Objective:To evaluate the predictive effect of the loss of signal (LOS) on the recurrent laryngeal nerve (RLN) injury.Methods:The literatures on PubMed, Web of Science, CNKI, and Wanfang Medical Network database were published before 30 April 2023. English search terms included "thyroid gland surgery" "thyroidectomy" "intraoperative neuromonitoring" "intraoperative nerve monitoring" and "recurrent laryngeal nerve". Chinese search terms included "thyroidectomy", "thyroid surgery" "recurrent laryngeal nerve" "intraoperative nerve monitoring". Two evaluators screened the literature, extracted the materials and evaluated the risk of bias of the study independently. If there were different opinions, researchers should resolve which through consultation and ask the third-party researcher when necessary. The Meta-analysis was performed with the Review Manager 5.4 software.Results:A total of thirty-three studies were included and were all analyzed for primary outcome measures while only twenty-six of which were analyzed for secondary outcome measures. Meta-analysis showed that the positive predictive value of LOS in intraoperative nerve monitoring (IONM) was 65% [ OR=1.88, 95% CI: 1.36-2.60]. Then these thirty-three articles included in IONM were divided into I-IONM, C-IONM and mixed groups. Subgroup analysis showed that the positive predictive value of LOS in I-IONM, C-IONM and mixed groups were 62% [ OR=1.63, 95% CI: 1.05-2.52], 75% [ OR=2.93, 95% CI: 1.64-5.22] and 70% [ OR=2.38, 95% CI: 1.77-3.12] respectively. When these thirty-three included articles were divided into Asian, European, North American and Oceania, subgroup analysis showed that the positive predictive value of LOS was 50% [ OR=1.01, 95% CI: 0.44-2.31], 70% [ OR=2.29, 95% CI: 1.60-3.28], 82% [ OR=4.68, 95% CI: 3.79-5.78] and 83% [ OR=4.81, 95% CI: 3.10-7.46] respectively. Meta-analysis of secondary outcome measures in twenty-six articles showed that the negative predictive value of LOS was 99.6% [ RD=1.51, 95% CI: 1.48-1.53], with the sensitivity of 89% [ RD=1.24, 95% CI: 1.11-1.37] and specificity of 98%[ RD=1.43, 95% CI: 1.40-1.47]. Conclusion:The occurrence of LOS during IONM in thyroidectomy has a positive prediction effect and a higher negative prediction effect, sensitivity and specificity on RLN injury.

Objective:To investigate the effects of dietary management during labor process on pregnancy outcome of pregnant women with gestational diabetes mellitus.Methods:A retrospective analysis was conducted on the clinical data of 122 pregnant women with gestational diabetes mellitus who delivered at the Wenzhou People's Hospital between January and December 2022. Based on their dietary management methods, these patients were divided into an observation group and a control group, with 61 cases in each group. The control group underwent routine dietary management, whereas the observation group received dietary management during labor process. The labor process indicators and delivery outcomes between the two groups were compared.Results:The energy intake in the observation group was (75.36 ± 9.54) kcal/h, which was significantly higher than (57.23 ± 8.12) kcal/h in the control group ( t = -11.30, P < 0.05). Furthermore, the highest blood glucose levels, hyperglycemia ratios, and proportions of insulin usage in the observation group were (6.74±0.99) mmol/L, 4.92% (3/61), and 3.28% (2/61), respectively, which were significantly lower than those in the control group [(7.72 ± 1.05) mmol/L, 40.98% (25/61), 21.31% (13/61), t = 5.30, χ2 = 22.43, 9.20, all P < 0.05]. Additionally, the observation group had significantly shorter first stage labor time [(418.66 ± 114.26) minutes], active stage time [(281.37 ± 129.65) minutes], and second stage labor time [38.14 ± 17.25) minutes] compared with the control group [(519.93 ± 132.45) minutes, (358.69 ± 153.26) minutes, (51.37 ± 18.62) minutes, t = 4.52, 3.00, 4.07, all P < 0.05]. The incidence of neonatal hypoglycemia in the observation group was 1.64% (1/61), which was significantly lower than 16.39% (10/61) in the control group ( χ2 = 6.39, P < 0.05). Conclusion:Dietary management during the labor process can effectively improve the blood sugar level of pregnant women with gestational diabetes mellitus, as well as enhance the maternal and fetal outcomes.

