Spots Research Articles

Optical coherence tomography angiography characteristics of choroidal neovascularizaiton in eyes with flat irregular pigment epithelial detachments

Objective To assess the occurrence of CNV in patients presenting with flat irregular pigment epithelial detachments (FIPED). Methods Forty-five patients (49 eyes) with FIPED on OCT were enrolled in this retrospective study. There were 25 males (28 eyes) and 20 females (21 eyes). The mean age was 61.022±9.292 years. FFA, ICGA, spectral domain OCT and OCT angiography (OCTA) were performed in all patients during the same period. The FIPED was defined as an irregular elevation of the RPE allowing distinct visualization of Bruch’s membrane on OCT B-scan. The abnormal vascular signals from the deep retinal layer to the choroid layer on OCTA was defined as CNV. The CNV was classified into a type 1 CNV and a type 2 CNV according to the OCT characteristics. The CNV was classified into a typical and occult CNV according to the characteristics of the FFA image. Of all 49 eyes, fundus angiography revealed 18 eyes (36.7%) with CNV, and 31 eyes (63.3%) with no characteristic signs of CNV. FFA examination found that CNV in 8 eyes (classic CNV in 1 eyes, occult CNV in 7 eyes), which confirmed by OCT were type 1 CNV; transmitted fluorescence in 41 eyes. ICGA examination showed that CNV-like hyperfluorescence spots in 18 eyes, suspicious hyperfluorescence spots in late stage in 20 eyes, and choroidal high permeability in 11 eyes, respectively; and 18 CNV eyes were confirmed to be type 1 CNV by OCT. To compare the detection of CNV by OCTA and fundus angiography. Results Of the 49 eyes with FIPED, OCTA detected 36 eyes (73.5%) of type 1 CNV, and full or partial strong reflex signals were seen in FIPED; 13 eyes (26.5%) were not associated with CNV, and some strong reflection signals were found in FIPED in 9 eyes, 4 eyes with weak reflection signal. The FFA was examined for 1, 7 eyes of the classic and occult CNV, which confirmed to be type 1 CNV by OCTA. Among the 18 eyes with CNV which detected by ICGA, OCTA also found type 1 CNV. Among the 20 eyes with ICGA’s late suspicious strong fluorescent spots, OCTA showed 17 eyes of type 1 CNV; in 11 eyes with high choroidal permeability, OCTA showed type 1 CNV in 1 eye. Among the 36 eyes with CNV which detected by OCT, there were SRD in 32 eyes, no SRD in 2 eyes and retinal interlamellar cavities in 2 eyes. Conclusion OCTA can detect 73.5% of FIPED eyes with CNV. Compared with traditional fundus angiography, OCTA has a higher detection rate of CNV under FIPED. The FIPED of the internal strong reflection signal has a certain diagnostic value for the type 1 CNV. Key words: Flat irregular pigment epithelial detachments; Choroidal Neovascularization/diagnosis; Tomography, optical coherence; Fluorescein angiography; Indocyanine green/diagnostic use

Molecular targeted therapy for acute myeloid leukemia

In recent years, genetic alterations have played a crucial role in the diagnosis and prognostic stratification of acute myeloid leukemia (AML) and provided targeted spots for molecular targeted therapy. Due to the limitations of traditional chemotherapy, more and more targeted drugs are going to clinic or undergoing clinical trials. This article introduces several molecular targeted agents reported in the 60th American Society of Hematology (ASH) Annual Meeting. Key words: Leukemia, myeloid, acute; Genes; Mutation; Molecular targeted therapy; American Society of Hematology Annual Meeting

