Microaneurysm (MA) detection is a crucial step in the early diagnosis of diabetic retinopathy. However, existing detection algorithms often struggle with accurately identifying tiny lesions and maintaining robustness across varying image conditions. To address the challenges of MA detection in retinal fundus images, this paper proposes a detection algorithm based on a modified High-Resolution Network (HRNet) integrated with a channel attention mechanism and a Multi-Scale Feature Fusion Module (MSFFM) applied to the multi-resolution feature outputs of third stage. By preserving high-resolution spatial information and adaptively focusing on discriminative features, the proposed method enhances detection performance. Experimental results on publicly available fundus image datasets demonstrate that our model outperforms traditional architectures such as U-Net, achieving an accuracy of 0.995 and a specificity of 0.996. These results indicate that the proposed method can detect microaneurysms(MAs) with high precision and reliability, making it a promising tool for automated diabetic retinopathy screening.

CRISPR-Cas systems, harnessing their precise nucleic acid recognition via CRISPR RNA (crRNA), offer promise for the accurate testing of nucleic acids in the field. However, the inherent susceptibility of crRNA to degradation poses challenges for accurate detection in low-resource settings. Here, we utilized the chemically modified crRNA for the CRISPR-Cas-based assay (CM-CRISPR). We found that the extension and chemical modification to crRNA significantly enhanced the trans-cleavage activity of LbCas12a. The chemically modified crRNA was resistant to degradation, and CM-CRISPR showed superior detection capability in complex environments. CM-CRISPR could be combined with recombinase polymerase amplification (RPA) and applied in a droplet digital platform, enabling attomolar-level sensitivity. We also developed a portable and automated device for a digital CRISPR assay, which is amenable to point-of-care testing (POCT). The extraction-free procedure was integrated with this assay to streamline the workflow, and clinical samples were successfully detected. This work finds a simple and efficient way to improve the performance of CRISPR-Cas and develops a portable platform for POCT, representing a significant advance toward practical applications of CRISPR-based diagnostics.

Circular RNA (circRNA) is a novel class of non-coding RNA that is a promising biomarker for the diagnosis and prognosis of diseases, such as cancer. Sensitive and quantitative detection of circRNA is of particular significance. However, conventional qRT-PCR is not appropriate for accurate quantification due to the strand-substitution potential during the reverse transcription, which has severely hindered the studies of circRNA. Here, we present a sensitive assay for the detection of circRNA using reverse transcription-hyperbranched rolling circle amplification (RT-HRCA). We further developed droplet digital RT-HRCA (ddRT-HRCA) for circRNA quantification using the microfluidic device. We demonstrate the ddRT-HRCA, modeled on circHIPK3, can achieve a limit of detection (LOD) as low as 6.6 aM with excellent selectivity. As far as we know, this is the first digital isothermal platform for quantitative analysis of low-abundance circRNA, which could be applied in liquid biopsy for early diagnosis and prognosis. This novel strategy paves new avenues for the development of the digital platform for accurate quantification of circRNA, to further promote this cutting-edge research area.

目的:探讨血管免疫母细胞性T细胞淋巴瘤(AITL)的临床特点、诊断过程和治疗方法,提高临床医生对该病的认识.方法:收集1例AITL患者的临床资料、影像学表现、支气管镜和病理检查结果,分析上述资料,并进行相关文献复习.结果:患者,女性,66岁,因"发热伴咳嗽和咳痰15 d"入院.患者四肢散在红色皮疹,胸廓无畸形,气管居中,叩诊左下肺浊音,左下肺呼吸音减弱,无其他明显阳性体征.胸部CT检查结果显示双肺下叶见多发条片状高密度影,以左下肺为著,纵隔和双侧腋窝淋巴结肿大.初步考虑双肺炎症可能性大,待除外占位性病变.经支气管镜肺活检术(TBLB)、纵隔淋巴结支气管穿刺针吸活检术(TBNA)和胸水脱落细胞检测,结果均排除肺恶性病变.先后行抗感染治疗和实验性抗结核治疗,患者仍反复发热,多次复查胸部CT结果显示左下肺高密度影范围增大和实变.全面的实验室检查和影像学检查均未见异常,患者具体发热原因不明确.患者查体见躯干和四肢多发淡红色皮疹,双侧锁骨上淋巴结肿大,经右侧锁骨上淋巴结穿刺活组织检查,最终病理回报AITL.结论:有肺部影像学改变的不明原因发热,且伴有皮疹及淋巴结肿大的患者,如系统抗感染治疗效果不好,应考虑AITL.

