PDGFD switches on stem cell endothelial commitment.

The critical factors regulating stem cell endothelial commitment and renewal remain not well understood. Here, using loss- and gain-of-function assays together with bioinformatic analysis and multiple model systems, we show that PDGFD is an essential factor that switches on endothelial commitment of embryonic stem cells (ESCs). PDGFD genetic deletion or knockdown inhibits ESC differentiation into EC lineage and increases ESC self-renewal, and PDGFD overexpression activates ESC differentiation towards ECs. RNA sequencing reveals a critical requirement of PDGFD for the expression of vascular-differentiation related genes in ESCs. Importantly, PDGFD genetic deletion or knockdown increases ESC self-renewal and decreases blood vessel densities in both embryonic and neonatal mice and in teratomas. Mechanistically, we reveal that PDGFD fulfills this function via the MAPK/ERK pathway. Our findings provide new insight of PDGFD as a novel regulator of ESC fate determination, and suggest therapeutic implications of modulating PDGFD activity in stem cell therapy.

Luminescent Coordination Polymer for Picric Acid Detection and Treatment on Spinal Cord Injury Model Via Upregulating the trka Expression.

A luminescent coordination polymer based on Tb(III) has been synthesized with the tripodal carboxylic acid ligand containing N,O codonors (H2PBA = 5-[4-pyridin-3-yl-benzoylamino]-isophthalic acid) as ligand under solvothermal conditions. The chemical formula of this polymer is {[Tb2(PBA)3(H2O)3]·DMF·3H2O}n (1). Complex 1 has good sensitivity and selectivity to picric acid (PA). At 0-30 µmol/L, 1's quenching constant is 4.5 × 104 L/mol. In the biological function study, the motor function of spinal cord-injured animals after different treatments was evaluated using the blood-brain barrier (BBB) method. The trka expression level on the neural stem cells after treatment was measured to reveal the underlying mechanism.

Postdural disc herniation at L5/S1 level mimicking an extradural spinal tumor.

INTRODUCTION: Postdural disc herniation has been documented rarely and the pathogenesis is still unknown. The average age of postdural disc herniations is between 50 and 60 years, and the sites most frequently affected by postdural lumbar disc herniations are L3-L4 and L4-L5, only less than 10 % in L5-S1. Although magnetic resonance imaging (MRI) is a useful tool in the diagnosis of this disease, the postdural disc herniation is usually misdiagnosed as extradural spine tumor preoperatively. The definitive diagnosis is made during operation or according to the postoperative pathology. METHODS: In this article, we described here a 48-year-old male patient who presented with intermittent pain in the low back and frequent urination for 4 years as well as hypesthesia and pain of the left lower extremity for 1 month. RESULTS: A standard total laminectomy was performed and the histopathological diagnosis was consistent with a degenerated intervertebral disc. The patient presented significant relief of the pain and of the neurological symptoms, but no improvement of frequent urination, in the postoperative period. CONCLUSIONS: The diagnosis of postdural disc herniations is very difficult and mainly based on intraoperative and histopathological results. Early surgical intervention is important to relieve symptoms and prevent severe neurological deficits.

Ultraviolet (UV) and hydrogen peroxide activate ceramide-ER stress-AMPK signaling axis to promote retinal pigment epithelium (RPE) cell apoptosis.

Ultraviolet (UV) radiation and reactive oxygen species (ROS) impair the physiological functions of retinal pigment epithelium (RPE) cells by inducing cell apoptosis, which is the main cause of age-related macular degeneration (AMD). The mechanism by which UV/ROS induces RPE cell death is not fully addressed. Here, we observed the activation of a ceramide-endoplasmic reticulum (ER) stress-AMP activated protein kinase (AMPK) signaling axis in UV and hydrogen peroxide (H2O2)-treated RPE cells. UV and H2O2 induced an early ceramide production, profound ER stress and AMPK activation. Pharmacological inhibitors against ER stress (salubrinal), ceramide production (fumonisin B1) and AMPK activation (compound C) suppressed UV- and H2O2-induced RPE cell apoptosis. Conversely, cell permeable short-chain C6 ceramide and AMPK activator AICAR (5-amino-1-ß-D-ribofuranosyl-imidazole-4-carboxamide) mimicked UV and H2O2's effects and promoted RPE cell apoptosis. Together, these results suggest that UV/H2O2 activates the ceramide-ER stress-AMPK signaling axis to promote RPE cell apoptosis.

