Objective·To evaluate the relationships between disc-condyle distance and anterior disc displacement,as well as between disc-condyle distance and disc morphology,in patients with temporomandibular disorders(TMD)using magnetic resonance imaging(MRI)of the temporomandibular joint(TMJ).Methods·From September 2023 to March 2024,90 patients(180 TMJs)who visited the TMJ clinic of Department of Stomatology,The Second Affiliated Hospital of Anhui Medical University,with clinical symptoms of TMD and were diagnosed via MRI with either anterior disc displacement or no significant displacement,were included.Clinical data were collected,and MRI images were used to measure the angle of disc displacement,disc-condyle distance,disc length,and thickness.The degree of disc deformation was assessed.The relationships between clinical symptoms and anterior disc displacement,between anterior disc displacement and both disc morphology and disc-condyle distance,and between disc-condyle distance and disc morphology were analyzed.Results·Among the 90 patients,there were 16 males and 74 females,with a mean age of(28.1±14.5)years.Among the 180 TMJs,175 had clinical symptoms and 5 were asymptomatic.There were 40 joints with no displacement,78 with reducible anterior disc displacement,and 62 with irreducible anterior disc displacement.In the joints with irreducible anterior disc displacement,the proportion of those with two or more symptoms was slightly higher at 62.9%,but the difference was not statistically significant compared with the joints with no displacement or reducible anterior disc displacement.MRI assessment revealed that in the joints with irreducible anterior disc displacement,the proportion of disc deformation type Ⅲ or higher was significantly higher compared with the non-displaced joints(P<0.001).The disc length was significantly shorter(P<0.001),and the intermediate zone thickness was significantly greater(P<0.001)compared with the non-displaced joints.The disc displacement angles at centric closure and maximum opening were also significantly larger(P<0.001).The disc-condyle distance was 3.10(2.70,3.70)mm for non-displaced joints,3.40(3.00,4.00)mm for joints with reducible anterior disc displacement,and 6.60(4.78,7.90)mm for joints with irreducible anterior disc displacement,with significant differences(P<0.001).The disc-condyle distance was 3.10(2.80,3.60)mm for type Ⅰ discs,3.70(3.10,4.60)mm for type Ⅱ discs,5.10(4.00,7.30)mm for type Ⅲ discs,and 6.80(4.98,8.20)mm for type Ⅳ/Ⅴ discs,with significant differences(P<0.001).The disc-condyle distance was negatively correlated with disc length(rs=-0.469,P<0.001),positively correlated with intermediate zone thickness(rs=0.319,P<0.001),and positively correlated with disc displacement angle at centric closure(rs=0.626,P<0.001).Conclusion·With increasing severity of disc deformation,intermediate zone thickness,and disc displacement angle at centric closure,as well as decreasing disc length,the disc-condyle distance increases.The disc-condyle distance is an important indicator for MRI assessment of pathological changes in TMD.

