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Abstract To address challenges in screening for chronic kidney disease (CKD), we devised a deep learning-based CKD screening model named UWF-CKDS. It utilizes ultra-wide-field (UWF) fundus images to predict the presence of CKD. We validated the model with data from 23 tertiary hospitals across China. Retinal vessels and retinal microvascular parameters (RMPs) were extracted to enhance model interpretability, which revealed a significant correlation between renal function and RMPs. UWF-CKDS, utilizing UWF images, RMPs, and relevant medical history, can accurately determine CKD status. Importantly, UWF-CKDS exhibited superior performance compared to CTR-CKDS, a model developed using the central region (CTR) cropped from UWF images, underscoring the contribution of the peripheral retina in predicting renal function. The study presents UWF-CKDS as a highly implementable method for large-scale and accurate CKD screening at the population level.

Abstract It is a developed photosynthetic co‐culture system to alleviate the hypoxia and hypoxia/reoxygenation (H/R)‐injured human umbilical vein endothelial cells (HUVECs). The algae, Chlorella vulgaris, were encapsulated to slow their growth while not affecting the photosynthetic oxygen‐producing capacity by Layer‐by‐layer (LbL) using gelatin and sodium alginate as the positive and negative charges materials, respectively. Then, the photosynthetic co‐culture system of HUVECs and self‐oxygenating alginate hydrogel (Algae‐gel) was constructed in which the optimal ratios between algae and HUVECs were 5:1 and 20:1 for a 2D or 3D co‐cultured manner, respectively. It indicated that the 3D co‐cultured manner of HUVECs needed more O2 by the production of algae than it did in a 2D co‐cultured manner. The co‐cultured Algae‐gel could alleviate hypoxia and the oxidative stress injury of hypoxia and hypoxia/reoxygenation (H/R)‐treated HUVECs in the proliferation, intracellular ROS and cellular migratory ability. In addition, the Algae‐gel could downregulate the expression of hypoxia‐inducible factors 1α (HIF‐1α) and vascular endothelial growth factor (VEGF) of hypoxia and H/R‐injured HUVECs due to the improvement of hypoxia and H/R injury. This photosynthetic co‐culture system could offer a promising approach for repairing hypoxia and H/R‐injured cells or tissue by providing safe and stable O2.

BackgroundAlthough ophthalmic ambulatory surgeries are less costly and may enhance the more efficient utilization of hospital resources, inpatient surgeries were preferable alternatives for patients with complicated eye diseases or poor general health. However, the incidence, causes, and related factors of ophthalmic inpatient surgery cancellation remained largely unknown.MethodsThe electronic medical records of ophthalmic inpatient surgeries between January 2012 and December 2022 was retrospectively reviewed. Cancellation-related factors were explored using multivariate logistic regression analysis and the reasons of cancellation were also evaluated.ResultsIn total, 820 cancelled surgeries and 42,073 performed surgeries were included, with a cancellation rate of 1.9%. Any other ocular comorbidities were risk factors for cancellation (odds ratio (OR) 1.872, 95% confidence intervals (CI) 1.504–2.331; p

Background Polypoidal choroidal vasculopathy (PCV) is a hemorrhagic fundus disease that can lead to permanent vision loss. Predicting the treatment response to anti-VEGF monotherapy in PCV is consistently challenging. We aimed to conduct a prospective multicenter study to explore and identify the imaging biomarkers for predicting the anti-VEGF treatment response in PCV patients, establish predictive model, and undergo multicenter validation.Methods This prospective multicenter study utilized clinical characteristics and images of treatment naïve PCV patients from 15 ophthalmic centers nationwide to screen biomarkers, develop model, and validate its performance. Patients from Peking Union Medical College Hospital were randomly divided into a training set and an internal validation set. A nomogram was established by univariate, LASSO regression, and multivariate regression analysis. Patients from the other 14 centers served as an external test set. Area under the curve (AUC), sensitivity, specificity, and accuracy were calculated. Decision curve analysis (DCA) and clinical impact curve (CIC) were utilized to evaluate the practical utility in clinical decision-making.Findings The eye distribution for the training set, internal validation set, and external test set were 66, 31, and 71, respectively. The ‘Good responder’ exhibited a thinner subfoveal choroidal thickness (SFCT) (230.67 ± 61.96 vs. 314.42 ± 88.00 μm, p

