Purpose: This study evaluated the performance of the YOLOv8m-seg model in detecting and delineating interproximal caries and cervical burnout on bitewing radiographs and examined whether increasing the number of training epochs improved segmentation accuracy and consistency. Materials and Methods: In total, 1,410 bitewing radiographs were annotated using polygon-based masks by a trained dental clinician. The YOLOv8m-seg model was trained for 50, 100, and 150 epochs on 1,128 images and validated on 282 images using the Ultralytics segmentation framework. Model performance was assessed using precision, recall, and mean average precision at intersection-over-union thresholds of 0.5 and 0.5 to 0.95 (mAP0.5, mAP0.5-0.95) for both bounding box and mask outputs. Additional evaluation was conducted on a non-augmented validation subset. Results: Extended training duration was associated with improved segmentation performance. The highest mask mAP0.5-0.95 value was 0.828 at epoch 150. Both box-based precision and recall increased with longer training, whereas mask-based evaluation more accurately reflected the model’s ability to delineate the boundaries of caries and cervical burnout. Performance appeared consistent across both classes in the augmented validation split but was reduced in the non-augmented validation subset. Conclusion The YOLOv8m-seg model demonstrated high diagnostic accuracy in distinguishing proximal caries from cervical burnout on bitewing radiographs. Its mask-based outputs may assist clinicians in early lesion recognition and support improved diagnostic decision-making. Future studies should evaluate model generalizability across broader populations and diverse clinical environments and should prioritize assessment using non-augmented validation sets and independent test datasets.

Introduction: The growing popularity of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight management has inadvertently perpetuated demand for unregulated experimental peptides procured through gray markets. Retatrutide, a novel triple GLP-1/glucose-dependent insulinotropic polypeptide (GIP)/glucagon receptor agonist undergoing Phase III trials; AOD -9604, an abandoned synthetic human growth hormone fragment; and tesamorelin, a synthetic GHRH analogue, are increasingly self-administered without medical supervision. Their combined metabolic and thromboembolic risks remain unknown and unreported. Case: A 50-year-old Malaysian female with morbid obesity and poorly controlled type 2 diabetes mellitus (hemoglobin A1c 13%) presented with acute dyspnea, chest tightness, syncope, and cardiogenic shock. Three weeks prior, she had self-initiated subcutaneous retatrutide, AOD-9604, and tesamorelin procured through unregulated online platforms, achieving rapid weight loss of 10 kg. Despite markedly reduced oral intake from GLP-1-mediated gastrointestinal side effects, she continued her prescribed high-dose insulin regimen and sodium-glucose cotransporter-2 (SGLT2) inhibitor without dose adjustment. She developed concurrent diabetic ketoacidosis, confirmed biochemically, alongside massive saddle pulmonary embolism with right ventricular strain on echocardiography and computed tomography pulmonary angiography. She was successfully treated with systemic thrombolysis using alteplase, guideline-directed diabetic ketoacidosis management including fixed-rate insulin infusion and fluid resuscitation, and anticoagulation. The SGLT2 inhibitor was withheld throughout admission. She was discharged on rivaroxaban with counseling to cease all unregulated compounds. All three agents were submitted to the National Pharmaceutical Regulatory Authority/Malaysian Adverse Drug Reactions Advisory Committee for adverse drug reaction reporting. Conclusion To our knowledge, this is the first reported case of concurrent massive pulmonary embolism and diabetic ketoacidosis precipitated by unsupervised gray-market retatrutide, AOD-9604, and tesamorelin. Clinicians should enquire about unregistered supplement use, counsel insulin-dependent patients on sick-day rules when appetitesuppressing agents are initiated, and report adverse events to pharmacovigilance authorities.
AOD 9604 ; tesamorelin ; Diabetic Ketoacidosis ; Pulmonary Embolism ; Peptides

Gut microbiota is the microbial community that is specifically planted in the human gut and interacts with the human body.It plays an important role in the human body by regulating the basal metabolism and immunity of the host to maintain the homeostasis of the human body.Once the intestinal flora is dysregulated,it can lead to multi-system diseases.Hashimoto's thyroiditis is an organ-specific autoimmune disease.The pathogenesis of Hashimoto's thyroiditis is complex and its incidence is increasing year by year,which is gradually becoming a serious public health disease affecting the world.In recent years,the relationship between gut microbiota and bridge onychitis has received extensive attention.A large number of studies have shown that the richness and diversity of intestinal flora in Hashimoto's thyroiditis patients are changed compared with healthy people.Studies have shown that traditional Chinese medicine therapy can play a role in treating this disease by regulating intestinal flora.This article systematically summarizes the relationship between the two and the effect of traditional Chinese medicine on the treatment of bridge onychitis by regulating intestinal flora,so as to provide some reference for research in this field.

