Prognosis and Factors 4 to 10 Years After Deep Vein Thrombosis: A Long-Term Follow-up Cohort Study.

Post-thrombotic syndrome (PTS) is one of the most common long-term complications of lower extremity deep vein thrombosis (DVT). In order to study the long-term adverse prognosis of patients with DVT, explore the influencing factors for the prognosis of DVT, and provide a reliable reference for future research in the field of venous thrombosis, we collected and summarized information about the incidence of PTS, the PTS score and grading, the associated symptoms and drug-related adverse reactions in 501 patients with DVT. In our study, 54.1% of patients with DVT (271 of 501) experienced indications and manifestations of PTS, the male to female ratio was approximately 1:1. During the long-term follow up, the most common symptoms of PTS were anterior tibial edema and pain. By statistical analysis, we found that the outcome of thrombosis was the influencing factor of PTS score (1-4 points, P<.05). The grading of PTS was primarily influenced by the history of varicose veins and DVT in the lower extremities. The duration of taking antithrombotic drugs affected the outcome of thrombosis (P<.05), especially among the female patients. In addition, varied factors, such as lower extremity DVT complicated with pulmonary embolism and the duration of antithrombotic drug use were found to increase the chances of experiencing drug-related adverse reactions (odds ratio [OR]=2.798, 95% confidence interval [CI]: 1.413-5.541 / OR=2.778, 95% CI: 1.231-6.269). The above 2 factors were significant only among female patients with DVT (OR=4.03, 95% CI: 1.608-10.103 / OR=3.918, 95% CI: 1.123-13.669).

What Do Higher Alanine Aminotransferase Levels Mean in Premature Ovarian Insufficiency?

The objective of this study was to investigate the relationship between alanine aminotransferase and related biochemical parameters and potential risk factors in women with premature ovarian insufficiency (POI). This is a retrospective cohort study with 126 POI patients (including subclinical POI, n= 27) and 130 healthy controls who visited our clinic between April 2021 to November 2022. Associations were investigated by multiple linear regression, Person correlation analysis, the Kruskal-Wallis test, Mann-Whitney U test, and the independent t-test. When compared to controls, analysis of POI patients showed that body mass index (BMI), uric acid (UA) and urea, alanine aminotransferase (ALT), aspartate aminotransferase (AST), monocyte/lymphocyte ratio, monocyte count (MONO), neutrophil count (NEUT), follicle-stimulating hormone (FSH), luteinizing hormone, and neutrophil/lymphocyte ratio (NLR) were significantly higher, while estradiol (E2), the lymphocyte count and the AST/ALT ratio were lower (P < 0.05). According to linear correlation, it was clear that BMI, FSH, white blood cell count (WBC), NEUT, MONO, UA, AST, and NLR were positively associated with ALT (r = 0.215, 0.388, 0.195, 0.187, 0.184, 0.605, 0.819, and 0.189, respectively, all P < 0.05) while E2 was negatively associated with ALT (r = -0.278, P < 0.05). In addition, multiple linear regression revealed a significant, independent, and positive correlation between AST, FSH, and ALT (B =1.403 and 0.069, respectively, P < 0.05). Analysis revealed that the levels of ALT were significantly higher in POI patients. In addition, BMI, FSH, UA, AST, MONO, NLR, NEUT, and WBC were positively associated with ALT in POI patients. E2 was negatively associated with ALT. Multiple linear regression revealed an independent and positive correlation between AST, FSH, and ALT. In addition, there was also a risk of liver function damage in women with POI and subclinical POI. If patients were diagnosed with POI, early examination and corresponding intervention will be required to effectively prevent the further development of liver disease.

Comprehensive assessment of the anterior segment in refraction corrected OCT based on multitask learning.

Anterior segment diseases are among the leading causes of irreversible blindness. However, a method capable of recognizing all important anterior segment structures for clinical diagnosis is lacking. By sharing the knowledge learned from each task, we proposed a fully automated multitask deep learning method that allows for simultaneous segmentation and quantification of all major anterior segment structures, including the iris, lens, cornea, as well as implantable collamer lens (ICL) and intraocular lens (IOL), and meanwhile for landmark detection of scleral spur and iris root in anterior segment OCT (AS-OCT) images. In addition, we proposed a refraction correction method to correct for the true geometry of the anterior segment distorted by light refraction during OCT imaging. 1251 AS-OCT images from 180 patients were collected and were used to train and test the model. Experiments demonstrated that our proposed network was superior to state-of-the-art segmentation and landmark detection methods, and close agreement was achieved between manually and automatically computed clinical parameters associated with anterior chamber, pupil, iris, ICL, and IOL. Finally, as an example, we demonstrated how our proposed method can be applied to facilitate the clinical evaluation of cataract surgery.