Objective:To evaluate the prognosis of patients with resectable pancreatic ductal adenocarcinoma (PDAC) treated by gemcitabine and nab-paclitaxel (AG) or AG combined with pro-grammed death-1 (PD-1) inhibitor regimen and application value of the Cleveland Clinic Foundation (CCF) risk score.Methods:The retrospective cohort study was conducted. The clinicopathological data of 151 PDAC patients who were treated by AG regimen or AG combined with PD-1 inhibitor regimen in Zhejiang Cancer Hospital from January 2013 to March 2024 were collected. There were 84 males and 67 females, aged (64±9)years. Observation indicators: (1) comparison of clinical characteristics among resectable PDAC patients with different CCF risk score; (2) analysis of influencing factors for overall survival time of resectable PDAC patients; (3) survival of resectable PDAC patients. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the rank sum test. Univariate and multivariate analyses were conducted using the Cox regression model. Kaplan-Meier method was used to calculate survival rate and plot survival curve, and Log-rank test was used for survival analysis. Results:(1) Comparison of clinical characteristics among resectable PDAC patients with different CCF risk score. Based on CCF risk score, 102 of 151 patients were classified as low risk and 49 cases were classified as intermediate-to-high risk. There were signi-ficant differences in sex, age, smoking status, alcohol consumption, hypertension, and diabetes between the two categories ( P<0.05). (2) Analysis of influencing factors for overall survival time of resectable PDAC patients. Results of multivariate analysis showed that the treatment regimen was an indepen-dent influencing factor for overall survival time of resectable PDAC patients ( hazard ratio=1.976, 95% confidence interval as 1.065?3.666, P<0.05). (3) Survival of resectable PDAC patients. The follow-up time of 151 patients was 21.8(18.7,24.2)months, and the median overall survival time was 23.3(19.0,32.4)months. The follow-up time was 22.1(18.9,30.7)months of patients treated by AG regimen and 11.2(8.1,23.3)months of patients treated by AG combined with PD-1 inhibitor regimen, respectively. The median overall survival time of the two types of patients was 24.4(17.2,31.7)months and 16.9(8.9,24.9)months. The 1-year overall survival rates were 79.1% and 60.0%, and the 2-year overall survival rates were 53.4% and 28.5%, respectively. There was a significant difference in the overall survival between the two types of patients ( hazard ratio=1.913, 95% confidence interval as 1.041?3.516, P<0.05). Of the intermediate-to-high risk patients, the follow-up time was 18.5(8.8,28.1)months of 37 patients treated by AG regimen and 8.1(7.3,9.0)months of 12 patients treated by AG combined with PD-1 inhibitor regimen. The median overall survival time of the two types of patients was 32.4(15.7,49.0)months and 8.9(5.7,12.1)months, respectively. The 1-year overall survival rates were 82.7% and 31.3%, and the 2-year overall survival rates were 66.5% and 0, respectively. There was a significant difference in the overall survival between the two types of patients ( hazard ratio=5.402, 95% confidence interval as 1.811?16.118, P<0.05). Conclusions:The treatment regimen is an independent influencing factor for overall survival in patients with resectable PDAC. Compared with the AG combined with PD-1 inhibitor regimen, AG regimen is associated with good survival of patients with resectable PDAC. For patients classified as intermediate-to-high risk based on the CCF risk score, AG regimen is assiociated with a better overall survival compared to AG combined with PD-1 inhibitor regimen.