Objective:To explore the relationship between anxiety status and progestogen level in perimenopausal women and their effects on the pathogenesis of uterine fibroid.Methods:A total of 376 perimenopausal women who visited the Department of Gynecology and Neurology of Nanjing Tongren Hospital affiliated School of Medicine of Southeast University from August 2019 to July 2023 were selected as the study subjects.Based on the and divided into two groups according to the Self-Rating Anxiety Scale(SAS),they were divided into a non-anxiety group(n=202,SAS score<50)and an anxiety group(n=174,SAS score≥50).Additionally,according to the presence or absence of uterine fibroids,they were categorized into a non-uterine fibroid group(n=225)and a uterine fibroid group(n=151).The t test or x2 test was used to compare general demographic and clinical data between the non-uterine fibroid group and the uterine fibroid group.Multivariate logistic regression analysis was used to analyze the correlation between anxiety status,progesterone level,and uterine fibroid risk in perimenopausal women.The bootstrap method was used to analyze whether progesterone level mediate the relationship between anxiety status and uterine fibroid risk.Results:Comparison of baseline data between the non-uterine fibroid group and the uterine fibroid group showed that previous caesarean section,number of abortions,hemoglobin level,neutrophil count,lymphocyte count,and neutrophil-to-lymphocyte ratio(NLR)were not associated with the incidence of uterine fibroid(all P>0.05).In contrast,menstrual period,menstrual cycle,progesterone level,and SAS score were significantly associated with the incidence of uterine fibroid(all P<0.05).Analysis of the effects of different clinical features on the risk of uterine fibroid showed that age,chronic diseases history,and dysmenorrhea history were all significantly associated with the incidence of uterine fibroid in perimenopausal women(all P<0.05).Further,univariate logistic regression analysis showed that age≥55 years,chronic diseases,and dysmenorrhea were significant risk factors for uterine fibroid in perimenopausal women(all P<0.05).These seven significant risk factors(menstrual period,menstrual cycle,progesterone level,SAS score,age,chronic disease history,and dysmenorrhea history)were included in a multivariate logistic regression analysis,which identified SAS score and progesterone level as independent risk factors for uterine fibroid in perimenopausal women.Specifically,SAS score was positively correlated with uterine fibroid risk,while progesterone level was negatively correlated with the risk.Restriction cubic spline analysis showed a nonlinear quantitative response relationship between continuously changing progesterone level and the risk of uterine fibroid(x2=12.315,P<0.001),when progesterone level was≤2.00 ng/mL,the risk of uterine fibroid decreased with the increase of progesterone level(HR=1.014,95%CI:1.006-1.012,P<0.001),and when progesterone level was>2.00 ng/mL,the risk of uterine fibroid stabilized with further increases in progesterone level(HR=1.003,95%CI:0.998-1.002,P=0.001).After further adjusting for a variety of related confounding factors affecting the incidence of uterine fibroid in perimenopausal women,it was found that SAS score was an independent risk factor for predicting the incidence of uterine fibroid in perimenopausal women.Mediation effect analysis revealed that SAS score had a direct effect on the incidence of uterine fibroid(β1=0.202,95%CI:0.124-0.216),and progesterone level partially mediated the effect of SAS score on uterine fibroid risk(β2=0.196,95%CI:0.152-0.207).The total effect value was βtotal=0.398,and the mediating effect accounted for 49.25%of the total effect.Conclusion:There was an independent correlation between anxiety status and progestogen level in perimenopausal women,anxiety status was a risk factor for the development of uterine fibroids,while progestogen levelwas a protective factor.

