Journal of Shandong University (Health Sciences)

Applying artificial intelligence in ophthalmic real-world practice: opportunities and challenges

Mingguang HE,Chi LIU,Zhixi LI

Journal of Shandong University (Health Sciences). 2020, 58(11): 1-10. doi:10.6040/j.issn.1671-7554.0.2020.1181

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Artificial intelligence has rapidly evolved from the experimental phase to the implementation phase in many clinical disciplines, including ophthalmology. The data-driven deep learning technology has created unprecedented opportunities for major breakthroughs in the imaging data-based automated diagnoses in ophthalmology, significantly improving the accessibility, efficiency, and cost-effectiveness of eye care systems. Although this technology will have a profound impact on clinical flow and practice patterns sooner or later, translating such a technology into clinical practice is challenging. With comprehensively going through the latest progress in this research domain, this article highlights the opportunities and challenges of the real-world deployment of artificial intelligence in ophthalmology, and figures out the potential problems that may arise during the transition, such as diagnosis bias, clinical evaluation, medical accountability, as well as ethical and legal issues. The discovery could facilitate the integration of artificial intelligence into routine clinical practice and further improve the relevant applications.

Research progress of artificial intelligence in childhood eye diseases

Haotian LIN,Longhui LI,Jingjing CHEN

Journal of Shandong University (Health Sciences). 2020, 58(11): 11-16. doi:10.6040/j.issn.1671-7554.0.2020.1173

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Childhood is a critical period of visual system development, during which eye diseases can easily lead to irreversible visual impairment and cause heavy family and socioeconomic burdens. Early screening and early treatment have always been essential, but due to the shortage of pediatric ophthalmologists, it is very difficult to carry out large-scale screening. With the tremendous progress of data processing technology, artificial intelligence is used greatly in the medical field. At present, artificial intelligence has been widely studied and applied in the fields of retinopathy of prematurity (ROP), congenital cataract, strabismus, refractive error and visual function screening. It has excellent performance in early screening, diagnosis and staging, treatment recommendations, and prognosis prediction of a variety of childhood eye diseases. However, childhood eye diseases are far less focused than adult eye diseases, and there are still many problems to be solved.

New developments in ophthalmic AI algorithms

Zongyuan GE,Wanji HE,Lie JU,Xuan YAO,Lin WANG,Yelin HUANG,Zhiwen YANG,Jianhao XIONG,Yining BAO,Ming LI,Bing ZHANG,Xin ZHAO

Journal of Shandong University (Health Sciences). 2020, 58(11): 17-23. doi:10.6040/j.issn.1671-7554.0.2020.1227

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Deep neural networks, combined with high quality annotated medical data and low-cost GPU devices, have been successfully implemented in the field of ophthalmology. Impressive grounding outcomes have occurred in both in-hospital and out-hospital scenarios. Some of the published results demonstrated AI could achieve better diagnosis performance than general practice in the diagnosis of certain retinal diseases. In this article, we will discuss how classification, detection, segmentation and domain adaptation play their roles in AI ophthalmology. We will also discuss the limitations of the current state-of-the-art (SOTA) algorithms, hoping to provide prevision for future research in this field.

Artificial intelligence deep learning in glaucoma imaging: current progress and future prospect

Carol Y. Cheung,Anran RAN

Journal of Shandong University (Health Sciences). 2020, 58(11): 24-32, 38. doi:10.6040/j.issn.1671-7554.0.2020.1249

