Abstract:Asthma is one of the most common chronic respiratory diseases in the world. Non-eosinophilic asthma（NEA） is a special type of asthma. NEA is characterized by airway inflammation with the absence of eosinophils， and the cellular infiltration is dominated by neutrophils. NEA is associated with environmental and host factors，such as occupational exposure，environmental pollution，smoking，infection，and obesity，which can，alone or in combination，activate specific cellular and molecular pathways to result in NEA. NEA features a poor response to standard asthma treatments，especially inhaled corticosteroids，which can lead to more serious and unmanageable asthma. Although NEA is not the most common type of asthma，it cannot be ignored because of a high proportion in patients with severe asthma. This article reviews the epidemiology，pathogenic factors，pathogenesis，and treatment of NEA in recent years.

Abstract:As an important part of the human immune system，lymph nodes are extensively distributed throughout the body. Various benign and malignant diseases may lead to lesions in lymph nodes，and the differentiation of benign and malignant lymph nodes is very important for prognosis prediction and staging. Ultrasound elastography（UE） is a non-invasive technique that can visualize the hardness and uniformity of the cortex and medulla of the lymph nodes and detect early local malignant infiltration. Therefore，this paper mainly discusses the principles and advantages and disadvantages of ultrasound elastography and the application progress on ultrasound elastography in lymphadenopathy.

Abstract:Vitamin D receptor（VDR） is widely expressed in female reproductive organs，and vitamin D binds with VDR to regulate bone and calcium homeostasis and participate in various signaling pathways such as inflammation，cell-mediated immunity，cell cycle，and apoptosis inside the body. Vitamin D regulates follicular development，ovarian reserve，and endometrial receptivity，and vitamin D deficiency is associated with the pathological process of polycystic ovary syndrome. Vitamin D supplementation is of great significance in preventing premature ovarian failure，uterine myoma，endometriosis，and ovarian cancer. The level of vitamin D inside the body is also associated with the outcome of in vitro fertilization. Vitamin D deficiency is a major public health problem，and reasonable supplementation of vitamin D may help to maintain female reproductive health.

Abstract:Objective To investigate the prevalence of cardiac autonomic neuropathy（CAN） with retinopathy and nephropathy in patients with type 2 diabetes mellitus（T2DM） and associated risk factors.Methods A total of 203 patients with T2DM who were hospitalized in the Department of Endocrinology of The First People’s Hospital of Yunnan Province from May 2022 to May 2023 were included. CAN was determined based on the scores of cardiovascular autonomic reflex tests. According to the presence or absence of diabetic retinopathy（DR） and diabetic kidney disease（DKD），the patients with CAN were divided into CAN alone group，CAN+DR group，CAN+DKD group，and CAN+DR+DKD group. The clinical data of all subjects were collected for statistical analysis using SPSS 26.0 software.Results Among the 203 patients with T2DM，the prevalence rate of CAN was 58.62%，with the prevalence rate of CAN+DR，CAN+DKD，CAN+DR+DKD being 10.08%，7.56%，and 10.92%，respectively. There were significant differences between the four groups in age，glycosylated hemoglobin（HbA1c），estimated glomerular filtration rate（eGFR），lactate dehydrogenase（LDH），direct bilirubin（DBIL），and the amount of time for blood glucose levels in the target range over 72 hours（TIR）（P<0.05）. The logistic regression analysis showed that HbA1c（odds ratio［OR］=2.948，95%CI=1.015-8.560，P=0.047） and LDH（OR=1.151，95%CI=1.035-1.280，P=0.010） were factors promoting the development and progression of CAN with DR and DKD； and DBIL（OR=0.057，95%CI=0.005-0.658，P=0.022），eGFR（OR=0.700，95%CI=0.513-0.955，P=0.025），TIR（OR=0.877，95%CI=0.775-0.992，P=0.037），and age（OR=0.550，95%CI=0.349-0.868，P=0.010） were significantly associated with the development and progression of CAN with DR and DKD.Conclusion Lower eGFR，TIR，DBIL，and age are negatively correlated with the occurrence of CAN with DR and DKD，while higher HbA1c and LDH are positively correlated with the occurrence of CAN with DR and DKD. Therefore，more attention should be paid to screening for CAN with DR and DKD in patients with T2DM with low eGFR，TIR，DBIL，age and/or high HbA1c and LDH.

