Objective To explore the application of plasma 7 microRNA (miR7) testing in the differential diagnosis of very early-stage hepatocellular carcinoma (HCC). Methods This study is a multicenter real-world study. Patients with single hepatic lesion (maximum diameter≤2 cm) who underwent plasma miR7 testing at Zhongshan Hospital, Fudan University, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Anhui Provincial Hospital, and Peking University People’s Hospital between January 2019 and December 2024 were retrospectively enrolled. Patients were divided into very early-stage HCC group and non-HCC group, and the clinical pathological characteristics of the two groups were compared. The value of plasma miR7 levels, alpha-fetoprotein (AFP), and des-gamma-carboxy prothrombin (DCP) in the differential diagnosis of very early-stage HCC was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC). In patients with both negative AFP and DCP (AFP＜20 ng/mL, DCP＜40 mAU/mL), the diagnostic value of plasma miR7 for very early-stage HCC was analyzed. Results A total of 64 528 patients from 4 hospitals underwent miR7 testing, and 1 682 were finally included, of which 1 073 were diagnosed with very early-stage HCC and 609 were diagnosed with non-HCC. The positive rate of miR7 in HCC patients was significantly higher than that in non-HCC patients (67.9% vs 24.3%, P＜0.001). ROC curves showed that the AUCs for miR7, AFP, and DCP in distinguishing HCC patients from the non-HCC individuals were 0.718, 0.682, and 0.642, respectively. The sensitivities were 67.85%, 43.71%, and 44.45%, and the specificities were 75.70%, 92.78%, and 83.91%, respectively. The pairwise comparison of AUCs showed that the diagnostic efficacy of plasma miR7 detection was significantly better than that of AFP or DCP (P＜0.05). Although its specificity was slightly lower than AFP and DCP, the sensitivity was significantly higher. Among patients negative for both AFP and DCP, miR7 maintained an AUC of 0.728 for diagnosing very early-stage HCC, with 67.82% sensitivity and 77.73% specificity. Conclusions Plasma miR7 testing is a potential molecular marker with high sensitivity and specificity for the differential diagnosis of small hepatic nodules. In patients with very early-stage HCC lacking effective molecular markers (negative for both AFP and DCP), miR7 can serve as a novel and effective molecular marker to assist diagnosis.

Objective:To explore the clinical application value of convolutional neural network（CNN）based on deep learning in the automatic measurement of dynamic pelvic floor ultrasound video parameters and the diagnosis and classification of cystocele.Methods:A retrospective analysis was conducted on dynamic pelvic floor ultrasound videos from 398 postpartum women who underwent examinations at the First People's Hospital of Foshan between June 2020 and June 2022. The lowest point of the posterior bladder wall（PWB），urethral rotation angle（URA），and retrovesical angle（RVA）were manually measured by a senior radiologist（R1）and a junior radiologist（R2），and cystocele was classified according to the Green standard. The CNN model was employed to automatically extract the above parameters and to diagnose and classify cystocele. Using R1 measurements as a reference，intraclass correlation coefficient（ICC）was used to evaluate the consistency between the CNN model and R1，as well as between R2 and R1. The Kappa value was used to assess the agreement between the CNN model，R2，and R1 in the diagnosis and classification of cystocele. Additionally，the time consumption of the three measurement methods was compared.Results:The CNN model showed good consistency with R1 in measuring PWB and URA（ICC = 0.983，0.894），while its consistency in measuring RVA was moderate（ICC = 0.614）. The ICC between R2 and R1 in measuring PWB，URA，and RVA was 0.979，0.815，and 0.627，respectively. In the measurement of PWB and URA，the consistency between the CNN model and R1 was superior to that between R2 and R1. For cystocele diagnosis，the Kappa value between the CNN model and R1 was 0.924，which was higher than that between R2 and R1（0.904）. In cystocele classification，the Kappa value between the CNN model and R1 was 0.503，also higher than that between R2 and R1（0.426）. The CNN model processed a single video in 2.5（0.6）s，significantly faster than R1［59.9（16.9）s］and R2［56.8（11.2）s］（all P < 0.001）. Conclusions:The CNN model demonstrates high accuracy and efficiency in the measurement，diagnosis，and classification of cystocele，outperforming a junior radiologist and showing potential for clinical application.

