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AIM: To observe the clinical features of acute macular neuroretinopathy(AMN)induced by Omicron.METHODS: A retrospective study. A total of 9 patients(18 eyes)diagnosed with AMN from December 2022 to January 2023 in the Hospital of Chengdu University of Traditional Chinese Medicine were included. Patients underwent spectral-domain optical coherence tomography(SD-OCT), fundus fluorescein angiography(FFA), fundus photography, autofluorescence(AF), infrared reflectance(IR), optical coherence tomography angiography(OCTA)and multicolor, etc. Furthermore, they were followed up for 1～3mo and observed the prognosis.RESULTS: The initial symptom of the Omicron-induced AMN was the sudden onset of central/paracentral scotoma in the eyes with or without impaired vision and metamorphopsia, and the scotoma could persist for at least 3mo. The image features of AMN are as follows. First, the SD-OCT examination showed the rupture of outer retinal layers, scattered hyperreflective lesions, and atrophy of outer retinal layers. In severe cases, hyperreflective lesions were seen in the inner nuclear layer(INL)or with microcystic cavities under the retinal pigment epithelium(RPE). Second, the OCTA examination demonstrated the decreased blood flow density of the deep capillary plexus(DCP)of the macula. Third, the IR examination showed the weak reflection of lesion areas. Fourth, the fundus photography demonstrated the localized brown wedge-shaped lesion.CONCLUSIONS: The Omicron-induced AMN is mostly found in young females, and the characteristic manifestation of fundus is damage to the outer retinal layers. The extent of fundus lesions is related to the systemic inflammatory response and ocular microcirculatory changes after infection. The multimodal fundus image examination and a history of Omicron infection are helpful to diagnose the Omicron-induced AMN.
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Dandy-Walker syndrome is one of the posterior fossa malformations, which is easily confused with arachnoid cyst or cerebellar dysplasia in clinical practice, leading to misdiagnosis. Dandy-Walker syndrome is easy to be combined with hydrocephalus, resulting in increased intracranial pressure, increased head circumference, growth retardation, spastic hemiplegia and other manifestations, and can also be accompanied by other nervous system malformations. On February 27, 2021, a child with Dandy-Walker syndrome with growth retardation as the primary manifestation was admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine. After multiple surgical treatment, the child's hydrocephalus was significantly improved. Through the analysis of the clinical data of the child's operation and the treatment of complications, it is helpful to improve the clinicians' understanding of the surgical treatment of the disease.
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Early screening based on computed tomography (CT) pulmonary nodule detection is an important means to reduce lung cancer mortality, and in recent years three dimensional convolutional neural network (3D CNN) has achieved success and continuous development in the field of lung nodule detection. We proposed a pulmonary nodule detection algorithm by using 3D CNN based on a multi-scale attention mechanism. Aiming at the characteristics of different sizes and shapes of lung nodules, we designed a multi-scale feature extraction module to extract the corresponding features of different scales. Through the attention module, the correlation information between the features was mined from both spatial and channel perspectives to strengthen the features. The extracted features entered into a pyramid-similar fusion mechanism, so that the features would contain both deep semantic information and shallow location information, which is more conducive to target positioning and bounding box regression. On representative LUNA16 datasets, compared with other advanced methods, this method significantly improved the detection sensitivity, which can provide theoretical reference for clinical medicine.