Abstract:Objective To investigate the prevalence of thyroid nodules and thyroid cancer and the risk factors for thyroid nodules in a rural elderly population in iodine-sufficient areas of Jiangsu Province，China.Methods A cross-sectional survey was performed in iodine-sufficient areas of Jiangsu Province，investigating a total of 2 590 permanent residents aged ≥60 years selected by cluster sampling. They underwent physical examination and biochemical tests. Thyroid nodules were classified using the Thyroid Imaging Report and Data System（TI-RADS），part of which were examined for pathological information through an ultrasound-guided biopsy. A logistic regression analysis was used to analyze the risk factors for thyroid nodules.Results A total of 883 cases of thyroid nodules were detected in 2590 subjects. With an overall prevalence of 34.09%（883/2 590）. The prevalence of female subjects was significantly higher than that of male subjects（χ²=27.885，P=0.000）. There were significant differences in height（Ht），body mass index（BMI），fasting blood glucose（FBG），glycosylated hemoglobin（HbA1c），fasting insulin（FINS），triglyceride（TG），and 25-hydroxyvitamin D［25（OH）D］ between the participants with and without thyroid nodules（t=5.337、P=0.000，t=-5.160、P=0.000，t=-2.341、P=0.019，t=-4.993、P=0.000，t=-2.384、P=0.020，t=-2.940、P=0.003，t=6.432、P=0.000，respectively）. The prevalence of thyroid nodules in men increased with age. The overall detection rate of thyroid cancer in the elderly was 0.34%. The logistic regression analysis showed that the BMI and HbA1c hemoglobin were risk factors for thyroid nodules（OR=1.054，95%CI=1.028-1.081，P<0.01；OR=1.257，95%CI=1.117-1.414，P<0.01）.Conclusion Thyroid nodules are prevalent in the elderly in iodine-sufficient areas of Jiangsu Province，with a low prevalence of thyroid cancer. Glucose and lipid metabolism disorders are significantly related to the prevalence of thyroid nodules.

Abstract:Objective To investigate the influence of lifestyle and family history of cardiometabolic diseases on the risk of cardiometabolic diseases and the interaction between lifestyle and family history，and to guide disease prevention and control.Methods A total of 3009 permanent residents，aged 30-79 years，in Hechuan District were selected as subjects according to the inclusion and exclusion criteria，and a questionnaire survey，physical examination，and laboratory tests were performed. SPSS 26.0 was used to perform the chi-square test and the multivariate logistic regression analysis，and the multiplicative model and the additive model were used to investigate the interaction between lifestyle and family history on the onset of cardiometabolic diseases.Results There was neither multiplicative interaction（OR_int=1.22，95%CI=0.86-1.73） nor additive interaction between lifestyle and family history on cardiometabolic diseases，with a relative excess risk due to interaction of 0.69（95%CI=-3.98 to 5.36），an attributable proportion of 0.21（95%CI=-0.95 to 1.37），and a synergy index of 1.44（95%CI=0.16-13.03）. The individuals with an unhealthy lifestyle and a family history of cardiometabolic diseases had a higher risk of cardiometabolic diseases than those with a healthy lifestyle and no family history（odds ratio[OR]=3.26，95%CI=2.52-4.23），and male individuals（OR=5.16，95%CI=3.12-8.52） had a higher risk than female individuals（OR=2.72，95%CI=1.96-3.77）.Conclusion There is no interaction between lifestyle and family history on the risk of cardiometabolic diseases，but there is a combined effect. For individuals with such family history，maintaining a healthy lifestyle may help to control cardiometabolic diseases.

