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

Objective:To analyze the clinical characteristics of patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR), and to explore the risk factors leading to poor prognosis.Methods:The clinical data of 95 patients with ECPR admitted to the First Affiliated Hospital of Zhengzhou University from January 2020 to May 2023 were retrospectively analyzed. According to the survival status at the time of discharge, the patients were divided into the survival group and death group. The difference of clinical data between the two groups was compared to explore the risk factors related to death and poor prognosis. Risk factors associated with death were identified by Binary Logistic regression analysis. Results:A total of 95 patients with ECPR were included in this study, 62 (65.3%) died and 33 (34.7%) survived at discharge. Patients in the death group had longer low blood flow time [40 (30, 52.5) min vs. 30 (24.5, 40) min ] and total cardiac arrest time[40 (30, 52.5) min vs. 30(24.5, 40) min], shorter total hospital stay [3 (2, 7.25) d vs. 19 (13.5, 31) d] and extracorporeal membrane oxygenation (ECMO) assisted time [26.5 (17, 50) h vs. 62 (44, 80.5) h], and more IHCA patients (56.5% vs. 33.3%) and less had spontaneous rhythm recovery before ECMO (37.1% vs. 84.8%). Initial lactate value [(14.008 ± 5.188) mmol/L vs.(11.23 ± 4.718) mmol/L], APACHEⅡ score [(30.10 ± 7.45) vs. (25.88 ± 7.68)] and SOFA score [12 (10.75, 16) vs. 10 (9.5, 13)] were higher ( P< 0.05). Conclusions:No spontaneous rhythm recovery before ECMO, high initial lactic acid and high SOFA score are independent risk factors for poor prognosis in ECPR patients.

Objective To observe the effects of Guanxinning tablet on atherosclerotic plaque,renal function,hemorheology,blood homocysteine(Hcy)and immunoinflammation in patients with blood stasis type chronic renal failure complicated by hemodialysis and carotid atherosclerosis.Methods According to the diagnosis,inclusion and exclusion criteria,67 patients with blood stasis type chronic renal failure complicated with carotid atherosclerosis and undergoing hemodialysis from Lishui Second People's Hospital and Lishui Hospital of Traditional Chinese Medicine from January 2023 to January 2024 were selected and randomly divided into control group(33 cases)and observation group(34 cases).The control group received routine treatment of chronic renal failure and hemodialysis.In the observation group,Guanxinning tablet was added to the basic treatment,and the levels of carotid atherosclerotic plaque,renal function,hemorheology,blood Hcy and immunoinflammation were detected in both groups before and after treatment.Results There were no significant differences in general information,carotid atherosclerotic plaque,renal function,hemorheology,blood Hcy level and immunoinflammation level between the two groups before treatment(P>0.05).After treatment,the observation group was superior to the control group in reducing carotid plaque,improving carotid intimedia thickening,improving renal function,reducing inflammatory index level and improving immune function(P<0.05),but there was no significant difference in reducing blood Hcy level compared with the control group(P>0.05).Conclusion Guanxinning tablet can improve the chronic inflammation in the body of patients with blood stasis type chronic renal failure combined with hemodialysis and carotid atherosclerosis,reduce blood viscosity,inhibit red blood cell aggregation,thereby improving carotid atherosclerosis,reducing carotid atherosclerotic plaque,improving renal function and improving immune function of patients,but does not reduce blood Hcy level.

Objective:To evaluate the effectiveness of left ventricular assist device (LVAD)implantation via minimally invasive thoracotomy.Methods:From April 2022 to October 2023, we retrospectively collected and analyzed the perioperative data of 16 patients underwent LVAD via minimally invasive thoracotomy in our institute. 16 patients included 10 males and 6 females, the mean age was(58.6±7.6)(49-76)years old, BSA was (1.75±0.90)(1.35-2.01)m 2, 6 cases of dilated cardiomyopathy (DCM), 8 cases of ischemic cardiomyopathy (ICM) and 2 cases of end-stage valvular heart disease. LVAD type included 8 cases of CH-VAD, 7 cases of HeartCon and 1 case of Corheart-6. All the 16 patients underwent LVAD implantation were performed in condition of CPB, 13 patients on-beating heart, 3 patients with heart arrest. The outflow graft of 15 patients were place at ascending aorta, 1 patient was descending aorta. Results:The average surgical time was about 5.09 h, CPB time was(137±32)min, and the mechanical ventilation time was (20.8±13.6)h, stay in the ICU was(10.0±6.3)days, and the length of stay was(45.4±17.0)days. No case transition to sternotomy, no case in right ventricular failure, and no death case during 30 days.Conclusion:Minimally invasive thoracotomy approach is a safe and reliable method for left ventricular assist devices implantation, and can be used as a choice for LVAD implantation.