Objective:To investigate the change trend of hepatectomy for hepatocellular carcinoma and efficacy of fluorescent laparoscopic hepatectomy in a single center from 2014?2023.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 17 232 patients of hepatocellular carcinoma who were admitted to Zhongshan Hospital of Fudan University from January 2014 to December 2023 were collected. There were 14 404 males and 2 828 females, aged 58(range, 11?94)years. Observation indicators: (1) change trend of hepatectomy for hepatocellular carcinoma and application of fluorescent laparoscopy in 2014?2023; (2) propensity score matching between patients undergoing fluorescent and conventional laparoscopic hepatectomy; (3) intraoperative and postoperative conditions of patients in the fluorescent laparoscopy group and the conventional laparoscopy group after propensity score matching. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the nonparametic rank sum test. Propensity score matching was performed using the 1∶3 nearest neighbor matching method, with the caliper value of 0.01. Results:(1) Change trend of hepatectomy for hepatocellular carcinoma and application of fluorescent laparoscopy in 2014-2023. Among 17 232 patients of hepatocellular carcinoma, 4 074 cases underwent laparoscopic surgery, and 13 158 cases underwent open surgery or conversion from laparoscopic to open surgery. From 2014 to 2023, the proportions of laparos-copic surgery in hepatectomy were 8.993%(117/1 301), 6.804%(99/1 455), 9.379%(145/1 546), 17.511%(287/1 639), 23.828%(427/1 792), 24.572%(459/1 868), 29.662%(544/1 834), 31.568%(584/1 850), 38.080%(599/1 573), and 34.246%(813/2 374), respectively. The proportions of Grade Ⅲ surgery in laparoscopic hepatectomy were 11.966%(14/117), 7.071%(7/99), 12.414%(18/145), 21.254%(61/287), 28.337%(121/427), 27.887%(128/459), 34.375%(187/544), 34.644%(214/584), 35.726%(214/599), and 42.681%(347/813), respectively. From 2016 to 2023, the proportions of the application of fluorescent laparoscopy in laparoscopic hepatectomy were 2.069%(3/145), 5.923%(17/287), 8.431%(36/427), 10.022%(46/459), 17.647%(96/544), 24.829%(145/584), 9.182%(55/599), and 12.915%(105/813), respectively. (2) Propensity score matching between patients undergoing fluorescent and conventional laparoscopic hepatectomy. Among the 4 074 patients who underwent laparoscopic liver resection, 503 cases using fluorescent laparoscopy were assigned to the fluorescent laparoscopy group, 3 571 cases using conventional laparoscopy were assigned to the conventional laparoscopy group. A total of 1 794 patients were successfully matched, with 483 cases in the fluorescent laparoscopy group and 1 311 cases in the conventional laparoscopy group. After propensity score matching, the confounding biases of the maximum tumor diameter and the year of surgery were eliminated, and the two groups were comparable. (3) Intraoperative and postoperative conditions of patients in the fluorescent laparoscopy group and the conventional laparoscopy group after propensity score matching. After propensity score matching, there was no perioperative death in either the fluorescent laparoscopy group or the conventional laparoscopy group.The operation time of patients in the fluorescent laparoscopy group was 240(150,328)minutes, the portal triad clamping time was 30(15,45)minutes, the volume of intraoperative blood loss was 50(30,100)mL, the number of patients with complication 72, respectively. For patients in the conventional laparoscopy group, the above indicators were 180(131,240)minutes, 23(15,30)minutes, 55(50,100)mL, and 248, respectively. There were significant differences in the above indicators between the two groups ( Z=?7.593, ?7.372, ?4.941, χ2=3.873, P<0.05). Conclusion:The proportion and difficulty level of laparoscopic hepatectomy for hepatocellular carcinoma in Zhongshan Hospital of Fudan University have shown an upward trend during 2014?2023. Compared with conventional laparoscopy, patients undergoing fluorescent laparoscopic hepatectomy have longer operation time and portal triad clamping time, but less intraoperative blood loss and lower iproportion of complications.

