An improved U-Net model(channel attention module U-Net,CAMU-Net)is proposed to achieve precise segmentation of retinal vessels.CAMU-Net model enhances its understanding of regional features by employing residual enhancement convolution to extract important information from the regions,improves the global feature acquisition capability by introducing feature refinement module to promote feature extraction,realizes precise segmentation by adding channel attention module to capture image features accurately,and enhances its capability to perceive target boundaries and details through a multi-scale feature fusion structure.The ablation study on the DRIVE dataset validates the role of each module in retinal vessel segmentation.The comparison with other mainstream network models on DRIVE and STARE datasets verify that CAMU-Net model is superior to other models.

OBJECTIVE To investigate the causal association between ticagrelor and risk of infection METHODS Two-sample Mendelian randomization was adopted. Genetic instrumental variables were selected based on the results of the largest genome-wide association analysis to in vivo exposure of ticagrelor and its major active metabolite AR-C124910XX. The causal associations of ticagrelor and its major active metabolite AR-C124910XX with drug indications （coronary artery disease， unstable angina pectoris， myocardial infarction， stroke and ischemic stroke）were analyzed by inverse variance weighted Mendelian randomization model as a positive control for genetic instrumental variables. The causal relationship between ticagrelor and bacterial infection， acute lower respiratory infection， bacterial pneumoniae， pneumoniae，acute upper respiratory infection and sepsis were furtheranalyzed by using this method， and the robustness of the results was assessed by using heterogeneity tests and horizontal 202002030415） pleiotropy tests. RESULTS The increase of area under the curve at steady state （AUCss） of the genetic surrogated ticagrelor significantly reduced the risk of coronary artery disease， myocardial infarction and unstable angina pectoris （P＜0.001）. AUCss genetic instrument variables of its main active metabolite AR-C124910XX failed to pass positive control. Further analysis showed that the increase of the genetic surrogated ticagrelor exposure suggestively reduced the risk of bacterial infection [OR（95%CI）＝0.80（0.65，0.99），P＝0.040] and sepsis [OR （95%CI）＝0.84（0.73， 0.98）， P＝0.023]. The results of the heterogeneity tests showed that there was no heterogeneity in the causal association of the genetic surrogated ticagrelor AUCss with bacterial infection and sepsis （P＞0.05）. The results of horizontal pleiotropy tests showed that the causal association of genetic surrogated ticagrelor AUCss with bacterial infection and sepsis had no effects on horizontal pleiotropy （P＞0.05）. CONCLUSIONS Ticagrelor has a potential role in reducing the risk of sepsis and bacterial infections.

Objective:To study the effects of enhanced breastfeeding management on the neurodevelopmental outcomes of preterm infants in neonatal intensive care unit (NICU).Methods:From January to December 2020, preterm infants with gestational age (GA) ≥32 weeks admitted to NICU of our hospital were randomly assigned into the enhance group and the control group. Breast-feeding education using WeChat and routinely playing recorded mother's sound to the infants were carried out in the enhance group, while conventional management was carried out in the control group. Breastfeeding status was followed up regularly in both groups. Mental development index (MDI) and psychomotor development index (PDI) at 6-month of corrected GA were measured using Infant Intelligence Development Scale.Results:A total of 109 cases were included in the enhance group and 118 cases in the control group. The breast-feeding rates in the enhance group were significantly higher than the control group at discharge, 3-month and 6-month of corrected GA [88.1% (96/109) vs. 61.0% (72/118), 90.8% (99/109) vs. 67.8% (80/118), 88.1% (96/109) vs. 61.9% (73/118)] ( P<0.05). MDI and PDI at 6-month of corrected GA in the enhance group were significantly higher than the control group [(106.2±10.7) vs. (101.9±11.4), (103.4±13.7) vs. (99.5±11.6)] ( P<0.05). Conclusions:Enhanced breast-feeding management is helpful improving the breast-feeding rate of preterm infants in NICU and beneficial to the neurodevelopment of preterm infants.

