OBJECTIVE To explore the diagnostic value of combined detection of microRNA(miRNA)and alpha-fetoprotein(AFP),protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)in ascites and serum ex-tracellular vesicles(EVs)for hepatitis B virus(HBV)-related primary hepatocellular carcinoma(HCC).METHODS From Nov.2023 to Nov.2024,41 patients with liver cancer and 26 patients with liver cirrhosis who underwent ascites placement or ascites concentration and reinfusion procedures at the Fifth Medical Center of Chi-nese PLA General Hospital were selected as study subjects.Ascites and serum samples were collected.Real-time quantitative reverse transcription polymerase chain reaction(qRT-PCR)was used to detect the expression levels of miR-21,miR-125a,miR-150 and miR-200a in EVs.Chemiluminescence was used to measure the levels of AFP and PIVKA-Ⅱ in ascites,serum and EVs from ascites and serum.An artificial neural network was utilized to con-struct a combined diagnostic model of serum and ascites markers.RESULTS The area under the curve(AUC)for distinguishing HCC from liver cirrhosis using a combination of serum and other indicators was 0.933.The AUC for distinguishing HCC from liver cirrhosis using a combination of ascites and other indicators was 0.912.By screening all detected indicators using an artificial neural network and incorporating indicators with a relative im-portance＞0.5 into the diagnostic model,the model included four indicators:ascites AFP,ascites EVs miR-21,ascites EVs miR-200a and serum EVs miR-200a.This model had a sensitivity of 80.77％,a specificity of 87.80％and an AUC of 0.960 for distinguishing HCC from liver cirrhosis patients.CONCLUSION The combined diagnos-tic markers of miRNA,AFP and PIVKA-Ⅱ in ascites and serum-derived EVs have good application value in the diagnosis of HCC.

Objective:To investigate the efficacy and prognosis of biliary drainage via endoscopic retrograde cholangiopancreatography (ERCP) before steroid therapy in treating autoimmune pancreatitis (AIP) complicated with obstructive jaundice.Methods:A retrospective analysis was performed on clinical data of patients with AIP complicated with obstructive jaundice who received steroid therapy at the First Affiliated Hospital of Naval Medical University from 2010 to 2023. Patients were divided into a drainage group (receiving ERCP biliary drainage before steroid therapy) and a steroid group (receiving only steroid therapy). Short-term efficacy, long-term efficacy, hospitalization costs and postoperative complications of ERCP biliary drainage were compared between the two groups.Results:A total of 69 patients were included, with 32 in the drainage group, aged 62.78±11.21 years, which demonstrated significantly higher costs (34 816.57±11 688.85 yuan VS 16 518.50±6 544.37 yuan, t=7.0, P<0.001), with 25.00% (8/32) experiencing ERCP-related complications, compared with 37 patients in the steroid group, aged 55.41±2.15 years. There was no significant difference in hospitalization duration between the drainage group (10.38±4.56 days) and the steroid group (8.95±4.99 days, t=1.2, P=0.219). After 1 month of treatment, total bilirubin [118.5 (76.2, 309.3) μmol/L VS 48.7 (30.5, 148.4) μmol/L, U=1 728.5, P<0.001] and direct bilirubin [84.5 (47.7, 236.3) μmol/L VS 37.7 (18.3, 105.7) μmol/L, U=1 588.5, P=0.001] levels in the drainage group remained higher than those in the steroid group, while alanine aminotransferase levels were lower [74.0 (46.5,110.5) U/L VS 143.0 (51.0,253.5) U/L, U=769.0, P=0.006]. No significant differences were observed in these biochemical indices between the two groups at 4-month and 12-month follow-ups ( P>0.05). The recurrence rates were 28.1% (9/32) in the drainage group and 21.6% (8/37) in the steroid group, with no significant difference in recurrence rate between groups ( χ2=0.4, P=0.266). Conclusion:ERCP biliary drainage does not significantly improve long-term efficacy or reduce recurrence rates in AIP patients with obstructive jaundice. Instead, it increases the risk of postoperative complications and medical costs. Direct steroid therapy is safe and feasible for confirmed AIP with obstructive jaundice.