Objective     To summarize the effectiveness of Bentall procedure through the right anterior mini-incision. Methods    The clinical data of patients who underwent Bentall via right anterior mini-incision from September 2020 to September 2021 in the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively analyzed. Results    A total of 14 males with an average age of 55.1±9.3 years and body mass index of 24.7±2.8 kg/m2 were enrolled. The cardiopulmonary bypass (CPB) time was 185.6±32.9 min, the aortic cross-clamping (ACC) time was 144.8±30.3 min, the ventilation time was 18.1±13.5 h, the time in the intensive care unit was 3.7±1.8 d, and the hospital stay time was 13.4±1.6 d. Postoperative complications occurred in 5 patients: 3 patients of pleural effusion, 1 patient of pericardial effusion and 1 patient of postoperative bleeding with secondary thoracotomy hemostasis. The median follow-up time was 4 (2, 6) months. There was no mortality in the hospital or during the follow-up. As for the learning curve, the ACC time, CPB time and operation time were significantly shortened after four cases (P<0.05). Conclusion    The right anterior mini-incision for Bentall operation is safe and effective, and has clinical value.

Objective:To identify and characterize one Spiroplasma strain (designated as DGKH1) isolated from the blood of a patient with sepsis. Methods:The traditional bacterial culture, staining, morphological observation, physiological and biochemical identification, 16S rRNA gene sequencing, phylogenetic analysis, genome sequencing, and the genome-related index analysis were performed to accurately determine the taxonomic status of the strain DGKH1. Antibiotic susceptibility testing was performed using a specific kit for culturing and testing Ureaplasma urealyticum/ Metamycoplasma hominis. Results:The strain DGKH1 could weakly grow on Columbia blood agar, chocolate agar, and Haemophilus chocolate 2 agar. However, it did not grow in liquid culture medium containing tetracycline (4 μg/ml), doxycycline (1 μg/ml), minocycline (1 μg/ml), josamycin (2 μg/ml), roxithromycin (1 μg/ml), clarithromycin (1 μg/ml), or telithromycin (1 μg/ml). DGKH1 resembling Metamycoplasma hominis formed "fried egg-like colonies" on Mycoplasma solid culture medium. DGKH1 could not be stained by Gram staining. When observed under transmission electron microscopy (TEM) using phosphate buffer as the matrix, the bacteria were spiral-shaped. Results of 16S rRNA gene sequence alignment showed that DGKH1 was highly similar (99.85%) to Spiroplasma eriocheiris CCTCC M 207170 T. However, the urea decomposition test was positive, which was different from all of the known Spiroplasma species. The phylogenetic analysis based on whole genome showed that DGKH1 was clustered in a small branch along with Spiroplasma eriocheiris CCTCC M 207170 T. However, the average nucleotide identity (ANI) and digital DNA-DNA hybridization (dDDH) values between the two strains were 94.14% and 56.00%, respectively, both below the threshold for prokaryotic species identification. Conclusions:DGKH1 represented a potential new species of genus Spiroplasma, closely related to Spiroplasma eriocheiris. Some microbiological characteristics of DGKH1 were similar to Mycoplasmas. However, the natural host and epidemiological data of DGKH1 need to be further studied.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death of urban and rural residents in China, and dyslipidemia is the most important pathogenic risk factor for the occurrence and development of ASCVD. Faced with the increasing ASCVD burden in China, there is an urgent need to improve the lipid management in China. Clinical blood lipid testing is an important component of lipid management, and the accurate test results are a fundamental requirement for effective lipid management. The "China guidelines for clinical lipid profile testing" and "China guidelines for lipid management (2023)" are newly published. With the continuous updating of concepts on clinical lipid profile testing and lipid management, it is essential to further strengthen the communication and cooperation between clinical medicine and laboratory medicine, widely promote and apply the new concepts of updated guidelines, in order to better guide clinical practice, comprehensively improve the level of clinical lipid profile testing and lipid management in China, and assist in the standardized prevention and treatment of ASCVD in China and the early arrival of the turning points.

Objective:To evaluate and compare the clinical efficacy and safety of three different medicated eye patches in the treatment of Demodex blepharitis. Methods:A multicenter, randomized, double-blind, parallel-controlled clinical trial was conducted.A total of 140 patients (280 eyes) with Demodex blepharitis were recruited in Shanghai Jing'an District Shibei Hospital, Xi'an Fourth Hospital and Kunming First People's Hospital from July 2021 to December 2022.The affected eyes were randomly divided into tea tree oil group, okra oil group, basal fluid control group and metronidazole group by the random number table method.Eye patches containing 20% tea tree oil, 1% okra oil, prepared base solution and 2% metronidazole were applied to the eyes for 28 days by the double-blind method.The count of Demodex was evaluated before treatment and on days 14 and 28 of treatment.Ocular surface symptoms were scored according to Ocular Surface Disease Index (OSDI). The degree of congestion at the eyelid margin and cylindrical dandruff at the root of eyelashes were scored under a slit lamp microscope.The effective rate was calculated according to the comprehensive scores above, and the adverse reactions of the subjects were observed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Shanghai Jing'an District Shibei Hospital (No.YL-20200320-05). All the subjects were informed of the significance, purpose and method of the study.Written informed consent was obtained from each subject before any medical examination. Results:All subjects completed the treatment and follow-up, and the loss to follow-up rate was 0%.After 14 and 28 days of treatment, the Demodex count was significantly decreased in all groups compared with before treatment (all at P<0.05). After 28 days of treatment, the number of Demodex in tea tree oil group, okra oil group and metronidazole group were significantly lower than that in basal fluid control group, with statistically significant differences (all at P<0.05). The OSDI score, palpebral margin congestion score and cylindrical dandruff score on 14 and 28 days after treatment in tea tree oil group, okra oil group and metronidazole group were significantly lower than before treatment, showing statistically significant differences (all at P<0.05). After 28 days of treatment, the effective rates of tea tree oil group, okra oil group and metronidazole group were 71.4%, 71.4% and 62.9%, respectively, which were significantly higher than 25.7% in basal solution control group.No serious local or systemic adverse reactions were found during the treatment and follow-up. Conclusions:Eye patches containing tea tree oil, okra oil and metronidazole have significant effects on the treatment of Demodex blepharitis, which can improve the biological environment of the palpebral margin and eliminate the inflammation related to blepharitis.

