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Diabetic retinopathy (DR) is one of the most serious complications of diabetes mellitus. Severe diabetic macular edema or proliferative retinopathy may lead to impaired vision or even blindness in diabetic patients. The glucagon-like peptide-1 receptor agonist (GLP-1RA) is now commonly used as novel glucose-lowering agents in the clinical management of type 2 diabetes, but the rapid glycaemic changes associated with the use of the GLP-1RA may aggravate the risk of an increase in the occurrence of short-term potential DR. Potential effects and mechanisms of DR include oxidative stress, vascular endothelial growth factor, inflammation, retinal neurodegeneration, and other cytokines.Whether GLP-1RA leads to the increased risk of DR remains controversial. More basic and clinical studies are needed with the aim of further clarifying the correlation between GLP-1RA and DR risk.

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Objective To explore the diagnostic value of transcranial substantia nigra ultrasound in Parkinson's disease(PD)and the clinical characteristics of patients with different substantia nigra(SN)echoes.Methods Sixty patients with PD admitted to Yichun Hospital of Traditional Chinese Medicine from October 2020 to January 2023 were included in study group,and another 60 normal persons who received health examination in our hospital during the same period were included in control group.Both groups were examined by transcranial substantia nigra ultrasound.The SN high-echo area and ratio of total area of hyperechoic substantia nigra to total area of mesencephalon(S/M)of two groups were compared,and the positive rate of PD diagnosed by transcranial substantia nigra ultrasound was calculated.According to the intensity of SN echo,PD patients were divided into PD-SN-group and PD-SN+ group,and the clinical characteristics of patients with different SN echo were compared.Results The SN high-echo area and S/M of study group were significantly higher than those of control group(P<0.05).Transcranial substantia nigra ultrasound showed PD-SN-in 10 cases and PD-SN+ in 50 cases.The positive rate of PD diagnosed by transcranial substantia nigra ultrasound was 83.33%(50/60).There were statistically significant differences between PD-SN+ group and PD-SN-group in gender,age,H-Y stage,age of onset,score of mini mental status examination and score of Montreal cognitive assessment(P<0.05).Conclusion Transcranial substantia nigra ultrasound can better help clinical screening and detection of PD,and improve the positive detection rate of PD.

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@#Abstract: Objective To investigate the impacts of blood pressure (BP) variability on neurological deterioration in patients with acute ischemic stroke after intravenous thrombolysis (IVT). Methods The clinical data of 134 patients after IVT in Department of Neurology, Affiliated jinhua Hospital, Zhejiang University School of Medicine from January 2020 to September 2020 were retrospectively analyzed, including hour-to-hour BP measurements. BP variability profiles, including average squared difference between successive measurements (sv), standard deviation (sd) were calculated. Early neurological deterioration (END) was defined as the National Institutes of Health Stroke Scale > 4 or death within 24 hour after IVT. The binary logistic-regression model was performed to determine the independent risk factors of END. Results Among134 patients, with mean age 67 year and median NIHSS 5,11 (8. 2%) patients achieved END. Compared with non-END group, END group has higher systolic BP sd (18 vs 14, t=-2.567,P=0.011),systolic BP sv (22 vs 17, t= -1.988, P=0.049). diastolic BP sd (13 vs 9.8.t= -2.431, P=0.016). Systolic BP sd, systolic BP sv and diastolic BP sd were related to the occurring of END independently. Conclusions SP variability is negatively associated with neurological deterioration occurring within 24h following ischemic stroke with intravenous thrombolysis.

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Takayasu arteritis (TA) is a rare, chronic non-specific vasculitis that can lead to ocular hypoperfusion. As a result, ocular ischemic syndrome (OIS), which prominently manifests as Takayasu retinopathy, may develop subsequently. Ocular manifestations mainly consist of progressive painless vision loss and amaurosis fugax in TA patients complicated with OIS. However, due to the lack of specific clinical characteristics, it is of great significance to improve the timely diagnosis aided by multimodal imaging, especially fundus fluorescein angiography. Early diagnosis of OIS is essential for reversal of ocular ischemia and better prognosis of TA patients. Management of OIS patients associated with Takayasu arteritis requires a combination of systemic and ophthalmic treatment. Therefore, the optimal individualized regiment should be determined by disease activity and progression, which are addressed by multi-disciplinary team assessment. Ophthalmologists should further understand the clinical features and the importance of regular ophthalmologic examinations during the disease course, thus to improve the overall survival and visual outcomes.

