HIUNET: A Hybrid Inception U-Net for Diagnosis of Diabetic Retinopathy

Type 2 diabetes patients often suffer from microvascular compli-cations of diabetes.These complications,in turn,often lead to vision impair-ment.Diabetic Retinopathy(DR)detection in its early stage can rescue people from long-term complications that could lead to permanent blindness.In this study,we propose a complex deep convolutional neural network architecture with an inception module for automated diagnosis of DR.The proposed novel Hybrid Inception U-Net(HIUNET)comprises various inception modules connected in the U-Net fashion using activation maximization and filter map to produce the image mask.First,inception blocks were used to enlarge the model’s width by substituting it with primary convolutional layers.Then,aggregation blocks were used to deepen the model to extract more compact and discriminating features.Finally,the downsampling blocks were adopted to reduce the feature map size to decrease the learning time,and the upsam-pling blocks were used to resize the feature maps.This methodology ensured high prominence to lesion regions compared to the non-lesion regions.The performance of the proposed model was assessed on two benchmark compet-itive datasets called Asia Pacific Tele-Ophthalmology Society(APTOS)and KAGGLE,attaining accuracy rates of 95%and 92%,respectively.

Clinical and experimental study on angiopoietin-like protein 8 associated with proliferative diabetic retinopathy

AIM：To confirm the role of angiopoietin-like protein 8（Angptl 8） in proliferative diabetic retinopathy（PDR）.METHODS：The sera and aqueous humor of 10 PDR patients and 10 non-diabetic retinopathy（NDR） patients（idiopathic macular hole patients） were collected and the expression of Angptl 8 was detected by enzyme linked immune-sorbent assay（ELISA）.Experimental diabetes mice model was induced with streptozotocin.The expression of glycosylated hemoglobin and Angptl 8 in sera was detected.Recombinant Angptl 8 was re-infused into wild type（WT） diabetic mice and spatial frequency threshold and contrast sensitivity were measured.In vitro retinal pigment epithelium（RPE） were stimulated by recombinant Angptl 8 for 24 h.MMT assay were used to detect cell proliferation.At the same time,q RT-PCR and Western blot was used to measure the expression of proliferation-related factors in PRE cells.RESULTS：The expression of Angptl 8 was markedly increased in the sera and aqueous humor of PDR patients（F=99.02,P〈0.0001 in sera;t=10.42,P〈0.0001 in aqueous）.After successfully establishing the diabetic mice model,we found that glycosylated hemoglobin and Angptl 8 expression levels were increased.Re-infusion of recombinant Angptl 8 into WT diabetic mice could further decrease spatial frequency threshold and contrast sensitivity（P〈0.01）.In vitro,RPE cells stimulated by recombinant Angptl 8could increase the relative absorbance of MMT assay（1.486±0.042 vs 1.000±0.104,P〈0.05） and proliferating cell nuclear antigen（PCNA） expression（0.55±0.01 vs 0.29±0.03,P〈0.05）.The proliferative effect of Angptl 8 is mainly mediated by increasing the expression of proliferation-activating factors cyclin A1（4.973±0.205 vs 2.720±0.197,P〈0.05）,cyclin F（5.690±0.219 vs 4.297±0.292,P〈0.05） and E2 F2（2.297±0.102 vs 1.750±0.146,P〈0.05）,and reducing the expression of proliferation-inhibiting factors cdkn1（2.370±0.074 vs 3.317±0.135,P〈0.05） and cdkn2（4.793±0.065 vs 5.387±0.149,P〈0.05）.CONCLUSION：The expression of Angptl 8 is increased in PDR,and the increased Angptl 8 can promote proliferation and increase proliferation-related factors.

Importance of telemedicine in diabetes care: Relationships between family physicians and ophthalmologists

Diabetic retinopathy(DR) is the worldwide leading cause of legal blindness. In 2010, 1.9% of diabetes mellitus(DM) patients were legally blind and 10.2% had visual impairment. The control of DM parameters(glycemia, arterial tension and lipids) is the gold standard for preventing DR complications, although, unfortunately, DR still appeared in a 25% to 35% of patients. The stages of severe vision threading DR, include proliferative DR(6.96%) and diabetic macular edema(6.81%). This review aims to update our knowledge on DR screening using telemedicine, the different techniques, the problems, and the inclusion of different professionals such as family physicians in care programs.

Expression and effect of proline hydroxylase domain 2 in retina of diabetic rats

AIM： To observe the expression of proline hydroxylase domain 2 （PHD2） in the retina of diabetic rats and investigate the relationship between PHD2 and relevant intraocular vascular proliferation factors, METHODS： Sixty male specific pathogen free （SPF） Sprague-Dawley （SD） rats were randomly divided into two groups： the diabetic group and the control group. The rats in the diabetic group were intraperitoneally injected with 60 mg/kg （0.60 mL/100 g） of streptozotocin to induce a diabetic rat model. The rats in the control group were injected with an equal volume of sodium citrate buffer solution by the same method. Hematoxylin- eosin （HE） staining and immumofiuorescence （IF） method were adopted to observe the pathological changes of retinal tissues and the expression of PHD2, glial fibrillary acidic protein （GFAP）, vascular endothelial growth factor （VEGF） by 8wk. RT-PCR method was applied to detect the expressions of mRNA of PHD2, VEGF and GFAP. The relationship between PHD2 and other vascular proliferation factors was analyzed. RESULTS： HE staining showed that there was the retinal tissue edema in the diabetic group, and the arrangement was in disorder, and proliferation could be seen. IF staining： in the retina of normal rats, PHD2 was not expressed, GFAP and VEGF were mainly expressed in astrocytes; while in the diabetic rats, PHD2, GFAP and VEGF staining showed strong positivity in all retinal layers, mainly in neurogliocytes. PHD2 was co-expressed with VEGF and GFAP. The mRNA expression levels of PHD2, GFAP and VEGF in the diabetic group were obviously higher than that in the control group, respectively 1.83 times, 1.75 times and 2.08 times. The difference had statistical significance （P〈0.01）. CONCLUSION： The high expression of PHD2 in the retina of early-stage diabetic rats might result from secretion of neurogliocytes induced by local high- concentration blood glucose, thus promoting the expression of VEGF and GFAP, PHD2 plays an important role during the occurrence of diabetic retinopathy.