Objective:To evaluate the curative efficacy of tacrolimus (FK506)combined with corticosteroids in the treatment of idiopathic membranous nephropathy (IMN ), and to analyze the response of anti-M-type phospholipase A2 receptor (PLA2R)antibody to the treatment.Methods:Sixty-one adult IMN patients were divided into FK506 group (FK506 combined with corticosteroids,n = 24)and CTX group (cyclophosphomide combined with corticosteroids,n=37)according to their willing to the acceptance of different immunosuppressives. The remission rates of the patients at 4,8,12 and 24 weeks after treatment in two groups were analyzed.The ELISA method was used for the detection of serum anti-PLA2R antibodies of the patients before and after treatment.The antibody level changes were observed and the difference of remission rates was compared between the antibody positive patients and the negative patients in FK506 group.Results:The total remission rates of the patients in FK506 and CTX groups 24 weeks after treatment were 91.7% and 64.9% respectively and the total remission rate of the patients in FK506 group was significantly higher than that in CTX group (P < 0.05).The total remission rates at 8,12,24 week after treatment and the partial remission rates at 12 and 24 weeks in FK506 group were significantly higher than those in CTX group (P <0.05).The anti-PLA2R antibody positive rates in FK506 group and CTX group were 75.0% and 70.3%,respectively;the negative conversion rate of anti-PLA2R antibody at 24 weeks after treatment in two groups were 61.6% and 57.7%,respectively;there were no significant differences between two groups (P >0.05).The total remission rates of the antibody positive patients and negative patients at baseline in FK506 group 24 weeks after treatment were 88.9% and 100.0%,respectively;there was no significant difference (P > 0.05).Except the characteristic side effects of corticosteroids,the patients in FK506 group presented no hyperglycemia,tubulointerstitial damage,hepatic lesion or neurotoxicity. But the patients in CTX group showed mild hepatic lesion or gastrointestinal symptoms.Conclusion:The remission rate of FK506 combined with corticosteroids is higher than that of CTX combined with corticosteroids in the treatment of IMN patients.FK506 treatment has relatively rapid effect and less side effects as well.The negative conversion of serum anti-PLA2R antibody follows the remission after treatment;however,the negative conversion rate has no significant difference between FK506 group and CTX group.The remission rate of IMN patients treated with FK56 combined with hormone has no relationship with the baseline anti-PLA2R antibody.

Objective To analyze serum 25(OH)D level and the influence factors in preterm infants. Methods The data of serum 25(OH)D level in preterm infants born from July 2012 to June 2014 were retrospectively analyzed along with gestational age, gender, parity, delivery mode, birth season, birth weight, age of the mother and pregnancy complications. Results Totally 325 cases were included and their average gestational age was 33.41±2.29 week, the ratio of male to female was 1.32?1 and average serum 25(OH)D level was 37.34±16.17 nmol/L. The incidence of vitamin D deficiency and insufficiency in preterm infants was 37.8% and 41.8% respectively. Serum 25 (OH) D levels in preterm infants born in summer and autumn were higher than those born in winter and spring, and there was statistical difference (P<0.05). Logistic regression analysis showed that birth season and the mother's age may be the risk factors that influence serum 25 (OH) D levels in preterm infants. Conclusion The incidence of vitamin D deficiency and insufficiency in preterm infants is high, and the factors affecting the level of vitamin D need to be further studied.

Objective To investigate the impact of childhood abuse and exposure to family violence on college students'self-esteem.Methods Using Childhood Trauma Questionnaire-28 Item Short Form(CTQ-SF),Witness to interparental Violence Questionnaire,Self-esteem Scale(SES),and to investigate 412 college students tional abuse,emotional ignorance,physical ignorance or exposure to interparental physical violence had lower selfesteem(28.04±4.31,28.43±3.81,28.55±3.70,28.66±3.67,28.15±3.87),compared to the students withStudy showed the self-esteem was negatively correlated with childhood physical abuse,emotional abuse,sexual abuse,emotional ignorance,physical ignorance and exposure to interparental physical violence(r=-0.134,-0.216,-0.359,-0.250,-0.170,P＜0.01).Study showed most significant correlation between childhood emotional ignorance,childhood emotional abuse and self-esteem.Conclusion The experience of childhood abuse and ignorance,exposure to family violence have side effects on college students'self-esteem.The most important factors are childhood emotional ignorance and emotional abuse.

