Objective To explore the value of intensity ratio(IR)of lesion to non-tumor liver parenchyma on contrast-enhanced ultrasound(CEUS)Kupffer phase for differentiating hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(IHC)/metastatic liver carcinoma.Methods Totally 54 patients with HCC(HCC group),30 with IHC and 51 with liver metastatic carcinoma(non-HCC group)diagnosed by pathology were retrospectively enrolled.Quantitative parameters derived from CEUS time-intensity curves,including peak intensity(PI),time to peak(TTP),wash-in area under the curve(WiAUC),wash-out area under the curve(WoAUC),wash-in and wash-out area under the curve(WiWoAUC)of lesion in vascular phase and IR of lesion to non-tumor liver parenchyma in Kupffer phase were compared between groups,and a combined diagnostic model was established based on parameters being significantly different between groups using binary logistic regression analysis.Receiver operating characteristic(ROC)curves were plotted,and the area under the curves(AUC)were calculated to evaluate the efficacy of each CEUS parameter alone and the combined model for differentiating HCC and IHC/liver metastatic carcinoma.Results In HCC group,PI,WoAUC and WiWoAUC were all higher(all P＜0.001),while IR was significantly lower than those in non-HCC group(P＜0.001).The AUC of PI,WoAUC,WiWoAUC and IR for differentiating HCC and IHC/metastatic liver carcinoma was 0.673,0.741,0.738 and 0.736,respectively,all lower than that of combined model(0.862,all P＜0.05).Conclusion IR of lesion to non-tumor liver parenchyma on CEUS Kupffer phase could be used to differentiate HCC and IHC/metastatic liver carcinoma.Combining with quantitative parameters on CEUS vascular phase could improve differentiating efficiency.

Objective:To analyze the relationship between folate and thyroid antibody in early pregnancy and adverse pregnancy outcome in pregnant women with hypothyroidism during pregnancy.Methods:The data of 97 pregnant women with hypothyroidism from Jul. 2020 to Mar. 2023 in the Obstetrics Department of Liaocheng Second People’s Hospital were retrospectively analyzed. The levels of folate, thyroglobulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb) were detected in the first trimester. According to whether adverse pregnancy outcome occurred in pregnant women with hypothyroidism during pregnancy, they were divided into occurrence group and non-occurrence group. The clinical data of the occurrence group and the non-occurrence group were compared. Logistic regression was used to analyze the influencing factors of adverse pregnancy outcomes in pregnant women with hypothyroidism during pregnancy, and receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of folic acid, TGAb, TPOAb and their combination on adverse pregnancy outcomes in pregnant women with hypothyroidism during pregnancy.Results:Among 97 pregnant women, the incidence of adverse pregnancy outcome was 14.43% (14/97) .The folate level in the occurrence group was lower than non-occurrence group ( P<0.05) , and the TGAb and TPOAb levels in the occurrence group were higher than non-occurrence group ( P<0.05) . The occurrence group with alanine aminotransferase (ALT) , glutamine transpeptidase (GGT) and aspartate aminotransferase (AST) were all higher than non-occurrence group ( P<0.05) .The folate, TGAb, and TPOAb levels were factors influencing adverse pregnancy outcomes in pregnant women with hypothyroidism ( P<0.05) . The area under the curve (AUC) values of folate, TGAb, TPOAb and their combined prediction of adverse pregnancy outcomes in pregnant women with hypothyroidism during pregnancy were 0.804, 0.843, 0.799, 0.909 ( P<0.05) , while the combined three with AUC values were higher ( P<0.05) . Conclusion:The folate, TGAb and TPOAb levels in early pregnancy can be used to evaluate adverse pregnancy outcomes in hypothyroidism pregnant women, and the combination of the three has a higher evaluation value.

