Objective:To develop an artificial intelligence (AI) quality control model of fetal heart in the first trimester and verify its effectiveness.Methods:A total of 18 694 images of the four-chamber view(4CV) and three-vessel and tracheal view(3VT) of fetal heart in the first trimester were selected from Shenzhen Maternal and Child Health Hospital Affiliated to Southern Medical University since January 2022 to December 2022. A total of 14 432 images were manually annotated. The one-stage target detection algorithm YOLO V5 was used to train the AI quality control model in the first trimester of fetal heart, and 4 262 images (golden standard set by expert group) were used to evaluate the application effectiveness of AI quality control model. Kappa consistency test was used to compare the results of section classification and standard degree judgment from AI quality control model, Doctor 1(D1) and Doctor 2(D2).Results:①Precision of the AI quality control model was 0.895, recall was 0.852, mean average precision (mAP 50) was 0.873.The average precision(AP) of the AI quality control model for section classification was 0.907 (4CV) and 0.989 (3VT), respectively. ②Compared with the gold standard, the overall coincidence rate and consistency of section classification of AI quality control model, D1 and D2 were 99.91% (Kappa=0.998), 100% (Kappa=1.000), 100% (Kappa=1.000), respectively. The coincidence rate and consistency of the plane standard degree evaluation from the AI quality control model, D1 and D2 were 97.46% (Weighted Kappa=0.932), 93.73% (Weighted Kappa=0.847), and 93.12% (Weighted Kappa=0.832), respectively. Strong consistency was displayed. Moreover, AI quality control model showed the highest coincidence rate and the strongest consistency in judging section standard degree, which was superior to manual quality control. The time-consuming of AI quality control (0.012 s/sheet) was significantly less than the way of manual quality control (4.76-6.11 s/sheet)( Z=-8.079, P<0.001). Conclusions:The use of artificial intelligent fetal heart quality control model in the first trimester can effectively and accurately control the image quality.

Objective:To observe any effect of supplementing head-eye movement with repeated transcranial magnetic stimulation (rTMS) on the lower limb movement and balance of hemiplegic stroke survivors.Methods:Forty stroke survivors with hemiplegia were divided at random into a control group and an observation group, each of 20. Both groups received conventional medication and head-eye movement rehabilitation training, while the observation group was additionally provided with rTMS daily for 20 days. The head-eye movement training involved one minute for each movement, twice a day, five days a week for 4 weeks. Before and after the treatments, both groups were assessed using the Fugl-Meyer Assessment Scale for the Lower Extremities (FMA-LE), the Berg Balance Scale (BBS), timed up and go tests (TUGs), and the Modified Barthel Index (MBI).Results:The treatment improved both groups′ average FMA-LE, BBS and MBI scores significantly, and significantly shortened their average TUG times. The observation group showed significantly greater improvement than the control group, on average.Conclusion:Combining rTMS with head-eye movement can significantly improve the lower limb movement and balance of hemiplegic stroke survivors.

