Objective To analyze the value of sentinel lymph node biopsy (SLNB)in predicting axillary lymph node status by injection of fluorescence agent and methylene blue.Methods 156 breast cancer patients receiving surgery from Oct.2013 to Jun.2014 were studied and they were randomly divided into the experimental group(n =78) and the control group(n =78).The fluorescent agent combined with methylene blue and methylene blue were used respectively as tracers for SLNB.Axillary lymph nodes dissection was made during surgery and combined with pathology the status of sentinel lymph node(SLN) metastasis was distinguished between true negative,false negative,true positive,and false positive.Results A total of 164 SLNs were detected by the method of fluorescent agent combined with methylene blue with the detection rate of 97.44％.An average of 2.10 SLNs were detected for each patient.The accuracy rate was 97.44％,the sensitivity was 97.44％,the false negative rate and the false positive rate was 0％ and 0％.A total of 139 SLNs were detected by the method of methylene blue with the detection rate of 89.74％.An average of 1.78 SLNs were detected for each patient.The accuracy rate was 89.74％,the sensitivity was 89.74％,the false negative rate and the false positive rate was 10.26％ and 3.85％.There was statistical difference between the two groups in the average detection number and the false negative rate (P ＜ 0.05)while no statistical difference was found in the detection rate,accuracy,or sensitivity between the two groups (P ＞ 0.05).Conclusion Fluorescent agent combined with methylene blue as tracer for lymph nodes has the advantages of higher detection rate and less trauma,which is worth of clinical application.

Objective In order to improve diagnosis of pulmonary thromboembolism(PTE),the clinical features of pulmonary embolism between older and younger patients were compared.Methods Totally 105 patients(57 older and 48 younger)with diagnosed PTE were assessed retrospectively.Results There were more risk factors in the elderly as compared with younger group.Phlebitis was the major risk factor in both groups.Other risk factors,such as COPD,immobilization,malignancy and cardiac disease,were more frequent in the elderly;whereas in younger patients,intravenous drug injection and genetic factors were more frequent.Chest pain and hemoptysis were less frequent in older patients whereas syncope occurred more often in the older group."Triplicate symptoms" (including dyspnea,chest pain and hemoptysis)occurred more often in the younger group.Massive PTE occurred more often in the older patients.Severe complications were more frequent in cTnT-positive patients.Conclusion There are more risk factors in the elderly.The clinical presentation of PTE is often atypical in elderly patients,and prone to develop massive PTE.cTnT(Cardiac troponin T)is an independent predictor of prognostic implications in patients with confirmed PTE.

Objective To explore the effect of health education through different postoperative follow-up method, including telephone、Email and QQ, on patients with indwelling D-J stents. Methods 319patients with indwelling D-J stents were divided into the control group(88 cases), the telephone group(89 cases), the Email group (70 cases) and the QQ group (72 cases). M1 patients received rourine health education during hospitalization and before discharge, the latter three groups received follow-up by telephone、Email and QQ after discharge respectively. The rehabilitation effect was observed in the four groups. Results The complication rates of the telephone group, the Email group and the QQ group was significantly less and the mastering of knowledge about prevention and handling of complication was better than the control group during the follow-up. Conclusions Different types of follow-up can be selected by patients according to their actual status. Decreasing complication rate, favorable social benefit and approval of the patients family members will be seen due to involvement of the patients family in health education.

Objective Prognostic value of cardiac troponin T,echocardiography and ECG in patients with confirmed pulmonary embolism were evaluated. Methods 105 consecutive patients with confirmed PE were enrolled in this retrospective study. PE was confirmed by pulmonary angiography,lung scan or echocardiography and subsidiary analyses, cTnT was measured within 24 hours after admission. ECG and ECHO were recorded within 24 hours after admission. Results ECG signs of acute right ventricular strain are not predictors of mortality and severe complications in patients with confirmed PE. Only right ventricular dilation but not pulmonary hypertension detected at echocardiography in patients with acute PE is an independent risk factor for fatal outcome. There were significant differences in right ventricular dysfunction,massive PE and severe complications between the troponin-positive group and the troponin-negative group. In logistic regression analysis,cTnT is an independent predictor of severe complications. Furthermore,high cTnT was significantly associated with severe PE. Conclusion Right ventricular function is an important prognostic factor for pulmonary embolism. Echocardiographically detected right ventricular dysfunction can be used to assess the prognosis of PE. Elevation of cTnT was significantly associated with right ventricular dysfunction,and can be used to assess the prognosis of PE. ECG signs of acute right ventricular strain were not specific, so can not be used to assess the prognosis of PE.

