Mesenchymal stem cells for repairing glaucomatous optic nerve

Glaucoma is a common and complex neurodegenerative disease characterized by progressive loss of retinal ganglion cells(RGCs)and axons.Currently,there is no effective method to address the cause of RGCs degeneration.However,studies on neuroprotective strategies for optic neuropathy have increased in recent years.Cell replacement and neuroprotection are major strategies for treating glaucoma and optic neuropathy.Regenerative medicine research into the repair of optic nerve damage using stem cells has Received considerable attention.Stem cells possess the potential for multidirectional differentiation abilities and are capable of producing RGCfriendly microenvironments through paracrine effects.This article reviews a thorough researches of recent advances and approaches in stem cell repair of optic nerve injury,raising the controversies and unresolved issues surrounding the future of stem cells.

Algorithm of automatic identification of diabetic retinopathy foci based on ultra-widefield scanning laser ophthalmoscopy

AIM:To propose an algorithm for automatic detection of diabetic retinopathy(DR)lesions based on ultra-widefield scanning laser ophthalmoscopy(SLO).METHODS:The algorithm utilized the FasterRCNN(Faster Regions with CNN features)+ResNet50(Residua Network 50)+FPN(Feature Pyramid Networks)method for detecting hemorrhagic spots,cotton wool spots,exudates,and microaneurysms in DR ultra-widefield SLO.Subimage segmentation combined with a deeper residual network FasterRCNN+ResNet50 was employed for feature extraction to enhance intelligent learning rate.Feature fusion was carried out by the feature pyramid network FPN,which significantly improved lesion detection rates in SLO fundus images.RESULTS:By analyzing 1076 ultra-widefield SLO images provided by our hospital,with a resolution of 2600×2048 dpi,the accuracy rates for hemorrhagic spots,cotton wool spots,exudates,and microaneurysms were found to be 87.23%,83.57%,86.75%,and 54.94%,respectively.CONCLUSION:The proposed algorithm demonstrates intelligent detection of DR lesions in ultra-widefield SLO,providing significant advantages over traditional fundus color imaging intelligent diagnosis algorithms.

Pituitary metastasis from lung adenocarcinoma:A case report

BACKGROUND Pituitary gland metastasis is an unusual event,and pituitary metastasis from lung adenocarcinoma is extremely rare and associated with poor prognosis.To date,approximately 15 cases have been reported.CASE SUMMARY Here,we present the case of a 64-year-old woman with pituitary metastasis derived from lung adenocarcinoma,which was difficult to distinguish from other sellar tumors.The patient presented to the neurosurgery clinic with blurred vision and intermittent headache.During hospitalization,brain computed tomography(CT)and magnetic resonance imaging revealed a pituitary macroadenoma.Chest CT revealed irregular nodules in the basal segment of the lower lobe of the left lung,which were likely lung cancer.Positron emission tomography-CT revealed a carbohydrate metabolism tumor in the lungs and sellar region,which was considered malignant.Postoperative pathological examination of the sellar tumor revealed lung adenocarcinoma.CONCLUSION Excision of pituitary metastases combined with radiotherapy and chemotherapy should be a priority treatment for patients with pituitary metastasis.

Clinical significance of episcleral venous fluid wave in gonioscopy-assisted transluminal trabeculotomy

AIM:To evaluate the clinical significance of checking episcleral venous fluid wave(EVFW)during gonioscopyassisted transluminal trabeculotomy(GATT)in patients with open angle glaucoma(OAG).METHODS:This retrospective case series study comprised 30 patients(45 eyes)with OAG underwent GATT.The location and extent of EVFW were examined and graded after intraoperative compression flushing of the anterior chamber angle during the operation.Patients were followed up for 1y.A complete success for surgery is defined as a postoperative intraocular pressure(IOP)<18 mm Hg without any anti-glaucoma medication.IOP<18 mm Hg with less than two anti-glaucoma medications is defined as qualified success,while the control of IOP requiring three anti-glaucoma medications is considered as unsuccess.RESULTS:The mean IOP was 35.38±7.16 mm Hg before surgery and 15.52±4.22 mm Hg 1y after surgery(P<0.01).The average number of anti-glaucoma medication was 2.8±1.2(2-4)preoperation and 0.6±1.3(0-3)1y postoperation(P<0.01).The success rate of the operation was 93.33%.Complete success rate was 66.67%,qualified success rate was 26.67%,and 6.66%of unsuccessful cases required reoperation.EVFW of all cases was grade 2-4,and the percentages of grade 2,3 and 4 were 33.33%,40.0%and 26.67%,respectively.The distribution and percentage of EVFW were inferior(36%),nasal(28%),superior(20%),and temporal(16%).The EVFW grade of complete success patients was 3.4±0.6(3-4),and that of qualified success patients was 2.6±1.0(2-4).The larger the range of EVFW,the lower the IOP,and the better the IOP reduction effect.CONCLUSION:During GATT surgery,pressurized irrigation of anterior chamber to check EVFW can reduce the outflow resistance of aqueous humor and increase the effect of postoperative IOP.The range of EVFW is negatively correlated with postoperative IOP.Therefore,EVFW may be a valuable prognostic indicator for the success of GATT surgery.

