Alzheimer's disease(AD)is an irreversible neurodegenerative disorder,making early screening and diagno-sis pivotal for its effective treatment.The complexity of diagnosing AD,however,poses significant challenges for primary-level screening.As an extension of the central nervous system,the retina exhibits changes closely linked to AD,offering a new pathway for non-invasive early detection of AD.In recent years,deep learning(DL)has achieved notable advance-ments in the medical field,especially in image recognition and analysis.The synergy between DL and retinal imaging has unveiled substantial potential in diagnosing and treating AD.This article reviews the advancements in applying DL to ana-lyze retinal images related to AD,encompassing the diagnosis,prediction of progression,and long-term management of AD,as well as the current shortcomings in clinical practice,providing a reference for further research into the application of DL in retinal imaging for AD.

Objective Study on the reduction of false positive interference in the detection of human immunodeficiency virus(HIV)by chemiluminescence method with polyethylene glycol(PEG)precipitation.Methods A total of 109 outpatients and inpatients in Ningbo Medical Center,Lihuili Hospital from January to June 2022 were selected.The positive samples initially screened by chemiluminescence method were confirmed by Western blotting,and 20 true positive samples and 89 false positive samples were confirmed.According to whether treatment agent was added,the false-positive samples were divided into three groups:no PEG precipitation group(no special treatment,89 cases),PEG precipitation group(PEG precipitation treatment,89 cases)and control group(normal saline treatment,89 cases).The level of HIV antigen/antibody(Ag/Ab)in supernatant was measured after centrifugation,and the difference of HIV Ag/Ab level and recovery rate before and after different treatment methods were compared.Results After intervention,the HIV Ag/Ab concentration in PEG precipitation group and control group was significantly lower than that in non-PEG precipitation group(P<0.001).After intervention,there were 3 positive cases in PEG precipitation group and 56 positive cases in control group,and the positive rates were significantly lower than those in non-PEG precipitation group(P<0.001).The recovery rate of PEG precipitation group was 4.92(2.12,12.69)%,and that of control group was 65.28(18.04,91.28)%.The recovery rate of true positive samples was>50%regardless of PEG treatment or normal saline treatment.Conclusion PEG precipitation method can effectively reduce the false positive interference of chemiluminescent HIV fourth-generation reagent detection,and has no effect on true positive samples.

Objective To analyze the changes of immune indicators in patients with systemic lupus erythematosus(SLE)and explore their correlation with lupus nephritis(LN).Methods A total of 109 SLE patients treated in Affiliated Lihuili Hospital of Ningbo University from November 2021 to October 2023 were retrospectively included in SLE group,SLE patients were divided into LN group(56 cases)and non-LN group(53 cases)according to whether they were diagnosed with LN or not.32 healthy people who underwent physical examination in the hospital during the same period were included in healthy control group.The immune indicators of subjects were detected,and the clinical data and the scores of systemic lupus erythematosus disease activity index 2000(SLEDAI-2000)were collected.Spearman correlation method was used to analyze correlation between SLEDAI-2000 scores and immune indicators in SLE patients.Multivariate Logistic regression was used to analyze the influencing factors of LN in SLE patients.Results The total lymphocyte count,T cell count,natural killer(NK)cell count,B cell count,helper T(Th)cell proportion,NK cell proportion,B cell proportion,immunoglobulin(Ig)M,complement C3 and complement C4 in SLE group were significantly lower than those in healthy control group(P<0.05),T cell proportion,suppressor T(Ts)cell proportion and anti-double-stranded DNA antibody IgG were significantly higher than those in healthy control group(P<0.05).SLEDAI-2000 scores in SLE group were negatively correlated with NK cell count,B cell count and NK cell proportion(P<0.05),and were positively correlated with T cell proportion and Ts cell proportion(P<0.05).The NK cell count,B cell count,NK cell proportion and B cell proportion in LN group were significantly lower than those in non-LN group(P<0.05),T cell proportion,anti-double-stranded DNA antibody IgG and SLEDAI-2000 scores were significantly higher than those in non-LN group(P<0.05).Multivariate Logistic regression analysis showed that NK cell count and SLEDAI-2000 scores were all factors influencing the development of LN in SLE patients(P<0.05).Conclusion Immune indicators have the ability to evaluate the disease status of SLE patients.SLE patients with decreased NK cell count and increased SLEDAI-2000 scores are more likely to develop LN.

