Objective:To observe and analyze the clinical and imaging features of eyes with cystoid macular degeneration (CMD) secondary to chronic central serous chorioretinopathy (cCSC).Methods:A retrospective clinical study. From February 2018 to June 2023, 9 patients of 15 eyes with cCSC secondary CMD diagnosed by ophthalmology examination in Yunnan University Affiliated Hospital were included in the study. All patients were male. The age was (53.67±3.83) years. The cases of binocular and monocular were 6 and 3 respectively. The visual acuity of the affected eye ranges from 0.02 to 0.1, which cannot be corrected. Visual acuity decreased and the duration of shadow occlusion was >1 year. Half dose photodynamic therapy (PDT) was performed on 8 eyes. All the patients underwent the best corrected visual acuity, posterior mydriatic fundus color photography, infrared fundus photography (IR), fundus autofluorescence (AF), fluorescein fundus angiography (FFA), optical coherence tomography (OCT), and multi-wavelength dazzling imaging (MC). The patients who received half dose PDT were followed up until 3 months after treatment. Patients who did not receive treatment were followed up to 2 years after the first diagnosis.Results:The light reflection in macular area decreased or disappeared in all eyes, and abnormal macular pigmentation was observed in 12 eyes. IR examination showed diffuse patchy weak fluorescence in the macular area in all affected eyes, and dotted strong fluorescence in the periphery. Fundus AF examination showed disc-like weak AF in the macular area, and scattered small amounts of strong AF in the middle and margins, among which the retinal pigment epithelium (RPE) atrophy trace in the macular area was observed in 7 eyes. By MC examination, the green signal in the macular area of the posterior pole of all affected eyes was uneven and mottled. FFA examination showed that no abnormal fluorescein leakage was observed in 15 eyes and 8 eyes showed strong fluorescence caused by diffuse permeation fluorescence. A small amount of active fluorescein was found in 7 eyes. OCT examination showed that there were several cystic cavities of different sizes in all the affected eyes, RPE atrophied to different degrees, and RPE cell compensatory ridges and tubular structures in the outer retina were seen in 6 eyes; 7 eyes with CMD and active leakage showed signs of subcortical fluid accumulation. Choroidal hypertrophy was seen in all affected eyes, with significant expansion of the great vascular layer and compression of the middle vascular layer and capillary layer. In 8 eyes treated with half-dose PDT, 6 eyes were ineffective at 3 months after treatment. The treatment was effective in 2 eyes. In 7 eyes that did not receive half-dose PDT, CMD structure did not improve significantly after 2 years of follow-up. The visual acuity decreased with the prolongation of the disease.Conclusions:CMD is more common in cCSC with a long course of disease, which has significant effects on vision and poor prognosis. Fundus color photography shows that the reflection in the macular area of the pole is weakened or disappeared, which may be combined with macular abnormal pigmentation. IR and AF examination show uneven fluorescence in macular area. The green signal in macular area is not uniform according to MC inspection. FFA shows strong fluorescence caused by diffuse permeable fluorescence and fluorescein leakage in active lesions. OCT examination shows that multiple small sacs or connections between sacs were broken and fused, and RPE atrophied to varying degrees.

Objective:To observe the clinical features of collateral circulation in different types of retinal vein occlusion.Methods:A retrospective clinical study. A total of 360 patients with monocular retinal vein occlusion diagnosed by ophthalmic examination in Department of Ophthalmology of Yunnan University Affiliated Hospital from December 2021 to December 2023 were included in the study. Among them, 157 males had 157 eyes and 203 females had 203 eyes. Age were (61.0±5.9) years. The duration of the disease from the onset of symptoms to the time of treatment was 3 days to 6 months. Macular branch vein occlusion (MBRVO), retinal branch vein occlusion (BRVO) and central retinal vein occlusion (CRVO) were observed in 67, 187 and 106 eyes, respectively. 210 eyes were with macular edema. All patients with macular edema were treated with anti-vascular endothelial growth factor (VEGF) by intravitreal injection. All eyes were examined by scanning source optical coherence tomography. The incidence, location, morphological characteristics, formation time of retinal collateral circulation and the effect of anti-VEGF drug on the formation of collateral circulation were observed. A short circuit in which blood vessels originating from the optic disc in the form of a blood loop return to the optic disc after the disc has been deformed for some time is defined as a short-circuited collateral circulation of the ciliary vessels of the optic disc.Results:After 1 week of disease course, MBRVO and collateral circulation of BRVO affected eye were established. By 1 to 2 months, a relatively abundant and stable collateral circulation had been established. In the course of 2 to 3 months, the short-circuit collateral circulation of ciliary vessels in the optic disc of the affected eye gradually formed. At 6 months, collateral circulation was established in 36 eyes (53.7%, 36/67) in 67 MBRVO patients. Collateral circulation was observed in 187 eyes of BRVO patients (100.0%, 187/187). In 106 eyes with CRVO, collateral circulation was established in 29 eyes (18.1%, 29/106). In 36 eyes with MBRVO, collateral circulation was established at the vertical horizontal slit between the blocked area and the non-blocked area. In 187 eyes of BRVO patients, collateral circulation was established in the vertical horizontal slit between the blocked and non-blocked areas in 102 eyes; 54 eyes were blocked the most central bypass to the collateral circulation on normal blood vessels. The collateral circulation of 19 eyes was established through nasal and temporal side. Collateral circulation through the fovea was established in 12 eyes. Its morphology is straight out of shape, spiral sinuous and flower cluster. CRVO established collateral circulation in 29 eyes, all of which had short-circuit collateral circulation of ciliary vessels. In 210 eyes treated with anti-VEGF drugs, collateral circulation was established in 160 eyes. Among them, 32 eyes were MBRVO (50.7%, 32/63), BRVO 119 eyes (100.0%, 119/119), CRVO 9 eyes (32.1%, 9/28).Conclusions:The incidence of collateral circulation of MBRVO, BRVO and CRVO is 53.7%, 100.0% and 18.1%, respectively. The forms of MBRVO were varied and the course of disease is about 2 months. Anti-VEGF therapy did not inhibit the establishment of collateral circulation.