Objective To explore the optimal body position of patients during rigid laryngoscopy.Methods 120 outpatients who underwent rigid laryngoscopy from December 2023 to March 2024 were divided into the conventional body position group(58 cases)and the anterior tilted position group(62 cases)by the random number table method.Patients in the conventional body position group were examined in the conventional body position(upright lower head position)and patients in the anterior tilted position group were examined in the anterior tilted position(body tilted forward by 60° and jaw lifted).The vocal folds were scored on the Friedman scale,the visual analogue scale(VAS)score was used to evaluate the comfortable degree of patients during the examination,the incidence of gag reflex sensitivity and the rate of complete pharyngeal exposure were compared between the two groups of patients.Results In the conventional body position group,there were 26 cases of Friedman's difficult exposure and 32 cases of easy exposure.The VAS scores of difficult exposure and easy exposure patients were 2.5(1.0,5.8)and 1.0(1.0,3.0),respectively;The incidence of gag reflex sensitivity was 42.3%and 34.4%,respectively;and the rates of complete pharyngeal exposure were 76.9%and 100.0%,respectively.In the anterior tilted position group,there were 28 cases of Friedman difficult exposure and 34 cases of easy exposure.The VAS scores of patients with difficult and easy exposure were 1.5(1.0,7.0)and 2.0(1.0,4.0),respectively;The incidence of gag reflex sensitivity was 46.4%and 29.4%,respectively;And the rates of complete pharyngeal exposure were 82.1%and 91.2%,respectively;The differences were not statistically significant(P>0.05).Conclusion When rigid laryngoscopy is performed in the upright lower head position or anteriorly tilted position,there is no significant difference in the comfortable degree scores,incidence of gag reflex sensitivity,and the rate of complete pharyngeal exposure in the patients in the two positions,and the examiners can choose the appropriate position according to their own examination habits.

PURPOSE: Assessing fluid responsiveness relying on central venous oxygen saturation (ScvO₂) yields varied outcomes across several studies. This study aimed to determine the ability of the change in ScvO₂ (ΔScvO₂) to detect fluid responsiveness in ventilated septic shock patients and potential influencing factors. METHODS: In this prospective, single-center study, all patients conducted from February 2023 to January 2024 received fluid challenge. Oxygen consumption was measured by indirect calorimetry, and fluid responsiveness was defined as an increase in cardiac index (CI) ≥ 10% measured by transthoracic echocardiography. Multivariate linear regression analysis was conducted to evaluate the impact of oxygen consumption, arterial oxygen saturation, CI, and hemoglobin on ScvO₂ and its change before and after fluid challenge. The Shapiro-Wilk test was used for the normality of continuous data. Data comparison between fluid responders and non-responders was conducted using a two-tailed Student t-test, Mann Whitney U test, and Chi-square test. Paired t-tests were used for normally distributed data, while the Wilcoxon signed-rank test was used for skewed data, to compare data before and after fluid challenge. RESULTS: Among 49 patients (31 men, aged (59 ± 18) years), 27 were responders. The patients had an acute physiology and chronic health evaluation II score of 24 ± 8, a sequential organ failure assessment score of 11 ± 4, and a blood lactate level of (3.2 ± 3.1) mmol/L at enrollment. After the fluid challenge, the ΔScvO₂ (mmHg) in the responders was greater than that in the non-responders (4 ± 6 vs. 1 ± 3, p = 0.019). Multivariate linear regression analysis suggested that CI was the only independent influencing factor of ScvO₂, with R² = 0.063, p = 0.008. After the fluid challenge, the change in CI became the only contributing factor to ΔScvO₂ (R² = 0.245, p < 0.001). ΔScvO₂ had a good discriminatory ability for the responders and non-responders with a threshold of 4.4% (area under the curve = 0.732, p = 0.006). CONCLUSION ΔScvO₂ served as a reliable surrogate marker for ΔCI and could be utilized to assess fluid responsiveness, given that the change in CI was the sole contributing factor to the ΔScvO₂. In stable hemoglobin conditions, the absolute value of ScvO₂ could serve as a monitoring indicator for adequate oxygen delivery independent of oxygen consumption.
Humans ; Shock, Septic/blood* ; Male ; Female ; Middle Aged ; Prospective Studies ; Oxygen Saturation ; Aged ; Fluid Therapy ; Oxygen/blood* ; Oxygen Consumption ; Adult