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Humans , Algorithms , Lung Neoplasms/diagnostic imaging , Neural Networks, Computer , Radiographic Image Interpretation, Computer-Assisted/methods , Tomography, X-Ray Computed/methodsABSTRACT
Objective: To explore the relationship between the levels of serum soluble CD137 (sCD137) and membrane-bound CD137 (mCD137) and the occurrence of ischemia reperfusion injury (IRI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: This is a cross-sectional study. Consecutive patients with acute STEMI, who underwent emergency percutaneous coronary intervention (PCI) in the Department of Cardiology, Jiangsu University Affiliated Hospital from May 2019 to September 2020, were enrolled. According to the absence or presence of IRI, patients were divided into IRI group and non-IRI group. Clinical data of the two groups were collected and compared. sCD137 level was detected by enzyme linked immunosorbent assay. Ficoll density gradient centrifugation was used to separate peripheral blood mononuclear cells (PBMC) and RNA was extracted, mCD137 mRNA expression level was detected by PCR. Serum sCD137 levels and the mCD137 mRNA levels of PBMC before, after PCI and 24 hours after PCI were compared. The correlation between serum sCD137 level, PBMC mCD137 mRNA level and clinical indicators was observed. The univariate and multivariate logistic binary regression analyses were performed to evaluate the related risk factors of IRI. ROC curve was used to analyze the predictive value of defined parameters for IRI. Results: A total of 112 STEMI patients were enrolled. There were 42 cases (of which 33 were males (78.6%), mean age was (58.6±12.7) years) in non-IRI group and 70 cases(of which 56 were males (80.0%), mean age was (64.5±11.6) years) in IRI group. Compared with the non-IRI group, patients in the IRI group had longer hospital stays, older age, lower rates of obesity, lower systolic and diastolic blood pressure at admission, higher proportion of the the right coronary artery as culprit vessel, lower rate of the use of angiotensin-converting enzyme inhibitor/angiotensin-Ⅱ receptor blocker/angiotensin receptor neprilysin inhibitor, higher levels of urea nitrogen and creatinine, lower glomerular filtration rate, lower triglycerides, higher D-dimer and B-type natriuretic peptidemax, higher proportion of Killip grade Ⅳ and cardiovascular adverse events (all P<0.05). sCD137 levels at the preoperative, postoperative and 24 hours after surgery were significantly higher in the IRI group than in the non-IRI group, while the mRNA levels of CD137 was similar between the two groups. The level of sCD137 in patients after PCI was lower than that before operation, the level of mCD137 mRNA was higher than that before operation (P<0.05). Serum sCD137 levels were positively correlated with hospitalization days, age, B-type natriuretic peptide, creatinine, ischemic time, C Reactive protein (CRP) and CRP/albumin (P<0.05), and negatively correlated with body mass index, glomerular filtration rate and albumin (P<0.05). The mCD137 mRNA expression level of PBMC was positively correlated with hospital stay, age, B-type natriuretic peptide, ischemic time, CRP and CRP/albumin (P<0.05), and negatively correlated with body mass index, glomerular filtration rate, albumin (P<0.05). Multivariate logistic regression analysis showed that higher sCD137 (OR=1.038, 95%CI: 1.009-1.069), aspartate aminotransferase, (OR=1.029, 95%CI: 1.009-1.050) and lower albumin (OR=0.829, 95%CI: 0.703-0.829) before surgery were independent risk factors of IRI (P<0.05). Receiver operating characteristic curve showed that the area under the curve of sCD137 was 0.672 (95%CI: 0.574-0.770, P=0.002) for the prediction of IRI, the best cut-off value was 28.43×10-3 μg/L with sensitivity of 95.2% and specificity of 48.6%. Conclusion: The significantly increased level of sCD137 in acute STEMI patients is positively correlated with reperfusion injury, which is an independent risk factor of IRI and may be related to the prognosis of patients with IRI.
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Aged , Humans , Male , Middle Aged , Cross-Sectional Studies , Leukocytes, Mononuclear , Percutaneous Coronary Intervention , Reperfusion Injury , ST Elevation Myocardial InfarctionABSTRACT
Based on the biomechanical simulation curve of OpenSim, an open source software of biomechanical model, a spherical exoskeleton parallel mechanism with two degrees of freedom for hip joint is proposed in this paper for the rehabilitation therapy of patients with impaired leg motor function or elderly people with walking dysfunction. Firstly, the parallel mechanism is modeled and the position inverse solution of the parallel mechanism is obtained using inverse kinematics analysis. The velocity analysis expression of the mechanism is derived by deriving the inverse kinematics solution. The model is imported into the mechanical system dynamics analysis software ADAMS and matrix processing analysis software MATLAB to carry out simulation experiments. The correctness of the velocity analysis is verified by comparing the velocity simulation results of the two methods. Then, three singular types of the mechanism are analyzed according to the obtained Jacobian matrix. According to the inverse solution of the mechanism, the reachable workspace of the mechanism is obtained by programming in MATLAB with given mechanism parameters and restriction conditions. Finally, the prototype platform is built. The experimental results show that the exoskeleton hip joint using this parallel mechanism can satisfy the requirement of rotation angle of human hip joint movement, but also can be good to assist patients with leg flexion-extension movement and adduction-abduction movement, and it is helpful to carry out corresponding rehabilitation training. It also has theoretical significance and application value for the research work of human hip exoskeleton parallel mechanism.
