Objective To study the effect of α-lipoic acid on the retinal expression level of VEGF and diabetic retinopathy in rats with diabetes mellitus and mechanism.Methods Totally 72 Wistar rats were divided into 4 groups:12 (control group)in group A,24 in modeling group(group B),24 in group treated withα-LA(group C)and 12 in high-glucose(group D).Group B to group D were given 60 mg/kg STZ through intraperitoneal injection,rats in group C were given 100 mg/kg α-LA and rats in group D were given 5.0% glucose-solution.The body mass,FPG,FINS,HOMA-IR,expression level of VEGF,activity of SOD,GSH and IL-6 of 4 groups were compared by statistics.Results After 72 h,the FPG of group A was(4.57 ±0.1 5 )mmol/L,that of group B was (21.72±4.28)mmol/L,that of group C was(21.54±4.96)mmol/L and that of group D was(21.83±4.77)mmol/L,the difference had statistical significance (P <0.05).The body mass of group A was(210.5±5.2)g,that of group B was(21 1.2 ±5.7)g,that of group C was(209.8±5.8)g and that of group D was(208.7±3.4)g,the difference had no statistical significance (P >0.05).The body mass,FPG,FINS,HOMA-IR,expression level of VEGF,activity of SOD,GSH and IL-6 among 4 groups at 4 w,8 w and 12 w had statistical difference (P <0.05).After 12 w,the difference of GR stage among group B to group D had statistical significance (P <0.05).Conclusion α-LA can inhibit the expression of VEGF in rats with diabetes mellitus,which is related to its ability to re-duce the oxidative stress and inflammation reaction,as well as to alleviate the insulin resistance.

Objective To observe the optic disc perfusion in anterior ischemic optic neuropathy (AION) patients.Methods Forty eyes of 40 AION patients and 30 eyes of 30 normal subjects were included.The stage of the diseases was defined based on the course of the disease,including acute stage (less than 3 weeks) and recovery stage (more than 3 months).Optic disc blood flow area,outer vascular density and blood flow index were measured by optical coherence tomography angiography in all the subjects.Optic disc perfusion was observed in acute and recovery stage of disease.Results The optic disc blood flow area,outer vascular density and blood flow index were decreased of AION eyes in acute stage compared with the normal subjects,the difference was statistically significant (P＜0.05);while the optic disc blood flow area,outer vascular density and blood flow index of AION eyes in the recovery stage showed no significant difference compared with normal subjects (P＞0.05).Conclusion Disc perfusion is reduced in AION at the acute stage,but recovered at the recovery stage.

Idiopathic parafoveal telangiectasis (IPT) is a retinal vascular disease which is characterized by foveal and parafoveal telangiectasia.The main clinical manifestations are retinal telangiectasis,reduced retinal transparency,retinal venular dilatation,yellow exudation,retinal pigment epithelial lesions,retinal hemorrhage,macular atrophy,macular hole or lamellar hole,subretinal neovascularization and retinal detachment.According to the clinical characteristics and features of fluorescein angiography,IPT can be divided into 3 types and 6 subtypes.Laser photocoagulation,photodynamic therapy,and intravitreal injection of glucocorticoid or anti-vascular endothelial growth factor drugs,can reduce the macular edema and neovascularization.However,due to the unclear etiology of IPT,the existing treatment measures are not specific for its etiology.We need to work hard to understand further the clinical features and pathogenesis of IPT and search the targeted treatments based on its pathogenesis mechanism.

