BACKGROUND Disorders of gut-brain interaction(DGBI)are defined as a variable combination of chronic or recurrent gastrointestinal symptoms.Early-life stressors have been implicated as possible contributing factors.AIM...BACKGROUND Disorders of gut-brain interaction(DGBI)are defined as a variable combination of chronic or recurrent gastrointestinal symptoms.Early-life stressors have been implicated as possible contributing factors.AIM To determine if prematurity and neonatal factors influence the development of DGBI in adults.METHODS A case-control study was carried out at a tertiary referral center from July 2019 to July 2021.Cases(adults born with extremely premature<29 weeks of gestation)were recruited from the Health of Adults Born Preterm Investigation cohort.Control subjects were recruited from the general population.All participants completed the Rome IV diagnostic questionnaire online.Cases completed anxiety and depression questionnaires(Patient-Reported Outcomes Measurement Infor-mation System-29 items,Generalized Anxiety Disorder-7 items,Patient Health Questionnaire-9 items).Neonatal data and sociodemographic status were collected.RESULTS A total of 79 cases and 124 controls were enrolled in the study.The group of adults born preterm exhibited a significantly higher prevalence of functional bowel disorders(P=0.01)and a trend suggesting a higher prevalence of func-tional gastroduodenal disorders(P=0.06).Among women born prematurely,the prevalence of functional gastroduodenal disorders,functional bowel disorders,and functional constipation was significantly higher compared to the female control group(P=0.02 for all).The identified risk factors are categorized as directly linked to prematurity(e.g.,chorioamnionitis),indirectly related to prematurity(e.g.,anxiety,depression,and social skills as consequences of prematurity),or independent of prematurity(e.g.,female sex).CONCLUSION This is the first case-control study reporting the prevalence of DGBI in a cohort of well-characterized adults born prematurely.We confirm that prematurity is a risk factor for developing a DGBI.展开更多
To review the existing deep learning applications for diagnosing diabetic retinopathy and retinopathy of prematurity diseases,the available public retinal databases for the diseases and apply the International Journal...To review the existing deep learning applications for diagnosing diabetic retinopathy and retinopathy of prematurity diseases,the available public retinal databases for the diseases and apply the International Journal of Medical Informatics(IJMEDI)checklist were assessed the quality of included studies;an in-depth literature search in Scopus,Web of Science,IEEE and ACM databases targeting articles from inception up to 31st January 2023 was done by two independent reviewers.In the review,26 out of 1476 articles with a total of 36 models were included.Data size and model validation were found to be challenges for most studies.Deep learning models are gaining focus in the development of medical diagnosis tools and applications.However,there seems to be a critical issue with most of the studies being published,with some not including information about data sources and data sizes which is important for their performance verification.展开更多
AIM:To compare the changes in preschool refractive status,ocular biological parameters,and higher-order aberrations in children with retinopathy of prematurity(ROP)after retinal laser photocoagulation or anti-vascular...AIM:To compare the changes in preschool refractive status,ocular biological parameters,and higher-order aberrations in children with retinopathy of prematurity(ROP)after retinal laser photocoagulation or anti-vascular endothelial growth factor(anti-VEGF)treatment and explore their underlying factors.METHODS:This observational study involved 118 eyes of 59 children,aged 3 to 6y,with ROP followed up between March 2023 and October 2024.They were divided into the laser,anti-VEGF,and anti-VEGF+laser groups.The laser group received a single session of laser photocoagulation.The anti-VEGF group received a single anti-VEGF treatment.The anti-VEGF+laser group received a single anti-VEGF treatment after birth followed by supplementary laser treatment within 2wk to 6mo.Ocular biological parameters were measured using IOL Master 700 and Pentacam HR.Right-eye higher-order aberrations were measured using the OPD-Scan III.Best-corrected visual acuities(BCVA),refractive statuses,ocular biological parameters,and higherorder aberrations were assessed and compared.Multiple linear regression analysis was conducted to evaluate the relationships among ocular biological parameters,higherorder aberrations,spherical equivalent(SE),and treatment methods.Pearson’s correlation coefficients were used to assess the relationships between the SE and higher-order aberrations.RESULTS:The laser group had a higher incidence of myopia and a lower SE than the anti-VEGF group.The incidence of astigmatism and cylindrical power were significantly lower for the anti-VEGF than for the laser and anti-VEGF+laser groups(P<0.05).The anterior corneal surface astigmatism was higher for the laser and anti-VEGF+laser groups than for the anti-VEGF group.The anterior corneal surface K2 and lens thickness were higher for the laser and anti-VEGF+laser groups than for the anti-VEGF group.The whole-eye higher-order aberration root mean square(RMS)values for the right eye were significantly higher for the laser and anti-VEGF+laser groups than for the anti-VEGF group.The whole-eye trefoil RMS values for the right eye were also significantly higher for the laser and anti-VEGF+laser groups than for the anti-VEGF group(P<0.05).Laser treatment was significantly associated with SE,anterior corneal surface curvature and astigmatism,lens thickness,whole-eye highorder aberrations,and whole-eye trefoil(all P<0.05).CONCLUSION:Children with ROP who received laser treatment have higher myopia and astigmatism than those who received anti-VEGF treatment.Children treated with laser or supplementary laser treatment have higher anterior corneal astigmatism,anterior corneal curvature,thicker lenses,whole-eye higher-order aberrations,and whole-eye trefoil.The cause of myopia in children with ROP after laser treatment is increased anterior corneal surface curvature and lens thickness.展开更多
AIM:To observe the effect of human umbilical cord mesenchymal stem cells(hUCMSCs)secretions on the relevant factors in mouse retinal astrocytes,and to investigate the effect of hUCMSCs on the expression of vascular en...AIM:To observe the effect of human umbilical cord mesenchymal stem cells(hUCMSCs)secretions on the relevant factors in mouse retinal astrocytes,and to investigate the effect of hUCMSCs on the expression of vascular endothelial growth factor-A(VEGF-A)and to observe the therapeutic effect on the mouse model of retinopathy of prematurity(ROP).METHODS:Cultured hUCMSCs and extracted exosomes from them and then retinal astrocytes were divided into control group and hypoxia group.MTT assay,flow cytometry,reverse transcription-polymerase chain reaction(RT-PCR)and Western blot were used to detect related indicators.Possible mechanisms by which hUCMSCs exosomes affect VEGF-A expression in hypoxia-induced mouse retinal astrocytes were explored.At last,the efficacy of exosomes of UCMSCs in a mouse ROP model was explored.Graphpad6 was used to comprehensively process data information.RESULTS:The secretion was successfully extracted from the culture supernatant of hUCMSCs by gradient ultracentrifugation.Reactive oxygen species(ROS)and hypoxia inducible factor-1α(HIF-1α)of mice retinal astrocytes under different hypoxia time and the expression level of VEGF-A protein and VEGF-A mRNA increased,and the ROP cell model was established after 6h of hypoxia.The secretions of medium and high concentrations of hUCMSCs can reduce ROS and HIF-1α,the expression levels of VEGF-A protein and VEGF-A mRNA are statistically significant and concentration dependent.Compared with the ROP cell model group,the expression of phosphatidylinositol 3-kinase(PI3K)/protein kinase B(AKT)/mammalian target of rapamycin(mTOR)signal pathway related factors in the hUCMSCs exocrine group is significantly decreased.The intravitreal injection of the secretions of medium and high concentrations of hUCMSCs can reduce VEGF-A and HIF-1αin ROP model tissues.HE staining shows that the number of retinal neovascularization in ROP mice decreases with the increase of the dose of hUCMSCs secretion.CONCLUSION:In a hypoxia induced mouse retinal astrocyte model,hUCMSCs exosomes are found to effectively reduce the expression of HIF-1αand VEGF-A,which are positively correlated with the concentration of hUCMSCs exosomes.HUCMSCs exosomes can effectively reduce the number of retinal neovascularization and the expression of HIF-1αand VEGF-A proteins in ROP mice,and are positively correlated with drug dosage.Besides,they can reduce the related factors on the PI3K/AKT/mTOR signaling pathway.展开更多
