Objective:To explore the clinical application value of a deep learning algorithm-based ultrasound biomicroscopy (UBM) image analysis system for primary angles-closure glaucoma (PACG) anterior located ciliary body.Methods:A diagnostic test study was conducted.A total of 2 132 UBM images from 726 eyes of 378 PACG patients who underwent UBM examination were collected at Renmin Hospital of Wuhan University from August 2022 to December 2023.The dataset was divided into a training set of 1 599 images and a test set of 533 images, and a deep learning algorithm was employed to construct a model.An additional 334 UBM images from 101 eyes of 69 PACG patients treated at Huangshi Aier Eye Hospital were selected to conduct external testing.A separate set of another 110 UBM images were selected for a human-machine competition to compare the accuracy and speed between anterior located ciliary body evaluation system and three senior ophthalmologists.Furthermore, eight junior ophthalmologists assessed the 110 UBM images independently without and with the assistance of the model, and the differences between the two evaluations were analyzed to assess the assisstance effect of the model.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY-2022-K109).Results:The model achieved an accuracy of 93.43% for anterior located ciliary body identification in the internal test set, with a sensitivity of 84.30% and a specificity of 97.78%.The model also performed well on the external test set with an accuracy of 92.81%.In the human-machine competition, the model's accuracy was comparable to that of the senior ophthalmologists and outperformed two of the three senior ophthalmologists.The average total time of the three senior ophthalmologists was 726.73 seconds, approximately 12.47 times longer than the model's 58.30 seconds.With model assistance, the diagnostic accuracy of the eight junior ophthalmologists was 86.71%, which was significantly higher than 76.25% without model assistance ( χ2=-7.550, P<0.001).And the image evaluation time was (714.91±213.82)seconds, which was significantly lower than (987.90±238.56)seconds without model assistance ( t=2.774, P<0.05). Conclusions:The UBM image analysis system based on a deep learning algorithm demonstrates high accuracy in diagnosing anterior located ciliary body in PACG and provides a strong support for the UBM image recognition training of junior ophthalmologists.

Objective:To investigate the effects of self-made Hezhong-Jianpi Decoction on gastrointestinal motility and level of inflammatory cell factors in patients with reflux esophagitis. Methods:A total of 102 patients with reflux esophagitis who met the inclusion criteria in our hospital from May 2016 to September 2018 were divided into two group according to the random number table method, 51 cases in each group. The control group was treated with conventional western medicine. The intervention group was treated with self-made Hezhong-Jianpi Decoction based on the control group. Both groups were treated for 8 weeks. The levels of serum gastrin (GAS) and motilin (MTL) were detected by radioimmunoassay, the levels of TNF-α, IL-6 and IL-17 were detected by ELISA, the adverse reactions during the treatment were recorded, and the clinical efficacy was evaluated. Results:The total effective rate of the experimental group was 92.1% (47/51) and that of the control group was 72.5% (37/51). The difference between the two groups was statistically significant ( χ2=6.746, P=0.009). After the treatment, the levels of serum GAS (152.93 ± 26.85 ng/L vs. 134.30 ± 29.88 ng/L, t=3.312), MTL (291.58 ± 29.75 ng/L vs. 262.40 ± 38.71 ng/L, t=4.268) in the intervention group were significantly higher than those in the control group ( P<0.05), and serum TNF-α, IL-6, IL-17 levels were significantly lower than those in the control group ( t value were 4.653, 5.362, 4.759, respectively, all Ps<0.01). During the treatment, the incidence of adverse reactions was 9.8% (5/51) in the control group and 12.0% (6/51) in the intervention group, and there was no significant difference between the two groups ( χ2=0.102, P=0.750). Conclusions:The self-made Hezhong-Jianpi Decoction combined with the conventional western medicine can promote the gastrointestinal motility of patients with reflux esophagitis, reduce the inflammatory reaction and improve the clinical efficacy.