OBJECTIVE: To review the development of adult and pediatric liver transplantation in Tianjin First Center Hospital, and to enhance academic exchanges, improve technological innovation, and jointly promote the progress and maturity in the field of liver transplantation. METHODS: The development of liver transplantation in Tianjin First Center Hospital was analyzed. The clinical data of adult and pediatric liver transplantation from September 1998 to September 2018 were collected. The important events and technological innovation achievements of liver transplantation during the 20 years were summarized. RESULTS: The first clinical liver transplantation was attempted in Tianjin First Central Hospital in April 1980. The first long-term survival adult liver transplantation in China was completed in 1994 (11 years survival after the operation). The specialized team of liver transplantation was formally established in September 1998. The 20-year clinical exploration and progress reflected the characteristics of era changes and technological innovation during the rapid development of liver transplantation in China. Our center performed liver re-transplantation in January 1999, reduced-size pediatric liver transplantation in August 2000. In May 2001, we organized the formulation for the preventive and treatment plan for hepatitis B recurrence after liver transplantation. We performed combined liver and kidney transplantation in July 2002, split liver transplantation (SLT) in April 2004, the first domino liver transplantation (DLT) in August 2005. Pediatric living donor liver transplantation (LDLT) was initiated in October 2006, adult LDLT was carried out in August 2007. In September 2007, the first living donor combined liver and kidney transplantation from the same donor in Asia was performed. The first domino+living donor double grafts liver transplantation in the world was performed in January 2009. In March 2011, we performed laparoscopically assisted right hepatic lobe liver transplantation (LDLT) with middle hepatic vein. In May 2014, living donor laparoscopic left lateral lobe procurement was successfully established. In April 2016, simultaneous liver, pancreas and kidney multi-organ transplantation was completed. Domino donor-auxiliary liver transplantation was performed in February 2017. In December 2017, extracorporeal membrane oxygenation (ECMO)-supported liver transplantation in a patient with severe pulmonary hypertension was successfully completed. Liver transplantation combined with partial splenectomy was established in April 2018. Cross-domino liver transplantation (hypersensitive kidney transplantation with auxiliary liver transplantation+pediatric liver transplantation) was performed in May 2018. During the 20 years, the team has performed or assisted other centers in Beijing, Shanghai, Guangzhou and Shenzhen to carry out more than 10 000 cases of liver transplantations. A total of 7 043 cases of various types of liver transplantation were performed in the single center of the hospital (6 005 adult liver transplantations and 1 038 pediatric liver transplantations). Concerning adult liver transplantation, the cumulative 1-year, 3-year and 5-year survival rate from September 1998 to March 2003 were 83.1%, 73.0% and 69.0%, from April 2003 to March 2009 were 85.3%, 76.2% and 72.1% and from April 2009 to September 2018 were 87.5%, 79.2% and 75.1%, respectively. The cumulative 1-year, 3-year and 5-year survival rate for pediatric liver transplantation were 93.5%, 92.2% and 90.2%, respectively. The nucleoside (acid) analogue combined with low dose hepatitis B immunoglobulin (HBIG) was developed to prevent the recurrence of hepatitis B after liver transplantation, this plan has reduced the recurrence rate of hepatitis B and the 5-year re-infection rate of hepatitis B virus (HBV) after liver transplantation significantly. The risk assessment system for tumor recurrence after liver transplantation was established and individual treatment method was established based on this assessment system. Continuous exploration and improvement of liver transplantation for liver cancer, liver re-transplantation, liver transplantation with portal vein thrombosis, SLT, DLT and multi-organ combined transplantation have significantly improved the clinical efficacy of patients and the post-operative survival rate. CONCLUSIONS The liver transplantation team of Tianjin First Center Hospital has carried out a scientific and technological exploration on the key problems and technical difficulties of clinical liver transplantation. This work strongly has initiated and promoted the rapid development of liver transplantation in China. The restrictive barrier of hepatitis B recurrence after liver transplantation has been overcome. The risk prevention and control system of tumor recurrence after liver transplantation has been established. A series of innovative achievements that can be popularized have been achieved in the field of complex liver transplantation and expansion of donor liver source. The iterative progress and sustainable development of liver transplantation have been realized.
China ; Humans ; Liver Transplantation

