One of the significant hurdles in telemedicine, particularly in ophthalmology, is the absence of direct physical examination. This specialty depends extensively on specialized instruments that typically require proficient operators. Visual function tests are crucial for both outpatient and inpatient ophthalmic services, playing a vital role in screening, diagnosing, monitoring treatment effectiveness, and managing follow-ups for various eye conditions. The progress in mobile technology has paved the way for expanding these tests beyond traditional clinic settings, promoting the creation of patient-focused, straightforward, cost-effective, and efficient measurement tools. In light of the swift advancement of digital technologies, this article reviews the characteristics, and reliability of self-administered visual function tests tools, including visual acuity, refractive error assessment, visual field, contrast sensitivity, and color vision, along with other pertinent diagnostic tools that have been developed and validated for accuracy and repeatability through research, with a view to providing ophthalmologists and patients with scientific and practical references when selecting and using these tools, further promoting efficiency and efficacy of teleophthalmology.

OBJECTIVE To investigate the changes in serum metabolites of mice with radiation-induced intestinal injury under the intervention of baicalein and the changing characteristics of endogenous biological small molecules during the process of baicalein's participation in the prevention and treatment of radiation-induced intestinal injury through the metabolomics method based on GC-MS technology,in order to explore the potential regulatory mechanism of baicalein.METHODS A mouse radioactive intestinal injury model was established and randomly divided into normal control group,model group,low-dose baicalein group and high-dose baica-lein group.Baicalein was administered by gavage.Gas chromatography-mass spectrometry(GC-MS)technology was used to analyze the serum samples of mice in each group,and differential metabolites were screened through partial least squares-discriminant analysis(PLS-DA).Potential metabolic pathways were analyzed with MetaboAnalyst.RESULTS The pathological sections of mouse intesti-nal tissue showed that the high-dose and low-dose baicalein groups had a certain protective effect on radiation-induced intestinal dam-age.Metabolomic analysis showed that there were significant differences in the metabolic profiles of the blank control group,model group,low-dose and high-dose baicalein administration groups.After intragastric administration of baicalein,the endogenous metabo-lites in mice with radiation intestinal injury tended to normalize.The study screened out a total of 11 potential metabolic markers and 5 related metabolic pathways,among which pathways related to glucose metabolism,glutathione pathway,and ammonia metabolism were particularly significant.CONCLUSION Baicalein has a certain preventive and therapeutic effect on radiation-induced intestinal in-jury;baicalein participates in glucose metabolism and glutathione metabolism,and improving the endogenous substance disorder caused by radiation is its potential mechanism of action.

Purpose To explore the ability of proton density fat fraction(PDFF)and decay constant T2* values in MRI to reflect skeletal muscle aging.Materials and Methods 3T MRI data of skeletal muscle in the middle thigh of 211 healthy adults from the Third Affiliated Hospital of Southern Medical University from August to December 2023 were prospectively collected.Gender,age,height,weight and body mass index(BMI)were recorded.PDFF value and T2* value of thigh skeletal muscle were measured at post-processing workstation,and statistical differences among different age,gender and BMI groups were analyzed.The correlation between PDFF value and T2* value of thigh skeletal muscle and age and BMI was analyzed.Results There were statistically significant differences in PDFF values of thigh skeletal muscle among different age groups(H=18.476-85.619,all P<0.01).There were significantly differences in T2*values of the left and right quadriceps muscles,hamstrings and adductors among different age groups(H=13.342-47.566,all P<0.05).There were statistically significant differences in the PDFF values of right quadriceps,left and right hamstring,adductor and sartor muscles between male and female groups(Z=-4.929--1.626,all P<0.05),while there were statistically significant differences in T2* values of left sartor muscle(Z=-2.971,P=0.003).There was no statistical significance in PDFF value of skeletal muscle of thigh in different BMI groups(P>0.05),but there were statistically significant differences in T2* value of left and right quadriceps muscle,hamstring muscle and adductor muscle(H=9.542-24.495,all P<0.05).There was a moderate positive correlation between age and PDFF value of thigh skeletal muscle(r=0.635,P<0.01),but a slight negative correlation with T2* value of left and right quadriceps,hamstring and sarcoleus(r=-0.451--0.189,all P<0.01).There was a slight positive correlation between BMI and T2* values of thigh skeletal muscle(r=0.317,P<0.01).There was a moderate negative correlation between the PDFF value and T2* value of all thigh skeletal muscles(r=-0.749--0.624,P<0.01).The PDFF and T2* values of the front and back thigh muscles(quadriceps,hamstring)were most significantly correlated with age and BMI.Conclusion PDFF based on MRI can reflect the age-related changes in the microenvironment of thigh skeletal muscle,and is a potential imaging biological marker for accurate and non-invasive quantitative evaluation of thigh skeletal muscle aging.