Objective:To investigate the relationship between carotid atherosclerosis(CAS)and subclinical left ventricular(LV)dysfunction in type 2 diabetes mellitus patients with preserved LV ejection fraction(LVEF).Methods:A total of 120 patients with type 2 diabetes mellitus who had LVEF≥50% were selected in the Department of Endocrinology, the First Affiliated Hospital of Air Force Medical University from June 2021 to October 2021. The global longitudinal strain(GLS)was obtained by two-dimensional speckle tracking echocardiography(STE)to assess subclinical LV systolic function. The mitral ratio of peak early to late diastolic filling velocity(E/A), and mitral velocity to early diastolic velocity of the mitral annulus(E/E′)ratio were obtained by pulsed tissue Doppler echocardiography to assess LV diastolic function. Acrroding to bilateral carotid ultrasound examination, the subjects were divided into normal carotid arteries group( n=46) and CAS group( n=74). Demographics and biochemical parameters were compared between two groups. Binary logistic regression and Pearson correlation analysis were used to evaluate the relationship between CAS and subclinical LV dysfunction. Results:The CAS group had a higher proportion of men, older age, and a longer duration of diabetes than the normal carotid arteries group(all P<0.05). There was no difference in LVEF and GLS between the two groups [normal carotid arteries group vs CAS group, LVEF: (60.72±4.73)% vs(60.07±4.28)%; GLS: (18.24±3.72)% vs(17.81±3.47)%, respectively; both P>0.05]. However, compared with normal carotid arteries group, E/A ratio was decreased and E/E′ ratio was significantly increased in CAS group(both P<0.01). Pearson correlation analysis showed that GLS was not correlated with carotid plaque thickness and carotid intima-media thickness(CIMT; both P>0.05). By contrast, E/E′ ratio was positively correlated with carotid plaque thickness and CIMT(both P<0.05). Binary logistic regression analysis showed that GLS and E/E′ ratio were not associated with CAS( both P>0.05). However, decreased E/A ratio was significantly associated with the existence of CAS( OR=0.09, 95% CI 0.01-0.67, P=0.018). Conclusions:In type 2 diabetes mellitus patients without overt heart failure and with preserved LVEF, the occurrence of CAS is not associated with subclinical LV systolic impairment assessed by GLS, but is significantly associated with LV diastolic dysfunction, and is independent of traditional cardiovascular risk factors.

Objective: To evaluate the clinical value of color Doppler signal at the nasal lip in the diagnosis of fetal cleft palate. Methods: Twenty fetuses diagnosed with fetal cleft lip and cleft palate by targeted ultrasonography and magnetic resonance imaging were enrolled in this study. Color Doppler was used during each ultrasound scan. All prenatal diagnoses were confirmed either by postnatal follow-up or autopsy. The location and degree of cleft lip and palate was also recorded. During inspiration or swallowing color signal acrossed the defects at the fetal palate was indicated cleft palate, and no color signal acrossed the defects at the fetal palate was indicated without cleft palate. Two dimensional ultrasound combined with color Doppler was used to diagnose cleft lip and palate in midsagittal plane or paratsagittal plane, then compared with the results of post-natal evaluation or abortion, and the value of color signal at the nasal lip in the diagnosis of fetal cleft palate was analyzed. Results: Twenty cases of postpartum fetus (including post-natal evaluation or abortion ) confirmed 15 cases of cleft lip and palate, 5 cases of cleft lip (2 cases with upper alveolar cleft). For prenatal diagnosis, 5 cases of cleft lip and 15 cases of cleft lip and palate were diagnosed by two-dimensional ultrasound, of which 3 cases of cleft lip and palate were misdiagnosed as cleft lip, whereas 3 cases of cleft lip were misdiagnosed as cleft lip and palate with 2 cases combined with upper alveolar cleft. Two-dimensional ultrasound in the diagnosis of cleft lip and palate is consistent with postnatal results by additional evaluation of the color signal in nasolabial area in median sagittal section. In the cleft lip and cleft lip with the alveolar cleft fetuses, the color signal in nasolabial area was undetectable during fetal respiratory-like movement or swallowing by ultrasound.However, it was detectable in cleft lip and palate fetuses. A total of 3 cases of simple cleft lip and 17 cases of cleft lip and palate were detected by magnetic resonance imaging(MRI). In 2 cases of cleft lip and palate diagnosed by MRI, no blood flow signal was detected at the nasolabial area. Conclusions The connected color signal in nasolabial area assessed by color Doppler ultrasound during fetal respiratory-like movement or swallowing showed an promising value for prenatal diagnosis of cleft palate. Cleft palate could be ruled out if the connected color signal was undetectable in nasolabial area.

