Objective:To realize the optimization and upgradation of the detection method of you only look once(YOLO)algorithm model based on the improved YOLO network on the ultrasound image for breast tumor.Methods:A total of 659 images of breast tumor of the Kaggle database were selected as the initially dataset,and the image annotation tool Labelimg was used to conduct pre-labeling for the detection targets in the images.According to a ratio as 7:3,629 images of the 659 images were divided into the train set and validation set,and the other 30 images were used as the test set.The convolutional block attention module(CBAM)and bidirectional feature pyramid network(BiFPN)were introduced into the original YOLO algorithm to underwent structural improvement,which was named as YOLOv5-BiFPN-CBAM.Both the train set and validation set were placed in original YOLO algorithm model and YOLOv5-BiFPN-CBAM model to conduct train,which included 200 rounds of iterative training.The obtained optimal weight files were used in the final test of test set.Results:After 200 rounds of iterative train for two kinds of models,the test results of validation set indicated that the mean values of average precision of two kinds of models were respectively 72.1%and 80.5%for all ultrasound images of breast tumor.The result,that the optimal weight file of improved model was tested by test set,indicated the test ability of improved model was significantly enhanced than that of original model for small target in image.Conclusion:Compared with the original YOLO algorithm model,the improved YOLO algorithm model has higher recognition capability for image,which also enhances precision and sensitivity in identifying small targets of ultrasound images of breast tumor.This model is helpful to improve the diagnostic efficiency in clinical practice for breast tumor.

Objective:To investigate the efficacy and prognostic survival of pembrolizumab combined with apatinib and chemotherapy in the treatment of human epidermal growth factor receptor-2 (HER2)-negative advanced gastric cancer.Methods:Patients with HER2-negative advanced gastric cancer were selected from December 2019 to December 2022 as the study subjects. Forty-five patients who received chemotherapy therapy (fluorouracil+cisplatin) were randomly collected and included in control group, and 52 patients who were treated with pembrolizumab combined with apatinib were randomly selected and enrolled as observation group. The difference in short-term efficacy was compared. The levels of serum tumor markers and immune function (CD3 +, CD4 +, CD8 +, CD4 +/CD8 +) were recorded. The long-term efficacy and adverse reactions of patients were compared. Measurement data conforming to the normal distribution were expressed as xˉ± s, and the mean comparison between groups was performed by independent sample t test. Chi-square test was used to compare the rate or composition ratio among enumeration data. P<0.05 was considered statistically significant. Results:At 6 months after treatment, the disease control rate in observation group was significantly higher than that in control group (78.85% (41/52) vs 57.78% (26/45)) ( χ2=5.01, P=0.025), but there was no statistical significance in objective response rate between groups (36.54% (19/52) vs 24.45% (11/45)) ( χ2=1.65, P=0.199). The levels of pepsinogen I, tissue polypeptide specific antigen, carcinoembryonic antigen, carbohydrate antigen 199 and CD8 + in both groups were reduced after treatment, and the levels were lower in observation group than those in control group ( t=6.06, 6.78, 4.68, 11.21, 3.45, all P<0.001). The levels of CD3 +, CD4 + and CD4 +/CD8 + were enhanced significantly in the two groups, and the observation group had higher levels after treatment ( t values were 2.10, 3.74, and 5.19; P values were 0.028, <0.001, and <0.001). After 1 year of follow-up, the survival rate in observation group with 59.62% (31/52) was significantly higher than 37.78% (17/45) in control group ( χ2=4.60, P=0.032). The progression-free survival time ((10.22±1.62) months vs (8.13±1.57) months, t=6.43, P<0.001) and overall survival time ((11.62±1.84) months vs (9.73±1.71) months, t=5.21, P<0.001) in observation group were significantly longer compared to control group. There were no statistical differences in the incidence rates of bone marrow suppression ( χ2=1.92, P=0.165), hand-foot syndrome ( χ2=3.47, P=0.062), gastrointestinal reaction ( χ2=0.32, P=0.574), hypertension ( χ2=0.94, P=0.333) and proteinuria ( χ2=2.39, P=0.122) between the two groups. Conclusion:Compared with chemotherapy, pembrolizumab combined with apatinib shows good short-term efficacy and long-term efficacy in patients with HER2-negative advanced gastric cancer.