Abstract:Objective To investigate the correlation of soluble growth stimulation expressed gene 2（sST2） and galectin-3（Gal-3） with myocardial fibrosis（MF） in patients with coronary artery disease（CAD），and to guide the evaluation of ischemic MF in clinical practice.Methods A total of 56 patients with CAD and 31 patients without CAD who were hospitalized in our department from September 2021 to September 2022 were enrolled as subjects，and according to the results of cardiovascular magnetic resonance-late gadolinium enhancement（CMR-LGE），the CAD group was further divided into MF（LGE positive） subgroup and non-MF（LGE negative） subgroup. General clinical data were collected from all subjects，and ELISA was used to measure the serum levels of sST2 and Gal-3. The correlation of sST2 and Gal-3 with CMR-LGE results was analyzed.Results Compared with the non-CAD group，the CAD group had significantly higher levels of sST2 and Gal-3，blood pressure，creatinine，uric acid，interventricular septum thickness，glycosylated hemoglobin，and CAS score（P<0.05） and significantly lower glomerular filtration rate and high-density lipoprotein（P<0.05）. Compared with the LGE-negative subgroup，the LGE-positive subgroup had significantly higher levels of sST2，Gal-3，and pro-B-type natriuretic peptide（P<0.05） and a significantly lower level of high-density lipoprotein（P<0.05）. LGE was positively correlated with sST2（r_s=0.338，P=0.011），Gal-3（r_s=0.428，P=0.001），and pro-B-type natriuretic peptide（r_s=0.364，P=0.006） and was negatively correlated with high-density lipoprotein（r_s=-0.339，P=0.011），and the partial correlation analysis with control variables showed that LGE was independently correlated with sST2（r=0.312，P=0.037） and Gal-3（r=0.419，P=0.004）. The analysis showed that sST2 or Gal-3 used alone or in combination had a sensitivity of 65%，87%，and 70%，respectively，and a specificity of 81%，56%，and 87%，respectively，in detecting MF，and sST2 and Gal-3 had an optimal cut-off value of 36.01 ng/mL and 13.04 ng/mL，respectively，in predicting the presence or absence of ischemic MF.Conclusion This study shows that sST2 and Gal-3 can be used to predict ischemic MF and are highly consistent with CMR-LGE in evaluating MF.

Abstract:Objective To investigate the correlation between muscle echogenicity and plasma inflammatory factors in patients with intensive care unit-acquired weakness（ICUAW） and its diagnostic and prognostic value for ICUAW.Methods Patients hospitalized in the intensive care unit（ICU） in Chongging Emergency Medical Center were included. Their muscle echogenicity was measured using bedside ultrasonography on the 1st，3rd，and 7th day，and the global muscle echogenicity（GME） score was assessed. Serum interleukin-6（IL-6） and procalcitonin（PCT） levels were measured. Muscle strength was scored using the Medical Research Council Scale for Muscle Strength（MRC-ss）. The patients were divided into ICUAW group and non-ICUAW group according to the MRC-ss score on the 7th day after admission to the ICU. We compared GME，IL-6，and PCT between the two groups，and analyzed their correlations with one another. Receiver operating characteristic（ROC） curves were generated to analyze the diagnostic efficacy and prognostic value of the above parameters for ICUAW.Results The ICUAW group showed a significantly higher GME score on day 3 and a significantly higher IL-6 level and GME score on day 7 compared with the non-ICUAW group（P<0.05）. On day 7，there was a significant positive correlation between the GME score and IL-6 level（r=0.221） and a significant negative correlation between the GME score and MRC-ss score（r=-0.581）. The ROC curve analysis showed that the GME score on day 7 had diagnostic and predictive value for ICUAW，and the area under the ROC curve（AUC） was 0.838； the diagnostic AUC of the combination of GME score，IL-6，and PCT was 0.885（P<0.05）. The Barthel index（BI） score was significantly lower in the ICUAW group than in the non-ICUAW group，and in the ICUAW group，patients with a higher GME score had a significantly lower BI than those with a lower GME score（P<0.05）.Conclusion The GME score is related to plasma IL-6 and PCT levels in ICU patients，showing value for the diagnosis and outcome prediction of ICUAW.

