Objective:To study the efficiency and difference of the artificial intelligence (AI) system based on fundus-reading in community and hospital scenarios in screening/diagnosing diabetic retinopathy (DR) among aged population, and further evaluate its application value.Methods:A combination of retrospective and prospective study. The clinical data of 1 608 elderly patients with diabetes were continuously treated in Henan Eye Hospital & Henan Eye Institute from July 2018 to March 2021, were collected. Among them, there were 659 males and 949 females; median age was 64 years old. From December 2018 to April 2019, 496 elderly diabetes patients were prospectively recruited in the community. Among them, there were 202 males and 294 female; median age was 62 years old. An ophthalmologist or a trained endocrinologist performed a non-mydriatic fundus color photographic examination in both eyes, and a 45° frontal radiograph was taken with the central fovea as the central posterior pole. The AI system was developed based on the deep learning YOLO source code, AI system based on the deep learning algorithm was applied in final diagnosis reporting by the"AI+manual-check" method. The diagnosis of DR were classified into 0-4 stage. The 2-4 stage patients were classified into referral DR group.Results:A total of 1 989 cases (94.5%, 1 989/2 104) were read by AI, of which 437 (88.1%, 437/496) and 1 552 (96.5%, 1 552/1 608) from the community and hospital, respectively. The reading rate of AI films from community sources was lower than that from hospital sources, and the difference was statistically significant ( χ2=51.612, P<0.001). The main reasons for poor image quality in the community were small pupil (47.1%, 24/51), cataract (19.6%, 10/51), and cataract combined with small pupil (21.6%, 11/51). The total negative rate of DR was 62.4% (1 241/1 989); among them, the community and hospital sources were 84.2% and 56.3%, respectively, and the AI diagnosis negative rate of community source was higher than that of hospital, and the difference was statistically significant ( χ2=113.108, P<0.001). AI diagnosis required referral to DR 20.2% (401/1 989). Among them, community and hospital sources were 6.4% and 24.0%, respectively. The rate of referral for DR for AI diagnosis from community sources was lower than that of hospitals, and the difference was statistically significant ( χ2=65.655, P<0.001). There was a statistically significant difference in the composition ratio of patients with different stages of DR diagnosed by AI from different sources ( χ2=13.435, P=0.001). Among them, community-derived patients were mainly DR without referral (52.2%, 36/69); hospital-derived patients were mainly DR requiring referral (54.9%, 373/679), and the detection rate of treated DR was higher (14.3%). The first rank of the order of the fundus lesions number automatically identified by AI was drusen (68.4%) and intraretinal hemorrhage (48.5%) in the communities and hospitals respectively. Conclusions:It is more suitable for early and negative DR screening for its high non-referral DR detection rate in the community. Whilst referral DR were mainly found in hospital scenario.

