CauDR: A causality-inspired domain generalization framework for fundus-based diabetic retinopathy grading.

Diabetic retinopathy (DR) is the most common diabetic complication, which usually leads to retinal damage, vision loss, and even blindness. A computer-aided DR grading system has a significant impact on helping ophthalmologists with rapid screening and diagnosis. Recent advances in fundus photography have precipitated the development of novel retinal imaging cameras and their subsequent implementation in clinical practice. However, most deep learning-based algorithms for DR grading demonstrate limited generalization across domains. This inferior performance stems from variance in imaging protocols and devices inducing domain shifts. We posit that declining model performance between domains arises from learning spurious correlations in the data. Incorporating do-operations from causality analysis into model architectures may mitigate this issue and improve generalizability. Specifically, a novel universal structural causal model (SCM) was proposed to analyze spurious correlations in fundus imaging. Building on this, a causality-inspired diabetic retinopathy grading framework named CauDR was developed to eliminate spurious correlations and achieve more generalizable DR diagnostics. Furthermore, existing datasets were reorganized into 4DR benchmark for DG scenario. Results demonstrate the effectiveness and the state-of-the-art (SOTA) performance of CauDR. Diabetic retinopathy (DR) is the most common diabetic complication, which usually leads to retinal damage, vision loss, and even blindness. A computer-aided DR grading system has a significant impact on helping ophthalmologists with rapid screening and diagnosis. Recent advances in fundus photography have precipitated the development of novel retinal imaging cameras and their subsequent implementation in clinical practice. However, most deep learning-based algorithms for DR grading demonstrate limited generalization across domains. This inferior performance stems from variance in imaging protocols and devices inducing domain shifts. We posit that declining model performance between domains arises from learning spurious correlations in the data. Incorporating do-operations from causality analysis into model architectures may mitigate this issue and improve generalizability. Specifically, a novel universal structural causal model (SCM) was proposed to analyze spurious correlations in fundus imaging. Building on this, a causality-inspired diabetic retinopathy grading framework named CauDR was developed to eliminate spurious correlations and achieve more generalizable DR diagnostics. Furthermore, existing datasets were reorganized into 4DR benchmark for DG scenario. Results demonstrate the effectiveness and the state-of-the-art (SOTA) performance of CauDR.

No side effects on rabbit retina or vitreous microenvironment by nd:YAG laser vitreolysis.

BACKGROUND: To explore the safety of Neodymium:Yttrium-aluminum-garnet (Nd:YAG) laser vitreolysis based on the histological examination of the retina and the alteration of vitreous cytokines in the rabbits. METHODS: Nine male New Zealand rabbits underwent Nd:YAG laser vitreolysis of 10 mJ x 500 pulses in the left eyes, while the right eyes were used as controls. Intraocular pressure, color fundus photography, and ultrasound B scan were measured before, as well as 1 day, 4 weeks, and 12 weeks after Nd:YAG laser vitreolysis. Three rabbits were euthanized 1 day, 4 weeks, and 12 weeks after treatment, respectively. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining and hematoxylin-eosin (H&E) staining were used to look for pathological changes in the retina. An enzyme-linked immunosorbent assay (ELISA) was utilized to detect the expression of vascular endothelial growth factor (VEGF) and some inflammatory cytokines, including interferon inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1) and interlenkin 6 (IL-6) in the vitreous humor. The ascorbic acid (AsA) and total reactive antioxidant potential (TRAP) in the vitreous humor were also measured. RESULTS: Following Nd:YAG laser vitreolysis, the levels of VEGF, IP-10, MCP-1, IL6, AsA, and TRAP in the vitreous humor did not change substantially (P > 0.05). There were no detectable pathological changes in the retinal tissues, and no apoptotic signal was found. CONCLUSIONS: Rabbits tolerate Nd:YAG laser vitreolysis without observable impact on retinal tissue or the microenvironment of the vitreous.

Interventional treatment of traumatic carotid-cavernous fistula: A case report.

RATIONALE: Patients with traumatic carotid-cavernous fistula (TCCF) usually go to the ophthalmology department first because of the symptoms such as protrusion of eyes, edema and congestion of combined membrane, vision loss and so on. It is easy to be misdiagnosed and missed. PATIENT CONCERNS: We report a case of left eye swelling and vision loss caused by TCCF after head injury due to traffic accident, which failed to respond to ophthalmic treatment for many times. The similar situation is very likely to cause panic among patients. DIAGNOSIS: Cerebral angiography revealed left internal carotid-cavernous fistula (high flow type). INTERVENTIONS: Left internal carotid artery covered stent implantation was performed. OUTCOMES: The fistulas and the original venous mass were completely covered by the covered stent, and the development of the vascular mass disappeared. The patient's eye symptoms basically disappeared 14 days after the operation. LESSONS: Interventional treatment of TCCF is effective.

