Objective:the subclavian approach without insufflation, the ability of assistants to master the technique of holding the endoscope plays a crucial role in the thoroughness and smoothness of the surgery. The author has summarized the "six-marker method", which adjusts the mirror holding technique based on surgical steps and surgical operation goals, so that assistants can quickly grasp the essentials of mirror holding and assist the chief surgeon in completing the surgery smoothly. This method has wide applicability and feasibility, which can achieve good coordination between the surgeon and the mirror holder, shorten the surgical time and break in period. It is worth promoting and applying in clinical practice.

Objective:the subclavian approach without insufflation, the ability of assistants to master the technique of holding the endoscope plays a crucial role in the thoroughness and smoothness of the surgery. The author has summarized the "six-marker method", which adjusts the mirror holding technique based on surgical steps and surgical operation goals, so that assistants can quickly grasp the essentials of mirror holding and assist the chief surgeon in completing the surgery smoothly. This method has wide applicability and feasibility, which can achieve good coordination between the surgeon and the mirror holder, shorten the surgical time and break in period. It is worth promoting and applying in clinical practice.

Objective:To build a small-sample ultra-widefield fundus images (UWFI) multi-disease classification artificial intelligence model, and initially explore the ability of artificial intelligence to classify UWFI multi-disease tasks.Methods:A retrospective study. From 2016 to 2021, 1 608 images from 1 123 patients who attended the Eye Center of the Renmin Hospital of Wuhan University and underwent UWFI examination were used for UWFI multi-disease classification artificial intelligence model construction. Among them, 320, 330, 319, 268, and 371 images were used for diabetic retinopathy (DR), retinal vein occlusion (RVO), pathological myopia (PM), retinal detachment (RD), and normal fundus images, respectively. 135 images from 106 patients at the Tianjin Medical University Eye Hospital were used as the external test set. EfficientNet-B7 was selected as the backbone network for classification analysis of the included UWFI images. The performance of the UWFI multi-task classification model was assessed using the receiver operating characteristic curve, area under the curve (AUC), sensitivity, specificity, and accuracy. All data were expressed using numerical values and 95% confidence intervals ( CI). The datasets were trained on the network models ResNet50 and ResNet101 and tested on an external test set to compare and observe the performance of EfficientNet with the 2 models mentioned above. Results:The overall classification accuracy of the UWFI multi-disease classification artificial intelligence model on the internal and external test sets was 92.57% (95% CI 91.13%-92.92%) and 88.89% (95% CI 88.11%-90.02%), respectively. These were 96.62% and 92.59% for normal fundus, 95.95% and 95.56% for DR, 96.62% and 98.52% for RVO, 98.65% and 97.04% for PM, and 97.30% and 94.07% for RD, respectively. The mean AUC on the internal and external test sets was 0.993 and 0.983, respectively, with 0.994 and 0.939 for normal fundus, 0.999 and 0.995 for DR, 0.985 and 1.000 for RVO, 0.991 and 0.993 for PM and 0.995 and 0.990 for RD, respectively. EfficientNet performed better than the ResNet50 and ResNet101 models on both the internal and external test sets. Conclusion:The preliminary UWFI multi-disease classification artificial intelligence model using small samples constructed in this study is able to achieve a high accuracy rate, and the model may have some value in assisting clinical screening and diagnosis.

Objective:To investigate the causes, diagnosis and treatment of postoperative pulmonary changes in patients with thyroid cancer.Methods:Data of 378 patients with thyroid cancer surgery admitted from Oct. 1, 2019 to Jan. 31, 2020 were retrospectively analyzed. SPSS 23.0 statistical software was adopted to analyze the effect of gender, age, smoking history, BMI, operation way and the surgical approach on postoperative changes in the lungs. The two groups of counting data were compared using χ2 method. Results:Age, gender, smoking history and surgical approach had no significant influence on postoperative pulmonary change ( P>0.05) . Lung changes in patients receiving thyroid cancer plus lateral neck dissection were greater than those receiving radical thyroid cancer alone ( P=0.001) , and lung changes in patients receiving bilateral neck dissection were greater than those receiving unilateral neck dissection ( P=0.027) . The pulmonary changes in patients with underweight and obesity were greater than those in patients with normal weight and hyperreorganization ( P=0.019) . Conclusions:Lateral neck dissection and patients’ body mass index are important factors affecting the postoperative lung changes in thyroid cancer patients. Thyroid cancer patients undergoing lateral neck dissection should actively check their lung changes through chest radiographs after surgery, especially for lean and obese patients, and patients undergoing bilateral neck dissection.

