TL-MSE2-Net: Transfer learning based nested model for cerebrovascular segmentation with aneurysms.

Cerebrovascular (i.e., cerebral vessel) segmentation is essential for diagnosing and treating brain diseases. Convolutional neural network models, such as U-Net, are commonly used for this purpose. Unfortunately, such models may not be entirely satisfactory in dealing with cerebrovascular segmentation with tumors due to the following issues: (1) Relatively small number of clinical datasets from patients obtained through different modalities such as computed tomography (CT) and magnetic resonance imaging (MRI), leading to inadequate training and lack of transferability in the modeling; (2) Insufficient feature extraction caused by less attention to both convolution sizes and cerebral vessel edges. Inspired by the existence of similar features on cerebral vessels between normal subjects and patients, we propose a transfer learning strategy based on a pre-trained nested model called TL-MSE2-Net. This model uses one of the publicly available datasets for cerebrovascular segmentation with aneurysms. To address issue (1), our transfer learning strategy leverages a pre-trained model that uses a large number of datasets from normal subjects, providing a potential solution to the lack of sufficient clinical datasets. To tackle issue (2), we structure the pre-trained model based on 3D U-Net, comprising three blocks: ResMul, DeRes, and REAM. The ResMul and DeRes blocks enhance feature extraction by utilizing multiple convolution sizes to capture multiscale features, and the REAM block increases the weight of the voxels on the edges of the given 3D volume. We evaluated the proposed model on one small private clinical dataset and two publicly available datasets. The experimental results demonstrated that our MSE2-Net framework achieved an average Dice score of 70.81 % and 89.08 % on the two publicly available datasets, outperforming other state-of-the-art methods. Ablation studies were also conducted to validate the effectiveness of each block. The proposed TL-MSE2-Net yielded better results than MSE2-Net on a small private clinical dataset, with increases of 5.52 %, 3.37 %, 6.71 %, and 0.85 % for the Dice score, sensitivity, Jaccard index, and precision, respectively.

Evaluation of the Effects of Myopic Astigmatism Correction and Anterior Corneal Curvature on Functional Optical Zone After SMILE.

PURPOSE: To evaluate the influence of different degrees of myopic astigmatism correction and preoperative anterior corneal curvature on the functional optical zone (FOZ) following small incision lenticule extraction (SMILE). METHODS: In this retrospective study, 68 patients (106 eyes) treated with SMILE were grouped according to myopic astigmatism correction: control (0.00 diopters [D]), moderate astigmatism (-0.50 to -2.00 D), and high astigmatism (> -2.00 D). The FOZ was measured and compared between the three groups for 3 months. Correlations between attempted correction, anterior corneal curvature, corneal aberrations, and the FOZ were analyzed. RESULTS: The preoperative mean treatment spherical equivalent was comparable among the three groups. The average FOZ was 5.06 ± 0.24 mm in the control group, 5.19 ± 0.25 mm in the moderate astigmatism group, and 5.35 ± 0.20 mm in the high astigmatism group The FOZ showed statistically significant differences among the three groups (P < .001), particularly between the high astigmatism group and the other two groups (P < .001 and .018). Correlation analysis showed that the total higher order aberrations, coma, and spherical aberration change were correlated with the FOZ (P < .001). Preoperative steep keratometry, average keratometry, and corneal astigmatism were significantly correlated with the FOZ (P < .05). The correlation remained after excluding the influence of attempted correction on the FOZ (P < .05). After adjusting for other risk factors using multiple linear regression analysis, there was still a significant positive association between preoperative steep keratometry and the FOZ (P < .001). CONCLUSIONS: Patients with higher myopic astigmatism achieved a larger FOZ and less induced horizontal coma than the control and moderate astigmatism groups. A larger FOZ after SMILE can be achieved in eyes with steeper keratometry. [J Refract Surg. 2023;39(2):135-141.].

Three-year results of small incision lenticule extraction and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis for correction of high myopia and myopic astigmatism.