AIM:To define the predictive factors of severe retinopathy of prematurity(ROP)and develop a nomogram for predicting severe ROP in southeast China.METHODS:Totally 554 infants diagnosed with ROP hospitalized in the Seco...AIM:To define the predictive factors of severe retinopathy of prematurity(ROP)and develop a nomogram for predicting severe ROP in southeast China.METHODS:Totally 554 infants diagnosed with ROP hospitalized in the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University and hospitalized in Taizhou Women and Children’s Hospital were included.Clinical data and 43 candidate predictive factors of ROP infants were collected retrospectively.Logistic regression model was used to identify predictive factors of severe ROP and to propose a nomogram for individual risk prediction,which was compared with WINROP model and Digirop-Birth model.RESULTS:Infants from the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University(n=478)were randomly allocated into training(n=402)and internal validation group(n=76).Infants from Taizhou Women and Children’s Hospital were set as external validation group(n=76).Severe ROP were found in 52 of 402 infants,12 of 76 infants,and 7 of 76 infants in training group,internal validation group,and external validation group,respectively.Birth weight[odds ratio(OR),0.997;95%confidence interval(CI),0.996-0.999;P<0.001],multiple births(OR,1.885;95%CI,1.013-3.506;P=0.045),and non-invasive ventilation(OR,0.288;95%CI,0.146-0.570;P<0.001)were identified as predictive factors for the prediction of severe ROP,by univariate analysis and multivariate analysis.For predicting severe ROP based on the internal validation group,the areas under receiver operating characteristic curve(AUC)was 78.1(95%CI,64.2-92.0)for the nomogram,32.9(95%CI,15.3-50.5)for WINROP model,70.2(95%CI,55.8-84.6)for Digirop-Birth model.In external validation group,AUC of the nomogram was also higher than that of WINROP model and Digirop-Birth model(80.2 versus 51.1 and 63.4).The decision curve analysis of the nomogram demonstrated better clinical efficacy than that of WINROP model and Digirop-Birth model.The calibration curves demonstrated a good consistency between the actual severe ROP incidence and the predicted probability.CONCLUSION:Birth weight,multiple births,and noninvasive ventilation are independent predictors of severe ROP.The nomogram has a good ability to predict severe ROP and performed well on internal validation and external validation in southeast China.展开更多
AIM:To quantitatively assess the changes in mean vascular tortuosity(mVT)and mean vascular width(mVW)around the optic disc and their correlation with gestational age(GA)and birth weight(BW)in premature infants without...AIM:To quantitatively assess the changes in mean vascular tortuosity(mVT)and mean vascular width(mVW)around the optic disc and their correlation with gestational age(GA)and birth weight(BW)in premature infants without retinopathy of prematurity(ROP).METHODS:A single-center retrospective study included a total of 133(133 eyes)premature infants[mean corrected gestational age(CGA)43.6wk]without ROP as the premature group and 130(130 eyes)CGA-matched fullterm infants as the control group.The peripapillary mVT and mVW were quantitatively measured using computerassisted techniques.RESULTS:Premature infants had significantly higher mVT(P=0.0032)and lower mVW(P=0.0086)by 2.68(10^(4) cm^(-3))and 1.85μm,respectively.Subgroup analysis with GA showed significant differences(P=0.0244)in mVT between the early preterm and middle to late preterm groups,but the differences between mVW were not significant(P=0.6652).The results of the multiple linear regression model showed a significant negative correlation between GA and BW with mVT after adjusting sex and CGA(P=0.0211 and P=0.0006,respectively).For each day increase in GA at birth,mVT decreased by 0.1281(10^(4) cm^(-3))and for each 1 g increase in BW,mVT decreased by 0.006(10^(4) cm^(-3)).However,GA(P=0.9402)and BW(P=0.7275)were not significantly correlated with mVW.CONCLUSION:Preterm birth significantly affects the peripapillary vascular parameters that indicate higher mVT and narrower mVW in premature infants without ROP.Alterations in these parameters may provide new insights into the pathogenesis of ocular vascular disease.展开更多
Purpose:Artificial intelligence(AI)significantly enhances the screening and diagnostic processes for retinopathy of prematurity(ROP).In this article,we focused on the application and performance of AI in detecting ROP...Purpose:Artificial intelligence(AI)significantly enhances the screening and diagnostic processes for retinopathy of prematurity(ROP).In this article,we focused on the application and performance of AI in detecting ROP and distinguishing plus disease(PLUS)in ROP.Methods:We searched PubMed,Embase,Medline,Web of Science,and Ovid for studies published from January2018 to July 2024.Studies evaluating the diagnostic performance of AI with expert ophthalmologists’judgment as a reference standard were included.The risk of bias was assessed using the QUADAS-2 tool and QUADAS-AI tool.Statistical analysis included data pooling,forest plot construction,heterogeneity testing,and meta-regression.Results:Fourteen of the 186 studies were included.The pooled sensitivity,specificity and the area under the curve(AUC)of the AI diagnosing ROP were 0.95(95%CI 0.93-0.96),0.97(95%CI 0.94-0.98)and 0.97(95%CI 0.95-0.98),respectively.The pooled sensitivity,specificity and the AUC of the AI distinguishing PLUS were 0.92(95%CI 0.80-0.97),0.95(95%CI 0.91-0.97)and 0.98(95%CI 0.96-0.99),respectively.Cochran’s Q test(P<0.01)and Higgins I2 heterogeneity index revealed considerable heterogeneity.The country of study,number of centers,data source and the number of doctors were responsible for the heterogeneity.For ROP diagnosing,researches conducted in China using private data in single center with less than 3 doctors showed higher sensitivity and specificity.For PLUS distinguishing,researches in multiple centers with less than 3 doctors showed higher sensitivity.Conclusions:This study revealed the powerful role of AI in diagnosing ROP and distinguishing PLUS.However,significant heterogeneity was noted among all included studies,indicating challenges in the application of AI for ROP diagnosis in real-world settings.More studies are needed to address these disparities,aiming to fully harness AI’s potential in augmenting medical care for ROP.展开更多
Background: Prematurity is the leading cause of neonatal mortality. Most preterm births can be associated to an identifiable risk factor. In Cameroon, especially in the Southwest Region, there is limited data regardin...Background: Prematurity is the leading cause of neonatal mortality. Most preterm births can be associated to an identifiable risk factor. In Cameroon, especially in the Southwest Region, there is limited data regarding prematurity associated risk factors. The aim of this study was to evaluate the risk factors and complications of prematurity in two health facilities in the Fako division, the BRH and RHL. Methods: A hospital based retrospective case control study was done from the 1<sup>st</sup> of January 2021 to 28<sup>th</sup> of February 2022. We assessed the gestational ages at which preterm birth occurred and their short-term outcome using a structured pretested questionnaire to collect data from files. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 26. Results: The minimum sample size was 137 preterms. 45.5% of cases were born between 34 and increased the risk of having a preterm birth meanwhile being married (AOR: 0.410;95% CI: 0.217 - 0.773;p = 0.006) decreased the risk. Hospital complications were neonatal infection 103 (51.5%), respiratory distress 79 (39.5%) and neonatal jaundice 61 (30.50%). Among the cases, 97 (48.50%) stayed in the hospital for 2 to 4 weeks and 177 (88.5%) were discharged alive. Conclusions: Modifiable factors that increased the risk of prematurity were advanced maternal age, secondary level of education, rural residence, and prenatal alcohol consumption. Being married decreased the risk. The most common hospital complications in both the cases and controls were neonatal infection, respiratory distress syndrome and neonatal jaundice.展开更多
