The present study aimed to observe the progression of diabetic retinopathy (DR) and compare the clinical outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy, laser photocoagulation and vitrectomy in a real-world setting, to inform treatment strategies. The present prospective, observational study enrolled 371 patients (466 eyes) with DR who were followed for over 3 years at Xi'an Bright Eye Hospital (Xi'an, China). Patients received treatment with anti-VEGF, laser, combined therapy or vitrectomy based on their clinical condition. Best-corrected visual acuity (BCVA), central subfield thickness (CST) and incidence of complications were evaluated. The anti-VEGF group demonstrated a significantly greater improvement in BCVA and a reduction in CST compared with the laser group. Eyes with early-stage DR required fewer anti-VEGF injections to achieve stability than those with advanced disease. In eyes with low vision, the anti-VEGF group had a lower incidence of tractional retinal detachment but a higher rate of persistent macular edema compared with those in the laser group. For stages 4-5 DR, the rate of vision improvement was similar between anti-VEGF therapy and vitrectomy. In conclusion, anti-VEGF therapy is generally superior to laser in improving visual and anatomical outcomes. However, treatment strategies should be individualized based on disease stage and specific complications, with anti-VEGF favoring traction prevention and laser potentially offering better control for recurrent edema in some cases.

Myasthenia gravis (gMG) is a critical autoimmune disease, which has a serious impact on the life and survival of patients. Ocular Myasthenia Gravis (oMG) is often the initial manifestation of MG and has the potential to progress to gMG. However, to date no distinct mechanism has been found to clarify the pathogenesis of conversion from oMG to gMG. Recent studies have shown that the development and clinical progression of MG is closely associated with the abnormal function of follicular helper T (Tfh) cells. Thus, this article reviews the recently achieved research progress on the involvement of Tfh cells in MG immunopathogenesis and focuses on the role of Tfh cells and related-factors (IL-21, CXCL13, CXCR5, bcl-6 etc.) in germinal center formation and antibody production in MG immune response.

Flight safety event reasoning is an important task both in QAR (quick access recorder) data exceedence and statistical analyses. Situation awareness is booming recently as a very useful tool. It perceives, understands environments both inside and outside pilot's compartment, and then helps pilot think ahead about potential threats, risks toward targets (like operation during taking off or landing, etc.) and how to overcome them. QAR monitors the whole situation awareness process for subsequent analysis. Through QAR big data digging, we re-appear this process and evaluate pilot's performance. Risk situations/scenarios cause events for certain reasons. Correction methods for managing risk situations are obtained from opinion leaders and also included into our simulation system. This is a requisite step to introduce Artificial intelligence and machine learning algorithms later to fully automatically classify pilot behaviors into classes which will be studied later. We incorporate QAR as the situational awareness into Bowtie model to study the sequence of the event reasoning. Hard landing and long flare distance are studied through multiple flights QAR data and the achieve the Bowtie reasoning model.

目的:研究泊沙康唑在预防恶性血液病患者侵袭性真菌病中的应用效果.方法:选取我院2018年1月～2019年9月收治的50例恶性血液病患者,按照随机数余数分组法分为采取泊沙康唑预防的泊沙康唑组以及采取伊曲康唑预防的伊曲康唑组各25例,对两组预防效果进行对比.结果:泊沙康唑组预防治疗成功率为84.00％(21/25),显著高于伊曲康唑组的68.00％(17/25),侵袭性真菌病发生率为4.00％(1/25),显著低于伊曲康唑组的16.00％(4/25)(P＜0.05);给药前两组炎性细胞因子差异无统计学意义(P＞0.05),给药结束后均较本组给药前降低(P＜0.05),组间比较泊沙康唑组均低于伊曲康唑组(P＜0.05);泊沙康唑组治疗期间不良反应发生率为8.00％(2/25),伊曲康唑组治疗期间不良反应发生率为20.00％(5/25),两组不良反应发生率对比无统计学意义(P＞0.05).结论:在预防恶性血液病患者侵袭性真菌病中泊沙康唑效果更佳且安全性高,可作为优选用药方案推广使用.