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Glaucoma is a group of heterogeneous neurodegenerative diseases, characterized by the gradual loss of retinal ganglion cells and their axons, and has now become the major reason of irreversible blindness worldwide. Artificial intelligence (AI) is intelligence demonstrated by machines. Deep learning (DL) is a subset of AI based on deep neural networks, and it has made great breakthroughs in medical imaging. In glaucoma imaging, research interests have been increasing on applying DL in fundus photographs and optical coherence tomography (OCT) for glaucomatous optic neuropathy (GON) detection. Promising results show that the incorporation of DL technology in imaging for glaucoma assessment is efficient and accurate, which could potentially address some gaps in the current practice and clinical workflow. However, further research is crucial in tackling some existing challenges, such as setting a standard for ground truth labelling among different studies, visualizing the learning process in the "black box", improving the model generalizability on unseen datasets, developing the DL-powered infrastructure for real-world implementation, establishing a practical clinical workflow, conducting prospective validation and cost-effectiveness analysis. This review summarizes recent studies on the application of AI on glaucoma imaging, discusses the potential clinical impact and future research directions.

Advances in the intelligent diagnosis of eye diseases

Yilong YIN,Xiaoming XI

Journal of Shandong University (Health Sciences). 2020, 58(11): 33-38. doi:10.6040/j.issn.1671-7554.0.2020.1136

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As the number of elderly people increases, eye diseases have become a tremendous economic and societal burden. Medical imaging plays an important role in the diagnosis of eye diseases. With the development of artificial intelligence, automatic diagnosis of eye diseases with medical imaging has attracted great attention in recent years. In order to provide new insights into the intelligent diagnostics methods of eye diseases, this paper reviews the recent advances including methods based on object segmentation and eye diseases diagnosis and discusses the future work.

Research progress of artificial intelligence diagnosis system in retinal diseases

Yi QU,Huankai ZHANG,Xian SONG,Baorui CHU

Journal of Shandong University (Health Sciences). 2020, 58(11): 39-44. doi:10.6040/j.issn.1671-7554.0.2020.1256

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Retinal diseases are the main cause of severe vision loss in humans. Early screening and timely follow-up of diseases such as diabetic retinopathy (DR), glaucomatous retinopathy and optic neuropathy, age-related macular degeneration (AMD) are the key of disease prevention and treatment. However, due to the limited number of ophthalmologists and the high cost of manual screening, it is difficult to carry out large-scale disease screening. The application of artificial intelligence (AI) in ophthalmology has brought dawn to solve the problems. This article reviews the application of AI in the diagnosis of DR, glaucomatous retinopathy and optic neuropathy, AMD and other diseases, discusses the application of AI diagnosis system in the teaching of retinal diseases, points out the current problems of AI systems, and looks forward to its development prospects in the field of retinopathy.

Effects of 27-hydroxycholesterol and cholesterol on the proliferation of esophageal squamous cell carcinoma in nude mice and human esophageal carcinoma cells(ECA109)

LI Changda, SHI Yongjun, LIN Yanliang

Journal of Shandong University (Health Sciences). 2020, 58(11): 45-52. doi:10.6040/j.issn.1671-7554.0.2020.0378