Objective Aiming at detecting Staphylococcus aureus、Pseudomonas aeruginosa and Klebsiella pneumoniae in laboratory animals,the paper provides a rapid,sensitive and simple test method.Methods According to Staphylococcus aureus nuc gene,Pseudomonas aeruginosa LasI gene,Klebsiella pneumonia PhoE gene and general 16S rRNA gene, designed specific primers;Through the optimization of multiplex PCR primer concentrations and annealing temperature, the specificity and sensitivity of detection, establishing multiplex PCR system.Application of the PCR system test specimens of artificial infections and experiment animal feces is compared with traditional test method.Results Multiplex PCR amplification of Staphylococcus aureus (153 bp), Pseudomonas aeruginosa (600 bp) with Klebsiella pneumoniae (368 bp) and general (520 bp).The multiplex sensitivity for the purpose of 10pg, specificity of detection was not detected from other pathogens.Application of establishing multiplex PCR system to detect the artificial positive samples, and detect 1 Pseudomonas aeruginosa positive case in 76 fecals.Conclusions This paper established the multiplex PCR method which has the advantages of specific,sensitive,simple and rapid, and provides a reliable way for rapid test in laboratory animals microbiology.

Objective: To establish a screening system for anti-metastatic small-molecule compounds based on perinucleolar compartment (PNC) prevalence in liver cancer cells and to investigate its validity. Methods: Polypyrimidine tract-binding protein (PTB) monoclonal antibody was used to measure the PNC prevalence in HepG2, HepG2M, and Huh7 cells, and wound healing assay and transwell assay were used to analyze the migration and invasion abilities of hepatoma cells. HepG2M cells were used as the model for the screening of anti-metastatic small-molecule compounds, and after the treatment with the compounds A1, A4, and E696, qPCR was used to measure the expression of metastasis-related miRNAs (miR-141 and miR-200c). A one-way analysis of variance was used for comparison of data between multiple groups. Results: PTB immunofluorescence assay showed that HepG2M cells had the highest PNC prevalence, followed by Huh7 and HepG2 cells, and PNC prevalence was positively correlated with the metastasis and invasion abilities of hepatoma cells. The PNC prevalence of HepG2M cells was reduced to 22.88% ±4.61% by A1, 14.22% ± 3.05% by A4, and 26.12% ± 4.94% by E696. Wound healing assay showed that the 48-hour scratch ratio increased from 17.70% ± 3.34% to 64.50% ± 2.65%, 83.40% ± 5.10%, and 57.20% ± 3.06% (F = 171.1, P < 0.01), respectively. Transwell assay showed that the number of invasive cells was reduced from 264.33 ± 30.50 to 104.33 ± 13.50, 58.00 ± 11.00, and 111.33 ± 19.50 (F = 59.87, P < 0.01), respectively. The anti-metastatic effect of these three compounds was positively correlated with their ability to destroy PNC. A4 upregulated the expression of miR-141 and miR-200c in a dose-dependent manner, and after HepG2M cells were treated with A4 at a concentration of 5 μM, 10 μM, or 20 μM, the level of miR-141 was increased to 3.61 ± 0.78, 8.12 ± 1.15, and 18.24 ± 2.44 folds (F = 88.01, P < 0.01), respectively, and that of miR-200c was increased to 2.82 ± 0.43, 4.82 ± 0.89, and 10.74 ± 1.22 folds (F = 87.94, P < 0.01), respectively. Conclusion The screening system for anti-metastatic small-molecule compounds based on PNC prevalence can provide an effective technical platform for research and development of anti-metastatic drugs for liver cancer.

OBJECTIVETo evaluate surgical outcomes and the feasibility of robotic thyroidectomy and central neck dissection (CND).

METHODSThe clinical data of 40 patients of papillary thyroid microcarcinoma underwent total thyroidectomy (or lobectomy and isthmusectomy) and CND using the Da Vinci system through axillo-bilateral-breast approach in Jinan Military General Hospital of People's Liberation Army from February to December 2014 were analyzed retrospectively (robotic group). Other forty patients of papillary thyroid microcarcinoma underwent total thyroidectomy (or lobectomy and isthmusectomy) and CND by open approach were selected as the control (open group). Cosmetic satisfaction was assessed after a month postoperation by the numerical score system. t-test and χ(2) test were used to compare the clinical characters, total operative time, intraoperative estimated blood loss, postoperative hospital stay, number of lymph nodes removed, visual analogue scale for pain, postoperative complications, and cosmetic effect between the 2 groups.