OBJECTIVE:To explore the value of CpG-oligonucleotide(CpG-ODN) immunostimulatory method in chromosome culture of chronic lymphocytic leukemia (CLL) cells and to compare the differences between related studies at home and abroad, so as to improve the success rate of CLL karyotype culture and the detection rate of abnormal karyo-types.METHODS:Bone marrow samples from 82 CLL patients were collected and cultured with phytohemagglutinin (PHA), CpG-oligonucleotide plus interleukin-2 (CpG-ODN DSP30+IL-2) for 72 hours. Chromosomes were prepared and analyzed by conventional cytogenetics (CC). Meanwhile, D13S25, Rb1, ATM, p53 and CSP12 probes were used for interphase fluorescence in situ hybridization (iFISH) test. The differences of chromosome culture and iFISH test results between two cell stimulants were compared.RESULTS:The success rate of karyotype culture in PHA and CpG-ODN DSP30+IL-2 immunostimuli (analyzable mitotic t >20) was 90.2% (74 cases), 68.3% (56 cases) respectively, and the detection rate of abnormal karyotype was 13.5% (10 cases) and 46.4% (26 cases), respectively. The success rate of karyotype culture in PHA group was significantly higher than that in CpG-ODN DSP30+IL-2 group (P=0.01). The detection rate of abnormal karyotypes in CpG-ODN DSP30+IL-2 group was significantly higher than that in PHA group, and the difference was statistically significant (P=0.003). The detection rate of abnormal karyotypes in iFISH group was 74.4% (61 cases), which was significantly higher than that in CpG-ODN DSP30+IL-2 group (P=0.000). iFISH detection could verify the abnormalities detected by CC analysis.CONCLUSION:Application of CpG-ODN DSP30+IL-2 immunostimulation method in culture of CLL cells can enhance the detection rate of abnormal karyotypes, especially the detection of various translocations suggesting poor prognosis.

目的 构建科学、合理、规范的体检中心护理质量评价体系,为客观评价并提升体检中心护理质量提供依据.方法 运用文献法和访谈法初步确定体检中心护理质量评价指标清单;运用Delphi专家咨询法进行两轮函询,筛选评价指标;采用层次分析法确立指标权重,构建体检中心护理质量评价体系.结果 咨询专家共15名,两轮函询问卷回收率均为100.00％,专家权威程度分别为0.800和0.792,两轮肯德尔和谐系数为0.201～0.345,三级条目变异系数处在0.099～0.196之间,所构建的体检中心护理质量评价体系包括3项一级条目、11项二级条目、51项三级条目.结论 构建的体检中心护理质量评价体系能够凸显体检中心护理的特殊性,可推广应用于体检中心护理质量评价.

Objective: The aim of this work was to evaluate the association between pretreatment inflammation-based factors and outcomes in patients with macular edema (ME) secondary to retinal vein occlusion (RVO) and its subtypes after intravitreal ranibizumab or conbercept implant. Methods: This retrospective observational study included patients who were diagnosed with ME secondary to RVO at the First Affiliated Hospital of Nanchang University between January 2017 and January 2019, and who subsequently received intravitreal anti-vascular endothelial growth factor (VEGF) treatment. Blood-based parameters were measured before treatment, and correlations between best-corrected visual acuity (BCVA) and each of 3 parameters – neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) – were analyzed to identify predictors of effective intravitreal injection treatment outcomes. Results: A total of 315 treatment-naïve eyes treated with anti-VEGF drugs for RVO-ME were retrospectively analyzed in this study. The mean PLR value was significantly different in the effective and ineffective group for RVO-ME (138.03 ± 48.61 vs. 106.79 ± 27.28), branch RVO (BRVO)-ME (216.47 ± 53.04 vs. 185.94 ± 51.47), and central RVO (CRVO)-ME (231.07 ± 66.05 vs. 196.20 ± 60.44). The cutoff value of the PLR was 97.92, the area under the curve was 0.70, and the sensitivity and specificity were 81.5 and 44.3%, respectively. The mean NLR value was significantly different in the effective and ineffective groups for RVO-ME (2.20 ± 1.40 vs. 1.92 ± 0.89), and BRVO-ME (2.01 ± 0.80 vs. 1.82 ± 0.84), but not in patients with CRVO-ME (2.51 ± 2.02 vs. 2.12 ± 0.95). There are no significant differences between BRVO-ME and its subtype groups in MLR values. But the mean MLR value was significantly higher in the conbercept group than in the ranibizu­mab group among patients in the effective group (0.27 ± 0.11 vs. 0.25 ± 0.14). Conclusion: Higher pretreatment PLR was associated with BCVA in patients with RVO-ME and its subtypes who were treated with anti-VEGF drugs. The PLR may be used as a predictive and prognostic tool for effective intravitreal injection treatment outcomes.