Abstract:Objective To explore the value of placental growth factor（PLGF），soluble fms-like tyrosine kinase-1（SFLT-1），and glycosylated fibronectin（GLYFN） in predicting preeclampsia.Methods A total of 188 pregnant women who visited Wuxi Maternal and Child Health Hospital were enrolled in the study and divided into control group（154 normal pregnant women） and preeclampsia group（34 patients with preeclampsia）. The concentrations of serum PLGF，SFLT-1，and GLYFN at the 16th to 18th weeks of gestation were measured by immunofluorescence assay. The levels of individual markers were compared between the preeclampsia group and the control group. The receiver operating characteristic（ROC） curves were used to assess the efficiency of the three markers in terms of predictive value.Results During the mid-pregnancy period，the preeclampsia group had a significantly lower concentration of serum PLGF but significantly higher concentrations of serum SFLT-1 and GLYFN compared with the control group（all P=0.000）. The areas under the ROC curve（AUC） for the 95% confidence interval were 0.941（0.907-0.974），0.881（0.800-0.962），and 0.951（0.918-0.985） for PLGF，SFLT-1，and GLYFN，respectively. The AUCs for SFLT-1 combined with GLYFN and the combined detection of the three indices were 0.968 and 0.986，respectively.Conclusion There are significant differences between the control group and the preeclampsia group in the marker levels of serum PLGF，SFLT-1，and GLYFN，which has some value in predicting the onset of preeclampsia. The predictive value of SFLT-1 combined with PLGF，SFLT-1 combined with GLYFN，and the combination of the three markers are greater than that of any single index.

Abstract:Objective To investigate the echocardiographic changes in patients with acromegaly with hypertension and abnormal glucose metabolism.Methods We retrospectively included 120 patients with acromegaly diagnosed in The Second Affiliated Hospital of Army Medical University from April 2016 to August 2021. According to the presence or absence of hypertension and/or abnormal glucose metabolism，the patients were divided into group A（without hypertension or abnormal glucose metabolism），group B（with only abnormal glucose metabolism），group C（with only hypertension），and group D（with both hypertension and abnormal glucose metabolism）. We compared the echocardiographic parameters of the groups，and analyzed the influence of comorbidities on the structure and function of the heart in patients with acromegaly.Results There were no significant differences in the echocardiographic parameters of the right heart between the groups. The results of left heart echocardiogphic parameters showed that the left ventricular mass index and interventricular septal thickness of group D were significantly higher than groups A and B， and mitral ratio of peak early and late diastolic filling velocity （E/A） was significantly lower than groups A and B（P<0.05）. Group D had significantly higher probabilities of left ventricular hypertrophy，left atrial enlargement，and an abnormal left ventricular E/A ratio（odds ratio ［OR］=3.40，P=0.005；OR=4.14，P=0.009；OR=5.95，P<0.001）.Conclusion Echocardiography can sensitively detect and accurately evaluate cardiac changes in patients with acromegaly with hypertension and/or abnormal glucose metabolism.

Abstract:Objective To compare the bone age assessment efficiency of radiologists for children by left hand radiography before and after the implementation of the artificial intelligence（AI）-assisted bone age assessment system.Methods We conducted a retrospective analysis of left hand X-ray plain films of 300 children treated in our hospital. The China-05 standards were used to assess bone age. The bone age development grade of each bone in the left hand was assessed by two junior physicians（physician 1 and physician 2，experimental group） with and without the assistance of the AI system，and the time was recorded. The accuracy，root mean square error（RMSE），and time of bone age assessment were calculated with the mean values of assessment results of two senior radiologists（control group） with and without the assistance of the AI system as the reference standards.Results Without the assistance of the AI system，the diagnostic accuracy rates of physician 1 and physician 2 were 77.3%/83% and 88.7%/93.7% at month 6 and month 12，respectively，and the RMSE values were 9 and 8，respectively. With the assistance of the AI system，the diagnostic accuracy rates of physician 1 and physician 2 were 88.7%/90.3% and 97%/97.3% at month 6 and month 12，respectively，and the RMSE values were 6 and 6，respectively，showing significant differences. Without the assistance of the AI system，the mean assessment time of physicians in the experimental and control groups was 124.79 s and 89.13 s，respectively. With the assistance of the AI system，the mean assessment time of physicians in the experimental and control groups was 86.10 s and 63.87 s，respectively. By utilizing AI，the mean assessment time was significantly reduced（P<0.001）.Conclusion The AI-assisted bone age assessment system can significantly improve physicians’ work efficiency and reduce the film reading time.