BACKGROUND:It is wel-known that vitamin E holds antioxidant capacity, but whether other growth factors have the same effect on endplate chondrocytes has not yet been reported. OBJECTIVE:To observe the effect of different growth factors on the antioxidant ability of endplate chondrocytes in the intervertebral disc. METHODS:Endplate chondrocytes were primary cultured, and then divided into four groups, including blank control, serum deprivation, hydrogen peroxide stimulation and hydrogen peroxide stimulation combined with different growth factors groups. The 4th group was subdivided into insulin-like growth factor-1, basic fibroblast growth factor, transforming growth factorβ, forskolin and vitamin E groups. The expression levels of caspase-3, matrix metal oproteinase 13 and 3, inhibitor of metal oproteinase 1 as wel as thrombin 4 and 5 were detected by real-time PCR. Cel apoptosis was analyzed through apoptosis kit and flow cytometry. Cel synthesis and secretion were detected by western blot assay. The total antioxidant capacity and the hydrogen peroxide content were determined by kit, and then statistical y analyzed. RESULTS AND CONCLUSION:Different growth factors had significant differences in the endplate chondrocyte apoptosis, secretion and antioxidant capacity. To conclude, transforming growth factorβand forskolin do further damage to the cel s stimulated by hydrogen peroxide, while insulin-like growth factor-1 and vitamin E expose protective effect on the injured cel s.

Objective:To estimate the status of pregnancy complications among women with polycystic ovary syndrome (PCOS) through a systematic review of published literatures.Methods:Systematic literature searches were conducted in PubMed,Web of Science,Medline,Embase,Cochrane Library,China National Knowledge Infrastructure (CNKI),Wanfang,Weipu and China Biology Medicine disc (CBMdisc),as well as the relevant articles published from inception to April 1st 2017,which reported the prevalence of pregnancy complications among women with PCOS.Random effective models were used to calculate pooled prevalence and 95％ confidence intervals.The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of those included studies.Subgroup analyses were used to evaluate the influence of overweight/obesity and insulin resistance before pregnancy on the estimates of pregnancy complications among women with PCOS.Results:Fifty-nine studies involving 13 378 PCOS women and 49 395 non-PCOS women were included.Among women with PCOS,pooled estimates were 20.26％ for gestational diabetes mellitus,13.94％ for hypertensive disorder ofpregnancy,64.16％ for caesarean section,13.35％ for preterm birth,9.84％ for macrosomia,5.88％ for low birth weight,5.25％ for early gestational age,8.45％ for late gestational age,1.93％ for neonatal malformations,0.88％ for perinatal mortality and 3.71％ for neonatal asphyxia.And the estimates of gestational diabetes mellitus,hypertensive disorder of pregnancy,caesarean section,preterm birth,macrosomia and neonatal asphyxia among women with PCOS were significantly higher than those in women without PCOS (all P＜0.05).Subgroup analysis showed the estimates of gestational diabetes mellitus,macrosomia and late gestational age among PCOS women who were overweight/obesity before pregnancy were significant higher than those among PCOS women with normal BMI (all P＜0.05);and compared to PCOS women without insulin resistance prior to pregnancy,PCOS women with pre-pregnancy insulin resistance were at an increased risk for gestational diabetes mellitus,preterm birth and macrosomia (all P＜0.05).Conclusion:PCOS in pregnancy is associated with high rates of pregnancy complications.It is an important risk factor for pregnancy complications.

BACKGROUND:Zinc-modified calcium silicate (CaSiO3) bioceramics coating on the titanium surface prepared in preliminary experiments has good chemical stability and antibacterial property. OBJECTIVE:To observe the effects of zinc-modified CaSiO3 bioceramics coating on osteointegration. METHODS:MC3T3-E1 cels were respectively cultured on the titanium with zinc-modified CaSiO3 bioceramics coating (experiment group), titanium with CaSiO3 bioceramics coating (control group) and pure titanium (blank control group). Then, cel adhesion, proliferation, calcification rate and the expression of type I colagen and osteocalcin were detected. The implant materials mentioned above were respectively inserted into the femurs of New Zealand white rabbits, and after 1.5 months, the osteoproliferation and osteointegration between the implants and the host were tested. RESULTS AND CONCLUSION:In vitro experiment: The number of adhesive cels at 12 hours after co-culture was significantly increased in the experimental group compared with the control group and blank control group (P < 0.05). At 14 days after co-culture, cel proliferation ability and ability of calcium nodule formation in the experiment group were significantly better than those in the other groups (P < 0.05). At 21 days after co-culture, there was no significant difference in the expression of type I colagen, but the expression of osteocalcin in the experiment group was higher than that in the control group and blank control group (P < 0.05).In vivo experiment: In the experiment group, a large amount of bone substances were detected, the coating materials directly contacted with the bone interface, new bone tissues and little fibrous tissues were observed at the interface. In contrast, there was a small amount of bone hyperplasia in the control group and almost no bone hyperplase in the blank control group. Moreover, a small part of the implant directly contacted with the bone interface and the most part was separated from bone trabeculae by fibrous tissues. These findings indicate that zinc-modified CaSiO3 bioceramics coating can enhance the ability of osteointegration between titanium implants and the host.

