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Objective:To establish an artificial intelligence robot-assisted diagnosis system for fundus diseases based on deep learning optical coherence tomography (OCT) and evaluate its application value.Methods:Diagnostic test studies. From 2016 to 2019, 25 000 OCT images of 25 000 patients treated at the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine were used as training sets and validation sets for the fundus intelligent assisted diagnosis system. Among them, macular epiretinal membrane (MERM), macular edema, macular hole, choroidal neovascularization (CNV), and age-related macular degeneration (AMD) were 5 000 sheets each. The training set and the verification set are 18 124 and 6 876 sheets, respectively. Through the transfer learning Attention ResNet structure algorithm, the OCT image was characterized by lesion identification, the disease feature was extracted by a specific procedure, and the given image was distinguished from other types of disease according to the statistical characteristics of the target lesion. The model algorithms of MERM, macular edema, macular hole, CNV and AMD were initially formed, and the fundus intelligent auxiliary diagnosis system of five models was established. The performance of each model-assisted diagnosis in the fundus intelligent auxiliary diagnostic system was evaluated by applying the subject working characteristic curve, area under the curve (AUC), sensitivity, and specificity.Results:With the intelligent auxiliary diagnosis system, the diagnostic sensitivity of the MERM was 93.5%, the specificity was 99.23%, and AUC was 0.983 7; the diagnostic sensitivity of macular edema was 99.02%, the specificity was 98.17%, and AUC was 0.994 6; the diagnostic sensitivity of macular hole was 98.91%, the specificity was 99.91%, AUC was 0.996 2; the diagnostic sensitivity of CNV was 97.54%, the specificity was 94.71%, AUC was 0.987 5; the diagnostic sensitivity of AMD was 95.12%, the specificity was 97.09%, AUC was 0.985 3.Conclusions:The artificial intelligence robot-assisted diagnosis system for fundus diseases based on deep learning for OCT images has accurate and efficient diagnostic performance for assisting the diagnosis of MERM, macular edema, macular hole, CNV, and AMD.
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Objective:To establish a scoring scale for trial of labor after cesarean section (TOLAC), to explore the evaluation ability of this scoring scale for vaginal delivery after cesarean section (VBAC), and to improve the success rate of TOLAC.Methods:The delivery information of 661 TOLAC pregnant women admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from 2014 to 2017 was retrospectively analyzed, and the TOLAC scoring scale was established by referring to relevant literatures. A prospective cohort study of pregnant women with TOLAC from January 2018 to December 2019 in Zhengzhou Central Hospital was conducted, including 440 pregnant women who were excluded from contraindications in trial labor. According to TOLAC scoring scale, pregnant women were divided into 3 groups, 0-6 group (94 cases), 7-9 group (234 cases) and 10-15 group (112 cases). The success rate of trial labor, failure reasons and incidence of maternal and neonatal complications were compared among the three groups.Results:(1) The overall success rate of TOLAC in 440 pregnant women was 75.0% (330/440). The success rates of 0-6, 7-9 and 10-15 groups were 53.2% (50/94), 76.9% (180/234) and 89.3% (100/112), respectively. The success rate of 10-15 group were significantly higher than those of 0-6 and 7-9 groups (all P<0.05). (2) Among the causes of trial labor failure, there were statistically significant differences between the three groups in terms of threatened uterine rupture and maternal abandonment (all P<0.05). Pairings showed that the incidences of threatened uterine rupture and maternal abandonment in 0-6 group was lower than those in 7-9 and 10-15 groups, and the differences were statistically significant (all P<0.05). (3) Maternal and neonatal complications mainly included postpartum hemorrhage and neonatal asphyxia, but there were no significant difference in the incidence of TOLAC success or failure among the three groups (all P>0.05). There was no uterine rupture in all groups. (4) The main factors affecting TOLAC score of pregnant women in the three groups included natural labor, estimated weight of the fetus at this time, Bishop score of the cervix at admission and gestational age, and the scores of the above indexes in 10-15 group were significantly higher than those in 0-6 group and 7-9 group (all P<0.05). Conclusions:TOLAC scoring scale has more accurate evaluation ability for VBAC, which could improve the success rate of TOLAC and maternal and child safety. The score of 0-6 is not recommended for vaginal trial labor, the score of 7-9 is recommended for vaginal trial labor, and the score of 10-15 is strongly recommended for vaginal trial labor.