BACKGROUND:The pathogenesis of myasthenia gravis (MG) depends upon T and B cells, as well as complement and cytokines. The activation of functional subpopulations of T and B cells is the basis of the immune response. However, the activation levels of T and B cell subsets remain unclear in the pathogenesis of MG. Here, we evaluated the proportions of T and B cell subsets and related cytokines in ocular MG (oMG) patients and generalized MG (gMG) patients, and analyzed the potential roles of T and B cell subsets in the pathogenesis of oMG.METHODS:In total, 16 patients with oMG, 31 patients with gMG, and 20 healthy controls (HCs) were included in this study. Peripheral blood mononuclear cells (PBMCs) were separated from venous blood via density centrifugation. The percentages of CD3+CD4+ T cells, CD3+CD8+ T cells, CD4+CD25+CD127- regulatory T cells (Tregs), CD19+CD27+CD38- memory B cells, CD19+CD24hiCD27+ regulatory B cells (Bregs), CD19+CD38+CD138+ plasma cells, and CD19+CD40+ B cells in PBMCs were detected by flow cytometry. The levels of interleukin (IL)-2, IL-4, IL-6, IL-10, IL-17, and interferon (IFN)-γ in serum were detected by enzyme linked immunosorbent assay (ELISA). Differences in T and B cell subsets and related cytokines were compared among the three groups of participants.RESULTS:The proportions of CD19+CD27+CD38- memory B cells were significantly higher in the oMG and gMG groups than in the HC group (P = 0.004; P < 0.001), whereas the proportion of CD19+CD27+CD38- memory B cells was significantly lower in the oMG group than in the gMG group (P < 0.001). Moreover, the proportion of CD19+CD24hiCD27+ Bregs was significantly higher in the oMG group than in the gMG and HC groups (P = 0.001). The proportion of CD4+CD25+CD127- Tregs was significantly lower in the gMG group than in the oMG and HC groups (P < 0.001). Finally, the level of serum IL-10 was significantly higher in the oMG group than in the gMG and HC groups (P < 0.05). Compared with the HC group, serum IL-2 levels were significantly increased in the oMG and gMG groups (P = 0.016; P = 0.002).DISCUSSION:The reduced ratios of Tregs and Bregs may contribute to the progression of oMG to gMG, and the increased proportion of memory B cells may be closely related to the progression of oMG. IL-2 and IL-10 are important in the development of oMG.

