Objective:Using different machine learning methods to construct and screen the best prediction model for predicting the risk of death within 30 days after surgery in patients with acute type A aortic dissection.Methods:Five hundred and twenty-one patients with acute type A aortic dissection who underwent surgery between 2015 and 2022 were included, after collecting their perioperative date and screening them, 329 patients were retained. two different groups of predictor variables were generated by using Lasso regression and principal component analysis, after that, logistic regression, support vector machine algorithm, random forest algorithm, gradient boosting algorithm, and super learning algorithm were used to develop prediction models for the risk of death within 30 days after surgery. Finally, we compare the models and select the best one. Results:The AUC values for all models rangrd from 0.791-0.959. The model using Lasso regression to determine the predictor variables and built by the super learning algorithm had the best prediction with an AUC value of 0.959. Conclusion:The super learning algorithm better than other algorithms in predicting death within 30 days after acute type A aortic dissection.

Persistent fetal vasculature syndrome (PFVS) is a rare congenital vitreous dysplasia, which is classified as anterior, posterior and combined types according to the location of the vascular abnormalities. The clinical manifestations of PFVS are diverse, and early surgical intervention is very important. The main objective of surgical treatment is to remove the anterior and posterior traction between fibrovascular membranes and retina as well as lens, and to reconstruct clear visual axis. Surgical treatments include pupilloplasty, lensectomy with or without intraocular lens implantation and vitrectomy via limbal or scleral approach. For new technologies, the applications of ophthalmic viscosurgical device and femtosecond lasers have desirable results . In addition to focusing on improving the success rate of surgery, it is also necessary to systematically and comprehensively assess the overall preoperative condition and postoperative visual function of the patients. PFVS eyes have limited improvement in postoperative vision, which is related to the extent of lesion involvement and the occurrence of complications. Eyes with macular dysplasia and tractional retinal detachment, as well as elongated ciliary process, have a poor prognosis of vision after surgery. How to improve postoperative vision in the eye affecting the posterior segment of the eye with PFVS from the microscopic anatomical relationship between the fibrous vascular pedicle and the retina is worth further study. On the other hand, reducing surgical trauma and optimizing surgical procedures in order to improve postoperative visual acuity and reduce postoperative complications are also the key research directions of future PFVS treatments.

Objective:To evaluate the functional and anatomical outcomes of autologous single retinal pigment epithelium (RPE) transplantation for severe obsolete submacular hemorrhage (SMH) in late age-related macular degeneration (AMD).Methods:A retrospective clinical study. From January 2012 to December 2015, 11 patients with AMD (11 eyes) with obsolete SMH who were diagnosed and treated by pars plana vitrectomy (PPV) combined with autologous RPE transplantation at the Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were included. Among them, there were 9 eyes in 9 males and 2 eyes in 2 females. All the eyes underwent the examinations of best corrected visual acuity (BCVA) and optical coherence tomography; 4 eyes underwent macular fixation function (MAIA) at the same time. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. All eyes were treated with PPV combined with autologous single-layer RPE transplantation or autologous RPE-choroidal full-thickness transplantation, and were divided into S group and C group, with 5 and 6 eyes respectively. The differences of age ( t=-0.363), gender composition ratio ( χ2=0.549), course and thickness of SMH ( t=0.118, 0.231), average times of anti-vascular endothelial growth factor drug treatments ( t=0.129), times of PPV ( t=-0.452) between the two groups were not statistically significant ( P>0.05). The follow-up period was 6-40 months after the operation, and the BCVA, MAIA, graft status and complications of the eyes after the operation were observed. The comparison of continuous variables between groups was performed by independent-sample t test; the comparison of categorical variables was performed by χ2 test. Results:At the last follow-up, the average logMAR BCVA of the eyes in group S and C were 1.62±0.34 and 1.03±0.20, respectively; group C was better than group S, however, the difference was not statistically significant ( t=1.532, P=0.160). There were 4 eyes (80%, 4/5) and 6 eyes (100%, 6/6) in S group and C group with BCVA better than preoperative, the difference was no statistical significance ( χ2=0.677, P=0.895). There were 2 (40%, 2/5) and 3 (50%, 3/6) eyes with logMAR BCVA better than 1.0 in S group and C group, and the difference was not statistically significant ( χ2=0.572, P=0.423). After the operation, 6 eyes of grafts were in good condition and 5 eyes were in poor condition; the BCVA of grafts in good condition was significantly higher than that of poor condition, the difference was statistically significant ( t=4.894, P=0.001). Among the 4 eyes that underwent MAIA examination, 2 eyes were unstable and diffusely fixed on the graft; the fixation point was located at the normal retina adjacent to the graft area in 2 eyes. Secondary subretinal hemorrhage occurred in 3 eyes after the operation; the intraocular pressure was high in 1 eye after the operation. During the follow-up period, no intraocular infection, secondary retinal detachment, recurrent choroidal neovascularization or low intraocular pressure occurred in all eyes. Conclusions:Both autologous single-layer RPE transplantation and autologous RPE-choroidal full-thickness transplantation can help stabilize or even improve the visual function of eyes with severe SMH secondary to advanced AMD. The visual acuity after surgery is closely related to the state of the graft.