To estimate the national prevalence of paternal postpartum depression in China and evaluate its association with maternal postpartum depression.
 Methods: Systematic literature searches were conducted in databases including PubMed, Web of Science, Embase, Medline, China National Knowledge Infrastructure (CNKI), Wangfang Database, Chinese science & technology journal database (VIP) and SinoMed database. The articles reported the prevalence of paternal postpartum depression in China were collected from inception to October 1, 2015. Random effect models were used to calculate pooled estimates and 95% confidence intervals. Subgroup analysis were undertaken by period of measurement, case identification, study location and study quality.
 Results: Fourteen studies with a total sample size of 3 819 partners were included in this study. The pooled estimate of paternal postpartum depression was 13.6% (95% CI 8.7%-21.3%). The Pearson correlation coefficien between maternal PPD and paternal PPD was 0.295 (95% CI 0.218-0.367). The subgroup analysis showed that the estimates of paternal PPD in 0-5+6 weeks postpartum, 6-8 weeks postpartum and 8+1-24 weeks postpartum were 28.7%, 11.4% and 5.5%, respectively; when the rating scale was used as case identification method, the estimate of paternal PPD was 16.8%, and it was 4.1% when interview was used. The estimate of paternal PPD in inner areas was 22.2%, in coastal areas was 13.3% and in Hongkong/Taiwan was 7.8%. In studies with lower quality, the estimate of paternal PPD was 23.0%, and it was 9.1% in studies with higher quality.
 Conclusion: The national prevalence of paternal postpartum depression in China was at a high level, particularly during the postpartum 0-5+6 weeks. Paternal postpartum depression also showed a moderate positive correlation with maternal postpartum depression.
Asian Continental Ancestry Group ; China ; epidemiology ; Depression, Postpartum ; epidemiology ; Fathers ; psychology ; Female ; Humans ; Male ; Mothers ; psychology ; Postpartum Period ; Prevalence

Objective To estimate HIV seroprevalence among pregnant women with syphilis and evaluate the influence of syphilis infection on mother-to-child-transmission (MTCT) of HIV by meta-analysis.Methods We conducted a systematic literature search for 1 678 articles related to maternal syphilis and HIV infection published until October 1st 2015 using the PubMed,Web of Science,Chinese Web of Knowledge,Wanfang,Weipu,and SinoMed databases and evaluated the quality of each papers using the STROBE checklist,and the keywords were "pregnant women/maternal/pregnancy","syphilis/AIDS","HIV/human immunodeficiency virus","mother-to-child transimission/vertical transmission".Excluding studies with the special subgroups of HIV-positive pregnant women as the research objects,review or meeting abstract,impossibility of full-text acquisition,sample size ＜50,duplication or impossibility of data extraction,finally,16 studies were included.Random-effects meta-analysis was used to estimate HIV seroprevalence among pregnant women with syphilis and the RR of MTCT for women infected with both syphilis and HIV.Subgroup analyses were undertaken by study location,sample size,use of anti-retroviral therapy and study quality.Results Sixteen studies with a combined sample of 110 573 pregnant women were included in the analysis.Of these,ten reported HIV seroprevalences among pregnant women with syphilis and six studies evaluated the influence of syphilis infection on MTCT of HIV.Pooled estimates yielded a HIV seroprevalence of 11.6％ (95％CI:6.7％-19.5％) among pregnant women with syphilis.We estimated that the risk of MTCT of HIV was 1.86 times (RR=l.86,95％CI:0.89％-3.89％) higher among pregnant women with syphilis compared with those only infected with HIV-although this effect was not statistically significant.Cochran's Q test showed a high degree of heterogeneity in estimates of HIV seroprevalence and the effect of syphilis infection on MTCT of HIV across studies (I2=89.4％ and 86.2％,respectively,P＜0.10).Subgroup analysis estimated HIV seroprevalences of 24.9％ (95％CI:17.4％-34.3％)in Africa,2.8％ (95％CI:1.4％-5.6％) in Asia and 2.2％ (95％CI:0.7％-6.7％) in South America.While studies with a large sample size (≥100) or of higher quality estimated overall seroprevalence at 15.2％ (95％CI:9.0％-24.7％),this was 2.2％ (95％CI:0.7％-6.7％) for lower-quality or smaller studies.Meanwhile,subgroup analyses of the RR of MTCT of HIV in pregnant women infected both with HIV and syphilis gave estimates of 1.19 (0.62-2.29) for the higher quality studies,4.76 (2.65-8.53) for the lower-quality studies,1.47 (0.77-2.81) for studies with a large sample size,5.82 (3.16-10.74) for studies with a small sample size,4.76 (2.65-8.53) for studies in which participants received antiretroviral treatment and 1.19 (0.62-2.29) for studies in which they did not.While Begg's test showed evidence of publication bias in studies of HIV seroprevalence estimates in pregnant women with syphilis (t=-2.48,P=-0.038),no evidence of publication bias was found in studies on the influence of syphilis infection on MTCT of HIV (t=-0.22,P=0.835).Conclusion HIV seroprevalence is higher among pregnant women with syphilis than uninfected women.Further research is warranted to verify whether syphilis infection can increase the risk of MTCT of HIV.