Evaluation of Ocular Diameter Parameters Using Swept-Source Optical Coherence Tomography.

Purpose: To investigate the iridocorneal angle-to-angle (ATA), sclera spur-to-sclera spur (STS), and white-to-white (WTW) ocular diameters and their potential influence on anterior chamber intraocular lens (ACIOL) and implantable collamer lens (ICL) sizing in Chinese subjects by using a swept-source optical coherence tomography system (SS-OCT). Design: A retrospective, observational, cross-sectional study. Methods: In 60 right eyes (60 subjects), the ATA, STS, and WTW were measured in six axes (0°-180°, 30°-210°, 60°-240°, 90°-270°, 120°-300°, and 150°-330°) using SS-OCT. The ACIOL and ICL sizes were calculated based on horizontal and vertical axes anterior segment data. A paired sample t-test was used to test the differences in each parameter across the six axes, the potential difference between each pair of parameters in a given axis, and the artificial lens size difference between the horizontal and vertical directions. Pearson's correlation analysis was used to determine the potential correlation between age and AL, WTW, STS, and ATA distances. Results: ATA and STS were the longest on the vertical and shortest on the horizontal axis, while WTW was similar on both axes. These three parameters differed only in the vertical axis (F = 4.910, p = 0.008). ATA and STS were by 0.23 ± 0.08 mm (p = 0.005) and 0.21 ± 0.08 mm wider (p = 0.010) than WTW, respectively. ICL size was 0.27 ± 0.23 mm smaller when based on the horizontal than on the vertical axis parameters (p < 0.001), while ACIOL remained similar (p = 0.709). Age correlated negatively and axial length positively with all measured values. ATA, STS, and WTW correlated positively in the same axis (all p < 0.001). Conclusions: ATA and STS were longer in the vertical than in the horizontal direction, while WTW measurements remained similar. ATA and STS diameters more accurately depicted anatomic relationships for phakic IOL sizing than WTW.

The Corneal Ectasia Model of Rabbit: A Validity and Stability Study.

Keratoconus is a bilateral progressive degenerative corneal disease characterized by localized corneal thinning and dilatation. The pathogenesis of keratoconus is not fully elucidated. To gain a better understanding of the pathophysiology of this disease and to explore potential treatments, animal models are essential for basic research. Several attempts have been made to establish animal models of corneal ectasia by using collagenase. However, continuous changes of the cornea have not been well-tracked for the model. In this study, corneal morphology and biomechanical behavior in vivo were determined before and after collagenase Ⅱ treatment at 2, 4, and 8 weeks. The elastic modulus and histology of cornea tissues ex vivo were measured at 8 weeks postoperatively. The results showed that the posterior corneal curvature (Km B) increased and central corneal thickness (CCT) decreased after collagenase treatment. The mechanical properties of ectatic corneas weakened significantly and the collagen fiber interval in the stromal layer was increased and disorganized. This study provides insights into the changes of corneal morphology and biomechanical properties in a rabbit model of corneal ectasia. Changes observed at 8 weeks indicated that the cornea was still undergoing remodeling.

Automatic measurement of anterior chamber angle parameters in AS-OCT images using deep learning.

The early assessment of angle closure is of great significance for the timely diagnosis and treatment of primary angle-closure glaucoma (PACG). Anterior segment optical coherence tomography (AS-OCT) provides a fast and non-contact way to evaluate the angle close using the iris root (IR) and scleral spur (SS) information. The objective of this study was to develop a deep learning method to automatically detect IR and SS in AS-OCT for measuring anterior chamber (AC) angle parameters including angle opening distance (AOD), trabecular iris space area (TISA), trabecular iris angle (TIA), and anterior chamber angle (ACA). 3305 AS-OCT images from 362 eyes and 203 patients were collected and analyzed. Based on the recently proposed transformer-based architecture that learns to capture long-range dependencies by leveraging the self-attention mechanism, a hybrid convolutional neural network (CNN) and transformer model to encode both local and global features was developed to automatically detect IR and SS in AS-OCT images. Experiments demonstrated that our algorithm achieved a significantly better performance than state-of-the-art methods for AS-OCT and medical image analysis with a precision of 0.941, a sensitivity of 0.914, an F1 score of 0.927, and a mean absolute error (MAE) of 37.1±25.3 µm for IR, and a precision of 0.805, a sensitivity of 0.847, an F1 score of 0.826, and an MAE of 41.4±29.4 µm for SS, and a high agreement with expert human analysts for AC angle parameter measurement. We further demonstrated the application of the proposed method to evaluate the effect of cataract surgery with IOL implantation in a PACG patient and to assess the outcome of ICL implantation in a patient with high myopia with a potential risk of developing PACG. The proposed method can accurately detect IR and SS in AS-OCT images and effectively facilitate the AC angle parameter measurement for pre- and post-operative management of PACG.