OBJECTIVE To explore the diagnostic value of combined detection of microRNA(miRNA)and alpha-fetoprotein(AFP),protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)in ascites and serum ex-tracellular vesicles(EVs)for hepatitis B virus(HBV)-related primary hepatocellular carcinoma(HCC).METHODS From Nov.2023 to Nov.2024,41 patients with liver cancer and 26 patients with liver cirrhosis who underwent ascites placement or ascites concentration and reinfusion procedures at the Fifth Medical Center of Chi-nese PLA General Hospital were selected as study subjects.Ascites and serum samples were collected.Real-time quantitative reverse transcription polymerase chain reaction(qRT-PCR)was used to detect the expression levels of miR-21,miR-125a,miR-150 and miR-200a in EVs.Chemiluminescence was used to measure the levels of AFP and PIVKA-Ⅱ in ascites,serum and EVs from ascites and serum.An artificial neural network was utilized to con-struct a combined diagnostic model of serum and ascites markers.RESULTS The area under the curve(AUC)for distinguishing HCC from liver cirrhosis using a combination of serum and other indicators was 0.933.The AUC for distinguishing HCC from liver cirrhosis using a combination of ascites and other indicators was 0.912.By screening all detected indicators using an artificial neural network and incorporating indicators with a relative im-portance＞0.5 into the diagnostic model,the model included four indicators:ascites AFP,ascites EVs miR-21,ascites EVs miR-200a and serum EVs miR-200a.This model had a sensitivity of 80.77％,a specificity of 87.80％and an AUC of 0.960 for distinguishing HCC from liver cirrhosis patients.CONCLUSION The combined diagnos-tic markers of miRNA,AFP and PIVKA-Ⅱ in ascites and serum-derived EVs have good application value in the diagnosis of HCC.

Objective:To investigate the efficacy and prognosis of biliary drainage via endoscopic retrograde cholangiopancreatography (ERCP) before steroid therapy in treating autoimmune pancreatitis (AIP) complicated with obstructive jaundice.Methods:A retrospective analysis was performed on clinical data of patients with AIP complicated with obstructive jaundice who received steroid therapy at the First Affiliated Hospital of Naval Medical University from 2010 to 2023. Patients were divided into a drainage group (receiving ERCP biliary drainage before steroid therapy) and a steroid group (receiving only steroid therapy). Short-term efficacy, long-term efficacy, hospitalization costs and postoperative complications of ERCP biliary drainage were compared between the two groups.Results:A total of 69 patients were included, with 32 in the drainage group, aged 62.78±11.21 years, which demonstrated significantly higher costs (34 816.57±11 688.85 yuan VS 16 518.50±6 544.37 yuan, t=7.0, P<0.001), with 25.00% (8/32) experiencing ERCP-related complications, compared with 37 patients in the steroid group, aged 55.41±2.15 years. There was no significant difference in hospitalization duration between the drainage group (10.38±4.56 days) and the steroid group (8.95±4.99 days, t=1.2, P=0.219). After 1 month of treatment, total bilirubin [118.5 (76.2, 309.3) μmol/L VS 48.7 (30.5, 148.4) μmol/L, U=1 728.5, P<0.001] and direct bilirubin [84.5 (47.7, 236.3) μmol/L VS 37.7 (18.3, 105.7) μmol/L, U=1 588.5, P=0.001] levels in the drainage group remained higher than those in the steroid group, while alanine aminotransferase levels were lower [74.0 (46.5,110.5) U/L VS 143.0 (51.0,253.5) U/L, U=769.0, P=0.006]. No significant differences were observed in these biochemical indices between the two groups at 4-month and 12-month follow-ups ( P>0.05). The recurrence rates were 28.1% (9/32) in the drainage group and 21.6% (8/37) in the steroid group, with no significant difference in recurrence rate between groups ( χ2=0.4, P=0.266). Conclusion:ERCP biliary drainage does not significantly improve long-term efficacy or reduce recurrence rates in AIP patients with obstructive jaundice. Instead, it increases the risk of postoperative complications and medical costs. Direct steroid therapy is safe and feasible for confirmed AIP with obstructive jaundice.