浅部真菌病是一种皮肤科常见病,近年来,随着肿瘤、艾滋病等免疫功能受损患者的增多,以及抗菌类药物滥用,真菌感染发病率呈上升趋势。侵袭性真菌感染（IFD）是感染性疾病死亡的主要原因之一[1-2]。目前临床诊断中真菌感染最常用检查办法是真菌镜检及真菌培养,

目的:探讨肺梭形细胞癌(SpCC)患者的临床特征、诊断过程和治疗方法,旨在提高临床医生对该病的认识.方法:收集1例SpCC患者的临床资料、影像学表现、支气管镜和病理检查结果,分析上述资料,并进行相关文献复习.结果:患者,男性,71岁,因咳嗽和气短1个月入院.查体见左侧胸廓凹陷,肋间隙变窄,气管向左侧移位,叩诊左肺浊音,左肺呼吸音消失,无其他明显阳性体征.胸部CT显示左侧气道内高密度影,左肺体积减小.纤维支气管镜显示左主支气管内见带蒂新生物阻塞气道.病理检测结果显示支气管腺性乳头状瘤形成伴鳞化.入院后行胸部增强CT检查显示左主支气管条片状软组织密度影,增强扫描呈轻度强化,左肺体积减小,呈条片状软组织密度影,增强扫描呈不均匀强化.综合全面的实验室和影像学检查考虑支气管良性肿瘤可能性大,行2次纤维支气管镜下电圈套器治疗.支气管镜肺活检见大量梭形细胞,结合免疫组织化学染色结果确诊为SpCC.结论:SpCC是一种特殊类型的上皮来源肿瘤,形态与肉瘤相似,极易误诊.以主支气管占位性病变伴肺不张为主要影像学表现的SpCC患者较为少见,应与支气管良性肿瘤相鉴别.

目的:探讨肺浸润性黏液腺癌(IMAs)患者的临床特征、诊断方法和治疗过程,提高临床医生对IMAs的认识.方法:收集1例IMAs患者的一般资料、影像学表现和治疗方案,并进行相关文献复习.结果:患者,女性,42岁,因咳嗽和咳痰入院,CT检查显示双肺斑片状影,因疑似双肺肺炎行抗感染治疗后症状未见好转,经支气管镜肺活检术(TBLB)及胸水脱落细胞检测结果均为炎性表现,后经皮穿刺活检病理回报为IMAs.基因检测结果为KRAS外显子2点突变.行紫杉醇加卡铂并联合应用血管靶向药物贝伐珠单抗化疗后,患者临床症状明显改善,肺部影像学表现明显改变.结论:IMAs是一种特殊病理类型的肺腺癌(ADCs),该类患者影像学表现多样,基因表达特殊,治疗原则与其他类型ADCs不同.

The United States is the country of origin, advocacy and development of STEM education. Around 2012, the research on STEM education began to increase gradually in China's education circle. At present, STEM has become a hot word in China's K-12 stage. Due to the different learning environment and development stage of STEM education, there are many problems in STEM education in China, such as lack of necessary top-level design, incoherence of curriculum system, lack of professional teachers and confusion of educational institutions. Through comparative analysis, this paper puts forward constructive suggestions on the implementation of STEM education in China.