Objective·To evaluate the relationships between disc-condyle distance and anterior disc displacement,as well as between disc-condyle distance and disc morphology,in patients with temporomandibular disorders(TMD)using magnetic resonance imaging(MRI)of the temporomandibular joint(TMJ).Methods·From September 2023 to March 2024,90 patients(180 TMJs)who visited the TMJ clinic of Department of Stomatology,The Second Affiliated Hospital of Anhui Medical University,with clinical symptoms of TMD and were diagnosed via MRI with either anterior disc displacement or no significant displacement,were included.Clinical data were collected,and MRI images were used to measure the angle of disc displacement,disc-condyle distance,disc length,and thickness.The degree of disc deformation was assessed.The relationships between clinical symptoms and anterior disc displacement,between anterior disc displacement and both disc morphology and disc-condyle distance,and between disc-condyle distance and disc morphology were analyzed.Results·Among the 90 patients,there were 16 males and 74 females,with a mean age of(28.1±14.5)years.Among the 180 TMJs,175 had clinical symptoms and 5 were asymptomatic.There were 40 joints with no displacement,78 with reducible anterior disc displacement,and 62 with irreducible anterior disc displacement.In the joints with irreducible anterior disc displacement,the proportion of those with two or more symptoms was slightly higher at 62.9%,but the difference was not statistically significant compared with the joints with no displacement or reducible anterior disc displacement.MRI assessment revealed that in the joints with irreducible anterior disc displacement,the proportion of disc deformation type Ⅲ or higher was significantly higher compared with the non-displaced joints(P<0.001).The disc length was significantly shorter(P<0.001),and the intermediate zone thickness was significantly greater(P<0.001)compared with the non-displaced joints.The disc displacement angles at centric closure and maximum opening were also significantly larger(P<0.001).The disc-condyle distance was 3.10(2.70,3.70)mm for non-displaced joints,3.40(3.00,4.00)mm for joints with reducible anterior disc displacement,and 6.60(4.78,7.90)mm for joints with irreducible anterior disc displacement,with significant differences(P<0.001).The disc-condyle distance was 3.10(2.80,3.60)mm for type Ⅰ discs,3.70(3.10,4.60)mm for type Ⅱ discs,5.10(4.00,7.30)mm for type Ⅲ discs,and 6.80(4.98,8.20)mm for type Ⅳ/Ⅴ discs,with significant differences(P<0.001).The disc-condyle distance was negatively correlated with disc length(rs=-0.469,P<0.001),positively correlated with intermediate zone thickness(rs=0.319,P<0.001),and positively correlated with disc displacement angle at centric closure(rs=0.626,P<0.001).Conclusion·With increasing severity of disc deformation,intermediate zone thickness,and disc displacement angle at centric closure,as well as decreasing disc length,the disc-condyle distance increases.The disc-condyle distance is an important indicator for MRI assessment of pathological changes in TMD.