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Age-related macular degeneration (AMD) causes vision loss mainly due to apoptosis of retinal pigment epithelium cells and subsequent degeneration of photoreceptors.Active and passive smoking can increase the incidence of AMD and the progression risk of advanced AMD, and affect the treatment effect of wet AMD.Smoking can cause choroidal vasoconstriction, increased vascular resistance, vascular endothelial dysfunction, thinned choroid and ganglion cell complexes, resulting in impaired vascular reactivity of choroid and retinal vessels.Nicotine in cigarettes can lead to the overexpression of vascular endothelial growth factor (VEGF), which increases the permeability of vessel and proliferation of endothelial cells, thus induces the formation of choroidal neovascularization (CNV). Smoking can induce oxidative stress leading to oxidative damage, reduce the expression of complement factor H, increase the membrane attack complex, lead to macrophage dysfunction, promote the formation of drusen, and induce the formation of CNV.Therefore, a full and deep understanding of the relationship between smoking and CNV and AMD in controlling the occurrence of AMD and preventing the formation of CNV is of great significance for the early prevention of AMD and the exploration of more effective treatment approaches.

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Nanophthalmos is a congenital disorder, which is characterized by small eye without any ocular or systemic malformation. It has autosomal-dominant and recessive forms of inheritance. It manifests as reduced total axial length, high hyperopia and thickened sclera. Nanophthalmos is relatively rare, but at high risk of secondary angle-closure glaucoma, uveal effusion syndrome. It can be spontaneous remission or recurrent, and responses poorly to medication. The effect of systemic glucocorticoid treatment is not ideal. The surgery challenges with very high rate of intra- and post-operative complications such as hemorrhage, choroidal and retinal detachment, malignum glaucoma and uveal effusion, so that the prognosis is poor. It is of great instructive significance to further understand the clinical features, complications and treatment progress and to avoid the missed diagnosis and misdiagnosisi of its complications, and thus choose the right management.

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BACKGROUND: Age, sex, body mass index, hepatitis C infection, immunosuppressive drugs and family history of diabetes mellitus are shown to be risk factors for new-onset diabetes mellitus after kidney transplantation, but their effects remain controversial. OBJECTIVE: To systematically assess the risk factors for new-onset diabetes mellitus after kidney transplantation, so as to provide evidences for preventing and controlling the disease. METHODS: PubMed, Embase, Cochrane Library and CBMdisc databases were searched for the articles concerning risk factors for new-onset diabetes mellitus after kidney transplantation published between January 2005 and May 2018. Two researchers extracted data from each study based on inclusion and exclusion criteria. Quality assessment was conducted in accordance with New castle-Ottawa Scale standard. Meta-analysis was performed on Revman 5.3 software to identify the risk factors for new-onset diabetes mellitus after kidney transplantation. RESULTS AND CONCLUSION: (1) Twenty-one studies involving 8 206 patients were included. There were 1 489 cases of new-onset diabetes mellitus after kidney transplantation, and the morbidity was 18.15％. (2) The meta-analysis identified the following seven significant risk factors, non-modifiable risk factors: age ≥ 50 years, and donor type; modifiable risk factors: body mass index ≥ 25 kg/m2, acute rejection, tacrolimus usage, hepatitis C infection and polycystic kidney. (3) Uncertain risk factor was family history of diabetes. (4) To conclude, age, donor type, body mass index ≥ 25 kg/m2, acute rejection, tacrolimus usage, hepatitis C infection and polycystic kidney are risk factors for new-onset diabetes mellitus after kidney transplantation. But whether the family history of diabetes mellitus is the risk factor remains uncertain.

