ObjectiveThis study aims to construct a semantic segmentation-based auxiliary diagnostic model for thyroid eye disease (TED) focusing on eyelid retraction, eye movement disorders, ocular inflammation related to Clinical Activity Score (CAS), facilitating rapid and non-invasive diagnosis for suspected TED patients and enhancing the efficiency of treatment and diagnosis.MethodsData were collected from 153 subjects exhibiting symptoms of eyelid retraction, eye movement disorders, and ocular inflammation related to CAS. After quality screening, datasets for the primary position (303 eyes), gaze positions (1,199 eyes), and a multi-label inflammatory classification dataset (272 eyes) were constructed. The constructed TBRM-Net adopts a dual-branch feature extraction and fusion strategy to extract inflammation features for multi-label classification and recognition; the constructed DSR-Net performs segmentation of ocular structures and has designed a quantitative diagnostic algorithm.ResultsThe semantic segmentation-based auxiliary diagnostic model for TED demonstrated a mean pixel accuracy (MPA) of 94.1% in the primary position dataset and 95.0% in the gaze positions dataset. The accuracy for diagnosing eye movement disorders, upper eyelid retraction, and lower eyelid retraction reached 85.4%, 95.1%, and 87.0%, respectively. The accuracy for Redness of Eyelids, Swelling of Eyelids, Redness of Conjunctiva, Swelling of Conjunctiva, and Swelling of Caruncle or Plica reaches 81.8%, 78.8%, 90.6%, 73.5%, and 83.9%, respectively, with an average accuracy of 81.7%. Segmenting and classifying images of structures affected by ocular inflammation can effectively exclude interfering features. The designed quantitative algorithm provides greater interpretability than existing studies, thereby validating the effectiveness of the diagnostic system.ConclusionThe deep learning-based auxiliary diagnostic model for TED established in this study exhibits high accuracy and interpretability in the diagnosis of ocular inflammation related to CAS, eyelid retraction, and eye movement disorders. It holds significant medical value in assisting doctors in formulating treatment plans and evaluating therapeutic effects.

BackgroundThyroid-associated ophthalmopathy (TAO) is the most prevalent autoimmune orbital condition, significantly impacting patients’ appearance and quality of life. Early and accurate identification of active TAO along with timely treatment can enhance prognosis and reduce the occurrence of severe cases. Although the Clinical Activity Score (CAS) serves as an effective assessment system for TAO, it is susceptible to assessor experience bias. This study aimed to develop an ensemble deep learning system that combines anterior segment slit-lamp photographs of patients with facial images to simulate expert assessment of TAO.MethodThe study included 156 patients with TAO who underwent detailed diagnosis and treatment at Shanxi Eye Hospital Affiliated to Shanxi Medical University from May 2020 to September 2023. Anterior segment slit-lamp photographs and facial images were used as different modalities and analyzed from multiple perspectives. Two ophthalmologists with more than 10 years of clinical experience independently determined the reference CAS for each image. An ensemble deep learning model based on the residual network was constructed under supervised learning to predict five key inflammatory signs (redness of the eyelids and conjunctiva, and swelling of the eyelids, conjunctiva, and caruncle or plica) associated with TAO, and to integrate these objective signs with two subjective symptoms (spontaneous retrobulbar pain and pain on attempted upward or downward gaze) in order to assess TAO activity.ResultsThe proposed model achieved 0.906 accuracy, 0.833 specificity, 0.906 precision, 0.906 recall, and 0.906 F1-score in active TAO diagnosis, demonstrating advanced performance in predicting CAS and TAO activity signs compared to conventional single-view unimodal approaches. The integration of multiple views and modalities, encompassing both anterior segment slit-lamp photographs and facial images, significantly improved the prediction accuracy of the model for TAO activity and CAS.ConclusionThe ensemble multi-view multimodal deep learning system developed in this study can more accurately assess the clinical activity of TAO than traditional methods that solely rely on facial images. This innovative approach is intended to enhance the efficiency of TAO activity assessment, providing a novel means for its comprehensive, early, and precise evaluation.