A case of Posner-Schlossman syndrome treated by gonioscopy-assisted transluminal trabeculotomy

Dear Editor,We present the reported case of Posner-Schlossman syndrome(PSS)treated by gonioscopy-assisted transluminal trabeculotomy(GATT).A 28-year-old male presented recurrent PSS in his left eye,leading to uncontrolled intraocular pressure(IOP)and thus glaucomatous optic neuropathy.Two years ago,the patient suddenly experienced swelling with impaired vision in his left eye with no obvious cause,and was diagnosed with the PSS in left eye in another hospital.

Surgical strategies for Mirizzi syndrome:A ten-year single center experience

BACKGROUND Mirizzi syndrome(MS)remains a challenging biliary disease,and its low rate of preoperative diagnosis should be resolved.Moreover,technological advances have not resulted in decisive improvements in the surgical treatment of MS.Complex bile duct lesions due to MS make surgery difficult,especially when the laparoscopic approach is adopted.The safety and long-term effect of MS treatment need to be guaranteed in terms of preoperative diagnosis and surgical strategy.AIM To analyze preoperative diagnostic methods and the safety,effectiveness,prognosis and related factors of surgical strategies for different types of MS.METHODS The clinical data of MS patients who received surgical treatment from January 1,2010 to December 31,2020 were retrospectively reviewed.Patients with malignancies,choledochojejunal fistula,lack of data and lost to follow-up were excluded.According to preoperative imaging examination records and documented intraoperative findings,the clinical types of MS were determined using the Csendes classification.The safety,effectiveness and long-term prognosis of surgical treatment in different types of MS,and their interactions with the clinical characteristics of patients were summarized.RESULTS Sixty-six patients with MS were included(34 males and 32 females).Magnetic resonance imaging/magnetic resonance cholangiopancreatography(MRI/MRCP)showed specific imaging features of MS in 58 cases(87.9%),which was superior to ultrasound scan(USS)in the diagnosis of MS and more sensitive to subtle biliary lesions than USS.The overall laparoscopic surgery completion rate was 53.03%(35/66),where the completion rates of MS type I,II and III were 69.05%(29/42),42.86%(6/14)and zero(0/10),respectively.Thirty-one patients(46.97%)underwent laparotomy or conversion to laparotomy including 11 cases of iatrogenic bile duct injury which occurred in type I patients,and 25 of these patients underwent bile duct exploration,repair and T-tube drainage.In addition,25 patients underwent intraoperative choledochoscopy and T-tube cholangiography.Overall,21 cases(31.8%)were repaired by simple suturing,and 14 cases(21.2%)were repaired using the remaining gallbladder wall patch in the subtotal cholecystectomy.The ascendant of the Csendes classification types led to an increase in surgical complexity reflected by increased operation time,bleeding volume and cost.Gender,acute abdominal pain and measurable stone size had no effect on Csendes type of MS or final surgical approach.Age had no effect on the classification of MS,but it influenced the final surgical approach,hospital stay and cost.A total of 66 patients obtained a relatively high preoperative diagnostic rate and underwent surgery safely without serious complications,and no mortality was observed during the follow-up period of 36.5±26.5 mo(range 13-76,median 22 mo).CONCLUSION MRI/MRCP can improve the preoperative diagnosis of MS.The Csendes classification can reflect the difficulty of treatment.The surgical strategies including laparoscopic surgery for MS should be formulated based on full evaluation and selection.

