A semantic segmentation method to analyze retinal vascular parameters of diabetic nephropathy.

Assessing urinary levels of IL-18, NGAL and albumin creatinine ratio in patients with diabetic nephropathy

Objective. To investigate the expression of miR-192 and its significance in diabetic nephropathy (DN) patients. Methods. 464 patients with type 2 diabetes mellitus (T2DM) were divided into normal albuminuria group (NA, n = 157), microalbuminuria group (MA, n = 159), and large amount of albuminuria group (LA, n = 148). 127 healthy persons were selected as the control group (NC, n = 127). The serum miR-192 levels were detected by Real-Time PCR and transforming growth factor-β1 (TGF-β1) and fibronectin (FN) were detected by enzyme-linked immunosorbent assay. The relationships among these parameters were analyzed by Pearson correlation analysis and multiple linear regression analysis. Results. The miR-192 in the LA group was significantly lower than other groups, which was lower in the MA group than in the NA group (P < 0.01). The TGF-β1 and FN in the LA group were significantly higher than other groups, which were higher in the MA group than in the NA group (P < 0.01). The expression of miR-192 was negatively correlated with TGF-β1, FN, and Ln (UACR) and miR-192, TGF-β1, and FN were independent relevant factors affecting Ln (UACR) in T2DM (P < 0.01). Conclusions. These findings indicate that the levels of miR-192 were lower accompanied by the decrease of urine albumin creatinine ratio (UACR) and the association between miR-192 and nephritic fibrosis in DN.

Background and objective: Serum beta-2 microglobulin (β2M) has been used as a useful clinical marker of chronic kidney dysfunction. The current study aims to evaluate the diagnostic accuracy of β2M for the early detection of diabetic nephropathy among Iraqi patients with type II diabetes mellitus. Methods: The study included 84 participants divided into four groups, three of them were type II diabetics and the fourth is the healthy individuals’ (control) group. The diabetic’ subgroups were named according to the Micral test as: normoalbuminuria (21 patients), microalbuminuria (21 patients), and macroalbuminuria group (21 patients). The control group included 21, age- and sex-matched, healthy participants. Biochemical markers for diabetes mellitus as well as β2M were determined for each participant and then were analyzed statistically. Results: The serum β2M of normoalbuminuria group was (2.86±0.95 µg/mL), microalbuminuria group was (5.06±1.97 µg/mL) and macroalbuminuria group (3.6±1.59 µg/mL). The results showed significant increase (p˂0.05) in the β2M level of microalbuminuria group when compared with that of normoalbuminuria and macroalbuminuria groups. In addition, a highly significant increase (p˂0.01) in β2M concentration was observed in microalbuminuria group when compared with that of the control group. Conclusions: β2M can be used as a useful biomarker for the early detection of diabetic nephropathy.

ObjectiveTo investigate the role of zinc-alpha-2-glycoprotein (ZAG) in the early stage of diabetic nephropathy, in patients with type 2 diabetes mellitus (T2DM).MethodsThis cross-sectional observational study recruited patients with longstanding T2DM and healthy control subjects. Patients with T2DM were further stratified based on their urine albumin–creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR). Serum and urine concentrations of ZAG were determined using an enzyme-linked immunosorbent assay.ResultsEighty patients with T2DM and 20 healthy control subjects were enrolled in the study. Mean ± SD concentrations of ZAG in serum and urine were both significantly higher in patients with T2DM (serum: 38.29 ± 22.72 mg/l; urine: 53.64 ± 29.48 mg/g) compared with concentrations in healthy control subjects (serum: 21.61 ± 8.83 mg/l; urine: 28.17 ± 10.64 mg/g). Serum ZAG concentration was positively correlated with serum creatinine and eGFR. Urine ZAG concentration was positively correlated with UACR. Urine concentration of ZAG in the higher eGFR group was higher than that in the normal eGFR group (41.26 ± 13.67 versus 32.05 ± 8.55 mg/g, respectively).ConclusionThese preliminary findings suggest that ZAG might be a potentially useful biomarker for early diagnosis of diabetic nephropathy in patients with T2DM.

