Background As myopia is a common ocular condition which has been reported as the risk factor of primary open angle glaucoma,it is of great importance to evaluate the optic disc morphology in myopic eyes.Objective This study was to evaluate the agreement of optic disc measurements between Cirrus high-density optical coherence tomography (HD-OCT) and Heidelberg retina tomograph (HRT) in myopic eyes;and to investigate the relationships between axial length (AL) and differences of optic disc parameters measured with the two devices.Methods One hundred and fifty myopic subjects were included in this prospective cross-sectional study.One eye from each subject was randomly selected for optic disc imaging by Cirrus HD-OCT and HRT2 in Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong from September to December in 2010 under the approval of Ethic Committee of this hospital and informed consent of each patient was received.Each subject received complete ophthalmic examinations including intraocular pressure (IOP) measurement,visual acuity,refraction,slit lamp,dilated fundus examination and perimetry.The subjects were divided into low (≤-3.00 D,35 eyes),moderate (-3.00 D＜SE＜-6.00 D,60 eyes) and high myopia (SE ≥-6.00 D,55 eyes) groups according to the refractive status.Measurement of axial length was performed with IOL master.Optic disc parameters including disc area,rim area,cup volume,vertical cup-to-disc ratio (VCDR) and average cup-to-disc area ratio (ACDR) were measured by Cirrus HD-OCT and HRT2,respectively.The OCT measurements were corrected for ocular magnification using the Littman's formula,and the results were compared between the instruments.The measurement agreement was evaluated using Bland-Altman plots.Pearson correlation analysis was used to evaluate the associations between AL and the measurement differences of the two instruments.Results The mean axial length and refraction were (25.62±1.10) mm and (-5.22±2.34) D,respectively.The corrected optic disc parameters were significantly larger than those without adjustment by using Cirrus HD-OCT (all at P＜ 0.001).In the high myopic group,the disc area measured by Cirrus HD-OCT was significantly larger than that by HRT2 (P＜0.001).In the moderate myopic group,the rim area measured by HRT2 was significantly larger than that by the Cirrus HD-OCT (P =0.040).The measurements of ACDR,VCDR and cup volume by Cirrus HD-OCT were all larger than those by HRT2 in the three myopic groups (all at P＜0.001).The 95％ limits of agreement (LoA) of disc area and rim area with the two devices were-0.64 to 0.74 and-0.74 mm to 0.62 mm2,respectively.The differences of disc area,rim area and cup volume measurements from the two devices were significantly and positively associated with axial length (r=0.158,0.148,0.156,all at P＜0.05).No significant correlation was detected between AL and the differences of ACDR and VCDR (r =0.012,0.093,both at P ＞ 0.05).Conclusions Optic disc parameters measured by Cirrus HD-OCT are affected by optical magnification in myopic eyes.Poor agreement is found across all of the disc measurements with Cirrus HD-OCT and HRT2.The two devices should not be used interchangeably for measurements of optic disc.Moreover,the differences between measurements of the two devices are significantly associated with AL.

Objective To investigate the relationships of serum angiopoietin-like protein 4(ANGPTL4)and fibroblast growth factor-23(FGF-23)levels with the severity and prognosis of patients with diabet-ic nephropathy.Methods A total of 120 patients(diabetic nephropathy group)with diabetic nephrop-athy were selected from July 2018 to July 2020 and divided into mild group(n=62)and severe group(n=58)according to the staging criteria of diabetic nephropathy;based on the prognosis within 3 years,they were also divided into good prognosis group(n=94)and poor prognosis group(n=26).Addition-ally,102 diabetic patients were enrolled as diabetic group,and 81 healthy volunteers were selected as control group.The serum levels of ANGPTL4 and FGF-23 in diabetic nephropathy patients were detected by enzyme-linked immunosorbent assay(ELISA).Logistic regression analysis was used to analyze the influencing factors of prognosis,and receiver operating characteristic(ROC)curves were drawn to ana-lyze the values of ANGPTL4,FGF-23 and their combination in assessing the severity and prognosis of diabetic nephropathy.Results The levels of ANGPTL4 and FGF-23 in the diabetic nephropathy group and simple diabetic group were significantly higher than those in the control group(P＜0.05);compared with the simple diabetic group,the levels of ANGPTL4 and FGF-23 in the diabetic ne-phropathy group were significantly increased(P＜0.05);the levels of ANGPTL4 and FGF-23 in the severe group were significantly higher than those in the mild group(P＜0.05);the ROC curve analysis revealed that the areas under the curve(AUCs)for assessing disease severity of ANGPTL4,FGF-23 and their combination were 0.748,0.781 and 0.858 respectively,and the combined diagnosis was significantly better than FGF-23(Z=2.149,P=0.032)and ANGPTL4(Z=2.886,P=0.004)alone;the levels of ANGPTL4 and FGF-23 in the good prognosis group were significantly lower than those in the poor prognosis group(P＜0.05);significant differences were observed in diabetes dura-tion,blood urea nitrogen(BUN),serum creatinine(Scr),fasting blood glucose(FBG),glycated hemoglobin(HbA1C),hypertension,ANGPTL4 and FGF-23 levels between diabetic nephropathy pa-tients with different prognoses(P＜0.05);the Scr,ANGPTL4 and FGF-23 levels were all risk factors affecting the prognosis of diabetic nephropathy(P＜0.05);the ROC curve analysis for prognosis as-sessment showed that the AUCs of ANGPTL4,FGF-23 and their combination were 0.774,0.795 and 0.874 respectively;the combined diagnosis was significantly better than FGF-23(Z=2.385,P=0.171)and ANGPTL4(Z=2.317,P=0.021)alone.Conclusion The serum levels of ANGPTL4 and FGF-23 are significantly increased in diabetic nephropathy patients,and they have certain refer-ence value for the clinical diagnosis and prognosis assessment of diabetic nephropathy patients.