Experimental investigation on fracturing effects in hydraulic sand fracturing with acoustic emission and 3d laser scanning.

Due to the extremely low permeability of shale reservoirs, large-scale reservoir fracturing is required. Hydraulic fracturing is one of the most important technologies in shale gas exploration and development. In this paper, the acoustic emission energy and the number of location and fracture surface morphology of specimens before and after fracture are studied through hydraulic sand fracturing test. The test results show that: (1) the energy ratio obtained during hydraulic fracturing without proppant is the smallest, and increasing the confining pressure, as well as reducing the displacement and viscosity of the fracturing fluid will cause the energy ratio to decrease. From the perspective of acoustic emission energy, the proppant play an important role in the generation of fractures during hydraulic sand fracturing; (2) when the confining pressure increases, the number of shale specimens before and after rupture is the largest, but the total number of locating events is smaller than the sanding ratio increased; there is no proppant hydraulic fracturing, the number of specimens before and after the rupture is the largest. And the total number reached the minimum, indicating that the proppant can play an important role in the hydraulic sand fracturing test; (3) the sand is relatively large, the specific surface and standard deviation both reach the maximum, indicating that the fracture surface roughness is the largest under the test condition, and the fracturing effect is the best, but the specific surface and standard deviation are the minimum when fracturing without proppant, so indicating that the fracture surface fracturing effect is the worst at this time.

Ascending aortic volume: A feasible indicator for ascending aortic aneurysm elective surgery?

Diameter-based criterion have been widely adopted for preventive surgery of ascending thoracic aortic aneurysm (ATAA). However, recent and growing evidence has shown that diameter-based methods may not be sufficient for identifying patients who are at risk of an ATAA. In this study, fluid-structure interaction (FSI) analysis was performed on one-hundred ATAA geometries reconstructed from clinical data to examine the relationship between hemodynamic conditions, ascending aortic volume (AAV), ascending aortic curvature, and aortic ratios measured from the reconstructed 3D models. The simulated hemodynamic and biomechanical parameters were compared among different groups of ATAA geometries classified based on AAV. The ATAAs with enlarged AAV showed significantly compromised hemodynamic conditions and higher mechanical wall stress. The maximum oscillatory shear index (OSI), particle residence time (PRT) and wall stress (WS) were significantly higher in enlarged ATAAs compared with controls (0.498 [0.497, 0.499] vs 0.499 [0.498, 0.499], p = 0.002, 312.847 [207.445, 519.391] vs 996.047 [640.644, 1573.140], p < 0.001, 769.680 [668.745, 879.795] vs 1072.000 [873.060, 1280.000] kPa, p < 0.001, respectively). Values were reported as median with interquartile range (IQR). AAV was also found to be more strongly correlated with these parameters compared to maximum diameter. The correlation coefficient between AAV and average WS was as high as 0.92 (p < 0.004), suggesting that AAV might be a feasible risk identifier for ATAAs. STATEMENT OF SIGNIFICANCE: Ascending thoracic aortic aneurysm is associated with the risk of dissection or rupture, creating life-threatening conditions. Current surgical intervention guidelines are mostly diameter based. Recently, many studies proposed to incorporate other morphological parameters into the current clinical guidelines to better prevent severe adverse aortic events like rupture or dissection. The purpose of this study is to gain a better understanding of the relationship between morphological parameters and hemodynamic parameters in ascending aortic aneurysms using fluid-solid-interaction analysis on patient-specific geometries. Our results suggest that ascending aortic volume may be a better indicator for surgical intervention as it shows a stronger association with pathogenic hemodynamic conditions.

A Novel PAX6 Frameshift Mutation Identified in a Large Chinese Family with Congenital Aniridia.

