Automated Classification of Inherited Retinal Diseases in Optical Coherence Tomography Images Using Few-shot Learning / 生物医学与环境科学（英文）

OBJECTIVE@#To develop a few-shot learning (FSL) approach for classifying optical coherence tomography (OCT) images in patients with inherited retinal disorders (IRDs).@*METHODS@#In this study, an FSL model based on a student-teacher learning framework was designed to classify images. 2,317 images from 189 participants were included. Of these, 1,126 images revealed IRDs, 533 were normal samples, and 658 were control samples.@*RESULTS@#The FSL model achieved a total accuracy of 0.974-0.983, total sensitivity of 0.934-0.957, total specificity of 0.984-0.990, and total F1 score of 0.935-0.957, which were superior to the total accuracy of the baseline model of 0.943-0.954, total sensitivity of 0.866-0.886, total specificity of 0.962-0.971, and total F1 score of 0.859-0.885. The performance of most subclassifications also exhibited advantages. Moreover, the FSL model had a higher area under curves (AUC) of the receiver operating characteristic (ROC) curves in most subclassifications.@*CONCLUSION@#This study demonstrates the effective use of the FSL model for the classification of OCT images from patients with IRDs, normal, and control participants with a smaller volume of data. The general principle and similar network architectures can also be applied to other retinal diseases with a low prevalence.

Investigation of treatment and analysis of prognostic risk on enterocutaneous fistula in China: a multicenter prospective study / 中华胃肠外科杂志