Looking back 2018--focused on colorectal cancer

Colorectal cancer is one of the most common malignant tumors, and its incidence and mortality are increasing year by year in China. In 2018, for the first time, the FIT-DNA test was written into the expert consensus as the recommended screening technology in China. As the core technology of colorectal cancer screening, colonoscopy for right colon cancer is further supported. With the application of artificial intelligence technology in colonoscopy, the efficiency and accuracy of screening will be greatly improved. New screening technologies represented by circulating tumor cell (CTC) and individualized screening programs based on molecular genetics are future directions. As the core of colorectal cancer treatment, surgery has become quite mature. Traditional laparoscopic surgery has become an optimal choice for colorectal cancer surgery. Open surgery, robotic surgery and single-incision laparoscopic surgery have not been found superior to multiport laparoscopic surgery. The focus of surgical research is to precisely select surgical methods, and to protect normal physiological function of patients. For example, in order to reduce complications and improve quality of life in patients undergoing rectal cancer surgery after neoadjuvant radiotherapy, the "Tianhe surgery" was invented by the authors' team. Chemotherapy as the basis of colorectal cancer treatment has shown good results in many aspects: The PRODIGE-7 trial has confirmed that systemic chemotherapy is more important for colorectal peritoneal metastasis after high quality cytoreductive surgery (CRS). While the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin does not result in the better overall survival (OS), but increases the risk of postoperative complications. The FOWARC study has found that the FOLFOX regimen (oxaliplatin and fluorouracil) achieved a 3-year disease-free survival (DFS) rate similar to that of neoadjuvant chemoradiotherapy, challenging the clinical value of radiotherapy. Although several studies have confirmed that total neoadjuvant therapy (TNT) can improve pathological complete response (pCR) rate and DFS of patients with colorectal cancer, we do not recommend unretricted expansion of chemotherapy. How to combine the clinical characteristics and molecular biological markers to select high-risk groups for chemotherapy, and how to use personalized medicine according to the genetic characteristics of patients, are also hot spots of current research. Immunotherapy is a game-changer in all aspects of colorectal cancer. In order to adapt to the immune therapy, the efficacy evaluation standard of solid tumors (iRECIST) has been revised. Immune score could redefine tumor clinical staging system. Both the Checkmate-142 study for advanced tumors and the NCT03026140 study on neoadjuvant treatment for early tumors showed promising results. Although no significant progress has been seen in the EGFR-targeted therapy and VEGFR-targeted therapy, new targeted drugs such as Eltanexor (ETLA, kpt -8602) and cobimetinib (MEK inhibitor) have been found to be effective in clinical studies. According to the detection results of tumor-related signaling pathways in patients, cross-guidance selection of targeted drug therapy is also the direction of research. Although the IWWD research results give a big blow to the "watch and wait" strategy, with the exploration of TNT plan, more accurate imaging efficacy evaluation and the application of immunotherapy, the "watch and wait" strategy will also receive new attention. In recent years, we have seen the rapid development of artificial intelligence technology. Although it is still in the exploratory stage in the field of medicine, it will certainly reshape all aspects of colorectal cancer diagnosis and treatment in the future, leading the research direction.

An eye for reproduction: Gravid spots in fish

An eye for reproduction: Gravid spots in fish

High risk disease mapping and spatial effect of pulmonary tuberculosis in Kerbala, Iraq