Congenital aniridia is a rare autosomal dominant congenital ocular disorder. Genetic studies suggest that heterozygous mutations in the developmental regulator PAX6 gene or the related regulatory regions leading to haploinsufficiency are the main cause of congenital aniridia. In this study, the clinical characteristics and pathogenic mutation of a four-generation Chinese family with congenital aniridia were investigated. All members recruited in this study underwent comprehensive ophthalmic examinations. Targeted gene capture sequencing and Sanger sequencing were performed to screen and confirm the candidate pathogenicity gene and its mutation. A multiple alignment of homologous sequences covering the identified mutation from different species was investigated, and the mutant protein structure was predicted using Swiss-Model. Additionally, the prediction of pathogenicity was analyzed using the ACMG Guidelines. Thirteen patients in this pedigree were diagnosed with congenital aniridia. A novel heterozygous frameshift mutation (c.391_398dupATACCAAG, p.Ser133Argfs*8) in exon 7 of the PAX6 gene was identified in all affected individuals in the family. This study demonstrates that this frameshift mutation of the PAX6 gene might be the causative genetic defect of congenital aniridia in this family. This mutation is predicted to cause the premature truncation of the PAX6 protein, leading to the functional haploinsufficiency of PAX6, which may be the major molecular mechanism underlying the aniridia phenotype. To the best of our knowledge, this is the first report of a novel pathogenic PAX6 gene variant c.391_398dupATACCAAG(p.Ser133Argfs*8) identified in a Chinese family with congenital aniridia.

TNF-α promotes human retinal pigment epithelial (RPE) cell migration by inducing matrix metallopeptidase 9 (MMP-9) expression through activation of Akt/mTORC1 signaling.

Tumor necrosis factor-alpha (TNF-α) promotes in vitro retinal pigment epithelial (RPE) cell migration to initiate proliferative vitreoretinopathy (PVR). Here we report that TNF-α promotes human RPE cell migration by inducing matrix metallopeptidase 9 (MMP-9) expression. Inhibition of MMP-9 by its inhibitor or its neutralizing antibody inhibited TNF-α-induced in vitro RPE cell migration. Reversely, exogenously-added active MMP-9 promoted RPE cell migration. Suppression Akt/mTOR complex 1(mTORC1) activation by LY 294002 and rapamycin inhibited TNF-α-mediated MMP-9 expression. To introduce a constitutively active Akt (CA-Akt) in cultured RPE cells increased MMP-9 expression, and to block mTORC1 activation by rapamycin inhibited its effect. RNA interference (RNAi)-mediated silencing of SIN1, a key component of mTOR complex 2 (mTORC2), had no effect on MMP-9 expression or secretion. In conclusion, this study suggest that TNF-α promotes RPE cell migration by inducing MMP-9 expression through activation of Akt/ mTORC1, but not mTORC2 signaling.

Study of the Mechanical Properties of Alkali-Activated Solid Waste Cementitious Materials at the Interface.

The paper uses alkali-activated slag and fly ash as cementitious materials to pour and repair concrete. Their modification on the bonding surface of new and old concrete is studied. The new and old concrete composite specimens were prepared. The split tensile strength test of the new and old concrete specimens along the interface was carried out, and the test results of different alkali-stimulated slag and fly ash concrete as repair materials were compared and analyzed. The influence of activator modulus and other factors on the bond strength of new and old concrete interfaces was studied, and the law of its strength change was explored. The research results show that with the gradual increase in the amount of fly ash minerals, the splitting tensile strength presents a trend of first increasing and then decreasing. When the amount is 50%, the splitting surface partly occurs on the old concrete. It shows that the bonding effect is the best at this content; the alkali excitation modulus gradually increases, and the splitting tensile strength shows a downward trend. When the activator modulus is 1.3, more gelatinous substances can be observed in the section of the specimen. These overlap each other to form a tight material skeleton structure; a comparative analysis of the bonding strength of the new and old concrete interfaces with different interface agents and without interface agents showed that the alkali-activated solid waste cementitious material has the best repair performance and greater bonding strength when the water-to-binder ratio is 0.3.

A Novel System for Measuring Pterygium's Progress Using Deep Learning.