PurposeTo investigate the longitudinal alterations of retinal microvasculature in patients with primary coronavirus disease 2019 (COVID-19) infection.MethodsA cohort of participants, who had never been infected with COVID-19, was recruited between December 2022 and May 2023 at Peking Union Medical College Hospital in Beijing, China. Participants underwent comprehensive ophthalmologic examinations and fundus imaging, which included color fundus photography, autofluorescence photography, swept-source optical coherence tomography (SS-OCT) and SS-OCT angiography (SS-OCTA). If participants were infected with COVID-19 during the study, follow-ups with consistent imaging modality were conducted within one week and two months after recovery from the infection.Results31 patients (61 eyes), with a mean age of 31.0 ± 7.2 years old, were eligible for this study. All participants contracted mild COVID-19 infection within one month of baseline data collection. The average period was 10.9 ± 2.0 days post-infection for the first follow-up and 61.0 ± 3.5 days for the second follow-up. No clinical retinal microvasculopathy features were observed during the follow-ups. However, SS-OCTA analysis showed a significant increase in macular vessel density (MVD) from 60.76 ± 2.88% at baseline to 61.59 ± 3.72%(p=0.015) at the first follow-up, which subsequently returned to the baseline level of 60.23 ± 3.33% (p=0.162) at the two-month follow-up. The foveal avascular zone (FAZ) remained stable during the follow-ups with areas of 0.339 ± 0.097mm2, 0.342 ± 0.093mm2, and 0.344 ± 0.098mm2 at the baseline, first follow-up (p=0.09) and second follow-up (p=0.052), respectively. Central macular thickness, cube volume and ganglion cell-inner plexiform layer showed a transient decrease at the first follow-up(p

Deep venous thrombosis (DVT) has a significant negative impact on surgical and tumor patient's safety and quality of life. There was no specific report on the incidence and risk factors of postoperative lower extremity DVT in cervical cancer patients. Analysis of the risk factors of postoperative DVT in patients with cervical cancer is of great clinical significance for prevention and treatment. We retrospectively analyzed 309 cervical cancer patients treated by the Hubei Cervical Cancer Prevention Center and used a logistic regression model to test the risk variables of postoperative lower extremity deep venous thrombosis in cervical cancer patients. By univariate analyses, the results of the study showed that the incidence of postoperative DVT was significantly increased in cervical cancer patients complicated with old age, obesity, high preoperative plasma D-dimer level, increased preoperative triglyceride level, chronic diseases (hypertension, diabetes, and cardiovascular disease), open surgery, long operation time, intraoperative blood transfusion, advanced tumor stage, and preoperative chemotherapy/radiotherapy. Advanced age, obesity, elevated preoperative D-dimer level, high preoperative triglyceride level, and open surgery were independent risk factors for postoperative lower extremity DVT in patients with cervical cancer by multivariate regression analyses (all P

PurposeTo assess the retinal vasculature changes quantitatively using wide-field optical coherence tomography angiography (OCTA) in systemic lupus erythematosus (SLE), and explore its correlation with systemic clinical features.DesignProspective, cross-sectional, observational study.Participants and controlsPatients with SLE who presented to the Ophthalmology Department of Peking Union Medical College Hospital from November 2022 to April 2023 were collected. The subjects were divided into retinopathy and without retinopathy groups. Age and gender-matched healthy subjects were selected as controls.MethodsPatients with SLE and control subjects were imaged with 24×20 mm OCTA scans centered on the fovea and 6×6 mm OCTA scans centered on the optic disc. The sub-layers of OCTA images were stratified by the built-in software of the device and then the retinal thickness and vessel density were measured automatically. The characteristics of retinal OCTA parameters of SLE and its correlation with systemic clinical indicators of patients without retinopathy were analyzed.Main outcome measuresOCTA parameters, visual acuity, intraocular pressure, and systemic clinical indicators of patients such as disease activity index, autoimmune antibodies, and inflammatory marker levels were collected.ResultsA total of 102 SLE patients were included, 24 of which had retinopathy, and 78 had unaffected retina. Wide-field OCTA could effectively detect retinal vascular obstruction, non-perfusion area, and morphological abnormalities in patients with lupus retinopathy. SLE patients without retinopathy had significantly higher retinal superficial vessel density (SVD) in foveal (P=0.02), para-foveal temporal (P=0.01), nasal (P=0.01), peripheral foveal temporal (P=0.02), and inferior areas (P=0.02), as well as subregion temporal (P=0.01) and inferior areas (P=0.03) when compared with healthy controls (n=65 eyes from 65 participants). The area under curve (AUC) value of subregion inferior SVD combined parafoveal temporal SVD was up to 0.70. There was a significantly positive correlation between SVD and disease activity in SLE without retinopathy group. Patients with severe activity had the most significant increase in SVD.ConclusionWide-field OCTA can provide a relatively comprehensive assessment of the retinal vasculature in SLE. In the absence of pathological changes of the retina, the SVD was significantly increased and was positively correlated with the disease activity of SLE.

