Objective:To explore the application value of artificial intelligence (AI) model based on deep learning in breast nodules classification of Breast Imaging Reporting and Data System of ultrasound (BI-RADS-US).Methods:The ultrasound images of 2 426 breast nodules from 1 558 female patients with breast diseases at Beijing Tongren Hospital, Capital Medical University between December 2006 and December 2019 were collected . The image data sets were divided into training (63%), verification (7%), and test (30%) subsets for the construction of AI model. The diagnostic efficiencies of AI model, doctors' arbitration results and doctors' diagnosis with or without AI model assistance were analyzed by using receiver operating characteristic (ROC) curve. The Cohen weighted Kappa statistic was used to compare the consistency of BI-RADS-US classification among 5 ultrasound doctors' diagnosis with or without AI model assistance. And the changes of BI-RADS-US classification were analyzed before and after each doctor adopted AI model assistance.Results:The differences in diagnostic efficiencies of AI model, doctors' arbitration results and doctors' diagnosis with or without AI model assistance were statistically significant (all P > 0.05). The consistency among 5 ultrasound doctors was improved due to AI model assistance and Kappa value was increased from 0.433 (category 3), 0.600 (category 4a), 0.614 (category 4b), 0.570 (category 4c) and 0.495 (category 5) to 0.812, 0.704, 0.823, 0.690 and 0.509 (all P < 0.05), respectively. The upgrade and downgrade of BI-RADS-US classification occurred in 5 doctors after the classification of AI model assistance. Downgrade from category 4 to 3 in benign nodules of 56.6% (47/76) and upgrade from category 4 to 5 in malignant nodules of 69.4% (34/49) were mostly observed. Conclusions:AI-assisted BI-RADS-US classification can effectively improve the consistency of classification among the doctors without reducing the diagnostic efficiency. AI model shows clinical values in reducing unnecessary biopsy of partial benign lesions and increasing diagnostic accuracy of partial malignant lesions through the adjustment of breast nodule classification.

Objective To measure the area of optic nerve subarachnoid and evaluate its sensitivity and specificity to predicting elevated intracranial pressure, so as to explore the mechanism of visual im-pairment and intracranial pressure in astronauts with this noninvasive method. Methods Based on the results of intracranial pressure measured by lumbar puncture, 51 subjects were divided into the elevat-ed intracranial pressure group and the normal intracranial pressure group. The general data were col-lected, and optic nerve sheath diameter(ONSD) at 3 mm behind the ball and area of optic nerve sub-arachnoid space(ONSASA) between 3～7 mm behind the ball were measured by ultrasonic examina-tion and Image J 1.51 analysis software. The prediction ability of these two indexes for elevated in-tracranial pressure was compared by receiver operating characteristic curve and area under curve. Results The optic nerve sheath diameter and the area of optic nerve subarachnoid were larger in the ele-vated intracranial pressure group, and the difference between the two groups was statistically signifi-cant. The area under curve of the area of optic nerve subarachnoid(0.894) to predict elevated in-tracranial pressure was larger than the optic nerve sheath diameter(0.764). Conclusion The measure-ment of area of optic nerve subarachnoid by ultrasonography can predict elevated intracranial pressure, which provides a possible and effective method to study the mechanism of visual impairment and in-tracranial pressure in space environment.

Objective:To analyze the value and difference of the optic nerve sheath pulse dynamic deformation index (DI) in normal-tension glaucoma (NTG) and high-pressure primary open angle glaucoma (POAG).Methods:A cross-sectional study was conducted to collect clinical data at the Eye Center of Beijing Tongren Hospital from June 2016 to March 2017, 32 patients with NTG and 35 patients with high-pressure POAG were sampled.For all subjects, their basic information, body mass index (BMI), mean arterial blood pressure (MAP), 24 hours intraocular pressure, and ophthalmologic examinations required for diagnosis were recorded.All subjects underwent transorbital ultrasonography and for each 15 seconds of consecutive ultrasound images were taken.The dynamic post-processing technique was used to calculate the DI.The difference in DI between the two groups and the correlation of DI with other variables were analyzed.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital.Written informed consent was obtained from all subjects prior to their entering the study cohort and receiving the transorbital ultrasound examination.Results:The median level of DI in the NTG group was 0.51 (0.48, 0.54), which was higher than that in the high-pressure POAG group (0.23[0.20, 0.25]), exhibiting a significant difference ( Z=-7.01, P<0.01). The mean BMI in the NTG group was lower than that in the high-pressure POAG group([21.29±4.64]kg/m 2vs. [23.53±3.40]kg/m 2), the mean MAP in the NTG group was lower than that in the high-pressure POAG group([91.44±14.30]mmHg vs. [104.05±13.96] mmHg), the differences between the two groups were statistically significant ( t=-2.30, P<0.05; t=-3.65, P<0.01). There was no statistical association between the two groups of DI and age, MAP, BMI, mean intraocular pressure and maximum intraocular pressure (all at P>0.05). Conclusions:The DI of the NTG patient is higher than that of the POAG patient, which indicates that the optic nerve sheath subarachnoid pressure and optic nerve sheath stiffness in NTG patients are lower than those in POAG patients.Therefore, the DI is a potential indicator of non-invasive intracranial pressure and translaminar cribrosa pressure difference detection in ophthalmology.

