AIM: To analyze the related factors influencing the progression of diabetes retinopathy(DR).METHODS: This study retrospectively collected the patients with nonproliferative diabetes retinopathy(NPDR)and followed up at the same time. A total of 77 patients in the cohort who progressed from NPDR to proliferative diabetes retinopathy(PDR)were taken as the disease progression group, while 115 NPDR patients who did not progress to PDR were selected as the observation group for a nested case-control study, comparing the general information and laboratory indicators of NPDR and PDR groups, taking general data and laboratory indicators as independent variables and PDR as outcome variables; Finally, diagnostic tests were conducted to evaluate the independent influencing factors of DR progression.RESULTS: PDR group was younger than patients in the NPDR group(P=0.001), and the course of diabetes was longer(P=0.01); Glycated hemoglobin(HbA1c; P=0.001), blood urea nitrogen(BUN; P=0.003), erythrocyte sedimentation rate(ESR; P<0.001), and homocysteine(HCY; P=0.001)in the PDR group were significantly higher than those in the NPDR group, while mean red blood cell hemoglobin(MCH; P=0.043)and mean red blood cell hemoglobin concentration(MCHC; P=0.002)were significantly lower than those in the NPDR group. The independent influencing factors for screening DR progression include HbA1c(OR=1.587, P<0.001), BUN(OR=1.456, P=0.008), MCH(OR=0.540, P=0.038), ESR(OR=1.122, P=0.005), and HCY(OR=1.838, P=0.002). ROC curve was analyzed to determine the optimal diagnostic cut-off point for the influencing factors of DR progression: HbA1c: 8.18%; BUN: 5.46 mmol/L; ESR: 8.93 mm/h; HCY: 13.95 μmol/L.CONCLUSION: Research has shown that HbA1c, BUN, MCH, ESR, and HCY are independent risk factors for DR progression. Among them, HbA1c, BUN, ESR, and HCY are independent risk factors for DR progression, while MCH is an independent protective factor for DR progression.

Objective:To investigate the feasibility and accuracy of computer vision-based artificial intelligence technology in detecting and recognizing instruments and organs in the scenario of radical laparoscopic gastrectomy for gastric cancer.Methods:Eight complete laparoscopic distal radical gastrectomy surgery videos were collected from four large tertiary hospitals in China (First Medical Center of Chinese PLA General Hospital [three cases], Liaoning Cancer Hospital [two cases], Liyang Branch of Jiangsu Province People's Hospital [two cases], and Fudan University Shanghai Cancer Center [one case]). PR software was used to extract frames every 5–10 seconds and convert them into image frames. To ensure quality, deduplication was performed manually to remove obvious duplication and blurred image frames. After conversion and deduplication, there were 3369 frame images with a resolution of 1,920×1,080 PPI. LabelMe was used for instance segmentation of the images into the following 23 categories: veins, arteries, sutures, needle holders, ultrasonic knives, suction devices, bleeding, colon, forceps, gallbladder, small gauze, Hem-o-lok, Hem-o-lok appliers, electrocautery hooks, small intestine, hepatogastric ligaments, liver, omentum, pancreas, spleen, surgical staplers, stomach, and trocars. The frame images were randomly allocated to training and validation sets in a 9:1 ratio. The YOLOv8 deep learning framework was used for model training and validation. Precision, recall, average precision (AP), and mean average precision (mAP) were used to evaluate detection and recognition accuracy.Results:The training set contained 3032 frame images comprising 30 895 instance segmentation counts across 23 categories. The validation set contained 337 frame images comprising 3407 instance segmentation counts. The YOLOv8m model was used for training. The loss curve of the training set showed a smooth gradual decrease in loss value as the number of iteration calculations increased. In the training set, the AP values of all 23 categories were above 0.90, with a mAP of 0.99, whereas in the validation set, the mAP of the 23 categories was 0.82. As to individual categories, the AP values for ultrasonic knives, needle holders, forceps, gallbladders, small pieces of gauze, and surgical staplers were 0.96, 0.94, 0.91, 0.91, 0.91, and 0.91, respectively. The model successfully inferred and applied to a 5-minutes video segment of laparoscopic gastroenterostomy suturing.Conclusion:The primary finding of this multicenter study is that computer vision can efficiently, accurately, and in real-time detect organs and instruments in various scenarios of radical laparoscopic gastrectomy for gastric cancer.