Introduction: Pulmonary tuberculosis (PTB) remains one of the top ten causes of death globally. A crucial component of controlling this infection is by limiting the spread of the disease. This study aimed to identify hot spot geographical areas with PTB incidence and to evaluate spatial global autocorrelation using geographical information science (GIS) technology. Methods: Using tuberculosis register software, cases of PTB were recorded by Chest and Respiratory illnesses center in Kerbala governorate. Seven years' data records were used to investigate hot spots and spatial distribution of PTB cases in Kerbala. Patients whom reside outside Kerbala were excluded from the current analysis. Loess smoothing Seasonal decomposition trend was applied to analyze temporal patterns and clusters mapping of tuberculosis, using R statistical software version 3.5.1. Correlation analysis (pairwise Spearman) was used to observe the association among the factors contributing to PTB prevalence. Standard morbidity ratio (SMRs) was used to find the morbidity rate Bayesian conditional auto-regressive model was used in the analysis and estimation of the parameters was done through Markov Chain Monte Carlo methods to estimate the space mapping variability cluster of disease risk and covariates effect. Results: A significant correlation was found between PTB prevalence and the age (r = 0.731) and was also found in gender (r = 0.822). Most of the cases were distributed within the age of 17–50 years (68.4%). Tuberculosis cases were not randomly distributed in which the variables occur with asymptotic probabilities with unpredictable spacing and that there was the presence of high global autocorrelation among PTB cases in the City of Kerbala. Approximately, 59% of all PTB cases were seen in six quarters. Conclusion: Spatial analysis using GIS reveals useful information about epidemiological situation of PTB cases in Kerbala Province, Iraq. Additionally, this study predicted possible places for PTB transmission based on hot spot analysis and the continuous presence of infection during the studied period.

Effect of chitosan coating in the shelf life and control of Listeria monocytogenes growth on the surface of ready-to-eat bovine meatballs during chilled storage

Edible chitosan coating on the surface of ready-to-eat (RTE) bovine meatballs was evaluated for its effect in the shelf life of them and the control of Listeria monocytogenes at 5 °C. L. monocytogenes was inoculated onto the surface of RTE bovine meatballs with and without edible chitosan coating. The samples were stored at 5 °C. Total aerobic viable count (TVC) and the bacterial counts of L. monocytogenes , lactic acid bacteria and Enterobacteriaceae were determined on days 0,1,7,14,21 and 28. The sensory characteristics were also evaluated at the same time spots by semi trained panelists. The analysis depicted that the use of edible chitosan membranes reduced all of the microbial populations that were enumerated, and retard their growth leading to the conclusion that they can prolong the span life of these products by 14 days. Moreover, the population of the inoculated L. monocytogenes was about 2 log CFU/g lower in the meatballs coated with chitosan, indicating an inhibitory effect of chitosan in the growth of L. monocytogenes . The sensory analysis showed that the coated with chitosan samples were satisfactorily accepted by the panelists even at day 28, in contrast to the samples without chitosan (control samples) which were unacceptable at day 14. These results indicate that edible chitosan coatings represent a potential agent in controlling L. monocytogenes on the surface of RTE meatballs as well as other RTE meat products, prolonging their shelf life without affecting their sensory characteristics.

Immunological characteristics of peritoneal cavity and intra-abdominal infection

Despite the evolution of aggressive surgical techniques, extensive methods of supportive care and a vast array of anti-microbial options, intra-abdominal infection (IAI) is still a challenging clinical issue. Especially, when progressed IAI with septic complications because of unbalanced immune responses, the prognosis will deteriorated significantly. Recent studies indicate that besides the natural immunological cells, including macrophages and neutrophils, local immunological characteristics of peritoneal cavity should be studied with great attention. Among them, the omentum is considered to be a visceral adipose tissue with unique immune function. The milky spots(MSs) formed by the accumulation of immune cells performs immune surveillance and has a lymph node-like immune function, which is very important for the immune defense of the abdominal cavity. B1 cells and two types of intrinsic lymphocytes(ILC2) in the peritoneal cavity, although belonging to the lymphatic lineage, may play an important role in abdominal infections, especially in the early stages of the disease, due to their rapid responsiveness and acquired immune function. Therefore, paying attention to the immunological characteristics of the peritoneal cavity, and elucidating the changes, functions and regulatory mechanisms of B1 cells and ILC2 around the MSs and their components in the process of IAI, in order to explore the immunomodulation targets of blocking the infection from local to systemic dissemination, may be the key to solving the clinical problem of severe IAI and improving prognosis.

