Objective To analyze the multiple indicators of neonates morbidity to provide reference for treatment and preven‐tion of newborns and improve the neonatal birth and survival quality .Methods Totally 3 542 neonates delivered in the obstetric de‐partment of our hospital from January 1 ,2013 to December 31 ,2014 were investigated .The multiple item data included the birth in‐formation ,clinical manifestations ,treatment and prognosis ,and so on .The data were analyzed by the SPSS17 .0 software ,the χ2 test was adopted to conduct the comparison ,P<0 .05 was considered as statistically significant difference .Results The top three neo‐natal diseases with highest incidence were neonatal pathologic jaundice (11 .06% ) ,neonatal pneumonia (10 .43% ) ,and premature (8 .13% ) .Conclusion It should be to strengthen the health care during pregnancy and neonatal monitoring ,reduce the infection in‐cidence ,find out the causes leading bilirubin increase ,actively conduct the symptomatic treatment ,prevent and treat premature de‐livery and improve the survival rate and survival quality of premature infants .

Objective: To evaluate the efficacy of Tuina (Chinese therapeutic massage) at points on abdomen and back meridians in the treatment of infantile colic.Methods: A total of 120 infants with intestinal colic were randomly divided into a control group and an observation group, with 60 cases in each group. In the control group, the parents of the infants were given soothing and health education. In addition to the intervention used in the control group, the observation group was treated with Tuina at points on abdomen and back meridians once a day for 5 consecutive days as a course of treatment. The pain scale score and clinical symptoms of the two groups were recorded before and after treatment. Results: After treatment, the total effective rate of the observation group was higher than that of the control group, and the difference was statistically significant (P<0.05). The pain scale score of the observation group was lower than that of the control group, and the difference was statistically significant (P<0.05). In the 24 h behavior diary indicators, the daily attack duration, the daily attack times, and the weekly attack days in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.05). Conclusion: Tuina at points on abdomen and back meridians is effective and safe in the treatment of infantile colic.

OBJECTIVETo analyze and compare vaginal microbiomes in healthy women at child-bearing ages and patients with bacterial vaginosis (BV).

METHODSA total of 74 vaginal swabs of the vaginal fornix were collected from 37 BV patients and 37 healthy women. BV status was assessed according to Amsels clinical criteria for all the subjects and confirmed using Gram-stain criteria (Nugent scores). Genomic DNA of the samples was extracted for amplifying the 16S rRNA V6 hypervariable region by PCR and pyrosequencing by Illumina. BIPES, UCHIME, TSC and GAST were employed to analyze the information of the species from the samples.

RESULTSLactobacillus was the predominant species in healthy women (more than 95%), including mainly L. iners and L. crispatus, with a small quantity of Gardnerella, Granulicatella, Streptococcus, Prevotella, Escherichia and other genus. The α diversity was significantly increased in 30 BV patients (P<0.001), and β diversity also changed obviously shown by decreased Lactobacillus (varying from 45% to 1%, consisting mainly of L. iners) or even absence Lactobacillus in 6 cases, with increased relative abundance of Gardnerella, Prevotella, Granulicatella, Anaerococcus, Parvimonas, Peptoniphilus.harei, Peptostreptococcus, and Dialister. Different from previous data, 7 BV cases showed a predominance of the rare species L.gasseri and L.acidophilus (75% to 50%).

CONCLUSIONLactobacillus is the predominant vaginal species in healthy women (mainly L. iners and L. crispatus) co-existing with many other bacteria and a variety of microorganisms. Lactobacillus is significantly decreased and even absent in most of BV patients, and some cases show the predominance of the rare species L.gasseri and L.acidophilus.

Adult ; Case-Control Studies ; DNA, Bacterial ; genetics ; Female ; Humans ; Microbiological Techniques ; Microbiota ; Middle Aged ; RNA, Ribosomal, 16S ; genetics ; Reagent Kits, Diagnostic ; Vagina ; microbiology ; Vaginosis, Bacterial ; microbiology ; Young Adult