Objective To analyze the distribution and antimicrobial resistance of bloodstream pathogens in surgical intensive care unit (SICU) and medical intensive care unit (MICU) of Fujian Provincial Hospital in the past four and half years for better use of antimicrobial drugs.Methods A retrospective analysis was carried out for the bloodstream pathogens isolated from SICU and MICU patients from January 2012 to June 2016.The clinical data and outcomes of patients were also reviewed.Results A total of 329 strains of isolates were recovered from blood samples in SICU,including gram-negative bacteria (53.5％),gram-positive bacteria (39.2％),and fungi (7.3％);258 strains were collected from MICU,including gram-negative bacteria (57.8％),gram-positive bacteria (36.0％),and fungi (6.2％).A.baumannii,K.pneumonia and E.coli were the top three gram-negative species in both SICU and MICU.The main gram-positive species were coagulase-negative Staphylococcus and Enterococcusfaecium.Overall,386 cases of bloodstream infections were diagnosed,including 226 cases in SICU (202 cases of single bacterial infection and 24 cases of multiple bacterial infection),and 160 cases in MICU (138 cases of single bacterial infection and 22 cases of multiple bacterial infection).A.baumannii isolates showed significantly higher rate of resistance to antibiotics in SICU than in MICU,while the K.pneumoniae and E.coli isolates in MICU showed higher resistance rates to cephalosporins,quinolones,penicillins and carbapenems than the corresponding isolates in SICU.The coagulase negative Staphylococcus and E.faecium isolates in MICU were associated with significantly higher resistance rates to quinolones and tigecycline than those strain in SICU.The bloodstream infections due to K.pneumoniae,E.coli and E.faecium were associated with higher mortality in MICU than in SICU,while the bloodstream infections due to A.baumannii were associated with higher mortality in SICU than in MICU.The total mortality rate of bloodstream infections was higher in MICU than in SICU.Conclusions SICU and MICU share similar profile of main bloodstream pathogens even though the disease spectrum was different between SICU and MICU.All the bloodstream pathogens isolated from MICU patients except A.baumannii showed significantly higher antimicrobial resistance rates than the isolates from SICU.The mortality rate associated with bloodstream infection was also higher in MICU patients than in SICU.

Objective To evaluate the olfactory function and its influence factors by using Sniffin ’ Sticks test, and to compare the quality of Parkinson ’s disease (PD) recognition between Sniffin’ Sticks and 16 kinds of odor identification in Sniffin ’ Sticks(SS-16) tests.Methods The Sniffin’Sticks test was used to assess the olfactory function of 68 PD patients and 76 healthy volunteers , and the relationship between smell and age, disease duration, Unified Parkinson’ s Disease Rating Scale score, Hoehn-Yahr (H-Y) rating, and cognitive function level (Montreal Cognitive Assessment) was analyzed.Results (1)The prevalence of olfactory dysfunction in PD group (83.3%) was significantly higher than that in control group (21.2%).The Sniffin’ Sticks test showed that the odor threshold score (6.6 ±3.2, P=0.000), odor discrimination score (6.6 ±3.3, P=0.000), 16 kinds of odor identification score (6.8 ±2.4, P=0.000) in PD group were significantly lower than those in control group.( 2 ) When comparing the PD cases and healthy controls in recognition , the sensitivity and the specificity of the Sniffin ’ Sticks test were 0.897 and 0.737, respectively, similar to the SS-16 test.However, the Sniffin’ Sticks test showed advantage compared with odor threshold and odor discrimination.( 3 ) The olfactory score in PD group was positively correlated with cognitive function (r=0.243, P=0.046), and was unrelated with age, gender, disease duration, and disease severity.The olfactory score in control group was negatively correlated with age (r=-0.270, P=0.018), but positively correlated with cognitive function (r=0.281, P=0.014).Conclusions There is a higher incidence of olfactory dysfunction in PD patients than in control group.Sniffin’ Sticks test is superior to SS-16 test in quantitative and qualitative analysis of olfactory function in PD patients.Two tests both have high sensitivity and specificity in the recognition of PD .

Objective To improve the quality standard of Tongluo-Zhujing pills.Methods We added the identification ofradix notoginseng andtypha orientalisby TLC and determination of the content of wedelolactone by HPLC. The study used Agilent ZORBAX SB-C18 (4.6 mm × 250 mm, 5 μm) column and the velocity of flow manufactured by the proper proportion was 1 ml/min. The detection wavelength was 249 nm . Results The new method could well identify radix notoginsengandtypha orientalis. The calibration curves of wedelolactone was in good linearity over the range of 0.064-0.642 μg (r=0.999 7) and the average recovery was 98.74%(RSD=1.61%).Conclusions The quality standard of Tongluo-Zhujing pills was proved effectively.

