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Introduction Central retinal artery occlusion (CRAO), an ocular stroke, causes severe and permanent visual impairment. Thrombolytic therapy is currently the main treatment option for CRAO. Intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) has been extensively applied in the treatment of CRAO with the proven advantages of effectiveness and safety. This meta-analysis aimed to assess the efficacy of intravenous rt-PA thrombolysis for the management of CRAO by evaluating the pooled evidence. Methods A comprehensive literature search of electronic databases including PubMed, OVID, and Cochrane Library was conducted up to and including March 2019. All studies reporting visual outcomes after CRAO with thrombolytic therapy were collected. Data on visual acuity and adverse events were recorded and assessed in this analysis. Data were inputted into the statistical software of STATA. The studies were weighed by the inverse of the variance and merged in a random-effects model. Results The systematic review process yielded 7 eligible studies including 121 patients with CRAO who received the intravenous rt-PA treatment. Sixty-two patients showed improvement in visual acuity (52.0%; 95% CI, 34.0%-70.0%) following rt-PA intravenous thrombolytic therapy. The observed improvement rate in the intravenous rt-PA treatment group was significantly higher than the conservative treatment group (40.4% vs. 13.0%; OR = 5.16; 95% CI, 1.90-14.05). The incidence rate of complications was relatively low (11 out of the 121 patients). Hemorrhage (9/11) was the major reported complication. Mortality was zero. Discussion This meta-analysis indicated that intravenous rt-PA thrombolysis could be an effective and safe strategy for the management of CRAO. However, a more detailed large-scale clinical trial is warranted to strengthen the evidence-based therapeutic guidance.

Rationale: Mallet finger fracture is a common sports-related injury that may lead to the tearing of extensor tendon and protrusion of a bony fragment located at the base of the distal phalanx. We affirmed that the elastic fixation of with two K-wires technique is a good method to deal with Mallet Finger fractures that fractures could gain effective fixation than the conventional treatment method and avoid surgical incision complication Patient concerns: We reported a 33-year-old female patient came to our hospital complaining of mild pain, swelling and her right little finger was deformed because of sport's injury. Diagnosis: Acute mallet finger fracture type IV B according to Doyle classification of mallet injuries. Interventions: We performed an emergency operation for the elastic fixation of the mallet finger fractures with two K-wires. Outcomes: After the surgery, the patient showed functional recovery. No evidence of recurrence was noted 6 months after the operation, and the patient showed no symptoms of sports-related injuries. Lessons: We discuss the clinical diagnosis, treatment, and follow-up of the patient and suggest that elastic fixation with two K-wires is a good method to treat mallet finger fractures.

Backgrounds To assess the changes in individual retinal layer thickness and visual function associated with gains in visual acuity after an intravitreal conbercept injection in the diabetic macular edema (DME) on spectral domain optical coherence tomography (SD-OCT) and microperimetry during 1-year follow-up. Methods Retrospective observational study. Twenty patients with clinically significant DME in the study eye were imaged by SD-OCT every 3 months and MP1 microperimeter in the third month while receiving anti-vascular endothelial growth factor (VEGF) (conbercept) treatment. In each patient, seven retinal layers were segmented in 98 scans covering a 6 mm × 6 mm area of the macula at baseline and during 1 year of treatment. An automatic, full-threshold microperimetry of the central field (10° × 10°, 40 stimulated points) with the MP1 microperimeter. Thickness and microperimetry changes were quantitatively measured and evaluated for their correlation with increases in visual acuity. Results Although thicknesses of the inner nuclear layer (INL) and the outer nuclear layer (ONL) were reduced the most after treatment (p

Purpose We determined vitreous and serum levels of high mobility group box‐1 (HMGB‐1) in patients with proliferative diabetic retinopathy (PDR) and elucidate their relationship with receptor for advanced glycation end products (RAGE), vascular endothelial growth factor (VEGF) and interleukin‐1β (IL‐1β). Methods In this cross‐sectional study, patients with PDR who underwent vitrectomy were enrolled, and the control group included non‐diabetic eyes. Vitreous and serum samples were analysed for HMGB‐1, RAGE, VEGF and IL‐1β by ELISA. We investigated the correlation between serum and vitreous levels of each cytokine, and we analysed the influence of intravitreal anti‐VEGF treatment prior to vitrectomy on the cytokine levels in PDR. Results Of 78 eyes of 78 patients enrolled consecutively, there were 32 PDR eyes and 46 control eyes. The serum levels were higher in diabetic than in non‐diabetic subjects for HMGB‐1, RAGE, VEGF and IL‐1β (all p