AIM: To compare and calculate the 3-year refractive results, higher-order aberrations (HOAs), contrast sensitivity (CS) and dry eye parameters after small incision lenticule extraction (SMILE) and wavefront-guided femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for correction of high myopia and myopic astigmatism. METHODS: In this prospective, non-randomized comparative study, 78 eyes with spherical equivalent (SE) of -8.11±1.09 diopters (D) received a SMILE surgery, and 65 eyes with SE of -8.05±1.12 D received a wavefront-guided FS-LASIK surgery with the VisuMax femtosecond laser (Carl Zeiss Meditec, Jena, Germany) for flap cutting. Visual acuity, manifest refraction, CS, HOAs, ocular surface disease index (OSDI) and tear break-up time (TBUT) were evaluated during a 3-year follow-up. RESULTS: The difference of uncorrected distance visual acuity (UDVA) postoperatively was achieved at 1mo and at 3mo, whereas the difference of the mean UDVA between two groups at 3y were not statistically significant (t=-1.59, P=0.13). The postoperative change of SE was 0.89 D in the FS-LASIK group (t=5.76, P=0.00), and 0.14 D in the SMILE group (t=0.54, P=0.59) from 1mo to 3y after surgery. At 3-year postoperatively, both HOAs and spherical aberrations in the SMILE group were obviously less than those in the FS-LASIK group (P=0.00), but the coma root mean square (RMS) was higher in the SMILE group (0.59±0.26) than in the FS-LASIK group (0.29±0.14, P=0.00). The mesopic CS values between two groups were not statistically significant at 3y postoperatively. Compared with the FS-LASIK group, lower OSDI scores and longer TBUT values were found in the SMILE group at 1mo and 3mo postoperatively. With regard to safety, no eye lost any line of CDVA in both groups at 3y after surgery. CONCLUSION: Both SMILE and wavefront-guided FS-LASIK procedures provide good visual outcomes. Both procedures are effective and safe, but SMILE surgery achieve more stable long-term refractive outcome and better control of early postoperative dry eye as compared to FS-LASIK.

Comparison of the femtosecond laser and mechanical microkeratome for flap cutting in LASIK.

AIM: To compare refractive results, higher-order aberrations (HOAs), contrast sensitivity and dry eye after laser in situ keratomileusis (LASIK) performed with a femtosecond laser versus a mechanical microkeratome for myopia and astigmatism. METHODS: In this prospective, non-randomized study, 120 eyes with myopia received a LASIK surgery with the VisuMax femtosecond laser for flap cutting, and 120 eyes received a conventional LASIK surgery with a mechanical microkeratome. Flap thickness, visual acuity, manifest refraction, contrast sensitivity function (CSF) curves, HOAs and dry-eye were measured at 1wk; 1, 3, 6mo after surgery. RESULTS: At 6mo postoperatively, the mean central flap thickness in femtosecond laser procedure was 113.05±5.89 µm (attempted thickness 110 µm), and 148.36±21.24 µm (attempted thickness 140 µm) in mechanical microkeratome procedure. An uncorrected distance visual acuity (UDVA) of 4.9 or better was obtained in more than 98% of eyes treated by both methods, a gain in logMAR lines of corrected distance visual acuity (CDVA) occurred in more than 70% of eyes treated by both methods, and no eye lost ≥1 lines of CDVA in both groups. The difference of the mean UDVA and CDVA between two groups at any time post-surgery were not statistically significant (P>0.05). The postoperative changes of spherical equivalent occurred markedly during the first month in both groups. The total root mean square values of HOAs and spherical aberrations in the femtosecond treated eyes were markedly less than those in the microkeratome treated eyes during 6mo visit after surgery (P<0.01). The CSF values of the femtosecond treated eyes were also higher than those of the microkeratome treated eyes at all space frequency (P<0.01). The mean ocular surface disease index scores in both groups were increased at 1wk, and recovered to preoperative level at 1mo after surgery. The mean tear breakup time (TBUT) of the femtosecond treated eyes were markedly longer than those of the microkeratome treated eyes at postoperative 1, 3mo (P<0.01). CONCLUSION: Both the femtosecond laser and the mechanical microkeratome for LASIK flap cutting are safe and effective to correct myopia, with no statistically significant difference in the UDVA, CDVA during 6mo follow-up. Refractive results remained stable after 1mo post-operation for both groups. The femtosecond laser may have advantages over the microkeratome in the flap thickness predictability, fewer induced HOAs, better CSF, and longer TBUT.

Interleukin-17 enhanced immunoinflammatory lesions in a mouse model of recurrent herpetic keratitis.

