Objectives:To investigate the effect of non-optimal temperature exposure during pregnancy on the risk for preterm birth and identify the susceptible exposure window. At the same time, the interaction between non-optimal temperature and pollutants exposure during pregnancy on preterm birth was analyzed, in order to provide strong clues for the influence of non-optimal temperature exposure during pregnancy on the risk for preterm birth.Methods:A total of 1 852 pregnant women were recruited from September 2021 to June 2023 in Fujian Provincial Maternal and Child Health Care Center. Questionnaire survey was conducted, and their health records were analyzed. The permanent address of each pregnant woman was matched with Fifth Generation European Centre for Medium-Range Weather Forecasts Atmospheric Reanalysis of the Global Climate and a geo-statistical combination model based on satellite remote sensing data collection, then follow-up for pregnancy outcome was conducted. Distributed lag nonlinear model was used to assess the association between exposure to non-optimal temperature during pregnancy and the risk for preterm birth and a multiplicative interaction model was used to assess the interaction between exposure to pollutants and non-optimal temperatures during pregnancy on the risk for preterm birth.Results:After adjusting for potential confounders such as maternal age, occupation, Gross Domestic Product of the region, pre-pregnancy preconception BMI, newborn sex, the weekly susceptibility windows of extreme low temperature ( P1, P3, P5) were week 1-22 , and the weekly susceptibility windows of extreme high temperature ( P95, P97, P99) were week 27 and week 32-36. Extreme low temperature [ P1 ( OR=1.147, 95% CI: 1.041-1.265), P5 ( OR=1.284, 95% CI: 1.035-1.501)] and extreme high temperature [ P97 ( OR=1.146, 95% CI: 1.039-1.263), P99 ( OR=1.216, 95% CI: 1.099-1.345)] exhibited multiplicative interaction with PM 2.5. Conclusions:Exposure to non-optimal temperature during pregnancy was associated with an increased risk for preterm birth. The susceptible exposure windows of extreme low temperature were mainly in early and mid-pregnancy, and the susceptible exposure windows of extreme high temperature were mainly in late-pregnancy. Exposure to non-optimal temperatures and pollutants during pregnancy was associated with an increased risk for preterm birth.

Objective:To develop and evaluate a deep learning-based automatic measurement model for panoramic ultrasound biomicroscopy (UBM) images.Methods:A diagnostic test study was conducted.Preoperative UBM examination results of 372 patients who underwent implantable collamer lens (ICL) implantation were collected at the Eye Center of Renmin Hospital of Wuhan University between February 2021 and March 2023.A total of 1 368 panoramic UBM images were obtained to establish an image database.The dataset was divided into a training set (760 images), a validation set (86 images) and an internal test set (522 images).An expert panel consisting of three ophthalmologists annotated the images.The UNet+ + network was used to automatically segment anterior segment tissues, such as the cornea, lens and iris.In addition, image processing techniques and geometric localization algorithms were developed to automatically identify the anatomical landmarks of pupil diameter (PD), anterior chamber depth (ACD), angle-to-angle distance (ATA) and sulcus-to-sulcus distance (STS) to complete the measurement of these parameters.Additionally, 480 panoramic UBM images of 135 patients (240 eyes) from Aier Eye Hospital of Wuhan University were used as an external test set to further evaluate the performance of the model in different centers.The consistency between the measurements from the model and expert panel, the Pentacam system was assessed.Finally, 150 images were randomly selected from the external test set for a human-machine comparison to further evaluate the model's performance.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY-2022-K109) and Aier eye Hospital of Wuhan University (No.2023IRBKY120903).Written informed consent was obtained from each subject.Results:In the internal test dataset and external test dataset, with manual labeling as the reference standard, the model achieved a mean Dice coefficient of not less than 0.882.At least 95.65% of the anatomical landmark localization results had Euclidean distance differences within 250 μm.The intraclass correlation coefficients (ICCs) for the measurements of PD, ACD, angle-to-angle ATA, and STS were at least 0.958, with mean relative errors not exceeding 2.407%.With the Pentacam measurements as the reference standard, the ICCs for PD in the internal and external test sets were 0.540 and 0.466, respectively, while the ICCs for ACD were 0.946 and 0.908, respectively.In the human-machine comparison, the ICCs between the model's measurements and those of senior experts were all not lower than 0.969.Conclusions:The deep learning-based model can automatically measure anterior segment parameters from preoperative panoramic UBM images of patients undergoing ICL surgery.The model demonstrates a consistency comparable to that of senior experts, while providing higher efficiency.In terms of ACD measurement, the model shows good agreement between the measurements obtained from the model and Pentacam system.

