[Surgical treatment of fecal incontinence].

This article describes the surgical treatment of fecal incontinence. There are many surgical methods for fecal incontinence, and each treatment has its own advantages and disadvantages and indications. The appropriate surgical procedure should be selected according to the patient's history, anatomical structure and severity of incontinence. Injectable bulking agents is suitable for passive fecal incontinence. Sphincteroplasty is suitable for patients with sphincter injury caused by vaginal delivery or surgical trauma. Sacral nerve stimulation and posterior tibial nerve stimulation are relatively conservative methods. Gracilomyoplasty, artificial anal sphincter or magnetic anal sphincter can be used in the treatment of refractory fecal incontinence, but with many complications. Colostomy is the ideal choice for patients who have failed to respond to conservative treatment and cannot undergo these procedures.

[Applications of anterior segment optical coherence tomography in corneal refractive surgery].

Anterior segment optical coherence tomography (AS-OCT) has the characteristics of non-contact, noninvasive, high sensitivity, and repeatability, and offers high-resolution in vivo imaging of the structures of the anterior eye segment. It can be used in the diagnosis and assistance of conditions related to the anterior eye segment. This review provides an update on the research and clinical applications of AS-OCT in corneal refractive surgery, including preoperative keratoconus screening, intraoperative real-time visualization of corneal structures, postoperative corneal evaluation, and management of postoperative complications. We also explore the potential application of AS-OCT in combination with corneal biomechanical detection for corneal refractive surgery.

[Preliminary report on the use of total lumpectomyconical remnant gastric - esophagus side overlap anastomosis in radical resection of Siewert type II proximal gastric cancer].

Objective: There is no standard method for esophageal remnant gastric reconstruction for proximal gastrectomy. Reflux esophagitis caused by esophagogastrostomy remains a difficult surgical problem. To report the preliminary surgical results of novel esophagus-conical remnant gastric side overlap anastomosis (CGEO) , with particular emphasis on postoperative esophageal reflux. Methods: In June 2022, we developed a novel CGEO for laparoscopic proximal gastrectomy on two patients with Siewert type II esophagogastric junction adenocarcinoma. Surgical procedures for CGEO: (1) Laparoscopic proximal gastrectomy and preparation of conically shaped gastric remnant; (2) Determining anastomotic site of residual stomach and esophagus; (3) Side-to-side anastomosis of right esophageal wall to anterior of conical gastric remnant; (4) Valvuloplasty of esophageal stump. Results: Case 1 was a 71-year-old man with an operation time of 305 minutes and was successfully discharged from the hospital on the 9th day after surgery, and the postoperative pathology was T3N0M0. Case 2 was an 82-year-old man with an operation time of 325 minutes. He was discharged on the 10th day after surgery. In both cases, only mild esophageal mucosal changes were seen in gastroscopy, there were no obvious symptoms of esophageal reflux. There was also no significant weight change at half a year after operation. Conclusion: CGEO is moderately safe in radical surgery for proximal gastric cancer, and may have a preventive effect on the occurrence of postoperative esophageal reflux, but long-term results need to be confirmed by further studies with follow-up.

[Corneal ectasia following small-incision lenticule extraction: a case report].

A 22-year-old male presented with complaints of blurred vision in his right eye over the past 2 years following small incision lenticule extraction (SMILE) surgery conducted 4 years ago. Following a thorough ocular examination and evaluation, he was diagnosed with corneal ectasia in the right eye after the SMILE procedure. Subsequently, the patient underwent corneal cross-linking (CXL) treatment in the right eye to prevent the progression of the condition. After 3 months of treatment, the corneal ectasia remained stable. This article outlines the process of diagnosis and treatment, reviews the corneal conditions prior to the SMILE surgery, and analyzes the possible reasons behind the occurrence of postoperative corneal ectasia.

Amplification of a terahertz wave via stimulated Raman scattering.

Extremely strong terahertz (THz) waves are desperately demanded for investigating nonlinear physics, spectroscopy, and imaging in the THz range. However, traditional crystal-/semiconductor-based THz sources have limitations of reaching extremely high amplitude due to the damage threshold of devices. Here, by introducing Raman amplification to the THz range, we propose a novel, to the best of our knowledge, scheme to amplify THz waves in plasma. A long-pulse CO2 pump laser transfers its energy to a multicycle, 10-THz seed in a two-step plasma. By one-dimensional simulations, a 0.87-GV/m, 1.2-ps-duration THz seed is amplified to 10 GV/m in a 5.7-mm-long plasma with an amplification efficiency approaching 1%. The method provides a new technology to manipulate the intensity of THz waves.