Objective To explore the relationship between hemorheology and Carotid Atherosclerosis.Methods The clinical data of 153 patients who underwent both hemorheological testing and carotid artery ultrasound were divided into a CAS group(n=96)and a non-CAS group(n=57)based on ultrasound findings.Clinical data and laboratory indicators were compared between two groups.Multivariate logistic regression analysis was used to explore the influencing factors of CAS.The ROC curves graph were drawn to observe the role of hemorheological indicators in predicting CAS and select the optimal cutoff value based on the maximum Youden index.Results The CAS group demonstrated higher levels in age,BMI,RBC aggregation index,low&high shear reduced viscosity of whole blood,plasma viscosity and fibrinogen compared to the non-CAS group(P<0.05).The multivariate logistic regression analysis showed that plasma viscosity(OR=38.270,95%CI:1.206～1214.508),age(OR=1.119,95%CI:1.065～1.176)were risk factors for the occurrence of CAS(P<0.05).The ROC curves showed that the area under the curve(AUC)of plasma viscosity and age were 0.623、0.728.Conclusion CAS patients have high levels of plasma viscosity and advanged age compared to the patient without CAS.Elevated plasma viscosity and age is a risk factor for CAS,with plasma viscosity≥1.46 mPa·s,over the age of 56.5 as a significant value for predicting CAS.

Objective To investigate the diagnostic accuracy and clinical applicability of the Linknet-VGG16 deep learning algorithm for measuring the effective optical zone(EOZ)after corneal refractive surgery.Methods This single-center retrospective cohort study included 69 patients(69 eyes)who underwent femtosecond laser-assisted in situ kerato-mileusis(FS-LASIK)(34 eyes)or small incision lenticule extraction(SMILE)(35 eyes)at the Refractive Surgery Center of Affiliated Zhengzhou Aier Eye Hospital of Henan University from June 2023 to June 2024.Data from the right eyes of all patients were selected for statistical analysis.During the surgery,patients in the FS-LASIK group adopted the VisuMax fem-tosecond laser system combined with the Amaris 750S excimer laser system,while those in the SMILE group only used the VisuMax femtosecond laser system.A total of 276 Pentacam images were re-examined postoperatively.A Linknet segmenta-tion model based on the VGG16 encoder was constructed,and image normalization techniques were applied to accelerate model convergence.Model performance was assessed using accuracy,intersection over union(IoU),and the Dice coeffi-cient.The traditional EOZ measurement method based on corneal tangential curvature served as the reference standard.Bland-Altman analysis was conducted to evaluate consistency across all images and within each group,and the time effi-ciency of both methods was compared.Results Six representative medical image segmentation architectures(U-Net,U-Net++,DeepLabv3-ResNet50,DeepLabv3+-ResNet50,Unet-Densenet169,and Linknet-VGG16)were systematically evaluated.The Linknet-VGG16 model demonstrated superior performance over the other 5 models in pixel-level accuracy,IoU and Dice coefficient,which were 99.83％,99.48％and 99.74％,respectively.Although there was no significant differ-ence in accuracy and Dice coefficient between Linknet-VGG16 and U-Net models(whose accuracy was 99.82％and Dice coefficient was 99.72％),the inference speed of the U-Net model(62.46 ms)was 31.76％slower than that of the Linknet-VGG16 model(42.62 ms).The evaluation results of a clinically applicable comprehensive scoring model(weights:accura-cy 20％,IoU 20％,Dice coefficient 20％,speed 25％,model size 15％)showed that the Linknet-VGG16 model achieved a score of 88.01,surpassing other architectures(U-Net:86.29;DeepLabv3+-ResNet50:80.41;DeepLabv3-ResNet50:73.82;U-Net++:73.22;Unet-Densenet169:66.66).Bland-Altman analysis revealed that the mean difference of the 136 images in the FS-LASIK group was 0.01 mm[95％limits of agreement(LoA):-0.36 to 0.35 mm],with 96.3％of data points falling within the LoA.The mean difference of the 140 images in the SMILE group was-0.01 mm(95％LoA:-0.36 to 0.33 mum),with 95.7％of data points falling within the LoA.The mean difference of all 276 images was 0.00 mm(95％LoA:-0.36 to 0.34 mm),with 96.4％of data points falling within the LoA.These results indicated excellent consistency.The average measurement time per image using the traditional EOZ measurement method was 13.00 minutes,whereas the deep learning model required only 3.22 seconds.Conclusion The traditional EOZ measurement method based on corne-al tangential curvature exhibits good consistency with the fully automatic EOZ measurement method based on deep learning algorithms,achieving high image recognition accuracy.Additionally,the deep learning algorithm significantly reduces measurement time,compared with the traditional method based on corneal tangential curvature.

Objective To explore the relationship between hemorheology and Carotid Atherosclerosis.Methods The clinical data of 153 patients who underwent both hemorheological testing and carotid artery ultrasound were divided into a CAS group(n=96)and a non-CAS group(n=57)based on ultrasound findings.Clinical data and laboratory indicators were compared between two groups.Multivariate logistic regression analysis was used to explore the influencing factors of CAS.The ROC curves graph were drawn to observe the role of hemorheological indicators in predicting CAS and select the optimal cutoff value based on the maximum Youden index.Results The CAS group demonstrated higher levels in age,BMI,RBC aggregation index,low&high shear reduced viscosity of whole blood,plasma viscosity and fibrinogen compared to the non-CAS group(P<0.05).The multivariate logistic regression analysis showed that plasma viscosity(OR=38.270,95%CI:1.206～1214.508),age(OR=1.119,95%CI:1.065～1.176)were risk factors for the occurrence of CAS(P<0.05).The ROC curves showed that the area under the curve(AUC)of plasma viscosity and age were 0.623、0.728.Conclusion CAS patients have high levels of plasma viscosity and advanged age compared to the patient without CAS.Elevated plasma viscosity and age is a risk factor for CAS,with plasma viscosity≥1.46 mPa·s,over the age of 56.5 as a significant value for predicting CAS.