Objective@#To investigate the diagnosis and treatment for enterocutaneous fistula (ECF) in China, and to explore the prognostic factors of ECF.@*Methods@#A multi-center cross-sectional study was conducted based on the Registration System of Chinese Gastrointestinal Fistula and Intra-Abdominal Infections to collect the clinical data of ECF patients from 54 medical centers in 22 provinces/municipalities from January 1, 2018 to December 31, 2018. The clinical data included patient gender, age, length of hospital stay, intensive care unit (ICU) admission, underlying diseases, primary diseases, direct causes of ECF, location and type of ECF, complications, treatment and outcomes. All medical records were carefully filled in by the attending physicians, and then re-examined by more than two specialists. The diagnosis of ECF was based on the clinical manifestations, laboratory/imaging findings and intraoperative exploration.@*Results@#A total of 1521 patients with ECF were enrolled, including 1099 males and 422 females, with a median age of 55 years. The top three primary diseases of ECF were malignant tumors in 626 cases (41.2%, including 540 gastrointestinal tumors, accounting for 86.3% of malignant tumors), gastrointestinal ulcers and perforations in 202 cases (13.3%), and trauma in 157 cases (10.3%). The direct causes of ECF were mainly surgical operation in 1194 cases (78.5%), followed by trauma in 156 (10.3%), spontaneous fistula due to Crohn′s disease in 92 (6.0%), radiation intestinal injury in 41 (2.7%), severe pancreatitis in 20 (1.3%), endoscopic treatment in 13 (0.9%) and 5 cases (0.3%) of unknown reasons. All the patients were divided into three groups: 1350 cases (88.7%) with simple ECF, 150 (9.9%) with multiple ECF, and 21 (1.4%) with combined internal fistula. Among the patients with simple ECF, 438 cases (28.8%) were jejuno-ileal fistula, 313 (20.6%) colon fistula, 170 (11.2%) rectal fistula, 111 (7.3%) duodenal fistula, 76 (5.0%) ileocecal fistula, 65 (4.3%) ileocolic anastomotic fistula, 55 (3.6%) duodenal stump fistula, 36 (2.4%) gastrointestinal anastomotic fistula, 36 (2.4%) esophagogastric/esophagojejunal anastomotic fistula, 29 (1.9%) gastric fistula and 21 (1.4%) cholangiopancreatiointestinal. Among all the simple ECF patients, 991 were tubular fistula and 359 were labial fistula. A total of 1146 patients finished the treatment, of whom 1061 (92.6%) were healed (586 by surgery and 475 self-healing) and 85 (7.4%) died. A total of 1043 patients (91.0%) received nutritional support therapy, and 77 (6.7%) received fistuloclysis. Infectious source control procedures were applied to 1042 patients, including 711 (62.0%) with active lavage and drainage and 331 (28.9%) with passive drainage. Among them, 841 patients (73.4%) underwent minimally invasive procedures of infectious source control (replacement of drainage tube through sinus tract, puncture drainage, etc.), 201 (17.5%) underwent laparotomy drainage, while 104 (9.1%) did not undergo any drainage measures. A total of 610 patients (53.2%) received definitive operation, 24 patients died within postoperative 30-day with mortality of 3.9% (24/610), 69 (11.3%) developed surgical site infection (SSI), and 24 (3.9%) had a relapse of fistula. The highest cure rate was achieved in ileocecal fistula (100%), followed by rectal fistula (96.2%, 128/133) and duodenal stump fistula (95.7%,44/46). The highest mortality was found in combined internal fistula (3/12) and no death in ileocecal fistula. Univariate prognostic analysis showed that primary diseases as Crohn′s disease (χ2=6.570, P=0.010) and appendicitis/appendiceal abscess (P=0.012), intestinal fistula combining with internal fistula (χ2=5.460, P=0.019), multiple ECF (χ2=7.135, P=0.008), esophagogastric / esophagojejunal anastomotic fistula (χ2=9.501, P=0.002), ECF at ileocecal junction (P=0.012), non-drainage/passive drainage before the diagnosis of intestinal fistula (χ2=9.688, P=0.008), non-drainage/passive drainage after the diagnosis of intestinal fistula (χ2=9.711, P=0.008), complicating with multiple organ dysfunction syndrome (MODS) (χ2=179.699, P<0.001), sepsis (χ2=211.851, P<0.001), hemorrhage (χ2=85.300, P<0.001), pulmonary infection (χ2=60.096, P<0.001), catheter-associated infection (χ2=10.617, P=0.001) and malnutrition (χ2=21.199, P<0.001) were associated with mortality. Multivariate prognostic analysis cofirmed that sepsis (OR=7.103, 95%CI:3.694-13.657, P<0.001), complicating with MODS (OR=5.018, 95%CI:2.170-11.604, P<0.001), and hemorrhage (OR=4.703, 95%CI: 2.300-9.618, P<0.001) were independent risk factors of the death for ECF patients. Meanwhile, active lavage and drainage after the definite ECF diagnosis was the protective factor (OR=0.223, 95%CI: 0.067-0.745, P=0.015).@*Conclusions@#The overall mortality of ECF is still high. Surgical operation is the most common cause of ECF. Complications e.g. sepsis, MODS, hemorrhage, and catheter-associated infection, are the main causes of death. Active lavage and drainage is important to improve the prognosis of ECF.

Research progress on potential targets of liposarcoma / 实用肿瘤学杂志

Liposarcoma(LPS)is the most common type of soft-tissue sarcoma(STS). The current treatment methods are still based on complete surgical resection. Radiotherapy and chemotherapy as adjuvant treatment or distant metastasis,and the main treat-ment of unresectable liposarcoma have limited efficacy,have not widely recognized. With the extensive and in-depth of LPS molecular targeted therapy,the research achievements in this area are remarkable. Emerging targets for LPS include receptors such as tyrosine ki-nase receptor AXL,fibroblast growth factor receptor(FGFR),insulin-like growth factor-1 receptor(IGF-1R),nuclear export re-ceptor XPO1(Exportin-1),and proteins/enzymes such as heat shock protein 90( Hsp90),bispecific tyrosine( Y) phosphorylation-regulated kinase 1B( DYRK1B) and signal pathways such as SRC/FAK/RHO/ROCK have shown good prospects for anti-LPS in preclinical studies. The research progress in the aspects is summarized as follows.