Objective:To analyze the relationship between folate and thyroid antibody in early pregnancy and adverse pregnancy outcome in pregnant women with hypothyroidism during pregnancy.Methods:The data of 97 pregnant women with hypothyroidism from Jul. 2020 to Mar. 2023 in the Obstetrics Department of Liaocheng Second People’s Hospital were retrospectively analyzed. The levels of folate, thyroglobulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb) were detected in the first trimester. According to whether adverse pregnancy outcome occurred in pregnant women with hypothyroidism during pregnancy, they were divided into occurrence group and non-occurrence group. The clinical data of the occurrence group and the non-occurrence group were compared. Logistic regression was used to analyze the influencing factors of adverse pregnancy outcomes in pregnant women with hypothyroidism during pregnancy, and receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of folic acid, TGAb, TPOAb and their combination on adverse pregnancy outcomes in pregnant women with hypothyroidism during pregnancy.Results:Among 97 pregnant women, the incidence of adverse pregnancy outcome was 14.43% (14/97) .The folate level in the occurrence group was lower than non-occurrence group ( P<0.05) , and the TGAb and TPOAb levels in the occurrence group were higher than non-occurrence group ( P<0.05) . The occurrence group with alanine aminotransferase (ALT) , glutamine transpeptidase (GGT) and aspartate aminotransferase (AST) were all higher than non-occurrence group ( P<0.05) .The folate, TGAb, and TPOAb levels were factors influencing adverse pregnancy outcomes in pregnant women with hypothyroidism ( P<0.05) . The area under the curve (AUC) values of folate, TGAb, TPOAb and their combined prediction of adverse pregnancy outcomes in pregnant women with hypothyroidism during pregnancy were 0.804, 0.843, 0.799, 0.909 ( P<0.05) , while the combined three with AUC values were higher ( P<0.05) . Conclusion:The folate, TGAb and TPOAb levels in early pregnancy can be used to evaluate adverse pregnancy outcomes in hypothyroidism pregnant women, and the combination of the three has a higher evaluation value.

Objective To explore the value of intensity ratio(IR)of lesion to non-tumor liver parenchyma on contrast-enhanced ultrasound(CEUS)Kupffer phase for differentiating hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(IHC)/metastatic liver carcinoma.Methods Totally 54 patients with HCC(HCC group),30 with IHC and 51 with liver metastatic carcinoma(non-HCC group)diagnosed by pathology were retrospectively enrolled.Quantitative parameters derived from CEUS time-intensity curves,including peak intensity(PI),time to peak(TTP),wash-in area under the curve(WiAUC),wash-out area under the curve(WoAUC),wash-in and wash-out area under the curve(WiWoAUC)of lesion in vascular phase and IR of lesion to non-tumor liver parenchyma in Kupffer phase were compared between groups,and a combined diagnostic model was established based on parameters being significantly different between groups using binary logistic regression analysis.Receiver operating characteristic(ROC)curves were plotted,and the area under the curves(AUC)were calculated to evaluate the efficacy of each CEUS parameter alone and the combined model for differentiating HCC and IHC/liver metastatic carcinoma.Results In HCC group,PI,WoAUC and WiWoAUC were all higher(all P＜0.001),while IR was significantly lower than those in non-HCC group(P＜0.001).The AUC of PI,WoAUC,WiWoAUC and IR for differentiating HCC and IHC/metastatic liver carcinoma was 0.673,0.741,0.738 and 0.736,respectively,all lower than that of combined model(0.862,all P＜0.05).Conclusion IR of lesion to non-tumor liver parenchyma on CEUS Kupffer phase could be used to differentiate HCC and IHC/metastatic liver carcinoma.Combining with quantitative parameters on CEUS vascular phase could improve differentiating efficiency.

Objective To explore the role of an artificial intelligence(AI)model based on real-time object detection network in fetal facial ultrasound examination.Methods With the normal fetal facial ultrasound standard plane(FFUSP)at 20-24 weeks of gestation as the research object,a FFUSP recognition model based on real-time object detection network was constructed.The recognition accuracy of the model for FFUSP and the anatomical structures were analyzed,and the clinical value was evaluated by analyzing its performance in identifying FFUSP in 119 cases of fetal ultrasound images.Results The overall precision,recall rate,mAP@.5 and mAP@.5:.95 of the AI model were 97.8%,98.5%,98.1%and 61.0%,respectively.The clinical validation showed that the AI model had a sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 100.0%,98.5%,87.4%,100.0%and 98.7%for facial anatomy recognition,and the results were highly consistent with the classification of fetal ultrasound experts(k=0.925,P<0.001).The recognition accuracy of the model for 3 types of standard planes reached 100%;and the average speed of dynamic video detection was 33.93 frames per second.Conclusion The FFUSP recognition model based on real-time object detection network exhibits excellent performance,and it can be applied to real-time ultrasound diagnosis,teaching and intelligent quality evaluation.