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Objective To investigate the effects of cholesterol and 27-hydroxycholesterol on the proliferation, invasion and migration of esophageal squamous cell carcinoma(ESCC)and on the secretion of cytokine MCP-1. Methods In vivo animal experiments: After animal models of ESCC were established, they were given high cholesterol diet(high cholesterol diet group, n=4)or normal diet(control group, n=4), to observe the effects of cholesterol on the growth of ESCC in vivo. At the end of the 5th week, the tumor volume of the two groups was measured and tumor inhibition rate was calculated. Cell experiments: Effects of cholesterol(0, 0.123, 0.148, 0.185, 0.269, 0.370 mg/mL)and 27-hydroxycholesterol(0, 1, 5, 10, 20 μmol/mL)on the proliferation of normal ECA109 cells, and ECA109 cells with cyp27a1 and cyp7b1 knockout were observed. The cell proliferation at different concentrations was detected with CCK-8. Cell invasion was determined with scratch test and invasion test(cholesterol 0.185 mg/mL, 27-hydroxycholesterol 1 μmol/mL). The upstream gene cyp27a1 and downstream gene CYP7B1 of 27-hydroxycholesterol were transfected with lentivirus. The above experiments were repeated to observe the effects of gene knockout on proliferation, invasion and migration of cells, and the effect on the secretion of MCP-1 was detected with ELISA. The tumor volume and absorbance measured by CCK-8 in the two groups at different times were analyzed with two-factor ANOVA. When the interaction was statistically significant, simple effect analysis was performed. One-way ANOVA was used for the comparison of mean differences between groups, and LSD method was used for pairwise multiple comparison. Results Animal experiments showed the tumor volume was(5.055±0.774)cm³ in the high cholesterol diet group and(5.055±0.774)cm³ in the control group, and the tumor inhibition rate was-170.79%, with statistically significant difference(P<0.05). Cell experiments showed: (1) Cholesterol promoted the proliferation of ECA109 cells and ECA109 cells with cyp27a1 knockout at low concentration(P<0.05). 27-hydroxycholesterol inhibited the proliferation of ECA109 cells, but promoted the proliferation of ECA109 cells with CYP7b1 knockout(P<0.05). (2) Cholesterol and 27-hydroxycholesterol had no effects on the migration of ECA109 cells(F=2.418, P=0.170), and no effects on the migration of ECA109 cells with cyp27a1 and CYP7b1 knockout(F=0.602, P=0.578). (3) After gene knockout, the cell invasion changed(F=3.992, P=0.047). Cells with CYP27b1 knockout had inhibited invasion(P<0.05), while cells with CYP7a1 knockout had unchanged invasion(P>0.05). (4) Gene knockout affected the secretion of MCP-1(F=553.538, P<0.001). CYP27A1 knockout increased the secretion of MCP-1(213.823±4.572), while CYP7B1 knockout decreased the secretion of MCP-1(107.240±4.121)(P<0.001). Conclusion Cholesterol can stimulate the proliferation of ECA109 cells both in vivo and in vitro. 27-hydroxycholesterol can inhibit the proliferation of ECA109 cells while cholesterol can promote the proliferation of ECA109 cells, both in a concentration-dependent manner. The knockdown of upstream gene cyp27a1 can enhance the effect of cholesterol on the proliferation but does not affect the cell invasion. The knockdown of downstream gene cyp7b1 can enhance the effect of 27-hydroxycholesterol on cell proliferation and inhibit cell invasion. The secretion of MCP-1 is increased by cyp27a1 knockout and inhibited by cyp7b1 knockout.

Effects of propofol on proliferation, migration and expressions of Wnt1 and β-catenin in colon cancer cells

HONG Jiageng, NIE Yangyang, SU Guoqiang

Journal of Shandong University (Health Sciences). 2020, 58(11): 53-58. doi:10.6040/j.issn.1671-7554.0.2019.1426

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Objective To investigate the effects of propofol on the proliferation, migration and mRNA expressions of Wnt1 and β-catenin in human colon cancer cells with different degrees of differentiation in vitro. Methods Two human colon cancer cell lines Caco-2(highly differentiated)and LoVo(lowly differentiated)were selected and assigned to P₀(0 μg/mL), P_6.25(6.25 μg/mL), P₂₅(25 μg/mL), and P₁₀₀(100 μg/mL)groups according to different concentrations of propofol. The effects of propofol on the proliferation and migration of Caco-2 and LoVo cells were detected with CCK-8 and Transwell migration assay, respectively. The sensitivity of cells to different concentrations of propofol was compared. The mRNA expressions of Wnt1 and β-catenin in Caco-2 and LoVo cells were determined with real-time PCR. Results The CCK-8 results showed significant difference in Caco-2 viability between P₁₀₀ group treated for 24 h and P₀ group(P<0.001), and between P₂₅ group treated for 48 h and P₀ group(P<0.05); and significant difference in LoVo viability between P₁₀₀ group treated for 24 h and P₀ group(P<0.05 ), and between P₂₅ group treated for 48 h and P₀ group(P<0.05). Transwell migration results showed significant difference in OD_{570 nm} value in Caco-2 cell line between P_6.25, P₂₅, P₁₀₀ groups and P₀ group(P<0.001); and in LoVo cell line between P₂₅, P₁₀₀ groups and P₀ group(P<0.001). Real-time PCR results showed significant difference in Wnt1 mRNA expression in Caco-2 cell line between P₂₅, P₁₀₀ groups and P₀ group(P<0.05), in LoVo cell line between P₂₅, P₁₀₀ groups and P₀ group(P<0.001); and significant difference in β-catenin mRNA expression in Caco-2 cell line between P₂₅, P₁₀₀ groups and P₀ group(P<0.001), and in LoVo cell line between P₁₀₀ group and P₀ group(P<0.001). Conclusion Propofol inhibits the proliferation and migration of human colon cancer cells Caco-2 and LoVo in a dose- and time-dependent manner. Caco-2 is more sensitive to the inhibitory effects of propofol than LoVo.