Objective To summarize the common traditional Chinese medicine(TCM)syndrome types and syndrome characteristics of depressive disorder(DD)by analyzing the existing clinical research literature,and to provide a basis for TCM syndrome classification and research on DD.Methods The documents related to TCM syndrome classification of DD were retrieved systematically from China National Knowledge Infrastructure(CNKI),China Biology Medicine Literature Service System(SinoMed),China Science and Technology Journal Database(VIP)and China Academic Journals Full-text Database(WanFang).The literature was organized and analyzed,and Gephi software was used to do the visual analysis.Results A total of 262 literature that met the criteria were included in the study.The annual average number of publications exceeds 10 articles since 2010.The top 5 syndrome types in TCM were Liver Qi Stagnation(LQS)type,Liver Stagnation and Spleen Deficiency(LSSD)type,Heart and Spleen Deficiency(HSD)type,Liver Stagnation and Phlegm Obstruction type and Liver Stagnation and Kidney Deficiency type,viscera syndrome classification mainly involved Liver,Spleen,Heart,Kidney and Gallbladder.The main syndrome type based on deficiency-excess syndrome classification was excess type.The strongest correlation of excess type was LQS,the strongest correlation of deficiency types was HSD,and the strongest correlation of deficiency and excess mixed syndrome type was LSSD.Conclusion The publication volume of literature related to TCM syndrome types of DD shows a fluctuating upward trend.The occurrence and development of DD are related to dysfunction of multiple organs,and liver stagnation is the core syndrome,which may run through the entire process of DD.

OBJECTIVES: Shelter hospital was an alternative way to provide large-scale medical isolation and treatment for people with mild coronavirus disease 2019 (COVID-19). Due to various reasons, patients admitted to the large shelter hospital was reported high level of psychological distress, so did the healthcare workers. This study aims to introduce a comprehensive and multifaceted psychosocial crisis intervention model. METHODS: The psychosocial crisis intervention model was provided to 200 patients and 240 healthcare workers in Wuhan Wuchang shelter hospital. Patient volunteers and organized peer support, client-centered culturally sensitive supportive care, timely delivery of scientific information about COVID-19 and its complications, mental health knowledge acquisition of non-psychiatric healthcare workers, group activities, counseling and education, virtualization of psychological intervention, consultation and liaison were exhibited respectively in the model. Pre-service survey was done in 38 patients and 49 healthcare workers using the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Patient Health Questionnaire 2-item (PHQ-2) scale, and the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (PC-PTSD-5). Forty-eight healthcare workers gave feedback after the intervention. RESULTS: The psychosocial crisis intervention model was successfully implemented by 10 mental health professionals and was well-accepted by both patients and healthcare workers in the shelter hospital. In pre-service survey, 15.8% of 38 patients were with anxiety, 55.3% were with stress, and 15.8% were with depression; 16.3% of 49 healthcare workers were with anxiety, 26.5% were with stress, and 22.4% were with depression. In post-service survey, 62.5% of 48 healthcare workers thought it was very practical, 37.5% thought more practical; 37.5% of them thought it was very helpful to relief anxiety and insomnia, and 27.1% thought much helpful; 37.5% of them thought it was very helpful to recognize patients with anxiety and insomnia, and 29.2% thought much helpful; 35.4% of them thought it was very helpful to deal with patients' anxiety and insomnia, and 37.5% thought much helpful. CONCLUSIONS Psychological crisis intervention is feasible, acceptable, and associated with positive outcomes. Future tastings of this model in larger population and different settings are warranted.
Humans ; COVID-19 ; Sleep Initiation and Maintenance Disorders ; Crisis Intervention ; Psychosocial Intervention ; SARS-CoV-2 ; Mental Health ; Depression/epidemiology* ; Health Personnel/psychology* ; Anxiety/etiology*