RESULTSAll 80 patients were diagnosed of papillary thyroid microcarcinoma. The total thyroidectomy (or lobectomy/isthmusectomy) with CND of 40 patients were successfully performed by da Vinci Si surgical system. The numbers of total thyroidectomy of robotic group and the open group were 36 and 37, respectively. The numbers of metastatic lymph nodes of robotic group and open group were 14 and 15, respectively. The operation time of the robotic group was (130±12) minutes, which was longer than that of open group (98±11) minutes (t=12.432, P<0.05). The study showed statistical significant difference between the two groups regarding the visual analog scale pain assessment (1.9±0.9 vs.3.9±1.1, t=8.900, P<0.05). There were no statistical significant difference of intraoperative estimated blood loss, postoperative hospital stay, number of lymph nodes removed, and the complication rate between the 2 groups.Postoperative cosmetic result was more satisfying on the robotic group (9.1±0.5) than open group (4.8±1.5) (t=17.200, P<0.05).

CONCLUSIONSThe robotic total thyroidectomy (or lobectomy and isthmusectomy) and CND has similar surgery safety and feasibility as open procedures. The robotic thyroidectomy is a good alternative surgical modality for patients with papillary thyroid microcarcinoma who wish to avoid neck scars.

Axilla ; Breast ; Carcinoma, Papillary ; surgery ; Humans ; Length of Stay ; Lymph Nodes ; Neck Dissection ; Operative Time ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Robotic Surgical Procedures ; Thyroid Neoplasms ; surgery ; Thyroidectomy ; methods

This article proposes a novel occupational practice model implied from the native concept of Taiji Diagram. Four elements of Taiji Diagram, namely Yang-fish, Yin-fish, Yin-fish-eye and Yang-fish-eye, are matched to the elements of occupational practice, namely person, environment, economic condition and mental condition, respectively. The interaction between persons and their environment can be thought as the interaction between Yin and Yang, and the balance would be focused on. Some different ideas may be brought from this model, such as Appropriate Challenge, Appropriate Empowerment.

Objective To investigate the role of the clock gene promoter methylation in aging. Methods C57BL mice of 4- (young, n=9) and 20- (old, n=10) month-old were determined the promoter methylation level of clock genes (Per1/2, Bmal1/2, Cry1/2, Clock, Npas2) in the stomach, spleen, vascular, kidney and striatum with methylation-specific polymerase chain reaction (MSP). Results The incidence of promoter methylation of Cry1, Bmal2 and Npas2 in spleen increased in old mice (P<0.05), while the promoter methylation of Per1 in stomach decreased (P<0.05), and the promoter methylation of Bmal1 in vascular increased (P<0.05). Conclusion Promoter methylation of some clock genes is involved in process of aging in a tissue-specific way.

OBJECTIVETo analyze the relationship between normal serum uric acid (SUA) levels and nonalcoholic fatty liver disease (NAFLD) among postmenopausal women, and determine the possible risk factors of NAFLD in this patient population.

METHODSChinese postmenopausal women who participated in the annual health check-up program from March 2009 to February 2010 were retrospectively assessed to identify individuals with SUA within normal range for study inclusion. For the total 1425 study participants, the recorded data of anthropometric parameters, metabolic factors, and serum biochemical parameters were collected. Results from abdominal ultrasonography examination were used to group participants according to presence of fatty liver. Women with fatty liver were divided into NAFLD and non-NAFLD groups. Further sub-grouping was performed according to SUA quartiles, as follows: Q1 group: less than 226.1 mumol/L); Q2 group: 226.1 mumol/L less than or equal to SUA less than 267.8 mumol/L; Q3 group: 267.8 mumol/Lless than or equal to SUA less than 303.5 mumol/L); Q4 group: 303.5 mumol/Lless than or equal toSUAless than or equal to357.0 mumol/L. The independent-sample t-test was used to compare normally distributed variables between groups, and the Mann-Whitney U test was used to analyze variables with skewed distribution. Categorical variables were examined by the R * C x2 test. Binary logistic analysis was used to determine the risk factors for fatty liver and to adjust for possible confounders. The multiple non-parameter independent-sample test (Kruskal-Wallis test) was used to compare the differences of SUA levels among NAFLD groups with different disease severity.