Pterygium is a common ocular surface disease. When pterygium significantly invades the cornea, it limits eye movement and impairs vision, which requires surgery to remove. It is medically recognized that when the width of the pterygium that invades the cornea is >3 mm, the patient can be treated with surgical resection. Owing to this, this study proposes a system for diagnosing and measuring the pathological progress of pterygium using deep learning methods, which aims to assist doctors in designing pterygium surgical treatment strategies. The proposed system only needs to input the anterior segment images of patients to automatically and efficiently measure the width of the pterygium that invades the cornea, and the patient's pterygium symptom status can be obtained. The system consists of three modules, including cornea segmentation module, pterygium segmentation module, and measurement module. Both segmentation modules use convolutional neural networks. In the pterygium segmentation module, to adapt the diversity of the pterygium's shape and size, an improved U-Net++ model by adding an Attention gate before each up-sampling layer is proposed. The Attention gates extract information related to the target, so that the model can pay more attention to the shape and size of the pterygium. The measurement module realizes the measurement of the width and area of the pterygium that invades the cornea and the classification of pterygium symptom status. In this study, the effectiveness of the proposed system is verified using datasets collected from the ocular surface diseases center at the Affiliated Eye Hospital of Nanjing Medical University. The results obtained show that the Dice coefficient of the cornea segmentation module and the pterygium segmentation module are 0.9620 and 0.9020, respectively. The Kappa consistency coefficient between the final measurement results of the system and the doctor's visual inspection results is 0.918, which proves that the system has practical application significance.

Screening of Common Retinal Diseases Using Six-Category Models Based on EfficientNet.

Purpose: A six-category model of common retinal diseases is proposed to help primary medical institutions in the preliminary screening of the five common retinal diseases. Methods: A total of 2,400 fundus images of normal and five common retinal diseases were provided by a cooperative hospital. Two six-category deep learning models of common retinal diseases based on the EfficientNet-B4 and ResNet50 models were trained. The results from the six-category models in this study and the results from a five-category model in our previous study based on ResNet50 were compared. A total of 1,315 fundus images were used to test the models, the clinical diagnosis results and the diagnosis results of the two six-category models were compared. The main evaluation indicators were sensitivity, specificity, F1-score, area under the curve (AUC), 95% confidence interval, kappa and accuracy, and the receiver operator characteristic curves of the two six-category models were compared in the study. Results: The diagnostic accuracy rate of EfficientNet-B4 model was 95.59%, the kappa value was 94.61%, and there was high diagnostic consistency. The AUC of the normal diagnosis and the five retinal diseases were all above 0.95. The sensitivity, specificity, and F1-score for the diagnosis of normal fundus images were 100, 99.9, and 99.83%, respectively. The specificity and F1-score for RVO diagnosis were 95.68, 98.61, and 93.09%, respectively. The sensitivity, specificity, and F1-score for high myopia diagnosis were 96.1, 99.6, and 97.37%, respectively. The sensitivity, specificity, and F1-score for glaucoma diagnosis were 97.62, 99.07, and 94.62%, respectively. The sensitivity, specificity, and F1-score for DR diagnosis were 90.76, 99.16, and 93.3%, respectively. The sensitivity, specificity, and F1-score for MD diagnosis were 92.27, 98.5, and 91.51%, respectively. Conclusion: The EfficientNet-B4 model was used to design a six-category model of common retinal diseases. It can be used to diagnose the normal fundus and five common retinal diseases based on fundus images. It can help primary doctors in the screening for common retinal diseases, and give suitable suggestions and recommendations. Timely referral can improve the efficiency of diagnosis of eye diseases in rural areas and avoid delaying treatment.

Automated measurement of the disc-fovea angle based on DeepLabv3.

Purpose: To assess the value of automatic disc-fovea angle (DFA) measurement using the DeepLabv3+ segmentation model. Methods: A total of 682 normal fundus image datasets were collected from the Eye Hospital of Nanjing Medical University. The following parts of the images were labeled and subsequently reviewed by ophthalmologists: optic disc center, macular center, optic disc area, and virtual macular area. A total of 477 normal fundus images were used to train DeepLabv3+, U-Net, and PSPNet model, which were used to obtain the optic disc area and virtual macular area. Then, the coordinates of the optic disc center and macular center were obstained by using the minimum outer circle technique. Finally the DFA was calculated. Results: In this study, 205 normal fundus images were used to test the model. The experimental results showed that the errors in automatic DFA measurement using DeepLabv3+, U-Net, and PSPNet segmentation models were 0.76°, 1.4°, and 2.12°, respectively. The mean intersection over union (MIoU), mean pixel accuracy (MPA), average error in the center of the optic disc, and average error in the center of the virtual macula obstained by using DeepLabv3+ model was 94.77%, 97.32%, 10.94 pixels, and 13.44 pixels, respectively. The automatic DFA measurement using DeepLabv3+ got the less error than the errors that using the other segmentation models. Therefore, the DeepLabv3+ segmentation model was finally chosen to measure DFA automatically. Conclusions: The DeepLabv3+ segmentation model -based automatic segmentation techniques can produce accurate and rapid DFA measurements.