Objective:To investigate the feasibility and accuracy of computer vision-based artificial intelligence technology in detecting and recognizing instruments and organs in the scenario of radical laparoscopic gastrectomy for gastric cancer.Methods:Eight complete laparoscopic distal radical gastrectomy surgery videos were collected from four large tertiary hospitals in China (First Medical Center of Chinese PLA General Hospital [three cases], Liaoning Cancer Hospital [two cases], Liyang Branch of Jiangsu Province People's Hospital [two cases], and Fudan University Shanghai Cancer Center [one case]). PR software was used to extract frames every 5–10 seconds and convert them into image frames. To ensure quality, deduplication was performed manually to remove obvious duplication and blurred image frames. After conversion and deduplication, there were 3369 frame images with a resolution of 1,920×1,080 PPI. LabelMe was used for instance segmentation of the images into the following 23 categories: veins, arteries, sutures, needle holders, ultrasonic knives, suction devices, bleeding, colon, forceps, gallbladder, small gauze, Hem-o-lok, Hem-o-lok appliers, electrocautery hooks, small intestine, hepatogastric ligaments, liver, omentum, pancreas, spleen, surgical staplers, stomach, and trocars. The frame images were randomly allocated to training and validation sets in a 9:1 ratio. The YOLOv8 deep learning framework was used for model training and validation. Precision, recall, average precision (AP), and mean average precision (mAP) were used to evaluate detection and recognition accuracy.Results:The training set contained 3032 frame images comprising 30 895 instance segmentation counts across 23 categories. The validation set contained 337 frame images comprising 3407 instance segmentation counts. The YOLOv8m model was used for training. The loss curve of the training set showed a smooth gradual decrease in loss value as the number of iteration calculations increased. In the training set, the AP values of all 23 categories were above 0.90, with a mAP of 0.99, whereas in the validation set, the mAP of the 23 categories was 0.82. As to individual categories, the AP values for ultrasonic knives, needle holders, forceps, gallbladders, small pieces of gauze, and surgical staplers were 0.96, 0.94, 0.91, 0.91, 0.91, and 0.91, respectively. The model successfully inferred and applied to a 5-minutes video segment of laparoscopic gastroenterostomy suturing.Conclusion:The primary finding of this multicenter study is that computer vision can efficiently, accurately, and in real-time detect organs and instruments in various scenarios of radical laparoscopic gastrectomy for gastric cancer.

International collaboration in education enables learning from advanced teaching experience and promotes the reform, optimization, and upgrading of medical education and teaching. We analyzed the difficulties and challenges in the education concept, curriculum system, and teaching language mode of infectious diseases under the condition of international cooperation in education in Chongqing Medical University. We tried to upgrade the teaching concepts, optimize the curriculum, and explore teaching language mode in the practice of teaching infectious diseases. We used the methods of deepening cooperation between departments, strengthening the communication between teachers and students, and emphasizing teacher training. We also adopted a variety of teaching methods and flexible teaching modes based on teaching content. With these methods, we explored teaching models of infectious diseases suitable in the context of international cooperation in education.

[Abstract] Objective: To investigate the expression of chemokine-like factor-like MARVEL transmembrane domain-containing family member 6 (CMTM6) in breast cancer tissues and its correlation with clinicopathological features and prognosis of patients. Methods:Atotal of 136 breast cancer tissue chips (purchased from Superchip Company), including 42 pairs of matched cancer and paracancerous tissues, were used for this study. The expression level of CMTM6 in cancer and paracancerous tissues was detected by immunohistochemistry. The comparison of CMTM6 expression between breast cancer and paracancerous tissues was conducted by paired χ2 test. The relationship between CMTM6 expression in breast cancer tissues and the clinicopathological characteristics of patients was analyzed by χ2 test. Kaplan-Meier and Log rank test analyses were used to analyze the relationship between CMTM6 expression and the survival of patients, and Cox model was used to evaluate the effect of different indicators on the prognosis of patients. Results: The expression of CMTM6 in breast cancer tissues was significantly higher than that in paracancerous tissues (P<0.01). The expression of CMTM6 was correlated with pathological type of breast cancer and HER2 positivity (P<0.05). The survival time of patients in CMTM6 high expression group was significantly shorter than that of patients in CMTM6 low expression group (P<0.05). Pathological type (HR=10.374, 95%CI: 3.529-30.497, P<0.01), TNM stage (HR=4.599, 95%CI: 1.784-11.856, P<0.01), triple-negative breast cancer (HR=3.370, 95%CI: 1.055-10.761, P<0.05) and high expression of CMTM6 (HR=0.195, 95%CI: 0.073-0.518, P<0.01) were independent risk factors for prognosis of breast cancer patients. Conclusion: CMTM6 is highly expressed in breast cancer tissues, which can be used as a risk factor for prognosis evaluation of breast cancer patients.