Incidence and Risk Factors for Berger's Space Development after Uneventful Cataract Surgery: Evidence from Swept-Source Optical Coherence Tomography.

Background: This study investigates the incidence and risk factors for the development of Berger's space (BS) after uneventful phacoemulsification based on swept-source optical coherence tomography (SS-OCT). Methods: Cataractous eyes captured using qualified SS-OCT images before and after uneventful phacoemulsification cataract surgery were included. Six high-resolution cross-sectional anterior segment SS-OCT images at 30° intervals were used for BS data measurements. BS width was measured at three points on each scanned meridian line: the central point line aligned with the cornea vertex and two point lines at the pupil's margins. Results: A total of 223 eyes that underwent uneventful cataract surgery were evaluated. Preoperatively, only two eyes (2/223, 0.9%) were observed to have consistent BS in all six scanning directions. BS was observed postoperatively in 44 eyes (44/223, 19.7%). A total of 13 eyes (13/223, 5.8%) with insufficient image quality, pupil dilation, or lack of preoperative image data were excluded from the study. A total of 31 postoperative eyes with BS and 31 matched eyes without BS were included in the final data analysis. The smallest postoperative BS width was in the upper quadrant of the vertical meridian line (90°), with a mean value of 280 µm. The largest BS width was observed in the opposite area of the main clear corneal incision, with a mean value >500 µm. Conclusions: Uneven-width BS is observable after uneventful phacoemulsification. Locations with a much wider BS (indirect manifestation of Wieger zonular detachment) are predominantly located in the opposite direction to the main corneal incisions.

Comparison Study of the Two Biometers Based on Swept-Source Optical Coherence Tomography Technology.

This research aimed to investigate the potential differences in the parameters, including axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), flat keratometry (Kf), steep keratometry (Ks), mean keratometry (Km), astigmatism, white-to-white (WTW) distance, acquired rate, and intraocular lens (IOL) power, between the two swept-source optical coherence tomography (SS-OCT) biometers, the ANTERION (biometer A) and IOLMaster 700 (biometer B). In a prospective observational comparative case series study, we enrolled 198 eyes undergoing cataract surgery. The AL, CCT, ACD, LT, Kf, Ks, Km, astigmatism, WTW, acquired rate, and IOL power were assessed. McNemar tests compared the acquired rate, and the paired sample t-test compared the quantitative measurement results between the groups. Nineteen eyes were excluded owing to missing AL data for either biometer. Finally, data from 179 eyes were analyzed. Between the two devices, no significant difference was found in AL, astigmatism magnitude, J0, and J45, while significant differences existed in CCT, ACD, LT, Kf, Ks, Km, WTW, astigmatism axis, and IOL power; no statistical significance was found in the AL acquired rate (biometer A, 90.9% and biometer B, 93.9%). Approximately 65.4% of eyes demonstrated ≥0.5-D difference in IOL power between the two biometers. In conclusion, the two biometers showed significant differences in all measurements (CCT, ACD, LT, K, WTW, astigmatism axis, and IOL power), except for AL.

Comparison of Mean Corneal Power of Annular Rings and Zones Using Swept-Source Optical Coherence Tomography.

This study aims to investigate differences in the mean corneal power of annular zones (corneal power measured over the inner annular zone of difference diameters) and rings (corneal power measured over a ring of different diameters) centered on the corneal apex using the swept-source optical coherence tomography technique. The mean anterior axial curvature (AAC), posterior axial curvature (PAC), and total corneal power (TCP) centered on the corneal apex with the annular rings (0−2 mm, 2−4 mm, 4−6 mm, and 6−8 mm) and zones were assessed using the ANTERION device. The paired-sample t-test was used for data comparison. For the 0−2 mm comparison, the AAC, PAC, and TCP values of rings and zones were interchangeable. For the 2−4 mm comparison, the AAC of the rings was lower than that of the zones (p = 0.004), and the TCP values of the rings were higher than that of the zones (p < 0.001). For the 4−6 mm comparison, the AAC of the rings was lower than that of the zones (p < 0.001), and the PAC and TCP values of the rings were higher than that of the zones (both p < 0.001). For the 6−8 mm comparison, the AAC of the rings was lower than that of the zones (p < 0.001), and the PAC and TCP values of the rings were higher than that of the zones (both p < 0.001). Comparisons between AAC and TCP in each sub-region showed significant differences both in the rings (p < 0.001) and the zones (p < 0.008). Differences in the AAC, PAC, and TCP measured at different diameters (2−4 mm, 4−6 mm, and 6−8 mm) of the rings and zones, centered on the corneal apex, should be noticed in clinical practice. As the diameter increases, the difference between the rings and the zones in terms of AAC, PAC, and TCP increase as well. Clinicians should also pay attention to differences between AAC and TCP for the rings and the zones within the same annular region.

miR-221 confers lapatinib resistance by negatively regulating p27kip1 in HER2-positive breast cancer.