To investigate whether diabetic retinopathy phenotypes and albuminuria are associated with the overexpression of plasma semaphorin 3A (Sema3A). The study group with severe nonproliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR), the diabetes without diabetic retinopathy group, and the control group without diabetes consisted of all consecutive patients who were scheduled to undergo intravitreal bevacizumab injection for treatment-naïve diabetic macular edema (DME) and senile cataract surgery, respectively. In all subjects, the plasma Sema3A levels before intravitreal bevacizumab injections or cataract surgery were measured by enzyme-linked immunosorbent assay. In the patients with DME, the capillary nonperfusion area (measured by fluorescein angiography), total macular volume (measured by spectral-domain optical coherence tomography), and the urine albumin-to-creatinine ratio were determined. Severe NPDR (57 eyes) and PDR groups (51 eyes) both had significantly higher Sema3A levels than the control (58 eyes) and diabetes without diabetic retinopathy groups (54 eyes) (P < 0.001). Moreover, the PDR group had higher Sema3A levels than the severe NPDR group (P < 0.001). Plasma Sema3A levels correlated positively with the retinal nonperfusion area size (r = 0.844, P = 0.004), total macular volume (r = 0.765, P = 0.005), and the urine albumin-to-creatinine ratio (r = 0.752, P < 0.001). When DME patients were divided into normo-, micro-, and macroalbuminuria groups, the macroalbuminuria group had significantly higher plasma Sema3A levels than the microalbuminuria group or the normoalbuminuria group (P = 0.002 and P < 0.001, respectively). The plasma Sema3A levels correlated significantly with the phenotypes of diabetic retinopathy and albuminuria. This suggests that Sema3A may be a potential biomarker for diabetic retinopathy and nephropathy.

BackgroundTo explore the changes in blood supply and structure around the optic nerve head (ONH) in thyroid-associated ophthalmopathy (TAO) patients with suspected dysthyroid optic neuropathy (DON).MethodsTAO patients [19 with DON; 24 non-DON (NDON); 20 with equivocal DON (EDON)], and 34 control subjects were examined. Optical coherence tomography angiography (OCTA) was used to obtain peripapillary retinal nerve fiber layer (p-RNFL) and vessel density parameters, including the ONH whole image vessel density (ONH-wiVD) and the radial peripapillary capillary vessel density (RPC-VD) in early DON.ResultsAlthough there were no differences in p-RNFL thickness among the groups, there were differences in the ONH-wiVD of each grid section and the RPC-VD in all areas (P < 0.01). Compared with healthy controls, the EDON eyes had significantly lower RPC-VDs in all aeras (P < 0.05).The peripapillary region was further divided into eight sectors, and the RPC-VD in the temporal upper, superior temporal, and temporal lower sectors in the EDON group were significantly lower than in the controls. The visual impairment was closely related to the loss of peripapillary capillary vessel density. Univariate correlation analysis showed that the ONH-wiVD and RPC-VD of the TAO groups were negatively correlated with the intraocular pressure (r = − 0.296, P = 0.006; r = − 0.258, P = 0.016 respectively).ConclusionsEDON patients had significantly lower ONH-wiVD and RPC-VD than control subjects, and the temporal and upper VDs were more likely to be affected in the early stage of TAO. The combined use of spectral domain optical coherence tomography and OCTA technologies offer a new method for early diagnosis of suspected DON patients.