Retinopathy of prematurity (ROP) is a proliferative vascular retinal disease. Cryotherapy, laser photocoagulation, intravitreal injection of anti-vascular endothelial growth factor, scleral buckling surgery and vitrectomy are the main treatments. Treated with cryotherapy or laser photocoagulation or intravitreal injection of anti-vascular endothelial growth factor, patients with a history of ROP have thicker foveas, and the morphology of the fovea and the development of the retinal vessels in the macular area are affected, resulting in abnormal vision development. However, the specific mechanisms by which different treatments of ROP affecting the development of the macula are not yet clear. It still need further study with large samples to verify and explore, whether changes in the levels of intraocular vascular endothelial growth factor changing the process of normal macular development and how the abnormal development of the macula affects visual function.

Objective:To observe and analyze the genotype and clinical phenotype in 34 families of familial exudative vitreoretinopathy associated with (FEVR) gene variation.Methods:Cohort study. Thirty-four FEVR families, in which the patients and both of their parents were all found to have FEVR-related gene mutations (proband 34 cases, 67 eyes; parents 68 cases, 136 eyes), were included in the study. These patients were identifIed from 722 FEVR patients through genetic screening, which diagnosed in Department of Ophtalmology of Xinhua Hospital and Tianjin Medical University Eye Hospital from January 2010 to December 2018. The probands and their parents underwent a comprehensive ophthalmological examination appropriate to their age, including BCVA, intraocular pressure, axial length, slit lamp examination, indirect ophthalmoscopy, FFA or color fundus photography or wide field color fundus photography. According to the severity of the disease, the clinical manifestations were divided into severe phenotype and mild phenotype. Thirty-four normal healthy people over 40 years old were included as the control group. The peripheral blood samples of FEVR family members and control group members were collected, and the genes known to be involved in FEVR, such as FZD4, LRP5, NDP, TSPAN12, ZNF408 and KIF11, were analyzed by next generation sequencing molecular genetics. The data were statistically analyzed by SPSS. The counting data was expressed in numbers or rates, and tested by Kruskal-Wallis test and χ2 test to find out the existence of significant difference. Results:In 67 eyes of the 34 probands, 48 eyes (71.64%) were classified into severe phenotype and 19 eyes (28.36%) were mild phenotype. In 136 eyes of 68 parents of the proband patients, 76 eyes (55.88%) were normal, 60 eyes (44.12%) were classified into mild phenotype, and no severe phenotype was found. A total of 65 variants of FEVR-related genes were detected in the 34 probands, of which LRP5 mutation was the most common (64.61 %), followed by FZD4 (12.31%), NDP (10.77%), TSPAN12 (6.15%), ZNF408 (4.62%) and KIF11 (1.54%). Missense mutations were the most common variant in FEVR-related genes. However, the results of correlation analysis indicated that there was no significant correlation between the type of mutation and the severity of clinical phenotype ( H=1.775, P=0.620). Among the 65 mutation types, 21 types have been previously identified and 44 were novel in this study. Thirty-nine eyes of 20 cases had only one single pathogenic mutation gene but with multiple mutation sites, 26 eyes of 13 cases carried 2 relevant pathogenic mutation genes, and 2 eyes in one case had 3 pathogenic mutation genes. The mutation frequencies of LRP5, NDP, ZNF408, FZD4, TSPAN12 and KIF11 genes in probands were significantly higher than those in control group, and the difference was statistically significant. The total mutation frequencies of LRP5, NDP, ZNF408, FZD4, TSPAN12 and KIF11 genes in proband group were significantly higher than those in control group ( χ2=64.702, P <0.001). Conclusions:In the FEVR families, the most frequent mutations were those in LRP5, followed by FZD4, NDP, TSPAN12,ZNF408 and KIF11. Missense mutation is the most common type of FEVR-related gene mutation, but there is no significant correlation between the clinical phenotype and gene variation type. Most of the probands were with severe clinical phenotype, while most of the parents with FEVR pathogenic gene mutation showed normal or mild manifestations.