Objective:To observe and analyze the accuracy of the optic disc positioning and segmentation method of fundus images based on deep learning.Methods:The model training strategies were training and evaluating deep learning-based optic disc positioning and segmentation methods on the ORIGA dataset. A deep convolutional neural network (CNN) was built on the Caffe framework of deep learning. A sliding window was used to cut the original image of the ORIGA data set into many small pieces of pictures, and the deep CNN was used to determine whether each small piece of picture contained the complete disc structure, so as to find the area of the disc. In order to avoid the influence of blood vessels on the segmentation of the optic disc, the blood vessels in the optic disc area were removed before segmentation of the optic disc boundary. A deep network of optic disc segmentation based on image pixel classification was used to realize the segmentation of the optic disc of fundus images. The accuracy of the optic disc positioning and segmentation method was calculated based on deep learning of fundus images. Positioning accuracy=T/N, T represented the number of fundus images with correct optic disc positioning, and N represented the total number of fundus images used for positioning. The overlap error was used to compare the difference between the segmentation result of the optic disc and the actual boundary of the optic disc.Results:On the dataset from ORIGA, the accuracy of the optic disc localization can reach 99.6%, the average overlap error of optic disc segmentation was 7.1%. The calculation errors of the average cup-to-disk ratio for glaucoma images and normal images were 0.066 and 0.049, respectively. Disc segmentation of each image took an average of 10 ms.Conclusion:The algorithm can locate the disc area quickly and accurately, and can also segment the disc boundary more accurately.

Objective To investigate the clinical characteristics of bloodstream infections in obstetric patients and analyze the distribution and antimicrobial susceptibility of the pathogenic organisms. Methods The clinical data of bloodstream infections in obstetric patients treated in the Third Affiliated Hospital of Guangzhou Medical University from December 2014 to December 2017 were studied retrospectively. Results A total of 111 cases were identified, including 31(27.9％)during pregnancy and 80(72.1％)after delivery. Most(79.3％, 88/111)of these patients had obstetric disease or complication, and urinary, abdominal or intrauterine infection was found in 15(13.5％)cases. All patients had fever, and 7 cases showed septic shock. After treatment, 109(98.2％)patients were cured, despite infectious abortions in 6 cases. A total of 118 isolates were collected, including 31(26.3％)from pregnant women and 87(73.7％)isolates from puerperants. Gram-negative organisms, gram-positive organisms and Candia accounted for 58.5％, 39.0％, and 2.5％, respectively. The most common pathogens identified were Escherichia coli(44.1％), Enterococcus spp.(22.0％), and Staphylococcus spp.(5.1％). The prevalence of ESBLs-producing strains was 62.5％ in E. coli. All the E. coli strains were susceptible to piperacillin-tazobactam, imipenem, and tigecycline. No Enterococcus isolates were resistant to vancomycin or tigecycline. About 88.5％ of the Enterococcus strains were susceptible to ampicillin. Conclusions Bloodstream infection in obstetric patients usually occurs after delivery, probably resulting in septic shock or infectious abortion. The main pathogens are gram-negative bacteria and Enterococcus spp. The prevalence of ESBLs-producing strains was high in E. coli. Most of the Enterococcus strains were susceptible to ampicillin.