Clinical analysis of microvascular decompression in 48 patients with hemifacial spasm

GUO Wenqiang, JIANG Bin, HE Zheng, HUANG Dezhang, ZHANG Hongying, YIN Xin, WANG Zhigang

Journal of Shandong University (Health Sciences). 2020, 58(11): 59-64. doi:10.6040/j.issn.1671-7554.0.2020.0255

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Objective To investigate the efficacy of microvascular decompression in the treatment of hemifacial spasm. Methods The clinical data of 48 patients with hemifacial spasm treated in department of neurosurgery during Feb. 2014 and Sep. 2018 were retrospectively analyzed, including the effective rate, complication rate, treatment plan and prognosis. The patients were divided into two groups: immediate cure group and delayed cure group. The length of medical history, gender, age, severity of symptoms, and number of responsible vessels were compared between the two groups. Results All patients were followed up, and no death occurred. Of all patients, 35 cases(72.92%)were immediately cured, 12 cases(25.00%)had delayed recovery, and 1 case(2.08%)was not responsive. No case deteriorated. The overall effective rate was 97.92%. Analysis of the influencing factors of delayed cure showed that there were no significant differences in gender, age, severity of symptoms, and number of responsible vessels between the two groups(P>0.05), while there was significant difference in medical history. Complications included headache in 17 cases(35.42%), dizziness and nausea in 27 cases(56.25%), leakage of cerebrospinal fluid in 2 cases(4.17%), fever in 7 cases(14.58%), facial paralysis in 12 cases(25.00%), and hearing loss in 7 cases(14.58%). All complications were cured except for 1 case with facial paralysis and hearing loss. Conclusion Microvascular decompression is effective in the treatment of hemifacial spasm. Longer length of medical history is associated with delayed cure.

Effect of fetal reduction in early pregnancy on perinatal mothers and infants after embryo transfer

CAO Mingya, ZHAO Hanjie, FENG Tengfei, JIA Rui, ZHAO Zhiming, HAO Guimin

Journal of Shandong University (Health Sciences). 2020, 58(11): 65-70. doi:10.6040/j.issn.1671-7554.0.2020.0546