Objective:To observe the clinical efficacy of Qigui Tangtongning Granules in the treatment of diabetic peripheral neuropathy (DPN) with qi deficiency and blood stasis.Methods:Prospective cohort study. A total of 80 DPN patients with Qi deficiency and blood stasis in Endocrinology Department of the First Affiliated Hospital of Anhui University of Chinese Medicine from May 2021 to May 2022 who met the inclusion criteria were divided into 2 groups by random number table method, with 40 cases in each group. The control group was treated with epalrestat on the basis of routine hypoglycemia, and the treatment group was treated with Qigui Tangtongning Granules on the basis of control group. Both groups were treated for 8 weeks. TCM syndromes were scored before and after treatment. Disease severity was assessed using the Toronto Clinical Scoring System (TCSS). The motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of median nerve and common peroneal nerve were detected by electromyography/induced potentiometer. Serum CRP, TNF-α and IL-6 were detected by ELISA, fasting blood glucose (FPG) and two hours post-meal blood glucose (2 hPG) were detected by automatic biochemical analyzer, and glycosylated hemoglobin (HbA1c) was detected by automatic HBA1C analyzer. Adverse reactions were recorded and clinical efficacy was evaluated.Results:The total effective rate was 95.0% (38/40) in the treatment group and 77.5% (31/40) in the control group, the difference between the two groups was statistically significant ( χ2=5.17, P=0.023). After treatment, the TCM syndrome score and TCSS score of the treatment group were significantly lower than those in the control group ( t=-3.19 and -7.63, P<0.01); Median nerve SNCV [(47.90±4.51) m/s vs. (44.76±3.72) m/s, t=3.40], MNCV [(53.79±3.65) m/s vs. (51.32±4.25) m/s, t=2.79] and common peroneal nerve SNCV [(44.21±2.08) m/s vs. (40.51±2.49) m/s, t=7.23], MNCV [(44.63±4.72) m/s vs. (41.36±4.87) m/s, t=3.05] were significantly higher than those in the control group ( P<0.01); FPG [(5.05±0.63) mmol/L vs. (7.05±1.23) mmol/L, t=-9.17], 2 hPG [(9.10±1.64) mmol/L vs. (12.19±2.61) mmol/L, t=-6.35], HbA1c [(6.79±0.90) % vs. (7.22±1.02) %, t=-2.02] were significantly lower than those in the control group ( P<0.01 or P<0.05); TNF-α [(15.75±5.44) ng/L vs. (32.01±5.33) ng/L, t=-13.51], hs-CRP [(2.58±0.80) mg/L vs. (3.79±1.04) mg/L, t=-5.83], IL-6 [(18.20±4.92) ng/L vs. (29.97±5.18) ng/L, t=-10.41] were significantly lower than those in the control group ( P<0.01). No obvious adverse reactions were observed in 2 groups during treatment. Conclusion:Qigui Tangtongning Granules combined with conventional Western medicine can improve nerve conduction velocity, reduce inflammation and improve clinical efficacy in DPN patients with Qi-deficiency and blood-stasis syndrome.