Introduction: Prematurity is the leading cause of neonatal death in Africa. More than a million children die each year due to co-morbidities related to prematurity. In addition to being one of the causes of neonatal d...Introduction: Prematurity is the leading cause of neonatal death in Africa. More than a million children die each year due to co-morbidities related to prematurity. In addition to being one of the causes of neonatal deaths, the health problems associated with prematurity can also lead to severe lifelong impairment in those who survive. Objectives: This paper aims to determine the epidemiology and identify co-morbidities of prematurity in the neonatology units of the Douala General Hospital (DGH) and the Laquintinie Hospital of Douala (LHD). Patients and Methodology: We conducted an analytical retrospective cohort study from January 2015 to January 2018 in the neonatology department of the GDH and the LHD, which are considered reference hospitals for the management of preterm babies in Cameroon. We included all newborns aged less than 37 weeks admitted to the neonatology units of the GDH and the LHD. The descriptive component was based on the analysis of quantitative variables using measures of central tendency. The analytical component was evaluated using Spearman correlations and the Chi-square and Fisher tests. Simple and multiple logistic regressions measured factors predictive of mortality. The Kaplan Meier survival curve used the Log Rank test and significance at p ≤ 0.05. Results: We recorded 908 preterm newborns in neonatal service and 1,124 preterm deliveries in maternity, representing an incidence of 32.5% in neonatal unit and 10.6% in maternity. 51% of whom were girls, given a sex ratio M/F of 0.9. Hypertension was the main prenatal pathology (9.1%), while premature rupture of membranes: PROM (35.5%) and eclampsia/pre-eclampsia (18.6%) were the most common obstetrical pathologies. 75.9% of deliveries were vaginal with 65.2% being performed in our referral hospitals. Gestational age ranged from 22 to 36 weeks, with a mean of 32.4 weeks. Late preterm birth rate was 53.7%, and birth weight varied between 590 and 3200 g with an average of 1747 ± 479 g. The percentage of low birth weight (1500 - 2499 g) preterm infants was predominant (65.3%), and the intrauterine growth restriction (IUGR) was estimated to be 12.4%. The majority (96.7%) had pathologies in the neonatal period, the most common being neonatal infection (86.9%). The case-fatality rate was 27.4%, compared to 72.6% live births. Factors influencing mortality are risk of premature labour, gestational age ≤ 32 SA, premature birth in hospitals other than our two referral hospitals, birth weight ≤ 1500 g, Apgar at the 10th minute, late secondary anaemia, hospital resuscitation, oxygen therapy, and duration of hospitalization Conclusion: The incidence of prematurity and the mortality rate remains high in neonatal units in Cameroon. Adequate monitoring of pregnancies and management of preterm infants remains a challenge in our context.展开更多
Retinopathy of prematurity(ROP)is a disorder of the retina in neonates.If ROP is not treated at early stage,neonates’vision is affected,leading to blindness.It is necessary to diagnose and treat ROP at earliest.Sever...Retinopathy of prematurity(ROP)is a disorder of the retina in neonates.If ROP is not treated at early stage,neonates’vision is affected,leading to blindness.It is necessary to diagnose and treat ROP at earliest.Several ROP assessment techniques based on Image analysis have been introduced in recent years.These studies identify only normal,abnormal,and plus disease.This research article explores the identification of distinct ROP stages along with normal and abnormal detection.Detecting the stages will help to expedite the treatment and prevent vision loss.The proposed framework consists of feature extraction using scale-invariant feature transform(SIFT)and pyramid histogram of words(PHOW)techniques.Three efficient supervised machine learning algorithms,namely random forest(RF),support vector machine(SVM),and extreme boosting gradient(XGBoost),are used to classify different stages of ROP.A dataset captured by RetCam 3 is used to evaluate the model.Based on rigorous evaluation,the accuracy of different ROP stages is 93.68%,83.33%,85.71%,55.55%,and 100%for normal,stage 1,stage 2,stage 3,and stage 4,respectively.展开更多
AIM: To estimate the potential systemic events during and after retinopathy of prematurity (ROP) screening. ' METHODS: A prospective and descriptive designed study was conducted to detect the physiologic and patho...AIM: To estimate the potential systemic events during and after retinopathy of prematurity (ROP) screening. ' METHODS: A prospective and descriptive designed study was conducted to detect the physiologic and pathological changes 24h before, during, and 72h after ROP screening. Control blood pressure (BP), saturation, pulse rate, and body temperature were routinely taken at various time internals before and after screening. Adverse effects pertain to cardiovascular system, respiratory system, gastric system, urinary system and nervous system were retrospect 0-72h after ROP screening at a 24-hour interval. RESULTS: Totally 1254 prematurity babies receiving ROP screening during Jan. 1st 2013 to Dec. 31th 2013 were enrolled in our survey. Compared to control vital sign data taken before the examination, there was a fluctuation in the diastolic BP with the increased 3.03 mm Hg (P=0.04) after 3 doses of mydriatic drops. Immediately after the examination, there was a further 12.64 mm Hg (P<0.01) increase in systolic BP and a 7.24 mm Hg (P<0.01) in diastolic BP. The mean pulse rate during examination was 22.4 bpm (P<0.01) higher than the 133.3 +/- 9.0 bpm control level. The oxygen saturation shared an average drop of 5% (P<0.01) during screening. In prematurity with postconceptional age less than 31wk, the incidence of apnea (23.5%), necrotizing enterocolitis (NEC) (8.7%), gastric residual (25.4%) and upper digestive tract hemorrhage (6.4%) also demonstrated a significant rise (P<0.01). CONCLUSION: In our study sample, ROP screening was associated with NEC, gastric residual and upper digestive tract hemorrhage. These gastrointestinal side effects, along with breath activity pattern change and vital signs indicators fluctuation, may be results of additional stress responses.展开更多
Retinopathy of prematurity(ROP)is the leading cause of preventable infant blindness in the world and predominantly affects babies who are born low birth weight and premature.India has the largest number of surviving p...Retinopathy of prematurity(ROP)is the leading cause of preventable infant blindness in the world and predominantly affects babies who are born low birth weight and premature.India has the largest number of surviving preterm births born annually.ROP blindness can be largely prevented if there is a robust screening program which detects treatment requiring disease in time.ROP treatment must be provided within 48 h of reaching this threshold of treatment making it a relative emergency.During the severe acute respiratory syndromecoronavirus disease 2019 pandemic in 2020 ROP screening was disrupted throughout the world due to lockdowns and restriction of movement of these infants,their families,specialists and healthcare workers.The Indian ROP Society issued guidelines for ROP screening and treatment in March 2020,which was aimed at preserving the chain-of-care despite the potential limitations and hazards during the(ongoing)pandemic.This preferred practice guideline is summarized in this manuscript.展开更多
Successful management of a case of aggressive posterior retinopathy of prematurity(APROP)poorly responsive to laser therapy with intravitreal bevacizumab(IVB)is discussed.IVB is useful as rescue therapy in such cases,...Successful management of a case of aggressive posterior retinopathy of prematurity(APROP)poorly responsive to laser therapy with intravitreal bevacizumab(IVB)is discussed.IVB is useful as rescue therapy in such cases,if given within the correct window period post laser therapy.展开更多