甲状腺相关性眼病(TAO),又称格雷夫斯(Graves)眼病,是一种以眼球突出、结膜水肿、眼睑退缩、眼球运动障碍、视力下降等为临床特点的自身免疫性疾病.由于本病的发病机制尚不完全清晰,治疗方法各异,多采用糖皮质激素冲击治疗、放射治疗及其他辅助治疗,但不良反应的问题不可忽视.中医在治疗上秉持辨证论治的观点,采用中药汤剂、针灸等多种治疗方式,显示出特有优势.目前,中医药对于甲状腺相关性眼病的辨证分型、分期还未做出统一标准,中药组方的作用机制尚在探索,应建立相关动物模型,进行相关的动物实验研究,以期为临床开展相关工作提供参考.

Thyroid-associated ophthalmopathy (TAO) leads a significant negative impact on patients' quality of life, mental health and community economy. Treatment in the early active stage of the disease will achieve better efficacy. At present clinical activity score (CAS) is the mainly method of judging disease activity, but it has many shortcomings. Recent studies have suggested that 99Tc m-diethylene triamine pentaacetic acid (DTPA) orbital SPECT/CT shows important value in the early diagnosis, treatment and follow-up of TAO. It can complement with CAS and has a broad application prospect. The authors summarize the current research progress in this field and highlight the need for more research to establish a standardized consensus on collection method and result analysis. Investigating a new tool to judge disease activity which can combine 99Tc m-DTPA orbital SPECT/CT with the artificial intelligence will more accurately and conveniently guide the clinical practice.

目的 观察冻融胚胎过夜培养后卵裂球增长及胚胎继续发育情况与患者临床妊娠率、种植率及早期流产率的关系.方法 回顾性分析2018年1月至2019年3月在西安市第四医院生殖医学中心进行冻融胚胎移植患者的536个周期,依照移植的2枚胚胎过夜培养后(18～20h)有无卵裂球增长分为A2组(n=425)、A1组(n=89)、A0组(n=22).再根据2枚胚胎均有卵裂球生长的A2组的卵裂球增长的数目及发育情况将其进一步分层为aa组、ab组、ac组、bb组和cc组5个小组,观察各组的临床妊娠率、胚胎种植率及流产率,统计分析各组的差异.结果 ①A2组、A1组、A0组的临床妊娠率分别为60.9％、36.0％、9.1％,差异有统计学意义(χ2=37.76,P<0.05);3组的胚胎种植率分别为41.1％、21.3％、4.5％,差异有统计学意义(χ2=44.73,P<0.05);3组的早期流产率差异无统计学意义(P>0.05).②aa组的临床妊娠率(70.1％vs 50.9％)和胚胎种植率(49.2％vs 26.4％)均显著高于ac组,χ2值分别为5.976、15.906,P<0.05;ab组的胚胎种植率(44.5％)显著高于ac组(26.4％),χ2=9.839,P<0.05.③aa组的临床妊娠率(70.1％v s 36.8％)和胚胎种植率(49.2％v s 26.3％)均显著高于cc组,χ2值分别为8.108、6.971,P<0.05;bb组的流产率(7.5％)显著低于cc组(42.9％),χ2=3.890,P<0.05.结论 冻融胚胎过夜培养后移植2个以上卵裂球均有增长,尤其是已经发生致密化、融合或者形成早期囊胚的胚胎,能获得较高的临床妊娠率、胚胎种植率和较低的流产率;单胚胎移植时可优先选择过夜培养后胚胎已经致密化、融合或者形成早期囊胚的胚胎.

玉环市自实施县域医共体建设以来,在医保部门指导下基于医保支付方式改革进行探索分级诊疗的实施路径,通过服务模式和管理模式的优化,运用医保总额预算管理、建立"结余适当留用、超支合理分担"机制、门诊病人结合家庭医生签约服务按人头包干付费、住院服务按疾病诊断相关分组(DRG)、统筹区差别化报销等政策手段,为有效促进分级诊疗制度的落地提供支撑.