Objective To observe the clinical characteristics of ankylosing spondylitis (AS) patients with hyperuricemia (HUA), and to understand the correlation between AS and HUA, so as to improve the understanding of AS patients with HUA. Methods A retrospective analysis was carried out in patients with the diagnosis with AS from November 2012 to August 2016. Patients were divided into two groups based on complicated with and without HUA. The clinical manifestations, inflammatory indicators, imaging manifest-ations, treatment and outcomes of the two groups were statistically analyzed, and the follow-up results of some patients with HUA were analyzed. The chi-square test was used for the counting data. The measurement data in line with the normal distribution were tested by t test, and the measurement data in non-normal distribution were tested by Mann-Whitney U test. Results Three hundred and sixty-two patients with AS were collected, consisting of 288 males (79.6％) and 74 females (20.4％), aged from 14 to 72 years, a course of disease was 3 months to 40 years. There were 87 cases (24.0％) with hyperuricemia, 77 cases were male (88.5％, 21.3％of all AS patients), and 10 were female (11.5％, 2.8％ of all AS patients). Shorter morning stiffness time [(13 ±31) min and (22 ±48) min, Z=-2.231, P=0.026], lower IgM level [(1.4 ±1.3) g/L and (3.0 ±4.3) g/L, Z=-2.040, P=0.041], and lower erythrocyte sedimentation rate [(25±17) mm/1 h and (33±22) mm/1 h, t=-2.617, P=0.007] in the HUA group when compared with patients without HUA. The difference between the two groups was statistically significant. Four cases (4.6％) had gout arthritis in the group with HUA, all were male, blood uric acid level all>420 μmol/L. There were 7 cases (8.0％) of urolithiasis in the group with HUA, and 24 cases (8.7％) of urolithiasis in the group without HUA, but there was no statistically significant difference in the incidence of urolithiasis between the two groups. None developed hypertensive disease, heart disease, nephropathy, or diabetis. Conclusion The incidence of hyperuricemia is high in AS, and with lower disease activity, and fewer complications.

Objective:To systematically evaluate the clinical efficacy of laparoscopic common bile duct exploration (LCBDE) combined with endoscopic nasobiliary drainage (ENBD) versus T-tube drainage in the treatment of choledocholithiasis.Methods:Databases including PubMed(Medline), Embase, the Cochrane Library, Web of Science, Wanfang, CNKI and CBM were searched for literatures from January 1960 to May 2019 with the key words including "胆总管结石病,胆总管结石; T管引流, T管;鼻胆管引流,经内镜鼻胆管引流术, ENBD管, ENBD引流; cholelithiasis, common bile duct stone, jaundice, obstructive, Jaundice, gallstone; T-tube drainage, T-tube, t-tube, biliary tract drainge, drainge tube; endoscopic nasobiliary drainage, nasobiliary drainage, nasobiliary tube, endoscopic drainage tubes, endoscopic drainage tube, endoscopic retrograde biliary drainage" . The randomized controlled trials (RCTs) and high quality non-randomized controlled trials (NRCTs) on comparing ENBD and T-tube drainage during laparoscopic choledocholithotomy were included.Patients who received LCBDE combined with preoperative or intraoperative ENBD were allocated into ENBD group, and patients who received LCBDE combined with postoperative T-tube drainage were allocated into T-tube drainage group. Reported outcomes: operation time, volume of intraoperative blood loss, duration of postoperative hospital stay, time to drainage tube removal, time to postoperative gastrointestinal function recovery, treatment expenses, rate of surgical failure, incidence of postoperative biliary fistula, incidence of postoperative incisional infection, incidence of postoperative residual stones, incidence of postoperative pancreatitis, incidence of postoperative hyperamylasemia, incidence of postoperative bile peritonitis. Count data were represented as odds ratio ( OR) and 95% confidence interval (95% CI). Measurement data were represented as mean difference ( MD) and 95% CI. The I2 and Q tests were used to analyze literature heterogeneity. I2≤50% or P>0.10 indicated no significant heterogeneity, so fixed effects model was used for Meta analysis. I2>50% and P≤0.10 indicated a significant heterogeneity, so random effects model was used for Meta analysis. When analyzing the measurement data, subgroup analysis of individual indicators was performed if there were more than 4 RCTs included, and NRCTs were analyzed for supplement if there were no more than 4 RCTs included. When analyzing the count data, RCTs and NRCTs were combined for analysis. Funnel plots were used to test potential publication bias if there were more than or equal to 10 studies included, while no test was needed if there were less than 10 studies included. Results:(1) Document retrival: 26 literatures meeting the standards were included, including 9 RCTs and 17 NRCTs (4 semi-randomized studies and 13 case-control studies). There were 2 098 patients, including 1 114 patients in the ENBD group and 984 