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Adaptive optics (AO) is a technique to improve the performance of optical systems by reducing the influence of optical aberrations. Combined with scanning laser ophthalmoscope (AOSLO), the aberration of human refractive system can be corrected. Thus, the resolution and quality of imaging can be greatly improved to the cellular level in vivo retina (such as photoreceptor, nerve fibers, vascular parietal cell), therefore the earlier changes of the diseases can be detected. At the same time, microstructure changes of retinal can also be observed during the follow-up of the disease. Due to inherent technical defects of AOSLO, its wide application in clinical practice is limited. With the continuous progress of AO technology and the further improvement of related software functions, the function of the system will become more stronger and will play a more and more important role in scientific research and clinic.

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Adaptive optics (AO) is a technique to improve the performance of optical systems by reducing the influence of optical aberrations.Combined with scanning laser ophthalmoscope (AOSLO),the aberration of human refractive system can be corrected.Thus,the resolution and quality of imaging can be greatly improved to the cellular level in vivo retina (such as photoreceptor,nerve fibers,vascular parietal cell),therefore the earlier changes of the diseases can be detected.At the same time,microstructure changes of retinal can also be observed during the follow-up of the disease.Due to inherent technical defects of AOSLO,its wide application in clinical practice is limited.With the continuous progress of AO technology and the further improvement of related software functions,the function of the system will become more stronger and will play a more and more important role in scientific research and clinic.

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Optical coherence tomography angiography (OCTA) is a new and noninvasive imaging technique that generates real-time blood flow pattern on chorioretinal vasculature. In order to apply this novel technology in the practice to diagnose and treat ocular fundus diseases, we need to further strengthen the quality of OCTA image acquisition and reporting specifications. We need to understand its technical principle, and multiple factors affecting the OCTA image acquisition and interpretation. Furthermore, In the process of image acquisition, as well as analysis and interpretation, we need to pay attention to the stratification, interpretation of blood flow signals and identification of artifacts of OCTA images.

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Objective To investigate the efficacy and side effects of aripiprazole combined with modified electroconvulsive therapy (MECT) in the treatment of female refractory schizophrenia.Methods One hundred and five female refractory schizophrenia patients in the Second Affiliated Hospital of Xinxiang Medical University from July 2014 to May 2016 were selected and divided into control group and observation group.Fifty-two patients in the control group were treated with aripiprazole.In the observation group,53 patients were treated with aripiprazole combined with MECT.All the patients were treated for eight weeks.Clinical efficacies were assessed with the positive and negative syndrome syndrome scale (PANSS);Wechsler memory scale (WMS) were used to evaluate the effect of MECT on memory.Adverse drug reactions were evaluated by treatment emergent symptom scale(TESS) before and after treatment in both groups.Results There was no significant difference in PANSS scores between the two groups before treatment (P ＞ 0.05).The positive symptom scores,the general mental pathology scores and the PANSS total scores in the two groups at the end of the second week were significantly lower than before treatment(P ＜ 0.05);at the end of fourth and eighth week of treatment,the negative symptom scores,the positive symptom scores,the general psychopathological scores and the PANSS total scores of the two groups were significantly lower than those before treatment (P ＜ 0.05 or P ＜ 0.01).The positive symptoms,the general psychopathological scores and the PANSS total score in the observation group were significantly lower than those in the control group at the end of fourth week of treatment (P ＜0.05).At the end of the eighth week of treatment,the negative symptom scores,the positive symptom scores,the general psychopathological scores and the PANSS total scores in the observation group were significant lower than those in the control group (P ＜ 0.05).At the end of the eighth week of treatment,the decreasing rates of PANSS score in the observation group and control group were (39.89-8.62) ％ and (31.97-± 8.17) ％,and the total effective rates were 66.67％ and 48.08％,respectively.The decreasing rates of PANSS score and total effective rates in the observation group were higher than those in the control group (P ＜ 0.05).The WMS score of the observation group decreased more significantly at the end of the second week of treatment compared with that before treatment;at the end of the fourth week of treatment,the score of the picture was louer than that before treatment(P ＜ O.05);but there was no significant difference in WMS score between that at the end of the eighth week and before treatment(P ＞ 0.05).There was no significant difference between the two groups in the TESS score and adverse reaction rate (P ＞ 0.05).Conclusion Compared with single application of aripiprazole,MECT combined with aripiprazole can significantly improve effects in treating female refractory schizophrenia and it can not increase the side effects.

