Diabetic retinopathy is a common blinding complication in diabetic patients. Compared with conventional fundus color photography, fundus fluorescein angiography can dynamically display retinal vessel permeability changes, offering unique advantages in detecting early small lesions such as microaneurysms. However, existing intelligent diagnostic research on diabetic retinopathy images primarily focuses on fundus color photography, with relatively insufficient research on complex lesion recognition in fluorescein angiography images. This study proposed an adaptive multi-label classification model (D-LAM) to improve the recognition accuracy of small lesions by constructing a category-adaptive mapping module, a label-specific decoding module, and an innovative loss function. Experimental results on a self-built dataset demonstrated that the model achieved a mean average precision of 96.27%, a category F1-score of 91.21%, and an overall F1-score of 94.58%, with particularly outstanding performance in recognizing small lesions such as microaneurysms (AP = 1.00), significantly outperforming existing methods. The research provides reliable technical support for clinical diagnosis of diabetic retinopathy based on fluorescein angiography.
Diabetic Retinopathy/diagnostic imaging* ; Humans ; Fluorescein Angiography ; Microaneurysm/diagnostic imaging* ; Retinal Vessels ; Algorithms

This study was aimed at exploring the mechanism underlying the effects of nitidine chloride against Talaromyces marnef-fei through network pharmacology analysis.We collected NC and TM action targets from various databases;constructed a protein-protein interaction(PPI)network by using common drug and disease targets;and performed KEGG pathway and GO enrichment analy-ses.In vitro cellular experiments were conducted to test the antibacterial ability of NC at various concentrations,qPCR was used to de-tect the mRNA expression of genes in the target pathway,and WB was used to examine the expression of proteins associated with tar-get signaling pathways in cells.We identified 153 target genes for NC and 2 095 target genes for TM,among which 23 targets over-lapped.By integrating the PPI network with KEGG enrichment analysis,we selected key target genes in the MAPK signaling pathway,such as FLT1,FLT3,CD38,and PRF1.The CFU results indicated that NC had favorable antibacterial capability.Moreover,qPCR demonstrated that NC downregulated the mRNA expression of FLT1,FLT3,and RPS6KA3,and upregulated the mRNA expression of MAP3K8.WB findings indicated that NC downregulated the expression of RSK2,VEGF,and FLT3 proteins,and upregulated the ex-pression of MAP3K8 protein.NC may exert its anti-TM effects by downregulating the expression of RSK2,VEGF,and FLT3 proteins,thereby inhibiting MAPK pathway activation.The potential targets and signaling pathways underlying NC's anti-TM action may pro-vide new insights to guide the clinical application of NC.

This study was aimed at exploring the mechanism underlying the effects of nitidine chloride against Talaromyces marnef-fei through network pharmacology analysis.We collected NC and TM action targets from various databases;constructed a protein-protein interaction(PPI)network by using common drug and disease targets;and performed KEGG pathway and GO enrichment analy-ses.In vitro cellular experiments were conducted to test the antibacterial ability of NC at various concentrations,qPCR was used to de-tect the mRNA expression of genes in the target pathway,and WB was used to examine the expression of proteins associated with tar-get signaling pathways in cells.We identified 153 target genes for NC and 2 095 target genes for TM,among which 23 targets over-lapped.By integrating the PPI network with KEGG enrichment analysis,we selected key target genes in the MAPK signaling pathway,such as FLT1,FLT3,CD38,and PRF1.The CFU results indicated that NC had favorable antibacterial capability.Moreover,qPCR demonstrated that NC downregulated the mRNA expression of FLT1,FLT3,and RPS6KA3,and upregulated the mRNA expression of MAP3K8.WB findings indicated that NC downregulated the expression of RSK2,VEGF,and FLT3 proteins,and upregulated the ex-pression of MAP3K8 protein.NC may exert its anti-TM effects by downregulating the expression of RSK2,VEGF,and FLT3 proteins,thereby inhibiting MAPK pathway activation.The potential targets and signaling pathways underlying NC's anti-TM action may pro-vide new insights to guide the clinical application of NC.