Objective To observe the changes of optic disc structure and retinal nerve fiber layer thickness (RNFL) in patients with different degrees of Parkinson's disease (PD).Methods Thirty eyes of 30 patients with primary PD and 20 eyes of 20 healthy subjects (control group) in Xuanwu Hospital of Capital Medical University from October 2016 to October 2017 were enrolled in this study.The patients were divided into mild to moderate PD group (15 eyes of 15 patients) and severe PD group (15 eyes of 15 patients).All the patients underwent OCT examination.The optic disc area,cup area,C/D area ratio,rim volume,disc volume,cup volume,rim area,C/D area,linear C/D,vertical C/D,the thickness of average RNFL,superior,inferior,temporal upper (TU),superior temporal (ST),superior nasal (SN),nasal upper (NU),nasal lower (NL),inferior nasal (IN),inferior temporal (IT),temporal lower (TL) quadrant RNFL thickness.Analysis of variance was performed for comparison among three groups.Minimum significant difference t test was performed for comparison between two groups.Results Optic disc structure parameters:there was no significant difference in the area of optic disc between the three groups (F=1.226,P＞0.05).The other optic disc parameters were significantly different in the three groups (F=5.221,5.586,6.302,5.926,5.319,5.404,5.861,6.603;P＜ 0.05).The cup area,cup volume,C/D area,linear C/D,vertical C/D of the mild to moderate PD group and severe PD group were higher than that of the control group (P＜0.05).The cup area,cup volume,C/D area,linear C/D,vertical C/D of the severe PD group were higher than those of mild to moderate PD group (P＜ 0.05),the rim area,rim volume and disc volume of the severe PD group were smaller than that of mild to moderate PD group (P＜ 0.05).The thickness of RNFL:there was no significant difference between the three groups of ST,SN,NU and NL (F=3.586,2.852,2.961,2.404;P＞0.05).The average thickness of RNFL,TU,IN,IT and TL in patients of the mild to moderate PD group and severe PD group were less than that in the control group (P＜0.05).The thickness of the average RNFL,TU,IN,IT and TL in patients of the severe PD group were less than that in the mild to moderate PD group (P＜0.05).With the increase of PD severity,the RNFL of TL and TU thinned most significantly.Conclusions With the increase of the severity of PD,the optic disc structure and RNFL thickness changes obviously,showing reduced optic disc area and volume,enlarged cup area and volume significantly enlarged C/D ratio.The average RNFL thickness of PD patients is significantly thinner than that of the controls,and it is the most obvious in the TU and TL quadrant.

Objective To observe the macular retinal thickness and volume in patients with different degrees of Parkinson's disease (PD).Methods Thirty eyes of 30 patients with primary PD and 20 eyes of 20 healthy subjects (control group) in Xuanwu Hospital of Capital Medical University from October 2016 to October 2017 were enrolled in this study.There were 17 males and 13 females,with the mean age of 63.2±6.4 years and disease course of 3.9± 2.4 years.The patients were divided into mild to moderate PD group (15 eyes of 15 patients) and severe PD group (15 eyes of 15 patients).The macular area was automatically divided into 3 concentric circles by software,which were foveal area with a diameter of 1 mm (inner ring),middle ring of 1 to 3 mm,and outer ring of 3 to 6 mm.The middle and outer ring were divided into 4 quadrants by 2 radiations,respectively.The changes of retinal thickness and macular volume of the macular center and its surrounding quadrants were analyzed.SPSS 16.0 software was used for statistical analysis.One-way ANOVA were used to analyze all data.Results Compared with the control group,the retinal thickness and volume in macular center and each quadrant of the mild to moderate PD group and severe PD group were reduced.Compared with the mild to moderate PD group,the retinal thickness and volume in macular center and each quadrant of the severe PD group were reduced.The differences of retinal thickness and macular volume among 3 groups were significant (F=5.794,5.221,5.586,5.302,5.926,5.319,5.404,5.261,5.603;P=0.001,0.007,0.003,0.005,0.000,0.004,0.004,0.006,0.002).In inner ring of the mild to moderate PD group and the severe PD group,the retinal thickness and macular volume in the upper and the nasal were the largest,the inferior was followed,and the temporal was the smallest.In outer ring of the mild to moderate PD group and the severe PD group,the retinal thickness and macular volume in the nasal was the largest,the upper was the second,the temporal and the inferior were the smallest.Conclusions The retinal thickness and volume of the macular central fovea and its surrounding areas in PD patients are significantly thinner than that in the healthy subjects.And with the increase of the severity of PD,the macular structure changes obviously,showing macular center and its surrounding macular degeneration thin,macular volume reduced.