Retinopathy of prematurity (ROP), a retinal vascular disease of premature infants, continues to be a major cause of preventable childhood blindness all over the world. The incidence of ROP varies among countries, bein...Retinopathy of prematurity (ROP), a retinal vascular disease of premature infants, continues to be a major cause of preventable childhood blindness all over the world. The incidence of ROP varies among countries, being influenced by the quality of the level of neonatal intensive care. Here, we discuss the potential treatments that are now available or will soon or probably be available for ROP. Although ablation of the avascular retina with laser photocoagulation remains the current gold standard and well established therapy for ROP, some new therapeutic options including angiostatic therapies are being explored based on our knowledge of the pathophysiology of the ROP and complications and efficacy of laser treatment. However, prevention of the development of severe ROP and screening for ROP seem to be the best strategy in avoiding visual impairment caused by ROP in premature infants. New therapeutic interventions including vascular endothelial growth factor antibody administration, gene therapy and supplemental therapies should be supported with evidence-based data for the treatment of ROP.展开更多
AIM: To determine the incidence and risk factors of retinopathy of prematurity(ROP) and the sensitivity of current screening criteria in a tertiary eye center in Tehran, Iran. METHODS: In a cross-sectional observation...AIM: To determine the incidence and risk factors of retinopathy of prematurity(ROP) and the sensitivity of current screening criteria in a tertiary eye center in Tehran, Iran. METHODS: In a cross-sectional observational study, neonates weighing ≤2000 grams at birth or born <34 wk gestational age(GA) and all other infants at risk of ROP admitted to the neonatal intensive care unit(NICU) or referred to our ROP clinic were investigated. The incidence of ROP and severe ROP(i.e. patients needing treatment) were determined. The associations between risk factors and the development and severity of ROP were assessed. We also examined the sensitivity of the current national screening guideline in Iran. RESULTS: Among 207 infants, the incidence of ROP and severe ROP was 33.3% and 11.1%, respectively. Mean GA and birth weight(BW) were significantly lower in ROP vs non-ROP infants(29±2 wk vs 33±3 wk, P<0.001;1274±489 g vs 1916±550 g, P<0.001, respectively). Univariate analysis displayed significant association between ROP incidence and GA, BW, NICU admission period, blood transfusion, surfactant usage, sepsis, intraventricular hemorrhage and patent ductus arteriosus(P<0.05 for all). BW [relative risk(RR): 0.857(0.711-0.873), P<0.001], GA [RR: 0.788(0.711-0.873), P<0.001] and blood transfusion [RR: 1.888(0.995-3.583), P=0.052] were independent ROP risk factors. The sensitivity of country-specific screening guidelines was 95.7% and 100% for overall and severe ROP detection, respectively. CONCLUSION: ROP incidence is relatively high in Iran. Identifying ROP risk factors results in more accurate screening and reduces the risk of irreversible vision loss. The ROP screening criteria utilized in Iran are efficient at the present time.展开更多
Retinopathy of prematurity（ROP） is a retinal vascular disorder frequently found in premature infants.Different therapeutic strategies have been developed to treat ROP.However,there are still many children with ROP s...Retinopathy of prematurity（ROP） is a retinal vascular disorder frequently found in premature infants.Different therapeutic strategies have been developed to treat ROP.However,there are still many children with ROP suffering by severe limitations in vision or even blindness.Recently,ROP has been suggested to be caused by abnormal development of the retinal vasculature,but not simply resulted by retinal neovascularization which takes about 4 to 6 wk after birth in premature infants.Thus,instead of focusing on how to reduce retinal neovascularization,understanding the pathological changes and mechanisms that occur prior to retinal neovascularization is meaningful,which may lead to identify novel target（s） for the development of novel strategy to promote the healthy growth of retinal blood vessels rather than passively waiting for the appearance of retinal neovascularization and removing it by force.In this review,we discussed recent studies about,1） the pathogenesis prior to retinal neovascularization in oxygen-induced retinopathy（OIR;a ROP in animal model） and in premature infants with ROP;2） the preclinical and clinical research on preventive treatment of early OIR and ROP.We will not only highlight the importance of the mechanisms and signalling pathways in regulating early stage of ROP but also will provide guidance for actively exploring novel mechanisms and discovering novel treatments for early phase OIR and ROP prior to retinal neovascularization in the future.展开更多
Retinopathy of prematurity(ROP) is a vasoproliferative disorder of the retina occurring principally in new born preterm infants. It is an avoidable cause of childhood blindness. With the increase in the survival of pr...Retinopathy of prematurity(ROP) is a vasoproliferative disorder of the retina occurring principally in new born preterm infants. It is an avoidable cause of childhood blindness. With the increase in the survival of preterm babies, ROP has become the leading cause of preventable childhood blindness throughout the world. A simple screening test done within a few weeks after birth by an ophthalmologist can avoid this preventable blindness. Although screening guidelines and protocols are strictly followed in the developed nations, it lacks in developing economies like India and China, which have the highest number of preterm deliveries in the world. The burden of this blindness in these countries is set to increase tremendously in the future, if corrective steps are not taken immediately. ROP first emerged in 1940 s and 1950 s, when it was called retrolental fibroplasia. Several epidemics of this disease were and are still occurring in different regions of the world and since then a lot of research has been done on this disease. However, till date very few comprehensive review articles covering all the aspects of ROP are published. This review highlights the past, present and future strategies in managing this disease. It would help the pediatricians to update their current knowledge on ROP.展开更多
The Delta-like ligand 4/Notch signaling pathway was shown to participate in the process of retinal development and angiogenesis. However, the function of the Delta-like ligand 4/Notch signaling pathway in retinopathy ...The Delta-like ligand 4/Notch signaling pathway was shown to participate in the process of retinal development and angiogenesis. However, the function of the Delta-like ligand 4/Notch signaling pathway in retinopathy of prematurity requires further study. Retinopathy of prematurity was induced in 5-day-old Sprague-Dawley rats exposed to hyperoxia for 7 days, and then returned to room air. Reverse transcription-PCR and western blot revealed that Delta-like ligand 4 levels decreased at postnatal day 12 and increased at postnatal day 17 in retinopathy of prematurity rats. Flat-mounted adenosine diphosphatase stained retina and hematoxylin-eosin stained retinal tissue slices showed that the clock hour scores and the nuclei counts in retinopathy of prematurity rats were significantly different compared to normal control rats. After retinopathy of prematurity rats were intravitreally injected with Delta-like ligand 4 monoclonal antibody to inhibit the Delta-like ligand 4/Notch signaling pathway, there was a significant increase in the severity of retinal neovascularization （clock hours） in the intravitreally injected eyes. The nuclei count was highly correlated with the clock hour score. These results suggest that Delta-like ligand 4/Notch signaling plays an essential role in the process of physiological and pathological angiogenesis in the retina.展开更多
AIMTo evaluate the incidence of spontaneous regression of changes in the retina and vitreous in active stage of retinopathy of prematurity(ROP) and identify the possible relative factors during the regression.
