Objective:To investigate the etiology of high myopia and the correlation between best corrected visual acuity and myopic diopter and fundus lesions.Methods:The clinical data of 112 patients (198 eyes) with high myopia diagnosed in Yuyao Hospital of Traditional Chinese Medicine from December 2018 to December 2019 were retrospectively analyzed. The factors that influence high myopia were analyzed. Myopic diopter, the type and severity of fundus lesions, and best corrected visual acuity were evaluated. The correlation between observation indexes was analyzed.Results:The occurrence of high myopia was related to partial lens opacity, fundus aberrations, corneal pannus and heredity. Unconditional multivariable logistic regression revealed that parental myopia [73 (83.91%) vs. 39 (57.34%)], outdoor activities < 4.17 h [47 (89.36%) vs. 24 (61.54%), 26 (68.42%), 20 (65.42%)] are the risk factors of high myopia ( χ2 = 13.427, 10.300, P < 0.05 or P < 0.01). Pearson linear correlation analysis showed that myopia diopter was negatively correlated with best corrected visual acuity ( r = -0.729, P < 0.001). Tigroid fundus, tilted optic disc, β-zone parapapillary atrophy and posterior polar annular choroidal dystrophy were positively correlated with best corrected visual acuity ( r = 0.461, 0.732, 0.528, 0.825, P < 0.05 or P < 0.001). The severity of lesion was negatively correlated with best corrected visual acuity( r = -0.673, P < 0.001). Conclusion:The myopia diopter and fundus lesion characteristics in patients with high myopia are closely related to best corrected visual acuity, which can be used to evaluate patient's condition and provide guidance for prevention and treatment of high myopia.

Developmental dysplasia of the hip (DDH) is a common skeletal malformation in children and the prominent cause of hip osteoarthritis and lower limb disability. The therapeutic difficulty and effect of DDH are closely related to an early and proper diagnosis. Hip ultrasonography and anteroposterior pelvic radiography are preferred depending on the presence of the secondary ossification center of the femoral head. Conventional diagnostic methods primarily relied on manual measurements and empirical judgments by clinicians, which were laborious and generally lacked reliability. The effective integration of medical imaging and artificial intelligence algorithms is expected to improve the diagnosis of pediatric DDH and enhance the efficiency of clinical diagnosis and treatment. Segmentation algorithms based on the extraction of local geometric features, 3D map search-based segmentation algorithms, and deep learning networks were utilized to assist in analyzing hip ultrasound images, calculating key dysplasia indicators, and diagnosing DDH in infants under 4-6 months. Computer-aided techniques, such as bone edge detection and template matching algorithms, deep transfer learning algorithms, and local-global feature mining convolutional neural networks were used to automatically identify bony landmarks on pelvic radiographs for measuring hip parameters and evaluating DDH in children over 4-6 months. However, there were several crucial problems in the clinical application of the artificial intelligence model for the auxiliary diagnosis of DDH due to technical limitations and insufficient understanding of researchers. This paper aims to review the progress of application in the medical artificial intelligence technology for the clinical auxiliary diagnosis of DDH. The author also provides references for future research for truly intelligent diagnostic tools.