AIM: To compare the anatomic and functional outcomes between vitrectomy with internal limiting membrane (ILM) peeling and internal ILM flap insertion technique for high myopia macular hole (MH).METHODS: PubMed, Cochrane Library, EMBASE, and CNKI were systematically searched, and all studies involved MH were included. The closure rate of MH and the postoperative best-corrected visual acuity (BCVA) at 6mo after the initial surgery were the primary measures. All statistical tests were performed in Review Manager 5.3.RESULTS: Five studies that included 151 eyes of 151 patients were finally included, all of which were retrospectively comparative studies. Between the pars plana vitrectomy (PPV) with ILM peeling surgery and the ILM insertion technique, the latter had significantly better efficacy with respect to the closure rate of MH (OR=21.32, 95%CI=7.25-62.67, P<0.001); However, regarding BCVA at 6mo after the initial surgery in MH, there was no statistical significance between the groups (OR=-0.04, 95%CI=-0.22-0.14, P=0.66). In addition, regardingthe rate of retinal reattachment after the initial surgery, the two different methods were not significantly different (OR=2.22, 95%CI=0.34-14.32, P=0.4).CONCLUSION: Both ILM peeling and ILM insertion technique could significantly improve anatomic outcomes of MH in high myopia with or without retinal detachment (RD), and anatomic outcomes are more effective. However, there is no statistical significance in BCVA at 6mo after the initial surgery in MH, or in the rate of retinal reattachment after the first surgery, between the two methods.

BCOR/BCORL1 mutation is more common in MDS patients and often company with other genes co-mutations. BCOR/BCORL1 mutation is not associated with disease progression and AML transformation in MDS patients, but it predicts poor overall survival.

BACKGROUND:Previous studies have linked high myopia (HM) to brain activity, and the difference between HM and low myopia (LM) can be assessed. PURPOSE:To study the differences in functional networks of brain activity between HM and LM by the voxel-level degree centrality (DC) method. MATERIAL AND METHODS:Twenty-eight patients with HM (10 men, 18 women), 18 patients with LM (4 men, 14 women), and 59 healthy controls (27 men, 32 women) were enrolled in this study. The voxel-level DC method was used to assess spontaneous brain activity. Correlation analysis was used to explore the change of average DC value in different brain regions, in order to analyze differences in brain activity between HM and LM. RESULTS:DC values of the right cerebellum anterior lobe/brainstem, right parahippocampal gyrus, and left caudate in HM patients were significantly higher than those in LM patients (P < 0.05). In contrast, DC values of the left medial frontal gyrus, right inferior frontal gyrus, left middle frontal gyrus, and left inferior parietal lobule were significantly lower in patients with HM (P < 0.05). However, there was no correlation between behavior and average DC values in different brain regions (P < 0.05). CONCLUSION:Different changes in brain regions between HM and LM may indicate differences in neural mechanisms between HM and LM. DC values could be useful as biomarkers for differences in brain activity between patients with HM and LM. This study provides a new method to assess differences in functional networks of brain activity between patients with HM and LM.

High myopia (HM) is associated with impaired long-distance vision. accumulating evidences reported that abnormal visual experience leads to dysfunction in brain activity in HM even corrected. However, whether the long-term of abnormal visual experience lead to neuroanatomical changes remain unknown, the aim at this study is to investigate the alternation of cortical surface thickness in HM patients. 82 patients with HM (HM groups), 57 healthy controls (HC groups) were recruited. All participants underwent high-resolution T1 and resting-state functional magnetic resonance imaging (MRI) scans. The cortical thickness analysis was preformed to investigate the neuroanatomical changes in HM patients using computational anatomy toolbox (CAT 12) toolbox. Compare with HCs, HM patients showed decreased the cortical surface thickness in the left middle occipital gyrus (MOG), left inferior parietal lobule (IPL), right inferior temporal gyrus (ITG), right precuneus, right primary visual area 1 (V1), right superior temporal gyrus (STG), right superior parietal lobule (SPL), right occipital pole, and right the primary motor cortex (M1), and increased to the parietal operculum (OP4) (P<0.01, FWE-corrected), the mean cortical thickness of right orbitofrontal cortex (OFC), right dorsolateral prefrontal cortex (DLPFC) and right subcallosal cortex showed negatively correlation between clinical variables (axis length (ALM), the average macular thickness (AMT), keratometer (KER) 1, KER2, the mean KER, the mean macular fovea thickness (MFK), the refractive diopter) in HM patients. Our result mainly provided an evidence of cortical thickness reduction and disconnection in visual center and visual processing area, and cortical thickness increase in left multimodal integration region in HM patients. This may provide important significance of the study of the neural mechanism of HM.