正>1临床资料患者女,47岁。因不规则阴道流血半个月,于2018年6月5日入院。既往体健,孕2产1,平素月经规律。妇科查体:子宫前位,增大,于子宫左侧壁可触及一肌瘤结节外凸,质韧,活动性尚可,无压痛。妇科彩超:子宫前位,子宫体大小约5.9cm×5.9cm×4.7cm,形态轮廓大致清晰正常,各壁反射均匀。宫腔内探及内膜样反射,厚约1.1cm。宫腔内探及正常位置节育器。宫颈处探及多个无回声区,较大的直径约1.1cm,盆腔内探及最大前后径约3.6cm的液性暗区。

目的:探讨以双肺肺大泡为肺部影像学表现的干燥综合征(SS)的临床特点,分析SS累及肺部的常见影像学表现,提高临床医生对SS患者常见胸部影像学表现的认识.方法:收集1例以双肺肺大泡为肺部影像学表现的SS患者的临床资料、支气管镜和病理检查结果,并进行相关文献复习.结果:患者,青年女性,以呼吸困难、咳血为首发症状入院.查体可见猖獗齿,无其余明显阳性体征.胸部CT显示双肺肺大泡,行风湿系列、角膜染色、唇腺活检及其他相关检查,并给予相关治疗.患者血清免疫学提示抗SSA、抗SSB和类风湿因子阳性,角膜染色(+),下唇腺病理示每灶淋巴细胞数≥50个,最终临床诊断为SS.给予糖皮质激素和环磷酰胺治疗.治疗后患者症状好转,出院继续口服糖皮质激素和环磷酰胺,治疗2个月后复查胸部CT示双肺肺大泡未见明显变化.结论:SS作为一种结缔组织病,其临床表现多样,累及肺部时,肺部的影像学表现也各不相同.当患者胸部CT提示存在双肺不明原因的多发肺大泡时,应考虑SS的可能,做到早发现、早治疗,避免漏诊、误诊及延误病情.

Objective The aim of the study is to detect the protein and mRNA expression level of RBM5, EGFR and KRAS in serum and tissues in patients with NSCLC, to analyze the correlation between the expression level and clinical pathological parameters.Accordingly, it can be helpful to provide clues for early diagnosis of lung cancer and targeted treatment.Methods The fresh postoperative specimens of 42 cases of carcinoma tissue and para-carcinoma tissue from August 2017 to August 2018 at the Second Hospital of Jilin University were selected.The protein and mRNA relative expression level of RBM5、EGFR and KRAS in tissues were measured by Western blot and the real-time fluorescent quantitative PCR (RT-qPCR).And the protein expression level of the above genes in serum of 44 patients were detected by ELISA.Results Compared to para-cancerous tissues, the relative expression of RBM5 mRNA was significantly decreased in NSCLC tissues (P＜0.05), and the decrease was related to smoking history and lymph node metastasis;the expression of EGFR mRNA was significantly increased in NSCLC tissues (P＜0.05), and the relative expression of EGFR in the lymph node metastasis group was higher than that in the non-lymph node metastasis group (P＜0.05).The expression level of serum RBM5 protein of the patients in NSCLC was significantly lower than that in controls (P＜0.01), and the extent of decrease was related to the status of smoking and metastasis.Increased expression of KRAS mRNA is associated with clinical stage, lymph node metastasis, etc.The expression of RBM5, EGFR and KRAS mRNA in NSCLC tissues and para-cancerous tissues was related to some clinical pathological factors.The expression level of EGFR and KRAS protein in patients' serum were significantly higher than those in healthy control group (P＜0.001).Conclusion The tumor suppressor gene RBM5 plays a negative regulatory role in the development of NSCLC, while EGFR and KRAS play apositive regulatory role;serum RBM5 and EGFR may become new indicators for early diagnosis and predictive metastasis of lung cancer, providing new treatment for lung cancer.