Objective To investigate the hemodynamic,cerebral perfusion and neurological function changes between unilateral symptomatic internal carotid artery occlusion(SICAO)and symptomatic middle cerebral artery occlusion(SMCAO)after superfical temporal artery-middle cerebral artery(STA-MCA)bypass surgery as well as the correlation between relative peak volume of blood flow(rPVOL)in STA measured by carotid Doppler ultrasonography(CDU)and relative cerebral blood flow(rCBF)by CT perfusion(CTP).Methods Retrospective analysis of 112 patients who diagnosed with unilateral SICAO or SMCAO through DSA and/or CT angiography(CTA)and underwent superficial temporal artery-middle cerebral artery(STA-MCA)bypass in the Department of Neurosurgery at First Affiliated Hospital of Soochow University from March 2019 to June 2022.The patients were divided into SICAO group(50 cases)and SMCAO group(62 cases)and followed up for 360 days.General clinical and imaging data of patients in two groups were collected.General clinical information included age,gender,clinical manifestations(stroke,transient ischemic attack[TIA]),hypertension,diabetes,smoking history,blood biochemical indicators(total cholesterol,triacylglycerol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,high-sensitivity C-reactive protein),National Institute of Health stroke scale(NIHSS)scores at admission and 7 days after surgery,and modified Rankin Scale(mRS)scores at admission and 7,180 and 360 days after surgery(mRS scores 2 as good prognosis,＞2 as poor prognosis).Imaging data included hemodynamic parameters(STA diameter[D],resistance index[RI],time-averaged-mean velocity[TAMV],and time-average-peak flow velocity[TAPV])evaluated by CDU within 7 days before and 7,30,180 and 360 days after STA-MCA bypass,as well as CTP parameters(rCBF,relative cerebral blood volume[rCBV],relative mean transit time[rMTT]and relative time to peak[rTTP])of the head region of interest(ROI)before and 7,180 and 360 days after surgery.Patients were observed 1 year after surgery through outpatient or telephone follow-up to determine if they have experienced recurrent stroke(TIA,cerebral infarction,etc.)and other postoperative complications(subdural hematoma,cerebral hemorrhage,etc.).DSA imaging was also performed to determine the patency of vascular anastomosis of patients in SICAO and SMCAO groups.STA hemodynamic parameters,head CTP parameters,NIHSS scores,and mRS scores at different time points before and after STA-MCA bypass surgery were compared between SICAO and SMCAO groups correspondingly;STA hemodynamic parameters,head CTP parameters,and mRS scores were pairwise compared between different time points within each group.A correlation analysis was conducted between rCBF and rPVOL in STA which was measured by CTP and CDU accordingly in the SICAO and SMCAO groups to further determine the consistency of the blood flow through STA and intracranial cerebral blood flow.Results(1)There was no statistically significant difference in general clinical data between the two groups(all P＞0.05).(2)Comparison of STA hemodynamic parameters:D,TAMV,and TAPV of both groups significantly increased at 7,30,180,and 360 days after surgery(all P＜0.05)compared with preoperative,and reaching their peak at 7 days after surgery,and there was no statistically significant difference in D,TAMV,and TAPV among 30,180,and 360days after surgery(all P＞0.05).There was no statistically significant difference in D,TAMV,or TAPV between the two groups at each time point(D:F=2.286,TAMV:F=0.180,TAPV:Wald x=1.709;all P＞0.05).RI of the two groups was significantly reduced at 7,30,180,and 360 days after surgery(all P＜0.05)compared with preoperative,and there was no statistically difference in RI among 7,30,180,and 360 days after surgery(all P＞0.05).There was also no statistically difference in RI between the two groups at each time point(Wald x2=0.788,P＞0.05).(3)Comparison of CTP parameters between two groups:compared to preoperative,rCBF and rCBV in the SICAO group and SMCAO group increased at 7,180,and 360 days after surgery(all P＜0.05),there was no statistically difference in CTP parameters within the two groups at different time points(Wald x2 was 0.177,2.954,respectively,all P＞0.05),and the rMTT and rTTP of both groups decreased at 7,180,and 360 days after surgery(all P＜0.05),there was no significant difference in rMTT and rTTP between the two groups at different time points(Waldx2 was 2.157,1.706,respectively,all P＞0.05),and there was no statistically difference in the parameters of each postoperative time point within each group(all P＞0.05).(4)Comparison of vascular patency between two groups:1 year DSA showed that 91.1％(102/112)of patients were patent,with 92.0％(46/50)in the SICAO group and 90.3％(56/62)in the SMCAO group.There was no statistically difference between the two groups(x2=0.001,P＞0.05).The STA hemodynamics and intracranial CTP parameters of the two groups of patients with patent anastomosis were significantly improved compared to preoperative.A total of 10 patients were non-patent by 1 year DSA,including 4 cases in the SICAO group and 6 cases in the SMCAO group.In 1 non-patent SICAO patient and 3 non-patent SMCAO patients,the STA hemodynamic parameters evaluated by CDU 180 days and 360 days after surgery also showed corresponding improvement compared to preoperative,with an increase in TAMV and TAPV,and a decrease in RI.