Here the authors quantitatively characterize binding to transcription factor (TF) binding site clusters in vitro, followed by characterizing clusters in synthetic and native gene regulatory systems in yeast. They show low-affinity clusters achieve high TF occupancies in vitro and gene activation in vivo, suggesting occupancy rather than individual TF dwell times drive transcriptional activation.

BackgroundTo explore the central and peripheral retinal and choroidal changes in diabetic patients without clinical diabetic retinopathy (DM-NoDR) using ultra-wide-field swept-source optical coherence tomography angiography (UWF-SS-OCTA).Methods67 DM-NoDR eyes and 32 age-matched healthy eyes were recruited. Retinal and choroidal parameters, including qualitative retinal microangiopathy, vessel flow (VFD) and linear density (VLD), thickness, and volume, were measured in the central and peripheral areas of the 24 × 20 mm2 UWF-SS-OCTA images.ResultsDM-NoDR eyes had significantly more nonperfusion area and capillary tortuosity than controls in the central and peripheral areas (p

Axenfeld-Rieger syndrome (ARS) is an autosomal dominant disorder that is primarily due to disruption of the development of neural crest cells. The onset of associated symptoms in both eyes accompanied by extraocular developmental defects is referred to as ARS. Cardiac defects associated with ARS have been reported, but the extent of the cardiac defects has yet to be defined. We report a case of a 17-year-old girl with ARS with typical facial malformations and severe mitral and tricuspid valve insufficiency. The patient was diagnosed with secondary glaucoma detected on ophthalmologic examination. Echocardiography showed severe mitral and tricuspid valve insufficiency. This case provides further evidence of the association of ARS with cardiac malformations and extends the reported range of cardiac malformations in patients with ARS.

The demand for leaf area index (LAI) retrieval from spaceborne full-waveform LiDAR increases due to its direct sampling of the three-dimensional forest structure at a near-global scale. However, the nonrandomness (i.e., clumping effect) of canopy composition limits the reliability of LAI derived from two common methods. They either assume a homogeneous scene in the footprint or just correct for the large gaps-induced between-crown clumping. The clumping in the crown is still an unaddressed issue. We proposed a method to compensate occlusion (i.e., lower canopy layers are occluded by the upper canopy in the process of LiDAR measurement), through which the vertical canopy profile can be resolved from the waveform. Further, we developed a method of deriving relative path length distribution that can reflect the heterogeneity of the canopy from the occlusion-corrected waveform. In addition to correcting the between-crown clumping, we corrected the within-crown clumping further using the derived relative path length distribution, based on path length distribution (PATH) theory. We used simulated waveform data with known LAI and GLAS data with corresponding field-measured LAI to test the performance of our and the other two common LAI retrieval methods. Results show that the errors of our approach are the lowest (with an error generally below 10% and the maximum error below 20%, compared with up to 69% and 47% for the other two methods), and it is relatively stable in various scenes. This study demonstrated the potential of improving LAI retrieval through full utilization of full-waveform data.

The automatic segmentation of the left ventricle in magnetic resonance (MR) images is the basis of computer-aided diagnosis systems. To accurately extract the endocardium and epicardium of the left ventricle from MR images, a method based on a dilated dense convolutional network (DDCN) has been proposed in this article. First, to reduce memory consumption, computing time and the class imbalance between the target and background, a clustering algorithm that combines the prior knowledge of the spatial relationship between the slices has been proposed to crop the region of interest (ROI). Then, the DDCN model with 8 dilated convolutional layers and dense connections, which is efficient with respect to its memory consumption and training time, has been proposed to delineate the endocardium and epicardium. To compare the DDCN model with other algorithms, 30 sequences of the MICCAI 2009 left ventricle segmentation challenge database are used to train the proposed model and the other 15 sequences are used for testing. The performance of the proposed method is evaluated by the percentage of “good” contours (PGC), average Dice metric (ADM) and average perpendicular distance (APD). Our results show that for the endocardial and epicardial contours, the PGCs are 99.49%±1.99% and 100%±0%, the APDs are 1.50±0.34 mm and 1.31±0.22 mm, and the ADMs are 0.93±0.03 and 0.96±0.01, respectively, which indicates that our method provides contours with great agreement with the ground truth. In addition, the comparison results show that our method exhibits outstanding performance and possesses promising potential to be used in computer-aided diagnosis systems for cardiovascular disease.

