automatic segmentation of carotid vessel wall in multicontrast MR images can be achieved using fine?tuned U?Net neural network, which is trained and tested in the large scale dataset labeled by professional radiologists.

Objective: To investigate the value of automatic segmentation of carotid vessel wall in multicontrast MR images using U-Net neural network. Methods: Patients were retrospectively collected from 2012 to 2015 in Carotid Atherosclerosis Risk Assessment (CARE II) study. All patients who recently suffered ischemic stroke and/or transient ischemic attack underwent identical, state-of-the-art multicontrast MRI technique. A total of 17 568 carotid vessel wall MR images from 658 subjects were included in this study after inclusion criteria and exclusion criteria. All MR images were analyzed using customized analysis platform (CASCADE). Randomly, 10 592 images were assigned into training dataset, 3 488 images were assigned into validating dataset and 3 488 images were assigned into test dataset according to a ratio of 6∶2∶2. Data augmentation was performed to avoid over fitting and improve the ability of model generalization. The fine-tuned U-Net model was utilized in the segmentation of carotid vessel wall in multicontrast MR images. The U-Net model was trained in the training dataset and validated in the validating dataset. To evaluate the accuracy of carotid vessel wall segmentation, the sensitivity, specificity and Dice coefficient were used in the testing dataset. In addition, the interclass correlation and the Bland-Altman analysis of max wall thickness and wall area were obtained to demonstrate the agreement of the U-Net segmentation and the manual segmentation. Results: The sensitivity, specificity and Dice coefficient of the fine-tuned U-Net model achieved 0.878,0.986 and 0.858 in the test dataset, respectively. The interclass correlation (95% confidence interval) was 0.921 (0.915-0.925) for max wall thickness and 0.929 (0.924-0.933) for wall area. In the Bland-Altman analysis, the difference of max wall thickness was (0.037±0.316) mm and the difference of wall area was (1.182±4.953) mm². The substantial agreement was observed between U-Net segmentation method and manual segmentation method. Conclusion Automatic segmentation of carotid vessel wall in multicontrast MR images can be achieved using fine-tuned U-Net neural network, which is trained and tested in the large scale dataset labeled by professional radiologists.

Objective To compare the clinical curative effect of bridge combined internal fixation system (BCFS) and digital customized steel plate(DCSP) for treating complex extremity fracture.Methods Fortyseven cases of complex extremity fracture in this hospital from October 2012 to October 2015 were treated by BCFS and DCSP,among them,26 cases adopted BCFS(BCFS group) and 21 cases were treated by DCSP(DCSP group).Then the operation time,intraoperative blood loss volume,hospitalization time,healing time of fracture,postoperative complications and function evaluation of limbs were compared between the two groups.Results The two group were followed up for 6-15 months with an average of(13.57±1.37)months.The DCSP group was better than the BCFS group in the aspects of operation time and intraoperative blood loss volume,the difference was statistically significant(P＜0.05).The fracture healing time in the BCFS group was significantly shorter than that in the DCSP group,the difference was statistically significant(P＜0.05).The hospitalization time,postoperative complications and function evaluation of limbs had no statistical differences between the two groups(P＞0.05).Conclusion Both BCFS and DCSP can acquire good clinical curative effect in the treatment of complex extremity fracture,however BCFS has a shorter healing time of fracture.

Objective To evaluate the influences of statin treatment on MR vessel wall imagingobserved characteristics of atherosclerotic plaque in the thoracic aorta of the elderly.Methods Elderly subjects (≥ 60 years) without any serious cerebro-cardiovascular diseases were recruited.Thoracic aorta was imaged on MR scanner for all the subjects.The plaque burden was calculated quantitatively,the composition of plaque in thoracic aorta was evaluated qualitatively,and the contributions of statin treatment to these characteristics were also compared by image interpretation personals.The thoracic aorta was divided into three segments (AAO:ascending aorta;AOA:aortic arch,and DOA:descending aorta)on the imaging.Results Totally 55 recruited subjects had atherosclerotic plaque in thoracic aorta,with 24 subjects receiving statin treatment,and 50 ％ (12/24) male,aged 73.8±6.3 years.The level of LDL C[(2.4±0.7)mmol/L vs.(3.1±0.8)mmol/L(P＜ 0.01)]and total cholesterol[(4.4±0.6)mmol/L vs.(5.1 ±1.0)mmol/L(P＜0.01)]were significantly lower in statin group than in non-statin group.The lumen area,wall area,and total vessel area in all three segments of thoracic aorta were significantly smaller in statin group(all P＜0.05)than in nonstatin group.The average wall thickness in segment of AOA[(2.7±0.3)mm vs.(2.8±0.4)mm(P＜0.01)]and DAO[(2.5±0.4)mm vs.(2.6±0.5)mm(P＜0.01)]were smaller in statin group than in non-statin group.The incidence rate of intraplaque hemorrhage / mural thrombus [6 cases (25.0％) vs.8 cases(25.8 ％)]in thoracic aorta was a little lower in statin group than in non-statin group,with no significant difference(P＞0.05).Conclusions Statin treatment decreases LDL-C level,reduces the burden of atherosclerotic plaque in thoracic aorta,and maintains the atherosclerotic plaque stability.