Objective:To investigate the therapeutic effect of sequential therapy with butylphthalein on acute cerebral infarction and mild-to-moderate increases in middle cerebral artery blood flow in patients.Methods:The clinical data of 92 patients with acute cerebral infarction and mild-to-moderate increases in middle cerebral artery blood flow who received treatment at the Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2018 to October 2021 were retrospectively analyzed. These patients were divided into a study group and a control group using a random number table method. The control group was given an intravenous infusion of butylphthalein sodium chloride injection, while the study group took oral butylphthalein soft capsules after intravenous infusion of butylphthalein sodium chloride injection. The baseline data, hemodynamics, neurological function, and clinical outcomes were compared between the two groups. At 90 days after treatment, the National Institutes of Health Stroke Scale (NIHSS), the Activity of Daily Living Scale (ADL), and the modified Rankin Scale (mRS) were used to evaluate clinical outcomes. Transcranial Doppler ultrasound (TCD) examination was performed to evaluate hemodynamic changes.Results:A total of 92 patients completed all the observation indices as required, including 48 patients in the study group and 44 patients in the control group. There were no significant differences in demographics, vascular risk factors, laboratory results, NIHSS score, ADL score, or arterial hemodynamics of the diseased brain between the two groups (all P > 0.05). At 90 days after treatment, the NIHSS score in the study group was significantly lower than that in the control group [(4.00 ± 1.95) points vs. (4.91 ± 2.08) points; t =-2.16, P = 0.033]. The ADL score in the study group was significantly higher than that in the control group [(82.71 ± 9.56) points vs. (76.25 ± 11.47) points; t = 2.94, P = 0.004]. The good rate of outcomes in the study group was significantly higher than that in the control group [70.83% (34/48) vs. 50.00% (22/44); χ2 = 4.18, P = 0.041]. There were significant differences in the peak systolic velocity [(152.33 ± 9.58) cm/s vs. (157.41 ± 11.77) cm/s; t = 2.27, P = 0.025] and the mean velocity [(90.00 ± 8.30) cm/s vs. (94.45 ± 9.07) cm/s; t = -2.46, P = 0.016] of the middle cerebral artery between the study and control groups. The difference in pulsitility index between the two groups was not statistically significant [(0.97 ± 1.06) vs. (1.01 ± 1.21); t = 1.69, P = 0.093]. Compared with the poor outcome group, patients in the good outcome group had lower NIHSS and ADL scores after discharge (both P < 0.001), and the proportion of patients who received sequential therapy with butylphthalein in the good outcome group was higher [(60.70% (34/56) vs. 38.90% (14/36); χ2 = 4.18, P = 0.041]. Conclusion:Sequential therapy with butylphthalein can reduce neurological deficits, promote neurological function recovery, improve the hemodynamics of diseased blood vessels, and greatly improve daily living activities in patients with acute cerebral infarction complicated by mild to moderate increases in middle cerebral artery blood flow.

Objective:To investigate the expression of long non-coding RNA growth retard-specific transcript 5 (LncRNA GAS5) and micrornas (miR) 23a-3p in patients with sepsis complicated with acute kidney injury (AKI) and their clinical significance.Methods:A total of 206 patients with sepsis admitted to the Department of Emergency Medicine, Fuyang First Hospital Affiliated to Binjiang College of Zhejiang University of Traditional Chinese Medicine from May 2020 to February 2023 were prospectively selected and divided into AKI group (95 cases) and control group (111 cases) according to whether they had concurrent AKI. Serum LncRNA GAS5 and miR-23a-3p expressions were detected. logistic regression analysis was used to screen the influencing factors of patients with sepsis complicated with AKI, and receiver operating characteristic (ROC) curve was used to analyze the value of LncRNA GAS5 and miR-23a-3p in predicting sepsis complicated with AKI.Results:Mechanical ventilation, blood transfusion treatment ratio, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, Sequential Organ Failure Assessment (SOFA) score, white blood cell count (WBC), serum C-reactive protein (CRP), procalcitonin (PCT), blood urea nitrogen (BUN), Scr, blood lactic acid level of the AKI group were higher than those of the control group (all P<0.05); mean arterial pressure (MAP), urine volume, estimate glomerular filtration rate (eGFR) at admission were lower than those of the control group (all P<0.05). Serum LncRNA GAS5 expression (5.12±1.69 vs 2.30±0.42) in AKI group was higher than that in the control group ( P<0.05), and miR-23a-3p expression (1.05±0.13 vs 3.04±0.67) was lower than that in the control group ( P<0.05). Logistic regression analysis showed that high APACHE Ⅱ score, high SOFA score and high expression of LncRNA GAS5 were risk factors for AKI in sepsis patients (all P<0.05). High eGFR and high expression of miR-23a-3p were protective factors (all P<0.05). The area under the curve (AUC) predicted by LncRNA GAS5 and miR-23a-3p for patients with sepsis complicated with AKI was 0.808 and 0.759, and the AUC of combined prediction was 0.882, which was higher than that predicted by single indicator. Conclusions:The expression of LncRNA GAS5 is up-regulated and the expression of miR-23a-3p is down-regulated in serum of patients with sepsis complicated with AKI. The combined detection of LncRNA GAS5 and miR-23a-3p is of high value in predicting the risk of AKI in patients with sepsis.