Objectives:To investigate the effect of non-optimal temperature exposure during pregnancy on the risk for preterm birth and identify the susceptible exposure window. At the same time, the interaction between non-optimal temperature and pollutants exposure during pregnancy on preterm birth was analyzed, in order to provide strong clues for the influence of non-optimal temperature exposure during pregnancy on the risk for preterm birth.Methods:A total of 1 852 pregnant women were recruited from September 2021 to June 2023 in Fujian Provincial Maternal and Child Health Care Center. Questionnaire survey was conducted, and their health records were analyzed. The permanent address of each pregnant woman was matched with Fifth Generation European Centre for Medium-Range Weather Forecasts Atmospheric Reanalysis of the Global Climate and a geo-statistical combination model based on satellite remote sensing data collection, then follow-up for pregnancy outcome was conducted. Distributed lag nonlinear model was used to assess the association between exposure to non-optimal temperature during pregnancy and the risk for preterm birth and a multiplicative interaction model was used to assess the interaction between exposure to pollutants and non-optimal temperatures during pregnancy on the risk for preterm birth.Results:After adjusting for potential confounders such as maternal age, occupation, Gross Domestic Product of the region, pre-pregnancy preconception BMI, newborn sex, the weekly susceptibility windows of extreme low temperature ( P1, P3, P5) were week 1-22 , and the weekly susceptibility windows of extreme high temperature ( P95, P97, P99) were week 27 and week 32-36. Extreme low temperature [ P1 ( OR=1.147, 95% CI: 1.041-1.265), P5 ( OR=1.284, 95% CI: 1.035-1.501)] and extreme high temperature [ P97 ( OR=1.146, 95% CI: 1.039-1.263), P99 ( OR=1.216, 95% CI: 1.099-1.345)] exhibited multiplicative interaction with PM 2.5. Conclusions:Exposure to non-optimal temperature during pregnancy was associated with an increased risk for preterm birth. The susceptible exposure windows of extreme low temperature were mainly in early and mid-pregnancy, and the susceptible exposure windows of extreme high temperature were mainly in late-pregnancy. Exposure to non-optimal temperatures and pollutants during pregnancy was associated with an increased risk for preterm birth.

Objective:To develop and evaluate a deep learning-based automatic measurement model for panoramic ultrasound biomicroscopy (UBM) images.Methods:A diagnostic test study was conducted.Preoperative UBM examination results of 372 patients who underwent implantable collamer lens (ICL) implantation were collected at the Eye Center of Renmin Hospital of Wuhan University between February 2021 and March 2023.A total of 1 368 panoramic UBM images were obtained to establish an image database.The dataset was divided into a training set (760 images), a validation set (86 images) and an internal test set (522 images).An expert panel consisting of three ophthalmologists annotated the images.The UNet+ + network was used to automatically segment anterior segment tissues, such as the cornea, lens and iris.In addition, image processing techniques and geometric localization algorithms were developed to automatically identify the anatomical landmarks of pupil diameter (PD), anterior chamber depth (ACD), angle-to-angle distance (ATA) and sulcus-to-sulcus distance (STS) to complete the measurement of these parameters.Additionally, 480 panoramic UBM images of 135 patients (240 eyes) from Aier Eye Hospital of Wuhan University were used as an external test set to further evaluate the performance of the model in different centers.The consistency between the measurements from the model and expert panel, the Pentacam system was assessed.Finally, 150 images were randomly selected from the external test set for a human-machine comparison to further evaluate the model's performance.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY-2022-K109) and Aier eye Hospital of Wuhan University (No.2023IRBKY120903).Written informed consent was obtained from each subject.Results:In the internal test dataset and external test dataset, with manual labeling as the reference standard, the model achieved a mean Dice coefficient of not less than 0.882.At least 95.65% of the anatomical landmark localization results had Euclidean distance differences within 250 μm.The intraclass correlation coefficients (ICCs) for the measurements of PD, ACD, angle-to-angle ATA, and STS were at least 0.958, with mean relative errors not exceeding 2.407%.With the Pentacam measurements as the reference standard, the ICCs for PD in the internal and external test sets were 0.540 and 0.466, respectively, while the ICCs for ACD were 0.946 and 0.908, respectively.In the human-machine comparison, the ICCs between the model's measurements and those of senior experts were all not lower than 0.969.Conclusions:The deep learning-based model can automatically measure anterior segment parameters from preoperative panoramic UBM images of patients undergoing ICL surgery.The model demonstrates a consistency comparable to that of senior experts, while providing higher efficiency.In terms of ACD measurement, the model shows good agreement between the measurements obtained from the model and Pentacam system.