目的 :分析以持续性中、高热为首发症状的痛风急性发作患者的临床诊治方法 ,以提高临床医生对以持续性中、高热为首要表现的痛风急性发作的认识.方法:收集1例不明原因发热老年男性患者的临床资料,并结合文献复习,探讨该病的诊断和治疗方法.结果 :患者以"持续性发热4d"入院,血常规检查示白细胞计数明显升高,胸部C T示左肺下叶炎症,给予积极抗感染治疗10 d,患者发热症状无明显缓解,白细胞计数仍明显高于正常水平,全面的实验室检查和影像学检查均未见引起发热的阳性结果.患者查体见双足痛风结节,血尿酸水平明显升高,结合患者既往痛风病史,给予试验性抗痛风治疗;治疗2周后,患者发热症状逐渐缓解,白细胞计数和尿酸水平逐渐恢复正常,考虑发热原因为痛风急性发作.结论 :对于不明原因发热,尤其是中、高度热型患者,如系统抗感染治疗效果不好,应考虑痛风急性发作.

目的:探讨肺结节病的临床特点、诊断和治疗方法,提高临床医生对该疾病的认识.方法:收集1例肺结节病患者的临床资料、支气管镜和病理检查结果,并进行相关文献复习.结果:患者因咳嗽、渐进性呼吸困难2个月入院,查体未见明显阳性体征.胸部CT显示双肺多发结节影,双肺门及纵隔淋巴结肿大;PET-CT影像诊断为肺癌伴癌性淋巴管炎(PLC),双侧锁骨上、双肺门及纵隔淋巴结转移.入院后纤维支气管镜病理回报肺组织内见慢性肉芽肿性炎,未见明确坏死,不能完全排除结核.给予患者糖皮质激素和预防性抗结核治疗,1个月后复查胸部CT显示双肺结节明显减少,3个月后患者症状消失,胸部CT显示双肺结节基本消失,肺门和纵隔淋巴结明显缩小,最终诊断为肺结节病.结论:结节病的确诊应主要依据患者的病理诊断并结合临床表现,仅凭临床表现和影像学结果易误诊为肿瘤或者结核.

根据国际癌症研究机构2018年报道的数据显示,肺癌是世界上最常见的癌症（占总病例的11.6%）,并且是癌症相关死亡的主要原因（占总癌症死亡人数的18.4%）[1]。其中,非小细胞肺癌（NSCLC）占病理类型的85%,而肺腺癌（LUAD）和肺鳞状细胞癌（LUSC）是最常见的亚型。与NSCLC相比,具有快速倍增时间和早期广泛转移特点的小细胞肺癌（SCLC）,由于缺乏早期检测方法[2],5年生存率一般低于

In this paper, we propose an optic disc detection method based on convolutional neural network (CNN) and conditional random field (CRF). We pre-classify the color fundus retinal images by CNN, and construct first-order potential functions of CRF. Then the linear combination of Gaussian kernel functions is used to construct the second-order potential function of CRF model. Finally, regional restricts method is applied that analyzes the consistency of the connected region labels and corrects the labels of each pixel by calculating the posterior probability mean of the super-pixel region. The combination of CNN and CRF not only uses the pixel's intrinsic features, but also the spatial context information to make the detection more accurate. The added constraints further preserve the local information of the target and infer the entire model through a mean field approximation algorithm. This improves the accuracy of detection of optic discs in color fundus retina images. Experiments show that the CNN-CRF model performs better than the existing algorithms for the optic disc detection in pathological images. It provides an effective solution to optic disc detection problem by inhibiting its vulnerability to noise interference such as peripheral lesions and pigmentation. We compare our results to recent published results on several retina databases and show that the CNN-CRF model outperforms the current state-of-the-art methods.

Objective:To explore the etiology of chylothorax by analyzing the clinical data of one patient with chylothorax and combining with the review of relative literatures,and to improve the ability of clinicians for understanding the rare etiology of chylothorax.Methods:A young female with cough,chest pain and dyspnea as the first symptom was admitted to the hospital.Left lymph node enlargement in the neck of the patient was found in examination and bilateral pleural effusion was found in chest CT scanning.After puncture drainage and testing,the pleural effusion was confirmed the chylothorax.Since the examinations for common causes of chylothorax produced negative results,the patient was eventually diagnosed as infectious chylothorax.The patient received anti-infective therapy for 5 d.Results:After treatment,the symptoms of the patients were improved obviously;the pleural effusion disappeared,and the lymph nodes in the neck were shrink detected with chest color ultrasound.One month after follow-up,all the symptoms,enlarged lymph nodes and pleural effusion were recovered.There was no abnormity in chest CT.Conclusion:The possibility of infection should be considered in clinic for the patients with atypical chylothorax and anti-infective treatment should be performed in order to avoid the failed diagnosis and misdiagnosis.