(5)Comparison of neurological improvement between the two groups:compared with preoperative,the mRS scores of the SICAO group and the SMCAO group significantly decreased at 7,180,and 360days postoperatively(all P＜0.05);there was no statistically difference in the mRS scores within each group at 7,180,and 360 days after surgery(P＞0.05).There was no statistically difference in mRS scores between the two groups at different time points including admission and 7,180 and 360 days after surgery(Wald x2=0.006,P＞0.05).The NIHSS scores of the SICAO group and the SMCAO group decreased at 7 days after surgery compared to admission(Z was 21.040,-5.183,respectively,all P＜0.01),and there was no statistically difference in NIHSS scores between the two groups at admission and 7 days after surgery(both P＞0.05).(6)Spearman rank correlation analysis showed that rPVOL and rCBF were highly positively correlated in the SICAO group(r=0.865,P＜0.01)and in the SMCAO group(r=0.864,P＜0.01).Conclusions Unilateral STA-MCA bypass can improve cerebral perfusion and neurological function in patients with SICAO and SMCAO,and there is no statistical difference between the two groups of patients.The rPVOL measured by CDU was highly correlated with the rCBF in patients after STA-MCA bypass surgery.

Objective To investigate the transmission of blaNDM-1 gene in carbapenem-resistant Citrobacter freundii. Methods A total of 18 strains of NDM-1-producing C. freundii were collected from the First Affiliated Hospital of Kunming Medical University during the period from June 2012 to October 2014. The isolates were identified and subjected to antimicrobial susceptibility testing with VITEK 2 System. Conjugation experiments, pulsed-field gel electrophoresis (PFGE) and Southern blot hybridization were performed to determine the transferability of plasmids. Results The antibiotic susceptibility results showed that all the NDM-1-producing C. freundii isolates were resistant to penicillins, cephalosporins and carbapenems. All isolates exhibited different level resistance to other antibiotics. Conjugation experiments revealed that the plasmids harboring blaNDM-1 in 13 strains were transformed into E. coli 600, and exhibited carbapenem resistance. PFGE and Southern blot hybridization found that blaNDM-1 was located on a 33.3 kb plasmid in 16 isolates and on 33.3-54.7 kb plasmid in 2 isolates. Conclusions Our findings suggest that plasmids contribute to the horizontal dissemination of blaNDM-1 gene in carbapenemresistant C. freundii.

Objective To investigate the feasibility and reliability of three-dimensional ultrasound in evaluating carotid artery vulnerable plaques with the method of prospective plaque scoring.Methods From February 2016 to March 2017,41 patients who performed carotid endarterectomy (CEA) in the department of neurosurgery at the First Affiliated Hospital of Soochow University were scheduled for conventional cervical vascular ultrasonography,three-dimensional ultrasonography (3D-US),CT angiography (CTA),CT perfusion imaging (CTP) and / or digital subtraction angiography (DSA) examinations before surgery.On pathology,the atherosclerotic plaque morphology and HE staining findings were evaluated after surgery.The results of preoperative 3D-US were compared with the corresponding postoperative pathologic findings.Each plaque was scored based on the plaque morphology,homogeneity,echo characteristics and degree of vascular stenosis in 3D-US.According to the pathological results,the plaques were divided into vulnerable plaque group (n=35) and stable plaque group (n=10).The plaque score difference between groups was compared using independent sample t test.Patients were classified into ischemic stroke group (n=27) and non-ischemic stroke group (n=14) according to whether ischemic stroke symptoms occurred during the last 6 months.Pearson x2 test was used to analyze the correlation between ischemic events and the vulnerable plaques.Results Plaque scores were significantly different between vulnerable plaque group and stable plaque group (5.3 ±0.2 vs 3.4±0.3,t=5.339,P ＜ 0.05).The accuracy of identifying vulnerable plaque by plaque score is high,while the area under the ROC curve is 0.907 with a cutoff 4.5 (the maximum Youden index is 0.671,the sensitivity is 77％,the specificity is 90％).There is a significant positive correlation between the occurrence of ischemic events and plaque vulnerability (r=0.858,P ＜ 0.05).Conclusion 3D-US can accurately and quantitatively assess vulnerability of carotid plaques,carotid artery vulnerable plaque was significantly associated with ischemic stroke,which can provide the basis for clinical individualized treatment.

