AIM:To compare the efficacy and safety of early combination therapy with ranibizumab and dexamethasone intravitreal implants versus ranibizumab monotherapy for the treatment of macular edema secondary to retinal vein occlusion(RVO-ME).METHODS: A retrospective cohort study was conducted on a total of 62 cases(64 eyes)of patients who were first diagnosed with RVO-ME at the Eye Centre of the Affiliated Hospital of Shandong Second Medical University between February 2022 and February 2023. The subjects were divided into two groups according to the different treatment regimens: 32 cases(34 eyes)in the monotherapy group received only ranibizumab [3+pro re nata(PRN)regimen], and 30 cases(30 eyes)in the combination therapy group were injected with ranibizumab once first, followed by dexamethasone intravitreal implant 3 wk later(1+DEX regimen). The best corrected visual acuity(BCVA), central retina thickness(CRT), foveal avascular zone(FAZ)area, macular vascular density(MVD)at the level of the deep vascular complex(DVC)of the retina, the incidence of ocular adverse effects, the number of drug injections, and the total cost between the two groups were compared before and after treatment.RESULTS: At 3 wk, 3 and 6 mo, and at the final follow-up of the two groups of patients, the improvement in BCVA, CRT, and MVD in the DVC layer was significantly better than that before treatment(all P<0.05); there were differences in the comparisons of BCVA and CRT between the two groups at 6 mo and the final follow-up(all P<0.05), and the increase in the number of letters of BCVA was the most pronounced in the combination therapy group at 6 mo of treatment. Statistical significant difference was observed in the comparison of MVD in the DVC layer between the two groups at 3 and 6 mo after treatment and at the final follow-up(all P<0.05). However, no significant change in FAZ area was evident before and after treatment in both groups(P>0.05). The combination therapy group exhibited a reduced number of injections and total cost in comparison to the monotherapy group. The combination therapy group exhibited a slightly higher incidence of high intraocular pressure and cataract progression compared to the monotherapy group, with no statistical significant difference(all P>0.05). Furthermore, no serious adverse events were observed in either group following treatment.CONCLUSION:Compared with ranibizumab alone, ranibizumab combined with dexamethasone intravitreal implant significantly improved vision, reduced macular edema, and lowered the frequency of injections and total treatment cost in patients with RVO-ME. CRT and MVD in the DVC layer are reliable prognostic indicators for patients with RVO-ME.

Objective To explore the clinical value of artificial intelligence (AI) quantitative parameters in distinguishing pathological grades of stageⅠ invasive adenocarcinoma (IAC). Methods Clinical data of patients with clinical stageⅠ IAC admitted to Yantaishan Hospital Affiliated to Binzhou Medical University from October 2018 to May 2023 were retrospectively analyzed. Based on the 2021 WHO pathological grading criteria for lung adenocarcinoma, IAC was divided into gradeⅠ, grade Ⅱ, and grade Ⅲ. The differences in parameters among the groups were compared, and logistic regression analysis was used to evaluate the predictive efficacy of AI quantitative parameters for grade Ⅲ IAC patients. Parameters were screened using least absolute shrinkage and selection operator (LASSO) regression analysis. Three machine learning models were constructed based on these parameters to predict grade Ⅲ IAC and were internally validated to assess their efficacy. Nomograms were used for visualization. Results A total of 261 IAC patients were included, including 101 males and 160 females, with an average age of 27-88 (61.96±9.17) years. Six patients had dual primary lesions, and different lesions from the same patient were analyzed as independent samples. There were 48 patients of gradeⅠ IAC, 89 patients of grade Ⅱ IAC, and 130 patients of grade Ⅲ IAC. There were statitical differences in the AI quantitive parameters such as consolidation/tumor ratio (CTR), ect among the three goups. (P<0.05). Univariate analysis showed that the differences in all variables except age were statistically significant (P<0.05) between the group gradeⅠ+grade Ⅱand the group grade Ⅲ . Multivariate analysis suggested that CTR and CT standard deviation were independent risk factors for identifying grade Ⅲ IAC, and the two were negatively correlated. Grade Ⅲ IAC exhibited advanced TNM staging, more pathological high-risk factors, higher lymph node metastasis rate, and higher proportion of advanced structure. CTR was positively correlated with the proportion of advanced structures in all patients. This correlation was also observed in grade Ⅲ but not in gradeⅠand grade ⅡIAC. CTR and CT median value were selected by using LASSO regression. Logistic regression, random forest, and XGBoost models were constructed and validated, among which, the XGBoost model demonstrated the best predictive performance. Conclusion Cautious consideration should be given to grade Ⅲ IAC when CTR is higher than 39.48% and CT standard deviation is less than 122.75 HU. The XGBoost model based on combined CTR and CT median value has good predictive efficacy for grade Ⅲ IAC, aiding clinicians in making personalized clinical decisions.

