Objective:To develop a deep learning-based system for real-time recognition and classification of portal hypertensive gastropathy (PHG) and evaluate its ability to assist junior endoscopists.Methods:A total of 2 848 gastroscopy images from 832 patients with liver cirrhosis were selected from Digestive Endoscopy Center databases of Renmin Hospital of Wuhan University, Wuhan Hospital of Traditional Chinese and Western Medicine, and the Second Hospital of Jingzhou from January 2015 to October 2023. This system referred to 3 endoscopic features of Baveno Ⅱ scoring system. Three models were developed respectively for gastric antral vascular ectasia (GAVE), mosaic-like pattern (MLP), and red marks (RM). The specific classification references were as follows: (1) GAVE model: 0 no, 1 yes; (2) MLP model: 0 no, 1 mild, 2 severe; (3) RM model: 0 no, 1 isolated, 2 fused. The classification results for endoscopic characteristics of PHG of 3 endoscopy experts were taken as the gold standard. The yolov8-m model was used for training. The training dataset, validation dataset, and test dataset were allocated at a ratio of 8∶1∶1. The test dataset was used to evaluate the performance of models and their auxiliary effects on endoscopists. The accuracy, recall, precision, specificity and Kappa coefficient were calculated. Results:The accuracy, recall, specificity of GAVE model were 96.0% (48/50), 87.5% (7/8) and 97.6% (41/42). There was no significant difference between its accuracy and the gold standard ( χ2=316.226, P=1.000). The precision of GAVE1 and GAVE0 were 87.5% (7/8) and 97.6% (41/42) respectively. The accuracy of MLP model was 84.1% (132/157), and there was no significant difference compared with the gold standard ( χ2=3.286, P=0.193). The precision and recall of MLP2 were 88.2% (15/17) and 75.0% (15/20). The precision and recall of MLP1 were 77.9% (60/77) and 88.2% (60/68). The precision and recall of MLP0 were 90.5% (57/63) and 82.6% (57/69). The accuracy of RM model was 87.9% (123/140), and there was no significant difference compared with the gold standard ( χ2=2.891, P=0.409). The precision and recall of RM2 were 94.7% (18/19) and 78.3% (18/23). The precision and recall of RM1 were 72.2% (26/36) and 81.3% (26/32). The precision and recall of RM0 were 92.9% (79/85) and 92.9% (79/85). The mean accuracy of the three junior endoscopists, with and without the assistance of the GAVE model, MLP model, and RM model, respectively increased from 95.3% to 99.3%, from 83.9% to 91.9%, and from 81.9% to 83.1%. The overall consistency analysis of the 3 junior endoscopists with the gold standard indicated that the consistency of the GAVE model before and after assistance was extremely strong (both an overall Kappa of 1.000); the consistency before assistance of the MLP model was moderate (with an overall Kappa of 0.601), which increased to extremely strong after assistance (with an overall Kappa of 0.964); and the consistency of the RM model before and after assistance was also relatively strong (with an overall Kappa of 0.792 before and 0.798 after). Conclusion:The deep learning system accurately identifies and classifies PHG features and significantly enhances diagnostic performance of junior endoscopists.