Objective:To observe and analyze the macular choroidal thickness and choroidal blood perfusion (CBP) in eyes with idiopathic macular hole (IMH) and their correlation.Methods:A cross-sectional observational clinical study. From March 2019 to October 2021, 60 IMH patients with 60 eyes (IMH group) and 60 healthy volunteers with 60 eyes (control group) who consecutively visited Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University were included in the study. Among the 60 eyes in the IMH group, 8, 8, 15, and 29 eyes were at stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. There was no significant difference in age, spherical equivalent power and axial length between the two groups ( t=1.327, 0.157, 0.542; P>0.05). The average macular choriodal thickness (AMCT) and CBP in different regions of the macular region of the examined eye were measured using a swept-frequency light source optical coherence tomography scanner. According to the zoning method for the treatment of diabetic retinopathy, the choroid within 6 mm of the fovea was divided into 3 concentric circles with the fovea as the center. They are the central area with a diameter of 1 mm, the inner ring area of 1-3 mm, and the outer ring area of 3-6 mm; the inner ring area and the outer ring area were divided into 4 areas by 2 radiations respectively, including the upper part of the inner superior (IS), the lower part of the inner inferior (Ⅱ ), and the nasal side of the inner nasal (IN), inner temporal (IT), outer superior (OS), outer inferior (OI), outer nasal (ON), outer temporal (OT), a total of 9 regions. The distribution characteristics of AMCT and CBP in different regions were observed. The correlation between AMCT and CBP was analyzed by Pearson correlation; the correlation between AMCT, CBP and IMH stage was analyzed by Spearman correlation. Results:Compared with the eyes of the control group, the AMCT of the affected eyes in the IMH group was significantly thinner in all areas of the macula, and the difference was statistically significant ( t=2.378, 4.641, 2.888, 3.390, 3.575, 4.870, 4.077, 4.946, 4.578; P<0.05). Compared with the control group, the CBP in the OS and OT regions of the affected eyes in the IMH group was significantly lower, the difference was statistically significant ( t=3.424, 4.516; P<0.05). The results of Pearson correlation analysis showed that there was a significant positive correlation between AMCT and CBP in the OT region ( r=0.314, P<0.001). Spearman correlation analysis showed that there was a significant positive correlation between AMCT and IMH staging in each region ( r=0.375, 0.374, 0.289, 0.379, 0.441, 0.392, 0.303, 0.341, 0.292; P<0.05). There was no significant correlation between CBP and IMH staging in IN, OI and OT regions ( r=-0.138, -0.016, -0.221; P>0.05); CBP and IMH staging in other regions were significantly negatively correlated ( r=-0.560, -0.390,-0.819, -0.692, -0.329, -0.587; P<0.05). Conclusions:The choroidal thickness in the macular region of the eyes with IMH is significantly thinner than that of the normal subjects; there is choroidal hypoperfusion in local areas. There is a significant positive correlation between local regional AMCT and CBP; IMH stage is higher, the trend of AMCT in each region is thickening, and the CBP in most regions decrease.

Objective:To report the BEST1 gene mutations and clinical phenotypes in two pedigrees with Best vitelliform macular dystrophy (BVMD) and autosomal recessive bestrophinopathy (ARB). Methods:A retrospective clinical study. From November 2019 to March 2021, in the Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University, the BVMD family (4 patients and 6 family members) and the ARB family (2 patients, 2 family members), a total of 6 patients and 8 normal family members were included in the study. Detailed medical history was obtained; best corrected visual acuity, fundus color photography, electrophysiology, optical coherence tomography and fundus autofluorescence examination were performed. The clinical characteristics for all patients in the two families were analyzed. Three milliliter peripheral venous blood of all participants in the family was collected, and the whole genomic DNA was extracted with gene sequencing using next-generation sequencing technology based on targeted capture. Compared with the database to identify the pathogenicity mutation sites, suspected pathogenic mutation sites were selected, then mutations in other members in the family was assayed by Sanger sequencing.Results:In family 1, the proband was demonstrated as typical BVMD, other patients were multifocal vitelliform macular dystrophy. The DNA sequencing result showed that all the 4 patients carried heterozygous missense mutations in exon 3 of BEST1 gene: c.240C>G (p.F80L) (M1) and 2 members carried this mutation, but without clinical phenotype. M1 was a likely-pathogenic mutation reported for the first time. In family 2, the proband and the other patient were diagnosed as ARB. The DNA result showed that the 2 patients carried heterozygous missense mutations in exon 5 and exon 2 of BEST1 gene: c.584C>T (p.A195V) (M2)、c.139C>A (p.R47S) (M3), and a heterozygous frameshift mutation in exon 3 of BEST1 gene: c.235dupT (p.S79Ffs*153) (M4). M2 was a pathogenic mutation reported previously. M3 variant was of undetermined significance. M4 was a first reported pathogenic mutation. Conclusions:The BEST1 gene mutation is the main cause of BVMD and ARB. Different mutation sites have different clinical phenotypes. BVMD and ARB have genetic and clinical heterogeneity.

