Automatic detection of retinopathy with optical coherence tomography images via a semi-supervised deep learning method

Automatic detection of retinopathy via computer vision techniques is of great importance for clinical applications. However, traditional deep learning based methods in computer vision require a large amount of labeled data, which are expensive and may not be available in clinical applications. To mitigate this issue, in this paper, we propose a semi-supervised deep learning method built upon pre-trained VGG-16 and virtual adversarial training (VAT) for the detection of retinopathy with optical coherence tomography (OCT) images. It only requires very few labeled and a number of unlabeled OCT images for model training. In experiments, we have evaluated the proposed method on two popular datasets. With only 80 labeled OCT images, the proposed method can achieve classification accuracies of 0.942 and 0.936, sensitivities of 0.942 and 0.936, specificities of 0.971 and 0.979, and AUCs (Area under the ROC Curves) of 0.997 and 0.993 on the two datasets, respectively. When comparing with human experts, it achieves expert level with 80 labeled OCT images and outperforms four out of six experts with 200 labeled OCT images. Furthermore, we also adopt the Gradient Class Activation Map (Grad-CAM) method to visualize the key regions that the proposed method focuses on when making predictions. It shows that the proposed method can accurately recognize the key patterns of the input OCT images when predicting retinopathy.     

Multifactor study of efficacy and recurrence in laparoscopic surgery for inguinal hernia

BACKGROUNDInguinal hernia is a common clinical manifestation in children with a low self-healing rate. AIMTo determine the effect of laparoscopic surgery on indirect inguinal hernia and the risk factors for postoperative recurrence and to provide a reference for the clinical treatment and prevention of recurrence.METHODSWe selected 360 children who underwent laparoscopic high ligation in our hospital as the laparoscopic group and 120 patients treated for inguinal hernia with conventional surgery as the control group. The operation time, blood loss, incision length, hospitalization time, total hospitalization cost and surgical complications were compared between the two groups. According to telephone follow-up or return visits, the children who had recurrence within 2 years after the operation in the laparoscopic group were analyzed, and the laparoscopic high ligation hernia sac level was analyzed by the logistic multifactor method. Ligation was used to treat recurrence in children with inguinal hernia.RESULTSThe operation time, blood loss, length of incision, and length of hospital stay in the laparoscopic group were lower than those in the control group (P < 0.05). The total hospitalization cost in the laparoscopic group was higher than that in the control group (P < 0.05). The operative complication rate was 1.67% lower than that in the control group (12.50%) (P < 0.05). In 360 children with laparoscopic high ligation of the hernia sac, 14 patients had recurrence within 2 years after surgery. After analysis, 14 cases in the recurrence group did not recur. The preoperative incarceration rate, inner ring diameter, ligature use and age difference were statistically significant (P < 0.05). According to logistic regression multivariate analysis, an inner ring diameter ≥ 1.0 cm, the use of an absorbable ligature line and age > 3 years increased the risk of postoperative recurrence in children with inguinal hernia after laparoscopic high ligation of the hernia sac (P < 0.05). CONCLUSIONLaparoscopic surgery for indirect inguinal hernia in children has the advantages of low trauma and a rapid postoperative recovery. An inner ring diameter ≥ 1.0 cm, the use of absorbable ligature, and age > 3 years may increase the risk of recurrence after laparoscopic high ligation of the hernia sac.     

Combined cesarean delivery and repair of acute aortic dissection at 34 weeks of pregnancy during COVID-19 outbreak: A case report

BACKGROUNDSince the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, the exclusion of a patient from COVID-19 should be performed before surgery. However, patients with type A acute aortic dissection (AAD) during pregnancy can seriously endanger the health of either the mother or fetus that requires emergency surgical treatment without the test for COVID-19. CASE SUMMARYA 38-year-old woman without Marfan syndrome was admitted to the hospital because of chest pain in the 34^th week of gestation. She has diagnosed as having a Stanford type-A AAD involving an aortic arch and descending aorta via aortic computed tomographic angiography. The patient was transferred to the isolated negative pressure operating room in one hour and underwent cesarean delivery and ascending aorta replacement. All medical staff adopted third-level medical protection measures throughout the patient transfer and surgical procedure. After surgery, the patient was transferred to the isolated negative pressure intensive care unit ward. The nucleic acid test and anti-COVID-19 immunoglobulin (Ig) G and IgM were performed and were negative. The patient and infant were discharged without complication nine days later and recovered uneventfully. CONCLUSIONThe results indicated that the procedure that we used is feasible in patients with a combined cesarean delivery and surgery for Stanford type-A AAD during the COVID-19 outbreak, which was mainly attributed to rapid multidisciplinary consultation, collaboration, and quick decision-making.     