硫酸镁可改善早产儿脑组织血供,抑制自由基与兴奋性氨基酸,从而抑制神经细胞凋亡,对有早产风险的患者产前应用硫酸镁可降低早产儿脑神经损害的风险.多个前瞻性研究以及荟萃分析显示硫酸镁可以降低早产儿脑瘫的发生率,且极少发生母体严重不良反应,但可能对胎儿/新生儿骨骼及呼吸产生不良影响.对于硫酸镁的治疗剂量、应用时限以及时机尚需进一步研究.

Glaucoma is an important irreversible blinding eye disease [1]. For primary open-angle glaucoma (POAG), intraocular pressure (IOP) is a known pathogenic factor. Other factors are also associated with morbidity, including low body mass index (BMI), ocular perfusion pressure, migraine, cardiovascular disease, and vasospastic disorders [2–6]. Intracranial pressure (ICP) has been receiving attention in recent years [7], especially in normal pressure glaucoma. At present, it is believed that the trans-lamina cribrosa pressure difference (TLCPD) of normal-tension glaucoma (NTG) is affected by the low cerebrospinal fluid pressure (CSFP) in the subarachnoid space.

Objective: To investigate the ultrasonographic measurements of the optic nerve subarachnoid space (ONSAS) in patients with normal tension glaucoma (NTG). Methods: Cross-sectional study. Patients with NTG or primary open-angle glaucoma (POAG) but without any anti-glaucoma treatment and the control group were collected from June 2016 to March 2017 at Beijing Tongren Hospital affiliated to Capital Medical University. Measurements of 24-h intraocular pressure, central corneal thickness, mean visual field damage, visual axis, blood pressure and body mass index and ocular ultrasound scans were performed. The differences in the ONSAS of the two-dimensional ultrasound images of the three groups of subjects and their correlation with various clinical variables were evaluated. Qualitative data were analyzed by the chi-square test for comparison between groups; quantitative data were analyzed by the one-way ANOVA for comparison between groups, and the LSD-t test was used for comparison between groups; the Pearson correlation analysis was used for correlation analysis of measurement data. The intra-group correlation coefficient was used to evaluate the reproducibility and repeatability of two measurements by different measurers or the same measurer. Results: A total of 35 patients (35 eyes) with NTG were enrolled in the NTG group, including 14 males and 21 females, aged (50±8) years; 32 patients (32 eyes) with POAG were enrolled in the POAG group, including 14 males and 18 females, aged (52±10) years; 37 healthy people (37 eyes) were enrolled in the control group, including 20 males and 17 females, aged (49±9) years. The ONSAS was (5.07±0.83) mm(2) in the retrobulbar 3- to 7-mm range in the NTG group, significantly smaller than the control group (6.57±1.43) mm(2) and the POAG group (6.19±0.90) mm(2) (t=1.17, 1.29; P=0.03, 0.01). There was no significant difference in the statistical results between the control group and the POAG group (t=1.31, P=0.75). Between the ONSAS and mean intraocular pressure and maximum intraocular pressure, there was a statistically positive correlation in the NTG group (r=0.66, 0.48; both P<0.01), but there was no linear correlation; there was no statistical correlation in the control group or the POAG group (all P>0.05). There was no statistically significant association between the ONSAS and age, mean arterial pressure, body mass index, central corneal thickness, visual axis length, and mean visual field loss in any group (all P>0.05). Conclusion: Compared with the POAG group and the control group, the ONSAS is smaller in the NTG group, indicating lower retrobulbar cerebrospinal fluid pressure, and it is positively correlated with the mean intraocular pressure and the highest intraocular pressure. (Chin J Ophthalmol, 2018, 54: 827-832).

ObjectiveTo review the diagnosis, monitoring, management and perinatal outcomes of monochoriotic monoaminiotic twin pregnancy.MethodSummary clinical experience by discuss the 2 cases and review relevant literature.ResultTwo cases were terminated pregnancy by cesarean section in the late pregnancy, two fetuses in the same amniotic cavity were found intraoperatively.ConclusionEarly ultrosonography is important to diagnosis the MCMA twin pregnancy, there is controvercy in monitoring and delivery time of MCMA twin pregnancy, it is better to terminate pregnancy by cesarean section.

目的 对人离体甲状腺组织进行射频消融(radiofrequency ablation,RFA),了解消融形态、大小和消融区域的病理变化.方法 采用单针双极式电极,设定5W功率,RFA人离体甲状腺新鲜标本18块,观察消融形态,测量消融区大小(长径和宽径),记录消融时间,观察消融区病理改变.结果 消融区长径0.7～1.5 cm,平均(1.15±0.21) cm,宽径0.4～0.9 cm,平均(0.64±0.14) cm.消融时间8～88 s,平均(50.5±20.0)s.肉眼观察显示各标本消融区形态稳定一致,呈椭圆形,剖面上从中心向外周依次是针道区、消融区、消融周围区.镜下显示消融区发生凝固性坏死,细胞结构被破坏,核减少和核变形明显.结论 采用低功率(5W)单针双极式电极RFA人甲状腺离体组织,可获得椭圆形的凝固性坏死的消融区.

<正>病例资料:付某,女,54岁,主因"头部剧烈疼痛8年余"于2012年6月21日入院入院。患者8年前无明显诱因出现右侧枕部疼痛,疼痛呈持续性、刀割样,随后波及至同侧额颞顶部,枕部仍为持续性、刀割样疼痛,额、顶、颞部为持续性胀痛,2年前疼痛又波及至右肩部;1年前出现左枕、颞、顶部疼痛,每次为先右侧疼痛发作,后出现左侧疼痛。患者自诉近几年来面容变化较大,呈肢端肥大症面容,于1年前行头颅