Objective:To investigate the clinical effect of Jiedu Limai decoction in septic patients with syndrome of heat-toxin exuberance.Methods:A prospective randomized controlled trial was conducted. From March 2019 to April 2020, septic patients with syndrome of heat-toxin exuberance admitted to intensive care unit (ICU) of Shanghai General Hospital and Songjiang Branch of Shanghai General Hospital were enrolled as the research objects, and they were divided into routine treatment group and Jiedu Limai decoction group by the random number table method. Patients in both groups were given standard treatment in accordance with the guidelines, and patients in the Jiedu Limai decoction group were given Jiedu Limai decoction in addition to the standard treatment, once a day for 14 days. The 28-day survival of patients of the two groups were recorded, the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score, coagulation indexes, infection indexes, inflammatory cytokines and organ function indicators before treatment and 7 days after treatment in both groups were recorded, and the prognosis of the two groups were recorded.Results:A total of 259 patients with infection or clinical diagnosis of infection admitted during the experimental observation period were included, and those who did not meet the Sepsis-3 diagnostic criteria, more than 80 years old or less than 18 years old, with multiple tumor metastases, autoimmune system diseases, with length of ICU stay less than 24 hours, with acute active gastrointestinal bleeding and with incomplete data were excluded. One hundred patients were finally enrolled, with 50 patients in the routine treatment group and 50 patients in the Jiedu Limai decoction group. There were no statistically significant differences in coagulation indexes, infection indicators, inflammatory cytokines and organ function indicators before treatment between the two groups. After 7 days of treatment, the coagulation indexes, infection biomarkers and inflammatory cytokines in the Jiedu Limai decoction group were significantly lower than those in the routine treatment group [D-dimer (mg/L): 2.2 (1.8, 8.5) vs. 4.0 (1.5, 8.7), fibrinogen (Fib, g/L): 3.7 (3.4, 4.3) vs. 4.2 (3.7, 4.3), fibrinogen degradation product (FDP, mg/L): 7.2 (5.4, 10.2) vs. 13.2 (9.2, 15.2), procalcitonin (PCT, μg/L): 0.4 (0.2, 2.9) vs. 0.5 (0.2, 0.9), C-reactive protein (CRP, mg/L): 50.1 (9.5, 116.0) vs. 75.1 (23.5, 115.2), interleukin-6 (IL-6, ng/L): 31.6 (21.6, 81.0) vs. 44.1 (14.0, 71.3), all P < 0.05], and the levels of B-type brain natriuretic peptide (BNP) and kidney injury molecule-1 (KIM-1) were significantly lowered [BNP (ng/L): 261.1 (87.5, 360.3) vs. 347.3 (128.8, 439.4), KIM-1 (μg/L): 0.86 (0.01, 1.40) vs. 1.24 (1.05, 1.57), both P < 0.05]. Compared with the routine treatment group, the number of new organ failure in the Jiedu Limai decoction group was decreased (30.0% vs. 50.0%, P < 0.05). Although there was no significant difference in 28-day mortality between the two groups ( P > 0.05), the 28-day mortality in the Jiedu Limai decoction group was lower than that in the routine treatment group (18.0% vs. 24.0%). Conclusion:Combining Jiedu Limai decoction to the sepsis guideline in treating syndrome of heat-toxin exuberance can effectively improve patients' coagulation function, the situation of heart and renal injury, reduce the level of inflammatory cytokines, and fewer people develop new organ failure after treatment.

Total synthesis of cyclodepsipeptide Hikiamides A-C was described. Fragment convergent condensation method was applied for the preparation of Hikiamides A-C, starting from Commercially available amino acid such as L-N-Boc-Phe-OH, L-N-Boc-Trp-OH, L-N-Cbz-Van-OH etc. Tripeptide fragments(compounds 5a/5b)and dipeptide fragments(compounds 8a/8b)were first prepared. The subsequent condensation of the resulted two fragments provided protected linear pentapetides(compounds 9a/9b/9c); Finally, the linear pentapetide was cyclized by a mixed condensing agents comprised of PyBOP and HBTU. Hikiamides A-C was obtained with total yields of 9%, 11% and 6. 5%, respectively. Compared with the natural source, this method has the advantages of low cost, convenient operation and high yield, which effectively solves the problem of low isolated yield of Hikiamides A-C from Fusarium sp.