A new diagnostic method using air perfusion radiography under DSA for gastric stump-pleural fistula: Report of five cases.

Gastric stump-pleural fistula is a common complication following gastroesophageal anastomosis in patients diagnosed with gastric cancer. Mortality is high because of the severe subsequent relevant complications caused by the fistula. Here we report five cases of gastric stump-pleural fistula diagnosed by air perfusion radiography under digital subtraction angiography (DSA). DSA air perfusion radiography provides a reliable basis for the development of clinical programmes; it is a simple method which does not involve any pain or trauma to the patient.

Effects of compound chemical activators on the hydration of low-carbon ferrochrome slag-based composite cement.

Low-carbon ferrochrome slag (LCFS), a by-product of the ferrochrome alloy industry, has potential for use as a cementitious material due to its pozzolanic characteristic. The objective of the present study was to determine the optimum compound chemical activators for LCFS-based composite cement using an orthogonal test, in which 7 d and 28 d compressive strengths were used as the evaluating indices. The influences of compound chemical activators on the hydration of a composite cement mix were investigated using X-ray diffraction (XRD), scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM/EDS) and thermogravimetry-differential scanning calorimetry (TG-DSC). The optimum activator to activate the composite cement was a compound of NaCl (NC) at a dosage of 0.6%, Na2SO4 (NS) at a dosage of 1.2%, NaF (NF) at a dosage of 0.6% and Al2(SO4)3 (AS) at a dosage of 0.9% or 0.7%. The compressive strengths of the optimum composite cement mix at ages of 3, 28 and 180 d increased by 50.1%, 22.4% and 16.5%, respectively. More hydration products including ettringite and calcium silicate hydrate were formed at an early age of hydration. The compound chemical activators effectively activated the ferrochrome slag (FS), blast-furnace slag (BFS) and fly ash (FA) in the composite cement.

Perceived Parental Control, Self-Criticism, and Nonsuicidal Self-Injury Among Adolescents: Testing the Reciprocal Relationships by a Three-Wave Cross-Lag Model.

This study examined the prospective and reciprocal relationships among perceived parental control, self-criticism, and nonsuicidal self-injury (NSSI). We also examined the mediating effect of self-criticism in the relationship between perceived parental control and NSSI. We aimed to find out whether perceived parental control and self-criticism acted as risk factors for NSSI, or consequences of NSSI, or both. A group of 3,600 Chinese adolescents (mean age = 14.63 years, 56.6% female) completed questionnaires, with measures assessing NSSI, self-criticism, and parental control. A cross-lag model was used to test the reciprocal relationships among variables at 3 time points with 6-month intervals. Perceived parental control and self-criticism did not reliably predict later NSSI, but NSSI predicted later perceived parental control and self-criticism. Findings of this study emphasize the adverse effects of NSSI, and shed light on the intervention efforts of this behavior.

The effect of curcumin and its nanoformulation on adjuvant-induced arthritis in rats.

BACKGROUND: Rheumatoid arthritis (RA), induced by the prolonged inappropriate inflammatory responses, is one of the most prevalent of all chronic inflammatory joint diseases. Curcumin (CM), a yellow hydrophobic polyphenol derived from the herb turmeric, has various pharmacological activities against many chronic diseases and acts by inhibiting cell proliferation and metastasis and downregulating various factors, including nuclear factor kappa B, interleukin-1ß and TNF-α. Given the pathogenesis of RA, we hypothesized that the drug also has antiarthritic effects. The aims of the present study included the following: 1) examining the therapeutic effect of CM administered via intravenous (iv) injection on RA and 2) formulating the drug into oil-water nanoemulsions (Ns) to overcome the low oral bioavailability of CM and achieve oral delivery of the drug. METHODS: The effect of CM administered through iv injection on adjuvant-induced arthritis in rats was studied in terms of paw swelling, weight indices of the thymus and spleen, and pathological changes in nuclear factor kappa B expression and inflammatory cytokines. Methotrexate was used as a positive control. The CM-Ns were prepared using a high-pressure homogenizing method and characterized with respect to the particle size and morphology. The stability of the CM-Ns in simulated gastrointestinal (GI) fluids and in vitro release were also investigated. A pharmacokinetic study of the CM-Ns and suspensions in which the plasma levels were determined using an high performance liquid chromatography method and the pharmacokinetic parameters were calculated based on a statistical moment theory was also performed in rats. RESULTS: CM administered via iv injection had a therapeutic effect on RA similar to methotrexate. CM-Ns with a diameter of approximately 150 nm were successfully prepared, and the drug was well encapsulated into the Ns without degradation in simulated GI conditions. The area under the curve (AUC) and Cmax for the CM-Ns were more than threefold greater than those for the suspensions; moreover, similar decreases in the levels of TNF-α and interleukin-1ß in both synovial fluid and blood serum were obtained from oral administration of CM-Ns and iv injection. CONCLUSION: CM was an effective antiarthritic agent, and the present N formulation appeared to be a promising system that allowed RA therapy with CM to be converted from iv to oral administration.