A deep learning-based model for automatic diagnosis and classification of adolescent idiopathic scoliosis has been constructed.This model mainly included key points detection and Cobb angle measurement.748 full-length standing spinal X-ray images were retrospectively collected,of which 602 images were used to train and validate the model,and 146 images were used to test the model performance.The results showed that the model had good diagnostic and classification performance,with an accuracy of 94.5%.Compared with experts'measurement,94.9%of its Cobb angle measurement results were within the clinically acceptable range.The average absolute difference was 2.1°,and the consistency was also excellent(r2≥0.9552,P<0.001).In the future,this model could be applied clinically to improve doctors'diagnostic efficiency.

Objective A deep learning-based method for evaluating the quality of pediatric pelvic X-ray images is proposed to construct a diagnostic model and verify its clinical feasibility.Methods Three thousand two hundred and forty-seven children with anteroposteric pelvic radiographs are retrospectively collected and randomly divided into training datasets,validation datasets and test datasets.Artificial intelligence model is conducted to evaluate the reliability of quality control model.Results The diagnostic accuracy,area under ROC curve,sensitivity and specificity of the model are 99.4%,0.993,98.6%and 100.0%,respectively.The 95%consistency limit of the pelvic tilt index of the model is-0.052-0.072.The 95%consistency threshold of pelvic rotation index is-0.088-0.055.Conclusion This is the first attempt to apply AI algorithm to the quality assessment of children's pelvic radiographs,and has significantly improved the diagnosis and treatment status of DDH in children.

Objective To explore the dynamic changes in cerebral hemodynamics in patients with unilateral middle cerebral artery(MCA)occlusion after superficial temporal artery(STA)-MCA bypass surgery.Methods One hundred and nine patients diagnosed with unilateral MCA occlusion by DSA who underwent STA-MCA bypass surgery were retrospectively included in the Department of Neurosurgery of the First Affiliated Hospital of Soochow University.Clinical data of patients were collected within 24 hours after admission,including age,sex,body mass index,stroke risk factors including hypertension,hyperlipidemia,diabetes,smoking,drinking history and atrial fibrillation,clinical manifestations(within the last 6 months;nonspecific symptoms[dizziness,memory loss,unresponsiveness,etc.],transient ischemic attack,and stroke),blood biochemical markers(low density lipoprotein cholesterol,high density lipoprotein cholesterol,triglyceride,total cholesterol,fasting blood glucose,and hypersensitive C-reactive protein),and National Institutes of Health stroke scale(NIHSS)score at admission.Color Doppler ultrasound(CDU)and transcranial color coded Doppler(TCCD)ultrasound were used to evaluate the hemodynamic parameters of STA before and at different periods after surgery(4-7 days and 1,3,6,12 months after surgery)to analyze the patency of bypass arteries and intracranial hemodynamic changes,and to check the consistency of the results of the bridge artery patency at 12 months postoperatively by CDU and DSA,consistency test was performed.According to the results of the DSA examination 12months after surgery,the patients were divided into the bypass artery patency group and the non-patency group(stenosis or occlusion).The hemodynamic parameters at the trunk of STA,namely the extracranial segment,transcranial,and intracranial part of the bypass arteries,were compared between the two groups.It included inner diameter(D),peak systolic velocity(PSV),end-diastolic velocity(EDV),resistance index(RI),pulsation index(PI),time-averaged mean velocity(TAMV),time-averaged peak velocity(TAPV),and calculated flow of the STA trunk including TAMV flow and TAPV flow.Head CT,CT angiography(CTA)above the aortic arch,and CT perfusion(CTP)of the whole brain were performed 1 to 3 days before surgery and 12 and 18 months after surgery to observe the changes in cerebral perfusion.Head CT was performed 1 to 2 days after the operation to observe