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Humans , Biomechanical Phenomena , Exoskeleton Device , Hip Joint , Physiology , Models, Theoretical , Movement , Rehabilitation , Rotation , WalkingABSTRACT
Objective To explore the risk factors of in-stent restenosis in coronary artery disease (CAD) patients with CYP2C19*1/ *1. Methods The population diagnosed with CAD subsequently underwent PCI, followed by CYP2C19 genotype examination. 127 patients with CYP2C19*1/ *1 followed up 1 year after PCI in our hospital were divided into ISR group (n = 47) and control group (n = 76) according to absence or presence of in-stent restenosis (the restenosis was defined as the reduction of lumen diameter ≥ 50%). The basic clinical data, laboratory results and medication and PCI of the two groups were retrospectively analyzed to figure out the etiological risk factors of in-stent restenosis in CAD patients with CYP2C19*1/ *1. Results Based on bivariate analysis, we found several independent variables (P > 0.05) including age, hypertension, BMI, smoking and drinking history. The independent variables with results of bivariate analysis of P < 0.05 included DM, physical exercise, TG, TBIL, FIB, and the stent length, diameter and number. A multivariate logistic regression analysis showed that such variables including DM,TG,FIB, stent length were independent predictors of ISR (P < 0.05). On the contrary, exercise and stent diameter may be the protective factor (P<0.05). Conclusions Clinical treatment for patients with high risk factors including improved life style, strengthened biochemical indicators monitoring, a reasonable treatment and appropriate stent placement according to individual coronary artery lesions , is expected to reduce the incidence of in-stent restenosis and improve the prognosis.
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ObjectiveTo investigate the clinical effect of regular hepatectomy in patients with complex intrahepatic bile duct stones. MethodsA retrospective analysis was performed for the clinical data of 98 patients with complex intrahepatic bile duct stones who were treated in our hospital from January to December, 2013. The distribution characteristics of intrahepatic bile duct stones, clinical manifestations, extent of operation, time of operation, complications, and surgical outcome were analyzed. ResultsAll the 98 patients completed regular hepatectomy. Of all patients, 37 underwent choledocholithotomy with T-tube drainage and segmental hepatectomy, 6 underwent resection of the left lateral lobe of the liver, 1 underwent left hemihepatectomy, 7 underwent resection of a single hepatic segment in the right lobe of the liver combined with segmental hepatectomy, 45 underwent combined segmental hepatectomy of the left and right lobes of the liver, and 2 underwent biliary-enteric basin anastomosis after hilar bile duct reconstruction. No patients died during the perioperative period. The mean time of operation was 65.0±5.0 min, and the mean intraoperative blood loss was 83.0±6.2 ml. No patients experienced residual stones after surgery. Of all patients, 5 (5.1%) experienced complications, among whom 3 experienced bile leakage and 2 experienced blood exudation on the surface of the wound in the liver; 3 patients were diagnosed with intrahepatic cholangiocarcinoma by postoperative pathological examination. All the patients for followed up for 5 years, and 11 (11.2%) experienced recurrence of stones after surgery. ConclusionRegular hepatectomy is safe and effective in the treatment of complex intrahepatic bile duct stones, with few complications and a low recurrence rate of stones. Therefore, it holds promise for wide clinical application.