Objective:To compare serum procalcitonin and fibrinogen degradation product levels between type 2 diabetes mellitus patients with Escherichia coli bloodstream and urinary tract infections. Methods:The clinical data of 82 type 2 diabetes mellitus patients with Escherichia coli infections who received treatment between December 2014 and December 2019 in the First Affiliated Hospital of Datong University (The Fifth People's Hospital of Datong) were retrospectively analyzed. These patients were assigned to bloodstream infection ( n = 40) and urinary tract infection ( n = 42) according to the way of Escherichia coli infection. Serum procalcitonin and fibrinogen degradation product levels, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein, white blood cell count, D-Dimer level, antithrombin III activity, and electrolytes were determined and compared between the two groups. Correlation between procalcitonin and other variables was analyzed. Multiple linear regression analysis was performed with procalcitonin level as a dependent variable and other relevant indexes as independent variables. Results:Body temperature, white blood cell count, neutrophil count, monocyte count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, procalcitonin level, C-reactive protein level, fibrinogen degradation product level, and D-Dimer level in the bloodstream injection group were (39.49 ± 0.64) ℃, (14.92 ± 11.78) × 10 9/L, (13.39 ± 11.60) × 10 9/L, (0.72 ± 0.36) ×10 9/L, (14.86 ± 10.52), (199.15 ± 160.69), (22.81 ± 17.86) μg/L, (133.44 ± 63.63) mg/L, (49.71 ± 41.44) mg/L, (16.56 ± 12.20) mg/L, respectively, which were significantly higher than those in the urinary tract infection group [(37.12 ± 1.20) ℃, (9.04 ± 3.95) × 10 9/L, (6.25 ± 4.02) × 10 9/L, (0.42 ± 0.29) × 10 9/L, (3.67 ± 3.34), (120.01 ± 44.08), (4.46 ± 8.69) μg/L, (39.22 ± 22.16) mg/L, (3.81 ± 3.41) mg/L, (0.84 ± 0.75) mg/L), t = 7.356, 2.578, 3.162, 2.958, 5.538, 2.591, 2.810, 4.825, 2.902, 2.375, all P < 0.05]. Platelet count, lymphocyte count, blood sodium level and antithrombin Ⅲ activity in the bloodstream infection group were (167.50 ± 104.93) × 10 9/L, (1.06 ± 0.58) × 10 9/L, (130.89 ± 6.50) mmol/L, (57.88 ± 16.28)% , which were significantly lower than those in the urinary tract infection group [(239.40 ± 82.52)× 10 9/L, (2.14 ± 0.71) × 10 9/L, (138.46 ± 5.96) mmol/L, (90.11 ± 8.90)%, t = -2.853, -6.313, -4.046, -7.350, all P < 0.05]. Correlation analysis revealed that serum procalcitonin level was positively correlated with body temperature ( r = 0.387), white blood cell count ( r = 0.355), neutrophil count ( r = 0.368), C-reactive protein ( r = 0.605), fibrinogen degradation product level ( r = 0.616), D-Dimer level ( r = 0.486) (all P < 0.05), and it was negatively correlated with sodium level ( r = -0.319) and antithrombin Ⅲ activity ( r = -0.465) (both P < 0.05). Multiple linear regression analysis results revealed that fibrinogen degradation product level and body temperature were greatly correlated with procalcitonin level. Conclusion:Inflammatory indicators procalcitonin level, body temperature, white blood cell count, neutrophil count, C-reactive protein, fibrinogen degradation product level and D-Dimer level were remarkably higher in type 2 diabetes mellitus patients with Escherichia coli bloodstream infection than those in type 2 diabetes mellitus patients with Escherichia coli urinary tract infection. Procalcitonin level was greatly correlated with body temperature and fibrinogen degradation product level.

Objective:To investigate the relationship between procalcitonin(PCT) and insulin resistance in diabetic foot infection.Methods:Sixty patients with diabetic foot infection hospitalized in the Fifth People's Hospital of Datong from March 2015 to March 2017 were selected and divided into three groups according to the value of PCT: slightly elevated group(L group, n=18), moderately elevated group(M group, n=21), highly elevated group(H group, n=21). Another 20 patients with type 2 diabetes mellitus were collected as control group.The PCT, C-reactive protein(CRP), white blood cell count(WBC), fasting and postprandial blood glucose, fasting insulin and insulin resistance index(HOMA-IR) were calculated and compared. Results:In the control group, the levels of PCT, HOMA-IR, CRP and WBC were (0.14±0.12)μg/L, (17.70±8.86), (32.90±24.19)mg/L, (8.01±2.21)×10 9/L, respectively, which in the L group were (0.31±0.14)μg/L, (20.42±9.71), (50.85±27.81)mg/L, (9.95±3.35)×10 9/L, respectively, which in the M group were (1.11±0.52)μg/L, (24.08±14.09), (64.31±40.21)mg/L, (10.86±2.25)×10 9/L, respectively, which in the H group were (5.31±3.04)μg/L, (31.73±14.13), (72.29±50.26)mg/L, (12.51±5.51)×10 9/L, respectively, and there were statistically significant differences among the four groups( F=50.744, 5.195, 4.303, 5.252, all P<0.01). With the increase of PCT, the levels of WBC, CRP and HOMA-IR were increased, and HOMA-IR was positively correlated with PCT( r=0.265, P=0.017). Conclusion:Serum level of PCT has correlation with infection degree of diabetic foot and is positively correlated with insulin resistance.