White-matter tracts play a pivotal role in transmitting sensory and motor information, facilitating interhemispheric communication and integrating different brain regions. Meanwhile, sensorimotor disturbance is a common symptom in patients with major depressive disorder (MDD). However, the role of aberrant sensorimotor white-matter system in MDD remains largely unknown. Herein, we investigated the topological structure alterations of white-matter morphological brain networks in 233 MDD patients versus 257 matched healthy controls (HCs) from the DIRECT consortium. White-matter networks were derived from magnetic resonance imaging (MRI) data by combining voxel-based morphometry (VBM) and three-dimensional discrete wavelet transform (3D-DWT) approaches. Support vector machine (SVM) analysis was performed to discriminate MDD patients from HCs. The results indicated that the network topological changes in node degree, node efficiency, and node betweenness were mainly located in the sensorimotor superficial white-matter system in MDD. Using network nodal topological properties as classification features, the SVM model could effectively distinguish MDD patients from HCs. These findings provide new evidence to highlight the importance of the sensorimotor system in brain mechanisms underlying MDD from a new perspective of white-matter morphological network.
Humans ; Depressive Disorder, Major/pathology* ; White Matter/pathology* ; Male ; Female ; Support Vector Machine ; Adult ; Magnetic Resonance Imaging ; Middle Aged ; Case-Control Studies ; Sensorimotor Cortex ; Brain

BACKGROUND: Implantation of bone marrow mesenchymal stem cells (BMSCs) is a potential alternative for promoting bone defects healing or osseointegration in osteoporosis. However, the reactive oxygen species (ROS) accumulated and excessive inflammation in the osteoporotic microenvironment could weaken the self-replication and multi-directional differentiation of transplanted BMSCs. METHODS: In this study, to improve the hostile microenvironment in osteoporosis, Poloxamer 407 and hyaluronic acid (HA) was crosslinked to synthetize a thermos-responsive and injectable hydrogel to load MnO2 nanoparticles as a protective carrier (MnO2 @Pol/HA hydrogel) for delivering BMSCs. RESULTS: The resulting MnO2 @Pol/HA hydrogel processed excellent biocompatibility and durable retention time, and can eliminate accumulated ROS effectively, thereby protecting BMSCs from ROS-mediated inhibition of cell viability, including survival, proliferation, and osteogenic differentiation. In osteoporotic bone defects, implanting of this BMSCs incorporated MnO2 @Pol/HA hydrogel significantly eliminated ROS level in bone marrow and bone tissue, induced macrophages polarization from M1 to M2 phenotype, decreased the expression of pro-inflammatory cytokines (e.g., TNFa, IL-1b, and IL-6) and osteogenic related factors (e.g., TGF-b and PDGF). CONCLUSION This hydrogel-based BMSCs protected delivery strategy indicated better bone repair effect than BMSCs delivering or MnO2 @Pol/HA hydrogel implantation singly, which providing a potential alternative strategy for enhancing osteoporotic bone defects healing.

Objective:To evaluate the efficacy of arthroscopic suture combined with perforator tendon double reduction and Endobutton plate technique for the treatment of tibial avulsion fracture of posterior cruciate ligament (PCL).Methods:A retrospective case series study was conducted to analyze the clinical data of 32 patients with tibial avulsion fracture of PCL, who were admitted to First People′s Hospital of Huizhou from January 2018 to October 2022. There were 19 males and 13 females, with age range of 18-65 years [(42.8±15.0)years]. By the Meyers-Mckeever classicfication, 27 patients were type II, and 5 type III. All the patients were treated with arthroscopic suture combined with perforator tendon double reduction and Endobutton plate technique to fix PCL tibial avulsion fracture at the insertion point. The fracture reduction was observed by X-ray films before discharge. Three months postoperatively, the fracture healing was observed by CT imaging, and the stability of knee joint was evaluated by posterior drawer test. The knee active range of motion, visual analogue score (VAS), Lysholm score, and International Knee Documentation Committee (IKDC) score were used to evaluate the pain and knee function before operation, at 3 months after operation, and at the last follow-up. Intraoperative and postoperative complications were observed.Results:All the patients were followed up for 6-36 months [(19.7±8.7)months]. The X-ray films showed satisfactory reduction of the fracture before discharge, and the CT showed that the fracture line was blurred to various degrees at 3 months after operation. Two patients had degree I positive posterior drawer test at 3 months after operation, and the rest were negative. The knee active range of motion was improved from 54.2°(45.0°, 70.0°) preoperatively to 124.8°(120.0°, 130.0°) at 3 months postoperatively and to 130.6°(125.0°, 135.0°) at the last follow-up (all P<0.01). The VAS was decreased from 5.1(3.0, 7.0)points preoperatively to 1.2(1.0, 2.0)points at 3 months postoperatively and to 0.1(0.0, 0.0)points at the last follow-up (all P<0.01). The Lysholm score was improved from 31.2(24.3, 37.0)points preoperatively to 73.6(69.3, 78.8)points at 3 months postoperatively and 92.6(91.0, 95.0)points at the last follow-up (all P<0.01). The IKDC score was increased from (20.9±7.1)points preoperatively to (59.2±8.9)points at 3 months postoperatively and to (77.5±7.0)points at the last follow-up (all P<0.01). Compared with 3 months after operation, the last follow-up showed significantly improved knee active range of motion, significantly decreased VAS, and significantly increased Lysholm score and IKDC score (all P<0.05). No intraoperative nerve vascular injury, postoperative incision infection, or lower limb venous thrombosis was observed. Conclusion:Arthroscopic suture combined with perforator tendon double reduction and Endobutton plate technique can achieve good reduction and high healing rate in patients with tibial avulsion fracture of PCL, with improved joint mobility, relieved pain, good recovery of knee joint function, and few complications.