Objective: To explore the characteristics of gallstone-like echo in fetal gallbladder and its changes with gestational age, and following up its prognosis as well as the relationship with bilirubin after birth so as to provide more information for prenatal consultation about neonatal jaundice related diseases. Methods: A total of 82 fetuses from January 2014 to December 2017 at Women′s Hospital of Zhejiang University School of Medicine, who had prenatal ultrasound diagnosis and follow-up results with gallstone-like echo in fetal gallbladder, were included in this study. The characteristics of gallstone-like echo in fetal gallbladder were summarized, its change with gestational age, and its association with the status of pregnant mother were analyzed. Bilirubin and the prognosis of the gallstone-like echo were followed up after birth. Results: Four different types of prenatal ultrasound characteristics of gallstone-like echo in fetal gallbladder were observed: sediment-like type(n=13), full of hyperechoic type (n=19), multiple hyperechoic type (n=42), and single or scattered hyperechoic type(n=8). Of the total 82 cases, 2 fetus were induced abortion. In the 80 normal-born fetuses, the number of gallstone-like echo were reduced in 9 cases during pregnancy, the gallstone-like echo disappeared in uterus in 8 cases. During the follow up, the gallstone-like echoes disappeared at 3 days, 42 days, 1 year and 2 years after birth in the rest 72 cases, respectively. In the 80 fetuses, 20 cases of neonates with hyperbilirubinemia after birth (4 males and 16 females) including 4 cases of ABO hemolytic, 2 cases of neonatal sepsis.No abnormalities occurred in the remaining 60 neonates during the follow-up period. Conclusions Gallstone-like echo in fetus is a self-limiting disease that occurs in late pregnancy.Some neonates develop hyperbilirubinemia after birth with good prognosis. After phototherapy, the jaundice index decreased to the normal standard and the serum bilirubin content decreased.

Objective To evaluate the clinical value of color Doppler signal at the nasal lip in the diagnosis of fetal cleft palate . Methods Twenty fetuses diagnosed with fetal cleft lip and cleft palate by targeted ultrasonography and magnetic resonance imaging were enrolled in this study . Color Doppler was used during each ultrasound scan . All prenatal diagnoses were confirmed either by postnatal follow‐up or autopsy . T he location and degree of cleft lip and palate was also recorded . During inspiration or swallowing color signal acrossed the defects at the fetal palate was indicated cleft palate ,and no color signal acrossed the defects at the fetal palate was indicated without cleft palate . T wo dimensional ultrasound combined with color Doppler was used to diagnose cleft lip and palate in midsagittal plane or paratsagittal plane ,then compared with the results of post‐natal evaluation or abortion ,and the value of color signal at the nasal lip in the diagnosis of fetal cleft palate was analyzed . Results Twenty cases of postpartum fetus ( including post‐natal evaluation or abortion ) confirmed 15 cases of cleft lip and palate ,5 cases of cleft lip ( 2 cases with upper alveolar cleft) . For prenatal diagnosis ,5 cases of cleft lip and 15 cases of cleft lip and palate were diagnosed by two‐dimensional ultrasound ,of which 3 cases of cleft lip and palate were misdiagnosed as cleft lip ,w hereas 3 cases of cleft lip were misdiagnosed as cleft lip and palate with 2 cases combined with upper alveolar cleft . T wo‐dimensional ultrasound in the diagnosis of cleft lip and palate is consistent with postnatal results by additional evaluation of the color signal in nasolabial area in median sagittal section . In the cleft lip and cleft lip with the alveolar cleft fetuses ,the color signal in nasolabial area was undetectable during fetal respiratory‐like movement or swallowing by ultrasound .However ,it was detectable in cleft lip and palate fetuses . A total of 3 cases of simple cleft lip and 17 cases of cleft lip and palate were detected by magnetic resonance imaging( M RI) . In 2 cases of cleft lip and palate diagnosed by M RI ,no blood flow signal was detected at the nasolabial area . Conclusions The connected color signal in nasolabial area assessed by color Doppler ultrasound during fetal respiratory‐like movement or swallowing showed an promising value for prenatal diagnosis of cleft palate . Cleft palate could be ruled out if the connected color signal was undetectable in nasolabial area .