泪点开口的膜闭是泪溢常见的病因之一,主要由眼部炎症、外伤,泪道肿瘤、局部及全身药物毒性引起[1].近年,由于过敏性结膜炎的高发[2]及肿瘤患者全身化学治疗药物的普遍使用,使得泪点膜闭复发的概率增高.加之,既往的泪点三剪成形术破坏了泪点的解剖结构,术后泪点膜闭的复发不容忽视.有文献[3]报道,使用小梁咬切器环形咬切泪点处增殖膜并联合双泪小管置入式人工泪管治疗泪点膜闭,损伤小,不影响泪点环形结构,远期疗效好.随着丝裂霉素在眼科各个亚专业的的广泛用,其抗增殖、抗代谢作用及安全性得到验证[4].有望提高泪点手术的成功率.

Thyroid associated ophthalmopathy (TAO) is an organ specific autoimmune disease associated with autoimmune thyroid disease. Currently, the pathogenesis of TAO has not been completely determined, but oxidative stress has been found to have an important impact on the occurrence and development of TAO. The vicious cycle of inflammation and oxidative stress, the depletion of enzymatic antioxidant system and various environmental factors could induce the oxidative stress response of TAO, promote the proliferation of orbital fibroblasts and the expression of inflammatory mediators. The treatment of TAO patients with selenium and other antioxidants could improve the clinical symptoms by inhibiting oxidative stress. In this paper, the pathological changes, pathogenesis and antioxidant treatment of oxidative stress for TAO patients were reviewed.

甲状腺相关性眼病(TAO)的发病率在成人眼眶病中居于首位,病机不明,诊治困难,严重影响患者视力及生活质量.西医对TAO的治疗以对症治疗为主,包括以糖皮质激素及免疫抑制剂为主的药物治疗、局部放射治疗和手术治疗等,并发症及治疗副作用不容忽视,且部分患者存在疾病复发及加重的风险.中医学认为TAO属于"鹘眼凝睛"范畴,本病病位在肝,与脾肾密切相关,多因肝郁犯脾、痰瘀互结、气血郁滞所致.本研究组使用中西医结合治疗TAO,在减少糖皮质激素及免疫抑制剂的用量,改善眶周放射治疗后,患者眼部反应及全身免疫状态等方面有明显疗效,同时能提高TAO的治愈率并减少其复发率.TAO中西医结合的个性化治疗方案,对控制病情有一定的优势.

目的 就男性体质指数(BMI)对精子质量及性激素水平的影响进行Meta分析.方法 通过计算机检索CNKI、VIP、CBM、万方数据库及PubMed、Medline、EMBASE、Cochrane图书馆建库至2018年4月有关男性BMI与精子质量及性激素水平的文献,由2位研究者按照纳入和排除标准进行文献筛选、资料提取和质量评价,并采用RevMan5.3软件进行Meta分析.结果 共纳入7项队列研究,包括各种级别BMI的男性共15 256名.Meta分析结果显示:①超重组与正常体重组男性相比较,其促卵泡生成素(FSH)水平(WMD=-0.22,95％CI:-0.37～-0.07,P＜0.05)、促黄体生成素(LH)水平(WMD=-0.30,95％CI:-0.34～-0.25,P＜0.000 01)差异有统计学意义;②肥胖组与正常体重组相比较,其精子浓度(WMD=-5.83,95％ CI:-9.07～-2.59,P＜0.05)、前向运动精子百分率(WMD=-1.83,95％CI:-2.66～-0.99,P＜0.000 1)、总活力(WMD=-2.69,95％CI:-3.96～-1.42,P＜0.000 01)、LH水平(WMD=-0.30,95％CI:-0.34～-0.25,P＜0.000 01)差异有统计学意义.结论 对于超重人群,FSH、LH水平可能与BMI有一定关系;而对于肥胖人群,BMI的增高可能影响精子浓度、前向运动精子、总活力、LH水平与BMI有一定关系,从而影响生育能力.BMI可能是一个更全面,敏感的评价肥胖人群生育力的指标.