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Abstract@#With the promotion of health-promoting school (HPS) in China, the school health workers’ awareness of the HPS’ connotation is deepening. The literature review method was used to systematically review the relevant research literature about HPS in Taiwan. We summarized the characteristics of Taiwan HPS in 4 stages: embryonic stage, growing stage, consolidation stage and up-graded stage. Furthermore, we concluded that the HPS’ features of strengthening the evidencebased HPS program, establishing the Health-Promoting School Supporting Network(HPSSN), promoting life skills integrated the health education, and building comprehensive supportive environment as well as Taiwan HPS website. In summary, we proposed that the government should provide much more policy support and funding, establish the HPS supporting network, and strengthen life skills as well as health literacy oriented health teaching, and so on.
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Objective Related factors of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) combined with attention deficit hyperactivity disorder (ADHD) were retrospectively analyzed in OSAHS children. Methods The research included 437 cases of children hospitalized for OSAHS from January, 2014 to December, 2014. All the cases were divided into OSAHS group and OSAHS combined with ADHD group, according to the presence or absence of ADHD. Patient's general conditions (gender, age, height, weight, allergic rhinitis history, tonsil grade and adenoid grade), OSA-18 quality of life score, intention-hyperactivity score, polysomnography parameter (apnea hypopnea index, lowest oxygen) were collected as variables. SPSS20.0 was used to perform statistical analyses.Results There were 437 cases in this research, 298 of them were males, and 139 of them were females. Of 437 patients, 147 had OSAHS combined with ADHD (33.64%). Higher apnea hypopnea index (P <0.01) and severer oxygen deflciency (P < 0.01) were found in OSAHS combined with ADHD group than those in OSAHA group. Five projects of OSA - 18 score of in OSAHS combined with ADHD group were all higher than those in OSAHS group (P <0.01).Conclusions The incidence of pediatric OSAHS combined with ADHD in this research was more than 30%. More OSAHS combined with ADHD were found in male children. The quality of life was lower in pediatric OSAHS combined with ADHD. Oxygen deflciency was suggested to be the most important risk factor of ADHD in pediatric OSAHS.
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[Objective] To observe the effect of cyclosporine A (CSA) on the activity and expression of MMP-2 and MMP-9 in renal tubular epithelial cells. [Methods] NRK52E cells were cultured until its reached confluent. Then NRK52E cells were exposed to different concentration of CSA (0, 0.42, 0.84, 4.2, and 8.4 μmoL/L) for 48 h or 72 h respectively. MMP-2 and MMP-9 activities were detected by gelatin zymography. The expression of MMP-2 and MMP-9 mRNA were detected by RT-PCR. [Results] MMP-2 activity and mRNA levels were decreased in a dose dependent manner after exposed to different concentration of CSA for 48 h or 72 h in NRK52E cells. Compared with control (CSA 0 μmoL/L), CSA 0.42, 0.84, 4.2, 8.4 μmoL/L decreased the MMP-2 activities to 27%, 24%, 11%, and 9% respectively; The differences are significant, P<0.05. But the MMP-9 activity and mRNA levels were increased after exposed to CSA for 48 h or 72 h in NRK52E cells. Compared with control group, CSA 4.2 μmoL/L exposure increased MMP-9 activity to 438% in 48 h, and 237% in 72 h; the differences are significant as well, P<0.05. [Conclusion] A dose-dependent decrease in the expression and activity of MMP-2, and the up-regulation of the expression and activity of MMP-9 by CSA in renal epithelial cells may related to CSA associated tubulointerstitial damage.