Objective:To explore whether deep learning could apply to recognize the recurrent laryngeal nerve in the video of unilateral axillary approach endoscopic thyroidectomy.Methods:Videos of endoscopic thyroidectomy via unilateral axillary approach in Peking Union Medical College Hospital from Jul. 1st, 2020 to May. 1st, 2021 were collected. Videos containing the recurrent laryngeal nerve were selected, and the outline of recurrent laryngeal nerve were marked by two senior thyroid surgeons and staffs. Data were divided into training set and test set in a ratio of 5:1, and classified into high, medium and low recognition group according to difficulty of recognizing the outline of the nerve. The neuron network was based on PSPNet combined with Resnet50. All data were analyzed by R (ver. 4.0.2) .Results:A total of 38 videos including 35,501 frames of pictures were included in this study. 29, 704 frames of 32 videos were in our training set and 5797 frames of 6 videos were in the test set. When the intersection over union (IOU) threshold is 0.1, the sensitivity and precision is 100.0%/92.1%, 95.8%/80.2% and 81.0%/80.6% in high, medium and low recognition group respectively. When the IOU threshold is 0.5, the sensitivity and precision is 92.6%/85.3%, 71.7%/60.5% and 38.1%/37.9% in high, medium and low recognition group respectively, indicating that neuron network could located the outline of recurrent laryngeal nerve in high and medium recognition group. False negatives were often due to small targets and unclear boundaries.Conclusion:Recurrent laryngeal nerve recognition based on deep learning is feasible and has potential application value in endoscopic thyroidectomy, which may help surgeons reduce the risk of accidental injury of recurrent laryngeal nerve and improve the safety of thyroidectomy.

Objective:To investigate the application value of machine learning algorithms for gauze detection in laparoscopic pancreatic surgery.Methods:The retrospective and descriptive study was conducted. The 80 intact laparoscopic pancreatic surgery videos from Peking Union Medical College Hospital of Chinese Academy of Medical Sciences with timing of July 2017 to July 2020 were collected. The training set was used to train the neural network, and the test set was used to test the ability of neural network for gauze detection under different difficulties. Under the supervision of two superior doctors, videos that containing gauze were selected and classified according to recognition difficulty into three difficulty level including easy, normal and hard difficulty, and further divided based on random number method into training set with 61 videos and test set with 19 videos in a ratio of 3:1 roughly. The minimum enclosing rectangle of the gauze were marked frame by frame. All images were input to the neural network model for training after normalization and preprocessing. For every image, the output of neural network is the predicted minimum enclosing rectangle of gauze. The intersection over union >0.5 was identified as positive result. Observation indicators: (1) video annotation and classification; (2) test outcomes of neural network for test set.Count data were represented as absolute numbers or percentages.Results:(1) Video annotation and classification: a total of 26 893 frames of images form 80 videos were annotated, with 61 videos including 22 564 frames of images as the training set and 19 videos including 4 329 frames of images as the test set. Of the training set, 19 videos including 5 791 frames of images were classifed as easy difficulty, 38 videos including 15 771 frames of images were classifed as normal difficulty, 4 videos including 1 002 frames of images were classifed as hard difficulty, respectively. Of the test set, 4 videos including 1 684 frames of images were classifed as easy difficulty, 6 videos including 1 016 frames of images were classifed as normal difficulty, 9 videos including 1 629 frames of images were classifed as hard difficulty, respectively. (2) Test outcomes of neural network for test set: the overall sensitivity and accuracy of gauze detection by neural network in the test set were 78.471%(3 397/4 329) and 69.811%(3 397/4 866), respectively. The sensitivity and accuracy of gauze detection by neural network were 94.478%(1 591/1 684) and 83.168%(1 591/1 913) in easy difficulty test set. The sensitivity and accuracy of gauze detection by neural network were 80.413%(817/1 016) and 70.859%(817/1 153) in normal difficulty test set, 60.712%(989/1 629) and 54.944%(989/1 800)in hard difficulty test set. The frame rate reached more than or equally to 15 fps. The overall false negative rate and false positive rate of gauze detection by neural network in the test set were 21.529%(932/4 329) and 30.189%(1 469/4 866), respectively. The false negative was mainly due to the existence of blurred images, too small gauze exposure or blood immersion of gauze. The false positive was caused by the reflection of connective tissue or body fluids.Conclusion:The machine learning algorithms for gauze detection in laparoscopic pancreatic surgery is feasible, which could help medical staff identify gauze.