Objective To investigate the clinical manifestations and gene mutation of a pedigree with retinal lattice degeneration and granular corneal dystrophy (GCD) type 2.Methods Ten members in 3 generations of a pedigree with retinal lattice degeneration and GCD2 were included in the study, including 6 patients (3 males and 3 females) and 4 healthy family members. All members underwent visual acuity, slit lamp microscope, three-mirror lens, fundus color photography, optical coherence tomography, and corneal endothelial cells counting. Genomic DNA was extracted from peripheral venous blood (2 ml) from all the subjects and their spouses, who had no related inherited diseases. The next generation sequencing method was used to detect the mutation sites of transforming growth factor β (TGFBI), and all results underwent Sanger verification.Results Among the 12 eyes of 6 patients, the visual acuity was FC/20 cm-1.0. In the superficial central corneal stroma, snowflake-like deposits were observed in three cases (6 eyes), and a small amount of granular deposits were observed in three cases (6 eyes). Corneal endothelial cell counts were normal. Retinal lattice degeneration were observed in 3 cases, 6 eyes (including 3 cases of rhegmatogenous retinal detachment in 4 eyes); retinal thinning without obvious lattice degeneration in 4 eyes of 2 patients. Nystagmus in 1 patient and fundus examination showed no significant abnormalities. DNA sequencing results showed that the proband and 4 patients had missense mutation of TGFBI gene in exon 4 c.371G> A, the mutation site corresponding to the amino acid change encoded by TGFBI gene No. 124 Amino acids, from arginine to histidine (p.R124H). Patients with this mutation have varying degrees of clinical phenotype.Conclusions The mutation of c.701G> A (p.R124H) in TGFBI gene is the causative gene of GCD in this pedigree. The patients with this mutation have different clinical phenotypes.

Objective To observe the surgical outcome of the modified transconjunctival technique for minimal segmental buckling on rhegmatogenous retinal detachment (RRD).Methods This is a retrospective case series.Seventy-six patients (78 eyes) with uncomplicated RRD who underwent the modified transconjunctival technique for minimal segmental buckling were enrolled in this study.There were 41 male (42 eyes) and 35 female (36 eyes).The average age was (33.9± 15.6) years.Best corrected vision acuity (BCVA),fundus examination with three-mirrors lens,ocular B ultrasound,optical coherence tomography (OCT) were performed in all patients.BCVA was examined through Standard logarithmic visual acuity chart and transferred to logMAR vision for statistical analysis.The logMAR BCVA was 0.88± 0.88.The technique was successfully performed in all 78 eyes.After transconjunctival location of the retinal break was made,a 5 to 6 mm radial conjunctival incision was performed corresponding to the retinal break without cutting the limbal conjunctiva-Tenon's capsule.After cryopexy,a minimal explant was fixed with one to two sutures through the conjunctival opening,expanded by a pediatric speculum.BCVA,intraocular pressure,tear film stability,conjunctival recovery and retinal reattachment were collected 1 week,1 month,3 months,6 months after surgery.Results One week after surgery,retinal reattachments were achieved in 77 of 78 (98.7％) eyes and 1 eye (1.3％) received vitrectomy.Compared before surgery,the logMAR BCVA improved to 0.44± 0.41,with significant difference (t=3.092,P＜0.01).Conjunctival incision tear occurred in 1 eye.Subretinal hemorrhage occurred in 5 eyes during subretinal fluid drainage procedure.Subretinal hemorrhage occurred in 5 eyes during subretinal fluid drainage procedure.Hemorrhage was absorbed in 2 of the 5 eyes at 3 months after surgery and absorbed in all 5 eyes at 6 months after surgery.Subretinal fluid occurred in 10 eyes at 1 week after surgery and be absorbed completely at 6 months after surgery.Tear film stability improved to preoperative lever at 1 week after surgery.Less change in corneal and conjunctival sensitivity was observed in all eyes.No other surgical complications were observed within the follow-up period,such as scleral perforation,explant extrusion,diplopia or infection.Conclusions The modified transconjunctival technique for minimal segmental buckling minimizes the damage to conjunctiva without reducing the retinal reattachment rate.It can effectively treat uncomplicated RRD with preserving an intact limbal conjunctiva and rapid tear film stability recovery.