ObjectiveIn order to improve the recognition accuracy of named entities in medical record texts and realize the effective mining and utilization of medical record knowledge， a Bert-Radical-Lexicon（BRL） neural network model is constructed to recognize medical record entities with respect to the characteristics of medical record texts. MethodWe selected 408 medical records related to hypertension from the the Complete Library of Famous Medical Records of Chinese Dynasties and constructed a dataset consisting of 1 672 medical records by manually labeling. Then， we randomly divided the dataset into three subsets， including the training set（1 004 cases）， the testing set （334 cases） and the validation set（334 cases）. Based on this dataset， we built a BRL model that fused various text features of medical records， as well as its variants BRL-B， BRL-L and BRL-R， and a baseline model Base for experiments. During the model training phase， we trained the above models using the training set to reduce the risk of overfitting. We continuously monitored the performance of each model on the validation set during training and saved the model with the best performance. Finally， we evaluated the performance of these models on the testing set. ResultCompared with other models， the BRL model had the best performance in the medical records named entity recognition task， with an overall recognition precision of 90.09%， a recall of 90.61%， and the harmonic mean of the precision and recall（F1） of 90.35% for eight types of entities， including disease， symptom， tongue manifestation， pulse condition， syndrome， method of treatment， prescription and traditional Chinese medicine（TCM）. Compared with the Base model， the BRL model improved the overall F1 value of entity recognition by 5.22%， and the F1 value of pulse condition entity increased by 6.92%， which was the largest increase. ConclusionBy incorporating a variety of medical record text features in the embedding layer， the BRL neural network model has stronger named entity recognition ability， and thus extracts more accurate and reliable TCM clinical information.

ObjectiveTo improve the quality standard of Yuanhu Zhitong oral liquid in order to strengthen the quality control of this oral liquid. MethodThin layer chromatography（TLC） was used for the qualitative identification of Corydalis Rhizoma and Angelicae Dahuricae Radix in Yuanhu Zhitong oral liquid by taking tetrahydropalmatine， corydaline reference substances and Corydalis Rhizoma reference medicinal materials as reference， and cyclohexane-trichloromethane-methanol（5∶3∶0.5） as developing solvent， Corydalis Rhizoma was identified using GF254 glass thin layer plate under ultraviolet light（365 nm）. And taking petroleum ether（60-90 ℃） -ether-formic acid（10∶10∶1） as developing solvent， Angelicae Dahuricae Radix was identified using a silica gel G TLC plate under ultraviolet light（305 nm）. High performance liquid chromatography（HPLC） was performed on a Waters XSelect HSS T3 column（4.6 mm×250 mm， 5 μm） with acetonitrile（A）-0.1% glacial acetic acid solution（adjusted pH to 6.1 by triethylamine）（B） as the mobile phase for gradient elution（0-10 min， 20%-30%A； 10-25 min， 30%-40%A； 25-40 min， 40%-50%A； 40-60 min， 50%-60%A）， the detection wavelength was set at 280 nm， then the fingerprint of Yuanhu Zhitong oral liquid was established， and the contents of tetrahydropalmatine and corydaline were determined. ResultIn the thin layer chromatograms， the corresponding spots of Yuanhu Zhitong oral liquid， the reference substances and reference medicinal materials were clear， with good separation and strong specificity. A total of 12 common peaks were identified in 10 batches of Yuanhu Zhitong oral liquid samples， and the peaks of berberine hydrochloride， dehydrocorydaline， glaucine， tetrahydropalmatine and corydaline. The similarities between the 10 batches of samples and the control fingerprint were all >0.90. The results of determination showed that the concentrations of corydaline and tetrahydropalmatine had good linearity with paek area in the range of 0.038 6-0.193 0， 0.034 0-0.170 0 g·L^-1， respectively. The methodological investigation was qualified， and the contents of corydaline and tetrahydropalmatine in 10 batches of Yuanhu Zhitong oral liquid samples were 0.077 5-0.142 9、0.126 1-0.178 2 g·L^-1， respectively. ConclusionThe established TLC， fingerprint and determination are simple， specific and reproducible， which can be used to improve the quality control standard of Yuanhu Zhitong oral liquid.