AIM:To evaluate the predicting efficacy of severe retinopathy of prematurity(ROP)by the WINROP algorithm(http://winrop.com)in Southern China.METHODS:All preterm infants with the gestational age(GA)less than 32 wk were...AIM:To evaluate the predicting efficacy of severe retinopathy of prematurity(ROP)by the WINROP algorithm(http://winrop.com)in Southern China.METHODS:All preterm infants with the gestational age(GA)less than 32 wk were included.Their ROP screening results and serial postnatal body weight were analysed retrospectively.Weekly body weight was entered into and measured by the WINROP system.The outcomes were analysed,and the sensitivity,specificity,positive predictive value and negative predictive value(NPV)were calculated.RESULTS:Totally 432 infants with a median GA of 30.0(24.0-31.9)wk,and a median birth weight(BW)of 1360(540-2700)g were included.Among these 432 infants,50 were diagnosed as type 1 ROP but only 28 were identified by the WINROP algorithm.The sensitivity was 56%(28/50)and the NPV was 92%(252/274).However,for infants with BW<1000g or GA<28 wk,the sensitivity was 93.8%(15/16)and 93.3%(14/15),respectively.Meanwhile,with several postnatal complications added as additional risk factors,the sensitivity was increased to 96%(48/50).CONCLUSION:The sensitivity of the WINROP algorithm from the Southern Chinese cohort is not as high as that reported in developed countries.This algorithm is effective for detecting severe ROP from extremely small or preterm infants.Modification of the algorithm with additional risk factors could improve the predictive value for infants with a GA>28 wk in China.展开更多
基金Supported by Sainte-Justine University Hospital Research Center excellence grant in 2020-2021.
文摘BACKGROUND Disorders of gut-brain interaction(DGBI)are defined as a variable combination of chronic or recurrent gastrointestinal symptoms.Early-life stressors have been implicated as possible contributing factors.AIM To determine if prematurity and neonatal factors influence the development of DGBI in adults.METHODS A case-control study was carried out at a tertiary referral center from July 2019 to July 2021.Cases(adults born with extremely premature<29 weeks of gestation)were recruited from the Health of Adults Born Preterm Investigation cohort.Control subjects were recruited from the general population.All participants completed the Rome IV diagnostic questionnaire online.Cases completed anxiety and depression questionnaires(Patient-Reported Outcomes Measurement Infor-mation System-29 items,Generalized Anxiety Disorder-7 items,Patient Health Questionnaire-9 items).Neonatal data and sociodemographic status were collected.RESULTS A total of 79 cases and 124 controls were enrolled in the study.The group of adults born preterm exhibited a significantly higher prevalence of functional bowel disorders(P=0.01)and a trend suggesting a higher prevalence of func-tional gastroduodenal disorders(P=0.06).Among women born prematurely,the prevalence of functional gastroduodenal disorders,functional bowel disorders,and functional constipation was significantly higher compared to the female control group(P=0.02 for all).The identified risk factors are categorized as directly linked to prematurity(e.g.,chorioamnionitis),indirectly related to prematurity(e.g.,anxiety,depression,and social skills as consequences of prematurity),or independent of prematurity(e.g.,female sex).CONCLUSION This is the first case-control study reporting the prevalence of DGBI in a cohort of well-characterized adults born prematurely.We confirm that prematurity is a risk factor for developing a DGBI.
基金Supported by DAAD,Google Research,and the Organization for Women in Science for the Developing World(OWSD).
文摘To review the existing deep learning applications for diagnosing diabetic retinopathy and retinopathy of prematurity diseases,the available public retinal databases for the diseases and apply the International Journal of Medical Informatics(IJMEDI)checklist were assessed the quality of included studies;an in-depth literature search in Scopus,Web of Science,IEEE and ACM databases targeting articles from inception up to 31st January 2023 was done by two independent reviewers.In the review,26 out of 1476 articles with a total of 36 models were included.Data size and model validation were found to be challenges for most studies.Deep learning models are gaining focus in the development of medical diagnosis tools and applications.However,there seems to be a critical issue with most of the studies being published,with some not including information about data sources and data sizes which is important for their performance verification.
基金Supported by Key Research and Development Program of Shaanxi Province(No.2024SF-YBXM-320)the Clinical Research Project of the Fourth Military Medical University(No.2022LC2247)Medical Staff Training Boosting Project of Xijing Hospital,Air Force Medical University(No.XJZT24CY52).
文摘AIM:To compare the changes in preschool refractive status,ocular biological parameters,and higher-order aberrations in children with retinopathy of prematurity(ROP)after retinal laser photocoagulation or anti-vascular endothelial growth factor(anti-VEGF)treatment and explore their underlying factors.METHODS:This observational study involved 118 eyes of 59 children,aged 3 to 6y,with ROP followed up between March 2023 and October 2024.They were divided into the laser,anti-VEGF,and anti-VEGF+laser groups.The laser group received a single session of laser photocoagulation.The anti-VEGF group received a single anti-VEGF treatment.The anti-VEGF+laser group received a single anti-VEGF treatment after birth followed by supplementary laser treatment within 2wk to 6mo.Ocular biological parameters were measured using IOL Master 700 and Pentacam HR.Right-eye higher-order aberrations were measured using the OPD-Scan III.Best-corrected visual acuities(BCVA),refractive statuses,ocular biological parameters,and higherorder aberrations were assessed and compared.Multiple linear regression analysis was conducted to evaluate the relationships among ocular biological parameters,higherorder aberrations,spherical equivalent(SE),and treatment methods.Pearson’s correlation coefficients were used to assess the relationships between the SE and higher-order aberrations.RESULTS:The laser group had a higher incidence of myopia and a lower SE than the anti-VEGF group.The incidence of astigmatism and cylindrical power were significantly lower for the anti-VEGF than for the laser and anti-VEGF+laser groups(P<0.05).The anterior corneal surface astigmatism was higher for the laser and anti-VEGF+laser groups than for the anti-VEGF group.The anterior corneal surface K2 and lens thickness were higher for the laser and anti-VEGF+laser groups than for the anti-VEGF group.The whole-eye higher-order aberration root mean square(RMS)values for the right eye were significantly higher for the laser and anti-VEGF+laser groups than for the anti-VEGF group.The whole-eye trefoil RMS values for the right eye were also significantly higher for the laser and anti-VEGF+laser groups than for the anti-VEGF group(P<0.05).Laser treatment was significantly associated with SE,anterior corneal surface curvature and astigmatism,lens thickness,whole-eye highorder aberrations,and whole-eye trefoil(all P<0.05).CONCLUSION:Children with ROP who received laser treatment have higher myopia and astigmatism than those who received anti-VEGF treatment.Children treated with laser or supplementary laser treatment have higher anterior corneal astigmatism,anterior corneal curvature,thicker lenses,whole-eye higher-order aberrations,and whole-eye trefoil.The cause of myopia in children with ROP after laser treatment is increased anterior corneal surface curvature and lens thickness.
基金Supported by Tianjin Key Medical Discipline Specialty Construction Project(No.TJXZDXK-016A)Science Foundation of Tianjin Eye Hospital(No.YKZD1901).