Objective To investigate the diagnostic accuracy and clinical applicability of the Linknet-VGG16 deep learning algorithm for measuring the effective optical zone(EOZ)after corneal refractive surgery.Methods This single-center retrospective cohort study included 69 patients(69 eyes)who underwent femtosecond laser-assisted in situ kerato-mileusis(FS-LASIK)(34 eyes)or small incision lenticule extraction(SMILE)(35 eyes)at the Refractive Surgery Center of Affiliated Zhengzhou Aier Eye Hospital of Henan University from June 2023 to June 2024.Data from the right eyes of all patients were selected for statistical analysis.During the surgery,patients in the FS-LASIK group adopted the VisuMax fem-tosecond laser system combined with the Amaris 750S excimer laser system,while those in the SMILE group only used the VisuMax femtosecond laser system.A total of 276 Pentacam images were re-examined postoperatively.A Linknet segmenta-tion model based on the VGG16 encoder was constructed,and image normalization techniques were applied to accelerate model convergence.Model performance was assessed using accuracy,intersection over union(IoU),and the Dice coeffi-cient.The traditional EOZ measurement method based on corneal tangential curvature served as the reference standard.Bland-Altman analysis was conducted to evaluate consistency across all images and within each group,and the time effi-ciency of both methods was compared.Results Six representative medical image segmentation architectures(U-Net,U-Net++,DeepLabv3-ResNet50,DeepLabv3+-ResNet50,Unet-Densenet169,and Linknet-VGG16)were systematically evaluated.The Linknet-VGG16 model demonstrated superior performance over the other 5 models in pixel-level accuracy,IoU and Dice coefficient,which were 99.83％,99.48％and 99.74％,respectively.Although there was no significant differ-ence in accuracy and Dice coefficient between Linknet-VGG16 and U-Net models(whose accuracy was 99.82％and Dice coefficient was 99.72％),the inference speed of the U-Net model(62.46 ms)was 31.76％slower than that of the Linknet-VGG16 model(42.62 ms).The evaluation results of a clinically applicable comprehensive scoring model(weights:accura-cy 20％,IoU 20％,Dice coefficient 20％,speed 25％,model size 15％)showed that the Linknet-VGG16 model achieved a score of 88.01,surpassing other architectures(U-Net:86.29;DeepLabv3+-ResNet50:80.41;DeepLabv3-ResNet50:73.82;U-Net++:73.22;Unet-Densenet169:66.66).Bland-Altman analysis revealed that the mean difference of the 136 images in the FS-LASIK group was 0.01 mm[95％limits of agreement(LoA):-0.36 to 0.35 mm],with 96.3％of data points falling within the LoA.The mean difference of the 140 images in the SMILE group was-0.01 mm(95％LoA:-0.36 to 0.33 mum),with 95.7％of data points falling within the LoA.The mean difference of all 276 images was 0.00 mm(95％LoA:-0.36 to 0.34 mm),with 96.4％of data points falling within the LoA.These results indicated excellent consistency.The average measurement time per image using the traditional EOZ measurement method was 13.00 minutes,whereas the deep learning model required only 3.22 seconds.Conclusion The traditional EOZ measurement method based on corne-al tangential curvature exhibits good consistency with the fully automatic EOZ measurement method based on deep learning algorithms,achieving high image recognition accuracy.Additionally,the deep learning algorithm significantly reduces measurement time,compared with the traditional method based on corneal tangential curvature.

ObjectiveTo analyze the trend and influencing factors of low birth weight (LBW) among newborns in Chongming District of Shanghai from 2008 to 2022, so as to provide references for the development of intervention measures reducing the rate of LBW. MethodsBirth surveillance data of Chongming District of Shanghai from 2008 to 2022 were collected and organized, and the annual percentage change (APC) of LBW was calculated by using Joinpoint 5.0.2 software for trend change analysis. Logistic regression analysis was used to analyze the influencing factors of LBW. ResultsThe overall incidence of LBW was 3.71% in Chongming District, Shanghai from 2008 to 2022. Joinpoint trend analysis showed that the incidence of LBW in Chongming District had an upward trend (APC=5.49%, 95%CI: 3.31%‒7.72%, P<0.001).Multivariate logistic regression analysis showed that preterm birth, multiple births, female infants, birth defects, first pregnancy, primiparity, and a young father age (<20 years) were risk factors for LBW in Chongming District. Among the term infants, female infants, birth defects, and first pregnancy were risk factors for LBW (P<0.05). Female infants, birth defects, first pregnancy, primiparity, advanced maternal age (≥35 years), and a young father age (<20 years) were risk factors in singleton neonates. ConclusionThe incidence of LBW among newborns is on the rise in Chongming District of Shanghai. Therefore, high risk groups need to be identified, and prenatal check-ups and pregnancy care should be strengthened to reduce the risk of neonatal LBW.