RESULTSThe prevalence of NAFLD among Chinese postmenopausal women with normal SUA was 32.8%, with NAFLD prevalences of 20.4% (70/343) in women with Q1 SUA, 26.3% (104/395) with Q2 SUA, 35.2% (128/364) with Q3 SUA, and 51.4% (166/323) with Q4 SUA. The prevalence of fatty liver showed a significant increasing trend according to the SUA quartile (x2 = 76.470, P-trend less than 0.01). Women in the SUA Q3 and Q4 groups had significantly higher risk of fatty liver presence than women in the Q1 group (P less than 0.01 for both, with or without adjustment of confounders). Disease severity did not appear to be related to disease severity, as the SUA levels in women with mild, moderate or severe fatty liver were not significantly different (286.8+/-48.2 mumol/L vs. 277.9+/-53.0 mumol/L vs. 281.4+/-48.2 mumol/L, respectively; x2 = 3.025, P more than 0.05).

CONCLUSIONSUA levels were independently correlated with NAFLD in Chinese postmenopausal women. SUA levels in the higher quartiles of the normal range may be an independent risk factor of NAFLD.

Aged ; Female ; Humans ; Middle Aged ; Non-alcoholic Fatty Liver Disease ; blood ; diagnosis ; Postmenopause ; Retrospective Studies ; Risk Factors ; Uric Acid ; blood

Objective To observe the effect of general anesthesia induction assisted dexme-detomidine on blood pressure responses to ephedrine.Methods Forty-four patients scheduled for lap-aroscopic cholecystectomy were randomly divided into normal saline(group N)and dexmedetomidine (group D)group.Group D was treated 15 minutes by micro pump injecting the dose of 0.8 μg/kg dexmedetomidine before anesthesia induction.Then the rate was changed to 0.4 μg·kg-1 ·h-1 and maintained.Meanwhile patients were given anesthesia induction and trachea intubation.0.1 mg/kg ephedrine was injected 5 minutes after trachea intubation.Likewise group N was treated 15 minutes by micro pump injecting physiological saline before anesthesia induction.The other treatments were same.SBP,DBP and HR were recorded before micro pump injecting dexmedetomidine or physiologi-cal saline(T0 ),before anesthesia induction(T1 ),during trachea intubation(T2 ),2 min after trachea intubation(T3 ),during ephedrine injection(T4 ),2 min,5 min,10 min and 15 min after ephedrine (T5 ,T6 ,T7 ,T8 ).Results Compared with T0 ,SBP and DBP of group N was lower at T1 ,T3-T8 but SBP,DBP and HR was higher at T2 (P<0.05 or P<0.01).HR of group N was lower at T4 ,T7 and T8 (P<0.05 or P<0.01).SBP at T1-T8 ,DBP at T1-T4 and T8 ,HR at T1 and T3 ,T4 was lower in group D(P<0.05 or P<0.01).Compared with T2 ,SBP,DBP and HR of group N was lower at T3 and T4 (P<0.01).SBP of group D was lower at T4 (P<0.01).Compared with T4 ,SBP of group N was only higher at T5 and T6 (P<0.05 or P<0.01).SBP,DBP and HR of group D were higher at T5-T7 and SBP was kept higher until T8 (P <0.01).Compared with group N,HR of group D was lower at T1-T3 (P<0.05 or P<0.01),SBP,DBP was lower at T2 (P <0.01)and was kept higher from T5 to T8 (P<0.05 or P<0.01).Conclusion Intubation stress response will be relieved during anesthesia induction with dexmedetomidine,which can amplified ephedrine effect.

Objective To evaluate the safety of the da Vinci Si surgical system in thyroid surgery and to accumulate operation experience .Methods The da Vinci Si surgical system consists of a surgeon's console, a patient-side robotic cart, and high-definition 3D vision system.The robot arm tips were introduced via a single axillary incision or small chest wall ports and attached to the arms of the robot .The surgeon , sitting at the con-sole, manipulated the EndoWrist instruments and endoscope view that transfer the surgeon 's movements to the arm tips.The so called EndoWrist'technology offers seven degrees of movements ( up, down, left, right, twist, et al) , thus exceeding the capacity of a surgeon's hand in open surgery .The da Vinci Si surgical system was used to perform thyroidectomy in two small pigs .The animals were intubated and kept anesthetized with halothane .Re-sults Four surgical procedures were done using the da Vinci Si system from beginning to the end , including 2 thyroidectomies and 2 thymectomies .No conversions to open or laparoscopic procedure was used .The procedure length was 61 minutes and 50 minutes, respectively.Conclusions Robotic thyroidectomy can be performed safe-ly by the experienced surgeons after short-term da Vinci Si surgical system training .The learning curve for robotic thyroidectomy is shorter .