[Enhance the management of cardiac arrest and improve the prognosis of the patients].

Cardiac arrest is one of the major public health problems with sudden onset, high mortality and high disability rate. The prevalence of cardiovascular disease continues to rise and the burden of cardiac arrest is increasing in China. It is of great significance to explore more effective prevention and treatment measures to improve the prognosis of patients with cardiac arrest. This article discusses the relevant progress on the treatment ability of emergency and critical cardiovascular diseases, medicines and technologies for cardiac arrest care, and registry studies of cardiac arrest, to further promote the effective improvement of key capacities at various stages of the prevention and treatment of cardiac arrest in China.

[Safety and efficacy of the early administration of levosimendan in patients with acute non-ST-segment elevation myocardial infarction and elevated NT-proBNP levels: An Early Management Strategy of Acute Heart Failure (EMS-AHF)].

Objectives: To investigated the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and elevated levels of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) with levosimendan within 24 hours of first medical contact (FMC). Methods: This multicenter, open-label, block-randomized controlled trial (NCT03189901) investigated the safety and efficacy of levosimendan as an early management strategy of acute heart failure (EMS-AHF) for patients with NSTEMI and high NT-proBNP levels. This study included 255 patients with NSTEMI and elevated NT-proBNP levels, including 142 males and 113 females with a median age of 65 (58-70) years, and were admitted in the emergency or outpatient departments at 14 medical centers in China between October 2017 and October 2021. The patients were randomly divided into a levosimendan group (n=129) and a control group (n=126). The primary outcome measure was NT-proBNP levels on day 3 of treatment and changes in the NT-proBNP levels from baseline on day 5 after randomization. The secondary outcome measures included the proportion of patients with more than 30% reduction in NT-proBNP levels from baseline, major adverse cardiovascular events (MACE) during hospitalization and at 6 months after hospitalization, safety during the treatment, and health economics indices. The measurement data parameters between groups were compared using the t-test or the non-parametric test. The count data parameters were compared between groups using the χ² test. Results: On day 3, the NT-proBNP levels in the levosimendan group were lower than the control group but were statistically insignificant [866 (455, 1 960) vs. 1 118 (459, 2 417) ng/L, Z=-1.25,P=0.21]. However, on day 5, changes in the NT-proBNP levels from baseline in the levosimendan group were significantly higher than the control group [67.6% (33.8%,82.5%)vs.54.8% (7.3%,77.9%), Z=-2.14, P=0.03]. There were no significant differences in the proportion of patients with more than 30% reduction in the NT-proBNP levels on day 5 between the levosimendan and the control groups [77.5% (100/129) vs. 69.0% (87/126), χ²=2.34, P=0.13]. Furthermore, incidences of MACE did not show any significant differences between the two groups during hospitalization [4.7% (6/129) vs. 7.1% (9/126), χ²=0.72, P=0.40] and at 6 months [14.7% (19/129) vs. 12.7% (16/126), χ²=0.22, P=0.64]. Four cardiac deaths were reported in the control group during hospitalization [0 (0/129) vs. 3.2% (4/126), P=0.06]. However, 6-month survival rates were comparable between the two groups (log-rank test, P=0.18). Moreover, adverse events or serious adverse events such as shock, ventricular fibrillation, and ventricular tachycardia were not reported in both the groups during levosimendan treatment (days 0-1). The total cost of hospitalization [34 591.00(15 527.46,59 324.80) vs. 37 144.65(16 066.90,63 919.00)yuan, Z=-0.26, P=0.80] and the total length of hospitalization [9 (8, 12) vs. 10 (7, 13) days, Z=0.72, P=0.72] were lower for patients in the levosimendan group compared to those in the control group, but did not show statistically significant differences. Conclusions: Early administration of levosimendan reduced NT-proBNP levels in NSTEMI patients with elevated NT-proBNP and did not increase the total cost and length of hospitalization, but did not significantly improve MACE during hospitalization or at 6 months.

Isolation, identification, and evaluation of the biocontrol potential of a Bacillus velezensis strain against tobacco root rot caused by Fusarium oxysporum.

