Comparison of intravitreal ganciclovir monotherapy and combination with foscarnet as initial therapy for cytomegalovirus retinitis

AIM：To compare the effectiveness between multiple intravitreal injections of ganciclovir alone and combined with foscarnet as initial treatment for patients with newlyonset cytomegalovirus retinitis （CMVR）.METHODS：The retrospective study observed 37 patients（58 eyes） who suffered from CMVR onset between 2013 and 2015. Among them, 35 eyes underwent 4 weekly intravitreal injections of 3.0 mg ganciclovir, and 23 eyes underwent 4 weekly injections of 3.0 mg ganciclovir combined with 2.4 mg foscarnet. Visual acuity, intraocular pressure and viral load of cytomegalovirus （CMV） in aqueous humor measured by real-time polymerase chain reaction were compared before and after each injection.RESULTS：CMV-DNA copies in aqueous humor decreased remarkably in both groups. The average of CMV-DNA copies in patients’ aqueous decreased from 38.3×10~4 copies/mL at baseline to 2.2×10~4 copies/mL after the 4^（th） injection in patients who were treated with ganciclovir monotherapy,and decreased from 76.9×10~4 copies/mL to 11.3×10~4 copies/mL after 4 continuous injections of ganciclovir combined with foscarnet. No significant difference was found in reduction of viral load, change of visual acuities or intraocular pressures between monotherapy or combined therapy.CONCLUSION：Results of this study show that the initial effectiveness of treating CMVR after 4 weekly intravitreal injections is not significantly different from ganciclovir alone or combined with foscarnet. Continuous injection of ganciclovir alone is sufficient in treating immunosuppressive patients with newly-onset CMVR.

Application of artificial intelligence-driven endoscopic screening and diagnosis of gastric cancer

The landscape of gastrointestinal endoscopy continues to evolve as new technologies and techniques become available.The advent of image-enhanced and magnifying endoscopies has highlighted the step toward perfecting endoscopic screening and diagnosis of gastric lesions.Simultaneously,with the development of convolutional neural network,artificial intelligence(AI)has made unprecedented breakthroughs in medical imaging,including the ongoing trials of computer-aided detection of colorectal polyps and gastrointestinal bleeding.In the past demi-decade,applications of AI systems in gastric cancer have also emerged.With AI’s efficient computational power and learning capacities,endoscopists can improve their diagnostic accuracies and avoid the missing or mischaracterization of gastric neoplastic changes.So far,several AI systems that incorporated both traditional and novel endoscopy technologies have been developed for various purposes,with most systems achieving an accuracy of more than 80%.However,their feasibility,effectiveness,and safety in clinical practice remain to be seen as there have been no clinical trials yet.Nonetheless,AI-assisted endoscopies shed light on more accurate and sensitive ways for early detection,treatment guidance and prognosis prediction of gastric lesions.This review summarizes the current status of various AI applications in gastric cancer and pinpoints directions for future research and clinical practice implementation from a clinical perspective.

Vitreous haemorrhage:a population-based study of the incidence and risk factors in Taiwan

AIM：To report the epidemiology and incidence of vitreous hemorrhage and to evaluate risk factors for patients with vitreous hemorrhage（VH）in Taiwan.METHODS：A retrospective population-based study.Analyzing a sample of one million subjects from all enrollees of the Taiwan Health Insurance programme. All data were obtained from the Taiwan Health Insurance Research Database,which contained patient sex,date of birth,all records of clinical visits and hospitalizations,and diagnosis codes as included in the International Classification of Diseases,Ninth Revision,Clinical Modification（ICD-9-CM）. The main outcome measures were the incidence and risk factors of VH.RESULTS：From 2001 to 2010,the database claim 4379 newly diagnosed cases were identified with VH. The average incidence of VH in Taiwan was 4.8 cases per ten-thousand person-years generally and increased with time especially in subjects who aged between 40 and 59 y and when the VH was associated with proliferative diabetic retinopathies or retinal vein occlusions. A de-finitely upward trends in the incidence of VH from 2001 to 2010 were noted（P-value for increasing trend 〈0.001）. Univariate Cox＇s regression analysis pointed out that older age（for 40-59,P〈0.001,HR=9.39; for ≥60,P〈0.001,HR=11.39）,male gender（P=0.03,HR=1.07）and subjects who had been prescribed anti-coagulation drug included aspirin,warfarinand clopidogrel（P〈0.001,HR=2.20）were significant risk factors for suffering from VH.CONCLUSION：The incidence of VH is estimated being 4.8 cases per 10 000 person-years in Taiwan. Age,male gender and having been prescribed anti-coagulation drugs are associated with the incidence of VH.