whether there were new hemorrhagic and ischemic lesions in the operative area.the CTP parameters of the two groups were compared including 12 and 18 months after the operation with 1 to 3 days before the surgery,and the differences in CTP parameters between the two groups were compared.The modified Rankin scale(mRS)was used to evaluate the neurological function prognosis of the patients at 12 and 18 months after surgery.The mRS score 2 was divided into a good prognosis and mRS score≥3 was a poor prognosis.NIHSS score of the patients was recorded 7 days,12,and 18 months after surgery.Results(1)Consistency analysis of CDU and DSA:the consistency of the assessment of bypass artery patency was excellent at 12 months after surgery,and the Kappa value was 0.94(95％CI 0.81-1.00,P＜0.01).According to DSA,101 cases(92.7％)were in bypass artery patency group,while 8 cases(7.3％)in the non-patency group(no case of occluded bridge vessel was found),and the sites of stenosis in the bypass arteries were all located in the transcranial segment.(2)Hemodynamic parameters:compared with the preoperative results,the D of the extracranial segment increased on 4-7 days and 1,3,6,and 12 months after the operation(Wald x2=30.438).Hemodynamic parameters included increased blood velocity such as PSV,EDV,TAMV,and TAPV(Waldx2 was 12.117,29.310,31.075 and 17.525,respectively)and blood flow including TAMV flow and TAPV flow(Wald x2 was 54.503 and 34.986,respectively)increased,while RI and PI values were decreased(Waldx2 was 112.568 and 103.629,respectively),and the differences were statistically significant(all P＜0.05).However,there was no significant difference in hemodynamic parameters in the non-patency group at 12 months after operation(all P＞0.05).Compared with 4-7 days after surgery,PSV(252.0[206.8,315.3]cm/s vs.102.5[84.0,119.0]cm/s)and EDV(119.5[106.3,159.8]cm/s vs.43.5[36.8,52.0]cm/s)in the non-patency group were significantly higher at the cranial entrance 12 months after surgery(both P＜0.05),but there was no significant difference in RI and PI values(both P＞0.05).Compared with 4-7 days after surgery,the blood flow parameters of STA intracranial segment,including PSV(29.4[24.8,41.4]cm/s vs.111.5[63.3,120.0]cm/s),EDV(19.7[15.2,22.2]cm/s vs.58.5[28.3,70.0]cm/s)and PI(0.55[0.42,0.63]vs.0.83[0.61,0.90])values in the non-patency group at 12 months after surgery were significantly decreased(all P＜0.05).(3)CTP parameters:the relative cerebral blood flow(rCBF)of the patency group increased at 12 and 18 months after surgery compared to preoperative levels,while relative cerebral blood volume(rCBV),relative peak time(rTTP)and relative mean transit time(rMTT)decreased,with statistical significance(all P＜0.05).At 12 and 18 months after operation,rCBF increased,while rMTT decreased in the non-patency group(both P＜0.05),but there was no significant difference as for rCBV and rTTP.The rTTP of the patency group at 12 and 1 8 months was lower than that of the non-patency group(12 months after surgery:1.14[1.06,1.15]vs.1.20[1.14,1.28],P=0.024;1 8 months after surgery:1.14[1.06,1.15]vs.1.20[1.14,1.28],P=0.023),but there was no statistical significance for other parameters between the two groups(all P＞0.05).(4)NIHSS score and prognosis:clinical follow-up results 18 months after the operation showed that no new stroke occurred during the follow-up period.The NIHSS scores in the patency group and the non-patency group were remarkably lower at 7 days,12,and 18 months after surgery than at admission(patency group:2[0,4],1[0,2],0[0,2]vs.3[0,6],respectively;the non-patency group:3[1,5],3[1,6],2[1,6]vs.4[1,7],respectively),with significant differences(all P＜0.05);However,the NIHSS scores in the patency group were significantly lower than that in the non-patency group at 12 and 18 months after surgery,and the proportion of patients with good prognosis in the patency group was substantially higher than that in the non-patency group(12months:87.1％[88/101]vs.4/8,P=0.039;18 months:90.1％[91/101]vs.4/8,P=0.025).Conclusion CDU can quantitatively evaluate the hemodynamic changes of bypass arteries after the STA-MCA bypass procedure,which can be applied to the long-term dynamic follow-up after the surgery.