Objective:To investigate the change trend of hepatectomy for hepatocellular carcinoma and efficacy of fluorescent laparoscopic hepatectomy in a single center from 2014?2023.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 17 232 patients of hepatocellular carcinoma who were admitted to Zhongshan Hospital of Fudan University from January 2014 to December 2023 were collected. There were 14 404 males and 2 828 females, aged 58(range, 11?94)years. Observation indicators: (1) change trend of hepatectomy for hepatocellular carcinoma and application of fluorescent laparoscopy in 2014?2023; (2) propensity score matching between patients undergoing fluorescent and conventional laparoscopic hepatectomy; (3) intraoperative and postoperative conditions of patients in the fluorescent laparoscopy group and the conventional laparoscopy group after propensity score matching. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the nonparametic rank sum test. Propensity score matching was performed using the 1∶3 nearest neighbor matching method, with the caliper value of 0.01. Results:(1) Change trend of hepatectomy for hepatocellular carcinoma and application of fluorescent laparoscopy in 2014-2023. Among 17 232 patients of hepatocellular carcinoma, 4 074 cases underwent laparoscopic surgery, and 13 158 cases underwent open surgery or conversion from laparoscopic to open surgery. From 2014 to 2023, the proportions of laparos-copic surgery in hepatectomy were 8.993%(117/1 301), 6.804%(99/1 455), 9.379%(145/1 546), 17.511%(287/1 639), 23.828%(427/1 792), 24.572%(459/1 868), 29.662%(544/1 834), 31.568%(584/1 850), 38.080%(599/1 573), and 34.246%(813/2 374), respectively. The proportions of Grade Ⅲ surgery in laparoscopic hepatectomy were 11.966%(14/117), 7.071%(7/99), 12.414%(18/145), 21.254%(61/287), 28.337%(121/427), 27.887%(128/459), 34.375%(187/544), 34.644%(214/584), 35.726%(214/599), and 42.681%(347/813), respectively. From 2016 to 2023, the proportions of the application of fluorescent laparoscopy in laparoscopic hepatectomy were 2.069%(3/145), 5.923%(17/287), 8.431%(36/427), 10.022%(46/459), 17.647%(96/544), 24.829%(145/584), 9.182%(55/599), and 12.915%(105/813), respectively. (2) Propensity score matching between patients undergoing fluorescent and conventional laparoscopic hepatectomy. Among the 4 074 patients who underwent laparoscopic liver resection, 503 cases using fluorescent laparoscopy were assigned to the fluorescent laparoscopy group, 3 571 cases using conventional laparoscopy were assigned to the conventional laparoscopy group. A total of 1 794 patients were successfully matched, with 483 cases in the fluorescent laparoscopy group and 1 311 cases in the conventional laparoscopy group. After propensity score matching, the confounding biases of the maximum tumor diameter and the year of surgery were eliminated, and the two groups were comparable. (3) Intraoperative and postoperative conditions of patients in the fluorescent laparoscopy group and the conventional laparoscopy group after propensity score matching. After propensity score matching, there was no perioperative death in either the fluorescent laparoscopy group or the conventional laparoscopy group.The operation time of patients in the fluorescent laparoscopy group was 240(150,328)minutes, the portal triad clamping time was 30(15,45)minutes, the volume of intraoperative blood loss was 50(30,100)mL, the number of patients with complication 72, respectively. For patients in the conventional laparoscopy group, the above indicators were 180(131,240)minutes, 23(15,30)minutes, 55(50,100)mL, and 248, respectively. There were significant differences in the above indicators between the two groups ( Z=?7.593, ?7.372, ?4.941, χ2=3.873, P<0.05). Conclusion:The proportion and difficulty level of laparoscopic hepatectomy for hepatocellular carcinoma in Zhongshan Hospital of Fudan University have shown an upward trend during 2014?2023. Compared with conventional laparoscopy, patients undergoing fluorescent laparoscopic hepatectomy have longer operation time and portal triad clamping time, but less intraoperative blood loss and lower iproportion of complications.