Chlamydia trachomatis (Ct) is the causative agent of bacterial sexually transmitted diseases (STDs) worldwide.The incidence of Ct infection has exceeded that of Neisseria gonorrhoeae,and becomes the highest in STDs in many countries.Ct infection can lead to urethritis,epididymitis,prostatitis and infertility in males,and cervicitis,endometritis,pelvic inflammatory disease,infertility in females,and neonatal conjunctivitis.Additionally,urogenital Ct infection is always ignored due to its concealed symptoms,leading to a long clinical course,recurrence or repeated infections.Furthermore,Ct infection can increase the risk of human immunodeficiency virus and human papilloma virus infections.Therefore,how to prevent and control the transmission of Ct has become one of the global public health issues.Currently,a growing body of researches have focused on the molecular epidemiological characteristics of Ct,which are aiming to identify the mutant strains,elaborate transmission dynamics,investigate the distribution of Ct serotypes in different populations,so as to provide molecular epidemiological evidence for the prevention and control of Ct infection.This review summarizes the epidemic status and research methods for molecular epidemiological characteristics of Ct,as well as application of Ct serotyping in clinical practice,providing references for the prevention,control and research of Ct infection.

Objective To study the risk factors for progressive cardiogenic stroke (CS).Methods Seventy-one acute ischemic stroke patients admitted to our hospital from 2008-08-01 to 2014-12-31 were divided into progressive CS group (n=14) and non-progressive CS group (n=57).The NIHSS was used to assess the neurologic deficit when the patients were admitted and 30 days after the stroke onset.Their clinical data were retrospectively analyzed.The risk factors for progressive CS were analyzed by univariate logistic regression analysis and multivariate logistic regression analysis respectively,their critical thresholds were analyzed according to the ROC curve.Results The NIHSS improvent of the progressive CS group was significantly less than that of the non-progressive CS group (P＜0.01).The age was significantly older,the incidence of right-side infarction and the serum level of D-dimer were significantly higher while the serum level of glutamic pyruvic transaminase was significantly lower in progressive CS group than in non-progressive CS group (77.29±8.87 years vs 71.44±9.51 years,P=0.041;71.4％ vs 33.3％,P=0.009;2.82 mg/L vs 0.91 mg/L,P=0.048;13.79±4.44 U/L vs 21.98±17.34 U/L,P=0.002).Lo gistic regression analysis showed a significant difference in age,right-side infarction and serum D-dimer level between the two groups (P=0.030,P=0.007,P=0.025).The area under the ROC curve revealed that age ＞ 70.75 years and serum D-dimer level ＞1.23 mg/L were the risk factors for progressive CS.Conclusion Age,right-side infarction and serum D-dimer level are the risk factors for progressive CS and can thus be used as predictors of progressive CS.

Objective To evaluate the efficacy and safety of tigecycline-based treatment approach on severe infection of patients with hematological diseases. Methods The clinical data of 64 patients who were treated with tigecycline-based treatment approach for severe infection were retrospectively reviewed. The curative effect was evaluated, meanwhile the drug side effects were observed. Results A total of 51 strains of bacteria were isolated from 64 patients, including 12 extended-spectrum β-lactamase(ESBL)and 15 multi-drug resistant strains and the total effective rate was 59.4%(38/64). Five patients diagnosed as carbapenem resistant infection and were treated with the addition dose of tigecycline and 3 patients relieved. Main adverse events were nausea, vomiting, diarrhea and hepatic dysfunction, but all events were slight. Conclusions Tigecycline-based treatment approach has a good clinical efficacy in treating severe infection of patients with hematological diseases, and the side effect is few.Tigecycline-based treatment approach could be used as a new choice for patients non-responding favorably to conventional anti-infective treatment or multiple resistant bacteria.