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Objective To assess the benefit of intraoperatively placed nasointestinal feeding tubes for early postoperative enteral nutrition.Methods The retrospective study was carried out on 19 cases of in-fants with long gap esophageal atresia who underwent one-stage operation in Xinhua Hospital from January 2006 to December 2013.Patients were divided into two groups according to whether the transanastomotic na-sointestinal feeding tubes(TNFT)were placed.Demographics,associated anomalies,operative findings,com-plications,duration of enteral nutrition(EN),length of stay were analyzed.Results Thirty-seven patients had long gap esophageal atresia and nineteen underwent one-stage operation.Eight patients were identified as TNFT group while eleven patients were identified as nonfeeding tube(NFT)group.There was no significant differences between the two groups in gestational age,birth weight,associated anomalies,anastomotic leak, weight gain,ICU-free days and length of stay(P>0.05).But the ventilator-free days(23.5 d vs.19.3 d), first EN time(0.8 d vs.9.1 d)and total EN feeding time(15.9 d vs.21.4 d)between the two groups were significantly different(P<0.05 ).Conclusion Intraoperatively placed TNFT may lead to earlier EN feeding and shorter parenteral nutrition duration,but a larger prospective study would be required to prove the benefits and ensure the safety.
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Objective: To explore the correlation of plasma level N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with non-diabetic acute myocardial infarction (AMI) combining stress hyperglycemia. Methods: A total of 327 non-diabetic AMI patients treated in our hospital from 2012-02 to 2014-05 were studied. The patients were divided into 2 groups according to fasting blood glucose level:Stress group, the patients with blood glucose≥7.0 mmol/L, n=182 and Non-stress group, the patients with blood glucose Results: The patients’ age, gender, history of hypertension, smoking, drinking, and blood levels of TC, TG, HDL-C, LDL-C were similar between 2 groups, P>0.05. Plasma levels of NT-proBNP, CK-MB, MYO, ultra-TnI, ALT, AST and blood glucose level were signiifcantly different between 2 groups P ultra-TnI (r2=0.811, r=0.901, P Conclusion: Plasma levels of NT-proBNP may judge the severity and evaluate recent prognosis in patients with non-diabetic AMI combining stress hyperglycemia, it could be used as a risk indicator for relevant patients in clinical practice.
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Objective To explore the expression of and its clinical significance of plasma omentin-1 in coronary heart disease in central obesity. Methods Plasma omentin-1 levels were measured by enzyme linked immunosorbent assay( ELISA)in 49 central obesity participants without coronary heart disease and 67 central obesity participants with coronary heart disease,as well as 56 normal healthy individuals as control group. In addition,glucose and lipid metabolism parameter and morphological characters were assessed. Finally multivariate logistic regression analysis was used to explore the risk fact for coronary heart disease in central obesity. Results The serum plasma omentin-1 level of central obesity participants without coronary heart disease group was (45. 63 ± 9. 66)μg/L,much higher than those of people in and central obesity participants with coronary group ((30. 67 ± 6. 78 )μg/L,P ﹤0. 01 ),while lower than control group(( 53. 12 ± 7. 97 )μg/L,P ﹤ 0. 01 ) . Multivariate logistic regression analysis revealed that,age was independent risk factor of coronary heart disease in central obesity(OR=1. 176,95%CI:1. 012-1. 330,P=0. 041),while plasma omentin-1 and high density lipoprotein cholesterol were independent protective factors(OR=0. 576,95%CI:0. 254-0. 898,P=0. 000;OR=0. 466,95%CI:0. 242 -0. 690,P =000). Conclusion Detection of plasma omentin-1 level may play an important role in early diagnosis and prevention of coronary heart disease in central obesity.
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Objective To evaluate the clinical diagnostic value of 64-slice computed tomography coronary angiography (CTCA) for the detection of significant coronary artery stenosis ( ≥50% lumen reduction). Methods We enrolled 61 patients (47 male, 14 female; mean age 62.8 ± 9.7 years) with suspected coronary artery disease into the study and performed selective coronary angiography (SCA) within 2 weeks after CTCA examination. Results One patient was excluded from the analysis because of unsuccessful CTCA evaluation as a result of severe coronary artery calcification in 4 vessels. 240 vessels of remaining 60 patients were achieved good coronary artery imaging by CTCA. Sensitivity,specificity and positive and negative predictive value of CTCA for detecting significant coronary artery sternosis on a per-vessel basis were 90.0 % ,91.9% ,84. 7% and 94.8% ,respectively. Conclusions Our data indicated that 64-slice CTCA is a noninvasive method to reliably rule out significant coronary sternosis with high diagnostic value in negative prediction.