瑞马唑仑临床应用的研究进展

瑞马唑仑是一种新型的超短效苯二氮?类药,它具有像瑞芬太尼一样器官独立的新陈代谢作用,并能像咪达唑仑一样作用于γ氨基丁酸（GABA）受体。其起效快,恢复迅速,对肝肾功能及血流动力学影响较轻,且能够被氟马西尼快速逆转,这些药理作用使瑞马唑仑在理论上成为较理想的镇静药物。本文主要就瑞马唑仑的作用机制、药代动力学、对器官功能的影响、临床应用研究进展进行综述,为其临床应用提供理论依据。     

Intentional replantation of periodontally involved hopeless teeth: a case series study

To explore the clinical effect, the healing modes, and the potential influence factors of intentional replantation for periodontally hopeless teeth in comb     

低氧环境下Notch信号通路对人牙髓干细胞成牙本质向分化的影响

目的探讨低氧环境下通过低氧诱导因子-1α（HIF-1α）调控Notch信号通路对人牙髓干细胞（HDPSC）成牙本质向分化能力的影响。 方法组织块酶消化法培养HDPSC,给予氯化钴（CoCl₂）诱导的化学性低氧环境,Western blot检测HIF-1α蛋白表达,茜素红染色检测细胞矿化结节形成能力,反转录聚合酶链反应（RT-PCR）检测Notch下游靶基因Hes1与成牙本质相关基因的表达;进一步加入Notch信号通路特异性阻断剂γ分泌酶抑制剂（GSI）,观察以上指标的变化。报告基因方法检测HIF-1α对Notch信号通路的调控作用。采用R version 3.5.3软件进行统计分析,计量资料进行正态检验,多组间比较采用单因素方差分析（方差齐）或Kruskal-Wallis H检验（方差不齐）,两两比较采用LSD-t检验（方差齐）或Mann-Whitney U检验（方差不齐）。 结果（1）CoCl₂诱导的低氧条件下HDPSC中的HIF-1α蛋白水平上调,Notch下游靶基因Hes1 mRNA相对表达量为1.46 ± 0.12,相比常氧组（1.06 ± 0.09）显著增高（t = -4.64,P = 0.012）;GSI处理阻断Notch信号通路后,低氧条件下HDPSC中HIF-1α蛋白水平下调,Hes1 mRNA相对表达量降低至0.82 ± 0.14,与处理前相比差异有统计学意义（t = 5.98,P = 0.004）;常氧条件下GSI处理后的HDPSC中HIF-1α蛋白水平也明显下调,Hes1 mRNA相对表达量（0.30 ± 0.09）相比处理前也显著降低（t = 10.08,P = 0.001）;（2）矿化诱导后的茜素红染色结果显示：低氧处理后,HDPSC细胞成牙本质分化能力下降;GSI处理后,成牙本质向分化能力增强。成骨/牙本质相关基因mRNA表达水平检测结果显示：低氧处理后,BSP、OCN和DSPP的mRNA相对表达量分别为0.53 ± 0.14、0.43 ± 0.20、0.48 ± 0.11,相比常氧组（1.21 ± 0.12、1.08 ± 0.19、1.03 ± 0.13）显著降低（t_BSP = 6.30,P_BSP = 0.003;t_OCN = 4.07,P_OCN = 0.015;t_DSPP = 5.67,P_DSPP = 0.005）;GSI处理后,低氧条件下BSP、OCN和DSPP mRNA相对表达量分别为0.99 ± 0.13、1.09 ± 0.13、0.95 ± 0.16,与处理前相比显著增高（t_BSP = -4.17,P_BSP = 0.014;t_OCN = -4.83,P_OCN = 0.012;t_DSPP = -4.30,P_DSPP = 0.017）,常氧条件下BSP、OCN和DSPP mRNA相对表达量分别为1.73 ± 0.20、1.55 ± 0.08、1.52 ± 0.14,与处理前相比显著增高（t_BSP = -3.84,P_BSP = 0.027;t_OCN = -3.99,P_OCN = 0.035;t_DSPP = -4.43,P_DSPP = 0.011）。（3）荧光素酶报告基因结果显示,HIF-1α可调控NICD启动子,使双荧光素酶相对表达活性为5.37 ± 0.12,与对照组（2.09 ± 0.15）相比显著增强（t = -28.92,P<0.001）,提示HIF-1α可能使Notch信号通路激活。 结论低氧引起HDPSC中HIF-1α升高并可能通过激活Notch信号通路抑制其成牙本质向分化能力。     