Ji-Chuan decoction ameliorates slow transit constipation via regulation of intestinal glial cell apoptosis

BACKGROUND Slow transit constipation(STC)is a common intestinal disease with increasing incidence.STC results from various factors,such as the enteric nervous system and metabolic changes.As a classical formula of traditional Chinese medicine,Ji-Chuan decoction(JCD)has been extensively and effectively used in STC treatment,yet its pharmacological mechanism remains unclear.AIM To explore the integrated regulatory pattern of JCD against STC through hyphenated techniques from metabolism,network pharmacology and molecular methods.METHODS STC model mice were generated by intragastric administration of compound diphenoxylate(10 mg/kg/d)for 14 d.The STC mice in the low dose of JCD(3.04 g/kg),middle dose of JCD(6.08 g/kg)and high dose of JCD(12.16 g/kg)groups were orally administered JCD solution once a day for 2 wk.The acetylcholine(ACH)level was examined by enzyme-linked immunosorbent assay.The pathological features of colon tissue were observed by hematoxylin and eosin staining.The differentially expressed metabolites and metabolic pathways were tested by nontargeted metabolomics.The main targets and core ingredients of JCD were identified by network pharmacology,and the expression of AKT was confirmed by immunohistochemistry.Finally,the pathways involved in JCD treatment were predicted using a combination of differentially expressed metabolites and targets,and intestinal glial cell apoptosis was demonstrated by immunofluorescence.RESULTS JCD significantly promoted intestinal motility,increased the levels of the excitatory neurotransmitter ACH and reduced intestinal inflammation in STC mice.Untargeted metabolomics results showed that JCD significantly restored metabolic dysfunction and significantly affected taurine and hypotaurine metabolism.Network pharmacology and molecular experiments showed that JCD regulates AKT protein expression,and the core component is quercetin.Combined analysis demonstrated that apoptosis may be an important mechanism by which JCD relieves constipation.Further experiments showed that JCD reduced enteric glial cell(EGC)apoptosis.CONCLUSION This work demonstrated that reducing EGC apoptosis may be the critical mechanism by which JCD treats STC.These findings call for further molecular research to facilitate the clinical application of JCD.

Comparative Study on the Trans-Province Transfer of the Multiple Trauma Patients after Sichuan Earthquake

Background: Trans-province transfer of the patients has been successfully carried out and has greatly relieved the burden of the hospitals in Sichuan Province after Sichuan earthquake. The aim of the study was to retrospectively analyze the efficacy and feasibility of the trans-province transfer of the multiple trauma patients after Sichuan earthquake. Methods: A retrospective and descriptive analysis was conducted based on the medical records of the multiple trauma patients (ISS ≥ 16) transferred to the Grade 3A hospitals outside Sichuan province. The patients were divided into two groups based on the distance to Sichuan province, i.e., Group A (the seismic patients transferred to Chongqing) and Group B (the seismic patients transferred to the other provinces/ municipalities). A comparison was done in aspects of distance of transfer, time from injury to transfer, vital signs, the infection rates (at transfer and on discharge), injury severity and prognostic indices (cure rate, disability rate and mortality). Results: The distance between Chengdu and the other places was at a wide range of 313 - 1653 km, whereas the time from injury to transfer showed no statistical difference between groups (P > 0.05). There were no significant differences between both groups with respects to patient demographics, injury mechanism, time from injury to transfer, vital signs, infection rate and injury severity. The prognostic indices showed no significant difference, except for FIM scores (P < 0.05). Conclusions: The results of the study indicate that the different distance of the transfer of the multiple trauma patients does not aggravate the severity or deteriorate the prognosis, which proves that the medical supportive transfer system is acceptable, effective and worthy of further implementation in China, which may be ascribed to the advanced transportation system and high level of therapeutic capacity of the hospitals. In the meantime, attention should be paid to psychological intervention and functional rehabilitation during the treatment of the transferred seismic patients.

Ferroptosis in chronic obstructive pulmonary disease:From cellular mechanisms to therapeutic applications

To the Editor:Chronic obstructive pulmonary disease(COPD)is a global public health challenge without effective treatment currently available,affecting>300 million individuals worldwide.Comprehensively understanding the pathogenesis of this disease is required.Recently,ferroptosis,a form of cell death driven by iron-dependent lipid peroxidation,has been associated with the pathogenesis of COPD.[1]Multiple signaling pathways,such as glutathione peroxidase 4(GPX4),ferroptosis suppressor protein 1(FSP1),and tetrahydrobiopterin-dependent pathways,as well as iron metabolism,are involved in regulating ferroptosis[2,3][Figure 1A].Here,we provide a comprehensive overview of recent advances in understanding the role of ferroptosis in COPD,highlighting potential therapeutic strategies targeting ferroptosis for treating the disease.