To investigate the correlation between retinal vascular changes and ICA stenosis by measuring retinal vessels using full-width-at-half-maximum (FWHM) and intelligent image recognition. This research selected patients who were admitted to the Vascular Surgery Department of Quzhou People's Hospital from January 2018 to December 2020 and were preparing for Carotid Artery Stenting (CAS). Participants were divided into two groups: without ICA stenosis (Group 0) and with ICA stenosis (Group 1). A total of 109 cases were included in the study, with 50 cases in Group 1 and 59 cases in Group 0. Vascular images of superior temporal zone B of the retina were obtained by spectral domain optical coherence tomography (SD-OCT). The edges of retinal vessels were identified by FWHM. Each vessel of all subjects was measured three times with the FWHM, and the average value was taken to obtain the retinal arteriolar lumen diameter (RALD), retinal arteriolar outer diameter (RAOD), retinal venular lumen diameter (RVLD), and retinal venular outer diameter (RVOD),Arterial Wall Thickness (AWT),Venular Wall Thickness (VWT)=(RVOD-RVLD)/2,Arteriovenous Ratio (AVR) = RAOD/RVOD. We found that compared to Group 0, Group 1 had smaller RALD (P < 0.001) and RAOD (P < 0.001), and wider RVOD (P < 0.001), with thicker VWT (P < 0.001). When compared with the contralateral eye in Group 1, the ipsilateral eye exhibited even smaller RALD,RAOD and AVR (P < 0.001, P < 0.001, P < 0.001). After CAS, the RALD,RAOD and AVR in Group 1 increased (P < 0.001, P < 0.001, P < 0.001),while the RVLD and RVOD decreased (P < 0.05, P < 0.001). Our research reveals a significant correlation between retinal vascular changes and internal ICA stenosis. Utilizing SD-OCT in conjunction with the FWHM,we achieved a non-invasive, intelligent, stable, and precise acquisition of data pertaining to retinal vessels. These findings underscore a significant correlation between alterations in retinal vascular structure and the presence of ICA stenosis, as demonstrated by our research.

Gestational diabetes mellitus (GDM) is a temporary metabolic disorder in which small retinal vessels may have experience subtle changes before clinical lesions of the fundus retina appear. An innovative artificial intelligence image processing technology was applied to locate and analyze the small retinal vessel morphology and accurately evaluate the changes of the small retinal vessels in GDM patients and pregnant women with normal blood glucose and non-pregnant women with normal blood glucose. The subjects were divided into three groups:GDM group, pregnant control group (PC), and normal control group (NC). Use optical coherence tomography angiography (OCTA) to collect OCT images of subjects,and perform quantitative identification and analysis of retinal vessel parameters based on artificial intelligence measurement software integrated the prior knowledge supervised edge-aware multi-task network (PKSEA-Net): Retinal arteriolar lumen diameter (RALD), retinal arteriolar outer diameter (RAOD), retinal venular lumen diameter (RVLD),retinal venular outer diameter (RVOD),arterial wall thickness (AWT),venular wall thickness (VWT),arterial wall to lumen ratio (AWLR),venular wall to lumen ratio (VWLR),arterial wall cross-sectional area (AWCSA),venular wall cross-sectional area (VWCSA), arteriovenous ratio (AVR). This study revealed significant differences in RVOD, RVLD, VWT, VWCSA and AVR between the GDM group and the PC group (p = 0.005, p < 0.027, p = 0.008, p = 0.001, p = 0.022), significant differences in RVOD, RVLD, VWT, VWCSA and AVR between the GDM group and the NC group (p < 0.001, p = 0.001, p < 0.001, p < 0.001, p = 0.001). In GDM group, RVOD, RVLD, VWT and VWCSA increased, while AVR decreased. There were no significant differences in RVOD, RVLD, VWT, VWCSA and AVR between PC group and NC group (p = 0.139, p = 0.263, p = 0.107, p = 0.059, p = 0.218), and no significant differences in VWLR among the three groups (p > 0.05). No significant difference was observed in retinal artery vascular parameters (RAOD, RALD, AWT, AWLR, AWCSA) across the three groups (p > 0.05). There were increases in RVOD, RVLD, VWT, and VWCSA, decrease in AVR in patients with GDM. However, no significant difference of retinal vascular parameters was shown between normal pregnant women and normal non-pregnant women. PKSEA-Net can assist to identify changes in retinal vascular morphology and diagnose micro-vascular lesion early in normal pregnant women and high-risk groups of GDM.