Objective:To evaluate the feasibility of using a fully automated iodine analyzer to measure urinary iodine.Methods:A fully automated iodine analyzer was used to determine the urinary iodine content, a methodological evaluation was conducted on the linear relationship, detection limit, precision, and accuracy (urinary iodine standard substances GBW109m, GBW110e within the range of 0 - 300 μg/L, and GBW111m, GBW112h within the range of 300 - 1 200 μg/L) of the standard curve within the ranged from 0 to 1 200 μg/L (low concentration standard series: 0 - 300 μg/L, high concentration standard series: 300 - 1 200 μg/L). A method comparison experiment with the manual measurement results of arsenic cerium catalytic spectrophotometry was conducted.Results:The fully automated iodine analyzer had a good linear relationship for the determination of urinary iodine within the standard curve ranges of 0 - 1 200 μg/L, with│ r│ > 0.999 0; the minimum detection limit was 3.17 μg/L. Among them, the coefficients of variation for low, medium, and high concentrations of urinary iodine standard substances in the range of 0 - 300 μg/L were 6.79%, 2.53% and 1.20%, respectively; and the recovery rate ranged from 94.8% to 101.2%. The coefficients of variation for low and high concentrations of urinary iodine standard substances within the range of 300 - 1 200 μg/L were 1.21% and 1.62%, respectively; and the recovery rate ranged from 100.6% to 105.1%. The determination results of urinary iodine standard substances GBW109m, GBW110e, GBW111m, and GBW112h were all within the given standard value ± uncertainty range [(69.7 ± 9.0), (210 ± 15), (574 ± 17), (794 ± 28) μg/L]. There was no statistically significant difference between the results obtained by using a fully automated iodine analyzer and the manual measurement results of arsenic cerium catalytic spectrophotometry ( P > 0.05). Conclusion:The fully automated iodine analyzer detection method can be fully automated, with simple and time-saving operation, high system accuracy, and good precision, suitable for large-scale urine iodine sample detection.

Objective:To evaluate the feasibility of using a fully automated iodine analyzer to measure urinary iodine.Methods:A fully automated iodine analyzer was used to determine the urinary iodine content, a methodological evaluation was conducted on the linear relationship, detection limit, precision, and accuracy (urinary iodine standard substances GBW109m, GBW110e within the range of 0 - 300 μg/L, and GBW111m, GBW112h within the range of 300 - 1 200 μg/L) of the standard curve within the ranged from 0 to 1 200 μg/L (low concentration standard series: 0 - 300 μg/L, high concentration standard series: 300 - 1 200 μg/L). A method comparison experiment with the manual measurement results of arsenic cerium catalytic spectrophotometry was conducted.Results:The fully automated iodine analyzer had a good linear relationship for the determination of urinary iodine within the standard curve ranges of 0 - 1 200 μg/L, with│ r│ > 0.999 0; the minimum detection limit was 3.17 μg/L. Among them, the coefficients of variation for low, medium, and high concentrations of urinary iodine standard substances in the range of 0 - 300 μg/L were 6.79%, 2.53% and 1.20%, respectively; and the recovery rate ranged from 94.8% to 101.2%. The coefficients of variation for low and high concentrations of urinary iodine standard substances within the range of 300 - 1 200 μg/L were 1.21% and 1.62%, respectively; and the recovery rate ranged from 100.6% to 105.1%. The determination results of urinary iodine standard substances GBW109m, GBW110e, GBW111m, and GBW112h were all within the given standard value ± uncertainty range [(69.7 ± 9.0), (210 ± 15), (574 ± 17), (794 ± 28) μg/L]. There was no statistically significant difference between the results obtained by using a fully automated iodine analyzer and the manual measurement results of arsenic cerium catalytic spectrophotometry ( P > 0.05). Conclusion:The fully automated iodine analyzer detection method can be fully automated, with simple and time-saving operation, high system accuracy, and good precision, suitable for large-scale urine iodine sample detection.

Objective:To study the clinicopathological characteristics, treatment and prognosis in lupus nephritis (LN) patients with renal thrombotic microangiopathy (TMA), so as to provide more theoretical basis for clinicians to recognize and treat this disease.Methods:The clinical data of LN patients who underwent renal biopsy in the First Affiliated Hospital of Zhengzhou University from January 1, 2012 to May 31, 2019 were retrospectively collected and analyzed. According to renal clinicopathological examination, the patients were divided into renal TMA group and non-renal TMA group. The clinical data, laboratory examination, renal pathological examination, therapeutic measures and prognostic between the two groups were compared. Follow-up end points were defined as composite ends, including all-cause death, entry into end-stage renal disease, and estimated glomerular filtration rate decrease>50% of baseline. Kaplan-Meier survival curve and log-rank test were used to compare the difference of survival rate between the two groups, and multivariate Cox regression equation was used to analyze the risk factors of endpoint events in LN patients.Results:A total of 1 133 patients with LN were enrolled in this study. Patients with renal TMA were more likely to have hypertension ( χ2=16.310, P<0.001), higher baseline serum creatinine ( Z=-6.918, P<0.001) and 24-hour urine protein ( Z=-2.232, P=0.026), and higher renal pathology activity index (AI) score ( Z=1.957, P=0.001)and chronic index (CI) score ( Z=1.836, P=0.002). The proportions of hormone shock ( P<0.001) and plasma exchange ( P<0.001) in the renal TMA group were higher than those in non-renal TMA group. After treatment of (12±2) months, patients in the renal TMA group had a lower complete response rate ( χ2=10.455, P=0.001) and a higher non-response rate ( χ2=6.047, P=0.014) than those in non-renal TMA group, and were associated with worse prognosis (Log-rank test χ2=26.490, P<0.001). Renal TMA was an independent risk factor for poor prognosis ( HR=2.347, 95% CI 1.210-4.553, P=0.012). Conclusions:Compared with LN patients without renal TMA, LN patients with renal TMA are more likely to have hypertension, with higher serum creatinine, 24-hour urinary protein, AI and CI, suggesting poorer treatment response and renal prognosis. Moreover, renal TMA is an independent risk factor for poor prognosis in patients with LN.