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Objective To explore the effects of different number of fetal reduction in early pregnancy on perinatal mothers and infants after triplet pregnancy in embryo transfer. Methods The clinical data of 282 cycles of triplet pregnancy with fetal reduction after embryo transfer were retrospectively analyzed. According to the keeping number of fetus, the reduction group was divided into singleton group with 28 cycles and twin group with 254 cycles. The subjects of single or twin pregnancy who did not reduce the fetus after embryo transfer were matched with propensity score matching(PSM)and 846 cycles were enrolled as the control group, including 84 cycles in the singleton control group and 762 cycles in the twin control group. The general information, pregnancy outcomes, neonatal weight and perinatal complications of the 4 groups were compared, and Logistic regression was used to make further sensitivity analysis. Results (1)Compared with the control group, the reduction group had higher abortion rate, late abortion rate and perinatal complications rate(P<0.01); shorter gestational weeks(P=0.01); lower full-term birth weight(P<0.01), full-term birth rate(P=0.016), and cesarean section rate(P=0.037). (2)Compared with the twin group, the singleton group had lower cesarean section rate(P=0.001), longer gestational weeks(P<0.01), and higher full-term birth weight(P<0.01). Compared with the twin control group, the singleton control group had higher abortion rate, early abortion birth rate, full-term birth weight and premature birth weight(P<0.01), but lower preterm birth rate(P<0.01). Conclusion Fetal reduction in early pregnancy dose not increase premature birth rate or birth defect rate. However, it does increase abortion rate, risk of perinatal complications and low birth weight. The pregnancy outcome is better in patients with reduction of triplets to singletons than in those to twins.

Expression and clinical significance of exosomal long non-coding RNA OGFRP1 in 84 cases of non-small cell lung cancer

LIU Xiaojing, XIA Xiyan, XIAO Ke, CHEN Wendan, ZHUANG Xuewei

Journal of Shandong University (Health Sciences). 2020, 58(11): 71-75. doi:10.6040/j.issn.1671-7554.0.2020.1127

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Objective To explore the expression and clinical significance of long non-coding RNA(lncRNA)OGFRP1 in serum exosomes of non-small cell lung cancer(NSCLC). Methods A total of 84 cases preliminarily diagnosed as NSCLC and 84 healthy controls were enrolled. The serum exosomes were extracted and identified, the RNA was extracted, and lncRNA expression was detected. The sensitivity, specificity and diagnostic accuracy of lncRNA OGFRP1 were statistically analyzed. The relationship between the lncRNA OGFRP1 expression and clinicopathological factors were analyzed. Results All cases were pathologically confirmed as NSCLC. lncRNA OGFRP1 was highly expressed in NSCLC(χ2=96.459, P<0.001). With pathological diagnosis as the gold standard, the sensitivity, specificity and accuracy of lncRNA OGFRP1 in the auxiliary diagnosis of NSCLC were 89.4%, 87.9% and 89.4%, respectively, higher than those of carcino-embryonic antigen(P<0.01). The relative expression of lncRNA OGFRP1 in serum exosomes was significantly associated with lymph node metastasis(P=0.034)and T stage(P=0.030)in NSCLC patients. Conclusion The detection of exosomal lncRNA OGFRP1 has high sensitivity, specificity and accuracy in the diagnosis of NSCLC, which can be used as a novel tumor marker for early screening, diagnosis and staging of NSCLC.

Effect of stains on the prognosis of 70 patients with pulmonary embolism

YAO Yu, WANG Wenjun, LIANG Yuling

Journal of Shandong University (Health Sciences). 2020, 58(11): 76-80. doi:10.6040/j.issn.1671-7554.0.2020.0356

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Objective To investigate the effect of statins on the patients with pulmonary embolism. Methods From Aug. 1^st, 2013 to Aug. 15^th, 2019, the clinical data of 162 patients with initial diagnosis of pulmonary embolism admitted to the Affiliated Hospital of Southwest Medical University were retrospectively screened. According to the use of statins, the patients were divided into statin group(n=70)and non-statin group(n=92). The deadline of follow-up was Sep. 15^th, 2019. The end-event was all-cause death. Kaplan-Meier method was applied to draw the survival curves of two groups which were compared by Log-rank test. Univariate and multivariate Cox proportional hazards regression model were performed to analyze of end-event, use of statins and underline disease, etc. Results During follow-up period, 39 patients(24.07%)died by all-cause, among whom, 9 cases were in statin group and 30 cases were in non-statin group. Univariate Cox proportional hazards regression model analysis showed that age, history of malignancy, use of statins, HDL level, LDL level and TC level influenced the prognosis of patients. After adjustment of age, history of malignancy, HDL level and other factors, multivariate Cox proportional hazards regression model analysis concluded that use of statins had a protective effect on the prognosis of patients with pulmonary embolism(P=0.009, HR=0.348, 95%CI: 0.158-0.766). Conclusion The use of statins can improve prognosis of patients with pulmonary embolism.