BACKGROUND: Tibia open fracture is a common disease, and intramedullary fixation has become the first choice, but the high risk of postoperative infection limits its clinical application.OBJECTIVE: To investigate the early prevention effect of vancomycin-hydroxyapatite (VCM-HA) coated titanium intramedullary nail in a rabbit model of open femoral fracture combined with wound infection.METHODS: Titanium intramedullary nails coated with three different concentrations of VCM-HA were prepared using biomimetic deposition, and subsequently in vitro bacteriostasis experiment was performed. Forty healthy male New Zealand white rabbits were selected and the model of mid-femur open fracture with wound infection was prepared. The rabbit models were then divided into ordinary intramedullary nail, low-, middle- and high-concentration VCM-HA coated intramedullary nail groups (n=10 per group). The wound appearance of the animals was dynamically observed. The body mass, anal temperature, white blood cells and C-reactive protein contents in the venous blood were monitored. The pathological examination of the soft tissue around the fracture and injured limb X-ray were conducted regularly.RESULTS AND CONCLUSION: The prepared VCM-HA coated titanium intramedullary nail exerted obvious antibacterial effects in vitro. The anal temperature in the ordinary nail group was significantly higher than that in the other three groups at 3 days after modeling (P < 0.05). The white blood cells and C-reactive protein contents in the venous blood in the VCM-HA groups were significantly lower than those in the ordinary nail group at 3, 7, 14 and 28 days after modeling (P < 0.05). The hematoxylin-eosin staining of the peripheral tissues displayed the inflammatory response in the VCM-HA groups was milder than that in the ordinary nail group at each time point after modeling. The injured limb X-ray displayed that the callus grew slowly accompanied with sequestration in the ordinary nail group, while the callus growth in the VCM-HA groups was significantly better than that in the ordinary nail group. To conclude, the VCM-HA coated intramedullary nail can effectively reduce postoperative infection in an animal model of open femoral fracture combined with wound infection.

Objective To investigate the profile and antibiotic resistance of bacteria in patients with ascites infection in intensive care unit (ICU) patients in order to provide a reference for rational clinical use of antibiotics. Methods A retrospective analysis was conducted. The bacteria isolated from ascetic fluid patients admitted from January 1st, 2004 to October 31st, 2015 to ICU of the First Affiliated Hospital of Anhui Medical University were identified, and their susceptibility to antibiotics was analyzed. Patients, who were admitted from January 1st, 2004 to December 31st, 2009 were assigned to group A, and patients admitted afterwards were assigned to group B. Results A total of 637 specimens of ascetic fluid were examined, with 185 positive culture (29.0%) during the 12 years, and 203 strains of bacteria were found. Among them 126 strains (62.1%) of gram-negative bacteria (G-), 54 (26.6%) of gram-positive bacteria (G+) and 23 (11.3%) strains of fungi were found. Compared the result of group B with that of group A, the proportion of G- bacteria was increased [71.2% (99/139) vs. 44.2% (27/64)], and that of G+ decreased [17.3% (24/139) vs. 46.9% (30/64)] in group B. The difference was statistically significant (χ2 = 20.34, P = 0.001). The main pathogenic bacteria were G-, and Enterobacteriaceae was the most common pathogenic bacteria in intra-abdominal infection of ICU patients. The isolation rate of Escherichia coli and Klebsiella pneumoniae(35.7%, 10.3%) ranked in the first and third in G- bacteria, respectively. The resistant rate of Escherichia coli against penicillin and third generation cephalosporin were > 95.0% and > 73.3%, and it showed a sensitive rate of 70% to β-lactam/inhibitor, amikacin and minocycline, and a higher sensitivity to carbapenems and tigecycline (11.1%, 0). Forty-eight strains of non-fermentation bacteria were found with a rate of 23.7%. The positive rates of Acinetobacter baumannii in groups A and B were 7.8% (5/64) and 23.7% (33/139), respectively, and they ranked first among non-fermentation bacteria. Twenty strains (62.5%) multidrug-resistant Acinetobacter baumannii were found. Acinetobacter baumannii showed a resistance rate of 84.6% to cefoperazone/sulbactam, 35.3% to minocycline, and 53.3% to tigecycline. Candida albicans was the most commonly isolated fungus in intra-abdominal infections (87.5%). No strains resistant to common antifungal drugs were isolated. Conclusions G- bacteria was the main pathogen in intra-abdominal infection in patients with ascites. Non-fermenters showed an increasing trend of producing infection, and the proportion of multidrug-resistant Acinetobacter baumannii infection increased year by year, and more attention should be taken by attending doctors.