Objective To preliminary evaluate the mid-term clinical effect of endovascular repair in treating spontaneous extracranial internal carotid artery (ICA) dissection,and to observe the patency of stent.Methods The clinical data and imaging materials of 6 patients with spontaneous extracranial ICA dissection,who were treated with endovascular repair during the period from March 2012 to December 2012,were retrospectively analyzed.The U.S.National Institute of Heahh Stroke Scale (NIHSS) scores were determined before and after endovascular repair,and the postoperative stent patency condition was assessed,the results were analyzed.Results A total of 6 patients,including 4 males and 2 females with a median age of 50 years old (40.75-54.75 years old),received endovascular repair therapy.The median interval from the onset of disease to accept endovascular treatment was 10 days (one week-3 months).After the implantation of stent,the blood flow in the true lumen returned to normal immediately,although part of the false lumen was still filled with contrast agent.Embolism of retinal artery occurred in one patient during the operation,no death occurred.The median follow-up time was 54.4 months (49.7-57.9 months).The NIHSS score determined at the last follow-up visit was not significantly different from the preoperative one (P=0.102).Imaging reexamination revealed that the false lumen at the ICA stent segment disappeared in all 6 patients,and no obvious in-stent stenotic changes were observed.Conclusion Endovascular therapy of selected symptomatic extracranial carotid artery dissection with bare stents can effectively prevent the recurrence of clinical symptoms and promote ICA remodeling with excellent mid-term patency.

Objective To evaluate the efficacy of surgical procedure for tibia-fibula fracture using a combination of internal fixation and vacuum sealing drainage(VSD).Methods Totally 108 patients were enrolled in this study and these patients were from January 2012 to December 2015 divided into two groups(54 per group) according to the surgical method.Patients in the observation group were treated with locking plates or intramedullary naiis fixation combined with VSD covered the wound for the following 6 to 10 days,and then the transplantation was performed.Patients in control group received external fixation with kirschner wire and screw fixation.When granulation tissue filled the wound,flap transplantation was performed to repair tissue defect and cover the exposed bone.The average hospital stay,operation time,local infection rate,fracture healing time were recorded and analyzed.Results In the observation group,the average hospital stay was (24.8 ± 4.2) d,wound closure time was (9.4 ± 1.7) d,rate of local infection was 5.6％,rate of bone nonunion was 7.4％,rate of osteomyelitis was 1.9％,fracture healing time was (17 ±4.7)weeks;the corresponding data in the control group was (32.2 ±8.7)d,(14.1 ±3.8)d,22.2％,9.3％,0 and (16 ± 6.5) weeks.The average hospital stay,wound closure time and infection rate of the two groups were of significant difference(P ＜0.05).There was no significant difference in terms of bone nonunion rate,osteomyelitis rate and union time (P ＞ 0.05).Conclusion Tibia-fibula fracture patients can be effectively treated with a combination of internal fixation and vacuum sealing drainage (VSD).This treatment may shorten the length of hospital stay,reduce the wound-close time and lower the infection rate.

Objective To investigate the feasibility and preventive effect of benign esophageal restenosis by binding 125I seeds to upper esophageal stent through animal experiments.Methods Eight 125I seeds were evenly bound to upper normal esophageal stents for the animal experiments.A total of 32 beagle dogs were randomly assigned to 2 groups:experimental group,implanted with esophageal stents with eight 125I seeds (33.3 MBq),and the control (stents without 125I seeds).Four dogs of each group were killed at the 1 st,2nd,4th,and 8th week after imaging studies.The tissue of 2 cm upper stent underwent pathology analysis.Results All the novel stents were successfully implanted.No radioactive leak was detected by ECT.The lumen diameter of the top stent showed the tract gradually narrowed and at the 4th and 8th weeks,the experiment group narrowed more seriously compared with the control group and the difference was statistically significant (P ＜ 0.05).PCNA,ot-SMA mean optical density were significantly different in the 4th week.Both hydroxyproline and total amino acid increased progressively,with significant difference at the 4th and 8th weeks.The macroscopic and optical findings of the trachea and major vessels were basically the same in both groups.Conclusion The novel stent is feasible and safe for preventing benign esophageal restenosis and preventing benign esophageal stent restenosis.