Tophaceous wound represent a severe complication of end-stage gout, characterized by the deposition of monosodium urate (MSU) crystals leading to localized tissue ischemia, chronic inflammation, and non-healing ulcers. The pathological mechanism involves the formation of MSU crystals under persistent hyperuricemia, inflammatory encapsulation, and mechanical compression of the vascular system due to tophus enlarge-ment, ultimately resulting in chronic non-healing ulcers. This article consolidates current evidence to outline an integrated management strategy for such wounds, combining systemic metabolic control with localized interventions. Effective treatment depends on maintaining serum uric acid levels below 300 μmol/L through urate-lowering agents, including conventional drugs and novel urate transporter 1 inhibitors such as AR882, complemented by anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs and glucocorticoids to alleviate pain and reduce inflammation. Topical agents and advanced dressings are utilized to support healing and manage exudate. Debridement, which encompasses sharp, ultrasonic, and micro-techniques, is essential for removing necrotic tissue and MSU deposits, with efficacy assessed via local uric acid monitoring. Surgical reconstructions, including skin flap grafting and tendon or ligament reconstruction, are indicated for significant tissue loss or functional impairment. Long-term management emphasizes continuous metabolic control, personalized rehabilitation, and lifestyle modification. The comprehensive treatment of tophaceous wounds requires multidisciplinary collaboration to balance local repair and systemic regulation for improved prognosis. Future research directions include gene therapy to regulate purine metabolism and artificial intelligence-assisted personalized treatment plans, to achieve precision medicine for tophaceous wounds.
Humans ; Wound Healing ; Gout/therapy* ; Uric Acid/blood* ; Debridement

Objective: To systematically evaluate the detection rate of prenatal depression in Chinese women, so as to provide the reference for mental health care during pregnancy among women. Methods: Publications pertaining to the detection rate of prenatal depression in Chinese women were retrieved from international and national databases from inception to July 30, 2023, including CNKI, Wanfang Data, VIP, PubMed and other databases. The Stata 17.0 software was used for meta analysis, sensitivity analysis was performed using the leave-one-out method, and the publication bias was evaluated using funnel plot and Egger's test. Results: A total of 5 687 publications were retrieved, and 60 studies were finally included, with 58 in Chinese and 2 in English, 51 of medium quality and 9 of high quality, and 114 168 participants. The results of meta-analysis showed that the overall detection rate of prenatal depression in Chinese women was 23.7% (95%CI: 20.0%-27.5%). The detection rates of prenatal depression in the first, second and third trimesters were 22.1% (95%CI: 15.5%-28.6%), 16.3% (95%CI: 12.0%-20.6%) and 19.9% (95%CI: 16.0%-23.7%), in Eastern and Midwestern China were 19.7% and 27.5%, and in women with an education level of junior high school or below and high school or above were 27.2% and 17.9%, respectively, with statistically significant differences (all P<0.05). Sensitivity analysis showed that the study results were stable. There were publication bias in the results of overall detection rate of prenatal depression, and detection rates in the second and third trimester. Conclusions The overall detection rate of prenatal depression in Chinese women ranges from 20.0% to 27.5%. There are differences in the detection rate of prenatal depression in different pregnancies, with the highest detection rate in the first trimester.

The incidence of lung micropapillary adenocarcinoma is low, and it is easy to relapse and metastasize after operation, which leads to poor prognosis. This article mainly summarizes the imaging and histopathological features of lung micropapillary adenocarcinoma and discusses the effects of surgical procedures, chemotherapy and targeted drug therapy on the prognosis of patients, in order to deepen the understanding of lung micropapillary adenocarcinoma.