The effect of incorporating the quantitative analysis besides visual assessments of 18F-FDG brain PET images for the localization of epileptogenic zones

Introduction: FDG Brain PET is a valuable paraclinical tool for presurgical assessments of patients suffering from refractory epilepsy. By the widespread accessibility of PET, recognizing the functional lesions has become a current practical method especially in preoperative evaluations of the partial epilepsy disorders. The aim of our study was to assess the impact of quantitative software-aided method in localizing epileptic zones in human brain using 18F-FDG Brain PET scan beside the physician qualitative interpretations. Materials and Methods: The subjects have been selected among patients referred to brain PET imaging who were suffering from refractory epilepsy. Seventeen patients (9 men, 8 women ; 25±11 YO) underwent PET scan. Quantitative analysis of brain functional images were applied by the Scenium software which provided statistical color-coded images of Z-scores and standard deviations (1). We considered Z-scores<-2 as an abnormal range of brain metabolism. It is worth mentioning that, we categorized the patients based on their MRI investigations to lesional and non-lesional groups. Two physicians presented visual assessments in order to localizing epileptic spots. Also, the kappa index had been calculated as an agreement coefficient via SPSS (V.19.0) software. Results: In the case of assessing the accordance of lesions’ localization among MRI, EEG, and PET/CT evaluations, the agreement level of EEG versus quantitative and qualitative method were reported 0.67 and 0.12, respectively, which were related to non-lesional group. Also, in the lesional category, the kappa indices for quantitative and qualitative analysis against the suspicious lesions on MRI were 0.56 and 0.27, respectively Conclusion: Epilepsy disorder has destructive effects on quality of life. Thereby, accurate diagnosis of lesion locations could have a vital impact in order to patients’ treatment, exclusively in refractory epilepsy which might treat through doing the brain’s operation (2). The foregoing discussion is a confirmation of the supplementary role of quantitative software alongside visual assessments, in order to do pre-surgical evaluations of epileptic positions in human brain via 18F-FDG Brain PET images. Hence, utilizing of quantitative software could be a complementary method together with MRI and EEG procedures to improve the confidence of surgeon about the epileptic spots(3).

Determination of an Effective Wedge Angle by Combination of Two Arbitrary Universal Wedge Fields in Radiation Therapy of Cancer Patients with Megavoltage Photon Beams.

Introduction: Wedge filters are commonly used in radiation oncology for eliminating hot spots and creating a uniform dose distribution in optimizing isodose curves in the target volume for clinical aspects. These are some limited standard physical wedges (15°, 30°, 45°, 60°), or creating an arbitrary wedge angle, like motorized wedge or dynamic wedge, ... The new formulation is presented by the combination of wedge fields for determining an arbitrary effective wedge angle. The isodose curves also are derived for these wedges. Materials and Methods: we performed the dosimetry of Varian Clinac 2100C/D with Scanditronix Wellhofer water blue phantom, CU500E, OmniPro - Accept software and 0.13cc ionization chamber for 6Mv photon beam in depth of 10cm (reference depth) for universal physical wedges (15°, 30°, 45°, and 60°) and reference field 10x10cm2. By combining the isodose curve standard wedge fields with compatible weighting dose for each field, the effective isodose curve is calculated for any wedge angle. Results: The relation between a given effective wedge angle and the weighting of each combining wedge fields was derived. A good agreement was found between the measured and calculated wedge angles and the maximum deviation did not exceed 3°. The difference between the measured and calculated data decreased when the combined wedge angles were closer. The results are in agreement with the motorized single wedge appliance in the literature. Conclusion: This technique showed that the effective wedge angle that is obtained from this method is adequate for clinical applications and the motorized wedge formalism is a special case of this consideration.