Outcomes of combined treatments in patients with retinal arterial macroaneurysm.

PURPOSE: To evaluate the outcome of the combined approach between intravitreal ranibizumab (IVR) and focal laser photocoagulation (FLP) in the treatment of symptomatic retinal arterial macroaneurysm (RAM). METHODS: A total of 10 patients were included in this clinical case series report. They were diagnosed with symptomatic RAM (one eye in each) and assessed by a comprehensive ophthalmologic examination, including fluorescein angiography (FA), optical coherence tomography angiography (OCT-A), and indocyanine green angiography (ICGA). All patients were treated with an IVR followed by an FLP 2 weeks later. If necessary, a second IVR was given 1 month after the first one (or 2 weeks after the first FLP), which was followed by a second FLP treatment 2 weeks later in the needed cases. All cases were followed up for 6 months after the last treatment. RESULTS: Both the retina hemorrhage and edema were resolved by the treatment. No ocular and/or systemic side effects were evident, and no recrudescence of RAM was seen within the 6 months of follow-up. CONCLUSION: The combined treatment of IVRs and FLPs was successful in the management of symptomatic RAM.

Research on an Intelligent Lightweight-Assisted Pterygium Diagnosis Model Based on Anterior Segment Images.

AIMS: The lack of primary ophthalmologists in China results in the inability of basic-level hospitals to diagnose pterygium patients. To solve this problem, an intelligent-assisted lightweight pterygium diagnosis model based on anterior segment images is proposed in this study. METHODS: Pterygium is a common and frequently occurring disease in ophthalmology, and fibrous tissue hyperplasia is both a diagnostic biomarker and a surgical biomarker. The model diagnosed pterygium based on biomarkers of pterygium. First, a total of 436 anterior segment images were collected; then, two intelligent-assisted lightweight pterygium diagnosis models (MobileNet 1 and MobileNet 2) based on raw data and augmented data were trained via transfer learning. The results of the lightweight models were compared with the clinical results. The classic models (AlexNet, VGG16 and ResNet18) were also used for training and testing, and their results were compared with the lightweight models. A total of 188 anterior segment images were used for testing. Sensitivity, specificity, F1-score, accuracy, kappa, area under the concentration-time curve (AUC), 95% CI, size, and parameters are the evaluation indicators in this study. RESULTS: There are 188 anterior segment images that were used for testing the five intelligent-assisted pterygium diagnosis models. The overall evaluation index for the MobileNet2 model was the best. The sensitivity, specificity, F1-score, and AUC of the MobileNet2 model for the normal anterior segment image diagnosis were 96.72%, 98.43%, 96.72%, and 0976, respectively; for the pterygium observation period anterior segment image diagnosis, the sensitivity, specificity, F1-score, and AUC were 83.7%, 90.48%, 82.54%, and 0.872, respectively; for the surgery period anterior segment image diagnosis, the sensitivity, specificity, F1-score, and AUC were 84.62%, 93.50%, 85.94%, and 0.891, respectively. The kappa value of the MobileNet2 model was 77.64%, the accuracy was 85.11%, the model size was 13.5 M, and the parameter size was 4.2 M. CONCLUSION: This study used deep learning methods to propose a three-category intelligent lightweight-assisted pterygium diagnosis model. The developed model can be used to screen patients for pterygium problems initially, provide reasonable suggestions, and provide timely referrals. It can help primary doctors improve pterygium diagnoses, confer social benefits, and lay the foundation for future models to be embedded in mobile devices.

Optimized-Unet: Novel Algorithm for Parapapillary Atrophy Segmentation.