Objective:To determine the plasma level of apelin in patients of maintenance hemodialysis (MHD) and to explore the relationship between apelin level and carotid atherosclerosis (AS) in MHD patients.Methods:A total of 92 MHD patients and 36 sex-and age-matched healthy subjects were enrolled in this study.The plasma level of apelin was evaluated by radiation immunoassay;serum endothelial injury markers including thrombomodulin,von Willebrand factor (vWF),and CD 146,and inflammatory factors including high sensitive C-reactive protein (hsCRP),IL-6 and TNF-α were determined by ELISA.Common Carotid arteries intima media thickness (CCA-IMT),cross-sectional calculated intima-media area (cIM area) area and atherosclerotic plaque were measured by non-invasive high-resolution B-mode ultrasonography.Results:The plasma levels of apelin was significantly decreased in MHD patients compared with healthy subjects (P＜0.01),accompanied with elevated plasma levels of thrombomodulin,vWF,CD 146,hsCRP,IL-6 and TNF-α (all P＜0.01).The plasma levels of apelinin in MHD patients with carotid artery plaques were obviously lower than those without plaques [(43.16± 10.12) pg/mL vs (61.43±16.25) pg/mL,P＜0.01].Plasma level of apelin was inversely related with CCA-IMT and cIM area (r=-0.355 and r=-0.297 respectively,all P＜0.01).Multiple stepwise regression analysis showed that plasma level of apelin was an independent risk factor for CCA-IMT and cIM area.Conclusion:The plasma apelin in MHD patients might take part in vascular endothelial injury and the progress of atherosclerosis.It plays an important role in the initiation and development of uremia associated atherosclerosis through elevating inflammatory factors including hsCRP,IL-6 and TNF-α levels.

Objective To evaluate prenatal sonograpic findings and clinical value in fetus with congenital portal-hepatic venous shunt.Methods The prenatal ultrasonographic characteristic of ten cases of congenital portal-hepatic venous shunt were analyzed and summarized.Results Three cases had portal vein-left hepatic venous shunt,two cases with portal vein-right hepatic venous shunt,two cases with situs inversus of left right portal vein,and three cases with multiple shunt among portal and hepatic veins.All the 10 cases with portal-hepatic venous shunt had common sonographic features,①Two-dimensional ultrasound revealed the distal hepatic veins.The hepatic vein and portal vein were both visualized on the same plane and connected by an anechoic area.②Vascular signal were noted inside the anechoic area.③Blood flow inside the anechoic area demonstrated by spectral Doppler was similar to that of the portal vein.Conclusions Prental ultrasonography is valuable in the diagnosis of fetal portal-hepatic venous shunt.

When senescence induction is based on DNA damage, senescent cells display a unique phenotype, which has been termed “senescence-associated secretory phenotype”( SASP ) . SASP, including proinflammatory cytokines, growth factors, chemokines, matrix remodeling enzymes and other cytokines, may be an important driver of chronic inflammation and therefore may be part of a vicious cycle of inflammation, DNA damage and senescence. Senescence-associated secretory products released by such cells can affect the neighboring cells and further exacer-bate their regenerative capacity. SASP is associated with many chronic age-related diseases.

BACKGROUND:The prosthesis fusion rate after total hip replacement is closely related to the reconstruction process of bone,which is affected by the factors around the implant of patient.Trace elements are strongly associated with the ossification.Thus,the content of trace elements in proximal femur may affect the bone fusion and survival rate of the prosthesis.OBJECTIVE:To analyze the correlation of trace elements and bone fusion surrounding the prosthesis in proximal femur.METHODS: Bone samples were obtained from the discarded metaphysis region of the proximal femur in 24 patients with primary total hip replacement.Trace element (calcium,magnesium,zinc,parathyroid hormone,activated vitamin D3) contents were detected aftervitro cel culture.Bone mineral density was tested surrounding the prosthesis at 1 week,3 and 6 months after replacement by dual energy X-ray absorption method with a bone density meter.The difference in trace elements was compared in patients at different ages and different genders.The correlation between above five kinds of trace elements and bone mineral density was analyzed.RESULTS AND CONCLUSION:No significant difference in trace element contents was detected in different age groups and different gender groups (P＞ 0.05).Zinc content was positively correlated with parathyroid hormone and magnesium contents (P＜ 0.05).Zinc was positively associated with bone mineral density in the region 7 (P＜ 0.05).The further studies concerning the trace elements in proximal femur can be used to predict and intervene in the longevity of hip prosthesis.