Genomic characterization of avian influenza A(H7N9) virus in Zhaoqing, China, 2014-2016 / 中国人兽共患病学报

We analyzed genetic evolution characteristics of avian influenza A (H7N9) virus isolated in Zhaoqing,China,2014-2016.Nucleic acid were extracted and sequenced from 17 samples of H7N9 positive cases in Zhaoqing.Genetic characteristics of homology and important amino acid sites were analyzed by using BioEdit5.0 and MEGA6.0.The evolutionary trees were constructed by Neighbor-Joining and the referenced sequences were downloaded from GenBank,Eight nucleic acid fragments from 7 strains of H7N9 viruses were successfully generated.The highest homology was found in HA gene with A/chicken/Dongguan/695/2014(H7N9),and NA gene with A/chicken/Dongguan/1075/2014(H7N9).The internal genes were high homology with avian H7N9 and H9N2 virus from Dongguan and Shenzhen in Guangdong,China.The HA and NA genes were directly evolved in the Pearl River Delta evolution branch with the H7N9 sequences from the cities of Dongguan,Guangzhou and Shenzhen,while the sequences from the provinces of Anhui,Zhejiang,and Jiangsu were in the Yangtze River Delta evolution branch.There were 2 alkaline amino acids in cleavage site of HA,2 mutations (G186V and Q226L) in the crucial sites related with the receptor of HA protein,1 mutation (E627K) in PB2 protein,and 1 drug resistance mutation (S31N) in M2 protein.And no evidence of neuraminidase resistance in NA protein was found.In conclusion,the H7N9 virus for human infection in Zhaoqing may originate from avian H7N9 and H9N2 viruses,which circulated in the Pearl River Delta region of Guangdong from 2013 to 2014.The mutations of G186V,Q226L and E627 K might be related with high susceptibility to human beings.

Effects of glycogen synthase kinase-3βon migration and invasion of human osteosarcoma cells / 实用肿瘤学杂志

Objective To investigate the role of glycogen synthase kinase -3beta(GSK3β)on invasion and metastasis of human osteosarcoma cells .Methods Expression and phosphorylation of GSK 3βwere examined in osteosarcoma cell lines and tumor tissue from osteosarcoma patients by Western blot .The effects of small mole-cule GSK3βinhibitors on cell metastasis were detected by cell invasion assay and cell migration assay .Results Osteosarcoma cell lines showed increased GSK 3βexpression and abnormal activity regulation .In tumor tissue of patients with osteosarcoma metastasis and non -metastasis,GSK3βwere detected expression and abnormal activi-ty,especially in tumor tissue of the patients with osteosarcoma metastasis .Inhibition of GSK3βactivity resulted in inhibiting cells invasion and migration in osteosarcoma cell line .Conclusion In this research,we demonstrated that GSK3βencouraged osteosarcoma cells metastasis .The result will open up a potential target for clinical treat-ment of osteosarcoma .

The study on SIRT4 gene expression and prognostic factors in osteosarcoma / 实用肿瘤学杂志

Objective To explore SIRT4 gene expression in tumor tissue and investigate the clinicol-pathological features in osteosarcoma .Methods In this study ,SIRT4 protein expression was detected in 106 os-teosarcoma tissues and 36 paired neighboring non -tumorous tissues by immunohistochemistry and determined the correlation between the SIRT 4 expression and the clinicopathological features .Results SIRT4 protein was dra-matically decreased in osteosarcoma cells compared with neighboring non -tumorous bone cells .The low expres-sion of SIRT4 was notably associated with a poor overall survival and disease -free survival in osteosarcoma pa-tients.By using univariate and multivariate analyses ,we confirmed that the increased SIRT 4 expression was an in-dependent factor in predicting better prognosis for patients .Conclu is on SIRT4 expression might be an inde-pendent biomarker for prognostic evaluation of osteosarcoma .