Objective:To develop a deep learning-based system for real-time recognition and classification of portal hypertensive gastropathy (PHG) and evaluate its ability to assist junior endoscopists.Methods:A total of 2 848 gastroscopy images from 832 patients with liver cirrhosis were selected from Digestive Endoscopy Center databases of Renmin Hospital of Wuhan University, Wuhan Hospital of Traditional Chinese and Western Medicine, and the Second Hospital of Jingzhou from January 2015 to October 2023. This system referred to 3 endoscopic features of Baveno Ⅱ scoring system. Three models were developed respectively for gastric antral vascular ectasia (GAVE), mosaic-like pattern (MLP), and red marks (RM). The specific classification references were as follows: (1) GAVE model: 0 no, 1 yes; (2) MLP model: 0 no, 1 mild, 2 severe; (3) RM model: 0 no, 1 isolated, 2 fused. The classification results for endoscopic characteristics of PHG of 3 endoscopy experts were taken as the gold standard. The yolov8-m model was used for training. The training dataset, validation dataset, and test dataset were allocated at a ratio of 8∶1∶1. The test dataset was used to evaluate the performance of models and their auxiliary effects on endoscopists. The accuracy, recall, precision, specificity and Kappa coefficient were calculated. Results:The accuracy, recall, specificity of GAVE model were 96.0% (48/50), 87.5% (7/8) and 97.6% (41/42). There was no significant difference between its accuracy and the gold standard ( χ2=316.226, P=1.000). The precision of GAVE1 and GAVE0 were 87.5% (7/8) and 97.6% (41/42) respectively. The accuracy of MLP model was 84.1% (132/157), and there was no significant difference compared with the gold standard ( χ2=3.286, P=0.193). The precision and recall of MLP2 were 88.2% (15/17) and 75.0% (15/20). The precision and recall of MLP1 were 77.9% (60/77) and 88.2% (60/68). The precision and recall of MLP0 were 90.5% (57/63) and 82.6% (57/69). The accuracy of RM model was 87.9% (123/140), and there was no significant difference compared with the gold standard ( χ2=2.891, P=0.409). The precision and recall of RM2 were 94.7% (18/19) and 78.3% (18/23). The precision and recall of RM1 were 72.2% (26/36) and 81.3% (26/32). The precision and recall of RM0 were 92.9% (79/85) and 92.9% (79/85). The mean accuracy of the three junior endoscopists, with and without the assistance of the GAVE model, MLP model, and RM model, respectively increased from 95.3% to 99.3%, from 83.9% to 91.9%, and from 81.9% to 83.1%. The overall consistency analysis of the 3 junior endoscopists with the gold standard indicated that the consistency of the GAVE model before and after assistance was extremely strong (both an overall Kappa of 1.000); the consistency before assistance of the MLP model was moderate (with an overall Kappa of 0.601), which increased to extremely strong after assistance (with an overall Kappa of 0.964); and the consistency of the RM model before and after assistance was also relatively strong (with an overall Kappa of 0.792 before and 0.798 after). Conclusion:The deep learning system accurately identifies and classifies PHG features and significantly enhances diagnostic performance of junior endoscopists.

Objective:To explore the relation among self-esteem, psychological flexibility and mental health in medical students, and to provide scientific reference for mental health education for medical students.Methods:A total of 788 medical students selected from a medical university in Chongqing City were investigated with the symptom checklist 90 (SCL-90), self-esteem scale (SES), acceptance and action questionnaire-Ⅱ (AAQ-Ⅱ), and cognitive fusion questionnaire-fusion (CFQ-F). SPSS 22.0 software was used for statistical analysis. T test, ANOVA, correlation analysis and tests for mediation effects were conducted. Results:There were significant differences in self-esteem and mental health level among medical students in gender and different grades ( t=-2.55, P<0.05; F=6.53, P<0.05). Mental health, self-esteem and psychological flexibility of medical students were correlated in pairs ( r=-0.528-0.694, P<0.01). Psychological flexibility played a partial mediation role between self-esteem and mental health of medical students, and the mediating effect accounted for 60.03% of the total effect. Conclusion:Self-esteem can directly predict the mental health of medical students, and can also indirectly affect mental health through psychological flexibility. Medical universities should carry out psychological education and promotion work with pertinence.