In recent years, an increasing number of people have myopia in China, especially the younger generation. Common myopia may develop into high myopia. High myopia causes visual impairment and blindness. Parapapillary atrophy (PPA) is a typical retinal pathology related to high myopia, which is also a basic clue for diagnosing high myopia. Therefore, accurate segmentation of the PPA is essential for high myopia diagnosis and treatment. In this study, we propose an optimized Unet (OT-Unet) to solve this important task. OT-Unet uses one of the pre-trained models: Visual Geometry Group (VGG), ResNet, and Res2Net, as a backbone and is combined with edge attention, parallel partial decoder, and reverse attention modules to improve the segmentation accuracy. In general, using the pre-trained models can improve the accuracy with fewer samples. The edge attention module extracts contour information, the parallel partial decoder module combines the multi-scale features, and the reverse attention module integrates high- and low-level features. We also propose an augmented loss function to increase the weight of complex pixels to enable the network to segment more complex lesion areas. Based on a dataset containing 360 images (Including 26 pictures provided by PALM), the proposed OT-Unet achieves a high AUC (Area Under Curve) of 0.9235, indicating a significant improvement over the original Unet (0.7917).

EAD-Net: A Novel Lesion Segmentation Method in Diabetic Retinopathy Using Neural Networks.

Diabetic retinopathy (DR) is a common chronic fundus disease, which has four different kinds of microvessel structure and microvascular lesions: microaneurysms (MAs), hemorrhages (HEs), hard exudates, and soft exudates. Accurate detection and counting of them are a basic but important work. The manual annotation of these lesions is a labor-intensive task in clinical analysis. To solve the problem, we proposed a novel segmentation method for different lesions in DR. Our method is based on a convolutional neural network and can be divided into encoder module, attention module, and decoder module, so we refer it as EAD-Net. After normalization and augmentation, the fundus images were sent to the EAD-Net for automated feature extraction and pixel-wise label prediction. Given the evaluation metrics based on the matching degree between detected candidates and ground truth lesions, our method achieved sensitivity of 92.77%, specificity of 99.98%, and accuracy of 99.97% on the e_ophtha_EX dataset and comparable AUPR (Area under Precision-Recall curve) scores on IDRiD dataset. Moreover, the results on the local dataset also show that our EAD-Net has better performance than original U-net in most metrics, especially in the sensitivity and F1-score, with nearly ten percent improvement. The proposed EAD-Net is a novel method based on clinical DR diagnosis. It has satisfactory results on the segmentation of four different kinds of lesions. These effective segmentations have important clinical significance in the monitoring and diagnosis of DR.

Increased Serum Expression of Inflammatory Cytokines may Serve as Potential Diagnostic Biomarker for Bilirubin Encephalopathy.

OBJECTIVES: The present study was designed to explore the roles of inflammatory cytokines interleukin-1ß (IL-1ß) and Tumor growth factor-ß (TGF-ß) in the diagnosis and treatment of neonate bilirubin encephalopathy (BE). METHODS: A total of 128 BE neonates and 128 normal neonates were included. The serum samples of the BE children and controls were collected, and the levels of IL-1ß and TGF-ß were examined. Moreover, the correlation between the level of bilirubin and serum expression of IL-1ß or TGF-ß in BE patients was analyzed. Finally, receiver operating characteristic (ROC) curves were generated to determine the diagnostic value of the cytokines. RESULTS: IL-1ß and TGF-ß levels were higher in the serum of BE patients than those in non-BE patients, and the expression of either IL-1ß or TGF-ß showed a strong positive correlation with the serum expression of bilirubin in BE patients. Moreover, the results of ROC analysis showed that either IL-1ß or TGF-ß could distinguish BE patients from healthy controls. CONCLUSION: IL-1ß and TGF-ß levels were upregulated in BE and might function as potential biomarkers or therapeutic targets for BE patients.

Sequence effect in the treatment of proliferative diabetic retinopathy with intravitreal ranibizumab and panretinal photocoagulation.