Clinical Study on Moxibustion for Perimenopausal Syndrome / 上海针灸杂志

Objective To observe the clinical efficacy of moxibustion in treating perimenopausal syndrome (PMS).Method Totally 108 PMS patients of yang deficiency or yin deficiency constitution were randomized into a treatment group of 56 cases and a control group of 52 cases. The treatment group was intervened by moxibustion, while the control group was by medication. The modified Kupperman Index (KI), Hamilton Anxiety Scale (HAMA), Symptom Checklist-90 (SCL-90), and Self-rating Depression Scale (SDS) were observed before and after treatment for comparison.Result The KI score, HAMA score, SCL-90 total score, and SDS score were significantly changed in both groups after intervention (P<0.01,P<0.05). After treatment, the KI score, HAMA score, SCL-90 total score, and SDS score in the treatment group were significantly different from that in the control group (P<0.01,P<0.05).Conclusion Moxibustion is effective in treating PMS, and it can improve the anxiety and depression symptoms of the patients.

E ffects of glycogen synthase Kinase-3 on proliferation of human osteosarcoma ec lls / 实用肿瘤学杂志

Objective To investigate the molecular mechanisms of effect of glycogen synthase kinase -3beta( GSK3β) on proliferation of human osteosarcoma cells .Methods Normal osteoblast hFO and osteosarcoma cell lines were examined for GSK 3βexpression and activity by Western blot and in vitro kinase assay ( NIRKA) . The effects of small molecule GSK3βinhibitors on cell proliferation and apoptosis were examined .Depletion of en-dogenous GSK3βby GSK 3βsiRNA detected the expression and phosphorylation of p 27 and its downstream cy-clinD1-CDK-Rb pathway factor by Western blot .Human osteosarcoma cell xenografts ,in athymic mice model , were treated with DMSO as control or with GSK 3βinhibitor SB-216763 or AR-A014418 by intraperitoneal in-jection,3 times a week.The tumor growth and body weight were observed in nude mice .Results Osteosarcoma cell lines showed increased GSK 3βexpression and decreased serine 9 phosphorylation compared with normal oste-oblast cells.Inhibition of GSK3βresulted in attenuated cell proliferation and increased apoptosis in most osteosar-coma cell lines in vitro and in vivo in MG 63 xenografts in rodents but not in hFOB cells .We decreased endoge-nous GSK3b activity,tumor growth was inhibited in SB216763,AR -A014418 group compared with control group.There was statistical significance(P<0.05).GSK3βinhibition in osteosarcoma cells was associated with decreased p27 expression, Rb expression and phosphorylation level of decline , CDK2, 4, 6 protein level de-creased,the upregulation of cyclin D1 expression but the phosphorylation level of no effect .Conclusion In this research,we demonstrate that deregulated GSK 3βsustains osteosarcoma cells survival through modulation of p27and cyclinD1-CDK-Rb pathway.The result will open up a potential target for clinical treatment of osteosar -coma.

Clinical study on percutaneous radiofrequency nucleoplasty treatment for cervical disc herniation / 中国基层医药

Objective To explore the clinical outcomes of the percutaneous radiofrequency nucleoplasty in the treatment of cervical disc herniation.Methods 183 patients with cervical disc herniation were treated with percutaneous radiofrequency nucleoplasty.A retrospective analysis of 183 patients was made,and their effects were evaluated using the VAS and the subjective satisfactory degree of the patients.Results All cases were followed up for 3 to 36 months( average 12 months).There were no complications observed such as hemorrhages,infections and nerve root injurys due to the procedure.One week after operation,symptom remission rate was 58.4％ and perfect rate of subjective satisfaction was 95.1％.At final follow up,symptom remission' rate was 66.1％ and perfect rate of subjective satisfaction was 85.8％.Conclusion Percutaneous radiofrequency nucleoplasty was an effective,minimally invasive and safe procedure to treat cervical disc herniation,and the operative treatment had shown better results.