Purpose To quantify and evaluate macular superficial capillaries and large vessels separately using an optical coherence tomographic angiography (OCTA)-based automatic segmentation algorithm. Methods In this cross-sectional study, all eyes were scanned using an OCTA device with 3 × 3 mm cube centered on the fovea. Retinal large vessels (arterioles/venules) were automatically segmented from superficial vasculature en-face images. All images were normalized, binarized, and skeletonized for quantification. Metrics of retinal capillaries were calculated by subtracting the measurements of large vessels from total vasculature. Perfusion density (PD), vessel length density (VLD), and vessel diameter index (VDI) within Early Treatment Diabetic Retinopathy Study (ETDRS) 3-mm ring were calculated for total superficial vasculature, large vessels (PDlarge, VLDlarge, and VDIlarge) and capillaries (PDcap, VLDcap, and VDIcap), respectively. Results Fifty-nine eyes from 59 healthy participants (mean age, 45 ± 14 years, 36 females) and 118 eyes from 67 patients with diabetes mellitus (mean age, 57 ± 10 years, 28 females) were included. The diabetic cohort included four subgroups (35 eyes without diabetic retinopathy, 30 eyes with mild to moderate nonproliferative diabetic retinopathy [NPDR], 27 eyes with severe NPDR, and 26 eyes with PDR). Linear regression showed that all above metrics were correlated with the disease stage (from healthy state to PDR), and the β value was -0.76, 0.24, -0.78, 0.80, 0.30, 0.77, -0.81, 0.16, and -0.82 for VD, VDlarge, VDcap, VDI, VDIlarge, VDIcap, VLD, VLDlarge, and VLDcap, respectively. Conclusions Retinal capillaries and large vessels responded differently in the context of diabetes. VLD of capillary is a potentially reliable metric in diabetic retinopathy staging.

The aim of this study is to investigate the effects of electroacupuncturing (EA) zusanli points on levels of basic hemodynamics, lactate, and cytokines in dogs with hemorrhagic shock. Thirty healthy dogs were randomly divided into 5 groups: sham hemorrhagic shocked group, hemorrhagic shocked group, EA group, nonacupuncturing group, and EA after vagotomy group. Zusanli points were electroacupunctured with constant voltage (10-15 V, 30 Hz) for 30 minutes immediately after the shock models were established. Before the stimulation, a blood pressure transducer was implanted into the right femoral artery for continuous recording of mean arterial pressure (MAP), and a 5F Swan-Ganz pediatric catheter was implanted into the pulmonary artery. The levels of serum tumor necrosis factor α (TNF-α) in the femoral artery were detected at 0, 120, and 180 minutes after hemorrhage. The levels of serum lactate in the femoral artery were detected before hemorrhage (-45 minutes), at 0 minute, and at 180 minutes. In the hemorrhagic shocked group, the levels of MAP, cardiac output, cardiac index, central venous pressure, and pulmonary arterial wedge pressure decreased significantly; at the same time, the levels of serum TNF-α and serum lactate increased significantly. There were no differences between these groups and the hemorrhagic group, but they were different from the sham hemorrhagic shocked group. In the EA group, the levels of MAP, cardiac output, cardiac index, central venous pressure, and pulmonary arterial wedge pressure gradually increased, but the content of serum TNF-α and lactate obviously decreased. The results suggested that EA zusanli points produce a protective effect on hemorrhagic shock in dogs.

Rationale: Abdominal wall defects are common after tumor resection. Patient concerns: We report an 83-year-old male patient with recurrent tumors in his abdomen, and who had an incision wound that could not be directly closed. Mesh was not suitable because the wound was infected. Diagnoses: Abdominal wall defect result from the resection of recurrent tumor. Interventions: We carried out a vascularized ribs-pleural transfer operation. Outcomes: After the surgery, the patient gained a functional recovery. No evidence of recurrence was noted 1 year after operation, and the patient showed no symptoms of abdominal compression syndrome. Lessons: We discuss the clinical diagnosis, treatment, and follow up and argue that the vascularized ribs-pleural transfer technique is a good method to deal with abdominal wall defects.

Identifying reliable biomarkers for predicting thyroid nodules diagnosis needs understanding of all aspects of cancer cell death and survival. The thyroid nodule tissue samples were recovered from 80 patients who had undergone surgery treatment. Bioinformatics technology was used to explore the identification and characterization of Galectin-3 based on the thyroid carcinama. RNA from the thyroid nodule tissue samples was extracted, reverse transcripted. The partial gene of Galectin-3 was amplified non-specifically with the adapter molecule as primers, then all the PCR products were sequenced and analyzed. The results showed that a number of exogenous DNA fragments were obtained using DNase-sequence-independent single primer amplification. All results indicated that the Gal-3 gene showed the shift mutation in the postion of 301, 480 and 601, from Gly to Leu, Asp to Gly, Glu to Tyr from the thyroid cancer, comparad to the thyroid nodules. The partial Gal-3 gene variation as a diagnostic marker for thyroid nodules represents a promising avenue for future study, and its clinical application could significantly reduce the number of diagnostic thyroid operations performed for cases of indeterminant fine needle aspiration.

A new Key-Insulated group signature scheme is proposed under standard model. This paper takes advantage of helpers to help update member keys in every time section, meets the forward security and backward security.

This paper presents a distributed anonymous authentication scheme for MANET based on the technique of group signature, secret share and zero-knowledge proof. The scheme takes advantage of the distributed certificate management to solve the authentication and key management problems of MANET which is lack of fixed infrastructure. Meanwhile, the scheme adopts the efficient group signature presented by Camenisch and Stadler, achieved the anonymity in the process of authentication and public key transmission. In the case of a later dispute, the group manager can reveal the identity of node by opening its signature. Besides anonymity and traceability, the scheme also has the property of unforgeability and robustness.

In this paper we propose the way to form a kind of medicine Image information sharing platform, which is based on PACS and broadband network. And we also discuss some key technologies used in building up the platform, such as sharing information between heterogeneous data sources based on HL7, storing and transmission the medical images based on DICOM. The study result shows that it can make full use of those heterogeneous data resources currently in different hospitals, and give them a good way to share the data.