PURPOSE: To compare the outcome of the sequence in the two treatments (intravitreal ranibizumab and panretinal photocoagulation) in high-risk proliferative diabetic retinopathy. METHODS: This retrospective study included 35 patients with newly diagnosed high-risk proliferative diabetic retinopathy in 43 eyes; 18 (22 eyes) received intravitreal ranibizumab before panretinal photocoagulation (intravitreal ranibizumab+ group), while the other 17 (21 eyes) received panretinal photocoagulation before intravitreal ranibizumab (panretinal photocoagulation+ group). Each subject received three intravitreal ranibizumabs that were interleaved with three panretinal photocoagulations. The first treatment (either intravitreal ranibizumab or panretinal photocoagulation) was done 1 week before the second one. The interval between intravitreal ranibizumabs was 4 weeks, panretinal photocoagulation was 2 weeks. The power and pulse duration were determined based upon the status of each retinal spot before each panretinal photocoagulation. The retinal non-perfusion region was measured with fundus fluorescein angiography before and 1 month after the final treatment. The central macular thickness was measured with optical coherence tomography within 1 week before the first treatment, before each panretinal photocoagulation, and 1 month after the final intravitreal ranibizumab. RESULTS: The panretinal photocoagulation energy required for effective treatment was lower in intravitreal ranibizumab+ group in the first and second sessions and in total energy (p < 0.05). Central macular thickness reduction before the second panretinal photocoagulation session was significant in the intravitreal ranibizumab+ group (p < 0.05). CONCLUSION: The sequence used in intravitreal ranibizumab+ group showed clear advantages over that in panretinal photocoagulation+ group in the treatment of proliferative diabetic retinopathy, not only in the use of lower energy for panretinal photocoagulation but also in the more rapid regression of neovascularization and less need of additional treatment.

Effects of less invasive surfactant administration (LISA) via a gastric tube on the treatment of respiratory distress syndrome in premature infants aged 32 to 36 weeks.

To explore the clinical effects of less invasive surfactant administration (LISA) via a gastric tube on the treatment of respiratory distress syndrome (RDS) in premature infants aged 32 to 36 weeks.A total of 97 premature infants with RDS admitted to the Children's Hospital of Shanxi from February 2017 to January 2018 were randomly divided into LISA (47 cases) and (intubation-surfactant-extubation,) INSURE groups (50 cases). In the LISA group, 6F gastric tubes were inserted into the trachea through direct laryngoscopy under nasal continuous positive airway pressure (NCPAP), and pulmonary surfactant (PS) was injected. In the INSURE group, PS was injected via tracheal intubation and NCPAP was performed after extubation. The incidence of technical-related adverse events and various complications in the two groups were observed.PS was successfully injected through gastric tube in the LISA group. There were no significant differences in reflux, asphyxia, bradycardia (<100 beats/min), apnea, FiO2, changes in PaO2 and PaCO2 at 1 hour post-treatment between the groups. During the course of administration, blood pressure and SpO2 in the LISA group were more stable, and significant differences between the 2 groups were observed. However, no significant differences in the complications and outcomes between the 2 groups occurred.The LISA technique can be used to treat premature infants with RDS aged 32 to 36 weeks with stronger spontaneous breathing ability. Further clinical studies are required to determine the optimal strategy of LISA administration and the most profitable patient population.

Prognostic value of tripartite motif containing 29 expression in patients with gastric cancer following surgical resection.

Tripartite motif containing 29 (TRIM29) dysregulation serves an important function in the progression of numerous types of cancer, but its function in the prognosis of patients with gastric cancer remains unknown. The present study assessed the prognostic value of TRIM29 in patients with gastric cancer following surgical resection. A total of 243 fresh gastric adenocarcinoma and adjacent normal tissues were continuously retrieved from patients who underwent curative surgery for gastric cancer at the Cancer Hospital of Henan Province (Zhengzhou, China) between January 2005 and December 2011. The reverse transcription-quantitative polymerase chain reaction was performed to assess TRIM29 expression. The association between TRIM29 expression and clinicopathological features and prognosis was subsequently evaluated. The results of the present study revealed that the expression of TRIM29 was increased in the gastric cancer tissues compared with the normal adjacent tissues, and that upregulated expression of TRIM29 was associated with tumor cell differentiation, tumor stage, lymph node metastasis, and tumor-node-metastasis (TNM) stage. In the training and validation data, high TRIM29 expression was associated with poor overall survival in patients with gastric cancer. Furthermore, multivariate analysis identified that TRIM29 expression was an independent prognostic factor for overall survival, in addition to TNM stage and Lauren classification. Combining TRIM29 expression with the TNM staging system generated a novel predictive model that exhibited improved prognostic accuracy for overall survival in patients with gastric cancer. The present study revealed that TRIM29 was an independent adverse prognostic factor in patients with gastric cancer. Incorporating TRIM29 expression level into the TNM staging system may improve risk stratification and render prognosis more accurate in patients with gastric cancer.