Myasthenia gravis(MG)is a B cell-mediated,T cell-dependent,complements-involved autoimmune disease.Ocular myasthenia gravis(OMG)is a typical MG,with its symptoms limited to the extraocular muscles.The occurrence and development of a variety of autoimmune diseases including OMG are closely associated with the imbalanced expression of follicular regulatory T cells(Tfr cells).Therefore,Tfr cells may be a new research topic for OMG.

Background: To investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients with diabetic macular edema (DME) treated monthly with ranibizumab. Methods: We retrospectively analyzed the medical records of all patients who received intravitreal ranibizumab (IVR) treatment for DME at the First Affiliated Hospital of Nanchang University between December 2015 and December 2017. Clinicopathological parameters, including NLR, were evaluated to identify predictors of better outcomes of IVR monotherapy. Results: Ninety-one treatment-naïve eyes treated with IVR for DME were retrospectively analyzed in this study. Baseline best-corrected visual acuity (BCVA), neutrophils, NLR, monocyte-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were negatively correlated with the changes in BCVA at 24 weeks compared with the baseline, while baseline central retinal thickness and lymphocytes were positively correlated with the changes in BCVA at 24 weeks compared with the baseline. Multiple linear regression analysis revealed that NLR was independently associated with the mean change of BCVA between baseline and week 24. In addition, patients with NLR < 2.27 showed a better improvement in letter score than those with NLR > 2.27. Conclusion: Pretreatment NLR is independently associated with the BCVA in DME patients treated with IVR, and higher pretreatment NLR may contribute to inferior BCVA outcomes.

Objective To analyze the levels of cytokines (IL-2,IFN-γ,IL-6,IL-10) associated with Th1 and Th2 cells in HLA-DQ8 transgenic mice model of ocular experimental autoimmune myasthenia gravis (oEAMG) induced by recombinant H-AChR γ subunit immunization.Methods DQ8 mice were immunized with 20 μg of AChR γ subunit,20 μg of crude E. coli extract (E. coli group),or complete Freund's adjuvant (CFA) only (CFA group). All mice were immunized on days 0,30,and 60. Mice were euthanized 28 days after the third immunization,and draining lymph node cells (LNC) and spleen lymphocytes were cultured in vitro. The supernatant was collected to observe the interleukin(IL)-2,interferon(IFN)-γ,IL-6,IL-10 production by ELISA.Results LNCs and spleen lymphocytes of H-AChR γ subunit-immunized mice exhibited significantly enhanced IFN-γ (F=76.332,P<0.001;F=34.865,P<0.001) and IL-2 (F=42.835,P<0.001;F=38.030,P<0.001),which associated with Th1 cells,as compared to E. coli group and CFA group. There were no significant differences in IL-6 (F=1.325,P=0.284;F=1.935,P=0.166) and IL-10 (F=0.908,P=0.417;F=1.189,P=0.322) levels,which secreted by Th2 cells,among these three groups.Conclusion Th1 cytokines play key roles in the pathogenesis of oEAMG,while the mechanism of Th2 cytokines for oEAMG remains unclear.

Application of 8color fluorescent antibody panels to detect minimal residual disease in multiple myeloma and its significance Lu Xiupan, Zhao Sishu, Qu Xiaoyan, Shi Qinglin, Wu Yujie, Xu Ji, Li Jianyong, Chen Lijuan Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China Corresponding author: Chen Lijuan, Email: chenljb@126.com

Retinopathy of prematurity(ROP)is a pathological neovascularization with fibrotic changes in the fundus of premature infants.It is a major cause of preventable blindness in children in both developing and developed countries.Treatment of ROP has long been a hot research topic in ophthalmology and pediatrics.With a clearer knowledge of the pathogenesis of ROP,more basic and clinical studies have been carried out.The anti-vascular endothelial growth factor therapy and surgical treatment have become mature strategies,and a variety of therapeutic drugs including insulin-like growth factor-1,transforming growth factor-β,polyunsaturated fatty acids,and β-adrenergic receptor blockers have been developed.This article reviews the recent advances in ROP.