Objective To estimate HIV seroprevalence among pregnant women with syphilis and evaluate the influence of syphilis infection on mother-to-child-transmission (MTCT) of HIV by meta-analysis.Methods We conducted a systematic literature search for 1 678 articles related to maternal syphilis and HIV infection published until October 1st 2015 using the PubMed,Web of Science,Chinese Web of Knowledge,Wanfang,Weipu,and SinoMed databases and evaluated the quality of each papers using the STROBE checklist,and the keywords were "pregnant women/maternal/pregnancy","syphilis/AIDS","HIV/human immunodeficiency virus","mother-to-child transimission/vertical transmission".Excluding studies with the special subgroups of HIV-positive pregnant women as the research objects,review or meeting abstract,impossibility of full-text acquisition,sample size ＜50,duplication or impossibility of data extraction,finally,16 studies were included.Random-effects meta-analysis was used to estimate HIV seroprevalence among pregnant women with syphilis and the RR of MTCT for women infected with both syphilis and HIV.Subgroup analyses were undertaken by study location,sample size,use of anti-retroviral therapy and study quality.Results Sixteen studies with a combined sample of 110 573 pregnant women were included in the analysis.Of these,ten reported HIV seroprevalences among pregnant women with syphilis and six studies evaluated the influence of syphilis infection on MTCT of HIV.Pooled estimates yielded a HIV seroprevalence of 11.6％ (95％CI:6.7％-19.5％) among pregnant women with syphilis.We estimated that the risk of MTCT of HIV was 1.86 times (RR=l.86,95％CI:0.89％-3.89％) higher among pregnant women with syphilis compared with those only infected with HIV-although this effect was not statistically significant.Cochran's Q test showed a high degree of heterogeneity in estimates of HIV seroprevalence and the effect of syphilis infection on MTCT of HIV across studies (I2=89.4％ and 86.2％,respectively,P＜0.10).Subgroup analysis estimated HIV seroprevalences of 24.9％ (95％CI:17.4％-34.3％)in Africa,2.8％ (95％CI:1.4％-5.6％) in Asia and 2.2％ (95％CI:0.7％-6.7％) in South America.While studies with a large sample size (≥100) or of higher quality estimated overall seroprevalence at 15.2％ (95％CI:9.0％-24.7％),this was 2.2％ (95％CI:0.7％-6.7％) for lower-quality or smaller studies.Meanwhile,subgroup analyses of the RR of MTCT of HIV in pregnant women infected both with HIV and syphilis gave estimates of 1.19 (0.62-2.29) for the higher quality studies,4.76 (2.65-8.53) for the lower-quality studies,1.47 (0.77-2.81) for studies with a large sample size,5.82 (3.16-10.74) for studies with a small sample size,4.76 (2.65-8.53) for studies in which participants received antiretroviral treatment and 1.19 (0.62-2.29) for studies in which they did not.While Begg's test showed evidence of publication bias in studies of HIV seroprevalence estimates in pregnant women with syphilis (t=-2.48,P=-0.038),no evidence of publication bias was found in studies on the influence of syphilis infection on MTCT of HIV (t=-0.22,P=0.835).Conclusion HIV seroprevalence is higher among pregnant women with syphilis than uninfected women.Further research is warranted to verify whether syphilis infection can increase the risk of MTCT of HIV.