ObjectiveTo observe the effect of salvianolate on the protein expressions of adenosine monophosphate （AMP）-activated protein kinase （AMPK）， silent information regulator 1 （SIRT1） and peroxisome proliferator-activated receptor-γ coactivator-1α （PGC-1α）， autophagy and apoptosis in kidney tissue of rats with membranous nephropathy （MN）， and to explore its possible molecular mechanism against MN. MethodEighty male SD rats were randomly divided into normal group， model group， benazepril hydrochloride group （10 mg·kg^-1）， and salvianolate low-， medium-， and high-dose groups （16.7， 33.3 and 66.7 mg·kg^-1）. The rats were modeled by injection of cationized bovine serum albumin （C-BSA） into the tail vein. After successful modeling， rats in the administration groups were given corresponding doses of drugs for 4 consecutive weeks， and then 24-hour urine， serum and kidney tissue were collected for the detection of 24-hour urinary protein （UTP）， blood urea nitrogen （BUN）， serum creatinine （SCr）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， C reactive protein （CRP）， glutathione peroxidase （GSH-Px）， superoxide dismutase （SOD）， and malondialdehyde （MDA）. The pathological changes of kidneys were observed by light microscope， electron microscope and immunofluorescence. Western blot was used to detect the protein expressions of phospho-AMPK （p-AMPK）， AMPK， phospho-SIRT1 （p-SIRT1）， SIRT1 and PGC-1α in rat kidney tissue. The protein expressions of autophagy-specific gene （Beclin-1）， microtubule-associated protein 1 light chain 3 （LC3） Ⅱ， ubiquitin-binding protein （p62）， B cell lymphoma （Bcl-2）， Bcl-2-associated X （Bax）， and cysteine aspartic protease-7 （Caspase-7） in rat kidney tissue were determined by immunohistochemistry （IHC）. ResultCompared with the conditions in the normal group， the levels of UTP， IL-6， TNF-α， CRP and MDA in the model group were increased （P<0.05） while the levels of SOD and GSH-Px were decreased （P<0.05）， and there was no difference in BUN and SCr. Compared with the model group， the administration groups had lowered UTP， IL-6， TNF-α， CRP and MDA （P<0.05） while elevated SOD and GSH-Px （P<0.05）. It could be seen from hematoxylin and eosin （HE） staining， Masson staining， immunofluorescence and electron microscopy that the pathological damage of rat kidney tissue in the model group was significant， but after treatment with benazepril hydrochloride and salvianolate， the pathological damage of kidney cells was gradually improved. The expressions of p-AMPK/AMPK， p-SIRT1/SIRT1， PGC-1α， Bcl-2， Beclin-1 and LC3Ⅱ in rat kidney in the model group were lower than those in the normal group （P<0.05） while the expressions of Bax， Caspase-7 and p62 were higher （P<0.05）. Compared with the model group， benazepril hydrochloride group and salvianolate groups had an up-regulation in the expressions of p-AMPK/AMPK， p-SIRT1/SIRT1， PGC-1α， Bcl-2， Beclin-1 and LC3Ⅱ in the kidney （P<0.05） while a down-regulation in the expressions of Bax， Caspase-7 and p62 （P<0.05）. ConclusionThe protective effect of salvianolate on the kidneys of MN rats may be related to the activation of AMPK/SIRT1/PGC-1α signaling pathway， the up-regulation of autophagy and the reduction of apoptosis.

Objective To describe status of cancer-related fatigue (CRF) and its trajectory during three different time node for the operation, chemotherapy, and radiotherapy among breast cancer patients. Methods The convenience sampling method was used for 242 cases diagnosed with breast cancer which prepared for breast cancer resection, prepared to be treated with adjuvant chemotherapy and radiotherapy, and conformed to the sample standard from a tumor hospital and two affiliated hospital of medical college from February 2014 to November 2015 in a city. The follow-up survey of CRF was conducted respectively in the three different point-in-time for one week after the operation, at the end of chemotherapy and radiotherapy. Results After the operation mean rating for general fatigue was mild (2.59±2.41) points, and approximately 76.0% (184/242) patients experienced fatigue to low- grade degree; After the chemotherapy fatigue was significantly increased (6.57 ± 2.43) points, and 75.2% (182/242) patients accounted for severe fatigue; After the radiotherapy mean rating for fatigue was moderate (4.38 ± 2.46) points, and 57.0%(138/242) patients suffered to moderate fatigue. During the whole treatment period the level for general fatigue and four dimensions of fatigue were in the unstable state ofwaveof fluctuations with mild, severe, moderate, and fatigue were statistically different in three different stages of treatment ( F= 43.16,P=0.000). The age and operation method were associated with CRF in thephaseofoperation(age t=7.365, P=0.003; operation method t=5.166, P=0.009), chemotherapy (age t=9.835, P=0.000; operation method t=3.313, P=0.025) and radiotherapy (age t=9.014, P=0.000;operation method t=10.392, P=0.000). Conclusions There is a certain difference with CRF of breast cancer patients at different stage of rehabilitation treatment. There are two factors that could affect CRF such as age and operation method in the whole rehabilitation treatmentperiod.