Objective:To analyze the correlation of perifollicular blood flow parameters with follicle development, embryo quality and pregnancy outcome in in vitro fertilization and embryo transfer (IVF-ET). Methods:A retrospective case-control study was conducted to analyze the data of 112 infertile patients who underwent IVF-ET admitted to the Department of Reproductive Medicine of Zhumadian Central Hospital from October 2020 to October 2022. Perifollicular blood flow parameters [peak systolic velocity/end diastolic velocity (S/D), resistance index (RI), pulsatility index (PI) and peak systolic velocity (PSV)] were measured by vaginal color doppler ultrasound. A total of 1 156 follicles were extracted, they were divided into high-quality follicle group ( n=208), and non-high-quality follicle group ( n=948) according to follicle development, high-quality embryo group ( n=161) and non-high-quality embryo group ( n=995) according to embryo quality, pregnant group ( n=37) and non-pregnant group ( n=75) according to pregnancy outcome. The S/D, RI, PI and PSV of the groups were compared. The correlation indexes of PSV peak velocity among different perifollicular blood flow were compared, and the correlation between PSV and follicle development and embryo quality in non-high-quality follicle group, non-high-quality embryo group and non-pregnant group was analyzed by Pearson method. Results:PSV in high-quality follicle group [(11.26±0.94) cm/s] was significantly higher than that in non-high-quality follicle group [(10.31±0.78) cm/s, P<0.001], but there were no significant differences in S/D, RI and PI between high-quality follicle group and non-high-quality follicle group (all P>0.05). PSV was significantly higher in the high-quality embryo group [(13.38±1.19) cm/s] than in the non-high-quality embryo group [(12.02±0.85) cm/s, P<0.001], but there were no significant differences in S/D, RI and PI between high-quality embryo group and non-high-quality embryo group (all P>0.05). PSV of pregnant group [(15.14±1.25) cm/s] was significantly higher than that of non-pregnant group [(8.27±0.75) cm/s, P<0.001], and there were no significant differences in S/D, RI and PI between pregnant group and non-pregnant group (all P>0.05). There were no statistically significant differences in age, infertility duration, body mass index, basal follicle-stimulating hormone level, total dosage and duration of gonadotropin used among different perifollicular blood flow PSV peak velocity (all P>0.05), but there were statistically significant differences in the number of high-quality follicles, the number of high-quality embryos and the level of β-human chorionic gonadotropin (β-hCG) [<9 cm/s: 1.05±0.23, 0.73±0.14, (3.05±0.61) U/L;9-10 cm/s: 1.35±0.35, 0.85±0.16, (22.14±5.78) U/L; >10 cm/s: 2.01±0.41, 1.12±0.20, (71.33±8.63) U/L; all P<0.001]. Pearson correlation analysis showed that PSV was positively correlated with follicle diameter, embryo quality score and blood β-hCG level ( r=0.767, P<0.001; r=0.750, P<0.001; r=0.700, P<0.001) in non-high-quality follicle group, non-high-quality embryo group,non-pregnant group. Conclusion:Perifollicular blood flow parameter PSV is correlated with IVF-ET follicle development, embryo quality and pregnancy outcome, which can provide an important reference for clinical evaluation of follicle development, embryo quality and pregnancy outcome.

Objective:To analyze the correlation of perifollicular blood flow parameters with follicle development, embryo quality and pregnancy outcome in in vitro fertilization and embryo transfer (IVF-ET). Methods:A retrospective case-control study was conducted to analyze the data of 112 infertile patients who underwent IVF-ET admitted to the Department of Reproductive Medicine of Zhumadian Central Hospital from October 2020 to October 2022. Perifollicular blood flow parameters [peak systolic velocity/end diastolic velocity (S/D), resistance index (RI), pulsatility index (PI) and peak systolic velocity (PSV)] were measured by vaginal color doppler ultrasound. A total of 1 156 follicles were extracted, they were divided into high-quality follicle group ( n=208), and non-high-quality follicle group ( n=948) according to follicle development, high-quality embryo group ( n=161) and non-high-quality embryo group ( n=995) according to embryo quality, pregnant group ( n=37) and non-pregnant group ( n=75) according to pregnancy outcome. The S/D, RI, PI and PSV of the groups were compared. The correlation indexes of PSV peak velocity among different perifollicular blood flow were compared, and the correlation between PSV and follicle development and embryo quality in non-high-quality follicle group, non-high-quality embryo group and non-pregnant group was analyzed by Pearson method. Results:PSV in high-quality follicle group [(11.26±0.94) cm/s] was significantly higher than that in non-high-quality follicle group [(10.31±0.78) cm/s, P<0.001], but there were no significant differences in S/D, RI and PI between high-quality follicle group and non-high-quality follicle group (all P>0.05). PSV was significantly higher in the high-quality embryo group [(13.38±1.19) cm/s] than in the non-high-quality embryo group [(12.02±0.85) cm/s, P<0.001], but there were no significant differences in S/D, RI and PI between high-quality embryo group and non-high-quality embryo group (all P>0.05). PSV of pregnant group [(15.14±1.25) cm/s] was significantly higher than that of non-pregnant group [(8.27±0.75) cm/s, P<0.001], and there were no significant differences in S/D, RI and PI between pregnant group and non-pregnant group (all P>0.05). There were no statistically significant differences in age, infertility duration, body mass index, basal follicle-stimulating hormone level, total dosage and duration of gonadotropin used among different perifollicular blood flow PSV peak velocity (all P>0.05), but there were statistically significant differences in the number of high-quality follicles, the number of high-quality embryos and the level of β-human chorionic gonadotropin (β-hCG) [<9 cm/s: 1.05±0.23, 0.73±0.14, (3.05±0.61) U/L;9-10 cm/s: 1.35±0.35, 0.85±0.16, (22.14±5.78) U/L; >10 cm/s: 2.01±0.41, 1.12±0.20, (71.33±8.63) U/L; all P<0.001]. Pearson correlation analysis showed that PSV was positively correlated with follicle diameter, embryo quality score and blood β-hCG level ( r=0.767, P<0.001; r=0.750, P<0.001; r=0.700, P<0.001) in non-high-quality follicle group, non-high-quality embryo group,non-pregnant group. Conclusion:Perifollicular blood flow parameter PSV is correlated with IVF-ET follicle development, embryo quality and pregnancy outcome, which can provide an important reference for clinical evaluation of follicle development, embryo quality and pregnancy outcome.