Analysis of the bronchodilator test of 122 patients with asthma

LI Yan, NIU Rui, WANG Chaochao

Journal of Shandong University (Health Sciences). 2020, 58(11): 81-84. doi:10.6040/j.issn.1671-7554.0.2019.1435

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Objective To analyze the results and characteristics of pulmonary function test and bronchodilator test in patients with asthma, and to explore the value of pulmonary function test in diagnosis and curative effect of asthma. Methods Pulmonary function results of 122 patients with asthma in 2018 were collected. According to FEV1/FVC%, the cases were divided into normal group(n=30)and airflow restricted group(n=92). Airflow restricted group was further divided into mild group(n=63), moderately severe group(n=16)and severe group(n=13)based on FEV1. Then the data of different groups were analyzed. Results The positive rates of bronchodilator test were 16.7%, 58.7%, 81.3%, and 100.0% in normal group, mild group, moderately severe group, and severe group, respectively, with a statistical difference between different groups(χ2=35.8, P=0.001). There was no significant difference of improvement quantity and improvement rate between FEV1 and FVC in normal group(P=0.39, P=0.14). FEV1/FVC% values before and after bronchodilator test in moderately severe group and severe group were lower than that in mild group(before the test: χ2=52.16, P<0.001; after the test: χ2=49.49, P<0.001). FEV1/FVC% value was increased after bronchodilator test in all airflow restricted groups(all P<0.05). Only 9.8% of patients were released from air restriction after bronchodilator test, which were entirely from mild group. Conclusion Positive rate of bronchodilator test increases depending on the aggravation of airflow obstruction in patients with asthma. The patients with normal pulmonary function can also reveive the bronchodilator test. Specific flow volume loops are showed in positive cases of normal group. It is a lifelong process and needs individualized management in the control or treatment of asthma. Pulmonary function test examined regularly is beneficial to guide clinical treatment and manage asthma.

Clinical observation of heart rate variability in patients with gastric cancer during perioperative period under the guidance of enhanced recovery after surgery

ZHI Mengwei, JIANG Zhiwei, DAI Xinjuan, WANG Gang, CHENG Wei

Journal of Shandong University (Health Sciences). 2020, 58(11): 85-91. doi:10.6040/j.issn.1671-7554.0.2020.0113

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Objective To explore the changes of heart rate variability(HRV)in patients undergoing laparoscopic radical gastrectomy under the guidance of enhanced recovery after surgery(ERAS). Methods The clinical data of 50 patients who received laparoscopic radical gastrectomy during Jan. 2019 and Dec. 2019 were retrospectively analyzed. According to whether ERAS concept was adopted, the patients were divided into the control group(n=25)and ERAS group(n=25). Patients in the control group received traditional perioperative management, while patients in the ERAS group received multimodal health education, fluid management, multimodal analgesia, early enteral nutrition, early ambulation and so on. Perioperative HRV parameters were compared between the two groups, including standard deviation of NN intervals(SDNN), triangle index, number of pairs of successive NNs that differ by more than 50ms(pNN50), low frequency(LF), high frequency(HF), low frequency/high frequency(LF/HF). The serum hypersensitive C-reactive protein level in the two groups were also observed. Results In postoperative days 1-4, SDNN was significantly higher in the ERAS group than in the control group(P<0.05). In postoperative days 1, 2, 3 and 5, triangle index was significantly higher in the ERAS group than in the control group(P<0.05). In postoperative days 2-4, LF/HF was significantly higher in the ERAS group than in the control group(P<0.05). In postoperative days 1-5, there were no differences in LF, HF and LF/HF between the two groups(P>0.05). In postoperative days 1 and 3, C-reactive protein was significantly lower in the ERAS group than in the control group(P<0.05). Conclusion ERAS improves HRV, reduces surgical stress and inflammatory response, and promotes recovery in patients undergoing laparoscopic radical gastrectomy.