Objective:To explore the correlations of α-melanocyte stimulating hormone ( α-MSH) levels in serum and synovial fluid with progression of primary knee osteoarthritis (KOA). Methods:A retrospective analysis was conducted of the 96 patients who had been diagnosed as primary KOA at Department of Orthopedics, The First Hospital of Huizhou from October 2018 to October 2019. Radiographic severity of KOA was determined by Kellgren-Lawrence (K-L) grades; α-MSH levels were measured by enzyme-linked immunosorbent assay (ELISA). Levels of pro-inflammatory cytokine interleukin-1 β (IL-1 β) and matrix metalloproteinase-3 (MMP-3) were also detected. Another 64 patients with patellar dislocation, matched in age and gender, were enrolled as controls. The Numeric Pain Scale (NPS) and revised Oxford Knee Score (OKS) were employed to evaluate their symptomatic severity. Receiver operating characteristics (ROC) curve was used to compare α-MSH, IL-1 β and MMP-3 with regard to their diagnostic values in the K-L grading. Results:There were no statistically significant difference in age, gender and body mass index between the 2 groups, showing they were comparable ( P> 0.05). The α-MSH levels in synovial fluid were significantly lower in the KOA patients than in the controls [(16.9±3.8) pg/mL versus (18.8±2.7) pg/mL] ( P<0.001); there were no significant differences between the KOA patients and the controls in the serum α-MSH levels [(24.9±1.8) pg/mL versus (24.8±1.7) pg/mL] ( P>0.05). The α-MSH levels in synovial fluid were negatively correlated with K-L grades ( r=-0.382, P<0.001) and negatively correlated with NPS ( r=-0.382, P<0.001) but positively correlated with OKS ( r=0.339, P<0.001). Moreover, the α-MSH levels in synovial fluid were negatively correlated with the IL-1 β levels in synovial fluid ( r=-0.483, P<0.001) and with the MMP-3 levels in synovial fluid ( r=-0.336, P< 0.001). Conclusions:The level of serum α-MSH may not be correlated with the progression of KOA but the synovial fluid α-MSH is negatively correlated with the progression of KOA. Therefore, the expression level of α-MSH in joint synovial fluid can be used as a potential biomarker for assessment of severity of knee osteoarthritis.

Objective　This study retrospectively analyzed reported cases of subacute combined degeneration of spinal cords(SCD).The purpose of this study was to provide theoretical basis for the prevention,diagnosis,treatment and research of SCD.Methods　We searched the PubMed database for terms related to subacute combined degeneration of spinal cords from March 2,2019 to January 1,1990.255 cases were finally included in the study.Results　The common causes of SCD were Vitamin B12 deficiency (128 cases),inhaled N-2O (70 cases) and copper deficiency (31 cases).The disease usually happened on middle-ager (44.5±19.9) years old.The course of the disease is relatively long (36.5±85.1) weeks.Limbs hypoesthesia was the most common symptom (73.3%),followed by ataxia (61.6%),and limb motor system could also be involved (35.3%).Autonomic nervous system,cranial nerve,consciousness disorder and cognitive disorder are rare.The patients were often complicated with giant cell anemia (72.5%) and hyperhomocysteinemia (80.9%).Spinal cord MR could show abnormal signal shadow in posterior cord (82.9%),most of which occurred in cervical cord.Conclusion　Vitamin B12 deficiency was the most common cause of SCD in adults and N-2O abuse must be paid attention in young people.Most patients of SCD showed peripheral nervous system damage that sensory system damage is common.Abnormal signal shadow in posterior cord of spinal MR was specific for the diagnosis of SCD.Most patients with SCD have a good prognosis after treatment.