Steroid saponins are secondary metabolites with multiple medicinal values that are found in large quantities in natural medicines, especially Vernonia amygdalina, a famous nature medicine for the treatment of tonsillitis, diabetes, pneumonia. The current study was designed to combine molecular networking (MN) with diagnostic ions for rapid identification of Δ^7,9(11) stigmastane-type saponins which were the α-glucosidase inhibitory active substances in V. amygdalina. First, the α-glucosidase inhibitory activities of five Δ^7,9(11) stigmastane-type steroid saponins that were previously isolated were screened, which indicated that the Δ^7,9(11) stigmastane-type steroid saponin was one of the active constituents responsible for ameliorating diabetes. Furthermore, a strategy was proposed to identify stigmastane-type steroid saponins and verify the plausibility of derived fragmentation pathways by applying MN, MolNetEnhancer and unsupervised substructure annotation (MS2LDA). Based on this strategy, other seven Δ^7,9(11) stigmastane-type steroid saponins were identified from this plant. Our research provide scientific evidence for the antidiabetic potential of the steroid saponin-rich extract of V. amygdalina leaf.
alpha-Glucosidases/metabolism* ; Vernonia/chemistry* ; Plant Extracts/chemistry* ; Plant Leaves/chemistry* ; Saponins/chemistry* ; Steroids/chemistry* ; Diabetes Mellitus

欧阳洋，李娟娟，涂毅，孙圣荣（武汉大学人民医院 乳腺甲状腺外科，湖北 武汉 430060） [摘 要] 目的：借助多种癌症生物信息数据库研究乳腺癌组织中缺氧诱导因子1亚基α（HIF1A）的表达水平及其与乳腺癌患者预后及肿瘤免疫细胞浸润的关系。方法：利用Oncomine、人类蛋白质图谱、基因表达谱交互式分析（GEPIA）及TCGA数据库分析HIF1A基因在乳腺癌组织中的表达及其与患者预后、临床病理特征的关系，并在中国人乳腺癌组织标本（选用2011年1月至2015年12月中国武汉大学人民医院手术切除的93例乳腺癌组织和14例良性乳腺疾病组织）中进行验证。对HIF1A高低表达组间的差异基因进行基因本体（GO）和京都基因与基因组百科全书（KEGG）富集分析，用Cibersort R软件评估HIF1A高低表达样本中免疫细胞浸润丰度差异。结果：生物信息数据显示，HIF1A在乳腺癌组织中高表达，预示着患者DFS预后更好（P<0.05）。HIF1A的表达与雌激素受体（ERP）、孕激素受体（PR）和人表皮生长因子受体2（HER2）表达相关（均P<0.05）。GO生物功能及KEGG通路富集分析结果提示，HIF1A可能参与肿瘤免疫调节等生物活动。使用Cibersort分析结果显示，HIF1A与肿瘤免疫细胞浸润之间具有相关性（均P<0.01），发现活化记忆CD4 + T细胞、M0和M1型巨噬细胞与HIF1A表达呈正相关，在乳腺癌组织中高表达，Treg细胞、活化NK细胞、M2型巨噬细胞与HIF1A表达呈负相关（均P<0.01）。结论：HIF1A参与调节肿瘤微环境的免疫活性，与乳腺癌患者DFS相关，其可能成为乳腺癌分级诊断、免疫治疗和预后判断的生物标志物。

Lower limb ankle exoskeletons have been used to improve walking efficiency and assist the elderly and patients with motor dysfunction in daily activities or rehabilitation training, while the assistance patterns may influence the wearer's lower limb muscle activities and coordination patterns. In this paper, we aim to evaluate the effects of different ankle exoskeleton assistance patterns on wearer's lower limb muscle activities and coordination patterns. A tethered ankle exoskeleton with nine assistance patterns that combined with differenet actuation timing values and torque magnitude levels was used to assist human walking. Lower limb muscle surface electromyography signals were collected from 7 participants walking on a treadmill at a speed of 1.25 m/s. Results showed that the soleus muscle activities were significantly reduced during assisted walking. In one assistance pattern with peak time in 49% of stride and peak torque at 0.7 N·m/kg, the soleus muscle activity was decreased by (38.5 ± 10.8)%. Compared with actuation timing, the assistance torque magnitude had a more significant influence on soleus muscle activity. In all assistance patterns, the eight lower limb muscle activities could be decomposed to five basic muscle synergies. The muscle synergies changed little under assistance with appropriate actuation timing and torque magnitude. Besides, co-contraction indexs of soleus and tibialis anterior, rectus femoris and semitendinosus under exoskeleton assistance were higher than normal walking. Our results are expected to help to understand how healthy wearers adjust their neuromuscular control mechanisms to adapt to different exoskeleton assistance patterns, and provide reference to select appropriate assistance to improve walking efficiency.
Aged ; Ankle/physiology* ; Ankle Joint/physiology* ; Biomechanical Phenomena/physiology* ; Electromyography ; Exoskeleton Device ; Gait/physiology* ; Humans ; Muscle Contraction ; Muscle, Skeletal/physiology* ; Walking/physiology*