文摘AIM:To observe the effect of human umbilical cord mesenchymal stem cells(hUCMSCs)secretions on the relevant factors in mouse retinal astrocytes,and to investigate the effect of hUCMSCs on the expression of vascular endothelial growth factor-A(VEGF-A)and to observe the therapeutic effect on the mouse model of retinopathy of prematurity(ROP).METHODS:Cultured hUCMSCs and extracted exosomes from them and then retinal astrocytes were divided into control group and hypoxia group.MTT assay,flow cytometry,reverse transcription-polymerase chain reaction(RT-PCR)and Western blot were used to detect related indicators.Possible mechanisms by which hUCMSCs exosomes affect VEGF-A expression in hypoxia-induced mouse retinal astrocytes were explored.At last,the efficacy of exosomes of UCMSCs in a mouse ROP model was explored.Graphpad6 was used to comprehensively process data information.RESULTS:The secretion was successfully extracted from the culture supernatant of hUCMSCs by gradient ultracentrifugation.Reactive oxygen species(ROS)and hypoxia inducible factor-1α(HIF-1α)of mice retinal astrocytes under different hypoxia time and the expression level of VEGF-A protein and VEGF-A mRNA increased,and the ROP cell model was established after 6h of hypoxia.The secretions of medium and high concentrations of hUCMSCs can reduce ROS and HIF-1α,the expression levels of VEGF-A protein and VEGF-A mRNA are statistically significant and concentration dependent.Compared with the ROP cell model group,the expression of phosphatidylinositol 3-kinase(PI3K)/protein kinase B(AKT)/mammalian target of rapamycin(mTOR)signal pathway related factors in the hUCMSCs exocrine group is significantly decreased.The intravitreal injection of the secretions of medium and high concentrations of hUCMSCs can reduce VEGF-A and HIF-1αin ROP model tissues.HE staining shows that the number of retinal neovascularization in ROP mice decreases with the increase of the dose of hUCMSCs secretion.CONCLUSION:In a hypoxia induced mouse retinal astrocyte model,hUCMSCs exosomes are found to effectively reduce the expression of HIF-1αand VEGF-A,which are positively correlated with the concentration of hUCMSCs exosomes.HUCMSCs exosomes can effectively reduce the number of retinal neovascularization and the expression of HIF-1αand VEGF-A proteins in ROP mice,and are positively correlated with drug dosage.Besides,they can reduce the related factors on the PI3K/AKT/mTOR signaling pathway.
基金Supported by Wenzhou Science and Technology Project(No.Y20190173).
文摘AIM:To define the predictive factors of severe retinopathy of prematurity(ROP)and develop a nomogram for predicting severe ROP in southeast China.METHODS:Totally 554 infants diagnosed with ROP hospitalized in the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University and hospitalized in Taizhou Women and Children’s Hospital were included.Clinical data and 43 candidate predictive factors of ROP infants were collected retrospectively.Logistic regression model was used to identify predictive factors of severe ROP and to propose a nomogram for individual risk prediction,which was compared with WINROP model and Digirop-Birth model.RESULTS:Infants from the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University(n=478)were randomly allocated into training(n=402)and internal validation group(n=76).Infants from Taizhou Women and Children’s Hospital were set as external validation group(n=76).Severe ROP were found in 52 of 402 infants,12 of 76 infants,and 7 of 76 infants in training group,internal validation group,and external validation group,respectively.Birth weight[odds ratio(OR),0.997;95%confidence interval(CI),0.996-0.999;P<0.001],multiple births(OR,1.885;95%CI,1.013-3.506;P=0.045),and non-invasive ventilation(OR,0.288;95%CI,0.146-0.570;P<0.001)were identified as predictive factors for the prediction of severe ROP,by univariate analysis and multivariate analysis.For predicting severe ROP based on the internal validation group,the areas under receiver operating characteristic curve(AUC)was 78.1(95%CI,64.2-92.0)for the nomogram,32.9(95%CI,15.3-50.5)for WINROP model,70.2(95%CI,55.8-84.6)for Digirop-Birth model.In external validation group,AUC of the nomogram was also higher than that of WINROP model and Digirop-Birth model(80.2 versus 51.1 and 63.4).The decision curve analysis of the nomogram demonstrated better clinical efficacy than that of WINROP model and Digirop-Birth model.The calibration curves demonstrated a good consistency between the actual severe ROP incidence and the predicted probability.CONCLUSION:Birth weight,multiple births,and noninvasive ventilation are independent predictors of severe ROP.The nomogram has a good ability to predict severe ROP and performed well on internal validation and external validation in southeast China.
基金Supported by the Fundamental Research Funds for the Central Universities (No.WK2100000045)the National Natural Science Foundation of China (No.U19B2044)+1 种基金Hefei Health Care Commission 2022 Applied Medical Research Project (No.Hwk2022yb028)Zhejiang Lab Open Research Project (No.K2022QA0AB04).
文摘AIM:To quantitatively assess the changes in mean vascular tortuosity(mVT)and mean vascular width(mVW)around the optic disc and their correlation with gestational age(GA)and birth weight(BW)in premature infants without retinopathy of prematurity(ROP).METHODS:A single-center retrospective study included a total of 133(133 eyes)premature infants[mean corrected gestational age(CGA)43.6wk]without ROP as the premature group and 130(130 eyes)CGA-matched fullterm infants as the control group.The peripapillary mVT and mVW were quantitatively measured using computerassisted techniques.RESULTS:Premature infants had significantly higher mVT(P=0.0032)and lower mVW(P=0.0086)by 2.68(10^(4) cm^(-3))and 1.85μm,respectively.Subgroup analysis with GA showed significant differences(P=0.0244)in mVT between the early preterm and middle to late preterm groups,but the differences between mVW were not significant(P=0.6652).The results of the multiple linear regression model showed a significant negative correlation between GA and BW with mVT after adjusting sex and CGA(P=0.0211 and P=0.0006,respectively).For each day increase in GA at birth,mVT decreased by 0.1281(10^(4) cm^(-3))and for each 1 g increase in BW,mVT decreased by 0.006(10^(4) cm^(-3)).However,GA(P=0.9402)and BW(P=0.7275)were not significantly correlated with mVW.CONCLUSION:Preterm birth significantly affects the peripapillary vascular parameters that indicate higher mVT and narrower mVW in premature infants without ROP.Alterations in these parameters may provide new insights into the pathogenesis of ocular vascular disease.
基金supported by Sichuan University West China Hospital 2024 Plateau Medicine Center'1.3•5 Project(Project NosGYYX24011).
文摘Purpose:Artificial intelligence(AI)significantly enhances the screening and diagnostic processes for retinopathy of prematurity(ROP).In this article,we focused on the application and performance of AI in detecting ROP and distinguishing plus disease(PLUS)in ROP.Methods:We searched PubMed,Embase,Medline,Web of Science,and Ovid for studies published from January2018 to July 2024.Studies evaluating the diagnostic performance of AI with expert ophthalmologists’judgment as a reference standard were included.The risk of bias was assessed using the QUADAS-2 tool and QUADAS-AI tool.Statistical analysis included data pooling,forest plot construction,heterogeneity testing,and meta-regression.Results:Fourteen of the 186 studies were included.The pooled sensitivity,specificity and the area under the curve(AUC)of the AI diagnosing ROP were 0.95(95%CI 0.93-0.96),0.97(95%CI 0.94-0.98)and 0.97(95%CI 0.95-0.98),respectively.The pooled sensitivity,specificity and the AUC of the AI distinguishing PLUS were 0.92(95%CI 0.80-0.97),0.95(95%CI 0.91-0.97)and 0.98(95%CI 0.96-0.99),respectively.Cochran’s Q test(P<0.01)and Higgins I2 heterogeneity index revealed considerable heterogeneity.The country of study,number of centers,data source and the number of doctors were responsible for the heterogeneity.For ROP diagnosing,researches conducted in China using private data in single center with less than 3 doctors showed higher sensitivity and specificity.For PLUS distinguishing,researches in multiple centers with less than 3 doctors showed higher sensitivity.Conclusions:This study revealed the powerful role of AI in diagnosing ROP and distinguishing PLUS.However,significant heterogeneity was noted among all included studies,indicating challenges in the application of AI for ROP diagnosis in real-world settings.More studies are needed to address these disparities,aiming to fully harness AI’s potential in augmenting medical care for ROP.