Objective:To explore whether circular RNA HECTD1 (circ-HECTD1) is involved in oxygen-glucose deprivation (OGD)-induced neuronal cell damage by regulating the expressions of miR-98-5p/ephrin A4 (EPHA4).Methods:Mouse primary cortical neuronal cells were isolated and cultured in vitro. The targeting relations of circ-HECTD1 and miR-98-5p with EPHA4 were detected by dual luciferase reporter assay and RNA binding protein immunoprecipitation assay. These neurons were randomly divided into control group (cultured for 24 h under normal condition) and 6, 12 and 24 h OGD treatment groups (treated with OGD for 6, 12 and 24 h, respectively), OGD+Vector group and OGD+circ-HECTD1 group, OGD+small interfering RNA (siRNA) negative control (si-NC) group and OGD+siRNA circ-HECTD1 (si-circ-HECTD1) group, OGD+micro RNA (miR) negative control (miRNC) group and OGD+miR-98-5p mimic group, OGD+miRNA inhibitor negative control (anti-miRNC) group and OGD+miR-98-5p inhibitor (anti-miR-98-5p) group, OGD+miR-98-5p mimic+pcDNA group and OGD+miR-98-5p mimic+EPHA4 group, OGD+si-circ-HECTD1+anti-miR-NC group and OGD+si-circ-HECTD1+miR-98-5p inhibitor group; pCD5-ciR empty vector, pCD5-ciR-circ-HECTD1, si-NC, si-circ-HECTD1, miR-NC, miR-98-5p mimic, anti-miR-NC or anti-miR-98-5p were transfected into the neurons, and miR-98-5p mimi and pcDNA3.1 empty vector, miR-98-5p mimic and pcDNA3.1-EPHA4 overexpression vector, si-circ-HECTD1 and anti-miR-NC, or si-circ-HECTD1 and anti-miR-98-5p were co-transfected into the neurons. After 24 h of OGD treatment, the circ-HECTD1, miR-98-5p and EPHA4 mRNA expressions were detected by real-time fluorescent quantitative PCR (qRT-PCR), the EPHA4 protein expression was detected by Western blotting, the proliferation activity was detected by MTT assay, the apoptosis rate was detected by flow cytometry, the levels of interleukin (IL)-1β and tumor necrosis factor (TNF)-α in cell culture medium were detected by ELISA, and the activities of superoxide dismutase (SOD) and malondialdehyde (MDA) were detected by kit assay. Results:(1) Targeting relations between circ-HECTD1 and miR-98-5p, and EPHA4 and miR-98-5p were verified. (2) As compared with the control group, the neurons in 6, 12 and 24 h OGD treatment groups had significantly increased circ-HECTD1 and EPHA4 protein expressions and significantly decreased miR-98-5p expression ( P<0.05). (3) As compared with OGD+Vector group, OGD+circ-HECTD1 group had significantly increased circ-HECTD1 expression, and significantly decreased miR-98-5p expression ( P<0.05); as compared with OGD+si-NC group, OGD+si-circ-HECTD1 group had significantly increased miR-98-5p expression, and significantly decreased EPHA4 mRNA and protein expressions ( P<0.05); as compared with OGD+miR-NC group, OGD+miR-98-5p mimic group had significantly increased miR-98-5p expression, and significantly decreased EPHA4 protein expression ( P<0.05); as compared with OGD+anti-miR-NC group, OGD+anti-miR-98-5p group had significantly decreased miR-98-5p expression, and significantly increased EPHA4 protein expression ( P<0.05); as compared with the OGD+si-circ-HECTD1+anti-miR-NC group, OGD+si-circ-HECTD1+anti-miR-98-5p group had significantly increased EPHA4 mRNA and protein expressions ( P<0.05). (4) As compared with the control group, the OGD groups had significantly decreased cell viability and SOD activity, and significantly increased IL-1β and TNF-α levels, apoptosis rate and MDA activity ( P<0.05); as compared with the OGD+si-NC group, the OGD+si-circ-HECTD1 group had significantly decreased cell apoptosis rate, IL-1β and TNF-α levels, and MDA activity, and significantly increased cell viability and SOD activity ( P<0.05); as compared with the OGD+si-circ-HECTD1+anti-miR-NC group, the OGD+si-circ-HECTD1+anti-miR-98-5p group had significantly decreased cell viability and SOD activity, and significantly increased IL-1β and TNF-α levels, apoptosis rate and MDA activity ( P<0.05); as compared with the OGD+miR-NC group, OGD+miR-98-5p mimic group had significantly decreased cell apoptosis rate, IL-1β and TNF-α levels, and MDA activity, and significantly increased cell viability and SOD activity ( P<0.05); as compared with OGD+miR-98-5p mimic+pcDNA group, OGD+miR-98-5p mimic+EPHA4 group has significantly increased cell apoptosis rate, IL-1β and TNF-α levels, and MDA activity, and significantly increased cell viability and SOD activity ( P<0.05). Conclusion:Knockdown of circ-HECTD1 could ameliorate the OGD-induced neuronal cell damage in mice by targeting the expressions of miR-98-5p/EPHA4.