ObjectiveTo explore the relationship between snoring and hypertension in middle-aged and elderly residents in Yangpu District， Shanghai. MethodsThe data of this study were obtained from the project of “early screening and comprehensive intervention for high-risk of cardiovascular diseases” carried out by the National Cardiovascular Disease Center in Yangpu District in 2017. Questionnaire survey， physical examination and laboratory test were conducted among permanent residents aged 35‒75 years. Logistic regression model was used to analyze the influence of sleep snoring on hypertension. ResultsA total of 11 100 people with complete data were included in the analysis， The self-reported snoring rate of male was significantly higher than female （48.12% vs 36.21%， χ²=137.70， P<0.01）. The proportion of self-reported occasional snoring， frequent snoring and daily snoring were 14.67%（1 628/11 100）， 7.59%（843/11 100） and 17.50% （1 943/11 100）， respectively， and the prevalence of hypertension gradually increased with the increase of snoring frequency （≤60 years，male： χtrend2=51.83，P<0.01；female： χtrend2=95.01， P<0.01； >60 years， male： χtrend2=9.22， P<0.01； female： χtrend2=27.10， P<0.01）. Multivariate logistic regression analysis showed that in people aged ≤60 years， both men and women， snoring frequency was significantly associated with hypertension after adjusting for education， total family income， smoking， alcohol consumption， diabetes， body mass index （BMI） and waist circumference. In the males： occasional snoring OR （95%CI） was 1.95 （1.36，2.80）， frequent snoring OR （95%CI） was 1.55 （1.04，2.31）， daily snoring OR （95%CI） was 1.92 （1.43，2.59）. In the females： occasional snoring OR （95%CI） was 1.31 （1.08，1.59）， frequent snoring OR （95%CI） was 1.41 （1.07，1.88）， daily snoring OR （95%CI） was 1.63 （1.32，2.00）. But in people aged >60 years， the significant association between snoring frequencies and hypertension did not exist， after adjusting for education， total family income， smoking， alcohol consumption， diabetes， BMI and waist circumference. In the males： occasional snoring OR （95%CI） was 1.31 （0.97，1.78）， frequent snoring OR （95%CI） was 1.22 （0.87，1.73）， daily snoring OR （95%CI） was 1.19 （0.94，1.73）. In the females： occasional snoring OR （95%CI） was 1.06 （0.87，1.29）， frequent snoring OR （95%CI） was 1.30 （0.99，1.72）， daily snoring OR （95%CI） was 1.19 （0.97，1.46）. ConclusionIn people ≤60 years old， snoring is significantly associated with hypertension， so more attention should be paid to sleep snoring monitoring in middle-aged people for early detection of hypertension.

Objective:To explore the effect of scenario simulation nursing in fundus fluorescein angiography (FFA) examination of preschool children.Methods:From January 2017 to March 2021, 98 preschool children who underwent FFA examination in the Fluorescence Contrast Room of Shanxi Eye Hospital were selected as the research object. Children from 2017 to December 2018 were in the control group with routine nursing, and children from January 2019 to March 2021 were in the experimental group with scenario simulation nursing. The incidence of adverse reactions and satisfaction with cooperation were compared between the two groups of children.Results:The incidence of adverse reactions in children in the experimental group was 2.00%, which was lower than 16.67% in children in the control group. The satisfaction with cooperation in the experimental group was 94.0%, which was higher than 79.2% in the control group. The differences were all statistically significant ( P<0.05) . Conclusions:The application of scenario simulation nursing in FFA examination of preschool children can effectively reduce the incidence of adverse reactions in children and improve the satisfaction of children with cooperation during the examination.