Unilateral facial injection of Botulinum neurotoxin A attenuates bilateral trigeminal neuropathic pain and anxiety-like behaviors through inhibition of TLR2-mediated neuroinflammation in mice

ObjectivesIn this study, we investigated the possible analgesic effects of Botulinum toxin type A (BoNT/A) on trigeminal neuralgia (TN). A modified TN mouse model was established by chronic constriction injury of the distal infraorbital nerve (dIoN-CCI) in mice, and the possible roles of microglia toll-like receptor 2 (TLR2) and neuroinflammation was investigated.MethodsMale C57BL/6 mice were divided into 3 groups, including sham group, vehicle-treated TN group and BoNT/A-treated TN group. Bilateral mechanical pain hypersensitivity, anxiety-like and depressive-like behaviors were evaluated by using von Frey test, open field, elevated plus-maze testing, and forced swimming test in mice, respectively. The mRNA or protein expression levels of toll-like receptors (TLRs), glia activation markers and proinflammatory factors in the trigeminal nucleus caudalis (TNC) were tested by RT-qPCR, immunofluorescence and Western blotting. We also tested the pain behaviors of TN in Tlr2^−/− mice.ResultsWe found that unilateral subcutaneous injection of BoNT/A into the whisker pad on the ipsilateral side of dIoN-CCI mice significantly attenuated bilateral mechanical pain hypersensitivity and anxiety-like behaviors induced by dIoN-CCI surgery in mice. The dIoN-CCI surgery significantly up-regulated the expression of TLR2, MyD88, CD11b (a microglia marker), IL-1β, TNF-α and IL-6 in the ipsilateral TNC in mice, and BoNT/A injection significantly inhibited the expression of these factors. Immunostaining results confirmed that BoNT/A injection significantly inhibited the microglia activation in the ipsilateral TNC in dIoN-CCI mice. TLR2 deficiency also alleviated bilateral mechanical pain hypersensitivity and the up-regulation of MyD88 expression in the TNC of dIoN-CCI mice.ConclusionThese results indicate that unilateral injection of BoNT/A attenuated bilateral mechanical pain hypersensitivity and anxiety-like behaviors in dIoN-CCI mice, and the analgesic effects of BoNT/A may be associated with the inhibition of TLR2-mediated neuroinflammation in the TNC.     

Recent advances in liquid hydrosilane-mediated catalytic N-formylation of amines with CO2

Carbon dioxide is an ideal raw material for the synthesis of complex organic compounds because of its rich, non-toxic, and good physical properties. It is of great significance to transform CO₂ into valuable fine chemicals and develop a green sustainable cycle of carbon surplus. Based on hydrosilane as a reducing agent, this work summarizes the recent applications of reductive amidation of CO₂ using different catalysts such as organocatalysts, ionic liquids (ILs), salts, transition metal complexes, and solvents. The main factors affecting the reductive amidation of CO₂ and the possible reaction mechanism are discussed. Moreover, the future orientation and catalytic systems of the formylation of amines with CO₂ and hydrosilane are prospected.

This review depicts different types of catalyst systems developed for upgrading of amines and carbon dioxide into N-formylated products in the presence of hydrosilane, with attention on reaction mechanism and process optimization.