Abstract:Objective To investigate the efficacy and complications of endoscopic surgery through three different approaches in the treatment of thyroid microcarcinoma.Methods We retrospectively included 240 patients with thyroid microcarcinoma who had undergone endoscopic surgery in The Second Affiliated Hospital of Wannan Medical College from January 2020 to March 2023. According to surgical approaches，the patients were divided into transoral vestibular approach group（n=71），transaxillary approach group（n=73）， and breast approach group（n=96）. The three groups were comparted in terms of general clinical data， perioperative indicators，postoperative pain，incision aesthetics，patients’ degree of satisfaction， and postoperative complications.Results The operation time of the transaxillary group was significantly shorter than that of the other two groups（P<0.001）. The length of incision was significantly different between the three groups： the transoral group < the breast group < the transaxillary group（P<0.001）. The transoral group had a significantly greater number of dissected central lymph nodes and a significantly shorter dissection time compared with the other two groups（P<0.001）. The visual analogue scale score was significantly lower in the transoral and transaxillary groups than in the breast group at 6 h，12 h，24 h，and 48 h after operation（P<0.001）. The transoral group and the transaxillary group were significantly superior to the breast group in incision aesthetics and patients’ degree of satisfaction（P<0.001）. The overall incidence of complications showed no significant difference between the three groups（P=0.491）.Conclusion Endoscopic surgery through the three approaches were equivalently effective in the treatment of thyroid microcarcinoma， with no difference in complications. However，the transaxillary approach showed the shortest operation time， and the transoral vestibular approach was superior in central lymph node dissection， dissection time， and incision aesthetics while ensuring the effectiveness. Surgical approach selection should be based on patient’s actual condition.

Abstract:Objective To investigate the safety and feasibility of robot-assisted laparoscopic total hysterectomy versus traditional laparoscopic total hysterectomy in patients with different levels of body mass index.Methods A retrospective analysis was performed for the case data of 416 patients who received robot-assisted laparoscopic total hysterectomy and 725 patients who received traditional laparoscopic total hysterectomy in The First Affiliated Hospital of Chongqing Medical University from February 2016 to April 2021. The patients were stratified according to the different levels of body mass index（non-overweight，overweight，and obese），and the two groups and the subgroups based on body mass index were compared in terms of perioperative conditions and intraoperative and postoperative complications.Results The overweight subgroup in the robot-assisted laparoscopic group had a significantly shorter time of operation than that in the traditional laparoscopic group［（125.37±50.92） min vs. （135.68±44.55） min，P<0.05］，and all three subgroups in the robot-assisted laparoscopic group had significantly lower intraoperative blood loss than those in the traditional laparoscopic group［non-overweight：（60.46±45.20） mL vs. （92.88±105.13） mL，P<0.05；overweight：（72.01±62.03） mL vs. （115.02±123.38） mL，P<0.05； obese：（65.59±37.92） mL vs. （125.16±96.07） mL，P<0.05］. The overweight and obese subgroups in the robot-assisted laparoscopic group had a significantly shorter time to first flatus than those in the traditional laparoscopic group［overweight：（2.04±0.83） d vs. （2.19±0.63） d，P<0.05；obese：（1.97±0.54） vs. （2.19±0.54） d，P<0.05］. All three subgroups in the robot-assisted laparoscopic group had a lower overall incidence rate of intraoperative and postoperative complications than those in the traditional laparoscopic group，but with no statistical significance（P>0.05）.Conclusion As for total hysterectomy in overweight and obese patients，robot-assisted laparoscopy has certain advantages over traditional laparoscopy in reducing perioperative complications.

Abstract:Objective To investigate the efficacy of deep brain stimulation（DBS） at different targets in the treatment of Meige syndrome.Methods A retrospective analysis was performed for the clinical data of eight patients with Meige syndrome who underwent DBS therapy at different targets in Department of Neurosurgery，The First Affiliated Hospital of Chongqing Medical University，from March 2019 to April 2022. The eight patients with primary Meige syndrome received DBS at bilateral subthalamic nucleus（STN） or bilateral globus pallidus internus（GPI）. Burke-Fahn-Marsden Dystonia Rating Scale（BFMDRS），Hamilton Anxiety Scale（HAMA），and Hamilton Depression Scale（HAMD） were used to evaluate the muscle tension，limb motor function，and mental condition of the patients before and after surgery，and postoperative complications were also recorded.Results At 12 months after surgery，the mean improvement rate of BFMDRS was （77.17±11.63）% for the eight patients，and the mean improvement rate of motor score was 76.49% in the patients receiving GPI stimulation and 77.85% in those receiving STN stimulation（P>0.05），suggesting that DBS at both targets could effectively improve the symptoms of patients without significant differences. In addition，there were varying degrees of improvement in HAMA and HAMD scores after surgery.Conclusion DBS treatment at different targets can effectively and safely improve the clinical symptoms of Meige syndrome and can thus be used as an alternative regimen in case of no response to local injection of drugs and botulinum toxins.