Purpose: This study aims to evaluate the efficacy and safety of a new combination treatment of vinorelbine and pyrotinib in human epidermal growth factor receptor 2 (HER2)–positive metastatic breast cancer (MBC) and provide higher level evidence for clinical practice. Materials and Methods: This was a prospective, single-arm, phase 2 trial conducted at three institutions in China. Patients with HER2-positive MBC, who had previously been treated with trastuzumab plus a taxane or trastuzumab plus pertuzumab combined with a chemotherapeutic agent, were enrolled between March 2020 and December 2021. All patients received pyrotinib 400 mg orally once daily plus vinorelbine 25 mg/m2 intravenously or 60-80 mg/m2 orally on day 1 and day 8 of 21-day cycle. The primary endpoint was progression-free survival (PFS), and the secondary endpoints included the objective response rate (ORR), disease control rate (DCR), overall survival, and safety. Results: A total of 39 patients were enrolled. All patients had been pretreated with trastuzumab and 23.1% (n=9) of them had accepted trastuzumab plus pertuzumab. The median follow-up time was 16.3 months (95% confidence interval [CI], 5.3 to 27.2), and the median PFS was 6.4 months (95% CI, 4.0 to 8.8). The ORR was 43.6% (95% CI, 27.8% to 60.4%) and the DCR was 84.6% (95% CI, 69.5% to 94.1%). The median PFS of patients with versus without prior pertuzumab treatment was 4.6 and 8.3 months (p=0.017). The most common grade 3/4 adverse events were diarrhea (28.2%), neutrophil count decreased (15.4%), white blood cell count decreased (7.7%), vomiting (5.1%), and anemia (2.6%). Conclusion Pyrotinib plus vinorelbine showed promising efficacy and tolerable toxicity as second-line treatment in patients with HER2-positive MBC.

ObjectiveTo construct a traditional Chinese medicine （TCM） syndrome diagnosis and prescription model for coronary heart disease with the improved Transformer algorithm. MethodTaking the syndrome elements of coronary heart disease as key links， the model was constructed based on the clinical diagnosis and treatment principle of "symptoms-syndrome elements-syndrome-treatment method-prescription-medicine （dose）". The basic logic of improved Transformer algorithm was constructed with multi-head attention mechanism， compound term vector and dropout， in order to form the model with functions of TCM syndrome elements judgment， syndrome diagnosis， prescription recommendation. After the model was constructed， it was trained by 8 030 cases. And 100 cases with TCM prescriptions were randomly selected for testing， and the model output prescriptions were compared with those of clinicians for qualitative evaluation of the model. ResultThe improved Transformer with multi-head attention improved the accuracy of the model. The model was consistent with clinicians in the judgment of main syndromes and the selection of prescriptions. Whereas there was a certain room for improvement in the addition and subtraction of medicines. ConclusionThe improved Transformer model can improve the accuracy and stability of output， which is an embodiment of the intelligent development of TCM.

Humans ; Parkinson Disease/diagnosis* ; Machine Learning

Objective To investigate the dosimetric effect of truncated regions in computed tomography (CT) images on the targets and organs at risk in volumetric modulated arc therapy (VMAT) for middle thoracic esophageal cancer. Methods CT images of 15 patients with middle thoracic esophageal cancer were selected. Circle masks were used to make the volume of the truncated region account for 10%, 20%, 30%, and 40% of the arm volume, and the corresponding truncated CT images were obtained. The real CT was denoted as CT0. Two radiotherapy plans were made on CT0. One plan was VMAT_1F with full arcs, and the other one was VMAT_3F with arm avoidance. The plans were transplanted to four truncated CT, respectively, and the dosimetric differences between different plans were compared using Wilcoxon signed-rank test. Results Compared with VMAT_1F in CT0, D_mean and V₅ of the lung decreased in VMAT_3F, but D_max of the spinal cord, D_mean of the heart, and V₂₀ of the lung increased. In VMAT_3F, there was no statistically significant difference between the dosimetric parameters in the four truncated CT and those in CT0 (all P > 0.05). In VMAT_1F, except for homogeneity index and D_max of the spinal cord, the dosimetric parameters in four truncated CT were significantly different from those in CT0 (P < 0.05). The dosimetric difference increased with the increase in truncated region-to-volume ratio. Conclusion Complete CT data should be collected in clinical practice, and the radiation field avoiding the truncated regionshould be set if necessary to reduce the influence of the truncated region on dosimetry.

Obesity is one of the most challenging global public health issues, and more than half of adults in Chia are overweight or obese. Obesity has been shown to be a risk factor for type 2 diabetes, cardiovascular disease, colon cancer and other specific cancers, and has become a serious threat and even a danger to the health and quality of life of the nation. With the mature development of bariatric surgery in the last 20 years, it is now widely recognized for its effectiveness and safety in the treatment of obesity and related metabolic diseases, as well as improving patients′ life expectancy and quality of life. However, previous data from the literatures suggest that some patients require revisional surgery after bariatric surgery, with the incidence of revisional bariatric surgery as 5% to 50%. The main reasons for revisional bariatric surgery are poor post-operative outcomes, including the lack of significant weight loss, weight regain and no significant improvement or even recurrence of associated metabolic disease, and other reasons include the development of anaemia, malnutrition and long-term chronic pain. Currently, there is only the East Asian expert consensus on revised bariatric surgery proposed by Chinese Society for Metabolic & Bariatric Surgery in 2018. However, there are still no uniform standards regarding the indications, contraindications and surgical modalities of revisional bariatric surgery in clinical practice. The authors summarize the latest researches of revisional bariatric surgery, in order to provide the guidance value for clinical practice.