Development of acquired resistance to lapatinib, a dual epidermal growth factor receptor (EGFR)/human epidermal growth factor receptor 2 (HER2) tyrosine kinase inhibitor, severely limits the duration of clinical response in advanced HER2-driven breast cancer patients. Although the compensatory activation of the PI3K/Akt survival signal has been proposed to cause acquired lapatinib resistance, comprehensive molecular mechanisms remain required to develop more efficient strategies to circumvent this therapeutic difficulty. In this study, we found that suppression of HER2 by lapatinib still led to Akt inactivation and elevation of FOX3a protein levels, but failed to induce the expression of their downstream pro-apoptotic effector p27kip1 , a cyclin-dependent kinase inhibitor. Elevation of miR-221 was found to contribute to the development of acquired lapatinib resistance by targeting p27kip1 expression. Furthermore, upregulation of miR-221 was mediated by the lapatinib-induced Src family tyrosine kinase and subsequent NF-κB activation. The reversal of miR-221 upregulation and p27kip1 downregulation by a Src inhibitor, dasatinib, can overcome lapatinib resistance. Our study not only identified miRNA-221 as a pivotal factor conferring the acquired resistance of HER2-positive breast cancer cells to lapatinib through negatively regulating p27kip1 expression, but also suggested Src inhibition as a potential strategy to overcome lapatinib resistance.

Postpartum septic pelvic thrombophlebitis and ovarian vein thrombosis after caesarean section: a rare case report.

BACKGROUND: Septic pelvic thrombophlebitis (SPT) is a well-recognized but rare puerperal complication that has two types: ovarian vein thrombophlebitis (OVT) and deep septic pelvic thrombophlebitis (DSPT). The present case report describes the clinical and imaging findings of a female patient diagnosed with right ovarian vein infectious thrombophlebitis after caesarean section (C-section). CASE PRESENTATION: A 35-year-old G3P2 female who presented with a foetal vein Galen malformation at 41 weeks of gestation underwent C-section. The patient had high fever after C-section, and anti-inflammatory treatment was not effective within 1 week. An abdominal wall incision haematoma was found, and a second surgery for the removal of the abdominal wall haematoma was performed. The patient was ultimately diagnosed with abdominal incision haematoma and right ovarian vein infectious thrombophlebitis after C-section. We used imipenem and tigecycline to strengthen the anti-inflammatory effects, simultaneously administrating low-molecular-weight heparin and warfarin as anticoagulant therapy. On the 30th day after C-section, the right ovarian vein thrombus disappeared. CONCLUSION: This case illustrates the need to consider the potential relationship between abdominal incision haematoma and ovarian vein thrombophlebitis. Despite advances in the management of venous thromboembolism globally, more data on epidemiology in terms of first incidence, prevalence, recurrence and risk factors, management of bleeding complications, and increased awareness in Asian populations are necessary.

Reaction paths between LiNH2 and LiH with effects of nitrides.

The solid-state reaction between LiNH2 and LiH potentially offers an effective route for hydrogen storage if it can be tailored to meet all the requirements for practical applications. To date, there still exists large uncertainty on the mechanism of the reaction--whether it is mediated by a transient NH3 or directly between LiNH2 and LiH. In an effort to clarify this issue and improve the reactivity, the effects of selected nitrides were investigated here by temperature-programmed desorption, X-ray diffraction, in-situ infrared analysis, and hydrogen titration. The results show that the reaction of LiNH2 with LiH below 300 degrees C is a heterogeneous solid-state reaction controlled by Li+ diffusion from LiH to LiNH2 across the interface. At the LiNH2/LiH interface, an ammonium ion Li2NH2+ and a penta-coordinated nitrogen Li2NH3 could be the intermediate states leading to the production of hydrogen and the formation of lithium imide. In addition, it is identified that BN is an efficient "catalyst" that improves Li+ diffusion and hence the kinetics of the reaction between LiNH2 and LiH. Hydrogen is fully released within 7 h at 200 degrees C with BN addition, rather than several days without the modification.