Objective To investigate the level of cancer-related fatigue (CRF) and its trajectory in three different periods including operation,chemotherapy,and radiotherapy among breast cancer patients,in order to provide references for clinical intervention during comprehensive treatment period.Methods By convenience sampling method,242 cases of patients diagnosed with breast cancer who are prepared for breast cancer resection,prepared to be treated with adjuvant chemotherapy and radiotherapy,and conformed to the sample standard from a tumor hospital and two affiliated hospitals of medical college from February 2014 to November 2015 in a city were selected as the research object. The follow-up survey of CRF was conducted respectively in the three different point-in-time for one week after operation,and at the end of chemotherapy and radiotherapy in order to analyze variation characteristics of CRF during comprehensive treatment period.Results In operation period,the fatigue of breast cancer patients was mild,the average scores was (2.59±2.41) and approximately 76% patients experienced fatigue to low-grade degree;After chemotherapy,the fatigue level of patients was significantly increased (6.57±2.43),and 75.2% patients were accounted for severe fatigue;After radiotherapy, the fatigue level of patients (4.38±2.46) was slightly declined compared with that in chemotherapy period,but it was still higher than that in the operation period. and 57% patients suffered from moderate fatigue. During the whole treatment period,the level for general fatigue and four dimensions of fatigue were in the unstable state of "wave" of fluctuations with mild,severe,moderate (F=43.16,P<0.001).Conclusions There is a certain difference with CRF of breast cancer patients at different stage of comprehensive treatment. CRF in operation period is mild,in radiotherapy period is moderate and in chemotherapy period is severe. We should actively focus on the changes of CRF in order to take timely intervention.

OBJECTIVETo assess the impact of metabolic syndrome(MS) on Framingham risk score(FRS) in patients with type 2 diabetes mellitus (T2DM).

METHODSThe anthropometric and biochemical data of 1708 patients with T2DM admitted in hospital from May 2008 to April 2013 were retrospectively analyzed, including 902 males and 806 females with a mean age of 57.1±11.8 years (20-79 years). Diagnosis of MS was made according to the criteria of the Adult Treatment Panel Ⅲ Criteria modified for Asians.

RESULTSCompared to non-MS/T2DM patients, MS/T2DM patients had higher waist circumference, body weight, body mass index, systolic and diastolic blood pressure, fasting C peptide, total cholesterol, triglyceride, and LDL-C (P<0.05), while lower HDL-C (P<0.01). Both FRS [13.0(10.0, 15.0) vs 11.0(9.0, 13.0) in male,15.0(12.0, 18.0) vs 12.0(6.0, 14.8) in female,P<0.01)] and 10-year cardiovascular risk [12.0%(6.0%, 20.0%) vs 8.0%(5.0%,12.0%) in male,3.0%(1.0%, 6.0%) vs 1.0%(0.0%, 2.8%) in female,P<0.01] were higher in MS/T2DM patients than those in non-MS/T2DM patients.Both FRS and 10-year cardiovascular risk were increased with the components of MS.

CONCLUSIONT2DM patients with MS have more cardiovascular risk factors, higher FRS and 10-year cardiovascular risk.

Objective To explore the influence of the old Chinese national match the experience of haplostele liters of blood prescription of chemotherapy for colorectal cancer patients with immune function and bone marrow suppression .Methods 94 cases of metastatic nodes in patients with rectal cancer treated in our hospital from February 2011 to June 2015 were selected as the re‐search object ,and were randomly divided into observation group and control group according to different regimen in the treatment , with 47 cases in each group .Patients in control group was treated with conventional XELON chemotherapy ,and patients in the ob‐servation group recieved rise blood prescription treatment based on the chemotherapy in the control group .The immune function and bone marrow suppression situation in both groups were observed after two treatment cycles .Results The stable rate of the obser‐vation group was 42 .55% ,significantly higher than that of the control group (P<0 .05);the CD4+ /,CD8+ CD8+ and NK cells were significantly higher than those in the control group (P<0 .05) ,while those of the control group was significantly higher than that in control group (P>0 .05);the CD4+ /,CD8+ CD8+ and CD4+ /cells were significantly higher than those in control group (P<0 .05);The incidence rate of KPS in the observation group and control group was 70 .21% ,70 .21% ,17 .02% ,14 .89% , 87 .23% ,25 .53% and 23 .40% respectively .The KPS score of the observation group and the control group were significantly higher than that in control group (P<0 .05) ,and the G‐CSF in the observation group was significantly higher than that in control group (P<0 .05) .Conclusion The treatment of advanced metastatic colorectal cancer patients in the course of chemotherapy to give rise to blood formula can effectively improve the patient′s immune function ,reduce the bone marrow suppression effect ,improve the quality of life ,and it is worthy of clinical application .