Objective: To evaluate the performance of a convolutional neural network (CNN) model that can automatically detect and classify rib fractures, and output structured reports from computed tomography (CT) images. Materials and Methods: This study included 1079 patients (median age, 55 years; men, 718) from three hospitals, between January 2011 and January 2019, who were divided into a monocentric training set (n = 876; median age, 55 years; men, 582), five multicenter/multiparameter validation sets (n = 173; median age, 59 years; men, 118) with different slice thicknesses and image pixels, and a normal control set (n = 30; median age, 53 years; men, 18). Three classifications (fresh, healing, and old fracture) combined with fracture location (corresponding CT layers) were detected automatically and delivered in a structured report. Precision, recall, and F1-score were selected as metrics to measure the optimum CNN model. Detection/diagnosis time, precision, and sensitivity were employed to compare the diagnostic efficiency of the structured report and that of experienced radiologists. Results: A total of 25054 annotations (fresh fracture, 10089; healing fracture, 10922; old fracture, 4043) were labelled for training (18584) and validation (6470). The detection efficiency was higher for fresh fractures and healing fractures than for old fractures (F1-scores, 0.849, 0.856, 0.770, respectively, p = 0.023 for each), and the robustness of the model was good in the five multicenter/multiparameter validation sets (all mean F1-scores > 0.8 except validation set 5 [512 x 512 pixels; F1-score = 0.757]). The precision of the five radiologists improved from 80.3% to 91.1%, and the sensitivity increased from 62.4% to 86.3% with artificial intelligence-assisted diagnosis. On average, the diagnosis time of the radiologists was reduced by 73.9 seconds. Conclusion Our CNN model for automatic rib fracture detection could assist radiologists in improving diagnostic efficiency, reducing diagnosis time and radiologists’ workload.

Objective To investigate the peripheral vascular findings in eyes with branch retinal vein occlusion (BRVO) and hemi-retinal vein occlusion (HRVO) using ultra-wide field fluorescein angiography (UWFFA),and analyze the influence of relative systemic factors on retinal vascular leakage.Methods A retrospective case-control study was designed.The 153 eyes of 146 patients with BRVO and 40 eyes of 40 patients with HRVO were include in Tianjin Medical University Eye Institute from September 2017 to March 2018.UWFFA was carried out in the patients,and the images were analyzed by Vantage Review software.The eyes were divided into two groups based on the whether the leakage occurred in other quadrant or fellow eye.The eyes with the fluorescence leakage only in the quadrant of affected vessel in late stage of UWFFA were in the RVO1 group,and the eyes with the fluorescence leakage in other quadrants or fellow eye besides affected vessel were in the RVO2 group.Relative past medical histories were recorded,such as hypertension,high cholesterol and diabetes mellitus.The influence of medical histories on vascular leakage in RVO1 group and RVO2 group with different histories was analyzed,respectively,and systemic factors which affected lcakage degree were evaluated.Results In 179 eyes with RVO,fluorescence leakage occurred in late stage of UWFFA besides affected vessel in 25 eyes (14.0％),including 19 eyes in the affected eyes (10.6％) and 6 eyes in fellow eyes (3.4％).Hypertension,high cholesterol and diabetes mellitus were found in 77,28 and 21 patients,respectively.In 77 hypertension patients,66 were in the RVO1 group,and 9 were in the RVO2 group (11.69％),and in 102 non-hypertension patients,86 were in the RVO1 group,and 16 were in the RVO2 group (15.69％),without significant difference was seen in the fluorescence leakage in other quadrants or fellow eye besides affected vessel between hypertension and non-hypertension patients (x2 =0.298,P =0.585).In 28 high cholesterol patients,24 were in the RVO1 group,and 4 were in the RVO2 group (14.29％),and in the 151 patients without high cholesterol,130 were in the RVO1 group,and 21 were in the RVO2 group (13.91％),without significant difference in the fluorescence leakage in other quadrants or fellow eye besides affected vessel between high cholesterol and non-high cholesterol (x2 =0.000,P =1.000).In 21 diabetes mellitus patients,17 patients were in the RVO1 group,and 4 patients were in the RVO2 group (19.05％),and in 158 patients without diabetes mellitus,137 were in the RVO1 group,and 21 were in the RVO2 group (13.29％),without significant difference was seen in the fluorescence leakage in other quadrants or fellow eye besides affected vessel between diabetes mellitus and non-diabetes mellitus (x2 =0.144,P=0.704).Conclusions Unexpected late peripheral retinal leakage can be seen on the UWFFA in the eyes with BRVO and HRVO.Hypertension,high cholesterol and diabetes mellitus are not the main cause of these findings.UWFFA can disclose more peripheral,wider retinal lesions.