Objective:To explore the clinical application value of convolutional neural network（CNN）based on deep learning in the automatic measurement of dynamic pelvic floor ultrasound video parameters and the diagnosis and classification of cystocele.Methods:A retrospective analysis was conducted on dynamic pelvic floor ultrasound videos from 398 postpartum women who underwent examinations at the First People's Hospital of Foshan between June 2020 and June 2022. The lowest point of the posterior bladder wall（PWB），urethral rotation angle（URA），and retrovesical angle（RVA）were manually measured by a senior radiologist（R1）and a junior radiologist（R2），and cystocele was classified according to the Green standard. The CNN model was employed to automatically extract the above parameters and to diagnose and classify cystocele. Using R1 measurements as a reference，intraclass correlation coefficient（ICC）was used to evaluate the consistency between the CNN model and R1，as well as between R2 and R1. The Kappa value was used to assess the agreement between the CNN model，R2，and R1 in the diagnosis and classification of cystocele. Additionally，the time consumption of the three measurement methods was compared.Results:The CNN model showed good consistency with R1 in measuring PWB and URA（ICC = 0.983，0.894），while its consistency in measuring RVA was moderate（ICC = 0.614）. The ICC between R2 and R1 in measuring PWB，URA，and RVA was 0.979，0.815，and 0.627，respectively. In the measurement of PWB and URA，the consistency between the CNN model and R1 was superior to that between R2 and R1. For cystocele diagnosis，the Kappa value between the CNN model and R1 was 0.924，which was higher than that between R2 and R1（0.904）. In cystocele classification，the Kappa value between the CNN model and R1 was 0.503，also higher than that between R2 and R1（0.426）. The CNN model processed a single video in 2.5（0.6）s，significantly faster than R1［59.9（16.9）s］and R2［56.8（11.2）s］（all P < 0.001）. Conclusions:The CNN model demonstrates high accuracy and efficiency in the measurement，diagnosis，and classification of cystocele，outperforming a junior radiologist and showing potential for clinical application.

Objective:To investigate the clinical efficacy of neoadjuvant chemotherapy for the resectable locally advanced adenocarcinoma at the gastroesophageal junction.Methods:A retrospective cohort study was conducted to analyze 86 patients with resectable locally advanced Siewert type Ⅱ and Ⅲ adenocarcinoma at the gastroesophageal junction (T 3-4N +M 0) who were admitted to the Panzhihua Central Hospital of Sichuan Province from January 2013 to January 2016. All the patients were divided into the neoadjuvant chemotherapy group [preoperative XELOX regimen (oxaliplatin + capecitabine) adjuvant chemotherapy + surgery + postoperative XELOX regimen adjuvant chemotherapy, 46 cases] and non-neoadjuvant chemotherapy group (surgery + postoperative XELOX regimen adjuvant chemotherapy, 40 cases) according to whether neoadjuvant chemotherapy was performed before surgery. The total gastrectomy + Roux-en-Y esophagojejunostomy + D 2 lymphadenectomy or proximal subtotal gastrectomy + esophageal gastric remnant anastomosis + D 2 lymphadenectomy were applied to patients by the same team of doctors. The observation indicators included treatment situations, results of postoperative pathological examination and prognosis in the two groups. Results:In the neoadjuvant chemotherapy group, 25 patients (54.3%) had partial remission (PR), 21 patients (45.7%) had stable disease (SD), the clinical response rate was 54.3% (25/46), tumor control rate was 100.0% (46/46), and clinical stage reduction rate was 37.0% (17/46). Compared with the non-neoadjuvant chemotherapy group, the neoadjuvant chemotherapy group had a higher R 0 resection rate [100.0% (46/46) vs. 80.0% (32/40), χ2 = 4.024, P = 0.045], and in the neoadjuvant chemotherapy group, the pathological complete