1临床资料患者男,62岁,因"咳嗽、咳痰伴活动后呼吸困难1个月"入院。该患于1个月前无明显诱因出现呼吸困难,进行性加重,活动后为著,夜间可平躺,无憋醒,同时伴有咳嗽、咳白痰,偶有黄痰,量少,易咳出,痰中无血丝。病程中患者有胸闷、气短,偶有反酸、嗳气,且有明显关节疼痛,自述有间断发热（体温未测量）,无皮疹、光过敏、肌痛等,有明显口渴,牙齿无缺损,无眼干,无雷诺现象。既往:20年前于体检

In order to provide effective foundation for retinal image registration, illumination adjustment and pathological detection of retina interior and other problems, a fully automatic method of detecting and recognizing blood vessel for color retina fundus images effectively was proposed.Aimed at the state with elongated tubular shape and preferably linear structure in local part of visible blood vessel, combinatorial shifted filter response model that is applicable to strip structure was used for feature extraction.Taking different features of blood vessel and the end of blood vessel into consideration, two types of filtering modes with symmetry and dissymmetry were configured for tracking, feature vector library was established by response acquired from combinatorial shifting filter response model (symmetry and dissymmetry) and G channel pixel value together and each pixel was classified and determined by AdaBoost classifier.The experimental result based on international public database DRIVE and STARE shows that the segmentation result of proposed method on two standard databases (DRIVE: Accuracy=0.948 9, Sensitivity=0.765 7, Specificity=0.980 9;STARE: Accuracy=0.956 7, Sensitivity=0.771 7, Specificity=0.976 6) is better than existing methods.It is applicable to computer-assisted quantitative analysis of color retina fundus images and can be used as clinical reference.

通过比对新城疫病毒强、弱毒株F基因序列,根据其在F0裂解位点的差异以及F基因保守序列设计合成NDV-V-probe和NDV-L-probe探针组和NDV-F、NDV-R引物组,以基因Ⅶ型NA-1株和基因Ⅱ型LaSota疫苗株病毒RNA作为定量检测的标准品,建立检测方法.对所建立的标准曲线进行分析,相关系数R2均为0.997,线性关系良好.通过计算变异系数Cv/％分别为0.034％和0.027％,均小于1％,说明稳定性良好.对禽类常见病毒IBV、H9亚型AIV检测未发现有交叉反应,特异性好、重复性佳.结果表明:成功建立了新城疫病毒强、弱毒双重荧光定量RT-PCR的检测方法,实现了从分子水平上快速鉴别强、弱毒力的新城疫病毒,也可快速区分野毒感染动物和疫苗接种动物,减少不必要的经济损失.

Dissipative soliton is one of the research hotspot in the field of nonlinear optical fiber optics because of its high single pulse energy. The characteristics of dissipative soliton in passively mode-locked Yb-doped fiber laser was studied. First, each device in the cavity is modeled. Then, the evolution of parabolic shape dissipative soliton with strictly linear chirp in the cavity is studied by numerical simula-tions. Finally, the influences of dispersion and gain saturation energy of Yb-doped fiber on pulse duration and peak power of dissipative soliton is analyzed. Simulations indicate that the pulse duration of the dissi-pative soliton becomes wider with increase of the dispersion, and the peak power decreases with increase of the dispersion. The effect of gain saturation energy on the pulse duration is non monotonic. When gain saturation energy is 70 pJ, the pulse duration reaches the minimum value. And the peak power of dissipa-tive soliton increases linearly with the increase of gain saturation energy.