patients in the T-tube drainage group. (2) Results of Meta analysis. ① Duration of postoperative hospital stay: there was a significant difference in the duration of postoperative hospital stay between the ENBD group and T-tube drainage group ( MD=-6.53, 95% CI: -8.64 to -4.43, P<0.05). Further analysis of 9 RCTs showed significant differences in the duration of postoperative hospital stay between patients without acute complications of choledocholithiasis in the ENBD group and those in the T-tube drainage group, between patients with acute complications of choledocholithiasis in the ENBD group and T-tube drainage group, respectively ( MD=-5.88, -8.77, 95% CI: -8.32 to -3.45, -12.39 to -5.15, P<0.05). ② Time to drainage tube removal: for the RCTs, there was a significant difference in the time to drainage tube removal between the ENBD group and T-tube drainage group ( MD=-46.01, 95% CI: -83.64 to -8.37, P<0.05). For the NRCTs, there was a significant difference in the time to drainage tube removal between the ENBD group and T-tube drainage group ( MD=-24.05, 95% CI: -32.93 to -15.18, P<0.05). ③ Time to postoperative gastrointestinal function recovery: for the RCTs, there was a significant difference in the time to postoperative gastrointestinal function recovery between the ENBD group and T-tube drainage group ( MD=17.80, 95% CI: -31.11 to -4.48, P<0.05). For the NRCTs, there was a significant difference in the time to drainage tube removal between the ENBD group and T-tube drainage group ( MD=-5.64, 95% CI: -10.16 to -1.12, P<0.05). ④ Incidence of postoperative biliary fistula: there was a significant difference in the incidence of postoperative biliary fistula between the ENBD group and T-tube drainage group ( OR=0.50, 95% CI: 0.28-0.89, P<0.05). ⑤ Incidence of postoperative incisional infection: there was a significant difference in the incidence of postoperative incisional infection between the ENBD group and T-tube drainage group ( OR=0.35, 95% CI: 0.17-0.73, P<0.05). (3) Analysis of publication bias. The incidence of postoperative biliary fistula in the two groups was analyzed by funnel plot based on the 15 studies. The bilateral symmetry was presented in the funnel plot for incidence of postoperative biliary fistula, suggesting that publication bias had little influence on results of Meta analysis. Conclusion:For patients with choledocholithiasis that endoscopic lithotomy is not feasible, LCBDE combined with ENBD can significantly shorten duration of postoperative hospital stay, time to drainage tube removal, postoperative gastrointestinal function recovery time, reduce the incidence of postoperative biliary fistula and incisional infection compared with LCBDE combined with T-tube drainage.

Objective:To evaluate the efficiency of ResNet50-OC model based on deep learning for multiple classification of color fundus photographs.Methods:The proprietary dataset (PD) collected in July 2018 in BenQ Hospital of Nanjing Medical University and EyePACS dataset were included.The included images were classified into five types of high quality, underexposure, overexposure, blurred edges and lens flare according to clinical ophthalmologists.There were 1 000 images (800 from EyePACS and 200 from PD) for each type in the training dataset and 500 images (400 from EyePACS and 100 from PD) for each type in the testing dataset.There were 5 000 images in the training dataset and 2 500 images in the testing dataset.All images were normalized and augmented.The transfer learning method was used to initialize the parameters of the network model, on the basis of which the current mainstream deep learning classification networks (VGG, Inception-resnet-v2, ResNet, DenseNet) were compared.The optimal network ResNet50 with best accuracy and Micro F1 value was selected as the main network of the classification model in this study.In the training process, the One-Cycle strategy was introduced to accelerate the model convergence speed to obtain the optimal model ResNet50-OC.ResNet50-OC was applied to multi-class classification of fundus image quality.The accuracy and Micro F1 value of multi-classification of color fundus photographs by ResNet50 and ResNet50-OC were evaluated.Results:The multi-classification accuracy and Micro F1 values of color fundus photographs of ResNet50 were significantly higher than those of VGG, Inception-resnet-v2, ResNet34 and DenseNet.The accuracy of multi-classification of fundus photographs in the ResNet50-OC model was 98.77% after 15 rounds of training, which was higher than 98.76% of the ResNet50 model after 50 rounds of training.The Micro F1 value of multi-classification of retinal images in ResNet50-OC model was 98.78% after 15 rounds of training, which was the same as that of ResNet50 model after 50 rounds of training.Conclusions:The proposed ResNet50-OC model can be accurate and effective in the multi-classification of color fundus photograph quality.One-Cycle strategy can reduce the frequency of training and improve the classification efficiency.