BACKGROUND:Calcium phosphate cement and recombinant human bone morphogenetic protein-2 both have bone osteoinductivity. Maybe both of them could promote repair of tendon-to-bone interface damage. OBJECTIVE:To evaluate the effect of calcium phosphate cement-II containing recombinant human bone morphogenetic protein-2 on tendon-to-bone interface healing after rotator cuff injury . METHODS: Twenty-seven adult healthy rabbits were enroled in the study. The tendon-to-bone interface of the bilateral shoulder joints was taken from three rabbits as normal group, and the bilateral shoulder joints of the other 24 rabbits were subjected to acute rupture of the rotator cuff and tendon-to-bone reconstructive surgery as experimental group (n=12) and control group (n=12). Rabbits in the experimental group were treated with calcium phosphate cement-II, while those in the control group treated with nothing. Specimens were colected at 2, 4, 8 postoperative weeks for biomechanical test. RESULTS AND CONCLUSION:The maximum tensile strength of the rotator cuff in the experimental group was higher than that in the control group (P < 0.001), but lower than that in the normal group (P < 0.001). At postoperative 8 weeks, the rigidity of rotator cuff of the experiment group was higher than the control group (P < 0.001) but lower than the normal group (P < 0.001). These findings indicate that calcium phosphate cement-II can improve the maximum tensile strength and rigidity of rabbit tendon-to-bone interface in the early postoperative period, enhance tendon-to-bone interface binding force, and promote tendon-to-bone interface healing.

BACKGROUND: During xenogenic liver transplantation, major histocompatibility antigen can induce immunological rejection, and immunosuppressant can cause adverse effect on organism. Recently, treatment prior to transplantation induces immune tolerance, which is perspective for organ transplantation.OBJECTIVE: To investigate the correlation between thymus induction and immunological rejection during liver transplantation. METHODS: A total of 40 male SD rats of clean grade were selected as donors. Moreover, 30 male Wistar rats of clean grade and 10 male SD rats of clean grade were selected as recipients. The donor rats were divided into allogeneic gene transplantation, allotransplantation, cyclosporine, and thymus induction groups, with 10 rats in each group. The modified Kamada and improved two-cuff technique was used to establish a stable rat orthotopic liver transplantation model. The cyclosporine group was given cyclosporine (50 mg/kg) for 5 successive days. Thymus induction group was injected with major histocompatibility antigens (50 pL) for 5 successive days. Other groups were not given any interventions. Survival time of rats was recorded in each group. Pathological observation and mixed lymphocyte cultured were performed at days 3, 7, 14, 21, and 28 after transplantation. RESULTS AND CONCLUSION: Survival time was longer in the thymus induced group compared with other groups (> 60 days), damaged level was mild, local immunological rejection was reduced, and lymphocytes were decreased. The effect after liver transplantation was similar to allogeneic gene transplantation but superior to cyclosporine intervention (P < 0.05). This suggested that thymus induction relieved immunological rejection following liver transplantation.

BACKGROUND: Most patients who underwent liver transplantation would suffer acute rejection or transplanted liver failure resulted by chronic rejection, therefore, inducing specific immune tolerance via varied pathways is the ideal method to solve this problem. OBJECTIVE: To treat rat transplanted liver by injecting transforming growth factor β1 (TGF-β_1) plasmid, and to analyze the relationship between TGF-β1 and allograft rejection from gene level. METHODS: A total of 30 male, Wistar rats were served as allogenic liver donors, and 10 male, SD rats served as syngeneic donors Totally 40 male SD rats were served as liver recipients, and divided into 4 groups by order number table: ailogenic transplantation, syngeneic transplantation, ciclosporin, and ciclosporin plus TGF--β_1 groups. In each group, rat orthotopic liver transplantation model was established by modified Kamada and improved two-cuff technique. After modeling, rats were received cyclosporine 1-5 days in the cyclosporine group, or intraperitoneal injected ciclosporin for 1-5 days, combined with TGF-β_1 plasmid 0-2 days in the cyclosporine plus TGF-β_1 group. No intervention was performed in the other groups. The survival time of rats were recorded, and the pathological changes was detected at days 3, 7, 14, 21, and 28 after transplantation, then the mixed lymphocyte culture was performed. RESULTS AND CONCLUSION: The survival time of rats in syngeneic transplantation group and cyclosporine plus TGF-1,β_1 group was more than 60 days, which was obviously greater than that of allogenic transplantation and cyclosporine groups (P< 0.05). The histopathologic slide showed that there was moderate and severe acute rejection, with evident intrahepatic inflammatory cell infiltration in the allogenic transplantation and cyclosporine groups. Few rejections were observed in the syngeneic transplantatior group, which was close to the normal lever tissues. Mixed lymphocyte culture of the cyclosporine plus TGF-β_1 group was superior to the syngeneic transplantation group or cyclosporine group (P < 0.05). The results demonstrated that cyclosporine combined with local injection of TGF-β_1 plasmid can relieve post-transplant immune rejection.