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Objective: To investigate the effects of extract of Bulbus Allii Caespitosi on cardiocyte viability of swines with myocardial reperfusion injury by analyzing the 18F-fluorodeoxyglucose ((18)F-FDG) position emission tomography (PET) imaging. Methods: Twenty-four swines were randomly divided into sham-operated group, untreated group, trimethazine group and extract of Bulbus Allii Caespitosi group. Myocardial reperfusion injury was induced by plugging the anterior descending coronary artery of swine with sacculus. Bulbus Allii Caespitosi or trimetazidine was given twice daily for 28 days. Then myocardial perfusion was detected with (18)F-FDG PET/CT and the radioactivity distribution was evaluated. Results: Compared with the untreated group, Bulbus Allii Caespitosi and trimetazidine could improve the activity of myocardial cells after myocardial infarction (P0.05). Conclusion: Bulbus Allii Caespitosi can improve myocardial metabolism after ischemia and reperfusion in swines.
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<p><b>OBJECTIVE</b>To investigate the stimulating effect of sera from severe multiple trauma patients within 24 h post trauma on nuclear factor-kappaB (NF-kappaB) activity in macrophage and their relationship with patients prognosis.</p><p><b>METHODS</b>Peripheral blood of 47 patients with multiple traumas with injury severity score (ISS) > or = 16 and 24 healthy volunteers were obtained, and sera samples were isolated. And 24 h after transfection of the recombinant NF-kappaB plasmid containing luciferase reporter gene into the mouse macrophage line (RAW 264.7), the cells were stimulated by sera from different patients for 6 h, then stimulating effect of sera on NF-kappaB was assessed by luciferase activity. The concentrations of interleukin-1 beta, tumor necrosis factor alpha, interleukin-10, interleukin-1 receptor antagonist, and soluble tumor necrosis factor receptor I were detected with ELISA kits.</p><p><b>RESULTS</b>The stimulating activity of sera from trauma patients on NF-kappaB was increased significantly, and it was higher in MODS group, non-survivor group than that in non-MODS, survivor group respectively. The level of activity was correlated positively with APACHE II score, while it did not have relationship to the cytokine or endogenous antagonist levels. The area under the receiver operating characteristic curve (ROC) of NF-kappaB activity for predicting MODS and mortality was significantly higher than that of APACHE II score.</p><p><b>CONCLUSION</b>Early measurement of NF-kappaB stimulating activity of sera from severe multiple trauma patients may have the value to predict occurrence of MODS and mortality.</p>
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Adolescent , Adult , Animals , Female , Humans , Male , Mice , Middle Aged , Young Adult , Cell Line , Macrophages , Metabolism , Multiple Organ Failure , Blood , Pathology , Multiple Trauma , Blood , NF-kappa B , Metabolism , Prognosis , SerumABSTRACT
To develop a gene therapy strategy for treating bovine mastitis, a new mammary-specific vector containing human lysozyme (hLYZ) cDNA and kanamycin resistance gene was constructed for intramammary expression and clinical studies. After one time acupuncture or intracisternal infusion of healthy cows with 400 microg of the p215C3LYZ vector, over 2.0 microg/ml of rhLYZ could be detected by enzymatic assay for about 3 weeks in the milk samples. Western blotting showed that rhLYZ secreted into milk samples from the vector-injected cows had molecular weight similar to that of the natural hLYZ in human colostrums. Twenty days after the primary injection, the quarters were re-injected with the same vector by quarter acupuncture and even higher concentrations of rhLYZ could be detected. Indirect competitive ELISA of milk samples showed that the vector injection did not induce detectable humoral immune response against hLYZ. Clinical studies showed that twice acupuncture of quarters with the p215C3LYZ vector had overt therapeutic effect on clinical and subclinical mastitis previously treated with antibiotics, including disappearance of clinical symptoms and relatively high microbiological cure rates. These data provide a solid rationale for using the vector to develop gene therapy for treating bovine mastitis.