Cardiovascular diseases are reported as the leading cause of death around the world. Automatic segmentation of the left ventricle (LV) from magnetic resonance (MR) images is essential for an early diagnosis. An enhanced ResUnet is proposed in this paper to improve the performance of extracting LV endocardium and epicardium from MR images, improving the accuracy of the model by introducing a medium skip connection for the contracting path and a short skip connection for the residual unit. Also, a depth-wise separable convolution replaces the typical convolution operation to improve training efficiency. In the MICCAI 2009 LV segmentation challenge test dataset, the percentages of “good” contours, dice metric, and average perpendicular distance of endocardium (epicardium) are 99.12%±2.29%100%±0%,0.93±0.02 0.96±0.01,and 1.60±0.42 mm 1.37±0.23 mm, respectively. Experimental results demonstrate that the proposed model obtains promising performance and outperforms state-of-the-art methods. By incorporating these various skip connections, the segmentation accuracy of the model is significantly improved, while the depth-wise separable convolution also improves the model efficiency.

Background: Ozone (O3) and nitrogen dioxide (NO2) are substances with oxidizing ability in the atmosphere. Only considering the impact of a single substance is not comprehensive. However, people’s understanding of “total oxidation capacity” (Ox) and “weighted average oxidation” (Oxwt) is limited. Objectives: This investigation aims to assess the impact of Ox and Oxwt on the novel coronavirus disease (COVID-19). We also compared the relationship between the different calculation methods of Ox and Oxwt and the COVID-19 infection rate. Method: We recorded confirmed COVID-19 cases and daily pollutant concentrations (O3 and NO2) in 34 provincial capital cities in China. The generalized additive model (GAM) was used to analyze the nonlinear relationship between confirmed COVID-19 cases and Ox and Oxwt. Result: Our results indicated that the correlation between Ox and COVID-19 was more sensitive than Oxwt. The hysteresis effect of Ox and Oxwt decreased with time. The most obvious statistical data was observed in Central China and South China. A 10 µg m−3 increase in mean Ox concentrations were related to a 23.1% (95%CI: 11.4%, 36.2%) increase, and a 10 µg m−3 increase in average Oxwt concentration was related to 10.7% (95%CI: 5.2%, 16.8%) increase in COVID-19. In conclusion, our research results show that Ox and Oxwt can better replace the single pollutant research on O3 and NO2, which is used as a new idea for future epidemiological research.

Summary: Stretchable, biocompatible devices can bridge electronics and biology. However, most stretchable conductors for such devices are toxic, costly, and regularly break/degrade after several large deformations. Here we show printable, highly stretchable, and biocompatible metal-polymer conductors by casting and peeling off polymers from patterned liquid metal particles, forming surface-embedded metal in polymeric hosts. Our printable conductors present good stretchability (2,316 S/cm at a strain of 500%) and repeatability (ΔR/R

Leaf angle distribution (LAD) is an important attribute of forest canopy architecture and affects the solar radiation regime within the canopy. Terrestrial laser scanning (TLS) has been increasingly used in LAD estimation. The point clouds data suffer from the occlusion effect, which leads to incomplete scanning and depends on measurement strategies such as the number of scans and scanner location. Evaluating these factors is important to understand how to improve LAD, which is still lacking. Here, we introduce an easy way of estimating the LAD using open source software. Importantly, the influence of the occlusion effect on the LAD was evaluated by combining the proposed complete point clouds (CPCs) with the simulated data of 3D tree models of Aspen, Pin Oak and White Oak. We analyzed the effects of the point density, the number of scans and the scanner height on the LAD and G-function. Results show that: (1) the CPC can be used to evaluate the TLS-based normal vector reconstruction accuracy without an occlusion effect; (2) the accuracy is slightly affected by the normal vector reconstruction method and is greatly affected by the point density and the occlusion effect. The higher the point density (with a number of points per unit leaf area of 0.2 cm−2 to 27 cm−2 tested), the better the result is; (3) the performance is more sensitive to the scanner location than the number of scans. Increasing the scanner height improves LAD estimation, which has not been seriously considered in previous studies. It is worth noting that relatively tall trees suffer from a more severe occlusion effect, which deserves further attention in further study.

In this paper, we investigate essential mechanical properties and cell behaviors of the scaffolds fabricated by rolling polylactic-co-glycolic acid (PLGA) electrospinning (ES) films for small-diameter vascular grafts (inner diameter < 6 mm). The newly developed strategy can be used to fabricate small diameter vascular grafts with or without pre-seeded cells, which are two main branches for small diameter vascular engineering. We demonstrate that the mechanical properties of our rolling-based scaffolds can be tuned flexibly by the number of layers. For cell-free scaffolds, with the increase of layer number, burst pressure and suture retention increase, elastic tensile modulus maintains unchanged statistically, but compliance and liquid leakage decrease. For cell-containing scaffolds, seeding cells will significantly decrease the liquid leakage, but there are no statistical differences for other mechanical properties; moreover, cells live and proliferate well in the scaffold after a 6-day culture.