Objective:To construct a non-invasive pre-hospital screening model and early based on artificial intelligence algorithms to provide the severity of stroke in patients, provide screening, guidance and early warning for stroke patients and their families, and provide data support for clinical decision-making.Methods:A retrospective study was conducted. The clinical information of stroke patients ( n = 53?793) were extracted from the Yidu cloud big data server system of the Second Affiliated Hospital of Dalian Medical University from January 1, 2001 to July 31, 2023. Combined with the results of single factor screening and the opinions of experts with senior professional titles in neurology, the input variable was determined, and the output variable was the National Institutes of Health Stroke Scale (NIHSS) representing the severity of the disease at admission. Python 3.7 was used to build DeepFM algorithm model, and five data mining models including Logistic regression, CART decision tree, C5.0 decision tree, Bayesian network and deep neural network (DNN) were built at the same time. The original data were randomly divided into 80% training set and 20% test set, which were used to train and test the models, adjust the parameters of each model, respectively calculate the accuracy, sensitivity and F-index of the six models, carry out the comprehensive comparison and evaluation of the model. The receiver operator characteristic curve (ROC curve) and calibration curve were drawn, compared the prediction performance of DeepFM model and the other five algorithms. In addition, the data of stroke patients ( n = 1?028) were extracted from Dalian Central Hospital for external verification of the model. Results:A total of 14?015 stroke patients with complete information were selected, including 11?212 in the training set and 2?803 in the testing set. After univariate screening, 14 indicators were included to construct the model, including gender, age, recurrence, physical impairment, facial problems, speech disorders, head reactions, disturbance of consciousness, visual disorders, abnormal cough and swallowing, high risk factor, family history, smoking history and drinking history. DeepFM model adopted the two-order crossover feature. The number of hidden layers in DNN layer was 3. Dropout was used to discard the neurons in the neural network. Rule was used as the activation function. Each layer used Dense full connection. The objective function was random gradient descent. The number of iterations was 15. There were 133?922 training parameters in total. Comparing the predictive value of the six models showed that the accuracy of DeepFM model was 0.951, the sensitivity was 0.992, the specificity was 0.814, the F-index was 0.950, and the area under the curve (AUC) was 0.916. The accuracy of the other five data mining models were between 0.771-0.780, the sensitivity were between 0.978-0.987, the F-index were between 0.690-0.707, and the AUC were between 0.568-0.639. The calibration curve of the DeepFM model was more aligned with the ideal curve than the other five data mining models. Suggesting that the prediction performance of DeepFM model was the best. External validation was conducted on the DeepFM model, and its accuracy was 0.891, indicating good generalization performance of the model.Conclusion:The pre-hospital non-invasive screening prediction model based on DeepFM can accurately predict the severity grading of stroke patients, and has potential application value in rapid screening and early clinical decision-making of stroke.

Purpose To evaluate the differential diagnostic value of conventional ultrasound in the ureteral polyps and ureteral carcinoma via continuous observation.Materials and Methods The conventional ultrasound of patients with ureteral polyps and ureteral carcinoma treated in Shaanxi Provincial People's Hospital were retrospectively analyzed from June 2015 to June 2022.According to the pathological results,all participants were divided into the ureteral polyp group(98 cases)and the ureteral carcinoma group(151 cases).All clinical and ultrasound data were recorded,and the differences of echo,blood flow and peristalsis were compared between the two groups.Results There were significant differences in ureteral peristalsis,color Doppler flow distribution,periureteral tissue thickening,increased echo,and hydronephrosis(χ2=197.50,138.89,26.97,36.13,all P<0.05)between the two groups.Low echo was predominant in both groups[67(68.37)vs.114(75.50)],with no significant difference(χ2=1.52,P>0.05).In the ureteral polyp group,67 cases were found in the upper ureter,89 cases were observed continuously with common peristalsis,and 73 cases with color blood flow were mostly central blood flow,while in the ureteral cancer group,85 cases were found in the middle and lower ureter,148 cases showed almost no peristalsis,and 122 cases with color blood flow were mostly peripheral blood flow.Conclusion There are some differences in clinical features such as the location as well as whether hydronephrosis between ureteral polyps and carcinoma.Peristalsis can provide the differential diagnosis for ureteral polyps and ureteral carcinoma via continuous observation.