Ocular myasthenia gravis(OMG)is an autoimmune disease caused by neuromuscular junction transmission disorders and manifested mainly as fluctuating blepharoptosis and diplopia,with the extraocular muscles as the main involveed sites.While the pathogenesis of OMG remains unclear,some antibodies,complements,and cytokines may be the contributing factors.The diagnosis and treatment of OMG have been defined in recent years.This article reviews the pathogenesis,diagnosis,and treatment of OMG.

Objective To explore the differences in expression level of miR-181 b (miR-181 b) in CD19+B lymphocytes in patients with chronic lymphocytic leukemia ( CLL) and analyze its clinical significance. Methods Fifty patients with CLL, and collecting healthy controls 20 cases. All patients took 15 ml of peripheral blood and the total RNA of CD19+B lymphocyte was extracted after sorting with CD19 magnetic beads, and the expression lever of miR-181 b was measured by Taq Man probe. The difference expression lever of miR-181 b in prognostic groups were analyzed, such as clinical stages, Serological indicators, CD38, Zeta chain related protein kinase-70, immunoglobulin heavy chain variable region and Abnormal genetics. Survival analysis was performed on the above indexes. Results (1) The expression lever of miR-181 b in CD19+B lymphocytes in Fifty patients with CLL was significantly lower than the healthy controls ( P ＜ 0. 01). (2) The expression level of miR-181 b in different groups: according to the prognosis of FISH groups, the poor prognosis group was significantly lower than the favorable prognosis group ( P ＜ 0. 05), ATM deletion group was significantly lower than the ATM normal group ( P ＜ 0. 05), There was no statistical difference in the expression level of miR-181 b in other groups (P＞ 0. 05). (3) Survival analysis: The expression level of mir-181 b was divided into low expression group and high expression group by median of 0. 033. The comparison showed that the OS of mir-181 b low expression group was shorter than the mir-181 b high expression group ( P ＜ 0. 05). Combined COX multivariate analysis with poor prognostic factors, the results showed that the high-risk group of FISH prognosis group, P53 deletion, ATM deletion, miR181 b lower expression were all independent prognostic factors affecting survival ( P ＜ 0. 05). Conclusion The expression level of mir-181 b in CLL patients is significantly lower than normal people, and the low expression of mir-181 b is an independent prognostic factor of CLL.

Objective To analyze the risk factors of upper extremity deep venous thrombosis in elderly inpatients following peripherally inserted central catheter(PICC).Methods A total of 564 elderly inpatients following PICC enrolled were divided into upper extremity deep venous thrombosis group(n=141)and control group(n=423).All the clinical data was retrospectively analyzed by the use of univariate and multivariate logistic regression analysis to explore the risk factors with the elderly inpatients.Results Upper extremity deep vein thrombosis occurred in 141(25%)out of the 564 patients.Multivariatelogistic regression analysis revealed that atrial fibrillation(OR=2.15,95%CI:1.298-3.433),atherosclerosis(OR=2.72,95%CI:1.715-4.372),surgery longer than 1 h during dwell time of the catheter(OR=3.23,95%CI:1.358-7.584)and history of deep vein thrombosis(OR=7.68,95%CI:4.513-13.311)were the independent risk factors for the PICC-DVT in elderly inpatients.Conclusions Elderly patients are under high risk state of PICC-DVT.Atrial fibrillation,atherosclerosis,surgery longer than 1h during dwell time of the catheterand history of deep vein thrombosis are the independent risks factors for PICC-DVT in elderly inpatients.