Screening indices and their cut-off values for full-term neonates carrying β-thalassemia gene

To investigate the screening indices and their cut-off values for full-term neonates carrying β-thalassemia gene. A retrospective analysis was performed for the clinical data of 1 193 full-term neonates who underwent β-thalassemia screening (hemoglobin analysis with dried blood spots on neonatal heel blood filter paper and mutation detection of 17 β-globin genes). A multivariate logistic regression analysis was used to investigate the association between screening indices and β-thalassemia gene, and the receiver operating characteristic (ROC) curve was used to analyze the value of screening indices in determining the presence or absence of β-thalassemia gene. Of the 1 193 neonates, 638 carried β-thalassemia gene. Of the 1 193 neonates, 637 (53.39%) had no HbA2, among whom 310 carried β-thalassemia gene and 327 did not carry this gene; 556 (46.61%) had HbA2, among whom 328 carried β-thalassemia gene and 228 did not carry this gene. As for the neonates without HbA2, the β-thalassemia gene group had a significantly lower HbA level and a significantly higher HbF level than the β-thalassemia gene-negative group (P<0.01). As for the neonates with HbA2, the β-thalassemia gene group had a significantly lower HbA level and significantly higher HbF and HbA2/HbA ratio than the β-thalassemia gene-negative group (P<0.01). In the neonates without HbA2, HbA, gestational age, and HbA combined with gestational age had an area under the ROC curve (AUC) of 0.865, 0.515, and 0.870, respectively, in determining the presence or absence of β-thalassemia gene (P<0.01), and HbA and HbA combined with gestational age had a similar AUC and a certain diagnostic value. In the neonates with HbA2, HbA, HbA2/HbA ratio, and HbA combined with HbA2/HbA ratio had an AUC of 0.943, 0.885, and 0.978, respectively, in determining the presence or absence of β-thalassemia gene. The HbA combined with HbA2/HbA ratio had the largest AUC. In the neonates without HbA2, HbA had the largest AUC in determining the presence or absence of β-thalassemia gene at the cut-off value of 11.6%, with a sensitivity of 85.81% and a specificity of 79.82%. In the neonates with HbA2, an HbA of 16.1%-22.0% and an HbA2/HbA ratio of >1.4 had the largest AUC in determining the presence or absence of β-thalassemia gene, with a sensitivity of 91.38% and a specificity of 91.89%. HbA and HbA2/HbA ratio are effective indices for screening out full-term neonates carrying β-thalassemia gene.

Quantification the dosimetric parameters of asymmetric physical wedged-6MV photon beam

Introduction: Physical wedge as a useful tool has been utilized in radiotherapy to modify photon beam shape and intensity such that it distributes dose uniformly in tumor site and reduces hot points. Since during Linac commissioning dosimetric parameters like output factors and lateral dose profiles are measured only for symmetric open and wedged fields, so calculation the parameters for asymmetric wedged fields become necessary. The study aims to achieve output factors and dose profiles for symmetric and asymmetric wedged fields of 6 MV photon beams. Materials and Methods: The Siemens PRIMUS Linac head for 6 MV photon beam was simulated by BEAMnrc and all dose calculations were performed by DOSXYZnrc code. Percentage depth dose (PDD) and profiles for open and wedged (15° and 45°) fields were compared with corresponding measurements. Wedge factors for 10 x 10 cm2 field size as a function of lateral distance from central axis were obtained as well for half beam (negative or positive Y jaws were closed) wedged fields. All mesurments were carried out using 0.125 cm3 Farmer type ionization chamber with DOSE1 electrometer (FC65G, Scanditronix-Wellhofer, Germany) at the depth of 10 cm with source to surface distance (SSD) of 100 cm in 50 cm3 PTW-Blue water phantom and processed by dosimetry software RFAplus (Version 5.2, Scanditronix-Wellhofer, Germany). Results: The calculated doses were in agreement with measured data that confirmed the simulated MC model. The output factors on the central axis of symmetric wedged beams decreased to 0.693 and 0.307 for 15˚ and 45˚ wedges, respectively. The total photon fluence of 15˚ and 45˚ physical wedged fields reduced to 71.6% and 27.7% of fluence for open field, respectively. It was found that the output factor for asymmetric wedged fields is lower than ones from symmetric fields, particularly at field edges. Conclusion: The presences of physical wedge across the beamline decrease the photon fluence and cases beam hardening both for symmetric and asymmetric wedged fields. Lack of scattering photons near the half beam edges in asymmetric wedged field causes a dose fall off in these regions where have potential to overestimate the calculated dose by treatment planning system and consequent cold spots at target volume. Our calculated correction coefficients are recommended to calculate doses by TPS in case of asymmetric wedged fields.