Objective To evaluate the clinical value of thyroid cancer gene detection and its joint diagnos-tic model in early diagnosis of thyroid nodule. Methods Retrospective study was used to analyze 61 cases of thy-roid nodules. These cases were divided into benign nodules and malignant nodules according to the pathology out-comes. We evaluated the AUC,sensitivity and specificity of preoperative fine needle aspiration biopsy(FNAB), thyroid cancer gene detection and color ultrasonography feature in the early diagnosis of thyroid nodule through lo-gistic regression analysis and ROC working curve. Results Among the 61 patients with thyroid nodules,there were 31 cases of benign thyroid nodules and 30 cases of malignant nodules.Diagnostic indexes significantly related with thyroid nodules and their AUC were listed as following:cancer gene detection 0.915(95% CI:0.814-0.971), FNAB 0.813(95% CI:0.691-0.902),low echo 0.657(95% CI:0.523-0.775),size of nodules 0.623(95% CI:0.488-0.745),joint diagnostic model respectively 0.957(95%CI:0.871-0.993). The value of joint diagnosis was the highest,whose sensitivity was 93.1% and the specificity was 90.3%.Conclusion Preoperative cancer gene de-tection joint FNAB and color ultra-sonography will improve the detection rate of thyroid cancer and reduce unneces-sary operation.

OBJECTIVE:To investigate the occurrence of ADR induced by over-the-counter(OTC)drug in order to guide the rational use of drugs. METHODS:45 cases of ADR induced by OTC drug were analyzed retrospectively in terms of patient's gen-eral information,allergic history,allergenic drugs,reason for drug use,route of administration,incubation period,days of hospi-talization,clinical manifestation,treatment,outcome,etc. RESULTS:Among 45 patients,there were 14 male and 31 female. The patients were mainly 20-30 year-old(31.1%). Three patients had previous history of allergy(6.7%). Most ADR were induced by oral drugs(82.2%). Reasons for drug use were mainly disease of respiratory system(23 cases,51.1%). The results of causality as-sessment were positive in 3 patients(6.7%),probable in 35(n=77.8%),and possible in 7 patients(15.6%). ADR were mainly induced by non-steroidal anti-inflammatory drugs (NSAIDs,57.8%),Chinese patent medicine (20.0%),drugs for external use (17.8%). The clinical manifestations mainly included exanthematous drug eruption (33.3%),erythama multiforme drug eruption (24.4%),urticarial drug eruption(13.3%). CONCLUSIONS:NSAIDs are the main allergenic drugs,and ADR induced by OTC traditional Chinese medicine can not be ignored. To improve medical knowledge and skills of the public and the scientific use of OTC drug are beneficial to improve the clinical treatment level.

Objective To evaluate the effects of multiple exposures to sevoflurane anesthesia on the expression of apolipoprotein E (ApoE) in the hippocampus of neonatal rats.Methods Twenty-four pathogen-free Sprague-Dawley rats (12 males,12 females),aged 7 days,weighing 15-20 g,were randomly divided into 2 groups (n=12 each) using a random number table:control group (group Con) and multiple exposures to sevoflurane anesthesia group (group Sev).On postnatal day 7,14 and 21,2.6％ sevoflurane was inhaled for 2 h in group Sev,while the mixed gas of oxygen and air was inhaled instead of sevoflurane in group Con.Morris water maze test was carried out on postnatal day 31-37 to assess cognitive function.The rats were then sacrificed,and the hippocampus was removed to determine the expression of ApoE protein in hippocampal CA1,CA3 and DG regions (by immunohistochemistry) and the expression of ApoE mRNA (by fluorescent quantitative real-time reverse transcriptase polymerase chain reaction).Results There was no significant difference between the two groups in cognitive function (P＞0.05).Compared with group Con,the expression of ApoE protein in hippocampal CA1 and CA3 regions and ApoE mRNA was significantly up-regulated in group Sev (P＜0.05),and no statistically significant change was found in the expression of ApoE protein in hippocampal DG region in group Sev (P＞0.05).Conclusion Multipie exposures to sevoflurane anesthesia can up-regulate the expression of hippocampal ApoE and produce mild neurotoxicity without causing changes in cognitive function in neonatal rats.