Objective:To investigate the clinical characteristics of different stages of type 2 diabetic nephropathy(DN), and to explore the possible factors affecting visceral fat area (VFA).Methods:From September 2018 to March 2019, 464 patients with type 2 diabetes who were hospitalized in the First Affiliated Hospital of Datong University were selected.Among them, 315 patients with urinary albumin/creatinine ratio(UACR)<30 mg/g were selected as normal proteinuria group, 72 patients with UACR 30-299 mg/g were selected as microalbuminuria group, 45 patients with UACR>300 mg/g were selected as massive proteinuria group, and 32 patients with serum creatinine higher than the reference value were selected as renal failure group.The serum creatinine of the first three groups was in the normal range.The clinical data of these patients such as blood pressure, body mass index(BMI), VFA, subcutaneous fat area(SFA), brachial-ankle pulse wave velocity(BAPWV), blood lipid, renal function and blood sugar were collected and compared among the four groups.Using VFA as strain and other indicators as independent variables, multivariate linear regression analysis was carried out.Results:There were statistically significant differences among the four groups in age, height, weight, BMI, head circumference, neck circumference, waist circumference, hip circumference and waist-hip ratio ( F=15.580, 4.679, 6.186, 3.553, 3.153, 2.689, 5.170, 3.114, 3.535, all P<0.05). The VFA of the normal proteinuria group, microalbuminuria group, massive proteinuria group and renal failure group were (102.25±37.09)cm 2, (104.12±40.93)cm 2, (119.63±48.82)cm 2, (110.54±41.58)cm 2, respectively, and the BAPWV were (1 546.97±330.18)cm/s, (1 595.52 ±381.27)cm/s, (1 459.63±285.61)cm/s, (1 703.89±318.64)cm/s, the differences were statistically significant among the four groups( F=3.344, 4.020, all P<0.05). There were statistically significant differences in alanine aminotransferase, creatinine, uric acid, total cholesterol, red blood cell, hemoglobin, ratio of neutrophils to lymphocytes (NLR) and ratio of platelets to lymphocytes (PLR) among the four groups ( F=3.405, 15.535, 6.552, 2.803, 6.158, 15.580, 3.764, 3.262, all P<0.05). With VFA as strain, multivariate linear regression analysis showed that waist circumference, BMI, TG and BAPWV were risk factors for VFA. Conclusion:DN is associated with multiple obesity-related indicators and inflammatory indicators such as NLR, PLR; VFA is associated with BAPWV.

Objective:To conduct reliability and validity test of Chinese versions of TeamSTEPPS medical teamwork perceptions questionnaire and TeamSTEPPS medical teamwork attitudes questionnaire so as to evaluate whether they are applicable to the current situation of medical teamwork in China.Methods:From January to April 2019, the Chinese versions of TeamSTEPPS teamwork perceptions questionnaire and TeamSTEPPS teamwork attitudes questionnaire were used to evaluate 900 emergency department workers in 9 ClassⅢGrade A hospitals in Shanghai by cluster sampling, and reliability and validity of the questionnaires were analyzed and evaluated. In this study, a total of 900 questionnaires were issued, 870 were recovered and 861 were valid, with an effective recovery rate of 96%.Results:The exploratory factor analysis of the Chinese versions of Chinese versions of TeamSTEPPS medical teamwork perceptions questionnaire and TeamSTEPPS medical teamwork attitudes questionnaire was carried out to extract the five dimensions of team structure, leadership, situation monitoring, mutual assistance and communication. The cumulative variance contribution rates were respectively 71.248% and 71.010%. In addition, a confirmatory factor analysis was performed on the questionnaires. The Chi-square degrees of freedom ratio (χ 2/ df) values were 2.870 and 2.214, normed fitting index ( NFI) values were 0.861 and 0.906, Tucker-Lewis index values were 0.896 and 0.940, incremental fit index ( IFI) values were 0.905 and 0.946, comparative fit index (CFI) values were 0.904 and 0.946, and root mean square error of approximation ( RMSEA) values were 0.066 and 0.053. The fitting values all reached the judgment standard, and the structural validity of the two questionnaires was good. The content validity indexes were good and they were respectively 0.94 and 0.95. The overall Cronbach's α coefficients of TeamSTEPPS medical teamwork perceptions questionnaire and TeamSTEPPS medical teamwork attitudes questionnaire were respectively 0.949 and 0.938, the split-half reliability was respectively 0.848 and 0.959, and the test retest reliability were respectively 0.959 and 0.964. Conclusions:The Chinese versions of TeamSTEPPS medical teamwork perceptions questionnaire and TeamSTEPPS medical teamwork attitudes questionnaire have good reliability and validity and high applicability, which can be used to measure the attitude and perceptions of medical teamwork in China.