Testicular histology based on testicular biopsy is an important factor for determining appropriate testicular sperm extraction surgery and predicting sperm retrieval outcomes in patients with azoospermia. Therefore, we developed a deep learning (DL) model to establish the associations between testicular grayscale ultrasound images and testicular histology. We retrospectively included two-dimensional testicular grayscale ultrasound from patients with azoospermia (353 men with 4357 images between July 2017 and December 2021 in The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China) to develop a DL model. We obtained testicular histology during conventional testicular sperm extraction. Our DL model was trained based on ultrasound images or fusion data (ultrasound images fused with the corresponding testicular volume) to distinguish spermatozoa presence in pathology (SPP) and spermatozoa absence in pathology (SAP) and to classify maturation arrest (MA) and Sertoli cell-only syndrome (SCOS) in patients with SAP. Areas under the receiver operating characteristic curve (AUCs), accuracy, sensitivity, and specificity were used to analyze model performance. DL based on images achieved an AUC of 0.922 (95% confidence interval [CI]: 0.908-0.935), a sensitivity of 80.9%, a specificity of 84.6%, and an accuracy of 83.5% in predicting SPP (including normal spermatogenesis and hypospermatogenesis) and SAP (including MA and SCOS). In the identification of SCOS and MA, DL on fusion data yielded better diagnostic performance with an AUC of 0.979 (95% CI: 0.969-0.989), a sensitivity of 89.7%, a specificity of 97.1%, and an accuracy of 92.1%. Our study provides a noninvasive method to predict testicular histology for patients with azoospermia, which would avoid unnecessary testicular biopsy.
Humans ; Male ; Azoospermia/diagnostic imaging* ; Deep Learning ; Testis/pathology* ; Retrospective Studies ; Adult ; Ultrasonography/methods* ; Sperm Retrieval ; Sertoli Cell-Only Syndrome/diagnostic imaging*

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Diagnosis-related groups (DRG) payment is an important component of deepening the reform of medical insurance payment methods. In June 2023, a tertiary hospital launched an intelligent DRG grouping audit system to enhance grouping accuracy. By establishing a multi departmental collaborative organizational structure, building a standardized knowledge base and a rule base covering five categories (diagnosis, fees, testing, nursing, and pathology), and integrating electronic medical records, medical orders, testing, and imaging data throughout the entire diagnosis and treatment process, the intelligent DRG grouping audit system with data collection, identification, extraction, comparison, and output modules was constructed to achieve intelligent audit. At the same time, it was formed a closed-loop management system for pre reporting quality control, in-process group entry control, and post data analysis and assessment, which would prevent the risk of differentiated behaviors such as high coding and high sets, and ensure the reasonable use of medical insurance funds. By January 2024, the system had covered 89 ADRG groups, and improved the efficiency and quality of DRG grouping audit. Compared with February to May 2023, the monthly average rejection rate of medical records on the first page decreased by 9.4% after the system was put into operation (June to December 2023), and core medical indicators such as the number of DRG groups, medical insurance settlement cases, and time consumption index continued to improve. The practical experience could provide reference and inspiration for other hospitals in China.

Objective:To systematically evaluate the current financing status of Beijing's urban and rural residents'basic medical insurance,analyze equity disparities among different groups under the existing flat-rate financing policy.By simulating the equity changes of various financing schemes with different contribution rates,this study aims to provide foundations for advancing medical insurance financing system reform.Methods:Based on the per capita disposable income and number of insured residents in Beijing's 16 districts from 2018 to 2023,we separately calculated the Gini coefficient,concentration index,and Kakwani index,along with their changes before and after financing adjustments,to assess the funding burden among different insured groups.Using the geometric mean method,we projected per capita disposable income and insured populations for each district in Beijing from 2024 to 2035,simulating various financing schemes under different premium rate systems.Results:From 2018 to 2023,the Gini coefficient of net income after financing consistently exceeded that of original income before financing.The concentration index remained positive and showed an upward trend,while the Kakwani index was negative for all periods.The Gini coefficient after financing slightly decreased for the elderly and working populations with fiscal subsidy support,whereas it remained higher than that for students and children.Under the simulated differentiated rate system,the post-funding Gini coefficient for 2024-2035 was lower than the original value,and the Kakwani index was positive.Conclusions:The current fixed-amount financing mechanism for urban and rural residents'basic medical insurance exhibits regressive characteristics and insufficient fairness,with disparities in equity among different insured groups.It is necessary to establish differentiated financing standards based on differential rates,particularly implementing a financing mechanism with dynamic adjustments according to regional and group income levels,to enhance the fairness of financing for urban and rural residents'basic medical insurance.