Objective To evaluate the effects of low-dose 125I seeds to the esophagus fibroblast cell proliferation in vitro.Methods The titanium wire was implanted in the beagle dog's esophagus to induce fibroblast proliferation,and the esophageal tissue was removed after two weeks and cultured in vitro.The 125I seeds with different dose commonly used were chosen to irradiation fibroblast in group B (11.1 MBq × 9)、C (22.2 Mbq ×9) 、D (33.3 MBq ×9) for 72 hours,while in control group no 125I seeds were used.After irradiation,cells were collected.MTT and AnnexinV/PI double staining were performed respectively to evaluate the effects of 125I seeds in cell proliferation and apoptosis.Results The inhibition rate respectively:(26.81 ± 1.96) ％、(34.52 ± 3.21) ％ and (45.33 ± 2.59) ％ ; the apoptosis rate respectively:(6.73 ±0.57)％ 、(13.11 ± 1.39)％ and (15.23 ± 0.90)％.There were significant differences among the experimental groups and between every experimental group and the control group.Conclusion The three doses of 125I seeds could significantly inhibit the fibroblast proliferation and promote cells apoptosis,of which 33.3 MBq 12sI seed was the most significant.

Objective To establish and observe the canine model with esophageal stent implantation for further study of the benign stenosis caused by proliferation.Methods According to orthogonal design,different combinations of two stents and six polytetrafluoroethylene (PTFE) patches were confirmed.Stent was designed as cylinder with mushroom shape on both ends.Beagle dogs (weight 10-12 kg) were adopted and cervical segment of esophagus were dissected.After PTFE patch was encircled around the esophagus,stent was delivered under fluoroscopy.The main body of the stent was located in accordance with the patch.Eating condition and position of the stent were followed on week 1,2,4,6 and 8.Gross specimen was harvested at the end point,and the degree of tissue hyperplasia was evaluated.Each animal model was given a mark according to the eating condition and tissue hyperplasia.Results Eight combinations of stent and patch were provided with orthogonal design.Three models failed for the following reasons:unable to eat in one dog,stent disgorged out in another,and the third died from esophageal necrosis between stent and patch.Four models had obvious tissue hyperplasia on the segment of stent,and weight loss or stent dislocation were observed in each model.One model developed appropriate tissue hyperplasia with normal diet,and stent dislocation was not found during the follow-up.Significant difference was confirmed among 8 models (F =14.7000,P =0.031).Conclusion Animal model with appropriate tissue hyperplasia could be established with following elements:beagle dogs weight from 10 kg to 12 kg; stent 50 mm in length,20 mm in diameter,with top mushroom 10 mm in length,30 mm in diameter,and end mushroom 10 mm in length,25 mm in diameter; PTFE patch 60 mm in length,15 mm in width.

Periampullary carcinoma is a rare malignant tumor of digestive system,and its accurate diagnosis is still difficult.From January 2007 to July 2012,12 patients with periampullary carcinoma had been admitted to the Southwest Hospital of Third Military Medical University,and the imaging data were retrospectively analyzed.The results of ultrasonography revealed that all tumors were hypoechoic.The tumor displayed hyperenhancement in 3 patients,isoenhancement in 1 patient,hypoenhancement in 8 patients during the arterial phase on contrastenhanced ultrasonography (CEUS),while the tumor displayed hypoenhancement in all patients during the venous phase.Magnetic resonance imaging (MRI) plain scanning showed duodenal papilla enlargement in 1 patient,ampullary tissue mass signal in 2 patients,tissue mass signal at distal common bile duct in 2 patients,the rest 7 patients did not show tissue mass signal.Lower biliary obstruction was the common manifestation of the 12 patients on magnetic resonance cholangiopancreatography (MRCP),intrahepatic and extrahepatic bile vine-like expansion in 4 patients,double duct sign in 2 patients,the bottom of common bile duct with filling defect in 2 patients and it revealed beak-like narrow in 1 patient.CEUS,MRI and MRCP could both play an important role as conventional methods in diagnosing periampullary carcinoma.