Objective To investigate the relationships of serum angiopoietin-like protein 4(ANGPTL4)and fibroblast growth factor-23(FGF-23)levels with the severity and prognosis of patients with diabet-ic nephropathy.Methods A total of 120 patients(diabetic nephropathy group)with diabetic nephrop-athy were selected from July 2018 to July 2020 and divided into mild group(n=62)and severe group(n=58)according to the staging criteria of diabetic nephropathy;based on the prognosis within 3 years,they were also divided into good prognosis group(n=94)and poor prognosis group(n=26).Addition-ally,102 diabetic patients were enrolled as diabetic group,and 81 healthy volunteers were selected as control group.The serum levels of ANGPTL4 and FGF-23 in diabetic nephropathy patients were detected by enzyme-linked immunosorbent assay(ELISA).Logistic regression analysis was used to analyze the influencing factors of prognosis,and receiver operating characteristic(ROC)curves were drawn to ana-lyze the values of ANGPTL4,FGF-23 and their combination in assessing the severity and prognosis of diabetic nephropathy.Results The levels of ANGPTL4 and FGF-23 in the diabetic nephropathy group and simple diabetic group were significantly higher than those in the control group(P＜0.05);compared with the simple diabetic group,the levels of ANGPTL4 and FGF-23 in the diabetic ne-phropathy group were significantly increased(P＜0.05);the levels of ANGPTL4 and FGF-23 in the severe group were significantly higher than those in the mild group(P＜0.05);the ROC curve analysis revealed that the areas under the curve(AUCs)for assessing disease severity of ANGPTL4,FGF-23 and their combination were 0.748,0.781 and 0.858 respectively,and the combined diagnosis was significantly better than FGF-23(Z=2.149,P=0.032)and ANGPTL4(Z=2.886,P=0.004)alone;the levels of ANGPTL4 and FGF-23 in the good prognosis group were significantly lower than those in the poor prognosis group(P＜0.05);significant differences were observed in diabetes dura-tion,blood urea nitrogen(BUN),serum creatinine(Scr),fasting blood glucose(FBG),glycated hemoglobin(HbA1C),hypertension,ANGPTL4 and FGF-23 levels between diabetic nephropathy pa-tients with different prognoses(P＜0.05);the Scr,ANGPTL4 and FGF-23 levels were all risk factors affecting the prognosis of diabetic nephropathy(P＜0.05);the ROC curve analysis for prognosis as-sessment showed that the AUCs of ANGPTL4,FGF-23 and their combination were 0.774,0.795 and 0.874 respectively;the combined diagnosis was significantly better than FGF-23(Z=2.385,P=0.171)and ANGPTL4(Z=2.317,P=0.021)alone.Conclusion The serum levels of ANGPTL4 and FGF-23 are significantly increased in diabetic nephropathy patients,and they have certain refer-ence value for the clinical diagnosis and prognosis assessment of diabetic nephropathy patients.