Optimization of tangential fields arrangement in the breast cancer 3D conformal radiation therapy

Introduction: The incidence of breast cancer increases with the rate of 1-2% at the world. Radiation therapy is one of the available choices for breast cancer treatment. The single isocentre half-beam block technique is considered as a standard technique to avoid hot and cold spots within the PTV. The major advantage of half beam technique is that the both contralateral breast and lung are completely spared. Also, using this technique, we don’t have any field matching problem. But, Lateral and medial movement of isocenter in conjunction of supraclavicular and tangential beams affect the divergence of tangential fields. Therefore, opposite tangential field can be parallel either in posterior border or beam central axis. The aim of this study is to compare the dosimetric parameters of three plans for tangential beams arrangement and select the optimal one. Materials and Methods: In this study, we selected 6 patients with breast cancer that underwent breast conserving surgery and considered for radiotherapy. CT simulation of patients were done based on standard protocols and imported to Isogray treatment planning system. Contouring of target volume and organs at risk (OARs) was done by radiotherapist. The tangential fields were considered in three different geometries of parallel in the posterior border with divergence in back jaws, parallel in central axis with divergence in back jaws and Parallel in posterior border without divergence of back jaws (half beam). Dosimetric parameters of each plan for OARs and target volumes extracted from DVHs data and compared statistically using ANOVA one-way repeated measurement test. Results: There was no statistical difference between dosimetric parameters (D95, V95, Dmax, and Dmean) of the target volume in three mentioned plans (P-value = 0.93). Although, there was no statistical difference between mean dose of the ipsilateral lung, the difference of V10 and V20 parameters for this organ is significant (P=0.01). Furthermore, there was no statistical difference in dosimetric parameters of OARs such as contralateral breast, lung, heart, and spinal cord. Conclusion: This study showed that back jaw divergence and arrangement of parallel opposite field can affect the ipsilateral lung dose. The V20 and V10 of ipsilateral lung are two dose constraints parameters in quantitative treatment planning evaluation of breast treatment. Quantitative variations of these parameters with changing the tangential field’s arrangement was significant which depends on the isocenter position and back jaw divergence. The values of these parameters were the highest when tangential fields were arranged as parallel in posterior border with divergence in the back jaw.

14. Les marchés financiers sont-ils des marchés d’opinion ?

Soumis à la fois à une mathématisation savante qui a envahi les salles de marché à partir des années 1970, à une spéculation de plus en plus professionnelle grâce aux perfectionnements de l’algorithmique, et aux réactions affectives des intervenants devant les incertitudes futures, les marchés financiers influencent l’économie d’une façon à la fois puissante et très particulière parce que limitée par leur propre agitation structurelle. On voit mieux aujourd’hui les angles morts que laisse cette coordination vis-à-vis des problèmes énergétiques et environnementaux.

High-frequency skin ultrasonographic and dermoscopic features of seborrheic keratosis