Objective:To evaluate the accuracy of measuring the siae of atrial septal defect(ASD) by transthoracic echocardiography(TTE) on " compression of right superior pulmonary vein sheath during operation" (compression-size) using multi-layer perceptron.Methods:From January 2016 to January 2019, 460 cases of ASD with soft margin, thin growth or central type with atrial septal tumor in the First Hospital Affiliated of Air Force Medical University were analyzed retrospectively. The age was (34.32±18.84)years, 129 males and 331 females. Preoperative TTE and intraoperative TTE were performed to measure the size of ASD and compression-size. With the final occluder size selected as the dependent variable, the preoperative and intraoperative ultrasound measurements were used as covariates, and all patients were randomly divided into training set, test set and verification set according to the proportion of 5∶2∶3, which were imported into multi-layer perceptron. Gradient descent method was used to optimize and adjust the weight, and 10 operations were carried out respectively, and the average value was calculated to evaluate the two ultrasound methods for blocking.Results:The mean values of ASD were (15.26±5.33)mm for preoperative, (23.83±6.39)mm for compression-size intraoperative TTE, and (25.14±6.55)mm for the occluder, respectively. The difference was statistically significant (χ 2=850.450, P<0.001). There were significant differences between the pairwise ( P<0.001). Ten times of multi-layer perceptron were used to obtain a training model for predicting the size of the occluder based on preoperative transthoracic ultrasound and TTE measurement after right upper pulmonary vein sheath compression. The average relative error of the model obtained by preoperative ultrasound measurement in the validation set was (16.55±0.02)%, and that of the model obtained by intraoperative ultrasound measurement in the validation set was (4.81±0.01)%. The difference between the two methods was statistically significant ( t=16.185, P<0.001). Conclusions:It is more accurate to measure the ASD size for selection of occluder by the use of the right superior pulmonary vein sheath compression and TTE, especially for ASD patients with soft margin, thin growth or atrial septal tumor.

Macrophages play critical roles in renal fibrosis. However, macrophages exhibit ontogenic and functional heterogeneities, and which population of macrophages contributes to renal fibrosis and the underlying mechanisms remain unclear. In this study, we genetically targeted Notch signaling by disrupting the transcription factor recombination signal binding protein-Jκ (RBP-J), to reveal its role in regulation of macrophages during the unilateral ureteral obstruction (UUO)-induced murine renal fibrosis. Myeloid-specific disruption of RBP-J attenuated renal fibrosis with reduced extracellular matrix deposition and myofibroblast activation, as well as attenuated epithelial-mesenchymal transition, likely owing to the reduced expression of TGF-β. Meanwhile, RBP-J deletion significantly hampered macrophage infiltration and activation in fibrotic kidney, although their proliferation appeared unaltered. By using macrophage clearance experiment, we found that kidney resident macrophages made negligible contribution, but bone marrow (BM)-derived macrophages played a major role in renal fibrogenesis. Further mechanistic analyses showed that Notch blockade reduced monocyte emigration from BM by down-regulating CCR2 expression. Finally, we found that myeloid-specific Notch activation aggravated renal fibrosis, which was mediated by CCR2 macrophages infiltration. In summary, our data have unveiled that myeloid-specific targeting of Notch could ameliorate renal fibrosis by regulating BM-derived macrophages recruitment and activation, providing a novel strategy for intervention of this disease.

Objective To discuss the safety and clinical efficacy of modified traction method using endoloop and clip for endoscopic submucosal dissection(ESD).Methods Fifty patients who underwent ESD at Renmin Hosptial of Wuhan University between August 2016 and February 2017 were randomly divided into two groups, including 25 patients in modified ESD group and 25 patients in conventional ESD group as control. The therapeutic conditions, dissection time and incidence of complications were compared between the two groups. Results In the modified ESD group, the dissection time of submucosal exposure to the full dissection (19. 9±6. 5 min VS 26. 4±9. 2 min, P＝0. 001), total dissection time (27. 5±8. 1 min VS 35. 1± 10. 7 min, P＝0. 003), and dissection time per unit area (2. 4±1. 1 min/cm2VS 3. 3±1. 3 min/cm2, P＝0. 009) were significantly shorter compared with those in the control group. There were 1 case of delayed bleeding in the modified group and 2 cases in the control group with no significant difference ( P＝0. 248). No perforation occurred. Conclusion The modified traction method using endoloop and clip for ESD is safe and effective with a shorter operation time.