Objective: To study the clinical effect of fasudil plus cattle encephalon glycoside and ignotin injection in treating diabetic deafness and tinnitus. Methods: From January 2016 to December 2016, 60 patients with diabetic deafness and tinnitus in the Fifth People's Hospital of Datong were selected and randomly divided into two groups according to the digital table, with 30 cases in each group.The treatment group received fasudil injection plus cattle encephalon glycoside and ignotin injection (iv gtt), and the control group received cattle encephalon glycoside and ignotin injection.The effective rate after treatment for 10 days and 20 days were compared between the two groups. Results: Compared with the control group, the effective rate of hearing in the treatment group was not higher at 10 days after treatment (26.7% vs.16.7%, χ²=0.884, P=0.347), while it was higher in the treatment group at 20 days after treatment (53.3% vs.26.7%, χ²=4.444, P=0.035). The effective rate of tinnitus in the treatment group at 10 days after treatment was not higher compared with the control group (30.0% vs.20.0%, χ²=1.491, P=0.222), while it was higher in the treatment group at 20 days after treatment (56.7% vs.30.0%, χ²=4.344, P=0.037). As far as hearing threshold: there were no statistically significant differences between the control group and the observation group before treatment and 10 days after treatment(all P>0.05). The hearing threshold of the observation group was significantly better than that of the control group at 20 days after treatment (t=-2.511, P=0.02). Conclusion The combination therapy of fasudil injection plus cattle encephalon glycoside and ignotin injection has better efficacy for diabetic deafness and tinnitus.

Objective To discuss the surgical treatment of anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA) and the risk factors of postoperative recovery in infants and children.Methods A retrospective review of all patients who underwent surgical treatment of ALCAPA in Shanghai Children Medical Center(2003.1-2018.1) was conducted.Patients were divided into early surgery group (2003.1-2012.12) and late surgery group (2013.1-2018.1) according to the operation time,a preoperative left ventricular ejection fraction(LVEF) ＜0.35 was defined as severe group and LVEF≥0.35 as the control group in both surgery group.Meantime,and the clinical data among the groups were analyzed and compared.Results 102 patients were included in our study.According to the operation time and preoperative LVEF grouping:10 cases in the early severe group,early death in 4 cases(40％);28 cases in the early control group,and 3 cases died(10.7％)in hospital.Preoperative LVEF(0.29 ± 0.06 vs.0.53 ± 0.12),surgical age [(8.0 ± 7.9) months vs.(23.3 ± 27.7)months],and cardiopulmonary bypass time [(131.1 ± 39.6) min vs.(103.8 ± 29.8) min] were statistically different between the early two groups.The results of the late surgery had been improved:24 cases in the late severe group,4 cases died in hospital(16.7％);40 cases in the late control group,and early death in 2 cases (5％).In the late surgery groups,there was a statistically significant difference in preoperative LVEF(0.28 ±0.05 vs.0.59 ±0.12),left ventricular end-diastolic diameter(LVDD) Z-score(3.09 ±1.16 vs.2.11 ±0.95),and surgical age [(5.3 ±3.0) months vs.(24.8 ±30.5)months],clamping time [(67.1 ± 15.5) min vs.(82.7 ± 28.4) min].In the severe group,there was no significant difference in preoperative clinical data between early and late patients,and the early mortality decreased from 40％ in the early period to 16.7％ in the late period.In this study,13 cases(38.2％) of children with severe ALCAPA underwent mechanical circulation support(MCS).One patient died during MCS support and 2 died after weaning.Conclusion The early mortality severe ALCAPA remains high,which may be related to severe cardiac ischemia,left ventricular enlargement and age at surgical time.The modify of surgery technology and the use of MCS in the early clinical stage can improve the early survival rate.