Objective To describe high-frequency skin ultrasonographic and dermoscopic features of seborrheic keratosis (SK) . Methods Between August and December in 2017, 46 outpatients with SK were enrolled from the Department of Dermatology of Peking Union Medical College Hospital, and 50 SK lesions were observed by 50-and 20-MHz high-frequency skin ultrasonography and dermoscopy. The high-frequency ultrasonographic and dermoscopic features of SK lesions were summarized and analyzed. Statistical analysis was done by using chi-square test for comparisons of evaluation results of SK lesions between 50-and 20-MHz ultrasonography, and the correspondence between high-frequency skin ultrasonographic and dermoscopic features of SK was analyzed by calculating the simple matching coefficient. Results As 50-and 20-MHz ultrasonography showed, ultrasonographic features of SK lesions from top to bottom were enhanced hyperecho (48/50 vs. 39/50, respectively, P= 0.007) , enhanced hyperechoic masses or spots in the stratum corneum (22/50 vs. 11/50, respectively, P= 0.019) , sound shadows behind the epidermis (34/50 vs. 13/50, respectively, P 3) under dermoscopy were 58% (29) and 48% (24) respectively. Conclusion High-frequency skin ultrasonography and dermoscopy both are of great value to the assessment of SK lesions, and 50-MHz ultrasonography is superior to 20-MHz ultrasonography for imaging skin lesions. Key words: Keratosis, seborrheic; Ultrasonography; Dermoscopy; Pathologic processes; Skin manifestations

The Sunniest Spots On The Moon Are Not Where You'd Expect Them

The Sunniest Spots On The Moon Are Not Where You'd Expect Them

Chemically Induced Cellular Proteolysis: An Emerging Therapeutic Strategy for Undruggable Targets.

Traditionally, small-molecule or antibody-based therapies against human diseases have been designed to inhibit the enzymatic activity or compete for the ligand binding sites of pathological target proteins. Despite its demonstrated effectiveness, such as in cancer treatment, this approach is often limited by recurring drug resistance. More importantly, not all molecular targets are enzymes or receptors with druggable ‘hot spots’ that can be directly occupied by active site-directed inhibitors. Recently, a promising new paradigm has been created, in which small-molecule chemicals harness the naturally occurring protein quality control machinery of the ubiquitin-proteasome system to specifically eradicate disease-causing proteins in cells. Such ‘chemically induced protein degradation’ may provide unprecedented opportunities for targeting proteins that are inherently undruggable, such as structural scaffolds and other non-enzymatic molecules, for therapeutic purposes. This review focuses on surveying recent progress in developing E3-guided proteolysis-targeting chimeras (PROTACs) and small-molecule chemical modulators of deubiquitinating enzymes upstream of or on the proteasome.

Clinical study on the treatment of II and III stage of pressure ulcer in elderly patients by Moxibustion along the meridian

Objective To investigate the therapeutic effect of moxibustion on theⅡ andⅢ stage of pressure ulcer. Methods A total of 50 cases of pressure ulcer patients in the Geriatric Department of Hangzhou Red Cross Hospital from January 2016 to October 2017 were selected by convenience sampling method. According to the random number sequence table, 50 cases (total of 63 injured spots) were divided into control group and observation group, with 25 cases in each group. The control group received routine nursing care, moist healing treatment. The observation group was treated with moxibustion along meridians combined with strong points and wounds on the basis of routine treatment. Two groups of patients were compared with healing days and vascular endothelial growth factor (VEGF). Results The healing days in the observation group (21.43±2.75) days were less than that in the control group (25.15±3.23) days. The VEGF level in the observation group was (370.22±51.48) pg/ml, which was lower than that in the control group (401.62±54.23) pg/ml, and the differences were statistically significant (P<0.05). Conclusions Moxibustion along the meridian can effectively treat the Ⅱ and Ⅲ stages of pressure ulcer in elderly patients and obviously shorten the healing course. This traditional Chinese medicine should be popularized in clinical practice. Key words: Pressure ulcer; Heal; Moxibustion; Along the meridian