Assessing the impact of leather industries on the quality of water discharged into the East China Sea from Wenzhou Watersheds.

Ammonium nitrogen and total germanium are among the main pollutants in the wastewater discharged from the leather industry. The intake of high concentrations of ammonium nitrogen and/or total germanium harms human health and biological species, as is well documented in literature. This paper focuses on assessing the trends of ammonium nitrogen and total germanium concentrations through time in two watersheds (Aojiang and Oujiang) in the Wenzhou metropolitan area of Zhejiang Province and their relationships with the released wastewater using regression and correlation statistics. The paper also utilizes the integrated pollution index to evaluate water quality in the two watersheds. Preliminary results show that, from 1992 to 1998 in the Aojing watershed, the concentrations of ammonium nitrogen and total germanium increased 13 and 14 times, respectively, decreasing somewhat after 1998, while between 1992 and 1997 in the Oujiang watershed, the concentrations increased, then decreased after 1997. The concentrations of ammonium nitrogen and total germanium are positively related to the amount of released wastewater. The concentrations of ammonium nitrogen and total germanium exceeded water standards 12 and 3 times, respectively, in Pingyang county of the Aojiang watershed, 14 and 3.3 times in Lucheng District of the Oujiang watershed, and 14 and 3.8 times in the Ouhai Oujiang watershed, respectively. In Pingyang county of the Aojiang watershed, the water quality degraded from Type III in 1992 to over Type V in 2003, and in the Oujiang watershed, the water quality degraded from Type II to over Type IV in 1999, when they were compared with the water quality standards. The water quality slightly improved in 2003 for the Oujiang watershed. It appears that pollution did have a direct positive correlation with leather industry production in the Pingyang Aojing watershed, while there was a negative correlation between the two in the Oujiang watershed. In these two watersheds, the integrated pollution index did not appear to relate to population dynamics and agricultural production. This paper also discusses the current new methodologies and approaches adopted nationally and internationally to reduce the contaminants and purify the environment for maintaining a sustainable and healthier environment in Wenzhou.

Assessing the impact of leather industry to water quality in the Aojing watershed in Zhejiang Province, China.

The development of the leather industry in the Aojiang watershed of Zhejiang province increased the release of waste water. In the waste water, ammonium nitrogen (NH(+) (4)-N) and germanium (Ge) are the main pollutants. In recent years, literature has documented that the intake of high concentrations of NH(+) (4)-N and Ge harms human health and biological species. This paper focuses on assessing the trends of NH(+) (4)-N and Ge concentrations in the released waste water in Aojiang watershed and on understanding their relationships with the released waste water using regression and correlation statistics. The paper also utilizes the integrated pollution index to evaluate the water quality in the watershed. Preliminary results show that, from 1992 to 1998, the concentrations of NH(+) (4)-N and total Ge increased 13 and 14 times, respectively, and they decreased somewhat after 1998. The concentrations of NH(+) (4)-N and total Ge are positively correlated to the amount of released waste water. These concentrations of NH(+) (4)-N and Ge, respectively, exceed 12 and 3 times, of the water standards. The water quality in the watershed degraded from Type III in 1992 to over Type V in 2003 when they were compared with the national water quality standards. It appeared that the pollution had positive correlation with leather industry production. The degraded water has no doubt affected human health and the ecosystem health. These results can provide scientific information for the local government to reasonably adjust the industry structure and reduce the pollution to protect the environment.