OBJECTIVES: Sepsis associated encephalopathy (SAE) is a common neurological complication of sepsis. Delirium is a common symtom of SAE. The pathophysiology of SAE is still unclear, but several likely mechanisms have been proposed, such as mitochondrial and endothelial dysfunction, neurotransmission disturbances, derangements of calcium homeostasis, cerebral microcirculation dysfunction, and brain hypoperfusion. Near-infrared spectroscopy (NIRS) is a non-invasive measure for regional cerebral oxygen saturation (rSO METHODS: A total of 48 septic patients who admitted to the intensive care unit (ICU) of Xiangya Hospital, Central South University from August 2017 to May 2018, were retrospectively study. Septic shock was diagnosed according to the criteria of sepsis 3.0 defined by the American Association of Critical Care Medicine and the European Society of Critical Care Medicine. NIRS monitoring was performed during the first 6 hours admitted to ICU with sensors placed on the bilateral forehead of patients. The maximum (rSO RESULTS: The overall 28-day mortality of septic shock patients was 47.92% (23/48), and the incidence of delirium was 18.75% (9/48). The rSO CONCLUSIONS Cerebral anoxia and hyperoxia, as well as the large fluctuation of cerebral oxygen saturation are important factors that affect the outcomes and the incidence of delirium in septic shock patients, which should be paid attention to in clinical practice. Dynamic monitoring of cerebral oxygen saturation and maintain its stability may be of great significance in patients with septic shock.
APACHE ; Humans ; Intensive Care Units ; Oxygen Saturation ; Prognosis ; Retrospective Studies ; Sepsis ; Shock, Septic

Objective:To explore the correlation between different types of microcirculation alterations and the prognosis in patients with septic shock.Methods:This research employed a prospective observational study methodology for selecting subjects with septic shock. Side-stream dark field(SDF) was used to monitor the sublingual microcirculation to determine the total vascular density (TVD), perfused vessel density (PVD), the proportion of perfused vessels (PPV), and the microvascular flow index (MFI), heterogeneity index (HI) indicators. At the bedside, patients with microcirculation disorders were divided into four types: stasis, dilution, heterogeneity, and hyperdynamic. The 30-day survival status after enrollment and hemodynamics parameters were recorded.Results:A total of 64 patients with septic shock were selected in the study, including 18 cases of stasis type, 11 of dilution type, 18 of heterogeneous type, and 17 of hyperdynamic type. There were statistical differences in the mean arterial pressure (MAP) [stasis:(77±9) mmHg (1 mmHg=0.133 kPa), dilution:(80±11) mmHg, heterogeneity: (78±12) mmHg, hyperdynamic:(88±12) mmHg], TVD [ stasis:(10.84±3.01) mm/mm 2, dilution:(9.64±1.72) mm/mm 2, heterogeneity:(11.39±2.18) mm/mm 2, hyperdynamic: (11.87±2.67) mm/mm 2 ], PVD [stasis:(5.93±1.94) mm/mm 2, dilution:(6.86±1.48) mm/mm 2, heterogeneity: (8.31±1.78) mm/mm 2, hyperdynamic:(9.68±2.46) mm/mm 2], PPV [stasis:52.45 (46.25, 63.33)%, dilution:73.70 (61.50, 75.20)%, heterogeneity: 71.25 (67.95, 77.00)%, hyperdynamic:80.70 (77.25, 86.45)%], MFI(stasis:1.34±0.45, dilution: 1.70±0.38, heterogeneity:1.82±0.28, hyperdynamic:2.25±0.33), and HI [stasis:0.68 (0.51, 1.87), dilution: 0.57 (0.49, 0.64), heterogeneity:0.70 (0.59, 0.91), hyperdynamic: 0.40 (0.37, 0.52)] of the four types of microcirculation alterations. The cumulative survival rates in stasis, dilution, heterogeneity and hyperdynamic types at 30 day were 7/18, 4/11, 10/18 and 14/17, respectively, which in stasis and dilution types was significantly lower than that of hyperdynamic type (χ2=7.221, P=0.007;χ 2=6.764, P=0.009). Multivariate Cox regression analysis showed the type of microcirculation alterations (stasis: RR=4.551, 95 %CI 1.228-16.864, P=0.023; dilution: RR=4.086, 95 %CI 1.011-16.503, P=0.048), acute physiology and chronic health evaluation Ⅱ ( RR=1.077, 95 %CI 1.006-1.153, P=0.032) were independent prognostic risk factors. Conclusions:Microcirculation alterations are common in patients with septic shock, and it is hard to predict the types of microcirculation alterations with hemodynamics parameters. The prognosis of patients with septic shock is related to the types of microcirculation alterations, suggesting that routine monitoring of microcirculation might be helpful to guide hemodynamic therapy.