Convolutional Neural Network (CNN) is widely used for semantic segmentation and land-use and land-cover (LULC) mapping of very high-resolution (VHR) remote sensing images. The convolution operation is a powerful method for VHR classification, but the loss of high-frequency detail information caused during its operation decreases the classification accuracy, particularly in the boundary. Thus, it is necessary to supply additional boundary information to the CNN for alleviating this situation. In the classification task (and in LULC mapping), providing more effective information generates a better classification result. Current methods regard the boundary of images as the same category object and process it uniformly, which loses a notable amount of useful information because of the different properties, such as ambiguity and transition, between remote sensing images and their boundaries. Thus, a semantic segmentation method with category boundary for LULC mapping is proposed in this paper. First, a multi-task CNN called the category boundary detection network (CBDN) is designed to extract the boundary information of different category objects. Second, this category boundary and VHR images are used for initial semantic segmentation. Finally, the category boundary and the initial semantic segmentation result (ISSR) are fused to obtain the final LULC map by a two-step strategy, including the explicit fusion and the boundary attention loss function. To verify whether category boundary improved the classification accuracy, a set of comparative experiments were conducted on the International Society for Photogrammetry and Remote Sensing (ISPRS) Vaihingen and Potsdam datasets. The method in this paper was compared with a semantic segmentation method with no boundary information and a semantic segmentation method with global boundary. The results showed that the proposed method in this paper achieved good performances in the Vaihingen (overall accuracy (OA) = 0.924, Kappa coefficient (K) = 0.898, mean F1 score (mF1) = 0.896 and mean Intersection over Union (mIoU) = 0.817) and Potsdam datasets (OA = 0.890, K = 0.857, mF1 = 0.923, and mIoU = 0.860) based on the eroded labels.

Background: Brachial ankle pulse wave velocity (BaPWV) and cardio ankle vascular index (CAVI), as indicators of arterial stiffness, are increased in type 2 diabetes. Albuminuria, as a cardiovascular risk factor in type 2 diabetes, can cause endothelial dysfunction and atherosclerosis, and these can increase arterial stiffness. So we investigated the hypothesis that increased albuminuria reflects increased BaPWV and CAVI in type 2 diabetes. Methods: We retrospectively analyzed 106 patients (58 men and 48 women) with type 2 diabetes from March 2005 to September 2006. Urine albumin creatinine ratio (ACR) to evaluate urinary albumin excretion, BaPWV and CAVI were measured in all patients. Results: All patients were divided 3 groups, normal group (ACR 300 mg/g Cr., n = 33). BaPWV and CAVI in microalbuminuria group and proteinuria group are faster than normal group. In bivariate correlation analysis, BaPWV was not associated with ACR, but CA VI was positively correlated to ACR (r = 0.285, P = 0.003). BaPWV was positively correlated to age, diabetes duration, body mass index, systolic blood pressure, diastolic pressure, pulse pressure and negatively correlated to glomerular filtration rate (GFR). CAVI was positively correlated to age, diabetes duration and negatively correlated to GFR. In multiple linear stepwise regression analysis, BaPWV was not associated with ACR, but ACR was independent predictor for CAVI (P = 0.002). Conclusion: In type 2 diabetes, albuminuria was independent predictor for indicators of arterial stiffness,

To study the role of hypoxia inducible factor-1α (HIF-1α) in patients with diabetic nephropathy (DN). In total, 133 participants were selected to conduct the investigation, parameters such as fasting blood sugar (FBS), blood urea nitrogen (BUN), and urine albumin-creatinine ratio (UACR) were tested and recorded. The biopsy assessment was conducted when renal function or urinary abnormalities. Western blotting was used to test the expression of serum HIF-1α in all patients and control group. The values of FBS, BUN, and UACR were higher in DN and diabetes groups than in the healthy control. The values of FBG, BUN, and UACR were higher in DN patients than in the diabetes patients with no nephropathy. eGFR in DN patients was lower than the other two groups. The expression of HIF-1α was higher than both diabetes patients with no nephropathy and healthy control, P < 0.05. Patients with lots of albuminuria showed the highest expression of HIF-1α than the other groups. HIF-1α in normoalbuminuria and microalbuminuria groups showed no significant difference. HIF-1α was up-regulated in DN patients, which might give clinical basis to the role of HIF-1α in the development of DN.