Objective To study the clinical features of congenital glucose-galactose malabsorption (CGGM),and to improve the understanding of CGGM.Method Clinical manifestations and treatment process of one patient with CGGM in our hospital were retrospectively analyzed.From 1966 to 2016 May,Chinese medical database and PUBMED were searched using Malabsorption syndrome,dehydration,hypernatremia , diarrhea , newborn , carbohydrate metabolism ,andglucose/galactose malabsorption as key words.The clinical features of CGGM reported in literatures were summarized.Result The patient in our hospital was a full-term female infant naturally delivered.The onset of the disease was on the 9th day after birth,and the clinical manifestations included severe diarrhea,severe dehydration,hypernatremia,metabolic acidosis and malnutrition.After intravenous infusion and symptomatic treatment,dehydration,hypernatremia and metabolic acidosis were corrected.However,there was no improvement of diarrhea characterized with watery and acidic stools,and neither was weight gain.Glucose loading test was negative,and fructose loading test was positive.Diarrhea was improved markedly using diagnostic carbohydrate-free formula,so CGGM was diagnosed clinically.SLC5A1 homozygous IVS7-2 A ＞ G mutation was detected which confirmed the diagnosis of CGGM.With carbohydrate-free formula feeding,the body weight of the infant was increased.Followed up for 2 months now,her body length and body weight were at P25 and P22 on growth curve respectively,and no obvious neurological sequela was observed.Our literature review revealed 7 reports including 48 cases of CGGM children.Literature review showed that:most children with CGGM (79.2％) had the onset within 7 days of life;main clinical features included diarrhea (100％),dehydration (100％),and malnutrition (54.2％);22.9％ of patients with carbohydrate-free formula and 27.1％ with fructose matrix formula were fed well;no death was detected,77.1％ had normal weight gain,and 91.7％ had normal development of the nervous system.Conclusion CGGM is rare.The symptoms include severe watery and acidic stools with onset during neonatal period.CGGM is associated with severe complications such as hypertonic dehydration and hypernatremia.The diagnosis is established based upon typical clinical manifestations,sugar loading test and SLC5A1 gene detection.Carbohydrate-free formula feeding is effective.

Objective To investigate the expression and the possible clinical significance of serum Golgi protein(GP73)in infantile hepatitis syndrome(IHS)by different causes.Methods Totally 79 patients with IHS in Guangzhou Women and Children's Medical Center from February 2012 to December 2012 were enrolled in this study,including 15 cases with biliary atresia(BA)group,29 cases with infection(infection group),5 cases with neonatal intrahepatic cholestasis caused by citrin deficiency(NICCD group),and 30 cases with unknown etiology(idiopathic infantile hepatitis group).At the same time,30 healthy infants were enrolled as healthy control group.The serum levels of GP73 were determined by quantitative enzyme-linked immunosorbent assay(ELISA),and the children's liver function[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL),alkaline phosphatase(ALP),γ-glutamyl trans-peptidase(γ-GT),total bile acid(TBA)and albumin(ALB)] were measured by turbidimetric inhibition immuno assay.Then,the corresponding data were statistically analyzed.Results Serum GP73 in BA group,infection group,NICCD group,idiopathic infantile hepatitis group and the healthy control group were(296.6±67.5)μg/L,(185.1±66.4)μg/L,(199.2±87.1)μg/L,(181.7±74.2)μg/L and(65.3±17.0)μg/L,respectively.Serum γ-GT levels in BA group,infection group,NICCD group,idiopathic infantile hepatitis group and healthy control group were(764.7±775.8)U/L,(448.2±352.7)U/L,(239.4±88.7)U/L,(283.3±377.2)U/L and(54.0±72.6)U/L,respectively.The levels of GP73 and γ-GT were significantly higher in infants with IHS,and the levels of GP73 and γ-GT in infants with BA were the highest(F=46.775,9.238,all P<0.05).There was a positive correlation between serum levels of GP73 and γ-GT(r=0.280,P<0.05),and there was no correlation between GP73 and ALT,AST,TBIL,DBIL,ALP,TBA,ALB(r=-0.061,-0.071,0.164,0.123,0.137,0.008,-0.047,respectively,all P>0.05).The receiver operating characteristic curve(ROC)constructed with GP73 showed a sensitivity of 80.0％and specificity of 82.8％with an area under the receiver(AUC)of 0.872 for diagnosis of BA,comparatively,a sensitivity of 66.7％and specificity of 71.9％were showed with a AUC of 0.731 when performed with γ-GT.Conclusions Serum GP73 concentration significantly increased in all liver disease groups,regardless of the etiology.Serum GP73 expression is significantly higher in infants with BA.Serum GP73 shows a superior sensitivity and specificity to γ-GT for diagnosis of BA,which might be useful for early diagnosis of BA and IHS with different causes.