Objective To compare the clinical outcomes and retinal volume changes in patients with ischemic and non-ischemic macular edema secondary to branch retinal vein occlusion(BRVO-ME)using optical coherence tomography angiography(OCTA).Methods The clinical data of 34 ischemic BRVO-ME patients(34 eyes,ischemic group)and 21 non-ischemic BRVO-ME patients(21 eyes,non-ischemic group)were retrospectively analyzed.Patients in both groups re-ceived intravitreal injections of ranibizumab.The best corrected visual acuity(BCVA)and retinal volume of the macular ar-ea were assessed before,1 day,1 week,1 month,3 months and 6 months after the treatment.Results The BCVA(log-MAR)at 1 day after the treatment was 0.63±0.37 in the ischemic group and 0.44±0.22 in the non-ischemic group,and the difference was statistically significant(P=0.017).The retinal volumes of the outer retina,the full retina,and the Farafovea and Perifovea subdivisions of the full retina before the treatment were(6.42±1.90)mm3,(8.75±1.82)mm3,(3.20±0.87)mm3 and(5.10±0.89)mm3 in the ischemic group and(5.52±1.57)mm3,(7.83±1.56)mm3,(2.80± 0.71)mm3,and(4.66±0.77)mm3 in the non-ischemic group,respectively;1 day after treatment,they were(4.97± 1.18)mm3,(7.46±1.47)mm3,(2.62±0.60)mm3 and(4.53±0.80)mm3 in the ischemic group and(4.25±0.48)mm3,(6.58±0.56)mm3,(2.26±0.26)mm3 and(4.06±0.40)mm3 in the non-ischemic group,respectively;at 1 week after the treatment,they were(4.40±0.82)mm3,(6.90±0.85)mm3,(2.38±0.36)mm3 and(4.24±0.49)mm3 in the ischemic group and(4.04±0.35)mm3,(6.33±0.49)mm3,(2.15±0.19)mm3 and(3.95±0.35)mm3 in the non-ische-mic group,respectively,and the differences between the two groups were statistically significant(all P＜0.05).The a-mount of retinal volume change from baseline in the outer retina and the full retina was(-2.48±2.38)mm3 and(-2.54±2.38)mm3 in the ischemic group,and(-1.31±1.58)mm3 and(-1.38±1.58)mm3 in the non-ischemic group at 1 month after treatment,respectively,and the differences between the two groups were statistically significant(both P＜0.05).Conclusion Ranibizumab is effective in treating both ischemic and non-ischemic BRVO-ME.The short-term visu-al prognosis is better in the non-ischemic group than the ischemic group,and the retinal volume is higher in the ischemic group than the non-ischemic group.However,no significant difference is observed in the visual prognosis or retinal volume between the two groups after long-term treatment.

The Asian expert working group completed the 2022 consensus on vernal keratitis (VKC), which provides detailed information on the definition, classification, clinical manifestation, diagnosis and treatment of VKC in Asia and identifies unmet treatment needs, including: (1) lack of clear criteria for the diagnosis and treatment of patients with VKC.The pathogenesis of the disease is unclear, and anti-allergy therapy is often ineffective in patients with moderate or severe VKC; (2) the need for standardized treatment and management strategies.Treatment and management of patients with the same severity varies widely among Asian countries, with a lack of clear, standardized guidelines and grading systems; (3) safety and iatrogenic complications; (4) optimal dosing regimen for pharmacologic treatment.In this article, the aspects mentioned above were interpreted and analyzed in the context of the Expert Consensus on the Diagnosis and Treatment of Allergic Conjunctivitis in China ( 2018), with a view to helping the prevention and treatment of VKC in China.