文摘Background: Prematurity is the leading cause of neonatal mortality. Most preterm births can be associated to an identifiable risk factor. In Cameroon, especially in the Southwest Region, there is limited data regarding prematurity associated risk factors. The aim of this study was to evaluate the risk factors and complications of prematurity in two health facilities in the Fako division, the BRH and RHL. Methods: A hospital based retrospective case control study was done from the 1<sup>st</sup> of January 2021 to 28<sup>th</sup> of February 2022. We assessed the gestational ages at which preterm birth occurred and their short-term outcome using a structured pretested questionnaire to collect data from files. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 26. Results: The minimum sample size was 137 preterms. 45.5% of cases were born between 34 and increased the risk of having a preterm birth meanwhile being married (AOR: 0.410;95% CI: 0.217 - 0.773;p = 0.006) decreased the risk. Hospital complications were neonatal infection 103 (51.5%), respiratory distress 79 (39.5%) and neonatal jaundice 61 (30.50%). Among the cases, 97 (48.50%) stayed in the hospital for 2 to 4 weeks and 177 (88.5%) were discharged alive. Conclusions: Modifiable factors that increased the risk of prematurity were advanced maternal age, secondary level of education, rural residence, and prenatal alcohol consumption. Being married decreased the risk. The most common hospital complications in both the cases and controls were neonatal infection, respiratory distress syndrome and neonatal jaundice.
文摘Introduction: Prematurity is the leading cause of neonatal death in Africa. More than a million children die each year due to co-morbidities related to prematurity. In addition to being one of the causes of neonatal deaths, the health problems associated with prematurity can also lead to severe lifelong impairment in those who survive. Objectives: This paper aims to determine the epidemiology and identify co-morbidities of prematurity in the neonatology units of the Douala General Hospital (DGH) and the Laquintinie Hospital of Douala (LHD). Patients and Methodology: We conducted an analytical retrospective cohort study from January 2015 to January 2018 in the neonatology department of the GDH and the LHD, which are considered reference hospitals for the management of preterm babies in Cameroon. We included all newborns aged less than 37 weeks admitted to the neonatology units of the GDH and the LHD. The descriptive component was based on the analysis of quantitative variables using measures of central tendency. The analytical component was evaluated using Spearman correlations and the Chi-square and Fisher tests. Simple and multiple logistic regressions measured factors predictive of mortality. The Kaplan Meier survival curve used the Log Rank test and significance at p ≤ 0.05. Results: We recorded 908 preterm newborns in neonatal service and 1,124 preterm deliveries in maternity, representing an incidence of 32.5% in neonatal unit and 10.6% in maternity. 51% of whom were girls, given a sex ratio M/F of 0.9. Hypertension was the main prenatal pathology (9.1%), while premature rupture of membranes: PROM (35.5%) and eclampsia/pre-eclampsia (18.6%) were the most common obstetrical pathologies. 75.9% of deliveries were vaginal with 65.2% being performed in our referral hospitals. Gestational age ranged from 22 to 36 weeks, with a mean of 32.4 weeks. Late preterm birth rate was 53.7%, and birth weight varied between 590 and 3200 g with an average of 1747 ± 479 g. The percentage of low birth weight (1500 - 2499 g) preterm infants was predominant (65.3%), and the intrauterine growth restriction (IUGR) was estimated to be 12.4%. The majority (96.7%) had pathologies in the neonatal period, the most common being neonatal infection (86.9%). The case-fatality rate was 27.4%, compared to 72.6% live births. Factors influencing mortality are risk of premature labour, gestational age ≤ 32 SA, premature birth in hospitals other than our two referral hospitals, birth weight ≤ 1500 g, Apgar at the 10th minute, late secondary anaemia, hospital resuscitation, oxygen therapy, and duration of hospitalization Conclusion: The incidence of prematurity and the mortality rate remains high in neonatal units in Cameroon. Adequate monitoring of pregnancies and management of preterm infants remains a challenge in our context.
文摘Retinopathy of prematurity(ROP)is a disorder of the retina in neonates.If ROP is not treated at early stage,neonates’vision is affected,leading to blindness.It is necessary to diagnose and treat ROP at earliest.Several ROP assessment techniques based on Image analysis have been introduced in recent years.These studies identify only normal,abnormal,and plus disease.This research article explores the identification of distinct ROP stages along with normal and abnormal detection.Detecting the stages will help to expedite the treatment and prevent vision loss.The proposed framework consists of feature extraction using scale-invariant feature transform(SIFT)and pyramid histogram of words(PHOW)techniques.Three efficient supervised machine learning algorithms,namely random forest(RF),support vector machine(SVM),and extreme boosting gradient(XGBoost),are used to classify different stages of ROP.A dataset captured by RetCam 3 is used to evaluate the model.Based on rigorous evaluation,the accuracy of different ROP stages is 93.68%,83.33%,85.71%,55.55%,and 100%for normal,stage 1,stage 2,stage 3,and stage 4,respectively.
基金Supported by the National Natural Science Foundation of China(No.71173055)
文摘AIM: To estimate the potential systemic events during and after retinopathy of prematurity (ROP) screening. ' METHODS: A prospective and descriptive designed study was conducted to detect the physiologic and pathological changes 24h before, during, and 72h after ROP screening. Control blood pressure (BP), saturation, pulse rate, and body temperature were routinely taken at various time internals before and after screening. Adverse effects pertain to cardiovascular system, respiratory system, gastric system, urinary system and nervous system were retrospect 0-72h after ROP screening at a 24-hour interval. RESULTS: Totally 1254 prematurity babies receiving ROP screening during Jan. 1st 2013 to Dec. 31th 2013 were enrolled in our survey. Compared to control vital sign data taken before the examination, there was a fluctuation in the diastolic BP with the increased 3.03 mm Hg (P=0.04) after 3 doses of mydriatic drops. Immediately after the examination, there was a further 12.64 mm Hg (P<0.01) increase in systolic BP and a 7.24 mm Hg (P<0.01) in diastolic BP. The mean pulse rate during examination was 22.4 bpm (P<0.01) higher than the 133.3 +/- 9.0 bpm control level. The oxygen saturation shared an average drop of 5% (P<0.01) during screening. In prematurity with postconceptional age less than 31wk, the incidence of apnea (23.5%), necrotizing enterocolitis (NEC) (8.7%), gastric residual (25.4%) and upper digestive tract hemorrhage (6.4%) also demonstrated a significant rise (P<0.01). CONCLUSION: In our study sample, ROP screening was associated with NEC, gastric residual and upper digestive tract hemorrhage. These gastrointestinal side effects, along with breath activity pattern change and vital signs indicators fluctuation, may be results of additional stress responses.
文摘Retinopathy of prematurity(ROP)is the leading cause of preventable infant blindness in the world and predominantly affects babies who are born low birth weight and premature.India has the largest number of surviving preterm births born annually.ROP blindness can be largely prevented if there is a robust screening program which detects treatment requiring disease in time.ROP treatment must be provided within 48 h of reaching this threshold of treatment making it a relative emergency.During the severe acute respiratory syndromecoronavirus disease 2019 pandemic in 2020 ROP screening was disrupted throughout the world due to lockdowns and restriction of movement of these infants,their families,specialists and healthcare workers.The Indian ROP Society issued guidelines for ROP screening and treatment in March 2020,which was aimed at preserving the chain-of-care despite the potential limitations and hazards during the(ongoing)pandemic.This preferred practice guideline is summarized in this manuscript.
文摘Successful management of a case of aggressive posterior retinopathy of prematurity(APROP)poorly responsive to laser therapy with intravitreal bevacizumab(IVB)is discussed.IVB is useful as rescue therapy in such cases,if given within the correct window period post laser therapy.