Objective: To discuss the predictive value of liver and spleen stiffness detected by transientelasticity imaging technology on esophageal varices bleeding (EVB) of patients with hepatitis B cirrhosis. Methods: 100 patients with hepatitis B cirrhosis (18 cases were no EV, 30 cases were mild EV, 28 cases were moderate EV and 24 cases were severe EV) were selected. In these patients, 52 cases were no bleeding, 28 cases were single hemorrhage and 20 cases were multiple hemorrhage. As the Child-Pugh grading, there were 34 cases were A grade, 30 cases were B grade and 36 cases were C grade. All of the liver and spleen stiffness of these patients were detected by instantaneous elasticity imaging technology, and to compare different Child-Pugh grading of patients, different EV degree, and liver and spleen stiffness on different EVB situation. Results: The liver and spleen stiffness of patients in Child-Pugh C stage were significantly higher than that in Child-Pugh A stage and B stage, respectively (t=21.13, t=12.04, t=11.24, t=9.741; P<0.05). With the aggravating of the severe degree of EV, the liver and spleen stiffness were significant increasing, and there were significant differences between different EV degree patients for liver stiffness and spleen stiffness, respectively (F=7.494, F=8.129, P<0.05). The liver and spleen stiffness of multiple hemorrhage group were significant higher than that of no-hemorrhage group and single hemorrhage group, respectively (t=13.13, t=18.14, t=12.15, t=17.46; P<0.05). Conclusion: By using instantaneous elasticity imaging technology to detect liver and spleen stiffness can predict EVB of patient with hepatitis B cirrhosis and it has higher clinical value, therefore, it is a sophisticated noninvasive examination with simple operation and better repeatability.

Objective To investigate the clinical effect of "pre-purse-string" suture on submucous gastric lesions of external growth type in endoscopic patients. Methods Clinical data of 27 patients with gastric lesions of external growth type admitted to the digestive endoscopy center of Renmin Hospital of Wuhan University from August 2016 to October 2016 for endoscopic submucosal dissection ( ESD ) were analyzed. Patients were randomly divided into two groups, the experiment group receiving the "pre-purse-string" suture, the control group receiving purse-string suture after ESD. Mean size of the lesions, procedure time, withdrawal time of gastric decompression, and hospitalization time were compared. Results In the 15 patients of the experiment group, there were 3 cases whose lesions were located in gastric antrum, 6 in gastric body and 6 in gastric fundus. In the 12 cases of the control group, 3 lesions were located in gastric antrum, 5 in gastric body and 4 in gastric fundus. All procedures were successfully completed in endoscopy. No obvious postoperative complications occurred. The mean size of lesions was 2. 5 cm × 3. 2 cm in the experiment group,and 2. 4 cm×3. 0 cm in the control group (P=0. 63). The operation time was 28. 0-43. 0 min (35. 8±6. 1 min) in the experiment group, and 45. 6-68. 8 min (48. 8±5. 3 min) in control group ( P<0. 01) . Conclusion "Pre-purse-string" technique is of clinical effect on gastric submucosal tumor of external growth.

Objective To investigate the consistency of mRECIST criterion and RECIST criterion in evaluating the curative effect of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) for primary hepatocellular carcinoma (PHC) which condition exceeds Milan liver transplantation standard in order to determine which criterion can evaluate the curative effect better.Methods A total of 78 PHC patients,whose lesion's extent exceeded Milan standard and who had received TACE combined with RFA therapy,were included in this study.The curative effect was separately evaluated by mRECIST criterion and RECIST criterion.KAPPA coefficient was calculated to determine the consistency of the evaluation results by the two criteria.By using Kaplan-Mier method,the median survival time (MST) of patients achieving different remission degree was calculated.Log-rank test was used to draw survival curve.The MST and the survival curve of patients with different remission degree were statistically compared between the two criteria.Results By using SPSS19.0 software,the KAPPA coefficient of the evaluation results of the two criteria was 0.243 (x2=5.250,P＜0.01).The MST of patients,which was calculated by Kaplan-Mier method,had multiple overlapping parts with SD and PR curves that were drawn by log-rank test based on RECIST criterion,the difference between the two was not statistically significant (P＞0.05).When mRECIST criterion was based on,the survival curve of patients with different remission degree was relatively balanced and showed no overlapping parts,the difference between the two was statistically significant (P＜0.01).Conclusion (1) The mRECIST criterion is not suitable for the evaluation of the curative effect of PHC patients whose lesion's extent exceeds Milan standard,and mRECIST criterion can not apply to make evaluation of the curative effect for PHC when the lesion's border is unclear and its enhancement is not obvious.(2) mRECIST criterion can more accurately evaluate the curative effect of TACE combined with PRA in treating PHC which extent exceeds Milan liver transplantation standard.