Background Schizophrenia and the use of antipsychotic medications are identified to be the likely contributors to the development of metabolic syndrome(MS)and cardiovascular disease,and jeopardize the prognosis of schizophrenia.Therefore,effectively preventing or reducing the risk of developing MS in patients with schizophrenia is critical.Objective To explore the efficacy of aripiprazole combined with olanzapine for male schizophrenia patients and its effect on MS,so as to provide a certain reference for the selection of antipsychotic drugs for schizophrenia patients.Methods Male patients(n=80)who were hospitalized in The Third People's Hospital of Meizhou from February to June 2023 and fulfilling the International Classification of Diseases,tenth edition(ICD-10)diagnostic criteria for the schizophrenia were enrolled,and grouped using random number table method,each with 40 cases.Study group was treated with aripiprazole combined with olanzapine,while control group was given aripiprazole monotherapy.The treatment lasted for 6 continuous weeks in both groups.At the baseline,Positive and Negative Symptom Scale(PANSS)score,MS-related indices[fasting plasma glucose(FPG),hemoglobin A1c(HbA1c),body mass index(BMI),waist-to-hip ratio(WHR),lipid profile],S100 calcium-binding protein B(S100B)and high sensitivity C-reactive protein(hs-CRP)were recorded.Then the PANSS scores at the end of the 2nd,4th and 6th week of treatment,the Clinical Global Impression(CGI)scores at the end of the 2nd and 6th week of treatment,as well as the MS-related indices,S100B,hs-CRP,Treatment Emergent Symptom Scale(TESS)score and Rating Scale for Extrapyramidal Side Effects(RSESE)score at the end of the 6th week of treatment were recorded in all participants.Results Analysis on PANSS score revealed a significant group effect,time effect and group×time interaction effect(F=18.092,634.780,2.917,P<0.05 or 0.01).Analysis on CGI score revealed a significant group effect and time effect(F=20.492,99.190,P<0.01).At the end of the 6th week of treatment,study group detected lower serum concentrations of HbA1c and triglyceride(TG)compared with control group(t=-3.495,-3.293,P<0.05).The post-treatment hs-CRP level was lower in study group than that in control group(t=-3.916,P<0.05).Study group scored lower on TESS compared with control group(t=-4.684,P<0.01).Conclusion Aripiprazole combined with olanzapine can effectively alleviate psychotic states in male schizophrenia patients,and the combination therapy yields less impact on MS-related indices than olanzapine monotherapy.

Objective:To explore the correlation between socioeconomic status (SES) and diabetic kidney disease (DKD) in patients with type 2 diabetes (T2D).Methods:A total of 276 T2D patients admitted to the Second Affiliated Hospital of Nanjing Medical University from January to June 2020 were enrolled in this cross-sectional study. The estimated glomerular filtration rate (eGFR) was calculated according to the urinary albumin/creatinine ratio (UACR) and the chronic kidney disease epidemiology collaboration equation(CKD-EPI formula) based on serum creatinine. The patients were divided into simple T2D group (184 cases) and DKD group (92 cases). Collect demographic and laboratory examination data, record education, income and occupation, and calculate standardized SES scores. According to SES scores, subjects were divided in three levels: SES≤9, SES≥10-≤12, and SES≥13. Student's t test was used for comparison of measurement data with normal distribution between two groups, and one-way ANOVA was used for comparison between multiple groups. Non-normal distribution was represented by M( Q1, Q3), and rank-sum test was used for comparison between groups. Counting data were expressed as frequency or percentage, and chi-square test was used for comparison between groups. Bofferoni test was further used for pairwise comparison of indicators with statistical significance among multiple groups. Spearman correlation analysis was used to analyze the correlation between variables. The risk factors were analyzed by binary Logistic regression. Results:The