Interleukin-17 (IL-17), mainly produced by activated (memory) T cells, has been found in the corneas from herpetic stromal keratitis (HSK) patients. To better understand the role of IL-17 and to optimize fidelity to human recurrent HSK, in this study, we utilized a mouse model of recurrent HSK, examined the expression of IL-17 and Th17 cells, and determine the alterability of virus-induced corneal inflammation after anti-IL-17 antibody treatment during murine recurrent HSK. We found that Th17 cells were obviously up-regulated in both cornea and DLNs of recurrent mice. Peak IL-17 protein present in recurrent cornea in conjunction with peak opacity mediated by CD4(+) T cells. Systemic administration of anti-IL-17 antibody resulted in a diminished severity of corneal opacity, neovascularization, and CD4(+) T cells infiltration compared to control. Anti-IL-17 treatment down-regulated the mRNA and protein levels of TNF-α expression in recurrent corneas, and decreased HSV-specific DTH responses. Our results indicate that elevated IL-17 expression may be involved in the development of recurrent HSK. The likely mechanisms of action for IL-17 are through up-regulating TNF-α expression and promoting HSV-specific DTH responses. Thus, IL-17 might constitute a useful target for therapeutic intervention in recurrent HSK.

The role of CTGF in the diabetic rat retina and its relationship with VEGF and TGF-ß(2) , elucidated by treatment with CTGFsiRNA.

PURPOSE: The critical association of connective tissue growth factor (CTGF) with diabetic retinopathy (DR) remains to be clarified. We detected alterations in the gene and protein expression of CTGF and related cytokines, including vascular endothelial growth factor (VEGF) and transforming growth factor-ß(2) (TGF-ß(2) ), and their response to small interfering RNA (siRNA) targeting the CTGF (CTGFsiRNA) in the retina of diabetic rats. The relationships between CTGF, VEGF and TGF-ß(2) levels, as well as the degree of apoptosis in the diabetic retina, were also investigated. METHODS: Diabetes was induced in rats by the ß-cell toxin streptozotocin (STZ). Retinas were obtained from control and diabetic rats and similar animals treated with CTGFsiRNA by intravitreal injection. mRNA level and protein expression of CTGF, VEGF and TGF-ß(2) were measured by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting, and located by immunohistochemistry. Retinal apoptosis was detected by TUNEL staining. RESULTS: The levels of CTGF, VEGF and TGF-ß(2) and the number of TUNEL-positive nuclei were significantly higher in diabetic retinas than in control retinas (p<0.01). The level of CTGF rose at 8weeks, earlier than levels of VEGF and TGF-ß(2) , which rose at 12weeks after the onset of diabetes. The difference was significant (p<0.05). siRNA-mediated inhibition of CTGF mRNA inhibited retinal VEGF and TGF-ß(2) and also resulted in a significant decrease in apoptosis. Significant correlations were found between CTGF and VEGF (p=0.009), CTGF and TGF-ß(2) (p=0.01), and apoptosis and these three cytokines (p<0.01) in the rat retina early in diabetes. CONCLUSIONS: These results suggest that the diabetes-mediated increase in CTGF upregulates VEGF and TGF-ß(2) expression and induces apoptosis in the retina. This elevation may be inhibited by treatment with CTGFsiRNA. Connective tissue growth factor may serve as a potential target for the prevention and treatment of DR.

[Suppression effects of interleukin-10 on mouse herpetic stromal keratitis].

OBJECTIVE: To investigate the role of interleukin-10 (IL-10) in herpetic stromal keratitis (HSK). METHODS: Eighty BALB/c mice were divided into two groups and infected with HSV-1 Mckrae strain by corneal scarification. Murine rIL-10 (20 ng/ml) was inoculated intracorneally 6 h before and again on days 0, 2 and 4 after topical HSV-1 corneal infection. rIL-10 (500 ng) was given intraperitoneally in treated mice simultaneously. The same amount of saline was injected into the control mice. The effects of IL-10 on HSK were evaluated. RESULTS: In the IL-10-treated animals, the onset of HSK was delayed, corneal stromal opacification and neovascularization were reduced, extensive cellular infiltrates in the cornea were prevented and delayed type hypersensitivity (DTH) was weakened. Examination of pro-inflammatory cytokine levels in the cornea 10 days after the infection revealed that the amounts of IL-2 and IL-6 were lower than those found in the controls. IL-10 did not suppress the viral replication nor did it eliminate the virus from IL-10-treated eyes, as compared with the controls. CONCLUSIONS: IL-10 treatment can suppress DTH responsiveness and the production of certain cytokines by corneal cells. It delays the onset and decreases the severity of HSK.