AIMS: Tobacco (Nicotiana tabacum) is an economically important crop. Root rot caused by Fusarium oxysporum has become a damaging disease in N. tabacum crops grown in Henan province of China. Therefore, the objectives of this study were to screen bacterial isolates against F. oxysporum from rhizosphere soils of tobacco growing areas and to evaluate their antifungal activities, biocontrol effects, and effects on plant growth. METHODS AND RESULTS: Nineteen strains with antifungal inhibition effects of >60% against F. oxysporum were obtained using the method of flat confrontation; the strain Ba-0321 was the strongest, with an antifungal effect of 75%. Moreover, this strain had broad spectrum antimicrobial activity to eight additional tobacco pathogens. The strain was identified as Bacillus velezensis by morphology and the 16S rDNA sequence. The B. velezensis strain Ba-0321 had strong UV resistance as well as tolerance to high temperatures and low nutrition. The bacteria inhibited spore germination and mycelial growth of F. oxysporum under in vitro co-culture conditions. In vivo assays demonstrated that the Ba-0321 strain significantly reduced the pathogenicity of F. oxysporum, resulting in a control effect on tobacco root rot of 81.00%. Simultaneously, the bacteria significantly promoted root development and the growth of tobacco plants. CONCLUSION: Our results confirmed that the B. velezensis strain Ba-0321 has a strong antifungal effect and stress resistance that enable it to be used as a biological control agent for tobacco root rot caused by F. oxysporum. SIGNIFICANCE AND IMPACT OF THE STUDY: Tobacco root rot caused by F. oxysporum has become a damaging disease in China. The B. velezensis strain Ba-0321 has promising application value for controlling tobacco root rot diseases, and it could provide a new biocontrol agent against root rot caused by F. oxysporum in other plant species.

[New progress of excimer laser corneal refractive surgery for presbyopia].

Presbyopia refers to the decline in the accommodation of eye that occurs with age, symptoms begin to appear after the age of 40 and the clarity of vision at near is insufficient to satisfy an individual's requirements. The correction of presbyopia include restoring natural accommodation and improving symptom. The former is still difficult to achieve at present, while the latter mainly involves wearing convex lens, and with more and more patients wanting to get rid of frame glasses, refractive surgery is gradually promoted and applied. Corneal refractive surgery, especially laser-assisted in situ keratomileusis, is one of the most common methods for surgical correction of presbyopia. We reviewed the recent literature to introduce the mechanism of corneal refractive surgery treating presbyopia and the efficacy of different surgical algorithms.

[Paying extremely high attention to customized option and visual quality evaluation of refractive surgery].

As one of the methods to correct ametropia, refractive surgery has been accepted by more and more patients for its good safety, effectiveness and long-term stability. The two major types of refractive surgery are corneal refractive surgery, which is mainly performed with excimer laser and/or femtosecond laser, and phakic intraocular lens implantation. Each type has its own advantages and disadvantages. Surgeons should choose the best method according to their own technical conditions and the individual situation of each patient. In the preoperative and postoperative evaluation, we should not only pay attention to uncorrected vision and refraction, but also carry out a comprehensive visual quality assessment from both subjective and objective aspects. The ultimate goal of refractive surgery is to maximize patient satisfaction.

[Correlation between the increase in corneal higher-order aberrations and the control of children's myopic anisometropia after wearing orthokeratology lenses].