Objective To investigate the factors affecting survival of dilated cardiomyopathy(DCM)after treatment with decreased left ventricular ejection fraction(LVEF).Methods A total of 158 DCM patients with decreased LVEF treated in Huzhou First People's Hospital from June 2020 to June 2023 were selected and divided into death group(n=40)and survival group(n=1 18)according to their survival status.The clinical data of two groups were analyzed by Cox proportional risk regression model to analyze the factors affecting the survival of DCM with decreased LVEF after treatment.Results The age of patients in death group was significantly higher than that in survival group,and the combination of hypertension,New York Heart Association(NYHA)cardiac function grade Ⅳ,ventricular arrhythmia and left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),and brain natriuretic peptide(BNP)were significantly higher than those in survival group,global longitudinal strain(GLS),standard deviation of RR interval(SDNN),standard deviation of the average RR interval(SDANN),the average standard deviation of RR interval(SDNNindex),root mean square of RR interval difference(rMSSD),the percentage of total number of adjacent RR intervals＞50ms to total heart rate(pNN50),end diastolic interventricular septal thickness(IVSd),left ventricular posterior wall diastolic thickness(LVPWD),stroke volume(SV),and cardiac output(CO)were significantly lower than those in survival group(P＜0.05).Cox regression analysis showed that age,combined hypertension,NYHA cardiac function grade,ventricular arrhythmia,GLS,SDNN,SDANN,SDNNindex,rMSSD,pNN50,LVEDD,LVESD and BNP were risk factors affecting the survival rate of DCM patients with decreased LVEF after treatment,IVSd and LVPWD were protective factors(P＜0.05).Conclusion DCM patients with decreased LVEF had a higher mortality rate,which was affected by multiple factors such as age,hypertension,NYHA cardiac function grade,ventricular arrhythmia,GLS,heart rate variability,LVEDD,LVESD,BNP,IVSd,LVPWD,etc.Targeted intervention should be given early to improve the survival rate of patients after treatment.

Objective To observe the correlations of conventional ultrasound and contrast-enhanced ultrasound(CEUS)features with expression level of Ki-67 of intrahepatic cholangiocarcinoma(ICC).Methods A total of 77 patients with pathologically confirmed ICC were retrospectively enrolled.According to the expression level of Ki-67 of target lesions,the patients were divided into high expression group(Ki-67≥20%,n=53)and low expression group(Ki-67＜20%,n=24).The features showed on conventional ultrasound and CEUS were compared between groups,and the variables being significantly different were analyzed with multivariate logistic regression to select ultrasonic features being correlated with Ki-67 expression level of ICC.Results The mean maximum diameter of ICC in high expression group was larger than that in low expression group([6.2±2.0]cm vs.[5.2±1.9]cm,P=0.041),and the percentage of ICC with maximum diameter>5 cm in high expression group was higher than that in low expression group(66.04%vs.33.33%,P=0.007).No significant difference of the lesions shape,border nor the internal echogenicity showed on conventional ultrasound was found between groups(all P＞0.05).The percentage of ICC with peripheral rim enhancement and enlargement after enhancement in high expression group were both higher than those in low expression group(both P＜0.05),but no significant difference of the enhancement pattern,the presence or absence of non-enhance area within the lesion nor the peak intensity of lesions was found between groups(all P＞0.05).The maximum diameter larger than 5 cm(OR=5.612,P=0.004)and peripheral rim enhancement(OR=3.880,P=0.025)were both independent factors for predicting high Ki-67 expression level of ICC.Conclusion ICC with the maximum diameter larger than 5 cm and peripheral rim enhancement on CEUS might indicate high expression level of Ki-67,which was helpful for clinical treatment decisions.