Objective:To study the respiratory morbidity and the risk factors of respiratory complications in late-preterm infants.Methods:The data of 959 late-preterm infants in 21 hospitals in Beijing from October 2015 to April 2016 were collected.These infants were divided into the respiratory morbidity group (237 cases) and the control group (722 cases) according to whether they had short-term respiratory morbidity after birth.Clinical data of the two groups were compared.Results:Among the 959 late-preterm babies, 530 were male and 429 were female.Two hundred and thirty-seven cases (24.7%) developed short-term respiratory morbidity after birth.Infectious pneumonia developed in the most cases (81 cases, 8.4%), followed by transient tachypnea (65 cases, 6.8%), amniotic fluid aspiration (51 cases, 5.3%), and respiratory distress syndrome (24 cases, 2.5%) successively.All the infants recovered and discharged.There were no differences between gender and maternal age between 2 groups (all P>0.05). Compared with the control group, more late-preterm infants were delivered by cesarean section (73.4% vs.59.7%, χ2=14.43, P<0.001) and the 1-minute Apgar score was lower [(9.41±1.66) scores vs.(9.83±0.53) scores, t=5.40, P<0.001] in the respiratory morbidity group.The differences were statistically significant.There were more cases with maternal complications in the respiratory morbidity group that in the control group (66.7% vs.58.6%, χ2=4.877, P=0.027), but no difference in various complications between 2 groups was observed ( P>0.05). In the respiratory morbidity group, the most frequent complications were maternal hypertension and preeclampsia (27.8% vs.22.6%, χ2=2.728, P=0.099). There were no differences between 2 groups in gestational age, birth weight and birth length (all P>0.05). There were more infants small for gestational age and large for gestational age in the respiratory morbidity group than in the control group (18.8% vs.14.1%, 6.3% vs.2.4%, χ2=8.960, P=0.011). The duration of hospitalization of the respiratory morbidity group was significantly longer than that of the control group [(9.00±4.42) d vs.(6.82±4.19) d, t=6.676, P<0.001] since the infants with respiratory morbidity needed to be hospita-lized. Conclusions:Respiratory diseases occur in about 1/4 of late-preterm infants.Infants who are delivered by cesarean section and whose mothers are complicated with the maternal hypertension and preeclampsia should be monitored closely.Respiratory support should be provided for infants not appropriate for gestational age who are more likely to suffer from respiratory diseases, so that they can successfully pass through the transition period.

Objective To investigate the risk factors of hyperbilirubinemia in late preterm infants. Methods The clinical data of 815 late preterm infants (449 males and 366 females) from 25 hospitals in Beijing were collected from October 2015 to April 2016, including 340 cases(41.7％) with hyperbilirubinemia (hyperbilirubinemia group), and 475 cases without hyperbilirubinemia (control group). The clinical data of two groups were compared, and the maternal factors influencing hyperbilirubinemia in late preterm infants were analyzed with logistic regression. Results There were no significant differences in gender ratio (M:F 1.39 vs. 1.12, t=1.811,P=0.172)and birth weight[(2502.6±439.6)g vs. (2470.2±402.9)g,χ2=2.330,P=0.127)]between two groups. The incidence rates of hyperbilirubinemia in infants of 34 wks, 35 wks and 36 wks of gestational age were 22.9％(87/174), 35％(119/300) and 42.1％(143/341) respectively (χ2=1.218,P=0.544). The multivariate logistic regression analysis indicated that the maternal age(OR=1.044,95％ CI:1.010-1.080,P=0.011)was independent risk factor and multiple births(OR=1.365,95％CI:0.989-1.883,P=0.048), premature rupture of membranes(OR=2.350,95％ CI:1.440-3.833,P=0.001), cesarean section(OR=1.540,95％CI:0.588-4.031,P=0.014)were risk factors for hyperbilirubinemia in late preterm infants. Conclusions The incidence of hyperbilirubinemia in late preterm infants is relatively high. Maternal age, multiple births, premature rupture of membranes and cesarean section are risk maternal factors related to hyperbilirubinemia in late preterm infants.