Objective To study the effects of interferon γ(IFN-γ) on terminal erythroid differentiation.Methods RT-qPCR was used to detect the expression of IFN-γ receptors during erythroid differentiation of K562 induced by hemin.Both hemin-induced K562 cells and human umbilical cord CD34+ cell derived primary erythroid cells were treated with IFN-γ.Erythroid differentiation of the cells was evaluated using RT-qPCR to detect the mRNA level of erythroid specific surface markers CD71 and CD235a,and benzidine staining assay was applied to explore the change of hemoglobin expression.Results The expression of IFN-γ receptors in K562 cells decreased and climbed up again after reaching the lowest point at 48 h of hemin induction.IFN-γ treatment increased CD71 and CD235a expression in both hemin-induced K562 cells and the later stage (E15D) primary erythroid cells.Benzidine staining showing increased globin protein expression in hemin-induced K562 cells after IFN-γstimulation.Furthermore,our results indicated that IFN-γ promoted hemin-induced K562 erythroid differentiation in a time dependent manner.Mechanistically,the results showed that IFN-γ treatment stimulated the expression of erythroid transcription factors NFE2,which was critically for erythroid maturation.Conclusions IFN-γaccelerates terminal erythroid differentiation in hemin-induced K562 cells and human umbilical cord CD34+ derived primary erythroid cells.

Objective To Apply appropriate dose of Glutamine(Gln)(300mG/d)for patients with acute cerebral infarction,and observe its preventinG and curinG function to the stress ulcer. Methods Sixty cases patients of acute cerebral infarction were observed and divided into the conventional treatment Group( 30 cases),Glutamine treatment Group( GLU,30 cases). Gastric pH value of patients was tested before treatment and after one week treatment. The stool or vomit occult blood positive( OB+)number of patients within one week, OB( +) duration and the number of patients need blood filterinG were observed. Results There was no siGnificant difference between the conventional treatment Group and the GLU Group in the Gastric juice PH value before treatment(t=0. 647,P>0. 05). After one week treatment,the Gastric juice PH value of the GLU Group was siGnificant hiGher than the conventional treatment Group(t=5. 25,P<0. 05);the number of OB( +)of GLU Group were less than the conventional treatment Group,but there was no statistical siGnificant difference(χ2=0. 577,P>0. 05);the OB( +)duration of GLU Group was less than the conventional treatemnt Group,and there was satistical siGnificant difference(t =4. 768,P <0. 05);the number of blood filterinG of GLU to treat stress ulcer was less than conventional treatment Group,and there was satistical siGnificant difference(χ2=l. 0l6,P>0. 05). Conclusion SupplementinG appropriate dose of Glutamine in patients with acute cerebral infarction can reduce the incidence of stress ulcer,decrease medical expenses.

Objective To observe the effect of conductive education on gross motor function for children with cerebral palsy. Methods 98 children with cerebral palsy were divided into control group (n=48) and observation group (n=50) according to the wish of their parents.All the children received conventional rehabilitation, while the observation group accepted conductive education in addition. They were assessed with the total score of Gross Motor Function Measure (GMFM-88) before and 6 months after treatment. Results The total score of GMFM-88 was not significantly different between the groups before treatment (P>0.05), but it was different after treatment (P<0.01). Conclusion Conductive education may promote the recovery of gross motor function for children with cerebral palsy.