Objective: To explore the interocular differences in both the increase of corneal higher-order aberrations (HOAs) and axial length elongation, and the correlation between them after orthokeratology lens (OK lens) wear in children with myopic anisometropia. Methods: It was a prospective cohort study. From 2018 to 2019, 31 children with myopic anisometropia who were fitted with OK lenses initially in the Department of Ophthalmology of Peking University Third Hospital were enrolled, including 15 males (30 eyes) and 16 females (32 eyes). The age was (10.7±1.4) years. Before (baseline) and 12 months after wearing OK lenses, corneal aberrations, corneal relative refractive power (corneal RRP, the difference between peripheral corneal refraction and central corneal refraction) and axial length were measured using the Sirius combining a corneal topographer and a tomographer and an IOL-Master intraocular lens biometer in two eyes. Interocular differences in corneal aberrations, corneal RRP and axial length were analyzed by the paired t test and Wilcoxon rank sum test. The Pearson and Spearman correlation analyses were used to explore the correlation between the increase in corneal HOAs, corneal RRP and axial length elongation. Results: At 12 months after wearing OK lenses, 6 children were lost for follow-up, and the data of the remaining 25 children (50 eyes) were evaluated. With 3.0- and 6.0-mm measuring zones of the total cornea and the anterior surface, the increases in total corneal HOAs, coma, spherical aberration of higher myopic eyes were significantly more than fellow lower myopic eyes (all P<0.05). The corneal RRP with 2.0-mm and 2.5-mm radius in the upper cornea and 2.5-mm radius in the inferior cornea of higher myopic eyes were more than fellow lower myopic eyes (t=-2.06, -2.07, -2.42; P=0.05, 0.049, 0.023), but there was no significant interocular difference in corneal RRP in the horizontal meridian direction of the cornea (both the nasal and temporal sides of the cornea) (both P>0.05). The axial length elongation in higher myopic eyes was 0.14 (0.08, 0.20) mm, which was significantly less than that in the contralateral eyes [0.18 (0.14, 0.35) mm] (Z =-3.21, P= 0.001). The interocular difference in axial length decreased from 0.40 (0.34, 0.54) mm at baseline to 0.33 (0.24, 0.54) mm (Z =-3.21, P = 0.001). The increases in HOAs, coma and spherical aberration of the anterior corneal surface with 3.0-mm measuring zone and the increase in coma of the anterior corneal surface with 6.0-mm measuring zone were all negatively correlated with axial length elongation (r=-0.493, -0.606, -0.500, -0.307; P<0.05). But the corneal RRP had no significant correlation with axial length elongation (r=-0.092, -0.104, -0.230, -0.061; P>0.05). Conclusion: After 12 months of OK lens wear, interocular difference in axial length reduced significantly in children with myopic anisometropia, which was related to the larger increase in corneal HOAs of higher myopic eyes than fellow lower myopic eyes, especially coma.

[Effect of hormones on keratoconus and its mechanism].

Keratoconus is an ectatic corneal disorder and characterized by central and/or inferior temporal corneal thinning in a cone shape. Studies have shown that its pathogenesis is related to changes in tissue proteins, enzymes, immune functions and specific genes, but the exact pathogenesis has not been clearly clarified yet. Hormones such as sex hormones have been found to be associated with keratoconus. This review aims to summarize and analyze the research progress of the effect of hormones on keratoconus and its mechanism, so as to explore the role of hormones in the early diagnosis of keratoconus and find new targets in the treatment of keratoconus, providing reference for clinical work.

Quercetin suppresses cell survival and invasion in oral squamous cell carcinoma via the miR-1254/CD36 cascade in vitro.

OBJECTIVE: This study aimed to investigate the effects of quercetin on the proliferation and invasion in oral squamous cell carcinoma (OSCC) and examine its effect on the activation of the miR-1254/CD36 signaling pathway. METHODS: Proliferation and invasion experiments were performed in the OSCC cell line CAL-27 in which miR-1254 was overexpressed or inhibited. The levels of miR-1254 and CD36 were determined using quantitative real-time polymerase chain reaction and Western blotting assays. RESULTS: Quercetin significantly suppressed the proliferation and invasion of CAL-27 cells in a dose-dependent manner, while up-regulating miR-1254 and down-regulating CD36. The overexpression of miR-1254 also considerably down-regulated CD36 and enhanced the ability of quercetin to inhibit CAL-27 cell survival and invasion. Conversely, the inhibition of miR-1254 significantly up-regulated CD36 and antagonized the inhibitory effects of quercetin. CONCLUSION: Our study suggests that quercetin might suppress the progression of OSCC by activating the miR-1254/CD36 signaling pathway, indicating its potential as a treatment against OSCC.

Absolute stimulated Brillouin side scattering in an inhomogeneous flowing plasma.

Theory of absolute stimulated Brillouin side scattering in an inhomogeneous flowing plasma is presented and verified numerically. The linearized coupling equations are transformed into a Schrödinger equation in k space and solved as an eigenvalue problem. Analytic threshold, growth rate, and scattering geometry are obtained for the pump laser with arbitrary incidence angle. Numerical solutions of the coupling equations show good agreements between the theoretical and numerical absolute thresholds when ion-acoustic wave damping is not too large, and thus an old but famous threshold in [Phys. Fluids 17, 1211 (1974)PFLDAS0031-917110.1063/1.1694867] is corrected. It also indicates that the theoretical analysis is not accurate for strong dampings, since it will overestimate the absolute threshold. Possibility of finding such instability in the current experiments is also discussed.