Abstract:Objective To analyze risk factors for cervical adhesions after loop electrosurgical excision procedure（LEEP） of the cervix，and to establish and verify a risk prediction model for it.Methods We prospectively selected 200 patients with cervical squamous intraepithelial lesions（SILs） who received LEEP treatment in The First People’s Hospital of Zunyi from September 2021 to April 2022. According to the presence or absence of cervical adhesions after LEEP，they were divided into adhesion group（n=45） and non-adhesion group（n=155）. Univariable and multivariable logistic regression analyses were performed to determine risk factors for the occurrence of postoperative cervical adhesions. A nomogram model was established based on the selected risk factors，followed by accuracy verification.Results The independent risk factors for postoperative cervical adhesions included age［odds ratio（OR）=1.152，95%CI=1.063-1.249］，cervical wound bleeding（OR=6.602，95%CI=2.652-16.436），cervical wound infection（OR=6.288，95%CI=2.357-16.772），and the depth of excision（OR=3.383，95%CI=1.367-8.373）. The verification results showed that the CI was 0.904. The Hosmer-Lemeshow test showed no significant difference between the nomogram model-predicted value and the observed value of the risk of cervical adhesions after LEEP（χ²=1.810，P=0.840）. For predicting the occurrence of cervical adhesions after LEEP，the calibration curve of the nomogram model was close to the ideal curve，with the mean absolute error before and after verification being 0.033. The area under the receiver operating characteristic curve of the nomogram model predicting the occurrence of postoperative cervical adhesions was 0.904（95%CI=0.858-0.950），with a sensitivity of 0.933 and a specificity of 0.768.Conclusion The established risk prediction model performs well in predicting the occurrence of cervical adhesions in patients with SILs undergoing LEEP，which can provide a reference for early preventive intervention measures for these patients.

Abstract:Objective To investigate the influence of intrahepatic cholestasis of pregnancy（ICP） on fetal ventricular systolic function，and to provide a basis for the early identification of fetal cardiac dysfunction in ICP.Methods A total of 67 pregnant women at 27-40 weeks of pregnancy who attended Affiliated Hospital of North Sichuan Medical College from July 2022 to April 2023 were enrolled，among whom there were 29 women with ICP（ICP group） and 38 normal pregnant women（control group）. Quantitative fetal heart analysis software was used to measure fetal ventricular systolic function，including longitudinal systolic function（global longitudinal strain ［GLS］，septal wall strain［SWS］，and free wall strain［FWS］ of the left and right ventricles），traverse systolic function（24-segment fractional shortening［FS］ of the left and right ventricles），and global systolic function（fetal area change［FAC］ of the left and right ventricles and ejection fraction［EF］ of the left ventricle）.Results As for longitudinal systolic function，the ICP group had significantly lower GLS，SWS，and FWS of the left and right ventricles than the control group（P<0.05）. As for traverse systolic function，there was no significant difference in the 24-segment FS of the left and right ventricles between the two groups（P>0.05）. As for global systolic function，the ICP group had significantly lower FAC of the left and right ventricles than the control group（P>0.05），while there was no significant difference in EF of the left ventricule between the two groups（P>0.05）.Conclusion In the intrauterine environment with high bile acid，the global systolic function and longitudinal systolic function of the left and right ventricles are significantly impaired in the fetus of women with ICP，and there is no significant change in traverse systolic function. Compared with EF of the left ventricule as the traditional indicator for evaluating cardiac function，FAC can be a more sensitive indicator in reflecting the changes of fetal heart function.

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