Objective To investigate the differences of multiple factors in acute cerebral infarction (ACI) patients with and without multiple organ dysfunction syndrome (MODS),as well as in ACI patients in different MODS score groups.Methods One hundred and fifty-seven ACI patients were divided into non-MODS group( without concurrent MODS group)and MODS group.The MODS group patients were further divided into four subgroups according to the scores,including 1 -6points,7 - 12 points,13 - 18 points and points over 19.All patients were measured for procalcitonin(PCT) and C-reactive protein(CRP).The National Institutes of Health stroke score( NHISS score),acute physiology and chronic health evaluation( APACHE Ⅱ score)and Watian water test score were calculated.The differences in age,gender,PCT,CRP,NHISS score,APACHE Ⅱ score,Watian water score,breathing support rate,eating rate and mortality rate between the two groups were compared.Results Non-MODS group,compared with the MODS group,was significantly younger( [72.11 ± 16.41 ] years vs.[ 77.88 ±17.67 ] years,t=2.451,P ＜ 0.05 ),and the difference in the ratio of male to female between groups was not significant (57/38 vs.34/28,x2 =0.414,P ＞ 0.05 ).Differed from MODS group,non-MODS group had significant lower PCT value ( 1.83 ± 0.51 vs.2.98 ± 0.71,P ＜ 0.01 ),CRP value ( [ 12.53 ± 7.12] mg/L vs.[69.89 ±43.83 ] mg/L,P ＜0.01 ),NHISS score(9.38 ±5.24 vs.21.35 ±7.47,P ＜0.01 ),APACHE Ⅱ score ( 11.63 ± 4.22 vs.30.92 ± 7.80,P ＜ 0.01 ),Watian water score ( 2.36 ± 0.98 vs.3.88 ± 1.09,P ＜ 0.01 ),breathing support rate ( 2.1％ vs.43.5％,P ＜ 0.01 ) and mortality rate ( 4.2％ vs.43.5％,P ＜ 0.01 ),but had remarkable higher eating rate(95.8％ vs.66.1％,P ＜0.01 ).Pairwised comparison among the four MODS score groups,the PCT,CRP,NHISS score,APACHE score,Watian water test,breathing support rate and mortality rate were significantly different(P ＜ 0.05) ;The differences in age between the 1 -6 points group and the other three groups was significant ( P ＜ 0.05 ).Conclusion Age,PCT,CRP,NHISS score,APACHE score,Watian water test score,breathing support rate,mortality rate of the high-score MODS groups were higher than those of MODS groups with low-score in ACI patients,while eating rate was lower than that of the low-score groups.

Objective To explore and compare the therapeutic effects of Fufangkushen injection and Aidi injection on improving quality of life for patients with advanced lung cancer. Methods 60 patients in late stage of lung cancer with pathological diagnosis were split into two groups randomly. 30 patients in Kushen group received Fufangkushen injection plus base therapy, 30 patients in Aidi group received Aidi injection plus base therapy.The data was analyzed on term of tumour size,clinical symptoms,Karnofsky score,cancer marker CA125,CEA,before and after treatment in two groups.The therapeutic effects were evaluated after two circles of treatment. Results Compared the short term therapeutic effect, Kushen group had the stability rate for 83.3 ％(25/30),and 80.0 ％(24/30) for Aidi group.There was no significant difference.(P＞0.05).Compare the clinical therapeutic effect,Kushen group had the improving rate for 83.3 ％(25/30),and 80.0 ％(24/30) for Aidi group.There was no significant difference(P＞0.05).Compare the Karnofsky score,two groups had equal increasing stability rate (P＞0.05). Compare decreasing ratio of CEA and CA125 after treatment in two groups,there was no significant difference (P＞0.05). Conclusion Fufangkushen injection and Aidi injection both have acceptable therapeutic effects in the treatment of patients with later stage lung cancer.The result is equal. As well as they have some other characters themselves to improve lung cancer related symptoms. Fufangkushen injection is better to improve symptoms of heat toxin, and Aidi injection is better to improve symtoms of deficiency Qi. For Fufangkushen injection, it can also adjust disorder of liver function and relieve pain.