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<p><b>OBJECTIVE</b>To investigate the relationship between maximal infarct volume to benefit from intravenous thrombolysis (IVT) and onset to needle time (ONT).</p><p><b>METHODS</b>The clinical and image data of acute ischemic stroke patients who received IVT in the second Affiliated Hospital, Zhejiang University School of Medicine during May 2009 to June 2016 were retrospectively reviewed. Patients were classified into within-time-window group (ONT ≤ 4.5 h) and beyond-time-window group (ONT>4.5 h). Good and poor outcome were defined as modified Rankin scale (mRS) ≤ 2 or >2 at 3 months, respectively. The maximal infarct volume was analyzed by receiver operating characteristic (ROC) curve.</p><p><b>RESULTS</b>Among 587 patients (465 cases were within-time-window, 122 cases were beyond-time-window), baseline core volume was 15(2-46)mL,and 324 (55.2%) patients achieved good outcome. Compared with the good-outcome group, the baseline core volume was larger in the poor-outcome group (32 mL vs 5 mL,=-9.766,<0.01). After adjusting age, ONT, baseline National Institutes of Health Stroke Scale (NIHSS) and atrial fibrillation, baseline infarct core volume independently predicted poor outcome (=1.014, 95%:1.008-1.020,<0.01). The ROC curve analysis showed that the maximal infarct core volume for achieving good outcome in the within-time-window group and beyond-time-window group were 152 mL and 71mL, respectively. The maximal infarct volume to benefit from IVT diminished with the increasing delayed ONT of every 30 min (=-0.691,<0.05).</p><p><b>CONCLUSIONS</b>The maximal infarct volume to benefit from thrombolysis is larger in patients treated within time window than those beyond the time window, and that volume diminishes with ONT delay.</p>

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<p><b>OBJECTIVE</b>To evaluate the value of collateral score based on CT perfusion (CTP-CS) in predicting the clinical outcome of patients with anterior circulation ischemic stroke after thrombectomy.</p><p><b>METHODS</b>Clinical data of acute ischemic stroke patients with anterior artery occlusion undergoing endovascular treatment in the Second Affiliated Hospital, Zhejiang University School of Medicine during October 2013 and October 2016 were retrospectively reviewed. Collateral scores were assessed based on CTP and digital subtraction angiography (DSA) images, respectively. And DSA-CS or CTP-CS 3-4 was defined as good collateral vessels. Good clinical outcome was defined as a modified Rankin Scale (mRS) ≤ 2 at 3 months after stroke. The binary logistic regression model was used to analyze the correlation between the collateral score and clinical outcome, and the receiver operating characteristic (ROC) curve was used to analyze the value of DSA-CS and CTP-CS in predicting the clinical outcome.</p><p><b>RESULTS</b>Among 40 patients, 33 (82.5%) acquired recanalization and 16 (40.0%) got good outcome. Compared with poor outcome group, the collateral score (all<0.05) and the rate of good collateral vessels were higher in good outcome group (all<0.01). After adjust baseline National Institute of Health Stroke Scale (NIHSS) and onset to recanalization time (ORT), good collateral vessels were independent factor of good outcome (CTP-CS:=48.404, 95%:1.373-1706.585,<0.05; DSA-CS:=34.651, 95%:1.147-1047.018,<0.05). Collateral scores based on CTP and DSA had good consistency (=0.697,<0.01), and ROC curve showed that the predictive value of CTP-CS and DSA-CS were comparable (both AUC=0.726, 95%:0.559-0.893,<0.05).</p><p><b>CONCLUSIONS</b>CTP-CS can predict the clinical outcome of patients with anterior circulation ischemic stroke after thrombectomy.</p>

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Objective:To observe the efficacy and safety of azithromycin combined with Bailing capsules in the treatment of chron -ic obstructive pulmonary disease ( COPD) in stable phase .Methods:Totally 154 cases of COPD patients were randomly divided into the treatment group(80 cases)and the control group(74 cases).Both groups were treated with the routine symptomatic treatment , and at the same time, the control group was treated with Bailing capsules (1 g, po, tid)and the treatment group was treated with azithromy-cin tablets (250 mg, po, qd)combined with Bailing capsules(1 g, po, tid).The course of treatment was 6 months and all the patients were followed up for 6 months after the treatment.The clinical efficacy, lung function, exercise tolerance, quality of life, the times of acute exacerbation and the incidence of adverse drug reactions of the two groups were observed and compared .Results:After the treat-ment, the lung function, exercise tolerance and quality of life were improved significantly in the two groups (P0.05).Conclusion:Azithromycin tablets combined with Bailing capsules can improve lung function , enhance exer-cise tolerance , improve the quality of life and reduce the frequency of acute exacerbation effectively with good security in the treatment of patients with COPD in stable phase .