Background: At present, clinical dilemma remains to be solved in terms of therapy-choices for specific locally advanced cervical cancer (LACC) patients: 1) Although concurrent chemoradiotherapy (CCRT) is recommended as the first choice for them, many patients, influenced by the Chinese culture, prefer to choose radical surgery (RS) as their primary treatment. The difference between the 2 therapies in improving patient prognosis is still unknown. 2) Laparoscopy has been questioned since the noted Laparoscopic Approach to Cervical Cancer trial. Nevertheless, clinical research on laparoscopic surgery under the strict tumor-free principle is still underway globally, therefore whether laparoscopic surgery can be used for specific LACC is also an urgent issue to be explored. Methods A multi-center, randomized controlled study is designed to investigate the effect of different treatment strategies on the prognosis and quality of life (QoL) in patients with specific locally LACC. A total of 402 patients will be enrolled over a period of 3 years. Eligible patients will be randomized (3:1) to either RS group or CCRT group. Patients assigned to RS group will be randomized (1:2) to the abdominal RS group or laparoscopic RS group. All patients will then be followed-up for 5 years. The primary end point is the 2-year progression-free survival (PFS). The secondary end points include 5-year PFS, 2-year overall survival (OS), 5-year OS, adverse events caused by RS or CCRT and QoL.

Objective:To explore the application value of two-dimensional speckle tracking imaging (2D-STI) in evaluating diaphragm function, and to compare the ability of 2D-STI and conventional diaphragm ultrasonography in diagnosing diaphragmatic dysfunction and evaluating disease severity in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:A total of 58 AECOPD patients admitted to the First Affiliated Hospital of Xi′an Jiaotong University from January to October 2021 were retrospectively enrolled as AECOPD group, and 34 healthy subjects were recruited as control group during the same period. Repeatability test of diaphragmatic 2D-STI was performed. According to modified Medical Research Council (mMRC) dyspnea scores system and COPD Assessment Test (CAT), mMRC 0-1 and CAT<10 was classified as group A, mMRC≥2 and CAT≥10 was classified as group B. The baseline characteristics, conventional diaphragm ultrasonography parameters(thickening fraction and excursion) and 2D-STI parameters (longitudinal and radial strains) were compared between the AECOPD group and the control group, and the Spearman correlation between parameters of AECOPD group and forced expiratory volume in one second (FEV1) was analyzed. The differences of these parameters between group A and B were also compared. The ROC curve of conventional diaphragm ultrasonography parameters and 2D-STI parameters was plotted to differentiate group A from group B, and the diagnostic efficacy was evaluated.Results:Great intra- and inter-observer reproducibility was found for all diaphragmatic 2D-STI parameters, with ICCs above 0.80 for all measurements. The control group and the AECOPD group did not differ in age, sex and body mass index( P>0.05), whereas there were significant differences in smoking history, lung function, bilateral thickening fraction, excursion, longitudinal and radial strains( P<0.05). Compared with control group, patients in group A had a significant increase in diaphragm thickness ( P<0.05), while there was no significant difference in that between group B and control group ( P>0.05). The bilateral longitudinal strains, radial strains and thickening fraction of diaphragm were linearly correlated with FEV1 (right side rs=0.828, 0.794, 0.843, respectively; all P<0.001; left side rs=0.757, 0.704, 0.752, respectively; all P<0.001 ), while the correlation between excursion and FEV1 was not significant(right side rs=0.247, left side rs=0.253; all P>0.05). There were significant differences in bilateral longitudinal strains, radial strains and thickening fraction between group A and group B(all P<0.05), whereas there was no significant difference in excursion between the two groups ( P>0.05). ROC analysis showed bilateral longitudinal and radial strains had higher accuracy in distinguishing group A from group B than thickening fraction and excursion(right side AUCs 0.90, 0.84, 0.78 and 0.62, respectively; left side AUCs 0.85, 0.83, 0.77 and 0.62, respectively). Conclusions:2D-STI is a real-time noninvasive technique for diaphragm function assessment, which has high clinical value. Compared with conventional ultrasonography, 2D-STI shows more accuracy and effectiveness in diagnosing diaphragmatic dysfunction and evaluating disease severity of patients with AECOPD.