[The role of Wnt/ß-catenin/TCF-4 pathway on biological behavior of renal cell carcinoma and its mechanism].

Objective: To investigate the role of Wnt/ß-catenin/TCF-4 pathway in renal cancer cells and to analyze its possible mechanism. Methods: ß-catenin and TCF-4 were inhibited by siRNA in 786-O cells. The proliferation of transfected cells was detected by CCK8. The cell death of transfected cells was detected by acridine orange -ethidium bromide staining. The expressions of TCF-4, bcl-2, bax and Caspase-3 were detected in transfection group, empty vector group and negative control groups by western blot. Results: The cell proliferation ability of the ß-catenin transfection group was significantly lower than that of the control group (0.443±0.145 vs 0.910±0.721), meanwhile, the cell death rate was significantly increased (16.38±5.32 vs 6.61±1.04), the expression level of Caspase 3 and bax was increased, and the expression of anti-apoptotic protein Bcl-2 was decreased. Decreased TCF-4 led to the same results as inhibition of ß-catenin (all P<0.05). Conclusion: The Wnt/ß-catenin/TCF-4 pathway may play a role in the regulation of proliferation and apoptosis in 786-O renal cancer cells. The mechanism might through regulating of the downstream apoptosis proteins Caspase 3, bax and anti-apoptotic protein Bcl-2.

Investigation on gas permeability of compacted GMZ bentonite with consideration of variations in liquid saturation, dry density and confining pressure.

During the long term operation of a disposal repository, gas will be inevitably generated. Determination of gas permeability of compacted bentonite is of great importance for the safety assessment of the engineered barrier system. In the present work, the steady-state and residual pressure methods were employed to determine the gas permeability of GaoMiaoZi (GMZ) bentonite with consideration of variations in liquid saturation, dry density and confining pressure. Results show that, gas migration in saturated GMZ bentonite was mainly controlled by diffusion with an effective gas permeability of 1E-23 m2 - 1E-25 m2. While in unsaturated GMZ bentonite, significant gas flow rates could be observed, which increased stably with the increase of gas injection pressure. Klinkenberg effect was significant when gas flow through GMZ bentonite. The Klinkenberg corrected gas permeability decreased by 3.5-5.5 orders of magnitude as the liquid saturation increased from 10% to 70%. A decreasing magnitude of 1-2 orders in Klinkenberg corrected gas permeability was presented with the dry density increased from 1.5 Mg/m3 and 1.7 Mg/m3. The Klinkenberg corrected gas permeability decreased by 0-1 orders of magnitude as the confining pressure increased from 3 MPa to 7 MPa. By using the accessible porosity, gas measured intrinsic permeability could be determined with values ranged between 1E-15 m2 to 4E-15 m2, which was higher than the water measured one by 5 orders of magnitude. Additionally, a generalized power law was successfully adopted in this study to describe the evolution of gas relative permeability with the liquid saturation. Overall, the effective gas permeability, Klinkenberg corrected gas permeability, intrinsic and relative permeability determined in this study provided a comprehensive perspective to assess the buffering property of GMZ bentonite in multi-physical field coupling environment. The parameters obtained can be adopted in further simulation works for long-term safety analysis of the disposal repository from the viewpoint of gas migration.

[Clinical study on topography-guided laser ablation combined with accelerated corneal collagen cross-linking for early keratoconus].