Objective To study the clinical effect of total parathyroidectomy (TPTX) on treatment of secondary hyperparathyroidism (SHPT) in patients with chronic renal failure.Methods 24 patients undergoing TPTX in Mianyang Central Hospital from Jan.2014 to Nov.2016 were retrospectively analyzed.The preoperative,postoperative and follow-up intact parathyroid hormone (iPTH),serum calcium,serum phosphorus and calciumphosphorus product were statistically analyzed.The postoperative complications and recurrence were observed.Results For preoperative,1 week after operation,3 months after operation,6 months after operation,12 months after operation,24 months after operation and 36 months after operation,the mean values of iPTH were (1771.7± 244.5) pg/ml,(70.2±18.2) pg/ml,(106.5±35.3) pg/ml,(114.3±31.3) pg/ml,(122.1±27.8) pg/ml,(128.1±12.5) pg/ml and (113.8±24.9) pg/ml.The mean values of serum calcium were (2.6±0.4) mmol/L,(1.9±0.4) mmol/L,(2.1±0.3) mmol/L,(2.1±0.2) mmol/L,(1.8±0.2) mmol/L,(1.8±0.2) mmol/L and (1.8±0.3) mmol/L.The mean values of serum phosphorus were (2.1±0.7) mmol/L,(1.4±0.6) mmol/L,(1.3±0.4) mmol/L,(1.4±0.3) mmol/L,(1.3±0.3) mmol/L,(1.5±0.2) mmol/L and (1.4±0.4) mmol/L.The mean values of calcium-phosphorus product were (61.9±17.0) mg2/dl2,(34.6±19.4) mg2/dl2,(37.4±14.4) mg2/dl2,(40.4±12.3) mg2/dl2,(29.2±5.3) mg2/dl2,(35.0 ±7.1) mg2/dl2 and (32.4 ± 11.3) mg2/dl2,respectively.Compared with those before operation,postoperative iPTH,serum calcium,serum phosphorus and calcium-phosphorus product decreased significantly at 1 week after operation,3 months after operation,6 months after operation,12 months after operation,24 months after operation and 36 months after operation,and the differences had statistical significance (all P＜0.05).Temporary injury of recurrent laryngeal nerve was found in one patient (4.2％).Early postoperative hypocalcemia rate was 91.7％ (22/24).No recurrence developed after operation.Conclusion TPTX is safe and effective in treatment of SHPT in patients with chronic renal failure,with low recurrence rate and satisfactory treatment outcome.

Objective To compare the clinical characteristics and the outcomes of severe hyperlipidemic pancreatitis (SHLP) and severe acute gallstone pancreatitis (SAGP).Methods The clinical data of 22 patients with SHLP and 91 patients with SAGP admitted from January 2009 to December 2015 were retrospectively reviewed.The clinical manifestations,laboratory tests,organ dysfunction,medical treatment,complications and outcomes in 30 d after admission were analyzed and compared between two groups of patients.Results There were 16 males and 6 females with a mean age of (60.5 ± 9.1) years in SHLP group;while 32 males and 59 females with a mean age of (54.3 ± 5.4) years in SAGP group.The blood and urine amylase levels in SHLP group were significantly lower than those in SAGP group [(715 ±99) U/L vs.(1 551 ± 107) U/L,t =4.65,P =0.00;(382 ±56) U/L vs.(773 ± 66) U/L,t =4.52,P =0.00,respectively].The incidence of circulation insufficiency,respiratory insufficiency,renal dysfunction,and long-term puhnonary infection in SHAP patients was significantly higher than that in SAGP patients [36 ％ (8/22) vs.14 ％ (13/91),x2 =5.22,P =0.01;41％ (9/22) vs.7 ％ (6/91),x2 =9.46,P =0.01;23％(51/22) vs.5％ (5/91),x2 =4.20,P=0.03;55％(12/22) vs.32％ (29/91),x2 =7.02,P =0.01].Two cases died in the SHLP group and 9 cases died in SAGP group due to critical infection,cardiac events and bleeding.Conclusion Compared to SAGP patients,the blood and urine amylase levels are usually not remarkably high in SHLP patients,and the prevention and management of multi-organ failure and lung infection are more important for SHLP patients.