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Objective:To extract, separate and identify the flavonoids in Humulus Scandens and detect their cytotoxic effect on cells HepG2. Methods: After Humulus scandens bing was extracted by alcohol, luteolin-7-O-β-D-glucoside ( LGL) and cosmoiin ( AGL) were obtained by using column chromatography and identified by spectral analysis. The inhibitory effects of LGL and AGL on HepG2 cells were detected by a typan blue dye method. Results:The main flavonoids in Humulus Scandens were LGL and AGL. When the concentration of LGL and AGL was increased from 6. 25 μmol·L-1 to 100. 0 μmol·L-1 , the inhibition rate of LGL was increased from 28. 8% to 95. 2% and that of AGL was increased from 3. 6% to 21. 3%. Conclusion: LGL has notable inhibitory effect on HepG2 cells in a dose-dependent manner, while the inhibitory effect of AGL is not obvious.

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Background It is well known that tissue factor (TF) is expressed in tumor cells and neovascular endothelial cells of tumor.It plays an important role in the formation of new blood vessels as well as the growth and metastasis of tumor.However,whether TF is expressed or not in choroidal melanoma(CM)is unclear.Objective This study is to investigate the expression of TF in a choroidal melanoma cell line and human choroidal melanoma.Methods The expression of TF was studied in the optimal choroidal melanoma-1 (OCM-1) cell line and ten specimens from CM patients using immunhistochemistry.Ten normal eye specimens from donators were used as controls.Results The TF protein was mainly expressed in the cytoplasm.It is over-expressed in OCM-1 cells with positive rate of 85.33±5.47%.Hyper-expression of TF also was found in human choroidal melanoma with a positive rate of 41.60±14.17%.The integrated optical density (IOD) of positive cells in CM was 33853.67±16445.30,and only 5.65±4.26% of positive cells was found in normal human choroidal tissue.The IOD of TF expression in normal human choroidal tissue was 426.43±316.62.Conclusion The overexpression of TF in CM cells may be a new immunotherapy target for CM treatment.

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HLA-A * 0201, HLA-A * 1101, and HLA-A * 2401 CTL restricted epitopes of platelet membrane glycoprotein II b/III a antibody of human and mice were predicted by use of SYFPEITHI, RANKPEP, BIMAS, SVMHC, PREDEP, MHCPRED, and PROPRED predictive programs. In the results, the peptides (found in HLAPRED) that can lead to autoimmune disease and have been published were removed; and the epitopes of HLA-A * 0201 must cover the epitopes of HLA-A * 1101 and HLA-A * 2401 being combined to predTAP and TAPPred for predicting the binding affinity of peptides toward the TAP transporter and NetChop, MAPPP, PAProc for predicting cleavages; HLA-DR Th restricted epitopes of GPII b/III a antibody were predicted by SYFPEITHI, RANKPEP, MHCPRED, and HLAPRED, after removal of the peptides (found in HLAPRED) that can lead to autoimmune disease and have been published, the Th epitopes must cover the CTL mixed epitopes as being stated above. The secondary structure, hydrophobic regions, flexibility, surface probability and the B cell epitope were predicted by using various methods. Ten mixed peptides of T cell epitopes were selected from more than 1 740 peptides. They were located at the aa9-115, aa24-38, aa50-64, aa65-81, aa109-121 of anti-GP II b/III a-Human and the aal-15, aa26-40, aa46-60, aa68-82, aa93-107 of anti-GP II b/III a-Mice. B cell epitopes of anti-GP II b/III a-Human might locate at aa5-9, aa22-30, aa40-46, aa55-71, aa80-90, aa100-105, aa110-115; and the epitopes of anti-GP II b/III a-Human might locate at aa5-10, aa38-43, aa58-70, aa77-84, and aa99-105.