Objective:To explore whether deep learning could apply to recognize the recurrent laryngeal nerve (RLN) in videos of endoscopic thyroidectomy (ETE) via breast approach.Methods:Videos of ETE via breast approach in Peking Union Medical College Hospital from Feb. 2020 to Aug. 2021 were collected. Videos containing RLN were selected, and the outline of RLN was marked by two thyroid surgeons. Then data were divided into a training set and a test set in a ratio of 5:1 and classified into the high and low difficulty group according to a senior thyroid surgeon’s opinion. Those pictures were input to D-LinkNet model. Precision, sensitivity and mean dice index was calculated.Results:A total of 46 videos including 153, 520 frames of pictures were included in this study. 131,039 frames of 39 videos were in the training set and 22,481 frames of 7 videos were in the test set. When the intersection over union threshold was 0.1, the sensitivity and precision was 92.9%/72.8% and 47.6%/54.9% in high and low recognition group, respectively. When the intersection over union threshold was 0.5, the sensitivity and precision turned to 85.8%/67.2% and 37.6%/43.5% in high and low difficulty group, respectively. Mean Dice index was 0.781 and 0.663 in high and low difficulty group, respectively.Conclusions:RLN recognition based on deep learning is feasible and has potential application value in ETE, which may help surgeons reduce the risk of accidental injury of RLN and improve the safety of thyroidectomy.

Objective:To investigate the influencing factors for the development of gall-stone in population of Beijing.Methods:The retrospective cross-sectional survey was conducted. From November 2016 to September 2020, patients living in Beijing (registered residence in Beijing ≥12 months) who visited the biliary outpatient of Department of General Surgery of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences for the first time were recruited to participate as respondents. The survey was conducted by the questionnaire survey on correlation between dietary habits and incidence of gallstones, in which the information of gender, age, body mass index (BMI), gallstone status, metabolic indicators (hypercholesterolemia, history of diabetes mellitus, reproductive times for female, menopause status of female, duration of menopause for female, history of weight loss), dietary indicators (dietary mix of meat and vegetable dishes, times of coffee intake per month, times of alcohol consumption per month, times of greasy diet intake per month, times of breakfast skipping per week, average overnight fasting time of breakfast skipping, times of supper skipping per week, average overnight fasting time of supper skipping), family history of gallstones, lifestyle indicators (times of staying up late per month, average overnight fasting time when staying up late, daily sedentary time, weekly physical activity score). Observation indicators: (1) results of questionnaire survey; (2) analysis of influencing factors for the occurrence of gallstone. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3). Count data were expressed as absolute numbers or percentages. Univariate and multivariate analyses were performed using the Logistic regression model. Results:(1) Results of questionnaire survey. A total of 1 036 questionnaires were distributed, and 1 004 complete questionnaires were recovered. Of the 1 004 patients who completed the questionnaire survey, there were 329 males and 675 females, aged (44±12)years. The BMI of 1 004 patients was (24±3)kg/m 2. Of the 1 004 patients, there were 659 cases with a history of cholecystolithiasis and 345 cases without. (2) Analysis of influencing factors for the occurrence of gallstone. Results of univariate analysis showed that age, history of diabetes mellitus, history of weight loss, times of coffee intake per month, times of greasy diet intake per month, family history of gallstone and daily sedentary time were related factors for the development of gallstone in 1 004 patients ( odds ratio=1.03, 2.26, 1.74, 1.01, 1.01, 2.22, 1.06, 95% confidence intervals as 1.02?1.05, 1.09?5.18, 1.22?2.53, 1.00?1.03, 1.00?1.01, 1.60?3.11, 1.01?1.11, P<0.05). Results of multivariate analysis showed that age, history of diabetes mellitus, history of weight loss, times of greasy diet intake per month, family history of gallstone and daily sedentary time were independent influencing factors for the development of gallstone in 1 004 patients ( odds ratio=1.03, 2.26, 1.82, 1.01, 2.22, 1.06, 95% confidence intervals as 1.02?1.05, 1.11?5.13, 1.28?2.62, 1.00?1.02,1.60?3.09, 1.01?1.12, P<0.05). Conclusion:Age, history of diabetes mellitus, history of weight loss, times of greasy diet intake per month, family history of gallstone and daily sedentary time are independent influencing factors for the development of gallstone in population of Beijing.