Micropulse transscleral laser therapy for secondary angle-closure glaucoma in nanophthalmos: a case report

Dear Editor,The choice of surgical intervention for nanophthalmos patients with secondary angle-closure glaucoma poses a challenging decision for ophthalmologists.Because nanophthalmos patients who have undergone filtration surgery or other intraocular procedures are more susceptible to severe complications,including choroidal effusion,malignant glaucoma,and explosive choroidal hemorrhage,all of which can lead to vision loss[1].This dilemma is particularly pronounced in patients with shorter axial lengths.Micropulse transscleral laser therapy(M-TLT),also known as micropulse transscleral cyclophotocoagulation(MP-TSCPC),is a nonincisional laser therapy surgery for glaucoma[2].In 2015,Golan and Kurtz[3]were the first to report four patients with secondary angle-closure glaucoma in nanophthalmos with axial lengths ranging between 17 and 19 mm(mean 18 mm)who were successfully treated with M-TLT,and choroidal detachment was observed in all patients(recovery spontaneously in two patients and recovery after systemic steroid treatment in the other two),of which two had a slight decrease in visual acuity.

Laparoscopic liver resection:a review of current indications and surgical techniques

Laparoscopic liver resection (LLR) has been the most impressive development in the field of liver surgery in recent two decades. Technical innovations and experience accumulation have made LLR a safe and effective procedure with faster postoperative recovery. Despite the fast spreading of the procedure, details regarding the indications, oncological outcomes and technical essentials were still disputable. To address these issues, two international consensus conferences were hold to update the knowledge in this field. The statements of the both conferences were not conclusive and more high-quality researches are required. In this article, we reviewed the development and the current state of LLR. Indications, outcomes, surgical techniques and devices used in LLR were also discussed.

Microglial Exosome miR-7239-3p Promotes Glioma Progression by Regulating Circadian Genes

Glioma-associated microglial cells,a key component of the tumor microenvironment,play an important role in glioma progression.In this study,the mouse glioma cell line GL261 and the mouse microglia cell line BV2 were chosen.First,circadian gene expression in glioma cells co-cultured with either M1 or M2 microglia was assessed and the exosomes of M2-polarized and unpolarized BV-2 microglia were extracted.Subsequently,we labeled the exosomes with PKH67 and treated GL261 cells with them to investigate the exosome distribution.GL261 cell phenotypes and related protein expression were used to explore the role of M2 microglial exosomes in gliomas.Then a specific miR-7239-3p inhibitor was added to verify miR-7239-3p functions.Finally,the mouse subcutaneous tumorigenic model was used to verify the tumorigenic effect of M2 microglial exosomes in vivo.Our results showed that in gliomas co-cultured with M2 microglia,the expression of the BMAL1 protein was decreased(P<0.01),while the expression of the CLOCK protein was increased(P<0.05);opposite results were obtained in gliomas co-cultured with M1 microglia.After treatment with M2 microglial exosomes,the apoptosis of GL261 cells decreased(P<0.001),while the viability,proliferation,and migration of GL261 cells increased.Increased expression of N-cadherin and Vimentin,and decreased E-cadherin expression occurred upon treatment with M2 microglial exosomes.Addition of an miR-7239-3p inhibitor to M2 microglial exosomes reversed these results.In summary,we found that miR-7239-3p in the glioma microenvironment is recruited to glioma cells by exosomes and inhibits Bmal1 expression.M2 microglial exosomes promote the proliferation and migration of gliomas by regulating tumor-related protein expression and reducing apoptosis.

Study on driver’s braking intention identification based on functional near-infrared spectroscopy

Purpose–Cooperative driving refers to a notion that intelligent system sharing controlling with human driver and completing driving task together.One of the key technologies is that the intelligent system can identify the driver’s driving intention in real time to implement consistent driving decisions.The purpose of this study is to establish a driver intention prediction model.Design/methodology/approach–The authors used the NIRx device to measure the cerebral cortex activities for identifying the driver’s braking intention.The experiment was carried out in a virtual reality environment.During the experiment,the driving simulator recorded the driving data and the functional near-infrared spectroscopy(fNIRS)device recorded the changes in hemoglobin concentration in the cerebral cortex.After the experiment,the driver’s braking intention identification model was established through the principal component analysis and back propagation neural network.Findings–The research results showed that the accuracy of the model established in this paper was 80.39 per cent.And,the model could identify the driver’s braking intent prior to his braking operation.Research limitations/implications–The limitation of this study was that the experimental environment was ideal and did not consider the surrounding traffic.At the same time,other actions of the driver were not taken into account when establishing the braking intention recognition model.Besides,the verification results obtained in this paper could only reflect the results of a few drivers’identification of braking intention.Practical implications–This study can be used as a reference for future research on driving intention through fNIRS,and it also has a positive effect on the research of brain-controlled driving.At the same time,it has developed new frontiers for intention recognition of cooperative driving.Social implications–This study explores new directions for future brain-controlled driving and wheelchairs.Originality/value–The driver’s driving intention was predicted through the fNIRS device for the first time.