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Objective To study the levels of CD62P and CD44 in the peripheral blood of children with lupus nephritis (LN) and their clinical significances were investigated. Methods Twenty-two children with active LN were divided into two groups by their clinical features,nephritic syndrome group (NS group,12 patients) and nonnephritic syndrome group (non NS group, 10 patients). Those patients were also divided into two groups according to their pathologic grading,grade Ⅱ+Ⅲ group (6 patients) and grade Ⅳ+Ⅴ group(16 patients).According to their tubulointerstitial lesions (TIL), those patients were divided into three groups, TIL grade 0 group (5 patients), grade Ⅰ group (13 patients), grade Ⅱ group (4 patients). The blood of the 18 patients who were in inactive state after treatment were retested blood again. The levels of CD62P and CD44 in the peripheral blood were assayed by radioimmunoassay (RIA) and enzyme-linked immunoabsorbant assay (ELISA) in LN children and in 20 normal age and sex-matched controls, and their correlation with clinical peripheral blood levels of CD62P and CD44 in NS group, grade Ⅳ+Ⅴ group were significantly higher than CD44 were positively correlated with 24-hour proteinuria,ESR, urine NAG, urine β2-MG and the TIL grade (P<0.05 and P<0.01, respectively), but negatively correlated with the levels of serum complement 3 (C3) and albumin (ALB) (P<0.05).The levels of CD62P was positively correlated with those of CD44 (P<0.05). Conclusion CD62P and CD44 may be involved in the pathogenesis of LN. The peripheral blood levels of CD62P and CD44 in LN children could be used as one of the indicators for lupus activity, severity, treatment effectiveness and prediction of outcome.
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AIM:To study whether albumin overload in proximal tubular epithelial cells(PTCs)induces epithelial to myofibroblast transdifferentiation(EMT).METHODS:Rat renal proximal tubular cell line NRK52E was cultured on 6 well plates.When the cells reached 70% confluens or complete confluens,cells were serum starved for 24 h.Different concentrations of delipidated bovine serum albumin(dBSA),ranging from 0-30 g/L,were then added to the cells.The media was changed every 48 h until the end of 144 h.Cell shapes were monitored by light microscope during experiment.Cell structures were detected by electron microscopy.Epithelial cell markers:E-cadherin,?-catenin,and myofibroblast marker:?-smooth muscle actin(?-SMA)were detected by immunofluorescent microscopy and Western blotting.RESULTS:dBSA overload induced the expression of ?-SMA in sub-confluent NRK52E,and a few cells elongated,but the induced expression of ?-SMA was not in a dose dependent manner.dBSA overload did not induce the expression of ?-SMA in complete confluent NRK52E,cell shape did not change either.dBSA overload did not inhibit expression of E-cadherin or ?-catenin both in sub-confluent and complete confluent NRK52E.The electron microscope showed that these cells retained epithelial phenotype,with microvilli and tight junction.CONCLUSION:Albumin overload induces PTCs expressing myofibroblast marker ?-SMA and promotes EMT.However,complete EMT does not achieve.Complete confluens(cell-cell contacts)inhibits albumin induced ?-SMA expression in PTCs.
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Objective To study the effect of Astragalus and Angelica mixture on growth failure induced by dexaraethasone in rats with nephrotic syndrome (NS) . Methods Forty six-week old male Sprague-Dawley rats with a starting weight of 160 ~ 180 g were randomly divided into five groups: control group, NS model group, NS group treated with Astragalus and Angelica mixture, NS group treated with dexamethasone, and NS group treated with Astragalus and Angelica mixture and dexamethasone. Weight, length, urine protein, and serum albuine were measured. Serum and urine concentrations of IGF-1 and IGFBP-3 were assayed by RIA and IRMA respectively; and IGF-1 mRNA and IGFBP-3 mRNA levels in liver were assayed by RT-PCR. Results Weight gain and length gain, serum IGF-1 and IGFBP-3 levels in NS model group were significantly lower than that of the control group and urine IGF-1 levels were higher than that of the control group (P
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Objective To observed the alteration of the glomerular charge-barrier (GCB) in children with idiopathic nephrotic syndrome(INS) and relationship between GCB and severity of proteinuria. Mothods The clearance ratios of pancreatic to salivary isoamylase(CPAM/CSAM) were detected in 21 cases with INS and 29 healthy controls by use of a selective inbibitor, then use the clearance ration to show the CCB. Results The ratio of CPAM/CSAM in the cases with massive proteinuria was mean 1. 18 (range 0.82 - l .54), in the cases with no-massive proteinuria was mean 2.06(1 .22 - 3. 14), in healthy controls was 3 .33 (l. 18 - 6.54). There was a significant difference in ratios CPAM/CSAM between three groups. As all cases with INS, the ratio was very significantly negatively correlated with 24-hour urine protein quantity, but not correlated when 24 hour proteinuria was in excess of 50 mg/kg. Conclusion GCB of the cases with INS is reduced, and of the cases with massive proteinuria almost dissappeared.