Constraints in Grain quality management: A warehouse journey: Presentation

India produces about 150 million tons of food grains per year. The major components of production are 47 million tonnes of wheat, 64 million tonnes of rice, and 13 million tonnes of pulses. Seasonal fluctuations in harvesting of grains impose efficient design for long term storage. Quality of grains will be retained by proper storage. Post harvest processing and storage conditions such as temperature, humidity, aeration, insect infestation, rodents, fungus, etc., at a particular geographical location influence the qualitative and quantitative losses of grains. Approximately about 10% of produce wasted during post production such as harvesting, threshing, and storage which means that about 15 million tons of grains are being washed out per year. Main intention of any government in warehousing is to offer a safe buffer stock during off-season. Knowledge about existing storage criteria creates a vision to develop new strategies. Based on this concept, a compartment in a godown of dimension 37.2m x 24.2m x 8m made of concrete and asbestos roof, with six doors and thirty-four windows was selected for the research. The stacks of dimension 6.5m x 3.9m x 6.1m with two hundred and sixtyfour numbers of gunny bags filled with grains arranged above the wooden dunnage were selected for insect and chemical analysis. Temperature, humidity and aeration rate were recorded at four corners and at center of the stack and also at 26 different spots in whole godown. The influence of various factors on insect infestation in grains during storage was studied. The results will help to design an advanced scientific grain storage godown for safe storage of grains in gunny bags for longer duration.

Clinical etiological analysis of severe vitreous hemorrhage in venerable age patients

Objective To analyze the etiologies of severe vitreous hemorrhage in venerable age patients. Methods A retrospective series case study was adopted.Medical records of 30 cases 30 eyes severe vitreous hemorrhage venerable age patients were analyzed in Xuanwu Hospital Capital Medical University, Peking University Third Hospital and Beijing Tsinghua Chang Gung Hospital from July in 1999 to June in 2015.Visual acuity, intraocular pressure, anterior segment slit lamp microscopy, mydriasis funduscopy and ophthalmic B type ultrasound examination were used to evaluate 30 cases 30 eyes.Thirty eyes were all treated with pars plana vitrectomy (PPV). Results Mydriasis funduscopy examination showed that vitreous hemorrhage was so dense in 30 eyes that the fundus cannot be observed.The initial visual acuity examination showed that 8 eyes were count finger, 5 eyes were hand move, 16 eyes were light perception, and 1 eye was no light perception.There were dense light spots or clusters of high echoes in vitreous cavities, complete/incomplete posterior vitreous detachment (PVD) of all eyes; retinal detachment with different degrees in 5 eyes; proliferating cord adhesion to the wall of eyeball in 3 eyes.The etiologies included retinal vein occlusion (RVO) in 10 eyes (33.33%), retinal tear or retinal detachment in 7 eyes (23.33%), polypoidal choroidal vasculopathy (PCV) in 7 eyes (23.33%), proliferative diabetic retinopathy (PDR) in 4 eyes (13.33%). The above 4 etiologies were in 28 eyes, accounting for 93.33%.The others were ocular trauma in 2 eyes (6.67%). Conclusions The main cause to severe vitreous hemorrhage venerable age patients is RVO, followed by retinal tear or retinal detachment, PCV and PDR.Ocular trauma is rare.Vitrectomy is a diagnostic treatment, which can remove vitreous hemorrhage, improve the visual acuity of the patients, and determine the etiologies of the vitreous hemorrhage. Key words: Venerable age; Severe vitreous hemorrhage; Etiology; Vitrectomy

Test on Noxious Gases in Urban Sewage Pipe Based on Odor Classification

Urban sewage pipes are filled with flammable, explosive, toxic and other noxious gases, which have brought hidden troubles during system maintenance and operation. To ease these threats to the urban sewage pipeline network, we should perform spot inspection and take some measures against safety risks that may occur on them. But of those, the test of noxious gases is the most challenging. Based on the odor classification method, we take an urban sewage pipe network in Chongqing as a study case for sample collection and spot inspection. The purpose of this paper is to classify and test the methane CH4 and hydrogen sulfide H2S by different methods. Data available from individual supervision spots are compared and analyzed in parallel, in order to explore how to measure these noxious gases and what’s the distribution and concentration change laws of them in urban sewage pipes, hoping to provide the clues to the early warning and safety operation of urban sewage pipeline network.