Application of enhanced recovery after surgery in 44 cases of uvulopalatopharyngoplasty

LI Yujie, HAN Wei, HUANG Wei, DONG Yuke, LI Tao, DANG Yanwei, CAI Xiaoqing, SHEN Xiao, GONG Wendan, XU Lianfang

Journal of Shandong University (Health Sciences). 2020, 58(11): 92-97. doi:10.6040/j.issn.1671-7554.0.2020.0908

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Objective To explore the application value of enhanced recovery after surgery(ERAS)in the perioperative period of uvulopalatopharyngoplasty(UPPP). Methods A total of 84 patients with severe obstructive sleep apnea hypopnea syndrome(OSAHS)were randomly divided into the ERAS group(n=44)and control group(n=40). Both groups underwent UPPP. The ERAS group received a series of optimization measures, and the control group received traditional perioperative management. All patients filled in the hospital anxiety and depression scale(HADS), MOS-SS sleep scale and visual analog scale(VAS). The emotional changes of patients in the ERAS group before and after psychological intervention were recorded. The postoperative sleep quality, degree of discomfort symptoms, waiting time before hospitalization, hospitalization time after surgery and incidence of complications were compared between the two groups. Results The HADS scores reduced from 5(3, 9.75)to 3(2, 5.75)in the ERAS group. The postoperative MOS-SS score was(46.09±4.86)in the ERAS group and(33.43±4.44)in the control group, the perioperative weight loss was(2.30±0.65)kg and(5.12±0.78)kg, respectively, and the differences were statistically significant(P<0.05). The ERAS group had shorter preoperative waiting time and postoperative hospitalization time, and lower VAS scores of postoperative pharyngeal pain, pharyngeal foreign body sensation, dysphagia and dry throat than the control group(P<0.05). There were no statistically significant differences in the incidences of postoperative bleeding, nausea, vomiting, and nasopharyngeal reflux between the two groups(P>0.05). Conclusion The personalized ERAS program can create good physical conditions for UPPP in severe OSAHS patients, reduce their physical and psychological stress, improve medical experience, and promote postoperative recovery.

A new method to identify parathyroid glands in surgery: parathyroid autofluorescence imaging(a report of 6 cases)

ZHUANG Dayong, HE Qingqing, ZHOU Peng, YUE Tao, LI Xiaolei, XU Jing

Journal of Shandong University (Health Sciences). 2020, 58(11): 98-102. doi:10.6040/j.issn.1671-7554.0.2020.1168

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Objective To introduce a new method to identify and protect the parathyroid glands in thyroid surgery with autofluorescence imaging. Methods A total of 6 patients who underwent thyroid surgery at our department in June 2020 were enrolled. The preoperative parathyroid hormone, serum calcium and phosphorus measurements were within the normal range. For the 3 patients with nodular goiter, 1 received thyroid lobectomy, and 2 received total thyroidectomy. Three patients with papillary thyroid carcinoma underwent total thyroidectomy, 2 of whom received simultaneous central lymph nodes dissection, and 1 received simultaneous lymph nodes dissection of central area + unilateral neck. Fluorescence surgical navigation system was used to perform autofluorescence imaging of parathyroid glands at the following time points: after the thyroid glands were exposed, after the parathyroid glands were exposed, after thyroidectomy, and after the completion of central lymph node dissection. Results Twenty-two parathyroid glands in 6 patients were not detected with autofluorescence before being exposed, but could be detected with obvious autofluorescence after being exposed. The autofluorescence imaging rate was 100%. The thyroids, lymph nodes and adipose tissues did not show substantial autofluorescence. One parathyroid gland still showed autofluorescence after being isolated. Conclusion Parathyroid glands show autofluorescence characteristics in the near-infrared spectrum. This can help to identify the parathyroid glands during thyroidectomy, but cannot be used as a navigation tool for parathyroid recognition.