Objective: To investigate the clinical value of laparoscopic peritoneal dialysis catheter implantation in peritoneal chemotherapy for gastric cancer with peritoneal metastasis. Methods: From January 2019 to June 2019, the clinical data of 6 patients diagnosed as gastric cancer with peritoneal metastasis were retrospectively analyzed in the Gastrointestinal Surgery Department of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine. Five were male and 1 was female. The median age was 69.5 (28-77) years. The median body mass index (BMI) was 22.8 (19.6-23.5). All procedures were performed under general anesthesia with endotracheal intubation. The patient′s body position and facility layout in the operating room were consistent with those of laparoscopic gastrectomy. The operator′s position: the main surgeon was located on the right side of the patient, the first assistant stood on the left side of the patient, and the scopist stood between the patient′s legs. Surgical procedure: (1) trocar location: three abdominal trocars was adopted, with one 12 mm umbilical port for the 30° laparoscope (point A). Location of the other two trocars was dependent on the procedure of exploration or biopsy as well as the two polyester cuff position of the peritoneal dialysis catheter: Usually one 5 mm port in the anterior midline 5 cm inferior to the umbilicus point was selected as point B to ensure that the distal end of the catheter could reach the Douglas pouch. The other 5 mm port was located in the right lower quadrant lateral to the umbilicus to establish the subcutaneous tunnel tract, and the proximal cuff was situated 2 cm away from the desired exit site (point C).(2) exploration of the abdominal cavity: a 30° laparoscope was inserted from 12 mm trocar below the umbilicus to explore the entire peritoneal cavity. The uterus and adnexa should be explored additionally for women. Once peritoneal metastasis was investigated and identified, primary laparoscopic peritoneal dialysis catheter implantation was performed so as to facilitate subsequent peritoneal chemotherapy. Ascites were collected for cytology in patients with ascites. (3) peritoneal dialysis catheter placement: the peritoneal dialysis catheter was introduced into the abdominal cavity from point A. Under the direct vision of laparoscopy, 2-0 absorbable ligature was reserved at the expected fixation point of the proximal cuff (point B) for the final knot closure. Non-traumatic graspers were used to pull the distal cuff of peritoneal dialysis catheter out of the abdominal cavity through point B. The 5-mm trocar was removed simultaneously, and the distal cuff was fixed between bilateral rectus sheaths at the anterior midline port site preperitoneally. To prevent subsequent ascites and chemotherapy fluid extravasation, the reserved crocheted wire was knotted. From point C the subcutaneous tunnel tract was created before the peritoneal steath towards the port site lateral to the umbilicus. Satisfactory catheter irrigation and outflow were then confirmed. Chemotherapy regimen after peritoneal dialysis catheterization: all patients began intraperitoneal chemotherapy on the second day after surgery. On the 1st and 8th day of each 3-weeks cycle, paclitaxel (20 mg/m²) was administered through peritoneal dialysis catheter, and paclitaxel (50 mg/m²) was injected intravenously. Meanwhile, S-1 was orally administered twice daily at a dose of 80 mg·m^-2·d^-1 for 14 consecutive days followed by 7-days rest. To observe the patients′ intraoperative and postoperative conditions. Results: All the procedures were performed successfully without intraoperative complications or conversion to laparotomy. No 30 day postoperative complications were observed. The median operative time was 33.5 (23-38) min. The median time to first flatus was 1(1-2) days, and the median postoperative hospital stay was 3 (3-4) days, without short-term complications within 30 days postoperatively. The last follow-up was up to July 10, 2019, and the patients were followed for 4(1-6) months. No ascites extravasation was observed and no death occurred in the 6 patients. There was no catheter obstruction or peritoneal fluid extravasation during and after chemotherapy. Conclusion Laparoscopic peritoneal dialysis catheter implantation was safe and feasible for patients with peritoneal metastasis of gastric cancer. The abdominal exploration, tumor staging and the abdominal chemotherapy device implantation can be completed simultaneously, which could simplify the surgical approach, improve the quality of life for patients and further propose a new direction for the development of abdominal chemotherapy.

Understanding the effect of immunosuppressive agents on intestinal microbiota is important to reduce the mortality and morbidity from orthotopic liver transplantation (OLT). We investigated the relationship between the commonly used immunosuppressive agent cyclosporine A (CSA) and the intestinal microbial variation in an OLT model. The rat samples were divided as follows: (1) N group (normal control); (2) I group (isograft LT, Brown Norway [BN] rat to BN); (3) R group (allograft LT, Lewis to BN rat); and (4) CSA group (R group treated with CSA). The intestinal microbiota was assayed by denaturing gradient gel electrophoresis profiles and by using real-time polymerase chain reaction. The liver histopathology and the alanine/aspartate aminotransferase ratio after LT were both ameliorated by CSA. In the CSA group, the numbers of rDNA gene copies of Clostridium cluster I, Clostridium cluster XIV, and Enterobacteriaceae decreased, whereas those of Faecalibacterium prausnitzii increased compared with the R group. Cluster analysis indicated that the samples from the N, I, and CSA groups were clustered, whereas the other clusters contained the samples from the R group. Hence, CSA ameliorates hepatic graft injury and partially restores gut microbiota following LT, and these may benefit hepatic graft rejection.