age of the subjects was (53.37±10.68) years, men accounted for 55.8% (154/276), the duration of diabetes was 60.00 (12.00, 134.00) months, and eGFR was (97.56±21.15) mL/(min·1.73 m 2). In simple T2D group and DKD group, prevalence of hypertension were 39.7% (73/184) and 57.6% (53/92), systolic blood pressure were (129.43±14.92) mmHg and (139.29±17.61) mmHg, diastolic blood pressure were (81.86±10.06) mmHg and (87.74±11.19) mmHg, serum albumin were (45.74±4.15) g/L and (43.99±5.05) g/L, triglycerides were (1.82±1.24) mmol/L and (2.64±2.92) mmol/L, high density lipoprotein cholesterol were (1.17±0.37) mmol/L and (1.07±0.26) mmol/L, serum uric acid were (298.44±90.73) μmol/L and (336.22±94.01) μmol/L, serum creatinine were (62.83±14.45) μmol/L and (87.75±57.37) μmol/L, eGFR were (102.6±14.28) mL/(min·1.73 m 2) and (87.47±28.04) mL/(min·1.73 m 2), UACR were (7.60 (4.63, 13.15)) mg/g and (93.95 (47.25, 310.25)) mg/g. Prevalence of hypertension, systolic blood pressure, diastolic blood pressure, triglycerides, serum uric acid, serum creatinine, UACR in DKD group were higher than those in simple T2D group. Serum albumin, high density lipoprotein cholesterol and eGFR in DKD group were lower than those in simple T2D group. There was significant difference between the two groups ( χ2=7.95, t values were 4.87, 4.40, 3.04, 3.26, 2.30, 3.22, 5.56, 5.95, Z=13.07, P values were 0.005, <0.001, <0.001, 0.003, 0.001, 0.022, 0.001, <0.001, <0.001, and <0.001, respectively). The number of males in the three groups with SES ≥13 group, SES≥10-≤12 group, SES ≤9 group were 61 (81.3%, 61/75), 55 (59.8%, 55/92), 38 (34.9%, 38/109), respectively. The number of cases with smoking history were 42 (56.0%, 42/75), 41 (44.6%, 41/92), 35 (32.1%, 35/109), respectively. The number of cases with drinking history were 38 (50.7%, 38/75), 32 (34.8%, 32/92), 26 (23.9%, 26/109), respectively. The ages were (47.77±10.76), (52.76±11.22), (57.74±7.96) years old, respectively. Body mass index (BMI) were (26.17±3.87), (24.96±3.93), (24.27±4.89) kg/m 2, respectively. High density lipoprotein cholesterol (HDL) were (1.03±1.03), (1.16±0.41), (1.21±0.32) mmol/L, respectively. Serum uric acid were (336.56±82.05), (293.78±94.78), (307.99±96.53) μmol/L, respectively. EGFR were (105.03±19.72), (99.77±19.44), (90.57±21.49) mL/(min·1.73 m 2),respectively.The difference between groups were statistically significant (χ 2=39.79, 10.55, 14.08, F=22.69, 4.03, 6.20, 4.53, 12.02, P values were <0.001, 0.005, 0.001, <0.001, 0.019, 0.002, 0.012, and <0.001, respectively). Pairwise comparison shows that male and eGFR in SES ≤9 group were lower than those in SES ≥13 group and SES≥10-≤12 group, age in SES ≤9 group was higher than that in SES ≥13 group and SES≥10-≤12 group. The difference was statistically significant (all P<0.05). Smoking history, alcohol history and BMI in SES ≤9 group were lower than those in SES ≥13 group, and the high density lipoprotein cholesterol in SES ≤9 were higher than that in SES ≥13 group. The difference was statistically significant (all P<0.05). Male, alcohol history and serum uric acid in SES≥10-≤12 group were lower than those in SES ≥13 group, and age and high density lipoprotein cholesterol in SES≥10-≤12 group were higher than those in SES ≥13 group. The difference was statistically significant (all P<0.05). Spearman correlation analysis showed that SES in T2D was positively correlated with male, smoking history, alcohol history, BMI, serum uric acid and eGFR ( r values were 0.38, 0.20, 0.24, 0.16, 0.13 and 0.31, P values were <0.001, 0.001, <0.001, 0.008, 0.028, and <0.001, respectively), and negatively correlated with age, high density lipoprotein cholesterol and UACR ( r values were -0.35, -0.24 and -0.14, P values were <0.001, <0.001, and 0.017, respectively). Logistic regression analysis showed that SES (OR=2.71,95% CI:1.10-6.68, P=0.031) was associated with T2DM combined with DKD. The risk of developing DKD increased when the SES was ≤9. Conclusion:The SES in patients with type 2 diabetes is closely related to DKD. Low SES may be a new risk factor for DKD in type 2 diabetic patients.