Objective To explore the relationship between vitamin D receptor (VDR) expression on fetal-maternal interface and recurrent miscarriage (RM) and placental hormone.Methods Villous and decidual tissue samples from patients with RM and those at normal early pregnancy were collected outpatient department of obstetrics and gynecology in the First Affiliated Hospital of Xi'an Jiaotong University from July to September in 2014.VDR, human chorionic gonadotropin receptor (HCGR), estrogen receptor (ER) and progesterone receptor (PR) mRNA levels in two groups were detected by fluorescence real-time quantitative polymerase chain reaction (FQ-PCR) and expression difference was compared

OBJECTIVE:To assess the effects of testicular sperm and epididymal sperm on the outcomes of ICSI for patients with obstructive azoospermia. METHODS:We searched PubMed, MEDLINE, EMBASE, Cochrane, CNKI, VIP, CBM, and Wanfang Database up to December 2015 for published literature relevant to ICSI with testicular or epididymal sperm for obstructive azoospermia patients. According to the inclusion and exclusion criteria, two reviewers independently conducted literature screening, data extraction and quality assessment of the included trials, followed by meta-analysis with the RevMan 5.3 software. RESULTS:A total of 14 studies were identified, involving 1 278 patients and 1 553 ICSI cycles. ICSI with epididymal sperm exhibited a significantly higher fertilization rate than that with testicular sperm (RR = 1.08, 95% CI 1.05－1.11, P<0.01). No statistically significant differences were observed between the epididymal and testicular sperm groups in the rates of cleavage (RR = 1.04, 95% CI 0.99－1.10, P = 0.13), good-quality embryo (RR = 1.01, 95% CI 0.93－1.09,P = 0.85), implantation (RR = 1.14, 95% CI 0.75－1.73, P = 0.55), clinical pregnancy (RR = 1.14, 95% CI 0.98－1.31, P = 0.08), and miscarriage (RR = 0.86, 95% CI 0.53－1.39,P = 0.54). CONCLUSIONS:ICSI with epididymal sperm yields a markedly higher fertilization rate than that with testicular sperm, but has no statistically significant differences from the latter in the rates of cleavage, good-quality embryo, implantation, clinical pregnancy, and miscarriage in the treatment of obstructive azoospermia.

Background Effects of vitamin D deficiency in pregnancy have been associated with some adverse pregnancy outcomes. The 25-hydroxyvitamin D3-1α-hydroxylase (CYP27B1) is integral to the vitamin D metabolic pathway. The enzyme catalyzes localized conversion of pro-hormone 25-hydroxyvitamin D3 to active 1,25-dihydroxyvitamin D3. Our aim was to investigate the expression of CYP27B1 at the fetal-maternal interface in the first trimester pregnancy and to determine whether CYP27B1 was associated with recurrent miscarriage (RM). Methods Expressions of CYP27B1 mRNA and protein in villi and decidua from 20 women undergoing primary miscarriage, 20 women with RM and 20 women with normal pregnancy were evaluated by western blot, and quantitative real-time PCR. The co-localization of CYP27B1 and certain cytokines including IL-10, IFN-γ, TNF-α, and IL-2 expression were examined using immunohistochemistry and confocal microscopy. Results Women with RM had a significantly lower expression of CYP27B1 mRNA and protein in villous and decidual tissues compared with the normal pregnant women (P = 0.000 in villus, P = 0.002 in decidua for mRNA; P = 0.036 in villus, P = 0.007 in decidua for protein.). Compared with the normal pregnancy, immunostaining for CYP27B1 was significantly decreased in villous trophoblasts and decidual glandular epithelial cells in RM women. No significant differences in the localization of CYP27B1, IL-10, IFN-γ, TNF-α, and IL-2 expression were identified between the normal pregnant and RM women. Conclusions Women with RM have a lower level of CYP27B1 expression in chorionic villi and decidua compared with normal pregnant women, suggesting that reduced CYP27B1 expression may be associated with RM. The consistent localization of CYP27B1 and IL-10, IFN-γ, TNF-α, and IL-2 expression in villous and decidual tissues suggests the importance of the local production of 1,25(OH)2D3 at the fetal-maternal interface to regulate cytokine responses.