Association between dietary patterns and depressive symptoms among Chinese elderly women

LYU Yan, YU Xiao, LIN Xinying, ZHAO Qi, WANG Baozhen

Journal of Shandong University (Health Sciences). 2020, 58(11): 103-108. doi:10.6040/j.issn.1671-7554.0.2020.0413

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Objective To explore the association between dietary patterns and depressive symptoms among Chinese elderly women. Methods With cluster random sampling method, 707 elderly women over 60 years were recruited from the urban, suburban, and rural areas of Liaocheng from April to May 2017. Their dietary intakes were surveyed with a simplified semi-quantitative food frequency questionnaire(FFQ), and depressive symptoms were assessed with a simplified Chinese version of Geriatric Depression Scale(GDS-15). According to the factor score of each dietary pattern, the subjects were divided into T1, T2 and T3 groups. The association between dietary patterns and depressive symptoms was analyzed with multivariate Logistic regression. Results Among the 610 subjects who were finally recruited in the study, 102(16.7%)had depressive symptoms. Three dietary patterns were identified, including high-quality protein pattern, vegetarian pattern and egg-alcohol-cereal pattern. Multivariate Logistic regression showed in the high-quality protein pattern, T3 group had a significantly lower risk of depressive symptoms than T1 group(OR=0.48, 95%CI: 0.24-0.94; P=0.028). In the vegetarian pattern, the T3 group had a significantly lower risk of depressive symptoms than T1 group(OR=0.46, 95%CI: 0.24-0.87; P=0.015). These associations were independent of the confounding factors. No statistical association was found between egg-alcohol-cereal pattern and depressive symptoms. Conclusion The high-quality protein pattern and vegetarian pattern may have a protective effect on the occurrence of depressive symptoms among the elderly. The results of this study can provide reference for prevention of depression with diets in the elderly.

Survey of medical students attitudes toward statistics and analysis of influencing factors

LIU Yumei, YUAN Zhongshang, SUN Xiubin, LI Xiujun, WANG Shukang, LIU Jing

Journal of Shandong University (Health Sciences). 2020, 58(11): 109-114. doi:10.6040/j.issn.1671-7554.0.2020.1115

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Objective To investigate medical students attitudes toward statistics, explore the influencing factors, and to explore the correlation between attitudes and course performance, so as to provide reference for teaching reform and to improve teaching effect. Methods Medical students registered for medical statistics during the academic year of 2018-2019 in a comprehensive university were surveyed with the Chinese version of Scale of Attitudes Toward Statistics(SATS-36). The items in the scale were scored with Likert 7-point method. Higher scores meant more positive attitude. The data were collected with online questionnaire and analyzed with SPSS 25.0 software. Results A total of 776 students completed the survey, and the mean score of scale was 4.84±0.64. The mean score of effort dimension(6.41±0.85)was the highest, followed by the dimension of value(5.93±0.88), and the dimension of difficulty had the lowest mean score(2.73±0.77). Gender, education level, major and self-evaluation of mathematical ability influenced students attitudes toward statistics. Male students had more positive attitudes than female students, and postgraduates were more positive than undergraduates. Students who majored in public health or clinical medicine were more positive than students in other majors. Higher self-evaluation of mathematical ability was associated with more positive attitude. There was a positive correlation between course performance and attitudes, but the correlation was weak(Spearman correlation coefficient was 0.227, P<0.001). Conclusion Medical students attitudes toward statistics were fairly positive, especially in terms of effort and value dimensions. However, statistics was widely considered difficult. The attitudes were positively correlated with course performance. In the teaching process of medical statistics, teachers should pay more attention to students emotion and cater to students individual needs.

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