Objectives To research clinical effects of severe brain injury patients treated by acupuncture and herb combine mild hypothermia,discuss the new approach of severe brain injury patients treatment combine Chinese traditional and Western medicine.Methods Investigated 68 severe traumatic brain injured patients,randomly divided into three groups,acupuncture and herb combine mild hypothermia group (n =22),mild hypothermia group (n =24) and normal temperature routine treatment group (n =22).Dynamic intracranial pressure,brain damage index (cytoskeletal protein),immunologic function (IL-6,β2 microglobulin),combine rate of complications (including irritable ulcer,lung infection,epilepsy,sugar metabolism disorder,and so on),and long-term GOS score were analyzed.SPSS12.0 software was used for statistical processing,and the standard deviation of the measurement data were expressed as the standard deviation.The counting data were expressed as apercentage,and the chi-square test was used for the comparison between group.Results There were significant differences between three groups of intracranial pressure,immunologic function,complication occurring rate (P ＜0.05),but there had no significant difference between acupuncture and herb combine mild hypothermia group and mild hypothermia group of brain damage index and GOS,and there have significant difference between these two groups and normal temperature routine treatment group.Conclusions Acupuncture and herb combined mild hypothermia might be better in reducing intracranial pressure,the incidence of complication,and improving immune function of severe brain injury,than mild hypothermia group and normal temperature routine treatment group.

Medical ethics has a long history and rich connotations.It has developed from the simple "medical morality" of ancient times to the modem medical ethics.The basic principles of medical ethics include autonomy,non-maleficence,beneficence,justice,and so on.Researchers often conduct clinical researches in the balance between achievements and ethical norms.Clinical researchers of surgery should have a deep understanding of medical ethical principles and strictly abide by medical ethics.Ethics committee should strictly perform their duties and play the role of inspection and supervision.Modem medical knowledges should be popularized throughout the society to make clinical research correctly understood.Adhering principles of ethics first,people orientation and cooperation practice,with patients' benefit as evaluation criteria,balance of surgical "Dao" and "Shu" can be achieved.

ObjectiveTo investigate the therapeutic effects and difference in the effects of Arisaematis Rhizoma （AR） before and after processing （i.e.， Arisaematis Rhizoma Preparatum， ARP） with Zingiberis Rhizoma Recens-Alumen on allergic asthma in rats and to provide a basis for the theory of processing improving the efficacy. MethodA rat model of allergic asthma was established in 70 SD rats by intraperitoneal injection of ovalbumin （OVA）-aluminum hydroxide. The rats were administrated with the aqueous extracts of AR （1.2， 0.3 g∙kg^-1） and ARP （1.2， 0.3 g∙kg^-1） aqueous extracts by gavage， and montelukast sodium （0.001 g∙kg^-1） was used as the positive drug. The T helper cell type 1/type 2 （Th1/Th2） ratio in the serum and bronchoalveolar lavage fluid （BALF） and percentages of inflammatory cells in BALF were determined. Polymerase chain reaction （PCR） was employed to determine the mRNA level of mucin 5AC （MUC5AC） in the lung tissue. The pathological changes in the lung tissue were observed by hematoxylin-eosin （HE） staining and PAS staining. Immunohistochemical assay was employed to measure the expression of c-Jun amino-terminal kinase （JNK）， extracellular signal regulated protein kinase （ERK）， and p38 mitogen-activated protein kinase （p38 MAPK） in rat lung tissue. Western blot was employed to determine the protein levels of ERK， p-ERK， JNK， p-JNK， p38， p-p38 in the lung tissue. The effects of AR and ARP were compared based on overall desirability. ResultCompared with the blank group， the levels of interleukin-12 （IL-12） and γ interferon （IFN-γ） in serum and BALF of rats in the model group were significantly lower （P<0.05， P<0.01）， and the levels of interleukin-4 （IL-4）， interleukin-5 （IL-5） and interleukin-13 （IL-13） were significantly higher （P<0.05， P<0.01）. Compared with the model group， the serum and BALF contents of IL-12 and IFN-γ in rats in the montelukast sodium group， high-dose AR group and high-dose ARP group were significantly higher （P<0.05， P<0.01）， and the contents of IL-4， IL-5 and IL-13 were significantly lower （P<0.05， P<0.01）， and the serum contents of IFN-γ in rats in the low-dose AR group and low-dose ARP group were in BALF was significantly higher （P<0.05） and IL-4 and IL-13 were significantly lower （P<0.05， P<0.01）， the percentages of macrophages， lymphocytes， neutrophils， and eosinophils were reduced in BALF， and the expression of JNK/ERK/p38 MAPK signaling pathway and MUC5AC protein was inhibited in lung tissues. Overall assessment of the normalized analysis revealed that the ARP group was slightly more potent than the AR group after administration of the same dose. ConclusionAR and ARP can effectively treat allergic asthma by inhibiting JNK/ERK/p38 MAPK signaling pathway， and the effect is better after concoction， which can provide data support for its "concoction efficiency".