remission [tumor regression grade (TRG) 0] rate was 13.0% (6/46), and the overall pathological response (TRG 1 + TRG 0) rate was 56.5% (26/46). The postoperative pathological examination showed that the neoadjuvant chemotherapy group and the non-neoadjuvant chemotherapy group had statistically significant differences in the longest tumor diameter, vessel carcinoma embolus, perineural invasion, and pathological TNM staging (all P < 0.05). However, there was no statistical difference in the total humber of lymph nodes, the number of positive lymph nodes, pathological T stage, N stage, and human epidermal growth factor receptor 2 (HER2) expression in specimens (all P > 0.05). In the neoadjuvant chemotherapy group, 6 patients had grade 3 adverse reactions, and chemotherapy was suspended or the dose was adjusted. Adverse reactions in the blood system included the red blood cells reduction, white blood cells reduction and thrombocytopenia. Other adverse reactions included nausea, vomiting, and decreased appetite. There were no deaths related to radiotherapy. In the neoadjuvant chemotherapy group, the median tumor-free survival time was 20 months (5-36 months), and the 1-year and 3-year tumor-free survival rates were 89.5% and 52.4%, respectively; the median postoperative overall survival time was 20 months (9-36 months), and the 1-year and 3-year overall survival rates were 91.0% and 48.0%, respectively; 12 patients had tumor recurrence. In the non-neoadjuvant chemotherapy group, the median tumor-free survival time was 19 months (10-35 months), and the 1-year and 3-year tumor-free survival rates were 87.3% and 30.0%, respectively. The median postoperative overall survival time was 20 months (10-35 months), the 1-year and 3-year overall survival rates were 87.0% and 18.6%, respectively; 14 patients had tumor recurrence. There was a statistical difference in the tumor-free survival between the two groups ( χ2 = 4.522, P = 0.03), and there was no statistical difference in the overall survival between the two groups ( χ2 = 3.717, P > 0.05). Conclusions:XELOX regimen neoadjuvant chemotherapy is safe and effective for patients with resectable locally advanced Siewert type Ⅱ and Ⅲ adenocarcinoma at the gastroesophageal junction. It can decrease the tumor clinical stage and increase the R 0 resection rate and tumor-free survival rate.

Objective To evaluate the influence of orthokeratology lenses on vision,intraocular pressure and biometric measurement parameters in adolescent myopia.Methods A total of 72 adolescent myopia patients (136 eyes) with orthokeratology lens,aged 8-16 years old,in Hebei Provincial Eye Hospital from Junuary 2013 to December 2015 were randomly selected.The vision,intraocular pressure,axial length,corneal topography,corneal thickness and anterior chamber depth were observed before wearing glasses,at 1 week,1,3,6 months after wearing glasses.Results After orthokeratology wearing,the uncorrected visual acuity was obviously improved (P＜0.05),the average refraction diopter was declined (P＞0.05) and the non-contact intraocular pressure was decreased (P＜0.05).The axial length after orthokeratology wearing had little change (P＞0.05).The curvature of the patient's cornea at one week after wearing glasses was deceased (P＜0.05) and the posterior corneal curvature tended towards stability.The corneal thickness at 1 week after wearing glasses had no obvious change compared with before wearing glasses(P＞0.05),which at 1 month after wearing glasses was decreased(P＜0.05) and which at 3,6 months after wearing glasses trended to be stabilized.The anterior chamber depth after wearing glasses had no obvious change.Conclusion Orthkeratology lens can decrease the myopia degree,increases the uncorrected visual acuity and has obvious effect for controlling adolescent myopia.The intraocular pressure and biometric measurement parameters have corresponding change after wearing orthkeratology lens.