Objective To observe optic nerve axons degenerative disorder and microglial responses by establishing unilateral optic nerve crush model.Methods YFP mouse group with axonal markers and GFP mouse group with microglia markers were divided into surgery and control group,the optic nerve were dissected at 4 hours,1 day,3 days,5 days,10 days after optic nerve crush,and the neuronal degenerative disorder and microglial responses were observed by confocal laser scanning microscope.Rrsults Compared with control group,the optic nerve axons in YFP mouse group were fractured in injury region at postoperative 4 hours;The partial axon became beadlike change at postoperative 1 day;Most of the axons turned into the process of beadlike change at postoperative 3 days;The axons became to debris from beadlike at postoperative 5 days;The axons changed into many debris at postoperative 10 days.Compared with control group,the formation of glial scar and resting microglia in GFP mouse group began to emerge at postoperative 4 hours;The microglia gradually activated and began to cover the injury region at postoperative 1 day;The activated miacroglia basically covered the injury region at postoperative 3 days;The number of microglia roughly remained stable,although the axons continued to deteriorate at postoperative 5 days and 10 days.Conclusion The optic nerve occur irreversible degenerative disorder after being injured,meanwhile with the microglial increase and activation.This phenomenon suggests that microglia is closely associated with optic nerve degeneration.

Objective To explore the correlation between pregnancy-related anxiety and serum 25 (OH)D level during early pregnancy. Methods A radioimmunoassay was used to determine the serum 25 (OH)D levels of 2 122 early pregnant women in Maanshan Maternal and Child Health Care Hospital, from June 2015 to 2016. Data were collected using a questionnaire. Results The mean serum 25(OH)D level was(29.71±32.27)nmol/L.About 15.2% of the subjects had adequate,22.6% had insufficient,45.1% had deficient,and 17.1% had severely deficient serum 25(OH)D levels.The type of housing and testing seasons were significantly associated with the serum 25(OH)D level.Single factor logistic regression analysis results show that pregnancy-related anxiety incidence in the group deficient in 25(OH)D was higher than that in the adequate group, which has a statistically significant difference (P<0.05). After adjusting for the maternal age,BMI,and educational level,multivariate logistic regression analysis results showed that the difference was statistically significant. Conclusion The serum 25(OH)D level in early pregnant women was inadequate. Furthermore, lack of serum 25(OH)D in early pregnancy and pregnancy-related anxiety were negatively correlated.

ObjectiveTo study the efficacy and safety of heated humidified high flow nasal cannula ( HHHFNC) and nasal continuous positive airway pressure( NCPAP) ventilation for prevention of extubation failure in extremely low birth weight(ELBW)infants in our NICU.MethodsFrom Jan.2011 to Dec. 2014, 129 ELBW infants admitted to our hospital were randomly assigned into HHHFNC group and NCPAP group. The inclusion criteria were gestational age ( GA ) <34 w, birth weight ( BW )<1000 g, admission within 7 d after birth and transition to noninvasive respiratory support after a period of mechanical ventilation with an endotracheal tube. The primary outcome included:the incidence of extubation failure, nasal injury, air leak, abdominal distention and bronchopulmonary dysplasia ( BPD). Results Statistically significant difference sexisted between the two groups on oxygen the rapyduration, the time required reaching total enteral feedings and the incidences of nasal injury, air leak, abdominal & nbsp;distention and necrotizing enterocolitis ( P<0. 05). The incidence of extubation failure within 7 days was 25. 8℅ in HHHFNC group and 47. 6℅ in NCPAP group ( P <0. 05 ) . No differences between the 2 groups on total ventilation duration, non-invasive ventilation duration, re-intubation rate at 3d after extubation, BPD, retinopathy of prematurity ( ROP ) , intracerebral hemorrhage ( ICH ) , periventricular leukomalacia(PVL)and patent ductus arteriosus(PDA).Conclusions HHHFNC is an effective and safe method for prevention of extubation failure in ELBW infants.