Objective To investigate the therapeutic effect of the method of Fast Elimination of Malaria by Source Eradication (FEMSE) in Moheli island of Comoros. Methods Based on the FEMSE project, parasite positive cases were given a standard treatment course of ARTEQUICK (artemisinin plus piperaquine) plus primaquine: two tablets for adults at 0 hour and two tablets at 24 hours, a total of 4 tablets during one treatment course. One time of Mass Drug Administration (MDA) was for the children with parasite carrier rate less than 10%. Two times of MDA was for the children with parasite carrier rate more than 10%, and the interval between the two MDA was 42 days. Coverage rate for MDA and population carrier rate were observed. Results The number of people taking the first MDA of Artequick-Primaquine was 32,519 (the whole population registered at the same time being 37,243, 367 infants under 6 months old not involved), and the coverage rate for MDA was 88.2%. The population involved in the second MDA was 35,370 (the whole population registered at the same time being 37,112, 335 infants under 6 months old not involved), and the coverage rate for MDA was 96. 2%. Parasite carrier rate was 22.95% (281/ 1,224) before MDA, 1.41% (28/1, 987) two months after MDA and 0. 33% (8/2,458) four months after MDA, with a decrease of 98.56% . Conclusion The decrease of parasite carrier rate from 22. 95% to 0. 33% before and after MDA indicates that MDA of Artequick-Primaquine based on FEMSE can decrease the parasite carrier rate in a short time, without any obvious side effects. Further decrease of parasite carrier rate and incidence will be achieved if the measures for clearing malaria are fully implementated during the consolidation phase.

[Objective] To examine the sensitivity of P. falciparum to the components of dihydroartemisinin (DHA) and piperaquine (PQ) in Dihydroartemisinin Compounds. [Methods] WHO (World Health Organization) standard micro test and in-vitro test were used. [Results] Survey in the year of 2001 for 61 cases and in 2004 for 28 cases showed that the DHA-resistant rate of P. falciparum in all cases was zero with inhibitory concentration of 50% (IC50) being 6.84 nmol/L and 5.67 nmol/L, and the mean concentration for complete inhibition of schizont formation was 35 nmol/L and 39 nmol/L, respectively. Survey in the year of 2001 for 75 cases and in 2004 for 29 cases showed that PQ-resistant rate of P. falciparum was 22.67% and 17.24% with IC50 being 274 nmol/L and 317 nmol/L, and the mean concentration for complete inhibition of schizont formation was 1 220 nmol/L and 1 269 nmol/L, respectively. [Conclusion] No DHA -resistance exists and PQ-resistance decreases for the treatment of P. falciparum in Dongfang city of Hainan province.

Objective To study the effects of dihydroartemisinin and quinine on plasmodium falciparum gametocytes at early stage. Methods Eleven patients with falciparum malaria who had plasmodium falciparum gametocytes at early stage(PFGe) in bone marrow but no matured plasmodium falciparum gametocytes(PFGm) in bone marrow and peripheral blood were allocated to two groups.Group A(n=6) were administered orally with dihydroartemisinin at a total dosage of 480mg for 7 days and Group B(n=5) with quinine sulfate at a total dosage of 10?500 mg for 7 days.The number of gametocytes in bone marrow and peripheral blood was examined at regular time. Results PFGe in bone marrow disappeared in Group A on 10 th day after the first administration while existed in all the cases of Group B on 10 th day and still in 2 cases on 14 th day.The clearance time for peripheral PFGe was 4.8?0.9 days in Group A and 22.0?5.8 days in Group B. Conclusion Dihydroartemisinin can clear PFGe but quinine shows no this action.