文摘Retinopathy of prematurity (ROP), a retinal vascular disease of premature infants, continues to be a major cause of preventable childhood blindness all over the world. The incidence of ROP varies among countries, being influenced by the quality of the level of neonatal intensive care. Here, we discuss the potential treatments that are now available or will soon or probably be available for ROP. Although ablation of the avascular retina with laser photocoagulation remains the current gold standard and well established therapy for ROP, some new therapeutic options including angiostatic therapies are being explored based on our knowledge of the pathophysiology of the ROP and complications and efficacy of laser treatment. However, prevention of the development of severe ROP and screening for ROP seem to be the best strategy in avoiding visual impairment caused by ROP in premature infants. New therapeutic interventions including vascular endothelial growth factor antibody administration, gene therapy and supplemental therapies should be supported with evidence-based data for the treatment of ROP.
文摘AIM: To determine the incidence and risk factors of retinopathy of prematurity(ROP) and the sensitivity of current screening criteria in a tertiary eye center in Tehran, Iran. METHODS: In a cross-sectional observational study, neonates weighing ≤2000 grams at birth or born <34 wk gestational age(GA) and all other infants at risk of ROP admitted to the neonatal intensive care unit(NICU) or referred to our ROP clinic were investigated. The incidence of ROP and severe ROP(i.e. patients needing treatment) were determined. The associations between risk factors and the development and severity of ROP were assessed. We also examined the sensitivity of the current national screening guideline in Iran. RESULTS: Among 207 infants, the incidence of ROP and severe ROP was 33.3% and 11.1%, respectively. Mean GA and birth weight(BW) were significantly lower in ROP vs non-ROP infants(29±2 wk vs 33±3 wk, P<0.001;1274±489 g vs 1916±550 g, P<0.001, respectively). Univariate analysis displayed significant association between ROP incidence and GA, BW, NICU admission period, blood transfusion, surfactant usage, sepsis, intraventricular hemorrhage and patent ductus arteriosus(P<0.05 for all). BW [relative risk(RR): 0.857(0.711-0.873), P<0.001], GA [RR: 0.788(0.711-0.873), P<0.001] and blood transfusion [RR: 1.888(0.995-3.583), P=0.052] were independent ROP risk factors. The sensitivity of country-specific screening guidelines was 95.7% and 100% for overall and severe ROP detection, respectively. CONCLUSION: ROP incidence is relatively high in Iran. Identifying ROP risk factors results in more accurate screening and reduces the risk of irreversible vision loss. The ROP screening criteria utilized in Iran are efficient at the present time.
基金Supported by the National Natural Science Foundation of China(No.81570873)the Science and Technology Department of Shaanxi Province(No.2015JM8481)
文摘Retinopathy of prematurity（ROP） is a retinal vascular disorder frequently found in premature infants.Different therapeutic strategies have been developed to treat ROP.However,there are still many children with ROP suffering by severe limitations in vision or even blindness.Recently,ROP has been suggested to be caused by abnormal development of the retinal vasculature,but not simply resulted by retinal neovascularization which takes about 4 to 6 wk after birth in premature infants.Thus,instead of focusing on how to reduce retinal neovascularization,understanding the pathological changes and mechanisms that occur prior to retinal neovascularization is meaningful,which may lead to identify novel target（s） for the development of novel strategy to promote the healthy growth of retinal blood vessels rather than passively waiting for the appearance of retinal neovascularization and removing it by force.In this review,we discussed recent studies about,1） the pathogenesis prior to retinal neovascularization in oxygen-induced retinopathy（OIR;a ROP in animal model） and in premature infants with ROP;2） the preclinical and clinical research on preventive treatment of early OIR and ROP.We will not only highlight the importance of the mechanisms and signalling pathways in regulating early stage of ROP but also will provide guidance for actively exploring novel mechanisms and discovering novel treatments for early phase OIR and ROP prior to retinal neovascularization in the future.
文摘Retinopathy of prematurity(ROP) is a vasoproliferative disorder of the retina occurring principally in new born preterm infants. It is an avoidable cause of childhood blindness. With the increase in the survival of preterm babies, ROP has become the leading cause of preventable childhood blindness throughout the world. A simple screening test done within a few weeks after birth by an ophthalmologist can avoid this preventable blindness. Although screening guidelines and protocols are strictly followed in the developed nations, it lacks in developing economies like India and China, which have the highest number of preterm deliveries in the world. The burden of this blindness in these countries is set to increase tremendously in the future, if corrective steps are not taken immediately. ROP first emerged in 1940 s and 1950 s, when it was called retrolental fibroplasia. Several epidemics of this disease were and are still occurring in different regions of the world and since then a lot of research has been done on this disease. However, till date very few comprehensive review articles covering all the aspects of ROP are published. This review highlights the past, present and future strategies in managing this disease. It would help the pediatricians to update their current knowledge on ROP.
文摘The Delta-like ligand 4/Notch signaling pathway was shown to participate in the process of retinal development and angiogenesis. However, the function of the Delta-like ligand 4/Notch signaling pathway in retinopathy of prematurity requires further study. Retinopathy of prematurity was induced in 5-day-old Sprague-Dawley rats exposed to hyperoxia for 7 days, and then returned to room air. Reverse transcription-PCR and western blot revealed that Delta-like ligand 4 levels decreased at postnatal day 12 and increased at postnatal day 17 in retinopathy of prematurity rats. Flat-mounted adenosine diphosphatase stained retina and hematoxylin-eosin stained retinal tissue slices showed that the clock hour scores and the nuclei counts in retinopathy of prematurity rats were significantly different compared to normal control rats. After retinopathy of prematurity rats were intravitreally injected with Delta-like ligand 4 monoclonal antibody to inhibit the Delta-like ligand 4/Notch signaling pathway, there was a significant increase in the severity of retinal neovascularization （clock hours） in the intravitreally injected eyes. The nuclei count was highly correlated with the clock hour score. These results suggest that Delta-like ligand 4/Notch signaling plays an essential role in the process of physiological and pathological angiogenesis in the retina.
基金Guangdong Provincial Science and Technology Projects,China (No.2011B031800105)
文摘AIMTo evaluate the incidence of spontaneous regression of changes in the retina and vitreous in active stage of retinopathy of prematurity(ROP) and identify the possible relative factors during the regression.
基金Supported by the National Nature Science Foundation of China(No.81500722)。
文摘AIM:To evaluate the predicting efficacy of severe retinopathy of prematurity(ROP)by the WINROP algorithm(http://winrop.com)in Southern China.METHODS:All preterm infants with the gestational age(GA)less than 32 wk were included.Their ROP screening results and serial postnatal body weight were analysed retrospectively.Weekly body weight was entered into and measured by the WINROP system.The outcomes were analysed,and the sensitivity,specificity,positive predictive value and negative predictive value(NPV)were calculated.RESULTS:Totally 432 infants with a median GA of 30.0(24.0-31.9)wk,and a median birth weight(BW)of 1360(540-2700)g were included.Among these 432 infants,50 were diagnosed as type 1 ROP but only 28 were identified by the WINROP algorithm.The sensitivity was 56%(28/50)and the NPV was 92%(252/274).However,for infants with BW<1000g or GA<28 wk,the sensitivity was 93.8%(15/16)and 93.3%(14/15),respectively.Meanwhile,with several postnatal complications added as additional risk factors,the sensitivity was increased to 96%(48/50).CONCLUSION:The sensitivity of the WINROP algorithm from the Southern Chinese cohort is not as high as that reported in developed countries.This algorithm is effective for detecting severe ROP from extremely small or preterm infants.Modification of the algorithm with additional risk factors could improve the predictive value for infants with a GA>28 wk in China.