Objective To explore the expression and its clinical significance of serum procalcitonin (PCT)level in ventilator-associated pneumonia( VAP)in newborns. Methods One hundred and fifty-five children with suspected VAP in Shajing Hospital of Shenzhen Affiliated to Medical University of Guangzhou from June 2013 to December 2014 who were in intensive care kiunit(NICU)were selected as our subjects. According to whether they had VAP or not could be divided into VAP group(80 cases)and non-VAP group(75 cases). Immunoluminometric method was used to detect PCT level at 1st day. According to the different medicine,VAP group was divided into 40 cases of two groups. The control group was according to the situation of children which was used empirical antibiotic by clinicians. The observation group was given antibiotics according to the level of PCT(the antibiotics were used when PCT > 0. 25 μg/ L). After treatment,if PCT did not decrease,the antibiotics was replaced. If PCT decreased,the antibiotics was continued to use the same kind of antibiotics. While the PCT< 0. 25 μg/ L,the antibiotics were stopped using. The change of the PCT level at 1st,4th,7th,10th day of two groups were observed. Results Serum PCT level of VAP group was(1. 68 ± 0. 83)μg/ L,significantly higher than that of non-VAP((0. 10 ± 0. 02)μg/ L),and there was statistically significant difference( t = 52. 614,P< 0. 05). Clinical effective rate of observation group was 87. 5%(35 / 40),which was higher than that of the control group(80. 0%(32 / 40),P = 2. 067). At 4th,7th and 10th day after treatment,PCT expressions of the observation group were all significantly lower than those of the control group. The medical costs and antibiotic using time were significantly lower than those of the control group((3 525. 8 ± 1 162. 9)yuan vs.(4 706. 7 ± 803. 4),(10. 3 ± 2. 7)d vs.(13. 5 ± 1. 4)d;t = 5. 28,6. 65;P < 0. 05). Conclusion The serum PCT levels of newborns of VAP significantly increase,and monitoring the PCT can guide reasonably the use of antibiotics in clinic.

Objective To evaluate the influence of black dots,isolated line above the best correct visual acuity and multiple lines containing the best correct visual acuity in the accuracy of Jackson cross cylinder examination.Methods Forty students were chosen(11 males,29 females,between 24 to 29 years old).Routine examination of phoropter was used to check under the maximum plus to maximum visual acuity(MPMVA) status.The sequence of three fixation targets was chosen randomly.Astigmatism chart was used to judge the best one when the different results were obtained.Results Among the 80 eyes of 40 students,12 eyes were spherical(the cylinder degree below 0.25 DC).The response of three fixation targets was the same in 19 eyes(27.9%),23 eyes(33.8%)were sensitive to the black dots target,14 eyes(20.6%)were sensitive to the isolated line above the best correct visual acuity,12 eyes(17.6%) were sensitive to multiple lines containing the best correct visual acuity.Kruska Wallis Test was used to detect the difference among three groups.No significant difference was found(?2 =4.026,P=0.134).Conclusion According to the efficiency of examination,communication and judgment,black dots target is recommended although no difference is detected among three fixation targets.

Objective To determine the content of octopamine,a kind of ?3-adrenergic receptor agonists in edible part of various fresh water and seawater aquatic products,and provide data for exploitation and utilization of octopamine in aquatic products.Methods After homogenate and ultrasound treatment,edible parts of fish,shellfish and cephalopodium were centrifugalized,then octopamine content in supernatant liquid was detected with HPLC.Results In eight kinds of fresh water fish,the octopamine contents of dorsal meat were generally higher than abdominal meat,which were in the range of 30~130?g?g-1 and roughly similar to seawater fish and freshwater shellfish.The octopamine contents in seawater shellfish were particularly high,almost dozens even thousands times of those in fish and freshwater shellfish.Cephalopodium also had a high content of octopamine while it was not detected in ocean algae.Conclusion Seawater mollusks are the most affluent resource of octopamine in aquatic products and ideal food of weight-watchers and diabetics.