Operative treatment of 107 cases with tibial plateau fractures / 中国基层医药

Objective To investigate the surgical techniques and curative effect for the treatment of tibial plmeau fracture. Methods Totally 107 cases( male 62 cases;female 45 cases) of tibia plateau fractures were operated with internal fixation from January 2000 to December 2006 in our hospital. According to Schatzker classification,there were type Ⅰ fracture 2 cases,type Ⅱ 37 cases,type Ⅲ 29 cases,type Ⅳ 22 cases,type Ⅴ 10 cases,type Ⅵ 7 csses. Type Ⅰ fractures were treated with cannulated screws,other type fractures were treated by open reduction,internal fixation with buttress plates,and bone graft if bone defect existed. The therapeutic characteristics and the functions of the knee were evaluated. Results 107 cases cases were followed-up for 15 ～96 months,mean 28. 8 months.All fractures were healed without any complications. The knee Merchant scores were excellent in 62 cases, good in 24 cases,common in 17 cases,bad in 4 cases. The rate of fineness was 80. 37%. Conclusion Surgical operation is effective methods of treating tibia plateau fracture.

Pressure changes in cervical disc after percutaneous radiofrequency nucleoplasty / 中国医师进修杂志

Objective To study the changes of pressure in cervical disc after percutaneous radiofrequency nucleoplasty,and provide theoretical basis for percutaneous radiofrequency nucleoplasty in the treatment of cervical disc herniation. Methods Forty-two patients with cervical disc herniation (33 cases of nerve root-type cervical spondylopathy and 9 cases of vertebral artery-type cervical spondylopathy) were treated with pereutaneous radiofrequeney nucleoplasty. The pressures of operated cervical disc were measured in the operation, and their clinical effects were evaluated using the JOA values 1 week after operation. The relationship between pressure changes in cervical disc and clinical effect was studied. Results The pressure in the cervical disc in 33 cases of nerve root-type cervical spondylopathy was decreased (1.84 ± 0.96) kPa (P=0.000), and the JOA values increased (3.27 ± 1.35) scares (P=0.000) 1 week after operation. The pressure in the cervical disc in 9 cases of vertebral artery-type cervical spondylopathy was decreased (1.72 ± 0.92) kPa (P= 0.000), and the JOA values increased (2.78 ± 0.67) scores (P= 0.000) 1 week after operation. Correlative analysis showed that there was a positive correlation between the pressure decrease of cervical disc and the JOA values increase (P < 0.05). Conclusion Percutaneous radiofrequency nucleoplasty can help to reduce pressure in the cervical disc and relieve the clinical symptoms.

Application of Ligasure vessel sealing system for resection of retroperitoneal tumor / 中国综合临床

Objective To explore the value of Ligasure vessel sealing system(LVSS)during resection of retroperitoneal tumor.Methods Group 1 including 32 cases were performed resection of retroperitoneal tumor with LVSS and electrosurgical seapel from Jun.2004 to Oct.2008.group 2 including 26 cases were done with electrosurgieal seapel from Jan.2001 to Jun.2004.Operating blood loss,operating time,iatrogenic injury,postoperative blood loss and hospital stay were compared between the two groups.Results There was no significant difference in hospital stay[(11.7±0.7)d vs.(12.3±1.4)d)]and iatrogenic injury(9.38%vs.16.00%)between two groups statistically(P＞0.05),but the intraoperative blood lose[(403.1±37.1)ml vs.(704.0±129.0)m1)s,postoperative blood loss[(131.5±18.4)ml vs.(214.8±29.2)ml)]and operating time[(166.5±8.9)min vs.(186.8±15.4)min]were less in group 1 than that in group 2(P＜0.05).Conclusion Ligasure vessel sealing system has advantages of safe coagulation,shortening operation time in resection of retroperitoneal tumor.