The multiple functions of vitamin D-3 have stimulated interest in the role that this vitamin may play during pregnancy. The present study investigated the expression of the vitamin D receptor (VDR) in women during the first trimester of pregnancy in order to determine whether VDR is associated with recurrent pregnancy loss (RPL). Forty women at 7-10 weeks gestation with RPL and 40 women of similar gestational age with a healthy pregnancy were recruited. VDR mRNA and protein in chorionic villi and decidua were evaluated by immunohistochemistry, confocal laser scanning microscopy (CLSM), western blot, and quantitative real-time polymerase chain reaction. The serum levels of VDR were measured by an enzyme-linked immunosorbent assay. Women with RPL had a significantly weaker expression of VDR mRNA in villi and decidual tissues compared with the control women (both p < 0.0001). Western blot analysis showed an approximately 46% decrease in VDR expression in villi and a 52% decrease in decidua in the RPL vs. the controls. Serum VDR levels were also significantly lower in the RPL group than in the control group (p = 0.003). Compared with the controls, immunohistochemical and CLSM analysis revealed significantly lower VDR expression in villous cytotrophoblasts and stromal cells, as well as in decidual glandular epithelial and stromal cells (all p < 0.05). In conclusion, these observations show that women with RPL have lower levels of VDR expression in chorionic villi, decidua and serum compared with normal pregnant women, suggesting that decreased VDR expression in the first trimester pregnancy may be associated with RPL. (C) 2016 Elsevier Inc. All rights reserved.

Objective To investigate the effect of uterine natural killer (uNK)cells in the endometrium of implantation window stage on endometrial angiogenesis and the relationship between uterine artery pulsation index and in vitro fertilization (IVF)treatment outcome.Methods We recruited 30 patients who all had received IVF and embryo transfer (IVF-ET)at the age of less than 3 5 years.Uterine artery pulsation indexes were assessed by vaginal color Doppler, and the endometrium in the window of implantation was collected. Expression and localization of CD5 6+,uNK cells marker;F8 factor,vascular endothelial cell marker;alpha smooth muscle actin (αSMA ), vascular smooth muscle cell marker;and heavy chain smooth myosin (SMM ) were detected by immunohistochemical SP method.The patients were divided into pregnancy group and repeated implantation failure group based on assisted pregnancy outcome.Results ① The positive expression rates of uNK cells and F8 factor were positively related (r=0 .5 8 1 ,P<0 .0 1 ).② The positive expression rate of uNK cells was positively related to that ofαSMA and SMM (r=0 .5 7 2 ,r=0 .5 6 9 ,P<0 .0 1 ).③ Uterine artery pulsation index was 0 .8 5 ± 1 .5 1 in repeated implantation failure group and 0.93±0.24 in pregnancy group,without any significant difference between the two groups (t=-0.98,P>0.05).Conclusion ① uNK cells in the window of implantation are positively correlated with microvascular density and vascular maturity, indicating that they play an important role in angiogenesis of the endometrium.② The effect of uterine artery dynamic index on embryo transfer outcome does not differ significantly between pregnancy group and repeated implantation failure group.Further study is needed.

目的：探讨种植窗期子宫动脉血流及子宫内膜微血管密度对胚胎种植结局的影响。方法：体外受精-胚胎移植（IVF-ET ）治疗的30例患者，随访IVF-ET 结局，根据是否临床妊娠及至少有2次或2次以上的IVF助孕失败史，分为妊娠组和反复种植失败组。三维超声检测种植窗期子宫动脉搏动指数，免疫组化SP法检测子宫内膜血管内皮细胞标记物F8因子。结果：①F8因子特异性的表达于血管内皮细胞，妊娠组微血管密度（5．10±1．28），高于反复种植失败组（3．13±1．1），差异有统计学意义（t＝-3．87，P＜0．05）。②反复种植失败组和妊娠组子宫动脉搏动指数分别为（0．85±1．51，0．93±0．24），差异无统计学意义（t＝-0．98，P＞0．05）。结论：种植窗期子宫内膜微血管密度临床妊娠组高于反复种植失败组，对预测胚胎移植结局有一定的临床意义；子宫动脉搏动指数对胚胎移植结局的影响，两组之间无统计学差异，有待进一步探讨。