Objective:To confirm the reuse of mismatched regenerated motor axons of brachial plexus and explore the effect of target organs on their regeneration in a rat model.Methods:This study was carried out between January 2021 and December 2021 at the research laboratory of the Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, the First Affiliated Hospital of Sun Yat-sen University. Animals were randomly assigned into 2 groups, as a regeneration group (RGen) with 5 subgroups and a reuse group (RUs) with 3 subgroups. There were 6 rats per subgroup with 42 rats in total. It was observed that in the groups of RGen1-4, after the transection and suture of the musculocutaneous nerve, the motor axons of the proximal end could accurately grow into the distal corresponding endoneural tube. It was also observed that in the mismatched regenerated group, motor axons were the axons that grew into the endoneurial tube of the lateral forearm cutaneous nerve (LFCN), and other non-target organ contacts were made to the regenerated nerves after mismatch. It was specifically further divided into RGen1, the group without an organ for nerve to make contact with; RGen2, the group with skin as the target organ with nerves contact by neurorrhaphy; RGen3, the group with skin as the target organ with originally reserved natural nerve contact; RGen4, the group with muscle as the target organ with nerves contact by neurorrhaphy and RGen5, a control group. After 8 weeks, the positive area (PA), mean density (MD) and integral optical density (IOD) were measured, with AChE and ChAT fluorescence staining of the medial branch of LFCN, to evaluate the regenerated nerves after mismatch. Of the RUs group, firstly, the innervating branches of the flexor carpi radialis (FCR) were dissected and exposed, then further assigned according to initially innervated FCR (RUs1), contacted with regenerated nerves after mismatch (RUs2) and denervated (RUs3), respectively. After 8 weeks, compound muscle action potential (CMAP) and wet weight ratio of FCR were taken. Masson staining of FCR was also performed to evaluate muscle reinnervation by the regenerated nerves after mismatch. Data analysis with One-Way ANOVA and Bonferroni 0.05 indicated a statistically significant difference.Results:In the RGen groups, after AChE staining, the PA, MD and IOD of RGen3 and RGen4 were higher than that of RGen1 and RGen5, and PA of RGen4 were higher than that of RGen2, with a statistically significant difference ( P<0.05). After ChAT staining, the values of PA and IOD of RGen3 and RGen4 were higher than that of RGen1 and RGen5, and PA of RGen4 were higher than that of RGen2, with a statistically significant difference ( P<0.05). In the RUs, electrophysiological assessment showed that no CMAP was observed in RUs3, there was no significant difference in Latency of RUs1 and RUs2. The difference was statistically significant ( P<0.05). Wet weight rate of muscle of RUs1 (98.91%±3.86%) was higher than that of RUs3 (86.67%±4.68%) with a statistically significant difference ( P<0.01), but no significant difference when compared with RU2 (92.74%±3.88%). Masson staining showed that the CVF value of RUs2 (8.61%±1.16%) was significantly higher than that of RUs1 (3.17%±0.76%), and statistic significantly lower than that of RUs3 (16.44%±2.26%)( P<0.01). Conclusion:Target organ contact can promote the regenerated nerves after mismatched regeneration, and the muscle target organs exhibit greater facilitation than the cutaneous target organs. Besides, regenerated nerves after mismatch can establish effective innervation with muscle target organs, comfirming their effective reuse.

Objective To evaluate the application of the standard manual labeling on identification of retinopathy of prematurity ( ROP) images in deep learning. Methods According to the International Classification of ROP,different periods of ROP were classified into stage disease and plus disease in this study. From Joint Shantou International Eye Center from August 2009 to July 2018, a total of 1464 labeled fundus retinal photographs were divided randomly by stratified sampling into 3 groups:stage disease group(subgroup 1:173,subgroup 2:117) was used to train for labeling stage disease,whereas plus disease group(subgroup 1:163,subgroup 2:116) was used to train for labeling plus disease,and consistent labels group consisted of 895 consistent labeled images on both disease. Graders consisted of senior experts,3 senior ophthalmologists and 2 interns,and received training for classification and labeling on ROP fundus images. The results were compared among the doctors and doctors with deep learning,and the agreement between non-experts doctors and the reference standards, and deep learning and the reference standards were tested. Results After the first training,the overall agreement rate of the senior ophthalmologist group and the intern group were lower than 90％ for both two disease labeling. After two to three times of training, in image of consistent labels group,overall agreement rates of senior ophthalmologists and intern doctor's were 98. 99％ ( Kappa=0. 979),99. 22％ (Kappa=0. 984) on stage disease,and 97. 43％ (Kappa=0. 914),98. 11％ (Kappa=0. 935) on plus disease,respectively. The agreement on stage disease using deep learning based on human-machine combination was 94. 08％,Kappa value was 0. 880,which achieved good degree. Conclusions Standardized manual labeling can improve the intelligentization of deep learning on identification of ROP images,and be considered as an innovative method of homogenization and standardized training for doctors in ophthalmology.