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Animals , Cattle , Female , Acupuncture , Genetic Therapy , Methods , Genetic Vectors , Genetics , Mastitis, Bovine , Genetics , Therapeutics , Milk , Chemistry , Muramidase , Genetics , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To investigate the feasibility and features of 3 catheter-mediated approaches of gene transfer into heart, including direct myocardial injection (DMI), coronary artery perfusion (CAP), and intrapericardial cavity injection (ICI).</p><p><b>METHODS</b>Fifteen dogs were used, and 0.3 ml (1 x 10(9) pfu) of an adenovirus (Adex1SR LacZ) was injected into the heart by 3 methods. The dogs were killed 5 days following injection, and gene expressions in heart and liver were evaluated by histochemical analysis.</p><p><b>RESULTS</b>The results showed that (1) the CAP method was relatively less damaging and induced sparse LacZ expression in the myocardium, and the gene expression was also found in both vessels within the myocardium and liver; (2) gene transfer by DMI resulted in intense LacZ expression around the injection accompanied by a local inflammatory response; (3) LacZ expression elicited by ICI was detected in either the inner surface of the parietal pericardium or epicardial surface of the heart, and also in the myocardium underlying the visceral pericardium.</p><p><b>CONCLUSION</b>Three catheter-mediated methods of gene transfer into the heart may be used and a reasonable approach should be chosen according to purpose.</p>
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Animals , Dogs , Female , Male , Adenoviridae , Genetics , Cardiac Catheterization , Gene Expression , Gene Transfer Techniques , Genetic Vectors , Genetics , Inflammation , Injections , Methods , Lac Operon , Genetics , Liver , Metabolism , Myocardium , MetabolismABSTRACT
Objective To investigate the prevalence of urinary incontinence among Uigurs in Xinjiang district. Methods 506 adults Uigurs (over 18 years old)in Xinjiang, 200 men and 306 women, were interviewed with questionnaire. Results The total incidence of urinary incontinence was 38.9%, 43.8% in women and 31.5% in men, P
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Objective To determine the relevant factors of under staging and under grading in patients undergoing radical prostatectomy and to define important predictors of under staging in this population. Methods The clinical T stages and biopsy Gleason scores were compared with the pathological T stages and prostatectomy Gleason scores in 55 patients. Results Among the 55 cases,50 were preoperatively classified as clinical stages T 1～T 2,of whom 21(42%) were postoperatively classified as pathological stages T 3～T 4.Of the 26 cases who preoperatively had the Gleason scores of 2 to 6,11(42%) had postoperatively pathological grades of 7 to 10.Logistic regression analysis revealed that PSA( P =0.0159)at diagnosis and the percentage of positive biopsies of prostate ≥50%( P =0.0013) were significant predictors for preoperative clinical staging lower than postoperative pathological staging. Conclusions The results demonstrate that patients who were classified as clinical stages T 1～T 2 with PSA≥20 ng/ml and percentage of positive biopsies≥50% may have high possibility of under staging.
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AIM:To investigate the influence of free hemoglobin on the initiation and progression of atherosclerosis and the role of CD163 in this process.METHODS:Thirty male SD rats were randomly divided into three groups:control group(group C),atherosclerosis group(group A),atherosclerosis and hemolysis group(group P).The hemolysis and atherosclerosis animal model was established.The free hemoglobin(FHb)and MDA levels in plasma,(RAAPIs)and intima area/midmembrane area(I/M)of each group were measured.The expressions of CD163 and heme oxygenase-1(HO-1)in atherosclerosis plaques in group A and P were detected and measured by means of immunohistochemistry and Western blotting.RESULTS:Compared with group C,the FHb,MDA,CD163 and HO-1 in group A and group P increased significantly(P0.05).The FHb level in plasma and the expressions of CD163 and HO-1 in atherosclerotic plaques correlated with each other(r=0.526,r=0.498,r=0.653;P