Effect of decalcified freeze-dried bone nail alone on 83 cases of intraarticular fracture / 中国组织工程研究

BACKGROUND: A process of -80 ℃ profound hypothermia over three months and freeze drying will suppress the histocompatibility antigen of decalcified freeze-dried bone and reduce their immunogenicity. OBJECTIVE: To investigate the effect of treating intraarticular fracture using allogeneic decalcified freeze-dried bone nail alone. DESIGN, TIME AND SETTING: From August 2000 to August 2007, a clinical analysis was performed among 83 patients of cancellous bone fracture involving articulus, who were enrolled from Department of Orthopaedics in the Central People's Hospital of Zhanjiang (Zhanjiang, Guangdong, China). MATERIALS: The involved patients consisted of 64 males and 19 females, aged 16-53 years with a mean of 36.3. The lesioned sites were elbow joint in 28 cases, acetabulum in 6 cases, femoral condyles in 9 cases, tibial plateau in 17 cases and ankle joint in 23 cases. Allogeneic decalcified freeze-dried bone nail was developed by the Biomaterial Laboratory of the Southern Medical University (also known as the First Medical University of Chinese PLA). METHODS: Totally 83 cases of cancellous bone fracture involving articulus were fixed with bone nail or bone screw after reducing of bone fracture. Bone nails or screws were pretreated with saline or allogeneic blood over 30 minutes. Bone nail at 3.5-mm diameter were applied on elbow joints and ankle joints, while those at 4.0-mm diameter for knee joints and hip joints. After implantation, hip and femoral condyles fractures were treated with the traction for 4-6 weeks, and the fractures of elbow joints, ankle joints and tibial plateau were fixed with gypsum for 4-6 weeks. Patients received functional exercise after wound healing. Subsequent to draining for 48 hours, antibiotics were used to prevent infection, but immune depressant was unnecessary. MAIN OUTCOME MEASURES: Wound healing was observed. The growth of osteotylus and the absorption of bone nail were checked with X-ray. Immunological rejection was also checked. RESULTS: One case had dystopia at postoperative 2 weeks, one case with breakage of bone nail was found at postoperative 3 weeks, and two cases developed immunological rejection in advanced stage. The other 79 cases got bone healing without dystopia or immunological rejection, and they achieved bone union within 1-3 months with normal joint function. CONCLUSION: Being internal fixation material of intraarticular fracture, allogeneic bone nail can maintain the stabilization of cancellous bone fracture to bone healing, exhibit complete absorption and be good at bone repair.

Laparoscopic gastrectomy / 中国微创外科杂志

Ojective To evaluate the value of laparoscopic gastrectomy in the management of gastric diseases. Methods 18 laparoscopic gastric operation were performed in our hospital from August 2000 to April 2001. The ages of the patients ranged from 28 to 87 years. One patient received Billroth-Ⅰ gastrectomy, 7 Billroth-Ⅱ gastrectomy, 3 proximal subtotal gastrectomy, 4 distal subtotal gastrectomy and 3 total gastrectomy. Results All the operations were successfull, the duration of operation was 150～340min, the estimated blood loss was 20～120ml, and the average postoperative hospitalized days were 8 days. All patients recovered quickly without any postoperative complication. Flatus was present quickly. no death occurred in all the patients. Conclusions Laparoscopic gastrectomy is an effective and safe technique for the manaqement of gastric disease, if used properly.

Surgical therapy of lumbar disc herniation by vertebral lamia fenestration: an analysis of 5482 cases / 中国医师杂志

Objective To explore the clinical outcomes of the removal of nucleus pulposus with vertebral lamia fenestration in the treatment of lumbar disc herniation.Methods A total of 5482 patients with lumbar disc herniation were performed to remove nucleus pulposus with vertebral lamia fenestration.The follow-up study was conducted in 4329 cases for the duration varying from 6 months to 20 years,averaging 6.7 years,and the therapeutic effect of the operation was evaluated.Results After operation,the patients could walk in(3?2) days,resumed their daily activities in (15?6) days and went back to work in(28?9) days.According to the Nakai scale,excellent results were achieved in 3374 cases(77.9%),good in 652 cases(15.2%),improved in 249 cases(5.8%) and poor in 54 cases(1.1%).The rate of excellent and good results was 93.1%.Conclusion The advantages of the removal of nucleus pulposus with vertebral lamia fenestration are the removal of the annulus fibrosus,the calcified ligamentum flavum and osteophyte under direct vision.The operation may preserve the utmost integrity of the posterior lumbar structures,and the operative treatment has shown its good results.