Objective:To analyze the clinical efficacy of three-dimensional(3D) reconstruction guided uniportal fluorescence thoracoscopic subsegmentectomy for the pulmonary nodules.Methods:We retrospectively analyzed 50 patients with nodules who underwent uniportal fluorescence thoracoscopic subsegmentectomy from December 2021 to February 2024. All patients underwent thin-slice CT scanning and 3D reconstruction preoperatively. 12 patients were given CT-guided hookwire localization preoperatively.The intersegmental plane was identified by fluorescence method.Results:One patient was converted to right upper lobectomy due to no lesion found in S1b. The mean blood loss was(23.4±16.5)ml and the mean operative time was(126.5±38.5)min. The mean duration of postoperative drainage was(2.6±0.8)days. Mean postoperative hospitalization was(4.8±1.8)days. There were 2 cases with postoperative pulmonary infections, including one with encapsulated pleural effusion. There was no air leakage over 3 days, and no death within 30 days after surgery.Conclusion:3D reconstruction guided uniportal fluorescence thoracoscopic subsegmentectomy is a safe and feasible technique for resection of pulmonary nodules in lung subsegments, and surgical indications must be strictly controlled.

Objective    To explore the clinical issues associated with video-assisted pulmonary segmentectomy and to provide reference for better implementation of thoracoscopic pulmonary segmentectomy and reduction of perioperative complications through analyzing the clinical results of thoracoscopic segmentectomy. Methods    The clinical data of 90 patients who planned to undergo thoracoscopic segmentectomy in our department from October 2017 to December 2019 were retrospectively analyzed, including 35 males with an average age of 60.34±9.40 years and 55 females with an average age of 56.09±12.11 years. The data including lung nodule number, benign or malignant, preoperative location by Hookwire, preoperative planning and actual implementation, operation time, intraoperative blood loss, postoperative drainage volume and time of drainage tube removal, postoperative hospital stay and complications were collected and analyzed. Results    Among the 90 patients, 38 were preoperatively positioned by Hook-wire, 52 were directly operated on; 87 were completed under thoracoscopic surgery among whom 3 underwent passive lobectomy after segmentectomy under thoracoscopic surgery, and 3 were converted to thoracotomy among whom 1 underwent lobectomy. Operation time was 198.58±56.42 min, intraoperative blood loss was 129.78±67.51 mL, lymph node samples were 6.43±1.41, drainage time was 2.98±1.25 d, the amount of postoperation drainage was 480.00±262.00 mL, hospital stay was 7.60±2.38 d. In all patients, 73 had single nodules and 17 had multiple nodules. Totally 113 pulmonary nodules were resected, 14 (12.39%) were benign nodules and 99 (87.61%) were malignant nodules. There was no perioperative death or serious complications. Conclusion    For those pulmonary parenchymal nodules which meet the  indications, it is feasible to perform thoracoscopic anatomic pulmonary segmentectomy according to preoperative thin-slice CT and three-dimensional computed tomography-bronchography and angiography (3D-CTBA) reconstruction results. Preoperative Hookwire localization can ensure effective edge resection and reduce unplanned lobotomy for intersegmental nodules and non-palpable peripheral pure ground-glass nodules.

Objective    To summarize the clinical experience of thoracoscopic combined subsegmentectomy (CSS). Methods    The clinical data of 76 patients who underwent thoracoscopic CSS in Anqing Municipal Hospital from May 2018 to July 2022 were retrospectively analyzed, including 22 males and 54 females, aged 27.0-76.0 (54.3±10.5) years. All patients underwent preoperative three-dimensional computed tomography bronchography and angiography using dual source CT. The modified inflation-deflation technique or indocyanine green was used to identify the intersubsegmental border. Results    A total of 86 pulmonary nodules were resected in 76 patients. One patient of left upper lobe S1+2c+S4a, 1 patient of right upper lobe S2b+S3a and 1 patient of right upper lobe S1b+S3b were further performed lobectomy due to insufficient margin. One patient of left upper lobe S1+2+S3a was further performed left upper division segmentectomy due to residual atelectasis. One patient of left upper lobe S1+2c+S3a was further performed left upper division segmentectomy due to B3b+c injury, and the rest completed planned surgeries successfully. The operative time was 90.0-350.0 (174.9±53.2) min. The operative hemorrhage volume was 50.0 (20.0, 50.0) mL. The postoperative hospital stay time was 6.0 (5.0, 7.0) d. Postoperative complications included pulmonary infection in 9 patients, hemoptysis in 3 patients, persistent pulmonary leakage>3 d in 4 patients, pneumothorax in 1 patient, pleural effusion in 1 patient, and myocardial infarction in 1 patient. All of the patients were cured and discharged without perioperative death. Conclusion    Thoracoscopic CSS is relatively complex. Preoperative planning under three-dimensional reconstruction and intraoperative fine operation are helpful for safe completion.