Objective:To explore the characteristics of gut microbiota in the preoperative, short-term postoperative and long-term postoperative period at (15.61±4.51) months in children with ventricular septal defect (VSD) of congenital heart disease (CHD) treated with cardiopulmonary bypass (CPB).Methods:A prospective study was conducted.In Guangzhou Women and Children′s Medical Center, 13 patients with VSD who were scheduled for CPB and additional 10 age- and gender-matched healthy infants as pre-CPB control group from January 2021 to January 2022 were enrolled.Fecal samples were collected at pre- and early post-CPB.Meanwhile, 18 gender- and CHD diagnosis and operation-matched patients at (15.61±4.51) months after CPB and 8 healthy age- and gender-matched children as long-term control group after CPB were also enrolled, and fecal samples were collected.16S rRNA sequencing of fecal samples from all subjects were performed and comparing the differences in gut microbiota between two groups via comparing alpha and beta diversity, parameter test or nonparametric test, and LEfSe analysis.Results:Compared with those of pre-CPB control group, there was a significant difference in the composition of gut microbiota in the preoperative period of VSD children, with significantly increased abundances of Enterobacteriaceae and Shigella, and decreased abundance of Bifidobacterium (all P<0.05). The diversity of gut microbiota was comparable in VSD children before CPB and in the short period time after CPB (all P>0.05), except for the abundances of Clostridium and Streptococcus (all P<0.05), and there was no significant difference in the relative abundances of other highly abundant gut bacteria between the two periods (all P>0.05). Compared with that in VSD children in the short period time after CPB, the abundances of short-chain fatty acids-producing microbes were significantly higher at (15.61±4.51) months postoperatively (all P<0.05), and the gut bacteria profile was similar to that of the long-term control group after CPB (all P>0.05). Conclusions:Gut microbiota imbalance exists in VSD children before CPB.The gut microbiota profile is not influenced by CPB, which returns normal at (15.61±4.51) months postoperatively.

Objective:To systematically review qualitative research on maternal participation in skin-to-skin contact experience during cesarean delivery, the promotion of skin-to-skin contact in cesarean section.Methods:We searched databases including the PubMed, Embase, Web of Science, Cochrane Library, Ebsco, SinoMed, Wan Fang, CNKI, VIP. All of the qualitative research on the real experience of skin-to-skin contact from the participation of caesarean section women were collected. The search time limit was from the establishment of the databases to May 2022. The JBI Critical Appraisal Tool for qualitative studies from Australia was used to evaluate the methodology quality of the included research, and the meta-aggregation was used to conduct the synthesis.Results:Totally 11 qualified studies were included and integrated into 49 valuable findings. Similar results were summarized into 12 groups, and 4 integrated results were synthesized, including the needs of cesarean section mothers; positive experience after skin-to-skin contact in caesarean section; skin-to-skin contact practice strengthen the role of mothers and promotes breastfeeding; difficulties and challenges of skin-to-skin contact during cesarean section.Conclusions:Skin-to-skin contact positively affects mother and infant delivered by cesarean section. Medical staff need to pay attention to the feelings and needs of cesarean section women participating in skin-to-skin contact, optimize information, environment, and humanistic support, and improve skin-to-skin contact practices. Medical institutions should rationally allocate obstetric resources to alleviate the difficulties faced by skin-to-skin contact practices.

Objective:To assess the combination of conventional ultrasound with contrast-enhanced ultrasound(CEUS)in the diagnosis of urothelial carcinoma(UC)of the renal pelvis in elderly patients.Methods:Sixty-seven elderly patients with a histopathologic diagnosis of UC of the renal pelvis and surgically treated at our hospital between April 2015 and March 2023 were retrospectively analyzed.Characteristics of regular preoperative 2D ultrasound, color Doppler flow imaging(CDFI)and CEUS were examined.Results:Of 67 patients, 49(73.13%)were found to have localized lesions in the renal pelvis and renal calyces.Lesions in 53 patients(79.10%)could be clearly identified by conventional ultrasound, with 46(86.79%)being isoechoic or hypoechoic, and 7(13.21%)being hyperechoic.Analysis of tumor blood flow by CDFI found 22 cases(41.51%)with avascular lesions, 21(39.62%)with hypovascular lesions and 10(18.87%)with hypervascular lesions.The average value of the resistance index(RI)was 0.64.Enhancement was seen in 62 lesions(92.54%)by CEUS after injection of SonoVue.Compared with the cortex of the ipsilateral kidney, a slow enhancement pattern was observed in 46(74.19%), 14(22.58%)showed simultaneous enhancement, and 2(3.23%)showed fast enhancement.At peak enhancement, 43 lesions(69.35%)had hypo-enhancement, 10(16.13%)had iso-enhancement, and 9(14.52%)had hyper-enhancement, compared with the cortex.Concerning the homogeneity of enhancement, 16(25.81%)displayed heterogeneous enhancement, with tumor necrosis or hemorrhage, and 46(74.19%)had homogeneous enhancement.When the contrast agent washout rate was assessed, a fast washout pattern was observed in 53(85.48%), synchronous washout in 6(9.68%), and slow washout in 3(4.84%).Conclusions:UC of the renal pelvis mostly shows isoechoic and hypoechoic lesions on conventional ultrasound, avascular or hypo-vascular lesions on CDFI, and slow-in, fast-out and hypo-enhancement on CEUS, compared with the cortex.Conventional ultrasound combined with CEUS can help improve the diagnostic accuracy of UC of the renal pelvis.