Objective: To study the safety and efficacy of topography-guided customized excimer laser subepithelial ablation combined with accelerated collagen cross-linking technique in treatment of early keratoconus. Methods: Ninteen patients(20 eyes) (13 males 14 eyes, and 6 females 6 eyes), aged 12 to 44 years (24.7±8.0) were diagnosed as keratoconus by three-dimensional corneal topography and tomography, clinical history and examinations, and classified as KC1~KC3. Based on the classical excimer laser subepithelial keratomileusis (LASEK) method, topography guided laser ablation was performed with an excimer laser system (WaveLight EX500). After laser ablation, the corneal stromal bed was immersed with 0.1% riboflavin for 10 minutes, and then was irradiated by ultraviolet light (Avedro KXL) at 30 mW/cm(2) for 4 minutes. All the patients were followed up for more than 12 months. The uncorrected visual acuity (UCVA), diopter, best corrected visual acuity (BSCVA), corneal topography, central corneal endothelial cell density (ECD), hexagonal cell percentage (HEX), coefficient of variation (CV) and other indicators were observed. For normal distribution variables, Dunnett-t test was used before and after operation, and Wilcoxon test was used for variables with abnormal distribution. And the complications were recorded. Results: There was no loss of BSCVA at 12 months postoperatively, 20% of the eyes had no change of BSCVA, and 15% of the eyes gained 1 line of BSCVA, 15% of the eyes gained 2 lines of BSCVA, 50% of the eyes gained 3 lines and more of BSCVA. There was no significant difference in UCVA, BSCVA, manifest refractive spherical equivalent (MRSE) and the cylinder at 3 months postoperatively (P>0.05). The BSCVA were significantly improved at 6 and 12 months postoperatively compared with those before operation (t=3.095, 3.079, <0.05). Although there was no significant difference in UCVA and MRSE, the cylinder was significantly reduced at 6 and 12 months postoperatively (t=-2.890, -2.435, P<0.05). Apex curvature (Kapex) and mean pupil power (MPP) within 4.5mm of central cornea decreased significantly (Z=-2.903, P<0.01; Z=-2.667, P<0.01). Even though the thinnest corneal thickness decreased from pre-operational (461.9±31.1) µm to post-operational (416.6±27.0) µm (Z=-3.059, P<0.01), the cornea became regular with keratometric asymmetry index of anterior corneal surface decreased (Z=-2.667, P<0.01). The corneal optical quality parameters were improved. There was no significant difference in ECD, HEX and CV at 12 months postoperatively (P>0.05). Twelve months after operation, grade 0, 0.5, 1 and 2 haze were seen on 20%, 55%, 20% and 5% corneas respectively. Conclusions: The topography guided excimer laser ablation combined with accelerated corneal collagen cross linking is safe and effective in treatment of early stage keratoconus. It can significantly improve corneal regularity while preventing keratoconus progression, so as to improve the best corrected visual acuity postoperatively. (Chin J Ophthalmol, 2019, 55: 904-910).

L-butyl phthalein improves neural function of vascular dementia mice by regulating the PI3K/AKT signaling pathway.

OBJECTIVE: L-3-n-butylphthalide (L-NBP) is a type of anti-ischemic cranial nerve protective drug that may act on vascular dementia (VD). Phosphatidylinositol-3 kinase (PI3K)/protein kinase B (AKT/PKB) signaling pathway can up-regulate B-cell lymphoma 2 (Bcl-2) expression, reduce reactive oxygen species (ROS) production, and alleviate cell apoptosis. This study aimed at investigating the role of L-NBP on neurological function and cell apoptosis in VD mouse through regulating PI3K/AKT signaling pathway. MATERIALS AND METHODS: The mice were divided into four groups, including Sham, VD, VD + solvent, and VD + L-NBP. HT22 cells were cultured in vitro and treated by ischemia/reperfusion (I/R). HT22 cells were divided into four groups, including I/R, VD + solvent, VD + L-NBP, and VD + L-NBP + LY294002 groups. Phosphorylated AKT (p-AKT) and Bcl-2 expressions were tested. ROS content in hippocampus tissue was detected by flow cytometry. Cell apoptosis was evaluated by transferase-mediated deoxyuridine triphosphate-biotin nick end labeling (TUNEL) assay. RESULTS: ROS content and cell apoptosis increased, while p-AKT and Bcl-2 expressions reduced in hippocampus tissue from VD group compared with sham group. L-NBP significantly up-regulated p-AKT and Bcl-2 expressions and decreased ROS content and cell apoptosis in hippocampus tissue. I/R treatment markedly induced HT22 cell apoptosis and ROS production, and reduced p-AKT and Bcl-2 expressions. L-NBP treatment markedly up-regulated p-AKT and Bcl-2 levels, restrained cell apoptosis, and reduced ROS content in TH22 cells intervened by I/R. LY294002 apparently attenuated the protective effect of L-NBP on HT22 cells. CONCLUSIONS: L-NBP protects VD by up-regulating PI3K/AKT signaling pathway, elevating Bcl-2 expression, reducing nerve cell apoptosis, and restraining ROS production.