Objective To observe the difference of macular microvascular features in superficial and deep vascular plexi in patients with branch retinal vein occlusion (BRVO).Methods A total of 63 BRVO patients (63 eyes) were enrolled in this study. There were 28 males (28 eyes) and 35 females (35 eyes). The patients aged from 39 to 74 years, with the mean age of (59.76±8.48) years. All eyes were evaluated by optical coherence tomography angiography (OCTA). The macular angiography scan protocol covered a 3 mm×3 mm area. The focus of angiography analysis included superficial vascular plexus and deep vascular plexus. The following vascular morphological parameters were assessed in these two plexi: foveal avascular zone (FAZ) enlargement, capillary non-perfusion (CNP) occurrence, microvascular abnormalities (MA) appearance, and vascular congestion (VC) signs. The FAZ area was measured by the built-in software. The macular microvascular morphology changes in superficial and deep vascular plexi were compared through McNemar test. Results The superficial and deep plexi showed FAZ enlargement in 43 eyes (68.3％) and 50 eyes (79.4％), CNP in 51 eyes (81％) and 50 eyes (79.4％), MA in 62 eyes (98.4％) and 62 eyes (98.4％), VC in 23 eyes (36.5％) and 52 eyes (82.5％), respectively. FAZ area was (0.55±0.37) mm2. There was no difference in CNP (P=1.000) and MA (P=1.000) between superficial and deep plexi. But, there was difference in FAZ enlargement (P=0.039) and VC signs (P<0.001) between superficial and deep plexi.Conclusion Deep vascular plexus showed more FAZ enlargement and VC sign than superficial plexus in BRVO patients.

Objective To observe the effect of different macular edema on the area of foveal avascular zone (FAZ) and its correlation in eyes with branch retinal vein occlusion (BRVO).Methods A total of 72 patients (75 eyes) diagnosed with BRVO were included in the study.There were 40 patients males (42 eyes) and 32 females (33 eyes),with the mean age of (56.00±9.96) years.All the eyes were examined by BCVA,intraocular pressure,slit lamp microscope combined with preset lens,fundus color photography and optical coherence tomography angiography (OCTA).BRVO patients were divided into two groups according to the degree of macular edema:group M300 that was CRT ≥300 μm (38 patients,39 eyes) and group L300 that was CRT＜300 μmn (34 patients,36 eyes).The macular angiography scan protocol covered a 3 mm × 3 mm area.The parameters of macular were measured by the built-in measurement software of the system:(1) area of FAZ,perimeter ofFAZ (PERIM),avascular index ofFAZ (AI),vascular density within a width of 300 μm around the FAZ region (FD-300);(2) central retinal thickness (CRT);(3) vascular density (VD):the superficial central fovea vascular density (SFVD),the deep central fovea vascular density (DFVD),the superficial hemi-macular vascular density (SHVD),the deep hemi-macular vascular density (DHVD).Spearman test was used to test the correlation between FAZ area and other parameters in each group.Results The FAZ area in group M300 and L300 were 0.388 ± 0.166 mmn2 and 0.596± 0.512 rmm2,respectively.The results of Spearman test showed that the FAZ area of group M300 was positively correlated with PERIM and AI (r=0.932,0.591;P=0.000,0.000),negatively correlated with SFVD,DFVD and SHVD (r=-0.490,-0.429,-0.339;P=0.002,0.006,0.035).But there was no significant negative correlation between FAZ area and FD-300,CRT,DHVD in group M300 (r=-0.129,-0.053,-0.400;P=0.435,0.749,0.395).The FAZ area in group L300 was positively correlated with PERIM and AI (r=0.887,0.633;P=0.000,0.000),negatively correlated with SFVD,DFVD,SHVD and DHVD (r=-0.413,-0.643,-0.630,-0.370,-0.411;P=0.012,0.000,0.000,0.026,0.013).But there was no significant positive correlation between FAZ area and FD-300 in group L300 (r=0.093,P=0.590).Conclusion FAZ area varies with the degree of macular edema.The degree of macular edema is higher,the FAZ area is smaller.FAZ area is positively correlated with PERIM and AI significantly,and negatively correlated with SFVD,DFVD and SHVD.