Cardiometabolic index is associated with urinary albumin excretion and renal function in aged person over 60: Data from NHANES 2011–2018

Regional veno-occlusive remodelling of pulmonary veins in EIPH-affected horses, suggests that pulmonary veins may be central to pathogenesis. The current study quantified site-specific changes in vein walls, collagen and haemosiderin accumulation, and pleural vascular profiles in the lungs of horses suffering EIPH. In the caudodorsal lung regions of EIPH-affected horses, there is veno-occlusive remodelling with haemosiderosis, angiogenesis and fibrosis of the interstitium, interlobular septa and pleura. Morphometric methods were used to analyse the distribution and accumulation of pulmonary collagen and haemosiderin, and to count pleural vascular profiles in the lungs of 5 EIPH-affected and 2 control horses. Vein wall thickness was greatest in the dorsocaudal lung and significantly correlated with haemosiderin accumulation. Increased venous, interstitial, pleural and septal collagen; lung haemosiderin; and pleural vascular profiles occurred together and changes were most pronounced in the dorsocaudal lung. Further, haemosiderin accumulation colocalised with decreased pulmonary vein lumen size. Vein wall thickening, haemosiderin accumulation and histological score were highly correlated and these changes occurred only in the caudodorsal part of the lung. The colocalisation of these changes suggests that regional (caudodorsal) venous remodelling plays an important role in the pathogenesis of EIPH. The results support the hypothesis that repeated bouts of venous hypertension during strenuous exercise cause regional vein wall remodelling and collagen accumulation, venous occlusion and pulmonary capillary hypertension. Subjected to these high pressures, there is capillary stress failure, bleeding, haemosiderin accumulation and, subsequently, lung fibrosis.

We propose an estimation method of water quality of a river based on convolutional neural networks (CNNs), a semantic segmentation method, and a new dataset. Since floods are serious problems for riversides, various technologies have been proposed as a safety system. So far, measurement methods of water level are proposed as one of various systems. However, these methods cannot estimate a flood which is caused by debris flows because the flood does not follow the increasing water level. To estimate floods, water quality is more important information because water become muddy before floods. Hence, we estimate water quality using monitoring images and CNNs which trained new dataset. Furthermore, we combine a pre-processing using a semantic segmentation method. Since regions of no-river water often produces misdetections, we exclude these regions using a semantic segmentation method before CNNs. In simulations, it was observed that the proposed method objectively outperforms state-of-the-art methods in accuracy based on our dataset.

To explore the association between urinary microalbumin-to-creatinine ratio (ACR) and brachial-ankle pulse wave velocity (baPWV) in hypertensive patients. A total of 877 primary hypertension patients were enrolled in this trial from September 2009 to December 2012, and were randomly recruited and patients were divided into normal ACR group (ACR < 30 mg/g, n = 723), micro-albuminuria group (30 mg/g ≤ ACR < 300 mg/g, n = 136) and macro-albuminuria group (ACR ≥ 300 mg/g, n = 18). baPWV was measure by automatic pulse wave velocity measuring system. The baPWV values in patients of micro-albuminuria group and macro-albuminuria group were significantly higher than in the normal ACR group (all P < 0.05). The baPWV value of macro-albuminuria group was significantly higher than in the micro-albuminuria group (P < 0.05). Linear correlation analysis revealed that ACR was positively correlated with baPWV (r = 0.413, P < 0.01). Multiple linear regression analysis showed that ACR independently correlated with baPWV in patients with primary hypertension (β = 0.29, R(2) = 0.112, P < 0.01) after adjusting for age, sex, body mass index, systolic blood pressure, diastolic blood pressure, blood glucose, total cholesterol, low density lipoprotein, high density lipoprotein and triglyceride. Using ACR < 30 mg/g and ACR ≥ 30 mg/g as dichotomous variable, binary logistic regression analysis showed that ACR ≥ 30 mg/g was also a risk factor of the ascending baPWV in primary hypertension patients (OR: 1.73, 95% CI: 1.62-2.98) after adjusting the traditional cardiovascular risk factors. ACR is positively correlated to baPWV in primary hypertension patients, and the ascending baPWV is a risk factor of early renal dysfunction in primary hypertension patients.