Objective:To investigate the epidemiological characteristics and prognosis of critically ill patients with sepsis combined with acute kidney injury (AKI) in intensive care unit (ICU) in Beijing, and to analyze the risk factors associated with in-hospital mortality among these critically ill patients.Methods:Data were collected from the Beijing AKI Trial (BAKIT) database, including 9 049 patients consecutively admitted to 30 ICUs in 28 tertiary hospitals in Beijing from March 1 to August 31, 2012. Patients were divided into non-AKI and non-sepsis group, AKI and non-sepsis group, non-AKI and sepsis group, AKI and sepsis group. Clinical data recorded included demographic characteristics, primary reasons for ICU admission, comorbidities, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) within 24 hours of ICU admission, physiological and laboratory indexes, treatment in the ICU, AKI staging based on the Kidney Disease: Improving Global Outcomes (KDIGO), as well as the prognostic indicators including length of stay in ICU, length of stay in hospital, ICU and in-hospital mortality. The primary endpoint was discharge or in-hospital death. Multivariate Logistic regression analysis was used to investigate the risk factors for hospital death in ICU patients. Kaplan-Meier survival curve was drawn to analyze the cumulative survival of ICU patients during hospitalization.Results:A total of 3 107 critically ill patients were ultimately enrolled, including 1 259 cases in the non-AKI and non-sepsis group, 931 cases in the AKI and non-sepsis group, 264 cases in the non-AKI and sepsis groups, and 653 cases in the AKI and sepsis group. Compared with the other three group, patients in the AKI and sepsis group were the oldest, had the lowest mean arterial pressure (MAP), and the highest APACHEⅡscore, SOFA score, blood urea nitrogen (BUN), and serum creatinine (SCr) levels, and they also had the highest proportion of receiving mechanical ventilation, requiring vasopressor support, and undergoing renal replacement therapy (RRT), all P < 0.01. Of these 3 107 patients, 1 584 (51.0%) were diagnosed with AKI, and the incidence of AKI in patients with sepsis was significantly higher than in those without sepsis [71.2% (653/917) vs. 42.5% (931/2 190), P < 0.01]. The highest proportion of KDIGO 0 stage was observed in the non-sepsis group (57.5%), while the highest proportion of KDIGO 3 stage was observed in the sepsis group (32.2%). Within the same KDIGO stage, the mortality of patients with sepsis was significantly higher than that of non-sepsis patients (0 stage: 17.8% vs. 3.1%, 1 stage: 36.3% vs. 7.4%, 2 stage: 42.7% vs. 17.1%, 3 stage: 54.6% vs. 28.6%, AKI: 46.1% vs. 14.2%). The ICU mortality (38.7%) and in-hospital mortality (46.1%) in the AKI and sepsis group were significantly higher than those in the other three groups. Kaplan-Meier survival curves further showed that the cumulative survival rate of patients with AKI and sepsis during hospitalization was significantly lower than that of the other three groups (53.9% vs. 96.9%, 85.8%, 82.2%, Log-Rank: χ2 = 379.901, P < 0.001). Subgroup analysis showed that among surviving patients, length of ICU stay and total length of hospital stay were significantly longer in the AKI and sepsis group than those in the other three groups (both P < 0.01). Multivariate regression analysis showed that age, APACHEⅡscore and SOFA score within 24 hours of ICU admission, coronary heart disease, AKI, sepsis, and AKI combined with sepsis were independent risk factors for ICU mortality in patients (all P < 0.05). After adjusting for covariates, AKI, sepsis, and sepsis combined with AKI were significantly associated with higher ICU and in-hospital mortality, with the highest ICU mortality [adjusted odds ratio ( OR) = 14.82, 95% confidence interval (95% CI) was 8.10-27.12; Hosmer-Lemeshow test: P = 0.816] and in-hospital mortality (adjusted OR = 7.40, 95% CI was 4.94-11.08; Hosmer-Lemeshow test: P = 0.708) observed in patients with sepsis combined with AKI. Conclusions:The incidence of AKI is high in sepsis patients, and those with both AKI and sepsis have a higher disease burden, more abnormalities in physiological and laboratory indicators, and significantly increased ICU and in-hospital mortality. Among surviving patients, the length of ICU stay and total length of hospital stay are also longer in the AKI and sepsis group. Age, APACHEⅡscore and SOFA score within 24 hours of ICU admission, coronary heart disease, AKI, and sepsis are independent risk factors for in-hospital mortality in ICU patients.