Objective To explore the influence of levothyroxine(L-T4) in the treatment of primary hypothyroidism on myocardial enzymes and lipids.Methods 78 patients with primary hypothyroidism were selected and treated with L-T4 for 12 weeks.The fasting serum levels promote thyroid hormone(TSH),free T3 (FT3),free T4 (FT4),total cholesterol (TC),triglycerides (TG),low-density lipoprotein cholesterol (LDL-C),aspartate aminotransferase enzyme (AST),creatine kinase (CK) and its isoenzyme (CK-MB),lactate dehydrogenase(LDH) were monitored and analyzed before and after treatment.Results After L-T4 treatment for 12 weeks,compared with before treatment,TSH,TC,TG,LDL-C,CK,CK-MB,LDH,AST were significantly decreased or restored (t =10.5223,26.8498,22.7699,16.2735,22.9329,13.1910,32.0907,22.9597,all P ＜ 0.01).The FT3 was negatively correlated with TG (r =-0.3782),LDL-C(r =-0.3506),AST(r =-0.2843),LDH(r =-0.2974),CK(r =-0.3726) (all P ＜ 0.01)and CK-MB(r =-0.2559) (P ＜ 0.05).FT4 was negatively correlated with TC (r =-0.2660),TG (r =-0.4661),LDL-C(r=-0.5119),LDH(r=-0.5936),CK(r=-0.4877),CK-MB(r=-0.5463) (all P＜0.01)and AST(r =-0.2328) (P ＜0.05).TSH was positively correlated with TC(r =0.5341),TG(r =0.7567),LDL-C(r =0.8240),AST (r =0.3923),LDH (r =0.8073),CK (r =0.9661),CK-MB (r =0.7336) (all P ＜0.01).TSH had,the best correlationship with CK (r =0.9661).Conclusion L-T4 can significantly improve the thyroid function and reduce the blood lipids,myocardial enzymes levels of patients with primary hypothyroidism.

ObjectiveTo unify the definitions of colonoscopic characteristics of Crohn disease (CD) and intestinal tuberculosis ( ITB),and to evaluate colonoscopic and clinical features in the differential diagnosis of CD and ITB.MethodsA collaborative group composed of 10 experts from 5 hospitals voted to identify and confirm the colonoscopic characteristics.Clinical and colonoscopic characteristics were analyzed,thereafter,characteristics were scored based on different diagnostic specificity.ROC curve was used for determining the cutoff point to differentiate CD from ITB.ResultsFirstly,standard endoscopic images and descriptions were determined.Secondly,colonoscopic parameters which were significantly different between the CD and ITB patients included the follows:involvement of more than four intestinal segments,anorectal involvement,longitudinal ulcers,cobblestone appearance and transverse ulcers.Clinical findings which were significantly different between the CD and ITB patients included active pulmonary tuberculosis,PPD-test strong positive,anal fistula/perianal abscess and extra-intestinal manifestations in CD.4.4％(6/136) patients were confirmed by histological evidence of caseating granulomas.By using our scoring system,39.7％ (54/136) confirmed diagnoses and 18.4％ (25/136) suspected diagnoses were made in patients without histological evidence.ConclusionIdentification of colonoscopic characteristics and unification of the colonscopic diagnostic criteria were helpful in the differential diagnosis between CD and ITB.The differential diagnosis rate could he improved by using the scoring system.Half cases could not be confirmed even with combined pathology and the scoring system,so a more comprhensive scoring system would be warranted.

Objective To investigate the outcome of postoperative hypopituitarism and hormone replacement in patients with pituitary adenoma,and to analyze the potential factors related to postoperative hypopituitarism.Methods A total of 215 postoperative patients with pituitary adenoma were analyzed.Pituitary functions( including gonadal,thyroid,and adrenal axes ) were asessed by strict criteria.Data of surgery history and hormone replacement situation were collected for statistical analysis.Results The prevalence of hypopituitarism was 54.0％,including 36.7％ hypogonadism,32.6％ hypothyroidism,and 28.4％ hypoadrenalism.Replacements of gonadal steroid,glucocorticoid,and thyroxine were carried out in 25.6％,84.3％,and 80.6％ of the cases,respectively.Univariate analysis showed that male sex and large tumor were related to hypopituitarism. Conclusion After pituitary adenomectomy,approximately half of the patients present anterior pituitary dysfunction,while quite a number of them have not been treated appropriately.