Objective:To evaluate direct and indirect costs for schizophrenia,major depressive disorder(MDD)and bipolar disorder,and to compare their differences of cost composition,and to explore the drivers of the total costs.Methods:A total of 3 175 inpatients with schizophrenia,MDD,and bipolar disorder were recruited.In-patient's self-report total direct of medical costs outpatient and inpatient,out-of-pocket costs,and direct non-medical costs were regarded as direct costs.Productivity loss and other loss caused by damaging properties were defined as indirect costs.The perspectives of this study included individual and societal levels.Multivariate regression analysis was applied for detecting the factors influencing disease costs.Results:The total cost of schizophrenia was higher than those of MDD and bipolar disorder at individual and societal levels.The indirect costs of three mental disorders were higher than the direct costs,and the indirect cost ratio of bipolar disorder was higher than those of schizophre-nia and MDD.Age,gender,working condition and marital status(P＜0.05)were the important drivers of total costs.Conclusion:The economic burden of the three mental disorders is relatively heavy.Schizophrenia has heaviest disease burden,and the productivity loss due to mental disorders is the driving force of the soaring disease cost

Background::In vitro fertilization (IVF) has emerged as a transformative solution for infertility. However, achieving favorable live-birth outcomes remains challenging. Current clinical IVF practices in IVF involve the collection of heterogeneous embryo data through diverse methods, including static images and temporal videos. However, traditional embryo selection methods, primarily reliant on visual inspection of morphology, exhibit variability and are contingent on the experience of practitioners. Therefore, an automated system that can evaluate heterogeneous embryo data to predict the final outcomes of live births is highly desirable. Methods::We employed artificial intelligence (AI) for embryo morphological grading, blastocyst embryo selection, aneuploidy prediction, and final live-birth outcome prediction. We developed and validated the AI models using multitask learning for embryo morphological assessment, including pronucleus type on day 1 and the number of blastomeres, asymmetry, and fragmentation of blastomeres on day 3, using 19,201 embryo photographs from 8271 patients. A neural network was trained on embryo and clinical metadata to identify good-quality embryos for implantation on day 3 or day 5, and predict live-birth outcomes. Additionally, a 3D convolutional neural network was trained on 418 time-lapse videos of preimplantation genetic testing (PGT)-based ploidy outcomes for the prediction of aneuploidy and consequent live-birth outcomes.Results::These two approaches enabled us to automatically assess the implantation potential. By combining embryo and maternal metrics in an ensemble AI model, we evaluated live-birth outcomes in a prospective cohort that achieved higher accuracy than experienced embryologists (46.1% vs. 30.7% on day 3, 55.0% vs. 40.7% on day 5). Our results demonstrate the potential for AI-based selection of embryos based on characteristics beyond the observational abilities of human clinicians (area under the curve: 0.769, 95% confidence interval: 0.709–0.820). These findings could potentially provide a noninvasive, high-throughput, and low-cost screening tool to facilitate embryo selection and achieve better outcomes. Conclusions::Our study underscores the AI model’s ability to provide interpretable evidence for clinicians in assisted reproduction, highlighting its potential as a noninvasive, efficient, and cost-effective tool for improved embryo selection and enhanced IVF outcomes. The convergence of cutting-edge technology and reproductive medicine has opened new avenues for addressing infertility challenges and optimizing IVF success rates.