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OBJECTIVE@#To investigate the mechanism underlying the anticancer activity of cucurbitacin B on human laryngeal cancer.@*METHOD@#Hep-2 cells were treated with different concentrations of cucurbitacin B for different time. MTT assay was used to evaluate cell proliferation. Flow cytometry with PI staining and fluorescent microscopy with Hoechst 33258 staining were used to estimate cell cycle distribution and cell apoptosis. Expression of p-STAT3, cyclin B1 and Bcl-2 proteins was evaluated by Western blot assay. In vivo inhibitory effects of cucurbitacin B on tumor growth was evaluated in a nude mouse xenograft model.@*RESULT@#Cucurbitacin B inhibited cellular proliferation in a dose and time dependent manner (P <0.05 or 0.01). Flow cytometry analysis showed that treatment with cucurbitacin B resulted in accumulation of cells at the G2/M phase of the cell cycle and cell apoptosis in a dose and time dependent manner (P <0.05 or P <0.01). Marked morphological changes of cell apoptosis including condensation of chromatin, nuclear fragmentation and apoptotic bodies were observed clearly by Hoechst 33258 staining. Western blot analysis demonstrated that the expression of p-STAT3, cyclin B1 and Bcl-2 proteins was suppressed significantly. In vivo studies showed that the inhibitory rates on laryngeal squamous carcinoma xenograft model were 32.43%, 43.24% and 70.27% for lower, moderate and higher dosage group, respectively.@*CONCLUSION@#Cucurbitacin B inhibited cell proliferation and induced apoptosis of Hep-2 cells by suppressing STAT3 signal pathway, down regulating the expression of cyclin B1 and Bcl-2 proteins.

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Objective To evaluate the inhibited effects of small interfering RNA targeting Rac1(Rac1-siRNA)on rat retinal neovascularization in retinae.Methods Retinal vein occlusion was indueedby retinal photodynamic medthod in 25 Sprague-Dawley rats.Rae1-siRNA vector DNA was injected intothe vitrous of one eye of those rats(gene intervention group),and empty vector DNA was injected into thefellow eye(blank control group).Rae1-siRNA vector was injected in other 25 SD rats without retinal veinocclusion(blank intervention group).Two weeks after injection,fluorescein isothiocyanate(FITC)-dextran was perfused into the hearts of all the rats,and the retinal wholemount was made to observe theneovascularization.The numbers of endothelial cells which break through the internal limiting membranewere counted after hematoxylin-eosin staining.Resuits A massive of neovascularization and FITCleakage were found in blank control group.Small part of neovaseularization and a little FITC leakage wereobserved in the gene intervention group.Retinal vessels were normal in blank intervention group.Compared with blank contrast group and blank intervention group.the difference of the mean numbers ofendothelial cells which broke through the internal limiting membrane in the gene intervention group wassignificant(F=47.168,P=0.000).Conclusion Racl-siRNA can inhibit retinal neovascularizationinduced by retinal vein occlusion in rats.

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Objective To investigate the effect of 8 Hz infrasound on the expression of brain derived neurotrophic factor(BDNF)in the rat hippocampus.Methods Forty-eight Sprague-Dawley rats were randomly divided into groups to be exposed to 90,100 and 130 dB infrasound,and a control group(n=12).All the animals in the infrasound exposure groups were exposed to 8 Hz infrasound at the planned intensity for 2 hours daily for 4 weeks.The rats of the control group were treated identically except that the infrasound amplitude was 0 dB.The animals were sacrificed and their brains were examined at the end of the 4-week infrasound exposure.Western blotting was used to detect the expression of BDNF protein,and in situ hybridization(ISH)was used to observe the distribution of BDNF mBNA in the hippocampus.Results Eight Hz infrasound induced down-regulation of BDNF protein in the hippocampus,with volume-dependent characteristics.ISH showed that BDNF mRNA was distributed widely in the hippocampus.After exposed to infrasound,BDNF mRNA in the hippocampus decreased,especially in the dental gyrus.Conclusion Eight Hz infrasound can down-regulate the expression of BDNF in the hippocampus,especially in the dental gyrus.