Objective:To explore the feasibility of deep learning-based restoration of obscured thyroid ultrasound images.Methods:A total of 358 images of thyroid nodules were retropectively collected from January 2020 to October 2021 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, and the images were randomly masked and restored using DeepFillv2. The difference in grey values between the images before and after restoration was compared, and 6 sonographers (2 chief physicians, 2 attending physicians, 2 residents) were invited to compare the rate of correctness of judgement and detection of image discrepancies. The ultrasound features of thyroid nodules (solid composition, microcalcifications, markedly hypoechoic, ill-defined or irregular margins, or extrathyroidal extensions, vertical orientation and comet-tail artifact) were extracted according to the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS). The consistency of ultrasound features of thyroid nodules before and after restoration were compared.Results:The mean squared error of the images before and after restoration ranged from 0.274 to 0.522, and there were significant differences in the rate of correctness of judgement and detection of image discrepancies between physicians of different groups(all P<0.001). The overall accuracy rate was 51.95%, the overall detection rate was 1.79%, there were significant differences also within the chief physicians and resident groups (all P<0.001). The agreement rate of all ultrasound features of the nodules before and after image restoration was higher than 70%, over 90% agreement rate for features such as solid composition and comet-tail artifact. Conclusions:The algorithm can effectively repair obscured thyroid ultrasound images while preserving image features, which is expected to expand the deep learning image database, and promote the development of deep learning in the field of ultrasound images.

Objective:To compare and analyze the differences of exercise cardiopulmonary function and the correlation of different cardiopulmonary function indexes among different aircraft types in pilots.Methods:Retrospective study was used. The exercise cardiopulmonary function of 68 Air Force pilots who were qualified for flight in aeromedical identification were tested with the Italian Cosmed exercise cardiopulmonary function tester at a power increasing rate of 25 W/min. The subjects were divided into fighter group and other aircraft group according to aircraft types. The differences of exercise cardiopulmonary function between 2 groups were compared. The correlation between maximal oxygen uptake and age, body mass index, and the correlation between heart rate recovery and exercise endurance were analyzed.Results:There were significant differences in maximal heart rate, respiratory quotient and heart rate recovery value at 1 min after exercise between fighter group (32 cases) and other aircraft group (36 cases) ( t=2.28, 2.50, 2.37, P=0.026, 0.049, 0.021). There was no significant difference in other indexes. The maximal oxygen uptake was negatively correlated with age and body mass index ( r=-0.329, -0.339, both P<0.001). The values of heart rate recovery at 2 min and 3 min after exercise were positively correlated with maximal oxygen uptake and maximal exercise power ( r=0.284, 0.290, 0.306, 0.268, P=0.001, 0.026, 0.002, 0.002). Conclusions:The indexes of exercise cardiopulmonary function have significant differences among pilots in different aircraft types, and there are significant changes with age and weight gain. The heart rate after exercise can monitor the changes of cardiopulmonary function under different training conditions.